scholarly journals P-OGC20 Can prehabilitation prevent development of sarcopenia during neoadjuvant chemotherapy for oesophagogastric adenocarcinoma?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jakub Chmelo ◽  
Maziar Navidi ◽  
Alexander W Phillips ◽  
Alastair Greystoke ◽  
Rhona CF Sinclair
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Smoking Status ◽  
Clinical Stage ◽  
Neoadjuvant Treatment ◽  
Historical Cohort ◽  
Computed Tomography Scans ◽  
Before And After ◽  
Tumour Location ◽  
Patient Prognosis ◽  
And Function

Abstract Background Sarcopenia characterised as a loss of muscle mass and function is prevalent in cancer populations. It is known to occur in patients receiving neoadjuvant treatment and is associated with poorer outcomes. Thus, minimizing sarcopenia may lead to improved patient prognosis. It has been suggested that exercise can reverse and prevent sarcopenia. Little is known as to whether prehabilitation as an intervention to enhance patients’ functional capacity prior to surgery can lead to sarcopenia prevention. Methods Patients enrolled into a prospective prehabilitation study (ChemoFit) during neoadjuvant chemotherapy (NAC) for oesophagogastric adenocarcinoma (OGA) had their radiological sarcopenia measured before and after neoadjuvant chemotherapy (NAC). Radiological sarcopenia and lean body mass (LBM) were measured from computed tomography scans at the level of the L3 vertebra. ChemoFit patients were compared with an historical cohort (NO-PREHAB) which did not undergo prehabilitation and which had their radiological sarcopenia evaluated prospectively prior to and after NAC for OGA. Results Patients in the ChemoFit group were younger compared to the NO-PREHAB group (median age 70 vs 65, p = 0.04). Otherwise there were no differences in gender, BMI, smoking status, comorbidities, tumour location and clinical stage of the disease. Radiological sarcopenia was present prior to NAC in 17/36 (47%) which increased to 26/36 (72%) after NAC amongst ChemoFit patients. Sarcopenia prior to NAC in the NO-PREHAB cohort was 12/28 (43%) which increased to 16/28 (57%) post NAC. Intergroup difference (p = 0.291). Median (IQR) ΔLBM at two time points was in ChemoFit -2.6kg (-5.2;-0.6) and in NO-PREHAB -3.1kg (-4.7;-1.0) (p = 0.730). Conclusions Radiological sarcopenia increased in both groups during NAC for OGA. Prehabilitation did not prevent this from happening. Other strategies must be explored in order to mitigate against sarcopenia.

Neoadjuvant cisplatin/gemcitabine (CG) chemotherapy for muscle-invasive transitional cell carcinoma of the bladder (TCCB): A single-institution experience.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 304-304
Author(s):  
Scott A. North ◽  
Faraj El-Gehani ◽  
Peter Venner
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Clinical Stage ◽  
Transitional Cell ◽  
Neoadjuvant Treatment ◽  
Retrospective Chart Review ◽  
Pathologic Response ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pre Treatment ◽  
Muscle Invasive

304 Background: Despite evidence of a survival advantage for neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy (RC) for muscle-invasive TCCB, many patients are not treated. While many Canadian centers use CG chemotherapy in this setting, there is little data on pathologic response rate, often considered an important predictor of long term outcome. This retrospective study was undertaken to determine the use of neoadjuvant treatment prior to RC at our institution and assess pathologic response rates at time of RC for patients receiving neoadjuvant CG. Methods: A retrospective chart review was performed on all patients undergoing RC between January 1, 2007 and June 30, 2011 in Edmonton, Alberta, Canada. Data were collected on patient demographics, pre-treatment clinical stage information, type and amount of chemotherapy administered, and pathologic data from RC specimens. Results: A total of 251 RC were performed during the study period. Eighty-three RC were performed for non-muscle invasive TCC: 15 non-malignant causes, 27 refractory superficial TCC, 41 non-TCC malignant histology. A total of 168 RC were performed for T2-T4 TCC. Median age at diagnosis was 68 years. Ninety-two (55%) patients received neoadjuvant CG. Seventy-five (45%) patients went straight to RC. Reasons for neoadjuvant GC not being given include: medical contraindication in 43 patients (56%), patient refusal in 9 patients (12%) and lack of referral to Medical Oncologist in 24 patients (32%). Of a possible 116 patients who would have been eligible to receive neoadjuvant chemotherapy, 92/116 (79%) were treated. Of the 92 patients receiving chemotherapy prior to RC, 19 (21%) of the surgical specimens were pathologically free of cancer (pT0) at the time of surgery and 18 (20%) had only superficial disease remaining. By contrast, only three (4%) of the 75 patients who went to immediate RC achieved pT0 status and 5 (7%) had remaining superficial disease. Conclusions: The use of neoadjuvant chemotherapy prior to RC at our institution is higher than quoted in published literature. The use of neoadjuvant GC improves the chances of eliminating residual cancer in the RC specimen.

Correlation between change of FA score and postoperative recurrence in esophageal cancer patients who received neoadjuvant treatment.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 41-41
Author(s):  
Satoru Matsuda ◽  
Hiroya Takeuchi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
Tsunehiro Takahashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Neoadjuvant Treatment ◽  
Postoperative Recurrence ◽  
Transthoracic Esophagectomy ◽  
Clinicopathological Factors ◽  
Significant Difference

41 Background: We previously reported that fibrinogen and albumin score (FA score), which was consisted of plasma fibrinogen level (FNG) and serum albumin level (Alb), was shown to predict postoperative survival in esophageal cancer patients who underwent transthoracic esophagectomy. In this study, in patients who received neoadjuvant chemotherapy (NAC), change of FA score during NAC was reviewed and the correlation with recurrence free survival (RFS) was investigated. Methods: We retrospectively reviewed 125 patients who received neoadjuvant chemotherapy and underwent transthoracic esophagectomy in our institution between 2001 and 2012. FNG and Alb before (preTx) and after (preope) NAC were confirmed in 92 patients. Based on our previous reports, patients with elevated fibrinogen ( > 350 mg/dL) and decreased albumin ( < 3.8 g/dl) levels were allocated a FA score of 2, those with only one of these abnormalities were allocated a FA score of 1, and those with neither of these abnormalities were allocated a FA score of 0. Regarding change of FA score, based on the preTx and preope FA score, we classified into decrease group and increase (no change or increase) group. Patient characteristics, clinicopathological factors, preTx FA score, and preope FA score were reviewed, and correlation with RFS was investigated. Results: The number of preTx and preope FA score 0/1/2 was 39/41/12, 36/37/19. Regarding change of FA score, FA score decreased in 70 patients (76%), increased in 22 (24%). There was no significant difference in patient background and clinicopathological factors between groups. In survival univariate analysis, change of FA score (Increase group, HR 2.023, p = 0.025) were significantly correlated with RFS. In multivariate analysis, using preTx clinical stage as a covariate, FA score was shown to be an independent predict factor (Increase group, HR 2.076, p = 0.023) for RFS significantly. Conclusions: Change of FA score between before and after NAC was shown to be a predictive factor of RFS in esophageal cancer patients who received NAC. Both fibrinogen and albumin are popular indicators routinely measured in daily clinical practice, FA score may be highly validate and feasible.

scholarly journals P-OGC23 Significance of neoadjuvant downstaging in gastric adenocarcinoma

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Pooja Prasad ◽  
Ashwin Sivaharan ◽  
Shajahan Wahed ◽  
Alexander Phillips
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Clinical Outcomes ◽  
Gastric Adenocarcinoma ◽  
Clinical Stage ◽  
Neoadjuvant Treatment ◽  
High Volume ◽  
Recurrence Rates ◽  
The Impact

Abstract Background Neoadjuvant chemotherapy is established in the treatment of gastric adenocarcinoma. Histopathological regression as a result of neoadjuvant treatment can potentially have important prognostic implications in gastric cancer. There is little data comparing the clinical outcomes of patients with gastric adenocarcinoma at the same pathological stage with and without neoadjuvant treatment. The aim of this study is to determine the impact of neoadjuvant chemotherapy upon the prognosis of patients being treated for gastric adenocarcinoma.  Methods Consecutive patients with gastric cancer treated in a single, tertiary high-volume centre between 2007 and 2017 were evaluated. All patients with gastric adenocarcinoma were treated with either a subtotal or total gastrectomy with D2 lymphadenectomy. A stage-by-stage comparison of the extent of pathological downstaging was conducted for patients who received neoadjuvant treatment (ypTNM) and those that did not (pTNM). The pTNM and ypTNM stages were defined as per the TNM 8th Edition.  Results Among 384 patients undergoing gastrectomy for gastric adenocarcinoma, 141 patients received neoadjuvant chemotherapy. Of them, 86 patients (58.1%) benefitted from a downstaging effect. Patients with downstaged disease had improved overall survival compared to patients who did not respond to neoadjuvant chemotherapy (NR vs 66 months, p &lt; 0.001). Downstaging by &gt; 3 stages was the strongest independant predictor of overall survival (hazard ratio: 0.17; 95% Confidence Interval (CI) 0.062-0.44). Overall survival was significantly better when a stage-by-stage comparison was performed between patients in the ypTNM and pTNM groups. Conclusions Pathological staging following neoadjuvant chemotherapy is a more accurate predictor of prognosis compared to pre-neoadjuvant chemotherapy clinical stage with downstaged patients benefitting from lower recurrence rates and improved overall survival. Patients downstaged due to neoadjuvant chemotherapy receipt can potentially have more favourable clinical outcomes compared to stage-matched patients who did not receive this.

EFEITOS DO DEEP RUNNING SOBRE A AMPLITUDE DE MOVIMENTO E A CAPACIDADE FUNCIONAL DOS MEMBROS SUPERIORES DE MULHERES MASTECTOMIZADAS: RELATO DE CASOS

2019 ◽  
pp. 121-131
Keyword(s):  
Range Of Motion ◽  
Upper Limb ◽  
Functional Capacity ◽  
External Rotation ◽  
Treatment Protocol ◽  
Range Of Movement ◽  
Flexion Extension ◽  
Before And After ◽  
In The Beginning ◽  
And Function

Introduction: Breast cancer is the most common type of cancer among women in Brazil and in the worl. The surgical treatment procedure may cause severe morbidity in the upper limb homolateral to surgery, including the reduction of the range of motion, with consequent impairment of function. A physiotherapeutic approach has an important role in the recover range of motion and the functionality of these women, guaranteeing the occupational, domestestic, familiar and conjugated activities, and, in this way, also improving the quality of life. Objectives: To analyse chances in the shoulder's range of motion and the functional capacity of the upper limbs, promoted by the deep running procedure in women with late postoperative mastectomy. Methods: All the patients were submitted to an evaluation in the beginning and end of the treatment, including: goniometry of flexion, extension, abduction, adduction, internal and external rotation of the shoulder joint; and function capacity analysis in activities that involve the upper members by DASH questionnaire. The treatment protocol includes twelve sessions of deep running, realized twice a week, in deep pool, for 20-minute during six weeks. Results: Were submitted to treatment a total of 4 patients. Despite the improvement in the numerical values, statistically significant differences were not found on the range of movements and in the functional capacity of upper members before and after the deep running sessions in post-mastectomy women. Conclusion: Deep running had effects on the numerical values of range of movement and upper limb functionality in women in the late postoperative period of the mastectomy procedure, but without statistically significant differences.

Effect of heightened interoceptive awareness among smokers on misinterpretation of emotional arousal

2020 ◽  
Vol 48 (2) ◽  
pp. 1-8
Author(s):  
Minseung Kim ◽  
Yeon-Ju Park ◽  
Kiho Kim ◽  
Jang-Han Lee
Keyword(s):  
Smoking Status ◽  
The Body ◽  
Interoceptive Awareness ◽  
Emotional Stimuli ◽  
High Arousal ◽  
Amplification Bias ◽  
Video Clips ◽  
Before And After ◽  
Positive Stimuli ◽  
Subjective Arousal

We investigated the differences in the emotional experiences of people who smoke and have damaged interoceptive awareness. Interoception is the sensation of the physiological condition of the body, and it has 2 biases: neglect and amplification of bodily feedback. We recruited 72 participants and divided them into 4 groups according to smoking status and interoceptive bias based on their scores on the Multidimensional Assessment of Interoceptive Awareness. All groups assessed their physiological and subjective arousal before and after watching video clips (positive–low arousal, positive–high arousal, negative–low arousal, negative–high arousal, neutral). The results indicated that people with amplification (vs. neglect) bias who smoked showed stronger subjective arousal to neutral stimuli. In contrast, people with amplification (vs. neglect) bias who did not smoke showed stronger subjective arousal to positive stimuli. These findings suggest that people who smoke and have an amplification bias could be more likely to misinterpret neutral emotional stimuli, leading to an increased craving for smoking.

scholarly journals Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database

2019 ◽  
Author(s):  
Alessandro Brunelli ◽  
Gaetano Rocco ◽  
Zalan Szanto ◽  
Pascal Thomas ◽  
Pierre Emmanuel Falcoz
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Bronchopleural Fistula ◽  
Neoadjuvant Treatment ◽  
Mortality Rates ◽  
Induction Treatment ◽  
Score Analysis ◽  
Cardiopulmonary Complications ◽  
Lung Resections

Abstract OBJECTIVES To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. METHODS Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007–31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. RESULTS 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). CONCLUSIONS Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

scholarly journals Are Three Weeks of Oral Anticoagulation Sufficient for Safe Cardioversion in Atrial Fibrillation?

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 554
Author(s):  
Stefan Naydenov ◽  
Nikolay Runev ◽  
Emil Manov
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Open Label ◽  
Before And After ◽  
Individualized Approach ◽  
Baseline Factors ◽  
And Function

Background and Objectives: Patients with atrial fibrillation (AF), lasting >48 h, considered for cardioversion, are recommended ≥3 weeks of oral anticoagulation before sinus rhythm restoration because of high risk of development of left atrial thrombosis (LAT) and stroke. However, the optimal duration of anticoagulation in the presence of overt LAT is unknown. Materials and Methods: An open-label study aimed to investigate the prevalence of spontaneous echo contrast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment. We included 51 consecutive patients (50.9% males), mean age 69.3 ± 7.4 years with paroxysmal/unknown duration of AF, considered for cardioversion, who agreed to have transesophageal echocardiography at enrollment and 3 weeks later. Results: At baseline SEC was present in 26 (50.9%) and LAT in 10 (19.6%) of 51 patients. After 3 weeks on DOAC, SEC persisted in 12 (25.0%) and LAT in 7 (14.5%) of 48 patients, p < 0.05 vs. baseline. Factors, associated most strongly with persistence of SEC/LAT, were left atrial appendage (LAA) emptying velocity <20 cm/s (OR = 2.82), LAA lobes >2 (OR = 1.84), and indexed left atrial volume ≥34 mL/m2 (OR = 1.37). Conclusions: In our study the incidence of SEC/LAT, particularly in AF with unknown duration, was not as low as we expected. The prevalence of SEC/LAT seemed to be dependent on factors not routinely evaluated in AF patients planned for cardioversion (indexed LA volume, LAA morphology and number of lobules, LAA emptying velocity, etc.). Our data suggested an individualized approach for DOAC duration in AF patients before an attempt for restoration of sinus rhythm is made, taking into consideration the LAA morphology and function.

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