scholarly journals Histological regression of gastrointestinal peritoneal metastases after systemic chemotherapy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Laura Toussaint ◽  
Hugo Teixeira Farinha ◽  
Jean-Luc Barras ◽  
Nicolas Demartines ◽  
Christine Sempoux ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
Complete Response ◽  
Peritoneal Metastases ◽  
Response To Therapy ◽  
Significant Heterogeneity ◽  
Histological Response ◽  
Small Cohort ◽  
The Difference ◽  
Peritoneal Spread ◽  
Histological Regression

Abstract Objectives Peritoneal metastases (PM) are relatively resistant to systemic chemotherapy, and data on histological response to therapy is rare. The aim of this study was to quantify the treatment response of PM after systemic chemotherapy. Methods Retrospective monocentric cohort study of 47 consecutive patients with PM from gastrointestinal origin undergoing surgery (cytoreduction: CRS + Hyperthermic IntraPEritoneal Chemotherapy [HIPEC] or Pressurized IntraPeritoneal Aerosol Chemotherapy [PIPAC]) after prior systemic chemotherapy from 1.2015 to 3.2019. Tumor response was assessed using the 4-scale Peritoneal Regression Grading System (PRGS) (4: vital tumor to 1: complete response). Results Patients had a median of 2 (range: 1–7) lines and 10 (3–39) cycles of prior systemic chemotherapy. A median of four biopsies (range: 3–8) was taken with a total of 196 analyzed specimens. Twenty-four biopsies (12%) showed no histological regression (PRGS4), while PRGS 3, two and one were diagnosed in 37 (19%), 39 (20%), and 69 (49%) specimens, respectively. A significant heterogeneity was found between peritoneal biopsies in 51% patients. PRGS correlated strongly with peritoneal spread (PCI, p<0.0001), and was improved in patients with more than nine cycles of systemic chemotherapy (p=0.04). Median survival was higher in patients with PRGS < 1.8 (Quartiles one and 2) than higher (Q3 and Q4), but the difference did not reach significance in this small cohort. Conclusions PRGS is an objective too to describe histological response of PM of GI origin after systemic chemotherapy. This response differs significantly between patients, allowing to distinguish between chemosensitive and chemoresistant tumors.

scholarly journals Predictors and Early Markers of Response to Biological Therapies in Inflammatory Bowel Diseases

2021 ◽  
Vol 10 (4) ◽  
pp. 853
Author(s):  
Giuseppe Privitera ◽  
Daniela Pugliese ◽  
Gian Ludovico Rapaccini ◽  
Antonio Gasbarrini ◽  
Alessandro Armuzzi ◽  
...  
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Current Knowledge ◽  
Real Life ◽  
Response To Therapy ◽  
Significant Heterogeneity ◽  
Intestinal Damage ◽  
Biological Therapies ◽  
Early Markers ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Inflammatory bowel diseases (IBD) are chronic conditions that primarily affect the gastrointestinal tract, with a complex pathogenesis; they are characterized by a significant heterogeneity of clinical presentations and of inflammatory pathways that sustain intestinal damage. After the introduction of the first biological therapies, the pipeline of therapies for IBD has been constantly expanding, and a significant number of new molecules is expected in the next few years. Evidence from clinical trials and real-life experiences has taught us that up to 40% of patients do not respond to a specific drug. Unfortunately, to date, clinicians lack a valid tool that can predict each patient’s response to therapies and that could help them in choosing what drug to administer. Several candidate biomarkers have been investigated so far, with conflicting results: clinical, genetic, immunological, pharmacokinetic and microbial markers have been tested, but no ideal marker has been identified so far. Based on recent evidence, multiparametric models seemingly hold the greatest potential for predicting response to therapy. In this narrative review, we aim to summarize the current knowledge on predictors and early markers of response to biological therapies in IBD.

Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

Breast Care ◽  
2021 ◽  
pp. 1-7
Author(s):  
Tal Hadar ◽  
Michael Koretz ◽  
Mahmood Nawass ◽  
Tanir M. Allweis
Keyword(s):  
Systemic Therapy ◽  
Percutaneous Biopsy ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Response To Therapy ◽  
Neoadjuvant Endocrine Therapy ◽  
Oncoplastic Breast Surgery ◽  
Tumor Bed ◽  
Treatment Indications ◽  
Neoadjuvant Systemic Therapy

<b><i>Background:</i></b> The goal of neoadjuvant systemic therapy (NST) in breast cancer is to downstage tumors and downgrade treatment. Indications are constantly evolving. These changes raise practical questions for planning of surgery after NST. <b><i>Summary:</i></b> In this review we discuss current evolving aspects of surgery of the breast after NST. Breast-conserving surgery (BCS) eligibility increases after NST – both neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy. Adequate margin width in NST and upfront surgery are similar – “no tumor on ink” for invasive cancer. Oncoplastic breast surgery after NST is feasible – both for BCS and mastectomy with reconstruction. There is increasing interest in the possibility of omitting surgery in patients with a complete response to NAC. Several trials are being conducted in aim of achieving acceptable prediction of pathological complete response, by combination of imaging and percutaneous biopsy of the tumor bed, as well as assessing the safety of such an approach. <b><i>Key Messages:</i></b> Surgery of the breast after NST should be determined not only according to biologic and anatomic parameters at diagnosis, but is dynamic, and must be tailored according to the response to therapy. The omission of surgery in exceptional responders after NAC is being explored.

scholarly journals ANALYSIS OF ACOUSTIC ANISOTROPY PARAMETERS OF PYROXENE-MAGNETITE ROCKS OF THE PISCHANKA STRUCTURE

2020 ◽  
pp. 40-45
Author(s):  
I. Bezrodna ◽  
V. Svystov ◽  
D. Bezrodny
Keyword(s):  
Acoustic Properties ◽  
Significant Heterogeneity ◽  
Depth Range ◽  
Transverse Waves ◽  
Acoustic Anisotropy ◽  
Micro Cracks ◽  
Acoustic Tensor ◽  
Transverse Isotropic ◽  
Different Depths ◽  
The Difference

The analysis of the results of acoustic properties of rocks study of Pischans`ka iron-ore structure is presented. The aim of the work is to establish the features of the distribution of acoustic properties and parameters of acoustic anisotropy in samples of core rocks selected from the well No. 3 of the Pischans`ka structure to determine the nature of its occurrence. A sample of 35 samples from the depth range 144-273 m is divided into 3 groups of rocks, namely: magnetite-pyroxene, quartz-magnetitepyroxene and biotite-amphibole crystalline shales. Based on an invariant polarization method, a number of acoustic laboratory measurements have been carried out. The values of the measured phase velocities "quasi-longitudinal" and two "quasi-transverse" waves at the stage of measurements showed significant acoustic anisotropy of the rocks. The ranges of the measured speeds of the collection samples are 7661 ÷ 5046 m / s for longitudinal waves and 4232 ÷ 2648 m/s for transverse ones. The difference in values measured for each of the sides of the cubic rhombic dodecahedron is from 100 to 800 m / s and from 0 to 500 m/s for Vp and Vs, respectively. The parameters of an acoustic ellipsoid were calculated, on the basis of which the division of samples into 3 main groups has been performed, according to the acoustic texture: acoustically linear, shale and rhombic. Separately, a group of samples with a more complex texture was discovered. The analysis of coefficients of anisotropy by different methods is carried out: longitudinal, transverse and relative acoustic anisotropy. Most of the samples are characterized by low or average acoustic anisotropy (from 2 to 7 %). A group of highly anisotropic rocks (11–14 %), represented by samples of biotite-amphibole crystalline silicates, is singled out. According to the parameters of the acoustic tensor of most samples, the transverse isotropic type of symmetry inherent to samples from the depth intervals 174–220 m and 222–232 m, while the smaller part is rhombic, is inherent. Differences in the parameters of anisotropy of samples can be explained by the significant heterogeneity of their textures, namely: micro cracks, minerals of various sizes, shapes and orientations. The results of the research show that the acoustic properties of the samples are quite heterogeneously distributed along the investigated depth range. This indicates the difficult conditions for the formation of rocks at different depths and the presence of different types of deformations, which accompanied the formation of the Pischans`ka structure.

scholarly journals Extrém magas B típusú natriureticus prohormon prognosztikai szerepe a szívelégtelenség miatt kezelt betegek kórházi halálozására

2017 ◽  
Vol 158 (20) ◽  
pp. 779-782
Author(s):  
Béla Bózsik ◽  
Erzsébet Nagy ◽  
Miklós Somlói ◽  
János Tomcsányi
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Prognostic Value ◽  
Response To Therapy ◽  
Cardiology Department ◽  
The Difference ◽  
One Year

Abstract: Introduction: Patients hospitalized for heart failure have a very high in-hospital as well as one-year mortality. Natriuretic peptides play both a diagnostic and a prognostic role in this disease. Changes of natriuretic peptide levels in response to therapy are a well-known prognostic marker. Regarding in-hospital mortality, however, little is known about the prognostic value of extremely high levels of natriuretic peptides measured on admission. Aim: To decide whether extremely high levels of B-type natriuretic peptide have a prognostic value with regard to in-hospital mortality. Method: NT-proBNP levels on admission and in-hospital mortality were extracted retrospectively from the data of patients treated with heart failure in the cardiology department of the Hospital of St. John of God in Budapest. We separately analyzed the data of patients hospitalized for heart failure in 2015 with extremely high initial NT-proBNP levels. The cut-off value in this regard was 10 000 ng/l. We also analyzed the comorbidities of these patients. Results: The median NT-proBNP level of those patients who survived beyond the index hospital stay in the last 10 years was 4842 ng/l, whereas the median NT-proBNP level of those 182 patients who died during their hospital stay was 10 688 ng/l (p<0.001). In the year 2015, we treated 118 patients with an NT-proBNP level above 10 000 ng/l. Thirteen of these patients died, which means that their in-hospital mortality exceeded 10%. In comparison, the in-hospital mortality of all heart failure patients was 5.8%. The difference of median NT-proBNP levels of surviving versus deceased patients in this group with extremely high NT-proBNP levels was no longer significant (17 080 ng/l vs. 19 152 ng/l). Conclusions: Patients with an NT-proBNP level of >10 000 ng/l on admission have a significantly higher in-hospital mortality. The difference of NT-proBNP levels of surviving versus deceased patients in the group with admission NT-proBNP levels >10 000 ng/l is no longer significant. We could not identify any etiological factors that would explain these extremely high NT-proBNP levels or the excess in-hospital mortality. Orv Hetil. 2017; 158(20): 779–782.

scholarly journals High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis

Blood ◽  
2007 ◽  
Vol 110 (3) ◽  
pp. 827-832 ◽  
Author(s):  
Frits van Rhee ◽  
Vanessa Bolejack ◽  
Klaus Hollmig ◽  
Mauricio Pineda-Roman ◽  
Elias Anaissie ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Prognostic Significance ◽  
Complete Response ◽  
High Serum ◽  
Free Light Chain ◽  
Response To Therapy ◽  
Rapid Reduction ◽  
Serum Free ◽  
Serum Free Light Chain

Abstract Serum-free light chain (SFLC) levels are useful for diagnosing nonsecretory myeloma and monitoring response in light-chain–only disease, especially in the presence of renal failure. As part of a tandem autotransplantation trial for newly diagnosed multiple myeloma, SFLC levels were measured at baseline, within 7 days of starting the first cycle, and before both the second induction cycle and the first transplantation. SFLC baseline levels higher than 75 mg/dL (top tertile) identified 33% of 301 patients with higher near-complete response rate (n-CR) to induction therapy (37% vs 20%, P = .002) yet inferior 24-month overall survival (OS: 76% vs 91%, P < .001) and event-free survival (EFS: 73% vs 90%, P < .001), retaining independent prognostic significance for both EFS (HR = 2.40, P = .008) and OS (HR = 2.43, P = .016). Baseline SFLC higher than 75 mg/dL was associated with light-chain–only secretion (P < .001), creatinine level 176.8 μM (2 mg/dL) or higher (P < .001), beta-2-microglobulin 297.5 nM/L (3.5 mg/L) or higher (P < .001), lactate dehydrogenase 190 U/L or higher (P < .001), and bone marrow plasmacytosis higher than 30% (P = .003). Additional independent adverse implications were conferred by top-tertile SFLC reductions before cycle 2 (OS: HR = 2.97, P = .003; EFS: HR = 2.56, P = .003) and before transplantation (OS: HR = 3.31, P = .001; EFS: HR = 2.65, P = .003). Unlike baseline and follow-up analyses of serum and urine M-proteins, high SFLC levels at baseline—reflecting more aggressive disease—and steeper reductions after therapy identified patients with inferior survival.

scholarly journals The Clinical Outcome in Patients with Peritoneal Metastasis

2020 ◽  
pp. 1-3
Author(s):  
Spiliotis J ◽  
◽  
Farmakis D ◽  
Raptis A ◽  
Kopanakis N ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Survival Rates ◽  
Peritoneal Metastases ◽  
Mortality And Morbidity ◽  
Chemotherapy Group ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D

Cytroreductive surgery (CRS) and HIPEC are controversial effective treatment options for selected patients with peritoneal metastases. We retrospectively examined 4.500 patients with peritoneal metastases from different tumors from 2005 to 2020. Patients were divided in 4 groups, surgery plus HIPEC and then systemic chemotherapy: Group A n=730, Group B n=700, R0 surgery plus systemic chemotherapy, Group C n=870, palliative surgery plus systemic chemotherapy and Group D n=2.200, palliative care and best support. The postoperative outcomes, morbidity, mortality were compared between the 4 groups. The mean survival rates Group A=24,4+10,2m, Group B= 18,4+6,3m, Group C=12,3+5,7m, Group D=5,8+2,3m (p<0.05 between Gr A vr Gr B). There was no statistically significant difference in the 30-day mortality and morbidity. In conclusion CRS + HIPEC are feasible in 16% of our patients with peritoneal metastases and are associated with pro-longed survival.

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