scholarly journals Radiosurgery for brain oligometastases in lung cancer

Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e8184-e8184
Author(s):  
Gabriela Antúnez ◽  
Tomás Merino
Keyword(s):  
Lung Cancer ◽  
Systematic Reviews ◽  
Poor Prognosis ◽  
Randomized Trials ◽  
Information Sources ◽  
Meta Analysis ◽  
Whole Brain Radiation ◽  
Therapeutic Alternatives ◽  
Brain Radiation ◽  
Grade Approach

INTRODUCTION Brain metastases are a common problem in oncology patients, especially in lung cancer. The usual treatment for cerebral oligometastases is whole brain radiation therapy. Given the persistent poor prognosis of this disease, other therapeutic alternatives such as stereotactic radiosurgery have been considered. However, there is no clarity regarding the effectiveness of its addition. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 17 systematic reviews including seven studies overall, of which four were randomized trials. All trials assessed patients with brain oligometastases, but none of them included exclusively lung cancer population. We concluded that it is not possible to clearly establish whether radiosurgery decreases neurological functionality, cognitive impairment, mortality or serious adverse effects, as the certainty of the existing evidence has been assessed as very low.

scholarly journals Atypical antipsychotics for delirium in hospitalized patients

Medwave ◽  
2021 ◽  
Vol 21 (04) ◽  
pp. e8168-e8168
Author(s):  
Daniza Belén Bilicic Ubierna ◽  
Nicolás Cattarinich Schiffrin ◽  
Daniela Coronel Cárdenas ◽  
Rubén Soto Munizaga ◽  
José Miguel Bernucci Piedra
Keyword(s):  
Systematic Reviews ◽  
Atypical Antipsychotics ◽  
Randomized Trials ◽  
Information Sources ◽  
Response Rate ◽  
Meta Analysis ◽  
Low Complexity ◽  
Hospitalized Patients ◽  
Risk Of Mortality ◽  
Grade Approach

Introduction For the pharmacotherapy of delirium in elderly adults who are hospitalized, atypical antipsychotics are used. Currently, there is insufficient evidence on the effectiveness of this treatment in low complexity units. Methods We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE/PubMed, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. Results and conclusions We identified 13 systematic reviews that included three randomized trials. We concluded that the use of atypical antipsychotics in hospitalized patients likely increases the risk of mortality compared to placebo and could decrease the response rate associated with reducing the risk of adverse effects. Furthermore, using atypical antipsychotics probably results in low or no difference in the severity of delirium.

scholarly journals Palliative chemotherapy for advanced gallbladder cancer

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8046-e8046
Author(s):  
Gonzalo A Bravo-Soto ◽  
Rocío Brañes ◽  
José Peña ◽  
Bruno Nervi
Keyword(s):  
Gallbladder Cancer ◽  
Systematic Reviews ◽  
Palliative Chemotherapy ◽  
Meta Analysis ◽  
Methodological Errors ◽  
Advanced Gallbladder Cancer ◽  
Therapeutic Alternatives ◽  
New Evidence ◽  
Grade Approach ◽  
Common Malignancy

INTRODUCTION Gallbladder cancer is the most common malignancy of the biliary tract. Given the lack of therapeutic alternatives for advanced stage patients studies have suggested that palliative chemotherapy could benefit these patients. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified two systematic reviews including two studies overall, of which one was a randomized trial. We concluded that palliative chemotherapy may increase survival in advanced gallbladder cancer patients. However, palliative chemotherapy probably increases adverse effects. In addition, it is essential to carry out a new systematic review, since methodological errors were identified in the analysis and there is new evidence that has not been included in the previous reviews

scholarly journals Vortioxetine for generalised anxiety disorder in adults

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8171-e8171
Author(s):  
Nicolás Meza ◽  
Fanny Leyton
Keyword(s):  
Anxiety Disorder ◽  
Adverse Effects ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Current Treatment ◽  
Response To Treatment ◽  
Generalised Anxiety Disorder ◽  
Psychopharmacological Treatment ◽  
Grade Approach

INTRODUCTION The currently accepted psychopharmacological treatment for generalised anxiety disorder in adults is associated with several adverse effects which threaten its acceptability. In this line, vortioxetine has been proposed as an alternative with less adverse effects in the treatment of this pathology. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including five primary studies, all corresponding to randomized trials evaluating the effectiveness of vortioxetine in adult patients with generalized anxiety disorder without current treatment. We conclude that there is uncertainty whether vortioxetine increases the response to treatment or improves anxious symptoms, because the certainty of the existing evidence has been assessed as very low. Furthermore, vortioxetine may increase nausea (low certainty evidence).

Survival and Neurologic Outcomes in a Randomized Trial of Motexafin Gadolinium and Whole-Brain Radiation Therapy in Brain Metastases

2003 ◽  
Vol 21 (13) ◽  
pp. 2529-2536 ◽  
Author(s):  
Minesh P. Mehta ◽  
Patrick Rodrigus ◽  
C.H.J. Terhaard ◽  
Aroor Rao ◽  
John Suh ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Brain Metastases ◽  
Randomized Trial ◽  
Cancer Patients ◽  
Treatment Benefit ◽  
Motexafin Gadolinium ◽  
Lung Cancer Patients ◽  
Whole Brain Radiation ◽  
Brain Radiation

Purpose: This phase III randomized trial evaluated survival as well as neurologic and neurocognitive function in patients with brain metastases from solid tumors receiving whole-brain radiation therapy (WBRT) with or without motexafin gadolinium (MGd). Patients and Methods: Patients were randomly assigned to 30 Gy of WBRT ± 5 mg/kg/d MGd. Survival and time to neurologic progression determined by a blinded events review committee (ERC) were coprimary end points. Standardized investigator neurologic assessment and neurocognitive testing were evaluated. Results: Four hundred one (251 non–small-cell lung cancer) patients were enrolled. There was no significant difference by treatment arm in survival (median, 5.2 months for MGd v 4.9 months for WBRT; P = .48) or time to neurologic progression (median, 9.5 months for MGd v 8.3 months for WBRT; P = .95). Treatment with MGd improved time to neurologic progression in patients with lung cancer (median, not reached for MGd v 7.4 months for WBRT; P = .048, unadjusted). By investigator, MGd improved time to neurologic progression in all patients (median, 4.3 months for MGd v 3.8 months for WBRT; P = .018) and in lung cancer patients (median, 5.5 months for MGd v 3.7 months for WBRT; P = .025). MGd improved neurocognitive function in lung cancer patients. Conclusion: The overall results did not demonstrate significant differences by treatment arm for survival and ERC time to neurologic progression. Investigator neurologic assessments demonstrated an MGd treatment benefit in all patients. In lung cancer patients, ERC- and investigator-determined time to neurologic progression demonstrated an MGd treatment benefit. MGd may improve time to neurologic and neurocognitive progression in lung cancer.

scholarly journals The Current Role of Whole Brain Radiation Therapy in Non–Small Cell Lung Cancer Patients

2017 ◽  
Vol 12 (10) ◽  
pp. 1467-1477 ◽  
Author(s):  
Gokoulakrichenane Loganadane ◽  
Lizza Hendriks ◽  
Cécile Le Péchoux ◽  
Antonin Levy
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Small Cell ◽  
Small Cell Lung ◽  
Current Role ◽  
Lung Cancer Patients ◽  
Whole Brain Radiation ◽  
Brain Radiation
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