Pancreatic cancer(PDAC) is an aggressive and chemoresistant disease, representing the fourth cause of cancer related deaths in western countries. Majority of patients have unresectable, locally advanced or metastatic ...Pancreatic cancer(PDAC) is an aggressive and chemoresistant disease, representing the fourth cause of cancer related deaths in western countries. Majority of patients have unresectable, locally advanced or metastatic disease at time of diagnosis and the 5-year survival rate in these conditions is extremely low. For more than a decade gemcitabine has been the cornerstone of metastatic PDAC treatment, although survival benefit was very poor. PDAC cells are surrounded by an intense desmoplastic reaction that may create a barrier to the drugs penetration within the tumor. Recently PDAC stroma has been addressed as a potential therapeutic target. Nano albumin bound(Nab)-paclitaxel is an innovative molecule depleting tumor stroma, through interaction between albumin and secreted protein acidic and rich in cysteine. Addition of nab-paclitaxel to gemcitabine has showed activity and efficacy in metastatic PDAC first-line treatment improving survival and overall response rate vs gemcitabine alone in the MPACT phase Ⅲ study. This combination represents one of the standards of care in advanced PDAC therapy and is suitable to a broader spectrum of patients compared to other schedules. Nab-paclitaxel is under investigation as a backbone of chemotherapy in novel combinations with target agents or immunotherapy in locally advanced or metastatic PDAC. In this article, we provide an updated and critical overview about the role of nab-paclitaxel in PDAC treatment based on the latest advances in preclinical and clinical research. Furthermore, we focus on the use of nab-paclitaxel within the context of metastatic PDAC treatment landscape and we discuss about future implications in the light of current clinical ongoing trials.展开更多
Uveal melanoma(UM)is the most common primary intraocular cancer in adults.The incidence in Europe and the United States is 6-7 per million population per year.Although most primary UMs can be successfully treated and ...Uveal melanoma(UM)is the most common primary intraocular cancer in adults.The incidence in Europe and the United States is 6-7 per million population per year.Although most primary UMs can be successfully treated and locally controlled by irradiation therapy or local tumor resection,up to 50%of UM patients develop metastases that usually involve the liver and are fatal within 1 year.To date,chemotherapy and targeted treatments only obtain minimal responses in patients with metastatic UM,which is still characterized by poor prognosis.No standard therapeutic approaches for its prevention or treatment have been established.The application of immunotherapy agents,such as immune checkpoint inhibitors that are effective in cutaneous melanoma,has shown limited effects in the treatment of ocular disease.This is due to UM’s distinct genetics,natural history,and complex interaction with the immune system.Unlike cutaneous melanomas characterized mainly by BRAF or NRAS mutations,UMs are usually triggered by a mutation in GNAQ or GNA11.As a result,more effective immunotherapeutic approaches,such as cancer vaccines,adoptive cell transfer,and other new molecules are currently being studied.In this review,we examine novel immunotherapeutic strategies in clinical and preclinical studies and highlight the latest insight in immunotherapy and the development of tailored treatment of UM.展开更多
Breast cancer(BC)is the most common malignant tumor and the main cause of death in women worldwide.With increased knowledge regarding tumor escape mechanisms and advances in immunology,many new antitumor strategies su...Breast cancer(BC)is the most common malignant tumor and the main cause of death in women worldwide.With increased knowledge regarding tumor escape mechanisms and advances in immunology,many new antitumor strategies such as nonspecific immunotherapies,monoclonal antibodies,anticancer vaccines,and oncolytic viruses,among others,make immunotherapy a promising approach for the treatment of BC.However,these approaches still require meticulous assessment and readjustment as resistance and modest response rates remain important barriers.In this article,we aim to summarize the most recent data available in BC immunotherapy to include the results of ongoing clinical trials and approved therapies used as monotherapies or in combination with conventional treatments.展开更多
Concurrent dural and leptomeningeal metastatic carcinomatosis are very rare and have a poor prognosis. Here we present a woman with advanced estrogen receptor (ER) positive and progesterone receptor (PR) positive brea...Concurrent dural and leptomeningeal metastatic carcinomatosis are very rare and have a poor prognosis. Here we present a woman with advanced estrogen receptor (ER) positive and progesterone receptor (PR) positive breast cancer who presented with leptomeningeal disease. Patient underwent multi targeted epigenetic therapies applied in a protocol called MTET. She continued to respond to the interval treatment, which consisted only of the nutraceutical agents. Here we discuss her case in detail and we believe that such an example might be applied to other patients in this situation resulting clinical improvement and less toxicity.展开更多
Due to extremely poor prognosis,pancreatic cancer(PDAC)represents the fourth leading cause of cancerrelated death in Western countries.For more than a decade,gemcitabine(Gem)has been the mainstay of first-line PDAC tr...Due to extremely poor prognosis,pancreatic cancer(PDAC)represents the fourth leading cause of cancerrelated death in Western countries.For more than a decade,gemcitabine(Gem)has been the mainstay of first-line PDAC treatment.Many efforts aimed at improving single-agent Gem efficacy by either combining it with a second cytotoxic/molecularly targeted agent or pharmacokinetic modulation provided disappointing results.Recently,the field of systemic therapy of advanced PDAC is finally moving forward.Polychemotherapy has shown promise over single-agent Gem:regimens like PEFG-PEXG-PDXG and GTX provide significant potential advantages in terms of survival and/or disease control,although sometimes at the cost of poor tolerability.The PRODIGE 4/ACCORD 11 was the first phaseⅢtrial to provide unequivocal benefit using the polychemotherapy regimen FOLFIRINOX;however the less favorable safety profile and the characteristics of the enrolled population,restrict the use of FOLFIRINOX to young and fit PDAC patients.The nanoparticle albumin-bound paclitaxel(nab-Paclitaxel)formulation was developed to overcome resistance due to the desmoplastic stroma surrounding pancreatic cancer cells.Regardless of whether or not this is its main mechanisms of action,the combination of nabPaclitaxel plus Gem showed a statistically and clinically significant survival advantage over single agent Gem and significantly improved all the secondary endpoints.Furthermore,recent findings on maintenance therapy are opening up potential new avenues in the treatment of advanced PDAC,particularly in a new era in which highly effective first-line regimens allow patients to experience prolonged disease control.Here,we provide an overview of recent advances in the systemic treatment of advanced PDAC,mostly focusing on recent findings that have set new standards in metastatic disease.Potential avenues for further development in the metastatic setting and current efforts to integratenew effective chemotherapy regimens in earlier stages of disease(neoadjuvant,adju展开更多
Soft tissue sarcomas represent only 1% of all adult cancers;myxofibrosarcoma is the most common type that arises in adult extremities, particularly lower limbs (77%), other less common locations are the trunk (12%) an...Soft tissue sarcomas represent only 1% of all adult cancers;myxofibrosarcoma is the most common type that arises in adult extremities, particularly lower limbs (77%), other less common locations are the trunk (12%) and neck (3%). Usually presenting as a painless, subcutaneous, slow growing mass with tendency for recurrence, they are prone to have higher histological grade and metastatic potential after recurrence;even in optimal multidisciplinary settings patients can have incomplete resections, making metastatic disease more common after misdiagnosis. We present the case of a 69-year-old male patient with a right infraescapular tumor, presenting as a painless 15 × 8 cm, mobile mass, with a slow but progressive growth, history of a previous tumor excised at the same location 5 years prior without histopathological report.展开更多
Pancreatic cancer is one of the most deadly cancers and is characterized by a poor prognosis. Single agent gemcitabine, despite its limited activity and modest impact on disease outcome, is considered as the standard ...Pancreatic cancer is one of the most deadly cancers and is characterized by a poor prognosis. Single agent gemcitabine, despite its limited activity and modest impact on disease outcome, is considered as the standard therapy in pancreatic cancer. Most of the combination regimens used in the treatment of this disease, also including the targeted agents, did not improve the outcome of patients. Also, taxanes have been tested as single agent and in combination chemotherapy, both in first line and as salvage chemotherapy, as another possible option for treating pancreatic cancer. The inclusion of taxanes in combination with gemcitabine as upfront therapy obtained promising results. Accordingly, taxanes, and above all, new generation taxanes, appear to be suitable candidates for further testing to assess their role against pancreatic cancer in various clinical settings.展开更多
Introduction: Metastatic thyroid carcinoma presenting at the initial time of diagnosis is uncommon and the prognosis is unclear. Long term survival rates are variable ranging from 13% to 100%. This case report is pres...Introduction: Metastatic thyroid carcinoma presenting at the initial time of diagnosis is uncommon and the prognosis is unclear. Long term survival rates are variable ranging from 13% to 100%. This case report is presented to illustrate potential management and lend statistical power to future analysis of the correct treatment planning, mortality rates, and prognostic indications for an uncommon presentation of thyroid cancer. Case presentation: This patient is a 63 year old female who presented with new onset of progressive right hip pain. She was treated with a cortisone injection for presumed osteoarthritis but did not improve. Physical exam at the time was pertinent for a body mass index (BMI) of 38.4, mild systolic hypertension, difficulty walking secondary to the right hip pain, limited range of motion at the hip, and fullness of right thyroid gland with no palpable nodules. Laboratory evaluation including thyroid function tests was normal. However, CT and MRI scans revealed a 6.5 cm × 5 cm osteolytic expansive lesion on the right iliac crest with a soft tissue mass. In addition, an enlarged right thyroid lobe and small nodular densities in the lungs suspicious for metastatic disease were noted. A fine needle aspiration of the right ileum revealed metastatic follicular adenocarcinoma consistent with a thyroid primary. The patient was not a surgical candidate due to the extent of disease. She received 37.5 Gy to both the right iliac crest mass and the neck to include the thyroid lesion, followed by iodine-131 ablation and bisphosphonate therapy. Her disease was stable on her last follow up at 48 months. Conclusion: Further studies identifying independent variables such as age of the patient, site and extent of the disease and histology of the tumor are needed to help determine the true prognosis and proper management patients with this presentation. The optimal treatment with potential chance for cure in patients with metastatic thyroid carcinoma has yet to be elucidated.展开更多
Estrium Whey is an alternative nutritional support therapy for women.It’s enhanced with specific nutrients including phytoestrogens,folate,antioxidants and fiber to support healthy estrogen detoxification and hormon... Estrium Whey is an alternative nutritional support therapy for women.It’s enhanced with specific nutrients including phytoestrogens,folate,antioxidants and fiber to support healthy estrogen detoxification and hormone balance.We describe the first case of hepatotoxicity due to Estrium Whey in a 51-year old female with metastatic breast cancer with clinical,laboratory and histopathological changes.展开更多
Proximal humeral reconstructive options following radical resection of proximal humeral primary and metastatic bone malignancies have evolved over time.With the relatively recent advent of the reverse total shoulder(R...Proximal humeral reconstructive options following radical resection of proximal humeral primary and metastatic bone malignancies have evolved over time.With the relatively recent advent of the reverse total shoulder(RTSA),this technique has been increasingly employed in this setting over hemiarthroplasty techniques.An array of options,including proximal humeral allograft-prosthetic composites(including both RTSA and hemiarthroplasty),megaprostheses,and osteoarticular allografts,is reviewed from the perspective of their indications,techniques,complications,and published results.An extensive case-based pictorial presentation illustrates these options.展开更多
Background:In stage Ⅳ breast cancer,surgical resection of the primary tumor was traditionally performed solely to palliate symptoms such as bleeding,infection,or pain.The ongoing discussion has shown that there are m...Background:In stage Ⅳ breast cancer,surgical resection of the primary tumor was traditionally performed solely to palliate symptoms such as bleeding,infection,or pain.The ongoing discussion has shown that there are many research gaps in the current literature and differences in clinical practice.Thus,this systematic review and meta-analysis was designed to evaluate how primary tumor resection(PTR)affects the overall survival(OS)of patients with stage Ⅳ breast cancer.Method:A thorough literature search was completed using different databases(PubMed,Google Scholar,Scopus,ScienceDirect,and Cochrane Library)to find papers contrasting PTR with no PTR.The quality of research articles was evaluated using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale(NOS).Review Manager 5.4 was used to determine how much demographic and clinical factors contribute to heterogeneity through subgroup and meta-regression analysis.Results:Data derived from 44 observational studies(OS)and four randomized controlled trials(RCTs)including 227,889 patients were analyzed.Of all cases,150,239 patients were included in the non-PTR group,and 70,795 patients in the PTR group(37 observational studies and 4 randomized control trials).The pooled outcomes of four RCT studies(Hazard Ratio(HR)=1.03,95%CI:0.67-1.58;I2=88%;P<0.0001;chi-square 24.57)favor non-PTR.While pooled outcomes of 43 observational studies showed PTR significantly improved OS(HR=0.66,95%CI:0.61-0.71;I2=87%;P<0.00001;chi-square 359.12).Additionally,subgroup analysis that compared PTR with non-PTR in patients with stage IV breast cancer for progression free-survival(HR=0.89,95%CI:0.62-1.28;P=0.03;I2=71%)and locoregional progression-free survival(LPFS)(HR=0.33,95%CI:0.14-0.74;P=0.0004;I^(2)=87%)was found to be significant favoring the PTR group.Distant progression-free survival(DPFS)had a non-significant relationship(HR=0.42,95%CI:0.29-0.60;P=0.12;I^(2)=53%),while overall,there was a significant relationship(HR=0.49,95%CI:0.32-0.75;P<0.00001;I2=90%).Subgroup analysis展开更多
A variety of indications have been published regarding the use of percutaneous thermal ablation for treating tumors of the musculoskeletal system,including bone and soft tissue lesions,benign and malignant lesions,and...A variety of indications have been published regarding the use of percutaneous thermal ablation for treating tumors of the musculoskeletal system,including bone and soft tissue lesions,benign and malignant lesions,and primary and metastatic tumors.In the appropriately selected patient,the advantages of percutaneous thermal ablation include decreased morbidity,decreased cost,and shorter hospitalization stays compared to surgery.The number of different thermal ablation modalities is increasing,and each modality has its advantages and disadvantages.Studies directly comparing the effectiveness of the various thermal ablation modalities are sparse,however,so the choice of ablation modality often depends on availability,user preference,and local expertise.Although the list of uses for percutaneous thermal ablation is ever-expanding,in this article,we will discuss the two most well-established indications,which are palliation of pain attributed to bone and soft tissue metastases and local control of oligometastatic disease.Numerous clinical trials have shown percutaneous thermal ablation to be an effective method of palliating pain due to bone and soft tissue metastases and of achieving local control in the setting of oligometastatic disease with low rates of complication.展开更多
Metastatic bone disease of the distal extremities,also known as acrometastasis,is very rare.Thus,there is very limited information regarding the clinical manifestations and methods of surgical treatment.The current av...Metastatic bone disease of the distal extremities,also known as acrometastasis,is very rare.Thus,there is very limited information regarding the clinical manifestations and methods of surgical treatment.The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival.As metastatic bone disease is generally uncurable,the goal of surgical treatment is to provide the patient with good function with as few complications as possible.In this article,we discuss the clinical manifestation of acrometastases,the methods of surgical intervention,and the expected clinical outcome.Non-surgically managed pathological fractures generally remain ununited;therefore,conservative treatment is reserved for patients with poor general condition or dismal prognosis.The current evidence suggests that in lesions of the lower arm and leg,osteosynthesis(plate and screw fixation or intramedullary nail)is the most common method of reconstruction,whereas local excision or amputation are more commonly used in cases of more distal lesions(such as ankle,foot and hand).Following surgery most patients receive adjuvant radiotherapy,even though its role is poorly documented.Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome.Further studies are needed in order to provide stronger clinical evidence and improve decision-making,in an effort to optimize the patients’quality of life and avoid the need for revision surgery.展开更多
Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reprod...Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operation. Currently, she is free of disease with no e展开更多
Triple-negative breast cancer(TNBC)is a highly complex,heterogeneous disease and historically has limited treatment options.It has a high probability of disease recurrence and rapid disease progression despite adequat...Triple-negative breast cancer(TNBC)is a highly complex,heterogeneous disease and historically has limited treatment options.It has a high probability of disease recurrence and rapid disease progression despite adequate systemic treatment.Immunotherapy has emerged as an important alternative in the management of this malignancy,showing an impact on progression-free survival and overall survival in selected populations.In this review we focused on immunotherapy and its current relevance in the management of TNBC,including various scenarios(metastatic and early-neoadjuvant,adjuvant-),new advances in this subtype and the research of potential predictive biomarkers of response to treatment.展开更多
Pancreatic neuroendocrine tumors(PNETs)are a rare group of neoplasms originating from the endocrine pancreas.PNETs are classified as functional or non-functional tumors.PNETs are more often diagnosed at a higher stage...Pancreatic neuroendocrine tumors(PNETs)are a rare group of neoplasms originating from the endocrine pancreas.PNETs are classified as functional or non-functional tumors.PNETs are more often diagnosed at a higher stage with distant metastases or advanced locoregional disease.The majority of individuals with hepatic metastases will ultimately die of liver failure;therefore,the treatment of liver tumor burden is critical to providing a survival impact.While surgical resection remains the only chance of cure for disease confined to the pancreas or for locoregional disease,the treatment of advanced or metastatic PNETs is more complex and often requires a multimodal approach.This review focuses on treatment options for well and moderately differentiated PNETs with metastatic disease to the liver.These include surgery,liver-directed therapies including ablative and intra-arterial therapies,and systemic therapies such as somatostatin analogues,targeted therapies,chemotherapy,and peptide receptor radionuclide therapy.Developing an individualized treatment strategy requires careful assessment of liver tumor burden and predicted biological behavior.Aggressive surgical resection of hepatic metastases secondary to PNET primary tumors is associated with improved survival in multiple retrospective studies.General goals of treatment for metastatic disease include prolonging overall survival and progression free survival,improving quality of life,and control of symptoms.展开更多
文摘Pancreatic cancer(PDAC) is an aggressive and chemoresistant disease, representing the fourth cause of cancer related deaths in western countries. Majority of patients have unresectable, locally advanced or metastatic disease at time of diagnosis and the 5-year survival rate in these conditions is extremely low. For more than a decade gemcitabine has been the cornerstone of metastatic PDAC treatment, although survival benefit was very poor. PDAC cells are surrounded by an intense desmoplastic reaction that may create a barrier to the drugs penetration within the tumor. Recently PDAC stroma has been addressed as a potential therapeutic target. Nano albumin bound(Nab)-paclitaxel is an innovative molecule depleting tumor stroma, through interaction between albumin and secreted protein acidic and rich in cysteine. Addition of nab-paclitaxel to gemcitabine has showed activity and efficacy in metastatic PDAC first-line treatment improving survival and overall response rate vs gemcitabine alone in the MPACT phase Ⅲ study. This combination represents one of the standards of care in advanced PDAC therapy and is suitable to a broader spectrum of patients compared to other schedules. Nab-paclitaxel is under investigation as a backbone of chemotherapy in novel combinations with target agents or immunotherapy in locally advanced or metastatic PDAC. In this article, we provide an updated and critical overview about the role of nab-paclitaxel in PDAC treatment based on the latest advances in preclinical and clinical research. Furthermore, we focus on the use of nab-paclitaxel within the context of metastatic PDAC treatment landscape and we discuss about future implications in the light of current clinical ongoing trials.
文摘Uveal melanoma(UM)is the most common primary intraocular cancer in adults.The incidence in Europe and the United States is 6-7 per million population per year.Although most primary UMs can be successfully treated and locally controlled by irradiation therapy or local tumor resection,up to 50%of UM patients develop metastases that usually involve the liver and are fatal within 1 year.To date,chemotherapy and targeted treatments only obtain minimal responses in patients with metastatic UM,which is still characterized by poor prognosis.No standard therapeutic approaches for its prevention or treatment have been established.The application of immunotherapy agents,such as immune checkpoint inhibitors that are effective in cutaneous melanoma,has shown limited effects in the treatment of ocular disease.This is due to UM’s distinct genetics,natural history,and complex interaction with the immune system.Unlike cutaneous melanomas characterized mainly by BRAF or NRAS mutations,UMs are usually triggered by a mutation in GNAQ or GNA11.As a result,more effective immunotherapeutic approaches,such as cancer vaccines,adoptive cell transfer,and other new molecules are currently being studied.In this review,we examine novel immunotherapeutic strategies in clinical and preclinical studies and highlight the latest insight in immunotherapy and the development of tailored treatment of UM.
基金Jacinto Convit World Organization Inc.and Fundación Jacinto Convit。
文摘Breast cancer(BC)is the most common malignant tumor and the main cause of death in women worldwide.With increased knowledge regarding tumor escape mechanisms and advances in immunology,many new antitumor strategies such as nonspecific immunotherapies,monoclonal antibodies,anticancer vaccines,and oncolytic viruses,among others,make immunotherapy a promising approach for the treatment of BC.However,these approaches still require meticulous assessment and readjustment as resistance and modest response rates remain important barriers.In this article,we aim to summarize the most recent data available in BC immunotherapy to include the results of ongoing clinical trials and approved therapies used as monotherapies or in combination with conventional treatments.
文摘Concurrent dural and leptomeningeal metastatic carcinomatosis are very rare and have a poor prognosis. Here we present a woman with advanced estrogen receptor (ER) positive and progesterone receptor (PR) positive breast cancer who presented with leptomeningeal disease. Patient underwent multi targeted epigenetic therapies applied in a protocol called MTET. She continued to respond to the interval treatment, which consisted only of the nutraceutical agents. Here we discuss her case in detail and we believe that such an example might be applied to other patients in this situation resulting clinical improvement and less toxicity.
文摘Due to extremely poor prognosis,pancreatic cancer(PDAC)represents the fourth leading cause of cancerrelated death in Western countries.For more than a decade,gemcitabine(Gem)has been the mainstay of first-line PDAC treatment.Many efforts aimed at improving single-agent Gem efficacy by either combining it with a second cytotoxic/molecularly targeted agent or pharmacokinetic modulation provided disappointing results.Recently,the field of systemic therapy of advanced PDAC is finally moving forward.Polychemotherapy has shown promise over single-agent Gem:regimens like PEFG-PEXG-PDXG and GTX provide significant potential advantages in terms of survival and/or disease control,although sometimes at the cost of poor tolerability.The PRODIGE 4/ACCORD 11 was the first phaseⅢtrial to provide unequivocal benefit using the polychemotherapy regimen FOLFIRINOX;however the less favorable safety profile and the characteristics of the enrolled population,restrict the use of FOLFIRINOX to young and fit PDAC patients.The nanoparticle albumin-bound paclitaxel(nab-Paclitaxel)formulation was developed to overcome resistance due to the desmoplastic stroma surrounding pancreatic cancer cells.Regardless of whether or not this is its main mechanisms of action,the combination of nabPaclitaxel plus Gem showed a statistically and clinically significant survival advantage over single agent Gem and significantly improved all the secondary endpoints.Furthermore,recent findings on maintenance therapy are opening up potential new avenues in the treatment of advanced PDAC,particularly in a new era in which highly effective first-line regimens allow patients to experience prolonged disease control.Here,we provide an overview of recent advances in the systemic treatment of advanced PDAC,mostly focusing on recent findings that have set new standards in metastatic disease.Potential avenues for further development in the metastatic setting and current efforts to integratenew effective chemotherapy regimens in earlier stages of disease(neoadjuvant,adju
文摘Soft tissue sarcomas represent only 1% of all adult cancers;myxofibrosarcoma is the most common type that arises in adult extremities, particularly lower limbs (77%), other less common locations are the trunk (12%) and neck (3%). Usually presenting as a painless, subcutaneous, slow growing mass with tendency for recurrence, they are prone to have higher histological grade and metastatic potential after recurrence;even in optimal multidisciplinary settings patients can have incomplete resections, making metastatic disease more common after misdiagnosis. We present the case of a 69-year-old male patient with a right infraescapular tumor, presenting as a painless 15 × 8 cm, mobile mass, with a slow but progressive growth, history of a previous tumor excised at the same location 5 years prior without histopathological report.
文摘Pancreatic cancer is one of the most deadly cancers and is characterized by a poor prognosis. Single agent gemcitabine, despite its limited activity and modest impact on disease outcome, is considered as the standard therapy in pancreatic cancer. Most of the combination regimens used in the treatment of this disease, also including the targeted agents, did not improve the outcome of patients. Also, taxanes have been tested as single agent and in combination chemotherapy, both in first line and as salvage chemotherapy, as another possible option for treating pancreatic cancer. The inclusion of taxanes in combination with gemcitabine as upfront therapy obtained promising results. Accordingly, taxanes, and above all, new generation taxanes, appear to be suitable candidates for further testing to assess their role against pancreatic cancer in various clinical settings.
文摘Introduction: Metastatic thyroid carcinoma presenting at the initial time of diagnosis is uncommon and the prognosis is unclear. Long term survival rates are variable ranging from 13% to 100%. This case report is presented to illustrate potential management and lend statistical power to future analysis of the correct treatment planning, mortality rates, and prognostic indications for an uncommon presentation of thyroid cancer. Case presentation: This patient is a 63 year old female who presented with new onset of progressive right hip pain. She was treated with a cortisone injection for presumed osteoarthritis but did not improve. Physical exam at the time was pertinent for a body mass index (BMI) of 38.4, mild systolic hypertension, difficulty walking secondary to the right hip pain, limited range of motion at the hip, and fullness of right thyroid gland with no palpable nodules. Laboratory evaluation including thyroid function tests was normal. However, CT and MRI scans revealed a 6.5 cm × 5 cm osteolytic expansive lesion on the right iliac crest with a soft tissue mass. In addition, an enlarged right thyroid lobe and small nodular densities in the lungs suspicious for metastatic disease were noted. A fine needle aspiration of the right ileum revealed metastatic follicular adenocarcinoma consistent with a thyroid primary. The patient was not a surgical candidate due to the extent of disease. She received 37.5 Gy to both the right iliac crest mass and the neck to include the thyroid lesion, followed by iodine-131 ablation and bisphosphonate therapy. Her disease was stable on her last follow up at 48 months. Conclusion: Further studies identifying independent variables such as age of the patient, site and extent of the disease and histology of the tumor are needed to help determine the true prognosis and proper management patients with this presentation. The optimal treatment with potential chance for cure in patients with metastatic thyroid carcinoma has yet to be elucidated.
文摘 Estrium Whey is an alternative nutritional support therapy for women.It’s enhanced with specific nutrients including phytoestrogens,folate,antioxidants and fiber to support healthy estrogen detoxification and hormone balance.We describe the first case of hepatotoxicity due to Estrium Whey in a 51-year old female with metastatic breast cancer with clinical,laboratory and histopathological changes.
文摘Proximal humeral reconstructive options following radical resection of proximal humeral primary and metastatic bone malignancies have evolved over time.With the relatively recent advent of the reverse total shoulder(RTSA),this technique has been increasingly employed in this setting over hemiarthroplasty techniques.An array of options,including proximal humeral allograft-prosthetic composites(including both RTSA and hemiarthroplasty),megaprostheses,and osteoarticular allografts,is reviewed from the perspective of their indications,techniques,complications,and published results.An extensive case-based pictorial presentation illustrates these options.
文摘Background:In stage Ⅳ breast cancer,surgical resection of the primary tumor was traditionally performed solely to palliate symptoms such as bleeding,infection,or pain.The ongoing discussion has shown that there are many research gaps in the current literature and differences in clinical practice.Thus,this systematic review and meta-analysis was designed to evaluate how primary tumor resection(PTR)affects the overall survival(OS)of patients with stage Ⅳ breast cancer.Method:A thorough literature search was completed using different databases(PubMed,Google Scholar,Scopus,ScienceDirect,and Cochrane Library)to find papers contrasting PTR with no PTR.The quality of research articles was evaluated using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale(NOS).Review Manager 5.4 was used to determine how much demographic and clinical factors contribute to heterogeneity through subgroup and meta-regression analysis.Results:Data derived from 44 observational studies(OS)and four randomized controlled trials(RCTs)including 227,889 patients were analyzed.Of all cases,150,239 patients were included in the non-PTR group,and 70,795 patients in the PTR group(37 observational studies and 4 randomized control trials).The pooled outcomes of four RCT studies(Hazard Ratio(HR)=1.03,95%CI:0.67-1.58;I2=88%;P<0.0001;chi-square 24.57)favor non-PTR.While pooled outcomes of 43 observational studies showed PTR significantly improved OS(HR=0.66,95%CI:0.61-0.71;I2=87%;P<0.00001;chi-square 359.12).Additionally,subgroup analysis that compared PTR with non-PTR in patients with stage IV breast cancer for progression free-survival(HR=0.89,95%CI:0.62-1.28;P=0.03;I2=71%)and locoregional progression-free survival(LPFS)(HR=0.33,95%CI:0.14-0.74;P=0.0004;I^(2)=87%)was found to be significant favoring the PTR group.Distant progression-free survival(DPFS)had a non-significant relationship(HR=0.42,95%CI:0.29-0.60;P=0.12;I^(2)=53%),while overall,there was a significant relationship(HR=0.49,95%CI:0.32-0.75;P<0.00001;I2=90%).Subgroup analysis
文摘A variety of indications have been published regarding the use of percutaneous thermal ablation for treating tumors of the musculoskeletal system,including bone and soft tissue lesions,benign and malignant lesions,and primary and metastatic tumors.In the appropriately selected patient,the advantages of percutaneous thermal ablation include decreased morbidity,decreased cost,and shorter hospitalization stays compared to surgery.The number of different thermal ablation modalities is increasing,and each modality has its advantages and disadvantages.Studies directly comparing the effectiveness of the various thermal ablation modalities are sparse,however,so the choice of ablation modality often depends on availability,user preference,and local expertise.Although the list of uses for percutaneous thermal ablation is ever-expanding,in this article,we will discuss the two most well-established indications,which are palliation of pain attributed to bone and soft tissue metastases and local control of oligometastatic disease.Numerous clinical trials have shown percutaneous thermal ablation to be an effective method of palliating pain due to bone and soft tissue metastases and of achieving local control in the setting of oligometastatic disease with low rates of complication.
文摘Metastatic bone disease of the distal extremities,also known as acrometastasis,is very rare.Thus,there is very limited information regarding the clinical manifestations and methods of surgical treatment.The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival.As metastatic bone disease is generally uncurable,the goal of surgical treatment is to provide the patient with good function with as few complications as possible.In this article,we discuss the clinical manifestation of acrometastases,the methods of surgical intervention,and the expected clinical outcome.Non-surgically managed pathological fractures generally remain ununited;therefore,conservative treatment is reserved for patients with poor general condition or dismal prognosis.The current evidence suggests that in lesions of the lower arm and leg,osteosynthesis(plate and screw fixation or intramedullary nail)is the most common method of reconstruction,whereas local excision or amputation are more commonly used in cases of more distal lesions(such as ankle,foot and hand).Following surgery most patients receive adjuvant radiotherapy,even though its role is poorly documented.Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome.Further studies are needed in order to provide stronger clinical evidence and improve decision-making,in an effort to optimize the patients’quality of life and avoid the need for revision surgery.
文摘Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operation. Currently, she is free of disease with no e
文摘Triple-negative breast cancer(TNBC)is a highly complex,heterogeneous disease and historically has limited treatment options.It has a high probability of disease recurrence and rapid disease progression despite adequate systemic treatment.Immunotherapy has emerged as an important alternative in the management of this malignancy,showing an impact on progression-free survival and overall survival in selected populations.In this review we focused on immunotherapy and its current relevance in the management of TNBC,including various scenarios(metastatic and early-neoadjuvant,adjuvant-),new advances in this subtype and the research of potential predictive biomarkers of response to treatment.
文摘Pancreatic neuroendocrine tumors(PNETs)are a rare group of neoplasms originating from the endocrine pancreas.PNETs are classified as functional or non-functional tumors.PNETs are more often diagnosed at a higher stage with distant metastases or advanced locoregional disease.The majority of individuals with hepatic metastases will ultimately die of liver failure;therefore,the treatment of liver tumor burden is critical to providing a survival impact.While surgical resection remains the only chance of cure for disease confined to the pancreas or for locoregional disease,the treatment of advanced or metastatic PNETs is more complex and often requires a multimodal approach.This review focuses on treatment options for well and moderately differentiated PNETs with metastatic disease to the liver.These include surgery,liver-directed therapies including ablative and intra-arterial therapies,and systemic therapies such as somatostatin analogues,targeted therapies,chemotherapy,and peptide receptor radionuclide therapy.Developing an individualized treatment strategy requires careful assessment of liver tumor burden and predicted biological behavior.Aggressive surgical resection of hepatic metastases secondary to PNET primary tumors is associated with improved survival in multiple retrospective studies.General goals of treatment for metastatic disease include prolonging overall survival and progression free survival,improving quality of life,and control of symptoms.
