sábado, 29 de junio de 2013
Palliative Care Consultation, Quality-of-Life Measurements, and Bereavement for End-of-Life Care in Patients With Lung Cancer
Objective: To develop clinical practice guidelines for application of palliative care consultation,
quality-of-life measurements, and appropriate bereavement activities for patients with lung
cancer.
Methods: To review the pertinent medical literature on palliative care consultation, quality-of-life measurements, and bereavement for patients with lung cancer, developing multidisciplinary
discussions with authorities in these areas, and evolving written guidelines for end-of-life care of
these patients.
Results: Palliative care consultation has developed into a new specialty with credentialing of
experts in this field based on extensive experience with patients in end-of-life circumstances
including those with lung cancer. Bereavement studies of the physical and emotional morbidity
of family members and caregivers before, during, and after the death of a cancer patient have
supported truthful communication, consideration of psychological problems, effective palliative
care, understanding of the patient’s spiritual and cultural background, and sufficient forewarning
of impending death.
Conclusion: Multidisciplinary investigations and experiences, with emphasis on consultation and
delivery of palliative care, timely use of quality-of-life measurements for
morbidities of treatment
modalities and prognosis, and an understanding of the multifaceted complexities of the bereavement
process, have clarified additional responsibilities of the attending physician.
(CHEST 2007; 132:404S–422S)
Foto Propiedad David Muñoz Carmona© si usas la foto comenta la fuente
quality-of-life measurements, and appropriate bereavement activities for patients with lung
cancer.
Methods: To review the pertinent medical literature on palliative care consultation, quality-of-life measurements, and bereavement for patients with lung cancer, developing multidisciplinary
discussions with authorities in these areas, and evolving written guidelines for end-of-life care of
these patients.
Results: Palliative care consultation has developed into a new specialty with credentialing of
experts in this field based on extensive experience with patients in end-of-life circumstances
of family members and caregivers before, during, and after the death of a cancer patient have
supported truthful communication, consideration of psychological problems, effective palliative
care, understanding of the patient’s spiritual and cultural background, and sufficient forewarning
of impending death.
Conclusion: Multidisciplinary investigations and experiences, with emphasis on consultation and
delivery of palliative care, timely use of quality-of-life measurements for
morbidities of treatment
modalities and prognosis, and an understanding of the multifaceted complexities of the bereavement
process, have clarified additional responsibilities of the attending physician.
(CHEST 2007; 132:404S–422S)
Foto Propiedad David Muñoz Carmona© si usas la foto comenta la fuente
lunes, 17 de junio de 2013
Hypofractionation for prostate cancer: a critical review.
Semin Radiat Oncol. 2008 Jan;18(1):41-7.
EF, Lee WR.
Source
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA.
Abstract
In ideal circumstances, the fractionation schedule of radiotherapy should match the fractionation sensitivity of the tumor relative to the nearby normal tissues. A number of recent publications have suggested that the alpha-beta ratio (alpha/beta) for prostate is low, in the range of 1 to 3 Gy. If alpha/beta is truly low, then hypofractionated schedules using fewer, larger fractions should improve the therapeutic ratio. This critical review examines the clinical experience with hypofractionation. Several prospective trials indicate that toxicity is limited with sophisticated dose delivery and compact clinical target volume to planning target volume margins, but the single-arm nature of these trials precludes definitive statements on efficacy. Several large randomized trials comparing conventional fractionation to hypofractionation are ongoing and are described. Until these trials are completed and the results submitted for rigorous peer review, the notion that alpha/beta for prostate cancer is low remains an unconfirmed hypothesis.
Hypofractionation for clinically localized prostate cancer
Semin Radiat Oncol. 2013 Jul;23(3):191-7. doi: 10.1016/j.semradonc.2013.01.005.
Source
Department of Radiation Oncology, Duke Cancer Institute, Durham, NC. Electronic address: alvin.cabrera@duke.edu.
Abstract
This manuscript reviews the clinical evidence for hypofractionation in prostate cancer, focusing on data from prospective trials. For the purposes of this manuscript, we categorize hypofractionation as moderate (2.4-4 Gy per fraction) or extreme (6.5-10 Gy per fraction). Five randomized controlled trials have evaluated moderate hypofractionation in >1500 men, with most followed for >4-5 years. The results of these randomized trials are inconsistent. No randomized trials or other rigorous comparisons of extreme hypofractionation with conventional fractionation have been reported. Prospective single-arm studies of extreme hypofractionation appear favorable, but small sample sizes preclude precise estimates of efficacy and short follow-up prevents complication estimates beyond 3-5 years. Over the next several years, the results of 3 large noninferiority trials of moderate hypofractionation and 2 randomized trials of extreme hypofractionation should help clarify the role of hypofractionation in prostate cancer therapy.
jueves, 13 de junio de 2013
ASCO: Heat Shock Protein 90 Inhibitor Shows Promise in NSCLC
Results from the GALAXY-1 trial showed that the novel second-generation heat shock protein 90 (HSP90) inhibitor ganetespib could potentially improve survival in patients with advanced-stage non–small-cell lung cancer (NSCLC).
Suresh S. Ramalingam, MD, of Emory University’s Winship Cancer Institute in Atlanta, presented results at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago. He said that the HSP family of inhibitors are “important chaperone proteins for several key cellular oncogenic proteins.” Inhibiting HSP90 could inhibit proteins that are key to NSCLC’s development; in previous work, ganetespib has shown single agent activity and has been well tolerated as both monotherapy and in combination with docetaxel(Drug information on docetaxel).
In the GALAXY-1 trial, 252 patients were randomized to either a combination of ganetespib and docetaxel or docetaxel alone. Initially, the trial included both adenocarcinoma and non-adenocarcinoma patients, but after 72 of the latter were enrolled, the investigators saw a signal for lack of efficacy and amended the trial to include only adenocarcinoma. The analysis presented at ASCO included 125 patients in the combination group and 127 in the docetaxel alone arm.
The median progression-free survival was 4.5 months in the combination group and 3.2 months in the monotherapy group, for a hazard ratio of 0.84 (90% CI, 0.65–1.07; P = .038). Overall survival was 9.8 months and 7.4 months for the two groups, respectively (HR = 0.82; 90% CI, 0.62–1.09; P = .082).
Patients were stratified by either less than or more than 6 months from diagnosis of advanced disease, and subgroup analysis suggested that those diagnosed more than 6 months prior to treatment were “deriving the robust benefit,” said Dr. Ramalingam. Progression-free survival in just those patients was 5.4 months for the combination group and 3.4 months for the monotherapy group (P = .0041), and overall survival was 10.7 months and 6.4 months, respectively (P = .0093).
“The observed improvement in survival at this point does not appear to be associated with EGFR or KRAS mutational status,” said Dr. Ramalingam. He noted that GALAXY-2, a phase III trial of the therapy in patients with diagnosis at least 6 months earlier, is ongoing.
Natasha B. Leighl, MD, of Princess Margaret Cancer Centre in Toronto, commented on the study and agreed that “HSP90 is a very interesting target in lung cancer.” She noted that it was somewhat surprising to see no treatment-related deaths in the study, and no increase in the number of patients that needed to stop therapy because of adverse events in the combination arm.
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