27 research outputs found
Tracheobronchial obstruction: Follow-up study of 100 children treated with airway stenting
No full textOBJECTIVE: We described a cohort of 100 children with a wide variety of airway obstruction who underwent stent positioning in the last 7 years. The study examined the outcomes of this treatment in the largest series of paediatric patients reported in the literature with special concern over safety and clinical effectiveness. METHODS: We performed a retrospective analysis of 100 consecutive paediatric patients who underwent stent insertions between January 2005 and May 2012. Statistical analysis was performed and exact likelihood was used. RESULTS: A total of 235 stents were placed for severe airway obstruction. One hundred and twelve silicone stents (cylinder, hourglass or Y-shaped), 120 metallic stents (covered Nitinol stents, expandable coronary and vascular stents) and 3 biodegradable polydioxanone (PDS) stents were used. Eighty patients presented clinical improvement after stent insertion, 17 were weaned off mechanical ventilation and 3 showed no significant clinical improvement [95% confidence interval (CI) 0.1-8.0%]. Complications were different according to stent type. In our cohort, no fatal stent-related complications have been observed. At follow-up (median 41.4 months, range 1.1-145.4) complete resolution was registered for 60 patients (66%; 95% CI 55-76%), 17 are still under treatment, 9 were lost to follow-up, 8 underwent surgery and 6 died of causes not stent related. CONCLUSION: Airway stenting represents a conservative treatment before more invasive surgical procedures and can be very effective when performed in selected children and in specialized centres by physicians experienced in rigid and flexible bronchoscopy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved
Prevalence and impact of COVID-19 sequelae on treatment pathways and survival of patients with cancer who recovered from SARS-Cov-2 infection: results from the OnCovid registry.
No full textretrospective, registry study David J Pinato, Josep Tabernero, Mark Bower, Lorenza Scotti, Meera Patel, Emeline Colomba, Saoirse Dolly, Angela Loizidou, John Chester, Uma Mukherjee, Alberto Zambelli, Alessia Dalla Pria, Juan Aguilar-Company, Diego Ottaviani, Amani Chowdhury, Eve Merry, Ramon Salazar, Alexia Bertuzzi, Joan Brunet, Matteo Lambertini, Marco Tagliamento, Anna Pous, Ailsa Sita-Lumsden, Krishnie Srikandarajah, Johann Colomba, Fanny Pommeret, Elia Segui, Daniele Generali, Salvatore Grisanti, Paolo Pedrazzoli, Gianpiero Rizzo, Michela Libertini, Charlotte Moss, Joanne S Evans, Beth Russell, Nadia Harbeck, Bruno Vincenzi, Federica Biello, Rossella Bertulli, Raquel Lilian, Sabrina Rossi, Maria Carmen Carmona-Garcia, Carlo Tondini, Laura Fox, Alice Baggi, Vittoria Fotia, Alessandro Parisi, Giampero Porzio, Maristella Saponara, Claudia Andrea Cruz, David Garcia-Illescas, Eudald Felip, Ariadna Roque Lloveras, Rachel Sharkey, Elisa Roldan, Roxana Reyes, Irina Earnshaw, Daniela Ferrante, Javier Marco-Hernandez, Isabel Ruiz-Camps, Gianluca Gaidano, Andrea Patriarca, Riccardo Bruna, Anna Sureda, Clara Martinez-Vila, Ana Sanchez de Torre, Luca Cantini, Marco Filetti, Lorenza Rimassa, Lorenzo Chiudinelli, Michela Franchi, Marco Krengli, Armando Santoro, Aleix Prat, Mieke Van Hemelrijck, Nikolaos Diamantis, Thomas Newsom-Davis, Alessandra Gennari, Alessio Cortellini, on behalf of the OnCovid study group
Oncological treatment administration at end of life: a retrospective study
No full textBackground: This work evaluated the proportion of patients who continue therapy until their last month of life or initiate a new therapy in the last 3 months of life (end of life [EOL]). Methods: Data for 486 patients were retrospectively collected. Results: In EOL, 205 (42.3%) received systemic therapy. Better performance status (last month OR: 0.39; 95% CI: 0.25-0.60; p < 0.001; last 3 months OR: 0.47; 95% CI: 0.34-0.65; p < 0.001) and lack of activation of palliative care (last month OR: 0.26; 95% CI: 0.13-0.54; p < 0.001; last 3 months OR: 0.18; 95% CI: 0.10-0.32; p < 0.001) were associated with higher probability of EOL therapy. Conclusion: A non-negligible proportion of patients in real-life settings continue to receive systemic treatment in EOL
Progression of vertebral fractures in metastatic melanoma and non-small cell lung cancer patients given immune checkpoint inhibitors
No full textIntroduction: The immune system mediates important effects on bone metabolism, but little has been done to understand immunotherapy's role in this interaction. This study aims to describe and identify risk factors for the occurrence and/or exacerbation of vertebral fractures (vertebral fracture progression) during immune checkpoint inhibitors (ICIs). Methods: We conducted an observational, retrospective, monocentric study. We collected data on melanoma and NSCLC patients, treated with first-line ICIs at the Medical Oncology Department ASST Spedali Civili of Brescia, between January 2015 and November 2021, and with a median follow-up of 20.1 (6-36) months. We collected data on patients, diseases, immune-related adverse events, and cortico-steroid therapy initiated on concomitant ICIs. Results: We identified 135 patients, 65 (48.2 %) with locally advanced/metastatic melanoma and 70 (51.8 %) with locally advanced/metastatic non-small cell lung cancer (NSCLC). Twenty-one (15.6 %) patients already had an asymptomatic vertebral fracture at baseline before starting ICIs in monotherapy. A total of ten patients, or 7.4 %, had a vertebra fracture progression defined as a new vertebral fracture or a worsening of a previous fracture. There was a strong relation between the steroid therapy and irAEs with vertebra fracture progression [OR (95 % CI) 8.1 (3.7-17.8) p-value < 0.0011 in univariable analysis. However, only steroid therapy resulted to be an independent risk factor [8.260 (95 % CI 0.909-75.095); p-value 0.0611 at the multivariable analysis. Conclusion: Concurrent steroid therapy in patients receiving immunotherapy exposes them to a high risk of fractures due to skeletal fragility. The use of bone resorption inhibitors should be considered in these patients to prevent these adverse events
Prognostic and predictive value of histogram analysis in patients with non-small cell lung cancer refractory to platinum treated by nivolumab: A multicentre retrospective study
No full textPurpose: The aim of this study was to assess computed-tomography histogram analysis (CTHA) as prognostic and predictive factor in platinum-refractory non-small cell lung carcinoma (NSCLC) treated with immune checkpoint inhibitor Nivolumab.Method: One hundred and four patients were enrolled from 3 different centers. CT was performed using similar parameters among different scanners. CTHA was performed with the proprietary software TexRAD, which extracts histogram features at different spatial scale (spatial scale filters, SSF) producing 30 CTHA features per patients. Cross-validated Least Absolute Shrinkage and Selection Operator LASSO was used to select those features which were related to overall and progression-free survival (OS and PFS, respectively). High- and low-risk subgroups were identified using the best cutoff.Results: Median follow-up was 13.8 weeks. Median OS and PFS were 7.3 and 3 months, respectively. LASSO selected kurtosis obtained by SSF = 4 mm as the single feature related to OS, leading to an hazard ratio (HR) of 0.476 (95%CI 0.29-0.77). PFS was related with kurtosis SSF = 6 mm, with HR of 0.556 (95%CI 0.36-0.86).Conclusion: Despite its limitations, this study is the first which suggests that CTHA could play a role in stratifying prognosis and treatment response in patients with NSCLC treated with Nivolumab
High Prevalence and Early Occurrence of Skeletal Complications in EGFR Mutated NSCLC Patients With Bone Metastases
No full textObjectivesThe prevalence of Skeletal Related Adverse Events (SREs) in EGFR mutated non-small cell lung cancer (NSCLC) patients with bone metastases, treated with modern tyrosine kinase inhibitors (TKIs), has been scarcely investigated.Materials and MethodsWe retrospectively evaluated the data of EGFR mutated NSCLC patients with bone metastases treated with TKIs in 12 Italian centers from 2014 to 2019, with the primary aim to explore type and frequency of SREs.ResultsSeventy-seven out of 274 patients enrolled (28%) developed at least one major SRE: 55/274 (20%) bone fractures, 30/274 (11%) spinal cord compression, 5/274 (2%) hypercalcemia. Median time to the onset of SRE was 3.63 months. Nine patients (3%) underwent bone surgery and 150 (55%) radiation therapy on bone. SREs were more frequently observed within the 12 months from TKI start than afterwards (71 vs 29%, p 0.000). Patient Performance Status and liver metastases where independently associated with the risk of developing SREs. Median TKI exposure and overall survival were 11 and 28 months, respectively. Bone resorption inhibitors were associated with a lower risk of death (HR 0.722, 95% CI: 0.504-1.033, p = 0.075) although not statistically significant at multivariate analysis.ConclusionBone metastatic NSCLC patients with EGFR mutated disease, treated with EGFR TKIs, have a relatively long survival expectancy and are at high risk to develop SREs. The early SRE occurrence after the TKI start provides the rationale to administer bone resorption inhibitors
Corrigendum to "Real world data of cemiplimab in locally advanced and metastatic cutaneous squamous cell carcinoma" [Eur J Canc 157 (2021) 250-258]
No full textbackground: cutaneous squamous cell carcinoma (cSCC) has an overall favourable outcome, except for patients with an advanced stage disease. the programmed death protein-1 (PD-1) inhibitor cemiplimab has been approved for use in advanced cSCC. we report clinical outcomes from the named patient programme-compassionate use of cemiplimab for patients with advanced cSCC in italy. methods: this is a retrospective, observational, multicentre study. we analysed medical records of patients with advanced cSCC treated with cemiplimab between may 2019 and february 2020 in 17 referral italian centres. we assessed the safety profile according to the common terminology criteria for ddverse events, version 5.0 (CTCAE v 5.0), the clinical activity in terms of response rate, clinical benefit and duration of response and baseline clinical-pathologic characteristics associated with response. results: 131 patients were included, with a median age of 79 years. of them, 9.2% had a concurrent chronic lymphoproliferative disease and 8.5% a concomitant autoimmune disease. some 42.7% of the total patients had at least one treatment-related adverse events (AEs); out of above, 9.2% had grade 3-4 adverse events, and there were two fatal adverse events. the overall response rate (ORR) was 58%, and the disease control rate (DCR) was 71.7%. cutaneous squamous cell carcinomas (cSCCs) arising on the head and neck area (p = 0.007) and haemoglobin values in normal range (p = 0.034) were significantly associated with a better response, while cSCCs on the genitalia (p = 0.041), treatment with any systemic antibiotic within 1 month of cemiplimab initiation (p = 0.012), performance status >1 (p = 0.012), chronic corticosteroids therapy (p = 0.038), previous radiation therapy to lymph nodes (p = 0.052) and previous chemotherapy (p = 0.0020) were significantly associated with a worse response. Conclusions: Our real-world study showed safety and effectiveness results comparable to those obtained in clinical trials. we identified some clinical and biochemical factors potentially associated with response to cemiplimab. (c
Uso da plataforma Moodle como ferramenta de apoio para a criação de uma monitoria virtual de física
No full textTCC (graduação) - Universidade Federal de Santa Catarina, Campus Araranguá, Curso de Tecnologias da Informação e Comunicação.O presente trabalho tem como objetivo principal a criação de uma monitoria virtual no ambiente virtual de aprendizagem Moodle, que permita ao professor de Física “C” da Universidade Federal de Santa Catarina (UFSC), Campus Araranguá, trabalhar de forma conjunta com seus monitores. Elaborou-se uma proposta de ações a serem realizadas em parceria com o professor e a monitora da disciplina, a fim de minimizar os índices de reprovação ou evasão dos alunos da disciplina de Física C decorrentes da falta de conhecimento de conteúdos. Para tanto, a pesquisa explora sobre a educação a distância, o uso das tecnologias de informação e comunicação na educação, ambiente virtual de aprendizagem, bem como levanta aspectos gerais sobre o Moodle. A proposta foi aplicada no semestre de 2012/2, com uma turma de 56 alunos dos cursos de engenharia de energia e engenharia da computação. Nesta pesquisa foi adotada uma abordagem qualitativa. A técnica utilizada para coleta de dados foi a aplicação de questionários disponibilizados uma parte no Moodle do Laboratório de Experimentação Remota (RExLab) e outra parte encaminhados por email. Por fim, os resultados da pesquisa demonstraram que a criação de uma Monitoria Virtual como apoio ao estudo complementar a disciplina de Física C, apresentou algumas dificuldades na sua aplicação, pelo fato de ter sido implementada parcialmente ao longo do semestre, devido a greve dos docentes e servidores, muitos alunos não acreditaram na proposta e não freqüentaram a monitoria virtual.This work has as main objective the creation of a virtual tutoring in the environment Moodle virtual learning, enabling the Professor of Physics "C" of the Federal University of Santa Catarina (UFSC), Campus Araranguá, working jointly with their monitors. We developed a proposal for actions to be undertaken in partnership with the teacher monitors and discipline in order to minimize failure rates and dropout of students of Physics C due to lack of content knowledge. Therefore, the research explores on distance education, the use of information and communication technologies in education, virtual learning environment, and raises general issues about Moodle. The proposal was applied in the first half of 2012/2, with a class of 56 students of power engineering and computer engineering. This research adopted a qualitative approach. The technique used for data collection was the use of questionnaires available in Moodle part of the Laboratory for Remote Experimentation (RExLab) and elsewhere forwarded by email. Finally, the results of the research showed that the creation of a Virtual Monitoring and support further study the discipline of Physics C, presented some difficulties in its implementation, because it has been partially implemented during the semester due to teachers' strike and servers, many students did not believe in the proposal and did not attend virtual tutoring
Corrigendum: “Real world data of cemiplimab in locally advanced and metastatic cutaneous squamous cell carcinoma” (European Journal of Cancer (2021) 157 (250–258), (S0959804921005360), (10.1016/j.ejca.2021.08.018))
No full textThe authors regret that some Author information was incorrectly given in the published article. Author Manuel Zamparini was missed in the Author list, and the listed affiliation for Paola Queirolo was incorrect. The full and correct details for the Authors are: Paola Queirolo Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy Manuel Zamparini University of Brescia, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, ASST-Spedali Civili, Brescia, Lombardia, ItalyThe Authors also note that values in the first column of Table 4 were mistakenly reversed for ‘Antibiotic intake (within 1 month before therapy)’ and ‘Haemoglobin’. The correct table in full is given here
Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma: A Systematic Review and Meta-Analysis
No full textMany clinical trials have investigated the role of ICIs in PM, with contrasting results. We performed a systematic review and meta-analysis of clinical trials testing single-agent anti-Programmed Death -1 (PD-1)/Programmed Death-Ligand 1 (PD-L1), anti-Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) or combined treatment in PM patients, analyzing response and survival rate as well as safety data. We selected 17 studies including 2328 patients. Both OS and PFS rates were significantly higher with combined ICI treatments than with single agent anti-PD-1/PD-L1 (p < 0.001 and p = 0.006, respectively) or anti CTLA-4 (p < 0.001) treatments. ORR and DCR for all ICI treatments were 20% (95% CI 13–27%) and 56% (95% CI 45–67%), respectively, and they did not significantly differ between combined and single agent treatments (p = 0.088 and p = 0.058, respectively). The 12-month OS and 6-month PFS rates did not differ significantly (p = 0.0545 and p = 0.1464, respectively) among pre-treated or untreated patients. Combined ICI treatments had a significantly higher rate of Adverse Events (AEs) (p = 0.01). PD-L1-positive patients had a higher probability of response and survival. In conclusion, combined ICI treatments have higher efficacy than single agents but are limited by higher toxicity. Efficacy was independent of treatment line, so a customized sequential strategy should still be speculated. PD-L1 expression could influence response to ICIs; however, reliable biomarkers are warranted
