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Hou L, Han W, Jin J, Chen X, Zou Y, Yan L, He J, Bu H. Clinical efficacy and safety of different doses of intrathecal methotrexate in the treatment of leptomeningeal carcinomatosis: a prospective and single-arm study. Jpn J Clin Oncol 2021; 51:1715-1722. [PMID: 34585252 DOI: 10.1093/jjco/hyab155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/14/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the clinical efficacy and safety of different doses of intrathecal methotrexate in the treatment of leptomeningeal carcinomatosis. METHODS 53 patients admitted to the Second Hospital of Hebei Medical University with leptomeningeal carcinomatosis were recruited. They were divided into two groups: 15-mg-group received 15 mg methotrexate intrathecally, while the other received 10 mg methotrexate. All patients were followed up to 31 December 2020 or until death. Primary endpoint was the response rate. Secondary endpoints were survival and safety. Treatment-related adverse events were recorded. RESULTS The intrathecal chemotherapy was regularly maintained in 42 cases. Most primary cancers were lung (60.4%), stomach (18.9%) or breast (5.7%). The clinical response rate was higher in the 15 mg group than the 10 mg group (62.5 vs. 34.5%, P = 0.042). In the 15 mg group, two cases showed myelosuppression and one case showed seizures. In the 10 mg group, one patient appeared fever, three patients appeared myelosuppression and one showed leukoencephalopathy. However, there were no serious irreversible adverse reactions in neither of the two groups. In terms of survival, the median survival was 15.7 weeks in the 15 mg group and 27.1 weeks in the 10 mg group (P = 0.116). Multivariate analysis showed that only targeted therapy improved the survival (P < 0.0001, HR = 5.386). CONCLUSION Increased dose of methotrexate did not prolong the overall survival, but it was more effective in relieving clinical symptoms with no increased adverse reactions. Targeted therapy might improve the survival.
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Affiliation(s)
- Lan Hou
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Weixin Han
- Department of Neurology, Hebei Chest Hospital, Shijiazhuang, China
| | - Jie Jin
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Xin Chen
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Yueli Zou
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Litian Yan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Junying He
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Hui Bu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
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A comprehensive analysis of adult patients with secondary hemophagocytic lymphohistiocytosis: a prospective cohort study. Ann Hematol 2020; 99:2095-2104. [PMID: 32440790 DOI: 10.1007/s00277-020-04083-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Secondary hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal condition with various underlying disorders in adult patients and is diagnosed based on the HLH-2004 criteria, which were established based on experience in pediatric patients. However, few studies have prospectively evaluated the treatment outcomes and diagnostic performance of HLH criteria in adult patients with secondary HLH. Thus, we performed a single-center, prospective cohort study of adult patients with suspected HLH, and we analyzed treatment outcomes of patients enrolled between 2017 and 2019 as an interim analysis ( ClinicalTrials.gov Identifier: NCT03117010). Of the 73 patients with suspected HLH, 70 patients completed the evaluation for ≥ 7 of the HLH-2004 criteria, and 55 patients were diagnosed with HLH (55/73, 75%). Although serum ferritin and fever had a sensitivity of more than 90%, both had exceptionally low specificity, whereas soluble CD25 had a sensitivity of more than 90% and specificity of 80%. Forty patients with malignancy-associated HLH had B cell (n = 19) or T- or NK-cell (n = 21) lymphoid malignancy, whereas 15 patients had non-malignant disorders. Non-malignancy-associated HLH had greater than 90% 1-year overall survival (OS) after diagnosis of HLH, whereas that for malignancy-associated HLH was less than 40%. In conclusion, our study showed promising treatment outcomes for patients enrolled in our prospective cohort study, and prospectively demonstrated the diagnostic performance of the HLH-2004 criteria in adult patients with suspected HLH. Given that lymphoma was the most common cause of HLH in adults, thorough evaluation for lymphoma should be performed in adults with suspected HLH.
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Brault C, Marc J, Delette C, Gruson B, Marolleau JP, Maizel J, Zerbib Y. L’effetWarburg, un challenge diagnostique pour le médecin réanimateur. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’effetWarburg (EW) est une complication rare des cancers solides et des hémopathies malignes. Il est lié à une dérégulation du métabolisme glucidique au sein des cellules cancéreuses, entraînant la dégradation du glucose en lactate. Elle s’accompagne d’hypoglycémies asymptomatiques et d’une accumulation de lactate responsable d’une acidose lactique de type B. Dans cet article, nous proposons un algorithme pour aider le clinicien à diagnostiquer l’EW et discutons des thérapeutiques à envisager.
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De Potter B, Huyskens J, Hiddinga B, Spinhoven M, Janssens A, van Meerbeeck JP, Parizel PM, Snoeckx A. Imaging of urgencies and emergencies in the lung cancer patient. Insights Imaging 2018; 9:463-476. [PMID: 29644546 PMCID: PMC6108967 DOI: 10.1007/s13244-018-0605-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 12/15/2022] Open
Abstract
Lung cancer patients often experience potentially life-threatening medical urgencies and emergencies, which may be a direct or indirect result of the underlying malignancy. This pictorial review addresses the most common thoracic, neurological and musculoskeletal medical emergencies in lung cancer patients, including superior vena cava syndrome, pulmonary embolism, spontaneous pneumothorax, cardiac tamponade, massive haemoptysis, central airway obstruction, oesophagorespiratory fistula, malignant spinal cord compression, carcinomatous meningitis, cerebral herniation and pathological fracture. Emphasis is placed on imaging findings, the role of different imaging techniques and a brief discussion of epidemiology, pathophysiology and therapeutic options. Since early diagnosis is important for adequate patient management and prognosis, radiologists have a crucial role in recognising and communicating these urgencies and emergencies. TEACHING POINTS • Multiplanar multidetector computed tomography is the imaging examination of choice for thoracic urgencies and emergencies. • Magnetic resonance imaging is the imaging modality of choice for investigating central nervous system emergencies. • Urgencies and emergencies can be the initial manifestation of lung cancer. • Radiologists have a crucial role in recognising and in communicating these urgencies/emergencies.
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Affiliation(s)
- Bruno De Potter
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Jef Huyskens
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Birgitta Hiddinga
- Department of Thoracic Oncology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
- Department of Thoracic Oncology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Maarten Spinhoven
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Annelies Janssens
- Department of Thoracic Oncology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Thoracic Oncology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Annemie Snoeckx
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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Wu X, Li J, Xiao J, Yang B, Yu L, Wu X, Wan J, Xu H, Kong J. [Efficacy and Security of Intrathecal with Methotrexate in the Treatment of Meningeal Carcinomatosis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:252-6. [PMID: 27215452 PMCID: PMC5973059 DOI: 10.3779/j.issn.1009-3419.2016.05.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
背景与目的 脑膜癌病是中枢神经系统转移瘤的一种少见类型。近年来,随着恶性肿瘤治疗疗效的提高,患者生存期延长,脑膜癌病的发病率逐年增加,目前尚缺乏有效的治疗手段。本研究旨在探讨鞘内注射甲氨蝶呤(methotrexate, MTX)治疗脑膜转移的疗效、安全性和预后。 方法 对27例脑膜转移患者的临床资料、脑脊液实验室检查进行回顾性分析,并分析鞘注化疗后的不良反应及预后。 结果 27例脑膜转移患者接受鞘注化疗后,70.4%获得临床症状缓解,但脑脊液压力和脑脊液生化改变无统计学差异。55.6%患者无不适,25.9%出现下肢麻木、轻微疼痛,无严重不可逆的不良反应发生。本组患者中位生存期4个月。 结论 鞘内注射MTX可改善脑膜癌病患者临床症状,无严重不良反应发生。
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Affiliation(s)
- Xi Wu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Junling Li
- Internal Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Jianping Xiao
- Radiotherapy Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Boyan Yang
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Lei Yu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Xiaoming Wu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Jinghai Wan
- Neurosurgery Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Haiyan Xu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Jianxin Kong
- Neurosurgery Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
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