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Poole D, Pisa A, Fumagalli R. Prone position for acute respiratory distress syndrome and the hazards of meta-analysis. Pulmonology 2023:S2531-0437(23)00009-0. [PMID: 36907814 PMCID: PMC9874051 DOI: 10.1016/j.pulmoe.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/17/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Researchers have tried unsuccessfully for many years using randomized controlled trials to show the efficacy of prone ventilation in treating ARDS. These failed attempts were of use in designing the successful PROSEVA trial, published in 2013. However, the evidence provided by meta-analyses in support of prone ventilation for ARDS was too low to be conclusive. The present study shows that meta-analysis is indeed not the best approach for the assessment of evidence as to the efficacy of prone ventilation. METHODS We performed a cumulative meta-analysis to prove that only the PROSEVA trial, due to its strong protective effect, has substantially impacted on the outcome. We also replicated nine published meta-analyses including the PROSEVA trial. We performed leave-one-out analyses, removing one trial at a time from each meta-analysis, measuring p values for effect size, and also the Cochran's Q test for heterogeneity assessment. We represented these analyses in a scatter plot to identify outlier studies influencing heterogeneity or overall effect size. We used interaction tests to formally identify and evaluate differences with the PROSEVA trial. RESULTS The positive effect of the PROSEVA trial accounted for most of the heterogeneity and for the reduction of overall effect size in the meta-analyses. The interaction tests we conducted on the nine meta-analyses formally confirmed the difference in the effectiveness of prone ventilation between the PROSEVA trial the other studies. CONCLUSIONS The clinical lack of homogeneity between the PROSEVA trial design and the other studies should have discouraged the use of meta-analysis. Statistical considerations support this hypothesis, suggesting that the PROSEVA trial is an independent source of evidence.
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Affiliation(s)
- D Poole
- Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy.
| | - A Pisa
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan, Italy
| | - R Fumagalli
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan, Italy; Department of Anesthesia and Intensive Care, Niguarda Hospital, Milan, Italy
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Font R, Espinas J, Layos L, Martinez Villacampa M, Capdevila J, Tobeña M, Pisa A, Pericay C, Lezcano C, Fort E, Cardona I, Berga N, Solà J, Borras J. Adherence to capecitabine in preoperative treatment of stage II and III rectal cancer: do we need to worry? Ann Oncol 2017; 28:831-835. [DOI: 10.1093/annonc/mdx006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Irigoyen A, Gallego J, Guillén Ponce C, Vera R, Iranzo V, Ales I, Arévalo S, Pisa A, Martín M, Salud A, Falcó E, Sáenz A, Manzano Mozo JL, Pulido G, Martínez Galán J, Pazo-Cid R, Rivera F, García García T, Serra O, Fernández Parra EM, Hurtado A, Gómez Reina MJ, López Gomez LJ, Martínez Ortega E, Benavides M, Aranda E. Gemcitabine-erlotinib versus gemcitabine-erlotinib-capecitabine in the first-line treatment of patients with metastatic pancreatic cancer: Efficacy and safety results of a phase IIb randomised study from the Spanish TTD Collaborative Group. Eur J Cancer 2017; 75:73-82. [PMID: 28222309 DOI: 10.1016/j.ejca.2016.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/30/2016] [Accepted: 12/26/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Gemcitabine and erlotinib have shown a survival benefit in the first-line setting in metastatic pancreatic cancer (mPC). The aim of this study was to assess whether combining capecitabine (C) with gemcitabine + erlotinib (GE) was safe and effective versus GE in patients with mPC. PATIENTS AND METHODS Previously untreated mPC patients were randomised to receive G (1000 mg/m2, days 1, 8, 15) + E (100 mg/day, days 1-28) + C (1660 mg/m2, days 1-21) or GE, q4 weeks, until progression or unacceptable toxicity. Primary end-point: progression-free survival (PFS); secondary end-points: overall survival (OS), response rate, relationship of rash with PFS/OS and safety. RESULTS 120 patients were randomised, median age 63 years, ECOG status 0/1/2 33%/58%/8%; median follow-up 16.5 months. Median PFS in the gemcitabine-erlotinib-capecitabine (GEC) and GE arms was 4.3 and 3.8 months, respectively (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.58-1.31; p = 0.52). Median OS in the GEC and GE arms was 6.8 and 7.7 months, respectively (HR: 1.09, 95% CI: 0.72-1.63; p = 0.69). Grade 3/4 neutropenia (GEC 43% versus GE 15%; p = 0.0008) and mucositis (GEC 9% versus GE 0%; p = 0.03) were the only statistically significant differences in grade 3/4 adverse events. PFS and OS were significantly longer in patients with rash (grade ≥1) versus no rash (grade = 0): PFS 5.5 versus 2.0 months (HR = 0.39, 95% CI: 0.26-0.6; p < 0.0001) and OS: 9.5 versus 4.0 months (HR = 0.51, 95% CI: 0.33-0.77; p = 0.0014). CONCLUSION PFS with GEC was not significantly different to that with GE in patients with mPC. Skin rash strongly predicted erlotinib efficacy. The study was registered with ClinicalTrials.gov: NCT01303029.
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Affiliation(s)
| | - Javier Gallego
- General Universitario de Elche Hospital, Alicante, Spain
| | | | | | | | - Inmaculada Ales
- Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | | | - Aleydis Pisa
- Sabadell Hospital, Corporación Sanitaria Parc Tauli, Barcelona, Spain
| | - Marta Martín
- Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Esther Falcó
- Fundación Son Llatzer Hospital, Palma de Mallorca, Spain
| | | | | | - Gema Pulido
- Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | | | - Roberto Pazo-Cid
- Aragon Institute of Biomedical Research (IISA), Miguel Servet University Hospital, Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Zaragoza, Spain
| | | | | | - Olbia Serra
- Moisés Broggi Hospital, Institut Català Oncologia - Hospitalet del Llobregat, Barcelona, Spain
| | | | | | | | | | | | - Manuel Benavides
- Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | - Enrique Aranda
- Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
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Rivera F, Polo Marques E, Aranda E, Fernandez-Martos C, La Casta Munoa A, Guillen C, Lopez R, Gil S, Lema L, Aparicio J, Martinez Villacampa M, Pisa A, Borrega P, Lopez-Vivanco G, Garcia Alfonso P. Aflibercept (Z) in combination with FOLFIRI for second-line treatment of patients (pts) with metastatic colorectal cancer (mCRC): Safety and quality of life (QoL) data from the Spanish subgroup of the Aflibercept Safety and Quality-of-Life Program (ASQoP). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
751 Background: In the VELOUR trial, adding Z to FOLFIRI improves OS, PFS and RR in mCRC pts progressing after oxaliplatin ±biologic agents. The ASQoP trial (NCT01571284) was designed to gather safety and QoL data from mCRC in real-life setting. We report data collected by the Spanish investigators. Methods: ASQoP is single-arm, open-label trial evaluating safety and QoL of Z in mCRC pts as 2nd line. Eligible pts received Z (4mg/kg) q2wks on day 1/cycle, followed by FOLFIRI (dosing was at physician’s discretion) until disease progression, unacceptable toxicity, death, or investigator/pt decision. The EQ-5D was used for utility index (UI) measure and the EORTC QLQ-C30 as generic cancer instrument. QoL population consisted of pts completing the questionnaire at baseline and ≥1 assessment post-baseline and received ≥1 part of 1 dose of study treatment. Results: The safety population comprised 77 pts with ≥1 completed cycle of treatment. Grade (G)3/4 AEs were reported in 72.7% of pts (vs 83.5% in VELOUR), being G3 most commonly reported. There was no G4 hypertension, stomatitis, or proteinuria. G4 Diarrhea was found in 1.3% of pts. Mean baseline UI was 0.7 (95% CI, 0.63-0.78) in 51 pts, and remained relatively stable at cycles 3 (n=39) and 7 (n=24), with a mean (±SD) change from baseline of 0.03 (±0.26) and -0.06 (±0.35), respectively. Mean baseline global health status score was 63.1 (95% CI, 55.8-70.4) in 54 pts, and remained stable up to cycle 9 with a mean (±SD) change from baseline of 4.17 (±38). Conclusions: Thisanalysis has identified no new safety signals and suggests an acceptable toxicity profile with a relatively stable UI and QoL in Spanish mCRC pts in the real-life setting. [Table: see text]
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Affiliation(s)
- Fernando Rivera
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | | | | | - Carmen Guillen
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Rafael Lopez
- Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Silvia Gil
- H. Universitario Carlos Haya, Malaga, Spain
| | - Laura Lema
- Hospital 12 de Octubre Avda de Cordoba, Madrid, Spain
| | - Jorge Aparicio
- Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | | | - Aleydis Pisa
- Institut Oncologic del Valles, Corporacio Sanitària Parc Tauli, Consorci Sanitari de Terrassa, Sabadell, Spain
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Blanco R, Capo M, Libran AM, Alfaro J, Dotor E, Fernandez L, Guerra D, Jovell E, Llonch M, Pisa A, Arcusa A. Multidisciplinary treatment planning in elderly patients with cancer: a prospective observational study. J Community Support Oncol 2016. [DOI: 10.12788/jcso.0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ferrer M, Pericay C, Macías Declara I, Saigí E, Dotor E, Pisa A. P-082 Three years of metastatic gastric cancer follow up in our hospital. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pericay C, Losa F, Alfaro J, Cirera L, Pisa A, Salud A, Falco E, Casado E, Nogue M, Dotor E, Serra O, Fernandez J, Saigí E. Phase II study with docetaxel (D), cisplatin (C) and continuous capecitabine (X) schedule (DCX) in advanced gastric cancer (AGC): ML21085. Final results. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carles Pericay
- Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Ferran Losa
- Hospital Moises Broggi, Sant Joan Despi, Spain
| | - Jordi Alfaro
- Institut Oncològic del Vallès, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Luis Cirera
- Hospital Mutua De Terrassa, Barcelona, Spain
| | - Aleydis Pisa
- Institut Oncològic del Vallès, Corporació Sanitària Parc Taulí, Consorci Sanitari de Terrassa, Sabadell, Spain
| | | | | | | | - Miquel Nogue
- Hospital de Granollers, Granollers (Barcelona), Spain
| | - Emma Dotor
- Corporació Sanitària Parc Taulí, Hospital de Sabadell, Sabadell-Barcelona, Spain
| | - Olbia Serra
- Institut Catala d'Oncologia, ICO H. M. Broggi, IDIBELL, Sant Joan Despi, Barcelona, Spain
| | | | - Eugeni Saigí
- Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain
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Ferrer M, Pericay C, Macias I, Dotor E, Pisa A, Saigí E. Analysis and follow-up of the patients diagnosed with metastatic gastric adenocarcinoma in the Parc Taulí Hospital, Sabadell, between 2010 and 2013. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
169 Background: The primary endpoint of this study was to know the incidence and treatment of gastric carcinoma in our area. Other secondary endpoints were percentage of treated patients, overall survival (OS), survival in subgroups, and more frequent treatments. Methods: Since 2010 to 2013 all the patients diagnosed with metastatic gastric adenocarcinoma and treated at the hospital Parc Taulí from Sabadell were registered. The clinical information was compiled and analyzed. Survivals curves were determined with Kaplan-Meier functions Results: 168 patients were studied, with 79 metastatic (47%). 56% men and median age 67 years. Localizations were gastric body 52%, gastro-esophageal junction 20%, and antrum 25%. OS of the series was 5,05 months (95% CI, 2,99-7,10). 60% of the patients were treated with first line chemotherapy (CT). From them, 42% had a second line and 25% a third line. DFS were respectively 6,62 months (4,06-9,17), 4,29 months (2,28-6,30), and 2,88 months (1,12-4,64) for every line of treatment. OS of the patients that received chemotherapy was 9.7 months (6,40-13,00). CT more used in first line were triplets of fluropyrimidines, platinum and taxanes, in 45% (21 patients). Also just fluoropyrimidines and platinum without taxanes, in 38%. As a second line the predominant CT is also platinum and fluoropyrimidines (37%), and irinotecan (30%). In third line, 50% are combinations based on irinotecan. Conclusions: The OS of the patients who received CT is significantly prolonged respect the ones who didn’t. The data obtained matches the data already published in the literature, even the more frequent chemotherapy.
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Affiliation(s)
| | - Carles Pericay
- Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Oncològic del Vallès, Sabadell, Spain
| | | | - Emma Dotor
- Institut Oncològic del Vallès, Corporació Sanitària Parc Taulí, Consorci Sanitari de Terrassa, Sabadell-Barcelona, Spain
| | - Aleydis Pisa
- Institut Oncològic del Vallès, Corporació Sanitària Parc Taulí, Consorci Sanitari de Terrassa, Sabadell, Spain
| | - Eugeni Saigí
- Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain
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Pericay C, Serra-Aracil X, Ocaña-Rojas J, Mora-López L, Dotor E, Casalots A, Pisa A, Saigí E. Further evidence for preoperative chemoradiotherapy and transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer. Clin Transl Oncol 2015; 18:666-71. [DOI: 10.1007/s12094-015-1415-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/23/2015] [Indexed: 12/21/2022]
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Benavides M, Gallego Plazas J, Guillen C, Vera R, Iranzo V, Diaz IALES, Arevalo S, Pisa A, Martin-Richard M, Salud Salvia A, Falco E, Saenz A, Manzano JL, Pulido G, Martínez-Galán J, Pazo Cid RA, Rivera F, Garcia T, Irigoyen A, Aranda E. Gemcitabine(G)/erlotinib(E) versus gemcitabine/erlotinib/capecitabine(C) in the first-line treatment of patients with metastatic pancreatic cancer (mPC): Efficacy and safety results of a phase IIb randomized study from the Spanish TTD Collaborative Group. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Carmen Guillen
- Hospital Universitario Ramon y Cajal, Medical Oncology Department, Madrid, Spain
| | - Ruth Vera
- Service of Medical Oncology, Hospital de Navarra, Pamplona, Spain
| | - Vega Iranzo
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Aleydis Pisa
- Institut Oncològic del Vallès, Corporació Sanitària Parc Taulí - Consorci Sanitari de Terrassa, Sabadell, Spain
| | | | | | | | | | - Jose Luis Manzano
- Institut Català d'Oncologia, Hospital Universitario German Trias i Pujol, Badalona, Spain
| | - Gema Pulido
- Medical Oncology Department University Reina Sofía Hospital, Cordoba, Spain
| | | | - Roberto A. Pazo Cid
- Medical Oncology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Fernando Rivera
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Teresa Garcia
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Antonio Irigoyen
- Medical Oncology Department. Hospital Virgen de la Salud, Toledo, Spain
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Pisa A, Pericay C, Dotor E, Alfaro J, Orellana R, Pujal M, Amador MA, Garcia Borobia F, Mato R, Saigí E. The effect of time to adjuvant chemotherapy on survival in nonmetastatic resectable pancreatic adenocarcinoma: A retrospective analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Piulats JM, Vidal A, Nadal M, Pisa A, Germa-Lluch JR, Condom E, Villanueva A, Garcia del Muro X. 9q32-q33.1 amplification as a prognostic factor for overall survival in metastatic germ cell tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Pericay C, Losa F, Pisa A, Alfaro J, Cirera L, Salud A, Falco E, Dotor E, Vicente P, Casado E, Oliva JC, Saigí E. Phase II study with docetaxel (D), cisplatin (C), and continuous capecitabine (CAP) combination (TCX) in advanced gastric cancer: Preliminary data. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Martinez Villacampa M, Santos C, García M, Navarro V, Teule A, Losa F, Pisa A, Lema L, Biondo S, Salazar R. Phase II study of preoperative bevacizumab, capecitabine, and radiotherapy for resectable locally advanced rectal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
516 Background: Bevacizumab into chemoradiotherapy appears safe and active in locally advanced rectal cancer (LARC).This study evaluates whether the addition of bevacizumab to capecitabine-based chemoradiotherapy in the preoperative treatment of LARC improves pathological complete response rate (pCR). Methods: Open-label, unicentric, phase II study in patients with resectable LARC (stage II or III), with or without nodal involvement and no evidence of distant metastases. Treatment schedule of 4-cycles: bevacizumab administered iv on day 1 (10 mg/kg in the first cycle and 5 mg/kg in the following 3 cycles) and capecitabine (900mg/m2/bid) in the 2nd cycle (5 d/wk) concomitantly with radiotherapy 45Gy (25 fractions of 1.8Gy/day) over 5 weeks. Surgical resection was scheduled 6-8 weeks after therapy completion. Preliminary results from ITT analysis are presented. Results: Of the 43 patients included, 41 comprised ITT population. Baseline characteristics: median age 63 (55-67) years; male 76%; ECOG 0/1 49%/51%; stage T3/N1 80.5%/58.5%; nodal metastases 85%. 39 patients underwent surgery, 9 abdominoperineal and 30 anterior resection. No evidence of metastasis after surgery in 97%. Total mesorectal excision was performed in 69% of patients and 85% underwent R0 resection. Sphincter-preservation was achieved in 79.5%. Downstaging occurred in 82%. Among 39 patients evaluable for pathological response, 7.7% experienced pCR, 69.2% partial response and 20.5% stable disease. Grade 3/4 toxicities: 9.8% lymphopenia (all related to capecitabine and 4.9% to bevacizumab), 2.4% neutropenia (capecitabine-related), 2.4% radiodermatitis (related to RT and capecitabine) and 2.4% vasospastic angina (bevacizumab and capecitabine-related). 13 patients had postoperative complications not treatment-related. The most common were wound infection (6), intra-abdominal collection (3), wound dehiscence (2) and paralytic ileus (2). Conclusions: Preoperative regimen with bevacizumab, capecitabine and RT is active for LARC with promising results of R0 resection, sphincter- preservation and tumour downstaging as well as manageable toxicity. Further studies are ongoing to confirm these data. No significant financial relationships to disclose.
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Affiliation(s)
- M. Martinez Villacampa
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - C. Santos
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - M. García
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - V. Navarro
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - A. Teule
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - F. Losa
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - A. Pisa
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - L. Lema
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - S. Biondo
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
| | - R. Salazar
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Consorci Sanitari Integral, Barcelona, Spain; Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Instituto Catala d'Oncologia, L'Hospitalet Servicio de Oncologia, Barcelona, Spain
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Pisa A, Moya I, Pericay C, Dotor E, Alfaro J, Alvarado A, Navarro S, Orellana R, Pampols M, Saigí E. Role of chemoradiotherapy alone in the management of unfit patients with nonmetastatic locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
138 Background: Surgery is considered the best treatment for patients (pts) with non-metastatic locally advanced squamous cell carcinoma of the esophagus who have responded to neoadjuvant chemoradiotherapy (CRT) in terms of locoregional control. However, in these pts PFS and OS have not been proved superior to those achieved by CRT alone. Besides, the addition of surgery to CRT increases treatment-related morbidity and mortality. Unfit pts are usually declined for surgical procedures and included in definitive CRT programs. The aim of this study was to define the role of non-surgical strategies (CRT, CT or RT) in unfit pts considered non-optimal for surgical procedures. Methods: We retrospectively reviewed 90 pts with squamous cell carcinoma of the esophagus who had been diagnosed and treated at our institution from January 2004 to December 2009. Fifty-one pts were non-metastatic among which 19 underwent surgery and 32 a non-surgical procedure (CRT, CT, RT or BSC). Our aim was to identify OS, PFS, RR, data on comorbidity and toxicity in these 32 pts. Results: Thirty out of the 32 pts were men with a median age of 62 years (range 41-90). Comorbidity was detected in 17 pts (53%) as means of respiratory disorders (21.9%), cardiopathy (12.5%), hepatopathy (21.9%), synchronic tumors (25%) and metachronic tumors (25%). Seventeen pts received CRT, 7 received CT, 1 received RT and 7 received BSC alone (53%, 22%, 3% and 22% respectively). Grade 3 and 4 toxicities were observed in 15 pts (46.9%) as means of mucositis (18.8%), oesophagitis (15.6%), diarrhoea (12.5%) and neutropaenia (12.5%). One patient in the CRT group died of toxicity. RR was 43.8% (70.6% for CRT, 14.3% for CT alone). Median follow-up was 17.2 months. Median PFS was 11.3 ± 6.12 months (17.9 for CRT, 5.1 for CT alone). Median OS was 15.6 ± 7.6 months (6.9 for CT alone). Conclusions: Our experience with CRT alone in unfit pts with locally advanced squamous cell carcinoma of the oesophagus supports its use with a median PFS of 17.9 months and controllable toxicity. Data on median OS are lacking due to pending long-term follow-up. No significant financial relationships to disclose.
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Affiliation(s)
- A. Pisa
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - I. Moya
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - C. Pericay
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - E. Dotor
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - J. Alfaro
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - A. Alvarado
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - S. Navarro
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - R. Orellana
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - M. Pampols
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
| | - E. Saigí
- Corporació Sanitària Parc Taulí, Sabadell, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Consorci Sanitari de Terrassa, Institut Oncològic del Vallás, Terrassa, Spain; Hospital General de Catalunya, Sant Cugat, Spain
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M. Piulats J, Vidal A, Villanueva A, Muñoz C, Pisa A, Nadal M, Germa-Lluch JR, Condom E, Garcia del Muro X. MLH1 and BRAF status analysis in metastatic germ cell tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Querol R, Pericay C, Pisa A, Dotor E, Perendreu J, Falcó J, Moya I, Pampols M, Seguí M, Saigí E. Long-term follow-up of treatment of acute malignant colorectal obstruction with self-expanding metallic stent as a preoperative brigde to surgery. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pernas S, Gil M, Benítez A, Bajen MT, Climent F, Pla MJ, Benito E, Gumà A, Gutierrez C, Pisa A, Urruticoechea A, Pérez J, Gil Gil M. Avoiding Axillary Treatment in Sentinel Lymph Node Micrometastases of Breast Cancer: A Prospective Analysis of Axillary or Distant Recurrence. Ann Surg Oncol 2009; 17:772-7. [DOI: 10.1245/s10434-009-0804-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Blanco R, Capo M, Libran A, Alfaro J, Arcusa A, Fernandez L, Dotor E, Leon C, Llonch M, Pisa A. P7 Multidisciplinary assessment in elderly oncologic patients for treatment planning: final results of a prospective observational study in a General Hospital. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70045-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pisa A, Pericay C, Losa F, Nogué M, Alfaro J, Dotor E, Bonfill T, Querol R, MoyaHorno I, Saigí E. 6532 Prospective study of docetaxel in combination with cisplatin and an oral fluoropyrimidine in patients with gastric and esohagogastric junction adenocarcinoma. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pericay C, Querol R, Moya-Horno I, Pisa A, Dotor E, Casalots A, Bombardó J, Bonfill T, Saigí E. 6116 Epidermal growth factor receptor (EGFR) expression in stage II-III colon carcinoma (CC) – nine years of follow-up. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Romeo M, Soler G, Villacampa MM, Laquente B, Doriga AL, Pisa A, Rey M, Santos C, Salazar R, Lluch JRG. Cost-effectiveness analysis of cetuximab as third-line treatment in metastatic colorectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pisa A, Calvo M, Pérez X, Villacampa MM, Soler G, Laquente B, Santos C, Kreissler E, Salazar R, Lluch JRG. Descriptive study of patients with peritoneal carcinomatosis and colorectal cancer: An overall survival clinical prognostic score. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pernas S, Urruticoetchea A, Benitez A, Bajen M, Pisa A, Pla M, Gumà A, Serra J, Benito E, Gil M. Is axillary dissection necessary for breast cancer patients with micrometastasis in the sentinel lymph node? EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Arrazubi V, Martinez Villacampa M, Navarro M, Pareja L, Majem M, Figueras J, de Oca J, Pisa A, Nadal E, Germa JR. Imaging techniques are useful in the surveillance after adjuvant treatment of colorectal cancer (CRC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- V. Arrazubi
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - M. Martinez Villacampa
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - M. Navarro
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - L. Pareja
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - M. Majem
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - J. Figueras
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - J. de Oca
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - A. Pisa
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - E. Nadal
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
| | - J. R. Germa
- Inst catala d’Oncologia, L’Hospitalet de llobregat, Spain; Hosp de Bellvitge, L’Hospitalet de llobregat, Spain
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Nadal E, Majem M, Navarro M, Pareja L, Pisa A, Arrazubi V, Pares D, Martinez Villacampa M, Soler G, Germa JR. Intermittent chemotherapy in advanced unresectable colorectal cancer. An option for our patients? J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Nadal
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - M. Majem
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - M. Navarro
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - L. Pareja
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - A. Pisa
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - V. Arrazubi
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - D. Pares
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - M. Martinez Villacampa
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - G. Soler
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
| | - J. R. Germa
- Inst Catala d’Oncologia, L’Hospitalet de Llobregat, Spain; Bellvitge Hosp, L’Hospitalet De Llobregat, Spain
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Abstract
Staff at the day treatment center at Norristown (Pa.) State Hospital have found several ways of using psychodrama to facilitate information gathering, diagnostic decision-making, and treatment planning and implementation. They use behavioral techniques such as role rehearsal and modeling. In addition they use techniques such as the mirror image, in vivo dramas, and slight deception to facilitate catharsis. These approaches, which broaden the applicability of psychodrama, are illustrated by case examples.
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