摘要:

Purpose of reviewIn recent years, considerable progress in the management of invasive mycoses in immunocompromised patients has been achieved. However, the prognosis of these infections, in particular those caused by filamentous fungi, continues to be dramatically poor, with mortality rates reaching more than 80% in selected categories of patients. New antifungal drugs in the classes of triazoles and echinocandins, with interesting antimicrobial and pharmacokinetic characteristics, are under investigation, and important trials have been reported in the last 2 years. These studies seem to suggest the relevant role of these new drugs in the antifungal armamentarium.Recent findingsThe triazole voriconazole and the echinocandin caspofungin demonstrated significant advantages in term of toxicity and response rate, when compared with conventional amphotericin B in the treatment of aspergillosis and candidiasis, respectively. However, because of the peculiar characteristics of the design of both studies, the interpretation of the results may be difficult, and further confirmatory experiences are needed. Other noncontrolled studies showed a promising role of caspofungin in the treatment ofAspergillusinfections and of voriconazole in the treatment of other rare mycoses.SummaryThe increasing incidence and severity of invasive mycoses have led to the development of new strategies with new antifungal agents, and amphotericin B no longer is the gold standard for a variety of fungal infections. However, these results should be considered with caution. The latest generation drugs need to be investigated further in proper trials, and old drugs, especially conventional amphotericin B, continue to have a central role in the antifungal armamentarium.

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThrombosis is one of the most frequent complications of indwelling central venous catheters. During the past year, new information has emerged regarding the incidence and predisposing factors of thromboembolic complications of indwelling central venous catheters. Because indwelling central venous catheters are widely used, it is important to be aware of new information regarding thromboembolic complications of these devices.Recent findingsRecent studies have better defined the risks of thromboembolic complications in patients with cancer with indwelling central venous catheters. Acquired hypercoagulable disorders such as heparin‐induced thrombocytopenia, antiphospholipid syndrome, and therapy with asparaginase are associated with thromboembolic disorders in patients with indwelling central venous catheters. Studies analyzing the association between inherited hypercoagulable disorders and thrombosis have shown conflicting results. Preliminary studies suggest that low molecular weight heparins could have a role in the prevention of catheter‐related thromboembolic disorders. Nevertheless, larger prospective studies will be necessary to determine the role of anticoagulants in the prevention of thromboembolic disorders in patients with cancer with indwelling central venous catheters.SummaryRecent reports will facilitate the evaluation and risk assessment of children with cancer who have indwelling central venous catheters. Despite these advances, large, controlled studies focusing on specific populations of patients, such as children, should be undertaken to determine the true performance and optimal use of indwelling central venous catheters. Future studies should also address better ways to prevent catheter‐related thrombosis and infection.

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Changes in drug delivery as well as new drug development have impacted on cancer care in the past twenty years. Several modified release chemicals now have a role in cancer care, and new routes of drug delivery have been established as part of standard care. A range of strategies has been investigated to enhance anti‐tumor selectivity of drugs including antibodies, liposomes and carrier molecules homing or activated in the environment of tumors. Fixed drug combinations are also used in cancer supportive care, and may find use in a range of settings.

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;High local drug concentrations can be achieved in a limb with minimal systemic toxicity with the technique of hyperthermic isolated limb perfusion (HILP). The currently most successful drugs are still Tumor Necrosis Factor alpha (TNF&agr;) and melphalan. With HILP, as an induction chemotherapy treatment of locally advanced primarily irresectable soft tissue sarcomas of a limb, a limb salvage rate of 71% can be achieved, with a minimal treatment related morbidity. For the HILP is no upper age limit. Systemic inflammatory response syndrome is currently seldom seen. The exact working mechanisms of TNF&agr; are still unknown. Experimental work is now directed to the development of drugs sensitizing the tumor vasculature to the effects of TNF&agr;. In the clinical HILP setting are currently lower doses of TNF&agr; in combination with melphalan investigated. Although multidrug resistance (MDR) is a major issue in effectiveness of chemotherapy in human cancer treatment, HILPs with TNF&agr; and melphalan did not induce MDR in sarcomas. The future research in HILP with TNF&agr; is directed in increasing tumor sensitivity for TNF with lowering the dosage without decreasing tumor response.

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The concept of limb‐sparing surgery for bony sarcomas has evolved over the past 25 years. Today, more than 90% of patients treated by surgeons with expertise in musculoskeletal oncology undergo successful limb‐sparing procedures. Many large centers have abandoned osteochondral allografts and resection arthrodesis for the reconstruction of segmental bone and joint defects in favor of metallic endoprostheses. Endoprosthesis survival rates now exceed 85% at 5 years for reconstructions about the knee, which is the most common site for primary bone sarcomas. In the shoulder girdle, the type of resection and soft‐tissue reconstruction is probably more important than the type of implant. Extra‐articular resection is recommended for most large stage IIB tumors. New expandable prostheses able to be lengthened nonoperatively hold promise for very young children with lower extremity sarcomas. Allograft‐prosthetic composites and proximal femoral prostheses provide reliable and stable hip reconstructions. Acetabular components are not required, but attention to capsular reconstruction is necessary to prevent hip dislocation. Techniques of scapula replacement have advanced and provide better upper extremity function after scapula resection than resection alone.

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Perioperative brachytherapy results in a better local control rate than surgery alone for extremity soft tissue sarcoma. Brachytherapy enables the delivery of a high radiation dose to a limited volume of tissue, allows the reduction of radiation treatment time, enables direct visualization of the tumor bed and surrounding critical structures, and costs less than external beam radiotherapy. The literature seems to regard the effectiveness of brachytherapy as comparable to that of external beam radiotherapy, and the side effect profile is acceptable. Traditional low‐dose‐rate brachytherapy methods require extended periods of patient isolation, but recent technologic advances may obviate this necessity. Newer high‐dose‐rate (HDR) brachytherapy delivery methods allow for the fractionation of radiation delivery and outpatient treatment in some cases. Furthermore, with HDR brachytherapy, the radiation dose distribution can be tailored around critical anatomic structures. Although the application of HDR brachytherapy to soft tissue sarcoma is relatively new, it seems to result in a satisfactory local control rate and may replace traditional low‐dose‐rate techniques.

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Understanding prognostic variables is important for counseling patients, selecting patients for adjuvant therapy, stratifying patients for inclusion in clinical trials, and setting goals for patient treatment. Prognostic variables in soft tissue sarcoma have been defined for local recurrence, distant recurrence, and disease‐specific and overall survival. Significant prognostic variables are site‐dependent and time‐dependent. A recently created nomogram that accounts for tumor size, grade, histology, and depth and patient age is a tool that can be used to predict 12‐year sarcoma‐specific survival at diagnosis. Emerging areas in predicting outcome of patients with soft tissue sarcoma include response to neoadjuvant chemotherapy and molecular markers.

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The purpose of this review is to underscore the value of positron emission tomography (PET) in the management of patients with soft tissue sarcomas. Although the most essential step in the diagnostic evaluation of soft tissue sarcomas is tumor biopsy, functional imaging techniques is growing and becoming more popular than before. PET scan traces molecular and cellular activities of normal and tumor cells through the use of radiotracers that engage in cell metabolism. The most important and widely used tracer is fluorodeoxyglucose (18FDG). PET scan usefulness is not limited to its ability to differentiate benign from malignant lesions. The scan can detect intralesional morphologic variation which is especially true in soft tissue sarcomas, it can predict tumor grade, and it is of value in staging, restaging and prognosis. As for the time, PET is not meant to replace tissue biopsy but rather complement the biopsy to better understand the biological behavior of soft tissue sarcomas. Curr Opin Oncol

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:2003

数据来源: OVID