Splenomegaly and Tumor Marker Response Following Selective Internal Radiation Therapy for Non-Resectable Liver Metastases from Neuroendocrine Tumor

PURPOSE:The aim of this study was to investigate changes in spleen size, the level of chromogranin Aas a tumor marker, and the relationship between these two parameters before and 3 months after selectiveinternal radiation therapy (SIRT) for non-resectable liver metastases from neuroendocrine tumor (NET).Our first serious adverse event with this relatively new treatment is also discussed.METHODS:A retrospective review of a prospective database identified patients with non-resectable livermetastases from NET who underwent SIRT between 2003 and 2007. Patients who underwent CT scansbefore and 3 months after treatment were included. The patients were divided into two groups:those withand without a 20 % or more increase in splenic volume on the CT scans. The percentages of patients showinga tumor marker response in the two groups were then comparedRESULTS:Fourteen patients were included in the present analysis. A tumor marker response was seenin 6 of 7 patients( 85.7%) who showed an increase in splenic volume of>20%, and in 3 of 7 patients( 42.9%) without an increase in splenic volume (p=0.266). There was one death as a result of oesophageal varicealbleeding due to portal hypertension at 9 months after treatment.CONCLUSION:Splenic enlargement after SIRT may be associated with tumor marker response, althoughthis could not be confirmed statistically in this study due to the small number of patients. Long-termsplenomegaly and portal hypertension may be important complications of SIRT. This issue needs to be investigatedfurther using a larger number of patients and longer follow-up

フクマク チュウヒシュ 11レイ ニ タイスル Peritonectomy オ モチイタ シュウガクテキ チリョウ セイセキ

目的 当科では腹膜中皮腫に対してPeritonectomyを用いた集学的治療(術中温熱化学療法(HIPEC),術後早期腹腔内化学療法(EPIC))を施行している.この治療結果を検討し,他施設と比較した.方法 1999年～2006年にPeritonectomyを施行した腹膜中皮腫11症例を対象に検討を加えた. 11例中, 3例に2回, 1例に3回,計16回のペリトネクトミーを, 9例に11回のHIPECを, 4例に6回のEPICを施行した.結果 男女比は7対4,平均年齢52.8±18.2,明らかなアスベスト暴露を4例で認めた. 11例中1例が周術期死亡, 3例が原病死, 7例が生存中である.統計学的検討では生存期間と2回目のPeritonectomy施行に10%の有意差を認めた(P=0.0734). Kaplan-Meier生存曲線からの1, 3, 5年生存率は72.7, 62.3, 62.3%であった.結論 我々と他施設の生存率に文献的考察を加えると, Peritonectomy集学的治療は腹膜中皮腫患者の予後の向上に寄与すると考えられる.AIMS : Recently, the issue of Asbestos-related disease has increased dramatically though out the world. Deaths from mesothelioma are often caused by asbestos exposure. The aim of the study was to present our unit\u27s experience in the treatment of peritoneal mesothelioma between 1999 and 2006. In addition, the data was assessed and validated compared with other peritonectomy units. METHODS : Records of 11 patients with peritoneal mesothelioma were reviewed retrospectively. All patients were treated by cytoreductive surgery with peritonectomy procedures, 4 patients had second and 1 patient had third peritonectomy (in total 16 times peritonectomy). Hyperthermic Intraperitoneal Perioperative Chemotherapy (HIPEC) was performed 11 times across 9 patients. Early Postoperative Intraperitoneal Chemotherapy (EPIC) was performed 6 times across 4 patients. RESULTS : 4 female and 7 male patients with a mean age of 52.8±18.2 years old were studied. Asbestos exposure was recorded in 4 patients. Overall projected survival at 1, 3 and 5 years were 72.7, 62.3 and 62.3 per cent from Kaplan-Meier survival curve. The most significant positive predictive factor of survival was second peritonectomy (P=0.0734). CONCLUSION : Our unit\u27s survival rate agreed with the experience from other units and supports peritonectomy with HIPEC and EPEC as the gold standard in the treatment of peritoneal mesothelioma worldwide

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials

Abstract Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials

Abstract Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care