Дослідження консолідаційної хіміорадиційної терапії при місцево-поширенній карциномі стравоходу в лікарні третинного рівня

Concurrent chemoradiation (CCRT) is considered the standard of care in locally advanced and inoperable carcinoma oesophagus patients. However, the majority of these patients have residual disease after completion of CCRT, and there are no definitive treatment guidelines for the management of the residual disease. Reports on consolidation chemotherapy for patients with oesophagal cancer after definitive CCRT are rare and have shown mixed results. The aim of this study was to see the effects of consolidation chemotherapy in patients of CCRT who had residual disease and were not surgical candidates and also monitor its side effects. Material and methods: It was a prospective interventional protocol over 2 years where patients received 4 cycles of consolidation chemotherapy post-CCRT. These patients were followed after completion of chemotherapy for response, toxicity and survival. Results: 45 patients were initially enrolled for the study, histopathologically proven carcinoma of the oesophagus, out of which 30 patients finally received the full course of treatment and were available for final assessment. After consolidation chemotherapy, 23 (76.7 %) patients had a complete response, 3 (10 %) had a partial response, and 4 (13.3 %) had stable disease. There was no progression of the disease during treatment. The overall treatment protocol was well tolerated by all the patients. There were no grade IV toxicities. On follow-up till the compilation of this data, 23 (76.6 %) of the patients were alive, and 7 (23.3 %) died (disease-related events). Out of these 7 patients, 4 patients had a local failure, and 3 patients developed distant metastasis in the form of brain and liver metastasis. Conclusion: Consolidation chemotherapy after concurrent chemoradiation in locally advanced, inoperable carcinoma oesophagus is a well-tolerable protocol with high chances of complete response ratesОдночасна хіміопроменева терапія (CCRT) вважається стандартом лікування місцеворозповсюджених та неоперабельних пацієнтів із карциномою стравоходу. Однак більшість цих пацієнтів мають залишкову хворобу після завершення CCRT, і немає остаточних рекомендацій щодо лікування залишкової хвороби. Звіти про консолідаційну хіміотерапію для пацієнтів із раком стравоходу після остаточної CCRT є рідкісними та показали неоднозначні результати. Мета цього дослідження полягала в тому, щоб побачити ефекти консолідуючої хіміотерапії у пацієнтів з CCRT, які мали залишкову хворобу і не були кандидатами на хірургічне втручання, а також відстежити її побічні ефекти. Матеріали та методи: це був проспективний інтервенційний протокол протягом 2 років, коли пацієнти отримували 4 цикли консолідуючої хіміотерапії після CCRT, і ці пацієнти спостерігалися після завершення хіміотерапії щодо реакції на неї, токсичності та виживання. Результати: 45 пацієнтів спочатку були включені до дослідження з гістопатологічно підтвердженою карциномою стравоходу, з яких 30 пацієнтів нарешті отримали повний курс лікування та були доступні для остаточної оцінки. Після консолідуючої хіміотерапії у 23 (76,7 %) пацієнтів була повна відповідь, у 3 (10 %) — часткова відповідь і у 4 (13,3 %) захворювання було у стабільному стані. Під час лікування не було прогресування захворювання. Загалом протокол лікування добре переносився всіма пацієнтами. Токсичності IV ступеня не було. Під час подальшого спостереження до моменту збирання цих даних, 23 (76,6 %) пацієнтів були живі, а 7 (23,3 %) померли (через причини пов’язані із захворюванням). З цих 7 пацієнтів, у 4 пацієнтів була місцева недостатність, а у 3 пацієнтів розвинулися віддалені метастази у вигляді метастазів у мозок і печінку. Висновок: консолідуюча хіміотерапія після одночасної хіміопроменевої терапії при місцево поширеній неоперабельній карциномі стравоходу є добре переносимим протоколом із високими шансами на повну відповід

Early-stage endometrial carcinoma; risk factors for recurrence

Background: Endometrial carcinoma (EC) is the most common gynecological malignancy in developed countries. The overall prognosis is excellent, as most cases are diagnosed at an early stage with low-grade histology, but once the recurrence occurs, the median survival decreases severely. Aims and Objectives: The aim of this study was to identify the risk factors associated with recurrence in early-stage EC and explore their impact on overall survival (OS) after recurrence. Materials and Methods: Records from patients diagnosed with EC were retrospectively reviewed. 220 patients were identified as early-stage, low-risk EC who underwent primary surgical treatment between January 2010 and December 2022, and their baseline characteristics were analyzed. Cox regression analysis was used to identify various factors for tumor recurrence. Survival analysis was done using the Kaplan-Meier method. Results: In a cohort of 220 patients, we observed tumor recurrence in 44 (20%) patients and 34 (15.45%) deaths over a median follow-up of 72 months (range, 12–144 months). Multivariate analysis confirmed two risk factors: myometrial invasion (MMI) of any depth and lymphovascular invasion (LVI) as independent predictors of recurrence. The prognosis was worse for patients with recurrence than for those without. The OS for the recurrent group was 38.6%, compared to 96.0% in the non-recurrent group. In our study, the median time to recurrence was 19 months (confidence interval 18–30) months. Conclusion: The presence of MMI and LVI are important predictors for recurrence in early-stage low-risk EC

To evaluate the analgesic effectiveness of bilateral erector spinae plane block versus thoracic epidural analgesia in open cardiac surgeries approached through midline sternotomy

Abstract Background The efficacy of the erector spinae plane (ESP) block in mitigating postoperative pain has been shown for a range of thoracic and abdominal procedures. However, there is a paucity of literature investigating its impact on postoperative analgesia as well as its influence on weaning and subsequent recovery in comparison to thoracic epidural analgesia (TEA) in median sternotomy-based approach for open-cardiac surgeries and hence the study. Methods Irrespective of gender or age, 74 adult patients scheduled to undergo open cardiac surgery were enrolled and randomly allocated into two groups: the Group TEA (thoracic epidural block) and the Group ESP (bilateral Erector Spinae Plane block). The following variables were analysed prospectively and compared among the groups with regard to pain control, as determined by the VAS Scale both at rest (VASR) and during spirometry (VASS), time to extubation, quantity and frequency of rescue analgesia delivered, day of first ambulation, length of stay in the intensive care unit (ICU), and any adverse cardiac events (ACE), respiratory events (ARE), or other events, if pertinent. Results Clinical and demographic variables were similar in both groups. Both groups had overall good pain control, as determined by the VAS scale both at rest (VASR) and with spirometry (VASS) with Group ESP demonstrating superior pain regulation compared to Group TEA during the post-extubation period at 6, 9, and 12 h, respectively (P > 0.05). Although statistically insignificant, the postoperative mean rescue analgesic doses utilised in both groups were comparable, but there was a higher frequency requirement in Group TEA. The hemodynamic and respiratory profiles were comparable, except for a few arrhythmias in Group TEA. With comparable results, early recovery, fast-track extubation, and intensive care unit (ICU) stay were achieved. Conclusions The ESP block has been found to have optimal analgesic effects during open cardiac surgery, resulting in a decreased need for additional analgesic doses and eliminating the possibility of a coagulation emergency. Consequently, it presents itself as a safer alternative to the potentially invasive thoracic epidural analgesia (TEA)