Adjuvant Chemoradiotherapy (Gemcitabine-based) in Pancreatic Adenocarcinoma: The Pisa University Experience

Introduction: The role of adjuvant chemoradiotherapy in patients with pancreatic adenocarcinoma (PA) is controversial. In this study we aimed to assess the feasibility, disease-free survival (DFS) and overall survival (OS) of adjuvant chemoradiotherapy (gemcitabine based) in patients with resected PA and their correlation with prognostic factors. Methods: 122 resected patients (stage â¥IIa) treated between February 1999 and December 2013 were analyzed. Two cycles of gemcitabine (1,000 mg/m2 on days 1, 8 and 15 every 28 days) were administered before concomitant radiotherapy (45 Gy/25 fractions) and chemotherapy (gemcitabine 300 mg/m2weekly). Results: Median follow-up was 22.7 months (range 4-109). Gastrointestinal toxicity (G3), neutropenia (G3-G4) and cardiac toxicity (G2-G3) were observed in 2.4%, 10.6% and 1.6% of patients, respectively. OS at 12, 24 and 60 months was 79%, 55% and 31%, respectively (median 25 months). Two-year OS in patients with postoperative Karnofsky performance status (KPS) â¤70 and â¥80 was 37.1% and 62.3%, respectively (p<0.0001). OS was better in the group of patients with a postoperative CA 19-9 level â¤100 U/mL (p = 0.014). Median DFS was 17 months. Conclusions: The combination of concomitant gemcitabine and radiotherapy in patients with radically resected PA was well tolerated and associated with a low incidence of local recurrences. Five-year OS was significantly influenced by postoperative KPS and CA 19-9 values

Rights, World-Society and the Crisis of Legal Universalism

The universalism of rights is a corollary to the individualistic semantics of the Enlightment and the French Revolution. Paradoxically, the grounds of universalism were those legal and political concepts that theoretically describe the 19th century nation-state (such as sovereignty of the people, citizenship, rights, and the like). All these concepts of the liberal tradition construct the nation-state on the presupposition of a highly homogeneous political community of rational subjects, whose homogeneity consists in the very social, economic, political and sexual conditions of their rationality. This kind of legal and political semantics is no longer adequate to characterize contemporary society which is a multicultural, highly inhomogeneus world-society. It no longer incorporates an ethic which is able to enforce universal leading values for human action. The example discussed is that of constitutional patriotism of Jurgen Haberma