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    Systemic treatment of patients with non small cell lung cancer: from nihilism to hope

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    Review of Polish and international guidelines on hormonal therapy in localized prostate cancer

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    Prostate cancer is the second most common male malignancy in Poland. We present guidelines of Polish and international oncology and urology societies on hormonal therapy for localized prostate cancer

    Chemotherapy for advanced colorectal patients: daily practice results may not reflect the outcomes of prospective clinical trials

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    Introduction. Colorectal cancer is the second cause of cancer deaths worldwide. The development of new drugs in recent years has improved the outcomes, but it is not clear whether this progress also includes patients managed in daily clinical practice. Treatment outcomes in patients with advanced colorectal cancer treated in Poland outside of clinical trials are scare. Methods. We analyzed the results of first-line chemotherapy in 165 patients with advanced colorectal cancer treated between May 2010 and December 2013 in two institutions. Results. The mean patient age was 61 卤 8.7 years; 105 patients received irinotecan-based regimens (CLF1 or XELIRI), 41 oxaliplatin-based regimens (FOLFOX4 or XELOX) and 19 patients received single-agent 5-fluorouracil. A partial response was achieved in 48 patients (29%), stable disease in 71 (43%) and 46 patients (28%) progressed during treatment. Median survival in the entre group was 14 months. Respective average response rate and median overall survival in recent clinical trials were 39% and 17 months, respectively. Compared to single agent treatment, multidrug chemotherapy was associated with increased general toxicity (p = 0.039), in particular with higher occurrence of diarrhea (p = 0.003) and peripheral neuropathy (p < 0.001). There was no apparent impact of chemotherapy on overall quality of life. Conclusions. Treatment results of advanced colorectal cancer in daily practice may be worse than those obtained in prospective clinical trials. The use of palliative chemotherapy has no noticeable impact on quality of life

    Pulmonary bleedings

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    Krwawienia z dr贸g oddechowych towarzysz膮 najcz臋艣ciej zaawansowanym stadiom przewlek艂ych schorze艅 uk艂adu oddechowego. Nasilone krwawienie, opr贸cz zwi膮zanego z nim bezpo艣redniego zagro偶enia, wywo艂uje na og贸艂 u chorych poczucie silnego l臋ku i znacznie obni偶a jako艣膰 ich 偶ycia. Istotne jest zatem szybkie rozpoznanie przyczyny krwawienia i niezw艂oczne podj臋cie w艂a艣ciwego leczenia. Dora藕ne post臋powanie obejmuje zabezpieczenie dro偶no艣ci oskrzeli, uspokojenie chorego, do偶ylne podanie 10–40 ml 10-procentowego roztworu NaCl, podanie lek贸w przeciwkaszlowych i hamuj膮cych fibrynoliz臋, a tak偶e inhalacje roztworem epinefryny. Wskazane jest wykonanie bronchoskopii, co pozwala ustali膰 przyczyn臋 i miejsce krwawienia, odessa膰 zalegaj膮c膮 krew, usun膮膰 skrzepy i podj膮膰 pr贸b臋 zatamowania krwawienia. W wybranych przypadkach nale偶y rozwa偶y膰 zabieg operacyjny. W leczeniu wspomagaj膮cym krwawie艅 z dr贸g oddechowych stosuje si臋 preparaty nasilaj膮ce hemostaz臋 i zwi臋kszaj膮ce biosyntez臋 protrombiny. Skuteczn膮 metod膮 leczenia nawracaj膮cych krwawie艅 jest embolizacja naczy艅 t臋tniczych. W krwawieniach towarzysz膮cych nowotworom uk艂adu oddechowego metod膮 z wyboru jest radioterapia wi膮zk膮 zewn臋trzn膮 lub brachyterapia.Pulmonary bleedings typically accompany advanced chronic diseases of the respiratory system. Massive bleedings, apart form imminent threats, is associated with strong patient fear and considerably deteriorates quality of life. Immediate diagnosis and active therapy are therefore essential. Emergency measures include facilitating bronchial passage, sedation, intravenous injection of 10–40 ml of 10% NaCl solution, antitussive and antifibrinolitic agents, as well as epinephrine inhalations. Bronchoscopy should be attempted to establish the cause and localisation of bleeding, to allow blood aspiration and clot removal. In selected cases surgical intervention should be considered. Supportive therapy includes antihemostatic agents and compounds stimulating prothrombin synthesis. Effective palliative measure of recurrent pulmonary bleeding is vessel embolisation. Bleeding related to advanced lung cancer should primarily be managed with externalbeam irradiation or brachytherapy

    List otwarty Przewodnicz膮cego Zarz膮du G艂贸wnego Polskiego Towarzystwa Onkologicznego

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