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[PMID]: 29206996 [Au] Autor: Fokas E; Ströbel P; Fietkau R; Ghadimi M; Liersch T; Grabenbauer GG; Hartmann A; Kaufmann M; Sauer R; Graeven U; Hoffmanns H; Raab HR; Hothorn T; Wittekind C; Rödel C; German Rectal Cancer Study Group [Ad] Endereço: Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany. [Ti] Título: Tumor Regression Grading After Preoperative Chemoradiotherapy as a Prognostic Factor and Individual-Level Surrogate for Disease-Free Survival in Rectal Cancer. [So] Source: J Natl Cancer Inst;109(12), 2017 Dec 01. [Is] ISSN: 1460-2105 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Background: We investigated tumor regression grading (TRG) as a prognostic marker and individual-level surrogate for disease-free survival (DFS) in patients with rectal carcinoma treated within the Chirurgische Arbeitsgemeinschaft fur Onkologie/Arbeitsgemeinschaft Radiologische Onkologie/Arbeitsgemeinschaft Internistische Onkologie (CAO/ARO/AIO)-04 randomized trial. Methods: TRG was recorded prospectively using the Dworak classification in 1179 patients after preoperative fluorouracil-based chemoradiotherapy (CRT) with or without oxaliplatin. Multivariable analysis was performed using Cox regression models adjusted for treatment arm, resection status, and pathologic stage. Individual-level surrogacy of TRG for DFS was examined using the four Prentice criteria (PC1-4). All statistical tests were two-sided. Results: With a median follow-up of 50 months, the addition of oxaliplatin to fluorouracil-based CRT led to statistically significantly improved three-year DFS (75.9%, 95% CI = 72.3 to 79.5, vs 71.3%, 95% CI = 67.6 to 74.9, P = .04, PC 1) and a shift toward more advanced TRG groups ( P < .001, PC 2) compared with CRT with fluorouracil alone. The three-year DFS was 64.6% (95% CI = 57.3 to 71.9), 77.6% (95% CI = 74.5 to 80.7), and 92.3% (95% CI = 88.4 to 96.2) for TRG 0 + 1 (poor regression), TRG 2 + 3 (intermediate regression), and TRG 4 (complete regression), respectively ( P < .001, PC 3). TRG constituted an independent prognostic factor for DFS (TRG 2 + 3 vs TRG 0 + 1, HR = 0.68, 95% CI = 0.51 to 0.90, P = .007). Due to multicollinearity, TRG 4 and pathologic stage could not be tested within the same model. The treatment effect on DFS was captured by TRG, satisfying individual-level PC4. Conclusions: Higher TRG after preoperative CRT predicted a favorable long-term outcome. At the individual patient level, TRG was a surrogate marker for DFS. Further phase III trials are needed to validate TRG as a surrogate at trial level. [Mh] Termos MeSH primário: Carcinoma/secundário Carcinoma/terapia Recidiva Local de Neoplasia Neoplasias Retais/patologia Neoplasias Retais/terapia [Mh] Termos MeSH secundário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico Quimiorradioterapia Adjuvante Intervalo Livre de Doença Feminino Fluoruracila/administração & dosagem Seguimentos Seres Humanos Masculino Margens de Excisão Gradação de Tumores Recidiva Local de Neoplasia/patologia Neoplasia Residual Compostos Organoplatínicos/administração & dosagem Período Pré-Operatório [Pt] Tipo de publicação: CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Organoplatinum Compounds); 04ZR38536J (oxaliplatin); U3P01618RT (Fluorouracil) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 180308 [Lr] Data última revisão: 180308 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171206 [St] Status: MEDLINE [do] DOI: 10.1093/jnci/djx095

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[PMID]: 29465604 [Au] Autor: Shen K; Cui X; Xie Z [Ad] Endereço: Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University Changchun, Jilin, P. R. China. [Ti] Título: Double laparoscopy assisted cylindrical abdominal-perineal resection for low rectal cancer with 4 cases report. [So] Source: Medicine (Baltimore);97(8):e9995, 2018 Feb. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: INTRODUCTION: Rectal cancer is a common cancer worldwide. Low rectal cancer exhibits a tendency for recurrence. Surgical resection is an important treatment for rectal cancer. Cylindrical abdominal-perineal resection is suitable for patients with low rectal cancer and has helped improve the prognosis of these patients. However, there are some difficulties during the operation. Especially the perineal area operation cannot be performed under direct vision, which affects the quality of surgical resection. To resolve these constraints, our group designed double laparoscopy assisted cylindrical abdominal-perineal resection for low rectal cancer. CONCLUSION: The procedure effectively solved these problems and reduced the operation time with no increase in surgery complications. [Mh] Termos MeSH primário: Abdome/cirurgia Laparoscopia/métodos Períneo/cirurgia Neoplasias Retais/cirurgia [Mh] Termos MeSH secundário: Idoso Feminino Seres Humanos Masculino Meia-Idade Duração da Cirurgia Neoplasias Retais/patologia [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180222 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009995

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[PMID]: 29361627 [Au] Autor: Takeuchi K; Hayakawa N; Ouchi M [Ad] Endereço: Dept. of Thoracic Surgery, Seirei Yokohama General Hospital. [Ti] Título: [A Case of Long-Term Survival after Resection of Metachronous Metastases to the Liver and Lungs from Primary Rectal Cancer]. [So] Source: Gan To Kagaku Ryoho;44(13):2105-2107, 2017 Dec. [Is] ISSN: 0385-0684 [Cp] País de publicação: Japan [La] Idioma: jpn [Ab] Resumo: A 81-year-old man had undergone high anterior resection for rectalcancer in 20XX. Abdominalcomputed tomography (CT)showed an isolated shadow of 2 cm in size in the liver, 9 years after surgery for colorectal cancer. We performed liver S4 segmental resection and cholecystectomy. Histopathological examination confirmed liver metastases of rectal cancer. On examination of the liver metastasis 5 years after surgery, chest CT showed a shadow of 10mm in size in S6 of the left lung. We performed partialresection via video-assisted thoracic surgery(VATS)in 20XX+14. Histopathological examination revealed lung metastases of rectal cancer. We believe that metachronous metastases from rectal cancer should be removed surgically if radicalcure is possible. [Mh] Termos MeSH primário: Neoplasias Hepáticas/cirurgia Neoplasias Pulmonares/cirurgia Neoplasias Retais/patologia [Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais Hepatectomia Seres Humanos Neoplasias Hepáticas/diagnóstico por imagem Neoplasias Hepáticas/secundário Neoplasias Pulmonares/diagnóstico por imagem Neoplasias Pulmonares/secundário Masculino Pneumonectomia Fatores de Tempo Tomografia Computadorizada por Raios X Resultado do Tratamento [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180124 [St] Status: MEDLINE

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[PMID]: 29268274 [Au] Autor: Saito G; Sadahiro S; Ogimi T; Miyakita H; Okada K; Tanaka A; Suzuki T [Ad] Endereço: Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan. [Ti] Título: Relations of Changes in Serum Carcinoembryonic Antigen Levels before and after Neoadjuvant Chemoradiotherapy and after Surgery to Histologic Response and Outcomes in Patients with Locally Advanced Rectal Cancer. [So] Source: Oncology;94(3):167-175, 2018. [Is] ISSN: 1423-0232 [Cp] País de publicação: Switzerland [La] Idioma: eng [Ab] Resumo: OBJECTIVES: The histologic response to neoadjuvant chemoradiotherapy (nCRT) has been intimately related to outcomes in locally advanced rectal cancer. Serum carcinoembryonic antigen (CEA) levels change after nCRT and after surgery as compared with before nCRT. METHODS: The subjects were 149 patients with locally advanced rectal cancer who received nCRT between 2005 and 2013. The patients were divided into 4 groups according to the serum CEA levels: group 1, 55 patients with negative serum CEA levels before nCRT; group 2, 41 patients with positive serum CEA levels before nCRT that became negative after nCRT; group 3, 37 patients with positive serum CEA levels after nCRT that became negative after surgery; and group 4, 16 patients with positive serum CEA levels after nCRT as well as after surgery. RESULTS: Pathological complete response, T downstaging, and tumor shrinkage were significantly higher in group 1 than in other groups. Disease-free survival was significantly poorer in group 4. The lack of a decrease in the serum CEA level in group 4 was most likely attributed to the persistence of micrometastases outside the resection field. CONCLUSIONS: Changes in serum CEA levels measured before nCRT, after nCRT, and after surgery can be used to reliably predict the histologic response to nCRT and outcomes. [Mh] Termos MeSH primário: Antígeno Carcinoembrionário/sangue Neoplasias Retais/sangue Neoplasias Retais/patologia [Mh] Termos MeSH secundário: Adenocarcinoma/sangue Adenocarcinoma/patologia Adenocarcinoma/cirurgia Adenocarcinoma/terapia Adulto Idoso Idoso de 80 Anos ou mais Biomarcadores Tumorais/sangue Quimiorradioterapia/métodos Intervalo Livre de Doença Feminino Seres Humanos Masculino Meia-Idade Terapia Neoadjuvante/métodos Neoplasias Retais/cirurgia Neoplasias Retais/terapia Reto/patologia Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Biomarkers, Tumor); 0 (Carcinoembryonic Antigen) [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171222 [St] Status: MEDLINE [do] DOI: 10.1159/000485511

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[PMID]: 29390320 [Au] Autor: Xu G; Wang P; Xiao Y; Wu X; Lin G [Ad] Endereço: Department of Liver Surgery. [Ti] Título: Local resection of rectal neuroendocrine tumor with first clinical manifestation of giant liver metastasis by transanal endoscopic microsurgery: A case report. [So] Source: Medicine (Baltimore);96(50):e9153, 2017 Dec. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: RATIONALE: Rectal neuroendocrine tumor (NET) is a relatively rare tumor. Well-differentiated NETs (G1 and G2) rarely display distant metastasis at initial diagnosis. Currently, treatment for the primary lesions of rectal NETs with liver metastasis remains controversial. The liver metastasis was resected in local hospital. Transanal endoscopic microsurgery (TEM) has emerged as an effective minimally invasive surgery for local resection of lower rectal lesions. Herein, we reported the initial application of TEM to remove the rectal primary lesion in patients with low rectal NETs (G2) with giant liver metastases. PATIENT CONCERNS: The patient, a 45-year-old woman, was primarily diagnosed with hepatocellular carcinoma and underwent curative resection of a giant liver lesion in a local hospital. Nevertheless, the postoperative pathologic examination revealed that the lesion was an NET (G2). The colonoscopy then showed a nodule 1.4 cm in diameter, 4 cm above the anal verge, located on the anterior wall of the rectum. The biopsy revealed that the nodule was also an NET (G2). However, the patient did not consent to abdominoperineal resection based on concerns for quality of life. DIAGNOSES: Rectal NET with liver metastasis. INTERVENTIONS: The patient underwent curative resection of liver metastasis. And, TEM was adopted to resect the primary tumor in rectum. OUTCOMES: The patient has been disease-free for 2 years with a good quality of life and presents no local recurrence in the rectum. LESSONS: TEM is an appropriate palliative operation for therapy of rectal NETs with distant metastases, especially for primary rectal NETs located in low rectal. [Mh] Termos MeSH primário: Neoplasias Hepáticas/secundário Neoplasias Hepáticas/cirurgia Tumores Neuroendócrinos/secundário Tumores Neuroendócrinos/cirurgia Neoplasias Retais/patologia Neoplasias Retais/cirurgia Microcirurgia Endoscópica Transanal [Mh] Termos MeSH secundário: Biópsia Colonoscopia Feminino Seres Humanos Meia-Idade [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180301 [Lr] Data última revisão: 180301 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180203 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009153

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[PMID]: 29304105 [Au] Autor: Wang H; Du K; Qu J; Chandarana H; Das IJ [Ad] Endereço: Department of Radiation Oncology, New York University School of Medicine, New York, NY, United States of America. [Ti] Título: Dosimetric evaluation of magnetic resonance-generated synthetic CT for radiation treatment of rectal cancer. [So] Source: PLoS One;13(1):e0190883, 2018. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE: The purpose of this study was to assess the dosimetric equivalence of magnetic resonance (MR)-generated synthetic CT (synCT) and simulation CT for treatment planning in radiotherapy of rectal cancer. METHODS: This study was conducted on eleven patients who underwent whole-body PET/MR and PET/CT examination in a prospective IRB-approved study. For each patient synCT was generated from Dixon MR using a model-based method. Standard treatment planning directives were used to create a four-field box (4F), an oblique four-field (O4F) and a volumetric modulated arc therapy (VMAT) plan on synCT for treatment of rectal cancer. The plans were recalculated on CT with the same monitor units (MUs) as that of synCT. Dose-volume metrics of planning target volume (PTV) and organs at risk (OARs) as well as gamma analysis of dose distributions were evaluated to quantify the difference between synCT and CT plans. All plans were calculated using the analytical anisotropic algorithm (AAA). The VMAT plans on synCT and CT were also calculated using the Acuros XB algorithm for comparison with the AAA calculation. RESULTS: Medians of absolute differences in PTV metrics between synCT and CT plans were 0.2%, 0.2% and 0.3% for 4F, O4F and VMAT respectively. No significant differences were observed in OAR dose metrics including bladder V40Gy, mean dose in bladder, bowel V45Gy and femoral head V30Gy in any techniques. Gamma analysis with 2%/2mm dose difference/distance to agreement criteria showed median passing rates of 99.8% (range: 98.5 to 100%), 99.9% (97.2 to 100%), and 99.9% (99.4 to 100%) for 4F, O4F and VMAT, respectively. Using Acuros XB dose calculation, 2%/2mm gamma analysis generated a passing rate of 99.2% (97.7 to 99.9%) for VMAT plans. CONCLUSION: SynCT enabled dose calculation equivalent to conventional CT for treatment planning of 3D conformal treatment as well as VMAT of rectal cancer. The dosimetric agreement between synCT and CT calculated doses demonstrated the potential of MR-only treatment planning for rectal cancer using MR generated synCT. [Mh] Termos MeSH primário: Neoplasias Retais/radioterapia [Mh] Termos MeSH secundário: Feminino Seres Humanos Imagem por Ressonância Magnética Masculino Imagem Multimodal Tomografia por Emissão de Pósitrons Dosagem Radioterapêutica Tomografia Computadorizada por Raios X [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180223 [Lr] Data última revisão: 180223 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180106 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0190883

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[PMID]: 28462478 [Au] Autor: Francis N; Penna M; Mackenzie H; Carter F; Hompes R; International TaTME Educational Collaborative Group [Ad] Endereço: Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, Somerset, BA21 2RH, UK. nader.francis@ydh.nhs.uk. [Ti] Título: Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). [So] Source: Surg Endosc;31(7):2711-2719, 2017 Jul. [Is] ISSN: 1432-2218 [Cp] País de publicação: Germany [La] Idioma: eng [Ab] Resumo: BACKGROUND: The interest and adoption of transanal total mesorectal excision (TaTME) is growing amongst the colorectal surgical community, but there is no clear guidance on the optimal training framework to ensure safe practice for this novel operation. The aim of this study was to establish a consensus on a detailed structured training curriculum for TaTME. METHODS: A consensus process to agree on the framework of the TaTME training curriculum was conducted, seeking views of 207 surgeons across 18 different countries, including 52 international experts in the field of TaTME. The process consisted of surveying potential learners of this technique, an international experts workshop and a final expert's consensus to draw an agreement on essential elements of the curriculum. RESULTS: Appropriate case selection was strongly recommended, and TaTME should be offered to patients with mid and low rectal cancers, but not proximal rectal cancers. Pre-requisites to learn TaTME should include completion of training and accreditation in laparoscopic colorectal surgery, with prior experience in transanal surgery. Ideally, two surgeons should undergo training together in centres with high volume for rectal cancer surgery. Mentorship and multidisciplinary training were the two most important aspects of the curriculum, which should also include online modules and simulated training for purse-string suturing. Mentors should have performed at least 20 TaTME cases and be experienced in laparoscopic training. Reviewing the specimens' quality, clinical outcome data and entering data into a registry were recommended. Assessment should be an integral part of the curriculum using Global Assessment Scales, as formative assessment to promote learning and competency assessment tool as summative assessment. CONCLUSIONS: A detailed framework for a structured TaTME training curriculum has been proposed. It encompasses various training modalities and assessment, as well as having the potential to provide quality control and future research initiatives for this novel technique. [Mh] Termos MeSH primário: Cirurgia Colorretal/educação Currículo Neoplasias Retais/cirurgia Reto/cirurgia Cirurgia Endoscópica Transanal/educação [Mh] Termos MeSH secundário: Seres Humanos Cooperação Internacional Cirurgia Endoscópica Transanal/métodos [Pt] Tipo de publicação: CONSENSUS DEVELOPMENT CONFERENCE; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180223 [Lr] Data última revisão: 180223 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170503 [St] Status: MEDLINE [do] DOI: 10.1007/s00464-017-5562-5

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[PMID]: 29443751 [Au] Autor: Zhang K; Qu S; Li J; Cheng Y; Shi J; Liu T [Ad] Endereço: Department of General Surgery. [Ti] Título: A case report of rectal schwannoma treated with laparoscopic proctectomy. [So] Source: Medicine (Baltimore);97(7):e9866, 2018 Feb. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: RATIONALE: Schwannomas of gastrointestinal tracts are rare and difficult to detect preoperatively because of negative results of endoscopic and imaging examinations. Here, we reported a case of rectal schwannoma, which was diagnosed by immunohistochemical staining after laparoscopic protectomy. PATIENT CONCERNS: A 61-year-old woman complained of a 1-month history of difficulty in defecation and irregularly abdominal discomfort during her physical checkup in our hospital. DIAGNOSES: Immunohistochemical staining results after laparoscopic protectomy revealed a strong positive reaction for S-100 protein. Therefore, rectal schwannoma was confirmed. INTERVENTIONS: Treatment with laparoscopic protectomy was given. OUTCOMES: Symptoms resolved completely after 12 days of the surgery, and was regular followed-up in outpatient clinic. LESSONS: Schwannomas are difficult to identify preoperatively, and immunohistochemical staining for S-100 protein is an effective method to diagnose it. [Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório/métodos Laparoscopia/métodos Neurilemoma Neoplasias Retais Proteínas S100/análise [Mh] Termos MeSH secundário: Biópsia/métodos Feminino Seres Humanos Imuno-Histoquímica Meia-Idade Neurilemoma/patologia Neurilemoma/fisiopatologia Neurilemoma/cirurgia Neoplasias Retais/patologia Neoplasias Retais/fisiopatologia Neoplasias Retais/cirurgia Resultado do Tratamento [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Nm] Nome de substância: 0 (S100 Proteins) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180222 [Lr] Data última revisão: 180222 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180215 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009866

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[PMID]: 29390548 [Au] Autor: Huang MJ; Wang XD; Hu YJ; Yang J; Li K [Ad] Endereço: Nursing Department. [Ti] Título: Short-course neoadjuvant chemoradiotherapy and surgery are beneficial in Chinese patients: A retrospective study. [So] Source: Medicine (Baltimore);96(51):e9394, 2017 Dec. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Preoperative neoadjuvant chemoradiotherapy (NACR) is used to reduce tumor size for easier resection or improved resectability rates. Considering the difficulties regarding health insurance and health resources in China, an evidence-based short-course neoadjuvant chemoradiotherapy with surgery to cure patients was performed. This study compared the postoperative effects between short-course neoadjuvant chemoradiotherapy and surgery and surgery without neoadjuvant chemoradiotherapy.The current retrospective study was based on a rectal cancer database, including 274 patients diagnosed with rectal cancer between January 2014 and October 2016. Data were analyzed with respect to curative rate, postoperative recovery indicators (times to nasogastric tube, urinary catheter, and drainage tube removal and times to first oral feeding and passing of flatus postsurgery), chemoradiotherapy-related indicators [white blood cell count (WBC) and carcinoembryonic antigen (CEA) levels], and adverse effects indicators, evaluated according to Common Terminology Criteria for Adverse Events Version 4.0.There was no significant difference between the combined therapy and surgery groups (P > .05) in terms of radical resection rates and the times to urinary catheter removal and passing flatus (P > .05). Statistically significant differences (P < .05) in terms of earlier time for removal of the nasogastric and drainage tubes and time to first oral feeding were observed in the combined therapy group. The decreases in WBC and CEA levels in the combined therapy group were significantly greater than those in the surgery group 1 week after surgery (P < .05); after 1 month, the CEA decrease in the combined therapy group was significantly greater than that in the surgery group (P < .05). More patients in the combined therapy group experienced vomiting, indigestion, dehydration, oral mucositis, sensory neuritis, and alopecia compared with those in the surgery group 1 week after surgery (P < .05); after 1 month, only the incidence of alopecia was higher in the combined therapy group (P < .05).The combined therapy group demonstrated earlier postoperative recovery compared with the surgery group. Short-course neoadjuvant chemoradiotherapy with surgery may lead to postoperative treatment-related adverse effects of varying degrees; however, these adverse effects eventually improve with time. [Mh] Termos MeSH primário: Adenocarcinoma/terapia Antineoplásicos/uso terapêutico Quimiorradioterapia Adjuvante Terapia Neoadjuvante Neoplasias Retais/terapia Reto/cirurgia [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais China Feminino Seguimentos Seres Humanos Masculino Meia-Idade Melhoria de Qualidade Estudos Retrospectivos Resultado do Tratamento [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Nm] Nome de substância: 0 (Antineoplastic Agents) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180214 [Lr] Data última revisão: 180214 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180203 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009394

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[PMID]: 29390545 [Au] Autor: Duan SJ; Gao ZM; Wang PL; Gong BC; Huang HW; Luo L; Wang X; Xing YN; Xu HM; Liu FN [Ad] Endereço: Department of Surgical Oncology, The First Affiliated Hospital of China Medical University. [Ti] Título: Rare upper gastrointestinal hemorrhage of cetuximab: A case report. [So] Source: Medicine (Baltimore);96(51):e9391, 2017 Dec. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: RATIONALE: cetuximab, an epidermal growth factor receptor inhibitor, is a targeted therapeutic regimen of colorectal cancers. Several common adverse effects have been found, such as cutaneous or gastrointestinal toxicity. However, according to the articles had been published, upper gastrointestinal bleeding (UGIB) is considered to be rare and its mechanism remains unclear. PATIENT CONCERNS: In this report, we presented a 42-year-old male patient with advanced recto-sigmoid cancer. After palliative operation, the patient suffered from complete upper gastrointestinal (GI) obstruction, which was induced by extensive abdominal metastasis of the tumor. Considering his poor condition, we chose the targeted drug, cetuximab, as his further treatment. But after the application of cetuximab, the UGIB immediately happened twice in this patient. DIAGNOSIS: UGIB, as a rare complication of cetuximab, occured to the patient. INTERVENTIONS: We stopped the bleeding with thrombin, hemocoagulase and somatostatin and suspended the subsequent treatment plan of cetuximab. At the same time, anti-shock treatment was given immediately. OUTCOMES: He was died of respiratory and circulatory failure caused by UGIB and advanced tumor eventually. LESSONS: UGIB should be considered as a rare but severe complication of cetuximab. When cetuximab is applied for patients with advanced colon tumors, more cautions should be required if the patients are accompanied by upper gastrointestinal obstruction. In addition, for those patients who suffered from UGIB recently, cetuximab should be prohibited if the Rockall score ranged > 5 points. [Mh] Termos MeSH primário: Adenocarcinoma/tratamento farmacológico Antineoplásicos Imunológicos/efeitos adversos Cetuximab/efeitos adversos Hemorragia Gastrointestinal/induzido quimicamente Hematemese/induzido quimicamente Neoplasias Retais/tratamento farmacológico Neoplasias do Colo Sigmoide/tratamento farmacológico [Mh] Termos MeSH secundário: Adulto Antineoplásicos Imunológicos/uso terapêutico Cetuximab/uso terapêutico Evolução Fatal Hemorragia Gastrointestinal/diagnóstico Hematemese/diagnóstico Seres Humanos Masculino [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Nm] Nome de substância: 0 (Antineoplastic Agents, Immunological); PQX0D8J21J (Cetuximab) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180214 [Lr] Data última revisão: 180214 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180203 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009391

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2	and or and not		PalavrasDescritor de assuntoDescritor de assunto primárioLimitesAutorPalavras do títuloPalavras do resumoIdiomaPaís de publicaçãoNome de substânciaNome de pessoa como assuntoRevistaAssunto de RevistaISSNTipo de publicaçãoIdentificador únicoMês de entradaAno de publicaçãoTexto completoAtualização por classeCategoria DeCSCategoria DeCS explodidaCategoria CID-10SubSetsPais de AfiliaçãoAfiliaçãoAfiliação 2
3	and or and not		PalavrasDescritor de assuntoDescritor de assunto primárioLimitesAutorPalavras do títuloPalavras do resumoIdiomaPaís de publicaçãoNome de substânciaNome de pessoa como assuntoRevistaAssunto de RevistaISSNTipo de publicaçãoIdentificador únicoMês de entradaAno de publicaçãoTexto completoAtualização por classeCategoria DeCSCategoria DeCS explodidaCategoria CID-10SubSetsPais de AfiliaçãoAfiliaçãoAfiliação 2

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