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Pedro L Martínez-Hernández,
Angel Hernanz-Macías,
Carmen Gómez-Candela,
Cristina Grande-Aragón, Jaime Feliu-Batlle,
Javier Castro-Carpeño,
Isabel Martínez-Muñoz,
Laura Zurita-Rosa,
Marta Villarino-Sanz,
Concepción Prados-Sánchez,
Joaquín Sánchez García-Girón
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ABSTRACT: Interleukin-15 (IL-15) has important anabolic effects on muscle protein metabolism through a decrease in the ATP-ubiquitin-dependent proteolytic pathway. The role of IL-15 in human cancer cachexia is unknown. The aim of this study was to assess the relationship between interleukin-15 (IL-15) in cancer patients with cachexia at diagnosis of malignancy and 8 weeks later. An observational study of 21 cancer patients (with and without cachexia) and 8 healthy subjects was conducted. Body composition was measured by leg-to-leg impedance. Serum IL-15 levels were assessed at baseline and after 4 and 8 weeks. Baseline IL-15 values were similar in cancer patients and in healthy subjects. Cancer patients with lower baseline levels of IL-15 (<2 pg/ml) had significantly higher fat mass (%) along the study. Eighteen patients completed the study: five patients showed an increase of 3.7 kg at the end of the study (5.4% of body weight) and showed a mean increase of IL-15 of 1.32 pg/ml (121%) at 4 weeks and 2.32 pg/ml (197%) at 8 weeks, as compared with mean decrease of -4.1 kg (-5.3%) and -0.09 pg/ml (-2.5%) and 0.6 pg/ml (40.8%) in the 13 patients who lost weight (P=0.001 and P=0.022, respectively). Changes of IL-15 at 4 and 8 weeks were directly associated with changes in body weight, body mass index (BMI), fat-free mass and muscle mass (P<0.05), and indirectly associated with percentage of weight loss (P<0.05). In summary, although the results indicate that IL-15 does not have a role in cancer cachexia pathogenesis, the association during evolution between serum IL-15 and changes in weight and muscle mass suggests a possible role of IL-15 as a marker of the body composition response in cancer patients who are losing weight at the time of diagnosis.
Oncology Reports 07/2012; 28(4):1443-52. · 1.84 Impact Factor
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ABSTRACT: The use of indwelling central venous catheters (CVCs) has improved the management of patients with cancer. However, these devices can be complicated by thrombosis because of their procoagulant state, therapies, immobility, and comorbidities. In addition, an indwelling CVC is a foreign body within the blood stream and can cause a mechanical injury during its insertion. Female sex, age, weight, primitive tumor (ovarian and lung adenocarcinoma), factor V Leiden, increased plasma levels of homocysteine, previous CVC risk of thrombosis, and chemotherapy as well as the material of the catheter, its tip location, the side of implantation insertion, and insertion time and attempts have shown relationships with higher rates of thrombosis. Actual data report a lower incidence of asymptomatic and symptomatic thrombosis (5%). This could be explained by technical improvement, different patient populations, and methodologic limitations in studies. Prophylaxis with heparins and coumarins are not supported by actual reliable evidence. The best treatment is not defined, but thrombolysis could be a simple, safe, and effective method that could decrease the rate of postphlebotic syndrome. A systematic phase III clinical trial should be performed to clarify these issues. Central venous catheter infection, postphlebitic syndrome, and pulmonary embolism are the most relevant complications of catheter-related thrombosis.
Supportive Cancer Therapy 05/2007; 4(3):145-51.
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ABSTRACT: The aim of this study was to evaluate the efficacy of preoperative radiation therapy for resectable rectal adenocarcinoma (T3-T4) when delivered in combination with chemotherapy (oral tegafur-uracil modulated with leucovorin).
Thirty-eight patients (23 males; mean age, 62 years.) with histologically proven rectal adenocarcinoma with primary tumor clinical classification T3-T4 (resectable) and N0 or N1-N2, according to TNM staging system, took part in the present clinical trial. After tumor and metastasis resectability confirmation, radiation therapy was administered by delivering a dose of 45 Gy in 25 fractions for 5 weeks. Chemotherapy treatment was initiated on the same day as radiotherapy and consisted of intravenous infusion of 6S-steroisomer of leucovorin 250 mg/m /day in 2 hours on Day 1, followed by oral 350 or 300 mg/m /day of tegafur (a 5-fluorouracil prodrug) plus uracil on Days 1 to 14 divided into 2 daily doses, and oral 6S-steroisomer of leucovorin 7.5 mg/12 hours on Days 2 to 14, with a total of 102 courses of neoadjuvant chemotherapy (, mean of 2.7 courses per patient). Six additional courses of tegafur-uracil were given postoperatively to all 38 patients but 1 who refused.
As a result of preoperative chemoradiation treatment, 4 (10.5 percent) complete responses, 20 (52.6 percent) partial responses, and 14 (36.8 percent) patients with disease stabilization were observed. No patients had preoperative disease progression. Histologically proven downstaging was observed in 23 (60 percent) patients. On initial evaluation, only 39 percent of patients were considered as being good candidates for sphincter-preserving surgery; however, on preoperative chemoradiation completion this figure increased up to 60 percent. For the 23 patients eventually undergoing sphincter-preserving surgery, postoperative sphincter function assessment showed excellent function in 15 (65 percent) patients, good in 5 (22 percent), fair in 2 (9 percent), and poor in 1(4 percent). With a median follow-up of 37 (range, 10-62) months, local failure was found in 3 (8 percent) patients and distant failure in 2 (5 percent). Three-year actuarial disease-free survival and 3-year overall survival rates were 83 and 90 percent, respectively. Local control rate was 92 percent. Toxicity and postoperative complication rates were reasonable.
Our neoadjuvant radiation therapy protocol is efficient for the preoperative treatment of resectable rectal adenocarcinoma when combined with chemotherapy (oral tegafur-uracil modulated with leucovorin). this protocol needs to be tested in a phase-III clinical trial with a larger sample size.
Diseases of the Colon & Rectum 11/2002; 45(10):1349-58. · 3.13 Impact Factor
