topics / مواضيع

  Abstract BACKGROUND: Chemo- and radiotherapy for breast cancer (BC) can lead to cardiotoxicity even years after the initial treatment. The pathophysiology behind these late cardiac effects is poorly understood. Therefore, we studied a large panel of biomarkers from different pathophysiological domains in long-term BC survivors, and compared these to matched controls. METHODS AND RESULTS: In total 91 biomarkers were measured in 688 subjects: 342 BC survivors stratified either to treatment with chemotherapy ± radiotherapy (n = 170) or radiotherapy alone (n = 172) and matched controls. Mean age was 59 ± 9 years and 65 ± 8 years for women treated with chemotherapy ± radiotherapy and radiotherapy alone, respectively, with a mean time since treatment of 11 ± 5.5 years. No biomarkers were differentially expressed in survivors treated with radiotherapy alone vs. controls (P for all >0.1). In sharp contrast, a total of 19 biomarkers were elevated, relative to controls, in BC survivors trea

Abstract Chemotherapy-induced cardiovascular toxicity (CICT) is a well-established risk for cancer survivors and causes diseases such as heart failure, arrhythmia, vascular dysfunction, and atherosclerosis. As our knowledge of the precise cardiovascular risks of each chemotherapy agent has improved, it has become clear that genomics is one of the most influential predictors of which patients will experience cardiovascular toxicity. Most recently, GWAS-led, top-down approaches have identified novel genetic variants and their related genes that are statistically related to CICT. Importantly, the advent of human-induced pluripotent stem cell (hiPSC) models provides a system to experimentally test the effect of these genomic findings in vitro, query the underlying mechanisms, and develop novel strategies to mitigate the cardiovascular toxicity liabilities due to these mechanisms. Here we review the cardiovascular toxicities of chemotherapy drugs, discuss how these can be modeled in vitro,

  Abstract INTRODUCTION: Despite the growing spotlight on value-based care and patient safety, little is known about the influence of patient-, reconstruction-, and facility-level factors on safety events following breast reconstruction. The purpose of this study is to characterize postoperative complications in light of hospital-level risk factors. METHODS: Using the National Inpatient Sample, all patients who underwent free flap and prosthetic breast reconstruction from 2012 to 2014 were identified. Predictor variables included patient demographic and clinical characteristics, type and timing of reconstruction, annual hospital reconstructive volume, hospital bed size, hospital setting (rural vs. urban), and length of stay. Patient safety indicators (PSIs) were based on the Agency for Healthcare Research and Quality's designation of preventable hospital complications: venous thromboembolism, bleeding, wound complications, pneumonia, and sepsis. Logistic models were used to analyze

  Abstract Myocardial steatosis, also known as lipomatosis cordis, is characterized by adipose tissue within the myocardium without significant fibrosis. Evidence suggests that accumulation of fat can disturb the normal electromechanical physiology of the myocardium. Herein, we discuss the case of a 60-year-old woman with a history of chronic obstructive pulmonary disease who died because of anoxic encephalopathy after a sudden cardiac arrest (SCA). An electrocardiogram showed QRS fragmentation noted as notched R in inferior leads. The autopsy revealed a very small thromboembolus in a distal subsegmental branch of the pulmonary artery, which could not explain the SCA. There was an extensive intramyocardial accumulation of adipose tissue involving the right ventricle and interventricular septum, which split the myocardium into discrete bundles. Arrhythmogenic right ventricular cardiomyopathy was ruled out based on the absence of typical fibrofatty changes. The mechanism of fat replaceme

  Abstract PURPOSE: Verify whether there is a difference in likelihood of developing pulmonary embolism (PE) between pregnant women, nonpregnant women of reproductive age, and postpartum (up to 6 weeks) women, by comparing their outcomes on computed tomography pulmonary angiography (CTPA) done for suspicion of PE. MATERIALS AND METHODS: Retrospective cohort study of 1463 CTPA done for suspicion of PE in females of reproductive age (18-40 years), nonpregnant, pregnant (antepartum), and postpartum, from 2 tertiary-care academic hospitals between October 2006 and September 2015. Primary outcome was diagnosis of PE on imaging. Additional assessment was made of technical adequacy of the studies and method of delivery for the postpartum cohort (vaginal vs caesarean birth). Twenty-nine technically nondiagnostic studies were excluded. The effect of any potential variable on PE status was tested using univariate logistic regression. Subgroup analysis was performed after excluding patients with

  Abstract BACKGROUND: Venous thromboembolism (VTE) is a frequent complication of cancer. Elevated D-Dimer is associated with an increased risk of cancer-associated VTE. Whether changes in D-Dimer over time harbor additional prognostic information that may be exploited clinically for dynamic prediction of VTE is unclear. OBJECTIVES: To explore the potential role of longitudinal D-Dimer trajectories for personalized prediction of cancer-associated VTE. PATIENTS/METHODS: 167 patients with active malignancy were prospectively enrolled (gastrointestinal: n=59 (35%), lung: n=56 (34%), brain: n=50 (30%), others: n=2 (1%); metastatic disease: n=74 (44%)). D-Dimer (median=0.8µg/mL [25th -75th percentile: 0.4-2.0]) was measured at baseline and during 602 monthly follow-up visits. Joint models of longitudinal and time-to-event data were implemented to quantify the association between D-Dimer trajectories and prospective risk of VTE. RESULTS: VTE occurred in 20 patients (250-day VTE risk=12.1%, 9

  Abstract CASE DESCRIPTION: A 55-year-old patient with locally advanced pancreatic carcinoma will start Folfirinox. Should he get thromboprophylaxis? CONSIDERATION: Patients with malignant disease have increased risk of venous thromboembolism (VTE). Several types of malignancy, surgery, chemotherapy and metastasis lead to increased risk. VTE is an underdiagnosed phenomenon and the second cause of death in patients treated with chemotherapy. Therapeutic doses increase the risk of bleeding compared to prophylactic anticoagulant treatment. Even though they are less than perfect, several risk scores are able to identify patients with high risk of VTE. The AVERT and CASSINI trials showed that prophylactic doses of DOACs in cancer patients with high risk of VTE are able to significantly reduce this risk. CONCLUSION: Even though there are many unresolved questions, it seems rational to start thromboprophylaxis in patients with aggressive types of cancer, preferably using DOACs, but low molec

  Abstract Cardiac dysfunction is a major side effect of trastuzumab therapy for patients with HER2-positive breast cancer. Beta blockers, such as carvedilol, have been used for protection of trastuzumab cardiotoxicity but there is no definitive conclusive clinical report on their efficacy. In the present study, the preservability effects of carvedilol on trastuzumab-induced left ventricular (LV) dysfunction and the reversibility of trastuzumab-induced cardiotoxicity were evaluated in Wistar rats by echocardiography method. We showed that trastuzumab treatment of rats could induce the LV dysfunction through increasing the LV internal systolic diameter (LVIDs), increasing the end-systolic volume (ESV), decreasing the ejection fraction (EF), and decreasing the fractional shortening (FS). These parameters were not reversed after 14 days of stopping trastuzumab administration. Interestingly, carvedilol improved LVIDs, ESV, EF, and FS. Collectively, the results of this study have verified c

  Abstract INTRODUCTION:  Urothelial carcinoma of the urinary bladder is a tumour of advanced age. The demographic change increases the number of very old patients ( > 80 years) subjected to TUR-B. MATERIAL AND METHODS:  In a retrospective analysis, perioperative complications in 89 patients (> 80 years), who underwent a transurethral resection of the bladder between 2013 and 2016 in our department, were recorded and evaluated using the Clavien-Dindo grading system. RESULTS:  Mean patient age was 87 years (82 - 94). 81 patients (91 %) were treated with oral anticoagulants (32 × ASA, 24 × NOACs, 25 × Marcumar). A histological examination revealed no tumour in 25/89 (28 %) patients, pTa in 28/89 (31 %), pT1 in 22/89 (25 %) and pT2 or higher in 14/89 patients (16 %), respectively. A total of 36/89 (40 %) patients experienced complications according to the Clavien-Dindo classification. 21/89 (23 %) of patients had a prolonged bladder irrigation due to macrohaematuria, 5/89 (6 %) need

  Abstract Vascular air embolism (VAE) is a known complication of contrast-enhanced CT (CECT) scan occurring in venous or arterial circulation with a wide spectrum of presentations. We report a case of a 44-year-old woman with endometrial adenocarcinoma stage IVB complicated with liver abscess and pulmonary embolism who developed VAE following a routine CECT scan after the sixth cycle of chemotherapy. This was an incidental finding and the patient remained asymptomatic throughout. As such, she was treated conservatively and gradually recovered. This case report serves as a reminder that VAE should be considered in patients presenting with unexplained symptoms following this procedure. PMID: 31466969 [PubMed - indexed for MEDLINE] 18:40 Photo Not included, change data exporting settings to download. 256×256, 6.0 KB 18:40 In reply to this message pubmed: caandvteortroorpul [Intra- and postoperative complications classified according to the Clavien-Dindo classification in patients > 80

  Abstract INTRODUCTION: Patients with cancer have higher risk of thrombosis compared to the general population and particularly lung adenocarcinoma is considered at high risk for venous thromboembolism. Some targetable oncogenic drivers are supposed to further increase this risk. CASE DESCRIPTION: A 35-year-old man who had developed a recurrent venous thromboembolism and pulmonary embolism (PE) was diagnosed with ROS1 rearranged non-small cell lung cancer (NSCLC). While molecular examinations were ongoing, he developed progressive respiratory failure. For PE and thrombosis worsening with detection of right heart thrombus, he underwent therapy with unfractionated heparin. Despite initial good radiologic results, only with the start of crizotinib did the patient's clinical condition significantly improve to configure a Lazarus response. CONCLUSIONS: Cancer diagnosis should always be considered in patients with unprovoked thrombosis and, if NSCLC is diagnosed, genetic alterations sho

  Abstract Background Coexistence of cancer and cardiovascular disease is increasingly frequent, but nationwide data covering cancer patients with myocardial infarction (MI) are scarce. We sought to investigate the prevalence of cancer in patients with first MI, and its impact on cardiovascular and bleeding outcome. Methods and Results Using nationwide Swedish quality registries, all patients admitted for first MI between 2001 and 2014 were identified. Data on comorbidity, cancer, and outcome were obtained from the national cancer and patient registries. Stratification was performed according to cancer during the 5 years before MI. Multivariable Cox proportional hazards analyses adjusting for cardiovascular risk factors and invasive treatment assessed the association of cancer with outcome. In total, 175 146 patients with first MI were registered, of whom 9.3% (16 237) had received care for cancer in the 5 years before admission. The cancer rate increased from 6.7% in the years 2001-20

  Abstract PURPOSE: To evaluate cardiac imaging abnormalities after modern radiotherapy and trastuzumab in breast cancer patients. PATIENTS AND METHODS: All patients treated with trastuzumab and radiotherapy for breast cancer between 2006 and 2014 with available cardiac imaging (echocardiogram or multigated acquisition scan) were retrospectively analyzed. Cardiac abnormalities included myocardial abnormalities (atrial or ventricular dilation, hypertrophy, hypokinesis, and impaired relaxation), decreased ejection fraction > 10%, and valvular abnormalities (thickening or stenosis of the valve leaflets). Breast laterality (left vs. right) and heart radiation dose volume parameters were analyzed for association with cardiac imaging abnormalities. RESULTS: A total of 110 patients with 57 left- and 53 right-sided breast cancers were evaluated. Overall, 37 patients (33.6%) developed a new cardiac abnormality. Left-sided radiotherapy was associated with an increase in new cardiac abnormalit

  Abstract INTRODUCTION: The number of hematopoietic stem cell transplants (HSCTs) performed in the United States and worldwide is increasing. Cardiac events have been well described in HSCT, and the incidence and type of cardiac events have not changed over recent decades. PATIENTS AND METHODS: This study adds to the body of evidence in describing the incidence and type of cardiac events experienced by an allogeneic and autologous HSCT population at a single institution from 2012 to 2017. RESULTS: Sixty-five (9.8%) patients experienced cardiac events, including atrial arrhythmia (N = 39), acute heart failure (N = 9), acute coronary syndrome (N = 7), and new onset hypertension (N = 9), with a few instances of bradycardia, ventricular arrhythmia, pericardial effusion, and pericarditis. Our multivariable regression analysis identified age (older), creatinine (higher), and history of coronary artery disease to significantly correlate with risk of cardiac event (P = .005, P = .039, and P =

  Abstract AIMS: Childhood cancer therapy is associated with a significant risk of therapy-related cardiotoxicity. This meta-analysis aims to evaluate cardiac biomarkers for the detection of cancer therapy-related left ventricular (LV) dysfunction in childhood cancer patients. METHODS AND RESULTS: PubMed, Cochrane Library, Wiley Library, and Web of Science were screened for studies investigating brain natriuretic peptide (BNP)/N-terminal proBNP (NT-proBNP) or cardiac troponin in childhood cancer patients. The odds ratios (OR) for elevation of cardiac biomarkers and association with LV dysfunction were calculated using a random-effects model. Data from 27 studies with 1651 subjects were included. BNP/NT-proBNP levels were higher post-treatment compared with controls or pre-treatment values [standardized mean difference = 1.0; 95% confidence interval (CI) = 0.6-1.4; n = 320; P < 0.001]. CONCLUSIONS: BNP/NT-proBNP is associated with cardiotoxicity in paediatric cancer patients receivin

  Abstract BACKGROUND: Mechanisms underlying impaired exercise capacity and increased cardiovascular mortality observed in breast cancer (BC) patients remain unclear. The prevalence, functional, and prognostic significance of elevated resting heart rate (HR) and abnormal heart rate recovery (HRR) in breast cancer (BC) requires evaluation. METHODS: In a single-center, retrospective, case-control study of women referred for exercise treadmill testing (ETT), 448 BC patients (62.6 ± 10.0 years) were compared to 448 cancer-free, age-matched controls. Elevated resting HR was defined as HR ≥80 bpm at rest. Abnormal HRR at 1-minute following exercise was defined as ≤12 bpm if active recovery or ≤18 bpm if passive recovery. Association of these parameters with exercise capacity and all-cause mortality was evaluated. RESULTS: Elevated resting HR (23.7% vs 17.0%, P = 0.013) and abnormal HRR (25.9% vs 20.3%, P = 0.048) were more prevalent in BC cohort than controls. In adjusted analyses, BC patien

  Abstract Anthracyclines have proved to be one of the most effective chemotherapeutic agents in the treatment of numerous solid tumors and hematologic malignancies in both adult and pediatric patients. Their clinical benefit, however, is sometimes hampered by the development of cardiotoxicity, a process that still remains elusive despite decades of investigation. It has been postulated that anthracycline-induced cardiotoxicity is mediated in part by reactive oxygen species and redox cycling. This article reviews anthracycline cardiotoxicity in terms of historical significance, epidemiology, current detection strategies, prevention strategies, and patient care after anthracycline-based chemotherapy. PMID: 31587778 [PubMed - indexed for MEDLINE] 00:40 Video file Not included, change data exporting settings to download. 00:00, 2.1 KB 00:40 In reply to this message pubmed: ctoall&ca or conall Case-control study of heart rate abnormalities across the breast cancer survivorship continuu

  Abstract The introduction of targeted agents into modern cancer therapy pursued the goal of molecularly more specific, and thereby more effective and safer, therapies. Paradoxically, however, several toxicities were brought to greater attention, among these not only cardiac but also vascular toxicities. The latter reach far beyond venous thromboembolism and include a broad spectrum of presentations based on the vascular territories and pathomechanisms involved, including abnormal vascular reactivity, acute thrombosis, or accelerated atherosclerosis. This article provides an overview of the most common presentations and their management strategies. PMID: 31587779 [PubMed - indexed for MEDLINE] 00:40 Photo Not included, change data exporting settings to download. 256×256, 6.0 KB 00:40 In reply to this message pubmed: ctoall&ca or conall Anthracycline Cardiotoxicity: It Is Possible to Teach an Old Dog Some New Tricks. //www.ncbi.nlm.nih.gov/corehtml/query/egifs/https:--linkinghub.el

  Abstract The advent of immunotherapy, particularly immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, has ushered in a promising new era of treatment of patients with a variety of malignancies who historically had a poor prognosis. However, these therapies are associated with potentially life-threatening cardiovascular adverse effects. As immunotherapy evolves to include a wider variety of malignancies, risk stratification, prompt recognition, and treatment of cardiotoxicity will become increasingly important and hence cardiologists will need to play a fundamental role in the comprehensive care of these patients. This article reviews cardiotoxicity associated with contemporary immunotherapy and discusses potential management strategies. PMID: 31587780 [PubMed - indexed for MEDLINE] 00:39 Photo Not included, change data exporting settings to download. 256×256, 6.0 KB 00:39 In reply to this message pubmed: ctoall&ca or conall Common Vascular Toxicities of Ca

  Abstract Fluoropyrimidines are chemotherapeutic agents that confer great benefit to many patients with solid tumors, but their use is often limited by cardiotoxicity. The incidence and precise mechanisms of cardiotoxicity remain uncertain. Clinical presentations of fluoropyrimidine toxicity are varied and include chest pain, myocardial infarction, acute cardiomyopathy, arrhythmia, cardiogenic shock, and sudden cardiac death. Proposed mechanisms include coronary vasospasm, coronary endothelial dysfunction, direct myocardial toxicity, myocarditis, and Takotsubo cardiomyopathy. Therapeutic and prophylactic interventions primarily target coronary vasospasm as the underlying cause. Prospective studies are needed to develop evidence-based approaches to cardioprotection in patients receiving fluoropyrimidines. PMID: 31587781 [PubMed - indexed for MEDLINE] 00:39 Photo Not included, change data exporting settings to download. 256×256, 6.0 KB 00:39 In reply to this message pubmed: ctoall&c

  Abstract Over the last three decades, the scaffold proteins prohibitins-1 and -2 (PHB1/2) have emerged as key signaling proteins regulating a myriad of signaling pathways in health and diseases. Small molecules targeting PHBs display promising effects against cancers, osteoporosis, inflammatory, cardiac and neurodegenerative diseases. This review provides an updated overview of the various classes of PHB ligands, with an emphasis on their mechanism of action and therapeutic potential. We also describe how these ligands have been used to explore PHB signaling in different physiological and pathological settings. PMID: 32062751 [PubMed - as supplied by publisher] 00:38 Photo Not included, change data exporting settings to download. 256×256, 6.0 KB 00:39 In reply to this message pubmed: ctoall&ca or conall Solid organ transplant rejection associated with immune-checkpoint inhibitors. Related Articles Solid organ transplant rejection associated with immune-checkpoint inhibitors. Ann

  Abstract Background: Anthracycline-treated childhood cancer survivors are at higher risk of cardiotoxicity, especially with cumulative doses received above 250 mg/m2. Dexrazoxane is the only option recommended for cardiotoxicity prevention in high-risk patients supported by randomised trials but its cost-effectiveness in paediatric cancer patients has not been established. Methods: A cost-effectiveness model applicable to different national healthcare system perspectives, which simulates 10,000 patients with either sarcoma or haematologic malignancies, based upon baseline characteristics including gender, age at diagnosis, cumulative anthracycline dose and exposure to chest irradiation. Risk equations for developing congestive heart failure and death from recurrence of the original cancer, secondary malignant neoplasms, cardiac death, pulmonary death, and death from other causes were derived from published literature. These are applied to the individual simulated patients and time un

  Abstract To uncover the genetic basis of anthracycline-induced cardiotoxicity (AIC), we recently established a genetic suppressor screening strategy in zebrafish. Here, we report the molecular and cellular nature of GBT0419, a salutary modifier mutant that affects retinoid x receptor alpha a (rxraa). We showed that endothelial, but not myocardial or epicardial, RXRA activation confers AIC protection. We then identified isotretinoin and bexarotene, two FDA-approved RXRA agonists, which exert cardioprotective effects. The therapeutic effects of these drugs only occur when administered during early, but not late, phase of AIC or as pretreatment. Mechanistically, these spatially- and temporally-predominant benefits of RXRA activation can be ascribed to repair of damaged endothelial cell-barrier via regulating tight-junction protein Zonula occludens-1. Together, our study provides the first in vivo genetic evidence supporting RXRA as the therapeutic target for AIC, and uncovers a previous

  Abstract INTRODUCTION: Within the first year of diagnosis, up to 1 in 3 multiple myeloma (MM) patients will experience a venous thromboembolism (VTE). The International Myeloma Working Group (IMWG) has thromboprophylaxis guidelines that stratify patients into low or high risk for thrombosis and subsequently recommend thromboprophylaxis, but it is unknown if these recommendations are being followed or if they are effective. The purpose of this study was to assess efficacy of the IMWG guidelines and investigate other potential VTE risk factors. METHODS: Study participants were treated at the University of Kansas Medical Center between 2007 and 2013, and charts were reviewed to extract data. Cases (MM and VTE) were matched to controls (MM and no VTE) at approximately 1:3 ratio based on gender, age (±5 years), and time of MM diagnosis (±5 years). RESULTS: A total of 80 cases and 211 controls were matched. Most patients (82%) were considered high risk for experiencing a VTE at the time of

  Abstract OBJECTIVE: The objective of this study was to evaluate complications of Greenfield (Boston Scientific, Marlborough, Mass) stainless steel inferior vena cava (IVC) filters on follow-up computed tomography (CT) imaging and to elucidate associated risk factors. METHODS: Ninety-three patients with CT studies obtained for other reasons after Greenfield IVC filter placement (2007-2014) were retrospectively studied. Greenfield filters were placed permanently in those with venous thromboembolism and an expected lifelong contraindication to anticoagulation or life expectancy <6 months. RESULTS: A total of 190 follow-up CT imaging studies were available for review. In total, filter-associated IVC thrombus (n = 10 [10.7%]) and pulmonary embolism breakthrough (n = 4 [4.3%)] were documented by contrast-enhanced CT. Perforation was evident in 18 patients (19.4%) with an average indwelling time of 256 days. No symptomatic perforation and no strut fracture were documented. There was no s

  Abstract OBJECTIVE: Lower extremity deep venous thrombosis (LEDVT) is common and can lead to pulmonary embolism (PE). Currently, the mechanism of how LEDVT causes PE is unclear. The aim of this study was to explore the relationship between the thrombus sites and PE in LEDVT patients. METHODS: A retrospective study that included the medical data of 3101 patients aged >18 years who were diagnosed with LEDVT by duplex ultrasound was performed at The First Affiliated Hospital of Wenzhou Medical University from 2008 to 2017. The clinical information of the patients was collected. According to the thrombosis sites, the patients were divided into three groups. We determined the cumulative prevalence and prevalence rate of PE between the groups and used Cox proportional hazard regression models, which were stratified on matched sets, to calculate the hazard ratios (HRs) for all of the outcomes of interest. We focused on the relationship of proximal or isolated distal LEDVT with PE and als

  Abstract BACKGROUND: Anatomical lung resection for curative treatment of a tumour disease is the most common selective procedure in oncological thoracic surgery. The goal of the working group of the German Thoracic Surgery Society (DGT) was to achieve a consensus on the perioperative management of selective oncological lung resection procedures. METHODS: The assigned group of the DGT designed and conducted two electronic rounds of questions in all major thoracic and lung centres. Consensus was considered as a rate of ≥ 75%. After statistical analysis of the results, an expert meeting took place and a final Delphi process poll was used in order to reach consensus for controversial topics. RESULTS: Fourteen questions on the perioperative management of anatomical oncological lung resections were proposed and voted on. A consensus was reached for the following topics: preoperative infectiological screening, extended respiratory diagnostics for impaired lung function, use of a cardiac ris

  Abstract OBJECTIVES: Neoadjuvant chemotherapy may be considered  for women with epithelial ovarian cancer who have poor  performance status or a disease burden not amenable to  primary cytoreductive surgery. Overlap exists between  indications for neoadjuvant chemotherapy and known risk  factors for venous thromboembolism, including impaired  mobility, increasing age, and advanced malignancy. The  objective of this study was to determine the rate of  venous thromboembolism among women receiving  neoadjuvant chemotherapy for epithelial ovarian cancer. METHODS: A multi-institutional, observational study of  patients receiving neoadjuvant chemotherapy for primary  epithelial ovarian, fallopian tube, or peritoneal  cancer was conducted. Primary outcome was rate of  venous thromboembolism during neoadjuvant chemotherapy.  Secondary outcomes included rates of venous  thromboembolism at other stages of treatment  (diagnosis, following interval debulking surgery,  during adjuvant chemotherap

  Abstract BACKGROUND: Our knowledge on the burden of symptomatic  and asymptomatic venous thromboembolism (VTE) in  patients with cancer undergoing chemotherapy is  limited. The aim of our study was to prospectively  investigate the frequency of symptomatic VTE and  asymptomatic deep vein thrombosis of the lower limbs  among cancer patients undergoing chemotherapy. METHODS: We studied 231 patients (164 men) with  pancreatic (n=36), lung (n=136), ovarian (n=32) or  prostate (n=27) cancer receiving first line (n=192,  83.1%) or adjuvant chemotherapy, followed-up for 3-6  months. RESULTS: Some 17 patients were diagnosed with VTE,  either asymptomatic detected on leg ultrasound (n=7) or  symptomatic (n=10). The total frequency of VTE was  10.3% (17/165 with follow-up). Pancreatic cancer had  the highest frequency of VTE (4/25, 16%) followed by  ovarian (3/26, 11.5%) and lung cancer (10/94, 10.6%).  There was no statistically significant difference in  VTE rates among cancer types (p=0.36)

  Abstract Venous thromboembolism (VTE) is a common disease  complication in cancer patients and the second cause of  death after cancer progression. VTE management and  prophylaxis are critical in cancer patients, but  effective therapy can be challenging because these  patients are at higher risk of VTE recurrence and  bleeding under anticoagulant treatment. Numerous  published studies report inconsistent implementation of  existing evidence-based clinical practice guidelines  (CPG), including underutilization of  thromboprophylaxis, and wide variability in clinical  practice patterns across different countries and  various practitioners. This review aims to summarize  the 2019 ITAC-CME evidence-based CPGs for treatment and  prophylaxis of cancer-related VTE, which include  recommendations on the use of direct oral  anticoagulants specifically in cancer patients. The  guidelines underscore the gravity of developing VTE in  cancer and recommend the best approaches for treating  and pr

  Abstract Radiofrequency ablation (RFA) can be a therapeutic  option in medically inoperable lung cancer patients. In  this study, we evaluated a prototype bipolar RFA device  applicator that can be deployed from a standard  endobronchial ultrasound (EBUS) bronchoscope to  determine feasibility and histopathological analysis in  animal models. Rabbit lung cancers were created by  transbronchial injection of VX2 rabbit cancer cells.  Once the tumors were developed, they were ablated  transpleurally, under EBUS guidance using the prototype  RFA device. The animals were then sacrificed for  specimen resection. Pig inflammatory lung pseudo-tumors  and lymphadenopathy were created by transbronchial  injection of a talc paste and ablated transbronchially  under EBUS guidance. Pigs were evaluated at five days,  two weeks, and four weeks following ablation by  bronchoscopy and cone-beam computed tomography before  necropsy. Nicotinamide adenine dinucleotide hydrogen  diaphorase staining was e

  Abstract Radiation therapy (RT) is an important component of  cancer therapy, with >50% of cancer patients receiving  RT. As the number of cancer survivors increases, the  short- and long-term side effects of cancer therapy are  of growing concern. Side effects of RT for thoracic  tumors, notably cardiac and pulmonary toxicities, can  cause morbidity and mortality in long-term cancer  survivors. An understanding of the biological pathways  and mechanisms involved in normal tissue toxicity from  RT will improve future cancer treatments by reducing  the risk of long-term side effects. Many of these  mechanistic studies are performed in animal models of  radiation exposure. In this area of research, the use  of small animal image-guided RT with treatment planning  systems that allow more accurate dose determination has  the potential to revolutionize knowledge of clinically  relevant tumor and normal tissue radiobiology. However,  there are still a number of challenges to overcome to

  Abstract Owing to early diagnosis and rapid development of  treatments for cancers, the five-year survival rate of  all cancer types has markedly improved worldwide. Over  time, however, there has been an increase in the number  of cancer patients who develop coronary artery disease  (CAD) due to different causes. First, many risk factors  are shared between cancer and CAD. Second, inflammation  and oxidative stress are common underlying pathogeneses  in both disorders. Lastly, cancer therapy can result in  endothelial injury, coronary artery spasm, and  coagulation, thereby increasing the risk of CAD. As  more cancer patients are being diagnosed with CAD,  specialized cardiac care should be established to  minimize the cardiovascular mortality of cancer  survivors. PMID: 32055781 [PubMed] 12:06 Photo Not included, change data exporting settings to  download. 256×256, 6.0 KB 12:06 In reply to this message pubmed: ctoall&ca or conall Advances in Preclinical Research Models of Radi

Abstract BACKGROUND: Cardiovascular disease (CVD) has become an  increasingly common limitation to effective anticancer  therapy. Yet, whether CVD events were consistently  reported in pivotal trials supporting contemporary  anticancer drugs is unknown. OBJECTIVES: The authors sought to evaluate the  incidence, consistency, and nature of CVD event  reporting in cancer drug trials. METHODS: From the Drugs@FDA, clinicaltrials.gov,  MEDLINE, and publicly available U.S. Food and Drug  Administration (FDA) drug reviews, all reported CVD  events across latter-phase (II and III) trials  supporting FDA approval of anticancer drugs from 1998  to 2018 were evaluated. The primary outcome was the  report of major adverse cardiovascular events (MACE),  defined as incident myocardial infarction, stroke,  heart failure, coronary revascularization, atrial  fibrillation, or CVD death, irrespective of treatment  arm. The secondary outcome was report of any CVD event.  Pooled reported annualized incidenc

  Abstract INTRODUCTION: Unprovoked venous thromboembolism (uVTE) may be the first manifestation of cancer. The main objectives of this study were to compare limited screening (LS) and extended screening (ES) and to make a protocol to approach these patients. METHODS: This is a retrospective, unicentric observational study that included 245 patients with venous thromboembolism (VTE) admitted to an Internal Medicine Service for five years. The incidence of cancer and mortality during hospitalization, and at one and three years after admission were calculated in both LS and ES groups and compared. RESULTS: Of the 245 patients with VTE, 59 (24.1%) had uVTE: 35 (59.3%) were submitted to LS and 24 (40.7%) to ES, with 10 (4.1%) diagnosis of cancer. In the following three years, 10 more patients were diagnosed. There were no statistically significant differences in inpatient diagnosis rates (8.6% vs. 4.2%; p=0.51) or in-hospital mortality (2.9% vs. 4.2%; p=0.79) or mortality at one year (8.6%

  Abstract Low molecular weight heparins (LMWH) are the standard of care for the treatment of cancer-associated venous thromboembolism (CA-VTE). We performed a systematic review and meta-analysis to compare the effects of direct oral anticoagulants (DOAC) versus LMWH for the treatment of CA-VTE. The primary efficacy and safety outcomes were VTE recurrence and major bleeding (MB). The secondary outcomes were clinically relevant non-MB (CRNMB), all-cause mortality and the net clinical benefit. We searched MEDLINE, EMBASE, CENTRAL and Web of Science (inception-December 2019) and abstracts of relevant conferences (2000-2019) to identify randomized controlled trials comparing DOAC and LMWH for the treatment of CA-VTE. Relative risks (RR) and 95% confidence intervals were estimated (Mantel-Haenszel method, random-effects models). A non-inferiority analysis with a margin of 1.3 for the upper boundary of the RR was conducted for the primary outcomes. From 637 references, we included four publi

  Abstract PURPOSE OF REVIEW: Current standard for HER2+ early breast cancer patients includes chemotherapy and trastuzumab for 1 year. The purpose of this article is to review available evidence on escalated treatment strategies for high-risk patients and de-escalated treatments for patients at low risk of relapse or high risk of cardiac toxicity. RECENT FINDINGS: Recent results have led to the approval of two adjuvant escalated treatment strategies: pertuzumab and trastuzumab combined with chemotherapy for up to 1 year for high-risk patients; extension of adjuvant anti-HER2 treatment with 1 year of neratinib. However, these treatments are associated with increased costs and toxicity, therefore careful patients' selection is highly required. With regard to de-escalated treatments, the anthracycline-free regimen of adjuvant paclitaxel and 1 year trastuzumab has entered clinical practice for early-stage patients. One year of trastuzumab remains the standard; however, shorter trastuz

  Abstract Patients with myeloproliferative neoplasms (MPNs), such as polycythemia vera, essential thrombocythemia, and primary myelofibrosis, are at increased risk for arterial and venous thrombosis/thromboembolism. In particular, the risk of splanchnic venous thrombosis, such as portal vein thrombosis or Budd-Chiari syndrome, is significantly higher in patients with MPN than in the normal population. At the same time, MPN patients are at increased risk for severe bleeding. Therefore, the treatment of patients with MPN must be based on their suspected probability of thrombosis/thromboembolism and bleeding. For this purpose, patient and MPN-specific risk factors are used. Patients at expected high risk of thrombosis should receive adequate primary or secondary thromboprophylaxis in addition to cytoreductive therapy. This may consist of antiplatelet agents and/or anticoagulant agents and must be balanced with the individual bleeding risk. The goal is to increase the quality of life and

  Abstract OBJECTIVE: To determine the cause of a markedly raised D-dimer among patients in whom a diagnosis of pulmonary embolism (PE) has been excluded by CT pulmonary angiogram (CTPA) with particular reference to new cases of cancer and aortic dissection. METHODS: One thousand consecutive patients, suspected of PE, who had undergone CTPA and for whom a D-dimer had been requested, were seen between 2012 and 2016. Retrospectively we examined the case records of all those in the top quintile of the D-dimer distribution whose CTPA was negative for PE. D-dimer in the top quintile ranged from 7.5 to 260 times upper limit normal. RESULTS: Eighty-five patients fulfilled our inclusion criteria. The likely causes of their very high D-dimer were infection (n=35, 41.2%), cardiovascular disease (n=12, 14.1% including two patients with previously undiagnosed aortic dissection), surgery or trauma (n=12, 14.1%), new or active cancer (n=9, 10.6% comprising six new cancers and three patients with can