Manejo de la caquexia en oncología |
Treatment of cachexia in oncology
EM Tazi, H Errihani
Indian J Paliative Care 2010:16;136-144. DOI: 10.4103/0973-1075.73644
Background: Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology. Aims and Objectives : The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research. Results : Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine). Conclusions : To date, despite several years of coordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful. Enlace para leer el artículo completo: |
| Un abordaje innovativo para el tratamiento de la anorexia relacionada al cáncer y el estress oxidativo: antecedentes y diseño de un ensayo clínico fase III, en curso |
An Innovative Treatment Approach for Cancer-Related Anorexia/Cachexia and Oxidative Stress: Background and Design of an Ongoing, Phase III, Randomized Clinical Trial.
Mantovani G, Madeddu C, Gramignano G, Serpe R, Massa E, Deiana L, Macciò A.
Department of Medical Oncology, University of Cagliari, Italy
Support Cancer Ther. 2007 May 1;4(3):163-7. Introduction
Cancer-related anorexia/cachexia syndrome (CACS), which often precedes death, is complex and is characterized by progressive weight loss with depletion of host reserves of skeletal muscle and, to a lesser extent, adipose tissue, anorexia, reduced food intake, poor performance status (PS) and quality of life (QOL).1 At diagnosis, 80% of patients with upper gastrointestinal cancers and 60% of patients with lung cancer have already experienced substantial weight loss.2
The prevalence of cachexia increases from 50% to > 80% before death, and in > 20%, it is the main cause of death. Cancer-related anorexia/cachexia syndrome results from the interaction between the host and the tumor. However, its nature is not completely understood,3-6 including the dynamics of host response (activation of systemic inflammatory response and metabolic, immune, and neuroendocrine changes) and tumor characteristics or tumor-derived products that influence expression of the syndrome (eg, proteolysis-inducing factor). Enlace para leer el articulo completo: |
| Caquexia por cáncer: aspectos patofisiológicos y opciones terapéuticas |
Cancer cachexia: pathophysiologic aspects and treatment options.
Topkan E, Yavuz AA, Ozyilkan O.
Department of Radiation Oncology, Baskent University Medical Faculty, Adana Research and Treatment Centre, 01120, Adana/ Turkey.drerkantopkan@yahoo.com
Asian Pac J Cancer Prev. 2007 Jul-Sep;8(3):445-51. Abstract
Cancer cachexia is a syndrome characterized with progressive weight loss and abnormal wasting of fat and muscle tissue, and affects 40 to 85% of all terminally ill patients, accounting more than 20% of all cancer deaths. Current treatment for cancer cachexia principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. Although the exact mechanism and predisposing factors have yet to be clarified in detail, our growing knowledge about the pathophysiology and biochemical changes considering this life threatening condition should help in development of future therapeutic strategies. In the present paper, the current preclinical and clinical features considering the pathophysiology and treatment of cancer related cachexia are reviewed Enlace para leeer el artículo completo: |
| Profundidad de la sedación durante anestesia espinal y el desarrollo de delirio postoperatorio en ancianos con reparación de fractura de cadera |
Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair.
Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB, Mears SC.
Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224, USA.fsieber1@jhmi.edu
Mayo Clin Proc. 2010 Jan;85(1):18-26. Abstract
OBJECTIVE: To determine whether limiting intraoperative sedation depth during spinal anesthesia for hip fracture repair in elderly patients can decrease the prevalence of postoperative delirium. PATIENTS AND METHODS: We performed a double-blind, randomized controlled trial at an academic medical center of elderly patients (>or=65 years) without preoperative delirium or severe dementia who underwent hip fracture repair under spinal anesthesia with propofol sedation. Sedation depth was titrated using processed electroencephalography with the bispectral index (BIS), and patients were randomized to receive either deep (BIS, approximately 50) or light (BIS, >or=80) sedation. Postoperative delirium was assessed as defined by Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) criteria using the Confusion Assessment Method beginning at any time from the second day after surgery.RESULTS: From April 2, 2005, through October 30, 2008, a total of 114 patients were randomized. The prevalence of postoperative delirium was significantly lower in the light sedation group (11/57 [19%] vs 23/57 [40%] in the deep sedation group; P=.02), indicating that 1 incident of delirium will be prevented for every 4.7 patients treated with light sedation. The mean +/- SD number of days of delirium during hospitalization was lower in the light sedation group than in the deep sedation group (0.5+/-1.5 days vs 1.4+/-4.0 days; P=.01).CONCLUSION: The use of light propofol sedation decreased the prevalence of postoperative delirium by 50% compared with deep sedation. Limiting depth of sedation during spinal anesthesia is a simple, safe, and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted. Enlace para leer el artículo completo:
|
|
No hay comentarios:
Publicar un comentario