Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma
adolescent; Female; Humans; Male; Adult; Prognosis; Aged; Middle Aged; Treatment Outcome; Kaplan-Meier Estimate; Antineoplastic Agents; Combined Modality Therapy; 80 and over; Brain neoplasms; Disease-Free Survival; Local; Glioblastoma; Neoplasm Recurrence; Neurosurgical Procedures; Radiotherapy
Reliable data on large cohorts of patients with glioblastoma are needed because such studies differ importantly from trials that have a strong bias toward the recruitment of younger patients with a higher performance status. We analyzed the outcome of 676 patients with histologically confirmed newly diagnosed glioblastoma who were treated consecutively at a single institution over a 7-year period (1997-2003) with follow-up to April 30, 2006. Survival probabilities were 57% at 1 year, 16% at 2 years, and 7% at 3 years. Progression-free survival was 15% at 1 year. Prolongation of survival was significantly associated with surgery in patients with a good performance status, whatever the patient's age, with an adjusted hazard ratio of 0.55 (p < 0.001) or a 45% relative decrease in the risk of death. Radiotherapy and chemotherapy improved survival, with adjusted hazard ratios of 0.61 (p = 0.001) and 0.89 (p = 0.04), respectively, regardless of age, performance status, or residual tumor volume. Recurrence occurred in 99% of patients throughout the follow-up. Reoperation was performed in one-fourth of these patients but was not effective, whether performed within 9 months (hazard ratio, 0.86; p = 0.256) or after 9 months (hazard ratio, 0.98; p = 0.860) of initial surgery, whereas second-line chemotherapy with procarbazine, lomustine, and vincristine (PCV) or with temozolomide improved survival (hazard ratio, 0.77; p = 0.008). Surgery followed by radiotherapy and chemotherapy should be considered in all patients with glioblastoma, and these treatments should not be withheld because of increasing age alone. The benefit of second surgery at recurrence is uncertain, and new trials are needed to assess its effectiveness. Chemotherapy with PCV or temozolomide seems to be a reasonable option at tumor recurrence.
2008-02
Filippini G; Falcone C; Boiardi A; Broggi G; Bruzzone MG; Caldiroli D; Farina R; Farinotti M; Fariselli L; Finocchiaro G; Giombini S; Pollo B; Savoiardo M; Solero CL; Valsecchi MG; Brain Cancer Register of the Fondazione IRCCS (Istituto Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta
Neuro-oncology
2008
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1215/15228517-2007-038" target="_blank" rel="noreferrer">10.1215/15228517-2007-038</a>
Abdominal pain related to mitochondrial neurogastrointestinal encephalomyopathy syndrome may benefit from splanchnic nerve blockade
Humans; Male; Magnetic Resonance Imaging; Nerve Block; Anesthetics; adolescent; Electromyography; Neurologic Examination; Analgesics/therapeutic use; Local; Amines/therapeutic use; Cyclohexanecarboxylic Acids/therapeutic use; gamma-Aminobutyric Acid/therapeutic use; Abdominal Pain/etiology/therapy; Gastrointestinal Diseases/complications/radiography; Mitochondrial Encephalomyopathies/complications/radiography; Paresthesia/etiology; Prilocaine; Splanchnic Nerves
Patients diagnosed with abdominal pain related to mitochondrial neurogastrointestinal encephalopathy (MNGIE) may benefit from splanchnic nerve blockade. MNGIE, varying in age of onset and rate of progression, is caused by loss of function mutation in thymidine phosphorylase gene. Gastrointestinal dysmotility, pseudo-obstruction and demyelinating sensorimotor peripheral neuropathy (stocking-glove sensory loss, absent tendon reflexes, distal limb weakness, and wasting) are the most prominent manifestations. Patients usually die in early adulthood (mean 37.6 years; range 26-58 years). We report a case of an 18-year-old patient with MNGIE. Our patient's abdominal pain was relieved after splanchnic nerve blockade.
2006
Celebi N; Sahin A; Canbay O; Uzumcugil F; Aypar U
Paediatric Anaesthesia
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1460-9592.2006.01918.x" target="_blank" rel="noreferrer">10.1111/j.1460-9592.2006.01918.x</a>
Analgesics for the treatment of pain in children
Child; Humans; infant; Analgesics; Analgesia; Anesthetics; Non-U.S. Gov't; P.H.S.; Research Support; U.S. Gov't; infant; Chronic disease; Newborn; Pain/drug therapy/etiology; Anesthesia; Anti-Inflammatory Agents; Neoplasms/complications; Patient-Controlled; Analgesics/administration & dosage/therapeutic use; General; Acetaminophen/therapeutic use; Aspirin/therapeutic use; Local; Non-Steroidal/therapeutic use; Opioid/pharmacokinetics/pharmacology/therapeutic use
2002
Berde CB; Sethna NF
The New England Journal Of Medicine
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1056/NEJMra012626" target="_blank" rel="noreferrer">10.1056/NEJMra012626</a>
Nurses' Experiences Of Spiritual Communication With Seriously Iii Children.
Methods; Nurse's Role; Pediatric Nursing; Child; Adolescent; Health Promotion; Nursing & Ancillary Services; Electronic Books; Local; Children's Health; Health & Fitness
Palliative Care Nursing Issues; Pediatric Palliative Care; Spirituality
The goal of this study was to explore nurse experiences in communication with children about spiritual topics in order to develop training in this area.
BACKGROUND:
Although spiritual care is essential in pediatric palliative care, few providers receive training about communication with ill children about spirituality.
METHODS:
Researchers developed a brief survey to prompt nurses to reflect on pediatric palliative care experiences that included spiritual discussions. Nurses attending training courses voluntarily submitted stories. Qualitative data were thematically analyzed by members of the research team, consisting of two researchers with expertise in palliative care, spirituality, and communication and two expert pediatric palliative care clinicians.
RESULTS:
Nurses' spiritual conversations with children revealed that children question God and the reason for their illness, have a desire to talk about the afterlife as a way of understanding their limited lifespan, and to share descriptions of an afterlife, in these cases described as heaven. Nurses conveyed the importance of being present and engaging in spiritual communication with children.
DISCUSSION:
Communication training is needed and should prepare providers to respond to a child's spiritual questioning, assist parents when the child initiates discussion about the afterlife, and help parent and child understand the spiritual meaning of their illness. Chaplains serve as spiritual care experts and can help train nurses to screen for spiritual distress, have greater competence in spiritual communication, and to collaborate with chaplains in care. Quality palliative care is incomplete without attention to spiritual care.
Ferrell B; Wittenberg E; Battista V; Walker G
Journal Of Palliative Medicine
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
DOI: 10.1089/jpm.2016.0138