Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Alternating chemoradiotherapy was shown by our institution to be superior to standard radiation in patients with nonsurgical squamous cell carcinoma of the head and neck (SCC-HN). Gemcitabine has shown in vitro and in vivo radiosensitizing properties, synergistic activity with cisplatin, and cytotoxic activity against SCC-HN. Thus, the authors tested the feasibility and antitumoral activity of a modified alternating chemoradiotherapy program that includes gemcitabine. Fourteen patients with stage IV (nine patients) or relapsed after surgery (five patients) unresectable SCC-HN were enrolled. None had previously received chemotherapy or radiotherapy. The treatment plan consisted of cisplatin, 20 mg/m2/day, days 1 to 5, weeks 1 and 5, and gemcitabine 800 mg/m2, day 5, weeks 1, 2, 3, and 5, 6, 7. Radiation was administered during weeks 2, 3, and 4 and 6, 7, and 8 with conventional fractionation up to 60 Gy. At the end of the combined therapy, patients had to receive two additional courses of cisplatin, 20 mg/m2/day, and fluorouracil, 200 mg/m2/day, for 5 days every 21 days. All the patients are evaluable for toxicity and 11 for response. Main grade III-IV toxicities and frequencies were: neutropenia (79%), neutropenia with fever (50%), thrombocytopenia (57%), anemia (35%), mucositis (100%), and cutaneous toxicity (14%). Ten patients (71%) had a weight loss greater than 10%. All but two patients needed hospitalization and tube feeding or parenteral nutrition. The median relative dose intensity of gemcitabine actually delivered was 83%. Two patients died 1 month after the end of treatment before the final evaluation. One patient died of sepsis during the additional cisplatin and fluorouracil courses before response assessment. Ten patients reached a complete response (intention to treat: 71%), and 1 patient had a partial response (9%). At a median follow-up of 34 months, the actuarial 3-year progression-free survival and overall survival are 41% and 63%, respectively. The estimated 3-year locoregional control is 70%. Considering the expected poor prognosis of the enrolled patients, this combined regimen showed an impressive antitumoral activity, but the severity of acute local and hematologic toxicity correlated makes the exportation of this regimen unproposable. However, the activity observed warrants the exploration of different, less toxic, chemo-radiotherapy programs including gemcitabine.
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PMID:Gemcitabine, cisplatin, and radiation in advanced, unresectable squamous cell carcinoma of the head and neck: a feasibility study. 1180 67

Contraception in women affected by renal insufficiency aims at preserving their fertility potential while waiting for a kidney transplant which may make childbearing possible. In older women contraception aims at avoiding a pregnancy which may worsen their condition. Women with renal insufficiency and aged 40-50 must avoid combined oral contraceptives. An IUD would be the best choice as well as progestational agents in regular doses 21 days a month, from the 5th to the 25th day of the cycle. Given the different metabolic impact of each progestational agent the choice remains with the gynecologist after a careful consideration of the patient's condition. Contraception by low-dose progestational agents may be advisable in some patients. Women undergoing periodic hemodialysis usually have normally ovulating cycles. An IUD would not be advisable since it may cause anemia, the same for low-dose progestational agents. The continued administration of high-dose progestational agents would be better suited for this group of patients, alternated with combined sequential pills in women with normal lipid and cholesterol levels. Women who have had a kidney transplant must wait at least 2 years before becoming pregnant. During this period mechanical contraception and the IUD are not indicated, and neither are combined contraceptives because of the risk of vascular side effects; continued or discontinued administration of low-dose progestin would be the method of choice. Alternating the different contraceptive methods is a possibility at every stage of the disease. Patients must be carefully checked at regular intervals.
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PMID:[Contraception in women with renal failure (author's transl)]. 1231 7