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International Journal of Molecular... Jan 2023Rehabilitation might improve bone health in breast cancer (BC) patients, but the effects on bone biomarkers are still debated. Thus, this meta-analysis of randomized... (Meta-Analysis)
Meta-Analysis Review
Rehabilitation might improve bone health in breast cancer (BC) patients, but the effects on bone biomarkers are still debated. Thus, this meta-analysis of randomized controlled trials (RCTs) aims at characterizing the impact of rehabilitation on bone health biomarkers in BC survivors. On 2 May 2022, PubMed, Scopus, Web of Science, Cochrane, and PEDro were systematically searched for RCTs assessing bone biomarker modifications induced by physical exercise in BC survivors. The quality assessment was performed with the Jadad scale and the Cochrane risk-of-bias tool for randomized trials (RoBv.2). Trial registration number: CRD42022329766. Ten studies were included for a total of 873 patients. The meta-analysis showed overall significant mean difference percentage decrease in collagen type 1 cross-linked N-telopeptide (NTX) serum level [ES: -11.65 (-21.13, -2.17), = 0.02)] and an increase in bone-specific alkaline phosphatase (BSAP) levels [ES: +6.09 (1.56, 10.62). According to the Jadad scale, eight RCTs were considered high-quality studies. Four studies showed a low overall risk of bias, according to RoBv.2. The significant effects of rehabilitation on bone biomarkers suggested a possible implication for a precision medicine approach targeting bone remodeling. Future research might clarify the role of bone biomarkers monitoring in rehabilitation management of cancer treatment induced bone-loss.
Topics: Female; Humans; Quality of Life; Exercise; Breast Neoplasms; Exercise Therapy; Biomarkers
PubMed: 36674436
DOI: 10.3390/ijms24020921 -
Medicina Oral, Patologia Oral Y Cirugia... May 2023Osteoradionecrosis of the jaws (ORNJ) is a severe and challenging complication of head and neck radiation therapy. Despite its aggressiveness and controversy respect to...
BACKGROUND
Osteoradionecrosis of the jaws (ORNJ) is a severe and challenging complication of head and neck radiation therapy. Despite its aggressiveness and controversy respect to its efficacy, surgical intervention remains the main treatment modality. Nevertheless, due to advances in the understanding of ORNJ physiopathology, new treatment alternatives such as the combination of pentoxifylline with tocopherol (PENTO) have emerged. The aim of this systematic review was to assess the reported efficacy of PENTO for the treatment of ORNJ. Material and Methods: Studies were search using Pubmed, The Cochrane Library, Scopus, and Web of Science data bases following the PRISMA guidelines. Inclusion criteria were cohort, case series, randomized or non-randomized clinical studies published in English including human subjects who received PENTO as treatment for ORN of the jaws. Results: Eleven articles met the inclusion criteria and were included for data analysis. All studies reported patients with complete mucosal coverage with no exposed bone (considered healthy) after PENTO treatment, ranging from 16.6% to 100% of the patients, depending on the study. Clinical improvement or disease stabilization was reported between 7.6% and 66.6% of studied individuals, while disease progression was seen in only 5 studies involving 7.6 - 32% of patients.
CONCLUSIONS
PENTO treatment achieved a complete disease control in a significant number of patients in all studies. However, there is no standardized protocol for administering the therapy. It is necessary to determine the pharmacological doses and to evaluate the benefits of adding antibiotics and clodronate. Good quality clinical trials are needed to develop a successful algorithm for the management of ORN of the jaws.
Topics: Humans; Tocopherols; Pentoxifylline; Osteoradionecrosis; Head and Neck Neoplasms; Jaw
PubMed: 36641743
DOI: 10.4317/medoral.25729 -
Journal of Pediatric Surgery Jul 2023Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been... (Review)
Review
BACKGROUND
Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been described. We performed a systematic review of the literature to describe commonly used approaches and outcomes.
METHODS
A systematic literature search was performed for English-language publications describing chest wall tumor resection and reconstruction using implantable materials in patients ≤21 years, excluding soft tissue resection only, sternal resection, and reconstruction by primary repair or muscle flaps alone. Data were collected on diagnoses, reconstructive method, and outcomes. Rigid chest wall reconstruction was compared to mesh reconstruction.
RESULTS
There were 55 articles with 188 patients included. The median age was 12 years. Most tumors were malignant (n = 172, 91.5%), most commonly Ewing's sarcoma (n = 65, 34.6%), followed by unspecified sarcomas (n = 34, 18.1%), Askin's tumor (n = 16, 8.5%; a subset of Ewing's sarcoma) and osteosarcoma (n = 16, 8.5%). A median of 3 ribs were resected (range 1-12). Non-rigid meshes were most common (n = 138, 73.4%), followed by rigid prostheses (n = 50, 26.6%). There were 19 post-operative complications (16.8%) and 22.2% of patients developed scoliosis. There were no significant differences in complications (20.5% rigid vs. 10.6% non-rigid, p = 0.18) or scoliosis (22.7% vs. 14.0%, p = 0.23) by reconstruction method, but complications after rigid reconstruction were more likely to require surgery (90.0% vs. 53.9%, p = 0.09). The median follow-up duration was 24 months.
CONCLUSIONS
In this review of the literature, there were no significant differences in overall post-operative complications or scoliosis development by reconstruction method, yet complications after rigid reconstruction were more likely to require surgical intervention.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Child; Sarcoma, Ewing; Thoracic Wall; Scoliosis; Plastic Surgery Procedures; Bone Neoplasms; Thoracic Neoplasms; Postoperative Complications
PubMed: 36585305
DOI: 10.1016/j.jpedsurg.2022.11.008 -
Hellenic Journal of Nuclear Medicine 2022The aim of this study was to assess the diagnostic value of gallium-68-prostate specific membrane antigen (Ga-PSMA) positron emission tomography/computed tomography... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this study was to assess the diagnostic value of gallium-68-prostate specific membrane antigen (Ga-PSMA) positron emission tomography/computed tomography (PET/CT) in detecting metastases in prostate cancer (PCa) patients.
MATERIALS AND METHODS
A comprehensive literature search of studies published before August 2021 in PubMed, Embase and Cochrane Library databases was conducted.The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Studies investigating the diagnostic value of Ga-PSMA PET/CT were selected for qualitative and quantitative analysis.
RESULTS
Twenty-five articles using Ga-PSMA PET/CT for detecting metastases in PCa patients were selected for qualitative analysis, 16 of which were selected for meta-analysis. The sensitivities of Ga-PSMA PET/CT in detecting lymph node metastases ranged from 33.3% to 96.08%, with high specificities ranged from 82% to 100%. Gallium-68-PSMA PET/CT demonstrated outstanding diagnostic performance in PCa patients with bone metastases. Only two articles about Ga-PSMA PET/CT for lung metastases showed that the detection value was limited. It was difficult to distinguish lung metastases in PCa patients from benign lesions or primary lung cancer. There was only one article about Ga-PSMA PET/CT for liver metastases, which showed that about 77.7% of metastatic lesions will be Ga-PSMA-positive and 22.3% will be false negatives. Due to the lack of articles on PCa visceral metastases, we only conducted a meta-analysis on lymph node metastases and bone metastases. In our meta-analysis, the per-patient pooled sensitivity, specificity, positive likelihood ratio (LR), negative likelihood ratio (LR), diagnostic odds ratio (DOR), and the area under the ROC curve (AUC) of lymph node metastases were 0.61, 0.96, 14.4, 0.41, 35, and 0.95, respectively. The per-lesion pooled sensitivity, specificity, LR, LR, DOR, and AUC of V were 0.74, 0.99, 76.0, 0.26, 289 and 0.99, respectively. The per-patient pooled sensitivity, specificity, LR, LR, DOR, and AUC of bone metastases were 0.97, 1.00, 1100.1, 0.03, 37490 and 0.98, respectively.
CONCLUSION
Gallium-68-PSMA PET/CT demonstrated outstanding diagnostic performance for bone metastases in PCa patients. The majority of lymph node metastases, lung metastases, and liver metastases overexpressed PSMA, which could be directly detected. However, a considerable number of lesions were false negatives.
Topics: Male; Humans; Positron Emission Tomography Computed Tomography; Lymphatic Metastasis; Gallium Radioisotopes; Prostatic Neoplasms
PubMed: 36576728
DOI: 10.1967/s002449912525 -
BMC Cancer Dec 2022Osteosarcoma is the most common bone tumor in children and adolescents. Despite multiagent chemotherapy, only 71% of patients survives and these survivors often...
BACKGROUND
Osteosarcoma is the most common bone tumor in children and adolescents. Despite multiagent chemotherapy, only 71% of patients survives and these survivors often experience long-term toxicities. The main objective of this systematic review is to provide an overview of the discovery of novel associations of germline polymorphisms with treatment response and/or chemotherapy-induced toxicities in osteosarcoma. METHODS: MEDLINE and Embase were systematically searched (2010-July 2022). Genetic association studies were included if they assessed > 10 germline genetic variants in > 5 genes in relevant drug pathways or if they used a genotyping array or other large-scale genetic analysis. Quality was assessed using adjusted STrengthening the REporting of Genetic Association studies (STREGA)-guidelines. To find additional evidence for the identified associations, literature was searched to identify replication studies.
RESULTS
After screening 1999 articles, twenty articles met our inclusion criteria. These range from studies focusing on genes in relevant pharmacokinetic pathways to whole genome sequencing. Eleven articles reported on doxorubicin-induced cardiomyopathy. For seven genetic variants in CELF4, GPR35, HAS3, RARG, SLC22A17, SLC22A7 and SLC28A3, replication studies were performed, however without consistent results. Ototoxicity was investigated in one study. Five small studies reported on mucosistis or bone marrow, nephro- and/or hepatotoxicity. Six studies included analysis for treatment efficacy. Genetic variants in ABCC3, ABCC5, FasL, GLDC, GSTP1 were replicated in studies using heterogeneous efficacy outcomes.
CONCLUSIONS
Despite that results are promising, the majority of associations were poorly reproducible due to small patient cohorts. For the future, hypothesis-generating studies in large patient cohorts will be necessary, especially for cisplatin-induced ototoxicity as these are largely lacking. In order to form large patient cohorts, national and international collaboration will be essential.
Topics: Child; Adolescent; Humans; Pharmacogenetics; Ototoxicity; Osteosarcoma; Cisplatin; Bone Neoplasms
PubMed: 36536332
DOI: 10.1186/s12885-022-10434-5 -
International Journal of Environmental... Nov 2022This review analyzed the effects of an exercise program on psychoemotional and quality-of-life (QoL) factors in adult patients with cancer and hematopoietic stem cell... (Review)
Review
Effects of Exercise Programs on Psychoemotional and Quality-of-Life Factors in Adult Patients with Cancer and Hematopoietic Stem Cell Transplantation or Bone Marrow Transplantation: A Systematic Review.
This review analyzed the effects of an exercise program on psychoemotional and quality-of-life (QoL) factors in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). Studies were identified from the PubMed and Web of Science databases (from inception to 24 August 2022), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based in turn on the Delphi list. A total of 20 randomized controlled studies were included with 1219 participants. The main result of this systematic review is that exercise program interventions produce improvements on psychoemotional and QoL factors in adult patients with cancer and HSCT or BMT. Moreover, exercise programs may have a beneficial effect on health, maintaining or increasing the patient's QoL. Further, it has a positive effect on the prevention and control of transplant complications in combination with medical treatment.
Topics: Humans; Adult; Bone Marrow Transplantation; Quality of Life; Hematopoietic Stem Cell Transplantation; Neoplasms; Exercise Therapy
PubMed: 36497971
DOI: 10.3390/ijerph192315896 -
Medicine Dec 2022The effect of thyroid stimulating endocrine (TSH) suppression medical aid on bone mineral density (BMD) of patients with differentiated thyroid carcinoma (DTC) or...
BACKGROUND
The effect of thyroid stimulating endocrine (TSH) suppression medical aid on bone mineral density (BMD) of patients with differentiated thyroid carcinoma (DTC) or differentiated thyroid malignant neoplastic disease is still controversial. Our aim was to investigate the effect of TSH suppression therapy on BMD of patients with DTC.
METHODS
A total of 1651 DTC patients with TSH-suppression medical care were analyzed by RevMan 5.3 software (https://training.cochrane.org/online-learning/core-software/revman/revman-5-download) in the present study. The PubMed and Embase databases were consistently hunted for works revealed through July 29, 2022.
RESULTS
The results indicated that a significant association between femoral bone mineral density (FN-BMD) (P = .02) or lumbar spine bone mineral density (L-BMD) (P = .04) and DTC patients with TSH-suppression therapy. However, the total hip bone mineral density (TH-BMD) was not significantly related to DTC patients with TSH-suppression therapy (P = .11). For premenopausal women, it was shown that TH-BMD (P = .02) or L-BMD (P = .01) were closely related to DTC patients with TSH-suppression therapy. However, there was no relationship between FN-BMD and DTC patients with TSH-suppression therapy (P = .06). For postmenopausal women, TH-BMD was closely related to DTC patients with TSH-suppression therapy (P = .02). It was revealed that there was no significant difference between L-BMD (P = .16) or FN-BMD (P = .26) and DTC patients with TSH-suppression therapy. For men, there was no relationship between FN-BMD (P = .94) or L-BMD (P = .29) and DTC patients with TSH-suppression therapy.
CONCLUSION
Our systematic review has demonstrated that TSH inhibition treatment mainly influence the TH-BMD or L-BMD of the DTC patients who were premenopausal women; the TH-BMD of the DTC patients who were postmenopausal women. In addition, there was no influence on the FN-BMD or L-BMD of the DTC patients who were men.
Topics: Humans; Female; Thyrotropin; Bone Density; Thyroid Neoplasms
PubMed: 36482589
DOI: 10.1097/MD.0000000000031991 -
Journal of Neuro-oncology Dec 2022Spheno-orbital meningiomas are rare tumors, accounting for up to 9% of all intracranial meningiomas. Patients commonly present with proptosis, and visual deficits. These... (Review)
Review
Endoscopic endonasal approach for resection of a recurrent spheno-orbital meningioma resulting in complete resolution of visual symptoms: A case report and review of literature.
PURPOSE
Spheno-orbital meningiomas are rare tumors, accounting for up to 9% of all intracranial meningiomas. Patients commonly present with proptosis, and visual deficits. These slow growing tumors are hard to resect due to extension into several anatomical compartments, resulting in recurrence rates as high as 35-50%. Although open surgical approaches have been historically used for resection, a handful of endoscopic approaches have been reported in recent years. We aimed to review the literature and describe a case of spheno-orbital meningioma with severe vision loss which was resected with an endoscopic endonasal approach achieving complete resolution of visual symptoms.
METHODS
A systematic review of literature was conducted in accordance with the PRISMA guidelines. PubMed, Cochrane, and Web of Science databases were queried for spheno-orbital meningiomas resected via an endoscopic endonasal approach. Furthermore, the presentation, surgical management, and post-operative outcomes of a 53-year-old female with a recurrent spheno-orbital meningioma are described.
RESULTS
The search yielded 26 articles, of which 8 were included, yielding 19 cases. Average age at presentation was 60.5 years (range: 44-82), and 68.4% of patients were female. More than half of the cases achieved subtotal resection. Common complications associated with endoscopic endonasal surgery included CN V2 or CN V2/V3 hypoesthesia. Following surgical intervention, visual acuity and visual field remained stable or improved in the majority of the patients.
CONCLUSION
Endoscopic approaches are slowly gaining momentum for treatment of spheno-orbital meningiomas. Further studies on the clinical benefits of this approach on patient outcomes and post-operative complications is warranted.
Topics: Humans; Female; Adult; Middle Aged; Aged; Aged, 80 and over; Male; Meningioma; Sphenoid Bone; Orbital Neoplasms; Neurosurgical Procedures; Treatment Outcome; Neoplasm Recurrence, Local; Meningeal Neoplasms; Retrospective Studies
PubMed: 36445608
DOI: 10.1007/s11060-022-04141-1 -
Oncogene Jan 2023Over the last 40 years osteosarcoma (OS) survival has stagnated with patients commonly resistant to neoadjuvant MAP chemotherapy involving high dose methotrexate,...
Over the last 40 years osteosarcoma (OS) survival has stagnated with patients commonly resistant to neoadjuvant MAP chemotherapy involving high dose methotrexate, adriamycin (doxorubicin) and platinum (cisplatin). Due to the rarity of OS, the generation of relevant cell models as tools for drug discovery is paramount to tackling this issue. Four literature databases were systematically searched using pre-determined search terms to identify MAP resistant OS cell lines and patients. Drug exposure strategies used to develop cell models of resistance and the impact of these on the differential expression of resistance associated genes, proteins and non-coding RNAs are reported. A comparison to clinical studies in relation to chemotherapy response, relapse and metastasis was then made. The search retrieved 1891 papers of which 52 were relevant. Commonly, cell lines were derived from Caucasian patients with epithelial or fibroblastic subtypes. The strategy for model development varied with most opting for continuous over pulsed chemotherapy exposure. A diverse resistance level was observed between models (2.2-338 fold) with 63% of models exceeding clinically reported resistance levels which may affect the expression of chemoresistance factors. In vitro p-glycoprotein overexpression is a key resistance mechanism; however, from the available literature to date this does not translate to innate resistance in patients. The selection of models with a lower fold resistance may better reflect the clinical situation. A comparison of standardised strategies in models and variants should be performed to determine their impact on resistance markers. Clinical studies are required to determine the impact of resistance markers identified in vitro in poor responders to MAP treatment, specifically with respect to innate and acquired resistance. A shift from seeking disputed and undruggable mechanisms to clinically relevant resistance mechanisms may identify key resistance markers that can be targeted for patient benefit after a 40-year wait.
Topics: Humans; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cisplatin; Clinical Relevance; Doxorubicin; Neoplasm Recurrence, Local; Osteosarcoma; Drug Resistance, Neoplasm
PubMed: 36434179
DOI: 10.1038/s41388-022-02529-x -
European Spine Journal : Official... Jan 2023Lung cancer is one of the most common malignant tumors. Most patients develop spinal metastases during the course of cancer and suffer skeletal-related events.... (Meta-Analysis)
Meta-Analysis
PURPOSE
Lung cancer is one of the most common malignant tumors. Most patients develop spinal metastases during the course of cancer and suffer skeletal-related events. Currently, no consensus has been reached on the prognostic factors in patients undergoing surgeries. This study aimed to answer two questions: (1) what are the effects of surgical intervention, and (2) what are the factors associated with postoperative survival.
METHODS
Searches were performed on electronic databases including PubMed, Ovid/MEDLINE, Cochrane, and Scopus for articles published before February of 2022, involving the survival factors of patients with spinal metastasis. Multiple data items were considered, such as baseline demographics, surgical details, clinical outcome, and prognostic factors. The analysis was performed in Review Manager (RevMan) 5.5. The prognostic factors of survival were analyzed with univariate and multivariate cox regression analysis.
RESULTS
Finally, 14 studies with 813 patients were identified. Their 6, 12, and 24 months survival rates ranged from 18 to 58%, 18 to 22.4%, and 0 to 58.5%, respectively. The pooled hazard ratio of preoperative ambulatory status and the number of involved vertebrae demonstrated statistical significance, while no significant prognostic effect on the overall survival was found for targeted therapy, visceral metastases, chemotherapy, radiotherapy, or postoperative ambulatory status.
CONCLUSION
Overall, surgical intervention could achieve significant pain relief and neurological function improvements. For patients receiving surgery for spinal metastasis from lung cancer, preoperative ambulatory status and the number of involved vertebrae were significant prognostic factors associated with their survival.
Topics: Humans; Prognosis; Spinal Neoplasms; Lung Neoplasms; Spine; Multivariate Analysis; Retrospective Studies
PubMed: 36372842
DOI: 10.1007/s00586-022-07444-z