European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
-
Clinical Trial
Neoadjuvant radio-chemotherapy in advanced primarilynon-resectable carcinomas of the pancreas.
To investigate the feasibility of neoadjuvant radio-chemotherapy (RCT) in the treatment of primarily non-resectable pancreas carcinoma the parameters tumour regression, possibility of subsequent resection and tolerability were examined. ⋯ The study protocol described is feasible without significant acute toxicity and when used the resectability rate was improved; the survival rate, however, was not improved. Additional intra-arterial or intraportal application of such drugs as mitomycin C or cisplatin may be necessary.
-
This study aimed to evaluate hypocalcaemia (time-course) and need for calcium administration after thyroid surgery in 135 consecutive cases (69 bilateral subtotal thyroidectomies, 50 unilateral lobectomies, 13 total thyroidectomies and three isthmectomies) for benign lesions and for differentiated carcinoma in 89% and 11% respectively. ⋯ The number of parathyroid glands preserved in situ did not help predict the duration of post-surgical calcium treatment, nor the final outcome of hypocalcaemia. However, when total calcium levels were compared in patients having had one or two glands preserved vs three or four parathyroid glands, it was possible to show that despite prolonged calcium administration, late calcaemias remained significantly lower during the first 6 months in patients with a smaller number of parathyroid glands. Hypoparathyroidism, defined functionally on the basis of requirement of calcium supplementation 1 year after surgery, occurred in 8.6% of patients after bilateral lobectomy (despite measurable but inappropriately low-PTH concentration). This outcome could have been predicted earlier (after 3 to 6 months) and the patients perhaps given the benefit of definitive vitamin D treatment earlier, in order to avoid late and prolonged hypocalcaemia. Evaluation after 1 year showed that only one patient out of 82 bilateral lobectomies (1.2%) had permanent hypoparathyroidism and needed calcium whereas hypocalcaemia was persistent in one out of four patients who had undergone a staged procedure (i.e. heterolateral lobectomy years after a previous operation).