Journal of chemotherapy
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Journal of chemotherapy · Feb 2002
Comparative StudyRetrospective comparison of single-agent chemotherapy with weekly 5-fluorouracil or weekly irinotecan in previously treated patients with metastatic colorectal cancer.
This study is a retrospective analysis of response, toxicity and freedom from progression of two single-agent chemotherapy regimens in patients with previously treated metastatic colorectal cancer. Thirty-five patients with histologically confirmed measurable metastatic colorectal cancer received chemotherapy after failure of first-line 5-fluorouracil (5-FU) and leucovorin treatment. The median age was 61 years. Twenty-seven patients had liver metastases, 6 had local recurrence, 1 had retroperitoneal lymph node metastases and 1 had lung metastases. Eighteen patients received weekly 2600 mg/m2 5-FU and 17 patients received weekly 125 mg/m2 irinotecan (CPT-11). Treatment was given until disease progression. Total number of cycles was 202 for 5-FU and 248 for CPT-11. The relative dose intensity was 1.0 for 5-FU and 0.84 for CPT-11. No grade 3-4 toxicity was registered in patients who received 5-FU. Grade 3-4 toxicity rates were as follows in those who received CPT-11: vomiting 1 (5.9%) patient in 1 cycle, diarrhea 3 (17.7%) patients in 3 cycles and neutropenia in 3 (17.7%) patients in 3 cycles. No patients manifested febrile neutropenia. Two patients (11.8%) needed hospital admission because of toxicity: 1 for vomiting and 1 for diarrhea. No objective responses were observed in the 5-FU group of patients. Three patients (17.6%) who received CPT-11, achieved partial response with a median duration of 8 months. Stable disease was registered in 3 (17.6%) and 9 (52.9%) patients in 5-FU and CPT-11 groups respectively (p=0.05). Median time to progression was 3.3 months for patients who received 5-FU and 4.2 months for those treated with CPT-11 (not significant). One-year survival was 22.2% and 54.3% respectively (p=0.05). ⋯ Weekly chemotherapy with CPT-11 is tolerated with acceptable toxicity and leads to a better response rate than weekly high dose 5-FU. It also significantly improves survival but does not prolong freedom from progression.
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Journal of chemotherapy · Feb 2002
Questionnaire survey of perioperative antibiotic prophylaxis in Italian surgical departments.
Correct antibiotic prophylaxis reduces the incidence of postoperative infections. 600 questionnaires on perioperative antibiotic prophylaxis were sent to Italian Surgical Departments. Each questionnaire included a series of 17 multi-choice-questions concerning the specific approach of the department to: organization, type, timing, duration, auditing of prophylaxis. 435 departments (72.5%) responded to the questionnaire; 50 of these were blank, so 385 out of 435 (88.5%) were suitable for statistical evaluation. Results were as follows: 90.5% of departments perform some form of prophylaxis under the control, in 90.5% of cases, of surgeons; 89.3% differentiate antibiotics according to class of operation; 67.4% give the antibiotic preoperatively and prefer i.v. injection (61.0%), mostly in the ward (56.2%); in 33.3% of cases the prophylaxis is standard (more than 2 doses), but 55.8% of Italian surgeons do not give a boost-dose in operations longer than 3 h; 54.2% of patients receive a cephalosporin (mostly III generation), with a rotation of molecules in 53.9% of cases; 71.7% of departments register the incidence of infections, but only 43.2% control the patients 30 days after surgery; finally, 54.2% of departments work together with a bacteriology laboratory active 24 hours, while in 81.7% of cases the hospital has an Infection Committee which meets together usually without a programmed date (60.3%). In conclusion, antibiotic prophylaxis in Italian Surgery Departments appears adequate, even though some problems still remain regarding time-dose-duration-schedule, rotation of molecules, excess of cephalosporins, availability of a 24-h bacteriological laboratory and infection surveillance after discharge.