Bulletin du cancer
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We had defined, discussed and illustrated the principle of clinical equipoise that ethically and methodologically justifies the randomisation in clinical trials.
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Malnutrition concerns 20% of cancer patients. It is an independent risk factor for morbidity and mortality. And nutritional support has to be integrated in anti-cancer treatment project, and could improve the prognosis and quality of life. ⋯ Today, nutrition is not any more palliative care but has to be included in anti-cancer treatment plan. According to the degree of malnutrition or malnutrition risk, different levels of nutritional support could be purposed. And immunonutrition could improve beneficial effects of nutritional support during cancer chemotherapy or radiotherapy.
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Review Practice Guideline
[Prescription guidebook for temozolomide usage in brain tumors].
Malignant gliomas are the most frequent primary brain tumors in adults. Temozolomide is an oral alkylating cytotoxic agent of second generation, used in the treatment of high-grade gliomas. It is indicated in newly diagnosed glioblastoma multiform as well as in recurrent or progressive malignant gliomas, such as glioblastoma multiform or anaplastic astrocytoma. ⋯ For high-grade and low-grade gliomas, based on the level of evidence from the literature, the use of temozolomide can be justified, with a B2 score attributed to these indications. In contrast, for the others indications, the use of temozolomide appeared to be more controversial or even not recommended (score C to E). Regarding the dosing schedule and administration scheme, as well as the co-administration with other anticancer drugs, a C score was attributed for the off label situations.
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Since the 1980's, women treated for breast cancer are reporting moderate cognitive impairments during and after chemotherapy. These cognitive impairments may be related to chemotherapy but also to hormone therapy, psychological distress, fatigue... ⋯ These studies--selected between 1997 and 2008--show that cognitive impairments are frequently reported by patients with breast cancer but that the mechanisms are still poorly understood and that the methods of assessment are very heterogeneous and difficult to compare. This review indicates that future studies should include more homogenous patient groups, be longitudinal, use more sensitive and specific assessment tools and control moderators factors that play a role in impairment in cognitive function.
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Aprepitant is actually recommended in the prevention of nausea and vomiting induced by high emetic risk chemotherapy using cisplatin. We performed an observational prospective study on 101 patients evaluating the efficacy of aprepitant in the clinical conditions of use of cisplatin, out of context of clinical trial. We did not perform any intervention on the choice of anti-emetic treatment by the clinicians. ⋯ Inclusions were closed when we lay 50 patients who received aprepitant associated to standard anti-emetic treatment (ondansetron and prednisolone) and 51 patients who received standard anti-emetic treatment. We observed a significant positive effect of aprepitant in the prevention of acute (84 vs 74.4 %, P = 0.24) and delayed vomiting (84 vs 60.8%, P = 0.009). But there was not a significant difference between the two groups regarding the prevention of nausea and the rate of complete response (absence of nausea and vomiting during five days).