The objective: to assess changes in energy expenditures (EE) when reducing pressure support (PS) as a predictor of the patient’s readiness for transfer to spontaneous breathing. Subjects and methods. The study included 33 patients who had been on mechanical ventilation for at least 7 days. PS reduced from 20 to 4 cmH2O at the interval of 4 cmH2O. At each level, the patient's EE were measured with indirect calorimetry. At the end of the study, spontaneous breathing trial (SBT) was performed. Results. In 22 (67%) patients, at least one episode of a statistically significant increase in EE was observed upon transition to a lower level of PS (Group 1). In remaining 11 (33%) patients, with decreased level of PS, EE decreased or did not significantly change (Group 2). SBT was successful in 14 out of 22 patients from Group 1 and all 11 patients from Group 2. The absence of episodes of increased EE during decreased PS was a predictor of successful SBT (sensitivity – 44%, specificity – 100%). Conclusion. The absence of episodes of a statistically significant increase in EE during the transition to a lower level of PS is a highly specific predictor of successful SBT.
Цель исследования: проанализировать результаты лечения рецидивного неоперабельного рака слизистой оболочки полости рта и глотки с применением цетуксимаба. Материалы и методы. Проспективное исследование эффективности лечения рецидивного неоперабельного рака слизистой оболочки полости рта и глотки с применением цетуксимаба 20 пациентов в возрасте от 32 до 70 лет, из них мужчин - 13, женщин - 7. Девяти (45,0%) пациентам проводилась монотерапия цетуксимабом, 11 (55,0%) пациентам - с добавлением цетуксимаба к схемам полихимиотерапии, включающим платиносодержащие препараты: TPeX (4 пациента), TPF (3 пациента), PF (1 пациент), а также в комбинации с карбоплатином (3 пациента). Эффективность лечения определялась по критериям оценки ответа солидных опухолей RECIST 1.1 с учетом рекомендаций по оценке эффективности иммунотерапии IrRECIST. Результаты и обсуждение. Длительность наблюдения пациентов составила от 0,6 до 16,3 мес. Частичная ремиссия наблюдалась у 3 (15%) пациентов, стабилизация опухолевого процесса - у 11 (55%) пациентов. Прогрессирование заболевания отмечено у 6 (30%) пациентов. Общая выживаемость пациентов с рецидивным плоскоклеточным раком слизистой оболочки полости рта и ротоглотки, получавших терапию с цетуксимабом, составила 22,9±12,5%, медиана выживаемости - 8,7 (95% ДИ 7,1-10,3) месяца. Однолетняя выживаемость составила 43,0±12,0%. Не установлено статистически достоверной взаимосвязи между общей выживаемостью и режимом иммунотерапии цетуксимабом (монотерапия/комбинация с платиносодержащими препаратами (r=0,33; p>0,05). Заключение. Полученные результаты свидетельствуют о возможности достижения локорегионарного контроля в 70% случаев, а медиана общей выживаемости пациентов, получавших терапию с цетуксимабом, сопоставима с данными исследования EXTREME, что позволяет считать приведенные результаты удовлетворительными, принимая во внимание сложность лечения данной категории пациентов. Purpose. To analyze the results of treatment of recurrent inoperable cancer of the oral cavity and oropharynx using cetuximab. Materials and methods. There was conducted a prospective study of the effectiveness of treatment of the recurrent inoperable oral and oropharyngeal cancer using cetuximab in 20 patients aged from 32 to 70 years (13 men, 7 women). 9 (45.0%) patients received cetuximab monotherapy, 11 (55.0%) patients - with the addition of cetuximab to polychemotherapy regimens that include platinum- containing drugs: TPeX (4 patients), TPF (3 patients), PF (1 patient), as well as in combination with carboplatin (3 patients). The effectiveness of treatment was determined according to the RECIST 1.1 criteria for evaluating the response of solid tumors, taking into account the recommendations for evaluating the effectiveness of IrRECIST immunotherapy. Results and discussion. The duration of the patients’ follow-up ranged from 0.6 to 16.3 months. Partial remission was observed in 3 (15%) patients, stabilization of the tumor process - in 11 (55%) patients. Disease progression was observed in 6 (30%) patients. Overall survival of patients with recurrent squamous cell carcinoma of the oral and oropharyngeal cancer treated with cetuximab was 22.9±12.5%, median survival was 8.7 (95% CI 7.1-10.3) months. The one-year survival rate was 43.0±12.0%. There was no statistically significant relationship between overall survival and the cetuximab immunotherapy regimen (monotherapy/combination with platinum-containing drugs (r=0.33; p>0.05). Conclusion. The obtained results indicate the possibility of achieving locoregional control in 70% of cases, and the median overall survival of patients receiving therapy with cetuximab is comparable to the data of the EXTREME study, which allows us to consider these results as satisfactory, taking into account the complexity of treatment of this category of patients.
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