Temozolamide como Adyuvancia en Glioblastoma - ¿por cuánto tiempo?

Abstract

Introducción: el glioblastoma multiforme se considera altamente letal, donde la duración óptima de quimioterapia adyuvante con base en temozolamide no ha sido definida.
 Objetivo: evaluar la sobrevida según la duración de quimioterapia adyuvante basada en el esquema estándar de plataforma Stupp.
 Material y métodos: análisis de cohorte retrospectiva de 299 tumores del sistema nervioso central de alto grado, valorados en Oncólogos del Occidente enfocado sólo a glioblastoma multiforme según variables clínicas, terapéuticas y de resultados.
 Resultados: ciento noventa y tres pacientes con glioblastoma, 84 (44%) recibieron manejo estándar tipo plataforma Stupp; edad media 54 años; hombres 55%; tamaño tumoral medio 28.79 mm2; hemisferio derecho 48%; 21% cruzaban línea media; 33% presentaron convulsiones y 42% déficit neurológico; 55% Karnofsky menor a 70% y 66% clasificación RPA IV; 77% recibieron radioterapia con 60.00 Gys o mayor; 19% presentaron complicaciones; resección parcial 79% y 12% total; 77% recayeron; al cierre 57% se encontraban vivos, sobrevida global de 26% y media de 26 meses con diferencia de 31 meses para adyuvancia en <o> a 6 meses y 30 meses en adyuvancia <o> a 12 meses sin alcanzar mediana en los grupos <o> de 18 y 24 meses favoreciendo en todos al grupo de mayor tiempo.
 Conclusión: se demuestra aumento claro en la sobrevida con el empleo de temozolamide adyuvante por periodos mayores a seis meses y una tendencia a mejores resultados mientras mayor sea el tiempo de adyuvancia.

Transmisogyny in later (1588–1623) hagiography on Mother Juana de la Cruz (1481–1534)

“…As a child, he wrote, Juana 'showed great humility in the composure of her face, spoke few words and none of them idle, so that when they came out of her mouth, they were either praising God or helping her neighbor'. 74 Emphasising the adult Juana's pious (and womanly) obedience, Villegas reproduced a passage from her original Vida in which the abbess was asked for advice regarding how best to 'be and remain' in God's grace. In response, Juana advised: 'weep with those who weep, laugh with those who laugh, and be silent with those who speak'.…”

“…In response, Juana advised: 'weep with those who weep, laugh with those who laugh, and be silent with those who speak'. 75 Next, embellishing upon a description of self-mortification found in Juana's original Vida, in one instance, Villegas added a gruesome metaphor of his own creation. Juana disciplined herself 'so mercilessly', he wrote, 'that her body became a lake of blood'.…”

“…Juana disciplined herself 'so mercilessly', he wrote, 'that her body became a lake of blood'. 76 Such descriptions evoke well-known late-medieval saints like Catherine of Siena, whose self-mortification practices, according to her hagiographer, included self-flagellation, extreme fasting and wearing a hair shirt. 77 Villegas went on to link Juana's mortifications to her desire to join a convent, writing that 'when she was most wounded and tormented, she asked Our Lord to receive her into the monastery of His wives and make her a nun, as a reward for her pains'.…”

“…77 Villegas went on to link Juana's mortifications to her desire to join a convent, writing that 'when she was most wounded and tormented, she asked Our Lord to receive her into the monastery of His wives and make her a nun, as a reward for her pains'. 78 Passages emphasising Juana's obedience and asceticism help explain the acceptance of Villegas' narrative by inquisitors. Apart from strengthening Juana's cause for canonisation by stressing her similarities to a successful saint, such passages would have served the interests of inquisitors by encouraging readers of popular hagiography to pursue a piety based on asceticism and obedience rather than on mystical practice or independent theological learning.…”