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A systematic review of talc compared with bleomycin for patients with malignant pleural effusions

Bibliographic details: Wei Y, Yu Q, Luo H.  A systematic review of talc compared with bleomycin for patients with malignant pleural effusions. Chinese Journal of Lung Cancer 2009; 12(3): 222-226

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Intracystic bleomycin for children with cystic craniopharyngiomas

Craniopharyngiomas are rare, slow‐growing, benign tumours in the hypothalamic‐pituitary region of the brain. Although they are benign, i.e. the tumour lacks the ability to invade neighboring tissue or metastasise, there is considerable morbidity and disability even when the tumour can be resected completely. Cystic craniopharyngiomas are the commonest type of craniopharyngiomas. They consist of a solid portion that contain fluid‐filled balloon‐like structures (cysts). Cysts are a problem because secretion of fluid into them allows the tumour to increase in size, which puts pressure on parts of the brain, and can cause damage. Radical resection (removal by surgery) alone is not sufficient because the rate of recurrence is high and this procedure has a high risk of endocrinological/neurological deficits such as blindness; loss of control of appetite, urine production, emotional behaviour, and physical co‐ordination; memory loss; sleep disturbances; cessation of growth and sexual development; low thyroxine levels; hydrocephalus (high pressure inside the skull); and death. While in adults radiotherapy represents a valid postoperative adjunctive (additional) therapy, in children it has a high risk of side effects including further damage to any remaining sight with reduction of intelligence quotient (IQ) and ability to perform complex tasks in later life. Intracystic bleomycin (i.e. a type of chemotherapeutic agent injected into the cyst) has been used to potentially decrease the damage associated with cystic craniopharyngioma. This systematic review focused on (randomised) controlled studies. We could not identify any randomised controlled trials (RCTs), quasi‐randomised trials or controlled clinical trials (CCTs) in which the only difference between the intervention and control group was the use of intracystic bleomycin. However, we did identify one RCT comparing intracystic bleomycin with intracystic phosphorus32 (32P), which is a radioactive isotope of phosphorous used for intracystic irradiation. Only 7 children were included in this study. The study has a high risk of bias and the sample size is too small to detect a difference in outcomes. The therapeutic use of intracystic bleomycin in children with cystic craniopharyngiomas currently remains uncertain. Although there was no significant difference in total adverse effects between the two treatment groups, there was a significant difference in both headache and vomiting in favour of the 32P group. More high‐quality studies are needed but will be difficult as so few children get these tumours.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet]

Nausea and vomiting are major concerns for patients undergoing chemotherapy, radiation therapy and surgery with general anesthesia. Risk factors associated with chemotherapy-induced nausea and vomiting include emetogenicity of the chemotherapy regimen, dose, speed of intravenous infusion, female gender, age under 50 years, history of ethanol consumption, and history of prior chemotherapy. Factors predictive of radiation therapy-induced nausea and vomiting include site of irradiation (in particular, total body irradiation and radiation fields that include the abdomen), total field size, dose per fraction, age, and predisposition for emesis (history of sickness during pregnancy or motion sickness). Female gender, a history of motion sickness or prior postoperative nausea and vomiting, nonsmoking status, and use of postoperative opioids have been suggested as factors predictive of postoperative nausea and vomiting. The objective of this review was to evaluate the comparative effectiveness and harms of newer antiemetic drugs including the 5-HT3 and NK-1 antagonists.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2009
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Antitumor effectiveness of electrochemotherapy: a systematic review and meta-analysis

BACKGROUND: This systematic review has two purposes: to consolidate the current knowledge about clinical effectiveness of electrochemotherapy, a highly effective local therapy for cutaneous and subcutaneous tumors; and to investigate the differences in effectiveness of electrochemotherapy with respect to tumor type, chemotherapeutic drug, and route of drug administration.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis

BACKGROUND: Several treatment strategies are available for adults with advanced-stage Hodgkin's lymphoma, but studies assessing two alternative standards of care-increased dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated), and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)-were not powered to test differences in overall survival. To guide treatment decisions in this population of patients, we did a systematic review and network meta-analysis to identify the best initial treatment strategy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. Criteria for randomised clinical trial (RCT) eligibility were random allocation of patients and non-concurrent use of another experimental medication or device. Methodological quality evaluation of the trials was based on randomisation, blinding, allocation concealment and intention to treat analysis. A random effect model was used to combine the relative risk estimates of the treatment effects whenever pooling for an overall effect was considered appropriate. Forty-six RCTs with a total of 2053 patients with malignant pleural effusions were reviewed for effectiveness of pleurodesis. Talc tended to be associated with fewer recurrences when compared to bleomycin (RR, 0.64; 95% CI, 0.34-1.20) and, with more uncertainty, to tetracycline (RR, 0.50; 95% CI, 0.06-4.42). Tetracycline (or doxycycline) was not superior to bleomycin (RR, 0.92; 95% CI, 0.61-1.38). When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a reduction in recurrence (RR, 0.21; 95% CI, 0.05-0.93). Strategies such as rolling the patient after instillation of the sclerosing agent, protracted drainage of the effusion and use of larger chest tubes were not found to have any substantial advantages. Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Medical treatment of advanced testicular cancer

The review concluded that favourable outcomes for advanced testicular cancer have been achieved through accurate risk stratification and well-designed trials of risk-tailored therapy. Some patients refractory to initial treatment can be cured with second- or third-line salvage therapy. Limitations of the review and the poor reporting of review methods mean that these conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Warts (non-genital)

INTRODUCTION: Warts are caused by the human papillomavirus (HPV), of which there are over 100 types. HPV probably infects the skin via areas of minimal trauma. Risk factors include use of communal showers, occupational handling of meat, and immunosuppression. In immunocompetent people, warts are harmless and resolve as a result of natural immunity within months or years.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Treatments for classic Kaposi sarcoma: a systematic review of the literature

BACKGROUND: Treatment guidelines are lacking for classic Kaposi sarcoma.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Comparison of the two international standards of chemotherapy for patients with early unfavourable or advanced stage Hodgkin lymphoma

Hodgkin lymphoma is a malignancy of the lymphatic system. It is one of the most common cancers in young adults, particularly in their third decade of life, but it occurs also in children and elderly people. Within the last fifty years it has become one of the most curable forms of cancer. To find the best treatment with the greatest efficacy and least toxicity is the most important challenge in treating Hodgkin lymphoma. There are two international standards for the treatment of early unfavourable or advanced stage Hodgkin lymphoma: chemotherapy with escalated BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone) regimen initiated by the German Hodgkin Study Group (GHSG) and chemotherapy with ABVD (doxorubicin/ bleomycin/ vinblastine/ dacarbazine) regimen, which is widely used because it has been proven to be effective, well tolerated and easy to administer. We aimed to clarify the advantages and disadvantages of both treatments by comparing the chance of survival (overall survival), the chance of recurrence of the tumour and the frequencies of adverse events after treatment in patients with early unfavourable stage or advanced stage Hodgkin lymphoma.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for treating oral leukoplakia

No evidence from trials to show how to prevent leukoplakia in the mouth becoming malignant.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Topical treatments for skin warts

Viral warts are a common skin disease, most frequently affecting the hands and feet, caused by the human papilloma virus. While warts are not harmful and usually go away in time without any treatment, they can be unsightly and painful. Warts on the soles of the feet are also called 'plantar warts' or 'verrucas'.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

A pooled analysis of thyroid cancer incidence following radiotherapy for childhood cancer

Childhood cancer five-year survival now exceeds 70-80%. Childhood exposure to radiation is a known thyroid carcinogen; however, data are limited for the evaluation of radiation dose-response at high doses, modifiers of the dose-response relationship and joint effects of radiotherapy and chemotherapy. To address these issues, we pooled two cohort and two nested case-control studies of childhood cancer survivors including 16,757 patients, with 187 developing primary thyroid cancer. Relative risks (RR) with 95% confidence intervals (CI) for thyroid cancer by treatment with alkylating agents, anthracyclines or bleomycin were 3.25 (0.9-14.9), 4.5 (1.4-17.8) and 3.2 (0.8-10.4), respectively, in patients without radiotherapy, and declined with greater radiation dose (RR trends, P = 0.02, 0.12 and 0.01, respectively). Radiation dose-related RRs increased approximately linearly for <10 Gy, leveled off at 10-15-fold for 10-30 Gy and then declined, but remained elevated for doses >50 Gy. The fitted RR at 10 Gy was 13.7 (95% CI: 8.0-24.0). Dose-related excess RRs increased with decreasing age at exposure (P < 0.01), but did not vary with attained age or time-since-exposure, remaining elevated 25+ years after exposure. Gender and number of treatments did not modify radiation effects. Thyroid cancer risks remained elevated many decades following radiotherapy, highlighting the need for continued follow up of childhood cancer survivors.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Treatments for strawberry birthmarks of the skin in infants and children

Infantile haemangiomas are soft, raised swellings on the skin, often with a bright, red surface. They are a non‐cancerous overgrowth of blood vessels in the skin. They are commonly known as 'strawberry birthmarks', 'strawberry naevi', or 'capillary haemangiomas'. They occur in five per cent of babies, with the majority appearing within the first few weeks of life, and reach their full size at about three to six months of age. The vast majority are uncomplicated and will shrink on their own by five to seven years of age and require no further treatment. However, some infantile haemangiomas may occur in high‐risk areas (such as near the eyes and nose which can result in impairment to vision and airway obstruction, respectively) and some of them are disfiguring and psychologically distressing to the children and their parents. Some may also develop complications so early medical treatment may be necessary. Corticosteroids are currently the standard treatment; however, it is not known which of a variety of treatments is best.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Treatment of severe or progressive Kaposi's sarcoma in HIV‐infected adults

Kaposi’s sarcoma was the first tumor to be described in association with HIV infection and is an AIDS‐defining condition. It is also known as Kaposi's sarcoma‐associated herpes virus (KSHV) as Herpes virus 8 (HHV8) is recognized as an essential and necessary factor in the pathogenesis of KS. Nonetheless, not all HHV‐8‐infected individuals will develop the disease. The abnormal cells of KS form purple, red, or brown patches, plaques or tumors on the skin. There is no universally accepted system for staging Kaposi's sarcoma. The most commonly used staging system for AIDS‐related KS in adults is the AIDS Clinical Trial Group (ACTG) staging.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Adult Hodgkin Lymphoma Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of adult Hodgkin lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 28, 2014

Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of childhood extracranial germ cell tumors.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: October 27, 2014

Testicular Cancer Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of testicular cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 11, 2014

Are any effective treatment options available for the management of granulosa cell tumour of the ovary?

Granulosa cell tumours (GCTs) of the ovary are rare ovarian tumours (2% to 5% of all ovarian cancers). Most ovarian tumours arise from the outer surface layer of the ovary, but GCTs arise from granulosa cells (sex cord cells) within the ovaries that produce oestrogen (primary female sex hormones). These tumours grow relatively slowly and can recur 10 to 15 years after primary treatment. If women with these tumours want to have children, the surgeon usually removes only the diseased ovary. However, standard treatment has consisted of surgery to remove tubes, ovaries and uterus, as most women develop GCTs around the time of the menopause, when fertility is no longer a matter of concern.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Anti‐cancer drug treatment for gestational trophoblastic neoplasia (GTN) that does not respond to first‐line treatment or that re‐occurs

This review concerns anti‐cancer drug treatment for women with GTN that does not respond to first‐line treatment or that re‐occurs. GTN is the name given to a type of cancer that arises from placental tissue following pregnancy, most frequently a molar pregnancy. Molar pregnancies are benign abnormal growths of placental tissue inside the womb. Most are cured by evacuation (D&C) of the womb, however, in up to 20% of cases they become malignant. GTN is usually very responsive to anti‐cancer drugs (chemotherapy), however, these drugs can be toxic, therefore the aim of treatment is to achieve a cure with the least side effects. To help doctors select the most appropriate treatment for women with GTN, the disease is classified as low‐ or high‐risk according to specific risk factors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Systematic Reviews in PubMed

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