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PubMed2004

Retreatment of chronic hepatitis C virus infection in patients who failed to achieve sustained virologic response.

The treatment of patients with chronic hepatitis C virus (HCV) has improved dramatically over the past several years. Despite this nearly half of all patients fail to achieve a sustained virologic response (SVR) following therapy. The decision to retreat a non-responder depends upon several factors which include data regarding the response to the previous course of therapy and the likelihood that a favorable response can be achieved with retreatment. These factors must be balanced against the risk for fibrosis progression and developing cirrhosis in each individual patient before a decision is made for embark upon retreament. The management of patients who have failed to achieve SVR is therefore one of the most complicated in the spectrum of treating chronic HCV. This manuscript will review the factors to consider when assessing such patients, the likelihood of achieving an SVR with current therapy and options for patients who continue to manifest non-response.

Hepatitis C, Chronic↗

PubMed2005

[A non-healing dark area: surgical treatment or non-surgical retreatment?].

There are a lot of studies discussing success rates of root canal treatment. They show a big variety in their outcomes. Success rates are reported between 54 and 96 percent with a majority reporting a figure towards the higher end of the range. Despite high success rates reported, there are still cases showing no healing after an evaluation period. At that point the dentist has to make a decision: retreatment or surgical endodontics. To make this decision various factors influencing the outcome should be considered carefully. The overall conclusion is that when failure occurs, endodontic retreatment is the first treatment of choice. Periapical surgery is a treatment option which should carefully be considered in specific circumstances.

Decision Making↗

PubMed1996

Endodontic retreatment. 1: Indications and case selection.

Conventional root canal treatment, despite having a reportedly high success rate may not invariably lead to the desired healing response in clinical practice because of shortcomings in the treatment. This is the first of two articles on this subject, and will cover indications and case selection for root canal retreatment. Part 2 will discuss methods of retreatment.

Dental Pulp Diseases↗

PubMed1986

Retreatment of pediatric brain tumors with radiation and misonidazole. Results of a CCSG/RTOG phase I/II study.

Twenty-nine patients with recurrent pediatric brain tumors after full-dose treatment with radiation were retreated with misonidazole (9 gm/m2) and whole-brain irradiation (300 rad X 10). Seventeen of 29 patients (59%) experienced nausea and vomiting with misonidazole administration and 6 patients (21%) developed peripheral neuropathy. Serum levels of misonidazole were similar to those reported for adults. One patient died of trauma shortly after retreatment. For the remaining 28 patients, the median time-to-progression was 5.5 months. Median survival was 13 months. Six patients (21%) developed radiation toxicity, two of whom died from the toxicity. Whereas the results on this study are similar to reported series of patients receiving salvage chemotherapy for recurrent pediatric brain tumors, more effective treatment clearly is needed.

Adolescent↗

PubMed2006

Second complete remission in an elderly patient with acute myeloid leukemia retreated with decitabine.

A 67-year-old man with acute myeloid leukemia (AML) was treated with low-dose decitabine. He achieved a complete remission (CR) after two cycles of therapy, and he remained in remission during 1 year of treatment. He developed recurrent AML after discontinuation of decitabine. He was retreated with decitabine and again achieved a CR, which has been maintained for 6 months. This case demonstrates that durable responses can occur upon retreatment with decitabine.

Aged↗

PubMed1990

Failure of orthoclone OKT3 retreatment in a pancreas transplant recipient with antimurine antibodies.

Orthoclone OKT3 is a murine monoclonal antibody that blocks the generation and function of T lymphocytes. It has been shown to be effective in reversing acute cellular rejection in solid organ transplants. However, potential development of antimurine antibodies restricts the duration that the drug can be used and the ability to reuse the drug. The case reported in this article illustrates the failure of retreatment with OKT3 when high titer (1:3200) antimurine antibodies are present. Lack of efficacy of the drug was documented by virtually undetectable circulating OKT3 levels in plasma, no decrease in T3 lymphocytes, and organ rejection. OKT3 should only be reused when immune monitoring (antimurine antibody status, lymphocyte subsets, and OKT3 plasma levels) is performed before, during, and after its use. Patients with high-titer anti-OKT3 antibody should not be retreated with OKT3.

Adult↗

PubMed1983

Retreatment of recurrent carcinoma of the head and neck by afterloading interstitial 192Ir implant.

From January 1975 to December 1980, 25 patients with persistent or recurrent carcinomas of the head and neck were retreated for palliation at the Division of Radiation Oncology, Mallinckrodt Institute of Radiology. These patients had all undergone extensive previous treatment by surgery and/or radiation. All were retreated with 192Ir interstitial implant with or without external radiation and/or surgical excision. Of 25 patients, 13 had complete response (CR) and 6 had partial response for a follow-up period of 1 to 7 years. Of 13 patients with CR, 6 are alive with no evidence of disease (NED) and two died NED. We present detailed results and discuss our new strategy for such patients.

Aged↗

PubMed2002

Analysis of patients with epithelial ovarian cancer or fallopian tube carcinoma retreated with cisplatin after the development of a carboplatin allergy.

OBJECTIVE: We report the outcome of seven patients treated for recurrent ovarian cancer with cisplatin after an allergic reaction to carboplatin. One case is presented in which a heavily pretreated patient suffered a severe anaphylactic reaction, which was refractory to standard resuscitative measures and resulted in her death. METHODS: Six further patients who received cisplatin after documentation of an allergic reaction to carboplatin (CBDCA) for the treatment of recurrent epithelial ovarian cancer between 1993 and 2000 were identified from the MSKCC database. Electronic medical records were reviewed for relevant treatment and outcome data. RESULTS: Five of six of these patients were successfully treated without further allergic reactions. One patient with platinum-refractory disease had an allergic reaction to carboplatin and subsequently to cisplatin. CONCLUSION: Few patients with a carboplatin allergy are subsequently treated with cisplatin at our center. One patient suffered a serious hypersensitivity reaction following retreatment and died. Based on this limited experience, cross allergy can exist although the true incidence is not known. Routine retreatment of carboplatin-allergic patients with cisplatin in the relapsed setting cannot be recommended without careful consideration of potential risks and benefits.

Adult↗

PubMed2000

Retreatment with chimeric CD 20 monoclonal antibody in a patient with nodal marginal zone B-cell lymphoma.

A patient with advanced and chemotherapy-refractory nodal marginal zone B-cell lymphoma was given a course of chimeric CD 20 monoclonal antibody Rituximab. Partial response was observed without any major toxicities. Retreatment with Rituximab for disease progression six months after the first course led to partial remission. Adjuvant radiotherapy was given for the residual disease and, currently, patient's disease remains stable eight months after the second course of Rituximab. This case demonstrates the therapeutic efficacy and feasibility of retreatment with Rituximab for relapsed or refractory low grade lymphoma.

Antibodies, Monoclonal↗

PubMed1992

Fractionation sensitivity of the rat cervical spinal cord during radiation retreatment.

Data concerning the fractionation sensitivity of normal tissues during radiation retreatment are limited. Experiments were performed to investigate whether the fractionation sensitivity of the rat cervical spinal cord is changed during retreatment 6 months after a first dose of 15 Gy, representing about half the biologically effective dose for induction of paresis. After a 6 months interval, the long-term recovery from the first treatment was about 45%. The fractionation sensitivity of the rat cervical spinal cord during reirradiation was not significantly different from the fractionation sensitivity of not previously irradiated control rats, with an alpha/beta ratio of 2.3 Gy in control rats and 1.9 Gy during reirradiation of the spinal cord. An additional observation from these experiments was the presence of incomplete repair after fractionated treatment with 2 fractions of 3 Gy per day with 10-h intervals.

Animals↗

PubMed1987

Retreatment with the induction regimen in small cell lung cancer relapsing after an initial response to short term chemotherapy.

In 37 patients with small cell lung cancer treatment with five cycles of cyclophosphamide, doxorubicin and etoposide (CDE), resulted in 23 complete (CR) and 14 partial responses (PR). Median response duration was 34 weeks. At relapse all patients were retreated with CDE. In 23 (62%) patients this gave a second response (6 CR, 17 PR). Factors influencing the occurrence of a second response were: 1. a CR after the first five cycles of CDE; 18 out of 23 CR patients responded again whereas only five of the 14 PR patients responded (P less than 0.01). 2. 15 out of 19 patients with a first response duration greater than 34 weeks reached a second response and in eight of the other 18 patients retreatment was successful (P less than 0.05). Reinduction at relapse, after short term chemotherapy and a treatment-free interval, with the induction regimen is an effective second line treatment in patients with an initial CR and a first response duration of greater than 34 weeks.

Adult↗

PubMed1994

Radiation myelopathy following single courses of radiotherapy and retreatment.

PURPOSE: To assess the latent time, survival and dose-fractionation factors associated with permanent radiation myelopathy following single and multiple courses of radiotherapy to the spinal cord. METHODS AND MATERIALS: A retrospective analysis was undertaken of all patients who were registered at the Princess Margaret Hospital between 1955 and 1985, and who developed permanent radiation myelopathy. There were 22 males and 13 females with ages ranging from 30 to 72 years. Twenty-four patients developed permanent myelopathy after one course of radiation therapy and 11 patients following retreatment. Seven patients had histological confirmation of radiation myelopathy at autopsy. RESULTS: The actuarial survival was 14% at 5 years (median: 8.3 months) from the date of diagnosis of radiation myelopathy. Latent times for myelopathy following a single course of treatment (mean: 18.5 months, 7-57 months), were significantly longer than those after reirradiation (mean: 11.4 months, 4-25 months), p = 0.03. There was not a single incident of myelopathy in patients who received fractionated radiotherapy given once daily to an extrapolated response dose (ERD) of < or = 100 Gy2 (equivalent to 50 Gy in 25 daily fractions). Four patients who developed myelopathy after an ERD of < 100 Gy2 were all treated on accelerated fractionation protocols with multiple fractions given per day. Patients who were reirradiated received significantly higher doses (mean ERD of 148 Gy2) than those who had a single course of treatment (mean ERD of 121 Gy2), p = 0.001. CONCLUSION: We conclude that the risk of radiation myelopathy following conventionally fractionated radiotherapy to the spinal cord is extremely small; giving multiple fractions per day reduces the spinal cord tolerance; latent time to myelopathy decreases following retreatment; and there is possible long-term recovery of radiation damage in the human spinal cord.

Adult↗

PubMed1997

Retreatment of decentered excimer photorefractive keratectomy ablations.

PURPOSE: To present two cases of excimer photorefractive keratectomy decentration associated with visual distortion secondary to irregular astigmatism. METHOD: Patients were retreated with a repeat photorefractive keratectomy using a technique whereby the circle of adherent epithelium overlying the decentered ablation served as a mask. RESULTS: After retreatment, there was significant improvement in the patients' visual symptoms, decreased astigmatism on refraction, and better centration on corneal topography. CONCLUSION: This method appears to offer an effective means to treat photorefractive keratectomy ablation zone decentration by improving the abnormalities introduced by the initial decentration.

Adult↗

PubMed2003

Platinum retreatment of platinum-resistant ovarian cancer after nonplatinum therapy.

OBJECTIVE: The objective was to determine the response rate to platinum retreatment of "platinum-resistant" ovarian cancer after intervening nonplatinum therapy. METHODS: We retrospectively identified 30 patients with platinum-resistant ovarian cancer who received nonplatinum chemotherapy for recurrent epithelial ovarian cancer prior to additional platinum therapy. All patients were treated between July 1, 1997, and June 30, 2001. Platinum resistance was defined as less than a partial response to platinum therapy or progression within 6 months of the last platinum therapy. RESULTS: Overall, 7 of 30 patients experienced an objective response to platinum therapy (partial response, 23%; complete response, 0%) based on CT scan (2/21) and/or CA-125 (5/9) criteria. The median time to progression for the group was 17 weeks (range, 4-59 weeks). Several predictive factors were identified. The interval since the last platinum treatment did not appear to be predictive in this group. Only 1 of 16 patients who did not have an objective response to the most recent platinum-based therapy responded to platinum rechallenge. Similarly, no patient who received more than three intervening nonplatinum treatments responded to additional platinum therapy (0/10). CONCLUSIONS: Our small retrospective series suggest that the platinum-resistant category is heterogenous and includes patients who may respond to retreatment with platinum-based agents. This group includes the patients with prior platinum responses and early progression. However, patients without an objective response to the last prior platinum therapy or more than three intervening treatments are unlikely to respond to subsequent platinum therapy.

Adult↗

PubMed1993

Comparison of endodontic retreatment of laterally condensed gutta-percha and Thermafil with plastic carriers.

The purpose of this study was to evaluate canal wall cleanliness in cases of retreatment using laterally condensed gutta-percha and Thermafil with plastic carriers. Forty extracted mandibular canines were prepared using a step-back flared technique and divided into two groups: group A, obturated with lateral condensation and group B, obturated with Thermafil. AH26 was the sealer used in both groups. Retreatment of all teeth was done using Gates Glidden burs and a solvent. The teeth were then split longitudinally, photographed, and projected onto a screen at x10 magnification. The total area of the canal and the area of gutta-percha/sealer were then traced on white paper. Both areas were accurately quantified using a computerized image analysis system and the ratio of remaining obturation material to root canal periphery was derived and statistically analyzed. Results showed that the average percentage of the remaining gutta-percha/sealer was 14.23 for the lateral condensation group and 15.70 for the Thermafil group with no statistically significant difference (Student's t test, p = 0.01). The plastic carrier was easily removed from the canals.

Humans↗

PubMed2002

Posterior corneal topographic changes after retreatment LASIK.

PURPOSE: To evaluate posterior corneal topographic changes after retreatment after myopic laser in situ keratomileusis (repeat LASIK). DESIGN: Retrospective nonrandomized comparative self-controlled trial. PARTICIPANTS: Thirty-three eyes of 23 patients who underwent repeat LASIK for residual myopia. INTERVENTION: Retreatments were performed. Slit-scanning corneal topography was performed before and at 1, 3, and 6 months after repeat LASIK. MAIN OUTCOME MEASURES: Posterior corneal topographic changes before and after repeat LASIK were correlated with central corneal pachymetry (preoperatively, before repeat LASIK, after repeat LASIK), residual bed thickness (RBT) and ablation depth (after primary laser in situ keratomileusis (LASIK) and repeat LASIK). On the basis of the amount of posterior corneal elevation after repeat LASIK, the eyes were divided into two groups: group 1 (>66 micro m) and group 2 (< or =66 micro m). Student's t test/Mann-Whitney rank-sum test was used to determine the significant difference of mean level of each variable between the two groups. RESULTS: After primary LASIK, an increase in posterior corneal elevation had significant positive correlation with attempted correction (P = 0.02), ablation depth (P = 0.008), and significant negative correlation with preoperative central pachymetry (P = 0.0003), RBT (P = 0.0003), and postoperative central pachymetry (P = 0.00008). After repeat LASIK, the mean increase in posterior corneal elevation had significant negative correlation with preoperative central pachymetry (P = 0.03). However, its correlation with the ablation depth (P = 0.43) during repeat LASIK and RBT after repeat LASIK (P = 0.11) was statistically insignificant. On multiple linear regression analysis, the attempted correction (P < 0.01) and RBT after primary LASIK (P < 0.001) were two independent significant determinants of an increase in posterior corneal elevation after primary LASIK. However, for increase in posterior corneal elevation after repeat LASIK, preoperative central pachymetry (P < 0.01) and posterior corneal elevation increase after primary LASIK (P < 0.05) were the two significant determinants. Compared with group 2, group 1 had significantly high values of posterior corneal elevation both after primary LASIK (P = 0.0037) and after repeat LASIK (P = 0.0000). This group also had significantly low values of central pachymetry preoperatively (P = 0.0003) and after primary LASIK (P = 0.0001) and repeat LASIK (P = 0.0001) surgeries. The mean RBT after primary LASIK (P = 0.0006) and after repeat LASIK (P = 0.001) was also lower in group 1. CONCLUSIONS: Posterior corneal elevation increases after repeat LASIK. Eyes with an increase in posterior corneal elevation after primary LASIK and with thinner cornea are more predisposed.

Adolescent↗

PubMed2000

Excimer laser retreatment of residual myopia following photoastigmatic refractive keratectomy for compound myopic astigmatism.

PURPOSE: To prospectively evaluate the safety, efficacy, and visual performance of excimer laser enhancement following photoastigmatic refractive keratectomy (PARK) with the Summit Apex Plus. SETTING: Stanford University School of Medicine Eye Laser Clinic, Stanford, California, USA. METHODS: As part of a Food and Drug Administration clinical trial, 93 eyes of 56 patients with a mean spherical equivalent (SE) of -4.98 diopters (D) +/- 1.80 (SD) (range -1.75 to -8.50 D) had PARK for compound myopic astigmatism using the Summit Apex Plus excimer laser and a poly(methyl methacrylate) erodible mask. Seventeen eyes with a mean SE of -2.08 +/- 0.76 D required excimer laser refractive keratectomy for residual spherical myopia or compound myopic astigmatism. Patients were prospectively followed 1, 3, 6, 9, and 12+ months after the enhancement procedure. Primary outcome variables included uncorrected visual acuity (UCVA), refraction, vector analysis, best spectacle-corrected visual acuity (BSCVA) under standard ambient conditions (photopic, scotopic, and glare), corneal clarity, and contrast sensitivity function curve under photopic and scotopic conditions. RESULTS: At the last postoperative visit, the mean sphere had been corrected 82% to a residual of -0.29 +/- 1.23 D and mean SE had been corrected 65% to a residual of -0.74 +/- 1.27 D. Eighty-two percent of eyes were within +/-1.0 D of attempted correction. Eighty-eight percent had a UCVA of 20/40 or better. Vector analysis demonstrated a difference vector of within +/-1.0 D in 75% of eyes that had PARK retreatment. There was no significant loss in the contrast sensitivity curve. Late regression associated with corneal haze and loss of BSCVA occurred in 2 eyes (11.7%). CONCLUSIONS: Retreatment following PARK for compound myopic astigmatism results in effective reduction in residual spherical myopia and compound myopic astigmatism. An improvement in UCVA without loss of contrast sensitivity can be expected in most eyes. However, regression, corneal haze, and loss of BSCVA may occur. Further studies are indicated to predict risk factors for these complications.

Astigmatism↗

PubMed1995

An uncontrolled trial of pefloxacin in the retreatment of patients with pulmonary tuberculosis.

OBJECTIVE: To study the role of Pefloxacin in the retreatment of pulmonary tuberculosis. DESIGN: 14 cases of sputum smear-positive tuberculosis were given pefloxacin in doses of 400 mg daily, along with isoniazid and thioacetazone plus additional drugs wherever indicated. They were followed and assessed by sputum smear microscopy and chest X-ray regularly for the total duration, which ranged from 15-18 months. RESULTS: 10 of the patients completed treatment and achieved a satisfactory response in the form of persistent sputum, negativity and radiologically quiescent disease. Two developed serious side-effects and had to discontinue medication. One patient failed on therapy as evidenced by persistent sputum positivity at 6 months. CONCLUSION: Pefloxacin may have a role in the retreatment of pulmonary tuberculosis along with other drugs, as a companion drug in selected cases. The other advantages are the low cost of treatment and high safety profile.

Adult↗