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Paul G. Richardson, Jacob P. Laubach, Robert L. Schlossman, Constantine Mitsiades and Kenneth Anderson

neuropathy may be detected in 11% to 52% and 39% to 46% of these populations, respectively. 1 – 6 Risk factors for PN include treatment-specific characteristics, such as therapy duration, dose intensity, and cumulative dose, and patient-specific factors

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Alberto Carmona-Bayonas, Paula Jiménez-Fonseca, Maria Luisa Sánchez Lorenzo, Avinash Ramchandani, Elena Asensio Martínez, Ana Custodio, Marcelo Garrido, Isabel Echavarría, Juana María Cano, Jose Enrique Lorenzo Barreto, Teresa García García, Felipe Álvarez Manceñido, Alejandra Lacalle, Marta Ferrer Cardona, Monserrat Mangas, Laura Visa, Elvira Buxó, Aitor Azkarate, Asunción Díaz-Serrano, Ana Fernández Montes and Fernando Rivera

coded as “gastric cancer.” Dose intensity was defined as the drug dose delivered per time unit and was expressed as mg/m 2 per week. Cumulative dose was defined as total dose and expressed as mg/m 2 . Relative dose intensity (RDI) was defined as the

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Chemotherapy-induced neutropenia is the major dose-limiting toxicity of systemic cancer chemotherapy, associated with substantial morbidity, mortality, and cost. Although prophylactic colony-stimulating factors (CSFs), can reduce this complication, their routine use in all patients on myelosuppressive chemotherapy is prohibitively costly. Selective use in patients most at risk for neutropenia may enhance cost-effectiveness, but determining the actual risk is complicated by issues in reporting myelosuppression and dose intensity, among other factors. For this reason, NCCN experts developed these guidelines to assist practitioners in the appropriate prophylactic use of CSFs.

For the most recent version of the guidelines, please visit NCCN.org

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Gary H. Lyman and Jessica Malone Kleiner

discussed in the article or their competitors. References 1. Dale DC McCarter GC Crawford J . Myelotoxicity and dose intensity of chemotherapy: reporting practices from randomized clinical trials . J Natl Compr Canc Netw 2003 ; 1 : 440

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Jeffrey Crawford, James Armitage, Lodovico Balducci, Charles Bennett, Douglas W. Blayney, Spero R. Cataland, David C. Dale, George D. Demetri, Harry P. Erba, James Foran, Alison G. Freifeld, Marti Goemann, Mark L. Heaney, Sally Htoy, Susan Hudock, Dwight D. Kloth, David J. Kuter, Gary H. Lyman, Laura Boehnke Michaud, Sarah C. Miyata, Martin S. Tallman, Saroj Vadhan-Raj, Peter Westervelt and Michael K. Wong

Web site at www.nccn.org .) These guidelines are also available on the Internet. For the latest update, please visit www.nccn.org . References 1 Dale DC McCarter GC Crawford J . Myelotoxicity and dose intensity of chemotherapy

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Pain Caused by Invasive Procedures in Cancer Patients Portnow Jana * MD Lim Christine † MS Grossman Stuart A. † MD 7 2003 1 1 3 3 435 435 439 439 10.6004/jnccn.2003.0037 Myelotoxicity and Dose Intensity of Chemotherapy: Reporting

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Pankaj Singhal and Shashikant Lele

: 1589 – 1599 . 22. Gore M Mainwaring P A'Hern R . Randomized trial of dose-intensity with single-agent carboplatin in patients with epithelial ovarian cancer. London Gynaecological Oncology Group . J Clin Oncol 1998 ; 16 : 2426 – 2434

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Jeffrey Crawford, Jeffrey Allen, James Armitage, Douglas W. Blayney, Spero R. Cataland, Mark L. Heaney, Sally Htoy, Susan Hudock, Dwight D. Kloth, David J. Kuter, Gary H. Lyman, Brandon McMahon, David P. Steensma, Saroj Vadhan-Raj, Peter Westervelt and Michael Westmoreland

myelosuppressive chemotherapy. Selective use of CSFs in patients at increased risk for neutropenic complications may, however, enhance the cost-effectiveness. The risk of FN is usually based on the treatment regimen and delivered dose intensity. A survey of the

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Robert F. Ozols

/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer . J Natl Cancer Inst 2003 ; 95 : 1320 – 1330 . 13 Levin L Hryniuk WM . Dose intensity analysis of chemotherapy regimens in ovarian carcinoma . J Clin Oncol 1987 ; 5

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.6004/jnccn.2009.0008 Impact of Chemotherapy Dose Intensity on Cancer Patient Outcomes Lyman Gary H. MD, MPH, FRCP (Edin) 1 2009 7 7 1 1 99 99 108 108 10.6004/jnccn.2009.0009