Perfil clínico-epidemiológico de pacientes pediátricos de um centro de oncohematologia de pernambuco / Clinical-epidemiological profile of pediatric patients at a center of oncohematology in Pernambuco / Perfil clínico-epidemiológico de pacientes pediátricos en un centro de oncohematología de Pernambuco

ntrodução:O câncer infantojuvenil corresponde a um grupo de várias doenças que têm em comum a proliferação descontrolada de células anormais e que pode ocorrer em qualquer local do organismo. Objetivo:Identificar os tipos de neoplasias mais frequentes na infância e adolescência e analisar o perfil clínico-epidemiológicodos pacientes. Metodologia:Estudo de transversal exploratório, de natureza aplicada com análise documental, realizado no Centro de Oncohematologia Pediátrica do Hospital Universitário Oswaldo Cruz, Recife, Pernambuco.Foram incluídos crianças e adolescentes diagnosticados com neoplasia e tratados por terapia antineoplásica.Os critérios de exclusão foram crianças e adolescentes normorreativas e/ou com doenças sistêmicas; prontuários ilegíveis ou com falta de informações clínicas.Resultados:Identificou-se que 54,21% dos pacientes eram dosexo feminino, seguido por 44,86% do sexo masculino.A faixa etária prevalente no estudo foi o de crianças de 5 a 14 anos (54,21%), ainda sobre o perfil dos pacientes, identificou-se que população autodeclarada como negra foi a mais prevalente representando 44,86% do total, seguido dos brancos com 43,93%. O diagnóstico que prevaleceu foi o de Leucemia Linfoide Aguda(23,36%), seguido pela Retinoblastoma (7,48%) e pela Rabdomiossarcoma embrionário (6,54%), e consequentemente o local da neoplasia primária que prevaleceu foi a Medula óssea (27,10%) seguido do olho (10,28%), deste total nota-se que o tratamento antineoplásico mais utilizado foi a quimioterapia (40,19%) seguido da quimioterapia associada à radioterapia(12,15%) e pela quimioterapia associada a cirurgia (10,28%). Conclusões:A leucemia linfoide aguda foi a neoplasia mais frequente na infância e adolescência, com prevalência na idade entre 5 e 14 anos, no sexo feminino e na etnia negra. A terapia antineoplásica mais utilizada foi a quimioterapia, seguida da associação entre quimioterapia e radioterapia (AU).

Introduction:Childhood cancer correspondsto a group of several diseases that have in common the uncontrolled proliferation of abnormal cells and that can occur anywhere in the body. Objective:Identify the most frequent types of neoplasms in childhood and adolescence and analyze the clinical-epidemiological profile of patients. Methodology:Exploratory cross-sectional study, applied in nature with document analysis, carried out at the Pediatric Oncohematology Center of Oswaldo Cruz University, Recife, Pernambuco. Children and adolescents diagnosed with neoplasia and treated with antineoplastic therapy were included. Exclusion criteria were normoreactive children and adolescents and/or with systemic diseases; illegible medical records or lacking clinical information. Results:It was identified that54.21% of the patients were female, followed by 44.86% male. The prevalent age group in the study was children from 5 to 14 years old (54.21%), still regarding the patients'profile , it was identified that the population self-declared as black was the most prevalent, representing 44.86% of the total, followed by of whites with 43.93%. The diagnosis that prevailed was Acute Lymphoid Leukemia (23.36%), followed by Retinoblastoma (7.48%) and Embryonic Rhabdomyosarcoma (6.54%), and consequently,the site of the primary neoplasm that prevailed was Bone marrow (27.10%) followed by the eye (10.28%), of this total it is noted that the most used anticancer treatment was chemotherapy (40.19%) followed by chemotherapy associated with radiotherapy (12.15% ) and chemotherapy associated with surgery (10.28%). Conclusions:Acute lymphoblastic leukemia was the most frequent neoplasm in childhood and adolescence, with a prevalence between 5 and 14 years of age, in females,and black ethnicity. The most used antineoplastic therapy was chemotherapy, followed by the association between chemotherapy and radiotherapy (AU).

ntroducción: El cáncer infantil corresponde a un grupo de varias enfermedades que tienen en común la proliferación descontrolada de células anormales y que pueden presentarse en cualquier parte del cuerpo. Objetivo: Identificar los tipos de neoplasias más frecuentes en la infancia y la adolescencia y analizar el perfil clínico-epidemiológico de los pacientes. Metodología: Estudio transversal exploratorio, aplicado en la naturaleza con análisis de documentos, realizado en el Centro de Oncohematología Pediátrica del Hospital Universitario Oswaldo Cruz, Recife, Pernambuco. Se incluyeron niños y adolescentes con diagnóstico de neoplasia y tratados con terapia antineoplásica. Los criterios de exclusión fueron niños y adolescentes normorreactivos y/o con enfermedades sistémicas; registros médicos ilegibles o carentes de información clínica. Resultados: Se identificó que el 54,21% de los pacientes eran del sexo femenino, seguido del 44,86% del masculino. El grupo etario prevalente en el estudio fueron los niños de 5 a 14 años (54,21%), en cuanto al perfil de los pacientes, se identificó que la población autodeclarada afrodescendiente fue la más prevalente, representando el 44,86% del total, seguido de los blancos con un 43,93%. El diagnóstico que predominó fue Leucemia Linfoide Aguda (23,36%), seguido de Retinoblastoma (7,48%) yRabdomiosarcoma Embrionario (6,54%), y en consecuencia el local de la neoplasia primaria que predominó fue Médula Ósea (27,10%) seguido de ocular (10,28%), de este total se destaca que el tratamiento anticancerígeno más utilizado fue la quimioterapia (40,19%) seguida de la quimioterapia asociada a radioterapia (12,15%) y la quimioterapia asociada a cirugía (10,28%). Conclusiones: La leucemia linfoblástica aguda fue la neoplasia más frecuente en la infancia y la adolescencia, con prevalencia entre los 5 y los 14 años, en el sexo femenino y en la etnia negra. La terapia antineoplásica más utilizada fue la quimioterapia, seguida de la asociación entre quimioterapia y radioterapia (AU).

High versus low frequency transcutaneous acupoint electrical stimulation as an adjunct therapy to prevent nausea and vomiting in the first 24 hours after infusion of high-grade emetic chemotherapy: a randomized controlled trial / Estimulação elétrica transcutânea de alta versus baixa frequência como terapia adjuvante para prevenir náuseas e vômitos nas primeiras 24 horas após a infusão de quimioterapia emética de alto grau: um estudo controlado randomizado

Introdução: A estimulação elétrica transcutânea em pontos de acupuntura (TAES) foi testada como terapia antiemética. Objetivo: Avaliar a eficácia de duas frequências diferentes de corrente elétrica como terapia adjuvante para a prevenção de náusea e vômito. Métodos: Este ensaio clínico controlado por placebo comparou a incidência de náusea e vômito (nas primeiras 24 horas após a infusão de quimioterapia emética de alto grau) em 61 mulheres (54 ± 11 anos) com câncer de mama em três modos de TAES: alta frequência (HF:150 Hz), baixa frequência (LF:10 Hz) e placebo (P). Os eletrodos foram fixados no ponto de acupuntura PC6 e uma corrente bipolar simétrica (largura de pulso 200 µs) foi aplicada em uma única sessão de 30 minutos antes do início da infusão de quimioterapia. Todos os pacientes recebem infusões fixas de tratamento antiemético (ondansetrona - 8mg) e orientação de uso de medicação de resgate, se necessário, conforme rotina para infusões de ciclofosfamida associada à antraciclina. Resultados: A incidência de náusea foi de 47% no P, 45% na HF e 26% na LF. Embora não significativa, a intervenção com LF-TAES no ponto de acupuntura PC6, alcançou valores relevantes na redução do risco relativo de desenvolver náuseas (RR = 0,51; IC 95% = 0,18 a 1,44; p = 0,18) e tendência de melhora na sensação de bem estar (p = 0,06) e pontuação mais baixa na Edmonton Symptom Rating Scale (p = 0,08). A incidência de vômitos e o consumo de doses antieméticas de resgate foram muito semelhantes entre os grupos. Conclusão: Novos estudos com LF e HF de TAES como terapia adjuvante na prevenção de náuseas e vômitos devem ser realizados para confirmar essa hipótese.

Reacción adversa a Citarabina con compromiso cutáneo: reporte de caso / Adverse reaction to Cytarabine with skin involvement: case report: case report

RESUMEN Presentamos el caso de una paciente de 67 años con un diagnóstico clínico de reacción adversa cutánea al uso del agente quimioterapéutico citarabina, el cual recibió en el contexto del tratamiento médico por leucemia mieloide aguda. Se realiza la descripción epidemiológica, signos clínicos, evolución médica y realizamos la comparación con casos similares previamente descritos. Para excluir otros diagnósticos diferenciales se realizó estudio histopatológico y su correlación con el examen clínico.

ABSTRACT We report the case of a 67-year-old female patient with a medical diagnosis of cutaneous adverse reaction to the use of the chemotherapeutic agent cytarabine, which she received in the context of medical treatment for acute myeloid leukemia. Epidemiological description, clinical signs, medical evolution, and comparison with similar cases previously described. In order to exclude other differential diagnoses, histopathological study and its correlation with the clinical examination were performed.

Dados de mundo real: o impacto econômico da inclusão de antineoplásicos orais para as operadoras de saúde no Sistema de Saúde Suplementar do Brasil / Real world data: the economic impact of including oral antineoplastic agents for health care providers in the Brazilian Supplementary Health System

Objetivo: Avaliar o incremento mensal do custo por beneficiário da incorporação das terapias antineoplásicas orais se aprovado o PL nº 6.330/2019. Métodos: As características clínicas e dos medicamentos utilizados em pacientes em tratamento oncológico foram coletadas da base de dados de mundo real Auditron®, plataforma de avaliações de solicitações de pré-autorização de procedimentos médicos. Com base nas características dos pacientes, foram avaliadas as possibilidades de uso dos medicamentos antineoplásicos orais, conforme as diretrizes da NCCN e ESMO. O cálculo do custo incremental foi realizado utilizando o número total de pacientes diagnosticados com uma neoplasia específica e o número de pacientes aptos a receber antineoplásicos orais. Foi utilizada lista de preços CMED para cálculo dos custos de aquisição de medicamentos. Resultados: O custo incremental da incorporação de 34 drogas antineoplásicas orais em 2019 foi de R$ 5.362.642.580 (R$ 3.944.321.786- R$ 6.483.413.466), representando impacto mensal de R$ 9,50 por beneficiário. O custo incremental da incorporação de 21 drogas antineoplásicas orais em 2021 era de R$ 2.028.538.791 (R$ 1.485.919.710-R$ 3,016,407,794), representando impacto mensal de R$ 3,59 por beneficiário. Conclusão: A incorporação das drogas antineoplásicas orais acarretariam um baixo incremento mensal por beneficiário.

Objective: To evaluate the monthly increase in the cost per member of incorporating all oral neoplastic therapies if approved the bill 6,330/2019. Methods: The clinical characteristics and medications used by patients undergoing cancer treatment were collected from the real-world Auditron® database, a platform for evaluating requests for pre-authorization of medical procedures. Based on the characteristics of each patient, the possibility of using oral antineoplastic drugs according to the NCCN and ESMO guidelines was evaluated. The incremental cost calculation was performed using the total number of patients diagnosed with a specific neoplasm and the number of patients eligible to receive oral anticancer drugs. CMED price list was used to calculate drug acquisition costs. Results: The incremental cost of incorporating 34 neoplastic drugs in 2019 was R$ 5,362,642,580 (R$ 3,944,321,786- R$ 6,483,413,466), representing a monthly impact of R$ 9.50 per member. The incremental cost of incorporating 21 neoplastic drugs in 2021 was R$ 2,028,538,791 (R$ 1,485,919,710-R$ 3,016,407,794), representing a monthly impact of R$ 3.59 per beneficiary. Conclusion: The incorporation of oral anticancer drugs in the coverage of health plans following international and national treatment guidelines would result in a low monthly increase in the cost per beneficiary.

Oral health status before, during and after antineoplastic treatment at a cancer institute in Barranquilla, Colombia / Estado de salud oral antes, durante y después del tratamiento antineoplásico en un instituto de cáncer en Barranquilla, Colombia

Chemotherapy and radiotherapy are aggressive treatments for cancer management. Both therapies make the stomatogatic system vulnerable to adverse effects on the oral mucosa and hard tissues. This may result in severe oral complications that can affect the quality of life of the oncologic patient. Consequently, oral diagnosis and interdisciplinary management by the stomatologist are critical for cancer treatment, regardless of its location. Objective. To determine the oral health status of cancer patients before, during and after antineoplastic treatment at a cancer institute in the city of Barranquilla, Colombia. Materials and Methods. A descriptive, longitudinal and prospective study of 131 cancer patients, was conducted. The study consisted of initial stomatological assessment of the antineoplastic therapy; classification according to the antineoplastic therapy given by the oncologist; a second stomatological assessment during treatment; and a final stomatological assessment or evaluation forty days after the end of therapy. Descriptive statistics, chi-square and MacNemar test were used to compare and identify variances at the different stages. Results. Female patients accounted for 69%, and breast cancer had 24% prevalence among the included subjects. At the initial stomatological assessment, high frequency lesions were identified, such as generalized biofilm-associated gingivitis in 69% of the cases, followed by oral candidiasis in 61%. The specific prevalence of lesions was 10.65%. In the second stomatological assessment, a greater frequency of periodontal abscesses was observed in 31%, and oral mucositis type II in 18%. The third clinical assessment showed significant changes in oral health status; an increase in the frequency of gingivitis was found in 9.9% (p<0.001); unlike before and during, there was an increment in dental caries of 26.73% (p<0.00000) at this last stage, root remains increased by 39.53% (p<0.00000), and finally, xerostomia increased by 45%. Oral candidiasis was the only lesion that showed improvement. Conclusion. An increase in the number of lesions was observed during and after antineoplastic treatment. The oral cavity is susceptible to antineoplastic treatments; gingivitis, candidiasis, xerostomia, and mucositis were observed, among others conditions.

La quimioterapia y la radioterapia son tratamientos agresivos para el manejo del cáncer, producen susceptibilidad en el sistema estomatogático causando efectos adversos en mucosa bucal y tejidos duros. Esto se traduce a complicaciones bucales agresivas, que afectan la calidad de vida del paciente oncologico, por lo que es fundamental el diagnostic bucal y manejo interdisciplinario que incluya el estomatologo en manejo del cáncer, indistintamente de su localizacion. Objetivo. Determinar el estado de salud bucal antes, durante y después del tratamiento antineoplásico en un instituto oncológico de la ciudad de Barranquilla. Materiales y Métodos. Estudio descriptivo prospectivo longitudinal, con una muestra de 131 pacientes con cáncer. Constó de: valoración estomatológica inicial a la terapia antineoplásica, clasificación según la terapia antineoplásica asignada por el oncólogo, una segunda valoración estomatológica durante los tratamientos, y finalmente una última valoración estomatológica cuarenta días de culminadas las terapias. Se empleó estadística descriptiva, chi cuadrado y prueba de MacNemar para comparar e identificar varianzas en las diferentes fases. Resultados. Un 69% eran del género femenino con frecuencia de cáncer de mama en un 24%. A la valoración estomatológica inicial se identificó alta frecuencia de lesiones como gingivitis asociada a biofilm generalizada en un 69%, seguida de candidiasis oral en un 61%. La prevalencia puntual de lesiones fue de 10,65%. En el segundo examen estomatológico se observó mayor frecuencia de abscesos periodontales en un 31% y mucositis oral tipo II en un 18%, entre otras. La tercera valoración clínica mostró cambios significativos en la salud bucal; se encontró un aumento de la frecuencia de gingivitis en un 9,9% (p<0,001) a diferencia del antes y el durante, igualmente para la caries dental se encontró aumentada en un 26,73% (p<0,00000), restos radiculares aumentó en un 39,53% (p<0,00000) y finalmente la xerostomía aumentando en un 45%, entre otras; la única lesión que mostró mejoria fue la candidiasis oral. Conclusión. Se observó un aumento de las lesiones, durante y después del tratamiento antineoplásico. La cavidad oral es susceptible a los tratamientos antineoplásicos, se relacionan con: gingivitis, candidiasis, xerostomía, mucositis entre otras.

Evaluación de la calidad de vida en pacientes con cáncer de esófago tratados con endoprótesis autoexpandibles / Evaluation of the quality of life in patients with esophageal cancer treated with self-expanding stent

RESUMEN Fundamento: el estudio de la calidad de vida relacionada con la salud en pacientes que presenten cáncer de esófago inoperable con uso de endoprótesis autoexpandibles, proporciona información útil para seleccionar la opción de tratamiento adecuado. El instrumento EORTC QLQ- C30 para evaluar al paciente con cáncer de esófago y el módulo de complemento EORTC QLQ-OES18, permiten el intercambio directo con el paciente y predecir el impacto de la enfermedad y del tratamiento sobre este. Objetivo: realizar una revisión y reflexión acerca de los diferentes aspectos relacionados con la evaluación de la calidad de vida en pacientes oncológicos tratados con endoprótesis esofágicas metálicas autoexpandibles. Métodos: se realizó una búsqueda en los motores Google, PUBMED, SciELO Regional, SciELO Public Health, SciELO Cuba, Biblioteca Virtual de Salud Cuba, Medline Plus, WebMD, Medscape, National Institutes of Health, National Library of Medicine GoPubMed. En la estrategia de búsqueda, se utilizaron los términos: calidad de vida, calidad de vida relacionada con salud, cáncer de esófago, prótesis esofágicas autoexpandibles. Se evaluaron los documentos en extenso y se desarrolló un documento resumen de la información recolectada. Desarrollo: en la búsqueda bibliográfica realizada encontraron 20 trabajos relacionados con la caracterización de pacientes con cáncer de esófago cuatro, paliación de disfagia con uso de prótesis esofágicas autoexpandibles siete, específicos de calidad de vida cuatro, instrumentos de medición tres y modalidad de tratamientos combinados dos. Conclusiones: la calidad de vida relacionada con la salud se considera hoy en día uno de los pilares más importantes para poder evaluar el impacto de un determinado tratamiento sobre pacientes con una sobrevida menor a tres meses, esto generará la adquisición y actualización de conocimientos entre el personal de la salud y servirá de impulso y motivación para su puesta en práctica de forma generalizada.

ABSTRACT Background: the study of health-related quality of life in patients with inoperable esophageal cancer using self-expanding stent provides useful information for selecting the appropriate treatment option. The EORTC QLQ-C30 instrument for evaluating the patient with esophageal cancer and the EORTC QLQ-OES18 complement module allows direct exchange with the patient and predicts the impact of the disease and treatment on the patient. Objective: to perform a review and reflection on the different aspects related to the evaluation of the quality of life in cancer patients treated with self- expanding metal esophageal stent. Methods: a search was carried out in the engines Google, PUBMED, SciELO Regional, SciELO Public Health, SciELO Cuba, Biblioteca Virtual de Salud Cuba, Medline Plus, WebMD, Medscape, National Institutes of Health, National Library of Medicine GoPubMed. In the search strategy, the terms quality of life, health-related quality of life, esophageal cancer and Self-expanding esophageal stent were used. The documents were extensively evaluated and a summary document of the information collected was developed. Development: a total of 20 papers were reviewed, including the characterization of patients with esophageal cancer 4, dysphagia palliation using self-expanding esophageal stent 7, quality of life 4 specific, measurement instruments 3 and modality of combined treatments 2. Conclusions: health-related quality of life is nowadays considered one of the most important pillars in order to evaluate the impact of a given treatment on patients with a survival shorter than three months, this will generate the acquisition and updating of knowledge among the health personnel and will serve as an impetus and motivation for its implementation in a generalized way.

Neutropenia em pacientes com câncer de cólon e reto submetidos a tratamento quimioterápico adjuvante / Neutropenia in patients with colon and rectal cancer who underwent adjuvant chemotherapeutic treatment

O tratamento quimioterápico do câncer de cólon e reto pode provocar efeitos adversos que limitam a efetividade da terapia e tem grande impacto nos resultados finais do tratamento, sendo a neutropenia a toxicidade hematológica mais comum decorrente do tratamento quimioterápico. O presente estudo teve como objetivos identificar a ocorrência de neutropenia em pacientes com câncer de cólon e reto submetidos a tratamento quimioterápico adjuvante do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e avaliar o risco para o desenvolvimento de neutropenia febril (NF) de acordo com o índice de risco da Associação Multinacional de Cuidados de Assistência ao Câncer (MASCC), em pacientes que apresentaram neutropenia durante o tratamento quimioterápico. Trata-se de um estudo descritivo e retrospectivo, realizado por meio da revisão de 60 prontuários de pacientes com diagnóstico de câncer de cólon e reto submetidos ao tratamento quimioterápico com 5-fluorouracil, ácido folínico e oxaliplatina (FLOX), seguidos no ambulatório de Coloproctologia deste referido hospital, entre os anos de 2010 a 2017. Foi realizada a avaliação dos resultados laboratoriais a cada semana do tratamento quimioterápico nos pacientes elegíveis para este estudo. A idade média dos participantes foi de 63,8 anos. 34 pacientes (56,7%) eram do sexo masculino. A maioria 50 (83,3%) era da raça branca. Quanto ao estado civil 37 (61,7%) eram casados. O tipo de neoplasia mais frequente foi o adenocarcinoma de reto, representado por 38 (63,3%) pacientes, seguido pelo adenocarcinoma de cólon com 22 (36,7%). Os estadiamentos clínicos mais observados foram o IIIb em 18 (30%) pacientes, seguido do IVa em 16 (26,7%). Foi analisado um total de 146 ciclos de quimioterapia com uma média de 2,5 ciclos por paciente, e 876 semanas de tratamento quimioterápico. Dos 60 pacientes participantes no estudo, 41,7% apresentaram neutropenia em algum momento do tratamento quimioterápico. Entre estes 60 pacientes, 21,6% apresentaram um episódio de neutropenia, dois episódios foram observados em 13,3%, quatro episódios em 3,4% e, 3,4% dos pacientes desenvolveram seis episódios de neutropenia. No total, foram identificados 49 episódios de neutropenia. Registrou-se 67 atrasos entre as semanas de tratamento com uma média de 5,02 dias. A redução de doses foi utilizada em 30 pacientes, com um total de 40 ciclos e 218 semanas de tratamento reduzidos, e a suspensão do tratamento ocorreu em 21 pacientes, totalizando 57 semanas de tratamento com suspensão de 27 ciclos. A neutropenia neste estudo esteve entre os principais motivos para os atrasos, reduções de dose e suspensão do tratamento quimioterápico. Quanto a avaliação de risco para o desenvolvimento de NF, 23 pacientes (84%) apresentaram baixo risco, 2 (8%) apresentaram alto risco e 2 (8%) apresentaram baixo e/ou alto risco concomitantemente. Os resultados deste estudo evidenciam que a neutropenia em pacientes com câncer de cólon e reto em tratamento quimioterápico tem uma incidência relativamente baixa em seus diferentes graus, possui baixo risco para o desenvolvimento de NF, e sugere a elaboração e implantação de instrumentos nos serviços de saúde que forneçam o melhor registro de informações da incidência de neutropenia, evitando sua subnotificação

The chemotherapeutic treatment of colon and rectal cancer can entail adverse effects that limit the effectiveness of the therapy and have a great impact on the final results of the treatment, where neutropenia is the most common hematological toxicity resulting from the chemotherapeutic treatment. This study was aimed to identify the occurrence of neutropenia in patients with colon and rectal cancer who underwent adjuvant chemotherapeutic treatment at the Clinical Hospital of the Ribeirão Preto Medical School, which belongs to the University of São Paulo (HCFMRP-USP), and to assess the development of febrile neutropenia (FN), according to the risk index of the Multinational Association for Supportive Care in Cancer (MASCC), in patients who had neutropenia during the chemotherapeutic treatment. This is a descriptive and retrospective study, which was performed through the review of 60 medical charts of patients diagnosed with colon and rectal cancer who underwent chemotherapeutic treatment with 5-fluorouracil, folinic acid and oxaliplatin (FLOX) and were monitored at the outpatient clinic of Coloproctology of this hospital between 2010 and 2017. We performed the assessment of the laboratory results of the chemotherapeutic treatment in patients allowable for this study on a weekly basis. The average age of participants was 63.8 years. A total of 34 patients (56.7%) were male. Most, 50, (83.3%) were white. As for marital status, 37 (61.7%) were married. The most frequent type of neoplasm was rectal adenocarcinoma, represented by 38 (63.3%) patients, followed by colon adenocarcinoma with 22 (36.7%). The most observed clinical staging were IIIb, 18 (30%) patients, followed by IVa, 16 (26.7%). We analyzed a total of 146 chemotherapeutic cycles, with an average of 2.5 cycles per patient, and 876 weeks of chemotherapeutic treatment. Of the 60 patients participants in the study, 41.7% had neutropenia at some time over the chemotherapeutic treatment. Among these 60 patients 21.6% had one episode of neutropenia, two episodes were observed in 13.3%, four episodes in 3.4%, and 3.4% of the patients developed six episodes of neutropenia. Altogether, 49 episodes of neutropenia were identified. We noted 67 delays among the treatment weeks, with an average of 5.02 days. Dose reduction was used in 30 patients, with a total of 40 cycles and 218 weeks of treatment reduced, and treatment suspension happened to 21 patients, totaling 57 treatment weeks with 27 suspension cycles. In this study, neutropenia was among the main reasons for the delays, dose reductions, and suspension of chemotherapeutic treatment. As for the risk assessment for the development of FN, 23 patients (84%) showed low risk, 2 (8%) showed high risk and 2 (8%) showed low and/or high risk concomitantly. The results of this study highlight that neutropenia in patients with colon and rectal cancer undergoing chemotherapeutic treatment has a relatively low incidence in its different stages, has low risk for the development of FN, in addition to suggesting the preparation and implementation of instruments capable of providing the best record of information on the incidence of neutropenia in health services, thus avoiding its underreporting

Importancia del odontólogo dentro del plantel multidisciplinario de oncología / Importance of the dentist within the multidisciplinary team of oncology

Se revisó en la literatura científica la importancia del odontólogo dentro del plantel multidisciplinario de oncología en artículos científicos extraídos de bases de datos tales como: PubMed, SciELO, CrossRef, Revistas USC, Revista Científica Odontológica, Elsevier, Researchgate, Google Académico, Wiley Online Library y Springer. En base a 32 artículos seleccionados se concluye que el odontólogo como parte del plantel multidisciplinario de oncología tiene un papel sumamente importante, ya que su integración permite contrarrestar las distintas complicaciones orales que se presentan a consecuencia de las diferentes terapias antineoplásicas a las cuales son sometidos los pacientes con cáncer. Estas complicaciones orales deben ser indefectiblemente tratadas, pues, su presencia en la cavidad oral constituye un riesgo aún mayor en cuanto a infección sistémica se refiere. He aquí la importancia del odontólogo dentro del plantel multidisciplinario de oncología evitando y previniendo la propagación de focos infecciosos y mejorando así la calidad de vida de los pacientes oncológicos.

The importance of the dentist within the oncology multidisciplinary staff in scientific articles extracted from databases such as PubMed, SciELO, CrossRef, USC Journals, Dental Scientific Journal, Elsevier, Researchgate, Google Scholar, Wiley Online Library and Springer was reviewed. Based on 32 selected articles, it is concluded that the dentist as part of the oncology multidisciplinary team plays an extremely important role, since its integration allows counteracting the different oral complications that arise as a consequence of the different antineoplastic therapies to which the cancer patients are subjected. These oral complications must be treated unfailingly, since their presence in the oral cavity constitutes an even greater risk as far as systemic infection is concerned. Here is the importance of the dentist within the oncology multidisciplinary staff, avoiding and preventing the spread of infectious foci and thus improving the quality of life of cancer patients.

Linfoma Hodgkin clássico de apresentação incomum. Relato de caso / An unusual presentation of a classic Hodgkin lymphoma. Case report

O linfoma é uma neoplasia originária do sistema linfático, a partir de células linfocitárias. A sintomatologia mais comum é febre, tosse, sudorese noturna, perda de peso, fraqueza e linfoadenopatia indolor. A etiologia ainda permanece desconhecida, tendo sido relacionada ao vírus Epstein-Barr. O diagnóstico se baseia na visualização das células de Reed-Sternberg. O esquema adriamicina, bleomicina, vinblastina e dacarbazina (ABVD) ainda é o tratamento preconizado, associado ou não à radioterapia. Relatamos um caso de linfoma de Hodgkin de apresentação atípica, cujo diagnóstico só foi possível por esplenectomia.(AU)

The lymphoma is a cancer of the lymphatic system originating from lymphocyte cells. The most common symptoms are fever, cough, night sweats, weight loss, weakness, and painless lymphadenopathy. The etiology remains unknown, having been related to the Epstein Barr virus. The diagnosis is based on visualization of Reed Sternberg cells. The adriamycin, bleomicin, vinblastine and dacarbazine (ABVD) regimen is still the preferred treatment, with or without radiation therapy. We report a case of Hodgkin's lymphoma of atypical presentation, the diagnosis of which was only possible through splenectomy.(AU)

Linfoma primario de ano en un paciente con virus de la inmunodeficiencia humana/sida / Primary lymphoma of anus in a patient with human immunodeficiency virus/AIDS

Se presenta el caso clínico de un paciente de 47 años de edad con seropositividad del virus de inmunodeficiencia humana/sida desde hacía 5 años, quien acudió a la consulta de Cirugía en el Hospital Gubernamental de Mbabane en Suazilandia, por presentar un tumor anal; se diagnosticó hemorroides, pero el tumor continuó aumentando de tamaño, unido a sangrado e intenso dolor. Se realizó una biopsia por incisión que indicó la presencia de un linfoma de alto grado de malignidad. Posteriormente el paciente fue evaluado en la consulta de Oncología, donde se le indicaron los exámenes complementarios necesarios, los que revelaron que la neoplasia se encontraba en estadio IE; de manera que fue remitido a Sudáfrica para recibir quimioterapia combinada, con la cual desapareció la lesión maligna y se controló la enfermedad

The case report of a 47 years patient with the human immunodeficiency virus/AIDS for 5 years is presented. He went to the Surgery Service in the Government Hospital of Mbabane in Swaziland, due to an anus malignancy; hemorrhoids was diagnosed, but its size continued increasing, along with bleeding and acute pain. An incision biopsy that indicated the presence of a high grade lymphoma malignancy was carried out. Later on the patient was evaluated in the Oncology Service, where the necessary complementary exams were indicated, revealing that neoplasm was in IE stage; so he was referred to South Africa to receive combined chemotherapy, with which the malignant lesion disappeared and the disease was controlled

Reação adversa a medicamento: uma análise comparativa de protocolos utilizados para o tratamento do câncer colorretal / Adverse drug reaction: a comparative analysis of protocols used for treatment of colorectal cancer

Study design: Cohort study Objective: Analyze the adverse reactions that occurred in Brazilian patients with colorectal cancer submitted to chemotherapy with two different protocols, in order to identify the types and severity of those most frequent recorded. Methods: Sixty-three patients, who started treatment from June 2014 to May 2015, were separated into two groups: mFOLFOX6 (protocol containing oxaliplatin, folinic acid and 5-fluorouracil in bolus and continuous infusion, n= 40) and FOLFIRI (protocol containing irinotecan, folinic acid and 5-fluorouracil in bolus and continuous infusions, n= 23). Data related to the demographic and clinical profile of the patients were collected from the medical record, as well as information about the treatment performed and the adverse reactions manifested. The reactions were classified according to their severity (grades 1, 2, 3 and 4) and causality (definite, probable, possible and doubtful). Results: A high frequency of adverse reactions was observed in both groups, reaching 92.5% of patients with mFOLFOX6 protocol and 95.6% with FOLFIRI protocol. Gastrointestinal and neurological toxicities were the most frequent among the groups. When comparing the occurrence of intergroup reactions, there was difference only for gastrointestinal toxicities (p= 0.035). In 17.5% of patients mFOLFOX6 group (n= 7) and in 8.7% of patients FOLFIRI group (n= 2), grades 3 and 4 adverse reactions were observed and classified as probable. Conclusion: The adverse reactions were more diversified and frequent in the mFOLFOX6 group compared to the FOLFIRI group. However, no difference was observed in the severity and causality of reactions in both groups (AU)

Study design: Cohort study Objective: Analyze the adverse reactions that occurred in Brazilian patients with colorectal cancer submitted to chemotherapy with two different protocols, in order to identify the types and severity of those most frequent recorded. Methods: Sixty-three patients, who started treatment from June 2014 to May 2015, were separated into two groups: mFOLFOX6 (protocol containing oxaliplatin, folinic acid and 5-fluorouracil in bolus and continuous infusion, n= 40) and FOLFIRI (protocol containing irinotecan, folinic acid and 5-fluorouracil in bolus and continuous infusions, n= 23). Data related to the demographic and clinical profile of the patients were collected from the medical record, as well as information about the treatment performed and the adverse reactions manifested. The reactions were classified according to their severity (grades 1, 2, 3 and 4) and causality (definite, probable, possible and doubtful). Results: A high frequency of adverse reactions was observed in both groups, reaching 92.5% of patients with mFOLFOX6 protocol and 95.6% with FOLFIRI protocol. Gastrointestinal and neurological toxicities were the most frequent among the groups. When comparing the occurrence of intergroup reactions, there was difference only for gastrointestinal toxicities (p= 0.035). In 17.5% of patients mFOLFOX6 group (n= 7) and in 8.7% of patients FOLFIRI group (n= 2), grades 3 and 4 adverse reactions were observed and classified as probable. Conclusion: The adverse reactions were more diversified and frequent in the mFOLFOX6 group compared to the FOLFIRI group. However, no difference was observed in the severity and causality of reactions in both groups.(AU)

Factores pronósticos de remisión en pacientes con leucemia linfoblástica aguda posterior a primer recaída / Prognostic factors of remission in patients with acute lymphoblastic leukemia after a first relapse

Objetivos: Identificar aquellos factores que impactan en la respuesta terapéutica para alcanzar una segunda remisión (2 RC) en pacientes con leucemia aguda linfobl´stica (LAL) en recaída. Métodos: Estudio observacional y analítico anidado en una cohorte retrospectiva de adultos (>18 años) portadores de LAL que fueron atendidos durante 2008-2014 y que interrumpieron el protocolo HGMLAL07 al detectarse recaída e iniciaron otro esquema. Resultados: Se estudiaron 69 pacientes y el 62,3% (n = 43) correspondía a hombres. La media de edad fue de 29 años. Los regímenes terapéuticos empleados fueron: alta intensidad (55,1%) [Hyper-CVAD (n = 34), IDA-Flag (n = 1), mitoxantrona-DARAC (n = 3) ], moderada intensidad (4,3%) [Esquemas de reinducción (n = 3) ] y tratamiento paliativo de baja intensidad con soporte transfusional (40,6%, n = 28). Solo 19 pacientes (27,5%) integraron una 2 RC. La media de supervivencia fue 120 (2- 575) días y el 29% sobrevivió al año de seguimiento. El uso de un segundo régimen intensivo o moderado no brindó ventaja sobre el esquema conservador (prueba log-Rank, p = 0,812). Ninguna variable demostró valor pronóstico sobre la supervivencia a 1 año. La duración de la primera RC (OR 6,78, p = 0,005, 95% IC: 1,7532-26,2803) y recibir un primer tratamiento intensivo (OR 0,22, p = 0,018, 95% IC: 0,0661-0,7813) fueron variables pronósticas de falla terapéutica para alcanzar la 2 RC. Conclusiones: Poseer una primera RC < 1 año fue un factor de riesgo importante para no integrar una 2 RC. No se identificaron factores pronósticos de supervivencia ni superioridad de alguno de los esquemas de rescate empleados.

Aims: To identify those factors that affect therapeutic response to achieve a second remission (2 RC) in patients with acute lymphoblastic leukaemia (ALL) in relapse. Methods: Observational, descriptive and analytical study nested in a retrospective cohort of adults (> 18 years-old) ALL carriers treated during the period from 2008 to 2014 that disrupted the HGMLAL07 protocol when relapse was detected and began another therapeutic scheme. Results: The study included 69 patients, of whom 62.3% (n = 43) were males, and the mean age was 29 years-old. The therapeutic regimens used were: high intensity (55.1%) [Hyper-CVAD (n = 34), IDA-Flag (n = 1), mitoxantrone-DARAC (n = 3) ], moderate intensity (4.3%) [Re-induction schemes (n = 3) ], and palliative treatment of low intensity with transfusion support (40.6%, n = 28).Only 19 patients (27.5%) achieved a 2 RC. The median overall survival was 120 (2-575) days, 29% of patients were alive at one year. Using a high or moderate intensity regime as the rescue scheme gave no advantage over the conservative one (log-rank test, P = .812). None of the variables showed prognostic value of survival at one year. The duration of the first RC (OR 6.78, P = .005, 95% CI; 1.75 -26.28) and receiving high intensity treatment (OR 0.22, P = 018, 95% CI: 0.06 -0.78) were predictors of treatment failure to achieve 2 RC. Conclusions: To achieve a first RC < 1 year was an important risk factor for not achieving a 2 RC. No prognostic factors for survival were identified. None of the schemes used for rescue showed superiority.

Candidiasis bucal en pacientes con tratamiento antineoplásico / Oral candidiasis in patients with antineoplastic treatment

Se efectuó un estudio descriptivo y transversal de 40 pacientes con cáncer, quienes presentaron candidiasis bucal por la aplicación de terapias antineoplásicas, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Clinicoquirúrgico Docente "Saturnino Lora Torres" de Santiago de Cuba, desde febrero de 2013 hasta igual mes de 2015, a fin de evaluar los resultados del diagnóstico clínico e histopatológico de esta afección. En la casuística predominaron el sexo masculino, el grupo etario de 60 años y más; el dolor, la ardentía, así como la resequedad bucal, simultáneamente, como los síntomas clínicos más significativos y los afectados que recibieron radioterapia combinada con quimioterapia. El paladar duro y el dorso de la lengua fueron los sitios de mayor prevalencia. La candidiasis eritematosa resultó la forma clínica más usual y las seudohifas patógenas, así como las células levaduriformes, los hallazgos histopatológicos más exclusivos.

A descriptive and cross-sectional study of 40 patients with cancer who presented oral candidiasis due to the treatment with antineoplastic therapies, assisted in the estomatological department of the Specialties Polyclinic from "Saturnine Lora Torres" Teaching Provincial Clinical-Surgical Hospital in Santiago de Cuba was carried out from February, 2013 to the same month of 2015, in order to evaluate the results of the clinical and histopatological diagnosis of this disorder. The male sex, the age group 60 years and more; pain, ardour, as well as the oral dryness, simultaneously prevailed in the case material, as the most significant clinical symptoms and the affected ones who had received radiotherapy combined with chemotherapy. The hard palate and the back of the tongue were the places of higher prevalence. The erythematous candidiasis was the most usual clinical form and the pathogen pseudohifas, as well as the levaduriform cells, the most exclusive histopatological findings.

Dermatite flagelada induzida por bleomicina: relato de caso / Bleomycin-induced flagellate dermatitis: a case report / Dermatitis flagelada inducida por bleomicina: relato de caso

A Dermatite Flagelada consiste de uma hiperpigmentação cutânea de aspecto flagelado, tendo como causa específica a bleomicina. A bleomicina é um agente quimioterápico usado no tratamento de diferentes neoplasias. O objetivo deste relato é descrever o caso de uma paciente de 31 anos de idade, em tratamento de Linfoma de Hodgkin com protocolo de Quimioterapia Antineoplásica composto por quatro drogas, dentre elas, a bleomicina, que cursou com o desenvolvimento da Dermatite Flagelada. Trata-se de um relato de caso ocorrido num hospital universitário do nordeste do Brasil em 2014. A terapia utilizada como tratamento foi uso de corticoide, o que proporcionou a remissão das lesões do tipo flagelo e permitiu a continuidade do tratamento sem necessidade de mudança do protocolo quimioterápico. A importância do estudo se deve por levantar discussão sobre os aspectos que envolvem o manejo dessa hipersensibilidade, para garantir a continuidade do tratamento antineoplásico (AU).

Flagellate Dermatitis consists of cutaneous hyperpigmentation with a flagellate appearance, one specific cause of which is bleomycin. Bleomycin is a chemotherapy agent used in the treatment of different neoplasias. This report's objective is to describe the case of a 31-year-old patient receiving treatment for Hodgkin Lymphoma with a protocol of Antineoplastic Chemotherapy made up of four drugs, including bleomycin, which led to the development of Flagellate Dermatitis. This is a report of a case which took place in a teaching hospital in the Northeast of Brazil in 2014. The therapy used as treatment was use of corticosteroid, which led to the remission of the lesions of the flagellate type and allow the continuation of the treatment without the need for changing the chemotherapy protocol. The study's importance lies in that it raises discussion regarding the aspects involving the management of this hypersensitivity so as to ensure the continuity of the antineoplastic treatment (AU).

La dermatitis flagelada consiste en una hiperpigmentación cutánea de aspecto flagelado y su causa específica es la bleomicina. La bleomicina es un agente quimioterápico usado en el tratamiento de diferentes neoplasias. El objetivo de este relato fue describir el caso de una paciente de 31 años de edad, en tratamiento de Linfoma de Hodgkin con protocolo de Quimioterapia Antineoplásica compuesto por cuatro drogas, entre las cuales la bleomicina, ocasionada con desarrollo de Dermatitis Flagelada. El caso ocurrió en un hospital universitario del nordeste del Brasil en 2014. La terapia utilizada como tratamiento fue uso de corticoide, lo que proporcionó la remisión de las lesiones del tipo flagelo y permitió la continuidad del tratamiento sin necesidad de cambio del protocolo quimioterápico. El papel del estudio es abrir discusión acerca de los aspectos que involucran el manejo de esa hipersensibilidad, para garantizar la continuidad del tratamiento antineoplásico (AU).

Intervenciones de enfermería durante el tratamiento con quimioterapia antineoplásica del cáncer en el usuario pediátrico aplicada al segundo y tercer nivel de atención / Nursing interventions for the care of leukemia in pediatric user, applied to the three levels of care

El tratamiento de quimioterapia promueve una serie de transformaciones en el niño con cancer, altera física y emocionalmente tanto al niño como a la familia. Los efectos colaterales más frecuentes son: apatía, pérdida del apetito, pérdida de peso, alopecia, mucositis, náuseas, vómitos y diarrea. Otro efecto colateral es la neutropenia, que aumenta significativamente los riesgos de morbilidad y mortalidad por procesos infecciosos. A través de esta Guía de Práctica Clínica se pretende contribuir a disminuir la incidencia de efectos secundarios y complicaciones durante el periodo de tratamiento con quimioterapía, determinar las intervenciones de enfermería que contribuyan a garantizar la calidad de los cuidados y del proceso de la atención durante el periodo de tratamiento con quimioterapia antineoplásica en el usuario pediátrico con cáncer. Métodos: Se plantea preguntas a responder por la GPC, se realiza búsqueda sistemática, recuperación de artículos científicos que den respuesta a las preguntas clínicas, para lo cual se seleccionaron las fuentes con mayor calidad en su metodología y mayor nivel de evidencia científica.Resultados: El protocolo sistematizado de búsqueda arrojó 275 artículos, de los cuales se utilizó 26 fuentes documentales que corresponden a 3 revisiones sistemáticas, 6 Ensayos Clínicos Aleatorizados, 4 estudios observacionales, 3 estudios de cohorte, 10 de tipo de estudios.Conclusiones: Para dar respuesta a las preguntas planteadas se consideran la valoración, cuidados, limitación del daño y educación en el manejo de los efectos secundarios del tratamiento con quimioterapia del niño con cáncer en el segundo y tercer nivel de atención.

Chemotherapy treatment promotes a series of transformations in children with cancer, physically and emotionally disturbed both the child and the family. The most common side effects are: apathy, loss of appetite, weight loss, alopecia, mucositis, nausea, vomiting and diarrhea. Another side effect is neutropenia, which significantly increases the risk of morbidity and mortality from infectious processes. Through this Clinical Practice Guideline is intended to help reduce the incidence of side effects and complications during the treatment with chemotherapy, determine nursing interventions that help ensure the quality of care and process of care during the treatment period with cancer chemotherapy in pediatric cancer user.Methods: It raises questions to answer for the GPC, systematic search, retrieval of scientific articles that answer clinical questions, is done for which the sources were selected with higher quality in their methodology and highest level of scientific evidence.Results: The systematic search protocol yielded 275 articles, of which 26 documentary sources corresponding to 3 systematic reviews, 6 randomized clinical trials, 4 observational studies, three cohort studies, 10 such studies was used.Conclusions: To answer the questions posed are considered the assessment, care, damage limitation and education in managing the side effects of chemotherapy treatment of children with cancer in the second and third levels of care.

O tratamento quimioterápico promove uma série de transformações em crianças com câncer, física e emocionalmente perturbado tanto a criança quanto a família. Os efeitos colaterais mais comuns são: apatia, perda de apetite, perda de peso, alopecia, mucosite, náuseas, vómitos e diarreia. Outro efeito colateral é a neutropenia, o que aumenta significativamente o risco de morbidade e mortalidade por processos infecciosos. Através desta diretriz de prática clínica destina-se a ajudar a reduzir a incidência de efeitos colaterais e complicações durante o tratamento com quimioterapia, determinar intervenções de enfermagem que ajudam a garantir a qualidade do cuidado e processo de atendimento durante o período de tratamento com quimioterapia de câncer em usuários câncer pediátrico.Métodos: levanta questões a responder pela GPC, busca sistemática, recuperação de artigos científicos que respondem a questões clínicas, é feito para as quais foram selecionadas as fontes com maior qualidade na sua metodologia e maior nível de evidência científica.Resultados: O protocolo de pesquisa sistemática rendeu 275 artigos, dos quais 26 fontes documentais, correspondentes a 3 revisões sistemáticas, 6 ensaios clínicos randomizados, 4 estudos observacionais, três estudos de coorte, foi usado 10 desses estudos.Conclusões: Para responder às questões colocadas são considerados na avaliação, cuidado, limitação de danos e educação na gestão dos efeitos colaterais do tratamento de quimioterapia de crianças com câncer nos segundo e terceiro níveis de atenção.

Comparación del hyper-CVAD con un régimen institucional en el tratamiento de la leucemia linfoblástica aguda del adulto en un hospital de México / Comparison of the hyper-CVAD with an institutional regimen for the treatment of acute lymphoblastic leukemia in adults in a hospital of Mexico

Con el objetivo de evaluar la mortalidad y toxicidad del protocolo Hyper-CVAD utilizado como primera línea de tratamiento de la leucemia linfoblástica aguda se realizó un estudio de cohorte retrospectiva en pacientes de 40 años a menos durante marzo a septiembre de 2011 atendidos con el régimen Hyper-CVAD. La mortalidad y toxicidad se comparó con los resultados de los pacientes atendidos con el régimen institucional HGMLAL07 entre 2009 a 2012. Se incluyeron 18 pacientes, la mediana de edad fue de 26 años. Tanto las remisiones completas (67,7% frente a 81,9%) como la supervivencia a un año (40% frente a 62%) y 2 años (18% frente a 34%) fueron menores con el régimen Hyper-CVAD. Al seleccionar exclusivamente pacientes menores de 35 años, la eficacia de Hyper-CVAD también fue menor. Según esta experiencia y debido a su alto costo y toxicidad, el régimen Hyper-CVAD debe de limitarse a aquellos pacientes con leucemias refractarias o en recaída...

In order to assess the mortality and toxicity of the Hyper-CVAD protocol used as first-line treatment of acute lymphoblastic leukemia, a retrospective cohort study was performed in patients less than 40 years of age from March to September 2011 treated with Hyper-CVAD regimen. Mortality and toxicity was compared with the results of patients treated with the institutional HGMLAL07 regimen between 2009-2012. 18 patients were included; the median age was 26 years old. Complete remissions (67.7% versus 81.9%) as well as one-year (40% versus 62%) and 2 year survival rates (18% versus 34%) were lower with the Hyper-CVAD regimen. By selecting only patients younger than 35 years, the effectiveness of Hyper-CVAD was also lower. In our experience and because of its high cost and toxicity, the Hyper-CVAD regimen should be limited to patients with relapsed or refractory leukemia...

Clinical and economic aspects of the use of rituximab in non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma (NHL) consists of a group of neoplasias involving mainly B cells and represents 90% of all lymphomas. The current available therapy is based on chemotherapy associated with the monoclonal antibody rituximab (Mab Thera(r)), which targets the CD20 protein, present in over 80% of NHL mature B cells. Recent clinical reports show a preference for combining the benefits of immunotherapy and adjuvant chemotherapy, thus generating safe and effective alternative treatments. The current review aimed at evaluating various aspects related to the use of rituximab for NHL, highlighting the possible inhibitory mechanisms of cell proliferation, the achieved clinical results, and the expected clinical and economic outcomes of treatments. The results from clinical tests indicate the need for a better understanding of the critical mechanisms of action of this antibody, which may maximize its therapeutic efficacy. This therapy not only represents a viable option to treat most types of NHLs, especially when associated with conventional chemotherapy, but also offers cost-utility and cost-effectiveness advantages.

O Linfoma não-Hodgkin (LNH) consiste em um grupo de neoplasias envolvendo, principalmente, as células B e representa 90% de todos os linfomas. A terapia atual disponível é baseada em quimioterapia associada ao anticorpo monoclonal rituximabe (Mab Thera(r)), que tem como alvo a proteína CD20, presente em mais de 80% das células B maduras do LNH. Recentes relatórios clínicos mostram preferência para combinar os benefícios da quimioterapia adjuvante e imunoterapia, gerando alternativas de tratamentos seguro e eficaz. O trabalho de revisão teve por objetivo avaliar vários aspectos relacionados à aplicação do rituximabe no LNH, destacando os possíveis mecanismos inibitórios da proliferação celular, os resultados clínicos obtidos e as implicações clínicas e econômicas esperadas para o tratamento. Os resultados de testes clínicos indicam a necessidade de uma melhor compreensão dos mecanismos críticos de ação deste anticorpo, que poderão maximizar a sua eficácia terapêutica. Essa terapia não representa apenas uma opção viável para o tratamento da maioria dos tipos de LNH, principalmente quando associado à quimioterapia convencional, mas, também, oferece vantagens em termos de custo-utilidade e custo-efetividade.

Efeito do tratamento antineoplásico adjuvante na mudança de peso corporal em mulheres com câncer de mama / Effect of adjuvant antineoplastic treatment on body weight change in women with breast cancer

Aims: To identify the effect of adjuvant antineoplastic treatment on body weight change of women with breast cancer.METHODS: A non-randomized clinical study included women with a recent surgical diagnosis of breast cancer, admitted tothe Maternidade Carmela Dutra hospital in Florianópolis, Santa Catarina, southern Brazil, between October 2006 and July2008. Food intake, weight, body mass index, hip circumference, waist circumference and other variables were measuredbefore (baseline) and after the adjuvant antineoplastic treatment (pos-treatment). A mixed effects linear regression modelwas used to estimate the longitudinal changes occurring in weight.Results: The sample comprised 53 patients. A significant increase (P<0.05) was observed in body weight (2.81 kg), bodymass index (1.08 kg/m2), hip circumference (3.62 cm) and waist circumference (1.93 cm). In relation to diet, there was asignificant increase (P<0.05) in the intake of energy (272.7 kcal), total fat (11.2 g) and polyunsaturated fatty acids (5.4 g).The final regression model for the change in body weight demonstrated that the women who were exposed to chemotherapytreatment, and to chemotherapy associated with radiotherapy, had the largest mean increase in body weight (2.47 kg and 5.21kg, respectively). Socio-economic, demographic and nutritional factors were not associated with the increase in body weight.Conclusions: Weight gain was associated with chemotherapy treatment either alone or in combination with radiotherapy.

Objetivos: Identificar o efeito do tratamento antineoplásico adjuvante sobre a mudança de peso corporal em mulheres com câncer de mama. Métodos: Um estudo clínico não randomizado incluiu mulheres com diagnóstico cirúrgico recente de câncer de mama, admitidas no hospital Maternidade Carmela Dutra em Florianópolis, Santa Catarina, entre outubro de 2006 e julho de 2008. Os dados de consumo alimentar, peso corporal, índice de massa corporal, circunferência do quadril, circunferência da cintura e outras variáveis, foram avaliados antes (basal) e depois do tratamento antineoplásico adjuvante (pós-tratamento). Um modelo de regressão linear de efeitos mistos foi utilizado para estimar as mudanças longitudinais que ocorreram no peso corporal. Resultados: A amostra foi composta por 53 pacientes. Foi observado um aumento significativo (P<0,05) no peso corporal (2,81 kg), índice de massa corporal (1,08 kg/m2), circunferência do quadril (3,62 cm) e circunferência da cintura (1,93 cm). Em relação aos aspectos dietéticos, houve um significativo aumento (P<0,05) na ingestão de energia (272,7 kcal), gorduras totais (11,2 g) e ácidos graxos poliinsaturados (5,4 g). O modelo final para a mudança no peso corporal demonstrou que as mulheres as quais foram expostas ao tratamento quimioterápico, e quimioterápico associado ao radioterápico, tiveram um maior aumento médio no peso corporal (2,47 kg e 5,21 kg, respectivamente). Os fatores socioeconômicos, demográficos e nutricionais não foram associados com o aumento no peso corporal. Conclusões: O aumento de peso esteve associado com o tratamento quimioterápico sozinho ou em combinação com o tratamento radioterápico.

Metástase cutânea como primeira manifestação de adenocarcinoma pulmonar / Cutaneous metastasis as the initial manifestation of lung adenocarcinoma

Relatamos o caso de um paciente do sexo masculino de 58 anos de idade, que foi encaminhado para a consulta de oncologia por apresentar uma massa epigástrica de crescimento rápido em três meses de evolução. A investigação diagnóstica revelou tratar-se de um adenocarcinoma pulmonar metastático estádio IV. Recebeu cinco ciclos de cisplatina e gemcitabina como tratamento de primeira linha, que foi interrompido devido a efeitos adversos. Houve estabilidade da doença pulmonar e progressão cutânea. Recebeu pemetrexed como tratamento de segunda linha e radioterapia externa concomitante, com boa tolerância e regressão completa da massa epigástrica. Entretanto, o paciente faleceu três meses após o tratamento. Destacamos aqui importância da multidisciplinaridade e do seu papel na individualização do tratamento.

We report the case of a 58-year-old male patient who was referred for oncology consultation due to an epigastric mass that had been growing rapidly for three months. Diagnostic investigation revealed that the mass was a metastasis of stage IV lung adenocarcinoma. The patient received five cycles of chemotherapy with cisplatin and gemcitabine as a first-line treatment, which was interrupted due to major adverse events. Although the pulmonary disease stabilized, the cutaneous disease progressed. The patient then received pemetrexed as a second-line chemotherapy, together with concurrent external radiotherapy, which was well tolerated. There was complete remission of the epigastric mass. However, the patient died three months after the treatment. Here, we emphasize the importance of a multidisciplinary approach and of its role in individualizing the treatment.

Uso de gemtuzumabe ozogamicina combinado com quimioterapia convencional em pacientes com leucemia mieloide aguda / Use of gemtuzumab ozogamycin combined with conventional chemotherapy in patients with acute myeloid leukemia

Objective: To analyze the outcome of patients treated with gemtuzumab ozogamycin combined with conventional therapy treated at Hospital Israelita Albert Einstein. Methods: 14 patients who had high risk features (secondary leukemia, unfavorable cytogenetics, and refractory disease) were treated with gemtuzumab ozogamycincombined with conventional therapy and their outcome was analysed by reviewing their medical records. Results: Overall response rate was 58%, with 43% achieving complete response, with a median followup of 11 months, event-free survival was 3 months. Eleven patients died, 6 of them due to refractory acute myeloid leukemia. Only four patients presented with grade 3 to 4 toxicities and only one patient had sinusoidal obstruction syndrome after bone marrow transplant. Conclusion: gemtuzumab ozogamycin combined with chemotherapy is a feasible treatment regimen in acute myeloid leukemia patients. However, further studies are necessary to clarify which subgroup of patients may benefit from this treatment.

Objetivo: Analisar a evolução de pacientes tratados com gemtuzumabe ozogamicina combinado à terapêutica convencional no Hospital Israelita Albert Einstein. Métodos: 14 pacientes que tinham alto risco (leucemia secundária, citogenética desfavorávele doença refratária) foram tratados com gentuzumabe ozogamicina associado à terapêutica convencional, e sua evolução foi analisada por meio de seus prontuários médicos. Resultados: A taxa total de resposta foi de 58%, com 43% chegando a resposta completa, em acompanhamento médio de 11 meses, e três meses com intervalo de sobrevivência livre. Foram a óbito 11 pacientes, 6 deles por leucemia mieloide aguda. Somente quatro pacientes apresentaram graus 3 a 4 de toxicidade e apenas um paciente teve síndrome de obstrução sinusoidal após transplante de medula. Conclusão: Gemtuzumabe ozogamicina associado à terapêutica quimioterápica convencional éum tratamento factível em pacientes com leucemia mieloide aguda. Contudo, novos estudos são necessários para esclarecer qual o subgrupo de pacientes que pode se beneficiar desse tratamento.