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

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

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)

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)

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).

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...

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.

Resultados de tratamiento para cáncer infantil en una población de recursos limitados en Bogotá, Colombia / Pediatric cancer results in a population with limited resources in Bogota, Colombia

Introducción. A pesar de los notables progresos en cáncer infantil, más del 60% de los niños afectados en el mundo tienen escaso acceso a tratamientos eficaces. El propósito de este estudio fue evaluar los resultados de tratamiento en una situación de recursos limitados. Métodos. Fue un estudio descriptivo-histórico con componente analítico en 242 menores de 16 años atendidos entre 1990 y 2007 en la Clínica Infantil Colsubsidio de Bogotá, Colombia. Durante tres periodos se introdujeron protocolos internacionales, atención en "hospital de día" para tratamientos de quimioterapia y soporte ambulatorio, con enfermeras entrenadas en oncología, una pediatra oncóloga y un hematólogo con dedicación de 8 horas, el apoyo en hospitalización de médicos pediatras 24 horas y la agilización de trámites administrativos. Se compararon la supervivencia y las fallas de tratamiento. Resultados. Se observó aumento (40.5 a 63%) en la supervivencia (P =0.021) y disminución (22.4 a 8.9%) en la remisión a otros centros (P =0.025); tendencia a la reducción en mortalidad por complicaciones agudas (16.3 a 9.9%) y en frecuencia de rechazo o abandono del tratamiento (5.2 a 3%). La supervivencia libre de eventos para leucemia linfoblástica fue de 65% a 10 años. Conclusiones. El programa mostró resultados alentadores en un contexto de recursos limitados.

Background. Despite remarkable progress achieved for pediatric cancer, >60% of children affected worldwide have little or no access to effective therapy. This study assessed the results of a pediatric cancer program in a limited resources setting. Methods. A historical descriptive study with analytic component was conducted between 1990 and 2007 in 242 children <16 years of age at Clínica Infantil Colsubsidio in Bogotá, Colombia. Measures included international protocol-based therapy, day-hospital system for chemotherapy and blood-cell support provided by trained nurses, pediatric oncologist and hematologist staffed 8-h with 24-h on-site physician coverage, as well as rapid administrative support. Treatment failure rates and survival were compared during the study. Results. An increase (40.5% to 63.3%) in survival (p =0.021) and a reduction in the referral for treatment (22.4% to 8.9%) to other centers (p =0.025) were observed during the study. There were also tendencies towards reduction in mortality due to acute complications (16.3-9.9%) and in frequency of those who refused or abandoned therapy (5.2 to 3%).The 10-year event-free-survival for acute lym-phoblastic leukemia was 65%. Conclusions. The strategy provided encouraging survival outcomes in a limited resources setting.

Estudo de fase I/II de erlotinib (OZI-774) combinado com radioterapia e cisplatina em pacientes com carcinoma epidermóide de cabeça e pescoço, localmente avançado / Phase I/II study of erlotinib combined with cisplatin and radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck

Propósito: Erlotinib, um inibidor oral da Tirosina Quinase posicionada junto ao domínio intracelular do EGFR, é uma droga ativa contra Carcinoma de Células Escamosas de Cabeça e Pescoço (CECCP) avançado e possivelmente possui sinergismo com a quimioterapia e radioterapia. O objetivo deste trabalho foi avaliar a dose adequada, a segurança e eficácia do Erlotinib associado à combinação padrão de quimioterapia e radioterapia no CECCP localmente avançado. Pacientes e Métodos: Pacientes com CECCP localmente avançado são o fundamento deste ensaio clínico de FaseI/II, cujo tratamento consistiu da combinação de Cisplatina 100mg/m² intra-venoso (iv), administrada nos dias 8, 29 e 50 do tratamento; e radioterapia na dose de 70.2Gy administrada em 39 frações a partir do Dia 8. Durante a fase I do estudo a dose de Erlotinib foi escalonada (50 mg, 100mg e 150mg por via oral, tomado uma vez ao dia) em consecutivas coortes de três pacientes. Toxicidade dose limitante (TDL) foi avaliada pelos critérios do CTCAE e do RTOG e foi definida como qualquer evento grau 4 que requeresse interrupção da radioterapia. A fase II do estudo foi iniciada 8 semanas após o último registro de paciente na fase I. Resultados: Nove pacientes foram recrutados na fase I e 28 na fase II; todos foram avaliados para análise de segurança e eficácia. Nenhuma TDL ocorreu durante o escalonamento na fase I e foi recomendada para fase II a dose de 150mg ao dia de erlotinib. As toxicidades não hematológicas observadas mais frequentes foram náusea e vômitos, disfagia, estomatite, xerostomia, dermatite no campo de radiação, rash acneiforme, e diarréia. Dos 31 pacientes que usaram Erlotinib na dose de 150mg/dia, 23 (74%, 95% CI 56,8% - 86,3%) obtiveram resposta completa, 3 apresentaram doença residual que foi resgatada imediatamente com cirurgia e ficaram sem evidência de doença, 4 permaneceram com doença residual inoperável, e 1 morreu de sepse durante o tratamento. Com seguimento médio de 37 meses...

Purpose: Erlotinib, an oral tyrosine-kinase inhibitor, is active against squamous cell carcinoma of the head and neck (HNSCC) and possibly has a synergistic interaction with chemotherapy and radiotherapy. We investigated the safety and efficacy of erlotinib added to cisplatin and radiotherapy in locally advanced HNSCC. Patients and Methods: Phase I/II trial of cisplatin 100 mg/m2 on days 8, 29 and 50; and radiotherapy 70 Gy starting on day 8. During the phase I, erlotinib dose was escalated (50 mg, 100 mg and 150 mg) in consecutive cohorts of three patients, starting on day 1 and continued during radiotherapy. Dose-limiting toxicity (DLT) was defined as any grade 4 event requiring radiotherapy interruptions. Phase II initiated 8 weeks after the last phase I enrollment. Results: Nine patients were accrued in the phase I and 28 in the phase II; all were evaluable for efficacy and safety. No DLT occurred in the phase I and the recommended phase II dose was 150mg. The most frequent non-hematological toxicities were nausea/vomiting, dysphagia, stomatitis, xerostomia and in-field dermatitis, acneiform rash, and diarrhea. Of the 31 patients in the erlotinib 150 mg daily dose, 23 (74%, 95% CI 56.8% 86.3%) had a complete response, 3 were disease-free after salvage surgery, 4 had an inoperable residual disease, and 1 died of sepsis during treatment. With a median 37 months follow-up, the 3-year progression-free and overall survival were 61 and 72% respectively. Conclusion: This combination appears safe, has encouraging activity and deserves further studies in locally advanced HNSCC.

Estudo de fase I/II de Erlotinib (OZI-774) combinado com a radioterapia e cisplatina em pacientes com carcinoma epidermóide de cabeça e pescoço, localmente avançado / Phase I/II study of erlotinib combined with cisplatin and radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck

Propósito: Erlotinib, um inibidor oral da tirosina quinase posicionada junto ao domínio intracelular do EGFR, é uma droga ativa contra carcinoma de células escamosas de cabeça e pescoço (CECCP) avançado e possivelmente possui sinergismo com a quimioterapia e radiotetapia. O objetivo deste trabalho foi avaliar a dose adequada, a segurança e eficácia do Erlotinib associado à combinação padrão de quimioterapia e radioterapia no CECCP localmente avançado. Pacientes e métodos: Pacientes com CECCP localmente avançado são o fundamento deste ensaio clínico de Fase I/II, cujo tratamento consistiu da combinação de Cisplatina 100mg/m2 intra-venoso (iv), administrada nos dias 8, 29 e 50 do tratamento; e radioterapia na dose de 70.2gy administrada em 39 frações a partir do dia 8. Durante a fase I do estudo a dose de erlotinib foi escalonada (50mg, 100mg e 150mg por via oral, tomando uma vez ao dia) em consecutiva coortes de três pacientes. Toxidade dose limitante (TDL) foi avaliada pelos critérios do CTCAE e do RTOG e foi definida como qualquer evento grau 4 que requeresse interrupção da radioterapia. A fase II do estudo foi iniciada 8 semanas após o último registro de paciente na fase I. Resultados:

Totally implantable catheter embolism: two related cases / Embolia de cateter totalmente implantável: relato de dois casos

CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath®) are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

CONTEXTO E OBJETIVO: Os cateteres de longa permanência totalmente implantáveis (por exemplo, Port-a-Cath®) são muito utilizados para acesso venoso de longa duração em crianças com câncer. O uso deste tipo de cateter está associado a algumas complicações como infecção, extrusão, extravasamento e trombose. A embolia de fragmento de cateter é complicação rara, mas com potencial morbidade. O objetivo do estudo foi relatar dois casos em que houve embolia de fragmento de cateter de longa permanência. TIPO DE ESTUDO E LOCAL: Série de casos do Hospital do Servidor Público estadual, São Paulo. MÉTODOS: Estudo retrospectivo das embolias de cateter de longa permanência em crianças. RESULTADOS: No primeiro caso, descreve-se uma menina com diagnóstico de tumor de Wilms estádio IV aos três anos de idade. Iniciou tratamento com implante de cateter de longa permanência em veia subclávia. Três anos após diagnóstico, foi programada a retirada do cateter por término de tratamento. No momento da retirada, houve fratura intracardíaca do cateter. Houve necessidade de retirada do fragmento intracardíaco com hemodinâmica. O segundo caso tratava-se de um menino com diagnóstico de tumor de Wilms estádio II aos dois anos de idade. Teve o cateter implantado no início do tratamento. No momento da retirada por fim de tratamento, o cateter já havia desconectado e embolizado. O fragmento intracardíaco foi retirado também por procedimento de hemodinâmica. CONCLUSÃO: A embolia de fragmentos de cateter em cateteres de longa permanência é uma complicação rara, mas que necessita ser reconhecida, mesmo em pacientes assintomáticos.

Assistência de enfermagem a portadores de linfoma de hodgkin submetidos à quimioterapia: revisão integrativa / Asistencia de enfermería a pacientes con linfoma de hodgkin sujetos a quimioterapia: revisión integrativa / Nursing care for hodgkin's lymphoma patients subject to chemotherapy: an integrative review

The high occurrence rates of Hodgkin's Lymphomas and the treatment-associated complications as well as the complication of the disease itself evidence the need for a technical-scientific training of nurses in order to provide health care to this population. In this sense, this study had the aim to identify the nursing care described in the literature for these patients subject to chemotherapy treatment. An integrative review of the 15 eligible articles was carried out. Findings show that the generated knowledge is aimed at the epidemiological aspects of the disease, therapeutic forms, besides nursing interventions. Regarding the latter, the teaching process, use of coping and technical-technological procedures were found appropriate and feasible.

As altas taxas de ocorrência de Linfoma de Hodgkin (LH) e as complicações relacionadas ao tratamento e à própria doença evidenciam a necessidade de que os enfermeiros tenham capacitação técnico-científica para prestar assistência a essa clientela. Neste sentido, buscou-se identificar os cuidados de enfermagem arrolados na literatura a esses pacientes submetidos a tratamento quimioterápico. Foi realizada revisão integrativa dos 15 artigos elegíveis. Os achados mostram que o conhecimento produzido está voltado para os aspectos epidemiológicos da doença, modalidades terapêuticas, além das intervenções de enfermagem. Destas, o ensino, o uso de coping e de procedimentos técnico-tecnológicos mostraram-se adequados e viáveis.

Las altas tasas de ocurrencia de los Linfomas de Hodgkin (LH) y las complicaciones relacionadas al tratamiento y a la propia enfermedad evidencian la necesidad de que los enfermeros tengan una capacitación técnico-científica para prestar asistencia a esa clientela. En este sentido, el estudio buscó identificar los cuidados de enfermería relacionados en la bibliografia a estos pacientes sujetos a tratamiento quimioterápico. Una revisión integrativa de los 15 artículos elegibles fue realizada. Hallazgos muestran que el conocimiento producido está direccionado para los aspectos epidemiológicos de la enfermedad, modalidades terapéuticas, y para las intervenciones de enfermería. De los últimos, la enseñanza, el uso de coping y de procedimientos técnico-tecnológicos se mostraron adecuados y viables.

Mudança do paradigma no carcinoma espinocelular recidivado de boca e orofaringe: Paliação versus quimioradioterapia / Paradigm change in recurrent squamous cell carcinoma of the mouth and oropharynx: Palliation versus chemoradiotherapy

Introdução: As recidivas locais do carcinoma espinocelular de boca e orofaringe ocorrem em torno de 20% a 30% dos casos, enquanto que as recidivas regionais ocorrem em 10% a 15%. O tratamento depende do sítio do tumor primário e do tipo de tratamento inicial e, para o resgate não-cirúrgico, são reservados os casos de lesões irressecáveis. Objetivo: Avaliar a sobrevida nos pacientes com recidiva loco-regional de carcinoma espinocelular de cavidade oral e orofaringe submetidos à quimioradioterapia de resgate, comparando-os com os pacientes encaminhados à paliação. Métodos: Estudo retrospectivo de 127 recidivas loco-regionais, sendo que 51 (40,2%) casos foram considerados elegíveis, com seis casos de diagnóstico no estádio clínico precoce (I e II) e 45 casos nos estádios clínicos avançados (III e IV). Resultados: Treze (10,2%) dos 127 pacientes submetidos ao tratamento de resgate foram à quimioradioterapia, com dose média de radioterapia de 65,7Gy e seis ciclos de quimioterapia com cisplatina. Trinta e oito (29,8%) pacientes foram aos cuidados paliativos multidisciplinares. Na avaliação da sobrevida livre de doença a um ano dos pacientes submetidos à quimioradioterapia de resgate, 16,7% estavam vivos e sem doença, enquanto no grupo dos pacientes submetidos à paliação, a sobrevida média foi de 3,9 meses. Conclusões: O tratamento quimioradioterápico de resgate nas recidivas loco-regionais apresenta resultados pobres em relação à sobrevida livre de doença, todavia promissores quando comparado aos pacientes com indicação de cuidados paliativos.

Introduction: the local relapse of the mouth and oropharynx squamous cell carcinoma occurs in 20% to 30% of patients and the regional relapse occurs in 10% to 15% of them. The treatment depends on the primary location of the tumor and the initial treatment that have influence in the salvage treatment, being indicated the conservative therapy for unresectable tumors. Objective: to assess the survival rate in patients with loco-regional relapse of oral cavity and oropharynx tumors, undergoing salvage chemoradiotherapy or palliative care in loco-regional relapses. Methods: retrospective study of 127 loco-regional relapses and 51 patients were considered elegible for study, being six cases with early clinical stage (I and II) and 45 cases with advanced clinical stage (III and IV). Results: thirteen (10.2%) out of 127 patients underwent salvage chemoradiotherapy with mean radiation dose of 65.7Gy and six-cycle chemotherapy using cisplatin (CDDP) weekly. Thirty-eight (29.8%) out 127 patients with loco-regional relapse were followed with palliative care. The free of disease survival at 1 year of the patients undergoing salvage chemoradiotherapy was 16.7%, whereas the average survival time of the patients of the palliative care group was 3.9 months. Conclusion: the chemoradiotherapy salvage treatment of loco-regional relapses showed poor results in relation to free-disease survival, therefore better when compared to the patients of palliative care.

Low-cost outpatient chemotherapy regimen of cisplatin, 5-fluorouracil and leucovorin for advanced head and neck and esophageal carcinomas

CONTEXT AND OBJECTIVE: Patients with advanced head and neck (H/N) and esophageal squamous cell carcinoma (SCC) often have a poor performance status and a dire prognosis. Our aim was to evaluate the feasibility, activity and quality of life (QOL) of an outpatient chemotherapy regimen consisting of cisplatin, 5-fluorouracil and leucovorin (CFL). DESIGN AND SETTING: Prospective phase II study conducted at a Brazilian public institution. METHODS: Fifteen patients with residual, recurrent or metastatic SCC of the H/N or esophagus received bolus infusions of leucovorin 20 mg/m²/day and 5-fluorouracil 370 mg/m²/day on days 1-4, and 90 minutes of infusion of cisplatin 25 mg/m²/day on days 1-3, every 21 to 28 days, depending on hematological recovery. We also evaluated QOL by applying the European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC QLQ-C30) before each cycle. RESULTS: The overall response rate was 36 percent, and the mean overall survival and progression-free survival were six and three months, respectively. We observed grade 3 or higher hematological toxicity in seven patients and one patient had grade 3 nausea and vomiting. One patient died because of neutropenic fever. Seven out of the 12 patients who could be evaluated regarding QOL presented an improvement in their overall health status and functional QOL scores over the course of the treatment. CONCLUSIONS: CFL is an active outpatient protocol with tolerable toxicity and a favorable QOL impact. Larger studies are warranted, in order to confirm these results.

CONTEXTO E OBJETIVO: Pacientes com carcinoma espinocelular (CEC) de cabeça e pescoço e esôfago frequentemente tem um baixo Karnofsky Performance Status (KPS) e um prognóstico ruim. Nosso objetivo foi avaliar eficácia, taxa de resposta e qualidade de vida nesse contexto, em pacientes tratados com o regime ambulatorial cisplatina, 5-fluoruracil e leucovorin (CFL). TIPO DE ESTUDO: Estudo prospectivo fase II conduzido em uma instituição pública brasileira. MÉTODOS: 15 pacientes com CEC de cabeça e pescoço e esôfago persistente, recorrente ou metastático receberam leucovorin 20 mg/m²/dia, in bolus seguido de 5-fluoruracil 370 mg/m²/dia, in bolus nos dias 1 a 4 e cisplatina 25 mg/m²/dia em infusão de 90 minutos nos dias 1 a 3 a cada 21 ou 28 dias, dependendo da recuperação hematológica. Qualidade de vida foi analisada utilizando o questionário EORTC QLQ-C30, aplicado antes de cada ciclo. RESULTADOS: A taxa de resposta objetiva foi de 36 por cento e a sobrevida global e a sobrevida livre de progressão médias foram de 6,7 e 3,7 meses, respectivamente. Toxicidade hematológica maior ou igual a grau 3 foi observada em sete pacientes e um paciente apresentou náusea e vômito grau 3. Um paciente foi a óbito por neutropenia febril. Sete de 12 pacientes avaliáveis apresentaram melhora no estado geral de saúde e oito nas escalas funcional e sintomática com o tratamento. CONCLUSÃO: CFL é um protocolo ambulatorial factível, com toxicidade aceitável e com impacto favorável na qualidade de vida. Estudos maiores devem ser realizados para confirmar estes resultados.