Resultados del tratamiento de la Leucemia Linfoide Aguda del niño en Cuba / Results of the treatment of child Acute Lymphoid Leukemia in Cuba

Introducción: la leucemia linfoide aguda (LLA) es la enfermedad maligna más frecuente en la infancia y la primera que se trató con un protocolo común en Cuba. Se han aplicado diferentes protocolos a lo largo del tiempo y actualmente existen en el país 10 centros que tratan niños con LLA. Objetivo: presentar los resultados alcanzados en el tratamiento de la LLA desde 2002 hasta 2008 con el protocolo del grupo ALLIC (Acute Lymphoblastic Leukemia Intercontinental). Métodos: se trataron 166 niños menores de 18 años al inicio de la enfermedad. Para conformar los grupos pronóstico se utilizaron diferentes criterios que incluyeron la edad y el número de leucocitos en el momento del diagnóstico, las alteraciones moleculares y la respuesta al tratamiento. Resultados: la supervivencia libre de eventos (SLE) a los 4 años fue del 69 por ciento y la supervivencia global del 78 por ciento. La SLE en los diferentes grupos pronósticos fue del 85 por ciento para los pacientes de riesgo estándar, 77 por ciento para los de riesgo intermedio y 59 por ciento para los de riesgo alto. El porcentaje de remisión inicial fue inferior al obtenido por el grupo total. La mayoría de las muertes ocurrieron al inicio de la aplicación del protocolo. La recaída hematológica fue la causa más frecuente de terminación de la remisión completa. Las recaídas del sistema nervioso central, las testiculares y las combinadas fueron inferiores al 5 por ciento. La presencia de reordenamientos genéticos del tipo bcr/abl o MLL/AF4 se confirmaron como elementos de muy mal pronóstico. Conclusiones: estos resultados, aunque son susceptibles de ser mejorados, muestran un nivel adecuado, sobre todo si se tiene en cuenta que se han logrado en un país en vías de desarrollo

Introduction: Acute lymphoid leukaemia (ALL) is the most frequent malignant disease in childhood and the first one to be treated with a common protocol in Cuba. Different protocols have been used and at present there are 10 health centers in Cuba treating children with ALL. Objective: To present the results achieved in the treatment of ALL from 2002 to 2008 with protocol ALLIC (Acute Lymphoblastic Leukemia Intercontinental). Methods: 166 children under 18 years old at the beginning of the disease were treated. Different criteria were used to make prognostic groups which included age and leukocyte counts in the peripheral smear at diagnosis, DNA molecular rearrangements and response to therapy. Results: Event free survival (EFS) after 4 years for the whole group was 69 percent and overall survival (SV) was 78 percent. EFS in the different prognostic groups were 85 percent for standard risk patients, 77 percent for the intermediate risk group and 59 percent for high risk children. Percentage of initial remission in our patients was lower than the one obtained for the whole group. The majority of early deaths occurred at the beginning of the protocol application. Bone marrow relapses were the more frequent ones. Central nervous system, testicular or combined relapses were lower than 5 percent. DNA rearrangements for bcr/ abl or MLL/AF4 were signs of very bad prognosis. Conclusions: These results, even when susceptible to be better, show an adequate level considering that they were achieved in a developing country

Estudo referencial de um protocolo quimioterápico para leucemia linfocítica aguda infantil / Referential study of a chemotherapy protocol for acute lymphocytic leukemia in childhood

O objetivo deste estudo foi o de avaliar o protocolo do Grupo Brasileiro de Tratamento da Leucemia na Infância (GBTLI-99), um dos protocolos para leucemia linfocítica aguda (LLA) utilizados atualmente no Hospital de Clínicas de Porto Alegre fazendo sua comparação com a bibliografia existente, procurando também encontrar indicações sobre uma ordem específica de administração de medicamentos. A metodologia empregada foi a de revisão bibliográfica sobre o tema “Protocolo de Leucemia Linfocítica Aguda Infantil” fundamentando-se em pesquisas na base de dados PubMed, Science Direct, Literatura Latino Americana e do Caribe (LILACS) e Scientific Electronic Library Online (SciELO), através das seguintes palavras chaves: leucemia linfocítica aguda, protocolos quimioterápicos, ordem de infusão de antineoplásicos, acute lymphoblastic leukemia, acute lymphocytic leukemia, oncology, drug scheduling. Além dos dados bibliográficos houve a comparação ao protocolo atual utilizado. Na revisão realizada não foram encontradas instruções específicas quanto à ordem ou horário para infusão dos medicamentos. No protocolo avaliado, as mesmas instruções não foram identificadas havendo apenas um cronograma dos antineoplásicos administrados a cada dia. Podemos concluir que através da comparação do protocolo GBTLI-99 com a literatura científica atual, foi possível verificar que os medicamentos utilizados e as fases da terapia são similares aos recomendados por outros protocolos terapêuticos, obtendo taxas adequadas de remissões. Quanto à ordem preferencial de administração de medicamentos, não foram encontrados estudos que mostrem evidências de uma terapêutica otimizada.

The aim of this study was to evaluate the protocol of the Brazilian Treatment Group for Leukemias in Childhood (GBTLI-99), one of the protocols for acute lymphoblastic leukemia (ALL) currently used in the Hospital de Clinicas de Porto Alegre making its comparison with the existing literature, searching also for information about a specific order of drug administration. The methodology was to review the literature on the topic "Protocol of Childhood Acute Lymphocytic Leukemia” based on research in PubMed, Science Direct, Latin American and Caribbean Health Sciences (LILACS) and Scientific Electronic Library Online (SciELO) by the following key words: acute lymphocytic leukemia, chemotherapy protocols, order of infusion of anticancer drugs, acute lymphoblastic leukemia, oncology, drug scheduling. In addition to bibliographic data, we made a comparison with the current protocol used. In the review conducted there were no specific instructions regarding the order or schedule infusion of drugs. In the evaluated protocol the same instructions were not identified, with only a timeline of antineoplasics administered every day. We can conclude that protocol GBTLI-99 compares to current scientific literature, regarding the drugs used and the stages of therapy, obtaining adequate rates of remissions. As for the preferred order of administration of medications, there are no studies that show evidence of an optimized scheme.

Complicações orais decorrentes da terapia antineoplásica / Oral complications of cancer therapy

É comum, em pacientes oncológicos submetidos à terapia antineoplásica, o desenvolvimento de complicações orais agudas ou tardias. Esses distúrbios na integridade e função da cavidade bucal se devem ao fato de que a radioterapia e quimioterapia não são capazes de destruir as células tumorais sem lesionar células normais. Dentre as complicações orais encontram-se a mucosite, xerostomia, disgeusia, as infecções fúngicas, bacterianas e virais, as cáries de radiação, trismo, osteorradionecrose, neurotoxicidade, e, em pacientes pediátricos, o comprometimento da formação óssea, muscular e dentária. Esses efeitos geralmente variam a cada paciente dependendo de variáveis do tratamento, do paciente e do tumor. O objetivo do presente trabalho foi apresentar as complicações orais decorrentes da terapia antineoplásica bem como a importância da atuação do cirurgião-dentista nesse contexto. Através da literatura pesquisada, foi possível concluir que é imprescindível que os pacientes oncológicos sejam acompanhados antes, durante e após a terapia antineoplásica a fim de que o cirurgião-dentista possa elaborar um plano de tratamento adequado às suas necessidades, de forma a prevenir ou controlar a ocorrência dessas complicações.

Intent of therapy in metastatic breast cancer with isolated ipsilateral supraclavicular lymph node spread--a therapeutic dilemma.

AIMS OF THE STUDY: Isolated ipsilateral supraclavicular lymph nodal (IISCLN) metastasis was considered part of locally advanced breast cancer (LABC) previously but the recent staging system categorised this group to metastatic disease (stage IV). There is no clear consensus on intent of therapy in patients with IISCLN. A retrospective comparative analysis of IISCLN and LABC patients treated with a curative multimodality approach was performed to evolve guidelines on treatment approach in patients with IISCLN spread. METHODOLOGY: A total number of 670 patients with breast cancer treated in the Department of Surgical Oncology, IRCH, AIIMS, during the period between January, 1993 to December, 2000 were studied retrospectively. Out of these 16 (2.4%) patients with cytology proven isolated metastasis to ipsilateral SCLN without any other distant disease and 299 LABC patients were analysed. All patients received neoadjuvant anthracycline based chemotherapy, surgery, postoperative radiotherapy (50 Gy) including supraclavicular fossa. The relapse patterns and survival in both the groups were compared. RESULTS: At a median follow up of 36 months (range 9-72 months) the total recurrence in the IISCLN group was 31% and in the LABC group was 26%, the systemic recurrence was equal at 25% in each group while the locoregional recurrence was 12% and 7% in the IISCLN and LABC groups respectively. The overall survival (OS) was 81% and 91% whereas the disease-free survival (DFS) was 12% and 7% in the IISCLN and LABC groups, respectively. CONCLUSION: Intent of therapy in metastatic breast cancer is palliative. However, patients with IISCLN metastasis have a relatively less aggressive biologic behaviour as compared to patients with spread to other distant sites. Results of the current study shows that the relapse patterns and survival of IISCLN group and LABC are comparable. Hence, despite being staged as metastatic disease, patients with IISCLN spread should be treated with combined modality approach for prolonged survival.