Outcomes after surgical resection of primary non-myxoma cardiac tumors

Abstract Objective: Primary cardiac tumors are rare lesions with different histological type. We reviewed our 17 years of experience in the surgical treatment and clinical results of primary non-myxoma cardiac tumors. Methods: Between July 2000 and February 2017, 21 patients with primary cardiac tumor were surgically treated in our institution. The tumors were categorized as benign non-myxomas and malignants. Data including the demographic characteristics, details of the tumor histology and grading, cardiac medical and surgical history, surgical procedure of the patients were obtained from the hospital database. Results: Eleven patients were diagnosed with benign non-myxoma tumor (male/female:7/4), ranging in age from 10 days to 74 years (mean age 30.9±26.5 years). Papillary fibroelastoma was the most frequent type (63.6%). There were two early deaths in benign group (all were rhabdomyoma), and mortality rate was 18%. The mean follow-up period was 69.3±58.7 months (range, 3 to 178 months). All survivals in benign group were free of tumor-related symptoms and tumor relapses. Ten patients were diagnosed with malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from 14 years to 73 years (mean age 44.7±18.9 years). Total resection could be done in only three (30%) patients. The mean follow-up period was 18.7±24.8 months (range, 0-78 months). Six patients died in the first 10 months. Conclusion: Complete resection of the cardiac tumors, whenever possible, is the main goal of surgery. Surgical resection of benign cardiac tumors is safe, usually curative and provides excellent long-term prognosis. On the contrary, malignant cardiac tumors still remain highly lethal.

The role of surgery in primary central nervous system lymphomas / El rol de la cirugía en los linfomas primarios del sistema nervioso central

ABSTRACT Background Primary central nervous system lymphomas (PCNSL) are infrequent. The traditional treatment of choice is chemotherapy. Complete resections have generally not been recommended, because of the risk of permanent central nervous system deficits with no proven improvement in survival. The aim of the current study was to compare survival among patients with PCNSL who underwent biopsy versus surgical resection. Methods A retrospective study was conducted on 50 patients with a confirmed diagnosis of PCNSL treated at our center from January 1994 to July 2015. Results Patients in the resection group exhibited significantly longer median survival time, relative to the biopsy group, surviving a median 31 months versus 14.5 months; p = 0.016. Conclusions In our series, patients who had surgical resection of their tumor survived a median 16.5 months longer than patients who underwent biopsy alone.

RESUMO Introducción Los linfomas primarios del sistema nervioso central (LPSNC) son infrecuentes. Tradicionalmente el tratamiento de elección es la quimioterapia. Existe un paradigma de no indicar resección, por el riesgo de déficit neurológico sin aumento de la sobrevida. El objetivo del presente estudio es comparar la sobrevida de pacientes con LPSNC sometidos a biopsia versus resección. Métodos Estudio retrospectivo que incluye 50 pacientes con diagnóstico confirmado de LPSNC tratados en nuestra Institución desde enero de 1994 hasta julio de 2015. Resultados Los pacientes del "grupo resección" mostraron una sobrevida media significativamente mayor respecto a los del "grupo biopsia"; 31 meses versus 14,5 meses respectivamente, p = 0,016. Conclusiones En nuestra serie, los pacientes que con resección quirúrgica de su tumor tuvieron una sobrevida media de 16,5 meses superior que los pacientes biopsiados.

Surgical treatment of gastric cancer: a 10-year experience in a high-volume university hospital

OBJECTIVES: Surgery remains the cornerstone treatment modality for gastric cancer, the fifth most common type of tumor in Brazil. The aim of this study was to analyze the surgical treatment outcomes of patients with gastric cancer who were referred to a high-volume university hospital. METHODS: We reviewed all consecutive patients who underwent any surgical procedure due to gastric cancer from a prospectively collected database. Clinicopathological characteristics, surgical and survival outcomes were evaluated, with emphasis on patients treated with curative intent. RESULTS: From 2008 to 2017, 934 patients with gastric tumors underwent surgical procedures in our center. Gastric adenocarcinoma accounted for the majority of cases. Of the 875 patients with gastric adenocarcinoma, resection with curative intent was performed in 63.5%, and palliative treatment was performed in 22.4%. The postoperative surgical mortality rate for resected cases was 5.3% and was related to D1 lymphadenectomy and the presence of comorbidities. Analysis of patients treated with curative intent showed that resection extent, pT category, pN category and final pTNM stage were related to disease-free survival (DFS) and overall survival (OS). The DFS rates for D1 and D2 lymphadenectomy were similar, but D2 lymphadenectomy significantly improved the OS rate. Additionally, clinical factors and the presence of comorbidities had influence on the OS. CONCLUSIONS: TNM stage and the type of lymphadenectomy were independent factors related to prognosis. Early diagnosis should be sought to offer the optimal surgical approach in patients with less-advanced disease.

Relevance of prognostic factors in the decision-making of stem cell transplantation in Myelodysplastic Syndromes / Relevância dos fatores prognósticos na decisão do transplante de células-tronco na Síndrome Mielodisplásica

ABSTRACT The hematopoietic stem cell transplantation (HSCT) is the only curative alternative for Myelodysplastic Syndrome (MDS), but many patients are not eligible for this treatment, as there are several limiting factors, especially in the case of patients with low-risk MDS. The aim of this study is to discuss the factors that can guide the decision-making on referring or not a patient to HSCT. Three cases of MDS, two of which were submitted to HSCT are presented. We intend to report the difficulties in referring patients with MDS to transplant and the prognostic factors that contribute to define eligibility.

RESUMO O transplante de células-tronco hematopoéticas (TCTH) é a única alternativa curativa para Síndrome Mielodisplásica (SMD), porém muitos pacientes não são elegíveis para esta opção, pois existem diversos fatores limitantes, principalmente no caso de pacientes com SMD de baixo risco. O objetivo do estudo é discutir os fatores que podem orientar a decisão no encaminhamento ou não para o TCTH. São apresentados três casos de SMD, dos quais dois foram submetidos ao TCTH. Nos propomos a relatar as dificuldades no encaminhamento dos pacientes com SMD ao transplante e os fatores prognósticos que contribuem para definir a elegibilidade.

Most small bowel cancers are revealed by a complication / A maioria dos cânceres de intestino delgado são revelados por uma complicação

ABSTRACT Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. Conclusion Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.

RESUMO Objetivo Caracterizar o padrão de neoplasias malignas primárias do intestino delgado em um hospital terciário de Leste Europeu. Métodos Estudo retrospectivo de pacientes com câncer de intestino delgado, internados em um hospital terciário e de emergência, ao longo dos últimos 15 anos. Resultados Foram avaliados 57 pacientes com neoplasias malignas gastrintestinais, o que representou 0,039% das admissões e 0,059% das laparotomias realizadas. Total de 37 (64,9%) pacientes masculinos, média de idade de 58 anos, e de 72 anos para mulheres. Dentre os 57 pacientes, 48 (84,2%) foram internados em situação de emergência: obstrução intestinal em 21 (38,9%), perfuração em 17 (31,5%), hemorragia digestiva alta em 8 (14,8%), e hemorragia digestiva baixa em 2 (3,7%). Houve 10 (17,5%) tumores duodenais, 21 (36,8%) jejunais e 26 (45,6%) ileais. As neoplasias mais frequentes foram tumor estromal gastrintestinal, em 24 (42,1%) pacientes, adenocarcinoma em 19 (33,3%), linfoma em 8 (14%) e carcinoides em 2 (3,5%). A prevalência de adenocarcinoma duodenal foi 14,55 vezes maior do que a do intestino delgado, e a prevalência de tumores estromais duodenais foi 1,818 vez maior do que a do intestino delgado. A obstrução intestinal foi complicação do adenocarcinoma em 57,9% dos casos, e a perfuração foi a principal complicação local (47,8%) dos tumores estromais. Conclusão As neoplasias malignas primárias do intestino delgado foram geralmente diagnosticadas em estado avançado e reveladas por uma complicação local do tumor. O tratamento cirúrgico em situação de emergência está associado à significativa morbimortalidade.

Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status / Análise de sobrevida em pacientes com doença metastática espinhal: influência da cirurgia, histologia, status clínico e neurológico

Spine is the most common site for skeletal metastasis in patients with malignancy. Vertebral involvement quantification, neurological status, general health status and primary tumor histology are factors to set surgical planning and therapeutic targets. We evaluated the impact of general clinical and neurological status, histologic type and surgery in survival. Method : The study sample consisted of consecutive patients admitted from July 2010 to January 2013 for treatment. Results : Sixty eight patients were evaluated. 23 were female and 45 were male. Main primary neoplasic sites were: breast, prostate, lung/pleura and linfoproliferative. Thirty three out of 68 received surgical treatment, 2 received percutaneous biopsy and 33 had nonsurgical treatment. Survival : Log Rank curves revealed no statistical significant difference according to histological type, surgical approach and Frankel Score. Karnofsky Score was statistically different. Conclusion : Histological type and clinical status were statistically associated with life expectancy in vertebral metastatic disease. .

A coluna vertebral é o sítio mais comum de metastases ósseas. A quantificação do acometimento vertebral, o status neurológico, status clínico e histologia do tumor primário são fatores importantes para planejamento cirúrgico e metas terapêuticas. Nós avaliamos o impacto do status clinico geral e neurológico, tipo histológico e cirurgia na sobrevida de pacientes com metástases espinhais. Método : A amostra consistiu de pacientes consecutivamente admitidos de Julho de 2010 a Janeiro de 2013. Resultados : Sessenta e oito pacientes foram avaliados. 23 eram mulheres e 45 eram homens. Os principais sítios primários foram mama, próstata, pulmão e linfoproliferativos. Trinta e três realizaram tratamento cirúrgico, 2 realizaram biópsia percutânea e 33 tiveram tratamento conservador e radioterapia. Conclusão As curvas Log Rank não revelaram significância quanto à cirurgia e escore de Frankel, mas revelaram associação com Karnofsky e tipo histológico. .

Mortalidade por câncer hematopoiético na Colômbia: um estudo ecológico, 1985-2012 / Mortality from hematopoietic cancer in Colombia: an ecological study, 1985-2012

As leucemias são ocasionadas pela proliferação descontrolada de células imaturas da medula óssea. Os linfomas são doenças dos tecidos linfáticos que resultam do crescimento anormal das células do sistema imune. A etiologia da maioria das neoplasias hematológicas é pouco conhecida assim, analisar sua distribuição é de fundamental importância para elucidar fatores de risco em nível ecológico. Sujeitos e Métodos: Trata-se de um estudo ecológico descritivo para analisar a tendência da mortalidade por leucemias e linfomas, categorizados segundo faixas etárias de 0 a 14, 15 a 44, 45 a 59, 60 a 69 e 70 ou mais anos de idade, residentes da Colômbia e de Bogotá, no período de 1985 a 2012. As informações dos óbitos e os dados populacionais foram provenientes da página web do Departamento Nacional de Estadística (DANE), órgão oficial responsável pelas estatísticas vitais no território nacional. Os modelos de tendência e a variação percentual anual estimada (APC) foram estimados por regressão de Poisson mediante o programa de Joinpoint, versão 4.1.1.3. Resultados: O comportamento das taxas de mortalidade para o câncer hematopoiético no grupo de 0 a 14 anos revelou uma tendência de declínio; para as faixas etárias intermediárias, entre as idades de 15 a 69 anos, o padrão revelou diferenças segundo tipo de câncer e sexo; por fim para os maiores de 70 anos, a mudança percentual média anual foi de aumento, coincidindo com a literatura internacional. A magnitude da tendência para Bogotá é maior em comparação com Colômbia e se relaciona com o acesso aos serviços de saúde e aderência a o protocolo médicoConclusão: Foi possível observar uma tendência à diminuição dos óbitos por leucemias em crianças menores de 15 anos de idade, na Colômbia e em Bogotá, ao passo que se encontrou uma tendência ao aumento dos óbitos por leucemias nos maiores de 70 anos de idade...

Tendência de mortalidade por leucemias e linfomas em menores de 20 anos, Brasil / Mortality Trends from Leukemia and Lymphomas in People with less than 20

Introdução: O câncer pediátrico responde por 2 a 3% de todos os tumores malignos e no mundo são diagnosticados mais de 160.000 casos por ano. Objetivo: Descrever a tendência de mortalidade e sua razão de taxas por leucemias e linfomas em menores de 20 anos, no Brasil e nas capitais brasileiras que dispõem de Registros de Câncer de BasePopulacional. Método: Foram utilizados dados de óbitos por leucemias e linfomas de menores de 20 anos obtidosno Sistema de Informação de Mortalidade para o período de 1996 a 2008. O período de análise foi estratificado em triênios e foram calculadas taxas de mortalidade, para o Brasil e as capitais, ajustadas pela população mundial. Modelosde regressão polinomial foram utilizados para a análise considerando o nível de significância de 5%. Resultados: Parao Brasil, foi observada tendência de declínio não constante das taxas de mortalidade por linfomas e para leucemia nenhum modelo se mostrou estatisticamente significativo. Houve variação da tendência da mortalidade por neoplasias hematológicas segundo capitais. As leucemias apresentaram taxas mais elevadas de mortalidade para todo o período e para todas as faixas etárias estudadas. Para o grupo dos linfomas, houve redução das taxas de mortalidade para todas as faixas etárias, exceto 10 a 14 anos, sendo observado aumento da mortalidade no último período. Conclusão: As variações da mortalidade por neoplasias hematológicas entre as capitais sugerem diferenças no acesso ao diagnósticoe tratamento dessas doenças

Increasing and Worsening Late Effects in Childhood Cancer Survivors during Follow-up

Recent advances in childhood cancer treatment have increased survival rates to 80%. Two out of three survivors experience late effects (LEs). From a group of 241 survivors previously described, 193 were followed at the long-term follow-up clinic (LTFC) of Severance Hospital in Korea; the presence of LEs was confirmed by oncologists. We reported the change in LEs during 3 yr of follow-up. The median follow-up from diagnosis was 10.4 yr (5.1-26.2 yr). Among 193 survivors, the percentage of patients with at least one LE increased from 63.2% at the initial visit to 75.1% at the most recent visit (P = 0.011). The proportion of patients having multiple LEs and grade 2 or higher LEs increased from the initial visit (P = 0.001 respectively). Forty-eight non-responders to the LTFC were older and had less frequent and severe LEs than responders at initial visit (all P < 0.05). In multivariate analysis, younger age at diagnosis, older age at initial visit, a diagnosis of a brain tumor or lymphoma, and use of radiotherapy were significant risk factors for LEs (all P < 0.05). Adverse changes in LEs were seen among the survivors, regardless of most clinical risk factors. They need to receive comprehensive, long-term follow up.

Incidência, Mortalidade e Sobrevida de Leucemia e Linfoma no Município de Fortaleza, Ceará

Analisou-se a tendência da incidência e da mortalidade para as leucemias e linfomas em Fortaleza/Ceará e sua distribuição segundo sexo e faixa etária. Estimou-se a sobrevida em cinco anos a partir de dados compilados pelo Registro de Câncer de Base Populacional (RCBP) do Município. A tendência da incidência e a sobrevida foram estimadas a partir das informações do RCBP de Fortaleza (1990-2002) e a tendência da mortalidade (1980-2007) a partir do Sistema de Informação sobre Mortalidade do Ministério da Saúde. As taxas de incidência e de mortalidade foram padronizadas pela população mundial e as tendências estimadas a partir de modelos de regressão linear. O tempo de sobrevida foi calculado da data do diagnóstico até a data do último contato ou óbito. As probabilidades acumuladas de sobrevida foram calculadas utilizando o estimador produto limite de Kaplan-Meier. Observou-se que as taxas de mortalidade para as leucemias apresentaram uma tendência decrescente durante todo o período, enquanto que, para os linfomas, as taxas mantiveram-se estáveis. Em relação à incidência, nota-se uma tendência decrescente não constante no início do período e, em anos mais recentes, uma estabilização tanto para as leucemias quanto para os linfomas. Das 191 crianças registradas por leucemia e das 78 por linfoma no RCPB de Fortaleza, no período de 01/01/1996 a 31/12/2002, 133 e 56 tiveram seguimento para as leucemias e linfomas, respectivamente. Nestas, a sobrevida em cinco anos foi de 49% para as leucemias e 57% para os linfomas. Esforços objetivando uma melhor estruturação organizacional do registro e a integração de instituições envolvidas (fontes notificadoras, secretarias municipais e estaduais) deverão ser empreendidos visando a imprimir uma maior qualidade nas informações.

We analyzed the trend of incidence and mortality for the leukemia and lymphomas in Fortaleza, Ceará, and its distribution by sex and age. Survival was estimated in five years from data compiled by the Population-Based Cancer Registry (PBCR) in the city. The trend of incidence and survival were estimated from PBCR Fortaleza (1990-2002) database and mortality trends (1980-2007) from the Mortality Information System of the Brazilian Ministry of Health. Incidence and mortality rates were adjusted by World Population and trends were estimated from linear regression models. Survival time was calculated from the date of diagnosis to date of last contact or death. Cumulative probabilities of survival were calculated using the product limit estimator of Kaplan-Meier. It was observed that mortality rates for leukemia showed a decreasing trend throughout the period, while for the lymphomas, the rates remained stable. From the incidence, it was observed a not constant downward trend in the early period and a stabilization for both leukemia and lymphomas in more recent years. 191 children were diagnosed with leukemia and 78 with lymphoma, from Jan,1996 to Dec,2002. 133 and 56 were monitored for leukemia and lymphoma, respectively. Five-year survival was 49% for leukemia and 57% for lymphomas. Efforts aiming at a better organizational structure of the record and the integration of institutions involved (notifying sources, city and state) should be undertaken in order to print a higher quality of information.

Linfoma ósseo em cão / Bone lymphoma in a dog

It was reported one case of primary bone lymphoma in eight year-old bitch, Fila, with history of anterior limbs paralysis and side lied. A cervical vertebrae neoplasm was suspected and in view of the poor prognosis, the animal was euthanatized. Based on the anatomopathological and histological findings it was firmed the diagnosis of primary bone lymphoma.

Comparison of catheter-related infection risk in two different long-term venous devices in adult hematology-oncology patients

OBJETIVO: Infecção é a principal complicação relacionada ao uso de cateteres venosos de longa permanência em pacientes oncológicos e sua incidência pode variar a depender do tipo de cateter utilizado. O objetivo deste estudo foi comparar a freqüência e risco de infecção entre dois tipos de dispositivos de longa permanência. MÉTODOS: Estudo retrospectivo com 96 pacientes onco-hematológicos portadores de cateteres parcialmente implantáveis (n=55) ou totalmente implantáveis (n=42). Dados demográficos e cuidados com o dispositivo foram similares entre os dois grupos. A comparação entre os dispositivos foi realizada através da avaliação da incidência de infecção e da sobrevida livre de infecção. RESULTADOS: Em uma mediana de acompanhamento de 210 dias, a incidência de infecção relacionada ao cateter foi de 0,2102/100 cateter-dias para os dispositivos parcialmente implantáveis e de 0,0045/100 cateter-dias para os totalmente implantáveis, com uma razão de incidência de 46,7 (IC 95% = 6,2 a 348,8). A taxa de sobrevida livre de primeira infecção em um ano foi de 45% versus 97% e a taxa de sobrevida livre de retirada por infecção foi de 42% versus 97%, respectivamente para cateter parcialmente ou totalmente implantável (p<0,001 para ambas comparações). Conclusão: No presente estudo, o risco de infecção foi menor nos dispositivos totalmente implantáveis do que nos parcialmente implantáveis.

Primary Lymphoma of Bone: Survival and Prognosis

BACKGROUND: Primary lymphoma of bone is a rare disease. There is yet no systematical evaluation of primary lymphoma of bone in Korea. Here we report our experience of sixteen cases with primary lymphoma of bone focusing on the survival. METHODS: Sixteen cases, collected for 13 years, were evaluated on the clinical presentation, histologic subtype, stage and treatment outcomes of the primary bone lymphoma. RESULTS: The most common presenting complaint was bone pain. Malignant lymphoma of bone involved a wide variety of sites, the most prevalent site of which in this study was the spine. Most of the cases were in the diffuse large B-cell category. The clinical stage of lymphoma was IEA in two cases, IIEA in three cases, IVEA in five cases and IVEB in three cases. All treated cases received systemic chemotherapy and ten cases among them were treated with combined modality therapy. Median overall survival was not reached after median follow-up period of 28 months and five-year overall survival rate was 54%. CONCLUSION: More promising therapeutic strategies are needed for survival improvement on more accumulated cases.

Linfomas extranodales de cabeza y cuello / Extranodal lymphoma of the head and neck

Antecedentes: Representan menos del 5 por ciento de todos los tumores malignos de cabeza y cuello y generalmente no son analizados en grandes series. Objetivo: Analizar la experiencia de 20 años en una sola institución sobre la base de una única clasificación y hallar variables pronósticas. Lugar de Aplicación: Hospital Público Municipal. Diseño: Retrospectivo. Población: 19 hombres y 17 mujeres con una edad media de 63,5 años: 64 por ciento en EI-II; 72 por ciento grado intermedio o alto. 44,4 por ciento localizados en el anillo de Waldeyer. El resto en tiroides, glándula salivales, cavidades oral y sinusonasal. Método: El tratamiento fue en base a quimio y/o radioterapia. La cirugía fue diagnóstica y constó de exéresis del órgano en 11 pacientes y biopsia en 25. Resultado: La tasa de recaída a 5 años fue 58,3 por ciento, la mortalidad global 55,5 por ciento y la específica 75 por ciento. El estadío actuó como factor pronóstico frente a la muerte y la recaída de la enfermedad. Conclusiones: El tratamiento es clínico. La cirugía debe limitarse al diagnóstico. El estadío fue la única variable pronóstica. La aparición de recaídas actúa como aceleradora de muerte. Las tasas de recaída y mortalidad a 5 años superan el 50 por ciento

Autologous bone marrow/stem cell transplantation: initial experience at a north Indian referral centre.

BACKGROUND: High-dose chemotherapy and/or radiation therapy rescued by autologous bone marrow or peripheral blood stem cells is being increasingly used for the treatment of haematological and solid malignancies. While few centres in India use this modality of therapy, the worldwide experience is encouraging. We, therefore, analysed the results of our initial experience with this therapeutic modality. METHODS: Forty-two patients [multiple myeloma (17), Hodgkin's disease (4), non-Hodgkin's lymphoma (3), chronic myeloid leukaemia (2), acute myeloid leukaemia (2), acute lymphoblastic leukaemia (2), epithelial ovarian cancer (6), breast cancer (4), primitive neuroectodermal tumour and testicular germ cell tumour (1 each)] underwent high-dose chemotherapy followed by either autologous bone marrow transplant (n = 9), peripheral blood stem cell transplant (n = 30) or both (n = 3). The indications for transplant included either advanced stage at diagnosis, other adverse prognostic indicators during the course of their disease, or relapse. The data were analysed retrospectively in December 1998 using hospital records. Follow up data of all the patients were available. RESULTS: Thirty-four of the 42 patients (81%) showed stable engraftment. Eight patients (19%) died in the early post-transplant period (day 5 to day 52 post-transplant). Seven patients died due to neutropenic infections and one due to acute renal failure. Of the 34 surviving patients, 20 were alive at the time of analysis and 14 had died. All but one death in this group were due to progressive primary malignancy. The median overall survival for all patients was 17 months and for the 34 engrafted patients it was 27 months. An analysis of factors affecting survival revealed that patients with chemosensitive disease had a longer overall survival (20.9 v. 6.1 months, p = 0.04) compared to those with chemoresistant disease. CONCLUSION: Autologous bone marrow or peripheral stem cell transplantation is a feasible procedure in India with an acceptable morbidity and mortality. It should be offered more frequently to properly selected patients.

Survival improvement with combined radio-chemotherapy in the primary central nervous system lymphomas

The benefits of radio-chemotherapy in HIV-negative primary central nervous system (CNS) lymphomas were analyzed in 40 patients, who received radiotherapy to the brain or craniospinal axis with the total dose of 4460-5940 cGy to the primary tumor. Radiotherapy was followed by systemic chemotherapy, mainly with the cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen, in 16 of the patients. Follow-up ranged from four to 95 months with a median of 15 months. The relapse rate was 72.5%, and 83% of the relapses occurred within the radiation field. Median survival was 19 months and the two-year survival rate was 41%. Survival was significantly influenced by treatment method and radiation dose when measured by univariate analysis; median survival and the two-year survival rate was 29 months and 63% after radio-chemotherapy, while 13.5 month and 29% after radiotherapy alone (p= 0.027), and 22 months and 49% with doses of 50 Gy or more, but 12.5 months and 13% with doses less than 50 Gy (p=0.009). However, statistical significance was lost in multivariate analysis. These results might suggest the short-term efficacy of radio-chemotherapy, however, cautious observation is needed to confirm long-term effects.

Hipocolesterolemia en neoplasias hematológicas / Hypocholesterolemia in hematologic neoplasms

Nuestro objetivo es evaluar el metabolismo del colesterol en pacientes oncohematológicos e incluirlo como marcador bioquímico en el momento diagnóstico junto con otros datos (leucocitos, lactato deshidrogenasa, eritrosedimentación, haptoglobina). En distintos estudios epidemiológicos se discute la relación negativa entre alto riesgo de mortalidad por cáncer e hipocolesterolemia. Se ha publicado en pacientes con cáncer de colon, recto, ovario, cerebro como también en leucemias mieloides crónicas y agudas, policitemia vera. Un grupo normal (n=32) se enfrentó a un grupo de pacientes oncohematológicos (15 linfomas, 4 leucemias agudas, 7 leucemia mieloide crónica, 1 leucemia mielomonocítica crónica, 3 policitemia vera, 5 mielomas y 2 leucemias linfáticas crónicas). En todos ellos se determinó el colesterol total, los colesteroles de HDL y LDL y las Apolipoproteínas A1 y B. Las medianas en el grupo normal fueron 186 mg/dl, 48 mg/dl, 113 mg/dl, 142,5 mg/dl, 68 mg/dl, y las del grupo patológico 159 mg/dl, 36 mg/dl, 96,5 mg/dl, 120 mg/dl y 64,5 mg/dl, respectivamente. Se encontró diferencia altamente significativa en colesterol total, en el de HDL y en Apo A1. Asimismo fueron más bajos esos valores cuando el número de leucocitos fue superior a 10,0x10 /l. El mieloma fue donde se encontró el colesterol total más descendido. Se consideró de interés la determinación de colesterol, sus fracciones y proteínas transportadoras como marcadores bioquímicos en el momento diagnóstico ya que ellos juegan un rol importante en el metabolismo de las células tumorales.

Linfoma anaplasico a celulas grandes Ki1 negativo / Anaplastic limphoma Ki1 negative of large cells

Se presenta un caso de Linfoma anaplasico a celulas grandes Ki1 negativo, en un hombre de 66 anos, con marcada adenopatia cervical y paraaortica, rapido enflaquecimiento trastornos gastrointestinales y defuncion. La histologia demostro numerosas celulas gigantes anaplasicas, de nucleos voluminosos polinucleados, alternando con algunas celulas Sternbergoides, megacarioblastoides, linfocitos pequenos y grandes. No se demostraron plasmocitos ni aucinofilos. La inmunomarcacion con ICA, fue intensamente positiva y CD 30 negativa.