Tratamiento de la recaída de pacientes pediátricos con leucemia linfoblástica aguda en la Argentina: resultados de un ensayo clínico y una cohorte prospectiva / Treatment of Relapse in Pediatric Patients with Acute Lymphoblastic Leukemia in Argentina: Results from a Clinical Trial and a Prospective Cohort

Introducción: desde 2002, el Grupo Argentino para el Tratamiento de la Leucemia Aguda (GATLA) implementa protocolos del grupo Berlín-Frankfurt-Münster (BFM) como tratamiento estándar de las recaídas de la leucemia linfoblástica aguda (LLA). En 2010, el BFM generó el protocolo IntReALL 10, que en la Argentina se implementó con las limitaciones propias de la región. Población y métodos: 180 pacientes menores de 18 años fueron tratados entre 2010 y 2015 por una LLA recaída de alto riesgo en la Argentina siguiendo un protocolo de recaída del BFM que comparó en forma abierta el tratamiento estándar con una terapéutica innovadora (experimental); esta incluyó el fármaco clofarabina. Se evaluaron 171 pacientes, de los cuales 78 pacientes fueron aleatorizados en forma centralizada (ensayo clínico) y 93 fueron asignados a una de las ramas según el criterio del grupo tratante (cohorte prospectiva). La cohorte donde la asignación del tratamiento no fue aleatorizada fue analizada realizando un ajuste por sexo, edad y por la presencia o no de síndrome de Down, cromosoma Philadelphia e inmunofenotipo T. Resultados: los pacientes que recibieron el tratamiento experimental tuvieron peores resultados (el doble de mortalidad a cinco años) que los que recibieron tratamiento estándar. Esta diferencia alcanzó significancia estadística tanto en el ensayo clínico (p=0,001) como en la cohorte prospectiva (p=0,0009). Conclusiones: nuestros resultados avalan continuar con la rama estándar de los protocolos tipo BFM para el tratamiento de las recaídas de la LLA y fueron concordantes con las conclusiones del grupo ALLIC-REC. (AU)

Introduction: since 2002, the Grupo Argentino para el Tratamiento de la Leucemia Aguda (GATLA) has been implementing protocols from the Berlin-Frankfurt-Münster (BFM) group as the standard treatment for relapses of acute lymphoblastic leukemia (ALL). In 2010, BFM developed the IntReALL 10 protocol, implemented in Argentina with the inherent limitations of the region. Population and Methods: we treated a total of 180 patients under 18 years of age between 2010 and 2015 for high-risk relapsed acute lymphoblastic leukemia (ALL) in Argentina following a BFM relapse protocol. This protocol openly compared standard treatment with an innovative (experimental) therapeutic approach that included Clofarabine. Out of these, 171 patients were assessable, with 78 patients being centrally randomized in a clinical trial, and 93 were assigned to one of the arms based on the treating group's criteria (prospective cohort). The cohort where the treatment assignment had not been randomized, was analyzed with adjustments for gender, age, and the presence or absence of Down Syndrome, Philadelphia Chromosome, and T-cell immunophenotype. Results: patients who received the experimental treatment had worse outcomes (double the five-year mortality) compared to those who received the standard treatment. This difference reached statistical significance in the clinical trial (p=0.001) and the prospective cohort (p=0.0009). Conclusions: our results support the continuation of the standard arm in BFM-type protocols for relapsed ALL treatment and were consistent with the conclusions of the ALLIC-REC group. (AU)

Fatores associados à ressecção incompleta do câncer não melanoma / Factors associated with incomplete resection of non-melanoma cancer

Introdução: Analisar fatores associados e taxa de positividade de margem cirúrgica após ressecção primária de Câncer de Pele Não Melanoma (CNM). Métodos: Estudo transversal, quantitativo, realizado mediante a revisão de prontuários de pacientes submetidos à ressecção cirúrgica de carcinoma basocelular (CBC) e espinocelular (CEC) de pele. Foram estudadas as seguintes variáveis: idade, tipo de câncer, localização, diâmetro, variante histológica, presença de ulceração, presença e ressecção de lesões associadas e presença de comprometimento de margens cirúrgicas. Resultados: Foram inclusos 183 paciente no estudo. Destes, 130 eram CBC (71%) e 53 eram CEC (29%). A taxa global de comprometimento de margem foi de 13,1%, sendo 21 CBC (16%) e 3 CEC (5,66%). Margens cirúrgicas positivas estiveram mais associadas a lesões do tipo CBC (p<0,05) e em lesões localizadas em nariz e pálpebra (p<0,05). Presença de ulceração, diâmetro das lesões e variante histológica não foram associadas a uma maior taxa de ressecções incompletas. Conclusão: Nossa taxa global de ressecção incompleta de Câncer de Pele (CNM) apresenta-se semelhante ao encontrado na literatura. Lesões por CBC ou localizadas em nariz e pálpebra têm maiores taxas de positividade de margem após ressecção primária (AU)

Introduction: To analyze associated factors and surgical margin positivity rate after primary resection of Non-Melanoma Skin Cancer (NMC). Methods: A cross-sectional, quantitative study was carried out by reviewing medical records of patients submitted to surgical resection of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin. The following variables were studied: age, type of cancer, location, diameter, histological variant, presence of ulceration, presence and resection of associated lesions, and presence of surgical margins involvement. Results: 183 patients were included in the study. Of these, 130 were BCC (71%) and 53 were SCC (29%). The overall rate of margin involvement was 13.1%, of which 21 were CBC (16%) and 3 SCC (5.66%). Positive surgical margins were more associated with BCC lesions (p <0.05) and lesions located in the nose and eyelid (p <0.05). Presence of ulceration, lesion diameter and histological variant were not associated with a higher rate of incomplete resections. Conclusion: Our overall rate of incomplete resection of Skin Cancer is similar to that found in the literature. Lesions by BCC or located in the nose and eyelid have higher rates of margin positivity after primary resection (AU)

Factors affecting residual lesion in women with cervical adenocarcinoma in situ after cone excisional biopsy.

The objective of this study was undertaken to evaluate the factors affecting residual lesion in women with adenocarcinoma in situ (AIS) on cervical conization specimens. The medical records of women with AIS who had no associated invasive carcinoma after cervical conization and underwent subsequent hysterectomy at Chiang Mai University Hospital were reviewed. During March 1998 and March 2006, 45 women were included for analysis. The mean age was 45.2 years (range, 30-66 years). Thirteen (28.9%) women presented with AIS on Pap smear. Thirty (66.7%) underwent loop electrosurgical excision procedure and the remaining 15 (33.3%) underwent cold-knife conization. Twenty (44.4%) women had mixed lesions of AIS and squamous intraepithelial lesion on cervical specimens. Surgical cone margins were clear in 25 (55.6%) women. Eighteen (40%) and two (4.4%) women had involved and non-evaluable cone margins, respectively. Residual lesion was noted in 14 (31.1%) hysterectomy specimens. There was no residual lesion in women with clear cone margins while 72% and 50% of women with involved and non-evaluable cone margins, had residual lesion, respectively. These differences were statistically significant (P<0.001). No significant association between the ECC results and the residual lesion was noted (P=0.29). In conclusion, approximately one-third of women with AIS on cervical conization have residual lesion on subsequent hysterectomy specimens. Only cone margin status is a significant predictor for residual lesion.

Prevalence and risk factors for residual cervical neoplasia in subsequent hysterectomy following LEEP or conization.

OBJECTIVES: The purposes of the present study were to determine the prevalence of residual disease in the hysterectomy specimens following cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP) and to evaluate the predictive factors for residual disease. DESIGN: Descriptive study SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. SUBJECTS: A total of 120 patients who underwent hysterectomy after either LEEP or CKC. MATERIAL AND METHOD: The medical records of 120 women were reviewed to estimate the prevalence of residual disease.. The patients' characteristic and pathologic parameters were analyzed for the risk factors of residual disease. Chi square test and Student t test were used for statistical analysis. RESULTS: Of the 120 patients, 46 cases had residual disease in their hysterectomy specimens so the prevalence was 38.3% (95% CI 29.5, 47.2). Invasive cervical cancer was found in the hysterectomy specimens in 4 cases (8.7%). Only ectocervical margin was the predictive factor of residual disease in the hysterectomy specimen (p = 0.002). Age, conization pathologic findings, glandular involvement, endocervical margin status, stromal invasion, and endocervical curettage results were not predictive factors for residual disease in the hystectomy specimens. CONCLUSION: Residual disease was found in 38.3% of hysterectomy specimens after conization. Also undiagnosed invasive cervical cancer was found. Careful examination for residual disease in hysterectomy specimens should be performed, especially among those with positive cone margin.