Real-world molecular testing and treatment patterns in brazilian patients with newly diagnosed locally advanced or metastatic NSCLC

OBJECTIVES: To evaluate the molecular testing and treatment patterns in a retrospective cohort of newly diagnosed treatment-naïve patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC). METHODS: This is an observational retrospective cohort study conducted across 10 cancer centers in Brazil. Treatment-naïve patients with locally advanced or metastatic NSCLC were enrolled from January to December 2014. The following data were collected from the medical records of patients from diagnosis until the last record (death, loss to follow-up, or the end of the maximum follow-up period): demographics; medical history; smoking status; disease characteristics; previous treatments; and molecular testing patterns and results. The overall survival (OS) was also estimated. Results: A total of 391 patients from 8 different Brazilian states were included, with a median age of 64.1 years (23.7-98.7), with most patients being males (60.1%). The smoking status of 74.2% of patients was a 'former' or 'current smoker'. Stage IV NSCLC at diagnosis was observed in 82.4% of patients, with 269 of them (68.8%) presenting adenocarcinoma (ADC). Among the stage IV ADC patients, 54.0% were referred for molecular testing. Among the patients with an available epidermal growth factor receptor (EGFR) mutation status, 31 (24.0%) were EGFR-positive. The first-line treatment was a platinum-based chemotherapy for 98 patients (25.1%), while non-platinum-based regimens were used in 54 patients (13.8%). OS data were available for 370 patients, with a median OS of 10.8 months. Never smokers had a significantly higher median OS versus current or former smokers (14.6 versus 9.1 months; log-rank p=0.003). Among the patients for whom molecular testing data were available, those with EGFR-positive results had a longer median OS (34.6 versus 12.8 months; log-rank p=0.003). Conclusion: Our findings provide relevant information for prescribers and policy decision-makers by highlighting the unmet needs of patients and the importance of molecular testing in newly diagnosed locally advanced or metastatic lung adenocarcinoma. We also highlight the respective EGFR-tyrosine kinase inhibitor treatment when the result is positive and the areas in which further efforts are required to grant access to effective treatment.

Carcinoma de pequenas células em esôfago: relato de caso e revisão / Small cell carcinoma of the esophagus: a case report and literature review

O caso de um paciente do sexo masculino, com 54 anos, portador de carcinoma de pequenas células primitivas em terço inferior de esôfago. As manifestações iniciais da doença se caracterizaram por emagracimento acentuado e dores epigástricas com 3 meses de evolução. Ao exame físico observamos sinais evidentes de doença consuntiva. O estadiamento oncológico revelou acometimento secundário de linfonodos para-aórticos, mesentéricos e do tronco celíaco (doença extensa), além de possível invasão de aorta descendente. O tratamento baseou-se na quimioterapia com cisdiaminodicloroplatinum e etoposide, obtendo-se remissão clínica completa com três ciclos. Como consolidação do resultado, o paciente recebeu radioterapia externa dirigida ao local do tumor primário, porém a resposta obtida não se manteve, havendo progressão local e sistêmica após 40 dias do término da radioterapia. O óbito se deu em função de infecção respiratória e múltiplas metástases 9 meses do diagnóstico ...

Cirurgia tubária para infertilidade / Tubal surgery for infertility

OBJETIVOS: Análise retrospectiva de pacientes com infertilidade tubária. CASUISTICA E METODOLOGIA: Apresenta-se os dados clínicos de 51 pacientes com infertilidade de causa tubária primária ou secundária, entre fevereiro de 1991 e março de 1994, em acompanhamento no Setor de Infertilidade do Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre. Estas foram submetidas à microcirurgia tubária visando à resoluçao da infertilidade. RESULTADOS: Através de rossalpingografia pós-cirúrgica ou gestaçao comprovada, foi observado que em 80,85 por cento dos casos houve permeabilidade uni ou bilateral das tubas uterinas, com um índice de gestaçao de 17,02 por cento. CONCLUSOES: sugere-se que a microcirurgia tubária possa ser método satisfatório para o tratamento de infertilidade de causa tubária.