Sunitinib treatment in patients with advanced renal cell cancer: the Brazilian National Cancer Institute (INCA) experience

ABSTRACT Purpose: The aim of this study was to assess the impact of sunitinib treatment in a non-screened group of patients with metastatic renal cell cancer (mRCC) treated by the Brazilian Unified Health System (SUS) at a single reference institution. Material and Methods: Retrospective cohort study, which evaluated patients with mRCC who received sunitinib between May 2010 and December 2013. Results: Fifty-eight patients were eligible. Most patients were male 41 (71%), with a median age of 58 years. Nephrectomy was performed in 41 (71%) patients with a median interval of 16 months between the surgery and initiation of sunitinib. The most prevalent histological subtype was clear cell carcinoma, present in 52 (91.2%) patients. In 50 patients (86%), sunitinib was the first line of systemic treatment. The main adverse effects were fatigue (57%), hypothyroidism (43%), mucositis (33%) and diarrhea (29%). Grade 3 and 4 adverse effects were infrequent: fatigue (12%), hypertension (12%), thrombocytopenia (7%), neutropenia (5%) and hand-foot syndrome (5%). Forty percent of patients achieved a partial response and 35% stable disease, with a disease control rate of 75%. Median progression free survival was 7.6 months and median overall survival was 14.1 months. Conclusion: Sunitinib treatment was active in the majority of patients, especially those with low and intermediate risk by MSKCC score, with manageable toxicity. Survival rates were inferior in this non-screened population with mRCC treated in the SUS.

Câncer de tireoide na infância e na adolescência: estudo de casos e revisão da literatura / Thyroid cancer in childhood and adolescence: case study and literature review

Introdução: As neoplasias malignas da tireoide não são comuns na faixa etária pediátrica. O objetivo deste trabalho foi realizar um levantamento epidemiológico e clínico dos casos de câncer de tireoide (CT) atendidos no Hospital Universitário de Santa Maria (HUSM) entre 1993 e 2008, com descrição do diagnóstico e da terapêutica, acompanhado de uma revisão de literatura dessa patologia. Métodos: Estudo de demanda retrospectivo a partir do registro do Serviço de Patologia do Hospital Universitário de Santa Maria, RS (HUSM), no período de 1/1/1993 a 31/12/2008. Resultados: Nos 15 anos avaliados, foram encontrados 10 pacientes com diagnóstico de CT. Este estudo de casos inclui sete dos 10 pacientes; os demais foram excluídos devido à insuficiência de dados nos prontuários. O sexo feminino foi o mais acometido. Seis dos sete pacientes foram submetidos à tireoidectomia total com esvaziamento ganglionar. O tipo histológico predominante foi o carcinoma papilífero e o tamanho médio dos tumores foi de 2 cm. As metástases linfonodais foram encontradas em seis casos no momento do diagnóstico e o número médio de linfonodos acometidos foi quatro. Conclusão: Os resultados encontrados são consistentes com os achados epidemiológicos e clínicos encontrados na literatura para esta faixa etária. Destaca-se a importância do seguimento de um protocolo de manejo do CT dentro de um hospital universitário

Introduction: Malignant neoplasms of the thyroid are not common in pediatric patients. The aim of this study was to carry out an epidemiological and clinical survey of the cases of thyroid cancer (TC) treated at the University Hospital of Santa Maria (HUSM) between 1993 and 2008, with a description of diagnoses and treatment, together with a literature review of this disorder. Methods: A retrospective, demand study based on the registry of the Department of Pathology, University Hospital of Santa Maria-RS (HUSM) from 1/1/1993 to 31/12/2008. Results: Over the past 15 years, there were 10 patients diagnosed with TC. This case study includes seven of the 10 patients, the others were excluded because of insufficient data in the charts. Females were more affected. Six of seven patients underwent total thyroidectomy with lymph node dissection. The predominant histological type was papillary carcinoma and the average size of tumors was 2 cm. Lymph node metastases were found in six cases at diagnosis and the mean number of affected lymph nodes was four. Conclusion: The results are consistent with epidemiological and clinical findings in the literature for this age group. The study highlights the importance of following a management protocol of CT within a university hospital