Phase II trial of neoadjuvant gemcitabine and cisplatin in patients with resectable bladder carcinoma

OBJECTIVES: Gemcitabine and cisplatin (GC) is an active combination in the treatment of metastatic bladder cancer. We have prospectively analyzed the efficacy and tolerability of GC as neoadjuvant treatment of invasive bladder cancer MATERIALS AND METHODS: In this single-institution phase II trial, patients with muscle-invasive transitional cell carcinoma received three cycles of gemcitabine 1200 mg/m² on days 1 and 8 with cisplatin 75 mg/m² on day 1 prior to surgery. Radiologic response was evaluated by computed tomography and magnetic resonance imaging. All patients were referred to surgery after chemotherapy completion RESULTS: Between June 2002 and March 2005, 22 patients (19 males) were enrolled. Median age was 63 years. Initial stage was II (T2) in 11 and III (T3-4) in 11 patients. Median follow-up is 26 months (4-43). Partial or complete radiologic response rate was documented in 13 out of 20 assessable patients (70 percent). One patient was excluded due to sarcomatoid carcinoma at definitive pathologic examination. Cystectomy was performed in 15 patients and pelvic radiotherapy in four patients. Nine out of 21 patients (43 percent) relapsed and four (19 percent) died due to disease progression. Complete pathologic response was observed in four patients (26.7 percent of 15). Median progression-free survival was 27 months (CI 95 percent not reached) with median overall survival of 36 months (CI 95 percent: 28.7 - 43.3). Grade III/IV toxicity was infrequent, with no deaths due to chemotherapy CONCLUSIONS: The combination of GC is effective and well-tolerated when used as neoadjuvant therapy in muscle-invasive bladder cancer. Longer follow-up is necessary to evaluate its impact on the overall survival of these patients.

Retardo no diagnóstico e no tratamento cirúrgico do câncer de pulmão / Delay in the diagnosis and surgical treatment of lung cancer

INTRODUÇAO: O câncer de pulmão é a principal causa de morte relacionada a câncer no mundo. OBJETIVO: Determinar o tempo despendido com o diagnóstico, o estadiamento e o tratamento cirúrgico do câncer de pulmão em um hospital universitário. MÉTODO: Entre janeiro de 1990 e dezembro de 1998, 69 pacientes receberam diagnóstico de câncer de pulmão e foram tratados com cirurgia no Hospital das Clínicas de Porto Alegre. Os prontuários destes pacientes (53 homens e 16 mulheres) foram revisados, sendo coletados dados clínicos, histológicos, datas de consultas ambulatoriais, de internação hospitalar, de exames e de procedimentos, assim como o local de investigação. RESULTADOS: Quinze pacientes foram investigados em ambulatório (grupo I), 28 em ambulatório e durante internação (grupo II) e 26 durante internação (grupo III). A idade dos pacientes variou entre 43 e 79 anos (média de 61 ± 10 anos). Quarenta e três pacientes eram tabagistas atuais e 23 ex-tabagistas. O tempo médio do aparecimento dos sintomas até a primeira consulta foi de 110 dias e da primeira consulta até o diagnóstico foi de 33 dias. Vinte e cinco dias transcorreram entre o diagnóstico e a cirurgia. A média de tempo da primeira consulta até a cirurgia (tempo total) foi de 58 dias. A média do tempo total foi de 72 dias no grupo I, 72 dias no grupo II e 35 dias no grupo III (p < 0,01). Não houve diferença significativa no tempo total, considerando-se os diferentes estádios da doença (p = 0,16). CONCLUSÕES: Os resultados mostraram retardo na procura de atendimento médico e retardo adicional no tratamento do câncer de pulmão em pacientes cuja investigação foi ambulatorial.