Buscando una curva general de respuesta a la quimioterapia basada en la evaluación radiológica con criterio RECIST / Looking for a general response curve to chemotherapy based on radiological evaluation with RECIST criteria

Radiological evaluation of response to chemotherapy can be carried out by applying the RECIST (Response Evaluation Criteria in Solid Tumors) criteria, currently considered the most objective method for monitoring lesions. Aimed at finding a general response curve, 21 patients with lung and kidney tumors, as well as colorectal carcinoma were studied between 2006 and 2008. Statistical proceedings included variance (ANOVA), co-variance (ANCOVA) and logarithmic regression analysis. Target-lesion size reduction, duration of response and overall response of different types of tumors did not differ significantly A general response curve was obtained: log (RR)= 1,897-0,0281, where RRt is the relative RECIST count, and t is time (expressed in months). As an expected outcome -because of variety of drugs, type of tumors and variability rates in individual response- the determination coefficient in regression was 10.9 percent. However, it constitutes a first approach to solid tumors response and proves the accuracy and usefulness of RECIST methodology.

La evaluación radiológica de respuesta a la quimioterapia se puede hacer con el criterio RECIST, considerado actualmente el método más objetivo de seguimiento de lesiones. Con el objetivo de buscar una curva general de respuesta, entre los años 2006 y 2008 estudiamos 21 pacientes con tumores pulmonares, renales y cáncer colo-rectal. La estadística consistió en análisis de varianza (ANOVA), covarianza (ANCOVA) y regresión logarítmica. La reducción en tamaño y el tiempo de respuesta no difirieron significativamente, así como tampoco la respuesta global de los diferentes cánceres. Se obtuvo una curva general de respuesta: log (RR)= 1,897 -0,028 t, (RR= evaluación RECIST actual dividida por inicial y t= tiempo en meses). El coeficiente de determinación de la regresión fue 10,9 por ciento, esperable por la diversidad de fármacos, tipo de tumor y respuesta individual; sin embargo constituye una primera aproximación a la respuesta esperada mostrando la utilidad y objetividad del método.

Respuesta analgésica y efectos secundarios en pacientes con metástasis osteoblásticas tratados con samario-153 etilendiaminotetrametilenfosfato / Samarium 153 EDTMP in the treatment of metastatic bone pain: evaluation of analgesic response and secondary effects

Background: Samarium153 EDTMP, a beta and gamma emitter, is used in the palliative therapy of painful bone metastases. Aim: To evaluate the analgesic effects and myelotoxicity of Samarium153 EDTMP in patients with prostate, breast and renal carcinoma. Patients and methods: Twenty patients with bone metastases (11 males), aged 65 years old as a mean, received a 1 to 2 mCi/kg intravenous dose of Samarium153 EDTMP, produced in Chile. Patients were followed thereafter during 4 to 40 weeks. Pain was assessed using a visual analogue scale. Results: Pain decreased from a score of 6.4 prior to treatment, to 2.7 at the fourth week of therapy and the effect lasted a mean of 12.5 weeks. Myelotoxicity was observed in 68percent of cases (WHO stage I in 21 percent, stage II in 37 percent, stage III in 11percent and no patients in stage IV). Platelets were the most affected series and neutrophils the least affected. Cell counts returned to normal between the sixth and eighth week. Seventy nine percent of patients decreased their basal analgesic therapy at the sixth week and 88percent did so at the eighth week. Forty one percent of these patients discontinued all analgesics. Conclusions: Samarium153 EDTMP is effective in the treatment of pain in patients with bone metastases and its myelotoxicity is low to moderate. It should be considered as a therapy for this type of pain, with the precaution of performing periodical bood counts

Linfoma MALT de vejiga: informe de un caso / MALT lymphoma of the bladder: report of one case

Primary malignant lymphomas of the bladder are infrequent. We report a 70 years old woman presenting with hematurla, dysuria, malaise and a 5 Kg weigbt loss. Pelvic ultrasound examination showed a 8x8x8 cm solid and cystic mass adjacent to the bladder and uterus. Cytoscopic biopsy disclosed a low grade B cell non Hodgkin lymphoma. She was treated with 6 cycles of chemotherapy with disappearance of the mass. Two years after admission, the patient is free of disease

Cáncer gástrico y esofágico: nuevos conceptos / Gastric and esophageal cancer: new concepts

Se realizó un análisis de los aspectos epidemiológicos, etiopatológicos y terapéuticos del cáncer esofágico y gástrico. El cáncer de esófago es frecuente en el mundo con una sobrevida media de 10 meses, siendo la histología más frecuente la escamosa; sin embargo, ha existido un aumento de los adenocarcinomas en los países desarrollados. Se ha asociado a alcohol y tabaco y su etapificación se realiza de acuerdo a la clasificación TNM. Desde el punto de vista terapéutico, la cirugía es de elección en etapa I, la radioterapia es útil asociada a quimioterapia en mejorar la sobrevida y en forma paliativa el dolor y la disfagia; la quimioterapia tiene mejores resultados en histología escamosa, siendo la combinación más utilizada cisplatino-5-fluoruracilo. El cáncer de estómago ha disminuido su incidencia pero sigue siendo frecuente; se ha asociado al grupo sanguíneo A y a los nitritos de la dieta siendo la histología predominante el adenocarcinoma. Existe un aumento de los tumores proximales, los que tienen peor pronóstico; del punto de vista terapéutico la cirugía es factible en enfermedad localizada y tamaño menor de T4, habiéndose desarrollado en Japón una clasificación según la extensión de la resección nodal; la radioterapia: es útil en asociación con quimioterapia, no existiendo un esquema estándar de ésta. La combinación 5-fluroruracilo-doxorubicina y metotrexato se ha demostrado en estudios randomizados como superior en términos de sobrevida y toxicidad. El propósito de este artículo es revisar los aspectos clínicos más relevantes de algunos cánceres digestivos, con énfasis en el manejo terapéutico actual y en los progresos más importantes realizados en los últimos años

Tropisetrón en la prevención de náuseas y vómitos por quimioterapia: estudio clínico multicéntrico / Tropisetron in the prevention of nausea and vomiting due to chemotherapy: multicentric clinical study

The antiemetic effect of tropisetron was studied in 97 cancer patients (67 men, 30 women) receiving cisplatin in doses of 75 mg/m² or higher. On 279 chemotherapy cycles studied (max 6 per patient) 5 mg of tropisetron was admonistered once a day i.v. on day 1 and p.o. on day 2 to 6. Efficacy preventing vomiting and nausea was measured in 24 hour period as: complete control 0 episodes, major control 1 to 2 episodes, minor control 3 to 4 episodes and no control 5 or more episodes. Satisfactory vomiting control (complete and major) was 69 percent, 63 percent, 82 percent,88 percent, 96 percent and 96 percent in days 1 to 6 of cycle 1. Satisfactory nausea control (complete and major) for the same day was 70, 66, 72, 85 92 and 97 percent. Similar data was obtained for the subsequeny cycles. Complete vomiting control was obtained in 47, 35, 56, 72, 81 and 84 percent and for nausea in 42, 39, 48, 64, 81 and 87 percent. 19 patients presented adverse effects (19,6 percent). Only 2 headache episodes had a definitive relation with antiemetic drug. 12 patients discontinued the medication; 6 due to drug inefficacy, 2 to illness unrelated to the drug, 1 to lack of collaboration, and 3 due to other reasons. We conclude that tropisetron allows satisfactory control of acute and delayed vomiting in a high percentage of patients treated with high doses of cisplatin. The drug does not have significant secondary effects. Tropisetron administration in only 1 daily dose implies an evident advantage and a treatment cost reduction