Náuseas, vômitos e qualidade de vida de mulheres com câncer de mama em tratamento quimioterápico / Náuseas, vómitos y calidad de vida en mujeres con cáncer de mama en la quimioterapia / Nausea, vomiting and quality of life in women with breast cancer receiving chemotherapy

Objetivou-se avaliar a qualidade de vida (QV) de mulheres com câncer de mama em tratamento quimioterápico e identificar a ocorrência de náuseas e vômitos durante o tratamento. Os dados foram coletados com a aplicação do instrumento da Organização Europeia de Pesquisa e Tratamento de Câncer, EORTC-QLQ-C30, na versão em português, bem como do módulo para câncer de mama BR-23, aplicados antes, no meio e ao final do tratamento. Das 79 mulheres incluídas, 93% apresentaram náuseas e 87% vômitos pelo menos uma vez durante o tratamento. A QV apresentou pequena diminuição durante o tratamento. O coeficiente alfa de Cronbach para cada aplicação dos questionários foi de 0,890492, 0,936392 e de 0,937639. A disponibilidade de informações sobre o tratamento e de orientações quanto ao manejo da náusea e do vômito é crucial para o gerenciamento adequado das toxicidades da quimioterapia.

Evaluar la calidad de vida (QOL) de las mujeres con cáncer de mama durante la quimioterapia e identificar el acontecimiento de náuseas y vómitos durante el tratamiento. Se recogieron datos con la aplicación del instrumento de la Organización Europea para la Investigación y Tratamiento del Cáncer, EORTC-QLQ-C30 versión en portugués y módulo para el cáncer de mama BR-23 aplicado antes, en la mitad y al final del tratamiento. Se incluyeron 79 mujeres, el 93% tuvo náuseas, el 87% vómitos al menos una vez durante el tratamiento. La QOL presentó una ligera disminución durante el tratamiento. El coeficiente alfa de Cronbach para cada aplicación de los cuestionarios fue 0.890492, 0.936392 y 0.937639. La disponibilidad de informaciones sobre el tratamiento y directrices sobre el manejo de la náusea y vómito es fundamental para la correcta gestión de las toxicidades de la quimioterapia.

The aim of this study was to assess the quality of life (QoL) of women with breast cancer during chemotherapy and to identify the incidence of nausea and vomiting during the treatment. Data were assessed with the application of the instrument of the European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30 Portuguese version and breast cancer module BR-23, which was applied before, in the middle and in the end of the treatment. The participants were 79 women, of which 93% had nausea and 87% had vomited at least once during the treatment. QoL showed a slight decrease during treatment. Cronbach's alpha for each application of the questionnaires was 0.890492, 0.936392 and 0.937639. The availability of treatment information and guidelines on the management of nausea and vomiting is crucial for the proper management of the toxicities of chemotherapy.

Histopathologic changes following neoadjuvant chemotherapy in locally advanced breast cancer.

Aims: To compare the clinical and pathologic assessment of response to neoadjuvant chemotherapy and describe the various histopathologic changes observed. Materials and Methods: We studied a group of 40 patients with locally advanced breast cancer who had their initial workup in the form of clinico-imaging assessment of the size and pretreatment biopsy from the lesion. All the patients received two to six cycles of neoadjuvant chemotherapy, either cyclophosphamide 50 to 60 mg/m 2 IV, doxorubicin 40 to 50 mg/m 2 IV and 5-fluorouracil 500 to 800 mg/m 2 IV (CAF) or cyclophosphamide, epirubicin, and 5-fluorouracil (CEF). Clinical and pathologic assessment of response to chemotherapy was done based on the UICC guidelines. Result: Complete clinical response (cCR) was seen in 10% cases (4/40), thirty percent patients had (12/40) partial response and 60% (24/40) had stable disease after neoadjuvant chemotherapy. Pathologic complete response (pCR) with no evidence of viable tumor was observed in 20% patients (8/40). Fifteen patients (37.5%) showed partial response and 42.5% patients (17/40) had a stable disease. No patient progressed during the course of chemotherapy. Changes in the tumor type were observed following chemotherapy, most common being the mucinous change. Histologic changes like dyscohesion, shrinkage of tumor cells, elastosis, collagenization, necrosis, lymphocytic reaction, giant cell response are some of the common observations seen following treatment with neoadjuvant chemotherapy. Conclusion: Pathologic assessment of response to neoadjuvant chemotherapy is a better predictor than the clinical response. The chemotherapy drugs can be modified based on the response observed after 1-2 cycles of neoadjuvant, the response being based on both tumor and patient's responsiveness.

Sequential immunochemotherapy [Bacillus Calmette-Guerin and Epirubicin] versus chemoimmunotherapy [Epiviribicin and bacillus calmette-guerin] for stages pTa and pT1 transitional cell carcinoma of the bladder

Sequential immuno-chemotherapy using bacillus Calmette-Guerin [BCG] and epirubicin has been found to be as effective as and less toxic than BCG alone in recurrence prophylaxis of superficial bladder tumors. Some investigators speculated that: if intravesical chemotherapy is instilled before immunotherapy it will produce inflammation and denudation of the mucosa so that the submucosa will be ready for a potentiated effect of the immunotherapy. To test this hypothesis we conducted this study. Between Jan. 1993 and July 1999 a prospective randomized trial was performed on 159 patients who underwent transurethral resection [[TURBT] of bladder transitional cell carcinoma [stages pTa and pTl]. Following TURBT, patients were randomly allocated to 2 treatment arms. Patients in arm I [78] received weekly doses of 150 mg BCG alternating with 50 mg epirubicin for 6 weeks. Maintenance was carried out by a monthly course of the same doses of BCG alternating with epirubicin for 10 months. Patients in arm II [81] received thy same protocol, but with a reversed order with epirubicin being used initially. 154 patients; 108 men and 36 women, mean age 59 years, were evaluable. 5 patients were excluded in view of severe side effects [3 in arm 1 and 2 in arm II]. Follow up ranged from 12 to 74 months [mean 38 +/- 16.9]. Recurrence rate was] comparable in the 2 arms: 11/75 [14.7%] and 13/79 [16.5%], respectively. Recurrence rate per 12 patient months was again; comparable: 0.08 and 0.09, respectively. Interval to first recurrence and progression rate were also comparable. Toxicity developed in 29% and 26.6% of patients, respectively [p > 0.05]. Both treatment policies were comparable in terms of efficacy and loxicity

5-Fluorouracil-induced leukoencephalopathy in patients with breast cancer

The purpose of this study is to determine the characteristic clinical features, radiologic findings, and precipitating and prognostic factors in the patients with breast cancer and with 5-Fluorouracil (5-FU)-induced leukoencephalopathy. We reviewed the medical records of six breast cancer patients who developed leukoencephalopathy after chemotherapy which included 5-FU and also evaluated thorough neurological examinations including mini-mental status examination, cerebrospinal fluid studies, brain images and brain biopsies. Six patients exhibited slowly progressing neurologic symptoms characterized by the impairment of cognitive function, abulia, ataxic gait, and/or akinetic mutism. None of the patients had any specific causes or etiologic factors for leukoencephalopathy. Brain MRI in all patients showed diffuse periventricular white matter changes in the T2-weighted MR image. Brain biopsy in Patient 1 showed fragmented axonal fiber and minimally deprived myelination with many scattered macrophages. Five patients who treated with steroids at the onset of neurological symptoms showed clinical improvement, regardless of their age, sex, the pathology and stage of breast cancer, or the total dosage of chemotherapeutic agents. We conclude that leukoencephalopathy in these cases could be attributable to 5-FU neurotoxicity and suggest that the administration of steroids might be the treatment of choice.

Estudo com 4'-epirubicina em linfomas näo-Hodgkin / Study with 4'-epirubucin in non-Kodgkin's lymphomas

Com o objetivo de avaliar a eficácia e a toxicidade da 4'-epirubicina em poliquimioterapia no tratamento de linfomas näo-Hodgkin de alto grau, foram estudados 14 pacientes, sendo nove do sexo masculino e cinco do sexo feminino. A idade mediana dos homens foi de 52 anos e das mulheres, 32 anos. Linfoma histiocítico difuso foi o diagnóstico mais freqüente, representando 50 por cento dos casos. Nove oacientes haviam sido submetidos à cirurga antes do tratamento e um paciente foi submetido à radioerapia antes do início da quimioterapia. Dos 14 pacientes avaliáveis, 10 apresentaram resposta completa (91 por cento) e um apresentou resposta parcial (9 por cento). Dois pacientes faleceram durante o tratamento quimioterápico e um abandonou o tratamento por toxicidade. A duraçäo mediana da resposta foi de 17 meses após o início do tratamento. Com relaçäo à toxicidade, mucosite foi o sintoma mais freqüente, sendo observada em oito pacientes (73 por cento); náuseas e vômitos foram observados em três pacientese diarréia e alopecia, cada uma, em dois pacientes. Quatro pacientes apresentaram contagem plaquetária inferior a 150.000 plaquetas/mm3; nenhum paciente apresentou contagem leucocitária inferior a 2.000 leucócitos/mm3. Concluímos que este protocolo 4'epi é altamente eficaz no tratamento dos L.N.H. de alto grau, embora apresente expressiva toxicidade