ABSTRACT
BACKGROUND: Ovarian carcinosarcoma is a rare malignancy associated with a high rate of cancer-related mortality even at early stages. Guidelines for systemic treatment have been difficult to establish because the disease is commonly excluded from prospective clinical trials. Ovarian carcinosarcoma is usually managed as high-grade epithelial ovarian cancer despite major histologic differences. Owing to the rarity and poor prognosis of ovarian carcinosarcoma, salvage treatments and their efficacy have been poorly described. CASE PRESENTATION: A patient heavily treated for ovarian carcinosarcoma showed an objective response to an immune checkpoint inhibitor, pembrolizumab. Pembrolizumab in this patient appeared to provide tumor control in multifocal metastatic sites. CONCLUSIONS: Pembrolizumab should be evaluated in prospective trials for the treatment of ovarian carcinosarcoma and further work is needed to identify patients most likely to respond to this type of intervention.
ABSTRACT
BACKGROUND: Cancer of the exocrine pancreas is a highly lethal malignancy. Surgical resection is the only potentially curative treatment. Unfortunately, because of the late presentation, the majority have either locally advanced cancer at initial diagnosis. Systemic chemotherapy provides benefit to patients with advanced pancreatic cancer, improving disease-related symptoms and survival when compared to best supportive care alone. Based on fase III study, FOLFIRINOX regimen became the standard first-line treatment. But, the optimal management strategy for patients who fail initial FOLFIRINOX is undefined. Despite the lack of clinical trials that report the real benefit of gemcitabine in patients with advanced exocrine pancreatic cancer as second line treatment. We aim at reporting our experience with this regimen. METHODS: Patients with advanced exocrine pancreatic cancer who received gemcitabine (1.000 mg/m(2) on days 1, 8 and 15 every 4 weeks) until disease progression, as second-line therapy at our institution were retrospectively evaluated. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. RESULTS: A total of 20 patients were reviewed. Median age was 57 years (range, 43-74 years), and 55% were older than 60 years. Most patients were male (80%), had metastatic disease (60%), and ECOG performance status of 0 or 1 (65%). PFS and OS were 2.0 (95% CI, 1.2-2.8) and 5.7 months (95% CI, 3.9-7.4), respectively. There were no deaths due to the treatment. CONCLUSIONS: In this study, gemcitabine was a reasonable second-line treatment option for patients with advanced pancreatic adenocarcinoma and good ECOG performance status. Phase III trials are urgently needed comparing gemcitabine versus best supportive of care (BSC) can evaluate the real benefit of this chemotherapy after progression on FOLFIRINOX.
ABSTRACT
Lung cancer is the leading cause of cancer death in the United States and other industrialised countries. The most important risk factor is active smoking. However, given the increased incidence of lung cancer in non-smokers, it is necessary to improve knowledge regarding other risk factors. Radon (Rn) is a noble gas and is the most important natural source of human exposure to ionizing radiation. Exposure to high levels of this radioactive gas is related to an increased risk of developing lung cancer. The objective of this work is to highlight the importance of measuring indoor concentration of this gas and identify which steps should be taken for achieving radiological protection. A survey was conducted on the websites of the National Health Surveillance Agency (ANVISA), LAMIN (Mineral Analysis Laboratory), CPRM (Geological Survey of Brazil), Ministry of Health and PubMed. Using the words 'radon', 'lung', 'cancer', and PubMed®, 1,371 results were obtained; when using the words 'radon', 'lung', 'cancer', and with 'Brazil' or 'Brazilians', only six results were obtained. We emphasise that lung cancer is a major public health problem and the exposure to Rn indoors should be considered as a risk factor for lung cancer in non-smokers. Buildings or houses with high concentrations of Rn should be identified. However, currently in Brazil-a country with great potential for mineral extraction-there are no specific regulated recommendations to control indoor exposure to Rn.
ABSTRACT
Leiomyosarcoma (LMS) is a rare tumour and comprises 2-3% of all malignant uterus neoplasms [1]. Leiomyosarcoma is characterised by aggressive behaviour, high recurrence rates, and poor overall survival, despite multimodal treatment [3]. Surgery is the main treatment and consists of total abdominal hysterectomy. A randomised trial consisting of 224 patients diagnosed with uterine sarcomas stage I and II showed that adjuvant radiotherapy improves locoregional control. The role of adjuvant chemotherapy is still unclear [1]. Unfortunately, roughly 50% of patients with organ-confined disease will usually develop distant metastasis to lung, peritoneum, liver, pelvic, and para-aortic lymph nodes. Brain metastases are extremely rare [5].
ABSTRACT
Objetivo: Comparar o diagnóstico inicial, geralmente a partir de serviços de patologia geral, com o laudo médico definitivo do serviço de patologia certificada. Métodos: Análise retrospectiva de pacientes em uma instituição com diagnóstico final de câncer de mama metaplásico (CMM) foi realizada entre janeiro de 2008 e janeiro de 2014. Resultados: Um total de 18 pacientes com diagnóstico de CMM do sexo feminino e idade média de 49,8 anos foi reportado. O tamanho tumoral foi menor do que 3,0 cm em 52,9% das pacientes. Linfadenopatia axilar não estava presente inicialmente em 72,2% das pacientes e, em nenhum caso, foi identificada metástase a distância ao diagnóstico. Diagnóstico prévio de carcinoma ductal invasivo (CDI) foi descrito em 60% dos casos. Cerca de 80% foram tratadas com quimioterapia neoadjuvante e apresentaram progressão. Apenas um caso com diagnóstico de CMM antes do início da terapia recebeu quimioterapia neoadjuvante com platina e apresentou resposta clínica. Conclusão: Devido às características histopatológicas de triplo-negativos, o CMM pode ter sido subdiagnosticado em serviços de patologia geral. Nos casos de ausência de resposta ou progressão da doença frente ao tratamento tradicional, o diagnóstico de CMM deve ser considerado e o laudo médico deve ser revisado.
Objective: To compare the initial diagnosis, usually from community pathology services, with the final pathology report from certified pathology service. Methods: A retrospective analysis of patients in an institution with final diagnosis of metaplastic breast cancer (MBC) was conducted from January 2008 to January 2014. Results: There were 18 female patients diagnosed with MBC. Median age was 49.8 years old; 52.9% of the patients had a tumor size less than 3.0 cm; 72.2% had no axillary lymphadenopathy at diagnosis. None of them had distant metastases at presentation. Initial diagnosis of invasive ductal carcinoma (IDC) occurred in 60% of patients. Eighty percent of patients were treated with neo-adjuvant chemotherapy and presented progression. Only one case with diagnosis of MBC prior to therapy was submitted to neo-adjuvant chemotherapy with a platinum-based regimen and presented clinical response. Conclusion: Due to the triple-negative histopathology features, MBC might have been underdiagnosed in community pathology services. In cases of non-response or progression of the disease regarding the traditional treatment, MBC diagnosis should be considered and the medical report must be reviewed.
