ABSTRACT
INTRODUCTION: Neoadjuvant chemoradiotherapy before surgery is an option in the treatment of locally advanced resectable oesophageal cancer (EC). However toxicity is substantial and the improvement in overall survival (OS) with this approach is controversial. METHODS: This was a prospective, single-centre study of neoadjuvant chemotherapy and concomitant chemoradiotherapy with CDDP and 5-FU and 50.4 Gy of external radiotherapy before possible radical surgery in patients with locally advanced resectable EC. If surgery was not possible, a second-phase radiotherapy boost of 10 Gy and one cycle of modified dose chemotherapy were used. RESULTS: Seventy-three patients included between 1998 and 2007: 96% males, median age 61, 83% squamous cell carcinomas, 23% lower third tumours, 36% stage II and 54% stage III and 47% local lymph node involvement. Eighty-six percent completed the combined protocol. Main grade 3-4 toxicities: mucositis (19%) and infections (8%); 4 toxic deaths. Clinical response rates: complete response 54%, partial response 27%, stable disease 8%. Twenty-five patients proceeded to surgery, with radical resection in 24. Pathological response rate: complete response 32%, partial response 52%, progression 16%. There were 7 postoperative deaths and 16 of 34 patients that did not have surgery received the second-phase RT boost. Survival analysis: Median follow-up of 64 months (range 6-134 months). Median OS of 10.33 months. 2-year and 5-year OS of 22 and 16%. The only significant prognostic factor in OS is the clinical complete response rate: 13.9 vs. 7.7 months (p=0.0049). CONCLUSIONS: Our protocol offers a high rate of clinical activity although it is relatively toxic and seems to increase the postoperative mortality, which would blunt any small improvement in survival. The achievement of a complete response is a powerful prognostic factor (AU)
No disponible
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Adenocarcinoma/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Clinical Trials as Topic/methods , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/radiotherapy , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/radiotherapy , Adenocarcinoma/mortality , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carcinoma, Squamous Cell/mortality , Combined Modality Therapy , Disease Progression , Follow-Up Studies , Esophageal Neoplasms/mortality , Esophageal Neoplasms/surgeryABSTRACT
Pregunta de investigación. ¿Cuáles son las características bio-celularesde las leucemias agudas en Bolivia, y presentará diferencias comparando con otros países?. Objetivos: 1. Determinar las caracteristicas bio-celulares de las leucemias agudas en Bolivia. 2. Comparar la frecuencia y distribución de las características bio-celualres de las leucemias agudas en otros países. Diseño: Descriptivo, corte transversal.Lugar: Unidad de Biología Molecular Paolo Belli, Instituto de Genética, Facultad de Medicina. UMSA. La Paz, Bolivia. Poblacióo: 100 Pacientes con leucemias agudas, 48 niños y 52 adultos provenientes de diferentes Centros Hospitalarios del país. Métodos: Las muestras de sangre periférica y médula ósea fueron estudiados con lossiguientes métodos de análissi: a)Estudio morfológico con tinción May Grunwald-Giemsa, B9 Estudio citoquímico con Mieloperoxidasa y Alfa Nalfta Naftil Butirato Esterasa c) Estudio Inmunocitoquímico utilizando anticuerpos monoclonales. Los resultados fueron analizados según el paquete estadísitco EPIDAR versión 2.0. Resultados: De los 100 casos de leucemias agudas, 48 fueron pediatricos (LLA 83.3 porciento y LMA 16.7 porciento); 95 porciento fueron LLA-B y 5 porciento LLA-T; por ora parte las LMA se distribuyeron como sigue: 12.5 porciento MO, 37.5 M1, 37.5 porciento M2 y 12.5 porciento M4. De los 52 adultos (LLA 61.5 porciento y LMA 38.5 porciento); 87.5 porciento fueron LLA-B y 12.5 porciento LLA-T. La LMA se distribuyeron de la siguiente manera: 10 porciento MO, 35 porciento M1, 15 porciento M2, 35 porciento M3 y 5 porciento M5. Conclusiones: Los valores porcentuales obtenidos en el presente estudio reflejan un patrón característico para nuestra población y confirman su diversidad epidemiológica de las leucemias agudas en comparación con otras regiones.
