Tratamiento adyuvante en pacientes diagnosticados de carcinoma no microcítico de pulmón: estado de la evidencia científica / Adjuvant treatment of non-small cell lung cancer patients: state of the scientific evidence

La cirugía representa el tratamiento curativo de elección para los pacientes que son diagnosticadosde carcinoma no microcítico de pulmón en estadio local. Sin embargo, gran parte de ellos experimentanuna recurrencia de su enfermedad lo que ha llevado al empleo de opciones terapéuticas tanto localescomo sistémicas con el ánimo de mejorar las posibilidades de curación. Durante las últimas décadasdiversos estudios comparativos heterogéneos y varios meta-análisis publicados en los años 95 y 97no demostraron de forma significativa una ventaja al asociar la quimioterapia y/o radioterapia adyuvantea la cirugía. Desde entonces y hasta nuestros días otros trabajos realizados con un número mayorde pacientes y empleando una quimioterapia más eficaz basada en combinaciones de platino, coincidenen describir un beneficio con su utilización aunque no de forma unánime. Más recientemente, unnuevo meta-análisis recopilando la mayoría de los estudios antes mencionados ha confirmado de formasignificativa una mejoría absoluta del 4% en la supervivencia global de los pacientes sometidos aquimioterapia adyuvante, especialmente en los estadios patológicos II-III tras cirugía y tratados conregímenes que incluyen cisplatino y vinorelbina. Queda por ser determinado el papel que desempeñanotros agentes como el uracilo/tegafur así como la radioterapia en el contexto adyuvante

Surgery is the current treatment of choice in patients with early-stage non-small cell lung cancer.Based on the high rates of recurrence, additional local and systemic treatments have been developed,aimed at improving the cure rates. The comparative studies about the benefits of post-operativeadjuvant chemotherapy and/or radiotherapy, and the meta-analysis studies made during the lastdecades, reviewed in some articles appeared in 95 and 97, did not confirm a significant improvementof the overall survival. Since then, new comparative trials carried out with a higher number of patientsand with more active and standard chemotherapy seem to show a benefit of the administration ofplatinum-based chemotherapy, although it has not gained general acceptance. More recently, a newmeta-analysis, that included the previous studies, has confirmed an overall increase of 4 % in survivalof patients treated by surgery and adjuvant chemotherapy, especially in stages II-III patients receivingschedules of cisplatin and vinorelbine. Further studies are needed to determine the real therapeuticvalue of other agents, as uracil-tegafur and radiotherapy

Tratamiento anti-hormonal adyuvante en mujeres post-menopáusicas con diagnóstico de carcinoma de mama / Adjuvant anti-hormonal treatment of postmenopausal women with breast cancer

Durante las últimas décadas el tratamiento adyuvante anti-hormonal de elección para las pacientespost-menopáusicas con diagnóstico de carcinoma de mama localizado y con receptores hormonalespositivos ha sido el tamoxifeno al disminuir de una forma significativa el riesgo de muerte por tumor.Más recientemente, una serie de estudios comparativos utilizando tres agentes inhibidores aromatásicosde tercera generación y diferentes esquemas de administración, bien tras la cirugía inicial del primarioo después de 2-3 años o 5 años de tamoxifeno, han demostrado una ventaja en la supervivencialibre de enfermedad con respecto al tamoxifeno. Los efectos adversos acompañantes describen perfilesde toxicidad distintos entre ambos tipos de tratamiento anti-hormonal, siendo más comunes y frecuenteslos fenómenos osteo-musculares y cardiovasculares en el grupo de pacientes tratadas con inhibidoresaromatásicos así como los tromboembólicos y patología endometrial en el grupo tratado contamoxifeno. La mejor estrategia para la administración, la forma de prevenir los efectos adversos y eltipo de pacientes que más se pueden beneficiar de los inhibidores aromatásicos, quedan por ser definidoscon mayor precisión

Over the recent decades, tamoxifen has been considered the standard adjuvant treatment of postmenopausalwomen with hormone-receptor positive breast cancer based on its capacity to reduce the annualbreast cancer death. More recently, several major randomized controlled trials carried out with threedifferent new aromatase inhibitors used either from the time of primary surgery or after 2-3 or 5years of adjuvant tamoxifen therapy have shown a significant improvement in disease-free survivalwith respect to tamoxifen therapy. The described treatment-related side effects suggest different profilesof toxicity. Musculoskeletal disorders and cardiovascular events are the most serious side effectsassociated with the use of aromatase inhibitors, as well as the thromboembolic events and endometrialabnormalities are associated with tamoxifen therapy. An optimal treatment strategy for aromatase inhibitorsadministration, interventions to prevent or alleviate treatment-related side effects and identificationof women at higher risk having more benefit with aromatase inhibitors need to be addressed

Análisis retrospectivo multicéntrico del tratamiento adyuvante con quimioradioterapia en pacientes con cáncer gástrico resecado. Resultados preliminares. Grupo Oncológico del Norte (G.O.N) / No disponible

INTRODUCCIÓN. En el carcinoma gástrico (CG), los resultados del estudio IT-0116 pusieron de manifiesto el beneficio del tratamiento con quimioterapia más radioterapia adyuvante después de cirugía radical R0, en un grupo de pacientes en los que la linfadenectomía D0 (inferior a D1) se había realizado en el 53% de los casos. Si los resultados de este estudio son trasladables a nuestros pacientes ha sido un punto de controversia. MATERIAL Y MÉTODOS. Hemos iniciado un análisis retrospectivo multicéntrico de los pacientes con CG que han recibido tratamiento adyuvante según la pauta de IT-0116. Analizamos las características de los pacientes, el tipo de linfadenectomía realizada, el número de ganglios analizados, el tratamiento recibido y la toxicidad. RESULTADOS. Analizamos 31pacientes. Se realizó una linfadenectomía D0 en 8(26%), D1 y entre D1-D2 en 12 (39%) y D2 en 9 (29%). Esplenectomía en 2 (6.5%). La mediana de ganglios analizados fue de 12 (2-38). El 90% presentaba ganglios positivos. De los 23 pacientes evaluables para la tolerancia al tratamiento, 17 pacientes (74%) completaron el tratamiento, 7 (32%) desarrollaron toxicidad hematológica grado 3-4 y 5 (20 %) toxicidad digestiva grado 3. La intensidad de dosis del 5FU fue del 86% (64-108%). CONCLUSIONES. En nuestros hospitales el número de pacientes con linfadenectomías D0 es inferior al del estudio IT-0116. Realizaremos análisis de supervivencia tras mayor tiempo de seguimiento (AU)

BACKGROUND. In gastric cancer, the results of Intergroup 0116 trial showed a benefit for adyuvant chemoradiotherapy after radical surgery. However, in 53% of this group of patients the lymphadenectomy had been D0 (less than D1). Controversy exists as to whether the results of this study can be applied to our patients. MATERIAL AND METHODS. We have conducted a retrospective multicentric analysis including patients with gastric cancer who have received adyuvant treatment with the IT-0116 regimen after complete resection. We analyze patients characteristics, the extent of lymph-node dissection, the number of cycles administered and toxicity. RESULTS. Thirty one patients were analyzed. 26% of the patients underwent a D0 dissection. A D1 lymphadenectomy or a lymphadenectomy between D1 and D2 were performed in 12 patients (39%) and a D2 in 9 patients (29%). 2 patients were splenectomized. The median number of nodes analyzed were 12 (2-38). 90% of the patients had positive-nodes. There were 23 patients evaluables for treatment toxicity. 17 patients (74%) completed treatment as planned. 7 patients (32%) developed hematologic toxicity grade 3-4 and 20% grade 3 diarrhea. The dose-intensity of fluorouracil was 83%(64-100%). CONCLUSIONS. We have less patients with a D0 lymphadenectomy in our hospitals than in the Intergroup trial. We will make a survival analysis after a longer follow-up (AU)

Falsos negativos y positivos de los marcadores tumorales: sus limitaciones en la práctica clínica. Aplicaciones clínicas al CA-125 / False negative and false positive results of tumoral markers: Their limitation in the clinical practice. Clinical appications to CA-125

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Taxol, propanolol, cimetidina y parada cardiorespiratoria / Taxol, propanolol, cimetidine and cardiorespiratory arrest

Propósito: Estudiar un caso de parada cardiorespiratoria en una paciente tratada con paclitaxel a la luz de los datos de la literatura. Caso clínico: Paciente de 74 años de edad, sin antecedentes de patología cardiaca y con ingesta crónica de propanolol a causa de un temblor esencial, fue tratada con taxol en segunda línea y presentó a los pocos minutos de iniciarse su infusión una parada cardiorespiratoria, que fue rápidamente reversible al iniciarse las maniobras iniciales de resucitación cardiorespiratoria. Se analiza el caso, considerando la medicación concomitante (propanolol, cimetidina, dexclorferinamina) a la luz de los datos de la literatura. Conclusiones: En el momento del cuadro, tres drogas con efectos sobre el sistema de conducción cardiaco coincidieron en el tiempo. Es aconsejable la discontinuación de B-bloqueantes aunque se estén empleando a dosis bajas y no existan anormalidades en el ECG (AU)

Tratamiento del melanoma metastásico / Treatment of metastatic melanoma

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Experience with independent radiological review during a topotecan trial in ovarian cancer.

BACKGROUND: The results of phase II clinical trials are usually based on response of tumours to new oncolytic agents as evidenced by radiological imaging techniques. In this trial, all claimed responders were reviewed at a specially convened meeting by the peer group of study investigators and a radiologist, independent of the study institutions. PATIENTS AND METHODS: One hundred eleven patients with advanced epithelial ovarian cancer who had previously been treated with a platinum based regimen and had subsequently relapsed and who had measurable disease were treated with topotecan at a dose of 1.5 mg/m2/day i.v. on five consecutive days repeated every 21 days to assess efficacy and tolerability. Ninety-three were considered eligible for the study per protocol and lesions were assessed by either computerised tomography (CT) or ultrasound (US). At the meeting, scans from all 24 (25.8%) claimed responders were reviewed, lesions remeasured by the radiologist and a group discussion led to a final response classification. RESULTS: Ninety-two patients were found to be eligible for the study and 14 (15.2%) were confirmed as responders. Ten were rejected as responders, mainly because the lesion did not decrease in size by < or = 50%, but one patient failed to meet the entry criteria. Remeasurement of CT scans was more objective than US scans. Difficulties were encountered during review of some CT scan sequences because of non-uniform imaging parameters. CONCLUSIONS: Independent radiological review in conjunction with the peer review group in this trial enabled rigorous and consistent application of response criteria. This decreased the response rate from 25.8% to 15.2%, but this represents a more objective assessment. CT scanning is an objective technique for assessing response rates in phase II studies whereas US is subjective and dose not necessarily allow accurate lesion assessment on subsequent examinations, nor allows independent review at a later date. For these reasons it should not be used in such studies for accurate lesion assessment. Cross-sectional imaging techniques such as CT and magnetic resonance imaging (MRI) do allow accurate lesion assessment and independent review at a later date, but standard protocols need to be instituted, to allow consistency and a comparison to be made with subsequent studies using the same agent and a broad comparison to be made with other agents.