New challenges in kidney cancer management: integration of surgery and novel therapies.

Despite early renal carcinoma diagnosis is more frequent nowadays, ~25-30 % of patients have metastatic disease at presentation and another ~30 % develop recurrent or metastatic disease after radical treatment for localized disease. In recent years, treatment of renal carcinoma is increasing in complexity due to the inclusion of a number of effective systemic treatments prolonging survival and increasing the therapeutic strategies for tumor debulking, or even achieving surgical complete responses and prolonged disease-free intervals. Initial multimodal approaches with immunotherapeutic agents are now being validated in patients treated with the new-targeted agents. Patients are now able to receive an optimal therapeutic strategy seeking a longer survival with an acceptable life quality and avoiding unnecessary comorbidities. In this context and as an initial therapeutic approach, it is imperative to promote patients' selection with established prognostic models within a multidisciplinary team to assess the recommendation of a cytoreductive nephrectomy (CN), metastasectomy, and/or systemic treatment. In the context of mRCC, when feasible and in patients with favorable prognostic factors, the strategy should be to consider a CN or metastasectomy for tumor debulking in order to achieve free intervals of prolonged disease. By contrast, it is recommended to evaluate whether to perform a biopsy for histological diagnosis without nephrectomy in the following situations: high surgical risk, bulky metastatic disease or in specific sites (brain or liver) or ECOG PS 3/4. The following review covers from initial to recent studies on the integration of systemic treatment and surgery in the context of metastatic disease for an optimal multimodal management in renal carcinoma.

Cáncer de pulmón no microcítico: quimioterapia y otros tratamientos sistémicos / Non small-cell-lung cancer: chemotherapy and other systemic treatments

El cáncer de pulmón es la neoplasia más frecuente en la actualidad en los países industrializados y la primera causa de muerte por cáncer en el mundo. Entre el 75-80% pertenecen a la variedad histológica de cáncer de pulmón no microcítico (CPNM). Aproximadamente un tercio de estos debutan con enfermedad localmente avanzada (Estadio III de la clasificación TNM). Aunque la cirugía es el tratamiento de elección, aproximadamente un tercio de los mismos no tendrá una supervivencia mayor de 5 años, incluso en estadios I, debido a la existencia de recaídas y metástasis a distancia. Los ensayos de quimioterapia neoadyuvante han investigado el impacto del tratamiento en la supervivencia libre de enfermedad y global y los de tratamiento adyuvante se han diseñado con el objetivo de eliminar micrometástasis ocultas y de esta forma mejorar la supervivencia. En la enfermedad avanzada, los objetivos principales son el control sintomático y la mejoría o mantenimiento de la calidad de vida del paciente, teniendo en cuenta en todo momento la posible toxicidad añadida que conlleva la quimioterapia

Lung cancer is the most frequent neoplasia in industrialized countries and the leading cause of cancer death worldwide. Non-small cell lung cancer (NSCLC) accounts for 75-80% of lung carcinomas. Approximately one-third of these patients are diagnosed of locally advanced disease (Stage III of TNM staging system). Although surgery is the optimal treatment strategy, even in patients with stage I disease, approximately one third of them will die within 5 years, due to relapses and distant metastases. Several studies have explored the impact of neo-adyuvant chemotherapy in free disease survival and overall survival and adjuvant chemotherapy trials have been conducted to eliminate occult micrometastases and improve overall survival. In advanced disease, primary goals of therapy are palliation of symptoms as well as improvements in quality of life without high treatment-related toxicity

Cardiac metastasis from uterine leiomyosarcoma

Cardiac metastases are more frequent than primaryheart neoplasias. Nearly any malignant tumourmay metastasize to the heart, but the most commonare carcinomas rather than sarcomas. We report thecase of a patient who presented with heart metastasis6 years after resection of an uterine leiomyosarcoma.The patient died thirty months after surgicalresection without evidence of cardiac recurrence.Although cardiac metastases from uterine leiomyosarcomaare exceptional, they should be suspectedin the presence of suggestive symptoms, since theycan be associated with long survival after surgicaltreatment

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Brain metastases in metastatic breast cancer patients receiving trastuzumab-based therapies.

INTRODUCTION: CNS metastases mean a great challenge. It has been suggested that the brain metastases incidence could be high in metastasic breast cancer patients receiving trastuzumab based-therapies. MATERIAL AND METHODS: We performed a descriptive analysis of our experience in this setting. 86 patients met the criteria (From Oct/99 to Oct/03). RESULTS: CNS progression occurred in 17 patients (19.5%). Mean age of CNS progression disease patients was 45.4 years while mean age for all the patients was 50.5 years. Response rate for the entire group of patients was: OR 39.7%; CB (OR + SD) 69%. Response rate to trastuzumab based-therapy was OR 82.4% and CB 88.2 at the time of CNS progression. Median time from the start of trastuzumab therapy up to the CNS progression was 10 months. OS was 23.4 weeks. CONCLUSIONS: The incidence of CNS involvement is high in young metastasic breast cancer women responding to trastuzumab-based therapies. This may lead to prophylactic cranial irradiation strategies or to the early detection in asymptomatic patients to improve surgery or radiosurgery results in these patients.

Brain metastases in metastatic breast cancer patients receiving trastuzumab-based therapies

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Introduction. CNS metastases mean a great challenge.It has been suggested that the brain metastasesincidence could be high in metastasic breastcancer patients receiving trastuzumab based-therapies.Material and methods. We performed a descriptiveanalysis of our experience in this setting. 86 patientsmet the criteria (From Oct/99 to Oct/03).Results. CNS progression occurred in 17 patients(19.5%). Mean age of CNS progression disease patientswas 45.4 years while mean age for all the patientswas 50.5 years. Response rate for the entiregroup of patients was: OR 39.7%; CB (OR + SD)69%. Response rate to trastuzumab based-therapywas OR 82.4% and CB 88.2 at the time of CNS progression.Median time from the start of trastuzumabtherapy up to the CNS progression was 10 months.OS was 23.4 weeks.Conclusions. The incidence of CNS involvement ishigh in young metastasic breast cancer women respondingto trastuzumab-based therapies. This maylead to prophylactic cranial irradiation strategies orto the early detection in asymptomatic patients toimprove surgery or radiosurgery results in these patients