ABSTRACT
La preservación de la fertilidad es la aplicación de estrategias médicas y de laboratorio para preservar la descendencia genética parental en adultos o niños en riesgo de esterilidad. El cáncer es la principal indicación de preservación de fertilidad en pacientes en edad reproductiva. En las últimas décadas ha incrementado la incidencia de cáncer en adolescentes. Los tratamientos oncológicos también han mejorado significativamente, por lo que hoy es posible la curación en un amplio porcentaje de pacientes. La mayoría de los niños y adolescentes con cáncer se convierten en sobrevivientes a largo plazo, lo que aumenta el interés en los efectos del tratamiento del cáncer sobre la fertilidad. Las condiciones sociales, económicas y culturales también son determinantes para decidir el momento que una pareja busque promover su fertilidad. Además, otras patologías o incluso fármacos para prevención del rechazo de órganos trasplantados pueden afectar la fertilidad y, por tanto, tales pacientes son susceptibles de orientación sobre preservación de la fertilidad. El éxito en los programas de reproducción asistida y en los tratamientos oncológicos brindan alternativas para preservar la fertilidad. En esta primera Opinión de Grupo de Expertos Mexicanos en Preservación de la Fertilidad hemos evaluado pacientes oncológicas que son candidatas a preservación de fertilidad: jóvenes con riesgo de compromiso de su fertilidad por el tratamiento oncológico, pero con reserva ovárica suficiente y pronóstico vital aceptable. También se consideraron casos especiales como la preservación social, en casos de conceptualización sexual diferente, así como los aspectos legales y éticos básicos
Fertility preservation is the application of medical and laboratory strategies to preserve parental genetic offspring in adults or children at risk of sterility. Cancer is the main indication of fertility preservation in patients of reproductive age. In recent decades, the incidence of cancer in adolescents has increased. Cancer treatments have also improved significantly, making cure possible today in a large percentage of patients. Most children and adolescents with cancer become long-term survivors, increasing interest in the effects of cancer treatment on fertility. Social, economic and cultural conditions are also decisive in deciding when a couple seeks to promote their fertility. Furthermore, other pathologies or even drugs for the prevention of rejection of transplanted organs can affect fertility and, therefore, such patients are susceptible to guidance on fertility preservation. Success in assisted reproduction programs and cancer treatments provide alternatives to preserve fertility. In this first Opinion of the Group of Mexican Experts on Fertility Preservation, we have evaluated oncological patients who are candidates for fertility preservation: young people at risk of compromising their fertility due to oncological treatment, but with sufficient ovarian reserve and acceptable vital prognosis. Special cases such as social preservation were also considered, in cases of different sexual conceptualization, as well as the basic legal and ethical aspects
Subject(s)
Humans , Male , Female , Infertility/prevention & control , Fertility Preservation/methods , Organ Sparing Treatments/methods , Neoplasms/therapy , Risk Factors , Practice Guidelines as Topic , Fertility Preservation/standards , MexicoABSTRACT
PURPOSE: Preoperative chemoradiotherapy (CRT) is the treatment of choice for rectal cancer (RC), but half of the patients do not respond, suffer unnecessary toxicities, and surgery delays. We aimed to develop a model that could predict a clinically meaningful response to CRT by using formalin-fixed paraffin-embedded (FFPE) biopsies. EXPERIMENTAL DESIGN: We first carried out an exploratory screening of candidate genes by using SAGE technology to evaluate dynamic changes in the RC transcriptome in selected refractory patients before and after CRT. Next, 53 genes (24 from SAGE and 29 from the literature) were analyzed by qPCR arrays in FFPE initial biopsies from 94 stage II/III RC patients who were preoperatively treated with CRT. Tumor response was defined by using Dworak's tumor regression grade (2-3-4 vs. 0-1). Multivariate Cox methods and stepwise algorithms were applied to generate an optimized predictor of response and outcome. RESULTS: In the training cohort (57 patients), a 13-gene signature predicted tumor response with 86% accuracy, 87% sensitivity, and 82% specificity. In a testing cohort (37 patients), the model correctly classified 6 of 7 nonresponders, with an overall accuracy of 76%. A signature-based score identified patients with a higher risk of relapse in univariate (3-year disease-free survival 64% vs. 90%, P = 0.001) and multivariate analysis (HR = 4.35 95% CI: 1.2-15.75, P = 0.02), in which it remained the only statistically significant prognostic factor. CONCLUSIONS: A basal 13-gene signature efficiently predicted CRT response and outcome. Multicentric validation by the GEMCAD collaborative group is currently ongoing. If confirmed, the predictor could be used to improve patient selection in RC studies.
