EOM clinical guidelines for the adjuvant treatment of colorectal cancer

Colorectal cancer is the third most common malignant neoplasm and the second cause of death by cancer in western countries. In this manuscript, the clinical guidelines of the Spanish Society of Medical Oncology (SEOM) for diagnosis and adjuvant treatment of colon cancer and rectal cancer are reported (AU)

[Treatment decision in advanced testicular germ cell tumors]. / Decisión terapéutica en tumores de células germinales testiculares avanzados.

OBJECTIVE: To review the classifications of the risk groups of different prestigious institutions and collaborative groups that have had a major impact on our knowledge and therapeutic approach to germ cell tumors of the testis. METHODS: We reviewed the different classifications of renowned institutions and collaborative groups and the literature published over the last 15 years that provide evidence for the optimal therapeutic approach for each subgroup at risk. RESULTS/CONCLUSIONS: Germ cell testicular tumors is the paradigm of curable tumors of the adult. Patients with stage I tumors have an excellent prognosis with more than 98% probability of cure. The prognosis for the advanced stage tumors is superior to that of other solid tumors with a similar volume due to their exquisite chemosensitivity. Patients with advanced disease can be divided into two or three groups (low and high, or low, intermediate and high risk) with different probability of cure after treatment with cisplatin-based regimens, according to the location of the primary tumor, extent of the disease and serum levels of the markers. The standard treatment for the advanced disease consists of first line chemotherapy with cisplatin, etoposide and bleomycin (BEP) followed by surgery in cases with residual tumor. Approximately 10% of the patients with good-prognosis factors and 30%-50% of those with poor-prognosis factors will not cure after first line chemotherapy, although rescue with second line chemotherapy can be utilized in some of these patients. The search for more effective chemotherapeutic regimens for high risk patients and regimens with a lower toxicity for the low risk patients has been hampered by the lack of consensus among the working groups on the criteria for the classification of these patients into subgroups according to prognosis. The recent International Germ Cell Consensus Classification will permit studies on homogeneous risk groups of patients and will allow us to obtain reliable and reproducible results.

[Rescue chemotherapy in testicular germ cell tumors]. / Quimioterapia de rescate en tumores de células germinales testiculares.

OBJECTIVE: To review the different salvage chemotherapy regimens according to the prognostic factors based on the response to the different therapeutic alternatives. METHODS: The conventional rescue chemotherapy regimens, as well as the role of surgery, new drugs and therapeutic modalities, particularly high dose second and third line chemotherapy, were reviewed. RESULTS/CONCLUSIONS: Germ cell testicular tumor is the paradigm of curable tumors of the adult. Whereas the cure rate for stage I tumors is higher than 98%, patients with advanced stage tumors have a lower cure rate. Approximately 10% of the patients with good-prognosis factors and 30%-50% of those with poor-prognosis factors show tumor progression or recurrence after first line chemotherapy using cisplatin-based combinations. Patients who have recurrence after first line chemotherapy have a 40% probability of achieving second complete remission with second line chemotherapy, but will be sustained in only 20% of the patients, although rare cases of advanced pure seminoma that recurred have shown a cure rate of 55% with second line chemotherapy. New strategies have been developed using new drugs such as taxanes or high doses of well-known chemotherapeutic agents with autologous hematopoietic rescue that have been utilized with success in patients with refractory germ cell testicular tumors. A global analysis of the patients treated with third line chemotherapy shows a sustained complete remission rate of 22%. However, this percentage can only be increased to up to 50% for patients with no adverse factors.