Epirubicin, cisplatin plus ifosfamide versus standard chemotherapeutic regimens for advanced/unresectable primary thoracic sarcomas.

PURPOSE: Thoracic sarcomas are rare malignancies, with limited data for unresectable/advanced scenarios. Our goal is to provide insights of a three-drug chemotherapy regimen improving patient survival compared to standard regimens. METHODS: Retrospective cohort analysis of patients diagnosed with unresectable/advanced primary thoracic sarcoma divided between primary pulmonary sarcomas (PPS) and chest wall sarcomas (CWS) comparing chemotherapeutical regimens efficacy. Not true soft tissue sarcomas (STS) for PPS were excluded from the analysis. Univariate and multivariate analysis performed via Cox-regression model. Progression-free survival (PFS) and overall survival (OS) analysis via Kaplan-Meier with hazard ratio (HR) obtained via Mantel-Haenszel or log rank. RESULTS: 157 total cases were included, from which 50 cases were PPS and 107 cases CWS. For PPS, 4 cases were excluded from the analysis as they were not true STS. The most common histology was undifferentiated sarcomas, 63% of cases were treated with E/C/I and 37% with another regimen. The E/C/I regimen demonstrated a benefit for both OS (p = 0.020) and PFS (p = 0.010) when compared to any other regimen as well as when compared to non-platinum regimens (p = 0.016 and p = 0.001). Regarding CWS, the most common histology was synovial and undifferentiated sarcomas, 55.1% were treated with E/C/I and 44.9% treated with another regimen. The E/C/I regimen did not demonstrate a benefit for OS or PFS compared to any other regimen, neither when compared to other non-platinum regimens. However, a benefit was observed in favor of E/C/I when compared to other platinum regimens in both OS (p = 0.049) and PFS (0.015). Both analyses for PPS and CWS demonstrated a benefit in favor of cisplatin therapies compared to carboplatin in both OS and PFS. CONCLUSION: This study demonstrates that platinum therapy alone does not work, and that cisplatin must be the agent of choice and it's used in combination could increase treatment response. The E/C/I regimen demonstrated a in PPS but not for CWS, this is due do their rarity of PPS and that no standard treatment is established yet. The regimen proposed here could represent a possible new standard of treatment for PPS as long as it is validated in a prospective study.

Chemotherapy Treatments for Burkitt Lymphoma: Systematic Review of Interventional Studies.

BACKGROUND: Burkitt lymphoma (BL) is an aggressive hematologic cancer. This study synthetized the evidence about the efficacy and safety of chemotherapy treatments used in patients with BL using the World Health Organization classification. MATERIALS AND METHODS: A systematic review of interventional studies was performed. A search was carried out in PubMed, Scopus, and Web of Science, with additional manual and gray literature searches. The methodological quality of articles was assessed with the Newcastle-Ottawa scale. RESULTS: We identified 1358 studies; 9 nonrandomized studies satisfied the eligibility criteria (n = 544 patients). The BL epidemiologic variants were sporadic BL (44.5%), endemic BL (47.2%), and immunodeficiency-associated BL (8.3%). Regarding chemotherapy protocols, 4 groups were identified: based on CODOX-M/IVAC (n = 4), EPOCH (n = 1), BFM (n = 1), and simplified treatment schemes used in African countries (n = 3). Most studies had moderate quality. Empirically and qualitatively, the best options for adults with sporadic BL were 'DA-EPOCH-R' (7-year overall survival [OS], 100%; 95% confidence interval [CI], 82-100), 'HDR + LD into CODOX-M/IVAC' (2-year OS, 84%), and 'RD-CODOX-M/IVAC' (4-year progression-free survival, 92%; 95% CI, 77-100); in pediatric patients, the 'BFM-NHL-90-like' showed promising results (3-year OS, 90%). For immunodeficiency-associated BL, the 'SC-EPOCH-RR' demonstrated a good therapeutic profile (6-year OS, 90%; 95% CI, 60-98). The 'Malawi 2012-2014' (1-year OS, 73%; 95% CI, 61-85) could be the treatment choice in endemic BL (African countries). The main adverse events were hematologic. CONCLUSION: Selecting chemotherapy protocols for BL should be grounded in its epidemiologic variants. Further studies with greater methodological quality are needed to strengthen the evidence.

Scalp cooling to prevent chemotherapy-induced alopecia

Abstract Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.

Scalp cooling to prevent chemotherapy-induced alopecia.

Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.

Superiority of the triple combination of bortezomib, cyclophosphamide and dexamethasone versus cyclophosphamide, thalidomide and dexamethasone in patients with newly diagnosed multiple myeloma, eligible for transplantation

ABSTRACT Background: The treatment of multiple myeloma (MM) has evolved significantly in the past decade, and new drug combinations have improved the response rates and prolonged survival. Studies comparing different induction chemotherapy regimens have shown that triple combinations have better results than double combinations. However, comparisons among different triple combinations are rare in the literature. Methods: We retrospectively compared two triple combinations comprising bortezomib, cyclophosphamide and dexamethasone (VCD) versus thalidomide, cyclophosphamide and dexamethasone (CTD), and aimed at identifying which of the two combinations would yield better response rates following four induction cycles prior to hematopoietic cell transplantation in patients with untreated multiple myeloma. Results: We retrospectively reviewed the medical records of 311 patients from 24 different centers.The VCD regimen was used as induction therapy by 117 (37.6%) patients, whereas 194 (62.4%) patients received the CTD regimen. After four cycles of induction on an intention-to-treat basis, 54% of the patients in the VCD group achieved at least very good partial response versus 42.8% in the CTD group (p = 0.05). We observed no difference in neuropathy or thrombotic events rates among the two regimens. Conclusion: Our results corroborate the superiority of the triple combination regimes containing bortezomib over the triple combination with thalidomide as pre ASCT induction therapy in MM.

Superiority of the triple combination of bortezomib, cyclophosphamide and dexamethasone versus cyclophosphamide, thalidomide and dexamethasone in patients with newly diagnosed multiple myeloma, eligible for transplantation.

BACKGROUND: The treatment of multiple myeloma (MM) has evolved significantly in the past decade, and new drug combinations have improved the response rates and prolonged survival. Studies comparing different induction chemotherapy regimens have shown that triple combinations have better results than double combinations. However, comparisons among different triple combinations are rare in the literature. METHODS: We retrospectively compared two triple combinations comprising bortezomib, cyclophosphamide and dexamethasone (VCD) versus thalidomide, cyclophosphamide and dexamethasone (CTD), and aimed at identifying which of the two combinations would yield better response rates following four induction cycles prior to hematopoietic cell transplantation in patients with untreated multiple myeloma. RESULTS: We retrospectively reviewed the medical records of 311 patients from 24 different centers.The VCD regimen was used as induction therapy by 117 (37.6%) patients, whereas 194 (62.4%) patients received the CTD regimen. After four cycles of induction on an intention-to-treat basis, 54% of the patients in the VCD group achieved at least very good partial response versus 42.8% in the CTD group (p=0.05). We observed no difference in neuropathy or thrombotic events rates among the two regimens. CONCLUSION: Our results corroborate the superiority of the triple combination regimes containing bortezomib over the triple combination with thalidomide as pre ASCT induction therapy in MM.

Evaluación de la calidad de vida en pacientes con cáncer de esófago tratados con endoprótesis autoexpandibles / Evaluation of the quality of life in patients with esophageal cancer treated with self-expanding stent

RESUMEN Fundamento: el estudio de la calidad de vida relacionada con la salud en pacientes que presenten cáncer de esófago inoperable con uso de endoprótesis autoexpandibles, proporciona información útil para seleccionar la opción de tratamiento adecuado. El instrumento EORTC QLQ- C30 para evaluar al paciente con cáncer de esófago y el módulo de complemento EORTC QLQ-OES18, permiten el intercambio directo con el paciente y predecir el impacto de la enfermedad y del tratamiento sobre este. Objetivo: realizar una revisión y reflexión acerca de los diferentes aspectos relacionados con la evaluación de la calidad de vida en pacientes oncológicos tratados con endoprótesis esofágicas metálicas autoexpandibles. Métodos: se realizó una búsqueda en los motores Google, PUBMED, SciELO Regional, SciELO Public Health, SciELO Cuba, Biblioteca Virtual de Salud Cuba, Medline Plus, WebMD, Medscape, National Institutes of Health, National Library of Medicine GoPubMed. En la estrategia de búsqueda, se utilizaron los términos: calidad de vida, calidad de vida relacionada con salud, cáncer de esófago, prótesis esofágicas autoexpandibles. Se evaluaron los documentos en extenso y se desarrolló un documento resumen de la información recolectada. Desarrollo: en la búsqueda bibliográfica realizada encontraron 20 trabajos relacionados con la caracterización de pacientes con cáncer de esófago cuatro, paliación de disfagia con uso de prótesis esofágicas autoexpandibles siete, específicos de calidad de vida cuatro, instrumentos de medición tres y modalidad de tratamientos combinados dos. Conclusiones: la calidad de vida relacionada con la salud se considera hoy en día uno de los pilares más importantes para poder evaluar el impacto de un determinado tratamiento sobre pacientes con una sobrevida menor a tres meses, esto generará la adquisición y actualización de conocimientos entre el personal de la salud y servirá de impulso y motivación para su puesta en práctica de forma generalizada.

ABSTRACT Background: the study of health-related quality of life in patients with inoperable esophageal cancer using self-expanding stent provides useful information for selecting the appropriate treatment option. The EORTC QLQ-C30 instrument for evaluating the patient with esophageal cancer and the EORTC QLQ-OES18 complement module allows direct exchange with the patient and predicts the impact of the disease and treatment on the patient. Objective: to perform a review and reflection on the different aspects related to the evaluation of the quality of life in cancer patients treated with self- expanding metal esophageal stent. Methods: a search was carried out in the engines Google, PUBMED, SciELO Regional, SciELO Public Health, SciELO Cuba, Biblioteca Virtual de Salud Cuba, Medline Plus, WebMD, Medscape, National Institutes of Health, National Library of Medicine GoPubMed. In the search strategy, the terms quality of life, health-related quality of life, esophageal cancer and Self-expanding esophageal stent were used. The documents were extensively evaluated and a summary document of the information collected was developed. Development: a total of 20 papers were reviewed, including the characterization of patients with esophageal cancer 4, dysphagia palliation using self-expanding esophageal stent 7, quality of life 4 specific, measurement instruments 3 and modality of combined treatments 2. Conclusions: health-related quality of life is nowadays considered one of the most important pillars in order to evaluate the impact of a given treatment on patients with a survival shorter than three months, this will generate the acquisition and updating of knowledge among the health personnel and will serve as an impetus and motivation for its implementation in a generalized way.

Neutropenia em pacientes com câncer de cólon e reto submetidos a tratamento quimioterápico adjuvante / Neutropenia in patients with colon and rectal cancer who underwent adjuvant chemotherapeutic treatment

O tratamento quimioterápico do câncer de cólon e reto pode provocar efeitos adversos que limitam a efetividade da terapia e tem grande impacto nos resultados finais do tratamento, sendo a neutropenia a toxicidade hematológica mais comum decorrente do tratamento quimioterápico. O presente estudo teve como objetivos identificar a ocorrência de neutropenia em pacientes com câncer de cólon e reto submetidos a tratamento quimioterápico adjuvante do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e avaliar o risco para o desenvolvimento de neutropenia febril (NF) de acordo com o índice de risco da Associação Multinacional de Cuidados de Assistência ao Câncer (MASCC), em pacientes que apresentaram neutropenia durante o tratamento quimioterápico. Trata-se de um estudo descritivo e retrospectivo, realizado por meio da revisão de 60 prontuários de pacientes com diagnóstico de câncer de cólon e reto submetidos ao tratamento quimioterápico com 5-fluorouracil, ácido folínico e oxaliplatina (FLOX), seguidos no ambulatório de Coloproctologia deste referido hospital, entre os anos de 2010 a 2017. Foi realizada a avaliação dos resultados laboratoriais a cada semana do tratamento quimioterápico nos pacientes elegíveis para este estudo. A idade média dos participantes foi de 63,8 anos. 34 pacientes (56,7%) eram do sexo masculino. A maioria 50 (83,3%) era da raça branca. Quanto ao estado civil 37 (61,7%) eram casados. O tipo de neoplasia mais frequente foi o adenocarcinoma de reto, representado por 38 (63,3%) pacientes, seguido pelo adenocarcinoma de cólon com 22 (36,7%). Os estadiamentos clínicos mais observados foram o IIIb em 18 (30%) pacientes, seguido do IVa em 16 (26,7%). Foi analisado um total de 146 ciclos de quimioterapia com uma média de 2,5 ciclos por paciente, e 876 semanas de tratamento quimioterápico. Dos 60 pacientes participantes no estudo, 41,7% apresentaram neutropenia em algum momento do tratamento quimioterápico. Entre estes 60 pacientes, 21,6% apresentaram um episódio de neutropenia, dois episódios foram observados em 13,3%, quatro episódios em 3,4% e, 3,4% dos pacientes desenvolveram seis episódios de neutropenia. No total, foram identificados 49 episódios de neutropenia. Registrou-se 67 atrasos entre as semanas de tratamento com uma média de 5,02 dias. A redução de doses foi utilizada em 30 pacientes, com um total de 40 ciclos e 218 semanas de tratamento reduzidos, e a suspensão do tratamento ocorreu em 21 pacientes, totalizando 57 semanas de tratamento com suspensão de 27 ciclos. A neutropenia neste estudo esteve entre os principais motivos para os atrasos, reduções de dose e suspensão do tratamento quimioterápico. Quanto a avaliação de risco para o desenvolvimento de NF, 23 pacientes (84%) apresentaram baixo risco, 2 (8%) apresentaram alto risco e 2 (8%) apresentaram baixo e/ou alto risco concomitantemente. Os resultados deste estudo evidenciam que a neutropenia em pacientes com câncer de cólon e reto em tratamento quimioterápico tem uma incidência relativamente baixa em seus diferentes graus, possui baixo risco para o desenvolvimento de NF, e sugere a elaboração e implantação de instrumentos nos serviços de saúde que forneçam o melhor registro de informações da incidência de neutropenia, evitando sua subnotificação

The chemotherapeutic treatment of colon and rectal cancer can entail adverse effects that limit the effectiveness of the therapy and have a great impact on the final results of the treatment, where neutropenia is the most common hematological toxicity resulting from the chemotherapeutic treatment. This study was aimed to identify the occurrence of neutropenia in patients with colon and rectal cancer who underwent adjuvant chemotherapeutic treatment at the Clinical Hospital of the Ribeirão Preto Medical School, which belongs to the University of São Paulo (HCFMRP-USP), and to assess the development of febrile neutropenia (FN), according to the risk index of the Multinational Association for Supportive Care in Cancer (MASCC), in patients who had neutropenia during the chemotherapeutic treatment. This is a descriptive and retrospective study, which was performed through the review of 60 medical charts of patients diagnosed with colon and rectal cancer who underwent chemotherapeutic treatment with 5-fluorouracil, folinic acid and oxaliplatin (FLOX) and were monitored at the outpatient clinic of Coloproctology of this hospital between 2010 and 2017. We performed the assessment of the laboratory results of the chemotherapeutic treatment in patients allowable for this study on a weekly basis. The average age of participants was 63.8 years. A total of 34 patients (56.7%) were male. Most, 50, (83.3%) were white. As for marital status, 37 (61.7%) were married. The most frequent type of neoplasm was rectal adenocarcinoma, represented by 38 (63.3%) patients, followed by colon adenocarcinoma with 22 (36.7%). The most observed clinical staging were IIIb, 18 (30%) patients, followed by IVa, 16 (26.7%). We analyzed a total of 146 chemotherapeutic cycles, with an average of 2.5 cycles per patient, and 876 weeks of chemotherapeutic treatment. Of the 60 patients participants in the study, 41.7% had neutropenia at some time over the chemotherapeutic treatment. Among these 60 patients 21.6% had one episode of neutropenia, two episodes were observed in 13.3%, four episodes in 3.4%, and 3.4% of the patients developed six episodes of neutropenia. Altogether, 49 episodes of neutropenia were identified. We noted 67 delays among the treatment weeks, with an average of 5.02 days. Dose reduction was used in 30 patients, with a total of 40 cycles and 218 weeks of treatment reduced, and treatment suspension happened to 21 patients, totaling 57 treatment weeks with 27 suspension cycles. In this study, neutropenia was among the main reasons for the delays, dose reductions, and suspension of chemotherapeutic treatment. As for the risk assessment for the development of FN, 23 patients (84%) showed low risk, 2 (8%) showed high risk and 2 (8%) showed low and/or high risk concomitantly. The results of this study highlight that neutropenia in patients with colon and rectal cancer undergoing chemotherapeutic treatment has a relatively low incidence in its different stages, has low risk for the development of FN, in addition to suggesting the preparation and implementation of instruments capable of providing the best record of information on the incidence of neutropenia in health services, thus avoiding its underreporting

Linfoma Hodgkin clássico de apresentação incomum. Relato de caso / An unusual presentation of a classic Hodgkin lymphoma. Case report

O linfoma é uma neoplasia originária do sistema linfático, a partir de células linfocitárias. A sintomatologia mais comum é febre, tosse, sudorese noturna, perda de peso, fraqueza e linfoadenopatia indolor. A etiologia ainda permanece desconhecida, tendo sido relacionada ao vírus Epstein-Barr. O diagnóstico se baseia na visualização das células de Reed-Sternberg. O esquema adriamicina, bleomicina, vinblastina e dacarbazina (ABVD) ainda é o tratamento preconizado, associado ou não à radioterapia. Relatamos um caso de linfoma de Hodgkin de apresentação atípica, cujo diagnóstico só foi possível por esplenectomia.(AU)

The lymphoma is a cancer of the lymphatic system originating from lymphocyte cells. The most common symptoms are fever, cough, night sweats, weight loss, weakness, and painless lymphadenopathy. The etiology remains unknown, having been related to the Epstein Barr virus. The diagnosis is based on visualization of Reed Sternberg cells. The adriamycin, bleomicin, vinblastine and dacarbazine (ABVD) regimen is still the preferred treatment, with or without radiation therapy. We report a case of Hodgkin's lymphoma of atypical presentation, the diagnosis of which was only possible through splenectomy.(AU)

Linfoma primario de ano en un paciente con virus de la inmunodeficiencia humana/sida / Primary lymphoma of anus in a patient with human immunodeficiency virus/AIDS

Se presenta el caso clínico de un paciente de 47 años de edad con seropositividad del virus de inmunodeficiencia humana/sida desde hacía 5 años, quien acudió a la consulta de Cirugía en el Hospital Gubernamental de Mbabane en Suazilandia, por presentar un tumor anal; se diagnosticó hemorroides, pero el tumor continuó aumentando de tamaño, unido a sangrado e intenso dolor. Se realizó una biopsia por incisión que indicó la presencia de un linfoma de alto grado de malignidad. Posteriormente el paciente fue evaluado en la consulta de Oncología, donde se le indicaron los exámenes complementarios necesarios, los que revelaron que la neoplasia se encontraba en estadio IE; de manera que fue remitido a Sudáfrica para recibir quimioterapia combinada, con la cual desapareció la lesión maligna y se controló la enfermedad

The case report of a 47 years patient with the human immunodeficiency virus/AIDS for 5 years is presented. He went to the Surgery Service in the Government Hospital of Mbabane in Swaziland, due to an anus malignancy; hemorrhoids was diagnosed, but its size continued increasing, along with bleeding and acute pain. An incision biopsy that indicated the presence of a high grade lymphoma malignancy was carried out. Later on the patient was evaluated in the Oncology Service, where the necessary complementary exams were indicated, revealing that neoplasm was in IE stage; so he was referred to South Africa to receive combined chemotherapy, with which the malignant lesion disappeared and the disease was controlled

Reação adversa a medicamento: uma análise comparativa de protocolos utilizados para o tratamento do câncer colorretal / Adverse drug reaction: a comparative analysis of protocols used for treatment of colorectal cancer

Study design: Cohort study Objective: Analyze the adverse reactions that occurred in Brazilian patients with colorectal cancer submitted to chemotherapy with two different protocols, in order to identify the types and severity of those most frequent recorded. Methods: Sixty-three patients, who started treatment from June 2014 to May 2015, were separated into two groups: mFOLFOX6 (protocol containing oxaliplatin, folinic acid and 5-fluorouracil in bolus and continuous infusion, n= 40) and FOLFIRI (protocol containing irinotecan, folinic acid and 5-fluorouracil in bolus and continuous infusions, n= 23). Data related to the demographic and clinical profile of the patients were collected from the medical record, as well as information about the treatment performed and the adverse reactions manifested. The reactions were classified according to their severity (grades 1, 2, 3 and 4) and causality (definite, probable, possible and doubtful). Results: A high frequency of adverse reactions was observed in both groups, reaching 92.5% of patients with mFOLFOX6 protocol and 95.6% with FOLFIRI protocol. Gastrointestinal and neurological toxicities were the most frequent among the groups. When comparing the occurrence of intergroup reactions, there was difference only for gastrointestinal toxicities (p= 0.035). In 17.5% of patients mFOLFOX6 group (n= 7) and in 8.7% of patients FOLFIRI group (n= 2), grades 3 and 4 adverse reactions were observed and classified as probable. Conclusion: The adverse reactions were more diversified and frequent in the mFOLFOX6 group compared to the FOLFIRI group. However, no difference was observed in the severity and causality of reactions in both groups (AU)

Study design: Cohort study Objective: Analyze the adverse reactions that occurred in Brazilian patients with colorectal cancer submitted to chemotherapy with two different protocols, in order to identify the types and severity of those most frequent recorded. Methods: Sixty-three patients, who started treatment from June 2014 to May 2015, were separated into two groups: mFOLFOX6 (protocol containing oxaliplatin, folinic acid and 5-fluorouracil in bolus and continuous infusion, n= 40) and FOLFIRI (protocol containing irinotecan, folinic acid and 5-fluorouracil in bolus and continuous infusions, n= 23). Data related to the demographic and clinical profile of the patients were collected from the medical record, as well as information about the treatment performed and the adverse reactions manifested. The reactions were classified according to their severity (grades 1, 2, 3 and 4) and causality (definite, probable, possible and doubtful). Results: A high frequency of adverse reactions was observed in both groups, reaching 92.5% of patients with mFOLFOX6 protocol and 95.6% with FOLFIRI protocol. Gastrointestinal and neurological toxicities were the most frequent among the groups. When comparing the occurrence of intergroup reactions, there was difference only for gastrointestinal toxicities (p= 0.035). In 17.5% of patients mFOLFOX6 group (n= 7) and in 8.7% of patients FOLFIRI group (n= 2), grades 3 and 4 adverse reactions were observed and classified as probable. Conclusion: The adverse reactions were more diversified and frequent in the mFOLFOX6 group compared to the FOLFIRI group. However, no difference was observed in the severity and causality of reactions in both groups.(AU)

Multifocal primary cutaneous extranodal NK/T lymphoma nasal type

Abstract Nasal type extranodal NK/T-cell lymphoma is a distinct entity according to the World Health Organization classification. Although 60% to 90% of patients with this disease present with a destructive mass in the midline facial tissues, it may also primarily or secondarily involve extranasal sites, like the skin. We report the case of a 77-year-old patient that came to our department with erythematous plaques of the right leg and eczematous lesions of the trunk. These lesions were biopsied and the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. He was treated with multi-agent systemic chemotherapy but died 5 months after diagnosis. This case highlights the rarity and variability of cutaneous features of this disease and its aggressive course and poor prognosis.

Beneficio de la quimioterapia adyuvante en pacientes con cáncer de colon: cohorte retrospectiva de un hospital clínico universitario / Benefit of adjuvant 5-fluorouracil based chemotherapy for colon cancer: a retrospective cohort study

Background: Multiple clinical trials have demonstrated the benefits of adjuvant 5-fluorouracil-based chemotherapy for patients with resectable colon cancer (CC), especially in stage III. Aim: To describe the clinical characteristics of a cohort of CC patients treated at a single university hospital in Chile since 2002, and to investigate if chemotherapy had an effect on survival rates. Material and Methods: Review of a tumor registry of the hospital. Medical records of patients with CC treated between 2002 and 2012 were reviewed. Death certificates from the National Identification Service were used to determine mortality. Overall survival was described using the Kaplan-Meier method. A multivariate Cox proportional hazard regression model was also used. Results: A total of 370 patients were treated during the study period (202 in stage II and 168 in stage III). Adjuvant chemotherapy was administered to 22 and 70% of patients in stage II and III respectively. The median follow-up period was 4.6 years. The 5-year survival rate for stage II patients was 79% and there was no benefit observed with adjuvant chemotherapy. For stage III patients, the 5-year survival rate was 81% for patients who received adjuvant chemotherapy, compared to 56% for those who did not receive chemotherapy (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.15-0.56). The benefit of chemotherapy was found to persist after adjustment for other prognostic variables (HR: 0.47; 95% CI: 0.23-0.94).Conclusions: Patients with colon cancer in stage III who received adjuvant chemotherapy had a better overall survival.

Cutaneous primary B-cell lymphomas: from diagnosis to treatment

AbstractPrimary cutaneous B-cell lymphomas are a heterogeneous group of mature B-cells neoplasms with tropism for the skin, whose biology and clinical course differ significantly from the equivalent nodal lymphomas. The most indolent forms comprise the primary cutaneous marginal zone and follicle center B-cell lymphomas that despite the excellent prognosis have cutaneous recurrences very commonly. The most aggressive forms include the primary cutaneous large B-cell lymphomas, consisting in two major groups: the leg type, with poor prognosis, and others, the latter representing a heterogeneous group of lymphomas from which specific entities are supposed to be individualized over time, such as intravascular large B-cell lymphomas. Treatment may include surgical excision, radiotherapy, antibiotics, corticosteroids, interferon, monoclonal antibodies and chemotherapy, depending on the type of lymphoma and on the type and location of the skin lesions. In subtypes with good prognosis is contraindicated overtreatment and in those associated with a worse prognosis the recommended therapy relies on CHOP-like regimens associated with rituximab, assisted or not with local radiotherapy. We review the primary cutaneous B-cell lymphomas, remembering the diagnostic criteria, differential diagnosis, classification, and prognostic factors and presenting the available therapies.

Primary nodal peripheral T-cell lymphomas: diagnosis and therapeutic considerations

Nodal peripheral T-cell lymphomas are a rare group of neoplasms derived from post-thymic and activated T lymphocytes. A review of scientific articles listed in PubMed, Lilacs, and the Cochrane Library databases was performed using the term "peripheral T-cell lymphomas". According to the World Health Organization classification of hematopoietic tissue tumors, this group of neoplasms consists of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase positive (ALCL-ALK+), and a provisional entity called anaplastic large cell lymphoma-anaplastic lymphoma kinase negative (ALCL-ALK-). Because the treatment and prognoses of these neoplasms involve different principles, it is essential to distinguish each one by its clinical, immunophenotypic, genetic, and molecular features. Except for anaplastic large cell lymphoma-anaplastic lymphoma kinase positive, which has no adverse international prognostic index, the prognosis of nodal peripheral T-cell lymphomas is worse than that of aggressive B-cell lymphomas. Chemotherapy based on anthracyclines provides poor outcomes because these neoplasms frequently have multidrug-resistant phenotypes. Based on this, the current tendency is to use intensified cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) regimens with the addition of new drugs, and autologous hematopoietic stem cell transplantation. This paper describes the clinical features and diagnostic methods, and proposes a therapeutic algorithm for nodal peripheral T-cell lymphoma patients...

Primary nodal peripheral T-cell lymphomas: diagnosis and therapeutic considerations.

Nodal peripheral T-cell lymphomas are a rare group of neoplasms derived from post-thymic and activated T lymphocytes. A review of scientific articles listed in PubMed, Lilacs, and the Cochrane Library databases was performed using the term "peripheral T-cell lymphomas". According to the World Health Organization classification of hematopoietic tissue tumors, this group of neoplasms consists of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase positive (ALCL-ALK(+)), and a provisional entity called anaplastic large cell lymphoma-anaplastic lymphoma kinase negative (ALCL-ALK(-)). Because the treatment and prognoses of these neoplasms involve different principles, it is essential to distinguish each one by its clinical, immunophenotypic, genetic, and molecular features. Except for anaplastic large cell lymphoma-anaplastic lymphoma kinase positive, which has no adverse international prognostic index, the prognosis of nodal peripheral T-cell lymphomas is worse than that of aggressive B-cell lymphomas. Chemotherapy based on anthracyclines provides poor outcomes because these neoplasms frequently have multidrug-resistant phenotypes. Based on this, the current tendency is to use intensified cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) regimens with the addition of new drugs, and autologous hematopoietic stem cell transplantation. This paper describes the clinical features and diagnostic methods, and proposes a therapeutic algorithm for nodal peripheral T-cell lymphoma patients.

Dermatite flagelada induzida por bleomicina: relato de caso / Bleomycin-induced flagellate dermatitis: a case report / Dermatitis flagelada inducida por bleomicina: relato de caso

A Dermatite Flagelada consiste de uma hiperpigmentação cutânea de aspecto flagelado, tendo como causa específica a bleomicina. A bleomicina é um agente quimioterápico usado no tratamento de diferentes neoplasias. O objetivo deste relato é descrever o caso de uma paciente de 31 anos de idade, em tratamento de Linfoma de Hodgkin com protocolo de Quimioterapia Antineoplásica composto por quatro drogas, dentre elas, a bleomicina, que cursou com o desenvolvimento da Dermatite Flagelada. Trata-se de um relato de caso ocorrido num hospital universitário do nordeste do Brasil em 2014. A terapia utilizada como tratamento foi uso de corticoide, o que proporcionou a remissão das lesões do tipo flagelo e permitiu a continuidade do tratamento sem necessidade de mudança do protocolo quimioterápico. A importância do estudo se deve por levantar discussão sobre os aspectos que envolvem o manejo dessa hipersensibilidade, para garantir a continuidade do tratamento antineoplásico (AU).

Flagellate Dermatitis consists of cutaneous hyperpigmentation with a flagellate appearance, one specific cause of which is bleomycin. Bleomycin is a chemotherapy agent used in the treatment of different neoplasias. This report's objective is to describe the case of a 31-year-old patient receiving treatment for Hodgkin Lymphoma with a protocol of Antineoplastic Chemotherapy made up of four drugs, including bleomycin, which led to the development of Flagellate Dermatitis. This is a report of a case which took place in a teaching hospital in the Northeast of Brazil in 2014. The therapy used as treatment was use of corticosteroid, which led to the remission of the lesions of the flagellate type and allow the continuation of the treatment without the need for changing the chemotherapy protocol. The study's importance lies in that it raises discussion regarding the aspects involving the management of this hypersensitivity so as to ensure the continuity of the antineoplastic treatment (AU).

La dermatitis flagelada consiste en una hiperpigmentación cutánea de aspecto flagelado y su causa específica es la bleomicina. La bleomicina es un agente quimioterápico usado en el tratamiento de diferentes neoplasias. El objetivo de este relato fue describir el caso de una paciente de 31 años de edad, en tratamiento de Linfoma de Hodgkin con protocolo de Quimioterapia Antineoplásica compuesto por cuatro drogas, entre las cuales la bleomicina, ocasionada con desarrollo de Dermatitis Flagelada. El caso ocurrió en un hospital universitario del nordeste del Brasil en 2014. La terapia utilizada como tratamiento fue uso de corticoide, lo que proporcionó la remisión de las lesiones del tipo flagelo y permitió la continuidad del tratamiento sin necesidad de cambio del protocolo quimioterápico. El papel del estudio es abrir discusión acerca de los aspectos que involucran el manejo de esa hipersensibilidad, para garantizar la continuidad del tratamiento antineoplásico (AU).

Prognostic factors in adolescent and adult patients with acute lymphoblastic leukemia with two protocols of chemotherapy: a cross-sectional study.

BACKGROUND: We evaluated the clinical, laboratory, and prognostic factors in adolescent and adult patients with acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: In this observational, retrospective, cross-sectional study, we examined the medical records of all consecutive patients with ALL admitted to a public hospital in Brazil from 1990 to 2005. RESULTS: Of the 102 patients included, 88 were treated with 2 protocols of chemotherapy (Berlin-Frankfurt-Münster [BFM] 86 modified [BFM-86M] and UCLA [University of California, Los Angeles] protocol). The complete remission (CR), disease-free survival, and overall survival (OS) rate was 70.6%, 27%, and 30.5%, respectively (median follow-up, 49 months). Age < 18 years and no leukemic infiltration in the central nervous system (CNS) at diagnosis were positively associated with CR (P = .03); no bleeding and hepatomegaly at diagnosis and age < 35 years were associated with better OS on multivariate analyses of the whole population (P = .01). OS at 4 years was superior with BFM-86M than with UCLA (49.5% vs. 16%; P = .004), especially in young adults without risk factors. CONCLUSION: We identified age as the most important prognostic factor in patients with ALL. CNS infiltration, hepatomegaly, and bleeding were associated with lower OS but must be validated in future research with South American populations and worldwide. The BFM-86M protocol can be considered a therapeutic option for young adults (age < 35 years) without adverse prognostic factors. For other patients with ALL, we emphasize the need for different therapeutic approaches.

Comparación del hyper-CVAD con un régimen institucional en el tratamiento de la leucemia linfoblástica aguda del adulto en un hospital de México / Comparison of the hyper-CVAD with an institutional regimen for the treatment of acute lymphoblastic leukemia in adults in a hospital of Mexico

Con el objetivo de evaluar la mortalidad y toxicidad del protocolo Hyper-CVAD utilizado como primera línea de tratamiento de la leucemia linfoblástica aguda se realizó un estudio de cohorte retrospectiva en pacientes de 40 años a menos durante marzo a septiembre de 2011 atendidos con el régimen Hyper-CVAD. La mortalidad y toxicidad se comparó con los resultados de los pacientes atendidos con el régimen institucional HGMLAL07 entre 2009 a 2012. Se incluyeron 18 pacientes, la mediana de edad fue de 26 años. Tanto las remisiones completas (67,7% frente a 81,9%) como la supervivencia a un año (40% frente a 62%) y 2 años (18% frente a 34%) fueron menores con el régimen Hyper-CVAD. Al seleccionar exclusivamente pacientes menores de 35 años, la eficacia de Hyper-CVAD también fue menor. Según esta experiencia y debido a su alto costo y toxicidad, el régimen Hyper-CVAD debe de limitarse a aquellos pacientes con leucemias refractarias o en recaída...

In order to assess the mortality and toxicity of the Hyper-CVAD protocol used as first-line treatment of acute lymphoblastic leukemia, a retrospective cohort study was performed in patients less than 40 years of age from March to September 2011 treated with Hyper-CVAD regimen. Mortality and toxicity was compared with the results of patients treated with the institutional HGMLAL07 regimen between 2009-2012. 18 patients were included; the median age was 26 years old. Complete remissions (67.7% versus 81.9%) as well as one-year (40% versus 62%) and 2 year survival rates (18% versus 34%) were lower with the Hyper-CVAD regimen. By selecting only patients younger than 35 years, the effectiveness of Hyper-CVAD was also lower. In our experience and because of its high cost and toxicity, the Hyper-CVAD regimen should be limited to patients with relapsed or refractory leukemia...

[Effect of metformin addition to an acute lymphoblastic leukemia chemotherapy treatment]. / Metformina adicionada a la quimioterapia contra la leucemia linfoblástica aguda.

BACKGROUND: Recently it has been reported a benefit effect with the use of metformin in patients with malignant disease. Our objective was to evaluate the effect of adding metformin to chemotherapy regimen over the percentage of early relapse in acute lymphoblastic leukemia. METHODS: A prospective, longitudinal and experimental study was performed in patients with de novo acute lymphoblastic leukemia enrolled in the Hospital General de México. They were divided in two groups: first group received chemotherapy + metformin (850 mg three times a day); second group only received standard chemotherapy. The sample was randomized 3:1 in favor of the second group. RESULTS: 93 patients were included (73 treated with chemotherapy + metformin and 20 received standard chemotherapy), with 303 ± 53 days of follow-up. Complete remission was higher in the group without metformin (81.3 % [n = 61] versus 70 % [n = 14]), which also presented more patients with relapse (47.9 % versus 25 %). Overall survival at one year was of 68 % and free survival disease was 64 %, without significant differences between groups. Absence of metformin was the only variable of adverse prognostic considered significant (p = 0.55). Cox regression showed that adding metfomin reduced 56 % the risk of relapse. CONCLUSIONS: The adding metformin to the treatment of leukemias showed that was useful in our research. However, randomized and double-blind studies must be designed in order to express final recommendations about its use.

INTRODUCCIÓN: se ha informado efecto benéfico con metformina en pacientes con cáncer. El objetivo de esta investigación fue evaluar el efecto de adicionar metformina a la quimioterapia sobre las recaídas tempranas en pacientes con leucemia linfoblástica aguda. MÉTODOS: estudio prospectivo, longitudinal y experimental de pacientes portadores de leucemia linfoblástica aguda de novo, realizado en el Hospital General de Mexico. La muestra fue dividida en dos brazos de tratamiento: uno recibió metformina (850 mg cada ocho horas) + quimioterapia; otro recibió únicamente quimioterapia estándar. La distribución de los pacientes fue aleatoria, 3:1 a favor del segundo brazo. RESULTADOS: se incluyeron 93 pacientes (73 recibieron quimioterapia + metformina y 20, quimioterapia estándar); el seguimiento fue de 303 ± 53 días. La remisión completa fue mayor en el grupo sin metformina comparado con el que recibió quimioterapia + metformina (81.3 % [n = 61] y 70 % [n = 14], respectivamente), al igual que las recaídas (47.9 y 25 %, respectivamente). La supervivencia global a un año fue de 68 % y la supervivencia libre de la enfermedad fue de 64 %, sin diferencias entre los grupos. La única variable de pronóstico adverso con relevancia significativa fue la ausencia de metformina (p = 0.55). La regresión de Cox demostró que adicionarla redujo 56 % el riesgo de recaída. CONCLUSIONES: la adición de metformina al tratamiento de la leucemia fue de utilidad en nuestra investigación, sin embargo, deberán diseñarse estudios aleatorizados y doble ciego para emitir recomendaciones definitivas.