Postoperative adjuvant treatment for gastric cancer improves long-term survival after curative resection and D2 lymphadenectomy. Results from a Latin American Center.

BACKGROUND: The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for gastric cancer and a D2 lymph node dissection. METHODS: We performed a retrospective cohort study. Patients operated from 1996 to 2013 were selected. We compared long term survival of patients treated with surgery alone and those with surgery plus postoperative adjuvant treatment. A multivariate analysis for survival was applied in every stage. RESULTS: The study included 580 patients. Two-hundred and four patients received postoperative adjuvant treatment (AD) and 376 patients were treated only with surgery (SU). Patients in the AD group were younger (60 versus 68, p < 0.001), had a lower rate of multiple organ resection (21% versus 39%, p < 0.001) and had less postoperative complications (14% versus 32%, p < 0.001). In the AD group, patients had more advanced disease (stage III; 77% versus 66%, p < 0.001). No difference was found in lymph nodes resected (31 versus 30, p = ns). The median survival with adjuvant treatment was 33 months (39% 5 year survival) and 22 months (31% 5 year survival) for patients without adjuvant treatment (p = 0.003). On multivariate analysis, patients with stage IIIB and IIIC had significantly better overall and disease specific long-term survival with adjuvant treatment. CONCLUSIONS: These results suggest that there is a long-term survival benefit for patients treated with postoperative adjuvant treatment for stages IIIB and IIIC gastric cancer after D2 lymph node dissection.

Preoperative chemoradiotherapy in the treatment of gallbladder cancer.

Gallbladder cancer is generally associated with a poor prognosis, with local recurrence being the main pattern of failure. In an attempt to improve on the present status of management, we evaluated a prospective Phase II study involving preoperative 5-fluorouracil and radiation. Among 27 eligible patients with a potentially resectable gallbladder cancer detected after cholecystectomy, 18 were treated with preoperative radiation (4500 cGy; 180 cGy/fraction, 5 days/week) concurrent with a continuous infusion of 5-fluorouracil (350 mg/m2/day, days 1-5 and 21-25). Toxicity included leukopenia (8 patients) and thrombocytopenia (7 patients). Delay in surgery due to hematological toxicity was seen in 6 patients. Of the 18 patients, 15 underwent a reoperation. Resection was performed in 13 (86%). Pathologic findings after reoperation revealed residual tumor in both liver and lymph nodes in 3 patients. At a median follow-up of 24 months, 7 patients are alive. Among the patients who died after curative resection, local recurrence was demonstrated in only 1. This is the first report concerning preoperative chemoradiation in gallbladder cancer. To assess its effect on survival, a prospective randomized trial will be necessary.

[Is there risk of AIDS among adolescents?]. / Hay riesgo de SIDA en adolescentes?

PIP: No data are as yet available on the information and attitudes of the adolescent population of Chile regarding AIDS. A survey of 800 adolescents aged 16-19 in Massachusetts, US, indicated that 29% had no knowledge of AIDS, 70% were sexually active, and 15% would not change their sex habits to avoid AIDS. A study in Santiago, Chile, showed that young people with the least information on sex and reproduction had the earliest initiation of sexual activity and the most frequent relations. Surveys throughout Latin America have indicated that a significant proportion of adolescents have active sex lives, leaving them potentially vulnerable to risk of sexually transmitted diseases. The risk is increased by frequent changes of partners among couples not yet strongly committed to each other. The World Health Organization considers prevention of sexually transmitted diseases to be one of the main objectives of family planning programs for adolescents. Studies in various countries found that proportion of sexually active adolescents who routinely used condoms was low. The evidence thus indicates that adolescents are at substantial risk of AIDS through their lack of information about AIDS, their significant sexual activity, and their failure to use condoms. Measures to combat or minimize the threat of AIDS among adolescents should begin with educational programs beginning with teachers and families. Efforts should be made to reach young people in the informal sector who are at greatest risk through community based programs.^ieng

Retinoblastoma: nuevo protocolo de clasificacion y tratamiento. / Retinoblastoma: new protocol of classification and treatment

Se da a conocer un protocolo de tratamiento del retinoblastoma, que combina cirugia, fotocoagulacion, crioterapia, quimioterapia y radioterapia. Se pretende evaluar dicho tratamiento, como tambien la utilidad de la clasificacion anatomopatologica de Pratt, que complementa la de Reese Ellsworth. En forma preliminar se comunican 17 casos de retinoblastoma, clasificados y tratados segun el nuevo protocolo