RESUMEN
PURPOSE: Analysis of the feasibility and results of adjuvant chemotherapy followed by conformal chemoradiotherapy after surgery for gastric carcinoma. PATIENTS AND METHODS: Twenty-six patients (R0 or R1) were treated postoperatively by three cycles of 5-fluorouracil (5-FU) and cisplatin, followed by a concomitant association of LV5FU2 chemotherapy with a conformal radiotherapy of 45 Gy. RESULTS: The tumor was classified pT3-T4 in 77% of the patients and 92.5% had a nodal involvement (pN1: 54%; pN2: 31%). FEASIBILITY: (1) Adjuvant chemotherapy: nausea/vomiting grade II/III: 12 patients (48%); neutropenia grade III/IV: two patients; completed in all patients, except one. (2) Chemoradiotherapy: nausea/vomiting grade II/III: 10 patients; diarrhea grade II/3: two patients; oesophagitis grade II/III: two patients; myocardial infarction/pulmonary embolism: two patients. All patients except one received the planned dose of 45Gy. Radiotherapy was interrupted in six cases, with a median duration of 14 days. Survival: with a median follow-up of 30 months, 65% of the patients were alive without disease; median survival was 32 months. CONCLUSION: This postoperative schedule was judged feasible. It allowed the deliverance of a more intensified chemotherapy than the classical schedule. Its clinical benefit must be evaluated in a phase III trial.
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Radioterapia Conformacional/métodos , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/radioterapia , Adulto , Anciano , Quimioterapia Adyuvante/métodos , Terapia Combinada , Gastrectomía , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Análisis de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: We report two cases of patients with prostate cancer who underwent haematological complications from the disease. CLINICAL CASES: Diffuse intravascular coagulopathy (with thrombopenia) was observed in two patients (55 and 59 years-old) diagnosed with prostate cancer. In one patient who had normal prostate at clinical examination, thrombopenia with incomplete diffuse intravascular coagulopathy and biological inflammatory led to diagnosis. It was initially controlled by hormonal therapy and secondary by chemotherapy. In the other patient diffuse intravascular coagulopathy followed introduction of hormonal therapy and lead to the patient's death. DISCUSSION: Patients with metastatic hormone-refractory prostate carcinoma may have life-threatening coagulation complications due to their disease. Diffuse intravascular coagulopathy is the most frequent coagulation complication. Other coagulopathies associated with prostate cancer are thrombocytopenic thrombotic purpura, thrombosis, Trousseau's syndrome and acquired factor VIII inhibitor development. Usually these haematological manifestations complicate the course of the disease and appear to have a bad prognosis. But thrombopenia or haematologic features may lead to the diagnosis of medullary metastatic prostatic cancer, even if the prostate appears normal at the initial clinical examination.
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Coagulación Intravascular Diseminada/etiología , Neoplasias de la Próstata/diagnóstico , Trombocitopenia/etiología , Adenocarcinoma , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/tratamiento farmacológicoRESUMEN
Although well described in the literature, gastric metastases are often misdiagnosed in patients with breast cancer. The accuracy of diagnosis is critical because systemic therapy is beneficial, affording symptom palliation and an opportunity to avoid an unnecessary gastrectomy.
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Neoplasias de la Mama/patología , Neoplasias Gástricas/secundario , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologíaRESUMEN
PURPOSE: Several studies have demonstrated that systematic breast cancer screening increases overall survival. We report our experience regarding diagnosis of breast lesions detected using mammography. METHODS: Case reports of patients operated on in either 1992 or 1993 were retrospectively reviewed. A multivariate analysis of the clinico-pathological correlation was performed. RESULTS: Four hundred fifty seven patients representing on total 544 procedures, were included in the study. Mean age was 50.5 years (range 19-80 years). Most of the patients had no previous history of mammary lesion. Mammography was performed with prophylactic intent in more than 60% of the cases. Four hundred twelve (75.7%) benign lesions were diagnosed. Main lesions were: adenofibroma (15.7%), fibrocystic mastopathy (66.3%), adenosis (26.2%), ductal hyperplasia (23.9%), lobular hyperplasia (10.7%), and combined ductal and lobular hyperplasia (8.5%). Hyperplasia accompanied by cytonuclear atypia was observed in 49 (11%) cases. One hundred thirty two (24.3%) malignant lesions were reported, including 69 (52.3%) invasive carcinomas and 63 (47.7%) in situ carcinomas. Only nine axillary lymph node dissections were positive and 75 minimal breast cancers were diagnosed. The multivariate analysis showed that only radiological signs are a risk factor for cancer. The relative risk for cancer when focus of irregular and vermicular microcalcifications are diagnosed is 4.2 (2.0-8.5). It is 5.6 (2.5-12.5) in case of spiculated opacity. CONCLUSION: Exeresis following radiological prophylactic screening allows diagnosis of high-risk benign lesions and low-stage breast cancer. Radiological parameters are the most powerful predictive factors for malignancy.
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Neoplasias de la Mama/diagnóstico por imagen , Mamografía/normas , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Tamizaje Masivo , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
Ewing's sarcoma of the pelvic bones was diagnosed in a 21-year childbearing woman, raising major medical and ethical problems. The diagnostic and therapeutic approaches during the sixth month of gestation were tailored in order to cure the patient and avoid unnecessary toxicity to the fetus. Ancillary tests included ultrasound and MRI studies of the pelvis. Ifosfamide and adriamycin, premedicated by granisetron, were administered during gestation, and were found to be safe. Cesarean section was the preferred way of delivery since the tumor involved the pelvic bones. The outcome was a disease-free patient and a small healthy baby who is now two years of age.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Huesos Pélvicos , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Resultado del Embarazo , Diagnóstico Prenatal/métodos , Sarcoma de Ewing/tratamiento farmacológico , Adulto , Neoplasias Óseas/diagnóstico , Cesárea , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Ifosfamida/administración & dosificación , Recién Nacido , Bombas de Infusión Implantables , Infusiones Intravenosas , Imagen por Resonancia Magnética , Mesna/administración & dosificación , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico , Tercer Trimestre del Embarazo , Sarcoma de Ewing/diagnóstico , Ultrasonografía PrenatalRESUMEN
To evaluate CD34+ selection of peripheral blood stem cells (PBSC) as a graft for autologous transplantation. Eight relapsing follicular lymphoma (FL) patients were submitted to CD34+ autologous stem cell transplantation (ASCT). All patients received at least two front line conventional therapies; mean time to treatment failure (TTF) was 4.5 months. Patients had disseminated stage III-IV disease after a median number of 2.1 relapses. Chemotherapy and G-CSF were used as mobilization for leukapheresis. CEPRATE SC concentrator (CellPro, Inc, Bothell, WA) was used to select CD34+ cells from leukapheresis products. With a mean of 1.8 leukaphereses per patient, 8.1 x 10(8) mononuclear cells (MNCs)/kg were collected. After the selection process, the median number of MNCs was 9.4 x 10(6)/kg; 4.3 x 10(6)/kg CD34+ cells and 17 x 10(4)/kg CFU-GM, with a purity of 83.7% and a viability of 89.2%. Mbr bcl2/IgH PCR analysis of 5 grafts showed that initial buffy-coat, and CD34- fractions were negative in 3 cases and positive in 2 cases (from whom selected CD34+ fraction remained positive in 1 case). After a conditioning regimen including total body irradiation, cyclophosphamide and etoposide, CD34+ selected cells were reinfused. All patients but one had successful engraftment, median time to WBC > 1 x 10(9)/l was 12 days and platelets > 50 x 10(9)/l 17 days. No severe infectious complications were seen. After transplant, with a minimum follow up of 2 years, 5 patients are still in complete remission (CR). Three patients have relapsed after 1 year of transplant with a mean TTF of 15.6 months. We conclude that PBSC CD34+ selection for ASCT was a safe technique, capable of reconstituting hemopoiesis without severe complications for high risk FL patients included in this study. The effects of tumor cell purging need to be evaluated in a larger series.