Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up.

PURPOSE: Major progress has occurred in multiple myeloma (MM) treatment in recent years, but this is not seen in low- and middle-income countries. MATERIALS AND METHODS: We retrospectively assessed the efficacy and safety of cyclophosphamide, thalidomide, and dexamethasone (cyclophosphamide 400 mg/m2 for 5 days, thalidomide 100 mg once daily, if tolerated, and dexamethasone 40 mg once weekly; in 28-day cycles) in patients with newly diagnosed MM treated at our institution between April 2008 and December 2012. Survival outcomes were estimated by the Kaplan-Meier method. RESULTS: Fifty-nine patients were found to meet the selection criteria. Median age was 56 years (27-78). Fifty-nine percent (n = 35) were male. International Staging System three was found in 24%. The median number of treatment cycles was 11 (range 4-12). After a median of 81-month follow-up (range 5-138 months), the overall response rate was 69.5%. The complete response and very good partial response were 5% and 32%, respectively. Median progression-free survival (PFS) was 35 months (95% CI, 18 to 41). The 3-year PFS was 47.4% (95% CI, 34.5 to 59.6) and 5-year PFS was 24.9% (95% CI, 14.4 to 36.9). The median of overall survival (OS) was 81 months (95% CI, 33 to not reached). The 3-year OS was 63.4% (95% CI, 49.2 to 74.6), and 5-year OS was 57.5% (95% CI, 43.2 to 69.4). The most common adverse event was neutropenia (grade 3 and 4, 30.5%). Out of 23 patients eligible for stem-cell transplantation, 10 (43.5%) proceeded with autologous transplantation. Treatment-related deaths occurred in four patients (6.7%). CONCLUSION: Cyclophosphamide, thalidomide, and dexamethasone achieves good response rates with tolerable toxicity, especially in patients age 65 years or younger representing a feasible approach for patients with MM in low-income health care settings.

Plasma lactate and leukocyte mitochondrial DNA copy number as biomarkers of insulin sensitivity in non-diabetic women.

High plasma lactate levels have been associated with reduced mitochondrial respiratory capacity and increased type 2 diabetes risk, while mitochondrial DNA (mtDNA) copy number has been proposed as a biomarker of mitochondrial function linked to glucose homeostasis. The aim of this study was to evaluate the association between circulating lactate levels and leukocyte mtDNA copy numbers with insulin secretion/sensitivity indexes in 65 Chilean non-diabetic women. mtDNA copy numbers were measured in leukocytes using qPCR and digital-droplet PCR. A 75-g Oral Glucose Tolerance Test (OGTT) was performed to calculate systemic and tissue-specific insulin sensitivity indexes, as well as insulin secretion surrogates based on plasma c-peptide. An intravenous glucose tolerance test (IVGTT; 0.3 g/kg) was also carried out. Disposition indexes were calculated as the product of insulin secretion × sensitivity. Plasma levels of leptin, adiponectin, TNF-α, MCP-1, and non-esterified fatty acids were also determined. Fasting plasma lactate shows a significant association with a wide range of insulin sensitivity/resistance indexes based on fasting plasma samples (HOMA-S, adipose IR index, Revised-QUICKI, leptin-adiponectin ratio, TyG index, McAuley index and TG-to-HDL-C ratio), as well as OGTT-based measures such as the Matsuda index, the hepatic insulin resistance index, and the disposition index. Fasting plasma lactate was also positively associated with the circulating adipokines TNF-α and MCP-1. We also detected a direct association between fasting plasma lactate with leukocyte mtDNA copy numbers. The above results support the use of fasting plasma lactate, and possibly leukocyte mtDNA copy numbers, as biomarkers of reduced oxidative mitochondrial capacity, decreased hepatic insulin sensitivity, and future diabetes risk.

Primary cutaneous T-cell lymphoma: experience from the Peruvian National Cancer Institute.

BACKGROUND: Primary cutaneous T-cell lymphomas constitute a heterogeneous and rare group of diseases with regional particularities in Latin America. OBJECTIVE: To determine the clinicopathological features, relative frequency and survival among patients from a Peruvian institution. METHODS: Primary cutaneous T-cell lymphomas were defined based on the absence of extracutaneous disease at diagnosis. Classification was performed following the 2008 World Health Organization Classification of Neoplasms of the Hematopoietic and Lymphoid tissues. Risk groups were established according to the 2005 World Health Organization-EORTC classification for cutaneous lymphomas. Data of patients admitted between January 2008 and December 2012 were analyzed. RESULTS: 74 patients were included. Mean age was 49.5 years. In order of frequency, diagnoses were: mycosis fungoides (40.5%), peripheral T-cell lymphoma not otherwise specified (22.95%), adult T-cell lymphoma/leukemia (18.9%), CD30+ lymphoproliferative disorders (6.8%), hydroa vacciniforme-like lymphoma (5.4%), extranodal NK/T-cell lymphoma (4.1%) and Sézary syndrome (1.4%). Predominant clinical patterns were observed across different entities. Mycosis fungoides appeared mainly as plaques (93%). Peripheral T-cell lymphoma not otherwise specified and adult T-cell lymphoma/leukemia presentation was polymorphic. All patients with hydroa vacciniforme-like lymphoma presented with facial edema. All cases of extranodal NK/T-cell lymphoma appeared as ulcerated nodules/tumors. Disseminated cutaneous involvement was found in 71.6% cases. Forty-six percent of patients were alive at 5 years. Five-year overall survival was 76.4% and 19.2%, for indolent and high-risk lymphomas, respectively (p<0.05). High risk group (HR: 4.6 [2.08-10.18]) and increased DHL level (HR: 3.2 [1.57-6.46]) emerged as prognostic factors for survival. STUDY LIMITATIONS: Small series. CONCLUSION: Primary cutaneous T-cell lymphomas other than mycosis fungoides or CD30+ lymphoproliferative disorders are aggressive entities with a poor prognosis.

Primary cutaneous T-cell lymphoma: experience from the Peruvian National Cancer Institute

Abstract: Background: Primary cutaneous T-cell lymphomas constitute a heterogeneous and rare group of diseases with regional particularities in Latin America. Objective: To determine the clinicopathological features, relative frequency and survival among patients from a Peruvian institution. Methods: Primary cutaneous T-cell lymphomas were defined based on the absence of extracutaneous disease at diagnosis. Classification was performed following the 2008 World Health Organization Classification of Neoplasms of the Hematopoietic and Lymphoid tissues. Risk groups were established according to the 2005 World Health Organization-EORTC classification for cutaneous lymphomas. Data of patients admitted between January 2008 and December 2012 were analyzed. Results: 74 patients were included. Mean age was 49.5 years. In order of frequency, diagnoses were: mycosis fungoides (40.5%), peripheral T-cell lymphoma not otherwise specified (22.95%), adult T-cell lymphoma/leukemia (18.9%), CD30+ lymphoproliferative disorders (6.8%), hydroa vacciniforme-like lymphoma (5.4%), extranodal NK/T-cell lymphoma (4.1%) and Sézary syndrome (1.4%). Predominant clinical patterns were observed across different entities. Mycosis fungoides appeared mainly as plaques (93%). Peripheral T-cell lymphoma not otherwise specified and adult T-cell lymphoma/leukemia presentation was polymorphic. All patients with hydroa vacciniforme-like lymphoma presented with facial edema. All cases of extranodal NK/T-cell lymphoma appeared as ulcerated nodules/tumors. Disseminated cutaneous involvement was found in 71.6% cases. Forty-six percent of patients were alive at 5 years. Five-year overall survival was 76.4% and 19.2%, for indolent and high-risk lymphomas, respectively (p<0.05). High risk group (HR: 4.6 [2.08-10.18]) and increased DHL level (HR: 3.2 [1.57-6.46]) emerged as prognostic factors for survival. Study limitations: Small series. Conclusion: Primary cutaneous T-cell lymphomas other than mycosis fungoides or CD30+ lymphoproliferative disorders are aggressive entities with a poor prognosis.

Cáncer colorrectal en los jóvenes: factores pronósticos y características clínico patológicas en un instituto del cáncer de Perú.

OBJECTIVE: To determine clinicopathological features and prognostic factors among young colorectal cancer (CRC) patients in a Peruvian Cancer Institute. METHODS: Data of patients 40 years or younger, admitted between January 2005 and December 2010, were analyzed. RESULTS: During the study period, 196 young patients with CRC were admitted. The tumor was located in the rectum, left colon and right colon in 45.9%, 28.6% and 25.5% of cases. Family history of CRC was found in 13.2% and an autosomal pattern of inheritance, in 8.6% of the cases. The most common symptoms were pain (67.9%) and bleeding (67.3%). The majority (63.1%) of colon cancer cases and more than a third (34.4%) of rectal cancer cases were diagnosed in stage III or IV. The histologic type was tubular, mucinous and signet ring cell adenocarcinoma in 73.5%, 14.8% and 8.6%, respectively. The depth of invasion was T3 in 21.4% and T4 in 53%. Nodal involvement was detected in 44.5%. Five-year overall survival (OS) was 44.3%. In the multivariate analysis, only the stage resulted an independent prognostic factor for survival. CONCLUSIONS: CRC in Peruvian young patients is mostly sporadic. It presents more often in the distal colon or rectum and at advanced stages of the disease. Mucinous and signet ring cell carcinoma were requent histological types. Five-year OS stage by stage is similar to that reported in the literature for older patients. Stage was the only independent prognostic factor for survival.

Cáncer colorrectal en los jóvenes: factores pronósticos y características clínico patológicas en un instituto del cáncer de Perú / Colorectal cancer in the young: clinicopathologic features and prognostic factors from a cancer institute in Peru

To determine clinicopathological features and prognostic factors among young colorectal cancer (CRC) patients in a Peruvian Cancer Institute. Methods: Data of patients 40 years or younger, admitted between January 2005 and December 2010, were analyzed. Results: During the study period, 196 young patients with CRC were admitted. The tumor was located in the rectum, left colon and right colon in 45.9%, 28.6% and 25.5% of cases. Family history of CRC was found in 13.2% and an autosomal pattern of inheritance, in 8.6% of the cases. The most common symptoms were pain (67.9%) and bleeding (67.3%). The majority (63.1%) of colon cancer cases and more than a third (34.4%) of rectal cancer cases were diagnosed in stage III or IV. The histologic type was tubular, mucinous and signet ring cell adenocarcinoma in 73.5%, 14.8% and 8.6%, respectively. The depth of invasion was T3 in 21.4% and T4 in 53%. Nodal involvement was detected in 44.5%. Five-year overall survival (OS) was 44.3%. In the multivariate analysis, only the stage resulted an independent prognostic factor for survival. Conclusions: CRC in Peruvian young patients is mostly sporadic. It presents more often in the distal colon or rectum and at advanced stages of the disease. Mucinous and signet ring cell carcinoma were frequent histological types. Five-year OS stage by stage is similar to that reported in the literature for older patients. Stage was the only independent prognostic factor for survival...

Determinar las características clínicopatológicas y factores relacionados con el pronóstico del cáncer colorrectal (CCR) en los pacientes jóvenes del Instituto Nacional de Enfermedades Neoplásicas (INEN). Material y métodos: Se analizaron retrospectivamente los datos de los pacientes de 40 o menos años admitidos entre enero del 2005 y diciembre del 2010. Resultados: Se incluyeron 196 pacientes. La localización correspondió al recto, colon izquierdo y colon derecho en 45,9%, 28,6% y 25,5%. En 13,2% hubo antecedentes familiares de CCR y en 8.6%, un patrón de herencia autosómico dominante. Los síntomas más frecuentes fueron dolor (67,9%) y sangrado (67,3%). El 63,1% de los casos de cáncer de colon y el 34,4% de los casos de cáncer de recto, se diagnosticaron en estadio clínico (EC) III o IV. El tipo histológico correspondió a adenocarcinoma tubular, mucinoso y de células en anillo de sello en 73,5%, 14,8% y 8,6%, respectivamente. La profundidad de la invasión fue de T3 en 21,4% y de T4 en 53%. En 44,5% de los casos hubo compromiso ganglionar. La sobrevida global (SG) a 5 años fue de 44,3%. En el análisis multivariado, el estadio resultó ser un factor pronóstico independiente. Conclusiones: El CCR en jóvenes es en su mayoría esporádico, se presenta con mayor frecuencia en el colon distal o recto y en estadios avanzados. El carcinoma mucinoso y de células en anillo de sello fueron tipos histológicos frecuentes. La SG comparada por estadios es similar a la reportada en la literatura. El EC fue el único factor pronóstico independiente para sobrevida...

[Adjuvant chemo radiotherapy after gastrectomy and D2 lymphadenectomy in patients with gastric cancer in the National Institute of Cancer, Lima, Peru]. / Tratamiento adyuvante con quimioterapia y radioterapia luego de gastrectomía y disección ganglionar D2 en pacientes con cáncer gástrico en el Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú

INTRODUCTION: Adjuvant chemo radiotherapy is the standard treatment in Western countries in gastric cancer patients submitted to curative resection. INT0116 pivotal trial established adjuvant chemo radiation as the standard care for resected high risk adenocarcinoma of the stomach in US however was hampered by suboptimal surgery. There is controversial data about efficacy of this adjuvant therapy in patients who have undergone D2 lymphadenectomy predominantly. In our hospital D2 lymphadenectomy is standard surgery for gastric cancer. OBJECTIVE: To prove that chemo and radio therapy post gastrectomy and D2 linphadenectomy in patients' with gastric cancer is effective. MATERIAL AND METHODS: Retrospective study with gastric adenocarcinoma patients stage II to IV M0 who underwent curative resection at INEN (Instituto Nacional de Enfermedades Neoplasicas) Lima-Peru between 2001 and 2006. Standard treatment at institution is D2 lymphadenectomy. Chemo radiotherapy according to INT0116 was given like adjuvant therapy. Survivalcurves were calculated according to Kaplan-Meier method and compared with log-rank test. RESULTS: 84 patients were included 60.7% male and 39.3% female. Mean age was 49.5 years old. The pathologic stages were T1-T2 (15.5%), T3- T4 (84.5%), N0-N1 (10.7%), N2-N3 (89.3%). D2 lymphadenectomy was performed in all patients. The 3-year DFS was 17% and 3-year overall survival was 23.9%. However when we analyzed by subgroups the overall survival, was in group N1 (66.7%) and in group N2 (58.9%) and N3 (18.3%) and 3 years DFS by subgroups were N1 (100%), N2 (51.9%) and N3 (16.3%). CONCLUSIONS: Adjuvant chemo radiotherapy decreased risk of death and relapse to three years mainly in patients with node positive N1-N2, who underwent curative resection with D2 lymphadenectomy, but recurrence was most frequent in N3 node positive, maybe is necessary improve the chemotherapy in this group of patients for decrease the rate of relapse.

Tratamiento adyuvante con quimioterapia y radioterapia luego de gastrectomía y disección ganglionar D2 en pacientes con cáncer gástrico en el Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú / Adjuvant chemo radiotherapy after gastrectomy and D2 lymphadenectomy in patients with gastric cancer in the National Institute of Cancer, Lima, Peru

Introducción: La quimio radioterapia adyuvante es una alternativa de tratamiento especialmente para pacientes con cirugías inferiores a D2. El estudio INT016 estableció la quimio radioterapia adyuvante como el cuidado estándar para adenocarcinoma resecado de alto riesgo del estómago en Estados Unidos, sin embargo, se vio obstaculizado por la cirugía sub óptima. Existe controversia acerca de la eficacia de esta terapia adyuvante en pacientes sometidos a linfandenectomía D2. En nuestra institución la linfandenectomía D2 es la cirugía estándar para cáncer gástrico. Objetivo: Demostrar que la terapia adyuvante de quimio y radioterapia en pacientes con cáncer gástrico sometidos a gastrectomía y disección ganglionar D2 es efectiva. Materiales y métodos: Estudio retrospectivo de pacientes con adenocarcinoma gástrico estadío II a IV M0 quienes se sometieron a resección curativa en el Instituto Nacional de Enfermedades Neoplásicas, Lima-Perú en el periodo 2001 a 2006. El tratamiento estándar en la Institución es la linfandenectomía D2 y quimio radioterapia adyuvante de acuerdo al INT016. Las curvas de sobrevida fueron estimadas con el método Kaplan-Meier y comparadas con la prueba logrank. Resultados: 84 pacientes fueron incluidos 60,7% hombres y 39,3% mujeres. La edad media fue 49,5 años. Los estadios patológicos fueron T1-T2 (15,5%), T3-T4 (84,5%), N0-N1 (10,7%), N2-N3 (89,3%). Linfandenectomía D2 fue desarrollada en todos los pacientes. Encontramos una sobrevida libre de enfermedad a 3 años de 17% y una sobrevida global de 23,9%. Cuando se analiza por subgrupos, la sobrevida global en los grupos N1, N2 y N3 fueron 66,7%, 58,9% y 18,3%, respectivamente y la sobrevida libre de enfermedad fue 100%, 51,9% y 16,3%, respectivamente. Conclusiones: La quimio radioterapia adyuvante podría ser una alternativa para disminuir el riesgo de muerte y recaída a tres años principalmente en pacientes con ganglios positivos N1-N2, quienes se sometieron a resección curativa con linfandenectomía D2, pero la recurrencia fue más frecuente en ganglios positivos N3, la quimioterapia en este grupo de pacientes podría ser una alternativa para disminuir la tasa de recaída.

Introduction: Adjuvant chemo radiotherapy is the standard treatment in Western countries in gastric cancer patients submitted to curative resection. INT0116 pivotal trial established adjuvant chemo radiation as the standard care for resected high risk adenocarcinoma of the stomach in US however was hampered by suboptimal surgery. There is controversial data about efficacy of this adjuvant therapy in patients who have undergone D2 lymphadenectomy predominantly. In our hospital D2 lymphadenectomy is standard surgery for gastric cancer. Objective: To prove that chemo and radio therapy post gastrectomy and D2 linphadenectomy in patients’ with gastric cancer is effective. Material and methods: Retrospective study with gastric adenocarcinoma patients stage II to IV M0 who underwent curative resection at INEN (Instituto Nacional de Enfermedades Neoplasicas) Lima-Peru between 2001 and 2006. Standard treatment at institution is D2 lymphadenectomy. Chemo radiotherapy according to INT0116 was given like adjuvant therapy. Survival curves were calculated according to Kaplan-Meier method and compared with log-rank test. Results: 84 patients were included 60.7% male and 39.3% female. Mean age was 49.5 years old. The pathologic stages were T1-T2 (15.5%), T3-T4 (84.5%), N0-N1 (10.7%), N2-N3 (89.3%). D2 lymphadenectomy was performed in all patients. The 3-year DFS was 17% and 3-year overall survival was 23.9%. However when we analyzed by subgroups the overall survival, was in group N1 (66.7%) and in group N2 (58.9%) and N3 (18.3%) and 3 years DFS by subgroups were N1 (100%), N2 (51.9%) and N3 (16.3%). Conclusions: Adjuvant chemo radiotherapy decreased risk of death and relapse to three years mainly in patients with node positive N1-N2, who underwent curative resection with D2 lymphadenectomy, but recurrence was most frequent in N3 node positive, maybe is necessary improve the chemotherapy in this group of patients for decrease the rate of relapse.

Extranodal NK/T-cell lymphoma, nasal type: study of clinicopathologic and prognosis factors in a series of 78 cases from Peru.

It is well known that extranodal NK/T-cell lymphoma (NK/TCL) nasal type clusters in Asian countries. A large series of 78 cases of nasal NK/TCL from Peru is analyzed in the present study. Two histologic groups 1 (monomorphic) and 2 (polymorphic), were segregated according to the proportion of large cells (above and below 30%, respectively). Catalyzed signal amplification technique was performed for enhancement of immunohistochemistry reactivities. Epstein-Barr virus (EBV) sequences and types were investigated using polymerase chain reaction. Clinical characteristics, stage, outcome, and response to treatment were evaluated in both groups. Fourteen cases (18%) and 64 cases (82%) corresponded to groups 1 and 2, respectively. Except for nasal obstruction, more common in group 2, all other symptoms were similar in both groups. Local extension and staging were also comparable. Both groups showed CD3c+ CD2+ CD56+ CD3s- CD20- immunophenotype. All cases were positive for EBV. In this series type-2 EBV was found more frequent than type-1 EBV, contrarily to that observed in Asian series. However, about one-third of cases simultaneously harbored both viral types. Both groups received an average of 50-Gy dose of radiation therapy (RT), with or without chemotherapy. Complete therapeutic response was achieved in 89% of group 1 and in 74% of group 2, but this difference was not statistically significant. There were no significant differences between the groups regarding disease-free survival, failure-free survival, relapse, and overall survival. The overall survival, in both groups, was longer for patients treated with RT alone compared with those treated with combined RT therapy and chemotherapy. The present study has shown that dividing nasal NK/TCL in monomorphic and polymorphic variants, according to frequency of large cells, does not correlate with clinical and prognostic factors.

Infección por el virus de inmunodeficiencia humana en niños de Valencia: 17 años de experiencia / Human immunodeficiency virus infection in children of Valencia: 17 years of experience

Describir la experiencia de 17 años de manejo de niños infectados por virus de inmunodeficiencia humana, determinando el impacto de la terapia antirretroviral en su morbimortalidad. Estudio retrospectivo, descriptivo, obteniéndose las características demográficas, clínicas y terapéuticas de las historias médicas de niños infectados, presentándose la información en quinquenios (< 92 93-97 98-2002). 171 niños fueron evaluados, estando infectados por VIH 62 (36,2 por ciento); 3 de 5 (60 por ciento) al principio y 26 de 96 (27 por ciento) en el último quinquenio. La distribución por sexo fue similar; 54,8 por ciento menores de 2 años. La mayoría llegaron en estadio C, principalmente antes del 92, pero después 33 por ciento en estadios N o A. Desde 1993 los niños reciben mono o biterapia y en 1998, triterapia. Nuestros hallazgos sugieren que la terapia antirretroviral no sólo disminuyó la mortalidad de 60 por ciento en 1992 a 18,7 por ciento, el porcentaje de infecciones oportunistas (de 60 por ciento a 20 por ciento) y hospitalización (41,6 por ciento a 16,8 por ciento), sino que también modificó el tipo de severidad de las infecciones comunes; neumonía y otitis crónica en sin terapia antirretroviral vs piel y tejidos blandos en los tratados, bajando la neumonía al noveno lugar. Tuberculosis, herpes zóster y citomegalovirus fueron las infecciones oportunistas más frecuentes. Se observó un incremento de los casos, principalmente después de 1998, donde se diagnosticaron el 61,3 por ciento de los mismos. La terapia antirretroviral de alta eficacia generó un gran impacto en la disminución de la morbimortalidad, hospitalización e infecciones oportunistas.

Coccidioidomicosis diseminada: manifestación inicial de sida en residente de área no endémica / Disseminated coccidioidomycosis: initial manifestation of AIDS in a non-endemic area resident

La coccidioidomicosis es causada por Coccidioides immitis, hongo muy virulento cuyo hábitat natural se restringe a la región geográfica situada en el noroeste de la República Mexicana y el suroeste de Estados Unidos de América del Norte. La mayoría de las veces cursa en forma asintomática. El padecimiento suele presentarse en forma localizada (40 por ciento), limitado al aparato respiratorio. Raramente (0.5 por ciento) causa afección multiorgánica y se constituye en la forma diseminada. Aun en áreas endémicas, la enfermedad en su forma diseminada se presenta con igual prevalencia en pacientes con infección por el virus de la inmunodeficiencia humana (VIH), que en sujetos inmunocompetentes. Sin embargo, conforme aparece y avanza el deterioro de la inmunidad celular consecutivo a la infección por VIH se puede presentar la reactivación del hongo en pacientes que lo adquirieron previamente. En la coccidioidomicosis diseminada la afección de corazón, tiroides, hígado, bazo, intestino y encéfalo es poco común, incluso en pacientes con síndrome de inmunodeficiencia humana. Se informa de un paciente residente en un área no endémica, en el cual la coccidioidomicosis diseminada se presentó como reactivación de la infección y constituyó la manifestación inicial de sida.

Monoterapia con cefotaxima en el primer episodio febril en pacientes con cáncer y neutropenia / Cefotaxime monotherapy in the firs episode of fever in cancer patients with neutropenia

La presencia de neutropenia y fiebre en pacientes con cáncer son reconocidos factores de riesgo de sepsis que apoyan el uso empírico de terapia antimicrobiana. Entre junio y setiembre de 1992, llevamos a cabo un estudio clínico abierto y no controlado para evaluar la eficacia terapéutica de la cefotaxima (1 g. IV cada 8 horas por 7 días) en 41 primeros episodios febriles (temperatura oral mayor de 38.5o) en pacientes elegibles con cáncer con neutropenia inducida por quimioterapia (menos de 1000 neutrófilos/ml). La eficacia terapéutica fue definida como una disminución de la fiebre por más de 4 días y ausencia total de infección. La edad media de los pacientes fue de 48.3 años;46.4 por ciento de los pacientes fueron varones; 73.2 por ciento tuvieron cáncer de mama, ovario o linfoma; el promedio de la cifra de neutrófilos fue de 530.7 neutrófilos/ml. La eficacia terapeutica global fue de 80.5 por ciento (33/41.95 por ciento; CI:68.4-92.6 por ciento): la remisión de la fiebre fue demostrada al tercer día y el tratamiento fue continuado hasta la salida de neutropenia. No se observaron efectos secundarios por la cefotaxima. La eficacia terapéutica en los casos microbiológicamente documentados (Pseudomona aureginosa, E. coli, stafilococos, streptococos, Acinetobacter sp.) fue 75.0 por ciento (15/20; CI:56.0-94.0 por ciento; 2 casos de Pseudomonas y un caso de Stafilococo coagulasa negativo) fue 80.0 por ciento (18/21; CI: 70.7-99.9 por ciento) en casos bacteriológicamente no confirmados. Sólo 5 pacientes fueron clasificados como falla al tratamiento, con un recuento de leucocitos de menos de 1000/ml (3 pacientes con menos de 500/ml y 2 con cifras entre 500 a 1000/ml). Estos resultados sugieren que la monoterapia con cefotaxima es un tratamiento altamente efectivo para el primer episodio febril en pacientes con cáncer y neutropenia.

Linfomas del tracto gastrointestinal: una enfermedad neoplásica del subdesarrollo / Gastrointestinal lymphomas: malignant disease of under development

Cuatrocientos cincuentaiocho de los 3,495 casos de linfoma maligno registrados entre los años 1965 y 1992 en el Instituto de Enfemedades Neoplásicas, correspondieron a Linfomas del Tracto Gastrointestinal. Esta es una de las series de linfoma del TGI más grande entre las reportadas por hospitales de cáncer, y sugiere que esta rara patología es relativamente frecuente en nuestro medio. El análisis de esta casuística muestra una mayor frecuencia relativa de la localización en el intestino delgado de esta serie comparte algunas características con el linfoma de la enfermedad inmunoproliferativa del intestino delgado descrita en las poblaciones jóvenes y pobres del Mediterraneo. La enfermedad confinada a la viscera (estadíos I y II) es curable por cirugía en 0 por ciento de casos. La enfermedad avanzada incompletamente resecada puede beneficiarse con quimioterapia complementaria. La enfermedad irresecable quirurgicamente puede ser tratada con quimioterapia complementaria de inducción sin que el riesgo de perforación o hemorragia sea prohibitivo el 50 por ciento de los casos inoperables tratados con quimioterapia alcanzaron sobrevidas a 5 y 10 años libres de recidiva de la enfermedad

Quimioterapia del cáncer de testículos

Ciento treintaisiete casos de cáncer de testículo diseminado han sido tratados con régimenes de quimioterapia basados en cisplatino entre los años 1979 y 1980 en el INEN. 46/60 (76.7 por ciento) pacientes en estadío II; 6/14 (42.8 por ciento) estadíos III y 28/63 en estadío IV tuvieron respuestas completas totalizando 58.39 por ciento (80/137) para todo grupo. El total de respuesta incluyendo las respuestas parciales fue 10/137 (75 por ciento). El porcentaje de R. C. fue de 89 en el grupo de bajo riesgo y de 25.9 en el alto riesgo. 36/60 (60 por ciento) pacientes con histología mixta; 31/49 (63.2 por ciento) con carcinoma embrionario, y 5/13 (38.4 por ciento) con teratocarcinoma tuvieron R. C. La sobrevida promedio fue de 71+ meses para todo el grupo y de 120+ meses para los pacientes en estadío II; los pacientes en estadío IV tuvieron una sobrevida promedio de 58+ meses. La sobrevida actuarial fue 80 por ciento a diez años el estadío II y de 44 por ciento en el mismo lapso para el estadío IV.

Quimioterapia combinada con esquema FEM en Cáncer Gástrico Avanzado / Chemotherapy combined with scheme FEM in Cancer Advanced Gastric Use of the sequential alternating chemotherapy with epidoxorubicina in the induction of linfomas nonHodgkin

El Régimen FEM (Fluoruracil - Epidoxorubicina - Mitomicina) fue evaluado en 19 pacientes con diagnóstico de cáncer gástrico avanzado. Todos los pacientes fueron evaluables, catorce eran hombres (73.7 por ciento) y la edad mediana fue 55 años (24-75). Capacidad funcional según escala Zubrod fué 0-1 en 15 pacientes (78.9 por ciento). El diagnóstico fué hecho por endoscopía, radiología y/o cirugía, resultando según la clasificación de Borrmann, 9 casos tipo IV y 6 tipo III. En 10 pacientes no se practicó cirugía y 9 tuvieron Laparotomía solamente. El tipo histológico predominante fué adenocarcinoma 13 casos (68.4 por ciento). El índice de respuesta fué de 52.6 por ciento con una sobrevida mediana de 10.77 meses (4-15) y para el grupo no respuesta la sobrevida fué 3.24 meses (1-10). A la fecha ningún paciente sobrevive. Los efectos tóxicos más comunes fueron alopecía (67.9 por ciento), gastrointestinal (63.16 por ciento). No se registraron casos de cardiotoxicidad y/o hepatoxicidad. Se concluye que el esquema FEM es tán efectivo como el FAM para el tratamiento del cáncer gástrico avanzado.