Sarcoma European and Latin American Network (SELNET) Recommendations on Prioritization in Sarcoma Care During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 outbreak has resulted in collision between patients infected with SARS-CoV-2 and those with cancer on different fronts. Patients with cancer have been impacted by deferral, modification, and even cessation of therapy. Adaptive measures to minimize hospital exposure, following the precautionary principle, have been proposed for cancer care during COVID-19 era. We present here a consensus on prioritizing recommendations across the continuum of sarcoma patient care. MATERIAL AND METHODS: A total of 125 recommendations were proposed in soft-tissue, bone, and visceral sarcoma care. Recommendations were assigned as higher or lower priority if they cannot or can be postponed at least 2-3 months, respectively. The consensus level for each recommendation was classified as "strongly recommended" (SR) if more than 90% of experts agreed, "recommended" (R) if 75%-90% of experts agreed and "no consensus" (NC) if fewer than 75% agreed. Sarcoma experts from 11 countries within the Sarcoma European-Latin American Network (SELNET) consortium participated, including countries in the Americas and Europe. The European Society for Medical Oncology-Magnitude of clinical benefit scale was applied to systemic-treatment recommendations to support prioritization. RESULTS: There were 80 SRs, 35 Rs, and 10 NCs among the 125 recommendations issued and completed by 31 multidisciplinary sarcoma experts. The consensus was higher among the 75 higher-priority recommendations (85%, 12%, and 3% for SR, R, and NC, respectively) than in the 50 lower-priority recommendations (32%, 52%, and 16% for SR, R, and NC, respectively). CONCLUSION: The consensus on 115 of 125 recommendations indicates a high-level of convergence among experts. The SELNET consensus provides a tool for sarcoma multidisciplinary treatment committees during the COVID-19 outbreak. IMPLICATIONS FOR PRACTICE: The Sarcoma European-Latin American Network (SELNET) consensus on sarcoma prioritization care during the COVID-19 era issued 125 pragmatical recommendations distributed as higher or lower priority to protect critical decisions on sarcoma care during the COVID-19 pandemic. A multidisciplinary team from 11 countries reached consensus on 115 recommendations. The consensus was lower among lower-priority recommendations, which shows reticence to postpone actions even in indolent tumors. The European Society for Medical Oncology-Magnitude of Clinical Benefit scale was applied as support for prioritizing systemic treatment. Consensus on 115 of 125 recommendations indicates a high level of convergence among experts. The SELNET consensus provides a practice tool for guidance in the decisions of sarcoma multidisciplinary treatment committees during the COVID-19 outbreak.

Altas dosis de adriamicina seguido de CMF como tratamiento adyuvante en cáncer de mama operable de alto riesgo. Experiencia del Instituto de Enfermedades Neoplásicas / High doses of followed adriamicina of CMF as adjuvant treatment in cancer of operateable breast of high risk. Experience of the Institute of Neoplastic Diseases

El cáncer de mama (CM) es la patología maligna que más afecta a las mujeres de todo el mundo, se diagnostican 700,000 casos al año. El factor pronósticos más importante es el compromiso ganglionar. Se realiza un estudio retrospectivo en mujeres con cáncer de Mama Operable con compromiso ganglionar mayor a tres ganglios entre enero de 1998 a diciembre del 2000; se admiten 87 mujeres con Cáncer de Mama Operable (CMO) (T1, T2, T3; NO-1; MO) sometidas a Mastectomía Radical modificada (MRM), consideradas de alto riesgo por el compromiso ganglionar axilar mayor o igual a 4; recibieron quimioterapia adyuvante con adriamicina 90 mg/m2 cada tres semanas por 4 cursos seguidos de CMF (ciclofosfamida 600 mg/m2, metotrexate 40 mg/m2 y 5 fluoruracilo 600 mg/m2) 1 y 8 día cada 4 semanas por 4 cursos. Al finalizar algunas de las pacientes recibieron radioterapia para tratamiento de consolidación y/o iniciaron hormonoterapia con tamoxifeno 20 mg/d por 5 años. El principal punto de evaluación fue la sobrevida global (SG), el segundo punto de evaluación es la sobrevida libre de enfermedad (SLE); y se calculó Intensidad de Dosis Relativa (IDR). La edad media fue de 45 años; 56.3 por ciento premenopáusicas, la edad media del primer embarazo fue de 23.37 años, y 26.4 por ciento tuvieron 3 hijos. La ubicación preferente del tumor fue en el lado derecho 55.2 por ciento. El Estadío Clínico (EC) II-B 54 por ciento; 60.9 por ciento recibieron tamoxifeno; el 46 por ciento tuvieron RE - positivos; y el 70 por ciento tuvieron C-erb-B2 positivo. La IDR para adriamicina fue de 78 por ciento para el 51 por ciento de los pacientes, mientras que la IDR para ciclofosfamida fue del 88 por ciento para el 50 por ciento de pacientes. Toxicidad hematológica Grado IV fue de 4.05 por ciento...