RESUMO
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.
Assuntos
COVID-19/epidemiologia , Oncologia/organização & administração , Oncologia/normas , Sarcoma/terapia , COVID-19/prevenção & controle , Consenso , Europa (Continente)/epidemiologia , Humanos , América Latina/epidemiologia , Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Sarcoma/diagnósticoRESUMO
Se revisaron los registros de 211 pacientes con lesiones no palpables sometidos a cirugía en el año 2010 en el Instituto Nacional de Enfermedades Neoplásicas. La edad promedio del grupo fue 50.82 años, 41.2% eran pre menopausicas y 57,8% post menopausicas, 20.4%(43 pacientes) tenían antecedente familiar de cáncer de mama. 130 biopsias (61.6%) fueron realizadas bajo guía ecográfica, 41(19.4%) guiadas por mamografía (arpón) y 40 (19%) correspondieron a resección de conductos terminales. 168 procedimientos (79.6%) fueron realizadas en cirugía menor con anestesia local, 24 procedimientos (11,4%)en sala de operaciones con anestesia general y 19 (9%) en cirugía menor con sedación. Se diagnosticaron 37 casos de cáncer (17,5% del total de casos registrados en la serie). 23 de los cuales fueron sometidos a cirugía de conservación y 8 a tratamiento radical.
We reviewed the records of 211 patients with nonpalpable lesions underwent surgery in 2010 at the Peruvian National Cancer Institute. The average age group was 50.82 years, 41.2% were premenopausal and postmenopausal 57.8%, 20.4% (43 patients) had family history of breast cancer. 130 biopsies (61.6%) were performed under ultrasound guidance, 41 (19.4%) guided by mammography (Howpkins needle) and 40 (19%) were terminal duct resection. 168 procedures (79.6%) were performed in minor surgery under local anesthesia, 24 procedures (11.4%) in the operating room under general anesthesia and 19 (9%) in minor surgery with sedation. We diagnosed 37 cases of cancer (17.5% of total cases in the series). 23 of whom underwent conservation surgery and 8 radical treatment.
Assuntos
Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , PalpaçãoRESUMO
Melanoma maligno es considerado una entidad poco común en niños y adolescentes constituyendo el 1 a 3 % de todas las neoplasias pediátricas. Solo 2% de los melanomas ocurren en pacientes menores de 20 años, y 0.3% a 0.4% ocurren en niños prepúberes, sin embargo, su incidencia ha aumentado en todos los países del mundo durante los últimos años. Material Y Métodos: Se realizó un estudio retrospectivo en el cual se revisó 216 historia clínicas con diagnostico de Melanoma evaluadas en el Instituto Nacional de Enfermedades Neoplásicas entre Enero de 1985 y Abril de 2008. Resultados: Se encontró 9 casos de Melanoma cutáneo (MC) en niños menores de 15 años, seis mujeres y tres hombres. El promedio de edad de los casos fue de 5 años, sin diferencias entre hombres y mujeres. La localización más común fue la extremidad inferior (44,4 %), de los cuales la mayoría se encontró en el pie. Del total de casos, cuatro eran MC in situ (44,4%) y uno MC nodular (33.3). La escala de Breslow encontrado fue de 0 û 7,1 mm., con una mediana de 7,62 mm, Se encontró que en tres de nuestros pacientes las lesiones estuvieron presentes desde el nacimiento.
