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Background: Short-course radiotherapy (SCRT) of 25 Gy in five daily fractions is a recommended strategy in the neoadjuvant setting for resectable locally advanced rectal cancer (LARC), as well as in cases of metastatic disease for local control. There is scarce information regarding the use of SCRT for patients who have received nonoperative management. Objectives: To describe the characteristics of patients who received treatment with SCRT for LARC and metastatic rectal cancer, toxicity, and the approach after radiation treatment. Methods: This is a retrospective analysis of all patients who underwent SCRT for rectal cancer at the Alexander Fleming Institute from March 2014 to June 2022. Results: In total, 44 patients were treated with SCRT. The majority were male (29, 66%), with a median age of 59 years (interquartile range 46-73). Most patients had stage IV disease (26, 59.1%), followed by LARC (18, 40.9%). Most lesions were located in the middle rectum (30, 68%). The majority of LARC patients underwent SCRT followed by consolidation chemotherapy (ChT) (16/18, 89%), while most patients with metastatic disease underwent SCRT followed by consolidation ChT (14/26, 53.8%). A clinical complete response (cCR) was documented in 8/44, 18.2% of patients. Most patients with LARC and cCR were managed by a watch and wait approach (5/18, 27.7%). Local recurrence was observed in LARC cases (2/18, 11.1%). Patients who underwent SCRT following consolidation ChT were more likely to have adverse events (AEs) than those undergoing induction ChT following SCRT (11/30, 36.7% versus 3/12, 25%, p = 0.02). Conclusion: In a subgroup of patients diagnosed with LARC and treated with SCRT followed by ChT, surgical treatment could be omitted after they achieved a cCR. Local recurrence was similar to that reported in a previous study. SCRT is a reasonable option for local disease control in stage IV disease, yielding low toxicity rates. Therefore, decisions must be made by a multidisciplinary team. Prospective studies are necessary to reach further conclusions.
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Background: Immunotherapy is the first-line treatment in patients with advanced microsatellite instability-high (MSI-H) or deficient mismatch repair (dMMR) colorectal cancer (CRC). Although immune checkpoint inhibitors (ICIs) for locally advanced rectal cancer (LARC) are not yet a standard, the results are very encouraging and raise the question of whether patients with clinical complete response (cCR) could receive nonoperative management (NOM). However, different patterns of response have challenged management strategies. Case Description: A 34-year-old woman diagnosed with dMMR LARC started treatment with capecitabine 2,000 mg/m2 on day 1 to 14 and oxaliplatin 130 mg/m2 on day 1 and every 21 days. Magnetic resonance imaging (MRI), performed three cycles later, showed local progression of the primary rectal lesion, which at that time had new peritoneal reflex involvement. A new hepatic lesion in segment V was observed. Due to disease progression, she was administered pembrolizumab 200 mg every 21 days. After three cycles, a discordant radiological response was observed on a new MRI scan that showed a complete response of the liver lesion and magnetic resonance tumor regression grade (mrTRG) 1 in the rectum. However, new involvement of the mesentery and enlargement of the regional lymph nodes (LNs) were also evident. A new colonoscopic biopsy was performed, showing no cancerous cells. She underwent surgery on the rectum and liver lesion. Pathology showed a complete response of the rectal wall and liver lesion, but 1 of 22 LNs was positive for adenocarcinoma (ypT0 N1 M0). The patient continued on pembrolizumab, and 14 months after surgery, she had not relapsed. Conclusions: Neoadjuvant immunotherapy for rectal cancer requires new recommendations for the assessment of clinical response. Pseudoprogression should be ruled out as an atypical response before deciding on surgical treatment. We propose an algorithm to address pseudoprogression in this setting.
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Given the increasing complexity of cancer care, multidisciplinary tumor boards have become essential in daily clinical oncology practice. The Project Extension for Community Healthcare Outcomes (ECHO) initiative developed an innovative telementoring model using a "hub and spoke" design consisting of a team of experts (hub) that offers a full service to multiple participants (the spokes) during regularly scheduled sessions discussing patients' clinical cases. The Alexander Fleming Cancer Institute in Buenos Aires was the first hub in Latin America to implement Project ECHO for gastrointestinal tumors. In our 3-year experience, 80 patients from 37 centers were evaluated within Project ECHO and a range of three to five cases were discussed in each meeting. From our perspective, the impact of this novel approach was a remarkable strategy to reduce care disparities by equalizing access to high-quality medical knowledge in a multidisciplinary environment for medical discussions. Additionally, it was shown to have a cost-effective impact directly on the patients and the local health system, since relevant costs were saved after unnecessary treatments, studies and travel expenses were avoided.
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Introdução: as fissuras labiopalatais pertencem ao grupo de anomalias orofaciais, caracterizadas por uma fenda labial e/ou palatal na parte superior da boca, uni ou bilateral. Na literatura, as fissuras apresentam alta prevalência e podem interferir negativamente na vida dos pacientes e familiares, causando alterações estéticas, funcionais e psicossociais. Objetivo: pretendeu-se realizar um levantamento sobre quais aspectos psicológicos têm sido pesquisados neste tema, nos últimos cinco anos. Método: foi realizado um levantamento nas bases de dados SCIELO, LILACS e Periódicos CAPES para subsidiar uma revisão de literatura. Os descritores foram "Fissura labiopalatal", "Fissura labiopalatina", "Fissura labial", "Lábio leporino", "Fenda palatina", "Cleft Palate" e "Cleft Lip", todas associadas com os descritores "Psicologia" e "Psychology". Resultados e Discussão: houve predomínio de estudos com enfoque em aspectos psicológicos identitários, da família (ansiedade, stress, depressão e enfrentamento), desempenho escolar e qualidade de vida. Identificou-se carência de estudos brasileiros, pouco conhecimento sobre a doença e necessidade de maior inserção do psicólogo nas equipes multidisciplinares. Conclusão: conclui-se a relevância da participação dos cuidadores na recuperação deste indivíduo e suporte de enfrentamento diante às adversidades.
Introduction: the cleft cracks are within the group of orofacial anomalies being characterized by cleft lip and / or palate of the mouth at the top and can be unilateral or bilateral, having high prevalence. Studies show that cracks may negatively impact lives of patients and families, especially in relation to the aesthetic, functional and psychological changes. Objective: the aim was to conduct a survey on what aspects have been researched on people with cleft lip and palate in the last five years. Method: a survey was carried out in the SCIELO, LILACS and CAPES Periodic databases to support a literature review. The descriptors were "Cleft Palate", "Cleft Lip", "Cleft Lip", "Cleft Lip", "Cleft Palate", "Cleft Palate" and "Cleft Lip", all associated with the descriptors "Psychology" and "Psychology". Results and Discussion: the results showed a prevalence of studies focusing on psychological aspects of family (anxiety, stress, depression and coping), identity of patients, school performance and quality of life. It identified lack of Brazilian studies, little knowledge about the disease and the need for greater inclusion of psychologist in multidisciplinary teams. Conclusion: a multidisciplinary team is as important as the participation of caregivers to a satisfactory recovery and coping support.
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Fenda Labial/psicologia , Psicologia do Desenvolvimento , Anormalidades CraniofaciaisRESUMO
Introdução: as fissuras labiopalatais pertencem ao grupo de anomalias orofaciais, caracterizadas por uma fenda labial e/ou palatal na parte superior da boca, uni ou bilateral. Na literatura, as fissuras apresentam alta prevalência e podem interferir negativamente na vida dos pacientes e familiares, causando alterações estéticas, funcionais e psicossociais. Objetivo: pretendeu-se realizar um levantamento sobre quais aspectos psicológicos têm sido pesquisados neste tema, nos últimos cinco anos. Método: foi realizado um levantamento nas bases de dados SCIELO, LILACS e Periódicos CAPES para subsidiar uma revisão de literatura. Os descritores foram "Fissura labiopalatal", "Fissura labiopalatina", "Fissura labial", "Lábio leporino", "Fenda palatina", "Cleft Palate" e "Cleft Lip", todas associadas com os descritores "Psicologia" e "Psychology". Resultados e Discussão: houve predomínio de estudos com enfoque em aspectos psicológicos identitários, da família (ansiedade, stress, depressão e enfrentamento), desempenho escolar e qualidade de vida. Identificou-se carência de estudos brasileiros, pouco conhecimento sobre a doença e necessidade de maior inserção do psicólogo nas equipes multidisciplinares. Conclusão: conclui-se a relevância da participação dos cuidadores na recuperação deste indivíduo e suporte de enfrentamento diante às adversidades.
Introduction: the cleft cracks are within the group of orofacial anomalies being characterized by cleft lip and / or palate of the mouth at the top and can be unilateral or bilateral, having high prevalence. Studies show that cracks may negatively impact lives of patients and families, especially in relation to the aesthetic, functional and psychological changes. Objective: the aim was to conduct a survey on what aspects have been researched on people with cleft lip and palate in the last five years. Method: a survey was carried out in the SCIELO, LILACS and CAPES Periodic databases to support a literature review. The descriptors were "Cleft Palate", "Cleft Lip", "Cleft Lip", "Cleft Lip", "Cleft Palate", "Cleft Palate" and "Cleft Lip", all associated with the descriptors "Psychology" and "Psychology". Results and Discussion: the results showed a prevalence of studies focusing on psychological aspects of family (anxiety, stress, depression and coping), identity of patients, school performance and quality of life. It identified lack of Brazilian studies, little knowledge about the disease and the need for greater inclusion of psychologist in multidisciplinary teams. Conclusion: a multidisciplinary team is as important as the participation of caregivers to a satisfactory recovery and coping support.
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Fenômenos Psicológicos , Fenda Labial , Anormalidades CraniofaciaisRESUMO
Diagnosis and treatment of patients with rectal cancer has changed dramatically in recent decades. In order to assess the approach in this regard in Argentina we conducted a multicenter retrospective study in 18 health care services in Buenos Aires City, including patients operated on between June 2004 and May 2007. Data on demographics, diagnosis, surgery, pathology, radiotherapy and chemotherapy, contained in medical records, were analyzed in 397 patients (median age: 63.5 years). TNM stage was recorded in 253 (I: 23.7%, II: 32.8% and III: 39.5%). Pelvic magnetic resonance imaging (MRI) was performed in 44 patients (11.1%); 115 (29%) received neo-adjuvant therapy. Anterior resection was performed in 170 (42.8%), ultra-low resection in 95 (23.9%) and abdomino-perineal resection in 76 (19.1%) cases. There were no data regarding mesorectal excision in 135 (34.0%). The median number of lymph nodes removed was 13 and the median of nodal metastasis, 3. The circumferential resection margin was reported in 219 (55.2%) cases. Chemotherapy was used in 123 (31%) patients; the modality was postoperative in 40.6%, preoperative in 29.3% and pre plus postoperative in 30.1%. Comparing these data with international standards we observed appropriate results regarding surgical morbidity and mortality, while we found insufficient interdisciplinary discussion, low use of MRI for staging, low use of neo-adjuvant therapy, and scant mention of the type of mesorectal resection performed. This study suggests the desirability of a more widespread adoption of international standards and the need for educational action in this regard.
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Neoplasias Retais/patologia , Neoplasias Retais/terapia , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Retais/mortalidade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
El diagnóstico y tratamiento de los pacientes con cáncer de recto ha cambiado notoriamente en los últimos decenios. A fin de evaluar la conducta al respecto en nuestro medio, llevamos a cabo un estudio multicéntrico retrospectivo en 18 servicios asistenciales de la Ciudad de Buenos Aires, considerando los pacientes operados entre junio de 2004 y mayo de 2007. En 397 pacientes (mediana de edad: 63.5 años) se registraron y analizaron los datos de demografía, diagnóstico, cirugía, morbimortalidad, patología, radioterapia y quimioterapia consignados en la historia clínica. Constaba el "TNM" en 253 (estadio I: 23.7%, II: 32.8%, III: 39.5%). Se realizó resonancia nuclear magnética de pelvis en 44 (11.1%). Recibieron neoadyuvancia 115 (29%). Se efectuó resección anterior en 170 (42.8%), resección ultrabaja en 95 (23.9%), amputación abdominoperineal en 76 (19.1%). Faltaron datos sobre la escisión del mesorrecto en 135 (34.0%). La mediana de ganglios linfáticos resecados fue de 13; con metástasis: 3. El margen circunferencial de resección se informó en 219 (55.2%). Se empleó quimioterapia en 123 (31%). Se presentaron en Comité de Tumores 98 (24.7% del total). La confrontación de estos resultados con los estándares internacionales muestra una morbimortalidad quirúrgica adecuada a esos estándares, al tiempo que demuestra que fue insuficiente la discusión interdisciplinaria, reducido el empleo de resonancia nuclear magnética para la estadificación, baja la utilización de neoadyuvancia y escasa la mención del tipo de resección mesorrectal efectuada. Este estudio sugiere la conveniencia de una adopción más generalizada de las pautas internacionales y la necesidad de una acción educativa en tal sentido.
Diagnosis and treatment of patients with rectal cancer has changed dramatically in recent decades. In order to assess the approach in this regard in Argentina we conducted a multicenter retrospective study in 18 health care services in Buenos Aires City, including patients operated on between June 2004 and May 2007. Data on demographics, diagnosis, surgery, pathology, radiotherapy and chemotherapy, contained in medical records, were analyzed in 397 patients (median age: 63.5 years).TNM stage was recorded in 253 (I: 23.7%, II: 32.8% and III: 39.5%). Pelvic magnetic resonance imaging (MRI) was performed in 44 patients (11.1%); 115 (29%) received neo-adjuvant therapy. Anterior resection was performed in 170 (42.8%), ultra-low resection in 95 (23.9%) and abdomino-perineal resection in 76 (19.1%) cases. There were no data regarding mesorectal excision in 135 (34.0%). The median number of lymph nodes removed was 13 and the median of nodal metastasis, 3. The circumferential resection margin was reported in 219 (55.2%) cases. Chemotherapy was used in 123 (31%) patients; the modality was postoperative in 40.6%, preoperative in 29.3% and pre plus postoperative in 30.1%. Comparing these data with international standards we observed appropriate results regarding surgical morbidity and mortality, while we found insufficient interdisciplinary discussion, low use of MRI for staging, low use of neo-adjuvant therapy, and scant mention of the type of mesorectal resection performed. This study suggests the desirability of a more widespread adoption of international standards and the need for educational action in this regard.
