Latin American Consensus on the Treatment of Head and Neck Cancer.

Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.

Detection of NTRK gene fusions in solid tumors: recommendations from a Latin American group of oncologists and pathologists.

NTRK gene fusions have been detected in more than 25 types of tumors and their prevalence is approximately 0.3% in solid tumors. This low prevalence makes identifying patients who could benefit from TRK inhibitors a considerable challenge. Furthermore, while numerous papers on the evaluation of NTRK fusion genes are available, not all countries have guidelines that are suitable for their setting, as is the case with Latin America. Therefore, a group of oncologists and pathologists from several countries in Latin America (Argentina, Chile, Ecuador, Mexico, Peru and Uruguay) met to discuss and reach consensus on how to identify patients with NTRK gene fusions in solid tumors. To do so, they developed a practical algorithm, considering their specific situation and limitations.

Rol de la terapia altas dosis y el trasplante de células progenitoras hematopoyéticas en pacientes con Linfoma de Hodgkin y Linfoma no Hodgkin en el Hospital Nacional Edgardo Rebagliati Martins, durante los años 1994-2005 / Role of high-dose therapy and stem cell transplantation in patients with Hodgkin's and non-Hodgkin Lymphoma in the National Hospital Edgardo Rebagliati Martins, during the years 1994-2005

Antecedentes: El uso de la terapia altas dosis (TAD) con trasplante de células progenitoras hematopoyéticas (TCPH) en el tratamiento de Linfoma Hodgkin (LH), Linfoma no Hodgkin de Bajo Grado (LNHBG) y Linfoma no Hodgkin de Alto Grado (LNHAG) recurrente o refractario ha mostrado beneficios que en nuestro país se ven limitados por la limitada accesibilidad, capacidad de aseguramiento y altos costos. La experiencia de doce años en la realización de TAD TCPH en el Hospital Nacional Edgardo Rebagliati Martins (HNERM) ha sido descrita y analizada. Material y métodos: Se colectaron datos clínicos de todos los pacientes con el diagnóstico de Linfoma Hodgkin o Linfoma No Hodgkin que fueron sometidos a TAD TCPH en la Unidad de Trasplante de Médula Ósea (UTMO) del HNERM, entre Enero 1994 a Diciembre 2005. Se incluyeron 25 casos que cumplían criterios OMS. Los regimenes de movilización incluyeron ICE (55%), Ciclofosfamida (33%) y GCSF (11%) en LH; Ciclofosfamida (100%) en LNHBG; y, Ciclofosfamida (63%), ICE (27%) y GCSF (9%) en LNH agresivo. Los regimenes de terapia altas dosis incluyeron CVD (36%), BEAM (27%) en LH; BEAC (100%) LNHBG; y, BEAC (33%) y BEAM (33%) en LNHAG. 23 (92%) recibieron TCPH autólogo, (4%) con LH, TCPH alogénico, y 1 (4%) con LNHAG, TCPH singénico, respectivamente. Resultados: Se determinaron la sobrevida global (SG) y sobrevida libre de eventos (SLE). En LH, SG 50% a 3 años y SLE 40% a 3 años. En LNHBG, SG 75% a 7,7 años y SLE 70% a 3 años. En LNHAG, SG fue 40% a 4 años y SLE 50% a los 4 años. No se detectó ninguna muerte asociada al tratamiento. Conclusión: TAD y TCPH tienen un rol preponderante en el tratamiento de LH y LNH recurrente o refractario con buena tolerancia y efectividad. Se deben propugnar medidas para su mayor cobertura y accesibilidad.

Background: High dosis therapy (HDT) and hematopoyetic progenitor cells transplant (HPCT) for the treatment of recurrent or refratory Hodgkin’s Lymphoma (HL), Low-Grade Non-Hodgkin’s Lymphoma (LGNHL) and High-Grade Non-Hodkin’s Lymphoma (HGNHL) has shown benefits which are limited for accesibility and insurance. The HNERM’s experience has been shown in this paper. Material and Methods: Clinical dates have been colected from cases of HL, LGNHL and AGNHL. 25 cases were included. Movilization regimenes included ICE (55%), Ciclofosfamid (33%) and GCSF (11%) for HL; Ciclofosfamid (100%) for LGNHL; and, Ciclofosfamid (63%), ICE (27%) and GCSF (9%) for HGNHL. High dosis therapy regimen included CVD (36%) and BEAM (27%) for HL; BEAC (100%) for LGNHL; and, BEAC (33%) and BEAM (33%) for HGNHL. 23 (92%) received autologic HPCT, (4%) of LH, allogenic HPCT, y 1 (4%) HGNHL, singenic HPCT. Results: Overal Survive (OS) and Events Free Survive (EFS) were included. For HL, OS was 50% to 3 years and EFS was 40% to 3 years. For LGNHL, OS 75% to 7,7 years and EFL 70% to 3 years. In HGNHL, OS was 40% to 4 years and EFS 50% to 4 years. There was no one case of mortality. Conclusion: HDT and HPCT have an important rol for the treatment of recurrent or refractory HL and NHL.