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1.
Clin. transl. oncol. (Print) ; 25(5): 1368-1377, mayo 2023. graf
Artigo em Inglês | IBECS | ID: ibc-219520

RESUMO

Background and purpose To predict treatment-related cardiovascular disease (CVD) and second cancer 30-yea. absolute mortality risks (AMR30) for patients with mediastinal Hodgkin lymphoma in a large multicentre radiation oncology network in Ireland. Material and methods This study includes consecutive patients treated for mediastinal lymphoma using chemotherapy and involved site radiotherapy (RT) 2016–2019. Radiation doses to heart, left ventricle, cardiac valves, lungs, oesophagus, carotid arteries and female breasts were calculated. Individual CVD and second cancer AMR30 were predicted using Irish background population rates and dose–response relationships. Results Forty-four patients with Hodgkin lymphoma were identified, 23 females, median age 28 years. Ninety-eight percent received anthracycline, 80% received 4–6 cycles ABVD. Volumetric modulated arc therapy (VMAT) ± deep inspiration breath hold (DIBH) was delivered, median total prescribed dose 30 Gy. Average mean heart dose 9.8 Gy (range 0.2–23.8 Gy). Excess treatment-related mean AMR30 from CVD was 2.18% (0.79, 0.90, 0.01, 0.13 and 0.35% for coronary disease, heart failure, valvular disease, stroke and other cardiac diseases), 1.07% due to chemotherapy and a further 1.11% from RT. Excess mean AMR30 for second cancers following RT were: lung cancer 2.20%, breast cancer in females 0.34%, and oesophageal cancer 0.28%. Conclusion For patients with mediastinal lymphoma excess mortality risks from CVD and second cancers remain clinically significant despite contemporary chemotherapy and photon-RT. Efforts to reduce the toxicity of combined modality treatment, for example, using DIBH, reduced margins and advanced RT, e.g. proton beam therapy, should be continued to further reduce potentially fatal treatment effects (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/radioterapia , Neoplasias do Mediastino/etiologia , Neoplasias do Mediastino/radioterapia , Segunda Neoplasia Primária , Radioterapia de Intensidade Modulada , Protocolos de Quimioterapia Combinada Antineoplásica , Bleomicina/administração & dosagem , Dacarbazina/administração & dosagem , Dosagem Radioterapêutica , Vimblastina/administração & dosagem
2.
Actas dermo-sifiliogr. (Ed. impr.) ; 108(8): 708-720, oct. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-167176

RESUMO

Desde la introducción de la inmunoterapia el tratamiento del melanoma ha sufrido una revolución, consiguiéndose cifras de supervivencia superiores a las que se alcanzaban con los tratamientos previos. Los fármacos inmunomoduladores disponibles actualmente van dirigidos principalmente frente a las moléculas de superficie CTLA-4 y PD-1, que ejercen un efecto inhibidor sobre la respuesta inmune antitumoral. Se trata de un tratamiento en pleno proceso de expansión, y la investigación se dirige hacia el descubrimiento de nuevas moléculas, las combinaciones de los fármacos disponibles o la identificación de biomarcadores que permitan seleccionar a los pacientes idóneos para cada terapia (AU)


Approaches to treating melanoma have changed radically since the introduction of immunotherapy, and survival figures are now higher than possible with earlier therapies. The immunomodulators currently available mainly block CTLA-4 (cytotoxicT lymphocyte-associated molecule-4) and PD-1 (programed cell death protein 1) translocated to the cell surface, where they inhibit the antitumor immune response. Treatments blocking these molecules are being more widely used. Research now seeks new molecular targets, the best combinations of available drugs, and biomarkers that can identify ideal candidates for each one (AU)


Assuntos
Humanos , Neoplasias Cutâneas/imunologia , Melanoma/imunologia , Imunoterapia/métodos , Antígeno CTLA-4/imunologia , Receptores de Antígenos de Linfócitos T/imunologia , Fatores Imunológicos/farmacocinética , Dacarbazina/farmacocinética , Anticorpos Monoclonais/farmacocinética
3.
Actas dermo-sifiliogr. (Ed. impr.) ; 108(3): 229-236, abr. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-161638

RESUMO

INTRODUCCIÓN Y OBJETIVO: El conocimiento de los recursos utilizados en cada uno de los pasos del diagnóstico y tratamiento de las enfermedades es la base para poder optimizarlos. El melanoma cutáneo es un tipo tumoral en constante incremento, y con un importante coste asociado, por lo que se ha realizado un análisis actualizado de los costes de los procesos de su diagnóstico, terapia y seguimiento en función del estadio de la enfermedad. MÉTODOS: Se han elaborado tablas descriptivas de costes directos a partir de un modelo teórico basado en directrices nacionales e internacionales de manejo de pacientes con melanoma cutáneo dependiendo del momento de diagnóstico y evolución. Estas tablas permiten saber el coste de cada paciente individual y de todos aquellos en un mismo estadio. RESULTADOS: Los costes para un paciente en el primer ańo oscilan entre los 1.689 Euros del estadio I y los 88.268 Euros del estadio IV, las mayores diferencias se encuentran entre el estadio IA y el IB-IIA y entre el III y IV. Si comparamos los costes de los pacientes en estadio precoz con buena evolución con los de aquellos que recidivaron, las diferencias son considerables: llegan a ser de hasta 50 veces mayores en el primer ańo y 20 veces mayores en el seguimiento a 10 ańos. CONCLUSIONES: Los elevados costes del diagnóstico del melanoma cutáneo en estadio avanzado evidencian la necesidad de promocionar la prevención primaria y los programas de detección precoz. Nuestros resultados servirán como base para posteriores estudios de coste-efectividad


BACKGROUND AND OBJECTIVE: The basis for optimal resource allocation is an understanding of requirements during the diagnostic and treatment phases. Costs associated with the rising incidence of cutaneous melanoma are considerable. We undertook an up-to-date analysis of the cost of diagnosis, treatment, and follow-up according to tumor stage. METHODS: We constructed descriptive tables following a theoretical model of direct costs based on amounts published in directives for the Spanish national health system and in international guidelines for managing cutaneous melanoma according to stage at diagnosis and clinical course. The tables allowed us to calculate the cost of treating individual patients as well as the expected cost for all patients with tumors in the same stage. RESULTS: Individual patients would generate costs ranging from Euros 1689 (for a stage I tumor) to Euros 88, 268 (stage IV). The largest differences were between stages IA and IB-IIA and between stages III and IV. Costs differed greatly between patients with early-stage tumors and favorable outcomes and those with recurring tumors, which cost 50-fold more in the first year and 20-fold more after 10 years of follow-up. CONCLUSIONS: The high cost of diagnosing advanced-stage cutaneous melanoma calls attention to the need to promote primary prevention and early detection. Our findings provide the knowledge base for cost-effectiveness studies in this disease


Assuntos
Humanos , Masculino , Feminino , Melanoma/economia , Efeitos Psicossociais da Doença , Prevenção Primária/métodos , Diagnóstico Precoce , Metástase Neoplásica/diagnóstico , Excisão de Linfonodo/métodos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/radioterapia , Avaliação de Custo-Efetividade , Biópsia de Linfonodo Sentinela/métodos , Terapias Complementares , Interferon-alfa/uso terapêutico , Dacarbazina/uso terapêutico
5.
Clin. transl. oncol. (Print) ; 17(8): 612-619, ago. 2015. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-138176

RESUMO

Purpose. The cure rate in Hodgkin lymphoma is high, but the response along with treatment is still unpredictable and highly variable among patients. Detecting those patients who do not respond to treatment at early stages could bring improvements in their treatment. This research tries to identify the main biological prognostic variables currently gathered at diagnosis and design a simple machine learning methodology to help physicians improve the treatment response assessment. Methods. We carried out a retrospective analysis of the response to treatment of a cohort of 263 Caucasians who were diagnosed with Hodgkin lymphoma in Asturias (Spain). For that purpose, we used a list of 35 clinical and biological variables that are currently measured at diagnosis before any treatment begins. To establish the list of most discriminatory prognostic variables for treatment response, we designed a machine learning approach based on two different feature selection methods (Fisher’s ratio and maximum percentile distance) and backwards recursive feature elimination using a nearest-neighbor classifier (k-NN). The weights of the k-NN classifier were optimized using different terms of the confusion matrix (true- and false-positive rates) to minimize risk in the decisions. Results and conclusions. We found that the optimum strategy to predict treatment response in Hodgkin lymphoma consists in solving two different binary classification problems, discriminating first if the patient is in progressive disease; if not, then discerning among complete and partial remission. Serum ferritin turned to be the most discriminatory variable in predicting treatment response, followed by alanine aminotransferase and alkaline phosphatase. The importance of these prognostic variables suggests a close relationship between inflammation, iron overload, liver damage and the extension of the disease (AU)


No disponible


Assuntos
Idoso , Humanos , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/terapia , Ferritinas/uso terapêutico , Alanina Transaminase , Fosfatase Alcalina/uso terapêutico , Bleomicina/uso terapêutico , Vimblastina/uso terapêutico , Dacarbazina/uso terapêutico , Doxorrubicina/uso terapêutico , Estudos Retrospectivos , Estudos de Coortes , Prognóstico , Estimativa de Kaplan-Meier
7.
Clin. transl. oncol. (Print) ; 16(3): 273-279, mar. 2014.
Artigo em Inglês | IBECS | ID: ibc-127734

RESUMO

PURPOSE: The standard adjuvant treatment for glioblastoma is temozolomide concomitant with radiotherapy, followed by a further six cycles of temozolomide. However, due to the lack of empirical evidence and international consensus regarding the optimal duration of temozolomide treatment, it is often extended to 12 or more cycles, even in the absence of residual disease. No clinical trial has shown clear evidence of clinical benefit of this extended treatment. We have explored the economic impact of this practice in Spain. MATERIALS AND METHODS: Spanish neuro-oncologists completed a questionnaire on the clinical management of glioblastomas in their centers. Based on their responses and on available clinical and demographic data, we estimated the number of patients who receive more than six cycles of temozolomide and calculated the cost of this extended treatment. RESULTS: Temozolomide treatment is continued for more than six cycles by 80.5 % of neuro-oncologists: 44.4 % only if there is residual disease; 27.8 % for 12 cycles even in the absence of residual disease; and 8.3 % until progression. Thus, 292 patients annually will continue treatment beyond six cycles in spite of a lack of clear evidence of clinical benefit. Temozolomide is covered by the National Health Insurance System, and the additional economic burden to society of this extended treatment is nearly 1.5 million euros a year. CONCLUSIONS: The optimal duration of adjuvant temozolomide treatment merits investigation in a clinical trial due to the economic consequences of prolonged treatment without evidence of greater patient benefit (AU)


No disponible


Assuntos
Humanos , Antineoplásicos Alquilantes/administração & dosagem , Neoplasias Encefálicas/tratamento farmacológico , Dacarbazina/análogos & derivados , Glioblastoma/tratamento farmacológico , Antineoplásicos Alquilantes/economia , Neoplasias Encefálicas/economia , Quimioterapia Adjuvante/economia , Quimioterapia Adjuvante/métodos , Dacarbazina/administração & dosagem , Dacarbazina/economia , Glioblastoma/economia , Padrões de Prática Médica , Inquéritos e Questionários , Espanha
8.
Rev. esp. cir. oral maxilofac ; 35(4): 167-169, oct.-dic. 2013. ilus
Artigo em Espanhol | IBECS | ID: ibc-116203

RESUMO

Los melanomas mucosos son tumores raros y de mal pronóstico. Representan alrededor del 1% del total de melanomas y el 0,5% de los tumores malignos de cabeza y cuello. Cuando se localiza en las fosas nasales, produce sintomatología tardía e inespecífica como obstrucción respiratoria, epistaxis o dolor facial. El tratamiento de elección es la cirugía combinada con quimio y radioterapia. Presentamos un caso con sobrevida de 4 an˜ os y realizamos una revisión de la literatura (AU)


Head and neck mucosal melanoma is a rare entity with poor prognosis. This tumour represents less than 1% of malignant melanomas and 0.5% of head and neck malignancies. Melanomas that arise in the nasal cavity present with non-specific symptoms and have a poor prognosis. Wide local excision is the treatment of choice combined with postoperative chemoradiotherapy. We present a case with an unusual survival (4 years) and perform a review of the literature (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Melanoma/diagnóstico , Melanoma/cirurgia , Biópsia , Tomografia Computadorizada de Emissão/instrumentação , Tomografia Computadorizada de Emissão/métodos , Prognóstico , Dacarbazina/uso terapêutico , Melanoma/fisiopatologia , Melanoma , Septo Nasal/patologia , Septo Nasal/cirurgia , Septo Nasal , Doenças do Nervo Oculomotor/complicações , Melanoma/radioterapia
10.
Actas dermo-sifiliogr. (Ed. impr.) ; 103(7): 579-590, sept. 2012. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-103843

RESUMO

La investigación sobre dianas moleculares en el melanoma sobre las que se pueda actuar farmacológicamente está empezando a dar sus primeros frutos. De todos los fármacos ensayados hasta el momento en pacientes con melanoma diseminado, los que han conseguido mejores resultados son los inhibidores de la mutación V600E de BRAF en los melanomas portadores de la misma, los inhibidores de la actividad tirosin-cinasa de c-Kit en melanomas con mutaciones de este gen y los anticuerpos anti-CTLA-4, inhibidores de los mecanismos de inmunotolerancia. Sin embargo, aún quedan muchos problemas por resolver, como la rápida adquisición de resistencias frente a los dos primeros tipos de fármacos o la falta de biomarcadores predictivos de respuesta frente al último de ellos. En este artículo presentamos una revisión sobre los resultados de los tratamientos contra estas y otras dianas en el melanoma diseminado y lo que parece que podemos esperar del futuro (AU)


Research into molecular targets for drug development in melanoma is starting to bear fruit. Of the drugs tested to date in patients with metastatic melanoma, those that have yielded the best results are V600E BRAF inhibitors in melanomas carrying the V600E mutation; c-kit tyrosine kinase activity inhibitors in melanomas carrying c-kit mutations; and anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) antibodies, which block the mechanisms involved in immune tolerance. Many problems have yet to be resolved in these areas, however, such as the rapid development of resistance to BRAF and c-kit inhibitors and the lack of biomarkers to predict treatment response in the case of CTLA-4 blockers. We review the results of targeted therapy with these and other drugs in metastatic melanoma and discuss what the future holds for this field (AU)


Assuntos
Humanos , Masculino , Feminino , Melanoma/terapia , Sistemas de Liberação de Medicamentos , Antígeno CTLA-4/antagonistas & inibidores , Antígeno CTLA-4/análise , Antígeno CTLA-4/uso terapêutico , Antineoplásicos , Dacarbazina/farmacologia , Dacarbazina/uso terapêutico
11.
Prog. obstet. ginecol. (Ed. impr.) ; 54(7): 371-375, jul. 2011. ilus
Artigo em Espanhol | IBECS | ID: ibc-89664

RESUMO

Las metástasis en mama desde tumores primarios extramamarios suponen el 2% de todos los tumores malignos de la mama (linfomas y melanomas malignos son los más frecuentes), y pueden simular tumores primarios tanto clínica como radiológicamente. El pronóstico de pacientes con metástasis de mama de tumores sólidos en general es malo (el 80% mueren antes de un año). El tratamiento más aceptado es la escisión simple, por lo que conocer, previamente a la cirugía, la procedencia metastásica del nódulo impedirá una cirugía demasiado agresiva que no va a mejorar el pronóstico. Presentamos un caso de metástasis de mama de un melanoma maligno cutáneo diagnosticado en piel de costado derecho (extirpado 3 años antes) (AU)


Breast metastases from extramammary primary tumors account for 2% of all malignant breast tumors (the most common being lymphoma and malignant melanoma) and can mimic primary breast carcinoma clinically and radiologically. The prognosis of patients with metastases to the breast from solid tumors is generally poor, with 80% dying in the first year. The most widely accepted treatment is simple excision. Consequently, determining the source of metastases prior to surgery avoids further surgical procedures that will not improve prognosis. We present a case of metastases from malignant cutaneous melanoma to the breast diagnosed in the right thoracic wall and surgically excised 3 years previously (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Metástase Neoplásica/fisiopatologia , Melanoma/complicações , Melanoma/diagnóstico , Neoplasias Primárias Múltiplas , Mamografia/métodos , Mamografia , Ultrassonografia Mamária , Neoplasias da Mama/cirurgia , Neoplasias da Mama , Imageamento por Ressonância Magnética , Melanoma/fisiopatologia , Neoplasias da Mama/tratamento farmacológico , Dacarbazina/uso terapêutico , Cisplatino/uso terapêutico , Carmustina/uso terapêutico
12.
Clin. transl. oncol. (Print) ; 12(4): 306-309, abr. 2010. ilus
Artigo em Inglês | IBECS | ID: ibc-124075

RESUMO

We present the case of a 46-year-old woman diagnosed with a primary oesophageal melanoma (PEM), who was treated with radical surgery followed by combined chemoimmunotherapy (interferon, carboplatin, dacarbazine and external radiotherapy) and who achieved a complete response after this treatment. PEMs are rare malignancies, with less than 300 cases described in the literature. The main differential diagnosis is with metastases of skin or ocular malignant melanomas. They are usually diagnosed at advanced stages and prognosis is typically poor. The main treatment modality should be radical surgery. The role of adjuvant treatment is uncertain, although some long responses have been seen with the use of chemotherapy or immunotherapy alongside surgery (AU)


No disponible


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Melanoma/patologia , Melanoma/terapia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/cirurgia , Carboplatina/administração & dosagem , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante , Terapia Combinada/métodos , Dacarbazina/administração & dosagem , Esofagectomia/métodos , Hipertensão/complicações , Imunoterapia/métodos
13.
Clin. transl. oncol. (Print) ; 11(6): 382-386, jun. 2009. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-123647

RESUMO

INTRODUCTION: Bioimmunochemotherapy (BCT) is a combination of biological agents and cytostatics that has shown an increase in response rate (RR) in metastatic melanoma patients. The aim of the study is to evaluate RR, progression- free survival (PFS), overall survival (OS) and treatment toxicity. MATERIALS AND METHODS: Retrospective analysis of 11 metastatic melanoma patients treated from January 2002 to June 2008 with cisplatin 20 mg/m(2) i.v. days 1.4, dacarbazine 800 mg/m(2) i.v. day 1, vinblastine 1.5 mg/m(2) i.v. days 1.4, interleukin (IL)-2 9 MIU/m(2) s.c. 5.8 days and interferon (IFN)-alpha-2b 5 MIU/m2 s.c. days 5.9, 11, 13 and 15, with the support of granulocyte colony-stimulating factor (G-CSF) and antibiotics. Patients with ECOG 0, age < or = 65 years and with measurable disease were included. The planned number of courses was 4. RR was measured by Revised Evaluation Criteria in Solid Tumour (RECIST) criteria (computed tomography [CT]+/-proton emission tomography [PET]). Toxicity was measured according to the National Cancer Institute (NCI) common toxicity criteria. RESULTS: Observed RRs were 18% complete response (CR), 27% partial response (PR), 9% stable disease (SD) and 46% disease progression. The median PFS was 4 months (95% CI, 0.10 m), with a 23% one-year PFS. Median OS was 4.6 months (95% CI, 0.9.19 m), with a 29% one-year OS. Eighty-three percent of patients experienced grade 3-4 toxicity, mainly due to neutropenia, thrombocytopenia and flu-like syndrome. CONCLUSIONS: Treatment with BCT shows an increase in RR, some achieving durable CR; nevertheless it cannot be considered a standard treatment and should be employed only in selected patients (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias de Tecidos Moles/tratamento farmacológico , Neoplasias de Tecidos Moles/secundário , Melanoma/secundário , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/tratamento farmacológico , Interferon-alfa/uso terapêutico , Imunoterapia , Fatores Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ensaios Clínicos Fase III como Assunto , Neoplasias de Tecidos Moles/mortalidade , Melanoma/mortalidade , Melanoma/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Interferon-alfa/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/efeitos adversos , Dacarbazina/efeitos adversos , Estimativa de Kaplan-Meier , Estudos Retrospectivos
16.
Neurología (Barc., Ed. impr.) ; 22(3): 159-169, abr. 2007. ilus
Artigo em Es | IBECS | ID: ibc-054709

RESUMO

El pronóstico de los pacientes con tumores cerebrales malignos siempre ha sido sombrío y hasta hace relativamente poco la quimioterapia no había demostrado ninguna eficacia. La temozolomida es un nuevo fármaco alquilante de segunda generación que ha demostrado eficacia en el tratamiento de los gliomas de alto grado. Los pacientes suelen tolerarlo bien y tiene unas propiedades farmacodinámicas y farmacocinéticas favorables. En los pacientes con glioblastoma multiforme la radioterapia asociada a temozolomida como tratamiento concomitante y adyuvante mejora la supervivencia global de forma significativa con respecto a la radioterapia aislada. Este beneficio es mayor en los pacientes cuyo tumor presenta el promotor del gen 06-metilguanina ADN metiltransferasa metilado, lo cual incapacita a las células neoplásicas para reparar el ADN dañado por la quimioterapia. Este artículo revisa brevemente el diagnóstico y tratamiento de los pacientes con tumores cerebrales malignos y posteriormente se centra en el papel de la temozolomida en el tratamiento de los gliomas


The prognosis for patients with malignant brain tumors has always been poor and until recently chemotherapy had not shown to be very effective. Temozolomide is a novel second-generation alkylating agent that has shown efficacy for the treatment of high-grade gliomas. Temozolomide is well-tolerated by most patients and has favorable pharmacodynamic and pharmacokinetic properties. In patients with newly diagnosed glioblastoma multiforme, radiation therapy with concurrent and adjuvant temozolomide significantly improves orverall survival compared to treatment with only radiation. The benefit of temozolomide is greatest in patients with tumors that have a methylated 06-methyl-guanine DNA methyl transferase gene promoter that results in decreased repair of temozolomide-induced DNA damage. This chapter will briefly review the diagnosis and treatment of patients with malignant brain tumors and then will focus on the role of temozolomide in glioma therapy


Assuntos
Glioblastoma , Glioma/terapia , Neoplasias Encefálicas/terapia , Anticoagulantes/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antineoplásicos Alquilantes , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Astrocitoma/tratamento farmacológico , Terapia Combinada , Irradiação Craniana/métodos , Craniotomia , Dano ao DNA , Dacarbazina , Epilepsia/tratamento farmacológico , Trombofilia/tratamento farmacológico , Trombofilia/etiologia
19.
Gastroenterol. hepatol. (Ed. impr.) ; 28(7): 382-384, ago. 2005. ilus
Artigo em En | IBECS | ID: ibc-039993

RESUMO

El melanoma maligno primario del colédoco es una entidad rara. Sólo se han descrito 7 casos en la bibliografía. El diagnóstico se basa en ausencia de otra localización que pudiera considerarse primaria, en el examen de microscopia electrónica y en el estudio inmunohistoquímico. Describimos un nuevo caso de melanoma maligno primario del conducto biliar y presentamos una revisión de los casos previamente publicados


Primary malignant melanoma of the common bile duct is rare. Only seven cases have been described in the literature. Diagnosis is based on failure to find another primary site, histological examination with electron microscopy, and immunohistochemical tests. We describe a new case of primary malignant melanoma of the biliary tract and present a review of previous reports


Assuntos
Masculino , Humanos , Melanoma/patologia , Neoplasias do Ducto Colédoco/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/administração & dosagem , Colangiopancreatografia Retrógrada Endoscópica , Dacarbazina/administração & dosagem , Evolução Fatal , Interferon-alfa/administração & dosagem , Metástase Linfática , Melanoma/secundário , Melanoma , Microscopia Eletrônica , Cuidados Paliativos , Neoplasias do Ducto Colédoco , Neoplasias da Vesícula Biliar/secundário , Neoplasias Gástricas/secundário , Neoplasias Esplênicas/secundário
20.
Clin. transl. oncol. (Print) ; 7(6): 250-254, jul. 2005. tab
Artigo em En | IBECS | ID: ibc-040766

RESUMO

Introduction. Metastatic melanoma has an ominous prognosis. Bio-chemotherapy regimens can increase the response rate but with a high degree of toxicity due, mainly, to the use of high-dose intravenous interleukin-2. Objectives. To test the feasibility and activity profile of a bio-chemotherapy regimen of low-dose subcutaneous interleukin-2. Material and methods. Administration scheme: dacarbazine at 200 mg/m²/d on days 1-4, cisplatin at 20 mg/m²/d intravenous on days 1-4, vinblastine at 1.5 mg/m²/d on days 1-4, IL-2 at 4.5 MUI/m²/d subcutaneous on days 5-8, IFN-alpha at 5 MU subcutaneous on days 5-9, 11, 13, 15 of every 21-day cycle. Results. Objective response was obtained in 11 patients (39.3%; 95%CI: 21-59) including 4 with complete response (14.3%; 95%CI: 4-33). With an extended follow-up of 49 months and 60 months, respectively, 2 patients continue with complete response. The main toxicities were haematological: grade 3-4 neutropenia in 8.2% of cycles, thrombocytopenia in 1.2% and anaemia in 3.2%. Conclusions. The regimen is safe and has a good activity profile. The presence of long-term survivors, despite the use of lower doses and subcutaneous IL-2, is encouraging


Assuntos
Humanos , Interleucina-2/farmacocinética , Melanoma/tratamento farmacológico , Metástase Neoplásica/terapia , Vimblastina/uso terapêutico , Cisplatino/uso terapêutico , Dacarbazina/uso terapêutico , Seguimentos , Interleucina-2/efeitos adversos , Injeções Subcutâneas , Melanoma/secundário , Anemia/induzido quimicamente , Trombocitopenia/induzido quimicamente , Neutropenia/induzido quimicamente
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