Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study.

OBJECTIVE: To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy. METHODS: A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes. RESULTS: Thirty-three patients were included. Median age was 34 years (range 31-36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA-IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34-36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0-36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease. CONCLUSION: Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.

Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey.

OBJECTIVE: To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID-19 pandemic among Latin American gynecological cancer specialists. METHODS: Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. RESULTS: A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post-cancer treatment follow-up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo-oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). CONCLUSION: Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID-19 pandemic, which may reflect the region's particularities. The COVID-19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.

Asociación de catepsina D con factores pronósticos / Association of cathepsin D with prognosis factors in malingnant melanoma

Determinar la asocación de la catepsina D, como factor pronóstic inmunohistoquímico, para mejorar nuestro arsenal terapéutico. Se revisaron las historias clínicas de 23 pacientes con diagnóstico de melanoma en el Instituto de Oncología Dr. Miguel Pérez Carreño, en el lapso comprendido de enero de 1998 y diciembre de 2001, a los cuales, se les realizó la determinación de catepsina D en los bloques de parafina de las biopsias realizadas. El procedimiento de arcaje inmunohistoquímico de catepsina D se realizó en 23 pacientes según la técnica de revelado con aminoetilcarbazol. Se relacionaron los resultados con la presencia de factores pronósticos. Los pacientes con inmunomarcajes 41,17 por ciento Breslow > 3 mm, 70,58 por ciento presentaron ulceración 52,94 por ciento eran estadio III. Se evidenció un paralelismo entre los factores histológicos y el inmunomarcaje con catepsina D, pero se debe determinar la evolución natural de aquellos pacientes en estadios iniciales para poder determinar su valor como factor pronóstico

Análisis multifactorial del melanoma maligno: experiencia del Instituto de Oncología Dr. Miguel Pérez Carreño / Multifactorial analisys of malignal melanoma: esxperience of the Instituto de Oncología

El melanoma maligno es la principal causa de muerte por cáncer de piel en el mundo, representando el 75 por ciento de las mismas. Numerosos factores, tales como el tipo histológico, la influencia genética, invasión, localización, se han asociado al melanoma y a su gran agresividad. La detección temprana de la lesión y la identificación de estos factores ya establecidos, constituye actualmene. Se realizó estudio de 151 pacientes del servicio de tumores mixtos y partes blandas del Instituto de Oncología "Dr. Miguel Pérez Carreño" con diagnóstico de melanoma maligno. El 93,21 por ciento correspondieron a melanomas cutáneos, de los cuales 34,43 por ciento eran nodulares. Obtuvimos una sobrevida de 56 por ciento a los 5 años, pero al relacionarla con los niveles de Clark, fue de 20 por ciento Clark IV y 33 por ciento Clark V. Existe la tendencia de mantenerse elevada la incidencia de nuevos casos, tal y como se observa en los países desarrollados. Haciendo uso de los factores pronósticos, puede identificar a los pacientes de alto riesgo.Identificando en forma consistente los factores de riesgo en cada uno de los pacientes, podemos predecir su pronóstico y sobrevida. Es posible determinar la sobrevida de los pacientes por análisis de vaiables independientes; sin embargo, ideal es usar las variables de más consistencia para dar proyecciones más confiables