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OBJECTIVE: Anticipatory nausea and vomiting are unpleasant symptoms observed before undergoing chemotherapy sessions. Less is known about the occurrence of symptoms since the advent of the new neurokinin-1 antagonist. METHODS: This prospective cohort study was performed at a single Brazilian Institution. This study included breast cancer patients who received doxorubicin and cyclophosphamide chemotherapy and an appropriate antiemetic regimen (dexamethasone 10 mg, palonosetron 0.56 mg, and netupitant 300 mg in the D1 followed by dexamethasone 10 mg 12/12 h in D2 and D4). Patients used a diary to record nausea, vomiting, and use of rescue medication in the first two cycles of treatment. The prevalence of anticipatory nausea and vomiting was assessed before chemotherapy on day 1 of C2. RESULTS: From August 4, 2020, to August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50.8 (28-69) years, most had stage III (53.8%), and most received chemotherapy with curative intent (94%). During the first cycle, the frequency of overall nausea and vomiting was 67.31%, and that of severe nausea and vomiting (defined as grade>4 on a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had anticipatory nausea and vomiting (19.23%). The occurrence of nausea and vomiting during C1 was the only statistically significant predictor of anticipatory nausea and vomiting (OR=16, 95%CI 2.4-670.9, p=0.0003). CONCLUSION: The prevalence of anticipatory nausea is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control in C1 remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on C1 to avoid anticipatory nausea.
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Antieméticos , Neoplasias da Mama , Náusea , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Antieméticos/uso terapêutico , Idoso , Náusea/induzido quimicamente , Prevalência , Brasil/epidemiologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Doxorrubicina/efeitos adversos , Vômito Precoce , Vômito/induzido quimicamente , Vômito/epidemiologia , Dexametasona/uso terapêutico , Palonossetrom/uso terapêuticoRESUMO
OBJECTIVE: To evaluate whether intrathecal chemotherapy improves clinical outcomes in patients with meningeal carcinomatosis. METHODS: This retrospective cohort study included consecutive patients with breast cancer diagnosed with meningeal carcinomatosis. Clinical and treatment data were collected from the patients' medical charts. The primary outcome was overall survival, and the secondary outcomes were time to neurological deterioration and reporting of clinical benefit. Logistic regression and Cox proportional hazard models adjusted for potential confounders were used to evaluate the clinical response and overall survival, respectively. RESULTS: Overall, 109 female patients were included, 50 (45.9%) of whom received intrathecal chemotherapy with methotrexate and dexamethasone. The median treatment duration was 3 weeks (range, 1-13 weeks). Patients treated with intrathecal chemotherapy were more likely to report clinical benefit (74% versus 57.7%, adjusted odds ratio [OR] = 9.0, 95%CI=2.6-30.9, p<0.001). However, there was no difference in the time to neurologic deterioration (hazard ratio [HR] = 0.96, 95%CI= 0.57-1.59, p=0.86). Patients who received intrathecal chemotherapy did not show an increase in overall survival compared with that of patients who did not receive intrathecal chemotherapy (median overall survival = 1.8 months, 95%CI= 1.27-3.0 versus 2.5, 95%CI= 1.9-3.9, adjusted HR = 0.71, 95%CI= 0.41-1.22, p=0.21). There was a significant interaction between intrathecal chemotherapy and systemic treatment, and patients who received systemic therapy without intrathecal chemotherapy had better overall survival than that of the no-treatment group (adjusted HR = 0.38, 95%CI= 0.20-0.70, p=0.002). CONCLUSION: Intrathecal chemotherapy did not increase overall survival or time to neurological deterioration and should not preclude or postpone systemic treatments.
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Neoplasias da Mama , Carcinomatose Meníngea , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Carcinomatose Meníngea/tratamento farmacológico , Carcinomatose Meníngea/diagnóstico , Estudos Retrospectivos , Metotrexato/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
OBJECTIVE: To assess the incidence of febrile neutropenia without primary granulocyte colony-stimulating factor prophylaxis in patients undergoing chemotherapy with adjuvant docetaxel and cyclophosphamide, and to evaluate the toxicity profile of brand-name docetaxel (Taxotere ® ) and the generic formulation. METHODS: This retrospective study was conducted using data obtained from electronic medical records of patients treated at a Brazilian cancer center. Patients with breast cancer who underwent adjuvant treatment between January 2016 and June 2019 were selected. Data were analyzed using chi-square and Fisher correlation of variables, and multivariate analyses were adjusted for propensity score. RESULTS: A total of 231 patients with a mean age of 55.9 years at the time of treatment were included in the study. The majority (93.9%) had luminal histology, 84.8% were at clinical stage I, and 98.2% had a good performance status. The overall incidence of febrile neutropenia in the study population was 13.4% (31 cases). The use of brand-name docetaxel (Taxotere ® ) was the only factor associated with febrile neutropenia occurrence (OR= 3.55, 95%CI= 1.58-7.94, p=0.002). CONCLUSION: In patients with breast cancer who require treatment with adjuvant docetaxel and cyclophosphamide regimen, the toxicity profile differs between brand-name and generic docetaxel. Regardless of the formulation used, the incidence of febrile neutropenia was less than 20%, which may allow for the omission of primary prophylactic granulocyte colony-stimulating factor use in this setting.
Assuntos
Neoplasias da Mama , Neutropenia Febril , Humanos , Pessoa de Meia-Idade , Feminino , Docetaxel/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Estudos Retrospectivos , Incidência , Taxoides/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ciclofosfamida/efeitos adversos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Neutropenia Febril/induzido quimicamente , Neutropenia Febril/tratamento farmacológicoRESUMO
Para avaliar o papel da pregabalina na proteção das náuseas e vômitos induzidos pela quimioterapia, foi realizado um ensaio clínico de fase II, aleatorizado, duplamente cego, controlado por placebo, para investigar se a pregabalina poderia melhorar o controle completo das náuseas e vômitos (desfecho primário). Inscrevemos 82 pacientes virgens de quimioterapia, programados para receber quimioterapia moderadamente e altamente emetogênica. Todos os doentes receberam ondansetron 8mg por via intravenosa, dexametasona 10mg antes da quimioterapia no primeiro dia e, dexametasona 4 mg por via oral, b.d., nos dias dois e três. Os doentes foram distribuídos aleatoriamente para tomar pregabalina 75 mg ou placebo, bd, desde a noite anterior à quimioterapia até ao quinto dia. A resposta completa global não foi estatisticamente significativa entre os grupos (53,7 versus 48,8%, respetivamente, no grupo da pregabalina e no grupo de controlo (P=0,65)). Também não houve diferença estatística significativa durante a fase aguda (primeiras 24 horas) e a fase tardia (24-120h): 80,5% versus 82,9% (P=0,77), 53,7 versus 51,2% (P=0,82), respectivamente. Neste estudo não foi identificada ação da pregabalina na prevenção de náuseas e vômitos induzidos por quimioterapia. Número de registo no Clinicaltrial.gov: NCT04181346.
To evaluate the role of pregabalin in the protection of chemotherapy-induced nausea and vomiting, we performed a phase II randomized, double-blind, placebo-controlled trial to investigate whether pregabalin could improve the complete control of nausea and vomiting (primary end point). We enrolled 82 chemotherapy-naive patients, scheduled to receive moderately and highly emetogenic chemotherapy. All patients received IV ondansetron 8mg, dexamethasone 10mg before chemotherapy on day one and oral dexamethasone 4mg, b.d., on days two and three. Patients were randomly assigned to take pregabalin 75mg or placebo, bd, from the night before chemotherapy to day five. The overall complete response was not statistically significant between the groups (53.7 versus 48.8%, respectively, in the pregabalin group and the control group (P=0.65)). There was also no significant difference during the acute phase (first 24 hours) and delayed phase (24-120h): 80.5% versus 82.9% (P=0.77), 53.7 versus 51.2% (P=0.82), respectively. There is no role for pregabalin preventing chemotherapy-induced nausea and vomiting. Clinicaltrial.gov registration number: NCT04181346.
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SUMMARY OBJECTIVE: Anticipatory nausea and vomiting are unpleasant symptoms observed before undergoing chemotherapy sessions. Less is known about the occurrence of symptoms since the advent of the new neurokinin-1 antagonist. METHODS: This prospective cohort study was performed at a single Brazilian Institution. This study included breast cancer patients who received doxorubicin and cyclophosphamide chemotherapy and an appropriate antiemetic regimen (dexamethasone 10 mg, palonosetron 0.56 mg, and netupitant 300 mg in the D1 followed by dexamethasone 10 mg 12/12 h in D2 and D4). Patients used a diary to record nausea, vomiting, and use of rescue medication in the first two cycles of treatment. The prevalence of anticipatory nausea and vomiting was assessed before chemotherapy on day 1 of C2. RESULTS: From August 4, 2020, to August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50.8 (28-69) years, most had stage III (53.8%), and most received chemotherapy with curative intent (94%). During the first cycle, the frequency of overall nausea and vomiting was 67.31%, and that of severe nausea and vomiting (defined as grade>4 on a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had anticipatory nausea and vomiting (19.23%). The occurrence of nausea and vomiting during C1 was the only statistically significant predictor of anticipatory nausea and vomiting (OR=16, 95%CI 2.4-670.9, p=0.0003). CONCLUSION: The prevalence of anticipatory nausea is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control in C1 remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on C1 to avoid anticipatory nausea.
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ABSTRACT BACKGROUND: Patients with chronic renal disease and undergoing hemodialysis are at a high risk for developing several complications. Fatigue is a common, troubling symptom that affects such patients and can contribute to unfavorable outcomes and high mortality. OBJECTIVE: This cross-sectional study aimed to evaluate the prevalence of fatigue in Brazilian patients with chronic kidney disease undergoing hemodialysis and determine the predisposing factors for fatigue. DESIGN AND SETTING: An observational, cross-sectional, descriptive study was conducted in two renal replacement therapy centers in the Greater ABC region of São Paulo. METHODS: This study included 95 patients undergoing dialysis who were consecutively treated at two Brazilian renal replacement therapy centers between September 2019 and February 2020. The Chalder questionnaire was used to evaluate fatigue. Clinical, sociodemographic, and laboratory data of the patients were recorded, and the Short Form 36 Health Survey, Pittsburgh Sleep Quality Index, and Beck Depression Inventory were administered. RESULTS: The prevalence of fatigue in patients undergoing hemodialysis was 51.6%. Fatigue was independently associated with lower quality of life in terms of physical and general health. Patients with fatigue had a higher incidence of depression (65.9% vs. 34.1%, P = 0.001) and worse sleep quality (59.1% vs. 49.9%; P = 0.027) than those without fatigue. CONCLUSION: Prevalence of fatigue is high in patients undergoing hemodialysis and is directly related to physical and general health.
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ABSTRACT Objective To evaluate whether intrathecal chemotherapy improves clinical outcomes in patients with meningeal carcinomatosis. Methods This retrospective cohort study included consecutive patients with breast cancer diagnosed with meningeal carcinomatosis. Clinical and treatment data were collected from the patients' medical charts. The primary outcome was overall survival, and the secondary outcomes were time to neurological deterioration and reporting of clinical benefit. Logistic regression and Cox proportional hazard models adjusted for potential confounders were used to evaluate the clinical response and overall survival, respectively. Results Overall, 109 female patients were included, 50 (45.9%) of whom received intrathecal chemotherapy with methotrexate and dexamethasone. The median treatment duration was 3 weeks (range, 1-13 weeks). Patients treated with intrathecal chemotherapy were more likely to report clinical benefit (74% versus 57.7%, adjusted odds ratio [OR] = 9.0, 95%CI=2.6-30.9, p<0.001). However, there was no difference in the time to neurologic deterioration (hazard ratio [HR] = 0.96, 95%CI= 0.57-1.59, p=0.86). Patients who received intrathecal chemotherapy did not show an increase in overall survival compared with that of patients who did not receive intrathecal chemotherapy (median overall survival = 1.8 months, 95%CI= 1.27-3.0 versus 2.5, 95%CI= 1.9-3.9, adjusted HR = 0.71, 95%CI= 0.41-1.22, p=0.21). There was a significant interaction between intrathecal chemotherapy and systemic treatment, and patients who received systemic therapy without intrathecal chemotherapy had better overall survival than that of the no-treatment group (adjusted HR = 0.38, 95%CI= 0.20-0.70, p=0.002). Conclusion Intrathecal chemotherapy did not increase overall survival or time to neurological deterioration and should not preclude or postpone systemic treatments.
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O aumento das Infecções Sexualmente Transmissíveis e dos casos de contágio pelo HIV/AIDS na população idosa reflete aspectos da prática sexual e vulnerabilidades que podem estar sendo enfrentadas por essas pessoas em seu convívio social e familiar. Objetivo: descrever, por meio de incidentes críticos, as situações, comportamentos e consequências relacionadas à descoberta do HIV/AIDS por pessoas idosas soropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaram 25 idosos cadastrados no serviço, com idades entre 55 e 77 anos. Os dados foram coletados por meio de entrevista semiestruturada e o conteúdo analisado com auxílio do software IRaMuTeQ por meio de categorias temáticas. Resultados: os dados empíricos contendo as situações, comportamentos e consequências (incidentes críticos) elucidaram quatro categorias empíricas: descoberta do diagnóstico de HIV/AIDS; sentimentos, estigmas e preconceitos vivenciados; soropositividade e reflexos no convívio familiar e social; e mudanças no comportamento sexual após diagnóstico de HIV/AIDS. Conclusão: as relações familiares e sociais vivenciadas e os desafios enfrentados pelas pessoas idosas com HIV/AIDS constituíram incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.
The increase of Sexually Transmitted Infections and cases of HIV/AIDS in the elderly population reflects aspects of sexual practice and vulnerabilities that may be faced by these people in their social and family life. Objective: to describe, through critical incidents, the situations, behaviors and consequences related to the discovery of HIV/AIDS by seropositive elderly people. Method: a descriptive study with a qualitative approach, conducted at the Infectious Diseases Center of a city in the southern region of the state of Ceará, using the Critical Incident Technique (CIT), from February to September 2020. Twenty-five elderly people enrolled in the service, aged 55 to 77 years, participated. The data were collected through semi-structured interviews and the content analyzed with the help of IRaMuTeQ software through thematic categories. Results: The empirical data containing situations, behaviors and consequences (critical incidents) elucidated four empirical categories: discovery of the HIV/AIDS diagnosis; feelings, stigmas and prejudices experienced; seropositivity and reflections on family and social life; and changes in sexual behavior after the diagnosis of HIV/AIDS. Conclusion: the family and social relationships experienced and the challenges faced by elderly people with HIV/AIDS constituted complex critical incidents, affecting them from the moment of diagnosis, with negative impacts on their family and social lifestyles, which hinder inclusive and non-stigmatizing coexistence inside and outside the home.
El aumento de las Infecciones de Transmisión Sexual y de los casos de VIH/Sida en la población anciana refleja aspectos de la práctica sexual y vulnerabilidades que pueden enfrentar estas personas en su vida social y familiar. Objetivo: describir, a través de incidentes críticos, las situaciones, comportamientos y consecuencias relacionadas con el descubrimiento del VIH/SIDA por personas mayores seropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaron 25 ancianos registrados en el servicio, con edades comprendidas entre 55 y 77 años. Os dados foram recolhidos através de entrevistas semiestructuradas e o conteúdo foi analisado com a ajuda do software IRaMuTeQ através de categorias temáticas. Resultados: los datos empíricos que contienen las situaciones, comportamientos y consecuencias (incidentes críticos) elucidaron cuatro categorías empíricas: descripción del diagnóstico de VIH/SIDA; sentimientos, estigmas y preconceptos vividos; seropositividad y reflejos en la convivencia familiar y social; y cambios en el comportamiento sexual tras el diagnóstico de VIH/SIDA. Conclusão: as relações familiares e sociais vividas e os desafios enfrentados pelos idosos com HIV/AIDS constituem incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.
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ABSTRACT Objective To assess the incidence of febrile neutropenia without primary granulocyte colony-stimulating factor prophylaxis in patients undergoing chemotherapy with adjuvant docetaxel and cyclophosphamide, and to evaluate the toxicity profile of brand-name docetaxel (Taxotere ® ) and the generic formulation. Methods This retrospective study was conducted using data obtained from electronic medical records of patients treated at a Brazilian cancer center. Patients with breast cancer who underwent adjuvant treatment between January 2016 and June 2019 were selected. Data were analyzed using chi-square and Fisher correlation of variables, and multivariate analyses were adjusted for propensity score. Results A total of 231 patients with a mean age of 55.9 years at the time of treatment were included in the study. The majority (93.9%) had luminal histology, 84.8% were at clinical stage I, and 98.2% had a good performance status. The overall incidence of febrile neutropenia in the study population was 13.4% (31 cases). The use of brand-name docetaxel (Taxotere ® ) was the only factor associated with febrile neutropenia occurrence (OR= 3.55, 95%CI= 1.58-7.94, p=0.002). Conclusion In patients with breast cancer who require treatment with adjuvant docetaxel and cyclophosphamide regimen, the toxicity profile differs between brand-name and generic docetaxel. Regardless of the formulation used, the incidence of febrile neutropenia was less than 20%, which may allow for the omission of primary prophylactic granulocyte colony-stimulating factor use in this setting.
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ABSTRACT Objective To evaluate the severity of COVID-19 in cancer patients to describe clinical and epidemiological factors associated with poor outcomes (mortality and need of intensive care unit admission or mechanical ventilation). Methods Retrospective data from patients with cancer and laboratory diagnosis of COVID-19, obtained between March 16 and May 29, 2020, were retrieved out of a cancer center database. Data analyzed included patient history, age, sex, comorbidities, types of cancer and anticancer therapy. Results This sample comprised 105 patients aged 18-92 years, 80.9% of whom were females. Dyspnea was the most prevalent initial symptom (30.4%) among patients who died (p<0.0001). Overall, 57.1% of patients had metastatic disease and 60% had poor performance status (Eastern Cooperative Oncologic Group ≥2) at the time of COVID-19 diagnosis. The overall mortality rate was 40.95%. Mortality rates were higher in male patients and those with poor performance status (p<0.0001). Conclusion This cohort is one of the largest Brazilian studies describing clinical and epidemiological features of patients with cancer and concurrent COVID-19. Findings of this study emphasize the vulnerability of cancer patients in the current pandemic, and indicate high mortality from COVID-19 among male cancer patients and cancer patients with poor performance status. This analysis may assist the selection of patients who may benefit from strict isolation and eventual discontinuation of anticancer therapy to reduce exposure to infection.
RESUMO Objetivo Avaliar a gravidade da infecção por COVID-19 em pacientes oncológicos, determinando os aspectos clínicos e epidemiológicos associados ao pior desfecho, seja em termos de mortalidade, necessidade de internação em unidade de terapia intensiva ou ventilação mecânica. Métodos Pacientes com câncer e diagnóstico confirmado por laboratório de COVID-19 foram identificados nos bancos de dados de um hospital oncológico entre 16 de março e 29 de maio de 2020. Os dados coletados incluíram história, idade, sexo e comorbidades dos pacientes, além dos tipos de câncer e do tratamento anticâncer. Resultados Dentre os 105 pacientes analisados, a idade variou de 18 a 92 anos, e 80,9% eram do sexo feminino. Dispneia foi o sintoma inicial mais prevalente entre os que morreram (30,4%). No momento do diagnóstico da infecção, 57,1% apresentavam doença metastática e 60% performance status ruim (Eastern Cooperative Oncologic Group ≥2). A taxa de mortalidade geral foi 40,95% e superior entre os homens e pacientes com baixo nível de performance status (p<0,0001). Conclusão Este coorte é um dos estudos mais robustos do Brasil, descrevendo características clínicas e epidemiológicas de pacientes com câncer e COVID-19. Os achados do estudo alertam para a vulnerabilidade dos pacientes oncológicos na pandemia atual e demonstram alta mortalidade por COVID-19 em pacientes do sexo masculino e com pior performance status. Essa análise pode ajudar a selecionar os pacientes que podem se beneficiar de isolamento rigoroso e até mesmo da interrupção do tratamento, reduzindo a exposição à infecção.
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Humanos , Masculino , Feminino , COVID-19 , Neoplasias , Respiração Artificial , Comorbidade , Estudos Retrospectivos , Fatores de Risco , Teste para COVID-19 , SARS-CoV-2 , HospitalizaçãoRESUMO
ABSTRACT Objective To define a predictive factor for pathologic complete response, compare the oncologic outcomes associated with the degree of pathologic response after neoadjuvant chemotherapy, and to analyze pathologic complete response as a prognostic factor for overall survival and progression-free survival. Methods A retrospective study of patients admitted to Hospital Estadual Mário Covas and Hospital Anchieta from 2008 to 2012, with locally advanced breast cancer. Hormone receptor status, HER2 status, histologic and nuclear grade, age upon diagnosis and histological type of the tumor were analyzed. Pathologic evaluation of the tumor was subdivided into pathologic complete response, defined by the absence of tumor; intermediate response, considered as a favorable stage; and poor response, considering low-responder patients. Data obtained were submitted to statistical analysis. Results The study included 243 patients. There was an association of pathologic complete response with HER-2 negative, histological grade 3, stage III, hormone receptor negative, positive lymph node, older age and more advanced tumors. However, after multivariate analysis the only predictor of pathologic complete response was the presence of negative hormone receptor. By analyzing the prognostic factors, hormone receptor negative was considered as an independent risk factor, and pathologic complete response was considered as an independent protective factor. Conclusion Hormone receptor negative is predictive of pathologic complete response and is an isolated risk factor for lower progression-free survival and overall survival. Pathologic complete response is a protective factor for these same survival analyses.
RESUMO Objetivo Definir um fator preditivo para resposta patológica completa, comparar os resultados oncológicos associados com o grau de resposta patológica, após quimioterapia neoadjuvante, e analisar a resposta patológica completa como fator prognóstico para sobrevivência global e livre de progressão de doença. Métodos Estudo retrospectivo de pacientes admitidas no Hospital Estadual Mário Covas e Hospital Anchieta, no período de 2008 a 2012, com câncer de mama localmente avançado. Foram utilizados status dos receptores hormonais, proteína HER2, grau histológico e nuclear, idade do paciente ao diagnóstico e tipo histológico do tumor. A avaliação patológica do tumor foi subdividida em resposta patológica completa, definida com ausência de tumor; resposta intermediária, considerada como um estádio favorável; e resposta ruim, considerando os pacientes pouco respondedores. As informações obtidas foram submetidas à análise estatística. Resultados Foram incluídas 243 pacientes. Verificou-se associação de resposta patológica completa entre HER-2 negativo, grau histológico 3, estadiamento III, receptor hormonal negativo, linfonodo positivo, maior idade e tumores mais avançados. Porém, após análise multivariada, o único fator preditivo de resposta patológica completa foi presença de receptor hormonal negativo. Ao analisar fatores prognósticos, receptor hormonal negativo permaneceu como variável independente de risco, e resposta patológica completa, como variável independente de proteção. Conclusão O receptor hormonal negativo é fator preditivo isolado de resposta patológica completa e fator de risco para menor sobrevida livre de doença e sobrevida global. Já a resposta patológica completa é fator protetor para estas mesmas análises de sobrevivência.
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Humanos , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Neoplasias da Mama/tratamento farmacológico , Carcinoma/patologia , Carcinoma/tratamento farmacológico , Receptores de Progesterona/análise , Receptores de Estrogênio/análise , Terapia Neoadjuvante/métodos , Valores de Referência , Fatores de Tempo , Neoplasias da Mama/mortalidade , Neoplasias da Mama/química , Carcinoma/mortalidade , Carcinoma/química , Análise Multivariada , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Análise de Variância , Resultado do Tratamento , Intervalo Livre de Doença , Estimativa de Kaplan-Meier , Pessoa de Meia-IdadeRESUMO
A osteoartropatia hipertrófica primária é uma síndrome rara, caracterizada pela presença de baqueteamento digital de mãos e pés, aumento das extremidades e de tecidos periarticulares secundários à proliferação óssea, fisionomia facial grosseira, dor e edema articular. A forma primária representa 3 a 5% de todos os casos de osteoartropatia hipertrófica e tem como fatores etiológicos influência genética, anormalidade da atividade fibroblástica e alteração no suprimento sanguíneo periférico. Apresenta evolução crônica e insidiosa, alternando fases de exacerbação com períodos assintomáticos. As manifestações clínicas são variáveis. A denominação síndrome completa é reservada aos casos com paquidermia (espessamento cutâneo da face e couro cabeludo, periostite e cutis vertici gyrata); síndrome incompleta, quando não há envolvimento do couro cabeludo; e frustra, quando se observa paquidermia com periostite mínima ou ausente. Os autores descrevem um homem branco de 39 anos diagnosticado com a forma primária da osteoartropatia hipertrófica. A partir do relato de caso, discutem-se características clínicas, radiológicas e a abordagem terapêutica dessa patologia.
Primary hypertrophic osteoarthropathy is a rare syndrome, consisting of clubbed hands, fingers, and feet digits; enlarged extremities secondary to periarticular and bone proliferation; thickened facial skin; painful and swollen joints. The idiopathic form represents 3 to 5 per cent of all cases of hypertrophic osteoarthropaty. Genetic influence, abnormal fibroblasts activity, and changes of the peripherical blood flow appear to be significant on the pathogenesis. Clinical manifestations are variable: the term complete syndrome is used for the patient with pachydermia, coarsening of the face skin and scalp, periostitis, and cutis verticis gyrata); the incomplete form, when there is no sparing of the scalp; and the frusted form for pachydermia with minimal or absent periostitis. The authors describe a 39-year-old white man diagnosed with primary hypertrophic osteoarthropathy. We also report the clinical and radiological carateristics of this syndrome and terapeutical approach of pachydermoperiostosis.
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Humanos , Masculino , Adulto , Doenças Reumáticas/complicações , Osteoartropatia Hipertrófica Primária , Osteoartropatia Hipertrófica Primária , RevisãoRESUMO
Introdução: O linfoma primário da mama (LPM) é um tumor raro, sendo responsável por 0,04% a 0,5% de todos os tipos de câncer de mama. O tipo mais comum de LPM é o linfoma não Hodgkin de grandes células B (LNHDGCB), correspondendo a 40% a 70% dos casos. Relato do caso: Paciente de 59 anos de idade apresentava uma massa mamária de cerca de 13 cm de extensão, aumento progressivo e dor local. O diagnóstico foi realizado através de biópsia incisional da mama. A análise imuno-histoquímica confirmou o diagnóstico de linfoma não Hodgkin, com expressão dos marcadores CD20, MUM-1, Bcl2. O tratamento foi realizado com quatro ciclos de quimioterapia com esquema R-CHOP (rituximab, ciclofosfamida, adriamicina, vincristina e prednisona) e complementação com radioterapia, tendo apresentado resposta clínica completa. Conclusão: O LPM é um subtipo raro de neoplasia mamária. O tratamento do LPM é similar ao de linfomas de mesmo estádio e histologia de outras localizações.
RESUMO
Contexto: A colecistectomia laparoscópica é considerada a cirurgia padrão-ouro para remoção da vesícula biliar. O achado acidental de um carcinoma da vesícula, durante este procedimento, é pouco comum e de difícil diagnóstico pré-operatório. Objetivo: Relatar um caso de implante na cicatriz umbilical de um carcinoma de vesícula biliar não suspeitado no pré-operatório após uma colecistectomia laparoscópica. Relato do caso: Paciente de 78 anos apresentou queixas de dor no hipocôncrio direito, náuseas e vômitos deinício súbito. Não havia sinais de icterícia e as provas de função hepática eram normais. A ultra-sonografia abdominal revelou espessamento da parede da vesícula biliar com múltiplos cálculos biliares, sem sinais de tumor. O paciente submeteu-se a uma colecistectomia laparoscópica sem intercorrências. O exame histopatológico revelou um adenocarcinoma tubular bem diferenciado, invadindo completamente a parede da vesícula biliar. Quatro meses depois, o paciente apresentou dor periumbilical e uma massa semifixa palpável medindo 7x7 cm com aspecto tumoral no umbigo. O paciente foi submetido a uma ressecção para umbilical do tumor, sendo evidenciadas metástases peritoneais. O paciente evoluiu para óbito sete meses após a colecistectomia laparoscópica.
Assuntos
Masculino , Idoso , Humanos , Adenocarcinoma , Colecistectomia Laparoscópica/efeitos adversos , Neoplasias da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/diagnóstico , Metástase Neoplásica , Umbigo , LaparoscopiaRESUMO
O câncer de ânus é uma doença incomum, responsável por apenas 4% das neoplasias do trato gastrointestinal baixo. Na maioria dos casos, os tumores são de origem epidérmica, apresentam radio e quimiossensibilidade e a sobrevida dos pacientes após cinco anos varia de 60% a 80%. O presente estudo apresenta uma série de 31 pacientes com câncer de ânus atendidos no Hospital São Marcos, de julho de 1998 a novembro de 2003. A faixa etária variou de 18 a 95 anos (mediana 62 anos), com predominância do sexo feminino na proporção de 3:1. O carcinoma espinocelular mostrou-se o tipo histológico mais prevalente. O tratamento mais empregado foi a combinação entre radio e quimioterapia, seguido da radioterapia exclusiva. A sobrevida global após 42 meses de seguimento foi de 64,3%.