Prognostic factors for brain metastasis in women presenting cervical cancer.

PURPOSE: Although rare, brain metastases (BM) from cervical cancer (CC) are highly lethal. Adequate patient selection for specific treatments can improve survival rates in patients afflicted by this condition. This study aimed to describe the characteristics of CC patients who developed BM and overall survival-associated factors. Brain metastasis impact on the overall survival was assessed as a secondary objective. METHODS: This assessment comprises a retrospective cohort study on 3394 women presenting CC diagnosed between January 2010 and December 2017 at a single referral center. Incident BM cases were included. Descriptive statistics were calculated. Kaplan-Meier curves were used for the survival analysis and a Cox proportional hazards regression model was applied to explore the risk of death according to the analyzed independent variables. RESULTS: A total of 48 incident BM cases were identified. The median time between CC diagnosis and BM development was 1.5 years. Headaches (29.2%), dizziness/altered balance (29.2%), vertigo (29.2%) and motor disturbances (25.0%) were the most common signs and symptoms at presentation. Median overall survival after BM diagnosis was of 1.6 months (95% CI 0.9-2.3) while in the group of women without BM it was 5.5 years (95% CI 4.9-6.1). Concerning the Cox multivariate analysis, presenting one extracerebral metastases site (HR 2.8; 95% CI 1.3-6.2; p = 0.009) and receiving supportive treatment (HR 13.7; 95% CI 3.1-60.5; p 0.001) were independently associated with the risk of death. CONCLUSION: The median survival of women with BM following CC was poor. Women without extracerebral metastases and undergoing multimodal treatment displayed better overall survival rates.

Incidence and risk factors associated with the development of metastatic spinal cord compression due to bone metastasis in women with cervical cancer.

PURPOSE: The aim of this study was to determine the incidence and factors associated with the development of metastatic spinal cord compression (MSCC) after cervical cancer (CC). METHODS: This retrospective cohort of 3551 women with CC who underwent treatment at the Brazilian National Cancer Institute were included in the study. Clinical and sociodemographic variables were obtained from the Hospital Cancer Registry and from hospital records. A descriptive study of the population was carried out, using means and standard deviations or frequencies and percentages. The Kaplan-Meier curve was used to identify annual incidence rates. Associations between the independent variables and the outcome (MSCC) were evaluated by a univariate analysis, applying crude and adjusted odds ratios (aOR) assuming 95% confidence intervals. RESULTS: The MSCC incidence was of 1.5% (n = 51), associated to advanced staging (aOR = 2.65, 95% CI: 1.45-4.85, p = 0.001) and initial treatment with concomitant chemotherapy and radiotherapy (aOR = 4.40, 95% CI: 1.74-11.13, p = 0.002). CONCLUSIONS: Our findings revealed the incidence and factors associated with MSCC, indicating a subset of patients who may be potential targets for the prevention and early treatment of this condition, indicating unprecedented and relevant data for the Brazilian epidemiological scenario due to the high CC incidence rates.

Single-Center Experience in the Treatment of Visceral Artery Aneurysms.

BACKGROUND: Visceral artery aneurysms (VAAs), although rare, represent a life-threatening disease with high mortality rates. With the more frequent use of diagnostic tests, there has been an incidental detection of these lesions which are mostly asymptomatic. It follows that surgeons are increasingly called to decide on the most appropriate management of VAAs between an open surgical or endovascular approach and among the different endovascular options currently available. The aim of this retrospective study was to evaluate the results of open surgery and interventional endovascular strategies of visceral artery aneurysms with respect to technical success, therapy-associated complications, and postinterventional follow-up in the elective and emergency situation. METHODS: From January 1992 to January 2017, 125 open surgical or endovascular interventions for VAA were performed at our institution. Once the VAA was diagnosed and the indication for treatment was assessed, the preoperative diagnostic work-up consisted of contrast computed tomography (CT) or magnetic resonance imaging (MRI) and, in some patients, digital subtraction angiography. Follow-up included clinical and duplex ultrasound scan (DUS) and contrast-enhanced ultrasound to assess the treated vessel patency and organ perfusion after 1, 6, and 12 months, and yearly thereafter. CT or MRI controls were also performed at 1 year of follow-up and only when DUS was not diagnostic or showed a complication thereafter. After the first 5 years of follow-up, the status of the patient was obtained by a structured telephone survey. RESULTS: The treatment option was endovascular in 56 of 125 cases (44.8%). Technical success was 98.3%. In one case, the procedure was interrupted for the extensive dissection of the afferent vessel. Twenty-six patients were treated by coil embolization while 29 with covered stenting. The endovascular approach was in emergency in two cases (3.6%). In the endovascular group, mortality was nil. Complications occurred in 5 cases (8.9%): 1 subacute intestinal ischemia caused by superior mesenteric artery dissection, 2 aneurysm reperfusion, 1 stent thrombosis, and 1 massive splenic hematoma. In 69 (55.2%) cases, surgical treatment was preferred, with 24 VAA resections and 45 arterial reconstructions. In 20 cases (29%), open surgery was performed in emergency conditions. In the surgical group, 8 emergency patients (40%) died intraoperatively. The mortality after elective surgical interventions was nil. Complications after surgery were 4 graft late thrombosis (5.8%): asymptomatic in three cases and requiring splenectomy in one. CONCLUSIONS: There is no overall consensus regarding the indications for treatment of VAA. Currently in emergent setting, the endovascular approach should be considered as the first choice because of its reduced invasiveness, faster way to access and bleeding control; this accounts for the lower morality of the interventional therapy than open surgery. Endovascular approach is effective for elective repair of VAAs, but procedure-related complications may occur in a not negligible number of patients. Given comparable mortality rates and low procedure-related complication rate, surgical approach still has space in the elective management of VAAs, especially for aneurysms unsuitable or challenging for the endovascular option in patients with low surgical risk. The size, location, and morphology of VAAs, systemic or local comorbidities, and specific anatomical situations such as previous abdominal surgery should dictate treatment choice.

Treatment of a Juxtarenal Aneurysm with a Parallel Graft in the Left Renal Artery and Polymer-Based Technology to Seal the Entire Aneurysmal Sac.

BACKGROUND: Presenting the treatment of a juxtarenal aneurysm using a Nellix device combined with a chimney stent in a renal artery. CASE REPORT: A 72-year-old woman was diagnosed with a 5.5-cm bilobed juxtarenal aneurysm. She underwent successful aneurysm repair with the Nellix system combined with a chimney stent in the left renal artery. Angio computed tomography control showed complete sealing of the aneurysm sac and patent chimney stent. CONCLUSIONS: Endovascular aneurysm sealing combined with chimney may be a valid way to treat juxtarenal aneurysms, and the conformable polymer-filled endobags may provide a durable seal around the chimney-graft preventing gutter formation.

Incidence and risk factors for the development of cerebral metastasis in cervical cancer patients.

OBJECTIVE: Cerebral metastasis (CM) in cervical cancer (CC) cases, although rare, results in high lethality rates. The present study aimed to assess CM incidence in a Brazilian reference CC center and evaluate the risk factors for CM development. Retrospective observational study of patients diagnosed with CC between 2010 and 2017. METHODS: Cumulative CM incidence and incidence density were evaluated. Characteristics associated to CM development risks were identified using crude (cOR) or adjusted (aOR) odds ratios. RESULTS: A total of 3,397 patients were included in this study. Patient age ranged from 18 to 101 years, with a mean age of 48.8±14.0. After a mean follow-up time of 3.2±2.1 years, 51 CM cases were identified, resulting in a cumulative incidence of 1.5% (95% confidence intervals [CI]=1.12-1.97) and an incidence density at the end of the 6th year of 27.4 per 1,000 women/year. Advanced clinical stage (aOR=3.15; 95% CI=1.16-8.58; p=0.025), the presence of previous lung metastasis (aOR=4.04; 95% CI=1.82-8.94; p=0.001) and the adenocarcinoma (aOR=2.90; 95% CI=1.46-5.76; p=0.002), adenosquamous carcinoma (aOR=7.33; 95% CI=2.87-18.73; p<0.001), undifferentiated carcinoma (aOR=14.37; 95% CI=3.77-54.76; p<0.001) and neuroendocrine carcinoma (aOR=21.31; 95% CI=6.65-68.37, p<0.001) histological types were associated with a higher risk for CM development. CM risk was higher in the first years of follow-up, with no cases observed after the 6th year. CONCLUSION: CC patients in advanced clinical stages, displaying previous lung metastasis and non-squamous histological types are at high risk of developing CM.

Validation of the Portuguese version of functional assessment of cancer therapy-fatigue (FACT-F) in Brazilian cancer patients.

GOALS OF WORK: The purpose of this study was to validate the Portuguese version of the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) in order to establish its assessment properties, including validity and reliability in a sample of Brazilian cancer patients. MATERIALS AND METHODS: Two hundred seventy patients with different types of cancer were included for this study; the mean age was 50.5 years. The reliability was assessed by internal consistency and reproducibility. Construct validity was assessed through convergent validity and discriminant validity. Convergent validity was examined by comparing the FACT-F to the SF-36. Discriminant validity of the FACT-F evaluated the ability of the scale to differentiate defined groups, discriminating patients according to Eastern Cooperative Oncology Group Performance Status and different stages of disease. MAIN RESULTS: FACT-F had high internal consistency (Cronbach alpha coefficient was 0.78 for physical well-being, 0.68 for social/family well-being, 0.75 for emotional well-being, 0.74 for functional well-being, 0.91 for fatigue, and 0.92 for total FACT-F). The range of test-retest intraclass correlation was from 0.72 to 0.91 (p < 0.0001). The Pearson product correlation revealed good correlations between the total FACT-F and subscales of the SF-36 in most dimensions, ranging from r = 0.51 to r = 0.76, except for SF-36 physical (r = 0.31). The positive correlations between the SF-36 vitality scale and FACT-F total (r = 0.76) and the fatigue subscale (r = 0.77) support the convergent validity. CONCLUSIONS: The Portuguese version of FACT-F is a reliable and valid instrument to assess quality of life and fatigue, representing a valid tool to screen cancer-related fatigue in Brazilian cancer patients.

Fatores Prognósticos e Funcionalidade na Síndrome de Compressão Medular Metastática: um Estudo de Coorte / Prognostic Factors and Functionality in Metastatic Spinal Cord Compression: Cohort Study / Factores Pronósticos y Funcionalidad a Síndrome de Compresión Espinal Metástasico: un Estudio de Cohorte

Introdução: A síndrome de compressão medular metastática (SCMM) tem grande potencial de perda irreversível da função motora e sensitiva, sendo considerada uma emergência oncológica. Objetivo: Avaliar o prognóstico da SCMM e a funcionalidade dos pacientes com tumores sólidos. Método: Estudo de coorte que incluiu pacientes com câncer que desenvolveram SCMM entre janeiro de 2017 e dezembro de 2018. Os dados clínicos e sociodemográficos foram extraídos dos prontuários físicos e eletrônicos. Análise de sobrevida foi realizada pelo método Kaplan-Meier. Resultados: O estudo abrangeu 90 pacientes que apresentaram SCMM. Ao diagnóstico da SCMM, 55,5% dos pacientes não conseguiam realizar marcha. Os pacientes com SCMM após câncer de pulmão tiveram 4,1 vezes maior risco de morrer (IC 95%, 1,79-9,41; p=0,001), os pacientes com tumores geniturinários tiveram 1,9 vezes maior risco de morrer (IC 95%, 1,06- 3,45; p=0,02) e os pacientes com outros tipos de tumor tiveram 3,1 vezes maior risco de morrer (IC 95%, 1,58-6,24; p=0,001) quando comparados aos pacientes com SCMM após câncer de mama. Conclusão: Destaca-se a relevância clínica deste estudo ao descobrir que o tipo de tumor primário é um fator preditor independente para sobrevida da SCMM. Ao diagnóstico da SCMM, mais da metade dos pacientes não realizam marcha

Introduction: Metastatic Spinal Cord Compression (MSCC) has great potential of irreversible loss of motor and sensory function, and it is considered an oncological emergency. Objective: Evaluate the prognosis of MSCC and the functionality of patients with solid tumors. Method: Cohort study was conducted in patients with cancer who developed MSCC between January 2017 and December 2018. Clinical and socio-demographic data were extracted from physical and electronic charts. Survival analysis was performed by the Kaplan-Meier method. Results: The study included 90 patients who were diagnosed with MSCC. At the time of MSCC diagnosis, 55.5% of patients were unable to walk. Patients with MSCC after lung cancer had 4.1-fold more odds of death (95% CI: 1.79-9.41; p=0.001), those with genitourinary tumors, 1.9-fold higher risk of death (95% CI: 1.06-3.45; p=0,02), and with other types of tumors, 3.1-fold higher risk of death (95% CI: 1.58-6.24; p=0.001) when compared with patients with MSCC after breast cancer. Conclusion: The clinical relevance of this study relies on the findings that the primary type of tumor is a predictive factor for overall survival of MSCC. More than half of the patients were unable to walk at the MSCC diagnosis

Introducción: El síndrome de compresión espinal (SCE) tiene un gran potencial de pérdida irreversible de la función motora y sensorial, siendo considerado una emergencia oncológica. Objetivo: Evaluar el pronóstico de SCE y la funcionalidad de los pacientes. Método: Estudio de cohorte que incluyó pacientes con cáncer que desarrollaron SCE entre enero de 2017 y diciembre de 2018. Se extrajeron datos clínicos y sociodemográficos de historias clínicas físicas y electrónicas. El análisis de supervivencia se realizó mediante el método de Kaplan-Meier. Resultados: El estudio cubrió a 90 pacientes que tenían SCE. En el diagnóstico de SCE, 55,5% de los pacientes no pueden caminar. En comparación con los pacientes con cáncer de mama, los pacientes con cáncer de pulmón tenían 4,1 veces más riesgo de morir (IC 95%, 1,79-9,41; p=0,001), los pacientes con tumores genitourinarios 1,9 veces mayor de morir (IC 95%, 1,06-3,45; p=0,02) y aquellos pacientes con otro tipo de tumor, 3,1 veces mayor riesgo de morir (IC 95%, 1,58- 6,24; p=0,001). Conclusión: Este estudio encontró que el tipo de tumor primario es un factor predictivo para la supervivencia de le SCE. Más de la mitad de los pacientes no caminan en el momento del diagnóstico de SCE. Palabras clave: compresión de la médula espinal; neoplasias de la columna

Reproducibility of functional assessment of Cancer therapy-fatigue (FACT-F) questionnaire for cancer patients

Objective: The objective of this study was evaluating the reproducibility in Portuguese of Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire for cancer patients by applying it according to the test-retest method. Material and Methods: Subjects were 85 cancer patients with an average age of 51.0 years, being 56 (65.9%) women and 29 (34.1%) men. FACT-F questionnaire consists of 40 items, divided in five domains, and is applied for evaluating quality of life and fatigue in patients with cancer. We used as a measuring tool intraclass correlation coefficient values obtained from two measures of test-retest and scatter plot proposed by Bland-Altman. Results: In 36.5% of cases the questionnaire was self-administered, and in 63.5% of the cases read by an interviewer and filled after verbal answer. Intraclass correlation coefficient values found for the domains were: physical well-being 0.72; social/family well-being 0.91; emotional well-being 0.90; functional well-being 0.86; fatigue subscale 0.88, and for the FACT-F 0.91. The Bland-Altman plot showed to be adequate, since most points were within the limits of reliability. Conclusions: FACT-F questionnaire in Portuguese has good test-retest reproducibility in patients with different types of cancer, performance status and stages.