Brazilian Society of Surgical Oncology guidelines for malignant bowel obstruction management.

BACKGROUND: Malignant bowel obstruction (MBO) is a frequent complication in advanced cancer patients and especially those with abdominal tumors. The clinical management of MBO requires a specific and individualized approach based on the disease prognosis. Surgery is recommended. Less invasive approaches such as endoscopic treatments should be considered when surgery is contraindicated. The priority of care for inoperable and consolidated MBO is to control the symptoms and promote the maximum level of comfort. OBJECTIVES: This study aimed to develop recommendations for the effective management of MBO. METHODS: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology, of whom 41 surgeons participated in the survey. A literature review of studies retrieved from the National Library of Medicine database was conducted on particular topics chosen by the participants. These topics addressed questions regarding the MBO management, to define the level of evidence and strength of each recommendation, and an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS: Most aspects of the medical approach and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS: Guidelines outlining the strategies for management MBO were developed based on the strongest evidence available in the literature.

Primary Tumor Location Is a Predictor of Poor Prognosis in Patients with Locally Advanced Esophagogastric Cancer Treated with Perioperative Chemotherapy.

BACKGROUND: Esophagogastric cancer (EGC) is a leading neoplasm worldwide. Perioperative chemotherapy (periCT) is currently a standard of care for most patients (pts). Prevalence of esophagogastric junction (EGJ) tumors is increasing over the last years. METHODS: The aim of this study was to retrospectively search for prognostic factors in pts. with locally advanced EGC treated with periCT. Three-year overall survival (OS) and Event-Free Survival (EFS) were main end-points. HER-2 positive tumors were defined by immunohistochemistry or FISH. RESULTS: Between June/2007 and November/2015, 128 pts. started periCT for esophagogastric junction (EGJ) or gastric adenocarcinoma (GC). Median age was 59.5 y and 64% were male. Primary site was EGJ in 27% and 65% were cN+. Diffuse subtype was seen in 42%. Ninety-seven pts. were assessed for HER-2; 14 (14.4%) were positive. After median follow-up time of 45 m, 48 deaths occurred. The 3-year OS and EFS rate was 61.3% and 51.2%, respectively. Main prognostic factors were: AJCC ypT3-T4yN1-N3 (HR 6.75 p 0.002) and EGJ primary (HR 2.64, p 0.004). Overall HER-2 was not prognostic. Still, a difference in 3-year OS was observed for GC/HER2+ compared to EGJ/HER2+ (88.9% versus 20%, p = 0.002). This difference is greater for 3-year EFS with no patient with EGJ/HER2+ free-of-event against 62.5% for GC/HER+ (p = 0.011). CONCLUSION: In our analysis, pathological staging and primary site were main prognostic factors. Moreover, a small group of EGJ/HER2+ had very poor survival.

The roles of PTEN, cMET, and p16 in resistance to cetuximab in head and neck squamous cell carcinoma.

There is no established biomarker for cetuximab efficacy in recurrent head and neck squamous cell carcinoma (HNSCC). The aim of the present study was to evaluate the prognostic and predictive impact of PTEN, cMET, and p16 expression in recurrent HNSCC. In this retrospective study, 112 patients with recurrent HNSCC received chemotherapy (CT) alone (n = 37) or chemotherapy with cetuximab (n = 75). PTEN, cMET, and p16 protein expression were evaluated by immunohistochemistry. The median overall survival (mOS) for the patients treated with cetuximab + CT versus CT alone was 11.4 months and 7.0 months, (p = 0.949). The median progression-free survival (mPFS) was 6.2 months versus 3.0 months (p = 0.154). Patients with PTEN loss exhibited a mOS of 5.8 months versus 10.5 months (p = 0.002) and a mPFS of 3.2 months versus 4.7 months (p = 0.019). A multivariate analysis identified an independent association between PTEN loss and OS (HR 2.27; 95% confidence 95% CI 1.27-4.08; p = 0.006) and with PFS (HR 1.85; 95% CI 1.09-2.99; p = 0.022). A negative prognostic impact of PTEN loss was observed in the patients treated with cetuximab + CT, and not in the CT only group. Expression of cMET and p16 showed no impact on OS or PFS. The present findings confirm that PTEN is a prognostic factor for metastatic HNSCC and they support further studies of PTEN expression to evaluate its predictive value to cetuximab response.

Hepatotoxicidade e síndrome DRESS induzida por anticonvulsivantes: relato de dois casos e revisão da literatura / Hepatotocicity and anticonvulsant induced DRESS syndrome: report of two cases and literature review

O termo DRESS (Drug Rash with Eosinophilia and Systemic Symptoms - erupção a medicamento com eosinofilia e sintomas sistêmicos) é uma reação de hipersensibilidade com características sistêmicas, sendo o acometimento hepático manifestação visceral mais comum. Objetivo: descrever dois casos de síndrome DRESS e hepatotoxicidade por carbamazepina e fenitoína, e fazer uma breve revisão da literatura. Relato de Casos: dois pacientes usuários de fármacos anticonvulsivantes apresentaram reações adversas com comprometimento do estado geral, erupção cutânea, eosinofilia periférica, aumento das aminotransferases e enzimas canaliculares. Após serem firmados os diagnósticos de síndrome DRESS e hepatotoxicidade, foram suspensos os anticonvulsivantes e introduzida corticoterapia sistêmica. Os pacientes evoluíram com importante melhora do quadro clínico-laboratorial. Conclusão: o reconhecimento precoce da DRESS é essencial pois o atraso no diagnóstico e na suspensão do medicamento desencadeante pode resultar no aumento da mortalidade.

The term DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a hypersensitivity reaction to drugs with systemic features, and liver involvement is its most common visceral manifestation. Objective: describe two cases of DRESS syndrome and hepatotoxicity by carbamazepine and phenytoin and make a brief literature review. Case reports: two patients taking anticonvulsants had adverse reactions with malaise, cutaneous rash, peripheral eosinophilia, increasing of canalicular and liver enzymes. After DRESS syndrome and hepatotoxicity diagnose, the anticonvulsants were discontinued and oral corticosteroids were introduced. The patients had significant clinical and laboratory improvement. Conclusion: early detection of DRESS is essential because delay in both diagnosis and discontinuation of the triggering medication can result in increasing mortality.