The Brazilian national prospective active surveillance (AS) cohort of patients with low-risk prostate cancer in the public health system: vigiaSUS study protocol.

BACKGROUND: Prostate cancer exhibits a very diverse behaviour, with some patients dying from the disease and others never needing treatment. Active surveillance (AS) consists of periodic PSA assessment (prostate-specific antigen), DRE (digital rectal examination) and periodic prostate biopsies. According to the main guidelines, AS is the preferred strategy for low-risk patients, to avoid or delay definitive treatment. However, concerns remain regarding its applicability in certain patient subgroups, such as African American men, who were underrepresented in the main cohorts. Brazil has a very racially diverse population, with 56.1% self-reporting as brown or black. The aim of this study is to evaluate and validate the AS strategy in low-risk prostate cancer patients following an AS protocol in the Brazilian public health system. METHODS: This is a multicentre AS prospective cohort study that will include 200 patients from all regions of Brazil in the public health system. Patients with prostate adenocarcinoma and low-risk criteria, defined as clinical staging T1-T2a, Gleason score ≤ 6, and PSA < 10 ng/ml, will be enrolled. Archival prostate cancer tissue will be centrally reviewed. Patients enrolled in the study will follow the AS strategy, which involves PSA and physical examination every 6 months as well as multiparametric MRI (mpMRI) every two years and prostate biopsy at month 12 and then every two years. The primary objective is to evaluate the reclassification rate at 12 months, and secondary objectives include determining the treatment-free survival rate, metastasis-free survival, and specific and overall survival. Exploratory objectives include the evaluation of quality of life and anxiety, the impact of PTEN loss and the economic impact of AS on the Brazilian public health system. DISCUSSION: This is the first Brazilian prospective study of patients with low-risk prostate cancer under AS. To our knowledge, this is one of the largest AS study cohort with a majority of nonwhite patients. We believe that this study is an opportunity to better understand the outcomes of AS in populations underrepresented in studies. Based on these data, an AS national clinical guideline will be developed, which may have a beneficial impact on the quality of life of patients and on public health. TRIAL REGISTRATION: Clinicaltrials registration is NCT05343936.

What Cancer Patients Want to Know? Questions from Oncologic Patients in a Brazilian Private Cancer Center.

To establish the more relevant questions oncologic patients may have during cancer treatment. Cross-sectional observational study with all patients undergoing chemotherapy or radiotherapy for cancer in a Brazilian health institution. A questionnaire with open and close questions about cancer diagnosis, treatment, and prognosis was applied. A total of 198 patients were evaluated of whom 122 (62%) were female and 80% of the patients were between 50 and 89 years old. Sixty-one percent of women and 62% of men had questions about cancer diagnosis and treatment. Although questions about nutrition were the most frequent for all patients (72% of men and 48% of women), treatment short- and long-term consequences were a concern for 31% of men and treatment effects on esthetics for 21% of women. After having been informed by the oncology team about their diagnosis and treatment, 49% of the patients also searched for other sources of information. Thirty-eight patients (20%) searched for alternative treatments for cancer. About half of the patients searched for other sources of information after having been informed by the oncology team about their cancer diagnosis and treatment. The present study reinforces the importance for the oncologic health team to spend sufficient time with patients in order to clarify doubts about cancer diagnosis and treatment.

Ovarian yolk sac tumor coexisting with epithelial ovarian cancer: An aggressive rare entity.

Yolk sac tumor (YST) is the second most common subtype of ovarian germ cell tumors. It usually occurs in the second and third decades of life and is rare in postmenopausal women. In postmenopausal women, YST is commonly an aggressive tumor and can present as a pure germ cell component or as a mixed component with other germ cell or epithelial components. The recognition of this histological subtype is important not only for differential diagnosis but also for determining prognosis and treatment decisions. In this case report, we describe a 61-year-old woman with YST coexisting with epithelial carcinoma focusing on the efficacy of systemic therapies.

Effect of G-CSF on oral mucositis and traumatic ulcers produced in the tongue of rats undergoing radiotherapy: clinical and histologic evaluation.

OBJECTIVE: To investigate the effect of granulocyte colony-stimulating factor (G-CSF) on oral mucositis (OM) and on the healing of traumatic ulcers produced in the tongue of rats undergoing radiotherapy (RT). STUDY DESIGN: Twenty-seven Wistar rats were assigned to four groups: (1) RT + traumatic ulcer + filgrastim (G-CSF analog; n = 7); (2) RT + traumatic ulcer + saline (n = 7); (3) no RT + traumatic ulcer + filgrastim (n = 7); and (4) no RT + traumatic ulcer (n = 6). The radiation dose was 30 Gy, and medication was filgrastim (10 µg/kg) for 7 days. RESULTS: Clinically, groups differed in the presence (Fisher's exact test: P = .008) and size of traumatic ulcers after irradiation (Kruskal-Wallis test: P = .032) and in the severity of OM (Fisher's exact test: P = .005 between the irradiated groups). Histologically, there was an increased inflammatory response in the nonirradiated groups (Fisher's exact test: P = .001). CONCLUSIONS: Filgrastim reduced manifestations and the severity of trauma-induced ulcers and radiation-induced OM. Significant differences were not observed histologically between the study drug and respective control groups.

Transplante de células-tronco hematopoéticas em gamopatias monoclonais / Hematopoietic stem cell transplantation for monoclonal gammopathies

O transplante de células-tronco hematopoéticas (TCTH) é um procedimento de fundamental importância na estratégia terapêutica das gamopatias monoclonais. No mieloma múltiplo, em particular, o TCTH autólogo está indicado como estratégia de primeira linha para pacientes até 70 anos de idade. Nesta capítulo serão discutidas as indicações, estratégias e recomendações envolvendo o TCTH em gamopatias monoclonais, amiloidose e POEMS, frutos da Reunião de Consenso da Sociedade Brasileira de Transplante de Medula Óssea.

Hematopoietic stem cell transplantation (HSCT) is an important strategy in the treatment of monoclonal gammopathies. For multiple myeloma, in particular, autologous HSCT is indicated as first line therapy for under 70-year-old patients. In this chapter we will discuss indications, strategies and recommendations involving HSCT for monoclonal gammopathies from the Consensus Meeting of the Brazilian Society of Bone Marrow Transplantation.

Rituximab in association with rapamycin for post-transplant lymphoproliferative disease treatment.

Post-transplant lymphoproliferative disease (PTLD) is an uncommon but life-threatening complication of solid-organ and blood stem-cell transplants. It responds poorly to therapy, including reduction of immunosuppression, interferon, antivirals or chemotherapy. Small series of PTLD successfully treated with rituximab have been reported, and experimental studies suggest that rapamycin inhibits growth of human Epstein-Barr virus-transformed B lymphocytes. We report two cases of PTLD after renal transplantation that were successfully treated with rituximab in association with rapamycin. This report suggests that rituximab associated with rapamycin could be an effective and safe treatment for PTLD.

Leucemia aguda e gestaçäo: relato de 4 casos e revisäo da literatura / Acute leukemia and pregnancy: report of 4 cases and literature review

O diagnóstico de leucemia aguda na gestäo é pouco comum e possui particularidades próprias relacionadas, principalmente, ao manejo. A gestäo em si parece näo alterar a história natural da doença, nem a resposta ao tratamento. Sua maior implicaçäo reside nos riscos da exposiçäo fetal aos agentes quimioterápicos, bem como as complicaçöes maternas relacionadas à própria doença e tratamento. Os efeitos tóxicos do quimioterápicos säo potencialmente prejudiciais ao feto durante o período da embriogênese. Complicaçöes maternas relacionadas ao tratamento podem alterar o desenvolvimento fetal. Este trabalho realiza uma revisäo da literatura existente sobre leucemia e gestaçäo e relata a evoluçäo de 4 pacientes gestantes com diagnóstcio de leucemia aguda, atendidas no Serviço de Hematologia do Hospital de Clínicas de Porto Alegre (HCPA), entre 1990 - 1994. Em três casos o diagnóstico foi de leucemia linfocítica aguda (LLA) e em um de leucemia mielocitica aguda (LMA). O tratamento de induçäo foi realizado com quimioterapia intensiva, obtendo-se a remissäo em todos os casos. Três gestaçöes evoluíram com morte fetal e uma foi interrompida com cesareana. Todas as pacientes apresentaram algum tipo de complicaçäo (anemia, infecçäo) relacionada ao tratamento. A série apresentada é restrita pelo pequeno número de pacientes, assim, seus resultados näo säo conclusivos. A criaçäo de um registro geral destes casos poderia aumentar a casuística e as informaçöes referentes ao tratamento, evoluçäo e efeitos dos quimioterápicos sobre o feto