Complete pathological response in patients with HER2 positive breast cancer treated with neoadjuvant therapy in Colombia / Respuesta patológica completa de pacientes con cáncer de mama HER2 positivo tratadas con quimioterapia neoadyuvante en Colombia.

Introduction: Breast cancer is the most common type of cancer and the leading cause of death by cancer in women in Colombia. Approximately 15 to 20% of breast cancers overexpress HER2. Objective: To analyze the relationship between multiple clinical and histological variables and pathological complete response in patients with HER2-positive breast cancer undergoing neoadjuvant therapy in a specialized cancer center in Colombia. Materials and methods: We performed a retrospective analysis of non-metastatic HER2-positive breast cancer patients who received neoadjuvant therapy between 2007 and 2020 at the Instituto de Cancerología Las Americas Auna (Medellín, Colombia). Assessed parameters were tumor grade, proliferation index, estrogen receptor, progesterone receptor, HER2 status, type of neoadjuvant therapy, pathologic complete response rates, and overall survival. Results: Variables associated with low pathologic complete response rates were tumor grades 1-2 (OR = 0.55; 95% CI = 0.37-0.81; p = 0.03), estrogen receptor positivity (OR =0.65; 95%; CI = 0.43-0.97; p=0.04), and progesterone receptor positivity (OR = 0.44; 95% CI = 0.29-0.65; p = 0.0001). HER2 strong positivity (score 3+) was associated with high pathological complete response rates (OR = 3.3; 95% CI = 1.3-8.35; p=0.013). Five-year overall survival was 91.5% (95% CI = 82.6-95.9) in patients with pathological complete response and 73.6% (95% CI = 66.4-79.6) in patients who did not achieve pathological complete response (p = 0.001). Additionally, the pathological complete response rate was three times higher in patients receiving combined neoadjuvant chemotherapy with anti-HER2 therapy than in those with chemotherapy alone (48% versus 16%). Conclusions: In patients with HER2-positive breast cancer, tumor grade 3, estrogen receptor negativity, progesterone receptor negativity, strong HER2 positivity (score 3+), and the use of the neoadjuvant trastuzumab are associated with higher pathological complete response rates.

Complete pathological response in patients with HER2 positive breast cancer treated with neoadjuvant therapy in Colombia / Respuesta patológica completa de pacientes con cáncer de mama HER2 positivo tratadas con quimioterapia neoadyuvante en Colombia

Introduction. Breast cancer is the most common type of cancer and the leading cause of death by cancer in women in Colombia. Approximately 15 to 20% of breast cancers overexpress HER2. Objective. To analyze the relationship between multiple clinical and histological variables and pathological complete response in patients with HER2-positive breast cancer undergoing neoadjuvant therapy in a specialized cancer center in Colombia. Materials and methods. We performed a retrospective analysis of non-metastatic HER2- positive breast cancer patients who received neoadjuvant therapy between 2007 and 2020 at the Instituto de Cancerología Las Americas Auna (Medellín, Colombia). Assessed parameters were tumor grade, proliferation index, estrogen receptor, progesterone receptor, HER2 status, type of neoadjuvant therapy, pathologic complete response rates, and overall survival. Results. Variables associated with low pathologic complete response rates were tumor grades 1-2 (OR = 0.55; 95% CI = 0.37-0.81; p = 0.03), estrogen receptor positivity (OR = 0.65; 95%; CI = 0.43-0.97; p=0.04), and progesterone receptor positivity (OR = 0.44; 95% CI = 0.29-0.65; p = 0.0001). HER2 strong positivity (score 3+) was associated with high pathological complete response rates (OR = 3.3; 95% CI = 1.3-8.35; p=0.013). Five-year overall survival was 91.5% (95% CI = 82.6-95.9) in patients with pathological complete response and 73.6% (95% CI = 66.4-79.6) in patients who did not achieve pathological complete response (p = 0.001). Additionally, the pathological complete response rate was three times higher in patients receiving combined neoadjuvant chemotherapy with anti- HER2 therapy than in those with chemotherapy alone (48% versus 16%). Conclusion. In patients with HER2-positive breast cancer, tumor grade 3, estrogen receptor negativity, progesterone receptor negativity, strong HER2 positivity (score 3+), and the use of the neoadjuvant trastuzumab are associated with higher pathological complete response rates.

Introducción. El adenocarcinoma de seno es el tipo de cáncer más frecuente y con mayor tasa de mortalidad asociada en mujeres en Colombia. Aproximadamente entre el 15 al 20 % de estos cánceres sobreexpresan el gen HER2. Objetivo. Analizar las asociaciones existentes entre múltiples variables clínicas e histológicas con respecto a la respuesta patológica completa en pacientes con cáncer de mama HER2 positivo que fueron tratadas con quimioterapia neoadyuvante en un centro especializado en el tratamiento del cáncer en Colombia. Materiales y métodos. Se realizó un análisis retrospectivo de las pacientes con cáncer de mama HER2 positivo, no metastásicas, que recibieron quimioterapia neoadyuvante entre el 2007 y el 2020 en el Instituto de Cancerología Las Américas Auna (Medellín, Colombia). Se evaluaron los parámetros de grado tumoral, índice de proliferación, estatus de receptores de estrógeno y de progesterona, tipo de quimioterapia neoadyuvante recibida, tasas de respuesta patológica completa y supervivencia global. Resultados. Las variables asociadas con tasas de respuesta patológica completa más bajas fueron grados tumorales 1-2 (OR = 0,55; IC 95% = 0,37-0,81; p= 0,03), positividad de receptores de estrógeno (OR = 0,65; IC 95 % = 0,43-0,97; p = 0,04) y positividad de receptores de progesterona (OR = 0,44; IC 95 % = 0,29-0,65; p = 0,0001). La positividad fuerte para HER2 (puntaje 3+) se asoció a tasas de respuesta patológica completa más altas (OR = 3.3; IC 95 % = 1,3-8,35; p = 0,013). La supervivencia global a cinco años fue del 91,5 % (IC 95 % = 82,6-95,9) en pacientes con respuesta patológica completa y del 73,6 % (IC 95 % = 66.4-79.6) en pacientes sin respuesta patológica completa (p = 0.001). La tasa de respuesta patológica completa fue tres veces mayor en los pacientes que recibieron quimioterapia neoadyuvante con terapia anti-HER2 comparado con aquellos que recibieron quimioterapia sola sin agentes anti-HER2 (48 % versus 16 %). Conclusión. En pacientes con cáncer de mama con sobreexpresión de HER2, grado tumoral tres, receptores de estrógeno y progesterona negativos, positividad fuerte para HER2 (puntaje 3+) y uso de quimioterapia neoadyuvante con trastuzumab se asociaron con mayores tasas de respuesta patológica completa.

Interaction between Age and Primary Site on Survival Outcomes in Primary GI Melanoma over the Past Decade.

BACKGROUND: Primary malignant melanomas of the Gastrointestinal mucosa are uncommon. Most cases of gastrointestinal (GI) melanomas are secondary, arising from metastasis at distant sites. The purpose of this study is to assess to what extent the interaction between independent prognostic factors (age and tumor site) of primary GI melanoma influence survival. Furthermore, we also aimed to investigate the clinical characteristics, survival outcomes, and independent prognostic factors of patients with primary GI melanoma in the past decade. METHODS: A total of 399 patients diagnosed with primary GI melanoma, between 2008 and 2017, were enrolled in our study by retrieving data from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of primary GI melanoma. Variables with a p value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model (model 1) to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. Furthermore, we analyzed the effect of the interaction between age and primary location on mortality (model 2). RESULTS: Multivariate cox proportional hazard regression analyses revealed higher OM in age group 80+ (HR = 5.653, 95% CI 2.212-14.445, p = 0), stomach location of the tumor (HR = 2.821, 95% CI 1.265-6.292, p = 0.011), regional lymph node involvement only (HR = 1.664, 95% CI 1.051-2.635, p < 0.05), regional involvement by both direct extension and lymph node involvement (HR = 1.755, 95% CI 1.047-2.943, p < 0.05) and distant metastases (HR = 4.491, 95% CI 3.115-6.476, p = 0), whereas the lowest OM was observed in patients with small intestine melanoma (HR = 0.383, 95% CI 0.173-0.846, p < 0.05). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups and lower CSM in small intestine and colon melanoma excluding the rectum. For model 2, considering the interaction between age and primary site on mortality, higher OM was found in age group 80+, followed by age group 40-59 then age group 60-79, regional lymph node involvement only, regional involvement by both direct extension and lymph node involvement and distant metastases. The small intestine had a lower OM. The rectum as primary location and the age range 40-59 interacted to lower the OM (HR = 0.14, 95% CI 0.02-0.89, p = 0.038). Age and primary gastric location did not interact to affect the OM. For the CSM, taking into account the interaction between age and the primary location, higher mortality was found in the same groups and the colon location. The primary colon location also interacted with the age group 40-59 to increase the CSM (HR = 1.38 × 109, 95% CI 7.80 × 107-2.45 × 1010, p = 0). CONCLUSIONS: In this United States population-based retrospective cohort study using the SEER database, we found that only the age range 40-59 interacted with the rectum and colon to lower and increase mortality respectively. Primary gastric location, which was the single most important location to affect mortality, did not interact with any age range to influence mortality. With those results, we hope to shed some light on this rare pathology with a very dismal prognosis.

Fracturas atípicas de fémur, un evento adverso infrecuente de los bisfosfonatos en oncología. Reporte de caso / Atypical femur fractures, a rare adverse event of bisphosphonates in oncology: Case report

Resumen Los bisfosfonatos constituyen uno de los pilares fundamentales en el manejo de la morbilidad ósea de los pacientes con varios tipos de tumores sólidos (1, 3). Sin embargo, a pesar de la experiencia que tenemos por su uso desde hace décadas, existen eventos adversos como las fracturas atípicas (FA) que por su baja frecuencia pueden pasar desapercibidas y no recibir un manejo adecuado. Existen pocos reportes en la literatura de FA en el manejo de pacientes con cáncer. Se presenta un caso en el cual una paciente con un tumor metacrónico de mama con metástasis ósea al debut, actualmente en remisión, presenta una FA de fémur tras recibir bisfosfonatos durante 8 años.

Abstract Bisphosphonates are one of the fundamental pillars in the treatment of bone morbidities in patients with different types of solid tumors.1-3 However, despite the experience that we have accumulated during decades, there are adverse events such as atypical fractures (AF) that due to their low frequency can go unnoticed and might not receive adequate management. There are few reports in the literature about AF in cancer treatments. We present a case of a patient with metachronous breast cancer and bone metastases at initial diagnosis, currently in remission, who presents AF of the femur after receiving bisphosphonates for 8 years.

Toxicidad sistémica asociada con la inyección intramuscular de mercurio metálico: reporte de un caso / Systemic poisoning associated with the intramuscular injection of metallic mercury: a case report

Los informes de toxicidad relacionada con el mercurio metálico aluden principalmente a la inhalación de vapores con efectos sobre los riñones. Hay pocos informes de casos de toxicidad relacionada con la inyección subcutánea, muscular o venosa de este metal. El espectro de manifestaciones es variado y depende de la afectación de los sistemas renal, endocrino y neurológico. Presentamos un caso de toxicidad sistémica secundaria a la inyección intramuscular intencional de mercurio metálico en una mujer de 16 años; en un comienzo la paciente no recibió quelantes y evolucionó con disfunción renal, hiperparatiroidismo y osteoporosis secundaria con fractura patológica de cadera.

Reports of toxicity by metallic mercury are mainly related with exposure by inhalation, leading to renal dysfunction. There are few reports of toxicity related with subcutaneous, muscular or intravenous injections of this metal. The clinical spectrum of manifestations is wide arising from the renal, endocrine and neurologic lesions. We report the case of a 16 year-old woman who suffered from systemic mercurial toxicity after an intentional muscular injection of this metal. She did not initially receive a chelating agent and developed renal dysfunction, hyperparathyroidism and secondary osteoporosis with a pathological hip fracture.

Sistema de instrumentación transpedicular modificado, para el tratamiento de la inestabilidad vertebral toracolumbar / Modified transpedicular instrumentation system for the treatment of thoracolumbar vertebral instability

En estudio se revisaron 189 pacientes con diagnóstico de inestabilidad vertebral toracolumbar, ocasionada por enfermedades como: espondilolistesis, inestabilidad vertebral posquirúrgica, fracturas, infecciones, tumores óseos primarios y metastásicos a nivel toracolumbar. Su estabilidad fue recuperada mediante un implante de tornillos transpediculares conectados con barras de acero inoxidable. Actualmente existen sistemas de fijación transpendicular que requieren de mucho instrumental y de tornillos que se componen de varias piezas que hacen difícil su aplicación, además el valor económico de los sistemas de importación es muy elevado y no está al alcance de la mayoría de nuestros pacientes. Esto motivó al autor del trabajo para modificar y reducir el instrumento; los tornillos se componen de dos piezas, son autoperforantes (por dos ranuras en la punta en forma de bisel). La tuerca es de caja con un perno en el centro, que evita que se unan las espigas y así no hay aflojamiento de la unión tornillo-tuerca y barra. Esto proporciona la estabilidad vertebral requerida y permite una rehabilitación temprana sin complicaciones posteriores al reposo prolongado. Todos los pacientes tenían el diagnóstico de inestabilidad vertebral, tratados con el sistema de implante transpendicular modificado, con cinco años de evolución. Como complicaciones se tuvieron; cuatro infecciones de la herida quirúrgica, una embolia pulmonar, seis rechazos del implante, tres aflojamientos del sistema (uno por ruptura del implante, tres aflojamientos del sistema (uno por ruptura de tornillos y dos por aflojamiento de las tuercas). En todos los casos se alcanzó la artrodesis, la estabilidad vertebral y no existió agravamiento de daño neurológico. En conclusión, con las modificaciones que se hicieron de otros implantes para estabilizar la columna vertebral toracolumbar, se logró que la aplicación fuera más fácil, disminuyendo el tiempo y riesgo quirúrgico, el gasto de sangre y la administración de anestésico y medicamentos en el transoperatorio, además de abatir el costo del implante