Apoio social à mulher mastectomizada: um estudo de revisão / Social support to women after mastectomy: a review study

Para fundamentar as ações de cuidado integralizado em saúde da mulher é necessário compreender de que modo o apoio social pode contribuir para minimizar as repercussões do diagnóstico e do tratamento da neoplasia mamária. O objetivo deste estudo é analisar a contribuição da produção científica nacional e internacional acerca do apoio social percebido por mulheres diagnosticadas com câncer de mama. A amostra foi constituída de 12 publicações, obtidas a partir de critérios de inclusão preestabelecidos, nas bases de dados MedLine, Lilacs e PsycINFO, na última década (2000-2010). Os resultados foram sistematizados em categorias temáticas: percepção do apoio familiar, apoio social percebido, percepção do apoio educacional, necessidade de aprimoramento da pesquisa e assistência às mastectomizadas e suas famílias. Os estudos dedicados à dimensão subjetiva do apoio social ainda são incipientes. As evidências disponíveis sugerem que a literatura é circunscrita a temas de interesse das profissões tradicionais da área da saúde, como Enfermagem e Medicina, privilegiando construtos que podem ser diretamente quantificados. A preocupação com o apoio social deve estar presente desde a fase de diagnóstico até a reabilitação psicossocial, como parte do processo de enfrentamento.

It is necessary to understand how social support can contribute to minimize the impact of the diagnosis and treatment of mammary tumors in order to underpin the actions of comprehensive women's health care. This study seeks to analyze the contribution of the national and international literature regarding the perceived social support by women diagnosed with breast cancer. Twelve studies were selected from the MedLine, Lilacs and PsycINFO databases over a 10-year period (2000-2010) with pre-defined criteria for inclusion. The results were organized into thematic categories: the perception of family support; perceived social support; the perception of educational support; the need to improve the research and the assistance given to women after mastectomy and their families. The studies dedicated to the subjective dimension of social support are still incipient. The available evidence suggests that the literature is limited to topics of interest to the traditional health professions, such as Nursing and Medicine, focusing on constructs that can be directly quantified. The concern with social support must be present from the time of diagnosis to psychosocial rehabilitation, as part of the process of tackling the situation.

Comportamentos e práticas sexuais de homens que fazem sexo com homens / Sexual behaviors and practices of men who have sex with men / Conductas y prácticas sexuales de los hombres que tienen sexo con hombres

Objetivou-se identificar comportamentos e práticas sexuais de homens que fazem sexo com homens no contexto da vulnerabilidade ao HIV/AIDS. Estudo transversal, exploratório descritivo. Foi realizado em um local de sociabilidade gay de Fortaleza, no Estado do Ceará, entre novembro de 2010 e março de 2011, por meio de entrevista com 189 homens que fazem sexo com homens. Encontrou-se uma amostra composta, majoritariamente, por jovens, solteiros e com alto nível educacional. A história sexual demonstrou o início precoce da vida sexual, com prevalência elevada de relação sexual com parceira do sexo oposto. Houve alta frequência de testagem para o HIV. As práticas sexuais revelaram prevalência superior da realização de sexo oral e anal, bem como altos níveis de proteção no sexo anal, apesar de baixa no sexo oral. Constatou-se uma maior incorporação das práticas de prevenção em relação ao panorama nacional do início da epidemia.

The objective was to identify behaviors and sexual practices of men who have sexual relations with other men in the context of vulnerability to HIV/AIDS. This was a cross-sectional, exploratory and descriptive study. It was carried out in a gay sociability place in Fortaleza, Ceará, Brazil, between November 2010 and March 2011, through interviews with 189 men who have sex with men. The ethical aspects were respected. We found a sample consisting mostly by young, single, and highly educated men. The sexual history demonstrated the early onset of sexual activity, with a high prevalence of sexual intercourse with a partner of the opposite sex. There was also a high prevalence of HIV testing. Sexual practices revealed high prevalence of performing oral and anal sex, as well as high levels of protection in anal sex, despite the low protection in oral sex. A greater incorporation of prevention practices was found compared to the national scene in the beginning of the disease outbreak.

El objetivo fue identificar los comportamientos y las prácticas sexuales de los hombres que tienen sexo con hombres en el contexto de la vulnerabilidad al VIH/SIDA. Fue un estudio transversal, descriptivo y exploratorio. Se celebró en una sociabilidad local gay de Fortaleza, Ceará, Brasil, entre noviembre de 2010 y marzo de 2011, a través de entrevistas con 189 hombres que tienen sexo con hombres. Se encontró una muestra compuesta en su mayoría por jóvenes, solteros y con alto nivel de educación. La historia sexual demostró el inicio temprano de la actividad sexual, la alta prevalencia de relaciones sexuales con una pareja del sexo opuesto. Hubo alta prevalencia de la prueba del VIH. Las prácticas sexuales revelaron una alta prevalencia de realizar sexo oral y anal, así como altos niveles de protección en el sexo anal, a pesar de la baja protección en el sexo oral. Se encontró una mayor incorporación de las prácticas de prevención en relación con la escena nacional en el inicio de la epidemia.

Discomfort and unease of the subject in the interpretation movement of a Tuberculosis questionnaire / O desconforto e inquietação do sujeito em seu movimento de interpretação de um questionário sobre a tuberculose / Malestar e inquietud del sujeto en su movimiento de interpretación de un cuestionario sobre la Tuberculosis

OBJECTIVE: to propose a discussion about traces of the derivation of meanings, the subjects' discomfort and resistance when they are called upon to signify a questionnaire on the transfer of the Directly Observed Treatment of Tuberculosis policy, in order to reveal the limitations of closed questionnaires in the subject's interpretation process. METHOD: health professionals from a Primary Health Care Unit in Porto Alegre/RS were interviewed and some excerpts from the interviews were investigated in the light of French Discourse Analysis. RESULTS: resistance, discomfort, slips, silencing and the derivation of meanings were observed in the subjects' interpretation. CONCLUSION: the interpretation process has multiple meanings and varies from subject to subject. The questionnaire, as a prototype of the logically stabilized universe, fails when the purpose is to control the interpretation. Its isolated use in health research can entail inexactness or incompleteness of the collected data. Therefore, its use associated with qualitative research techniques is ideal. .

OBJETIVO: propor uma discussão a respeito de vestígios da derivação de sentidos, do desconforto e resistência dos sujeitos, quando convocados a significar um questionário referente à transferência da política do tratamento diretamente observado da tuberculose, de modo a revelar as limitações de questionários fechados, quando se trata do processo interpretativo do sujeito. MÉTODO: profissionais de saúde de uma Unidade de Atenção Primária de Saúde de Porto Alegre, RS, foram entrevistados e alguns recortes das entrevistas examinados à luz da Análise de Discurso de linha francesa. RESULTADOS: observou-se a resistência, o incômodo, o deslizamento, o silenciamento e a derivação dos sentidos no ato de interpretação dos sujeitos. CONCLUSÃO: o processo de interpretação é polissêmico e varia de sujeito para sujeito. O questionário, enquanto um protótipo do universo logicamente estabilizado, falha quando o propósito é o de controlar a interpretação. O seu uso de forma isolada, em pesquisas em saúde, pode incorrer em inexatidão ou incompletude dos dados obtidos, sendo ideal a sua utilização associada a técnicas qualitativas de pesquisa. .

OBJETIVO: proponer una discusión respecto a vestigios de la derivación de sentidos, del malestar y resistencia de los sujetos cuando convocados a significar un cuestionario respecto a la trasferencia de la política del Tratamiento Directamente Observado de la Tuberculosis, de manera a revelar las limitaciones de cuestionarios cerrados cuando se trata del proceso interpretativo del sujeto. MÉTODO: profesionales de salud de una Unidad de Atención Primaria de Salud de Porto Alegre/RS fueron entrevistados y algunos recortes de las entrevistas examinados a la luz del Análisis de Discurso de línea Francesa. RESULTADOS: fueron observados la resistencia, la molestia, el deslizamiento, el silenciamiento y la derivación de los sentidos en el acto de interpretación de los sujetos. CONCLUSIÓN: el proceso de interpretación es polisémico y varia de sujeto a sujeto. El cuestionario como un prototipo del universo lógicamente estabilizado falla cuando el objetivo es el de controlar la interpretación. Su uso de forma aislada en investigaciones en salud puede llevar a datos inexactos o incompletos, siendo ideal su utilización asociada a técnicas cualitativas de investigación. .

Influence of Apical Enlargement in Cleaning of Curved Canals Using Negative Pressure System

This study aimed to evaluate, by scanning electron microscopy (SEM), the cleaning of canal walls with moderate curvature subjected to biomechanical preparation with different final diameters using apical negative pressure irrigation. Thirty-two mesiobuccal roots of molars were divided into 4 groups (n=8) according to the instrument's final diameter: GI: 30.02, GII: 35.02, GIII: 40.02 and GIV: 45.02. Irrigating procedure was performed at each change of instrument with 1% NaOCl using the Endovac system. Final irrigation was conducted with 17% EDTA for 5 min. The SEM photomicrographs were evaluated under 35× and 1000× magnification, by three calibrated examiners, in a double-blind design. Data were submitted to Kruskal-Wallis and Dunn's post hoc tests (α=0.05). Canals instrumented with 30.02 and 35.02 final diameters showed more debris, statistically different from the other groups (p<0.05). Comparing each root canal third, for the cervical and apical portions no statistically significant difference (p>0.05) was found among the four groups. Regarding the presence of smear layer, canals with 30.02 final diameter showed the highest scores, statistically different from the 45.02 group (p<0.05) and similar to the 35.02 and the 40.02 groups (p>0.05). Although none of the studied diameters completely removed debris and smear layer, it may be concluded that instrumentation with higher final diameters was more effective in cleaning the root canals with moderate curvature.

Este estudo buscou avaliar, por meio de microscopia eletrônica de varredura (MEV), a limpeza das paredes de canais com curvatura moderada, submetidos ao preparo biomecânico com diferentes diâmetros finais utilizando-se irrigação por pressão apical negativa. Trinta e duas raízes mésio-vestibulares de molares foram divididas em 4 grupos (n=8) de acordo com o diâmetro final dos instrumentos: GI: 30.02, GII: 35.02, GIII: 40.02 e GIV: 45.02. O procedimento de irrigação foi realizado a cada troca de instrumento com NAOCl 1% utilizando o sistema EndoVac. A irrigação final foi conduzida com EDTA 17% por 5 min. As microfotografias de MEV foram avaliadas sob aumentos de 35× e 1000×, por três examinadores calibrados, em estudo duplo-cego. Os dados foram submetidos ao teste de Kruskal-Wallis e pós-teste de Dunn (=0,05). Os canais instrumentados com diâmetros finais de 30.02 e 35.02 demonstraram mais debris, estatisticamente diferente dos demais grupos (p<0,05). Comparando-se cada terço do canal radicular, para as porções cervical e apical não foi encontrada diferença estatisticamente significante (p>0,05) entre os quatro grupos. Com relação à presença de smear layer, canais com diâmetro final de 30.02 demonstraram os maiores scores, estatisticamente diferente do grupo 45.02 (p<0,05) e similar aos grupos 35.02 e 40.02 (p>0,05). Apesar de nenhum dos diâmetros estudados ter removido completamente os debris e a smear layer, pode ser concluído que a instrumentação com diâmetros finais maiores foi mais efetiva na limpeza dos canais radiculares com curvatura moderada.

Hand and foot syndrome secondary to capecitabine.

A 55-year-old woman on treatment with capecitabine and paclitaxel for breast carcinoma presented with history of a tingling sensation in her hands and feet with a progressive burning sensation. She also noted discomfort, minimal pain and stiffness while holding objects. On examination, there was patchy hyperpigmentation of both the palms and soles, and the dorsa of hands and feet. This was accompanied by a thickening of the skin more over the knuckles and toes. In addition there was a moist desquamation around the toes and over the palmar creases and a bluish discoloration of the lunulae of both thumbnails. She was diagnosed with hand and foot syndrome and started on pyridoxine and emollients. The finding of keratoderma noted in our patient is not seen commonly in hand and foot syndrome.

Study on adherecce to capecitabine among patiens with colorectal cancer and meetastatic breast cancer / Estudo de aderência a capecitabina em pacientes com câncer colorretal e câncer de mama metastático

Context Capecitabine, an oral drug, is as effective as traditional chemotherapy drugs. Objectives To investigate the adhesion to treatment with oral capecitabine in breast and colorectal cancer, and to determine any correlation with changes in patient’s quality of life. Methods Patients with colorectal cancer or breast cancer using capecitabine were included. The patients were asked to bring any medication left at the time of scheduled visits. The QLQ-C30 questionnaire was applied at the first visit and 8-12 weeks after treatment. Results Thirty patients were evaluated. Adherence was 88.3% for metastatic colon cancer, 90.4% for non-metastatic colon cancer, 94.3% for rectal cancer and 96.2% for metastatic breast cancer. No strong correlation between adherence and European Organisation for Research and Treatment of Cancer QLQ-C30 functional or symptom scale rates had been found. There was no statistically significant correlation between compliance and the functional and symptom scales of the questionnaire before and after chemotherapy, with the exception of dyspnea. Conclusions Although no absolute adherence to oral capecitabine treatment had been observed, the level of adherence was good. Health professionals therefore need a greater focus in the monitoring the involvement of patients with oral treatment regimens. Patients with lesser degrees of dyspnea had greater compliance. .

Contexto A capecitabina, uma droga oral, é tão eficaz quanto as drogas quimioterápicas tradicionais. Objetivos Investigar a adesão ao tratamento oral com capecitabina para câncer de mama e colorretal e determinar qualquer correlação com as mudanças na qualidade de vida do paciente. Métodos Pacientes com câncer colorretal ou de mama em uso de capecitabina foram incluídos. A cada consulta os pacientes trouxeram a medicação restante. O questionário de qualidade de vida QLQ- C30 foi aplicado na primeira visita e 8-12 semanas após o tratamento. Resultados Trinta pacientes foram avaliados. A adesão foi de 88,3% para o câncer de cólon metastático, 90,4% para o de cólon não-metastático, 94,3% para o de reto e 96,2% para o de mama metastático. Com exceção da dispnéia, não houve forte correlação entre adesão e as taxas European Organisation for Research and Treatment of Cancer QLQ-C30 em relação a escala funcional ou de sintomas no início ou após quimioterapia. Conclusões O nível de adesão foi bom, embora não houvesse adesão absoluta ao tratamento com capecitabina oral. Os profissionais de saúde, portanto, precisam dar maior atenção a pacientes em regimes de tratamento oral. Os pacientes com menor grau de dispneia tiveram maior adesão. Neoplasias colorretais, terapia .

Farmacogenómica del tratamiento de primera línea en el cáncer gástrico: avances en la identificación de los biomarcadores genómicos de respuesta clínica / Pharmacogenomics of the first-line treatment for gastric cancer: advances in the identification of genomic biomarkers for clinical response to chemotherapy

Debido a la inespecificidad de los síntomas, el cáncer gástrico (CG) es diagnosticado frecuentemente en etapas avanzadas, lo que da cuenta de los altos índices de mortalidad debido a esta neoplasia a nivel mundial. El esquema de tratamiento adyuvante o neoadyuvante en los países occidentales incluye el uso de fluoropirimidinas citotóxicas y compuestos de platino formadores de aductos en el ADN. La respuesta clínica al tratamiento con estos fármacos depende principalmente de la sensibilidad del tumor, la cual a su vez está condicionada por el nivel de expresión de los blancos terapéuticos y de las enzimas de reparación del ADN. Sumado a esto, algunos polimorfismos de línea germinal en genes asociados al metabolismo y a la respuesta a estos fármacos, han mostrado asociación con respuestas pobres y con el desarrollo de eventos adversos, incluso con resultados fatales. La identificación de biomarcadores genómicos, en la forma de polimorfismos genéticos o la expresión diferencial de genes específicos asociados a la respuesta quimioterapeútica ha sido motivo de intensa investigación como base para la aplicación de la farmacogenómica en el establecimiento de una terapia farmacológica racional y personalizada del CG. Sin embargo, ante la eventual aplicación de la farmacogenómica en el ámbito clínico, es necesario establecer el valor pronóstico real de dichos biomarcadores mediante los estudios de asociación genotipo-fenotipo, así como su prevalencia en el contexto de cada población de pacientes. Estos aspectos son indispensables al evaluar la relación costo-efectividad de la introducción de los productos de la medicina genómica predictiva en el tratamiento del CG.

Gastric cancer (GC) is often diagnosed at later stages due to the lack of specificity of symptoms associated with the neoplasm, causing high mortality rates worldwide. The first line of adjuvant and neoadjuvant treatment includes cytotoxic fluoropyrimidines and platin-containing compounds which cause the formation of DNA adducts. The clinical outcome with these antineoplastic agents depends mainly on tumor sensitivity, which is conditioned by the expression level of the drug targets and the DNA-repair system enzymes. In addition, some germ line polymorphisms, in genes linked to drug metabolism and response to chemotherapy, have been associated with poor responses and the development of adverse effects, even with fatal outcomes in GC patients. The identification of genomic biomarkers, such as individual gene polymorphisms or differential expression patterns of specific genes, in a patient-by-patient context with potential clinical application is the main focus of current pharmacogenomic research, which aims at developing a rational and personalized therapy (i.e., a therapy that ensures maximum efficacy with no predictable side effects). However, because of the future application of genomic technologies in the clinical setting, it is necessary to establish the prognostic value of these genomic biomarkers with genotype-phenotype association studies and to evaluate their prevalence in the population under treatment. These issues are important for their cost-effectiveness evaluation, which determines the feasibility of using these medical genomic research products for GC treatment in the clinical setting.

Role of neoadjuvant concurrent chemoradiation in locally advanced unresectable pancreatic cancer: A feasibility study at tertiary care centre.

BACKGROUND: Pancreatic cancer has an extremely poor prognosis and prolonged survival is achieved only by resection with macroscopic tumor clearance. There is a strong rationale for a neoadjuvant approach, since a relevant percentage of pancreatic cancer patients present with non‑metastatic but locally advanced disease. The objective of the present study was to assess the effect of neoadjuvant chemoradiation therapy (NACRT) on tumor response, down staging and resection, toxicity and any survival advantage. MATERIALS AND METHODS: A prospective pilot study was carried out from January 2009 to June 2011 in which 15 patients of locally advanced unresectable pancreatic cancer were included. All patients were treated with NACRT protocol with oral Capecitabine and 3D conformal radiotherapy (3DCRT) of 30 Gy in 10 fractions. The patients were restaged 3 to 4 weeks after the completion of NACRT and explored for resection. RESULTS: Out of 15 patients, fourteen were evaluable. Four patients underwent surgery, 5 had partial response but remained unresectable, 2 patients had stable disease and 3 had progressive disease. Most of the toxicities were slight and were in grade 1 to 2. None of the patients developed grade 3 or 4 gastrointestinal or hematological toxicity. The median survival was 15 months for resected patients and 8.6 months for unresected patients, respectively. The 2 year actuarial overall survival was 34.6%. CONCLUSION: All patients with locally unresectable pancreatic cancer should be offered chemoradiation therapy, in hopes of down staging the tumor for possible resection and achieving higher survival.

Use of microRNAs in directing therapy and evaluating treatment response in colorectal cancer / Utilização dos microRNAs no direcionamento da terapia e na avaliação da resposta ao tratamento do câncer colorretal

Colorectal cancer is the third most common cancer worldwide. Survival and prognosis depend on tumor stage upon diagnosis, and in more than 50% of cases, the tumor has already invaded adjacent tissues or metastasis has occurred. Aiming to improve diagnosis, clinical prognosis and treatment of patients with colorectal cancer, several studies have investigated microRNAs as molecular markers of the disease due to their potential regulatory functions on tumor suppressor genes and oncogenes. This review aimed to summarize the main topics related to the use of microRNAs in diagnosis, clinical prognosis and evaluating treatment response in colorectal cancer.

O câncer colorretal é o terceiro tipo de câncer mais comum em todo o mundo. A sobrevivência e o prognóstico dependem do estágio do tumor no diagnóstico, momento em que, em mais de 50% dos casos, o tumor já invadiu tecidos adjacentes ou ocorreu metástase. Objetivando-se melhorar o diagnóstico, o prognóstico clínico e o tratamento de pacientes com câncer colorretal, vários estudos investigaram microRNAs como marcadores moleculares da doença, devido à sua função reguladora potencial sobre genes supressores de tumor e oncogenes. Esta revisão procura resumir os principais tópicos relacionados ao uso de microRNAs no diagnóstico, na determinação do prognóstico clínico e na avaliação de resposta ao tratamento do câncer colorretal.

New drug in neoadjuvant chemoradiation for rectal cancer

In recent years, neoadjuvant chemoradiation and subsequent surgical resection with total mesorectal excision has been shown to increase local control with decreased toxicity. Neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer. In this study we evaluated the efficacy a cox-2 inhibitor on pathologic response, sphincter preservation and acute toxicity during neoadjuvant chemoradiation. Thirty-six patients with Adenocarcinoma of rectum [up to 15 cm of anal verge] was enrolled in this phase 2 study. Patients were undergone endorectal ultrasound, abdomino-pelvic and chest CT scan for staging. Then received neoadjuvant concurrent chemo radiation [capecitabine 825 mg/m2 bid in combination with celecoxib 100 mg qid and Radiotherapy "50-50.4Gy/25-28fraction"].Surgery was done 6-8 weeks after Chemoradiation. Acute complications were scored by common toxicity criteria 3.0 and tumor response was graded by tumor regression grade. Of 36 patients, total mesorectal excision was done in 30 patients. Tumor regression grade was reported as: 8 patients[26.7%] had grade 0 or complete response, 10 patients [33.3%] had grade 1 or moderate response,9 patients[30%] had grade 2 or minimal response and 3 patients [10%] had grade 3 or poor response. Tumor down staging was 43.3% and Node down staging was 30.8%.No patient had skin reaction or cardio-vascular toxicity. Results indicate celecoxib in combination with neoadjuvant chemoradiation is safe and associated with low toxicity. This combination can promote pathologic complete response, tumor regression grade and T and N down staging in rectal adenocarcinoma

phase 2 study of "[TOX] preoperative chemotherapy" response rate and side effects in [locally advanced operable gastric adenocarcinoma] patients with docetaxel, oxaliplatin and capecitabine

Early stage gastric cancer diagnosis has ensued different approaches in resection strategies. In order to increase the proportion of cases which have undergone radical resection or have reduced the recurrence rate, different pre-operative treatments have introduced. Here, we have verified an active preoperative chemotherapeutic regimen in locally advanced gastric cancer patients. Forty nine patients who have found eligible to enter this phase 2 trial have treated with oxaliplatin 100 mg/m[2] IV, docetaxel 50 mg/m[2] IV, plus capecitabine 625 mg/m[2] PO [TOX]. Clinical staging has been following the first 2 cycles of induction chemotherapy. Patients that have further undergone radical surgery, have evaluated for pathological response rate. Anemia [10.2%], nausea [10.2%] and vomiting [6.1%] were the most frequent grade 3 or 4 adverse effects. Regarding the pathologic staging, 6 patients [12.2%] had complete response [95% CI 3% to 21.4%], 18 of them [36.7%] had partial response [95% CI 23.2% to 50.2%], then 3 patients [6.1%] had stable disease [95% CI 0%-12.8%]. Among the patients who had surgery, 22% had pathologic complete response. Preoperative chemotherapeutic regimen of TOX seems to be an active and safe neoadjuvant therapy in non metastatic gastric cancer. It should further be considered with concurrent radiotherapy

Regressão do estádio clínico, preservação esfincteriana e qualidade de vida em câncer de reto: resultados de um estudo prospectivo randomizado comparando dois esquemas de radioquimioterapia neoadjuvante / [Regression of the clinical stage, sphincter preservation and quality of life in rectal cancer: results of a prospective randomized study comparing two neoadjuvant radiotherapy schemes]

Introdução: O tratamento do câncer de reto localmente avançado é a radioquimioterapia, seguido de ressecção, reduzindo a taxa de recidiva local. Estudos sugerem que a capecitabina, uma droga oral, usada como droga única combinada à radioterapia neoadjuvante em substituição ao 5-fluorouracil e leucovorin (5-FU/LV) intravenoso possa aumentar a taxa de resposta clínica e patológica. Um benefício potencial da regressão tumoral com o tratamento neoadjuvante é a redução da taxa de colostomia definitiva em pacientes com tumores no reto inferior. Objetivo: Comparar o esquema neoadjuvante com capecitabina ao esquema padrão no Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) (5-FU/LV em bólus), avaliando a taxa de preservação esfincteriana, complicações cirúrgicas, e o impacto na qualidade de vida. Métodos: Estudo de fase II randomizado, incluindo pacientes com adenocarcinoma retal localmente avançado (T>3 ou N>1, M0) até 10 cm da margem anal pela retossigmoidoscopia foram randomizados no INCA entre os esquemas: (1) capecitabina oral 825mg/m2 2x ao dia 5 dias por semana por cinco semanas e (2) 5-FU/LV IV na dose de 350mg/m2 /20 mg/m2 em bólus do 1º ao 5º dia na primeira e na quinta semanas, ambos concomitantes à radioterapia pélvica 50,4 Gy em 28 frações. Estadiamento clínico realizado antes e após o tratamento neoadjuvante por tomografia computadorizada de tórax, abdome e pelve, ressonância magnética (RNM) pélvica e ecoendoscopia transretal. Operação programada seis a oito semanas após o término da neoadjuvância. Preservação esfincteriana tentada sempre que possível se margens negativas. Avaliação histopatológica pela classificação TNM 7ª edição e incluiu o grau de regressão tumoral (GRT) segundo Mandard. Questionários de qualidade de vida QLQ-30 e QLQ-CR38 foram aplicados antes e após a neoadjuvância, após a operação e no seguimento. Resultados: Entre fevereiro de 2011 e dezembro de 2012, 50 pacientes foram randomizados (25 em cada braço). 49 pacientes foram operados. Os grupos foram equivalentes quanto à idade, gênero, índice de massa corpórea, performance status, antígeno carcinoembrionário, estadiamento, e localização tumoral. Ambos os esquemas foram bem tolerados, apenas uma paciente com toxicidade Grau >3. Regressão do estádio clínico foi mais frequente no grupo 1 (capecitabina) avaliado pela ecoendoscopia (50% vs 17%, p=0,02), assim como a variável T (35% vs 8%, p=0,05). Houve tendência a maior regressão da variável T pela RNM no grupo 1 (44% vs 20%, p=0,07). Não houve diferença entre os grupos quanto a complicações pós-operatórias (29,1% vs 32%p=0,247), e preservação esfincteriana (83,3% vs 84,0, p=1,00). Não houve diferença entre os grupos em relação ao estádio patológico (p=0,552) e ao GRT (p=0,546), mas houve mais resposta completa no grupo da capecitabina (22% vs 8%). Houve melhora da pontuação nos escores de qualidade de vida após o tratamento neoadjuvante, e queda posterior ao tratamento cirúrgico, em ambos os grupos. Conclusão: A radioquimioterapia neoadjuvante com capecitabina é bem tolerada e parece levar a uma maior taxa de resposta clínica. Pode ser substituta ao 5-FU, principalmente quando se pretende maior regressão tumoral, preservação esfincteriana ou aumento de margens, além da conveniência oral.

Síndrome mão-pé induzida por quimioterapia: relato de um caso / Hand-foot syndrome induced by chemotherapy: a case study / Síndrome mano-pie inducida por quimioterapia: relato de un caso

Objetivou-se relatar um caso de uma paciente que apresentou síndrome mão-pé de grau 3, decorrente do uso do quimioterápico Capecitabina e para a qual foi utilizada massagem local com creme hidratante aquoso à base de aloe vera. A capacidade funcional da paciente foi avaliada utilizando-se a Escala de Performance ECOG e as lesões fotografadas durante as consultas de enfermagem que ocorreram em intervalos de dez dias, totalizando quarenta dias de acompanhamento. Observou-se melhora significativa da integridade tissular, com regressão total dos sintomas, importante ganho em qualidade de vida, e retorno imediato ao tratamento quimioterápico. Acredita-se que o aloe vera pode ser um importante coadjuvante na assistência de enfermagem a pacientes submetidos à quimioterapia antineoplásica.

The study was aimed at reporting a case of a patient who developed Hand-Foot Syndrome (HFS) grade 3 due the use of capecitabine and for which massage was used with aqueous-based moisturizer, aloe vera. The patient's functional capacity was assessed using the ECOG Performance Scale and the lesions were photographed during nursing appointment that occurred at intervals of ten days, totaling forty days of monitoring. There was significant improvement in tissue integrity, with total regression of symptoms, an important gain in quality of life, and immediate return to chemotherapy. It is believed that aloe vera can be an important component in nursing care in patients undergoing cancer chemotherapy.

El estudio tiene como objetivo presentar un caso de una paciente que desarrolló la Síndrome Pie-Mano de grado 3 debido al uso de capecitabina y en que se utilizó el masaje con crema hidratante aloe vera, en base acuosa. La capacidad funcional de la paciente se evaluó mediante la Escala de Desempeño ECOG y las lesiones fueran fotografiadas durante las consultas de enfermería que ocurrirán a intervalos de diece días, con un total de cuarenta días de seguimiento. Hubo una mejora significativa en la integridad de los tejidos, con la regresión total de los síntomas, un aumento importante en la calidad de vida, y el retorno inmediato a la quimioterapia. Se cree que el aloe vera puede ser un componente importante en los cuidados de enfermería en pacientes sometidos a quimioterapia contra el cáncer.

Arsenic trioxide plus cisplatin/interferon alpha-2b/doxorubicin/capecitabine combination chemotherapy for unresectable hepatocellular carcinoma

The failure of existing treatments for liver cancer has recently been attributed to the existence of cancer stem cells, which are difficult to kill using current drugs due to their chemoresis-tant properties as well as their ability to stimulate neoangiogenesis. The aim of the current study was to evaluate in vitro the antitumor efficacy of arsenic trioxide in combination with conventional chemotherapy, as proposed by the concept of [differentiation therapy] in anticancer research. Cancer stem cells showed enhanced chemoresistance to cancer drugs [carboplatin and doxorubicin] and had the ability to exclude rhodamine 123 dye, proving the existence of the multidrug resistance efflux pump. Arsenic trioxide was added prior to a tyrosine kinase inhibitor or to a slightly modified Piaf regimen with capecitabine replacing 5-fluorouracil. We also compared both cancer and normal stem cell lines with the hepG2 non-stem liver cancer cell line to investigate the differences between differentiated and more anaplastic cells. Molecular characterization [immunocytochemistry and rt-PCr analysis] of all the cell lines was carried out. Initially, the cells had a high proliferative potential, even when cultured in a medium supplemented with cytostatics, eliminated rhodamine 123 immediately in culture and also formed spheroids in suspension. The molecular characterization showed the expression of albumin, alpha1 -antitrypsin, alpha-fetoprotein, citokeratin-18, telomerase, CD90 and CD133. Low concentrations of arsenic trioxide lead to morphologic differentiation and differentiation-associated cytochemical features, like increased sensitivity to cytostatic drugs. Our study suggests that arsenic trioxide sensitizes liver stem-like cancer cells to conventional chemotherapy. Still, further studies on animal models will be needed before we implement this idea in human clinical trials

Combination of oral vinorelbine and capecitabine in the treatment of metastatic breast cancer patients previously exposed to anthracyclines: a pilot study

Vinorelbine and capecitabine are both active in breast cancer with moderate toxicity. A pilot study conducted from December 2007 to January 2010 in patients with metastatic breast cancer [MBC] to the evaluate efficacy and safety of combination therapy with vinorelbine and capecitabine. The study included patients with MBC who were previously treated by anthracyclines either during the adjuvant phase or the metastatic phase. Patients were treated with oral vinorelbine [[60 mg/m[2]] on day 1+8 and capecitabine [1000 mg/m[2]] twice daily [VC] from day 1 to day 14 with both repeated every 3 weeks until progression, refusal or for a maximum of 8 cycles. A dose reduction was made in case of grade 3 and 4 toxicities. Of 31 women [median age, 51 years], 12 cases were first-line therapy and 19 cases were second-line therapy or greater, and 30 were evaluable for response. Two patients [6.4%] achieved complete response and 15 patients [48.4%] had a partial response giving an overall response rate of 54.8% [95% Cl, 42%-68%]. Time-to-disease progression was 7.8 months for patients receiving VC as first-line therapy versus 6 months for patients receiving VC as second-line therapy or more, while median survival time was 22 months and 10 months for the two groups, respectively. The oral VC regimen is effective and safe in patients with MBC previously exposed to anthracyclines, and offers a promising alternative to the intravenous route. Its role as a salvage therapy following anthracy-cline failure or as first-line chemotherapy requires further study

Lapatinib for treatment of advanced or metastasized breast cancer: systematic review / Lapatinib no tratamento do câncer de mama avançado ou metastático: revisão sistemática

Context and objective: Around 16 percent to 20 percent of women with breast cancer have advanced, metastasized breast cancer. At this stage, the disease is treatable, but not curable. The objective here was to assess the effectiveness of lapatinib for treating patients with advanced or metastasized breast cancer. Design and setting: Systematic review of the literature, developed at Centro Paulista de Economia da Saúde (CPES), Universidade Federal de São Paulo (Unifesp). Method: Systematic review with searches in virtual databases (PubMed, Lilacs [Literatura Latino-Americana e do Caribe em Ciências da Saúde], Cochrane Library, Scirus and Web of Science) and manual search. Results: Only one clinical trial that met the selection criteria was found. This study showed that lapatinib in association with capecitabine reduced the risk of cancer progression by 51 percent (95 percent confidence interval, CI: 0.34-0.71; P < 0.001), compared with capecitabine alone, without any increase in severe adverse effects. Conclusion: The combination of lapatinib plus capecitabine was more effective than capecitabine alone for reducing the risk of cancer progression. Further randomized clinical trials need to be carried out with the aim of assessing the effectiveness of lapatinib as monotherapy or in association for first-line or second-line treatment of advanced breast cancer.

Contexto e objetivo: Aproximadamente 16 por cento a 20 por cento das mulheres com câncer de mama têm doença avançada com metástases. Neste estágio, a doença é tratável, porém incurável. O objetivo foi avaliar a efetividade do lapatinib no tratamento de pacientes com câncer de mama avançado ou metastático. Tipo de estudo e local: Revisão sistemática da literatura desenvolvida no Centro Paulista de Economia da Saúde (CPES), Universidade Federal de São Paulo (Unifesp). Método: Revisão sistemática com busca em bases de dados virtuais (PubMed, Lilacs [Literatura Latino-Americana e do Caribe em Ciências da Saúde], Cochrane Library, Scirus and Web of Science) e busca manual. Resultados: Foi encontrado apenas um ensaio clínico que preencheu os critérios de seleção. Este estudo mostrou que o lapatinib em associação com a capecitabina reduziu em 51 por cento o risco de progressão da doença (intervalo de confiança, IC 95 por cento: 0,34-0,71; P < 0,001) quando comparado com a capecitabina isolada, sem aumento de efeitos adversos graves. Conclusão: A combinação de lapatinib e capecitabina foi mais efetiva do que a capecitabina isolada na redução do risco de progressão da doença. Ensaios clínicos aleatórios devem ser realizados com o objetivo de avaliar a efetividade do lapatinib como monoterapia ou em associação no tratamento primário ou secundário do câncer de mama avançado.

Neoadjuvant capecitabine-based chemoradiotherapy followed by total mesorectal excision for locally advanced resectable rectal cancer

Twenty three patients with respectable clinical stages II and III cancer rectum entered the study. All patients received concurrent chemoradiotherapy [CRT] based on capecitabine orally at a dose of 825 mg/m2 twice a day throughout the concurrent radiotherapy [RT] course. A radiation dose of 45 Gy was given to the posterior part of the pelvis to include the tumor, the mesorectum, followed by a boost of 5.4 Gy limited to the tumor and corresponding mesorectum with a 2 cm margin. A total mesorectal excision [TME] surgery was performed after a rest period of 6-7 weeks from completion of the preoperative chemo-irradiation. Acute toxicities of concurrent chemo-radiotherapy were reversible and controllable. Grade 3 leucopenia was noted in one patient only. Acute cystitis, moderate grade, was developed in 3 patients. Neurological symptoms were noted in 3 patients. Bleeding during operation occurred in 8.7% of patients. One patient who showed clinical leakage failed conservative management and required surgical re-intervention. Downstaging rate for T-stage was 69.5% [16/23 patients]. This rate was higher for N-stage constituting 84.2% [16/ 19 patients as 4 patients were NO]. There was no increase in T- and/or N-stage [upstaging] recorded in this study. Complete pathological response was recorded in 2 patients only [8.7%]. Sphincter-conserving surgery was successfully performed in 2 of 7 patients who were considered for abdomino-perineal resection before chemo-irradiation [28.6%]. After a median follow up period of 24 months, overall survival rate was 90.9% [20/22]. Distant failure was higher than local recurrence [13.6% Vs 9.1% respectively]. In conclusion; preoperative concurrent capecitabine and radiotherapy is considered to be a safe procedure and well-tolerated in patients with clinical stages II and III resectable rectal cancer treated with TME surgery. Successful high rate of sphincter-sparing procedure to some patients with low cancer rectum is possible after preoperative concurrent capecitabine and radiotherapy. Preoperative concurrent capecitabine and radiotherapy may reduce recurrence and improve survival rates

Single agent low dose capecitabine subsequent to docetaxel chemotherapy in HER-2 negative metastatic breast cancer

The objective of this study was to evaluate the efficacy and toxicity of low dose capecitabine chemotherapy in patients with metastatic breast cancer [MBC] who have previously received first line docetaxel chemotherapy. Metastatic breast cancer patients who responded or achieved a stable disease with first line docetaxel were enrolled. Female patients with visceral or visceral and bone metastases and a KPS > 70 were eligible. Adequate marrow, renal and hepatic function was required. Metastatic brain disease and bone as the only site of disease were excluded. Informed consent was obtained from all patients. Capecitabine 1,000 mg/m2 B.I.D 14 days for four cycles were given. Cycles were repeated every 3 weeks. Response Evaluation Criteria in Solid Tumors [RECIST] was used for evaluation of response and common Toxicity Criteria [CTC] Version 3.0 for evaluation of toxicity. From September 2006 to December 2007, 38 patients were enrolled. Median age was 49 years [Range 32-70]. Thirty six patients had received docetaxel at a dose of 75 mg/m2 for four cycles. Six patients had already achieved a complete response, 20 partial response and ten had achieved stable disease. Capecitabine added one CR [3.33%] and six partial responses [20%]. Median time to progression after capecitabine was 6.9 months [range, 3-22 months] and at a median follow up time of 24 months [range, 16 -34 months] 13 patients have died with an overall survival probability of docetaxel - capecitabine sequential therapy of 0.68. Significant grade 3 toxicities included hand-foot syndrome in three patients [8.33%], diarrhea in 2 [5.56%], stomatitis, dermatitis, fatigue and decrease in appetite in one patient [2.78%] each. Grade 2 toxicity included hand-foot syndrome in 12 [33.33%] patients, diarrhea and stomatitis in 8 patients [22.22%] each. Most common hematological toxicity included lymphopenia and anemia seen in 16 [44.44%] and 14 [38.89%] respectively. This treatment schedule of low dose capecitabine after docetaxel treatment is an effective treatment of MBC and has a manageable toxicity profile