Bone-targeted therapies to reduce skeletal morbidity in prostate cancer / 亚洲男科学杂志(英文版)

Bone metastases are the main driver of morbidity and mortality in advanced prostate cancer. Targeting the bone microenvironment, a key player in the pathogenesis of bone metastasis, has become one of the mainstays of therapy in men with advanced prostate cancer. This review will evaluate the data supporting the use of bone-targeted therapy, including (1) bisphosphonates such as zoledronic acid, which directly target osteoclasts, (2) denosumab, a receptor activator of nuclear factor-kappa B (RANK) ligand inhibitor, which targets a key component of bone stromal interaction, and (3) radium-223, an alpha-emitting calcium mimetic, which hones to the metabolically active areas of osteoblastic metastasis and induces double-strand breaks in the DNA. Denosumab has shown enhanced delay in skeletal-related events compared to zoledronic acid in patients with metastatic castration-resistant prostate cancer (mCRPC). Data are mixed with regard to pain control as a primary measure of efficacy. New data call into question dosing frequency, with quarterly dosing strategy potentially achieving similar effect compared to monthly dosing for zoledronic acid. In the case of radium-223, there are data for both pain palliation and improved overall survival in mCRPC. Further studies are needed to optimize timing and combination strategies for bone-targeted therapies. Ongoing studies will explore the impact of combining bone-targeted therapy with investigational therapeutic agents such as immunotherapy, for advanced prostate cancer. Future studies should strive to develop biomarkers of response, in order to improve efficacy and cost-effectiveness of these agents.

Fuente lineal radiactiva en cancer cervicouterino / Radiactive lineal source in cervico uterine cancer

Se dan a conocer los beneficios de una fuente lineal radiactiva aplicada a 110 pacientes con carcinoma cervicouterino invasor, atendidas en el servicio de oncología del Hospital 20 de Noviembre de la Ciudad de México, en el lapso de 1981-1984. La fuente lineal se elaboraba para cada enferma colocando las cápsulas de sodio longitudinalmente dentro del aplicador intrauterino de plástico flexible, insertado en el centro de un cilindro vaginal de acrilico, otorgando dosis de 5,000 a 6,000 rads a puntos A de Manchester; asimismo, se empleó telecobalto a la pelvis, dosis de 4,000 a 5,000 rads. La supervivencia obtenida a 5 años de control fue: 86.66% en la etapa clínica I-B, 75% en la II-A, 70.27% en la II-B y 42% en la etapa III-B, consignando una subrevida superior en las últimas tres etapas de un 7 a 8% que cuando utilizamos radio intrauterino y en colpostatos. Las conclusiones son: aplicación intrauterina de la fuente lineal en forma sencilla, bajo costo en la producción de cilindros vaginales y aplicadores intrauterinos, su fácil manufactura y mejores resultados de curabilidad