Uptake of Recommendations for Posttreatment Cancer-Related Fatigue Among Breast Cancer Survivors.

BACKGROUND: Physical activity (PA) and psychosocial interventions are recommended management strategies for cancer-related fatigue (CRF). Randomized trials support the use of mind-body techniques, whereas no data show benefit for homeopathy or naturopathy. METHODS: We used data from CANTO (ClinicalTrials.gov identifier: NCT01993498), a multicenter, prospective study of stage I-III breast cancer (BC). CRF, evaluated after primary treatment completion using the EORTC QLQ-C30 (global CRF) and QLQ-FA12 (physical, emotional, and cognitive dimensions), served as the independent variable (severe [score of ≥40/100] vs nonsevere). Outcomes of interest were adherence to PA recommendations (≥10 metabolic equivalent of task [MET] h/week [GPAQ-16]) and participation in consultations with a psychologist, psychiatrist, acupuncturist, or other complementary and alternative medicine (CAM) practitioner (homeopath and/or naturopath) after CRF assessment. Multivariable logistic regression examined associations between CRF and outcomes, adjusting for sociodemographic, psychologic, tumor, and treatment characteristics. RESULTS: Among 7,902 women diagnosed from 2012 through 2017, 36.4% reported severe global CRF, and 35.8%, 22.6%, and 14.1% reported severe physical, emotional, and cognitive CRF, respectively. Patients reporting severe global CRF were less likely to adhere to PA recommendations (60.4% vs 66.7%; adjusted odds ratio [aOR], 0.82; 95% CI, 0.71-0.94; P=.004), and slightly more likely to see a psychologist (13.8% vs 7.5%; aOR, 1.29; 95% CI, 1.05-1.58; P=.014), psychiatrist (10.4% vs 5.0%; aOR, 1.39; 95% CI, 1.10-1.76; P=.0064), acupuncturist (9.8% vs 6.5%; aOR, 1.46; 95% CI, 1.17-1.82; P=.0008), or CAM practitioner (12.5% vs 8.2%; aOR, 1.49; 95% CI, 1.23-1.82; P<.0001). There were differences in recommendation uptake by CRF dimension, including that severe physical CRF was associated with lower adherence to PA (aOR, 0.74; 95% CI, 0.63-0.86; P=.0001) and severe emotional CRF was associated with higher likelihood of psychologic consultations (aOR, 1.37; 95% CI, 1.06-1.79; P=.017). CONCLUSIONS: Uptake of recommendations to improve CRF, including adequate PA and use of psychosocial services, seemed suboptimal among patients with early-stage BC, whereas there was a nonnegligible interest in homeopathy and naturopathy. Findings of this large study indicate the need to implement recommendations for managing CRF in clinical practice.

A perspective on complementary/alternative medicine use among survivors of hematopoietic stem cell transplant: Benefits and uncertainties.

The widespread use of complementary and alternative medicine (CAM) in cancer survivors is well known despite a paucity of scientific evidence to support its use. The number of survivors of hematopoietic stem cell transplant (HCT) is growing rapidly and HCT clinicians are aware that many of their patients use CAM therapies consistently. However, due to a paucity of data regarding the benefits and harms of CAM therapies in these survivors, clinicians are reluctant to provide specific recommendations for or against particular CAM therapies. A systematic literature review was conducted with a search using PubMed, the Cochrane Database of Systematic Reviews, and Ovid online for each CAM therapy as defined by the National Center of Complementary and Alternative Medicine. The search generated 462 references, of which 26 articles were deemed to be relevant for the review. Due to extensive heterogeneity in data and limited randomized trials, a meta-analysis could not be performed but a comprehensive systematic review was conducted with specified outcomes for each CAM therapy. In randomized controlled trials, certain mind and body interventions such as relaxation were observed to be effective in alleviating psychological symptoms in patients undergoing HCT, whereas the majority of the other CAM treatments were found to have mixed results. CAM use is an understudied area in HCT survivorship and clinicians should convey the benefits and uncertainties concerning the role of CAM therapies to their patients.

Genetic variation may modify ovarian reserve in female childhood cancer survivors.

STUDY QUESTION: Are genetic polymorphisms, previously identified as being associated with age at menopause in the healthy population, associated with ovarian reserve and predicted age at menopause in adult long-term survivors of childhood cancer? SUMMARY ANSWER: The CT genotype of rs1172822 in the BRSK1 gene is associated with lower serum anti-Müllerian hormone (AMH) levels and a younger predicted age at menopause in adult survivors of childhood cancer. WHAT IS KNOWN ALREADY: Gonadotoxicity is a well-known late side effect of chemotherapy and radiotherapy in adult survivors of childhood cancer. In the healthy population, several genetic polymorphisms are associated with age at natural menopause. Currently, data on the impact of previously identified variants in gene loci associated with ovarian reserve in adult long-term survivors of childhood cancer are lacking. STUDY DESIGN, SIZE, DURATION: We performed a pilot study in a single-centre cohort of adult female Caucasian childhood cancer survivors (n = 176). PARTICIPANTS/MATERIALS, SETTING, METHODS: We determined serum AMH levels (a marker of ovarian reserve) in adult survivors of childhood cancer (n = 176) and studied single nucleotide polymorphisms (SNPs) previously reported to be associated with age at natural menopause: BRSK1 (rs1172822), ARHGEF7 (rs7333181), MCM8 (rs236114), PCSK1 (rs271924), IGF2R (rs9457827) and TNF (rs909253). Association analysis was performed using the additive genetic model. Linear regression was conducted to assess the effect of significant polymorphisms in two previously published menopause prediction models. MAIN RESULTS AND THE ROLE OF CHANCE: The CT genotype of rs1172822 in the BRSK1 (BR serine/threonine kinase 1) gene was negatively associated with serum AMH levels in our cohort (odds ratio: 3.15, 95% confidence interval: 1.35-7.32, P = 0.008) and significantly associated with the predicted age at menopause (P = 0.04). The other five SNPs were not associated with serum AMH levels. LIMITATIONS, REASONS FOR CAUTION: This is a pilot study showing preliminary data which must be confirmed. To confirm our findings and enlarge the project, a nationwide genome-wide association (GWA) project on the ovarian reserve in female survivors of childhood cancer should be performed, including a replication cohort. WIDER IMPLICATIONS OF THE FINDINGS: Our findings support the hypothesis that previously identified genetic polymorphisms associated with age at menopause in healthy women may have an effect on the onset of menopause in female survivors of childhood cancer. Our study highlights a new aspect of the influences on the ovarian reserve after childhood cancer, which should be investigated further in a nationwide GWA study. Eventually, this information can help us to improve counselling on fertility preservation prior to cancer treatment based on genetic factors in individual patients. STUDY FUNDING AND CONFLICT OF INTEREST: W.D. is supported by the Paediatric Oncology Centre Society for Research (KOCR), Rotterdam, The Netherlands. J.S.E.L. has received fees and grant support from the following companies (in alphabetic order): Ferring, Genovum, Merck-Serono, Organon, Schering Plough and Serono. All other authors have nothing to disclose.

Cross-sectional study of self-reported physical activity, eating habits and use of complementary medicine in breast cancer survivors.

BACKGROUND: Besides conventional adjuvant therapies, many breast cancer survivors engage in various activities like exercise, diet and complementary and alternative medicine (CAM) in order to improve their prognosis. Little is known about specific interests and willingness to participate in institutional programs (e.g. exercise classes). METHODS: We conducted a cross-sectional study in patients with early breast cancer assessing current physical activity (PA, e.g. 30 minutes brisk walking), attention to eating habits ("diet"), use of CAM, and interest in learning more about these fields. Patients indicating interest in PA counselling received a voucher for a free instruction by a certified physiotherapist. Data were analysed for factors predictive for engagement in the three fields using a stepwise multivariate logistic approach. RESULTS: Of 342 consecutive patients, 232 (69%) reported to be physically active more than once per week, 299 (87%) paying special attention to nutrition (in most cases fruits, "balanced diet", low fat), and 159 (46%) use of CAM (vitamins, special teas, homeopathy, herbal medicine, mistletoe). Factors predictive for PA were use of CAM, higher age, and fewer worries about the future. Swiss nationality at birth, physical activity and higher education were predictive for diet; whereas physical activity, higher education and lower age were predictive for use of CAM. No associations between any of the above variables and breast cancer characteristics were found. Around half of the patients reported interest in receiving more information and willingness to attend special counselling. Of 166 vouchers, only 7 (4%) were eventually utilized. CONCLUSIONS: A high proportion of breast cancer survivors report PA, following a specific diet and use of CAM. There were no disease related factors associated with such pursuits, but an association between patient related factors and these fields was observed suggesting general health awareness in some patients. Around half of the patients were interested in more information and indicated willingness to participate in institutional programs. Impact on disease specific and general health including health economic aspects warrants further research.

Complementary medicine use in stroke survivors: a US nationally representative survey.

BACKGROUND: Stroke is the second most common cause of death worldwide. Even after surviving, long-term rehabilitation often becomes necessary and does not always lead to complete recovery. Guidelines focus on prevention of risk factors and present concepts for rehabilitation after a stroke. Additional to these recommendations, complementary medicine (CM) utilization is common among patients with neurological conditions. CM also offers a wide range of therapies for both prevention and rehabilitation in stroke. There is limited information available on CM utilization among stroke survivors and differences to patients without former stroke diagnosis. METHODS AND RESULTS: This analysis was based on data of the 2017 National Health Interview survey (NHIS, n = 26,742; response rate 80,7%). We analyzed the prevalence of consultations among stroke patients with CM practitioners within the last 12 months and reasons for utilization. 3.1% of participants reported a stroke, individuals without a prior stroke diagnosis were more likely to have used CM in the past 12 months (31.3% without versus 28.9% with stroke). Consultations with a chiropractor and of using mind-body-medicine was higher in individuals without stroke diagnosis, while more stroke survivors had consulted a naturopath. Equal proportions had consulted a homeopath. Most common therapy approaches among stroke survivors were spiritual meditation (13.7%), progressive relaxation (5.4%), yoga (5.2%), mindfulness meditation (4.3%), mantra meditation (3.1%), guided imagery (2.6%) and tai chi (1.7%). CM use in stroke survivors was associated with female sex (adjusted odds ratio [AOR] = 2.12, 95% confidence interval [CI] = 1.56-2.88) and higher education (AOR = 1.94, CI = 1.42-2.65). CONCLUSION: Stroke patients were less likely to take advantage of complementary medicine than the general population. Since there are many safe and beneficial options, stroke survivors might profit from better information about the existing possibilities regarding prevention and rehabilitation.

Use of non-conventional medicine two years after cancer diagnosis in France: evidence from the VICAN survey.

PURPOSE: The purpose of this study was to assess the use of non-conventional medicine (NCM) in a representative sample of French patients 2 years after cancer diagnosis. METHODS: The study was based on data obtained in the VICAN survey (2012) on a representative sample of 4349 patients 2 years after cancer diagnosis. Self-reported data were collected at telephone interviews with patients. The questionnaire addressed the various types of non-conventional treatments used at the time of the survey. RESULTS: Among the participants, 16.4% reported that they used NCM, and 45.3% of this group had not used NCM before cancer diagnosis (new NCM users). Commonly, NCMs used were homeopathy (64.0%), acupuncture (22.1%), osteopathy (15.1%), herbal medicine (8.1%), diets (7.3%) and energy therapies (5.8%). NCM use was found to be significantly associated with younger age, female gender and a higher education level. Previous NCM use was significantly associated with having a managerial occupation and an expected 5-year survival rate ≥80% at diagnosis; recent NCM use was associated with cancer progression since diagnosis, impaired quality of life and higher pain reports. CONCLUSION: This is the first study on NCM use 2 years after cancer diagnosis in France. In nearly half of the NCM users, cancer diagnosis was one of the main factors which incited patients to use NCM. Apart from the NCM users' socioeconomic profile, the present results show that impaired health was a decisive factor: opting for unconventional approaches was therefore a pragmatic response to needs which conventional medicine fails to meet during the course of the disease. IMPLICATIONS FOR CANCER SURVIVORS: Better information of patients and caregivers is needed to allow access to these therapies to a larger population of survivors.

[Complementary and alternative therapies for climacteric symptoms]. / Alternative Therapiemoglichkeiten im Klimakterium.

OBJECTIVE: Review on complementary and alternative therapies for climacteric symptoms. METHODS: Search for publications about complementary or alternative treatments for climacteric symptoms based on Cochrane Library and Medline (1966-2006) including the references from the identified clinical trials and reviews. RESULTS: Cimicifuga may influence climacteric symptoms, especially hot flushes. Results for phytoestrogens, hop and Salvia seem promising but are less convincing. St. John's wort is an option for the treatment of moderate depressive symptoms. Phytoestrogens seem to have some potential for the prevention of osteoporosis and cardiovascular diseases. Results for the influence of lifestyle on hot flushes are conflicting, but interventions have demonstrated their use for the prevention of osteoporosis and cardiovascular diseases. CONCLUSIONS: Lifestyle modifications, Cimicifuga and phytoestrogens may relieve climacteric symptoms. Phytoestrogens and Cimicifuga should not be given to breast cancer survivors.

Epidemiology of complementary and alternative medicine therapy use in allogeneic hematopoietic stem cell transplant survivorship patients in Australia.

In addition to prescribed conventional medicines, many allogeneic hematopoietic stem cell transplant (HSCT) survivors also use complementary and alternative medical therapies (CAM), however, the frequency and types of CAMs used by allogeneic HSCT survivors remain unclear. Study participants were adults who had undergone an allogeneic HSCT between 1st January 2000 and 31st December 2012. Participants completed a 402-item questionnaire regarding the use of CAM, medical complications, specialist referrals, medications and therapies, infections, vaccinations, cancer screening, lifestyle, and occupational issues and relationship status following stem cell transplantation. A total of 1475 allogeneic HSCT were performed in the study period. Of the 669 recipients known to be alive at study sampling, 583 were contactable and were sent study packs. Of 432 participants who returned the completed survey (66% of total eligible, 76% of those contacted), 239 (54.1%) HSCT survivors used at least one form of CAM. These included dietary modification (13.6%), vitamin therapy (30%), spiritual or mind-body therapy (17.2%), herbal supplements (13.5%), manipulative and body-based therapies (26%), Chinese medicine (3.5%), reiki (3%), and homeopathy (3%). These results definitively demonstrate that a large proportion of HSCT survivors are using one or more form of CAM therapy. Given the potential benefits demonstrated by small studies of specific CAM therapies in this patient group, as well as clearly documented therapies with no benefit or even toxicity, this result shows there is a large unmet need for additional studies to ascertain efficacy and safety of CAM therapies in this growing population.

A pilot, randomized, double-blinded, placebo-controlled trial of individualized homeopathy for symptoms of estrogen withdrawal in breast-cancer survivors.

OBJECTIVE: To pilot an investigation of individualized homeopathy for symptoms of estrogen withdrawal in breast cancer survivors. DESIGN: Randomized, double-blinded, placebo-controlled trial. SETTING: Outpatient department of a National Health Service (NHS) homeopathic hospital. PARTICIPANTS: Fifty-seven (57) women met inclusion criteria and 53 were randomized to the study. INTERVENTION: After 2 weeks of baseline assessment, all participants received a consultation plus either oral homeopathic medicine or placebo, assessed every 4 weeks for 16 weeks. OUTCOME MEASURES: The primary outcome measures were the activity score and profile score of the Measure Yourself Medical Outcome Profile (MYMOP). RESULTS: Eighty-five percent (85%) (45/53) of women completed the study. There was no evidence of a difference seen between groups for either activity (adjusted difference =-0.4, 95% confidence interval CI -1.0 to 0.2, p = 0.17) or profile scores (adjusted difference = -0.4, 95% CI -0.9 to 0.1, p = 0.13) using this trial design, although post hoc power calculations suggests that 65-175 would be needed per group to detect differences of this magnitude with sufficient precision. Clinically relevant improvements in symptoms and mood disturbance were seen for both groups over the study period. CONCLUSION: Improvements were seen for symptom scores over the study period. However, presuming these improvements were caused by the individualized homeopathic approach, the study failed to show clearly that the specific effect of the remedy added further to the nonspecific effects of the consultation. Future trial design must ensure adequate power to account for the nonspecific impact of such complex individualized interventions while pragmatic designs may more readily answer questions of clinical and cost effectiveness.

Homeopathy for menopausal symptoms in breast cancer survivors: a preliminary randomized controlled trial.

OBJECTIVES: To carry out a preliminary trial evaluating the effectiveness of two types of homeopathy for the treatment of menopausal symptoms in breast cancer survivors. DESIGN: Randomized, double-blinded, placebo-controlled. SETTINGS/LOCATION: Private medical clinic, Seattle, WA. SUBJECTS: Women with a history of breast cancer who had completed all surgery, chemotherapy, and radiation treatment and who had an average of at least three hot flashes per day for the previous month. INTERVENTIONS: Subjects were randomized to receive either an individualized homeopathic single remedy, a homeopathic combination medicine, or placebo. Patients were seen by homeopathic providers every 2 months for 1 year. OUTCOME MEASURES: Hot flash frequency and severity, Kupperman Menopausal Index (KMI), Short Form 36 (SF-36). RESULTS: There was no significant difference found in the primary outcome measure, the hot flash severity score, although there was a positive trend in the single remedy group during the first 3 months of the study (p = 0.1). A statistically significant improvement in general health score in both homeopathy groups (p < 0.05) on the SF-36 after 1 year was found. Evidence of a homeopathic "drug proving" in the subjects receiving the homeopathic combination medicine who were not taking tamoxifen also was found. CONCLUSIONS: Small sample size precludes definitive answers, but results from this preliminary trial suggest that homeopathy may be of value in the treatment of menopausal symptoms and improving quality of life, especially in those women not on tamoxifen. Larger studies should be carried out that also include healthy women who want to avoid hormone replacement therapy.

Nonhormonal alternatives for the management of early menopause in younger women with breast cancer.

Current medical practice recommends the use of alternatives to estrogen-replacement therapy for the treatment of menopausal sequelae in younger women with breast cancer, although this clinical recommendation is undergoing reappraisal. Until prospective randomized studies addressing hormone use in this population are available, estrogen use in breast cancer patients will remain controversial. Because estrogen-replacement therapy is not the standard of practice and there is limited information available on nonestrogen therapies, women with breast cancer who are menopausal may not be prescribed or counseled about nonestrogen options. The efficacy, safety, and extent of use of most nonestrogen treatment modalities (other hormonal preparations, nonhormonal drugs, homeopathic preparations, and non-drug treatments) are not well documented and, unlike estrogen, many are selective in their benefit and do not share estrogen's universal impact. The use of several nonestrogen approaches for the prevention and treatment of osteoporosis has been promising. Traditional recommendations to maintain skeletal integrity, such as weight-bearing exercise; a diet rich in calcium and limited in caffeine, alcohol, and protein; avoidance of smoking; and measures to minimize trauma have been expanded to include the use or investigation of drugs (either alone or in combination). These drugs include progestins, vitamin D metabolites, injectable and intranasal synthetic salmon calcitonin, bisphosphonates, sodium fluoride, parathyroid hormone, growth factors, tamoxifen, etc. Strict control of the known risk factors, such as smoking, dyslipidemia, and hypertension as well as exercise, weight control, and the use of tamoxifen, are employed for the prevention and treatment of cardiovascular complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Complementary and alternative medicine in the treatment of refugees and survivors of torture: a review and proposal for action.

Survivors of torture and refugee trauma often have increased needs for mental and physical healthcare. This is due in part to the complex sequelae of trauma, including chronic pain, major depressive disorder, posttraumatic stress disorder (PTSD) and somatization. This article reviews the scientific medical literature for the efficacy and feasibility of some complementary and alternative medicine (CAM) modalities including meditation, Ayurveda, pranayama/yogic breathing, massage/body-work, dance/movement, spirituality, yoga, music, Traditional Chinese Medicine and acupuncture, qigong, t'ai chi, chiropractic, homeopathy, aromatherapy and Reiki specifically with respect to survivors of torture and refugee trauma. We report that preliminary research suggests that the certain CAM modalities may prove effective as part of an integrated treatment plan for survivors of torture and refugee trauma. Further research is warranted.

Classification of CAM use and its correlates in patients with early-stage breast cancer.

HYPOTHESIS: Self-reported use of complementary and alternative medicine (CAM) has been shown to increase following a cancer diagnosis, and breast cancer survivors are the heaviest users among cancer survivors. The aim of this study was to determine whether the prevalence estimate of CAM use varied according to classification of CAM. The authors used a comprehensive system to classify CAM users and test differences in demographic, lifestyle, quality of life, and cancer characteristics among them. STUDY DESIGN AND METHODS: Participants were 2562 breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study, aged 28 to 74 years. A structured telephone interview assessed CAM use, questioning about specific CAM practices, and whether use was related to cancer. This study examined CAM use in relation to demographics, health behaviors, and quality of life. RESULTS: Approximately 80% of the women used CAM for general purposes but only 50% reported CAM use for cancer purposes. Visual imagery, spiritual healing, and meditation were the most frequently used practices for cancer purposes. CAM use, defined as consulting a CAM practitioner and regular use, was significantly related to younger age, higher education, increased fruit and vegetable intake, and lower body mass index (P < .05). CAM users who had seen a practitioner were also more likely to report poor physical and mental health than non-CAM users (P < .05). CAM use was not associated with changes in physical and mental health between study baseline and 1-year follow-up. CONCLUSION: This study addressed important differences in the classification of CAM use among breast cancer survivors. Future studies need to further test the potential benefits and risks associated with CAM use.

Demographic, medical, and psychosocial correlates to CAM use among survivors of colorectal cancer.

GOALS OF WORK: Complementary and alternative medicines (CAM) use among cancer patients is becoming more prevalent; however, our understanding of factors contributing to patients' decisions to participate in CAM is limited. This study examined correlates of CAM use among colorectal cancer (CRC) survivors, an understudied population that experiences many physical and psychological difficulties. MATERIALS AND METHODS: The sample was 191, predominantly white, CRC survivors (mean age = 59.9 +/- 12.6) who were members of a colon disease registry at a NYC metropolitan hospital. Participants completed assessments of sociodemographic characteristics, psychosocial factors [e.g., psychological functioning, cancer specific distress, social support (SS), quality of life (QOL)], and past CAM use (e.g., chiropractic care, acupuncture, relaxation, hypnosis, and homeopathy). MAIN RESULTS: Seventy-five percent of participants reported using at least one type of CAM; most frequently reported was home remedies (37%). Younger (p < 0.01) or female patients (p < 0.01) were more likely to participate in CAM than their older male counterparts. Among psychosocial factors, poorer perceived SS (p = 0.00), more intrusive thoughts (p < 0.05), and poorer overall perceived QOL (p < 0.05) were associated to CAM use. In a linear regression model (including age, gender, SS, intrusive thoughts, and perceived QOL), only age remained a significant predictor of CAM use. CONCLUSION: These findings demonstrate that CAM use is prevalent among CRC survivors and should be assessed routinely by providers. CAMs may serve as a relevant adjunct to treatment among CRC patients as well as an indication of need for additional SS, especially among younger patients.

Homeopathy in survivors of childhood sexual abuse.

The objective of this review was to ascertain the incidence of childhood sexual abuse: to ascertain the long-term effects of childhood sexual abuse and to collate the experiences of homeopaths in caring for survivors. Childhood sexual abuse (CSA) is common with a high percentage of homeopathic patients giving a positive history. It is associated with many common clinical conditions, particularly pelvic pain. Survivors are more likely to present for medical help and to be hospitalised. Homeopaths have found work with such patients to be difficult, with cases being complex and multi-layered. New models for case-analysis have been developed.

Cáncer de endometrio: abordaje diagnóstico y terapéutico: experiencia en el Instituto Nacional de Cancerología / Endometrial carcinoma: diagnostic therapeutic approach: experience at Instituto Nacional de Cancerologia Mexico

El cáncer de endometrio en nuestro país ocupa el tercer lugar entre las neoplasias ginecológicas; su incidencia continúa incrementándose. Por fortuna, el mayor número de casos se diagnostica en etapa confinada al útero; sin embargo, es necesario seguir un adecuado abordaje diagnóstico y terapéutico que nos permita obtener los buenos resultados que generalmente se obtienen en esta neoplasia. Es importante distinguir entre factores de bajo y alto riesgo para diseminación extrauterina de la enfermedad que nos indique a qué pacientes, ya previamente intervenidas de histerectomía y salpingo-ooforectomía bilateral fuera de nuestro Instituto, será necesario reintervenir para completar la estadificación o a quiénes podría indicarse mantener en vigilancia o algún tipo de manejo adyuvante. Asimismo, en las pacientes vírgenes al tratamiento, estos factores de riesgo nos indican a quiénes practicar una disección selectiva de ganglios pélvicos o paraaórticos y, a la luz de los resultados patológicos de esta estadificación, a quiénes justificar un manejo adyuvante con radioterapia y, en pacientes con enfermedad extrauterina, a quiénes justificar tratamiento con quimio y hormonoterapia. En nuestra institución tratamos de seguir en forma estándar un abordaje diagnóstico y terapéutico; sin embargo, con frecuencia nos enfrentamos con casos que requieren de una decisión de manejo tomada en base a criterios individualizados

¿Es la distancia al ano un factor de alguna importancia en la sobrevida del carcinoma colorrectal? / Does the distance to the anal verge influence the outcome of patients with colorectal carcinoma?

Objetivos: El objetivo de este estudio es tratar de demostrar si la distancia al ano es un factor pronóstico independiente en la sobrevida del carcinoma colorrectal. Se analizan 498 casos tratados por el autor o su equipo desde 1980 hasta 1997 con recolección prospectiva de datos. Material y métodos: La distancia al ano de cada tumor fue endoscópicamente considerada cm a cm, incluyendo los tumores existentes desde la línea dentada hasta el ciego. Se recolectan de esta manera un número de casos a cada cm del ano que luego se reúnen en grupos de 5 cm., como factor independiente del sector colorrectal analizado. No se consideraron las distancias clásicas que dividen el recto en inferior medio y superior de 0 a 7 cm, 7 a 11 cm y 11 a 15 cm respectivamente. De esta manera se analizan los grupos en 7 columnas. El cáncer anal fue excluído. Métodos estadísticos: Para aseverar las diferencias de los factores pronósticos y sus combinaciones utilizamos el modelo proporcional de Cox, el método de Kaplan Meier y las diferencias entre los grupos fueron estudiados por el test de Mantel-Haenzel. Resultados: Se halló una peor evolución a medida que el tumor es más cercano al ano, en la sobrevida cruda global y en la diferencia por estadios del TNM. En los estadios 0 y 1 hasta los 20 cm del ano y hasta los 25 cm en el estadio 2. No se hallaron diferencias en los estadios 3 y 4. Resultados estadísticos: La correlación entre distancia y sobrevida dió una significancia estadística de P=0,0086 como variable pronóstica. De esta manera creemos que hemos probado nuestro desafío que la distancia es un factor independiente entre los factores pronósticos del carcinoma colorrectal hasta una altura de 25 cm del ano. Esto conlleva a la conclusión, que este factor pronóstico se aplica al recto y al colon sigmoideo hasta los 25 cm del ano. Por encima de esta distancia no se hallaron diferencias significativas. Con lo cual el resto del colón se halla fuera de esta variable. La distancia en el resto del colon deja de ser un factor pronóstico. Conclusiones: 1- Existe una menor sobrevida en los tumores más cercanos al ano. 2- Existe un aumento progresivo en la sobrevida hasta los 20 cm en los estadios 0, 1 y hasta los 25 cm en el estadio 2. 3- La distancia como factor pronóstico tiene aplicaciones para el recto y el sigmoides hasta los 25 cm del ano. En el resto del colon deja de ser una variable pronóstica...

Radioterapia en sarcoma de los tejidos blandos / Radiotherapy in soft tissue carcoma

El presente artículo es una breve revisión de las contribuciones más notables que ha hecho la radiotrapia al campo de la terapéutica de los sarcomas de los tejidos blandos. De antemano se sabe que el manejo clásico de este tipo de neoplasias es quirúrgico y que, según la amplitud del procedimiento empleado, la recurrencia local varía desde un 90 por ciento para la biopsia excisional únicamente, hasta un 18 por ciento para la cirugía radical o amputación. En algunas series se informa que más del 50 por ciento de pacientes sufrieron de cirugías mutilantes. En pacientes casi siempre inoperables, la radioterapia como tratamiento único resulta en índices de control local del 29 al 33 por ciento. Combinar radioterapia preoperatoria y cirugía brinda control local de 90 a 97 por ciento. Con la aplicación de la radioterapia después de la cirugía se logra control local de 78 a 91 por ciento; la tasa de falla local es del 18.5 por ciento; la preservación funcional del miembro afectado puede ser hasta de 84.7 por ciento. La radioterapia intraoperatoria, con braquiterapia de carga diferida con Ir-192, es otra modalidad terapéutica exitosa, sobre todo en los sarcomas de alto grado en los que se obtiene control local a cinco años hasta del 90 por ciento. El tratamiento combinado ciugía más radioterapia en cualquiera de sus variantes es el mayor avance registrado en el manejo de los sarcomas de los tejidos blandos en las últimas décadas

Tratamiento del cáncer mamario etapa IV y recurrente / Treatment of breast cancer, stage IV and recurrens

Objetivo. Análisis y revisión del tratamiento actual de cáncer de mama en etapa IV y recurrente. Sede. Division de Padecimientos Neoplásicos y Proliferativos del Centro Médico Nacional "20 de Noviembre" del ISSSTE. Método. Evaluación de la literatura internacional (20 referencias) en relación al tema. Experiencia personal en el tema. Resultados. El cáncer mamario etapa IV y recurrente representa un reto continuo para el clínico, el empleo de quimioterapia combinada, desde hace más de 3 décadas, ha permitido una paliación excelente, pero la mayoría de las pacientes morirán por su enfermedad, lo que ocurre pocos años o meses después de la recaída, sólo un pequeño número de ellas podrá sobrevivir libre de la enfermedad por un periodo prolongado de tiempo. Las combinaciones con antracilinas constituyen el tratamiento de primera línea. Los nuevos fármacos como el navelbine, el taxan y el gemcitabine están en estudio y requieren de la prueba del tiempo para ser incluidos, en forma rutinaria, como tratamiento de primera línea. Conclusión. La elección entre hormonoterapia y quimioterapia depende de una cuidadosa evaluación individual de cada paciente, considerando que el objetivo del tratamiento es paliativo