Prognostic factors in locally advanced cervical cancer with pelvic lymph node metastasis.

OBJECTIVE: To evaluate the prognostic impact of clinical and pathological variables and patterns of recurrence in patients with locally advanced cervical cancer with pelvic lymph node involvement (stage IIIC1 according to the 2018 FIGO Staging System). METHODS: We retrospectively analyzed 62 patients with locally advanced cervical cancer treated with curative intent with radiotherapy associated with chemotherapy in AC Camargo Cancer Center from January 2007 to December 2018. RESULTS: Lymph node involvement was assessed by CT, MRI and positron emission tomography (PET)/CT in 28 (45.2%), 20 (32.3%) and 14 (22.6%) patients, respectively. The median tumor size was 5.0 cm and 72.6% of cases were squamous cell carcinomas. The median number of positive pelvic lymph nodes was three, and the median size of lymph nodes was 24 mm. Twenty-two (35.5%) patients had recurrence and 50% had only one site of recurrence. The sites of recurrence were pelvic, para-aortic and distant in 12 (19.4%), 6 (9.7%) and 16 (25.8%) patients, respectively. The 3 year overall and disease-free survival were 70.8% and 64.6%, respectively. Patients with adenocarcinoma had worse disease-free survival (HR 2.38; 95% CI 1.01 to 5.60; p=0.047) and overall survival (HR 2.99; 95% CI 1.14 to 7.75; p=0.025) compared with squamous cell carcinoma. In multivariate analysis, metastatic pelvic lymph node size of >2.5 cm (HR 4.38; 95% CI 1.65 to 11.6; p=0.003) and incomplete response to radiotherapy (HR 5.14; 95% CI 1.60 to 16.4; p=0.006) maintained the negative impact for overall survival. CONCLUSIONS: We found that pelvic lymph node size and incomplete response to radiotherapy negatively impact overall survival in patients with advanced cervical cancer with pelvic lymph node involvement. This finding may help to stratify risk in this group of patients.

Janela pericárdica: história e seu uso nos dias atuais / Pericardial window: history and its use nowadays

O traumatismo cardíaco penetrante constitui-se em evento que pode evoluir para o óbito rapidamente e por isso demanda diagnóstico e tratamento imediatos. Apesar da evolução dos métodos de imagem, às vezes não é possível identificá-lo de maneira não invasiva. Assim, o emprego da janela pericárdica constitui-se um método de fácil realização, com elevada sensibilidade e baixa morbidade, especialmente útil em pequenos centros com recursos escassos e limitados. (AU)

The penetrating cardiac trauma is into event that can lead to death quickly and therefore demands immediate diagnosis and treatment. Despite the evolution of the imaging methods, sometimes it is not possible to identify it using a non-invasive method. Thus, the use of pericardial window is an easy to accomplish method, wich has high sensibility and low morbity, specially useful in small centers with few and limited resourses. (AU)