RESUMEN
Major advances in sequencing technologies and targeted therapies have accelerated the incorporation of oncology into the era of precision medicine and "biomarker-driven" treatments. However, the impact of this approach on the everyday clinic has yet to be determined. Most precision oncology reports are based on developed countries and usually involve metastatic, hard-to-treat or incurable cancer patients. Moreover, in many cases race and ethnicity in these studies is commonly unreported and real-world evidence in this topic is scarce. Herein, we report data from a total of 202 Chilean advanced stage refractory cancer patients. Retrospectively, we collected patient data from NGS tests and IHC in order to determine the proportion of patients that would benefit from targeted treatments. Overall >20 tumor types were included in our cohort and 37% of patients (n = 74) displayed potentially actionable alterations, including on-label, off-label and immune checkpoint inhibitor recommendations. Our findings were in-line with previous reports such as the cancer genome atlas (TCGA). To our knowledge, this is the first report of its kind in Latin America delivering real-world evidence to estimate the percentage of refractory tumor patients that might benefit from precision oncology. Although this approach is still in its infancy in Chile, we strongly encourage the implementation of mutational tumor boards in our country in order to provide more therapeutic options for advanced stage refractory patients.
RESUMEN
The objectives of this study were to define clinical problems and treatment strategies in vertebral metastases of prostate cancer. The clinical files of 634 patients with prostate cancer seen in a comprehensive cancer center during a 4-year period were retrospectively reviewed. One hundred nineteen patients (18.8%) had 212 significant episodes of osseous spinal metastases. Pain was nearly universal (93%), and motor and bladder impairment occurred in 25% and 3.1% of patients, respectively. Bone scan and magnetic resonance imaging (MRI) were performed in 197 and 64 episodes, respectively. Fifteen episodes of spinal cord compression were treated surgically. Other treatments included hormonal therapy (163 episodes), chemotherapy (70 episodes), and radiation therapy (103 episodes). Osteolytic lesions were observed alone and in combination with osteoblastic pattern in 18% and 26% of episodes, respectively. Bone scan was the most effective screening procedure of vertebral involvement, and MRI effectively showed epidural involvement. Overall treatment led to improvements in pain and motor impairment in 77% and 50% of patients, respectively. However, clinical episodes were recurrent (1.78 episodes per patient; range, 1-8). Median survival after vertebral metastasis episode was 14 months compared with only 4 months after surgery for spinal cord compression. Vertebral metastases strongly alter quality of life in patients with prostate cancer. Pain and neurologic complications are the major problems. Careful early screening with bone scan and MRI may help to define better treatment strategy. However, further prospective studies of clinical management are needed to determine the optimal timing of radiation therapy, medical treatments, and surgery.
Asunto(s)
Neoplasia Intraepitelial Prostática/secundario , Neoplasias de la Próstata/patología , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Anciano , Vértebras Cervicales , Estudios de Seguimiento , Humanos , Laminectomía/métodos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Neoplasia Intraepitelial Prostática/mortalidad , Neoplasia Intraepitelial Prostática/cirugía , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Medición de Riesgo , Neoplasias de la Columna Vertebral/mortalidad , Análisis de Supervivencia , Vértebras Torácicas , Resultado del TratamientoRESUMEN
Se efectúa un análisis retrospectivo de 700 pacientes intervenidos en el Hospital Roberto del Río con el diagnóstico preoperatorio de testículo no descendido entre los años 1982 a septiembre de 1986. La revisión incluyó pacientes de 1 a 15 años de edad y sólo 1,6% tenía menos de 2 años. Se comparan dos técnicas de uso frecuente en niños siendo la técnica del bolsillo escrotal la más empleada, en 390 pacientes; en otros 300 se usó la técnica clásica. La complicación tardía más importante fue la recidiva y se presentó en 27 pacientes, correspondiendo a 22 pacientes operados con la técnica clásica y sólo 5 con bolsillo escrotal. Del análisis de nuestra serie, en comparación con la literatura, concluimos que la edad de operación de nuestros pacientes es tardía y que la técnica del bolsillo escrotal es la más adecuada, porque presenta menor número de complicaciones