Advanced Breast Cancer Guidelines in Latin America: Assessment, Adaptation, and Implementation of Fifth Advanced Breast Cancer Consensus Guidelines.

PURPOSE: As the fifth international consensus on advanced breast cancer (ABC5) established guidelines for the management of this disease, the aim of this article was to present the applicability of the consensus recommendations and to generate knowledge to improve access. METHODS: Sixty-one recommendation statements were selected and discussed by 15 breast cancer experts from Latin America (LA). After the discussion, the level of consensus was determined through a vote. In addition to this, the level of access to each of the recommendations presented, according to the country and health system, was exposed. RESULTS: Latin American experts had a high level of agreement with the ABC5 consensus recommendations (range, 83%-100%). Twelve of 61 statements are not available for all patients in LA. Among the limitations to access, the following ones are described: limited access to certain technologies (stereotactic body radiotherapy, positron emission tomography-computed tomography), the high costs of drugs that limits access to treatment with CDK4/6 inhibitors, pertuzumab, or poly(ADP-ribose) polymerase inhibitors, and the lack of molecular tests for access to therapeutic targets, as well as the difficult geography and cultural diversity of our continent. CONCLUSION: Despite the great relevance of the recommendations of the ABC5 consensus guidelines, we highlight that we still need to improve access for all patients, regardless of the country or health system they are in, for which we call to action to policy makers and patient groups to improve clinical outcomes of patients with advanced breast cancer in our region.

Peripheral Neural Sheath Breast Sarcoma: Case Report and Literature Review.

Primary sarcomas of the breast are heterogeneous neoplasms derived from the non-epithelial elements of the mammary gland. Malignant peripheral nerve sheath tumors comprise 5-10% of all malignant soft tissue sarcomas. Its heterogeneity and low incidence (1 in 100,000) limit the performance of prospective studies. Therefore, most published articles include individual reports and case series with a small number of patients, making it impossible to determine clear treatment standards in this scenario. A 36-year-old young woman with no personal history consulted the National Cancer Institute of Colombia with a 1-year progression of a rapidly growing mass in her left breast until reaching an approximate tumor size of 20 × 20 cm. Histopathological analysis with a tru-cut biopsy taken from the lesion revealed the presence of a breast sarcoma with positive staining for SOX-10 and S-100. A radical mastectomy as her first treatment included the resection of a costal arch and, therefore, the reconstruction of the chest wall with coverage of the defect with an extended latissimus dorsi flap followed by consolidation therapy with adjuvant radiotherapy (RT) and chemotherapy. Evidence regarding malignant peripheral nerve sheath sarcoma of the breast treatment corresponds to retrospective analyses and case reports with high heterogeneity and variability about strategies in surgical procedures and adjunctive therapy such as complementary chemotherapy and RT; therapeutic approach should always include a multidisciplinary team.

Prevalence of BRCA1 and BRCA2 Germline Mutations in Patients of African Descent with Early-Onset and Familial Colombian Breast Cancer.

BACKGROUND: Pathogenic germline mutations in the BRCA1 and BRCA2 (BRCA1/2) genes contribute to hereditary breast/ovarian cancer (OC) in White/mestizo Colombian women. As there is virtually no genetic data on breast cancer (BC) in Colombians of African descent, we conducted a comprehensive BRCA1/2 mutational analysis of 60 Afro-Colombian families affected by breast/OC. MATERIALS AND METHODS: Mutation screening of the complete BRCA1/2 genes for small-scale mutations and large genomic alterations was performed in these families using next-generation sequencing and multiplex ligation-dependent probe amplification analysis. RESULTS: Four pathogenic germline mutations, including one novel mutation, were identified, comprising 3 in BRCA1 and one in BRCA2. The prevalence of BRCA1/2 mutations, including one BRCA1 founder mutation (c.5123C>A) previously identified in this sample set, was 3.9% (2/51) in female BC-affected families and 33.3% (3/9) in those affected by both breast and OC. Haplotype analysis of 2 BRCA2_c.2701delC carriers (one Afro-Colombian and one previously identified White/mestizo Colombian patient with BC) suggested that the mutation arose in a common ancestor. CONCLUSION: Our data showed that 2/5 (40%) mutations (including the one previously identified in this sample set) are shared by White/mestizo Colombian and Afro-Colombian populations. This suggests that these 2 populations are closely related. Nevertheless, variations in the BRCA1/2 mutational spectrum among Afro-Colombian subgroups from different regions of the country were observed, suggesting that specific genetic risk assessment strategies need to be developed.

Tumor-to-Tumor Metastasis: Lung Adenocarcinoma as a Recipient of Metastasis from Renal Cell Carcinoma: A Case Report.

BACKGROUND The occurrence of metastasis from one neoplasm to another is known as tumor-to-tumor metastasis (TTM). It is a rare phenomenon in the natural history of any neoplasm, with approximately 100 cases reported in the literature to date. The lungs are the most frequent metastatic tumor donors and kidney cancer is the most common recipient. However, the opposite phenomenon (lung adenocarcinoma as a recipient of metastasis from renal carcinoma) has not been previously reported in the literature. CASE REPORT We present the case of a man with a history of multiple neoplasms. He had a diffuse large B-cell lymphoma in 2006, a left papillary renal cell carcinoma (RCC) type 2 in 2006, and an acinar adenocarcinoma of the prostate in 2011. A follow-up computed tomography scan in July 2019 showed a suspicious lung nodule on the left upper lobe and a retroperitoneal hypermetabolic mass on the positron emission tomography scan. The lung nodule and retroperitoneal mass biopsies were consistent with a primary lung adenocarcinoma with a lepidic pattern and a metastatic RCC, respectively. In January 2020, he underwent a thoracoscopic left upper lobectomy and a mediastinal lymph node dissection. Histopathological evaluation revealed a 2-cm nodule composed of a lung adenocarcinoma with an intratumoral metastasis from a papillary RCC. To date, the patient has stable renal neoplastic metastatic disease and no locoregional recurrences of the lung adenocarcinoma. CONCLUSIONS Metastasis from one primary tumor to another primary tumor is an extremely unusual event. We report one of the first cases of an RCC metastasis to a primary lung adenocarcinoma.

Impact of COVID-19 Infection on Patients with Cancer: Experience in a Latin American Country: The ACHOCC-19 Study.

INTRODUCTION: The ACHOCC-19 study was performed to characterize COVID-19 infection in a Colombian oncological population. METHODOLOGY: Analytical cohort study of patients with cancer and COVID-19 infection in Colombia. From April 1 to October 31, 2020. Demographic and clinical variables related to cancer and COVID-19 infection were collected. The primary outcome was 30-day mortality from all causes. The association between the outcome and the prognostic variables was analyzed using logistic regression models and survival analysis with Cox regression. RESULTS: The study included 742 patients; 72% were >51 years. The most prevalent neoplasms were breast (132, 17.77%), colorectal (92, 12.34%), and prostate (81, 10.9%). Two hundred twenty (29.6%) patients were asymptomatic and 96 (26.3%) died. In the bivariate descriptive analysis, higher mortality occurred in patients who were >70 years, patients with lung cancer, ≥2 comorbidities, former smokers, receiving antibiotics, corticosteroids, and anticoagulants, residents of rural areas, low socioeconomic status, and increased acute-phase reactants. In the logistic regression analysis, higher mortality was associated with Eastern Cooperative Oncology Group performance status (ECOG PS) 3 (odds ratio [OR] 28.67; 95% confidence interval [CI], 8.2-99.6); ECOG PS 4 (OR 20.89; 95% CI, 3.36-129.7); two complications from COVID-19 (OR 5.3; 95% CI, 1.50-18.1); and cancer in progression (OR 2.08; 95% CI, 1.01-4.27). In the Cox regression analysis, the statistically significant hazard ratios (HR) were metastatic disease (HR 1.58; 95% CI, 1.16-2.16), cancer in progression (HR 1.08; 95% CI, 1.24-2.61) cancer in partial response (HR 0.31; 95% CI, 0.11-0.88), use of steroids (HR 1.44; 95% CI, 1.01-2.06), and use of antibiotics (HR 2.11; 95% CI, 1.47-2.95). CONCLUSION: In our study, patients with cancer have higher mortality due to COVID-19 infection if they have active cancer, metastatic or progressive cancer, ECOG PS >2, and low socioeconomic status. IMPLICATIONS FOR PRACTICE: This study's findings raise the need to carefully evaluate patients with metastatic cancer, in progression, and with impaired Eastern Cooperative Oncology Group status to define the relevance of cancer treatment during the pandemic, consider the risk/benefit of the interventions, and establish clear and complete communication with the patients and their families about the risk of complications. There is also the importance of offering additional support to patients with low income and residence in rural areas so that they can have more support during cancer treatment.

Características de los pacientes con cáncer de pulmón de célula no pequeña en el Instituto Nacional de Cancerología de Colombia / Characteristics of patients with non-small cell lung cancer at the National Cancer Institute of Colombia

Resumen Objetivos: Describir las características demográficas, histopatológicas, biología molecular tumoral y estadificación de los pacientes con cáncer de pulmón de célula no pequeña atendidos entre diciembre de 2013 y diciembre de 2018 en el Instituto Nacional de Cancerología de Colombia. Métodos: Estudio descriptivo de corte transversal. Resultados: Se incluyeron 392 pacientes con cáncer de pulmón de célula no pequeña, la mediana de edad fue 65.9 años (rango, 28,9 a 88,9 años). 198 (50,5%) pacientes fueron mujeres, obteniendo una relación hombre mujer 1:1. El 90.6% de los casos eran mayores de 50 años. Antecedente de tabaquismo se presentó en 211 (53,8%) pacientes, 75.8% de la población masculina y 32,3% de la población femenina eran fumadores. El adenocarcinoma se encontró en 293 (74,7%) pacientes y el carcinoma escamocelular en 73 (18,6%) pacientes. La estadificación patológica fue: estadio I en 22 (5,6%) pacientes, estadio II en 18 (4,6%), estadio III en 40 (10,2%) pacientes, estadio IV en 311 (79,3%) pacientes y no hubo dato en un solo paciente. Se detectó la mutación del EGFR en 21,2% de los pacientes. Los reordenamientos de ALK se identificaron en 4,6% de los pacientes y el PDL 1 solo se midió en el 9% de la población. Conclusiones: este estudio nos muestra el panorama general del cáncer de pulmón de célula no pequeña en la población colombiana, en donde la mayoría de los pacientes se diagnostican en estadios avanzados de la enfermedad y nos expone la necesidad de nuevas estrategias para la detección temprana y el acceso oportuno de los pacientes con cáncer de pulmón.

Abstract Objectives: to describe the demographic and histopathologic characteristics, tumor molecular biology and staging of patients with non-small cell lung cancer treated between December 2013 and December 2018 at the National Cancer Institute of Colombia. Methods: a retrospective cohort study based on data from medical records. Results: 392 patients with non-small cell lung cancer were included. The median age was 65.9 years (range: 28.9 to 88.9 years); 198 (50.5%) patients were women, obtaining a 1:1 male-female ratio. 90.6% of the cases were older than 50 years. History of smoking occurred in 211 patients (53.8%), 75.8% of the male population and 32.3% of the female population were smokers. Adenocarcinoma was found in 293 (74.7%) patients, while squamous cell carcinoma was present in 73 (18.6%) patients. The pathological staging was: 22 (5.6%) patients were in stage I, 18 (4.6%) had stage II, 40 (10.2%) patients were in stage III, stage IV was found in 311 (79.3%) patients, and there was no data in one patient. EGFR mutation was detected in 21.2% of patients. ALK rearrangements were identified in 4.6% of patients and PDL-1 was only found in 9% of the population. Conclusions: this study presents a general panorama of non-small cell lung cancer in the Colombian population, where most patients are diagnosed in advanced stages of the disease, and highlights the need for new strategies for early detection and better access for patients with lung cancer.

Role of RUNX2 transcription factor in epithelial mesenchymal transition in non-small cell lung cancer lung cancer: Epigenetic control of the RUNX2 P1 promoter.

Lung cancer has a high mortality rate in men and women worldwide. Approximately 15% of diagnosed patients with this type of cancer do not exceed the 5-year survival rate. Unfortunately, diagnosis is established in advanced stages, where other tissues or organs can be affected. In recent years, lineage-specific transcription factors have been associated with a variety of cancers. One such transcription factor possibly regulating cancer is RUNX2, the master gene of early and late osteogenesis. In thyroid and prostate cancer, it has been reported that RUNX2 regulates expression of genes important in tumor cell migration and invasion. In this study, we report on RUNX2/ p57 overexpression in 16 patients with primary non-small cell lung cancer and/or metastatic lung cancer associated with H3K27Ac at P1 gene promoter region. In some patients, H3K4Me3 enrichment was also detected, in addition to WDR5, MLL2, MLL4, and UTX enzyme recruitment, members of the COMPASS-LIKE complex. Moreover, transforming growth factor-ß induced RUNX2/ p57 overexpression and specific RUNX2 knockdown supported a role for RUNX2 in epithelial mesenchymal transition, which was demonstrated through loss of function assays in adenocarcinoma A549 lung cancer cell line. Furthermore, RUNX2 increased expression of epithelial mesenchymal transition genes VIMENTIN, TWIST1, and SNAIL1, which reflected increased migratory capacity in lung adenocarcinoma cells.

Low Prevalence of the Four Common Colombian Founder Mutations in BRCA1 and BRCA2 in Early-Onset and Familial Afro-Colombian Patients with Breast Cancer.

BACKGROUND: Inherited mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 (BRCA1/2) confer high risks of breast and ovarian cancer. In Colombian Hispanic families, four common BRCA1/2 founder mutations have previously been identified. Because nothing is known about the contribution of BRCA1/2 germline mutations to early-onset and hereditary breast and/or ovarian cancer in Afro-Colombians, we conducted the first study on 60 patients with early-onset and familial breast cancer in this population. MATERIALS AND METHODS: Screening for the four Colombian founder mutations BRCA1/c.3331_3334delCAAG, BRCA1/c.5123C>A, BRCA2/c.2806_2809delAAAC, and BRCA2/c.1763_1766delATAA was performed using mismatch polymerase chain reaction (PCR) analysis, PCR-based restriction fragment length polymorphism analysis, and qualitative real-time PCR. Mutations were confirmed by direct DNA sequencing. RESULTS: The BRCA1 founder mutation c.5123C>A was identified in one family with breast and ovarian cancer (1/60, 1.7%). Three women were diagnosed with breast cancer, including one with bilateral disease, at the ages of 30, 30/33, and 52 years, and one woman was diagnosed with ovarian cancer at the age of 60 years. CONCLUSION: Our data showed a low prevalence of the BRCA1/2 founder mutations in Colombians of African descent, implying that these mutations should not be recommended for genetic screening programs in the Afro-Colombian population. IMPLICATIONS FOR PRACTICE: Risk reduction intervention programs are needed for women who are found to carry a BRCA1/2 mutation, as is the implementation of prevention programs for patients with inherited breast cancer, to reduce the burden of inherited diseases. With the aim of reducing racial disparities in breast cancer prevention, this study focused on genetic testing and treatment for patients in a minority population with BRCA1/2 mutations.

Hiponatremia luego de uso de cisplatino: a propósito de un caso / Hyponatraemia after cisplatin use: a case report

Paciente de 26 años con diagnóstico de teratoma inmaduro de ovario derecho. Se le realizó resección del tumor más salpingooforectomía en junio de 2014. Recibió manejo adyuvante con carboplatino y ciclofosfamida por un ciclo en enero de 2015, pero sin respuesta. Se realizó laparotomía exploradora por obstrucción intestinal evidenciándose masa pélvica e implantes peritoneales a nivel hepático. Valoró oncología clínica del INC en febrero del 2015, se inicia manejo con esquema PEB; recibió el primer ciclo sin complicaciones. El segundo ciclo fue retrasado por infección en la pared abdominal. Empezó tratamiento con sodio sérico normal, con posterior descenso sin alteración en el resto de electrolitos, función renal, ni estado ácido base. La paciente no presentó síntomas neurológicos y estuvo euvolémica. Se inició estudio de hiponatremia haciéndose diagnóstico de SIADH. Se indicó manejo con restricción hídrica y dieta hipersódica, con posterior ascenso gradual de niveles séricos de Na, considerándose SIADH secundario a uso de cisplatino.

The case is presented of a 26 year-old patient diagnosed with an immature teratoma of the right ovary. Tumour resection plus salpingo-oophorectomy was performed in June 2014. She received one cycle of adjuvant treatment with carboplatin and cyclophosphamide, but with no response. An exploratory laparotomy was performed due to an intestinal obstruction, which showed a pelvic mass and peritoneal implants at hepatic level. She was assessed in the oncology clinic of the Colombian National Institute (INC) in February 2015, and treatment with a platinol (cisplatin), etoposide, and bleomycin (PEB) scheme was started. She received the first cycle without complications, but the second cycle was delayed due to an infection in the abdominal wall. She started the treatment with a normal serum sodium, with a subsequent decrease with no changes in the rest of the electrolytes, kidney function, or acid-base status. The patient showed no neurological signs and was euvolaemic. A hyponatraemia study was performed, ending up making the diagnosis of inappropriate antidiuretic hormone secretion (IADHS). A water restriction and high sodium diet was indicated, with the subsequent gradual increase in the serum Na levels. The IADHS was considered secondary to the use of cisplatin.

Encefalopatía inducida por 5-fluorouracilo Un mismo agente, dos entidades diferentes / Encephalopathy induced by 5-fluorouracil The same agent, two different entities

La neurotoxicidad de los medicamentos antineoplásicos es un fenómeno de relativa frecuencia, que ocurre principalmente sobre el sistema nervioso periférico y más comúnmente con fármacos citotóxicos como platinos, taxanos y derivados de la vinca. La toxicidad sobre el sistema nervioso central asociado al uso del 5-fluorouracilo es por el contrario un evento poco común, pero no por ello menos importante. El clínico debe aprender a reconocer y tratar las dos variedades de esta condición médica: la encefalopatía aguda y la leucoencefalopatía subaguda; cada una con fisiopatología, manifestaciones clínicas y tratamiento diferentes. La siguiente presentación de casos ejemplifica estas dos variedades y brinda elementos diagnósticos y terapéuticos para cada una de ellas. (ActaMed Colomb 2015; 40: 338-344).

The neurotoxicity of anticancer drugs is a relatively common phenomenon, occurring mainly on the peripheral nervous system, most commonly with cytotoxic drugs such as platinum, taxanes and vinca derivatives. Toxicity on the central nervous system associated with the use of 5-fluorouracil is on the contrary a rare event, which does not make it less important. The clinician must learn to recognize and treat the two varieties of this medical condition: acute encephalopathy and sub-acute leukoencephalopathy, each with different pathophysiology, clinical manifestations and treatment. The following case presentation illustrates these two varieties and provides diagnostic and therapeutic elements for each one of them. (Acta Med Colomb 2015; 40: 338-344).

Supervivencia en adenocarcinoma gástrico posterior a tratamiento adyuvante tratados en el Instituto Nacional de Cancerología de Colombia durante el 2009 / Survival in gastric adenocarcinoma patients after adjuvant treatment in the Colombian National Institute of Cancerology during 2009

Objetivo: Determinar la supervivencia libre de enfermedad y global a dos años en pacientes con cáncer gástrico que recibieron tratamiento adyuvante en el Instituto Nacional de Cancerología de Colombia (INC) durante el 2009. Pacientes y métodos: De forma retrospectiva, se incluyeron pacientes con diagnóstico de adenocarcinoma gástrico o de la unión gastroesofágica que hubieran recibido quimioterapia adyuvante en el INC durante el 2009. Se describieron las características clínicas, epidemiológicas, tratamiento recibido, supervivencia global y libre de enfermedad a dos años. Resultados: Se incluyeron en el análisis a 32 pacientes. La edad media fue de 55 años. Los hombres representaron el 56,2% de los casos. El subtipo histológico predominante fue el intestinal (53,1%). El grado de invasión tumoral T3-T4 se presentó en el 81,2%, y el compromiso ganglionar, en el 84,3%, con 34,3% de los casos, con siete o más ganglios comprometidos. El 96,8% recibieron tratamiento adyuvante de acuerdo con el protocolo Macdonald. El 75% de los pacientes completaron el tratamiento. En el 12% de los casos se suspendió el tratamiento por toxicidad. El seguimiento medio de los pacientes fue de 37,8 meses. La supervivencia global y libre de enfermedad a dos años en pacientes que recibieron quimioterapia adyuvante fue de 85,18% y 77,4%, respectivamente. Conclusiones: El estudio mostró una mayor supervivencia global y libre de enfermedad para pacientes que recibieron tratamiento adyuvante en el INC frente a la encontrada en los estudios INT 0116 y MAGIC; la supervivencia es similar a estudios con población asiática.

Objective: To determine the disease free and overall survival at two years in patients with gastric cancer who received adjuvant treatment in the Colombian National Institute of Cancerology (INC) during 2009. Patients and methods: A retrospective study was conducted on patients with a diagnosis of a gastric adenocarcinoma or of the gastroesophageal junction and who had received adjuvant chemotherapy in the INC during the year 2009. The variables recorded were: clinical and epidemiological characteristics, treatment received, and the overall and disease free survival at two years. Results: A total of 32 patients (56.2% males), with a mean age of 55 years were included in the analysis. The most predominant histological sub-type was intestinal (53.1%). T3-T4 tumor invasion grade was present in 81.2%, and lymph involvement in 84.3%, with 34.3% of cases with seven or more lymph nodes involved. Almost all of them (96.8%) received adjuvant treatment according to the Macdonald protocol. Three-quarters (75%) of the patients completed the treatment. Treatment was stopped in 12% of cases due to toxicity. The mean follow-up of the patients was 37.8 months. The overall and disease free survival was at two years in the patients who received adjuvant chemotherapy was 85.18% and 77.4%, respectively. Conclusions: The study showed a greater overall and disease free survival in patients who received adjuvant treatment in the INC compared to that found in patients in the INT 0116 and MAGIC studies. The survival is similar to that in studies with Asiatic populations.

Malignant solitary fibrous tumor of the kidney: report of the first case managed with interferon.

Solitary fibrous tumors of the kidney are extremely rare tumors with unpredictable behavior. We describe a case of a patient with a solitary fibrous tumor of kidney with malignant findings with distant metastasis and nephrectomy managed with subcutaneous interferon achieving 23 months of progression-free survival. To date there is no prospective evaluation of any specific modality of treatment, but the surgical management and long-term followup are the only ones so far recommended strategies in the management of these patients. Studies are awaited with more patients to evaluate the different strategies of systemic therapy reported so far to allow adding survival benefit.

Valor pronóstico de la densidad microvascular y de la expresión del VEGF, EGFR y HIF-1α en pacientes con cáncer de cérvix localmente avanzado tratados con quimiorradiación (ONCOLGroup)§ / Prognostic value of microvascular density and expression of VEGF, EGFR and HIF-1α in patients with locally advanced cervical cancer treated with chemoradiation (ONCOLGroup)§

Introducción: en Colombia el carcinoma de cuello uterino representa la segunda causa de muerte por cáncer entre las mujeres. Objetivo: describir el valor pronóstico de la densidad microvascular (DMV) y de la expresión proteica de varios genes relacionados con la supervivencia y proliferación del cáncer de cérvix localmente avanzado tratado con quimiorradiación/braquiterapia intracavitaria. Se estimaron la tasa de respuesta global (TRG), la supervivencia libre de progresión (SLP) y la supervivencia global (SG). Resultados: se incluyeron 61 mujeres con una edad media de 52 ± 10 años; todas tenían diagnóstico de cáncer de cérvix localmente avanzado (IIA 2.3%/IIB 47.5%/IIIA 4.9%/IIIB 37.7%/IVA 3.3%/no definido 3.3%), con un volumen tumoral promedio de 6.4cm (DE± 1.8cm) e infección por VPH en 46% de los casos; 58 sujetos (95%) tenían un patrón escamoso, dos fueron adenocarcinomas y >50% presentaba neoplasias moderada o pobremente diferenciadas. Todas fueron tratadas con quimiorradiación (interrupción transitoria de la teleterapia por toxicidad y otras causas en 19 y 21.4%, respectivamente/media de ciclos de platino concomitante 4.8 series ± 1.0) y braquiterapia (77% completaron el tratamiento intracavitario). La mediana para la SLP y global fue de 6.6 meses (4.0-9.1) y 30 meses (1148), respectivamente. Ninguna de las variables tuvo efecto sobre la SLP, mientras el análisis multivariado demostró que los niveles de expresión del VEGF (p=0.026), EGFR (p=0.030), y el volumen tumoral <6 cm (p=0.02) influyeron sobre este desenlace. Conclusión: la tipificación de genes relacionados con angiogénesis y proliferación celular en el cáncer de cérvix localmente avanzado tratado con quimiorradiación basada en platino tiene una influencia positiva sobre el pronóstico. (Acta Med Colomb 2012; 37: 106-117).

Introduction: cervical carcinoma is the second leading cause of cancer death among women in Colombia. Objective: to describe the prognostic value of microvascular density (MVD) and protein expression of several genes related to survival and proliferation of locally advanced cervical cancer (LACC) treated with chemoradiation / intracavitary brachytherapy. We estimated the overall response rate (ORR), progression-free survival (PFS) and overall survival (OS). Results: we included 61 women with a mean age of 52 ± 10 years; all were diagnosed with locally advanced cervical cancer (IIA 2.3% / IIB 47.5% / IIIA 4.9% / IIIB 37.7% / IVA 3.3% / 3.3% undefined ), with an average tumor volume of 6.4cm (SD ± 1.8cm) and HPV infection in 46% of cases. 58 subjects (95%) had a squamous pattern; two were adenocarcinomas and >50% had moderate or poorly differentiated neoplasms. All were treated with chemoradiation (temporary interruption of teletherapy due to toxicity, and other causes was documented in 19% and 21.4% respectively / mean of concomitant platinum cycles 4.8 ± 1.0) and brachytherapy (77% completed intracavitary treatment). The median PFS and OS was 6.6 months (4.0-9.1) and 30 months (11-48), respectively. None of the variables had an effect on the PFS, while multivariate analysis demonstrated that the levels of VEGF expression (p = 0.026), EGFR (p = 0.030), and tumor volume <6 cm (p = 0.02) influenced this outcome. Conclusion: the characterization of genes related to angiogenesis and cell proliferation in locally advanced cervical cancer treated with platinum-based chemoradiation had a positive influence on the prognosis. (Acta Med Colomb 2012; 37: 106-117).

Mieloptisis. Viejos aspectos, nuevos conceptos / Myelophthisis. Old aspects, new concepts

Introducción: la mieloptisis es la infiltración de la médula ósea por células no hematopoyéticas.Objetivo: realizar un análisis detallado de 89 sujetos con mieloptisis tratados entre 1991 y 2006.Material y métodos: se revisaron las historias clínicas de 138 pacientes en quienes se encontró leucoeritroblastosis. De éstos, se seleccionaron 89 sujetos mayores de 16 años, con diagnóstico de alguna neoplasia sólida y mieloptisis.Resultados: la edad promedio fue 47,5 ± 17,2 años, la distribución por sexo fue homogénea y el 62 por ciento tuvo un IK ≥60 por ciento. Veintisiete pacientes (30 por ciento) tenían cáncer de mama, patología seguida por los tumores de primario desconocido (27 por ciento), el rabdomiosarcoma (10 por ciento), adenocarcinoma de próstata (10 por ciento), el carcinoma gástrico (7 por ciento) y otras neoplasias sólidas (22 por ciento). En el momento en que se documentó la mieloptisis, 72 por ciento y 50 por ciento tenían metástasis óseas y viscerales, respectivamente; 81 pacientes presentaron anemia (Hb 9,8 ± 1,2 gr/dl), la mediana del recuento plaquetario fue 174.000 y el promedio de leucocitos 24.283 ± 5.447. Cuarenta y tres pacientes recibieron quimioterapia después del diagnóstico de infiltración medular, tras lo que se evidenció normalidad en el recuento leucocitario en 40 por ciento de los casos. Se presentaron nueve episodios de neutropenia febril, la mediana de supervivencia global (SG) a partir del diagnóstico de la neoplasia fue 13,8 meses, y después de la mieloptisis, 2,2 meses. Los factores relacionados con una menor supervivencia fueron: la presencia de Hb ≤8,5 gr/dl (HR: 0,54, IC95 por ciento 0,32-0,95; p = 0.04), >3 sitios de metástasis (HR: 0,67, IC95 por ciento 0,45-0,92; p = 0.03), enfermedad visceral (HR: 0,72, IC95 por ciento 0,66-0,89; p = 0.04) y la neutropenia febril por quimioterapia (HR: 0,52, IC95 por ciento 0,37-0,60; p = 0.02).Conclusiones: la mieloptisis es una condición grave que modifica la SG de los pacientes con tumores sólidos. El tratamiento de este subgrupo debe seleccionarse teniendo en cuenta su toxicidad hematológica.

Neoadyuvancia en cáncer de mama / Neoadjuvant Therapy in Breast Cancer

El tratamiento neoadyuvante —también denominado “terapia primaria sistémica” o “terapia preoperatoria”— tiene cuatro finalidades en cáncer de mama: disminuir el volumen tumoral para hacer operable lo que antes era inoperable, mejorar las probabilidades para hacer una cirugía conservativa, analizar la quimiosensibilidad in vivo y evaluar el manejo de las micrometástasis. Esta revisión descriptiva toma en cuenta los principales estudios clínicos sobre terapia sistémica neoadyuvante publicados hasta mayo del 2009.

Neoadjuvant treatment —also known as primary systemic therapy or preoperative therapy— has four objectives when applied to breast cancer: to reduce inoperable tumoral volume to operable size; to enhance the possiblility for conservative surgery; to analyze chemosensitivity in vivo; and, to evaluate the management of micrometastasis. This descriptive review takes into account the major clinical studies on systemic neoadjuvant therapy published as of May, 2009.

Hemodiálisis en pacientes con cáncer: análisis de la evidencia basado en una serie de casos del Instituto Nacional de Cancerología / Hemodialysis for Cancer Patients: Analysis of Evidence Based on case series at the National Cancer Institute of Colombia

Objetivos: Realizar un análisis detallado de la evolución y mortalidad de 13 pacientes con cáncer y FRA tratados con terapia de reemplazo renal (TRR). Métodos: Se evaluaron diversas variables demográficas, el compromiso funcional al momento del diagnóstico de la FRA, su causa y etiología. Además, varios desenlaces y dos índices, el de gravedad individual para FRA de Liaño (ISI) y el APACHE II. Resultados:Los pacientes tuvieron un promedio de 55 años, 70por ciento eran mujeres y el origen principal de las neoplasias fue el tracto genitourinario.Dos tercios de la población tenían un IK inferior o igual a 70por ciento, 53 porciento presentaba neoplasias en progresión, 38porciento tenía enfermedad no controlada en tratamiento y un sujeto estaba libre de cáncer. Todos los pacientes iniciaron hemodiálisis intermitente, en promedio, seis días después del ingreso hospitalario y cuatro días después del diagnóstico de la urgencia. Nueve sujetos tenían comorbilidad grave, y 8 murieron, con una mediana de 17 días entre el inicio de la diálisis y el fallecimiento; la mortalidad global fue del 61por ciento, la media de la puntuación del ISI fue 0,62 (DE +/- 0,012) y del APACHE II 26 (DE +/- 9). Conclusiones: La hemodiálisis está indicada en cualquier paciente con cáncer y FRA que se encuentre sin enfermedad o con una neoplasia potencialmente tratable, si tiene un buen estado funcional y está de acuerdo con dicha intervención.

Síndrome de Terson y hemorragía alveolar difusa en pacientes con leucemia mieloide aguda promielocítica / Terson´s Syndrome and Diffuse alveolar Hemorrhage in Acute Promyelocytic Leukemia

La leucemia promielocítica aguda (LPMA) constituye del 5 por ciento al 15 por ciento de los casos de leucemias agudas no linfocíticas y, con frecuencia, se relaciona con complicaciones hemorrágicas de curso fatal. este reporte describe los hallazgos en dos pacientes con LPMA que desarrollaron hemorragia alveolar difusa y cerebral, en asociación con sangrado vítreo, sonsistente con el síndrome de Terson, diagnosticado durante el tratamiento de inducción con ácido transretinoico.

Condiloma acuminado gigante: presentación de un caso / Giant Condyloma Acuminatum: A Case Report

El condiloma acuminado gigante (CAG) de la región anorrectal es una enfermedad rara, descrita originalmente en 1896 y que tiene un curso habitualmente fatal. Se caracteriza por la presencia de una lesión bien diferenciada de difícil tratamiento, debido a las dimensiones del tumor, por el extenso compromiso locorregional y la alta tasa de recurrencias. El CAG se ha diferenciado del condiloma común y del carcinoma escamocelular típico por el grosor de su estrato córneo, por la rápida proliferación papilar y por la ausencia de compromiso de la membrana basal, angioinvasión, infiltración linfática y metástasis. A continuación, se presenta el caso de una mujer con un CAG tratado con quimiorradiación.Palabras clave: condiloma acuminado, carcinoma verrucoso, queratoacantoma, carcinoma del canal anal.

Giant condyloma acuminatum (GCA) of the anorectum is a rare disease with potentially fatal course, originally described in 1896. Although this is a well differentiated tumor, its management is often challenging due to the size, degree of local invasion and recurrence rate. GCA can be differentiated from ordinary condiloma and squamous cell carcinoma because of its thicker stratum corneum, marked papillary proliferation, invasion of the normal tissue without compromise of the basement membrane, angioinvasion, lymphatic infiltration and metastases. We report a case of a woman with CGA treated by chemoradiotehrapy.