ABSTRACT
PURPOSE: To present a summary of the recommendations for the treatment and follow-up for the biochemical recurrence of castration-resistant prostate cancer (PCa) as acquired through a questionnaire administered at the Prostate Cancer Consensus Conference for Developing Countries. METHODS: A total of 27 questions were identified as relating to this topic. Responses from the clinician were tallied and are presented in percentage format. Topics included the use of imaging in staging, treatment recommendations across different patient scenarios of life expectancy and prostate-specific antigen (PSA) doubling time, and follow-up for nonmetastatic castration-resistant PCa. RESULTS: A consensus agreed that in optimal conditions, positron emission tomography-computed tomography with prostate-specific membrane antigen would be used although in limited resource situations the combined use of CT of the abdomen and pelvic (or pelvic MRI), a bone scan, and a CT of the thorax or chest x-ray was recommended. In cases when PSA levels double in < 10 months, more than 90% of clinicians agreed on the use of apalutamide or enzalutamide, regardless of life expectancy. With a doubling time of more than 10 months, > 54% of experts recommended no treatment independent of life expectancy. More than half of the experts, regardless of resources, recommended follow-up with a physical examination and PSA levels every 3-6 months and imaging only in the case of symptoms. CONCLUSION: The voting results and recommendations presented in this document can be used by physicians to support management for biochemical recurrence of castration-resistant PCa in areas of limited resources. Individual clinical decision making should be supported by available data.
Subject(s)
Prostatic Neoplasms, Castration-Resistant , Developing Countries , Follow-Up Studies , Humans , Male , Prostate-Specific Antigen , Prostatic Neoplasms, Castration-Resistant/drug therapy , Tomography, X-Ray ComputedABSTRACT
Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. Results : The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.
Racional : As metástases hepáticas de câncer colorretal são evento frequente e potencialmente fatal na evolução de pacientes com estas neoplasias. Objetivo : Neste módulo procurou-se contextualizar esta situação clínica, bem como parametrizar dados epidemiológicos e de resultados das diversas modalidades de tratamento estabelecidas. Método : Foi realizada discussão sobre como detectar e estadiar o câncer colorretal metastático, bem como o emprego dos métodos de imagem na avaliação de resposta ao tratamento sistêmico instituído. Resultado : Fundamentou na definição de quais pacientes teriam suas metástases consideradas ressecáveis e de como se poderia ampliar a gama de pacientes submetidos às modalidades de tratamento ditas de intuito curativo. Conclusão : Foram apresentados os fatores prognósticos clínicos, patológicos e moleculares com validação para serem levados em consideração na prática clínica.
Subject(s)
Humans , Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Brazil , Combined Modality Therapy , Practice Guidelines as TopicABSTRACT
AIM: To characterize APC gene mutations and correlate them with patient phenotypes in individuals diagnosed with familial adenomatous polyposis (FAP) in northern Brazil. METHODS: A total of 15 individuals diagnosed with FAP from 5 different families from the north of Brazil were analyzed in this study. In addition to patients with histopathological diagnosis of FAP, family members who had not developed the disease were also tested in order to identify mutations and for possible genetic counseling. All analyzed patients or their guardians signed a consent form approved by the Research Ethics Committee of the João de Barros Barreto University Hospital (Belem, Brazil). DNA extracted from the peripheral blood of a member of each of the affected families was subjected to direct sequencing. The proband of each family was sequenced to identify germline mutations using the Ion Torrent platform. To validate the detected mutations, Sanger sequencing was also performed. The samples from all patients were also tested for the identification of mutations by real-time quantitative polymerase chain reaction using the amplification refractory mutation system. RESULTS: Through interviews with relatives and a search of medical records, it was possible to construct genograms for three of the five families included in the study. All 15 patients from the five families with FAP exhibited mutations in the APC gene, and all mutations were detected in exon 15 of the APC gene. In addition to the patients with a histological diagnosis of FAP, family members without disease symptoms showed the mutation in the APC gene. In the present study, we detected two of the three most frequent germline mutations in the literature: the mutation at codon 1309 and the mutation at codon 1061. The presence of c.3956delC mutation was found in all families from this study, and suggests that this mutation was introduced in the population of the State of Pará through ancestor immigration (i.e., a de novo mutation that arose in one member belonging to this state from Brazil). CONCLUSION: Regardless of its origin, the c.3956delC mutation is a strong candidate biomarker of this hereditary cancer syndrome in families of northern Brazil.
Subject(s)
Adenomatous Polyposis Coli Protein/genetics , Adenomatous Polyposis Coli/genetics , Biomarkers, Tumor/genetics , Germ-Line Mutation , Adenomatous Polyposis Coli/diagnosis , Adolescent , Adult , Brazil , DNA Mutational Analysis , Female , Genetic Association Studies , Genetic Predisposition to Disease , Heredity , High-Throughput Nucleotide Sequencing , Humans , Male , Pedigree , Phenotype , Predictive Value of Tests , Real-Time Polymerase Chain Reaction , Reproducibility of Results , Young AdultABSTRACT
BACKGROUND: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. AIM: In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. METHOD: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. RESULTS: The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. CONCLUSION: Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.
Subject(s)
Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Brazil , Combined Modality Therapy , Humans , Practice Guidelines as TopicABSTRACT
Introdução: lesão de Dieulafoy é uma malfonnação arterial protrusa na submucosa gastrointestinal e é reconhecida como importante causa de hemorragia digestiva maciça, apresentando alta letalidade. Objetivo: relatar um caso clínico de paciente do sexo masculino, 74 anos, com hemorragia digestiva alta por lesão de Dieulafoy atípica. Método: a coleta dos dados foi feita por anamnese, exame físico e complementares de um paciente internado no Hospital Ofir Loyola, além de revisão do prontuário médico e documentação fotográfica. Resultados: o paciente, após ter apresentado episódios de hematoquezia, melena e anemia, foi submetido à endoscopia digestiva alta, na qual foi detectada lesão de Dieulafoy atípica,' sendo instituído, assim, escleroterapia e omeprazol. Conclusão: conclui-se que a lesão de Dieulafoy deve ser lembrada no diagnóstico diferencial das hemorragias digestivas altas, ressaltando a importância da endoscopia digestiva alta no diagnóstico de lesão bem como na obtenção do sucesso terapêutico