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BACKGROUND: Multiple primary melanoma (MPM) is a diagnostic challenge even with ancillary imaging technologies available to dermatologists. In selected patients' phenotypes, the use of imaging approaches can help better understand lesion characteristics, and aid in early diagnosis and management. METHODS: Under a 5-year prospective single-center follow-up, 58 s primary melanomas (SPMs) were diagnosed in two first-degree relatives, with fair skin color, red hair, green eyes, and personal history of one previous melanoma each. Patients' behavior and descriptive demographic data were collected from medical records. The information on the first two primary melanomas (PMs) were retrieved from pathology reports. The characteristics of 60 melanomas were collected from medical records, video dermoscopy software, and pathology reports. Reflectance confocal microscopy (RCM) was performed prior to excision of 22 randomly selected melanomas. RESULTS: From February 2018 to May 2023, two patients underwent a pooled total of 214 excisional biopsies of suspect lesions, resulting in a combined benign versus malignant treatment ratio (NNT) of 2.0:1.0. The number of moles excised for each melanoma diagnosed (NNE) was 1.7:1.0 and 6.9:1.0 for the female and male patient respectively. The in-situ melanoma/invasive melanoma ratio (IIR) demonstrated a higher proportion of in-situ melanomas for both patients. From June 2018 to May 2023, a total of 58 SPMs were detected by the combination of total body skin exam (TBSE), total body skin photography (TBSP), digital dermoscopy (DD), and sequential digital dermoscopy imaging (SDDI) via comparative approach. The younger patient had her PM one month prior to the second and third cutaneous melanomas (CMs), characterizing a case of synchronous primary CM. The male older relative had a total of 7 nonsynchronous melanomas. CONCLUSIONS: This CM cohort is composed of 83.3% in-situ melanoma and 16.7% invasive melanoma. Both patients had a higher percentage of SPM with clinical nevus-like morphology (84.5%), global dermoscopic pattern of asymmetric multiple component (60.3%) and located on the lower limbs (46.6%). When RCM was performed prior to excision, 81% of SPM had features suggestive of malignancy. As well, invasive melanomas were more frequent in the lower limbs (40%). In the multivariate model, for the two high-risk patients studied, the chance of a not associated with nevus ("de novo") invasive SPM diagnosis is 25 times greater than the chance of a diagnosis of a nevus-associated invasive SPM.
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Retroperitoneal sarcomas are rare entities. They have a tendency of growing slowly, rendering the patient apparently healthy for long periods of time, before diagnosis. Besides, they have a worse prognosis than sarcomas arising in extremities, with a higher local recurrence rate and lower 5-year survival rate. We describe a case of a 71-year-old male patient, who had a very well succeeded treatment of a large retroperitoneal sarcoma with the combination of chemoembolization, systemic chemotherapy, surgery, and radiation therapy. Initially, it was noticed in an incidental way he had a large retroperitoneal mass (15 cm × 10 cm × 9.2 cm) through magnetic resonance, when he was 63. The case was considered inoperable by the treating physicians. After neoadjuvant therapy, the residual tumor could be completely excised by the responsible surgeon. With a follow-up of >5 years, since the end of treatment, the patient remains in complete remission and, probably, cured from his illness. Large retroperitoneal sarcomas are still a great challenge for oncologists. According to the medical literature, chemoembolization can benefit some patients, but most of them in a palliative setting. In our report, we believe its contribution was critical for a great outcome. In selected cases, it is possible this procedure may be an additional therapeutic modality, as part of a multidisciplinary approach.
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OBJECTIVE: To define a predictive factor for pathologic complete response, compare the oncologic outcomes associated with the degree of pathologic response after neoadjuvant chemotherapy, and to analyze pathologic complete response as a prognostic factor for overall survival and progression-free survival. METHODS: A retrospective study of patients admitted to Hospital Estadual Mário Covas and Hospital Anchieta from 2008 to 2012, with locally advanced breast cancer. Hormone receptor status, HER2 status, histologic and nuclear grade, age upon diagnosis and histological type of the tumor were analyzed. Pathologic evaluation of the tumor was subdivided into pathologic complete response, defined by the absence of tumor; intermediate response, considered as a favorable stage; and poor response, considering low-responder patients. Data obtained were submitted to statistical analysis. RESULTS: The study included 243 patients. There was an association of pathologic complete response with HER-2 negative, histological grade 3, stage III, hormone receptor negative, positive lymph node, older age and more advanced tumors. However, after multivariate analysis the only predictor of pathologic complete response was the presence of negative hormone receptor. By analyzing the prognostic factors, hormone receptor negative was considered as an independent risk factor, and pathologic complete response was considered as an independent protective factor. CONCLUSION: Hormone receptor negative is predictive of pathologic complete response and is an isolated risk factor for lower progression-free survival and overall survival. Pathologic complete response is a protective factor for these same survival analyses.
Subject(s)
Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Carcinoma/drug therapy , Carcinoma/pathology , Neoadjuvant Therapy/methods , Receptors, Estrogen/analysis , Receptors, Progesterone/analysis , Adult , Aged , Aged, 80 and over , Analysis of Variance , Breast Neoplasms/chemistry , Breast Neoplasms/mortality , Carcinoma/chemistry , Carcinoma/mortality , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Reference Values , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
ABSTRACT Objective To define a predictive factor for pathologic complete response, compare the oncologic outcomes associated with the degree of pathologic response after neoadjuvant chemotherapy, and to analyze pathologic complete response as a prognostic factor for overall survival and progression-free survival. Methods A retrospective study of patients admitted to Hospital Estadual Mário Covas and Hospital Anchieta from 2008 to 2012, with locally advanced breast cancer. Hormone receptor status, HER2 status, histologic and nuclear grade, age upon diagnosis and histological type of the tumor were analyzed. Pathologic evaluation of the tumor was subdivided into pathologic complete response, defined by the absence of tumor; intermediate response, considered as a favorable stage; and poor response, considering low-responder patients. Data obtained were submitted to statistical analysis. Results The study included 243 patients. There was an association of pathologic complete response with HER-2 negative, histological grade 3, stage III, hormone receptor negative, positive lymph node, older age and more advanced tumors. However, after multivariate analysis the only predictor of pathologic complete response was the presence of negative hormone receptor. By analyzing the prognostic factors, hormone receptor negative was considered as an independent risk factor, and pathologic complete response was considered as an independent protective factor. Conclusion Hormone receptor negative is predictive of pathologic complete response and is an isolated risk factor for lower progression-free survival and overall survival. Pathologic complete response is a protective factor for these same survival analyses.
RESUMO Objetivo Definir um fator preditivo para resposta patológica completa, comparar os resultados oncológicos associados com o grau de resposta patológica, após quimioterapia neoadjuvante, e analisar a resposta patológica completa como fator prognóstico para sobrevivência global e livre de progressão de doença. Métodos Estudo retrospectivo de pacientes admitidas no Hospital Estadual Mário Covas e Hospital Anchieta, no período de 2008 a 2012, com câncer de mama localmente avançado. Foram utilizados status dos receptores hormonais, proteína HER2, grau histológico e nuclear, idade do paciente ao diagnóstico e tipo histológico do tumor. A avaliação patológica do tumor foi subdividida em resposta patológica completa, definida com ausência de tumor; resposta intermediária, considerada como um estádio favorável; e resposta ruim, considerando os pacientes pouco respondedores. As informações obtidas foram submetidas à análise estatística. Resultados Foram incluídas 243 pacientes. Verificou-se associação de resposta patológica completa entre HER-2 negativo, grau histológico 3, estadiamento III, receptor hormonal negativo, linfonodo positivo, maior idade e tumores mais avançados. Porém, após análise multivariada, o único fator preditivo de resposta patológica completa foi presença de receptor hormonal negativo. Ao analisar fatores prognósticos, receptor hormonal negativo permaneceu como variável independente de risco, e resposta patológica completa, como variável independente de proteção. Conclusão O receptor hormonal negativo é fator preditivo isolado de resposta patológica completa e fator de risco para menor sobrevida livre de doença e sobrevida global. Já a resposta patológica completa é fator protetor para estas mesmas análises de sobrevivência.
Subject(s)
Humans , Female , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/drug therapy , Carcinoma/pathology , Carcinoma/drug therapy , Receptors, Progesterone/analysis , Receptors, Estrogen/analysis , Neoadjuvant Therapy/methods , Reference Values , Time Factors , Breast Neoplasms/mortality , Breast Neoplasms/chemistry , Carcinoma/mortality , Carcinoma/chemistry , Multivariate Analysis , Predictive Value of Tests , Retrospective Studies , Risk Factors , Analysis of Variance , Treatment Outcome , Disease-Free Survival , Kaplan-Meier Estimate , Middle AgedABSTRACT
BACKGROUND: Advanced gastric cancers are usually associated with incurable conditions for which systemic treatments are indicated. Recent studies suggest that circulating cell-free plasma DNA of tumour origin (tDNA) is a promising non-invasive biomarker that can be used to predict the prognosis and monitor the efficacy of systemic treatments in patients with certain types of cancer. We conducted a pilot study to analyse the potential role of tDNA as a biomarker in patients with advanced gastric cancer. METHODS: We included 30 patients with locally advanced unresectable or metastatic gastric cancer. We obtained samples (10 mL of total blood) from each patient every 3 months and performed concomitant CT until disease progression or death. Total cell-free circulating DNA (cfDNA) samples were measured using GeneQuant RNA/DNA Calculator-Amersham Pharmacia Biotech (Biochrom) Ltd. The cfDNA was used to evaluate the ALU DNA sequences 247 and 115. The level of tDNA was calculated from the ratio of the expression of ALU DNA sequences and the concentration of total cell-free DNA. We utilized the RECIST criteria 1.1 to evaluate the tumour response. RESULTS: Patients with advanced gastric cancer had significantly higher concentrations of cfDNA compared with normal controls (p = 0.00015), which allowed us to conclude that the cfDNA in the patients originated from the tumour. We did not find any significant correlation between the level of tDNA and OS or tumour response. However, after the first cycles of chemotherapy (at 3 months), we observed that patients with lower tDNA levels had significantly longer DFS compared with those with higher levels (Cox Regression p = 0.0228). CONCLUSIONS: At 3 months after the beginning of chemotherapy, the tDNA levels are correlated with DFS in patients with advanced gastric cancer who receive systemic chemotherapy. tDNA may be a specific, non-invasive and cost effective new biomarker for these patients.
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O linfoma não Hodgkin de células T periféricas possui um subtipo denominado linfoma anaplásico de células grandes (LACG) que pode apresentar-se sob duas formas variantes que distinguem entre si na apresentação clínica e prognóstico. O artigo a seguir relata o caso de um paciente que teve o diagnóstico desta neoplasia após trauma no pé sofrido por acidente de moto. Relatos de casos publicados previamente na literatura descrevem a associação do surgimento desta entidade em partes do corpo que sofreram traumas locais de origens diversas, sugerindo uma relação direta entre eles através no influxo de células T na carcinogênese desta neoplasia linfoproliferativa.
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Purpose: To investigate oxaliplatin combined with fluorouracil-based chemoradiotherapy as preoperative treatment for locally advanced rectal cancer. Patients and methods: Seven hundred forty-seven patients with resectable, locally advanced (cT3-4 and/or cN1-2) adenocarcinoma of the mid-low rectum were randomly assigned to receive pelvic radiation (50.4 Gy in 28 daily fractions) and concomitant infused fluorouracil (225 mg/m(2)/d) either alone (arm A, n=379) or combined with oxaliplatin (60 mg/m(2) weekly × 6; arm B, n=368). Overall survival is the primary end point. A protocol-planned analysis of response to preoperative treatment is reported here. Results Grade 3 to 4 adverse events during preoperative treatment were more frequent with oxaliplatin plus fluorouracil and radiation than with radiation and fluorouracil alone (24% vs 8% of treated patients; P<.001). In arm B, 83% of the patients treated with oxaliplatin had five or more weekly administrations. Ninety-one percent, compared with 97% in the control arm, received ³ 45 Gy (P<.001). Ninety-six percent versus 95% of patients underwent surgery with similar rates of abdominoperineal resections (20% vs 18%, arm A vs arm B). The rate of pathologic complete responses was 16% in both arms (odds ratio = 0.98; 95% CI, 0.66 to 1.44; P=.904). Twenty-six percent versus 29% of patients had pathologically positive lymph nodes (arm A vs arm B; P=.447), 46% versus 44% had tumor infiltration beyond the muscularis propria (P=.701), and 7% versus 4% had positive circumferential resection margins (P=.239). Intra-abdominal metastases were found at surgery in 2.9% versus 0.5% of patients (arm A vs arm B; P=.014). Conclusion: Adding oxaliplatin to fluorouracil-based preoperative chemoradiotherapy significantly increases toxicity without affecting primary tumor response. Longer follow-up is needed to assess the impact on efficacy end points.
Radioterapia em combinação com as fluoropirimidinas é a abordagem neoadjuvante padrão do adenocarcinoma do reto médio e baixo. Na busca de tratamentos cada vez mais eficazes os autores avaliam, uma vez mais, se a adição de oxaliplatina ao tratamento convencional (radioterapia + 5-FU) poderia trazer algum benefício adicional. O estudo foi bem controlado e os pacientes, quase 750 no total, distribuídos aleatoriamente entre os dois braços.A taxa de resposta completa (16%) foi idêntica nos dois grupos. Em ambos os grupos a quase totalidade dos pacientes pode ser submetida à cirurgia, sendo que a necessidade de amputação abdominoperineal foi muito semelhante entre eles (20% versus 18% - p < 0,001).A maior diferença entre os dois braços foi no tocante à toxicidade. Efeitos colaterais graus 3 e 4 foram muito mais frequentes no grupo com oxaliplatina (24% versus 8%).Em suma, o tratamento primário padrão do adenocarcinoma do reto continua sendo a combinação de radioterapia e fluoropirimidina. A inclusão de oxaliplatina não se acompanhou de melhores resultados, o que já fora observado em estudos anteriores.
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Humans , Colonic Neoplasms/drug therapy , Colonic Neoplasms/radiotherapySubject(s)
Humans , Female , Pregnancy , Dactinomycin/therapeutic use , Trophoblastic Neoplasms/drug therapySubject(s)
Dermatofibrosarcoma , Gardner Syndrome , Hemangiosarcoma , Sarcoma , Sarcoma/epidemiologyABSTRACT
OBJECTIVE: to describe preliminary results ofcytoreductive surgery and intraperitoneal hyperthermicchemotherapy in the treatment of peritonealcarcinomatosis from a brazilian single institution.MATERIALS AND METHODS: a short cohort study wascarried out. 26 patients and 28 procedures wereperformed consecutively between March 2001 and June2005. 17 patients (65.4%) were treated for pseudomyxomaperitonei, 4 patients had mesothelioma, 2 carcinomatosisfrom colorectal cancer origin, 2 from ovary cancer and 1had peritoneal sarcomatosis. All cases were treated withclosed perfusion technique. The Completeness ofCytoreduction Score was used to classify the radicalityof the procedure and the NIH Commom Toxicity Criteriawas used to classify the complications. RESULTS: CC0and CC1 resections were achieved in 24 cases (85.7%).Grade 3 or 4 toxicity were observed in 5 cases (17.8%)and two patients died (7.1%). Severe complications weresignificant associated with the duration of surgery (morethan 10 hours). CONCLUSION: this radical treatment ofperitoneal carcinomatosis envolves high morbidity andmortality rates and must be conducted in referral centerswith multiprofessional teams and carefully selection ofpatients.
Subject(s)
Humans , Male , Female , Drug Therapy , Peritoneal Neoplasms , Carcinoma , Colorectal Neoplasms , Fever/therapyABSTRACT
OBJETIVO: Relatar os resultados do tratamento conservador do carcinoma de canal anal com radioterapia e quimioterapia do Centro de Tratamento e Pesquisa Hospital do Câncer A.C. Camargo. MÉTODO: De março de 1993 a dezembro de 2001, 47 pacientes com diagnóstico histológico de carcinoma do canal anal foram tratados de forma conservadora. A dose mediana de radioterapia na pelve e no tumor primário foi respectivamente de 45 e 55 Gy. A quimioterapia foi realizada com 5- Fluorouracil e Mitomicina-C, com doses medianas de 1000 mg/m² por quatro dias e 10 mg/m² por ciclo, respectivamente. Trinta e oito (80,8 por cento) pacientes não receberam radioterapia em região inguinal. O tempo de seguimento mediano foi de 40 meses (oito dias a 116 meses). RESULTADOS: A resposta completa foi alcançada em 40 pacientes (85,1 por cento). O controle local foi obtido em 31 (66 por cento), e a função esfincteriana foi preservada em 38 (80,9 por cento) casos. Metástases à distância foram detectadas em sete (14,9 por cento) pacientes. A sobrevida global e sobrevida livre de doença em cinco anos foram de 61,5 por cento e 50,1 por cento, respectivamente. A sobrevida global e a sobrevida livre de doença em cinco anos para os pacientes que tiveram controle local foram 77,8 por cento (p < 0,001) e 74,4 por cento (p < 0,001). A sobrevida global e livre de doença em cinco anos para os pacientes com linfonodo inguinal clinicamente tumoral foi de 70,7 por cento e 56,7 por cento, respectivamente (p = 0,0085 e p = 0,0207). Doze (25,5 por cento) pacientes necessitaram de interrupção temporária do tratamento. Cinco pacientes tiveram complicações crônicas leves. CONCLUSÃO: O tratamento realizado foi efetivo tanto para preservação do esfíncter anal quanto para controle local de doença. A presença de linfonodo inguinal clinicamente tumoral e a ausência de recidiva foram os principais fatores prognósticos para sobrevida global e sobrevida livre de doença. A taxa relativamente alta...
BACKGROUND: To report the results of conservative treatment in patients with anal canal carcinoma with radiotherapy and chemotherapy at Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo. METHODS: From March 1993 to December 2001, 47 patients with histological diagnosis of anal canal carcinoma were treated by conservative treatment. The median dose of radiotherapy at whole pelvis and at primary tumor was 45Gy and 55 Gy, respectively. The chemotherapy regimen was provided with 5-Fluorouracil and Mitomycin C, with median doses of 1000 mg/m² and 10 mg/m², respectively. Thirty-eight (80.8 percent) patients didnæt receive radiotherapy at inguinal region. The median follow-up period was 40 months (8 days-116 months). RESULTS: Complete responses were observed in 40 patients (85.1 percent). The local control was obtained in 38 patients (80.9 percent). Distant metastases were observed in 7 (14.9 percent) patients. The overall survival and colostomy and disease-free survival in 5 years were 61,5 percent and 50,1 percent, respectively. The overall survival and disease free survival in 5 years for patients that obtained local control were 77,8 percent (p < 0.001) and 74,4 percent (p < 0.001). The overall survival and disease free survival in 5 years for patients with clinical inguinal tumoral lymph nodes were 70.7 percent and 56.7 percent respectively (p = 0.0085 and p = 0.0207). Twelve (28 percent) patients required temporary interruption of treatment. Five patients had mild chronic complications. CONCLUSION: The treatment scheme of these patients was effective for anal sphincter preservation and local control of the disease. The presence of clinical tumoral inguinal lymph nodes and the local control were the main prognostic factors for overall and disease free survival. The relative elevated recurrence at inguinal region suggests the need of elective radiotherapy at this region. The acute toxicity was elevated.
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OBJETIVO: Reportar os resultados preliminares do tratamento do carcinoma do canal anal com radioterapia e quimioterapia concomitantes. MÉTODOS: De janeiro de 1992 a maio de 1998, foram tratados 24 pacientes com diagnóstico histológico de carcinoma do canal anal, sendo 18 pacientes do sexo feminino e seis do sexo masculino (3:1). A idade dos mesmos variou de 35 a 74 anos e a média foi de 59 anos. A distribuição do número de pacientes por estádio clínico foi: I - 1, II - 13, III - 9 e IV - 1. A radioterapia foi realizada com dose de 45 Gy na pelve no Acelerador Linear de 4 MV, seguida de complementação de dose no canal anal até 55 Gy através de campo direto no cobalto. A quimioterapia foi realizada com 5-FU (1.000mg/m²) em infusão contínua e mitomicina C (10mg/m²) em bólus durante os cinco primeiros e os cinco últimos dias da radioterapia. RESULTADOS: O seguimento médio foi de 34 meses. Resposta completa ao tratamento foi obtida em 23 (95,8 por cento) pacientes. Quatorze (58,3 por cento) estão vivos sem doença, três (12 por cento) vivos com doença, cinco (20,8 por cento) mortos pelo câncer e um (4,2 por cento) morreu sem câncer. Recidivas locais ocorreram em cinco (20,8 por cento) pacientes e metástase a distância em quatro (16,6 por cento). A função esfincteriana foi preservada em 18 (75 por cento) pacientes. Complicações agudas e crônicas foram observadas em 19 (79,2 por cento) e em nove (37,5 por cento) pacientes respectivamente. CONCLUSÕES: O tratamento foi efetivo em termos de controle local e preservação esfincteriana, porém com toxicidade aguda e tardia elevadas. Diminuição da dose de radioterapia em toda pelve representa uma estratégia razoável para diminuir os efeitos colaterais agudos e crônicos. Um maior número de pacientes e seguimento mais longo trarão mais informações sobre esta abordagem terapêutica.
BACKGROUND: To report our results of anal canal carcinoma treatment with concomitant radiotherapy and chemotherapy. METHOD: From January 1992 to May 1998, 24 patients with anathomo-pathologic diagnosis of anal canal carcinoma were treated. Age ranged from 35 years old to 74 years old median of 59 years old. Female and male ratio was 3:1. The number of patients per stage was: I - 1, II - 13, III - 9 and IV - 1. Radiotherapy was delivered with doses of 45 Gy at the whole pelvis with 4 MeV Linear Accelarator followed by boost to the anal canal until 55Gy through direct field at Cobalt unit. Chemotherapy consisted of 5-FU (1000 mg/m²) and Mitomycin C (10 mg/m²) during the first and last five days of radiotherapy. RESULTS: The mean follow-up period was 34 months. Complete response was observed in 23 (95,8 percent) patients. Fourteen (58,3 percent) patients are alive with no cancer, 3 (12 percent) are alive with cancer, 5 (20,8 percent) died with cancer and 1 (4,2 percent) died with no evidence of cancer. Local recurrences occurred in 5 (20,8 percent) and distant metastasis in 4 (16,6 percent). All patients with local recurrence were salvaged with abdominal perineal ressection. Sphincter function was preserved in 18 (75 percent) patients. Acute and chronic complications were observed in 19 (79,2 percent) and in 9 (37,5 percent) patients, respectively. CONCLUSIONS: The treatment was effective in terms of local control and sphincter preservation, but a with high incidence of acute and late complications. Lower dose of radiation at the whole pelvis should be a reasonable approach to improve acute and late side effects. A larger number of patients and a longer follow-up will give more information about this treatment approach.