RESUMEN
Introduction: energy metabolism in cancer patients is influenced by different factors. However, the effect of antineoplastic treatment is not clear, especially in women. Objective: to evaluate resting energy expenditure (REE) by indirect calorimetry (IC) before (T0) and after (T1) first cycle period of antineoplastic therapy: radiotherapy (RT), chemotherapy (CT), and concomitant chemoradiation therapy (CRT), quality of life (QoL) and accuracy of REE were compared with international guidelines recommendations per kilogram (European Society for Clinical Nutrition and Metabolism [ESPEN]). Methods: an observational, longitudinal study was conducted in women with gynecological cancer diagnosis undergoing antineoplastic treatment: RT, CT and CRT. Weight loss, actual body weight and height were measured. REE was evaluated in T0-T1 and compared with ESPEN recommendations. Kruskal-Wallis test and Bland-Alman analysis were used to determine the agreement (± 10 % of energy predicted) of REE adjusted by physical activity (TEE) compared with ESPEN recommendations, respectively. Results: fifty-four women with cancer were included: 31.5 % (n = 17) for RT group, 31.5 % (n = 17) for CT group and 37 % (n = 20) for CRT group. REE showed statistical differences between T0 and T1 in the total population (p = 0.018), but these were not associated with anticancer therapy groups (p > 0.05). QoL had no significant changes after treatment (p > 0.05). Accuracy of 25 and 30 kcal/kg compared to TEE was less than 30 %. Conclusion: REE in women with gynecological cancer decreased after antineoplastic treatments but this is not associated with a particular antineoplastic therapy. It is needed to develop research to determine the accuracy of ESPEN recommendations with TEE estimated by IC and clinical factors in women with cancer. (AU)
Antecedentes: el metabolismo energético en pacientes con cáncer está influenciado por diferentes factores. Sin embargo, el efecto sobre el tratamiento antineoplásico no es claro, especialmente en mujeres. Objetivo: evaluar el gasto energético en reposo (GER) mediante calorimetría indirecta (CI) antes (T0) y después (T1) del primer ciclo del tratamiento antineoplásico: radioterapia (RT), quimioterapia (QT) y quimio-radioterapia concomitante (QRT), calidad de vida (CdV) y precisión del GER con las con las recomendaciones internacionales por kilogramo de peso (European Society for Clinical Nutrition and Metabolism [ESPEN]). Métodos: se realizó un estudio longitudinal, observacional en mujeres con diagnóstico de cáncer ginecológico en tratamiento antineoplásico. Se evaluó el GER en T0 y T1. Se midieron la pérdida de peso, el peso corporal y la talla. Se usaron las pruebas de Kruskal-Wallis y el análisis Bland-Altman para determinar la concordancia (± 10 % de GER) del REE ajustado por actividad física (TEE) en comparación con las recomendaciones de ESPEN. Resultados: se incluyeron 54 mujeres con cáncer; 31,5 % (n = 17) en el grupo RT, 31,5 % (n = 17) en el de QT y 37 % (n = 20) en el de QRT. GER mostró diferencias estadísticas entre T0 y T1 en la población total (p = 0,018); no se asoció con la terapia contra el cáncer (p > 0,05). La calidad de vida no tuvo cambios significativos después del tratamiento (p > 0,05). La precisión de 25 y 30 kcal/kg en comparación con TEE fue inferior al 30 %. Conclusión: el GER en mujeres con cáncer ginecológico disminuyó después del tratamiento antineoplásico, pero no se asoció a una terapia antineoplásica en particular. Es fundamental desarrollar más investigaciones que compare las recomendaciones de ESPEN y con los valores de la CI comparando más factores clínicos para ofrecer una intervención nutricional precisa (AU)
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Metabolismo Energético , Antineoplásicos , Estudios de Cohortes , Estudios Prospectivos , Neoplasias de los Genitales Femeninos/tratamiento farmacológico , Neoplasias de los Genitales Femeninos/radioterapia , Calidad de VidaRESUMEN
Mexico has seen an increase in cancer prevalence in its entire population as well as particular age ranges, predominantly the older segment. The most frequently reported pelvic cancers in Mexico are cervical, endometrial, bladder, prostate, rectum, and anal canal. Approximately 80% of the population diagnosed with pelvic cancers present with locally advanced tumors and require concomitant chemoradiotherapy, sequential chemoradiotherapy, or radiotherapy alone. The toxicity of any of these treatment modalities may be manifested as intestinal injury, a significant problem that can compromise the response to treatment, the patient's nutritional state, quality of life, and survival. In this article, we will approach key aspects in nutrition as well as the epidemiological characteristics and toxicities in patients affected by these pelvic tumors.
Asunto(s)
Enfermedades Gastrointestinales/etiología , Neoplasias Pélvicas/terapia , Calidad de Vida , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Enfermedades Gastrointestinales/fisiopatología , Humanos , México/epidemiología , Neoplasias Pélvicas/epidemiología , Neoplasias Pélvicas/patología , Prevalencia , Traumatismos por Radiación/epidemiología , Traumatismos por Radiación/fisiopatologíaRESUMEN
INTRODUCTION: Worldwide, most cervical cancer (CC) patients require the use of drug therapy either adjuvant, concurrent with radiation or palliative. AREAS COVERED: This review briefly discusses the current achievements in treating CC with an emphasis in emerging agents. EXPERT OPINION: Concurrent cisplatin with radiation and lately, gemcitabine-cisplatin chemoradiation has resulted in small but significant improvements in the treatment of locally advanced and high-risk early-stage patients. So far, only antiangiogenic therapy with bevacizumab added to cisplatin chemoradiation has demonstrated safety and encouraging results in a Phase II study. In advanced disease, cisplatin doublets yield median survival rates not exceeding 14 months. The first Phase III study of bevacizumab, added to standard chemotherapy cisplatin- or non-cisplatin-containing doublet, has shown significant increase in both overall survival and progression-free survival. Further studies are needed before bevacizumab plus chemotherapy can be considered the standard of care for advanced disease. The characterization of the mutational landscape of CC and developments of novel targeted therapies may result in more effective and individualized treatments for CC. The potential efficacy of knocking down the key alterations in CC, E6 and E7 human papilloma virus oncoproteins must not be overlooked.
Asunto(s)
Antineoplásicos/uso terapéutico , Terapia Molecular Dirigida , Neoplasias del Cuello Uterino/tratamiento farmacológico , Animales , Antineoplásicos/administración & dosificación , Quimioterapia Adyuvante/métodos , Supervivencia sin Enfermedad , Diseño de Fármacos , Femenino , Humanos , Medicina de Precisión , Sobrevida , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapiaRESUMEN
Cervical cancer is the third most commonly diagnosed cancer worldwide and the fourth leading cause of cancer death in women. Major advances but still insufficient achievements in the treatment of locally advanced and high-risk early stage patients have occurred in the last decade with the incorporation of concurrent cisplatin with radiation and, lately, gemcitabine added to cisplatin chemoradiation. Despite a number of clinical studies incorporating molecular-targeted therapy as radiosensitizers being in progress, so far, only antiangiogenic therapy with bevacizumab added to cisplatin chemoradiation has demonstrated safety and shown encouraging results in a Phase II study. In advanced disease, cisplatin doublets do not have a great impact on the natural history of the disease with median survival rates not exceeding 13 months. The first Phase III study of bevacizumab, added to cisplatin or a non-cisplatin-containing doublet, showed significant increase in both overall survival and progression-free survival. Further studies are needed before bevacizumab plus chemotherapy can be considered the standard of care for advanced disease. Characterization of the mutational landscape of cervical cancer has already been initiated, indicating that, for now, few of these targetable alterations match with available agents. Progress in both the mutational landscape knowledge and developments of novel targeted therapies may result in more effective and individualized treatments for cervical cancer. The potential efficacy of knocking down the key alterations in cervical cancer - E6 and E7 human papillomavirus oncoproteins - must not be overlooked.
RESUMEN
PURPOSE: This study aimed to determine the patterns of follow-up visits for cervix cancer in a national cancer center in Mexico. MATERIALS AND METHODS: The National Cancer Institute of Mexico is cancer center with 119 beds that mostly cares for an underserved and socially disadvantaged population. The medical records of cases of cervical cancer that had at least one year of clinical follow-up after being in complete response at the end of primary treatment were analyzed. We recorded the numbers of total and yearly follow-up visits and these were compared with the number of follow-up visits recommended by the National Comprehensive Cancer Network 2013, version 2 for cervical cancer. RESULTS: Between March and June 2007, the medical records of 96 consecutive patients were reviewed. Twenty (21%) of these met inclusion criteria and were selected. In the first year the median number of visits was 11 (4-20). In the ensuing years, 2nd, 3rd, 4th and 5th, the number of analyzed patients remaining in follow-up decreased to 17, 14, 13 and 9 respectively. There were 462 follow-up visits to primary treating services (Gynecology Oncology, Radiation Oncology and Medical Oncology) as compared to 220 suggested by the NCCN guidelines (X2 test p<0.0001). There were 150 additional visits to other services. CONCLUSIONS: Our results suggest that in our institution there is an overuse of oncological services by cervical cancer patients once treatment is completed.
Asunto(s)
Instituciones Oncológicas/normas , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Monitoreo Fisiológico/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Incidencia , México , Persona de Mediana Edad , Monitoreo Fisiológico/normas , Cooperación del Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Derivación y Consulta/normas , Sistema de Registros , Estudios Retrospectivos , Factores de TiempoRESUMEN
AIMS: The objectives of this report are, first, to describe the clinical behavior of cases of carcinoma metastatic to the uterine cervix treated at our institution in order to carry out a systematic review to establish the behavioral patterns of the most frequent metastases to the cervix and, second, to generate guidelines for their diagnosis and treatment. METHODS: At the National Institute of Cancer of Mexico (INCan), we performed a review of the clinical files with a diagnosis of malignant neoplasm metastatic to the uterine cervix between 1990 and 2009. For a systematic review, we conducted a PubMed search between the years 1970 and 2009 of case reports and series of cases of patients with metastatic gastric, breast, ovarian and colorectal cancer. We analyzed each report individually and extracted the patients' clinical data from our cases and reports, including the primary tumor, cervical metastases and survival rates. RESULTS: There were 10 cases of tumors metastatic to the uterine cervix. Metastasis was documented in one-half of the patients during follow up, with two of these cases having the cervix as the only site. We included the following reports in the systematic review: 13 reports of gastric-associated cancer, 30 related to breast cancer, nine with ovarian-associated cancer and 10 related to colorectal cancer. CONCLUSIONS: Metastatic cervical activity is an infrequent event. The prognosis of survival is poor in the presence of gastric or ovarian cancer and cervical metastases.
Asunto(s)
Adenocarcinoma/secundario , Neoplasias del Cuello Uterino/secundario , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidad , Adulto , Anciano , Neoplasias de la Mama/patología , Neoplasias Colorrectales/patología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/patología , Estudios Retrospectivos , Neoplasias Gástricas/patología , Análisis de Supervivencia , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/mortalidadRESUMEN
INTRODUCTION: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically. CONCLUSIONS: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.
Asunto(s)
Neoplasias Ováricas , Cuidados Posteriores , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Terapia Combinada , Resistencia a Antineoplásicos , Diagnóstico Precoz , Femenino , Genes Relacionados con las Neoplasias , Humanos , Laparoscopía , Escisión del Ganglio Linfático , Terapia Neoadyuvante , Estadificación de Neoplasias/normas , Síndromes Neoplásicos Hereditarios/genética , Epiplón/cirugía , Compuestos Organoplatinos/administración & dosificación , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/genética , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Ovariectomía/métodos , Cuidados Paliativos , Calidad de Vida , Radioterapia Adyuvante , Terapia Recuperativa , Taxoides/administración & dosificaciónRESUMEN
INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.
Asunto(s)
Carcinoma , Neoplasias Endometriales , Antineoplásicos/uso terapéutico , Carcinoma/diagnóstico , Carcinoma/epidemiología , Carcinoma/patología , Carcinoma/terapia , Quimioterapia Adyuvante , Terapia Combinada , Diagnóstico por Imagen , Neoplasias Endometriales/diagnóstico , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/patología , Neoplasias Endometriales/terapia , Antagonistas de Estrógenos/efectos adversos , Terapia de Reemplazo de Estrógeno/efectos adversos , Estrógenos/efectos adversos , Medicina Basada en la Evidencia , Femenino , Humanos , Histerectomía/métodos , Laparoscopía , Escisión del Ganglio Linfático , Tamizaje Masivo , México , Estadificación de Neoplasias/métodos , Radioterapia Adyuvante , Factores de Riesgo , Terapia Recuperativa , Tamoxifeno/efectos adversosRESUMEN
BACKGROUND: Worldwide, lung cancer is the leading cause of death due to cancer. Non small cell lung cancer (NSCLC) constitutes 70% of cases. Clinical course and survival differ depending of age at diagnosis OBJECTIVE: Determine the epidemiology and survival rate of NSCLC associated with age of onset of the disease. PATIENTS AND METHODS: We carried out a retrospective study between January 1993-January 2007 and included patients with confirmed NSCLC. Three groups were included: group 1: < 49 yrs, group 2: 50-69 yrs, group 3: > 70 yrs. Age, ECOG, comorbidity, family background, smoking, clinical stage, histology, metastatic sites, treatment and overall survival were analyzed. Statistical analysis was done using descriptive methods, Kruskall-Wallis, ANOVA, chi-2, Student's T-test and Kaplan-Meier tests. RESULTS: 183 patients, 23 (12.6%) < 49 years, 108 (59%) from group 2 and 52 cases (28.4%) > 70 yrs. Median age was: 43.2, 61.2 and 75.6 yrs (p < 0.05), respectively. The majority were women (56.4%) in group 1, p= 0.036. Comorbidity: 17.4%, 55.5% and 76.9%, p= 0.000. 52.5% smokers, 87% and 62.9%, p= 0.009. Symptoms included: cough (38.9%, 25%, 43.6%), thoracic pain (33.3%, 41.3%, 30.8%) and dyspnea (33.3%, 16.3%, 38.5%), p > 0.05. Adenocarcinoma was the most frequent type (78.2%, 63.9% and 54.5%). Stage IIIB was observed among 17.4% of patients studied, 23.1%, 23.1% and stage IV 52.2%, 44.4%, 50%, respectively. Median overall survival in stages I and II was 21 months, 18 months in stage IIIA (p > 0.05). Stages IIIB-IV the median overall survival was 11, 8.5 and 4 months respectively (p= 0.034). CONCLUSIONS: Younger patients displayed a more aggressive disease course yet also displayed a higher survival rate. Patients over 70 years have a higher incidence of comorbidity and ECOG 2.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Antecedentes: El cáncer pulmonar es la principal causa de muerte por cáncer en el mundo; el de células no pequeñas (NSCLC por sus siglas en inglés) representa 70% de los casos. El comportamiento clínico y la supervivencia pueden variar en función de la edad. Objetivo: Determinar el comportamiento epidemiológico y supervivencia global en NSCLC en relación con la edad. Métodos: Estudio retrospectivo del periodo de enero de 1993 a diciembre de 2007, en pacientes con NSCLC confirmado. Se designaron tres grupos: 1, edad menor o igual a 49 años; 2, 50 a 69 años de edad; 3, 70 años o más. Analizamos edad, ECOG (escala para medir calidad de vida del Eastern Cooperative Oncologic Group), comorbilidad, historia familiar, tabaquismo, etapa clínica, sitios metastásicos, tipo histológico, tratamiento, supervivencia global. Para el análisis se emplearon métodos descriptivos y las pruebas de Kruskal-Wallis, ANOVA, χ2, t de Student y Kaplan-Meier. Resultados: Se estudiaron 183 pacientes, 23 (12.6%) del grupo 1, 108 (59%) del grupo 2 y 52 (28.4%) del grupo 3. Mediana de edad: 43.2, 61.2 y 75.6 años, respectivamente (p<0.05). Las mujeres predominaron en el grupo 1 (p=0.036). Comorbilidad: 17.4, 55.5 y 76.9% (p=0.000). Tabaquismo positivo: 52.5, 87 y 69.2% (p=0.009). Síntomas: tos (38.9, 25 y 43.6%), dolor torácico (33.3, 41.3, 30.8%) y disnea (33.3, 16.3, 38.5%), p>0.05. El adenocarcinoma fue el tipo más frecuente (78.2, 63.9 y 54.5%). Etapa IIIB (17.4, 23.1, 23.1%) y etapa IV (52.2, 44.4, 50%). Supervivencia global en etapas I y II: 21 meses versus 18 meses en la etapa IIIA (p>0.05); en las etapas IIIB a IV fue 11, 8.5 y 4 meses, respectivamente (p=0.034). Conclusiones: Los jóvenes cursan con enfermedad más agresiva y los mayores de 70 años tienen mayor frecuencia de comorbilidad y ECOG 2. La supervivencia es mayor entre los jóvenes.
BACKGROUND: Worldwide, lung cancer is the leading cause of death due to cancer. Non small cell lung cancer (NSCLC) constitutes 70% of cases. Clinical course and survival differ depending of age at diagnosis OBJECTIVE: Determine the epidemiology and survival rate of NSCLC associated with age of onset of the disease. PATIENTS AND METHODS: We carried out a retrospective study between January 1993-January 2007 and included patients with confirmed NSCLC. Three groups were included: group 1: < 49 yrs, group 2: 50-69 yrs, group 3: > 70 yrs. Age, ECOG, comorbidity, family background, smoking, clinical stage, histology, metastatic sites, treatment and overall survival were analyzed. Statistical analysis was done using descriptive methods, Kruskall-Wallis, ANOVA, chi-2, Student's T-test and Kaplan-Meier tests. RESULTS: 183 patients, 23 (12.6%) < 49 years, 108 (59%) from group 2 and 52 cases (28.4%) > 70 yrs. Median age was: 43.2, 61.2 and 75.6 yrs (p < 0.05), respectively. The majority were women (56.4%) in group 1, p= 0.036. Comorbidity: 17.4%, 55.5% and 76.9%, p= 0.000. 52.5% smokers, 87% and 62.9%, p= 0.009. Symptoms included: cough (38.9%, 25%, 43.6%), thoracic pain (33.3%, 41.3%, 30.8%) and dyspnea (33.3%, 16.3%, 38.5%), p > 0.05. Adenocarcinoma was the most frequent type (78.2%, 63.9% and 54.5%). Stage IIIB was observed among 17.4% of patients studied, 23.1%, 23.1% and stage IV 52.2%, 44.4%, 50%, respectively. Median overall survival in stages I and II was 21 months, 18 months in stage IIIA (p > 0.05). Stages IIIB-IV the median overall survival was 11, 8.5 and 4 months respectively (p= 0.034). CONCLUSIONS: Younger patients displayed a more aggressive disease course yet also displayed a higher survival rate. Patients over 70 years have a higher incidence of comorbidity and ECOG 2.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Factores de Edad , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Cancer is the second cause of death in Mexico, most cases are detected at advanced stages and the use of chemotherapy is frequent. At present, more than 300 types of complementary and/or alternative medicine (CAM) treatments are known that offer different therapeutic objectives. Many patients use this type of treatments. OBJECTIVE: To determine the characteristics of the patients that use CAM, to identify the aim of these treatments, the source of information and the potential benefits obtained by the patient. PATIENTS AND METHODS: A questionnaire was applied from February 20 to March 5, 2004 to non-selected patients with cancer in private consultation to determine age, sex, education level, work, use of CAM, type and number of used therapies, potential benefits and monthly cost. Two groups were formed, A for users and B for non-users of CAM. Results between groups were compared and the mentioned variables were correlated with the use of alternative medicine. RESULTS: Group A included 37 patients and group B included 38, with no difference regarding age, education level, work and oncological diagnosis, p > 0.05; a significant trend was found as regards the feminine sex, p = 0.07, neoplasm different from breast cancer, p = 0.08 and evident association with neoplasm advanced stages, p = 0.02. Most patients used between 1 and 3 types of therapies, 97.2%. The most common types of therapies were nutritional and spiritual, 54% and 48.6%, respectively. The source was the patient's family in 56.4% and the physician in 24.3%. Complementary and alternative therapy was considered a success in 57.1%; most of the users mentioned benefits (78.6%) deemed as tranquility (46.4%) or improvement of the physical condition (46.4%). The average monthly cost was $ 345.5 dollars, with a range of $ 13.6 to $ 2,545.5 dollars. CONCLUSIONS: The use of complementary and/or alternative therapy is frequent among young women with advanced cancer and high level of education. The family participates in the decision of using these methods; most users noticed a benefit in their general condition and reported tranquility; these patients may be prone to higher incidence of depression and anxiety. The effectiveness and safety of this type of treatments remain to be determined, as well as the possible interactions with conventional therapy.
Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Neoplasias/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
No disponible
Background. Cancer is the second cause of deathin Mexico, most cases are detected at advancedstages and the use of chemotherapy is frequent. Atpresent, more than 300 types of complementaryand/or alternative medicine (CAM) treatments areknown that offer different therapeutic objectives.Many patients use this type of treatments.Objective. To determine the characteristics of thepatients that use CAM, to identify the aim of thesetreatments, the source of information and the potentialbenefits obtained by the patient.Patients and methods. A questionnaire was appliedfrom February 20 to March 5, 2004 to non-selectedpatients with cancer in private consultation to determineage, sex, education level, work, use of CAM,type and number of used therapies, potential benefitsand monthly cost. Two groups were formed, Afor users and B for non-users of CAM. Results betweengroups were compared and the mentionedvariables were correlated with the use of alternativemedicine.Results. Group A included 37 patients and group Bincluded 38, with no difference regarding age, educationlevel, work and oncological diagnosis, p >0.05; a significant trend was found as regards thefeminine sex, p = 0.07, neoplasm different frombreast cancer, p = 0.08 and evident association withneoplasm advanced stages, p = 0.02. Most patientsused between 1 and 3 types of therapies, 97.2%. Themost common types of therapies were nutritionaland spiritual, 54% and 48.6%, respectively. Thesource was the patient's family in 56.4% and thephysician in 24.3%. Complementary and alternativetherapy was considered a success in 57.1%; most ofthe users mentioned benefits (78.6%) deemed astranquility (46.4%) or improvement of the physicalcondition (46.4%). The average monthly cost was $345.5 dollars, with a range of $ 13.6 to $ 2,545.5 dollars.Conclusions. The use of complementary and/or alternativetherapy is frequent among young womenwith advanced cancer and high level of education.The family participates in the decision of usingthese methods; most users noticed a benefit in theirgeneral condition and reported tranquility; thesepatients may be prone to higher incidence of depressionand anxiety. The effectiveness and safetyof this type of treatments remain to be determined,as well as the possible interactions with conventionaltherapy
Asunto(s)
Humanos , Terapias Complementarias/métodos , Neoplasias/terapia , Ansiedad/epidemiología , Depresión/epidemiología , Interacciones de Hierba-Droga , México , Encuestas EpidemiológicasRESUMEN
The HER2 oncogene encodes a transmembrane protein partially homologous to epidermal growth factor receptor. This oncogene has been studied mainly in breast cancer where it has prognostic, predictive and therapeutic target value. The expression of HER2 in epithelial ovarian cancer has been less studied. HER2 expression can be determined through IHC, FISH, CISH and ELISA among other tests, with reported positivity frequencies of overexpression varying from 1.8% to 76%. In some studies HER2 overexpression has been associated with advanced stages, poorly differentiated tumors, resistance to chemotherapy and shortened survival. Although trastuzumab is able to produce a low response rate as a single agent in pretreated ovarian cancer patients with overexpression of HER2, its usefulness is limited due to the low frequency of strong expression. To date there is not enough bases for assessment and HER2-based therapies in epithelial ovarian cancer.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Carcinoma/metabolismo , Neoplasias Ováricas/metabolismo , Receptor ErbB-2/metabolismo , Animales , Biomarcadores de Tumor/análisis , Neoplasias de la Mama/metabolismo , Carcinoma/química , Carcinoma/diagnóstico , Carcinoma/terapia , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Neoplasias Ováricas/química , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/terapia , Valor Predictivo de las Pruebas , Pronóstico , Receptor ErbB-2/análisis , Factores de Riesgo , Regulación hacia ArribaRESUMEN
Drug-metabolizing enzymes are responsible for the activation or detoxification of cytotoxic drugs. Allelic variants are present with a variable frequency in different populations around the world and have an important role in the therapeutic index of such drugs. It is known that polymorphisms in thiopurine methyltransferase and dihydropyrimidine dehydrogenase have been associated with altered drug metabolism and increased risk of severe toxicity from 6-mercaptopurine and 5-fluorouracil, respectively. Additionally, a variant number of dinucleotide-repeat sequences in the promotor for uridine 5'-diphosphate glucuronosyltransferase 1A1 influences the glucuronidation of SN-38, the active metabolite of irinotecan, which is associated with severe toxicity, including diarrhea and neutropenia. In the same way, polymorphisms in thymidylate synthase have been associated with pyrimidine-associated toxicity and also with response to chemotherapy. The examples shown in this review demonstrate the usefulness of pre-screening patients for well-characterized polymorphism to identify the best-tolerated and most-effective treatment.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Farmacogenética , Antineoplásicos/efectos adversos , Antineoplásicos/metabolismo , Citidina Desaminasa/genética , Citidina Desaminasa/metabolismo , Sistema Enzimático del Citocromo P-450/genética , Sistema Enzimático del Citocromo P-450/metabolismo , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/metabolismo , Dihidrouracilo Deshidrogenasa (NADP)/genética , Dihidrouracilo Deshidrogenasa (NADP)/metabolismo , Endonucleasas/genética , Endonucleasas/metabolismo , Glucuronosiltransferasa/genética , Glucuronosiltransferasa/metabolismo , Humanos , Metilenotetrahidrofolato Deshidrogenasa (NADP)/genética , Metiltransferasas/genética , Metiltransferasas/metabolismo , Neoplasias/genética , Polimorfismo Genético/genética , Polimorfismo de Nucleótido Simple/genética , Polimorfismo de Nucleótido Simple/fisiología , Timidilato Sintasa/genética , Timidilato Sintasa/metabolismo , Resultado del TratamientoRESUMEN
Antecedentes: en 1997, en México se registraron más de 87 mil casos nuevos de cáncer. Las neoplasias más frecuentes fueron: cuello uterino, mama, próstata, ganglios linfáticos y estómago. La angiogénesis es un factor determinante en el crecimiento y proliferación neoplásica, así como para conferir la capacidad metastásica tumoral. La talidomida, que fue vinculada con teratogénesis en los años 50, tiene capacidad de inhibir la angiogénesis, inducir la apoptosis y tiene efectos inmunomoduladores. Objetivo: evaluar la tolerancia y seguridad de la talidomida como agente antiangiogénico, en pacientes con neoplasia avanzada. Pacientes y método: mayores de 18 años, de uno y otro sexos, con neoplasia metastásica multitratada, con resistencia o progresión a terapia convencional, que recibieron talidomida como monoterapia al menos durante un mes. Este fármaco fue administrado a dosis de 100 mg/día, vía oral con ascenso a 200 mg la primera semana y luego cada 15 días hasta 800 mg. Se evaluaron edad, sexo, neoplasia y estirpe histológica, etapa clínica, dosis utilizada, tiempo de uso, efectos secundarios y tiempo de seguimiento. Resultados: 13 pacientes, 3 mujeres y 10 hombres, edad promedio 57.8 + 14.6 años margen de 31 a 76. Correspondían a: 10 tumores sólidos y 3 hematológicos. Se incluyeron 3 hepatocarcinoma, 2 mieloma múltiple, 2 melanoma, 2 pulmón y uno de mama, colon, recto y linfoma no Hodgkin. De las 10 sólidas, 7 en EC IV y 3 EC III; en las hematológicas, 2 etapa II de Durie-Salmon y el linfoma en etapa IV. Ocho pacientes tenían evidencia de actividad metastásica, 61.5 por ciento. Cinco pacientes habían recibido 1 línea de quimioterapia, otros 6 pacientes 2 y 3 más de 3 esquemas. Dosis de talidomida: 4 pacientes emplearon 100 mg/día; 7, 200 mg; 1, 300 mg y 1, 400 mg/día, sólo en 2 pacientes se intentó escalar la dosis. El tiempo promedio de uso 3.15 + 3.8 meses, margen de 1 a 12, mediana 1. Diez pacientes tuvieron efectos secundarios; somnolencia, 8; 6 neuropatía periférica sensitiva, 1 erupción cutánea. Se observaron casos con estabilidad de la enfermedad durante al menos dos meses y ocho casos con progresión. La talidomida fue adecuadamente tolerada a la dosis de 100 a 200 mg/día, su uso se asocia con somnolencia y neuropatía periférica sensitiva de bajo grado, los efectos secundarios se incrementan al elevar la dosis. Se requiere de más estudios para evaluar su efecto antitumoral, dosis óptima y su asociación con quimioterapia o agentes inmunomoduladores
Asunto(s)
Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Neoplasias Primarias Múltiples , Neovascularización Patológica/fisiopatología , Talidomida , Evaluación de Medicamentos/métodosRESUMEN
Un problema común en la gastroenterología y en otras áreas de la medicina interna es la ascitis. Esta entidad puede ser la manifestación de diversas patologías. Por esta razón, es necesario conocer el abordaje inicial de estos pacientes, así como sus complicaciones y tratamiento
Asunto(s)
Humanos , Ascitis/clasificación , Ascitis/complicaciones , Ascitis/diagnóstico , Ascitis/terapia , Líquido Ascítico/citología , Líquido Ascítico/complicaciones , Líquido Ascítico/etiología , Líquido Ascítico/fisiopatología , Líquido Ascítico/química , Líquido Ascítico/terapia , Peritonitis/etiologíaRESUMEN
Introducción. Los pacientes con cáncer requieren a menudo cuidados intensivos: la falla respiratoria es la causa principal de ingreso y la mortalidad es alta. Objetivo. Determinar las causas de ingreso a la UCI de pacientes con enfermedades oncológicas. Pacientes y métodos. Estudiamos los pacientes que ingresaron a la UCI del hospital ABC, de enero 1993 a junio de 1997 con el diagnóstico de neoplasias en diferente estadio clínico. Se registraron las variables demográficas como edad, tipo de tumor, estadio clínico, metástasis (sitio y número), escala de Karnofsky, diagnóstico de ingreso a la UCI, días de estancia, escala de APACHE II y causa de muerte. Resultados. Se incluyeron 48 pacientes (edad media 56.8 ñ 15.4 años, escala de Karnofsky 61.2 ñ 12.8 puntos y APACHE II 22.5 ñ 6.84 puntos); nueve tuvieron neoplasias hematológicas y 39 tumores sólidos, 27 se clasificaron en estadio IV, 22 ingresaron a la UCI por insuficiencia respiratoria (20 se ventilaron mecánicamente), 28 murieron en la UCI y 11 murieron varios meses después de haberse egresado del hospital. La estancia en la UCI fue de 5.04 ñ 5.12 días. No observamos relación entre el pronóstico y la edad, sexo, tipo de tumor puntaje elevado en la escala APACHE II y la causa más importante de ingreso fue falla respiratoria
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estado de Ejecución de Karnofsky , Estadificación de Neoplasias/mortalidad , Estadificación de Neoplasias/estadística & datos numéricos , Neoplasias/mortalidad , Insuficiencia Respiratoria/etiología , Servicio de Oncología en Hospital/estadística & datos numéricos , Sobrevivientes/estadística & datos numéricosRESUMEN
El síndrome de Miller-Fisher se integra por la tríada arreflexia, ataxia y oftalmoplegía, el cual queda englobado entre las enfermedades desmielinizantes. En sus fases iniciales afecta fundamentalmente a los nervios craneales, por lo que originalmente se consideró como una variante del síndrome de Guillain.Barré. A partir de 1956, se ha considerado como una entidad independiente debido a que involucra el sistema nervioso central. Se presenta el caso de un hombre en la octava década de la vida que ingresó a nuestro Hospital por presentar súbitamente ptosis palpebral bilateral, disartria y disfagia a sólidos. El paciente presentó una evolución rápidamente progresiva manifestada por limitación de los movimientos de las cuatro extremidades y por dificultad respiratoria que hizo necesaria la intubación ortotraqueal y asistencia mecánica ventilatoria. Dada la rapidez de la evolución, se decidió utilizar plasmaféresis; esta medida mejoró el estado respiratorio del paciente, pero no modificó sus condiciones neurológicas. Se presenta una revisión de la literatura relacionada con esta entidad