Epirubicin, cisplatin plus ifosfamide versus standard chemotherapeutic regimens for advanced/unresectable primary thoracic sarcomas.

PURPOSE: Thoracic sarcomas are rare malignancies, with limited data for unresectable/advanced scenarios. Our goal is to provide insights of a three-drug chemotherapy regimen improving patient survival compared to standard regimens. METHODS: Retrospective cohort analysis of patients diagnosed with unresectable/advanced primary thoracic sarcoma divided between primary pulmonary sarcomas (PPS) and chest wall sarcomas (CWS) comparing chemotherapeutical regimens efficacy. Not true soft tissue sarcomas (STS) for PPS were excluded from the analysis. Univariate and multivariate analysis performed via Cox-regression model. Progression-free survival (PFS) and overall survival (OS) analysis via Kaplan-Meier with hazard ratio (HR) obtained via Mantel-Haenszel or log rank. RESULTS: 157 total cases were included, from which 50 cases were PPS and 107 cases CWS. For PPS, 4 cases were excluded from the analysis as they were not true STS. The most common histology was undifferentiated sarcomas, 63% of cases were treated with E/C/I and 37% with another regimen. The E/C/I regimen demonstrated a benefit for both OS (p = 0.020) and PFS (p = 0.010) when compared to any other regimen as well as when compared to non-platinum regimens (p = 0.016 and p = 0.001). Regarding CWS, the most common histology was synovial and undifferentiated sarcomas, 55.1% were treated with E/C/I and 44.9% treated with another regimen. The E/C/I regimen did not demonstrate a benefit for OS or PFS compared to any other regimen, neither when compared to other non-platinum regimens. However, a benefit was observed in favor of E/C/I when compared to other platinum regimens in both OS (p = 0.049) and PFS (0.015). Both analyses for PPS and CWS demonstrated a benefit in favor of cisplatin therapies compared to carboplatin in both OS and PFS. CONCLUSION: This study demonstrates that platinum therapy alone does not work, and that cisplatin must be the agent of choice and it's used in combination could increase treatment response. The E/C/I regimen demonstrated a in PPS but not for CWS, this is due do their rarity of PPS and that no standard treatment is established yet. The regimen proposed here could represent a possible new standard of treatment for PPS as long as it is validated in a prospective study.

Brain activity correlated with food preferences: a functional study comparing advanced non-small cell lung cancer patients with and without anorexia.

OBJECTIVE: The aim of this study was to examine the brain activity manifested while non-small cell lung cancer (NSCLC) patients with and without anorexia were exposed to visual food stimuli. METHODS: We included 26 treatment-naïve patients who had been recently diagnosed with advanced NSCLC. Patients with brain metastasis were excluded. The patients were classified into anorectic and non-anorectic groups. Data from functional magnetic resonance imaging based on blood oxygen level-dependent (BOLD) signals were analyzed while the patients perceived pleasant and unpleasant food pictures. The brain records were analyzed with SPM 5 using a voxelwise multiple regression analysis. RESULTS: The non-anorexic patients demonstrated BOLD activation, comprising frontal brain regions in the premotor and the prefrontal cortices, only while watching unpleasant stimuli. The anorectic patients demonstrated no activation while watching the pleasant and unpleasant food pictures. CONCLUSIONS: Anorectic patients with lung cancer present a lack of activation in the brain regions associated with food stimuli processing. These results are consistent with experiences in the clinical environment: Patients describe themselves as not experiencing sensations of hunger or having an appetite.

Influence of taste disorders on dietary behaviors in cancer patients under chemotherapy.

OBJECTIVES: To determine the relationship between energy and nutrient consumption with chemosensory changes in cancer patients under chemotherapy. METHODS: We carried out a cross-sectional study, enrolling 60 subjects. Cases were defined as patients with cancer diagnosis after their second chemotherapy cycle (n = 30), and controls were subjects without cancer (n = 30). Subjective changes of taste during treatment were assessed. Food consumption habits were obtained with a food frequency questionnaire validated for Mexican population. Five different concentrations of three basic flavors --sweet (sucrose), bitter (urea), and a novel basic taste, umami (sodium glutamate)-- were used to measure detection thresholds and recognition thresholds (RT). We determine differences between energy and nutrient consumption in cases and controls and their association with taste DT and RT. RESULTS: No demographic differences were found between groups. Cases showed higher sweet DT (6.4 vs. 4.4 micromol/ml; p = 0.03) and a higher bitter RT (100 vs. 95 micromol/ml; p = 0.04) than controls. Cases with sweet DT above the median showed significant lower daily energy (2,043 vs.1,586 kcal; p = 0.02), proteins (81.4 vs. 54 g/day; p = 0.01), carbohydrates (246 vs.192 g/day; p = 0.05), and zinc consumption (19 vs.11 mg/day; p = 0.01) compared to cases without sweet DT alteration. Cases with sweet DT and RT above median were associated with lower completion of energy requirements and consequent weight loss. There was no association between flavors DT or RT and nutrient ingestion in the control group. CONCLUSION: Changes of sweet DT and bitter RT in cancer patients under chemotherapy treatment were associated with lower energy and nutrient ingestion. Taste detection and recognition thresholds disorders could be important factors in malnutrition development on patients with cancer under chemotherapy treatment.

[The first Mexican consensus of endometrial cancer. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México]. / Primer consenso Mexicano de cancer de endometrio.

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.

[Cancer and obesity]. / Cáncer y obesidad.

The prevalence of obesity is increasing worldwide. Obesity is also a major risk factor for developing chronic diseases, including malignancies thereby increasing the risk of several types of tumors such as breast, endometrium, colon, prostate and kidney cancer. The mechanisms associated with obesity and insulin resistance, hormonal regulation and other proinflammatory factors are also involved in neoplastic processes including: cell proliferation, carcinogenesis, and angiogenesis vascularization. In addition to contributing to cancer pathogenesis obesity is associated with comorbidities and poor prognosis in cancer patients. The aim of this review is to describe some of the mechanisms involved in the association of obesity and malignancies.

[The cachexia-anorexia syndrome among oncological patients]. / Síndrome de anorexia-caquexia en el paciente oncológico.

Approximately two thirds of cancer patients at advanced stages of the disease suffer from anorexia, which leads to significant weight loss and progressive cachexia, an important factor that contributes to death. It has been observed that cancer cachexia differs from simple starvation, although the exact mechanisms associated with cancer cachexia are not well known. Several theories regarding its pathogenesis point to a complex mixture of tumor, host and treatment variables. Unfortunately, the wasting syndrome also constitutes for the patient, a progression of the cancer process, significantly affecting quality of life and social interactions. Treatable causes should be identified and treated. Knowledge of the mechanisms underlying the effects of caquexia on the patient may play a role in identifying treatment measures targetted to muscle wasting and to maintain body strength. In this article we review the main features and mechanisms of the anorexia-cachexia syndrome in patients with cancer.

Síndrome de anorexia-caquexia en el paciente oncológico / The cachexia-anorexia syndrome among oncological patients

Se estima que dos terceras partes de los pacientes con cáncer sufren anorexia o pérdida significativa de apetito, lo que conduce a pérdida acentuada de peso y a desnutrición grave (caquexia), una de las principales causas contribuyentes de la muerte. Se ha observado que el síndrome de anorexia-caquexia en cáncer difiere de la desnutrición simple, si bien aún no se conocen los mecanismos exactos que lo ocasionan. Diversas hipótesis proponen que la patogénesis es multicausal, destacándose diversas características del tumor, del huésped y variables del tratamiento. Desafortunadamente, con frecuencia la pérdida acentuada de peso representa para el paciente la progresión del proceso de la enfermedad, lo que puede tener repercusiones significativas en su calidad de vida y en sus interacciones familiares y sociales. Se lleva a cabo una revisión bibliográfica de los procesos etiológicos del síndrome, así como de las posibles medidas terapéuticas y farmacológicas.

Approximately two thirds of cancer patients at advanced stages of the disease suffer from anorexia, which leads to significant weight loss and progressive cachexia, an important factor that contributes to death. It has been observed that cancer cachexia differs from simple starvation, although the exact mechanisms associated with cancer cachexia are not well known. Several theories regarding its pathogenesis point to a complex mixture of tumor, host and treatment variables. Unfortunately, the wasting syndrome also constitutes for the patient, a progression of the cancer process, significantly affecting quality of life and social interactions. Treatable causes should be identified and treated. Knowledge of the mechanisms underlying the effects of caquexia on the patient may play a role in identifying treatment measures targetted to muscle wasting and to maintain body strength. In this article we review the main features and mechanisms of the anorexia-cachexia syndrome in patients with cancer.

Adenocarcinoma of the stomach: univariate and multivariate analysis of factors associated with survival.

Gastric cancer is the most frequent tumor of the digestive tract in Mexico. Most patients are diagnosed at advanced stages, and fatal outcome is expected. One hundred fifty patient charts were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the impact of clinicopathologic and treatment variables on survival. Most patients (75%) were at advanced stages, harboring poorly differentiated tumors. Surgery, mostly palliative, was performed on 114 patients. Chemotherapy was administered to 47 patients. On univariate analysis, significant prognostic factors were TNM stage, chemotherapy, surgical attempt, performance status, histology, and tumor site (p < 0.001). On multivariate analysis, independent prognostic factors were TNM stage, histology, tumor site, surgical attempt, and chemotherapy (p < 0.01). Median survival for patients with palliative or adjuvant chemotherapy was 11.4 and 10.4 months, respectively, compared with +/- 3 months for patients with no chemotherapy (p < 0.03). Nonsurgical patients receiving chemotherapy survived 5.4 months versus 1.1 months for those without chemotherapy. The favorable influence of chemotherapy persisted after a stratified analysis of subgroups eliminating potential biases. We identified prognostic factors for survival. Chemotherapy should be considered even for advanced-stage patients with either adjuvant or palliative attempts, because we consistently found a favorable impact on the median survival time. However, phase III prospective randomized trials are awaited.

Trasplante de médula ósea en anemia aplástica: experiencia en una institución mexicana / Allogeneic bone marrow transplantarion in severe aplastic anemia: esperience in a Mexican hospital

Durante el período de mayo de 1986 a febrero de 1991 se llevaron a cabo en el Instituto Nacional de la Nutrición Salvador Zubirán, nueve transplantes de ocho pacientes con anemia aplástica grave (AAG). La edad promedio fue de 18 años (intervalo 12-30); siete eran hombres; todos habían sido transfundidos previamente y seis se encontraban infectados al momento del transplante. El régimen de acondicionamiento fue: ciclofosfamida (CFM) en tres transplantes; CFM más radioterapia nodal total en cinco, y radioterapia nodal en el segundo transplante de un caso. La profilaxis contra la enfermedad de injerto contra huésped aguda (EICHA) fue de metotrexate (MTX) + ciclosporina (CSP) en seis transplantes; metilprednisolana + CSP en dos, y prednisona + CSP en uno (2o transplante). Todos los transplantes se llevaron a cabo en cuartos hospitalarios convencionales utilizando aislamiento reverso simple. Siete de los transplantes injertaron: alcanzaron cifras de leucocitos >1 x 10/L en un promedio de 22 días (intervalo 11-31); >0.5 x 10/L neutrófilos en 27 días (intervalo 15-42); y >50 x 10/L plaquetas en 27 días (intervalo 15-42), con una duración promedio de hospitalización de 42 días (intervalo 15-61). Hubo un caso de EICHA en los siete transplantes que sobrevivieron el período de aplasia (14 por ciento). En los seis pacientes sobrevivientes a largo plazo (uno de ellos con dos transplantes), la enfermedad de injerto contra huésped crónico (EICHC) se presentó en cuanto (67 por ciento); la evolución de esta complicación ha sido estable bajo tratamiento inmunosupresor en tres de ellos y fatal en uno. Al momento del reporte cinco de ocho pacientes se encuentran vivos (62.5 por ciento) y tres han fallecido (dos por infección en el período de aplasia y uno por EICHC a los 14 meses post-transplante). Estos resultados son similare a lo reportado por otros grupos y demuestran que el TMO alogeneico en AAG es un tratamiento factible en nuestro medio

Utilidade de la valoración clínica, pruebas de función hepática ACE y hepatogamagrama en la detección de metástasis hepáticas / Utility of clinic evaluation, liver function, CEA and hepatogammagram in the detection in liver metastasis

Se investigó la sensibilidad, especificidad, valor predictivo postivio y negativo de varias pruebas de función hepática, del hepatogamagrama y de la determinación de antígeno carcinoembrionario en la detección de metástasis hepáticas en pacientes con cáncer gástrico y se comparó sus resultados con los obtenidos por la volaración clínica del hígado. El valor predictivo negativo, esto es la capacidad de que una prueba negativa descarte la presencia de metástasis hepáticas fué muy similar para todas las pruebas estudiadas. El valor predictivo positivo, esto es, la capacidad de que una prueba positiva indique la presencia de metástasis hepáticas varió entre 40 y 86%, siendo notoriamente alto para la presencia de hepatomegalia determinada clínicamente (86%) y de 100% para la combinación hepatomegalia fosfatasa alcalina elevada. El hepatogamagrama y el ACE no mostraron gran utilidad como pruebas aisladas. El enfoque más racional en la investigación de metástasis hepáticas parece ser el realizar una exploración cuidadosa en primer lugar, seguida de la determinación de fosfatasa alcalina, reservando el hepatogamagrama para los pacientes que presenten alguna alteración en estas y no realizar gamagramas de "rutina" en la evaluación preoperatoria de pacientes con neoplasias de tubo digestivo