Capecitabine/cisplatin combined with concurrent intensity-modulated radiation therapy: a feasible therapeutic strategy for anal squamous cell carcinoma.

PURPOSE: To evaluate the efficacy and safety of capecitabine/cisplatin (XP) combined with intensity-modulated radiation therapy (IMRT) in patients with non-metastatic anal squamous cell carcinoma (ASCC). METHOD AND MATERIALS: All patients with ASCC who received radical concurrent chemoradiotherapy in the past 8 years were screened. Patients who received XP or mitomycin/5-fluorouracil (MF) were selected and analyzed retrospectively. RESULTS: ASCC is an uncommon cancer, there were 36 patients were included in our study. The XP group and MF group included 18 patients each. The clinical complete response (cCR) rates in the XP group and the MF group were 94.4% and 88.9%, respectively (P = 1). The 2-year local control (LC), disease-free survival (DFS), and colostomy-free survival (CFS) rates were higher in the XP group than in the MF group (100% vs 93.3%, P = 0.32). Hematologic toxicities, especially grade ≥ 3 leukopenia (11.1% vs 44.4%, P = 0.06) and neutropenia (5.6% vs 61.1%, P = 0.001), were lower in the XP group than MF group. As a result of fewer side effects, fewer patients in the XP group demanded the dose reduction of chemotherapy (11.1% vs 50%, P = 0.03) and radiation interruption (55.6% vs 77.8%, P = 0.289). Delayed radiotherapy was shorter in the XP group (2.5 vs 6.5 days, P = 0.042) than in the MF group. CONCLUSION: The XP regimen was as effective as the MF regimen in non-metastatic ASCC. Compared with the standard MF regimen, XP combined with IMRT showed higher treatment completion and lower toxicities. It could be considered a feasible alternative for patients with non-metastatic ASCC.

Sarcoma de Kaposi anoperineal: uma rara apresentação / Perineal Kaposi's Sarcoma: a rare presentation

O sarcoma de Kaposi é uma neoplasia maligna associada à infecção pelo herpes vírus humano 8 em doentes imunossupressos. O sarcoma de Kaposi Epidêmico é o tipo epidemiológico mais frequente e afeta indivíduos VIH-positivos. A região anoperineal é raramente envolvida e as lesões suspeitas devem ser biopsiadas para confirmação histológica. A base do tratamento é a restauração imune do doente. Relatamos o caso de um jovem, com diagnóstico recente de infeção pelo VIH, sem tratamento, que foi admitido no serviço de infectologia apresentando sintomas constitucionais, adenomegalias inguinais e extensa lesão verrucosa e ulcerada na região anoperineal. As biópsias confirmaram o diagnóstico de sarcoma de Kaposi e o doente iniciou terapia antirretroviral e quimioterapia. Houve recuperação clínica, regressão das lesões e desaparecimento das adenomegalias. Este relato objetiva alertar as equipes médicas no sentido de se incluir o sarcoma de Kaposi no diagnóstico diferencial das lesões que afetam a região anoperineal.

Kaposi's sarcoma is a malignant neoplasm associated with human herpesvirus 8 infection in immunocompromised patients. Epidemic Kaposi's sarcoma is the most common epidemiological type and affects HIV-positive patients. Perineal involvement is rare, and suspicious lesions should be biopsied to confirm histological diagnosis. Treatment consists of restoring the patient's immune system. We report the case of a young patient recently diagnosed with HIV, without treatment, who was admitted to the Department of Infectious Diseases with nonspecific symptoms, inguinal lymphadenopathy, and an extensive verrucous ulcerated lesion in the perineal region. Biopsy confirmed the diagnosis of Kaposi's sarcoma, and the patient was started on antiretroviral therapy and chemotherapy. Clinical recovery was achieved, with lesion reduction and inguinal adenopathy resolution. This case report aims to encourage physicians to include Kaposi's sarcoma in the differential diagnosis of perineal lesions.

Outcomes of Patients With Metastatic Anal Cancer According to HIV Infection: A Multicenter Study by the Latin American Gastrointestinal Oncology Group (SLAGO).

BACKGROUND: HIV-positive patients are underrepresented in clinical trials of metastatic squamous cell carcinoma of the anal canal (mSCCA). We aimed to compare the clinical outcomes of mSCCA patients according to HIV infection. METHODS: This was a retrospective multicenter cohort study of consecutive patients with mSCCA. All HIV-positive patients received antiretroviral therapy. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival (PFS) and response rate (RR). RESULTS: From January 2005 to December 2019, 113 patients were included: 20 (17.6%) had HIV infection. HIV-positive patients were younger at diagnosis and more frequently male, and 20% (n = 8) received exclusively best supportive care in comparison with 8.6% of HIV-negative patients (P = .13). Both groups were similar in terms of Eastern Cooperative Oncology Group (ECOG) performance status, pattern of metastatic disease, and type of first-line chemotherapy. Five (25%) HIV-positive and 36 (38.7%) HIV-negative patients received second-line therapies (P = .24). RR and median PFS in first-line were similar between the groups: 35% and 30.1% (P = .78) and 4.9 and 5.3 months (P = .85) for patients with and without HIV infection, respectively. At a median follow-up of 26 months, median OS was 11.3 months (95% confidence interval [CI] 10.1 to 26.4) for HIV-infected patients versus 14.6 months (95% CI 11.1 to 18.1) for HIV-negative patients (P = .92). In the univariate analysis for OS, only ECOG performance status was significant. CONCLUSION: HIV-positive mSCCA patients under antiretroviral therapy have oncological outcomes similar to those of HIV-negative patients. These patients should be included in trials of mSCCA.

Tumor de Ackerman perianal / Ackerman's perianal tumor

Introducción: El carcinoma verrucoso o tumor de Ackerman es una rara entidad relacionada con la infección por el virus del papiloma humano, comportándose como una variante menos agresiva del carcinoma epidermoide. Caso clínico: Presentamos el caso clínico de un paciente de sexo masculino de 45 años portador de una gran lesión perianal con compromiso del canal anal y el aparato esfinteriano. Discusión: Existen varias alternativas para el tratamiento del tumor de Ackerman. Sin embargo en casos como este, y sobre todo ante la ausencia de respuesta al tratamiento de quimioradioterapia, se requiere de una resección amplia y radical. Pese a ello, la recidiva es frecuente. Conclusiones: En el caso analizado se destaca la forma particularmente agresiva de esta patología, con extensa invasión local y pobre respuesta al tratamiento oncoespecífico inicial.

Introduction: Verrucous carcinoma or Ackerman's tumor is a rare entity related to human papillomavirus infection, behaving as a less aggressive variant of squamous cell carcinoma. Clinical case: We present the case of a 45-year-old male patient with a large perianal lesion with involvement of the anal canal and sphincter. Discussion: Ackerman tumor treatment admits different therapeutic modalities; however, in cases such as this, and especially in the absence of response to chemo-radiotherapy treatment, a broad and radical resection is required. Despite this, recurrence is frequent. Conclusions: The particularly aggressive form of this pathology, with extensive local invasion and poor response to the initial oncoespecific treatment, stands out in the analyzed case

Prevalence and characterization of breakthrough pain in cancer patients with proctalgia treated with 3D pelvic radiotherapy.

PURPOSE: Radiotherapy-induced dysfunction of the gastrointestinal tract is common in cancer patients and has a significant impact on their quality of life. In this study, we investigated the prevalence of breakthrough cancer pain (BTcP) in patients undergoing 3D pelvic radiotherapy and who had proctalgia. METHODS: This observational, multicenter, cross-sectional epidemiological study was performed in 13 Spanish hospitals. Data were obtained on the presence and characteristics of BTcP, demographics, common comorbidities, and treatments prescribed to the patients. RESULTS: The prevalence of BTcP in patients undergoing pelvic 3D external radiotherapy with proctalgia (N = 105) was 48.6% (95% CI 39.0-58.1%). BTcP was further characterized in 59 patients. The mean (± SD) intensity of the BTcP episodes was 7.45 ± 1.47 in a visual analog scale. We found several statistically significant associations between the descriptive variables of BTcP with demographic and clinical variables associated with the tumor or the patient, such as an increased number of BTcP episodes per day depending on the presence or absence of diabetes (p = 0.001, Chi-square) or time to the onset of pain relief depending on the location of the tumor (p = 0.019, Chi-square). Fentanyl was the drug of choice in BTcP episodes for 95% of the patients. CONCLUSIONS: This study demonstrated a high prevalence of BTcP prevalence in cancer patients undergoing pelvic 3D radiotherapy and with proctalgia. Although the variables determining the onset of BTcP are still unclear, our results could help in the design of future clinical studies addressing the treatment of BTcP in these patients.

Tumor venéreo transmissível em região perianal em canino: relato de caso / Transmissible venereal tumor in perianal region in canine: case report / Tumor venéreo transmisible en região perianal en perro: reporte de caso

o tumor venéreo transmissível ou Tumor de Sticker, trata se de uma neoplasia de ocorrência espontânea comum nos órgãos genitais, sem envolvimento de qualquer agente infeccioso em sua etiologia, quando células tumorais ou neoplásicas são implantadas mecanicamente, através de montas naturais e também por lambedura excessiva da área genital, ocasionando lesões em nariz, boca, cavidade oral e até mesmo na pele, porém tem sido descrito em várias localizações extragenitais, como ânus, globo ocular, tecido subcutâneo e pele. Foi atendido numa Clínica Veterinária em Maceió - AL, um cão, macho, raça Poodle, 7 anos, domiciliado, apresentando aumento de volume na região perianal, uma massa com aspecto vegetante irregular e friável há 2 semanas, com presença de secreção serossanguinolenta ininterrupta, foram realizados exames citológicos através de decalque da lesão, onde foi possível observar a presença de células redondas, excêntricas, com nucléolo único proeminente e com múltiplos vacúolos claros individualmente com limites citoplasmáticos bem definidos. Foi instituído tratamento com quimioterápico, através do sulfato de vincristina na dose de 0,1 mg/kg, administrado por via intravenosa com fluidoterapia, uma vez por semana, durante quatro semanas. O animal recebeu alta com remissão completa das lesões.

Transmissible venereal tumor or Sticker tumor is a neoplasm of spontaneous occurrence common in the genital organs, without involvement of any infectious agent in its etiology, when tumor or neoplastic cells are implanted mechanically, through natural mounts and also by excessive licking of the genital area, causing lesions in the nose, mouth, oral cavity and even in the skin, but has been described in several extragenital locations, such as anus, eyeball, subcutaneous tissue and skin. It was attended at a Veterinary Clinic in Maceió - Al, a dog, male, Poodle breed, 7 years old, domiciled with increased volume in the perianal region, a mass with irregular and friable vegetative appearance for 2 weeks, with uninterrupted serosanguinolenta secretion, cytological exams were performed through a lesion decal, where it was possible to observe the presence of round, eccentric cells with prominent single nucleolus and with multiple clear vacuoles individually with well defined cytoplasmic limits. Treatment with chemotherapy with vincristine sulfate at a dose of 0.1 mg/kg was given intravenously with fluid therapy once a week for four weeks. The animal was discharged with complete remission of the lesions.

El tumor venéreo transmisible o Tumor de Sticker, se trata de una neoplasia de ocurrencia espontánea común en los órganos genitales, sin implicación de ningún agente infeccioso en sue tiología, cuando células tumorales o neoplásicas son implantadas mecánicamente, a través de montas naturales y también por lamedura excesiva de la zona genital, ocasionando lesiones en nariz, boca, cavidad oral e incluso en la piel, pero ha sido descrito en varias localizaciones extragenitales, como ano, globo ocular, tejido subcutáneo y piel. En el caso de la vacunación, se observó un aumento del volumen en la región perianal, una masa con aspecto vegetativo irregular y friable hace 2 semanas, con presencia de secreción serosanguinolenta ininterrumpida, se realizaron exámenes citológicos a través de la caldera de la lesión, donde fue posible observar la presencia de células redondas, excéntricas, con nucléolo único prominente y con múltiples vacuolos claros individualmente con límites citoplasmáticos bien definidos. Se estableció tratamiento con quimioterápico a través del sulfato de vincristina a una dosis de 0,1 mg/kg, administrada por vía intravenosa con fluidoterapia una vez a la semana durante cuatro semanas. El animal recibió alta con remisión completa de las lesiones.

Tumor venéreo transmissível em região perianal em canino: relato de caso / Transmissible venereal tumor in perianal region in canine: case report / Tumor venéreo transmisible en região perianal en perro: reporte de caso

o tumor venéreo transmissível ou Tumor de Sticker, trata se de uma neoplasia de ocorrência espontânea comum nos órgãos genitais, sem envolvimento de qualquer agente infeccioso em sua etiologia, quando células tumorais ou neoplásicas são implantadas mecanicamente, através de montas naturais e também por lambedura excessiva da área genital, ocasionando lesões em nariz, boca, cavidade oral e até mesmo na pele, porém tem sido descrito em várias localizações extragenitais, como ânus, globo ocular, tecido subcutâneo e pele. Foi atendido numa Clínica Veterinária em Maceió - AL, um cão, macho, raça Poodle, 7 anos, domiciliado, apresentando aumento de volume na região perianal, uma massa com aspecto vegetante irregular e friável há 2 semanas, com presença de secreção serossanguinolenta ininterrupta, foram realizados exames citológicos através de decalque da lesão, onde foi possível observar a presença de células redondas, excêntricas, com nucléolo único proeminente e com múltiplos vacúolos claros individualmente com limites citoplasmáticos bem definidos. Foi instituído tratamento com quimioterápico, através do sulfato de vincristina na dose de 0,1 mg/kg, administrado por via intravenosa com fluidoterapia, uma vez por semana, durante quatro semanas. O animal recebeu alta com remissão completa das lesões.(AU)

Transmissible venereal tumor or Sticker tumor is a neoplasm of spontaneous occurrence common in the genital organs, without involvement of any infectious agent in its etiology, when tumor or neoplastic cells are implanted mechanically, through natural mounts and also by excessive licking of the genital area, causing lesions in the nose, mouth, oral cavity and even in the skin, but has been described in several extragenital locations, such as anus, eyeball, subcutaneous tissue and skin. It was attended at a Veterinary Clinic in Maceió - Al, a dog, male, Poodle breed, 7 years old, domiciled with increased volume in the perianal region, a mass with irregular and friable vegetative appearance for 2 weeks, with uninterrupted serosanguinolenta secretion, cytological exams were performed through a lesion decal, where it was possible to observe the presence of round, eccentric cells with prominent single nucleolus and with multiple clear vacuoles individually with well defined cytoplasmic limits. Treatment with chemotherapy with vincristine sulfate at a dose of 0.1 mg/kg was given intravenously with fluid therapy once a week for four weeks. The animal was discharged with complete remission of the lesions.(AU)

El tumor venéreo transmisible o Tumor de Sticker, se trata de una neoplasia de ocurrencia espontánea común en los órganos genitales, sin implicación de ningún agente infeccioso en sue tiología, cuando células tumorales o neoplásicas son implantadas mecánicamente, a través de montas naturales y también por lamedura excesiva de la zona genital, ocasionando lesiones en nariz, boca, cavidad oral e incluso en la piel, pero ha sido descrito en varias localizaciones extragenitales, como ano, globo ocular, tejido subcutáneo y piel. En el caso de la vacunación, se observó un aumento del volumen en la región perianal, una masa con aspecto vegetativo irregular y friable hace 2 semanas, con presencia de secreción serosanguinolenta ininterrumpida, se realizaron exámenes citológicos a través de la caldera de la lesión, donde fue posible observar la presencia de células redondas, excéntricas, con nucléolo único prominente y con múltiples vacuolos claros individualmente con límites citoplasmáticos bien definidos. Se estableció tratamiento con quimioterápico a través del sulfato de vincristina a una dosis de 0,1 mg/kg, administrada por vía intravenosa con fluidoterapia una vez a la semana durante cuatro semanas. El animal recibió alta con remisión completa de las lesiones.(AU)

Rare perianal extramammary Paget disease successfully treated using topical Imiquimod therapy.

BACKGROUND: Perianal Paget's disease (PPD) is a rare intraepithelial adenocarcinoma of the anal margin. Primary PPD likely represents intra-epithelial neoplasm from an apocrine source, whereas secondary disease may represent "pagetoid" spread from an anorectal malignancy. CASE PRESENTATION: Histologic CDX-2 and CK20 are hallmark markers for colorectal-derived Paget's cells. Interestingly, our primary PPD patient presented both positive and no internal malignancy was identified. In addition, a negative CK7 marker was observed in our case in contrast with previously reported. Surgical excision is the standard treatment; however, previous studies have demonstrated good response with Imiquimod 5% cream in patients with vulval extramammary Paget disease (EMPD). The efficiency of Imiquimod treatment for PPD has not been well described. Our PPD patient was successfully treated using Imiquimod 5% cream. CONCLUSIONS: This study describes a primary cutaneous PPD patient CDX-2+/CK20+/CK7- without invasion of the dermis and no associated colorectal carcinoma effectively treated using topical Imiquimod therapy, suggesting that Imiquimod might potentially be considered as a first-line treatment for PPD.

Estudo de fase II de substituição do 5-FU por capecitabina no esquema de quimio-radioterapia em pacientes com carcinoma de células escamosas do canal anal / Phase II study of capecitabine in substitution of 5-FU in the chemoradiotherapy regimen for patients with squamous cell carcinoma of the anal canal

Introdução: O carcinoma de células escamosas (CEC) do canal anal é uma neoplasia pouco frequente, correspondendo a 1-5% dos tumores intestinais. Entretanto, o risco de CEC do canal anal vem crescendo. O tratamento padrão do CEC de canal anal nos estádios II-III consiste em 5-fluorouracil infusional associado a mitomicina-C e radioterapia, desde 1974. Estudos clínicos com o objetivo de identificar novos esquemas terapêuticos mais convenientes para câncer do canal anal devem continuar. Métodos: Pacientes com CEC de canal anal T2-4N0M0 ou T (qualquer) N1-3M0, com bom performance clínico, função renal e hematológica normais foram tratados com capecitabina 825 mg/m2 12/12 horas durante a radioterapia associada a dose única de mitomicina-C 15 mg/m2 no Dia 1. O objetivo primário do estudo foi determinar a taxa de controle local em 6 meses da associação de capecitabina, mitomicina-C e radioterapia em pacientes com câncer do canal anal. Os objetivos secundários foram determinar a taxa de toxicidade aguda graus 3-4, conforme os critérios da CTCaev4.0, taxa de resposta completa 6 semanas após término da quimio-radioterapia, sobrevida global e livre de progressão e taxa de colostomia em 1 ano. O tamanho da amostra foi calculado usando a ferramenta "estágio único de Fleming". Considerando 85% de eventos esperados (taxa de controle local em 6 meses), 1 desvio padrão e 5% de erro alfa, o tamanho ideal da amostra foi de 51 pacientes. Resultados: De novembro/2010 a fevereiro/2014, 51 pacientes foram incluídos, sendo avaliados 43 pacientes. Dezessete pacientes (39,5%) tinham estádio II, 11 (25,6%) estádio IIIA e 15 (34,9%) estádio IIIB. O seguimento mediano foi de 23,1 meses. Entre os pacientes que foram avaliados em 6 meses, 3 (7%) apresentaram resposta clínica parcial, 37 (86%) tiveram resposta clínica completa e 3 (7%) apresentaram progressão de doença. O controle loco-regional em 6 meses foi de 86%. Em relação às toxicidades graus 3-4, observaram-se diarreia grau 3, em...

Background: Squamous cell carcinoma (SCC) of the anal canal is an uncommon malignancy accounting for 1-5% of intestinal tumors; however, its incidence has been increasing. Treatment for stage II and III anal canal SCC is infusional 5-fluorouracil associated with mitomycin and radiotherapy, since 1974. More convenient treatments for patients are needed. Methods: Patients with SCC of anal cancer T2-4N0M0 or T (any) N1-3M0, with good performance status, normal blood, and renal function were treated with capecitabine 825 mg/m2 bid during radiotherapy associated with a single dose of mitomycin 15 mg/m2 on day 1. Primary objective was local control rate at 6 months determined by clinical examination and radiological assessment. Sample size was calculated using Fleming single stage design. Results: From november/2010 to february/2014 51 patients were initially included, however 43 patients were assessed. Seventeen patients (39.5%) were stage II, 11 patients (25.6%) stage IIIA, and 15 patients (34.9%) stage IIIB. Four patients (9.3%) were HIV-positive, while 39 (90.7%) were HIV-negative. Median follow-up was 23.1 months. Among patients who finished the treatment and were reevaluated at 6 months 3 patients (7%) presented partial response, 37 patients (86%) had complete response, and 3 patients developed progression of the disease (7%). Regarding grade 3-4 toxicities, 10 patients (23.2%) had grade 3 radiodermitis, 3 patients (6.9%) had grade 3-4 thrombocytopenia, 5 (11.6%) had grade 3 lymphopenia, 1 patient (2.3%) had grade 3 vomiting, 2 patients (4.6%) had grade 3 diarrhea and 3 patients (6.9%) had grade 3 leukopenia. One HIV+ patient had septic shock, pneumonia, herpetic encephalitis and macrophage activation syndrome. Colostomy rate was 18.6%. Conclusions: Capecitabine and mitomycin with radiotherapy seem to be a safe treatment for SCC of the anal cancer, with a complete response rate in 6 months of 86%.

Phase 1 study of cetuximab in combination with 5-fluorouracil, cisplatin, and radiotherapy in patients with locally advanced anal canal carcinoma.

BACKGROUND: This study sought to determine the feasibility and recommended phase 2 dose (RP2D) of the combination of cetuximab with chemoradiotherapy based on 5-fluorouracil (5-FU) and cisplatin (CP) in locally advanced anal canal carcinoma. METHODS: Cetuximab was administered on days 1, 8, 15, 29, 36, 43, and 50 (400 mg/m(2) initial dose, then 250 mg/m(2) /week) concurrent with total dose radiation of 55 to 59 Gy, both starting on day 1. Escalating doses of 5-FU (96-hour infusion) and CP (2-hour infusion), both on days 1 and 29, were administered according to the following design: starting dose level (0) 5-FU/CP = 800/60 mg/m(2) /day and up to dose level (+2) 5-FU/CP = 1000/80 mg/m(2) /day. RESULTS: Dose-limiting toxicity (DLT) events (uncontrolled diarrhea or febrile neutropenia) occurred in 3 of 14 assessable patients receiving escalated dose of 5-FU/CP, with 1 in dose level (0) and 2 in dose level (+2). The RP2D was 5-FU/CP = 800/80 mg/m(2) /day. Because of unexpected non-DLT treatment-related grade 3 (G3) adverse events (AEs) such as thrombosis/embolism, syncope, and infection occurring in ≥ 20% of patients, a safety expansion cohort with an additional 9 patients was investigated with the RP2D. The most frequent G3/G4 AEs evaluated in 23 patients were radiation dermatitis (12 patients), diarrhea (10 patients), thrombosis/embolism (6 patients), and infection (5 patients). The study was closed due to these severe AEs, although no G5 AEs occurred. Twenty of 21 patients (95%) achieved pathological complete response at primary tumor. With a median follow-up of 43.4 months, the 3-year locoregional control rate was 64.2%. CONCLUSIONS: Cetuximab could not be integrated with chemoradiotherapy-cisplatin-based therapy due to the high toxicity rate. However, efficacy is encouraging and further investigation of an epidermal growth factor receptor-targeted agent (other than cetuximab) concurrent with chemoradiation should be pursued.

Mitomycin-C- or cisplatin-based chemoradiotherapy for anal canal carcinoma: long-term results.

PURPOSE: To evaluate the long-term efficacy of concurrent radiotherapy with mitomycin-C (MMC)-based or cisplatin (CP)-based combinations in a cohort of patients with locally advanced anal canal carcinoma. METHODS AND MATERIALS: Between 1988 and 2000, 179 patients with locally advanced anal canal carcinoma were treated at the Instituto Nacional de Câncer with two cycles of chemotherapy during Weeks 1 and 5 of radiotherapy. 5-Fluorouracil (750 mg/m(2) 120-hour infusion or 1,000 mg/m(2) 96-hour infusion) plus CP (100 mg/m(2)) on the first day of each cycle or MMC (10-15 mg/m(2)) on the first day of Cycle 1 was administered concurrent with radiotherapy (total dose, 55-59.4 Gy). Of the 179 patients, 60% were included from a randomized trial initiated at the Instituto Nacional de Câncer in 1991 that compared concurrent chemoradiotherapy with MMC vs. CP. RESULTS: The median follow-up for the whole chemoradiotherapy group was 83 months. The median patient age was 58 years, 57% had Stage T3-T4 tumors, and 35% had N-positive disease. The 5-year cumulative colostomy rate was not significantly different between the CP group (22%) and MMC group (29%; p = .28). The actuarial 10-year overall survival and disease-free survival rate for the CP group was 54% and 49% and for the MMC group was 52% and 53%, respectively (p = .32 and p = .92, respectively). On multivariate analysis, male gender (p = .042) and advanced Stage T3-T4 disease (p <.0001) were statistically significant for worse disease-free survival. Stage T3-T4 (p = .039) and N+ (p = .039) disease remained independently significant for overall survival. CONCLUSION: Long-term follow-up has confirmed the good results of chemoradiotherapy with CP plus 5-fluorouracil, which seem to provide results equivalent to those with MMC plus 5-fluorouracil.

Efectividad del tratamiento de quimioradioterapia en pacientes con cáncer epidermoide de canal anal en el Hospital Nacional Edgardo Rebagliati Martins en el periodo 2006 - 2010 / Effectiveness of the treatment of chemo-radiotherapy in patients with epidermal cancer of anal channel in the National Hospital Edgardo Rebagliati Martins in period 2006 - 2010

Objetivos: Comprobar la efectividad del tratamiento de Quimioradioterapia concomitante en pacientes con cáncer de canal anal en el Hospital Nacional Edgardo Rebagliati Martíns. Material y métodos: Se realizó un estudio observacional, descriptivo, retrospectivo y transversal. Se revisaron 67 historias clínicas de pacientes con diagnostico de Cáncer de canal anal que cumplían criterios de inclusión y recibieron tratamiento de quimioradioterapia concomitante completo durante el periodo comprendido entre los años 2006 y 2010. Resultados: La edad media fue 66.7+/-10.8 años. El 79.1 por ciento de los pacientes fueron del sexo femenino; El 52.2 por ciento de los casos tuvieron escala de Zubrod. El tamaño del tumor estuvo entre 2 a 5 cm en el 73.1 por ciento de los casos y mayores de 5 cm en el 26.9 por ciento EL 46.3 por ciento de los casos tuvieron ganglios positivos. El grado histológico G2 fue el predominante en el 77.6 por ciento de los casos. En cuanto a la toxicidad se observó una mayor frecuencia de diarrea en el 13.4 por ciento de los casos. Hubo respuesta completa en el 71.6 por ciento de los casos y respuesta parcial en el 28.4 por ciento. Los pacientes que tuvieron un tamaño del tumor mayor de 5cm y presencia de ganglios tuvieron un menor tiempo de SLP de 15+/-7meses y 14+/-6 meses respectivamente. Hubo recurrencia en el 29.9 por ciento de los casos. Al 28.4 por ciento de los pacientes se les realizó colostomía. Los efectos graves tardíos fueron la fistula y la estenosis, ambos en un 6 por ciento de los casos. El 83.6 por ciento de los casos sobrevivieron. Conclusiones: El tratamiento de Quimioradioterapia concomitante es bastante efectivo en pacientes con cáncer de canal anal en el Hospital Nacional Edgardo Rebagliati Martins. La sobrevida libre de progresión de enfermedad fue de 19.1+/-1 0.8 meses, la sobrevida global fue de 25.48+/-10.3 meses y el Tiempo hasta la colostomía fue de 4.7+/-8.3. El tamaño tumoral mayor de 5cm y la presencia de ganglios se asocian a un menor tiempo hasta la colostomía y una menor sobrevida libre de progresión

[Treatment with imiquimod and surgical excision of a patient with extramammary Paget's disease. Case report]. / Tratamiento con imiquimod y escisión quirúrgica en un paciente con enfermedad extramamaria de Paget. Caso clínico.

Extramammary Paget's disease (EMPD) is a less common cutaneous type of cancer. It presents as erythematous plaques most frequently located in the genital region, perianal skin, and other cutaneous sites rich in apocrine glands, but it also may originate from keratinocytic stem cells. Recently, imiquimod has been used for the management of primary or relapsing extramammary Paget's disease. Complete healing, without recurrence, of extramammary Paget's disease in patients whom were treated topically with 5 % imiquimod cream was observed. We report a 78 year-old patient with scrotal and perianal extramammary Paget's disease treated with imiquimod cream in both lesions and subsequently with surgical excision in scrotum for the management of relapsing disease.

Tratamento com radio e quimioterapia do carcinoma epidermóide do canal anal: experiência do hospital Barão de Lucena / Radiochemotherapy for squamous cell carcinoma of the anal canal: Barao de Lucena hospital experience

Objetivos: Apresentar os resultados e analisar as variáveis implicadas no tratamento e prognóstico do carcinoma epidermóide do canal anal tratado através da radio e quimioterapia no Hospital Barão de Lucena-SUS-PE. Metodologia: Análise dos prontuários de pacientes com diagnóstico de câncer do canal anal submetidos a tratamento radioquimioterápico. O período de acompanhamento foi de junho de 1989 a junho de 2005. Foram incluídos os pacientes com diagnóstico histológico de câncer de canal anal, enquadrados nos estadios I, II, IIIa e IIIb, submetidos a dois ciclos de quimioterapia com 5-fluorouracil (5-FU) na dose de 1g/m²/dia em infusão contínua de 96 horas e cisplatino na dose de 100mg/m² administrado em 6 horas no segundo dia de infusão de cada ciclo, administrados na primeira e terceira semanas do esquema de tratamento radioterápico. Resultados: Avaliamos 108 prontuários de pacientes que preencheram os critérios do protocolo. O tempo médio de seguimento foi de 51 meses (1-182 meses). Houve predomínio do gênero feminino (81,5 por cento dos pacientes). A idade variou de 33 a 83 anos (média de 59 anos). O tipo histológico mais freqüente foi o carcinoma de células escamosas (80,6 por cento dos casos). Em 21 pacientes, foi diagnosticado carcinoma basalóide. Quanto ao grau de diferenciação, prevaleceu o tipo moderadamente diferenciado (61 por cento dos pacientes com carcinoma de células escamosas). O índice de resposta inicial completa foi de 89,8 por cento. Onze pacientes persistiram com tumor após o tratamento radio e quimioterápico. O índice de resposta inicial completa foi menor nos estadios IIIa e IIIb em relação aos estadios I e II com significância estatística (p<0,05). 14 pacientes evoluíram com recidiva tumoral, oito com recidiva local (7,4 por cento) e seis (5,5 por cento) com recidiva linfática e à distância. CONCLUSÕES: O tratamento radioquimioterápico exclusivo do carcinoma epidermóide do canal anal, tem índice de resposta completo bastante elevado co...

Objectives: To present the results and analyze the variables involved in the treatment and prognosis of squamous cell carcinoma of the anal canal treated by radiotherapy and chemotherapy at the Hospital Barao de Lucena-SUS-PE. Methodology: Analysis of medical records of patients diagnosed with anal cancer treated by chemoradiation. The monitoring period was from June 1989 to June 2005. We included patients with histologically confirmed cancer of the anal canal, framed in stages I, II, IIIa and IIIb, underwent two cycles of chemotherapy with 5-fluorouracil (5-FU) at a dose of 1g / m² / day continuous infusion 96 hours and cisplatin at a dose of 100 mg / m² administered at 6 hours the second day of infusion of each cycle, administered on the first and third weeks of radiotherapy treatment regimen. Results: We evaluated records of 108 patients who met the criteria of the protocol. The mean follow-up was 51 months (1-182 months). There were more females (81.5 percent of patients). The age ranged from 33 to 83 years (mean 59 years). The most common histological type was squamous cell carcinoma (80.6 percent of cases). In 21 patients, was diagnosed Basaloid carcinoma. Regarding the degree of differentiation, the most prevalent type was moderately differentiated (61 percent of patients with squamous cell carcinoma). The rate of initial complete response was 89.8 percent. Eleven patients had persistent tumor after radiotherapy and chemotherapy. The initial response rate was lower in complete stages IIIa and IIIb compared to stages I and II with statistical significance (p <0.05). 14 patients developed recurrence, eight with local recurrence (7.4 percent) and six (5.5 percent) with lymphatic recurrence and distance. CONCLUSIONS: The chemoradiation treatment of unique cell carcinoma of the anal canal, have complete response rate very high with acceptable morbidity. Surgical treatment still has its value in cases of persistent injury and / or local recurrence, with sati...

Rescate quirúrgico en cáncer de canal anal refractario al tratamiento de nigro / Surgical rescue in cancer of refractory anal channel to the treatment of nigro

Antecedentes: El cáncer de ano representa el 1,5% de los tumores digestivo siendo el tipo histológico predominante el carciroma escamoso. En el cáncer del canal, el tratamiento estándar con radioquimioterapia concurrente (protocolo de Nigro) permite obtener curaciones de alrededor del 60%. Ante su fracaso se puede recurrir a la cirugía (amputación abdominoperineal, linfadenectomía o ambas). Objetivo: Evuluar las opciones terapéuticas y sus resultados en carcinoma escamoso de canal anal y la conducta ante los fracasos de la radioquimioterapia. Lugar de aplicación: Hospital oncológico universitario. Diseño: Retrospectivo. Población 43 pacientes (25 mujeres y 18 hombres) con cáncer de canal anal tratados con radioquimioterapia. Método: Análsis de historias clínicas. Resultados: Mediana de edad: 56 años. Síntomas; dolor (77%); proctorragia (70%). Estadificación: 1 = 16%, II = 39%, IIIA = 12%, IIIB = 28%, IV = 5%. Complicaciones agudas de radioquimioterapia en el 51%. Dos pacientes fallecieron después del primer ciclo de quimioterapia. Respuesta completa: 65% de los pacientes; parcial: 12%; nula: 14%; progresión 2%. Recayeron luego de respuesta completa 6 pacientes; en 2 se efectúo amputación abdominoperineal; en 1 resección local y en 1 linfadenectomía. En los que tuvieron respuesta parcial o persistencia se llevaron a cabo en 3 amputación abdominoperineal y en 1 exploración. Mediana de seguimiento desde el ingreso: 26 meses (2-163 meses); desde la finalización de la radioquimioterapia: 22,5 meses. Libre de enfermedad 26 pacientes (60%), 4 de ellos a expensas de una amputación abdominoperineal. Conclusiones: El fracaso del tratamiento ocurre habitaulamente antes del tercer año y puede ser compensado con un rescate quirúrgico. El 28% de los pacientes de esta serie permanece libres de enfermedad a expensas de una resección quirúrgica radical.

Human papillomavirus (HPV) viral load and HPV type in the clinical outcome of HIV-positive patients treated with imiquimod for anogenital warts and anal intraepithelial neoplasia.

OBJECTIVE: To evaluate the efficacy of 5% imiquimod in HIV-positive male patients with anogenital warts or anal intraepithelial neoplasia (AIN), and to elucidate whether human papillomavirus (HPV) type and viral load were important for clinical outcome and recurrences. METHODS: Thirty-seven patients with histologically proven anogenital warts or AIN were enrolled. Topical 5% imiquimod was applied three times per week for more than 8 h overnight for 16 weeks, although patients were allowed to continue therapy for 4 more weeks if they did not have complete clearance of lesions. RESULTS: Mean age was 34 years. The perianal area was the main lesion location. Thirty-three patients had CD4 counts of < 500 cells/mm(3). Eighteen patients had a histopathological diagnosis of AIN-1. Main HPV types detected corresponded to low-risk HPV types. At 20 weeks of therapy, 46% patients achieved total clearance whereas 14 patients had > 50% clearance. Recurrence was observed in 5 of 17 patients who cleared. Clearance was not influenced by patients' CD4 counts, wart location, HIV viral load or HPV viral load. CONCLUSIONS: The assumption that visible perianal warts are benign lesions in HIV-positive patients has to be reevaluated since an important number of such lesions could correspond to low-grade anal disease, which in turn could progress to high-grade anal disease or cancer. In addition, our results in this preliminary study indicate that imiquimod appears to be effective in treating AIN in HIV-positive patients. Further studies are needed to document its utility to prevent high-grade dysplasia and/or anal cancer.

Câncer ano-reto-cólico - aspectos atuais: I - câncer anal / Anal canal and colorectal cancer - current features: I - anal canal cancer

A inclusão do tema - câncer anal - nessa revisão, apesar de sua relativa raridade, responde, em parte, ao propósito de chamar atenção para o significativo aumento dessa lesão e sua estreita relação com doenças sexualmente transmissíveis, principalmente causadas pelo vírus do papiloma humano (HPV); seus aspectos nosológicos, sua epidemiologia, sua etiologia multifatorial, seus fatores de riscos, sua prevenção e, em parte, para revelar a definição atual do tratamento.

The inclusion of the theme - anal cancer - in this revision, in spite of its relative rarity, it answers, partly, to the purpose of calling attention for the significant increase of that lesion and its narrow relationship with sexually transmissible diseases mainly caused by the human papilloma virus (HPV); its nosologic aspects, epidemiology, etiology, and the multifactorial nature of risk that is associated to the disease, its prevention, and, partly, to reveal the current definition of the treatment.

Tratamento do carcinoma do canal canal com quimiorradioterapia ou radioterapia exclusiva / Localized Anal Canal Carcinoma treated by Chemoradiotherapy (CRT) or Radiatherapy (RT) Alone

O melhor esquema de quimioterapia (QT) no tratamento do carcinoma anal ainda permanece indeterminado. O esquema quimioterápico aceito como padrão é a combinação de mitomicina-C com a infusão venosa continua (CIVI) de 5-FU. Resultados preliminares de estudo de Fase III randomizado têm confirmado sua equivalência das taxas de resposta clínica e de cura quando comparada à taxas obtidas com a combinação de cisplatina e 5-FU. Atualmente, três estudos clínicos prospectivos e randomizados em desenvolvimento estão utilizando a combinação de CP como comparação para esclarecer esta questão. Entretanto, a utilização de quimiorradioterapia na população idosa (> 70 anos) nem sempre é possível, levando estes pacientes à radioterapia exclusiva com objetivo de preservação esfincteriana. Entre o período de 1987 e 2000, um total de 179 pacientes com carcinoma localizado de canal anal foi tratado no Instituto Nacional de Câncer (INCA) com QT/RXT. As combinações quimioterápicas utilizadas foram CP (100 mg/m2 dia1 e dia 28) com 5-FU (750-1000 mg/m2 CIVI no dia1 a dia 5 e no dia 28 ao dia 32) ou MMC (10 mg/m2 dia 1) com 5-FU (mesmo esquema de administração) seguido concomitantemente de RXT (4140 a 4500 cGy). Durante o mesmo período, um grupo de pacientes idosos (> 70 anos) foi tratado com RXT exclusiva (4140 a 4500 cGy) principalmente por não terem condições clínicas para receber QT. Os pacientes com doença persistente no sítio primário e com linfonodos clínicamente comprometidos receberam dose adicional de reforço de 10 Gy a 14,4 Gy, após um descanso das irradiações de 2 semanas. Noventa por cento dos pacientes do grupo da CP (80/86), oitenta e dois por cento do pacientes da MMC (75/93) e oitenta e oito por cento dos pacientes da RXT exclusiva (30/34) eram mulheres. A idade mediana foi de 58 anos (35-77), 55 anos (31-75) e 76 anos (70-87) para os pacientes da CP, MMC e RXT exclusiva, respectivamente. Pelos critérios de estadiamento da UICC de 1987, o número das categorias TX/1/2/3/4 dos pacientes da CP foram de 3/3/33/18/29, 5/3/27/26/30 para os pacientes da MMC e 1/0/15/11/7 para os pacientes da RXT. O número e a porcentagem para a categoria de linfoadenopatias N1/2/3 foram para CP, MMC e RXT, 1/16/11 (32,6%), 2/23/11 (39,6%) e 0/3/8 (32,3%), respectivamente. As taxas de respostas completas clínica foram semelhantes para ambos os grupos de QT/RXT (CP=72,1% e MMC=71,4%) e inferior para o grupo de RXT exclusiva (53%). Somente o sexo masculino teve um impacto negativo na predição de resposta completa (p = 0,01) à quimiorradiação. O seguimento mediano para a QT/RXT foi de 83 meses e para a RXT exclusiva 60 meses (variação 3-179 meses). As taxas de sobrevida atuarial livre de doença (SLD) e global (SG) em 10 anos foram para a CP 49% e 54%, e para a MMC 53% e 52%, respectivamente (p = 0,32 e p = 0,92). As taxas de sobrevida livre de colostomia foram para a CP = 73% e MMC = 65% (p=0,16)...

The optimal chemotherapy (CT) regimen for anal carcinoma remains undetermined. Mitomycin - C (MMC) with continuous venous infusion (CIVI) of 5-FU is still accepted as standard chemotherapy regime and it has been confirmed by preliminary results of recent randomized phase III trial, yielding equivalent response and cure rates to the Cisplatinum (CP) and 5-FU combination. Three prospective randomized clinical trials are currently using CP combinations for comparison to define this matter. However, CRT is not always appropriated to be used in the elderly population (> 70 years), driving these patients to be treated by radiotherapy alone. From 1987 to 2000, 179 patients with localized anal carcinoma were treated at the Brazilian National Cancer Institute (INCA) with CRT using CP (100 mg/m2 day1 and day28) plus 5-FU (750-1000 mg/m2 CIVI day1 to day5 and day28 to day32) or MMC (10 mg/m2 day1) plus 5-FU at same schedule, followed by concomitant RT (4140 to 4500 cGy). During the same period, a group of thirty-four aged patients were treated with RT alone (same dose above) mainly because they were not fit to receive chemotherapy. Additional RT (10.0 to 14.4 Gy) was given to patients with persistent disease at primary site and clínically involved nodal regions received after a twoweek radiation break. Ninety percent (80/86) of CP patients, 82% (75/93) of MMC patients and 88% (30/34) of RT alone patients were female. Median age was 58 years (35-77), 55 years (31-75) and 76 years (70 -87) for CP, MMC and RT alone patients, respectively. By UICC criteria of 1987, the number of TX/1/2/3/4 patients was 3/3/33/18/29 for CP patients, 5/3/27/26/30 for MMC patients and 1/0/15/11/7 for RT. The number of N1/2/3 and the percentage of lymphadenophaty for CP, MMC and RT were 1/16/11 (32,6%), 2/23/11 (39,6%) and 0/3/8 (32,3%), respectively. Complete response rate were similar in both CRT groups (CP = 72.1% and MMC = 71.4%) and inferior in RT alone group (53%). Only male gender had a negative effect on clínical complete response (p = 0.01) to chemoradiation. Median follow-up for CRT was 83 months and for RT alone 60 months (range 3-179). The actuarial 10- year overall (OS) and disease-free survival (DFS) rates for CP were 54% and 49% and for MMC 52% and 53% respectively. (p = 0.32 and p = 0.92). Colostomy-free survival (CFS) rates for CP and MMC were 73% and 65%, respectively (p=0.16). RT alone in aged patients had inferior actuarial 5-year OS and DFS rates (43% and 37%, respectively). However, in the early stages of disease acceptable survivals rates were reached (DFS = 59% and OS=55%). After multivariate analysis, male gender (p=0,042) and advanced T3/T4 disease (p<0.0001) were statistically significant for worse disease free survival. T3/T4 disease (P=0.039), and N+ disease (p=0.039), remained independently significant for overall survival. Long-term follow-up confirms the good results...