Clinical experience with biweekly CHOP plus rituximab chemoimmunotherapy for the treatment of aggressive B-cell non-Hodgkin lymphoma

BACKGROUND: The results of CHOP-21 (cyclophosphamide, doxorubicin, vincristine and prednisone given every 21 days) for the treatment of aggressive B-cell lymphoma have recently been improved by the addition of rituximab and by increasing the dose density. R-CHOP-14 combines these two approaches. PATIENTS AND METHODS: We present our experience with R-CHOP-14 in a retrospective single-centre review of 50 patients consecutively treated for aggressive B-cell lymphoma. RESULTS: The median age was 59 years and 48% of patients were >60 years. Stage III-IV was present in 62% of the patients and international prognostic index was high-to-intermediate risk or high risk in 32% of the patients. Toxicity was mainly haematological, with grade 3-4 neutropenia observed in 32% and febrile neutropenia in 18%. Other relevant toxicities were peripheral neuropathy in 45% (grade 3 in 4%) and cardiac dysfunction grade 3 in 7.5%. After therapy, 82% of the patients achieved complete response or unproved complete response. With a median follow-up of 30 months, 3-year event-free survival and overall survival were 67% and 82% respectively. CONCLUSIONS: In our experience the combination of RCHOP- 14 is highly effective in patients with aggressive B-cell lymphoma. However special attention must be paid to the control of early and late toxicities (AU)

Primary duodenal follicular lymphoma successfully treated with rituximab.

Non-Hodgkin's lymphoma (NHL) of the gastrointestinal (GI) tract is the most common extranodal lymphoma, accounting for approximately 40% of all extranodal NHLs. Initial treatment of duodenal lymphoma includes surgery, chemotherapy and radiotherapy, alone or in combination. Here, we present a case of stage I primary duodenal follicular lymphoma (FL) showing a complete response after rituximab therapy. Rituximab alone can be an effective alternative treatment for duodenal FL.

Assessment of renal toxicity and osteonecrosis of the jaws in patients receiving zoledronic acid for bone metastasis.

BACKGROUND: Bisphosphonates (BP) decrease the incidence of skeletal related events among cancer patients with bone metastases from solid tumors and multiple myeloma. Renal safety and osteonecrosis of the jaws (ONJ) are two major concerns of toxicity. Information about safety of using BP beyond 2 years is scarce. MATERIALS AND METHODS: Patients receiving zoledronic acid (ZA) at the time of the study were reviewed. Serum creatinine levels (SCL) were collected at three different moments: before the start of BP (baseline), at the time of analysis (final), and the highest SCL during the treatment (highest). Oral examination was carried out in every patient. Separated analysis was made for patients on BP for >2 years. Concomitant risk factors for both renal toxicity and ONJ were evaluated. RESULTS: Sixty-seven patients were included. Median time of BP was 22 months, with 22 patients receiving BP for >2 years. Median baseline and final values of SCL were 0.71 mg/dl and 0.70 mg/dl, respectively (P = 0.121). Median highest SCL during treatment was 0.82 mg/dl (P <0.0001). A notable increase in the SCL was observed in six of the 67 patients (9%), four of them receiving BP for >2 years (P = 0.085). ONJ was also diagnosed in six patients, four of them in the group of prolonged BP treatment. CONCLUSION: ZA showed to be safe with a low rate of reversible renal toxicity. Patients receiving BP should be monitored carefully for renal toxicity and ONJ, especially those with exposure to BP beyond 2 years.

Osteonecrosis of the jaws in patients with bone metastasis receiving intravenous bisphosphonates. A rising concern.

Osteonecrosis of the jaws (ONJ) is a recognized complication of bisphosphonates (BP) therapy in cancer patients with bone metastasis. We report 2 additional cases of ONJ in women with breast cancer after long-term exposure to BP, discussing some considerations about the presentation and management of this rare and new complication.

Osteonecrosis of the jaws in patients with bone metastasis receiving intravenous bisphosphonates. A rising concern

Osteonecrosis of the jaws (ONJ) is a recognized complication of bisphosphonates (BP) therapy in cancer patients with bone metastasis. We report 2 additional cases of ONJ in women with breast cancer after long-term exposure to BP, discussing some considerations about the presentation and management of this rare and new complication (AU)

Estudio sobre factores pronósticos comparando 5-FU-Levamisol vs 5-FU-Levamisol-Leucovorin en pacientes con carcinoma colorrectal en estadios II-III / Study of prognostic factors comparing 5-FU-Levamisol with 5-FU-Levamisol-Leucovorin treatments in patients with stages II-III colorectal carcinoma

Propósito: Presentar los resultados de un estudio sobre factores pronósticos comparando la administración de 5-Fluorouracilo (5-FU) más Levamisol (Lev) versus 5-FU más Lev y Leucovorín (LV) en una serie pacientes con cáncer de cólon y recto en estadios II-III de la UICC (B2-C de Dukes). Material y métodos: Entre 1991 y 1997 doscientos pacientes fueron distribuidos en dos grupos, tras la cirugía, para recibir tratamiento con quimioterapia adyuvante. Grupo A: 5-FU 370 mg/m2 iv. día 1 cada cuatro semanas durante un año y Levamisol vo. 50mg/8 horas por tres días, cada 15 días durante un año. Grupo B: 5-FU y Lev a las mismas dosis más Leucovorín 200mg/m2 iv. una hora antes del 5-FU. Todos los pacientes con cáncer de recto recibieron tratamiento con radioterapia luego de la cirugía. Resultados: Ciento ochenta y cuatro pacientes fueron evaluables para el análisis estadístico. Los dos grupos, A y B, presentaron una distribución homogénea en cuanto a edad, sexo, localización tumoral, tipo de cirugía, estadio y modalidad de tratamiento. Con una media de seguimiento de 85 meses (rango 2-120meses), en el grupo A se produjeron 30/91 recaídas y 28/91 muertes, y en el grupo B 32/93 recaídas y 34/93 muertes. La supervivencia libre de enfermedad (SLE) y supervivencia global (SG) a los 10 años para el grupo A fueron de 67 por ciento y 69 por ciento y para el grupo B de 64 por ciento y 63 por ciento, con una p no significativa. Los análisis de supervivencia multivariante, realizados en base a la localización del tumor (colon o recto) para el estadio en relación con la SLE, mostró una estimación de riesgo RR=2,75 (IC 95 por ciento 1,59-4,77), para la afectación ganglionar >4 vs 0 un RR=6,46 (IC 95 por ciento 3,38-12,3) y para 1-3 vs 0 un RR=2,37(IC 95 por ciento 1,29-4,35).Para el estadio en relación con la SG se estimó un riesgo RR=2,46 (IC 95 por ciento 1,42-4,28), para la afectación ganglionar >4 vs 0 un RR=5,1 (IC 95 por ciento 2,68-9,88) y para 1-3 vs 0 un RR=2,03(IC 95 por ciento 1,11-3,69). En ninguno de los estudios de supervivencia realizados se observó que la modalidad de tratamiento complementario afectase al comportamiento clínico de los pacientes. Los tratamientos fueron bien tolerados y las toxicidades más relevantes fueron leucopenia, mucositis y diarrea grado I/II. Conclusiones: En nuestro estudio el estadio y el número de ganglios afectos, independientemente de la localización tumoral, demostraron ser los factores pronóstico más importantes con un RR progresivamente ascendente para la SLE y para la SG. La asociación de Leucovorín a la combinación 5FU-Levamisol, no supuso ningún beneficio en la Supervivencia Libre de Enfermedad ni en la Supervivencia Global de los pacientes. (AU)

Análisis de algunos aspectos epidemiológicos del cáncer de mama en Gran Canaria / Analysis of some epidemiological aspects of breast cancer in Gran Canaria

Propósito: La incidencia y mortalidad por cáncer de mama en Gran Canaria es una de las más altas de España. En este estudio analizamos las características epidemiológicas y clínico-patológicas de un grupo de pacientes con diagnóstico de cáncer de mama. Material y métodos: Se estudiaron 474 pacientes con cáncer de mama, diagnosticadas y tratadas entre diciembre de 1990 y marzo de 1996, en los dos Hospitales Generales de nuestra Provincia. Se confeccionó una base de datos y los análisis estadísticos realizados fueron, fundamentalmente, medidas de tendencia central y medidas de dispersión. Resultados: La edad media y mediana fue de 60 años. El grupo entre 56 y 60 años representó el 17,7 por ciento. El 83,8 por ciento de las neoplasias se detectaron por autopalpación y el 9,3 por ciento por mamografía. El 8,9 por ciento tenían antecedentes familiares de carcinoma de mama en primer grado. Se practicó mastectomía radical modificada en el 78,1 por ciento y cirugía conservadora en el 19,4 por ciento de los casos. Conclusiones: En nuestra serie, un alto porcentaje de tumores 83,8 por ciento fueron palpables precisando en el 78,1 por ciento la realización de mastectomía radical modificada (AU)

[Colorectal cancer in the context of multiple primary malignant neoplasms]. / El cáncer colorrectal en el contexto de las neoplasias primarias malignas múltiples.

INTRODUCTION: The finding of more than one carcinoma throughout the life of a patient is not unusual. In fact, the occurrence of multiple primary cancers has been well documented. However, the features, implications and prognosis of colorectal cancers associated to other malignancies, have been less well documented. PATIENTS AND METHOD: We report 29 patients with multiple primary neoplasms in which at least one of them was a colorectal cancer. Number, extension and localization of colonic neoplasm, and time interval between diagnosis of both neoplasms, and mortality and survival rate were retrospectively analyzed. Follow-up ranged from 1 to 360 months. RESULTS: Twenty three patients had two cancers, and six more than three neoplasms. Colorectal cancer was primary in 8 patients, metachronous in 14 patients and synchronous in 5 patients. Breast (7 cases), prostate (5 cases), endometrium (3 patients) and stomach (3 cases), were the other malignancies most frequently detected. Overall, 13 of the 27 patients (49%) died during the follow-up period after the recognition of the colorectal cancer. Two patients were lost to follow-up. Mantel-Haenszel test did not show significative differences in survival between patients with two or more neoplasms. There were no differences in survival depending upon the timing of diagnosis of the colorectal tumor. CONCLUSIONS: These data suggest that colorectal cancer may share etiologic factors with hormone-dependent neoplasms (breast, prostate) and gastric cancer. In patients with primary multiple neoplasms, the number of neoplasms detected and the interval time between both diagnosis are not prognostic factors when one of the malignancies in colorectal cancer.