RESUMO
Advances in genomic technologies have significantly improved the management of colorectal cancer (CRC). Several biomarkers have been identified in CRC that enable personalization in the use of biologic agents that have shown to enhance the clinical outcomes of patients. However, technologies used for their determination generate massive amounts of information that can be difficult for the clinician to interpret and use adequately. Through several discussion meetings, a group of oncology experts from Spain and several Latin American countries reviewed the latest literature to provide practical recommendations on the determination of biomarkers in CRC based on their clinical experience. The article also describes the importance of looking for additional prognostic biomarkers and the use of histopathology to establish an adequate molecular classification. Present and future of immunotherapy biomarkers in CRC patients are also discussed, together with several techniques for marker determination, including liquid biopsy, next-generation sequencing (NGS), polymerase chain reaction (PCR), and fecal immunohistochemical tests. Finally, the role of Molecular Tumor Boards in the diagnosis and treatment of CRC is described. All of this information will allow us to highlight the importance of biomarker determination in CRC.
RESUMO
OBJECTIVE: To demonstrate that superficial high-dose-rate (HDR) brachytherapy by means of Leipzig applicators or moulds with catheters is an adjuvant treatment with impact on local control and low toxicity. BACKGROUND: Keloid scars occur in 5-15 % of cases, secondary to an uncontrolled proliferation of fibroblasts and reduction in the inhibition of growth factors. MATERIAL AND METHODS: Retrospective, longitudinal and descriptive study in patients with keloid scars who were treated with superficial HDR brachytherapy in the General Hospital of Mexico between November 2009 and December 2013. RESULTS: Eighty patients were evaluated, and the mean follow-up was 22.18 months (range 8-48). The anatomic site treated was the ear in 72 patients (90.0 %), anterior thorax in 5 patients, retroauricular region in 2, and abdomen region in 1 patient. The application was performed 24 h after surgery; the dose for 79 patients (99 %) was 1500 cGy/3 fractions, and 1 received 500 cGy in 1 fraction. Adequate healing occurred in 76 patients (95 %), and the local failure was 5 % (95 % CI). Acute toxicity occurred in 15 % (12 patients) with grade 1 radioepithelitis. Chronic toxicity occurred in 22 patients (27.5 %) with grade 1 hypopigmentation and 18 patients (22.5 %) with grade 1 fibrosis. The cosmetic result was good in 72 patients (90 %). During follow-up, 2 patients presented recurrence, and 2 patients persisted. CONCLUSIONS: Treatment with superficial brachytherapy in keloid scars using a mould with catheters or a Leipzig applicator is a therapeutic option that results in 95 % local control and low toxicity.
