The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer.

Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.

Erdafitinib treatment in Brazilian patients with metastatic urothelial carcinoma (mUC): real-world evidence from an Expanded Access Program.

BACKGROUND: Erdafitinib is the first targeted therapy approved for the treatment of patients with metastatic urothelial carcinoma (mUC). Approval was based on a phase II single-arm trial that demonstrated significant activity of erdafitinib in patients with tumors harboring FGFR2/3 alterations. In Brazil, an Expanded Access Program (EAP) provided patients with early access to erdafitinib prior to market authorization. The current report describes characteristics and outcomes of patients with mUC on erdafitinib therapy. METHODS: Patients with mUC that failed first- and second-line systemic therapies were screened for FGFR2/3 alterations in primary or metastatic tumor tissues. Patients with FGFR2/3 alterations were selected to receive erdafitinib at the standard dosing schedule and were followed prospectively to evaluate the efficacy and safety outcomes. RESULTS: From 19 April 2019, through 13 March 2020, 47 patients with mUC from 10 Brazilian centers were tested for FGFR2/3 alterations. Alterations in FGFR2/3 were found in 12 patients (25.5%) and all of them were eligible for the EAP. Four patients (33%) had partial response, while two patients (17%) had stable disease. Progressive disease, the best response, was observed in five patients (42%). At a median follow-up of 16.2 months, the median time to treatment failure (TTF) was 2.8 months. When considering only patients with objective response, the median TTF was 5.3 months. Adverse events (AEs) were reported for any grade and grade 3 or higher in 10 patients (83%) and 5 patients (42%), respectively. The most common AE was hyperphosphatemia. CONCLUSION: This first real-world evidence report of heavily treated patients with mUC confirms the efficacy and safety of erdafitinib in a disease setting with a lack of treatment options.

Evaluation of high-grade astrocytoma recurrence patterns after radiotherapy in the era of temozolomide: A single institution experience.

AIM: Evaluating the recurrence patterns of high-grade astrocytomas in patients who were treated with radiotherapy (RT) plus temozolomide (TMZ). BACKGROUND: The current literature suggests that reducing the margins added to the CTV does not significantly change the risk of recurrence and overall survival; thus, we decided to analyze our data and to examine the possibility of changing the adopted margins. MATERIALS AND METHODS: From February 2008 till September 2013, 55 patients were treated for high-grade astrocytomas, 20 patients who had been confirmed to have recurrence were selected for the present study. Post-operative MRI was superimposed on the planning CT images in order to correlate the anatomical structures with the treatment targets. Recurrences were defined according to the Response Assessment Criteria for Glioblastoma. The mean margins of the PTVinitial and PTVboost were 1.2 cm and 1.4 cm, respectively. The analysis of the percentage of the recurrence volume (Volrec) within the 100% isodose surface was based on the following criteria: (I) Central: >95% of the Volrec; (II) In-field: 81-95% of the Volrec; (III) Marginal: 20-80% of the Volrec; and (IV) Outside: <20% of the Volrec. RESULTS: Of the 20 patients, 13 presented with central recurrences, 3 with in-field recurrences, 2 with marginal recurrences and 2 with outside recurrences. Therefore, the lower Volrec within 100% of the prescribed dose was considered in the classification. CONCLUSIONS: Of the selected patients, 80% had ≥81-95% of the Volrec within 100% of the prescribed dose and predominantly had central or in-field recurrences. These results are comparable with those from the literature.

Insuficiência aórtica / Aortic regurgitation

A regurgitação aórtica é causada pelo mau funcionamento das cúspides, que acaba por acarretar uma sobrecarga de volume e de pressão nas câmeras cardíacas esquerdas. A doença tem no ecocardiograma o principal exame para diagnóstico e na cirurgia para substituição da válvula o tratamento definitivo.

Aortic regurgitation is caused by malfunction of the leaflets, which ultimately lead to a volume overload and pressure in the left heart cameras. The disease has in echocardiography, the main test for diagnosis and surgery for valve replacement as definitive treatment.

Manejo de mediastinite no pós-operatório de cirurgia cardíaca com esternotomia longitudinal / Mediastinitis management in the postoperative period of cardiac surgery with longitudinal sternotomy

Os autores desse artigo fazem uma revisão sobre mediastinite no pós-operatório de cirurgia cardíaca, enfatizando seu manejo de acordo com a classificação de Emory.

The authors of this article make a review of mediastinitis after cardiac surgery, emphasizing its managemant acording to the Emory classification.

Randomized phase III trial exploring the use of long-acting release octreotide in the prevention of chemotherapy-induced diarrhea in patients with colorectal cancer: the LARCID trial.

PURPOSE: Chemotherapy-induced diarrhea (CID) is a relatively common adverse event in the treatment of patients with colorectal cancer. The LAR for Chemotherapy-Induced Diarrhea (LARCID) trial evaluated the efficacy and safety of long-acting release octreotide (octreotide LAR) for the prevention of CID in this population. PATIENTS AND METHODS: Patients with colorectal cancer starting adjuvant or first-line treatment with a chemotherapy combination containing fluorouracil, capecitabine, and/or irinotecan were randomly assigned to receive octreotide LAR 30 mg intramuscularly every 4 weeks (experimental arm) or the physician's treatment of choice in case of diarrhea (control arm). RESULTS: A total of 139 patients were randomly assigned, most of whom received fluorouracil- and oxaliplatin-containing chemotherapy regimens. The rate of diarrhea was 76.1% in the experimental group (n = 68) and 78.9% in the control group (n = 71). Treatment with octreotide LAR did not prevent or reduce the severity of CID. Treatment choices for diarrhea management included loperamide in the majority of patients. No benefit from octreotide LAR was identified in terms of need for diarrhea treatment, opioids, or intravenous hydration or in the rate of hospitalization or quality of life. CONCLUSION: This study could not prove the efficacy of octreotide LAR in the prevention of CID.

Adenocarcinoma mucinoso de anexo cutâneo: relato de caso / Mucinous Adenocarcinoma of Skin Annex: a Case Report

Introdução: O adenocarcinoma mucinoso é uma rara neoplasia formada por células apócrinas da pele hipersecretoras de muco. Pálpebras, couro cabeludo e outras regiões da cabeça e do pescoço são os sítios primários mais acometidos. Relatodo caso: Os autores descrevem o caso de uma lesão suspeita em couro cabeludo, cuja excisão e análise confirmaram um adenocarcino mamucinoso de anexo cutâneo. Mesmo após a ressecção, surgiram lesões metastáticas nas regiões retroauricular, cervical, supraclavicular e couro cabeludo. Fez-se, então, quimioterapia e radioterapia. Meses depois, a paciente relatou dor na coluna e no braço com irradiação para a mão e parestesias. Após exames, confirmou-se metástaseem linfonodos axilares, em ossos da coluna vertebral, com iminente compressão medular. A radioterapia, então, foi realizada nessas regiões. A paciente apresentou melhora significativa e mantém acompanhamento. Conclusão: O adenocarcinoma mucinoso é uma rara neoplasia e as características do relato apresentado tornam-no ainda mais raro. O diagnóstico da doença exige uma correlação clínica, radiológica e patológica. Quando submetidos a tratamento precoce, os pacientesapresentam um bom prognóstico com raras chances de metástases, embora recidivas sejam comuns.