Fertility preservation in women with breast cancer undergoing adjuvant chemotherapy: a systematic review.

OBJECTIVE: To investigate methods of fertility preservation in younger women exposed to adjuvant chemotherapy for breast cancer. DESIGN: Systematic review of literature. SETTING: Academic Department of Medical Oncology. PATIENT(S): Premenopausal women exposed to adjuvant chemotherapy for breast cancer. MAIN OUTCOME MEASURE(S): Fertility preservation. RESULT(S): Data for fertility preservation in this setting come from nonrandomized trials and observational studies. The main methods of fertility preservation are ovarian protection by gonadotropin-releasing hormone (GnRH) agonists, cryopreservation of embryos after in vitro fertilization, and preservation of operatively sampled ovarian tissue or eggs after stimulation and puncture. Ongoing trials are assessing the role of ovarian protection by GnRH agonists. CONCLUSION(S): At present, there are no high-level, evidence-based recommendations for preservation of fertility or of ovarian function in women with breast cancer. This is an important issue for young breast cancer survivors, and further studies are needed. Moreover, the interplay between ovarian protection by GnRH agonists and the efficacy of adjuvant chemotherapy remains elusive.

Factors correlated with peritoneal carcinomatosis and survival in patients with gastric cancer treated at a single institution in Brazil.

BACKGROUND: Gastric cancer is the second leading cause of death due to cancer worldwide and is particularly prevalent in Brazil. Promising new therapeutic agents have already shown activity in some gastrointestinal malignancies and their role in gastric cancer will need to be evaluated. Determining the prognostic factors of survival for patients with gastric cancer can help in identifying patients with a worse prognosis after treatment with the current chemotherapeutic regimens. METHODS: A retrospective chart review of 186 patients diagnosed with gastric cancer and treated at a single institution in Brazil from January 1994 to December 2004 was carried out. Univariate and multivariate analyses were performed to identify patient- and tumor-related characteristics associated with peritoneal metastasis at diagnosis and with overall survival. RESULTS: Of the 186 patients, 76 were alive at the time of this analysis. The median survival for all patients was 30.1 months. Two independent factors associated with the presence of peritoneal metastasis at diagnosis were identified by multivariate analysis: signet-ring cell type (odds ratio [OR], 10.8; 95% confidence interval [CI], 3.1 to 37.5), and visceral metastasis (OR, 51.8; 95% CI, 12.4 to 215.4). The prognostic factors for poor survival were tumor stage T3 or T4 (hazard ratio [HR], 1.87; 95% CI, 1.09 to 3.22) and visceral metastasis (HR, 4.98; 95% CI, 3.02 to 8.20). CONCLUSION: Two factors correlated with peritoneal metastasis and two prognostic factors for survival were identified. These findings may contribute to clinical decision-making, treatment tailoring, and the design of future trials.

Predictors of peritoneal carcinomatosis in patients with gastric cancer treated at a single institution in Brazil.

BACKGROUND: Peritoneal carcinomatosis is a common pattern of recurrence in gastric cancer and is associated with a poor prognosis. Determining predictive factors for peritoneal recurrence can help the selection of patients suitable for more aggressive treatment strategies. METHODS: A retrospective chart review of 162 patients diagnosed with gastric cancer with no peritoneal carcinomatosis and treated at a single institution in Brazil from January 1994 to December 2004 was carried out. Univariate and multivariate analyses were performed to identify patient and tumor-related characteristics associated with the development of peritoneal metastasis. RESULTS: Twenty-three (14.2%) patients developed peritoneal carcinomatosis. Three independent factors associated with the development of peritoneal metastasis were identified by multivariate analysis: signet-ring cell histology (odds ratio [OR] = 4.9; P = 0.018), the presence of vascular invasion (OR = 4.8; P = 0.022), and the presence of visceral metastasis at diagnosis (OR = 5.1; P = 0.011). Tumor stages T3 or T4 showed a trend towards significance (P = 0.062). CONCLUSIONS: Patients with gastric cancer presenting with signet-ring histology, vascular invasion, or visceral metastasis appear to be at higher risk for the development of peritoneal carcinomatosis.

Revisäo: transplante de medula óssea / Review - bone marrow transplantation

Consideradas no passado como incuráveis, muitas neoplasias malignas apresentam hoje taxas de cura cada vez maiores. Dentre as hemopatias malignas, a possibilidade de troca medular proporciona nÝo apenas remissÝo, mas cura. O transplante de medula óssea, autólogo ou alogênico, oferece esta possibilidade a portadores de tumores sólidos ou hematológicos. Neste artigo, os autores fazem uma revisÝo sobre os conceitos básicos, histórico, indicaçSes e complicaçSes deste procedimento.