SEOM clinical guideline for management of adult medulloblastoma (2020)

Recent advances in molecular profiling, have reclassified medulloblastoma, an undifferentiated tumor of the posterior fossa, in at least four diseases, each one with differences in prognosis, epidemiology and sensibility to different treatments. The recommended management of a lesion with radiological characteristics suggestive of MB includes maximum safe resection followed by a post-surgical MR < 48 h, LCR cytology and MR of the neuroaxis. Prognostic factors, such as presence of a residual tumor volume > 1.5 cm2, presence of micro- or macroscopic dissemination, and age > 3 years as well as pathological (presence of anaplastic or large cell features) and molecular findings (group, 4, 3 or p53 SHH mutated subgroup) determine the risk of relapse and should guide adjuvant management. Although there is evidence that both high-risk patients and to a lesser degree, standard-risk patients benefit from adjuvant craneoespinal radiation followed by consolidation chemotherapy, tolerability is a concern in adult patients, leading invariably to dose reductions. Treatment after relapse is to be considered palliative and inclusion on clinical trials, focusing on the molecular alterations that define each subgroup, should be encouraged. Selected patients can benefit from surgical rescue or targeted radiation or high-dose chemotherapy followed by autologous self-transplant. Even in patients that are cured by chemorradiation presence of significant sequelae is common and patients must undergo lifelong follow-up (AU)

Delay in starting radiotherapy due to neoadjuvant therapy does not worsen survival in unresected glioblastoma patients

Purpose: We retrospectively examined the potential effect on overall survival (OS) of delaying radiotherapy to administer neoadjuvant therapy in unresected glioblastoma patients. Patients and methods: We compared OS in 119 patients receiving neoadjuvant therapy followed by standard treatment (NA group) and 96 patients receiving standard treatment without neoadjuvant therapy (NoNA group). The MaxStat package of R identified the optimal cut-off point for waiting time to radiotherapy. Results: OS was similar in the NA and NoNA groups. Median waiting time to radiotherapy after surgery was 13 weeks for the NA group and 4.2 weeks for the NoNA group. The longest OS was attained by patients who started radiotherapy after 12 weeks and the shortest by patients who started radiotherapy within 4 weeks (12.3 vs 6.6 months) (P = 0.05). OS was 6.6 months for patients who started radiotherapy before the optimal cutoff of 6.43 weeks and 19.1 months for those who started after this time (P = 0.005). Patients who completed radiotherapy had longer OS than those who did not, in all 215 patients and in the NA and NoNA groups (P = 0.000). In several multivariate analyses, completing radiotherapy was a universally favorable prognostic factor, while neoadjuvant therapy was never identified as a negative prognostic factor. Conclusion: In our series of unresected patients receiving neoadjuvant treatment, in spite of the delay in starting radiotherapy, OS was not inferior to that of a similar group of patients with no delay in starting radiotherapy

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Geriatric oncology in Spain: survey results and analysis of the current situation

Introduction: Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. Objectives: The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. Methods: A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. Results: Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. Conclusions: From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived

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SEOM clinical guideline for treatment of cancer pain (2017)

Pain is a highly prevalent symptom in patients with cancer. Despite therapeutic advances and well-accepted treatment guidelines, a percentage of patients with pain are under-treated. Currently, it has been recognized that several barriers in pain management still exist and, in addition, there are new challenges surrounding complex subtypes of pain, such as breakthrough and neuropathic pain, requiring further reviews and recommendations. This is an update of the guide our society previously published and represents the continued commitment of SEOM to move forward and improve supportive care of cancer patients (AU)

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Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline

Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10-30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation (AU)

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SEOM Clinical Guidelines for the systemic treatment of early breast cancer 2013

The purpose of this article is to update our previous work on the treatment and follow-up in early breast cancer. In this new version we have classified a treatment by immunohistochemistry subtypes of breast cancer. Latest advances in the management of this disease have been compiled, either in the adjuvant and neoadjuvant setting or chemotherapy and hormonal treatment. This review is presented in an easy way for oncologist, fellows and for other specialties (AU)

Posible interacción exemestano con clopidogrel / Possible interaction between exemestane and clopidogrel

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mTOR inhibitors and the anti-diabetic biguanide metformin: new insights into the molecular management of breast cancer resistance to the HER2 tyrosine kinase inhibitor lapatinib (Tykerb)

The small molecule HER2 tyrosine kinase inhibitor (TKI) lapatinib (Tykerb) is approved for the therapy of patients with HER2-positive breast carcinomas who have progressed on trastuzumab (Herceptin). Unfortunately, the efficacy of this HER2 TKI is limited by both primary (inherent) and acquired resistance, the latter typically occurring within 12 months of starting therapy. One of the key factors limiting our understanding of the mechanisms involved in lapatinib resistance is the lack of published preclinical models. We herein review lapatinib-refractory models recently developed at the bench and the survival pathways discovered. As hyperactivation of the pharmacologically targetable PI3K/mTOR/p70S6K1 axis appears to be central to the occurrence of lapatinib resistance, preclinical data showing enhanced antitumour effects when combining lapatinib with mTOR inhibitors (e.g., rapamycin analogues and NVP-BEZ235) highlight the importance of translational work to yield clinically useful regimens capable of delaying or treating lapatinib resistance. The unexpected ability of the anti-type II diabetes drug metformin to inactivate mTOR and decrease p70S6K1 activity further reveals that this biguanide, generally considered non-toxic and remarkably inexpensive, might be considered for new combinatorial lapatinib-based protocols in HER2-overexpressing breast cancer patients (AU)

Resultados en el tratamiento del cáncer de mama metastásico. Factores de influencia en la respuesta y supervivencia / Results of the treatment of metastatic breast cancer. Factors influencing the survival response

- Introducción: Se diseñó el presente estudio para analizar que factores influyeron en la respuesta y supervivencia de las pacientes con cáncer de mama metastásico tratadas en nuestro centro.- Material y Métodos: Se trata de un estudio retrospectivo que consta de 244 mujeres afectas de cáncer de mama metastásico (CMM) que fueron atendidas en el Servicio de Oncología y Radioterapia del Hospital Clínico San Cecilio, de Granada, entre enero de 1980 y diciembre de 1997. Se utilizó el test estadístico de Fisher (X2) en la comparación de tasas de respuesta, Kaplan-Meier en el análisis de la supervivencia y regresión de Cox para el análisis multivariante.- Resultados: Los factores que mostraron una diferencia estadísticamente significativa en la consecución de una respuesta favorable al tratamiento de la 1a metástasis fueron: la baja carga tumoral, la localización ósea así como un tratamiento menos agresivo en la adyuvancia. De igual forma se analizó la influencia de todos los factores en la probabilidad de supervivencia a los 5 y 10 años de las pacientes siendo el Intervalo libre de enfermedad (ILE)>2 años, la baja carga tumoral, las metástosis (M1) óseas, la ausencia de tratamiento adyuvante, tratamiento con RT+ Hormonoterapia (HT) en la metástasis así como aquellas en las que se utilizó quimioterapia (QT), donde se encontró una mejor probabilidad de supervivencia. El dato que resultó más significativo en este último análisis fue la respuesta oblenida con el tratamiento en el cáncer de mama metastásico (CMM) hallando un 40.27 por ciento de probabilidad de supervivencia a los 5 años en las pacientes que obtuvieron una respuesta favorable. En el análisis multivariante resultaron significativas: el ILE, el tipo de metástasis y sobre todo la respuesta de la 1a metástasis al tratamiento realizado. El seguimiento medio de las pacientes, a contar desde la fecha en que se documentó la metástasis, es de 30 meses (rango 1-194). El 74,6 por ciento de las pacientes habían fallecido por su enfermedad a la fecha fin de análisis y sólo un 7 por ciento (17 pacientes) estaban vivas sin enfermedad. (AU)

A propósito de un caso: histiocitosis de células de Langerhans en adolescente / Langerhan’s cell histiocytosis in an adolescent. Report of a case

Propósito: El objetivo del artículo ha sido realizar una revisión de la Histiocitosis de células de Langerhans (HCL) a través de la presentación de un caso en nuestro centro. Material y métodos: A partir del caso clínico presentado en un paciente de 15 años se procedió a la revisión exhaustiva de la bibliografía encontrada de una enfermedad poco frecuente para los oncólogos. Para la realización de esta revisión se solicitó ayuda a la Sociedad Española de Oncología Pediatría. Conclusiones: La HCL es una patología propia de niños y adolescentes con una alta tasa de curabilidad de ahí la importancia en realizar un correcto estadiaje y tratamiento adecuado siguiendo las recomendaciones de la Sociedad Española de Oncología Pediátrica; asimismo se ha de hacer hincapié en el seguimiento de estos pacientes dada la posibilidad de recaída y tratamiento de rescate. (AU)

A propósito de un caso: linfoma anaplásico en un paciente con lupus eritematoso sistémico / Anaplastic lymphoma in a patient with systemic lupus erythematosus. Report of a case

Propósito: La asociación entre las enfermedades autoinmunes y linfomas es por todos bien conocida aunque la aparición suele ser posterior, por ello es de suma importancia la sospecha de esta relación en todo paciente con estos antecedentes y clínica de un síndrome linfoproliferativo (SLP). Material y métodos: Se presenta el caso de un varón de 68 años diagnosticado de lupus eritematoso sistémico (LES) y desarrollo a los 18 meses de un linfoma no Hodgkin (LNH) de alto grado. Resultados y conclusiones: Se postula si la terapia inmunosupresora recibida por los pacientes con enfermedades autoinmunes puede influir en el desarrollo posterior de un SLP. Se discute si, ante cualquier síntoma sospechoso es necesario la realización precoz de todas las pruebas diagnósticas para descartar un linfoma (AU)

Cáncer de endometrio en pacientes en tratamiento prolongado con tamoxifeno por cáncer de mama / Endometrial cancer in breast cancer patients with long tamoxifen treatment

Propósito: El tamoxifeno (TMX) es un fármaco útil en el tratamiento adyuvante del cáncer de mama (CM). Sin embargo, entre sus efectos adversos figura un incremento de la incidencia de cáncer de endometrio (CE). Este estudio retrospectivo de cohortes muestra los primeros datos españoles sobre el tema con especial mención de los tipos histológicos de CE. Material y métodos: Se estudiaron 574 pacientes con CM de las cuales 296 fueron tratadas con TMX (213 con 40 mg/día y 83 con 20 mg/día).Resultados: Se detectaron 7 casos de CE, 6 de los cuales se hallaron en el grupo tratado con TMX. La frecuencia de CE fue de 2.02 por ciento en el grupo con TMX y de 0.36 por ciento en el grupo sin TMX (p=0.0001). ta relación con la dosis (40 vs 20 mg/día con 6/1 CE) y la duración dei tratamiento (más vs menos de 2 años con 6/0 CE) fue altamente significativa (p=0.0001). Histológicamente correspondieron a 3 adenocarcinomas endometrioides, 1 rabdomiosarcoma, 1 carcinoma seroso papilar y 1 carcinosarcoma, éste con componente epitelial de tipo seroso papilar. La mitad de los casos se originaron sobre un pólipo endometrial. El CE del grupo no tratado con TMX fue un adenocarcinoma endometrioide grado 3.Concusiones: Hay una mayor incidencia de CE asociado a tratamientos con TMX. Las dosis elevadas (40 mg) y los tratamientos prolongados (más de 2 años) se relacionan con un riesgo superior de CE. La mitad corresponden a carcinomas endometrioides, siendo el resto tipos histológicos de mal pronóstico que asientan sobre lesiones polipoides (AU)