Resultados de supervivencia en cinco neoplasias malignas separados por una década en el Institut Català d'Oncologia / Survival results in five malignant neoplasms separated by a decade at Institut Català d'Oncologia, Spain

Fundamento y objetivo: Se presentan datos de supervivencia relativa (SR) (cociente entre la supervivencia observada y la esperada) a 5 años en las siguientes neoplasias: mama, pulmón, colorrectal (CCR), linfoma no Hodgkin de células grandes tipo B (LNHB) y mieloma múltiple (MM) tratados en el Institut Català d'Oncologia (ICO) en el período 2010-2011 y se comparan con los obtenidos en una cohorte especial histórica de los años 1998-1999. Material y métodos: Para el segundo estudio, se creó una base de datos donde se introdujeron 5.000 registros con datos de la historia clínica. Para el análisis de resultados se utilizó el paquete estadístico R®para la SR. Resultados: Las SR globales a 5 años del segundo período (2010-2011) fueron: CCR 67%, mama 93,6%, pulmón 28%, LNHB 68,3% y MM 61,7% y para el primero (1998-1999) fueron: CCR 61,8%, mama 88,8%, pulmón 23,1%, LNHB 67,7% y MM 43,4%. Conclusiones: Se registró una mejoría de la SR, de alrededor del 5%, en los 3 tumores sólidos, un incremento significativo en el MM y una estabilización en los LNHB (AU)

Background and objective: Five years' data relative survival (RS) is presented in 3 solid tumours: breast, colorectal (CRC) and lung and 2 haematologic neoplasms: large B cell lymphoma (NHL-B) and multiple myeloma (MM) treated at Institut Català d'Oncologia between 2010-2011 in comparison with the results obtained in a historical special cohort from 1998-1999. Material and methods: A database was created in a common safe and accessible repository. We have introduced more than 5,000 medical records. To analyse the results the statistical package R® was used for RS. Results: The overall RS at 5 years for 2010-2011 was: CRC 67%, breast 93.6%, lung 28%, NHL-B 68% and MM 62%, while for 1998-1999 is was: CRC 61.8%, breast 88.8%, lung 23.1%, NHL-B 67.7%, and MM 43.4%. Conclusions: Comparative results have shown a 5% overall improvement in RS for the 3 solid tumours, a significant increase in MM and a stabilisation in the NHL-B (AU)

Survival results in five malignant neoplasms separated by a decade at Institut Català d'Oncologia, Spain. / Resultados de supervivencia en cinco neoplasias malignas separados por una década en el Institut Català d'Oncologia.

BACKGROUND AND OBJECTIVE: Five years' data relative survival (RS) is presented in 3 solid tumours: breast, colorectal (CRC) and lung and 2 haematologic neoplasms: large B cell lymphoma (NHL-B) and multiple myeloma (MM) treated at Institut Català d'Oncologia between 2010-2011 in comparison with the results obtained in a historical special cohort from 1998-1999. MATERIAL AND METHODS: A database was created in a common safe and accessible repository. We have introduced more than 5,000 medical records. To analyse the results the statistical package R® was used for RS. RESULTS: The overall RS at 5 years for 2010-2011 was: CRC 67%, breast 93.6%, lung 28%, NHL-B 68% and MM 62%, while for 1998-1999 is was: CRC 61.8%, breast 88.8%, lung 23.1%, NHL-B 67.7%, and MM 43.4%. CONCLUSIONS: Comparative results have shown a 5% overall improvement in RS for the 3 solid tumours, a significant increase in MM and a stabilisation in the NHL-B.

Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database.

PURPOSE: Conventional-dose chemotherapy (CDCT) and high-dose chemotherapy (HDCT) may both be successfully used as salvage treatment for patients with metastatic germ cell tumors (GCTs) who experience progression with first-line treatment. PATIENTS AND METHODS: Data on 1,984 patients with GCTs who experienced progression after at least three cisplatin-based cycles and were treated with either cisplatin-based CDCT or carboplatin-based HDCT chemotherapy were collected from 38 centers or groups worldwide. Of 1,984 patients, 1,594 (80%) were eligible, and among the eligible patients, 1,435 (90%) could reliably be classified into one of the following five prognostic categories based on prior prognostic classification: very low (n = 76), low (n = 257), intermediate (n = 646), high (n = 351), and very high risk (n = 105). Within each of the five categories, the progression-free survival (PFS) and overall survival (OS) after CDCT and HDCT were compared using the Cox model adjusted for significant distributional differences between important variables. RESULTS: Overall, 773 patients received CDCT, and 821 patients received HDCT. Both treatment modalities were used with similar frequencies within each prognostic category. The hazard ratio for PFS was 0.44 (95% CI, 0.39 to 0.51) stratified on prognostic category, and the hazard ratio for OS was 0.65 (95% CI, 0.56 to 0.75), favoring HDCT. These results were consistent within each prognostic category except among low-risk patients, for whom similar OS was observed between the two treatment groups. CONCLUSION: This retrospective analysis suggests a benefit from HDCT given as intensification of first salvage treatment in male patients with GCTs and emphasizes the need for another prospective randomized trial comparing CDCT to HDCT in this patient population.

Unidades funcionales oncológicas / Oncologic functional units

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Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy.

PURPOSE: To develop a prognostic model in patients with germ cell tumors (GCT) who experience treatment failure with cisplatin-based first-line chemotherapy. PATIENTS AND METHODS: Data from 1,984 patients with GCT who progressed after at least three cisplatin-based cycles and were treated with cisplatin-based conventional-dose or carboplatin-based high-dose salvage chemotherapy was retrospectively collected from 38 centers/groups worldwide. One thousand five hundred ninety-four (80%) of 1,984 eligible patients were randomly divided into a training set of 1,067 patients (67%) and a validation set of 527 patients (33%). Seminomas were set aside for posthoc analyses. Primary end point was the 2-year progression-free survival after salvage treatment. RESULTS: Overall, 990 patients (62%) relapsed and 604 patients (38%) remained relapse free. Histology, primary tumor location, response, and progression-free interval after first-line treatment, as well as levels of alpha fetoprotein, human chorionic gonadotrophin, and the presence of liver, bone, or brain metastases at salvage were identified as independent prognostic variables and used to build a prognostic model in the training set. Survival rates in the training and validation set were very similar. The estimated 2-year progression-free survival rates in patients not included in the training set was 75% in very low risk, 51% in low risk, 40% in intermediate risk, 26% in high risk, and only 6% in very high-risk patients. Due to missing values in individual variables, 69 patients could not reliably be classified into one of these categories. CONCLUSION: Prognostic variables are important in patients with GCT who experienced treatment failure with cisplatin-based first-line chemotherapy and can be used to construct a prognostic model to guide salvage strategies.

European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II.

OBJECTIVES: The first consensus report that had been presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the Amsterdam Medical Center, The Netherlands. METHODS: Medical oncologists, urologic surgeons, radiation oncologists as well as pathologists from several European countries reviewed and discussed the data that had emerged since the 2002 conference and incorporated the new data into updated and revised guidelines. As for the first meeting the methodology of evidence-based medicine (EBM) was applied. The results of the discussion were compiled by the writing committee. All participants have agreed to this final update. RESULTS: The second part of the consensus paper includes the treatment of metastasised disease, residual tumour resection, salvage therapy, follow-up, and late toxicities. CONCLUSIONS: Whereas the vast majority of the recommendations made in 2004 remain valid 3 yr later, refinements in the treatment of early-stage as well as of advanced-stage testicular cancer have emerged from clinical trials. Despite technical improvements, expert clinical skills will continue to be one of the major determinants for the prognosis of patients with germ cell cancer. In addition, the particular needs of testicular cancer survivors have been acknowledged.

European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I.

OBJECTIVES: The first consensus report presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in the year 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the Amsterdam Medical Center, Amsterdam, The Netherlands. METHODS: Medical oncologists, urological surgeons, radiation oncologists as well as pathologists from several European countries reviewed and discussed the data that had emerged since the 2002 conference, and incorporated the new data into updated and revised guidelines. As for the first meeting, the methodology of evidence-based medicine (EBM) was applied. The results of the discussion were compiled by the writing committee. All participants have agreed to this final update. RESULTS: The first part of the consensus paper describes the clinical presentation of the primary tumor, its treatment, the importance and treatment of testicular intraepithelial neoplasia (TIN), histological classification, staging and prognostic factors, and treatment of stage I seminoma and non-seminoma. CONCLUSIONS: Whereas the vast majority of the recommendations made in 2004 remain valid 3 yr later, refinements in the treatment of early- and advanced-stage testicular cancer have emerged from clinical trials. Despite technical improvements, expert clinical skills will continue to be one of the major determinants for the prognosis of patients with germ cell cancer. In addition, the particular needs of testicular cancer survivors have been acknowledged.

Utilidad de los marcadores tumorales en el tratamiento de los tumores germinales / Utility of tumor markers in the treatment of germ cell tumors

OBJETIVO: Revisar el estado actual de la utilidad de los marcadores tumorales en el tratamiento de los tumores seminales. MÉTODO: Se han revisado los artículos publicados hasta la actualidad referentes al tema. RESULTADOS/CONCLUSIONES: Los marcadores tumorales (alfa-fetoproteína, Beta-HCG y LDH) constituyen un elemento esencial en el manejo de los tumores germinales. Son de gran utilidad en el diagnóstico inicial y el diagnóstico de extensión tras la cirugía, especialmente de la enfermedad residual postcirugía en el estadio I. Su papel como marcador pronóstico ha quedado claramente establecido en la clasificación IGCCCG. Por otro lado, una de sus utilidades más importantes se encuentra en el seguimiento y detección de recidivas, así como en la monitorización de la respuesta al tratamiento Es preciso conocer una serie de situaciones en las que pueden producirse elevaciones espúreas de marcador, no debidas a progresión tumoral. La elevación de Alfafetoproteína puede ser causada por daño hepático y lisis tumoral. La elevación de Beta-HCG puede deberse a hipogonadismo, lisis tumoral, elevación discordante, o efecto "hook" (AU)

Tratamiento con quimioterapia adyuvante en los tumores germinales no seminoma de testículo estadio I / Treatment of stage I monoseminomatous germ cell testicular tumors with adjuvant chemotherapy

OBJETIVO: Revisar el tratamiento con quimioterapia adyuvante en los tumores germinales no seminoma de testículo estadio I.MÉTODO: Se hace una revisión de la literatura publicada referente a este tema. RESULTADOS/CONCLUSIONES: Globalmente, un 30 por ciento de los tumores germinales no seminomatosos estadio I, sometidos a seguimiento, recidivan en los dos años posteriores. Se han descrito una serie de factores que se asocian a un riesgo aumentado de recidiva. Los más importantes son la presencia de invasión vascular venosa o linfática en el tumor, la presencia de componente de carcinoma embrionario, y la ausencia de tumor del seno endodérmico. En el grupo de pacientes definido por estas características, la tasa de recidiva se encuentra cercana al 50 por ciento. En los últimos años se han reportado algunas experiencias con 2 ciclos de quimioterapia adyuvante tipo BEP en los pacientes de riesgo, que muestran que la tasa de recidiva puede reducirse por debajo del 5 por ciento, con una toxicidad tardía mínima (AU)