Presente y futuro de la hormonoterapia adyuvante en cáncer de mama: evidencia clínica y ensayos clínicos / Present and future of adjuvant hormone therapy in breast cancer: clinical evidence and clinical trials

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Estudio sobre la respuesta dérmica enpacientes tratados con Aloe vera en eltratamiento radioterápico de cáncer de mama / A study of the dermal response in patients treated with Aloe vera in the radiotherapeutic management of breast cancer

Antecedentes: Históricamente los pacientes en tratamientos radioterápicos recibían la orden de no usar jabones ni cremas en la zona tratada mientras duraba el tratamiento, por la convicción clínica de que los jabones y las cremas podían crear irritación en la dermis de la zona tratada. Método: Se trataba de un estudio abierto y aleatorio sobre la respuesta dérmica en pacientes en los que se les aplicó Aloe vera frente a otros que no se les aplicó, bajo las mismas condiciones de radiación. Resultados: El uso de Aloe vera al 90 por ciento ha demostrado ser útil para proteger y calmar la piel en pacientes con cáncer de mama sometidos a tratamientos de radioterapia. Conclusiones: Por los resultados de estos estudios se ha demostrado que con los productos adecuados el radiólogo puede cuidar la zona tratada sin menoscabo del tratamiento radioterápico (AU)

Glioblastoma multiforme recidivado tratado con temozolomida oral, un agente activo y con perfil toxicológico favorable / Treatment of gliobastoma multiforme at first relapse with oral temozolomide: an active and weli tolerated treatment

Propósito: Estudio clínico, analítico, radiológico, histológico y terapéutico de un caso de glioblastoma multiforme recidivado tratado con temozolomida, un nuevo agente quimioterápico oral. Métodos: Tras documentación de recidiva tumoral se administró temozolomida a una dosis de 200 mg/m2/día x 5 días cada 28 días. Resultados: Con un seguimiento hasta la fecha de 22 meses y una supervivencia libre de progresión de 17 meses, se ha analizado la actividad antitumoral mediante RM objetivándose respuesta completa, mantenimiento en los parámetros de calidad de vida según cuestionario EORTC QLQ-C30 y buena tolerancia al tratamiento. Conclusiones: Temozolomida es un agente activo y con perfil toxicológico favorable para el tratamiento de gliomas malignos (AU)

Invasive bladder cancer: a single-institution experience with bladder-sparing approach.

Our objective was to assess the efficacy and safety of a selective bladder-preserving approach by transurethral resection and sequential chemoradiotherapy in patients with muscle-invasive bladder cancer. From 1989 through 1997, 40 patients with biopsy-confirmed bladder cancer, clinical stages T2-4NxM0, were treated with induction by aggressive transurethral resection (TUR) and three cycles of methotrexate, cisplatin, and vinblastine (MCV) chemotherapy. Tumor response was evaluated by cystoscopy and biopsy. In complete responders, the treatment was continued by radiotherapy (60 Gy to the bladder and 50 Gy to pelvic lymph nodes). Radical cystectomy was recommended to patients with residual tumor. Clinical complete response rate to TUR and MCV chemotherapy was 70%. The 4-year actuarial overall survival rate for the whole series was 80.5%. Among 36 patients who completed chemotherapy and radiotherapy, the 4-year actuarial survival was 84%, with 82.6% surviving with their bladders intact. Freedom from local failure in complete responders to TUR-chemotherapy was 84%. Multivariate analysis revealed that the extent of initial TUR and status after TUR-chemotherapy were independent prognostic factors associated with survival and disease-free survival. This study confirms that the combination of aggressive TUR and sequential chemoradiotherapy with bladder preservation is an alternative treatment option to primary cystectomy for selected patients with invasive bladder carcinoma.

[Biochemical control after external radiotherapy in localized prostatic cancer: results of a modern cohort]. / Control bioquímico tras radioterapia externa en el cáncer de próstata localizado: resultados de una cohorte moderna.

PURPOSE: The present study reports biochemical outcomes of a modern series of patients with localised prostate cancer treated with external beam radiation therapy, and analyses the implications of the nadir PSA levels in monitoring outcome after treatment. METHODS: From March 1993 to March 1997, eighty three patients with clinical stages T1-T3 NxM0 prostate cancer received definitive external radiation therapy, median dose 66 Gy (range 60 to 68 Gy). Adjuvant androgen deprivation was associated in 53 high risk patients. Initial response to treatment was defined as a decrease of serum PSA to levels of < or = 1.5 ng/ml, and biochemical failure as three consecutive PSA rises over post-treatment nadir PSA value. RESULTS: The 3-year actuarial BDFS was 78% +/- 7 for the whole series, 74% +/- 12 for patients treated with radiotherapy alone, and 71% +/- 10 for high risk patients treated with combination therapy (p = 0.27). Only nPSA emerged as a potential indicator of biochemical control. The probability of BDFS at 3 years was 82%, 83% and 40% for nPSA of < or = 1 ng/ml, 1-2 ng/ml and > 2 ng/ml respectively (p = 0.0409). In multivariate analysis, this correlation was independent on the effect of other variables and persisted after adjusting for the effect of hormonal therapy (p = 0.0540). CONCLUSION: Radiation therapy is a potentially curative treatment for prostate carcinoma. Our data indicate that the nadir PSA value after radiation can be an excellent early determinant of outcome.

Control bioquímico tras radioterapia externa en el cáncer de próstata localizado: resultados de una cohorte moderna / Biochemical control after external radiotherapy in localised prostate cancer: results from a modern cohort

FUNDAMENTO: En este trabajo presentamos los resultados de control bioquímico de una cohorte moderna de pacientes con cáncer de próstata localizado tratados con radioterapia, y las implicaciones del valor de nadir de PSA (nPSA) en la monitorización del tratamiento. MATERIAL Y MÉTODOS: Entre Marzo de 1993 y Marzo de 1997, 83 varones con adenocarcinoma de próstata T1-3 Nx M0, fueron tratados con radioterapia externa con intención radical (dosis total media de 66 Gy, rango 60-68 Gy). Se asoció deprivación androgénica en 53 pacientes de alto riesgo. Se ha definido la respuesta al tratamiento como un descenso del PSA a niveles ?1,5 ng/ml, y la recaída bioquímica como la presencia de tres elevaciones consecutivas de PSA sobre el valor de nPSA. RESULTADOS: La supervivencia libre de fracaso bioquímico (SLFB) actuarial a 3 años fue del 78 por ciento ñ 7 para toda la serie, 74 por ciento ñ 16 para los pacientes tratados con radioterapia exclusiva y 71 por ciento ñ 10 para los pacientes tratados con radioterapia y hormonoterapia adyuvante (p = 0,27). De los factores analizados, sólo el nivel de nPSA se correlacionó de forma significativa con la probabilidad de control bioquímico: la SLFB fue del 82 por ciento, 83 por ciento y 40 por ciento para valores de nPSA de ?1 ng/ml, 1-2 ng/ml y > 2 ng/ml respectivamente (p = 0,0409). En análisis multivariante, el valor pronóstico del nPSA se mantuvo independiente del resto de las variables y del efecto del tratamiento hormonal (p = 0,0540). CONCLUSIONES: La radioterapia externa es un tratamiento eficaz en los pacientes con cáncer de próstata localizado.El valor nadir de PSA tras radioterapia es un excelente predictor de los resultados del tratamiento (AU)

[Radiotherapy of localized cancer of the prostate: current status and new strategies]. / Tratamiento radioterápico del cáncer de próstata localizado: estado actual y nuevas estrategias.

Radiation therapy is a well established modality for the management of prostate cancer and the reported results are comparable to those obtained with radical prostatectomy. After the introduction of prostate specific antigen (PSA) determination, when results are analyzed on the basis of strict biochemical criteria, it is clearly evident that total and permanent eradication of the localized prostate cancer is obtained less frequently than what was thought in the las few decades. Although there are currently only a few series with radical radiation therapy with long results and with complete PSA determination during follow-up, disease free survival (DFS) for T1b-T2 Nx is approximately 65% at 4-5 years, whereas for T1-2 NO DFS at 9-10 years is maintained between 67% and 83%. New therapeutic strategies leading to improvement in the locoregional control are discussed, including dose escalation programs in the setting of new technologies of three-dimensional conforma radiation therapy, and neoadjuvant androgenic blockade.

[Conservative treatment with chemotherapy and radiotherapy in bladder cancer invading the muscle: preliminary results of a prospective study]. / Tratamiento conservador con quimioterapia y radioterapia en el cáncer de vejiga músculo invasivo: resultados preliminares de un estudio prospectivo.

OBJECTIVE: To analyze the possibility and safety of conservative treatment of muscle-invasive bladder cancer and to identify the prognostic factors for survival. METHODS: A total of 33 patients with invasive bladder cancer, clinical stages T2-4NxM0, were treated with aggressive transurethral resection (TUR) followed by three cycles of neoadjuvant methotrexate, cisplatin and vinblastine (MCV) chemotherapy and radiotherapy (60 Gy to the bladder). Cystectomy was recommended to patients without complete response to TUR and MCV chemotherapy. RESULTS: 31 of the 33 patients included in the study completed the protocol and were evaluable. The clinical complete response rate to TUR and MCV chemotherapy was 68% (21/31 Pts.). With a median follow-up of 39 months (range 12-78), 25/31 patients (81%) are alive and 24 (77%) have functioning preserved bladders. Four out of 31 patients (13%) developed distant metastases. The 5-year overall survival and disease free interval was 74.6% and 53.5%, respectively. By multivariate analysis response after TUR and chemotherapy (p = 0.022) was the more important risk factor associated with survival. CONCLUSION: These results indicate that MCV chemotherapy followed by radiotherapy may be effective in preserving bladder function in a high number of patients, with a survival rate comparable to that reported after cystectomy. The true efficacy of neoadjuvant chemotherapy remains to be proven by ongoing randomized trials.

Successful bone marrow transplantation in sensitized aplastic anemia patients using total lymphoid irradiation for conditioning: long-term follow-up.

Between June 1986 and November 1994, 22 previously transfused patients with severe aplastic anemia (SAA) were treated with high-dose cyclophosphamide (CY) (50 mg/kg over 4 consecutive days) and 7 Gy total lymphoid irradiation (TLI) in two fractions before allogeneic bone marrow transplantation (BMT) from HLA-identical sibling. Graft-versus-host-disease (GVHD) prophylaxis included the combination of methotrexate and cyclosporine A in all cases. Actuarial survival at 5 years is 73 +/- 9 per cent for the entire group and 86 +/- 13 per cent for the seven patients < or = 18 years. The incidence of graft failure was 0 per cent, and of acute GVHD and chronic GVHD was 31.5 per cent and 24 per cent respectively. Prolonged interval from diagnosis to BMT adversely influenced survival (P = 0.03). No hypothyroidism or secondary malignancies have been documented in this series. Our findings indicate that survival with CY-TLI is comparable to that obtained using preparative regimens without radiation. The changing role of radiotherapy in pretransplant immunosuppression for SAA is discussed.

Prognostic factors affecting leukemia relapse after allogeneic BMT conditioned with cyclophosphamide and fractionated TBI.

Between June 1985 and May 1992, 94 consecutive patients with acute myeloid leukemia (AML = 28), acute lymphoblastic leukemia (ALL = 27) and chronic myelogenous leukemia (CML = 39), were transplanted using genotypically HLA-identical marrow donors. All were conditioned with cyclophosphamide (CY) plus 12 Gy fractionated TBI. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A alone in nine patients and methotrexate-cyclosporin A in 85 patients. Forty-eight patients developed grades II-IV acute GVHD and 24 of 68 patients who survived at least 100 days developed chronic GVHD. The 5-year actuarial probability of survival, event-free survival and relapse were 41 +/- 5%, 37 +/- 5% and 37 +/- 6%, respectively. In multivariate analysis, an increased risk of leukemia relapse was associated with (1) absence of chronic GVHD (P = 0.017), (2) advanced disease at transplant (P = 0.034) and (3) diagnosis of AML (P = 0.047). Our results confirm that disease status at transplant and chronic GVHD are the more important risk factors associated with leukemia relapse, and suggest that CY-TBI has only a partial role in eradicating leukemia in AML.

[A comparative study in rectal adenocarcinoma: preoperative or postoperative radiotherapy]. / Estudio comparativo en el adenocarcinoma de recto: radioterapia preoperatoria o postoperatoria.

PURPOSE: To compare the results of preoperative and postoperative radiotherapy in rectal adenocarcinoma, in terms of overall survival and disease-free survival. PATIENTS AND METHODS: From 1989 to 1993, 52 patients with clinically operable rectal cancer were retrospectively analyzed. Two groups were compared: Patients in Group I received postoperative radiotherapy and those in Group II preoperative radiotherapy. Patients with a Karfnosky index > 70%, no evidence of distant disease and no major systemic problems were included in this study. RESULTS: The overall 5-year actuarial survival was 75% in Group I and 83% in Group II. The 5-year disease-free survival was 52% in Group I compared to 86% in Group II, a statistically significant difference (p = 0.025). A reduction in all Dukes' stages was observed in the preoperative radiation group, allowing preservation of the anorectal function in an increased number of patients. CONCLUSIONS: We observed better results with preoperative radiotherapy and conclude that this treatment might be justified in rectal carcinoma.

[Our results in the treatment of infiltrating carcinoma of the cervix]. / Nuestros resultados en el tratamiento del carcinoma infiltrante de cérvix.

The authors analyze the past history, evolution and results of therapy in 71 cases of invasive cervical carcinoma seen between 1980 and 1984. They are comparable to those published in the world literature.