Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases / Coagulação por plasma de argônio como adjuvante à curetagem estendida em tumores de células gigantes do osso: Um estudo de 50 casos

Abstract Objective Extended curettage with adjuvants of giant cell tumors of bone is associated with a lower rate of recurrence of the tumor while preserving the adjacent joint. The present study was conducted to estimate the recurrence rate and functional outcome after using argon beam as an adjuvant for extended curettage. Methods We selected 50 patients with giant cell tumors, meeting all the inclusion criteria, who underwent extended curettage using high speed burr and argon beam photocoagulation between July 2016 to January 2019. On their follow-up visit, they were assessed for any complaints of pain and signs like tenderness, locally raised temperature, and decreased range of motion of the adjacent joint. Radiologically, the patients were assessed for any increased lucency around the cement mantle and uptake of the subarticular graft. Musculoskeletal Tumor Society Score (MSTS) was administered to the patients, and range of motion of the adjacent joint was compared with the contralateral joint. Results Recurrence was found in 4 patients, that is, an 8% recurrence rate. Twenty-six out of 28 patients with a tumor in the lower limb had a grade-5 weight bearing status 6 months from the surgery, and their range of motion was comparable to contralateral healthy joint with an average MSTS score of 27 (18-30). Conclusion Extended curettage of giant cell tumors using argon beam coagulation is associated with low recurrence rates of the tumor and is an effective modality in the treatment of these tumors besides having a functional outcome comparable to the healthy limb.

Resumo Objetivo A curetagem estendida com adjuvantes de tumores de células gigantes do osso está associada a uma menor taxa de recidiva da neoplasia e à preservação da articulação adjacente. Este estudo foi feito para estimar a taxa de recidiva e o resultado funcional após o uso de plasma de argônio como adjuvante à curetagem estendida. Métodos Cinquenta pacientes com tumores de células gigantes que atendiam a todos os critérios de inclusão foram selecionados para o estudo e submetidos à curetagem estendida com broca de alta velocidade e fotocoagulação com plasma de argônio entre julho de 2016 e janeiro de 2019. À consulta de acompanhamento, os pacientes foram avaliados quanto a quaisquer queixas de dor e sinais como sensibilidade, aumento local da temperatura e diminuição da amplitude de movimento da articulação adjacente. Radiologicamente, os pacientes foram avaliados quanto à presença de qualquer aumento de radiotransparência ao redor do manto de cimento e incorporação do enxerto subarticular. O questionário Musculoskeletal Tumor Society Score (MSTS) foi administrado aos pacientes e a amplitude de movimentação da articulação adjacente foi comparada à articulação contralateral. Resultados Quatro pacientes apresentaram recidiva, o que corresponde a uma taxa de 8%. Seis meses após a cirurgia, 26 de 28 pacientes com tumor no membro inferior tinham capacidade de sustentação de peso de grau 5 e amplitude de movimento comparável à articulação saudável contralateral, com pontuação MSTS média de 27 (intervalo de 18 a 30). Conclusão A curetagem estendida de tumores de células gigantes com coagulação por plasma de argônio está associada a baixas taxas de recidiva da neoplasia; é uma modalidade eficaz no tratamento desses tumores e o resultado funcional é comparável ao do membro saudável.

Oligometastasis in gastric cancer treatment: is there a place for the surgeon? / Oligometástases no tratamento do câncer gástrico: existe um lugar para o cirurgião?

ABSTRACT Metastatic gastric cancer traditionally hinders surgical treatment options, confining them to palliative procedures. The presence of metastases in these tumors is classified as M1, irrespective of their characteristics, quantity, or location. However, oligometastatic disease emerged as an intermediate state between localized and widely disseminated cancer. It exhibits diverse patterns based on metastatic disease extent, type, and location. Adequately addressing this distinctive metastatic state necessitates tailored strategies that surpass the realm of palliative care. Differentprimary tumor types present discernible scenarios of oligometastatic disease, including preferred sites of occurrence and chronological progression. Due to the novelty of this theme and the heterogeneity of the disease, uncertainties still exist, and the ability to provide confident guidelines is challenging. Currently, there are no effective predictors to determine the response and provide clear indications for surgical interventions and systemic treatments in oligometastatic disease. Treatment decisions are commonly based on apparent disease control by systemic therapies, with a short observation period and imaging assessments. Nonetheless, the inherent risk of misinterpretation remains a constant concern. The emergence of novel technologies and therapeutic modalities, such as immunotherapy, cellular therapy, and adoptive therapies, holds the potential to reshape the landscape of surgical treatment for the oligometastatic disease in gastric cancer, expanding the surgeon's role in this multidisciplinary approach. Prospective tools for patient selection in oligometastatic gastric cancer are being explored. Using non-invasive, cost-effective, widely available imaging techniques that provide real-time information may revolutionize medical practice, ensuring precision medicine accessibility, even in resource-constrained small healthcare facilities. Incorporating molecular classifications, liquid biopsies, and radiomic analysis in a complementary protocol will augment patient selection precision for surgical intervention in oligometastasis. Hopefully, these advancements will render surgeries unnecessary in many cases by providing highly effective alternative treatments.

RESUMO O câncer gástrico metastático representa um desafio para o tratamento cirúrgico, restringindo-se a procedimentos paliativos. A presença de metástases nestes tumores é categorizada como estágio M1, independentemente das características, quantidade e localização. No entanto, a doença oligometastática surgiu como um estado intermediário entre o câncer localizado e o amplamente disseminado. A oligometastática apresenta diversos padrões com base na extensão, tipo e localização da doença metastática. Abordar adequadamente esse estado distintivo requer estratégias adaptadas que ultrapassem o escopo dos cuidados paliativos. Diferentes tipos de tumores primários exibem cenários distintos de oligometastática, incluindo locais preferenciais de ocorrência e progressão cronológica. Devido à novidade desse tema e à heterogeneidade da doença, ainda existem incertezas, e a capacidade de fornecer diretrizes seguras é limitada. Atualmente, não existem preditores eficazes para determinar a resposta e fornecer indicações claras para intervenções cirúrgicas e tratamentos sistêmicos em oligometastática. As decisões de tratamento geralmente se baseiam no controle aparente da doença por meio de terapias sistêmicas, com um curto período de observação e avaliação por imagem. No entanto, o risco inerente de interpretação incorreta continua sendo uma preocupação constante. A emergência de novas tecnologias e modalidades terapêuticas, como imunoterapia, terapia celular e terapias adotivas, tem o potencial de remodelar o panorama do tratamento cirúrgico da oligometastática no câncer gástrico, expandindo o papel do cirurgião nessa abordagem multidisciplinar. Ferramentas prospectivas para a seleção de pacientes com câncer gástrico oligometastático estão sendo exploradas. A utilização de técnicas de imagem não invasivas, rentáveis e amplamente disponíveis, que fornecem informações em tempo real, pode revolucionar a prática médica, garantindo a acessibilidade da medicina de precisão, mesmo em unidades de saúde com recursos limitados. A incorporação de classificações moleculares, biópsias líquidas e análises radiômicas em um protocolo complementar aumentará a precisão da seleção de pacientes para intervenção cirúrgica em oligometástases. Espera-se que esses avanços tornem as cirurgias desnecessárias em muitos casos, proporcionando tratamentos alternativos altamente eficazes.

Resultados del tratamiento a pacientes con cáncer anal en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo" / Results of Treating Of Anal Cancer Patients at Comandante Manuel Fajardo Surgical Clinical University Hospital

Introducción: El cáncer anal es el de menor incidencia del tubo digestivo, pero en los últimos años ha presentado un discreto incremento. Objetivo: Identificar los resultados del tratamiento empleado para el cáncer anal en el Servicio de Coloproctología del Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo". Métodos: Se realizó un estudio descriptivo y observacional con pacientes diagnosticados y tratados por cáncer anal en el período 2014-2019. Se estudiaron variables como antecedentes patológicos, factores de riesgo, síntomas, estadio de la enfermedad, tratamientos, entre otras. Resultados: La media de edad fue 58,4±14,7 años y el 75,3 por ciento fueron mujeres. El 52,1 por ciento presentaban antecedentes patológicos y el factor de riesgo más frecuente fue la edad (> 50 años: 80,8 por ciento). La localización más usual fue en el conducto anal y los estadios II y III. El sangrado se manifestó en el 58,9 por ciento de los pacientes. Se aplicó como tratamiento quimiorradioterapia (87,7 por ciento), exéresis local (17,8 por ciento) y cirugía abdominoperineal (8,2 por ciento). Se realizó colostomía al 14 por ciento de los individuos y el 72,6 por ciento estuvieron libres de colostomía más de un año. El tiempo libre de colostomía fue de 87,5 por ciento, con tratamiento de 5 años y más. De los pacientes fallecidos (24,7 por ciento), en el 55,6 por ciento la causa fue progresión de la enfermedad y la metástasis más frecuente fue la hepática. Conclusiones: La quimiorradioterapia fue el principal tratamiento con el que se obtuvo una aceptable tasa de sobrevida en los pacientes con cáncer anal(AU)

Introduction: Anal cancer is the one with the lowest incidence of the digestive tract, but in recent years it has slightly increased. Objective: To identify the results of the treatment used for anal cancer in the Coloproctology Service of Comandante Manuel Fajardo Surgical Clinical University Hospital. Methods: A descriptive and observational study was carried out with patients diagnosed and treated for anal cancer in the 2014-2019 period. Variables such as pathological history, risk factors, symptoms, stage of the disease, treatments, among others, were studied. Results: The mean age was 58.4 ± 14.7 years and 75.3 percent were women. 52.1 percent had pathological antecedents and the most frequent risk factor was age (> 50 years: 80.8 percent). The most usual location was in the anal canal and stages II and III. Bleeding appeared in 58.9 percent of the patients. Chemoradiation therapy (87.7 percent), local exeresis (17.8 percent) and abdominoperineal surgery (8.2 percent) were applied. Colostomy was performed in 14 percent of individuals; 72.6 percent were free of colostomy for more than one year. The colostomy-free time was 87.5 percent, with treatment of 5 years and more. 24.7 percent died, the disease progression was the cause of death in 55.6 percent of the diseased subjects, while the most frequent cause was liver metastasis. Conclusions: Chemoradiotherapy was the main treatment with which an acceptable survival rate was obtained in patients with anal cancer(AU)

Epidemiological and prognostic single center study of anal carcinoma / Estudo epidemiológico e prognóstico em um único centro de carcinoma anal

Abstract Background: Anorectal carcinoma includes the anal margin, the anal canal, and the lower rectum. The incidences of anal tumors represent 1.4 % of all gastrointestinal tumors. Patients and methods: Our study is retrospective and was conducted at Baghdad Medical City. Patient's data were collected from the medical records through a predesigned sheet that included the following information: demographic data, medical history, past-history, presenting symptoms, pathological data, and treatment details. Results: The median age was 49 years. As regard tumor extension, 85.71 % of patients had anal disease, while anorectal cancer was encountered in 14.28 % of cases only. Male to female ratio was 1:3. Most of cases were SCC 78.57 %. Only 11 patients (39.28 %) were diagnosed as Stage I, whereas 12 patients (42.85 %) had Stage II-III disease. Moderate differentiated tumors are the most common. The tumor mass located between 5-10 cm das a distance from anal verge in 12 (42.85 %) of patients. We found 6 (21.42 %) patients with positive virology tests with no specificity detected. APR was the mainstay for treatment of stage I disease. Neoadjuvant treatment followed by TME resection was the treatment found in locally advanced tumors. The mean Overall Survival (OS) for patients received neoadjuvant CRT in the study was 43.5 months, while, the mean OS was 45.73 months in the adjuvant setting. Univariate analysis for OS according to prognostic factors revealed that sites of cancer, grades and histopathology were significant independent prognostic factors for OS in this study. The anal canal tumor was associated with shorter OS (33.25) months in comparison to the anorectal cancer (OS = 47.22 months). Based on tumor grade, well and moderate differentiation have better OS (60.21 months) while, poorly grade was associated with shorter OS (43.07 months). On the concern of SCC, it was associated with shorter OS (37 months) in comparison to higher survival in patients with adenocarcinoma (46.13 months). Conclusion: Anal canal cancer has poorer prognosis than anorectal. The early-stage has a better OS that needs more effort for early diagnosis and treatment.

Resumo Antecedentes: O carcinoma anorretal inclui a margem anal, o canal anal e o reto inferior. A incidência de tumores anais representa 1.4 % de todos os tumores gastrointestinais. Pacientes e métodos: Nosso estudo é retrospectivo e foi realizado no Baghdad Medical City. Os dados do paciente foram coletados dos registros médicos por meio de uma folha pré-projetada que incluía as seguintes informações: dados demográficos, histórico médico, histórico anterior, sintomas de apresentação, dados patológicos e detalhes do tratamento. Resultados: A idade média foi de 49 anos. Quanto à extensão do tumor; 85,71 % dos pacientes apresentavam doença anal, enquanto o câncer anorretal foi encontrado em 14,28 % dos casos. A proporção homem/mulher foi de 1:3. A maioria dos casos foi de CEC 78,57 %. Apenas 11 pacientes (39,28 %) foram diagnosticados como Estágio I, enquanto 12 pacientes (42,85 %) apresentavam doença em Estágio II?III. Tumores diferenciados moderados são os mais comuns. A massa tumoral localizada entre 5-10 cm das distâncias da margem anal em 12 (42,85 %) dos pacientes. Foram encontrados 6 (21,42 % pacientes com testes virológicos positivos sem especificidade detectada. A TAEG foi a base para o tratamento da doença em Estágio I. O tratamento neoadjuvante seguido pela ressecção do TME foi o tratamento encontrado em tumores localmente avançados. A sobrevida global média OS dos pacientes que receberam TRC neoadjuvante no estudo foi de 43,5 meses, enquanto a OS média foi de 45,73 meses no cenário adjuvante. A análise univariada para OS de acordo com fatores prognósticos revelou que locais de câncer, notas e histopatologia foram fatores prognósticos independentes significativos para OS neste estudo. O tumor do canal anal foi associado a SG mais curtos 33,25 meses em comparação ao câncer anorretal OS = 47,22 meses. Com base no grau do tumor, a diferenciação boa e moderada apresenta melhor OS 60,21 meses, enquanto o grau ruim foi associado a um OS mais curto 43,07 meses. No que diz respeito ao CEC, este foi associado a uma OS mais curta 37 meses em comparação à maior sobrevida em pacientes com adenocarcinoma 46,13 meses. Conclusão: O câncer de canal anal tem pior prognóstico que o anorretal. O estágio inicial tem um sistema operacional melhor que precisa de mais esforço para diagnóstico e tratamento precoces.

Predictive factors for tumour response after the neoadjuvant-treatment of rectal adenocarcinoma / Fatores preditivos de resposta tumoral após tratamento neoadjuvante de adenocarcinoma retal

ABSTRACT Purpose Standard of care for locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. This study identified predictive factors for tumour response in our series. Patients and methods Between January 2005 and December 2018, 292 patients with locally advanced rectal cancer treated by preoperative chemo-radiation before surgery were retrospectively analyzed. The radiation dose was 50.4 Gy with fluoropyrimidine-based chemotherapy regimens. Patients-tumour and treatment-factors were tested for influence on tumour down staging and regression grade using Mandard scoring system on surgical specimens (TRG). Results Median age was 69 years (range 39-87); 33.9% of patients was Stage II and 54.5% Stage IIIB. Tumour down staging occurred in 211 patients (73%), including 63 patients (21.6%) with ypT0 (documented T0 at surgery) and 148 patients (50.7%) with a satisfactory tumour regression grade defined as TRG2­3. Upper rectal tumours were identified to predictive factors for pathologic complete response by univariate analysis (p = 0.002). TRG1­3 was associated with intervals from chemo-radiation to surgery (p = 0.004); TRG1­3 rates were higher with longer intervals: 1.71% in ≤ 5 weeks, 23.63% in 6-8 weeks and 46.9% in ≥ 9 weeks; and PTV 50.4 ≥ 800cc (p = 0.06); 3 and 5 years survivals were 85% and 90% for the group as a whole. Among ypT0 cases, the overall survival was 91.1% without significantly different (p = 0.25) compared with the remaining group, 87.2%. Among ypT0 cases, the relapse-free survival was 94.5%, with significantly different (p = 0.03) compared with the remaining group 78.2%. There were no treatment-associated fatalities. Thirty-two patients (10.96%) experienced Grade III/IV toxicities (proctitis, ephitelitis and neutropenia). Conclusions Tumour localization was identified as predictive factors of pathologic complete response for locally advanced rectal cancer treated with preoperative chemo-radiation. Upper rectal tumours are more likely to develop complete responses. Delay in surgery was identified as a favorable predictive factor for TRG1­3. The relapse-free survival in pathologic complete response group was higher compared with non-pathologic complete response.

RESUMO Objetivo O tratamento padrão para o câncer retal localmente avançado é a quimiorradioterapia neoadjuvante, seguida de cirurgia. Este estudo identificou fatores preditivos de resposta tumoral em nossa série. Pacientes e métodos Entre janeiro de 2005 e dezembro de 2018, 292 pacientes com câncer retal localmente avançado, tratados com quimiorradiação pré-operatória, foram retrospectivamente analisados. O tratamento quimioterápico foi à base de fluoropirimidina e a dose de radiação foi de 50,4 Gy. Os tumores dos pacientes e os fatores do tratamento foram testados quanto à influência no estadiamento do tumor e no grau de regressão usando o sistema de classificação de Mandard em espécimes cirúrgicos (TRG). Resultados A mediana das idades foi 69 anos (variação de 39 a 87); 33,9% dos pacientes estavam no estágio II e 54,5% no estágio IIIB. O estadiamento do tumor ocorreu em 211 pacientes (73%), incluindo 63 pacientes (21,6%) com ypT0 (T0 documentado na cirurgia) e 148 pacientes (50,7%) com grau satisfatório de regressão do tumor, definido como TRG1­3. Os tumores retais superiores foram identificados como fatores preditivos de resposta patológica completa por análise univariada p = 0,002. TRG1­3 foi associado aos intervalos entre a quimioterapia e a cirurgia p = 0,004; As taxas de TRG1­3 foram maiores com intervalos mais longos: 1,71% em ≤ 5 semanas, 23,63% em 6-8 semanas e 46,9% em ≥ 9 semanas; e PTV 50,4 ≥ 800cc (p = 0,06); as sobrevidas de 3 e 5 anos foram de 85% e 90% para o grupo em geral. Entre os casos de ypT0, a sobrevida global foi de 91,1%, sem diferença significativa (p = 0,25) na comparação com o grupo restante (87,2%). Entre os casos de ypT0, a sobrevida livre de recidiva foi de 94,5%, com diferença significativa (p = 0,03) na comparação com o grupo restante (78,2%). Não houve fatalidades associadas ao tratamento. Trinta e dois pacientes (10,96%) apresentaram toxicidade de grau III/IV (proctite, efitelite e neutropenia). Conclusões A localização do tumor foi identificada como fator preditivo de resposta patológica completa para o câncer retal localmente avançado tratado com quimiorradiação pré-operatória. Os tumores retais superiores têm mais probabilidade de desenvolver respostas completas. O atraso da cirurgia foi identificado como um fator preditivo favorável para o TRG1­3. A sobrevida livre de recidiva no grupo com resposta patológica completa à quimiorradioterapia pré-operatória foi maior comparado ao grupo com resposta patológica incompleta.

Prognostic importance of 18F-fluorodeoxyglucose uptake by positron emission tomography for stage III non-small cell lung cancer treated with definitive chemoradiotherapy. / Importancia pronóstica de la captación de 18F-Fluorodeoxiglucosa mediante tomografía de emisión de positrones para el cáncer de pulmón de células no pequeñas en estadio III tratado con quimio-radioterapia definitiva.

OBJECTIVES: Survival heterogeneity exists among patients with non-small cell lung cancer (NSCLC), even within the same stage. We aimed to evaluate the prognostic role of pre-treatment maximum standardized uptake value (SUVmax) in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC. MATERIALS AND METHODS: Between 2010 and 2017, 103 patients with stage III NSCLC who underwent 18F-FDG PET/CT at the time of diagnosis were included in the study. RESULTS: Higher tumor stages were correlated with higher pre-treatment SUVmax of lymph nodes (LNs) (p=0.005) but were not correlated with higher SUVmax of primary tumor (p=0.2). The median SUVmax of LNs was 2.84, 8.06, and 11.11 in stage IIIa, IIIb and IIIc, respectively. Higher nodal stage was also correlated with higher SUVmax of LNs (p=0.01). According to ROC analysis, there was no significant cut-off value of SUVmax observed for primary tumor, therefore continuous variables were used for survival analyses. The best SUVmax cut-off was 3.5 for the LNs, therefore the SUVmax of LNs was evaluated as both a dichotomous and a continuous variable. Pre-treatment SUVmax of primary tumor did not predict survival outcomes but both the continuous and dichotomous variables of SUVmax of LNs predicted recurrence free survival and overall survival. Nodal stage (N0-2 vs. N3) and AJCC stage (IIIa vs IIIb vs. IIIc) were the other prognostic factors. CONCLUSIONS: Pre-treatment SUVmax of LNs had prognostic value in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC. In future trials, pre-treatment SUVmax of the LNs would serve as a guide for patients who might benefit from more aggressive treatments.

Deglutition manifestations in patients with oropharyngeal cancer subjected to conservative therapy: systematic review / Manifestações da deglutição em pacientes com câncer de orofaringe submetidos à terapia conservadora: revisão sistemática

ABSTRACT Objectives: To characterize scientific production and identify deglutition changes in individuals with oropharyngeal cancer subjected to conservative therapy. Methods: The search was applied to five electronic database [Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine National Institutes of Health (PubMed), Web of Science, and Scopus], besides the search of grey literature in the databases (OpenThesis e OpenGrey), avoiding selection and publication bias. Prospective longitudinal studies concerning the theme: deglutition disorders in individuals with oropharyngeal cancer subjected to conservative therapy were considered eligible. The risk of bias and the evaluation of individual methodological quality of the selected studies were measured by "The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews" for prospective and longitudinal studies. Results: The search resulted in 899 records and after analysis four of them fulfilled the eligibility criteria. Among the studies included, all individuals presented some type of deglutition changes, the most common were: reduced of strength and retraction of the base of the tongue, delayed deglutition trigger, reduced laryngeal elevation, presence of residues on tongue and palate, in the pharyngeal area, valleculae, and posterior pharyngeal wall, as well as in the vestibules and in pyriform sinuses. Conclusion: The evidence from this systematic review suggests that conservative therapies cause deglutition changes or amplify the pre-existing ones, regardless of the type and magnitude of radiation, as well as tumor staging. However, there is little standardization in the research methodologies, making a meta-analysis study difficult to conduct.

RESUMEN Objetivos: Caracterizar la producción científica e identificar las alteraciones de deglución en personas con cáncer de orofaringe sometidas a tratamiento conservador. Métodos: Se realizó una búsqueda en cinco bases de datos electrónicas [Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine National Institutes of Health (PubMed), Web of Science y Scopus], además de la literatura gris en las bases de datos OpenThesis y OpenGrey, evitando sesgo de selección y publicación. Se consideraron elegibles los estudios longitudinales prospectivos sobre el tema: trastornos de deglución en pacientes con cáncer de orofaringe sometidos a tratamiento conservador. El riesgo de sesgo y la calidad metodológica individual de los estudios seleccionados se evaluaron mediante la herramienta de evaluación crítica del Instituto Joanna Briggs (JBI) para uso de sus revisiones sistemáticas, estudios prospectivos y longitudinales. Resultados: La búsqueda encontró 899 registros y, tras análisis, cuatro de ellos cumplieron los criterios de elegibilidad. Entre los estudios incluidos, todos los pacientes presentaron algún tipo de trastorno de la deglución. Los más frecuentes fueron: fuerza y retracción reducidas de la base de la lengua, retraso en el disparo de la deglución, elevación laríngea reducida, presencia de residuo en lengua y paladar, en región faríngea, valléculas y pared posterior de la faringe, así como en el interior de los vestíbulos y en los senos piriformes. Conclusión: Esta revisión sistemática sugiere que los tratamientos conservadores producen alteraciones de deglución o intensifican aquellas que ya existen, independientemente del tipo y de la intensidad de radiación, así como de la estadificación del tumor. Hay, sin embargo, poca estandarización en las metodologías de investigación, lo que hace difícil un estudio de metanálisis.

RESUMO Objetivos: Caracterizar a produção científica e identificar as alterações da deglutição em indivíduos com câncer de orofaringe submetidos à terapia conservadora. Métodos: Realizou-se uma busca em cinco base de dados eletrônicas [Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine National Institutes of Health (PubMed), Web of Science e Scopus], além da busca da literatura cinzenta nas bases de dados (OpenThesis e OpenGrey), evitando viés de seleção e publicação. Foram considerados elegíveis estudos longitudinais prospectivos sobre o tema: alterações de deglutição em indivíduos com câncer de orofaringe submetidos à terapia conservadora. O risco de viés e a qualidade metodológica individual dos estudos selecionados foram avaliados pela ferramenta de avaliação crítica do Joanna Briggs Institute (JBI) para uso de suas revisões sistemáticas, estudos prospectivos e longitudinais. Resultados: A busca resultou em 899 registros e, após análise, quatro deles atenderam aos critérios de elegibilidade. Entre os estudos incluídos, todos os indivíduos apresentaram algum tipo de alteração de deglutição; os mais frequentes foram: força e retração da base da língua reduzidas, atraso no disparo da deglutição, elevação laríngea reduzida, presença de resíduo em língua e palato, em região faríngea, valéculas e parede posterior da faringe, bem como no interior dos vestíbulos e em seios piriformes. Conclusão: Esta revisão sistemática sugere que as terapias conservadoras produzem distúrbios de deglutição ou intensificam os já existentes, independentemente do tipo e da intensidade de radiação, bem como do estadiamento do tumor. Há, no entanto, pouca padronização nas metodologias das pesquisas, dificultando um estudo de metanálise.

Rectal carcinoma with synchronous liver metastases / Carcinoma retal com metástases hepáticas síncronas

Abstract Introduction Colorectal cancer is amongst the most prevailing malignancies in the world and it is associated with a relatively high mortality rate. Rectal cancer occurs in 20-30% of all colorectal cancer cases, and 25% of this present synchronous metastatic disease. This study aims to review the current treatment approaches for rectal cancer patients with synchronous liver metastases, as there are no specific guidelines for the management of this group of patients. Methods A systematic literature search was performed on Pubmed database with a 10 year timeline limitation from 2008 to 2018. Results Currently, the only potentially curative approach remains to be the surgical resection. Conventionally, the classical strategy of these patients involves resection of rectal tumor, followed by liver resection, with chemotherapy sessions between the two procedures. However, recent studies have reported no inferiority, in safety and survival outcomes, when compared with other approaches (liver-first resection or simultaneous resection), except when symptoms of primary tumor are present. Hence, treatment strategy should be individualized based on the assessment of metastatic extent, primary tumor symptoms and the patient's overall clinical status. Chemotherapy and targeted agents have substantially contributed to overall survival improvements, allowing enhanced tumor down staging. Conclusion Complete resection of liver metastases is considered the major condition for a potential survival outcome in these patients. Management of these patients should include a multidisciplinary team with consideration of each individual specificities. Prospective randomized trials are needed to elucidate the optimal treatment strategy.

Introdução: O câncer colorretal está entre as neoplasias mais prevalentes no mundo, apresentando a uma taxa de mortalidade relativamente alta. Ele corresponde a 20% a 30% de todos os casos de câncer colorretal; 25% dos casos apresentam doença metastática síncrona. Este estudo teve como objetivo revisar as abordagens atuais de tratamento para pacientes com câncer retal com metástases hepáticas síncronas, uma vez que não existem diretrizes específicas para o manejo deste grupo de pacientes. Métodos: Uma busca sistemática da literatura foi realizada no banco de dados PubMed com uma limitação temporal de 10 anos (2008 a 2018). Resultados: Atualmente, a ressecção cirúrgica ainda é a única abordagem potencialmente curativa. Tradicionalmente, a estratégia clássica para o tratamento desses pacientes envolve a ressecção do tumor retal, seguida de ressecção hepática, com sessões de quimioterapia entre os dois procedimentos. No entanto, ao comparar a abordagem tradicional com outras técnicas (ressecção em primeiro plano do fígado ou ressecção simultânea), estudos recentes não relataram inferioridade nos desfechos de segurança e sobrevida, exceto quando sintomas de tumor primário estão presentes. Portanto, a estratégia de tratamento deve ser individualizada com base na avaliação da extensão metastática, nos sintomas primários do tumor e no estado clínico geral do paciente. A quimioterapia e os agentes dirigidos contribuíram substancialmente para as melhorias gerais na sobrevida, permitindo uma maior redução do estadiamento tumoral. Conclusão: A ressecção completa de metástases hepáticas é considerado o principal requisito para um possível resultado de sobrevida nesses pacientes. O manejo desses pacientes deve incluir uma equipe multidisciplinar e considerar as características específicas de cada paciente. Estudos prospectivos randomizados são necessários para elucidar a estratégia de tratamento ideal.

Rectal cancer and chemoradiation in Iraq: systematic review and meta-analysis / Câncer retal e quimiorradioterapia no Iraque: revisão sistemática e metanálise

Abstract Background: Rectal cancer is one of the most common malignant tumors of gastrointestinal tract. Combining chemotherapy with radiotherapy has a sound effect on its management. Objectives: Assessment the patterns of characterizations of rectal cancer. Evaluation of the efficacy, and long-term survival of pre-/ postoperative chemoradiation. Collecting all eligible evidence articles and summarize the results. Methods: By this systematic review and meta-analysis study, we include data of chemoradiation of rectal cancer articles from 2015 until 2019. The research was carried out at Baghdad Medical City oncology centers. Accordance with the PRISMA guidelines, and the Newcastle-Ottawa Scale used. Results: Starting with gender distribution as M:F ratio of 0.94:1.06. Regarding the age, recorded mean ± SD of 48.7 ± 14.2 years. Rectosigmoid represented the most common site as 50(49.5%), and adenocarcinoma was common histopathology as 76(75.2%) of patients, with localized stage in 50(49.5%). The moderate differentiation was most grade as 65(64.4%). The distant from anal verge mostly seen was 5-10 cm in 59(58.4%). The pulmonary was commonest site of metastasis in 11(10.9%). Most patients undergo APR operation, which has done in 41(40.6%). Adjuvant chemoradiation received by 40(39.6%) patients, whereas neoadjuvant chemoradiation gave to 25 patients. A total of 2609 articles from 12 databases met our search strategies. The highest Newcastle-Ottawa score (8) demonstrated in three studies, and median score (7) calculated in five studies. Conclusions: The incidence belonged to 5th and 6th decade of life. Rectosigmoid represented the most common site. Mostly, the 5-10 cm distant of tumor from anal verge was common finding. The pulmonary was most site of metastasis. We concluded the formulation of a novel point that survival benefit found in many pre or postoperative chemoradiation trials in rectal cancer.

Resumo Introdução: O câncer retal é um dos tumores malignos mais comuns do trato gastrointestinal. A combinação de quimioterapia e radioterapia em seu tratamento é eficaz. Objetivos: Avaliar os padrões de caracterização do câncer retal. Avaliar a eficácia e sobrevida a longo prazo em pacientes submetidos a quimiorradioterapia pré- ou pós-operatória. Coletar todos os artigos de evidências qualificados e resumir os resultados. Métodos: Esta revisão sistemática e metanálise incluiu dados de ensaios clínicos randomizados por cluster de 2015 até 2019. A pesquisa foi realizada nos centros de oncologia do Baghdad Medical City. As diretrizes PRISMA e a escala de Newcastle-Ottawa foram utilizadas para avaliar os estudos. Resultados: Quanto à distribuição por sexo, observou-se uma relação homem:mulher de 0,94:1,06. Em relação à idade, a média ± DP foi de 48,7 ± 14,2 anos. O retossigmoide fpo o local mais comum em 50 pacientes (49,5%); a histopatologia mais comum foi adenocarcinoma, observada em 76 pacientes (75,2%), com estágio localizado em 50 (49,5%). Diferenciação moderada foi observada em 65 pacientes (64,4%). A distância da borda anal variou entre 5 e 10 cm em 59 pacientes (58,4%). O pulmão foi o local mais comum de metástase, sendo observado em 11 pacientes (10,9%). A maioria dos pacientes (41 [40,6%]) foi submetida à ressecção abdominoperineal. Um total de 40 pacientes (39,6%) foram submetidos a quimiorradioterapia adjuvante e 25, a quimiorradioterapia neoadjuvante. Na revisão da literatura, foram encontrados 2.609 artigos que atendiam aos critérios de pesquisa utilizados em 12 bancos de dados. Três estudos atingiram o escore máximo na escala de Newcastle-Ottawa (8); cinco estudos atingiram o escore mediano (7). Conclusões: No presente estudo, a maior incidência de câncer retal foi observada entre a quinta e sexta décadas de vida. O retossigmoide foi o sítio tumoral mais comum. A maioria dos tumores estava localizado entre 5 a 10 cm de distância da margem anal. O pulmão foi o local mais importante de metástase. No presente estudo, quimiorradioterapia pré- ou pós-operatória estava relacionada a uma maior sobrevida em casos de câncer retal.

Carcinoma escamocelular del canal anal metastásico en un paciente con VIH tratado con quimiorradioterapia concomitante. Reporte de un caso y revisión de la literatura / Metastatic anal canal squamous cell carcinoma in a patient with HIV treated with concomitant radiotherapy chemo. Case report and literature review

Resumen El carcinoma del canal anal es responsable de hasta el 4% de los casos de cáncer de colon, recto y ano; el tipo histológico más común es el carcinoma escamocelular. Una proporción no despreciable de pacientes se presenta con enfermedad metastásica al momento del diagnóstico. En estos estadios, el pronóstico es pobre y su tratamiento usualmente se basa en quimioterapia paliativa con cisplatino y 5-fluorouracilo, con tasas de supervivencia que no superan el 30% a 5 años. Algunos estudios recientes han sugerido que el tratamiento multidisciplinario con quimiorradiación, que se brinda en estadios más tempranos de la enfermedad, podría mejorar la supervivencia en un grupo seleccionado de pacientes. A continuación, presentamos el caso de un paciente masculino de 54 años con carcinoma escamocelular del canal anal con compromiso metastásico extenso y con VIH atendido en una institución especializada en el manejo de cáncer, en el cual se logró remisión completa de la enfermedad luego del manejo con quimiorradioterapia concomitante con mitomicina C y 5-fluorouracilo y se mantiene en remisión después de cerca de 4 años de haberse suspendido el tratamiento. Se discute el caso y se revisa la literatura al respecto.

Abstract Anal canal carcinoma is responsible for up to 4% of all cases of colon, rectum and anus cancer. The most common histological type is squamous cell carcinoma. A non-negligible proportion of patients have metastasized by the time of diagnosis. In these stages the prognosis is poor, and treatment is usually based on palliative chemotherapy with cisplatin and 5-fluorouracil. Five year survival rates do not exceed 30%. Some recent studies have suggested that multidisciplinary chemoradiotherapy (chemotherapy combined with radiation therapy) in earlier stages of the disease could improve survival for a select group of patients. We present the case of a 54-year-old male patient with squamous cell carcinoma of the anal canal with extensive metastasis who also had HIV. He was treated at an institution specializing in cancer treatment where complete remission of the disease was achieved after treatment with chemoradiotherapy with Mitomycin C and 5-fluorouracil. He remains in remission four years after discontinuation of treatment. We discuss the case and review the literature.

HIF-1α Levels in patients receiving chemoradiotherapy for locally advanced non-small cell lung carcinoma

SUMMARY AIM To examine the relationship between treatment response and hypoxia-inducible factor-1 alpha (HIF-1α) levels in patients with locally advanced non-small cell lung cancer (NSCLC) who received chemoradiotherapy (CRT). METHODS Eighty patients with NSCLC were included in the study and treated at Acibadem Mehmet Ali Aydınlar University Medical Faculty. HIF-1 α levels were measured before and after CRT by the enzyme-linked immunosorbent assay (ELISA) method. RESULTS Patients' stages were as follows; stage IIIA (65%) and stage IIIB (35%). Squamous histology was 45%, adenocarcinoma was 44%, and others were 11%. Chemotherapy and radiotherapy were given concurrently to 80 patients. Forty-five (56%) patients received cisplatin-based chemotherapy, and 35 (44%) received carboplatin-based chemotherapy. Serum HIF-1α levels (42.90 ± 10.55 pg/mL) after CRT were significantly lower than the pretreatment levels (63.10 ± 10.22 pg/mL, p<0.001) in patients with locally advanced NSCLC. CONCLUSION The results of this study revealed that serum HIF-1α levels decreased after CRT. Decrease of HIF-1α levels after the initiation of CRT may be useful for predicting the efficacy of CRT.

RESUMO OBJETIVO Examinar a relação entre a resposta ao tratamento e os níveis de fator 1 induzida por hipóxia (HIF-1α) em pacientes com câncer de pulmão de células não pequenas localmente avançado (NSCLC) que receberam quimiorradioterapia (CRT). MÉTODO Oitenta pacientes com NSCLC foram incluídos no estudo e foram tratados na Faculdade de Medicina da Acibadem Mehmet Ali Aydınlar University. O nível de HIF-1α foi medido antes e depois da TRC pelo método de ensaio imunoenzimático (ELISA). RESULTADOS Os estágios dos pacientes foram os seguintes; estágio IIIA (65%) e estágio IIIB (35%). A histologia escamosa foi de 45%, o adenocarcinoma de 44% e o outro de 11%. Quimioterapia e radioterapia foram dadas simultaneamente a 80 pacientes. Quarenta e cinco (56%) pacientes receberam quimioterapia à base de cisplatina e 35 (44%) receberam quimioterapia à base de carboplatina. Os níveis séricos de HIF-1α (42,90 ± 10,55 pg / mL) após a TRC foram significativamente menores do que os níveis pré-tratamento (63,10 ± 10,22 pg / mL, p <0,001) em pacientes com NSCLC localmente avançado. CONCLUSÃO Os resultados deste estudo revelaram que os níveis séricos de HIF-1α diminuíram após a TRC. A diminuição dos níveis de HIF-1α após o início da TRC pode ser útil para prever a eficácia da TRC.

Timing of neoadjuvant therapy and surgical treatment in rectal cancer / Tempo da terapia neoadjuvante e tratamento cirúrgico no câncer retal

ABSTRACT Study objectives: To evaluate the ideal timing between neoadjuvant therapy and surgical treatment of rectal cancer, as well as the influence on treatment outcomes. Methods: Using PubMed, a systematic literature search was made on the influence of surgery timing after chemoradiotherapy in treating rectal cancer. Results and discussion: A total of 34 articles published until April 2017 were analyzed. Nine of them were randomized clinical trials, one was a non-randomized trial, 23 were retrospective studies, and one was a meta-analysis. These studies compared treatment intervals varying between two and 19 weeks. Intervals of nine to 14 weeks showed increased tumor downstaging and higher rates of complete pathological response. These intervals shown safety for patients. Nonetheless, few studies showed differences in overall survival. The most used intervals between neoadjuvant chemoradiotherapy are six to eight weeks. Despite that, intervals longer than these show potential benefits for patients without putting them at risk of disease progression. Studies evaluating the effect of overall survival and long-term recurrence are scarce. Conclusion: Programming surgery more than eight weeks after chemoradiotherapy seems preferable to the six to eight weeks most recently practiced, increasing tumor downstaging and having higher complete pathological response rates.

RESUMO Objetivos do estudo: Avaliar o timing ideal entre a terapêutica neoadjuvante e cirúrgica no carcinoma do reto e a sua influência nos outcomes de tratamento. Material e métodos: Utilizando a "PubMed", foi feita uma revisão sistemática da literatura disponível acerca da influência do timing cirúrgico após quimiorradioterapia neoadjuvante no tratamento do carcinoma do reto. Resultados e discussão: Foram analisados 34 artigos publicados até Abril de 2017, sendo que destes nove foram ensaios clínicos randomizados, um foi ensaio clínico não randomizado, 23 foram estudos retrospetivos e um foi uma meta-análise. Estes estudos compararam intervalos de tratamento que variaram entre 2 e 19 semanas. Intervalos entre as 9-14 semanas demonstraram aumento do downstaging tumoral e da taxa de resposta patológica completa. Estes intervalos demonstraram segurança para os doentes. Contudo, poucos estudos demonstraram diferenças na sobrevida dos doentes. Os intervalos mais usados entre a QRT neoadjuvante e o tratamento cirúrgico são de 6-8 semanas. Apesar disso, intervalos superiores às 6-8 semanas demonstram potenciais benefícios para os pacientes sem os colocar em risco de progressão da doença. São limitados os estudos que avaliam o efeito na sobrevida e recorrência em longo prazo. Conclusão: A programação da cirurgia superior às 8 semanas após quimiorradioterapia parece ser preferível às 6-8 semanas até recentemente praticada, aumentando o downstaging tumoral e a taxa de resposta patológica completa.

Patients with locally advanced hypopharyngeal carcinoma. Results over a 30-year period. / Pacientes con carcinoma localmente avanzado de hipofaringe. Resultados a lo largo de un periodo de 30 años.

INTRODUCTION AND OBJECTIVES: The treatment of locally advanced carcinomas of the hypopharynx may include surgery or several combinations of radiotherapy and chemotherapy as organ preservation strategies. The objective of the present study is to analyze the results of locally advanced hypopharyngeal carcinoma patients treated in a single centre over a 30-year period. METHODS: Retrospective chart review of 278 patients with T3-T4 hypopharyngeal carcinomas treated between 1985 and 2015 at a tertiary institution. RESULTS: As much as 15.5% of the patients received only palliative treatment. Surgery, usually followed by radiotherapy or chemoradiotherapy was offered to 38.1% of the patients, and radiotherapy or chemoradiotherapy alone was offered to the remaining 46.6% of the patients. Cause-specific survival at 5 years was 39.7% (95% CI 33.7-45.7) for the whole sample. Surgery achieved better local control of the disease, but these figures did not translate into an increase of cause-specific survival for T3 tumours. Five-year survival free of laryngeal dysfunction for patients who received conservative treatment was 36.4%. In a multivariate analysis, only T4 local extension, N2-3 category, and posterior hypopharyngeal wall location related significantly with cause-specific survival. CONCLUSIONS: There were no significant differences in cause-specific survival related to treatment modality for T3 carcinomas. On the other hand, surgery achieved a significant increase in cause-specific survival for T4 hypopharyngeal carcinomas.

Prognostic value of primary tumor SUVmax on pre-treatment 18F-FDG PET/CT imaging in patients with stage iii non-small cell lung cancer. / Valor pronóstico del SUVmáx del tumor primario pretratamiento con PET/TC con 18F-FDG en pacientes con cáncer de pulmón no microcítico en estadio iii.

OBJECTIVES: Concomitant chemoradiotherapy (CCRT) is widely used in the treatment of patients with stage iii non-small cell lung carcinoma (NSCLC). The early identification of patients with poor prognosis is the premise of personalized treatment for patients. The aim of the study was to evaluate the prognostic value of clinical parameters and primary tumor SUVmax on pre-treatment 18F-FDG PET/CT in patients with stage iii NSCLC. MATERIAL AND METHODS: Clinical records of 79 stage iii-NSCLC patients with pre-treatment 18F-FDG PET/CT imaging, treated with definitive CCRT were retrospectively reviewed. The clinical endpoints in terms of progression-free survival (PFS) and overall survival (OS) were correlated with the median pre-treatment primary tumor SUVmax. Furthermore, other factors influencing patient outcome were analyzed. RESULTS: The median age of patients was 58 years (range, 45-71) with 72 (91%) males. Squamous cell carcinoma (73%) was the most common histologic type. Performance status was very good (ECOG 0) in 64.5% of patients. Sixty (79%) patients had died at the time of this analysis. Median OS and PFS were 22.5 and 12.0 months, respectively. Patients were dichotomized according to pre-treatment primary tumor SUVmax≤15.0 vs.>15.0. There was no statistically significant difference for OS and PFS in both arms. Multivariate analysis showed that pre-treatment SUVmax was not a significant predictor of OS (HR 1.099, P=0.726) and PFS (HR 1.022, P=0.941). CONCLUSIONS: SUVmax with threshold value of 15.0 on the primary tumor before treatment had no prognostic value in our patient group with stage iii NSCLC treated with definitive CCRT.

Correlação da desvantagem vocal e qualidade de vida em deglutição de pacientes com câncer de laringe submetidos à quimiorradioterapia / Correlation between the Voice Handicap and Swallowing Quality of Life in patients with laryngeal cancer submitted to chemoradiotherapy

RESUMO Objetivo Verificar a correlação entre desvantagem vocal e a qualidade de vida em deglutição de indivíduos que foram submetidos ao tratamento quimiorradioterápico para câncer de laringe. Método Estudo transversal, observacional e quantitativo do qual participaram 14 indivíduos do gênero masculino diagnosticados com câncer de laringe, que, para tratamento, fizeram uso exclusivo de quimiorradioterapia. Aplicaram-se os instrumentos Índice de Desvantagem Vocal e Protocolo de Qualidade de Vida em Deglutição SWAL-QoL. Fez-se análise descritiva e, em seguida, aplicou-se o teste de Correlação de Spearman para verificar se havia correlação entre os escores dos instrumentos aplicados. Foram considerados estatisticamente significativos os valores de p ≤ 0,05. Resultados Não houve correlação significativa entre os domínios total do IDV e global do SWAl-QoL, porém houve correlação significante entre os domínios "Funcional" do IDV e os domínios "Fadiga" e "Social" do Swal-Qol; domínio "Orgânico" do IDV com o domínio "Social" do SWAL-QoL; escore total do IDV, com o domínio de "Deglutição como um fardo" do SWAL-QoL. Além disso, foi possível observar que o tratamento quimiorradioterápico ocasionou maior impacto em relação à voz do que em relação à deglutição para os pacientes estudados. Conclusão Os dados demonstraram correlação significante entre a desvantagem vocal e o impacto da qualidade de vida em deglutição de pacientes com câncer de laringe submetidos à quimiorradioterapia, podendo afetar seu estado emocional e sua socialização, piorando assim, sua qualidade de vida de modo geral.

ABSTRACT Purpose To verify the correlation between the voice handicap and swallowing quality of life in individuals submitted to chemoradiotherapy for laryngeal cancer treatment. Methods Cross-sectional, observational and quantitative study. Fourteen male individuals diagnosed with laryngeal cancer were submitted to exclusive chemoradiotherapy treatment. The individuals completed the Voice Handicap Index (VHI) and the Swallowing Quality of Life (SWAL-QOL) questionnaires. Data were submitted to descriptive and inferential analysis using Spearman's Correlation Test to verify possible correlations among the scores of these instruments. Values of p ≤ 0.05 were considered statistically significant. Results No significant correlation was found between the total VHI and overall SWAL-QOL scores. However, there was significant correlation between the domain Functional of the VHI and the domains Fatigue and Social of the SWAL-QOL, between the domain Organic in the VHI and the SWAL-QOL domain Social, and total VHI score and SWAL-QOL domain Swallowing as a burden. Furthermore, chemoradiotherapy treatment had a greater impact on the voice than on the swallowing for the studied individuals. Conclusion The data showed a significant correlation between voice handicap and the impact of quality of life involving swallowing in individuals with laryngeal cancer submitted to chemoradiotherapy. This may affect individuals' emotional and social aspects, impacting their overall quality of life.

Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical cancer / Influência da quimiorradioterapia no estado nutricional, capacidade funcional, qualidade de vida e toxicidade do tratamento para pacientes com câncer cervical

Introduction: The adverse effects provoked by antineoplastic therapy may aggravate preexisting alterations of the nutritional status and can result in a larger chance of toxicity, bringing about other adverse consequences, such as a diminished response and tolerance of the treatment and reduction of quality of life (QoL). Objective: The objective of this study was to assess the influence of chemoradiotherapy on the nutritional status, functional capacity, and quality of life (QoL), associating these indicators with toxicity and interruption of oncologic treatment in women with cervical cancer. Methods: Prospective cohort study performed on 49 women, who underwent treatment between August 2015 and January 2016. For data collection, two appointments took place with the researcher in charge: the first one occurring the day before the first chemotherapy session (T0) and the other one after 35 days (T1). Nutritional status was measured by anthropometry and computed tomography (skeletal muscle index ­ SMI), functional capacity by handgrip strength (HGS) and Karnofsky Perfomace Status (KPS), and application of QoL questionnaire (EORTC QLQ-C30). Results: There was significant reduction in weight, BMI, HGS, KPS and QoL between T0 and T1. The interruption of chemotherapy was significantly associated with the variables of nutritional status assessed, in addition to a significant QoL reduction according to worsening nutritional status. Women that interrupted their treatment due to acute toxicity also had an SMI median significantly smaller in relation to those who concluded the treatment and 83% of these patients presented cachexia. Conclusion: Chemoradiotherapy treatment in patients with cervical cancer had changed negatively nutritional parameters, function capacity and QoL.(AU)

Introdução: Os efeitos adversos provocados pela terapia antineoplásica podem agravar alterações preexistentes do estado nutricional, que resultam em maior chance de toxicidade, além de outras consequências adversas, como diminuição da resposta e tolerância ao tratamento e redução da qualidade de vida (QV). Objetivo: O objetivo do estudo foi avaliar a influência da quimiorradioterapia sobre o estado nutricional, capacidade funcional e QV, associando esses indicadores à toxicidade e interrupção do tratamento oncológico em mulheres com câncer de colo uterino. Método: Foi realizado um estudo de coorte prospectivo com 49 mulheres submetidas ao tratamento quimiorradioterápico entre agosto de 2015 e janeiro de 2016. Para coleta de dados, foram realizadas duas consultas com o pesquisador responsável: a primeira ocorreu no dia anterior à primeira sessão de quimioterapia (T0) e a outra após 35 dias (T1). Em ambas as consultas, o estado nutricional foi avaliado por antropometria, a capacidade funcional pela força de preensão palmar (FPP) e pelo Karnofsky Performance Status (KPS) e foi aplicado um questionário específico para QV (EORTC QLQ-C30). Adicionalmente, foi utilizada a tomografia computadorizada para avaliação da massa magra (índice de músculo esquelético - IME) disponível no T0. Resultados: Houve redução significativa no peso, IMC, FPP, KPS e QV entre T0 e T1. A interrupção da quimioterapia foi significativamente associada às variáveis de estado nutricional, além de uma redução significativa da QV de acordo com a piora do estado nutricional. As mulheres que interromperam seu tratamento devido à toxicidade aguda também apresentavam mediana de IME significativamente menor em relação àquelas que concluíram o tratamento e 83% dessas pacientes apresentaram caquexia. Conclusão: O tratamento quimiorradioterápico em pacientes com câncer de colo uterino impactou negativamente nos parâmetros nutricionais, na capacidade funcional e na QV.(AU)

Neoadjuvant therapy and transanal endoscopic surgery in T2-T3 superficial, N0, M0 rectal tumors. Local recurrence, complete clinical and pathological response. / Neoadyuvancia y cirugía endoscópica transanal en neoplasias de recto T2-T3 superficial, N0, M0. Recidiva local, respuesta clínica y patológica completa.

INTRODUCTION: The association of preoperative chemoradiotherapy and transanal endoscopic surgery in T2 and superficial T3 rectal cancers presents promising results in selected patients. The main objective is to evaluate the long-term loco-regional and systemic recurrence and, as secondary objectives, to provide results of postoperative morbidity and the correlation between complete clinical and pathological response. METHODS: This is a retrospective observational study including a consecutive series of patients with T2-T3 superficial rectal cancer, N0, M0 who refused radical surgery (2008-2016). The treatment consisted of preoperative chemotherapy (5-fluorouracil or capecitabine) combined with radiotherapy (50, 4Gy) and transanal endoscopic surgery after 8weeks. Preoperative, surgical, pathological and long-term oncologic results were analyzed. RESULTS: Twenty-four patients were included in the study. Two of them required rescue radical surgery for unfavorable pathological results. A local recurrence (4.5%) was observed and 2patients presented systemic recurrence (9%), with a median follow-up of 45 months. A complete clinical tumor response was achieved in 12 patients (50%), and complete pathological tumor response in 9 patients (37.5%). Postoperative complications were observed in 5 patients (20.8%), and they were mild except one. There was no postoperative mortality. CONCLUSIONS: In this stage of rectal cancer, our results seem to support this strategy, mainly when a complete pathological response is achieved. The complete clinical tumor response does not coincide with the pathological tumor response. Randomized prospective studies should be performed to standardize this treatment.

Aumento da fadiga e redução da qualidade de vida após tratamento de câncer do colo do útero / Increased fatigue and reduced quality of life after treatment of cervical cancer

Introdução: o câncer do colo do útero (CCU) acarreta prejuízos físicos e emocionais, sendo um grande problema de saúde pública. Objetivo: avaliar fadiga, capacidade funcional e qualidade de vida antes e após o tratamento com quimiorradioterapia para o CCU. Métodos: a avaliação de fadiga e qualidade de vida foi realizada por meio dos questionários: Inventário Breve de Fadiga (BFI) e Functional Assessment of Chronic Therapy ­ Cervix Cancer (FACT-Cx), respectivamente, já a capacidade funcional por mensuração direta pelo Teste do degrau (TD6). Participaram 11 mulheres com CCU. O Graphpad Prism® foi utilizado para estatística. Resultados: após a quimiorradioterapia houve aumento significativo da fadiga (de 2,80 para 4,83), redução significativa da qualidade de vida (de 107,8 para 88,1) e redução da capacidade funcional (de 91 degraus para 82 degraus). Conclusão: aumento da fadiga e redução da qualidade de vida foram observados uma semana após a realização de quimiorradioterapia para o CCU.

Introduction: cervical cancer (CC) causes physical and emotional damage and is a major public health problem. Objective: to evaluate fatigue, functional capacity and quality of life before and after treatment with chemoradiotherapy for CC. Method: the evaluation of fatigue and quality of life were performed through questionnaires the Brief Fatigue Inventory (BFI) and Functional Assessment of Chronic Therapy (FACT-Cx), respectively, and the functional capacity by direct measurement by the Test of the step (TD6). Eleven women participated with CC. Graphpad Prism® was used for statistics. Results: after chemoradiotherapy, there was a significant increase in fatigue (from 2.80 to 4.83), a significant reduction in quality of life (from 107.8 to 88.1) and reduction in functional capacity (from 91 steps to 82 steps). Conclusion: increased fatigue and reduced quality of life were observed one week after the completion of chemoradiotherapy for CC.

Tratamiento no quirúrgico en cáncer epidermoide de orofaringe avanzado: análisis de resultados oncológicos en función del subsitio tumoral y fraccionamiento de radioterapia / Nonsurgical treatment in advanced oropharyngeal squamous cell cancer

Objetivo: Reportar resultados de nuestro protocolo de radioquimioterapia concomitante exclusiva en el cáncer de orofaringe avanzado. Materiales y métodos: Estudio retrospectivo que incluyó 87 pacientes. Se realizó radioterapia concomitante con cisplatino semanal. Se aceptó la realización de fraccionamiento convencional (FC), hiperfraccionamiento (Hfx) o fraccionamiento acelerado tipo boost concomitante (FABC). Se revisó la sobrevida global (SG), sobrevida libre de enfermedad (SLE), sobrevida libre de recidiva local (SLRL) y regional (SLRR) según subsitio y fraccionamiento. Resultados: Ingresaron 87 pacientes. Mediana de seguimiento: 120 meses. El 53, 30 y 17% recibieron FC, FABC y Hfx respectivamente. La SG a 2, 5 y 10 años fue de un 73, 61 y 43% respectivamente. La SG a 5 años según subsitio anatómico fue: amígdala 74%, paladar blando 33%, base de lengua 33%, y pared faríngea posterior 33%. Al comparar la SG de amígdala versus otros subsitios se alcanza una diferencia estadísticamente significativa (p < 0,001). La mediana de SG para amígdala no fue alcanzada, mientras que en otros subsitios fue de 22 meses. La SLE fue diferente en los distintos subsitios, superior en amígdala y diferente entre los distintos fraccionamientos, a favor de Hfx, alcanzando diferencias significativas. Las mismas tendencias se demostraron en SLRL y SLRR. Observamos un 23% de segundos primarios, siendo el pulmón el sitio más frecuente. Conclusión: La radioterapia concomitante con cisplatino semanal es un tratamiento adecuado para el cáncer de orofaringe. Ofrece excelentes resultados en cáncer de amígdala, especialmente con fraccionamiento modificado. Para los otros subsitios nos parece recomendable explorar nuevas estrategias de tratamiento.

Objective: To report results of our concomitant radiochemotherapy protocol for advanced oropharyngeal cancer. Materials and methods: Retrospective study. Concomitant radiochemotherapy was performed with weekly cisplatin. Conventional fractionation (CF), hyperfractionation (Hfx) or accelerated fractionation with concomitant boost (FABC) were accepted. Overall survival (OS), Disease-free survival (RFS), Local relapse-free survival (LRFS) and Regional relapse-free survival (RRFS) were calculated, according subsite and radiotherapy fractionation. Results: We found 87 patients. Median follow-up: 120 months. 53%, 30% and 17% received FC, FABC, Hfx respectively. OS at 2, 5 and 10 years was 73%, 61% and 43% respectively. The 5-year OS was, by anatomic subsite: Tonsillar 74%, 33% soft palate, base of tongue 33%, and 33% for posterior pharyngeal wall. By comparing the OS in tonsil versus other subsites we found statistically significant difference in favor of tonsillar cancer (P < .001). Median OS for tonsillar cancer was not achieved, while in other subsites was 22 months. DFS was different in different subsites, better for amygdala and different among different fractionations, better for Hfx, reaching significant differences. The same trends were demonstrated in LRFS and RRFS. We observed a 23% of second cancers, being lung the most common site. Conclusion: Concomitant radiotherapy with weekly cisplatin is an appropriate treatment for oropharyngeal cancer. It provides excellent outcomes in tonsillar cancer, especially with modified fractionation and Hfx type. For other subsites it seems advisable to explore a new treatment approach.

Results of surgery for pelvic recurrence of rectal cancer. Experience in a referral center. / Resultados de la cirugía de la recidiva pélvica de cáncer de recto. Experiencia en un centro de referencia.

INTRODUCTION: The only curative treatment of pelvic recurrence of rectal cancer is radical resection. The aim of this paper is to analyze our experience in surgery for local recurrence of rectal cancer. METHODS: We performed a descriptive retrospective analysis of patients treated with curative intent for local recurrence of rectal cancer from May 2000 to January 2014. The presence of resectable liver or lung metastases was not an exclusion criterion. The descriptive results, overall survival and disease free survival are presented. RESULTS: A total of 35 patients were included. In 18 patients an abdomino-perineal resection of the remaining rectum was performed. Two of them included excision of lower sacral vertebrae, while in 17 patients, sphincter sparing surgery was performed. The most frequent postoperative complications were pelvic collection and postoperative ileus. Seven patients required reoperation and one patient died. Overall survival at one year was 91.2%, at 2 years 75.6% and at 5 years 37%. CONCLUSIONS: Local recurrence of rectal cancer is a disease with high curability rate. The only curative option is radical surgery, with acceptable mortality.