Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.382
Filtrar
1.
JAMA Netw Open ; 4(2): e2036741, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33630085

RESUMO

Importance: In clinical trials supporting the regulatory approval of oncology drugs, solid tumor response is assessed using Response Evaluation Criteria in Solid Tumors (RECIST). Calculation of RECIST-based responses requires sequential, timed imaging data, which presents challenges to the method's application in real-world evidence research. Objective: To evaluate the feasibility and validity of a novel real-world RECIST method in assessing tumor burden associated with therapy for a large heterogeneous patient population undergoing treatment in routine clinical practice. Design, Setting, and Participants: This cohort study used physician-abstracted data pooled from retrospective, multisite electronic health record (EHR) review studies of patients treated with anticancer drugs at US oncology practices from 2014 through 2017. Included patients were receiving first-line treatment for thyroid cancer, breast cancer, or metastatic melanoma. Data were analyzed from March through August 2020. Exposures: Undergoing treatment with immunotherapy or targeted therapy. Main Outcomes and Measures: Tumor response was classified according to RECIST guidelines (ie, change in sum diameter of target lesions) post hoc with measurements derived from imaging scans and reports. Results: Among 1308 completed electronic case report forms, 956 forms (73.1%) had adequate data to classify real-world RECIST response. The greatest difference between physician-recorded responses and real-world RECIST-based responses was found in the proportion of complete responses: 118 responses (12.3%) vs 46 responses (4.8%) (P < .001). Among 609 patients in the metastatic melanoma population, complete responses were reported in 112 physician-recorded responses (18.4%) vs 44 real-world RECIST-based responses (7.2%) (P < .001), compared with 11 of 247 responses (4.5%) to 31 of 192 responses (16.1%) across pivotal trials of the same melanoma therapies. Conclusions and Relevance: These findings suggest that comparing tumor lesion sizes and categorizing treatment response according to RECIST guidelines may be feasible using real-world data. This study found that physician-recorded assessments were associated with overestimation of treatment response, with the largest overestimation among complete responses. Real-world RECIST-based assessments were associated with better approximations of tumor response reported in clinical trials compared with those reported in EHRs.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma/tratamento farmacológico , Melanoma/tratamento farmacológico , Critérios de Avaliação de Resposta em Tumores Sólidos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Carcinoma/diagnóstico por imagem , Carcinoma/secundário , Ensaios Clínicos como Assunto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/secundário , Terapia de Alvo Molecular , Nivolumabe/uso terapêutico , Variações Dependentes do Observador , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias da Glândula Tireoide/patologia , Resultado do Tratamento , Carga Tumoral
2.
Lancet Oncol ; 22(1): 98-106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33387498

RESUMO

BACKGROUND: Stereotactic ablative body radiotherapy (SABR) is increasingly being used to treat oligometastatic cancers, but high-level evidence to provide a basis for policy making is scarce. Additional evidence from a real-world setting is required. We present the results of a national study of patients with extracranial oligometastases undergoing SABR, representing the largest dataset, to our knowledge, on outcomes in this population so far. METHODS: In 2015, National Health Service (NHS) England launched a Commissioning through Evaluation scheme that funded a prospective, registry-based, single-arm, observational, evaluation study of patients with solid cancer and extracranial oligometastases treated with SABR. Prescribed doses ranged from 24-60 Gy administered in three to eight fractions. The study was done at 17 NHS radiotherapy centres in England. Patients were eligible for the scheme if aged 18 years or older with confirmed primary carcinoma (excluding haematological malignancies), one to three extracranial metastatic lesions, a disease-free interval from primary tumour development to metastases of longer than 6 months (with the exception of synchronous colorectal liver metastases), a WHO performance status of 2 or lower, and a life expectancy of at least 6 months. The primary outcome was overall survival at 1 year and 2 years from the start of SABR treatment. The study is now completed. FINDINGS: Between June 15, 2015, and Jan 30, 2019, 1422 patients were recruited from 17 hospitals in England. The median age of the patients was 69 years (IQR 62-76), and the most common primary tumour was prostate cancer (406 [28·6%] patients). Median follow-up was 13 months (IQR 6-23). Overall survival was 92·3% (95% CI 90·5-93·9) at 1 year and 79·2% (76·0-82·1) at 2 years. The most common grade 3 adverse event was fatigue (28 [2·0%] of 1422 patients) and the most common serious (grade 4) event was increased liver enzymes (nine [0·6%]). Notreatment-related deaths were reported. INTERPRETATION: In patients with extracranial oligometastatic cancer, use of SABR was associated with high overall survival and low toxicity. 'The study findings complement existing evidence from a randomised, phase 2 trial, and represent high-level, real-world evidence supporting the use of SABR in this patient cohort, with a phase 3 randomised, controlled trial to confirm these findings underway. Based on the selection criteria in this study, SABR was commissioned by NHS England in March, 2020, as a treatment option for patients with oligometastatic disease. FUNDING: NHS England Commissioning through Evaluation scheme.


Assuntos
Carcinoma/radioterapia , Radiocirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Carcinoma/secundário , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiocirurgia/efeitos adversos , Radiocirurgia/mortalidade , Sistema de Registros , Medicina Estatal , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Medicine (Baltimore) ; 99(28): e20654, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664063

RESUMO

Albumin-bilirubin (ALBI) showed its prognostic and predictive value in hepatobiliary disease like hepatocellular carcinoma. However, little has been known about its role in pancreatic cancer.In this retrospective study, 149 patients with advanced pancreatic cancer (APC) treated in the Shanghai General Hospital from January 2009 to December 2014 were enrolled as the training cohort and 120 patients treated from January 2015 to December 2018 were taken as the validation cohort. We generated the ALBI score according previous studies. The correlations between ALBI and clinicopathological parameters were evaluated with the Pearson Chi-square test. Kaplan-Meier method and log-rank test were conducted to determine the correlation between ALBI and overall survival (OS). Then we used Cox regression model to investigate the prognostic significance of ALBI. We further assessed retrospectively whether ALBI score could be used to identify combination therapy candidates for APC.Eastern Cooperative Oncology Group Performance Status, hemoglobin, aspartate aminotransferase, and alanine aminotransferase were found to be significantly correlated with ALBI. Kaplan-Meier analysis showed that the median OS in patients with a pretreatment ALBI ≥-2.6 was 7.0 months, which was significantly shorter than OS of patients with a ALBI <-2.6 (13.0 months, P = .001). ALBI was independently correlated with OS in multivariate analysis. In the subgroup analysis, ALBI showed significant prognostic value in patients with liver metastasis but not those without liver metastasis in all 3 cohorts. In addition, only in the group with ALBI <-2.6, patients receiving combination therapy showed better prognosis than those receiving monotherapy.In conclusion, ALBI was a promising prognostic biomarker in APC with liver metastasis. ALBI also showed predictive value in identifying combination therapy candidates for patients with APC.


Assuntos
Albuminas/metabolismo , Bilirrubina/sangue , Carcinoma/sangue , Neoplasias Pancreáticas/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Carcinoma/diagnóstico , Carcinoma/secundário , Feminino , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos
6.
J Surg Res ; 255: 346-354, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32599454

RESUMO

BACKGROUND: For patients with colorectal cancer and synchronous liver metastasis, either a simultaneous, or a two-staged resection of the primary tumor and the liver metastases is possible. There are currently no guidelines preferring one approach to the other. MATERIAL AND METHODS: Consecutive patients who underwent hepatic resection at our university hospital from 2007-2016 were included. Clinical, histopathologic, serologic, and survival data were analyzed. The primary end point was tumor-specific survival for patients with simultaneous versus staged resections. RESULTS: Of all 140 patients, 68 underwent simultaneous resection and 72 underwent staged resection. The characteristics of both groups were comparable. Patients with simultaneous resections had a shorter duration of cumulative operation time (299 versus 460 min; P = 0.003) and a shorter cumulative length of hospital stay (23 versus 43 d; P = 0.002). Perioperative mortality (P = 0.257) did not differ significantly; however, patients with simultaneous resections had higher rates of grade 2 complications according to Clavien-Dindo (P < 0.001). Tumor-specific 1-y survival was 85 ± 5% for simultaneous and 83 ± 5% for staged resection (P = 0.631). On multivariable analysis, pT4 (P = 0.038), pN3 (P = 0.003), and G3/4 (P = 0.041) of the primary tumor and postoperative complications (Clavien-Dindo 3/4/5, P = 0.003) were poor prognostic factors regarding tumor-specific survival. CONCLUSIONS: This is one of the largest and most thoroughly documented retrospective single-center studies of consecutive patients with synchronous hepatic metastases. Simultaneous resection of colorectal cancer together with hepatic metastases is a safe procedure in selected patients and does not have a significant influence on long-term survival.


Assuntos
Carcinoma/cirurgia , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Carcinoma/secundário , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Feminino , Alemanha/epidemiologia , Humanos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
8.
World Neurosurg ; 139: 266-267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32289505

RESUMO

A 39-year-old man with a history of recurrent pituitary tumor, Cushing disease, and Nelson syndrome presented with neck stiffness. He previously had bilateral adrenalectomy and hypophysectomy 27 years ago. He subsequently had repeat pituitary surgery, stereotactic radiosurgery, and chemotherapy for recurrent pituitary tumor. During follow-up, he was noted to have rising basal adrenocorticotrophin (ACTH) level. On examination, he was neurologically intact with no signs of myelopathy. Magnetic resonance imaging of the spine showed a large intradural extramedullary lesion causing cord compression at the C2-3 level. He underwent a cervical laminectomy and debulking of the lesion under continuous monitoring of motor-evoked and somatosensory-evoked potentials. He remained neurologically intact postoperatively. Histologic analysis revealed a tumor of pituitary origin with synaptophysin and ACTH expression. Pituitary drop metastasis is a rare entity and should raise a high index of suspicion given this clinical presentation. The radiologic appearance can mimic benign lesions such as meningioma or schwannoma.


Assuntos
Carcinoma/secundário , Neoplasias Hipofisárias/patologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/secundário , Adulto , Carcinoma/cirurgia , Descompressão Cirúrgica , Humanos , Laminectomia , Masculino , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
9.
Cancer Radiother ; 24(3): 226-246, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32192840

RESUMO

We report the case of an 84-year-old woman with poorly differentiated non-small cell carcinoma of the right parotid who presented with headache, was found to have a primary right parotid gland cancer as well as metastatic disease, and underwent palliative radiotherapy to the primary site. The patient received no chemotherapy or immunotherapy, but both the primary site and several non-irradiated foci in the lungs regressed or completely resolved. The patient remained free of disease for about one year before progression. The case is a rare instance of abscopal regression of metastatic disease in the absence of pharmacologic immunomodulation. A literature review surveys the history of the abscopal effect of radiation therapy, attempts to understand the mechanisms of its successes and failures, and points to new approaches that can inform and improve the outcomes of radioimmunotherapy.


Assuntos
Carcinoma/radioterapia , Carcinoma/secundário , Neoplasias Pulmonares/secundário , Neoplasias Parotídeas/radioterapia , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Neoplasias Ósseas/secundário , Dor do Câncer/etiologia , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Evolução Fatal , Feminino , Humanos , Doenças Maxilomandibulares/etiologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Cuidados Paliativos/métodos , Glândula Parótida/patologia , Neoplasias Parotídeas/patologia , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios X
10.
Am J Surg ; 219(5): 795-799, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32145918

RESUMO

INTRODUCTION: Neuroendocrine tumors (NETs) metastatic to the ovary are traditionally considered rare, but data are lacking. This study seeks to better characterize the prevalence and outcomes of patients with neuroendocrine ovarian metastases (NOM). METHODS: Women with well-differentiated lung and gastroenteropancreatic NETs 2007-2017 were identified by medical record query. Clinicopathologic data were reviewed among patients with and without NOM. RESULTS: Of 242 patients, 27 (11.2%) developed NOM. NOM developed in 24.8% of SBNET patients and 65.7% of patients with carcinomatosis and intact ovaries. 33.3% had associated small bowel obstructions; 11.1% had ureteral obstruction. NOM were not apparent on imaging in 29.6% nor visible intraoperatively in 8.3%. Five-year survival rate was 61.5%. Those who underwent oophorectomy had a lower rate of subsequent ureteral obstruction (p < 0.01). CONCLUSIONS: NOM are more prevalent than previously reported and associated with significant morbidity. Empiric oophorectomy may be considered for SBNET patients and strongly advised in carcinomatosis.


Assuntos
Carcinoma/secundário , Neoplasias Intestinais/patologia , Neoplasias Pulmonares/patologia , Tumores Neuroendócrinos/secundário , Neoplasias Ovarianas/secundário , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/patologia , Feminino , Humanos , Obstrução Intestinal/patologia , Intestino Delgado , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Neoplasias Ovarianas/cirurgia , Ovariectomia , Obstrução Ureteral/patologia
11.
World Neurosurg ; 138: e17-e25, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32142948

RESUMO

BACKGROUND: Eccrine carcinoma involvement of the central nervous system (CNS) is exceedingly rare. The prognosis and response to treatment of this pathology remain poorly characterized. METHODS: A retrospective case series and literature review were conducted. RESULTS: CNS-invading eccrine carcinoma was diagnosed in 3 patients (2 male and 1 female; age range, 60-79 years), including 2 cases of brain metastases and 1 case of brain-invading skull metastasis with subsequent spinal metastasis. The interval from primary tumor to CNS invasion was 18-51 months. All patients received multimodal therapy following diagnosis of CNS involvement. One patient who harbored a NOTCH1 mutation demonstrated a durable oncologic response after treatment with the immune checkpoint inhibitor pembrolizumab and lived 39 months after CNS invasion. The other 2 patients were discharged to hospice care within 1 month after the diagnosis of eccrine carcinoma brain metastasis. Including this case series, 23 cases of eccrine carcinoma invasion or metastasis to the CNS have been reported, with survival after diagnosis of CNS involvement ranging from a few weeks to 4 years. CONCLUSIONS: We present 3 cases of eccrine carcinoma metastatic to the CNS, including the first reported case to our knowledge of eccrine carcinoma treated with immunotherapy. This case, harboring a NOTCH1 mutation, demonstrated the longest durable oncologic response reported in this rare disease. Genomic and molecular testing may play increasingly important roles in the evaluation of these metastases.


Assuntos
Neoplasias Encefálicas/secundário , Carcinoma/secundário , Glândulas Écrinas , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Cranianas/secundário , Neoplasias da Coluna Vertebral/secundário , Neoplasias das Glândulas Sudoríparas/patologia , Parede Abdominal , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/genética , Carcinoma/tratamento farmacológico , Carcinoma/genética , Carcinoma Ductal/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Receptor Notch1/genética , Couro Cabeludo , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem
12.
BMC Cancer ; 20(1): 225, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32178642

RESUMO

BACKGROUND: Considering the potential of p16 as a marker for diagnosis, prognosis and therapeutic response, the aim of this study was to assess its presence, via immunocytochemistry, in metastatic carcinoma of different primary sites and histological types obtained from effusions and peritoneal washings. A total of 118 samples including 85 of metastatic carcinoma and 33 samples of benign effusion/peritoneal washing were prepared by the plasma/thromboplastin method. Immunocytochemistry reactions were performed on cell block sections using antibodies against p16, claudin-4, MOC-31, calretinin, HBME and CD68. RESULTS: P16 overexpression was observed in 88.23% of all carcinoma samples. All cervix adenocarcinoma samples showed p16 overexpression. Overexpression in adenocarcinomas of ovary, lung and breast was observed in 93.75, 93.10 and 75% of the samples, respectively. Overexpression was observed in all different histological types analyzed: small cell carcinoma (lung), squamous cell carcinoma (cervical) and urothelial carcinoma (bladder). The specificity of p16 for carcinoma detection was of 96.96%. CONCLUSION: Overexpression of p16 was observed in most metastatic carcinoma, from different primary sites and histological types, obtained from effusions and peritoneal washings. Due to its high frequency of overexpression in metastatic carcinoma, p16 may play a possible role in tumor progression and it may be considered as a complementary diagnostic marker depending on histological type and primary site of carcinoma.


Assuntos
Líquido Ascítico/química , Biomarcadores Tumorais/análise , Carcinoma/diagnóstico , Carcinoma/secundário , Inibidor p16 de Quinase Dependente de Ciclina/análise , Neoplasias/diagnóstico , Neoplasias/patologia , Derrame Pericárdico/química , Derrame Pleural Maligno/química , Antígenos CD/análise , Antígenos CD/imunologia , Antígenos de Diferenciação Mielomonocítica/análise , Antígenos de Diferenciação Mielomonocítica/imunologia , Antígenos de Superfície/análise , Antígenos de Superfície/imunologia , Biomarcadores Tumorais/imunologia , Calbindina 2/análise , Calbindina 2/imunologia , Claudina-4/análise , Claudina-4/imunologia , Inibidor p16 de Quinase Dependente de Ciclina/imunologia , Humanos , Prognóstico
13.
J UOEH ; 42(1): 83-88, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32213746

RESUMO

A 68-year-old male with abdominal pain and vomiting was brought to our hospital by ambulance. Computed tomography showed multiple intussusceptions with pseudokidney signs in the jejunum and ileocecum, and a tumor of 5 cm in diameter in the left lower lobe of the lung. We performed an emergent operation, as a release of multiple intussusceptions was difficult by conservative treatment. There were two intussusceptions, in the jejunum and the ileocecum. We performed a partial resection of the jejunum and a resection of the ileocecum. Histopathological examination of the resected specimens and a biopsy specimen collected by bronchoscopy allowed us to diagnose multiple intussusceptions due to small intestine metastases from a pleomorphic carcinoma of the lung. This case is presented here, with a review of the literature.


Assuntos
Carcinoma/complicações , Carcinoma/secundário , Neoplasias Intestinais/complicações , Neoplasias Intestinais/secundário , Intussuscepção/etiologia , Neoplasias Pulmonares/patologia , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Intussuscepção/cirurgia , Masculino
14.
Can J Surg ; 63(1): E71-E79, 2020 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-32080999

RESUMO

Background: Peritoneal recurrences after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for appendiceal and colorectal cancers are frequent. This study aimed to evaluate the safety, technical feasibility and perioperative and long-term outcomes of repeat CRS/HIPEC in patients with recurrent peritoneal carcinomatosis of colorectal and appendiceal origin. Methods: Data were collected from patients treated from 2000 to 2016 for recurrent peritoneal carcinomatosis from appendiceal or colorectal cancer with CRS/HIPEC at 2 specialist centres. Data on demographics, procedure details, morbidity and survival were recorded. Analyses compared the iterations of CRS/HIPEC to assess the safety and effectiveness of repeat surgery. Results: Of all patients who underwent CRS/HIPEC in the 2 centres, 37 patients underwent a repeat procedure. Operative time was similar for the first and second surgeries (412.1 v. 412.5 min, p = 0.74) but patients had a significantly lower peritoneal carcinoma index score with the second surgery (21.8 in the first iteration v. 9.53 in the second iteration, p < 0.001) and significantly less blood loss (1762 mL in the first iteration v. 790 mL in the second iteration, p = 0.001). There was a nonsignificant decrease in grade III­IV complications and there was no 30-day mortality associated with repeat procedures. For patients with colorectal cancer, median disease-free survival was 9.6 months and median overall survival was 40 months. For patients with appendiceal cancer, median disease-free survival was 15 months and overall survival was 64.4 months. Conclusion: Repeat CRS/HIPEC procedures for recurrent appendiceal and colorectal peritoneal carcinomatosis are safe in well-selected patients, without increased morbidity or mortality, and they are associated with significant long-term survival, particularly for patients with appendiceal cancers. These results support the use of repeat CRS/HIPEC in these patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias do Apêndice/terapia , Carcinoma/terapia , Neoplasias Colorretais/terapia , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Recidiva Local de Neoplasia/terapia , Avaliação de Resultados em Cuidados de Saúde , Neoplasias Peritoneais/terapia , Reoperação , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Apêndice/mortalidade , Neoplasias do Apêndice/patologia , Canadá/epidemiologia , Carcinoma/mortalidade , Carcinoma/secundário , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Terapia Combinada , Estudos Transversais , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/secundário , Reoperação/efeitos adversos , Reoperação/mortalidade , Estudos Retrospectivos
15.
Rev. chil. obstet. ginecol. (En línea) ; 85(1): 53-59, feb. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1092775

RESUMO

INTRODUCCIÓN: el carcinoma endometrial es la sexta entidad maligna más común a nivel mundial. En la mayoría de casos se diagnóstica de forma temprana. Recurre principalmente a cúpula vaginal y a nivel linfático, sin embargo, se han descrito metástasis a vagina, peritoneo y pulmones, entre otros. PRESENTACIÓN DEL CASO: paciente femenina adulta mayor con antecedente de carcinoma endometrial hace 7 años, tratado quirúrgicamente con estudio histopatológico que evidenciaba un miometrio infiltrado en un 95% sin invasión a otros órganos y linfadenectomía libre de lesión (estadio FIGO IB), quien consulta por dolor abdominal localizado en mesogastrio y deposiciones melénicas, evidenciándose una lesión gástrica, con resultado de biopsia que reporta carcinoma pobremente diferenciado con positividad focal para vimentina compatible con metástasis gástrica secundaria a carcinoma endometrial. Se indica manejo sistémico con quimioterapia, se documenta respuesta total de la lesión. DISCUSIÓN: las lesiones tumorales a nivel de estómago son primarios en su gran mayoría, una metástasis a este nivel es inusual. En el momento del diagnóstico de una metástasis gástrica, la mitad de las pacientes presentan concomitante compromiso de otros órganos. El carcinoma endometrial no está descrito dentro de los primarios que generan este compromiso. CONCLUSIÓN: el caso expuesto es un reto clínico, que representa un vacío en la evidencia actual; se comparte la experiencia de un manejo exitoso. Son necesarios más estudios para evaluar el pronóstico, opciones de tratamiento y definir la pertinencia de métodos de tamización para la detección temprana de estos casos.


INTRODUCTION: the endometrial carcinoma is the sixth cancer worldwide. Usually it is diagnosed in early stages. The sites of recurrence includes vaginal cuff and lymph nodes, however some metastasis have been described to vagina, peritoneum and lungs, among others. CASE REPORT: Elder female with history of an endometrial carcinoma 7 years ago, surgically treated. With histopathology that reported myometrial infiltration in a 95% without invasion to other organs and lymphadenectomy free of neoplasm (FIGO IB), who consult at the emergency room due to abdominal pain and black stool, with further studies that make evident a gastric lesion with biopsy reported as a poorly differentiated carcinoma, vimentin positive, compatible with gastric metastasis secondary to an endometrial carcinoma. Chemoterapy was indicated, documenting total posterior response of the lesion. DISCUSSION: Secondary lessions in stomach are rare. If they are present at the moment of diagnosis half of the patients concomitantly have metastasis in other organs. The endometrial carcinoma hasn't been described as a common localization that result in this compromise. CONCLUSION: the case exposed is a clinical challenge, a therapeutic success is shared. Limited evidence is available. Further studies are necessary to evaluate the prognosis, therapeutic options and to define the relevance of screening tests for early detection.


Assuntos
Humanos , Feminino , Idoso , Carcinoma/secundário , Neoplasias do Endométrio/patologia , Neoplasias Gastrointestinais/secundário , Carcinoma/diagnóstico por imagem , Neoplasias Gastrointestinais/diagnóstico por imagem
16.
Neurology ; 94(5): e521-e528, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31907288

RESUMO

OBJECTIVE: The primary objective was to determine the sensitivity and specificity of epithelial cell adhesion molecule (EpCAM) immunoflow cytometry circulating tumor cells (CTC) analysis in CSF in patients with suspected leptomeningeal metastases (LM). The secondary objective was to explore the distribution of driver mutations in the primary tumor, plasma, cell free CSF (cfCSF), and isolated CTC from CSF in non-small cell lung cancer (NSCLC). METHODS: We tested the performance of the CTC assay vs CSF cytology in a prospective study in 81 patients with a clinical suspicion of LM but a nonconfirmatory MRI. In an NSCLC subcohort, we analyzed circulating tumor (ct)DNA of the selected driver mutations by digital droplet PCR (ddPCR). RESULTS: The sensitivity of the CTC assay was 94% (95% confidence interval [CI] 80-99) and the specificity was 100% (95% CI 91-100) at the optimal cutoff of 0.9 CTC/mL. The sensitivity of cytology was 76% (95% CI 58-89). Twelve of the 23 patients with NSCLC had mutated epidermal growth factor receptor (EGFR). All 5 tested patients with LM demonstrated the primary EGFR driver mutation in cfCSF. The driver mutation could also be detected in CTC isolated from CSF. CONCLUSION: CTC in CSF are detected with a high sensitivity for the diagnosis of LM. ddPCR can determine EGFR mutations in both cfCSF and isolated CTC from CSF of patients with EGFR-mutated NSCLC and LM. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that EpCAM-based immunoflow cytometry analysis of CSF accurately identifies patients with LM.


Assuntos
Carcinoma/líquido cefalorraquidiano , Carcinomatose Meníngea/líquido cefalorraquidiano , Células Neoplásicas Circulantes , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Carcinoma/diagnóstico , Carcinoma/secundário , Carcinoma Ductal de Mama/líquido cefalorraquidiano , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/líquido cefalorraquidiano , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/secundário , Carcinoma Pulmonar de Células não Pequenas/líquido cefalorraquidiano , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma de Células de Transição/líquido cefalorraquidiano , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/secundário , Molécula de Adesão da Célula Epitelial , Receptores ErbB/genética , Feminino , Citometria de Fluxo , Neoplasias Gastrointestinais/patologia , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética , Masculino , Carcinomatose Meníngea/diagnóstico , Carcinomatose Meníngea/genética , Carcinomatose Meníngea/secundário , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Sensibilidade e Especificidade , Carcinoma de Pequenas Células do Pulmão/líquido cefalorraquidiano , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/secundário
17.
Asian J Surg ; 43(9): 902-906, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31911035

RESUMO

BACKGROUND: To evaluate the safety, feasibility and outcomes of patients treated for colorectal liver metastases (CLM) with an innovative combined approach - hepatic resection and Stereotactic body radiotherapy (SBRT) using CyberKnife® system. METHODS: This was a retrospective cohort study conducted in a single institution. Patients with CLM and no evidence of extrahepatic disease were included during a 6-year study period. RESULTS: In total, 19 patients with 63 liver lesions underwent liver resection combined with SBRT of unresectable lesions. Major hepatectomy was performed in 42.1% patients; postoperative complications were noted in 31.6% patients. 27 unresectable lesions were treated by SBRT with a total dose of 50-60 Gy in five fractions. The median follow-up of study patients was 29.7 ± 20.58 months. Local control of CLM at 1 and 2 years was achieved in 89.5% of patients. Out-of-field hepatic recurrence was diagnosed in 63.1% patients. The 1-year disease-free survival (DFS) was 52.6%; 2-year DFS was 31.6%. The overall actuarial survival rates at 1 and 2 years were 88.2% and 50.4%. CONCLUSION: Liver resection combined with SBRT presents a promising therapeutic option for patients with CLM which traditionally are unresectable. The additional use of SBRT allows for the effective clearance of the disease for thoroughly selected patients.


Assuntos
Carcinoma/secundário , Carcinoma/cirurgia , Neoplasias Colorretais/patologia , Hepatectomia/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Radiocirurgia/métodos , Idoso , Carcinoma/mortalidade , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
18.
Am J Surg Pathol ; 44(5): 703-710, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31934917

RESUMO

The molecular pathogenesis of poorly differentiated sinonasal carcinoma received significant attention in recent years. As a consequence, several unclassified carcinomas in the morphologic spectrum of sinonasal undifferentiated carcinoma have been reclassified as distinctive genetically defined variants or entities. Among the latter are NUT-rearranged carcinoma and SMARCB1-deficient carcinomas. In this study, we further characterize a rare variant of sinonasal undifferentiated carcinoma-like tumors characterized by inactivation of the SWItch/Sucrose Nonfermentable chromatin remodeler SMARCA4 (BRG1) detectable by immunohistochemistry. Patients were 7 males and 3 females aged 20 to 67 years (median, 44). Tumors originated in the nasal cavity (6), nose and sinuses (2), or at unspecified site (2). Six tumors were initially misdiagnosed as small cell neuroendocrine carcinoma (SCNEC) or large cell neuroendocrine carcinoma (LCNEC). Histologically, the tumors were composed of small basaloid (3 cases) or large epithelioid (7) cells disposed into nests and solid sheets with extensive areas of necrosis. No glands or other differentiating features were noted. Abortive rosettes were seen in 1 case. Immunohistochemistry showed consistent expression of pankeratin and absence of CK5, p63, p16, and NUT in all tumors tested. Other tested markers were variably positive: CK7 (2/6), synaptophysin (9/10; mostly focal and weak), chromogranin-A (4/10; focal), and CD56 (3/5; focal). All tumors showed total loss of SMARCA4 and retained expression of SMARCB1/INI1. Co-loss of SMARCA2 was seen in 1 of 8 cases. Limited data were available on treatment and follow-up. Two patients received surgery (1 also radiotherapy) and 3 received chemotherapy. Metastases (cervical nodes, liver, bone, and lung/mediastinal) were detected in 3 patients; 2 were alive under palliative chemotherapy at 8 and 9 months while 1 died of progressive lung disease at 7 months. Three patients (1 with brain invasion) died soon after diagnosis (1 to 3 mo). In total, 4 of 6 patients (66%) with follow-up died of disease (median, 3 mo). This series characterizes SMARCA4-deficient sinonasal carcinoma as a genetically distinct aggressive entity in the spectrum of undifferentiated sinonasal carcinomas. These variants add to the spectrum of SWItch/Sucrose Nonfermentable-deficient sinonasal carcinomas, at the same time expanding the topographic distribution of SMARCA4-related malignancies.


Assuntos
Biomarcadores Tumorais/deficiência , Carcinoma/química , DNA Helicases/deficiência , Proteínas Nucleares/deficiência , Neoplasias dos Seios Paranasais/química , Fatores de Transcrição/deficiência , Adulto , Idoso , Biomarcadores Tumorais/genética , Carcinoma/genética , Carcinoma/secundário , Carcinoma/terapia , Diferenciação Celular , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/genética , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/terapia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Eur J Surg Oncol ; 46(4 Pt A): 675-683, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31806517

RESUMO

The presence of peritoneal metastases in patients with advanced colorectal cancer is associated with poor prognosis but the mechanisms for this are unclear. This review summarises the current knowledge of the pathophysiology, clinical features, prevalence, prognosis, and molecular biology of peritoneal metastases and the risk factors for the development of peritoneal metastases following resection of a primary colorectal tumour. Furthermore, the evidence for treatment strategies are described including cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, early post-operative intraperitoneal chemotherapy, sequential post-operative intraperitoneal chemotherapy and emerging novel strategies. Active areas of research should include the identification of individuals at high risk of peritoneal metastases after curative resection of primary tumour, development of a surveillance program for high-risk patients, optimisation of systematic therapies and further investigation of the use of intraperitoneal chemotherapy.


Assuntos
Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/terapia , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos de Citorredução , Neoplasias Peritoneais/terapia , Carcinoma/genética , Carcinoma/secundário , Quimioterapia Adjuvante , Neoplasias Colorretais/genética , Humanos , Hipertermia Induzida , Imunoterapia Adotiva , Infusões Parenterais , Neoplasias Peritoneais/genética , Neoplasias Peritoneais/secundário , Prognóstico , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Fatores de Risco
20.
Eur J Surg Oncol ; 46(4 Pt A): 590-599, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31806520

RESUMO

BACKGROUND: The peritoneal cancer index (PCI) calculated during exploratory laparotomy is a strong prognostic factor for overall survival (OS) in patients with colorectal peritoneal metastases (PM) who undergo cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). Progression of the PCI between diagnostic laparoscopy (DLS) and potential CRS + HIPEC (ΔPCI) might be a more dynamic prognostic factor for OS after CRS + HIPEC. MATERIALS AND METHODS: Between 2012 and 2018, all colorectal PM patients who underwent an exploratory laparotomy for potential CRS + HIPEC after DLS were retrospectively identified from a prospectively maintained database. Patients were divided into stable disease (ΔPCI 0-3), mild progression (ΔPCI 4-9), or severe progression (ΔPCI ≥10). Kaplan-Meier analysis and a multivariate Cox regression were performed. RESULTS: Eighty-four patients (ΔPCI 0-3, n = 35; ΔPCI 4-9, n = 34; and ΔPCI ≥10, n = 15) were analysed. Median OS after CRS + HIPEC was significantly decreased in patients with a ΔPCI of 4-9 (35.1 [95% CI 25.5-44.6]) or ΔPCI ≥10 (24.1 [95% CI 11.7-36.5]) compared to patients with a ΔPCI of 0-3 (47.9 [95% CI 40.0-55.7], p = 0.004). In multivariate regression analysis, ΔPCI remained an independent risk factor for OS: ΔPCI 4-9 HR 3.1 (95% CI 1.4-7.2, p = 0.007) and ΔPCI ≥10 HR 4.4 (95% CI 1.5-13.1, p = 0.007). CONCLUSION: A high ΔPCI is an independent dynamic prognostic factor for OS and might reflect a more aggressive tumour biology in patients with colorectal PM. HIPEC surgeons should be aware of a high-ΔPCI-associated diminished prognosis and should reconsider CRS + HIPEC when confronted with a ΔPCI ≥10.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Carcinoma/secundário , Neoplasias Colorretais/patologia , Mitomicina/uso terapêutico , Neoplasias Peritoneais/secundário , Idoso , Carcinoma/terapia , Procedimentos Cirúrgicos de Citorredução , Progressão da Doença , Feminino , Humanos , Hipertermia Induzida , Estimativa de Kaplan-Meier , Laparotomia , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/terapia , Prognóstico , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Carga Tumoral
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...