Osteonecrosis maxilar asociada con altas dosis de antirresortivos en paciente oncolólgico adulto mayor: resolución interdisciplinaria de caso clínico / Osteonecrosis of the jaw associated with high doses of antiresorptive in an elderly cancer patient: interdisciplinary resolution of a clinical case

La osteonecrosis maxilar relacionada con medicamentos (ONMM) es una patología de características clínicas objetivas con signo-sintomatología patogno-mónica. El criterio clínico aceptado es la presencia de hueso necrótico expuesto y visible sobre el reborde óseo maxilar que no ha cicatrizado luego de 8 sema-nas, en pacientes con antecedentes de tratamiento antirresortivo. La denominación relacionada con medicamentos se utiliza por el creciente número de casos asociados con otros fármacos antirresortivos como denosumab y con terapias antiangiogénicas, más allá de la conocida relación con bifosfonatos. Si bien la incidencia de ONMM en pacientes tratados por osteopatías metabólicas es muy baja, la situa-ción se torna más compleja en pacientes oncológicos con altas dosis de antirresortivos para tratamiento de metástasis ósea. Varios informes de casos des-criben cuadros de ONMM en pacientes con cáncer que reciben terapias dirigidas, específicamente TKI (inhibidores de tirosina kinasa) y anticuerpos mo-noclonales-VEGF (anticuerpos dirigidos al factor de crecimiento del endotelio vascular). La ONMM afecta negativamente la calidad de vida del paciente onco-lógico y produce comorbilidad significativa. Resulta imperioso identificar los pacientes en riesgo y dise-ñar un protocolo de atención odontológica específico para estos casos. En este artículo, se presenta un caso de ONMM asociado con altas dosis de Deno-sumab y administración simultánea de anticuerpos monoclonales específicos. El caso sorprende por la magnitud de la necrosis y su cuadro insidioso. El pro-tocolo de tratamiento descripto permitió controlar el cuadro inicial, limitar el avance de la lesión, asegurar el control del dolor y la infección, y finalmente, la cu-ración total de la lesión (AU)

Medication-related osteonecrosis of the jaws (MRONJ) is a pathology with objective clinical characteristics with pathognomonic signs and symp-toms. The accepted clinical criterion is the presence of exposed and visible necrotic bone on the maxillofacial region that has not healed after 8 weeks, in patients with history of antiresorptive treatment. The name medication-related is justified by the growing number of cases associated with other antiresorptive drugs such as denosumab and antiangiogenic therapies, beyond the known relationship with bisphosphonates. Although the incidence of MRONJ in patients treated for metabolic osteopathies is very low, the situation becomes more complex in cancer patients who re-ceive high doses of antiresorptives for the treatment of skeletal metastases. Several case reports describe the presence of MRONJ in cancer patients receiving targeted therapies, specifically TKI (tyrosine kinase inhibitors) and monoclonal antibodies-targeting VEGF (vascular endothelial growth factor). MRONJ nega-tively affects the quality of life in cancer patients and produces significant comorbidity. It is imperative to identify patients at risk and design a specific den-tal care strategy for these cases. In this article, we present a case of MRONJ associated with high doses of Denosumab and simultaneous administration of specific monoclonal antibodies. The case is surpris-ing due to magnitude of the necrosis. The described treatment strategies made it possible to control the initial symptoms, limit the lesion progression, ensure pain and infection control, and finally, the total heal-ing of the lesion (AU)

O itinerário terapêutico do paciente em tratamento oncológico: implicações para a prática de enfermagem / El itinerario terapéutico del paciente en tratamiento oncológico: implicaciones para la práctica de enfermería / The therapeutic itinerary of patient in oncological treatment: implications for nursing practice

RESUMO A trajetória do cliente oncológico ainda é permeada por percalços que interferem em seu prognóstico e qualidade de vida. Assim, este estudo visa a mapear o itinerário do paciente oncológico desde o diagnóstico até o tratamento e analisar suas implicações nas ações de enfermagem para o controle do câncer. Estudo qualitativo, realizado através da técnica de história oral de dez clientes oncológicos atendidos em um hospital federal no município do Rio de Janeiro, Brasil. Os dados foram tratados de acordo com a técnica de análise temática, além da confecção de representações do itinerário terapêutico de cada entrevistado. Foram identificados três eixos temáticos: trajetória antes do diagnóstico, trajetória do diagnóstico ao início do tratamento, e trajetória no tratamento. Percebe-se que o acesso aos serviços apresenta-se como um problema que culmina no agravamento da doença, no aparecimento de metástases e a morte do paciente, além de criar condições para a falta de adesão ao tratamento.

RESUMEN La trayectoria del cliente oncológico todavía es permeada por inconvenientes que interfieren en su pronóstico y calidad de vida. Así, este estudio pretende identificar el itinerario del paciente oncológico desde el diagnóstico hasta el tratamiento y analizar sus implicaciones en las acciones de enfermería para el control del cáncer. Estudio cualitativo, realizado a través de la técnica de historia oral de diez clientes oncológicos atendidos en un hospital federal en el municipio de Rio de Janeiro, Brasil. Los datos fueron tratados de acuerdo con la técnica de análisis temático, además de la confección de representaciones del itinerario terapéutico de cada entrevistado. Fueron identificados tres ejes temáticos: trayectoria antes del diagnóstico; trayectoria del diagnóstico al inicio del tratamiento; y trayectoria en el tratamiento. Se nota que el acceso a los servicios se presenta como un problema que culmina en el agravamiento de la enfermedad, el en surgimiento de metástasis y la muerte del paciente, además de crear condiciones para la falta de adhesión al tratamiento.

ABSTRACT The course of oncology patients is still crossed by setbacks that interfere with their prognosis and quality of life. This study aims to map the itinerary of cancer patients from diagnosis to treatment and to analyze its implications in nursing healthcare practices for the control of cancer. This is a qualitative study, conducted using oral history technique with ten cancer patients treated in a federal hospital in the city of Rio de Janeiro, Brazil. The data were analyzed according to thematic analysis technique and with the making of representations of the therapeutic itinerary of each interviewee. Three main themes were identified: course before diagnosis, course from diagnosis to the beginning of treatment, and course during treatment. We observed that the access to medical services is presented as a problem that culminates in the worsening of the disease, appearing of metastases and death of the patient, in addition to creating conditions that hinder the adherence to treatment.

Vemurafenib and cutaneous adverse events - report of five cases

Vemurafenib is a selective inhibitor of V600E-mutant BRAF protein used to treat metastatic and unresectable melanoma. Clinical trials have shown increased overall survival and progression-free survival in patients treated with Vemurafenib. However, cutaneous adverse events are common during treatment. We report fi ve cases of metastatic melanoma with BRAF V600E positivity, treated with Vemurafenib and its cutaneous adverse events. Dermatologists and oncologists need to be aware of possible skin changes caused by this medication, which is increasingly employed in melanoma treatment. Monitoring of patients during therapy is important for early treatment of adverse cutaneous cutaneous adverse events, improvement in quality of life and adherence to treatment.

Preoperative imatinib for patients with primary unresectable or metastatic/recurrent gastrointestinal stromal tumor

OBJECTIVES: Despite its rising popularity, reports on the use of preoperative imatinib mesylate (IM) in patients with advanced gastrointestinal stromal tumor (GIST) are limited. This study aims to explore the clinical efficacy of preoperative IM in patients with primarily unresectable or metastatic/recurrent GIST. METHODS: Between September 2009 and February 2014, patients with primarily unresectable or metastatic/recurrent GIST treated by a single medical team were recruited and considered for preoperative IM therapy. Re-examination was conducted regularly and abdominal enhanced CT data, blood biochemistry and responses to IM were recorded. RESULTS: A total of 18 patients were enrolled, including 13 with a primary tumor (7 stomach, 3 small bowel, 2 rectal and 1 pelvic tumor) and 5 with recurrent or metastatic GIST (2 with liver metastasis, 2 with anastomotic recurrence and 1 with pelvic GIST). The median follow-up time was 9.5 months (range of 3-63). The median tumor sizes before and after initiation of IM treatment were 9.1 cm and 6.0 cm (p = 0.003) based on the CT findings, respectively. All patients showed a decrease in tumor burden and the median tumor size reduction was 35%. Sixteen of the 18 patients showed a partial response to IM and two possessed stable disease. Nine of the 18 patients (50%) underwent surgical resection of primary or metastatic/recurrent tumors, with a median of 7 months of IM therapy. One case each of multivisceral resection and tumor recurrence were noted. CONCLUSIONS: IM as a preoperative therapy is feasible and safe for unresectable or metastatic/recurrent GIST that can effectively decrease tumor size, facilitating resection. .