RESUMEN
BACKGROUND: Although potentially curable with early detection and timely treatment, breast cancer (BC) and cervical cancer (CC) remain leading causes of death for Colombian women. Lack of education, complicated administrative processes, and geographic limitations hinder early cancer detection. Today, technological tools permeate the society and could assess user risk, deliver customized information, and provide care coordination. We evaluated the effectiveness of a free mobile application (mApp) to reach women, understand misconceptions, identify users at risk for BC and/or CC, and coordinate screening tests in Cali, Colombia. METHODS: The mApp was developed and advertised in four healthcare facility waiting rooms. It used educational, evaluative, and risk factor questions followed by brief explanations to assess the population's knowledge, educate on BC and/or CC, and identify users in need of screening test(s). Women who required screening were navigated and enrolled in the national cancer program. RESULTS: From August 2017 to August 2019, 1,043 women downloaded the mApp. BC misconceptions included beliefs that BC can be prevented (87%), obesity does not increase the risk of BC (49%), and deodorant causes BC (17%). CC misconceptions included that pap smears should not be performed while sexually active (64%), vaginal pain is an early sign of CC (44%), and only women contract human papilloma virus (33%). Overall, 29% (303) were identified as at risk and needed a screening test, with 32% (98) successfully screened. DISCUSSION: mApps can identify women at risk for BC and/or CC, detect barriers to early cancer detection, and help coordinate screening test(s). This technology has widespread applications and may be useful in other underserved communities.
Asunto(s)
Neoplasias del Cuello Uterino , Colombia , Detección Precoz del Cáncer , Femenino , Humanos , Tamizaje Masivo , Neoplasias del Cuello Uterino/diagnóstico , Frotis VaginalRESUMEN
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); however, stage IV (SIV) outcomes are rarely reported. We assessed our experience and outcomes treating newly diagnosed SIV EOC with NACT plus CRS/HIPEC compared to SIII patients. METHODS: Advanced EOC from 2015-2018 managed with NACT (carboplatin/paclitaxel) due to unresectable disease or poor performance status followed by interval CRS/HIPEC were reviewed. Perioperative factors were assessed. Overall survival (OS) and progression-free survival (PFS) were analyzed by stage. RESULTS: Twenty-seven FIGO stage IIIC (n = 12) and IV (n = 15) patients were reviewed. Median NACT cycles were 3 and 4, respectively. Post-NACT omental caking, ascites, and pleural effusions decreased/resolved in 91%, 91%, and 100% of SIII and 85%, 92%, and 71% of SIV. SIII/SIV median PCI was 21 and 20 obtaining 92% and 100% complete cytoreduction (≤0.25 cm), respectively. Median organ resections were 6 and 7, respectively. Grade III/IV surgical complications were 0% SIII and 23% SIV, without hospital mortality. Median time to adjuvant chemotherapy was 53 and 74 days, respectively (p=0.007). SIII OS at 1 and 2 years was 100% and 83% and 87% and 76% in SIV (p=0.269). SIII 1-year PFS was 54%; median PFS: 12 months. SIV 1- and 2- year PFS was 47% and 23%; median PFS: 12 months (p=0.944). CONCLUSION: Outcomes in select initially diagnosed and unresectable SIV EOC are similar to SIII after NACT plus CRS/HIPEC. SIV EOC may benefit from CRS/HIPEC, and further studies should explore this treatment approach.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Epitelial de Ovario/terapia , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Neoplasias Peritoneales/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carboplatino/administración & dosificación , Carcinoma Epitelial de Ovario/secundario , Quimioterapia Adyuvante , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Femenino , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Paclitaxel/administración & dosificación , Neoplasias Peritoneales/secundario , Complicaciones Posoperatorias/etiología , Supervivencia sin Progresión , Tasa de SupervivenciaRESUMEN
BACKGROUND: The completeness of cytoreduction (CC) score, which quantifies residual tumor, is a major prognostic factor when treating appendiceal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Both CC-0 and CC-1 are considered complete cytoreductions (CC-0/1) and associated with the best outcomes. We analyzed if the CC-0/1 definition is reliable across appendiceal histopathologic subtypes. METHODS: A prospective database of CRS/HIPEC patients with appendiceal carcinomatosis from 1998 to 2019 was reviewed to identify patients with CC-0/1. Kaplan-Meier overall survival (OS) and progression-free survival (PFS) by CC-score for each histopathology were calculated. RESULTS: Overall, 297 patients had CC-0/1. Mean age was 54 ± 12 years with 67% females. Histopathologic subtypes were 45% low-grade mucinous carcinoma peritonei (LGMCP), 27% high-grade MCP (HGMCP), 20% HGMCP with signet ring cells (HGMCP-S), and 8% goblet cell adenocarcinoma (GCAC). CC-0 and CC-1 occurred in 57% and 43% of LGMCP, 65% and 35% of HGMCP, 68% and 32% of HGMCP-S, and 79% and 21% of GCAC, respectively. OS and PFS were statistically longer for CC-0 versus CC-1 in HGMCP-S (p = 0.001 and p = 0.005, respectively) and GCAC (p < 0.001 and p < 0.001), but not in LGMCP (p = 0.098 and p = 0.398) or HGMCP (p = 0.167 and p = 0.356). CONCLUSIONS: Survival outcomes for CC-0 and CC-1 after CRS/HIPEC are different for HGMCP-S and GCAC but not for LGMCP and HGMCP. In HGCMP-S and GCAC, only CC-0 should be considered a complete cytoreduction and analyzed separately from CC-1. This distinction is key to understand disease behavior, accurately address patient prognosis, and explore new treatment strategies.
Asunto(s)
Quimioterapia Intraperitoneal Hipertérmica , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Apéndice/tratamiento farmacológico , Procedimientos Quirúrgicos de Citorreducción , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/tratamiento farmacológico , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
A facile method for the formation of zero-length covalent cross-links between protein molecules in the lyophilized state without the use of chemical reagents has been developed. The cross-linking process is performed by simply sealing lyophilized protein under vacuum in a glass vessel and heating at 85 degrees C for 24 h. Under these conditions, approximately one-third of the total protein present becomes cross-linked, and dimer is the major product. Chemical and mass spectroscopic evidence obtained shows that zero-length cross-links are formed as a result of the condensation of interacting ammonium and carboxylate groups to form amide bonds between adjacent molecules. For the protein examined in the most detail, RNase A, the cross-linked dimer has only one amide cross-link and retains the enzymatic activity of the monomer. The in vacuo cross-linking procedure appears to be general in its applicability because five different proteins tested gave substantial cross-linking, and co-lyophilization of lysozyme and RNase A also gave a heterogeneous covalently cross-linked dimer.