RESUMEN
INTRODUCTION: Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity. OBJECTIVE: The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City. METHODS: We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle. RESULTS: From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336). CONCLUSIONS: Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Retina/tratamiento farmacológico , Retinoblastoma/tratamiento farmacológico , Terapia Recuperativa/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Inyecciones Intraarteriales , Estudios Longitudinales , Masculino , Melfalán/administración & dosificación , México , Arteria Oftálmica , Estudios Prospectivos , Neoplasias de la Retina/patología , Retinoblastoma/patología , Topotecan/administración & dosificación , Resultado del TratamientoRESUMEN
INTRODUCTION: Alternative medicine is well accepted and widely used in Mexico so we researched the frequency and reasons for the use of alternative or complementary treatment (ACT) in pediatric oncologic patients at the Instituto Nacional de Pediatría (INP). METHODS: One hundred questionnaires were applied to caregivers of children with cancer in a course of 100 hundred consecutive patients. RESULTS: Fifty-one percent of caregivers interviewed accepted the use of some kind of ACT; biological therapies were the most frequent treatments used, and 73% felt satisfied with the results. Caregivers told their physicians they were using ACT in 35% of the questionnaires analyzed, and only 2% of the physicians asked directly about its use. None of the caregivers substituted or stopped allopathic treatment. ANALYSIS: These questionnaires reveal that more than a half of the caregivers use ACT. We believe superstitious and cultural beliefs, as well as the desire of the caregivers to participate actively in their patient's treatment, are the main reasons for the use of ACT; nevertheless, some caregivers do not notify their physicians and this may affect chemotherapy treatment in ways not investigated yet. CONCLUSIONS: The wide use of ACT in Mexico obliges every physician to enquire into it intentionally. It is therefore necessary to establish a stratification risk according to the combination of ACT and allopathic treatment used.
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Terapias Complementarias , Neoplasias/terapia , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , México , Encuestas y Cuestionarios , Centros de Atención TerciariaRESUMEN
AIM: Retinoblastoma is the most common primary ocular malignancy in childhood, but little has been documented on the clinical and biological differences in children diagnosed before one year of age. We observed patients in this age group and followed them for up to 19 years. METHODS: This retrospective, descriptive, observational study reviewed the medical records of Mexican patients, who were diagnosed with retinoblastoma before one year of age at a national paediatric hospital from 1995 to 2014. The variables analysed were age at diagnosis, weight, presenting signs, the time from first symptoms to diagnosis, family history, laterality, ocular rescue and survival rate. RESULTS: The 108 patients had a mean age of 7.65 months and 15.7% had a family history of retinoblastoma. The majority (55.5%) had bilateral retinoblastoma, the most common presenting sign was leukocoria (86.1%), and the most common stage of diagnosis was Group V (84.1%). More than half were underweight for their age. The overall survival rate was 92% and the disease-free survival rate was 84%. CONCLUSION: Retinoblastoma is a malignancy that can be present at birth, especially if it is a bilateral hereditary form of the disease. Leukocoria was the main presenting sign. Early diagnosis dramatically improved the prognosis for ocular rescue.
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Neoplasias de la Retina/terapia , Retinoblastoma/terapia , Factores de Edad , Antineoplásicos/uso terapéutico , Supervivencia sin Enfermedad , Enucleación del Ojo , Femenino , Hospitales Pediátricos , Humanos , Lactante , Masculino , México , Neoplasias de la Retina/diagnóstico , Neoplasias de la Retina/mortalidad , Retinoblastoma/diagnóstico , Retinoblastoma/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia , Centros de Atención Terciaria , Resultado del TratamientoRESUMEN
BACKGROUND: Early detection and timely referral are keys to improve survival in patients with retinoblastoma (Rb). In México, one of the main obstacles for an early diagnosis is the lack of knowledge of the disease. The objective of this study was to evaluate Rb comprehension in students in their last year of medical school. PROCEDURE: A questionnaire was completed by 791 students from 12 universities. Descriptive statistics from the population were obtained and every answer to each question was analyzed. RESULTS: Only 3.3% of the students got a proficiency grade. Less than 50% diagnosed Rb when an image was shown. CONCLUSIONS: The students evaluated do not have the knowledge to detect the disease. It is necessary to develop continuous educational programs for first contact physicians.
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Competencia Clínica , Neoplasias de la Retina/diagnóstico , Retinoblastoma/diagnóstico , Estudiantes de Medicina , Educación de Pregrado en Medicina , Femenino , Humanos , Masculino , México , MédicosRESUMEN
BACKGROUND: Staging in Hepatoblastoma has recently become controversial. In developing countries diagnosis occurs mostly in advanced stages under these circumstances, we propose another option that can be considered of prognostic value. METHOD: A retrospective analysis of cases diagnosed with Hepatoblastoma (HB), treated in a single Institution, in nine years was conducted. Chemotherapeutic regimens were analyzed, as well as the number of courses administered and response to treatment. RESULTS: Thirty-two patients were studied. Patients had symptoms from 1 to 25 weeks before diagnosis. SIOP stratification was used, finding 12 cases in PRETEXT II, 6 cases in PRETEXT III, and 14 cases in PRETEXT IV. No single case was identified in PRETEXT I. CONCLUSIONS: When comparing survival using the PRETEXT system, SIOP and our study showed marked differences. These results may not be comparable due to differences in tumor volume among the same PRETEXT stratification. We believe that tumor volume is related to prognosis.
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Hepatoblastoma/patología , Neoplasias Hepáticas/patología , Estadificación de Neoplasias/métodos , Niño , Preescolar , Quimioterapia/métodos , Femenino , Hepatoblastoma/tratamiento farmacológico , Hepatoblastoma/mortalidad , Humanos , Lactante , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/mortalidad , Masculino , México , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Carga Tumoral , alfa-Fetoproteínas/metabolismoRESUMEN
INTRODUCTION: Retinoblastoma (RB) is the most frequent malignant eye tumor in childhood. In developing countries advanced stages are common. The purpose of this paper is to present our 21-year clinical experience with metastatic extra ocular RB patients treated with 5 different chemotherapy schemas at a single Mexican Pediatric referral center. MATERIALS AND METHODS: A retrospective analysis was carried out reviewing the clinical characteristics of patients with metastatic RB. The information analyzed included the delay in diagnosis after first symptoms, age, sex, ocular staging, and anatomic site of metastases, treatment scheme, initial response and status at the last contact or date of death. RESULTS: Eighty-one patients were included; age range was from 3 to 80 months. The most common site of metastasis was central nervous system (83.9%). From those patients treated with chemotherapy (n = 74), 89.2% presented a complete initial response (n = 66). Early mortality occurred in 7 cases before any treatment. Fifty-six received treatment and died with progressive disease. All patients without radiotherapy died with tumor activity (n = 15). The use of cisplatin was related with longer disease free intervals; no other variable was related with survival. Four patients were alive and disease free at 33 to 144.3 months of follow up from diagnosis. The prevalent cause of death was tumor progression. CONCLUSIONS: In our experience, metastatic RB has a very high mortality rate in spite of the use of different chemotherapy regimens.