RESUMEN
PURPOSE: One of the best ways to control non-Hodgkin lymphoma (NHL) locally is radiation therapy (RT), which is a crucial component of care for many patients. There has not been any research on the risk and prognosis of secondary breast cancer (SBC) in females with NHL receiving RT. METHODS: In our study, females with NHL as their initial cancer diagnosis were included from 1975 to 2018 in the Surveillance, Epidemiology and End Results (SEER) database. Using Fine and Gray's competing risk regression assess the cumulative incidence of SBC. The standardized incidence ratios (SIR) and radiation-attributed risk (RR) for SBC were assessed using Poisson regression analysis. We evaluated the overall survival (OS) of SBC patients using the Kaplan-Meier technique. RESULTS: Of the 41,983 females with NHL, 10,070 received RT and 320 (3.18%) developed SBC. 31,913 females did not receive RT and 805 (2.52%) developed SBC. RT was significantly related with a greater chance of acquiring SBC in the Fine-Gray competing risk regression (adjusted hazard ratios (HR) = 1.14; 95% confidence intervals (CI), 1.09-1.30; P = 0.011). When an NHL diagnosis was made at an older age, the dynamic SIR and RR for SBC also declined over time. Regarding general survivability, there was not statistically significant (P = 0.970) after propensity score matching (PSM). CONCLUSIONS: RT is an independent risk factor for SBC in females with NHL. Special attention should be paid to the monitoring of breast cancer indicators in them, especially young.
Asunto(s)
Neoplasias de la Mama , Linfoma no Hodgkin , Femenino , Humanos , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/patología , Linfoma no Hodgkin/epidemiología , Linfoma no Hodgkin/radioterapia , Incidencia , Pronóstico , Factores de RiesgoRESUMEN
Introducción: los linfomas no Hodgkin son neoplasias hematológicas frecuentes en la infancia.Objetivo: describir las diferentes formas de presentación de esta enfermedad en la edad pediátrica, y determinar el promedio de años vividos después de concluido el tratamiento.Métodos: se realizó un estudio descriptivo retrospectivo en 79 pacientes con diagnóstico de linfomas no Hodgkin atendidos en el servicio de Oncocirugía del Hospital Pediátrico Docente William Soler, de marzo de 1995 a marzo de 2014.Resultados: 48 pacientes fueron del sexo masculino y 31 del femenino. El grupo de edad de mayor afectación fue el de 10 a 14 años. El 54,4 por ciento de los pacientes tuvieron linfomas de localización abdominal y el 29,1 por ciento fueron de localización mediastinal. Otros sitios afectados fueron la región cervical, la amígdala palatina y renal primaria en el 10,1, 3,8 y 2,6 por ciento de los pacientes respectivamente. La variante histológica más frecuente fue el linfoma no Hodgkin inmunofenotipo B (75,9 por ciento), seguido del linfoma no Hodgkin inmunofenotipo tipo T en el 21,5 por ciento de los casos. El dolor abdominal y la masa tumoral palpable fue la manifestación clínica principal en el 64,5 por ciento. El promedio de años vividos en el linfoma no Hodgkin de localización renal, cervical y amígdala palatina fue ligeramente superior (5,7 ± 0,3, 5,5 ± 1,8 y 5,2 ± 0,7 respectivamente).Conclusiones: el linfoma no Hodgkin inmunofenotipo B de localización abdominal es el más frecuente. El dolor y el tumor abdominal son las manifestaciones clínicas principales, y los pacientes con linfomas no Hodgkin de la región cervical y amígdala palatina tienen mayor promedio de vida después de concluido el tratamiento(AU)
Asunto(s)
Humanos , Niño , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/radioterapia , Linfoma no Hodgkin/terapia , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
INTRODUCCIÓN: los linfomas no Hodgkin son neoplasias hematológicas frecuentes en la infancia. OBJETIVO: describir las diferentes formas de presentación de esta enfermedad en la edad pediátrica, y determinar el promedio de años vividos después de concluido el tratamiento. MÉTODOS: se realizó un estudio descriptivo retrospectivo en 79 pacientes con diagnóstico de linfomas no Hodgkin atendidos en el servicio de Oncocirugía del Hospital Pediátrico Docente "William Soler", de marzo de 1995 a marzo de 2014. RESULTADOS: 48 pacientes fueron del sexo masculino y 31 del femenino. El grupo de edad de mayor afectación fue el de 10 a 14 años. El 54,4 % de los pacientes tuvieron linfomas de localización abdominal y el 29,1 % fueron de localización mediastinal. Otros sitios afectados fueron la región cervical, la amígdala palatina y renal primaria en el 10,1, 3,8 y 2,6 % de los pacientes respectivamente. La variante histológica más frecuente fue el linfoma no Hodgkin inmunofenotipo B (75,9 %), seguido del linfoma no Hodgkin inmunofenotipo tipo T en el 21,5 % de los casos. El dolor abdominal y la masa tumoral palpable fue la manifestación clínica principal en el 64,5 %. El promedio de años vividos en el linfoma no Hodgkin de localización renal, cervical y amígdala palatina fue ligeramente superior (5,7 ± 0,3, 5,5 ± 1,8 y 5,2 ± 0,7 respectivamente). CONCLUSIONES: el linfoma no Hodgkin inmunofenotipo B de localización abdominal es el más frecuente. El dolor y el tumor abdominal son las manifestaciones clínicas principales, y los pacientes con linfomas no Hodgkin de la región cervical y amígdala palatina tienen mayor promedio de vida después de concluido el tratamiento.
INTRODUCTION: non-Hodgkin lymphomas are frequent hematological neoplasias in infancy. OBJECTIVE: to describe the different forms of presentation of this disease at the pediatric age and to determine the average years lived after the treatment. METHODS: a retrospective and descriptive study of 79 patients was conducted; they had been diagnosed as non-Hodgkin lymphoma cases and attended to at the oncologic surgery service of "William Soler" pediatric teaching hospital from March 1995 to March 2014. RESULTS: forty eight patients were males and 31 were females. The most affected age group was the 10-14 years-old one. In the group, 54.4 % of patients had lymphomas located in the abdominal region and 29.1 % in the mediastinal location. Other affected areas were cervical region, palatal tonsil and primary renal region in 10.1 %, 3.8 % and 2.6 % of patients, respectively. The most common histological variant was immunophenotype B non-Hodgkin lymphoma (75.9 %) followed by immunophenotype T non-Hodgkin lymphoma (21.5 %). Abdominal pain and palpable tumor mass was the main clinical manifestation in 64.5 % of cases. The average life years in non-Hodgkin lymphoma located in the renal region, cervical region and palatal tonsil was slightly higher (5.7±0.3, 5.5±1.8 and 5.2±0.7, respectively). CONCLUSIONS: the immunophenotype B non-Hodgkin lymphoma of abdominal location is the most common. Abdominal pain and tumors are the main clinical manifestations and the patients with non-Hodgkin lymphomas in the cervical region and the palatal tonsil show higher average life years after treatment.
Asunto(s)
Humanos , Niño , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/radioterapia , Linfoma no Hodgkin/terapia , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
OBJECTIVES: We evaluated whether staging with positron emission tomography (PET) or treatment with rituximab after involved-field radiation therapy (IFRT) results in an improved progression-free survival (PFS) for early-stage indolent non-Hodgkin lymphoma (NHL). METHODS: We identified 42 patients with stage I/II low-grade NHL treated with initial IFRT at our institution between 1992 and 2009, who had been staged with computed tomography (CT) or PET. A retrospective analysis was performed to evaluate PFS according to staging by CT or PET, and by receipt of rituximab after IFRT. RESULTS: Overall PFS was 68% and 61% at 5 and 10 years, respectively. There was no significant difference in PFS whether patients were staged by CT (n=17) or by PET (n=25), with 5-year PFS rates of 76% and 60%, respectively. Eleven patients received 4 weekly doses of rituximab after IFRT, with no improvement in 5-year PFS: 46% for rituximab-treated patients versus 72% for patients who were not given rituximab. However, more patients who were given rituximab were stage II. CONCLUSIONS: Patients with limited stage indolent NHL staged with either CT or PET and treated with IFRT have favorable PFS compared with historical controls. The administration of 4 weekly doses of rituximab after IFRT did not improve PFS in these patients. The use of rituximab in this setting should be evaluated in a randomized prospective study.
Asunto(s)
Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Antineoplásicos/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Radioterapia Asistida por Computador/métodos , Adulto , Anciano , Factores de Confusión Epidemiológicos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Tomografía de Emisión de Positrones , Estudios Retrospectivos , Rituximab , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Chemotherapy is the mainstay of non-Hodgkin lymphoma (NHL) treatment. Based on expert opinion, the use of radiotherapy (RT) is currently preferred in some institutions as consolidative treatment for patients with localized disease. The lack of conclusive data coming from conflicting studies about the impact of treatment demands a systematic review, which could provide the most reliable assessment for clinical decision-making. We evaluate the addition of RT post-CT, for aggressive and localized NHL (ALNHL). METHODS: Randomized controlled trials (RCT) that evaluated chemotherapy alone versus chemotherapy plus RT were searched in databases. The outcomes were overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicity. Risk ratio (RR) and hazard ratio (HR) with their respective 95% confidence intervals (CI) were calculated using a fized-effect model. RESULTS: Four trials (1,796 patients) met the inclusion criteria. All trials tested the use of RT after systemic therapy comprising anthracycline-based chemotherapy. This systematic review showed that RT enhances PFS after chemotherapy (hazard ratio [HR] 0.81; 95% CI 0.67-0.98; p = 0.03), with no impact on ORR and OS. Some heterogeneity between trials could limit the conclusions about OS. Toxicity data could not be pooled due to differences in reporting adverse events. CONCLUSIONS: This systematic review with meta-analysis shows no improvement in survival when adding RT to systemic therapy for ALNHL. Our conclusions are limited by the available data. Further evaluations of new RT technologies and its association with biologic agents are needed.
Asunto(s)
Linfoma no Hodgkin/patología , Linfoma no Hodgkin/radioterapia , Terapia Combinada , Humanos , Linfoma no Hodgkin/mortalidad , Clasificación del Tumor , Estadificación de Neoplasias , Sesgo de Publicación , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
INTRODUCTION: The most successful clinical studies of immunotherapy in patients with non-Hodgkin's lymphoma (NHL) use the antibody rituximab (RTX) targeting CD20(+) B-cell tumors. Rituximab radiolabeled with ß(-) emitters could potentiate the therapeutic efficacy of the antibody by virtue of the particle radiation. Here, we report on a direct radiolabeling approach of rituximab with the (99m)Tc- and (188)Re-tricarbonyl core (IsoLink technology). METHODS: The native format of the antibody (RTX(wt)) as well as a reduced form (RTX(red)) was labeled with (99m)Tc/(188)Re(CO)(3). The partial reduction of the disulfide bonds to produce free sulfhydryl groups (-SH) was achieved with 2-mercaptoethanol. Radiolabeling efficiency, in vitro human plasma stability as well as transchelation toward cysteine and histidine was investigated. The immunoreactivity and binding affinity were determined on Ramos and/or Raji cells expressing CD20. Biodistribution was performed in mice bearing subcutaneous Ramos lymphoma xenografts. RESULTS: The radiolabeling efficiency and kinetics of RTX(red) were superior to that of RTX(wt) ((99m)Tc: 98% after 3 h for RTX(red) vs. 70% after 24 h for RTX(wt)). (99m)Tc(CO)(3)-RTX(red) was used without purification for in vitro and in vivo studies whereas (188)Re(CO)(3)-RTX(red) was purified to eliminate free (188)Re-precursor. Both radioimmunoconjugates were stable in human plasma for 24 h at 37 °C. In contrast, displacement experiments with excess cysteine/histidine showed significant transchelation in the case of (99m)Tc(CO)(3)-RTX(red) but not with pre-purified (188)Re(CO)(3)-RTX(red). Both conjugates revealed high binding affinity to the CD20 antigen (K(d) = 5-6 nM). Tumor uptake of (188)Re(CO)(3)-RTX(red) was 2.5 %ID/g and 0.8 %ID/g for (99m)Tc(CO)(3)-RTX(red) 48 h after injection. The values for other organs and tissues were similar for both compounds, for example the tumor-to-blood and tumor-to-liver ratios were 0.4 and 0.3 for (99m)Tc(CO)(3)-RTX(red) and for (188)Re(CO)(3)-RTX(red) 0.5 and 0.5 (24 h pi). CONCLUSION: Rituximab could be directly and stably labeled with the matched pair (99m)Tc/(188)Re using the IsoLink technology under retention of the biological activity. Labeling kinetics and yields need further improvement for potential routine application in radioimmunodiagnosis and therapy.
Asunto(s)
Anticuerpos Monoclonales de Origen Murino/química , Marcaje Isotópico/métodos , Compuestos de Organotecnecio/química , Radioisótopos/química , Renio/química , Animales , Anticuerpos Monoclonales de Origen Murino/sangre , Anticuerpos Monoclonales de Origen Murino/inmunología , Anticuerpos Monoclonales de Origen Murino/farmacocinética , Antígenos CD20/inmunología , Autorradiografía , Línea Celular Tumoral , Cisteína/química , Estabilidad de Medicamentos , Femenino , Histidina/química , Humanos , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/metabolismo , Linfoma no Hodgkin/radioterapia , Ratones , RituximabRESUMEN
El linfoma nasal de células T/natural killer fue definido y caracterizado, en el año 2001, por la Organización Mundial de la Salud (OMS). Se localiza preferentemente en las fosas nasales u senos maxilares, mostrando un curso clínico agresivo, definido por destrucción de los tejidos circundantes. Se ha observado una frecuente asociación con el virus de Epstein-Barr, de difícil tratamiento. Se presenta un caso con buena respuesta terapéutica a la radioterapia.
Nasal T cell/natural killer lymphoma was defined and described, in 2001, by the World Health Organization (WHO). It typically appears in the nasal cavity and maxillary sinuses, showing an aggressive clinical course, characterized by destruction of surrounding tissue. A frequent association with Epstein-Barr virus has been reported, which hampers the treatment. We present a case with good therapeutic response to radiotherapy.
Asunto(s)
Humanos , Masculino , Anciano , Células Asesinas Naturales , Linfocitos T , Linfoma no Hodgkin , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/radioterapia , Linfoma no Hodgkin/terapiaRESUMEN
O linfoma não-Hodgkin é a segunda neoplasia maligna mais prevalente na região da cabeça e do pescoço. A etiologia dos linfomas é desconhecida, porém distúrbios da função imune podem conferir risco aumentado para essa desordem. Apesar de as lesões orais serem freqüentemente uma manifestação da doença amplamente disseminada, às vezes, o linfoma origina-se nos tecidos bucais, sem ter se espalhado para outros locais. Paciente P.J.Q., 54 anos, masculino, compareceu ao ambulatório de cirurgia bucomaxilofacial do hospital São Félix, queixando-se de aumento de volume na região zigomática e na paranasal esquerda, após trauma severo por martelo, há um mês. Foi realizado punção aspiratória sem ter sido detectado qualquer sinal de infecção ou líquido cístico, no exame radiográfico não foi detectado fratura óssea. Foi colhido material para análise histopatológica, tendo como diagnóstico: linfoma não-Hodgkin de células B. Um ano após o diagnóstico, finalizado o tratamento quimioterápico, o paciente retornou para revisão quando foram realizadas extrações dentárias, para que pudesse ser submetido à radioterapia sem complicações. A proposta deste trabalho é apresentar um caso clínico de linfoma não-Hodgkin de células B, enfatizando a sua importância clínica e a necessidade do diagnóstico precoce na tentativa de melhorar a qualidade de vida dos pacientes.
Non-Hodgkin lymphoma is the second most prevalent malignant cancer of the head and neck region. The etiology of the lymphomas is unknown, but disorders of the immune function may result in an increased risk for this disease. Despite the fact that oral lesions are frequently a manifestation of a systemic pathology, the lymphoma sometimes arises in the oral tissues, without spreading to other organs. Patient P.J.Q, a fifty-four-year-old, male, presented at the clinic of oral and maxillofacial surgery of São Felix hospital, complaining of a swelling located in the left zygomatic paranasal region resulting from severe trauma caused by a hammer a month previously. Aspiratory punction was performed, resulting in no signs of infection or cystic fluid, and a radiograph revealed no bone fracture. Material from the lesion was collected sent for a histopathology examination, which led to a diagnosis of non-Hodgkin B-cell lymphoma. One year after the diagnosis, having completed a course of chemotherapy, the patient returned for follow-up, at which time some teeth were extracted so that the patient could undergo radiotherapy without complications. The aim of this paper is to present a case report of non-Hodgkin B-cell lymphoma, emphasizing the clinical importance of the disease and the need for an early diagnosis with a view to achieving a better life quality for patients.
Asunto(s)
Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/radioterapia , Mucosa Bucal/patologíaRESUMEN
BACKGROUND: Radioimmunotherapy is a molecular targeting treatment for high-risk leukemia and lymphoma. Rhenium-188-labeled anti-CD66 monoclonal antibody has been used successfully in patients with high-risk acute myeloid leukemia or myelodysplastic syndrome. Our aim was to establish the biokinetics of (188)Re-anti-CD20 in patients and to evaluate its dosimetry as a target-specific radiopharmaceutical for non-Hodgkin's lymphoma (NHL) radioimmunotherapy. METHODS: Whole-body images were acquired at various times after administration of (188)Re-anti-CD20, obtained from instant freeze-dried kit formulations with radiochemical purity >95%. Regions of interest (ROIs) were drawn around source organs in each time frame. The cpm of each ROI was converted to activity using the conjugate view counting method. The image sequence was used to extrapolate time-activity curves in each organ to calculate the total number of disintegrations (N) that occurred in the source regions. N data were the input for the OLINDA/EXM code to calculate internal radiation dose estimates. RESULTS: Dosimetric studies indicated that after administration of 4.87-8.72 GBq of (188)Re-anti-CD20, the absorbed dose to total body would be 0.75 Gy, which corresponds with the recommended dose for NHL therapies. CONCLUSIONS: The calculated absorbed doses of (188)Re-anti-CD20 indicate that it may be used in radioimmunotherapy. Therefore, these preliminary data justify a full assessment of the safety, toxicity, and efficacy of (188)Re-anti-CD20 in a clinical study.
Asunto(s)
Anticuerpos Monoclonales/farmacocinética , Linfoma no Hodgkin/radioterapia , Radioinmunoterapia , Adolescente , Anciano , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales de Origen Murino , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rituximab , Imagen de Cuerpo Entero , Recuento Corporal TotalRESUMEN
BACKGROUND: Ocular lymphomas and ocular adnexae lymphomas (OL and OAL) constitute 7-8% of all extranodal lymphomas. OBJECTIVE: Describe the clinical, morphologic and immunophenotypic characteristics of OAL seen in our hospital. MATERIAL AND METHODS: Retrospective analysis of patient records with OL and OAL between July 1994 and July 2005. The following data was analyzed: Clinical presentation, therapy, treatment response, overall survival and disease free survival. RESULTS: Ten patients with OL and OAL were identified. Of these, 8 were women and 2 men. Median age was 50. Eight of 10 patients achieved complete remission, 6 of the 6 presenting MALT Lymphoma. Two patients with stage IV had refractory disease. CONCLUSIONS: In our series 0.02% of lymphomas were OL and OAL of a total 498 LNH. MALT lymphomas appear at a more advanced age, sixty percent of the cases were MALT lymphomas and were diagnosed during their early stages. Patients were followed during 21 months, global survival was 100%, free illness survival had a mean of 868 days and a survival median of 442 days.
Asunto(s)
Neoplasias del Ojo/patología , Linfoma no Hodgkin/patología , Adulto , Anciano , Antineoplásicos/uso terapéutico , Neoplasias del Ojo/tratamiento farmacológico , Neoplasias del Ojo/radioterapia , Femenino , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Positron emission tomography (PET) with fluorine-18 labeled deoxyglucose (FDG) is useful in the management of lymphomas. In this review, some general concepts of this metabolic test are defined. It has an excellent diagnostic yield in Hodgkin disease as well as in most non Hodgkin lymphomas. Staging, restaging residual mass evaluation and the control of therapy are the main indications for FDG-PET. Images with FDG have a high diagnostic and prognostic value, that is superior to anatomical images and conventional staging techniques. They are also helpful for the assessment of tumor activity in abnormal lymph nodes or large masses that have been treated and reduce their size slowly or show an incomplete resolution. Currently, the resolution of dedicated PET equipments is 6 mm and bigger lesions can easily be detected. The main differences and advantages of FDG versus gallium-67 in lymphoma are also discussed, as well as the initial local experience with the technique in lymphoma patients.
Asunto(s)
Fluorodesoxiglucosa F18 , Enfermedad de Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Tomografía de Emisión de Positrones , Radiofármacos , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Radioisótopos de Galio , Enfermedad de Hodgkin/patología , Enfermedad de Hodgkin/radioterapia , Humanos , Linfoma no Hodgkin/patología , Linfoma no Hodgkin/radioterapia , Masculino , Estadificación de Neoplasias , Pronóstico , Sensibilidad y EspecificidadRESUMEN
Background: Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on the clinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy, cyclophosphamide, adriamicin, vincristine and prednisone (CHOP). Patients presenting with localized disease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results. Aim: To evaluate the treatment results including overall survival (OS) and event-free survival (EFS) in localized aggressive NHL patients treated at the Pontificia Universidad Católica de Chile, Clinical Hospital. Patients and Methods: Retrospective analysis of all patients with Ann Arbor stages I and II referred to the hematology and radiotherapy clinic between 1998 and 2003. OS and EFS analysis was made according to the Kaplan and Meier method. Log-rank and Cox methods were used for univariate and multivariate analyses, respectively. Chemotherapy and radiotherapy toxicities were scored according to World Health Organization (WHO) and Radiation Therapy Oncology Group (RTOG) scales, respectively. Results: 39 patients (20 men), aged between 20 to 85 years, were the source for this study. The average follow-up was 51 months (range 6-115). The 5 years OS and EFS were 72,4 percent and 63,3 percent, respectively. On univariate analysis, age over 60 was the only variable that affected negatively OS and EFS. Acute toxicity caused by chemotherapy and radiotherapy was uncommon. Conclusions: Age over 60 was the only independent variable associated with poor prognosis. The number of chemotherapy cycles and the drug combination did not influence the results. These results support the usefullness of a shortened chemotherapy regimen plus involved field radiotherapy.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Terapia Combinada/métodos , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Etopósido/administración & dosificación , Etopósido/efectos adversos , Estudios de Seguimiento , Linfoma no Hodgkin/mortalidad , Estadificación de Neoplasias , Prednisona/administración & dosificación , Prednisona/efectos adversos , Pronóstico , Radioterapia Adyuvante , Recurrencia , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Vincristina/administración & dosificación , Vincristina/efectos adversosRESUMEN
Antecedentes. Los linfomas oculares (LO) y de los anexos oculares (LAO) tienen una incidencia de 7- 8% de todos los tumores extraganglionares. Objetivo. Describir las características clínicas, morfológicas e inmunofenotípicas de los LO y LAO atendidos en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Material y métodos. Se revisaron los expedientes de los pacientes con diagnóstico de LO y LAO de julio de 1994 a julio del 2005. Se analizaron los siguientes datos: presentación clínica, tratamiento, respuesta al tratamiento, supervivencia global, y supervivencia libre de enfermedad (SVLE). Resultados. Se analizaron 10 pacientes, 8 mujeres y 2 hombres. La media de edad fue de 50 años. La remisión completa (RC) se presentó en 8 de 10 pacientes y en los 6 pacientes con linfoma de tejido linfoide asociado a mucosas (MALT). Se encontraron dos con enfermedad refractaria, los cuales estaban en estadio IV. Conclusiones. En este estudio los LO y LAO correspondieron a 0.02% de todos los linfomas no Hodgkin (LNH) estudiados (498 casos). Los linfomas tipo MALT se presentan a edad más avanzada, se encontraron en estadios más tempranos y en todos hubo RC, con una SVLE promedio de 868 días y una media de supervivencia de 442 días.
BACKGROUND: Ocular lymphomas and ocular adnexae lymphomas (OL and OAL) constitute 7-8% of all extranodal lymphomas. OBJECTIVE: Describe the clinical, morphologic and immunophenotypic characteristics of OAL seen in our hospital. MATERIAL AND METHODS: Retrospective analysis of patient records with OL and OAL between July 1994 and July 2005. The following data was analyzed: Clinical presentation, therapy, treatment response, overall survival and disease free survival. RESULTS: Ten patients with OL and OAL were identified. Of these, 8 were women and 2 men. Median age was 50. Eight of 10 patients achieved complete remission, 6 of the 6 presenting MALT Lymphoma. Two patients with stage IV had refractory disease. CONCLUSIONS: In our series 0.02% of lymphomas were OL and OAL of a total 498 LNH. MALT lymphomas appear at a more advanced age, sixty percent of the cases were MALT lymphomas and were diagnosed during their early stages. Patients were followed during 21 months, global survival was 100%, free illness survival had a mean of 868 days and a survival median of 442 days.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Linfoma no Hodgkin/patología , Neoplasias del Ojo/patología , Antineoplásicos/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Estadificación de Neoplasias , Neoplasias del Ojo/tratamiento farmacológico , Neoplasias del Ojo/radioterapia , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Positron emission tomography (PET) with fluorine-18 labeled deoxyglucose (FDG) is useful in the management of lymphomas. In this review, some general concepts of this metabolic test are defined. It has an excellent diagnostic yield in Hodgkin disease as well as in most non Hodgkin lymphomas. Staging, restaging residual mass evaluation and the control of therapy are the main indications for FDG-PET. Images with FDG have a high diagnostic and prognostic value, that is superior to anatomical images and conventional staging techniques. They are also helpful for the assessment of tumor activity in abnormal lymph nodes or large masses that have been treated and reduce their size slowly or show an incomplete resolution. Currently, the resolution of dedicated PET equipments is 6 mm and bigger lesions can easily be detected. The main differences and advantages of FDG versus gallium-67 in lymphoma are also discussed, as well as the initial local experience with the technique in lymphoma patients.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Enfermedad de Hodgkin , Linfoma no Hodgkin , Tomografía de Emisión de Positrones , Radiofármacos , Supervivencia sin Enfermedad , Radioisótopos de Galio , Enfermedad de Hodgkin/patología , Enfermedad de Hodgkin/radioterapia , Linfoma no Hodgkin/patología , Linfoma no Hodgkin/radioterapia , Estadificación de Neoplasias , Pronóstico , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Multiple therapeutic strategies have been proposed for the management of primary cutaneous lymphomas. We report the outcome data and therapeutic response of a group of patients treated with local radiotherapy. MATERIAL AND METHODS: Twenty seven patients with diagnostic of cutaneous lymphoma and treated with local radiation were evaluated for clinical response. Thirteen cases corresponded to cutaneous T-cell lymphomas (CTCL) and 14 to cutaneous B-cell lymphomas (CBCL). Orthovoltage radiotherapy of 100 Kv was used and total dose of radiation ranged from 15 to 30 Gy (mean 24 Gy; median 20 Gy). RESULTS: The immediate response to the treatment was satisfactory in all cases. In 24 patients (89%) complete response was obtained in the irradiated lesion and in 3 cases (11%) the response was partial. With a mean follow-up of 25.4 months (range 1-100 months) the overall response rate was 96.3%. Fourteen patients (52%) were alive without evidence of disease (6 CTCL and 8 CBCL), 5 patients (18%) retained cutaneous disease or had systemic progression (3 CTCL and 2 CBCL) and 8 patients died (30%). In 7 patients lymphoma progression was the factor leading to death (26%) and in one patient the cause was not related with the disease. CONCLUSIONS: Radiotherapy was demonstrated to be able to induce clinical remission of primary cutaneous lymphomas.
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Linfoma no Hodgkin/radioterapia , Neoplasias Cutáneas/radioterapia , Adulto , Anciano , Causas de Muerte , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Linfoma de Células B/radioterapia , Linfoma Cutáneo de Células T/radioterapia , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Dosificación Radioterapéutica , Tamaño de la Muestra , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on the clinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy, cyclophosphamide, adriamycin, vincristine and prednisone (CHOP). Patients presenting with localized disease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results. AIM: To evaluate the treatment results including overall survival (OS) and event-free survival (EFS) in localized aggressive NHL patients treated at the Pontificia Universidad Católica de Chile, Clinical Hospital. PATIENTS AND METHODS: Retrospective analysis of all patients with Ann Arbor stages I and II referred to the hematology and radiotherapy clinic between 1998 and 2003. OS and EFS analysis was made according to the Kaplan and Meier method. Log-rank and Cox methods were used for univariate and multivariate analyses, respectively. Chemotherapy and radiotherapy toxicities were scored according to World Health Organization (WHO) and Radiation Therapy Oncology Group (RTOG) scales, respectively. RESULTS: 39 patients (20 men), aged between 20 to 85 years, were the source for this study. The average follow-up was 51 months (range 6-115). The 5 years OS and EFS were 72,4% and 63,3%, respectively. On univariate analysis, age over 60 was the only variable that affected negatively OS and EFS. Acute toxicity caused by chemotherapy and radiotherapy was uncommon. CONCLUSIONS: Age over 60 was the only independent variable associated with poor prognosis. The number of chemotherapy cycles and the drug combination did not influence the results. These results support the usefulness of a shortened chemotherapy regimen plus involved field radiotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Terapia Combinada/métodos , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Etopósido/administración & dosificación , Etopósido/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Linfoma no Hodgkin/mortalidad , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Prednisona/administración & dosificación , Prednisona/efectos adversos , Pronóstico , Radioterapia Adyuvante , Recurrencia , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Vincristina/administración & dosificación , Vincristina/efectos adversosRESUMEN
El Consenso Colombiano de Hematología Oncológica (CCHO) es un proyecto apoyado por el Instituto Nacional de Cancerología, E.S.E y por la Sociedad Colombiana de Hematología y Oncología Clínica. Su propósito es mejorar los resultados de las intervenciones realizadas en los pacientes con cáncer, ayudando a los profesionales en salud a suministrar la mejor evidencia disponible; a fin de optimizar las decisiones clínicas y promover el uso racional de los recursos.La actividad del CCHO permite desarrollar pautas para la práctica siguiendo la metodología del grupo nominal, y los informes resultantes representan la síntesis de las recomendaciones extraídas de la información recolectada por medio de búsquedas sistemáticas de la literatura médica. La aprobación de las recomendaciones por parte de los miembros del CCHO no significa necesariamente que deba ser adoptada como política; depende del lector.Se revisaron las bases Medline 1966-2005,Cochrane Library tissue 2,2005,Embase 1974-2005,Biosis 1992-2005, Lilacs 1989-2005 y otras bases de datos relevantes.Esta guía ha sido revisada y aprobada por todos los miembros del Consenso,que incluyó hematólogos, oncólogos, epidemiólogos, hematopatólogos, un especialista en políticas de salud y un miembro de la comunidad. Tres hematólogos internacionales, de manera independiente, hicieron la revisión externa del documento de resumen. El documento final del consenso requirió un proceso formal de estandarización. Será obligatoria la revisión periódica y continua de la literatura científica y, cuando se considere apropiado, se integrara la nueva información relevante al consenso original.Población: El ámbito del consenso son los pacientes adultos con diagnóstico de linfoma folicular no Hodgkin (LFNH).
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Humanos , Conferencias de Consenso como Asunto , Linfoma Folicular/diagnóstico , Linfoma Folicular/tratamiento farmacológico , Linfoma Folicular/radioterapia , Linfoma Folicular/terapia , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Linfoma no Hodgkin/terapia , ColombiaRESUMEN
BACKGROUND: Therapies using Y-anti-CD20 or I-anti-CD20 have demonstrated their efficacy in patients with B-cell non-Hodgkin's lymphoma. Re is a radionuclide useful for radioimmunotherapy. AIM: To develop a procedure for efficient labelling of anti-CD20 with Re from lyophilized formulations to achieve high radiochemical yield, high specific activity and preservation of the molecular recognition after a simple kit reconstitution without further purification. METHODS: Re-anti-CD20 was prepared by a direct labelling method using sodium tartrate as a weak competing ligand. Different lyophilized formulations were prepared to optimize tartrate and stannous chloride concentration, pH and reaction time. To evaluate the biological recognition a comparative study of the in-vitro binding of Re-anti-CD20, I-anti-CD20 (positive control) and Re-anti-CEA (negative control) to normal B lymphocytes was performed. Biodistribution studies in normal mice were accomplished to assess the in-vivo Re-anti-CD20 complex stability. RESULTS: Re labelled anti-CD20 was obtained with high radiochemical purities (>97%) and high specific activity (0.5-0.7 GBq . mg) 1-1.5 h after addition of sodium perrhenate solution to a kit containing 4.4 muM anti-CD20, 4 mM anhydrous stannous chloride, and 140 mM dihydrate sodium tartrate at pH 4. The binding of Re-anti-CD20 to cells was in the same range as I-anti-CD20 (>80%) and was significantly different to cell binding of Re-anti-CEA (<10%). No evidence of free Re release was found at 2, 4 and 24 h after Re-anti-CD20 administration in mice. Lyophilized kits showed high stability during the storage at 4 degrees C for 6 months. CONCLUSIONS: Optimal reaction conditions were defined enabling high radiochemical purities of Re-anti-CD20 to be obtained routinely and therefore potentially useful in the treatment of non-Hodgkin's lymphoma.
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Anticuerpos Monoclonales/farmacocinética , Anticuerpos Monoclonales/uso terapéutico , Linfoma no Hodgkin/radioterapia , Radioinmunoterapia/métodos , Animales , Antígenos CD20 , Evaluación Preclínica de Medicamentos , Marcaje Isotópico/métodos , Masculino , Tasa de Depuración Metabólica , Ratones , Ratones Endogámicos BALB C , Especificidad de Órganos , Radiofármacos/síntesis química , Radiofármacos/farmacocinética , Radiofármacos/uso terapéutico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Distribución TisularRESUMEN
La Medicina Nuclear clínica se apoya tradicionalmente en tres grandes pilares básicos, estos son las imágenes, la terapia con radionucleidos y las técnicas "in vitro". En los últimos años, tanto con el desarrollo de las imágenes moleculares como con el surgimiento de nuevas aplicaciones terapéuticas con radionucleidos, se nos abren insospechadas oportunidades para que nuestra especialidad ocupe un valioso sitial en las nuevas aplicaciones oncológicas. En este artículo se revisa nuestra experiencia en dos novedosas áreas en las cuales hemos tenido la oportunidad de desarrollarlas en nuestro centro. Estas son la terapia con 90Y-DOTATOC en tumores con sobre-expresión de receptores de somatostatina[1] (carcinoides, neuroendocrinos y otros) y el uso de 90Y-Ibritumomab-Tiuxetan en Linfomas No Hodgkin de células B con presencia de antígeno CD20+[2].