RESUMO
OBJECTIVES: To assess the efficacy and toxicity of the most employed therapeutic approaches in the treatment of primary breast lymphoma (PBL). METHODS: Ninety-six patients with PBL in the early stage (I or II) were enrolled to receive radiotherapy (45 Gy); chemotherapy (six cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), every 21 days), or combined therapy. RESULTS: Complete response was achieved in 20 of 30 patients treated with radiotherapy, 19 of 32 who were treated with chemotherapy and 30 of 34 in the combined arm (p<0.01). Actuarial curves at 10 years showed that event-free survival was 50, 57 and 83%, respectively (p<0.01). Actuarial curves for overall survival were 50, 50 and 76% (p<0.01), respectively. The most common site of relapse was the central nervous system. Acute toxicity was mild. Until now, no second neoplasm or acute leukemia has been observed. CONCLUSIONS: In our study combined therapy is the best treatment in this special setting of patients; with improvement in event-free survival and overall survival without acute or severe late side effects. Prophylaxis to the central nervous system will be considered in the initial treatment to improve outcome.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Linfoma/tratamento farmacológico , Linfoma/radioterapia , Análise Atuarial , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/efeitos adversos , Ciclofosfamida/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Humanos , Linfoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Análise de Sobrevida , Resultado do Tratamento , Vincristina/administração & dosagemRESUMO
OBJECTIVES: We evaluate the long-term results of a randomized clinical trial in patients with advanced stages (III and IV) of follicular lymphoma using chemotherapy or combined therapy (chemotherapy following by adjuvant radiotherapy in patients with nodal bulky disease). MATERIAL AND METHODS: Between 1981 and 1995, patients with follicular lymphoma were treated with combined chemotherapy, mostly anthracycline-based regimens; patients who achieved complete response were randomly assigned either to receive adjuvant radiotherapy to sites or to nodal bulky disease or not (control group). RESULTS: Four hundred and sixty-nine patients were randomized; in an intent-to-treat analysis all were evaluable for efficacy and toxicity. Actuarial curves at 20yr showed that event-free survival (EFS) and overall survival (OS) in the control group were 41% [95% confidence interval (CI) 36-56%) and 71% (95% CI 65-78%), respectively; these were statistically different from results for the patients who received adjuvant radiotherapy: 68% (95% CI 62-72%) and 89% (95% CI 79-96%), respectively (P<0.01). Acute and late toxicity were minimal; only four patients (<1%) developed myelodysplastic syndrome/acute leukemia. Cardiac toxicity was 2%, but one case was lethal. Thirty-six patients (8%) died secondary to unrelated causes, in complete remission. CONCLUSIONS: The use of adjuvant radiotherapy in patients with poor-prognosis follicular lymphoma increases EFS and OS with minimal toxicity. We feel that follicular lymphoma should be treated curatively because <80% of patients will be in first complete response at <20yr. The use of adjuvant radiotherapy will be considered in the first line of treatment in this set of patients.
Assuntos
Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Causas de Morte , Terapia Combinada , Intervalo Livre de Doença , Feminino , Cardiopatias/induzido quimicamente , Humanos , Linfoma Folicular/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/induzido quimicamente , Estadiamento de Neoplasias , Prognóstico , Recidiva , Indução de Remissão , Taxa de SobrevidaRESUMO
Se estudió el comportamiento del virus del Distemper Canino (VDC) en cultivos celulares primarios y de líneas. Se emplearon diversos VDC, aislados de encéfalos provenientes de perros que murieron mostrando una sintomatología nerviosa; histológicamente, dichos encéfalos presentaron cuerpos de inclusión y reacción positiva por inmunofluorescencia (IF) al emplear un conjugado anti-DVC. Cada muestra se inoculó en células VERO y Cultivo Primario de Riñón de perro (CRP) para evaluar la capacidad de: a) producir efectos citopáticos (ECP),b) reaccionar frente a un conjugado fluorescente anti-DVC, c) hemoaglutinar glóbulos rojos de diversas especies en diferentes condiciones y d) hemoadsorber glóbulos rojos. Los resultados mostraron que: a) no hubo diferencia alguna entre emplear células VERO y CRP, observándose cambios citopáticos que permitieron diferenciar un cultivo infectado de uno no infectado con virus vacunal, b) el 88 por ciento de las muestras conservó su antigenisidad, pues resultó positivo en la prueba de IF, observándose la mayor intensidad de fluorescencia específica a las 48 horas postinfección, c) el 58 por ciento de las muestras mostró hemoadsorción y d) ninguna muestra, incluyendo los testigos, fue capaz de hemoaglutinar. No fue posible, con base en los resultados, establecer diferencias entre los virus "de campo" y los vacunales.