RESUMO
Knowledge of several pathways of oncogenesis has led to the development of novel therapies in the treatment of advanced kidney cancer in the last five years. These have targeted the vascular endothelium-derived factor (VEGF) (angiogenesis) and mammalian target of rapamycin (mTOR). Antiangiogenics are a group of active molecules with a peculiar spectrum of toxicity including the development of hypertension, thyroid dysfunction and hand-foot syndrome. The identification of molecular and clinical predictors would allow to identify those patients who would benefit from such treatment and saveguarding the rest from toxic exposure. The occurrence of hypertension has been correlated with treatment response and clinical efficacy. In our retrospective series, patients treated with antiangiogenic agents who developed high blood pressure showed a higher response rate and disease-free interval compared to those without increased blood pressure. Hypertension should be considered a clinical predictor in the treatment of these patients. These findings should be confirmed in a larger study population.
Assuntos
Inibidores da Angiogênese/efeitos adversos , Carcinoma de Células Renais/tratamento farmacológico , Hipertensão/induzido quimicamente , Neoplasias Renais/tratamento farmacológico , Adulto , Idoso , Inibidores da Angiogênese/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
El conocimiento de las diversas vías de oncogénesis ha llevado al desarrollo en los últimos cinco años de nuevas terapias para el tratamiento del cáncer renal avanzado, las que poseen como blanco al factor derivado del endotelio vascular (VEGF) y sus receptores (antiangiogénicos) y al blanco mamífero de la rapamicina (mTOR). Los antiangiogénicos constituyen un grupo de moléculas activas con un espectro de toxicidad peculiar que comprende el desarrollo de hipertensión arterial, disfunción tiroidea y síndrome de mano-pie. La identificación de factores predictivos clínicos y moleculares lograría identificar aquellos pacientes que se beneficiarían con dicho tratamiento, evitando exposición y toxicidad innecesaria al resto. La aparición de hipertensión arterial se ha correlacionado con respuesta al tratamiento y eficacia clínica. En nuestra serie retrospectiva, los pacientes tratados con antiangiogénicos que desarrollaron hipertensión arterial tuvieron aumento de la tasa de respuestas e intervalo libre de enfermedad en comparación con aquellos que, tratados de la misma manera, no manifestaron hipertensión. La hipertensión arterial debería considerarse como un factor predictor clínico en su tratamiento. Dichos hallazgos deberían ser corroborados en forma prospectiva y con un mayor número de pacientes.
Knowledge of several pathways of oncogenesis has led to the development of novel therapies in the treatment of advanced kidney cancer in the last five years. These have targeted the vascular endothelium-derived factor (VEGF) (angiogenesis) and mammalian target of rapamycin (mTOR). Antiangiogenics are a group of active molecules with a peculiar spectrum of toxicity including the development of hypertension, thyroid dysfunction and hand-foot syndrome. The identification of molecular and clinical predictors would allow to identify those patients who would benefit from such treatment and saveguarding the rest from toxic exposure. The occurrence of hypertension has been correlated with treatment response and clinical efficacy. In our retrospective series, patients treated with antiangiogenic agents who developed high blood pressure showed a higher response rate and disease-free interval compared to those without increased blood pressure. Hypertension should be considered a clinical predictor in the treatment of these patients. These findings should be confirmed in a larger study population.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Angiogênese/efeitos adversos , Carcinoma de Células Renais/tratamento farmacológico , Hipertensão/induzido quimicamente , Neoplasias Renais/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: We describe a surgical technique to reconstruct the glans secondary to partial penectomy or traumatic partial amputation as well as its complications. We assessed urethral flap vitality and the tumor recurrence rate using this technique. MATERIALS AND METHODS: Glanuloplasty with a urethral flap was done in 10 patients who underwent partial penectomy for penile squamous cell carcinoma. We reconstructed the neoglans with a urethral flap at the same surgical resection. Mean patient age was 61 years (range 18 to 71). Mean followup was 11 months (range 5 to 17). RESULTS: We noted no neomeatal stenosis or flap necrosis secondary to the technique. The early tumor recurrence rate was 10% and the penile curvature rate was 10%. Penile curvature was ventral with no associated penetration difficulty. CONCLUSIONS: This simple, reproducible technique has satisfactory functional and cosmetic results, and an acceptable complication rate for this type of pathological condition.