RESUMO
Introducción La quimioterapia neoadyuvante (qtn) es el tratamiento inicial para pacientes con tumores localmente avanzados, permitiendo la evaluación de la sensibilidad in vivo a los agentes antineoplásicos y la planificación de estrategias quirúrgicas con resultados cosméticos favorables. Objetivos Comparar la tasa de respuesta patológica completa (pcr), la tasa de conversión a cirugía conservadora (tccc), el tiempo a la recaída a distancia (trad) y la supervivencia libre de enfermedad a distancia (sled) a 60 meses en pacientes con cáncer de mama Estadio III que fueron tratadas con qtn antes y después del año 2007 Material y método Se trata de un estudio observacional de cohortes retrospectivo en el que se analizaron registros de pacientes con cáncer de mama Estadio III operadas entre 1987 y 2016 que hubieran realizado qtn . Se constituyeron dos cohortes: en la primera se reunieron pacientes tratadas entre 1987 y 2006; en la segunda se agruparon aquellas tratadas entre 2007 y 2016. Se estableció esta diferencia dado que a partir de 2007 hubo cambios en la modalidad terapéutica: se administró la quimioterapia en forma continua antes de la cirugía y se introdujeron los taxanos y la terapia anti-her2 neu en los esquemas de qtn . En total se registraron 202 pacientes, 146 pertenecientes a la primera cohorte y 56 pertenecientes a la segunda. La mediana de edad y el tamaño tumoral fueron similares entre ambos grupos, mientras que en el segundo grupo observamos mayor porcentaje de tumores Grado 3 y mayor carga tumoral axilar. Resultados La tasa de pcr fue del 2% (n=3) para el primer grupo y de 13% (n=7) para el segundo (p=0,0022). La tasa de conversión a cirugía conservadora fue del 27% (n=20) para el primer grupo y del 41% (n=17) para el segundo, observándose un 14% más de cirugías conservadoras en este último (p=0,11). La mediana de trad fue de 33 meses para el primer grupo y de 46,5 meses para el segundo (p=0,044). La sled a 60 meses fue del 58% vs el 74% para el primer y segundo grupo respectivamente (p=0,039). Conclusiones Los cambios en la modalidad terapéutica en qtn en nuestra práctica se tradujeron en mayores tasas de pcr, mayor porcentaje de conversión a cirugía conservadora, mayor tiempo a la recidiva a distancia y mayor supervivencia libre de enfermedad a distancia
Introduction Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer, allowing surgical planning with favorable cosmetic outcome and evaluation of in vivo response to antineoplastic agents. Objectives To compare pathologic complete response, breast conserving surgery conversion rates, time to distant relapse and distant recurrence free survival after 60 months in patients with Stage III breast cancer who received neoadjuvant chemotherapy before and after year 2007. Materials and method Observational retrospective cohort study analizing database and medical records of patients with Stage III breast cancer who had surgery after neoadjuvant therapy between 1987 and 2016. We divided the population into two cohorts, one with patients treated between 1987 and 2006, and another one with those ones treated between 2007 and 2016. We established that difference given that from 2007 and onwards there were major changes in treatment modality: chemotherapy was administered completely before surgery, and Taxane-containing regimens as well as Anti-her2 therapies were included. We registered 202 patients, 146 in the first group and 56 in the second. While median of age and tumor size were similar between groups, axillary tumor burden and histologic grade were higher in the second group. Results Pathologic complete response rate was 2% for the first group and 13% for the second (p=0.0022). Breast conserving surgery conversion rates were 27% vs 41%, with 14% more breast conserving surgeries in the second cohort. Median time to distant recurrence was 33 months vs 46.5 months (p=0.044) and distant recurrence free survival was 58% vs 74% (p=0.039) for groups 1 and two 2 respectively. Conclusions Changes in treatment modality in our practice resulted in better pcr outcomes, more breast conserving surgery conversion rates, longer time to distant relapse and a better distant recurrence free survival
Assuntos
Cirurgia Geral , Neoplasias da Mama , Terapia Neoadjuvante , NeoplasiasRESUMO
Resumen El carcinoma similar al linfoepitelioma (LELC) del cuello uterino es una variante infrecuente del carcinoma de células escamosas. Se presenta el caso de una mujer con un tumor exofítico en el cuello uterino de consistencia aumentada, sangrado al tacto y parametrios libres de tumor clasificándose como etapa clínica IBI; el estudio histopatológico reportó LELC con recurrencia a distancia al año de seguimiento. Debido a su buen pronóstico existen pocos casos reportados de recurrencia posterior al tratamiento inicial.
Abstract Lymphoepithelioma-like carcinoma (LELC) of the cervix is an uncommon variant of squamous cell carcinoma. We present the case of a woman with an exophytic tumor on the cervix of increased consistency, bleeding to the touch and tumor-free parametriums classified as clinical stage IBI; the histopathological study reported LELC with distant recurrence at one year of follow-up. Due to its good prognosis, there are few reported cases of recurrence after initial treatment.
Assuntos
Humanos , Feminino , Carcinoma de Células Escamosas , Colo do Útero , Mulheres , NeoplasiasRESUMO
OBJECTIVE: Despite the benefits of concomitant radiotherapy and cisplatin for locally advanced cervical cancer, recurrence rates remain high. New treatment strategies such as consolidation chemotherapy and different concomitant chemotherapy combinations have been tested in recent years. Identification of the best candidates for each treatment strategy could optimize results. STUDY DESIGN: A retrospective review of data from 127 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics Stages IIB-IVA), treated at a single institution from 2005 to 2014. Risk factors for loco-regional and systemic recurrence, and prognostic factors for overall survival (OS) were analysed using Cox regression. Survival of patients treated with consolidation chemotherapy was compared with survival of patients not treated with consolidation chemotherapy in the role cohort and in a propensity-score-matched cohort. RESULTS: With a median follow-up time of 48.7 months, loco-regional-recurrence-free survival (LRFS), distant-metastasis-free survival (DMFS) and OS at 5 years were 76.6%, 54.0% and 63.0%, respectively. On multivariate analysis, tumour size ≥6 cm was associated with shorter LRFS [hazard ratio (HR) 5.18; 95% confidence interval (CI) 1.45-18.45; p = 0.011], and adenocarcinoma (HR 2.48; 95% CI 1.10-5.57; p = 0.028) and positive lymph nodes (HR 2.21; 95% CI 1.303-4.72; p = 0.041) were associated with shorter DMFS. Tumour size ≥6 cm was associated with shorter OS (HR 2.64; 95% CI 1.09-6.35; p = 0.031). Twenty-two patients were treated with consolidation chemotherapy; on univariate analysis, these patients had longer OS compared with patients who were not treated with consolidation chemotherapy (p = 0.043). In a propensity-score-matched cohort, patients treated with consolidation chemotherapy had longer DMFS and OS compared with patients who were not treated with consolidation chemotherapy, although the difference was not significant. CONCLUSIONS: Different risk factors are associated with loco-regional and distant metastases in patients with locally advanced cervical cancer, and could potentially lead to particular therapeutic strategies. Although the number of patients treated with consolidation chemotherapy in the study cohort was small, they seemed to live longer and to have better control of distant relapse then patients who were not treated with consolidation chemotherapy.
Assuntos
Recidiva Local de Neoplasia/etiologia , Neoplasias Pélvicas/secundário , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Quimiorradioterapia/mortalidade , Cisplatino/uso terapêutico , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Neoplasias Pélvicas/mortalidade , Pelve/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Adulto JovemRESUMO
El cáncer de mama lidera las causas de muerte por cáncer en mujeres peruanas. Mientras los programas de control de cáncer se enfocan en incrementar el diagnóstico de estadios tempranos, es importante conocer bien los factores de prognóstico en este grupo de pacientes. El objetivo de este estudio fue Identificar factores prognósticos en pacientes con cáncer de mama en estadios clínicos tempranos (I-IIA) sometidas a cirugía como tratamiento de inicio. Se realizó un estudio observacional descriptivo de una serie de casos retrospectiva de pacientes diagnosticados con cáncer de mama en estad¡os I-IIA entre enero del 2000 hasta diciembre de 2005. Se incluyeron 952 pacientes. Se identificó el tamaño del tumor, número de ganglios comprometidos, estadio patológico, receptor de estrógeno, tipo de cirugía y a la hormonoterapia como factores prognósticos de sobrevida libre de recurrencia a distancia; mientras que para la sobrevida global las variables fueron la edad, el estadio T patológico, el tamaño del tumor, el número de ganglios comprometidos, el estadio patológico, los receptores de estr¢geno y progesterona, el fenotipo y la hormonoterapia. El análisis multivariado mostró que los factores de prognóstico independientes para la sobrevida libre de recurrencia a distancia fueron el estadio T patológico (HR=1,51, para T2, comparado a T1), y el estadio N patológico (HR=1,82, para N2, comparado a N1), mientras que para la sobrevida global fueron la edad (HR=4,14, para ≥70 años, comparado a <50), el estadio T patológico (HR=1,74, para T2, comparado a T1), estadio N patológico (HR=1,93, para N1, comparado a N0). En conclusión, la edad, estadios patológicos T y N, fueron los factores de prognóstico m s importantes.
Breast cancer is the leading cause of cancer death in Peruvian women and while the cancer control programs focus on increasing the diagnosis of early stages, it is important to know prognostic factors in this subgroup of patients. The aim of this study was to identify prognostic factors in patients with breast cancer in early clinical stages patients (I-IIA) with surgery as first treatment. We conducted a descriptive study of retrospective case series of patients diagnosed with breast cancer stages I-IIA is from January 2000 to December 2005 in the Instituto Nacional de Enfermedades Neopl sicas. During the study period 952 patients met eligibility criteria and were included in the study. The tumor size, number of involved nodes, pathological stage, estrogen receptor, the type of surgery and hormone therapy were identified predictors of recurrence-free survival at a distance, while for overall survival, variables were age at diagnostic, the pathological T stage, tumor size, number of involved nodes, pathological stage, estrogen receptor and progesterone status and the hormone phenotype. Multivariate analysis showed that independent prognostic factors for recurrence-free survival were pathological T stage (HR = 1.51, for T2, compared to T1), and pathologic N stage (HR = 1.82, for N2, compared to N1), whereas for overall survival were age at diagnosis (HR = 4.14, for ≥ 70 years, compared to <50), pathological T stage (HR = 1.74, for T2, compared to T1), pathologic N stage (HR = 1.93 for N1, compared to N0). In conclusion, age, pathologic T and N stages were the most important prognostic factors.