Estudo de coorte prospectiva de pacientes com câncer de colo de útero: a idade é um fator determinante? / Prospective cohort study of cervical cancer patients: is age a determining factor?

Introdução: O câncer de colo de útero (CCU) apresenta alta prevalência e mortalidade. No Brasil, é a terceira causa mais comum de câncer no grupo feminino, acometendo também a população idosa. Objetivo: Delinear a epidemiologia de pacientes jovens e idosas com câncer de colo de útero e avaliar a eficácia do tratamento desse câncer no Instituto de Medicina Integral Prof. Fernando Figueira. Método: A partir de 2015, iniciou-se uma coorte de pacientes geriátricos em paralelo a outra coorte de pacientes com câncer de colo de útero. Este trabalho é o resultado da análise retrospectiva, específica de pacientes com câncer de colo de útero extraídas de ambas as coortes citadas. Foram coletados os dados demográficos, sobre os sintomas iniciais, estadiamento na ocasião do diagnóstico, tempo de início dos sintomas até o estabelecimento do diagnóstico, tempo do diagnóstico até o início do tratamento, sobrevida livre de doença e sobrevida global. Resultados: Foram incluídas 120 pacientes em ambas as coortes. Dentre estas, 73 tinham o diagnóstico de CCU e dados suficientes. Escolaridade e multiparidade mostraram efeitos significativos, sendo o analfabetismo e paridade de quatro a seis fatores de risco para o câncer de colo, especialmente entre o grupo de idosas. Ambos os grupos realizaram quimioterapia concomitante à radioterapia, tendo as adultas maior percentual de óbito em relação às idosas, ainda que esta diferença não tenha sido significativa. Conclusão: Este estudo observou que o principal resultado histopatológico foi de carcinoma escamoso e o estadiamento mais comum foi o III, refletindo um tratamento principalmente quimioterápico, com uma sobrevida estatisticamente semelhante entre os dois grupos.

QUALIDADE DE VIDA, ANSIEDADE E DEPRESSÃO EM PACIENTES COM CÂNCER DE COLO DO ÚTERO AVANÇADO

Objective: evaluate the quality of life (QOL), anxiety and depression scores of patients with cervical cancer treated with neoadjuvant chemotherapy followed by chemoradiotherapy. Methods: prospective cohort study of patients with advanced uterine cervix cancer treated with neoadjuvant chemotherapy followed by radiochemotherapy at a teaching hospital in northeastern Brazil between November 2013 and January 2017. Quality of life was evaluated at four time-points: pre-treatment, after neoadjuvant chemotherapy, after radiotherapy and three months after the end of treatment using Functional Assessment of Cancer Therapy-Cervix (FACT-Cx). Anxiety and depression, we used the Hospital scale of Anxiety and Depression. Results: We studied 40 women, aged 24 to 67 years with an average age of 48 ±11.4 years who had between zero and nine children (mean =3). Most were single (57.5%), illiterate and with elementary school education (85.0%). At the 1st and 4th evaluation, the mean anxiety scores were 7 ±3.5 and 5.5 ±3.6, respectively, and the mean depression scores were 4.4 ±3.2 and 3.7 ±2.6, respectively, with significant variation between the depression scores. The mean FACT-Cx scores at pretreatment were 112.3 ±17.4. At the last evaluation, the mean was 116.3 ±27.6 with a range from 52 to 155, with no significant difference. Conclusion: QOL scores remained stable throughout the treatment. There was a significant variation between the means and proportions of depression, possibly the result of the psychological support offered, demonstrating the importance of follow-up during oncologic treatment, mitigating the impacts of the disease and its treatment. There was no significant difference in anxiety.Objetivo: evaluar la calidad de vida (CV), la ansiedad y la depresión en pacientes con cáncer de cuello uterino sometidas a quimioterapia neoadyuvante seguida de quimiorradioterapia. Métodos: cohorte prospectiva de pacientes con cáncer de cuello uterino avanzado, tratadas en un hospital escuela en el noreste de Brasil, entre noviembre de 2013 y enero de 2017. La CV fue evaluada en cuatro momentos: pretratamiento, después de la quimioterapia neoadyuvante, después de la radioterapia y tres meses después del final. del tratamiento utilizando la Evaluación Funcional de la Terapia del Cáncer-Cérvix (FACT-Cx). Ansiedad y Depresión, utilizando la Escala Hospitalaria de Ansiedad y Depresión – HAD. Resultados: se incluyeron 40 mujeres entre 24 y 67 años con una media de 48 (± 11,4) años que no habían procreado o tenían hasta nueve hijos (media=3). La mayoría eran solteros (57,5%), analfabetos o incluso con educación primaria (85,0%). En la 1ª y 4ª evaluación, las medias de ansiedad fueron 7± 3,5 y 5,5± 3,6 y las medias de depresión fueron 4,4± 3,2 y 3,7± 2,6 con variación significativa entre las puntuaciones de depresión. Las puntuaciones medias de FACT-Cx previas al tratamiento fueron 112,3 ± 17,4. En la última evaluación se obtuvo una media de 116,3 ± 27,6, variando de 52 a 155, sin diferencia estadísticamente significativa. Conclusión: las puntuaciones de calidad de vida de los pacientes se mantuvieron estables durante todo el tratamiento. Hubo variación significativa entre las medias y la proporción de depresión, lo que puede ser resultado del apoyo psicológico ofrecido a los pacientes, lo que demuestra la importancia de ese acompañamiento durante el tratamiento, mitigando los impactos de la enfermedad y del tratamiento. No se observó diferencia significativa con respecto a la ansiedad.Objetivo: avaliar qualidade de vida (QV), ansiedade e depressão de pacientes com câncer de colo de útero em quimioterapia neoadjuvante seguido de quimioradioterapia. Métodos: coorte prospectiva de pacientes com câncer de colo uterino avançado, tratadas em hospital de ensino no nordeste do Brasil, entre novembro 2013 e janeiro 2017. A QV foi avaliada em quatro momentos: pré-tratamento, após quimioterapia neoadjuvante, após radioterapia e três meses após término do tratamento através do Functional Assessment of Cancer Therapy- Cervix (FACT-Cx). Ansiedade e Depressão, utilizou-se escala hospitalar de Ansiedade e Depressão – HAD. Resultados: Foram incluídas 40 mulheres entre 24 e 67 anos com média de 48 (± 11,4) anos que não procriaram ou tiveram até nove filhos (média=3). A maioria delas era solteira (57,5%), analfabeta ou com até ensino fundamental (85,0%). Na 1ª e 4ª avaliação, as médias de ansiedade foram de 7± 3,5 e 5,5± 3,6 e as médias de depressão foram 4,4± 3,2 e 3,7± 2,6 com variação significante entre os escores de depressão. A média dos escores FACT-Cx no pré-tratamento foi de 112,3± 17,4. Na última avaliação obteve-se a média de 116,3± 27,6 com variação de 52 a 155, sem diferença estatisticamente significativa. Conclusão: scores de QV das pacientes permaneceram estáveis ao longo do tratamento. Houve variação significativa entre as médias e proporção de depressão, que pode ser resultado do suporte psicológico oferecido às pacientes, o que demonstra a importância deste acompanhamento durante o tratamento, amenizando os impactos da doença e tratamento. Não foi observada diferença significativa quanto à ansiedade

Meningeal carcinomatosis in breast cancer: prognostic factors and outcome

Meningeal carcinomatosis (MC) occurs in up to 5% of breast cancer patients. Few studies have evaluated prognostic markers in breast cancer patients with MC. Our aim was to describe the treatment of breast cancer patients with MC, and identify prognostic factors related to survival. Sixty breast cancer patients that had a diagnosis of MC between January 2003 and December 2009 were included. The median age was 46 years (range 27-76). Most patients had invasive ductal carcinoma (78.3%) and high histological/nuclear grade (61.7/53.3%). Estrogen and progesterone receptors were positive in 51.7 and 43.3% of patients, respectively, and 15% were HER-2-positive. Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%. Intrathecal (IT) chemotherapy was used in 68.3% of patients, and 21.6% received a new systemic treatment (chemo- or hormone therapy). Median survival was 3.3 months (range 0.03-90.4). There was no survival difference according to age, nuclear grade, hormonal and HER-2 status, CSF features, sites of metastasis, systemic and IT chemotherapy, or radiotherapy. However, histological grade and performance status had a significant impact on survival in the multivariate analysis. Only four papers have addressed prognostic factors in breast cancer patients with MC in the last two decades. The results of those reports are discussed here. High histological grade and poor performance status seem to impact survival of breast cancer patients with MC. Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients

Synchronous thyroid and colon metastases from epidermoid carcinoma of the lung: case report

CONTEXT: Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare. CASE REPORT: We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient

Data_Sheet_1_Exploratory analysis of radiomic as prognostic biomarkers in 18F-FDG PET/CT scan in uterine cervical cancer.docx

ObjectiveTo evaluate the performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) radiomic features to predict overall survival (OS) in patients with locally advanced uterine cervical carcinoma.MethodsLongitudinal and retrospective study that evaluated 50 patients with cervical epidermoid carcinoma (clinical stage IB2 to IVA according to FIGO). Segmentation of the 18F-FDG PET/CT tumors was performed using the LIFEx software, generating the radiomic features. We used the Mann–Whitney test to select radiomic features associated with the clinical outcome (death), excluding the features highly correlated with each other with Spearman correlation. Subsequently, ROC curves and a Kaplan–Meier analysis were performed. A p-value ResultsThe median follow-up was 23.5 months and longer than 24 months in all surviving patients. Independent predictors for OS were found–SUVpeak with an AUC of 0.74, sensitivity of 77.8%, and specificity of 72.7% (p = 0.006); and the textural feature gray-level run-length matrix GLRLM_LRLGE, with AUC of 0.74, sensitivity of 72.2%, and specificity of 81.8% (p = 0.005). When we used the derived cut-off points from these ROC curves (12.76 for SUVpeak and 0.001 for GLRLM_LRLGE) in a Kaplan–Meier analysis, we can see two different groups (one with an overall survival probability of approximately 90% and the other with 30%). These biomarkers are independent of FIGO staging.ConclusionBy radiomic 18F-FDG PET/CT data analysis, SUVpeak and GLRLM_LRLGE textural feature presented the best performance to predict OS in patients with cervical cancer undergoing chemo-radiotherapy and brachytherapy.</p