Actualización en el manejo de sarcomas retroperitoneales y pélvicos; el papel de la cirugía compartimental

Surgery for retroperitoneal sarcomas should be “en bloc” compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients.     

Pancreatic acinar cell carcinoma: A comprehensive review

Acinar cell carcinoma (ACC) is a rare pancreatic malignancy with distinctive clinical, molecular, and morphological features. The long-term survival of ACC patients is substantially superior to that of pancreatic adenocarcinoma patients. As there are no significant patient series about ACCs, our understanding of this illness is mainly based on case reports and limited patient series. Surgical resection is the treatment of choice for patients with the disease restricted to one organ; however, with recent breakthroughs in precision medicine, medicines targeting the one-of-a-kind molecular profile of ACC are on the horizon. There are no standard treatment protocols available for people in which a total surgical resection to cure the condition is not possible. As a result of shared genetic alterations, ACCs are chemosensitive to agents with activity against pancreatic adenocarcinomas and colorectal carcinomas. The role of neoadjuvant or adjuvant chemoradiotherapy has not been established. This article aims to do a comprehensive literature study and present the most recent information on acinar cell cancer.     

Neoadjuvant Therapy for Locally Advanced Rectal Cancer: Recent Advances and Ongoing Challenges

Locally advanced rectal cancer has a rising global incidence. Over the last 4 decades, advances first in surgery and later in radiotherapy and chemoradiotherapy have improved outcomes, particularly with regard to local recurrence. Unfortunately, distant metastases remain a significant problem. In clinical trials of patients with stage II and III disease, distant relapse occurs in 25% to 30% of patients regardless of the treatment approach. Recent phase 3 trials have therefore focused on intensification of systemic therapy for localized disease, with an aim of reducing the distant relapse rate. Early results of trials of total neoadjuvant therapy with combination systemic therapy provided in the neoadjuvant setting are promising; for the first time, a significant improvement in the rate of distant relapse has been noted. Longer-term follow-up is eagerly awaited. On the other hand, trimodal therapy with chemotherapy, radiotherapy, and surgery is toxic. Several trials are currently assessing the feasibility of a watch-and-wait approach, omitting surgery in those with complete response to neoadjuvant treatment, in an attempt to reduce the burden of treatment on patients. The future for rectal cancer patients is likely to be highly personalized, with more intense approaches for high-risk patients and omission of unnecessary therapy for those whose disease responds well to initial treatment. Biomarkers such as circulating tumor DNA will help to more accurately stratify patients into risk groups. Improvements in survival and quality of life are expected as the results of ongoing research become available throughout the next decade.     

Oocytes from stem cells

Folliculogenesis describes the process of activating an oocyte-containing primordial follicle from the ovarian reserve and its development to the mature ovulatory stage. This process is highly complex and is controlled by extra- and intra-ovarian signaling events. Oocyte competence and capacity for fertilization to support a viable pregnancy are acquired during folliculogenesis. Cancer and cancer-based therapies can negatively affect this process, compromising fertility. Currently, preservation of fertility in these patients remains limited to surrogacy, oocyte freezing, oocyte donation, or in vitro maturation (IVM). Recent reports of stem cells being used to produce fully competent oocytes and subsequently healthy offspring in mice have opened up a novel avenue for fertility preservation. However, translating these findings into human health first relies on enhancing our understanding of follicle growth and mimicking its intricacies in vitro. Indeed, the future of oocytes from stem cells in humans comes with many possibilities but currently faces several technical and ethical obstacles.     

Fertility preservation in male patients with cancer

Advances in the treatment of cancer in young patients have led to great improvements in life expectancy, which currently approaches 80% 5-year survival rate. As a result, fertility preservation and desire for paternity have become a significant issue in this group. However, a major concern is the negative impact of chemotherapy, radiotherapy, and the malignancy itself on fertility. Thus, men about to have treatment for malignant conditions may have sperm cryopreserved before commencing chemotherapy or radiotherapy. Ejaculated sperm cryopreservation is the most common technique used. Some patients with cancer may present initially with oligospermia or azoospermia. In cases when a sample is not produced due to medical, social, or religious reasons, sperm can be retrieved using penile vibratory stimulation, electroejaculation, or testicular sperm extraction. Fertility preservation in prepubertal boys presents a great challenge, as sperm banking is not possible. Alternative strategies have been developed, but all are currently experimental.