La astenia en el paciente con cáncer

Asthenia is a common symptom in cancer patients that impairs their quality of life. However when compared with other cancer related symptoms, there are few works designed to investigate its etiology and treatment. Literature data about epidemiology, evaluation, etiology and treatment of cancer related-fatigue are reviewed in this article. Oncologists usually undervalue this symptom, maybe because it is difficult to assess and because its etiology is poorly understood.     

Sarcoma de Kaposi en un paciente con linfoma T periférico

Kaposi’s sarcoma (KS) is a low grade malignant tumor of the endothelial cells of unknown etiology. Epidemiological and microbiological features supports a causative role for the human herpes virus 8 (HHV-8) in the development of the disease. Likewise KS has been observed more frequently in patients under pharmacological immunosuppression. We report a case of a patient diagnosed of peripheral T-cell lymphoma (stage IVB). She received combination chemotherapy using a CHOP regimen and achieved a complete remission; after that she developed a KS of fatal evolution. KS is a disease associated with immunosuppression (iatrogenic or acquired), racial distribution and HHV-8; its prevalence is highly influenced by immunosuppresive therapy, as in kidney graft recipients. The reported case is associated with combination chemotherapy induced immunosuppresion.     

La eutanasia en el paciente con cáncer y los cuidados continuos

Resumen La evolución de los enfermos con cáncer conduce en muchas ocasiones a fases de la enfermedad en las que no existen tratamientos específicos y éstos debemos aplicarlos en la consecución del máximo confort a través de un adecuado control sintomático, en esa etapa es fundamental el respeto de la autonomía personal y la posibilidad del rechazo de tratamientos fútiles. Con el adecuado control de síntomas es posible lograr que la mayoría de los enfermos no padezcan sufrimientos. Los cuidados continuos en el paciente oncológico son los responsables de ayudarnos a resolver estas situaciones. En medicina paliativa existe un procedimiento altamente eficaz en la ayuda en las últimas horas, la sedación, aplicable cuando sea imposible el control sintomático con otros medios. Con una cobertura adecuada de cuidados no debería ser necesario introducir leyes de suicidio asistido y/o eutanasia activa voluntaria, ni por la magnitud de la demanda, ni por las dificultades en el adecuado control sintomático.

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Euthanasia in patients with cancer and the continuous-care providers

During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms.

     

Bacteriemia causada por Leuconostoc spp. en una paciente con adenocarcinoma de ovario y neutropenia

A case of Leuconostoc spp. bacteremia in a patient with neutropenia secondary to chemotherapy is considered. The predisposing factors in this case were neutropenia, presence of central venous catheter and previous treatment with broad-spectrum antibiotic regimens. The patient was curred with removal of intravascular catheter and antimicrobial treatment (ampicillin 2 g i.v. every 6 hours for 21 days). Infection with Leuconostoc spp. should be suspected in patients with vancomycin-resistant gram-positive bacteremia.     

Recidiva cerebral en paciente con linfoma cardíaco primario

We report the case of a patient diagnosed of primary cardiac lymphoma who was treated by partial surgery and six cycles of CHOP chemotherapy. After 6 months free of tumor, she showed isolated intracerebral relapse for wich received holocraneal radio-therapy: complete response. Nine months later, the tumor was found in the brain again and it was treated by radiosurgery, but ultimate she died from progressive cerebral disease. The review of the literature, advise us about the possibility of intracerebral relapse in primary cardiac lymphomas as a characteristic event, and in consequence, perhaps we need drugs that cross better the blood-brain barrier.     

Disnea, oliguria y edema en extremidades inferiores en paciente en tratamiento de radioterapia mediastínica por carcinoma tímico irresecable

In this case report we present the clinical signs and symptoms of cardiac tamponade of tumor origin. We explain the clinical investigations for its diagnosis as well as its specific differential diagnosis in cancer patients. The different therapeutic options are also presented together with a brief summary of the thymic carcinoma.

     

Brote psicótico agudo en paciente con melanoma maligno en tratamiento con interferón alfa-2b

We describe the clinical characteristics of an acute psycotic episode in a patient with malignant melanoma under treatment with interferon alfa-2b (INF). The increase of the use of INF alfa-2b in the treatment of different diseases, among them malignant melanoma, has increased the number of patients with side effects derived from this treatment. The neuropsychiatric alterations more often associated with INF include depression, confusion, anxiety and in rare occasions delirium and psychosis.     

Leucemia mieloide aguda secundaria relacionada con el tratamiento en el Hospital Infantil de México

Treatment-related acute myeloid leukaemia has been described as a secondary neoplasm at least in 1% of children treated with epipodophilotoxins and cyclophosphamide. Monosomy 5, 7 and rearrangement of 11q23 have been described as occurring frequently. To determine the frequency and characteristics of patients with treatment-related myeloid leukaemia we conducted a retrospective study in patients treated at the Hospital Infantil de Mexico between the years 1994 and 2000. A frequency of 0.28% was observed; patients treated for lymphoblastic leukaemia being the most affected (0.61%). M2 morphologic subtype was the most frequent. One patient had rearrangement of chromosome 11q23. Survival was 25%.     

Metástasis hipotálamo-hipofisaria en paciente con cáncer de mama

Pan-hypopituitarism is an unusual initial clinical presentation of metastatic stage breast cancer. Breast and lung cancers are the most frequent sites in women and in men associated with parasellar metastasis and hypothalamic invasion. Reported incidence of pituitary metastases is <5%. Treatment is, essentially, palliative and depends on the symptoms, the extent of the systemic disease, and the performance status of the patient. Prognosis is poor not only because the location of the metastasis but because of the aggressiveness of the primary neoplasia. We report, here, the case of a 59 year-old woman with a medical history that included breast cancer in 1989 and colon cancer in 1998. She was admitted to our hospital with general malaise and hypoglycaemia. Endocrine testing revealed pan-hypopituitarism, and magnetic resonance imaging showed thickening of the pituitary stalk.     

Tratamiento de soporte en el enfermo con cáncer. Algunas propuestas basadas en nuestra experiencia

The medical oncologist has focused much of the time on the results of chemotherapy, and has forgotten a main issue in the global care of the patients with cancer: supportive care. Fortunatelly, things have evolved and today the management of signs and symptoms is a cornerstone in the therapeutic oncology approaches. Here we report our experience in the treatment of cancer patients regarding the management of pain, anorexia, anemia, febrile neutropenia and psychological care.     

Estudio retrospectivo de pacientes tratados con braquiterapia prostática con I-125 en el Instituto Catalán de Oncología

Introduction. Prostate brachytherapy is indicated in patients with initial-stage prostate cancer. Our objective is to describe, in a series of patients treated in our institution with permanent implants of¹²⁵I seeds, the dosimetric characteristics of the technique and the preliminary results together with the toxicity profile, biological relapse and survival. Material and methods. Between May 2000 and September 2003, we treated 153 patients using permanent transperineal¹²⁵I seed implants (target dose of 145 Gy), of whom 130 were included in the analysis for having a minimum of 6 months follow-up. Distribution by stage was: 73.85% (n=96) Tlc and 26.15% (n=34) T2a. Gleason <6,97% (n=127); median prostate specific antigen (PSA) pre-treatment was 6.24 ng/ml. The median prostate volume was 28 cc; 34 patients had received previous hormonal therapy prior to the implants. Median age was 65 years. Results. There were 130 patients with >6 months follow-up in the analysis (median age = 65 years) of whom 18.46% (n=24) had attended the Radiotherapy Service for the first time and who had previously been prescribed hormonal therapy. Technical characteristics of the implants: median number of needles = 24 (range 14–35); median number of seeds = 76 (range 46–111); median activity = 14.46 MBq/seed; total activity implanted (median) = 1,121.1 MBq. The median follow-up was 20 months (6–42 months). Survival free of disease at 1 and 2 years was 99.1 % and 89.9%, respectively. Based on the stratification of risk groups, 99% and 92.1% of the patients of low risk continued free of the disease at 1 and 2 years, respectively while for those patients of intermediate risk these values were 100% and 77.8% respectively. Frequency of relevant secondary effects were rectitis G1 5.38% and G2 of 1.54%; haematuria G2 44.62% and G3 1.54%. A probe was necessary to resolve acute urine retention in 3.85%. Conclusions. Prostate brachytherapy is a complex procedure that requires the participation of a multi-disciplinary team, it precludes prolonged hospitalisation and allows the patient to resume normal activity within a short period. Although the mean follow-up time is short, the results with respect to survival free of biochemical relapse and toxicity are comparable to those described in the literature. The patient tolerance of the implant has been good. Longer follow-up is necessary to confirm the long-term conclusions.     

Diabetes insípida central como primera manifestación clínica de un carcinoma colorrectal metastásico

Metastases of systemic tumours in the hypothalamus-pituitary region are reported to be around 1% to 4% of all intra-cranial metastases. Most of them are diagnosed when the primary tumour is operated-upon, or when widespread metastases occur. The metastasic infiltration of this region is usually asymptomatic and rarely recognised ante-mortem. The metastases rarely clinically manifest, but diabetes insipidus is the most frequent. Autopsy studies have shown breast and lung cancer are the mostfrequent cause of the metastases in this region. We present a clinical case of a patient presenting diabetes insipidus as the first manifestation of a metastasic colorectal cancer.     

Radioterapia preoperatoria frente a cirugía como tratamiento en el carcinoma de recto

A retrospective study of 133 patients with rectal cancer was undertaken to compare survival, diseasefree survival and complications of 61 treated with preoperative radiotherapy with those of 72 patients treated by resection alone. We studied 133 patients, 61 patients who were treated with radiotherapy and surgery and 72 patients with surgery alone (1990–1996). Radiotherapy consisted in giving 44 Gy in 22 fractions with an 18 Mv lineal accelerator with surgery being performed 3–4 weeks later. The global survival was 64,03% in irradiated group and 42,4% in surgical group (p=0,19). The free-disease survival was 64,9% and 33,6% (p=0,003) and local free recurrence survival was 81,5% and 37,5% (p=0,0001) respectively. The use of the preoperative radiotherapy and surgery in the rectal cancer reduces the local failure and can improve survival.     

Gemcitabina como radiosensibilizante en el carcinoma no microcítico de pulmón

Resumen El tratamiento estándar del carcinoma no microcítico de pulmón (CNMP) localmente avanzado inoperable es la combinación de quimioterapia y radioterapia tanto de forma secuencial como concurrente. Para aumentar el control locorregional se utilizan radiosensibilizantes que son agentes quimioterápicos que potencian el efecto biológico de la radiación sobre las células tumorales a dosis menores de las usadas habitualmente. Este trabajo es una revisión de la literatura sobre los estudiosin vitro ein vivo de la combinación de gemcitabina con radioterapia, estudios de viabilidad, ensayos pilotos y ensayos fase I y II, en el CNMP localmente avanzado inoperable.      

Protocolo de estudio molecular del oncogénHER2/neu en el carcinoma de mama

Resumen Antecedentes El oncogénHER2/neu es un determinante biológico predictivo esencial en el cáncer de mama por su papel como diana terapéutica del trastuzumab. No obstante, no se ha llegado aún a consensuar un método de referencia para su estudio. Métodos En este trabajo, hemos aplicado y comparado, sobre 222 carcinomas de mama recopilados prospectivamente, los dos ensayos de uso más frecuente para determinar el estado deHER2/neu: inmunohistoquímica para expresión de la proteína p185 empleando dos anticuerpos monoclonales (CB11 y TAB250) e hibridaciónin situ fluorescente (FISH), utilizando secciones de tejido incluido en parafina. Resultados Los resultados demuestran mayor sensibilidad y especificidad con CB11 (62,5% y 93,4% respectivamente) que con TAB250 (40% y 76,4% respectivamente). El estudio inmunohistoquímico con CB11 es adecuado como prueba inicial para predecir el estado del gen, proporciona un alto valor predictivo negativo (95,5%) en los casos de expresión débil o nula y positivo (96,2%) en los tumores con sobreexpresión. Si la expresión inmunohistoquímica es moderada debe considerarse no concluyente y es indispensable el estudio de FISH. También es recomendable aplicar FISH si hay discordancia entre la expresión de p185 y el perfil morfológico y/o molecular tumoral. Finalmente, aunque la tasa de falsos positivos producidos por estudios inmunohistoquímicos es inferior al 5%, debido a la toxicidad y coste de la terapia con trastuzumab es razonable considerar el empleo sistemático de FISH antes de indicar el tratamiento. Conclusión En base a nuestros resultados proponemos un protocolo para el estudio molecular deHER2/neu.      

Efectividad de 5-fluoruracilo y vinorelbina en pacientes multitratadas por cáncer de mama metastásico

Resumen Objectivo Evaluar la actividad y toxicidad de fluoruracilo en infusión continua y vinorelbina en segunda o tercera línea de tratamiento del cáncer de mama metastásico (CMM). Método y pacientes En este estudio fase II se incluyeron 24 pacientes que habían recibido doxorrubicina y/o paclitaxel. Se administró 5-fluoruracilo a 1g/m²/día en infusión continua por 3 días y vinorelbina a 30 mg/m² D1 cada 21 días por 6 ciclos. Resultados Las respuestas globales observadas fueron del 37,5% (12,5% respuestas completas). El período libre de enfermedad se calculó una media de 6,33 ±8,12 meses (IC 95% de 3,43 meses). Se observó toxicidad en el 12,5% de las pacientes y no se registró toxicidad grave ni muertes relacionadas a tratamiento. Conclusión El 5-fluoruracilo/vinorelbina a las dosis administradas es un esquema efectivo en pacientes con CMM multitratadas, con un bajo perfil de toxicidad y costo.      

Esofagitis y radioquimioterapia con taxanos en el cáncer de pulmón: presentación de 2 casos clínicos

Combined treatment with radiochemotherapy associating taxans is improving the results of non small cell lung cancer in stages IIIA and B, with an increment of esophagus and lung toxicities principally being the former the most frequent in the literature. We report 2 cases of patients treated with radiochemotherapy with taxans who achieved complete response of local tumor, presenting in their evolution aphagia secundary to benign estenosis probably secundary to chronic esophagitis.