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Martins MC, Miyazaki DL, Gabiatti CC, Silva LP, Macedo LT, Siqueira NS, Andreollo NA, Carvalheira JB. Chagasic Megaesophagus-Associated Carcinoma: Clinical Pattern and Outcomes. J Glob Oncol 2019; 5:1-5. [PMID: 31393754 PMCID: PMC6733205 DOI: 10.1200/jgo.19.00143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Approximately 4% to 10% of patients diagnosed with Chagas-induced megaesophagus disease develop esophageal carcinoma. However, the natural history and clinical pattern of this entity are not well described. METHODS Herein, we retrospectively analyzed 593 patients with esophageal carcinoma treated at a single Brazilian institution. We identified 32 patients with Chagas disease, of whom 11 had megaesophagus. The epidemiologic profile and oncological treatment outcomes were evaluated. RESULTS Although baseline characteristics were similar among the three groups, patients with Chagas megaesophagus-associated carcinoma (CMAC) presented with a lower rate of smoking. This factor reinforced the concept that achalasia is the predominant risk factor for cancer development. The CMAC group had a higher rate of tumor in situ (two of 11 patients) compared with the other groups. These patients were treated with endoscopic resection, and no recurrence was detected. Eight of 11 patients with CMAC were diagnosed with locally advanced disease. Patients with locally advanced CMAC presented with a median progression-free survival of 7.8 months and a median overall survival of 9.1 months. CONCLUSION If CMAC is not promptly detected, it has a dismal prognosis, indicating that a high index of suspicion of esophageal carcinoma is required for patients with Chagasic megaesophagus. Additional studies are needed to improve the surveillance and treatment approaches for this neglected disease.
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Affiliation(s)
| | | | | | | | | | | | | | - José B.C. Carvalheira
- State University of Campinas, Campinas, Brazil
- José B.C. Carvalheira, Department of Internal Medicine, FCM-State University of Campinas (UNICAMP)-MA: 13083-970, Campinas, SP, Brazil; e-mail:
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Ribeiro JT, Macedo LT, Curigliano G, Fumagalli L, Locatelli M, Dalton M, Quintela A, Carvalheira JBC, Manunta S, Mazzarella L, Brollo J, Goldhirsch A. Cytotoxic drugs for patients with breast cancer in the era of targeted treatment: back to the future? Ann Oncol 2012; 23:547-555. [PMID: 21896541 DOI: 10.1093/annonc/mdr382] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite current trend of targeted therapy development, cytotoxic agents are a mainstay of treatment of patients with breast cancer. We reviewed recent advances in cytotoxic therapy for patients with metastatic breast cancer (MBC). MATERIALS AND METHODS Medline searches were conducted for English language studies using the term 'MBC' and 'cytotoxic drugs'. The data search was restricted to the period 2000-2011. RESULTS Several novel cytotoxic compounds, all microtubule inhibitors, have been approved for clinical use in MBC: (i) nab-paclitaxel, reported to improve tumour response and decrease hypersensitivity reactions in comparison with other taxanes; (ii) ixabepilone, shown to have clinical benefit in taxane- and anthracycline-resistant disease and (iii) eribulin, shown to improve overall survival in heavily pre-treated patients, when compared with best available standard treatment. Agents, such as larotaxel, vinflunine, trabectidin and formulations, including cationic liposomal paclitaxel or paclitaxel poliglumex, are currently under evaluation in phase II/III trials. CONCLUSION Toxicity and chemotherapy resistance are still major limitations in the treatment of patients with MBC. Further research into new cytotoxic compounds is needed in order to maximise benefit, whilst minimising toxicity.
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Affiliation(s)
- J T Ribeiro
- Division of Medical Oncology, University of Lisboa Medical School, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - L T Macedo
- Division of Medical Oncology, Hospital de Clinicas, State University Medical School of Campinas, Campinas, Brazil
| | - G Curigliano
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
| | - L Fumagalli
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy
| | - M Locatelli
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy
| | - M Dalton
- Oxford University Medical School, Brasenose College, University of Oxford, Oxford, UK
| | - A Quintela
- Division of Medical Oncology, University of Lisboa Medical School, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - J B C Carvalheira
- Division of Medical Oncology, Hospital de Clinicas, State University Medical School of Campinas, Campinas, Brazil
| | - S Manunta
- Sassari University Medical School, Ospedale S. Campus, Sassari, Italy
| | - L Mazzarella
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy
| | - J Brollo
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy
| | - A Goldhirsch
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy
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Macedo LT, Ribeiro J, Curigliano G, Fumagalli L, Locatelli M, Carvalheira JBC, Quintela A, Bertelli S, De Cobelli O. Multidisciplinary approach in the treatment of patients with small cell bladder carcinoma. Eur J Surg Oncol 2011; 37:558-62. [PMID: 21555200 DOI: 10.1016/j.ejso.2011.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/10/2011] [Accepted: 04/12/2011] [Indexed: 02/07/2023]
Abstract
Small cell carcinoma of the urinary bladder (SCCUB) is considered to be a tumor with a neuroendocrine phenotype characterised by aggressive behaviour and poor prognosis. Small cell carcinoma of the urinary bladder comprises 0.35 to 1% of all bladder cancers and is frequently observed in combination with other histological subtypes of carcinoma. Clinical presentation is characterized by advanced stage at diagnosis and rapidly progressive disease. In daily clinical practice there is no gold standard for the management of patients affected by this disease. Treatment of patients with limited disease combines neoadjuvant platinum-based chemotherapy followed by specific local treatment of the primary tumour. Cystectomy or radiotherapy should be proposed on an individual basis. In the metastatic setting, prognosis remains poor with a potential benefit from chemotherapy containing platinum compounds. Treatment of small cell carcinoma of the urinary bladder is based on evidence obtained from case reports and retrospective analyses. Due to low disease frequency there is a lack of randomized trials to provide guidance as to optimal therapy. Thus, systemic and local approaches are extrapolated from the literature available for the treatment of small cell carcinomas at other (non-urological) sites. We provide an overview of the currently available literature with it's main focus on the treatment of either locally advanced or metastatic small cell carcinoma of the urinary bladder.
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Affiliation(s)
- L T Macedo
- Division of Medical Oncology, State University Medical School of Campinas, Hospital de Clinicas, Campinas, Brazil
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