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Treistman N, Nobre GM, Tramontin MY, da Silva GMW, Herchenhorn D, de Lima Araujo LH, de Andrade FA, Corbo R, Bulzico D, Vaisman F. Prognostic factors in patients with advanced differentiated thyroid cancer treated with multikinase inhibitors - a single Brazilian center experience. Arch Endocrinol Metab 2021; 65:411-420. [PMID: 33939907 PMCID: PMC10522180 DOI: 10.20945/2359-3997000000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to describe the real-world experience multikinase inhibitors (MKI) in the treatment advanced differentiated thyroid carcinoma (DTC) refractory to radioactive iodine (RAIR) therapy. METHODS We reviewed the records of all patients with MKI-treated DTC from 2010 to 2018. Progression free survival (PFS), response rates (RR) and adverse events (AE) profiles were assessed. Clinical parameters were compared between groups with different outcomes (disease progression and death) to identify possible prognostic factors and benefit from treatment. RESULTS Forty-four patients received MKI for progressive RAIR DTC. Median PFS was 24 months (10.2-37.7) and median overall survival (OS) was 31 months. Best overall response was complete response in one patient (4.5%), partial response in nine (20.4%), stable disease in twenty-two (50%), and progressive disease (PD) in twelve (27.3%). Seventy-two point 7 percent patients had clinical benefit and AE were mild in most cases (82.7%). Progressive patients were more likely to have FDG positive target lesion than those who did not progress (p = 0.033) and higher maximum SUV on target lesions (p = 0.042). Presence of lung-only metastasis and lower thyroglobulin (Tg) during treatment was associated with stable disease (p = 0.015 and 0,049, respectively). Patients with shorter survival had larger primary tumor size (p = 0.015) and higher maximum SUV on target lesions (p = 0.023). CONCLUSION Our findings demonstrate safety and effectiveness of MKI in patients with advanced RAIR DTC. We were able to identify as possible prognostic markers of better outcomes: absence of FDG uptake on target lesions, lower maximum SUV on PET-CT, presence of lung-only metastasis and lower Tg during treatment.
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Affiliation(s)
- Natalia Treistman
- Departamento de Medicina, Serviço de Endocrinologia, Instituto Nacional do Câncer (Inca), Rio de Janeiro, RJ, Brasil
- Departamento de Medicina, Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Gabriela Maia Nobre
- Departamento de Medicina, Serviço de Endocrinologia, Instituto Nacional do Câncer (Inca), Rio de Janeiro, RJ, Brasil
| | - Mariana Yoshii Tramontin
- Departamento de Medicina, Serviço de Endocrinologia, Instituto Nacional do Câncer (Inca), Rio de Janeiro, RJ, Brasil
| | | | - Daniel Herchenhorn
- Departamento de Medicina, Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Grupo de Oncologia D'Or, Instituto D'Or de Pesquisa e Educação (IDOR), Rio de Janeiro, RJ, Brasil
| | | | - Fernanda Accioly de Andrade
- Departamento de Medicina, Serviço de Endocrinologia, Instituto Nacional do Câncer (Inca), Rio de Janeiro, RJ, Brasil
| | - Rossana Corbo
- Departamento de Medicina, Serviço de Endocrinologia, Instituto Nacional do Câncer (Inca), Rio de Janeiro, RJ, Brasil
| | - Daniel Bulzico
- Departamento de Medicina, Serviço de Endocrinologia, Instituto Nacional do Câncer (Inca), Rio de Janeiro, RJ, Brasil
| | - Fernanda Vaisman
- Departamento de Medicina, Serviço de Endocrinologia, Instituto Nacional do Câncer (Inca), Rio de Janeiro, RJ, Brasil
- Departamento de Medicina, Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil,
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Alves LDB, de Melo AC, Farinha TA, de Lima Araujo LH, Thiago LDS, Dias FL, Antunes HS, Amaral Eisenberg AL, Santos Thuler LC, Cohen Goldemberg D. A systematic review of secretory carcinoma of the salivary gland: where are we? Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e143-e152. [PMID: 32493686 DOI: 10.1016/j.oooo.2020.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/10/2019] [Revised: 03/22/2020] [Accepted: 04/11/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this systematic review was to describe the epidemiology, diagnostic criteria, differential diagnosis, treatment, prognostic factors, and treatment outcomes of secretory carcinoma. STUDY DESIGN A comprehensive search of Lilacs, PubMed, Science Direct, and Web of Science databases was conducted to identify all case reports, letter to the editor, and histopathologic reclassifications regarding salivary gland secretory carcinoma published in English, Spanish, French, and Portuguese. RESULTS The final analysis included 119 studies, which totaled 642 secretory carcinoma diagnoses, with 239 case reports and 403 diagnostic reclassifications, mostly in the United States. The age range was 5 to 87 years, and cases were predominantly in males (58.7%) and mostly affecting the parotid glands (73.7%). The disease usually presents as a slow-growing, painless mass. The main differential diagnosis is acinic cell carcinoma, and the tumor is usually treated with surgery. The prognosis is considered favorable, although there have been reports of local recurrences, distant metastases, and deaths. CONCLUSIONS It is important that clinicians become aware of this salivary gland neoplasm and report clinical data, clinical course, management and long-term follow-up. There is an urgent need to conduct more clinical trials, especially on tropomyosin receptor kinase (TRK) inhibitors and other potential target therapy modalities.
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Affiliation(s)
| | | | - Thayana Alves Farinha
- Scientific Initiation Student, Clinical Research Division, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA)
| | | | - Leandro de Souza Thiago
- Clinical Research Division, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA)
| | - Fernando Luiz Dias
- Head and Neck Surgery Service, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA)
| | | | | | | | - Daniel Cohen Goldemberg
- Clinical Research Division, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA).
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Goldemberg DC, de Melo Pino LC, de Lima Araujo LH, de Melo AC, Antunes HS. Successful GaAlAs low-level laser therapy of self-inflicted thermal burns of the palate. SAGE Open Med Case Rep 2021; 9:2050313X21997205. [PMID: 33747516 PMCID: PMC7940780 DOI: 10.1177/2050313x21997205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/29/2021] [Indexed: 12/02/2022] Open
Abstract
Thermal burns of the oral cavity usually arise from ingestion of hot foods or beverages. A 38-year-old female patient presented with two painful ulcerative erythematous patches of the palate. The patient was consulted on the same day lesions appeared. Medical history was unremarkable. Clinically significant self-inflicted injuries may result in wide ulcers in the mouth and usually do not take less than 2 weeks to heal, whereas our patient, treated with low-level laser therapy, had a complete response in day 4, after 2 days of treatment. The fact that multiple lesions were present signaled against the World Health Organization exclusion diagnosis of erythroplakia for red patches. A traumatic ulcer, regardless of its cause of origin, usually heals within 2 weeks, after the source of injury is resolved. A thermal burn in the oral cavity usually takes longer than that to heal, but whenever this time frame is not respected, the suspicion of a potentially malignant disorder should always arise, and a biopsy should be performed. The present case showed two painful thermal burns with great results in terms of speeding up the relieve of symptoms and healing time with soft laser as opposed to the traditional treatment with oral topical corticosteroid.
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Affiliation(s)
- Daniel Cohen Goldemberg
- Leblon Medical Center, Rio de Janeiro, Brazil.,Clinical Research Division of the National Cancer Institute (INCA), Rio de Janeiro, Brazil
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Alves LDB, de Melo AC, de Lima Araujo LH, Thiago LS, Dos Santos Guimarães I, Fernandes PV, Rodrigues EM, Dias FL, Antunes HS, Eisenberg ALA, Cohen Goldemberg D. Secretory carcinoma of salivary glands at the National Cancer Institute: A 20-year retrospective clinical, pathological, immunohistochemical and molecular study. Oral Oncol 2021; 117:105198. [PMID: 33573874 DOI: 10.1016/j.oraloncology.2021.105198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aim was to review cases of acinic cell carcinoma (the main differential diagnosis of secretory carcinoma) that were diagnosed and treated at the National Cancer Institute of Brazil (INCA) between 1996 and 2016. The primary objective was to identify underdiagnosed cases of secretory carcinoma via a clinical, immunopathological and molecular reassessment. MATERIALS AND METHODS This is a cross sectional study, with retrospective data collection from medical records and histological specimen review, with staining for periodic acid-Schiff (PAS) and PAS with diastase, immunohistochemistry for S-100, mammaglobin, and DOG-1, and droplet digital RT-PCR for ETV6-NTRK3. The Research Ethics Committee approved this study, and the patients allowed their participation through informed consent. RESULTS Eighty-three cases of acinic cell carcinoma were diagnosed and treated in the specified period at INCA, of which, seven had their diagnosis changed to secretory carcinoma. CONCLUSION The present study adds seven cases of secretory carcinoma to the literature, contributing to a better understanding of the epidemiological, histological, immunohistochemical and molecular characteristics of this recently described tumor. Also, the use of a comprehensive diagnostic approach, including immunohistochemical and molecular methods, along with classical morphological studies, allowed the reclassification of acinic cell carcinoma to secretory carcinoma.
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Affiliation(s)
| | | | | | - Leandro Souza Thiago
- Clinical Research Division, National Cancer Institute of Brazil, Rio de Janeiro, Brazil
| | | | | | | | - Fernando Luiz Dias
- Head and Neck Surgery Service, National Cancer Institute of Brazil, Rio de Janeiro, Brazil
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Araujo LHDL, Baldotto CS, Zukin M, Vieira FMDAC, Victorino AP, Rocha VR, Helal RC, Salem JH, Teich N, Ferreira CG. Survival and prognostic factors in patients with non-small cell lung cancer treated in private health care. Rev Bras Epidemiol 2016; 17:1001-14. [PMID: 25388498 DOI: 10.1590/1809-4503201400040017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 11/13/2013] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Outcomes data on Non-Small Cell Lung Cancer (NSCLC) are scarce with regard to the private health care in Brazil. The aim of this study was to describe the characteristics, treatments performed, and the survival of patients with NSCLC in a Brazilian private oncologic institution. METHODS Medical charts from patients treated between 1998 and 2010 were reviewed, and data were transferred to a clinical research form. Long-term follow-up and survival estimates were enabled through active surveillance. RESULTS Five hundred sixty-six patients were included, and median age was 65 years. Most patients were diagnosed in advanced stages (79.6% III/IV). The overall survival was 19.0 months (95%CI 16.2 - 21.8). The median survival was 99.7, 32.5, 20.2, and 13.3 months for stages I, II, III, and IV, respectively (p < 0.0001). Among patients receiving palliative chemotherapy, the median survival was 12.2 months (95%CI 10.0 - 14.4). CONCLUSIONS The outcomes described are favorably similar to the current literature from developed countries. Besides the better access to health care in the private insurance scenario, most patients are still diagnosed in late stages.
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Affiliation(s)
| | | | - Mauro Zukin
- COI Institute for Education and Research, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | - Nelson Teich
- COI Institute for Education and Research, Rio de Janeiro, RJ, Brazil
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Zukin M, Barrios CH, Rodrigues Pereira J, De Albuquerque Ribeiro R, de Mendonça Beato CA, do Nascimento YN, Murad A, Franke FA, Precivale M, de Lima Araujo LH, Da Rocha Baldotto CS, Vieira FM, Small IA, Ferreira CG, Lilenbaum RC. Randomized Phase III Trial of Single-Agent Pemetrexed Versus Carboplatin and Pemetrexed in Patients With Advanced Non–Small-Cell Lung Cancer and Eastern Cooperative Oncology Group Performance Status of 2. J Clin Oncol 2013; 31:2849-53. [DOI: 10.1200/jco.2012.48.1911] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare single-agent pemetrexed (P) versus the combination of carboplatin and pemetrexed (CP) in first-line therapy for patients with advanced non–small-cell lung cancer (NSCLC) with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2. Patients and Methods In a multicenter phase III randomized trial, patients with advanced NSCLC, ECOG PS of 2, any histology at first and later amended to nonsquamous only, no prior chemotherapy, and adequate organ function were randomly assigned to P alone (500 mg/m2) or CP (area under the curve of 5 and 500 mg/m2, respectively) administered every 3 weeks for a total of four cycles. The primary end point was overall survival (OS). Results A total of 205 eligible patients were enrolled from eight centers in Brazil and one in the United States from April 2008 to July 2011. The response rates were 10.3% for P and 23.8% for CP (P = .032). In the intent-to-treat population, the median PFS was 2.8 months for P and 5.8 months for CP (hazard ratio [HR], 0.46; 95% CI, 0.35 to 0.63; P < .001), and the median OS was 5.3 months for P and 9.3 months for CP (HR, 0.62; 95% CI, 0.46 to 0.83; P = .001). One-year survival rates were 21.9% and 40.1%, respectively. Similar results were seen when patients with squamous disease were excluded from the analysis. Anemia (grade 3, 3.9%; grade 4, 11.7%) and neutropenia (grade 3, 1%; grade 4, 6.8%) were more frequent with CP. There were four treatment-related deaths in the CP arm. Conclusion Combination chemotherapy with CP significantly improves survival in patients with advanced NSCLC and ECOG PS of 2.
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Affiliation(s)
- Mauro Zukin
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Carlos H. Barrios
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Jose Rodrigues Pereira
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Ronaldo De Albuquerque Ribeiro
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Carlos Augusto de Mendonça Beato
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Yeni Neron do Nascimento
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Andre Murad
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Fabio A. Franke
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Maristela Precivale
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Luiz Henrique de Lima Araujo
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Clarissa Serodio Da Rocha Baldotto
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Fernando Meton Vieira
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Isabele A. Small
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Carlos G. Ferreira
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
| | - Rogerio C. Lilenbaum
- Mauro Zukin, Luiz Henrique de Lima Araujo, Clarissa Serodio Da Rocha Baldotto, Fernando Meton Vieira, Isabele A. Small, and Carlos G. Ferreira, Instituto Nacional do Cancer, Rio de Janeiro; Carlos H. Barrios, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre; Jose Rodrigues Pereira, Instituto do Cancer Arnaldo Vieira Carvalho; Maristela Precivale, PGS Medical Statistics, Sao Paulo; Ronaldo De Albuquerque Ribeiro, Instituto do Cancer do Ceara, Fortaleza; Carlos Augusto de Mendonça Beato,
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de Lima Araujo LH, Bissonnette A, Carbone DP, Nana-Sinkam P. Research Highlights: Highlights from the latest articles in translating genomics to clinical practice in lung cancer. Per Med 2013; 10:329-331. [DOI: 10.2217/pme.13.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Luiz Henrique de Lima Araujo
- Division of Medical Oncology, James Comprehensive Cancer Center, Wexner Medical Center at the Ohio State University, Columbus, OH 43210, USA
| | - Adam Bissonnette
- Division of Medical Oncology, James Comprehensive Cancer Center, Wexner Medical Center at the Ohio State University, Columbus, OH 43210, USA
| | - David P Carbone
- Division of Medical Oncology, James Comprehensive Cancer Center, Wexner Medical Center at the Ohio State University, Columbus, OH 43210, USA
| | - Patrick Nana-Sinkam
- Division of Medical Oncology, James Comprehensive Cancer Center, Wexner Medical Center at the Ohio State University, Columbus, OH 43210, USA.
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Araujo LHDL, Gouveia HR, Freitas EDQ, Pedras FV, Luz JHM. Hepatic transarterial chemoembolization and retroperitoneal lymph node radiofrequency ablation in the multidisciplinary approach of an overt metastatic leiomyosarcoma. Cancer Imaging 2013; 13:123-7. [PMID: 23545154 PMCID: PMC3613790 DOI: 10.1102/1470-7330.2013.0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Metastatic leiomyosarcoma has a dismal prognosis, and therapy mainly consists of palliative systemic chemotherapy. A selected subgroup of patients with limited metastatic disease may eventually derive benefit from more aggressive strategies, including resection of isolated metastasis. We report here the successful use of hepatic transarterial chemoembolization and retroperitoneal lymph node radiofrequency ablation in a patient with advanced leiomyosarcoma metastatic to the liver and retroperitoneum.
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Affiliation(s)
- Luiz Henrique de Lima Araujo
- Clínicas Oncológicas Integradas (COI) and Instituto COI (ICOI), Rio de Janeiro, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
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Domingues PM, Zylberberg R, da Matta de Castro T, Baldotto CS, de Lima Araujo LH. Survival data in elderly patients with locally advanced non-small cell lung cancer. Med Oncol 2013; 30:449. [PMID: 23307257 DOI: 10.1007/s12032-012-0449-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/27/2012] [Indexed: 11/29/2022]
Abstract
Combined chemoradiation (CRT) is the standard therapy in locally advanced non-small cell lung cancer (NSCLC). Nevertheless, the best approach in the elderly population is still poorly defined. We retrospectively reviewed the charts of elderly (≥ 65 years) patients with unresectable, locally advanced NSCLC, diagnosed at the Brazilian National Cancer Institute between 2003 and 2007. The primary outcome was overall survival (OS), measured from diagnosis until death. Palliative therapy (PT) included best supportive care radiation therapy (RT; ≤ 40 Gy) and palliative chemotherapy. Among patients treated with radical RT, OS was measured from date of treatment beginning until death (OST). One hundred seventy-one patients were included, with median age of 71 years (range 65-90). Thirty-nine percent received PT, 32 % exclusive RT (>40 Gy), and 29 % CRT (concomitant or sequential). Patients treated with RT and CRT had better OS (median 13.7 months [95 % CI 10.9-16.4] and 15.5 months [95 % CI 13.0-17.9]) than PT (median 4.1 months [95 % CI 3.6-4.6]; p < 0.0001). In the multivariate analysis, RT (HR 0.28 [95 % CI 0.18-0.42]; p < 0.0001) and CRT (HR 0.17 [95 % CI 0.1-0.27]; p < 0.0001) were independently correlated to better survival in comparison with PT. Among patients receiving radical RT, the addition of chemotherapy was correlated to longer OST (median 13.8 [95 % CI 10.6-17.0] vs. 10.8 months [95 % CI 8.6-13.1]; p = 0.018). This benefit was confirmed in the multivariate analysis (HR 0.59 [95 % CI 0.36-0.97]; p = 0.039). Elderly patients with locally advanced NSCLC derived significant survival benefit from radical RT and CRT, suggesting that age should not be a contraindication for these aggressive therapeutic strategies.
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Affiliation(s)
- Pedro Masson Domingues
- Medical Oncology Department and Thoracic Oncology Tumor Group, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil.
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Domingues PM, Zylberberg R, Matta-Castro T, Baldotto CS, de Lima Araujo LH. Survival benefit from combined chemoradiation (CRT) in elderly patients with unresectable stage III non-small cell lung cancer (NSCLC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e17548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17548 Background: CRT is the standard therapy in locally advanced NSCLC. Nevertheless, the best approach in the elderly population is still poorly defined. Methods: We retrospectively reviewed the charts of elderly (≥ 65 years) patients (pts) with diagnosed stage III (6th AJCC), unresectable, NSCLC, treated at the Brazilian National Cancer Institute (INCA) between 2003 and 2005. Pts with malignant pleural effusion were excluded. The primary outcome was overall survival (OS), measured from diagnosis until death. Prognostic factors were analyzed using log-rank and stepwise Cox model. Palliative therapy (PT) included best supportive care, radiation therapy (RT; ≤ 40 Gy), and palliative chemotherapy. Among pts treated with radical RT, OS was measured from date of treatment beginning until death (OST). Results: One hundred fifteen pts were included. Median age was 71 (range 65-83), 76% were male, 51% had squamous histology, and 82% stage IIIB. Seventy percent had more than 5% weigh loss at diagnosis, 44% had PS 0-1, while 29% and 26% had PS 2 and 3, respectively. Ninety percent were current/former-smokers, and Charlson comorbidity index (CCI) was 0 in 66% and 1-2 in 34%. Thirty-six percent received PT, 32% exclusive RT (>40 Gy), and 32% CRT (concomitant or sequential). Post-radiation surgery was not performed in this cohort. The median OS was 9.9 months (ms; 95% CI, 7.2-12.6). Survival was significantly longer among pts with PS 0-1 (p<0.0001) and no weigh loss (p=0.026), while histology (p=0.15), tumor stage (p=0.51), CCI (p=0.37), and age (p=0.54) were not prognostic factors. Pts treated with exclusive RT and CRT had better OS (median 14.3 ms [95% CI, 11.7-16.9] and 17.0 ms [95% CI, 14.1-19.9], respectively) than PT (median 4.1 ms [95% CI, 3.5-4.8]; p<0.0001). In the multivariate analysis, RT (HR 0.25 [95% CI, 0.15-0.42]; p<0.0001) and CRT (HR 0.16 [95% CI, 0.09-0.27]; p<0.0001) were independently associated with better survival in comparison to PT. Among pts receiving radical RT, the addition of chemotherapy was associated with longer OST (median 14.1 vs 10.7 ms; p=0.025). Conclusions: CRT was independently associated with longer survival in elderly pts with locally advanced NSCLC.
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Affiliation(s)
- Pedro Masson Domingues
- Medical Oncology Department and Thoracic Oncology Tumor Group, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Ricardo Zylberberg
- Medical Oncology Department and Thoracic Oncology Tumor Group, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Thalita Matta-Castro
- Clinical Research Coordination, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Clarissa Serodio Baldotto
- Medical Oncology Department and Thoracic Oncology Tumor Group, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Luiz Henrique de Lima Araujo
- Medical Oncology Department and Thoracic Oncology Tumor Group, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Lilenbaum R, Zukin M, Pereira JR, Barrios CH, De Albuquerque Ribeiro R, Beato CADM, Neron do Nascimento Y, Murad A, Franke FA, Precivale M, de Lima Araujo LH, Baldotto CSDR, Vieira FM, Small IA, Ferreira CGM. A randomized phase III trial of single-agent pemetrexed (P) versus carboplatin and pemetrexed (CP) in patients with advanced non-small cell lung cancer (NSCLC) and performance status (PS) of 2. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7506] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7506 Background: No standard of care exists for patients with advanced NSCLC and PS 2 and clinical practice ranges from supportive care to combination chemotherapy. Methods: In a Brazilian multicenter phase III randomized trial, advanced NSCLC patients, with any histology at first, amended to non-squamous only, PS 2, no prior chemotherapy, and adequate organ function, were randomized to P alone (500 mg/m2) or CP (AUC 5 + same P) administered every 3 weeks for 4 cycles. Stratification factors included stage (IIIB vs. IV); age (≥70 vs. <70); and weight loss (≥5 kg vs. <5kg). The primary endpoint was overall survival and the study was powered to demonstrate an improvement in median survival from 2.9 to 4.3 months based on a prior CALGB trial. Results: A total of 217 patients were enrolled from 8 centers in Brazil and 1 in the US from April 2008 to July 2011. Twelve patients were ineligible and excluded. The 2 arms (P=102; CP=103) were balanced for patient characteristics. 14 patients had squamous and another 12 had unknown histology. The response rates were P = 10% and CP = 24% (p=0.019). In the ITT population, the median PFS was P = 3.0 mo and CP = 5.9 mo (HR=0.46, 95% CI 0.34; 0.63, p<0.001) and median OS was P = 5.6 mo vs. CP = 9.1 mo (HR=0.57, 95% CI 0.41; 0.79, p=0.001). 1-year survival rates were 22% and 39% respectively. Similar results were seen when squamous patients were excluded from the analysis. Grade ¾ anemia (5.5%; 12%) and neutropenia (2.8%; 5.6%) were more frequent in CP. There were 4 treatment-related deaths in the CP arm. 30% of patients in each arm received 2nd line therapy Conclusions: Combination chemotherapy with CP significantly improves survival, with acceptable safety, in eligible patients with advanced NSCLC and PS 2, and represents a new standard.
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Affiliation(s)
| | - Mauro Zukin
- Instituto Nacional do Cancer, Rio de Janeiro, Brazil
| | | | - Carlos H. Barrios
- Grupo Latino Americano de Investigações Clínicas em Oncologia, Porto Alegre, Brazil
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