Marta Soares

Cancro do pulmão no norte de Portugal: um estudo de base hospitalar

INTRODUCTION Lung cancer is the deadliest cancer worldwide. In Portugal, the disease remains the main cause of cancer death in males. AIM This study aims to evaluate the demographic and clinical characteristics of lung cancer patients diagnosed and treated in northern Portugal hospitals from 2000 to 2010. PATIENTS AND METHODS Twelve hospitals in the north of Portugal contributed to this study. The demographic and clinic characteristics of the patients registered in each hospital from 2000 to 2010 and the patterns of their occurrence were analyzed. RESULTS During an 11-year period (2000-2010), 9767 lung cancer patients were registered in the participating hospitals. Comparing the number of the patients registered in the year 2000 to those registered during 2010, there was a significant increase in lung cancer cases. Females represent only 20% of the total registered lung cancer cases; however, during the study period, the number of female patients increased by 30%. A significant number of the patients, 3117 (48.6%), had poor performance status at presentation. The adenocarcinoma histology became more preponderant over the study period. Most of the patients were diagnosed as stages IIIB or IV: 7206 of 9267 (77.8%). Chemotherapy was the treatment of choice for 3529 (40.4%) patients, whereas surgical treatment was achieved in 1301 (14.9%) cases. CONCLUSION A significant number of lung cancer patients have been diagnosed and treated in hospitals in northern Portugal, and the incidence of the disease among females has been increasing. The overwhelming majority of the tumors were diagnosed in advanced stage; nevertheless, surgical treatment was possible in 14.9% of the patients.

Personalizando a medicina – estratégias para implementar a avaliação do rearranjo do ‘anaplastic lymphoma kinase’ no carcinoma do pulmão de não pequenas células em Portugal

a Serviço de Oncologia Médica, Instituto Português de Oncologia Francisco Gentil, Centro do Porto, Porto, Portugal b Unidade de Oncologia Molecular, Instituto Português de Oncologia Francisco Gentil, Centro do Porto, Porto, Portugal c Serviço de Pneumologia, Hospital de S. João, Porto, Portugal d Serviço de Pneumologia, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal e Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal f Serviço de Pneumologia, Centro Hospitalar de Coimbra, Coimbra, Portugal

Timomas malignos - A experiência do IPO do Porto e revisão da literatura

Resumo Introducao: Os tumores epiteliais timicos (TET), a maioria timomas, sao neoplasias desenvolvidas a partir das celulas epiteliais do timo e constituem cerca de 30% das massas do mediastino anterior em adultos. Os timomas sao constituidos por celulas sem caracteristicas citologicas de malignidade, sendo o comportamento maligno determinado pela invasao da capsula e estru-turas adjacentes. Estes tumores apresentam um amplo espectro de caracteristicas clinicas e morfologicas, e as pequenas series de doentes conhecidas tornam dificil o estabelecimento de um tratamento standard. Material e metodos: Efectuouse um estudo retrospectivo dos doentes admitidos com diagnostico de ti moma no Instituto Portugues de Oncologia - Centro do Porto (IPO-Porto), de 1983 a 2004. Foram anali-sadas as suas caracteristicas clinicas, classificacao histologica segundo a OMS, o estadiamento de Masaoka, e a sua relacao com as modalidades de tratamento. Procedeu-se a revisao dos registos clinicos destes doentes e revisao do material histologico para a classificacao segundo criterios da OMS de 1999. Resultados: No IPO-Porto, entre 1983 e 2004, fo-ram tratados 28 doentes com TET. Destes, 21 eram timomas invasivos, sendo estes o objecto deste estudo. Dos dados demograficos salienta-se que eram 11 homens, 10 mulheres, com uma idade mediana de 55 anos (24-79 anos). A classificacao histologica da OMS foi a seguinte: 2 doentes (9,5%) Tipo A, 6 (28,6%) tipo AB, 4 (19%) tipo B1, 2 (9,5%) tipo B2, 7 (33,4%) tipo B3. O estadiamento segundo Masaoka foi 9 doentes (42,8%) com estadio II, 6 (28,6%) com estadio III e 6 (28,6%) com estadio IVa. A maioria dos doentes apresentava sintomas locais a apresen-tacao, com apenas 1 doente com diagnostico de aplasia eritrocitaria e 5 com Mastenia gravis (MG). Os 6 doentes submetidos apenas a resseccao cirurgica completa nao tiveram evidencia de recorrencia da doenca (2 tipo A-II, 2 tipo AB-II, 1 tipo B1-II, 1 tipo B2-IVa), com follow-up variando entre 8 e 144 meses. 10 doentes com resseccao completa receberam tratamento adjuvante, 6 radioterapia (4 doentes B3-II, 2 doentes B3-III), 2 quimioterapia (AB-IVa) e 2 radioterapia e quimioterapia (B1-IVa, B2-III). Apenas os 2 doentes que efectuaram quimioterapia adjuvante reci-divaram, aos 168 e 46 meses, e morreram aos 168 e 49 meses. Os restantes doentes que efectuaram tratamento adjuvante encontram-se sem evidencia de doenca. Dos 5 doentes com resseccao incompleta seguido de tratamento complementar (2 doentes AB-III, 2 B1-IVa, 1 B3-III), 3 morreram aos 11 meses (B3-III), aos 12 meses (B1-IVa) e aos 241 meses (AB-III), este ulti-mo por MG. Conclusoes: Apesar de se tratar de uma pequena serie, os factores preditivos de mau prognostico foram a resseccao incompleta, estadio avancado e o subtipo histologico B3. E necessario investigar o papel do tratamento adjuvante e neoadjuvante no grupo de doentes com doenca avancada e subtipo histologico B3. Rev Port Pneumol 2007; XIII (4): 553-585

Erlotinib na segunda linha de tratamento do cancro do pulmão de não pequenas células – Caso clínico

the epidermal growth-factor receptor (EGFR) and its signaling pathway have become a major target for therapy of non-small cell lung cancer (NSCLC). After the BR.21 study showed its effectiveness and its tolerability in older patients, erlotinib, a specific EGFR tyrosine-kinase inhibitor, has been approved for NSCLC therapy after failure of treatment with at least one line of chemotherapy (CT). The authors present the case of a 63 years-old female patient, with a history of angina pectoris, who was diagnosed with a lung adenocarcinoma. Because of poor tolerance to first-line CT, she had second-line treatment with erlotinib. There was a good response to therapy, along with symptomatic improvement. Adverse effects were light to moderate, well tolerated, and required no dose reduction. Rev Port Pneumol 2008; XIV (Supl 3): S17-S22.the epidermal growth-factor receptor (EGFR) and its signaling pathway have become a major target for therapy of non-small cell lung cancer (NSCLC). After the BR.21 study showed its effectiveness and its tolerability in older patients, erlotinib, a specific EGFR tyrosine-kinase inhibitor, has been approved for NSCLC therapy after failure of treatment with at least one line of chemotherapy (CT). The authors present the case of a 63 years-old female patient, with a history of angina pectoris, who was diagnosed with a lung adenocarcinoma. Because of poor tolerance to first-line CT, she had second-line treatment with erlotinib. There was a good response to therapy, along with symptomatic improvement. Adverse effects were light to moderate, well tolerated, and required no dose reduction. Rev Port Pneumol 2008; XIV (Supl 3): S17-S22.

Elderly patients with advanced NSCLC: The value of geriatric evaluation and the feasibility of CGA alternatives in predicting chemotherapy toxicity

Cancer is primarily a disease of the elderly, with the incidence of older patients with cancer expected to increase in the coming years. Despite remarkable advances during the last decade, lung cancer remains a leading cause of mortality worldwide, non-small cell lung cancer (NSCLC) being the dominant (85-90%) subtype. At diagnosis, 50% of NSCLC patients are ≥70 years and 15%, over 80 years of age. Due to their under-representation in clinical trials, current treatment decisions for older patients with cancer are based on a low level of scientific evidence. The little evidence that exists suggests that chemotherapy is effective in elderly NSCLC patients, but also indicates that they are at more risk of chemotherapy toxicity than younger adults. However, if carefully selected and monitored, elderly patients can benefit from standard chemotherapy regimens. The Comprehensive Geriatric Assessment (CGA) has historically been adopted to identify elderly patients who are unfit for chemotherapy, yet in clinical practice this is often not feasible as it is too time-consuming. Two promising new tools have emerged - the CRASH and CARG scores - to assign patients to varying intensities of chemotherapy based on a pre-therapy risk assessment. The strengths and shortcomings of each tool were discussed by a group of six advisors with expertise in the treatment of NSCLC. Based on a literature review and on their personal experience, CRASH and CARG were considered feasible toxicity prediction tools, appropriate for implementation in routine clinical practice, with a potentially high impact in optimizing therapy selection for elderly patients with cancer.