Mayer Zaharia

La quimioterapia neoadyuvante en el tratamiento del cáncer de mama localmente avanzado

In the first stages of cancer treatment, it was believed that it spread by continuity, so the first strategies to treat locally advanced breast cancer were highly aggressive, as well as mutilating. A deeper knowledge of the biology of cancer later resulted in important changes in its treatment, such as the use of neoadjuvant chemotherapy, administered prior to surgical treatment, as an alternative therapy. Initially described by the University of Milan, neoadjuvant chemotherapy has proven to be a better alternative than surgical treatment alone, adjuvant (or post-surgical) chemotherapy and radiotherapy alone or in combination with the previously mentioned techniques. Among its advantages we find an increase in the rate of breast-conserving surgeries and a reduction in the ipsilateral breast tumor recurrence rate. Furthermore, it facilitates breast cancer control and follow-up. On the other hand, its main disadvantage is that it cannot modify some of the diseases prognostic factors, such as the tumor breast relation, multicentric disease, scattered microcalcifications and the coexistence of medical elements which contraindicate radiation therapy. Currently, neoadjuvant chemotherapy is a pillar of the treatment of locally advanced breast cancer and is recommended in order to guarantee a more conservative evolution of the disease.In the first stages of cancer treatment, it was believed that it spreaded by continuity, so the first strategies to treat locally advanced breast cancer were highly aggressive, as well as mutilating. A deeper knowledge of the biology of cancer later resulted in important changes in its treatment, such as the use of neoadyuvant chemotherapy, administered prior to surgical treatment, as an alternative therapy. Initially described by the University of Milan, neoadyuvant chemotherapy has proven to be a better alternative than surgical treatment alone, adjuvant (or postsurgical) chemotherapy and radiotherapy alone or in combination with the previously mentioned techniques. Among its advantages we find an increase in the rate of breast-conserving surgeries and a reduction in the ipsilateral breast tumor recurrence rate. Furthermore, it facilitates breast cancer control and follow-up. On the other hand, its main disadvantage is that it cannot modify some of the disease’s prognostic factors, such as the tumor breast relation, multicentric disease, scattered microcalcifications and the coexistence of medical elements which contraindicate radiation therapy. Currently, neoadyuvant chemotherapy is a pillar of the treatment of locally advanced breast cancer and is recommended in order to guarantee a more conservative evolution of the disease.

Phase I/II study on kilovoltage surface brachytherapy in conjunctival cancer: preliminary results

Introduction In ocular conjunctival carcinoma after surgery, adjuvant treatment has a role and kilovoltage surface brachytherapy opens a new door for the range of therapeutic options. Materials and methods Between October 2014 and June 2017, at the National Institute of Neoplastic Diseases (INEN) from Peru, 39 patients with squamous cell carcinoma of ocular conjunctiva, T1–T3, resected, were selected to receive adjuvant treatment. The portable accelerator of 50-kV INTRABEAM (Carl Zeiss Meditec) was used, after local anaesthesia and blocking of ocular muscles movement. The doses used were 18 Gy for patients with free margins and 22 Gy for positive edges, according to calculation of equivalent dose of 2Gy per fraction of 46 and 66 Gy, respectively, assuming a tumoural α/β ratio of 8 Gy. The prescription was done to 2 mm depth. Results The median age was 69 years, distributed evenly between both genders, with a median follow-up of 12 months. The surgical margins were 59% free and 41% committed, with no difference between the institutions where the surgery was performed (P = 0.069). The median tumour size was 7 mm with 2 mm of invasion, 61.5% was T2 and 35.9% T1. The mean time between surgery and irradiation was 1.5 months, 23.1% of patients developed grade I toxicity of spontaneous resolution, without evidence of greater degree in any case. The dose had no statistical relationship with toxicity (P = 0.533). One-year disease-free survival was 96.7%. Conclusions Kilovoltage surface brachytherapy is an applicable and reproducible tool in the treatment of squamous cell carcinoma of ocular conjunctiva. The administered doses are well tolerated by patients with low levels of acute toxicity. Longer follow-up is needed to establish disease control rates and late toxicities.

Abstract 2188: Different gene expression between men and women patients with lung adenoarcinoma reveals enrichment of immune gene sets

INTRODUCTION: There is different susceptibility to DNA damage induced by tobacco smoking between women and men. In despite of the great advances in the knowledge of the genomic landscape of lung cancer, is not explored the molecular differences between man and women. Our aim was to evaluate differentially enriched gene sets between the two genders. METHODS: We evaluated 03 public databases containing gene expression values from lung adenocarcinoma patients: GSE50081 (HG-U133_Plus_2; n = 181 samples), GSE47115 (Illumina HumanHT-12 WG-DASL V4.0 R2; n = 46 samples), GSE10072 (HG-U133A; n = 107 samples). We perform the Gene Set Enrichment Analysis (GSEA) to find differences between the genders. Each dataset was analyzed individually and was divided in cohorts of smokers and non-smokers (and healthy tissues by smoking status when it was included in the dataset). Cases with unknown smoking status and former smokers were excluded from the analysis. We use the Gene Ontology biological process terms to find similar enriched pathways between cohorts. We consider enriched process with statistical differences (p RESULTS: The analysis did show immune genes enrichment in women such as cytokine production, defense response to bacteria and response to other organisms. In another hand, regulation of JNK and MAPKKK cascades was enriched in tumors and healthy tissues from non-smokers women. In men, the oxidoreductase activity acting on sulfur group of donors was enriched in smoking men. CONCLUSION: There are differences between tumors from women and men that should be deeply explored. Citation Format: Joseph A. Pinto, Jhajaira M. Araujo, Alexandra Prado, Claudio Flores, Nadezhda K. Cardenas, Mayer Zaharia, Gustavo Sarria, Alfredo Aguilar, Silvia Neciosup, Henry Gomez, Luis Mas. Different gene expression between men and women patients with lung adenoarcinoma reveals enrichment of immune gene sets. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2188. doi:10.1158/1538-7445.AM2015-2188

El cáncer como problema de salud pública en el Perú

El cancer, en sus diferentes localizaciones y variantes, es un importante problema de salud publica a nivel mundial. De acuerdo con la Organizacion Mundial de la Salud, en Latinoamerica ocupa el tercer lugar como causa de muerte (1). La expectativa de vida de nuestras poblaciones esta creciendo debido a un mejor control de las enfermedades infecciosas, parasitarias y perinatales y, con ello, crece la proporcion de gente de edades mas avanzadas, en quienes la incidencia de cancer es mas alta. La combinacion del incremento poblacional, urbanizacion, cambios en la dieta y aumento de la expectativa de vida, impulsaran el marcado aumento en la incidencia de cancer en los paises en desarrollo y, por lo tanto, en el nuestro.