Introdução: A ressecão hepática é considerada um tratamento potencialmente curativo para metástases hepáticas de câncer colorretal (MHCCR), mas os benefícios a longo prazo oferecidos pela complementação do tratamento com quimioterapia sistêmica não foram completamente comprovados. Existe ganho já bem estabelecido para sobrevida livre de doença com o uso de quimioterapia perioperatória, mas não existe ganho de sobrevida global demonstrado em ensaios clínicos randomizados (ECR). Objetivo: Comparar sobrevida global e livre de doença em pacientes com MHCCR submetidos apenas ao tratamento cirúrgico com intenção curativa com aqueles que além da cirurgia também receberam tratamento complementar com quimioterapia sistêmica, independentemente do regime utilizado. Métodos: Construção de revisão sistemática com meta-análise avaliando estudos publicados entre 1991 e 2013 e que compararam o tratamento cirúrgico isolado ao associado à quimioterapia sistêmica para o tratamento de MHCCR ressecáveis. Os ECR foram avaliados através da ferramenta Cochrane para detecção de viéses, e os estudos observacionais comparativos (EOC) de boa qualidade foram incluídos no processo meta-analítico após terem sido selecionados seguindo a metodologia MINORS (índice metodológico para análise de ensaios clinicos não randomizados). Sobrevidas global e livre de doença foram comparadas utilizando modelos fixos e randômicos de efeitos de tratamento e razão de riscos (RR). Resultados: Na avaliação de sobrevida global foram incluídos 5 estudos (3 ECR e 2 EOC), compreendendo 2475 pacientes, com 1024 pacientes recebendo quimioterapia complementar e apresentando ganho relativo de sobrevida global de 23 % quando comparados com cirurgia isolada (RR 0.77, 95% IC. 0.67 - 0.88, p < 0.001). Quatro estudos reportaram sobrevida livre de doença e foram incluídos nesta análise (3 ECR e 1 EOC) totalizando 1592 pacientes e nestes, o uso de quimioterapia (702 pacientes) também reduziu o risco de recidiva em 29% (RR 0.71, 95% IC 0.61 - 0.83, p < 0.001). Conclusões: Esta revisão sistemática com meta-análise demonstrou que o uso de quimioterapia para pacientes submetidos à hepatectomia com intenção curativa como tratamento de MHCCR é uma estratégia terapêutica que propicia ganho de sobrevida global e livre de doença / Introduction: Hepatic resection is considered a potentially curative treatment for patients with colorectal liver metastases (CRLM). The benefits of the use systemic chemotherapy in these patients have not been proven. It is likely to improve recurrence free-survival (RFS); however, no differences in overall survival (OS) have been demonstrated yet. Objective: Comparison between surgery plus systemic chemotherapy, regardless of the timing of administration, with surgery alone looking for long term outcomes in patients with CRLM who underwent curative-intent liver resection. Methods: Systematic review and meta-analysis of studies published from January 1991 to December 2013 that compared surgery alone and surgery plus chemotherapy for patients with CRLM who underwent curative-intent liver resection. Randomized clinical trials (RCT\'s) were evaluated by Cochrane risk of bias tool. Selection of high-quality observational comparative studies (OCS) was based on a validated tool (Methodological Index for Nonrandomized Studies - MINORS). RFS and OS were compared using fixed and random effects model and Hazard Ratio (HR). Results: Concerning OS, 5 studies (3 RCT and 2 OCS), comprising 2475 patients were analyzed and chemotherapy (750 patients) relatively improved OS rates in 23% when compared to surgery alone (HR of 0.77, 95% C.I. 0.67 - 0.88, p < 0.001). Four studies described RFS (3 RCT and 1 OCS), totalizing 1592 patients, and chemotherapy (702 patients) also decreased the risk of recurrence in 29% (HR 0.71, 95% C.I 0.61 - 0.83, p < 0.001). Conclusion: This systematic review and meta-analysis has demonstrated that the use of chemotherapy for patients with CRLM who underwent curative-intent resection is a worthwhile strategy to improve both RFS and OS

Pacientes com diagnósticos oncológicos diversos sob terapia com agentes nefrotóxicos, foram avaliados através de procedimentos radioisotópicos, em três momentos diferentes. Os achados radioisotópicos foram comparados com as avaliações laboratoriais rotineiras. Não mostraram alterações estatisticamente significativas os seguintes parâmetros: uréia, creatinina, sedimentos anormais e índice de Crockoft-Gault. Concluiu-se que a avaliação da função renal com os métodos rotineiramente utilizados na prática oncológica não foram estatisticamente significativas. Dentre os estudos utilizando radionuclídeos, o DTPA-99mTc e DMSA-99mTc, evidenciaram alterações, enquanto o EC-99mTc, não as detectou / Patients with different oncologic diagnoses under treatment with nephrotoxic drugs were evaluated by radioisotopic agents at three different moments. Radioisotopic data were compared with biochemical routine tests. Concerning laboratorial parameters like serum creatinine, urea and Cockroft Gault index, no statistically significant changes were observed. Possible to conclude that renal function evaluation with methods routinely used in oncological practice did not reveal any statistically significant change. Radioisotopic studies using 99mTc-DTPA and 99mTc-DMSA showed considerable alterations, however with 99mTc-EC no significant changes were evidenced

Wong, Wai Ki Vicky. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 105-131). / Abstracts in English and Chinese. / Abstract --- p.ii / 摘要 --- p.iv / Acknowledgements --- p.vi / Table of contents --- p.vii / List of tables --- p.xii / List of figures --- p.xiii / List of abbreviations --- p.xiv / Chapter Chapter 1: --- Introduction --- p.1 / Chapter Chapter 2: --- Colorectal cancer / Chapter 2.1 --- Literature Review / Chapter 2.1.1 --- Colorectal cancer --- p.8 / Chapter 2.1.2 --- Incident rate of colorectal cancer --- p.8 / Chapter 2.1.3 --- Hereditary colorectal cancer --- p.9 / Chapter 2.1.4 --- Sporadic colorectal cancer and Wnt signaling pathway --- p.10 / Chapter 2.1.5 --- Chemotherapy treatment of colorectal cancer --- p.11 / Chapter 2.1.5.1 --- 5-Fluorouracil --- p.12 / Chapter 2.1.5.2 --- Oxaliplatin --- p.14 / Chapter 2.1.5.3 --- Irinotecan --- p.14 / Chapter 2.1.6 --- Biomarkers for colorectal cancer --- p.15 / Chapter 2.1.6.1 --- Thymidylate synthase --- p.15 / Chapter 2.1.6.2 --- Dihydropyrimidine dehydrogenase --- p.16 / Chapter 2.1.6.3 --- Thymidine phosphorylase --- p.16 / Chapter 2.1.6.4 --- Microsatellite-instability status --- p.16 / Chapter 2.1.6.5 --- Clinical uses of biomarkers for colorectal cancer --- p.17 / Chapter 2.1.7 --- Choice of cell line as colorectal cancer model --- p.17 / Chapter 2.1.8 --- Aims of study --- p.17 / Chapter 2.2 --- Materials and Methods / Chapter 2.2.1 --- Verification of SW480 as a nuclear β-catenin positive cell line / Chapter 2.2.1.1 --- Maintenance of cell lines --- p.21 / Chapter 2.2.1.2 --- Antibody --- p.21 / Chapter 2.2.1.3 --- Agar block preparation for SW480 and CCD-18C0 cells --- p.22 / Chapter 2.2.1.4 --- Immunocytochemical staining --- p.22 / Chapter 2.2.2 --- Effect of anti-cancer drugs on cell viability / Chapter 2.2.2.1 --- Maintenance of cell lines --- p.22 / Chapter 2.2.2.2 --- MTT cell viability assay --- p.23 / Chapter 2.3 --- Results / Chapter 2.3.1 --- SW480 is a β-catenin positive cell line --- p.24 / Chapter 2.3.2 --- Antiproliferative effects of cytotoxic drugs in SW480 cells / Chapter 2.3.2.1 --- 5-Fluorouracil --- p.26 / Chapter 2.3.2.2 --- Oxaliplatin --- p.29 / Chapter 2.3.2.3 --- Irinotecan --- p.31 / Chapter 2.4 --- Discussion / Chapter 2.4.1 --- SW480 as a nuclear β-catenin positive cell line --- p.33 / Chapter 2.4.2 --- Antiproliferative effects of 5-fluorouracil in SW480 cells --- p.33 / Chapter 2.4.3 --- Summary --- p.34 / Chapter Chapter 3: --- Effect of 5-fluorouracil on mRNA expression in SW480 cells / Chapter 3.1 --- Literature Review / Chapter 3.1.1 --- Application of quantitative real-time polymerase chain reaction in cancer research / Chapter 3.1.1.1 --- Principles of quantitative real-time polymerase chain reaction --- p.36 / Chapter 3.1.1.2 --- Advantages of quantitative real-time polymerase chain reaction over conventional polymerase chain reaction --- p.39 / Chapter 3.1.1.3 --- Determination of colorectal cancer biomarkers by quantitative real-time polymerase chain reaction --- p.39 / Chapter 3.2 --- Materials and Methods / Chapter 3.2.1 --- Determination of the effect of 5-fluorouracil on mRNA expression in SW480 cells / Chapter 3.2.1.1 --- Treatment of cells --- p.40 / Chapter 3.2.1.2 --- Extraction of total RNA from SW480 cells --- p.40 / Chapter 3.2.1.3 --- Removal of genomic DNA --- p.41 / Chapter 3.2.1.4 --- Determination of the efficiency of genomic DNA removal --- p.42 / Chapter 3.2.1.5 --- Determination of the purity and concentration of RNA --- p.42 / Chapter 3.2.1.6 --- Determination of the integrity of RNA --- p.43 / Chapter 3.2.1.7 --- First strand cDNA synthesis --- p.44 / Chapter 3.2.1.8 --- Real-time polymerase chain reaction using human Wnt signaling pathway RT2 ProfileŕёØ PCR array --- p.44 / Chapter 3.2.1.9 --- Calculation of the fold-change in genes expression between the 5-FU treated and control SW480 cells --- p.45 / Chapter 3.3 --- Results / Chapter 3.3.1 --- The quality and quantity of RNA --- p.46 / Chapter 3.3.2 --- Effects of 5-fluorouracil on genes expression in SW480 cells --- p.48 / Chapter 3.4 --- Discussion / Chapter 3.4.1 --- Alterations in mRNA expression in 5-fluorouracil treated SW480 cells --- p.55 / Chapter 3.4.1.1 --- Extracellular signaling molecules --- p.55 / Chapter 3.4.1.2 --- Canonical Wnt signaling pathway --- p.56 / Chapter 3.4.1.3 --- Regulators of cell cycle --- p.57 / Chapter 3.4.1.4 --- Regulators of growth and proliferation --- p.58 / Chapter 3.4.1.5 --- Regulators of transcription --- p.58 / Chapter 3.4.1.6 --- Regulators of Wnt receptor signaling pathway --- p.60 / Chapter 3.4.1.7 --- Other genes involved in Wnt signaling --- p.61 / Chapter 3.4.2 --- Limitations of Q-RT-PCR --- p.61 / Chapter 3.4.3 --- Summary --- p.62 / Chapter Chapter 4: --- Effect of 5-fluorouracil on proteins expression in SW480 cells / Chapter 4.1 --- Literature Review / Chapter 4.1.1 --- From mRNA to proteins --- p.63 / Chapter 4.1.2 --- Application of proteomics in cancer research --- p.63 / Chapter 4.1.3 --- Two-dimensional gel electrophoresis --- p.64 / Chapter 4.1.4 --- Principles of MALDI TOF mass spectrometry --- p.64 / Chapter 4.1.5 --- Peptide mass fingerprinting --- p.65 / Chapter 4.1.6 --- Drug response proteins detected by proteomics in colorectal cancer cell lines --- p.65 / Chapter 4.1.7 --- Detection of biomarker in colorectal cancer formation using proteomics --- p.66 / Chapter 4.2 --- Materials and Methods / Chapter 4.2.1 --- Determination of the effect of 5-fluorouracil on proteins expression in SW480 cells / Chapter 4.2.1.1 --- Treatment of cells --- p.67 / Chapter 4.2.1.2 --- Cell lysis --- p.67 / Chapter 4.2.1.3 --- Protein quantitation of cell lysate --- p.67 / Chapter 4.2.1.4 --- Sample preparation for two-dimensional electrophoresis --- p.68 / Chapter 4.2.1.5 --- Two-dimensional electrophoresis --- p.69 / Chapter 4.2.1.6 --- Silver staining --- p.69 / Chapter 4.2.1.7 --- Image analysis --- p.70 / Chapter 4.2.1.8 --- In-gel protein digestion --- p.70 / Chapter 4.2.1.9 --- Peptide mass fingerprinting using mass spectrometry --- p.71 / Chapter 4.3 --- Results / Chapter 4.3.1 --- Protein expression patterns of 5-fluorouracil treated and untreated SW480 cells by 2-dimensional electrophoresis --- p.72 / Chapter 4.3.2 --- Identification of the differentially expressed proteins after 5-fluorouracil treatment in SW480 cells --- p.75 / Chapter 4.4 --- Discussion / Chapter 4.4.1 --- Effects of 5-fluorouracil on protein expression in SW480 cells --- p.82 / Chapter 4.4.1.1 --- Identified upregulated proteins after 5-fluorouracil treatment in SW480 cells / Chapter 4.4.1.1.1 --- Cyclophilin A --- p.83 / Chapter 4.4.1.1.2 --- Cytokeratin 19 --- p.83 / Chapter 4.4.1.1.3 --- Cytokeratin 8 --- p.84 / Chapter 4.4.1.1.4 --- RAN --- p.84 / Chapter 4.4.1.1.5 --- Heat shock protein 27 --- p.84 / Chapter 4.4.1.1.6 --- Peroxiredoxin 6 --- p.85 / Chapter 4.4.1.2 --- Identified dowiiregulated proteins after 5-fluorouracil treatment in SW480 cells / Chapter 4.4.1.2.1 --- Heat shock protein 60 --- p.86 / Chapter 4.4.1.2.2 --- Cytokeratin 18 --- p.86 / Chapter 4.4.1.2.3 --- Cytokeratin 9 --- p.86 / Chapter 4.4.1.2.4 --- Carbamoylphosphate synthetase I --- p.87 / Chapter 4.4.1.2.5 --- a-Enolase --- p.87 / Chapter 4.4.1.2.6 --- Heat shock protein 70 --- p.87 / Chapter 4.4.1.2.7 --- nm23 --- p.88 / Chapter 4.4.1.2.8 --- β-actin --- p.88 / Chapter 4.4.2 --- Limitations of proteomics profiling --- p.89 / Chapter 4.4.3 --- Summary --- p.90 / Chapter Chapter 5: --- Verification of proteinśة identities by immunocytochemical staining / Chapter 5.1 --- Materials and Methods / Chapter 5.1.1 --- Antibodies --- p.91 / Chapter 5.1.2 --- Treatment of cells --- p.91 / Chapter 5.1.3 --- Agar block preparation of SW480 cells --- p.92 / Chapter 5.1.4 --- Immunocytochemical staining and evaluation --- p.92 / Chapter 5.1.5 --- Polymer-based immunohistochemical detection system --- p.93 / Chapter 5.1.6 --- Statistical analyses --- p.93 / Chapter 5.2 --- Results / Chapter 5.2.1 --- Confirmation of proteomic findings using immunocytochemical stainings in paraffin-embedded sections of 5-fluorouracil treated and untreated SW480 cells --- p.94 / Chapter 5.3 --- Discussion / Chapter 5.3.1 --- Immunocytochemical staining to verify proteomics findings of 5-fluorouracil treated and untreated SW480 cells --- p.99 / Chapter 5.3.2 --- Limitations of ICC staining --- p.100 / Chapter 5.3.3 --- Summary --- p.100 / Chapter Chapter 6: --- Conclusions and future perspectives / Chapter 6.1 --- Significance of study --- p.101 / Chapter 6.2 --- Future perspectives --- p.102 / References --- p.105

Pacientes com diagnósticos oncológicos diversos sob terapia com agentes nefrotóxicos, foram avaliados através de procedimentos radioisotópicos, em três momentos diferentes. Os achados radioisotópicos foram comparados com as avaliações laboratoriais rotineiras. Não mostraram alterações estatisticamente significativas os seguintes parâmetros: uréia, creatinina, sedimentos anormais e índice de Crockoft-Gault. Concluiu-se que a avaliação da função renal com os métodos rotineiramente utilizados na prática oncológica não foram estatisticamente significativas. Dentre os estudos utilizando radionuclídeos, o DTPA-99mTc e DMSA-99mTc, evidenciaram alterações, enquanto o EC-99mTc, não as detectou / Patients with different oncologic diagnoses under treatment with nephrotoxic drugs were evaluated by radioisotopic agents at three different moments. Radioisotopic data were compared with biochemical routine tests. Concerning laboratorial parameters like serum creatinine, urea and Cockroft Gault index, no statistically significant changes were observed. Possible to conclude that renal function evaluation with methods routinely used in oncological practice did not reveal any statistically significant change. Radioisotopic studies using 99mTc-DTPA and 99mTc-DMSA showed considerable alterations, however with 99mTc-EC no significant changes were evidenced

BACKGROUND: Human papilloma virus (HPV) in patients with esophageal carcinoma has previously been studied with an average detection rate of 15%, but the role of HPV in relation to survival is less clear. In cervical cancer, lung cancer and tonsil cancer HPV viral load is a predictive factor for survival and outcome of treatment. The primary aim was to study the spectrum of high-risk HPV types in esophageal tumors. Secondary, as a pilot study we investigated the association between HPV status and the survival rates. METHODS: We compared both the presence and the viral load of high-risk HPV types 16, 18, 31, 33, 39, 45, 52, 58, and 67 in relation to clinical data from patients with esophageal carcinoma. Survival data and tumor samples were retrieved from 100 patients receiving treatment at the Department of Oncology, Uppsala Hospital, Uppsala, Sweden. The tumor samples were investigated for HPV viral load using real-time PCR. RESULTS: HPV 16 was detected in 16% of the patients; no other HPV type was detected. HPV 16 infection had no significant effect on survival (p = 0.72). Also, HPV 16 did not improve survival after treatment (radiotherapy or chemotherapy). CONCLUSION: Only HPV 16 was detected among the patients. HPV 16 in esophageal carcinoma patients did not influence survival or improve therapy response. However, given the size of the study there is a need to examine a larger cohort in order to understand in more detail the effect of high risk HPV types in esophageal carcinoma. / <p>De två första författarna delar förstaförfattarskapet.</p>

The central role of Src in the development of several malignancies including breast cancer and the accumulating evidence of its interaction with receptor tyrosine kinases (RTK), integrins and steroid receptors have identified it as an attractive therapeutic target. In the current study we have evaluated the effect of a Src/Abl kinase inhibitor SKI-606, on breast cancer growth, migration, invasion and metastasis. Treatment of human breast cancer cells MDA-MB-231 with SKI-606 caused a marked inhibition of cell proliferation, invasion and migration by inhibiting MAPK and Akt phosphorylation. For in vivo studies MDA-MB-231 cells transfected with the plasmid encoding green fluorescent protein (GFP) [MDA-MB-231-GFP] were inoculated into mammary fat pad of female BALB/c nu/nu mice. Once tumor volume reached 30-50 mm3, animals were randomized and treated with vehicle alone or 150 mg/kg of SKI-606 by daily oral gavage. Experimental animals receiving SKI-606 developed tumors of significantly smaller volume (45-54%) as compared to control animals receiving vehicle alone. Analysis of lungs, liver and spleen of these animals showed a significant decrease in GFP positive tumor metastasis in animals receiving SKI-606 at a dose that was well tolerated. Western blot analysis and immunohistochemical analysis of primary tumors showed that these effects were due to the ability of SKI-606 to block tumor cell proliferation, angiogenesis, growth factors expression and inhibition of Src mediated signalling pathways in vivo. Together the results from these studies provide compelling evidence for the use of Src inhibitors as therapeutic agents for blocking breast cancer growth and metastasis.

Introdução: O carcinoma de células escamosas (CEC) do canal anal é uma neoplasia pouco frequente, correspondendo a 1-5% dos tumores intestinais. Entretanto, o risco de CEC do canal anal vem crescendo. O tratamento padrão do CEC de canal anal nos estádios II-III consiste em 5-fluorouracil infusional associado a mitomicina-C e radioterapia, desde 1974. Estudos clínicos com o objetivo de identificar novos esquemas terapêuticos mais convenientes para câncer do canal anal devem continuar. Métodos: Pacientes com CEC de canal anal T2-4N0M0 ou T (qualquer) N1-3M0, com bom performance clínico, função renal e hematológica normais foram tratados com capecitabina 825 mg/m2 12/12 horas durante a radioterapia associada a dose única de mitomicina-C 15 mg/m2 no Dia 1. O objetivo primário do estudo foi determinar a taxa de controle local em 6 meses da associação de capecitabina, mitomicina-C e radioterapia em pacientes com câncer do canal anal. Os objetivos secundários foram determinar a taxa de toxicidade aguda graus 3-4, conforme os critérios da CTCaev4.0, taxa de resposta completa 6 semanas após término da quimio-radioterapia, sobrevida global e livre de progressão e taxa de colostomia em 1 ano. O tamanho da amostra foi calculado usando a ferramenta \"estágio único de Fleming\". Considerando 85% de eventos esperados (taxa de controle local em 6 meses), 1 desvio padrão e 5% de erro alfa, o tamanho ideal da amostra foi de 51 pacientes. Resultados: De novembro/2010 a fevereiro/2014, 51 pacientes foram incluídos, sendo avaliados 43 pacientes. Dezessete pacientes (39,5%) tinham estádio II, 11 (25,6%) estádio IIIA e 15 (34,9%) estádio IIIB. O seguimento mediano foi de 23,1 meses. Entre os pacientes que foram avaliados em 6 meses, 3 (7%) apresentaram resposta clínica parcial, 37 (86%) tiveram resposta clínica completa e 3 (7%) apresentaram progressão de doença. O controle loco-regional em 6 meses foi de 86%. Em relação às toxicidades graus 3-4, observaram-se diarreia grau 3, em 4,6% dos pacientes, radiodermite grau 3, em 23,2%, vômitos grau 3, em 2,3%, plaquetopenia graus 3-4, em 6,9%, leucopenia grau 3, em 6,9%, e linfopenia grau 3, em 11,6%. Um paciente HIV positivo (2,3%) apresentou choque séptico grau 4, pneumonia grau 4, meningoencefalite herpética grau 4 e síndrome de ativação macrofágica grau 4. A taxa de colostomia foi de 18,6%. Conclusão: Capecitabina e mitomicina-C são um tratamento bem tolerado em pacientes com carcinoma de canal anal, com controle loco-regional em 6 meses em 86% dos pacientes. Palavras-chave: carcinoma de células escamosas, câncer anal, capecitabina, radioterapia, mitomicina-c / Background: Squamous cell carcinoma (SCC) of the anal canal is an uncommon malignancy accounting for 1-5% of intestinal tumors; however, its incidence has been increasing. Treatment for stage II and III anal canal SCC is infusional 5-fluorouracil associated with mitomycin and radiotherapy, since 1974. More convenient treatments for patients are needed. Methods: Patients with SCC of anal cancer T2-4N0M0 or T (any) N1-3M0, with good performance status, normal blood, and renal function were treated with capecitabine 825 mg/m2 bid during radiotherapy associated with a single dose of mitomycin 15 mg/m2 on day 1. Primary objective was local control rate at 6 months determined by clinical examination and radiological assessment. Sample size was calculated using Fleming single stage design. Results: From november/2010 to february/2014 51 patients were initially included, however 43 patients were assessed. Seventeen patients (39.5%) were stage II, 11 patients (25.6%) stage IIIA, and 15 patients (34.9%) stage IIIB. Four patients (9.3%) were HIV-positive, while 39 (90.7%) were HIV-negative. Median follow-up was 23.1 months. Among patients who finished the treatment and were reevaluated at 6 months 3 patients (7%) presented partial response, 37 patients (86%) had complete response, and 3 patients developed progression of the disease (7%). Regarding grade 3-4 toxicities, 10 patients (23.2%) had grade 3 radiodermitis, 3 patients (6.9%) had grade 3-4 thrombocytopenia, 5 (11.6%) had grade 3 lymphopenia, 1 patient (2.3%) had grade 3 vomiting, 2 patients (4.6%) had grade 3 diarrhea and 3 patients (6.9%) had grade 3 leukopenia. One HIV+ patient had septic shock, pneumonia, herpetic encephalitis and macrophage activation syndrome. Colostomy rate was 18.6%. Conclusions: Capecitabine and mitomycin with radiotherapy seem to be a safe treatment for SCC of the anal cancer, with a complete response rate in 6 months of 86%

O objetivo do estudo foi estudar a expressão de timidilato sintase (TS) como fator preditivo para eficácia de quimioterapia adjuvante com 5-fluorouracil (5-FU) e como fator prognóstico para sobrevida em pacientes portadores de câncer colorretal. Trata-se de estudo retrospectivo em uma série de 114 pacientes com carcinoma colorretal estádios II ou III, distribuídos em dois grupos: 1)cirurgia exclusiva (n=61); 2)cirurgia seguida de quimioterapia com 5-FU (n=53). A expressão de TS foi determinada por imunoistoquímica. Observou-se que a expressão intratumoral de TS foi capaz de selecionar pacientes que se beneficiaram com emprego de quimioterapia adjuvante, mas não se mostrou como variável independente para risco de recidiva ou óbito / The purpose of this study was trying to assess the value of TS expression as a predictive factor in the efficacy of adjuvant chemotherapy in colorectal cancer, as well as its independent prognostic value for survival. It deals with a retrospective study that assesses a series of 114 individuals with high risk colorectal cancer, distributed into two different groups: 1)surgery alone (n=61); 2)surgery and 5-FU-based chemotherapy (n=53). TS expression was determined by immunohistochemistry. We observed that TS expression may select patients that benefit from adjuvant chemotherapy, but it was not shown as an independent variable for the risk of recurrence or death

Infusões prolongadas de 5-fluorouracil são mais seguras e potencialmente mais efetivas no tratamento do câncer de cólon metastático do que infusões rápidas da mesma medicação. No entanto, infusões prolongadas requerem a disponibilidade de um acesso venoso central, bem como de bombas de infusão dispendiosas. O desenvolvimento de fluoropirimidinas orais permitiu que pacientes fossem expostos ao 5-fluorouracil por longo tempo, com maior conveniência. UFT e leucovorin administrados três vezes ao dia demonstraram previamente uma eficácia equivalente, com menor toxicidade, quando comparados a um regime convencional de infusão rápida de 5- fluorouracil e leucovorin. Este estudo com 98 pacientes foi desenhado e conduzido com objetivo de demonstrar equivalência no tempo de progressão com o uso de UFT e leucovorin administrados duas vezes ao dia, com o uso da mesma combinação administrada três vezes ao dia. Objetivos secundários incluíram análise de toxicidade, resposta objetiva e sobrevida global. O tempo mediano de progressão foi de 3,8 meses, comparado com 3,5 meses observados com o uso da medicação três vezes ao dia e a taxa de resposta foi de 11%, com uma sobrevida mediana de 12,8 meses, sendo comparável aos resultados de 12% e 12,4 meses obtidas com o uso da combinação três vezes ao dia. A incidência de diarréia com graus 3 e 4 foi de 30% no regime de administração duas vezes ao dia, e 21% no de três vezes ao dia. Esses resultados sugerem que o uso de UFT e leucovorin duas vezes ao dia tem eficácia e toxicidade similares àquelas obtidas com o uso da mesma medicação três vezes ao dia. / Prolonged infusions have been shown to be safer and potentially more effective than bolus regimens of 5- fluorouracil as treatment for advanced colorectal cancer. However, infusional 5- fluorouracil requires central venous access and costly infusion pumps. Development of oral fluoropyrimidines has allowed longer exposures to 5-fluorouracil with increased convenience. UFT and leucovorin given thrice daily showed improved safety and no significant difference in survival or response rate compared with bolus 5- fluorouracil and leucovorin. This study with 98 patients was conducted to evaluate whether UFT and leucovorin given twice daily provided comparable time to progression (TTP) to the same combination administered three times a day. Secondary objectives included evaluation of toxicity, overall tumor response rate, and survival. Median time to progression was 3.8 months, compared with 3.5 months observed with the thrice-daily regimen. The twice-daily regimen had a response rate of 11% and median survival of 12.8 months, comparable to the 12% and 12.4 months seen with the thrice-daily regimen. The incidence of grade 3-4 drug-related diarrhea was 30% on the twice-daily and 21% on the thrice-daily schedule. Results suggest that the twice-daily schedule has similar safety and efficacy to the thrice-daily schedule.

Introdução: A ressecão hepática é considerada um tratamento potencialmente curativo para metástases hepáticas de câncer colorretal (MHCCR), mas os benefícios a longo prazo oferecidos pela complementação do tratamento com quimioterapia sistêmica não foram completamente comprovados. Existe ganho já bem estabelecido para sobrevida livre de doença com o uso de quimioterapia perioperatória, mas não existe ganho de sobrevida global demonstrado em ensaios clínicos randomizados (ECR). Objetivo: Comparar sobrevida global e livre de doença em pacientes com MHCCR submetidos apenas ao tratamento cirúrgico com intenção curativa com aqueles que além da cirurgia também receberam tratamento complementar com quimioterapia sistêmica, independentemente do regime utilizado. Métodos: Construção de revisão sistemática com meta-análise avaliando estudos publicados entre 1991 e 2013 e que compararam o tratamento cirúrgico isolado ao associado à quimioterapia sistêmica para o tratamento de MHCCR ressecáveis. Os ECR foram avaliados através da ferramenta Cochrane para detecção de viéses, e os estudos observacionais comparativos (EOC) de boa qualidade foram incluídos no processo meta-analítico após terem sido selecionados seguindo a metodologia MINORS (índice metodológico para análise de ensaios clinicos não randomizados). Sobrevidas global e livre de doença foram comparadas utilizando modelos fixos e randômicos de efeitos de tratamento e razão de riscos (RR). Resultados: Na avaliação de sobrevida global foram incluídos 5 estudos (3 ECR e 2 EOC), compreendendo 2475 pacientes, com 1024 pacientes recebendo quimioterapia complementar e apresentando ganho relativo de sobrevida global de 23 % quando comparados com cirurgia isolada (RR 0.77, 95% IC. 0.67 - 0.88, p < 0.001). Quatro estudos reportaram sobrevida livre de doença e foram incluídos nesta análise (3 ECR e 1 EOC) totalizando 1592 pacientes e nestes, o uso de quimioterapia (702 pacientes) também reduziu o risco de recidiva em 29% (RR 0.71, 95% IC 0.61 - 0.83, p < 0.001). Conclusões: Esta revisão sistemática com meta-análise demonstrou que o uso de quimioterapia para pacientes submetidos à hepatectomia com intenção curativa como tratamento de MHCCR é uma estratégia terapêutica que propicia ganho de sobrevida global e livre de doença / Introduction: Hepatic resection is considered a potentially curative treatment for patients with colorectal liver metastases (CRLM). The benefits of the use systemic chemotherapy in these patients have not been proven. It is likely to improve recurrence free-survival (RFS); however, no differences in overall survival (OS) have been demonstrated yet. Objective: Comparison between surgery plus systemic chemotherapy, regardless of the timing of administration, with surgery alone looking for long term outcomes in patients with CRLM who underwent curative-intent liver resection. Methods: Systematic review and meta-analysis of studies published from January 1991 to December 2013 that compared surgery alone and surgery plus chemotherapy for patients with CRLM who underwent curative-intent liver resection. Randomized clinical trials (RCT\'s) were evaluated by Cochrane risk of bias tool. Selection of high-quality observational comparative studies (OCS) was based on a validated tool (Methodological Index for Nonrandomized Studies - MINORS). RFS and OS were compared using fixed and random effects model and Hazard Ratio (HR). Results: Concerning OS, 5 studies (3 RCT and 2 OCS), comprising 2475 patients were analyzed and chemotherapy (750 patients) relatively improved OS rates in 23% when compared to surgery alone (HR of 0.77, 95% C.I. 0.67 - 0.88, p < 0.001). Four studies described RFS (3 RCT and 1 OCS), totalizing 1592 patients, and chemotherapy (702 patients) also decreased the risk of recurrence in 29% (HR 0.71, 95% C.I 0.61 - 0.83, p < 0.001). Conclusion: This systematic review and meta-analysis has demonstrated that the use of chemotherapy for patients with CRLM who underwent curative-intent resection is a worthwhile strategy to improve both RFS and OS