1
|
Chiarantano RS, Vazquez FL, Franco A, Ferreira LC, Cristina da Costa M, Talarico T, Oliveira ÂN, Miziara JE, Mauad EC, Caetano da Silva E, Ventura LM, Junior RH, Leal LF, Reis RM. Implementation of an Integrated Lung Cancer Prevention and Screening Program Using a Mobile Computed Tomography (CT) Unit in Brazil. Cancer Control 2022; 29:10732748221121385. [PMID: 36204992 PMCID: PMC9549090 DOI: 10.1177/10732748221121385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Lung cancer is the deadliest cancer worldwide and in Brazil. Despite strong evidence, lung cancer screening by low-dose computed tomography (LDCT) in high-risk individuals is far from a reality in many countries, particularly in Brazil. Brazil has a universal public health system marked with important inequalities. One affordable strategy to increase the coverage of resources is to use mobile units. OBJECTIVES To describe the implementation and results of an innovative lung cancer prevention program that integrates tobacco cessation and lung cancer screening using a mobile CT unit. METHODOLOGY From May 2019 to Dec 2020, health professionals from 18 public primary health care units in Barretos, Brazil, were trained to offer smoking cessation counseling and treatment. Eligible high-risk participants of this program were also invited to perform lung cancer screening in a mobile LDCT unit that was specially conceived to be dispatched to the community. A detailed epidemiological questionnaire was administered to the LDCT participants. RESULTS Among the 233 screened participants, the majority were women (54.9%), and the average age was 62 years old. A total of 52.8% of participants showed high or very high nicotine dependence. After 1 year, 27.8% of participants who were involved in smoking cessation groups had quit smoking. The first LDCT round revealed that the majority of participants (83.7%) exhibited lung-Rads 1 or 2; 7.3% exhibited lung-Rads 3; 7.7% exhibited lung-Rads 4a; and 3% exhibited lung-Rads 4b or 4x. The three participants with lung-Rads 4b were further confirmed, and their surgery led to the diagnosis of early-stage cancer (1 case of adenocarcinoma and two cases of squamous cell carcinoma), leading to a cancer diagnosis rate of 12.8/1000. CONCLUSION Our results indicate promising outcomes for an onsite integrative program enrolling high-risk individuals in a middle-income country. Evidence barriers and challenges remain to be overcome.
Collapse
Affiliation(s)
- Rodrigo Sampaio Chiarantano
- Molecular Oncology Research Center,
Barretos Cancer Hospital, Barretos, Brazil,Department of Diagnostic and
Interventional Radiology, Barretos Cancer
Hospital, Barretos, Brazil
| | | | | | | | | | - Thais Talarico
- Molecular Oncology Research Center,
Barretos Cancer Hospital, Barretos, Brazil
| | | | - José Elias Miziara
- Department of Thoracic Surgery,
Barretos Cancer Hospital, Barretos, Brazil
| | | | | | - Luis Marcelo Ventura
- Department of Diagnostic and
Interventional Radiology, Barretos Cancer
Hospital, Barretos, Brazil
| | | | - Letícia Ferro Leal
- Molecular Oncology Research Center,
Barretos Cancer Hospital, Barretos, Brazil,Life and Health Sciences Research
Institute (ICVS), Medical School, University of
Minho, Braga, Portugal
| | - Rui Manuel Reis
- Molecular Oncology Research Center,
Barretos Cancer Hospital, Barretos, Brazil,ICVS/3B’s - PT Government Associate
Laboratory, Guimarães, Portugal,Rui Manuel Reis, Molecular Oncology
Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, Barretos
14784-400, Brazil.
| |
Collapse
|
2
|
Almeida C, Ventura LM, Previdelli S, Lamim ML, Mançano BM, Cavalcante CB, Lourenço LD. SURG-22. CERVICAL SPINE ANEURYSMAL BONE CYST OF A PEDIATRIC PATIENT. Neuro Oncol 2020. [PMCID: PMC7715211 DOI: 10.1093/neuonc/noaa222.816] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are benign, expanding lesions that represent 15% of all primary spine tumors, and only 2% have been found at the cervical level. There are different therapeutic options; the most successful is complete surgical resection. Although not always possible, due to high blood loss that occurs during the procedure, a combination of surgery with other treatment modalities was used in 40% of the cases reported so far. We describe a pediatric patient that we managed with embolization plus surgery. CASE REPORT: A 5-year-old girl presented with painful torticollis associated with a left posterior cervical mass, without neurological impairment. Magnetic resonance imaging of the cervical spine showed a multiseptated bony lesion with multiple fluid levels, involving the posterior elements of C2, associated with diffuse soft tissue enhancement of the left paravertebral muscles. We proposed a multi-staged treatment with pre-operative arterial embolization followed by the posterior surgical approach. Super selective embolization of the left ascending cervical artery was performed. The right ascending cervical artery also contributed to the tumor blush, but due to its connection to the right vertebral artery and, therefore, associated with a high risk of neurological injury, we prefer not to embolize it. Two days later, we performed a posterior surgical approach, with a gross total resection of the tumor. Histological examination revealed an ABC. CONCLUSION An aneurysmal bone cyst is a rare cervical spine lesion that demands a multidisciplinary approach due to its locally aggressive behavior and the excessive blood loss related to surgery.
Collapse
Affiliation(s)
- Carlos Almeida
- Barretos′s Children and Young Adults Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - Luis Marcelo Ventura
- Barretos′s Children and Young Adults Cancer Hospital, Barretos, Sao Paulo, Brazil
| | | | | | | | | | - Lucas Dias Lourenço
- Barretos′s Children and Young Adults Cancer Hospital, Barretos, Sao Paulo, Brazil
| |
Collapse
|
3
|
Falo C, Ventura LM, Petit A, Perez J, Cañellas J, Perez L, Loayza C, Gil M, Varela M, Garcia A, Pla MJ, Lopez A, Guma A, Pernas S. Abstract P2-08-31: Tumor and axillar downstaging as a prognostic factor and evaluation of effectiveness to primary chemotherapy in breast cancer: A retrospective analysis. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-31] [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: 11/16/2022]
Abstract
Abstract
Introduction: Evaluation of the benefit of primary chemotherapy (PC) is not easy to establish. Pathologic complete response (pCR) has been considered the main surrogate prognostic factor of patient's survival. However, patients achieving a pCR are not the only ones who benefit from PC. The purpose of our study is to find a measure of response that includes the maximum of patients that benefit from PC in terms of survival.
Patients and methods: 224 breast cancer patients were treated in Breast Cancer Unit from Institut Català d'Oncologia (ICO) L'Hospitalet with taxans and antracyclines-based PC +/- trastuzumab between 2009 and 2011. pCR was defined as no invasive carcinoma found in the tumor and in the axillary lymph nodes (ypT0/ypTis ypN0). Tumor and nodal downstaging (TNDS) was calculated according to the "neoadjuvant response index" (NRI) from Rodenhuis and also as a dichotomic variable: Positive includes those patients achieving dowstaging of both T and N plus T downstaging N0 and negatives those patients without downstaging in any of both variables. Those parameters were related to patient's overall survival (OS). Statistical analysis was performed with SPSS version 15.
Results: Median age 45.5 years (24-83). Main tumor characteristics: T2 (62.6%); N1 (50%); ductal infiltrating carcinoma (95.5%) and grade III (57.1%). Biological sub-type according to the last St Gallen classification: luminal A: 28 patients (pts); luminal B/Her2-: 61 pts; luminal B/HER2+: 34 pts; HER2+: 33 pts and triple negative: 69 pts. Pathologic complete response was achieved in 49 pts (22.5%). TNDS was evaluated in 181 patients and of those 90 was positive. According to NRI 74 patients presented cut-off> 0.5 and 52 pts > 0.7. Parameters related to OS were: biological subtype (P: 0.007); achieving a pCR (p: 0.007); NRI cut-off 0.5 (P: 0.001) and TNDS (p:0.000). In the multivariate analysis only TNDS and biological subtype remained statistically significant. When comparing those patients with positive vs. negative TNDS, the HR for recurrence was of 10.05 (IC 2.33 -43.57). The median OS of the series has not been reached. OS at 5y was 82.7% (IC: 77.1%-88%) and specific breast cancer OS at 5 y was 85% (IC:79.5%-90%). The number of events (breast cancer deaths) for each biological subtype according to positive vs. negative TNDS was: luminal A: 0/5 vs. 0/18; luminal B Her2-: 0/10 vs. 8/43; luminal B HER2+:0/23 vs. 2/9; HER2+: 0/22 vs. 0/2 and TN: 2/30 vs. 8/18. Survival data per subtypes and TNDS is immature due to the scarce number of events. Estimated 5y OS for TNDS positive vs. negative in luminal A: 100% vs. 100%; luminal B Her2-: 100% vs. 82%; luminal B HER2+:100 vs.77.7%; HER2+: 100% vs. 100% and TN: 93% vs. 55%, respectively.
Conclusion: In our series, TNDS measured either with the NRI from Rodenhuis or as a dichotomic variable was the best parameter to evaluate response to PC in terms of OS. OS of luminal A and luminal B/Her2 negative is less influenced by PC than the rest of subgroups. In fact both subgroups have good prognosis despite their poor sensitivity to chemotherapy. Those tumors that benefit most from PC were luminal B/ Her2+; Her2+ and triple negative patients who achieved a positive TNDS.
Citation Format: Falo C, Ventura LM, Petit A, Perez J, Cañellas J, Perez L, Loayza C, Gil M, Varela M, Garcia A, Pla MJ, Lopez A, Guma A, Pernas S. Tumor and axillar downstaging as a prognostic factor and evaluation of effectiveness to primary chemotherapy in breast cancer: A retrospective analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-31.
Collapse
Affiliation(s)
- C Falo
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - LM Ventura
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - A Petit
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - J Perez
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - J Cañellas
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - L Perez
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - C Loayza
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - M Gil
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - M Varela
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - A Garcia
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - MJ Pla
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - A Lopez
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - A Guma
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| | - S Pernas
- Institut Catala d'Oncologia, Hospitalet, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet, Barcelona, Spain
| |
Collapse
|