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Diaz-Padilla I.,Hospital Universitario Madrid Norte Sanchinarro | Poveda A.,Instituto Valenciano Of Oncologia
Clinical Ovarian Cancer | Year: 2010

Platinum-based chemotherapy constitutes the mainstay systemic treatment for patients with epithelial ovarian cancer (EOC). Significant and durable clinical responses are achieved when platinum is administered along with taxanes after debulking surgery, but relapses are common in advanced disease within 2 years upon completion of primary therapy. Furthermore, between 20% and 30% of patients will never respond or will progress shortly after finishing the platinum-containing regimen. To avoid unnecessary toxicities, ideally physicians should be capable of selecting which patients might benefit the most from a particular treatment based on established, predictive factors. Although the cytotoxicity of cisplatin is well described, the mechanisms of platinum resistance developed by tumoral cells are not so well understood. Changes in the DNA repair pathways in tumors possibly have an important role in the development of its platinum-resistant phenotype. Recent advances in this area have identified potential biomarkers (eg, ERCC1 mRNA and protein expression and BRCA mutational status) that may correlate with the clinical efficacy of a platinum-based chemotherapy. Clinical studies that evaluate its potential application in the management of patients with ovarian cancer are now emerging. Future validation of these predictive biomarkers of response to platinum, as well as to other chemotherapeutic agents (eg, taxanes), might set the stage for a more biology-based and rational therapeutic approach to advanced EOC. We review the most recent advances in translational research regarding the DNA repair pathways as a potential source for describing and validating biomarkers of response to platinum agents in ovarian cancer. Source

Peiretti M.,Italian National Cancer Institute | Zanagnolo V.,Italian National Cancer Institute | Aletti G.D.,Italian National Cancer Institute | Bocciolone L.,Italian National Cancer Institute | And 6 more authors.
Gynecologic Oncology | Year: 2010

Objective: To determinate the impact of maximal cytoreductive surgery on progression free survival (PFS), overall survival (OS) rates and morbidity, in patients with advanced epithelial ovarian or fallopian tube cancer. Methods: We reviewed all medical records of patients with stages IIIC-IV epithelial ovarian and fallopian tube cancer that were managed at our institution between January 2001 and December 2008. The following information was collected: demographics, tumor characteristics, operative information, surgical outcomes and peri-operative complication. Results: A total of 288 patients with advanced epithelial ovarian and fallopian tube cancer were referred to our institution between January 2001 and December 2008, 259 consecutive patients were enrolled in the study. After a median follow-up of 29.8 months, the PFS and OS were 19.9 and 57.6 months, respectively. At univariate analysis, factors significantly associated with decreased PFS included: age greater than median (> 60 years), stage IV, presence of ascites > 1000 cc, presence of diffuse peritoneal carcinomatosis and diameter of residual disease. This was confirmed also at multivariate analysis with age greater than 60 years (P = 0.025), stage IV vs IIIC (P = 0.037) and any residual disease (P = 0.032) having an independent association with worse PFS. Conclusions: Our study seems to demonstrate that a more extensive surgical approach is associated with prolonged disease-free interval and improved survival in patients with stages IIIC-IV epithelial ovarian and fallopian tube cancer. Moreover all patients with no residual tumor seem to have the best prognosis and in view of these results we believe that the goal of primary surgery should be considered as leaving no macroscopic disease. © 2010 Elsevier Inc. All rights reserved. Source

Lujan M.,Hospital Universitario Infanta Cristina | Paez A.,Rama Espanola Del European Randomized Study of Screening for Prostate Cancer | Paez A.,Hospital Universitario Of Fuenlabrada | Berenguer A.,Rama Espanola Del European Randomized Study of Screening for Prostate Cancer | And 2 more authors.
Actas Urologicas Espanolas | Year: 2012

Objective: To address if prostate cancer (PCa) screening decreases PCa mortality in the asymptomatic population, within the setting of the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Material and methods: From 1996 to 1999, 4,278 men aged 45-70 years were recruited and randomized to the screening arm (PSA every 4 years, prostate biopsy when PSA ≥ 3 ng/ml) and control arm (no tests). Dates and causes of death were collected on an annual basis. A Kaplan-Meier analysis was used to calculate overall and cancer-specific survival. Results: A total of 2,416 men were recruited in the screening arm and 1,862 in the control arm. Mean age was 57.8 years, median follow-up was 13.3 years. At the end of the follow-up period, 427 deaths (9 from PCa) were observed. Survival analysis did not show any difference between the study arms with respect to overall and cancer-specific survival (p = 0.939 and p = 0.544 respectively). Most relevant causes of death were malignant tumors (52.9%), cardiovascular disease (17.3%) and respiratory (8.9%). Only 2.1% of deaths (0.2% of all recruited men) were due to PCa (2.5% screening, 1.6% control). Conclusions: The Spanish arm of ERSPC failed to reproduce the long-term results shown in the whole study. No differences in mortality (overall or cancer-specific) were observed after 15 years of follow-up. PCa mortality was infrequent (less than 1%). These results suggest limited yield of PCa screening in our setting. © 2011 AEU. Publicado por Elsevier España, S.L. Todos los derechos reservados. Source

Minig L.,Italian National Cancer Institute | Minig L.,Hospital Universitario Madrid Norte Sanchinarro | Franchi D.,Italian National Cancer Institute | Boveri S.,Italian National Cancer Institute | And 3 more authors.
Annals of Oncology | Year: 2011

Background: To test the efficacy of levonorgestrel-release intrauterine device (LNG-IUD) plus gonadotropin-releasing hormone (GnRH) for treating women aged <40 years with atypical endometrial hyperplasia (AEH) or presumed International Federation of Gynecology and Obstetrics stage IA limited to the endometrium, well differentiated (G1), endometrioid endometrial cancer (EC), who wish to preserve their fertility. Patients and methods: A prospective observational study was conducted. Treatment consisted on the insertion of an LNG-IUD for 1 year plus GnRH analogue for 6 months. Results: From January 1996 to June 2009, 20 and 14 patients with AEH and EC, respectively, were studied. Complete response rate was 95% in patients with AEH and 57.1% in women with EC-G1. A progression of the disease was observed in one (5%) and in four patients (28%) with AEH and EC, respectively. Four of 20 patients with AEH and 2 of 14 with EC-G1 experienced recurrences. The average relapse time was 36 months (range: 16-62 months). All of them were alive without evidence of disease at the last follow-up, mean: 29 months (range: 4-102 months). Nine women achieved 11 spontaneous pregnancies. Conclusions: The combined treatment showed effectiveness in a substantial proportion of patients with AEH and EC. Close follow-up during and after treatment is crucial. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Torres I.,Hospital Universitario La Paz | Allona M.,Hospital Universitario Madrid Norte Sanchinarro | Martinez M.,Hospital Universitario La Paz | Lores V.,Hospital Universitario La Paz | And 2 more authors.
Archivos de Bronconeumologia | Year: 2010

Background and objetives: We compare the inspiratory and expiratory regional lung densities between different levels of COPD severity (as assessed by the GOLD scale and by the BODE index), and to assess the relationship between regional lung densities and functional lung parameters. Patients and methods: Fifty-five stable moderate-severe COPD men were selected. Functional evaluation included dyspnoea scale, blood gases, spirometry, plethysmography, diffusing capacity and six-minute walk test. Severity was classified according the GOLD scale and the BODE index. High resolution computed tomography (HRCT) scans of the entire lung at full inspiration and two sections at full expiration were obtained. Densitometry software was used to calculate the densities of the lung areas. Results: Inspiratory and expiratory mean lung densities (MLD) of the lower lobes were significantly lower in very severe and severe COPD patients than in moderate patients. In contrast, we only found differences between the upper lobe MLD values of moderate and severe COPD patients. Inspiratory and expiratory HRCT densities were similar among all BODE quartiles, for both the upper and lower lobes. In a multiple regression analysis, airway obstruction parameters were mainly related to the expiratory MLD of the lower lobes, whereas lung hyperinflation parameters were predicted by the inspiratory MLD of the lower lobes. Lastly, diffusion capacity was independently related to the expiratory/inspiratory MLD of the lower lobes and to the inspiratory MLD of the upper lobes. Conclusions: There are differences in lung attenuation measurements by HRCT between the varying levels of COPD severity as assessed by the GOLD scale. © 2009 SEPAR. Source

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