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Coleman R.E.,Park University | Winter M.C.,Park University | Cameron D.,University of Leeds | Bell R.,Andrew Love Cancer Center | And 9 more authors.
British Journal of Cancer | Year: 2010

Background:Pre-clinical studies have demonstrated synergistic anti-tumour effects of chemotherapy (CT) and zoledronic acid (ZOL). Within the AZURE trial, designed to determine whether the addition of ZOL to neoadjuvant therapy improves disease outcomes, a subgroup received neoadjuvant CT. We report a retrospective evaluation comparing pathological response in the primary tumour between treatment groups.Methods:In total, 205 patients received neoadjuvant CTZOL (CTZOL, n102; CT, n103). The primary end point was pathologically assessed residual invasive tumour size (RITS) at surgery. Secondary end points were pathological complete response (pCR) rate and axillary nodal involvement. Following review of surgical pathology reports (n195), outcome differences between groups were assessed adjusting for potential response modifiers.Results:Baseline characteristics and CT treatments were similar. In multivariate analysis, allowing for biological and clinical factors known to influence tumour response, the adjusted mean RITS in CT and CTZOL groups were 27.4 and 15.5 mm, respectively, giving a difference in means of 12 mm (95% confidence interval: 3.5-20.4 mm; P0.006). The pCR rate was 6.9% in the CT group and 11.7% in the CTZOL group (P0.146). There was no difference in axillary nodal involvement (P0.6315).Conclusion:These data suggest a possible direct anti-tumour effect of ZOL in combination with CT, warranting formal evaluation in prospective studies. © 2010 Cancer Research UK All rights reserved.


Goncalves F.,Instituto Portugues Of Oncologia
Supportive Care in Cancer | Year: 2010

Background: The attitudes and practise of doctors concerning euthanasia and assisted suicide have been the subject of studies performed in many countries. However, these issues have not been studied properly in Portugal. Materials and method: This study is a survey of 450 Portuguese oncologists by postal means and personal contact. Results: The response rate was 33% (143). Only 13% would practise euthanasia with the present law in force forbidding such practise, and 24% would do so if it were legalised; 39% favoured its legalisation and 36% would like to have the option of euthanasia if they had a terminal disease. About assisted suicide, 15% would do it with the current law in force forbidding such action and 25% would do so if it were made legal; 32% favoured its legalisation and 24% would like to have that option if they had a terminal disease. There was one case of euthanasia and no cases of assisted suicide. The most important factor related with the acceptance of euthanasia and assisted suicide was religion, with non-practising Catholics accepting such practises more often than practising Catholics. The Portuguese oncologists have a very positive view on the potential role of palliative care in preventing many requests for euthanasia and assisted suicide. Conclusion: Portuguese oncologists are mainly against the practise of euthanasia and assisted suicide and the number of requests is also relatively low; consequently, the number of episodes of assisted death is also apparently very low. © 2009 Springer-Verlag.


Loureiro J.,Instituto Portugues Of Oncologia | Oliva E.,Massachusetts General Hospital
Archives of Pathology and Laboratory Medicine | Year: 2014

• Context.-Premalignant and malignant glandular lesions of the cervix are known to often cause diagnostic problems with a variety of benign (more common) as well as other malignant mimics, the latter setting often being represented by secondary involvement by endometrioid endometrial carcinoma especially in small samplings. Objectives.-To highlight key histologic features and immunohistochemical markers that may be helpful in the distinction of in situ endocervical carcinoma from benign glandular proliferations, and those that separate different subtypes of invasive endocervical carcinoma, as well as invasive carcinoma from other carcinomas secondarily involving the cervix and nonneoplastic proliferations of the cervix. Conclusions.-Clinical and morphologic features as well as immunohistochemistry results should be used in conjunction in the differential diagnosis of glandular proliferations of the cervix, as correct interpretation has major clinical consequences for the patient in most instances (especially benign versus malignant). Immunohistochemical markers should be used as part of a panel of antibodies, as exceptions may occur to the usual pattern of staining, and if used singly, they may mislead the pathologist to establish a wrong diagnosis.


Mihon C.,Hospital Santo Antonio Dos Capuchos | Alexandre T.,Instituto Portugues Of Oncologia | Pereira A.,Hospital Of Santa Maria
Clinical Drug Investigation | Year: 2013

Fungal infections constitute an important cause of morbidity and mortality in HIV-infected patients. The authors describe the case of a 40-year-old healthy male patient with a 2-month history of fever, shivers, asthenia and anorexia, who had lost weight during the past 6 months. Laboratory investigations revealed a positive HIV screening. Computed tomography scans of the chest and abdomen showed thoracic and lumbo-aortic adenopathies. Cryptococcus neoformans was isolated from cultures of blood, bone marrow, cerebrospinal fluid and from material obtained by transbronchial biopsy. Moreover, Cryptococcus spp. were seen in the lymph node biopsy. Pneumocystis jirovecii was isolated from bronchoalveolar lavage, whereas Aspergillus fumigatus and Aspergillus flavus were detected in material from a transbronchial biopsy. The patient initially received treatment with sulfamethoxazole plus trimethoprim and amphotericin B, which resulted in a substantial clinical improvement. After the diagnosis of invasive aspergillosis, amphotericin B was replaced by voriconazole as antifungal therapy and antiretroviral therapy was added. The simultaneous occurrence of three different infectious diseases - disseminated cryptococcosis, invasive pulmonary aspergillosis and Pneumocystis jirovecii pneumonitis - in a HIV-infected patient is extremely rare and there is no doubt that both early diagnosis and treatment are crucial for the patient's chances of survival. © 2013 Springer International Publishing Switzerland.


de Carvalho J.C.,University of Lisbon | Ramos M.,University of Lisbon | Paixao C.,Instituto Portugues Of Oncologia
Risk Management and Healthcare Policy | Year: 2014

Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed 'remote' triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients. © 2014 Crespo de Carvalho et al.


Silva I.,Instituto Portugues Of Oncologia | Tome V.,Instituto Portugues Of Oncologia | Oliveira J.,Instituto Portugues Of Oncologia
BMJ Case Reports | Year: 2011

Adenoid cystic carcinoma (ACC) is a rare variant of adenocarcinoma of the breast. It affects mainly minor and major salivary glands, but may also occur in many others locations such as: breast (<1% of all breast cancers), lung, trachea, cervix and Bartholin's gland. Its prognosis is excellent, contrary to the extra-mammary form. In fact, metastisation is rare (there are only seven clinical cases with metastisation described in literature and the lung is the most affected organ) and when it occurs, generally, there is no axillary node involvement. The authors present the case of a 37-year-old patient, Caucasian, premenopausal, referred to our Cancer Institute with the diagnosis of ACC of the right breast. This case was peculiar because of its multiple and fatal metastisation pattern-nodal, pulmonary, hepatic, osseous and late multifocal cerebral involvement (brain stem and cerebellum). This is the first case-report of ACC with cerebral metastisation. Copyright 2011 BMJ Publishing Group. All rights reserved.


Silva I.,Instituto Portugues Of Oncologia
BMJ case reports | Year: 2012

Benign metastasising leiomyoma (BML) is a rare entity characterised by uterine leiomyoma that, later on, develops slow-growing metastasis mainly to the lung. In general, these lung metastases are incidentally discovered, but sometimes can become symptomatic with dyspnoea, cough and chest pain. The expression of oestrogen and progesterone receptors by these tumours supports the idea that they respond to hormone therapy (chemical, with oestrogen receptor modulators, aromatase inhibitors or luteinising hormone releasing hormone analogues and surgical, with bilateral adnexectomy). The authors present a case report of BML with two peculiarities: a less common pattern of metastisation (soft tissue), in addition to lung; and disease progression despite treatment with chemical and surgical castration.


Pimentel-Nunes P.,Instituto Portugues Of Oncologia | Mourao F.,CINTESIS Biostatistics and Medical Informatics | Veloso N.,Instituto Portugues Of Oncologia | Afonso L.P.,Portuguese Oncology Institute | And 3 more authors.
Endoscopy | Year: 2014

Background and study aims: Although endoscopic resection for the treatment of gastric superficial neoplastic lesions is an established first-line treatment in Eastern countries, its role has yet to be considered in Western guidelines, mostly due to a lack of long-term studies. The aim of this study was to describe long-term outcomes for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of gastric neoplasias in Portugal.Patients and methods: This was a single-center, retrospective, cohort study between March 2003 and April 2013. A total of 162 consecutive patients with 195 gastric superficial neoplasias underwent EMR (n = 54) or ESD (n = 141) and were followed up for a median of 3.2 years.Results: Resection was feasible in 97 %, with en bloc and R0 resection rates of 85 % (94 % ESD vs. 61 % EMR; P = 0.001) and 81 % (91 % ESD vs. 54 % EMR; P < 0.001), respectively. The recurrence rate was 7 %, and recurrence was associated with Rx/R1 resection irrespective of resection technique (OR 5.8; 95 % confidence interval 3.9 - 8.8). The long-term curative resection rate was 86 % after one procedure and 91 % after two procedures. Adverse events were observed in 13 % of cases: 8 % bleeding and 2 % of perforations (EMR = ESD). Surgery was performed in 7 %: 6 % after noncurative endoscopic resection and 1 % due to complications. Metachronous lesion detection rate was 1 % - 1.5 % per patient year. Cancer-specific survival rate was 100 % at follow-up.Conclusions: For the first time in a Western country, results are reported to be similar to those in Eastern countries. Endoscopic resection, particularly ESD, is a highly effective treatment for gastric superficial lesions, without compromising cancer survival. Endoscopic resection should also be considered as first-line treatment for gastric neoplasias in Western countries. © Georg Thieme Verlag KG Stuttgart - New York.


Goncalves F.,Instituto Portugues Of Oncologia
American Journal of Hospice and Palliative Medicine | Year: 2010

A 22-year-old woman with nodular sclerosis type II Hodgkin lymphoma diagnosed in June 2001. She initially underwent chemotherapy with 6 cycles of ABVD (adriamycin, bleomycin, vincristine, dacarbazine) regimen, leading to clinical remission. As it relapsed, she was again treated with 2 different chemotherapy regimens. In November 2003, she underwent bone marrowautotransplantation, but it relapsed after 2 months. After that, she was treated with chemotherapy in monotherapy until November 2005. In December 2005, she was referred to palliative care. Her main symptom was very severe pruritus that interfered with all aspects of her life, making her scratch continuously and interfering in all aspects of her life. She was treated with loratadine, hydroxyzine, prednisolone, paroxetine, mirtazapine, cimetidine, and ondansetron, individually and in various combinations. She also underwent ultraviolet phototherapy. All trials failed and her pruritus remained at level 8 of 10 most of the time. In April 2006, she started on thalidomide, 200 mg at night. The pruritus significantly improved to a level of 3 of 10 but did not disappear completely. She was at last able to sleep properly at night. She remained with a low level of pruritus until her death in July 2008, at the same dose of thalidomide. © The Author(s) 2010.


Breda E.,Instituto Portugues Of Oncologia | Medeiros R.,Instituto Portugues Of Oncologia Francisco Gentil Do Porto
Brazilian Journal of Otorhinolaryngology | Year: 2010

Several studies have been published concerning Epstein-barr virus (EBV) infection and nasopharyngeal cancer (NPC) development. The incidences of histological types are different according to endemic or non-endemic regions. Latent EBV infection is found in almost all cases of NPC in endemic regions, but normally absent in type I carcinomas, more common in non-endemic regions. Aim: The purpose of this hospital-based study was to analyze the presence of EBV in nasopharyngeal tumor tissues and in peripheral blood of nasopharyngeal cancer patients and healthy individuals, in a low risk, non-endemic area. Methods: EBV detection in samples of nasopharyngeal cancer patients and healthy individuals. Results: This study indicates that the frequency of EBV positive cases in peripheral blood is higher in advanced tumor stages. Conclusions: The incidence rates of NPC have a distinct distribution. Since the prevalence of this disease is low in occidental countries, little is known about the biology of these tumors in nonendemic areas. We observed statistically significant differences in EBV detection between the NPC patient group and the control group. This study may help to understand the biological mechanisms of NPC and the correlation of EBV infection with this disease, in a low risk, non-endemic region.

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