Climent M.A.,Instituto Valenciano Of Oncologia Ivo |
Piulats J.M.,Institute Catala dOncologia ICO |
Sanchez-Hernandez A.,Hospital Provincial Of Castellon |
Arranz J.A.,Hospital General Universitario Gregorio Maranon |
And 7 more authors.
Critical Reviews in Oncology/Hematology | Year: 2012
Prostate cancer is the most prevalent urogenital malignancy. However, despite initial disease control using androgen deprivation, most of patients eventually develop progressive disease that is resistant to further hormone manipulation. For these patients with castration-resistant prostate cancer (CRPC), and particularly patients with metastatic disease, options have been limited, and prognosis is grim. However, as newer regimens and agents become available, higher rates of objective and biochemical response are being achieved, providing renewed hope for the management of these patients. With the aim of facilitating the treatment of these patients, the Spanish Oncology Genitourinary Group (SOGUG) has issued a series of the recommendations which have been collected in this review. Each recommendation is accompanied by the appropriate level of evidence and grade of recommendation on the basis of the characteristics of the data available. © 2012 Elsevier Ireland Ltd.
PubMed | University of Limoges, Imperial College London, University of Zaragoza, University of Liverpool and 3 more.
Type: | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2016
The hormonal manipulation 5-Fluoro-uracil Epirubicin Cyclophosphamide (HMFEC) trial was developed at a time of uncertainty around the dose intensity of chemotherapy given to premenopausal patients with node positive breast cancer and to the benefits of tailored endocrine therapy in such patients.HMFEC was a multi-centre, phase III, open label, randomised controlled trial with a 22 factorial design. Eligible patients were premenopausal with node positive early breast cancer; significant cardiac disease or uncontrolled hypertension was exclusion criterion. Patients were allocated to receive either eight cycles of FE50C or FE75C (given 3 weekly) with or without hormone manipulation (HM; tamoxifen or luteinising hormone releasing hormone (LHRH) agonists according to residual hormone levels at the end of chemotherapy) irrespective of ER status. The primary end-point was disease free survival (DFS). Principal analyses were by intention to treat (ITT); however, to reflect contemporary practice, subgroup analyses according to ER status were also conducted. The mature follow-up now available from this modest sized trial enables presentation of definitive results.Between 1992 and 2000 a total of 785 patients were randomised into the HMFEC trial (203 FE50C-HM, 191 FE50C+HM, 198 FE75C-HM, 193 FE75C+HM). At a median follow-up of 7.4 years, 245 DFS events have been reported (92 ER-, 153 ER+/unknown). The effects on DFS were not statistically significantly different according to epirubicin dose (hazard ratio [HR]=0.82, 95% confidence interval [CI] 0.63-1.06; p=0.13 FE75C versus FE50C); however, FE75C appeared to induce more alopecia and neutropenia. No statistically significant evidence was observed to support an improvement in DFS in patients allocated HM either overall (HR=0.88, 95% CI0.68-1.13; p=0.32) or in patients with ER+/unknown disease (HR=0.85, 95% CI0.62-1.17; p=0.32) although effect sizes are consistent with worthwhile clinical effects. Overall, there was no evidence of a difference in survival between any of the four treatment groups of the trial.Higher doses of epirubicin cause more adverse events in the absence of clear improvement in overall survival. Endocrine therapy with either tamoxifen or goserelin provided no significant added benefit to cytotoxic chemotherapy in this group of patients.ISRCTN98335268.
PubMed | University of Barcelona, Hospital General Universitario Gregorio Maranon, Consorcio Hospitalario Provincial Of Castellon, Spanish National Cancer Research Center and 7 more.
Type: Journal Article | Journal: Critical reviews in oncology/hematology | Year: 2015
Prostate cancer is the most prevalent male urogenital malignancy. Approximately 30% of patients with prostate cancer will develop advanced disease. Androgen deprivation therapy achieves disease control in about 90% of these patients, but the majority of them will eventually develop progressive disease, a status called castration-resistant prostate carcinoma (CRPC). However, in recent years, several new therapy strategies, such as immunotherapy, hormonal manipulations, chemotherapy agents and some bone-targeted therapies, have demonstrated an improvement in terms of overall survival in controlled trials. In 2012, the Spanish Oncology Genitourinary Group (SOGUG) published its recommendations for the treatment of patients with CRPC. Due to the recent appearance of important new data and the complexity of decision-making in this field, SOGUG herein provides updated recommendations for the treatment of patients with metastatic prostate cancer.
PubMed | Hospital Universitario La Paz, Hospital Rio Hortega, Hospital Of Paraplejicos, Hospital Universitario Puerta del Hierro and 8 more.
Type: Journal Article | Journal: Actas urologicas espanolas | Year: 2014
To evaluate the psychometric properties of the Spanish version of the ICIQ-Male Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTS): Feasibility (% of completion and ceiling/ground effects), reliability (Test-retest), convergent validity (vs Bladder Control Self-Assessment Questionnaire [BSAQ] and vs International Prostate Symptom Score [I-PSS]) and criterion validity (according to presence or absence of symptoms).This was an observational, non-interventionist and multicenter study. 223 male patients with lower urinary tract symptoms (LUTS), predominantly storage symptoms and aged 18-65, took part in the study. Patients completed the ICIQ-MLUTS (test), I-PSS and BSAQ questionnaires and referred their urinary symptoms in a single visit, with the exception of a subgroup composed by 49 patients that completed the questionnaire again 15 days after initial visit to evaluate test-retest reliability. The questionnaire includes 13 items divided in 2 sub-scales: Voiding symptoms (V) from 0-20 and Incontinence symptoms (I) from 0-24.Percentage of patients that completed all items: 98.84%. Ground effect is 0 and ceiling effect was under 6% in both sub-scales. Test-retest reliability: Intraclass correlation coefficient (ICC) ranged from 0.68 to 0.88, except on Delay. Kappa shows a good agreement, between 0.60 and 0.81, except for Nocturia. Convergent validity: Correlation (Spearman) between the questionnaire sub-scales scores and the rest of measures is statistically significant (P < .01 and P < .05). Criterion validity: Statistically significant differences (P < .05) between scores on ICIQ-MLUTS, from patients that refer experiencing symptoms and those who do not.The Spanish version of the ICIQ-MLUTS questionnaire shows adequate feasibility, reliability and validity.
Treatment of Non Muscle Invasive Bladder Tumor Related to the Problem of Bacillus Calmette-Guerin Availability. Consensus of a Spanish Expert's Panel [Tratamiento del tumor vesical no músculo infiltrante frente al problema de disponibilidad de bacilo de Calmette-Guerin. Consenso de un panel de expertos españoles]
Fernandez-Gomez J.M.,University of Oviedo |
Carballido-Rodriguez J.,Autonomous University of Madrid |
Cozar-Olmo J.M.,Hospital Universitario Virgen Of Las Nieves |
Palou-Redorta J.,Servicio de Urologia |
And 2 more authors.
Actas Urologicas Espanolas | Year: 2013
Context Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives. Objective To present the work performed by said committee and the resulting recommendations. Acquisition of evidence An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG. Evidence synthesis In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available. Conclusions Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology. © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.
PubMed | Hospital Universitario La Paz, Complexo Hospitalario Universitario Of runa, Dana-Farber Cancer Institute, ProHEALTH Care Associates and 20 more.
Type: Journal Article | Journal: British journal of cancer | Year: 2014
In this study, we evaluated the ability of gene expression profiles to predict chemotherapy response and survival in triple-negative breast cancer (TNBC).Gene expression and clinical-pathological data were evaluated in five independent cohorts, including three randomised clinical trials for a total of 1055 patients with TNBC, basal-like disease (BLBC) or both. Previously defined intrinsic molecular subtype and a proliferation signature were determined and tested. Each signature was tested using multivariable logistic regression models (for pCR (pathological complete response)) and Cox models (for survival). Within TNBC, interactions between each signature and the basal-like subtype (vs other subtypes) for predicting either pCR or survival were investigated.Within TNBC, all intrinsic subtypes were identified but BLBC predominated (55-81%). Significant associations between genomic signatures and response and survival after chemotherapy were only identified within BLBC and not within TNBC as a whole. In particular, high expression of a previously identified proliferation signature, or low expression of the luminal A signature, was found independently associated with pCR and improved survival following chemotherapy across different cohorts. Significant interaction tests were only obtained between each signature and the BLBC subtype for prediction of chemotherapy response or survival.The proliferation signature predicts response and improved survival after chemotherapy, but only within BLBC. This highlights the clinical implications of TNBC heterogeneity, and suggests that future clinical trials focused on this phenotypic subtype should consider stratifying patients as having BLBC or not.
PubMed | Hospital Basurto, Hospital Universitario Marques Of Valdecilla Humv, Hospital La Luz, Hospital La Paz and 5 more.
Type: Clinical Study | Journal: Actas urologicas espanolas | Year: 2014
To analyze if the true number of BCG instillations applied in non-muscle invasive bladder tumors has any influence on their prognosis as well as other tumor and clinical characteristics: age, sex, different protocols, BCG dose, whether primary or recurrent, solitary or multiple, tumor size G3 or Cis.A total of 324 high grade NMIBC (15 TaG3, 184 T1G3, 125 Cis) out of 1491 cases included in the CUETO database were analyzed. Following 6 post transurethral resection (RTU) BCG instillations, the patients were scheduled to receive one instillation every two weeks (3-6 times), for a total of 9-12 instillations. One third of the dose (27 mg) (112 cases) or total dose of 81 mg (212 cases). Mean follow-up was 59.6 months. Statistical Analysis: Kaplan-Meier, Cox-regression (uni-multivariate).A higher level of recurrence (p = 0.032) and progression (P = .013) risk as well as worse Ca-specific survival (P = .005) were obtained if there were fewer than 12 instillations with the Kaplan-Meier and Cox-regression multivariate analysis. A 27 mg (P = .008) dosage and being a female (P < .001) were independent factors for a higher recurrence risk, but not for progression or Ca-specific survival. The remaining characteristics studied were not statistically significant.In accordance with the results obtained, we can conclude that the number of BCG instillations applied has some influence on the outcome of high grade NMIBC. The optimum number of instillations as well as their time of application must still be determined. A dose of 27 mg and being a female are predictive factors of recurrence.
Climent M.A.,Instituto Valenciano Of Oncologia Ivo |
Anido U.,Complejo Hospitalario Universitario Santiago Of Compostela |
Mendez-Vidal M.J.,Hospital Reina Sofia |
Puente J.,Hospital Clinico Universitario San Carlos
Clinical and Translational Oncology | Year: 2013
Bone metastases are a common complication of advanced prostate cancer and while they are less common in non-prostate genitourinary (GU) malignances, they have been reported in up to 35 % of patients with advanced renal cell carcinoma and bladder cancer. Furthermore, they may occur in more than two-thirds of those patients with bladder cancer who develop distant metastases. In the absence of bone-targeted therapies, approximately 50 % of all patients with metastatic bone disease from GU cancers experience at least one skeletal-related event within their lifetime. Zoledronic acid is a bisphosphonate that has been shown to delay or prevent the development of skeletal complications in patients with bone metastases and reduce bone pain in these patients. Furthermore, zoledronic acid has also demonstrated the ability to prevent osteopenia, which may occur with the prolonged use of some pharmacological interventions in patients with cancer. © Federación de Sociedades Españolas de Oncología (FESEO) 2013.
Solsona E.,Instituto Valenciano Of Oncologia Ivo
Archivos Espanoles de Urologia | Year: 2012
Radical prostatectomy is an excellent salvage method for patients with prostatic cancer when radical radiotherapy or brachytherapy fail. To define local failure is not always reliable; nevertheless, performing a prostatic biopsy two years after treatment could reach an early diagnosis. Another accepted attitude is to perform the biopsy after biochemical recurrence, but sometimes the pathological stage is already locally advanced tumor. It is also difficult to determine which patients are suitable for this rescue treatment, probably those with locally confined tumors and with favorable PSA kinetics, PSA velocity below 2.0 or a PSA doubling time over 12 months, and in whom detectable PSA is reached 2 years after treatment. These patients are suitable for radical prostatectomy if they have a live expectancy of more than 10 years. Although rescue radical prostatectomy has a higher rate of complications and worse functional results, cancer-specific survival rates are high, and remain high after 15 years of follow-up. Currently, new surgical improvements and new radiotherapy technology are diminishing surgical complications and improving functional results. In summary radical prostatectomy is a feasible rescue procedure after radiotherapy failure although the complications rate remains higher than prostatectomy as initial therapy.
Agusti-Mejias A.,Hospital General Universitario Of Valencia |
Messeguer Badia F.,Instituto Valenciano Of Oncologia Ivo |
Garcia Ruiz R.,Hospital General Universitario Of Valencia |
Oliver Martinez V.,Hospital General Universitario Of Valencia |
Alegre De Miquel V.,Hospital General Universitario Of Valencia
Actas Dermo-Sifiliograficas | Year: 2012
Background: Atypical lentiginous nevus (of the elderly) is a peculiar form of dysplastic nevus. Clinically, this condition can resemble malignant melanoma and histologically, it has a lentiginous pattern with variable degrees of atypia and an absence of dermal nests. These features may lead to an erroneous diagnosis of lentigo maligna melanoma or lentiginous melanoma. Material and methods: We reviewed 14 cases of atypical lentiginous nevus diagnosed at the dermatology department of Hospital General de Valencia in Valencia, Spain between December 2007 and March 2009. We studied the clinical and histopathologic features of the lesions after hematoxylin-eosin, Melan-A, and Ki-67 staining and compared our results to data reported in the literature. Results: Four (28%) of the 14 patients (7 men, 7 women) were under 50 years of age. Clinically, most of the lesions (8/14) resembled atypical nevi and they were all located on the back. Histologically, they all had irregular lentiginous epidermal hyperplasia, with a proliferation of individual melanocytes only in the basal layer of the epidermis and an absence of dermal nests. Focal upward migration of melanocytes into the epidermis was present in just 4 cases. All the lesions had cellular atypia, which was moderate in 85% of cases. The Ki-67 proliferation index was low (<5%) in all the lesions analyzed. Conclusions: Atypical lentiginous nevi, which can be classified as atypical pigmented lesions with a lentiginous pattern, may clinically and histologically resemble melanoma. Our findings support earlier reports that both clinical and histologic findings may suggest a diagnosis of dysplastic nevus. All of the patients in our series are healthy and free of recurrence after 18 months or longer. © 2011 Elsevier Espana, S.L. and AEDV. All rights reserved.