Portuguese Institute of Oncology

Vila Real de Santo António, Portugal

Portuguese Institute of Oncology

Vila Real de Santo António, Portugal

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Almeida Goncalves J.C.,Portuguese Institute of Oncology
Giornale Italiano di Dermatologia e Venereologia | Year: 2011

Aim. Cryosurgery with liquid nitrogen (LN) is a safe and effective method to treat skin cancer. With the correct protocol, its efficacy is extended to advanced and inoperable tumors. The aim of this study was to report the author's experience in the treatment of advanced squamous-cell carcinomas of the extremities. Methods. Forty-eight patients (31 women and 17 men; mean age of 79 years) with 50 advanced squamous-cell carcinomas (SCC) of the extremities were treated with open and thick LN spray -two freeze-thaw cycles - reaching a temperature around -50 °C inside the tumor, but not less than -20 °C in the tumor limits and the underlying structures. Temperature monitoring was made by thermocouples. All cases in this series were treated by the author. Results. The overall cure rate was 88%, with follow-up between 1 and 8 years (mean of 2.64 years). Conclusion. This cryosurgical method is an effective treatment for advanced cancers of the extremities, yielding a high cure rate and, in many cases, preventing amputation.


Coutinho R.,Queen Mary, University of London | Clear A.J.,Queen Mary, University of London | Owen A.,Queen Mary, University of London | Owen A.,Royal London Hospital | And 10 more authors.
Clinical Cancer Research | Year: 2013

Purpose: The opportunity to improve therapeutic choices on the basis of molecular features of the tumor cells is on the horizon in diffuse large B-cell lymphoma (DLBCL). Agents such as bortezomib exhibit selective activity against the poor outcome activated B-cell type (ABC) DLBCL. In order for targeted therapies to succeed in this disease, robust strategies that segregate patients into molecular groups with high reliability are needed. Although molecular studies are considered gold standard, several immunohistochemistry (IHC) algorithms have been published that claim to be able to stratify patients according to their cell-of-origin and to be relevant for patient outcome. However, results are poorly reproducible by independent groups. Experimental Design: We investigated nine IHC algorithms for molecular classification in a dataset of DLBCL diagnostic biopsies, incorporating immunostaining for CD10, BCL6, BCL2, MUM1, FOXP1, GCET1, and LMO2. IHC profiles were assessed and agreed among three expert observers. A consensus matrix based on all scoring combinations and the number of subjects for each combination allowed us to assess reliability. The survival impact of individual markers and classifiers was evaluated using Kaplan-Meier curves and the log-rank test. Results: The concordance in patient's classification across the different algorithms was low. Only 4% of the tumors have been classified as germinal center B-cell type (GCB) and 21% as ABC/non-GCB by all methods. None of the algorithms provided prognostic information in the R-CHOP (rituximab plus cyclophosphamide- adriamycin-vincristine-prednisone)-treated cohort. Conclusion: Further work is required to standardize IHC algorithms for DLBCL cell-of-origin classification for these to be considered reliable alternatives to molecular-based methods to be used for clinical decisions. © 2013 American Association for Cancer Research.


Silva S.S.,Abel Salazar Biomedical Sciences Institute | Silva S.S.,Portuguese Institute of Oncology | Lopes C.,Abel Salazar Biomedical Sciences Institute | Teixeira A.L.,Portuguese Institute of Oncology | And 4 more authors.
Forensic Science International: Genetics | Year: 2015

In forensic investigation, body fluids represent an important support to professionals when detected, collected and correctly identified. Through many years, various approaches were used, namely serology-based methodologies however, their lack of sensitivity and specificity became difficult to set aside. In order to sidetrack the problem, miRNA profiling surged with a real potential to be used to identify evidences like urine, blood, menstrual blood, saliva, semen and vaginal secretions. MiRNAs are small RNA structures with 20-25 nt whose proprieties makes them less prone to degradation processes when compared to mRNA which is extremely important once, in a crime scene, biological evidences might be exposed to several unfavorable environmental factors. Recently, published studies were able to identify some specific miRNAs, however their results were not always reproducible by others which can possibly be the reflection of different workflow strategies for their profiling studies. Given the current blast of interest in miRNAs, it is important to acknowledge potential limitations of miRNA profiling, yet, the lack of such studies are evident. This review pretends to gather all the information to date and assessed a multitude of factors that have a potential aptitude to discrediting miRNA profiling, such as: methodological approaches, environmental factors, physiological conditions, gender, pathologies and samples storage. It can be asserted that much has yet to be made, but we pretend to highlight a potential answer for the ultimate question: Can miRNA profiling be used as the forensic biomarker for body fluids identification? © 2014 Elsevier Ireland Ltd. All rights reserved.


Fontes A.S.,Joaquim Urbano Hospital Porto Hospital Center | Goncalves J.F.,Portuguese Institute of Oncology
American Journal of Hospice and Palliative Medicine | Year: 2014

Pain is a common and debilitating symptom of human immunodeficiency virus (HIV) disease, although it is often underestimated and undertreated, especially in HIV-infected intravenous drug users. It is more likely to occur in the later stages of the HIV disease, where it assumes particular significance, especially in terminally ill patients. However, its successful management is possible, though the goal of effective therapy is hampered by the side effects of highly active antiretroviral therapy and drug-drug interactions. In order to appraise these issues, a search in MEDLINE database was conducted. Book reviews and a search on relevant Web sites were also included. Treatment of HIV is itself very complex and becomes even more difficult when palliative therapy is added. Protease inhibitors, mainly ritonavir, and nonnucleoside reverse transcriptase inhibitors have higher interaction potential, due to their inducer or inhibitory actions on cytochrome P450, posing a risk when coadministered with palliative treatments; so, better outcomes can be achieved with knowledge of pharmacological aspects. © The Author(s) 2013.


Fernandes E.,Portuguese Institute of Oncology | Fernandes E.,University of Porto | Ferreira J.A.,Portuguese Institute of Oncology | Ferreira J.A.,University of Aveiro | And 8 more authors.
Journal of Controlled Release | Year: 2015

Digestive tract tumors are among the most common and deadliest malignancies worldwide, mainly due to late diagnosis and lack of efficient therapeutics. Current treatments essentially rely on surgery associated with (neo)adjuvant chemotherapy agents. Despite an upfront response, conventional drugs often fail to eliminate highly aggressive clones endowed with chemoresistant properties, which are responsible for tumor recurrence and disease dissemination. Synthetic drugs also present severe adverse systemic effects, hampering the administration of biologically effective dosages. Nanoencapsulation of chemotherapeutic agents within biocompatible polymeric or lipid matrices holds great potential to improve the pharmacokinetics and efficacy of conventional chemotherapy while reducing systemic toxicity. Tagging nanoparticle surfaces with specific ligands for cancer cells, namely monoclonal antibodies or antibody fragments, has provided means to target more aggressive clones, further improving the selectivity and efficacy of nanodelivery vehicles. In fact, over the past twenty years, significant research has translated into a wide array of guided nanoparticles, providing the molecular background for a new generation of intelligent and more effective anti-cancer agents. Attempting to bring awareness among the medical community to emerging targeted nanopharmaceuticals and foster advances in the field, we have conducted a systematic review about this matter. Emphasis was set on ongoing preclinical and clinical trials for liver, colorectal, gastric and pancreatic cancers. To the best of our knowledge this is the first systematic and integrated overview on this field. Using a specific query, 433 abstracts were gathered and narrowed to 47 manuscripts when matched against inclusion/exclusion criteria. All studies showed that active targeting improves the effectiveness of the nanodrugs alone, while lowering its side effects. The main focus has been on hepatocarcinomas, mainly by exploring glycans as homing molecules. Other ligands such as peptides/small proteins and antibodies/antibody fragments, with affinity to either tumor vasculature or tumor cells, have also been widely and successfully applied to guide nanodrugs to gastrointestinal carcinomas. Conversely, few solutions have been presented for pancreatic tumors. To this date only three nanocomplexes have progressed beyond pre-clinical stages: i) PK2, a galactosamine-functionalized polymeric-DOX formulation for hepatocarcinomas; ii) MCC-465, an anti-(myosin heavy chain a) immunoliposome for advanced stage metastatic solid tumors; and iii) MBP-426, a transferrin-liposome-oxaliplatin conjugate, also for advanced stage tumors. Still, none has been approved for clinical use. However, based on the high amount of pre-clinical studies showing enthusiastic results, the number of clinical trials is expected to increase in the near future. A more profound understanding about the molecular nature of chemoresistant clones and cancer stem cell biology will also contribute to boost the field of guided nanopharmacology towards more effective solutions. © 2015 Elsevier B.V. All rights reserved.


Dinis-Ribeiro M.,Portuguese Institute of Oncology | Dinis-Ribeiro M.,University of Porto | Kuipers E.J.,Erasmus University Rotterdam
Endoscopy | Year: 2015

In an aging European population, an increasing number of individuals will suffer from gastric cancer in the coming two decades. Recent research has determined the risk for gastric cancer in patients with different stages of gastric atrophy. Based on these data, it is now recommended that surveillance is offered to individuals with advanced stages of atrophic gastritis. Endoscopic biopsies of the gastric antrum and corpus are recommended in order to assess the severity and extent of gastric atrophy. This enables identification of those at highest risk of progressing to cancer. However, systematic reviews have shown that in recent years many researchers have assessed new endoscopic technologies for their accuracy in determining the severity and extent of gastric atrophy and metaplasia without the use of histology. Simple, reliable and accurate endoscopic features have been identified that can be used to either target biopsies or avoid biopsy sampling in the absence of endoscopic features of atrophy and intestinal metaplasia. This may largely simplify everyday practice. Randomized trials or large observational studies are now needed to demonstrate the accuracy of endoscopic assessment of the entire gastric mucosa and its impact on patient management.


Breda E.,Portuguese Institute of Oncology | Catarino R.,Portuguese Institute of Oncology | Monteiro E.,Portuguese Institute of Oncology
Head and Neck | Year: 2015

Background Although already established for treatment for early-stage laryngeal cancers, transoral laser microsurgery indications for more advanced tumors are not unanimous. Additionally, no outcomes concerning the Portuguese population are currently accessible. Methods Outcomes of 248 patients presenting laryngeal carcinoma primarily treated by transoral laser microsurgery with curative intention in tertiary referral center were retrospectively evaluated and compared with concerning literature. Results For supraglottic tumors (23 stage I-II and 20 stage III-IV), 5-year disease-specific survival (DSS) was, respectively, 88.4% and 72.7%, and the total larynx-preservation rate was 90.7%. For glottic cancer (165 stage I-II and 40 stage III-IV), 5-year DSS was, respectively, 96.5% and 90.8% and the larynx preservation rate was 88.3%. Conclusion Transoral laser microsurgery, alone or with neck dissection and adjuvant therapy, is an efficient procedure for treatment of laryngeal cancer in different stages. To the best of our knowledge, this is the first study reporting transoral laser microsurgery outcomes in the Portuguese population. © 2014 Wiley Periodicals, Inc.


Peralta J.P.,Portuguese Institute of Oncology
BMJ case reports | Year: 2013

The authors report a case of a 53-year-old male patient who came to the urologic clinic with symptoms of a left-sided testicular mass with 4 years of evolution. A left inguinal approach was decided for scrotal exploration. High clamping of the spermatic cord was performed with complete excision of the lesion, which was sent for pathology, preserving the spermatic cord and the testicle. The peroperative result was a well-differentiated liposarcoma of the spermatic cord. We then chose to preserve the ipsilateral testis (organ-sparing surgery). Postoperatively, the final pathology confirmed a well-differentiated spermatic cord liposarcoma, revealing negative surgical margins and no signs of local invasion, namely of the underlying structures. The patient is currently doing well, with no signs of recurrence after one and a half year of follow-up.


Goncalves F.,Portuguese Institute of Oncology
American Journal of Hospice and Palliative Medicine | Year: 2014

Aim: To develop a screening tool that was short, not time consuming but able to detect the patients' main problems at admission. Methods: A list of 106 symptoms/problems derived from a review of the literature was created and shortened using a Delphi process. Results: Thirteen experts scored each item with a numeric rating scale of 0 to 10 for relevance. After 3 rounds, the list was shortened to 14 items: general question-what bothers you the most? symptoms/problems-pain, lack of appetite, vomiting, tiredness/fatigue, nausea, constipation, shortness of breath, depression, anxiety, difficulty sleeping; activity (dressing, washing, etc); support from family/friends; and well-being. Conclusion: The final tool is short and seems to include the relevant items that would make it useful for clinical practice. © The Author(s) 2013.


Canavarro M.C.,University of Coimbra | Pereira M.,University of Coimbra | Simoes M.R.,University of Coimbra | Pintassilgo A.L.,Portuguese Institute of Oncology
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2011

The assessment of quality of life (QOL) in HIV infection has emerged as being vital to research and clinical practice. This assessment is also a challenge due to the specific characteristics of the infection, the increased availability of therapeutics, as well as the epidemiological variability inherent to HIV infection. The purpose of this study was to investigate the psychometric properties of the European Portuguese version of the World Health Organization's QOL Instrument in HIV Infection (WHOQOL-HIV) and to test its performance in a sample of HIV-infected patients. The European Portuguese version of WHOQOL-HIV was administered in a sample of 200 HIV-positive patients. The patients also completed the Portuguese versions of Beck Depression Inventory (BDI) and Brief Symptom Inventory (BSI). The WHOQOL-HIV showed quite an acceptable internal consistency (Cronbach's ranged from 0.86 to 0.95 across domains). Convergent validity with BDI and BSI was satisfactory for all domains (all r>0.50; p<0.001). Moreover, correlations between domains and between domains and overall QOL were all statistically significant (p<0.001). The reliability and validity studies of the European Portuguese version of the WHOQOL-HIV revealed good psychometric characteristics, which allows for the use of this version of WHOQOL in our country, and cross-cultural comparability. © 2011 Taylor & Francis.

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