Phẫu thuật nội soi ngực bụng trong điều trị ung thư thực quản

Objectives: Evaluating the results of thoraco-laparoscopic esophagectomy to treat esophageal cancer, prospective studies of 35 patients esophageal cancer were conducted from January 2016 to December 2019 at Hue Central Hospital. Results: Average age 57.6±6.3years (44-69), male/female 16.5/1. Clinical symptoms: 82.9% swallowing difficulty, weight loss 34.3%, increased preoperative CEA 31.4%, mean tumor size 2.6±1.2cm(3-6). Stage: I 31.4%; II 45.7%; III of 22.9%. Time of surgery 315.2±49.9minutes(240-420), mean hospital stay 15.6±7.2days(7-25). Postoperative complications: pneumonia 11.4% , leakage of neck anastomosis 8.6%, hoarseness 11.4% and mortality 2.9%. Follow-up time 2-35months, anastomotic recurrence 2.9%, local recurrence 5.9% and metastasis 8.8%. The overal survival time 28.4±1.9months, the survival time after 12 months 84.7% and after 2 years 73.9%. Conclusion: Thoraco-laparoscopic esophagectomy to treat esophageal cancer has many advantages, avoiding to the long thoracotomy-laparotomy, reducing postoperative pain, reducing respiratory complications during the postoperative period. However, a larger number of patients should be studied to accurately evaluate long-term results, especially in oncology results.

CDK4/6 inhibitors beyond second line, is it worthy? A real-world data experience.

e13033 Background: CDK4/6 inhibitors as Palbociclib, Ribociclib and Abemaciclib has become the first or second line in advanced or metastatic luminal breast cancer HER2 negative. We only have data about the use of Abemaciclib in monotherapy beyond second line. Methods: We have analyzed 200 patients treated in our center with CDK4/6 inhibitors since 2017. All of them belong to clinical practice, out of clinical trial context. The effect of CDK4/6 inhibitors was analyzed using logistic regression analyses. Results: 34 patients were treated beyond second line of treatment with a medium follow-up of 18 months. CDK4/6 inhibitors were used as fourth line as medium (range 3-9), median age of 45 years, 1 male. 52% patients had visceral disease and 8.8% were primary hormone resistance. 64.6% were treated with palbociclib, 26.5% with ribociclib and 8.8% with abemaciclib. 52.9% were asociated with Fulvestrant, 44.1% with Letrozol and 2.9% with tamoxifen. Clinical benefit of 67.6% and response rate of 32.3%. Similar toxicities to previosly published trials were observed. Median progression-free survival was 14.2 months and median overal survival was 26.6 months. Non statistical difference were observed by luminal subtype, number of prior lines, type of hormonal therapy or CDK4/6 inhibitor used. Conclusions: Despite of the small population, we can summarized that CDK4/6 inhibitors associated to hormonal therapy is a good option for patients previosly treated in the metastatic setting. We need further investigation to understand which patient will benefit from treatment with this drugs in advanced lines.

Prognostic value of absolute monocyte count in chronic lymphocytic leukaemia

Introduction: The low peripheral absolute lymphocyte and high monocyte count have been reported to correlate with poor clinical outcome in various lymphomas and other cancers. However, a few data known about the prognostic value of absolute monocyte count in chronic lymphocytic leukaemia. Aim: The aim of the authors was to investigate the impact of absolute monocyte count measured at the time of diagnosis in patients with chronic lymphocytic leukaemia on the time to treatment and overal survival. Method: Between January 1, 2005 and December 31, 2012, 223 patients with newly-diagnosed chronic lymphocytic leukaemia were included. The rate of patients needing treatment, time to treatment, overal survival and causes of mortality based on Rai stages, CD38, ZAP-70 positivity and absolute monocyte count were analyzed. Results: Therapy was necessary in 21.1%, 57.4%, 88.9%, 88.9% and 100% of patients in Rai stage 0, I, II, III an IV, respectively; in 61.9% and 60.8% of patients exhibiting CD38 and ZAP-70 positivity, respectively; and in 76.9%, 21.2% and 66.2% of patients if the absolute monocyte count was <0.25 G/l, between 0.25–0.75 G/l and >0.75 G/l, respectively. The median time to treatment and the median overal survival were 19.5, 65, and 35.5 months; and 41.5, 65, and 49.5 months according to the three groups of monocyte counts. The relative risk of beginning the therapy was 1.62 (p<0.01) in patients with absolute monocyte count <0.25 G/l or >0.75 G/l, as compared to those with 0.25–0.75 G/l, and the risk of overal survival was 2.41 (p<0.01) in patients with absolute monocyte count lower than 0.25 G/l as compared to those with higher than 0.25 G/l. The relative risks remained significant in Rai 0 patients, too. The leading causes of mortality were infections (41.7%) and the chronic lymphocytic leukaemia (58.3%) in patients with low monocyte count, while tumours (25.9–35.3%) and other events (48.1 and11.8%) occurred in patients with medium or high monocyte counts. Conclusions: Patients with low and high monocyte counts had a shorter time to treatment compared to patients who belonged to the intermediate monocyte count group. The low absolute monocyte count was associated with increased mortality caused by infectious complications and chronic lymphocytic leukaemia. The absolute monocyte count may give additional prognostic information in Rai stage 0, too. Orv. Hetil., 2015, 156(15), 592–597.

Comparison Between R-CHOP Vs R-CHOP Plus Etoposide in Untreated Patients with Primary Mediastinal B-Cell Lymphoma: Preliminary Findings

Background: Primary mediastinal B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma originating from the thymus with its own epidemiological, clinical, immunophenotypic and prognostic features and that was included as a distinct clinical entity in the last World Health Organization classification (2008). It is more prevalent in young female, and is characterized by a large mediastinal mass, with frequent infiltration of adjacent structures. Dissemination by distant sites may be identified at diagnosis or during the disease progression. It shows many similar aspects to nodular sclerosis Hodgkin’s Lymphoma in terms of clinical, pathological and immunohistochemical features. The standard treatment is based on multidrug regimens containing anthracyclines associated with rituximab and consolidation with radiotherapy. A recent study published in the NEJM in 2013, with a single-arm treatment with infusional dose-adjusted DA-EPOCH-R with no radiotherapy in untreated PMBCL, demonstrated 97% of overall survival (OS) and 93% of event-free survival (EFS) with a median of 5 years of follow-up. Methods: We analyzed retrospectively 40 patients with PMBCL treated at São Paulo’s Cancer Institute from June 2007 to January 2014. The objectives of the study were to compare the complete response (CR), progression-free survival (PFS) and overall survival (OS) rates between two different treatment strategies. All patients were initially evaluated with blood tests, whole-body computed tomography (CT) or fluorodeoxyglucose-positron-emission tomography (PET-CT) and bone marrow biopsy. Two chemotherapy regimens were used in the patient’s treatment: 6 to 8 cycles of conventional R-CHOP 21 with or without radiation therapy (n = 23) and R-CHOP regimen with addition etoposide (DA-EPOCH-R or R-CHOEP) with or without radiotherapy (n = 17). After 4 cycles of treatment, patients were evaluated for response to determine the total number of cycles (6 or 8). Results Among the 40 enrolled patients, 65% were female with median age of 31 years (range 14 to 62 years). The median size of the mediastinal mass was 13cm in the longest axis. Half of the patients (50%) were in advanced stage (III or IV of Ann Arbor staging) and 75% were in good prognosis category of R-IPI ( 1 or 2 risk factors of the International Prognostic Index Score for non Hodgkin lymphoma). 57,5% of patients were treated with R-CHOP and 42,5% had etoposide as part of the their treatment regimen (12,5% DA-EPOCH-R and 30% R-CHOP plus etoposide (100mg/m2 D1-D3). There was no statistically significant difference in CR rate between RCHOP vs RCHOP + etoposide (86.9% vs 86.6%). There were no differences in PFS or OS for the 2 groups (p=0.8202 and 0.9410). Conclusion The addition of etoposide to RCHOP regimen appears to increase OS and PFS of patients with untreated PMBCL as previously demonstrated. In our service, where there is difficult in hospitalization for the administration of infusional regimens such as DA-EPOCH-R, it was necessary to adjust for outpatient to R-CHOEP. The comparison between the two groups (RCHOP vs RCHOEP/DA-EPOCH-R) showed no statistically significant difference in CR, OS and PFS. However, the median of follow-up of patients who received etoposide was not sufficient to analyze the data adequately. Overall Survival Figure 1. Overal survival betwen R-CHOP and R-CHOEP in PMBCL (p = 0.8202) Figure 1. Overal survival betwen R-CHOP and R-CHOEP in PMBCL (p = 0.8202) Progression Free Survival Figure 2. Progression free survival betwen R-CHOP and R-CHOEP in PMBCL (p = 0.9410). Figure 2. Progression free survival betwen R-CHOP and R-CHOEP in PMBCL (p = 0.9410). Disclosures No relevant conflicts of interest to declare.