Trabalhos Científicos

INTRODUCTION: Barrett's Esophagus (BE) is considered a gastrointestinal pathology resulting from the alteration or replacement of the natural esophageal epithelium, specifically the stratified squamous epithelium that lines the distal portion, with intestinalized metaplastic columnar cells containing goblet cells. OBJECTIVE: To demonstrate the correlation between the pathophysiological process of Barrett's Esophagus and its progression to Esophageal Adenocarcinoma. METHOD: This study is a systematic review conducted between September and October 2023 through the consultation of Controlled Health Sciences Descriptors (DeCS): Cancer. Barrett's Esophagus. Metaplasia. The inclusion criteria were articles addressing the topic in Portuguese, English, and Spanish, and published within the last 5 years. Thirteen articles were included, obtained from the databases LANTIDEX (Regional Online Information System for Scientific Journals of Latin America), SCIELO (Scientific Electronic Library Online), and PUBMED (National Library of Medicine and National Institutes of Health). RESULTS: There is evidence that the esophageal epithelial body, in combination with genetic principles and embryogenesis, can alter its physiological form in BE and present structural and functional changes during the evolutionary process towards cancer, particularly in the metaplastic processing of the usual squamous cells, followed by dysplasia, one of the main contributors to Esophageal Adenocarcinoma (EAC) in association with intestinal cellular peculiarities, inversely proportional to the prognosis. CONCLUSION: The study reveals that Barrett's Esophagus causes limitations and decreases the quality of life due to alterations in the local epithelium, increasing the risk of progression to Esophageal Adenocarcinoma. It also emphasizes that continuous monitoring by specialists is essential to reduce damage and prevent serious complications, highlighting the vulnerability of this population to the development of adenocarcinoma.

Introduction: Novel antibody-drug conjugates (ADCs) have been recently approved in metastatic breast cancer. Trastuzumab deruxtecan (T-DXd) in HER2+ or HER2 low disease, while Sacituzumab Govitecan (SG) in triple negative breast cancer (TNBC) or hormone receptor (HR) +/HER2- disease. Given their high cost and risk of serious adverse events, early monitoring of their real-world adoption and outcomes is critical. Objective: To determine clinicopathological characteristics of breast cancer patients exposed to T-DXd and SG, either alone or sequentially, and estimate Time to Treatment Discontinuation (TTD) as a surrogate of progression or intolerable toxicity events. Methods: retrospective observational study from all breast cancer patients with T-DXd and SG prescriptions in a private healthcare outpatient network of clinics. Data were extracted from the Oncoclínicas Electronic Health Records database using technology-based abstraction and human curation by experts. Descriptive analysis was performed for variables such as age, molecular subtype, treatment line, and TTD was calculated using the Kaplan-Meier method. Results: In total, 383 patients were included. Median age was 57 years. T-DXd was administered in 255 cases (67%), SG in 105 (27%) and both ADCs in 23 patients (6%). There was more than two-fold increase in ADC use in 2023 (N=280) as compared to 2022 (N=103). For T-DXd, 54% were HER2+, 32% HER2-low/TNBC and 14% HER2-low/HR+. For SG, 82% were TNBC and 18% HR+/HER2-. Most patients used ADCs from the third line or beyond, representing 57% for T-DXd and 62% for SG. With a median follow-up of 8 months, 45 death events were reported (12%). Median TTD was 8 months (95% CI 6.78 - 8.63) for T-DXd and 4 months (95% CI 3.21 - 4.30) for SG. In the population that used both ADCs, most patients (61%) received T-DXd followed by SG. Median TTD of the first and second ADC treatments were 6 months (95% CI 3.83 - 8.86) and 3 months (95% CI 1.40 – 3.80), respectively. Conclusion: There was a significant increase in novel ADC use for breast cancer in recent year. Clinicopathological features of patients treated in the real-world are comparable to clinical trials, but most cases were heavily pre-treated when starting T-DXd or SG, potentially reducing their effectiveness. Longer follow-up and stratified analysis by molecular subtype will shed more light on the outcomes when compared to clinical trials.

Introduction: Psycho-oncology is a multidisciplinary field that brings together psychology and oncology to deal with emotional, social, and behavioral difficulties faced by children having cancer. It aims at improving the quality of life of these minors and their families through the provision of comprehensive care, such issues as anxiety, depression, and stress are some of the main targets of the field. Objective: This review paper aims to identify effective interventions in psycho-oncology for children, highlight challenges encountered, and suggest areas for future research. The objective is to outline best practices in pediatric psycho-oncology while pointing out areas where it is lacking. Methods: PubMed and PsychINFO were searched using the keywords “psycho-oncology”, “children” and “pediatric cancer”. All studies published between 2010-2023 were reviewed with emphasis on psychological interventions and psychoeducational interventions targeted towards children with cancer as well as their families. Results: Many methods are known to be effective in enhancing the welfare of children with cancer, including Cognitive-Behavioral Therapy (CBT) which reduces anxiety and depression by teaching coping skills. Acceptance and Commitment Therapy (ACT) helps one accept their medical condition while enhancing psychological flexibility. Meditation is recommended as it promotes stress reduction that enhances overall quality of life. Apart from that, psychoeducational Interventions improve patient's understanding of their condition and encourage cooperation towards treatment. Family Support is also essential for building resilience and providing emotional support to the patient. Conclusion: Psychological and psychoeducational interventions extensively enhance pediatric cancer patients’ quality of life. However, there are important research gaps, particularly on culturally appropriate interventions that address diverse problems. Future research should concentrate on developing innovative approaches to care as well as a better understanding of psychosocial needs among all types of pediatric cancer populations, hence ensuring comprehensive and inclusive care.

Introduction: Gastric cancer is the fifth most common and the fifth leading cause of cancer death in the world. In the Western world, most diagnosed cases are locally advanced, and standard treatment includes surgery and perioperative chemotherapy. There are few reports on the use of standard perioperative chemotherapy (FLOT) in patients with locally advanced gastric cancer in the Brazilian public health system, probably due to structural and financing limitations. Aim: To report the experience of using perioperative chemotherapy with FLOT in patients with locally advanced gastric cancer in a university hospital of the Brazilian public system. Methods: A retrospective survey of medical records of patients with locally advanced gastric cancer undergoing perioperative chemotherapy was performed. Epidemiological, clinical, surgical and pathological information was analyzed, as well their associations with pathological response and overall survival. The R program was used to evaluate the associations between clinicopathological factors and overall survival. Results: Between 2017 and 2023, 123 patients underwent perioperative chemotherapy of which 118 received FLOT (95,9%). There were 79 men (65%) and 44 women (35%) with a median age of 59,5 years (range 20-84). 54% of patients were clinical stage (CS) I and II, while 46% were CS III. Furthermore, 114 (92%) underwent surgery, and 75 (60.97%) received adjuvant therapy. Pathological evaluation showed that the ypN0 and ypN+ rates were 47% and 53%, respectively. Moreover, 12.2% (15/123) of patients had a complete pathological response (pCR, ypT0ypN0). With a median follow-up of 30,67 months (2,03 - 87,03 months), 50% of patients are still under follow-up and median overall survival has not yet been reached. The median disease-free survival among ypN0 patients was 24 months, while ypN+ patients had a median of 14 months. 3 patients (2.44%) died due to treatment toxicities, 15 patients (13.15%) died post-surgery. Among the 123 patients, 41 (33.33%) died, while 71 (57.72%) were alive, and 11 (8.94%) were lost to follow-up. Conclusion: This is the largest experience of using perioperative chemotherapy in patients with locally advanced gastric cancer in the Brazilian public system. The epidemiological profile of patients is similar to that of international literature. The rate of pCR was 12.2%. Patients with cpCR who were discharged from hospital remain alive and without evidence of disease.

Background: Antineoplastic treatments are highly complex procedures (HCP) that may be linked to drug-related problems (DRP). Safety during oncological patient's journey depends on the correct recording of specific documentation being evaluated: antineoplastic protocol (drug, dose, interval), high-alert drugs and treatment indication. This study describes internal pharmaceutical audit as a service routine in a private clinic. Methodology: First-time’s treatment or change requests for oral and intravenous oncological treatment were included and subsequently sent to health insurance companies. Data was collected during internal pharmaceutical audit between December 2023 and June 2024. Medical reports, prescriptions, histopathological, molecular and laboratory tests were evaluated and compared with American Society of Clinical Oncology and European Society for Medical Oncology guidelines. All pharmaceutical interventions were recorded on an Incident Reporting platform and evaluated by the patient safety center (PSC). Results: A total of 1,738 (100%) treatment requests were included. Among 206 (11.8%) inconsistencies has been founded, 124 (7.13%) were identified as dose discrepancies, 22 (1.3%) antineoplastic protocol’s discrepancies (according to histopathological report), 25 (1.4%) discrepancies between report and requested protocol, and 35 (2%) antineoplastic protocol’s registration inconsistencies. Interventions scored were accepted by clinical staff, adjusted and evaluated as near miss by PSC. Conclusion: All action plans defined by PSC are implemented to adjust and improve safety in patient's treatment journey. An effective pharmaceutical audit needs to assess medical progress; medical report with clinical’s condition, previous treatment and protocol’s data; histopathology and laboratory results. Pharmaceutical audit is recommended as a process to increase patient's journey safety, mitigating inconsistencies and avoiding postpone patient's treatment. Internal pharmaceutical audit process is the first gate to prevent early DRPs without treatment’s impact, increases pharmacist's bond with clinical staff and optimizes authorization process by health insurance companies.

Introduction: Women with breast cancer experience multiple symptoms that occur simultaneously during antineoplastic treatment, comprising symptom clusters. Researchers has focused on symptom clusters during chemotherapy and radiotherapy, especially in advanced disease. However, few studies have evaluated primary symptom clusters in patients with stage I and III non-metastatic breast cancer as well as how symptom clusters correspond at these stages. Objective: To identify and compare the prevalence, intensity, and severity of cancer symptom clusters inwomen with non-metastatic breast cancer at stage I and stage III of the disease. Methods: A cross-sectional study was conducted with 87 women aged >18 years old, with anatomopathological diagnosis of stage I or stage III breast cancer and undergoing any phase of antineoplastic treatment in a highly complex Oncology care center in Brazil. Symptoms were assessed using the Memorial Symptom Assessment Scale (MSAS). The bootstrap resampling method was employed to estimate the 95%CI of the prevalence ratio (PR) of MSAS symptoms, stratified by tumor stage. Cluster analysis was conducted using hierarchical and k-Means clustering. Results: The most prevalent symptoms in stage I patients were pain (68.63%), worrying (62.75%), difficulty sleeping (62.75%), followed by fatigue (60.78%), respectively. For stage III patients, the most prevalent symptoms were pain (72%), fatigue (66.67%), worrying (63.89%), and dry mouth (50%), respectively. The prevalence of the symptom "difficulty concentrating" in stage I breast cancer patients was 1.50 times the prevalence in stage III patients (PR=1.50; p=0.015). Similar patterns were observed for symptoms such as "shortness of breath" (PR=1.51; p<0.001), "feeling sad" (PR=1.41; p=0.002), and "hair loss" (PR=1.60; p=0.037). Conclusion: Non-metastatic breast cancer patients present several symptom profiles that vary according to disease stage, exhibiting clear trends of manifestation organized into four clusters for stage I (neuropsychological, gastrointestinal, neurocognitive, and psychological clusters) and III (psycho-neurocognitive, gastrointestinal, chemotherapy-related, and neurocognitive clusters).

INTRODUCTION: Multiple myeloma (MM) is a malignant neoplasm of plasma cells with high molecular heterogeneity that leads to increased production of monoclonal immunoglobulins or immunoglobulin chains. The tumor suppressor TP53 (chromosome 17) is one of the most commonly altered genes in this type of hematologic cancer. Some variants in this gene have been associated with worse prognosis in affected patients. A rare germline variant, TP53 rs78378222 (A>C), located in the 3'UTR, has been associated with overall increased risk in several types of cancer, but it has not been studied in MM patients. OBJECTIVE: The aim of the study was to assess the prevalence (genotype and allele frequencies) and possible clinical correlations of the functional variant TP53 rs78378222 in patients with MM in the southern region of Brazil. METHODS: This retrospective cross-sectional study assessed patients from two hospitals in Rio Grande do Sul, Brazil, using peripheral blood samples from a total of 86 patients. The variant was genotyped with Real-Time PCR and confirmed via Sanger sequencing. RESULTS: The TP53 variant was identified in two patients (in heterozygosity), diagnosed at 34 and 63 years-old with no other cancer history. The genotypic and allelic frequencies of the variant were 2,3% and 1,1%, respectively. The latter was nearly two-fold that of the general population, although databases show heterogeneity for this figure (average of 0,6%). However, public genomic databases have shown that European populations have the highest allele frequency (1,3-2,0%) and thus, the frequency observed among participants of the study is similar to that of the European population. A prior study by our research group offers a control group for the variant with an allelic frequency of 0,5%, also smaller than the prevalence obtained in this study. CONCLUSION: The present study suggests a two-fold increase in Southern Brazil of the TP53 rs78378222 variant in multiple myeloma patients in comparison to the general population. Southern Brazilians have a higher contribution of European descent, which may explain the higher frequency of the TP53 variant in this region compared to the remainder of Latin America. Nevertheless, further studies in larger samples of MM patients should confirm this result, as well as clinical characteristics and tumor molecular findings of carriers.

Introduction: Hepatic visceral crisis is a life threatening condition that can be defined as severe hepatic dysfunction, established by clinical changes, laboratory changes (rapid increase in bilirubin > 1.5 times the upper limit of normality, in the absence of Gilbert's syndrome or biliary tract obstruction) and rapid progression of metastatic câncer. The benefit of treatment and survival data in such conditions are lacking. Objectives: This is an observational and retrospective study from a single oncologic center, analyzing survival rate of hospitalized patients with hepatic visceral crisis, defined as the time from the diagnosis of the visceral crisis until death or last information available; to evaluate the proportion of patients who received treatment; and to compare overall survival of those who received treatment or not. Method: The survival curves were constructed according to the Kaplan-Meier method, and mean, median and standard error values were calculated for the overall survival of all patients and of those who received or not treatment. The survival curves were compared using the log-rank test. Results: From August 2021 to June 2024, 106 patients were diagnosed with hepatic visceral crisis. 92.5% were female, 47.2% were between 36 and 55 years old, and 71.3% had ECOG 1 or 2. Breast cancer was the most common primary tumor. The most common symptoms were abdominal pain, nausea, vomiting and fatigue. 93.4% had other metastases sites, and the most frequent of them were bones, lymph nodes and lungs. 21 (19.8%) patients received treatment and 85 (80.2%) were not treated. The average time from diagnosis to the start of treatment was 7.6 days. Until the completion of the data analysis of this study, 100 (94.3%) deaths occurred. The median overall survival was 12 days in the total population. The survival probability at 7, 15, 30 and 60 days was, respectively, 100%, 85.7%, 57.1% and 32.7% in those who received treatment, compared to, respectively, 56.0%, 27.4%, 10.7% and 3.2% in those who did not receive treatment. The median overall survival of those who received treatment was significantly higher, 37 days, compared to 9 days of those who were not treated (HR 3.85; 2.17-6.82; p<0.001). Conclusion: Despite the short overall survival of patients with hepatic visceral crisis, those who were treated had a longer overall survival than those who were not treated.

Background: Lung cancer is responsible for 1.8 million deaths annually, holding the highest mortality rate among cancers, with 85% of cases being non-small cell lung cancer (NSCLC). Immunotherapy using immune checkpoint inhibitors (ICIs) has made significant strides by employing monoclonal antibodies to regulate key immune signals. While ICIs have proven more effective than standard second-line chemotherapy, there remains a need for reliable prognostic markers. Aim: The study focused on investigating the prognostic significance of complete blood count (CBC) values for NSCLC patients undergoing ICIs therapy. Methods: A retrospective review of medical records was conducted for advanced NSCLC patients treated with ICIs at Barretos Cancer Hospital. Demographic data were collected and CBC values were analyzed using median values as cutoffs. Primary outcomes of overall survival (OS) and progression-free survival (PFS) were evaluated using SPSS software. Results: The study cohort comprised 105 patients, with adenocarcinoma being the most common histological type (57.0%). Among the patients, 58.0% were male, and 61.0% were diagnosed at stage IV. Within the cohort, 62.9% had a positive PD-L1 status, with 79.9% of these receiving anti-PD-1 treatment. Only 11.0% of the patients were never smokers. The study found significant associations between CBC components before first cycle (baseline) of ICIs treatment and clinical outcomes. Lower levels of hemoglobin (<11.8g/dL; p=0.038) and hematocrit (<35.7%; p=0.005) were linked to poorer OS. Furthermore, lower levels of hemoglobin (<11.8g/dL; p=0.028), and hematocrit (<35.7%; p=0.012) were linked to poorer PFS. Conclusion: Effective management of NSCLC with ICIs remains crucial. CBC values can serve as valuable and cost-effective prognostic biomarkers to guide treatment strategies.

Background: Uterine carcinosarcoma is a biphasic malignancy with a carcinomatous and a sarcomatous component, with a poor prognosis even in those treated with curative intent. Objective: Evaluate the prognostic of the sarcomatous component (homologous versus heterologous) in patients with localized/locally advanced uterine carcinosarcoma. Methods: This retrospective study evaluated patients with localized/locally advanced (FIGO I-IVA) uterine carcinosarcoma treated at a single cancer center (2003 - 2024). The endpoints were overall survival (OS) and disease-free survival (DFS) according to the sarcomatous component. The Kaplan-Meier method was used for survival analyses. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated using Cox regression. Results: 61 patients with localized/locally advanced disease (34 homologous vs 27 heterologous) were included. Among the heterologous group, the most common pathological subtype was Rhabdomyosarcoma (60%), while in the homologous group it was endometrial stromal sarcomas (95%). All patients underwent surgery. Adjuvant chemotherapy was indicated for approximately 70% of patients (mainly Carboplatin plus Paclitaxel). A difference was observed between patients who did not complete adjuvant chemotherapy: 23.5% vs. 40.7% patients in the homologous and in the heterologous groups, respectively (p=0.03). The main reason for this was recurrence during treatment. In the whole series, the median OS was 56.2 months. When comparing the homologous vs. the heterologous group, the median DFS was 143.2 months vs. 18.0 months (HR 3.72, 95%CI 1.73 - 8.02; p=0.001) and the median OS was 143.2 months vs. 34.4 months (HR 2.79, 95%CI 1.27 - 6.13; p=0.001), respectively. In a multivariable analysis, heterologous subtype (HR 4.34, 95%CI 1.59 - 11.85, p=0.004) and FIGO stage III (HR 3.33, 95%CI 1.18 - 9.39, p=0.023) were identified as factors associated with inferior DFS and OS, while completing adjuvant chemotherapy (HR 0.22, 95%CI 0.07 - 0.69, p=0.009) was associated with superior outcomes. Conclusions: The sarcomatous component has a relevant prognostic impact in localized/locally advanced uterine carcinosarcoma. In this cohort, the heterologous component was associated with a worse DFS and OS. Other negative prognostic factors were FIGO stage III and not completing adjuvant chemotherapy.

Introduction: Malignant neoplasms are autonomous, capable of metastasis, and more likely to cause death to the individual. The advanced age of the population corroborates the growing increase in neoplasms over the last decades and their greater occurrence in the elderly. One of the causes is the failure of their cellular repair mechanism. Prostate neoplasms are among the most common causes of death in elderly men. Objective: To describe the mortality rates of men affected by malignant prostate neoplasms. Methodology: Retrospective study carried out between 2012 and 2022 on the number of deaths from prostate cancer in the state of Paraíba. The data were obtained from DATASUS, through the TABNET tool, using the variables of number of deaths from prostate cancer, race, sex, age group, and health macroregion. Results: Analyzing the scenario related to prostate cancer (CaP) in the State of Paraíba, between 2012 and 2022, a total of 1184 deaths were evidenced. The highest incidence was in Macroregion I- João Pessoa with 47.29%, followed by Macroregion II- Campina Grande with 31.67% and Macroregion III-Sertão with 20.94% of deaths from CaP. Regarding mortality by age group, the most affected is that of 60-69 years with 44.51%, followed by the range of 70-74 years with 42.06%, which is related to the demographic changes observed in recent decades, where the increase in life expectancy contributes to the higher incidence of diseases related to senescence. Regarding deaths according to color/race, the highest mortality rate was in the brown population with 63.09% of cases and in the white population with 26.77% of deaths. Conclusion: Given the results obtained, the progressive increase in mortality from prostate cancer in Paraíba is evident, with the age group most affected being between 60-69 years old, which draws attention to a greater composition of public health policies, prevention, early diagnosis, and improvement of care provided to the population.

Introduction: Bladder cancer presents significant health challenges globally, with particular implications in developing countries. Understanding patient quality of life (QoL) and clinical profiles is crucial for improving outcomes in these settings. This study analyzes the QoL and clinical profiles of bladder cancer patients treated at an oncology center in Brazil. Objective: This study aims to retrospectively analyze the QoL and clinical profiles of bladder cancer patients in a developing country, focusing on the challenges and outcomes to inform care strategies. Methods: A retrospective analysis was conducted on patients diagnosed with bladder cancer from 2006 to August 2024. Data were collected from medical records and analyzed using descriptive statistics. QoL was assessed based on the impact of disease and treatment on daily activities, psychological well-being, body image, finances, and the effect on close contacts. Results: The study included 65 patients, with a mean age of 71 years, predominantly male. Among them, 60% were lifelong smokers, 9% were active smokers, and 40% had never smoked. Primary bladder cancer was observed in most cases, with 3% resulting from prostate cancer invasion. Metastasis to other organs occurred in 18% of patients. Neoadjuvant chemotherapy and TURBT were the most common treatments, received by 57% of patients. The primary symptom was painless hematuria (63%), followed by dysuria (30%) and urinary infections (21%). In QoL assessments, 64% of patients reported no significant changes in daily activities, though 35% experienced weight loss and 40% were psychologically affected. Close contacts reported minimal impact on their lives (46%). Conclusions: In this developing country setting, most bladder cancer patients maintained stable QoL during treatment, highlighting the effectiveness of individualized care. The Brazilian healthcare system played a role in reducing the financial impact on patients, contributing to better QoL. These findings provide insights into the vulnerabilities associated with bladder cancer and suggest the need for tailored interventions in similar contexts.

Colorectal cancer (CRC) is the third most common cancer and the second most lethal worldwide, according to data from the WHO. In Brazil, colon cancer ranks as the fourth most diagnosed malignant tumor, accounting for 6.5% of all registered neoplasms. CRC treatment is complex, involving surgery and adjuvant chemotherapy. The literature defines certain indicators to assess the quality of this treatment and classify hospitals based on their performance. From this perspective, we conducted a retrospective study at the Hospital Universitário Clementino Fraga Filho (HUCFF), analyzing data from the oncology treatment of 146 colon cancer patients (ICD18) treated between 2015 and 2020. METHODS:We conducted a retrospective observational study using data from the HUCFF electronic medical record, the HUCFF Cancer Hospital Registry (RHC), and the Rio de Janeiro Court of Justice. We assessed parameters defined by the National Quality Forum (NQF), including histopathological staging, the number of lymph nodes analyzed, the time span from diagnosis to the start of adjuvant chemotherapy for stage III patients and the proportion of stage III patients who received adjuvant chemotherapy. We also analyzed the interval between surgical treatment and the start of adjuvant chemotherapy for stage III patients. OBJECTIVE:To assess the quality of treatment for this cohort according to the parameters defined by the NQF. RESULTS:Regarding pathological reports, tumor size (pT) was defined in 88% of cases. Approximately 87% of patients had 12 or more lymph nodes evaluated in the surgical specimen. Of the stage III patients, 75% received adjuvant chemotherapy, while the remaining 25% either died shortly after surgery or were over 80 years old. These results would qualify HUCFF as a high-performance hospital according to NQF criteria. However, only 67% of stage III patients received adjuvant chemotherapy within the recommended 120-day period from diagnosis to treatment. Although the NQF does not include the interval between surgical treatment and the start of adjuvant chemotherapy as a parameter, the literature establishes a higher mortality with a longer interval between these dates—ideally 4 to 8 weeks. At HUCFF, this interval exceeds the expected range, at 10.1 weeks. Future discussions may analyze the overall survival of oncology patients at HUCFF, compare it with other hospitals, and possibly create internal quality indicators.

Background: Mucosal melanoma (MM) stands as a rare form of melanoma, characterized by its aggressive clinical progression. Despite strides in targeted and immune therapies, patients grappling with advanced or recurring mucosal melanomas continue to face grim survival rates. Accessing real-world data tracking shifts in clinical outcomes over time and assessing the efficacy of various treatment modalities could furnish valuable insights, empowering clinicians to make more evidence-driven treatment decisions and gauge the overarching benefits of contemporary therapies for MM patients. Methods: Patients with MM treated at a private reference center in São Paulo, between January 2018 and December 2023, were included retrospectively. Patient characteristics, treatment and outcome data were collected from electronic patient files. Results: A total of 12 patients with MM were identified (median age 70, females 66%); gastrointestinal tract location was the most frequent (41%), followed by facial sinuses (33%) and genitourinary (24%). 3 patients (25%) had somatic mutation, 10 patients (83%) underwent some upfront local treatment (3 had surgical excisions, 4 had radiotherapy and 3 both), 2 patients (16%) received neoadjuvant treatment followed by definitive treatment, 2 were de novo metastatic and 6 became metastatic during follow-up. The longest follow-up was 10,5 years for a patient with no metastatic disease who received adjuvant treatment with anti-PD-1, 4 deaths were recorded (mainly in patients who have not received adjuvant or neoadjuvant therapy). Median survival time was 28 weeks and overall survival rate 75%. At first line systemic therapy, anti PD-1 alone provided the longest response (14 months) even de novo metastatic patient. Conclusions: MM poses a significant clinical challenge due to its aggressive nature and limited treatment options. In recent years, immunotherapy has emerged as a promising strategy for MM, with a particular focus on immune checkpoint inhibitors such as PD-1 and CTLA-4 inhibitors. Based on our results together with the most important randomized trials, we recommend considering adding immunotherapy in the upfront treatment of localized disease.

Introdution: Malignant pancreatic neoplasm involves the mutation of DNA in pancreatic glandular epithelial cells, leading to uncontrolled division, tumor formation, and subsequently cancer. This type of cancer is considered fatal in most cases due to its extreme aggressiveness. Objective:o analyze regional differences in pancreatic cancer in Brazil and identify temporal trends. Methods: An ecological epidemiological study was conducted. The data were obtained from the Hospital Information System of each region of Brazil, covering the period from 2014 to 2023. Variables analyzed included age, hospitalization rate (per 100,000 inhabitants), mortality, and average length of stay. Simple Linear Regression and the Kruskal-Wallis test were used, employing Microsoft Excel and GraphPad Prism software. Results: All variables showed significant differences between regions (p<0.05).The average hospitalization rate in the country was 58.59, with the South region having the highest rate (108.9) and the North region the lowest rate (19.9). The age group of 60 to 69 years also had the highest hospitalization rate. All regions showed a significant trend of growth (p<0.05), with the highest increase in the South (β=4.37). The average mortality rate in the country was 23.50. The South region (22.4) had the lowest mortality rate, while the North (28.26) had the highest, with patients over 80 years old being the most affected. The largest trend of increase occurred in the Central-West region (p<0.05; β=0.77). Regarding the average length of stay, the country as a whole shows an average of approximately 7 days. The South and North regions stand out again, with the South having the shortest average (6.69 days) and the North the longest (10.27 days). In this variable, the individuals with the highest average were those aged between 50 and 79 years. Conclusion: The North, Northeast, and Central-West regions had hospitalization rates below the national average, with the North having the lowest rate and the South the highest. The North and Southeast have the highest mortality rates, while the South has the lowest. Regarding the average length of stay, the North and Northeast are above the overall average, indicating that, despite the North's lower hospitalization rate, patients stay in the hospital longer and have higher mortality rates. The South, despite its high hospitalization rate, has mortality and length of stay below the national average.

Introduction: Despite lung cancer being the most common and deadly type of respiratory cancer, trachea and bronchial cancer are also relevant types of respiratory cancers in Brazil. This highlights the importance of analyzing its data for Brazil's public health. Objective: To analyze regional differences in trachea, bronchial, and lung cancer in Brazil and identify temporal trends. Methods: This ecological and epidemiological study used data on malignant neoplasm of the trachea, bronchi, and lungs from Brazil's Hospital Information System (SIH/SUS) covering all regions (North, Northeast, Southeast, South, and Midwest) from 2014 to 2023. Simple linear regression, Kruskal-Wallis and ANOVA tests were conducted using Microsoft Excel and GraphPad Prism. The variables analyzed were, hospitalization rate (per 100,000), mortality, and average hospital stay (days). Results: Significant differences were observed between regions for all variables (p<0.05). The mean hospitalization rate in Brazil was 11,73, with the highest mean recorded in the South (22,51) and the lowest in the North (4,50). All regions showed significant growth trends in this variable (p<0,05), except the South (p=0,74). Brazil's mean mortality was 26,49‰, with the North (32,89‰) being the only region to stand out in this variable. Significant temporal trends (p<0,05) were only observed in the Northeast (β=-0,46) and South (β=0,36) regions. The average hospital stay across the country was 7,42 days. The North (10,18) was the only region to stand out in this variable. All regions showed significant growth trends (p<0,05), but the highest was in the North (β=-0,47). Conclusion: The results for the Southeast and midwest regions were similar to the country's average across all variables. The North, despite having the lowest hospitalization rate, exhibited the highest mortality, average hospital stay, and hospital stay growth trend, which suggests that the public health strategies against this type of cancer may not be so effective in this region. The South had the highest hospitalization rate but presented mortality and average hospital stay similar to the country's mean rates. These data indicate that this region may have an effective public health strategy to track and treat these types of cancer. The Northeast was the only region to show a reduction trend on mortality. It is evident that further studies are needed to understand the highlighted regions, to guide future public health strategies

Introduction Li-Fraumeni (LFS) and Li-Fraumeni-like (LFL) syndromes are rare genetic conditions associated with a heightened susceptibility to cancer development, stemming from germline mutations in the TP53 tumor suppressor gene. Prior studies highlighted an increased risk of secondary malignancies linked to radiotherapy (RTx). Here, we present the first systematic review with a meta-analysis evaluating the therapeutic effectiveness and the incidence of secondary malignancies in patients with pathogenic variants of TP53 who have undergone RTx. Methods We systematically searched Pubmed, Cochrane, and EMBASE databases until April 2024. Prospective and retrospective studies examining the effects of radiotherapy (RTx) in patients with Li-Fraumeni syndrome (LFS) were eligible for inclusion. We pooled the prevalence of radio-induced malignancies (RIM), total recurrence (TR), and other second primary malignancies (SCM), along with their respective 95% confidence intervals (95% CI). Statistical analyses were carried out using R software version 4.3.2, and heterogeneity was assessed using I² statistics. Results Out of 1291 studies identified, 10 studies involving 254 patients met the inclusion criteria, with 183 of these patients having received radiation therapy during their treatment. The prevalence of RIM in patients previously treated with radiation therapy was found to be 23.54% (95% CI 14.47-35.90). The risk ratio for TR (including local and distant recurrences) was 2.32 (95% CI 0.90-5.95). Additionally, the risk ratio for SPM was 1.73 (95% CI 0.84-3.60) in the radiation therapy group. Conclusions While the prevalence of radio-induced malignancies (RIM) in patients with Li-Fraumeni syndrome who underwent radiotherapy is noteworthy, the risk ratios for total recurrence (TR) and secondary primary malignancies (SPM) were not statistically significant. This suggests that the association between radiotherapy and increased risks of TR and SPM remains uncertain. Further research is needed to clarify these risks and to guide personalized treatment and long-term surveillance in this high-risk population.

Introduction: Neoadjuvant treatment of rectal adenocarcinoma (RA) is the standard of care for locally advanced disease and it may be done either with short-course radiotherapy (SRT) or with long-course concurrent chemoradiation (CRT). Complete pathologic response (cPR) occurs in 8-15% with CRT. Reaching cPR is linked to better oncologic outcomes and also allows conservative management without surgery and colostomy. Total neoadjuvant therapy (TNT) is defined by the sequential use of (chemo)radiotherapy and systemic chemotherapy and provides higher cPR rates (30%) compared to CRT. Objective: compare results between TNT and CRT. Methods: retrospective study evaluating sequential patients (pts) with RA submitted to neoadjuvant therapy at Hospital Santa Paula between January 2018 until December 2023. Clinical and pathological characteristics were described according to their frequency (%) and means and medians were presented as indicated. Fisher´s exact test was applied when needed. We excluded pts who were not operated at our institution. Results: Fourty-two pts with RA were submitted to neoadjuvant therapy and operated at our institution, being 27 male (64%). Mean age was 65 years old (34-88). Regarding to the rectal portion we had mostly middle rectum (69%) and lower rectum (24%). Tumor staging was presented as it follows: T1 (7%), T2 (14%), T3 (72%), T4 (7%), N0 (31%), N1 (48%) and N2 (21%). Twenty-seven out of 42 pts (64%) received SRT/CRT and 15/42 pts (36%) were treated with TNT. Short-course radiotherapy was offered to 7/42 pts (17%) and long-course radiotherapy to 35/42 pts (83%). Among TNT pts, 14/15 (93%) received FOLFOX and 1/15 (7%) received XELOX as systemic treatment. Three out of 27 SRT/CRT pts (11%) were not operated due to progressive disease (1 pt – 4%) and 2 pts (7%) reached complete clinical response (cCR) and were managed in a conservative way. Six out of 15 TNT pts (40%) were not operated because of refusal (1 pt – 7%) and 5 pts (33%) reached cCR. Twenty-four out of 27 SRT/CRT pts (89%) were submitted to surgery and 5 pts (21%) reached cPR. Nine out of 15 TNT pts (60%) were operated and 2 pts (22%) reached cPR. Considering cPR and cCR with conservative management as being the best possible outcome we could seen it in 7/27 SRT/CRT pts (26%) and in 7/15 TNT pts (47%), p=0,193462. Conclusion: Although without statistical significance, more pts managed with TNT reached desirable results in the setting of neoadjuvant treatment for RA.