Trabalhos Científicos

INTRODUCTION: Despite being preventable and having a well-known natural course, cervical cancer remains one of the leading causes of cancer-related death among women, being the third most common malignant disease among Brazilian women and the fourth worldwide. In the Northeast of Brazil, its adjusted incidence is 13.85 cases per 100,000 inhabitants, highlighting the influence of socioeconomic levels on access to healthcare. With 95% of cases attributed to HPV, early detection is essential but often fails due to limited access to healthcare, worsening treatment costs and outcomes. The clinical staging updated by FIGO in 2018 and chemoradiotherapy are crucial for treatment. This article explores how these factors impact survival in a reference cancer hospital in Paraíba. OBJECTIVE: To characterize the epidemiological and clinical profile of women with cervical cancer in Paraíba, their survival, and the relationship between survival and the therapeutic approach used. METHODS: An observational, retrospective, cross-sectional study with 126 medical records of women with cervical cancer treated between 2015 and 2020 at the reference oncology hospital in Paraíba. Data were analyzed using SPSS software, with descriptive statistics parameters, Relative Risk, survival analysis by the Actuarial method, Kaplan-Meier test, Odds Ratio, and Cox Regression, using a significance level of 5%. RESULTS: Two-thirds of the occupations were housewives and farmers, the majority were mixed-race, with only incomplete primary education or were illiterate. Smokers were 16 times more likely to develop poorly differentiated tumors. The most prevalent FIGO stages were IIB and IIIB. Stages I or II had a median survival of 176 months, with 10.3% of deaths in the period, while in stages III and IV, the median survival was 70 months, with 40.4% of deaths. Patients treated for more than 5 months had a 4.6 times higher risk of death, and those who only received brachytherapy/radiotherapy had a hazard ratio of 0.11 compared to those who also received chemotherapy and/or surgery. CONCLUSION: Lower socioeconomic levels were more strongly associated with cervical cancer. Most diagnoses are still made in more advanced stages of the disease, requiring longer treatment times with more combined therapies, which is associated with higher morbidity and mortality.

Introduction: There are many challenges that impact the time for diagnosing a neoplasm and initiating its treatment. The proposal to refer patients with suspected or newly diagnosed cancer from general hospitals to oncology services aims to enhance patient care within the Sistema Único de Saúde (SUS). Objective: To describe the clinical and epidemiological profile of patients referred between a general hospital and an Unidade de Alta Complexidade em Oncologia (UNACON). Methodology: This is a cross-sectional, retrospective study, based on the analysis of patient medical records from 2021 to 2022. Results: A total of 110 patients were analyzed, of whom 61 (55.4%) were male. Their average age was 65 years. In 50% of the cases, the confirmed oncological diagnosis by biopsy was performed at the originating hospital, as well as computed tomography scans (83.6%), magnetic resonances imaging (4.5%), endoscopies and/or colonoscopies (29%), bronchoscopies (4.5%), in addition to 23 surgeries (21%). The main referral specialties were Surgical Oncology (25.4%), Clinical Oncology (24.5%), Urology (16.4%) and Thoracic Surgery (12.7%). The mean interval between the referral request and the patient’s first consultation at UNACON was 12 days, with 93 patients (84.5%) attending the service. Of the 65 patients diagnosed with cancer, 40 (61.5%) received some type of treatment at UNACON. The remaining did not receive treatment due to loss of follow-up (13.8%), lack of permissible clinical performance (15.3%), absence of an indication for complementary therapy (7.5%) and death (1.5%). The mean duration between diagnosis and initiation of treatment was 83.2 days. The most prevalent tumor sites were gastrointestinal (31.7%), genitourinary (11.7%), and lung (4.5%). There was a predominance of advanced stages at diagnosis: stage III (21.5%) and stage IV (50.7%). Conclusion: Oncological referrals from general hospitals to oncological services plays a vital role in optimizing the flow of patients diagnosed with neoplasms for specialized evaluation. However, there is still a need to improve care pathways to ensure timely treatment initiation and reduce patient follow-up loss. Cancers diagnosed in the context of hospital admission tend to present at more advanced stages, and patients, often in more fragile conditions, face greater challenges in accessing adequate treatment.

INTRODUCTION: Cancer patients have a higher risk of developing a new primary malignancy compared to the general population. There are several risk factors that may be associated with the presence of synchronous and metachronous tumors, such as exposure to environmental carcinogens, effects of ionizing radiation, side effects of treatments used for another tumor and genetic predisposition to neoplasms. OBJECTIVE: To describe the clinical and epidemiological profile of patients diagnosed with two or more primary tumors, treated in a public oncology service. METHODOLOGY: This is a cross-sectional, descriptive study, carried out through the analysis of medical records of patients, between 2022 and 2023. RESULTS: A total of 102 patients were analyzed, of whom only six (5.9%) were diagnosed with three primary tumors and 13 (12.7%) had synchronous tumors (with less than two months of difference between diagnoses). The majority of patients were male (63.7%) and the median age at diagnosis of the first tumor (FT) was 58 years and that of the second tumor (ST) was 63 years. The most prevalent sites for the FT were breast (36.3%), prostate (12.7%), colorectal (12.7%) and head and neck (10.8%). For the ST, the most prevalent sites were breast (30.4%), colorectal (20.6%) and head and neck (12.7%). There was a predominance of stages I-II (59.8% for FT and 53.9% for ST), compared to stages III-IV (39.2% for FT and 45.1% for ST). The most common treatment was surgery (82.3% for FT and 40.2% for ST), followed by chemotherapy (49% for FT and 40.2% for ST) and radiotherapy (44.1% for FT and 22.5% for ST). Smoking was reported in 37.2% of cases and ten (9.8%) patients had multiple tumors known to be associated with smoking. Family history was positive in 35.3% of patients. Only nine (8.8%) of the patients underwent some type of test to evaluate potentially associated genetic mutations. CONCLUSION: Analyzing first and second tumors together, the most prevalent sites were breast, colorectal and head and neck, with the rate of the last two being higher in the second neoplasm. The diagnosis of stage III-IV tumors was also higher in the second neoplasm. Smoking cessation and genetic testing programs should be encouraged in public health services to better monitor patients at risk of developing two or more tumors.

Introduction: About 15 to 30% of patients with colorectal cancer present with metastatic disease at diagnosis. Of those initially diagnosed with localized disease, 20 to 50% will develop metastases. The treatment of metastatic colorectal cancer (mCRC) depends on several factors, such as the clinical performance of the patient, the laterality of the disease and the presence or absence of tumor biomarkers. Objective: To analyze the clinical, epidemiological and molecular profile of patients with mCRC followed in a public oncology service. Methodology: This is a cross-sectional, retrospective study, conducted through the analysis of medical records of patients with mCRC treated from June 2022 to June 2024. Results: A total of 96 patients were evaluated, of which 52.1% were male. The mean age at diagnosis was 59.5 years, and most diagnoses occurred between 50 and 69 years (61.4%). Sixty-eight (70.8%) patients were already metastatic at diagnosis. The main sites of metastases were liver (59.3%), lungs (45.8%) and peritoneum (39.6%). There was a predominance of left colon tumors (LCT) compared to right colon tumors (RCT), with 67.7% of cases. Of the 66 patients tested for RAS/BRAF mutations, 42 (63.6%) had RAS gene mutations and 24 (36.4%) were RAS/BRAF wild-type. No patient had a BRAF gene mutation. Of the 36 patients tested for microsatellite instability, only one (2.8%) was MSI. Among those with RCT, 48.4% were RAS mutated, 22.6% were RAS/BRAF wild-type, and 29% were not tested. Among those with LCT, 41.5% were RAS mutated, 26.2% were RAS/BRAF wild-type and 32.3% were not tested. Among patients with LCT and wild-type RAS, only 16.6% received anti-EGFR therapy. Regarding the systemic treatments instituted, 80.2% of patients received chemotherapy (CT) with oxaliplatin, 45.8% received CT with irinotecan and 15.6% received isolated fluoropyrimidine. The median overall survival (OS) was 41 months. There was no difference in OS between patients with RCT and LCT (38 versus 43 months; HR = 0,88, CI 95% 0,56 - 1,40, p = 0,176). Conclusion: Most patients were between 50 and 69 years at diagnosis, reinforcing the need to invest in screening programs for this population. Understanding tumor biology implies better management of patients with mCRC. However, clinical applicability in the context of the Sistema Único de Saúde (SUS) is still limited.

Introduction: Pancreatic malignant neoplasms are among the most lethal forms of cancer. They are usually diagnosed late, as they do not have specific symptoms in the early stages. Since most of them are malignant tumors of the pancreas of the histological adenocarcinoma type, one of the malignant neoplasms with the worst prognosis is associated with different risk factors. Objectives: To describe the trends in the diagnosis of malignant neoplasia of the pancreas in Brazil between the period 2019 and 2023. Methodology: It refers to an epidemiological, quantitative, retrospective and descriptive study, based on information relating to CID C25 regarding cases of malignant neoplasia of the pancreas diagnosed in the period 2019-2023, available in the DATASUS database. The following were compared: sex, age, region of the country and cases per year. Results: Between 2019 and 2023, 21,749 patients were registered with malignant pancreatic neoplasia in Brazil. 2023 stands out with the highest number of cases, totaling 4,716 in the country. During the five-year period, 10,677 (49.09%) occurred in males, while 11,072 (50.91%) occurred in females. There were records in all age groups, however, the largest number of cases occurred in patients aged between 65 and 69 years (3,677 cases). A significant prevalence of cases was observed in the Southeast region with 9,281 cases, while the North region recorded only 709 cases, being the region with the lowest prevalence of the disease. Analyzing data from 2019 to 2023, a trend towards an increase in the number of reported cases is observed. Between 2019 and 2023, there was an increase in the number of cases in almost all regions of Brazil. In the North, cases rose from 107 to 173, while in the Northeast they went from 727 to 877. In the Southeast, cases increased from 1,728 to 2,001, and in the South, from 1,165 to 1,319. The only exception was the Central-West, where there was a slight reduction, from 401 to 346 cases. Conclusion: Demographic factors and access to healthcare influence the incidence of the disease. The high prevalence in the Southeast may reflect both population increase and better access to diagnosis. Due to the non-specificity of the symptoms, it is essential to inform the population to raise awareness of possible sufferers, reducing the incidence and improving the prognosis.

Introduction: Squamous cell carcinoma (SCC) in the oral cavity represents a significant burden of morbidity and mortality globally. The National Cancer Institute (INCA) estimates that annually, during the 2023/2025 triennium, approximately 15,100 new cases of oral and oropharyngeal cancer will be diagnosed in Brazil, 10,900 in men and 4,200 in women. What characterizes patients with oral cancer is that they are mostly men, with advanced diagnosis (stages III and IV), with low education, smokers and heavy drinkers. Objective: To analyze the specific survival at 1, 3, and 5 years of patients diagnosed in the oral cancer screening program of a reference institution in the years 2014 to 2022. Methodology: Retrospective study of oral cancer cases from the Hospital Cancer Registry (HCR) and cases diagnosed in the oral cancer screening program of the Barretos Cancer Hospital (BCH). The BCH oral cancer prevention program recruits the high-risk population of the 18 municipalities of the Regional Health District of Barretos, São Paulo. The high-risk population is smokers or former smokers who have quit smoking in the last 20 years, drinkers or former drinkers who have stopped drinking in the last 20 years, with a minimum age of 35 years or, regardless of the previous criteria, who have had an oral cavity lesion for at least 2 weeks, and invites them to participate in the prevention program. The sample consisted of 2401 cases of oral cancer, diagnosed from 2014 to 2022, of which 333 were diagnosed in the HCB screening program. The survival analysis considered death due to cancer to be censored, estimated from Cox's univariate analysis. Results: The patients in the HCR and the screening were, respectively: 77.1% and 83.5% men, with a median age of 60 years and 62 years, 89.4% and 87.1% with less than eight years of schooling. There was a difference in survival curves when comparing patients who were and were not diagnosed at screening (p<0.001). It is estimated that 85.8% of patients who were screened were alive at 1 year and 66.5% at 5 years, while patients who did not receive screening were alive at 1 year, 80.4% and 55.6% at 5 years (p<0.001). In Cox regression, those who were not diagnosed at screening were 1.45 times more likely to die. Conclusion: Oral cancer screening in the high-risk population can reduce mortality and increase patient survival.

BACKGROUND: Sarcoma is a heterogeneous group of cancers with varying prognoses and subtypes. From a genetic standpoint, it is equally diverse, ranging from simple chromosomal translocations to mutations in canonical drivers. OBJECTIVE: To describe the frequency of mutations in sarcomas and correlate them to the epidemiological profiles and prognosis of patients. METHODOLOGY: The research was conducted using the National Cancer Institute Genomic Data Commons (GDC) database, analyzing information related to the frequency of genetic mutations in 148 cases of soft tissue cancer (sarcoma). First, the genes and types of mutations - deletion, insertion, and substitution - were analyzed. Subsequently, a more specific search was conducted on the 4 genes with the highest number of cases to identify the type of cancer and analyze its statistics, including distribution by type of cancer, gender, age at diagnosis, and survival duration. RESULTS: A total of 20 genes were evaluated, with 233 variations identified across 148 cases, primarily through substitution (81%). In this study, 4 genes accounted for the majority of instances, with the predominant age range being 70–80 years. The TP53 gene (n=42, 28%) was associated with 15 cases of soft tissue tumors and sarcomas (35%), as well as myomatous, fibromatous neoplasms, and other types. Among the sarcoma cases, there was a higher incidence in males (n=9, 60%), with a 5-year mortality rate of 33%. Similarly, the MUC16 gene (n=20, 13.5%) was linked to 5 cases of soft tissue tumors and sarcomas (25%), with a predominance in females (n=3, 60%) and a 5-year mortality rate of 40%. In this context, the ATRX gene (n=20, 13.5%) was associated with 9 cases of soft tissue tumors and sarcomas (45%), mostly in females (n=7, 77%), with a 5-year mortality rate of 33%. Lastly, the RB1 gene (n=18, 12%) was associated with 3 cases of soft tissue tumors and sarcomas (16%), predominantly in females (n=2, 66%), with a 5-year mortality rate of 33%. CONCLUSION: The prognosis, expressed as 5-year mortality, was similar among the 4 genes highlighted in this study. Additionally, regarding sex predominance, only the TP53 gene had mutations that were more prevalent in men.

Glioblastoma is the most prevalent tumor of the central nervous system in adults and has a poor prognosis. Hypermethylation of the 06-methylganine-DNA-methyltransferase (MGMT) promoter gene is a predictive factor for response to treatment with temozolomide plus radiotherapy, in addition, it is a prognostic factor for progression-free survival and overall survival. Objective: To evaluate the cost-effectiveness of analyzing MGMT methylation in patients with Glioblastoma in the public health service in Brazil in November 2021. Method: Survey the cost of research into MGMT methylation in Brazil, and temozolomide in the treatment of Glioblastoma. Results and Discussion: The values for the MGMT methylation test varied between $176.43 and $772.74 depending on the laboratory researched and the method for carrying out the test. The price survey for the drug temozolomide on November 6, 2021 per tablet according to the dosage, between 5mg, 20mg, 100mg and 140mg ranged between $1.84 and $130.68. Considering a methylation rate of 45% and that in Brazil it is estimated 3840 methylated people/year. Based on a dose of 75mg/m2 per day for 30 days during radiotherapy and maintenance with 200 mg/m2/day, 5/28 days X 6 cycles. The average cost of treatment with individual temozolomide is $9920.99, totaling a global cost of $84,645,919.50, if all Glioblastoma patients are treated without the test. Taking into account that the average cost of the exam is $562.80, the investment is $4,801,872.54, generating a surplus to the public coffers of $41,747,430.50, without generating losses in the treatment of non-methylated patients, which has no indication of temozolomide. Conclusion: Routinely carrying out MGMT Methylation research is cost-effective in patients in the public health service in Brazil.

INTRODUCTION: The COVID-19 pandemic changed social dynamics and health activity, especially between 2020-2022, instituting serious restrictions on elective care, including temporary suspension of cancer screening services. Thus corroborating diagnostic delays, as well as more advanced stages at diagnosis and possibly therapeutic outcomes with lower response rates. OBJECTIVE: The study aims to assess the impact of the pandemic in relation to the delay in screening and diagnosis in patients with breast and cervical cancer in the 16th health region of the state of Rio Grande do Sul (RS) METHODS: Through descriptive, quantitative and retrospective analysis of observational data about the performance of mammography (MMG) and cervical cytopathological (CP) screening exams carried out in the 16th health region of the state of RS between 2018-2021, data collection was carried out through of the public BI Portal evaluating the number of preventive MMG and cervical CP exams carried out in the location between 2018-2021, according to the screening age group. After analyzing the regions integrative Hospital Cancer Registry database with a view to analyzing data on the diagnosis of breast and cervical neoplasia between 2018-2020. The study data were compared using analysis of variance followed by the Tukey test, with p<0.05 being considered a significant difference. RESULTS: In relation to the monthly average of mammograms performed, n:14.129, a significant difference was found between 2018 and 2020 and between 2018 and 2021. In 2018: 587,3±67,74, in 2020 only 284,8±194,2 p= <0.0001 and in 2021: 450,8±99,6, MMG p= 0.0218. The average monthly cervical CP exams in the period, n: 21,682, found a significant difference between 2018 and 2020, in 2018: 1063±388,7, in 2020: 565,6±388.8 p= <0. 0185 and in 2021 the data did not surpass pre-pandemic data. The monthly diagnostic values for neoplasms studied in the 2018-2020 period demonstrated great variability, making it impossible to relate the drop in screening exams with a diagnostic reduction, as well as the time to diagnosis and initiation of treatment with no significant difference. CONCLUSION: Therefore, the lack of correspondence between the reduction in screening exams and the number of diagnoses in relation to the period and population studied does not mean that there has not been changed at a global level. Therefore, many studies are needed to elucidate the real consequences associated at a global level.

Introduction: Cancer mortality is a key public health indicator, reflecting both the effectiveness of prevention and treatment strategies and the socioeconomic conditions of a population. In the state of Espírito Santo, analyzing cancer mortality patterns is crucial for understanding local disease dynamics and guiding more effective health policies. Objective: To measure the types of neoplasms with the highest incidence of deaths by sex in the state of Espírito Santo from 2019 to 2020. Method:This is an ecological, cross-sectional, descriptive study with a quantitative approach. The study was conducted in August 2024, based on data provided by the State Health Department of Espírito Santo (SESA) through the technology of the Department of Informatics of the Unified Health System (DATASUS). The variables used were: primary location of neoplasms, sex, and deaths in the years 2019 and 2020. The collected data were structured and analyzed using descriptive statistics in Microsoft Excel, through spreadsheets. Results: During the analyzed period, 4,073 patients died from cancer in Espírito Santo between 2019 and 2020. The analysis by sex showed a predominance of males, with 2,256 deaths, accounting for 55.3% of the total sample. Bronchus and lung cancer presented the highest number of combined deaths among genders, totaling 974 (23.9%), followed by breast cancer in women with 680 deaths (16.5%) and prostate cancer in men with 623 deaths (15.2%). Cervical cancer, exclusive to women, accounted for 296 cases (7.3%). Another type of cancer with a high incidence in both men and women was stomach cancer, with 624 deaths (15.3%). Esophageal and liver cancers had a high prevalence in men, totaling 389 (17.2% of cancer deaths in men) and 243 (10.8% of cancer deaths in men) deaths, respectively, exclusively in men. Finally, colon cancer was responsible for the deaths of 244 women during the period, representing 7.44% of female cancer deaths. Conclusion: The study revealed a high cancer mortality rate during the analyzed period, with the highest number of deaths occurring among males. Bronchus and lung cancer were responsible for the highest number of combined deaths among sexes, and were the leading cause of death among males, while breast cancer was the leading cause among females. Understanding these epidemiological variables is of utmost importance for the development of appropriate public policies for promotion, prevention, and management.

Approximately 10-30% of cancers have a hereditary basis, influenced by germline genetic mutations that cause specific familial patterns of neoplasms. There are over 200 hereditary cancer predisposition syndromes associated with more than 400 genes, most of which are autosomal dominant in inheritance. The identification of hereditary cancers is based on pedigree analysis and genetic testing, with family history playing a crucial role in distinguishing between sporadic and hereditary cases. Various mathematical models, such as Gail, BOADICEA, BRCAPRO, and PREMM, have been developed to predict cancer risk based on family history. Mendelian models and artificial intelligence (AI) tools have also been applied to calculate genetic risks. This study proposes to develop an oncogenetic screening tool using AI to distinguish sporadic from hereditary cases in a cohort of Brazilian patients. The Department of Oncogenetics of the A.C. Camargo Cancer Center, with a digital database containing family histories and genetic tests of over 3,000 patients, in collaboration with the AI expertise of INSPER’s Engineering department, has been working on developing this tool, named the Oncogenetic Risk Calculator. The goal is to create a highly sensitive and specific Brazilian risk calculator to differentiate hereditary cancers from sporadic ones, which can be used for high-risk population screening. The initial prototype (training set) used the clinical data of 3,340 patients and their first-degree relatives, with a Machine Learning algorithm that showed moderate performance. The next step will be to incorporate oncological data from second-degree relatives and then validate the algorithm in a real-world setting (testing set) across different populations.

Hypothalamic Hamartoma (HH) is a tumor-like, rare congenital non-progressive lesion in the base of the brain, the hypothalamus, arising from the tuber cinereum. This type of lesion is a complex neuroendocrine disease that can cause seizures, behavioral problems, and the main purpose of this study: early onset of puberty. Nearly 95% of Hypothalamic Hamartomas cases are isolated lesions, although an association with Pallister-Hall syndrome has been described. HH occurs in nearly 1 to 100,000 children, with a slight predominance in males, and the lesion has no association to ethnicity. This study aims in finding the consequences of Hypothalamic Hamartomas related to hormonal changes which induce central precocious puberty. This study consists of a Literature Review, gathering pertinent articles and chapters from the last 15 years. The bibliographic research includes articles and chapters written in English, selected according to their relevance. A hypothalamic hamartoma consists of clusters of small neurons mixed with glia and large neurons and is a non-neoplastic mass lesion located in the hypothalamus that can cause gelastic seizures and/or central precocious puberty (CPP). The hypothalamus and pituitary glands are the “master glands” that control the initiation of puberty. The hypothalamus stimulates the pituitary gland to secrete LH and FSH by releasing gonadotropin-releasing hormone (GnRH), that stimulates the gonads to produce sex steroids (estrogen and testosterone) which will lead to physical changes of puberty. Hypothalamic hamartoma lesions may lead to secretion of GnRH before the normal time, escaping the body’s mechanism to inhibit central precocious puberty. Brain MRI (with or without contrast) is the gold standard for diagnosis of HH. To avoid misdiagnosis, the radiologist should be notified to focus on the hypothalamic region. The goal of treatment for CPP in HH is suppression of pubertal maturation and improvement of final height. To suppress puberty, Leuprolide acetate inhibits the releases of GnRH that triggers puberty. Although HH can be treated with medication, the gold standard treatment is open surgical resection of the hamartoma, since it provides the best outcome among other options. Central precocious puberty is a consequence of hypothalamic hamartomas. It is a rare, congenital lesion that can lead to severe complications in the future, such as gelastic seizures. Therefore, it should be treated as soon as possible.

Over 300,000 women worldwide die from cervical cancer each year. Mortality rates are nearly five times higher in low- and middle-income countries of Latin America compared to high-income regions of the world. The present study aimed to identify the profile of the cervical cancer population entering a Unified Health System (Sistema Unico de Saude; SUS) Oncology Service in the city of Rio de Janeiro, Brazil, and estimate the percentage of deaths that occurred during the evaluated period. Patients with cervical cancer diagnoses confirmed by histopathology and immunohistochemistry between January 2022 and September 2023 were included in the study. Patient data were recorded in Microsoft Excel spreadsheets and analyzed for the frequency of observed variables. The percentage of deaths during the studied period as well as complications resulting from advanced cancer were recorded in February 2024. The study included 21 patients with cervical cancer diagnoses confirmed by histopathology. The average age of the patients was 45 years. Squamous cell carcinoma was the most prevalent histopathological type (85.7%) followed by adenocarcinoma (14.3%) (p= 0.0023). The majority of patients were stage III (66.6%); the remaining patients were stage II (19%), stage IV (9.5%), and stage I (4.7%) (p= 0.0001). All patients underwent chemotherapy and radiotherapy. Regarding complications from advanced cervical cancer, 23.8% of patients developed acute renal failure, and most (80%) required nephrostomy. Approximately 10% of patients developed rectovaginal fistula, and another 10% presented with malignant hypercalcemia. Five patients (23.8%) died during the studied period: two from malignant hypercalcemia, one from acute renal failure, and the remaining two had neither complication. Cervical cancer remains a major public health challenge despite being considered a preventable and treatable disease. The long natural history of the human papillomavirus (HPV) carcinogenesis offers a window of opportunity for disease prevention, and prophylactic vaccination can reduce the incidence of causal infections. In addition to preventive and educational measures essential for disease control, facilitating access of patients with confirmed diagnoses to specialized health services is crucial to promote the earliest possible cancer treatment.

Introduction: In solid and hematological neoplasms, at any stage of the disease, pain is a substantial public health problem worldwide. Its prevalence is 64% in patients with metastatic, advanced or terminal disease and 59% in patients undergoing antineoplastic treatment. Managing this type of pain is a challenge for health professionals, and the World Health Organization's analgesic ladder is a useful tool for this purpose. Opioids are the mainstay of treatment for this type of issue. Therefore, opioid turnover should be seen as an essential activity for better optimization of analgesia and reduction of adverse effects resulting from their use. Objective: Analyze the profile of opioid use for managing cancer pain in hospitalized patients in a highly-complex oncology unit. Methods: A cross-sectional study with retrospective data collection from July 2023 in the medical clinic of a public hospital qualified as an oncology unit. The study began after approval by the local Research Ethics Committee (CAAE: 78810624.4.0000.5243). The opioid prescriptions of advanced-stage cancer patients were identified manually and analyzed using eletronic medical record data. The data was analyzed according to World Health Organization's opioid switch criteria of the analgesic ladder and descriptive statistics were used to understand the usage profile. Results: The most prescribed opioid was tramadol representing 53.12% of prescriptions, even though weak opioids are considered second-line for this management. Of the 45 inpatients during the month, 5 reached the maximum dose of tramadol, but only 4 did the turnover to morphine. These patients spent an average of 6 days using tramadol at the maximum dose, even though there are studies showing the reliability of using low doses of morphine to manage mild to moderate pain instead of weak opioids. Conclusion: The dose of opioids is influenced by the intensity of pain, but should be adjusted to balance pain relief and adverse effects. Lower doses of the representatives of the third level of the ladder have advantages over high doses of the second rung, in some cases. Evaluating the prescription of opioids according to the World Health Organization's analgesic ladder is an important strategy to help avoid adverse reactions and prevent the undertreatment cancer pain in order to contribute to increasing the quality of life of cancer patients.

Introduction: Breast cancer (BC) is a leading cause of cancer-related morbidity and mortality in women globally. The HER2+ and triple-negative (TN) subtypes exhibit distinct biological behaviors and treatment outcomes. With rising obesity rates, it is crucial to understand how obesity affects treatment responses in these hormone-negative subtypes to improve patient management. Objective: This study aims to compare demographic characteristics, tumor features, and treatment outcomes between HER2+ and TNBC patients, focusing on the impact of obesity on treatment efficacy. Methods: This retrospective analysis included women with histological diagnoses of BC treated at a SUS hospital in São Paulo from June 2016 to June 2023. Participants aged 18 or older, diagnosed with TNBC or HER2+ who received neoadjuvant chemotherapy were included. Data were collected from electronic medical records with approval from the Research Ethics Committee. A total of 76 HER2+ and 160 TN patients were included. Clinical and histopathological data included menopausal status, age, ethnicity, tobacco and alcohol consumption, number of births, and body mass index (BMI ≥ 30). The analysis assessed surgery type (mastectomy vs. quadrantectomy), radiotherapy (yes/no), and chemotherapy response (complete pathologic response [PCR] vs. residual disease), along with tumor stage, nodal stage, presence of metastases, histological type, and Ki67 expression. Results: The HER2+ group demonstrated a higher PCR rate of 44.7% compared to 33.1% in the TN group (p = 0.0075). Mastectomy was performed in 57.9% of HER2+ patients and 45.6% of TN patients (p = 0.6288). Among obese patients, those with HER2+ (n=27) had a higher mastectomy rate (63.0%) than TN patients (n=54) at 40.7% (p = 0.0979). Significant differences in radiotherapy were noted, with 74.1% of obese HER2+ receiving it versus 96.3% of TN patients (p = 0.0053). PCR in obese HER2+ patients was 66.7%, higher than 35.2% in obese TN patients (p = 0.0096). Conclusion: This study reveals significant differences in treatment responses and surgical decisions between HER2+ and TNBC patients, especially regarding obesity. Understanding the impact of obesity on treatment outcomes in these hormone-negative subtypes is vital for tailoring individualized treatment plans. Future research is needed to explore the relationship between obesity and treatment efficacy in these BC subtypes.

Introduction: Chemotherapy is a cornerstone in cancer treatment, yet its systemic and nonspecific nature often leads to significant adverse reactions. Objective: This study aimed to characterize immediate adverse reactions to chemotherapy infusion and to understand patient perceptions of these events. Method: From June 2023 to March 2024, adult outpatients receiving intravenous chemotherapy who experienced immediate adverse reactions to chemotherapy infusion were recruited (Ethics committee approval CAAE 69885623.3.0000.5153). Data were collected via structured patient interviews using a specific form, with reactions classified by severity (CTCAE) and causality (Naranjo algorithm). Follow-up interviews assessed patients' perceptions during subsequent treatment sessions. Results: A total of 71 immediate adverse reactions to chemotherapy infusion episodes were documented among 67 patients, predominantly female (85%), with an incidence of 0.19%. The primary diagnoses were breast (37.31%) and colon cancer (13.43%). Oxaliplatin (23%) and paclitaxel (21%) were the most frequently associated chemotherapeutic agents. Cardiovascular (30%) and respiratory (23%) symptoms were most common. Reaction severity ranged from mild (42.2%) to moderate (28.2%), necessitating corrective measures in all cases. According to the Naranjo algorithm, 79% of reactions were possibly linked to chemotherapeutic agents. A significant association was found between patient skin color and reaction severity (p=0.021), as well as between the chemotherapeutic agent classes and the number of signs and symptoms (p=0.015). Notably, 57% of patients expressed fear of future immediate adverse reactions to chemotherapy infusion episodes. Conclusion: In conclusion, while immediate adverse reactions to chemotherapy infusion to infusion were rare and typically mild to moderate, cardiovascular and respiratory symptoms were most prevalent. The patients' reported fear of future immediate adverse reactions to chemotherapy infusion episodes highlights the importance of improving communication and providing psychological support during treatment.

Increased leukocyte infiltration in the tumor microenvironment (TME) is significantly associated with improved prognosis and response to treatment in Head and Neck Squamous Cell Carcinoma (HNSCC). There is evidence that the association with prognosis depends not only on the number of infiltrating cells, but also on the cell type and phenotype. Infiltration of leukocytes in the TME is largely dependent on the chemokines and chemokine receptors expressed by neoplastic/stromal cells and leukocytes, respectively. Increased CCR4/CCL17 interactions are associated with greater infiltration of pro-tumoral M2-like macrophages, Tregs and Th2 cells and worse prognosis and poor response to treatment. The CCR5/CCL5 interaction is involved in the anti-tumoral response, as CCL5 can be secreted by M1-like (anti-tumoral) macrophages and attract Th1 and NK cells. In this study we assess the expression of selected chemokines and chemokine receptors in the TME of HNSCC and verify its association with tumor aggressiveness according to clinical TNM staging. Expression of CCL2, CCR2, CCL4, CCR4, CCL5, CCR5, CCL17, and CCL20 was determined by RT-qPCR in 47 cases of HNSCC treated at the Santa Casa of Araraquara Hospital (CONEP CAAE 53343421.0.0000.5416 ): 42 men, 7 women, 82,97% smokers, T1/T2=26, T3/T4=21, Nx/N0=18 and N1/N2/N3=29. Total RNA was extracted from surgical specimens and used for cDNA synthesis. The cDNA was used in qPCR reactions using the SYBR Green system and specific primers, with HRPT1 as the normalization gene. Expression of CCL2 (p=0.02) and CCR2 (p=0.03) was increased in tumors without nodal invasion, possibly indicating reduced aggressiveness. CCR4 expression was greater (p=0.0232) in smaller tumors, but there was difference regarding the presence of nodal invasion (p=0.2069). Expression of CCL20, CCL4, CCL5 and CCR5 were not significantly different when tumors were grouped by size or by presence of nodal invasion. There was a tendency for lower CCL17 expression, which may attract Treg cells, in more aggressive tumors with nodal invasion (p=0.0914). This data will be subsequently explored with the prevalence of infiltrating M1, M2 macrophages, as well as CD8+, CD4+ T and FOXP3+ Treg cells, but it supports the relevance of chemokines and chemokine receptors in shaping leukocyte infiltration in HNSCC tumor microenvironment. The data indicates that increased expression of CCL2 and CCR2 are associated with less aggressive HNSCC in this cohort of HNSCC patients.

Background: Pancreatic adenocarcinoma (PDAC) treatment remains a challenging problem. Although adjuvant chemotherapy is the gold standard in resectable disease, neoadjuvant have been investigated in recent trials. Also, it is known that 6-months of treatment is used in most adjuvant trials. However, it is a debate concerning the best strategy. This study aimed to assess the association of chemotherapy duration, treatment strategy (neoadjuvant vs adjuvant) in resected PDAC patients. Methods: This was a retrospective chart review of non-metastatic PDAC patients that were treated with surgery and received chemotherapy (neoadjuvant or adjuvant ) from January 1, 2019 through December 31, 2023 at AC Camargo Cancer Center. We analyzed the treatment duration (≤3 vs >3 months), treatment strategy (neo vs adjuvant) and others clinical-treatment features (ECOG, resectability classification, initial Ca19-9 levels). The primary endpoint was overall survival (OS). Cox regression multivariable analyses for OS was performed to adjust for prognostic variables in PDAC. Results: We included 86 patients in the study, in which 77.9% were classified as resectable, 24.1% had Ca19-9 levels>500 and 33.8% were ECOG 1/2. Chemotherapy duration ≤3 months occurred in 15.1%, FOLFIRINOXm was used in 74.4%. Concerning treatment strategy, patients received neoadjuvant (47.8%), adjuvant (37.5%) and perioperative (14.7%). Median follow-up time was 32.5 months. Overall survival was 39 months (95% CI: 31.9-46.1). Patients who received less than 3 months of chemotherapy had inferior survival (29.0 vs 48.0 months, P=0.01) compared to >3 months. Regarding FOLFIRINOX chemotherapy, patients who received neoadjuvant treatment had inferior prognosis compared to adjuvant FOLFIRINOX (37.0 vs 65.0, P=0.02). Neoadjuvant therapy was not associated with positive margins or post-operative complications. In Cox multivariate analysis (adjusted for ECOG, resectability classification, Ca19-9 levels), adjuvant FOLFIRINOX compared to neoadjuvant FOLFIRINOX was associated with 69% reduction in risk of death (95% CI: 0.09-0.95); regarding chemotherapy duration, patients who performed > 3 months had 88% reduction in risk of death (95% CI: 0.08-0.73). Conclusions: In this retrospective unicentric analysis in non-metastatic PDAC patients who were submitted to surgery the duration of total chemotherapy ≤3 months and neoadjuvant FOLFIRINOX were associated with worst survival.