Trabalhos Científicos

Background: Colorectal cancer is the third most common neoplasm, being treatable and potentially curable if diagnosed early. Adjuvant chemotherapy with oxaliplatin is debated for patients with stage II colon cancer with poor prognostic features such as obstruction or perforation, stage T4, resection of less than 12 lymph nodes, unfavorable histology. Objective: To evaluate the effectiveness of adding oxaliplatin to adjuvant chemotherapy in patients with stage IIA colorectal adenocarcinoma with less than 12 resected lymph nodes, IIB and IIC, given the controversy in the literature. Methods: An observational, analytical, retrospective cohort study was conducted. Data were obtained from medical records of two oncology hospitals in São Paulo, Brazil. Patients diagnosed with colorectal adenocarcinoma were eligible; ECOG 0 to 2; stage IIA with less than 12 resected lymph nodes, IIB and IIC, submitted to curative surgery; distal tumor more than 12 cm from the anal verge by endoscopy and/or above the peritoneal reflection at surgery; absence of gross or microscopic evidence of residual disease after surgery. The primary endpoint was progression-free survival (PFS), and the secondary endpoint was overall survival (OS). Results: From 2014 to 2020, 32 eligible patient records were identified. Of these, the median age was 65 years, 53.1% men and 68.8% with ECOG 0. The left colon was the predominant location (28.1%), rectosigmoidectomy the most common surgery (43.8%) and 28.1% had less than 12 resected lymph nodes. Recurrence occurred in 28.1%, mainly in the lungs (12.5%). Most received adjuvant chemotherapy with oxaliplatin (62.5%). Survival analysis showed a median PFS of 70.9 months and OS greater than 105 months from the start of treatment. There was no significant difference in PFS between patients according to the number of resected lymph nodes, or in OS between those using oxaliplatin or not. Conclusion: Adjuvant oxaliplatin increases disease-free survival and overall survival in patients with colorectal adenocarcinoma EC IIA with less than 12 resected lymph nodes, IIB and IIC, although there is a need for controlled and prospective studies as it was noted that the literature is still is not unanimous as to the results.

Introduction: Pancreatic cancer ranks 14th among the most common types of cancer in Brazil. In 2021, it was the 5th and 7th cancer with the highest mortality in women and men respectively. Objective: To analyze the epidemiological profile and incidence rate of pancreatic cancer in Brazil from 2013 to 2023. Methods: This is an ecological, quantitative and descriptive study on cases of pancreatic cancer in the period of 2013-2023 in Brazil. Data was obtained through DATASUS. Sex, age group, region and staging were analyzed in relation to CID 10 C25. Incidence rates were calculated based on data from the Population Projection of Brazil by sex and age for the period 2010-2060 (2018 edition), available through IBGE. Results: In the period analyzed, 34,144 new cases of pancreatic cancer were recorded, of which 49.7% were men and 50.3% were women. The number of cases increased during the period analyzed, with 1,752 cases in 2013 and 4,716 cases in 2023. The age groups with the highest number of cases were 60-79 years old (55.0%) and 40-59 years old (35.6%). Most of the diagnoses described were clinical stage IV (40.4%), III (11.0%), II (5.3%) and I (2.1%). However, 39.4% of diagnoses were staged as unknown (21%) or not applicable (18.4%). The incidence of pancreatic cancer in Brazil increased in the period analyzed, from 0.88 cases per 100,000 inhabitants in 2013 to 2.2 cases per 100,000 inhabitants in 2023. The incidence rate increased in all variables evaluated. In the analysis by gender, there was a similar increase in the incidence of both genders during the period analyzed. In the analysis by age group, the 60-79 age group stands out, with an increase from 4.67 to 9.48 cases per 100,000 inhabitants. Conclusion: The incidence of pancreatic cancer in Brazil increased during the period analyzed. The incidence was similar between genders but was higher in the 60-79 and 80+ age groups. Other Brazilian and global analyses also showed an increased incidence in older patients, but there were differences in relation to gender (some with no difference between genders and others with a higher incidence in women). The underreporting of Brazilian data regarding cancer and the use of a projection of the Brazilian population to calculate the incidence represent limitations of our study. Due to the increased incidence of pancreatic cancer, normally diagnosed at advanced stages and high mortality, it is urgent to improve screening and earlier diagnosis.

Introduction: Melanoma is a skin cancer originating in melanocytes. Its clinical characteristics are asymmetric lesions with irregular edges, variable color, diameter greater than 6 mm, and rapid changes in their characteristics. Some of its risk factors are excessive exposure to the sun and previous or family history of skin cancer. Melanoma can cause metastasis to lymph nodes, lungs, and brain even when the epithelial lesion is small, which increases the chance of later diagnosis and worse prognosis. Objective: To analyze the increase in the number of deaths from melanoma in Brazil between 1996 and 2022. Method: This is a descriptive epidemiological study of the type of survey, using data from the Mortality Information System (SIM) available in the SUS database, TABNET. We collected data about the deaths caused by melanoma (CID C43) considering Brazilian federal units and regions, gender, ages, race/skin color, and education from 1996 to 2022. We correlated this data with the number of inhabitants according to the Brazilian Institute of Geography and Statistics. We analyzed the data through descriptive statistics through proportional distribution per 100.000 inhabitants. Results: The average mortality rate from melanoma in Brazil between 1996 and 2022 was 19.79. Males had a higher mortality rate in all years, federative entities, color/race, and age group (23.15). However, when analyzing the number of deaths (ND) in patients without education, females were higher (54%). The average female mortality rate was 16.57. Mortality increases with age, reaching 238 in patients aged 80 or over. The white race had the highest mortality rate (32.56), followed by yellow (7.46), black (5.72), brown (5.17), and indigenous (2.19). Mortality in 2022 increased by 181% compared to 1996. White color/race had a peak of ND in the range of 4 to 7 years of education, while black and brown in the range of 1 to 3 years. The region with the highest ND was the Southeast (47%), followed by the South (34%), Northeast (12%), Central-West (5%) and North of Brazil (2%). Conclusion: There was an increase in melanoma mortality over these 27 years in Brazil. This study identified the level of education and race as vulnerabilities to death, as well as the relationship between the female gender and lack of education. These topics can be better explored in new studies. There is a necessity for a greater investment in public policies with an emphasis on early diagnosis and treatment.

Introduction: Tongue cancer is considered a malignant neoplasm of the head and neck, with squamous cell carcinoma being the most common histological type. Major risk factors include smoking and excessive alcohol consumption, with a lesser incidence associated with human papillomavirus (HPV) infection and poor oral hygiene. Initial symptoms are often subtle and may include a non-healing sore, dysphagia, and local pain. Objective: Analyze the number of deaths due to tongue cancer in Brazilian regions between 2015 and 2022, emphasizing the distribution by gender and age group. Methods: An ecological study on the number of deaths from tongue cancer between January 2015 and December 2022, based on data from the Mortality Information System (SIM) on the website of the Department of Informatics of the Unified Health System (DATASUS). The selected variables were: Gender, age group, region, deaths by residence, ICD-10 C01 (Malignant neoplasm of the base of the tongue), and C02 (Malignant neoplasm of other and unspecified parts of the tongue). Results: During the analyzed period, 14,928 deaths from tongue cancer were recorded, with the majority registered in the Southeast region (51.53%), followed by the Northeast (22.64%), South (15.76%), Midwest (6.04%), and North (4.03%). From 2015 to 2022, the number of deaths rose by 13.46%. Mortality was more pronounced in males (78.49%). Regarding age group, the peak of deaths was recorded in the group that is between 50 and 69 years old (58.44%), followed by those older than 70 years (28.47%), and finally, those younger than 40 years (13.02%). Conclusion: The rising number of deaths from tongue cancer poses a significant challenge in head and neck oncology due to the difficulty of early diagnosis, given its often subtle initial symptoms. The Southeast region experiences the highest number of deaths, likely due to its dense population and metropolitan lifestyle. The higher mortality rate among males may be linked to their greater use of tobacco and alcohol. Most deaths occur in individuals over 50 years old, probably due to prolonged exposure to risk factors. This highlights the need for effective preventive strategies and public awareness to improve early diagnosis and reduce mortality rates.

Introduction: Work-related cancer encompasses all neoplasms caused by exposure to risk agents and situations in the work environment and processes, even after exposure has ceased. In Brazil, this cancer is compulsorily notifiable in the Notifiable Diseases Information System, in accordance with the regulations of the Unified Health System, as part of a national policy aimed at workers' health. Objective: To describe the profile of work-related cancer cases notified in Brazil in 2022. Method: This study describes the profile of work-related cancer cases notified in Brazil in 2022, based on data provided by the Department of Information and Informatics of the Unified Health System. The analysis considered variables such as age, diagnosis, race, gender and occupation, with data organized in Excel tables. Results: In 2022, Brazil recorded 206 cases of work-related cancer, with men predominating (66%) in relation to women. The racial distribution showed that 57% of cases affected whites, 33% browns and 6% blacks. Among whites, the most common neoplasms were skin and breast (14% each). Between brown people, malignant neoplasms of the bronchi and lungs predominated (13%). Among blacks, malignant neoplasms of the bronchi and lungs and the prostate were equally frequent (15% each). The occupations most affected were agricultural workers (36 cases), agricultural producers (26 cases) and bricklayers (19 cases). In the middle of agricultural workers, skin neoplasms (19.4%) and non-Hodgkin's lymphomas (13.9%) were most common. Farmers had leukemia (15.4%) and prostate cancer (7.7%). Bricklayers had a high prevalence of neoplasms of the skin (26.3%) and bronchi and lungs (10.5%). Exposure to UV rays, benzene, formaldehyde, DDT, diazinon, glyphosate, malathion, soot, silica and tar are associated with these cancers. Conclusion: Underreporting is a challenge for understanding the problem and formulating effective public policies. It is crucial to integrate information on occupations and exposures into patient anamnesis to improve case detection and prevention, facilitating the creation of more effective public health strategies.

Introduction: Pancreatic neoplasia, although rarely covered by the media, is highly lethal and ranks among the top five causes of cancer-related death. Its pathophysiology is still uncertain, but known risk factors include smoking, diabetes, aging, obesity, and genetic predisposition. Diagnosis often occurs at advanced stages due to the lack of early symptoms and the location of the organ. Its morbidity and mortality are higher in developed regions, and in Brazil, its incidence has been rising in recent decades, becoming an increasing public health concern. Objective: Evaluate the rates of malignant pancreatic neoplasms in the Southeast region of Brazil in a four-year period. Method: Descriptive and quantitative epidemiological study using data from the SUS Department of Informatics (DATASUS) from 2019 to 2022. Deaths due to malignant pancreatic neoplasms in the Southeast region were analyzed, along with initial incidence data by gender obtained from the National Cancer Institute (INCA). The analysis was conducted using Microsoft Excel. Results: From 2019 to 2022, there were 24,050 deaths due to malignant pancreatic neoplasms in the Southeast region, representing nearly 50% of the total deaths from this disease in the country during that period (48,322 deaths). There was a progressive increase in deaths in the region, from 5,913 in 2019 to 6,278 in 2022. Higher mortality was observed among women, with a continuous rise until 2022 (3,173 deaths), while among men, there was a slight fluctuation, with a decrease from 2,916 deaths in 2019 to 2,809 in 2020, followed by an increase to 3,105 deaths in 2022. These data highlight the epidemiological complexity of pancreatic carcinoma and the importance of surveillance and prevention. Conclusion: The analysis of pancreatic carcinoma deaths in the Southeast between 2019 and 2022 represents nearly half of all deaths from this disease in Brazil. Higher mortality was observed among women, while the rates among men showed variations. The consistent rise in deaths highlights the need for increased investment in further research to better understand the determining factors and to develop more effective therapeutic approaches. Therefore, it is crucial to strengthen screening policies and implement preventive measures, with a greater focus on the Southeast region, and also to adapt them to gender variations and regional disparities to improve clinical management and the overall landscape of pancreatic cancer in Brazil.

INTRODUCTION: Myelodysplastic syndromes (MDS) are a diverse group of clonal disorders that affect hematopoietic progenitor cells, with a risk of developing into acute myeloid leukemia. Although rare, affecting 4.46/100,000 inhabitants/year in Brazil, their high incidence in the elderly highlights the importance of epidemiological studies for a comprehensive view of MDS. It is therefore crucial to know the epidemiological profile of MDS in Brazil between January 2014 and June 2024. Aim: To analyze the epidemiological profile of myelodysplastic syndromes in Brazil between January 2014 and June 2024. METHODOLOGY: This descriptive observational study collected data on MDS from Informatics Department of the Unified Health System (DATASUS), organized by region and variables such as number of annual diagnoses (2014-2024), sex, age group (0-19, 20-39, 40-59, 60-79, 80+), and treatment modalities (surgery, chemotherapy, radiotherapy) and their duration (up to 30 days, 31-60 days, or more than 60 days). Diseases other than MDS were excluded. RESULTS AND DISCUSSION: From January 2014 to June 2024, 9,506 MDS cases were diagnosed, with 5,218 receiving treatment. The incidence was higher in the Southeast, South and Northeast. Treatment rates were lower than diagnosis rates in the South (1,364 diagnosed vs. 1,326 treated) and Midwest (301 diagnosed vs. 351 treated). By age group, the majority of diagnoses occurred in people aged 60-79 (4837), followed by 40-59 (1968), over 80 (1363), 0-19 (677), and 20-39 (661). Chemotherapy was the most common treatment (5,157 cases), with few surgeries (30) and radiotherapies (31). Most treatments lasted up to 30 days (2276), followed by more than 60 days (2080), and between 31-60 days (862). In 4288 cases, no modalities or durations were reported. The number of diagnoses in women was higher in all regions, with 4916 compared to 4590 in men. The higher incidence in the elderly aligns with expectations, but the gap between diagnosed and treated cases suggests a need for better post-diagnostic follow-up and early diagnosis practices. CONCLUSION: There is a need for earlier investigative practices and better post-diagnostic approaches to cover patients with MDS in the public health system, ensuring access to specialized services. Attention to aging as a risk factor, as well as regional and gender disparities, is essential to optimize diagnosis.

Introduction: The lack of data collection on Sexual Orientation and Gender Identity in health instruments makes it difficult to assess the real impact of cancer on the transgender and LGBTQIAPN+ population. However, there is evidence that trans people disproportionately face cancer risk factors. The lack of adequate screening, combined with the increase in these factors, results in a higher incidence of diagnoses in advanced stages, harming the health prognosis of this marginalized population. The biggest challenge for the LGBTQIAPN+ population without access to healthcare is the fear of discrimination by professionals, often based on negative experiences. The literature points to the lack of cultural competence of health professionals in dealing with sexual and, above all, gender minorities. Objective: To map the evidence available in the literature on the instruments/methodologies used to assess the knowledge of health professionals about oncological care for the transsexual people. Methods: A scoping review was conducted following the JBI methodology. The search for studies took place in 2023 and was conducted in seven databases, including studies that answered the question: “What is the level of knowledge of health professionals about oncological care for the transsexual people?” Results: 41 articles were selected that specifically addressed the knowledge of health professionals in caring for the LGBTQIAPN+ population, with a special focus on the trans population. Among them, 18 studies evaluated patients' perception of professionals' knowledge, while others used their own instruments to evaluate considering the global context of LGBTQIAPN+ health. Conclusion: There is no validated instrument to measure the knowledge of health professionals about oncological health aimed at the transsexual people, which highlights the need to develop and validate an instrument targeted at needs.

Palliative Care (PC) is an approach that aims to provide quality of life and prevent the patients and family members suffering in the face of life-threatening conditions, understanding the patient as a biopsychosocial being and integrating physical, social, psychological and spiritual. Despite the movement in favor of implementation of PC, there are still significant challenges to its integration into clinical practice, due to the lack of specialized professionals, resources limitations and the negative stigma that associates PC exclusively with death. Objective: To demonstrate the positive impact in quality of life and survival of cancer patients when undergoing early PC integration on the treatment. Methods: It’s a literature research in which the following health descriptors were searched at PubMed and SciElo: “palliative care”, “advanced cancer”, “early integration”, “quality of life”. 148 results were found through PubMed and 16 through SciElo. After an individual analysis based on the inclusion criteria: scientific articles related to the theme; studies published from 2017 to 2024; in portuguese (BR), and the exclusion criteria: duplicated articles; unfinished articles; paid articles and the ones that did not breach the selected theme, 112 articles from PubMed and 16 from SciElo were included in the study. Results: The early approach of PC, done up to 8 weeks after the diagnosis, can decrease the symptomatology in patients (5,6,7,9,12,13); decrease psychosocial suffering and improve quality of life; besides increasing survival rates (9,11). The efficient communication and the educational support are essential to better the involvement of patients and shared decision making (18). However, the failure of health care professionals in knowing the ideal time to implement this treatment and transmitting an end-of-life connotation to the patient, causing them to not adhere to PC, is the main hindrance to carrying out this early care (2,5,7). Conclusion: According to the analyzed literature, the early implementation of PC in cancer patients is responsible for a reduction in psychosocial suffering, improvement in quality of life and symptom relief, in addition to providing an increase in survival. Thus, the need to introduce this approach early is evident, in addition to a clear and informative conversation with the patient and their family about the credibility and advantages of Palliative Care is important.

Introduction: In December 2019, the SARS-CoV-2 virus and the disease it caused called COVID-19 were identified in China, generating a global pandemic. The severity of the pandemic and the exhaustion of health services required the prioritization of urgent and emergency surgeries and the suspension of elective surgeries, minimizing the spread of COVID-19. Interrupting cancer surgeries poses a potential risk to patients and studies remain scarce. Objective: To analyze the impact of the COVID-19 pandemic on surgical patients with gastrointestinal cancer treated by the Unified Health System SUS in a Tertiary Hospital in the South of Brazil in the year 2020 (COVID-19 Pandemic) compared to the year 2019 (pre pandemic). Materials and methods: Cohort study that evaluated adult patients with gastrointestinal tumors who underwent surgery between the pre-pandemic and pandemic periods. Results: 372 patients with gastrointestinal cancer who underwent surgery were included, of which (54%) during the pandemic and (46%) pre-pandemic. There was a 14% increase in emergency surgeries (P = 0.001); 11% reduction in the need for an intensive care unit (p= 0.034) and a 7-day reduction in hospital stay (P=0.003) during the pandemic, with no impact on 30-day mortality, general mortality or advanced cancer. SARS-CoV-2 infection had a rate of 11.9%, these had a higher overall mortality rate (8 [33%] positive vs 8 [8%] negative, P = 0.003), 30-day mortality (6 [25%] %] positive vs 5 [5.2 %] negative, P = 0.008), and length of stay (mean 57.38 ± 69.47 days for positive vs 30.24 ± 23.91 for negative, P = 0.008). Conclusions: There was no significant impact of the pandemic on overall and 30-day mortality or on the incidence of advanced cancer. We suggest not suspending oncological surgeries during pandemics.

Introduction The insertion of biosimilars as a treatment option for complex diseases has brought a number of benefits, such as cost reduction and increased access to effective therapies. However, it has also raised important and challenging questions, both from a regulatory and clinical standpoint, such as interchangeability. Currently, there is a scarcity of clinical evidence, whether in randomized clinical trials or real-world studies, regarding the effect of this practice in patients with HER2-positive breast cancer. Objective To analysed the effect of interchangeability, involving multiple switches, on the effectiveness and safety of treatment for early-stage HER2-positive breast cancer. Methods This single-center retrospective cohort study included patients treated between 2018 and 2021. Sociodemographic, clinical, therapeutic, and safety data were collected. Logistic regression analyzed the association between interchangeability and pathological complete response (pCR). Disease-free survival (DFS) was assessed at 18 and 30 months using Kaplan-Meier and Log-rank tests between the interchangeability groups. Cox regression evaluated recurrence risk. Safety was assessed by adverse event (AE) occurrence, frequency, and severity. Results The study included 233 women, with 143 in the intervention group (interchangeability) and 90 in the control group (non-interchangeability). pCR rates were 31.5% (29/92) in the intervention group and 44.0% (62/141) in the control group (p=0.059). Median DFS at 18 months was 17.6 months in the intervention group and 17.4 in the control group, with 6 and 8 recurrences (HR 0.46, 95% CI 0.16 – 1.35; p = 0.161), respectively. At 30 months, median DFS was 28.1 months in the intervention group and 27.3 months in the control group, with 17 and 14 recurrences (HR 0.98, 95% CI 0.58–1.67; p=0.951), respectively. There was no statistically significant difference in the occurrence of AEs between the groups (p=0.427). After initiating Trastuzumab, 115 (80.4%) patients in Group 1 and 79 (87.8%) in Group 2 experienced at least one AE. It was found that 34 (23.8%) women in Group 1 and 20 (22.2%) in Group 2 (p=0.784) experienced severe AEs (grade 3 and 4). Cardiac events occurred in 18 (12.6%) patients in Group 1 and 6 (6.7%) in Group 2 (p=0.148). Conclusion Interchangeability did not influence pCR, DFS or safety outcomes in the studied population. Future studies may complement and corroborate these findings.

Background/aim: The combination of atezolizumab-bevacizumab changed the prognosis of unresectable hepatocellular carcinoma (HCC) since 2020. Present study aimed evaluate the outcomes of HCC patients who received this combination in a Cancer Center in Brazil and which factors were associated with prognosis. Patients and methods: This was a retrospective study of first-line patients treated with atezolizumab-bevacizumab from 2020 to 204. Patients’ data were collected retrospectively from patients’ files. Survival curves were calculated with the Kaplan–Meier method and compared by means of the log-rank test stratified by clinical pathological features. Results: Forty patients were included; Most patients had had BCLC C disease (80.0%). Most common hepatitis etiology was NASH (42.5%); viral etiology composed 20%. Twenty-one (52.5%) patients had esophageal varices before treatment. Thirty two patients had Child-Pugh A cirrhosis (80.0%), 22 (55.5%) had ALBI score 1 and macrovascular invasion was present in 23 patients (57.5%). Response evaluation was performed in 34 patients; response rate was 35.3%; disease control rate was 85.3%. In progressive disease, 14 patients had second-line treatment; in 11 of them Lenvatinib was performed. Five patients had variceal bleeding and five had immune-related adverse event (irAE). Median PFS and OS were 7.4 (95% CI: 2.4-12.4) and 19.3 (95% CI: 9.2-29.4) months, respectively. Factors associated with worst prognosis were: Child B, macrovascular invasion and esophageal varices. There was no association between cirrhosis etiology with survival. We found no association between response rate stratified by hepatitis etiology or Child classification. Conclusion: Our data had had comparable prognosis of the pivotal IMBRAVE trial, despite including patients with Child B liver function. Clinical factors like Child B, macrovascular invasion and esophageal varices were associated with worst survival.

Cisplatin-based concurrent chemoradiotherapy (CRT) is the standard of care for locally advanced head and neck cancer (HNC) as a definitive or adjuvant therapy. This approach has been associated with a 6.5% improvement in overall survival (OS) and enhanced locoregional control when compared to radiotherapy (RT) alone. However, Cisplatin and RT carry a significant risk of ototoxicity, with 53% developing grade two (G2) or higher hearing loss through audiometry. Pre-clinical studies have suggested that Flunarizine may offer otoprotective benefits. This is a unicentric, non-comparative, open-label, phase II clinical trial conducted to assess the otoprotective efficacy and safety of Flunarizine in patients undergoing Cisplatin-based CRT (100mg/m2 IV every 21 days), with the aim of reducing G2 or higher ototoxicity by 20%. Patients received Flunarizine for 21 days prior to CRT, continued throughout the course of CRT, and extended up to three months post-CRT. The primary endpoint was acute and late ototoxicity. Secondary endpoints included objective response rate, safety profile, quality of life and OS. Between October 2019 and December 2022, 91 patients were screened, and nine were enrolled. The high screening failure was due to the high prevalence of pre-existing hearing loss (36.3%): 17.6% symptomatic and 18.7% asymptomatic hearing loss (detectable only through audiometry). The median follow-up was 57.5 months. Flunarizine most frequent adverse events were weight loss (88.9% G1, 11.1% G2 e 22.2% G3), xerostomia (44.4% G1, 11,1% G2 e 11.1% G3), decreased appetite (33.3% G1, 33,3% G2 e 11,1% G3) and drowsiness (33.3% G1). At the three-month post-CRT assessment, audiometry was performed on five patients, all of them (5/5) exhibited G2 or higher hearing loss. One patient (14.3%) had G1 hearing loss and one patient (14.3%) had G1 tinnitus. At the six-month post-CRT assessment, seven patients underwent audiometry and five patients (71%) had G2 or higher hearing loss. The objective response rate was 66.67%. All patients achieved complete response. Three patients (33%) had disease progression and died due to cancer. The median OS was not reached, and two-year OS rate was 66.6%. Due to the lack of otoprotective effect observed in the interim analysis, the study was prematurely terminated for futility. This phase II trial demonstrated that Flunarizine did not confer any otoprotective benefit in patients undergoing Cisplatin-based concurrent CRT for locally advanced HNC.

Introduction: Melanoma recurrence rates remain high despite complete resection followed by adjuvant chemotherapy and immunotherapy. Different types of melanoma vaccines have emerged as complementary treatment to reduce recurrence. However, their effectiveness in preventing recurrence and improving survival remains debatable. Objectives: To evaluate the efficacy of different melanoma vaccines (TLPLDC, TLPLDC+G, and TLPO) compared to standard treatment, determine their impact on Disease-Free Survival (DFS) and Overall Survival (OS), and provide quantitative evidence on the effectiveness of these vaccines through a meta-analysis. Methods: We searched in Pubmed, Cochrane, and Embase in April 2024 for studies comparing different types of melanoma vaccines against standard treatment. Inclusion criteria were randomized controlled trials evaluating the effectiveness of tumor lysate, particle-loaded, dendritic cells (TLPLDC), TLPLDC+granulocyte-colony stimulating factor (G), and tumor lysate particle only (TLPO) vaccines against control on the recurrence and survival of patients with completely resected melanoma. Outcomes of interest included DFS and OS. Hazard ratios were pooled using random-effects models in R software version 4.3.2. Risk-of-bias assessment was conducted using RoB 2. Results: We included 7 randomized controlled trials comprising 1,211 patients. At the 3-year follow-up, TLPLDC favored DFS over control (HR=0.66 [0.47,0.93], p=0.02, I²=49%), although the 2-year follow-up was not statistically significant (HR=0.78,CI[0.59,1.03],p=0.07,I²=0%). At 3 years follow-up, TLPLDC+G (HR=1.31,CI[0.93,1.84],p=0.12,I²=0%) and TLPO (HR=0.71, CI[0.44,1.12],p=0.14,I²=74%) were not statistically significant. TLPLDC showed improved OS at both 3-year (HR=0.18, CI[0.07,0.48], p<0.01, I² =0%) and 2-year follow-ups (HR=0.28,CI[0.12,0.67],p<0.01,I²=36%). TLPO at 36-months (HR=0.55,CI[0.29,1.03],p=0.06,I²=35%) was not significant, while at 24-months (HR=0.41, CI[0.21,0.82],p=0.01,I²=0%) it was significant. TLPLDC+G could only be analyzed at the 3-year follow-up, showing no difference (HR=1.04,CI[0.6,1.8],p=0.88,I²=0%). Conclusion: TLPLDC vaccines consistently improved DFS and OS in the 3-year follow-up analysis. Therefore, TLPLDC vaccines could be an effective addition to resectable melanoma treatment.

INTRODUCTION: Representing 80% of all lung cancers, non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related death and encompasses adenocarcinoma and squamous cell carcinoma. Studies indicate that the use of inhibitors of programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 (PD-L1), which are common biomarkers in patients with NSCLC, may be effective in enhancing therapy for various diseases, including NSCLC. By inhibiting the PD-1/PD-L1 binding complex, patients may achieve improved survival. OBJECTIVES: To evaluate the efficacy of PD-L1 inhibitors in the treatment of non-small cell lung cancer and compare the efficacy of PD-L1 inhibitors with other immunotherapies. METHODOLOGY: A systematic review was conducted using PubMed with the descriptors "immune checkpoint inhibitors," "PD-L1 inhibitors," and "carcinoma, non-small-cell lung," combined with Boolean operators AND and OR. Studies in English published between 2019 and 2024 were included. Articles on other checkpoint inhibitors were excluded. Out of 153 articles identified, 16 were selected. RESULTS: Analysis of the studies showed that PD-L1 inhibitor monotherapy significantly improved Overall Survival (OS) as well as Progression-Free Survival (PFS). When used in combination with chemotherapy, there were significant improvements in OS, PFS, Objective Response Rate (ORR), Event-Free Survival (EFS), and PFS. However, there were many grade 3-5 adverse effects both in monotherapy and when combined with chemotherapy, leading to treatment discontinuation. Other therapies, such as PD-1 inhibitors, were associated with better OS, PFS, and safety, as well as lower mortality rates compared to PD-L1 inhibitors, with reduced adverse effects and treatment discontinuation. Comparison of CTLA-4 inhibitors with PD-L1 and PD-1 inhibitors did not yield significant results but suggested that PD-1 and PD-L1 inhibitors have better efficacy. CONCLUSION: There is a consistent relationship between PD-1 and PD-L1 inhibitors and significant improvements in survival-related outcomes, including reduced risk of death and adverse events, with PD-1 inhibitors showing superior results in terms of lower mortality and minimized treatment discontinuation.

INTRODUCTION: Sarcomas are malignant and rare tumors originating from mesenchymal cells with an undefined and multifactorial cause. The Brazilian Society of Oncological Surgery identifies risk factors associated with a higher incidence of sarcomas, including immunosuppressive conditions (such as HIV infection or patients with a history of transplantation), genetic conditions (such as neurofibromatosis), and exposure to arsenic. Objective: To identify regional disparities in the incidence of sarcomas from January 2019 to July 2024. METHODS: This is an epidemiological, retrospective, cross-sectional, and quantitative study conducted through data collection using the SINAN/DATASUS platform, analyzing the incidence of sarcomas by region between 2019 and 2024. RESULTS: During the specified time period, 60,770 new cases of sarcomas were identified in Brazil. The Northeast region had the highest incidence (25,604), followed by the Southeast (18,556) and South (11,595) regions, while the North region had the lowest incidence (1,825), preceded by the Central-West region (3,190). The age groups with the highest incidence in the Northeast and Southeast regions are the same: 70 to 74 years and 80 or older; however, it is notable that the Southeast region has a higher incidence in the 0 to 19 age group (1,066) compared to the Northeast (804) and other regions. CONCLUSION: The incidence of sarcomas in Brazil, with the exception of the Northeast region, aligns with its population distribution. However, the results indicate a significant disparity in the incidence of sarcomas in the Northeast compared to other regions, which deviates from the established trend. This highlights the importance of analyzing and identifying health inequities and tailoring public health policies to regional needs and specificities.

Introduction: Bladder cancer is a malignant neoplasm characterized by the uncontrolled growth of the cells lining the organ, with smoking being the main risk factor. This disease is classified into three main types: transitional cell carcinoma, which represents the majority of cases and begins in the cells of the innermost tissue of the bladder, potentially spreading through the tissue, invading the muscle wall, and metastasizing to nearby organs or lymph nodes; squamous cell carcinoma, which affects thin, flat cells and arises after prolonged infections or irritations; and adenocarcinoma, which begins in glandular cells after a long period of irritation or inflammation. Objectives: To characterize the panorama of bladder cancer in Brazil over the past five years, according to epidemiological indicators, considering the impact on the population. Methodology: A retrospective and ecological study was conducted using the DATASUS database for the period from 2019 to 2023. Morbidity and hospitalizations due to bladder cancer in Brazil were analyzed, using variables such as age group and sex by region. Results: Bladder cancer shows higher morbidity among people aged 60 years or older, with males being the most affected. Within this age group, the prevalence increases significantly among individuals aged 80 years or older. Regionally, the disease is more prevalent in the Southeast region across all age groups analyzed. An interesting observation is that children under one year old are more affected by bladder cancer than the population aged 1 to 29 years, when considering each age group. Hospitalizations are most common in the 20 to 29-year age group, with the highest number of cases recorded in the Southeast region, and are more frequent among women. Conclusion: The data revealed a higher prevalence of bladder cancer in men, particularly those over 60 years old, with an increasing incidence in the 80+ age group. Smoking, the main risk factor, combined with occupational exposure to carcinogenic substances, significantly contributes to these results, especially in the Southeast region where such exposures are more common. The unexpected detection of cases in children under one year old requires further investigation. These findings are essential for guiding public policies focused on reducing smoking and controlling occupational exposures to promote the health of these patients.

Introduction: Leukemias are common neoplasms characterized by non-solid tumors in blood tissue, displaying hallmark features like uncontrolled growth and mutagenic patterns. They are generally categorized by progression speed (acute or chronic) and the type of affected blood cells (myeloid or lymphoid). Symptoms include fatigue, fever, cachexia, and immunodeficiency, among others. Objective: Given the severity and varied presentations of leukemias, understanding the epidemiological profile of affected patients is crucial. This article aims to describe the profiles of leukemia patients from the North and Northeast regions of Brazil, focusing on age, gender, and ethnicity. It also seeks to identify the most common leukemia presentations in these regions to enhance clinical management. Materials and Methods: We analyzed retrospective data on leukemia from the Cancer Information System (SISCAN) and Hospital Morbidity of SUS, available on the TabNet/DATASUS platform. Data collection utilized R software with the "microdatasus" package (R. F. SALDANHA, 2019), including variables like gender, age, place of residence, and specific diagnosis. Data analysis was performed using Excel for better organization. Results: Using R software, we reviewed 883,165 cases of malignant neoplasms from the North and Northeast regions, identifying 23,205 leukemia diagnoses over 10 years, resulting in 135,880 hospitalizations and 8,982 deaths. The majority of cases were either myeloid or lymphoid, with about 1% being monocytic leukemia. Among lymphoid leukemia cases, 50% were under 19 years old, while myeloid leukemia was more prevalent in those over 50 years old. Hospitalizations showed two peaks: one in the under-19 age group and another in those over 50. Gender differences were not statistically significant, but ethnic distribution showed a higher number of cases and mortality among the Asian population, attributed to genetic factors. Conclusion: This study highlighted typical characteristics of oncologic diseases, including age-related risk factors and genetic predispositions, particularly prevalent in Asian populations. Although absolute mortality numbers were low, the high incidence underscores the need for effective population screening. The patient profile is predominantly young (lymphoid leukemia) and elderly (myeloid leukemia), particularly children up to 19 years old and adults over 50.