e18171 Background: The perception of symptoms, diagnosys, access to a cancer care institute and the first-line of therapy are milestones of cancer care. The success of an oncological treatment is directly relatable to these key-points and the time gaps between them. Growing research in developing countries points out the challenges of offering quality of care in this setting as social, cultural, economic and political factors are deeply intertwined. The objective of this study is to identify the key-points of cancer care, the time gaps between them and the time-related end-points of patients refered to a medical oncology department of a public university hospital in São Paulo, Brazil, in the period of one year. Methods: This is a observational retrospective study based on review of medical records of all cancer patients refered to the medical oncology department of a public university hospital in São Paulo, Brazil, from 01/01/17 to 12/31/17. The analysis was performed in January 2019. The data collected comprises the age at diagnosys, gender, primary tumor site, stage (AJCC 7th ed. staging system), onset of symptons, date of hystopathological diagnosys, the first therapeutic modality and when it was offered, intention of care (curative or palliative), outcomes and the following time-relations: symptoms-dyagnosis (SD), dyagnosis-treatment (DT) and symptoms-treatment (ST). Results: From 358 profiles, 275 were included. The average age at diagnosys was 58,7 years (15-88 years). Men were 147 (53,4%) and 128 (46,5%) were women. The most common primary tumor sites were gastrointestinal tract 22,9%, head and neck 20,3%, cutaneous melanoma 17,8% and genitourinary tract 16%. 160 (58,1%) patients were diagnosed at advanced/metastatic stages (III/IV). The median time-relations were: 5,5 months for SD; 2 months for DT and 8 months for ST. The first treatment offered was surgery at 63,2% of cases, radiotherapy 17,8%, systemic therapy 16,7% (endocrine therapy, targeted therapy or chemotherapy) or palliative care 1,8%. The intention of the initial treatment: 76,3% were curative and 23,2% palliative. At time of analysis, 63,6% of patients were alive, 19,2% deceased and 16,7% of unknown outcome. Conclusions: Our data endorses prevalent findings of developing countries epidemiological studies: late diagnosys, non-curative treatments and poor outcomes. Known causes are desfavorable social-economic conditions, symptom neglection, ineffective cancer screening and deficiency of public cancer care networks. We emphasize time goals as important quality indexes to guide new solutions.
e18512 Background: Cisplatin-based chemoradiotherapy (CRT) is a well-established regimen used for adjuvant and/or head-and-neck squamous cell carcinoma (HNSCC) radical treatment. The most classic protocol for chemoradiotherapy remains the administration of Cisplatin 100mg/m² EV D1 q3-week period, 3 cycles. The objective of this study is to assess the efficacy and tolerability of the weekly 40mg/m² cisplatin regimen. Methods: we conducted a retrospective study from 2007-2020 with 102 patients treated at a national reference institution. All of them with HNSCC received concurrent CRT with weekly cisplatin 40mg/m² EV D1. We analyzed the overall survival (OS), local recurrence and tolerability in this scheme. Results: The median cisplatin cumulative dose received by our patients was 240mg/m². Hence, we divided them in two groups for the analysis: Group A (41 patients) received less than 240mg/m² cisplatin total dose and Group B (61 patients) received more or equal 240mg/m² cisplatin total dose. Both groups were equally balanced between sex, clinic stage, histologic grade and clinic status. We found that the Group A experienced 5 deaths (12.2%) while the Group B experienced 6 deaths (9.8%). The mean time to recurrence disease in the Group A was 45.68 months and in Group B 60.22 months (p = 0.958). The estimated overall survival in the Group A was 150 months and in the Group B was 116.4 months (p = 0.443). Conclusions: The weekly cisplatin dose regimen showed to be feasible, more tolerable, and less toxic and with no difference in terms of OS then the classic 3-week cisplatin protocol in the CRT setting. Our group suggests that the 240mg/m² cumulative cisplatin weekly schedule should be a better option for CRT treatments then the classic cisplatin regimen. A phase III clinical trial is warranted to further understanding of this framework. Key-words: head and neck cancer, cisplatin, radiotherapy
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