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1.
J Vasc Interv Radiol ; 30(12): 1901-1907, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31530487

RESUMO

PURPOSE: To evaluate safety of endovascular coil fiducial placement and compare complication rates with transthoracic fiducial placement in patients with peripheral early-stage lung cancer receiving fiducial markers for stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS: This retrospective study included consecutive patients who received endovascular coils (n = 416 patients, n = 1,335 coils) or transthoracic fiducials (n = 30 patients, n = 80 fiducials) for SBRT between August 2005 and January 2017. During the first 3 years of the study period, patients preferentially received cylindrical platinum fiducial markers by percutaneous transthoracic placement; only patients with contraindications received endovascular coils. Thereafter, patients received endovascular fiducials as the first-line procedure. Endovascular embolization coils were placed via the femoral vein into subsegmental pulmonary artery branches near the tumor. Complications were scored by SIR criteria. RESULTS: The success rate of endovascular coil placement was 99.8%. One patient developed grade 2 hemoptysis requiring procedure discontinuation. Following placement, 1 patient (0.2%) developed grade 3 cardiac arrhythmia. A total of 36 patients (9%) developed grade 1 complications: mild hemoptysis (n = 4; 1%), small asymptomatic pulmonary infarction or hemorrhage (n = 30; 7%), hypoglycemia (n = 1; 0.2%), and vasovagal episode (n = 1; 0.2%). Following transthoracic marker placement, 4 patients (13%) developed a pneumothorax requiring hospital admission and chest tube (grade 2), 6 patients (20%) developed pneumothorax requiring no intervention (grade 1), 2 patients (7%) experienced asymptomatic pulmonary bleeding, and 1 patient (3%) developed persistent pain. CONCLUSIONS: Endovascular coil fiducial placement for lung SBRT is associated with high procedural success rates and lower rates of clinically relevant complications than transthoracic marker placement.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Marcadores Fiduciais , Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Radiocirurgia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
Int J Radiat Oncol Biol Phys ; 117(2): 422-433, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37120027

RESUMO

PURPOSE: Involved internal iliac and obturator lateral lymph nodes (LLNs) are a known risk factor for the occurrence of ipsilateral local recurrences (LLR) in rectal cancer. This study examined coverage of LLNs with routine radiation therapy practice in the Netherlands and associated LLR rates. METHODS AND MATERIALS: Patients with a primary tumor ≤8 cm of the anorectal junction, cT3-4 stage, and at least 1 internal iliac or obturator LLN with short axis ≥5 mm who received neoadjuvant (chemo)radiation therapy, were selected from a national, cross-sectional study of patients with rectal cancer treated in the Netherlands in 2016. Magnetic resonance images and radiation therapy treatment plans were reviewed regarding segmented LLNs as gross tumor volume (GTV), location of LLNs within clinical target volume (CTV), and received proportion of the planned radiation therapy dose. RESULTS: A total of 223 out of 3057 patients with at least 1 LLN ≥5 mm were selected. Of those, 180 (80.7%) LLNs were inside the CTV, of which 60 (33.3%) were segmented as GTV. Overall, 202 LLNs (90.6%) received ≥95% of the planned dose. Four-year LLR rates were not significantly higher for LLNs situated outside the CTV compared with those inside (4.0% vs 12.5%, P = .092) or when receiving <95% versus ≥95% of the planned radiation therapy dose (7.1% vs 11.3%, P = .843), respectively. Two of 7 patients who received a dose escalation of 60 Gy developed an LLR (4-year LLR rate of 28.6%). CONCLUSIONS: This evaluation of routine radiation therapy practice showed that adequate coverage of LLNs was still associated with considerable 4-year LLR rates. Techniques resulting in better local control for patients with involved LLNs need to be explored further.


Assuntos
Recidiva Local de Neoplasia , Neoplasias Retais , Humanos , Estudos Transversais , Recidiva Local de Neoplasia/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Neoplasias Retais/patologia , Recidiva , Estudos Retrospectivos , Estadiamento de Neoplasias
3.
Radiat Oncol ; 15(1): 89, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321553

RESUMO

BACKGROUND: Prognostication tools for early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) are currently lacking. The purpose of this study was to develop and externally validate a nomogram to predict overall survival in individual patients with peripheral early-stage disease. METHODS: A total of 587 NSCLC patients treated with biologically effective dose > 100 Gy10 were eligible. A Cox proportional hazards model was used to build a nomogram to predict 6-month, 1-year, 3-year and 5-year overall survival. Internal validation was performed using bootstrap sampling. External validation was performed in a separate cohort of 124 NSCLC patients with central tumors treated with SBRT. Discriminatory ability was measured by the concordance index (C-index) while predictive accuracy was assessed with calibration slope and plots. RESULTS: The resulting nomogram was based on six prognostic factors: age, sex, Karnofsky Performance Status, operability, Charlson Comorbidity Index, and tumor diameter. The slope of the calibration curve for nomogram-predicted versus Kaplan-Meier-estimated overall survival was 0.77. The C-index of the nomogram (corrected for optimism) was moderate at 0.64. In the external validation cohort, the model yielded a C-index of 0.62. CONCLUSIONS: We established and validated a nomogram which can provide individual survival predictions for patients with early stage lung cancer treated with SBRT. The nomogram may assist patients and clinicians with treatment decision-making.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Nomogramas , Radiocirurgia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes
4.
Radiat Oncol ; 2: 2, 2007 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-17201913

RESUMO

Common complications of thoracic radiotherapy include esophagitis and radiation pneumonitis. However, it is important to be aware of uncommon post-radiotherapy complications such as bronchiolitis obliterans organizing pneumonia (BOOP). We report on two patients with carcinoma of the breast who developed an interstitial lung disease consistent with BOOP. BOOP responds to treatment with corticosteroids and the prognosis is generally good despite of the need for long-term administration of corticosteroids as relapses can occur during tapering of steroids. This report provides guidelines for the evaluation and treatment of patients with pulmonary infiltrates after radiotherapy.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Carcinoma/complicações , Carcinoma/diagnóstico por imagem , Pneumonia em Organização Criptogênica/diagnóstico , Pneumonia em Organização Criptogênica/etiologia , Pneumonite por Radiação/etiologia , Radioterapia/efeitos adversos , Idoso de 80 Anos ou mais , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Lesões por Radiação , Pneumonite por Radiação/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
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