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OBJECTIVE: Severe lytic cancerous lesions of the spine are associated with significant morbidity and treatment challenges. Stabilization and restoration of the axial load capability of the vertebral body (VB) are important to prevent or arrest vertebral collapse. Percutaneous stent screw-assisted internal fixation (SAIF), which anchors a VB stent/cement complex with pedicular screws to the posterior vertebral elements, is a minimally invasive, image-guided, 360° internal fixation technique that can be utilized in this patient cohort. The purpose of this study was to assess the feasibility, safety, and stabilization efficacy of VB reconstruction via the SAIF technique in a cohort of patients with extensive lytic vertebral lesions, who were considered to have an unstable or potentially unstable spine according to the Spinal Instability Neoplastic Score (SINS). METHODS: This study was a retrospective assessment of a prospectively maintained database of a consecutive series of patients with neoplastic extensive extracompartmental osteolysis (Tomita type 4-6) of the VB treated with the SAIF technique. VB reconstruction was assessed on postprocedure plain radiographs and CT by two independent raters. Technical and clinical complications were recorded. Clinical and imaging follow-ups were assessed. RESULTS: Thirty-five patients with extensive osteolytic metastatic lesions of the VB underwent 36 SAIF procedures. SAIF was performed as a stand-alone procedure in 31/36 cases and was associated with posterior surgical fixation in 5/36 (4/5 with decompressive laminectomy). In 1 case an epidural cement leak required surgical decompression. VB reconstruction was categorized as satisfactory (excellent or good rating) by the two raters in 34/36 cases (94.5%) with an interrater reliability of 94.4% (Cohen's kappa of 0.8). Follow-up, ranging from 1 to 30 months, was available for 30/36 levels. Long-term follow-up (6-30 months, mean 11.5 months) was available for 16/36 levels. Stability during follow-up was noted in 29/30 cases. CONCLUSIONS: SAIF provides 360° nonfusion internal fixation that stabilizes the VB in patients with extensive lytic lesions that would otherwise be challenging to treat.
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Background: Molecular imaging methods are currently used in the management of patients with lung cancer. Compared to non-small cell lung cancer, less data are available about the impact of molecular imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in staging patients with small cell lung cancer (SCLC). Performing a systematic review and meta-analysis, we aimed to provide quantitative data about the impact of 18F-FDG PET/CT in staging SCLC. Methods: A comprehensive literature search of studies on the use of 18F-FDG PET/CT in patients with SCLC was performed. Three different databases were screened (PubMed/MEDLINE, EMBASE, and Cochrane library databases) until June 2019. Only articles describing the impact of 18F-FDG PET/CT in staging patients with SCLC were selected. A pooled analysis evaluating the change of binary SCLC staging (limited-stage vs. extensive-stage disease) using 18F-FDG PET/CT was carried out. Results: Nine articles including 721 patients with SCLC were included in the systematic review. Compared to conventional staging, a superior diagnostic accuracy of 18F-FDG PET/CT was found. A change of binary SCLC staging using 18F-FDG PET/CT was demonstrated in 15% (95% confidence interval, 9-21%) of patients with SCLC. Currently, it is not clearly demonstrated that the use of 18F-FDG PET/CT for staging may improve the survival outcome of patients with SCLC. Conclusions: 18F-FDG PET/CT is a useful molecular imaging method for staging patients with SCLC because it can change the management in a significant number of patients. More large prospective studies and cost-effectiveness analyses on the impact of 18F-FDG PET/CT in staging patients with SCLC are needed.
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OBJECTIVE: To analyze the impact of adjuvant radiotherapy (RT) on ipsilateral breast recurrence (IBR) and overall survival (OS) in patients older than 69 years with early-stage breast cancer. METHODS: From January 2007 to June 2015, we analyzed retrospectively 137 women with estrogen receptor-positive T1-2 invasive breast cancer, with negative axillary lymph nodes, dividing them into 2 subgroups: 70 to 79 years and older than 79 years. RESULTS: After a median follow-up of 43.2 months, the 3-year IBR-free survival in patients treated with surgery plus RT was 98.8% and 92.1% in patients treated with surgery alone, with a significant difference (p = .01). Radiotherapy did not impact overall survival (p = .10). A higher percentage of patients aged between 70 and 79 years received RT after conservative surgery if compared with the older subgroup (p < .01). CONCLUSIONS: In elderly women, adjuvant RT reduced the IBR, but did not improve OS.
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Neoplasias de la Mama/radioterapia , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirugía , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Mastectomía Segmentaria/métodos , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Radioterapia Adyuvante/métodos , Estudios RetrospectivosRESUMEN
A case-control study was conducted to determine the association between maternal height and infant length-for-age, and to evaluate how this association is modified by either maternal or infant nutritional status. We hypothesised that maternal excess caloric intake [measured as body mass index (BMI)] would increase the association, while infant nutrition (measured in main meals consumed in addition to breastfeeding) will diminish the effect. Mother and infant pairs in Chimaltenango, Guatemala, were measured for anthropometric values and nutritional status, and mothers were interviewed to elicit nutritional and socio-economic information. Infant length was converted into z-scores based on the World Health Organization's (WHO) standards. Odds ratios (ORs), associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases were infants below 2 z-scores of the WHO's length-for-age, while controls were infants within the -2 to 2 z-score range. Cases (n = 84) had an increased odds (OR: 3.00, 95% CI: 1.57-5.74) of being born to a stunted mother (below 145 cm) when compared with controls (n = 85). When adjusted for potential confounders, the OR decreased to 2.55 (95% CI: 1.30-5.02). Negative RERI values were produced for the joint exposure of maternal BMI ≥ 25 and maternal stuntedness (RERI: -0.96), as well as for the joint exposure of maternal stuntedness and infant nutrition (RERI: -2.27). Our results confirm that maternal stuntedness is a significant contributor to infant stuntedness; however, this association is modified negligibly by maternal nutritional status and significantly by infant nutritional status, each in a protective manner.
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Lactancia Materna , Estado Nutricional , Índice de Masa Corporal , Estudios de Casos y Controles , Ingestión de Energía , Femenino , Trastornos del Crecimiento/etiología , Trastornos del Crecimiento/fisiopatología , Guatemala , Humanos , Lactante , Masculino , Desnutrición/complicaciones , Desnutrición/fisiopatología , Fenómenos Fisiologicos Nutricionales Maternos , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
PURPOSE: Patients with brain metastases (BM) rarely survive longer than 6months and are commonly excluded from clinical trials. We explored two combined modality regimens with novel agents with single agent activity and radiosensitizing properties. PATIENTS AND METHODS: In this randomised phase II trial patients with BM from NSCLC were randomly assigned to 30Gy WBRT with either concomitant gefitinib (GFT) 250mg/day continuously or temozolomide (TMZ) 75mg/m(2) for 21/28days. The primary end-point was overall survival, with quality of life and cognitive function as secondary end-points. RESULTS: We enrolled 59 patients (GFT 16, TMZ 43), and 56 patients have died, mainly (80%) from disease progression. Four patients succumbed complications of the disease or corticosteroids (intestinal perforation (2), CNS haemorrhage and pulmonary emboli). Median overall survival in the gefitinib arm was 6.3months (95% CI 2.1-14.6), and 4.9months (95% CI 2.3-5.6) in TMZ treated patients. Fatigue was the main complaint. CONCLUSIONS: No relevant toxicity with those therapeutic regimens was observed. Fatal outcome in three patients may have been related to corticosteroids. Cognitive function improved during treatment. However, median overall survival for all patients was only 4.9months (95% CI 2.3-5.7) and 1-year survival 25.4% (95% CI 15.4-37.0%).
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Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/terapia , Carcinoma de Pulmón de Células no Pequeñas/terapia , Cognición , Irradiación Craneana , Dacarbazina/análogos & derivados , Neoplasias Pulmonares/patología , Calidad de Vida , Quinazolinas/uso terapéutico , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/fisiopatología , Neoplasias Encefálicas/secundario , Escalas de Valoración Psiquiátrica Breve , Carcinoma de Pulmón de Células no Pequeñas/secundario , Quimioradioterapia/métodos , Cognición/efectos de los fármacos , Cognición/fisiología , Cognición/efectos de la radiación , Irradiación Craneana/efectos adversos , Irradiación Craneana/métodos , Dacarbazina/uso terapéutico , Femenino , Gefitinib , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Análisis de Supervivencia , TemozolomidaRESUMEN
PURPOSE: To evaluate the role of postoperative radiotherapy (RT) in Merkel cell carcinoma (MCC). METHODS AND MATERIALS: A retrospective multicenter study was performed in 180 patients with MCC treated between February 1988 and September 2009. Patients who had had surgery alone were compared with patients who received surgery and postoperative RT or radical RT. Local relapse-free survival (LRFS), regional relapse-free survival (RRFS), and distant metastasis-free survival (DMFS) rates were assessed together with disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates. RESULTS: Seventy-nine patients were male and 101 patients were female, and the median age was 73 years old (range, 38-93 years). The majority of patients had localized disease (n = 146), and the remaining patients had regional lymph node metastasis (n = 34). Forty-nine patients underwent surgery for the primary tumor without postoperative RT to the primary site; the other 131 patients received surgery for the primary tumor, followed by postoperative RT (n = 118) or a biopsy of the primary tumor followed by radical RT (n = 13). Median follow-up was 5 years (range, 0.2-16.5 years). Patients in the RT group had improved LRFS (93% vs. 64%; p < 0.001), RRFS (76% vs. 27%; p < 0.001), DMFS (70% vs. 42%; p = 0.01), DFS (59% vs. 4%; p < 0.001), and CSS (65% vs. 49%; p = 0.03) rates compared to patients who underwent surgery for the primary tumor alone; LRFS, RRFS, DMFS, and DFS rates remained significant with multivariable Cox regression analysis. However OS was not significantly improved by postoperative RT (56% vs. 46%; p = 0.2). CONCLUSIONS: After multivariable analysis, postoperative RT was associated with improved outcome and seems to be an important component in the multimodality treatment of MCC.
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Carcinoma de Células de Merkel/radioterapia , Enfermedades Raras/radioterapia , Neoplasias Cutáneas/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células de Merkel/mortalidad , Carcinoma de Células de Merkel/secundario , Carcinoma de Células de Merkel/cirugía , Quimioterapia Adyuvante , Supervivencia sin Enfermedad , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Cuidados Posoperatorios , Enfermedades Raras/mortalidad , Enfermedades Raras/patología , Enfermedades Raras/cirugía , Análisis de Regresión , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaRESUMEN
PURPOSE: To report the treatment of cranio-spinal irradiation (CSI) with volumetric modulated arc therapy (RapidArc) in adults and a child. MATERIALS AND METHODS: Five patients from 5 institutions were treated with CSI using RapidArc technology. Patient age varied between 7 and 45 years. The lengths of the planning target volumes (PTV) and dose prescriptions ranged from 54.6 to 78.4 cm, and from 12 to 36 Gy, respectively. Different arc arrangements were used, with two or three isocentres, from two to six modulated arcs, for patient positioned either in prone (n=3) or supine position (n=2). Doses to PTV, organs at risk and non-target tissue are reported for each of the five patients. Data concerning imaging strategy and pre-treatment quality assurance are also reported. RESULTS: The mean conformity index CI(95%) was 1.05 ± 0.05 (range: 1.00, 1.13). Mean doses to the lenses, lungs, heart, and kidneys were, respectively, 7.6 ± 1.6, 6.6 ± 3.0, 5.7 ± 2.3, and 6.1 ± 2.1 Gy, keeping those value acceptably low. Mean non-target tissue dose was 21.0 ± 3.8% (5.6 ± 1.8 Gy, range: 3.0-8.1 Gy). All patients were successfully planned and treated with RapidArc. CONCLUSIONS: RapidArc techniques achieved highly conformal treatment plans for 5 adults or paediatric patients. Beam-on time was short, and RapidArc plans were satisfactorily delivered to all presented patients.
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Neoplasias Encefálicas/radioterapia , Irradiación Craneana/métodos , Radioterapia de Intensidad Modulada/métodos , Adolescente , Adulto , Neoplasias Encefálicas/diagnóstico por imagen , Niño , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Órganos en Riesgo/efectos de la radiación , Posicionamiento del Paciente , Dosis de Radiación , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: To report about initial clinical experience in radiation treatment of carcinoma of prostate with volumetric modulated arcs with the RapidArc (RA) technology. METHODS: Forty-five patients with a median age of 72 +/- 3, affected by prostate carcinoma (T1c: 22 patients, T2a-b: 17 patients, T3a-b: 6 patients. N0: 43 patients, N1-Nx: 2 patients, all M0), with initial PSA of 10.0 +/- 3.0 ng/mL, were treated with RapidArc in a feasibility study. All patients were treated with single arc using 6MV photons. Dose prescription ranged between 76 (7 patients) and 78 Gy (38 patients) in 2 Gy/fraction. Plan quality was assessed by means of Dose Volume Histogram (DVH) analysis. Technical parameters of arcs and pre-treatment quality assurance results (Gamma Agreement Index, GAI) are reported to describe delivery features. Early toxicity was scored (according to the Common Terminology Criteria of Adverse Effects scale, CTCAE, scale) at the end of treatment together with biochemical outcome (PSA). RESULTS: From DVH data, target coverage was fulfilling planning objectives: V95% was in average higher than 98% and V107% approximately 0.0% (D2% approximately 104.0% in average). Homogeneity D5%-D95% ranged between 6.2 +/- 1.0% to 6.7 +/- 1.3%. For rectum, all planning objectives were largely met (e.g. V70Gy = 10.7 +/- 5.5% against an objective of < 25%) similarly for bladder (e.g. D2% = 79.4 +/- 1.2 Gy against an objective of 80.0 Gy). Maximum dose to femurs was D2% = 36.7 +/- 5.4 Gy against an objective of 47 Gy. Monitor Units resulted: MU/Gy = 239 +/- 37. Average beam on time was 1.24 +/- 0.0 minutes. Pre-treatment GAI resulted in 98.1 +/- 1.1%. Clinical data were recorded as PSA at 6 weeks after RT, with median values of 0.4 +/- 0.4 ng/mL. Concerning acute toxicity, no patient showed grade 2-3 rectal toxicity; 5/42 (12%) patients experienced grade 2 dysuria; 18/41 (44%) patients preserved complete or partial erectile function. CONCLUSION: RapidArc proved to be a safe, qualitative and advantageous treatment modality for prostate cancer.
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Adenocarcinoma/radioterapia , Neoplasias de la Próstata/radioterapia , Radioterapia de Intensidad Modulada/métodos , Adenocarcinoma/patología , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de la Próstata/patología , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por ComputadorRESUMEN
BACKGROUND/AIMS: Management of patients with heavily pretreated malignant lymphoma failing frontline treatment and salvage high-dose chemotherapy and autologous peripheral stem cell rescue, is problematic. A pilot study was conducted to evaluate isolated thoracic perfusion of drugs by means of stopflow technique. METHODOLOGY: Six patients were enrolled in the study; diagnoses included 4 advanced Hodgkin's disease, 1 primary mediastinal B-cell lymphoma, and 1 anaplastic large cell lymphoma. Patients were aged 18-37 years; 4 presented with bulky mediastinum. They had never achieved a complete response since all had progressed from front-line treatment, and 3 had even failed salvage high-dose chemotherapy with autologous peripheral stem cell rescue. Cisplatin (100 mg/m2) and melphalan (35 mg/m2) were used. Carmustine (100 mg/m2) were added to these 2 drugs and cytarabine (2000 mg/m2) in patients not previously treated by carmustine, etoposide, cytarabine, and melphalan. Epidoxorubicin (70 mg/m2) was added in patients who previously received a suboptimal dosage of antracycline. Drugs were delivered monthly via aortic perfusion performed by means of Aigner's stop-flow technique. RESULTS: Overall 13 cycles of perfusional chemotherapy were administered with a median number of 2 cycles. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery. After 1 month, 6 (100%) objective responses after isolated thoracic perfusion were recorded, 3 (50%) of which were complete. Tolerance to therapy was excellent. Hematological toxicity was mild and transfusional support was needed only in one course. At the last follow-up, 2 patients are alive (1 complete response and 1 very good partial response, maintained). CONCLUSIONS: This new therapeutical approach seems very active in recurrent/refractory malignant lymphoma and may play an important role in this setting.