RESUMO
Malignant lymphoma and other lymphoproliferative disorders represent a group of malignant hemopathies where immunotherapy has allowed spectacular progresses over the last ten years. The recent W.H.O. classification, based upon tumor immunology, and cytogenetical anomalies, allows a better identification of each lymphoma and the comparison of homogeneous populations within various clinical studies. The increase in the incidence of non-Hodgkin lymphoma is related to the aging of the population as well as to other factors that are still to be analysed - a real challenge for the future. We have tried to offer an overview of the latest therapeutical advances while focusing on the major role of general practitioner. The most frequency askeed questions will be discussed.
Assuntos
Drogas em Investigação/uso terapêutico , Clínicos Gerais , Linfoma/terapia , Papel do Médico , Humanos , Linfoma/patologia , Padrões de Prática Médica , Terapias em Estudo/métodosRESUMO
This review updates the radiotherapy indications for non-malignant diseases, except those treated by radiosurgery. Since the last 2005 review, there have been no major changes in the indications: the prevention of heteropic bone formation and keloids remain classical indications, while the treatment of macular degeneration or the prevention of coronary restenosis are now past history. Nevertheless, the radiation treatment for benign diseases should have the same criteria as for malignant diseases: information of the patient on risks, benefits and treatment quality.
Assuntos
Radioterapia , Antineoplásicos Hormonais/efeitos adversos , Doenças Ósseas/radioterapia , Contraindicações , Oftalmopatias/radioterapia , Feminino , Ginecomastia/induzido quimicamente , Ginecomastia/prevenção & controle , Humanos , Artropatias/radioterapia , Masculino , Doenças Musculares/radioterapia , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Radioterapia/efeitos adversos , Radioterapia/normas , Dermatopatias/radioterapia , Doenças Vasculares/radioterapiaRESUMO
This article reviews and describes the progress made in the therapeutic management of patients suffering from a lung cancer, outlining the major improvements made and suggesting some perspectives for the future.
Assuntos
Neoplasias Pulmonares/radioterapia , Radioterapia (Especialidade)/tendências , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/tendências , Cisplatino/administração & dosagem , Ensaios Clínicos como Assunto , Terapia Combinada , Gerenciamento Clínico , Fracionamento da Dose de Radiação , Humanos , Neoplasias Pulmonares/terapia , Metanálise como Assunto , Terapia Neoadjuvante/tendências , Aceleradores de Partículas , Pneumonectomia , Radioterapia/instrumentação , Radioterapia/métodos , Radioterapia/tendências , Radioterapia Guiada por Imagem , Terapias em Estudo/tendênciasRESUMO
These updated clinical practice guidelines on the treatment of small cell lung cancer (SCLC) limited disease formulated by the ELCWP aim to answer the following questions: 1) What is the definition of limited disease? 2) Is thoracic irradiation needed and what are the benefits? 3) What is the optimal time and method of chest irradiation? 4) What are the optimal parameters of irradiation : dose, fractionation, target volume? 5) When radiochemotherapy is not possible at the outset, how should consider radiotherapy after induction chemotherapy ? 6) What is the optimal chemotherapy for limited stage SCLC? 7) Should preventive brain irradiation be given and if so, when and to which patients? 8) What is the complementary role of thoracic surgery in early SCLC?
Assuntos
Neoplasias Pulmonares/terapia , Carcinoma de Pequenas Células do Pulmão/terapia , Neoplasias Encefálicas/prevenção & controle , Quimiorradioterapia Adjuvante/métodos , Quimioterapia Adjuvante/métodos , Europa (Continente) , Medicina Baseada em Evidências , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia , Guias de Prática Clínica como Assunto , Radioterapia Adjuvante/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/radioterapia , Carcinoma de Pequenas Células do Pulmão/cirurgia , Resultado do TratamentoRESUMO
The present systematic review was performed under the auspices of the European Lung Cancer Working Party (ELCWP) in order to determine the role of early intermediate criteria (surrogate markers), instead of survival, in determining treatment efficacy in patients with lung cancer. Initially, the level of evidence for the use of overall survival to evaluate treatment efficacy was reviewed. Nine questions were then formulated by the ELCWP. After reviewing the literature with experts on these questions, it can be concluded that overall survival is still the best criterion for predicting treatment efficacy in lung cancer. Some intermediate criteria can be early predictors, if not surrogates, for survival, despite limitations in their potential application: these include time to progression, progression-free survival, objective response, local control after radiotherapy, downstaging in locally advanced nonsmall cell lung cancer (NSCLC), complete resection and pathological TNM in resected NSCLC, and a few circulating markers. Other criteria assessed in these recommendations are not currently adequate surrogates of survival in lung cancer.
Assuntos
Biomarcadores Tumorais/metabolismo , Biomarcadores/metabolismo , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/diagnóstico , Oncologia/normas , Pneumologia/métodos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/terapia , Intervalo Livre de Doença , Europa (Continente) , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/terapia , Oncologia/métodos , Resultado do TratamentoRESUMO
Traditionally, the target volumes of curative-intent radiotherapy for non-small cell lung cancer include all uninvolved mediastinal nodes. However, an improvement in tumour control requires an increase of the total dose to the macroscopic target volume. This is only achievable if the irradiation of the organs at risk is reduced, i.e. elective irradiation of the mediastinum is omitted. The available data suggest that elective mediastinal irradiation may be safely omitted, provided that an adequate staging procedure, including FDG PET-CT, has been performed.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Pulmonares/radioterapia , Irradiação Linfática/métodos , Metástase Linfática/radioterapia , Mediastino/efeitos da radiação , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Irradiação Linfática/efeitos adversos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/prevenção & controle , Estadiamento de Neoplasias/métodos , Órgãos em Risco , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Procedimentos DesnecessáriosRESUMO
Postoperative radiotherapy remains controversial in non-small cell lung cancer. The conclusions of several meta-analysis are still questioned, partly because of flaws in the randomized trials taken into account. The technological improvements of modern radiotherapy and several clinical observations have led to the launch of a new phase III trial.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Radioterapia Adjuvante , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Ensaios Clínicos Fase III como Assunto , Terapia Combinada , Humanos , Neoplasias Pulmonares/cirurgia , Metanálise como Assunto , Radioterapia Adjuvante/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Resultado do TratamentoRESUMO
Non hodgkin's lymphomas are a group of haematological malignancies in which spectacular progress has been made over the last ten years thanks to immunotherapy. Furthermore, the new WHO classification, based upon tumour immunology, the degree of tumour differentiation and cytogenetic abnormalities, has finally improved identification of each lymphoma and has enabled comparison of homogeneous populations between different clinical studies. The increase in the incidence of non hodgkin's lymphoma is related to the aging of the population and to other factors that are yet to be elucidated--a real challenge for the future. We have tried to offer an overview of the latest therapeutic advances, with a focus on (radio-) immunotherapy and haemopoietic stem cell transplantation.
Assuntos
Imunoterapia , Linfoma não Hodgkin/terapia , Humanos , Guias de Prática Clínica como AssuntoRESUMO
As concomitant chemoradiotherapy for stage III NSCLC is associated with survival advantage in comparison to a sequential approach, we conducted a phase III randomised study aiming to determine the best sequence and safety of chemotherapy (CT) and chemoradiotherapy (CT-RT), using a regimen with cisplatin (CDDP), gemcitabine (GEM) and vinorelbine (VNR). Unresectable stage III NSCLC patients received CDDP (60 mg/m(2)), GEM (1g/m(2), days 1 and 8) and VNR (25mg/m(2), days 1 and 8) with reduced dosage of GEM and VNR during radiotherapy (66Gy). Two cycles of CT with radiotherapy followed by two further cycles of CT alone were administered in arm A or the reverse sequence in arm B. The study was prematurely closed for poor accrual due to administrative problems. Forty-nine eligible patients were randomised. Response rates and median survival times were, respectively 57% (95% CI: 36-78%) and 17 months (95% CI: 9.3-24.6 months) in arm A and 79% (95% CI: 64-94%) and 23.9 months (95% CI: 13.3-34.5 months) in arm B (p>0.05). Chemotherapy dose-intensity was significantly reduced in arm A. Grade 3-4 oesophagitis occurred in 5 patients. One case of grade 5 radiation pneumonitis was observed. In conclusion, chemoradiotherapy with CDDP, GEM and VNR appears feasible as initial treatment or after induction chemotherapy. Consolidation chemoradiotherapy seems less toxic with a better observed response rates and survival although no valid conclusion can be drawn from the comparison of both arms.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Terapia Combinada , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Radioterapia/métodos , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vimblastina/análogos & derivados , Vinorelbina , GencitabinaRESUMO
The most important progress made during the last years in the management of small cell lung cancer is certainly the recognition of the impact of chest radiotherapy for limited disease and prophylactic cranial irradiation (PCI) for patients in complete response. How to optimize chemotherapy and radiotherapy is the topic of this paper. The current trend is to deliver thoracic radiation concurrently with the first cycles of chemotherapy (cisplatine and etoposide). The total dose is still not defined and the subject of phase III trials. PCI is delivered at the end of the chemotherapy with moderate doses. The place of PCI in extensive disease is still debate even if there is a clear benefit in quality of life.
Assuntos
Neoplasias Pulmonares/radioterapia , Carcinoma de Pequenas Células do Pulmão/radioterapia , HumanosRESUMO
If surgery remains the cornerstone for the curative treatment of non-small cell lung cancer, failures are common especially for stage III disease and adjuvant treatment (chemotherapy or radiotherapy) may be justified. After the two meta-analyses, new trials have showed a moderate but significant benefit from cisplatin based chemotherapy. The role of radiotherapy is still controversial but from some clinical observations, a new trial using the modern radiation technology should address the question.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Terapia Neoadjuvante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Humanos , Estadiamento de Neoplasias , Radioterapia AdjuvanteRESUMO
The authors present an update version of the indications for radiotherapy in the management of benign diseases. This is based on available randomized trials and recent international meetings. Validated indications remain the prevention of resected heterotopic bone ossifications, keloïds scars and pterygium and also treatment of arteriovenous malformations; the place of radiotherapy for malignant exophtalmia is more and more restricted. Randomized trials have demonstrated the efficacy of endobrachytherapy in the prevention of restenosis after angioplasty but the use of embedded stent has replaced this indication. Macular degeneration is no more an indication of radiotherapy. Quality requirements for radiotherapy are identical for benign or malignant indications.
Assuntos
Malformações Arteriovenosas/radioterapia , Doenças Ósseas/radioterapia , Radioterapia/tendências , Braquiterapia/métodos , Humanos , Controle de Qualidade , Radioterapia/métodosRESUMO
The main critical factors for lung cancer patient management, apart from TNM staging, include expertise required to offer optimal management and conditions related to the patient, including performance status and weight loss and the presence of lung, cardiac or other comorbidities. Performance status and weight loss must be assessed for all patients. The minimal pulmonary functional evaluation should include spirometry. The minimal cardiac evaluation should consist of a clinical history and evaluation for cardiac risk factors and disease and at least preoperatively, and ECG. Age per se is not a contraindication for curative treatment.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Planejamento de Assistência ao Paciente , Fatores Etários , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/patologia , Doenças Cardiovasculares/etiologia , Eletrocardiografia , Nível de Saúde , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Testes de Função Respiratória , Fatores de Risco , Redução de PesoRESUMO
Three cases of pigmented villonodular synovitis treated in recent years are described. One case presents a malignant transformation and raises the question of the benign character of these lesions. The therapeutic options are considered as well as the need for a larger series of patients to define therapeutic strategy.
Assuntos
Articulação do Joelho/patologia , Sarcoma Sinovial/patologia , Sinovite Pigmentada Vilonodular/patologia , Adulto , Amputação Cirúrgica , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Artroplastia do Joelho , Transformação Celular Neoplásica , Quimioterapia Adjuvante , Radioisótopos de Cobalto/uso terapêutico , Terapia Combinada , Progressão da Doença , Doxorrubicina/administração & dosagem , Evolução Fatal , Feminino , Cabeça do Fêmur/patologia , Humanos , Ifosfamida/administração & dosagem , Articulação do Joelho/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Teleterapia por Radioisótopo , Radioterapia Adjuvante , Radioterapia de Alta Energia , Recidiva , Espaço Retroperitoneal , Sarcoma Sinovial/tratamento farmacológico , Sarcoma Sinovial/radioterapia , Sarcoma Sinovial/cirurgia , Cisto Sinovial/diagnóstico , Sinovite Pigmentada Vilonodular/diagnóstico , Sinovite Pigmentada Vilonodular/radioterapia , Sinovite Pigmentada Vilonodular/cirurgiaRESUMO
Radiation therapy of benign diseases represent a wide panel of indications. Some indications are clearly identified as treatment of arteriovenous malformations (AVM), hyperthyroid ophtalmopathy, postoperative heterotopic bone formations or keloid scars. Some indications are under evaluation as complications induced by neo-vessels of age-related macular degeneration or coronary restenosis after angioplasty. Some indications remain controversial with poor evidence of efficiency as treatment of bursitis, tendinitis or Dupuytren's disease. Some indications are now obsolete such as warts, or contra-indicated as treatment of infant and children.
Assuntos
Radioterapia , Idoso , Artroplastia de Quadril , Cicatriz Hipertrófica/radioterapia , Contraindicações , Doença das Coronárias/radioterapia , Doença de Graves/radioterapia , Humanos , Degeneração Macular/radioterapia , Ossificação Heterotópica/prevenção & controle , Ossificação Heterotópica/radioterapia , Radioterapia/efeitos adversos , Radioterapia/estatística & dados numéricos , Dosagem Radioterapêutica , RecidivaRESUMO
The treatment by radiotherapy (10 Grays) of subfoveal choroidal neovascular membranes is disappointing. Although after one year, 22% of cases had a positive result, after a mean follow up of 2.5 years only 14% of cases had a favourable outcome. The final visual acuity 30 months after treatment was the same as the one observed after 21 months of natural evolution. The well-defined nature of the subretinal new vessels, the presence of a pigment epithelial detachment and the occurrence of a vast hemorrhage were of bad prognosis.