Organ-sparing techniques and dose-volume constrains used in breast cancer radiation therapy - Results from European and Latin American surveys.

Background: Advances in local and systemic therapies have improved the outcomes of patients with breast cancer (BC), leading to a possible increased risk for postoperative radiation therapy (RT) late adverse events. The most adequate technologies and dose constraints for organs at risk (OAR) in BC RT have yet to be defined. Methods: An online survey was distributed to radiation oncologists (ROs) practicing in Europe and Latin America including the Caribbean (LAC) through personal contacts, RO and BC professional groups' networks. Demographic data and clinical practice information were collected. Results:  The study included 585 responses from ROs practicing in 57 different countries. The most frequently contoured OAR by European and LAC participants were the whole heart (96.6 % and 97.7 %), the ipsilateral (84.3 % and 90.8 %), and contralateral lung (71.3 % and 77.4 %), whole lung (69.8 % and 72.9 %), and the contralateral breast (66.4 % and. 83.2 %). ESTRO guidelines were preferred in Europe (33.3 %) and the RTOG contouring guideline was the most popular in LAC (62.2 %), while some participants used both recommendations (13.2 % and 19.2 %). IMRT (68.6 % and 59.1 %) and VMAT (65.6 % and 60.2 %) were the preferred modalities used in heart sparing strategies, followed by deep inspiration breath-hold (DIBH) (54.8 % and 37.4 %) and partial breast irradiation (PBI) (41.6 % and 24.6 %). Only a small percentage of all ROs reported the dose-volume constraints for OAR used in routine clinical practice. A mean heart dose (Heart-Dmean) between 4 and 5 Gy was the most frequently reported parameter (17.2 % and 39.3 %). Conclusion:  The delineation approaches and sparing techniques for OAR in BC RT vary between ROs worldwide. The low response rate to the dose constraints subset of queries reflects the uncertainty surrounding this topic and supports the need for detailed consensus recommendations in the clinical practice.

Radiotherapy for Brain Metastases Near the End of Life: Characterizing Patients and Tumor Features.

PURPOSE: Patients with brain metastases are often referred for brain radiotherapy (BrRT) when exclusive palliative management would be more appropriate. To assess the indication of BrRT during end-of-life (EOL) care and evaluate the characteristics of the patients who underwent the treatment. METHODS: This retrospective study comprised patients from four independent oncology centers who had undergone BrRT for metastases. The variables included were Karnofsky performance status (KPS), primary tumor site, metastatic status, neurologic symptomatic status, the number and size of metastases, posterior fossa or meningeal involvement, type of BrRT, having undergone brain metastasectomy, and the availability of systemic therapies after BrRT. Patients were allocated into three subgroups with ≤30, 31-60, and 61-90 days of survival, and a control group of patients who survived >90 days. RESULTS: A total of 546 patients were included in the study. A KPS of <70 (P = .021), the number of brain metastases (P = .001), the lack of brain metastasectomy (P = .006), and the lack of systemic therapies after BrRT (P = .047) were significantly associated with the EOL subgroups. Multivariate analysis showed that a KPS of <70 (P < .001), the lack of brain metastasectomy (P = .015), and the lack of systemic therapies after BrRT (P = .027) were significantly associated with worse survival. In all, 241 (44.1%) patients died within 90 days-120 (22.0%) within 30 days, 75 (13.7%) within 31-60 days, and 46 (8.4%) within 61-90 days of BrRT. Patients with colorectal cancer were significantly more likely to die within 90 days of BrRT than >90 days. CONCLUSION: Considering patients' performance status and whether they are candidates for brain metastasectomy or systemic therapies after BrRT is critical to improving BrRT benefits in scenarios of EOL.

Real-World Evidence on the Use of Endocrine Therapy for Ductal Carcinoma In Situ in Patients Treated With Breast-Conserving Surgery Followed by Postoperative Radiation Therapy: A Brazilian Retrospective Cohort Study.

INTRODUCTION/BACKGROUND: This study aims to evaluate the reproducibility of findings from randomized controlled trials regarding adjuvant hormone therapy (HT) for breast ductal carcinoma in situ (DCIS) in a real-life scenario. MATERIALS/METHODS: This retrospective cohort study used Fundação Oncocentro de São Paulo database. It included DCIS patients DCIS who received breast-conserving surgery and postoperative radiation therapy. The endpoints were local control (LC), breast cancer-specific survival (BCSS), and overall survival (OS). RESULTS: We analyzed 2192 patients treated between 2000 and 2020. The median FU was 48.99 months. Most patients (53.33%; n = 1169) received adjuvant HT. Patients not receiving adjuvant HT tend to be older (P = .021) and have a lower educational level (P < .001). At the end of FU, 1.5% of patients had local recurrence, and there was no significant difference between groups (P = .19). The 10-year OS and BCSS were 89.4% and 97.5% for adjuvant HT versus 91.5% and 98.5% for no adjuvant HT, respectively, and there were no significant differences between groups. The 10-year OS was 93.25% for medium/high education level versus 87.31% for low (HR for death 0.51; 95% CI, 0.32-0.83; P = .007). CONCLUSIONS: The benefits of adjuvant HT for DCIS were not reproduced in a Brazilian cohort. Education significantly impacted survival and HT usage, reflecting the influence of socioeconomic factors. These findings can allow for more precise interventions.

Cost-effectiveness of hypofractionated versus conventional fractionated radiotherapy for the treatment of men with early glottic cancer: a study in the Brazilian public and private health system.

BACKGROUND: This study aims to evaluate whether hypofractionated radiotherapy (HYPOFRT) is a cost-effective strategy than conventional fractionated radiotherapy (CFRT) for early-stage glottic cancer (ESGC) in the Brazilian public and private health systems. METHODS: Adopting the perspective of the Brazilian public and private health system as the payer, a Markov model with a lifetime horizon was built to delineate the health states for a cohort of 65-year-old men after with ESGC treated with either HYPOFRT or CFRT. Probabilities of controlled disease, local failure, distant metastasis, and death and utilities scores were extracted from randomized clinical trials. Costs were based on the public and private health system reimbursement values. RESULTS: In the base case scenario, for both the public and private health systems, HYPOFRT dominated CFRT, being more effective and less costly, with a negative ICER of R$264.32 per quality-adjusted life-year (QALY) (public health system) and a negative ICER of R$2870.69/ QALY (private health system). The ICER was most sensitive to the probability of local failure, controlled disease, and salvage treatment costs. For the probabilistic sensitivity analysis, the cost-effectiveness acceptability curve indicates that there is a probability of 99.99% of HYPOFRT being cost-effective considering a willingness-to-pay threshold of R$2,000 ($905.39) per QALY (public sector) and willingness-to-pay threshold of R$16,000 ($7243.10) per QALY (private sector). The results were robust in deterministic and probabilistic sensitivity analyses. CONCLUSIONS: Considering a threshold of R$ 40,000 per QALY, HYPOFRT was cost-effective compared to CFRT for ESGC in the Brazilian public health system. The Net Monetary Benefit (NMB) is approximately 2,4 times (public health system) and 5,2 (private health system) higher for HYPOFRT than CFRT, which could open the opportunity of incorporating new technologies.

Three-Dimensional Dosimetry by Optical-CT and Radiochromic Gel Dosimeter of a Multiple Isocenter Craniospinal Radiation Therapy Procedure.

Craniospinal irradiation (CSI) is a complex radiation technique employed to treat patients with primitive neuroectodermal tumors such as medulloblastoma or germinative brain tumors with the risk of leptomeningeal spread. In adults, this technique poses a technically challenging planning process because of the complex shape and length of the target volume. Thus, it requires multiple fields and different isocenters to guarantee the primary-tumor dose delivery. Recently, some authors have proposed the use IMRT technique for this planning with the possibility of overlapping adjacent fields. The high-dose delivery complexity demands three-dimensional dosimetry (3DD) to verify this irradiation procedure and motivated this study. We used an optical CT and a radiochromic Fricke-xylenol-orange gel with the addition of formaldehyde (FXO-f) to evaluate the doses delivered at the field junction region of this treatment. We found 96.91% as the mean passing rate using the gamma analysis with 3%/2 mm criteria at the junction region. However, the concentration of fail points in a determined region called attention to this evaluation, indicating the advantages of employing a 3DD technique in complex dose-distribution verifications.

Cost-effectiveness of stereotactic body radiotherapy versus conventional radiotherapy for the treatment of surgically ineligible stage I non-small cell lung cancer in the Brazilian public health system.

Background: The Brazilian public health system does not pay for the use of Stereotactic body radiotherapy (SBRT) due to its costs and the absence of cost-effectiveness analysis showing its benefit. The present study aims to evaluate whether the SBRT is a more cost-effective strategy than the conventional fractionated radiotherapy (CFRT) for surgically ineligible stage I non-small cell lung cancer (NSCLC) in the Brazilian public health system. Methods: Adopting the perspective of the Brazilian Unified Healthcare System (SUS) as the payer, a Markov model with a lifetime horizon was built to delineate the health states for a cohort of 75-years-old men with medically inoperable NSCLC after treatment with SBRT or CFRT. Transition probabilities and health states utilities were adapted from the literature. Costs were based on the public health system reimbursement values and simulated in the private sector. Findings: The SBRT strategy results in more quality-adjusted life-year (QALYs) and costs with an incremental cost-effectiveness ratio (ICER) of R$ 164.86 (U$ 65.16) per QALY and R$ 105 (U$ 41.50) per life-year gained (LYG). This strategy was cost-effective, considering a willingness-to-pay of R$ 25,000 (U$ 9,881.42) per QALY. The net monetary benefit (NMB) was approximately twice higher. The outcomes were confirmed with 92% of accuracy in the probabilistic sensitivity analysis. Interpretation: Using a threshold of R$25,000 per QALY, SBRT was more cost-effective than CFRT for NSCLC in a public health system of an upper-middle-income country. SBRT generates higher NMB than CFRT, which could open the opportunity to incorporate new technologies. Funding: Varian Medical Systems.

Technical Note: Three-dimensional QA of simultaneous integrated boost radiotherapy treatments by a dose-volume histogram methodology and its comparison with 3D gamma results.

PURPOSE: Intensity-modulated radiotherapy with simultaneous integrated boost (SIB) presents several attractive advantages to be employed in clinical practice. Its secure application demands a rigorous quality assurance (QA) procedure, ideal for three-dimensional (3D) dose distribution measurements. Thus, a gel dosimetry methodology to evaluate the dose delivery of SIB treatments is presented and compared to conventional gamma evaluation. METHODS: MAGIC-f gel dosimeter with magnetic resonance images for dose reading were used following its standard procedures. Four SIB QA plans created in gel dosimeter phantoms were used. The gel measured and treatment planning system (TPS) calculated doses were compared using 3D gamma analyses (3%/3mm/15% threshold). Two structures were artificially on the TPS dose distribution expected on the phantom by converting the 1.7 and 2.0 Gy isodose levels into structures to represent the treatment. The gel and TPS dose-volume histogram (DVH) were compared based on five dose points: D95%, D90%, D50%, D10%, and D5%. RESULTS: Approvals of 93%, 96%, 98%, and 92% were achieved in the 3D gamma analyses for the plans QA 1, 2, 3, and 4. In the DVH analyses, QA plan 1 measured and expected curves showed a good agreement. QA plan 2 showed deviations in the highest doses for both structures with a maximum deviation (Δmáx ) of 8.0%. QA plans 3 and 4 showed the highest dose variation between the gel and TPS in the smaller doses of the DVH (Δmáx of 7.2% and -8.9%, respectively). For QA plan 4, the curves of the 1.7 Gy structure presented a good agreement, but deviations in the smaller dose region of the DVH occurred for the 2 Gy structure (Δmáx of 7.7%). CONCLUSIONS: A methodology for 3D dose evaluation of complex SIB treatments was proposed. It provided an important overview of the dose distributions. Their results significantly complemented the usual gamma analysis results.

Tridimensional dose evaluation of the respiratory motion influence on breast radiotherapy treatments using conformal radiotherapy, forward IMRT, and inverse IMRT planning techniques.

PURPOSE: To evaluate the respiratory motion influence on the tridimensional (3D) dose delivery to breast-shaped phantoms using conformal radiotherapy (3D-RT), Field-in Field (FiF), and IMRT planning techniques. METHODS: This study used breast-shaped phantoms filled with MAGIC-f gel dosimeter to simulate the breast, and an oscillation platform to simulate the respiratory motion. The platform allowed motion in the anterior-posterior direction with oscillation amplitudes of 0.34 cm, 0.88 cm, and 1.22 cm. CT images of the static phantom were used for the 3D-RT, FiF, and IMRT treatment planning. Five phantoms were prepared and irradiated for each planning technique evaluated. Phantom 1 was irradiated static, phantoms 2-4 were irradiated moving with the three different motion amplitudes, and phantom 5 was used as a reference. The 3D dose distributions were obtained by relaxometry of magnetic resonance imaging, and the respiratory motion influence in the doses distribution was accessed by gamma evaluations (3%/3mm/15% threshold) comparing the measurements of the phantoms irradiated under movement with the static ones. RESULTS: The mean gamma approvals for three oscillatory amplitudes were 96.44%, 93.23%, and 91.65%; 98.42%, 95.66%, and 94.31%; and 94.49%, 93.51%, and 86.62% respectively for 3D-RT, FiF and IMRT treatments. A gamma results profile per slice along the phantom showed that for FiF and IMRT irradiations, most of the failures occurred in the central region of the phantom. CONCLUSIONS: By increasing the respiratory motion movement, the dose distribution variations for the three planning techniques were more pronounced, being the FiF technique variations the smallest one.

The risk of induced cancer and ischemic heart disease following low dose lung irradiation for COVID-19: estimation based on a virtual case.

BACKGROUND: Recently, low dose radiotherapy delivered to the whole lung has been proposed as treatment for the pneumonia due to COVID-19. Although there is biological plausibility for its use, the evidence supporting its effectiveness is scarce, and the risks associated with it may be significant. Thus, based on a virtual case simulation, we estimated the risks of radiation-induced cancer (RIC) and cardiac disease. METHODS: Lifetime attributable risks (LAR) of RIC were calculated for the lung, liver, esophagus, and breast of female patients. The cardiovascular risk of exposure-induced death (REID) due to ischemic heart disease was also calculated. The doses received by the organs involved in the treatment were obtained from a simulation of conformal radiotherapy (RT) treatment, delivering a dose of 0.5 Gy-1.5 Gy to the lungs. We considered a LAR and REID <1% as acceptable, 1-2% cautionary, and >2% unacceptable. RESULTS: The lung was at the highest risk for RIC (absolute LAR below 5200 cases/100,000 and 2250 cases/100,000 for women and men, respectively). For women, the breast had the second-highest LAR, especially for young women. The liver and esophagus had LARs below 700/100,000 for both sexes, with a higher incidence of esophageal cancer in women and liver cancer in men. Regarding the LAR cutoff, we observed an unacceptable or cautionary LAR for lung cancer in all women and men <60 years with an RT dose >1 Gy. LAR for lung cancer with an RT dose of 1 Gy was cautionary for women >60 years of age and men <40 years of age. No LAR estimation was unacceptable for the RT dose ≤0.7 Gy in all groups irrespective of sex or age at exposure. Only 0.5 Gy had an acceptable REID. CONCLUSIONS: A RT dose ≤0.5 Gy provides an acceptable LAR estimate (≤1%) for RIC and REID, irrespective of sex and age. The current ongoing trials should initially use doses ≤0.5 Gy to maintain the risks at an acceptable level and include only patients who fail or do not have any other treatment option.

Plasma antioxidant substances apparently do not influence the radiodermatitis occurrence / Substâncias antioxidantes do plasma aparentemente não influenciam a ocorrência de radiodermatite

AIMS: Radiation affects not only tumors but also healthy tissues through the increment of oxidative stress. Thus, this study aimed to evaluate the oxidative stress degree as well as non-enzymatic antioxidant defenses in the plasma of patients submitted to radiotherapy and to verify if these parameters are modified in those patients who develop radiodermatitis. METHODS: Forty-one patients submitted to radiotherapy for treatment of breast cancer were followed. From these patients, plasma samples were obtained at the beginning, in the middle and at the end of the treatment, for analysis of thiobarbituric acid reactive substances (TBARS) and ferric reducing ability of plasma (FRAP). RESULTS: No significant differences were observed in terms of TBARS and FRAP in plasma harvested from these patients at the beginning and at the middle of the treatment. There was lower incidence of grade two radiodermatitis among patients undergoing radiotherapy with hypofractionated doses. There were no differences in FRAP or TBARS among patients who developed radiodermatitis of any degree in relation to those who did not develop this side effect. No differences of FRAP or TBARS were observed between patients that presented grade two radiodermatitis regarding to the others studied. CONCLUSION: There was no clear relationship between changes in TBARS or FRAP with the occurrence or severity of radiodermatitis.

Comparison among adjuvant treatments for primary pterygium: a network meta-analysis.

PURPOSE: Pterygium is a frequent ocular disease, where the major challenge is the high level of recurrence after its surgical removal. We performed a network meta-analysis to identify, among several adjuvant treatments for primary pterygium, which is the best to prevent recurrence. METHODS: A search was conducted using PubMed, Scientific Electronic Library Online, Latin American and Caribbean Centre on Health Sciences and Cochrane Eyes and Vision Group Trials Register between 1993 and 2015 for randomisedclinical trials (RCTs) comparing adjuvant treatments following primary pterygium surgery. RESULTS: 24 RCTs that studied 1815 eyes of 1668 patients were included and allowed direct and indirect comparison among 14 interventions through network meta-analysis. The rank from the best to worse treatment to prevent recurrence is: conjunctival autograft + ciclosporin 0.05% eye drops, bare sclera + intraoperativemitomycin C (MMC) <0.02%, bare sclera + beta therapy (2500 cGy single dose), conjunctival autograft + beta therapy (1000 cGy single dose), bare sclera + MMC 0.02% eye drops, conjunctival autograft, bare sclera + intraoperative MMC >0.02%, bare sclera + ciclosporin 0.05% eye drops, bare sclera + intraoperative 5-fluorouracil 5%, amniotic membrane transplantation, bare sclera + intraoperative MMC 0.02%, conjunctival autograft + bevacizumab 0.05% eye drops, bare sclera + bevacizumab 0.05% eye drops and bare sclera alone. CONCLUSION: The best adjuvant treatment to prevent recurrence after primary pterygium surgery is the association of conjunctival autograft and ciclosporin 0.05% eye drops. Bare sclera technique alone should be discontinued since it is associated with high recurrence rates.

Assessment of the Analgesic Effect of Magnesium and Morphine in Combination in Patients With Cancer Pain: A Comparative Randomized Double-Blind Study.

BACKGROUND: Morphine is the first-choice drug for moderate-to-severe cancer pain, nevertheless, some patients do not achieve adequate pain relief or exhibit intolerable side effects. The purpose of this study was to establish whether the analgesic effect of morphine improves in patients with cancer when administered in combination with magnesium. METHODS: Randomized double-blind study was conducted with 40 patients older than 18 years with cancer pain using morphine. Group 1 (G1) patients were given magnesium sulfate (65 mg elemental magnesium) twice per day by the oral route. Group 2 (G2) patients were given placebo twice per day. All the patients were administered morphine as needed. They were also given acetaminophen at 2 to 3 g/d. Adjuvants could be used when indicated. The following variables were assessed: pain intensity on a numeric scale at baseline and at weeks 1, 2, 3, and 4; functional performance and quality of life at baseline and week 4; and dose of morphine used. RESULTS: No difference was found between the groups as to pain intensity, dose of morphine used, functional performance, quality of life, or side effects. The average daily dose of morphine increased gradually, being significant in G2. CONCLUSIONS: The use of morphine combined with elemental magnesium at a dose of 65 mg twice per day by patients with cancer did not induce a better analgesic effect, did not improve their functional performance or quality of life, and did not reduce the occurrence of side effects. The dose of morphine increased significantly in G2.

Infarto agudo do miocárdio sob a ótica da população brasileira / Acute myocardial infarction from the standpoint of the brazilian population

Fundamentos: O infarto agudo do miocárdio constitui uma das principais causas de morbimortalidade e incapacidade no Brasil e no mundo, e representa umdesafio à saúde pública. O conhecimento dos sintomas do infarto pela população contribui para o diagnóstico precoce e rapidez na busca por tratamento, melhorando o prognóstico do paciente. Objetivo: Identificar o nível de conhecimento de umgrupo populacional sobre infarto agudo do miocárdio e ativação do serviço de emergência.Métodos: Estudo transversal realizado com transeuntes de diversos locais públicos da cidade de Marília, SP, Brasil. A partir de um caso clínico típico de infartoagudo do miocárdio apresentado, os entrevistados responderam a questionário estruturado de modo a evidenciar seus conhecimentos sobre infarto agudodo miocárdio e ativação do serviço de emergência, e coletar informações sociodemográficas. Resultados: Entrevistados 303 sujeitos (61,72% mulheres), média de idade 39,75±15,39 anos. Não reconheceram os sintomas do caso como decorrentes de infarto, 38,94% dos indivíduos. A maioria dos entrevistados (70,63%) respondeu que telefonaria para o serviço de emergência diante da situação apresentada, entretanto 40,59% não identificaram o número doserviço de emergência no Brasil. Maior nível de escolaridade, idade <40 anos e ausência de antecedentes de hipertensão arterial se associaram à identificaçãocorreta do número do serviço de emergência (p=0,035; p<0,001; p=0,020, respectivamente) e da ativação do mesmo (p=0,025; p=0,006; p=0,003, respectivamente). Conclusões: O estudo demonstrou que parcela significativa dos entrevistados não sabe o número do serviço de emergência no Brasil e apresenta déficit de conhecimento sobre infarto agudo do miocárdio.

Background: Acute myocardial infarction is one of the leading causes of morbidity, mortality and disability in Brazil and the world, offering a public health challenge. Knowledge of the symptoms of infarction among the population contributes to early diagnosis and speed in seeking treatment, improving patient prognoses. Objective: To identify the level of knowledge of a population group about acute myocardial infarction and alerting emergency services.Methods: Cross-sectional study conducted with passers-by in several public places in the town of Marilia, São Paulo State, Brazil. Based on the presentation of a typical clinical case of acutemyocardial infarction, respondents completed a structured questionnaire in order to demonstrate their knowledge about myocardial infarction and alerting emergency services, in addition to collecting social and demographic information. Results: 303 subjects were interviewed (61.72% women) with a mean age of 39.75 ± 15.39 years), with 38.94% not recognizing the case symptoms as resulting from infarction. Although most (70.63%) of therespondents said that they would call the emergency service in the presented situation, 40.59% could not state the emergency service number in Brazil. Higher educational levels, age less than 40 years and absence of any history of hypertension were associated with correct identification of the emergency service number p=0.035; p<0.001; p=0.020, respectively) andits activation (p=0.025; p=0.006; p=0.003, respectively). Conclusions: The study showed that a significant proportion of the respondents did not know the emergency service number in Brazil and had little knowledge about acute myocardial infarction.

Dry eye disease treatment: a systematic review of published trials and a critical appraisal of therapeutic strategies.

Dry eye disease (DED) treatment is an area of increasing complexity, with the emergence of several new treatment agents in recent years. Evaluation of the efficacy of these agents is limited by heterogeneity in outcomes definition and the small number of comparative studies. We provide a systematic review of clinical trials (CTs) related to DED treatment and a critical appraisal of CT public databases. CT reports obtained from eight databases were reviewed, as well as public free-access electronic databases for CT registration. Data evaluation was based on endpoints such as symptoms, Schirmer test, ocular surface staining scores, recruitment of patients, type and efficacy of the drug, and the design and site of performance of the study. Forty-nine CTs were evaluated involving 5,189 patients receiving DED treatment. Heterogeneity in study design prevented meta-analysis from yielding meaningful results, and a descriptive analysis of these studies was conducted. The most frequent categories of drugs for DED in these studies were artificial tears, followed by anti-inflammatory drugs and secretagogues. Although 116 studies have been completed, according to the registration database for clinical trials, only 17 of them (15.5%) were published. Out of 185 registered CTs related to DED, 72% were performed in the USA. The pharmaceutical industry sponsored 78% of them. The identification of effective DED treatment strategies is hindered by the lack of an accepted set of definitive criteria for evaluating disease severity.

Meta-analysis of beta radiation augmentation for trabeculectomy - results in distinct ethnic groups.

PURPOSE: To conduct a systematic review with meta-analysis on the efficacy of trabeculectomy (TREC) followed by beta irradiation (BRT/TREC) compared to TREC alone for glaucoma in terms of intraocular pressure (IOP) control and adverse effects of treatment in different ethnic groups. METHODS: A meta-analysis of randomized controlled trials (RCT) was performed comparing adjunct BRT treatment for glaucoma with standard TREC after 12 months. The MEDLINE, EMBASE, LILACS, and Cochrane Library databases, Trial registers, bibliographic databases and recent studies of relevant journals were searched. Two reviewers independently reviewed relevant reports and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria. RESULTS: Of a total of 1,350 citations, eight studies (five cohorts, three randomized) were identified and only 3 RCT were included in this meta-analysis. Higher IOP reductions were verified in the BRT arm compared to the control arm (mean difference=1.68 mmHg, 95% CI= 0.61-2.68, P=0.002). Uncontrolled postoperative IOP (>21 mmHg) was less frequent when BRT was used (BRT/ TREC arm) compared to the control arm (38/218=17.4% versus 9/239=3.8%; OR=6.7; 95% CI 3.2-14.3, P<0.0001). Although better IOP control was observed in all patients treated with adjuvant BRT, only Black patients displayed a significant difference (P=0.005). There were no significant differences between the BRT and control arms regarding loss of visual acuity, postoperative complications and necessity of cataract surgery. CONCLUSION: Adjunct BRT increases the success rate of TREC, with better results in non Caucasian patients, and does not influence the occurrence of postoperative complications.

Meta-analysis of beta radiation augmentation for trabeculectomy - results in distinct ethnic groups / Meta-análise da trabeculectomia potencializada pela radiação beta - resultados em grupos étnicos distintos

PURPOSE: To conduct a systematic review with meta-analysis on the efficacy of trabeculectomy (TREC) followed by beta irradiation (BRT/TREC) compared to TREC alone for glaucoma in terms of intraocular pressure (IOP) control and adverse effects of treatment in different ethnic groups. METHODS: A meta-analysis of randomized controlled trials (RCT) was performed comparing adjunct BRT treatment for glaucoma with standard TREC after 12 months. The MEDLINE, EMBASE, LILACS, and Cochrane Library databases, Trial registers, bibliographic databases and recent studies of relevant journals were searched. Two reviewers independently reviewed relevant reports and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria. RESULTS: Of a total of 1,350 citations, eight studies (five cohorts, three randomized) were identified and only 3 RCT were included in this meta-analysis. Higher IOP reductions were verified in the BRT arm compared to the control arm (mean difference=1.68 mmHg, 95 percent CI= 0.61-2.68, P=0.002). Uncontrolled postoperative IOP (>21 mmHg) was less frequent when BRT was used (BRT/ TREC arm) compared to the control arm (38/218=17.4 percent versus 9/239=3.8 percent; OR=6.7; 95 percent CI 3.2-14.3, P<0.0001). Although better IOP control was observed in all patients treated with adjuvant BRT, only Black patients displayed a significant difference (P=0.005). There were no significant differences between the BRT and control arms regarding loss of visual acuity, postoperative complications and necessity of cataract surgery. CONCLUSION: Adjunct BRT increases the success rate of TREC, with better results in non Caucasian patients, and does not influence the occurrence of postoperative complications.

OBJETIVO: Realizar uma revisão sistemática com meta-análise sobre a eficácia da trabeculectomia (TREC), seguida ou não por irradiação beta (BRT/TREC) para o tratamento do glaucoma, em termos de controle da pressão intraocular (PIO) e de efeitos adversos, em diferentes grupos étnicos. MÉTODOS: Uma meta-análise de ensaios clínicos randomizados (RCT) foi realizada, comparando os resultados de 12 meses da TREC com o uso adjuvante de BRT, com aqueles da TREC padrão. Foram fontes de pesquisa as bases de dados MEDLINE, EMBASE, LILACS, Cochrane, além de sítios de registro de ensaios clínicos, estudos recentes em revistas da área e outras bases de dados bibliográficos. Dois revisores avaliaram independentemente publicações relevantes e as referências desses trabalhos foram pesquisadas para procura de ensaios adicionais, de acordo com as diretrizes estabelecidas pelos critérios do QUOROM. RESULTADOS: De um total de 1.350 citações, oito estudos (cinco coortes e três aleatorizados) foram identificados e apenas 3 RCT foram incluídos nesta meta-análise. Maiores reduções na PIO foram verificadas no braço de estudo da BRT, comparado com o braço controle (diferença média=1,68 mmHg, 95 por cento CI= 0,61-2,68, P=0,002). A frequência de PIO pós-operatória não controlada (>21 mmHg) foi menor quando utilizada a BRT (BRT/TREC) em relação ao grupo controle (38/218 =17,4 por cento versus 9/239 =3,8 por cento; OR= 6,7 IC 95 por cento 3,2 14,3, P<0,0001). Apesar do melhor controle da PIO ter sido observada em todos os pacientes do braço BRT, apenas os pacientes negros apresentaram uma diferença significativa (P=0,005). Não houve diferenças significativas entre os braços BRT e controle, em termos de perda da acuidade visual, complicações pós-operatórias e necessidade de cirurgia de catarata. CONCLUSÃO: O uso de BRT adjuvante aumenta a taxa de sucesso da TREC, com melhores resultados em pacientes não-caucasianos, não influenciando a ocorrência de complicações pós-operatórias.

Audiological findings in patients treated with radiotherapy for head and neck tumors.

UNLABELLED: Radiotherapy has been widely used given its increase in the successful outcomes and cure of some cancers. AIM: To evaluate the functionality of the auditory system in patients who underwent radiotherapy treatment for head and neck tumors. MATERIALS AND METHODS: From May 2007 to May 2008, otorhinolaryngological and audiological evaluation (Pure Tone Audiometry (air and bone conduction), Speech Audiometry, Tympanometry, Acoustic Reflex testing and Distortion Product Otoacoustic Emissions) were performed in 19 patients diagnosed with head and neck neoplasia and treated with radiotherapy. Prospective case series study. RESULTS: 10.5% left ears and 26.3% right ears had bilateral hearing loss soon after radiotherapy according to ASHA criteria. CONCLUSIONS: Radiotherapy treatment for head and neck cancer has ototoxic effects. Early programs of auditory rehabilitation should be offered to these patients.