RESUMO
OBJECTIVE: To identify relevant relative cerebral blood volume biomarkers from T2* dynamic-susceptibility contrast magnetic resonance imaging to anticipate glioblastoma progression after chemoradiation. METHODS: Twenty-five patients from a prospective study with glioblastoma, primarily treated by chemoradiation, were included. According to the last follow-up MRI confirmed status, patients were divided into: relapse group (n = 13) and control group (n = 12). The time of last MR acquisition was tend; MR acquisitions performed at tend-2M, tend-4M and tend-6M (respectively 2, 4 and 6 months before tend) were analyzed to extract relevant variations among eleven perfusion biomarkers (B). These variations were assessed through R(B), as the absolute value of the ratio between ∆B from tend-4M to tend-2M and ∆B from tend-6M to tend-4M. The optimal cut-off for R(B) was determined using receiver-operating-characteristic curve analysis. RESULTS: The fraction of hypoperfused tumor volume (F_hPg) was a relevant biomarker. A ratio R(F_hPg) ≥ 0.61 would have been able to anticipate relapse at the next follow-up with a sensitivity/specificity/accuracy of 92.3 %/63.6 %/79.2 %. High R(F_hPg) (≥0.61) was associated with more relapse at tend compared to low R(F_hPg) (75 % vs 12.5 %, p = 0.008). CONCLUSION: Iterative analysis of F_hPg from consecutive examinations could provide surrogate markers to predict progression at the next follow-up. KEY POINTS: ⢠Related rCBV biomarkers from DSC were assessed to anticipate GBM progression. ⢠Biomarkers were assessed through their patterns of variation during the follow-up. ⢠The fraction of hypoperfused tumour volume (F_hP g ) seemed to be a relevant biomarker. ⢠An innovative ratio R(F_hP g ) could be an early surrogate marker of relapse. ⢠A significant time gain could be achieved in the management of GBM patients.
Assuntos
Biomarcadores/metabolismo , Neoplasias Encefálicas/terapia , Quimiorradioterapia/métodos , Glioblastoma/terapia , Adulto , Idoso , Volume Sanguíneo , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Meios de Contraste , Progressão da Doença , Feminino , Glioblastoma/patologia , Glioblastoma/fisiopatologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estudos Prospectivos , Curva ROCRESUMO
A multicystic intraventricular tumour of the right ventricular atrium was incidentally diagnosed on follow-up imaging of a 61-year-old man with a history of prostatic adenocarcinoma. Surgical resection of the lesion was performed after a one-year radio-clinical follow-up due to progressive expansion of the lesion size and a rising prostate specific antigen blood-level. Morphological features with papillary pattern on pathological examination were compatible with malignant adenocarcinoma or choroid plexus carcinoma. The immunoprofile was conclusive for an exceptional choroid plexus metastasis (CPM) of a prostatic adenocarcinoma. To our knowledge, this is the first report of a proven prostatic origin of a CPM.
Assuntos
Adenocarcinoma , Carcinoma , Neoplasias do Plexo Corióideo , Neoplasias da Próstata , Adenocarcinoma/patologia , Plexo Corióideo , Neoplasias do Plexo Corióideo/diagnóstico , Neoplasias do Plexo Corióideo/secundário , Neoplasias do Plexo Corióideo/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologiaRESUMO
We propose in this short review to report the impact of stereotactic body radiation therapy (SBRT) in oligometastatic or oligoprogressive cancer patients in terms of metastatic progression-free and global survival, and to identify the place of SBRT in patient's pathway.
Assuntos
Neoplasias da Mama/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Neoplasias da Próstata/radioterapia , Radiocirurgia/métodos , Neoplasias da Mama/patologia , Sobreviventes de Câncer , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/secundário , Progressão da Doença , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Metástase Neoplásica , Prognóstico , Neoplasias da Próstata/patologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Glioblastomas (GBMs) induce a peritumoural vasogenic oedema impairing functional status and quality of life. Steroids reduce brain tumour-related oedema but are associated with numerous side-effects. It was reported in a retrospective series that angiotensin receptor blockers might be associated with reduced peritumoural oedema. The ASTER study is a randomised, placebo-controlled trial to assess whether or not the addition of Losartan to standard of care (SOC) can reduce steroid requirement during radiotherapy (RT) in patients with newly diagnosed GBM. PATIENTS AND METHODS: Patients with a histologically confirmed GBM after biopsy or partial surgical resection were randomised between Losartan or placebo in addition to SOC with RT and temozolomide (TMZ). The primary objective was to investigate the steroid dosage required to control brain oedema on the last day of RT in each arm. The secondary outcomes were steroids dosage 1 month after the end of RT, assessment of cerebral oedema on magnetic resonance imaging, tolerance and survival. RESULTS: Seventy-five patients were randomly assigned to receive Losartan (37 patients) or placebo (38 patients). No difference in the steroid dosage required to control brain oedema on the last day of RT, or one month after completion of RT, was seen between both arms. The incidence of adverse events was similar in both arms. Median overall survival was similar in both arms. CONCLUSIONS: Losartan, although well tolerated, does not reduce the steroid requirement in newly diagnosed GBM patients treated with concomitant RT and TMZ. Trial registration number NCT01805453 with ClinicalTrials.gov.
Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Neoplasias Encefálicas/terapia , Quimiorradioterapia/mortalidade , Edema/prevenção & controle , Glioblastoma/terapia , Losartan/uso terapêutico , Prednisona/administração & dosagem , Idoso , Anti-Inflamatórios/administração & dosagem , Neoplasias Encefálicas/patologia , Método Duplo-Cego , Quimioterapia Combinada , Edema/epidemiologia , Feminino , Seguimentos , França/epidemiologia , Glioblastoma/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Taxa de SobrevidaRESUMO
Irradiation techniques for breast cancer (arctherapy, tomotherapy) are evolving and intensity-modulated radiation therapy is being increasingly considered for the management of these tumours. Here, we propose a review of intensity-modulated radiation therapy planning issues, clinical toxicities and indications for breast cancer.
Assuntos
Neoplasias da Mama/radioterapia , Radioterapia de Intensidade Modulada/métodos , Neoplasias da Mama/cirurgia , Estética , Feminino , Humanos , Mastectomia , Órgãos em Risco , Dosagem Radioterapêutica , Radioterapia AdjuvanteRESUMO
Surgery (radical cystectomy) is the standard treatment of muscle-invasive bladder cancer. Radiochemotherapy has risen as an alternative treatment option to surgery as part as organ-sparing combined modality treatment or for patients unfit for surgery. Radiochemotherapy achieves 5-year bladder intact survival of 40 to 65% and 5-year overall survival of 40 to 50% with excellent quality of life. This article introduces the French recommendations for radiotherapy of bladder cancer: indications, exams, technique, dosimetry, delivery and image guidance.
Assuntos
Carcinoma de Células de Transição/radioterapia , Neoplasias da Bexiga Urinária/radioterapia , Carcinoma de Células de Transição/cirurgia , Terapia Combinada , Cistectomia , Fracionamento da Dose de Radiação , Humanos , Irradiação Linfática , Metástase Linfática , Órgãos em Risco , Lesões por Radiação/prevenção & controle , Radioterapia/efeitos adversos , Radioterapia/métodos , Radioterapia/normas , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia Adjuvante/métodos , Radioterapia Guiada por Imagem/métodos , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
Palliative radiation therapy is well-known in the setting of metastatic lesions (haemostatic, analgesic, anti-inflammatory aims, etc.). Palliative primary tumour radiotherapy is less studied. Here we propose a review of palliative indications of primary tumours, the most studied in the literature, and their radiotherapy modalities (target volumes and fractionation).
Assuntos
Neoplasias/radioterapia , Hipofracionamento da Dose de Radiação , Neoplasias Encefálicas/radioterapia , Humanos , Neoplasias Otorrinolaringológicas/radioterapia , Cuidados Paliativos , Radioterapia/métodosRESUMO
Breast cancers are highly radiosensitive since the risk of recurrences and of mortality after adjuvant radiotherapy following breast-conserving surgery is decreased by 15.7% and 3.8%, respectively at 10 years. The total dose if irradiation also significantly increases local control: a boost of 16 Gy to the tumour bed after breast-conserving surgery reduces the absolute risk of recurrence by 4% at 10 years. Breast cancers are sensitive to the dose per fraction, as shown by the results from four randomized trials which compared standard irradiation (50 Gy/25 fractions) with a hypofractionated scheme: no statistical difference was observed in locoregional recurrence and overall survival at 10 years. The α/ß ratio, which reflects the dose per fraction and is theoretically over 10 Gy for tumour tissues, has been estimated between 2.2 and 4.4 Gy for breast cancers. Molecular abnormalities, such as overexpression of HER1 (especially in triple negative breast cancer) and HER2, induce a higher radioresistance. In vitro studies showed that targeted therapies, which block these receptors, increase breast cancer radiosensitivity. Tumour stem cells have been identified in breast cancers and are characterized by a higher radioresistance. This radioresistance could be related to a better repair of radiation-induced DNA damages and a decrease of reactive oxygen species (ROS), which are involved in their occurrence. In the future, a better understanding of genetics tumour abnormalities will allow to identify new radiosensitivity settings in breast cancers.
Assuntos
Neoplasias da Mama/radioterapia , Relação Dose-Resposta à Radiação , Feminino , HumanosRESUMO
One-day breast carcinoma treatment is defined as association of ambulatory surgery and intra-operative irradiation. Selection and rigorous process of patients is the key to success. The surgical technique is not changed by the radiotherapy. Patient's satisfaction index is very high. Financial loss should not be a hurdle to its implementation.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Neoplasias da Mama/cirurgia , Mastectomia Segmentar/métodos , Procedimentos Cirúrgicos Ambulatórios/economia , Neoplasias da Mama/economia , Neoplasias da Mama/radioterapia , Feminino , França , Humanos , Mastectomia Segmentar/economia , Assistência Perioperatória/economia , Assistência Perioperatória/métodos , Guias de Prática Clínica como Assunto , Radioterapia Adjuvante/economia , Radioterapia Adjuvante/instrumentação , Radioterapia Adjuvante/métodos , Biópsia de Linfonodo Sentinela/economia , Resultado do TratamentoRESUMO
In the era of high-tech radiotherapy, hypofractionated schema is more and more widely used regardless of tumour sites. In this article, we expose the role, techniques and indications of hypofractionated radiotherapy in adjuvant breast radiotherapy.