RESUMO
PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 (NCT00021450) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. PATIENT AND METHODS: Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis-free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. RESULTS: At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). CONCLUSION: Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance.
Assuntos
Antagonistas de Androgênios/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Fatores de Risco , Fatores de TempoRESUMO
Leptomeningeal carcinomatosis is a very rare manifestation in patients diagnosed with esophagogastric junction and gastric cancer. Its prognosis is ominous and therapy outcomes are disappointing. Herein, we present two patients; one initially diagnosed with gastric cancer and leptomeningeal carcinomatosis but no other evidence of metastatic disease and the other one initially diagnosed with esophagogastric junction cancer, who recurred solitary with leptomeningeal seedings several years after the initial diagnosis and treatment. Furthermore, a thorough and short review of the literature is carried out.
Assuntos
Hormônio Paratireóideo/sangue , Tiroxina/uso terapêutico , Adulto , Idoso , Feminino , Bócio/tratamento farmacológico , Humanos , Hipotireoidismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/tratamento farmacológico , Tireoidite/tratamento farmacológico , Tireotropina/sangueAssuntos
Neoplasias Ósseas/diagnóstico por imagem , Osteoblastoma/diagnóstico por imagem , Medronato de Tecnécio Tc 99m , Tecnécio Tc 99m Sestamibi , Adulto , Neoplasias Ósseas/metabolismo , Reações Falso-Negativas , Humanos , Masculino , Osteoblastoma/metabolismo , Cintilografia , Compostos Radiofarmacêuticos/farmacocinética , Medronato de Tecnécio Tc 99m/farmacocinética , Tecnécio Tc 99m Sestamibi/farmacocinética , Imagem Corporal TotalRESUMO
A 46-year-old man was referred to our department for a Tc-99m MDP bone scan after he was admitted to our hospital with diffuse bone pain and the subsequent finding of multiple mixed type (lytic-blastic) lesions on routine x-rays. The Tc-99m MDP scan was highly suspicious for malignancy and, therefore, a Tc-99m MIBI scan was performed, which also revealed abnormal uptake in all regions with increased osteoblastic activity. Clinical chemistry and further workup revealed a highly elevated serum alkaline phosphatase and increased excretion of hydroxyproline in the urine. The presumed diagnosis of Paget's disease of the bone was further confirmed by biopsy.
Assuntos
Osteíte Deformante/diagnóstico por imagem , Osteíte Deformante/patologia , Tecnécio Tc 99m Sestamibi , Neoplasias Ósseas/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Compostos RadiofarmacêuticosAssuntos
Neoplasias Abdominais/diagnóstico por imagem , Pulmão do Criador de Aves/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Coração/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Octreotida/análogos & derivados , Ácido Pentético/análogos & derivados , Neoplasias Abdominais/secundário , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/secundário , Doença Crônica , Diagnóstico Diferencial , Humanos , Achados Incidentais , Neoplasias Hepáticas/secundário , Masculino , Cintilografia , Compostos RadiofarmacêuticosRESUMO
BACKGROUND: In most cases of proximal cholangiocarcinoma, curative surgery is not possible. Radiotherapy can be used for palliative treatment. We report our experience with combined external beam and intraluminal radiotherapy of advanced Klatskin's tumors. PATIENTS AND METHODS: 30 patients were treated for extrahepatic proximal bile duct cancer. Our schedule consisted of external beam radiotherapy (median dose 30 Gy) and a high-dose-rate brachytherapy boost (median dose 40 Gy) delivered in four of five fractions, which could be applied completely in twelve of our patients. 15 patients in the brachytherapy and nine patients in the non-brachytherapy group received additional low-dose chemotherapy with 5-fluorouracil. RESULTS: The brachytherapy boost dose improved the effect of external beam radiotherapy by increasing survival from a median of 3.9 months in the non-brachytherapy group to 9.1 months in the brachytherapy group. The effect was obvious in patients receiving a brachytherapy dose above 30 Gy, and in those without jaundice at the beginning of radiotherapy (p < 0.05). CONCLUSIONS: The poor prognosis in patients with advanced Klatskin's tumors may be improved by combination therapy, with the role of brachytherapy and chemotherapy still to be defined. Our results suggest that patients without jaundice should be offered brachytherapy, and that a full dose of more than 30 Gy should be applied.