Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
1.
Curr Treat Options Oncol ; 22(1): 7, 2020 12 02.
Artículo en Inglés | MEDLINE | ID: mdl-33269438

RESUMEN

OPINION STATEMENT: Immune checkpoint inhibitors have importantly improved the outcome of patients with urothelial carcinoma. Different immune checkpoint inhibitors are currently approved and used in first- and second-line setting. The multiple agents currently approved in these setting make the choice sometimes difficult for clinicians. Furthermore, only a minority of patients present drastic response and long-term benefit with current immunotherapy. In this review, we describe the current use of immunotherapy in urothelial carcinoma but we also highlight the new strategies of treatment involving immune checkpoint inhibitors; we describe the place of immunotherapy with chemotherapy, targeted agents, and anti-angiogenic agents, incorporating the recent results presented at ASCO 2020. This review explores also the different action mechanisms of immune checkpoint inhibitors and the molecular rational to evaluate these agents in other strategies, such as maintenance and salvage strategies. The new advances in biomarker development are also presented.


Asunto(s)
Antineoplásicos/uso terapéutico , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Neoplasias Urológicas/tratamiento farmacológico , Neoplasias Urológicas/patología , Antineoplásicos/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor , Toma de Decisiones Clínicas , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Humanos , Inhibidores de Puntos de Control Inmunológico/farmacología , Proteínas de Punto de Control Inmunitario , Terapia Molecular Dirigida , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Retratamiento , Insuficiencia del Tratamiento , Resultado del Tratamiento , Neoplasias Urológicas/etiología , Neoplasias Urológicas/mortalidad
2.
Artículo en Inglés | MEDLINE | ID: mdl-39391230

RESUMEN

Introduction: Intra- and inter-fraction rectum motion is important for pelvic radiotherapy (RT). This study assesses how RT session duration, the presence or the absence of an intra-rectal tumour, and the distance from the anorectal junction (ARJd) impact rectal motion. Materials and methods: Analyses used cone-beam computed tomographies (CBCTs) from RT patients treated for rectal and prostate cancer. Three structures were evaluated: (1) the entire rectum in patients without a rectal tumour (RectumProstate); (2) the non-invaded portion (RectumRectum) and (3) the tumour-invaded portion (RectumTumour) in rectal cancer patients.Intrafraction motion was assessed using the Hausdorff distance 95% and the Mean distance-to-agreement between structures delineated on the first CBCT and the 2 subsequent CBCTs within a same RT session. Interfraction motion was quantified by comparing structures delineated on the planning-CT and the first CBCT of each session.Linear mixed model evaluated rectum motion in relation to time, tumour presence, and ARJd, respectively. Results: We included 10 patients with and 10 without rectal cancer, collecting 385 CBCTs. A significant correlation (p < 0.05) between rectum motion and RT session duration was found. Intrafraction motion was significantly higher in prostate cancer patients (RectumProstate motion > RectumRectum and RectumTumour, p < 0.01). For interfraction motion, only the mean distance to agreement was significantly higher for RectumProstate (p < 0.05). Motion increased significantly with ARJd for all three structures (p < 0.001). Conclusions: Session duration, absence of a tumour, and ARJd are associated with larger intra- and interfraction rectal motion. This highlights the need for tailored RT treatment, including online-adaptive RT, to manage intra- and interfraction variations. Rectal motion should be handled differently for patients with prostate cancer and those with rectal cancer.

3.
Cureus ; 16(9): e68919, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39381477

RESUMEN

Online adaptive radiotherapy (oART) uses daily imaging to identify changes in the patient's anatomy and generate a new treatment plan adapted to these changes, and it can be used for treating gastric mucosa-associated lymphoid tissue (MALT) lymphomas. This study aimed to determine the intrafraction motion and planning target volume (PTV) margins required for an oART workflow on a cone beam computed tomography (CBCT)-based dedicated system (Ethos®, Varian Medical Systems, Palo Alto, California, United States) and investigate the potential benefits for patients compared with a non-adaptive workflow. Involving three patients treated for gastric MALT lymphoma with the oART under breath-hold (BH) technique, the study determined a PTV margin for adaptive treatment using CBCT scans performed at the beginning and just before treating the patients for 34 fractions. Different PTVs were made by isotropically extending the clinical target volume (CTV) contoured on the first CBCT (CTV1) at intervals of 1 mm to evaluate intrafraction gastric motion, with the expansion covering the contoured CTV on the second CBCT (CTV2) quantifying the intrafraction motion (adaptive treatment) and the expansion from the CTV delineated on the planning scanner (CTVplanning) that could cover both CTV1 and CTV2 defining the interfraction motion (non-adaptive treatment). PTV margins were then determined as the extension of the CTV allowing coverage of 95% of its volume in 90% of fractions, and the dosimetric impact on dose constraints between an adaptive plan and a non-adaptive plan based on the predetermined margins was evaluated. A total of 68 CBCTs were analyzed, revealing that the PTV margin for oART was 4 mm, while for non-adaptive treatment it was 12 mm, with an average time elapsed between CBCT1 and CBCT2 of 11.62 minutes and no correlation between inter-CBCT timing and PTV margins (Pearson R-coefficient=0.10). All dosimetric constraints were met in both adaptive and non-adaptive plans, but the adaptive plan allowed for reduced organ-at-risk (OAR) doses in each patient. The study concluded that oART could reduce PTV margins in the treatment of gastric MALT lymphoma, especially with a BH strategy, impacting OAR dosimetry, though more prospective studies are required to validate these findings and determine their clinical impact on patients.

4.
Phys Med Biol ; 69(9)2024 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-38565128

RESUMEN

Objective. Radio-opaque markers are recommended for image-guided radiotherapy in liver stereotactic ablative radiotherapy (SABR), but their implantation is invasive. We evaluate in thisin-silicostudy the feasibility of cone-beam computed tomography-guided stereotactic online-adaptive radiotherapy (CBCT-STAR) to propagate the target volumes without implanting radio-opaque markers and assess its consequence on the margin that should be used in that context.Approach. An emulator of a CBCT-STAR-dedicated treatment planning system was used to generate plans for 32 liver SABR patients. Three target volume propagation strategies were compared, analysing the volume difference between the GTVPropagatedand the GTVConventional, the vector lengths between their centres of mass (lCoM), and the 95th percentile of the Hausdorff distance between these two volumes (HD95). These propagation strategies were: (1) structure-guided deformable registration with deformable GTV propagation; (2) rigid registration with rigid GTV propagation; and (3) image-guided deformable registration with rigid GTV propagation. Adaptive margin calculation integrated propagation errors, while interfraction position errors were removed. Scheduled plans (PlanNon-adaptive) and daily-adapted plans (PlanAdaptive) were compared for each treatment fraction.Main results.The image-guided deformable registration with rigid GTV propagation was the best propagation strategy regarding tolCoM(mean: 4.3 +/- 2.1 mm), HD95 (mean 4.8 +/- 3.2 mm) and volume preservation between GTVPropagatedand GTVConventional. This resulted in a planning target volume (PTV) margin increase (+69.1% in volume on average). Online adaptation (PlanAdaptive) reduced the violation rate of the most important dose constraints ('priority 1 constraints', 4.2 versus 0.9%, respectively;p< 0.001) and even improved target volume coverage compared to non-adaptive plans (PlanNon-adaptive).Significance. Markerless CBCT-STAR for liver tumours is feasible using Image-guided deformable registration with rigid GTV propagation. Despite the cost in terms of PTV volumes, daily adaptation reduces constraints violation and restores target volumes coverage.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Estudios de Factibilidad , Neoplasias Hepáticas , Hígado , Radiocirugia , Planificación de la Radioterapia Asistida por Computador , Radioterapia Guiada por Imagen , Humanos , Radiocirugia/métodos , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Guiada por Imagen/métodos , Hígado/diagnóstico por imagen , Hígado/efectos de la radiación , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/diagnóstico por imagen
5.
Biomolecules ; 13(4)2023 04 18.
Artículo en Inglés | MEDLINE | ID: mdl-37189436

RESUMEN

With the development of immune checkpoint inhibitors (ICIs), the tumour immune microenvironment (TIME) has been increasingly considered to improve cancer management. The TIME of metastatic lesions is strongly influenced by the underlying immune contexture of the organ in which they are located. The metastatic location itself appears to be an important prognostic factor in predicting outcomes after ICI treatment in cancer patients. Patients with liver metastases are less likely to respond to ICIs than patients with metastases in other organs, likely due to variations in the metastatic TIME. Combining additional treatment modalities is an option to overcome this resistance. Radiotherapy (RT) and ICIs have been investigated together as an option to treat various metastatic cancers. RT can induce a local and systemic immune reaction, which can promote the patient's response to ICIs. Here, we review the differential impact of the TIME according to metastatic location. We also explore how RT-induced TIME modifications could be modulated to improve outcomes of RT-ICI combinations.


Asunto(s)
Inhibidores de Puntos de Control Inmunológico , Neoplasias Hepáticas , Humanos , Inhibidores de Puntos de Control Inmunológico/farmacología , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Neoplasias Hepáticas/inmunología , Neoplasias Hepáticas/radioterapia , Microambiente Tumoral/inmunología
6.
Artículo en Inglés | MEDLINE | ID: mdl-37829146

RESUMEN

We report the case of a medically inoperable patient with localised colon cancer. Due to symptomatic bleeding, definitive radiotherapy (5 daily fractions of 5 Gy) has been performed using cone-beam computed tomography-based online-adaptive radiotherapy (ART). Online-ART enables compensation of interfraction motion of abdominal organs by performing daily delineation of organs at risk (OARs) and target volumes. Daily treatment replanning maximised target volume coverage while lowering the dose to OARs. Intrafraction variation of the tumour was still significant and had to be incorporated in the planning target volume margin computation. After the treatment, the patient did not develop any acute radiotherapy-induced adverse events and had no further rectal bleeding either at the end of the radiotherapy or at oncological follow-up 4 months later. Online-ART for colon cancer is feasible and is a valuable alternative when surgery is not an option.

7.
Acta Clin Belg ; 78(6): 516-520, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37466163

RESUMEN

We present the case of a 50-year-old woman previously treated with nivolumab-ipilimumab combination therapy for a metastatic melanoma. Despite premature discontinuation of these immune checkpoint inhibitors (ICIs) after 2 cycles due to severe immune-related hepatitis, the patient achieved a complete response. Nine months later, brain magnetic resonance imaging (MRI) showed progression of a single cerebral lesion, and the patient was referred for stereotactic radiosurgery. Unexpectedly, the brain MRI acquired one month later as part of radiosurgery planning showed a spontaneous regression of this lesion, allowing for radiosurgery cancellation. Follow-up imaging showed a sustained response, although the patient did not receive any other oncological treatment. We discuss here the potential immune mechanisms involved in this unusual course and the importance of better understanding the behaviour of tumours in the era of ICIs.

8.
Crit Rev Oncol Hematol ; 171: 103600, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35063636

RESUMEN

During the last decade, major improvements have been made in the treatment of renal cell carcinoma (RCC) with the development and use of multiple tyrosine kinase inhibitors and immune checkpoint inhibitors. Brain metastases in RCC patients (BM-RCC) is associated with poor outcome and their management represents a challenge for clinicians. In most of case, brain metastases in this context require local intervention such as radiotherapy, stereotactic radiotherapy/stereotactic radiosurgery and whole brain radiation therapy. Despite efficacy in extracranial metastases, systemic therapies have modest antitumoral effect on cerebral lesions. In this review, we highlight the benefits and pitfalls of the available therapies in BM-RCC.


Asunto(s)
Neoplasias Encefálicas , Carcinoma de Células Renales , Neoplasias Renales , Radiocirugia , Neoplasias Encefálicas/patología , Carcinoma de Células Renales/patología , Humanos , Neoplasias Renales/patología , Radiocirugia/efectos adversos , Estudios Retrospectivos
9.
Target Oncol ; 15(1): 139-146, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32020516

RESUMEN

BACKGROUND: We describe in a patient with breast cancer the change in c-MET expression during everolimus treatment, opening a better understanding of the resistance to everolimus and a role for cabozantinib. OBJECTIVE: The objective of this study was to evaluate c-MET as a potential predictive biomarker for everolimus efficacy in breast cancer. METHODS: We first selected a patient with breast cancer with a long-lasting response to everolimus and retrospectively profiled biopsies that were taken before everolimus initiation (Biopsy 1) and at progression on everolimus (Biopsy 2) using amplicon sequencing and immunohistochemistry. We then retrospectively evaluated c-MET expression in a cohort of patients with breast cancer treated with everolimus. RESULTS: While not expressed in Biopsy 1, c-MET was highly expressed in Biopsy 2, suggesting a role for c-MET in breast cancer progression. Cabozantinib resulted in a rapid radiological response in this patient. Twenty-nine patients were included (12 c-MET-positive and 17 c-MET-negative patients) in the second part of the study. Baseline c-MET expression was associated with higher tumor grade, higher frequency of visceral metastases, and lower endocrine sensitivity. The c-MET-positive patients presented with a shorter progression-free survival (6.1 vs 10.5 months, respectively; p = 0.002) and a lower response rate (0% vs 12%) to everolimus, compared with c-MET-negative patients. CONCLUSIONS: c-MET could play a role in the resistance to everolimus and its inhibition should be evaluated in breast cancer.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Everolimus/uso terapéutico , Proteínas Proto-Oncogénicas c-met/metabolismo , Anciano , Neoplasias de la Mama/mortalidad , Estudios de Cohortes , Everolimus/farmacología , Femenino , Humanos , Estudios Retrospectivos , Análisis de Supervivencia
10.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-31439558

RESUMEN

The increased use of immune checkpoint inhibitors (ICIs) has led to the observation of a variety of immune-related adverse events (irAEs). These irAEs occur usually within the first months after ICIs onset and can involve theorically all organs. We describe two rare irAEs occurring in a 70-year-old caucasian man who was treated with nivolumab for an advanced urothelial cancer of the left kidney. He developed an isolated adrenocorticotropic hormone deficiency that was diagnosed at week 19 and a neurological complication that appeared at week 79 and initially confounded with a lumbar spinal stenosis. Diagnosis of Guillain-Barré syndrome was finally confirmed with the complete resolution of symptoms after 5 days of intravenous immunoglobulin and corticosteroids. We highlight the importance of quickly recognising these potential life-threatening irAEs such as cortisol insufficiency and neurologic adverse events whose initially presentation could be non-specific.


Asunto(s)
Hormona Adrenocorticotrópica/deficiencia , Antineoplásicos Inmunológicos/efectos adversos , Enfermedades del Sistema Endocrino/diagnóstico , Enfermedades Genéticas Congénitas/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Hipoglucemia/diagnóstico , Nivolumab/efectos adversos , Hormona Adrenocorticotrópica/sangre , Anciano , Diagnóstico Diferencial , Enfermedades del Sistema Endocrino/sangre , Enfermedades del Sistema Endocrino/inducido químicamente , Enfermedades Genéticas Congénitas/sangre , Enfermedades Genéticas Congénitas/inducido químicamente , Síndrome de Guillain-Barré/inducido químicamente , Síndrome de Guillain-Barré/complicaciones , Síndrome de Guillain-Barré/fisiopatología , Humanos , Hipoglucemia/sangre , Hipoglucemia/inducido químicamente , Masculino , Neoplasias Uretrales/tratamiento farmacológico , Neoplasias Uretrales/cirugía
11.
World Neurosurg ; 111: e410-e417, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29274453

RESUMEN

BACKGROUND: The major limitation of computer-based three-dimensional fluoroscopy is increased radiation exposure of patients and operating room staff. Combining spine navigation with intraoperative three-dimensional fluoroscopy (io3DF) can likely overcome this shortcoming, while increasing pedicle screw accuracy rate. We compared data from a cohort of patients undergoing lumbar percutaneous pedicle screw placement using io3DF alone or in combination with spine navigation. METHODS: This study consisted of 168 patients who underwent percutaneous pedicle screw implantation between 2009 and 2016. The primary endpoint was to compare pedicle screw accuracy between the 2 groups. Secondary endpoints were to compare radiation exposure of patients and operating room staff, duration of surgery, and postoperative complications. RESULTS: In group 1, 438 screws were placed without navigation guidance; in group 2, 276 screws were placed with spine navigation. Mean patient age in both groups was 58.6 ± 14.1 years. The final pedicle accuracy rate was 97.9% in group 1 and 99.6% in group 2. Average radiation dose per patient was significantly larger in group 1 (571.9 mGym2) than in group 2 (365.6 mGym2) (P = 0.000088). Surgery duration and complication rate were not significantly different between the 2 groups (P > 0.05). CONCLUSIONS: io3DF with spine navigation minimized radiation exposure of patients and operating room staff and provided an excellent percutaneous pedicle screw accuracy rate with no permanent complications compared with io3DF alone. This setup is recommended, especially for patients with a complex degenerative spine condition.


Asunto(s)
Discectomía Percutánea/métodos , Imagenología Tridimensional/métodos , Degeneración del Disco Intervertebral/cirugía , Técnicas Estereotáxicas , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Estudios de Cohortes , Femenino , Fluoroscopía/métodos , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Tornillos Pediculares
12.
World Neurosurg ; 111: 28-35, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29229340

RESUMEN

BACKGROUND: Injury of the ureter is a potentially devastating complication most often reported in gynecologic, colorectal, or vascular pelvic surgery or endoscopic procedures for ureteric diseases. We report a rare case of ureteral rupture occurring as a complication of percutaneous pedicle screw placement. CASE DESCRIPTION: A 60-year-old man reported unbearable abdominal pain on the day after right L4-L5 transforaminal intervertebral fusion and percutaneous pedicle screw placement. A computer tomography workup showed contrast media extravasation outside the excretory system consistent with a left ureteral traumatic perforation. The patient underwent left nephrostomy and a double-J stent insertion and subsequently fully recovered. The ureter completely healed, enabling stent removal 5 months later. METHODS: PubMed and EMBASE were screened for ureteral injury caused by posterior lumbar surgery. RESULTS: We found 27 other reports with only 1 other case after minimally invasive transforaminal lumbar interbody. CONCLUSIONS: Complications of minimally invasive pedicle screw placement are often described as dural tear of neurologic impairment. This report shows that unexpected side effects are still possible and spine surgeons should be aware especially when performing minimally invasive procedures, in which, by definition, pedicles are concealed from direct visualization.


Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Tornillos Pediculares/efectos adversos , Complicaciones Posoperatorias/etiología , Uréter/lesiones , Dolor Abdominal/etiología , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/terapia , Fusión Vertebral/efectos adversos , Stents , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagen
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA