Impacto na deglutição e manejo da mucosite hipofaríngea em pacientes submetidos à quimiorradioterapia na região de cabeça e pescoço: uma revisão integrativa da literatura / Management of hypopharyngeal mucositis in patients undergoing chemoradiotherapy in the head and neck region and its impact on swallowing: an integrative literature review

RESUMO Objetivo Investigar o impacto da mucosite hipofaríngea quimiorradioinduzida na deglutição e o seu manejo, a partir de uma revisão integrativa de literatura. Estratégia de pesquisa A busca e a seleção dos artigos foram realizadas nas seguintes bases de dados: PubMed, Embase, Scopus, ScienceDirect e LILACS. Critérios de seleção Os termos de busca utilizados foram ''Pharyngeal Mucositis", ''Radiotherapy" e ''Esophagitis", com auxílio do operador booleano (AND). A equação de busca utilizada foi: ''Pharyngeal Mucositis" AND "Radiotherapy" AND "Esophagitis". A seguinte questão central orientou o estudo: "Qual a forma de avaliação e manejo da mucosite hipofaríngea induzida pela radiação na região de cabeça e pescoço e seu impacto na deglutição?". Resultados Foram identificados 75 estudos, sendo que 6 foram excluídos devido à duplicidade e 60 foram excluídos por não se encaixarem nos critérios de inclusão; os artigos restantes foram lidos na íntegra e 4 foram selecionados para fazerem parte desta revisão integrativa da literatura. Conclusão Apesar da escassa literatura e das poucas informações sobre os métodos de avaliação da mucosite hipofaríngea, os artigos apontam que, independentemente da dose de radiação, a radioterapia na região cervical causa mucosite hipofaríngea. A mucosite hipofaríngea provoca grande impacto na deglutição, resultando na necessidade de uso de via alternativa de alimentação. Além da ausência de informações quanto à avaliação e graduação da mucosite hipofaríngea, os estudos não discutem o tratamento direto ou a prevenção desse tipo de doença.

ABSTRACT Purpose To investigate the impact of chemoradiation-induced hypopharyngeal mucositis on swallowing and its management, based on an integrative literature review. Research strategy Two researchers were responsible for the search and selection of articles, within the following databases: PubMed, Embase, Scopus, Science Direct, and Lilacs. Selection criteria The search terms used were "Pharyngeal Mucositis", "Radiotherapy" and "Esophagitis", with the aid of the Boolean operator (AND). The search equation used was "Pharyngeal Mucositis" AND Radiotherapy AND Esophagitis. The following central question guided the study: "What is the assessment and management of radiation-induced hypopharyngeal mucositis in the head and neck region and its impact on swallowing?" Results 75 studies were identified, of which 6 were excluded due to duplicity and 60 were excluded for not meeting the inclusion criteria; the remaining articles were read in full and 4 were selected to be part of the integrative literature review. Conclusion Despite the scarce literature and little information on methods for evaluating hypopharyngeal mucositis, the articles point out that, regardless of the radiation dose, radiotherapy in the cervical region causes hypopharyngeal mucositis. Hypopharyngeal mucositis causes a great impact on swallowing, resulting in the need to use an alternative feeding route. In addition to the lack of information regarding the assessment and grading of hypopharyngeal mucositis, the studies do not discussitsdirect treatment or prevention.

Associations of genetic variations in pyroptosis related genes with acute adverse events in postoperative rectal cancer patients receiving concurrent chemoradiotherapy / 中华肿瘤杂志

Objective: This study aims to investigate the associations between genetic variations of pyroptosis pathway related key genes and adverse events (AEs) of postoperative chemoradiotherapy (CRT) in patients with rectal cancer. Methods: DNA was extracted from the peripheral blood which was collected from 347 patients before CRT. Sequenom MassARRAY was used to detect the genotypes of 43 haplotype-tagging single nucleotide polymorphisms (htSNPs) in eight pyroptosis genes, including absent in melanoma 2 (AIM2), caspase-1 (CASP1), caspase-4(CASP4), caspase-5 (CASP5), caspase-11 (CASP11), gasdermin D (GSDMD), gasdermin E (GSDME) and NLR family pyrin domain containing 3 (NLRP3). The associations between 43 htSNPs and AEs were evaluated by the odd ratios (ORs) and 95% confidence intervals (CIs) by unconditional logistic regression models, adjusted for sex, age, clinical stage, tumor grade, Karnofsky performance status (KPS), surgical procedure, and tumor location. Results: Among the 347 patients with rectal cancer underwent concurrent CRT with capecitabine after surgery, a total of 101(29.1%) occurred grade ≥ 2 leukopenia. rs11226565 (OR=0.41, 95% CI: 0.21-0.79, P=0.008), rs579408(OR=1.54, 95% CI: 1.03-2.29, P=0.034) and rs543923 (OR=0.63, 95% CI: 0.41-0.98, P=0.040) were significantly associated with the occurrence of grade ≥ 2 leukopenia. One hundred and fifty-six (45.0%) had grade ≥ 2 diarrhea, two SNPs were significantly associated with the occurrence of grade ≥ diarrhea, including CASP11 rs10880868 (OR=0.55, 95% CI: 0.33-0.91, P=0.020) and GSDME rs2954558 (OR=1.52, 95% CI: 1.01-2.31, P=0.050). In addition, sixty-six cases (19.0%) developed grade ≥2 dermatitis, three SNPs that significantly associated with the risk of grade ≥2 dermatitis included GSDME rs2237314 (OR=0.36, 95% CI: 0.16-0.83, P=0.017), GSDME rs12540919 (OR=0.52, 95% CI: 0.27-0.99, P=0.045) and NLRP3 rs3806268 (OR=1.51, 95% CI: 1.03-2.22, P=0.037). There was no significant difference in the association between other genetic variations and AEs of rectal cancer patients (all P>0.05). Surgical procedure and tumor location had great impacts on the occurrence of grade ≥2 diarrhea and dermatitis (all P<0.01). Conclusion: The genetic variants of CASP4, CASP11, GSDME and NLRP3 are associated with the occurrence of AEs in patients with rectal cancer who received postoperative CRT, suggesting they may be potential genetic markers in predicting the grade of AEs to achieve individualized treatment of rectal cancer.

Prehabilitation for gastrointestinal cancer patients / 中华胃肠外科杂志

Gastrointestinal cancer and related treatments (surgery and chemoradiotherapy) are associated with declined functional status (FS) that has impact on quality of life, clinical outcome and continuum of care. Psychological distress drives an impressive burden of physiological and psychiatric conditions in oncologic care. Cancer patients often experience anxiety, depression, low self-esteem and fears of recurrence and death. Cancer prehabilitation is a process from cancer diagnosis to the beginning of treatment, which includes psychological, physical and nutritional assessments for a baseline functional level, identification of comorbidity, and targeted interventions that improve patient's health and functional capacity to reduce the incidence and the severity of current and future impairments with cancer, chemoradiotherapy and surgery. Multimodal prehabilitation program encompasses a series of planned, structured, repeatable and purposive interventions including comprehensive physical exercise, nutritional therapy, and relieving anxiety and depression, which integrates into best perioperative management ERAS pathway and aims at using the preoperative period to prevent or attenuate the surgery-related functional decline, to cope with surgical stress and to improve the consequences. However, a number of questions remain in regards to prehabilitation in gastrointestinal cancer surgery, which consists of the optimal makeup of training programs, the timing and approach of the intervention, how to improve compliance, how to measure functional capacity, and how to make cost-effective analysis. Therefore, more high-level evidence-based studies are expected to evaluate the value of implementation of prehabilitation into standard practice.

Miel en el manejo de la mucositis inducida por quimioterapia y radioterapia en niños / Honey in the management of mucositis induced by chemotherapy and radiotherapy in children

La mucositis es una respuesta inflamatoria del epitelio de la mucosa a los efectos citotóxicos de la quimioterapia y la radioterapia, que causan dolor y ulceración oral severa. En los estudios de los últimos años se ha propuesto el uso de la miel en el manejo de la mucositis oral inducida por quimioterapia y radioterapia en pacientes pediátricos. La miel reduce la severidad y duración de la mucositis, reduce el dolor y es un producto agradable a los niños. Por tanto, podría ser un producto eficaz tanto en la profilaxis como en el tratamiento de la mucositis oral. Sin embargo, la pequeña cantidad de investigaciones realizadas en humanos no es suficiente para establecer recomendaciones generalizadas. Por ello, se debe aumentar las investigaciones en este campo. Con ello se podrá examinar la eficacia y posibles complicaciones a corto y largo plazo, explorar su posible efecto sinérgico con otras terapias, analizar su rentabilidad económica y el tipo de miel más adecuado. De esta forma, los profesionales sanitarios podrán ofrecer a los pacientes pediátricos los mejores cuidados basados en las últimas evidencias científicas demostradas.

Mucositis is an inflammatory response of the mucosal epithelium to the cytotoxic effects of chemotherapy and radiation therapy, causing pain and severe oral ulceration. In the studies of recent years, the use of honey has been proposed in the management of oral mucositis induced by chemotherapy and radiotherapy in pediatric patients. Honey reduces the severity and duration of mucositis, reduces pain and is a child-friendly product. Therefore, it could be an effective product both in the prophylaxis and in the treatment of oral mucositis. However, the small amount of human research is not enough to establish widespread recommendations. Therefore, research in this field should be increased. With this, it will be possible to examine the efficacy and possible complications in the short and long term, explore its possible synergistic effect with other therapies, analyze its economic profitability and the most appropriate type of honey. In this way, healthcare professionals will be able to offer pediatric patients the best care based on the latest scientific evidence.

Efectos endocrinológicos tardíos del tratamiento oncológico en supervivientes de meduloblastoma / Endocrinological late effects of oncologic treatment on survivors of medulloblastoma

INTRODUCCIÓN: La radioterapia, quimioterapia y la cirugía empleada en el tratamiento de los tumores cerebrales tienen efectos en el eje hipotálamo-hipofisario y pueden resultar en disfunción endocrina hasta en el 96% de los casos. PACIENTES Y MÉTODO: Estudio retrospectivo y descriptivo en pacientes diagnos ticados de meduloblastoma sometidos a tratamiento con quimio y radioterapia en los últimos 20 años en un hospital terciario. Se analizan variables edad, sexo, peso, talla, índice de masa corporal (IMC) al final del seguimiento, estadio de maduración sexual, niveles séricos de TSH y T4 libre, ACTH/cortisol e IGF-1, FSH, LH, estradiol, testosterona, perfil lipídico (colesterol total) y prueba de función dinámica de hormona de crecimiento. RESULTADOS: Muestra total de 23 pacientes. El déficit de hormona de crecimiento es la secuela más frecuente (82 %) seguido de disfunción ti roidea (44,8%) y disfunción puberal (24,1%). Solo se diagnosticó un caso de diabetes insípida y 2 casos de déficit de corticotrofina. CONCLUSIONES: El seguimiento a largo plazo de los supervivientes de meduloblastoma tratados con quimio y radioterapia revela una prevalencia muy alta de disfun ción endocrina, particularmente de deficiencia de hormona del crecimiento y de hipotiroidismo. Creemos oportuna la monitorización y el seguimiento a largo plazo de estos pacientes con el fin de garantizar un manejo terapéutico adecuado de aquellas disfunciones tratables.

INTRODUCTION: Radiation therapy, chemotherapy, and surgery used to treat brain tumors have effects on the hy pothalamic-pituitary-adrenal axis and can result in endocrine dysfunction in up to 96% of cases. PATIENTS Y METHOD: Retrospective and descriptive study in patients diagnosed with medulloblasto ma who underwent treatment with chemo and radiotherapy in the last 20 years in a tertiary hospital. The variables analyzed were age, sex, weight, height, body mass index (BMI) at the end of follow-up, sexual maturity stage, serum levels of TSH and free T4, ACTH/cortisol and IGF-1, FSH, LH, estradiol, testosterone, lipid profile (total cholesterol), and growth hormone dynamic function test. RESULTS: Total sample of 23 patients. Growth hormone deficiency is the most frequent sequelae (82%) fo llowed by thyroid dysfunction (44.8%), and disorders of puberty (24.1%). Only one case of diabetes insipidus and two cases of corticotropin deficiency were diagnosed. CONCLUSIONS: Long-term follow- up of medulloblastoma survivors treated with chemo and radiotherapy reveals a very high prevalence of endocrine dysfunction, especially growth hormone deficiency and hypothyroidism. We believe that monitoring and long-term follow-up of these patients is necessary in order to ensure adequate therapeutic management of those treatable dysfunctions.

Ototoxicidad inducida por quimio-radioterapia basada en platinos: una revisión / Ototoxicity induced by platinum compounds-based chemoradiotherapy: a review

RESUMEN Los análogos del platino, como el cisplatino, y la radioterapia son usados de forma individual y en conjunto para el tratamiento de diversas neoplasias en población adulta y pediátrica. Sin embargo, el uso de estos tratamientos puede generar ototoxicidad, especialmente cuando son usados de forma combinada para neoplasias que comprometen cabeza y cuello, manifestándose principalmente como una hipoacusia progresiva e irreversible que compromete la calidad de vida. Diversos mecanismos han sido propuestos para explicar el daño en las estructuras auditivas generado por estos tratamientos, incluyendo la producción de especies reactivas del oxígeno y la inflamación, desencadenando muerte celular. Si bien distintas estrategias otoprotectoras han sido probadas en humanos, es aún incierta su efectividad y seguridad en combinación con los tratamientos oncológicos. El objetivo de la siguiente revisión es proporcionar una visión general y actualizada de la ototoxicidad inducida por quimio-radioterapia basada en platinos, discutiendo sus bases, características clínicas, potenciales tratamientos y estrategias preventivas que se han desarrollado en los últimos años.

ABSTRACT Platinum analogues, such as cisplatin, and radiotherapy are used separately or in combination to treat several neoplasms in pediatric and adult populations. Nonetheless, the use of these treatments may lead to ototoxicity, especially when these treatments are concomitantly used to treat head and neck cancers, which can manifest as progressive and irreversible hearing loss that decreases quality of life. Several mechanisms have been proposed in order to explain the damage to the auditory structures induced by these treatment modalities, including: reactive oxygen species production and inflammation, leading to cell death. Although several otoprotective strategies have been attempted in humans, their effectiveness and security are unclear. The objective of this review is to provide an updated and general overview on platinum-based chemoradio-therapy induced ototoxicity, discussing its basis, clinical features, potential treatments and preventive strategies developed in recent years.

Radiation-Induced Uterine Carcinosarcoma after Concurrent Chemoradiotherapy for Cervical Squamous Cell Carcinoma

Abstract Objective To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. Case Report A 57-year-old woman with a history of pelvic chemoradiotherapy ~ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. Conclusion The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-termconsequences of its management.

Correlação da desvantagem vocal e qualidade de vida em deglutição de pacientes com câncer de laringe submetidos à quimiorradioterapia / Correlation between the Voice Handicap and Swallowing Quality of Life in patients with laryngeal cancer submitted to chemoradiotherapy

RESUMO Objetivo Verificar a correlação entre desvantagem vocal e a qualidade de vida em deglutição de indivíduos que foram submetidos ao tratamento quimiorradioterápico para câncer de laringe. Método Estudo transversal, observacional e quantitativo do qual participaram 14 indivíduos do gênero masculino diagnosticados com câncer de laringe, que, para tratamento, fizeram uso exclusivo de quimiorradioterapia. Aplicaram-se os instrumentos Índice de Desvantagem Vocal e Protocolo de Qualidade de Vida em Deglutição SWAL-QoL. Fez-se análise descritiva e, em seguida, aplicou-se o teste de Correlação de Spearman para verificar se havia correlação entre os escores dos instrumentos aplicados. Foram considerados estatisticamente significativos os valores de p ≤ 0,05. Resultados Não houve correlação significativa entre os domínios total do IDV e global do SWAl-QoL, porém houve correlação significante entre os domínios "Funcional" do IDV e os domínios "Fadiga" e "Social" do Swal-Qol; domínio "Orgânico" do IDV com o domínio "Social" do SWAL-QoL; escore total do IDV, com o domínio de "Deglutição como um fardo" do SWAL-QoL. Além disso, foi possível observar que o tratamento quimiorradioterápico ocasionou maior impacto em relação à voz do que em relação à deglutição para os pacientes estudados. Conclusão Os dados demonstraram correlação significante entre a desvantagem vocal e o impacto da qualidade de vida em deglutição de pacientes com câncer de laringe submetidos à quimiorradioterapia, podendo afetar seu estado emocional e sua socialização, piorando assim, sua qualidade de vida de modo geral.

ABSTRACT Purpose To verify the correlation between the voice handicap and swallowing quality of life in individuals submitted to chemoradiotherapy for laryngeal cancer treatment. Methods Cross-sectional, observational and quantitative study. Fourteen male individuals diagnosed with laryngeal cancer were submitted to exclusive chemoradiotherapy treatment. The individuals completed the Voice Handicap Index (VHI) and the Swallowing Quality of Life (SWAL-QOL) questionnaires. Data were submitted to descriptive and inferential analysis using Spearman's Correlation Test to verify possible correlations among the scores of these instruments. Values of p ≤ 0.05 were considered statistically significant. Results No significant correlation was found between the total VHI and overall SWAL-QOL scores. However, there was significant correlation between the domain Functional of the VHI and the domains Fatigue and Social of the SWAL-QOL, between the domain Organic in the VHI and the SWAL-QOL domain Social, and total VHI score and SWAL-QOL domain Swallowing as a burden. Furthermore, chemoradiotherapy treatment had a greater impact on the voice than on the swallowing for the studied individuals. Conclusion The data showed a significant correlation between voice handicap and the impact of quality of life involving swallowing in individuals with laryngeal cancer submitted to chemoradiotherapy. This may affect individuals' emotional and social aspects, impacting their overall quality of life.

Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical cancer / Influência da quimiorradioterapia no estado nutricional, capacidade funcional, qualidade de vida e toxicidade do tratamento para pacientes com câncer cervical

Introduction: The adverse effects provoked by antineoplastic therapy may aggravate preexisting alterations of the nutritional status and can result in a larger chance of toxicity, bringing about other adverse consequences, such as a diminished response and tolerance of the treatment and reduction of quality of life (QoL). Objective: The objective of this study was to assess the influence of chemoradiotherapy on the nutritional status, functional capacity, and quality of life (QoL), associating these indicators with toxicity and interruption of oncologic treatment in women with cervical cancer. Methods: Prospective cohort study performed on 49 women, who underwent treatment between August 2015 and January 2016. For data collection, two appointments took place with the researcher in charge: the first one occurring the day before the first chemotherapy session (T0) and the other one after 35 days (T1). Nutritional status was measured by anthropometry and computed tomography (skeletal muscle index ­ SMI), functional capacity by handgrip strength (HGS) and Karnofsky Perfomace Status (KPS), and application of QoL questionnaire (EORTC QLQ-C30). Results: There was significant reduction in weight, BMI, HGS, KPS and QoL between T0 and T1. The interruption of chemotherapy was significantly associated with the variables of nutritional status assessed, in addition to a significant QoL reduction according to worsening nutritional status. Women that interrupted their treatment due to acute toxicity also had an SMI median significantly smaller in relation to those who concluded the treatment and 83% of these patients presented cachexia. Conclusion: Chemoradiotherapy treatment in patients with cervical cancer had changed negatively nutritional parameters, function capacity and QoL.(AU)

Introdução: Os efeitos adversos provocados pela terapia antineoplásica podem agravar alterações preexistentes do estado nutricional, que resultam em maior chance de toxicidade, além de outras consequências adversas, como diminuição da resposta e tolerância ao tratamento e redução da qualidade de vida (QV). Objetivo: O objetivo do estudo foi avaliar a influência da quimiorradioterapia sobre o estado nutricional, capacidade funcional e QV, associando esses indicadores à toxicidade e interrupção do tratamento oncológico em mulheres com câncer de colo uterino. Método: Foi realizado um estudo de coorte prospectivo com 49 mulheres submetidas ao tratamento quimiorradioterápico entre agosto de 2015 e janeiro de 2016. Para coleta de dados, foram realizadas duas consultas com o pesquisador responsável: a primeira ocorreu no dia anterior à primeira sessão de quimioterapia (T0) e a outra após 35 dias (T1). Em ambas as consultas, o estado nutricional foi avaliado por antropometria, a capacidade funcional pela força de preensão palmar (FPP) e pelo Karnofsky Performance Status (KPS) e foi aplicado um questionário específico para QV (EORTC QLQ-C30). Adicionalmente, foi utilizada a tomografia computadorizada para avaliação da massa magra (índice de músculo esquelético - IME) disponível no T0. Resultados: Houve redução significativa no peso, IMC, FPP, KPS e QV entre T0 e T1. A interrupção da quimioterapia foi significativamente associada às variáveis de estado nutricional, além de uma redução significativa da QV de acordo com a piora do estado nutricional. As mulheres que interromperam seu tratamento devido à toxicidade aguda também apresentavam mediana de IME significativamente menor em relação àquelas que concluíram o tratamento e 83% dessas pacientes apresentaram caquexia. Conclusão: O tratamento quimiorradioterápico em pacientes com câncer de colo uterino impactou negativamente nos parâmetros nutricionais, na capacidade funcional e na QV.(AU)

Aumento da fadiga e redução da qualidade de vida após tratamento de câncer do colo do útero / Increased fatigue and reduced quality of life after treatment of cervical cancer

Introdução: o câncer do colo do útero (CCU) acarreta prejuízos físicos e emocionais, sendo um grande problema de saúde pública. Objetivo: avaliar fadiga, capacidade funcional e qualidade de vida antes e após o tratamento com quimiorradioterapia para o CCU. Métodos: a avaliação de fadiga e qualidade de vida foi realizada por meio dos questionários: Inventário Breve de Fadiga (BFI) e Functional Assessment of Chronic Therapy ­ Cervix Cancer (FACT-Cx), respectivamente, já a capacidade funcional por mensuração direta pelo Teste do degrau (TD6). Participaram 11 mulheres com CCU. O Graphpad Prism® foi utilizado para estatística. Resultados: após a quimiorradioterapia houve aumento significativo da fadiga (de 2,80 para 4,83), redução significativa da qualidade de vida (de 107,8 para 88,1) e redução da capacidade funcional (de 91 degraus para 82 degraus). Conclusão: aumento da fadiga e redução da qualidade de vida foram observados uma semana após a realização de quimiorradioterapia para o CCU.

Introduction: cervical cancer (CC) causes physical and emotional damage and is a major public health problem. Objective: to evaluate fatigue, functional capacity and quality of life before and after treatment with chemoradiotherapy for CC. Method: the evaluation of fatigue and quality of life were performed through questionnaires the Brief Fatigue Inventory (BFI) and Functional Assessment of Chronic Therapy (FACT-Cx), respectively, and the functional capacity by direct measurement by the Test of the step (TD6). Eleven women participated with CC. Graphpad Prism® was used for statistics. Results: after chemoradiotherapy, there was a significant increase in fatigue (from 2.80 to 4.83), a significant reduction in quality of life (from 107.8 to 88.1) and reduction in functional capacity (from 91 steps to 82 steps). Conclusion: increased fatigue and reduced quality of life were observed one week after the completion of chemoradiotherapy for CC.

Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort / 부인종양

OBJECTIVE: Concurrent chemoradiotherapy (CCRT) is the primary treatment for locally advanced cervical cancer. We studied prognostic factors for patients treated with CCRT. METHODS: We retrospectively reviewed records of 85 consecutive patients with cervical cancer who were treated with CCRT between 2002 and 2011, with external beam radiation therapy, intracavitary brachytherapy, and platinum-based chemotherapy. Survival data were analyzed with Kaplan-Meier methods and Cox proportional hazard models. RESULTS: Of the 85 patients, 69 patients (81%) had International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease; 25 patients (29%) had pelvic lymph node enlargement (based on magnetic resonance imaging), and 64 patients (75%) achieved clinical remission following treatment. Median maximum tumor diameter was 5.5 cm. The 3- and 5-year overall survival rates were 60.3% and 55.5%, respectively. Cox regression analysis showed tumor diameter >6 cm (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.2 to 4.6), pelvic lymph node enlargement (HR, 2.2; 95% CI, 1.1 to 4.5), and distant metastasis (HR, 10.0; 95% CI, 3.7 to 27.0) were significantly and independently related to poor outcomes. CONCLUSION: New treatment strategies should be considered for locally advanced cervical cancers with tumors >6 cm and radiologically enlarged pelvic lymph nodes.

Objective Assessment of Surgical Restaging after Concurrent Chemoradiation for Locally Advanced Pancreatic Cancer

The role of neoadjuvant chemoradiation therapy in locally advanced pancreatic cancer (LAPC) is still controversial. The aim of this study was to evaluate surgical downstaging after concurrent chemoradiation therapy (CCRT) for LAPC by measuring the objective changes after treatment. From January 2003 through July 2011, 54 patients with LAPC underwent neoadjuvant CCRT. Computed tomography findings of the tumor size, including major vessel invasion, were analyzed before and after CCRT. Among the total recruited patients, 14 had borderline resectable malignancy and another 40 were unresectable before CCRT. After CCRT, a partial response was achieved in four patients. Stable disease and further disease progression were achieved in 36 and 14 patients, respectively. Tumor size showed no significant difference before and after CCRT (3.6 +/- 1.1 vs. 3.6 +/- 1.0 cm, P = 0.61). Vessel invasion showed improvement in two patients, while 13 other patients showed further tumor progression. Thirty-nine patients with unresectable malignancy and 11 patients with borderline resectable malignancy at time of initial diagnosis remained unchanged after CCRT. Four patients with borderline pancreatic malignancy progressed to an unresectable stage, whereas one unresectable pancreatic malignancy improved to a borderline resectable stage. Only one patient with borderline resectable disease underwent operation after CCRT; however, curative resection failed due to celiac artery invasion and peritoneal seeding. The adverse events associated with CCRT were tolerable. In conclusion, preoperative CCRT in LAPC rarely leads to surgical downstaging, and it could lower resectability rates.

Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

Aims: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. Materials and Methods: A prospective study with women submitted to radical hysterectomy (RH) (n = 20), exclusive radiotherapy (RT) (n = 20) or chemoradiation (CT/RT) (n = 20) for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05). Results: The groups were similar in stress urinary incontinence incidence (p = 0.56), urinary urgency (p = 0.44), urge incontinence (p = 0.54), nocturia (p = 0.53), incomplete bowel emptying (p = 0.76), bowel urgency (p = 0.12) and soilage (p = 0.43). The CT/RT group presented a higher urinary frequency (p < 0.001) and diarrhea (p = 0.025). Patients in the RH group were more sexually active (p = 0.01) and experienced less dyspareunia (p = 0.021). Vaginal length was shorter in RT group (5.5 ± 1.9cm) and CT/RT(5.3 ± 1.5 cm) than in the RH group (7.4 ± 1.1 cm) (p < 0.001). Pelvic floor muscle contraction was similar (p = 0.302). Conclusions: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions. .

Mucosite em pacientes portadores de câncer de cabeça e pescoço submetidos à radioquimioterapia / Mucositis in head and neck cancer patients undergoing radiochemotherapy / Mucositis en pacientes portadores de cáncer de cabeza y cuello sometidos a radioquimioterapia

O objetivo do presente trabalho é classificar o grau de mucosite oral de acordo com os parâmetros internacionais do Common Toxicity Criterion (CTC) em pacientes portadores de tumor de cabeça e pescoço submetidos à radioterapia e quimioterapia concomitantes, e caracterizar um perfil dos pacientes em nosso meio, verificando os hábitos dos indivíduos, as características do tumor, o protocolo de tratamento e a intensidade desta reação aguda. Neste estudo foram avaliados 50 pacientes, submetidos à radioterapia em megavoltagem com doses entre 66 a 70 Gy e quimioterapia com cisplatina ou carboplatina concomitante. Semanalmente foi avaliado o grau de mucosite de acordo com o CTC, uma escala ordinal que apresenta 4 graus. Observou-se interrupção do tratamento por mucosite em 36 por cento do total de pacientes e em 100 por cento dos pacientes diabéticos, o que nos permitiu verificar que esta patologia contribui para a gravidade da mucosite.

The objective of present study was to classify oral mucositis according to the Common Toxicity Criterion (CTC) international parameters in head and neck tumor patients simultaneously treated with radio and chemotherapy, and characterize a patient profile in our area, observing the individuals' habits, tumor characteristics, treatment protocol and acute reaction intensity. Fifty patients undergoing simultaneous 66 to 70 Gy megavoltage radiotherapy and cisplatin/carboplatin chemotherapy were evaluated in this study. Weekly evaluations of the degree of mucositis were perfoemed according to CTC, a four-degree ordinal scale; 36 percent of all patients and 100 percent of those with diabetes discontinued treatment due to mucositis, showing that this pathology contributes to the severity of mucositis.

El trabajo objetivó clasificar el grado de Mucositis oral de acuerdo a parámetros internacionales del CTC en pacientes portadores de tumores de cabeza y cuello sometidos a radioterapia y quimioterapia concomitantes, y caracterizar un perfil de pacientes en nuestro medio, verificando hábitos de los individuos, características del tumor, protocolo de tratamiento e intensidad de esta reacción aguda. Fueron evaluados 50 pacientes sometidos a radioterapia en megavoltaje con dosis entre 66 y 70 G y quimioterapia con cisplatino o carboplatino concomitante. Se evaluó semanalmente el grado de Mucositis según el Common Toxicity Criterio - CTC, una escala ordinal que presenta cuatro grados. Se observó interrupción del tratamiento por Mucositis en 36 por ciento del total de pacientes y en 100 por ciento de los pacientes diabéticos, lo que nos permite verificar que dicha patología potencia la gravedad de la mucositis.

Concurrent chemoradiotherapy plus consolidation chemotherapy compared with concurrent chemoradiotherapy alone in unresectable stage III non-mall-cell lung cancer

To evaluate the addition of consolidation chemotherapy to concurrent Chemoradiotherapy in patients with locally advanced unresectable stage III non-small-cell lung cancer as regard efficacy and safety. Forty one patients were randomly assigned to either concomitant Chemoradiotherapy alone [arm 1, n = 19] or concomitant Chemoradiotherapy followed by consolidation chemotherapy [arm 2, n = 22]. In the concurrent arm, patients received weekly paclitaxel [45 mg/m[2]], carboplatin [100 mg/m[2]] and concomitant thoracic radiotherapy at a dose of 63 Gy in 34 fractions over 7 weeks. In the concurrent/consolidation arm, the same regimen was administered followed by two additional courses of paclitaxel [200 mg/m[2]] and carboplatin [300 mg/m[2]] every 3 weeks. Pre-treatment characteristics were well balanced between the two arms. Median survival was 13 months in the concurrent arm and 16.5 months in the concurrent/consolidation arm [p = 0.59]. One-, 2-, and 3- year survival rates were better in the concurrent/consolidation arm [63.6%, 36.4%, and 13.6% respectively] than in the concurrent arm [52.6%, 26.3%, and 10.5% respectively], p = 0.48. Grade 3/4 granulocytopenia occurred in 16% and 27% of patients on the concurrent and concurrent/consolidation arms respectively [p = 0.38]. The most common grade 3/4 non-hematological toxicity was esophagitis. It was more frequent in the consolidation arm than in the concurrent arm [32% v 21%], p = 0.43. Concurrent Chemoradiotherapy followed by consolidation chemotherapy represent the preferred regimen for the treatment of unresected stage III NSCLC. However, toxicity, particularly, non-hematological toxicity, remains a major obstacle