RESUMO
Context: According to the National Comprehensive Cancer Network guidelines for cervical cancer, patients with cervical cancer invading the lower one-third of the vagina require bilateral inguinal lymphatic area preventive irradiation. However, it is not clear whether they need preventive inguinal area irradiation. Aims: The aim of this study is to evaluate the necessity of bilateral inguinal lymphatic area irradiation for patients with cervical cancer with invasion of the lower one-third of the vagina. Settings and Design: Patients without inguinal lymph node metastasis were divided into preventive radiotherapy and nonpreventive radiotherapy groups. The occurrence of inguinal skin damage, lower extremity edema, and femoral head necrosis was observed during and after treatment. Methods and Material: In total, 184 patients with cervical cancer with invasion of the lower one-third of the vagina were selected. A trial and control method was used to select 180 patients without inguinal lymph node metastasis. Statistical Analysis: Comparison between groups was performed using a t test. Data were enumerated using frequency (percentage), and comparison between groups was performed using a Chi-square test. Results: Imaging examination revealed inguinal lymph node enlargement in 7.07% of patients, and only four cases (2.17%) were further confirmed by pathology. The inguinal lymph node metastasis rate in these patients was very low. The prophylactic irradiation group showed a high occurrence rate of side injury. In the follow-up of both groups, no recurrence was detected in the inguinal lymph nodes. Conclusions: Prophylactic irradiation of inguinal lymph nodes is not essential for patients without pathological metastasis.
Assuntos
Neoplasias do Colo do Útero , Feminino , Humanos , Virilha/patologia , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática/radioterapia , Metástase Linfática/patologia , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/patologia , Vagina/patologiaRESUMO
BACKGROUND AND OBJECTIVE: The optimal management of prostate cancer (PC) recurrences after definitive or postoperative radiotherapy (RT) is still controversial. The aim of the present retrospective study was to report the preliminary clinical results and toxicity of a mono-institutional series of patients re-irradiated with linac-based SBRT in recurrent prostate cancer. METHODS: Inclusion criteria were previous definitive or adjuvant/salvage RT, evidence of biochemical recurrence and radiological detection of local relapse (Magnetic Resonance Imaging or PSMA/choline-Positron Emission Tomography), and IPSS <10. Toxicity was assessed according to Common Terminology Criteria for Adverse Events v4.0. RESULTS: Between 12/2014 and 12/2019, 24 patients with median age 75 years (65-89) underwent re-RT for PC recurrence. Median follow-up was 21 months (2-68). The recurrences occurred in 13 cases within the prostate and in 11 cases within the prostate bed. All patients were treated with SBRT to a median total dose of 30â¯Gy (25-36â¯Gy) in 5-6 fractions, and simultaneous androgen deprivation therapy was administered in 4 patients. Acute toxicity was G1 in 8.3% and G2 in 12.5% for genitourinary (GU), no acute gastrointestinal (GI) toxicity occurred. Concerning late side effects, 19.7% of patients were found to have ≥G2 GU toxicity, including one G3 urethral stenosis. Only one case of G1 late GI toxicity occurred and no ≥G2. The 2year overall survival was 95%. The 1 and 2year biochemical relapse-free survival (BRFS) and progression-free survival (PFS) rates were 80 and 54.9%, respectively. CONCLUSION: Despite of the heterogeneity of the sample, linac-based SBRT as a salvage treatment in previously irradiated locally recurrent PC patients seems to be a safe and feasible treatment option. Long-term data are pending.
Assuntos
Adenocarcinoma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Neoplasias da Próstata/radioterapia , Radiocirurgia/métodos , Terapia de Salvação/métodos , Adenocarcinoma/secundário , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Seguimentos , Gastroenteropatias/etiologia , Humanos , Estimativa de Kaplan-Meier , Irradiação Linfática , Metástase Linfática/radioterapia , Masculino , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radiocirurgia/instrumentação , Estudos Retrospectivos , Resultado do Tratamento , Transtornos Urinários/etiologiaRESUMO
PURPOSE: To assess the effect of adding radioactive iodine (RAI) therapy to total thyroidectomy (TT) on overall survival (OS) in patients presenting with papillary thyroid cancer (PTC) and cervical pathologically proven LN metastases (pN1). METHODS AND MATERIALS: We identified a cohort of patients with PTC and nodal metastases treated with TT alone or TT plus RAI in the Surveillance, Epidemiology and End Results database between 2004 and 2013. Propensity score 1-to-1 matching was used to balance baseline characteristics. Cox proportional hazards regression models and Kaplan-Meier survival analysis were used to test the relationship between RAI and OS. RESULTS: In all, 15,953 patients were identified. After propensity score matching, 12,128 patients remained in each group. Based on multivariate Cox analysis, patients treated with TTâ¯+â¯RAI had a statistically significant improvement in OS compared with those treated with TT alone [hazard ratio (HR)â¯=â¯0.54, Pâ¯<â¯0.001)], and significance persisted in the matched cohort (HRâ¯=â¯0.41, Pâ¯<â¯0.001). In a subgroup analysis, the survival benefit was observed among patients ≥55â¯years but not among those <55â¯years (ageâ¯<â¯55: HRâ¯=â¯1.06, Pâ¯=â¯0.72; ageâ¯≥â¯55: HRâ¯=â¯0.33, Pâ¯<â¯0.001). Patients with stage T4 benefited most from RAI treatment (HRâ¯=â¯0.29, Pâ¯<â¯0.001). CONCLUSION: This propensity-matched analysis suggests that RAI therapy after TT was associated with improved OS in PTC patients with pN1 disease. Adjuvant RAI therapy needs to be considered in this patient group.
Assuntos
Radioisótopos do Iodo/administração & dosagem , Metástase Linfática/radioterapia , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Fatores Etários , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante/métodos , Programa de SEER/estatística & dados numéricos , Câncer Papilífero da Tireoide/mortalidade , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Resultado do TratamentoRESUMO
Standard-of-care imaging for initial staging of prostate cancer (PCa) underestimates disease burden. Prostate-specific membrane antigen (PSMA) PET/CT detects PCa metastasis with superior accuracy, having a potential impact on the planning of definitive radiation therapy (RT) for nonmetastatic PCa. Our objectives were to determine how often definitive RT planning based on standard target volumes covers 68Ga-PSMA-11 PET/CT-defined disease and to assess the potential impact of 68Ga-PSMA-11 PET/CT on definitive RT planning. Methods: This was a post hoc analysis of an intention-to-treat population of 73 patients with localized PCa without prior local therapy who underwent 68Ga-PSMA PET/CT for initial staging as part of an investigational new drug trial. Eleven of the 73 were intermediate-risk (15%), 33 were high-risk (45%), 22 were very-high-risk (30%), and 7 were N1 (9.5%). Clinical target volumes (CTVs), which included the prostate, seminal vesicles, and (in accord with the Radiation Therapy Oncology Group consensus guidelines) pelvic lymph nodes (LNs), were contoured on the CT portion of the PET/CT images by a radiation oncologist masked to the PET findings. 68Ga-PSMA-11 PET/CT images were analyzed by a nuclear medicine physician. 68Ga-PSMA-11-positive lesions not covered by planning volumes based on the CTVs were considered to have a major potential impact on treatment planning. Results: All patients had one or more 68Ga-PSMA-11-positive primary prostate lesions. Twenty-five (34%) and 7 (9.5%) of the 73 patients had 68Ga-PSMA-11-positive pelvic LN and distant metastases, respectively. The sites of LN metastases in decreasing order of frequency were external iliac (20.5%), common iliac (13.5%), internal iliac (12.5%) obturator (12.5%), perirectal (4%), abdominal (4%), upper diaphragm (4%), and presacral (1.5%). The median size of the LN lesions was 6 mm (range, 4-24 mm). RT planning based on the CTVs covered 69 (94.5%) of the 73 primary lesions and 20 (80%) of the 25 pelvic LN lesions, on a per-patient analysis. Conclusion:68Ga-PSMA-11 PET/CT had a major impact on intended definitive RT planning for PCa in 12 (16.5%) of the 73 patients whose RT fields covered the prostate, seminal vesicles, and pelvic LNs and in 25 (37%) of the 66 patients whose RT fields covered the prostate and seminal vesicles but not the pelvic LNs.
Assuntos
Ácido Edético/análogos & derivados , Oligopeptídeos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Simulação por Computador , Isótopos de Gálio , Radioisótopos de Gálio , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/radioterapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/efeitos da radiação , Compostos Radiofarmacêuticos , Glândulas Seminais/diagnóstico por imagem , Glândulas Seminais/efeitos da radiaçãoRESUMO
A 54-year-old man with progressive prostate cancer underwent a 68Ga-PSMA PET/CT, which showed lymph node and bone metastases. After 2-cycles of 177Lu-PSMA therapy, the repeated 68Ga-PSMA PET/CT showed decreased radiotracer uptake in lymph node and bones metastases, but there were new lesions which may be compatible with progression or tumour sink-effect. A review of 177Lu-PSMA-therapy images revealed that new lesions in the second PET/CT were the metastatic lesions that progressed after the first PET/CT, and subsequently showed a good response. The patient received additional cycles of 177Lu-PSMA therapy, and the disease regressed further, with a PSA of 0.06ng/ml. Response evaluation of new therapeutic diagnostics (theranostic) agents needs a review of not only diagnostic PET/CT images, but also post-therapy images and laboratory results.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Dipeptídeos/uso terapêutico , Compostos Heterocíclicos com 1 Anel/uso terapêutico , Lutécio/uso terapêutico , Metástase Linfática/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata/diagnóstico por imagem , Radioisótopos/uso terapêutico , Compostos Radiofarmacêuticos/uso terapêutico , Adenocarcinoma/sangue , Adenocarcinoma/radioterapia , Neoplasias Ósseas/sangue , Neoplasias Ósseas/radioterapia , Dipeptídeos/análise , Monitoramento de Medicamentos , Ácido Edético/análogos & derivados , Ácido Edético/análise , Isótopos de Gálio , Radioisótopos de Gálio/análise , Compostos Heterocíclicos com 1 Anel/análise , Humanos , Lutécio/análise , Metástase Linfática/radioterapia , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/análise , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/radioterapia , Radioisótopos/análise , Compostos Radiofarmacêuticos/análise , Sensibilidade e EspecificidadeRESUMO
The risk classification for localized prostate cancer is based on the groups "low", "intermediate", and "high-risk" prostate cancer. Following this established risk group definition, locally advanced prostate cancer (cT3/4N0M0) has to be classified as "high-risk" prostate cancer. Radical prostatectomy or high-dose radiotherapy, which is combined with androgen deprivation, are the only curative standard treatments for locally advanced prostate cancer. Particularly adequate radiation doses, modern radiotherapy techniques like IMRT/IGRT, as well as long-term androgen suppression are essential for an optimal treatment outcome. In combination with definitive radiotherapy, androgen deprivation therapy should be started neoadjuvant/simultaneous to radiotherapy and is recommended to be continued after radiotherapy. Previous data suggest that 2year long-term androgen deprivation in this setting may not be inferior to 3year long-term androgen deprivation in high-risk patients. An additional radiation therapy of the lymphatic pathways in men with cN0 locally advanced/high-risk prostate cancer is still a matter of research. Ongoing trials may define selected subgroups with a suggested benefit at its best.
Assuntos
Neoplasias da Próstata/radioterapia , Antagonistas de Androgênios/uso terapêutico , Terapia Combinada , Progressão da Doença , Humanos , Metástase Linfática/patologia , Metástase Linfática/radioterapia , Masculino , Drenagem Linfática Manual , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias da Próstata/patologia , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada , Fatores de RiscoRESUMO
BACKGROUND AND PURPOSE: The need for target adjustment due to respiratory motion variation and the value of carina as a motion surrogate is evaluated for locally advanced non-small-cell lung cancer. MATERIAL AND METHODS: Using weekly 4D CTs (with audio-visual biofeedback) of 12 patients, respiratory motion variation of primary tumors (PT), lymph nodes (LN) and carina (C) were determined. RESULTS: Mean (SD) 3D respiratory motion ranges of PT, LN and C were 4 (3), 5 (3) and 5 (3) mm. PT and LN (p = 0.003), and LN and C motion range were correlated (p = 0.03). Only 20 %/5 % of all scans had variations >3 mm/5 mm. Large respiratory motion range on the initial scan was associated with larger during-treatment variations for PT (p = 0.03) and LN (p = 0.001). Mean (SD) 3D relative displacements of PT-C, LN-C and PT-LN were each 6 (2) mm. Variations of displacements >3 mm/5 mm were observed in 28 %/6 % of scans for PT-LN, 20 %/9 % for PT-C, and 20 %/8 % for LN-C. CONCLUSIONS: Motion reassessment is recommended in patients with large initial motion range. Relative motion-related displacements between PT and LN were larger than PT and LN motion alone. Both PT and C appear to be comparable surrogates for LN respiratory motion.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Tomografia Computadorizada Quadridimensional , Neoplasias Pulmonares/radioterapia , Irradiação Linfática , Metástase Linfática/radioterapia , Respiração , Pontos de Referência Anatômicos/diagnóstico por imagem , Artefatos , Biorretroalimentação Psicológica , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma Pulmonar de Células não Pequenas/terapia , Cartilagem/diagnóstico por imagem , Quimiorradioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Irradiação Linfática/métodos , Movimento (Física) , Planejamento da Radioterapia Assistida por Computador , Mecânica Respiratória , Traqueia/diagnóstico por imagemRESUMO
Local control for advanced non-small cell lung cancer (NSCLC) remains a significant problem with chemoradiation local failure rates in the chest of 30-50%. Despite attempts at dose escalation with conventional radiation therapy techniques, toxicities limit the amount of radiation that can be delivered. For stage I NSCLC, mounting evidence supports the use of hypofractionated radiation therapy (SBRT) to gain high local control rates with acceptable toxicity. For healthy patients with stage II/III NSCLC, the National Comprehensive Cancer Network guidelines suggest surgery is the preferred standard of care for patients with Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia
, Neoplasias Pulmonares/radioterapia
, Carcinoma Pulmonar de Células não Pequenas/patologia
, Relação Dose-Resposta à Radiação
, Humanos
, Neoplasias Pulmonares/patologia
, Metástase Linfática/radioterapia
, Radiocirurgia
Assuntos
Anti-Inflamatórios/uso terapêutico , Cistite/tratamento farmacológico , Hematúria/tratamento farmacológico , Imunossupressores/uso terapêutico , Metilprednisolona/uso terapêutico , Lesões por Radiação/tratamento farmacológico , Óxido de Alumínio/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais Murinos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transfusão de Sangue , Terapia Combinada , Ciclofosfamida/administração & dosagem , Cistite/etiologia , Cistite/imunologia , Cistite/terapia , Doxorrubicina/administração & dosagem , Estrogênios/uso terapêutico , Etoposídeo/administração & dosagem , Hidratação , Hematúria/etiologia , Hematúria/imunologia , Hematúria/terapia , Humanos , Oxigenoterapia Hiperbárica , Imunossupressores/administração & dosagem , Irradiação Linfática/efeitos adversos , Metástase Linfática/radioterapia , Linfoma de Célula do Manto/complicações , Linfoma de Célula do Manto/tratamento farmacológico , Linfoma de Célula do Manto/radioterapia , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Lesões por Radiação/etiologia , Lesões por Radiação/imunologia , Radioterapia Conformacional/efeitos adversos , Recidiva , Rituximab , Terapia de Salvação/efeitos adversos , Vincristina/administração & dosagemRESUMO
BACKGROUND: While radioactive iodine (RAI) adjuvant therapy is commonly recommended for most papillary thyroid cancer patients presenting with large volume nodal involvement, it remains unclear if such therapy impacts the disease-specific recurrence rate and overall survival. In this study, we compared the risk of achieving a structural persistent response after low administered activity (100 mCi), intermediate administered activity (150 mCi), and high administered activity (>200 mCi) RAI adjuvant therapy in patients presenting with pathologic N1b disease. METHODS: This was a retrospective review of 181 papillary thyroid cancer patients with N1b disease treated with total thyroidectomy, neck dissection, and RAI remnant ablation. Dose-response relationships were determined between the administered activity of (131)I and the best response to initial therapy. RESULTS: Out of the 181 patients, only 39% achieved no clinical evidence of disease (NED) after initial therapy. Young patients (Stage I) had a statistically nonsignificant trend toward higher rates of NED with increasing dose (34% low activity, 36% intermediate activity, 46% high activity), but there was no evidence of dose-response effect with regard to the likelihood of having a structural persistent response to initial therapy or the likelihood of having persistent biochemical evidence of disease. However, analysis of the older patients (Stage IVa) did reveal a trend toward statistically significant dose-response relationships with increasing administered activities being associated with lower rates of structural persistent response (46% low activity, 23% intermediate activity, 17% high dose). Unfortunately, the lower rate of structural persistent response only modestly increased the likelihood that patients would be NED but was instead associated with a higher proportion of patients being classified as having biochemical persistent disease at 12-18 months. CONCLUSIONS: It appears that administering more than 100 mCi of RAI as adjuvant therapy in N1b disease is unlikely to improve the initial response to therapy. This is especially true for the younger (Stage I) patients. It is plausible that administered activities of 150-260 mCi may be associated with an improved response to initial therapy in older patients (Stage IVa) who are probably at highest risk of having poor outcomes, but the potential benefit from RAI should be balanced against potential adverse effects in those patients.
Assuntos
Carcinoma Papilar/terapia , Radioisótopos do Iodo/uso terapêutico , Metástase Linfática/radioterapia , Neoplasias da Glândula Tireoide/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Carcinoma Papilar/patologia , Carcinoma Papilar/radioterapia , Carcinoma Papilar/secundário , Terapia Combinada , Feminino , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Despite the lack of evidence to support its implementation in the clinical practice, induction chemotherapy (IC) before chemoradiotherapy (CRT) is often used in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). We retrospectively examined the tolerability, feasibility, and clinical outcome of both concepts in a single center analysis. PATIENTS AND METHODS: In all, 83 patients were treated between 2007 and 2010 with IC + CRT (n = 42) or CRT alone (n = 41). IC consisted of docetaxel, cisplatin and 5-fluorouracil (TPF), or cisplatin and 5-fluorouracil (PF). All patients were scheduled to receive 2 cycles of PF during concurrent CRT. Adverse events were assessed according to the common toxicity criteria of adverse events (CTCAE v. 3.0). Associations were tested using the χ² test, and survival estimates were calculated according to Kaplan-Meier. RESULTS: The median follow-up was 30.35 months (range 2.66-61.25 months). At 2 years, the overall survival rate was significantly higher for primary CRT compared to IC + CRT group (74.8 % vs. 54 %, respectively; p = 0.041). Significantly more treatment-related overall grade 4 toxicities were documented in the IC + CRT group compared to the CRT group (42.9% vs. 9.8%; p = 0.001). Renal toxicity ≥ grade 2 occurred in 52.4 % vs. 7.3 % (p < 0.001), respectively. In all, 93 % of the patients with primary CRT compared to 71 % with IC + CRT received the planned full radiotherapy dose (p = 0.012). CONCLUSION: This is, to our knowledge, the largest retrospective study to compare IC + CRT with primary CRT. IC showed high acute toxicity, compromised the feasibility of concurrent CRT, and was associated with reduced overall survival rates compared to primary CRT. The lack of clinical benefit in conjunction with the increased toxicity does not support implementation of IC.
Assuntos
Carcinoma de Células Escamosas/terapia , Quimiorradioterapia Adjuvante , Quimiorradioterapia , Quimioterapia de Indução , Neoplasias Otorrinolaringológicas/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/patologia , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Terapia Combinada , Docetaxel , Estudos de Viabilidade , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática/patologia , Metástase Linfática/radioterapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Otorrinolaringológicas/patologia , Estudos Retrospectivos , Taxoides/administração & dosagem , Taxoides/efeitos adversosRESUMO
PURPOSE: The aim of this study is to call attention to the role that radioactive iodine ((131)I) and stapes surgery may play in causing hyposalivation. MATERIALS AND METHODS: The manner in which (131)I and stapes surgery can cause salivary damage was reviewed. A case report is presented to illustrate the involved pathophysiology. RESULTS: The case report clearly shows the significant injury to the parotid glands caused by the (131)I. However, subjective symptoms of oral dryness only developed after injury to the chorda tympani nerve (CTN) during stapes surgery. CONCLUSIONS: The loss of function of both parotid glands after (131)I therapy for thyroid cancer was initially compensated by the secretions of the more radiation-resistant submandibular and sublingual salivary glands (SMSG/SLSG). Damage to the CTN's secretory fibers in one SMSG/SLSG complex led to subjective oral dryness by accentuating an existing objective hyposalivation.
Assuntos
Radioisótopos do Iodo/efeitos adversos , Compostos Radiofarmacêuticos/efeitos adversos , Cirurgia do Estribo/efeitos adversos , Xerostomia/etiologia , Carcinoma/radioterapia , Carcinoma/cirurgia , Carcinoma Papilar , Nervo da Corda do Tímpano/lesões , Feminino , Humanos , Metástase Linfática/radioterapia , Pessoa de Meia-Idade , Otosclerose/cirurgia , Glândula Parótida/efeitos da radiação , Radioterapia Adjuvante , Pertecnetato Tc 99m de Sódio , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
A case of squamous cell carcinoma of the tongue with advanced N3 cervical lymph node metastases in an 80-year-old female is reported. The patient was treated with a combination of radiotherapy (2 Gy/day, total 60 Gy), superselective intra-arterial chemotherapy via a superficial temporal artery and a femoral artery (docetaxel, total 124 mg; cisplatin, total 135 mg), and four sessions of hyperthermia for cervical lymph node metastases. The tumor responded well to therapy, and 18-fluorodeoxyglucose uptake in both primary and neck lesions disappeared on positron emission tomography-computed tomography. The patient has shown no clinical or radiological evidence of local recurrence or distant metastases 6 years after the end of treatment. Advanced oral cancer patients with N3 cervical lymph node metastases are particularly difficult to treat and have a poor prognosis. This method of thermochemoradiotherapy seems a promising modality for patients with N3 cervical lymph node metastases of oral cancer.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Metástase Linfática/radioterapia , Neoplasias da Língua/tratamento farmacológico , Neoplasias da Língua/radioterapia , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Colo do Útero/patologia , Quimiorradioterapia , Cisplatino/uso terapêutico , Terapia Combinada , Docetaxel , Feminino , Humanos , Hipertermia Induzida , Infusões Intra-Arteriais , Linfonodos/patologia , Recidiva Local de Neoplasia/patologia , Tomografia por Emissão de Pósitrons , Taxoides/uso terapêutico , Resultado do TratamentoRESUMO
Radiation recall phenomenon is an inflammatory process occurring at sites of previous radiation subsequent to administration of pharmacologic agents. The most common chemotherapeutic agents implicated with radiation recall phenomenon are anthracyclines and taxanes. Skin is the most common site for radiation recall. About 63% of the radiation recall events are reported to manifest as dermatitis. This finding differs from radiation recall due to Gemcitabine, in which approximately 70% cases manifested as inflammation of internal organs or tissues and 30% manifested as dermatitis. Here, we report a case of post-operative peri-ampullary carcinoma who developed radiation recall dermatitis during adjuvant chemotherapy with inj. Gemcitabine and inj. Carboplatin after concurrent chemoradiation with capecitabine.
Assuntos
Adenocarcinoma , Neoplasias dos Ductos Biliares , Desoxicitidina/análogos & derivados , Radiodermite/tratamento farmacológico , Adenocarcinoma/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/tratamento farmacológico , Neoplasias dos Ductos Biliares/radioterapia , Biópsia por Agulha Fina , Cefalosporinas/uso terapêutico , Quimioterapia Adjuvante/efeitos adversos , Ácido Clavulânico/uso terapêutico , Desoxicitidina/efeitos adversos , Desoxicitidina/uso terapêutico , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/radioterapia , Pessoa de Meia-Idade , Radiossensibilizantes/uso terapêutico , Radioterapia Guiada por Imagem , GencitabinaRESUMO
PURPOSE: To report our 20 yr experience of definitive radiotherapy for early glottic squamous cell carcinoma (SCC). METHODS AND MATERIALS: Radiation records of 141 patients were retrospectively evaluated for patient, tumor, and treatment characteristics. Cox proportional hazard models were used to perform univariate (UVA) and multivariate analyses (MVA). Cause specific survival (CSS) and overall survival (OS) were plotted using cumulative incidence and Kaplan-Meir curves, respectively. RESULTS: Of the 91% patients that presented with impaired voice, 73% noted significant improvement. Chronic laryngeal edema and dysphagia were noted in 18% and 7%, respectively. The five year LC was 94% (T1a), 83% (T1b), 87% (T2a), 65% (T2b); the ten year LC was 89% (T1a), 83% (T1b), 87% (T2a), and 53% (T2b). The cumulative incidence of death due to larynx cancer at 10 yrs was 5.5%, respectively. On MVA, T-stage, heavy alcohol consumption during treatment, and used of weighted fields were predictive for poor outcome (p < 0.05). The five year CSS and OS was 95.9% and 76.8%, respectively. CONCLUSIONS: Definitive radiotherapy provides excellent LC and CSS for early glottis carcinoma, with excellent voice preservation and minimal long term toxicity. Alternative management strategies should be pursued for T2b glottis carcinomas.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Glote/patologia , Neoplasias Laríngeas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Transtornos de Deglutição/etiologia , Disfonia/etiologia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Metástase Linfática/radioterapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Segunda Neoplasia Primária/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Qualidade de Vida , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Radioterapia/métodos , Dosagem Radioterapêutica , Estudos Retrospectivos , Fumar/efeitos adversos , Taxa de Sobrevida , Resultado do Tratamento , Trismo/etiologiaRESUMO
OBJECTIVE: To evaluate the efficacy of neoadjuvant chemotherapy, followed by radiotherapy and concurrent hyperthermia (triple therapy) in patients with advanced-stage cervical cancer. METHODS: We selected 43 patients from our hyperthermia database, who were treated from 1996 to 2010 with triple therapy for large primary tumours (>6 cm) or para-aortic lymph node metastases. All patients received platinum-based chemotherapy followed by full-dose radiotherapy, brachytherapy and five hyperthermia treatments. The response was evaluated by gynaecological examination and a CT-scan. Time-to-event variables were estimated using the Kaplan Meier method and the Cox regression method. RESULTS: The mean age of the patients was 50.4 years (range 29-80). The median tumour size was 5.6 cm at diagnosis (range 2.6-8.2), positive lymph nodes were present in 90.7%. A total of 67% of the patients completed all six planned courses of chemotherapy. After completion of neoadjuvant chemotherapy, 83.7% of patients achieved a complete or partial response. At the end of treatment, the complete response rate was 81.4% (95%CI 69.2-93.5). Grade 2, 3 and 4 acute vascular toxicity occurred in 17 patients. The incidence of grade 3-4 haematological toxicity did not exceed 10% and no neutropenic fever occurred. For grade 1-2 renal toxicity, a switch to carboplatin was made (n = 6). No acute grade 3-4 renal toxicity was observed. No treatment-related deaths were recorded. The median follow-up time was 29.8 months (range 4.1-124.8). Overall survival rate at 12 months was 79% (95%CI 57.4-92.3). CONCLUSION: The triple therapy seems feasible and effective in the treatment of advanced-stage, high-risk cervical cancer. However, chemotherapy-induced vascular toxicity occurred frequently, which may warrant the use of prophylactic anticoagulants. We recommend a phase II trial for prospective confirmation for comparison with standard chemoradiation and the use of anticoagulants.
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Braquiterapia , Hipertermia Induzida , Metástase Linfática/radioterapia , Terapia Neoadjuvante , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/métodos , Quimiorradioterapia/efeitos adversos , Cisplatino/efeitos adversos , Cisplatino/uso terapêutico , Terapia Combinada , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/métodos , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapiaRESUMO
PURPOSE: Evaluation of the lymph node situation in patients with prostate cancer is essential for effective radiotherapy. Using magnet resonance imaging (MRI) of the lymph nodes with ferumoxtran-10 (MR lymphography), it is possible to detect lymph node metastasis. We present our initial experience with ferumoxtran-10 MR lymphography as the basis for image-guided, dose-escalated lymph node radiotherapy and for early follow-up after radiotherapy. PATIENTS AND METHODS: A patient with suspicion for lymph node metastasis after radical prostatectomy was examined with MR lymphography with the lymph node-specific contrast media ferumoxtran-10. Radiotherapy was performed as intensity-modulated radiotherapy with a total dose of 44 Gy to the whole lymphatic drainage, 60 Gy to the area of affected lymph nodes, 71 Gy to the prostate bed, and 75 Gy to the anastomosis region. 8 weeks after completion of radiotherapy, a follow-up MR lymphography with ferumoxtran-10 was performed. RESULTS: In the first MRI with ferumoxtran-10, 5 metastatic lymph nodes were found in the iliac region. The scan 8 weeks postradiotherapy no longer showed lymph nodes suspicious for metastases. PSA (prostate-specific antigen) decreased from 2.06 ng/ml pretherapeutically to 0.02 ng/ml at 2 weeks after treatment and was no longer detectable at 8 months after treatment. CONCLUSIONS: Lymph node staging with ferumoxtran-10 and subsequent dose escalation with intensity-modulated radiotherapy led to the elimination of positive lymph nodes and a decrease in the PSA value.
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Biomarcadores Tumorais/sangue , Meios de Contraste/administração & dosagem , Dextranos , Processamento de Imagem Assistida por Computador/métodos , Irradiação Linfática/métodos , Metástase Linfática/patologia , Metástase Linfática/radioterapia , Linfografia/métodos , Imageamento por Ressonância Magnética/métodos , Nanopartículas de Magnetita , Recidiva Local de Neoplasia/radioterapia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/métodos , Terapia Combinada , Seguimentos , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Estadiamento de Neoplasias , Prostatectomia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/cirurgia , Radioterapia AdjuvanteRESUMO
INTRODUCTION: To investigate anatomical response-related changes in the head and neck region during a course of radical radiotherapy and their impact on the planned dosimetry. METHODS: The study consisted of 10 patients with primary mucosal carcinoma. Patients' nutritional requirements were managed as per departmental protocol to minimise weight loss during treatment. Kilovoltage computed tomography (CT) scans were acquired once 40 to 50 Gy had been delivered. Gross tumour volumes (GTV) and organs at risk were delineated and the initial optimised treatment plan was overlaid on the repeat CT. Comparisons were made between scans and absolute volume variations, centres of structures, dice similarity coefficients and the subsequent dosimetric impact were assessed. RESULTS: Median weight loss at second scan was 3%. Primary and lymph node GTVs reduced by 49.9% (range 21.3-82%) and 73.7% (range 61.7-88.6%), respectively, yet continued to receive the prescribed dose. Maximum dose to spinal cord and brainstem changed minimally. Spared and un-spared parotid gland volumes reduced by median 23.5% and 20.5%, respectively, with no consistent translational displacement direction and minimal change in the mean dose. CONCLUSIONS: Despite some significant geometric changes, nutritional management ensured patient size and shape was maintained in these consecutively selected patients and subsequently there was no apparent under-dosing of targets or over-dosing of normal structures with this technique. Further investigations which model gradual change and allow cumulative dosimetry are required to better characterise what occurs during the treatment course.
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Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Fracionamento da Dose de Radiação , Feminino , Gastrostomia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/radioterapia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/patologia , Terapia Nutricional , Glândula Parótida/efeitos da radiação , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios X , Redução de PesoRESUMO
PURPOSE: To establish an initial database of external-beam radiotherapy (EBRT) for clinically localized prostate cancer used in Osaka, Japan, and, by analyzing the results of the Osaka multicenter cooperative study, to determine time trends, outcome, and applicability of existing and the authors' original risk stratification methods. PATIENTS AND METHODS: Data of 652 patients with clinically localized prostate cancer (T1-4 N0 M0) were accrued from July to December 2007. These patients had been treated from 1995 through 2006 with consecutive definitive EBRT of > or = 60 Gy at eleven institutions, mainly in Osaka. Altogether, 436 patients were eligible for analysis using several risk stratification methods, namely, those of D'Amico et al., the National Comprehensive Cancer Network (NCCN), and Seattle, as well as the authors' original Prostate Cancer Risk Index (PRIX). RESULTS: The number of patients showed a tenfold increase over 10 years, together with a rapid spread of the use of Gleason Score from 0% to > 90% of cases. The dominant RT dose fractionation was 70 Gy/35 fractions (87%). Hormone therapy had been administered to 95% of the patients and the higher PRIX corresponded to the higher rate of hormone usage. 3- and 5-year biochemical relapse-free survival (bRFS) rates were 85% and 70%, respectively. The D'Amico (p = 0.132), NCCN (p = 0.138), Seattle (p = 0.041) and PRIX (p = 0.044) classifications showed weak or no correlation with bRFS, while the own modified three-class PRIX (PRIX 0, 1-5, 6) showed a strong correlation (p = 0.002). CONCLUSION: The use of prostate EBRT in Japan is still in its infancy, but is rapidly expanding. The short-term outcomes have been satisfactory considering the moderate RT dose. A very high rate of hormone usage may affect the outcome favorably, but also may compromise the usefulness of current risk stratification.
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Bases de Dados Factuais , Neoplasias da Próstata/radioterapia , Radioterapia/tendências , Idoso , Antineoplásicos Hormonais/uso terapêutico , Biomarcadores Tumorais/sangue , Terapia Combinada/tendências , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Medicina Baseada em Evidências/tendências , Previsões , Humanos , Japão , Metástase Linfática/patologia , Metástase Linfática/radioterapia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Estadiamento de Neoplasias/tendências , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Radioterapia/estatística & dados numéricos , Dosagem Radioterapêutica , Medição de Risco , Revisão da Utilização de Recursos de SaúdeRESUMO
PURPOSE: To evaluate the role of adjuvant chemoradiotherapy for ampulla of Vater cancer. METHODS AND MATERIALS: Between January 1991 and December 2002, 118 patients with ampulla of Vater cancer underwent en bloc resection. Forty-one patients received adjuvant chemoradiotherapy [RT(+) group], and 77 did not [RT(-) group]. Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes, for a total dose of up to 40 Gy delivered in 2-Gy fractions, with a planned 2-week rest period halfway through the treatment period. Intravenous 5-fluorouracil (500 mg/m(2)/day) was given on Days 1 to 3 of each split course. The median follow-up was 65 months. RESULTS: The 5-year overall survival rate in the RT(-) and RT(+) groups was 66.9% and 52.8%, respectively (p = 0.2225). The 5-year locoregional relapse-free survival rate in the RT(-) and RT(+) groups was 79.9% and 80.2%, respectively (p = 0.9582). When age, type of operation, T stage, N stage, histologic differentiation, and the use of adjuvant chemoradiotherapy were incorporated into the Cox proportional hazard model, there was an improvement in the locoregional relapse-free survival rate (p = 0.0050) and a trend toward a longer overall survival (p = 0.0762) associated with the use of adjuvant chemoradiotherapy. Improved overall survival (p = 0.0235) and locoregional relapse-free survival (p = 0.0095) were also evident in patients with nodal metastasis. In contrast, enhanced locoregional control (p = 0.0319) did not result in longer survival in patients with locally advanced disease (p = 0.4544). CONCLUSIONS: Adjuvant chemoradiotherapy may enhance locoregional control and overall survival in patients with ampulla of Vater cancer after curative resection, especially in those with nodal involvement.