The Role of Glucose Modulation and Dietary Supplementation in Patients With Central Nervous System Tumors.

OPINION STATEMENT: Central nervous system gliomas are the most common primary brain tumor, and these are most often high-grade gliomas. Standard therapy includes a combination of surgery, radiation, and chemotherapy which provides a modest increase in survival, but virtually, no patients are cured, the overall prognosis remains poor, and new therapies are desperately needed. Tumor metabolism is a well-recognized but understudied therapeutic approach to treating cancers. Dietary and nondietary modulation of glucose homeostasis and the incorporation of dietary supplements and other natural substances are potentially important interventions to affect cancer cell growth, palliate symptoms, reduce treatment-associated side effects, and improve the quality and quantity of life in patients with cancer. These approaches are highly desired by patients. However, they can be financially burdensome, associated with toxicities, and have, on occasion, reduced the efficacy of proven therapies and negatively impacted patient outcomes. The lack of rigorous scientific data evaluating almost all diet and supplement-based therapies currently limits their incorporation into standard oncologic practice. Rigorous studies are needed to document and improve these potentially useful approaches in patients with brain and other malignancies.

Gastrostomia Endoscópica Percutânea (GEP) em Pacientes Pediátricos Oncológicos

"GEP é um procedimento que visa oferecer acesso alimentar prolongado para pacientes com trato gastrointestinal íntegro e funcional, porém com impossibilidade ou dificuldade de deglutição. Em serviços de oncologia pediátrica, a GEP é mais frequentemente indicada para crianças com neoplasias do SNC e de cabeça e pescoço. Apesar de já ser claramente estabelecido, na prática clínica diária, como método efetivo e seguro para obtenção de acesso enteral, poucos trabalhos, na literatura, abordam especificamente a realização de GEP em crianças com câncer. Objetivos: Descrever os aspectos demográficos, patologia de base, complicações e desfechos da GEP em uma coorte de crianças com câncer. Metodologia: Estudo retrospectivo dos procedimentos de GEP realizados em crianças portadoras de doença neoplásica, na Seção de Endoscopia Digestiva do HC I / INCA, entre dezembro de 2008 a julho de 2015. Resultados: No período do estudo, um total de 42 crianças foram submetidas à GEP. A média de idade foi de 7,91 anos (variação de 0,5 a 17,4 anos). Vinte duas crianças (57,1%) eram do sexo masculino. As patologias oncológicas de base foram neurológicas em 33 casos (78,5%), de cabeça e pescoço em 7 casos (16,6%) e hematológicas em 2 casos (74,7%). Dezessete dos pacientes (40,4%) tiveram algum tipo complicação, incluindo infecção do estoma em 3 (7,14%), dor local em 4 (9,5%), sangramento em 2 (7,1%), sepultamento do retentor interno em 1 (2,3%) e fistula gastrocolocutânea em 1 (2,3%). O tempo médio de permanência com a sonda foi de 32,8 semanas (variação de 1,6 a 161,6 semanas). Ao final do estudo, 22 pacientes evoluíram para óbito (52,3%), 12 continuavam com a sonda em uso (28,5%), 6 retiraram a sonda após o tratamento (14,2%), e em 2 casos houve perda do seguimento (4,7%). Conclusão: A GEP é um procedimento seguro e eficaz para fornecimento de acesso nutricional enteral prolongado em crianças portadoras de doença neoplásica"...

"GEP is a procedure that aims to offer extended food access for patients with intact and functional gastrointestinal tract, but with inability or difficulty of swallowing. In pediatric oncology services, GEP is more often indicated for children with CNS and head and neck neoplasias. Although it is already clearly established in the daily clinical practice as an effective and safe method to obtain enteral access, few studies in the literature specifically address the performance of PEG in children with cancer. METHODS: Retrospective study of GEP procedures performed in children with neoplastic disease, in the Digestive Endoscopy Section of HC I / INCA, between December 2008 and July of In the study period, a total of 42 children were submitted to The mean age was 7.91 years (range of 0.5 to 17.4 years). Twenty two children (57.1%) were male. Oncological diseases were neurological in 33 cases (78.5%), head and neck in 7 cases (16.6%) and haematological in 2 cases (74.7%). Seventeen of the patients (40.4%) had some type of complication, including stoma infection in 3 (7.14%), local pain in 4 (9.5%), bleeding in 2 (7.1%), Internal retainer in 1 (2.3%) and gastrocolocutaneous fistula in 1 (2.3%). The mean residence time with the probe was 32.8 weeks (range 1.6 to 161.6 weeks). At the end of the study, 22 patients died (52.3%), 12 continued with the catheter in use (28.5%), 6 removed the catheter after treatment (14.2%), and in 2 cases there were Loss of follow-up (4.7%). Conclusion: GEP is a safe and effective procedure to provide prolonged enteral nutritional access in children with neoplastic disease "...