Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
Mais filtros

Base de dados
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Respiration ; 97(4): 310-318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30466111

RESUMO

BACKGROUND: In patients with locally advanced lung cancer treated with concurrent chemoradiation, outcome measurements have been mostly limited to survival. OBJECTIVES: We aimed to measure outcomes that matter to these patients beyond survival in a general clinical practice. METHODS: In a prospective single-centre study, consecutive patients with locally advanced non-small cell lung cancer reported their own outcomes using the EORTC Quality of Life Questionnaire Core 30 at baseline, during therapy, at therapy stop and till 1 year after therapy end every 3 months. Survival, complications, quality of death and case-mix variables were measured. RESULTS: There were 32 consecutive patients included prospectively from June 2013 until September 2016. Median overall survival was 24.3 months (95% CI 12.7-35.9). Severe toxicity (grade III-IV) was frequent (haematologic toxicity III-IV in 59%). Patient-reported outcomes (PROs) documented the burden on global health status and on functional domains (physical, role, social, emotional and cognitive functioning). Deterioration was pronounced during and after treatment with drops over 20 up to 40% points from baseline for physical, role and social functioning. Clinically meaningful negative effects did persist up to 6 and 9 months for physical and role functioning. Fifty-six percent of the deceased patients died in hospital. CONCLUSIONS: The assault on health-related quality of life during concurrent chemoradiation for locally advanced lung cancer is considerable. Loss of physical and role functioning persists up to 6 and 9 months after therapy end, respectively. Measuring PROs can help to identify issues for improvement of the value of care delivered.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Quimiorradioterapia/efeitos adversos , Neoplasias Pulmonares/terapia , Qualidade da Assistência à Saúde , Qualidade de Vida , Idoso , Bélgica/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos
2.
Stroke ; 48(12): 3393-3396, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29114088

RESUMO

BACKGROUND AND PURPOSE: In light of evidence from ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations), neurovascular specialists had to reconsider deliberate treatment of unruptured brain arteriovenous malformations (uBAVMs). Our objective was to determine the outcomes of uBAVM treated with primary embolization using ethylene vinyl alcohol (ONYX). METHODS: Patients with uBAVM who met the inclusion criteria of ARUBA and were treated with primary Onyx embolization were assigned to this retrospective study. The primary outcome was the modified Rankin Scale score. Secondary outcomes were stroke or death because of uBAVM or intervention and uBAVM obliteration. RESULTS: Sixty-one patients (mean age, 38 years) were included. The median observation period was 60 months. Patients were treated by embolization alone (41.0%), embolization and radiosurgery (57.4%), or embolization and excision (1.6%). Occlusion was achieved in 44 of 57 patients with completed treatment (77.2%). Forty-seven patients (77.1%) had no clinical impairment at the end of observation (modified Rankin Scale score of <2). Twelve patients (19.7%) reached the outcome of stroke or death because of uBAVM or intervention. Treatment-related mortality was 6.6% (4 patients). CONCLUSIONS: In uBAVM, Onyx embolization alone or combined with stereotactic radiosurgery achieves a high occlusion rate. Morbidity remains a challenge, even if it seems lower than in the ARUBA trial.


Assuntos
Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil , Tantálio , Adulto , Terapia Combinada , Combinação de Medicamentos , Embolização Terapêutica/mortalidade , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/mortalidade , Masculino , Complicações Pós-Operatórias , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos Retrospectivos , Ruptura , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
3.
Interv Neuroradiol ; : 15910199241277583, 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39219544

RESUMO

PURPOSE: To determine whether patients with a ruptured brain arteriovenous malformation (rBAVM) would benefit from an early embolization. METHODS: rBAVM treated first by embolization between March 2002 and May 2022 were included. Embolization was defined early (Group 1) when performed within 10 days postbleeding. If later, embolization was considered late (Group 2). Demographic and rBAVM data were compared between the groups. High-risk bleeding components and reasons for deferring embolization were retrieved. Primary endpoint was rebleeding. Secondary endpoints were good functional outcome (FO, modified Rankin Scale mRS ≤ 2) and angiographic occlusion. Predictors of rebleeding and FO were determined by multivariate analysis. RESULTS: 105 patients were recruited (N = 34 in Group 1; N = 71 in Group 2). No rebleeding was noted before, during or after the first embolization session in the early embolization group. Late embolization depended on missed diagnosis and referral pattern. Eleven patients (10.5%) suffered a rebleeding, of whom N = 3 before embolization (only in Group 2), N = 5 periembolization (N = 2 at the second embolization session in Group 1) and N = 3 spontaneous more than 30 days postembolization. More high-risk components were embolized in Group 1 (19/34; 55.9 vs 17/71; 23.9%; p = .011). Rebleeding rates, FO at last FU (90.9% vs 74.3%) and occlusion rates (80.8% vs 88.5%) did not differ between the groups. Glasgow coma scale ≤ 8 predicted rebleeding, rebleeding correlated with poor FO. CONCLUSION: Early embolization did prevent rebleeding. The overall rebleeding risk was linked to bleeding before late embolization and bleeding at the second embolization. Rebleeding predicted the final FO.

4.
Radiother Oncol ; 199: 110466, 2024 10.
Artigo em Inglês | MEDLINE | ID: mdl-39094630

RESUMO

AIM: To evaluate acute toxicity at 6 months after stereotactic body radiotherapy (SBRT) in patients with oligometastatic cancer within the OligoCare cohort. MATERIAL AND METHODS: OligoCare is a prospective, registry-based, single-arm, observational study that aims to report prospective real-world data of patients with oligometastases from solid cancer treated with SBRT (NCT03818503). Primary tumor included non-small cell lung cancer (NSCLC), breast cancer (BC), colorectal cancer (CRC), and prostate cancer (PC). This analysis addresses a secondary endpoint of the trial, acute toxicity within 6 months after SBRT. RESULTS: Out of 1,597registered patients, 1'468 patients were evaluated for acute toxicity. Globally, 290 (20 %) had NSCLC primary disease, 227 (16 %) had BC, 293 (20 %) had CRC, and 658 (45 %) had PC. Concomitant systemic treatment was administered in 527 (35.9 %) patients. According to the EORTC/ESTRO oligometastatic disease (OMD) classification, 828 (56 %) patients had de novo OMD, 464 (32 %) repeat OMD, and 176 (12 %) induced OMD. Acute grade ≥ 3 SBRT related adverse events were reported in 8 (0.5 %) patients, including 2 (0.1 %) fatal AEs. In particular, 6 (0.4 %) grade 3 events were: 1 empyema, 1 pneumonia, 1 radiation pneumonitis, 1 radiation skin injury, 1 decreased appetite, and 1 bone pain. Among those 2 occurred in NSCLC patients, 2 in BC patients, and 1 in CRC and PC patients each. The two (0.1 %) grade 5 toxicity were represented by: pneumonitis and cerebral hemorrhage. CONCLUSION: OligoCare is the largest prospective registry cohort on oligometastatic disease. Acute toxicity within 6 months was low, confirming the safety of SBRT in the treatment of oligometastases.


Assuntos
Neoplasias Pulmonares , Metástase Neoplásica , Radiocirurgia , Humanos , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Feminino , Masculino , Idoso , Estudos Prospectivos , Pessoa de Meia-Idade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/patologia , Adulto , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/patologia , Sistema de Registros , Neoplasias Colorretais/patologia
5.
Clin Transl Radiat Oncol ; 45: 100715, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38274388

RESUMO

Objective: To evaluate the impact of metastases-directed stereotactic body radiotherapy (SBRT) on health-related quality of life (HRQoL) in men with oligometastatic prostate cancer (PCa) using real-world data from the OligoCare cohort. Materials and methods: OligoCare is a pragmatic, observational cohort designed to assess the impact of metastases-directed SBRT on patients with oligometastatic disease (OMD). We report an interim analyses of the secondary endpoint HRQoL, assessed using the EORTC QLQ-C30, within six months of metastases-directed SBRT for oligometastatic disease in men with PCa among the first 1600 registered patients. HRQoL data collection was optional within the OligoCare cohort. To compare HRQoL between baseline and first follow-up assessment, a Wilcoxon signed-rank test was used. A multiple linear regression model was used to explore the HRQoL associations with predefined factors. Results: Out of the 1600 registered patients, 658 were treated for oligometastatic PCa, of which 233 had baseline QoL data and 132 patients had both baseline and follow-up HRQoL data. At baseline, most patients had a WHO performance status of 0 or 1 (87 %), were de-novo oligometastatic (79 %), had one metastasis (90 %), and had a good overall global health status (mean 80.81, SD16.11, IQR 75-92). 51 % received hormonal therapy as concomitant systemic treatment. Patients with comorbidities as assessed by the Charlson Comorbidity index had a worse global health status at baseline (-4.88, 95 % CI:-9.35, -0.42). No clinically meaningful significant difference in global health status was observed at first assessment following SBRT (median 3.0 months) compared with baseline (mean difference 2.27, 95 % CI:-1.54, 6.08). Upon evaluating the proportions, meaningful clinically important differences (a 10-point or more difference) was observed in, 17 % and 11 % of the patients reporting deterioration and improvement of global health status, respectively. Conclusion: Metastases-directed stereotactic body radiotherapy had no negative impact on global HRQoL within the first six months after treatment.

6.
Am Heart J ; 153(3): 398-402, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17307419

RESUMO

BACKGROUND: Vascular brachytherapy (VBT) has been used for the prevention of restenosis. Despite initial positive results, long-term follow-up has shown a progressive loss of benefit in clinical outcome after beta-irradiation. We report the 5-year follow-up of the BetAce trial. METHODS: This prospective, randomized, single-blind trial included 61 patients treated for 64 de novo coronary lesions: 31 patients (33 stenoses) were treated with bare metal stents (control group), and 30 patients (31 stenoses) were treated with intracoronary beta-irradiation at the time of stented angioplasty (VBT group). RESULTS: Baseline and procedural data were similar between treatment arms. At 6 months, VBT reduced the need for target vessel revascularization (13% vs 35.5%, P = .04), but there was no significant difference in the 6- and 12-month event-free survival when clinical events were ranked. Between 1 and 5 years, an increasing number of target vessel failures was observed in both groups, leading to a similar long-term clinical outcome at 5 years (event-free survival 43% and 45% in the VBT and control groups, respectively, log-rank 0.001, P = .9). CONCLUSIONS: Beta-irradiation in de novo coronary lesions significantly reduced in-stent recurrences at 6 months compared with standard procedures. However, this initial benefit was not sustained in the long term. The results of this randomized study confirm the delayed and progressive restenotic process after beta-irradiation and stent implantation in de novo lesions.


Assuntos
Angioplastia Coronária com Balão , Partículas beta/uso terapêutico , Braquiterapia/métodos , Estenose Coronária/terapia , Túnica Íntima/efeitos da radiação , Idoso , Terapia Combinada , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/prevenção & controle , Estenose Coronária/radioterapia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Stents
7.
Cardiovasc Revasc Med ; 6(1): 7-13, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16263350

RESUMO

BACKGROUND: This study evaluated vascular brachytherapy (VBT) as a potent antiproliferative treatment to prevent in-stent restenosis (ISR) after coronary angioplasty of de novo lesions in patients carrying the D allele of the I/D polymorphism of the ACE gene and high ACE plasma levels (>34 U/l). METHODS AND MATERIALS: A prospective randomized trial was designed to detect a 30% improvement in the minimal lumen diameter (MLD) of the stenotic artery, as measured by quantitative coronary analysis (QCA), 6 months following VBT at the time of stented angioplasty. All patients were carriers of the D allele of the ACE gene, with plasma ACE levels >34 U/l. RESULTS: Thirty-one patients (33 stenoses) were allocated to stent implantation (control group) and 30 patients (31 stenoses) to VBT and stented angioplasty. After angioplasty, in-stent MLD was similar in the two groups. At 6 months in the control group, in-stent MLD had decreased to 1.74+/-0.8 versus 2.25+/-1.05 mm in the VBT group (P=.04). The mean in-stent diameter was 2.3+/-0.8 mm in the control group versus 2.9+/-1.05 mm after VBT (P=.02), and the restenosis rate was 37.5% versus 17.9%, respectively (P=.08). At 6 months, a higher need for target vessel revascularization (TVR) was observed in the control group: 35.5% versus 13.3% (P=.04). CONCLUSIONS: This randomized study confirms that patients with high plasma ACE concentrations are exposed to an increased risk for ISR after coronary stenting. The preventive use of VBT in these patients reduced neointimal formation by 65% such that the MLD at follow-up was increased by 29% compared with the control group.


Assuntos
Braquiterapia/métodos , Doença da Artéria Coronariana/radioterapia , Oclusão de Enxerto Vascular/prevenção & controle , Peptidil Dipeptidase A/sangue , Stents , Túnica Íntima/efeitos da radiação , Alelos , Angioplastia/métodos , Partículas beta/uso terapêutico , Terapia Combinada , Doença da Artéria Coronariana/cirurgia , Feminino , Oclusão de Enxerto Vascular/genética , Humanos , Masculino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/genética , Polimorfismo Genético/fisiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Fatores de Risco , Túnica Íntima/fisiopatologia , Grau de Desobstrução Vascular/efeitos da radiação
8.
Med Phys ; 29(7): 1562-71, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12148739

RESUMO

The dose distribution around an intravascular brachytherapy 90Y line source with centering balloon catheters was measured with a plastic scintillator, TLD and radiochromic film. The absolute dose rates measured with the three detectors in a solid water phantom at 1, 2 and 3 mm distance from the centering balloon surfaces are in agreement within 3.5%, when the detectors are calibrated with the same 90Sr/90Y source. The dose rates measured with the plastic scintillator in the solid water phantom are in agreement with those directly measured in water. The measured relative dose distributions can be reproduced by Monte Carlo calculations. Also, the influence of the balloon diameter on the dose rate can be reproduced by the calculations. The dose rate calibration routinely performed with the plastic scintillator was checked for fifty-one sources with a well chamber and with another dedicated dose rate checking device. These measurements show that the consistency of the calibration of these sources was better than 10%. In a previous paper absolute dose rates for five other 90Y sources measured with TLD and radiochromic film in a solid water phantom were compared with those obtained with the plastic scintillator in water [Piessens and Reynaert, "Verification of absolute dose rates for intravascular beta sources," Phys. Med. Biol. 45, 2219-2231 (2000)]. Differences of 25 to 41%, depending on the balloon diameter, were reported. In this paper we show the evidence for three main reasons for these previously observed discrepancies: an inconsistency between a detector calibration performed with a 6 MeV electron beam and with a calibrated 90Sr/90Y source from NIST (16%), inaccuracies of the measuring distances in the solid water phantom (maximum 7.5%) and a time instability of the plastic scintillator, probably due to radiation damage (6%).


Assuntos
Braquiterapia/métodos , Braquiterapia/normas , Cateterismo/métodos , Radioisótopos/uso terapêutico , Itérbio/uso terapêutico , Calibragem , Humanos , Modelos Estatísticos , Método de Monte Carlo , Imagens de Fantasmas , Radiometria , Água , Filme para Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA