A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study / Um novo método para avaliar as taxas de fluxo salivar em pacientes com câncer de cabeça e pescoço após radioterapia: estudo piloto

Abstract Introduction The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. Objective To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. Methods 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70 Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. Results There was no statistically significant difference between the salivary evaluations of both groups (p = 0.4487 and p = 0.5615). Also, most of these rates were classified as very low and low. Conclusion This novel method seems to be suitable for patients submitted to radiotherapy.

Resumo Introdução O procedimento utilizado para avaliar a taxa de fluxo salivar é denominado sialometria. Pode ser realizado por meio de várias técnicas, mas nenhuma parece ser realmente eficiente para pacientes pós-radioterapia. Objetivo Adaptar sialometrias para pacientes com câncer de cabeça e pescoço submetidos à radioterapia. Método 22 pacientes xerostômicos pós-radioterapia (dose de radiação total variando de 60-70 Gy) foram incluídos neste estudo. Dez pacientes foram avaliados utilizando sialometrias originalmente propostas pelo Radiation Therapy Oncology Group e doze foram avaliados por nossos métodos modificados. Sialometrias não estimuladas e estimuladas foram conduzidas e os resultados foram classificados de acordo com uma escala de graduação e comparados entre os dois grupos. Resultados Não houve diferença estatisticamente significante entre as avaliações salivares de ambos os grupos (p = 0,4487 e p = 0,5615). Além disso, a maioria dessas taxas foi classificada como muito baixa e baixa. Conclusão Esse novo método parece ser adequado para pacientes submetidos à radioterapia.

A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study.

INTRODUCTION: The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. OBJECTIVE: To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. METHODS: 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. RESULTS: There was no statistically significant difference between the salivary evaluations of both groups (p=0.4487 and p=0.5615). Also, most of these rates were classified as very low and low. CONCLUSION: This novel method seems to be suitable for patients submitted to radiotherapy.

Impact of low-level laser therapy on hyposalivation, salivary pH, and quality of life in head and neck cancer patients post-radiotherapy.

Late effects of radiotherapy for head and neck cancer treatment have been increasingly investigated due to its impact on patients' quality of life. The purpose of this study was to evaluate the effect of low-level laser therapy on hyposalivation, low salivary pH, and quality of life in head and neck cancer patients post-radiotherapy. Twenty-nine patients with radiation-induced xerostomia received laser sessions twice a week, during 3 months (24 sessions). For this, a continuous wave Indium-Gallium-Aluminium-Phosphorus diode laser device was used punctually on the major salivary glands (808 nm, 0.75 W/cm2, 30 mW, illuminated area 0.04 cm2, 7.5 J/cm2, 10 s, 0.3 J). Six extraoral points were illuminated on each parotid gland and three on each submandibular gland, as well as two intraoral points on each sublingual gland. Stimulated and unstimulated salivary flow rate, pH (two scales with different gradations), and quality of life (University Of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer) were assessed at baseline and at the end of the treatment. There were significant increases in both mean salivary flow rates (unstimulated: p = 0.0012; stimulated: p < 0.0001), mean pH values (p = 0.0002 and p = 0.0004), and mean score from the quality of life questionnaire (p < 0.0001). Low-level laser therapy seems to be effective to mitigate salivary hypofunction and increase salivary pH of patients submitted to radiotherapy for head and neck cancer, thereby leading to an improvement in quality of life.

Low-Level Laser for Mitigation of Low Salivary Flow Rate in Head and Neck Cancer Patients Undergoing Radiochemotherapy: A Prospective Longitudinal Study.

OBJECTIVE: The present study aimed to assess the impact of low-level laser (LLL) on low salivary flow rate in patients undergoing radiochemotherapy (RT-CT) for head and neck cancer. BACKGROUND DATA: LLL has shown efficiency in preventing hyposalivation in patients under different pathological conditions, including those undergoing RT-CT. METHODS: During all RT-CT, 17 patients received laser therapy and 10 received clinical care only. An Indium-Gallium-Aluminum-Phosphorus diode laser was punctually used for intraoral (660 nm, 40 mW, 10 J/cm(2), illuminated area 0.04 cm(2), 10 sec) and extraoral irradiation (780 nm, 15 mW, 3.8 J/cm(2), illuminated area 0.04 cm(2), 10 sec), three times a week and on alternate days, for a total of 21 sessions. Unstimulated salivary flow rate was assessed before the first RT session (N0), at the 15th RT session (N15), at the last RT session (Nf), and at 30 (N30) and 90 days after the end of the oncologic treatment (N90). RESULTS: At N15, Nf, and N30, patients treated with LLL showed significantly higher averages of salivary flow rate when compared with patients receiving clinical care only. CONCLUSIONS: LLL seems to be an efficient tool for mitigation of salivary hypofunction in patients undergoing RT for head and neck cancer.

Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer.

OBJECTIVE: To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. MATERIALS AND METHODS: We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm(2) and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm(2), three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30). RESULTS: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). CONCLUSION: Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer.

OBJETIVO: Avaliar o impacto do laser de baixa potência na prevenção de hipofluxo salivar em pacientes portadores de câncer de cabeça e pescoço após radioterapia e quimioterapia. MATERIAIS E MÉTODOS: Treze pacientes receberam laserterapia e dez receberam cuidados clínicos. Utilizou-se um InGaAlP laser diodo para aplicação intraoral (comprimento de onda de 660 nm, 40 mW de potência e dose média de 10 J/cm2) e extraoral (comprimento de onda de 780 nm, 15 mW de potência e dose média de 3,7 J/cm2), três vezes por semana, em dias alternados. Sialometrias estimulada e não estimulada foram realizadas antes da primeira sessão de radioterapia e quimioterapia (N0) e 30 dias após o final do tratamento (N30). RESULTADOS: Em N30, os pacientes submetidos à laserterapia apresentaram médias estatisticamente maiores de fluxo salivar estimulado (p = 0,0131) e não estimulado (p = 0,0143), em comparação com os pacientes que receberam apenas cuidados clínicos. CONCLUSÃO: A laserterapia de baixa potência realizada concomitantemente a radioterapia e quimioterapia foi capaz de mitigar a hipofunção das glândulas salivares em pacientes portadores de câncer de cabeça e pescoço após o tratamento oncológico.

Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer / Laser de baixa potência para prevenção de hipofluxo salivar em pacientes portadores de câncer de cabeça e pescoço após radioterapia e quimioterapia

Abstract Objective: To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and Methods: We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2 and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm2, three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer.

Resumo Objetivo: Avaliar o impacto do laser de baixa potência na prevenção de hipofluxo salivar em pacientes portadores de câncer de cabeça e pescoço após radioterapia e quimioterapia. Materiais e Métodos: Treze pacientes receberam laserterapia e dez receberam cuidados clínicos. Utilizou-se um InGaAlP laser diodo para aplicação intraoral (comprimento de onda de 660 nm, 40 mW de potência e dose média de 10 J/cm2) e extraoral (comprimento de onda de 780 nm, 15 mW de potência e dose média de 3,7 J/cm2), três vezes por semana, em dias alternados. Sialometrias estimulada e não estimulada foram realizadas antes da primeira sessão de radioterapia e quimioterapia (N0) e 30 dias após o final do tratamento (N30). Resultados: Em N30, os pacientes submetidos à laserterapia apresentaram médias estatisticamente maiores de fluxo salivar estimulado (p = 0,0131) e não estimulado (p = 0,0143), em comparação com os pacientes que receberam apenas cuidados clínicos. Conclusão: A laserterapia de baixa potência realizada concomitantemente a radioterapia e quimioterapia foi capaz de mitigar a hipofunção das glândulas salivares em pacientes portadores de câncer de cabeça e pescoço após o tratamento oncológico.

Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer.

OBJECTIVE: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. MATERIALS AND METHODS: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. RESULTS: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation (p = 0.037). A baseline rectal volume superior to 70 cm(3) had a significant influence on the prostate motion in the anteroposterior direction (p = 0.045). CONCLUSION: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm(3). Therefore, the treatment of patients with a rectal volume > 70 cm(3) should be re-planned with appropriate rectal preparation.

Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer / Avaliação do impacto do volume retal na movimentação da próstata durante radioterapia conformacional para câncer de próstata

Abstract Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation ( p = 0.037). A baseline rectal volume superior to 70 cm3 had a significant influence on the prostate motion in the anteroposterior direction ( p = 0.045). Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm3. Therefore, the treatment of patients with a rectal volume > 70 cm3 should be re-planned with appropriate rectal preparation.

Resumo Objetivo: Avaliar a influência do volume retal na movimentação da próstata durante a radioterapia tridimensional conformacional (3D-CRT) para câncer de próstata. Materiais e Métodos: Cinquenta e um pacientes com câncer de próstata foram submetidos a três tomografias seriadas, sendo a primeira de planejamento e duas durante a 3D-CRT. Os órgãos de interesse foram delineados. O contorno da próstata foi comparado ao exame inicial em relação aos seus limites anterior, posterior, superior, inferior e laterais. As variações dos limites anterior do reto e de seu volume foram avaliadas e correlacionadas à movimentação da próstata no sentido anteroposterior. Resultados: As maiores variações na próstata foram observadas no sentido superoinferior, seguido pelo anteroposterior. Observou-se correlação significante da movimentação da próstata com a variação do volume do reto ( p = 0,037). O volume retal inicial superior a 70 cm3 influenciou significativamente na maior movimentação da próstata no sentido anteroposterior ( p = 0,045). Conclusão: Este estudo mostrou que a próstata apresenta significativa movimentação interfração durante a 3D-CRT, apresentando maiores variações nos sentidos superoinferior e anteroposterior, e que um volume retal inicial superior a 70 cm3 influencia na movimentação da próstata. Desta forma, os pacientes com volume retal superior a 70 cm3 devem ser replanejados com preparo retal adequado.

Long-term oral effects in patients treated with radiochemotherapy for head and neck cancer.

PURPOSE: The purpose of this study is to assess the late oral complications and the role of salivary gland hypofunction in the severity of mucosal reaction in nonsurgical head and neck cancer patients, submitted to radiotherapy with or without chemotherapy. METHODS AND MATERIALS: Five hundred fifteen charts from patients treated between 2005 and 2009 were reviewed, and 41 patients met the inclusion criteria. Salivary gland function was assessed using a simplified grading system (GSX) and sialometry. Late effects were assessed using the Common Toxicity Criteria (CTC Version 2.0). RESULTS: The average follow-up was 17.1 (4-51) months. A statistical correlation was found for whole salivary flow rates and the average CTC grades for the mucous membrane. Both unstimulated/stimulated whole salivary flow rates (<0.09 mL/min) were identified as potential risk factors (p < 0.05) and an independent predictor for late mucous membrane toxicity (≥ grade 2). A significant correlation was also found between unstimulated salivary flow rates-GSX scores (p = 0.001) and CTC grades for salivary glands. Eighty-five percent of the patients were classified as suffering from salivary gland hypofunction, as well as 58.2 % considered dryness of the mouth the most debilitating complication. CONCLUSIONS: Considering the late effects assessed, the salivary gland hypofunction was the most significant and received the highest morbidity graduation (grade 2/grade 3); xerostomia was also considered the most debilitating complication after treatment. Data show the role of salivary gland hypofunction in the severity of late mucous membrane complication.

Protracted hypofractionated radiotherapy for Graves' ophthalmopathy: a pilot study of clinical and radiologic response.

PURPOSE: To evaluate the clinical and radiologic response of patients with Graves' ophthalmopathy given low-dose orbital radiotherapy (RT) with a protracted fractionation. METHODS AND MATERIALS: Eighteen patients (36 orbits) received orbital RT with a total dose of 10 Gy, fractionated in 1 Gy once a week over 10 weeks. Of these, 9 patients received steroid therapy as well. Patients were evaluated clinically and radiologically at 6 months after treatment. Clinical response assessment was carried out using three criteria: by physical examination, by a modified clinical activity score, and by a verbal questionnaire considering the 10 most common signs and symptoms of the disease. Radiologic response was assessed by magnetic resonance imaging. RESULTS: Improvement in ocular pain, palpebral edema, visual acuity, and ocular motility was observed in all patients. Significant decrease in symptoms such as tearing (p < 0.001) diplopia (p = 0.008), conjunctival hyperemia (p = 0.002), and ocular grittiness (p = 0.031) also occurred. Magnetic resonance imaging showed decrease in ocular muscle thickness and in the intensity of the T2 sequence signal in the majority of patients. Treatments were well tolerated, and to date no complications from treatment have been observed. There was no statistical difference in clinical and radiologic response between patients receiving RT alone and those receiving RT plus steroid therapy. CONCLUSION: RT delivered in at a low dose and in a protracted scheme should be considered as a useful therapeutic option for patients with Graves' ophthalmopathy.

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.

[Mucositis in head and neck cancer patients undergoing radiochemotherapy]. / Mucosite em pacientes portadores de câncer de cabeça e pescoço submetidos à radioquimioterapia.

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% of all patients and 100% of those with diabetes discontinued treatment due to mucositis, showing that this pathology contributes to the severity of mucositis.

Acurácia na reprodutibilidade do posicionamento diário de pacientes submetidos a radioterapia conformada (RT3D) para câncer de próstata / Accuracy in the reproducibility of daily patients' setup in 3D conformal radiotherapy for prostate cancer

OBJETIVO: Avaliar a reprodutibilidade do posicionamento de pacientes com diagnóstico de câncer de próstata submetidos a radioterapia conformada. MATERIAIS E MÉTODOS: Foram avaliados 960 (posições anterior e lateral) filmes radiológicos, de um total de 120 pacientes que receberam radioterapia conformada na próstata com técnica isocêntrica. As imagens foram obtidas em acelerador linear de partículas 6 MV. Aplicou-se protocolo específico para planejamento e tratamento da próstata, com o paciente em posição supina, mãos colocadas sobre o tórax, pés apoiados em suporte apropriado. Diariamente, os pacientes foram posicionados conforme demarcações na pele, coincidentes com os lasers da sala. Os filmes radiológicos foram comparados com as radiografias reconstruídas digitalmente (digitally reconstructed radiography - DRR) em sistema de planejamento computadorizado Eclipse, a partir das tomografias. As radiografias de posicionamento foram realizadas no primeiro dia e após, semanalmente, até o término do tratamento. RESULTADOS: As médias dos deslocamentos observados foram de 1,99 ± 1,25 mm no sentido crânio-caudal, 1,37 ± 0,84 mm no látero-lateral e 1,94 ± 1,10 mm no ântero-posterior. CONCLUSÃO: O uso de protocolos específicos para posicionamento dos pacientes é possível na prática clínica, possibilita reprodutibilidade adequada e rápida correção dos possíveis erros.

OBJECTIVE: To evaluate the reproducibility of daily patients' setup in 3D conformal radiotherapy for prostate cancer. MATERIALS AND METHODS: The present study evaluated a total of 960 radiological images (anterior and lateral views) of 120 patients submitted to conformal radiotherapy for prostate cancer with the isocentric technique. A 6 MV particle accelerator was utilized in the process. A specific protocol for prostate radiotherapy planning and treatment was applied, with the patients placed in supine position, hands on the chest and legs placed on and appropriate support. Daily, the patients were positioned according to previously made skin markings in alignment with the in-room laser. The portal images were compared with digitally reconstructed radiographies (DRR) in the Eclipse treatment planning system based on the tomographic images. Radiography was performed at the first day, and weekly afterwards until the treatment was completed. RESULTS: The following average position shifts were observed: 1.99 ± 1.25 mm craniocaudally, 1.37 ± 0.84 mm laterally, and 1.94 ± 1.10 mm anteroposteriorly. CONCLUSION: The use of specific protocols for patients' setup is feasible in the clinical practice, allowing appropriate reproducibility and quick correction of possible errors in conformal radiotherapy for prostate cancer.

Ressonância magnética para avaliação dos limites dos campos clássicos de radioterapia em pacientes portadoras de neoplasia maligna de colo uterino / Magnetic resonance imaging in the evaluation of standard radiotherapy field borders in patients with uterine cervix cancer

OBJETIVO: Avaliar os limites de campo padronizados para radioterapia de neoplasia maligna de colo uterino com o uso de ressonância magnética e verificar a importância deste exame na redução de possíveis erros de planejamento com técnica convencional. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, exames de ressonância magnética do planejamento de 51 pacientes tratadas devido a neoplasia de colo uterino. Os parâmetros estudados foram limites anterior e posterior no corte sagital. RESULTADOS: Observou-se, no corte sagital das ressonâncias magnéticas, que o limite de campo anterior apresentou-se inadequado em 20 (39,2 por cento) pacientes e que houve perda geográfica em 37,3 por cento dos casos no limite posterior. A inadequação de ambos os limites de campo não se relacionou com parâmetros clínicos como idade das pacientes, estadiamento, tipo e grau histológico. CONCLUSÃO: A avaliação dos limites de campo padronizados pela literatura com o uso de ressonância magnética mostrou altos índices de inadequação dos limites do campo lateral, assim como a importância do uso deste exame no planejamento radioterápico de pacientes portadoras de câncer de colo uterino com a finalidade de reduzir a perda geográfica no volume alvo de tratamento.

OBJECTIVE: To evaluate, by means of magnetic resonance imaging, the standardized field borders in radiotherapy for malignant neoplasm of uterine cervix, and to determine the role of this method in the reduction of possible planning errors related to the conventional technique. MATERIALS AND METHODS: Magnetic resonance imaging studies for planning of treatment of 51 patients with uterine cervix cancer were retrospectively analyzed. The parameters assessed were the anterior and posterior field borders on sagittal section. RESULTS: The anterior field border was inappropriate in 20 (39.2 percent) patients and geographic miss was observed in 37.3 percent of cases in the posterior border. The inappropriateness of both field borders did not correlate with clinical parameters such as patients' age, tumor staging, histological type and degree. CONCLUSION: The evaluation of standardized field borders with the use of magnetic resonance imaging has demonstrated high indices of inappropriateness of the lateral field borders, as well as the relevant role of magnetic resonance imaging in the radiotherapy planning for patients with uterine cervix cancer with a view to reduce the occurrence of geographic miss of the target volume.

Avaliação de radio e quimioterapia concomitantes pós-operatórias nos pacientes portadores de tumores de cabeça e pescoço localmente avançados / Postoperative concurrent radio-chemotherapy for locally advanced head and neck cancer

OBJETIVO: Avaliar a evolução clínica e as complicações agudas e tardias de pacientes portadores de neoplasia de cabeça e pescoço localmente avançada submetidos a cirurgia com radio e quimioterapiaadjuvantes. MATERIAL E MÉTODO: No período de maio de 2004 a junho de 2007 foram analisados 39 pacientes com neoplasia de cabeça e pescoço localmente avançada submetidos a ressecção cirúrgica, radio e quimioterapia adjuvantes. RESULTADOS: A idade mediana foi de 54 anos. Estádio III foi observado em 30,8% e estádio IVA em 61,5% dos pacientes. Setenta e sete por cento dos pacientes realizaram radioterapia com dose de 66 Gy. Em relação às complicações agudas,a mais prevalente foi dermatite grau III em 46,2%, e 48,7% dos pacientes apresentaram fibrosecomo complicação tardia. O seguimento mediano foi de 30 meses, com estimativa de sobrevidalivre de doença locorregional de 70% e sobrevida global de 76% em cinco anos. CONCLUSÃO: Esteestudo mostra que, em pacientes com neoplasia de cabeça e pescoço localmente avançada, a cirurgia seguida de radio e quimioterapia apresentam resultados de controle locorregional e sobrevida livre de doença satisfatórios. Nossos resultados, bem como porcentagens de complicações agudas e tardias, estão compatíveis com a literatura.

OBJECTIVE: To evaluate the clinical outcome of patients with locallyadvanced head and neck cancer treated with postoperative concurrent radio-chemotherapy. MATERIAL AND METHOD: Thirtynine patients with locally advanced head and neck cancer submittedto resection of all visible and palpable disease, followed byradiotherapy (60–66 Gy in 30 to 33 fractions over a period of 6 to6.6 weeks) and concurrent cisplatin between May 2004 and June2007 were retrospectively analyzed. RESULTS: A predominance of male with a median age of 54 years was observed; 30.8% of patients were in stage III and 61.5% in stage IVA; 77% of patients received a radiation dose of 66 Gy; dermatitis grade III occurred in 46.2% and fibrosis in 48.7% of patients. The 5-year loco-regional failure and overall survival were 30% and 76%, respectively. CONCLUSION: Data show that surgery followed by concurrent radio-chemotherapypresents reasonable rate of loco-regional control and disease-free survival in high-risk patients. Our index of loco-regionaland distant failure and the rate of acute and late complicationare compatible with other series in the literature.

Glioblastoma: experiência uni-institucional com 48 pacientes tratados com cirurgia, radioterapia e quimioterapia / Glioblastoma: single institutional experience with 48 patients treated with surgery, radiotherapy and chemotherapy

OBJETIVO: Identificar fatores prognósticos e avaliar a evolução clínica de pacientes com diagnósticode glioblastoma submetidos a cirurgia e radioterapia, com ou sem quimioterapia adjuvante. MATERIAL E MÉTODO: trabalho retrospectivo com 48 pacientes portadores de glioblastoma tratadosno período de 1997 a 2007. Todos os pacientes foram classificados segundo critérios do recursive partitioning analysis (RPA). RESULTADOS: Observaram-se predominância do sexo feminino, idade maior ou igual a 50 anos, performance status maior ou igual a 70, e as classes mais prevalentes,de acordo com a classificação RPA, foram a V e VI. Em 72,9% dos pacientes foi realizada ressecção parcial da lesão e em 27,1%, ressecção subtotal ou total. Quimioterapia foi administrada em47,9% dos pacientes e a dose de radioterapia foi de 50û60 Gy em 72,9% dos casos. A sobrevida global mediana observada foi de 52 semanas. CONCLUSÃO: Os dados obtidos mostram que a sobrevida global de pacientes portadores de glioblastoma foi semelhante aos resultados encontrados na literatura e dependente de fatores como a adição de quimioterapia, dose de radioterapia eíndice de Karnofsky.

OBJECTIVE: To identify prognostic factors and evaluate the clinicaloutcome of patients with glioblastoma treated with surgery and radiotherapy combined or not with chemotherapy. MATERIAL AND METHOD: In this retrospective study, 48 patients with glioblastoma were treated between 1997 and 2007. All patients wereclassified according the recursive partitioning analysis (RPA) criteria.RESULTS: The majority of patients were female, with 50 years of age or above. Performance status of 70 or greater were found in 70.8% of cases, and RPA classes V and VI prevailed. Seventy-two percent of patients were submitted to partial resection and 27.1% to total or subtotal resection. Chemotherapy wasadministered in 47.9% of patients and doses between 50 and 60 Gy were delivered in 72.9%. The median overall survival was 52 weeks. CONCLUSION: Our data show an overall survival that approaches the related in others reports and were dependent of factors such as chemotherapy, dose of radiation and Karnofsky performance status.

Avaliação do perfil e resposta ao tratamento de pacientes portadores de adenoma hipofisário submetidos a radioterapia / Clinical profile and response to treatment of patients with pituitary

OBJETIVO: Avaliar o perfil de pacientes portadores de adenoma hipofisário e a resposta à radioterapia externa. MATERIAL E MÉTODO: Foi realizado estudo retrospectivo com 22 pacientes portadores de adenoma hipofisário, os quais foram submetidos à radioterapia entre março de 2004 e dezembrode 2008. Foram analisadas características dos pacientes, como sexo, idade e quadro clínico, tipo de cirurgia, perfil imuno-histoquímico, dose de radioterapia, resposta à terapia com dosagens hormonais e exames de imagem. RESULTADOS: Observou-se idade mediana de 51 anos, com distribuição semelhante em ambos os sexos. De acordo com a classificação de Hardy para tumores hipofisários, 27,5% apresentavam grau II, 27,5% eram grau III e 45%, grau IV. O principal sintoma apresentado pelos pacientes na ocasião do diagnóstico foi deficiência visual em 77% dos casos, seguido de cefaleia em 68%, acromegalia em 27%, amenorreia em 18% e galactorreia em 4,5%. A abordagem cirúrgica por via transesfenoidal ocorreu em 21 pacientes e em somente um por viatranscraniana, sendo realizadas ressecções parciais em 91% dos casos. Quanto à imuno-histoquímica, a expressão de ACTH foi a mais frequente, estando presente em 41% dos casos. Os pacientes foram tratados em aparelhos de megavoltagem, em sua grande maioria com acelerador linear de 6 MV, com dose total de 45 Gy em 68% e dose de 50,4 Gy em 13% dos casos. O planejamento tridimensional foi utilizado em 20 pacientes. O seguimento mediano foi de 41 meses, sendo observado, no seguimento laboratorial e de imagem, melhora em 73% dos pacientes, estabilidade do quadro em 22,5% e piora em 4,5%. CONCLUSÃO: Os resultados encontrados mostram bons índices de resposta e controle dos tumores de hipófise após radioterapia adjuvante à cirurgia, e por ser uma doença de resposta lenta ao tratamento é grande a probabilidade de melhora ainda maior dos resultados a médio prazo.

OBJECTIVE: To evaluate the clinical profile of patients with pituitaryadenoma and their response to radiotherapy. MATERIAL AND METHOD: Retrospective study with 22 patients with diagnosis of pituitary adenoma which were submitted to radiotherapy between March 2004 and December 2008. Patients' characteristics such as gender, age, clinical presentation, surgical approach, immunohistochemistry profile, dose of radiation and the response to therapy were analyzed using hormonal dosages and imaging exams. RESULTS: The median age was 51 years and equally distributed in both genders. The tumors were divided according to the Hardy's classification: 27.5% had grade II, 27.5% had grade III and 45% had grade IV. The main symptoms presented by patients at diagnosis were visual impairment in 77% of cases, headache in68%, amenorrhea and acromegaly in 27% and galactorrhea in 4.5%. Transphenoidal surgery was performed in 21 patients and only 1 patient was submitted to transcranial approach; 91% of cases had partial resection. Concerning to immunohistochemistry, the expression of ACTH was the most frequent, being present in 41% of cases.The patients were treated in megavoltage equipment mostly with6 MV linear accelerator. The total radiation dose was 45 Gy in 68%of patients and a dose of 50.4 Gy in 13% of cases. Three-dimensionalplanning was used in 20 patients. The median follow-up was 41 months. Laboratory and imaging improvement were observed in 73% of patients, stability in 22.5%, and worsening in 4.5%. CONCLUSION: The results show good rates of response and control of pituitary adenomas by radiation in the first four years after treatment. Considering it has a slow response to treatment, there is a high chance of improvement in results later during the follow-up. Keywords: Radiotherapy; Pituitary; Adenoma.

Braquiterapia com rutênio-106 em melanomas uveais - resultados preliminares: experiência uni-institucional / Ruthenium-106 brachytherapy for uveal melanomas - preliminary results: a single institutional experience

OBJETIVO: Analisar os resultados preliminares da braquiterapia com rutênio-106 em pacientes portadores de melanomas uveais. MATERIAIS E MÉTODOS: No período de abril de 2002 a julho de 2003, 20 pacientes com diagnóstico de melanoma uveal foram tratados com braquiterapia com rutênio-106. A dose calculada no ápice tumoral variou de 55 Gy a 100 Gy. Pacientes com lesões com altura maior que 5 mm foram submetidos a termoterapia transpupilar concomitante à colocação da placa oftálmica. RESULTADOS: Quanto à localização da lesão, esta se encontrava na coróide em 75 por cento dos casos, na íris em 15 por cento e no corpo ciliar em 10 por cento dos pacientes. Com seguimento mediano de 19 meses, a sobrevida livre de progressão para a braquiterapia e para a associação com a termoterapia transpupilar foi de 69 por cento e 87 por cento, respectivamente. Observou-se redução significante da altura tumoral após o tratamento. Nenhum dos pacientes foi submetido a enucleação. CONCLUSÃO: Nossos resultados preliminares mostram que a braquiterapia com rutênio-106 é uma opção adequada para o tratamento conservador de melanomas uveais em termos de controle local, manutenção do globo ocular e visão útil, com índice aceitável de complicações.

OBJECTIVE: To analyze the early response of uveal melanomas in patients treated with ruthenium-106 brachytherapy. MATERIALS AND METHODS: In the period between April 2002 and July 2003, 20 patients diagnosed with uveal melanoma were submitted to ruthenium-106 brachytherapy. The calculated dose delivered at the apex of the tumor ranged between 55 Gy and 100 Gy. Patients with lesions greater than 5 mm were submitted to transpupillary thermotherapy concomitantly with ophthalmic plaque insertion. RESULTS: As regards the lesions site, 75 percent of the lesions were located in the choroid, 15 percent in the iris, and the remainder 10 percent in the ciliary body. In a median 19-month-follow-up, the progression-free survival for brachytherapy was 69 percent, and 87 percent for associated brachytherapy and transpupillary thermotherapy. A significant tumor height reduction was observed after treatment. No patient was submitted to enucleation. CONCLUSION: Our preliminary results show that ruthenium-106 brachytherapy is an appropriate method for conservative treatment of patients with uveal melanomas in terms of local management, ocular and visual acuity preservation with an acceptable complications incidence rate.