ABSTRACT
PURPOSE: The objective of this study is to evaluate the tolerability and outcome of craniospinal irradiation (CSI) with helical tomotherapy (HT) in the treatment of medulloblastoma. METHODS: We evaluated 19 consecutive patients with primary medulloblastoma who were treated with HT from 2007 through 2010. HT regimens to the neuroaxis included: 23.4 Gy at 1.8 Gy/fraction (N = 10), 36 Gy at 1.8 Gy/fraction (N = 7), and 39 Gy bid at 1.3 Gy/fraction (N = 2). The tumor bed received 54-60 Gy. Potential associations between patient, treatment, and toxicity factors and overall survival (OS) were assessed in univariate analyses using the Cox proportional hazards model. Spearman's rank correlation coefficient was used to correlate potential risk factors with the grade of acute toxicity. RESULTS: The median age at diagnosis was 5 years (range 2-14) and the median follow-up for alive patients (N = 14) 40 months (range 10-62). Two- and three-year overall survival was 75 and 68 %, respectively. The most common acute toxicity was hematological (79 %), being grade 2 and grade 3 in 4 (21 %) and 11 (58 %) cases, respectively. No grade ≥2 late toxicities were observed. Higher grades of acute body toxicity were found in older children (P = 0.004). Longer time between diagnosis and radiation therapy was correlated with shorter OS (P = 0.03). In addition, higher grades of acute thrombocytopenia were associated with shorter OS (P = 0.03). CONCLUSIONS: CSI delivered with HT for medulloblastoma is well tolerated with low rates of severe acute toxicity. Further research is necessary to assess late toxicity with a longer follow-up (AU)
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Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Craniospinal Irradiation/adverse effects , Medulloblastoma/radiotherapy , Radiotherapy, Intensity-Modulated/adverse effects , Treatment Outcome , Brain Neoplasms/radiotherapy , Craniospinal Irradiation/methodsSubject(s)
Humans , Male , Middle Aged , Hypertriglyceridemia/therapy , Plasmapheresis/methods , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study is to assess the outcome of patients with Ewing sarcoma (EWS) of the bone and to identify prognostic factors. MATERIALS AND METHODS: Seventy-seven patients younger than 18 years old, diagnosed with EWS of the bone between 1979 and 2009, were analysed retrospectively. Four different protocols of chemotherapy were used successively. Local treatment consisted of surgery (N=32), radiotherapy (N=20) and a combination of both (N=19). RESULTS: The median age at diagnosis was 10 years old (range, 2-17) and the median follow-up for survivors 8.6 years (range, 1-18.8). Thirty-two relapses occurred (21 distant, 5 local and 6 both). The 2- and 5-year overall survival rates were 70% and 51%, respectively. Multivariate analysis showed four significant independent predictors for death: age ≥14 years old (HR: 5.06; p=0.019), lack of complete response (HR: 8.04; p<0.001), tumour volume ≥150 ml (HR: 2.21; p=0.045) and distant recurrences (HR: 1.45; p=0.001). CONCLUSIONS: Outcome of EWS of bone is influenced by many clinical and treatment-correlated variables. Criteria to stratify patients should include all the variables that have shown prognostic significance. The development of novel therapies should target these high-risk groups (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Bone Neoplasms/diagnosis , Bone Neoplasms/mortality , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/mortality , Combined Modality Therapy/methods , Medical Oncology/methods , Recurrence , Neoplasm Recurrence, Local , Survival Analysis , Treatment OutcomeABSTRACT
INTRODUCTION: Anemia is the most common haematological complication in cancer patients. OBJECTIVE: Analysis of the incidence, prevalence and treatment of anemia in oncologic patients treated in Radiation Oncology Departments in Spain (ROD) and monitoring of the existing recommendations for the treatment of anemia. MATERIAL AND METHODS: Observational, prospective, multicenter study which involved 19 Spanish ROD. The study was approved by the CEIC Central Defense Hospital. 477 patients with solid tumors, subsidiary of RT with radical intent referred to such centers within a period of one month (5/5/09 to 5/6/09) and gave their consent to participate in the study. We gathered the main characteristics of patients and their oncologic disease. All patients underwent a determination of Hb levels before RT, upon reaching 25-35 Gy and at the end treatment. In patients with anemia we assessed the existence of related symptoms and its treatment. RESULTS: Basal situation: The prevalence of anemia was 34.8% (166 patients). Mean Hb in patients with anemia was 11.17 ± 1.07 g/dl. Anemia-related symptoms were present in 34% of the patients. Anemia predisposing factors were: stage of the disease, previously received chemotherapy, and hormonal therapy. 39% (66 patients) received anemia treatment, with a mean Hb of 10.43 ± 1.04 g/dl. During RT: The prevalence of anemia was 38.9% (182 patients) with a mean Hb of 11.24 ± 1.21 g/dl. Predisposing factors for anemia during RT treatment were: age, male sex, chemotherapy prior to RT, basal anemia and chemotherapy during RT. 36.3% (66 patients) had anemia-related symptoms. 34.6% (63 patients) with a mean Hb of 10.5 ± 1.37 g/dl received treatment for anemia. The prevalence of anemia at the end of the RT was 38.1% (177 patients) with a mean Hb of 11.19 ± 1.18 g/dl. The predisposing factors for the appearance of anemia at the end of RT were: male sex, anemia at basal situation and during treatment and chemotherapy during RT. 34% (61 patients) had anemia-related symptoms and 73 patients (41.2%) with a mean Hb of 10.5 ± 1.22 g/dl received treatment for anemia. The presence of anemia-related symptoms was significantly correlated with the beginning of treatment for anemia. The incidence of anemia (new cases) during radiotherapy was 17.5%. CONCLUSION: The prevalence of anemia in basal situation, during RT and at the end of RT is 34.8%, 38.9% and 38.1%. During RT the incidence of anemia is 17.5%. 39.8%-41.2% of patients with anemia and 64.2%-68% of patients with anemia-related symptoms received treatment. Treatment of anemia starts with Hb<11 g/dl and the goal is to achieve Hb 12 g/dl. In our Radiotherapy Oncology Departments, the treatment of anemia complies with the current recommendations and guidelines in use (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Multicenter Studies as Topic/methods , Anemia/epidemiology , Anemia/etiology , Neoplasms/complications , Neoplasms/radiotherapy , Radiotherapy/adverse effects , Anemia/therapy , Incidence , Medical Oncology/methods , Prevalence , Prospective Studies , Radiotherapy/methods , Radiotherapy , Spain/epidemiologyABSTRACT
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Subject(s)
Humans , Female , Adult , Amyloidosis/complications , Pyoderma Gangrenosum/complications , Graft Rejection/etiology , Renal Dialysis , Renal Insufficiency, Chronic/therapyABSTRACT
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Subject(s)
Male , Aged , Humans , Liver Cirrhosis/complications , Demyelinating Diseases/diagnosis , Hepatitis C, Chronic/complications , Cholecystectomy/adverse effects , Corpus Callosum/physiopathology , Vitamin B Deficiency , Vitamin B 12 DeficiencyABSTRACT
El sarcoma de vainas nerviosas, también llamado schwannoma maligno, es originalmente un sarcoma de partes blandas. Se localiza preferentemente en las vainas nerviosas de los nervios periféricos de los miembros y suelen infiltrar las fibras nerviosas. Presentamos el caso de una mujer de 30 años, diagnosticada y tratada en varias ocasiones por un schwannoma maligno en el miembro inferior izquierdo, con invasión del nervio ciático. Para decidir la actitud terapéutica a seguir se realiza la tomografía por emisión de positrones (PET) con 18F-FDG en la que se objetiva nueva recidiva locorregional que obligó a realizar una amputación del miembro, comprobándose posteriormente histológicamente los hallazgos descritos en la PET. La PET puede ser una técnica muy útil para detectar recurrencia de estos tumores sobre todo en pacientes sometidos a radioterapia previa, cuando la RMN presenta dificultades para la realización de un diagnóstico diferencial entre fibrosis postirradiación y recurrencia tumoral, permitiendo un manejo terapéutico adecuado del paciente
The peripheral nerve sarcoma, also called malignant schwannoma, is originally a soft tissue sarcoma. It is mainly located in the peripheral sheath nerve of the limbs and usually infiltrates the nerve fibres. We present the case of a thirty year old woman with a malignant schwannoma in her left leg sciatic nerve who had been treated on several occasions. An 18-FDG positron emission tomography was performed to evaluate the management of the patient. It showed regional recurrence, which required leg amputation. The pathological result has confirmed the PET diagnosis. PET can be a useful technique to detect recurrence for this kind of tumor, mainly in patients who have been previously radiated when the MRI is insufficient to perform a differential diagnosis between postirradiation fibrosis and tumoral recurrence, allowing for suitable therapeutic management of the patient
Subject(s)
Female , Adult , Humans , Neurilemmoma , Tomography, Emission-Computed , Radiopharmaceuticals , Sciatic Neuropathy , Fluorodeoxyglucose F18 , Peripheral Nervous System NeoplasmsABSTRACT
- Introducción y objetivos: la anemia es el trastorno hematológico más frecuente en pacientes con cáncer; sin embargo, existen pocos datos en nuestro país sobre presencia de anemia en enfermos que son sometidos a radioterapia. Este estudio analiza la prevalencia e incidencia de anemia antes y durante la irradiación y secundariamente la influencia del tratamiento en la corrección de la misma según el momento de su aparición.- Material y método: 472 pacientes con cáncer han sido incluidos en un estudio observacional, prospectivo y multicéntrico. Los controles hematológicos se efectuaron antes de la irradiación, al inicio y cada dos semanas, hasta el final de la misma, para detectar la presencia de anemia. Se estudiaron las modificaciones de los niveles de hemoglobina en relación al tratamiento aplicado y al momento en que dicho tratamiento fue iniciado.- Resultados: un 28 por ciento de los pacientes se presentan con anemia de inicio y un 27 por ciento la desarrollan durante la radioterapia. Un 40 por ciento de los enfermos fueron tratados con eritropoyetina alfa en algún momento del estudio, produciéndose un incremento significativo en los niveles de Hb de aproximadamente 2 g/dl. En los enfermos que no recibieron eritropoyetina la incidencia de anemia se incrementó a lo largo de la radioterapia, alcanzando un pico de un 8 por ciento en la última semana de irradiación.- Conclusión: existe una alta incidencia y prevalencia de anemia en los pacientes sometidos a radioterapia, cuyo tratamiento es fundamental por la implicación pronóstica que tiene mantener niveles bajos de hemoglobina a lo largo de la irradiación. La eritropoyetina humana recombinante es un fármaco eficaz para corregir la anemia, independientemente del momento en que se inicie la aplicación de dicho tratamiento (AU)
Subject(s)
Female , Male , Middle Aged , Humans , Anemia/epidemiology , Anemia/radiotherapy , Erythropoietin/therapeutic use , Radiotherapy/methods , Radiotherapy/standards , Radiotherapy , Neoplasms/radiotherapy , Signs and Symptoms , Prospective Studies , Multicenter Studies as Topic/methodsABSTRACT
La histiocitosis de células de Langerhans (HCL) es una enfermedad poco frecuente caracterizada por el acúmulo de histiocitos anómalos, junto con linfocitos y eosinófilos en diferentes órganos y tejidos. La presentación inicial en cabeza y cuello es relativamente frecuente. Presentamos dos casos de HCL con síntomas otorrinolaringológicos. Se discuten aspectos relacionados con el diagnóstico, evaluación y tratamiento (AU)
Langerhans's cell histiocytosis (LCH) is an uncommon disease characterized by an accumulation of abnormal histiocytes, together lymphocytes and eosinophils in various organs and tissues. The head and neck are frequent sites of initial presentation. We present two cases of LCH with otorhinolaryngologic symptoms. Current recommendations for diagnosis, evaluation and treatment of LCH are also discussed (AU)
Subject(s)
Child, Preschool , Infant , Female , Humans , Otorhinolaryngologic Surgical Procedures , Ear/surgery , Histiocytosis, Langerhans-Cell/diagnosis , Tomography, X-Ray Computed , Diagnosis, Differential , Eosinophilic GranulomaABSTRACT
Los mioepiteliomas son tumores poco frecuentes (menos del 1 por ciento de la patología tumoral) y se localizan principalmente en parótida y glándulas salivares menores del paladar. Describimos las características histológicas e inmunohistoquímicas de este tipo de tumores a propósito de 2 casos intervenidos en nuestro Servicio de ORL (AU)
Myoepithelioma is a rare salivary gland tumor (less than 1%) which are usually located in parotid gland and minor salivary glands. Histology and immunohistochemical features of this tumors are reviewed. We report 2 cases arising in parotid and hard palate (AU)
Subject(s)
Adult , Aged , Male , Female , Humans , Keratinocytes , Myoepithelioma/pathology , Salivary Gland Neoplasms/pathology , Tomography, X-Ray Computed , S100 Proteins/metabolism , ImmunohistochemistryABSTRACT
[reaction: see text] 1-Substituted 1-(2,2-diphenylvinyl)cyclopropanes with electron-accepting groups at C1 undergo a novel rearrangement to benzocycloheptenes on triplet-sensitized irradiation. In some instances competition between rearrangement to cyclopentenes and formation of cycloheptenes takes place. When electron-acceptor groups are not present at C1, conventional ring opening to cyclopentenes occurs exclusively. A mechanism involving intramolecular SET from the diphenylvinyl unit to the electron-acceptor group is proposed for this novel photoreaction.
