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1.
Brachytherapy ; 15(1): 12-22, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26525215

RESUMEN

PURPOSE: To report our experience in long-term follow-up of ocular melanoma patients treated with custom OSU-Nag eye plaques using (125)I sources. METHODS: A retrospective chart review was conducted for 113 consecutive ocular melanoma patients with follow-up visual acuity data who were treated with OSU-Nag plaque episcleral brachytherapy at The Ohio State University Medical Center from 1994 to 2009. Visual acuity, complication data, and recurrence rates were recorded up to 120 months after brachytherapy. RESULTS: Median age at presentation was 63.0 years (range, 22-93). Median follow-up was 65.5 months (range, 2-180). Median radiation dose at the prescription point was 85.8 Gy (range, 51.8-103.7). Preservation of useful visual acuity, defined as better than 20/200, was noted in 43 of 74 (58%) of patients in the present study at 36 months compared with 50.1% of Collaborative Ocular Melanoma Study participants. By 120 months, 17 of 30 (57%; 95% confidence interval, 45-69%) progressed to visual acuity worse than 20/200, whereas 9 of 30 (30%) retained visual acuity of 20/40 or better, and 4 of 30 (13%) were 20/50-20/200. The rate of retinopathy after radiation was approximately 40% of all those observed by 60 months. Baseline visual acuity, apical tumor height, American Joint Committee on Cancer tumor category, and distance between the tumor and the fovea were all significantly associated with loss of visual acuity. The local tumor control rate by 60 months of follow-up was 93% (95% confidence interval, 85-97%). CONCLUSIONS: The OSU-Nag custom (125)I plaque is an effective treatment for uveal melanoma, with preservation of useful visual acuity in 58% of eyes 3 years after treatment and 43% of eyes 10 years after treatment.


Asunto(s)
Braquiterapia/métodos , Radioisótopos de Yodo/uso terapéutico , Melanoma/radioterapia , Traumatismos por Radiación/etiología , Enfermedades de la Retina/etiología , Neoplasias de la Úvea/radioterapia , Agudeza Visual/efectos de la radiación , Adulto , Anciano , Anciano de 80 o más Años , Braquiterapia/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Radioisótopos de Yodo/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
3.
Pediatr Blood Cancer ; 60(3): 377-382, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22692929

RESUMEN

BACKGROUND: The Pediatric Preclinical Testing Program (PPTP) has been successfully used to determine the efficacy of novel agents against solid tumors by testing them within a mouse-flank in vivo model. To date, radiation therapy has not been applied to this system. We report on the feasibility and biologic outcomes of a pilot study using alveolar and embryonal rhabdomyosarcoma xenograft lines. PROCEDURES: We developed a high-throughput mouse-flank irradiation device that allows the safe delivery of radiotherapy in clinically relevant doses. For our pilot study, two rhabdomyosarcoma xenograft lines from the PPTP, Rh30 (alveolar) and Rh18 (embryonal) were selected. Using established methods, xenografts were implanted, grown to appropriate volumes, and were subjected to fractionated radiotherapy. Tumor response-rates, growth kinetics, and event-free survival time were measured. RESULTS: Once optimized, the rate of acute toxicity requiring early removal from study in 93 mice was only 3%. During the optimization phase, it was observed that the alveolar Rh30 xenograft line demonstrated a significantly greater radiation resistance than embryonal Rh18 in vivo. This finding was validated within the standardized 30 Gy treatment phase, resulting in overall treatment failure rates of 10% versus 60% for the embryonal versus alveolar subtype, respectively. CONCLUSIONS: Our pilot study demonstrated the feasibility of our device which enables safe, clinically relevant focal radiation delivery to immunocompromised mice. It further recapitulated the expected clinical radiobiology.


Asunto(s)
Fraccionamiento de la Dosis de Radiación , Ensayos Analíticos de Alto Rendimiento/instrumentación , Radioterapia/instrumentación , Radioterapia/métodos , Rabdomiosarcoma/radioterapia , Animales , Humanos , Ratones , Proyectos Piloto , Ensayos Antitumor por Modelo de Xenoinjerto
5.
Cancer ; 118(1): 112-7, 2012 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-21692072

RESUMEN

BACKGROUND: Acute myeloid leukemia (AML) infrequently involves the central nervous system (CNS). This study was undertaken in patients with AML to determine whether cytogenetic findings predict CNS involvement. METHODS: The medical records of 1354 patients with AML who were treated at The University of Texas MD Anderson Cancer Center between January 2000 and December 2008 were reviewed. Forty patients (3%) had CNS involvement at time of presentation or disease recurrence, of whom 37 had conventional cytogenetics performed on bone marrow aspirate material. Demographics, treatment, and status at last follow-up were collected. RESULTS: Eleven patients (30%) had a diploid karyotype, and 14 patients (38%) had complex cytogenetics. Only 5 of the 40 patients had CNS disease at diagnosis, and the remaining patients had CNS disease at relapse. Patients who developed CNS disease were younger (P = .019), had a higher white blood cell (WBC) count at diagnosis (P = .001), had higher lactate dehydrogenase level (LDH) levels (P < .0001), and had higher percentages peripheral blast cells (P = .024) at diagnosis compared with the rest of the population. In addition, patients with CNS disease had higher rates of chromosome 16 inversion (P < .001), chromosome 11 abnormality (P = .005), and trisomy 8 (P = .02) and had a tendency toward complex cytogenetics (P = .2) compared with the control group (patients who had AML with no CNS involvement). CONCLUSIONS: Patients with AML and CNS disease often had higher LDH levels and WBC counts at diagnosis, and they often presented with chromosome 16 inversion and chromosome 11 abnormalities. The current study indicated that the overall survival of patients with AML who had CNS involvement is poor.


Asunto(s)
Neoplasias del Sistema Nervioso Central/secundario , Aberraciones Cromosómicas , Femenino , Humanos , Cariotipo , Leucemia Mieloide Aguda/genética , Masculino , Persona de Mediana Edad
6.
Future Oncol ; 7(10): 1169-83, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21992729

RESUMEN

Gliomas account for the vast majority of malignant adult brain tumors. Even though tremendous effort has been made to optimize treatment of patients with high-grade glioma, the prognosis remains poor, especially for patients with glioblastoma. The dismal prognosis conferred by these tumors is in part caused by the tendency to diffusely infiltrate into neighboring brain tissue, but also by the inherent resistance of these tumors to both chemotherapy and radiation. This article reviews the recent advancements in multimodality treatment of patients with gliomas, both in the primary and recurrent setting, with an emphasis on the emerging targeted therapies. Moreover, the external beam radiotherapy options, including intensity modulated radiotherapy and particle (proton and carbon ion) radiotherapy are reviewed.


Asunto(s)
Neoplasias Encefálicas/terapia , Glioma/terapia , Animales , Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Terapia Combinada , Glioma/diagnóstico por imagen , Glioma/patología , Humanos , Terapia Molecular Dirigida , Clasificación del Tumor , Tomografía de Emisión de Positrones , Inhibidores de Proteínas Quinasas/uso terapéutico , Radioterapia de Intensidad Modulada
7.
Breast Cancer Res Treat ; 124(1): 13-26, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20809361

RESUMEN

The risk of breast cancer has been associated with reproductive history. The purpose of this study was to determine the relationship between fertility drugs used in assisted reproductive procedures and the risk of breast cancer. We performed a literature search using the MEDLINE, the COCHRANE Library, and Scopus to identify studies linking breast cancer to fertility drugs. We excluded case series, case reports, and review articles from our analysis. The study populations included women who were treated for infertility with clomiphene, gonadotropins, gonadotropin-releasing hormones, or other unspecified fertility agents. We extracted information on study design, sample size, type of fertility drugs and number of treatment cycles, breast cancer incidence, and follow-up time from these studies. Eight case-control studies and fifteen cohort studies were included in the quantitative analyses. The Newcastle-Ottawa Quality Assessment Scales were used. Two investigators independently extracted study methods, sources of bias, and outcomes. We found that the risk of breast cancer was not significantly associated with fertility drug treatment. The follow-up periods were short in some of the studies analyzed in our study; however, we proceeded to test the trend in risk estimates across different durations of follow-up and found a trend for association using the nonparametric test; this was interpreted with caution in view of the lack of adjustment with other confounding factors. The current published data do not suggest higher risk of breast cancer in women who receive fertility treatment, but the lack of long-term follow up and the inherent weaknesses in some of the published studies have to be cautiously taken into account.


Asunto(s)
Neoplasias de la Mama/inducido químicamente , Fármacos para la Fertilidad Femenina/efectos adversos , Técnicas Reproductivas Asistidas/efectos adversos , Adulto , Anciano , Medicina Basada en la Evidencia , Femenino , Humanos , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
8.
Discov Med ; 9(48): 411-7, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20515609

RESUMEN

Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), has emerged as one of the standard treatment options for stage I non-small cell lung cancer (NSCLC), mainly in medically inoperable patients. Its use has also been explored in operable patients. A large body of experience, either from retrospective studies or clinical trials, has been accumulated over the years and more is known about the radiobiology, cancer biology, technical aspects, clinical outcomes, and toxicities of SBRT. This article provides updates of these aspects of SBRT for stage I NSCLC.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Radiobiología/métodos , Radiocirugia/métodos , Ensayos Clínicos como Asunto , Humanos , Radiocirugia/efectos adversos , Resultado del Tratamiento
9.
Rev Recent Clin Trials ; 5(1): 14-27, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20205684

RESUMEN

Glioblastoma (GBM), a WHO grade IV malignant glioma, is the most common and lethal adult primary brain tumor. Median survival rates range from 12-15 months. The current standard of care for GBM has evolved from resection followed by adjuvant radiotherapy to resection, concurrent adjuvant chemotherapy (temozolomide) and radiation, and additional adjuvant chemotherapy. The expression of specific molecular biomarkers, especially O-6-methylguanine methyltransferase (MGMT) status, may determine the response of the tumor to treatment, and helps in identifying the magnitude of benefit from this regimen. By identifying further biological subtypes of GBM at the molecular level, specific targeted therapies could be developed and used in the future for more individualized therapeutic regimens. This article will review the current therapies for GBM and the investigation of new molecular and targeted therapies, such as EGFR inhibitors, mTOR/PI3Kinase inhibitors, and anti-angiogenesis agents.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioblastoma/cirugía , Adulto , Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/análisis , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , Quimioterapia Adyuvante , Ensayos Clínicos como Asunto , Metilasas de Modificación del ADN/análisis , Enzimas Reparadoras del ADN/análisis , Relación Dosis-Respuesta a Droga , Relación Dosis-Respuesta en la Radiación , Receptores ErbB/antagonistas & inhibidores , Glioblastoma/tratamiento farmacológico , Glioblastoma/radioterapia , Humanos , Péptidos y Proteínas de Señalización Intracelular/antagonistas & inhibidores , Proteínas Serina-Treonina Quinasas/antagonistas & inhibidores , Radioterapia Ayuvante , Serina-Treonina Quinasas TOR , Proteínas Supresoras de Tumor/análisis
10.
Expert Rev Neurother ; 8(10): 1527-36, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18928345

RESUMEN

CNS germ cell tumors are rare primary brain malignancies. Germinomas comprise approximately two-thirds of CNS germ cell tumors. Owing to their radiosensitivity, radiotherapy has been used to treat patients with CNS germinomas, with favorable treatment outcomes. Historically, craniospinal irradiation has been used. Given the concerns over long-term toxicities associated with craniospinal irradiation, reduced volume radiotherapy with or without chemotherapy has been employed. Data on the use of different strategies in the treatment of CNS germinomas are emerging but a standard strategy has not been established. This article reviews the different strategies used in the management of CNS germinomas.


Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/terapia , Germinoma/terapia , Procedimientos Neuroquirúrgicos/tendencias , Pautas de la Práctica en Medicina/tendencias , Radioterapia/tendencias , Terapia Combinada/métodos , Humanos
11.
Expert Rev Anticancer Ther ; 8(1): 125-32, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18095889

RESUMEN

High-grade gliomas are the most commonly diagnosed malignant brain tumor in adults. Prognosis can be estimated by examining risk factors, including histology, age and performance status. Postoperative radiation therapy is associated with improved survival and standard treatment includes external beam radiotherapy to a dose of 60 Gy in 30-33 fractions. Patients with poor prognostic features have a more limited benefit from radiotherapy. This article reviews the current state of knowledge on risk stratification and analyzes strategies that can be employed to better individualize treatment for poor-prognosis patients.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Cuidados Paliativos , Ensayos Clínicos como Asunto , Humanos , Pronóstico
12.
Expert Rev Neurother ; 7(4): 373-81, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17425492

RESUMEN

The standard treatment for medulloblastoma is surgery followed by adjuvant chemotherapy and external beam radiotherapy to the craniospinal axis and posterior fossa. However, in very young children, craniospinal irradiation has a more significant detrimental effect in terms of neurocognitive function and growth. This article reviews the different strategies used for very young patients with medulloblastoma.


Asunto(s)
Neoplasias Encefálicas/terapia , Quimioterapia Adyuvante/métodos , Meduloblastoma/terapia , Radioterapia Ayuvante/métodos , Preescolar , Ensayos Clínicos como Asunto , Terapia Combinada , Femenino , Humanos , Lactante , Recién Nacido , Masculino
13.
Resuscitation ; 62(1): 97-106, 2004 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-15246589

RESUMEN

Post-ischemic myocardial dysfunction has been observed in a variety of clinical situations including cardiac arrest. Potentially survivable cardiac arrest following short-term global myocardial ischemia may be of insufficient duration to cause irreversible myocyte injury, but still results in contractile and bioenergetic dysfunction. The purpose of this study was to characterize the ischemic transition from reversible to irreversible injury in the isolated perfused rat heart. Isolated, buffer perfused, male Sprague-Dawley rat hearts underwent normothermic ischemia of 15, 20, 25 or 30 min with or without 30 min of reperfusion and were freeze clamped in liquid nitrogen for bioenergetic analysis of LV tissue. Post-ischemic LV function and measurements of bioenergetic recovery were made between groups and with non-ischemic controls. Baseline LV function was similar in all groups. Post-ischemic contractile function was markedly depressed in the 25 and 30 min ischemia groups with persistent depression of high-energy phosphates, total adenine nucleotide pool, myocardial oxygen consumption, elevated CK release and evidence of significant mitochondrial edema in the 30 min group. In contrast with longer ischemic periods, the reduction in LV contractile function after 15 and 20 min of ischemia was mild, with more complete bioenergetic recovery, minimal CK release, and normal appearing mitochondrial. This data suggests a period of transition from reversible to irreversible injury occurring at approximately 20 min of normothermic global ischemia in the isolated perfused rat heart.


Asunto(s)
Daño por Reperfusión Miocárdica/fisiopatología , Aturdimiento Miocárdico/fisiopatología , Adenosina Trifosfato/metabolismo , Animales , Circulación Coronaria , Creatina Quinasa/metabolismo , Corazón , Masculino , Modelos Cardiovasculares , Reperfusión Miocárdica , Consumo de Oxígeno/fisiología , Perfusión , Ratas , Ratas Sprague-Dawley , Factores de Tiempo , Función Ventricular Izquierda/fisiología
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