Comparison of quality of life after radical treatment in prostate cancer: radical prostatectomy versus external radiotherapy.

OBJECTIVE: To assess and compare the functional and quality of life results in patients treated with curative intent for localized prostate cancer during 2015 in our hospital. METHOD: 77 patients treated by radical prostatectomy or external radiotherapy with androgen deprivation were prospective enrolled. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire at 3-year follow-up and Spanish Questionnaire on Quality of Life in Patients with Prostate Cancer (CAVIPRES-30) at diagnosis and at 3-year follow-up were registered. RESULTS: 68 patients were included, 39 patients treated by radical prostatectomy and 29 received external radiotherapy with androgen deprivation. Among the operated patients, 61.5% were dry and 17.9% use three or more daily pads, compared to 72.4% and 6.8%, respectively, in the radiotherapy group. 48.7% of prostatectomized patients reported very poor or no capacity to have a sufficiently rigid erection, compared to 69% of the radiated group. After surgery, 43.6% considered bad or very bad quality-of-life, compared to 68.9% in the radiotherapy group. In the comparison of the data of the pre- and post-treatment questionnaire can be seen that the patients had a superior perception before the procedure. CONCLUSIONS: Patients treated by surgery have a better perception of quality-of-life compared to those treated by radiotherapy.

OBJETIVO: Determinar y comparar los resultados funcionales y de calidad de vida de pacientes con cáncer de próstata tratados con intención curativa durante el año 2015 en nuestro centro. MÉTODO: Se incluyeron 77 pacientes sometidos a prostatectomía radical (PR) o radioterapia externa con terapia de deprivación androgénica (TDA). Se realizaron el Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) tras 3 años de seguimiento y el Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata (CAVIPRES-30) al diagnóstico y a los 3 años. RESULTADOS: Se incluyeron 68 pacientes, 39 con PR y 29 con radioterapia más TDA. De los pacientes intervenidos, el 61.5% están secos y el 17.9% usan tres o más compresas, diarias frente al 72.4% y el 6.8%, respectivamente, en el grupo de radioterapia. El 48.7% de los prostatectomizados refieren erecciones muy malas o ninguna, frente al 69% de los radiados. Tras la cirugía, el 43.6% refieren mala o muy mala calidad de vida, frente al 68.9% de los radiados. En la comparación de los datos del cuestionario pre- y postratamiento, los pacientes tenían una percepción superior antes del procedimiento. CONCLUSIONES: Los pacientes tratados mediante cirugía tienen una mejor percepción de su calidad de vida relacionada con la salud que los radiados.

Estimación del tiempo de Sobrevida después de Radioterapia Holoencefálica en Metástasis Cerebrales / Estimation of Survival time after Holoencephalic Radiotherapy in Brain Metastases

Introducción: Las metástasis cerebrales constituyen una causa importante de mortalidad y son los tumores intracraneales más comunes en adultos, ocurren en aproximadamente el 20% y el 40% de los pacientes diagnosticados con cáncer. Los factores pronósticos que permiten estimar la esperanza de vida, son las herramientas que se deberían usar para proponer el fraccionamiento y duración del tratamiento con energía radiante. Métodos: Estudio de tipo retrospectivo realizado en el Hospital de Solón Espinosa Ayala, SOLCA-Quito. Se registraron los pacientes con metástasis cerebrales tratados con radioterapia holoencefálica en el período comprendido entre enero del 2003 a diciembre del 2018. Para el análisis de supervivencia se usaron las curvas de Kaplan Meier y la significación de diferencias con la prueba de Long-rank con un error tipo I o alfa del 5%. Además se realizó un análisis bivariado con el modelo de regresión logística de Cox entre la mediana de supervivencia y las variables: Indice de Karnofsky (IK), edad, número de metástasis cerebrales, metástasis extracraneales, tumor primario y la escala "Graded Prognostic Assessment" (GPA). Resultados: Se registraron309 pacientes, la mediana de supervivencia global fue de 5 meses. Todos los factores afectan la supervivencia (p ≤0.05); los que alcanzaron los mejores resultados en términos de sobrevida fueron: IK ≥90, grupo etario entre 51-60 años, los pacientes con 1 metástasis cerebral, ausencia de metástasis extra craneales y las metástasis cerebrales originadas en mama con puntuaciones de GPA entre 3.5-4. Conclusión: La edad, el índice de Karnofsky, el número de metástasis cerebrales, la presencia de metástasis extra craneales, tumor primario y clasificación GPA son factores que permiten estimar el tiempo de supervivencia en pacientes con metástasis cerebrales

Introduction: Brain metastases are an important cause of mortality and the most common intracranial tumors in adults, observed in approximately 20% and 40% of patients diagnosed with cancer. The prognostic factors that allow estimating life expectancy are the tools that should be used to propose the fractionation and duration of the radiant energy treatment. Methods: The present retrospective study was carried out at the Solón Espinosa Ayala Hospital, SOLCA-Quito. The patients who received whole brain radiotherapy in the study period from January 2003 to December 2018, were registered. For survival analysis, use the Kaplan Meier curves and the significance of differences with the long-range test with a 5% type I or alpha error. In addition, a bivariate analysis was performed with the Cox logistic regression model between the median survival and the variables: Karnofsky index (IK), age, number of brain metastases, extracranial metastases, primary tumor and the "Graded Prognostic Assessment" (GPA). Results: 309 patients were registered and the median overall survival of patients with brain metastases treated with whole brain radiotherapy was 5 months. All factors affect survival (p ≤ 0.05); those who achieved the best results in terms of survival were: Karnofsky Performance Status (KPS) ≥ 90, age group between 51-60 years, patients with 1 brain metastasis, absence of extracranial metastases and brain metastases originated in breasts with Graded Prognostic Assessment (GPA) score between 3.5- 4. Conclusion: Age, KPS, number of brain metastases, presence of extracranial metastases, primary tumor and GPA are factors that allow estimating survival time in patients with brain metastases

Differences in overall survival and cancer-specific survival in high-risk prostate cancer patients according to the primary treatment. / Diferencias en la supervivencia global y supervivencia cáncer específica en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado.

INTRODUCTION AND OBJECTIVES: There is no high-level evidence as to which primary treatment provides an overall survival (OS) or cancer-specific survival (CSS) advantage in high-risk localised prostate cancer (HRLPC). Our aim was to analyse the differences in survival and predictive factors in this group of patients, according to their primary treatment (radical prostatectomy (RP) or radiotherapy and androgen blockade (RT+HT)). MATERIAL AND METHODS: A retrospective study of 286 HRLPC patients diagnosed between 1996-2008, treated by RP (n=145) or RT+HT(n=141). Survival was assessed using the Kaplan-Meier method. Significant differences between the different variables were analysed using the log-rank test. A uni and multivariate Cox regression analysis was performed to identify risk factors. RESULTS: the median follow-up was 117.5 (IQR 87-158) months. The OS was longer (p=.04) in the RP patients, while there were no differences (P=.44) in CSS between either group. The type of primary treatment was not related to OS or CSS. Age (P=.002), the onset during follow-up of a 2nd tumour (P=.0001), and stage cT3a (P=.009) behaved as independent predictive variables of OS. None of the variables behaved as an independent predictive variable of CSS, although biochemical recurrence after rescue treatment (P=.058), and the onset of a 2nd tumour during follow-up showed a significant trend to statistical significance, the latter reducing specific cancer mortality (HR .16, 95%CI .02-1.18, P=.07). CONCLUSIONS: Primary treatment did not relate to OS or CSS in patients with HRPC.

Incidence of second tumours in high risk prostate cancer patients according to the primary treatment applied. / Incidencia de segundos tumores en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado.

INTRODUCTION AND OBJECTIVES: The onset of second primary tumours should be considered in high-risk prostate cancer patients in the natural course of the disease. Our aim was to evaluate the influence of primary treatment with curative intent for these patients on the development of second primary tumours. MATERIAL AND METHODS: A retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n=145) or radiotherapy and androgen blockade (n=141). The homogeneity of both series was analysed using the Chi-squared test for the qualitative variables, and the Student's t-test for the quantitative variables. A multivariate Cox regression analysis was performed to assess whether the type of primary treatment influenced the development of second tumours. RESULTS: The median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour. In the prostatectomy group it was located in the pelvis in 13 (9%) cases, and those treated with radiotherapy and hormonotherapy in 8 (5.7%) cases (P=.29). The most common organ sites were: colo-rectal in 17 (28.3%) patients, the lung in 11 (18.3%), and the bladder in 6 (10%) patients. In the multivariable analysis, the risk of a second tumour doubled for those treated with radiotherapy and hormonotherapy (HR=2.41, 95%CI: 1.31-4.34, P=.005) compared to the patients treated by prostatectomy. Age and rescue radiotherapy did not behave as independent predictive factors. CONCLUSIONS: The onset of a second primary tumour was related with the primary treatment given; thus the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled.

Irradiación parcial acelerada de mama (apbi) después de cuadrantectomía más biopsia del ganglio centinela axilar: características clínico-patológicas e inmunohistoquímicas / Accelerated partial breast irradiation (apbi) after breast conservative surgery plus sentinel node biopsy: clinical-pathological and immunohistochemical characteristics

Introducción El tratamiento estándar en estadios tempranos del cáncer de mama es la cirugía conservadora (cc) más radioterapia del volumen total mamario (wbi). Dado que la mayoría de las recidivas locales ocurren cercanas al sitio del tumor (85%) y existiendo la posibilidad de acortar tiempos de irradiación ­debido a que esta insume varias semanas­, podría no ser necesario irradiar toda la mama, sino el área donde estaba situado el tumor más margen de seguridad, lo que insume un menor tiempo. Este el fundamento de la Irradiación Parcial Acelerada Mama (apbi). Consensos internacionales proporcionan guías para administrar apbi fuera de ensayos clínicos. Objetivos El objetivo principal de este trabajo es determinar y analizar las características clinico-anatomopatológicas e inmunohistoquímicas de las pacientes que fueron operadas y luego seleccionadas para ser irradiadas con técnica de apbi con radioterapia externa con intensidad modulada guiada por imágenes (imrt). Material y método Se trata de un trabajo prospectivo, no randomizado. La muestra está constituida por las primeras 20 pacientes ingresadas al protocolo apbi. El reclutamiento se realizó entre marzo de 2012 y julio de 2014. Se analizaron las características clínico-patológicas e inmunohistoquímicas de esas pacientes luego de cc más biopsia del ganglio centinela (bgc). Resultados Media de seguimiento en meses: 37,7 (r: 22-51); edad media: 65,7 años. Tamaño tumoral medio por anatomía patológica: 12,03 mm. Media de número de ganglios centinelas extirpados: 1,7. Todos los tumores fueron unifocales. Los márgenes quirúrgicos resultaron negativos en todos los casos. Tumores Luminal A: 19 pacientes; tumores Luminal B: 1 paciente. Hormonoterapia adyuvante en todas las pacientes. Control locorregional: 100%. Conclusiones A pesar del corto tiempo de seguimiento y del escaso número de pacientes, este análisis sugiere que la apbi en el lecho del tumor marcado intraoperatoriamente con fiduciales de titanio es factible para pacientes que reúnen los criterios estrictos clínico-patológicos e inmunohistoquímicos acordes con las guías internacionales.

Introduction The standard conservative treatment for early stage breast carcinomas is the breast conservative surgery plus whole breast irradiation. Because most local recurrences occur close to the site of the primary tumor (80- 90%) and the possibility of shortening the irradiation times ­because it takes several weeks­, it may not be necessary to irradiate the entire breast, but the area where the tumor was located plus a margin of safety in less time. This is the basis of Accelerated Partial Irradiation of the Breast Objectives Determination and analysis of clinical-pathological and immunohistochemical characteristics in patients selected for Accelerated Partial Breast Irradiation (apbi) performed by imrt + igrt technique after breast conservative surgery plus sentinel node biopsy. Materials and method A prospective, non-randomized study of the first 20 patients performed apbi strictly following the recommendations of international consensus. It was initiated in March 2012 until July 2014. Clinical-pathological and immunohistochemical characteristics of these patients were analyzed to be selected for apbi, after breast conservative surgery plus sentinel node biopsy. Results Median follow up: 37.7 months (r: 22-51); average age: 65.7 years. Mean tumor size by pathological analysis: 12.03 mm. Mean number of sentinel nodes removed: 1.7. All tumors were unifocal. Negative surgical margins in all cases. Luminal A tumors: 19 patients; Luminal B tumors: 1 patient. Adjuvant hormone therapy in all patients. Loco-regional control: 100%. Conclusions Despite the short time of follow up and the small numbers of patients, this analysis suggests that apbi performed by imrt + igrt technique added to the placement of fiduciary marks at the time of surgery is feasible for highly selected patients who meet the clinical-pathological and immunohistochemical selection criteria according to international guidelines

Complicaciones agudas de la radioterapia externa convencional en el paciente con cáncer de próstata / Acute complications of conventional external radiotherapy treatment in patients with prostate cancer

Se realizó un estudio descriptivo y retrospectivo con la finalidad de identificar las toxicidades agudas más frecuentes, provocadas por el tratamiento de radioterapia externa convencional en dos dimensiones, en los pacientes diagnosticados con cáncer de próstata en el Instituto Nacional de Oncología y Radiobiología (INOR), en el período comprendido entre 2008 y 2012. Además se evaluaron otras variables de interés para una mejor descripción de la serie. El universo lo constituyeron los adultos con cáncer de próstata inscritos en el INOR (235) y la muestra fue de 138 individuos con cáncer de próstata confirmado y con criterio de recibir tratamiento radiante. Se obtuvo la información a través de la revisión de las historias clínicas que se encontraban en el archivo del Departamento, previa confección de un cuestionario, que se utilizó como instrumento para la recolección de los datos y que permitió evaluar las variables trazadas. Los resultados obtenidos fueron expresados en porcientos y se plasmaron en tablas. Se pudo llegar a la conclusión de que predominaron las edades comprendidas entre 60 y 79 años, los pacientes en etapa clínica III, así como la enfermedad de alto riesgo. Las toxicidades que prevalecieron fueron la disuria, la diarrea y la polaquiuria (AU)

A descriptive and retrospective study was carried out with the objective to describe the main acute toxicities of the patients with prostate adenocarcinoma who received 2 dimensional external beam radiotherapy treatments at the National Institute of Oncology in Havana City, from 2008 to 2012. Others variables were examined to get a better description of the study. The universe was made up by all the patients diagnosed with prostate cancer and admitted at the National Institute of Oncology in Havana City (235 patients) and the sample was formed by 138 adults with confirmed prostate adenocarcinoma who were applied a questionnaire to collect the data that permitted to assess the variables established. The results obtained were expressed in percentage and were represented in charts. The conclusions allowed knowing that the ages between 60-79 years old and the clinical stage III prevailed as well as the high risk disease. The mos t common acute toxicities were: dysuria, diarrhea and miccional urgency (AU)

Radioterapia externa parcial acelerada en pacientes con cáncer de seno en estado temprano / External Beam Partial Breast Irradiation for Early Breast Cancer

Objetivo: Demostrar la eficacia y efectividad de la radioterapia parcial acelerada en cáncer temprano de mama en pacientes tratadas con cirugía conservativa. Método: Se trataron cien mujeres con radioterapia externa parcial acelerada, con dosis en un rango de 35 a 38,5 Gy, en 10 fracciones en 5 días dos veces al día con un intervalo de 6 horas. Todas se trataron con 4 campos no cooplanares. El volumen tumoral clínico estuvo cubierto de forma homogénea con la isodosis del 100 %; así mismo el volumen de planeación del blanco, incluido en la isodosis del 95 %. Resultados: El seguimiento promedio fue de 54,3 meses. La tolerancia al tratamiento fue buena y ninguna mujer presentó toxicidad grado 2 o 3. Hasta el momento una paciente presentó recaída ganglionar, local y a distancia. Conclusión: El tratamiento fue bien tolerado, con toxicidad baja y con buenos resultados, en un tiempo corto, con posibles beneficios económicos especialmente en la población de países en vías de desarrollo...

Objective: In this study, our purpose was todemonstrate the feasibility and effectiveness ofexternal beam partial breast irradiation (PBI) inpatients with early-stage breast cancer treated withbreast-conserving surgery. Methods: 100 patientswere treated with PBI with doses ranging from 35to 38.5 Gy, in 10 fractions b.i.d. All patients weretreated with four non-coplanar fields. The clinicaltumor volume was well encompassed withinthe isodose line of 100 % as well as the planningtarget volume which was within the isodose lineof 95 %. Results: The median follow-up was of54.3 months. The treatment was well tolerated,with no more than grade I toxicity. So far, therehas been one patient with local and axillar recurrence.Conclusions: In our experience, thetreatment was well tolerated with low toxicityand with good results, in a shorter treatment time,with the economical benefits this has, especiallyfor populations in developing countries...

Resultados comparativos en el tratamiento del cáncer de próstata localizado con intención curativa / Comparative results in the treatment with curative intent of localized prostate cancer

Introducción: El cáncer de próstata es la segunda causa de muerte por cáncer en los hombres. La determinación del Antígeno Prostático Específico (PSA) que permite detectar muchos tumores órgano-confinados, que hasta hace pocos años pasaban desapercibidos, ha llevado a la migración del diagnóstico hacia estadios más precoces de la enfermedad. La prostatectomía radical ha sido considerada tradicionalmente el tratamiento preferente para el cáncer de próstata localizado en los hombres con una esperanza de vida de 10 años o más. La radioterapia externa (RT) también se ha utilizado extensamente, principalmente en aquellos pacientes no pasibles a ser sometidos a procedimientos invasivos mayores por su elevado riesgo quirúrgico. Tanto la cirugía como la radioterapia externa han obtenido buenos resultados en el control del cáncer de próstata a largo plazo de acuerdo a series publicadas. Sin embargo parecería ser que la prostatectomia radical arrojado mejores resultados en función al periodo libre de enfermedad hasta evidenciarse progresión de la enfermedad. Objetivos: Comparar resultados obtenidos de la evolución de los pacientes con diagnostico de cáncer de próstata en estadio clínico localizado, que fueron tratados por una u otra modalidad. La comparación se realizo en función al periodo libre de enfermedad hasta presentar recidiva de enfermedad, ante pacientes del mismo grupo de riesgo. Materiales y métodos: Se realizó un estudio retrospectivo, analítico y documental de las historias clínicas de 139 pacientes con diagnostico de cáncer de próstata órgano confinado en el período comprendido entre marzo del 2001 y junio del 2010. Los pacientes fueron tratados quirúrgicamente o recibieron radioterapia conformada externa con una radiación promedio de7030 Gy (6500-7560 Gy). Con una edad promedio de 67 años y un seguimiento entre 12 meses y 9 años. Se valoro el periodo transcurrido libre de progresión de enfermedad hasta presentar recaída bioquímica...(AU)

Prostate cancer is the second leading cause of cancer death in men. Prostate specific antigen (PSA) determination can be used to detect organ confined tumors in earlier stages of disease. Radical prostatectomy has traditionallybeen considered as the preferred treatment for localized prostate cancer in men with life expectancy over 10 years. External radiation therapy (RT) has also been used extensively,mainly in patients with high surgical risk. Both surgery and radiotherapy have been successful in controlling prostate cancer, according to published series, but radical prostatectomy yielded better results according to disease free period. Objectives: To compare obtained results from the evolution of patients diagnosed with localizes prostate cancer, treated byeither modality. The comparison was carried out according to disease free interval until disease recurrence.Material and methods: A retrospective and documentary analysis was realized between March 2001 and June 2010,including 139 patients diagnosed with localized prostate cancer. The patients were treated surgically or with external radiotherapy, receiving a mean of 7030 Gy radiation (6500-7560 Gy). Patientshave a mean age of 67 years and have been monitored between 12 months and 9 years. Time elapsed free of disease progression without biochemical relapse were analyzed. Each treatment modality was compared with patients who have the same risk.Results: In low risk patients (55), 18 underwent surgical treatment, of which 16,6% observed biochemical recurrence...(AU)

Resultados comparativos en el tratamiento del cáncer de próstata localizado con intención curativa / Comparative results in the treatment with curative intent of localized prostate cancer

Introducción: El cáncer de próstata es la segunda causa de muerte por cáncer en los hombres. La determinación del Antígeno Prostático Específico (PSA) que permite detectar muchos tumores órgano-confinados, que hasta hace pocos años pasaban desapercibidos, ha llevado a la migración del diagnóstico hacia estadios más precoces de la enfermedad. La prostatectomía radical ha sido considerada tradicionalmente el tratamiento preferente para el cáncer de próstata localizado en los hombres con una esperanza de vida de 10 años o más. La radioterapia externa (RT) también se ha utilizado extensamente, principalmente en aquellos pacientes no pasibles a ser sometidos a procedimientos invasivos mayores por su elevado riesgo quirúrgico. Tanto la cirugía como la radioterapia externa han obtenido buenos resultados en el control del cáncer de próstata a largo plazo de acuerdo a series publicadas. Sin embargo parecería ser que la prostatectomia radical arrojado mejores resultados en función al periodo libre de enfermedad hasta evidenciarse progresión de la enfermedad. Objetivos: Comparar resultados obtenidos de la evolución de los pacientes con diagnostico de cáncer de próstata en estadio clínico localizado, que fueron tratados por una u otra modalidad. La comparación se realizo en función al periodo libre de enfermedad hasta presentar recidiva de enfermedad, ante pacientes del mismo grupo de riesgo. Materiales y métodos: Se realizó un estudio retrospectivo, analítico y documental de las historias clínicas de 139 pacientes con diagnostico de cáncer de próstata órgano confinado en el período comprendido entre marzo del 2001 y junio del 2010. Los pacientes fueron tratados quirúrgicamente o recibieron radioterapia conformada externa con una radiación promedio de7030 Gy (6500-7560 Gy). Con una edad promedio de 67 años y un seguimiento entre 12 meses y 9 años. Se valoro el periodo transcurrido libre de progresión de enfermedad hasta presentar recaída bioquímica...

Prostate cancer is the second leading cause of cancer death in men. Prostate specific antigen (PSA) determination can be used to detect organ confined tumors in earlier stages of disease. Radical prostatectomy has traditionallybeen considered as the preferred treatment for localized prostate cancer in men with life expectancy over 10 years. External radiation therapy (RT) has also been used extensively,mainly in patients with high surgical risk. Both surgery and radiotherapy have been successful in controlling prostate cancer, according to published series, but radical prostatectomy yielded better results according to disease free period. Objectives: To compare obtained results from the evolution of patients diagnosed with localizes prostate cancer, treated byeither modality. The comparison was carried out according to disease free interval until disease recurrence.Material and methods: A retrospective and documentary analysis was realized between March 2001 and June 2010,including 139 patients diagnosed with localized prostate cancer. The patients were treated surgically or with external radiotherapy, receiving a mean of 7030 Gy radiation (6500-7560 Gy). Patientshave a mean age of 67 years and have been monitored between 12 months and 9 years. Time elapsed free of disease progression without biochemical relapse were analyzed. Each treatment modality was compared with patients who have the same risk.Results: In low risk patients (55), 18 underwent surgical treatment, of which 16,6% observed biochemical recurrence...

Targeted molecular therapies in thyroid carcinoma: [review] / Terapias moleculares direcionadas em câncer de tireoide: [revisão]

Thyroid cancer incidence has significantly increased in the last three decades and many patients seek medical attention for its treatment every year. Among follicular cell-derived tumors, the majority are differentiated thyroid carcinomas (DTC), whose prognosis is very good with only 15 percent of the cases presenting disease persistence or recurrence after initial treatment. Medullary thyroid carcinoma has a worse prognosis, especially in patients with diffused cancers at the time of initial surgery. Traditional treatment options for persistent or recurrent disease include additional surgery, radioiodine treatment and TSH-suppression in DTC patients; external beam radiotherapy, and cytotoxic chemotherapy, often have low efficacy and many patients with advanced disease ultimately die. In the last two decades many of the molecular events involved in cancer formation have been uncovered. This knowledge has prompted the development of novel therapeutic strategies mainly based on the inhibition of key molecular mediators of the tumorigenic process. In particular the class of small-molecule tyrosine kinase inhibitors was enriched by many compounds that have reached clinical trials and in some cases have had approval for clinical use in specific cancers. Many of these compounds entered clinical trials also for locally advanced or metastatic thyroid carcinomas showing very promising results.

O câncer de tireoide tem aumentado significativamente nas últimas três décadas e muitos pacientes têm buscado cuidados médicos para o tratamento a cada ano. Entre os tumores derivados de células foliculares, a maioria é carcinoma diferenciado de tireoide (CDT), cujo prognóstico é muito bom, em que somente em 15 por cento dos casos a doença é persistente ou recorrente após o tratamento inicial. O carcinoma medular de tireoide tem um prognóstico pior, especialmente em pacientes com câncer difuso no momento da cirurgia inicial. As opções no tratamento tradicional para a doença persistente ou recorrente incluem cirurgia adicional, radioiodoterapia e supressão de TSH em pacientes CDT; a radioterapia externa e a quimioterapia citotóxica apresentam com frequência uma baixa eficácia e muitos pacientes com doença avançada não sobrevivem. Nas últimas duas décadas, muitos dos eventos envolvidos na formação do câncer tornaram-se conhecidos. Esse conhecimento possibilitou o desenvolvimento de novas estratégias terapêuticas, baseadas principalmente na inibição de mediador molecularchave no processo tumorigênico. Em particular, a classe das pequenas moléculas inibidoras de tirosina-quinase foi enriquecida por muitos compostos investigados em estudos clínicos e alguns casos foram aprovados para uso clínico em tipos específicos de câncer. Muitos desses compostos foram aplicados em estudos clínicos de câncer de tireoide com extensa invasão local ou metástase, mostrando resultados muito promissores.

Weekly monitoring of the effects of conventional external beam radiation therapy on patients with head and neck, chest, and pelvis cancer by means of blood cells count / Avaliação semanal dos efeitos da radioterapia externa convencional pela contagem dos leucócitos e plaquetas de pacientes portadores de câncer nas áreas de cabeça e pescoço, tórax e pelve

OBJETIVO: Avaliar a necessidade de monitoração semanal, pela contagem de leucócitos e plaquetas, dos pacientes portadores de câncer das áreas de cabeça e pescoço, tórax e pelve submetidos a radioterapia externa convencional. MATERIAIS E MÉTODOS: Cento e um adultos, portadores de câncer das áreas de cabeça e pescoço (11 pacientes), tórax (35 pacientes) e pelve (55 pacientes), submetidos a radioterapia, avaliados semanalmente com leucograma e contagem de plaquetas, comparando-se as contagens das células antes do início do tratamento com as obtidas nas semanas ao longo do tratamento, área tratada, sexo e faixa etária. RESULTADOS: A maior queda dos leucócitos e plaquetas ocorreu na quarta semana, quando linfócitos, leucócitos totais, neutrófilos, monócitos e plaquetas apresentaram diminuição de 53,5 por cento, 26,8 por cento, 19,4 por cento, 22,2 por cento e 14,6 por cento, respectivamente, ao serem comparados aos valores do início do tratamento. Durante o tratamento, as médias geométricas da pelve foram estatisticamente menores do que as de tórax e cabeça e pescoço. Os linfócitos foram os mais sensíveis à irradiação. Não houve alteração da contagem de leucócitos e plaquetas relacionadas ao sexo ou à faixa etária. CONCLUSÃO: A partir dos resultados obtidos não parece ser necessária a contagem semanal de leucócitos e plaquetas para pacientes submetidos a radioterapia externa convencional em campos localizados.

OBJECTIVE: To evaluate the necessity of weekly monitoring by means of leukocyte and platelet counts of patients with head and neck, chest, and pelvis cancer submitted to conventional radiotherapy. MATERIALS AND METHODS: A hundred and one adult patients with cancer of head and neck (n = 11), chest (n = 35) and pelvis (n = 55), submitted to radiotherapy were assessed by means of leukocyte and platelet counts on a weekly basis, with a comparison between the results before and during the treatment and in correlation with the area treated, patient's sex and age group. RESULTS: The most significant decrease in leukocytes was observed in the fourth week, when lymphocytes, total leukocytes, neutrophils, monocytes and platelets presented a decrease of 53.5 percent, 26.8 percent, 19.4 percent, 22.2 percent and 14.6 percent, respectively, in comparison with the values found before the beginning of the therapy. Geometric means for pelvis during the treatment were lower than those for chest, and head and neck. Lymphocytes demonstrated to be more sensitive to radiation therapy. No alteration was found in leukocyte or platelet counts in correlation with patients' sex or age. CONCLUSION: Based on the results of the present study, weekly leukocyte and platelet counts do not seem to be useful in the assessment patients submitted to conventional radiotherapy for localized cancer.

Assistência de Enfermagem em Teleterapia em um hospital universitário: sistematização da consulta de enfermagem / Teletherapy nursing care in a university hospital: systematization of nursing consultation

O presente estudo visa proporcionar um embasamento te6rico-cientifico acerca da Assistência de Enfermagem em Teleterapia a ser aplicada em um Hospital Universitário através da Sistematização da Consulta de Enfermagem que proporcionara o desenvolvimento das ações do enfermeiro frente a assistência. Objetiva atender as necessidades do cliente oncológico, de seu familiar e/ou cuidador por meio de informações sobre a doença, tratamento e complicações. Sendo a teleterapia também conhecida como radioterapia externa, uma das formas de tratamento do câncer, e por ocasionar efeitos colaterais que levam o cliente a sentirse inseguro, ocasionando o stress não só advindo da descoberta da patologia como etapas a serem seguidas no tratamento, que objetivou na execução deste trabalho pelo reconhecimento de que através da educação em saúde, o enfermeiro passa a ser um membro fundamental na prevenção, tratamento e controle das doenças crônicas. Através do pensamento educativo, elaboramos material didático informativo que servira como um agenciador das informações prestadas preliminarmente na forma visual previamente elaborada, que será utilizada no primeiro contato com o cliente que levara ao objetivo principal, que e minimizar os feitos colaterais advindos do tratamento que ocasionarão as complicações que são causadoras da interrupção da terapia. Desta forma, através da Consulta de Enfermagem, poderemos proporcionar uma melhor qualidade de vida ao cliente oncológico face ao tratamento por teleterapia.)