Treatment of Localized and Locally Advanced, High-Risk Prostate Cancer: A Report From the First Prostate Cancer Consensus Conference for Developing Countries.

PURPOSE: To generate and present survey results on important issues relevant to treatment and follow-up of localized and locally advanced, high-risk prostate cancer (PCa) focusing on developing countries. METHODS: A panel of 99 PCa experts developed more than 300 survey questions of which 67 questions concern the main areas of interest of this article: treatment and follow-up of localized and locally advanced, high-risk PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up of localized and locally advanced, high-risk PCa in areas of limited resources discussed in this article. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion and not on a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations considered cost-effectiveness as well as the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. Results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this article can guide physicians managing localized and locally advanced, high-risk PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment of localized and locally advanced, high-risk PCa in developing countries have not been defined, this article will serve as a point of reference when confronted with this disease.

Consensus on Prostate Cancer Treatment of Localized Disease With Very Low, Low, and Intermediate Risk: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC).

PURPOSE: A group of international urology and medical oncology experts developed and completed a survey on prostate cancer (PCa) in developing countries. The results are reviewed and summarized, and recommendations on consensus statements for very low-, low-, and intermediate-risk PCa focused on developing countries were developed. METHODS: A panel of experts developed more than 300 survey questions of which 66 questions concern the principal areas of interest of this paper: very low, low, and intermediate risk of PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up for very low-, low-, and intermediate-risk PCa in areas of limited resources discussed in this manuscript. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this document can be used by physicians to support management for very low, low, and intermediate risk of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment for very low, low, and intermediate risk of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.

Analysis of the Abscopal Effect With Anti-PD1 Therapy in Patients With Metastatic Solid Tumors.

Abscopal effect is a rare phenomenon characterized by tumor regression of untreated metastatic lesions after a local therapy (eg, radiotherapy). We studied the probability of abscopal effect with radiotherapy associated with anti-programmed death cell 1 (PD1) therapy after progression on anti-PD1. This study is a retrospective analysis of patients treated with nivolumab or pembrolizumab for melanoma, non-small cell lung cancer (NSCLC) and renal cancer at Antônio Ermírio de Moraes Oncology Center, Brazil. To be eligible for this analysis, patients must have had unequivocal evidence of disease progression on anti-PD1 therapy and subsequent radiotherapy for any tumor site while still receiving anti-PD1. The abscopal effect was characterized as a response outside the irradiated field after radiotherapy plus anti-PD1. Sixteen patients were evaluated, including 12 metastatic melanoma, 2 metastatic NSCLC, and 2 metastatic renal cell carcinoma. The median time to disease progression on anti-PD1 was 3 months. The radiotherapy field included lung, lymph nodes, and bones, with a median total dose of 24 Gy (1-40 Gy), usually in 3 fractions (1-10 fractions). Three patients with melanoma developed an abscopal effect at a rate of 18.7% (25% among melanoma patients). Of note, one of them achieved a remarkable complete response lasting >6 months. Three patients with melanoma obtained a significant local response after radiotherapy, despite no response in distant metastases. Eleven patients presented disease progression after radiotherapy. No increased toxicity was observed. In conclusion, no patients with NSCLC or renal cancer showed abscopal effect, but 25% of patients with melanoma showed regression of nonirradiated lesions when anti-PD1 was continued after radiation to a tumor site that had progressed on anti-PD1 monotherapy.

Oral mucositis prevention by low-level laser therapy in head-and-neck cancer patients undergoing concurrent chemoradiotherapy: a phase III randomized study.

PURPOSE: Oral mucositis is a major complication of concurrent chemoradiotherapy (CRT) in head-and-neck cancer patients. Low-level laser (LLL) therapy is a promising preventive therapy. We aimed to evaluate the efficacy of LLL therapy to decrease severe oral mucositis and its effect on RT interruptions. METHODS AND MATERIALS: In the present randomized, double-blind, Phase III study, patients received either gallium-aluminum-arsenide LLL therapy 2.5 J/cm(2) or placebo laser, before each radiation fraction. Eligible patients had to have been diagnosed with squamous cell carcinoma or undifferentiated carcinoma of the oral cavity, pharynx, larynx, or metastases to the neck with an unknown primary site. They were treated with adjuvant or definitive CRT, consisting of conventional RT 60-70 Gy (range, 1.8-2.0 Gy/d, 5 times/wk) and concurrent cisplatin. The primary endpoints were the oral mucositis severity in Weeks 2, 4, and 6 and the number of RT interruptions because of mucositis. The secondary endpoints included patient-reported pain scores. To detect a decrease in the incidence of Grade 3 or 4 oral mucositis from 80% to 50%, we planned to enroll 74 patients. RESULTS: A total of 75 patients were included, and 37 patients received preventive LLL therapy. The mean delivered radiation dose was greater in the patients treated with LLL (69.4 vs. 67.9 Gy, p = .03). During CRT, the number of patients diagnosed with Grade 3 or 4 oral mucositis treated with LLL vs. placebo was 4 vs. 5 (Week 2, p = 1.0), 4 vs. 12 (Week 4, p = .08), and 8 vs. 9 (Week 6, p = 1.0), respectively. More of the patients treated with placebo had RT interruptions because of mucositis (6 vs. 0, p = .02). No difference was detected between the treatment arms in the incidence of severe pain. CONCLUSIONS: LLL therapy was not effective in reducing severe oral mucositis, although a marginal benefit could not be excluded. It reduced RT interruptions in these head-and-neck cancer patients, which might translate into improved CRT efficacy.

Comparação entre os volumes pulmonares irradiados com técnica bidimensional e tridimensional conformada na radioterapia de pacientes com tumores de pulmão localmente avançados / Comparison between irradiated lung volumes with two-dimensional and three-dimensional conformal radiotherapy techniques for locally advanced lung cancer

OBJETIVO: Comparar e quantificar os volumes pulmonares irradiados utilizando planejamentos bidimensional (2D) e tridimensional (3D) conformado na radioterapia de tumores de pulmão. MATERIAIS E MÉTODOS: Em 27 pacientes portadores de câncer de pulmão foi feito planejamento 3D e outro correspondente em 2D. As doses prescritas variaram de 45 a 66 Gy. Foram avaliadas as doses no volume alvo planejado (PTV), volume tumoral macroscópico (GTV) e pulmões (volume de pulmão que recebe 20 Gy ou 30 Gy - V20 e V30, respectivamente, e dose média). Os órgãos de risco adjacentes (medula espinhal, esôfago e coração) receberam doses abaixo dos limites de tolerância. RESULTADOS: O GTV variou de 10,5 a 1.290,0 cm³ (média de 189,65 cm³). Nos planejamentos 2D foi utilizado, em média, um total de 59,33 campos, e nos planejamentos 3D, 75,65 campos. Em todas as situações analisadas houve significante (p < 0,05) preservação dos volumes pulmonares com o planejamento 3D, com diminuição de cerca de 15 por cento dos volumes irradiados. O pulmão sem tumor foi mais beneficiado. CONCLUSÃO: A radioterapia 3D permitiu maior preservação dos pulmões, tanto para tumores iniciais quanto avançados. A radioterapia 3D deve ser utilizada nos pacientes com tumores de pulmão, mesmo que volumosos.

OBJECTIVE: To compare and quantify irradiated lung volumes using two-dimensional (2D) and three-dimensional (3D) conformal planning for radiotherapy in the treatment of lung cancer. MATERIALS AND METHODS: 2D and 3D conformal radiotherapy plannings were performed for 27 patients with lung cancer. Prescribed doses ranged from 45 to 66 Gy. The analysis covered the doses to planning target volume (PTV), gross tumor volume (GTV) and lungs (lung volume receiving 20 Gy or 30 Gy - V20 and V30, respectively, and mean dose). The doses to adjacent organs at risk (spinal cord, esophagus and heart) were maintained below the tolerance limits. RESULTS: GTV ranged from 10.5 to 1,290.0 cm³ (mean, 189.65 cm³). On average, a total of 59.33 fields were utilized in the 2D planning and 75.65 fields in the 3D planning. Lung volumes were significantly preserved (P < 0.05) with the 3D conformal planning in all the evaluated cases, with about 15 percent decrease in the irradiated lung volumes. Lungs without tumor were most benefited from this technique. CONCLUSION: 3D radiotherapy allowed a better sparing of the lungs, both in cases of early and advanced tumors. 3D radiotherapy should be used in the treatment of patients with lung cancer, even in cases of large tumors.

Analise do Timi Risk score em pacientes com infarto agudo do miocardio com supradesenvolvimento do segmento ST apos 6 meses / The Timi Risk score analysis in ST-elevation myocardial infarction patients after 6 months

O escore de Timi Risk (TR) para infarto agudo do miocardio com supradesnivelamento do segmento ST (IAM) foi...