RESUMO
Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.
Assuntos
Neoplasias Gastrointestinais , Radiocirurgia , Humanos , Estudos Prospectivos , Neoplasias Gastrointestinais/radioterapiaRESUMO
INTRODUCTION: This document is a summary of the French intergroup guidelines regarding the management of esophageal cancer (EC) published in July 2022, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org). METHODS: This collaborative work was conducted under the auspices of several French medical and surgical societies involved in the management of EC. Recommendations were graded in three categories (A, B and C), according to the level of evidence found in the literature until April 2022. RESULTS: EC diagnosis and staging evaluation are mainly based on patient's general condition assessment, endoscopy plus biopsies, TAP CT-scan and 18F FDG-PET. Surgery alone is recommended for early-stage EC, while locally advanced disease (N+ and/or T3-4) is treated with perioperative chemotherapy (FLOT) or preoperative chemoradiation (CROSS regimen) followed by immunotherapy for adenocarcinoma. Preoperative chemoradiation (CROSS regimen) followed by immunotherapy or definitive chemoradiation with the possibility of organ preservation are the two options for squamous cell carcinoma. Salvage surgery is recommended for incomplete response or recurrence after definitive chemoradiation and should be performed in an expert center. Treatment for metastatic disease is based on systemic therapy including chemotherapy, immunotherapy or combined targeted therapy according to biomarkers testing such as HER2 status, MMR status and PD-L1 expression. CONCLUSION: These guidelines are intended to provide a personalised therapeutic strategy for daily clinical practice and are subject to ongoing optimization. Each individual case should be discussed by a multidisciplinary team.
Assuntos
Adenocarcinoma , Neoplasias Esofágicas , Humanos , Seguimentos , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/terapia , Terapia Combinada , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapiaRESUMO
CDK4/6 inhibitors are nowadays commonly used in metastatic HR+/HER2- breast cancer. Herein, we report a literature review regarding the benefits and risks of their combination with radiotherapy. Numerous pre-clinical studies have indeed shown a potential synergistic effect of these treatments in combination with radiotherapy in various types of cancers. On the other hand, some retrospective clinical studies have reported increased acute toxicity in case of digestive or pulmonary irradiation; therefore, it is advisable to discontinue CDK4/6 inhibitors before starting irradiation. Several prospective clinical trials are currently ongoing to assess the feasibility of this combination.
Assuntos
Neoplasias da Mama , Quinase 6 Dependente de Ciclina , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Quinase 4 Dependente de Ciclina/uso terapêutico , Quinase 6 Dependente de Ciclina/uso terapêutico , Feminino , Humanos , Estudos Prospectivos , Inibidores de Proteínas Quinases/efeitos adversos , Receptor ErbB-2 , Estudos RetrospectivosRESUMO
Esophageal cancers continue to have a poor prognosis, even if this has improved over the past 25 years due to better management. Pre-operative chemotherapy with Paclitaxel-Carboplatin followed by adjuvant immunotherapy with Nivolumab represents a major advance in the management of locally advanced oesophageal cancer. Pre-operatively, chemo-radiotherapy can be performed in combination with FOLFOX or Paclitaxel-Carboplatin. Several trials are currently ongoing to evaluate the benefit of immunotherapy in non-operable cancers. In contrast, dose escalation in locally advanced non-operable tumors and the combination of pre-operative chemo-radiotherapy with trastuzumab have not been shown to be beneficial.
Assuntos
Neoplasias Esofágicas , Neoplasias Pulmonares , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Humanos , Neoplasias Pulmonares/radioterapia , Nivolumabe/uso terapêutico , Paclitaxel , Trastuzumab/uso terapêuticoRESUMO
We present the updated recommendations of the French society for radiation oncology on radiotherapy of oesophageal cancer. Oesophageal cancer still remains a malignant tumour with a poor prognosis. Surgery remains the standard treatment for localized cancers, regardless of histology. For locally advanced stages, surgery remains a standard for adenocarcinomas after neoadjuvant treatment with chemotherapy or chemoradiotherapy. However, it is a therapeutic option after initial chemoradiotherapy for stage III squamous cell carcinomas, given the increased morbidity and mortality with a multimodal treatment, which results in an equivalent overall survival with or without surgery. Preoperative or exclusive chemoradiotherapy should be delivered according to validated regimens with an effective total dose (50Gy), if surgery is not planned or if the tumour is deemed resectable before chemoradiotherapy. Intensity-modulated radiotherapy significantly reduces irradiation of the lungs and heart and may reduce the morbidity of this treatment, especially in combination with surgery. In case of exclusive chemoradiotherapy, dose escalation beyond 50Gy is not currently recommended. Some technical considerations still remain questionable, such as the place of prophylactic lymph node irradiation, adaptive radiotherapy, evaluation of response during and after chemoradiotherapy and the value of proton therapy.
Assuntos
Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Cárdia , Neoplasias Esofágicas/radioterapia , Neoplasias Gástricas/radioterapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Braquiterapia/métodos , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , França , Humanos , Irradiação Linfática , Terapia Neoadjuvante/métodos , Posicionamento do Paciente/métodos , Radioterapia (Especialidade) , Dosagem Radioterapêutica , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada/métodosRESUMO
We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of cutaneous cancers. The indications of radiotherapy for skin cancers are not clearly defined because of the lack of randomized trials or prospective studies. For basal cell carcinomas, radiotherapy frequently offers a good local control, but a randomized trial showed that surgery is more efficient and less toxic. Indications of radiotherapy are contra-indications of surgery for patients older than 60, non-sclerodermiform histology and located in non-sensitive areas. Adjuvant radiotherapy could be proposed to squamous cell carcinomas, in case of poor prognostic factors. Dose of 60 to 70Gy are usually required, and must be modulated to the size of the lesions. Adjuvant radiotherapy seems beneficial for desmoplastic melanomas but not for the other histological types. Prophylactic nodal irradiation (45 to 50Gy), for locally advanced tumors (massive nodal involvement), decreases the locoregional failure rate but do not increase survival. Adjuvant radio- therapy (50 to 56Gy) for Merkel cell carcinomas increases also the local control rate, as demonstrated by meta-analysis and a large epidemiological study. Nodal areas must be included, if there is no surgical exploration (sentinel lymph node dissection). Kaposi sarcomas are radiosensitive and could be treated with relatively low doses (24 to 30Gy). Also, cutaneous lymphomas are good indications for radiotherapy: B lymphomas are electively treated with limited fields. The role of total skin electron therapy for T-lymphomas is still discussed; but palliative radiotherapy is very efficient in case of cutaneous nodules.
Assuntos
Neoplasias Cutâneas/radioterapia , Carcinoma Basocelular/radioterapia , Carcinoma Basocelular/cirurgia , Carcinoma de Célula de Merkel/radioterapia , Carcinoma de Células Escamosas/radioterapia , França , Humanos , Linfoma Cutâneo de Células T/radioterapia , Melanoma/patologia , Melanoma/radioterapia , Cuidados Paliativos , Prognóstico , Radioterapia (Especialidade) , Dosagem Radioterapêutica , Radioterapia Adjuvante , Sarcoma de Kaposi/radioterapia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
The place of personalized treatments is highly increasing in medical and radiation oncology. During the last decades, a huge number of assays have been developed to predict responses of normal tissues and tumours. These tests have not yet been included into daily clinical practice but the recent developments of radiation oncology are paving the way of personalized strategies including the risk of tumour recurrence and normal tissue reactions. Concerning tumor radiosensitivity prediction, no test are currently used, even if the radiosensitivity index and the genome-based model for adjusting radiotherapy dose assays seem the most promising with level II of evidence. Commercial developments are under progress. Concerning normal tissue radiosensitivity prediction, single nucleotide polymorphims of prostate cancer patients and radiation-induced CD8 T-lymphocyte apoptosis breast and prostate assays are of level I of evidence. They can be proposed before the beginning of radiotherapy in order to propose personalized treatments according to both risks of tumour and normal tissue radiosensitivity. Commercial developments are also under way.
Assuntos
Neoplasias/radioterapia , Órgãos em Risco/efeitos da radiação , Medicina de Precisão/métodos , Tolerância a Radiação/genética , Reparo do DNA , Fibroblastos/efeitos da radiação , Expressão Gênica , Marcadores Genéticos , Humanos , Neoplasias/genética , Neoplasias/imunologia , Polimorfismo de Nucleotídeo Único , Prognóstico , Resultado do TratamentoRESUMO
Management of high-risk prostate cancers is still a subject of debate, because of the lack of randomized trial comparing surgery and radiotherapy. If external beam radiotherapy is proposed, it must be associated with a long-term androgen deprivation therapy, at least 18-months. Irradiation of pelvic lymph nodes seems to improve distant metastasis-free survival and is so indicated in most of the cases. Moderate hypofractionation is not validated for pelvic lymph nodes irradiation. A combination of external beam radiotherapy and brachytherapy improved biochemical control in randomized trials without impact on survival. But this combination has been evaluated in large retrospective studies and seems to improve specific and overall survivals. An integrated boost on the MRI-defined index lesion is another way of dose escalation and improved also biochemical control. Stereotactic radiotherapy is not a validated option at this moment. For each patient, according to the extension of the disease, age, comorbidities and also his willingness, the best approach must be chosen, ideally in multidisciplinary meeting.
Assuntos
Neoplasias da Próstata/radioterapia , Antagonistas de Androgênios/uso terapêutico , Braquiterapia , Terapia Combinada/métodos , Humanos , Irradiação Linfática/métodos , Masculino , Pelve , Intervalo Livre de Progressão , Prostatectomia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Hipofracionamento da Dose de Radiação , Radiocirurgia , Radioterapia de Intensidade Modulada/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reirradiação , RiscoRESUMO
Basal cell carcinomas and cutaneous squamous cell carcinomas are among the most common cancerous tumors in the world. Their treatment is most often based on surgery. Adjuvant radiotherapy may be indicated in case of risk factors for recurrence or as an alternative to surgery if surgery is not feasible due to the patient's advanced age and/or co-morbidities or as an alternative to potentially mutilating surgery. Radiotherapy is also part of the therapeutic arsenal for rarer skin tumors such as Merkel cell carcinoma, cutaneous lymphomas, Kaposi's disease and cutaneous adnexal carcinomas.
Assuntos
Carcinoma de Célula de Merkel/radioterapia , Neoplasias de Anexos e de Apêndices Cutâneos/radioterapia , Neoplasias Cutâneas/radioterapia , Carcinoma Basocelular/radioterapia , Carcinoma de Célula de Merkel/patologia , Carcinoma de Células Escamosas/radioterapia , Quimiorradioterapia , Humanos , Linfoma/radioterapia , Sarcoma de Kaposi/radioterapia , Neoplasias Cutâneas/patologiaRESUMO
For many years, adjuvant chemoradiotherapy remained essential in the therapeutic management of gastric and pancreatic adenocarcinomas. For these tumours, surgical excision, the only hope of offering the patient prolonged survival, is only possible in 20% of cases. The median survival of operated patients is only 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. For stomach cancers, adjuvant chemoradiotherapy is justified by the results of the phase III trial Intergroup 0116 published by MacDonald et al. The gain in survival was at the cost of significant toxicity. This treatment was supplanted in the early 2000s by perioperative chemotherapy. Currently, neoadjuvant chemoradiotherapy clinical studies are ongoing with the aim of improving treatments observance and tolerance. For pancreatic cancers, the role of adjuvant chemoradiotherapy has long been discussed because of trials with contradictory results. Neoadjuvant radiotherapy has many advantages in terms of efficacy and tolerance. It increases the chances of subsequent complete tumour resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal.
Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia Adjuvante , Terapia Neoadjuvante , Neoplasias Pancreáticas/terapia , Neoplasias Gástricas/terapia , HumanosRESUMO
ANTECEDENTES Y OBJETIVO: Los objetivos de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SCI-SEDAR) con el presente trabajo son: establecer nuevas recomendaciones adaptando los estándares publicados por el Ministerio de Sanidad y Política Social, y alineadas con las principales guías internacionales, y desarrollar una herramienta de mejora de la calidad y la eficiencia. MATERIALES Y MÉTODO: A lo largo de 2018, 3 miembros de la SCI-SEDAR definieron la metodología, desarrollaron las recomendaciones y seleccionaron al panel de expertos. Debido a la limitada evidencia de buena parte de las recomendaciones y a la importante variabilidad estructural de las unidades de cuidados intensivos de anestesia actuales, se optó por un abordaje Delphi modificado para determinar el grado de consenso. RESULTADOS: Un total de 24 expertos de 21 instituciones constituyeron el grupo de expertos del presente trabajo. Se establecieron 175 recomendaciones sobre 8 apartados, incluyendo 129 con consenso fuerte y 46 con consenso débil. CONCLUSIONES: La SCI-SEDAR estableció las recomendaciones estructurales de las unidades de cuidados intensivos de anestesia que deberán guiar la renovación o la creación de nuevas unidades
BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units
Assuntos
Humanos , Anestesiologia/normas , Consenso , Arquitetura de Instituições de Saúde/normas , Unidades de Terapia Intensiva/normas , Anestesia , Anestesiologia/legislação & jurisprudência , Acessibilidade Arquitetônica/legislação & jurisprudência , Acessibilidade Arquitetônica/normas , Técnica Delphi , Arquitetura de Instituições de Saúde/legislação & jurisprudência , Número de Leitos em Hospital/normas , Zeladoria , Zeladoria Hospitalar/normas , Unidades de Terapia Intensiva/legislação & jurisprudência , Decoração de Interiores e Mobiliário/normas , Serviço Hospitalar de Lavanderia/normas , Iluminação/normas , Quartos de Pacientes/legislação & jurisprudência , Quartos de Pacientes/normas , Melhoria de Qualidade , Sociedades Médicas , EspanhaRESUMO
A pesar de la extendida y frecuente utilización del catéter de arteria pulmonar en nuestro medio para el manejo hemodinámico en pacientes críticos y particularmente en pacientes tras cirugía cardiaca, en la actualidad siguen planteándose dudas sobre la necesidad de su uso. Es preciso valorar el riesgo/beneficio de su colocación y tener en cuenta sus posibles complicaciones, que aun siendo poco frecuentes, pueden llegar a ser potencialmente graves. En este artículo exponemos una complicación muy poco frecuente ocurrida en nuestro centro sobre el uso del catéter de arteria pulmonar de la que no teníamos constancia hasta ahora. Se trata de una perforación del tabique interventricular y de la pared libre del ventrículo izquierdo debido a una acodadura firme del catéter de arteria pulmonar, que no fue sospechada ni diagnosticada salvo por la visión directa del corazón, tras la esternotomía, durante la cirugía cardiaca. La mejora de la seguridad del paciente implica reflexionar sobre el valor de los eventos adversos, de manera que al aumentar la conciencia de la situación y del mecanismo por el que se producen, pueda reducirse la probabilidad de repetición
Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future
Assuntos
Humanos , Feminino , Idoso , Cateterismo de Swan-Ganz/efeitos adversos , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Complicações Intraoperatórias/etiologia , Aneurisma Aórtico/cirurgia , Cateterismo de Swan-Ganz/instrumentação , Ecocardiografia/métodos , Falha de Equipamento , Septos Cardíacos/lesões , Artéria Pulmonar/diagnóstico por imagemRESUMO
Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future.
Assuntos
Cateterismo de Swan-Ganz/efeitos adversos , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Complicações Intraoperatórias/etiologia , Idoso , Aneurisma Aórtico/cirurgia , Cateterismo de Swan-Ganz/instrumentação , Ecocardiografia/métodos , Falha de Equipamento , Feminino , Septos Cardíacos/lesões , Humanos , Artéria Pulmonar/diagnóstico por imagemRESUMO
BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units.
Assuntos
Anestesiologia/normas , Consenso , Arquitetura de Instituições de Saúde/normas , Unidades de Terapia Intensiva/normas , Anestesia , Anestesiologia/legislação & jurisprudência , Acessibilidade Arquitetônica/legislação & jurisprudência , Acessibilidade Arquitetônica/normas , Técnica Delphi , Arquitetura de Instituições de Saúde/legislação & jurisprudência , Número de Leitos em Hospital/normas , Zeladoria , Zeladoria Hospitalar/normas , Humanos , Unidades de Terapia Intensiva/legislação & jurisprudência , Decoração de Interiores e Mobiliário/normas , Serviço Hospitalar de Lavanderia/normas , Iluminação/normas , Quartos de Pacientes/legislação & jurisprudência , Quartos de Pacientes/normas , Melhoria de Qualidade , Sociedades Médicas , EspanhaRESUMO
Chemoradiotherapy is now considered the standard of care for many locally advanced diseases. Cytotoxic drugs have been largely evaluated in this setting, with cisplatin and 5FU the most often used drugs. A large amount of pre-clinical studies has demonstrated the synergy between both modalities. Concomitant administration seems the more beneficial in many diseases. Emergence of new approaches, combining targeted therapies and radiotherapy (RT) is now a reality. The main example is the association of cetuximab and RT in head and neck carcinomas, even if, 14 years after the initial publication, the best way to use it is still unknown. New compounds as inhibitors of DNA-repair or immune checkpoints are under investigation and showed early promising results.
Assuntos
Antineoplásicos/administração & dosagem , Quimiorradioterapia/tendências , Neoplasias/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cetuximab/administração & dosagem , Quimiorradioterapia/métodos , Cisplatino/administração & dosagem , Reparo do DNA/efeitos dos fármacos , Docetaxel/administração & dosagem , Esquema de Medicação , Fluoruracila/administração & dosagem , Humanos , Terapia de Alvo Molecular/métodos , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/prevenção & controle , Fatores de TempoRESUMO
Along with the surgeon, the gastroenterologist and the general practitioner, the radiation oncologist is involved in the follow-up of patients with rectal cancer treated by radiation. Post-treatment follow-up is recommended by major professional expert groups and consists of clinical examination, monitoring of carcinoembryonic antigen, colonoscopy and computed tomography of the abdomen and pelvis. Three recent large phase III randomized trials demonstrated a lack of survival benefit from intensive follow-up strategies in comparison with minimal follow-up. However, a follow-up program is not only important for the detection of an early disease relapse but it can be also used for the identification and the management of long-term toxicity and sequalae related to rectal cancer treatment.
Assuntos
Assistência ao Convalescente/métodos , Recidiva Local de Neoplasia/diagnóstico , Segunda Neoplasia Primária/prevenção & controle , Papel do Médico , Radio-Oncologistas , Neoplasias Retais/diagnóstico , Neoplasias Retais/radioterapia , Ensaios Clínicos Fase III como Assunto , Feminino , Seguimentos , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Fractionation was established more than fifty years ago as the best way to obtain a differential effect between tumors and normal tissues. However, new technologies allowed today to spare critical organs from the radiation fields. And so protracted courses of irradiation are no longer required. Hypofractionation have clear practical advantages over classical fractionation: it saves the patient time; it saves money for public health system; it reduces pressure on radiotherapy units. In several localization, it has proved to be as efficient as classical fractionation without increasing late effects. In prostate cancer, some radiobiological considerations argue in favor of a better efficiency, but clinical trials did not demonstrated differences in biological control. In conclusion, for all diseases where hypofractionation was demonstrated efficient, it must be fully implemented. Invoice procedures must be adapted to maintain a sufficient level of reimbursement of radiotherapy centers.
Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação/normas , Institutos de Câncer/economia , Feminino , Humanos , Masculino , Tamanho do Órgão/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Tolerância a Radiação , Mecanismo de Reembolso , Reprodutibilidade dos TestesRESUMO
Management of resectable esophageal carcinoma is based on a multimodal treatment associating neo-adjuvant chemoradiation before surgery. This therapeutic sequence allows a disease-free survival rate at 2 years around 45% but remains associated with a high post-operative morbidity. In case of definitive chemoradiotherapy, the dose delivered to the macroscopic disease is a controversial topic since decades and the prognosis of patients treated in this setting at the dose of 50Gy remains poor. This article proposes a review of the main published data and the ongoing studies related to the management of these patients.
Assuntos
Carcinoma/terapia , Quimiorradioterapia Adjuvante/métodos , Neoplasias Esofágicas/terapia , Terapia Neoadjuvante , Humanos , Cuidados Pré-Operatórios/métodos , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodosRESUMO
PURPOSE: The purpose of this study was to determine the efficacy of salvage cryotherapy for intra-prostatic and local extraprostatic recurrences after curative treatment of prostate adenocarcinoma. MATERIAL AND METHOD: Twenty-eight men (mean age, 69±6 [SD] years; range: 51-82 years) treated with cryoablation for prostatic (N=21) or extraprostatic (N=7) recurrent prostate cancer after radiotherapy with or without associated prostatectomy were included. Technical success, complication and recurrences were reported. Biological recurrence was defined as an elevation ≥2ng/mL of prostate specific antigen (PSA) serum level after the treatment. RESULTS: The mean follow-up was 18 months. Among the 21 patients with intraprostatic recurrence, 14 had successful cryotherapy with a mean decrease in serum prostate-specific antigen (PSA) levels of -5.7±2.6 (SD) ng/mL (range: -2.1 to -16.9ng/mL). Four patients (19%) had early progression and three patients (14%) had delayed biological recurrence (mean time: 15 months). Among the 7 patients with extraprostatic recurrence, 2/7 (291%) had successful cryotherapy with a decrease in PSA serum level of -2.7±1.6 (SD) ng/mL (range: -0.5--5.5ng/mL) and 4/7 (57%) had early biological recurrence after cryotherapy that required androgen deprivation therapy, whereas 1/7 (4%) was lost to follow-up. No major complications were observed for both intra- and extraprostatic recurrence. CONCLUSION: Salvage cryoablation of locally recurrent prostate cancer after curative treatment is feasible and safe when the half prostate is treated. It could delay initiation of androgen deprivation therapy in these patients.
Assuntos
Adenocarcinoma/cirurgia , Criocirurgia/métodos , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Próstata/cirurgia , Terapia de Salvação/métodos , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/radioterapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/diagnóstico por imagem , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Estudos RetrospectivosRESUMO
OBJETIVO: Conocer el grado de correlación entre el diagnóstico clínico previo al proceso de cirugía menor y su concordancia con los resultados de anatomía patológica, al igual que conocer los datos de cirugía de escasa trascendencia clínica frente a la realmente necesaria y coste-efectiva. MATERIAL Y MÉTODO: Para ello realizamos un estudio descriptivo, observacional, retrospectivo y transversal de las actividades de cirugía menor de una consulta del Centro de Salud Ciudad Real I. RESULTADOS: Se remiten 124 piezas para su diagnóstico histológico, de las cuales los principales diagnósticos clínicos son: nevus melanocíticos intradérmicos (34,67%), queratosis seborreica (11,30%) y quistes epidermoides o sebáceos (10,48%). Se obtiene una correlación clinicopatológica del 68%. Se han seguido los protocolos del centro de trabajo para la realización de este estudio en relación con la confidencialidad de los datos. CONCLUSIONES: Analizamos estos resultados y los comparamos con otros trabajos similares realizados en el ámbito de la cirugía menor en atención primaria, pudiendo afirmar que existe una buena correlación entre el diagnóstico clínico inicial y los resultados anatomopatológicos
OBJECTIVE: To determine the degree of correlation between the clinical diagnosis prior to the minor surgery process and its concordance with the results of histopathology report, as well as to determine the surgical data of little clinical importance compared to that which is really necessary and cost-effective. MATERIAL AND METHOD: A descriptive, observational, retrospective and transversal study was conducted of the Minor Surgery Activities of a clinic in the Ciudad Real Health Centre I. RESULTS: A total of 124 surgical specimens were sent for clinical diagnostic comparison, of which, the main clinical diagnoses were: intradermal melanocytic nevi (34.67%), seborrheic keratosis (11.30%), and epidermoid or sebaceous cysts (10.48%). A correlation of 68% was obtained. The protocols of the work centre have been followed to carry out this study in relation to the confidentiality of the data. CONCLUSIONS: These results were analysed and compared with other similar works performed in the field of minor surgery in Primary Care, being able to affirm that there is a good correlation between the initial clinical diagnosis and the histopathology results