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1.
Anticancer Res ; 41(10): 5065-5069, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593456

RESUMO

BACKGROUND/AIM: Many patients with head-and-neck cancer are scheduled for irradiation. This study was performed to determine the frequency of and risk factors for pre-radiotherapy sleep disturbances in these patients. PATIENTS AND METHODS: A total of 103 patients with head-and-neck cancer scheduled for radiotherapy were included in this retrospective study. Eighteen characteristics were evaluated including timing of start of radiotherapy relative to COVID-19 pandemic; age; gender; Karnofsky performance score; Charlson comorbidity index; history of another malignancy; family history of malignancy; distress score; number of emotional, physical or practical problems; request for psychological support; tumor site and stage; upfront surgery; planned chemotherapy; and brachytherapy boost. RESULTS: The frequency of pre-radiotherapy sleep disturbances was 42.7%. This was significantly associated with age ≤63 years (p=0.049), Karnofsky performance score ≤80 (p=0.002), Charlson comorbidity index ≥3 (p=0.005), history of another malignancy (p=0.012), emotional (p=0.001) or physical (p<0.001) problems, and request for psychological support (p=0.002). CONCLUSION: Sleep disturbances were frequent in patients assigned to radiotherapy of head-and-neck cancer. Recognizing risk factors for sleep disturbance helps identify patients requiring psychological support.


Assuntos
Neoplasias de Cabeça e Pescoço/psicologia , Neoplasias de Cabeça e Pescoço/radioterapia , Transtornos do Sono-Vigília/psicologia , COVID-19/epidemiologia , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Transtornos do Sono-Vigília/epidemiologia
2.
Anticancer Res ; 41(10): 5165-5169, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593468

RESUMO

BACKGROUND/AIM: Many patients with prostate cancer receive definitive or adjuvant radiotherapy. This study aimed to identify the frequency of sleep disturbances and corresponding risk factors prior to radiation treatment. PATIENTS AND METHODS: Data of 48 patients assigned to local or loco-regional irradiation for prostate cancer were retrospectively analyzed for pre-radiotherapy sleep disturbances. Fifteen characteristics were analyzed including age, performance status, comorbidity, history of previous malignancy, distress score, (emotional, physical or practical) problems, prostate-specific antigen, primary tumor stage, Gleason-score, upfront androgen deprivation therapy (ADT), treatment volume, brachytherapy, and COVID-19 pandemic. RESULTS: Pre-radiotherapy sleep disturbances were reported by 20.8% of patients and significantly associated with distress scores ≥4 (p<0.0001) and ≥3 physical problems (p=0.0001). Trends were found for Karnofsky performance score ≤80 (p=0.095), Gleason score 7b-9 (p=0.079), and ADT (p=0.067). CONCLUSION: Pre-radiotherapy sleep disturbances were less common in prostate cancer patients than in other cancer patients. Risk factors were identified that can help identify patients requiring psychological support prior to radiotherapy.


Assuntos
Neoplasias da Próstata/psicologia , Neoplasias da Próstata/radioterapia , Transtornos do Sono-Vigília/psicologia , Idoso , COVID-19/epidemiologia , Humanos , Masculino , Prevalência , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Transtornos do Sono-Vigília/epidemiologia
3.
Anticancer Res ; 41(9): 4407-4410, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475061

RESUMO

BACKGROUND/AIM: Many patients with gynecological malignancies receive postoperative radiotherapy, which can lead to fear and sleep disorders. We aimed to identify the prevalence of and risk factors for sleep disorders. PATIENTS AND METHODS: Sixty-two patients assigned to radiotherapy for gynecological malignancies were retrospectively evaluated. Seventeen characteristics were analyzed for associations with pre-radiotherapy sleep disorders including age, Karnofsky performance score, Charlson comorbidity index, history of additional malignancy, family history of gynecological cancer, distress score, emotional, physical or practical problems, tumor site/stage; chemotherapy, treatment volume, brachytherapy, and the COVID-19 pandemic. RESULTS: The prevalence of pre-radiotherapy sleep disorders was 46.8%. Sleep disorders were significantly associated with Charlson comorbidity index ≥3 (p=0.012), greater number of physical problems (p<0.0001), and advanced primary tumor stage (p=0.005). A trend was found for greater number of emotional problems (p=0.075). CONCLUSION: Pre-radiotherapy sleep disorders are common in patients with gynecological malignancies, particularly in those with specific risk factors. Patients should be offered early psychological support.


Assuntos
Neoplasias dos Genitais Femininos/radioterapia , Neoplasias dos Genitais Femininos/cirurgia , Radioterapia Adjuvante/métodos , Transtornos do Sono-Vigília/epidemiologia , Adulto , Braquiterapia , COVID-19/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/psicologia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prevalência , Estudos Retrospectivos , Fatores de Risco , Transtornos do Sono-Vigília/etiologia , Resultado do Tratamento
4.
Anticancer Res ; 41(9): 4439-4442, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475066

RESUMO

BACKGROUND/AIM: Radiotherapy and radiochemotherapy are common treatments for rectal and anal cancer. Anticipation of treatment may cause distress and sleep disorders. This study aimed to identify risk factors for sleep disorders. PATIENTS AND METHODS: In 42 patients with rectal or anal cancer scheduled for radiotherapy, 16 characteristics were analyzed for associations with pre-radiotherapy sleep disorders including age, gender, performance score, comorbidity, patient's or family history of additional cancer/melanoma, distress score, emotional/physical/practical problems, tumor site and stage, surgery and relation to COVID-19 pandemic. RESULTS: Overall prevalence of pre-radiotherapy sleep disorders was 42.9%. Sleep disorders were significantly associated with Karnofsky performance score 60-80 (p=0.044), Charlson comorbidity index ≥3 (p=0.0012), distress score 6-10 (p=0.00012), and more emotional (p=0.0012), physical (p=0.0004) or practical (p=0.033) problems. A trend was found for female gender (p=0.061). CONCLUSION: Sleep disorders were common in patients with rectal or anal cancer scheduled for radiotherapy. Risk factors can help identify patients requiring psychooncological support already prior to the start of radiotherapy.


Assuntos
Neoplasias do Ânus/radioterapia , Neoplasias do Ânus/cirurgia , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Transtornos do Sono-Vigília/epidemiologia , Idoso , Neoplasias do Ânus/patologia , Neoplasias do Ânus/psicologia , COVID-19/epidemiologia , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prevalência , Neoplasias Retais/patologia , Neoplasias Retais/psicologia , Caracteres Sexuais , Transtornos do Sono-Vigília/etiologia , Resultado do Tratamento
5.
In Vivo ; 35(5): 2763-2770, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410966

RESUMO

BACKGROUND/AIM: Being scheduled for radiotherapy can cause emotional distress. This study aimed to identify risk factors in 338 patients assigned to radiotherapy for breast cancer. PATIENTS AND METHODS: Nineteen potential risk factors including the COVID-19 pandemic were investigated for associations with the six emotional problems included in the National Comprehensive Cancer Network Distress Thermometer. RESULTS: Worry and fears were significantly associated with age ≤60 years; sadness with age and Karnofsky performance score (KPS) <90; depression with KPS and Charlson Comorbidity Index ≥3; loss of interest with KPS. Trends were found for associations between sadness and additional breast cancer/DCIS, Charlson Index and chemotherapy; between depression and additional breast cancer/DCIS, treatment volume and nodal stage N1-3; between nervousness and additional breast cancer/DCIS, mastectomy and triple-negativity; between loss of interest and Charlson Index, family history of breast cancer/DCIS, invasive cancer, chemotherapy, and treatment volume. The COVID-19 pandemic did not increase emotional problems. CONCLUSION: Several risk factors for emotional problems were identified. Patients with such factors should receive psychological support well before radiotherapy.


Assuntos
Neoplasias da Mama , COVID-19 , Carcinoma Intraductal não Infiltrante , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Mastectomia , Mastectomia Segmentar , Pessoa de Meia-Idade , Pandemias , Radioterapia Adjuvante/efeitos adversos , SARS-CoV-2
6.
Anticancer Res ; 41(2): 877-884, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517293

RESUMO

BACKGROUND/AIM: Prognosis of patients with unresectable squamous cell carcinomas of the head and neck requires improvement. This retrospective study compared accelerated radiotherapy plus chemotherapy to conventional radiochemotherapy. PATIENTS AND METHODS: Patients received definitive treatment with accelerated radiotherapy plus chemotherapy (group A, n=10) or conventional cisplatin-based radiochemotherapy (group B, n=85). Groups were matched for several patient and tumor characteristics and compared for locoregional control (LRC), overall survival (OS) and toxicities. Additionally, accelerated radiotherapy plus chemotherapy and chemotherapy regimens in group B were compared for LRC and OS. RESULTS: Treatment type had no significant impact on LRC (p=0.98) and OS (p=0.57). In group A, toxicities occurred more often, including grade ≥3 mucositis (p=0.041), grade ≥2 lymphedema (p=0.007) and grade ≥3 leucopenia (p=0.007). Best 2-year LRC (p=0.39) and OS (p=0.015) was achieved with 20 mg/m2 cisplatin days 1-5 every 4 weeks; accelerated radiochemotherapy resulted in second-worst outcomes. CONCLUSION: Given the limitations of this study, accelerated radiotherapy plus chemotherapy provided no significant benefit but increased toxicity compared to conventional radiochemotherapy.


Assuntos
Quimiorradioterapia/métodos , Cisplatino/administração & dosagem , Neoplasias de Cabeça e Pescoço/terapia , Quimiorradioterapia/efeitos adversos , Quimioterapia Adjuvante , Cisplatino/efeitos adversos , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Radioterapia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
7.
Strahlenther Onkol ; 196(9): 795-804, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32533228

RESUMO

PURPOSE: To investigate the efficacy and toxicity of cetuximab when added to radiochemotherapy for unresectable esophageal cancer. METHODS: This randomized phase 2 trial (clinicaltrials.gov, identifier NCT01787006) compared radiochemotherapy plus cetuximab (arm A) to radiochemotherapy (arm B) for unresectable esophageal cancer. Primary objective was 2­year overall survival (OS). Arm A was considered insufficiently active if 2­year OS was ≤40% (null hypothesis = H0), and promising if the lower limit of the 95% confidence interval was >45%. If that lower limit was >40%, H0 was rejected. Secondary objectives included progression-free survival (PFS), locoregional control (LC), metastases-free survival (MFS), response, and toxicity. The study was terminated early after 74 patients; 68 patients were evaluable. RESULTS: Two-year OS was 71% in arm A (95% CI: 55-87%) vs. 53% in arm B (95% CI: 36-71%); H0 was rejected. Median OS was 49.1 vs. 24.1 months (p = 0.147). Hazard ratio (HR) for death was 0.60 (95% CI: 0.30-1.21). At 2 years, PFS was 56% vs. 44%, LC 84% vs. 72%, and MFS 74% vs. 54%. HRs were 0.51 (0.25-1.04) for progression, 0.43 (0.13-1.40) for locoregional failure, and 0.43 (0.17-1.05) for distant metastasis. Overall response was 81% vs. 69% (p = 0.262). Twenty-six and 27 patients, respectively, experienced at least one toxicity grade ≥3 (p = 0.573). A significant difference was found for grade ≥3 allergic reactions (12.5% vs. 0%, p = 0.044). CONCLUSION: Given the limitations of this trial, radiochemotherapy plus cetuximab was feasible. There was a trend towards improved PFS and MFS. Larger studies are required to better define the role of cetuximab for unresectable esophageal cancer.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Cetuximab/uso terapêutico , Quimiorradioterapia , Neoplasias Esofágicas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/efeitos adversos , Cetuximab/efeitos adversos , Quimiorradioterapia/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão
8.
Anticancer Res ; 40(3): 1661-1664, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132071

RESUMO

BACKGROUND/AIM: Elderly patients with metastatic esophageal cancer may benefit from individualized therapies. A tool to predict the survival of such patients with brain metastases was created. PATIENTS AND METHODS: In 11 elderly patients (≥65 years) receiving whole-brain irradiation (WBI) for brain metastases from esophageal cancer, age, gender, performance status, number of brain metastases, metastases outside the brain, time between cancer diagnosis and WBI, and WBI regimen were evaluated for survival. RESULTS: On univariate analyses, age ≥73 years (p=0.046) and time between diagnosis of esophageal cancer and WBI ≤6 months (p=0.046) were significantly associated with poorer survival. On multivariate analysis, both showed a trend. Based on these two factors, the following points were assigned: age ≤72 years=1 point, age ≥73 years=0 points; time between cancer diagnosis and WBI >6 months=1 point, and ≤6 months=0 points. Three prognostic groups were thus formed: 0, 1 and 2 points. Survival rates of these groups at 6 months were 0%, 0% and 40% (p=0.012), respectively. CONCLUSION: This new tool allows estimation of survival and treatment individualization in elderly patients irradiated for brain metastases from esophageal cancer.


Assuntos
Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Neoplasias Esofágicas/complicações , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Feminino , Humanos , Masculino , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento
9.
Anticancer Res ; 40(3): 1665-1668, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132072

RESUMO

BACKGROUND/AIM: Treatment of elderly patients with cancer has increasing importance. Since many of these patients may not tolerate standard treatments, they might benefit from personalized approaches. This study was performed to identify characteristics that allow estimation of survival in elderly patients with prostate cancer with cerebral metastases. PATIENTS AND METHODS: Data of 21 elderly patients (≥65 years) receiving whole-brain radiotherapy (WBRT) for cerebral metastases from prostate cancer were retrospectively evaluated. Six characteristics were investigated: WBRT program, age, Karnofsky performance score (KPS), number of brain metastases, extra-cerebral metastases, and interval between diagnosis of prostate cancer and WBRT. RESULTS: On univariate analyses, KPS ≥80% resulted in better survival than KPS ≤70% (log-rank p=0.018). Three-month survival was 60% vs. 36%, and 6-month survival 50% vs. 0%, respectively. In the Cox model, KPS maintained significance (hazard ratio=3.18, p=0.031). CONCLUSION: KPS is a significant prognostic factor of survival in elderly patients with prostate cancer receiving WBRT for cerebral metastases.


Assuntos
Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Neoplasias da Próstata/complicações , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Humanos , Masculino , Neoplasias da Próstata/patologia , Taxa de Sobrevida
10.
Radiat Oncol ; 14(1): 152, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455428

RESUMO

AIM: To quantify the prevalence of brain metastases involving the hypothalamic-pituitary (HT-P) area. INTRODUCTION: Cognitive impairment and fatigue are common side effects of whole brain irradiation (WBI) comprising the quality of life (QoL) for survivors. While the former is related to radiation-induced hippocampal injury, the latter could be secondary to hormonal disbalance as a consequence of radiation of the HT-P area. Thus, sparing both regions from higher irradiation doses could reduce these sequelae. METHODS: T1 contrast medium enhanced magnetic resonance imaging (MRI) scans of 865 patients with brain metastases (4,280 metastases) were reviewed. HT-P area was individually contoured with a margin of 5 mm in order to evaluate the prevalence of brain metastases in this region. RESULTS: Involvement of the hypothalamic region was found in 26 patients (involvement rate of 3% for patients and 1% for metastases), involvement of the pituitary gland in 9 patients (1% for patients and < 1% for metastases). Binary logistical regression analysis revealed the presence of > 10 brain metastases as the only factor associated with hypothalamic involvement while no distinct factor was associated with an involvement of the pituitary gland. CONCLUSION: The low prevalence of metastases within the HT-P area in patients with brain metastases calls for further studies examining whether sparing of this region might improve patients QoL.


Assuntos
Neoplasias Encefálicas/radioterapia , Irradiação Craniana/efeitos adversos , Hipocampo/patologia , Neoplasias/radioterapia , Neoplasias Hipofisárias/epidemiologia , Lesões por Radiação/etiologia , Planejamento da Radioterapia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/secundário , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Hipocampo/efeitos da radiação , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Tratamentos com Preservação do Órgão , Órgãos em Risco/efeitos da radiação , Neoplasias Hipofisárias/secundário , Prevalência , Prognóstico , Qualidade de Vida , Lesões por Radiação/patologia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Taxa de Sobrevida
11.
Radiother Oncol ; 139: 79-82, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31431372

RESUMO

Mepitel® Film (MEP) and standard care (STD) were compared for radiation dermatitis in SCCHN patients. This trial was stopped prematurely since13/28 patients did not tolerate MEP. Grade ≥2 dermatitis: 34.8% (MEP) vs. 35.7% (STD) at 50 Gy, 65.2% vs. 59.3% at 60 Gy. MEP was unsatisfactorily tolerated and appeared not superior (NCT03047174).


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Radiodermatite/prevenção & controle , Silicones/uso terapêutico , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Silicones/efeitos adversos
12.
J Cancer Res Clin Oncol ; 145(1): 129-136, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30327940

RESUMO

PURPOSE: The introduction of immunochemotherapy has led to a significant improvement in treatment results and prognosis of diffuse large B-cell non-Hodgkins lymphoma (DLBCL) both at initial diagnosis and in relapse. Trofosfamide, an oxazaphosphorine derivative, has been utilized as alternative treatment option for patients with lymphoproliferative diseases unsuitable for conventional chemotherapy agents and protocols because of age, comorbidity, or poor performance score. While data on the activity and safety of single-agent trofosfamide have been published, the potential value of this agent in immunochemotherapy in combination with anti-CD20 antibodies such as rituximab has not been investigated to our knowledge. METHODS: Safety and therapeutic effectiveness of trofosfamide given orally at a dose of 50 mg twice daily alone, or in combination with standard-dose rituximab, was investigated in a cohort of elderly and/or highly comorbid patients with histologically confirmed primary or secondary DLBCL. RESULTS: Treatment with trofosfamide in this combination setting was generally well tolerated with no treatment-related deaths and manageable side effects, most of which were WHO class I-II; the most clinically relevant toxicity was cytopenia. 19 of 21 examined patients responded to therapy with 11 of 21 (52.4%) achieving a complete remission (CR). Median overall and progression-free survival (OS and PFS) in the CR-group was 14 and 9 months, respectively. In the subgroup with trofosfamide-based first-line therapy, 7 of 10 (70%) achieved CR and median PFS was not reached. CONCLUSIONS: Immunochemotherapy with rituximab and trofosfamide (RT) is safe and effective in elderly and poor-performance patients with DLBCL. Response rates are comparable to most commonly used primary and salvage treatment protocols. The potential value of TR regimen in both first-line and relapsed/refractory DLCBL merits further investigation and is probably underestimated.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Ciclofosfamida/análogos & derivados , Idoso Fragilizado , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Alquilantes/efeitos adversos , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Indução de Remissão , Rituximab/administração & dosagem , Rituximab/uso terapêutico , Resultado do Tratamento
13.
Anticancer Res ; 38(6): 3653-3656, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29848723

RESUMO

BACKGROUND/AIM: Patients with secondary/ recurrent squamous cell head and neck cancer (SCCHN) have poor prognoses. Outcomes of re-irradiation with ≥42 Gy plus paclitaxel for secondary/recurrent SCCHN are herein presented. PATIENTS AND METHODS: Two patients re-irradiated for secondary/recurrent SCCHN were evaluated. Patients received 44.4 Gy (2×1.2 Gy/day) or 42.0 Gy (2×1.5 Gy/day), respectively, plus concurrent paclitaxel (35 mg/m2 weekly or 20 mg/m2 twice per week). RESULTS: One patient developed a locoregional recurrence and additional metastases at 12 months after re-irradiation and died at 13 months. The other patient developed multiple bone metastases at 103 months and died at 104 months. Acute toxicities included grade 2 anemia and mucositis in both patients. Radiation dermatitis was grade 2 in one patient and grade 3 in the other. CONCLUSION: Re-irradiation with 42.0-44.4 Gy given twice daily plus paclitaxel was well tolerated and achieved a favorable response. The results need to be confirmed in a prospective trial.


Assuntos
Carcinoma de Células Escamosas/terapia , Fracionamento da Dose de Radiação , Neoplasias de Cabeça e Pescoço/terapia , Paclitaxel/uso terapêutico , Reirradiação/métodos , Idoso , Anemia/etiologia , Antineoplásicos Fitogênicos/efeitos adversos , Antineoplásicos Fitogênicos/uso terapêutico , Carcinoma de Células Escamosas/secundário , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Evolução Fatal , Neoplasias de Cabeça e Pescoço/secundário , Humanos , Pessoa de Meia-Idade , Mucosite/etiologia , Recidiva Local de Neoplasia , Paclitaxel/efeitos adversos , Reirradiação/efeitos adversos
14.
Anticancer Res ; 38(5): 2973-2976, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29715126

RESUMO

AIM: To create an instrument for estimating the risk of new brain metastases after stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) alone in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: In 45 patients with 1-3 brain metastases, seven characteristics were analyzed for association with freedom from new brain metastases (age, gender, performance score, number and sites of brain metastases, extra-cerebral metastasis, interval from RCC diagnosis to SRS/FSRT). RESULTS: Lower risk of subsequent brain lesions after RT was associated with single metastasis (p=0.043) and supratentorial involvement only (p=0.018). Scoring points were: One metastasis=1, 2-3 metastases=0, supratentorial alone=1, infratentorial with/without supratentorial=0. Scores of 0, 1 and 2 points were associated with 6-month rates of freedom from subsequent brain lesions of 25%, 74% and 92% (p=0.008). After combining groups with 1 and 2 points, 6-month rates were 25% for those with 0 points and 83% for those with 1-2 points (p=0.002). CONCLUSION: Two groups were identified with different risks of new brain metastases after SRS or FSRT alone. High-risk patients may benefit from additional whole-brain irradiation.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Recidiva Local de Neoplasia , Radiocirurgia/métodos , Adulto , Idoso , Carcinoma de Células Renais/radioterapia , Irradiação Craniana/métodos , Fracionamento da Dose de Radiação , Feminino , Humanos , Neoplasias Renais/radioterapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
Anticancer Res ; 38(5): 3111-3114, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29715148

RESUMO

AIM: To design a tool to predict the probability of new cerebral lesions after stereotactic radiosurgery/radiotherapy for patients with 1-3 brain metastases from colorectal cancer. PATIENTS AND METHODS: In 21 patients, nine factors were evaluated for freedom from new brain metastases, namely age, gender, Karnofsky performance score (KPS), tumor type, number, maximum total diameter of all lesions and sites of cerebral lesions, extra-cranial metastases, and time from cancer diagnosis to irradiation. RESULTS: Freedom from new lesions was positively associated with KPS of 90-100 (p=0.013); maximum total diameter ≤15 mm showed a trend for positive association (p=0.09). Points were assigned as: KPS 70-80=1 point, KPS 90-100=2 points, maximum diameter ≤15 mm=2 points and maximum diameter >15 mm=1 point. Six-month rates of freedom from new lesions were 29%, 45% and 100% for those with total scores of 2, 3 and 4 points, respectively, with corresponding 12-month rates of 0%, 45% and 100% (p=0.027). CONCLUSION: This study identified three risk groups regarding new brain metastases after stereotactic irradiation. Patients with 2 points could benefit from additional whole-brain radiotherapy.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Neoplasias Colorretais/radioterapia , Neoplasias Colorretais/secundário , Avaliação de Estado de Karnofsky , Adulto , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Colorretais/patologia , Irradiação Craniana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia , Estudos Retrospectivos
16.
Anticancer Res ; 38(3): 1611-1613, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29491092

RESUMO

BACKGROUND/AIM: Locoregional recurrences of head and neck cancers are often associated with a poor overall survival (OS). Outcomes may be improved with individualized treatments considering a patient's lifespan. A specific scoring system for estimating OS prognoses is presented. PATIENTS AND METHODS: In a preceding study of these 60 patients, Eastern Cooperative Oncology Group performance score (ECOG 0-1 versus 2, p=0.002) and N-stage (N0-1 versus N2, p=0.004) were identified as independent predictors of OS. RESULTS: In the current study, the following scoring points were assigned: ECOG performance score 2=0 points, ECOG performance score 0-1=1 point, N2=0 points, N0-1=1 point. Patient scores were 0, 1 or 2 points with 3-year OS rates of 0%, 46% and 83%, respectively (p<0.0001). On multivariable analysis, differences remained significant (p<0.0001). CONCLUSION: This new scoring system includes three groups of patients with significantly different OS prognoses and can assist physicians when designing individualized therapy for locoregional recurrences of head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Avaliação de Resultados em Cuidados de Saúde/métodos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estimativa de Kaplan-Meier , Análise Multivariada , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos
17.
Anticancer Res ; 38(4): 2391-2394, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29599366

RESUMO

BACKGROUND/AIM: Patients with brain metastases from thyroid cancer are extremely rare. This study evaluated clinical factors for survival following whole-brain radiotherapy (WBRT) alone. PATIENTS AND METHODS: In six patients, the following factors were analyzed for survival: Regimen of WBRT (5×4 Gy vs. 10×3 Gy), gender, age (≤55 vs. ≥56 years), Karnofsky performance score (KPS) (60% vs. 70-80%), number of brain lesions (2-3 vs. ≥4) and number of extra-cranial metastatic sites (one vs. more than one). RESULTS: KPS 70-80% (p=0.036) and involvement of only one extra-cranial site (p=0.018) were associated with better survival on univariate analysis. On Cox regression analysis, KPS (p=0.14) and number of extra-cranial sites (p=0.14) showed trends for association with survival. In patients with KPS 70-80% and only one extra-cranial site, 6-month survival was 100%, no patient with KPS 60% and more than one extra-cranial site survived to 6 months. CONCLUSION: KPS and number of involved extra-cranial metastatic sites were associated with survival and may be helpful for individualizing therapy in patients with brain metastases from thyroid cancer.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias da Glândula Tireoide/mortalidade
18.
Anticancer Res ; 38(4): 2415-2418, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29599370

RESUMO

BACKGROUND/AIM: To identify predictors of local control and survival after whole-brain irradiation (WBI) for cerebral metastases from cancer of unknown primary (CUP). PATIENTS AND METHODS: In 140 patients receiving WBI alone or following resection, seven factors were investigated including treatment approach, WBI-regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extra-cerebral metastases. RESULTS: On univariate analysis, resection plus WBI and boost (p=0.002), ECOG 0-1 (p<0.001) and a single lesion (p<0.001) were positively associated with local control. On Cox regression, ECOG-score remained significant (p=0.002). On univariate analysis of survival, surgery plus WBI and boost (p=0.009), ECOG 0-1 (p<0.001), a single lesion (p=0.024) and no extra-cerebral metastases (p<0.001) were associated with better outcomes. On Cox regression, ECOG-score (p<0.001) and extra-cerebral lesions (p<0.001) were significant. CONCLUSION: Significant predictors of local control and survival were identified that contribute to treatment personalization and design of prospective trials in patients with cerebral metastases from CUP.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/radioterapia , Neoplasias Primárias Desconhecidas/diagnóstico , Neoplasias Primárias Desconhecidas/mortalidade , Neoplasias Primárias Desconhecidas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/secundário , Irradiação Craniana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Dosagem Radioterapêutica , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
19.
Anticancer Res ; 38(1): 519-523, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29277818

RESUMO

BACKGROUND/AIM: Many patients developing a loco-regional recurrence of squamous cell carcinoma of head and neck (SCCHN) have a poor prognosis. Often, recurrences are unresectable, and patients require a second course of radiotherapy or chemoradiation. We present an approach of chemoradiation including mainly 30 Gy of radiotherapy (1.5 Gy twice daily) plus concurrent paclitaxel. To further improve the prognoses of these patients, we increased the radiation dose from 30 to 36 Gy. PATIENTS AND METHODS: In four patients with recurrent and previously irradiated SCCHN (60-70 Gy) chemoradiation was carried out using 36 Gy (1.5 Gy twice daily) and concurrent paclitaxel (4-5 times 20-25 mg/m2). RESULTS: One-year loco-regional control rates were 75% inside and 67% outside re-irradiated regions. One-year survival was 50%, and median survival time 11 months. Toxicities were mild (grade 0-2). CONCLUSION: Re-irradiation with 36 Gy (1.5 Gy twice daily) plus paclitaxel appears feasible and may lead to promising outcomes. This study is preceding a phase I trial.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Neoplasias de Cabeça e Pescoço/terapia , Recidiva Local de Neoplasia/terapia , Reirradiação/métodos , Carcinoma de Células Escamosas/mortalidade , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Masculino , Recidiva Local de Neoplasia/mortalidade , Paclitaxel/uso terapêutico , Carcinoma de Células Escamosas de Cabeça e Pescoço
20.
Anticancer Res ; 37(12): 7011-7015, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29187488

RESUMO

AIM: To our knowledge, this is the first study focusing on metastatic spinal cord compression (MSCC) from carcinoma of the salivary glands. PATIENTS AND METHODS: Nine patients receiving radiation alone were evaluated for improvement of motor deficits, post-radiation gait function and survival. RESULTS: Of nine characteristics (radiation program, age, sex, additional metastases to bone or to other organs, dynamic of motor deficits, pre-radiation gait function, number of vertebrae affected by MSCC, general condition), strong trends were found for associations between improved motor deficits and their dynamic (p=0.05), post-radiation gait function and pre-treatment ambulatory status (p=0.08) and between survival and additional metastases to other organs (p=0.07), dynamic of motor deficits (p=0.07) and general condition (p=0.07). In addition, a survival score was created. Patients with 2-3 points had a significantly better 6-month survival than those with 0-1 points (100% vs. 0%, p=0.027). CONCLUSION: Characteristics predicting outcomes identified in this study and the new survival score can guide physicians when making treatment decisions.


Assuntos
Neoplasias das Glândulas Salivares/complicações , Compressão da Medula Espinal/radioterapia , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Transtornos Motores/fisiopatologia , Prognóstico , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Análise de Sobrevida , Resultado do Tratamento
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