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1.
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
2.
Anticancer Res ; 41(5): 2489-2494, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952476

RESUMO

BACKGROUND/AIM: Most patients with breast cancer are assigned to radiotherapy, which may cause fears leading to sleep disorders. Very few data are available regarding the prevalence of sleep disorders and corresponding risk factors. PATIENTS AND METHODS: Data of 175 patients with breast cancer presenting for adjuvant radiotherapy were retrospectively analyzed. Twenty-three patient and tumor characteristics were investigated for associations with pre-radiotherapy sleep disorders. RESULTS: Seventy-eight patients (44.6%) stated sleep disorders prior to radiotherapy. These were significantly associated with higher distress score (p<0.0001); greater number of emotional (p<0.0001), physical (p<0.0001) or practical problems (p<0.001); and request for psycho-oncological support (p<0.001). Trends were found for worse performance status (p=0.062) and higher comorbidity index (p=0.059). CONCLUSION: Sleep disorders prior to radiotherapy for breast cancer are common. This applies particularly to patients with risk factors including distress due to emotional, physical or practical problems. These patients should be offered psycho-oncological support as soon as possible.


Assuntos
Neoplasias da Mama/radioterapia , Radioterapia Adjuvante/efeitos adversos , Transtornos do Sono-Vigília/radioterapia , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/patologia
3.
Anticancer Res ; 40(7): 4081-4086, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620656

RESUMO

BACKGROUND/AIM: Treatment for elderly patients with few brain metastases is controversial. A score was generated to predict distant brain metastases (DBMs) after stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). PATIENTS AND METHODS: Ten characteristics were retrospectively analyzed for freedom from new DBMs in 104 elderly patients receiving SRS or FSRT alone for 1-3 brain metastases. Characteristics that were significant or showed a trend on multivariate analysis were used for the score. RESULTS: On multivariate analysis, favorable histology (p=0.026) and single brain metastasis (p=0.006) showed significant associations with freedom from DBMs. A trend was found for supra-tentorial location only (p=0.065). Three groups were designed, 10-14, 16-20 and 21-25 points, with 6-month rates of freedom from DBMs of 10%, 54% and 95%, respectively (p<0.0001). Positive predictive values to predict DBMs and freedom from DBMs at 6 months were 91% and 94%. CONCLUSION: This new score provided high accuracy in predicting DBMs and freedom from DBMs.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/radioterapia , Radiocirurgia , Idoso , Neoplasias Encefálicas/mortalidade , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Risco
4.
Anticancer Res ; 40(6): 3429-3434, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487641

RESUMO

BACKGROUND/AIM: Seizures are a serious condition for patients with brain metastases. Prevalence, risk factors and a potential association of seizures with survival prior to whole-brain irradiation (WBI) for cerebral metastases were retrospectively investigated. PATIENTS AND METHODS: In 1,934 patients, the prevalence of pre-treatment seizures (pre-WBI) was determined. Seven pre-treatment characteristics were evaluated for associations with seizures. Ten characteristics including pre-treatment symptoms (none vs. seizures only vs. seizures+others vs. others only) and seizures (yes vs. no) were analyzed for survival. RESULTS: In 251 patients (13.0%), pre-treatment seizures were documented. The occurrence of seizures was significantly associated with 1-3 brain metastases and lack of extra-cerebral spread. On multivariate analysis, age, gender, performance score, number of metastases and extra-cerebral spread were significantly associated with survival; pre-treatment symptoms and seizures showed associations on univariate but not on multivariate analyses. CONCLUSION: Few brain metastases and lack of extra-cerebral spread were independent risk factors for pre-treatment seizures. Seizures appeared positively associated with survival.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Convulsões/etiologia , Adulto , Idoso , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/radioterapia , Irradiação Craniana , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Dosagem Radioterapêutica , Medição de Risco , Fatores de Risco , Convulsões/diagnóstico , Convulsões/epidemiologia , Resultado do Tratamento
5.
BMC Cancer ; 19(1): 1163, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783816

RESUMO

BACKGROUND: Patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses can benefit from radiation doses greater than 30Gy in 10 fractions in terms of improved local progression-free survival (LPFS) and overall survival (OS). METHODS/DESIGN: This prospective study mainly investigates LPFS after precision radiotherapy (volumetric modulated arc therapy or stereotactic body radiotherapy) with 18 × 2.33Gy in 3.5 weeks. LPFS is defined as freedom from progression of motor deficits during radiotherapy and an in-field recurrence of MSCC following radiotherapy. The maximum relative dose allowed to the spinal cord is 101.5% of the prescribed dose, resulting in an equivalent dose in 2Gy-fractions (EQD2) for radiation myelopathy is 45.5Gy, which is below the tolerance dose of 50Gy according to the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC). The EQD2 of this regimen for tumor cell kill is 43.1Gy, which is 33% higher than for 30Gy in 10 fractions (EQD2 = 32.5Gy). Primary endpoint is LPFS at 12 months after radiotherapy. Secondary endpoints include the effect of 18 × 2.33Gy on motor function, ambulatory status, sensory function, sphincter dysfunction, LPFS at other follow-up times, overall survival, pain relief, relief of distress and toxicity. Follow-up visits for all endpoints will be performed directly and at 1, 3, 6, 9 and 12 months after radiotherapy. A total of 65 patients are required for the prospective part of the study. These patients will be compared to a historical control group of at least 235 patients receiving conventional radiotherapy with 10x3Gy in 2 weeks. DISCUSSION: If precision radiotherapy with 18 × 2.33Gy results in significantly better LPFS than 10x3Gy of conventional radiotherapy, this regimen should be strongly considered for patients with MSCC and favorable survival prognoses. TRIAL REGISTRATION: Clinicaltrials.gov NCT04043156. Registered 30-07-2019.


Assuntos
Fracionamento da Dose de Radiação , Compressão da Medula Espinal/radioterapia , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Ensaios Clínicos como Assunto , Relação Dose-Resposta à Radiação , Humanos , Lesões por Radiação , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Compressão da Medula Espinal/patologia , Análise de Sobrevida
6.
Anticancer Res ; 39(8): 4273-4277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366517

RESUMO

BACKGROUND/AIM: For treatment of brain metastases, a patient's survival prognosis should be considered. Existing survival scores appear complex and require complete tumor staging. For many patients, a faster and simpler tool would be helpful. PATIENTS AND METHODS: This retrospective study investigated the prognostic value of the number of pre-treatment symptoms plus eight other factors on survival of patients irradiated for brain metastases. Other factors included whole-brain radiotherapy (WBRT) regimen, age, gender, performance score, primary tumor type, number of brain metastases, extracranial metastases, and interval between cancer diagnosis and WBRT. RESULTS: The number of symptoms (p=0.002) and all other factors were significantly associated with survival on univariate analyses. On multivariate analysis, all factors but the number of symptoms (p=0.47) and primary tumor type (p=0.48) were significant. CONCLUSION: Since the number of symptoms was not an independent predictor of survival, it cannot replace existing scoring tools and may only serve for orientation.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias/radioterapia , Prognóstico , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Irradiação Craniana/efeitos adversos , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/classificação , Neoplasias/patologia
7.
Radiol Oncol ; 53(2): 219-224, 2019 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-31103998

RESUMO

Background Previous survival scores for breast cancer patients with cerebral metastases were developed in cohorts receiving heterogeneous treatments, which could have introduced selection biases. A new instrument (WBRT-30-BC) was created from 170 patients receiving whole-brain radiotherapy (WBRT) alone with 30 Gy in 10 fractions. Methods Characteristics showing significant associations (p < 0.05) with overall survival (OS) or a trend (p < 0.08) on multivariate analysis were used for the WBRT-30-BC. For each characteristic, 6-month OS rates were divided by 10. These scoring points were added for each patient (patient scores). The WBRT-30-BC was compared to the diagnosis- specific graded prognostic assessment (DS-GPA) classification and Rades-Score for breast cancer regarding positive predictive values (PPVs) to identify patients dying within 6 months and patients surviving at least 6 months following WBRT. Results On multivariate analysis, Karnofsky performance score (KPS) was significant (risk ratio [RR]: 2.45, p < 0.001). In addition, extra-cerebral metastatic disease (RR: 1.52, p = 0.071) and time between breast cancer diagnosis and WBRT (RR: 1.37, p = 0.070) showed a trend. Based on these three characteristics, four predictive groups were designed: 7-9, 10-12, 13-15 and 16 points. Six-month OS rates were 8%, 41%, 68% and 100% (p < 0.001). PPVs to identify patients dying within 6 months were 92% (WBRT-30-BC), 84% (DS-GPA) and 92% (Rades-Score). PPVs to identify patients surviving for at least 6 months were 100% (WBRT-30-BC), 74% (DS-GPA) and 68% (Rades-Score). Conclusions The WBRT-30-BC appeared very accurate in predicting death ≤ 6 months and survival ≥ 6 months of breast cancer patients receiving WBRT. It was superior to previous instruments in predicting survival ≥ 6 months.


Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/radioterapia , Neoplasias da Mama/mortalidade , Irradiação Craniana/métodos , Neoplasias Encefálicas/secundário , Estudos de Coortes , Fracionamento da Dose de Radiação , Feminino , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Pessoa de Meia-Idade , Análise Multivariada , Taxa de Sobrevida , Fatores de Tempo
8.
Anticancer Res ; 39(3): 1501-1505, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30842188

RESUMO

BACKGROUND/AIM: Diagnosis-specific scoring systems developed for predicting survival of patients with cerebral metastases from malignant melanoma (MM) were evaluated. PATIENTS AND METHODS: The new whole-brain radiotherapy (WBRT)-30-MM was created in homogeneously treated patients receiving 10×3 Gy of WBRT for cerebral metastases from MM. It consisted of three groups with significantly different 6-month survival rates of 0% (3-5 points), 30% (7 points) and 52% (9 points) (p=0.001). The WBRT-30-MM was compared to three other scores created for cerebral metastases from MM, including first updated DS-GPA classification, Dziggel-Score and Sehmisch-Score. RESULTS: Positive predictive values (PPVs) for predicting death ≤6 months after WBRT were 100% (WBRT-30-MM), 77% (DS-GPA), 69% (Dziggel-Score) and 73% (Sehmisch-Score). PPVs for predicting survival ≥6 months were 52%, 38%, 63% and 75%, respectively. CONCLUSION: WBRT-30-MM was the most accurate instrument for predicting death ≤6 months. For predicting survival ≥6 months, Sehmisch-Score was most accurate, although all existing scorring systems appeared suboptimal for this purpose.


Assuntos
Neoplasias Encefálicas/radioterapia , Irradiação Craniana/métodos , Melanoma/radioterapia , Neoplasias Cutâneas/radioterapia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundário , Feminino , Humanos , Masculino , Melanoma/diagnóstico , Melanoma/patologia , Pessoa de Meia-Idade , Prognóstico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Análise de Sobrevida
9.
In Vivo ; 32(4): 825-828, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29936465

RESUMO

BACKGROUND/AIM: Personalization of the treatment of brain metastases considering patient's overall survival (OS) prognosis is gaining importance. This study was conducted to develop an OS score particularly for patients receiving local therapies for single brain metastasis from gynecological malignancies. PATIENTS AND METHODS: In 11 patients, the following factors were retrospectively analyzed for associations with OS: Age, Karnofsky performance score (KPS), tumor type, extra-cranial metastatic sites, and time from diagnosis of gynecological malignancy to treatment of brain metastasis. Factors showing at least a strong trend were used for the score. RESULTS: A KPS of 80-90% resulted in a significantly better OS than a KPS of 50-70% (p=0.008). Absence of extra-cranial metastases showed a strong trend (p=0.052). For the score, the following points were used: KPS 50-70%=0, KPS 80-90%=1, presence of extra-cranial metastatic sites=0, absence=1. Patients' scores were 0, 1 or 2 points. OS rates at both 6 and 12 months were 0%, 67% and 100%, respectively (p=0.020). CONCLUSION: This specific score can be used to estimate OS in patients receiving local therapies for single brain metastasis from gynecological malignancies and personalize their care.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias dos Genitais Femininos/radioterapia , Prognóstico , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Irradiação Craniana , Intervalo Livre de Doença , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Pessoa de Meia-Idade , Metástase Neoplásica
10.
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
11.
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
12.
In Vivo ; 32(3): 633-636, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29695570

RESUMO

BACKGROUND/AIM: This study aimed to create a predictive tool for estimating the remaining lifespan of patients after whole-brain irradiation (WBI) for cerebral metastases from bladder cancer. PATIENTS AND METHODS: In 34 of these patients clinical parameters were analyzed for survival including age at start of WBI, gender, Karnofsky score, number of cerebral metastases and involvement of extra-cranial sites of metastasis. RESULTS: Involvement of extra-cranial sites (14%) and Karnofsky score (9%) showed the greatest difference regarding 6-month survival and were considered for the tool. Points were assigned based on the following: no involvement of extra-cranial sites=1 point, involvement of extra-cranial sites=0 points, Karnofsky score ≥70=1 point, Karnofsky score ≤60=0 points. Patients' scores were 0, 1 or 2 points with 6-month survival rates of 13%, 27% and 50%, respectively. CONCLUSION: Based on two clinical parameters, a tool was developed that may help estimate the lifespan of patients irradiated for cerebral metastases from bladder cancer.


Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Neoplasias da Bexiga Urinária/patologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/radioterapia , Irradiação Craniana/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Doses de Radiação , Resultado do Tratamento
13.
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
14.
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
15.
In Vivo ; 32(2): 381-384, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29475924

RESUMO

BACKGROUND/AIM: We developed a scoring system to predict 1-year survival after radiosurgery for 1-3 brain metastases. This study aimed to validate this system. PATIENTS AND METHODS: Seventy-six new patients were included in this validation study. Like in the original scoring-system, three factors (age, performance status, extra-cranial metastases) were used. For each factor, 1-year survival rates in % were divided by 10, and the three scoring-points were added for each patient. RESULTS: Patient's scores were 10, 11, 13, 14, 16 or 17 points with 1-year survival rates ranging between 31% and 80%. Two groups, 10-14 and 16-17 points were formed. In the 14-16 points group, 1-year survival was 47% (versus 33% in the preceding study, p=0.060). In the 16-17 points group, 1-year survival rates were 75% versus 77% (p=0.79). CONCLUSION: In the more favorable group, the scoring-system was very reproducible. In the less favorable group, the difference was larger, but also not signficant.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Fracionamento da Dose de Radiação , Radiocirurgia , Adulto , Idoso , Neoplasias Encefálicas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Radiocirurgia/métodos , Análise de Sobrevida , Resultado do Tratamento
16.
Anticancer Res ; 38(1): 565-567, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29277825

RESUMO

BACKGROUND/AIM: The use of stereotactic radiosurgery (SRS) alone has become popular for treating patients with a limited number of brain metastases. In very few patients, the primary tumor leading to cerebral spread is unknown. This study investigated the role of SRS for this rare situation. PATIENTS AND METHODS: Eight patients with 1-2 brain metastases from cancer of unknown primary (CUP) received SRS alone (median dose 20 Gy). Five clinical factors were evaluated for association with local control of the irradiated lesions, freedom from new cerebral lesions and survival. RESULTS: Six-month and 12-month survival rates were 63% and 63%, respectively. Improved survival was associated with male gender and only one cerebral lesion. Local control rates at 6 and 12 months were 100%. Six-month rate of freedom from new cerebral lesions was 86%. CONCLUSION: SRS appeared effective and resulted in promising local control and survival rates in patients with 1-2 brain metastases from CUP.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Neoplasias Primárias Desconhecidas/patologia , Radiocirurgia/métodos , Irradiação Craniana/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Taxa de Sobrevida , Resultado do Tratamento
17.
In Vivo ; 31(1): 35-38, 2017 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-28064217

RESUMO

BACKGROUND/AIM: Patients with prostate cancer represent a small minority of cancer patients presenting with metastases to the brain. This study investigated the role of whole-brain irradiation (WBI) in this rare group. PATIENTS AND METHODS: Eighteen such patients were included. Clinical factors including fractionation program of WBI, age at WBI, Karnofsky performance score (KPS), number of metastases to the brain, involvement of extracerebral metastatic sites, time from prostate cancer diagnosis to WBI and recursive-partitioning-analysis (RPA) class were investigated regarding local (intracerebral) control and survival. RESULTS: On multivariate evaluation, longer time from prostate cancer diagnosis to WBI showed a trend towards improved local control (hazard ratio 2.77, p=0.098). Better KPS (hazard ratio 5.64, p=0.021) and longer time from prostate cancer diagnosis to WBI (hazard ratio 5.64, p=0.013) were significantly associated with better survival. CONCLUSION: Two independent predictors of survival were identified and should be considered when designing for personalized treatment regimens and clinical trials.


Assuntos
Neoplasias Encefálicas/radioterapia , Irradiação Craniana , Neoplasias da Próstata/radioterapia , Idoso , Neoplasias Encefálicas/secundário , Seguimentos , Humanos , Masculino , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
BMC Cancer ; 17(1): 30, 2017 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-28061768

RESUMO

BACKGROUND: This matched-pair study was initiated to validate the results of a retrospective study of 186 patients published in 2007 that compared whole-brain irradiation (WBI) alone and radiosurgery (RS) alone for up to three brain metastases. METHODS: One-hundred-fifty-two patients receiving WBI alone for up to three brain metastases were matched with 152 patients treated with RS of fractionated stereotactic radiotherapy (FSRT) alone 1:1 for each of eight factors (age, gender, Eastern Oncology Cooperative Group (ECOG)-performance score, nature of tumor, brain metastases number, extra-cerebral spread, period from cancer detection to irradiation of brain metastases, and recursive partitioning analysis (RPA)-class. Groups were analyzed regarding intracerebral control (IC) and overall survival (OS). RESULTS: On univariate analysis of IC, type of irradiation did not significantly affect outcomes (p = 0.84). On Cox regression, brain metastases number (p < 0.001), nature of tumor (p < 0.001) and period from cancer detection to irradiation of brain metastases (p = 0.013) were significantly associated with IC. On univariate analysis of OS, type of irradiation showed no significant association with outcomes (p = 0.63). On multivariate analyses, OS was significantly associated with ECOG performance score (p = 0.011), nature of tumor (p = 0.035), brain metastases number (p = 0.048), extra-cerebral spread (p = 0.002) and RPA-class (p < 0.001). CONCLUSION: In this matched-pair study, RS/FSRT alone was not superior to WBI alone regarding IC and OS. These results can be considered a revision of the findings from our retrospective previous study without matched-pair design, where RS alone resulted in significantly better IC than WBI alone on multivariate analysis.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Irradiação Craniana , Radiocirurgia , Neoplasias Encefálicas/radioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
Anticancer Res ; 36(9): 4777-80, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27630327

RESUMO

BACKGROUND/AIM: Patients with gynecological malignancies account for 2% of patients with cerebral metastases. Many patients receive whole-brain irradiation (WBI) alone. Local therapies (resection, stereotactic radiosurgery (SRS)) are becoming more popular. This study compared intracerebral control after local therapy to WBI alone in patients with gynecological malignancies. PATIENTS AND METHODS: Of 56 patients, 45 received WBI alone, 6 SRS alone and 5 resection plus WBI. Treatment type, age, performance score, cancer site, number of cerebral lesions, metastases outside the brain, recursive partitioning analysis (RPA) class and period from gynecological cancer diagnosis to brain metastasis treatment were evaluated. RESULTS: On univariate analyses, local therapy (p=0.003), single cerebral lesion (p<0.001) and RPA class 1/2 (p=0.027) were positively related to intracerebral control. On Cox regression analysis, local therapy (p=0.013) and RPA class 1/2 (p=0.014) were significant. CONCLUSION: Local therapies led to better intracerebral control than WBI alone and should be considered for brain metastasis from gynecological malignancies whenever reasonable.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Neoplasias dos Genitais Femininos/radioterapia , Neoplasias dos Genitais Femininos/cirurgia , Idoso , Encéfalo/patologia , Encéfalo/efeitos da radiação , Encéfalo/cirurgia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Córtex Cerebral/patologia , Córtex Cerebral/cirurgia , Terapia Combinada , Irradiação Craniana , Feminino , Neoplasias dos Genitais Femininos/patologia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Radiocirurgia , Resultado do Tratamento
20.
Anticancer Res ; 36(9): 4817-9, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27630334

RESUMO

BACKGROUND/AIM: To identify predictors and develop a score for overall survival of patients with intracerebral metastasis from testicular cancer. PATIENTS AND METHODS: Whole-brain radiation therapy program, age, Karnofsky performance score (KPS), number of intracerebral metastases, number of other metastatic sites and time between testicular cancer diagnosis and radiation therapy were analyzed for their association with overall survival in eight patients. RESULTS: KPS of 80-90% was significantly associated with better overall survival (p=0.006), one or no other metastatic sites showed a trend for a better outcome (p=0.10). The following scores were assigned: KPS 60-70%=0 points, KPS 80-90%=1 point, ≥2 other metastatic sites=0 points, 0-1 other metastatic sites=1 point. Two groups, with 0 and with 1-2 points, were formed. Overall survival rates were 33% vs. 100% at 6 months and 0% vs. 100% at 12 months (p=0.006), respectively. CONCLUSION: A simple instrument enabling physicians to judge the overall survival of patients with intracerebral metastasis from testicular cancer is provided.


Assuntos
Neoplasias Encefálicas/radioterapia , Prognóstico , Neoplasias Testiculares/radioterapia , Adulto , Idoso , Encéfalo/patologia , Encéfalo/efeitos da radiação , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Taxa de Sobrevida , Neoplasias Testiculares/patologia
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