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1.
Ann Dermatol ; 33(5): 459-462, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34616128

RESUMO

Sweet's syndrome was first described as a reactive dermatosis characterized by sudden onset of fever, leukocytosis, and erythematous plaques infiltrated with neutrophils. Therefore, Sweet's syndrome is also known as acute febrile neutrophilic dermatosis. However, subsequently, it became clear that fever and neutrophilia in Sweet's syndrome vary depending on the case, and several other characteristics have been described. The lesions in Sweet's syndrome are typically observed not only in the limbs but also in the face, neck, and upper trunk. A 28-year-old female without a specific medical history presented in a hospital following the complaint of painful erythematous patches and pustules on her palms and soles. She had no previous history of palmoplantar pustulosis and other infections or malignancies. A skin biopsy showed diffuse dermal infiltration of neutrophils. Laboratory tests showed increased neutrophil count and erythrocyte sedimentation rate. After systemic corticosteroid administration was initiated, the lesions gradually disappeared. The patient was subsequently diagnosed with Sweet's syndrome according to histology, clinical feature, and response to treatment. However, there have been few reports of Sweet's syndrome confined to the individuals' palms and soles. According to the literatures, although the dorsum of the hand is frequently affected, the palmoplantar involvement as in our case appears to be rare.

2.
Mol Cell ; 81(16): 3323-3338.e14, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34352207

RESUMO

The emerging "epitranscriptomics" field is providing insights into the biological and pathological roles of different RNA modifications. The RNA methyltransferase METTL1 catalyzes N7-methylguanosine (m7G) modification of tRNAs. Here we find METTL1 is frequently amplified and overexpressed in cancers and is associated with poor patient survival. METTL1 depletion causes decreased abundance of m7G-modified tRNAs and altered cell cycle and inhibits oncogenicity. Conversely, METTL1 overexpression induces oncogenic cell transformation and cancer. Mechanistically, we find increased abundance of m7G-modified tRNAs, in particular Arg-TCT-4-1, and increased translation of mRNAs, including cell cycle regulators that are enriched in the corresponding AGA codon. Accordingly, Arg-TCT expression is elevated in many tumor types and is associated with patient survival, and strikingly, overexpression of this individual tRNA induces oncogenic transformation. Thus, METTL1-mediated tRNA modification drives oncogenic transformation through a remodeling of the mRNA "translatome" to increase expression of growth-promoting proteins and represents a promising anti-cancer target.


Assuntos
Carcinogênese/genética , Metiltransferases/genética , Neoplasias/genética , tRNA Metiltransferases/genética , Guanosina/análogos & derivados , Guanosina/genética , Humanos , Metilação , Neoplasias/patologia , Oncogenes/genética , Processamento Pós-Transcricional do RNA/genética , RNA Mensageiro/genética , RNA de Transferência/genética
3.
Int J Drug Policy ; 97: 103363, 2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34314955

RESUMO

British Columbia (BC) has been the hardest hit province in Canada's ongoing overdose epidemic. As part of the province-level response, the College of Physicians and Surgeons of British Columbia (CPSBC) implemented the "Safe Prescribing of Drugs with Potential for Misuse/Diversion" practice standard in June 2016. The practice standard established specific dose and quantity thresholds for opioid prescribing as professional and ethical conduct expectations for physicians in BC. This supply side intervention was based on expert interpretation of available evidence of non-superiority of opioid treatments to non-opioid treatments. However, the potential for misinterpretation of dosage ceiling thresholds and the negative repercussions to patients that could follow raised concerns among both physicians and patients. We provide a comprehensive overview of the rationale, early impact, controversies, and potential shortcomings of the CPSBC's practice standard.

4.
J Am Coll Radiol ; 18(10): 1423-1429, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34043974

RESUMO

PURPOSE: Hepatic steatosis is a common incidental finding on abdominal imaging that is not always reported or recognized as having clinical significance. Because of its association with liver disease, cirrhosis, and diabetes, the aim of this study was to bring attention to this finding and provide clinical guidance to referring clinicians by inserting standardized text into radiology reports of patients with incidentally detected hepatic steatosis. METHODS: Patients with incidentally discovered hepatic steatosis on abdominal ultrasound or CT had standard text inserted into the impression sections of their diagnostic imaging reports. A total of 1,256 patients whose reports were tagged between April 2016 and September 2017 were retrospectively identified and their electronic medical records reviewed to determine subsequent acknowledgment in the medical record or clinical action in response to the tagged report. Information regarding patient demographics, the type of provider who ordered the examination, and the acuity of the examination results was also recorded. RESULTS: Acknowledgment and subsequent clinical action were more likely in patients whose examinations was ordered by primary care providers, whose examination results were not urgent, and who were in the ultrasound group. The overall diagnostic yield in patients who underwent clinical evaluation was nonalcoholic fatty liver disease in 70%, nonalcoholic steatohepatitis in 6%, and alcoholic hepatitis in 17%. CONCLUSIONS: Opportunistic screening for incidental hepatic steatosis on abdominal CT and ultrasound is feasible, with substantial yield for patients with clinically important entities including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

5.
Radiographics ; 41(1): 58-74, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33245670

RESUMO

Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. ©RSNA, 2020 See discussion on this article by Patlas.

6.
J Control Release ; 327: 406-419, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-32835710

RESUMO

Selective inhibition of microRNAs (miRNAs) offers a new avenue for cancer therapeutics. While most of the current anti-miRNA (antimiR) reagents target full length miRNAs, here we investigate novel nanoparticle-delivered short PNA probes containing cationic domains targeting the seed region of the miRNA for effective antimiR therapy. For proof of concept, we tested PNAs targeting miRNA-155 and employed poly(lactic-co-glycolic acid) (PLGA)-based nanoparticle formulation for delivery. A comprehensive evaluation of PLGA nanoparticles (NPs) containing short PNA probes showed significantly superior loading, release profile, and uniform size distribution, compared to conventional non-cationic PNA probes. Confocal microscopy and flow cytometry analyses showed efficient transfection efficiency and uniform distribution of PLGA NPs containing short PNA probes in the cytoplasm. Functional analysis also confirmed efficient miRNA-155 inhibition including an effect on its downstream target proteins. Further, reduced tumor growth was observed after systemic delivery of PLGA nanoparticles containing short PNA probes in vivo in a xenograft mouse model following inhibition of miR-155. There was no evidence of acute or chronic toxicity associated with systemic delivery of PLGA NPs containing short PNA probes in the mice. Overall, in this paper we present a novel antimiR strategy based on PLGA nanoparticle delivered short PNA probes for potential cancer therapy.


Assuntos
MicroRNAs , Nanopartículas , Ácidos Nucleicos Peptídicos , Animais , Camundongos , MicroRNAs/genética , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Transfecção
7.
Mol Ther Nucleic Acids ; 19: 267-277, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-31855835

RESUMO

MicroRNAs (miRNAs) have increasingly been shown to be involved in human cancer, and interest has grown about the potential use of miRNAs for cancer therapy. miRNA levels are known to be altered in cancer cells, including in non-small cell lung cancer (NSCLC), a subtype of lung cancer that is the most prevalent form of cancer worldwide and that lacks effective therapies. The let-7 miRNA is involved in the regulation of oncogene expression in cells and directly represses cancer growth in the lung. let-7 is therefore a potential molecular target for tumor therapy. However, applications of RNA interference for cancer research have been limited by a lack of simple and efficient methods to deliver oligonucleotides (ONs) to cancer cells. In this study, we have used in vitro and in vivo approaches to show that HCC827 cells internalize hydrophobically modified let-7b miRNAs (hmiRNAs) added directly to the culture medium without the need for lipid formulation. We identified functional let-7b hmiRNAs targeting the HMGA2 mRNA, one of the let-7 target genes upregulated in NSCLC, and show that direct uptake in HCC827 cells induced potent and specific gene silencing in vitro and in vivo. Thus, hmiRNAs constitute a novel class of ONs that enable functional studies of genes involved in cancer biology and are potentially therapeutic molecules.

8.
Oncotarget ; 10(51): 5349-5358, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31523393

RESUMO

Developing new targeted therapy for pancreatic cancer is one of the major current challenges in cancer research. KRAS mutations and miRNA dysregulation (e.g. miR-21-5p oncomiR) play key roles in Pancreatic Ductal Adenocarcinoma (PDAC), leading to rapid progression of the disease. As the KRAS mutation is a main driver of PDAC, anti-KRAS strategies remain a major therapeutic approach for PDAC treatment. Previously, utilization of either siKRAS or small chemically modified single-stranded RNA molecules that specifically disable miR-21 (anti-miR-21) were effective in slowing PDAC tumor growth in various tumor models when packaged in an innovative delivery system (TPN) required for efficient drug delivery to the PDAC tumor site. Here we have tested the utility of targeting the KRAS pathway through multiple mechanisms and via dual targeting of a PDAC oncomiR and oncogene. Initially we found that miR-217, which has been shown to directly regulate KRAS expression, is downregulated in our PDAC samples, thus we tested the benefits of anti-miR-21, miR-217 mimic or siKRAS loaded into the tumor-penetrating nanoparticles (TPN) that we had previously shown to potently target the largely impenetrable PDAC tumors, and found an enhanced anti-tumoral response upon dual treatments in KRAS-mutated PDAC models.

10.
Telemed J E Health ; 24(9): 722-724, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29297769

RESUMO

INTRODUCTION: The integration of remote specialists into local care teams has not been widely evaluated. METHODS: Therefore, we surveyed clinicians whose patients with Parkinson's disease had participated in a national randomized controlled trial of video visits to determine (1) whether clinicians received recommendations from remote specialists; (2) whether those recommendations were implemented; (3) what barriers to specialty care local clinicians perceived; and (4) whether they would recommend video visits. RESULTS: Of 183 clinicians surveyed, 89 (49%) responded. Less than half received the recommendations of remote specialists, but they implemented most of the recommendations they received and found them to be beneficial. CONCLUSION: The greatest perceived barrier among respondents was distance from patient to specialist, and 40% of local clinicians would recommend video visits. As telemedicine grows, improved communication between remote specialists and local clinicians is likely needed.


Assuntos
Neurologia/organização & administração , Doença de Parkinson/terapia , Telemedicina/organização & administração , Comunicação por Videoconferência/organização & administração , Atitude do Pessoal de Saúde , Humanos , Neurologia/estatística & dados numéricos , Satisfação do Paciente , Consulta Remota , Telemedicina/estatística & dados numéricos , Viagem , Comunicação por Videoconferência/estatística & dados numéricos
11.
Antivir Ther ; 23(4): 345-351, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29171837

RESUMO

BACKGROUND: Inflammation is associated with the downregulation of drug metabolizing enzymes and transporters. Thus, we investigated the chronic inflammatory state associated with HIV infection as a source of pharmacokinetic variability of atazanavir. We also explored the association of total bilirubin concentrations with markers of inflammation and endothelial activation. METHODS: Apparent oral clearance (CL/F) of atazanavir was estimated from plasma samples collected from participants in AIDS Clinical Trials Group Study A5202. Several inflammatory and endothelial activation biomarkers were measured at baseline and weeks 24 and 96 as part of metabolic substudy A5224s: high-sensitivity C-reactive protein (hsCRP), interleukin-6, tumour necrosis factor-α and its soluble receptors, soluble vascular cellular and intracellular adhesion molecules and total bilirubin. Statistical analysis was performed by a matrix of correlation coefficients between atazanavir CL/F and biomarker concentrations measured at week 24. The correlation between atazanavir clearance and percentage change in bilirubin from baseline to weeks 24 and 96, and between biomarkers and bilirubin concentrations at each week were also evaluated. RESULTS: Among 107 participants, there were no significant correlations observed between atazanavir CL/F and inflammatory and endothelial activation biomarkers measured at week 24 (P≥0.24). As expected, bilirubin increased with increasing exposure to atazanavir (rho=-0.25, P=0.01). Bilirubin concentrations were inversely correlated (P<0.01) with each of the biomarkers except hsCRP. CONCLUSIONS: Atazanavir CL/F did not correlate with the inflammatory biomarkers changes. Inflammatory-mediated inhibition of cytochrome P450 3A may have been attenuated due to atazanavir-associated increases of bilirubin, which has known anti-inflammatory properties.


Assuntos
Sulfato de Atazanavir/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Inflamação/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/imunologia , Síndrome de Imunodeficiência Adquirida/virologia , Adulto , Sulfato de Atazanavir/farmacocinética , Biomarcadores , Feminino , Infecções por HIV/imunologia , Infecções por HIV/virologia , Inibidores da Protease de HIV/farmacocinética , Humanos , Masculino , Resultado do Tratamento
12.
Am J Clin Oncol ; 41(3): 295-301, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-26808259

RESUMO

PURPOSE: To study the prevalence and effect of smoking on cervical cancer recurrence and mortality in patients undergoing definitive treatment with radiation. MATERIALS AND METHODS: Between July 2007 and September 2013, 96 locally advanced cervical cancer patients received definitive radiation or chemoradiation followed by brachytherapy. Smoking status was obtained from prospective intake questionnaires and quantified by pack-years. Pelvic control (PC), disease-free survival (DFS), and overall survival (OS) were analyzed by multivariable Cox proportional hazards models. RESULTS: Smoking history included 51 (53.1%) nonsmokers, 45 active smokers, and former smokers: 20 (20.8%) with 1 to 20 pack-years and 25 (26%) with 21+ pack-years. With a median follow-up of 2 years on univariate analysis, the impact of 1 to 20 pack-years on PC, DFS, and OS relative to nonsmokers was hazard ratio (HR) 4.29 (95% confidence interval [CI], 1.36-14.1; P=0.014), 4.99 (95% CI, 1.21-22.4; P=0.027), and 4.77 (95% CI, 1.34-17.8; P=0.017), respectively. For patients with 21+ pack-years, the impact on PC, DFS, and OS was HR=6.13 (95% CI, 2.29-18.6; P<0.001), 7.24 (95% CI, 2.28-29.1; P=0.001), and 4.21 (95% CI, 1.26-15.4; P=0.02). On multivariate analysis, there remained a significant difference of 1 to 20 pack-years smoking history on OS relative to nonsmokers, HR=4.68 (95% CI, 1.02-29; P=0.047). For patients with 21+ pack-years smoking history, there continued to be a negative impact on PC and DFS, HR=5.66 (95% CI, 1.7-22.18; P=0.004) and HR=6.89 (95% CI, 1.54-42; P=0.011), respectively. CONCLUSIONS: Former and active tobacco smoking during radiation therapy for cervical cancer is associated with unfavorable PC, DFS, and OS outcomes. The increased number of smoking pack-years conferred a worse outcome effect in those treated with radiation.


Assuntos
Fumar Tabaco/efeitos adversos , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Radioterapia/métodos , Fumar Tabaco/epidemiologia , Resultado do Tratamento
13.
Am J Clin Oncol ; 40(5): 451-457, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25784565

RESUMO

PURPOSE: We examined the incidence and the effect of alcohol abuse on pelvic control (PC), disease-free survival (DFS), and overall survival (OS) in locally advanced cervical cancer patients undergoing definitive radiation therapy (RT). METHODS: Between 2007 and 2013, 95 patients treated with RT were reviewed, and the tumor characteristics, the RT dose, the treatment time, chemotherapy, and the number of cycles were recorded. The association between alcohol abuse and DFS, OS, and the duration of PC was analyzed using multivariable Cox proportional hazards models. RESULTS: Of the 95 patients with an average age of 54.8 years (range, 27 to 91 y), 30% were FIGO stage 1B1, 1B2, 2A, 52% stage 2B, 3A; and 18% stage 3B; 86% of the patients were treated with weekly cisplatin chemotherapy. Alcohol history showed that 10 (10.5%) patients met the CDC criteria for heavy alcohol use. With a mean follow-up time of 2 years, 85 patients (88.5%) achieved PC and 86 patients (90.5%) were free of distant metastasis. A total of 82 patients (86.3%) were alive at the last follow-up. When controlling for the total treatment time, excessive alcohol abuse was significantly associated with a decrease in DFS (P=0.005; hazard ratio [HR], 6.19; 95% confidence interval [CI]: 1.73, 22.18), OS (P=0.001; HR, 6.68; 95% CI: 2.10, 21.26), and PC (P=0.029; HR, 3.10; 95% CI: 1.13, 8.56) on univariable analysis. On multivariable analysis, excessive alcohol abuse was significantly associated with a decrease in DFS (P=0.005; HR, 10.57; 95% CI: 2.07, 53.93) and OS (P=0.001; HR, 10.80; 95% CI: 2.57, 45.40). CONCLUSIONS: In this small hypothesis-generating series of patients with heavy alcohol use, the data support the association that heavy alcohol use increases the risk of cancer recurrence and mortality. Additional research is required to better define the patient- and treatment-related factors that may be targeted for intervention.


Assuntos
Alcoolismo/fisiopatologia , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Quimiorradioterapia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia , Estilo de Vida , Pessoa de Meia-Idade , Estudos Retrospectivos , Fumar , Resultado do Tratamento , Neoplasias do Colo do Útero/fisiopatologia
14.
Int J Gynecol Cancer ; 25(5): 897-902, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25768077

RESUMO

OBJECTIVE: To calculate dose delivered to the lumbosacral plexus (LSP) with cervical brachytherapy using 3-dimensional imaging, and to compare this with the position of the tandem in the pelvis using bony landmarks. We also report long-term LSP toxicity outcomes. METHODS AND MATERIALS: Treatment planning images from 55 patients treated with tandem and ring brachytherapy from October 2009 through November 2012 were reviewed. The LSP was contoured on planning computed tomographic scans to calculate dose received. Lumbosacral plexus dose was studied as a function of tandem distance from the sacrum and pubic symphysis (STratio) measured on digitally reconstructed radiographs. Patient and implant characteristics were included as covariates on LSP dose. Clinical follow up on LSP toxicity was recorded. RESULTS: Patients were prescribed 550 to 700 cGy using computed tomography-based imaged-guided brachytherapy for 4 to 5 fractions. The maximum dose to 2 cc (D2cc) of LSP ranged from 44 to 287 cGy per implant. The median D2cc was 118 cGy, corresponding to 18% of prescription dose. Patients with an STratio less than 0.33 (closer to the sacrum) and at least 0.33 had median LSP doses of 138 and 98 cGy, respectively. Lumbosacral plexus dose did not change significantly with body mass index, uterus position, or tumor stage. Two patients reported symptoms of peripheral neuropathy, with a median follow-up of 14.7 months. CONCLUSIONS: The mean D2cc per fraction to the LSP is roughly 20% of the prescribed high dose-rate and varies with the position of the tandem from the sacrum. The dose threshold for radiation-induced neuropathy of the LSP remains undefined.


Assuntos
Adenocarcinoma/terapia , Braquiterapia , Carcinoma de Células Escamosas/terapia , Plexo Lombossacral/efeitos da radiação , Neoplasias do Colo do Útero/radioterapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Plexo Lombossacral/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Neoplasias do Colo do Útero/patologia
15.
Ann Rehabil Med ; 37(5): 730-4, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24236264

RESUMO

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

16.
Int J Gynecol Cancer ; 23(6): 1078-83, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23792603

RESUMO

OBJECTIVE: Computed tomography-based treatment planning for cervical cancer has allowed investigation into the volumetric radiation dose delivered to the rectum. The goal of intracavitary brachytherapy is to maximize the tumor dose while decreasing the dose to normal tissue like the rectum. We investigated the effects of tandem angle and maximum rectal distention on rectal dose delivered in HDR brachytherapy for locally advanced cervical cancer. MATERIALS AND METHODS: Between July 2007 and January 2010, 97 brachytherapy treatment planning computed tomographic scans from the first and last implant of 51 patients with locally advanced cervical cancer were reviewed. The rectum was manually contoured from the ischial tuberosity to the bottom of the sacroiliac joint. The maximum rectal distention was determined by measuring the largest anterior-posterior diameter of the rectum superior to the tandem ring and inferior to the end of the applicator. A volumetric measurement of the maximum and mean rectal dose, dose to 2 cc (D2cc), dose to 1cc (D1cc) of the rectum was calculated. The tandem angle and the Internal Commission on Radiation Units and Measurement rectal point were recorded, and a dose volume histogram was referenced. RESULTS: The mean maximum rectal distention was 3.01 cm. The mean D1cc, D2cc, mean rectal dose, maximum rectal dose, and Internal Commission on Radiation Units and Measurement rectal dose were 3.03 Gy, 2.78 Gy, 4.19 cGy, 1.40 cGy, and 2.99 Gy per treatment, respectively. In a multivariate analysis controlling for surface area, tandem angle, and body mass index, there was a significant increase in D2cc with increasing rectal distention (P = 0.016). There were no significant findings when observing the effects of tandem angle on D2cc. CONCLUSION: Rectal distention significantly affects D2cc delivered in HDR brachytherapy. In contrast, tandem angle does not. Concerted efforts to decrease rectal distention should be considered during treatment planning and delivery.


Assuntos
Braquiterapia , Imageamento Tridimensional , Planejamento da Radioterapia Assistida por Computador , Reto/patologia , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Dosagem Radioterapêutica , Reto/efeitos da radiação , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/patologia
17.
Brachytherapy ; 12(6): 550-4, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23706512

RESUMO

PURPOSE: The impact of body mass index (BMI) on rectal dose in brachytherapy for cervical cancer is unknown. We assessed the association of BMI on rectal dose and lower gastrointestinal (GI) toxicity. METHODS AND MATERIALS: Between 2007 and 2010, 51 patients with 97 brachytherapy planning images were reviewed. Volumetric measurements of the maximum percentage, mean percentage, dose to 2cc (D2cc), and dose to 1cc (D1cc) of the rectum, and the Internal Commission on Radiation Units and Measurement (ICRU) rectal point were recorded. Linear mixed effect models, analysis of variance, and regression analyses were used to determine the correlation between multiple observations or to detect a difference in the mean. The GI acute and late toxicity were prospectively recorded and retrospectively analyzed. RESULTS: The average BMI (kg/m(2)) was 27.7 with a range of 17.4-46.6. Among the patients, 8% were morbidly obese, 25% obese, 25% overweight, 40% normal weight, and 2% underweight. The mean D1cc, D2cc, mean rectal dose (%), maximum rectal dose (%), and ICRU rectum was 3.03 Gy, 2.78 Gy, 20%, 60%, and 2.99 Gy, respectively. On multivariate analysis, there was a significant decrease in the D1cc and D2cc rectal dose (p=0.016), ICRU rectal point dose (p=0.022), and mean rectal dose percentage (p=0.021) with an increase in BMI. There was, however, no statistically significant relationship between BMI and GI toxicity. CONCLUSIONS: Obesity decreases the rectal dose given in high-dose-rate brachytherapy for locally advanced cervical cancer because of an increase in fatty tissue in the recto-uterine space. There is no significant correlation between BMI and acute or late GI toxicity.


Assuntos
Índice de Massa Corporal , Braquiterapia/métodos , Obesidade Mórbida/complicações , Radioterapia de Alta Energia/métodos , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Reto/efeitos da radiação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/diagnóstico
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