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1.
Cancer Radiother ; 23(6-7): 503-509, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31471253

RESUMO

There are many treatment options for localized prostate cancers, including active surveillance, brachytherapy, external beam radiotherapy, and radical prostatectomy. Quality of life remains a primary objective in the absence of superiority of one strategy over another in terms of specific survival with similar long-term biochemical control rates. Despite a significant decrease in digestive and urinary toxicities thanks to IMRT and IGRT, external radiotherapy remains a treatment that lasts approximately 2 months or 1.5 months, when combined with a brachytherapy boost. Given the specific radiosensitivity of this tumor, several randomized studies have shown that a hypofractionated scheme is not inferior in terms of biochemical control and toxicities, allowing to divide the number of fractions by a factor 2 to 8. Given that SBRT becomes a validated therapeutic option for a selected population of patients with localized prostate cancer, extreme hypofractionation is becoming a strong challenger of conventional external radiotherapy or brachytherapy.


Assuntos
Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Braquiterapia , Ensaios Clínicos Fase III como Assunto , Estudos de Equivalência como Asunto , Humanos , Irradiação Linfática/métodos , Masculino , Seleção de Pacientes , Cuidados Pós-Operatórios , Qualidade de Vida , Hipofracionamento da Dose de Radiação/normas , Tolerância a Radiação , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Cancer Radiother ; 23(6-7): 526-530, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31400957

RESUMO

The decision to reirradiate a volume which had been previously irradiated remains in 2019 one of the most difficult challenge for a radiation oncologist. Such a decision has to be based on a number of clinical and technological criteria, and the radiation oncologist will have to answer three main questions: i) can the patient clinically tolerate a second irradiation in the same previously irradiated area? While waiting for fully reliable individual tests of radiosensitivity, one has to take into account the tolerance of the first irradiation, as well as the comorbidities and/or habits which could impact the patient intrinsic radiosensitivity; ii) do the technical data of the first radiotherapy allow a re-irradiation? Unfortunately, and essentially when the discussion of re-irradiating the patient occurs many years (or even decades) after the first treatment, those precise technical data can be missing; iii) which technique should be used for the re-irradiation? In such a specific situation, the patient should be offered the more precise modern technology: stereotactic radiotherapy, protons, brachytherapy (low-, high-, or pulsed-dose rate). The indisputable improvement of the ballistic precision linked to our new technologies should lead to refine and to develop the indications of re-irradiation in the next future.


Assuntos
Tomada de Decisão Clínica , Tolerância a Radiação , Reirradiação/métodos , Braquiterapia/métodos , Humanos , Terapia com Prótons , Radioterapia , Dosagem Radioterapêutica , Fatores de Tempo
3.
Cancer Radiother ; 23(6-7): 541-558, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31421999

RESUMO

PURPOSE: Literature review reporting results of salvage brachytherapy and stereotactic body radiotherapy for prostate recurrence only after radiotherapy for prostate cancer. MATERIALS AND METHODS: A total of 38 studies (including at least 15 patients per study) were analysed: 19 using low-dose-rate brachytherapy, nine high-dose-rate brachytherapy and ten stereotactic body radiotherapy. Only five studies were prospective. The median numbers of patients were 30 for low-dose-rate brachytherapy, 34 for high-dose-rate brachytherapy, and 30 for stereotactic body radiotherapy. The median follow-up were 47months for low-dose-rate brachytherapy, 36months for high-dose-rate brachytherapy and 21months for stereotactic body radiotherapy. RESULTS: Late genitourinary toxicity rates ranged, for grade 2: from 4 to 42% for low-dose-rate brachytherapy, from 7 to 54% for high-dose-rate brachytherapy and from 3 to 20% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 24% for low-dose-rate brachytherapy, from 0 to 13% for high-dose-rate brachytherapy and from 0 to 3% for grade 3 or above (except 12% in one study) for stereotactic body radiotherapy. Late gastrointestinal toxicity rates ranged, for grade 2: from 0 to 6% for low-dose-rate brachytherapy, from 0 to 14% for high-dose-rate brachytherapy and from 0 to 11% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 6% for low-dose-rate brachytherapy, and from 0 to 1% for high-dose-rate brachytherapy and stereotactic body radiotherapy. The 5-year biochemical disease-free survival rates ranged from 20 to 77% for low-dose-rate brachytherapy and from 51 to 68% for high-dose-rate brachytherapy. The 2- and 3-year disease-free survival rates ranged from 40 to 82% for stereotactic body radiotherapy. Prognostic factors of biochemical recurrence have been identified. CONCLUSION: Despite a lack of prospective data, salvage reirradiation for prostate cancer recurrence can be proposed to highly selected patients and tumours. Prospective comparative studies are needed.


Assuntos
Braquiterapia , Recidiva Local de Neoplasia/radioterapia , Neoplasias da Próstata/radioterapia , Radiocirurgia , Reirradiação/métodos , Terapia de Salvação/métodos , Braquiterapia/estatística & dados numéricos , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Radiocirurgia/estatística & dados numéricos , Reirradiação/estatística & dados numéricos , Terapia de Salvação/estatística & dados numéricos
4.
Cancer Radiother ; 23(6-7): 565-571, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31447344

RESUMO

Prostate cancer is the most common cancer of men over 50 years old. Localized prostatic cancer treatment may be responsible of a decline of patient's quality of life. The main actors of treatment are now focused on minimizing functional consequences of treatments. The radiation oncologist has a central role in patient monitoring. The follow-up is codified by official recommendations of learned societies to enhance the post-cancer period. The main objective of this article is to review the recommendations for clinical and biological follow-up. An inventory of the functional consequences of the various treatments will be detailed, and particularly those caused by androgen deprivation therapy, with a review of precautions before implementation, adverse effects and their management, as well as monitoring recommendations. The analysis of quality of life after curative treatment and suggestions to improve monitoring will also be discussed.


Assuntos
Assistência ao Convalescente/normas , Papel do Médico , Neoplasias da Próstata/terapia , Radio-Oncologistas , Idoso , Antagonistas de Androgênios/uso terapêutico , Braquiterapia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Guias de Prática Clínica como Assunto , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/sangue , Qualidade de Vida , Disfunções Sexuais Fisiológicas/terapia , Resultado do Tratamento
5.
Cancer Radiother ; 23(6-7): 559-564, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31451359

RESUMO

Despite progress in the management of head and neck squamous cell carcinoma (HNSCC), a significant proportion of patients previously irradiated for head-and-neck cancer will develop locoregional recurrence or a second primary. Because of the heterogeneity of this population with respect to disease-related factors (localization, volume, recurrence or second primary, time interval from previous irradiation…) and patient-related factors (comorbidities, sequelae of previous irradiation…), the optimal reirradiation treatment remains to be defined. Salvage therapy using reirradiation, despite some encouraging results, has historically been avoided because of concerns regarding toxicity. The results of more recent studies using contemporary treatment techniques and conformal delivery methods such as intensity modulated radiation therapy (IMRT) or stereotactic radiotherapy (SBRT) have been somewhat more promising. The aim of this review is to discuss the reirradiation of HNSCC in terms of patient selection and modern radiotherapy techniques.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Segunda Neoplasia Primária/radioterapia , Seleção de Pacientes , Radiocirurgia , Radioterapia de Intensidade Modulada , Reirradiação/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Braquiterapia , Humanos , Cuidados Pós-Operatórios , Terapia com Prótons , Lesões por Radiação/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Medição de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Fatores de Tempo
6.
Cancer Radiother ; 23(6-7): 765-772, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31451358

RESUMO

Image-guided brachytherapy is crucial in the management of locally advanced cervical cancers and has benefited from advances in imaging over recent decades. The recommendations of the European Brachytherapy - European Society for Radiation Oncology (GEC-ESTRO) have resulted in harmonized practices and improved clinical outcomes in terms of efficacy and toxicity. Post-implant magnetic resonance imaging (MRI) has become the reference imaging modality to guide brachytherapy. There is an increasing interest for other multimodal imaging in these patients. The metabolic information provided by Positrons Emission Tomography/computed tomodensitometry (PET/CT) is also very promising approach to guide personalized dose escalation strategies. The prognostic values of MRI and PET scanner before brachytherapy make it possible to consider personalizing the dose delivered in brachytherapy and to propose a dose escalation to patients who really need it and to possibly consider a deescalation strategy in patients with a very good prognosis. However, further studies are needed to confirm this approach.


Assuntos
Braquiterapia/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Imagem Multimodal/métodos , Órgãos em Risco/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Radioterapia Guiada por Imagem/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia , Feminino , Humanos , Neoplasias do Colo do Útero/patologia
7.
Cancer Radiother ; 23(6-7): 737-744, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31455591

RESUMO

The treatment of cervical cancer patients relies on surgery and radiotherapy (according to the stage) and requires a multimodal discussion before any treatment to avoid adding the morbidities of each individual intervention and to optimize functional and oncological outcomes. The places of surgery and radiotherapy have been highlighted in recent international guidelines. For early stage tumors, an exclusive surgery with or without fertility sparing (according to well defined criteria) is the therapeutic standard. For tumors with risk factors (measuring more than 2cm in size and/or presence of lymphovascular invasion) a preoperative brachytherapy can be proposed to minimize the need for postoperative external beam radiotherapy and optimize local control. For locally advanced disease, the standard treatment relies on chemoradiation followed by a brachytherapy boost. A primary paraaortic lymph node dissection may guide radiotherapy volumes and is useful to identify patients requiring a para-aortic radiotherapy. The technical evolutions of surgical approaches and technological improvement of radiotherapy and brachytherapy should be analyzed in the context of prospective studies. We review the literature on the respective places of radiotherapy and surgery for the treatment of cervical cancer.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Braquiterapia , Terapia Combinada/métodos , Feminino , Humanos , Metástase Linfática , Recidiva Local de Neoplasia/cirurgia , Guias de Prática Clínica como Assunto , Carga Tumoral , Neoplasias do Colo do Útero/patologia
8.
Medicine (Baltimore) ; 98(33): e16874, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415427

RESUMO

To expand our prior statewide analysis of care distribution for locally advanced cervical cancer in Virginia to include 2 more states and to develop a tool for predicting quality of care. Complete treatment was defined as receiving chemotherapy (CT), brachytherapy (BT), and external beam radiotherapy.State cancer registry databases yielded a three-state cohort of 3197 women diagnosed with locally advanced cervical cancer from 2000 to 2013. A logistic regression evaluated predictors for receipt of BT, CT, and high (2-3 modalities received) versus low (0-1 modalities received) quality care. A Cox proportional hazards models determined predictors of survival. Finally, a predictive model was developed and preliminarily validated using our cohort.Only 35.3% of the cohort received complete treatment and only 57.3% received BT. Significant predictors of lower odds of receiving high quality care varied by state but included: 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; public insurance with supplement as compared to private; treatment at a low volume facility; and closer distance quintiles to a high volume treatment center as compared to the furthest quintile. Significant predictors of worse survival varied by state but included: low quality score (0-1 modalities received); 2000 to 2004 or 2005 to 2009 year of diagnosis as compared to 2010 to 2013; 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; treatment at a low volume facility; and unmarried/unknown marital status as compared to married. Our treatment quality prediction tool included age, age, treatment at high volume facility, and cancer stage and demonstrated 78.2% sensitivity and a 62.9% specificity.Only 35.3% of patients received complete guidelines-concordant treatment. Additionally, in 2/3 states it appeared that BT usage may have decreased during the study period. Our predictive model may help identify patients/regions at risk of receiving low quality care to target interventions aimed at improving cervical cancer treatment quality and survival.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Segunda Neoplasia Primária/terapia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Braquiterapia/estatística & dados numéricos , Feminino , Humanos , Kentucky , Pessoa de Meia-Idade , Estadiamento de Neoplasias , North Carolina , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Virginia , Adulto Jovem
10.
Medicine (Baltimore) ; 98(30): e16421, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348242

RESUMO

Cervical cancer is among the most frequent cancer types in women worldwide. Radiotherapy, including external beam radiation and brachytherapy, is one of the commonly used treatment options for cervical cancer. However, the adverse effects of radiation therapy on cervical cancer survival have been poorly investigated with inconclusive results. Therefore, the aim of this study was to determine the suitable radiotherapy modality according to patients' characteristics. A retrospective survival analysis of 44,602 patients was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate proportional hazard Cox model was used to evaluate the prognostic impact of different radiotherapy modalities, primary surgery, age, TNM stage, and tumor size. Our results indicated that patients without primary surgery, diagnosed at older age (≥45 years' old), at advanced TNM stages (III/IV) or with larger tumor size (≥3 cm) could benefit from radiotherapy. However, radiotherapy was detrimental in patients with primary surgery, diagnosed at younger age (<45 years' old), at earlier TNM stages (I/II) or with smaller tumor size (<3 cm). In addition, external beam radiation was in most cases less effective compared with combined external beam and brachytherapy. These results highlighted the necessity of realizing personalized radiotherapy treatments for patients with cervical cancer.


Assuntos
Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapia , Adulto , Fatores Etários , Idoso , Braquiterapia/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Menopausa , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Observacionais como Assunto , Prognóstico , Estudos Retrospectivos , Programa de SEER , Fatores Socioeconômicos , Carga Tumoral , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
11.
Cancer Radiother ; 23(5): 426-431, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31255579

RESUMO

The purpose of this article was to report the treatment effect of image-guided high-dose-rate interstitial brachytherapy boost in the radical radiotherapy for a huge metastatic carcinoma of cervical lymph nodes from an unknown primary site. The patient was a 75-year-old male. A diagnostic biopsy showed metastatic squamous cell carcinoma and the tumour size was 7.5×6.5×11.5cm3 before treatment (N3; AJCC 7th). After external beam radiotherapy with a dose of 60Gy in 30 fractions, the residual tumour (6.2×4.7×6.0cm3) was treated with image-guided high-dose-rate interstitial brachytherapy boost under ultrasound guidance. The brachytherapy dose was 16Gy in four fractions of 4Gy each. Removal of the huge metastatic tumour was securely achieved by high dose rate interstitial brachytherapy guided with ultrasound scanning. The refractory tumour in the patients healed uneventfully after image-guided high-dose-rate interstitial brachytherapy without recurrence during the 24 months of follow-up. The image-guided high-dose-rate interstitial brachytherapy boost may be a proposed treatment strategy for metastatic carcinoma of cervical lymph nodes from an unknown primary site with radical radiotherapy, especially for huge residual tumour.


Assuntos
Braquiterapia/métodos , Carcinoma de Células Escamosas/secundário , Irradiação Linfática/métodos , Metástase Linfática/radioterapia , Neoplasias Primárias Desconhecidas , Radioterapia Guiada por Imagem/métodos , Ultrassonografia de Intervenção/métodos , Idoso , Carcinoma de Células Escamosas/radioterapia , Fracionamento da Dose de Radiação , Humanos , Imagem por Ressonância Magnética , Masculino , Pescoço , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Órgãos em Risco , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radioterapia de Intensidade Modulada
12.
Cancer Radiother ; 23(5): 401-407, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351809

RESUMO

PURPOSE: The purpose of this study was to describe the adjuvant management of high grade uterine sarcoma and highlight prognostic factors for overall survival and progression-free survival. MATERIAL AND METHODS: Between 01/2000 and 01/2015, 91 patients undergoing surgery were presented at the multidisciplinary team meeting of our institution. The type of surgery, the anatomopathological features, adjuvant treatments, dates and sites of recurrence were collected. The prognostic value of the various factors was evaluated with the multivariate Cox model. RESULTS: A total of 50 women with uterine sarcoma were identified and lesions included 43 leiomyosarcomas (86%) and seven high grade sarcomas (14%). Eighteen patients received adjuvant pelvic radiotherapy (36%) and six adjuvant systemic therapy (12%). The median follow-up time was 63 months. Thirty-nine patients (78%) had a recurrence: 22 had only metastatic recurrence (58%), two had isolated pelvic recurrence (5%) and 15 had pelvic and metastatic recurrence (38%). Adjuvant radiotherapy was associated with survival without pelvic recurrence in univariate analysis (P=0.005, hazard ratio [HR]=0.15); age greater than 55 years and adjuvant radiotherapy were associated with metastatic free survival in multivariate analysis (P=0.015, HR=2.37, and P=0.013, HR=0.41 respectively) CONCLUSION: According to the results of our series, there is a benefit of radiotherapy after surgery in terms of local control of uterine sarcoma. It is necessary to identify the subgroup of patients who will benefit from an adjuvant radiotherapy in order to provide them with more optimal care.


Assuntos
Radioterapia Adjuvante , Neoplasias Uterinas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Braquiterapia , Quimioterapia Adjuvante/estatística & dados numéricos , Terapia Combinada , Feminino , Humanos , Histerectomia , Estimativa de Kaplan-Meier , Leiomiossarcoma/tratamento farmacológico , Leiomiossarcoma/radioterapia , Leiomiossarcoma/cirurgia , Excisão de Linfonodo , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Prognóstico , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Radioterapia Adjuvante/estatística & dados numéricos , Sarcoma , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/cirurgia
13.
Gynecol Oncol ; 154(3): 487-494, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31257010

RESUMO

OBJECTIVES: To determine which patients with locoregionally advanced endometrial cancer may benefit from pelvic external beam radiotherapy (EBRT) in addition to chemotherapy compared to chemotherapy alone. METHODS: Patients with FIGO stages III-IVA endometrial carcinoma between 2004 and 2016 who underwent at least total hysterectomy and adjuvant multiagent chemotherapy were identified in the National Cancer Database. The primary outcome was overall survival according to receipt of pelvic EBRT, analyzed using the Kaplan-Meier method and Cox multivariable regression. RESULTS: In total, 13,270 patients were identified (62% pure endometrioid, 38% serous/clear cell or mixed histology; 22.6% stage IIIA, 4.7% stage IIIB, 71.2% stage IIIC, 1.5% stage IVA), of whom 40% received pelvic EBRT. In univariable analysis, EBRT was associated with absolute 5-year survival increases of 5% and 9% in the endometrioid and non-endometrioid cohorts, respectively (P < 0.0001). In multivariable analyses stratified by stage and histology, patients with a significant benefit from EBRT were stage IIIC (specifically IIIC2) endometrioid (adjusted hazard ratio [HR] 0.73, P = 0.01) and stages IIIB and IIIC non-endometrioid (adjusted HR 0.52, P = 0.01 and adjusted HR 0.79, P < 0.0001). The benefit of EBRT in node-positive patients persisted in those who underwent more extensive lymphadenectomy. CONCLUSIONS: Stages III-IVA endometrial cancer comprised a heterogeneous population with respect to the added benefit of radiotherapy compared to chemotherapy alone. Patients with stage IIIC2 endometrioid and stages IIIB-C non-endometrioid cancer may be most likely to benefit from pelvic EBRT.


Assuntos
Carcinoma Endometrioide/mortalidade , Carcinoma Endometrioide/terapia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia , Carcinoma Endometrioide/patologia , Quimioterapia Adjuvante , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante , Sistema de Registros , Estados Unidos/epidemiologia
14.
Gynecol Oncol ; 154(3): 595-601, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31292103

RESUMO

OBJECTIVE: Black women have the highest incidence and mortality from cervical cancer in the United States. This study evaluated whether racial disparities in the receipt of brachytherapy (BT) for locally advanced cervical cancer mediate survival differences by race using the National Cancer Database. METHODS: A retrospective cohort study was performed using 16,116 women with stage IB2-IVA cervical cancer treated from 2004 to 2014. Women who did not receive external beam radiation therapy, those with unknown survival data or stage, and those status post hysterectomy or pelvic exenteration were excluded. Multivariate logistic regression was performed to evaluate factors associated with BT use. Using a propensity score adjusted model with inverse probability treatment weighting, adjusted hazard ratios for overall survival were calculated, including an interaction term between BT and race. RESULTS: Of 16,116 patients, 19.2% were black and 55.8% received BT. Black women were significantly less likely to receive BT (AOR 0.87, 95% confidence interval [CI] 0.79-0.96, p = 0.007) and had worse all-cause mortality (median survival 3.9 years [95% CI 3.6-4.6] versus 5.2 years [95% CI 4.9-5.5] for non-black women, p < 0.001). In the adjusted model, black patients had an increased risk of death compared to non-black patients (AHR 1.14, 95% CI 1.05-1.24; p = 0.002) among women who did not receive BT. However, there was no difference in survival by race when both groups received BT (AHR 1.04, 95% CI 0.95-1.13, p = 0.42; p-interaction = 0.005). CONCLUSIONS: Black women with locally advanced cervical cancer are less likely to receive brachytherapy, which mediates survival differences by race. Improving access to brachytherapy may improve overall survival.


Assuntos
Afro-Americanos/estatística & dados numéricos , Braquiterapia/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/mortalidade
15.
Igaku Butsuri ; 39(1): 24-28, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31168035

RESUMO

One of the characteristics of deformable image registration (DIR) is to detect anatomical coincidence points between two different images. The advantages of using DIR with radiotherapy are as follows. (1) to support the determination of the target using images of modality and series different from the treatment plan image, and (2) to evaluate the dose administered to the target and risk organs by summing the multiple dose distributions. Although DIR has been widely used in the field of external irradiation, application in the field of brachytherapy has been widespread in recent years. Also, the use of DIR is tried for quantitative assessment of anatomical changes over time during the treatment period and determination of the treatment effect after completion of treatment.In this article, we describe the outline of the technique and the evidence of the current status about the application of DIR in clinical practice.


Assuntos
Braquiterapia , Planejamento da Radioterapia Assistida por Computador , Algoritmos , Processamento de Imagem Assistida por Computador , Dosagem Radioterapêutica
16.
Nuklearmedizin ; 58(3): 242-248, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31167272

RESUMO

AIM: To evaluate the feasibility of early metabolic response assessment with 18F-FDG PET/CT in patients with breast cancer liver metastases 4 weeks after radioembolization with Yttrium-90 labeled microspheres. METHODS: 25 patients (mean age 58y, range 40-74) with advanced stage liver metastases of breast cancer were treated with 1.9 ± 0.4 GBq of 90Y-microspheres in the salvage setting and underwent 18F-FDG PET/CT at baseline and 4 weeks post-radioembolization. 14 patients (56 %) had an excessive hepatic tumor burden (> 50 % of total liver volume), 21 patients (84 %) had extrahepatic disease. Liver lesions with the highest SUVmax were selected as target lesions and a cut-off was set at 50 % reduction to separate responders from non-responders. The predictive impact of metabolic response on overall survival (OS) was investigated along with other prognostic factors. RESULTS: The median OS in this highly advanced metastatic cohort was 7 months (95 % CI, 5-9). All patients had a reduction in SUVmax (mean ΔSUVmax: -49 ± 26 %) at 4 weeks post-treatment. Patients with > 50 % SUVmax reduction survived longer (median OS 13 mo, 95 % CI 8-18) than the remaining patients (median OS 4 mo, 95 % CI 2-6; p = 0.001). From all investigated baseline factors including age, performance status, and presence of extra-hepatic disease, only the hepatic tumor burden had a significant impact on OS (p = 0.02). CONCLUSIONS: This is the first preliminary evidence in breast cancer that early post-radioembolization molecular response assessment of treated liver metastases - as early as 4 weeks posttreatment - may predict survival. If confirmed by larger series, FDG PET/CT could be considered for early response-adapted treatment modifications.


Assuntos
Neoplasias da Mama/mortalidade , Fluordesoxiglucose F18/uso terapêutico , Neoplasias Hepáticas/mortalidade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/uso terapêutico , Radioisótopos de Ítrio/uso terapêutico , Adulto , Idoso , Braquiterapia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Microesferas , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Radioisótopos de Ítrio/química
17.
Anticancer Res ; 39(6): 2919-2926, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177130

RESUMO

BACKGROUND/AIM: We evaluated patients undergoing salvage hysterectomy after brachytherapy (BT) following concomitant chemoradiation (CRT) for locally advanced cervical cancers (LACC), when residual disease was suspected. PATIENTS AND METHODS: From 2004 to 2013, 29 patients had a radical hysterectomy at the Gustave Roussy for suspicion of clinical and/or radiological residual disease. Outcomes, morbidities and the accuracy of the evaluation of response to CRT and BT were evaluated. RESULTS: The rate of complications grade>IIIa was 24%, with no difference between the 14 patients with histological residual disease and the 15 with a complete response. Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) revealed a sensitivity of 92% and 100%, but a poor specificity of less than 40%. Three recurrences occurred in patients with residual disease (brain, rectosigmoid colon, peritoneum and lung). CONCLUSION: The clinical examination, MRI and PET-CT are suboptimal for diagnosing residual disease after CRT and BT. The morbidity of adjuvant hysterectomy is high and does not prevent recurrences.


Assuntos
Histerectomia/métodos , Neoplasia Residual/cirurgia , Terapia de Salvação/métodos , Neoplasias do Colo do Útero/terapia , Adulto , Braquiterapia , Quimiorradioterapia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sensibilidade e Especificidade , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia
18.
Anticancer Res ; 39(6): 3015-3024, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177143

RESUMO

AIM: To compare the advantage of image-guided brachytherapy (IGBT) over conventional two-dimensional brachytherapy (2DBT) in patients with advanced cervical squamous cell carcinoma. PATIENTS AND METHODS: This study included 253 patients with stage IB2-IVA diseases treated with two schemes of brachytherapy. One hundred and thirty-six patients received 2DBT, whereas 117 patients received IGBT. Tumor stage, age, and tumor diameter were matched between the two groups. Local relapse-free survival, overall survival, and cumulative incidences of gastrointestinal and genitourinary complications were compared between the two groups. RESULTS: The overall and local relapse-free survival rates were similar between the two groups. The cumulative rate of grade 2 and higher gastrointestinal complication was 21.3% for the 2DBT group, and 8.5% for the IGBT group (p=0.007), whereas that of grade 2 and higher genitourinary injury was 11.8% for the 2DBT group, and 1.7% for the IGBT group (p=0.002). CONCLUSION: In patients with advanced cervical squamous cell carcinoma, IGBT achieves a higher therapeutic ratio compared to 2DBT technique by minimizing the late toxicities.


Assuntos
Braquiterapia/métodos , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Antineoplásicos/administração & dosagem , Braquiterapia/efeitos adversos , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Quimiorradioterapia/efeitos adversos , Cisplatino/administração & dosagem , Fracionamento da Dose de Radiação , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Estudos Retrospectivos , Fatores de Tempo , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia
19.
Anticancer Res ; 39(6): 3095-3100, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177154

RESUMO

BACKGROUND/AIM: To retrospectively evaluate the outcome of patients with unresectable biliary cholangiocarcinoma (CC) treated with radiotherapy (RT) plus/minus chemotherapy (CHT). MATERIALS AND METHODS: Data of patients with intrahepatic CC (ICC), Klatskin's tumor (KT), distal extrahepatic CC (ECC), and gallbladder cancer (GBC) diagnosed from 1991 to 2017 were retrospectively analyzed. The treatment was mainly based on RT plus concurrent CHT +/- brachytherapy (BRT) boost. The Kaplan-Meier method was used to calculate survival curves that were compared using the log-rank test. RESULTS: Seventy-six patients were included in this analysis (males: 59%; females: 41%; median age: 66.5 years). A minority of patients (7.9%) were treated for disease recurrence after surgery. According to TNM, 78.5% of patients had T stage >3 and 77.6% of patients were treated with concurrent CHT-RT while 22.3% received RT followed by sequential CHT. Median RT dose was 50 Gy (range: 16-75 Gy) delivered with conventional fractionation. CHT was based on Gemcitabine or 5-fluorouracil. BRT was prescribed to 51.3% of patient with a median dose of 14 Gy. Reported Grade ≥3 acute GI and hematological toxicity were 13.2% and 8.1%, respectively. No other severe acute toxicities were reported. One- and 2-year overall survival (OS) were 58.1% and 25.8%, respectively (median: 13.5 months), while 1- and 2-year progression-free survival (PFS) were 43.4% and 9.4%, respectively. None of the following variables had a significant impact on OS and PFS: BRT boost, tumor site, concurrent CHT, and the drugs used in concurrent CHT. In contrast, patients receiving RT with 2D technique showed a PFS significantly higher compared to patients treated with the 3D technique (median: 15.5 vs. 8.5 months; p=0.02). CONCLUSION: Combined modality treatment (RT+CHT±BRT) in unresectable biliary cancer was associated with acceptable toxicity and OS comparable to the actual standard treatment (CHT). The significantly improved PFS in patients undergoing 2D-RT raises doubts regarding the adequacy of target delineation in these neoplasms.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Braquiterapia , Quimiorradioterapia , Colangiocarcinoma/terapia , Neoplasias da Vesícula Biliar/terapia , Tumor de Klatskin/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antimetabólitos Antineoplásicos/administração & dosagem , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/patologia , Braquiterapia/efeitos adversos , Braquiterapia/mortalidade , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/mortalidade , Colangiocarcinoma/mortalidade , Colangiocarcinoma/patologia , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Fracionamento da Dose de Radiação , Feminino , Fluoruracila/administração & dosagem , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/patologia , Humanos , Tumor de Klatskin/mortalidade , Tumor de Klatskin/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
20.
Int J Nanomedicine ; 14: 4157-4165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31239674

RESUMO

Background: During decades, all improvements and developments in radiation therapy technologies have been focused on its main goal: maximize the dose in the tumor and minimize it in surrounding normal tissues. Recently, scientists have some approaches to nanoparticles, especially gold nanoparticles (GNPs), for dose localization. Purpose: Herein, the effect of GNPs in combination with electron brachytherapy in a model of eye tumor has been investigated. Materials and methods: Monte Carlo simulation was utilized and a complete anatomical model of the eye, a tumor with 5 mm thick, and a type of Ruthenium-106 beta emitter ophthalmic plaque were simulated. Simulation results have been validated by a Plexiglas eye phantom and film dosimetry, experimentally. Results: The results showed using GNPs causes the dose amplification in 2 mm from the plaque surface which the higher concentration has the higher enhancement. At more distances, Dose Enhancement Factors (DEFs) have the negative amounts, so that total delivered dose to the tumor has decreased with increasing of Au concentrations and the dose of organ at risk like sclera has increased. Conclusion: Therefore, using of GNPs along with a 106Ru/106Rh ocular plaque, as an electron emitter source, is a good choice only for superficial lesions, and it is not recommended for deeper tumors due to the parameters of radiation treatment and delivered dose to the tissues.


Assuntos
Braquiterapia , Elétrons , Neoplasias Oculares/radioterapia , Ouro/uso terapêutico , Nanopartículas Metálicas/uso terapêutico , Simulação por Computador , Relação Dose-Resposta à Radiação , Olho/patologia , Olho/efeitos da radiação , Humanos , Método de Monte Carlo , Imagens de Fantasmas , Dosagem Radioterapêutica , Reprodutibilidade dos Testes , Rutênio/química , Prata/uso terapêutico
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