Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.323
Filtrar
1.
Medicine (Baltimore) ; 99(34): e21800, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846816

RESUMO

Delineation of organs at risk (OARs) is important but time consuming for radiotherapy planning. Automatic segmentation of OARs based on convolutional neural network (CNN) has been established for lung cancer patients at our institution. The aim of this study is to compare automatic segmentation based on CNN (AS-CNN) with automatic segmentation based on atlas (AS-Atlas) in terms of the efficiency and accuracy of OARs contouring.The OARs, including the lungs, esophagus, heart, liver, and spinal cord, of 19 non-small cell lung cancer patients were delineated using three methods: AS-CNN, AS-Atlas in the Pinnacle-software, and manual delineation (MD) by a senior radiation oncologist. MD was used as the ground-truth reference, and the segmentation efficiency was evaluated by the time spent per patient. The accuracy was evaluated using the Mean surface distance (MSD) and Dice similarity coefficient (DSC). The paired t-test or Wilcoxon signed-rank test was used to compare these indexes between the 2 automatic segmentation models.In the 19 testing cases, both AS-CNN and AS-Atlas saved substantial time compared with MD. AS-CNN was more efficient than AS-Atlas (1.6 min vs 2.4 min, P < .001). In terms of the accuracy, AS-CNN performed well in the esophagus, with a DSC of 73.2%. AS-CNN was better than AS-Atlas in segmenting the left lung (DSC: 94.8% vs 93.2%, P = .01; MSD: 1.10 cm vs 1.73 cm, P < .001) and heart (DSC: 89.3% vs 85.8%, P = .05; MSD: 1.65 cm vs 3.66 cm, P < .001). Furthermore, AS-CNN exhibited superior performance in segmenting the liver (DSC: 93.7% vs 93.6%, P = .81; MSD: 2.03 cm VS 2.11 cm, P = .66). The results obtained from AS-CNN and AS-Atlas were similar in segmenting the right lung. However, the performance of AS-CNN in the spinal cord was inferior to that of AS-Atlas (DSC: 82.1% vs 86.8%, P = .01; MSD: 0.87 cm vs 0.66 cm, P = .01).Our study demonstrated that AS-CNN significantly reduced the contouring time and outperformed AS-Atlas in most cases. AS-CNN can potentially be used for OARs segmentation in patients with pathological N2 (pN2) non-small cell lung cancer.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Redes Neurais de Computação , Órgãos em Risco , Planejamento da Radioterapia Assistida por Computador/métodos , Esôfago , Coração , Humanos , Fígado , Pulmão , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medula Espinal , Fatores de Tempo
2.
Medicine (Baltimore) ; 99(34): e21715, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846789

RESUMO

BACKGROUND: Stereotactic body radiotherapy (SBRT) superseded conventional radiotherapy (CRT) for the treatment of patients with inoperable early stage non-small cell lung cancer (NSCLC) over a decade ago. However, the direct comparisons of the outcomes of SBRT and CRT remain controversial. This meta-analysis was performed to compare the survival and safety of SBRT and CRT in patients with inoperable stage I NSCLC. METHODS: We systematically searched the Cochrane Library, Embase, PubMed, Web of Science, Ovid MEDLINE, ScienceDirect, Scopus and Google Scholar for relevant articles. Overall survival (OS), progression-free survival (PFS), lung cancer-specific survival (LCSS), local control rate (LCR) and adverse effects (AEs) were the primary outcomes. RESULTS: We identified 11,110 articles, 17 of which were eventually included in this study; these 17 articles had 17,973 patients (SBRT: 7395; CRT: 10,578). Compared to CRT for the treatment of inoperable stage I NSCLC, SBRT had superior survival in terms of OS (hazard ratio [HR]: 0.66, 95% confidence interval [CI]: 0.62-0.70, P < .00001), LCSS (HR: 0.42 [0.35-0.50], P < .00001), and PFS (HR: 0.34 [0.25-0.48], P < .00001). The 4-year OS rate (OSR); 4-year LCSS rate (LCSSR); 3-year local control rate (LCR); 5-year PFS rate (PFSR) with SBRT were all higher than those with CRT. With regard to all-grade AEs, the SBRT group had a significantly lower rate of dyspnea, esophagitis and radiation pneumonitis; no significant difference was found in grade 3-5 AEs (risk ratio [RR]: 0.68 [0.30-1.53], P = .35). CONCLUSIONS: With better survival and a lower rate of dyspnea, esophagitis and radiation pneumonitis than CRT, SBRT appears to be more suitable for patients with inoperable stage I NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Radiocirurgia/métodos , Fatores Etários , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Lesões por Radiação/epidemiologia , Radiocirurgia/efeitos adversos , Taxa de Sobrevida
3.
Cancer Radiother ; 24(6-7): 554-558, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32828666

RESUMO

The management of metastatic lung cancers, either of the small-cell (SCLC) or the non-small cell (NSCLC) subtype, largely based on systemic treatments so far, has been the subject of breakthrough advances over the past few years, with notably the wide use of immunotherapy changing the landscape of these harmful prognosis diseases. In parallel with this major progress, the increasing use of radiotherapy (RT) for the treatment of the primary thoracic lesion±the distant lesions, may contribute to improving the condition of these metastatic patients, both in terms of progression-free survival (PFS) and overall survival (OS). This review proposes to summarize and explain the findings provided by the different studies published in the last years experiencing RT of the primary tumor in metastatic lung cancers, either associated or not with the local ablative treatment of a low number of distant lesions. It will also expose the respective limits encountered in these studies and, in the light of all these elements, suggests various promising issues and fields of research for the future.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Pequenas/patologia , Previsões , Humanos , Neoplasias Pulmonares/patologia , Metástase Neoplásica/radioterapia
4.
PLoS One ; 15(7): e0236245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706818

RESUMO

We have previously demonstrated that endothelial targeting of gold nanoparticles followed by external beam irradiation can cause specific tumor vascular disruption in mouse models of cancer. The induced vascular damage may lead to changes in tumor physiology, including tumor hypoxia, thereby compromising future therapeutic interventions. In this study, we investigate the dynamic changes in tumor hypoxia mediated by targeted gold nanoparticles and clinical radiation therapy (RT). By using noninvasive whole-body fluorescence imaging, tumor hypoxia was measured at baseline, on day 2 and day 13, post-tumor vascular disruption. A 2.5-fold increase (P<0.05) in tumor hypoxia was measured two days after combined therapy, resolving by day 13. In addition, the combination of vascular-targeted gold nanoparticles and radiation therapy resulted in a significant (P<0.05) suppression of tumor growth. This is the first study to demonstrate the tumor hypoxic physiological response and recovery after delivery of vascular-targeted gold nanoparticles followed by clinical radiation therapy in a human non-small cell lung cancer athymic Foxn1nu mouse model.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Nanopartículas Metálicas/uso terapêutico , Hipóxia Tumoral , Células A549 , Animais , Carcinoma Pulmonar de Células não Pequenas/irrigação sanguínea , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Ouro/uso terapêutico , Humanos , Neoplasias Pulmonares/irrigação sanguínea , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Camundongos , Camundongos Nus , Imagem Óptica/métodos , Hipóxia Tumoral/efeitos dos fármacos , Hipóxia Tumoral/efeitos da radiação , Ensaios Antitumorais Modelo de Xenoenxerto
5.
Lung Cancer ; 146: 230-235, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32585497

RESUMO

COVID-19 has spread around the planet, sending billions of people into lockdown as health services struggle to cope. Meanwhile in Asia, where the disease began, the spread continues, in China it seems for now to have passed its peak. Italy, Spain, France, UK, and the US have been the countries more affected in terms of deaths. The coronavirus is more dangerous to the elderly and those with certain pre-existing medical conditions which is precisely the profile of lung cancer patients. Essential cancer services should be delivered but all steps should be taken to protect patients and the health workforce from infection with COVID-19. This presents a major challenge to radiotherapy (RT) departments worldwide. An international panel with expertise in the management of lung cancer in high-volume comprehensive centres has come together to share its experience on COVID-19 preparedness to deliver optimal care in such exceptional circumstances. A comprehensive systematic review of the literature through a PubMed search was undertaken. Twelve recommendations including, among others, the consideration of shorter courses, delays, and the omission of RT for lung cancer are proposed by the panel. In summary, we recommend the screening of every single person accessing the treatment room, the consideration of hypofractionation and to delay postoperative RT for non-small cell lung cancer, to avoid twice-daily treatments and delay or deliver prophylactic cranial irradiation during radio(chemo)therapy for limited-stage small cell lung cancer, review image guided RT images for suspicious image findings, and the use of single-fraction RT for the palliative treatment of stage IV lung cancer patients. Given that lung cancer is one of the most common and severe pathologies in radiation oncology departments, the following recommendations require particularly urgent consideration. The decision-making paths strongly depend on locally available resources, and a tailored approach should be used to attend lung cancer patients during this pandemic.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Infecções por Coronavirus/radioterapia , Surtos de Doenças , Pneumonia Viral/radioterapia , Carcinoma de Pequenas Células do Pulmão/radioterapia , Betacoronavirus/patogenicidade , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/virologia , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Fracionamento da Dose de Radiação , França/epidemiologia , Humanos , Itália/epidemiologia , Cuidados Paliativos/métodos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Carcinoma de Pequenas Células do Pulmão/complicações , Carcinoma de Pequenas Células do Pulmão/epidemiologia , Carcinoma de Pequenas Células do Pulmão/virologia , Espanha/epidemiologia
6.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32518630

RESUMO

Cancer in the elderly remains an evolving issue and a health challenge. Several improvements in the radiotherapy field allow the delivery of higher doses/fractions with a safe toxicity profile, permitting the reduction of radiation treatment protocols in the elderly. Regarding breast, prostate, and lung cancer, the under-representation of older patients in clinical trials limits the extension of treatment recommendations to elderly patients in routine clinical practice. Among the feasible alternatives to standard whole breast radiotherapy (WBRT) in older patients are shorter courses using higher hypofractionation (HF) and accelerated partial breast irradiation (APBI). The boost continues to be used in women at high risk of local recurrence but is less widely accepted for women at lower risk and patients over 70 years of age. Regarding prostate cancer, there are no published studies with a focus on the elderly. Current management decisions are based on life expectancy and geriatric assessment. Regimens of HF and ultra-HF protocols are feasible strategies for older patients. Several prospective non-randomized studies have documented the safe delivery of ultra-HF for patients with localized prostate cancer, and multiple phase III trials and meta-analyses have confirmed that the HF regimen should be offered with similar acute toxicity regardless of patient age and comorbidity. A recent pooled analysis from two randomized trials comparing surgery to stereotactic body radiation therapy (SBRT) in older adult patients with early stage non-small cell lung cancer did show comparable outcomes between surgery and SBRT. Elderly cancer patients are significantly under-represented in all clinical trials. Thus, the inclusion of older patients in clinical studies should be strongly encouraged to strengthen the evidence base for this age group. We suggest that the creation of oncogeriatric coordination units may promote individualized care protocols, avoid overtreatment with aggressive and unrecommended therapies, and support de-escalating treatment in elderly cancer patients.


Assuntos
Neoplasias da Mama/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Neoplasias da Próstata/radioterapia , Doses de Radiação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Cancer Radiother ; 24(5): 379-387, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32534799

RESUMO

The increasing use of stereotactic body radiation therapy for lung tumours comes along with new post-therapeutic imaging findings that should be known by physicians involved in patient follow-up. Radiation-induced lung injury is much more frequent than after conventional radiation therapy, it can also be delayed and has a different radiological presentation. Radiation-induced lung injury after stereotactic body radiation therapy involves the lung parenchyma surrounding the target tumour and appears as a dynamic process continuing for years after completion of the treatment. Thus, the radiological pattern and the severity of radiation-induced lung injury are prone to changes during follow-up, which can make it difficult to differentiate from local recurrence. Contrary to radiation-induced lung injury, local recurrence after stereotactic body radiation therapy is rare. Other complications mainly depend on tumour location and include airway complications, rib fractures and organizing pneumonia. The aim of this article is to provide a wide overview of radiological changes occurring after SBRT for lung tumours. Awareness of changes following stereotactic body radiation therapy should help avoiding unnecessary interventions for pseudo tumoral presentations.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Lesão Pulmonar/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Pulmão/efeitos da radiação , Lesões por Radiação/diagnóstico por imagem , Radiocirurgia/métodos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Diagnóstico Diferencial , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Lesão Pulmonar/etiologia , Neoplasias Pulmonares/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Fibrose Pulmonar/etiologia , Fibrose Pulmonar/patologia , Lesões por Radiação/etiologia , Pneumonite por Radiação/diagnóstico por imagem , Radiocirurgia/efeitos adversos , Fatores de Tempo
8.
Anticancer Res ; 40(5): 2537-2548, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366398

RESUMO

BACKGROUND/AIM: Radiotherapy-induced autophagy affects radiation-sensitivity and radiotherapy efficacy. Histone modifications also occur during radiotherapy. This study assessed radiotherapy effects on histone modification and autophagy in non-small cell lung cancer (NSCLC) cells. MATERIALS AND METHODS: NSCLC cells were subjected to γ-irradiation. Autophagy was detected using western blotting and acridine orange staining. Radiation effect on cell growth was evaluated by clonogenic assay. Histone modifications were assessed by western blotting. Next generation sequencings (NGSs) were conducted to identify histone modification target genes. RESULTS: Radio-protective autophagy and histone H4 lysine 20 trimethylation (H4K20me3) were up-regulated after irradiation. By NGSs, genes that are differentially expressed upon irradiation were identified, including the candidate H4K20me3 target gene GABARAPL1. Furthermore, we showed that GABARAPL1 is essential for the radiation-induced autophagy. CONCLUSION: Our findings revealed the regulatory axis of radiation-induced H4K20me3-GABARAPL1 in radio-protective autophagy. Modulation of this axis may be a new strategy to enhance radiotherapy efficacy in NSCLC.


Assuntos
Autofagia/efeitos da radiação , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Histonas/metabolismo , Neoplasias Pulmonares/metabolismo , Lisina/metabolismo , Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Biomarcadores Tumorais , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Linhagem Celular Tumoral , Epigênese Genética , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Metilação , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , RNA Interferente Pequeno/genética
9.
J Surg Oncol ; 122(2): 328-335, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32436267

RESUMO

INTRODUCTION: Sleeve resection is an established oncological operative treatment for centrally located tumors with reduced complications compared to pneumonectomy. In cases of neoadjuvant chemoradiotherapy, the optimal timing of surgery for bronchial anastomotic healing has not been adequately explored. MATERIALS AND METHODS: Between 2006 and 2017, 584 tracheobronchial sleeve resections were retrospectively analyzed. We selected all patients (n = 88) after sleeve lobectomy or sleeve bilobectomy for lung cancer with fully completed neoadjuvant chemoradiotherapy. Bronchial healing was assessed by bronchoscopy on the 7th postoperative day using our earlier published classification from grades 1 to 5. RESULTS: The median interval to surgery was 50 days (interquartile range 46-53, mean 50.03 ± 3.72). Mean anastomotic grade was 2.05 ± 1.03 and in 29.5% of the patients a critical anastomosis (grade ≥3) was documented. Anastomotic healing showed optimal results (bronchoscopic grade mean value: 1.5 ± 0.70) between the 6th and 8th postchemoradiotherapy week (P = .001). All patients operated before (bronchoscopic grade mean value: 2.3 ± 1.02) or after the above period (bronchoscopic grade mean value: 2.5 ± 1.15) had an increased ratio of anastomotic healing complications. CONCLUSION: It is safer to perform sleeve-resections for non-small cell lung cancer after neoadjuvant trimodal treatment between the 6th and 8th week of completion of chemoradiotherapy.


Assuntos
Anastomose Cirúrgica/métodos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Anastomose Cirúrgica/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Quimiorradioterapia Adjuvante , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Pneumonectomia/efeitos adversos , Estudos Retrospectivos
10.
Clin Oncol (R Coll Radiol) ; 32(8): 481-489, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32405158

RESUMO

Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic. Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.


Assuntos
Betacoronavirus , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Infecções por Coronavirus/complicações , Fracionamento da Dose de Radiação , Neoplasias Pulmonares/radioterapia , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto/normas , Carcinoma de Pequenas Células do Pulmão/radioterapia , Carcinoma Pulmonar de Células não Pequenas/virologia , Ensaios Clínicos como Assunto , Infecções por Coronavirus/virologia , Humanos , Neoplasias Pulmonares/virologia , Metanálise como Assunto , Pandemias , Pneumonia Viral/virologia , Gestão de Riscos , Carcinoma de Pequenas Células do Pulmão/virologia , Revisões Sistemáticas como Assunto
12.
Cancer Radiother ; 24(3): 182-187, 2020 Jun.
Artigo em Francês | MEDLINE | ID: covidwho-100544

RESUMO

Overall treatment time is an important factor of local recurrence and indirectly of distant evolution, namely in case of protracted treatments. The current pandemic impacts on the duration of radiotherapy if patients under treatments and synchronously suffering from COVID-19. The models used to compensate the total dose in case of temporary treatment interruption are well known but it is of importance in that pandemic context to update and homogenize clinical practice in order to improve local control without increasing normal tissue complications.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias/radioterapia , Pandemias , Pneumonia Viral/epidemiologia , Suspensão de Tratamento , Neoplasias da Mama/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Proliferação de Células , Feminino , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Neoplasias/patologia , Neoplasias da Próstata/radioterapia , Radiobiologia/métodos , Dosagem Radioterapêutica , Fatores de Tempo , Neoplasias do Colo do Útero/radioterapia
14.
Cancer Radiother ; 24(3): 182-187, 2020 Jun.
Artigo em Francês | MEDLINE | ID: covidwho-47899

RESUMO

Overall treatment time is an important factor of local recurrence and indirectly of distant evolution, namely in case of protracted treatments. The current pandemic impacts on the duration of radiotherapy if patients under treatments and synchronously suffering from COVID-19. The models used to compensate the total dose in case of temporary treatment interruption are well known but it is of importance in that pandemic context to update and homogenize clinical practice in order to improve local control without increasing normal tissue complications.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias/radioterapia , Pandemias , Pneumonia Viral/epidemiologia , Suspensão de Tratamento , Neoplasias da Mama/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Proliferação de Células , Feminino , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Neoplasias/patologia , Neoplasias da Próstata/radioterapia , Radiobiologia/métodos , Dosagem Radioterapêutica , Fatores de Tempo , Neoplasias do Colo do Útero/radioterapia
16.
Cancer Radiother ; 24(5): 362-367, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32284178

RESUMO

Therapeutic effectiveness in radiotherapy is partly related to correct staging of the disease and then precise therapeutic targeting. Positron emission tomography (PET) allows the stage of many cancers to be determined and therefore is essential before deciding on radiation treatment. The definition of the therapeutic target is essential to obtain correct tumour control and limit side effects. The part of adaptive radiotherapy remains to be defined, but PET by its functional nature makes it possible to define the prognosis of many cancers and to consider radiotherapy adapted to the initial response allowing an increase over the entire metabolic volume, or targeted at a subvolume at risk per dose painting, or with a decrease in the dose in case of good response at interim assessment.


Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Radioterapia Guiada por Imagem/métodos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/radioterapia , Feminino , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Neoplasias dos Genitais Femininos/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Pulmonares/radioterapia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Linfoma/radioterapia , Masculino , Prognóstico , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica
17.
Br J Radiol ; 93(1110): 20190692, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32293191

RESUMO

OBJECTIVE: The internal target volume (ITV) strategy generates larger planning target volumes (PTVs) in locally advanced non-small cell lung cancer (LA-NSCLC) than the Mid-position (Mid-p) strategy. We investigated the benefit of the Mid-p strategy regarding PTV reduction and dose to the organs at risk (OARs). METHODS: 44 patients with LA-NSCLC were included in a randomized clinical study to compare ITV and Mid-p strategies. GTV were delineated by a physician on maximum intensity projection images and on Mid-p images from four-dimensional CTs. CTVs were obtained by adding 6 mm uniform margin for microscopic extension. CTV to PTV margins were calculated using the van Herk's recipe for setup and delineation errors. For the Mid-p strategy, the mean target motion amplitude was added as a random error. For both strategies, three-dimensional conformal plans delivering 60-66 Gy to PTV were performed. PTVs, dose-volume parameters for OARs (lung, esophagus, heart, spinal cord) were reported and compared. RESULTS: With the Mid-p strategy, the median of volume reduction was 23.5 cm3 (p = 0.012) and 8.8 cm3 (p = 0.0083) for PTVT and PTVN respectively; the median mean lung dose reduction was 0.51 Gy (p = 0.0057). For 37.1% of the patients, delineation errors led to smaller PTV with the ITV strategy than with the Mid-p strategy. CONCLUSION: PTV and mean lung dose were significantly reduced using the Mid-p strategy. Delineation uncertainty can unfavorably impact the advantage. ADVANCES IN KNOWLEDGE: To the best of our knowledge, this is the first dosimetric comparison study between ITV and Mid-p strategies for LA-NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Movimentos dos Órgãos , Respiração , Idoso , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/efeitos da radiação , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Esôfago/diagnóstico por imagem , Esôfago/efeitos da radiação , Tomografia Computadorizada Quadridimensional , Coração/diagnóstico por imagem , Coração/efeitos da radiação , Humanos , Pulmão/diagnóstico por imagem , Pulmão/efeitos da radiação , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Estudos Prospectivos , Lesões por Radiação/prevenção & controle , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia Conformacional/métodos , Medula Espinal/diagnóstico por imagem , Medula Espinal/efeitos da radiação , Carga Tumoral
18.
Cancer Radiother ; 24(3): 182-187, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32307313

RESUMO

Overall treatment time is an important factor of local recurrence and indirectly of distant evolution, namely in case of protracted treatments. The current pandemic impacts on the duration of radiotherapy if patients under treatments and synchronously suffering from COVID-19. The models used to compensate the total dose in case of temporary treatment interruption are well known but it is of importance in that pandemic context to update and homogenize clinical practice in order to improve local control without increasing normal tissue complications.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias/radioterapia , Pandemias , Pneumonia Viral/epidemiologia , Suspensão de Tratamento , Neoplasias da Mama/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Proliferação de Células , Feminino , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Neoplasias/patologia , Neoplasias da Próstata/radioterapia , Radiobiologia/métodos , Dosagem Radioterapêutica , Fatores de Tempo , Neoplasias do Colo do Útero/radioterapia
19.
Br J Radiol ; 93(1109): 20191027, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32125893

RESUMO

OBJECTIVE: To investigate the suitability of the new diameter-based subgroupings of the eighth edition Tumor Node Metastasis (TNM) classification system regarding radiotherapy treatment for early-stage non-small-cell lung cancer (NSCLC), we retrospectively re-analyzed the clinical data of patients treated with intensity-modulated radiotherapy using non-coplanar beams (ncIMRT) for Stage I NSCLC. METHODS: Between March 2011 and March 2018, 92 patients with 94 tumors who were diagnosed with Stage I NSCLC according to the seventh edition TNM classification system were enrolled and underwent ncIMRT of 75 Gy in 30 fractions. Local control (LC), progression-free survival (PFS), and overall survival (OS) were retrospectively investigated according to the T-classification subdivisions of the eighth edition and maximal solid tumor component diameter. RESULTS: The median follow-up period was 32.5 months. The median maximum tumor and solid tumor component diameters were 22 mm and 18 mm, respectively. 3-year LC, PFS, and OS rates were 84.1%, 69.4%, and 85.3%, respectively. The 3-year LC rates were 91.0 and 76.8% in the groups with tumor diameter ≤2 cm and >2 cm, corresponding to the T1c and T1b subdivisions of the eighth edition, respectively (p = 0.24). In the ≤2 cm and >2 cm solid tumor component groups, the 3 year LC rates were 93.6 and 63.2%, respectively, which were significantly different (p = 0.007). CONCLUSION: LC rates after radiotherapy in patients with Stage I NSCLC were correlated with solid tumor component diameter. High LC rates in patients with solid tumor components <2 cm in diameter were associated with high PFS and OS rates. ADVANCES IN KNOWLEDGE: This study suggests that the eighth edition TNM classification system, which focuses on solid tumor components rather than tumor diameter, can be applied to radiotherapy.


Assuntos
Adenocarcinoma/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Pulmonares/radioterapia , Radioterapia de Intensidade Modulada/métodos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
20.
Cancer Radiother ; 24(2): 120-127, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32173269

RESUMO

BACKGROUND: The main complication after hypofractionated radiotherapy for lung carcinoma is radiation-induced lung toxicity, which can be divided into radiation pneumonitis (acute toxicity, occurring within 6 months) and lung fibrosis (late toxicity, occurring after 6 months). The literature describes several predictive factors related to the patient, to the tumor (volume, central location), to the dosimetry and to biological factors. MATERIALS AND METHODS: This study is a retrospective analysis of 90 patients treated with stereotactic body irradiation for stage I non-small-cell lung carcinoma between December 2010 and May 2015. RESULTS: Radiation pneumonitis was observed in 61.5% of the patients who were mainly asymptomatic (34%). Chronic obstructive pulmonary disease was not predictive of radiation pneumonitis, whereas active smoking was protective. Centrally located tumors were not more likely to result in this complication if the radiation schedule utilized adapted fractionation. In our study, no predictive factor was identified. Whereas the mean lung dose was a predictive factor in 3D radiotherapy, the lung volume irradiated at high doses seemed to be involved in the pathogenesis after hypofractionated radiotherapy. CONCLUSION: The discovery of predictive factors for radiation pneumonitis is difficult due to the rarity of this complication, especially with an 8×7.5Gy schedule. Radiation pneumonitis seems to be correlated with the volume irradiated at high doses, which is in contrast to the known knowledge about the organs in parallel. This finding leads us to raise the hypothesis that vessel damage, organs in series, occurring during hypofractionated radiotherapy could be responsible for this toxicity.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Pulmão/efeitos da radiação , Pneumonite por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Doença Pulmonar Obstrutiva Crônica/complicações , Fibrose Pulmonar/etiologia , Fibrose Pulmonar/prevenção & controle , Pneumonite por Radiação/prevenção & controle , Radiocirurgia/métodos , Estudos Retrospectivos , Fumar
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA