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3.
Vasc Endovascular Surg ; 54(2): 172-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31714184

RESUMO

Axillary artery blowout is a rare life- and limb-threatening condition. The traditional surgical approach of ligation and extra-anatomic bypass is associated with a high morbidity and mortality. We present a case report of a 65-year-old male with axillary artery hemorrhage secondary to an irradiated squamous cell cancer. We propose a staged hybrid approach for the treatment of this unusual clinical entity consisting of emergent stent grafting followed by planned elective extra-anatomic bypass, debridement, and a course of specific antimicrobial therapy.


Assuntos
Artéria Axilar/efeitos da radiação , Artéria Axilar/cirurgia , Implante de Prótese Vascular , Carcinoma de Células Escamosas/radioterapia , Procedimentos Endovasculares , Hemorragia/cirurgia , Lesões por Radiação/terapia , Neoplasias Cutâneas/radioterapia , Idoso , Anti-Infecciosos/administração & dosagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Carcinoma de Células Escamosas/patologia , Desbridamento , Procedimentos Endovasculares/instrumentação , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Masculino , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Neoplasias Cutâneas/patologia , Stents , Resultado do Tratamento
4.
Urology ; 135: 111-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31454660

RESUMO

OBJECTIVE: To explore relationships between dose to periprostatic anatomic structures and erectile dysfunction (ED) outcomes in an institutional cohort treated with prostate brachytherapy. METHODS: The Sexual Health Inventory for Men (SHIM) instrument was administered for stage cT1-T2 prostate cancer patients treated with Pd-103 brachytherapy over a 10-year interval. Dose volume histograms for regional organs at risk and periprostatic regions were calculated with and without expansions to account for contouring uncertainty. Regression tree analysis clustered patients into ED risk groups. RESULTS: We identified 115 men treated with definitive prostate brachytherapy who had 2 years of complete follow-up. On univariate analysis, the subapical region (SAR) caudal to prostate was the only defined region with dose volume histograms parameters significant for potency outcomes. Regression tree analysis separated patients into low ED risk (mean 2-year SHIM 20.03), medium ED risk (15.02), and high ED risk (5.54) groups. Among patients with good baseline function (SHIM ≥ 17), a dose ≥72.75 Gy to 20% of the SAR with 1 cm expansion was most predictive for 2-year potency outcome. On multivariate analysis, regression tree risk group remained significant for predicting potency outcomes even after adjustment for baseline SHIM and age. CONCLUSION: Dose to the SAR immediately caudal to prostate was predictive for potency outcomes in patients with good baseline function. Minimization of dose to this region may improve potency outcomes following prostate brachytherapy.


Assuntos
Braquiterapia/efeitos adversos , Disfunção Erétil/diagnóstico , Ereção Peniana/efeitos da radiação , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico , Idoso , Braquiterapia/métodos , Relação Dose-Resposta à Radiação , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Paládio/administração & dosagem , Paládio/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Prognóstico , Estudos Prospectivos , Próstata/patologia , Próstata/efeitos da radiação , Neoplasias da Próstata/patologia , Lesões por Radiação/etiologia , Radioisótopos/administração & dosagem , Radioisótopos/efeitos adversos , Análise Espaço-Temporal , Fatores de Tempo
5.
Z Gastroenterol ; 57(11): 1304-1308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31739376

RESUMO

Selective internal radiation therapy (SIRT) is a therapeutic option for primary and metastatic liver tumors. Microspheres containing Yttrium 90, a beta-emitting radionuclide, are administered into the hepatic artery allowing selective internal radiation of a liver tumor. SIRT-related complications may appear due to migration of the radiation microspheres to organs distant from the tumor site. In order to prevent these complications, unintended non target embolization of Yttrium microspheres has to be avoided. However, data from external-beam radiation therapy (EBRT) suggests that the stomach/small bowel may actually be less radiosensitive than the liver. Gastric ulcers, a well-known SIRT-related complication, may therefore not only be caused by local radiation but also by unusual accumulation of microspheres in the submucosa and small vessel damage. We herein report a more than two- year-long persisting, highly symptomatic, non-neoplastic ulceration of the gastric antrum leading to pyloric stenosis caused by SIRT therapy with Yttrium 90 microspheres for the treatment of intrahepatic cholangiocellular carcinoma. The chronic courses of the ulcer disease together with the specific histological features highlight the pivotal role of radiation-induced small vessel damage in SIRT-induced adverse events.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/patologia , Colangiocarcinoma/radioterapia , Lesões por Radiação/diagnóstico , Úlcera Gástrica/etiologia , Radioisótopos de Ítrio/efeitos adversos , Ductos Biliares Intra-Hepáticos , Feminino , Artéria Hepática , Humanos , Microesferas , Pessoa de Meia-Idade , Úlcera Gástrica/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Radioisótopos de Ítrio/uso terapêutico
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1021-1026, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770832

RESUMO

Radiation-induced bowel injury is a common complication of radiation therapy for pelvic malignancy. Given the huge number of patients diagnosed with pelvic malignancy, the number of patients diagnosed with radiation-induced bowel injury increased year by year, which put a great burden on the clinical diagnosis and treatment of radiation-induced bowel injury. In particular, chronic radiation-induced bowel injury, which is manifested in the process of prolonged, repeated and progressive aggravation, seriously affects the physical and mental health of patients and makes clinical diagnosis and treatment difficult. However, due to insufficient attention and understanding from doctors and patients, standardized diagnosis and treatment of radiation-induced bowel injury still have a long way to go. Radiation-induced bowel injury is self-limited but irreversible. During diagnosis, we should pay attention to overall evaluation of the stage of disease based on clinical symptoms, endoscopic examination, imaging examination, pathology and nutritional risk. The treatment methods include health education, drug therapy, enema therapy, formalin local treatment, endoscopic treatment and surgical treatment, etc. The treatment decision-making should be based on clinical symptoms, endoscopic or imaging findings to alleviate the clinical symptoms of patients as the primary goal and to improve the long-term quality of life of patients as the ultimate goal.


Assuntos
Enteropatias/terapia , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/terapia , Radioterapia/efeitos adversos , Doença Crônica , Humanos , Enteropatias/diagnóstico , Enteropatias/etiologia , Intestinos/efeitos da radiação , Qualidade de Vida , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia
7.
Kathmandu Univ Med J (KUMJ) ; 17(65): 61-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734681

RESUMO

Background Radiation-induced oral mucositis is one of the major ionizing radiation toxicities and normal tissue injuries resulting from radiotherapy. It occurs in up to 80% of head and neck cancer irradiated patients, reaching up to 100% in patients with altered fractionation. Objective To assess the grade of Radiation induced oral mucositis as per World Health Organization grading system among post-radiotherapy patients of Head and Neck cancer. Method World Health Organization grading for oral mucositis was done in patients reporting to Department of Radiation oncology for radiotherapy at BP Koirala Memorial Cancer Hospital, Bharatpur. A total of 71 patients in 1 month duration were included. Result Grade 2 mucositis was most common, 52.11% followed by grade 1 (22.5%), grade 3 (18.3%) and grade 4 (7.04%). There were no post-radiotherapy patients who presented without mucositis. Conclusion Radiation induced oral mucositis is a common adverse reaction of radiotherapy. With increase in dose and duration of radiotherapy, grade of mucositis was increasing.


Assuntos
Neoplasias de Cabeça e Pescoço/complicações , Radioterapia/efeitos adversos , Estomatite/diagnóstico , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Estomatite/etiologia , Organização Mundial da Saúde
8.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586950

RESUMO

Periprostatic abscess is a rare complication of hydrogel spacers in radiotherapy for prostate cancer. We present the case of a 61-year-old man who developed this condition. Abdominopelvis CT scan revealed a 54×35×75 mm collection in the location of the SpaceOAR, for which ultrasound-guided transperineal percutaneous drainage of the periprostatic abscess was performed. The patient remains well with serial CT scans showing near resolution of the collection.


Assuntos
Abscesso/diagnóstico , Hidrogéis/efeitos adversos , Doenças Prostáticas/diagnóstico , Lesões por Radiação/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus anginosus/isolamento & purificação , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/cirurgia , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/cirurgia , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/cirurgia , Tomografia Computadorizada por Raios X
9.
BMC Ophthalmol ; 19(1): 201, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533669

RESUMO

BACKGROUND: To document the visual acuity, spectral domain optical coherence tomography (SD-OCT) findings and prognosis in10 eyes of 6 patients with foveal damage from solar retinopathy in 1 year. METHODS: This was a prospective, observational case series of patients presented by solar maculopathy at Ophthalmology department, Sohag University. All patients underwent visual acuity (VA) testing, refraction, dilated fundus examination fluorescein angiography (FA) and SD-OCT (spectral Domain ocular coherence Tomography) imaging and follow up for 1 year. RESULTS: The mean age was 16.5 years (range 9-27 years, both eyes are affected in 4 patients. The mean spherical equivalent (SE) was - 0.25 ± 0.50 D. The visual acuity of the affected eyes ranged from 0.4 to 0.9 on presentation. At presentation Significant foveal pathology was identified on SD-OCT in 10 eyes, All eyes showed disruption of the photoreceptor ellipsoid zone and the interdigitation zone on SD-OCT, Follow up of the cases continued for 1 year.100% of cases showed improvement in VA: 20% eyes regained 1, 50% eyes with VA of 0.9; two eyes 20% 0.8 and one eyes (10%) with 0.4. The improvement began after 1 week and reached its maximum and became stationary after the 6th month of follow up, the outer retinal hole persist in OCT in 80% of cases. CONCLUSION: Solar maculopathy has a good prognosis yet shows no improvement after 6 months. Young age might pose as a risk factor.


Assuntos
Lesões por Radiação/etiologia , Retina/efeitos da radiação , Doenças Retinianas/etiologia , Luz Solar/efeitos adversos , Adolescente , Adulto , Criança , Angiofluoresceinografia , Seguimentos , Humanos , Prognóstico , Estudos Prospectivos , Lesões por Radiação/diagnóstico , Lesões por Radiação/fisiopatologia , Refração Ocular/fisiologia , Retina/fisiopatologia , Doenças Retinianas/diagnóstico , Doenças Retinianas/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Adulto Jovem
10.
Crit Care Clin ; 35(4): 619-631, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445609

RESUMO

Radiation accidents are rare, but can produce large numbers of casualties with predictable patterns of injury. Casualties may suffer from a wide range of radiation exposures. Triage based on presence or absence of conventional injuries and an accurate assessment of radiation dose based on event history, symptoms, and laboratory testing, is critical. Treatment of acute radiation syndrome is supportive: including fluids, antibiotics, blood products, colony-stimulating factors, and stem cell or bone marrow transplantation. Care of radiation-injured patients with conventional trauma or burns needs to be modified to account for adverse effects of radiation on wound healing and susceptibility to infections.


Assuntos
Planejamento em Desastres , Lesões por Radiação/terapia , Liberação Nociva de Radioativos , Cuidados Críticos/métodos , Descontaminação , Humanos , Lesões por Radiação/diagnóstico , Lesões por Radiação/epidemiologia
11.
BMC Cancer ; 19(1): 846, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455251

RESUMO

BACKGROUND: To explore the association between biologically effective dose (BED) and survival rates in Child-Pugh A classification (CP-A) small hepatocellular carcinoma (HCC) patients treated with stereotactic body radiation therapy (SBRT). METHODS: This retrospective study included 108 small HCC patients who were treated with SBRT between 2011 and 2014. The prescribed dose delivered to the tumor were 48Gy/8f, 49Gy/7f, 50Gy/5f and 54Gy/6f. The median biologically effective dose (BED10) of the total prescribed dose was 100Gy (76.8-102.6Gy). Factors associated with the survival rate were examined using the Cox proportion hazards model, and the factors associated with radiation-induced liver injury (RILD) were examined by logistic regression analysis. RESULTS: For these patients, the median follow-up time was 42 months (6-77 months), and the 1-, 2- and 3-year overall survival (OS) rates were 96.3, 89.8 and 80.6%, respectively. The 1-, 2- and 3-year progression-free survival (PFS) rates were 85.2, 70.1 and 60.6%, respectively. The 1-, 2- and 3-year local control (LC) rates were 98.1, 96.2 and 95.1%, respectively. The 1-, 2- and 3-year distant metastasis- free survival (DMFS) rates were 86.1, 72.8 and 61.2%. The OS, PFS and DMFS were significantly higher in the BED10 ≥ 100Gy group than in the BED10 < 100Gy group (OS: p = 0.020; PFS: p = 0.017; DMFS: p = 0.012). The PLT count was a predictive factor of RILD. CONCLUSIONS: SBRT is a safe and effective option for CP-A HCC patients. A BED10 value greater than 100Gy and lower CP score are associated with improved OS and PFS. Additionally, the peripheral PLT count are predictive factors of RILD.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/radioterapia , Radiocirurgia , Dosagem Radioterapêutica , Adulto , Idoso , Biomarcadores Tumorais , Carcinoma Hepatocelular/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Recidiva , Retratamento , Resultado do Tratamento , Carga Tumoral
12.
Oral Dis ; 25(7): 1744-1750, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295368

RESUMO

OBJECTIVES: Though xerostomia is a frequent oral symptom, there is no validated disease-specific questionnaire in German. The purpose of this study was to translate and validate versions of the Xerostomia Inventory and the Summated Xerostomia Inventory in a German-speaking population. PARTICIPANTS AND METHODS: Thirty-nine patients including 18 patients suffering from radiation-induced xerostomia enrolled in this study. Both questionnaires were translated into German language according to international accepted guidelines. For validation, we evaluated reliability, validity, and responsiveness using the COSMIN manual for cross-cultural adaptation. RESULTS: Cronbach's α was 0.92 for XI and 0.91 for SXI, showing both high internal consistency. Patients suffering from xerostomia showed significantly higher average scores demonstrating its discriminant validity. Confirmatory factor analysis showed excellent "goodness-of-fit" values for SXI and good to moderate values for XI, confirming the assumed factor structures. The Xerostomia Inventory and its summated version both showed excellent test-retest reliability in the non-xerostomia group (ICC = 0.85 and 0.84). CONCLUSIONS: The XI and SXI in their cross-cultural adapted versions are the first validated self-report assessments for xerostomia in German language. They are characterized by practical design and can be easily interpreted by the treating physician.


Assuntos
Saúde Bucal , Psicometria/métodos , Qualidade de Vida , Lesões por Radiação/diagnóstico , Inquéritos e Questionários/normas , Traduções , Xerostomia/diagnóstico , Endoscopia , Feminino , Humanos , Linguagem , Masculino , Psicometria/estatística & dados numéricos , Lesões por Radiação/etiologia , Reprodutibilidade dos Testes , Xerostomia/etiologia , Xerostomia/psicologia
13.
PLoS One ; 14(5): e0217443, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150454

RESUMO

Breast cancer (BC) is one of the most important neoplasias among women. Many patients receive radiotherapy (RT), which involves radiation exposure of the thoracic zone, including the heart and blood vessels, leading to the development of cardiovascular disease (CVD) as a long-term side effect. The severity of CVD-related pathologies leads research on assessing novel CVD biomarkers as diagnostic, prognostic or therapeutic agents. Currently, the possible candidates include blood microRNAs (miRNAs). Previous studies have supported a role for miRNA-146a, -155, -221, and -222 in the progression of CVD. Our purpose was to evaluate the RT-induced modulation of the expression of these miRNAs in the blood of women with BC. Pre-RT control and post-RT blood samples were collected, and after miRNA isolation and reverse transcription, the levels of the selected miRNAs were measured by real-time PCR. Our results showed that miRNA-155 exhibited the lowest expression, while miRNA-222 exhibited the highest expression, followed by miRNA-221. The expression of each individual miRNA was positively correlated with that of the others both pre-RT control and post-RT and inversely correlated with age before RT. Furthermore, RT promoted the overexpression of the selected miRNAs. Their levels were also affected by CVD-linked clinical parameters, treatment and BC side. Modulation of the expression of the selected miRNAs together with other risk factors might be associated with the development of future cardiovascular pathologies. Further confirmatory studies are needed to assess their potential as possible biomarkers in the progression of or as therapeutic targets for RT-induced CVD in BC patients.


Assuntos
Neoplasias da Mama/terapia , Doenças Cardiovasculares/diagnóstico , Lesões por Radiação/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Quimiorradioterapia Adjuvante/efeitos adversos , Quimiorradioterapia Adjuvante/métodos , Progressão da Doença , Fracionamento da Dose de Radiação , Feminino , Perfilação da Expressão Gênica , Coração/efeitos da radiação , Humanos , Mastectomia , MicroRNAs/sangue , MicroRNAs/metabolismo , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/sangue , Lesões por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos
14.
Gynecol Oncol ; 154(1): 183-188, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104905

RESUMO

OBJECTIVE: Women with endometrial or cervical cancer at risk for recurrence receive postoperative radiation therapy (RT). A patient reported outcomes (PRO) instrument to assess bowel and urinary toxicities is the Expanded Prostate Cancer Index Composite (EPIC), which has been validated in men with prostate cancer. As this instrument specifically measures bowel toxicity and the degree to which this is a problem, it was used in NRG Oncology/RTOG 1203 to compare intensity modulated RT (IMRT) to standard RT. This paper reports on the expanded validation of EPIC for use in women receiving pelvic RT. METHODS: In addition to the EPIC bowel domain, urinary toxicity (EPIC urinary domain), patient reported bowel toxicities (PRO-CTCAE) and quality of life (Functional Assessment of Cancer Therapy (FACT)) were completed before, during and after treatment. Sensitivity, reliability and concurrent validity were assessed. RESULTS: Mean bowel and urinary scores among 278 women enrolled were significantly worse during treatment and differed between groups. Acceptable to good reliability for bowel and urinary domain scores were obtained at all time points with the exception of one at baseline. Correlations between function and bother scores within the bowel and urinary domains were consistently stronger than those across domains. Correlations between bowel domain scores and PRO-CTCAE during treatment were stronger than those with the FACT. CONCLUSION: Correlations within and among the instruments indicate EPIC bowel and urinary domains are measuring conceptually discrete components of health. These EPIC domains are valid, reliable and sensitive instruments to measure PRO among women undergoing pelvic radiation.


Assuntos
Neoplasias do Endométrio/radioterapia , Enteropatias/etiologia , Doenças Urológicas/etiologia , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Enteropatias/diagnóstico , Intestinos/efeitos da radiação , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Cuidados Pós-Operatórios , Qualidade de Vida , Lesões por Radiação/diagnóstico , Radioterapia de Intensidade Modulada , Reprodutibilidade dos Testes , Uretra/efeitos da radiação , Doenças Urológicas/diagnóstico , Neoplasias do Colo do Útero/cirurgia
16.
PLoS One ; 14(5): e0216081, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31059552

RESUMO

A sensitive biodosimetry tool is required for rapid individualized dose estimation and risk assessment in the case of radiological or nuclear mass casualty scenarios to prioritize exposed humans for immediate medical countermeasures to reduce radiation related injuries or morbidity risks. Unlike the conventional Dicentric Chromosome Assay (DCA), which takes about 3-4 days for radiation dose estimation, cell fusion mediated Premature Chromosome Condensation (PCC) technique in G0 lymphocytes can be rapidly performed for radiation dose assessment within 6-8 hrs of sample receipt by alleviating the need for ex vivo lymphocyte proliferation for 48 hrs. Despite this advantage, the PCC technique has not yet been fully exploited for radiation biodosimetry. Realizing the advantage of G0 PCC technique that can be instantaneously applied to unstimulated lymphocytes, we evaluated the utility of G0 PCC technique in detecting ionizing radiation (IR) induced stable and unstable chromosomal aberrations for biodosimetry purposes. Our study demonstrates that PCC coupled with mFISH and mBAND techniques can efficiently detect both numerical and structural chromosome aberrations at the intra- and inter-chromosomal levels in unstimulated T- and B-lymphocytes. Collectively, we demonstrate that the G0 PCC technique has the potential for development as a biodosimetry tool for detecting unstable chromosome aberrations (chromosome fragments and dicentric chromosomes) for early radiation dose estimation and stable chromosome exchange events (translocations) for retrospective monitoring of individualized health risks in unstimulated lymphocytes.


Assuntos
Aberrações Cromossômicas/efeitos da radiação , Linfócitos/efeitos da radiação , Radiometria/métodos , Animais , Células CHO/efeitos da radiação , Fusão Celular , Centrômero/efeitos da radiação , Cricetulus , Feminino , Raios gama/efeitos adversos , Humanos , Hibridização in Situ Fluorescente , Masculino , Lesões por Radiação/diagnóstico , Lesões por Radiação/genética , Radiação Ionizante , Estudos Retrospectivos , Cariotipagem Espectral/métodos , Telômero/efeitos da radiação , Raios X/efeitos adversos
17.
J Urol ; 202(2): 369-378, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31059663

RESUMO

PURPOSE: Urinary incontinence after prostate treatment (IPT) is one of the few urologic diseases that is iatrogenic, and, therefore, predictable and perhaps preventable. Evaluation of the incontinent patient, risk factors for IPT, the assessment of the patient prior to intervention, and a stepwise approach to management are covered in this guideline. Algorithms for patient evaluation, surgical management, and device failure are also provided. MATERIALS AND METHODS: This guideline was developed using a systematic review from the Mayo Clinic Evidence Based Practice Center with additional supplementation by the authors. A research librarian conducted searches from 2000 to December 21st, 2017 using Ovid, MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Databases of Systematic Reviews. Additional references through 12/31/2018 were identified. RESULTS: This guideline was developed by a multi-disciplinary panel to inform clinicians on the proper assessment of patients with IPT and the safe and effective management of the condition in both surgical and non-surgical contexts. Statements guiding the clinician on proper management of device failure are also included. CONCLUSION: Most patients who undergo radical prostatectomy (RP), and some patients who undergo radiation therapy (RT) or surgery for benign prostatic hyperplasia (BPH), will experience IPT. Although non-surgical options, such as pelvic floor muscle exercises (PFME), can hasten continence recovery, patients who remain incontinent at one-year post-procedure, or have severe incontinence at six months, may elect to undergo surgical treatment (e.g. artificial urinary sphincter). Prior to IPT surgery, the risks, benefits, alternatives, and additional likely procedures should be discussed with the patient.


Assuntos
Doenças Prostáticas/terapia , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prostatectomia/efeitos adversos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/terapia , Incontinência Urinária/etiologia
18.
Acta Oncol ; 58(8): 1178-1186, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31066326

RESUMO

Purpose: To evaluate the rate and dose response of brachial plexus toxicity post stereotactic body radiation therapy (SBRT) of apically situated lung lesions. Material/methods: We retrospectively identified all patients with apically located tumors, defined by the epicenter of the tumor being located superiorly to the aortic arch, and treated with SBRT between 2008 and 2013. Patients with a shorter follow-up than 6 months were excluded. Primary aim was to evaluate radiation-induced brachial plexopathy (RIBP). Dose to the plexus was assessed by a retrospective delineation of the brachial plexus on the CT used for treatment planning. Then, Dmax, D0.1cc, D1cc and D3.0cc of the brachial plexus were collected from the dose-volume histograms (DVH) and recalculated to the biologically effective dose (BED) using α/ß = 3 Gy. A normal tissue complication probability (NTCP) model, based on four different dose-volume parameters (BED3,max, BED3,0.1cc, BED3,1.0cc, BED3,3.0cc) was fitted to the data. Results: Fifty-two patients with 56 apically located tumors were identified. Median prescription dose per fraction was 15 Gy (range 6-17) and median number of fractions was 3 (3-10). With a median follow-up of 30 months (6.1-72) seven patients experienced maximum grade 2 (scored 3 times) or 3 (scored 4 times) RIBP after a median of 8.7 months (range 4.0-31). Three patients had combined symptoms with pain, sensory and motor affection and four patients had isolated pain. Median BED3,max for the patients experiencing RIBP was 381 Gy (range 30-524) versus BED3,max of 34 Gy (range 0.10-483) for the patients without RIBP. The NTCP models showed a very high predictive ability (area under the receiver operating characteristic curve (AUC) 0.80-0.88). Conclusion: SBRT of apically located lung lesions may cause severe neurological symptoms; for a three-fraction treatment, we suggest that the maximum dose to the plexus should be kept ≤30 Gy (130 Gy BED3).


Assuntos
Neuropatias do Plexo Braquial/epidemiologia , Neoplasias Pulmonares/radioterapia , Lesões por Radiação/epidemiologia , Radiocirurgia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/efeitos da radiação , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/etiologia , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
20.
J Cancer Res Ther ; 15(1): 42-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30880753

RESUMO

Introduction: Selective internal radiation therapy (SIRT) is increasingly used in different scenarios. Although portal hypertension (PHT) has been described as a nonclinically relevant finding after SIRT, its real incidence could have been neglected due to the nature of the diseases for which SIRT is indicated. Case Reports: Here we report three cases with clinically relevant late PHT after treatments including SIRT and oxaliplatin among others. Discussion: The sequential use of oxaliplatin and SIRT in patients with colorectal cancer metastases could have additive effects on the liver.


Assuntos
Braquiterapia/efeitos adversos , Neoplasias Colorretais/terapia , Hipertensão Portal/etiologia , Lesões por Radiação/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Biópsia , Braquiterapia/métodos , Quimiorradioterapia Adjuvante/efeitos adversos , Quimiorradioterapia Adjuvante/métodos , Feminino , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/patologia , Masculino , Microesferas , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico , Lesões por Radiação/patologia , Fatores de Tempo , Resultado do Tratamento , Radioisótopos de Ítrio/administração & dosagem , Radioisótopos de Ítrio/efeitos adversos
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