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1.
Bone Joint J ; 101-B(9): 1151-1159, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474143

RESUMO

AIMS: We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts. PATIENTS AND METHODS: This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). CONCLUSION: Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151-1159.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Osso e Ossos/cirurgia , Salvamento de Membro/métodos , Reimplante , Transplante Autólogo/métodos , Adolescente , Adulto , Autoenxertos/efeitos da radiação , Osso e Ossos/efeitos da radiação , Criança , Seguimentos , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Radioterapia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Adulto Jovem
2.
Cancer Radiother ; 23(6-7): 496-499, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31471251

RESUMO

Stereotactic radiotherapy of oligometastases, mono- or hypofractionated, represents a fundamental change in the practice of the specialty as it was developed for a century. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Four main phase II and III trials are underway in France. Future research concerns the association of stereotactic radiotherapy with immunotherapy or different conventional chemotherapy protocols, the identification of the best clinical presentations, and optimization of fractionation and biological dose for poor prognosis localizations.


Assuntos
Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Neoplasias/radioterapia , Radiocirurgia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/radioterapia , Terapia Combinada/métodos , Previsões , França , Humanos , Imunoterapia , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/radioterapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Metástase Neoplásica , Neoplasias/patologia , Neoplasias/terapia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia
3.
Chem Pharm Bull (Tokyo) ; 67(9): 897-903, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31474726

RESUMO

The word "theranostics," a portmanteau word made by combining "therapeutics" and "diagnostics," refers to a personalized medicine concept. Recently, the word, "radiotheranostics," has also been used in nuclear medicine as a term that refer to the use of radioisotopes for combined imaging and therapy. For radiotheranostics, a diagnostic probe and a corresponding therapeutic probe can be prepared by introducing diagnostic and therapeutic radioisotopes into the same precursor. These diagnostic and therapeutic probes can be designed to show equivalent pharmacokinetics, which is important for radiotheranostics. As imaging can predict the absorbed radiation dose and thus the therapeutic and side effects, radiotheranostics can help achieve the goal of personalized medicine. In this review, I discuss the use of radiolabeled probes targeting bone metastases, sigma-1 receptor, and αVß3 integrin for radiotheranostics.


Assuntos
Neoplasias Ósseas/diagnóstico , Compostos Radiofarmacêuticos/química , Animais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/radioterapia , Meios de Contraste/química , Meios de Contraste/metabolismo , Humanos , Oligopeptídeos/química , Oligopeptídeos/metabolismo , Oligopeptídeos/uso terapêutico , Compostos Radiofarmacêuticos/farmacocinética , Compostos Radiofarmacêuticos/uso terapêutico , Receptores sigma/química , Receptores sigma/metabolismo , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Distribuição Tecidual
4.
Medicine (Baltimore) ; 98(36): e17029, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490390

RESUMO

There is an increased enthusiasm in treating osteolytic metastatic acetabulum via injecting polymethyl-methacrylate (PMMA) as a bone filler to provide pain relief and potential structural support. The aim of this respective study is to determine the function and quality of life improvement after cement acetabuloplasty.Thirty two patients underwent acetabular cement augmentation between May 2014 and March 2018 were respectively reviewed. Isolated percutaneous acetabuloplasty (PA) was performed in 15 patients (group A) while radiofrequency ablation with PA (RFA-PA) in 12 patients (group B). Together with PA, open reconstructive surgery on ipsilateral femur was performed in another 5 cases (group C). Pre- and posttreatment functional evaluation and quality of life (QoL) assessment were carried out.The average followup duration was 11.5 (range, 3-36) months. None of major complications occurred. 81.2% (26/32) of patients achieved complete pain relief. Reduction of pain intensity and improvement of functional status achieved significantly differences after treatment (P = .00). Significant improvement (P = .00) was observed in scales of global QoL and pain-related restrictions in daily activities. Both isolated PA and RFA-PA procedures were equally effective towards the improvement of function and quality of life (P > .05). Regarding 5 patients in group C, pain intensity decreased when loading the affected limb and they could walk with crutches or cane.Bone cement acetabuloplasty is an adequate and effective mini-invasive procedure to relieve pain, restore function, and enhance the quality of life of patients for as long as possible in metastatic patients with short life expectancy. Ipsilateral surgery appears to be safe and well tolerated.


Assuntos
Acetabuloplastia/métodos , Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Carcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Carcinoma/radioterapia , Carcinoma/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Ablação por Radiofrequência , Recuperação de Função Fisiológica , Estudos Retrospectivos
5.
Anticancer Res ; 39(9): 5065-5069, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519616

RESUMO

BACKGROUND/AIM: The primary endpoint of this phase I study was the maximum tolerated dose (MTD) of middle half body (MHB) accelerated radiotherapy (RT) in multiple bone metastatic (BM) prostate cancer (PCa) patients. PATIENTS AND METHODS: Three step dose escalation [13 Gy (3.25 Gy/fraction), 14 Gy (3.5 Gy/fraction), and 15 Gy (3.75 Gy/fraction)] in three consecutive patient cohorts were planned. RT was delivered in two consecutive days and two daily fractions. Six patients were enrolled in the first two cohorts and 12 in the third cohort. Grade ≥3 toxicity was considered as a dose-limiting toxicity (DLT). RESULTS: Twenty-five patients (median age=71 years, median follow-up=7.4 months) were enrolled. Defined MTD dose was 15 Gy. Overall pain response rate was 76%: 9 patients (36%) showed complete and 10 patients (40%) reported partial response of pain. CONCLUSION: MHB accelerated RT (total dose: 15 Gy) delivered in two consecutive days and two daily fractions is well tolerated.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias da Próstata/patologia , Radioterapia , Idoso , Terapia Combinada , Seguimentos , Humanos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Qualidade de Vida , Radioterapia/efeitos adversos , Radioterapia/métodos , Dosagem Radioterapêutica , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(31): e16688, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374054

RESUMO

The objectives of this study were to analyze the clinical features of patients with bone involved lymphoma and identify the prognostic factors and to explore the optimized treatment strategy for bone involved lymphoma.A total of 1948 patients with lymphoma in our cancer center from September 2006 to October 2017 were retrospectively evaluated. Among these, 109 patients with skeletal involvement in lymphoma were enrolled. According to the pathologic subtypes, the patients were divided into 3 subgroups: classic Hodgkin lymphoma (cHL), B-cell non-Hodgkin lymphoma (B-NHL), and T-cell non-Hodgkin lymphoma (T-NHL). The clinical characteristics and overall survival (OS) of 3 groups of patients were reviewed, and the prognostic factors were analyzed.There were 9 (3 unifocal, 6 multifocal) patients with primary bone lymphoma. The 5-year OS of cHL, B-NHL, and T-NHL patients was 88.24%, 54.09%, and 61.58%, respectively. Advanced stage, elevated lactate dehydrogenase (LDH), age above 60, high International Prognostic Index score, and treatment without radiotherapy for the bone involved were significant poor prognostic factors for OS of all patients in univariate analysis. There was a trend toward better OS not only in limited-stage but also in advanced-stage patients with radiotherapy for the bone involved compared with the patients without radiotherapy. Elevated LDH level and age above 60 were the independent unfavorable prognostic factor in multivariate analysis.Elevated LDH level and age above 60 predict the poor prognosis of patients with bone involvement. The potential for long-term survival suggests that additional consolidative radiotherapy for the site of skeleton involvement may have a better chance of long-term success.


Assuntos
Neoplasias Ósseas/radioterapia , Doença de Hodgkin/radioterapia , Linfoma de Células B/radioterapia , Linfoma de Células T/radioterapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/mortalidade , Estudos de Casos e Controles , Terapia Combinada , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/mortalidade , Humanos , Estimativa de Kaplan-Meier , Linfoma de Células B/tratamento farmacológico , Linfoma de Células B/mortalidade , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/mortalidade , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Estudos Retrospectivos , Vincristina/uso terapêutico
7.
Cancer Radiother ; 23(5): 365-369, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300329

RESUMO

PURPOSE: The main goal of palliative radiotherapy is to reduce patient's discomfort. But sometimes patients do not receive any benefits from this treatment because of rapid worsening of their general condition. This prospective monocentric study assessed the effective delivery of palliative radiotherapy. MATERIALS AND METHODS: From 1st December 2015 to 29th February 2016, all consecutive patients receiving palliative radiotherapy in our hospital were included. The primary endpoint was the effective delivery of palliative radiotherapy according to the initial prescription (total dose, overall treatment time and fractionation). The secondary endpoints were the number of treatment breaks, the clinical benefit, the number of deaths and the delays for admission in the palliative care unit. RESULTS: Fifty-nine patients were included and 64 treatments were analysed. The treatment sites were: bone (70.3%) and brain (21.9%). The treatment goals were: pain control only (43.8%), decompression only (21.9%), pain control and decompression (32.8%), haemostatic aim (1.6%). Palliative treatment was achieved in 57 cases (89%). Temporary interruption of the radiotherapy treatment was necessary in six cases (9.4%; three for medical reason, three for logistic reason). The main reason of permanent interruption was worsening of performance status (seven cases). Palliation of symptoms (complete or partial responses) was obtained in 44 cases (68.8%). Seven patients (11.9%) died during the month after the end of the treatment. No delay or cancellation for admission in the palliative care unit were observed. CONCLUSION: Palliative radiotherapy was completed as originally planned in 51 cases (79.9%) with a clinical benefit for 44 cases (68.8%). Radiation therapy must not be neglected as a palliative treatment at the end-of-life.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Encefálicas/secundário , Cuidados Paliativos , Radioterapia Conformacional , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/radioterapia , Neoplasias Encefálicas/radioterapia , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Radioterapia Conformacional/métodos , Resultado do Tratamento
9.
Arch Esp Urol ; 72(5): 500-507, 2019 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31223127

RESUMO

The treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) has evolved dramatically in the recent years with the approval of several new drugs. Together with other treatment modalities including chemotherapy, hormonal therapy and immunotherapy, radiopharmaceuticals have recently been incorporated to the therapeutic scenario of prostate cancer with the approval of Radium 223 dichloride (Ra-223) for the treatment of mCRPC patients with symptomatic bone metastasis and no visceral metastases. Radiopharmaceuticals have long been used for pain palliation in patients with bone metastases. However, the bone seeking properties and the favourable physical characteristic of alpha emitter radium 223 encouraged the clinical development of the drug, leading to survival advantage in the phase III trial ALSYMPCA. Now the efforts are directed to define the optimal patient selection and drug sequence. In this review, we will provide the best available evidence of mechanism of action, clinical data and future directions of Ra-223 in mCRPC.


Assuntos
Neoplasias Ósseas , Neoplasias de Próstata Resistentes à Castração , Rádio (Elemento) , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/radioterapia , Compostos Radiofarmacêuticos , Rádio (Elemento)/uso terapêutico
10.
Tumori ; 105(5): 367-377, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31096849

RESUMO

Radium-223 dichloride (223Ra) is the first, recently approved, α-particle-emitting radiopharmaceutical for the treatment of patients with bone metastases in castration-resistant prostate cancer (CRPC) and no evidence of visceral metastases. We explored MEDLINE, relevant congresses, and websites for data on 223Ra and prostate cancer therapies, focusing on therapeutic strategies and timing, bone metastases, and diagnostic assessment. 223Ra represents the only bone-targeting agent that has significantly extended patients' overall survival while reducing pain and symptomatic skeletal events. Unlike other radiopharmaceuticals, such as strontium-89 and samarium-153 EDTMP, 223Ra (11.4-days half-life) has shown a high biological efficiency mainly due to its short penetration range. These features potentially allow reduced bone marrow toxicity and limit undue exposure. 223Ra has been validated under the product name Xofigo® by the US Food and Drug Administration and the European Medicines Agency. Patient selection, management, and treatment sequencing is recommended to be discussed in the context of a multidisciplinary environment, including oncology, urology, nuclear medicine, and radiation therapy physicians. No consensus has been achieved regarding the optimal timing and its administration as single agent or in combination with zoledronic acid or chemotherapy, so far. This review aims to provide a rationale for the use of 223Ra in treating metastases from CRPC, highlighting the crucial role of a multidisciplinary approach, the disputed inclusion and exclusion criteria on the basis of agencies regulations, and the value of diagnostics for therapy assessment.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias de Próstata Resistentes à Castração/radioterapia , Rádio (Elemento)/uso terapêutico , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/patologia , Radioisótopos , Cintilografia , Compostos Radiofarmacêuticos/uso terapêutico , Samário/efeitos da radiação , Radioisótopos de Estrôncio/uso terapêutico
11.
Br J Radiol ; 92(1099): 20181048, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31075040

RESUMO

OBJECTIVE: To report treatment outcomes of stereotactic ablative radiation therapy (SABR) for non-spinal bone metastases in a single institution, and to compare assessments of Response Evaluation Criteria in Solid Tumors (RECIST) v. 1.1 and the University of Texas MD Anderson Cancer Center (MDA) criteria. METHODS: From July 2011 to January 2017, 33 patients with 38 non-spinal bone metastatic lesions were treated using SABR. Treatment intent was categorized as follows: single metastasis or oligo-metastases; oligo-progression; and dominant areas of progression. Tumor responses were evaluated according to the RECIST and MDA criteria. Local control (LC) was defined as lesions that were not classified as progressive disease on both criteria. RESULTS: The median follow-up period was 10.4 months (range, 2.5-47.4). Both 1- and 2 year LC rates were 94.2 %. The median overall survival (OS) was 20.2 months, and the median progression-free survival (PFS) was 6.9 months. Treatment intent was a significant factor for OS in multivariate analysis. The 1 year OS rates for single metastasis or oligo-metastasis, for oligo-progression, and for dominant areas of progression were 84.2%, 66.7%, and 0.0%, respectively ( p < 0.001). Overall response rate was 86.8 % according to MDA criteria, and 75.7 % according to RECIST criteria. When using MDA criteria, there appeared to be significant associations both between response and PFS (median 7.6 months for responders vs 2.5 months for non-responders; p = 0.036) and between response and OS. In contrast, when using RECIST criteria, the associations were significant neither between response and PFS (median 5.8 months for responders vs 9.3 months for non-responders; p = 0.522) nor between response and OS (25.7 months for responders vs 18.5 months for non-responders; p = 0.811). CONCLUSION: SABR for non-spinal bone metastases demonstrated high LC rates with acceptable toxicity. The MDA criteria demonstrated advantages in predicting survival outcomes. ADVANCES IN KNOWLEDGE: SABR for non-spinal bone metastases is a promising treatment option to achieve good local control. The MDA criteria, which is a newly proposed response evaluation criteria for bone metastases, has advantages in predicting survival outcomes compared to other established criteria.


Assuntos
Neoplasias Ósseas/radioterapia , Radiocirurgia/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Anticancer Res ; 39(5): 2607-2614, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092459

RESUMO

BACKGROUND/AIM: To evaluate our initial experience with radium-223 chloride (Ra-223). MATERIALS AND METHODS: A total of 26 castration-resistant prostate cancer (CRPC) patients with bone metastases, treated with Ra-223 at our hospital were evaluated. This study aimed to observe adverse events (AEs) and changes in serum markers, and Bone Scan Index (BSI). Additionally, the relationship between these values and OS was investigated. RESULTS: The observed AEs mainly included fatigue and nausea. Alkaline phosphatase (ALP) and bone-type alkaline phosphatase (BAP) levels decreased following the treatment; however, those of PSA and 1-CTP tended to increase, regardless of Ra-223 administration. Overall survival (OS) was significantly improved in cases with a baseline BSI value of <2 compared with those with a baseline BSI value of ≥2. Moreover, the decrease in BSI after administration of Ra-223 was an independent factor, significantly prolonging OS. CONCLUSION: ALP and BAP levels and BSI values are suitable evaluation markers during treatment with Ra-223. Also, baseline BSI values and the decrease in BSI following treatment are independent factors predicting OS.


Assuntos
Neoplasias Ósseas/radioterapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Neoplasias de Próstata Resistentes à Castração/radioterapia , Rádio (Elemento)/administração & dosagem , Idoso , Fosfatase Alcalina/sangue , Neoplasias Ósseas/sangue , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/efeitos da radiação , Intervalo Livre de Doença , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/sangue , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Humanos , Masculino , Antígeno Prostático Específico/sangue , Neoplasias de Próstata Resistentes à Castração/sangue , Neoplasias de Próstata Resistentes à Castração/patologia , Resultado do Tratamento
13.
Vet Radiol Ultrasound ; 60(4): 447-455, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31012206

RESUMO

Multilobular osteochondrosarcoma is an uncommon canine tumor but presents a treatment challenge when arising on the skull. This retrospective case series study aimed to describe outcome of a multimodality treatment approach involving aggressive surgical resection and adjuvant definitive radiation therapy in a group of dogs with multilobular osteochondrosarcoma of the calvarium. Clinical, imaging, treatment, and outcome data were collected from retrospective review of medical records. Three dogs met inclusion criteria. The presenting clinical complaint was the presence of a mass effect of the skull in all three dogs and concurrent neurologic abnormalities in one dog. Advanced imaging revealed aggressive lytic and proliferative tumors arising from the calvarium in all three dogs. All dogs were treated surgically with a modified craniectomy, repaired with a titanium mesh-polymethyl methacrylate bone cement implant or a low prolife titanium mesh plate and followed by adjuvant definitive radiation therapy with 2.5 Gy per fraction for 22 daily fractions. There were no major immediate surgical complications and radiation was well tolerated overall. Neurologic improvement was seen in the patient that presented with neurologic disease. Survival times from surgery were 387, 422, and 730 days and from the time of radiation were 358, 397, and 677 days. Findings in this sample of three dogs supported the use of aggressive therapy with a combination of surgical craniectomy and cranioplasty utilizing a titanium mesh implant and high dose definitive radiation therapy for local control and prolonged survival times in dogs with multilobular osteochondrosarcoma of the skull.


Assuntos
Neoplasias Ósseas/veterinária , Condrossarcoma/veterinária , Craniotomia/veterinária , Doenças do Cão , Osteossarcoma/veterinária , Radioterapia Adjuvante/veterinária , Procedimentos Cirúrgicos Reconstrutivos/veterinária , Animais , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Condrossarcoma/radioterapia , Condrossarcoma/cirurgia , Terapia Combinada/veterinária , Doenças do Cão/radioterapia , Doenças do Cão/cirurgia , Cães , Feminino , Masculino , Osteossarcoma/radioterapia , Osteossarcoma/cirurgia , Crânio/cirurgia
14.
Anticancer Res ; 39(4): 2015-2023, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30952745

RESUMO

BACKGROUND/AIM: Reconstruction of diaphyseal tibial sarcomas with extracorporeal irradiated autograft is a rarely applied technique and is analyzed in this study. PATIENTS AND METHODS: Eight patients with malignant sarcomas received local treatment by means of a wide resection and reimplantation of an extracorporeally-irradiated autograft. The graft was combined with an ipsilateral vascularized fibula when a full-thickness segment of the tibia had to be resected and no cortex could be preserved (n=5). Oncological and functional results were recorded. RESULTS: All patients had clear margins after resection, and with no local recurrence 72 months after treatment. Full weight-bearing was allowed at the time of radiological consolidation of the irradiated grafts (after a median of five months). The functional results were good and excellent in 7 of 8 patients, respectively. CONCLUSION: Extracorporeal irradiation grafting is a suitable method for the treatment of localised and resectable tibial sarcomas.


Assuntos
Neoplasias Ósseas , Reimplante , Sarcoma , Neoplasias de Tecidos Moles , Tíbia/cirurgia , Adolescente , Adulto , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoma/radioterapia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/cirurgia , Adulto Jovem
16.
J Neurooncol ; 142(3): 557-563, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30827010

RESUMO

BACKGROUND: We sought to evaluate the effectiveness of definitive or adjuvant external-beam proton therapy on local control and survival in patients with skull-base chondrosarcoma. METHODS: We reviewed the medical records of 43 patients with a median age of 49 years (range, 23-80 years) treated with double-scattered 3D conformal proton therapy for skull-base chondrosarcomas between January 2007 and February 2016. Proton therapy-related toxicities were scored using CTCAE v4.0. RESULTS: The median radiotherapy dose was 73.8 Gy(RBE) (range, 64.5-74.4 Gy[RBE]). Thirty-six (84%) and 7 (16%) patients underwent surgical resection or biopsy alone. Tumor grade distribution included: grade 1, 19 (44%) patients; grade 2, 22 (51%); and grade 3, 2 (5%). Forty patients had gross disease at the time of radiotherapy and 7 patients were treated for locally recurrent disease following surgery. The median follow-up was 3.7 years (range, 0.7-10.1 years). There were no acute grade 3 toxicities related to RT. At 4 years following RT, actuarial rates of overall survival, cause-specific survival, local control, and RT-related grade 3 toxicity-free survival were 95%, 100%, 89%, and 95%. CONCLUSION: High-dose, double-scattered 3D conformal proton therapy alone or following surgical resection for skull-base chondrosarcoma is an effective treatment with a high rate of local control with no acute grade 3 radiation-related toxicity. Further follow-up of this cohort is necessary to better characterize long-term disease control and late toxicities.


Assuntos
Neoplasias Ósseas/radioterapia , Condrossarcoma/radioterapia , Terapia com Prótons/mortalidade , Neoplasias da Base do Crânio/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Condrossarcoma/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Neoplasias da Base do Crânio/patologia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
17.
Clin Nucl Med ; 44(6): 483-484, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30829871

RESUMO

A 68-year-old man with metastatic castration-resistant prostate cancer and widespread bone metastases as well as a history of kidney transplant, underwent 5 cycles of Lu-prostate-specific membrane antigen 617 therapies in our department. Being more cautious of the radiation burden imposed on the transplanted kidney, a lower average dose of 4 GBq per cycle was administered (instead of the more routine 6.0-7.4 GBq per cycle). However, excellent response was noted and serum creatinine level of 0.8 mg/dL remained stable.


Assuntos
Neoplasias Ósseas/radioterapia , Dipeptídeos/uso terapêutico , Compostos Heterocíclicos com 1 Anel/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/radioterapia , Compostos Radiofarmacêuticos/uso terapêutico , Idoso , Neoplasias Ósseas/secundário , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/patologia
18.
Surg Technol Int ; 34: 489-496, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30888673

RESUMO

BACKGROUND: Although multidisciplinary therapies have improved local control and overall survival in Ewing sarcoma (ES), the prognosis of pelvic lesions remains markedly worse than that of limb ES. METHODS: We retrospectively evaluated the influence of the type of local treatment, margins, necrosis and sacrum involvement on overall survival (OS) and disease-free survival (DFS) in a series of 21 non-metastatic pelvic ES. RESULTS: The average follow-up was 46.3 months (range 3-156). Only one patient had recurrence, at 11 months after surgery. Eight patients showed pulmonary metastasis and five showed bone metastases. Necrosis was the only significant prognostic factor for overall survival at 5 years (p=0.0132) and disease-free survival (p=0.0086). Overall survival at 5 years was 40.1%. CONCLUSION: Local control in pelvic Ewing sarcoma is comparable for patients treated with surgery (S), surgery plus radiotherapy (S/RT), or definitive radiotherapy (RT). The combination of surgery plus radiotherapy could be indicated in cases of large tumor, a poor necrosis response (< 90%), or an inadequate margin with involvement of the sacrum. A poor response to neoadjuvant therapy is a significant risk factor for both local control and overall survival.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Ossos Pélvicos , Sarcoma de Ewing/radioterapia , Sarcoma de Ewing/cirurgia , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Terapia Combinada , Análise Fatorial , Humanos , Terapia Neoadjuvante , Prognóstico , Estudos Retrospectivos , Sarcoma de Ewing/mortalidade , Sarcoma de Ewing/patologia , Análise de Sobrevida
19.
J Clin Neurosci ; 64: 50-54, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30922532

RESUMO

Metastatic disease to the spine are becoming increasingly common with an aging population and improvements in systemic cancer therapies. Surgery, radiation, and vertebroplasty are mainstay modalities for treating painful spine metastases. Recently, image-guided percutaneous ablation techniques have emerged a promising therapeutic option. Multiple studies have demonstrated the safety and efficacy of percutaneous ablation techniques; however, complications can arise from these procedures. Here, we present a case involving a rare complication of percutaneous microwave, thermal spinal cord injury, as well as a brief review of the current literature.


Assuntos
Neoplasias Ósseas/radioterapia , Ablação por Cateter/efeitos adversos , Micro-Ondas/efeitos adversos , Lesões por Radiação/etiologia , Medula Espinal/efeitos da radiação , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Feminino , Humanos , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/etiologia
20.
Int J Clin Oncol ; 24(5): 557-566, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30875000

RESUMO

BACKGROUND: Radium-223 is a first-in-class targeted alpha therapy to prolong overall survival (OS) in castration-resistant prostate cancer with bone metastases (mCRPC). The aim of the present analysis was to assess the long-term safety with radium-223 in Japanese patients with mCRPC. METHODS: Patients with symptomatic mCRPC, ≥ 2 bone metastases and no known visceral metastases received up to 6 injections of radium-223 (55 kBq/kg), one every 4 weeks. Adverse events (AEs) considered to be related to radium-223 were reported until 3 years after the first injection. Pre-specified conditions, such as acute myelogenous leukemia, myelodysplastic syndrome, aplastic anemia, primary bone cancer, or other primary malignancies, were reported regardless of causality. RESULTS: Of the 49 patients enrolled in the study, 44 (89.8%) entered the survival follow-up period and 33 (67.3%) died. Throughout the entire study, there were no reports of second primary malignancy or other pre-specified conditions. Eight patients (16.3%) experienced post-treatment drug-related AEs, which were all hematological (anemia and decreased lymphocyte, platelet, and white blood cell counts). No serious post-treatment drug-related AEs were reported. Updated median OS was 19.3 months (95% CI: 14.2, 28.5). CONCLUSIONS: In Japanese patients with symptomatic mCRPC and bone metastases, radium-223 had a favorable long-term safety profile with no second primary malignancies reported. Taken together with median OS, which was comparable to that in the pivotal phase III ALSYMPCA study, these results support continued benefit from radium-223 in Japanese patients with mCRPC.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias de Próstata Resistentes à Castração/radioterapia , Rádio (Elemento)/efeitos adversos , Rádio (Elemento)/uso terapêutico , Administração Intravenosa , Idoso , Anemia/induzido quimicamente , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Seguimentos , Doenças Hematológicas/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia , Lesões por Radiação/etiologia , Radioisótopos/administração & dosagem , Radioisótopos/efeitos adversos , Radioisótopos/uso terapêutico , Rádio (Elemento)/administração & dosagem
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