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1.
Anticancer Res ; 40(2): 977-981, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014942

RESUMO

BACKGROUND/AIM: The aim of this study was to analyze the survival of patients with brain metastases treated with best supportive care or additional whole-brain radiotherapy (WBRT), in order to confirm results from the prospective randomized QUARTZ study, which suggested prolonged survival after WBRT (5 fractions of 4 Gy) if favorable prognostic factors were present (age younger than 60 years, graded prognostic assessment score 2.5-3 points). PATIENTS AND METHODS: We performed a retrospective single institution analysis of 76 patients with favorable prognosis. In contrast to the QUARTZ trial, inclusion was not limited to patients with non-small cell lung cancer (NSCLC). Furthermore, a cohort treated with higher total doses of WBRT was included (10 fractions of 3 Gy). RESULTS: All patients were younger than 60 years or had a graded prognostic assessment score of 2.5-3. The median survival was significantly shorter after best supportive care (1.2 months; 3.2 months after WBRT with 5 fractions of 4 Gy and 3.9 months after 10 fractions of 3 Gy). Also, in multivariate analyses, survival was significantly better after WBRT. Further favorable prognostic factors included better performance status, no or limited extracranial metastases and primary tumor other than gastrointestinal. CONCLUSION: In line with the QUARTZ trial results, WBRT prolonged survival in patients with favorable prognostic features.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Carcinoma Pulmonar de Células não Pequenas/patologia , Irradiação Craniana , Neoplasias Pulmonares/patologia , Adulto , Idoso , Neoplasias Encefálicas/mortalidade , Irradiação Craniana/métodos , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento
2.
Int J Radiat Oncol Biol Phys ; 106(3): 604-611, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32014151

RESUMO

PURPOSE: Steep dose falloff outside of tumors is a hallmark of stereotactic radiosurgery (SRS) and radiation therapy (SRT). Dose gradient index (DGI) quantifies the dose drop off. Tables of DGIs versus target volumes have been published for body sites, but none is available for brain. This study recommends guidelines for DGIs for brain SRS/SRT treatments based on clinical CyberKnife (CK) cases. METHODS AND MATERIALS: Four hundred ninety-five plans for patients with central nervous system tumors treated with CK at our institution between March 2015 and May 2018 were analyzed. The CK treatment planning system MultiPlan was used for planning. SRS/SRT plans were stratified into 6 groups by tumor size (Group I [0-1 cm3], II [1.0-3.0 cm3], III [3.0-5.0 cm3], IV [5.0-10.0 cm3], V [10.0-15.0 cm3], and VI [15.0-40.0 cm3]). Ideal and minimally acceptable DGIs were determined for each size group. To evaluate the effect of target shape on DGI criteria, the plans were divided into 4 target shape groups: (1) homogeneous shape (circular), (2) adjacent to radiosensitive organs at risk (adjacent), (3) irregularly shaped (irregular), and (4) multiple target plans (multilesion). The mean for each target size group was defined as the ideal DGI. Minimally acceptable DGI criteria are specified to reject the lowest 10% of cases. RESULTS: The minimal acceptable DGIs were 83 (Group I), 72 (II), 65 (III), 58 (IV), 52 (V), and 35 (VI). The ideal DGI is designated to evaluate SRS/SRT plans for homogeneous circular lesions, whereas minimal DGI is chosen to assess the plans for irregular, adjacent to organs at risk, and multilesions. SRS/SRT plans with higher DGI values are correlated with lower irradiated normal tissue volumes. CONCLUSIONS: This study provides a table of DGIs for brain SRS/SRT treatments as a tool for assessing the quality of intracranial SRS/SRT plans. DGI guidelines support SRS/SRT planning that results in lower risk of radionecrosis.


Assuntos
Neoplasias Encefálicas/radioterapia , Órgãos em Risco/efeitos da radiação , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Guias como Assunto , Humanos , Órgãos em Risco/diagnóstico por imagem , Tolerância a Radiação , Radiocirurgia/efeitos adversos , Dosagem Radioterapêutica , Radioterapia Conformacional/efeitos adversos , Espalhamento de Radiação
3.
Medicine (Baltimore) ; 99(5): e18455, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000358

RESUMO

INTRODUCTION: Whole brain radiotherapy (WBRT) has been the mainstay treatment of brain metastases (BM) in non-small cell lung cancer (NSCLC) patients for years. Temozolomide (TMZ) could penetrate the blood-brain barrier and some studies showed that TMZ plus MBRT may improve clinical effectiveness. This meta-analysis is aim to evaluate the clinical effectiveness and safety of TMZ plus MBRT in the NSCLC patients with BM. METHODS AND ANALYSIS: We systematically searched databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and four Chinese databases (Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Database and Chinese Scientific Journal Database) without language restrictions from inception until July 26, 2019. Randomized controlled trials (RCTs) which compared TMZ plus WBRT with single WBRT in the advanced NSCLC patients with BM were included. The outcomes analysis reported objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), quality of life (QOL), and adverse effects. Two reviewers will independently extract data from the selected studies and assess the quality of studies. Statistical analyses will be performed using Review manager 5.3 software. Random-effects or fixed models were used to estimate pooled hazard ratio and relative risk. RESULTS: This systemic review and meta-analysis will evaluate the effects of TMZ plus MBRT in the NSCLC patients with BM in RCTs. CONCLUSION: Our study will provide evidence to judge if TMZ plus MBRT are effective treatment for NSCLC patients with BM.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Temozolomida/uso terapêutico , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/secundário , Humanos , Neoplasias Pulmonares/patologia , Metanálise como Assunto , Revisão Sistemática como Assunto
4.
Isr Med Assoc J ; 22(1): 22-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927801

RESUMO

BACKGROUND: Prophylactic cranial irradiation (PCI) exclusion in favor of brain magnetic resonance imaging (MRI) staging and surveillance in the management of small cell lung cancer (SCLC) is controversial yet accepted by some centers. The use of MRI suggests performing stereotactic radiosurgery (SRS) treatment for limited brain metastases. Data regarding SRS efficacy in this setting is limited. OBJECTIVES: To assess intracranial objective response rate (iORR), progression-free survival (iPFS), intracranial failure patterns, overall survival (OS) and time-to-whole-brain radiation therapy (WBRT)/death, whichever occurred first (TTWD) with SRS in SCLC. METHODS: The study comprised 10 consecutive SCLC patients with brain metastases treated with SRS and followed-up at Davidoff Cancer center between Aug 2012 and March 2019. Brain MRI images were reviewed by a neuro-radiology specialist. RESULTS: iORR was 57% as assessed by response assessment in neuro-oncology brain metastases. Intracranial progression developed in 8 patients. Median iPFS was 4.0 months (95% confidence interval [95%CI] 1.7-7.2). In-site, off-site and combined pattern of intracranial failure was seen in 0, 5, and 3 patients, respectively; median number of new brain lesions following SRS was 4 (range, 1-12). SRS was performed 10 additional times in 6 patients (median number of lesions irradiated per round was 1, range 1-5). WBRT was administered in 3 patients. Median TTWD was 20.9 months (95% CI, 1.9-26.8). Median OS since SRS administration was 23.2 months (95% CI, 4.2-not reached). CONCLUSIONS: MRI surveillance with multiple rounds of SRS may serve a reasonable alternative to PCI or therapeutic WBRT in SCLC.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Pulmonares/patologia , Radiocirurgia , Carcinoma de Pequenas Células do Pulmão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Intervalo Livre de Progressão , Radiocirurgia/métodos , Resultado do Tratamento
5.
No Shinkei Geka ; 48(1): 25-32, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31983685

RESUMO

Intracranial pseudoaneurysms arising after radiotherapy for brain tumors are a relatively rare occurrence and associated with high-volume radiotherapy such as stereotactic radiosurgery. Herein, the authors report a rare case of intracranial pseudoaneurysm after conventional radiotherapy for oligodendroglioma. Case:A 46-year-old female incidentally presented with an intracranial hemorrhage from a middle temporal artery aneurysm. Four years earlier, she underwent surgical resection and conventional radiation therapy for oligodendroglioma. The aneurysm was successfully treated with middle cerebral artery(MCA)aneurysm trapping, in conjunction with a parietal branch superficial temporal artery-MCA bypass, to prevent re-rupture. Formation of intracranial pseudoaneurysm after conventional radiotherapy is extremely rare. However, the occurrence of cerebral aneurysm(s), as well as vascular stenosis during follow-up for brain tumors treated with radiotherapy, should be considered.


Assuntos
Falso Aneurisma , Neoplasias Encefálicas , Aneurisma Intracraniano , Oligodendroglioma , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Neoplasias Encefálicas/radioterapia , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/etiologia , Pessoa de Meia-Idade , Artéria Cerebral Média , Oligodendroglioma/radioterapia , Artérias Temporais
6.
J Cancer Res Clin Oncol ; 146(1): 137-152, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31813004

RESUMO

With the advancement of imaging technology, systemic disease control rate and survival rate, the morbidity of brain metastases (BMs) from non-small cell lung cancer (NSCLC) has been riding on a steady upward trend (40%), but management of BMs from NSCLC remains obscure. Systemic therapy is anticipated to offer novel therapeutic avenues in the management of NSCLC BMs, and radiotherapy (RT) and immunotherapy have their own advantages. Recently, it was confirmed that immune checkpoint inhibitors (ICIs) and RT could mutually promote the efficacy in the treatment of BMs from NSCLC. In this paper, we provide a review on current understandings and practices of separating or combining ICIs and RT, which could provide a reference for the coming laboratory and clinical studies and contribute to the development of new approaches in NSCLC BMs.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/imunologia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/radioterapia , Antígeno CTLA-4/antagonistas & inibidores , Antígeno CTLA-4/imunologia , Carcinoma Pulmonar de Células não Pequenas/imunologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimiorradioterapia , Humanos , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/patologia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/imunologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
7.
World Neurosurg ; 133: e115-e120, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550545

RESUMO

OBJECTIVE: Pilocytic astrocytoma (PA) is rare in adults comprising 5.1% of the primary central nervous system tumors. The aim is to describe the first Brazilian series of adult patients with PA and compare its features with the available literature. METHODS: We retrospectively review all patients 18 years or older with PA from our institution's database from 1991 to 2018. We analyzed information regarding clinical presentation, location, imaging features, extent of resection, adjuvant treatments, and follow-up. RESULTS: Twenty-three patients with PA were analyzed: 60.9% male; median age 26 years. The most frequent symptoms were headache (34.8%) and seizure (26.1%). Temporal and parietal lobes were the most common locations, 21.7% each. All patients underwent a surgical procedure, gross total resection in 40.9%, subtotal resection in 22.7%, and biopsy in 27.3%. Adjuvant treatment with radiotherapy was performed in 2 patients. Only 4 patients had disease progression, 2 after gross total resection and 2 after subtotal resection. They were all alive and without evidence of new progression at the last follow-up (October 2018). Median overall survival was not reached after a median follow-up time of 88.9 months. CONCLUSIONS: This is the first Brazilian series regarding adults with PA, and our patients had a favorable outcome as reported in recent literature reviews. The tumor's prevalence reduces within older patients and supratentorial lesions are more frequent, especially on the temporal lobe. There was no significant relationship between location and progression, although according to the literature the extent of resection remains the most important prognostic factor.


Assuntos
Astrocitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Adolescente , Adulto , Astrocitoma/complicações , Astrocitoma/epidemiologia , Astrocitoma/radioterapia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/radioterapia , Brasil/epidemiologia , Terapia Combinada , Irradiação Craniana , Progressão da Doença , Feminino , Seguimentos , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante , Estudos Retrospectivos , Convulsões/etiologia , Resultado do Tratamento , Adulto Jovem
8.
World Neurosurg ; 133: e6-e17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31284062

RESUMO

BACKGROUND: Pineal region glioma is a rare systematically reported tumor in the literatures, and little is known about its behavior, development, and best treatment strategies because of its complex anatomical relationship and rarity. OBJECTIVE: We reviewed the outcomes of patients with pineal region gliomas in West China hospital in the past 5 years and searched the literature to add more information. As a result, key factors related to prognosis are identified. METHODS: Twenty-five patients with pineal region gliomas were selected and information was collected about detailed medical history, imaging data, treatment methods, pathologic results, and latest neurosurgical radiologic progress during follow-up. RESULTS: Pilocytic astrocytomas (20%) and glioblastomas (24%) were the most common pathologic subtypes. Twenty-three patients underwent open surgery, 3 Gamma Knife radiosurgery, and 4 whole-brain radiation therapy. Chemotherapy was applied to 3 patients. Low-grade gliomas tended to have a better prognosis than did high-grade. Karnofsky Performance Status at admission (≤60) was intimately associated with prognosis for low-grade gliomas. As for high-grade gliomas, patients whose age at admission was ≤30 years had a better prognosis than did older patients (>30 years). However, whatever the grade, there was no overall survival difference as to gender, gross total resection versus not gross total resection, preoperative maximal tumor diameter (≤4 vs. >4 cm), and time since first symptoms (≤30 vs. >30 days), and radiation therapy versus no radiation therapy. CONCLUSIONS: Open surgery is the first-line strategy for pineal region gliomas with tolerable mortality and disability rate. Radiosurgery and chemotherapy can be applied as adjuvant or alternative methods when surgery is contraindicated.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Glândula Pineal/cirurgia , Adolescente , Adulto , Fatores Etários , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/radioterapia , Quimioterapia Adjuvante , Criança , Pré-Escolar , Terapia Combinada , Irradiação Craniana , Craniotomia/métodos , Feminino , Seguimentos , Glioma/tratamento farmacológico , Glioma/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Pineal/patologia , Prognóstico , Radiocirurgia/métodos , Radioterapia Adjuvante , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
9.
Int J Radiat Oncol Biol Phys ; 106(1): 194-205, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610250

RESUMO

PURPOSE: To develop and validate combined ion-beam with constant relative biological effectiveness (RBE) (CICR) particle therapy in single field arrangements for improved treatment efficacy, robustness, and normal tissue sparing. METHODS AND MATERIALS: The PRECISE (PaRticle thErapy using single and Combined Ion optimization StratEgies) treatment planning system was developed to investigate clinical viability of CICR treatments. Single-field uniform dose (SFUD) with a single ion (proton [p], helium [He], or carbon [C]) and CICR (C-p and C-He) treatments were generated for 3 patient cases with a clinically prescribed dose of 3 Gy (RBE) per fraction. Spread-out Bragg peak plans were irradiated in homogenous and clinical-like settings using an anthropomorphic head phantom. A dosimetric and biological verification of CICRC-p treatments using a murine glioma cell line (GL261) was performed. RESULTS: CICR treatment plans for the 3 patients presented highly uniform physical dose while reducing high dose-averaged linear energy transfer gradients compared with carbon ions alone. When considering uncertainty in tissue parameter (α/ß)x assignment and RBE modeling, the CICRC-p treatment exhibited enhanced biophysical stability within the target volume, similar to protons alone. CICR treatments reduced dose to normal tissue surrounding the target, exhibiting similar or improved dosimetric features compared with SFUDHe. For both CICRC-p and SFUD treatments, measurements verified the planned dose in the target within ∼3%. Planned versus measured target RBE values were 1.38 ± 0.02 and 1.39 ± 0.07 (<1% deviation), respectively, for the CICRC-p treatment in heterogenous settings. CONCLUSIONS: Here, we demonstrate that by combining 2 (or more) ions in a single field arrangement, more robust biological and more conformal dose distributions can be delivered compared with conventional particle therapy treatment planning. This work constitutes the first dosimetric and biological verification of multi-ion particle therapy in homogeneous as well as heterogenous settings.


Assuntos
Neoplasias Encefálicas/radioterapia , Carcinoma Adenoide Cístico/radioterapia , Cordoma/radioterapia , Glioma/radioterapia , Radioterapia com Íons Pesados/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias da Coluna Vertebral/radioterapia , Animais , Neoplasias Encefálicas/diagnóstico por imagem , Carbono/uso terapêutico , Carcinoma Adenoide Cístico/diagnóstico por imagem , Linhagem Celular Tumoral , Cordoma/diagnóstico por imagem , Terapia Combinada/métodos , Fracionamento da Dose de Radiação , Glioma/diagnóstico por imagem , Hélio/uso terapêutico , Humanos , Transferência Linear de Energia , Camundongos , Órgãos em Risco , Imagens de Fantasmas , Terapia com Prótons/métodos , Lesões por Radiação/prevenção & controle , Planejamento da Radioterapia Assistida por Computador , Eficiência Biológica Relativa , Sacro , Neoplasias da Coluna Vertebral/diagnóstico por imagem
10.
Anticancer Res ; 39(12): 6743-6750, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810939

RESUMO

BACKGROUND: Glioblastoma (GBM) is the most aggressive type of primary malignant brain tumour. The interaction between high-mobility group box 1 (HMGB1) and receptor for advanced glycation end-products (RAGE) is important for tumour cell growth. Previously, we identified an anticancer candidate, papaverine, that inhibited the HMGB1-RAGE interaction. MATERIALS AND METHODS: Our study assessed the anticancer effects of papaverine alone or in combination with temozolomide on U87MG and T98G human GBM cells using clonogenicity assays, as well as in a U87MG xenograft mouse model. The radiosensitizing efficacy of papaverine was measured based on the clonogenicity of T98G cells. RESULTS: Papaverine significantly inhibited the clonogenicity of U87MG and T98G cells. Compared with single treatment, the combination of papaverine and temozolomide more highly suppressed the clonogenicity of T98G cells and delayed tumour growth in the U87MG xenograft mouse model. Furthermore, papaverine increased the radiosensitivity of T98G cells. CONCLUSION: Papaverine is a potential anticancer drug in GBM treatment.


Assuntos
Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Proliferação de Células/efeitos dos fármacos , Glioblastoma/tratamento farmacológico , Papaverina/uso terapêutico , Temozolomida/uso terapêutico , Animais , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/radioterapia , Linhagem Celular Tumoral , Glioblastoma/metabolismo , Glioblastoma/patologia , Glioblastoma/radioterapia , Proteína HMGB1/antagonistas & inibidores , Proteína HMGB1/metabolismo , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Tolerância a Radiação/efeitos dos fármacos , Receptor para Produtos Finais de Glicação Avançada/antagonistas & inibidores , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Carga Tumoral/efeitos dos fármacos , Ensaios Antitumorais Modelo de Xenoenxerto
11.
Cancer Radiother ; 23(8): 860-866, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677901

RESUMO

PURPOSE: Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy are standard treatments for brain metastases when they are small in size (at the most 3cm in diameter) and limited in number, in patients with controlled extracerebral disease and a good performance status. Large inoperable brain metastases usually undergo hypofractionated stereotactic radiotherapy while haemorrhagic brain metastases have often been contraindicated for both stereotactic radiosurgery or hypofractionated stereotactic radiotherapy. The objective of this retrospective study was to assess a six 6Gy-fractions hypofractionated stereotactic radiotherapy scheme in use at our institution for haemorrhagic brain metastases, large brain metastases (size greater than 15cm3) or brain metastases located next to critical structures. MATERIAL AND METHODS: Patients with brain metastases treated with the 6×6Gy scheme since 2012 to 2016 were included. Haemorrhagic brain metastases were defined by usual criteria on CT scan and MRI. Efficacy, acute and late toxicity were evaluated. RESULTS: Sixty-two patients presenting 92 brain metastases were included (32 haemorrhagic brain metastases). Median follow up was 10.1 months. One-year local control rate for haemorrhagic brain metastases, large brain metastases, or brain metastases next to critical structures were 90.7%, 73% and 86.7% respectively. Corresponding overall survival rates were 61.2%, 32% and 37.8%, respectively. Haemorrhagic complications occurred in 5.3% of patients (N=5), including two cases of brain metastases with pretreatment haemorrhagic signal. Tolerance was good with only one grade 3 acute toxicity. CONCLUSION: The 6×6Gy hypofractionated stereotactic radiotherapy scheme seems to yield quite good results in patients with haemorrhagic brain metastases, which must be confirmed in a prospective way.


Assuntos
Neoplasias Encefálicas/radioterapia , Hemorragia Cerebral/radioterapia , Hipofracionamento da Dose de Radiação , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Hemorragia Cerebral/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Radiocirurgia/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Carga Tumoral
12.
Mutat Res ; 816-818: 111679, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31715522

RESUMO

Glioblastoma (GBM) is the most lethal type of primary brain tumor. Currently, even with optimal and multimodal cancer therapies, the survival rate of GBM patients remains poor. One reason for inadequate response of GBM tumors to radiotherapy is radioresistance (RR). Thus, there is a critical need for new insights about GBM treatment to increase the chance of treatment. microRNAs (miRNAs) are important regulatory molecules that can effectively control GBM radiosensitivity (RS) by affecting radiation-related signal transduction pathways such as apoptosis, proliferation, DNA repair and cell cycle regulation. miRNAs provide new clinical perspectives for developing effective GBM treatments. A growing body of literature has demonstrated that GBM RS can be modified by modulating the expression of miRNAs such as miR-7, miR-10b, miR-124, miR-128, miR-320, miR-21, miR-203, and miR-153. This paper highlights the miRNAs and the underlying molecular mechanisms that are involved in the RS of GBM. Besides highlighting the role of miRNAs in different signaling pathways, we explain the mechanisms that affect RS of GBM for modulating radiation response at the clinical level.


Assuntos
Neoplasias Encefálicas/genética , Glioblastoma/genética , MicroRNAs/genética , Tolerância a Radiação/genética , Transdução de Sinais/genética , Animais , Neoplasias Encefálicas/radioterapia , Proliferação de Células/genética , Proliferação de Células/efeitos da radiação , Regulação Neoplásica da Expressão Gênica/genética , Regulação Neoplásica da Expressão Gênica/efeitos da radiação , Glioblastoma/radioterapia , Humanos , Tolerância a Radiação/efeitos da radiação , Transdução de Sinais/efeitos da radiação
13.
Medicine (Baltimore) ; 98(45): e17759, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702627

RESUMO

BACKGROUND: Glioblastoma (GB) is one of the most common malignancies with limited standard therapies such as surgery, radiotherapy (RT) plus temozolomide (TMZ). Molecularly targeted drugs have been investigated among various clinical trials and are expected to develop in the field of tumor therapy, while the efficacy remains uncertain due to limited previous results. Thus, we focus on the evaluation of molecularly targeted drugs to clarify its overall effectiveness in terms of treating newly diagnosed GB. METHODS: Electronic databases were searched for eligible literatures updated to April 2018. Randomized-controlled trials were included to assess the efficacy and safety of molecularly targeted drugs in patients with newly diagnosed GB. The main outcomes were further calculated including the following parameters: PFS (progression-free survival), OS (overall survival) as well as AEs (adverse events). All data were pooled along with their 95% confidence interval using RevMan software. Sensitivity analyses and heterogeneity were evaluated quantitatively. RESULTS: The combination of molecularly targeted drugs with TMZ + RT had no significant effects on OS (OR = 0.96, 95%CI = 0.89-1.04, P = .36). Meanwhile, the combination regimen significantly improved the PFS of patients with newly diagnosed GB (OR = 0.86 ,95% CI 0.75-0.98, P = .02). The rate of AEs (OR = 1.68,95%CI = 1.44-1.97, P < .00001) was higher in patients receiving molecularly targeted drugs, which was comparable to the contemporary group. CONCLUSION: Longer PFS and a higher rate of AEs were observed with the addition of molecularly targeted drugs to standard chemoradiation in patients harboring newly diagnosed GB. Nevertheless, compared with the control arm, the regimen did not significantly prolong OS.


Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Glioblastoma/tratamento farmacológico , Temozolomida/uso terapêutico , Neoplasias Encefálicas/radioterapia , Quimiorradioterapia , Feminino , Glioblastoma/radioterapia , Humanos , Masculino , Terapia de Alvo Molecular , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Resultado do Tratamento
14.
Radiol Clin North Am ; 57(6): 1199-1216, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582045

RESUMO

Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Diagnóstico por Imagem/métodos , Glioblastoma/diagnóstico por imagem , Glioblastoma/radioterapia , Lesões por Radiação/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Progressão da Doença , Glioblastoma/patologia , Humanos , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Imagem Multimodal , Necrose , Tomografia por Emissão de Pósitrons , Lesões por Radiação/patologia
15.
BMC Neurol ; 19(1): 232, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578138

RESUMO

BACKGROUND: Radiation therapy can cause cerebral arteriopahty, resulting in ischemic stroke. We document late-delayed cerebral arteriopathy by high-resolution magnetic resonance imaging (HR-MRI) in a middle aged man who had cranial irradiation 19 years earlier. CASE PRESENTATION: A 45-year-old man was diagnosed with frontal lobe glioma 19 years ago and was treated with radiation after surgical resection. He was admitted to our hospital with an acute cerebral infarction in November 8, 2017. Traditional MRI examination and HR-MRI (sagittal, reconstruction of coronal and axial) were performed at admission. He was treated with prednisone (30 mg/day) and clinical symptoms disappeared after 3 months by telephone follow-up. Our patient complained of dizziness and blurred vision and traditional MRI examination indicated acute ischemic stroke in temporal lobe and occipital lobe and microbleeds. In order to define the exact mechanism of stroke, blood tests, auto-immune screening and thrombophilia were performed and results were normal. Electrocardiography and echocardiography were negative and cardiogenic cerebral embolism was excluded. In cerebrospinal fluid (CSF) examination, level of albumin and IgG were elevated. HR-MRI showed vessel wall thickening in T1-weighted imaging, narrow lumen in proton density imaging and vessel wall concentric enhancement in contrast-enhanced T1- weighted imaging. Combined with radiotherapy history, the patient was diagnosed with radioactive vasculitis. CONCLUSION: Radiation-induced cerebrovascular damages could be a lasting progress, which we cannot ignore. HR-MRI can provide sensitive and accurate diagnostic assessment of radiation-induced arteritis and may be a useful tool for the screening of causes of cryptogenic stroke.


Assuntos
Irradiação Craniana/efeitos adversos , Lesões por Radiação/diagnóstico por imagem , Vasculite do Sistema Nervoso Central/diagnóstico por imagem , Vasculite do Sistema Nervoso Central/etiologia , Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
16.
Phys Med ; 65: 227-237, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574356

RESUMO

Microbeam radiation therapy (MRT) uses synchrotron arrays of X-ray microbeams to take advantage of the spatial fractionation effect for normal tissue sparing. In this study, radiochromic film dosimetry was performed for a treatment where MRT is introduced as a dose boost in a hypofractionated stereotactic radiotherapy (SRT) scheme. The isocenter dose was measured using an ionization chamber and two dimensional dose distributions were determined using radiochromic films. To compare the measured dose distribution to the MRT treatment plan, peak and valley were displayed in separate dosemaps. The measured and computed isocenter doses were compared and a two-dimensional 2%/2 mm normalized γ-index analysis with a 90% passing rate criterion was computed. For SRT, a difference of 2.6% was observed in the dose at the isocenter from the treatment plan and film measurement, with a passing rate of 96% for the γ-index analysis. For MRT, peak and valley doses differences of 25.6% and 8.2% were observed, respectively but passing rates of 96% and 90% respectively were obtained from the normalized γ-index maps. The differences in isocenter doses measured in MRT should be further investigated. We present the methodology of patient specific quality assurance (QA) for studying MRT dose distributions and discuss ideas to improve absolute dosimetry. This patient specific QA will be used for large animal trials quality assurance where MRT will be administered as a dose boost in conventional SRT. The observed remaining discrepancies should be studied against approximations in the TPS phantom materials, beams characteristics or film read-out procedures.


Assuntos
Dosimetria Fotográfica/métodos , Radioterapia/métodos , Neoplasias Encefálicas/radioterapia , Fracionamento da Dose de Radiação , Humanos , Imagens de Fantasmas , Radiometria/métodos , Dosagem Radioterapêutica , Síncrotrons , Raios X
17.
Cancer Radiother ; 23(8): 917-921, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31540838

RESUMO

Nanomedicine has undergone significant development since the 2000s and it is only very recently that two metallic nanoparticles have emerged in clinical trials. The mechanism of these radiosensitizing agents is based on the presence of atoms with a high atomic number (Z) allowing a higher dose deposition into the tumor during irradiation. The first nanoparticle used in humans is NBTXR3, composed of hafnium (Z=79), with intratumor injection for the treatment of sarcoma. Another gadolinium-based nanoparticle (Z=64), AGuIX, has been used for intravenous injection in the treatment of brain metastases. The preliminary results are promising in terms of feasibility, safety and efficacy, as evidenced by the significant number of ongoing clinical trials. The upcoming challenges for the development of nanoparticles will be the targeting of cancer cells, their biodistribution into the body, their eventual toxicity and their industrial production. In the coming years, modalities of administration and optimal combinations with radiotherapy should be defined in connection with fundamental research.


Assuntos
Nanomedicina , Nanopartículas/uso terapêutico , Radiossensibilizantes/uso terapêutico , Adenocarcinoma/radioterapia , Adenocarcinoma/secundário , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Ensaios Clínicos Fase I como Assunto , Gadolínio/uso terapêutico , Ouro/uso terapêutico , Háfnio/uso terapêutico , Humanos , Neoplasias Pulmonares/patologia , Nanopartículas/efeitos adversos , Radiossensibilizantes/efeitos adversos , Sarcoma/radioterapia
18.
World Neurosurg ; 132: 356-362, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31536810

RESUMO

The degree of primary resection of malignant brain gliomas (MBGs) has correlated positively with progression-free and overall survival. The indications for surgery and reoperation in MBG relapse remain controversial. Surgery will not be curative and should be followed by adjuvant treatment. We reviewed the reported studies with respect to repeat resection and the various methods of intraoperative radiotherapy for MBGs from the initial experience with high-energy linear accelerators in Japan to modern, integrated brachytherapy solutions using solid and balloon applicators. Because of the findings from our review, we have begun to research into the use of intraoperative balloon brachytherapy for recurrent MBGs.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Glioma/radioterapia , Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Radioterapia/métodos , Terapia Combinada , História do Século XX , História do Século XXI , Humanos , Procedimentos Neurocirúrgicos/história , Procedimentos Neurocirúrgicos/tendências , Radioterapia/história , Radioterapia/tendências , Reoperação
19.
Crit Rev Oncol Hematol ; 143: 95-101, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563079

RESUMO

Extensive disease Small cell lung cancer (ED-SCLC) represents a very aggressive malignancy in which brain metastases (BM) are quite common. Clinical trials on prophylactic cranial irradiation (PCI) have showed a clear decrease in the risk of developing BM but conflicting results concerning a possible survival advantage. A landmark European Organisation for Research and Treatment of Cancer (EORTC) prospective trial, as well as multitude of retrospective series confirm survival benefit after PCI. Recently, a Japan Clinical Oncology Group (JCOG) study did not find such survival benefit, provided that non-irradiated patients are closely followed by MRI. Henceforth, the role of PCI in this population has been questioned, on the ground of the possible absence of survival benefit, leading to a gradual shift in oncology practice. We performed a review of the literature on the subject of PCI in ED-SCLC patients. We conclude that PCI could still play a crucial role in these patients, considering not only a possible survival benefit, but also alternative endpoints, such as improved local control, delay in the onset of symptomatic BM and lower toxicity of a prophylactic- rather than an eventual active-intent treatment. Individualized attitude should be discussed with patients, while addressing all arguments in favour and against PCI.


Assuntos
Neoplasias Encefálicas/prevenção & controle , Neoplasias Encefálicas/radioterapia , Irradiação Craniana/métodos , Neoplasias Pulmonares/radioterapia , Carcinoma de Pequenas Células do Pulmão/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana/efeitos adversos , Humanos , Neoplasias Pulmonares/patologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/patologia
20.
Cancer Radiother ; 23(6-7): 708-715, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31477442

RESUMO

Stereotactic radiation therapy of brain metastases is a treatment recognized as effective, well tolerated, applicable for therapeutic indications codified and validated by national and international guidelines. However, the effectiveness of this irradiation, the evolution of patient care and the technical improvements enabling its implementation make it possible to consider it in more complex situations: proximity of brain metastases to organs at risk; large, cystic, haemorrhagic or multiple brain metastases, combination with targeted therapies and immunotherapy, stereotactic radiotherapy in patients with a pacemaker. This article aims to put forward the arguments available to date in the literature and those resulting from clinical practice to provide decision support for the radiation oncologists.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Órgãos em Risco , Radiocirurgia/métodos , Neoplasias Encefálicas/patologia , Tronco Encefálico , Hemorragia Cerebral/complicações , Terapia Combinada/métodos , Contraindicações de Procedimentos , Humanos , Imunoterapia , Imagem por Ressonância Magnética/efeitos adversos , Terapia de Alvo Molecular , Nervo Óptico , Marca-Passo Artificial , Carga Tumoral
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