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1.
BMC Complement Med Ther ; 20(1): 146, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404169

RESUMO

BACKGROUND: Acute radiation-induced proctitis (ARP) is the most common side effect following radiotherapy for malignant pelvic disease. This study evaluated the efficacy of Aloe vera ointment in prevention of ARP. METHODS: Forty-two patients receiving external-beam radiotherapy (RT) for pelvic malignancies were randomized to receive either Aloe vera 3% or placebo topical ointment during radiotherapy for 6 weeks. These patients were evaluated based on the severity (grade 0-4) of the following symptoms weekly: rectal bleeding, abdominal/rectal pain, diarrhea, or fecal urgency. RTOG acute toxicity criteria and psychosocial status of the patients were also recorded weekly. Lifestyle impact of the symptoms, and quantitative measurement of C-reactive protein (CRP), an indicator of systemic inflammation, were also measured. RESULTS: The results of present study demonstrated a significant preventive effect for Aloe vera in occurrence of symptom index for diarrhea (p < 0.001), rectal bleeding (p < 0.001), and fecal urgency (p = 0.001). The median lifestyle score improved significantly with Aloe vera during RT (p < 0.001). Intervention patients had a significant lower burden of systemic inflammation as the values for quantitative CRP decreased significantly over 6 weeks of follow-up (p = 0.009). CONCLUSION: This study showed that Aloe vera topical ointment was effective in prevention of symptoms of ARP in patients undergoing RT for pelvic cancers. TRIAL REGISTRATION: IRCT201606042027N6. Registration date: 2016-09-04.


Assuntos
Aloe , Neoplasias Pélvicas/radioterapia , Preparações de Plantas/uso terapêutico , Proctite/prevenção & controle , Lesões por Radiação/prevenção & controle , Idoso , Proteína C-Reativa/análise , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pomadas/uso terapêutico , Estudos Prospectivos , Qualidade de Vida , Radioterapia/efeitos adversos , Inquéritos e Questionários
2.
Orthopade ; 49(2): 177-182, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32052075

RESUMO

Radiotherapy is one of the pillars in the multimodal therapy of sarcomas of the extremities or pelvis/retroperitoneum. It can be delivered prior to or following surgery. Novel radiation techniques, such as intensity-modulated radiotherapy using high-energy photons or protons, contribute to the reduction of acute and late toxicities. This review article summarizes these concepts.


Assuntos
Neoplasias Pélvicas/radioterapia , Radioterapia Adjuvante , Neoplasias Retroperitoneais/radioterapia , Sarcoma/radioterapia , Neoplasias de Tecidos Moles/radioterapia , Humanos , Ossos Pélvicos , Pelve , Dosagem Radioterapêutica , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Resultado do Tratamento
3.
Int J Radiat Oncol Biol Phys ; 106(5): 968-976, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31987977

RESUMO

PURPOSE: This study aimed to report on the institutional outcomes after proton therapy for pelvic rhabdomyosarcoma (RMS). METHODS AND MATERIALS: Thirty-one children (≤21 years old) with group III pelvic RMS were enrolled on a prospective outcome study and treated between 2007 and 2018. Patients with vaginal/cervical RMS were excluded. The median age was 2.6 years. Twenty-four patients had embryonal RMS. At diagnosis, the median tumor volume was 185 cm3 and the median maximum diameter was 9.4 cm. Seven patients had N1 disease. Nineteen and 12 patients received European Pediatric Soft Tissue Sarcoma Study Group- and Children's Oncology Group-based chemotherapy, respectively. Fourteen patients underwent resection of the primary tumor after induction chemotherapy, including 6 patients who had a total cystectomy. The median radiation dose was 50.4 Gy relative biological effectiveness. RESULTS: With a median follow-up of 4.2 years, the 5-year local control, progression-free survival, and overall survival rates were 83%, 80%, and 84%, respectively. Patients <3 years old had better local control (100% vs 68%; P = .02), and patients with embryonal histology had better survival (96% vs 54%; P = .02). No other factors were significantly associated with disease control or survival. Specifically, no statistically significant difference was observed in local control, progression-free survival, or overall survival when comparing patients who underwent biopsy versus gross total resection (75% vs 93%, 68% vs 93%, 75% vs 93%, respectively). Excluding patients who underwent cystectomy, urinary toxicity was limited to 2 patients with nocturnal enuresis. Exploratory surgery to address a persistent mass or thickened bladder wall after radiation was the most common source of serious toxicity. CONCLUSIONS: This cohort of young children with large pelvic tumors treated with proton therapy demonstrates similar local control with less toxicity than historic reports. Functional bladder preservation is possible in most patients. Exploratory biopsy in the 18 months after radiation should be approached with caution.


Assuntos
Neoplasias Pélvicas/radioterapia , Terapia com Prótons , Rabdomiossarcoma/radioterapia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Terapia com Prótons/efeitos adversos , Resultado do Tratamento , Adulto Jovem
4.
Int J Radiat Oncol Biol Phys ; 106(3): 485-492, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610251

RESUMO

PURPOSE: Older patients undergoing radiation therapy (RT) for pelvic malignancies are at increased risk for pelvic fracture, which is associated with significant morbidity and mortality. RT techniques such as brachytherapy or intensity modulated RT (IMRT) allow for more conformal dose distributions, but it is not known whether the risk for pelvic fracture varies by RT modality. METHODS AND MATERIALS: This observational cohort study involved 28,354 patients ≥65 years old, treated with RT for pelvic malignancies. We evaluated the relative risk of pelvic fracture by type of RT when accounting for baseline factors. To test for nonspecific effects, we also evaluated risk of nonpelvic fractures in the same population. RESULTS: The 5-year incidence of pelvic fractures was 12.7% (95% confidence interval [CI], 11.6%-13.8%), 11.8% (10.8%-12.8%), and 3.7% (3.4%-4.0%) for patients with gastrointestinal, gynecologic, and prostate cancer, respectively. On multivariable analysis, being treated with IMRT (hazard ratio, 0.85; 95% CI, 0.73-0.99) or brachytherapy therapy alone (hazard ratio, 0.43; 95% CI, 0.34-0.54) was associated with a reduced hazard for pelvic fractures compared with 3D conformal radiation therapy in female patients. In contrast, there was no association with RT modality and the hazard for nonpelvic fractures among females. There was no significant association between pelvic fractures and IMRT or brachytherapy for male patients. White race, advanced age, and higher comorbidity were associated with an increased hazard for pelvic fracture. CONCLUSIONS: IMRT and brachytherapy were associated with a reduced risk of pelvic fractures in older women undergoing RT for pelvic malignancies. Pelvic insufficiency fracture risk should be considered when treating with pelvic RT.


Assuntos
Braquiterapia/efeitos adversos , Fraturas Ósseas/etiologia , Ossos Pélvicos/lesões , Neoplasias Pélvicas/radioterapia , Radioterapia Conformacional/efeitos adversos , Fatores Etários , Idoso , Estudos de Coortes , Intervalos de Confiança , Grupo com Ancestrais do Continente Europeu , Feminino , Fraturas Ósseas/epidemiologia , Neoplasias Gastrointestinais/radioterapia , Neoplasias dos Genitais Femininos/radioterapia , Humanos , Incidência , Masculino , Ossos Pélvicos/efeitos da radiação , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Análise de Regressão , Risco , Fatores Sexuais
5.
Radiat Oncol ; 14(1): 230, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842971

RESUMO

BACKGROUND AND PURPOSE: How to protect the ovarian function during radiotherapy is uncertain. The purpose of this study was to explore the association between the location of the transposed ovary and the ovarian dose in patients with cervical cancer received radical hysterectomy, ovarian transposition, and postoperative pelvic radiotherapy. METHODS: A retrospective analysis was conducted of 150 young patients with cervical cancer who received radical hysterectomy, intraoperative ovarian transposition, and postoperative adjuvant radiotherapy in Zhejiang Cancer Hospital. Association between location of the transposed ovaries and ovarian dose was evaluated. The transposed position of ovaries with a satisfactory dose was explored using a receiver operator characteristic curve (ROC) analysis. Patients' ovarian function was followed up 3 months and 1 year after radiotherapy. RESULTS: A total of 32/214 (15%) transposed ovaries were higher than the upper boundary of the planning target volume (PTV). The optimum cutoff value of > 1.12 cm above the iliac crest plane was significantly associated with ovaries above the upper PTV boundary. When the ovaries were below the upper boundary of PTV, the optimum cutoff value of transverse distance > 3.265 cm between the ovary and PTV was significantly associated with ovarian max dose (Dmax) ≤ 4Gy, and the optimum cutoff value of transverse distance > 2.391 cm was significantly associated with ovarian Dmax≤5Gy. A total of 77 patients had received complete follow-up, and 56 patients (72.7%) showed preserved ovarian function 1 year after radiotherapy, which was significantly increased compared with 3 months (44.2%) after radiotherapy. CONCLUSIONS: The location of transposed ovaries in patients with cervical cancer is significantly correlated with ovarian dose in adjuvant radiotherapy. We recommend transposition of ovaries > 1.12 cm higher than the iliac crest plane to obtain ovarian location above PTV. When the transposed ovary is below the upper boundary of PTV, ovarian Dmax ≤4Gy may be obtained when the transverse distance between the ovary and PTV was > 3.265 cm, and the ovarian Dmax≤5Gy may be obtained when the transverse distance was > 2.391 cm.


Assuntos
Órgãos em Risco/efeitos da radiação , Ovário/efeitos da radiação , Neoplasias Pélvicas/radioterapia , Neoplasias do Colo do Útero/patologia , Adulto , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Ovário/fisiopatologia , Ovário/cirurgia , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/cirurgia , Cuidados Pós-Operatórios , Prognóstico , Dosagem Radioterapêutica , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
6.
Med Oncol ; 37(1): 3, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31713056

RESUMO

Reproducible patient positioning is essential for precision in radiation therapy (RT) delivery. We tested the hypothesis that a structured daily pre-treatment stretching regimen is both feasible and effective for minimizing variability in positioning, as measured by sacral slope angles (SSA). Eight female subjects undergoing pelvic radiotherapy performed a structured daily hip exercise regimen (extension and external rotation) immediately prior to both simulation imaging and daily treatment, throughout their RT course. This exercising cohort was compared to a retrospective review of 20 subjects (17 women and 3 men) undergoing RT, who had usual care. SSA measurements from daily pre-treatment imaging were compared to SSA measurements from the simulation CT. The average variation in SSA among the intervention subjects was 0.91° (± 0.58°), with a range among subjects of 0.57°-1.27°. The average variation for the control subjects was 2.27° (± 1.43°), ranging 1.22°-5.09°. The difference between the two groups was statistically significant (p = 0.0001). There was a statistically significant SSA variation between groups at each week of treatment. There was no significant variation among the intervention subjects between week 1 and later weeks, whereas subjects in the control group demonstrated significant SSA variation between week 1 and later weeks. We demonstrated a significant decrease in the variability of SSA by implementing a simple pre-treatment exercise program, while control subjects exhibited increasing variation in SSA over the course of treatment. We conclude that there is a potential benefit of prehabilitation during pelvic RT; however, a larger randomized control trial is required to confirm the findings.Clinical Trial: This research project was approved by the University of Massachusetts Medical School IRB (IRB ID H00012353) on January 21, 2017. The study is listed on ClinicalTrials.gov, provided by the U.S. National Library of Medicine, found with identifier NCT03242538.


Assuntos
Terapia por Exercício/métodos , Posicionamento do Paciente/métodos , Radioterapia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/radioterapia , Pelve/fisiologia , Projetos Piloto
7.
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
8.
Radiat Oncol ; 14(1): 207, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752932

RESUMO

PURPOSE: The purpose of this study was to compare carbon-ion (C-ion), proton and photon radiotherapy (RT) plans with regard to dose reduction of the gastrointestinal (GI) tract by using a greater omentum spacer (GO spacer). METHODS: We retrospectively retrieved data for ten patients who received the GO spacer as surgical spacer placement for abdominal and pelvic tumors. Simulation plans were created on pre-spacer Computed Tomography (CT) and post-spacer CT for C-ion RT, proton RT and photon RT to compare the dose of the GI tract. The plans were normalized so that at least 95% of the planning target volume (PTV) received 70 Gy (relative biological effectiveness equivalent) delivered in 35 fractions. All plans were created with the lowest possible dose to the GI tract under conditions that meet the dose constraints for the PTV and spinal cord (maximum dose < 45 Gy). The part of the GI tract to be evaluated was defined as that most adjacent to the PTV. C-ion RT plans and proton RT plans were calculated by a spot scanning technique, and photon RT plans were calculated employing by fixed-field intensity-modulated radiation therapy. RESULTS: D2 cc and V10-70 of the GI tract were significantly lower on post-spacer plans than on pre-spacer plans for all three RT modalities. Regarding post-spacer plans, D2 cc of the GI tract was significantly lower on C-ion RT plans and proton RT plans than on photon RT plans (C-ion vs photon p = 0.001, proton vs photon p = 0.002). However, there was no significant difference between C-ion RT plans and proton RT plans for D2 cc of the GI tract (C-ion vs proton p = 0.992). In the photon RT plan for one patient, D2 cc of the GI tract did not meet < 50 Gy. CONCLUSIONS: The GO spacer shows a significant dose reduction effect on the GI tract.


Assuntos
Neoplasias Abdominais/radioterapia , Radioterapia com Íons Pesados/métodos , Omento/efeitos da radiação , Neoplasias Pélvicas/radioterapia , Terapia com Prótons/métodos , Radioterapia de Intensidade Modulada/métodos , Neoplasias Abdominais/cirurgia , Simulação por Computador , Feminino , Trato Gastrointestinal/efeitos da radiação , Humanos , Masculino , Neoplasias Pélvicas/cirurgia , Fótons , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
9.
Clinics (Sao Paulo) ; 74: e1388, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778433

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the incidence of urinary tract infection (UTI) in patients with cystitis symptoms who underwent pelvic radiation therapy and identify correlated predictive factors. METHODS: A prospective cohort study was conducted of patients who met the following: primary pelvic cancer treated with curative intent, older than 18 years old, and good performance status. The exclusion criteria were patients being treated for a UTI, using a urinary catheter, in dialysis or with cystostomy or nephrostomy, and using antibiotics during treatment. Urinalysis and urine culture were collected before the beginning of radiation therapy. Weekly evaluations of urinary symptoms were subsequently performed. In cases of new or worsening symptoms, a questionnaire was applied, and new urine exams were collected. The UTI diagnosis was defined by uroculture as bacterial growth greater than 104 CFU/mL. RESULTS: From September 2014 to November 2015, 112 patients were sequentially recruited, and 72 (64%) fulfilled the inclusion criteria. During follow-up, 24 (33%) patients had new urinary symptoms or worse preexisting symptoms. A UTI was confirmed in the second urinary culture in only one (1.4%) patient. CONCLUSIONS: The incidence of UTI was much lower than expected, suggesting that asymptomatic bacteriuria develops symptoms due to radiotherapy. Due to the low rate of UTI, no predictive factor was identified.


Assuntos
Cistite/diagnóstico , Neoplasias Pélvicas/radioterapia , Radioterapia/efeitos adversos , Infecções Urinárias/etiologia , Adulto , Idoso , Bacteriúria/diagnóstico , Bacteriúria/etiologia , Cistite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Urinárias/diagnóstico
10.
Radiat Oncol ; 14(1): 177, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619296

RESUMO

AIM: There is no general consensus on the optimal treatment for prostate cancer (PC) patients with intrapelvic nodal oligorecurrences after radical prostatectomy. Besides androgen deprivation therapy (ADT) as standard of care, both elective nodal radiotherapy (ENRT) and stereotactic body radiotherapy (SBRT) as well as salvage lymph node dissection (sLND) are common treatment options. The aim of our study was to assess decision making and practice patterns for salvage radiotherapy (RT) in this setting. METHODS: Treatment recommendations from 14 Swiss radiation oncology centers were collected and converted into decision trees. An iterative process using the objective consensus methodology was applied to assess differences and consensus. RESULTS: PSMA PET/CT was recommended by 93% of the centers as restaging modality. For unfit patients defined by age, comorbidities or low performance status, androgen deprivation therapy (ADT) alone was recommended by more than 70%. For fit patients with unfavorable tumor characteristics such as short prostate-specific antigen (PSA) doubling time or initial high-risk disease, the majority of the centers (57-71%) recommended ENRT + ADT for 1-4 lesions. For fit patients with favorable tumor characteristics, there were low levels of consensus and a wide variety of recommendations. For 1-4 nodal lesions, focal SBRT was offered by 64% of the centers, most commonly as a 5-fraction course. CONCLUSIONS: As an alternative to ADT, ENRT or SBRT for pelvic nodal oligorecurrences of PC are commonly offered to selected patients, with large treatment variations between centers. The exact number of lymph nodes had a major impact on treatment selection.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Seleção de Pacientes , Neoplasias Pélvicas/radioterapia , Padrões de Prática Médica/normas , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Radioterapia/métodos , Humanos , Masculino , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Neoplasias Pélvicas/etiologia , Neoplasias Pélvicas/patologia , Prognóstico , Estudos Prospectivos , Neoplasias da Próstata/patologia , Terapia de Salvação
11.
J Appl Clin Med Phys ; 20(11): 80-87, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31605456

RESUMO

PURPOSE: Dose volume histogram (DVH)-based analysis is utilized as a pretreatment quality assurance tool to determine clinical relevance from measured dose which is difficult in conventional gamma-based analysis. In this study, we report our clinical experience with an ionization-based transmission detector and model-based verification system, using DVH analysis, as a comprehensive pretreatment QA tool for complex volumetric modulated arc therapy plans. METHODS AND MATERIALS: Seventy-three subsequent treatment plans categorized into four clinical sites (Head and Neck, Thorax, Abdomen, and Pelvis) were evaluated. The average dose (Dmean ) and dose received by 1% (D1 ) of the planning target volumes (PTVs) and organs at risks (OARs) calculated using the treatment planning system (TPS) were compared to a computed (model-based) and reconstructed dose, from the measured fluence, using DVH analysis. The correlation between gamma (3% 3 mm) and DVH-based analysis for targets was evaluated. Furthermore, confidence and action limits for detector and verification systems were established. RESULTS: Linear regression confirmed an excellent correlation between TPS planned and computed dose using a model-based verification system (r2  = 1). The average percentage difference between TPS calculated and reconstructed dose for PTVs achieved using DVH analysis for each site is as follows: Head and Neck - 0.57 ± 2.8% (Dmean ) and 2.6 ± 2.7% (D1 ), Abdomen - 0.19 ± 2.8% and 1.64 ± 2.2%, Thorax - 0.24 ± 2.1% and 3.12 ± 2.8%, Pelvis 0.37 ± 2.4% and 1.16 ± 2.3%, respectively. The average percentage of passed gamma values achieved was above 95% for all cases. However, no correlation was observed between gamma passing rates and DVH difference (%) for PTVs (r2  = 0.11). The results demonstrate a confidence limit of 5% (Dmean and D1 ) for PTVs using DVH analysis for both computed and reconstructed dose distribution. CONCLUSION: DVH analysis of treatment plan using a model-based verification system and transmission detector provided useful information on clinical relevance for all cases and could be used as a comprehensive pretreatment patient-specific QA tool.


Assuntos
Neoplasias Abdominais/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias Pélvicas/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/instrumentação , Radioterapia de Intensidade Modulada/normas , Neoplasias Torácicas/radioterapia , Algoritmos , Humanos , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Software
12.
Anticancer Res ; 39(8): 4237-4242, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366511

RESUMO

AIM: To define safety and efficacy of a palliative, short-course accelerated radiation therapy for symptomatic locally advanced primary pelvic cancer. MATERIALS AND METHODS: A phase II trial was planned based on the minimax Simon's two-stage design. A total of 18 Gy in 4.5 Gy/fraction administered twice a day was delivered (SHARON). Pain and quality of life were recorded according to the Visual Analogue self-assessment and the cancer linear analog scales (CLAS), respectively. RESULTS: Twenty-five patients were enrolled in the study. The most frequent baseline symptoms were pain (48%), bleeding (40%), bleeding/pain (8%), and intestinal sub-occlusion (4%). The overall palliative response rate was 96.0%, with a median palliative duration of 6 months. An improvement of quality-of-life indices (well-being, fatigue, and ability to perform daily activities) was noted in 64.0%, 36.0%, and 48.0% of patients, respectively. CONCLUSION: The SHARON regimen was well tolerated and effective in the palliative treatment of patients with locally advanced pelvic cancer. Based on these results, a multicentric prospective phase III trial is ongoing to compare this regimen with traditional 2-week radiotherapy treatment.


Assuntos
Cuidados Paliativos , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/patologia , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pélvicas/patologia , Pelve/patologia , Pelve/efeitos da radiação , Qualidade de Vida , Dosagem Radioterapêutica
13.
Int J Radiat Oncol Biol Phys ; 105(3): 479-492, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31271829

RESUMO

The use of magnetic resonance (MR) imaging scans alone for radiation therapy treatment planning (MR-only planning) has been highlighted as one method of improving patient outcomes. Recent technologic advances have meant that introducing MR-only planning to the clinic is becoming a reality, with several specialist radiation therapy clinics using this technique for treatment. As such, substantial efforts are being made to introduce this technique into wide-spread clinical implementation. A systematic review of publications investigating the clinical implementation of pelvic MR-only radiation therapy treatment planning was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase, Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases were searched (timespan: all years to January 2, 2019). Twenty-six articles met the inclusion criteria. The studies were grouped into the following categories: (1) MR acquisition and synthetic computed tomography generation verification, (2) MR distortion quantification and phantom development, (3) clinical validation of patient treatment positioning in an MR-only workflow, and (4) MR-only commissioning processes. Key conclusions from this review are (1) MR-only planning has been implemented clinically for prostate cancer treatments; (2) a substantial amount of work remains to translate MR-only planning into widespread clinical implementation for all pelvic sites; (3) MR scanner distortions are no longer a barrier to MR-only planning, but they must be managed appropriately; (4) MR-only-based patient positioning verification shows promise, but limited evidence is reported in the literature and further investigation is required; and (5) a number of MR-only commissioning processes have been reported, which can aid centers as they undertake local commissioning; however, this needs to be formalized in guidance from national bodies.


Assuntos
Imagem por Ressonância Magnética/métodos , Posicionamento do Paciente , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/radioterapia , Imagens de Fantasmas , Planejamento da Radioterapia Assistida por Computador/métodos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Imagem por Ressonância Magnética/tendências , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Planejamento da Radioterapia Assistida por Computador/tendências , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Fluxo de Trabalho
14.
Brachytherapy ; 18(5): 683-688, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31248823

RESUMO

PURPOSE: The CivaSheet device uses multiple directionally shielded Pd-103 CivaDot sources to produce a directional planar dose distribution. In postplanning, manually digitizing the 3D source orientation is challenging because the 3D vector must be digitized by using 2D displayed images. The aim of this study is to develop an algorithm that will automatically determine the direction of each CivaDot source based on the location of sources adjacent to it. METHODS AND MATERIALS: The algorithm determines the source direction by averaging the normal directions of multiple local planes established by the adjacent sources. The algorithm was tested on a manually constructed CivaSheet-like device that was CT scanned in known flat geometries and two known curved geometries. Algorithmically determined source directions were compared with the known directions. The algorithm was also used on a postplan for a gynecological pelvic sidewall tumor bed implant and compared against manual digitization of the source directions. RESULTS: For the flat and curved test geometries, the average angular difference between the algorithm determined and known orientation was 1.2° ± 0.8° (flat geometry), 1.7° ± 2.1° (curve about vertical axis), and 2.3° ± 2.4° (curve about horizontal axis). For the patient case, results showed on average a 23.1° ± 10.8° difference between the manual digitized orientation and the algorithm's predicted orientation. CONCLUSIONS: The algorithm calculates the source orientation with accuracy better than 2.3° for the controlled experiments. In addition to its accuracy, the algorithm produces consistent results and lessens the difficult challenge of orienting the partially shielded sources.


Assuntos
Algoritmos , Braquiterapia/instrumentação , Braquiterapia/métodos , Paládio/uso terapêutico , Radioisótopos/uso terapêutico , Braquiterapia/efeitos adversos , Feminino , Humanos , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/radioterapia , Imagens de Fantasmas , Próteses e Implantes , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos
15.
Radiat Oncol ; 14(1): 96, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174555

RESUMO

BACKGROUND: It is uncertain if whole-pelvic irradiation (WPRT) in addition to dose-escalated prostate bed irradiation (PBRT) improves biochemical progression-free survival (bPFS) after prostatectomy for locally advanced tumors. This study was initiated to analyze if WPRT is associated with bPFS in a patient cohort with dose-escalated (> 70 Gy) PBRT. METHODS: Patients with locally advanced, node-negative prostate carcinoma who had PBRT with or without WPRT after prostatectomy between 2009 and 2017 were retrospectively analyzed. A simultaneous integrated boost with equivalent-doses-in-2-Gy-fractions (EQD-2) of 79.29 Gy or 71.43 Gy to the prostate bed was applied in patients with margin-positive (or detectable) and margin-negative/undetectable tumors, respectively. WPRT (44 Gy) was offered to patients at an increased risk of lymph node metastases. RESULTS: Forty-three patients with PBRT/WPRT and 77 with PBRT-only were identified. Baseline imbalances included shorter surgery-radiotherapy intervals (S-RT-Intervals) and fewer resected lymph nodes in the WPRT group. WPRT was significantly associated with better bPFS in univariate (p = 0.032) and multivariate models (HR = 0.484, p = 0.015). Subgroup analysis indicated a benefit of WPRT (p = 0.029) in patients treated with rising PSA values who mostly had negative margins (74.1%); WPRT was not associated with a longer bPFS in the postoperative setting with almost exclusively positive margins (96.8%). CONCLUSION: We observed a longer bPFS after WPRT compared to PBRT in patients with locally advanced prostate carcinoma who underwent dose-escalated radiotherapy. In subset analyses, the association was only observed in patients with rising PSA values but not in patients with non-salvage postoperative radiotherapy for positive margins.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Neoplasias Pélvicas/radioterapia , Cuidados Pós-Operatórios , Próstata/efeitos da radiação , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/métodos , Idoso , Estudos de Coortes , Humanos , Masculino , Órgãos em Risco/efeitos da radiação , Prognóstico , Dosagem Radioterapêutica , Taxa de Sobrevida
16.
Radiat Oncol ; 14(1): 75, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068187

RESUMO

BACKGROUND: The radiation transmission through the multileaf collimators is undesired in modern techniques such as volumetric modulated arc therapy (VMAT). According to identical plans, in this study, we aim to investigate the dosimetric impact of jaw tracking on the VMAT plans on two adjacent targets. METHODS: Two treatment plans were designed for eight pelvic (cervical) patients with two targets using the same optimization parameters. The original plan (O-plan) used automatically selected jaw positions. In the new plan (F-plan), the jaws were fixed to block two targets in two beams. The dosimetric parameters of the two plans were compared to evaluate the improvement of dose sparing for the body volume between two targets (named interOAR) in F-VMAT. RESULTS: The mean dose of interOAR reduced significantly from 654.96 ± 113.38 cGy for O-VMAT, to 490.84 ± 80.26 cGy for F-VMAT (p = 0.018). The monitor units (MUs) in the F-plans were 1.49-fold higher than that in the O-plan. The F and O-plan performed similarly in target dose homogeneity. The differences in Dmax of spinal cord, Dmax of spinal cord planning organ at risk volume, and V20, V30, and V40 of the intestine were insignificant. CONCLUSIONS: VMAT plans with the fixed-jaw method can reduce the volume between two targets effectively. However, despite the plan quality, the method can only be used when the regular methods cannot reach the clinical requirements for critical organs because of additional MUs.


Assuntos
Arcada Osseodentária/fisiologia , Órgãos em Risco/efeitos da radiação , Neoplasias Pélvicas/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Algoritmos , Humanos , Arcada Osseodentária/efeitos da radiação , Registro da Relação Maxilomandibular , Pessoa de Meia-Idade , Prognóstico , Dosagem Radioterapêutica
17.
J Appl Clin Med Phys ; 20(9): 114-121, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31074197

RESUMO

PURPOSE: Cone-beam computerized tomography (CBCT) is routinely performed for verification of patient position in radiotherapy. It produced a large amount of data which require a method to compress them for efficient storage. In this study three video compression algorithms were introduced and their performance was evaluated based on real patient data. MATERIALS AND METHODS: At first CBCT images in multiple sets of a patient were transferred from reconstruction workstation or exported from treatment planning system. Then CBCT images were sorted according to imaging time (time-prioritized sequence) or imaging location (location-prioritized sequence). Next, this sequence was processed by a video compression algorithm and resulted in a movie. Three representative video compression algorithms (Motion JPEG 2000, Motion JPEG AVI, and MPEG-4) were employed and their compression performance was evaluated based on the CBCT data of 30 patients. RESULTS: Among three video compression algorithms, Motion JPEG 2000 has the least compression ratio since it is a lossless compression algorithm. Motion JPEG AVI and MPEG-4 have higher compression ratios than Motion JPEG 2000 but come with certain image losses. For MPEG-4, location-prioritized sequences show higher compression ratio than time-prioritized sequences. Based on the results achieved on the clinical target verification application, the registration accuracy of CBCT after decompression was comparable to that of the original CBCT. CONCLUSIONS: Video compression algorithms could provide a higher compression ratio comparing to static image compression algorithm. Although the loss of CBCT image due to compression its impact on registration accuracy of patient positioning is almost negligible. Video compression method is an effective way to substantially reduce the size of CBCT images for storage.


Assuntos
Algoritmos , Tomografia Computadorizada de Feixe Cônico/métodos , Compressão de Dados/métodos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Gravação em Vídeo , Tomografia Computadorizada Quadridimensional , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Movimento , Órgãos em Risco/efeitos da radiação , Posicionamento do Paciente , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/radioterapia , Prognóstico , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Processamento de Sinais Assistido por Computador , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/radioterapia
18.
World J Gastroenterol ; 25(13): 1618-1627, 2019 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-30983821

RESUMO

BACKGROUND: Chronic radiation proctitis (CRP) is a complication which occurs in 1%-5% of patients who undergo radiotherapy for pelvic malignancies. Although a wide range of therapeutic modalities are available, there is no literature to date showing any particularly appropriate therapeutic modality for each disease stage. Argon plasma coagulation (APC) is currently recommended as the first-choice treatment for hemorrhagic CRP, however, its indication based on long-term follow-up is still unclear. On the hypothesis that the long-term efficacy and safety of APC are not fully understood, we reviewed APC treatment for patients with hemorrhagic CRP from a single center. AIM: To assess the long-term efficacy and safety of APC for hemorrhagic CRP. METHODS: This is a retrospective study of consecutive patients treated with APC for hemorrhagic CRP from January 2013 to October 2017. Demographics, clinical variables, and typical endoscopic features were recorded independently. Success was defined as either cessation of bleeding or only occasional traces of bloody stools with no further treatments for at least 12 mo after the last APC treatment. We performed univariate and multivariate analyses to identify factors associated with success and risk factors for fistulas. RESULTS: Forty-five patients with a median follow-up period of 24 mo (range: 12-67 mo) were enrolled. Fifteen (33.3%) patients required blood transfusion before APC. Successful treatment with APC was achieved in 31 (68.9%) patients. The mean number of APC sessions was 1.3 (1-3). Multivariate analysis showed that APC failure was independently associated with telangiectasias present on more than 50% of the surface area [odds ratio (OR) = 6.53, 95% confidence interval (CI): 1.09-39.19, P = 0.04] and ulcerated area greater than 1 cm2 (OR = 8.15, 95%CI: 1.63-40.88, P = 0.01). Six (13.3%) patients had severe complications involving rectal fistulation. The only factor significantly associated with severe complications was ulcerated area greater than 1 cm2 (P = 0.035). CONCLUSION: The long-term efficacy of APC for hemorrhagic CRP is uncertain in patients with telangiectasias present on > 50% of the surface area and ulceration > 1 cm2.


Assuntos
Coagulação com Plasma de Argônio/efeitos adversos , Hemorragia Gastrointestinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Proctite/cirurgia , Lesões por Radiação/cirurgia , Telangiectasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Mucosa Intestinal/irrigação sanguínea , Mucosa Intestinal/patologia , Mucosa Intestinal/efeitos da radiação , Mucosa Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/radioterapia , Complicações Pós-Operatórias/etiologia , Proctite/etiologia , Proctite/patologia , Lesões por Radiação/etiologia , Lesões por Radiação/patologia , Reto/irrigação sanguínea , Reto/patologia , Reto/efeitos da radiação , Reto/cirurgia , Estudos Retrospectivos , Fatores de Risco , Telangiectasia/etiologia , Telangiectasia/patologia , Resultado do Tratamento
19.
Radiat Oncol ; 14(1): 57, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943992

RESUMO

BACKGROUND: Advanced pelvic radiotherapy techniques aim to reduce late bowel toxicity which can severely impact the lives of pelvic cancer survivors. Although advanced techniques have been largely adopted worldwide, to achieve their aim, knowledge of which dose-volume parameters of which components of bowel predict late bowel toxicity is crucial to make best use of these techniques. The rectum is an extensively studied organ at risk (OAR), and dose-volume predictors of late toxicity for the rectum are established. However, for other components of bowel, there is a significant paucity of knowledge. The Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) reviews recommend dose-volume constraints for acute bowel toxicity for peritoneal cavity and bowel loops, although no constraints are recommended for late toxicity, despite its relevance to our increasing number of survivors. This systematic review aims to examine the published literature to seek dose-volume predictors and constraints of late bowel toxicity for OARs (apart from the rectum) for use in clinical practice. METHODS: A systematic literature search was performed using Medline, Embase, Cochrane Library, Web of Science, Cinahl and Pubmed. Studies were screened and included according to specific pre-defined criteria. Included studies were assessed for quality against QUANTEC-defined assessment criteria. RESULTS: 101 studies were screened to find 30 relevant studies. Eight studies related to whole bowel, 11 to small bowel, and 21 to large bowel (including 16 of the anal canal). The anal canal is an important OAR for the development of late toxicity, and we recommend an anal canal Dmean <40Gy as a constraint to reduce late incontinence. For other components of bowel (sigmoid, large bowel, intestinal cavity, bowel loops), although individual studies found statistically significant parameters and constraints these findings were not corroborated in other studies. CONCLUSIONS: The anal canal is an important OAR for the development of late bowel toxicity symptoms. Further validation of the constraints found for other components of bowel is needed. Studies that were more conclusive included those with patient-reported data, where individual symptom scores were assessed rather than an overall score, and those that followed statistical and endpoint criteria as defined by QUANTEC.


Assuntos
Enteropatias/etiologia , Intestino Delgado/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Humanos , Prognóstico , Dosagem Radioterapêutica
20.
Asian Pac J Cancer Prev ; 20(3): 817-823, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30911301

RESUMO

Sexual dysfunction (SDF) is a common sequel to cancer treatment which affects the quality of life in women treated with pelvic radiotherapy. The aim of this study was to evaluate the safety, symptom resolution and objective improvement the injection of autologous platelet released growth factor (APRGF) for treatment of SDF in cited patients. This prospective pilot study enrolled 10 cancer-free patients with SDF who underwent pelvic radiotherapy at least 5 years ago, randomly. Each patient was received 1-2 cc APRGF within four weeks and all patients were re-evaluated at eight weeks and six months. CD34 immuno histochemistry and Masson's trichrome staining were performed on vaginal biopsy section for angiogenesis and fibrosis assay respectively. Sexual satisfaction after the injection of APRFG was clinically difference and the entire patient had sexual satisfaction. In the patient's follow-up, none of them needs to repeat the treatment. Our results declared that APRGF injection was effective and symptoms were disappeared in the entire patients. Significant objective improvements in vaginal diameter (mean before injection, 6.5 cm vs 7.1 cm after injection) (p-value = 0.001) and vaginal flexibility (mean before treatment, 0.72 cm vs 1.85 cm after injection) (P-value = 0.026) were observed. Characteristics of discharge before the injection in 60% of patients were included dry vagina and 40% had mild discharge but after injection 40% of patients had moderate and also 60% had mild and sufficient discharge (P-value= 0.190). Overally, our patients reported better sexual function and showed better vaginal function indexes, after APRFG injection.


Assuntos
Plaquetas/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/administração & dosagem , Neoplasias Pélvicas/radioterapia , Radioterapia/efeitos adversos , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Vagina/efeitos dos fármacos , Adulto , Transfusão de Sangue Autóloga , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Neoplasias Pélvicas/patologia , Projetos Piloto , Prognóstico , Estudos Prospectivos , Qualidade de Vida , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/patologia , Vagina/patologia
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