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1.
Cancer Invest ; 37(9): 501-505, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583922

RESUMO

Leptomeningeal metastasis (LM) in solid tumors are rare, even more in renal cell carcinoma (RCC). To date there is a lack of consensual treatment modalities of leptomeningeal metastasis. Furthermore, with the improvement of outcomes and more effective systemic targeted therapies, the management of leptomeningeal metastasis becomes a real challenge. We here report two cases of RCC with leptomeningeal metastasis at initial diagnosis. Both patients had concurrent adjacent skull bone metastasis. Therapeutic management of both patients consisted in surgical resection, followed by radiotherapy in one case. Systemic treatment was delayed according to current recommendations for the management of metastatic RCC. The aim of this work is to report the therapeutic approach and related outcomes and also provide a review of the currently available literature on leptomeningeal disease in renal cell carcinoma. Indeed, local treatment with curative outcome of meningeal location in RCC should be performed specially in LM at initial diagnosis.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Neoplasias Meníngeas/secundário , Neoplasias Cranianas/secundário , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/radioterapia , Terapia Combinada , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/radioterapia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Neoplasias Cranianas/radioterapia , Neoplasias Cranianas/cirurgia , Sunitinibe/uso terapêutico , Resultado do Tratamento
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.
Anticancer Res ; 39(4): 2091-2095, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30952754

RESUMO

BACKGROUND/AIM: A new tool for estimating survival of patients receiving whole-brain radiotherapy (WBRT) for intracerebral metastases from renal cell carcinoma (RCC) was created. PATIENTS AND METHODS: The new WBRT-30-RCC was developed in 34 patients homogeneously treated with 30 Gy in 10 fractions of WBRT and compared to updated diagnosis-specific graded prognostic assessment DS-GPA and Dziggel score for predicting death within 6 months and survival for at least 6 months following WBRT. RESULTS: WBRT-30-RCC included three groups with 6-month survival rates of 6.7% for those with 8-10 points, 38.5% for those with 12-14 points and 66.7% for those with 16-18 points. Positive predictive values (PPV)s for predicting death within 6 months were 93.3% using WBRT-30-RCC, 77.3% using updated DS-GPA and 93.7% using the Dziggel score. PPVs for predicting survival for at least 6 months were 66.7%, 50.0% and 50.0%, respectively. CONCLUSION: WBRT-30-RCC was more precise than the other scores in predicting survival for at least 6 months, although all three scores were not optimal. For predicting death within 6 months, WBRT-30-RCC and Dziggel score were similarly accurate and superior to the updated DS-GPA.


Assuntos
Neoplasias Encefálicas/radioterapia , Carcinoma de Células Renais/radioterapia , Irradiação Craniana , Neoplasias Renais/radioterapia , Neoplasias Encefálicas/secundário , Carcinoma de Células Renais/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico
4.
J Urol ; 201(6): 1097-1104, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30741849

RESUMO

PURPOSE: Stereotactic ablative radiotherapy is an emerging treatment for renal cell carcinoma. Our study objective was to evaluate this therapy in patients with a solitary kidney, focusing on oncologic and renal function outcomes. MATERIALS AND METHODS: We pooled individual patient data from 9 IROCK (International Radiosurgery Oncology Consortium for Kidney) institutions in Germany, Australia, the United States of America, Canada and Japan. Median followup was 2.6 years. Baseline characteristics and outcomes were compared between the solitary and bilateral kidney cohorts. Predictors of renal function after stereotactic ablative radiotherapy were assessed by logistic regression modeling. RESULTS: A total of 81 patients with a solitary kidney underwent stereotactic ablative radiotherapy. Mean age was 67.3 years and 97.5% of patients had good performance status, including ECOG (Eastern Cooperative Oncology Group) 0-1 or KPS (Karnofsky Performance Status) 70% or greater. Median tumor diameter was 3.7 cm (IQR 2.5-4.3) and 37% of tumors were 4 cm or greater. The 138 patients in the bilateral cohort harbored larger tumors and were older (p <0.001) with a lower baseline estimated glomerular filtration rate (p = 0.024). After stereotactic ablative radiotherapy in the solitary kidney cohort the mean ± SD estimated glomerular filtration rate decrease was -5.8 ± 10.8 ml per minute (-9%). No patient with a solitary kidney required dialysis. After stereotactic ablative radiotherapy a tumor size of 4 cm or greater was associated with an estimated glomerular filtration rate decrease of 15 ml per minute or greater (OR 4.2, p = 0.029). At 2 years the rates of local control, and progression-free, cancer specific and overall survival in the solitary cohort were 98.0%, 77.5%, 98.2% and 81.5%, respectively. There was no significant difference in renal function or oncologic outcomes between the cohorts (p >0.05). CONCLUSIONS: In this analysis of the IROCK database stereotactic ablative radiotherapy in patients with a solitary kidney had an acceptable impact on renal function and achieved excellent oncologic outcomes, similar to those in patients with bilateral kidneys. Thus, stereotactic ablative radiotherapy represents a viable treatment option in patients with renal cell carcinoma in a solitary kidney.


Assuntos
Carcinoma de Células Renais/radioterapia , Neoplasias Renais/radioterapia , Radiocirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/complicações , Feminino , Humanos , Neoplasias Renais/complicações , Masculino , Pessoa de Meia-Idade , Rim Único/complicações
5.
Cancer Treat Rev ; 69: 215-223, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30096699

RESUMO

In the last few years, immune checkpoint inhibitors have been extensively investigated in renal cell carcinoma and led to remarkable results. Radiation therapy may increase the activity of immune modulating agents through different mechanisms, priming the immune system, recruiting immune cells to the tumor environment, and altering the immunosuppressive effects of the tumor microenvironment. Preclinical studies reported increased loco-regional control when radiation is combined with immune-checkpoint blockade. Moreover, increased systemic disease control has been demonstrated when local radiation is combined with both anti-CTLA-4 and anti-PD-1/PD-L1 inhibitors. Actually, several trials are ongoing testing the activity of radiation therapy in combination with different immune-modulating agents for the treatment of metastatic renal cell carcinoma. The aim of this paper is to focus on the biological rationale of adding radiation therapy to immune-modulating agents in renal cell carcinoma and to review the currently available clinical evidence about the combination of radiotherapy and immunotherapy.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antígeno B7-H1/antagonistas & inibidores , Antígeno CTLA-4/antagonistas & inibidores , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/radioterapia , Radioterapia , Ensaios Clínicos como Assunto , Humanos , Prognóstico
6.
Crit Rev Oncol Hematol ; 128: 82-87, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29958634

RESUMO

Renal cell carcinoma (RCC) is classically regarded as extremely resistant to classical fractionated radiation therapy (RT). Nowadays, there is convincing data supporting RCC radiosensitivity to high fraction doses, which may represent an ideal issue for new treatment strategies in primary and oligometastatic RCC disease. This review discusses the role of RT in RCC and its potential therapeutic scenario focusing on the most interesting clinical trials.


Assuntos
Carcinoma de Células Renais/radioterapia , Neoplasias Renais/radioterapia , Hipofracionamento da Dose de Radiação , Animais , Humanos , Resultado do Tratamento
7.
Cancer Sci ; 109(9): 2873-2880, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29981249

RESUMO

Long-term oncological outcomes for primary renal cell carcinoma (RCC) treated with carbon-ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12 or 16-fraction CIRT at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease-free, cancer-specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7-16.5) years; 9 of these patients were inoperable because of comorbidities or advanced-stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre-CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non-renal adverse events. Local control rate, and disease-free, cancer-specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long-term follow-up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre-CIRT, and yield favorable treatment outcomes, even in inoperable cases.


Assuntos
Carcinoma de Células Renais/radioterapia , Radioterapia com Íons Pesados , Neoplasias Renais/radioterapia , Idoso , Carcinoma de Células Renais/mortalidade , Feminino , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Eficiência Biológica Relativa , Estudos Retrospectivos
8.
Anticancer Res ; 38(5): 2973-2976, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29715126

RESUMO

AIM: To create an instrument for estimating the risk of new brain metastases after stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) alone in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: In 45 patients with 1-3 brain metastases, seven characteristics were analyzed for association with freedom from new brain metastases (age, gender, performance score, number and sites of brain metastases, extra-cerebral metastasis, interval from RCC diagnosis to SRS/FSRT). RESULTS: Lower risk of subsequent brain lesions after RT was associated with single metastasis (p=0.043) and supratentorial involvement only (p=0.018). Scoring points were: One metastasis=1, 2-3 metastases=0, supratentorial alone=1, infratentorial with/without supratentorial=0. Scores of 0, 1 and 2 points were associated with 6-month rates of freedom from subsequent brain lesions of 25%, 74% and 92% (p=0.008). After combining groups with 1 and 2 points, 6-month rates were 25% for those with 0 points and 83% for those with 1-2 points (p=0.002). CONCLUSION: Two groups were identified with different risks of new brain metastases after SRS or FSRT alone. High-risk patients may benefit from additional whole-brain irradiation.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Recidiva Local de Neoplasia , Radiocirurgia/métodos , Adulto , Idoso , Carcinoma de Células Renais/radioterapia , Irradiação Craniana/métodos , Fracionamento da Dose de Radiação , Feminino , Humanos , Neoplasias Renais/radioterapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
9.
BMJ Case Rep ; 20182018 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-29778997

RESUMO

A 68-year-old woman with known metastatic renal cell carcinoma presented with an acutely swollen right leg. In between the two sessions of palliative radiotherapy to the right hip, she also had right hip modified Harrington procedure for tumour resection with hip replacement. Initial clinical evaluation raised the suspicion of right leg deep vein thrombosis (DVT). However, DVT was excluded and further investigations revealed stenosis of the right external and common iliac veins, likely secondary to radiotherapy.


Assuntos
Carcinoma de Células Renais/radioterapia , Veia Ilíaca/efeitos da radiação , Neoplasias Renais/radioterapia , Doenças Vasculares Periféricas/diagnóstico , Lesões por Radiação/diagnóstico , Idoso , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Doenças Vasculares Periféricas/etiologia , Doenças Vasculares Periféricas/patologia , Lesões por Radiação/etiologia , Lesões por Radiação/patologia , Trombose Venosa/diagnóstico
10.
Radiother Oncol ; 127(3): 501-506, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29754859

RESUMO

BACKGROUND AND PURPOSE: Investigate effects of stereotactic radiotherapy (SRT) or surgical metastasectomy (SM) on overall survival (OS) in metastatic renal cell carcinoma (mRCC) in the era of targeted agents (TA). MATERIAL AND METHODS: mRCC patients (n = 117) treated with SRT (n = 57), SM (n = 30) or both modalities sequentially (n = 30) at two oncological centres in Sweden in 2005-2014 were retrospectively included. Median follow-up (mFU) was 63 months. RESULTS: A majority had clear cell histology, 1-3 metastases, and ECOG performance status of 0 or 1. Two thirds had intermediate or poor risk and 44% synchronous metastases. 65% received TA. SRT patients were more likely to have adverse risk profiles. Median OS was 51 months without significant differences between SRT and SM. ECOG 1 vs 0 (HR 2.9; CI 1.6-5.2; p < 0.001), intracranial targets (HR 1.8; CI 1.1-3.2; p = 0.03) and watchful waiting >18 months prior to treatment (HR 0.3; CI 0.2-0.6; p = 0.001) were independently associated with OS. 15% of curatively treated patients (n = 60) were relapse-free with mFU of 87 months. CONCLUSIONS: OS after SRT was comparable to SM and longer than expected considering patients with adverse risk profiles were common. Fit patients with non-brain metastases treated after an initial period of watchful waiting had the best prognosis.


Assuntos
Carcinoma de Células Renais/radioterapia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/radioterapia , Neoplasias Renais/cirurgia , Radiocirurgia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/mortalidade , Terapia Combinada , Feminino , Humanos , Neoplasias Renais/mortalidade , Masculino , Metastasectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Suécia/epidemiologia , Resultado do Tratamento
11.
Radiat Oncol ; 13(1): 47, 2018 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-29558966

RESUMO

BACKGROUND: Cytoreductive nephrectomy is thought to improve survival in metastatic renal cell carcinoma (mRCC). As many patients are ineligible for major surgery, we hypothesized that SABR could be a safe alternative. METHODS: In this dose-escalation trial, inoperable mRCC patients underwent SABR targeting the entire affected kidney. Toxicity (CTCAE v3.0), quality of life (QoL), renal function, and tumour response (RECIST v1.0) were assessed. RESULTS: Twelve patients of mostly intermediate (67%) or poor (25%) International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic class, median KPS of 70%, and median tumour size of 8.7 cm (range: 4.8-13.8) were enrolled in successive dose cohorts of 25 (n = 3), 30 (n = 6), and 35 Gy (n = 3) in 5 fractions. SABR was well tolerated with 3 grade 3 events: fatigue (2) and bone pain (1). QoL decreased for physical well-being (p = 0.016), but remained unchanged in other domains. SABR achieved a median tumour size reduction of - 17.3% (range: + 5.3 to - 54.4) at 5.3 months. All patients progressed systemically and median OS was 6.7 months. Crude median follow-up was 5.8 months. CONCLUSIONS: In non-operable mRCC patients, renal-ablative SABR to 35 Gy in 5 fractions yielded acceptable toxicity, renal function preservation, and stable QoL. SABR merits further prospective investigation as an alternative to cytoreductive nephrectomy. TRIAL REGISTRATION: ClinicalTrials.gov NCT02264548. Registered July 22 2014 - Retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT02264548.


Assuntos
Carcinoma de Células Renais/radioterapia , Neoplasias Renais/radioterapia , Radiocirurgia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Radiocirurgia/efeitos adversos , Dosagem Radioterapêutica , Resultado do Tratamento
12.
World J Surg Oncol ; 16(1): 48, 2018 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514643

RESUMO

BACKGROUND: The development of a second primary tumor is a potential late side effect of radiotherapy. Particularly, an increased risk of secondary cancers, mostly of digestive or breast origin, has been observed in patients treated with high-dose radiotherapy for Wilms tumor (WT) in childhood. However, hepatocellular carcinoma (HCC) has been very rarely described as a potentially radiotherapy-induced tumor. We describe the case of a patient with an aggressive HCC 50 years after the treatment of a WT. CASE PRESENTATION: A 49-year old man, treated at the age of 6 weeks for a right WT by a right nephrectomy and adjuvant radiotherapy, presented with a right abdominal mass. Imaging demonstrated a 100-mm tumor invading the inferior segment of the right liver, the right colon and the right psoas muscle. The patient had no previous history of liver disease, nor of alcohol consumption, and hepatitis serologies were negatives. Biopsy demonstrated a poorly differentiated tumor of unknown origin. A panel of tumor markers was negative. Explorative surgery has been performed allowing en bloc R0 tumor resection, including resection of segments VI and VII of the liver, right hemicolectomy and resection of the anterior sheet of the right psoas muscle. Pathological examination revealed a poorly differentiated HCC. No signs of cirrhosis or chronic liver disease were observed in the non-tumor liver. Twenty weeks after surgery, the patient developed a multifocal tumor recurrence that was treated with intra-arterial 90Yttrium radioembolization. CONCLUSION: In this case, the absence of risk factors for HCC, such as cirrhosis, viral hepatitis and chronic liver disease, highly suggests the development of HCC to be related to previous high-dose radiation therapy given for a right WT to a field involving the inferior part of the liver. This observation shows radiotherapy to/near the liver, particularly in childhood, to be a potential risk factor for HCC, stressing the need for a long-term specific follow-up in patients irradiated in childhood.


Assuntos
Carcinoma Hepatocelular/etiologia , Neoplasias Renais/radioterapia , Neoplasias Hepáticas/etiologia , Nefrectomia/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Tumor de Wilms/radioterapia , Idade de Início , Carcinoma Hepatocelular/patologia , Humanos , Lactente , Neoplasias Renais/cirurgia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Tumor de Wilms/cirurgia
13.
J Cancer Res Ther ; 14(Supplement): S260-S262, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29578185

RESUMO

For localized the incidence of renal cell carcinoma (RCC), nephrectomy is the standard treatment. As RCC is generally regarded as a radiation-resistant tumor, the value of postoperative adjuvant radiotherapy is controversial. However, with new advance in radiotherapy (i.e., three-dimensional conformal radiation therapy [3DCRT] and intensity-modulated radiation therapy [IMRT]), target volume delineation, intensity modulation in treatment planning, and treatment delivery are more accurate with fewer adverse effect. A right renal tumor was identified in a 50-year-old man during a routine examination. T1N0M0 RCC was clinically diagnosed as the tumor was 3 cm × 3.5 cm and well-enhanced with intravenously infused contrast material in the arterial phase on computed tomography (CT). No metastases to regional lymph nodes or distant sites were evident. 3DCRT after the operation was carried out. A total dose of 50 Gy in 20 fractions over 28 days was delivered using a 15-MV X-ray. No clinical acute or chronic side effects were recorded during or after treatment, which was well tolerated. After radiotherapy, the patient came back to the hospital for a check regularly, with no evidence of recurrence and metastasis more than 11 years, and the CT for abdominal showed partial function of the right renal remained. The present case showed a good response with recovery after CRT of 50 Gy in 20 fractions for postoperative RCC. Although further experiences and longer follow-up are mandatory to conclude the optimal treatment schedule and efficacy of CRT for RCC, postoperative radiotherapy definitely reduces locoregional recurrences and with acceptable gastrointestinal toxicity if modern techniques (CRT and IMRT) are utilized.


Assuntos
Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/radioterapia , Neoplasias Renais/patologia , Neoplasias Renais/radioterapia , Cuidados Pós-Operatórios , Carcinoma de Células Renais/cirurgia , Terapia Combinada , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Hipofracionamento da Dose de Radiação , Radioterapia de Intensidade Modulada/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
BMC Urol ; 18(1): 4, 2018 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-29382325

RESUMO

BACKGROUND: We report an unusual case of a synchronous rectal and metachronous vaginal metastatic renal cell carcinoma. CASE PRESENTATION: A 78-year-old woman presented with hematochezia and a colonoscopy revealed a metastatic clear-cell renal cell carcinoma rectal polyp biopsy-proven. Abdominal computed tomography identified a 9.0-cm left renal mass with renal vein thrombosis, for which she underwent a laparoscopic radical nephrectomy. Histopathological examination confirmed a pT3a clear-cell renal cell carcinoma. Seven months later, the patient presented with vaginal bleeding. Physical examination revealed a vaginal polypoid mass and biopsy confirmed a clear-cell renal cell carcinoma metastasis. CONCLUSIONS: This case represents unusual manifestations of metastatic renal cell carcinoma and is a reminder of the wide spectrum of clinical course of this disease.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Hemorragia Uterina/diagnóstico por imagem , Idoso , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/radioterapia , Diagnóstico Diferencial , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/radioterapia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/radioterapia , Hemorragia Uterina/etiologia , Hemorragia Uterina/radioterapia
15.
Strahlenther Onkol ; 194(5): 365-374, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29362835

RESUMO

BACKGROUND: Improved survival of patients with spinal bone metastases has resulted in an increased number of referrals for retreatment and repeat reirradiation. METHODS: A consortium of expert radiation oncologists (RO) has been established with the aim of providing treatment recommendations for challenging clinical scenarios for which there are no established guidelines. In this case, a patient developed local progression of a T5 vertebral lesion after two prior courses of palliative radiotherapy (time interval >12 months, assumed cumulative biologically equivalent dose in 2­Gy fractions [EQD2] for spinal cord [alpha/beta 2 Gy] 75 Gy). Expert recommendations were tabulated with the aim of providing guidance. RESULTS: Five of seven RO would offer a third course of radiotherapy, preferably with advanced techniques such as stereotactic radiotherapy. However, the dose-fractionation concepts were heterogeneous (3-20 fractions) and sometimes adjusted to different options for systemic treatment. All five RO would compromise target volume coverage to reduce the dose to the spinal cord. Definition of the spinal cord planning-organ-at-risk volume was heterogeneous. All five RO limited the EQD2 for spinal cord. Two were willing to accept more than 12.5 Gy and the highest EQD2 was 19 Gy. CONCLUSIONS: The increasing body of literature about bone metastases and spinal cord reirradiation has encouraged some expert RO to offer palliative reirradiation with cumulative cord doses above 75 Gy EQD2; however, no consensus was achieved. Strategies for harmonization of clinical practice and development of evidence-based dose constraints are discussed.


Assuntos
Carcinoma de Células Renais/radioterapia , Comunicação Interdisciplinar , Colaboração Intersetorial , Neoplasias Renais/radioterapia , Competência Profissional , Reirradiação , Neoplasias da Coluna Vertebral/radioterapia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/secundário , Progressão da Doença , Fidelidade a Diretrizes , Humanos , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Dosagem Radioterapêutica , Medula Espinal/diagnóstico por imagem , Medula Espinal/efeitos da radiação , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Taxa de Sobrevida , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/efeitos da radiação , Tomografia Computadorizada por Raios X
16.
Thorac Cancer ; 9(2): 199-207, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29193688

RESUMO

Tumor metastases are the basic biological characteristics of malignant tumors, and the lungs are the second most prominent metastatic organs in which these develop after the liver. Currently, with the rapid development of ablation technology, ablation therapy as a local treatment is playing an increasingly important role in the treatment of lung metastases. Whether alone or in combination with other treatments, ablation therapy has achieved good therapeutic effects for the treatment of partial lung metastases. This article briefly summarizes the results of current and previous ablation treatments for lung metastases, and focuses on the value of ablation therapy for different kinds of lung metastases.


Assuntos
Ablação por Cateter/métodos , Neoplasias Colorretais/radioterapia , Neoplasias Renais/radioterapia , Neoplasias Pulmonares/radioterapia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Metástase Neoplásica , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Sarcoma/radioterapia , Resultado do Tratamento
17.
Int J Radiat Oncol Biol Phys ; 100(1): 226-234, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29254775

RESUMO

PURPOSE: To develop and implement a practical repainting method for efficient interplay effect mitigation in proton pencil beam scanning (PBS). METHODS AND MATERIALS: A new flexible repainting scheme with spot-adapted numbers of repainting evenly spread out over the whole breathing cycle (assumed to be 4 seconds) was developed. Twelve fields from 5 thoracic and upper abdominal PBS plans were delivered 3 times using the new repainting scheme to an ion chamber array on a motion stage. One time was static and 2 used 4-second, 3-cm peak-to-peak sinusoidal motion with delivery started at maximum inhalation and maximum exhalation. For comparison, all dose measurements were repeated with no repainting and with 8 repaintings. For each motion experiment, the 3%/3-mm gamma pass rate was calculated using the motion-convolved static dose as the reference. Simulations were first validated with the experiments and then used to extend the study to 0- to 5-cm motion magnitude, 2- to 6-second motion periods, patient-measured liver tumor motion, and 1- to 6-fraction treatments. The effect of the proposed method was evaluated for the 5 clinical cases using 4-dimensional (4D) dose reconstruction in the planning 4D computed tomography scan. The target homogeneity index, HI = (D2 - D98)/Dmean, of a single-fraction delivery is reported, where D2 and D98 is the dose delivered to 2% and 98% of the target, respectively, and Dmean is the mean dose. RESULTS: The gamma pass rates were 59.6% ± 9.7% with no repainting, 76.5% ± 10.8% with 8 repaintings, and 92.4% ± 3.8% with the new repainting scheme. Simulations reproduced the experimental gamma pass rates with a 1.3% root-mean-square error and demonstrated largely improved gamma pass rates with the new repainting scheme for all investigated motion scenarios. One- and two-fraction deliveries with the new repainting scheme had gamma pass rates similar to those of 3-4 and 6-fraction deliveries with 8 repaintings. The mean HI for the 5 clinical cases was 14.2% with no repainting, 13.7% with 8 repaintings, 12.0% with the new repainting scheme, and 11.6% for the 4D dose without interplay effects. CONCLUSIONS: A novel repainting strategy for efficient interplay effect mitigation was proposed, implemented, and shown to outperform conventional repainting in experiments, simulations, and dose reconstructions. This strategy could allow for safe and more optimal clinical delivery of thoracic and abdominal proton PBS and better facilitate hypofractionated and stereotactic treatments.


Assuntos
Neoplasias/radioterapia , Movimentos dos Órgãos , Terapia com Prótons/métodos , Respiração , Neoplasias Brônquicas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Renais/radioterapia , Expiração , Tomografia Computadorizada Quadridimensional/métodos , Humanos , Inalação , Neoplasias Renais/radioterapia , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/radioterapia , Neoplasias Pancreáticas/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Software , Fatores de Tempo
18.
Pediatr Blood Cancer ; 65(2)2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28960781

RESUMO

PURPOSE: To report the thyroid dosimetry and long-term follow-up of childhood cancer survivors treated with whole lung irradiation (WLI) for Wilms tumor. METHODS: Twenty-eight patients with pulmonary metastases from Wilms tumor who underwent WLI from 2000 TO 2012 at a single institution were reviewed. Radiation dose to the thyroid gland in each case was calculated. Postradiation thyroid function test (TFT) results and management of thyroid function abnormalities were extracted from the medical records. RESULTS: Median age at treatment was 5 years (range: 1-9 years), and median follow-up time was 74.1 months (7.2-198.4). The male/female ratio was 1:1.8. Complete dosimetry data were available for 22 of the 28 patients receiving WLI. Mean thyroid volume was 3.3 cc (range: 1-6.8). The average mean and median mean dose to the thyroid was 6.7 and 7.1 Gy, respectively (range: 1.3-11.7 Gy). Average max dose to the thyroid was 12.4 Gy (range: 7.8-20.3 Gy). Two patients were found to have a thyroid stimulating hormone (TSH) above the normal range, managed with levothyroxine. Another patient was found to have an isolated elevation of TSH which normalized without treatment. A fourth patient was found to have an enlarged thyroid on examination with no palpable nodules or abnormal TFTs. CONCLUSIONS: Average mean dose to the thyroid gland was 6.7 Gy for this population of stage IV Wilms tumor patients. There was a low rate of thyroid dysfunction, but limited follow-up. Attention to blocking the thyroid gland as much as possible when designing radiation fields can potentially mitigate the risks of long-term thyroid effects.


Assuntos
Neoplasias Renais , Neoplasias Pulmonares , Pulmão/patologia , Glândula Tireoide/patologia , Tumor de Wilms , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Neoplasias Renais/patologia , Neoplasias Renais/radioterapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Masculino , Metástase Neoplásica , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Tumor de Wilms/patologia , Tumor de Wilms/radioterapia
19.
Strahlenther Onkol ; 194(1): 1-8, 2018 01.
Artigo em Alemão | MEDLINE | ID: mdl-28819766

RESUMO

PURPOSE: We aim to introduce and discuss the statements and recommendations of the German S3 guideline on renal cell cancer for daily practice of radiation oncologists. METHODS: This report comprises indication, treatment decision, dose prescription and current literature including treatment of oligometastatic disease. RESULTS: According to different stages of the disease and the structure of the guideline we focus on five treatment situations and recommendations for decision making: (1) Neo-/adjuvant treatment before or after nephrectomy: No indication for radiotherapy. (2) Small renal mass: Stereotactic ablative radiotherapy is currently seen as experimental option due to small patient numbers reported in the literature. However, local tumor control achieved by SBRT appears favourable with >90% at 2 years. (3) Oligometastasis: Radiation treatment with higher local doses or stereotactic treatment is possible after interdisciplinary discussion. Indications for palliative (4) and symptomatic treatment (5) are not different compared to other tumor entities. CONCLUSION: Currently, there is no evidence-based indication for radiation treatment in the primary setting (adjuvant/neoadjuvant or definitive) of renal cell cancer. In the future stereotactic radiotherapy should have a stronger role in the treatment of medically inoperable patients with primary renal cell cancer and especially in the setting of oligometastasis.


Assuntos
Carcinoma de Células Renais/radioterapia , Carcinoma de Células Renais/cirurgia , Fidelidade a Diretrizes , Neoplasias Renais/radioterapia , Neoplasias Renais/cirurgia , Radiocirurgia , Radioterapia Adjuvante , Carcinoma de Células Renais/patologia , Terapia Combinada , Alemanha , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Neoplasias Renais/patologia , Terapia Neoadjuvante , Metástase Neoplásica , Estadiamento de Neoplasias , Cuidados Paliativos
20.
J Med Imaging Radiat Oncol ; 62(1): 128-132, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28990737

RESUMO

INTRODUCTION: The optimal delivery of stereotactic radiotherapy for kidney tumours requires an effective motion management strategy. This study assessed the effectiveness of a pneumatic abdominal compression belt in reducing kidney motion during free breathing. METHODS: Thirteen patients, with four-dimensional computed tomography (4DCT) of the abdomen in free breathing with and without a pneumatic abdominal compression belt, were retrospectively reviewed. Points of Interest (POI) were placed on each kidney to determine the greatest magnitude of displacement in all directions. RESULTS: Without compression, all patients had >5.0 mm motion in the craniocaudal (CC) direction in at least one kidney. Median CC excursion of the left superior pole was reduced with compression from 8.0 mm (range 2.0 mm-18.0 mm) to 4.0 mm (range 2.0 mm-10.0 mm, P = 0.047) and right superior pole from 10.0 mm (range 4.0 mm-16.0 mm) to 6.0 mm (range 2.0 mm-10.0 mm, P=value 0.051). A benefit was less evident for the left and right inferior poles with median CC excursion of 6.0 mm versus 4.0 mm and 5.0 mm versus 4.0 mm without and with compression, respectively. Median displacement in the anteroposterior direction (≤3.2 mm) and lateral directions (≤1.3 mm) was similar for left and right kidneys and not significantly altered by compression. Overall, seven patients had kidney motion reduced by >5.0 mm with two reduced by 10.0 mm. CONCLUSION: A pneumatic abdominal compression belt reduced kidney motion by >5.0 mm in seven of thirteen patients. The relative benefit is patient and location specific and should be assessed on an individual basis.


Assuntos
Imobilização/instrumentação , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/radioterapia , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Tomografia Computadorizada Quadridimensional , Humanos , Neoplasias Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Estudos Retrospectivos
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