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1.
Genetics ; 227(4)2024 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-38963803

RESUMO

Radiotherapy is a key treatment option for a wide variety of human tumors, employed either alone or alongside with other therapeutic interventions. Radiotherapy uses high-energy particles to destroy tumor cells, blocking their ability to divide and proliferate. The effectiveness of radiotherapy is due to genetic and epigenetic factors that determine how tumor cells respond to ionizing radiation. These factors contribute to the establishment of resistance to radiotherapy, which increases the risk of poor clinical prognosis of patients. Although the mechanisms by which tumor cells induce radioresistance are unclear, evidence points out several contributing factors including the overexpression of DNA repair systems, increased levels of reactive oxygen species, alterations in the tumor microenvironment, and enrichment of cancer stem cell populations. In this context, dysregulation of microRNAs or miRNAs, critical regulators of gene expression, may influence how tumors respond to radiation. There is increasing evidence that miRNAs may act as sensitizers or enhancers of radioresistance, regulating key processes such as the DNA damage response and the cell death signaling pathway. Furthermore, expression and activity of miRNAs have shown informative value in overcoming radiotherapy and long-term radiotoxicity, revealing their potential as biomarkers. In this review, we will discuss the molecular mechanisms associated with the response to radiotherapy and highlight the central role of miRNAs in regulating the molecular mechanisms responsible for cellular radioresistance. We will also review radio-miRs, radiotherapy-related miRNAs, either as sensitizers or enhancers of radioresistance that hold promise as biomarkers or pharmacological targets to sensitize radioresistant cells.


Assuntos
MicroRNAs , Neoplasias , Tolerância a Radiação , MicroRNAs/genética , MicroRNAs/metabolismo , Humanos , Tolerância a Radiação/genética , Neoplasias/radioterapia , Neoplasias/genética , Neoplasias/metabolismo , Reparo do DNA , Animais , Regulação Neoplásica da Expressão Gênica/efeitos da radiação , Dano ao DNA
2.
Rev Assoc Med Bras (1992) ; 70(6): e20231421, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39045950

RESUMO

OBJECTIVE: The objective of this study was to evaluate the quality of life of consecutive patients undergoing radiotherapy during the coronavirus disease 2019 pandemic at a private hospital in Southern Brazil from September 2020 to September 2021. METHODS: This study was approved by the Research Ethics Board under project number 112 on April 17, 2020, and it was a prospective descriptive cohort study conducted in a Brazilian radiotherapy department from September 2020 to September 2021. It involved the weekly administration of the European Organisation for Research and Treatment of Cancer Questionnaire Core 30 questionnaires via telephone to consecutively assess patients with pathology-proven cancer diagnoses. These questionnaires captured both demographic data and patients' concerns related to the pandemic, providing a comprehensive overview of their quality of life during radiotherapy treatment. RESULTS: In this study, 141 patients were analyzed, predominantly female (69.5%) with an average age of 61 years. Breast and prostate were the most treated sites, accounting for 51 and 19% of cases, respectively. The majority of treatments lasted between 3 and 5 weeks (73.77%). A small fraction (4.26%) tested positive for coronavirus disease 2019. The findings also highlighted a relatively high quality of life, with mean global scores of 77.95 and emotional functioning scores of 87.53, indicating maintained well-being during treatment. CONCLUSIONS: Oncological patients continuing radiotherapy at our center during the pandemic experienced a low coronavirus disease 2019 infection rate and maintained a high quality of life with minimal emotional distress throughout their treatment period.


Assuntos
COVID-19 , Neoplasias , Qualidade de Vida , Humanos , COVID-19/epidemiologia , Feminino , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Brasil/epidemiologia , Neoplasias/radioterapia , Idoso , Inquéritos e Questionários , SARS-CoV-2 , Pandemias , Adulto , Idoso de 80 Anos ou mais , Radioterapia
3.
Int J Radiat Oncol Biol Phys ; 120(5): 1226-1230, 2024 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-39066772

RESUMO

PURPOSE: In recent times, "ringing the bell" at the end of cancer treatment has attracted the attention of health care providers with regard to how this experience impacts patients' mental and emotional health. In this context, a study was conducted at a radiation oncology center in Santiago, Chile, to assess the perceived valorization of patients toward "ringing the bell" at the end of their treatment. It was further determined whether this experience had a positive or negative impact on their mental health. METHODS AND MATERIALS: Two hundred thirty-six patients were invited to respond to a printed anonymous survey that used a Likert scale to evaluate their perceived valorization of "ringing the bell" after radiation therapy. In this survey, patients were also asked questions regarding their background to examine possible trends related to different lifestyles and socioeconomic status. RESULTS: The results showed that 93.6% of participants classified the experience as "positive" or "very positive." There were 6 "negative" responses out of 708 (0.8%) to the 3 questions regarding perceived valorization of the experience and no "very negative" responses. CONCLUSIONS: "Ringing the bell" at the end of radiation therapy can be considered a psychological comfort that positively impacts patients' mental health. No trends related to socioeconomic status were observed.


Assuntos
Neoplasias , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias/radioterapia , Neoplasias/psicologia , Idoso , Chile , Adulto , Saúde Mental , Inquéritos e Questionários , Idoso de 80 Anos ou mais , Adulto Jovem
4.
Nutrients ; 16(9)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38732610

RESUMO

Oncological patients show intense catabolic activity, as well as a susceptibility to higher nutritional risk and clinical complications. Thus, tools are used for monitoring prognosis. Our objective was to analyze the nutrition prognosis of patients who underwent radiotherapy, correlating it with outcomes and complications. We performed a retrospective transversal study based on secondary data from hospital records of patients who started radiotherapy between July 2022 and July 2023. We established Prognostic Scores through a combination of Prognostic Nutritional Index (PNI) and a Subjective Global Assessment (SGA), assessed at the beginning and end of treatment. Score 3 patients, with PNI ≤ 45.56 and an SGA outcome of malnutrition, initially presented a higher occurrence of odynophagia, later also being indicative of reduced diet volume, treatment interruption, and dysphagia. SGA alone showed sensitivity to altered diet volume, dysphagia, and xerostomia in the second assessment. Besides this, PNI ≤ 45.56 also indicated the use of alternative feeding routes, treatment interruption, and hospital discharge with more complications. We conclude that the scores could be used to indicate complications; however, further studies on combined biomarkers are necessary.


Assuntos
Desnutrição , Avaliação Nutricional , Estado Nutricional , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Prognóstico , Idoso , Desnutrição/etiologia , Desnutrição/diagnóstico , Transtornos de Deglutição/etiologia , Neoplasias/radioterapia , Radioterapia/efeitos adversos , Estudos Transversais , Adulto
5.
J Cancer Policy ; 40: 100471, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38556128

RESUMO

BACKGROUND: For cancer patient populations worldwide, the synchronous scale-up of diagnostics and treatments yields meaningful gains in survival and quality of life. Among advanced cancer therapies, radiotherapy (RT) and theranostics are key to achieving practical, high-quality, and personalized precision medicine - targeting disease manifestations of individual patients and broad populations, alike. Aiming to learn from one another across different world regions, the six country vignettes presented here depict both challenges and victories in de novo establishment or improvement of RT and theranostics infrastructure. METHODS: The International Atomic Energy Agency (IAEA) convened global RT and theranostics experts from diverse world regions and contexts to identify relevant challenges and report progress in their own six countries: Belgium, Brazil, Costa Rica, Jordan, Mongolia, and South Africa. These accounts are collated, compared, and contrasted herein. RESULTS: Common challenges persist which could be more strategically assessed and addressed. A quantifiable discrepancy entails personnel. The estimated radiation oncologists (ROs), nuclear medicine physicians (NMPs), and medical physicists (MPs for RT and nuclear medicine) per million inhabitants in the six collective countries respectively range between 2.69-38.00 ROs, 1.00-26.00 NMPs, and 0.30-3.45 MPs (Table 1), reflecting country-to-country inequities which largely match World Bank country-income stratifications. CONCLUSION: Established goals for RT and nuclear medicine advancement worldwide have proven elusive. The pace of progress could be hastened by enhanced approaches such as more sustainably phased implementation; better multinational networking to share lessons learned; routine quality and safety audits; as well as capacity building employing innovative, resource-sparing, cutting-edge technologic approaches. Bodies such as ministries of health, professional societies, and the IAEA shall serve critical roles in convening and coordinating more innovative RT and theranostics translational research, including expanding nuanced global database metrics to inform, reach, and potentiate milestones most meaningfully. POLICY SUMMARY: Aligned with WHO 25×25 NCDs target; WHA70.12 and WHA76.5 resolutions.


Assuntos
Neoplasias , Humanos , Neoplasias/radioterapia , África do Sul , Jordânia , Brasil , Costa Rica , Medicina de Precisão , Radioterapia , Nanomedicina Teranóstica
6.
Nutrients ; 16(4)2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38398802

RESUMO

This study assesses the feasibility of calorie restriction (CR) and time-restricted feeding (TRF) in overweight and obese cancer patients who realized little to no physical activity undergoing curative radiotherapy, structured as a prospective, interventional, non-randomized open-label clinical trial. Of the 27 participants initially enrolled, 21 patients with breast cancer were selected for analysis. The participants self-selected into two dietary interventions: TRF, comprising a sugar and saturated fat-free diet calibrated to individual energy needs consumed within an 8 h eating window followed by a 16 h fast, or CR, involving a 25% reduction in total caloric intake from energy expenditure distributed across 4 meals and 1 snack with 55% carbohydrates, 15% protein, and 30% fats, excluding sugars and saturated fats. The primary goal was to evaluate the feasibility of these diets in the specific patient group. The results indicate that both interventions are effective and statistically significant for weight loss and reducing one's waist circumference, with TRF showing a potentially stronger impact and better adherence. Changes in the LDL, HDL, total cholesterol, triglycerides, glucose and insulin were not statistically significant.


Assuntos
Neoplasias , Sobrepeso , Humanos , Sobrepeso/terapia , Restrição Calórica , Estudos Prospectivos , Obesidade/terapia , Neoplasias/complicações , Neoplasias/radioterapia
7.
Rev. Bras. Cancerol. (Online) ; 70(3): e-074624, jul-set. 2024.
Artigo em Inglês, Português | Sec. Est. Saúde SP, LILACS | ID: biblio-1585340

RESUMO

Introdução: Uma das principais abordagens para o tratamento do câncer é a radioterapia, que pode causar consequências irreversíveis no indivíduo. Por meio da teoria das representações sociais (TRS), os profissionais conseguem identificar e intervir nas adversidades, proporcionando qualidade de vida ao paciente. Objetivo: Identificar e analisar a estrutura das representações sociais das pessoas vivendo com câncer frente à radioterapia. Método: Estudo descritivo, com abordagem qualitativa, fundamentado na TRS. A pesquisa com 111 participantes foi conduzida em um hospital de referência em tratamento oncológico, no Rio de Janeiro. A coleta de dados ocorreu durante o período de outubro a dezembro de 2019 por um questionário sociodemográfico e pela técnica de evocação livre ao termo indutor "radioterapia", sendo a análise por meio dos softwares Microsoft Excel e IRaMuTeQ. Resultados: As evocações que compõem o provável núcleo central são: "queima", seguida pelos termos "tratamento", "agressiva", "ruim" e "luz". O elemento "queima" representa um efeito colateral comum na pele, a radiodermatite. O termo "tratamento" corresponde à maneira de combater a doença. A díade "agressiva" e "ruim" pode estar associada aos efeitos colaterais gerados e "luz", à exposição à luz que recebem durante a irradiação. Conclusão: A pesquisa mostra os possíveis efeitos colaterais da radioterapia e os elementos atrelados e, com isso, evidencia a relevância de uma abordagem integral do indivíduo, promovendo um cuidado individualizado


Introduction: One of the main approaches to cancer treatment is radiotherapy, which can cause irreversible consequences to the individual. Through the theory of social representations (TSR), professionals are able to identify and intervene in the adversities, providing quality of life for the patient. Objective: To identify and analyze the structure of the social representations of people living with cancer due to radiotherapy. Method: Social representation-based descriptive qualitative approach study conducted with 111 patients in a reference hospital for cancer treatment in Rio de Janeiro. Data collection took place between October and December 2019 through a sociodemographic questionnaire and the free recall technique for the inducing term "radiotherapy", with analysis using Microsoft Excel and IRaMuTeQ software. Results: The evocations that make up the probable central nucleus are: "burning", being the most frequent, followed by the term "treatment", "aggressive", "bad" and "light". The element "burning" represents a common side effect on the skin, radiodermatitis. The term "treatment" corresponds to a modality to fight the disease. The dyad "aggressive" and "bad" may be associated with the side effects generated and "light" with the exposure to light they receive during irradiation. Conclusion: The research shows the possible side effects of radiotherapy and its associated elements and highlights the importance of a comprehensive approach to the individual, promoting individualized care


Introducción: Una de las principales aproximaciones al tratamiento del cáncer es la radioterapia, la cual puede causar consecuencias irreversibles en el individuo. A través de la teoría de las representaciones sociales (TRS), los profesionales son capaces de identificar e intervenir en las adversidades, brindando calidad de vida al paciente. Objetivo: Identificar y analizar la estructura de las representaciones sociales de las personas que viven con cáncer frente a la radioterapia. Método: Estudio descriptivo, con enfoque cualitativo, fundamentado en la TRS. La investigación con 111 participantes se llevó a cabo en un hospital de referencia en tratamiento oncológico en Río de Janeiro. La recopilación de datos se realizó durante el período de octubre a diciembre de 2019 mediante un cuestionario sociodemográfico y la técnica de evocación libre al término inductor "radioterapia", con análisis a través de los programas Microsoft Excel y IRaMuTeQ. Resultados: Las evocaciones que componen el probable núcleo central son: "quemadura", siendo la más frecuente, seguida por los términos "tratamiento", "agresivo", "malo" y "luz". El elemento "quemadura" representa un efecto secundario común en la piel, la radiodermatitis. El término "tratamiento" corresponde a la forma de combatir la enfermedad. La díada "agresivo" y "malo" puede estar asociada a los efectos secundarios generados y "luz" a la exposición a la luz que reciben durante la irradiación. Conclusión: La investigación destaca los posibles efectos secundarios de la radioterapia y los elementos asociados, evidenciando la importancia de un enfoque integral del individuo, promoviendo una atención personalizada


Assuntos
Humanos , Masculino , Feminino , Radioterapia/efeitos adversos , Demografia , Pessoal de Saúde , Representação Social , Neoplasias/radioterapia
8.
Photobiomodul Photomed Laser Surg ; 41(10): 513-538, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37788454

RESUMO

Objective: To systematically summarize the evidence for photobiomodulation therapy (PBMT) in the prevention and treatment of oral mucositis (OM) in patients undergoing cancer treatment. An electronic search was conducted in 8 databases and grey literature. Background: PBMT is recommended for the management of OM resulting from cancer treatment, with several systematic reviews (SRs) being published in recent years on this topic. Methods: Only SRs with outcomes from clinical trials were included, with no language or year restriction. The AMSTAR 2 tool was used to assess the methodological quality of the SRs. Results: Five thousand eight hundred fifty-six references were found, and 16 were selected for this review. OM prevention and treatment were favorable for PBMT in most studies, with a significant reduction in OM severity. Most studies obtained moderate confidence. Conclusions: PBMT represents an effective strategy in the management of OM, and this evidence is supported by studies with acceptable methodological quality.


Assuntos
Terapia com Luz de Baixa Intensidade , Neoplasias , Estomatite , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Revisões Sistemáticas como Assunto , Estomatite/etiologia , Estomatite/radioterapia , Neoplasias/radioterapia
9.
Lancet Oncol ; 24(8): 903-912, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37541272

RESUMO

BACKGROUND: The demand for radiotherapy in Brazil is unfulfilled, and the scarcity of data on the national network hampers the development of effective policies. We aimed to evaluate the current situation, estimate demands and requirements, and provide an action plan to ensure access to radiotherapy for those in need by 2030. METHODS: The Brazilian Society for Radiation Oncology created a task force (RT2030) including physicians, medical physicists, policy makers, patient advocates, and suppliers, all of whom were major stakeholders involved in Brazilian radiotherapy care. The group was further divided into seven working groups to address themes associated with radiotherapy care in Brazil. From March 1, 2019, to Aug 3, 2020, there were monthly meetings between the group's leaders and the Central Committee and six general meetings. First, a comprehensive search of all different national databases was done to identify all radiotherapy centres. Questionnaires evaluating radiotherapy infrastructure and human resources and assing the availability, distribution, capacity, and workload of resources were created and sent to the radioprotection supervisor of each centre. Results were analysed nationally and across the country's regions and health-care systems. A pre-planned review of available databases was done to gather data on active radiation oncology centres and the distribution of radiotherapy machines (linear accelerators [LINACs]) across Brazil. We used national population and cancer incidence projections, recommended radiotherapy usage from the medical literature, and national working patterns to project radiotherapy demands in 2030. An action plan was established with suggestions to address the gaps and meet the demands. FINDINGS: The database search yielded 279 centres with an active radiotherapy registry. After applying predefined exclusion criteria, 263 centres were identified that provided external beam radiotherapy machines with or without brachytherapy. All 263 operational centres answered the questionnaires sent on Dec 9, 2019, which were then returned between Jan 1 and June 30, 2020. There were 409 therapy machines, 646 radiation oncologists, 533 physicists, and 230 989 patients undergoing radiotherapy (150 628 [65·2%] in the public health-care system and 80 937 [35·0%] in private). The mean annual occupation rate was 566 patients per treatment machine (SD 250). The number of residents per treatment machine ranged from 258 333 to 1 800 000. Technology availability varied considerably among regions and systems. In 2030, 639 994 new cancer cases are expected, which will require 332 797 radiotherapy courses. Therefore, 530 LINACs, 1079 radiation oncologists, and 1060 medical physicists will be needed. INTERPRETATION: The expected increase in cancer incidence in the coming years will probably increase the disparities in cancer care and the burden for Brazilian patients. We provide a roadmap of the current situation and the particularities of the Brazilian radiotherapy network, which can serve as a starting point for cancer policy planning to improve this scenario. FUNDING: Accuray, BRAINLAB, Elekta, IBA, ONE medical solution, SUN NUCLEAR corporation, VARIAN, and ZIGMA.


Assuntos
Braquiterapia , Neoplasias , Radioterapia (Especialidade) , Humanos , Brasil/epidemiologia , Neoplasias/epidemiologia , Neoplasias/radioterapia , Radioterapia/métodos , Inquéritos e Questionários
10.
J Clin Nurs ; 32(19-20): 6917-6933, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37382085

RESUMO

AIMS AND OBJECTIVES: To describe the main acupuncture techniques and parameters that have been used in the most varied symptoms of different types of cancer. BACKGROUND: Clinical evidence about the potential effectiveness of acupuncture and related therapies to control signs and symptoms associated with cancer or its treatment has been in several studies. Currently, there is already evidence of the use of acupuncture for the treatment of nausea and vomiting, fatigue, dry mouth, anxiety, depression, insomnia and pain. However, many studies lack firm rights or reproducible guidelines for treatment. DESIGN: This study performs a systematic review of clinical trials related to the topic, based on the PRISMA protocol. Thus, a search was carried out in the Scopus, Pubmed and Web of Science databases, covering studies since January 2007. METHODS: Structured and organised according to PICO standards, using keywords ("cancer" OR "malignant tumour" OR "chemotherapy" OR "radiotherapy") AND ("acupuncture" OR "electroacupuncture") AND ("pain" OR "nausea" OR "vomit" OR "fatigue" OR "xerostomia" OR "insomnia" OR "depression" OR "neuropathy"). RESULTS: After the selection and evaluation phase, 23 studies were included and analysed. CONCLUSION: Based on this analysis, it is concluded that acupuncture is safe and there is evidence of the reduction of gastrointestinal symptoms, chemotherapy-induced peripheral neuropathy, pain, dry mouth, fatigue, insomnia, and improvement of cognitive capacity. RELEVANCE TO CLINICAL PRACTICE: Acupuncture treatments could act by minimising the side effects of conventional treatments and reducing symptoms induced by tumours. NO PATIENT OR PUBLIC CONTRIBUTION: The patients had no direct involvement with the study in question.


Assuntos
Terapia por Acupuntura , Eletroacupuntura , Neoplasias , Xerostomia , Humanos , Pontos de Acupuntura , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/métodos , Eletroacupuntura/efeitos adversos , Eletroacupuntura/métodos , Neoplasias/radioterapia , Náusea/induzido quimicamente , Náusea/terapia , Xerostomia/etiologia , Dor/etiologia
11.
Molecules ; 28(9)2023 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-37175226

RESUMO

The communication between tumor cells and the microenvironment plays a fundamental role in the development, growth and further immune escape of the tumor. This communication is partially regulated by extracellular vesicles which can direct the behavior of surrounding cells. In recent years, it has been proposed that this feature could be applied as a potential treatment against cancer, since several studies have shown that tumors treated with radiotherapy can elicit a strong enough immune response to eliminate distant metastasis; this phenomenon is called the abscopal effect. The mechanism behind this effect may include the release of extracellular vesicles loaded with damage-associated molecular patterns and tumor-derived antigens which activates an antigen-specific immune response. This review will focus on the recent discoveries in cancer cell communications via extracellular vesicles and their implication in tumor development, as well as their potential use as an immunotherapeutic treatment against cancer.


Assuntos
Vesículas Extracelulares , Neoplasias , Humanos , Neoplasias/radioterapia , Comunicação Celular , Antígenos de Neoplasias , Vesículas Extracelulares/patologia , Imunoterapia , Microambiente Tumoral
12.
Support Care Cancer ; 31(4): 240, 2023 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-36976404

RESUMO

PURPOSE: To evaluate the effectiveness and safety of oral supplementation as a radioprotective intervention in the management of radiation dermatitis (RD). METHODS: Systematic review and meta-analysis. Six databases and the gray literature were searched for randomized controlled clinical trials (RCTs). Meta-analysis was performed only with studies that evaluated the same intervention. Methodology of included studies was evaluated by the Cochrane risk-of-bias tool for randomized trials (RoB 2.0), and the certainty of evidence was assessed by the GRADE instrument. RESULTS: Seventeen RCTs were included in this review. These evaluated different types of oral supplementations. Findings from three meta-analyses demonstrated no significant benefits to the more severe grades of RD, as oral curcuminoids (RR, 0.59; 95% CI, 0.27 to 1.29; P = 0.19; I2 = 88%), glutamine (RR, 0.40; 95% CI, 0.15 to 1.03; P = 0.06; I2 = 78%) or Wobe-Mugos (RR, 0.57; 95% CI, 0.29 to 1.14; P = 0.11; I2 = 72%). Also, the certainty of the evidence of outcomes evaluated was moderate or low. Except for a few gastrointestinal adverse events, oral supplementation was well tolerated. CONCLUSION: Most oral supplements cannot yet be recommended to manage RD due to insufficient or conflicting evidence. However, despite no significant results, glutamine was shown to be a promising substance in terms of the potential radioprotective effect and may be well tolerated. These results suggest that more RCTs with larger samples are needed to evaluate the efficacy, safety, and tolerance of glutamine in the management of RD.


Assuntos
Neoplasias , Radiodermite , Humanos , Glutamina/uso terapêutico , Neoplasias/complicações , Neoplasias/radioterapia , Radiodermite/tratamento farmacológico , Suplementos Nutricionais
13.
J Appl Clin Med Phys ; 24(1): e13658, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36578218

RESUMO

The assessment of risk related to medical exposures as a justification tool to assist decision-making of the medical team is not available in clinical routine. The determination of diagnostic reference levels (DRLs) for nuclear medicine (NM) procedures has been proposed as an optimization tool, but this tool has still been aimed at a standard adult individual. It is known that the activity administered, and the consequent absorbed doses in critical organs, represents the risk of a procedure being cancer induction the greatest concern, especially for young patients. Thus, the adjustment of administered activity and procedure risk to promote risk-benefit assessment is a promising tool for routine clinical use. This work aims to present a tool for determining DRLs in the administered activity related to the patient's characteristics-age group, sex, and body mass index (BMI), in order to assist the medical decision regarding the risk-benefit ratio. Thus, it is possible to assess the risk of carcinogenesis in groups of patients, considering absorbed doses in organs, cancer incidence, and mortality rates in our country. NIREA is an IT tool developed in PHP language for web environment as a friendly software. It allows the establishment of DRL and risk of cancer induced by radiation assessment through the estimation of absorbed doses in specific organs and based on the risk methodology of BEIR VII. The absorbed and effective doses were estimated based on the dose conversion factors of the radiopharmaceuticals published by the International Commission on Radiological Protection adjusted for the patient groups. Based on data from 2256 patients who underwent diagnostic procedures at National Cancer Institute between 2017 and 2019, the program was used, resulting in important information for conducting the clinical routine extracted as DRL, absorbed doses, and risk assessments, considering patient-specific data such as age, sex, and BMI. The methodology developed in this work allows NM services to keep their data available and updated regarding local DRLs, in addition to allowing the nuclear physician to know the risk of each procedure performed, extracted by individual characteristics of the patient. The affirmative is significant because the data could be used by the regulatory body of practices with ionizing radiation in Brazil to establish a reference level in Activity that has not yet existed in the country.


Assuntos
Neoplasias , Medicina Nuclear , Adulto , Humanos , Níveis de Referência de Diagnóstico , Doses de Radiação , Neoplasias/radioterapia , Compostos Radiofarmacêuticos , Valores de Referência
14.
s.l; REDETS-AQuAS; 2023.
Não convencional em Espanhol | BRISA/RedTESA | ID: biblio-1570943

RESUMO

INTRODUCCIÓN El cáncer se define como una patología clínica caracterizada por la generación de un tumor maligno que posee tanto la capacidad de invadir tejidos circundantes, como de diseminarse a distancia en forma de metástasis. A efectos de este informe, se ha definido como cáncer pediátrico cualquier cáncer diagnosticado en un paciente de 0 a 19 años de edad. En España, el año 2021 se diagnosticaron 1.116 tumores pediátricos, siendo las neoplasias de tejido linfoide y hematopoyético las más frecuentes. La supervivencia del cáncer pediátrico en España a tres y cinco años es del 83 % y del 80 %, respectivamente. En el Sistema Nacional de Salud (SNS) de España, 255 centros tratan casos de oncología pediátrica y siete de ellos tienen acreditación de centro de referencia (CSUR). El tratamiento del cáncer pediátrico suele desarrollarse en el contexto de protocolos terapéuticos internacionales y en forma de ensayos clínicos en fase III o IV, y engloba la cirugía oncológica, la radioterapia y la quimioterapia pediátricas. La revisión panorámica de la literatura científica ha identificado 15 factores pronósticos asociados a los resultados en salud en cáncer pediátrico. Se han determinado cuatro factores pronósticos clínicos (edad, sexo, di


INTRODUCTION Cancer is defined as a clinical pathology characterized by the generation of a malignant tumour that possesses both the ability to invade surrounding tissues and to spread to distant sites in the form of metastasis. For the purposes of this report, paediatric cancer has been defined as any cancer diagnosed in a patient aged 0-19 years. In Spain, 1,116 paediatric tumours were diagnosed in 2021, with lymphoid and haematopoietic tissue neoplasms being the most frequent. The three- and five-year survival rates for paediatric cancer in Spain are 83% and 80%, respectively. In the Spanish National Health System (SNS), 255 centres treat paediatric oncology cases and seven of them are accredited as reference centres (CSUR). Paediatric cancer treatment is usually developed in the context of international therapeutic protocols and in the form of phase III or IV clinical trials, and encompasses paediatric cancer surgery, radiotherapy, and chemotherapy. The overview review of the scientific literature has identified 15 prognostic factors associated with health outcomes in paediatric cancer. Four clinical prognostic factors (age, sex, Down syndrome diagno


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Neoplasias/cirurgia , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Prognóstico , Serviço Hospitalar de Oncologia , Neoplasias/diagnóstico
15.
Rev. chil. anest ; 52(3): 297-303, 2023. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1577951

RESUMO

BACKGROUND: Anesthesia during brachytherapy therapy poses a significant challenge as radiotherapy rooms are neither designed nor equipped for the administration of anesthesia. AIMS: We conducted a retrospective cohort study of patients who underwent brachytherapy performed under anesthesia, to describe the anesthetic approach and assess anesthetic-related complications. METHODS: Data of all patients older than 18 years of age who underwent brachytherapy under anesthesia between November 2019 and January 2021 were recorded. Data were obtained from medical records, including all demographic characteristics and information regarding the anesthetic procedure and its associated complications. In addition, we describe our protocols for preoperative evaluation, anesthetic procedures, and anesthetic technique-related complications. RESULTS: Over the reporting period, 109 sessions of brachytherapy under anesthesia were performed in 70 patients (age range 25-75 years). The most frequent diagnoses were uterine cervical cancer (40%), prostate cancer (33.9%) and endometrial cancer (10.2%). 63.3% of the patients received only one dose of brachytherapy and 79.8% of the cases were ambulatory. Our most frequent anesthetic technique was spinal anesthesia (60.6%), followed by combined spinal-epidural anesthesia (27.5%). Complications related to anesthesia occurred in 25 sessions (22.9%). The most recurrent complications were hypotension (10.1%) and bradycardia (4.6%). CONCLUSIONS: The delivery of anesthesia in its different modalities; regional, spinal, combined spinal-epidural and general anesthesia can be safely and reliably performed in the radiotherapy bunker for patients undergoing brachytherapy.


La anestesia para braquiterapia implica un desafío, ya que las salas de radioterapia no están diseñadas ni equipadas para la administración de anestesia. OBJETIVO: Se realizó un estudio de cohorte retrospectivo de pacientes sometidos a braquiterapia para describir el enfoque anestésico y evaluar las complicaciones relacionadas con la anestesia. MATERIALES Y MÉTODOS: Se registraron los datos de todos los pacientes mayores de 18 años que se sometieron a braquiterapia bajo anestesia general entre noviembre de 2019 y enero de 2021. Los datos se obtuvieron de los registros médicos, incluyendo todas las características demográficas e información sobre el procedimiento anestésico y sus complicaciones asociadas. Además, describimos nuestros protocolos para la evaluación preoperatoria, los procedimientos anestésicos y complicaciones asociadas a la técnica anestésica utilizada. RESULTADOS: Durante el período de referencia, se realizaron 109 sesiones de anestesia para braquiterapia en 70 pacientes (rango etario 25-75 años). Los diagnósticos más frecuentes fueron cáncer cervicouterino (40%), próstata (33,9%) y endometrio (10,2%). El 63,3% recibió solo una dosis de braquiterapia y en 79,8% de los casos fueron ambulatorios. La técnica anestésica más utilizada fue la anestesia espinal (60,6%), seguido de anestesia combinada espinal-epidural (27,5%). Las complicaciones relacionadas con la anestesia se produjeron en 25 sesiones (22,9%). Las complicaciones más frecuentes hipotensión (10,1%) y bradicardia (4,6%). CONCLUSIÓN: La administración de anestesia en sus distintas modalidades; regional, espinal, combinada espinal-epidural y general puede ser realizada de forma segura y confiable en el bunker de radioterapia para pacientes sometidos a braquiterapia.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Braquiterapia/métodos , Anestésicos Gerais/efeitos adversos , Anestesia Geral/métodos , Neoplasias/radioterapia , Braquiterapia/efeitos adversos , Bradicardia/etiologia , Estudos Retrospectivos , Hipotensão/etiologia , Complicações Intraoperatórias , Anestesia/efeitos adversos , Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Oncologia
16.
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1448794

RESUMO

ABSTRACT Objective: To evaluate the physicians' knowledge regarding the referral for dental screening prior to chemotherapy and radiotherapy. Material and Methods: We conducted a cross-sectional study using simple random sampling among 468 physicians from various specialties with diverse experience levels from different regions in Saudi Arabia. A self-reporting questionnaire was distributed among the physicians, which consisted of questions assessing the physicians' knowledge about oral health and complications in patients prior to chemotherapy and radiotherapy. Statistical analysis was done after the data was collected employing SPSS, and p<0.05 was taken as significant. Results: Residents were more as expected (39.3%), followed by specialists (2.31%). The majority had a practice experience for more than five years (67.8%).The scores for the knowledge assessment showed that 51.3%, nearly half of the participants, had lower scores. The scores were statistically significant (p<0.05). Conclusion: General physicians and specialists should be aware of the dental complications and associated diseases in patients with malignancies and those undergoing chemo and radiotherapy. It is proposed that more awareness should be raised among physicians to rectify this lapse.


Assuntos
Médicos/ética , Conscientização/ética , Conhecimentos, Atitudes e Prática em Saúde , Tratamento Farmacológico , Neoplasias/radioterapia , Programas de Rastreamento/instrumentação , Estudos Transversais/métodos , Inquéritos e Questionários , Interpretação Estatística de Dados
17.
Acta méd. costarric ; 64(3)sept. 2022.
Artigo em Espanhol | LILACS, SaludCR | ID: biblio-1447053

RESUMO

Objetivo: Describir las aberraciones citogenéticas que pueden ser observadas por medio de la técnica Giemsa en fluorescencia y encontradas en pacientes con cáncer antes y después de ser sometidos a tratamiento con radioterapia. Métodos: Se analizó un mínimo de 200 metafases en primera división mitótica antes y después del tratamiento de radioterapia en nueve pacientes que asistieron a la sección de radioterapia del Hospital San Juan de Dios Costa Rica. En cada caso se contabilizó cada tipo de cromosomopatía por medio de la prueba de Giemsa en fluorescencia y utilizando bromodeoxiuridina y naranja de acridina. Resultados: Las cromosomopatías producidas por radioterapia se observaron tanto antes como después del tratamiento sin embargo destacó el incremento en la frecuencia de los cromosomas dicéntricos y anillos céntricos una vez finalizada la terapia. La frecuencia de fracturas cromatídicas de asociaciones satelíticas y de alteraciones morfológicas no se ve afectada por la radioterapia. Uno de los participantes presentó un recuento mitótico bajo. Conclusión: La radioterapia aumenta significativamente la frecuencia de los cromosomas dicéntricos y dicéntricos más anillos en la muestra en estudio. Este trabajo es relevante por ser el primer estudio en Costa Rica en el que se analizan los cromosomas dicéntricos como biomarcadores de exposición a radiaciones ionizantes mediante la prueba de Giemsa en fluorescencia y utilizando bromodeoxiuridina y naranja de acridina.


Aim: The objective of this study was to describe the before and after cytogenetic aberrations found in current patients of radiotherapy. This can be observed through the technique called "Giemsa in fluorescence" Methods: A minimum of 200 metaphases were analyzed in the first mitotic division in 9 patients. The patients where observed before and after radiotherapy treatment at the San Juan de Dios Hospital in Costa Rica. In each case any type of chromosomopathy was counted using the "Giemsa in fluorescence" test as well as Bromodeoxyuridine and acridine orange. Results: The chromosomopathies are observed before and after treatment with radiotherapy. The treatment seems to change the frecuency increasing the dicentric chromosomes and centric rings after the treatment. The frequency of chromatid fractures satellite associations and morphological alterations were not affected by radiotherapy. Conclusion: The chromosomopathies produced by radiotherapy were observed both before and after treatment with variations in their frequency. After radiotherapy dicentric chromosomes and dicentric chromosomes plus rings frequencies increased significantly. A low mitotic count was present this could have been the result of radiation on the bone marrow or by the cell repair and apoptosis system. The standardized " Fluorescence Plus Giemsa" test using Bromodesoxyuridine and acridine orange was used for the fiesta time in Costa Reica. This allowed for the measurement of radiation exposure used in the treatment or detection of diseases and cancer in pacients.


Assuntos
Humanos , Radioterapia/estatística & dados numéricos , Cromossomos em Anel , Cobalto/análise , Neoplasias/radioterapia , Radiação , Costa Rica
18.
Clin Transl Oncol ; 24(12): 2466-2474, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35976581

RESUMO

INTRODUCTION: Cancer remains one of the leading causes of death worldwide, with 50-60% of patients requiring radiotherapy during the course of treatment. Patients' survival rate has increased significantly, with an inevitable increase in the number of patients experiencing side effects from cancer therapy. One such effect is late radiation injuries in which hyperbaric oxygen therapy appears as complementary treatment. With this work we intend to divulge the results of applying hyperbaric oxygen therapy among patients presenting radiation lesions in our Hyperbaric Medicine Unit. MATERIALS AND METHODS: Retrospective analysis of clinical records of patients with radiation lesions treated at the Hyperbaric Medicine Unit assessed by the scale Late Effects of Normal Tissues-Subjective, Objective, Management, Analytical (LENT-SOMA) before and after treatment, between October 2014 and September 2019 were included. Demographic characteristics, primary tumor site, subjective assessment of the LENT-SOMA scale before and after treatment were collected and a comparative analysis (Students t test) was done. RESULTS: 88 patients included: 33 with radiation cystitis, 20 with radiation proctitis, 13 with osteoradionecrosis of the mandible and 22 with radiation enteritis. In all groups, there was a significant decrease (p < 0.005) in the subjective parameter of the LENT-SOMA scale. DISCUSSION: Late radiation lesions have a major influence on patients' quality of life. In our study hyperbaric oxygen therapy presents as an effective therapy after the failure of conventional treatments. CONCLUSION: Hyperbaric oxygen therapy is an effective complementary therapy in the treatment of refractory radiation lesions.


Assuntos
Oxigenoterapia Hiperbárica , Neoplasias , Proctite , Lesões por Radiação , Humanos , Oxigenoterapia Hiperbárica/efeitos adversos , Oxigenoterapia Hiperbárica/métodos , Neoplasias/complicações , Neoplasias/radioterapia , Proctite/complicações , Proctite/terapia , Qualidade de Vida , Lesões por Radiação/etiologia , Lesões por Radiação/terapia , Estudos Retrospectivos
19.
Molecules ; 27(7)2022 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-35408554

RESUMO

Actinium-225 and other alpha-particle-emitting radionuclides have shown high potential for cancer treatment. Reconstituted high-density lipoproteins (rHDL) specifically recognize the scavenger receptor B type I (SR-BI) overexpressed in several types of cancer cells. Furthermore, after rHDL-SR-BI recognition, the rHDL content is injected into the cell cytoplasm. This research aimed to prepare a targeted 225Ac-delivering nanosystem by encapsulating the radionuclide into rHDL nanoparticles. The synthesis of rHDL was performed in two steps using the microfluidic synthesis method for the subsequent encapsulation of 225Ac, previously complexed to a lipophilic molecule (225Ac-DOTA-benzene-p-SCN, CLog P = 3.42). The nanosystem (13 nm particle size) showed a radiochemical purity higher than 99% and stability in human serum. In vitro studies in HEP-G2 and PC-3 cancer cells (SR-BI positive) demonstrated that 225Ac was successfully internalized into the cytoplasm of cells, delivering high radiation doses to cell nuclei (107 Gy to PC-3 and 161 Gy to HEP-G2 nuclei at 24 h), resulting in a significant decrease in cell viability down to 3.22 ± 0.72% for the PC-3 and to 1.79 ± 0.23% for HEP-G2 at 192 h after 225Ac-rHDL treatment. After intratumoral 225Ac-rHDL administration in mice bearing HEP-G2 tumors, the biokinetic profile showed significant retention of radioactivity in the tumor masses (90.16 ± 2.52% of the injected activity), which generated ablative radiation doses (649 Gy/MBq). The results demonstrated adequate properties of rHDL as a stable carrier for selective deposition of 225Ac within cancer cells overexpressing SR-BI. The results obtained in this research justify further preclinical studies, designed to evaluate the therapeutic efficacy of the 225Ac-rHDL system for targeted alpha-particle therapy of tumors that overexpress the SR-BI receptor.


Assuntos
Nanopartículas , Neoplasias , Partículas alfa/uso terapêutico , Animais , Lipoproteínas HDL/química , Camundongos , Nanopartículas/química , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Receptores Depuradores
20.
Anticancer Agents Med Chem ; 22(17): 2985-2997, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35469576

RESUMO

BACKGROUND: Photodynamic therapy (PDT) is a therapeutic intervention that can be applied to cancer treatment. The interaction between a photosensitizer (PS), ideal wavelength radiation, and tissue molecular oxygen triggers a series of photochemical reactions responsible for producing reactive oxygen species. These highly reactive species can decrease proliferation and induce tumor cell death. The search for PS of natural origin extracted from plants becomes relevant, as they have photoactivation capacity, preferentially targeting tumor cells and because they do not present any or little toxicity to healthy cells. OBJECTIVE: Our work aimed to carry out a qualitative systematic review to investigate the effects of curcumin (CUR), a molecule considered as PS of natural origin, on PDT, using red light or near-infrared radiation in tumor models. METHODS: A systematic search was performed in three databases (PubMed, Scopus, and Web of Science) using the PICOT method, retrieving a total of 1,373 occurrences. At the end of the peer screening, 25 eligible articles were included in this systematic review using inclusion, exclusion, and eligibility criteria. RESULTS: CUR, whether in its free state, associated with metal complexes or other PS and in a nanocarrier system, was considered a relevant PS for PDT using red light or near-infrared against tumoral models in vitro and in vivo, acting by increasing cytotoxicity, inhibiting proliferation, inducing cell death mainly by apoptosis, and changing oxidative parameters. CONCLUSION: The results found in this systematic review suggest the potential use of CUR as a PS of natural origin to be applied in PDT against many neoplasms, encouraging further search in PDT against cancer and serving as an investigative basis for upcoming pre-clinical and clinical applications.


Assuntos
Curcumina , Neoplasias , Fotoquimioterapia , Linhagem Celular Tumoral , Curcumina/farmacologia , Humanos , Luz , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico
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