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1.
Medicine (Baltimore) ; 99(27): e20964, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629705

RESUMO

Intraoperative radiotherapy (IORT) has been used to treat different residual solid tumors after tumor removal and has shown many advantages over other treatment methods. However, the use of IORT for invasive thymoma has not been reported. Therefore, in this study, we tried to determine the safety and efficacy of INTRABEAM IORT for the treatment of invasive thymoma.Among the patients admitted to our hospital from September to December 2016 who were diagnosed with invasive thymoma, 14 were selected as study subjects. With medical histories taken beforehand, 8 of these patients were diagnosed with Masaoka stage IIA and 6 with Masaoka stage IIB; furthermore, 5 of the patients were diagnosed with myasthenia gravis (MG). INTRABEAM radiation (8-10 Gy, low energy) was delivered to the postoperative tumor bed of each patient during surgery. The intra- and postoperative complications were observed and evaluated, and the improvement in symptoms was assessed. An additional 23 patients with stage II thymoma undergoing radical surgery from April to August 2016 were chosen as the control group.One month after the operation, only 1 patient in the IORT group had cough, increased levels of leucocytes and neutrophils, and pulmonary inflammation on chest computed tomography. Reactive inflammation and pleural effusion in the 2 groups were similar (P > .05). There was no significant difference between the 2 groups in the improvement of myasthenia gravis (P > .05). Postoperative chest computed tomography and routine blood examination at 3 and 12 months showed that all the patients recovered, with normal hemogram levels and no pulmonary fibrosis around the radiation field. In addition, ultrasonic cardiography and electrocardiography demonstrated no significant difference before or after surgery within the IORT group. At the end of the follow-up, all the patients were alive, no relapse or remote metastasis was observed in the IORT group, and 2 inpatients in the control group had experienced relapse at 24 and 26 months. There was a significant difference in disease-free survival between the 2 groups (P = .00).It is safe to administer low-energy INTRABEAM IORT at a dose of approximately 10 Gy in patients with stage II invasive thymoma. INTRABEAM IORT does not significantly increase operation- or radiation-related complications and has no significant effect on vital organs such as the lungs and heart. Its long-term efficacy is worth expecting.


Assuntos
Timoma/radioterapia , Neoplasias do Timo/radioterapia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Dosagem Radioterapêutica , Radioterapia Adjuvante/instrumentação , Radioterapia Adjuvante/métodos , Cirurgia Torácica Vídeoassistida/métodos , Timoma/complicações , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia
2.
Breast ; 52: 110-115, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502796

RESUMO

BACKGROUND: Corona Virus Disease 19 (COVID-19) had a worldwide negative impact on healthcare systems, which were not used to coping with such pandemic. Adaptation strategies prioritizing COVID-19 patients included triage of patients and reduction or re-allocation of other services. The aim of our survey was to provide a real time international snapshot of modifications of breast cancer management during the COVID-19 pandemic. METHODS: A survey was developed by a multidisciplinary group on behalf of European Breast Cancer Research Association of Surgical Trialists and distributed via breast cancer societies. One reply per breast unit was requested. RESULTS: In ten days, 377 breast centres from 41 countries completed the questionnaire. RT-PCR testing for SARS-CoV-2 prior to treatment was reported by 44.8% of the institutions. The estimated time interval between diagnosis and treatment initiation increased for about 20% of institutions. Indications for primary systemic therapy were modified in 56% (211/377), with upfront surgery increasing from 39.8% to 50.7% (p < 0.002) and from 33.7% to 42.2% (p < 0.016) in T1cN0 triple-negative and ER-negative/HER2-positive cases, respectively. Sixty-seven percent considered that chemotherapy increases risks for developing COVID-19 complications. Fifty-one percent of the responders reported modifications in chemotherapy protocols. Gene-expression profile used to evaluate the need for adjuvant chemotherapy increased in 18.8%. In luminal-A tumours, a large majority (68%) recommended endocrine treatment to postpone surgery. Postoperative radiation therapy was postponed in 20% of the cases. CONCLUSIONS: Breast cancer management was considerably modified during the COVID-19 pandemic. Our data provide a base to investigate whether these changes impact oncologic outcomes.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Mastectomia/métodos , Pneumonia Viral/epidemiologia , Radioterapia/métodos , Antineoplásicos/uso terapêutico , Betacoronavirus , Quimioterapia Adjuvante , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Perfilação da Expressão Gênica , Humanos , Programas de Rastreamento , Pandemias , Pneumonia Viral/diagnóstico , Radioterapia Adjuvante , Inquéritos e Questionários , Tempo para o Tratamento/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
3.
Eur J Cancer ; 135: 101-102, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32563013
4.
Medicine (Baltimore) ; 99(23): e20550, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502019

RESUMO

Limb synovial sarcoma (LSS) patients with metastasis at presentation usually have a very poor prognosis. Little is known about survival prediction and risk factors in these patients owing to the condition's rarity. Thus, this study examined the survival and prognostic variables of metastatic LSS.Clinical data for LSS patients with metastasis at presentation from 1975 to 2016 were obtained from the surveillance, epidemiology, and end results database. The Kaplan-Meier method was used to determine the survival curves. Univariate and multivariate Cox regression analysis were conducted to identify the prognostic predictors.The study enrolled 217 patients. Male predominance was observed in the metastatic LSS group. The median age at diagnosis of this population was 40 years. The subtypes were "not otherwise specified" (49.8%), spindle cell (32.7%), biphasic (17.1%), and epithelioid cell (0.5%). The 3-year overall and cancer-specific survival rates of the entire group were 27.2% and 28.3%, respectively. Tumor size <10 cm, surgery, radiotherapy, and chemotherapy were independent predictors of improved overall and cancer-specific survival in the multivariate analyses.Comprehensive treatment for LSS patients with metastasis at diagnosis is necessary and effective and can prolong survival.


Assuntos
Extremidades/cirurgia , Metástase Neoplásica , Sarcoma Sinovial/mortalidade , Sarcoma Sinovial/terapia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/terapia , Adulto , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Prognóstico , Radioterapia Adjuvante , Programa de SEER , Sarcoma Sinovial/patologia , Neoplasias de Tecidos Moles/patologia , Análise de Sobrevida
5.
Lancet ; 395(10237): 1613-1626, 2020 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-32580883

RESUMO

BACKGROUND: We aimed to identify a five-fraction schedule of adjuvant radiotherapy (radiation therapy) delivered in 1 week that is non-inferior in terms of local cancer control and is as safe as an international standard 15-fraction regimen after primary surgery for early breast cancer. Here, we present 5-year results of the FAST-Forward trial. METHODS: FAST-Forward is a multicentre, phase 3, randomised, non-inferiority trial done at 97 hospitals (47 radiotherapy centres and 50 referring hospitals) in the UK. Patients aged at least 18 years with invasive carcinoma of the breast (pT1-3, pN0-1, M0) after breast conservation surgery or mastectomy were eligible. We randomly allocated patients to either 40 Gy in 15 fractions (over 3 weeks), 27 Gy in five fractions (over 1 week), or 26 Gy in five fractions (over 1 week) to the whole breast or chest wall. Allocation was not masked because of the nature of the intervention. The primary endpoint was ipsilateral breast tumour relapse; assuming a 2% 5-year incidence for 40 Gy, non-inferiority was predefined as ≤1·6% excess for five-fraction schedules (critical hazard ratio [HR] of 1·81). Normal tissue effects were assessed by clinicians, patients, and from photographs. This trial is registered at isrctn.com, ISRCTN19906132. FINDINGS: Between Nov 24, 2011, and June 19, 2014, we recruited and obtained consent from 4096 patients from 97 UK centres, of whom 1361 were assigned to the 40 Gy schedule, 1367 to the 27 Gy schedule, and 1368 to the 26 Gy schedule. At a median follow-up of 71·5 months (IQR 71·3 to 71·7), the primary endpoint event occurred in 79 patients (31 in the 40 Gy group, 27 in the 27 Gy group, and 21 in the 26 Gy group); HRs versus 40 Gy in 15 fractions were 0·86 (95% CI 0·51 to 1·44) for 27 Gy in five fractions and 0·67 (0·38 to 1·16) for 26 Gy in five fractions. 5-year incidence of ipsilateral breast tumour relapse after 40 Gy was 2·1% (1·4 to 3·1); estimated absolute differences versus 40 Gy in 15 fractions were -0·3% (-1·0 to 0·9) for 27 Gy in five fractions (probability of incorrectly accepting an inferior five-fraction schedule: p=0·0022 vs 40 Gy in 15 fractions) and -0·7% (-1·3 to 0·3) for 26 Gy in five fractions (p=0·00019 vs 40 Gy in 15 fractions). At 5 years, any moderate or marked clinician-assessed normal tissue effects in the breast or chest wall was reported for 98 of 986 (9·9%) 40 Gy patients, 155 (15·4%) of 1005 27 Gy patients, and 121 of 1020 (11·9%) 26 Gy patients. Across all clinician assessments from 1-5 years, odds ratios versus 40 Gy in 15 fractions were 1·55 (95% CI 1·32 to 1·83, p<0·0001) for 27 Gy in five fractions and 1·12 (0·94 to 1·34, p=0·20) for 26 Gy in five fractions. Patient and photographic assessments showed higher normal tissue effect risk for 27 Gy versus 40 Gy but not for 26 Gy versus 40 Gy. INTERPRETATION: 26 Gy in five fractions over 1 week is non-inferior to the standard of 40 Gy in 15 fractions over 3 weeks for local tumour control, and is as safe in terms of normal tissue effects up to 5 years for patients prescribed adjuvant local radiotherapy after primary surgery for early-stage breast cancer. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Neoplasias da Mama/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Mastectomia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Hipofracionamento da Dose de Radiação , Lesões por Radiação/epidemiologia , Lesões por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Medição de Risco/métodos , Resultado do Tratamento , Reino Unido/epidemiologia
6.
Rev Assoc Med Bras (1992) ; 66(3): 380-384, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32520162

RESUMO

INTRODUCTION: Radiotherapy (RT) plays an important role in the treatment of patients with head and neck neoplasia, and is frequently used as postoperative adjuvant therapy. This study aimed to review the literature about timing factors that may influence the clinical outcomes of patients with advanced head and neck neoplasia treated with adjuvant RT. RESULTS: Timing factors such as total treatment time, length of adjuvant RT, and the absence of interruptions during RT may influence the clinical outcome of these patients. CONCLUSIONS: In the same way that certain tumor factors can affect the prognosis of patients with squamous cell carcinoma of the head and neck, some therapeutic timing factors are also prognostic factors and therefore, must be carefully orchestrated in order to avoid loss at therapeutic outcomes for these patients.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Terapia Combinada , Intervalo Livre de Doença , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Radioterapia Adjuvante , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Taxa de Sobrevida , Fatores de Tempo
7.
J Cancer Res Clin Oncol ; 146(7): 1791-1800, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32405744

RESUMO

AIM: To assess the impact of age, comorbidities and endocrine therapy (ET) in older breast cancer (BC) patients treated with hypofractionated radiotherapy (Hypo-RT). METHODS: From June 2009 to December 2017, we enrolled in this study 735 ER-positive BC patients (stage pT1-T2, pNx-1, M0 and age ≥ 65 years) receiving hypo-RT and followed them until September 2019. Baseline comorbidities included in the hypertension-augmented Charlson Comorbidity Index were retrospectively retrieved. Logistic regression model estimated adjusted-odds ratios (ORs) of ET prescription in relation to baseline patient and tumor characteristics. Competing risk analysis estimated 5-year cumulative incidence function (CIF) of ET discontinuation due to side effects (with BC progression or death as competing events), and its effect on locoregional recurrence (LRR) and distant metastasis (DM) (with death as competing event). RESULTS: ET has been prescribed in 89% patients. In multivariable analysis, the odds of ET prescription was significantly reduced in older patients (≥ 80 years, OR 0.08, 95% CI 0.03-0.20) and significantly increased in patients with moderate comorbidity. Patients ≥ 80 years discontinued the prescribed therapy earlier and more frequently than younger (65-69 years) patients (p = 0.060). Five-year CIF of LLR, DM and death from causes other that BC were 1.7%, 2.2% and 7.5%, respectively. Patients who discontinued ET had higher chance of LRR (p = 0.004). ET use did not impact on OS in any of the analyzed groups. CONCLUSIONS: In older patients, ET did not show a benefit in terms of overall survival. Further studies focusing on tailored treatment approaches are warranted to offer the best care in terms of adjuvant treatment to these patients.


Assuntos
Neoplasias da Mama/epidemiologia , Avaliação Geriátrica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/radioterapia , Terapia Combinada , Comorbidade , Feminino , Humanos , Metástase Neoplásica , Estadiamento de Neoplasias , Cooperação do Paciente , Prognóstico , Hipofracionamento da Dose de Radiação , Radioterapia Adjuvante , Recidiva , Resultado do Tratamento
8.
Cancer Radiother ; 24(5): 388-397, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32448741

RESUMO

The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (18F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (18F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.


Assuntos
Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Quimiorradioterapia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/radioterapia , Feminino , Fluordesoxiglucose F18 , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/terapia , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Compostos Radiofarmacêuticos , Radioterapia Adjuvante , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/radioterapia , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia
9.
Am Surg ; 86(4): 377-385, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391763

RESUMO

Appalachian Kentucky (AK) has a disproportionally high breast cancer mortality rate. Postmastectomy radiotherapy (PMRT) in N2/N3 nodal disease improves survival and locoregional recurrence. We evaluated Kentucky patient compliance to the quality measure of PMRT received within one year of diagnosis. A population-based retrospective review of patients who received mastectomy with N2/N3 nodal disease from 2006 to 2015 was obtained through the Kentucky Cancer Registry. A total of 1489 patients met the inclusion criteria. Of these, 1104 (66.6%) received PMRT. AK patients were less likely to receive PMRT (58.3%) than non-AK patients (70%, P < 0.001). After adjusting for significant factors, private insurance, education level, treatment center, and receipt of adjuvant chemotherapy were independently associated with PMRT compliance. Patients who received PMRT had improved overall survival (OS, P < 0.0001) and disease-free survival (DFS, P < 0.0001). Appalachian status was not a major factor in OS (P= 0.1929) or DFS (P = 0.5840). Nearly two decades after the recommendation of PMRT, compliance remains poor in Kentucky. PMRT continues to be a major factor in survival and recurrence in this population. Interventions focusing on improving insurance coverage, education level, and guideline adherence in nonacademic centers are needed to improve compliance.


Assuntos
Neoplasias da Mama/radioterapia , Cooperação do Paciente , Radioterapia Adjuvante , Adulto , Idoso , Análise de Variância , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Cobertura do Seguro , Seguro Saúde , Kentucky , Metástase Linfática , Mastectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/prevenção & controle , Estudos Retrospectivos , Fatores Socioeconômicos , Análise de Sobrevida
10.
Medicine (Baltimore) ; 99(18): e19916, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358358

RESUMO

We compared the cumulative incidence of ipsilateral breast tumor recurrence (IBTR) between 2 whole breast irradiation (WBI) dose range with conventional fractionation.We retrospectively reviewed 1122 patients who received WBI at 2 institutions between 2004 and 2012. One institution delivered WBI 41.4 to 45 Gy followed by boost 14 to 18 Gy (adjusted group), while the other delivered WBI 50 to 50.4 Gy followed by boost 10 Gy (standard group).The median follow-up period was 85 months. The 10-year cumulative incidence in all patients was 6.1% (95% confidence interval [CI]: 4.3%-8.4%) for IBTR and 3.0% (95% CI: 1.7%-4.8%) for regional recurrence. The 10-year cumulative incidence of IBTR was not significantly influenced by WBI dose (6.3% in the adjusted group vs 5.2% in the standard group, P = .136). Comparable IBTR rates between the 2 groups were observed regardless of clinical and pathological factors. The WBI dose was not significantly associated with the 10-year cumulative incidence of regional recurrence in these groups (3.5% in the adjusted group vs 0.5% in the standard group, P = .214).De-escalated WBI doses while intensifying tumor bed boost did not compromise local and regional outcomes compared to standard group.


Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Fracionamento da Dose de Radiação , Recidiva Local de Neoplasia/patologia , Radioterapia Adjuvante/métodos , Adulto , Fatores Etários , Antineoplásicos/uso terapêutico , Feminino , Humanos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Estudos Retrospectivos
11.
Crit Rev Oncol Hematol ; 151: 102967, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32450277

RESUMO

We report on the second Assisi Think Tank Meeting (ATTM) on breast cancer which was held under the auspices of the European Society for RadioTherapy & Oncology (ESTRO). In discussing in-depth current evidence and practice it was designed to identify grey areas in diverse forms of the disease. It aimed at addressing uncertainties and proposing future trials to improve patient care. Before the meeting, three key topics were selected: 1) primary systemic therapy, mastectomy, breast reconstruction and post-mastectomy radiation therapy, 2) therapeutic options in ductal carcinoma in situ, and 3) therapy de-escalation in early stage breast cancer. Clinical practice in these areas was investigated by means of an online questionnaire. The time lapse period between the survey and the meeting was used to review the literature and on-going clinical trials. At the ATTM both were discussed in depth and research protocols were proposed.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Mastectomia/métodos , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Humanos , Mastectomia Segmentar , Radioterapia Adjuvante
12.
PLoS One ; 15(5): e0229518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32434215

RESUMO

BACKGROUND: Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Although RT is routinely used following breast conserving surgery (BCS), patients may occasionally be effectively treated with BCS alone. Currently, the selection of patients undergoing BCS who do not need breast irradiation is under investigation. With the advancement of personalized medicine, there is an increasing interest in reduction of aggressive treatments especially in older women. The primary objective of this study was to identify elderly patients who may forego breast irradiation after BCS without measurable consequences on local tumor growth and survival. METHODS: We analyzed 2384 early breast cancer patients aged 70 and older who were treated in 17 German certified breast cancer centers between 2001 and 2009. We compared RT versus no RT after guideline adherent (GA) BCS. The outcomes studied were breast cancer recurrence (RFS) and breast cancer-specific survival (BCSS). Low-risk patients were defined by luminal A, tumor size T1 or T2 and node-negative whereas higher-risk patients were defined by patients with G3 or T3/T4 or node-positive or other than Luminal A tumors. To test if there is a difference between two or more survival curves, we used the Gp family of tests of Harrington and Fleming. RESULTS: The median age was 77 yrs (mean 77.6±5.6 y) and the median observation time 46 mths (mean 48.9±24.8 mths). 950 (39.8%) patients were low-risk and 1434 (60.2%) were higher-risk. 1298 (54.4%) patients received GA BCS of which 85.0% (1103) received GA-RT and only 15% (195) did not. For low-risk patients with GA-BCS there were no significant differences in RFS (log rank p = 0.651) and in BCSS (p = 0.573) stratified by GA-RT. 5 years RFS in both groups were > 97%. For higher-risk patients with GA-BCS we found a significant difference (p<0.001) in RFS and tumor-associated OS stratified by GA-RT. The results remain the same after adjusting by adjuvant systemic treatment (AST) and comorbidity (ASA and NYHA). CONCLUSIONS: Patients aged 70 years and older suffering from low-risk early breast cancer with GA-BCS can avoid breast irradiation with <3% chance of relapse. In the case of higher-risk, breast irradiation should be used routinely following GA-BCS. As a side effect of these results, removing the entire breast of elderly low risk patients to spare them from breast irradiation seems to be not necessary.


Assuntos
Neoplasias da Mama/radioterapia , Mastectomia Segmentar , Recidiva Local de Neoplasia/radioterapia , Radioterapia Adjuvante , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Geriatria , Humanos , Metástase Linfática , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Fatores de Risco
13.
Br J Radiol ; 93(1111): 20200023, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436787

RESUMO

OBJECTIVE: This study investigates the impact of a restricted craniocaudal (CC) field length of <20 cm on the selection of head and neck cancer (HNC) patients who can be treated on the MR-Linac using a single isocentre technique. We also assess the effects of anthropometric factors and the neck position on the CC field length. METHODS: 110 HNC patients who underwent radical primary or adjuvant radiotherapy were retrospectively analysed. We assessed the proportion of treatment fields with a CC length of <20 cm and the effects of gender, height, hyo-sternal neck length (distance from superior surface of hyoid to sternal notch measured on the coronal reconstruction of the planning CT) and neck position on CC length. RESULTS: 95% of HNC patients had a CC field length <20 cm. Female patients showed a significantly shorter median CC length than male patients in both extended (p = 0.0003) and neutral (p = 0.008) neck positions. Neck position influenced the median CC length with neutral neck being significantly shorter than extended neck (p = 0.0119). Patient height and hyo-sternal neck length showed positive correlation with the CC length, with neck length in neutral position having the strongest correlation (r = 0.65, p = 0.0001 and r = 0.63, p < 0.0001, respectively for extended neck; r = 0.55, p = 0.0070 and r = 0.80, p < 0.0001, respectively for neutral neck). A hyo-sternal neck length of <14.6 cm predicted a CC length of <20 cm in neutral neck position. CONCLUSION: The majority of patients with HNC at the Royal Marsden Hospital have anthropometric features compatible with their being treated on the MR-Linac using a single isocentre technique. The absolute CC field size may vary according to primary tumour site, patient factors and neck position. A hyo-sternal neck length cut-off of 14.6 cm in the neutral neck position can be used as a surrogate marker for suitability of treatment on MR-Linac. ADVANCES IN KNOWLEDGE: This paper highlights the potential impact of a restricted CC field in HNC patient selection for the MR-Linac treatment. This is the first report to suggest the use of neck length as a surrogate marker for suitability of treatment on the MR-Linac.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Estatura , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Seleção de Pacientes , Radioterapia Adjuvante , Radioterapia de Intensidade Modulada , Estudos Retrospectivos , Fatores Sexuais
14.
Zhonghua Zhong Liu Za Zhi ; 42(4): 336-339, 2020 Apr 23.
Artigo em Chinês | MEDLINE | ID: mdl-32375451

RESUMO

Objective: To investigate the outcomes of limited stage small cell lung cancer (L-SCLC) undergoing surgical therapy and to explore the value of adjuvant therapy for those patients. Methods: A retrospective analysis was initialed for the L-SCLC patients who underwent the surgical treatment in the Zhongnan Hospital of Wuhan University from January 2012 to December 2018. The median disease-free survival (DFS) and overall survival (OS) were calculated by Kaplan-Meier method. Cox regression was used to explore the prognostic factors. Results: A total of 44 patients were included in our study. The median DFS was 25 months, 1- and 2-year DFS rate were 70.2% and 51.9%, respectively. The median OS was 41 months, 1- and 2- year OS rate were 88.4% and 69.9%, respectively. Multivariate analysis showed male (RR=6.56, P=0.03), T3-4 (RR=6.23, P=0.01), pathological lymph node metastasis (RR=6.52, P=0.03) and adjuvant radiotherapy (RR=0.13, P=0.002) were associated with disease relapse significantly. Moreover, pathological lymph node metastasis (RR=3.62, P=0.01) coupled with sufficient adjuvant chemotherapy (≥4 cycles) (RR=0.12, P=0.01) were independent prognostic factors of OS. Conclusions: Surgical therapy may be an alternative primary treatment for L-SCLC. Additional adjuvant radiotherapy can reduce the risk of recurrence. Giving sufficient course of adjuvant chemotherapy can improve OS.


Assuntos
Quimioterapia Adjuvante/métodos , Neoplasias Pulmonares/terapia , Pneumonectomia/métodos , Radioterapia Adjuvante/métodos , Carcinoma de Pequenas Células do Pulmão/terapia , Adulto , China/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/mortalidade , Carcinoma de Pequenas Células do Pulmão/patologia , Resultado do Tratamento
15.
Surg Clin North Am ; 100(3): 669-680, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32402308

RESUMO

Although the vast majority of soft tissue extremity masses are benign, approximately 13,000 people in the United States were diagnosed with soft tissue sarcoma in 2019. This article focuses on the optimal workup of soft tissue masses including the indications for ultrasound and MRI, as well as use of preoperative core needle biopsy. Current AJCC staging, surgical principles of soft tissue sarcoma management, and data regarding indications for radiation therapy and chemotherapy are reviewed. As up to 50% of patients with soft tissue sarcoma will develop recurrent disease, surgical management of locally recurrent and distant metastatic disease is discussed.


Assuntos
Extremidades/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Biópsia por Agulha Fina , Quimiorradioterapia , Terapia Combinada , Extremidades/patologia , Humanos , Interpretação de Imagem Assistida por Computador , Lipoma/patologia , Lipoma/cirurgia , Imagem por Ressonância Magnética , Margens de Excisão , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/patologia
16.
Anticancer Res ; 40(5): 3003-3009, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366455

RESUMO

Backround/Aim: Adjuvant radiotherapy in patients with cancer of the left breast may lead to impaired cardiac function. The aim of our prospective study is to evaluate (i) doses to the irradiated volume of the heart and its substructures and (ii) determine whether their correlation with changes in strain echo measurements contribute to the prediction of subclinical heart morbidity. PATIENTS AND METHODS: Twenty-five patients were enrolled in our study. We retrospectively assessed the radiation doses to the whole heart, left anterior descending artery (LAD) and left ventricle (LV). RESULTS: The mean heart dose (MHD) was 152 cGy (SD=50.56 cGy) and the range was 74-279 cGy. The LAD was the most exposed structure, with a mean dose of 448.91 cGy (SD=490.53 cGy) and range of 120-2,057cGy. Finally, the mean LV dose was 149.12 cGy (SD=69.57) with a range of 63-317 cGy. CONCLUSION: The early results of our study showed low radiation exposure of the whole heart and left ventricle, and higher exposure of the LAD. The data that will emerge from the evaluation of strain echo parameters should show whether these associations might be useful in clinical practice for the prediction of early subclinical cardiac changes.


Assuntos
Neoplasias da Mama/radioterapia , Coração/anatomia & histologia , Radioterapia Adjuvante/efeitos adversos , Feminino , Coração/fisiopatologia , Humanos , Pessoa de Meia-Idade , Radioterapia Adjuvante/métodos
17.
Medicine (Baltimore) ; 99(17): e19453, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332598

RESUMO

This study aimed to retrospectively analyze the efficacy and safety of esophagectomy and postoperative radiotherapy (PORT) for patients with thoracic esophageal squamous cell carcinoma (TESCC) in the young-old (aged between 65 and 75 years).The clinical data of 166 young-old patients with esophageal cancer who underwent esophagectomy and PORT from May 2004 to May 2018 in The First Affiliated Hospital of Nanjing Medical University and The PLA Cancer Center, Jinling Hospital were analyzed. The Kaplan-Meier method was used to calculate overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). The log-rank method was used to test the differences. The Cox regression model was used for the multivariate prognostic analysis.The follow-up rate was 98.5%, and the median follow-up time was 41.2 months. The whole 1-, 3-, and 5-year OS rates were 92.0%, 69.3%, and 58.3%, respectively, and the median OS was 64.7 months (95% CI, 58.3-71.1). The median DFS was 57.9 months (95% CI, 47.4-68.4), and the 1-, 3-, and 5-year DFS rates were 84.8%, 61.5%, and 44.6%, respectively. The median LRFS was 60.8 months (95% CI, 50.5-71.0), and the 1-, 3-, and 5-year LRFS rates were 85.8%, 64.94%, and 53.9%, respectively. The median DMFS was 65.0 months (95% CI, 60.6-69.6), and the 1-, 3-, and 5-year DMFS rates were 91.9%, 77.0%, and 67.5%, respectively. Pathological T staging, lymph node metastasis, pathologic staging, and Karnofsk Performance Status (KPS) were the main factors affecting prognosis. In addition, T staging, lymph node metastasis are also independent prognostic factors. Little severe toxicity was observed.The result indicates that PORT for TESCC patients who can tolerate surgery is safe in the young-old. The efficacy is similar to that of previous patients including younger populations. Pathological T and N stage are major factors that affect prognosis. Concurrent chemotherapy may not improve the survival of the young-old patients undergoing postoperative radiotherapy.


Assuntos
Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/métodos , Fatores Etários , Idoso , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carcinoma de Células Escamosas do Esôfago/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Doses de Radiação , Radioterapia Adjuvante , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida
18.
Plast Reconstr Surg ; 145(5): 917e-926e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332528

RESUMO

BACKGROUND: Whether to irradiate the tissue expander before implant exchange or to defer irradiation until after exchange in immediate, two-stage expander/implant reconstruction remains uncertain. The authors evaluated the effects of irradiation timing on complication rates and patient-reported outcomes in patients undergoing immediate expander/implant reconstruction. METHODS: Immediate expander/implant reconstruction patients undergoing postmastectomy radiation therapy at 11 Mastectomy Reconstruction Outcomes Consortium sites with demographic, clinical, and complication data were analyzed. Patient-reported outcomes were assessed with BREAST-Q, Patient-Reported Outcomes Measurement Information System, and European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality-of-Life Questionnaire surveys preoperatively and 2 years postoperatively. Survey scores and complication rates were analyzed using bivariate comparison and multivariable regressions. RESULTS: Of 317 patients who met inclusion criteria, 237 underwent postmastectomy radiation therapy before expander/implant exchange (before-exchange cohort), and 80 did so after exchange (after-exchange cohort). Timing of radiation had no significant effect on risks of overall complications (OR, 1.25; p = 0.46), major complications (OR, 1.18; p = 0.62), or reconstructive failure (OR, 0.72; p = 0.49). Similarly, radiation timing had no significant effect on 2-year patient-reported outcomes measured by the BREAST-Q or the European Organisation for Research and Treatment of Cancer survey. Outcomes measured by the Patient-Reported Outcomes Measurement Information System showed less anxiety, fatigue, and depression in the after-exchange group. Compared with preoperative assessments, 2-year patient-reported outcomes significantly declined in both cohorts for Satisfaction with Breasts, Physical Well-Being, and Sexual Well-Being, but improved for anxiety and depression. CONCLUSIONS: Radiation timing (before or after exchange) had no significant effect on complication risks or on most patient-reported outcomes in immediate expander/implant reconstruction. Although lower levels of anxiety, depression, and fatigue were observed in the after-exchange group, these differences may not be clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/terapia , Complicações Pós-Operatórias/epidemiologia , Dispositivos para Expansão de Tecidos/efeitos adversos , Expansão de Tecido/efeitos adversos , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Implante Mamário/instrumentação , Implante Mamário/métodos , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Qualidade de Vida , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Fatores de Tempo , Tempo para o Tratamento , Expansão de Tecido/instrumentação
19.
Cancer Immunol Immunother ; 69(8): 1549-1564, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32303794

RESUMO

BACKGROUND: Tumor-infiltrating lymphocytes (TILs) and their subsets contribute to breast cancer prognosis. We investigated the prognostic impact of CD3+, CD8+ and FOXP3+ TILs in patients with early intermediate/high-risk breast cancer treated with adjuvant anthracycline-based chemotherapy within two randomized trials conducted by our Group. METHODS: We examined 1011 patients (median follow-up 130.9 months) and their tumors for total, stromal (s) and intratumoral (i) CD3, CD8 and FOXP3 lymphocyte density (counts/mm2) on tissue-microarray cores by immunohistochemistry. Morphological sTIL density on whole H&E-stained sections was also evaluated. RESULTS: The majority of TILs were CD3+. Total CD3 and CD8, sCD3 and sCD8, iCD3 and iCD8, sFOXP3 and iFOXP3 were strongly correlated (Spearman's rho values > 0.6). High individual lymphocytic subsets and sTIL density were strongly associated with high tumor grade, higher proliferation and HER2-positive and triple-negative tumors (all p values < 0.001). Higher sTIL density (10% increments), high density of almost each individual marker and all-high profiles conferred favorable prognosis. However, when adjusted for sTIL density, stromal and intratumoral lymphocytic subsets lost their prognostic significance, while higher sTIL density conferred up to 15% lower risk for relapse. Independently of sTIL density, higher total CD3+ and CD8+ TILs conferred 35% and 28% lower risk for relapse, respectively. CONCLUSIONS: Stromal and intratumoral CD3+, CD8+ and FOXP3+ TIL density do not seem to add prognostic information over the morphologically assessed sTIL density, which is worth introducing in routine histology reports.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Complexo CD3/metabolismo , Antígenos CD8/metabolismo , Fatores de Transcrição Forkhead/metabolismo , Linfócitos do Interstício Tumoral/imunologia , Células Estromais/patologia , Adulto , Idoso , Neoplasias da Mama/imunologia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Subpopulações de Linfócitos , Pessoa de Meia-Idade , Prognóstico , Radioterapia Adjuvante , Células Estromais/imunologia , Células Estromais/metabolismo , Adulto Jovem
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