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1.
J Pak Med Assoc ; 71(4): 1288-1289, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34125793

RESUMO

Intracranial ependymoma are relatively common paediatric brain tumours, but their eloquent location and high recurrence rate pose a significant challenge. Gross total resection or maximum safe resection followed by adjuvant radiotherapy are currently the standard recommended treatment, although there is still nearly 50% recurrence risk at 5 years. Chemotherapy has shown some promising results after recent advances in molecular understanding of ependymomas, but needs further evaluation before it could be added to the treatment regime.


Assuntos
Neoplasias Encefálicas , Ependimoma , Neoplasias Encefálicas/terapia , Criança , Ependimoma/terapia , Humanos , Recidiva Local de Neoplasia/terapia , Radioterapia Adjuvante
2.
Afr J Reprod Health ; 25(1): 161-168, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077121

RESUMO

Primary vaginal leiomyosarcoma is a rare gynecological malignancy. The clinical presentation is a benign looking well circumscribed mobile mass which might however occasionally present with distant metastases. Post treatment recurrence is common, and the clinical course is often unpredictable. Primary surgical management plus radiotherapy is the commonly practiced treatment of choice. We report a case of primary vaginal epithelioid leiomyosarcoma that recurred twice after local surgical resection. The patient subsequently underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy for a recurrent vaginal leiomyosarcoma. Histopathology of the vaginal mass revealed an epithelioid leiomyosarcoma of the vagina. She also received a course of adjuvant radiotherapy. The patient was free of recurrence at 3 year follow up. Vaginal mass must be evaluated with a high index of suspicion for malignancy. Local surgical resection alone is insufficient for primary vaginal leiomyosarcoma. Surgical resection with adjuvant radiotherapy offers better treatment outcomes with decreased risk of recurrence. Empirical oophorectomy in patients with completed family size might confer additional benefit in preventing disease recurrence in resource limited settings where testing for estrogen and progesterone receptor status of the tumour is unavailable. Due to the unpredictable course of the disease, lifelong patient follow-up is critical for better outcomes.


Assuntos
Histerectomia/métodos , Leiomioma/cirurgia , Leiomiossarcoma/terapia , Radioterapia Adjuvante/efeitos adversos , Salpingo-Ooforectomia/métodos , Neoplasias Vaginais/cirurgia , Botsuana , Feminino , Humanos , Leiomioma/patologia , Leiomiossarcoma/patologia , Leiomiossarcoma/secundário , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Resultado do Tratamento , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia , Vagina/patologia , Vagina/cirurgia , Neoplasias Vaginais/patologia
3.
Ann Plast Surg ; 86(5S Suppl 3): S390-S394, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33976068

RESUMO

BACKGROUND: Postmastectomy radiation therapy (PMRT) is known to increase the risk of multiple adverse outcomes after breast reconstruction. In the context of delayed-immediate autologous breast reconstruction, PMRT is typically conducted after placement of subpectoral (SP) tissue expanders. With the re-emergence of prepectoral (PP) reconstruction, there are little data assessing the outcomes of PP reconstruction in breasts receiving PMRT. We compared postoperative outcomes of PMRT patients undergoing delayed-immediate, autologous breast reconstruction with placement of tissue expanders in either the PP or SP plane. METHODS: A retrospective chart review was conducted on all consecutive patients who underwent delayed-immediate autologous breast reconstruction and received PMRT at either the Stanford University or the Johns Hopkins University Hospitals between January 2009 and December 2018. Demographics, comorbidities, perioperative information, and oncologic data were collected for all patients. Complications were collected and analyzed after stage 1 surgery, between 30 days of stage 1 and up to stage 2 surgery, and after stage 2 surgery. Multivariable regressions were used to determine predictors of 1 or more complications. RESULTS: A total of 71 patients (73 breasts) were included. Prepectoral reconstruction comprised of 52.2% of the cohort, and the remaining 47.8% were SP reconstructions. Demographics and comorbidities were similar between groups, except for premastectomy radiation, which was more prevalent in the PP cohort (P = 0.010). Complications were similar between cohorts after stage 1 surgery (P = 0.420), between stages 1 and 2 (P = 0.100), and after stage 2 (P = 0.570). There were higher rates of skin necrosis in the SP cohort between stages 1 and 2 (PP: 2.6%, SP: 20%, P = 0.004). Multivariable analysis revealed body mass index to be the only predictor of complication (P = 0.041). The mean number of revisionary surgeries was higher in the SP cohort (PP: 0.8 vs SP: 1.9, P = 0.002). The mean follow-up was 385.5 days and similar between groups (P = 0.870). CONCLUSIONS: Rates of overall complication were similar between PP and SP expander placement. However, in SP reconstructions, skin necrosis was significantly higher between stages 1 and 2. The patients in the SP cohort also underwent a greater number of revisionary surgeries, although overall rates of pursuing any revisionary surgery were similar between groups.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Humanos , Mastectomia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante , Estudos Retrospectivos
4.
Radiat Oncol ; 16(1): 91, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001182

RESUMO

BACKGROUND: The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed. METHODS: Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LCCT. The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LCT2, LC2T1, LC5T1 and LC10T1, respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality. RESULTS: LCCT-LC10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LCCT-LCT2, 11.36% and 2.94% for LCCT-LC2T1, and 8.89% and 7.69% for LC5T1-LCCT, respectively. The center of mass (COM) of LCCT-LC10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LCCT-LCT2, LCCT-LC2T1 and LCCT-LC5T1, respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%). CONCLUSION: For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter (intra) variability was minimal for the delineation of the LC based on 10th min DE-TIWI.


Assuntos
Neoplasias da Mama/radioterapia , Mama/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Mastectomia Segmentar , Complicações Pós-Operatórias/diagnóstico por imagem , Decúbito Ventral , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Adjuvante , Seroma/diagnóstico por imagem , Adulto , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Marcadores Fiduciais , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Seroma/etiologia , Titânio , Tomografia Computadorizada por Raios X/métodos
5.
Chirurgia (Bucur) ; 116(2): 224-231, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33950819

RESUMO

BACKGROUND AND OBJECTIVES: Nowadays, breast cancer treatment spans from simple lesion excision to complex management including surgery (mastectomy with or without axillary lym-phadenectomy) and adjuvant treatment (chemotherapy, radiotherapy, hormonal therapy and im-munotherapy). Lately, breast reconstruction has become part of the breast cancer approach, but, while its physical and emotional benefits are undisputed, it comes with its own set of risks and complications, especially when delayed breast reconstruction after radiotherapy is performed. This paper aims to present our experience on the effects of radiotherapy in conjunction with de-layed alloplastic breast reconstruction. MATERIALS AND METHODS: We conducted a retrospective study on 16 patients with mastec-tomy for breast cancer, for whom delayed breast reconstruction was chosen. Depending on the existence of postmastectomy radiotherapy, patients were assigned to one of two groups: group 1 consisted of eight patients that received adjuvant radiotherapy and group 2 of eight patients that did not. We collected a series of data (sociodemographic, type of reconstructive intervention, adjuvant therapies, etc.) and afterwards we analyzed the cases in which complications occurred. Results: The number and severity of complications after breast reconstruction was higher in the adjuvant radiotherapy patient group. Seven patients had complications, three of those were major: one TRAM flap partial necrosis, one expander extrusion and one chest wall cellulitis. The therapeutic approach was surgical debridement and secondary reconstruction with latissimus dorsi flap. We noted only one major complication (expander extrusion) in the no-radiotherapy group. Conclusions: Despite the vast array of reconstructive surgical techniques at our disposal, there is still no clear protocol regarding breast reconstruction in patients receiving radiation thera-py. The majority of patients tend to opt for the simplest intervention, i.e. expander-implant recon-struction, which is usually accompanied by complications when combined with radiotherapy. Comprehensive and open communication between oncologist, radiotherapist, plastic surgeon and patient ensures optimal results.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Humanos , Mastectomia , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
6.
Chirurgia (Bucur) ; 116(2 Suppl): 110-119, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33963701

RESUMO

AIM OF THE STUDY: Use of a radiotherapy (RT) tumor bed boost in addition to whole breast irradiation (WBI) after oncoplastic breast conserving surgery (OBCS) can be very challenging due to the massive tissue displacements. The aim of our study is to present relevant RT data regarding the use of a boost RT in patients who underwent OBCS and received adjuvant RT at Neolife Medical Center Bucharest. Materials and Methods: 12 patients treated with intensity modulated radiotherapy (IMRT), after OBCS, using conventional or hypofractionated schedules, between 10/2018 and 12/2020 were included in the study. Pre- and postoperative CT images and surgical clips when available were used for tumor bed (TB) localization and definition of the boost volume. Results: One or more risk factors associated with local recurrence (age under 51 years, high grade tumors, associated ductal carcinoma in situ) were present in 10 patients. Boost RT was delivered in 3 patients. Conclusions: TB localization for the boost RT is difficult without an appropriate marking. Surgical clips and communication between the surgeon and the radiation oncologist are essential for treatment success.


Assuntos
Neoplasias da Mama , Carcinoma Intraductal não Infiltrante , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Radioterapia Adjuvante , Resultado do Tratamento
7.
Anticancer Res ; 41(5): 2489-2494, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952476

RESUMO

BACKGROUND/AIM: Most patients with breast cancer are assigned to radiotherapy, which may cause fears leading to sleep disorders. Very few data are available regarding the prevalence of sleep disorders and corresponding risk factors. PATIENTS AND METHODS: Data of 175 patients with breast cancer presenting for adjuvant radiotherapy were retrospectively analyzed. Twenty-three patient and tumor characteristics were investigated for associations with pre-radiotherapy sleep disorders. RESULTS: Seventy-eight patients (44.6%) stated sleep disorders prior to radiotherapy. These were significantly associated with higher distress score (p<0.0001); greater number of emotional (p<0.0001), physical (p<0.0001) or practical problems (p<0.001); and request for psycho-oncological support (p<0.001). Trends were found for worse performance status (p=0.062) and higher comorbidity index (p=0.059). CONCLUSION: Sleep disorders prior to radiotherapy for breast cancer are common. This applies particularly to patients with risk factors including distress due to emotional, physical or practical problems. These patients should be offered psycho-oncological support as soon as possible.


Assuntos
Neoplasias da Mama/radioterapia , Radioterapia Adjuvante/efeitos adversos , Transtornos do Sono-Vigília/radioterapia , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/patologia
8.
Medicine (Baltimore) ; 100(20): e26000, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011096

RESUMO

BACKGROUND: This meta-analysis evaluates the difference of sparing organs at risk (OAR) in different position (Prone position and Supine position) with different breathing patterns (Free breathing, FB/Deep inspiration breath hold, DIBH) for breast cancer patients receiving postoperative radiotherapy and provides a useful reference for clinical practice. METHOD: The relevant controlled trials of prone position versus supine position in postoperative radiotherapy for breast cancer were retrieved from the sources of PubMed, Cochrane Library, Embase, Web of Science and ClinicalTrails.gov. The principal outcome of interest was OAR doses (heart dose, left anterior descending coronary artery dose and ipsilateral lung dose) and target coverage. We mainly compared the effects of P-FB (Prone position FB) and S-FB (Supine position FB) and discussed the effects of DIBH combined with different positions on OAR dose in postoperative radiotherapy. We calculated summary standardized mean difference (SMD) and 95% confidence intervals (CI). The meta-analysis was performed using RevMan 5.4 software. RESULTS: The analysis included 751 patients from 19 observational studies. Compared with the S-FB, the P-FB can have lower heart dose, left anterior descending coronary artery (LADCA) dose, and ipsilateral lung dose (ILL) more effectively, and the difference was statistically significant (heart dose, SMD = - 0.51, 95% CI - 0.66 ∼ - 0.36, P < .00001. LADCA dose, SMD = - 0.58, 95% CI - 0.85 ∼ - 0.31, P < .0001. ILL dose, SMD = - 2.84, 95% CI - 3.2 ∼ - 2.48, P < .00001). And there was no significant difference in target coverage between the S-FB and P-FB groups (SMD = - 0.1, 95% CI - 0.57 ∼ 0.36, P = .66). Moreover, through descriptive analysis, we found that P-DIBH (Prone position DIBH) has better sparing OAR than P-FB and S-DIBH (Supine position DIBH). CONCLUSION: By this meta-analysis, compared with the S-FB we found that implementation of P-FB in postoperative radiotherapy for breast cancer can reduce irradiation of heart dose, LADCA dose and ILL dose, without compromising mean dose of target coverage. Moreover, P-DIBH might become the most promising way for breast cancer patients to undergo radiotherapy.


Assuntos
Neoplasias da Mama/terapia , Tratamentos com Preservação do Órgão/métodos , Órgãos em Risco/efeitos da radiação , Posicionamento do Paciente/métodos , Lesões por Radiação/prevenção & controle , Vasos Coronários/efeitos da radiação , Feminino , Coração/efeitos da radiação , Humanos , Pulmão/efeitos da radiação , Mastectomia , Decúbito Ventral , Lesões por Radiação/etiologia , Radiometria/estatística & dados numéricos , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Decúbito Dorsal
9.
Jpn J Clin Oncol ; 51(6): 905-910, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-33822980

RESUMO

OBJECTIVE: The aim of the present study was to retrospectively evaluate the toxicity and efficacy of post-operative small pelvic intensity-modulated radiotherapy in early-stage cervical cancer patients with intermediate-risk factors. METHODS: Between 2012 and 2016, 151 patients who had cervical cancer (International Federation of Gynecology and Obstetrics stage I-IIA) with intermediate-risk factors were treated with post-operative small pelvic intensity-modulated radiotherapy. The median dose of 50.4 Gy in 28 fractions with small pelvic intensity-modulated radiotherapy was prescribed to the planning target volume. The intensity-modulated radiotherapy technique used was conventional fixed-field intensity-modulated radiotherapy or helical tomotherapy. RESULTS: The median follow-up was 37 months. The 3-year disease-free survival and overall survival rates were 89 and 96%, respectively. A total of 144 patients (95.3%) were alive at the last follow-up. In total, 6 patients (3.9%) had recurrence: locoregional recurrence in 3 patients (2%), distant metastasis in 2 (1.3%), and both in 1 (0.6%). Diarrhoea was the most common acute toxicity. There were no patients suffering from acute or late grade ≥ 3 toxicity. Only 4 patients (2.6%) had late grade 2 toxicities. CONCLUSIONS: For early-stage cervical cancer patients with intermediate-risk factors, post-operative small pelvic intensity-modulated radiotherapy was safe and well tolerated. The rates of acute and late toxicities were quite satisfactory.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , China/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Pelve/patologia , Pelve/efeitos da radiação , Pelve/cirurgia , Período Pós-Operatório , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Carga Tumoral/efeitos da radiação , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Adulto Jovem
10.
Medicine (Baltimore) ; 100(16): e25373, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879666

RESUMO

INTRODUCTION: Radiation induced gliomas often occurs after radiation therapy for other brain tumors. Medulloblastoma often occurs in children and its associated radiation-induced glioblastoma multiforme's (GBM) after radiotherapy often has a long latency period. Our case is very unique because the medulloblastoma was detected at an advance age and the latency period of radiation-induced GBM was relatively shorter. PATIENTS CONCERNS: A 64-year-old male was first admitted at our hospital in March 2018 with dizziness, vomiting, and blurred vision. DIAGNOSIS: Magnetic resonance imaging of brain revealed a lesion with local mixed density and mass enhancement in left cerebellar region. Histopathology established medulloblastoma (World Health Organization) grade 4 and a classic histological subtype after surgery. INTERVENTION: Surgical resection followed by radiation therapy were the initial therapeutic modalities. OUTCOMES: In April 2019, the patient was readmitted with dizziness and blurred vision. Magnetic resonance imaging showed the left cerebellar hemisphere bulky enhancement lesion. Again, a multimodal therapy comprising surgical resection, radiation therapy as well as chemotherapy was adapted after histopathology established GBM. LESION: Radiotherapy for medulloblastoma patients at advance ages is a critical predisposing factor for the development of radiation-induced GBM in a very short period of time. We suggest that, radiotherapy as adjuvant therapy for medulloblastoma patients at advance ages should be chosen with extreme caution.


Assuntos
Neoplasias Cerebelares/terapia , Glioblastoma/etiologia , Meduloblastoma/terapia , Neoplasias Induzidas por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade
11.
J Med Case Rep ; 15(1): 184, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33879216

RESUMO

INTRODUCTION/BACKGROUND: Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual incidence rate of 0.10 per 100,000 children. CASE PRESENTATION: We report the case of an adolescent male belonging to central India who had presented with a history of persistent headache, projectile vomiting, neck stiffness, and an episode of generalized tonic-clonic seizure. Neurological examination was suggestive of a space-occupying lesion. Further neuroimaging was suggestive of a large left-sided choroid plexus carcinoma, later confirmed on pathological examination. Gross total resection was achieved and followed by radiation therapy. His recovery was satisfactory without any major events despite suffering from such a malignancy with a poor prognosis. CONCLUSION: In the absence of a global consensus on choroid plexus carcinoma management, our patient underwent a successful gross total resection and received postoperative radiotherapy. He made a satisfactory recovery with a further plan to review with gadolinium-enhanced neuroimaging at a later date. We conclude that, when possible, achieving gross total resection is of utmost importance.


Assuntos
Carcinoma/terapia , Neoplasias do Plexo Corióideo/radioterapia , Neoplasias do Plexo Corióideo/cirurgia , Radioterapia Adjuvante , Adolescente , Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Neoplasias do Plexo Corióideo/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Índia , Masculino , Neuroimagem , Resultado do Tratamento , Vômito/etiologia
12.
BMC Cancer ; 21(1): 413, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858353

RESUMO

BACKGROUND: This study analyzed the clinical results of palliative radiotherapy for bleeding control in patients with unresectable advanced gastric cancer. METHODS: We retrospectively reviewed the medical records of patients who met the following inclusion criteria between January 2002 and June 2018: histologically proven gastric cancer, gastric tumor bleeding confirmed by upper gastrointestinal endoscopy, and palliative radiotherapy performed for hemostasis. The median radiotherapy dose was 30 Gy, with a daily dose ranging from 1.8 to 3 Gy. RESULTS: Sixty-one patients were included in this analysis. The study population was predominantly male (72.1%), with a median age of 62 years (range: 32-92). The median baseline hemoglobin level was 7.1 g/dL, and the most common presenting symptom of gastric tumor bleeding was melena (85.2%). Bleeding control was achieved in 54 (88.5%) patients. The median levels of hemoglobin at 1, 2, and 3 months after completion of radiotherapy were 10.1 g/dL, 10.2 g/dL, and 10.4 g/dL, respectively; these values were significantly different from that before radiotherapy (7.1 g/dL; p < 0.001). The median overall survival was 4.8 months. Among the 54 patients who achieved bleeding control after radiotherapy, 19 (35.2%) experienced re-bleeding during the follow-up period. The median time to re-bleeding was 6.0 months. Multivariate analysis demonstrated that a higher radiation dose (p = 0.007) and additional chemotherapy after radiotherapy (p = 0.004) were significant factors for prolonging the time to re-bleeding. CONCLUSIONS: Tumor bleeding was adequately controlled by radiotherapy in patients with unresectable advanced gastric cancer.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/prevenção & controle , Cuidados Paliativos , Radioterapia Adjuvante , Neoplasias Gástricas/complicações , Neoplasias Gástricas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemostasia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Prognóstico , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/patologia
13.
Medicina (Kaunas) ; 57(4)2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33917690

RESUMO

We report the case of a primitive nasal melanoma in an 82-year-old patient, showing how this rare malignancy, with non-specific signs and symptoms, can represent a challenging diagnosis for the physician. A 82-year-old Caucasian patient presented for unilateral nasal obstruction and occasional epistaxis. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the facial massif revealed turbinate hypertrophy and a polypoid phlogistic tissue isointense in T1 with an intermediate signal in T2 and Short-TI Inversion Recovery (STIR)-T2, occupying the middle meatus and the anterior upper and lower left meatus with partial obliteration of the ostium and the infundibulum of the maxillary sinus. The Positron emission tomography (PET) exam was negative for metastases. Conservatory surgery in the left anterior video rhinoscopy was performed, allowing a radical 4-cm tumor excision. Histology reported epithelioid cell melanoma, PanK-, CD45-, and PanMelanoma+. Adjuvant radiotherapy was suggested, even considering a complete resection as the result of surgery. No local or systemic relapse was noticed at the 2-month follow-up visit. Although mucosal melanoma is a rare and aggressive malignancy characterized by a poor prognosis, early diagnosis allows a more conservative approach, with little surgical difficulty and no aesthetic effect. Our case raises awareness of the importance of early intervention even in those cases where the clinic symptoms and diagnostic images show uncertain severity.


Assuntos
Melanoma , Obstrução Nasal , Idoso de 80 Anos ou mais , Humanos , Melanoma/diagnóstico por imagem , Obstrução Nasal/diagnóstico por imagem , Obstrução Nasal/etiologia , Recidiva Local de Neoplasia , Radioterapia Adjuvante , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/cirurgia
14.
Anticancer Res ; 41(4): 1715-1726, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813375

RESUMO

Medulloblastoma (MB) is the most frequent malignant brain tumor in children. Treatment of MB is based on histopathological and molecular stratification, and includes surgical intervention, often with craniospinal irradiation and adjuvant chemotherapy. Unfortunately, however, this treatment leads to a high morbidity rate, and it does not cure all patients either, with around 30% succumbing to their disease. With improved cancer genomics and better molecular characterization, MB has been classified into four major subgroups, wingless-activated, sonic hedgehog-activated, Group 3, and Group 4, with each group consisting of additional subtypes. Recently disclosed genetic drivers of MB may in the future help improve treatment, and in this way reduce therapy-related toxicity. In this review, we describe the heterogeneity of the MB subgroups, and potential new options for targeted therapy.


Assuntos
Neoplasias Cerebelares/terapia , Imunoterapia , Meduloblastoma/terapia , Terapia de Alvo Molecular , Procedimentos Neurocirúrgicos , Medicina de Precisão , Biomarcadores Tumorais/genética , Neoplasias Cerebelares/genética , Neoplasias Cerebelares/mortalidade , Neoplasias Cerebelares/patologia , Quimioterapia Adjuvante , Criança , Pré-Escolar , Irradiação Craniana , Feminino , Humanos , Imunoterapia/efeitos adversos , Lactente , Masculino , Meduloblastoma/genética , Meduloblastoma/mortalidade , Meduloblastoma/patologia , Terapia de Alvo Molecular/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Radioterapia Adjuvante , Resultado do Tratamento
15.
Ann Plast Surg ; 86(5S Suppl 3): S414-S417, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33833172

RESUMO

INTRODUCTION: Radiation therapy is a known risk factor for capsular contracture formation after implant-based breast reconstruction. Although autologous fat grafting (AFG) has been shown to reverse radiation-induced tissue fibrosis, its use as a prophylactic agent against capsular contraction has not been assessed in the clinical setting. In the setting of 2-stage implant-based reconstruction and postmastectomy radiation therapy, we explored the effect AFG has on the prevalence of capsular contracture. MATERIALS AND METHODS: A retrospective chart review of patients who underwent immediate tissue expander (TE) placement followed by postmastectomy radiation therapy and secondary implant-based reconstruction at our institution between January 2012 and December 2019 was performed. Patients were divided into 2 cohorts based on whether or not AFG was performed at the time of secondary reconstruction. The primary outcome of interest was the occurrence of capsular contracture after TE exchange. RESULTS: Overall 57 patients (57 breasts) were included, 33 of whom received AFG at the time of TE exchange. All but 1 patient underwent submuscular implant placement, and the mean follow-up was 1.96 years. There was no significant difference in the prevalence of medical comorbidities between the study groups.Capsular contracture occurred in 24 patients (42.1%). Seventeen of these patients had undergone AFG at the time of TE exchange (17/33 patients, 51.5%), and 7 of these patients had not (7/24 patients, 29.2%). Most of the capsular contracture cases were Baker grades III or IV (14 patients, 58.3%), and 50% of patients with capsular contracture of any grade ultimately required operative intervention. Multivariate logistic regression analysis demonstrated that AFG did not significantly influence the occurrence or severity of capsular contracture, or did not impact the need for operative intervention in this patient population. CONCLUSIONS: Implant-based reconstruction of the irradiated breast is associated with high postoperative capsular contracture rates. Although AFG has shown promise in reversing radiation-induced dermal fibrosis, no protective effect on the development of capsular contracture after stage 2 reconstruction was observed in this study population. Further investigation in the form of randomized, prospective studies is needed to better assess the utility of AFG in preventing capsular contracture in irradiated patients.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Contratura , Mamoplastia , Tecido Adiposo , Implante Mamário/efeitos adversos , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Contratura/epidemiologia , Contratura/etiologia , Contratura/prevenção & controle , Humanos , Contratura Capsular em Implantes/epidemiologia , Contratura Capsular em Implantes/etiologia , Contratura Capsular em Implantes/prevenção & controle , Mastectomia , Estudos Prospectivos , Radioterapia Adjuvante , Estudos Retrospectivos
16.
Biomed Res Int ; 2021: 6650846, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33791369

RESUMO

Background: Surgical site infection represents the most severe complication in prosthetic breast reconstruction. Risk profiling represents a useful tool for both clinicians and patients. Materials and Methods: In our hospital, 534 breast reconstructions with tissue expander implants, in 500 patients, were performed. Several clinical variables were collected. In our study, we evaluated the different inflammatory markers present in the periprosthetic fluid and we compared them with the ones present in plasma. Results: The surgical site infection rate resulted to be 10.5%, and reconstruction failed in 4.5% of the cases. The hazard ratio for complications was 2.3 in women over 60 (CI: 1.3-4.07; p = 0.004), 2.57 in patients with expander volume ≥ 500 cc (CI: 1.51-4.38; p < 0.001), 2.14 in patients submitted to previous radiotherapy (CI: 1.05-4.36; p < 0.037), and 1.05 in prolonged drain use (CI: 1.03-1.07; p < 0.001). 25-OH, PCT, and total protein were less concentrated, and ferritin and LDH were more concentrated in the periprosthetic fluid than in plasma (p < 0.001). CRP (p = 0.190) and ß-2 microglobulin (p = 0.344) did not change in the two fluids analyzed. PCT initial value is higher in patients who underwent radiotherapy, and it could be related to the higher rate of their postoperative complications. Patients with a tissue expander with a volume ≥ 500 cc show an increasing trend for CRP in time (p = 0.009). Conclusions: Several risk factors (prolonged time of drains, age older than 60 years, and radiotherapy) have been confirmed by our study. The study of markers in the periprosthetic fluid with respect to their study in plasma could point toward earlier infection detection and support early management.


Assuntos
Implantes de Mama/efeitos adversos , Mamoplastia/efeitos adversos , Radioterapia Adjuvante , Infecção da Ferida Cirúrgica , Adulto , Biomarcadores/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/metabolismo , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/radioterapia
17.
Artigo em Inglês | MEDLINE | ID: mdl-33800387

RESUMO

This study aimed to investigate type of loco-regional treatment received, associated treatment factors and mortality outcomes in New Zealand women with early-stage breast cancer who were eligible for breast conserving surgery (BCS). This is a retrospective analysis of prospectively collected data from the Auckland and Waikato Breast Cancer Registers and involves 6972 women who were diagnosed with early-stage primary breast cancer (I-IIIa) between 1 January 2000 and 31 July 2015, were eligible for BCS and had received one of four loco-regional treatments: breast conserving surgery (BCS), BCS followed by radiotherapy (BCS + RT), mastectomy (MTX) or MTX followed by radiotherapy (MTX + RT), as their primary cancer treatment. About 66.1% of women received BCS + RT, 8.4% received BCS only, 21.6% received MTX alone and 3.9% received MTX + RT. Logistic regression analysis was used to identify demographic and clinical factors associated with the receipt of the BCS + RT (standard treatment). Differences in the uptake of BCS + RT were present across patient demographic and clinical factors. BCS + RT was less likely amongst patients who were older (75+ years old), were of Asian ethnicity, resided in impoverished areas or areas within the Auckland region and were treated in a public healthcare facility. Additionally, BCS + RT was less likely among patients diagnosed symptomatically, diagnosed during 2000-2004, had an unknown tumour grade, negative/unknown oestrogen and progesterone receptor status or tumour sizes ≥ 20 mm, ≤50 mm and had nodal involvement. Competing risk regression analysis was undertaken to estimate the breast cancer-specific mortality associated with each of the four loco-regional treatments received. Over a median follow-up of 8.8 years, women who received MTX alone had a higher risk of breast cancer-specific mortality (adjusted hazard ratio: 1.38, 95% confidence interval (CI): 1.05-1.82) compared to women who received BCS + RT. MTX + RT and BCS alone did not have any statistically different risk of mortality when compared to BCS + RT. Further inquiry is needed as to any advantages BCS + RT may have over MTX alternatives.


Assuntos
Neoplasias da Mama , Mastectomia Segmentar , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada , Feminino , Humanos , Mastectomia , Estadiamento de Neoplasias , Nova Zelândia/epidemiologia , Radioterapia Adjuvante , Estudos Retrospectivos
18.
Int J Mol Sci ; 22(6)2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33808722

RESUMO

Chemo-radiotherapy, which combines chemotherapy with radiotherapy, has been clinically practiced since the 1970s, and various anticancer drugs have been shown to have a synergistic effect when used in combination with radiotherapy. In particular, cisplatin (CDDP), which is often the cornerstone of multi-drug combination cancer therapies, is highly versatile and frequently used in combination with radiotherapy for the treatment of many cancers. Therefore, the mechanisms underlying the synergistic effect of CDDP and radiotherapy have been widely investigated, although no definitive conclusions have been reached. We present a review of the combined use of CDDP and radiotherapy, including the latest findings, and propose a mechanism that could explain their synergistic effects. Our hypothesis involves the concepts of overlap and complementation. "Overlap" refers to the overlapping reactions of CDDP and radiation-induced excessive oxidative loading, which lead to accumulating damage to cell components, mostly within the cytoplasm. "Complementation" refers to the complementary functions of CDDP and radiation that lead to DNA damage, primarily in the nucleus. In fact, the two concepts are inseparable, but conceptualizing them separately will help us understand the mechanism underlying the synergism between radiation therapy and other anticancer drugs, and help us to design future radiosensitizers.


Assuntos
Antineoplásicos/uso terapêutico , Cisplatino/uso terapêutico , Neoplasias/terapia , Radiossensibilizantes/uso terapêutico , Radioterapia Adjuvante , Animais , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Estudos Clínicos como Assunto , Ensaios Clínicos como Assunto , Terapia Combinada , Avaliação Pré-Clínica de Medicamentos , Humanos , Neoplasias/diagnóstico , Neoplasias/etiologia , Neoplasias/mortalidade , Radiossensibilizantes/administração & dosagem , Radiossensibilizantes/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Resultado do Tratamento
19.
Anticancer Res ; 41(4): 1909-1920, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813396

RESUMO

BACKGROUND/AIM: This comparative plan study examines a range of boost-radiation methods in adjuvant radiotherapy of breast cancer using helical intensity-modulated radiotherapy with TomoEdge-technique. Impact of hypofractionated radiation with simultaneous-integrated boost (SIB) and influence of differing assumed α/ß-values were examined. PATIENTS AND METHODS: For 10 patients with left-sided breast cancer each four helical IMRT-plans with TomoEdge-technique were created: hypofractionated+SIB (H-SIB) (42.4/54.4 Gy, 16 fractions), normofractionated+SIB (N-SIB) (50.4/64.4 Gy, 28 fractions), hypofractionated+sequential-boost (H-SB) (42.4 Gy/16 fractions+16 Gy/8 fractions), normofractionated+ sequential-boost (N-SB) (50.4 Gy/28 fractions+16 Gy/8 fractions). Equivalent doses (EQD2) to organs-at-risk (OAR) and irradiated mammary-gland were analysed for different assumed α/ß-values. RESULTS: The mean EQD2 to OAR was significantly lower using hypofractionated radiation-techniques. H-SIB and H-SB were not significantly different. H-SIB and N-SIB conformed significantly better to the breast planning-target volume (PTV) and boost-volume (BV) than H-SB and N-SB. Regarding BV, mean EQD2 was significantly higher for all α/ß-values investigated when using H-SIB and N-SIB. Regarding PTV, there were no clinically relevant differences. CONCLUSION: Relating to dosimetry, H-SIB is effective compared to standard-boost-techniques.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Hipofracionamento da Dose de Radiação , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Adulto , Neoplasias da Mama/patologia , Feminino , Coração/efeitos da radiação , Humanos , Pulmão/efeitos da radiação , Mastectomia Segmentar/métodos , Órgãos em Risco , Hipofracionamento da Dose de Radiação/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Planejamento da Radioterapia Assistida por Computador/normas , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Radioterapia Adjuvante/normas , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Radioterapia de Intensidade Modulada/normas , Padrões de Referência , Carga Tumoral/efeitos da radiação
20.
Anticancer Res ; 41(4): 1997-2005, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813406

RESUMO

BACKGROUND/AIM: We aimed to evaluate the clinical outcomes of oligometastatic colorectal cancer in the liver and lung treated with carbon-ion radiotherapy (C-ion RT). PATIENTS AND METHODS: Nineteen consecutive patients with oligometastatic colorectal cancer in the liver or lung who received C-ion RT were analyzed. The doses of C-ion RT were 60.0 Gy [relative biological effectiveness (RBE)] in 4 fractions, 60.0 Gy (RBE) in 12 fractions, or 64.8 Gy (BRE) in 12 fractions. RESULTS: The median follow-up duration was 19 months. There were 23 tumors in 19 patients. The 2-year overall survival and local control rates for the whole patient cohort were 100% and 67%, respectively. None of the patients developed grade 2 or higher acute or late toxicities. CONCLUSION: C-ion RT for oligometastatic colorectal cancer in liver and lung provides favorable clinical outcomes. These outcomes suggest C-ion RT is a treatment option for oligometastatic colorectal cancer in liver and lung.


Assuntos
Adenocarcinoma/radioterapia , Neoplasias Colorretais/radioterapia , Radioterapia com Íons Pesados , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/radioterapia , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Terapia Combinada/métodos , Feminino , Radioterapia com Íons Pesados/efeitos adversos , Radioterapia com Íons Pesados/métodos , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral/efeitos da radiação
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