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1.
Int J Radiat Oncol Biol Phys ; 106(2): 255-260, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31654784

RESUMO

PURPOSE: Whole brain radiation therapy (WBRT) remains a commonly used cancer treatment, although controversy exists regarding the optimal dose/fractionation to optimize intracranial tumor control and minimize resultant cognitive deficits. METHODS AND MATERIALS: NCCTG N107C [Alliance]/CEC.3 randomized 194 patients with brain metastases to either stereotactic radiosurgery alone or WBRT after surgical resection. Among the 92 patients receiving WBRT, sites predetermined the dose/fractionation that would be used for all patients treated at that site (either 30 Gy in 10 fractions or 37.5 Gy in 15 fractions). Analyses were performed using Kaplan-Meier estimates, log rank tests, and Fisher's exact tests. RESULTS: Among 92 patients treated with surgical resection and adjuvant WBRT, 49 were treated with 30 Gy in 10 fractions (53%), and 43 were treated with 37.5 Gy in 15 fractions (47%). Baseline characteristics, including cognitive testing, were well balanced between groups with the exception of primary tumor type (lung cancer histology was more frequent with protracted WBRT: 72% vs 45%, P = .01), and 93% of patients completed the full course of WBRT. A more protracted WBRT dose regimen (37.5 Gy in 15 fractions) did not significantly affect time to cognitive failure (hazard ratio [HR], 0.9; 95% confidence interval [CI], 0.6-1.39; P = .66), surgical bed control (HR, 0.52 [95% CI, 0.22-1.25], P = .14), intracranial tumor control (HR, 0.56 [95% CI, 0.28-1.12], P = .09), or overall survival (HR, 0.72 [95% CI, 0.45-1.16], P = .18). Although there was no reported radionecrosis, there is a statistically significant increase in the risk of at least 1 grade ≥3 adverse event with 37.5 Gy in 15 fractions versus 30 Gy in 10 fractions (54% vs 31%, respectively, P = .03). CONCLUSIONS: This post hoc analysis does not demonstrate that protracted WBRT courses reduce the risk of cognitive deficit, improve tumor control in the hypoxic surgical cavity, or otherwise improve the therapeutic ratio. Adverse events were significantly higher with the lengthened course of WBRT. For patients with brain metastases where WBRT is recommended, shorter course hypofractionated regimens remain the current standard of care.


Assuntos
Neoplasias Encefálicas/radioterapia , Transtornos Cognitivos/prevenção & controle , Irradiação Craniana/normas , Melhoria de Qualidade , Radiocirurgia/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Intervalos de Confiança , Irradiação Craniana/efeitos adversos , Fracionamento da Dose de Radiação , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Radiocirurgia/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/normas
2.
Vasc Endovascular Surg ; 54(2): 172-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31714184

RESUMO

Axillary artery blowout is a rare life- and limb-threatening condition. The traditional surgical approach of ligation and extra-anatomic bypass is associated with a high morbidity and mortality. We present a case report of a 65-year-old male with axillary artery hemorrhage secondary to an irradiated squamous cell cancer. We propose a staged hybrid approach for the treatment of this unusual clinical entity consisting of emergent stent grafting followed by planned elective extra-anatomic bypass, debridement, and a course of specific antimicrobial therapy.


Assuntos
Artéria Axilar/efeitos da radiação , Artéria Axilar/cirurgia , Implante de Prótese Vascular , Carcinoma de Células Escamosas/radioterapia , Procedimentos Endovasculares , Hemorragia/cirurgia , Lesões por Radiação/terapia , Neoplasias Cutâneas/radioterapia , Idoso , Anti-Infecciosos/administração & dosagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Carcinoma de Células Escamosas/patologia , Desbridamento , Procedimentos Endovasculares/instrumentação , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Masculino , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Neoplasias Cutâneas/patologia , Stents , Resultado do Tratamento
3.
Int J Radiat Oncol Biol Phys ; 106(3): 496-502, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31759077

RESUMO

PURPOSE: Variability exists in the adjuvant treatment for endometrial cancer (EC) based on surgical pathology and institutional preference. The radiosensitivity index (RSI) is a previously validated multigene expression index that estimates tumor radiosensitivity. We evaluate RSI as a genomic predictor for pelvic failure (PF) in EC patients treated with adjuvant radiation therapy (RT). METHODS AND MATERIALS: Using our institutional tissue biorepository, we identified EC patients treated between January 1999 and April 2011 with primarily endometrioid histology (n = 176; 86%) who received various adjuvant therapies. The RSI 10-gene signature was calculated for each sample using the previously published algorithm. Radiophenotype was determined using the previously identified cutpoint where RSI ≥ 0.375 denotes radioresistance (RR) and RSI < 0.375 describes radiosensitivity. RESULTS: A total of 204 patients were identified, of which 83 (41%) were treated with adjuvant RT. Median follow-up was 38.5 months. All patients underwent hysterectomy with bilateral salpingo-oophorectomy with the majority undergoing lymph node dissection (n = 181; 88%). In patients treated with radiation, RR tumors were more likely to experience PF (3-year pelvic control 84% vs 100%; P = .02) with worse PF-free survival (PFFS) (3-year PFFS 65% vs 89%; P = .04). Furthermore, in the patients who did not receive RT, there was no difference in PF (P = .87) or PFFS (P = .57) between the RR/radiosensitive tumors. On multivariable analysis, factors that continued to predict for PF included the RR phenotype (hazard ratio [HR], 12.2; P = .003), lymph node involvement (HR, 4.4; P = .02), and serosal or adnexal involvement (HR, 5.3; P = .01). CONCLUSIONS: On multivariable analysis, RSI was found to be a significant predictor of PF in patients treated with adjuvant RT. We propose using RSI to predict which patients are at higher risk for failing in the pelvis and may be candidates for treatment escalation in the adjuvant setting.


Assuntos
Neoplasias do Endométrio/genética , Neoplasias do Endométrio/radioterapia , Perfilação da Expressão Gênica , Recidiva Local de Neoplasia/genética , Neoplasias Pélvicas/genética , Tolerância a Radiação/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multivariada , Fenótipo , Intervalo Livre de Progressão , Radioterapia Adjuvante/efeitos adversos
4.
Int J Radiat Oncol Biol Phys ; 106(3): 514-524, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756414

RESUMO

PURPOSE: To compare single-stage direct-to-implant (DTI) immediate reconstruction to the commonly used 2-stages expander and implant (TE/I) or autologous reconstruction with focus on postmastectomy radiation therapy (PMRT) setting. METHODS AND MATERIALS: We reviewed the charts of 1,286 patients who underwent 1,814 breast reconstructions at our institution with and without PMRT from 1997 to 2017. Patients were divided into 6 groups according to type of reconstruction and PMRT status. Primary objective was reconstruction complications defined solely on surgical reintervention operative notes such as infection, skin necrosis, and fat necrosis across all groups. Implant-related complications such as capsular contracture, implant rupture or exposure, or implant failure were compared between TE/I and DTI. Kaplan-Meier estimates were used to calculate 5-year cumulative incidence of complications. The secondary objective was to compare the 3 reconstruction types in settings of immediate reconstruction followed by PMRT on multivariable analysis. RESULTS: Median follow-up was 5.8 years. Among 1286 patients, 41.1% (N = 529/1286) received PMRT. Among 1814 reconstructed breasts, autologous, single-stage, and TE/I represented 18.7%, 34.8%, and 46.2%, respectively. With no PMRT, the 5-year cumulative incidence of any reconstruction complication was 11.1%, 12.6%, and 19.5% for autologous, DTI, and TE/I reconstructions, respectively. The addition of PMRT resulted in 5-year cumulative incidence of 15.1%, 18.2%, and 36.8%, respectively. The multivariable analysis showed that DTI was associated with lesser complications compared with TE/I, whereas no significant difference was noted between DTI and autologous. CONCLUSIONS: Single-stage DTI reconstruction had significantly lower complication rates than TE/I with and without PMRT. Single-stage complication rates were not significantly different from autologous complication rates in PMRT settings. Single-stage reconstruction may offer a valuable option for patients receiving PMRT.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/radioterapia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias , Dispositivos para Expansão de Tecidos/efeitos adversos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Incidência , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Necrose , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/estatística & dados numéricos , Estudos Retrospectivos , Pele/patologia , Pele/efeitos da radiação , Fatores de Tempo
5.
J Surg Oncol ; 121(5): 766-776, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31879978

RESUMO

This systematic review with meta-analysis addressed late locoregional complications associated with adjuvant radiotherapy (RT) in breast cancer. Among 2120 titles, ten comparative studies in patients undergoing surgery vs surgery and radiotherapy reporting complications were evaluated. RT was associated with an increased risk of capsular contracture and decreased the mobility of the upper limb. A borderline association of lymphedema risk using RT was noted in the random-effects model but was significant in the fixed-effects model.


Assuntos
Neoplasias da Mama/terapia , Contratura/etiologia , Linfedema/etiologia , Radioterapia Adjuvante/efeitos adversos , Feminino , Humanos , Mastectomia
6.
Rev Med Chil ; 147(7): 928-931, 2019 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-31859992

RESUMO

Lhermitte phenomenon is a neurological symptom described as a sensation of electric shock that radiates from the back towards the extremities, which appears when a patient flexes the neck. A transient myelopathy as a late complication of radiotherapy is associated with this symptom. It appears two to four months after treatment and disappears spontaneously. We report a 45 years old female with a neck malignant melanoma treated with surgery and adjuvant radiotherapy. She experienced the Lhermitte phenomenon that was triggered by heat. This phenomenon must be differentiated from the Uhthoff phenomenon.


Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico , Temperatura Alta/efeitos adversos , Melanoma/diagnóstico , Dor/etiologia , Radioterapia Adjuvante/efeitos adversos , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Melanoma/radioterapia , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/cirurgia
7.
Health Qual Life Outcomes ; 17(1): 170, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703704

RESUMO

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyze major complication rates and different aspects of health-related quality of life (HRQoL) in extremity soft tissue sarcoma (STS) patients treated with or without radio (chemo) therapy and surgery. METHODS: We performed a retrospective analysis of all patients who underwent Extremity STS excision from 2004 to 2014 (182 patients included). Patients' data were collected from patients' records. HRQoL was assessed by using EORTC QLQ-C30. RESULTS: A total of 182 patients underwent sarcoma resection. After neoadjuvant radiochemotherapy (RCT), the major-complication rate amounted to 28% (vs. 7%, no radiotherapy, p <  0.001). Major-complication rates after adjuvant radiotherapy (RT) occurred in 8% (vs. 7%, no radiotherapy, p = 0.265). Comparison QoL scores between treating with neoadjuvant RCT or without RT revealed significant worse scores with neoadjuvant RCT. Further stratification of disease control of these patients showed significant reduced scores in the group of disease-free patients with neoadjuvant RCT compared to irradiated disease-free patients. DISCUSSION: To date, there have only been a few investigations of QoL in STS. Retrospective study on quality of life have limitations, like a lack of baseline evaluation of QoL. Patient candidated to radiation therapy could have had worse QoL baseline due to more advanced disease. Disease status of the patients who answered the questionnaires could have been an influence of QoL and we could show reduced scores in the group of disease-free patients with neoadjuvant RCT, but not for the patients with recurrence or metastasis, so it is very hard to discriminate whether radiation therapy could really have an impact or not. CONCLUSION: This study might assist in further improving the understanding of QoL in STS patients and may animate for prospective studies examining the oncological therapies impact on HRQoL.


Assuntos
Terapia Neoadjuvante/efeitos adversos , Qualidade de Vida , Radioterapia Adjuvante/efeitos adversos , Sarcoma/terapia , Adulto , Idoso , Estudos de Casos e Controles , Extremidades , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/psicologia , Radioterapia Adjuvante/psicologia , Estudos Retrospectivos , Inquéritos e Questionários
8.
J Surg Oncol ; 120(8): 1397-1403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31705561

RESUMO

BACKGROUND: We previously reported a prospective study showing axillary lymph node dissection (ALND) is associated with increased breast skin thickening during and 6 weeks post-radiation therapy (RT), and now report ALND's long-term impact at 1 year. METHODS: Among 66 women who received whole breast RT after lumpectomy, objective ultrasound measurements of epidermal thickness over four quadrants of the treated breast were measured at five time points: before RT, week 6 of RT, and 6 weeks, 6 months, and 1 year post-RT. Skin thickness ratio (STRA) was generated by normalizing for corresponding measurements of the contralateral breast. RESULTS: A total of 2,436 ultrasound images were obtained. Among 63 women with evaluable data at 1 year, mean STRA significantly increased at 6 months (absolute mean increase of 65%, SD 0.054), and remained elevated at 1 year post-RT (absolute mean increase of 44%, SD 0.048). In multivariable analysis, ALND compared to sentinel lymph node biopsy, longer interval between surgery and RT, increased baseline STRA, and Caucasian race predicted for more severe changes in STRA at 1 year compared to baseline (all P < .05). CONCLUSIONS: In the setting of whole breast RT, our findings suggest that ALND has long-term repercussions on breast skin thickening.


Assuntos
Axila/cirurgia , Neoplasias da Mama/radioterapia , Epiderme/diagnóstico por imagem , Excisão de Linfonodo/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Adulto , Idoso , Neoplasias da Mama/cirurgia , Grupo com Ancestrais do Continente Europeu , Feminino , Seguimentos , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Estudos Prospectivos , Tempo para o Tratamento , Ultrassonografia
9.
Indian J Cancer ; 56(4): 341-347, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607704

RESUMO

INTRODUCTION: To define indications for adjuvant radiotherapy in patients with endometrial cancer, the risk groups have been established according to clinical and pathological prognostic factors. The purpose was to determine precise criteria for adjuvant radiotherapy and identify patients with increased risk for disease relapse who may benefit from postoperative radiotherapy, with an acceptable level of toxicity. MATERIALS AND METHODS: A retrospective study was conducted at the Department of Oncology and Radiology, Kragujevac, during a 5-year period. A group of 80 patients with endometrial cancer treated with adjuvant radiotherapy were included in the study. Patients were divided into four risk groups according to ESMO-ESGO-ESTRO Consensus Conference classification. The Kaplan-Meier method was used for overall and progression-free survival. A statistical analysis was performed using SPSS 20.0 statistical software. RESULTS: The 5-year survival rate was 80%, and 66.3% patients were progression-free during this period. Fatal outcome occurred in 20% of patients. The results showed survival was shortest in patients from the high-risk group. Factors that had impact on the 5-year survival were comorbidities, FIGO stage, postoperative radiotherapy, organ site of late toxicity, and localization of metastases. The analysis of postoperative radiotherapy effects showed that 72.5% of patients had no complications. The most common symptoms of late irradiation toxicity arose from the gastrointestinal tract. Toxicity was usually moderate. CONCLUSIONS: Adjuvant radiotherapy can potentially prolong survival and prevent recurrence, with acceptable level of toxicity, to preserve patient's quality of life. Patient classification into appropriate risk groups allows for adjuvant treatment individualization.


Assuntos
Neoplasias do Endométrio/radioterapia , Seleção de Pacientes , Radioterapia Adjuvante/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/mortalidade , Feminino , Gastroenteropatias/etiologia , Humanos , Metástase Neoplásica , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Medicina de Precisão , Lesões por Radiação , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Risco
10.
Urology ; 134: 135-142, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494212

RESUMO

OBJECTIVES: To evaluate possible discrepancies between patients' expectations concerning sexual side effects related to prostate cancer treatment, based on the obtained information prior to treatment. Moreover, to determine if demographic or clinical factors may have an effect on the accuracy of patients' expectations concerning sexual side effects after treatment. METHODS: A multicenter, cross-sectional survey was performed among men treated with prostatectomy, brachytherapy, external-beam radiotherapy and/or hormonal therapy. RESULTS: In total, 412 questionnaires were analyzed. Of men with sexual side effects after treatment, 1 in 3 (32.5%, n = 109) reported their complaints as worse than expected; significantly more often reported by men treated surgically (P = .001), men with a local stage tumor (P = .005) and by men with a lower prostate-specific antigen level at diagnosis (P = .046). It was significantly less often reported by men treated with radiotherapy combined with hormonal therapy (P = .031). Men who used brochures as an information source reported their sexual side effects significantly less often as worse than expected (P < .001). CONCLUSION: One in three men with sexual side effects after prostate cancer treatment, experienced their complaints as worse than expected based on the obtained information prior to treatment. Men treated with radiotherapy combined with hormonal therapy indicated less discrepancy between expectations and developed sexual side effects, whereas prostatectomy, low stage tumor and low prostate-specific antigen level were associated with more discrepancy. Brochures should be administered additionally to verbal information to improve patients' understanding of possible sexual side effects and to enhance the accuracy of patients' expectations.


Assuntos
Disfunção Erétil/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias da Próstata/terapia , Idoso , Antagonistas de Androgênios/efeitos adversos , Braquiterapia/efeitos adversos , Estudos Transversais , Humanos , Masculino , Países Baixos , Folhetos , Educação de Pacientes como Assunto , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Inquéritos e Questionários
11.
Radiat Oncol ; 14(1): 155, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470867

RESUMO

BACKGROUND: Transforming growth factor beta 1 (TGF-ß1) and platelet-derived growth factor (PDGF) are cytokines involved in fibrotic processes causing radiotherapy (RT)-induced cardiovascular changes. We aimed to investigate the associations between TGF-ß1 and PDGF and the echocardiographic changes that occur during RT and during three-year follow-up. METHODS: The study included 63 women receiving adjuvant RT for early-stage breast cancer or ductal carcinoma in situ. Serum TGF-ß1 (ng/ml) and PDGF (ng/ml) levels were measured by enzyme-linked immunoassay and echocardiographic examination was performed before RT, after RT and at 3 years. Patients were grouped by biomarker behavior by a trajectory analysis. RESULTS: TGF-ß1 decreased from 19.2 (IQR 17.1-22.3) before RT to 18.8 (14.5-22.0) after RT (p = 0.003) and the decrease persisted at 17.2 (13.7-21.2) 3 years after RT (p = 0.101). PDGF decreased from 15.4 (12.6-19.1) before RT to 13.8 (11.7-16.2) after RT, p = 0.001, and persisted at 15.6 (10.4-18.4) at 3 years, p = 0.661. The TGF-ß1 level before RT (Spearman's rho 0.441, p < 0.001) and the three-year change in TGF-ß1 (rho = - 0.302, p = 0.018) correlated with global longitudinal strain (GLS) in echocardiography at 3 years. In trajectory analysis, two TGF-ß1 behavior groups were found. Group 1 had significantly higher TGF-ß1 levels before RT, 25.6 (22.3-28.6), than group 2, 17.8 (15.9-19.9), p < 0.001. In multivariable analysis, TGF-ß1 trajectory group 1 (ß = 0.27, p = 0.013), left-sided breast cancer (ß = 0.39, p = 0.001) and the use of aromatase inhibitors (ß = 0.29, p = 0.011) were significantly associated with a worsening in GLS from before RT to 3 years. CONCLUSION: An elevated pretreatment TGF-ß1 may predict RT-associated changes in echocardiography.


Assuntos
Neoplasias da Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Carcinoma Intraductal não Infiltrante/radioterapia , Doenças Cardiovasculares/diagnóstico , Fibrose/diagnóstico , Radioterapia Adjuvante/efeitos adversos , Fator de Crescimento Transformador beta1/metabolismo , Idoso , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Ecocardiografia/métodos , Feminino , Fibrose/etiologia , Fibrose/metabolismo , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
12.
BMC Cancer ; 19(1): 776, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387548

RESUMO

BACKGROUND: To report the clinical experience of eye sparing surgery (ESS) and adjuvant carbon-ion or proton radiotherapy (CIRT or PRT) for orbital malignancies. METHODS: An analysis of the retrospective data registry from the Shanghai Proton and Heavy Ion Center for patients with orbital tumors was conducted. The 2-year local progression-free, regional recurrence-free, distant metastasis-free, progression-free, and overall survival (LPFS, RRFS, DMFS, PFS, OS) rates as well as associated prognostic indicators were analyzed. Radiotherapy-induced acute and late toxicities were summarized. RESULTS: Between 7/2014 to 5/2018, 22 patients with orbital malignancies of various pathologies received ESS followed by CIRT (18), PRT (1), or PRT + CIRT boost (3). With a median follow-up of 20.25 (range 3.8-38.8) months, the 2-year OS, PFS, LPFS, RRFS, and DMFS rates were 100, 57.9, 92.9, 93.3, and 72.8%, respectively. No acute severe (i.e., ≥grade 3) toxicity was observed. Two patients experienced severe visual impairment as late toxicities. CONCLUSION: With few observed acute and late toxicities, particle radiotherapy following ESS provided effective local control with infrequent severe toxicities for patients with orbital malignancies.


Assuntos
Neoplasias Orbitárias/terapia , Adolescente , Adulto , Idoso , Biópsia , Terapia Combinada , Feminino , Radioterapia com Íons Pesados/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/mortalidade , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Prognóstico , Terapia com Prótons/métodos , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Análise de Sobrevida , Avaliação de Sintomas , Resultado do Tratamento , Adulto Jovem
13.
Medicina (Kaunas) ; 55(8)2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31416221

RESUMO

Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.


Assuntos
Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/cirurgia , Mastectomia , Complicações Pós-Operatórias , Adulto , Feminino , Humanos , Estudos Longitudinais , Obesidade , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
14.
Anticancer Res ; 39(8): 4467-4474, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366546

RESUMO

BACKGROUND/AIM: The aim of this study was to investigate the association between lymphopenia after breast conserving therapy (BCT) and ipsilateral breast tumor recurrence (IBTR) in early breast cancer (EBC). PATIENTS AND METHODS: We examined 216 EBC patients treated with partial mastectomy followed by radiotherapy (RT), none of whom received chemotherapy. Absolute lymphocyte counts (ALCs) during the two years after RT were collected from each patient: pretreatment ALC, ALC at 3-5 months (ALC1), ALC at 9-11 months, ALC at 15-17 months, and ALC at 21-23 months. RESULTS: The 102 patients with ALC1 ≤1,479 cells/µl (defined as lymphopenia) had significantly higher 10-year IBTR rate than the 102 patients with ALC1 >1,479 cells/µl (16.2% vs. 1%, p=0.0034). The multivariate analysis showed that age, resection margins, human epidermal growth factor receptor, and lymphopenia were significant predictors of IBTR. CONCLUSION: Lymphopenia is a potential predictor for IBTR in EBC patients treated with BCT.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Linfopenia/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Linfócitos , Linfopenia/induzido quimicamente , Linfopenia/epidemiologia , Linfopenia/patologia , Mastectomia , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Radioterapia Adjuvante/efeitos adversos
15.
Int J Radiat Oncol Biol Phys ; 105(5): 994-1004, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31461672

RESUMO

PURPOSE: Inflammatory bowel disease (IBD) is a known risk factor for rectal cancer, and RT is often an important part of therapy for these patients. Previously published studies have raised concerns for increased rates of RT toxicity in patients with IBD. We performed a matched case-control analysis to assess RT-related toxicity in a large sample of U.S. veterans afflicted with IBD and rectal cancer. METHODS AND MATERIALS: We identified 186 veterans with rectal cancer (71 Patients with IBD treated with RT, 71 matched controls without IBD treated with RT, and 44 nonmatched controls with IBD treated without RT) diagnosed between 2000 and 2015. We analyzed short- and long-term toxicity and mortality in multivariable logistic regression, Fine-Gray, and frailty models, adjusting for potential confounders. RESULTS: When comparing patients with and without IBD treated with RT there were no differences in RT breaks (adjusted odds ratio [aOR], 1.70; 95% confidence interval [CI], 0.38-4.76; P = .49) or the need for antidiarrheal medication during RT (aOR, 1.53; 95% CI, 0.70-3.35; P = .29). There was a trend toward higher risk of hospital admission during RT for RT + patients with IBD (aOR, 2.69; 95% CI, 0.88-8.22; P = .08). There were higher rates of small bowel obstruction (OR, 15; 95% CI, 1.9-115; P = .009) and a trend toward higher rates of abdominopelvic adhesions (OR, 3.6; 95% CI, 0.98-13; P = .05) in the RT + IBD cohort. However, compared with a nonmatched cohort of patients with IBD treated without RT there were no differences in long-term complications. No differences were found in other acute or long-term toxicities. Rectal cancer-specific mortality appeared similar across all cohorts. CONCLUSIONS: RT does not appear to increase the rates of acute or long-term toxicity in patients with IBD and should be considered a standard part of therapy when otherwise indicated.


Assuntos
Adenocarcinoma/radioterapia , Doenças Inflamatórias Intestinais/radioterapia , Neoplasias Retais/radioterapia , Adenocarcinoma/complicações , Estudos de Casos e Controles , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/terapia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Neoplasias Retais/complicações , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Resultado do Tratamento , Veteranos
16.
Br J Radiol ; 92(1102): 20190252, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31322910

RESUMO

OBJECTIVE: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities. METHODS: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3. RESULTS: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60-70 Gy;25-35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013). CONCLUSION: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging. ADVANCES IN KNOWLEDGE: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.


Assuntos
Radioterapia Conformacional/métodos , Radioterapia de Intensidade Modulada/métodos , Sarcoma/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Meios de Contraste , Extremidades , Feminino , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Radioterapia Conformacional/efeitos adversos , Radioterapia Conformacional/mortalidade , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/mortalidade , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/mortalidade , Sarcoma/patologia , Adulto Jovem
17.
Medicine (Baltimore) ; 98(29): e16507, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335723

RESUMO

BACKGROUND: To analyze whether BNP could be a potential biomarker for cardiac damage of breast cancer after radiotherapy. METHODS: PubMed, Web of Science, ProQuest and Medline were searched using the key words "breast cancer" ("breast tumor", "breast neoplasm", or "breast carcinoma"), "brain natriuretic peptide" (or BNP) and "radiotherapy" (or "radiation therapy"). Four articles were selected and analyzed using the STATA 12.0 software package. The standard mean difference (SMD) and its standard error for BNP were calculated to assess the relationship between BNP and radiotherapy for breast cancer patients. RESULTS: In total, 172 patients with breast cancer were identified. The pooled SMD was -0.233 (95% CI -1.113, -0.057). The pooled estimated SMD for all studies showed obvious significant difference (z = 3.99, P = .000). There was no publication bias. CONCLUSIONS: This meta-analysis suggested that BNP could be a biomarker of cardiac damage at high heart absorbed doses according to radiotherapy, especially for left breast cancer patients.


Assuntos
Neoplasias da Mama/radioterapia , Cardiotoxicidade/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Biomarcadores/sangue , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Mastectomia , Radioterapia Adjuvante/efeitos adversos
18.
Gynecol Obstet Invest ; 84(6): 606-615, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31344705

RESUMO

BACKGROUND: The yield of adjuvant radiotherapy in cervical cancer patients with intermediate risk factors is controversial. The objective of our meta-analysis was to shed light on this important issue. MATERIAL AND METHODS: Search was conducted in several databases. By independent screening of titles and abstracts, 2 investigators selected original researches examining the effect of adjuvant radiation treatment on overall survival and progression-free survival in cervical cancer patients with intermediate risk factors. RESULTS: Of the 5 articles included, a total of 591 patients with intermediate risk factors were encompassed. Statistical significance was noted in favor of radiation therapy in a subgroup of patients with 2 or more intermediate factors in terms of recurrence (OR 0.46 [95% CI 0.28-0.74, p = 0.001]) and overall survival (OR 1.86 [95% CI 1.03-3.36, p = 0.04]). After adding patients with one risk factor, radiation exerted a non-significant effect on recurrence rate, overall survival, disease-free survival, and 5-year cancer-specific survival, while increasing the rate of gastrointestinal side effects (2.4 vs. 0%, p = 0.0156). CONCLUSIONS: Adjuvant radiation therapy decreases the risk for recurrence and increases the overall survival in patients with 2 intermediate risk factors. These benefits were not shown after adding patients with one risk factor.


Assuntos
Radioterapia Adjuvante , Neoplasias do Colo do Útero/radioterapia , Intervalo Livre de Doença , Feminino , Gastroenteropatias/etiologia , Humanos , Histerectomia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Razão de Chances , Radioterapia Adjuvante/efeitos adversos , Fatores de Risco , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(6): 566-572, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31238636

RESUMO

Objective: To evaluate the effect of preservation of left colic artery (LCA) on postoperative anastomotic leakage in patients with rectal cancer after neoadjuvant therapy. Methods: A retrospective cohort study was conducted to collect data of rectal cancer patients at Department of Gastrointestinal Surgery of Fujian Cancer Hospital from September 2014 to August 2017. Inclusion criteria: (1) age of 18 to 79 years; (2) rectal adenocarcinoma confirmed by postoperative pathology; (3) patients without preoperative serious cardiovascular and cerebrovascular disease receiving preoperative neoadjuvant radiotherapy or chemoradiotherapy; (4) laparoscopic-assisted anterior rectal resection and distal ileostomy were performed simultaneously; (5) complete clinical data. Exclusion criteria: patients with extensive abdominal metastasis, or distant organ metastasis during operation, and combined organ resection. According to whether LCA was retained during operation, the patients were divided into two groups, then the intraoperative and postoperative clinical outcomes were compared. Moreover, univariate analysis and multivariate logistic regression were used to analyze risk factors of postoperative anastomotic leakage. Results: A total of 125 patients were included in this study, including 56 patients in the retained LCA group and 69 patients in the non-retained LCA group. Differences in baseline data, such as gender, age, diabetes mellitus, body mass index, hemoglobin, distance between tumor and anal margin, maximum diameter of tumor, preoperative neoadjuvant therapy, and ypTNM stage, between retained LCA group and non-retained LCA group were not statistically significant (all P>0.05), indicating that two groups were comparable. Meanwhile there were no significant differences in operation time, intraoperative blood loss, total number of lymph node harvested, number of harvested lymph node at the root of inferior mesenteric artery, circumferential margin, anastomotic bleeding, or postoperative hospital stay between two groups (all P>0.05). Thirteen patients in the non-retained LCA group (18.8%) developed postoperative anastomotic leakage, including 7 cases of grade A, 5 cases of grade B and 1 case of grade C, while in the retained LCA group, only 5.4% (3/56) of patients developed postoperative anastomotic leakage, including 1 case of grade A and 2 cases of grade B without case of grade C, whose difference was statistically significant (U=1674.500, P=0.028). Univariate analysis showed that preoperative hemoglobin <120 g/L and non-retained LCA were associated with postoperative anastomotic leakage (both P<0.05). Multivariate analysis cofirmed that preoperative hemoglobin < 120 g/L (OR=3.508, 95% CI: 1.158 to 10.628, P=0.017) and non-retained LCA (OR=4.065, 95%CI: 1.074 to 15.388, P=0.031) were independent risk factors for postoperative anastomotic leakage. Median follow-up time was 31 months (16 to 51 months), and no long-term complication was found. Local recurrence and distant metastasis were found in 1 case (1.8%) and 7 case (12.5%) in the retained LCA group, while those were found in 2 cases (2.9%) and 5 cases (7.2%) respectively, in the non-retained LCA group, whose differences were not statistically significant (P=1.000, P=0.321 respectively). Conclusion: Preservation of left colic artery not only can ensure radical lymph node dissection efficacy under the condition of similar operation time and blood loss, but also can effectively reduce the incidence of postoperative anastomotic leakage for rectal cancer patients after neoadjuvant therapy.


Assuntos
Adenocarcinoma/cirurgia , Fístula Anastomótica/etiologia , Artéria Mesentérica Inferior/cirurgia , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Reto/irrigação sanguínea , Quimiorradioterapia Adjuvante/efeitos adversos , Humanos , Terapia Neoadjuvante/efeitos adversos , Protectomia/métodos , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos
20.
Acta Oncol ; 58(9): 1250-1258, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31219359

RESUMO

Background: In this study, we evaluate the evolution of cardiac changes during a three-year follow-up after adjuvant breast radiotherapy (RT). Methods: Sixty patients with left-sided and 20 patients with right-sided early stage breast cancer without chemotherapy were included in this prospective study. Echocardiography and cardiac biomarkers were evaluated before, immediately after and 3 years after RT. Radiation doses to cardiac structures were calculated. Results: In echocardiography, left ventricle (LV) systolic measurements had impaired at 3 years compared to baseline: the mean global longitudinal strain (GLS) worsened from -18 ± 3 to -17 ± 3 (p = .015), LV ejection fraction from 62 ± 5% to 60 ± 4% (p = .003) and the stroke volume from 73 ± 16 mL to 69 ± 15 mL (p = .015). LV diastolic function was also negatively affected: the isovolumetric relaxation time was prolonged (p = .006) and the first peak of diastole decreased (p = .022). Likewise, left atrial (LA) measurements impaired. These changes in echocardiography were more prominent in left-sided than in right-sided patients. The concurrent aromatase inhibitor (AI) use was associated with GLS impairment. In all patients, the N-terminal pro-brain natriuretic peptide (proBNP) values were median (interquartile range) 74 (41-125) ng/L at baseline, 75 (41-125) ng/L at the end of RT and 96 (56-162) ng/L at 3 years (p < .001 from baseline to 3 years). However, proBNP did not increase in right-sided patients. Conclusion: During the 3-year follow-up after RT, negative subclinical changes in cardiac biomarkers and in LV systolic and diastolic function were observed. The measured changes were more pronounced in left-sided patients. In addition, AI use was associated with impaired cardiac systolic function.


Assuntos
Carcinoma Intraductal não Infiltrante/radioterapia , Coração/efeitos da radiação , Neoplasias Unilaterais da Mama/radioterapia , Adulto , Idoso , Biomarcadores/análise , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/efeitos da radiação , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/efeitos da radiação , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/análise , Doses de Radiação , Radioterapia Adjuvante/efeitos adversos , Volume Sistólico/efeitos da radiação , Fatores de Tempo , Neoplasias Unilaterais da Mama/patologia , Neoplasias Unilaterais da Mama/cirurgia , Função Ventricular Esquerda/efeitos da radiação
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