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1.
Anticancer Res ; 41(4): 2101-2110, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813420

RESUMO

BACKGROUND/AIM: To evaluate if topical support therapy during static-intensity modulated radiotherapy (sIMRT) course is able to equal the characteristic minimum risk for radiation proctitis of Image-guided volumetric modulated arc therapy (IG-VMAT) treatment among localized prostate cancer patients. PATIENTS AND METHODS: Rectal toxicity data of the above patients were retrospectively collected throughout three different clinical periods at our Radiotherapy Deparment: from October 2011 to December 2012, prostate cancer patients were treated with sIMRT and in advance supported by means of daily topical corticosteroids; from January 2013 to November 2016, topical corticosteroids were replaced by daily hyaluronic acid enemas; from December 2016 to May 2018 eligible patients were treated with newly introduced IG-VMAT supported by only on-demand topical corticosteroids. RESULTS: Among 359 eligible patients, IG-VMAT was proven generally more effective than sIMRT supported by topical medications in terms of proctitis reduction, although without clinical and practical relevance. CONCLUSION: Topical medications might have a role in radiation proctitis prevention.


Assuntos
Anti-Inflamatórios/administração & dosagem , Proctite/prevenção & controle , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Beclometasona/administração & dosagem , Enema/métodos , Humanos , Ácido Hialurônico/administração & dosagem , Itália , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Proctite/etiologia , Neoplasias da Próstata/patologia , Hipofracionamento da Dose de Radiação , Lesões por Radiação/prevenção & controle , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos
2.
Anticancer Res ; 41(3): 1587-1592, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33788753

RESUMO

BACKGROUND/AIM: Modern intensity-modulated radiotherapy (IMRT) is frequently applied to treat patients with nasal cavity and paranasal sinus (NC/PNS) malignancies. PATIENTS AND METHODS: One hundred and four patients who underwent radiotherapy (RT) between 1994 and 2020 were recognized. This analysis compared conventional-radiotherapy (CRT) and image-guided IMRT outcomes for NC/PNS malignancies. RESULTS: The median follow-up was 69 months. Eighty-eight patients (85%) were managed with image-guided IMRT. The median initial radiation dose was 65 Gy, with 68 Gy applied for patients treated with primary RT versus 63 Gy applied for adjuvant therapy (p=0.1). The 5-year locoregional control (LRC) was 85%. The locoregional recurrence rate was 18% following IMRT versus 31% in the 2D/3D-conventional RT group (p=0.09). Moreover, IMRT was associated with a lower inner-ear toxicity rate (8% vs. 20%, respectively; p=0.045). CONCLUSION: IMRT appears to be linked with higher LRC and lower inner-ear acute toxicities compared to conventional RT.


Assuntos
Cavidade Nasal , Neoplasias Nasais/radioterapia , Neoplasias dos Seios Paranasais/radioterapia , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Dosagem Radioterapêutica , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos
3.
Ann R Coll Surg Engl ; 103(3): e85-e87, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645266

RESUMO

Epidermolysis bullosa simplex (EBS) is a debilitating condition affecting the skin and mucous membranes that is characterised by frequent ulceration and blistering on trivial trauma. In EBS, oral cavity mucosal injuries lead to a high propensity for developing squamous cell carcinomas. Locally advanced tongue carcinoma arising in this background presents a challenging therapeutic conundrum. To our knowledge, this is the first case of aggressive locally advanced tongue carcinoma that has developed sporadically in a patient with EBS and no family history. Routine screening of oral mucosal lesions will lead to early detection and timely management of this debilitating condition.


Assuntos
Epidermólise Bolhosa Simples/diagnóstico , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias da Língua/diagnóstico por imagem , Adulto , Progressão da Doença , Epidermólise Bolhosa Simples/complicações , Epidermólise Bolhosa Simples/patologia , Evolução Fatal , Humanos , Masculino , Estadiamento de Neoplasias , Radiodermatite/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/complicações , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Estomatite/etiologia , Neoplasias da Língua/complicações , Neoplasias da Língua/patologia , Neoplasias da Língua/radioterapia
4.
BMC Neurol ; 21(1): 30, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468088

RESUMO

BACKGROUND: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear. METHODS: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to > 50 % stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group. RESULTS: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement. CONCLUSIONS: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.


Assuntos
Estenose das Carótidas/etiologia , Irradiação Craniana/efeitos adversos , Neoplasias de Cabeça e Pescoço/radioterapia , Hipotireoidismo/etiologia , Lesões por Radiação/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/epidemiologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
5.
Cancer Radiother ; 25(1): 39-44, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33419607

RESUMO

PURPOSE: Chemoradiotherapy (CRT) is considered as a standard treatment for unresectable and inoperable esophageal cancer (EC) patients. However, no consensus has been reached regarding the optimal synchronous chemotherapy regimen and the best combination of radiotherapy and chemotherapy. The aim of this study was to evaluate the efficacy and toxicity of raltitrexed plus cisplatin and docetaxel plus cisplatin to find a safe and effective concurrent chemotherapy schedule. PATIENTS AND METHODS: Our retrospective study included 151 EC patients treated with raltitrexed and cisplatin (RP) (n=90) or docetaxel and cisplatin (DP) (n=61) from 2011 till 2018. Survival outcomes and treatment related toxicity were analyzed between the two groups. RESULTS: PFS and OS were 18 and 34 months in the RP group, while 13 and 20 months in the DP group (P=0.118 and P=0.270). The 1-, 2-, 3-year survival rates of the RP group were 71.1, 55.4 and 46.4%. For the DP group, these were 63.9, 44.3 and 37.6%, respectively. Compared with DP group, RP group received a superior CR rate (68.9% versus 52.5%, P=0.041). There was a trend that the total number of toxic reactions in RP group was lower than that in DP group (P=0.058). CONCLUSIONS: Even RP and DP groups have the similar survival outcomes and toxicity, raltitrexed/cisplatin get a higher complete response rate. Our study suggests that raltitrexed combined with cisplatin is a safe and effective concurrent chemotherapy regimen and it might be used as an alternative for cisplatin/5-FU and cisplatin/docetaxel in CCRT for EC patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/terapia , Radioterapia de Intensidade Modulada/métodos , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimiorradioterapia/efeitos adversos , Cisplatino/administração & dosagem , Docetaxel/administração & dosagem , Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quinazolinas/administração & dosagem , Radioterapia de Intensidade Modulada/efeitos adversos , Análise de Regressão , Estudos Retrospectivos , Taxa de Sobrevida , Tiofenos/administração & dosagem , Resultado do Tratamento
6.
Anticancer Res ; 41(1): 467-475, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419845

RESUMO

BACKGROUND/AIM: Hypofractionated accelerated radiotherapy (HypoAR) is widely applied for the treatment of early laryngeal cancer. Its role in locally advanced head-neck cancer (LA-HNC) is unexplored. PATIENTS AND METHODS: We present results of a prospective trial on 124 patients with LA-HNC, treated with radio-chemotherapy with three different HypoAR fractionations (3.5 Gy/day × 14-15 fractions, 2.7 Gy/day × 20-21 fractions, and 2.5 Gy/day × 21-22 fractions). RESULTS: Protraction of the overall treatment time due to oropharyngeal mucositis was enforced in 18/57 laryngeal, 6/19 nasopharyngeal, and 15/48 cancer patients with other tumors. Regarding late toxicities, laryngeal edema grade 3 was noted in 5/57 patients with laryngeal cancer, while severe dysphagia was noted in 4/124 and tracheoesophageal fistula formation in 1/124 patients. The complete response rates obtained were 73%, 84%, and 67% in patients with laryngeal, nasopharyngeal, and other tumors, respectively. The 3-year locoregional progression-free survival was 58%, 73%, and 55%, respectively. CONCLUSION: HypoAR chemoradiotherapy is feasible, with acceptable early and late radiotherapy toxicities, response rates and LPFS.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/radioterapia , Hipofracionamento da Dose de Radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Terapia Combinada , Fracionamento da Dose de Radiação , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Resultado do Tratamento , Adulto Jovem
7.
Lancet Oncol ; 22(2): 190-197, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33450184

RESUMO

BACKGROUND: A novel approach for managing malignant pleural mesothelioma, surgery for mesothelioma after radiotherapy (SMART), consisting of a short accelerated course of high-dose, hemithoracic, intensity modulated radiotherapy (IMRT) followed by extrapleural pneumonectomy was developed. The aim of this study was to evaluate the clinical feasibility of the SMART protocol. METHODS: In this single-centre, phase 2 trial, patients aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-2, with histologically proven, resectable, cT1-3N0M0 disease who had previously untreated malignant pleural mesothelioma were eligible for inclusion. Patients received 25 Gy in five daily fractions over 1 week to the entire ipsilateral hemithorax with a concomitant 5 Gy boost to high risk areas followed by extrapleural pneumonectomy within 1 week. Adjuvant chemotherapy was offered to patients with ypN+ disease on final pathology. The primary endpoint was feasibility, which was defined as the number of patients with 30-day perioperative treatment-related death (grade 5 events) or morbidity (grade 3 or 4 events). A key secondary endpoint was cumulative incidence of distant recurrence. The final analysis was done on an intention-to-treat basis (including all eligible patients). This trial is registered with ClinicalTrials.gov, NCT00797719. FINDINGS: Between Nov 1, 2008, and Oct 31, 2019, 102 patients were enrolled onto the trial and 96 eligible patients were treated with SMART on protocol and included in the analysis. Extrapleural pneumonectomy was done at a median of 5 days (range 2-12) after completing IMRT. 47 (49%) patients had 30-day perioperative grade 3-4 events and one (1%) patient died within 30 days perioperatively (grade 5 event; pneumonia). After a median follow-up of 46·8 months (IQR 13·4-61·2), the 5-year cumulative incidence of distant recurrence was 62 (63·3% [95% CI 52·3-74·4]). The most common first sites of recurrence were the contralateral chest (33 [46%] of 72 patients) and the peritoneal cavity (32 [44%]). INTERPRETATION: Results from this study suggest that extrapleural pneumonectomy after radiotherapy can be done with good early and long-term results. However, minimising grade 4 events on the protocol is technically demanding and might affect survival beyond the post-operative period. FUNDING: Princess Margaret Hospital Foundation Mesothelioma Research Fund.


Assuntos
/radioterapia , Pneumonectomia , Adolescente , Adulto , Idoso , Quimioterapia Adjuvante , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Masculino , /patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Radioterapia de Intensidade Modulada/efeitos adversos
8.
Support Care Cancer ; 29(1): 127-134, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32318870

RESUMO

PURPOSE: The aim of this study was to evaluate the distribution of acute clinical complications that involve the oral cavity (oral mucositis and salivary flow), general health status (Karnofsky performance status scale (KPS) and weight), and quality of life using the worst performance throughout radiotherapy treatment by intensity-modulated radiation therapy (IMRT) in the head and neck region and to evaluate the correlation between these variables. METHODS: This prospective, longitudinal study evaluated 32 patients who were undergoing IMRT for head and neck tumors. The measures were collected weekly through standardized protocols and a quality of life questionnaire (UW-QOL version 4). RESULTS: The worst performance for all variables was concentrated in treatment weeks 2 and 5. Regarding quality of life, the emotional dimensions were the most affected (pain 62.86; activity 55; recreation 43.57; mood 49.97; shoulder 57.06; anxiety 42.91). There were a higher number of moderate mucositis correlations with quality of life (mucositis × KPS 0.002; mucositis × weight loss 0.03; mucositis × pain 0.001; mucositis × activity 0.002; mucositis × recreation 0.001; mucositis × swallowing 0.002; mucositis × saliva 0.006; mucositis × mood 0.007; mucositis × anxiety 0.002). CONCLUSIONS: IMRT treatment severely deteriorated the patients' quality of life. There were important correlations between the clinical variables and quality of life, especially mucositis.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Mucosa Bucal/patologia , Radioterapia de Intensidade Modulada/efeitos adversos , Glândulas Salivares/patologia , Estomatite/etiologia , Xerostomia/patologia , Adulto , Idoso , Feminino , Humanos , Avaliação de Estado de Karnofsky , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida/psicologia , Inquéritos e Questionários
9.
Cancer Radiother ; 25(1): 77-91, 2021 Feb.
Artigo em Francês | MEDLINE | ID: mdl-33358082

RESUMO

Pelvic bone marrow is the site of nearly 50% of total hematopoiesis. Radiation therapy of pelvic lymph node areas, and cancers located near the bony structures of the pelvis, exposes to hematological toxicity in the range of 30 to 70%. This toxicity depends on many factors, including the presence or absence of concomitant chemotherapy and its type, the volume of irradiated bone, the received doses, or the initial hematopoietic reserve. Intensity modulated radiation therapy allows the optimisation of dose deposit on at risk organs while providing optimal coverage of target volumes. However, this suggests that dose constraints should be known precisely to limit the incidence of radiation side effects. This literature review focuses firstly on pelvic lymph node areas and bony volumes nearby, then on the effects of irradiation on bone marrow and the current dosimetric constraints resulting from it, and finally on hematological toxicities by carcinologic location and progress in reducing these toxicities.


Assuntos
Medula Óssea/efeitos da radiação , Quimiorradioterapia/efeitos adversos , Hematopoese/efeitos da radiação , Irradiação Linfática/efeitos adversos , Ossos Pélvicos/efeitos da radiação , Neoplasias Pélvicas/terapia , Neoplasias do Ânus/terapia , Quimiorradioterapia/métodos , Feminino , Neoplasias dos Genitais Femininos/terapia , Células-Tronco Hematopoéticas/efeitos da radiação , Humanos , Masculino , Células-Tronco Mesenquimais/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Pelve , Neoplasias da Próstata/terapia , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Neoplasias Retais/terapia , Irradiação Corporal Total/efeitos adversos
10.
Niger J Clin Pract ; 23(12): 1683-1689, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33355821

RESUMO

Objectives: The study aims to retrospectively review the survival and toxicity outcomes of adaptive helical tomotherapy (HT) treatment of nasopharyngeal carcinoma (NPC) patients over 5 years. Methods: Between February 2010 and September 2017, 67 biopsy-proven non-metastatic NPC patients were analyzed. All patients except one received concurrent chemotherapy and treated with adaptive Simultaneous integrated boost- intensity-modulated radiation therapy (SIB-IMRT). The median age was 48.5 years (range, min: 11 max: 78) with male predominance (82.1% vs. 17.9%). Neck mass was the most common presenting symptom followed by hearing problems (52% and 24%). Results: The mean dose with standard deviation (sd) of D50 to patients' parotid glands and cochleae were 33 ± 11 Gy; 31 ± 11 9 Gy and 37 ± 11 14 Gy; 34 ± 11 14 Gy, respectively. Locoregional progression-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) estimated at 2 and 5 years were 83% and 63%, 78.4% and 61.7%, 83% and 69%, 86% and 71%, respectively. Acute Grade 3 or higher dysphagia and mucositis observed in 28 (42%) patients who required daily iv fluid transfusion and/or hyperalimentation. None of the patients had grade 3 and higher mucous membranes and salivary gland toxicity beyond 6 months. Two patients had ≥ grade 3 late toxicity. During the median 51 months (range 2-100) follow up, thirteen patients relapsed (19.4%), six of them (8.9%) recurred locoregionally, and 7 (10.4%) of them developed distant metastasis. Conclusion: The present study reemphasizes that adaptive SIB-IMRT with HT is a good option for the management of NPC with comparable loco-regional control rates and low salivary gland toxicity.


Assuntos
Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Criança , Humanos , Masculino , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Recidiva Local de Neoplasia , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
11.
Zhonghua Zhong Liu Za Zhi ; 42(12): 1040-1047, 2020 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-33342161

RESUMO

Objective: To explore the therapeutic efficacy and safety of elective nodal irradiation (ENI) and involved field irradiation (IFI) in intensity-modulated radiotherapy for esophageal cancer, screen the patients suitable to undergo ENI radiotherapy and provide evidences for individual treatment of esophageal cancer. Methods: A retrospective analysis was performed on the clinical data of 924 patients with esophageal cancer who received definitive intensity-modulated radiotherapy in our hospital from January 2006 to December 2015. Among them, 272 patients received ENI and the other 652 patients received IFI. The clinicopathologic characteristics of 272 cases in ENI group and 652 cases in IFI group, who were recruited according to the balance of propensity score matching method, were compared. The Kaplan-Meier method was used to calculate 1-year, 3-years and 5-years local-regional failure-free survival (LRFFS), progression-free survival (PFS) and overall survival (OS) rates. The univariate and multivariate analysis of prognostic factors were also determined by Cox proportional hazard model and Long-rank test. Results: The clinicopathologic characteristics of these two group were not significantly different (P>0.05). The median follow-up time was 85.9 months and the follow-up rate was 95.9%. The 1-year, 3-years, 5-years PFS rates of the ENI groups were 65.3%, 31.7%, 18.4%, respectively, higher than 54.0%, 20.9%, 12.7% of the IFI group (P=0.001). The 1-year, 3-years, 5-years OS rates of the ENI groups were 79.0%, 43.7%, 24.9%, respectively, higher than 75.0%, 31.8%, 17.2% of the IFI group (P=0.003). In multivariate analysis, the sex, tumor volume, N stage and radiation field were independent factors for PFS and OS (P<0.05). Subgroup analysis showed that patients with male, age≤66 year, cervical and upper-thoracic location, tumor length≤6 cm, T1-2 stage, N0-1 stage, Ⅰ-Ⅱ stage, tumor volume≤50 cm(3), dosage>60 Gy and≤2 cycles of chemotherapy in the ENI group had a better survival rate than those in the IFI group (P<0.05). The total failure rate, local-regional failure rate in ENI group were significantly lower than those of IFI group (P=0.001, P=0.004). The incidence of bone marrow depression≥ grade 2 and 3 in ENI group was higher than that of the IFI group (P<0.05). However, the incidences of radioactive esophagitis≥ grade 3, radioactive pneumonia and late adverse reactions were not significantly different between these two groups (P>0.05). Conclusion: Compared with IFI, ENI can significantly improve the long-term survival for young, early TN stage and cervical/upper-thoracic esophageal cancer patients underwent chemotherapy.


Assuntos
Neoplasias Esofágicas , Radioterapia de Intensidade Modulada , Idoso , Neoplasias Esofágicas/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
12.
Anticancer Res ; 40(11): 6499-6503, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109589

RESUMO

BACKGROUND/AIM: Late toxicity and long-term outcomes of a phase I-II trial on patients with prostate cancer treated with an integrated boost to the dominant intraprostatic lesion (DIL) are reported. PATIENTS AND METHODS: Patients were treated using intensity-modulated radiotherapy, with a simultaneous integrated boost to the DIL, defined on staging magnetic resonance imaging, delivering 72 Gy in 1.8 Gy/fraction to prostate/seminal vesicles and 80 Gy in 2 Gy/fraction to the DIL. The primary endpoint was acute toxicity and secondary endpoints were late toxicity and biochemical disease-free survival. RESULTS: Forty-four patients were enrolled. The median follow-up was 120 (range=25-150) months. Five-year rates of grade 3 late gastrointestinal and genitourinary toxicity were 2.3% and 4.5%, respectively; only one grade 4 late genitourinary toxicity was recorded. Five-year biochemical relapse-free and overall survival rates were 95.3% and 95.5%, respectively. CONCLUSION: The treatment was well tolerated and achieved excellent results in terms of outcome in patients with low-intermediate Gleason's score and low risk of nodal metastasis.


Assuntos
Próstata/efeitos da radiação , Neoplasias da Próstata/radioterapia , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Próstata/diagnóstico por imagem , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Radioterapia de Intensidade Modulada/efeitos adversos
13.
Am J Clin Oncol ; 43(9): 628-635, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889832

RESUMO

OBJECTIVES: Stereotactic body radiation treatment represents an intriguing therapeutic option for patients with early-stage prostate cancer. In this phase II study, stereotactic body radiation treatment was delivered by volumetric modulated arc therapy with flattening filter free beams and was gated using real-time electromagnetic transponder system to maximize precision of radiotherapy and, potentially, to reduce toxicities. MATERIALS AND METHODS: Patients affected by histologically proven prostate adenocarcinoma and National Comprehensive Cancer Network (NCCN) intermediate class of risk were enrolled in this phase II study. Beacon transponders were positioned transrectally within the prostate parenchyma 7 to 10 days before simulation computed tomography scan. The radiotherapy schedule was 38 Gy in 4 fractions delivered every other day. Toxicity assessment was performed according to Common Terminology Criteria for Adverse Events (CTCAE), v4.0. RESULTS: Thirty-six patients were enrolled in this study. Median initial prostate-specific antigen was 7.0 ng/mL (range: 2.3 to 14.0 ng/mL). Median nadir-prostate-specific antigen after treatment was 0.2 ng/mL (range: 0.006 to 4.8 ng/mL). A genitourinary acute toxicity was observed in 21 patients (dysuria grade [G] 1: 41.7%, G2: 16.7%). Gastrointestinal acute toxicity was found in 9 patients (proctitis G1: 19.4%, G2: 5.6%). Late toxicity was mild (genitourinary toxicity G1: 30.6%; G2: 8.3%; gastrointestinal toxicity G1: 13.9%; G2: 19.4%). At a median follow-up time of 41 months, 3 biochemical recurrences were observed (2 local recurrences, 1 distant metastasis). Three-year biochemical recurrence-free survival was 89.8% (International Society of Urologic Pathology Grade Group 2: 100%, Grade Group 3: 77.1%, P=0.042). CONCLUSION: Ultrahypofractionated radiotherapy, delivered with flattening filter free-volumetric modulated arc therapy and gated by electromagnetic transponders, is a valid option for intermediate-risk prostate cancer.


Assuntos
Adenocarcinoma/radioterapia , Recidiva Local de Neoplasia/sangue , Neoplasias da Próstata/radioterapia , Radiocirurgia/métodos , Radioterapia de Intensidade Modulada , Adenocarcinoma/secundário , Idoso , Diarreia/etiologia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Disuria/etiologia , Fenômenos Eletromagnéticos , Humanos , Masculino , Pessoa de Meia-Idade , Noctúria/etiologia , Proctite/etiologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos
14.
Phys Med Biol ; 65(17): 175014, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32663813

RESUMO

The purpose of this work was to develop a deep learning (DL) based algorithm, Automatic intensity-modulated radiotherapy (IMRT) Planning via Static Field Fluence Prediction (AIP-SFFP), for automated prostate IMRT planning with real-time planning efficiency. The following method was adopted: AIP-SFFP generates a prostate IMRT plan through predictions of fluence maps using patient anatomy. No inverse planning is required. AIP-SFFP is centered on a custom-built deep learning (DL) neural network for fluence map prediction. Predictions are imported to a commercial treatment-planning system for dose calculation and plan generation. AIP-SFFP was demonstrated for prostate IMRT simultaneously-integrated-boost planning (58.8 Gy/70 Gy to PTV58.8 Gy/PTV70 Gy in 28 fx, PTV = Planning Target Volume). Training data was generated from 106 patients using a knowledge-based planning (KBP) plan generator. Two types of 2D projection images were designed to represent structures' sizes and locations, and a total of eight projections were utilized to describe targets and organs-at-risk. Projections at nine template beam angles were stacked as inputs for artificial intelligence (AI) training. 14 patients were used as independent tests. The generated test plans were compared with the plans from the KBP training plan generator and clinic practice. The following results were obtained: After normalization (PTV70 Gy V70 Gy = 95%), all 14 AI plans met institutional criteria. The coverage of PTV58.8 Gy in the AI plans was comparable to KBP and clinic plans without statistical significance. The whole body (BODY) D1cc and rectum D0.1cc of AI plans were slightly higher (<1 Gy) compared to KBP and clinic plans; in contrast, the bladder D1cc and other rectum and bladder low doses in the AI plans were slightly improved without clinical relevance. The overall isodose distribution in the AI plans was comparable with KBP plans and clinical plans. AIP-SFFP generated each test plan within 20s including the prediction and the dose calculation. In conclusion, AIP-SFFP was successfully developed for prostate IMRT planning. AIP-SFFP demonstrated good overall plan quality and real-time efficiency. Showing great promise, AIP-SFFP will be investigated for immediate clinical application.


Assuntos
Aprendizado Profundo , Neoplasias da Próstata/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada , Automação , Humanos , Masculino , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos
15.
Anticancer Res ; 40(7): 4183-4190, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620668

RESUMO

BACKGROUND/AIM: The present study aimed to analyze the treatment outcome after definitive radiotherapy (dRT) using volumetric-modulated arc therapy (VMAT) in patients with hypopharyngeal cancer (HPC), including an examination of late toxicities. PATIENTS AND METHODS: A total of 62 patients with HPC, who underwent dRT using VMAT, were analyzed. Overall survival (OS), progression-free survival (PFS), laryngoesophageal dysfunction-free survival (LEDFS), and locoregional control (LRC) were calculated. RESULTS: The median follow-up period was 49 months. The 3- and 5-year OS, PFS, LEDFS, and LRC rates were 77% and 60%, 61% and 56%, 66% and 53%, and both 79%, respectively. Regarding late toxicities, 11 (17.7%) patients developed grade ≥2 late toxicity. Grade 3 dysphagia was observed in 4 (6.5%) patients, and grade 2 xerostomia in 6 (9.7%). CONCLUSION: VMAT was an effective treatment for HPC, with a low incidence of late toxicities.


Assuntos
Neoplasias Hipofaríngeas/radioterapia , Radioterapia de Intensidade Modulada , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Cisplatino/uso terapêutico , Feminino , Humanos , Neoplasias Hipofaríngeas/tratamento farmacológico , Neoplasias Hipofaríngeas/mortalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Radioterapia de Intensidade Modulada/efeitos adversos
16.
Medicine (Baltimore) ; 99(29): e20443, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702809

RESUMO

BACKGROUND: Although common, the use of concurrent chemoradiotherapy with adjuvant chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We, therefore, conducted a retrospective cohort study to investigate whether adjuvant chemotherapy confers survival gains to stage II NPC patients. METHODS: In this study, we examined whether combining adjuvant chemotherapy (AC) and/or concurrent chemotherapy with radiotherapy (CCRT) improved survival in patients with stage II NPC. Three hundred thirty-five stage II NPC patients were retrospectively analyzed between June 2003 and June 2016 and received CCRT; some patient groups also received AC every 3 weeks for 2 to 3 cycles. RESULTS: The median follow-up duration was 72 months for all patients (range, 26-151 months) and the estimated 5-year locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 95.1%, 97.8%, 93.5%, and 94.3%. At the last follow-up, there were no statistically significant differences among the CCRT and CCRT+AC groups in 5-year LRRFS (95.2% vs 94.9%, P = .599), DMFS (98.5% vs 92.4%, P = .152), PFS (93.8% vs 90.2%, P = .599), or OS (95.5% vs 93.9%, P = .682) rates. CONCLUSION: The analyses revealed that a combined regimen was not an independent prognostic factor for any survival outcome. However, patients who received CCRT plus AC experienced more acute adverse events than those who received CCRT alone. Thus, the addition of AC to CCRT did not improve survival outcomes, but was associated with higher incidences of acute treatment-associated toxicities than CCRT alone in patients with stage II NPC.


Assuntos
Quimiorradioterapia/métodos , Quimioterapia Adjuvante/métodos , Carcinoma Nasofaríngeo/tratamento farmacológico , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Quimiorradioterapia/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Terapia Combinada/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/mortalidade , Estadiamento de Neoplasias , Prognóstico , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
18.
Phys Med Biol ; 65(19): 195015, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32235058

RESUMO

We propose a multi-view data analysis approach using radiomics and dosiomics (R&D) texture features for predicting acute-phase weight loss (WL) in lung cancer radiotherapy. Baseline weight of 388 patients who underwent intensity modulated radiation therapy (IMRT) was measured between one month prior to and one week after the start of IMRT. Weight change between one week and two months after the commencement of IMRT was analyzed, and dichotomized at 5% WL. Each patient had a planning CT and contours of gross tumor volume (GTV) and esophagus (ESO). A total of 355 features including clinical parameter (CP), GTV and ESO (GTV&ESO) dose-volume histogram (DVH), GTV radiomics, and GTV&ESO dosiomics features were extracted. R&D features were categorized as first- (L1), second- (L2), higher-order (L3) statistics, and three combined groups, L1 + L2, L2 + L3 and L1 + L2 + L3. Multi-view texture analysis was performed to identify optimal R&D input features. In the training set (194 earlier patients), feature selection was performed using Boruta algorithm followed by collinearity removal based on variance inflation factor. Machine-learning models were developed using Laplacian kernel support vector machine (lpSVM), deep neural network (DNN) and their averaged ensemble classifiers. Prediction performance was tested on an independent test set (194 more recent patients), and compared among seven different input conditions: CP-only, DVH-only, R&D-only, DVH + CP, R&D + CP, R&D + DVH and R&D + DVH + CP. Combined GTV L1 + L2 + L3 radiomics and GTV&ESO L3 dosiomics were identified as optimal input features, which achieved the best performance with an ensemble classifier (AUC = 0.710), having statistically significantly higher predictability compared with DVH and/or CP features (p < 0.05). When this performance was compared to that with full R&D-only features which reflect traditional single-view data, there was a statistically significant difference (p < 0.05). Using optimized multi-view R&D input features is beneficial for predicting early WL in lung cancer radiotherapy, leading to improved performance compared to using conventional DVH and/or CP features.


Assuntos
Reação de Fase Aguda/diagnóstico , Algoritmos , Neoplasias Pulmonares/radioterapia , Aprendizado de Máquina , Radioterapia de Intensidade Modulada/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Perda de Peso/efeitos da radiação , Reação de Fase Aguda/diagnóstico por imagem , Reação de Fase Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
20.
Indian J Cancer ; 57(1): 70-75, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32129297

RESUMO

Background: Sexual dysfunction is an important side-effect after radiotherapy (RT) for prostate cancer (PCa). The aim of this study was to compare sexual functions of PCa patients before and after intensity-modulated RT and to analyze their correlation with penile bulb (PB) doses and patient characteristics. Materials and Methods: Forty-two patients who underwent RT ± hormone therapy for PCa between 2010 and 2013 were analyzed. Sexual functions assessed by patient-reported questionnaire and physician reported scale before and 3 years after treatment. The effect of patients' age, prostate volume, testosterone levels, comorbidity, smoking status, tumor stage, RT technique, hormone therapy, and PB doses to sexual functions were investigated. Results: After 3 years of RT, 64.3% of all patients had a lower erectile score; and 75% of patients who were previously potent (n = 24) had become impotent after treatment. However sexual desire still remained in 75.8% of patients who had desire before treatment (n = 33). Statistical analysis showed that two parameters were correlated with postradiotherapy impotency outcome; PB mean radiation dose (P = 0.033) and testosterone levels (P = 0.032). Conclusions: RT, despite modern techniques, affects the sexual function of PCa patients in varying degrees. Reducing radiation doses to penile structures may play a role in preventing erectile dysfunction.


Assuntos
Disfunção Erétil/terapia , Neoplasias da Próstata/complicações , Radioterapia de Intensidade Modulada/efeitos adversos , Idoso , Humanos , Masculino , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos
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