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1.
Rev Med Liege ; 76(5-6): 362-368, 2021 May.
Artigo em Francês | MEDLINE | ID: mdl-34080364

RESUMO

Radiotherapy established itself in the 20th century as an essential modality in the fight against cancer. The major technological advances of the last decades have allowed a considerable improvement in the therapeutic window. They have also paved the way for stereotactic radiotherapy and new indications. The aim of this article is to enable readers to understand external radiotherapy in 2021 and to understand the challenges of tomorrow. Three areas of improvement in the discipline will be described, the optimization of the prescribed therapeutic dose, the improvement of the distribution of this dose and, finally, the better understanding of radiobiology. For each of these axes, the current implications will be described as well as those which could/should have a major impact on the radiotherapy. FLASH radiotherapy will also be discussed.


Assuntos
Neoplasias , Radiocirurgia , Humanos , Neoplasias/radioterapia , Radiobiologia , Radioterapia
3.
Med Sci Monit ; 27: e930515, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33953150

RESUMO

BACKGROUND This study aimed to determine the value of the significant index in predicting symptomatic radiation pneumonitis (RP) in esophageal cancer patients, establish a nomogram prediction model, and verify the model. MATERIAL AND METHODS The patients enrolled were divided into 2 groups: a model group and a validation group. According to the logistic regression analysis, the independent predictors for symptomatic RP were obtained, and the nomogram prediction model was established according to these independent predictors. The consistency index (C-index) and calibration curve were used to evaluate the accuracy of the model, and the prediction ability of the model was verified in the validation group. Recursive partitioning analysis (RPA) was used for the risk stratification analysis. RESULTS The ratio of change regarding the pre-albumin at the end of treatment (P=0.001), platelet-to-lymphocyte ratio during treatment (P=0.027), and neutrophil-to-lymphocyte ratio at the end of treatment (P=0.001) were the independent predictors for symptomatic RP. The C-index of the nomogram model was 0.811. According to the risk stratification of RPA, the whole group was divided into 3 groups: a low-risk group, a medium-risk group, and a high-risk group. The incidence of symptomatic RP was 0%, 16.9%, and 57.6%, respectively. The receiver operating characteristic curve also revealed that the nomogram model has good accuracy in the validation group. CONCLUSIONS The developed nomogram and corresponding risk classification system have superior prediction ability for symptomatic RP and can predict the occurrence of RP in the early stage.


Assuntos
Neoplasias Esofágicas/radioterapia , Pneumonite por Radiação/diagnóstico , Pneumonite por Radiação/etiologia , Radioterapia/efeitos adversos , Plaquetas/patologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/patologia , Pneumonite por Radiação/patologia , Reprodutibilidade dos Testes , Risco
4.
Medicine (Baltimore) ; 100(21): e26014, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032719

RESUMO

BACKGROUND: Radiation enteritis (RE) is a common complication that often occurs after radiotherapy for abdominal and pelvic malignancies. RE could influence patients' quality of life seriously and it is difficult to cure by conventional treatments. A lot of studies have revealed that the external treatment of traditional Chinese medicine (TCM) for RE is a safe and economical approach, but there is no relevant systematic review. The present study performed a systematic review and meta-analysis to compare TCM external treatment and conventional treatment for RE to evaluate the effectiveness and safety of external treatment of traditional Chinese medicine in the treatment of RE. METHODS: Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wan-Fang database, VIP Chinese Science and Technique Journals Database, and the Chinese Biomedical Literature Database (CBM) were searched. The time of publication was limited from inception to April, 2021. Two reviewers independently searched for the selected articles and extract the data. The RevMan V.5.3 statistical software (Cochrane Collaboration) and Stata V.16.0 software were used to conduct the meta-analysis. RESULTS: We will show the results of this study in a peer-reviewed journal. CONCLUSION: This meta-analysis will provide reliable evidence for external treatment of TCM in the treatment of RE. INPLASY REGISTRATION NUMBER: INPLASY202140120.


Assuntos
Enterite/terapia , Medicina Tradicional Chinesa/métodos , Neoplasias/radioterapia , Qualidade de Vida , Lesões por Radiação/terapia , Enterite/diagnóstico , Enterite/etiologia , Enterite/psicologia , Humanos , Metanálise como Assunto , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/psicologia , Radioterapia/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
Anticancer Res ; 41(5): 2495-2499, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952477

RESUMO

BACKGROUND/AIM: Sino-nasal cancer is rare and often diagnosed at advanced stages. Some patients cannot receive curative treatment and are treated with palliative irradiation. We aimed to identify prognostic factors for survival to facilitate treatment personalization for this group. PATIENTS AND METHODS: Twelve patients treated with palliative radiotherapy for locally advanced sino-nasal cancer were retrospectively analyzed for survival. Ten characteristics were evaluated including age, gender, Karnofsky performance score (KPS), pre-radiotherapy hemoglobin, tumor site, lymph node involvement, histology, equivalent dose in 2 Gy-fractions, completion of radiotherapy and concurrent chemotherapy. RESULTS: On univariate analysis, KPS ≥70 (p<0.001) and completion of radiotherapy (p<0.001) were significantly associated with better survival. Chemotherapy showed a trend (p=0.097). In the multivariate analysis, KPS ≥70 was significant (p=0.025), and completion of radiotherapy showed a trend (p=0.080). CONCLUSION: KPS is an independent predictor of survival for palliative irradiation of sino-nasal cancer. Patients require close monitoring and care for side effects, since completion of radiotherapy is important for survival.


Assuntos
Neoplasias Nasais/radioterapia , Cuidados Paliativos/métodos , Radioterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias Nasais/patologia , Teste de Desfecho Sinonasal
6.
Anticancer Res ; 41(5): 2523-2531, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952480

RESUMO

BACKGROUND/AIM: To compare five radiotherapy methods for prostate cancer. PATIENTS AND METHODS: During 2005-2018, the data of patients with non-metastatic prostate cancer were retrospectively analysed. Patients were treated with high-dose-rate brachytherapy (HDR-BT); low-dose-rate brachytherapy (LDR-BT); or external-beam radiotherapy (EBRT), including conventionally fractionated radiotherapy (CFRT), moderate-hypofractionated radiotherapy (MHRT), and ultra-hypofractionated radiotherapy (UHRT). RESULTS: In total, 496 patients (149, HDR-BT; 100, LDR-BT; 100, CFRT; 97, MHRT, and 50, UHRT) with a median follow-up of 4.3 years were enrolled. The incidence of grade ≥2 acute genitourinary toxicities was significantly lower with HDR-BT (p<0.001) than with any other radiotherapy. The cumulative incidence of late grade ≥2 genitourinary toxicities was the highest with UHRT and significantly higher (p=0.005) with UHRT than with HDR-BT. Higher symptom score peaks were noted 4 weeks after therapy for LDR-BT than for EBRT. CONCLUSION: Physician-recorded toxicities were slightly lower with HDR-BT and patient-reported outcomes tended to be worse with LDR-BT.


Assuntos
Braquiterapia/efeitos adversos , Neoplasias da Próstata/radioterapia , Radioterapia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Neoplasias da Próstata/patologia , Doses de Radiação , Radioterapia/classificação
7.
Int J Mol Sci ; 22(5)2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33800829

RESUMO

Tumor-associated macrophages (TAMs) are the essential components of the tumor microenvironment. TAMs originate from blood monocytes and undergo pro- or anti-inflammatory polarization during their life span within the tumor. The balance between macrophage functional populations and the efficacy of their antitumor activities rely on the transcription factors such as STAT1, NF-κB, IRF, and others. These molecular tools are of primary importance, as they contribute to the tumor adaptations and resistance to radio- and chemotherapy and can become important biomarkers for theranostics. Herein, we describe the major transcriptional mechanisms specific for TAM, as well as how radio- and chemotherapy can impact gene transcription and functionality of macrophages, and what are the consequences of the TAM-tumor cooperation.


Assuntos
Antineoplásicos/efeitos adversos , Regulação Neoplásica da Expressão Gênica , Imunoterapia/efeitos adversos , Radioterapia/efeitos adversos , Transcrição Genética , /efeitos da radiação , Antineoplásicos/farmacologia , Citocinas/metabolismo , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/imunologia , Regulação Neoplásica da Expressão Gênica/efeitos da radiação , Humanos , Inflamação , Fatores Reguladores de Interferon/metabolismo , NF-kappa B/metabolismo , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/metabolismo , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Neoplasias/metabolismo , Neoplasias/radioterapia , Fatores de Transcrição STAT/metabolismo , Transcrição Genética/efeitos dos fármacos , Transcrição Genética/imunologia , Transcrição Genética/efeitos da radiação , Microambiente Tumoral/efeitos dos fármacos , Microambiente Tumoral/imunologia , Microambiente Tumoral/efeitos da radiação , Proteína Supressora de Tumor p53/metabolismo , /metabolismo
10.
Eur J Endocrinol ; 185(1): 67-75, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-33914702

RESUMO

Objective: Female childhood cancer survivors (CCS) are at risk of several late effects, such as metabolic syndrome (MetS) and premature ovarian insufficiency (POI). The objective is to study if POI is associated with risk of MetS and increased cardiovascular risk in CSS. Design: A cross-sectional study with a median time since the cancer diagnosis of 25 (12-41) years. Patients and controls were recruited from the South Medical Region of Sweden. Methods: The study included 167 female CCS, median age 34 (19-57) years, diagnosed with childhood cancer at median age 8.4 (0.1-17.9) years together with 164 controls, matched for age, sex, ethnicity, residence, and smoking habits. All subjects were examined with fasting glucose, insulin, HbA1c, and lipid profile. Fat mass was calculated with dual-energy X-ray absorptiometry (DXA), and questionnaires for medication were obtained. Detailed information of cancer treatment was available. Results: POI was present in 13% (22/167) among CCS (hypothalamic/pituitary cause excluded) and in none among controls. MetS was present in 14% (24/167) among all CCS (P = 0.001), in 23% (5/22) of those with POI (P < 0.001), compared with 4% (6/164) among controls. OR for MetS in all CCS compared with controls was 4.4 (95% CI: 1.8, 11.1) (P = 0.002) and among CCS with POI the OR was 7.7 (CI: 2.1, 28.1) (P = 0.002). Conclusion: The prevalence of MetS was higher in females treated for childhood cancer compared with controls, and the presence of POI significantly increased the risk of developing MetS.


Assuntos
Antineoplásicos/uso terapêutico , Sobreviventes de Câncer , Síndrome Metabólica/epidemiologia , Neoplasias/terapia , Insuficiência Ovariana Primária/epidemiologia , Radioterapia/métodos , Absorciometria de Fóton , Tecido Adiposo , Adulto , Hormônio Antimülleriano/sangue , Antineoplásicos Alquilantes/uso terapêutico , Glicemia/metabolismo , Composição Corporal , Estudos de Casos e Controles , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/sangue , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Insuficiência Ovariana Primária/metabolismo , Fatores de Risco , Triglicerídeos/sangue , Adulto Jovem
11.
BMJ Case Rep ; 14(4)2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858903

RESUMO

Stroke-like migraine attacks after radiation (SMART) syndrome is a rare and late complication of cerebral radiotherapy of unknown pathophysiology. It is characterised by hemicranial headache associated with persistent unilateral focal neurological signs and, occasionally, epileptic seizures. An increase in the frequency of SMART syndrome can be attributed to an increase in the survival rate of patients undergoing radiation therapy This study details the case of a 60-year-old woman with a history of small-cell lung carcinoma, who, in her late forties, was treated with prophylactic cranial irradiation. She presented at the emergency room with acute onset of global aphasia, lethargy and headache that started a few days before.


Assuntos
Neoplasias Pulmonares , Transtornos de Enxaqueca , Acidente Vascular Cerebral , Irradiação Craniana/efeitos adversos , Feminino , Cefaleia , Humanos , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Acidente Vascular Cerebral/etiologia
12.
Molecules ; 26(9)2021 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-33923028

RESUMO

Melatonin is a pleotropic molecule with numerous biological activities. Epidemiological and experimental studies have documented that melatonin could inhibit different types of cancer in vitro and in vivo. Results showed the involvement of melatonin in different anticancer mechanisms including apoptosis induction, cell proliferation inhibition, reduction in tumor growth and metastases, reduction in the side effects associated with chemotherapy and radiotherapy, decreasing drug resistance in cancer therapy, and augmentation of the therapeutic effects of conventional anticancer therapies. Clinical trials revealed that melatonin is an effective adjuvant drug to all conventional therapies. This review summarized melatonin biosynthesis, availability from natural sources, metabolism, bioavailability, anticancer mechanisms of melatonin, its use in clinical trials, and pharmaceutical formulation. Studies discussed in this review will provide a solid foundation for researchers and physicians to design and develop new therapies to treat and prevent cancer using melatonin.


Assuntos
Proliferação de Células/efeitos dos fármacos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Melatonina/uso terapêutico , Neoplasias/tratamento farmacológico , Apoptose/efeitos dos fármacos , Humanos , Metástase Neoplásica , Neoplasias/patologia , Neoplasias/radioterapia , Radioterapia/efeitos adversos
13.
BMC Cancer ; 21(1): 446, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888069

RESUMO

BACKGROUND: Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS: One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION: This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.


Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Glote/patologia , Laringe/efeitos da radiação , Prega Vocal/patologia , Prega Vocal/efeitos da radiação , Teorema de Bayes , Carcinoma de Células Escamosas/diagnóstico por imagem , Feminino , Glote/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Estadiamento de Neoplasias , Radioterapia/efeitos adversos , Radioterapia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
14.
Nutrients ; 13(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33801268

RESUMO

Radiation therapy is widely used in the treatment of tumor diseases, but it can also cause serious damage to the body, so it is necessary to find effective nutritional supplements. The main purpose of this study is to evaluate the protective effect of whey hydrolysate peptides (WHPs) against 60Coγ radiation damage in mice and explore the mechanism. BALB/c mice were given WHPs by oral gavage administration for 14 days. Then, some mice underwent a 30-day survival test after 8 Gy radiation, and other mice received 3.5 Gy radiation to analyze the changes in body weight, hematology and bone marrow DNA after three and 14 days. In addition, through further analysis of the level of oxidative stress and intestinal barrier function, the possible mechanism of the radioprotective effect of WHPs was explored. The study found WHPs can prolong survival time, restore body weight, and increase the number of peripheral blood white blood cells and bone marrow DNA content in irradiated mice. In addition, WHPs can significantly improve the antioxidant capacity, inhibit pro-inflammatory cytokines and protect the intestinal barrier. These results indicate that WHPs have a certain radioprotective effect in mice, and the main mechanism is related to reducing oxidative damage.


Assuntos
Raios gama/efeitos adversos , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/efeitos da radiação , Protetores contra Radiação/farmacologia , Soro do Leite , Animais , Antioxidantes/farmacologia , Peso Corporal , Medula Óssea/efeitos dos fármacos , Medula Óssea/efeitos da radiação , Citocinas , Dano ao DNA , Modelos Animais de Doenças , Feminino , Intestinos/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Radioterapia/efeitos adversos
15.
Oncol. (Guayaquil) ; 31(1): 1-7, Abril 30, 2021.
Artigo em Espanhol | LILACS | ID: biblio-1222455

RESUMO

Introducción: El hipofraccionamiento moderado (hRt) en cáncer de próstata, consisten en dismi-nuir el tiempo total de tratamiento con radioterapia, lo que mejora la adherencia terapéutica y opti-miza recursos tecnológicos. En cáncer de próstata, existe evidencia robusta con datos maduros a 5 años de seguimiento, donde se evidenció que hRtno es inferior al tratamiento con fraccionamiento estándar en control oncológico, con menor o igual toxicidad aguda y tardía. Se hace una revisión de la evidencia, dosis de tolerancia, contorneo de volúmenes objetivo (GTV-CTV-PTV) / órganos de ries-go, planificación y reproducibilidad del hRt en cáncer de próstata localizado.


Introduction: Moderate hypofractionation (hRt) in prostate cancer consists of reducing the total time of treatment with radiotherapy, which improves therapeutic adherence and optimizes technolog-ical resources. In prostate cancer, there is robust evidence with mature data at 5 years of follow-up, where it was evidenced that hRt is not inferior to treatment with standard fractionation in oncological control, with less or equal acute and late toxicity. A review of the evidence, tolerance dose, contouring of target volumes (GTV-CTV-PTV) / organs at risk, planning and reproducibility of hRt in localized prostate cancer is made.


Assuntos
Neoplasias da Próstata , Radioterapia , Hipofracionamento da Dose de Radiação , Radiação , Dosagem
17.
Radiol Med ; 126(5): 717-721, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33646520

RESUMO

BACKGROUND AND PURPOSE: COVID-19 constitutes a worldwide threat, prompting Italian Government to implement specific measures on March 8, 2020, to protect patients and health workers from disease transmission. The impact of preventive measures on daily activity of a radiotherapy facility may hamper the ability to fulfill normal workload burden. Thus, we assessed the number of delivered treatments in a specific observation period after the adoption of preventive measures (since March 11 to April 24, 2020) and compared it with the corresponding period of the year 2019. MATERIALS AND METHODS: Overall number of delivered fractions was related to actual time of platform daily activity and reported as a ratio between number of delivered fractions and activity hours (Fr/Hrs). Fr/Hrs were calculated and compared for two different periods of time, March 11-April 24, 2019 (Fr/Hrs1), and March 11-April 24, 2020 (Fr/Hrs2). RESULTS: Fr/Hrs1 and Fr/Hrs2 were 2.66 and 2.54 for year 2019 and 2020, respectively, for a Fr/Hrsratio of 1.07 (95% CI 1.03-1.12, p = 0.0005). Fr/Hrs1 was significantly higher than Fr/Hrs2 for SliR and PreciseR, with Fr/Hrsratio of 1.92 (95% CI 1.66-2.23, p < 0.0001) and 1.11 (95% CI 1.03-1.2, p = 0.003), respectively. No significant difference was reported for SynergyR and CyberknifeR with Fr/Hrsratio of 0.99 (95% CI 0.91-1.08, p = 0.8) and 0.9 (95% CI 0.77-1.06, p = 0.2), respectively. Fr/Hrs1 was significantly lower than Fr/Hrs2 for TomotherapyR, with Fr/Hrsratio of 0.88 (95% CI 0.8-0.96, p = 0.007). CONCLUSION: Preventive measures did not influence workload burden performed. Automation in treatment delivery seems to compensate effectively for health workers number reduction.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Radioterapia/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , /epidemiologia , Humanos , Itália/epidemiologia
18.
Lancet Oncol ; 22(3): 321-331, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33662285

RESUMO

BACKGROUND: Concurrent chemoradiotherapy is standard treatment for limited stage small-cell lung cancer (SCLC). Twice-daily thoracic radiotherapy of 45 Gy in 30 fractions is considered to be the most effective schedule. The aim of this study was to investigate whether high-dose, twice-daily thoracic radiotherapy of 60 Gy in 40 fractions improves survival. METHODS: This open-label, randomised, phase 2 trial was done at 22 public hospitals in Norway, Denmark, and Sweden. Patients aged 18 years and older with treatment-naive confirmed limited stage SCLC, Eastern Cooperative Oncology Group (ECOG) performance status 0-2, and measurable disease according to the Response Evaluation Criteria in Solid Tumors version 1.1 were eligible. All participants received four courses of intravenous cisplatin 75 mg/m2 or carboplatin (area under the curve 5-6 mg/mL × min, Calvert's formula) on day 1 and intravenous etoposide 100 mg/m2 on days 1-3 every 3 weeks. Participants were randomly assigned (1:1) in permuted blocks (sized between 4 and 10) stratifying for ECOG performance status, disease stage, and presence of pleural effusion to receive thoracic radiotherapy of 45 Gy in 30 fractions or 60 Gy in 40 fractions to the primary lung tumour and PET-CT positive lymph node metastases starting 20-28 days after the first chemotherapy course. Patients in both groups received two fractions per day, ten fractions per week. Responders were offered prophylactic cranial irradiation of 25-30 Gy. The primary endpoint, 2-year overall survival, was assessed after all patients had been followed up for a minimum of 2 years. All randomly assigned patients were included in the efficacy analyses, patients commencing thoracic radiotherapy were included in the safety analyses. Follow-up is ongoing. This trial is registered at ClinicalTrials.gov, NCT02041845. FINDINGS: Between July 8, 2014, and June 6, 2018, 176 patients were enrolled, 170 of whom were randomly assigned to 60 Gy (n=89) or 45 Gy (n=81). Median follow-up for the primary analysis was 49 months (IQR 38-56). At 2 years, 66 (74·2% [95% CI 63·8-82·9]) patients in the 60 Gy group were alive, compared with 39 (48·1% [36·9-59·5]) patients in the 45 Gy group (odds ratio 3·09 [95% CI 1·62-5·89]; p=0·0005). The most common grade 3-4 adverse events were neutropenia (72 [81%] of 89 patients in the 60 Gy group vs 62 [81%] of 77 patients in the 45 Gy group), neutropenic infections (24 [27%] vs 30 [39%]), thrombocytopenia (21 [24%] vs 19 [25%]), anaemia (14 [16%] vs 15 [20%]), and oesophagitis (19 [21%] vs 14 [18%]). There were 55 serious adverse events in 38 patients in the 60 Gy group and 56 serious adverse events in 44 patients in the 45 Gy group. There were three treatment-related deaths in each group (one neutropenic fever, one aortic dissection, and one pneumonitis in the 60 Gy group; one thrombocytic bleeding, one cerebral infarction, and one myocardial infarction in the 45 Gy group). INTERPRETATION: The higher radiotherapy dose of 60 Gy resulted in a substantial survival improvement compared with 45 Gy, without increased toxicity, suggesting that twice-daily thoracic radiotherapy of 60 Gy is an alternative to existing schedules. FUNDING: The Norwegian Cancer Society, The Liaison Committee for Education, Research and Innovation in Central Norway, the Nordic Cancer Union, and the Norwegian University of Science and Technology.


Assuntos
Neoplasias Pulmonares/radioterapia , Radioterapia/mortalidade , Carcinoma de Pequenas Células do Pulmão/radioterapia , Idoso , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Carcinoma de Pequenas Células do Pulmão/patologia , Taxa de Sobrevida
19.
Biomed Eng Online ; 20(1): 24, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653371

RESUMO

Osteosarcoma (OS) is the most common primary bone malignancy that affects children and young adults. OS is characterized by a high degree of malignancy, strong invasiveness, rapid disease progression, and extremely high mortality rate; it is considered as a serious threat to the human health globally. The incidence of OS is common in the metaphysis of long tubular bones, but rare in the spine, pelvis, and sacrum areas; moreover, majority of the OS patients present with only a single lesion. OS has a bimodal distribution pattern, that is, its incidence peaks in the second decade of life and in late adulthood. We examine historical and current literature to present a succinct review of OS. In this review, we have discussed the types, clinical diagnosis, and modern and future treatment methods of OS. The purpose of this article is to inspire new ideas to develop more effective therapeutic options.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Estadiamento de Neoplasias/métodos , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/terapia , Antineoplásicos/farmacologia , Progressão da Doença , Terapia Genética/métodos , Humanos , Imunoterapia/métodos , Imageamento por Ressonância Magnética , Radioterapia/métodos , Tomografia Computadorizada por Raios X
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