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1.
Bol. méd. postgrado ; 36(2): 21-25, dic.2020. tab, graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1117893

RESUMO

El síndrome de lisis tumoral (SLT) es una complicación potencialmente letal provocada por la liberación masiva de ácidos nucleicos, potasio y fosfato hacia la circulación sistémica lo cual se asocia a graves trastornos del metabolismo hidroelectrolítico. Se realizó una revisión retrospectiva de historias clínicas con el objetivo de describir las características clínicas de los pacientes con sospecha de SLT que ingresaron al Servicio de Medicina Interna del Hospital General Universitario Dr. Luis Gómez López durante el lapso 2017-2018. El 50% de los pacientes tenían una edad comprendida entre 51 y 70 años, siendo el 65% de sexo femenino. Los canceres más frecuentemente encontrados fueron el cáncer de mama (29%), cáncer gástrico (15%) y el linfoma no Hodgkin (12%). Todos los pacientes presentaron al menos tres de las manifestaciones clínicas asociadas al SLT entre las cuales se encuentran náuseas, vómitos, anorexia, debilidad, calambres, hiperreflexia, oliguria, anuria, hematuria, hipotensión, convulsiones y deshidratación. El 46% de los pacientes presentaron hiperpotasemia, mientras que 36% mostraron hipocalcemia y 18% hiperfosfatemia. El 76% de los pacientes cursaron con una creatinina > 1,4 mg/dl. El diagnóstico definitivo de SLT no fue posible realizarlo en ninguno de los pacientes incluidos en este estudio debido a la falta de estudios paraclínicos necesarios para satisfacer los criterios según los lineamientos internacionales(AU)


Tumor lysis syndrome (TLS) is a potentially lethal complication due to massive release of nucleic acids, potassium and phosphate into the systemic circulation which is associated with severe hydroelectrolitic metabolic disorders. A retrospective review of clinical charts was performed in order to describe clinical characteristics of patients with possible TLS that were admitted to the Servicio de Medicina Interna of the Hospital General Universitario Dr. Luis Gómez López during the period 2017-2018. The results show that 50% of patients were between 51 and 70 years old and 65% were female. Breast cancer (29%), stomach cancer (15%) and Non-Hodgkin lymphoma (12%) were more frequent in patients with possible TLS. All patients showed at least three of the clinical features commonly associated with TLS such as nausea, vomiting, anorexia, weakness, cramps, hyperreflexia, oliguria, anuria, hematuria, hypotension, convulsion and dehydration. 46% of patients had hyperkalemia, 36% hypocalcemia and 18% hyperphosphatemia. Creatinine levels > 1,4 mg/dl were seen in 76% of patients. Definitive diagnosis of TLS was not possible in any of the patients included in this study due to the lack of laboratory studies required according to international guidelines(AU)


Assuntos
Humanos , Fosfatos , Potássio , Radioterapia , Neoplasias da Mama , Ácidos Nucleicos , Síndrome de Lise Tumoral/fisiopatologia , Tratamento Farmacológico , Prescrições de Medicamentos , Cuidados Críticos , Hematologia , Medicina Interna , Oncologia
2.
J UOEH ; 42(3): 261-266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32879190

RESUMO

Radiation recall pneumonitis is a phenomenon in which a recall-triggering drug induces an acute inflammatory reaction in the lungs, corresponding to a previously irradiated area. Radiation recall reactions have been reported to occur following treatments with various cytotoxic anticancer agents and molecular-targeting drugs; however, only a few reports have described immune checkpoint inhibitor-induced radiation recall pneumonitis. We report a case of radiation recall pneumonitis induced by pembrolizumab in a patient with the postoperative local recurrence of non-small cell lung cancer. This case demonstrated that pembrolizumab might cause severe radiation recall pneumonitis, even after typical radiation pneumonitis has been resolved.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos/efeitos adversos , Doenças Assintomáticas , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Pneumonite por Radiação/etiologia , Radioterapia/efeitos adversos , Terapia Combinada , Humanos , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/radioterapia
3.
Hell J Nucl Med ; 23 Suppl: 31-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32860394

RESUMO

The global COVID-19 health and economic crisis has forced people to adopt challenging rules of social distancing and self-isolation. Health care staff has been advised to change working routines to keep themselves and their patients safe. Radionuclide therapy has had an increasing role in clinical practice. Most therapeutic radionuclide procedures have applications in oncology. Cancer patients are an especially fragile and vulnerable population with higher risk due to co morbidities and immunosuppression. COVID-19 is another risk that must be considered in treatment planning. Therapeutic, prophylactic, and supportive interventions may require changes for these patients. The most common radionuclide therapies involve patients with differentiated thyroid cancer (DTC) who need radioiodine therapy (RAI), patients with neuroendocrine tumours (NETs) who need peptide receptor radionuclide therapy (PRRT), patients with hepatocellular carcinoma (HCC) who need therapy with radiolabelled microspheres, and patients with prostate cancer and bone metastasis who need radionuclide palliative therapy. If infected, cancer patients could be at a higher risk for serious COVID-19 disease. Treatment decisions for thyroid cancer and NETs are challenging in this environment. Any decision to postpone therapy must be carefully considered, balancing risks and benefits. A risk of worsened prognosis due to delayed or suboptimal cancer treatment must be weighed against the risk of severe COVID-19 illness.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Radioterapia/normas , Infecções por Coronavirus/epidemiologia , Humanos , Controle de Infecções/métodos , Neoplasias/radioterapia , Serviço Hospitalar de Medicina Nuclear/organização & administração , Serviço Hospitalar de Medicina Nuclear/provisão & distribução , Pandemias , Pneumonia Viral/epidemiologia , Radioterapia/métodos
4.
Hell J Nucl Med ; 23 Suppl: 35-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32860395

RESUMO

The coronavirus disease 2019 (COVID-19) global pandemic poses a significant challenge to the national health systems. Not only China, the first country that experienced the health crisis since last December, but the rest of the world, is facing an unprecedented global health crisis, the most serious crisis in a century, with social and economic impact. However, the most important impact of the new pandemic is the human impact. Till 4th of June 2020, coronavirus SARS-CoV-2, causing COVID-19 disease, has infected more than 65000.000 people and has been responsible for more than 386000 deaths globally. The first priority of public health authorities is to contain and mitigate the spread and infection rate of the coronavirus SARS-CoV-2, distributing the number of infections over time and, if possible, reduce the incidence of the disease (COVID-19) it causes. A critical task for health systems confronted with the spread of the coronavirus is to protect the health of all citizens, so this requires that both diagnosis/testing and appropriate care should be readily available, affordable, and provided in a safe environment. The health care systems of many developed countries failed to demonstrate a satisfactory response to the increased demand for acute care hospital beds, ventilators, emergency services, diagnostics tests, support equipment for their COVID-19 patients, availability of essential medicines, protective equipment for their staff etc. Nuclear Medicine (NM) departments and their staff, in spite of the fact that not being in the front line of the pandemic response, have experienced a dramatic alteration in their daily clinical activity, trying to adapt their clinical routine to the new environment. There are several issued guidance from national and international organizations, trying to help to cope with suspected or verified COVID-19 patients. Patients with cancer are thought to be more susceptible and have higher morbidity and mortality rates from COVID-19 than the general population. In the current article, our aim is to present measures, guidance and thoughts that should be considered for the cancer patients.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Neoplasias/radioterapia , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Radioterapia/métodos , Infecções por Coronavirus/epidemiologia , Prioridades em Saúde , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/economia , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Radioterapia/normas
5.
Nat Commun ; 11(1): 4064, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32792542

RESUMO

Regulation of the programming of tumour-associated macrophages (TAMs) controls tumour growth and anti-tumour immunity. We examined the role of FGF2 in that regulation. Tumours in mice genetically deficient in low-molecular weight FGF2 (FGF2LMW) regress dependent on T cells. Yet, TAMS not T cells express FGF receptors. Bone marrow derived-macrophages from Fgf2LMW-/- mice co-injected with cancer cells reduce tumour growth and express more inflammatory cytokines. FGF2 is induced in the tumour microenvironment following fractionated radiation in murine tumours consistent with clinical reports. Combination treatment of in vivo tumours with fractionated radiation and a blocking antibody to FGF2 prolongs tumour growth delay, increases long-term survival and leads to a higher iNOS+/CD206+ TAM ratio compared to irradiation alone. These studies show for the first time that FGF2 affects macrophage programming and is a critical regulator of immunity in the tumour microenvironment.


Assuntos
Fator 2 de Crescimento de Fibroblastos/metabolismo , Radioterapia/métodos , Animais , Linhagem Celular Tumoral , Fator 2 de Crescimento de Fibroblastos/genética , Células HT29 , Humanos , Lectinas Tipo C/genética , Lectinas Tipo C/metabolismo , Ativação de Macrófagos/efeitos dos fármacos , Ativação de Macrófagos/efeitos da radiação , Lectinas de Ligação a Manose/genética , Lectinas de Ligação a Manose/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Nus , Óxido Nítrico Sintase Tipo II/genética , Óxido Nítrico Sintase Tipo II/metabolismo , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/metabolismo , Microambiente Tumoral/efeitos dos fármacos , Microambiente Tumoral/efeitos da radiação , Ensaios Antitumorais Modelo de Xenoenxerto
6.
PLoS Comput Biol ; 16(8): e1008041, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32745136

RESUMO

Hypoxia-activated prodrugs (HAPs) present a conceptually elegant approach to not only overcome, but better yet, exploit intra-tumoural hypoxia. Despite being successful in vitro and in vivo, HAPs are yet to achieve successful results in clinical settings. It has been hypothesised that this lack of clinical success can, in part, be explained by the insufficiently stringent clinical screening selection of determining which tumours are suitable for HAP treatments. Taking a mathematical modelling approach, we investigate how tumour properties and HAP-radiation scheduling influence treatment outcomes in simulated tumours. The following key results are demonstrated in silico: (i) HAP and ionising radiation (IR) monotherapies may attack tumours in dissimilar, and complementary, ways. (ii) HAP-IR scheduling may impact treatment efficacy. (iii) HAPs may function as IR treatment intensifiers. (iv) The spatio-temporal intra-tumoural oxygen landscape may impact HAP efficacy. Our in silico framework is based on an on-lattice, hybrid, multiscale cellular automaton spanning three spatial dimensions. The mathematical model for tumour spheroid growth is parameterised by multicellular tumour spheroid (MCTS) data.


Assuntos
Antineoplásicos/farmacologia , Hipóxia Celular/fisiologia , Modelos Biológicos , Pró-Fármacos/farmacologia , Microambiente Tumoral/fisiologia , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/efeitos da radiação , Biologia Computacional , Simulação por Computador , Humanos , Radiação Ionizante , Radioterapia , Esferoides Celulares , Células Tumorais Cultivadas
7.
Medicine (Baltimore) ; 99(32): e21631, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769927

RESUMO

RATIONALE: Acantholytic squamous cell carcinoma (ASCC) is an uncommon histopathologic variant of squamous cell carcinoma (SCC), which is the most common malignancy of the oral cavity. Though ASCC showed poor prognosis, the exact diagnosis is challenging. PATIENTS CONCERNS: A 59-year-old female patient with 1-month long symptoms of pain and burning sensation in the right maxilla. DIAGNOSES: Incisional biopsy in the maxilla established the pathologic diagnosis of SCC. INTERVENTION: The patient underwent mass resection with near total maxillectomy. OUTCOMES: The final diagnosis through the microscopic examination was ASCC. Palliative chemotherapy was done to relive the symptoms after the recurrence, however, the patient died of the disease at 8 months after her initial presentation. LESSONS: Special attention should be paid to this variant of SCC because most patients with ASCC have a very poor prognosis.


Assuntos
Acantólise/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Maxila/anormalidades , Acantólise/complicações , Biópsia/métodos , Carcinoma de Células Escamosas/fisiopatologia , Feminino , Humanos , Maxila/efeitos da radiação , Pessoa de Meia-Idade , Radioterapia/métodos
8.
Med Oncol ; 37(10): 85, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32808089

RESUMO

Management of patients with head and neck cancers (HNCs) is challenging for the Radiation Oncologist, especially in the COVID-19 era. The Italian Society of Radiotherapy and Clinical Oncology (AIRO) identified the need of practice recommendations on logistic issues, treatment delivery and healthcare personnel's protection in a time of limited resources. A panel of 15 national experts on HNCs completed a modified Delphi process. A five-point Likert scale was used; the chosen cut-offs for strong agreement and agreement were 75% and 66%, respectively. Items were organized into two sections: (1) general recommendations (10 items) and (2) special recommendations (45 items), detailing a set of procedures to be applied to all specific phases of the Radiation Oncology workflow. The distribution of facilities across the country was as follows: 47% Northern, 33% Central and 20% Southern regions. There was agreement or strong agreement across the majority (93%) of proposed items including treatment strategies, use of personal protection devices, set-up modifications and follow-up re-scheduling. Guaranteeing treatment delivery for HNC patients is well-recognized in Radiation Oncology. Our recommendations provide a flexible tool for management both in the pandemic and post-pandemic phase of the COVID-19 outbreak.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/radioterapia , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Itália/epidemiologia , Oncologia/métodos , Pneumonia Viral/epidemiologia , Radioterapia/métodos , Radioterapia/normas , Sociedades Médicas/normas
10.
Medicine (Baltimore) ; 99(34): e21642, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846773

RESUMO

Currently, the standard management for locally advanced prostate cancer (PCa) is still controversial. In our study, we aimed to compare the survival outcomes of radical prostatectomy (RP) versus external beam radiotherapy (EBRT).We conducted analyses with a large cohort of 38,544 patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016). Propensity score matching, Kaplan-Meier method, and Cox proportional hazard regression were used to reduce the influence of bias and compare the overall survival (OS) and cancer specific survival (CSS). Several different sensitivity analyses including inverse probability of treatment weighting and standardized mortality ratio weighting were used to verify the robustness of the results.Totally, 33,388 men received RP and 5,156 men received EBRT with cT3-4N0M0 PCa were included in this study. According to the Kaplan-Meier curves, RP performed better in both OS and CSS compared with EBRT (P < .0001). In the adjusted multivariate Cox regression, RP also showed better OS and CSS benefits (OS: HR=0.50; 95% confidence interval [CI]: 0.46-0.54; P < .0001 and CSS: HR=0.43; 95% CI: 0.38-0.49; P < .0001). After propensity score matching, RP is still the management that can bring more survival benefits to patients. (OS: HR=0.46; 95% CI: 0.41-0.51; P < .0001 and CSS: HR = 0.41; 95% CI: 0.34-0.48; P < .0001).Our research demonstrated the significantly better survival benefits of RP over EBRT in patients with locally advanced PCa. The results of this study will provide more evidence to help clinicians choose appropriate treatment strategies.


Assuntos
Prostatectomia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prostatectomia/métodos , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Radioterapia/métodos , Estudos Retrospectivos , Taxa de Sobrevida
11.
Medicine (Baltimore) ; 99(30): e21328, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791729

RESUMO

The purpose of this study was to report the clinicopathological characteristics and treatment outcomes of 45 rectal cancer patients who have a history of cervical cancer with or without remote radiotherapy. Twenty-nine patients (64.4%) with a history of cervical cancer treated with pelvic radiotherapy were classified as group A, 16 (35.6%) patients with a history of cervical cancer not treated with radiotherapy were classified as group B. The median duration between radiotherapy for cervical cancer and rectal adenocarcinoma diagnosis was 18 years. At the time of rectal cancer diagnosis, 5 (17.2%) patients presented stage I disease, 15 (51.7%) had stage II, 1 (3.4%) had stage III, and 8 (27.6%) had stage IV. The patients in group A had older age, higher rates of gross ulcerative lesions, low hemoglobin levels, and a lower rate of lymph node metastases. The patients with secondary rectal cancer developed after radiotherapy for cervical cancer usually presented with abnormal abdominal symptoms, such as proctitis, cystitis, or rectal fistula. Higher colostomy rate was found in this group of patients due to severe pelvic fibrosis or proctitis.


Assuntos
Segunda Neoplasia Primária/patologia , Radioterapia/efeitos adversos , Neoplasias Retais/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colostomia/estatística & dados numéricos , Cistite/epidemiologia , Cistite/etiologia , Feminino , Humanos , Metástase Linfática/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Induzidas por Radiação/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Proctite/epidemiologia , Proctite/etiologia , Prognóstico , Fístula Retal/epidemiologia , Fístula Retal/etiologia , Neoplasias Retais/mortalidade , Estudos Retrospectivos , Taiwan/epidemiologia , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapia
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(8): 734-736, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32810944

RESUMO

Radiation-induced intestinal injury is caused by radiotherapy of pelvic malignant tumors. The main symptoms include persistent blood in stool, tenesmus, perianal pain, and severe intestinal perforation. Compared to conventional radiotherapy, precision radiotherapy (PT) has a greater advantage in the protection of normal tissues by reducing radiation dose of intestinal tract. However, in the era of PT, we still need to face the balance between curative effect and side injury, especially for complex, recurrent or advanced tumors. In general, when making treatment decisions, we should give priority to radiotherapeutic efficacy and patient survival, then consider how to reduce radiotherapy injuries. Decision-making requires multidisciplinary team consultation, together with patients and their families. Due to the difficulty and complexity in the treatment of radiation-induced intestinal injury, its prevention is very important. PT is advised, including avoiding excessive intestinal doses, and controlling the irradiation area of the mucosa. Constipation prevention is important during and after radiotherapy, in order to avoid damage to the intestine. Diet education is necessary. Patient should not eat leftovers, cold dishes, pickles and other foods prone to cause intestinal infections. At present, there are still few researches in the field of radiation-induced intestinal injury. We expect that in the near future, there will be greater progress and breakthroughs in prevention, diagnosis and treatment of radiation-induced intestinal injury.


Assuntos
Neoplasias Pélvicas , Lesões por Radiação , Humanos , Mucosa Intestinal , Medicina de Precisão , Radioterapia , Reto
13.
Curr Oncol ; 27(3): e313-e317, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32669938

RESUMO

Background: The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non-covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services in the province of Quebec under the direction of the Ministère de la Santé et des Services sociaux, convened to develop recommendations to deal with the potential disruption of services in thoracic oncology in the province of Quebec. The summary provided here has been adapted from the original document posted on the Programme québécois du cancer Web site at: https://www.msss.gouv.qc.ca/professionnels/documents/coronavirus-2019-ncov/PJ1_Recommandations_oncologie-thoracique-200415.pdf. Methods: Plans to optimize the health care system and potentially to prioritize services were discussed with respect to various levels of activity. For each level-of-activity scenario, suggestions were made for the services and treatments to prioritize and for those that might have to be postponed, as well as for potential alternatives to care. Results: The principal recommendation is that the cancer centre executive committee and the multidisciplinary tumour board always try to find a solution to maintain standard-of-care therapy for all patients with thoracic tumours, using novel approaches to treatment and the adoption of a network approach to care, as needed. Conclusions: The effect of the covid-19 pandemic on the health care system remains unpredictable and requires that cancer teams unite and offer the most efficient and innovative therapies to all patients under the various conditions that might be forced upon them.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/terapia , Infecções por Coronavirus/epidemiologia , Neoplasias Pulmonares/terapia , Pneumonia Viral/epidemiologia , Radioterapia , Carcinoma de Pequenas Células do Pulmão/terapia , Procedimentos Cirúrgicos Torácicos , Triagem , Administração Oral , Antineoplásicos/uso terapêutico , Betacoronavirus , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Gerenciamento Clínico , Humanos , Neoplasias Pulmonares/diagnóstico , Mediastinoscopia , Oncologia , Técnicas de Diagnóstico Molecular , Estadiamento de Neoplasias , Pandemias , Quebeque/epidemiologia , Radiocirurgia , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Toracoscopia
14.
Rev Assoc Med Bras (1992) ; 66(6): 728-731, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32696876

RESUMO

Voluminous tumors represent a challenge in radiation oncology, particularly when surgical resection is not possible. Lattice radiotherapy (LTR) is a technique that may provide equivalent or superior clinical response in the management of large tumors while limiting toxicity to adjacent normal tissues. LRT can precisely deliver inhomogeneous high doses of radiation to different areas within the gross tumor volumes (GTV). The dosimetric characteristic of LTR is defined by the ratio of the valley dose (lower doses - cold spots) and the peak doses, also called vertex (higher doses - hot spots), or the valley-to-peak dose ratio. The valley-to-peak ratio thereby quantifies the degree of spatial fractionation. LRT delivers high doses of radiation without exceeding the tolerance of adjacent critical structures. Radiobiological experiments support the role of radiation-induced bystander effects, vascular alterations, and immunologic interactions in areas subject to low dose radiation. The technological advancements continue to expand in Radiation Oncology, bringing new safety opportunities of treatment for bulky lesions.


Assuntos
Imunoterapia , Neoplasias/terapia , Radioterapia , Fracionamento da Dose de Radiação , Humanos , Imunomodulação , Lesões por Radiação , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
15.
Br J Radiol ; 93(1113): 20200217, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32706989

RESUMO

The effects of various forms of ionising radiation are known to be mediated by interactions with cellular and molecular targets in irradiated and in some cases non-targeted tissue volumes. Despite major advances in advanced conformal delivery techniques, the probability of normal tissue complication (NTCP) remains the major dose-limiting factor in escalating total dose delivered during treatment. Potential strategies that have shown promise as novel delivery methods in achieving effective tumour control whilst sparing organs at risk involve the modulation of critical dose delivery parameters. This has led to the development of techniques using high dose spatial fractionation (GRID) and ultra-high dose rate (FLASH) which have translated to the clinic. The current review discusses the historical development and biological basis of GRID, microbeam and FLASH radiotherapy as advanced delivery modalities that have major potential for widespread implementation in the clinic in future years.


Assuntos
Fracionamento da Dose de Radiação , Neoplasias/radioterapia , Vasos Sanguíneos/efeitos da radiação , Efeito Espectador , História do Século XX , História do Século XXI , Humanos , Neoplasias/irrigação sanguínea , Neoplasias/imunologia , Órgãos em Risco/efeitos da radiação , Fótons/uso terapêutico , Terapia com Prótons/métodos , Terapia com Prótons/tendências , Lesões por Radiação/prevenção & controle , Radiobiologia , Radioterapia/história , Radioterapia/instrumentação
16.
PLoS One ; 15(7): e0235616, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639983

RESUMO

BACKGROUND: The Extended Prostate Cancer Index Composite (EPIC) instrument is a commonly used patient reported outcome (PRO) tool in prostate cancer clinical trials. Summary scores for EPIC subscales are calculated by averaging patient scores for attributes (e.g., side effects), implying equal weighting of the attributes in the absence of evidence showing otherwise. METHODS: We estimated patient preferences for each of the attributes included in the bowel subscale of the EPIC instrument using best-worst (B-W) scaling among a cohort of men with prostate cancer. Patients were presented with multiple tasks in which they were asked to indicate which attribute they would find most and least bothersome at different levels of severity. Analysis utilized both (simple) B-W counts and scores to estimate patient preferences for each attribute as well as attribute levels. RESULTS: A total of 174 respondents from two institutions participated in the survey. Preference estimates for each of the five attributes included in the EPIC-26 bowel subscale showed wide variation preferences: 'losing control of bowel movements' was found to be the most bothersome attribute, with a B-W score of -0.48, followed by bowel urgency which also had negative B-W score (-0.04). Increased frequency of bowel movements was the least bothersome attribute, with a B-W score of +0.33, followed by bloody stools (+0.12), and pelvic/rectal pain (+0.06). Analysis of preference weights for attribute bother levels showed preference estimates be linear. CONCLUSIONS: We provide novel evidence on patient preferences for side effect reduction following prostate radiotherapy. Within the bowel sub-scale of the EPIC-26 short form, we found that bowel incontinence was perceived to be the most bothersome treatment effect, while increased bowel frequency was least bothersome to patients.


Assuntos
Intestinos/efeitos da radiação , Preferência do Paciente , Neoplasias da Próstata/radioterapia , Radioterapia/efeitos adversos , Idoso , Estudos de Coortes , Humanos , Intestinos/patologia , Intestinos/fisiopatologia , Masculino , Qualidade de Vida
17.
J Laryngol Otol ; 134(6): 533-540, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32616096

RESUMO

OBJECTIVE: To evaluate the effect of definitive radiotherapy dose on survival in patients with human papillomavirus positive oropharyngeal carcinoma. METHODS: Human papillomavirus positive oropharyngeal carcinoma patients staged T1-3 and N0-2c, who received definitive radiotherapy (fraction sizes of 180 cGy to less than 220 cGy), were identified from the National Cancer Database 2010-2014 and stratified by radiation dose (50 Gy to less than 66 Gy, or 66 Gy or more). RESULTS: A total of 2173 patients were included, of whom 124 (6 per cent) received a radiation dose of 50 Gy to less than 66 Gy. With a median follow up of 33.8 months, patients had a 3-year overall survival rate of 88.6 per cent (95 per cent confidence interval = 87.1-90.1 per cent). On multivariate Cox analysis, a radiotherapy dose of 50 Gy to less than 66 Gy (hazard ratio = 0.95, 95 per cent confidence interval = 0.52-1.74, p = 0.86) was not a predictor of increased mortality risk. CONCLUSION: Human papillomavirus positive oropharyngeal carcinoma patients had excellent outcomes with definitive radiotherapy doses of 50 Gy to less than 66 Gy. These results further support patients enrolling into clinical trials for radiation dose de-escalation.


Assuntos
Carcinoma/radioterapia , Neoplasias Orofaríngeas/mortalidade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/virologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Radioterapia/métodos , Taxa de Sobrevida
18.
Anticancer Res ; 40(7): 3605-3618, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620600

RESUMO

Radiomics, an emerging field in radiation therapy, is hypothesized to improve classification of tumour risk and prognosis. Despite encouraging results, there are issues of practicality and interpretation of radiomic data. This study investigates the emerging role of radiomics in tumour risk classification and prognosis of breast and prostate cancer. A literature search was conducted using predefined terms to retrieve studies related to radiomics. Studies were evaluated and selected upon meeting the criteria defined. A total of 19 relevant publications were selected from 63 publications identified. Data from studies revealed significant area under the curve (AUC) values and high discriminative power. Significant AUC values for biochemical recurrence of disease and disease-free survival were reported for prognosis. Radiomics show promising potential in discriminating tumour risk and predicting prognosis of cancer using specified features. It is an alternative to conventional predictive tools and has the ability to improve with the use of existing tools.


Assuntos
Neoplasias/patologia , Neoplasias/radioterapia , Intervalo Livre de Doença , Humanos , Recidiva Local de Neoplasia/patologia , Neoplasias/mortalidade , Prognóstico , Radioterapia/métodos , Risco
20.
Medicine (Baltimore) ; 99(27): e21099, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629742

RESUMO

RATIONALE: Intramural esophageal squamous cell carcinoma (ESCC) without mucosal invasion is extremely rare. Endoscopic mucosal biopsy results are often negative, making diagnosis difficult. In these cases, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy is a useful diagnostic method. PATIENT CONCERNS: A 78-year-old female was admitted to hospital due to dysphagia, and gastroscopy showed a concentric narrowing of the esophageal lumen with a smooth and undamaged esophageal mucosa. DIAGNOSES: Endoscopic ultrasound (EUS) revealed that the esophageal mucosa was thickened with a low echo, and the layers of the esophageal wall could not be clearly distinguished. Cytologic and pathologic diagnoses were obtained through EUS-FNA, which suggested ESCC. INTERVENTIONS: According to the pathologic diagnosis obtained by EUS-FNA, surgery or radiotherapy were recommended for this patient. Eventually, this patient elected to seek treatment at another medical institution. OUTCOMES: This type of disease cannot be diagnosed according to gastroscopic biopsy alone, and the diagnosis was eventually confirmed through EUS-FNA. LESSONS: When an imaging examination suggests a possible malignant lesion of the oesophagus, EUS-FNA may be considered if the surface mucosa contains no endoscopic damage. EUS-FNA has high diagnostic value with high sensitivity, minimal invasiveness, and high safety.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Carcinoma de Células Escamosas do Esôfago/patologia , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Feminino , Gastroscopia/métodos , Hospitalização , Humanos , Membrana Mucosa/patologia , Pacientes Desistentes do Tratamento/psicologia , Radioterapia/normas , Procedimentos Cirúrgicos Operatórios/normas
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