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1.
Expert Opin Drug Saf ; 19(2): 187-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005072

RESUMO

Introduction: A range of combination chemotherapy regimens are currently used in clinical practice. However, international antiemetic guidelines often only categorize the emetogenic potential of single agents rather than the emetogenicity of combination chemotherapy regimens. To manage the nausea and vomiting induced by antineoplastic combinations, guidelines suggest antiemetics that are appropriate for the component drug with the highest emetogenic potential. Furthermore, antiemetic guidelines generally do not consider the influence of other factors, including individual patient characteristics, on the emetic effects of cancer treatments. Similarly, the emetogenic potential of radiotherapy is stratified only according to the site of radiation, while other factors contributing to emetic risk are overlooked.Areas covered: An Expert Panel was convened to examine unresolved issues and summarize the current clinical research on managing nausea and vomiting associated with combination chemotherapy and radiotherapy.Expert opinion: The panel identified the incidence of nausea and vomiting induced by multi-drug combination therapies currently used to treat cancer at different anatomic sites and by radiotherapy in the presence of other risk factors. Based on these data and the clinical experience of panel members, several suggestions are made for a practical approach to prevent or manage nausea and vomiting due to chemotherapy regimens and radiation therapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Náusea/prevenção & controle , Radioterapia/efeitos adversos , Vômito/prevenção & controle , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Humanos , Incidência , Náusea/epidemiologia , Náusea/etiologia , Neoplasias/terapia , Guias de Prática Clínica como Assunto , Fatores de Risco , Vômito/epidemiologia , Vômito/etiologia
2.
Cancer Radiother ; 24(1): 15-20, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-31983629

RESUMO

PURPOSE: Patients frequently report asthenia during radiation. The present study aimed at identifying the correlation between numerous clinical and tumoral factors and asthenia in breast and prostate cancer patients treated by curative radiotherapy. MATERIALS AND METHODS: A retrospective study was conducted at the Lucien Neuwirth Cancer Institute (France). All breast and prostate cancer patients undergoing curative radiotherapy during 2015 were screened (n=806). Patient's self-evaluation of asthenia and radiotherapy tolerance was assessed through verbal analogic scale (0/10 to 10/10). Data about toxicities, travel distance and travel time, tumor's characteristics, radiotherapy treatment planning, previous cancer therapies, were collected from medical records. RESULTS: 500 patients were included (350 in the breast cancer group and 150 in the prostate cancer group). In all, 86% of patients in the breast cancer group reported asthenia, with a 5/10 median score. In all, 54% of patients in the prostate cancer group reported asthenia, with a 2/10 median score. Univariate analysis showed correlation between asthenia and radiotherapy tolerance as well as tumor staging, in the prostate cancer group. No other correlation was evidenced. CONCLUSION: Radiotherapy-related fatigue is a common side effect. This study showed that most of the factors related to patients or disease that are commonly used to explain fatigue during curative treatments, seem finally to be not correlated with asthenia.


Assuntos
Astenia/etiologia , Neoplasias da Mama/radioterapia , Neoplasias da Próstata/radioterapia , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Radioterapia/efeitos adversos , Estudos Retrospectivos
3.
JAMA ; 323(2): 149-163, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935027

RESUMO

Importance: Understanding adverse effects of contemporary treatment approaches for men with favorable-risk and unfavorable-risk localized prostate cancer could inform treatment selection. Objective: To compare functional outcomes associated with prostate cancer treatments over 5 years after treatment. Design, Setting, and Participants: Prospective, population-based cohort study of 1386 men with favorable-risk (clinical stage cT1 to cT2bN0M0, prostate-specific antigen [PSA] ≤20 ng/mL, and Grade Group 1-2) prostate cancer and 619 men with unfavorable-risk (clinical stage cT2cN0M0, PSA of 20-50 ng/mL, or Grade Group 3-5) prostate cancer diagnosed in 2011 through 2012, accrued from 5 Surveillance, Epidemiology and End Results Program sites and a US prostate cancer registry, with surveys through September 2017. Exposures: Treatment with active surveillance (n = 363), nerve-sparing prostatectomy (n = 675), external beam radiation therapy (EBRT; n = 261), or low-dose-rate brachytherapy (n = 87) for men with favorable-risk disease and treatment with prostatectomy (n = 402) or EBRT with androgen deprivation therapy (n = 217) for men with unfavorable-risk disease. Main Outcomes and Measures: Patient-reported function, based on the 26-item Expanded Prostate Index Composite (range, 0-100), 5 years after treatment. Regression models were adjusted for baseline function and patient and tumor characteristics. Minimum clinically important difference was 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritative symptoms, and 4 to 6 for bowel and hormonal function. Results: A total of 2005 men met inclusion criteria and completed the baseline and at least 1 postbaseline survey (median [interquartile range] age, 64 [59-70] years; 1529 of 1993 participants [77%] were non-Hispanic white). For men with favorable-risk prostate cancer, nerve-sparing prostatectomy was associated with worse urinary incontinence at 5 years (adjusted mean difference, -10.9 [95% CI, -14.2 to -7.6]) and sexual function at 3 years (adjusted mean difference, -15.2 [95% CI, -18.8 to -11.5]) compared with active surveillance. Low-dose-rate brachytherapy was associated with worse urinary irritative (adjusted mean difference, -7.0 [95% CI, -10.1 to -3.9]), sexual (adjusted mean difference, -10.1 [95% CI, -14.6 to -5.7]), and bowel (adjusted mean difference, -5.0 [95% CI, -7.6 to -2.4]) function at 1 year compared with active surveillance. EBRT was associated with urinary, sexual, and bowel function changes not clinically different from active surveillance at any time point through 5 years. For men with unfavorable-risk disease, EBRT with ADT was associated with lower hormonal function at 6 months (adjusted mean difference, -5.3 [95% CI, -8.2 to -2.4]) and bowel function at 1 year (adjusted mean difference, -4.1 [95% CI, -6.3 to -1.9]), but better sexual function at 5 years (adjusted mean difference, 12.5 [95% CI, 6.2-18.7]) and incontinence at each time point through 5 years (adjusted mean difference, 23.2 [95% CI, 17.7-28.7]), than prostatectomy. Conclusions and Relevance: In this cohort of men with localized prostate cancer, most functional differences associated with contemporary management options attenuated by 5 years. However, men undergoing prostatectomy reported clinically meaningful worse incontinence through 5 years compared with all other options, and men undergoing prostatectomy for unfavorable-risk disease reported worse sexual function at 5 years compared with men who underwent EBRT with ADT.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Braquiterapia/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Prostatectomia/efeitos adversos , Neoplasias da Próstata/terapia , Radioterapia/efeitos adversos , Idoso , Antagonistas de Androgênios/uso terapêutico , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Radioterapia/métodos , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Incontinência Urinária/etiologia , Conduta Expectante
4.
Crit Rev Oncol Hematol ; 147: 102881, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31991224

RESUMO

Individuals do not react to radiation in a homogeneous manner. Recent radiogenomic research has proven that individual polymorphisms can correlate with treatment response most likely due to variation in the ability to recognise and repair DNA breaks. The difference in radiosensitivity between genders has been well documented, yet most radiotherapeutic guidelines are based solely on population averages rather than demographic subgroups such as age, race and gender. This paper is a review of the burgeoning literature available on the differences in efficacy and outcome of radiotherapy between genders. The work examines the effect of radiation on gender both from a tumour control as well as normal tissue toxicity perspective. While the literature reporting such findings is limited, the results show a small but significant difference in response to radiotherapy between sexes. Prospective and retrospective studies for evaluating these gender-specific differences are encouraged as a next step in personalised medicine.


Assuntos
Neoplasias/radioterapia , Medicina de Precisão , Radioterapia/efeitos adversos , Feminino , Humanos , Masculino , Tolerância a Radiação , Fatores Sexuais , Resultado do Tratamento
5.
BMJ ; 368: l6794, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941657

RESUMO

OBJECTIVE: To investigate the impact of modifications to contemporary cancer protocols, which minimize exposures to cardiotoxic treatments and preserve long term health, on serious cardiac outcomes among adult survivors of childhood cancer. DESIGN: Retrospective cohort study. SETTING: 27 institutions participating in the Childhood Cancer Survivor Study. PARTICIPANTS: 23 462 five year survivors (6193 (26.4%) treated in the 1970s, 9363 (39.9%) treated in the 1980s, and 7906 (33.6%) treated in the 1990s) of leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, renal tumors, neuroblastoma, soft tissue sarcomas, and bone sarcomas diagnosed prior to age 21 years between 1 January 1970 and 31 December 1999. Median age at diagnosis was 6.1 years (range 0-20.9) and 27.7 years (8.2-58.3) at last follow-up. A comparison group of 5057 siblings of cancer survivors were also included. MAIN OUTCOME MEASURES: Cumulative incidence and 95% confidence intervals of reported heart failure, coronary artery disease, valvular heart disease, pericardial disease, and arrhythmias by treatment decade. Events were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Multivariable subdistribution hazard models were used to estimate hazard ratios by decade, and mediation analysis examined risks with and without exposure to cardiotoxic treatments. RESULTS: The 20 year cumulative incidence of heart failure (0.69% for those treated in the 1970s, 0.74% for those treated in the 1980s, 0.54% for those treated in the 1990s) and coronary artery disease (0.38%, 0.24%, 0.19%, respectively), decreased in more recent eras (P<0.01), though not for valvular disease (0.06%, 0.06%, 0.05%), pericardial disease (0.04%, 0.02%, 0.03%), or arrhythmias (0.08%, 0.09%, 0.13%). Compared with survivors with a diagnosis in the 1970s, the risk of heart failure, coronary artery disease, and valvular heart disease decreased in the 1980s and 1990s but only significantly for coronary artery disease (hazard ratio 0.65, 95% confidence interval 0.45 to 0.92 and 0.53, 0.36 to 0.77, respectively). The overall risk of coronary artery disease was attenuated by adjustment for cardiac radiation (0.90, 0.78 to 1.05), particularly among survivors of Hodgkin lymphoma (unadjusted for radiation: 0.77, 0.66 to 0.89; adjusted for radiation: 0.87, 0.69 to 1.10). CONCLUSIONS: Historical reductions in exposure to cardiac radiation have been associated with a reduced risk of coronary artery disease among adult survivors of childhood cancer. Additional follow-up is needed to investigate risk reductions for other cardiac outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01120353.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Sobreviventes de Câncer/estatística & dados numéricos , Cardiopatias , Neoplasias , Radioterapia , Risco Ajustado , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cardiotoxicidade , Criança , Estudos de Coortes , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/classificação , Cardiopatias/epidemiologia , Humanos , Incidência , Masculino , Neoplasias/classificação , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/radioterapia , Modelos de Riscos Proporcionais , Radioterapia/efeitos adversos , Radioterapia/métodos , Estudos Retrospectivos , Risco Ajustado/métodos , Risco Ajustado/tendências , Estados Unidos/epidemiologia
6.
Int J Cancer ; 146(5): 1324-1332, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31523804

RESUMO

Modern cancer therapy has led to a growing number of pediatric and young adult cancer survivors, who are prone to increased morbidities caused by the late effects of therapy. The aim of our study was to investigate pediatric and young adult cancer survivors' morbidity due to renal and bone metabolism diseases and especially to study bone metabolism in cancer survivors with renal disease. Patients were identified from the Finnish Cancer Registry, and the cohort consisted of 13,860, 5-year survivors of cancer diagnosed below the age of 35 years. Healthy siblings were used as the comparison cohort. Information on the main outcomes was linked from the national Care Register for Health Care. Hazard ratios (HRs) comparing cancer survivors to siblings were calculated for various outcomes. The patient cohort was separated into two age groups, pediatric (0-19 years) and young adults (20-34 years). Significantly elevated HRs (p < 0.0001) in survivors were observed in both age groups for scoliosis (HR 1.6, 95% confidence interval [CI] 1.3-2.0), osteoporosis (HR 5.2, 95% CI 2.4-11.4), osteonecrosis (HR 12.7, 95% CI 5.4-29.7), nephritis (HR 1.9, 95% CI 1.5-2.2) and kidney failure (HR 3.6, 95% CI 2.4-5.3) for all. For cancer survivors with a renal outcome, the risk for developing any outcome of bone metabolism was increased (HR 2.3, 95% CI 1.4-3.6). These results show that pediatric and young adult cancer survivors have an elevated risk for long-term, adverse outcomes related to renal function and bone metabolism. These results suggest follow-up care for young cancer patients.


Assuntos
Doenças Ósseas Metabólicas/epidemiologia , Sobreviventes de Câncer/estatística & dados numéricos , Nefropatias/epidemiologia , Neoplasias/terapia , Adolescente , Antineoplásicos/efeitos adversos , Doenças Ósseas Metabólicas/etiologia , Criança , Pré-Escolar , Feminino , Finlândia/epidemiologia , Seguimentos , Nível de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Nefropatias/etiologia , Masculino , Neoplasias/complicações , Neoplasias/mortalidade , Modelos de Riscos Proporcionais , Radioterapia/efeitos adversos , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Irmãos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto Jovem
7.
Int J Cancer ; 146(3): 829-838, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30989639

RESUMO

Advances in multimodality cancer treatments have increased the risk of long-term complications in early-onset cancer survivors. For female cancer survivors, these include diminished reproductive function, often resulting in a narrowed fertile window. The aim of our study was to evaluate the use of fertility treatments in cancer survivors (aged 0-39 years at diagnosis) compared to siblings. Data from Finnish registers on cancer, birth and prescribed medications were merged to identify 8,929 survivors and 9,495 siblings without previous deliveries. Fertility drug purchases from 1993 to 2012 at the age of 16-41 years were included. A Poisson regression model was used to estimate incidence rate ratios (IRRs) for the use of fertility drugs, adjusting for age and calendar time at fertility drug purchase. Fertility treatments were more common in survivors compared to siblings, as 6.1% of survivors compared to 3.8% of siblings had bought fertility drugs (IRR 1.43, 95% confidence interval [CI] 1.25-1.65). A subclassification of fertility treatments into ovulation inductions and assisted reproductive technology (ART), showed increased use of ART (IRR 2.41, 95% CI 1.97-2.96), whereas the use of ovulation induction was similar in survivors and siblings. Analyses by calendar time periods showed the use of ART to be significantly higher in the most recent decade, from 2003 onwards. We conclude that cancer survivors have an increased risk for subfertility, which is why fertility counseling is important. However, our results mirror a more active approach among clinicians towards fertility treatments in cancer survivors during the most recent years.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Fármacos para a Fertilidade/uso terapêutico , Infertilidade Feminina/terapia , Neoplasias/complicações , Adolescente , Adulto , Antineoplásicos/efeitos adversos , Estudos de Casos e Controles , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Fertilidade/efeitos dos fármacos , Fertilidade/efeitos da radiação , Finlândia , Humanos , Lactente , Recém-Nascido , Infertilidade Feminina/etiologia , Masculino , Neoplasias/mortalidade , Neoplasias/terapia , Gravidez , Radioterapia/efeitos adversos , Sistema de Registros/estatística & dados numéricos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Irmãos , Adulto Jovem
8.
Support Care Cancer ; 28(1): 309-316, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31044307

RESUMO

PURPOSE: It is not known which side effects (SEs) cancer patients undergoing definitive radiotherapy (RT) perceive as worse than others. Our objectives were to (1) identify the worst SEs in patients receiving definitive RT-predominant treatment using patient-reported outcomes and (2) investigate the prominence of physical SEs relative to psychosocial SEs. METHODS: In a single-center outpatient radiation oncology clinic, patients were surveyed on the final day of definitive RT. Sixty-seven cards listed SEs (40 physical and 27 psychosocial), and patients ranked the five most severe. Fifteen points were assigned to the top five selected SEs with descending scores of 5, 4, 3, 2, and 1. RESULTS: Fifty-five patients completed ≥ 4 weeks of RT with or without concurrent chemotherapy and had not received ≥ 4 weeks of neoadjuvant chemotherapy. Patients with head and neck and pelvis cancers perceived physical SEs as worse relative to psychosocial SEs; physical SEs filled 78% and 69% of the 15 points, respectively. In breast cancer patients, however, psychosocial SEs filled 45% of the 15 points in breast cancer patients (anxiety, depression, and sequelae), compared to 25% in others (P = 0.007). Affects my work, home duties, a SE not associated with the treatment itself, was the most frequently cited psychosocial SE (20% of cohort) and was ranked ninth overall. CONCLUSION: Perceptions of SEs of cancer RT are dominated by physical quality of life (QoL) concerns and are influenced by the anatomic area receiving RT. Psychosocial QoL concerns are significantly more frequent in breast cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02978846.


Assuntos
Neoplasias/radioterapia , Medidas de Resultados Relatados pelo Paciente , Lesões por Radiação/patologia , Lesões por Radiação/psicologia , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias/psicologia , Qualidade de Vida/psicologia , Lesões por Radiação/etiologia , Radioterapia (Especialidade) , Radioterapia/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários
9.
Support Care Cancer ; 28(1): 341-349, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31044309

RESUMO

PURPOSE: This study analysed nutritional parameters (baseline body mass index (BMI), weight changes and enteral nutrition (EN) use, and their association with hospital admissions during radiotherapy in patients with head and neck cancer (HNC)). METHODS: A retrospective review of patients diagnosed with HNC and treated with radiotherapy between October 2012 and April 2014 was conducted. Data on each subject's diagnosis, age, sex, chemotherapy, previous surgery, EN use, weight changes, and BMI were examined for their association with hospital admissions during treatment. RESULTS: Eighty-three patients were included, mean age (±standard deviation) = 61 (± 11 years). Thirty-four percent had self-reported weight loss at diagnosis, and mean BMI was 26.2 ± 5.3 kg/m2. Mean weight change during treatment was - 5.1 ± 6.2%. Ten patients used EN, with mean weight stabilisation during EN use (0.3 ± 5.1%). Higher presenting BMI, younger age, and definitive radiotherapy ± chemotherapy predicted greater weight loss (p < 0.05). Critical weight loss ≥ 5% was associated with a higher number of hospital admissions for nutrition reasons (n = 10) (p = 0.011) compared with those without critical weight loss (n = 2). EN use was associated with a higher number of nutrition-related admissions; however, it did not predict length of stay among those admitted. CONCLUSION: Critical weight loss during radiotherapy was associated with unplanned nutrition-related hospital admissions. Higher BMI was associated with greater weight loss during radiotherapy, whilst EN use assisted in weight preservation. Further research around patient selection for nutritional interventions aimed at preventing critical weight loss and unplanned hospital admissions is needed.


Assuntos
Nutrição Enteral/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Estado Nutricional/fisiologia , Admissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Austrália/epidemiologia , Índice de Massa Corporal , Caquexia/epidemiologia , Caquexia/etiologia , Caquexia/terapia , Nutrição Enteral/efeitos adversos , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Perda de Peso/fisiologia
10.
Bull Cancer ; 107(1): 84-101, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31866074

RESUMO

The management of patients undergoing immunosuppressive agents is really challenging. Based on precaution principle, it seems mandatory to stop immunosuppressive (or immunomodulating) agents during radiation. Yet, it is impossible in grafted patients. It is possible in patients with autoimmune disease, but in this case, the autoimmune disease might modify patient's radio-sensitivity. We provide a short review about the safety of radiotherapy in grafted/auto-immune patients. The literature is limited with data coming from outdated case-report or case-control studies. It seems that radiotherapy is feasible in grafted patients, but special dose-constraints limitations must probably be considered for the transplant and the other organs at risk. There is very little data about the safety of radiotherapy, when associated with immunomodulating agents. The most studied drug is the methotrexate but only its prescription as a chemotherapy (high doses for a short period of time) was reported. When used as an immunomodulator, it should probably be stopped 4 months before and after radiation. Apart from rheumatoid arthritis, it seems that collagen vascular diseases and especially systemic scleroderma and systemic lupus erythematous feature increased radio-sensitivity with increased severe late toxicities. Transplanted patients and collagen vascular disease patients should be informed that there is very little data about safety of radiation in their case.


Assuntos
Doenças Autoimunes/tratamento farmacológico , Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Radioterapia/efeitos adversos , Transplantados , Feminino , Neoplasias dos Genitais Femininos/radioterapia , Humanos , Imunossupressão , Imunossupressores/efeitos adversos , Masculino , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Neoplasias/radioterapia , Órgãos em Risco/efeitos da radiação , Neoplasias da Próstata/radioterapia , Transplantes/efeitos da radiação , Suspensão de Tratamento
12.
Semin Oncol ; 46(6): 426-432, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31791551

RESUMO

Malignant disease and its treatment carry huge burdens for patients. Some are immediate, in that the disease itself presents as a life threatening event, or the treatment may result in immediate and devastating toxicity. More often the treatment of cancer is associated with more subtle or late events, yet these may impact the quality of life for cancer survivors in a variety of ways. In addition to the physical sequelae of cancer or its treatment, cancer survivors often experience consequences in the form of social or mental incapacity. Session III of this Colloquium on Cardio-Oncology focuses on some of these concerns, both from the perspective of health care providers who strive to minimize the burdens, but also from the viewpoint of the patient him or herself who must deal with the price that must often be paid for increased survival or cure.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Sobreviventes de Câncer , Doenças Cardiovasculares/etiologia , Neoplasias/complicações , Radioterapia/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Gerenciamento Clínico , Humanos , Incidência , Neoplasias/terapia , Guias de Prática Clínica como Assunto , Radioterapia/métodos
13.
Semin Oncol ; 46(6): 414-420, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31784040

RESUMO

Session IV of the Second International Colloquium on Cardio-Oncology held in Kraków, focused on the cardiovascular risks of using hormone replacement therapy in breast cancer and androgen deprivation therapy in prostate cancer and continued the theme from Session 3 with a discussion of risk reduction strategies. The discussion then moved to an overview of modern radiation therapy and evolving mechanisms of cardioprotection. The risks and late cardiotoxic effects that must be considered in patients treated prior to the "modern era" were enumerated stressing the importance of long term follow-up of this population.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Neoplasias/complicações , Neoplasias/terapia , Radioterapia/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Humanos , Neoplasias/mortalidade , Radioterapia/métodos , Fatores de Risco
14.
Semin Oncol ; 46(6): 433-436, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31784041

RESUMO

Guidelines for the diagnosis, management, and surveillance of cancer patients have evolved with the single goal of improving patient care based on established data when available, or in the absence of firm data, on the standard practices of those with broad experience in actual hands-on patient care. Two initiatives intended to disseminate information to cardio-oncologists, were discussed in this session: the first, from the American Society of Clinical Oncology was focused on available data and the confidence level of that data; the second, from The European Society of Cardiology was a position paper. Interestingly, notwithstanding the somewhat different focus, there is considerable agreement between these two initiatives. Nevertheless, guidelines my not be applicable to all afflicted patients, and may raise questions as to when deviations from published standards should be considered. Such deviations may result in allegations of failure to meet standards of care or legal liability.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Doenças Cardiovasculares/etiologia , Neoplasias/complicações , Radioterapia/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cardiotoxicidade , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Gerenciamento Clínico , Humanos , Terapia de Alvo Molecular/efeitos adversos , Terapia de Alvo Molecular/métodos , Neoplasias/terapia , Oncologistas , Papel do Médico , Guias de Prática Clínica como Assunto , Radioterapia/métodos
15.
Int. j. morphol ; 37(4): 1564-1571, Dec. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1040170

RESUMO

Las glándulas salivales humanas pueden ser gravemente lesionadas por la radioterapia utilizada contra neoplasias de cabeza y cuello, produciendo hiposialia y xerostomía, las cuales afectan la salud oral y sistémica, mermando la calidad de vida de la persona. Los tratamientos convencionales actuales están diseñados para disminuir los síntomas, sin actuar sobre los cambios fisiopatológicos que se dan a nivel glandular. Esta revisión intenta analizar aquellas terapias preventivas y/o curativas que están desarrollándose en el campo biomolecular y que tienen un futuro prometedor por sus características innovadoras: terapia génica, terapia con células madre y terapia con factores de crecimiento. Se evidencia un aporte adicional de la nanotecnología, la cual está mejorando las vías de aplicación de los tratamientos.


Human salivary glands can be seriously injured by the radiotherapy used against head and neck neoplasms, producing hyposialia and xerostomy, which affect oral and systemic health, diminishing the person's quality of life. Current conventional treatments are designed to reduce symptoms, without acting on the pathophysiological changes that occur at the glandular level. This review attempts to analyze those preventive and /or curative therapies that are developing in the biomolecular field and that have a promising future due to their innovative features: Gene therapy, stem cell therapy and growth factor therapy. An additional contribution of nanotechnology is evident, which is improving the routes of treatment application.


Assuntos
Humanos , Radioterapia/efeitos adversos , Doenças das Glândulas Salivares/prevenção & controle , Células-Tronco/fisiologia , Terapia Genética/métodos , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Lesões por Radiação/prevenção & controle , Protetores contra Radiação/uso terapêutico , Doenças das Glândulas Salivares/terapia , Glândulas Salivares/efeitos da radiação , Xerostomia/prevenção & controle , Nanotecnologia
17.
Nat Genet ; 51(12): 1732-1740, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31740835

RESUMO

Some cancer therapies damage DNA and cause mutations in both cancerous and healthy cells. Therapy-induced mutations may underlie some of the long-term and late side effects of treatments, such as mental disabilities, organ toxicity and secondary neoplasms. Nevertheless, the burden of mutation contributed by different chemotherapies has not been explored. Here we identify the mutational signatures or footprints of six widely used anticancer therapies across more than 3,500 metastatic tumors originating from different organs. These include previously known and new mutational signatures generated by platinum-based drugs as well as a previously unknown signature of nucleoside metabolic inhibitors. Exploiting these mutational footprints, we estimate the contribution of different treatments to the mutation burden of tumors and their risk of contributing coding and potential driver mutations in the genome. The mutational footprints identified here allow for precise assessment of the mutational risk of different cancer therapies to understand their long-term side effects.


Assuntos
Antineoplásicos/efeitos adversos , Mutação , Neoplasias/genética , Neoplasias/terapia , Radioterapia/efeitos adversos , Antineoplásicos/uso terapêutico , Humanos , Neoplasias/patologia , Fatores de Risco
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1021-1026, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770832

RESUMO

Radiation-induced bowel injury is a common complication of radiation therapy for pelvic malignancy. Given the huge number of patients diagnosed with pelvic malignancy, the number of patients diagnosed with radiation-induced bowel injury increased year by year, which put a great burden on the clinical diagnosis and treatment of radiation-induced bowel injury. In particular, chronic radiation-induced bowel injury, which is manifested in the process of prolonged, repeated and progressive aggravation, seriously affects the physical and mental health of patients and makes clinical diagnosis and treatment difficult. However, due to insufficient attention and understanding from doctors and patients, standardized diagnosis and treatment of radiation-induced bowel injury still have a long way to go. Radiation-induced bowel injury is self-limited but irreversible. During diagnosis, we should pay attention to overall evaluation of the stage of disease based on clinical symptoms, endoscopic examination, imaging examination, pathology and nutritional risk. The treatment methods include health education, drug therapy, enema therapy, formalin local treatment, endoscopic treatment and surgical treatment, etc. The treatment decision-making should be based on clinical symptoms, endoscopic or imaging findings to alleviate the clinical symptoms of patients as the primary goal and to improve the long-term quality of life of patients as the ultimate goal.


Assuntos
Enteropatias/terapia , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/terapia , Radioterapia/efeitos adversos , Doença Crônica , Humanos , Enteropatias/diagnóstico , Enteropatias/etiologia , Intestinos/efeitos da radiação , Qualidade de Vida , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia
20.
Kathmandu Univ Med J (KUMJ) ; 17(65): 61-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734681

RESUMO

Background Radiation-induced oral mucositis is one of the major ionizing radiation toxicities and normal tissue injuries resulting from radiotherapy. It occurs in up to 80% of head and neck cancer irradiated patients, reaching up to 100% in patients with altered fractionation. Objective To assess the grade of Radiation induced oral mucositis as per World Health Organization grading system among post-radiotherapy patients of Head and Neck cancer. Method World Health Organization grading for oral mucositis was done in patients reporting to Department of Radiation oncology for radiotherapy at BP Koirala Memorial Cancer Hospital, Bharatpur. A total of 71 patients in 1 month duration were included. Result Grade 2 mucositis was most common, 52.11% followed by grade 1 (22.5%), grade 3 (18.3%) and grade 4 (7.04%). There were no post-radiotherapy patients who presented without mucositis. Conclusion Radiation induced oral mucositis is a common adverse reaction of radiotherapy. With increase in dose and duration of radiotherapy, grade of mucositis was increasing.


Assuntos
Neoplasias de Cabeça e Pescoço/complicações , Radioterapia/efeitos adversos , Estomatite/diagnóstico , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Estomatite/etiologia , Organização Mundial da Saúde
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