Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 18.971
Filtrar
1.
Phytomedicine ; 80: 153402, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33203590

RESUMO

BACKGROUND: Although great achievements have been made in the field of cancer therapy, chemotherapy and radiotherapy remain the mainstay cancer therapeutic modalities. However, they are associated with various side effects, including cardiocytotoxicity, nephrotoxicity, myelosuppression, neurotoxicity, hepatotoxicity, gastrointestinal toxicity, mucositis, and alopecia, which severely affect the quality of life of cancer patients. Plants harbor a great chemical diversity and flexible biological properties that are well-compatible with their use as adjuvant therapy in reducing the side effects of cancer therapy. PURPOSE: This review aimed to comprehensively summarize the molecular mechanisms by which phytochemicals ameliorate the side effects of cancer therapies and their potential clinical applications. METHODS: We obtained information from PubMed, Science Direct, Web of Science, and Google scholar, and introduced the molecular mechanisms by which chemotherapeutic drugs and irradiation induce toxic side effects. Accordingly, we summarized the underlying mechanisms of representative phytochemicals in reducing these side effects. RESULTS: Representative phytochemicals exhibit a great potential in reducing the side effects of chemotherapy and radiotherapy due to their broad range of biological activities, including antioxidation, antimutagenesis, anti-inflammation, myeloprotection, and immunomodulation. However, since a majority of the phytochemicals have only been subjected to preclinical studies, clinical trials are imperative to comprehensively evaluate their therapeutic values. CONCLUSION: This review highlights that phytochemicals have interesting properties in relieving the side effects of chemotherapy and radiotherapy. Future studies are required to explore the clinical benefits of these phytochemicals for exploitation in chemotherapy and radiotherapy.


Assuntos
Antineoplásicos/efeitos adversos , Compostos Fitoquímicos/farmacologia , Substâncias Protetoras/farmacologia , Radioterapia/efeitos adversos , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Antineoplásicos/uso terapêutico , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Estresse Oxidativo/efeitos dos fármacos , Lesões por Radiação/prevenção & controle
2.
Br J Radiol ; 94(1117): 20200466, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33112664

RESUMO

Covid-19 is a morbid respiratory disease that has caused desperate times on a global scale due to the lack of any effective medical treatment. Some in the radiation community are actively proposing low-dose radiation therapy (LDRT) for managing the viral pneumonia associated with Covid-19. This commentary provides a rationale for exercising caution against such a decision as the efficacy of LDRT for viral diseases is unknown, while its long-term adverse risks are well known.


Assuntos
/radioterapia , Humanos , Radioterapia/efeitos adversos , Dosagem Radioterapêutica
3.
Ann Vasc Surg ; 70: 230-236, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32795652

RESUMO

BACKGROUND: Patients meeting criteria for intervention of carotid stenosis with a history of prior cervical radiation or neck dissection are considered "high risk" for carotid endarterectomy. This is a well-established indication for carotid artery stenting (CAS). The long-term outcomes of CAS in this population are less frequently published in the literature but are poor. The purpose of this study was to review long-term results of CAS in veteran patients with a prior history of treatment for head and/or neck cancer. METHODS: This is a retrospective review of a veteran patient population from 1998 to 2016. All patients at our institution with a prior history of treatment for head and/or neck cancer who underwent CAS were included in the analysis. During this time period, 44 patients met inclusion criteria and were treated with 57 carotid stenting interventions. The Kaplan-Meier analysis was used to determine survival and primary patency. The secondary aims were to analyze early outcomes and to identify predictive risk factors for mortality and reintervention. RESULTS: The mean follow-up was 42.9 ± 36.6 months. The cumulative survival at 1, 5, and 10 years was 91%, 67%, and 48%, respectively. The primary patency at 1, 5, and 10 years was 95%, 86%, and 86%, respectively. The reintervention rate was 11% (n = 6) with an assisted primary patency rate of 100%. No neurologic events occurred within 30 days. There were 3 strokes in late follow-up and no stroke-related deaths. Eighteen patients (41%) died during the follow-up period, 15 of whom died during the first 5 years of follow-up. Ten (66%) of those patients died of recurrent or active index cancer. On univariate analysis, tumor, node, metastasis stage IV was significantly associated with death (P = 0.02). Multivariate models were not statistically significant for predicting mortality or reintervention CONCLUSIONS: On the basis of the results in this series, CAS can be performed in these patients with low long-term rates of neurologic events and need for reintervention. However, the survival of patients with head and neck cancer undergoing CAS in this cohort is poor, which is consistent with other published series of patients undergoing CAS for head/neck cancer with at least 5-year follow-up. In this specific patient population, a more critical analysis of the patient's overall prognosis, especially as related to cancer, should be undertaken before offering CAS.


Assuntos
Estenose das Carótidas/terapia , Procedimentos Endovasculares/instrumentação , Neoplasias de Cabeça e Pescoço/terapia , Esvaziamento Cervical/efeitos adversos , Lesões por Radiação/terapia , Stents , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Estenose das Carótidas/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/mortalidade , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/mortalidade , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Saúde dos Veteranos
4.
Oncology ; 99(1): 1-14, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33221794

RESUMO

BACKGROUND: Out-of-field tumor regression effects of radiation therapy (abscopal response) have been sporadically observed in the past, but they have only recently gained significant importance due to the use of innovative high-precision radiation delivery devices for the treatment of various cancers including non-small cell lung cancer (NSCLC). In this study, we provide a detailed overview of the current state of knowledge and clinical experience of radiation therapy-induced abscopal effects in patients with advanced NSCLC. SUMMARY: Peer-reviewed published clinical evidence on the abscopal effect of radiation therapy was collected using electronic databases such as MEDLINE via PubMed and Google Scholar. The clinical data on the abscopal effect of radiation therapy were reviewed and the outcomes have been summarized. Most studies describing the abscopal effects of radiation therapy in patients with advanced NSCLC have been in the form of either case reports or small cohort studies. Although the exact molecular mechanisms for the abscopal effect are yet to be established, current evidence indicates that tumor cell destruction induced by local radiation therapy releases tumor antigens, which stimulate the immune system of the host to activate the body's immune effector cells systemically and trigger the regression of distant nonirradiated cancer cells. These off-target antitumor effects of radiation therapy provide an opportunity to explore the use of the radiation therapy in combination with novel immunotherapy agents to maximize treatment outcomes in patients with advanced NSCLC and other cancers. Key Message: The findings suggest that radiation therapy has the ability to induce abscopal effects with an increased potential to boost these effects when it is used in combination with immunotherapy for the treatment of patients with advanced NSCLC and other cancers. Clinical trials investigating radiation therapy-induced abscopal effects may lead to a dramatic change in its use especially when it is combined with immunotherapy for the treatment of patients with advanced NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/complicações , Neoplasias Pulmonares/radioterapia , Radioterapia/efeitos adversos , Idoso , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , PubMed , Resultado do Tratamento
5.
Support Care Cancer ; 29(1): 279-287, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32358775

RESUMO

IMPORTANCE: Chronic fatigue is present in 33.0% of all head and neck cancer (HNC) survivors; this impacts their quality of life negatively. A plausible cause is obstructive sleep apnea (OSA) after HNC treatment. However, studies regarding this topic are scarce. OBJECTIVE: To confirm if OSA is more prevalent after receiving radiotherapy for HNC. In addition, investigation of the risk factors for developing OSA in this population. DESIGN: A retrospective review of prospective data. METHODS: Treatment for HNC took place between 2016 and 2017 at the University Hospital of Leuven. One hundred sixty-four patients were eligible for participating in this study. Sixty-five responded (39.4%). Upon consulting their medical files, 15 patients were excluded based on the in- and exclusion criteria. Presence of OSA was estimated using standardized questionnaires, namely the Berlin Questionnaire, the Epworth Sleepiness Scale, and the CIS-20. This was compared to the proportion of OSA in the general population. RESULTS: Fifty patients (33 men, 17 women) with a mean age of 64.2 years (range 32-88) were included. Based on the questionnaires, OSA was suspected in twenty. The prevalence of suspected OSA in our study group (40.0%) was significantly greater (p < 0.0001) than our estimated prevalence of OSA in the general population (10.9%). No significant risk factors could be identified. CONCLUSION: Patients treated for HNC are at risk of developing OSA. When complaints of fatigue and sleeping problems persist, referral to a sleep clinic is suggested. Further investigation remains necessary to identify potential risk factors along with prevention and treatment strategies.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Fadiga/epidemiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia/efeitos adversos , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Qualidade de Vida/psicologia , Estudos Retrospectivos , Fatores de Risco , Sono/fisiologia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Inquéritos e Questionários
6.
Oral Dis ; 27(1): 7-13, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32166855

RESUMO

Pretreatment dental screening aims to locate and eliminate oral foci of infection in order to eliminate local, loco-regional, or systemic complications during and after oncologic treatment. An oral focus of infection is a pathologic process in the oral cavity that does not cause major infectious problems in healthy individuals, but may lead to severe local or systemic inflammation in patients subjected to oncologic treatment. As head and neck radiotherapy patients bear a lifelong risk on oral sequelae resulting from this therapy, the effects of chemotherapy on healthy oral tissues are essentially temporary and reversible. This has a large impact on what to consider as an oral focus of infection when patients are subjected to, for example, head and neck radiotherapy for cancer or intensive chemotherapy for hematological disorders. While in patients subjected to head and neck radiotherapy oral foci of infection have to be removed before therapy that may cause problems ultimately, in patients that will receive chemotherapy such, so-called chronic, foci of infection are not in need of removal of teeth but can be treated during a remission phase. Acute foci of infection always have to be removed before or early after the onset of any oncologic treatment.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Radioterapia/efeitos adversos
7.
Pediatr Clin North Am ; 67(6): 1051-1067, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131534

RESUMO

Advances in multimodality care for patients with pediatric cancer continues to improve long-term survival. The use of surgery, chemotherapy, and radiotherapy may lead to debilitating late effects in childhood cancer survivors. It is critically important to understand, mitigate, and screen for late effects to improve the quality of life in childhood cancer survivors. This review summarizes the use of radiotherapy in children, radiobiology of tissue injury, impact of age on late effects, important organ systems affected by radiotherapy during survivorship, and screening for radiotherapy late effects.


Assuntos
Sobreviventes de Câncer , Neoplasias/radioterapia , Radioterapia/efeitos adversos , Criança , Desenvolvimento Infantil , Humanos , Incidência , Lesões por Radiação/mortalidade
8.
Pediatr Clin North Am ; 67(6): 1155-1170, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131539

RESUMO

Childhood cancer survivors are at risk for developing cardiovascular disease and pulmonary disease related to cancer treatment. This might not become apparent until many years after treatment and varies from subclinical to life-threatening disease. Important causes are anthracyclines and radiotherapy involving heart, head, or neck for cardiovascular disease, and bleomycin, busulfan, nitrosoureas, radiation to the chest, and lung or chest surgery for pulmonary disease. Most effects are dose dependent, but genetic risk factors have been discovered. Treatment options are limited. Prevention and regular screening are crucial. Survivors should be encouraged to adopt a healthy lifestyle, and modifiable risk factors should be addressed.


Assuntos
Sobreviventes de Câncer , Doenças Cardiovasculares/etiologia , Pneumopatias/etiologia , Neoplasias/terapia , Antineoplásicos/efeitos adversos , Doenças Cardiovasculares/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Pneumopatias/mortalidade , Vigilância da População , Radioterapia/efeitos adversos , Fatores de Risco
9.
Pediatr Clin North Am ; 67(6): 1171-1186, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131540

RESUMO

Endocrine late effects, including reproductive disorders and secondary thyroid cancer, have been reported in up to 50 %childhood cancer survivors (CCS) more than 5 years after treatment. Most endocrine disorders are amenable to treatment; awareness of symptoms is therefore of great importance. Recognition of these symptoms may be delayed however because many are nonspecific. Timely treatment of endocrine disorders improves quality of life in CCS and prevents possible consequences, such as short stature, bone and cardiovascular disorders, and depression. At-risk CCS must therefore be regularly and systematically monitored. This article provides a summary of the most commonly reported endocrine late effects in CCS.


Assuntos
Sobreviventes de Câncer , Doenças do Sistema Endócrino/etiologia , Neoplasias/terapia , Antineoplásicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Sistema Endócrino/cirurgia , Humanos , Radioterapia/efeitos adversos , Fatores de Risco
10.
Pediatr Clin North Am ; 67(6): 1187-1202, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131541

RESUMO

Gonadal dysfunction and infertility after cancer treatment are major concerns for childhood cancer survivors and their parents. Uncertainty about fertility or being diagnosed with infertility has a negative impact on quality of survival. In this article, determinants of gonadal damage are reviewed and consequences for fertility and pregnancies are discussed. Recommendations for screening and treatment of gonadal function are provided. These should enable timely treatment of gonadal insufficiency aiming to improve linear growth, pubertal development, and sexual functioning. Options for fertility preservation are discussed.


Assuntos
Sobreviventes de Câncer , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Masculinos/etiologia , Neoplasias/terapia , Antineoplásicos/efeitos adversos , Criança , Desenvolvimento Infantil , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Masculino , Radioterapia/efeitos adversos
11.
Pediatr Clin North Am ; 67(6): 1203-1217, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131542

RESUMO

Childhood cancer survivors (CCSs) are at risk for renal and hepatic complications related to curative cancer treatments. Although acute renal and hepatic toxicities of cancer treatments are well described, data regarding long-term and late-occurring sequelae or their associations with acute sequelae are less robust. This article highlights the literature on the prevalence of and risk factors for late renal and hepatic toxicity in CCSs. Studies investigating these outcomes are needed to inform surveillance practices and the development of future frontline cancer treatment protocols.


Assuntos
Sobreviventes de Câncer , Nefropatias/etiologia , Hepatopatias/etiologia , Neoplasias/terapia , Antineoplásicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Radioterapia/efeitos adversos , Fatores de Risco
12.
Pediatr Clin North Am ; 67(6): 1219-1235, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131543

RESUMO

Ototoxicity and other neurologic toxicities are potential consequences of exposure to common therapeutic agents used during treatment of childhood cancer, including platinum and vinca alkaloid chemotherapy, cranial radiation, surgery involving structures critical to cochlear and neurologic function, and supportive care medications such as aminoglycoside antibiotics and loop diuretics. This article provides an overview of ototoxicity and other neurologic toxicities related to childhood cancer treatment, discusses the challenges that these toxicities may pose for survivors, and presents an overview of current recommendations for surveillance and clinical management of these potentially life-altering toxicities in survivors of childhood cancers.


Assuntos
Sobreviventes de Câncer , Transtornos da Audição/etiologia , Neoplasias/terapia , Doenças do Sistema Nervoso Periférico/etiologia , Antineoplásicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Radioterapia/efeitos adversos , Fatores de Risco
13.
Pediatr Clin North Am ; 67(6): 1237-1251, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131544

RESUMO

As treatment evolves and the population who survive childhood cancer ages and increases in number, researchers must use novel approaches to prevent, identify and mitigate adverse effects of treatment. Future priorities include collaborative efforts to pool large cohort data to improve detection of late effects, identify late effects of novel therapies, and determine the contribution of genetic factors along with physiologic and accelerated aging among survivors. This knowledge should translate to individual risk prediction and prevention strategies. Finally, we must utilize health services research and implementation science to improve adoption of survivorship care recommendations outside of specialized pediatric oncology centers.


Assuntos
Sobreviventes de Câncer , Assistência à Saúde/tendências , Oncologia/tendências , Neoplasias/terapia , Pesquisa Biomédica , Continuidade da Assistência ao Paciente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Radioterapia/efeitos adversos
14.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(5): 623-628, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33210491

RESUMO

Radiation-induced lung injury (RILI), including acute radiation pneumonitis and chronic radiation-induced pulmonary fibrosis (RIPF), is a side effect of radiotherapy for lung cancer and esophageal cancer. Pulmonary macrophages, as a kind of natural immune cells maintaining lung homeostasis, play a key role in the whole pathological process of RILI. In the early stage of RILI, classically activated M1 macrophages secrete proinflammatory cytokines to induce inflammation and produce massive reactive oxygen species (ROS) through ROS-induced cascade to further impair lung tissue. In the later stage of RILI, alternatively activated M2 macrophages secrete profibrotic cytokines to promote the development of RIPF. The roles of macrophage in the pathogenesis of RILI and the related potential clinical applications are summarized in this review.


Assuntos
Lesão Pulmonar , Pulmão , Macrófagos , Lesões por Radiação , Radioterapia , Humanos , Pulmão/efeitos da radiação , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Macrófagos/metabolismo , Pneumonite por Radiação/etiologia , Radioterapia/efeitos adversos
15.
Medicine (Baltimore) ; 99(48): e23318, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235092

RESUMO

Radiodermatitis is a common side effect of radiotherapy, but currently there is no standard treatment for its prevention. This study aimed to observe the effect of topical application of a paste based on traditional Chinese medicine, Jiawei Simiao Yongan Gao, on radiodermatitis caused by radiotherapy for patients with head and neck cancer.This was a retrospective cohort study of 40 patients with head and neck cancer evaluated during their radiotherapy. Of these, 20 patients were treated with Jiawei Simiao Yongan Gao on the irradiated skin from the beginning of radiotherapy (JSY group). The other 20 patients were given standard nursing (standard group). Acute skin reactions were classified according to the radiation-induced skin reaction assessment scale (RISRAS) and American radiation therapy oncology group (RTOG) acute toxicity grading criteria every 2 weeks, and adverse effects were recorded until the end of the radiotherapy.The two groups showed differences in severity of radiodermatitis. At 0 to 30 Gy, the skin reactions were similar in the two groups, while above 40 Gy the skin reactions were significantly lower grade in the JSY group (P < .05). At 0 to 20 Gy, there was no statistical significance (P > .05); but above 30 Gy they were lower in the JSY group (P < .05).Jiawei Simiao Yongan Gao effectively alleviated acute radiodermatitis caused by radiotherapy of head and neck cancer patients compared with standard nursing.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Radiodermatite/terapia , Administração Tópica , Adulto , Idoso , Estudos de Casos e Controles , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Medicina Tradicional Chinesa/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radiodermatite/etiologia , Radioterapia/efeitos adversos , Estudos Retrospectivos , Índice de Gravidade de Doença
16.
N Z Med J ; 133(1523): 41-54, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032302

RESUMO

AIM: The aim of this study was to determine the prevalence of dental developmental disturbances in long-term survivors of childhood malignancies in New Zealand children. This study reports associations with potential risk factors to inform oncologists and dentists of the likelihood of dental abnormalities. METHODS: The study population was children aged 14-16 years old who were diagnosed with cancer prior to 10 years of age. A total of 156 children were eligible, of which 59 participated in this study. The indices used in this study were Holtta's Defect Index (HDI), and Oral Health Impact Profile-14 (OHIP-14). RESULTS: The prevalence of agenesis was 15.3%, microdontia 6.8% and root abnormalities 32.2%. Cyclophosphamide equivalent doses above 8,000mg/m2, stem cell therapy (SCT), and head and neck radiation therapy (HNRT) were associated with a higher mean number of teeth missing due to agenesis. SCT and HNRT were associated with a higher total HDI. A binary logistic regression was carried out to determine the odds of agenesis and found that HNRT was the main contributing factor (OR=7.7, p-value=0.04). The linear regression model found that dactinomycin and agenesis correlated with the largest mean OHIP-14. CONCLUSION: This study found that childhood cancer survivors in New Zealand had a high prevalence of developmental dental abnormalities and it identified potential risk factors related to their cancer treatment. Inequitable access to oral rehabilitation for this patient group argues for a mechanism for consistent improved access to publicly funded dental care across district health boards in New Zealand.


Assuntos
Anodontia , Sobreviventes de Câncer/estatística & dados numéricos , Neoplasias , Adolescente , Anodontia/complicações , Anodontia/epidemiologia , Antineoplásicos Alquilantes/efeitos adversos , Antineoplásicos Alquilantes/uso terapêutico , Estudos Transversais , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Masculino , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Nova Zelândia , Prevalência , Radioterapia/efeitos adversos , Transplante de Células-Tronco/efeitos adversos
17.
Cancer Imaging ; 20(1): 76, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33097093

RESUMO

BACKGROUND: Radiation-induced insufficiency fractures (IF) is frequently occult without fracture line, which may be mistaken as metastasis. Quantitative apparent diffusion coefficient (ADC) shows potential value for characterization of benign and malignant bone marrow diseases. The purpose of this study was to develop a nomogram based on multi-parametric ADCs in the differntiation of occult IF from bone metastasis after radiotherapy (RT) for cervical cancer. METHODS: This study included forty-seven patients with cervical cancer that showed emerging new bone lesions in RT field during the follow-up. Multi-parametric quantitative ADC values were measured for each lesion by manually setting region of interests (ROIs) on ADC maps, and the ROIs were copied to adjacent normal muscle and bone marrow. Six parameters were calculated, including ADCmean, ADCmin, ADCmax, ADCstd, ADCmean ratio (lesion/normal bone) and ADCmean ratio (lesion/muscle). For univariate analysis, receiver operating characteristic curve (ROC) analysis was performed to assess the performance. For combined diagnosis, a nomogram model was developed by using a multivariate logistic regression analysis. RESULTS: A total of 75 bone lesions were identified, including 48 occult IFs and 27 bone metastases. There were significant differences in the six ADC parameters between occult IFs and bone metastases (p < 0.05), the ADC ratio (lesion/ muscle) showed an optimal diagnostic efficacy, with an area under ROC (AUC) of 0.887, the sensitivity of 95.8%, the specificity of 81.5%, respectively. Regarding combined diagnosis, ADCstd and ADCmean ratio (lesion/muscle) were identified as independent factors and were selected to generate a nomogram model. The nomogram model showed a better performance, yielded an AUC of 0.92, the sensitivity of 91.7%, the specificity of 96.3%, positive predictive value (PPV) of 97.8% and negative predictive value (NPV) of 86.7%, respectively. CONCLUSIONS: Multi-parametric ADC values demonstrate potential value for differentiating occult IFs from bone metastasis, a nomogram based on the combination of ADCstd and ADCmean ratio (lesion/muscle) may provide an improved classification performance.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Fraturas de Estresse/diagnóstico por imagem , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Neoplasias Ósseas/secundário , Feminino , Fraturas de Estresse/etiologia , Humanos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/secundário , Nomogramas , Radioterapia/efeitos adversos
18.
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
20.
Khirurgiia (Mosk) ; (8): 29-34, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869612

RESUMO

OBJECTIVE: To report our own experience of one-stage surgical treatment of irradiation-induced osteomyelitis as a complication of radiotherapy for breast cancer (BC). MATERIAL AND METHODS: The study included 25 patients with irradiation-induced chest osteomyelitis after previous radiotherapy for breast cancer. All patients were examined according to the same protocol. One-stage surgery with full-thickness resection of affected tissues and plastic closure of the wound was performed depending on localization of lesion and availability of plastic material. RESULTS: Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were assessed according to Clavien-Dindo classification. Complications followed by antibacterial therapy and/or local treatment were observed in 8 (32%) out of 25 patients (95% CI 11.5-43.4). Marginal necrosis of musculoskeletal flap was registered in 4 (16%) patients. One (4%) patient required redo thoracomyoplasty after excision of necrotic tissues of musculocutaneous flap due to extensive tissue defect. Total necrosis of musculocutaneous flap was not noted. There were no fatal outcomes. Mean length of hospital-stay was 13 (10; 27) days in the group of musculocutaneous flap from latissimus dorsi muscle and 11 days (7; 24) in the group of rectus abdominis muscle. Good and satisfactory treatment outcomes after one-stage surgical treatment were achieved in 24 (96%) out of 25 patients (95% CI: 75-97.8). CONCLUSION: Irradiation-induced chest osteomyelitis is still actual problem despite an improvement of modern medical equipment and accumulation of experience in radiotherapy. Surgery is preferable method of treatment. Comprehensive examination including contrast-enhanced chest CT with 3D reconstruction and Doppler ultrasound of vascular pedicle is valuable to determine type of resection and plastic technique. Simultaneous approach with resection and plastic closure of the wound is preferred for irradiation-induced chest osteomyelitis if sufficient amount of plastic material is available and contraindications for reconstructive surgery are absent.


Assuntos
Neoplasias da Mama/radioterapia , Retalho Miocutâneo , Osteomielite/cirurgia , Radioterapia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Parede Torácica/cirurgia , Humanos , Músculo Esquelético/transplante , Retalho Miocutâneo/efeitos adversos , Osteomielite/etiologia , Reoperação , Parede Torácica/efeitos da radiação , Toracoplastia/métodos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA