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1.
Br J Radiol ; 95(1129): 20210200, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34757824

RESUMO

OBJECTIVE: Uveal melanoma (UM) commonly metastasizes to the liver. Treatment usually consists of liver-directed therapies, such as selective internal radiation therapy (SIRT). This review aimed to assess the effectiveness and safety of SIRT for hepatic metastases from UM. METHODS: The study protocol is available at OSF (https://osf.io/vhyct/). EMBASE and MEDLINE were searched until July 2020, using terms related to SIRT and hepatic metastases from UM. Studies reporting outcomes of SIRT in patients with UM and at least one hepatic metastasis were included. Data on overall survival (OS), hepatic progression free survival (hPFS) or tumor response were collected. The Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. RESULTS: 11 studies were included, reporting outcomes for 268 patients with hepatic metastases from UM. Most studies (n = 9, 81.8%) were retrospective. Disease control was achieved in 170 patients (67.5%) and the median OS from time of SIRT was 12.3 months. Median hPFS was 5.4 months. Low-grade side-effects were common but serious complications were infrequent. There were two treatment-related deaths. The median NOS score was 6 (moderate risk of bias). CONCLUSION: SIRT appears to be a safe and effective treatment for patients with unresectable hepatic metastases from UM. The certainty of our results is unclear due to predominantly retrospective data with moderate risk of bias. Further prospective studies are required to explore the role of SIRT in UM. ADVANCES IN KNOWLEDGE: SIRT appears to be a safe treatment for patients with unresectable hepatic metastases from UM. Further prospective work is required.


Assuntos
Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Melanoma/patologia , Neoplasias Uveais/patologia , Humanos , Neoplasias Hepáticas/mortalidade , Melanoma/mortalidade , Intervalo Livre de Progressão , Radioterapia/efeitos adversos , Radioterapia/métodos , Neoplasias Uveais/mortalidade
2.
Hypertension ; 79(1): 50-56, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34739766

RESUMO

Injury of the afferent limb of the baroreflex from neck radiation causes radiation-induced afferent baroreflex failure (R-ABF). Identification and management of R-ABF is challenging. We aimed to investigate the pattern of autonomic dysfunction on standardized autonomic testing in patients with probable R-ABF. We retrospectively analyzed all autonomic reflex screens performed at Mayo Clinic in Rochester, MN, between 2000 and 2020 in patients with probable R-ABF. Additional tests reviewed included ambulatory blood pressure monitoring, plasma norepinephrine, and thermoregulatory sweat test. We identified 90 patients with probable R-ABF. Median total composite autonomic severity score (range, 0-10) was 7 (interquartile range, 6-7). Cardiovascular adrenergic impairment was seen in 85 patients (94.4%), increased blood pressure recovery time after Valsalva maneuver in 71 patients (78.9%; median 17.4 seconds), and orthostatic hypotension in 68 patients (75.6%). Cardiovagal impairment was demonstrated by abnormal heart rate responses to deep breathing (79.5%), Valsalva ratio (87.2%), and vagal baroreflex sensitivity (57.9%). Plasma norepinephrine was elevated and rose appropriately upon standing (722-1207 pg/mL). Ambulatory blood pressure monitoring revealed hypertension, postural hypotension, hypertensive surges, tachycardia, and absence of nocturnal dipping. Blood pressure lability correlated with impaired vagal baroreflex function. Postganglionic sympathetic sudomotor function was normal in most cases; the most frequent thermoregulatory sweat test finding was focal neck anhidrosis (78.9%). Standardized autonomic testing in R-ABF demonstrates cardiovascular adrenergic impairment with orthostatic hypotension, blood pressure lability, and elevated plasma norepinephrine. Cardiovagal impairment is common, while sudomotor deficits are limited to direct radiation effects.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/efeitos da radiação , Barorreflexo/efeitos da radiação , Radioterapia/efeitos adversos , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Pressão Sanguínea/efeitos da radiação , Feminino , Frequência Cardíaca/fisiologia , Frequência Cardíaca/efeitos da radiação , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Estudos Retrospectivos , Índice de Gravidade de Doença , Manobra de Valsalva
3.
Nutrients ; 13(12)2021 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-34959948

RESUMO

BACKGROUND: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. METHODS: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. RESULTS: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. CONCLUSIONS: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.


Assuntos
Antineoplásicos/efeitos adversos , Ingestão de Alimentos/efeitos dos fármacos , Ingestão de Alimentos/efeitos da radiação , Comportamento Alimentar/efeitos dos fármacos , Comportamento Alimentar/efeitos da radiação , Náusea/etiologia , Náusea/prevenção & controle , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Radioterapia/efeitos adversos , Vômito/etiologia , Vômito/prevenção & controle , Cuidadores , Humanos , Equipe de Assistência ao Paciente , Sarcopenia/etiologia , Sarcopenia/prevenção & controle
4.
Adv Skin Wound Care ; 34(12): 1-8, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34807900

RESUMO

OBJECTIVE: Radiation-induced skin injuries such as lesions (RSLs) and dermatitis are the most common complication during radiotherapy (RT) for nasopharyngeal carcinoma, but little is known about risk factors unique to oncology. This study sought a greater understanding of these risk factors to stratify patients based on risk and guide clinical decision-making. METHODS: Investigators analyzed the data of 864 consecutive patients referred to the RT center of the Southern Theater General Hospital for a new RSL from 2013 to 2019. These patients were followed up for an average of approximately 16 months until their death or March 30, 2020, whichever came first. Multivariate logistic regression analysis and Cox proportional hazards model were used to identify predictors of grade 3 or 4 dermatitis. RESULTS: The main causes of treatment interruption included dermatitis and oral mucositis. Significant patient-specific risk factors for RSLs included current smoking, current drinking, and lower Karnofsky Performance Scale score and significant procedure-specific risk factors included receiving intensity-modulated radiation therapy (IMRT), hyperfractionated RT, induction chemotherapy, multicycle chemotherapy, and taxol- and cisplatin-based drugs. The three factors that independently predicted risk of RSL were IMRT, lower Karnofsky Performance Scale score, and multicycle chemotherapy. Comparing predictive factors among patients with severe RSL revealed that patients who received IMRT were more likely to develop grade 3 or 4 dermatitis. CONCLUSIONS: Oncology providers should note that IMRT is an aggressive technique with a trend toward increased RSL. Providers should pay special attention to adverse effects to skin in patients with nasopharyngeal carcinoma.


Assuntos
Morbidade , Carcinoma Nasofaríngeo/terapia , Radiodermatite/classificação , Adulto , China , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Radiodermatite/fisiopatologia , Radioterapia/efeitos adversos , Radioterapia/métodos , Estudos Retrospectivos , Fatores de Risco
5.
Molecules ; 26(19)2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34641542

RESUMO

Cancer is the second leading cause of death in the world. Chemotherapy and radiotherapy (RT) are the common cancer treatments. In addition to these limitations, the development of adverse effects from chemotherapy and RT reduces the quality of life for cancer patients. Cellular radiosensitivity, or the ability to resist and overcome cell damage caused by ionizing radiation (IR), is directly related to cancer cells' response to RT. Therefore, radiobiological research is emphasizing chemical compounds 'radiosensitization of cancer cells so that they are more reactive in the IR spectrum. Recent years researchers have seen an increase in interest in natural products that have antitumor effects with minimal side effects. Natural products, on the other hand, are easy to recover and therefore less expensive. There have been several scientific studies done based on these compounds that have tested their ability in vitro and in vivo to induce tumor radiosensitization. The role of natural products in RT, as well as their usefulness and potential applications, is the goal of this current review.


Assuntos
Produtos Biológicos/farmacologia , Radioterapia/efeitos adversos , Berberina/farmacologia , Curcumina/farmacologia , Emodina/farmacologia , Genisteína/farmacologia , Humanos , Neoplasias/radioterapia , Triterpenos Pentacíclicos/farmacologia , Protetores contra Radiação/farmacologia , Radiossensibilizantes/farmacologia , Resveratrol/farmacologia , Sesquiterpenos/farmacologia , Triterpenos/farmacologia , Vitamina D/farmacologia , Vitanolídeos/farmacologia
6.
Int J Mol Sci ; 22(19)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34639014

RESUMO

The current state of cancer treatment is still far from being satisfactory considering the strong impairment of patients' quality of life and the high lethality of malignant diseases. Therefore, it is critical for innovative approaches to be tested in the near future. In view of the crucial role that is played by tumor immunity, the present review provides essential information on the immune-mediated effects potentially generated by the interplay between ionizing radiation and cytotoxic antitumor agents when interacting with target malignant cells. Therefore, the radiation-dependent abscopal effect (i.e., a biological effect of ionizing radiation that occurs outside the irradiated field), the influence of cancer chemotherapy on the antigenic pattern of target neoplastic cells, and the immunogenic cell death (ICD) caused by anticancer agents are the main topics of this presentation. It is widely accepted that tumor immunity plays a fundamental role in generating an abscopal effect and that anticancer drugs can profoundly influence not only the host immune responses, but also the immunogenic pattern of malignant cells. Remarkably, several anticancer drugs impact both the abscopal effect and ICD. In addition, certain classes of anticancer agents are able to amplify already expressed tumor-associated antigens (TAA). More importantly, other drugs, especially triazenes, induce the appearance of new tumor neoantigens (TNA), a phenomenon that we termed drug-induced xenogenization (DIX). The adoption of the abscopal effect is proposed as a potential therapeutic modality when properly applied concomitantly with drug-induced increase in tumor cell immunogenicity and ICD. Although little to no preclinical or clinical studies are presently available on this subject, we discuss this issue in terms of potential mechanisms and therapeutic benefits. Upcoming investigations are aimed at evaluating how chemical anticancer drugs, radiation, and immunotherapies are interacting and cooperate in evoking the abscopal effect, tumor xenogenization and ICD, paving the way for new and possibly successful approaches in cancer therapy.


Assuntos
Antineoplásicos/efeitos adversos , Imunidade/efeitos dos fármacos , Imunidade/efeitos da radiação , Neoplasias/complicações , Neoplasias/imunologia , Radiação Ionizante , Radioterapia/efeitos adversos , Animais , Antineoplásicos/uso terapêutico , Biomarcadores , Gerenciamento Clínico , Suscetibilidade a Doenças , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/metabolismo , Humanos , Modelos Animais , Neoplasias/terapia , Lesões por Radiação/etiologia , Lesões por Radiação/metabolismo , Lesões por Radiação/patologia , Radioterapia/métodos
7.
N Z Med J ; 134(1543): 113-122, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34695082

RESUMO

AIM: The aim of this study was to review and report on radiation therapy injury claims lodged with the Accident Compensation Corporation (ACC) in New Zealand in the last decade. METHODS: ACC's treatment injury database was used to identify injury claims decided between 1 July 2009 and 30 June 2019. The associated structured and unstructured data, including claim lodgement information and medical records, were reviewed. RESULTS: Of 121,168 treatment injuries, only 975 (0.8%) were radiation therapy injury claims, with 519 claims accepted for cover. Most declined claims were considered "ordinary consequences of treatment" rather than treatment injuries. Of the 519 accepted claims, ACC classified 21 as fatal and eight as serious, which indicates a need for lifelong ACC support. Injuries correlated with the age and gender of the most common cancers treated with radiation therapy in New Zealand. More treatment injury claims were submitted and accepted for New Zealand European patients compared with Maori and Pasifika patients. CONCLUSION: Radiation therapy injury claims make up a very small proportion of the total number of ACC treatment injury claims. A better understanding of the claim process may assist injured individuals better by improving appropriate claim lodgement and claim acceptance rates.


Assuntos
Lesões por Radiação/epidemiologia , Radioterapia/efeitos adversos , Lesões Acidentais/economia , Lesões Acidentais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Compensação e Reparação , Efeitos Psicossociais da Doença , Feminino , Humanos , Lactente , Recém-Nascido , Formulário de Reclamação de Seguro , Masculino , Pessoa de Meia-Idade , Neoplasias/radioterapia , Nova Zelândia/epidemiologia , Lesões por Radiação/economia , Adulto Jovem
8.
Expert Rev Proteomics ; 18(8): 707-717, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34468272

RESUMO

INTRODUCTION: Active matrix metalloproteinase (aMMP)-8 utilized in point-of-care testing (POCT) is regarded as a potential biomarker for periodontal and peri-implant diseases. Various host and microbial factors eventually influence the expression, degranulation, levels and activation of aMMP-8. The type of oral fluids (saliva, mouthrinse, gingival crevicular, and peri-implant sulcular fluids [GCF/PISF], respectively) affect the analysis. AREAS COVERED: With this background, we aimed to review here the recent studies on practical, inexpensive, noninvasive and quantitative mouthrinse and GCF/PISF chair-side POCT lateral flow aMMP-8 immunoassays (PerioSafe and ImplantSafe/ORALyzer) and how they help to detect, predict, monitor the course, treatment and prevention of periodontitis and peri-implantitis. The correlations of aMMP-8 POCT to other independent and catalytic activity assays of MMP-8 are also addressed. EXPERT OPINION: The mouthrinse aMMP-8 POCT can also detect prediabetes/diabetes and tissue destructive oral side-effects due to the head and neck cancers' radiotherapy. Chlorhexidine and doxycycline can inhibit collagenolytic human neutrophil and GCF aMMP-8. Furthermore, by a set of case-series we demonstrate the potential of mouthrinse aMMP-8 POCT to real-time/online detect periodontitis as a potential risk disease for coronavirus disease 2019 (COVID-19). The clinical interdisciplinary utilization of aMMP-8 POCT requires additional oral, medical, and interdisciplinary studies.


Assuntos
COVID-19/enzimologia , Metaloproteinase 8 da Matriz/metabolismo , Pandemias , SARS-CoV-2 , Biomarcadores/análise , Biomarcadores/metabolismo , COVID-19/complicações , COVID-19/tratamento farmacológico , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/enzimologia , Doxiciclina/uso terapêutico , Humanos , Imunoensaio/métodos , Metaloproteinase 8 da Matriz/análise , Antissépticos Bucais , Higiene Bucal , Peri-Implantite/diagnóstico , Peri-Implantite/enzimologia , Periodontite/complicações , Periodontite/diagnóstico , Periodontite/enzimologia , Testes Imediatos , Radioterapia/efeitos adversos , Fatores de Risco
9.
Elife ; 102021 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-34581269

RESUMO

Management of salivary gland hypofunction caused by irradiation (IR) therapy for head and neck cancer remains lack of effective treatments. Salivary glands, especially the parotid gland, actively uptake dietary nitrate and secrete it into saliva. Here, we investigated the effect of dietary nitrate on the prevention and treatment of IR-induced parotid gland hypofunction in miniature pigs, and elucidated the underlying mechanism in human parotid gland cells. We found that nitrate administration prevented IR-induced parotid gland damage in a dose-dependent manner, by maintaining the function of irradiated parotid gland tissue. Nitrate could increase sialin expression, a nitrate transporter expressed in the parotid gland, making the nitrate-sialin feedback loop that facilitates nitrate influx into cells for maintaining cell proliferation and inhibiting apoptosis. Furthermore, nitrate enhanced cell proliferation via the epidermal growth factor receptor (EGFR)-protein kinase B (AKT)-mitogen-activated protein kinase (MAPK) signaling pathway in irradiated parotid gland tissue. Collectively, nitrate effectively prevented IR-induced xerostomia via the EGFR-AKT-MAPK signaling pathway. Dietary nitrate supplementation may provide a novel, safe, and effective way to resolve IR-induced xerostomia.


Assuntos
Nitratos/metabolismo , Glândula Parótida/efeitos da radiação , Radioterapia/efeitos adversos , Porco Miniatura/fisiologia , Xerostomia/prevenção & controle , Ração Animal/análise , Animais , Dieta/veterinária , Suplementos Nutricionais/análise , Nitratos/administração & dosagem , Glândula Parótida/metabolismo , Glândula Parótida/fisiopatologia , Suínos , Xerostomia/etiologia
11.
Int J Mol Sci ; 22(18)2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34576231

RESUMO

Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.


Assuntos
Transtornos Cerebrovasculares/prevenção & controle , Neoplasias da Coroide/radioterapia , Neoplasias da Coroide/cirurgia , Melanoma/radioterapia , Melanoma/cirurgia , Neoplasias Uveais/radioterapia , Neoplasias Uveais/cirurgia , Cirurgia Vitreorretiniana/métodos , Neoplasias da Coroide/patologia , Corpo Ciliar , Humanos , Melanoma/patologia , Prognóstico , Terapia com Prótons , Radioterapia/efeitos adversos , Descolamento Retiniano/patologia , Neoplasias Uveais/patologia , Acuidade Visual
12.
Eur J Endocrinol ; 185(5): 717-728, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34519276

RESUMO

Objective: Female patients treated with alkylating agents in childhood are at risk for ovarian impairment. We aimed at describing the pattern of residual ovarian function in a cohort of survivors of hematological malignancies and/or hematopoietic stem cell transplantation (HSCT) and assessing the relationship between cyclophosphamide equivalent dose (CED) and anti-Müllerian hormone (AMH). Design and methods: Gonadal health was clinically and biochemically assessed in 124 post-menarchal survivors who underwent treatment for pediatric hematological malignancies and/or HSCT between 1992 and 2019. Results: Overt 'premature ovarian insufficiency' (POI) was detected in 72.1 and 3.7% of transplanted and non-transplanted patients, respectively; milder 'diminished ovarian reserve' (DOR) in 16.3 and 22.2%. In non-transplanted patients, increasing CED values were associated with lower AMH-SDS (P = 0.04), with the threshold of 7200 g/m2 being the best discriminator between DOR/POI and normal ovarian function (AUC: 0.75 on ROC analysis) and with an observed decrease of 0.14 AMH-SDS for each CED increase of 1 g/m2. In addition, age at diagnosis ≥10 years played a detrimental role on ovarian reserve (P = 0.003). In the HSCT group, irradiation was associated with a statistically significant reduction in AMH-SDS (P = 0.04). Conclusions: In non-transplanted patients, CED ≥ 7200 mg/m2 was associated with a DOR, while younger age at diagnosis played a protective role on ovarian reserve. As a result of the data collected, we propose a systematic algorithm to assess iatrogenic gonadal impairment in young female patients exposed to chemo-radiotherapy in childhood for hematological disorders.


Assuntos
Hormônio Antimülleriano/sangue , Gônadas/fisiologia , Transplante de Células-Tronco Hematopoéticas , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/fisiopatologia , Reserva Ovariana , Adolescente , Adulto , Fatores Etários , Algoritmos , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Alquilantes/uso terapêutico , Biomarcadores/sangue , Criança , Estudos de Coortes , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Feminino , Nível de Saúde , Humanos , Neoplasias Ovarianas/radioterapia , Insuficiência Ovariana Primária/sangue , Insuficiência Ovariana Primária/fisiopatologia , Radioterapia/efeitos adversos , Estudos Retrospectivos , Adulto Jovem
13.
Med Sci Sports Exerc ; 53(10): 2045-2053, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34519716

RESUMO

PURPOSE: This study investigated the effects of 12 wk of postexercise kefir consumption in cancer survivors who have undergone chemotherapy and/or radiation therapy. METHODS: All participants were enrolled in a structured exercise training program and separated into kefir (KEF) or control (CON) treatment groups. KEF consumed 8 oz. of kefir after exercise sessions (3 d·wk-1) for 12 wk. Outcome measures included assessments for body size and composition, aerobic fitness and muscular strength, medical history, and psychological state at pre- and postintervention time points. Blood was collected and analyzed for C-reactive protein (CRP), interleukin 6 (IL-6), and lipopolysaccharide (LPS) concentrations, and LPS-stimulated whole blood IL-6 and tumor necrosis factor α production were obtained using enzyme-linked immunosorbent assays at both time points. Monocyte numbers and phenotype were obtained using flow cytometry. RESULTS: Participants (N = 24; 9 males and 15 females) were an average of 61 ± 9.9 yr old. Kefir consumption was associated with 6.3% (P = 0.034) improvements in lean body mass, as well as 51.4% (P = 0.046), 39.3% (P = 0.017), and 64.7% (P = 0.021) improvements in measures of depression, fatigue, and gastric distress, respectively. KEF also experienced a significant 35.4% (P = 0.01) reduction in circulating LPS along with an 18.0% increase (P < 0.001) in classical monocytes % and a 22.3% decrease (P = 0.04) in nonclassical monocytes %. There were no significant changes in any other variables. CONCLUSION: Twelve weeks of kefir consumption improved lean body mass, depression, fatigue, gastric distress, and a biomarker of gut dysbiosis. Kefir improved overall and classical monocyte numbers. Kefir should be considered as a component of a postexercise dietary regimen for cancer survivors.


Assuntos
Sobreviventes de Câncer , Terapia por Exercício , Kefir , Adulto , Idoso , Antineoplásicos/efeitos adversos , Biomarcadores/sangue , Contagem de Células Sanguíneas , Índice de Massa Corporal , Sobreviventes de Câncer/psicologia , Aptidão Cardiorrespiratória , Citocinas/sangue , Depressão/prevenção & controle , Fadiga/prevenção & controle , Feminino , Gastroenteropatias/etiologia , Gastroenteropatias/prevenção & controle , Humanos , Inflamação/prevenção & controle , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Força Muscular , Qualidade de Vida , Radioterapia/efeitos adversos
14.
Ann Hematol ; 100(11): 2831-2841, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34536088

RESUMO

Since the survival rates of pediatric patients undergoing cancer treatment or hematopoietic stem cell transplantation (HSCT) have increased rapidly in recent decades, the late effects of treatment are now an important focus of patient care. Access to fertility preservation (FP) procedures as well as their financing differs considerably across Europe. However, some countries in Europe have recently changed the legal basis for financing FP procedures; therefore, the implementation of structures is mandatory to give patients access to FP. In this prospective cohort study, we characterized the process for establishing pediatric fertility counseling, including the development of an in-house standard procedure for recommendations regarding FP with potentially gonadotoxic treatment and valuating data from all FP counseling sessions. All data concerning patient characteristics (pubertal status, disease group) and recommendation of FP measures were prospectively collected and adoption of FP measures analyzed. Prior to the establishment of a structured process for FP in our pediatric oncology and stem cell transplantation center, there was no standardized FP counseling. We demonstrate that with the establishment of an inhouse standard procedure, it is possible to give consistent yet individualized FP counseling to approximately 90% of our patients facing gonadotoxic treatment, counseling over 200 patients between 2017 and 2019. This pilot study could potentially be adapted in other pediatric hematology, oncology, and stem cell transplantation centers to allow a more standardized handling of FP counseling for all patients facing gonadotoxic treatment.


Assuntos
Aconselhamento/métodos , Preservação da Fertilidade/métodos , Adolescente , Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Criopreservação , Feminino , Preservação da Fertilidade/economia , Preservação da Fertilidade/normas , Transplante de Células-Tronco Hematopoéticas , Humanos , Lactente , Infertilidade Feminina/induzido quimicamente , Infertilidade Feminina/etiologia , Infertilidade Feminina/prevenção & controle , Infertilidade Masculina/induzido quimicamente , Infertilidade Masculina/etiologia , Infertilidade Masculina/prevenção & controle , Masculino , Neoplasias/terapia , Recuperação de Oócitos , Ovário/transplante , Estudos Prospectivos , Puberdade , Lesões por Radiação/prevenção & controle , Radioterapia/efeitos adversos , Preservação do Sêmen , Condicionamento Pré-Transplante/efeitos adversos , Adulto Jovem
15.
Eur J Med Genet ; 64(10): 104293, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34352413

RESUMO

Bloom Syndrome (BS) is a genetic DNA repair disorder, caused by mutations in the BLM gene. The clinical phenotype includes growth retardation, immunodeficiency and a strong predisposition to different types of malignancies. Treatment of malignancies in BS patients with radiotherapy or chemotherapy is believed to be associated with increased toxicity, but clinical and laboratory data are lacking. We collected clinical data of two Dutch BS patients with solid tumors. Both were treated with radiotherapy before the diagnosis BS was made and tolerated this treatment well. In addition, we collected fibroblasts from BS patients to perform in vitro clonogenic survival assays to determine radiosensitivity. BS fibroblasts showed less radiosensitivity than the severely radiosensitive Artemis fibroblasts. Moreover, studies of double strand break kinetics by counting 53BP1 foci after irradiation showed similar patterns compared to healthy controls. In combination, the clinical cases and laboratory experiments are valuable information in the discussion whether radiotherapy is absolutely contraindicated in BS, which is the Case in other DNA repair syndromes like Ataxia Telangiectasia and Artemis.


Assuntos
Síndrome de Bloom/complicações , Carcinoma/radioterapia , Radioterapia/efeitos adversos , Adulto , Síndrome de Bloom/genética , Carcinoma/complicações , Células Cultivadas , Quebras de DNA de Cadeia Dupla , Reparo do DNA , Feminino , Fibroblastos/efeitos da radiação , Humanos , Masculino , Pessoa de Meia-Idade , Tolerância a Radiação , RecQ Helicases/genética
16.
J Am Heart Assoc ; 10(16): e021931, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34369199

RESUMO

Background Cardiovascular disease is an important cause of mortality among survivors of breast cancer (BC). We developed a prediction model for major adverse cardiovascular events after BC therapy, which is based on conventional and BC treatment-related cardiovascular risk factors. Methods and Results The cohort of the study consisted of 1256 Asian female patients with BC from 4 medical centers in Korea and was randomized in a 1:1 ratio into the derivation and validation cohorts. The outcome measures comprised cardiovascular mortality, myocardial infarction, congestive heart failure, and transient ischemic attack/stroke. To correct overfitting, a penalized Cox proportional hazards regression was performed with a cross-validation approach. Number of cardiovascular diseases (myocardial infarction, peripheral artery disease, heart failure, and transient ischemic attack/stroke), number of baseline cardiovascular risk factors (hypertension, age ≥60, body mass index ≥30 kg/m2, estimated glomerular filtration rate <60 mL/min per 1.73 m2, dyslipidemia, and diabetes mellitus), radiation to the left breast, and anthracycline dose per 100 mg/m2 were included in the risk prediction model. The time-dependent C-indices at 3 and 7 years after BC diagnosis were 0.876 and 0.842, respectively, in the validation cohort. Conclusions A prediction score model, including BC treatment-related risk factors and conventional risk factors, was developed and validated to predict major adverse cardiovascular events in patients with BC. The CHEMO-RADIAT (congestive heart failure, hypertension, elderly, myocardial infarction/peripheral artery occlusive disease, obesity, renal failure, abnormal lipid profile, diabetes mellitus, irradiation of the left breast, anthracycline dose, and transient ischemic attack/stroke) score may provide overall cardiovascular risk stratification in survivors of BC and can assist physicians in multidisciplinary decision-making regarding the BC treatment.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/terapia , Doenças Cardiovasculares/etiologia , Técnicas de Apoio para a Decisão , Lesões por Radiação/etiologia , Adulto , Antineoplásicos/administração & dosagem , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Cardiotoxicidade , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Tomada de Decisão Clínica , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Lesões por Radiação/diagnóstico , Lesões por Radiação/mortalidade , Radioterapia/efeitos adversos , Reprodutibilidade dos Testes , República da Coreia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Sci Rep ; 11(1): 16232, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376721

RESUMO

To predict grade ≥ 2 radiation pneumonitis (RP) in patients with locally advanced non-small cell lung cancer (NSCLC) using multi-region radiomics analysis. Data from 77 patients with NSCLC who underwent definitive radiotherapy between 2008 and 2018 were analyzed. Radiomic feature extraction from the whole lung (whole-lung radiomics analysis) and imaging- and dosimetric-based segmentation (multi-region radiomics analysis) were performed. Patients with RP grade ≥ 2 or < 2 were classified. Predictors were selected with least absolute shrinkage and selection operator logistic regression and the model was built with neural network classifiers. A total of 49,383 radiomics features per patient image were extracted from the radiotherapy planning computed tomography. We identified 4 features and 13 radiomics features in the whole-lung and multi-region radiomics analysis for classification, respectively. The accuracy and area under the curve (AUC) without the synthetic minority over-sampling technique (SMOTE) were 60.8%, and 0.62 for whole-lung and 80.1%, and 0.84 for multi-region radiomics analysis. These were improved 1.7% for whole-lung and 2.1% for multi-region radiomics analysis with the SMOTE. The developed multi-region radiomics analysis can help predict grade ≥ 2 RP. The radiomics features in the median- and high-dose regions, and the local intensity roughness and variation were important factors in predicting grade ≥ 2 RP.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Pneumonite por Radiação/diagnóstico , Radiometria/métodos , Radioterapia/efeitos adversos , Área Sob a Curva , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Pneumonite por Radiação/etiologia
18.
Fertil Steril ; 116(3): 618-624, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34462096

RESUMO

Primum non nocere. As physicians, our goal is to treat illnesses and alleviate suffering; however, in doing so, we can generate new problems in a game of medical whack-a-mole. For some patients, certain consequences or side effects are tolerable, while others may believe they have no alternative. For a male patient with infertility, a thorough history is imperative to elucidate whether the patient has been or is currently being exposed to medications that will harm libido, spermatogenesis, ejaculation, or the hypothalamic-pituitary-testosterone axis. This article will review the most common medications causing iatrogenic male infertility as well as options to minimize or even reverse their impact.


Assuntos
Inibidores de 5-alfa Redutase/efeitos adversos , Analgésicos Opioides/efeitos adversos , Antagonistas de Androgênios/efeitos adversos , Antineoplásicos/efeitos adversos , Fertilidade/efeitos dos fármacos , Infertilidade Masculina/induzido quimicamente , Antagonistas da Serotonina/efeitos adversos , Testosterona/efeitos adversos , Animais , Humanos , Infertilidade Masculina/fisiopatologia , Infertilidade Masculina/terapia , Masculino , Radioterapia/efeitos adversos , Fatores de Risco
19.
Cancer Radiother ; 25(6-7): 533-536, 2021 Oct.
Artigo em Francês | MEDLINE | ID: mdl-34462213

RESUMO

The abscopal effect has been mentioned since 1953. The increase in knowledge about the immune system and the development of immunotherapies support its potential therapeutic interest. While it is accepted that radiotherapy induces an immune response, demonstrating its systemic impact is not easy. The preclinical basis is solid but its clinical validation pending. Radiotherapy rarely induces tumor reduction at a distance from the beams, probably due to its immunosuppressive effect. This is why a synergy between radiotherapy and systemic treatments targeting these immunosuppressive mechanisms was observed. Several parameters can modulate the induction of the abscopal effect. Among these, the fractionation of the dose seems to be determining with currently a pre-eminence of hypofractionated stereotaxis. On the other hand, even if the choice of more immunogenic targets (liver, lung) should be favoured, the optimal number of lesions to be irradiated remains to be defined as well as the minimum volume allowing sufficient release of tumor antigens. The impact of radiation-induced lymphopenia on radiotherapy/immunotherapy efficacy needs to be assessed more precisely, as does the effect of radiotherapy techniques on them. Finally, the choice of immunotherapy(ies) and the combination regimen with radiotherapy remain under discussion. A sequential scheme appears to provide less toxicities but the concomitant would lead to a better response. The study of these different parameters should allow us to deliver optimized radiotherapy/immunotherapy(ies) combinations to our metastatic patients in order to benefit as many people as possible from this abscopal effect.


Assuntos
Imunoterapia/métodos , Metástase Neoplásica/radioterapia , Radioterapia/métodos , Antígenos de Neoplasias/imunologia , Terapia Combinada/métodos , Fracionamento da Dose de Radiação , Humanos , Sistema Imunitário/efeitos da radiação , Linfopenia/imunologia , Metástase Neoplásica/imunologia , Neoplasias/imunologia , Neoplasias/radioterapia , Radioterapia/efeitos adversos , Resultado do Tratamento
20.
Medicine (Baltimore) ; 100(31): e26833, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397848

RESUMO

ABSTRACT: To compare the outcomes of patients with high-risk prostate cancer treated by primary radical prostatectomy (RP) and primary androgen deprivation therapy (ADT).The study included patients with high-risk or very high-risk prostate cancer. Patients treated with definitive radiation therapy and those with clinical N1 and M1 disease were excluded. The RP group was divided into sub-cohorts of patients treated with ADT and those who received ADT after biochemical recurrence post-RP. Cancer-specific survival (CSS) and overall survival (OS) were analyzed using the Kaplan-Meier method and the Cox proportional hazards model.The study analyzed 859 patients divided into the RP group (n = 654) and ADT group (n = 205). Castration-resistant prostate cancer was detected in 23 (3.5%) patients in the RP group and 43 (21.0%) patients in the ADT group. Mortality cases included 63 (9.6%) patients in the RP group and 91 (44.4%) patients in the ADT group. CSS (P = .0002) and OS (P < .0001) were significantly higher in the RP group than in the ADT group. In the sub-cohort, CSS did not differ significantly between the RP and ADT groups, whereas OS was significantly higher in the RP group than in the ADT group (P < .0001). In the multivariate analysis, primary ADT increased CSS (hazard ratio, 2.068; P = .0498) and OS (hazard ratio, 3.218; P < .0001) compared with RP.In clinically localized high-risk prostate cancer patients, primary RP was associated with better CSS and OS than primary ADT. Comprehensive counseling in this cohort of patients will help the selection of treatment.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Prostatectomia , Neoplasias da Próstata , Radioterapia , Idoso , Biomarcadores Tumorais/sangue , Terapia Combinada/métodos , Humanos , Estimativa de Kaplan-Meier , Masculino , Estadiamento de Neoplasias , Avaliação de Processos e Resultados em Cuidados de Saúde , Seleção de Pacientes , Modelos de Riscos Proporcionais , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Neoplasias de Próstata Resistentes à Castração/diagnóstico , Neoplasias de Próstata Resistentes à Castração/epidemiologia , Radioterapia/efeitos adversos , Radioterapia/métodos , República da Coreia/epidemiologia , Medição de Risco
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