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1.
Medicine (Baltimore) ; 100(23): e26021, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114989

RESUMO

ABSTRACT: The present study aimed to develop nomograms to predict survival in patients with chondroblastic osteosarcoma (COS).An analysis was conducted of 320 cases of COS collected from the surveillance, epidemiology, and end results (SEER) database between 2004 and 2015. Independent prognostic factors were screened using univariate and multivariate Cox analyses. Subsequently, nomograms were established to predict the patients' cancer-specific survival (CSS) and overall survival (OS) rates. The prediction accuracy and discriminative ability of the nomograms were examined using calibration curves and the concordance index (C-index).As revealed in the univariate and multivariate Cox regression analysis, age, tumor size, the primary site, the presence of metastasis, a history of having undergone surgery, and a history of having received radiotherapy were found to be independent prognostic factors associated with survival in patients with COS (all P < .05). Furthermore, age >39 years, the presence of distant metastasis, no history of having undergone any surgery, and tumor size >103 mm were found to be associated with poor prognosis in patients, while the primary site of the mandible and no history of having undergone radiotherapy showed associations with a more favorable prognosis in patients. Next, nomograms were constructed to predict the OS and CSS in patients with COS.We constructed nomograms that can provide accurate survival predictions in patients with chondroblastic osteosarcoma. These nomograms can help surgeons customize the treatment strategies for patients with chondroblastic osteosarcoma.


Assuntos
Condroblastoma , Nomogramas , Osteossarcoma , Risco Ajustado/métodos , Programa de SEER/estatística & dados numéricos , Fatores Etários , Condroblastoma/mortalidade , Condroblastoma/patologia , Condroblastoma/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Osteossarcoma/terapia , Valor Preditivo dos Testes , Prognóstico , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Análise de Sobrevida , Carga Tumoral
2.
Medicine (Baltimore) ; 100(26): e26568, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190199

RESUMO

ABSTRACT: Due to the rarity of solitary bone plasmacytoma (SBP), few studies reported the prognosis and survival predictors of SBP, especially for patients with extremity SBP.A total of 552 patients with extremity SBP were identified from the Surveillance Epidemiology and Ends Results (SEER) database between 1973 and 2016. In order to obtain independent predictors of survival, we performed both univariate and multivariate analysis via Cox proportional hazards model. Additionally, we used the Kaplan-Meier method to construct survival curves.The mean and median age at diagnosis of all patients were 64 and 65 years, respectively. The ratio of male versus women was 1.3:1. Overall survival for this special population was 51.2% and 34.9% at 5 and 10 years, respectively. Cancer-specific survival (CSS) for this special population was 63.5% and 47.5% at 5 and 10 years, respectively. Age at diagnosis and radiotherapy treatment were found to be significant independent predictors of both overall survival and CSS. Additionally, multivariate analysis showed that year of diagnosis and marital status were significantly correlated with CSS.This is the first study to identify prognostic factors of extremity SBP by using the SEER database. Our findings highlight that radiotherapy is the mainstream treatment for extremity SBP. Additionally, age, year of diagnosis, and marital status were significant independent predictors of survival. Knowledge of these survival predictors may help clinicians provide appropriate management for extremity SBP patients.


Assuntos
Neoplasias Ósseas , Extremidades/patologia , Estado Civil/estatística & dados numéricos , Plasmocitoma , Radioterapia , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Neoplasias Ósseas/radioterapia , China/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Plasmocitoma/diagnóstico , Plasmocitoma/mortalidade , Plasmocitoma/patologia , Prognóstico , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos
3.
Anticancer Res ; 41(5): 2495-2499, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952477

RESUMO

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


Assuntos
Neoplasias Nasais/radioterapia , Cuidados Paliativos/métodos , Radioterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias Nasais/patologia , Teste de Desfecho Sinonasal
4.
Zhongguo Fei Ai Za Zhi ; 24(6): 377-383, 2021 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-34024060

RESUMO

The pandemic of coronavirus disease 2019 (COVID-19) has had a serious impact on global health. COVID-19 vaccines may be one of the most effective measure to end the pandemic. High infection risk and higher serious incident and mortality rates have been shown in cancer patients with COVID-19. Therefore, cancer patients should be the priority group for COVID-19 prevention. Until now, data of COVID-19 vaccination for cancer patients is lacking. We review the interim data of safety and immune-efficacy of COVID-19 vaccination in cancer patients based on the latest studies. Due to the complicated immune systems of cancer patients caused by the malignancy and anticancer treatments, we proposed preliminary specific COVID-19 vaccination recommendations for cancer patients with different anticancer treatments and at different stages of the disease. Preventing COVID-19 with vaccinations for cancer patients is crucial, and we call for more large-scale clinical trials and real-world studies, for further COVID-19 vaccination recommendations development.
.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Neoplasias/terapia , Guias de Prática Clínica como Assunto , SARS-CoV-2/efeitos dos fármacos , Vacinação/métodos , COVID-19/epidemiologia , COVID-19/virologia , Vacinas contra COVID-19/imunologia , Humanos , Pandemias , Radioterapia/métodos , SARS-CoV-2/imunologia , SARS-CoV-2/fisiologia , Procedimentos Cirúrgicos Operatórios/métodos
5.
BMC Cancer ; 21(1): 446, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888069

RESUMO

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


Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Glote/patologia , Laringe/efeitos da radiação , Prega Vocal/patologia , Prega Vocal/efeitos da radiação , Teorema de Bayes , Carcinoma de Células Escamosas/diagnóstico por imagem , Feminino , Glote/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Estadiamento de Neoplasias , Radioterapia/efeitos adversos , Radioterapia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
6.
Eur J Endocrinol ; 185(1): 67-75, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-33914702

RESUMO

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


Assuntos
Antineoplásicos/uso terapêutico , Sobreviventes de Câncer , Síndrome Metabólica/epidemiologia , Neoplasias/terapia , Insuficiência Ovariana Primária/epidemiologia , Radioterapia/métodos , Absorciometria de Fóton , Tecido Adiposo , Adulto , Hormônio Antimülleriano/sangue , Antineoplásicos Alquilantes/uso terapêutico , Glicemia/metabolismo , Composição Corporal , Estudos de Casos e Controles , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/sangue , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Insuficiência Ovariana Primária/metabolismo , Fatores de Risco , Triglicerídeos/sangue , Adulto Jovem
7.
Nuklearmedizin ; 60(3): 210-215, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-33822349

RESUMO

INTRODUCTION: The COVID-19 pandemic imposed an unimaginable challenge to the healthcare systems worldwide. This online survey captured the impact of the COVID-19 pandemic on nuclear medicine services in Germany comparing 2020 to 2019. MATERIALS AND METHODS: A web-based questionnaire was developed to record the 2020 numbers of nuclear medicine procedures and, in particular, the change compared with 2019. The changes in nuclear medicine diagnostics and therapy were queried, as well as the extent to which "Coronavirus SARS-CoV-2" recommendations provided by the DGN were implemented. RESULTS: 91 complete responses were recorded and evaluated. This corresponds to about 20 % of all German nuclear medicine facilities. Nuclear medicine diagnostic tests showed a decrease in scintigraphies for thyroid (15.9 %), bone (8.8 %), lung (7.6 %), sentinel lymph nodes (5.5 %), and myocardium (1.4 %) with small increases in PET/CT examinations (1.2 %) compared with 2019. Among nuclear medicine therapies, reductions were highest for benign indications (benign thyroid 13.3 %, RSO 7.7 %), while changes from 2019 were less pronounced for malignant indications (PRRT: + 2.2 %, PSMA: + 7.4 %, SIRT: -5.9 %, and RJT for thyroid carcinoma -2.4 %). The DGN recommendations for action were fully or partially applied in 90 %. CONCLUSIONS: The initial significant reduction in nuclear medicine procedures in the first three weeks of the COVID-19 pandemic did not continue, but there was no compensation of the previously not performed services. The decrease in diagnostics and therapy procedures of benign diseases was particularly severe.


Assuntos
COVID-19/epidemiologia , Utilização de Instalações e Serviços/estatística & dados numéricos , Serviço Hospitalar de Medicina Nuclear/estatística & dados numéricos , Alemanha , Humanos , Radiografia/métodos , Radiografia/estatística & dados numéricos , Cintilografia/métodos , Cintilografia/estatística & dados numéricos , Radioterapia/métodos , Radioterapia/normas , Inquéritos e Questionários
8.
Bull Cancer ; 108(4): 424-434, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33722379

RESUMO

Two forms of bone lymphomas can be distinguished: the primary bone lymphoma (PBL) and the secondary bone lymphoma (SBL). PBL is a rare disease with a good prognosis. Clinical manifestations and imaging findings are usually non-specific. Patient can present with pain, swelling of affected bone or pathologic fracture. Positron emission tomography-CT scan is a sensitive imaging modality and very useful for staging, restaging, surveillance of recurrence, and monitoring of treatment response of lymphoma. The diagnosis of PBL is often difficult and made after biopsy examination. Most patients have diffuse large B-cell lymphoma. Patients have been treated with radiotherapy, chemotherapy or combination of both. Localized disease, low IPI (International Prognostic Index) and complete remission after initial treatment were associated with a better outcome. Management of late sequelae deserves particular attention. SBL is more common than PBL; this is a disseminated lymphoma with concomitant involvement of the skeleton. We review the clinical, imaging and pathologic features of bone lymphomas; and discuss therapeutic modalities as well as prognosis of these lymphomas in the era of immunochemotherapy.


Assuntos
Neoplasias Ósseas , Linfoma não Hodgkin , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/classificação , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Neoplasias do Sistema Nervoso Central/prevenção & controle , Neoplasias do Sistema Nervoso Central/secundário , Terapia Combinada , Diagnóstico por Imagem/métodos , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/terapia , Masculino , Especificidade de Órgãos , Prognóstico , Radioterapia/métodos , Recidiva
9.
Biomed Eng Online ; 20(1): 24, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653371

RESUMO

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


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Estadiamento de Neoplasias/métodos , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/terapia , Antineoplásicos/farmacologia , Progressão da Doença , Terapia Genética/métodos , Humanos , Imunoterapia/métodos , Imageamento por Ressonância Magnética , Radioterapia/métodos , Tomografia Computadorizada por Raios X
10.
Int. j. med. surg. sci. (Print) ; 8(1): 1-9, mar. 2021. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1151572

RESUMO

El tratamiento con radioterapia, consiste en irradiar de forma homogénea el tumor, evitando irradiar los órganos cercanos. El desarrollo de la tecnología en el campo de la medicina, ha permitido que se cumpla este principio, con buenos resultados de respuesta objetiva, que se traduce en el control de la enfermedad de los pacientes con cáncer. La Tomografía axial computarizada por emisión de positrones (PET-CT) consigue una mayor precisión en el delineado del volumen blanco o tumoral. El propósito de este estudio fue analizar la influencia del uso del PET-CT en el delineado de volúmenes a tratar en la planificación del tratamiento con radiaciones.Se diseñó un estudio piloto con dos pacientes preparados para radioterapia por neoplasias malignas, a los cuáles se les realizó un TAC simple y un PET-CT y observadores independientes realizaron la delimitación del tumor. Se examinó la consistencia entre los observadores y las mediciones en las imágenes.El uso del PET-CT favoreció la delimitación del volumen a irradiar lo que disminuye el riesgo para los órganos vecinos.


The treatment with radiotherapy consists on irradiating in a homogeneous way the tumor, avoiding to irradiate the near organs. The development of the technology in the field of the medicine, it has allowed that this principle is completed, with good results of objective answer what allows the control of the illness of the patients with cancer. The computerized axial tomography by positrons emission (PET-CT) it gets a bigger precision in the one delineated of the white volume or tumoral. The purpose of this study was to analyze the influence of the use of the PET-CT in the one delineated of volumes to try in the planning of the treatment with radiations.A study pilot was designed with two prepared patients for radiotherapy for malignant diseases, to those which they were carried out a simple TAC and a PET-CT and independent observers carried out the delimitation of the tumor. The consistency was examined between the observers and the mensuration in the images.The use of the PET-CT favors the delimitation of the volume to irradiate what diminishes the risk for the neighboring organs.


Assuntos
Humanos , Masculino , Radioterapia/métodos , Radioterapia Guiada por Imagem/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Radioterapia (Especialidade)/métodos , Neoplasias/radioterapia , Neoplasias/diagnóstico por imagem
11.
JAMA Netw Open ; 4(2): e2034074, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33599771

RESUMO

Importance: The adoption of alternative fractionated radiotherapy regimens for the treatment of patients with cancer and comorbid collagen vascular disease (CVD) is controversial among oncologists because of concerns about potentially severe toxic effects; however, the association between fractionated radiotherapy and toxic effects in the modern era has not been well studied. Objective: To compare acute and late toxic effects among patients with cancer and comorbid CVD who received dose-fractionated radiotherapy. Design, Setting, and Participants: This retrospective cohort study examined 197 adult patients with cancer and CVD who received radiotherapy at a single-institution tertiary academic center over a 12-year period (February 1, 2007, to April 30, 2019), with a median follow-up of 23 months (range, 0-108 months). Data were analyzed from February 1 to August 31, 2020. Exposures: Three dose-fractionated radiotherapy regimens: conventional fractionation (CF; ≤2 Gy per fraction), moderate hypofractionation (MH; >2 Gy to <5 Gy per fraction), and ultrahypofractionation (UH; ≥5 Gy per fraction). Main Outcomes and Measures: The main outcomes were the incidence and severity of acute and late radiotherapy-associated toxic effects, which were assessed separately by dose-fractionation regimen. Toxic effects occurring within 90 days after radiotherapy completion were considered acute, and toxic effects occurring after that 90-day period were considered late. Secondary goals were to identify covariates associated with toxic effects and to characterize the incidence of CVD symptom flares (defined as worsening clinical symptoms and/or worsening results [transient or permanent] on associated blood tests compared with baseline, as documented by managing physicians) after radiotherapy. Results: Of 197 patients with cancer and comorbid CVD (mean [SD] age, 69 [12] years; 134 women [68.0%]; and 149 White participants [75.6%]), 80 patients (40.6%) received CF radiotherapy, 55 patients (27.9%) received MH radiotherapy, and 62 patients (31.5%) received UH radiotherapy. The most common CVD diagnoses were rheumatoid arthritis (74 patients [37.6%]), psoriasis (54 patients [27.4%]), systemic lupus erythematosus (34 patients [17.3%]), and scleroderma (8 patients [4.1%]). The most common radiotherapy sites were the breast (48 patients [24.4%]), thorax (25 patients [12.7%]), central nervous system (24 patients [12.2%]), and prostate (23 patients [11.7%]). Data on acute toxic effects were available for 188 patients (95.4%) and missing for 9 patients (4.6%). Data on late toxic effects were available for 142 patients (72.1%) and missing for 55 patients (27.9%). Over 12 years, the unadjusted incidences of severe acute toxic effects associated with CF, MH, and UH radiotherapy were 5.4% (95% CI, 0.3%-10.5%), 7.4% (95% CI, 0.4%-14.4%), and 1.7% (95% CI, 0%-5.0%), respectively. The incidences of severe late toxic effects associated with CF, MH, and UH radiotherapy were 8.3% (95% CI, 1.3%-15.3%), 0%, and 2.2% (95% CI, 0%-6.4%), respectively. No significant associations were found between severe acute or late toxic effects by dose fractionation regimen. In the multivariable analysis, MH radiotherapy was associated with a lower likelihood of developing late toxic effects (odds ratio [OR], 0.21; 95% CI, 0.05-0.83; P = .03) compared with CF radiotherapy. Those who received UH radiotherapy had a lower likelihood of experiencing late toxic effects (OR, 0.22; 95% CI, 0.04-1.21; P = .08). A total of 19 of 80 patients (23.8%), 15 of 55 patients (27.3%), and 10 of 62 patients (16.1%) experienced CVD symptom flares after receiving CF, MH, and UH radiotherapy, respectively (P = .33). Conclusions and Relevance: In this study, the incidences of unadjusted severe toxic effects over 12 years were less than 10% and were not significantly associated with dose fractionation. When clinically indicated, patients with cancer and comorbid CVD may not require immediate exclusion from the receipt of currently used hypofractionated radiotherapy regimens.


Assuntos
Doenças do Tecido Conjuntivo/epidemiologia , Neoplasias/radioterapia , Lesões por Radiação/epidemiologia , Radioterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/epidemiologia , Neoplasias da Mama/radioterapia , Comorbidade , Fracionamento da Dose de Radiação , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Incidência , Neoplasias Pulmonares/radioterapia , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias da Próstata/radioterapia , Psoríase/epidemiologia , Hipofracionamento da Dose de Radiação , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Estudos Retrospectivos , Escleroderma Sistêmico/epidemiologia
12.
Medicine (Baltimore) ; 100(7): e24854, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607858

RESUMO

ABSTRACT: Malignant gastric lymphoma (MGL) accounts for a small proportion (upto 5%) of gastric malignancies. However, unlike for advanced gastric cancer (AGC) that requires surgical treatment, the standard treatments for MGL are chemotherapy and radiotherapy. Hence, the initial impression of the endoscopist is critical for the differential diagnosis and for planning future treatment. The purpose of this study was to assess the endoscopic diagnostic accuracy and the possibility of distinguishing between AGC and MGL depending on the endoscopist's experience.A total of 48 patients who had MGL, and 48 age and sex-matched patients who had AGC were assessed by endoscopic review at a tertiary referral hospital between June 2008 and February 2017. Two endoscopic specialists reviewed the endoscopic findings and divided these diagnoses into 5 groups: Borrmann type (1, 2, 3, and 4) and early gastric cancer-like type. After this, 7 experts and 8 trainees were asked to complete a quiz that was comprised of 6 images for each of the 96 cases and to provide an endoscopic diagnosis for each case. The test results were analyzed to assess the diagnostic accuracy according to the pathologic results, endoscopic subgroups, and endoscopists' experience. For inter-observer agreement was calculated with Fleiss kappa values.The overall diagnostic accuracy of endoscopic findings by the experts was 0.604 and that by the trainees was 0.493 (P = .050). There was no significant difference in the diagnosis according to the final pathology (lymphoma cases, 0.518 vs 0.440, P = .378; AGC cases, 0.690 vs 0.547, P = .089, respectively). In the subgroup analysis, the experts showed significantly higher diagnostic accuracy for the endoscopic Borrmann type 4 subgroup, including lymphoma or AGC cases, than the trainees (P = .001). Inter-observer agreement of final diagnosis (Fleiss kappa, 0.174) and endoscopic classification groups (Fleiss kappa, 0.123-0.271) was slightly and fair agreement.The experts tended to have a higher endoscopic diagnostic accuracy. Distinguishing MGL from AGC based on endoscopic findings is difficult, especially for the beginners. Even if the endoscopic impression is AGC, it is important to consider MGL in the differential diagnosis.


Assuntos
Endoscopia/métodos , Linfoma não Hodgkin/patologia , Neoplasias Gástricas/patologia , Competência Clínica/estatística & dados numéricos , Diagnóstico Diferencial , Tratamento Farmacológico/métodos , Endoscopia/classificação , Endoscopia/estatística & dados numéricos , Feminino , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/radioterapia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radioterapia/métodos , Reprodutibilidade dos Testes , Especialização/estatística & dados numéricos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/radioterapia , Neoplasias Gástricas/cirurgia , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos
13.
Int J Nanomedicine ; 16: 1083-1102, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33603370

RESUMO

Radiotherapy (RT) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. Although great success has been achieved on radiotherapy, there is still an intractable challenge to enhance radiation damage to tumor tissue and reduce side effects to healthy tissue. Radiosensitizers are chemicals or pharmaceutical agents that can enhance the killing effect on tumor cells by accelerating DNA damage and producing free radicals indirectly. In most cases, radiosensitizers have less effect on normal tissues. In recent years, several strategies have been exploited to develop radiosensitizers that are highly effective and have low toxicity. In this review, we first summarized the applications of radiosensitizers including small molecules, macromolecules, and nanomaterials, especially those that have been used in clinical trials. Second, the development states of radiosensitizers and the possible mechanisms to improve radiosensitizers sensibility are reviewed. Third, the challenges and prospects for clinical translation of radiosensitizers in oncotherapy are presented.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias/radioterapia , Radiossensibilizantes/uso terapêutico , Radioterapia/métodos , Animais , Humanos
15.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568414

RESUMO

Paratesticular tumours are tumours arising from within the scrotum not of testicular origin. They may originate from the epididymis, spermatic cord, tunica vaginalis and other supporting structures. Preoperative diagnosis can be difficult as benign and malignant cases are often indistinguishable and may be confused with other benign or malignant pathology (testicular tumours or hernias).We describe the presentation and management of a patient managed at our centre (a tertiary referral teaching hospital).A high index of suspicion for malignancy should be considered when managing atypical scrotal lumps to ensure optimal management. This is particularly important when managing sarcomas due to the risk of local recurrence and spread.


Assuntos
Radioterapia/métodos , Sarcoma/diagnóstico , Sarcoma/fisiopatologia , Sarcoma/radioterapia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/fisiopatologia , Neoplasias Testiculares/radioterapia , Idoso de 80 Anos ou mais , Humanos , Masculino , Resultado do Tratamento
16.
Saudi Med J ; 42(3): 247-254, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33632902

RESUMO

This review summarizes the beginning of radiotherapy, techniques of modern radiation therapy with different types, toxicities induced by radiotherapy and their management. Head and neck radiation therapy is still improving for the better management and control of the cancer and induced radiotherapy toxicities.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia/métodos , Radioterapia/tendências , Fracionamento da Dose de Radiação , Exantema/etiologia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Oxigenação Hiperbárica , Osteorradionecrose/etiologia , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Radioterapia/efeitos adversos , Espécies Reativas de Oxigênio/metabolismo
17.
Nat Rev Clin Oncol ; 18(4): 191-192, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33597721
18.
Theranostics ; 11(7): 3167-3182, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33537080

RESUMO

Rationale: Iron-saturated Lf (Holo-Lactoferrin, Holo-Lf) exhibits a superior anticancer property than low iron-saturated Lf (Apo-Lf). Ferroptosis is an iron-dependent cell death characterized by the accumulation of lipid peroxidation products and lethal reactive oxygen species (ROS). Radiotherapy also exerts its therapeutic effect through ROS. Methods: The effect of different iron-saturated Lf on ferroptosis and radiotherapy were tested on triple-negative breast cancer (TNBC) cell line MDA-MB-231 and non-TNBC cell line MCF-7. Results: Holo-Lf significantly increased the total iron content, promoted ROS generation, increased lipid peroxidation end product, malondialdehyde (MDA), and enhanced ferroptosis of MDA-MB-231 cells. By contrast, Apo-Lf upregulated SLC7a11 expression, increased GSH generation and inhibited ferroptosis of MDA-MB-231 cells. However, non-TNBC MCF-7 cells were resistant to Holo-Lf-induced ferroptosis because MCF-7 cells have a higher redox balance capacity than MDA-MB-231 cells. More importantly, Holo-Lf downregulated HIF-1α expression, ameliorated the hypoxia microenvironment in subcutaneous MDA-MB-231 tumors, and promoted radiation-induced DNA damage to hypoxic MDA-MB-231 cells. Finally, the efficacy of radiotherapy to MDA-MB-231 tumors was enhanced by Holo-Lf. Conclusion: Holo-Lf could induce ferroptosis in MDA-MB-231 cells and sensitize MDA-MB-231 tumors to radiotherapy.


Assuntos
Ferroptose/fisiologia , Lactoferrina/metabolismo , Neoplasias de Mama Triplo Negativas/metabolismo , Animais , Biomarcadores Farmacológicos , Neoplasias da Mama/metabolismo , Neoplasias da Mama/terapia , Morte Celular/efeitos dos fármacos , Morte Celular/fisiologia , Linhagem Celular Tumoral , China , Feminino , Ferroptose/genética , Humanos , Ferro/metabolismo , Lactoferrina/efeitos dos fármacos , Lactoferrina/genética , Peroxidação de Lipídeos/fisiologia , Células MCF-7 , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Radioterapia/métodos , Espécies Reativas de Oxigênio/metabolismo , Neoplasias de Mama Triplo Negativas/radioterapia , Microambiente Tumoral/fisiologia
19.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509853

RESUMO

We present the first young paediatric patient with desmoplastic small round cell tumour (DSRCT) treated in UK with hyperthermic intraperitoneal chemotherapy (HIPEC). A 7-year-old girl was diagnosed with abdominal DSRCT with peritoneal and liver metastases. After six cycles of chemotherapy she obtained a partial response, including almost complete resolution of the two liver metastases. It was decided to pursue cytoreductive surgery (CRS) combined with HIPEC, a procedure commonly performed in adults, but seldom in a child. The surgery was macroscopically complete and the HIPEC uncomplicated. She continued treatment without delays, including whole abdomino-pelvic radiotherapy and maintenance chemotherapy (cyclophosphamide/vinorelbine for 12 months). She is currently in complete remission 4 months after end of treatment and 26 months after diagnosis. HIPEC was made possible by successful collaboration between multiple teams. CRS-HIPEC proved to be safe and feasible and could be offered to other children with diagnoses of peritoneal malignancies across the UK.


Assuntos
Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Procedimentos Cirúrgicos de Citorredução/métodos , Tumor Desmoplásico de Pequenas Células Redondas/terapia , Quimioterapia Intraperitoneal Hipertérmica/métodos , Neoplasias Hepáticas/terapia , Neoplasias Pélvicas/terapia , Neoplasias Peritoneais/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Ciclofosfamida/administração & dosagem , Tumor Desmoplásico de Pequenas Células Redondas/diagnóstico por imagem , Tumor Desmoplásico de Pequenas Células Redondas/secundário , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Ifosfamida/administração & dosagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Quimioterapia de Manutenção , Terapia Neoadjuvante , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/patologia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/secundário , Radioterapia/métodos , Indução de Remissão , Reino Unido , Vincristina/administração & dosagem , Vinorelbina/administração & dosagem
20.
Anticancer Res ; 41(1): 341-345, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419829

RESUMO

BACKGROUND/AIM: The aim of this study was to identify patients at high risk of death from neurological cause because these patients may be appropriate candidates for intense brain-directed treatment, in contrast to patients with uncontrollable extracranial disease, inevitably leading to death. In this context, the LabBM score (endpoint: overall survival; five blood test results; often abnormal in patients with widespread disease) may be a relevant tool. PATIENTS AND METHODS: This was a retrospective single-institution analysis of 101 patients, managed with upfront brain irradiation. Associations between neurological death and different baseline and treatment parameters were assessed. RESULTS: A LabBM score of 0 (five normal blood test results) was present in 32% of patients. Neurological death was recorded in 27%. Seven parameters were associated with neurological death, including the LabBM score (univariate analyses). Three out of the seven were significantly associated with neurological death in the multi-nominal logistic regression analysis. The most important parameter was primary tumor type (colorectal or melanoma), with a hazard ratio of 14.3. Patients without liver metastases were also more likely to die from neurological causes. Finally, patients who did not receive additional systemic therapy were more likely to die from central nervous system progression. The median survival time was 3.9 months (entire cohort). When censoring patients who died from extracranial progression, the median time to neurological death was 17.4 months. CONCLUSION: The LabBM score was not suitable for prediction of neurological death, in contrast to three other parameters. Interestingly, additional systemic therapy reduced the risk of neurological death, possibly because several new agents have known antitumor activity in the brain.


Assuntos
Morte Encefálica , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/radioterapia , Causas de Morte , Terapia Combinada , Irradiação Craniana/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiocirurgia/métodos , Radioterapia/métodos , Índice de Gravidade de Doença , Resultado do Tratamento
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