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2.
Medicine (Baltimore) ; 99(32): e21631, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769927

RESUMO

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


Assuntos
Acantólise/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Maxila/anormalidades , Acantólise/complicações , Biópsia/métodos , Carcinoma de Células Escamosas/fisiopatologia , Feminino , Humanos , Maxila/efeitos da radiação , Pessoa de Meia-Idade , Radioterapia/métodos
3.
Medicine (Baltimore) ; 99(34): e21642, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846773

RESUMO

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


Assuntos
Prostatectomia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prostatectomia/métodos , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Radioterapia/métodos , Estudos Retrospectivos , Taxa de Sobrevida
4.
Nat Commun ; 11(1): 4064, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32792542

RESUMO

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


Assuntos
Fator 2 de Crescimento de Fibroblastos/metabolismo , Radioterapia/métodos , Animais , Linhagem Celular Tumoral , Fator 2 de Crescimento de Fibroblastos/genética , Células HT29 , Humanos , Lectinas Tipo C/genética , Lectinas Tipo C/metabolismo , Ativação de Macrófagos/efeitos dos fármacos , Ativação de Macrófagos/efeitos da radiação , Lectinas de Ligação a Manose/genética , Lectinas de Ligação a Manose/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Nus , Óxido Nítrico Sintase Tipo II/genética , Óxido Nítrico Sintase Tipo II/metabolismo , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/metabolismo , Microambiente Tumoral/efeitos dos fármacos , Microambiente Tumoral/efeitos da radiação , Ensaios Antitumorais Modelo de Xenoenxerto
5.
Med Oncol ; 37(10): 85, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32808089

RESUMO

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


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/radioterapia , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Itália/epidemiologia , Oncologia/métodos , Pneumonia Viral/epidemiologia , Radioterapia/métodos , Radioterapia/normas , Sociedades Médicas/normas
6.
Hell J Nucl Med ; 23 Suppl: 31-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32860394

RESUMO

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


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Radioterapia/normas , Infecções por Coronavirus/epidemiologia , Humanos , Controle de Infecções/métodos , Neoplasias/radioterapia , Serviço Hospitalar de Medicina Nuclear/organização & administração , Serviço Hospitalar de Medicina Nuclear/provisão & distribução , Pandemias , Pneumonia Viral/epidemiologia , Radioterapia/métodos
7.
Hell J Nucl Med ; 23 Suppl: 35-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32860395

RESUMO

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


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Neoplasias/radioterapia , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Radioterapia/métodos , Infecções por Coronavirus/epidemiologia , Prioridades em Saúde , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/economia , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Radioterapia/normas
8.
Cancer Radiother ; 24(6-7): 477-481, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32828667

RESUMO

Metastases are the most common brain tumors. After surgery, stereotactic radiotherapy (SRT) of the resection cavity is the standard of care. Data from two randomized trials indicate that SRT to the surgical bed is an effective treatment in reducing local failure as compared with observation, while reducing the risk of cognitive deterioration and maintaining quality of life as compared with whole brain radiation therapy. Local control appears higher after hypofractionated SRT compared to single-fraction SRT. Several questions such as target volumes, the optimal regimen in particular for large tumor bed, strategies to reduce the risk of lepto-meningeal recurrence, and the treatment sequence still need to be answered.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Radiocirurgia , Neoplasias Encefálicas/cirurgia , Terapia Combinada , Humanos , Período Pós-Operatório , Radioterapia/métodos
9.
Cancer Radiother ; 24(6-7): 463-469, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32828669

RESUMO

The challenge of the management of brain metastases has not finished yet. Although new diagnosis-specific prognostic assessment classifications and guidelines for patients with brain metastases help to guide treatment more appropriately, and even if the development of modern technologies in imaging and radiation treatment, as well as improved new systemic therapies, allow to reduce cognitive side effects and make retreatment or multiple and combined treatment possible, several questions remain unanswered. However, tailoring the treatment to the patient and his expectations is still essential; in other words, patients with a poor prognosis should not be over-treated, and those with a favorable prognosis may not be subtracted to the best treatment option. Some ongoing trials with appropriate endpoints could better inform our choices. Finally, a case-by-case inter-disciplinary discussion remains essential.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana , Humanos , Radioterapia/métodos
10.
Cancer Radiother ; 24(6-7): 667-675, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32828670

RESUMO

The planning target volume is an essential notion in radiotherapy, that requires a new conceptualization. Indeed, the variability and diversity of the uncertainties involved or improved with the development of the new modern technologies and devices in radiotherapy suggest that random and systematic errors cannot be currently generalized. This article attempts to discuss these various uncertainties and tries to demonstrate that a redefinition of the concept of planning target volume toward its personalization for each patient and the robustness notion are likely an improvement basis to take into account the radiotherapy uncertainties.


Assuntos
Neoplasias/radioterapia , Carga Tumoral/efeitos da radiação , Humanos , Neoplasias/patologia , Planejamento de Assistência ao Paciente , Radioterapia/métodos , Dosagem Radioterapêutica , Incerteza
11.
Cancer Radiother ; 24(6-7): 658-666, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32859465

RESUMO

Radiation therapy (RT) is one of the main modalities of cancer treatment worldwide with computed tomography (CT), as the most commonly used imaging method for treatment planning system (TPS). Image reconstruction errors may greatly affect all the radiation therapy planning process, such as target delineation, dose calculation and delivery, particularly with particle therapy. Metallic implants, such as hip and spinal implants, and dental filling significantly deteriorate image quality. These hardware structures are often very complex in geometry leading to geometric complex artefacts in the clinical target volume (CTV) area, rendering the delineation of CTV challenging. In our review, we focus on the methods to overcome artefact consequences on CTV delineation: 1- medical approaches anticipating issues associated with imaging artefacts during preoperative multidisciplinary discussions while following standard recommendations; 2- common metal artefact reduction (MAR) methods such as manually override artefact regions, ballistics avoiding beam paths through implanted materials, megavoltage-CT (MVCT); 3- prospects with radiolucent implants, MAR algorithms and various methods of dual energy computed tomography (DECT). Despite substantial and broad evidence for their benefits, there is still no universal solution for cases involving implanted metallic devices. There is still a high need for research efforts to adapt technologies to our issue: "how do I accurately delineate the ideal CTV in a metal artefact area?"


Assuntos
Artefatos , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Próteses e Implantes , Tomografia Computadorizada por Raios X , Carga Tumoral/efeitos da radiação , Humanos , Neoplasias/patologia , Radioterapia/métodos , Dosagem Radioterapêutica
12.
Cancer Radiother ; 24(6-7): 755-761, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32859468

RESUMO

Radiomics is a field that has been growing rapidly for the past ten years in medical imaging and more particularly in oncology where the primary objective is to contribute to personalised and predictive medicine. This short review aimed at providing some insights regarding the potential value of radiomics for cancer patients treated with radiotherapy. Radiomics may contribute to each stage of the patients' management: diagnosis, planning, treatment monitoring and post-treatment follow-up (toxicity and response). However, its applicability in clinical routine is currently hindered by several factors, including lack of automation, standardisation and harmonisation. A major effort must be carried out to automate the workflow, standardise radiomics good practices and carry out large-scale studies before any transfer to daily clinical practice.


Assuntos
Neoplasias/radioterapia , Radioterapia (Especialidade)/métodos , Radioterapia Assistida por Computador , Humanos , Radioterapia/métodos
13.
Cancer Radiother ; 24(6-7): 676-686, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32861608

RESUMO

Continuous improvements have been made in the way to prescribe, record and report dose distributions since the therapeutic use of ionizing radiations. The international commission for radiation units and measurement (ICRU) has provided a common language for physicians and physicists to plan and evaluate their treatments. The PTV concept has been used for more than two decades but is becoming obsolete as the CTV-to-PTV margin creates a static dose cloud that does not properly recapitulate all planning vs. delivery uncertainties. The robust optimization concept has recently emerged to overcome the limitations of the PTV concept. This concept is integrated in the inverse planning process and minimizes deviations to planned dose distribution through integration of uncertainties in the planning objectives. It appears critical to account for the uncertainties that are specific to protons and should be accounted for to better exploit the clinical potential of proton therapy. It may also improve treatment quality particularly in hypofractionated photon plans of mobile tumors and more widely to photon radiotherapy. However, in contrast to the PTV concept, a posteriori evaluation of plan quality, called robust evaluation, using error-based scenarios is still warranted. Robust optimization metrics are warranted. These metrics are necessary to compare PTV-based photon and robustly optimized proton plans in general and in model-based NTCP approaches. Assessment of computational demand and approximations of robust optimization algorithms along with metrics to evaluate plan quality are needed but a step further to better prescribe radiotherapy may has been achieved.


Assuntos
Neoplasias Encefálicas/radioterapia , Carga Tumoral/efeitos da radiação , Humanos , Doses de Radiação , Radioterapia/métodos , Planejamento da Radioterapia Assistida por Computador
14.
J Laryngol Otol ; 134(6): 533-540, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32616096

RESUMO

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


Assuntos
Carcinoma/radioterapia , Neoplasias Orofaríngeas/mortalidade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/virologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Radioterapia/métodos , Taxa de Sobrevida
15.
Anticancer Res ; 40(7): 3605-3618, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620600

RESUMO

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


Assuntos
Neoplasias/patologia , Neoplasias/radioterapia , Intervalo Livre de Doença , Humanos , Recidiva Local de Neoplasia/patologia , Neoplasias/mortalidade , Prognóstico , Radioterapia/métodos , Risco
16.
Am J Cardiol ; 128: 196-201, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650920

RESUMO

Recently, the Heart Rhythm Society published recommendations on management of patients with cardiac implantable electronic device (CIED) who require radiotherapy (RT). We aimed to report the experience of a teaching hospital, and discuss our practice in the context of recently published guidelines. We identified all consecutive CIED recipients (12,736 patients) who underwent RT between March 2006 and June 2017. Among them, 90 (1%) patients (78.2 ± 10 years, 73% male) had a CIED: 82 pacemakers and 8 implantable cardioverter-defibrillators. Two patients required CIED extraction prior to RT for ipsilateral breast cancer (no device replacement in 1 patient). Four patients (5%) were considered at high-risk, 35 (39%) at intermediate-risk, and the remaining 50 (56%) at low-risk for CIED dysfunction. Overall, only a minority of patients followed recommended local protocol during RT delivery (31%) and during follow-up (56%). CIED malfunction was detected in 5 patients (6%), mainly back-up mode resetting (80%), with 4 (including 3 pelvic cancer location) patients initially classified as being at intermediate-risk and 1 at low-risk. Four out of the 5 patients with CEID malfunction had received neutron producing beams. In conclusion, our findings underline the lack of rigorous monitoring of patients undergoing RT (though CIED malfunction appears to be rare and relatively benign in nature), and emphasize the interest of considering neutron producing beam for risk stratification as recommended in recent guidelines. Optimization of patient's management requires a close collaboration between both CIED clinicians and radiation oncologists, and more systematic remote CIED monitoring may be helpful.


Assuntos
Desfibriladores Implantáveis , Falha de Equipamento/estatística & dados numéricos , Cardiopatias/terapia , Neoplasias/radioterapia , Marca-Passo Artificial , Radioterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiologia , Feminino , Cardiopatias/complicações , Humanos , Masculino , Neoplasias/complicações , Nêutrons , Radioterapia (Especialidade) , Dosagem Radioterapêutica , Estudos Retrospectivos
18.
Radiat Oncol ; 15(1): 140, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: covidwho-505582

RESUMO

To examine, if a shift in indications for radiotherapy is to be expected in the context of the COVID-19 pandemic, the database Pubmed was searched for multidisciplinary or surgical expert recommendations on the role of radiotherapy in modified treatment concepts. Increased use of radiotherapy or chemoradiation instead of surgical treatment was recommended for defined patient groups with head-and-neck cancer, lung cancer, cervix cancer, esophageal cancer and prostate cancer. Omission of radiotherapy was considered in elderly patients with low-risk breast cancer and in early-stage Hodgkin's lymphoma. Only adjustments to the timing of radiotherapy were discussed for sarcoma and rectal cancer. Emerging recommendations on multidisciplinary cancer treatment concepts during the COVID-19 pandemic indicate a shift in radiotherapy indications and a potentially increased demand for radiotherapy.


Assuntos
Infecções por Coronavirus/prevenção & controle , Oncologia/normas , Neoplasias/radioterapia , Neoplasias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Radioterapia/métodos , Betacoronavirus , Quimiorradioterapia , Humanos , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Comunicação Interdisciplinar , Oncologia/tendências , Sociedades Médicas
19.
Breast ; 52: 110-115, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: covidwho-437530

RESUMO

BACKGROUND: Corona Virus Disease 19 (COVID-19) had a worldwide negative impact on healthcare systems, which were not used to coping with such pandemic. Adaptation strategies prioritizing COVID-19 patients included triage of patients and reduction or re-allocation of other services. The aim of our survey was to provide a real time international snapshot of modifications of breast cancer management during the COVID-19 pandemic. METHODS: A survey was developed by a multidisciplinary group on behalf of European Breast Cancer Research Association of Surgical Trialists and distributed via breast cancer societies. One reply per breast unit was requested. RESULTS: In ten days, 377 breast centres from 41 countries completed the questionnaire. RT-PCR testing for SARS-CoV-2 prior to treatment was reported by 44.8% of the institutions. The estimated time interval between diagnosis and treatment initiation increased for about 20% of institutions. Indications for primary systemic therapy were modified in 56% (211/377), with upfront surgery increasing from 39.8% to 50.7% (p < 0.002) and from 33.7% to 42.2% (p < 0.016) in T1cN0 triple-negative and ER-negative/HER2-positive cases, respectively. Sixty-seven percent considered that chemotherapy increases risks for developing COVID-19 complications. Fifty-one percent of the responders reported modifications in chemotherapy protocols. Gene-expression profile used to evaluate the need for adjuvant chemotherapy increased in 18.8%. In luminal-A tumours, a large majority (68%) recommended endocrine treatment to postpone surgery. Postoperative radiation therapy was postponed in 20% of the cases. CONCLUSIONS: Breast cancer management was considerably modified during the COVID-19 pandemic. Our data provide a base to investigate whether these changes impact oncologic outcomes.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Mastectomia/métodos , Pneumonia Viral/epidemiologia , Radioterapia/métodos , Antineoplásicos/uso terapêutico , Betacoronavirus , Quimioterapia Adjuvante , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Perfilação da Expressão Gênica , Humanos , Programas de Rastreamento , Pandemias , Pneumonia Viral/diagnóstico , Radioterapia Adjuvante , Inquéritos e Questionários , Tempo para o Tratamento/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
20.
In Vivo ; 34(3 Suppl): 1675-1680, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-542896

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is now a global pandemic. It is unclear to radiotherapy practitioners how to carry out radiotherapy during the epidemic. PATIENTS AND METHODS: After the outbreak of COVID-19, our Institute established measures for the prevention and control of COVID-19, and continues to treat patients according to these measures. The Radiotherapy Department has been divided into a clean zone and a semi-contaminated zone, and corresponding personal protective equipment is used in these zones. The temperature of patients and their escorts, and history of fever are assessed daily. Special procedures are performed during radiotherapy setup and intracavitary brachytherapy. RESULTS: Over a period of 2 months, 655 patients were treated in the Department. Sixteen patients with fever were identified and no patient undergoing radiotherapy or medical staff have been infected with COVID-19. CONCLUSION: Our protective measures were found to be effective and can be used as a reference in places where COVID-19 situations are not markedly serious.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Serviço Hospitalar de Radiologia/organização & administração , Radioterapia/métodos , Adulto , Pequim , Criança , Técnicas de Laboratório Clínico/métodos , Contenção de Riscos Biológicos/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Desinfecção , Contaminação de Equipamentos/prevenção & controle , Febre/etiologia , Pessoal de Saúde/educação , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Neoplasias/radioterapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas , Equipamentos de Proteção , Avaliação de Sintomas , Termometria
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