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1.
PLoS One ; 15(9): e0237501, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877418

RESUMO

PURPOSE: The concept of dysphagia/aspiration-related structures (DARS) was developed against the background of severe late side effects of radiotherapy (RT) for head and neck cancer (HNC). DARS can be delineated on CT scans, but with a better morphological discrimination on magnetic resonance imaging (MRI). Swallowing function was analyzed by use of patient charts and prospective investigations and questionnaires. METHOD: Seventeen HNC patients treated with intensity-modulated radiotherapy (IMRT) ± chemotherapy between 5/2012 - 8/2015 were included. Planning CT (computed tomography) scans and MRIs (magnetic resonance imaging) prior, during 40 Gray (Gy) radiotherapy and posttreatment were available and co-registered to delineate DARS. The RT dose of each DARS was calculated. Five patients were investigated posttreatment for swallowing function and assessed by means of various questionnaires for quality of life (QoL), swallowing, and voice function. RESULTS: By retrospective comparison of DARS volume, a significant change in four of eight DARS was detected over time. Three increased and one diminished. The risk of posttreatment dysphagia rose by every 1Gy above the mean dose (D mean) of RT to DARS. 7.5 was the risk factor for dysphagia in the first 6 months, reducing to 4.7 for months 6-12 posttreatment. For all five patients of the prospective part of swallowing investigations, a function disturbance was detected. These results were in contrast to the self-assessment of patients by questionnaires. There was neither a dose dependency of D mean DARS volume changes over time nor of dysphonia and no correlation between volume changes, dysphagia or dysphonia. CONCLUSION: Delineation of DARS on MRI co-registered to planning CT gave the opportunity to differentiate morphology better than by CT alone. Due to the small number of patients with complete MRI scans over time, we failed to detect a dose dependency of DARS and swallowing and voice disorder posttreatment.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/radioterapia , Imagem por Ressonância Magnética , Sucção , Tomografia Computadorizada por Raios X , Adulto , Idoso , Deglutição , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Voz , Adulto Jovem
2.
BMC Cancer ; 20(1): 21, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906910

RESUMO

BACKGROUND: To the best of our knowledge, no study has reported mediastinal shift accompanied with obstructive atelectasis due to bulky primary esophageal tumor components treated with adaptive radiotherapy and concurrent chemotherapy. CASE PRESENTATION: Here we report the case of a 65-year-old male patient diagnosed with locally advanced thoracic esophageal squamous cell cancer, clinical T4bN1M0, stage IVA. Bronchoscopy and computed tomography (CT) revealed an almost complete obstruction of the lumen of the left bronchus due to compression by bulky primary esophageal tumor components. On admission, the patient presented with dyspnea and decreased arterial oxygen saturation. Chest radiography and CT on admission revealed mediastinal shift with left atelectasis, as opposed to findings from the chest radiography performed 26 days before admission. Because of the patient's overall good condition, we recommended definitive chemoradiotherapy instead of palliative bronchial stent placement. After obtaining the patient's consent, chemoradiotherapy was initiated on the following day and it comprised three-dimensional conformal radiotherapy with 60 Gy in 30 fractions with concurrent administration of cisplatin and 5-fluorouracil. During chemoradiotherapy, tumor location was monitored with cone-beam CT and chest radiography. Chemoradiotherapy on day 8 revealed no evidence of the mediastinal shift. CT simulation was reperformed to adjust the radiotherapy fields to account for geometrical changes induced by the absence of the mediastinal shift. Subsequently, the mediastinal shift and bronchial obstruction did not recur during the course of chemoradiotherapy. The patient completed the planned radiotherapy with concurrent and adjuvant chemotherapy, and no non-hematological grade ≥ 3 adverse events were observed. Complete response was confirmed 7 months after initiating chemoradiotherapy. Currently, no disease recurrence, dysphagia, or respiratory symptoms have been reported at 13 months after initiating chemoradiotherapy. CONCLUSIONS: In this study, a bulky primary esophageal tumor caused mediastinal shift due to ipsilateral bronchial obstruction. The close follow-up for monitoring resolution of the mediastinal shift during the course of chemoradiotherapy enabled adequate dose delivery to targets, thus reflecting the geometrical changes induced by the absence of the mediastinal shift. Adaptive radiotherapy technique was crucial for favorable patient outcomes in this challenging clinical situation.


Assuntos
Neoplasias Esofágicas/terapia , Mediastino , Atelectasia Pulmonar/etiologia , Idoso , Antineoplásicos/administração & dosagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Cisplatino/administração & dosagem , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Fluoruracila/administração & dosagem , Humanos , Masculino , Mediastino/diagnóstico por imagem , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/patologia , Atelectasia Pulmonar/terapia , Indução de Remissão
3.
Acta Oncol ; 59(2): 212-218, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31564184

RESUMO

Background: The majority of patients with incurable esophageal adenocarcinoma suffer from dysphagia. We assessed a novel treatment strategy with initial short-course radiotherapy followed by chemotherapy with the primary aim to achieve long-term relief of dysphagia.Methods: This phase II trial included treatment-naîve patients with dysphagia due to esophageal adenocarcinoma not eligible for curative treatment. External beam radiotherapy with 20 Gy in five fractions to the primary tumor was followed by four cycles of chemotherapy (FOLFOX regimen). Dysphagia was assessed using a five-grade scale.Results: From October 2014 to May 2018 a total of 29 patients were enrolled. The rate of dysphagia improvement was 79%, median duration of improvement 6.7 months (12.2 months for responders) and median overall survival 9.9 months. In the pre-specified per protocol analysis (23 patients) the rate of dysphagia improvement was 91%, median duration of improvement 12.2 months (14.0 months for responders) and median overall survival 16.0 months. The most common grade 3-4 adverse events were neutropenia (29%), infection (25%), anorexia (11%), esophagitis (11%) and fatigue (11%).Conclusion: Initial palliative short-course radiotherapy followed by chemotherapy is a promising treatment strategy that can provide long-lasting relief of dysphagia in patients with esophageal adenocarcinoma.


Assuntos
Adenocarcinoma/radioterapia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos/métodos , Adenocarcinoma/complicações , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica , Terapia Combinada/efeitos adversos , Transtornos de Deglutição/tratamento farmacológico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Feminino , Fluoruracila , Humanos , Leucovorina , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos , Hipofracionamento da Dose de Radiação , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-31731594

RESUMO

Oral complications of cancer therapy, such as oral dryness, dysphagia, and taste alteration, are associated with a negative impact in the quality of life of the patients. Few supportive care measures are available for such complications. This case series reveals the effectiveness of the photobiomodulation (PBM) therapy when used in a specific protocol and parameters, in the management of oral complications related to cancer therapy. Dysphagia was measured using the functional outcome swallowing scale for staging oropharyngeal dysphagia (FOSS). Oral mucositis was measured according to the National Cancer Institute scale. The quantity of the whole resting and stimulated saliva was measured in order to assess the oral dryness. In addition, the taste alteration was measured according to a protocol suggested by the International Standards organization (ISO). Sensation of burning mouth was measured using a visual analogue scale. These measurements were made before treatment, during, and at the end of the treatment. Diode laser 635 nm was used in 3 J/cm2. Five sessions interleaved with 24 h breaks were conducted for the dysphagia and oral dryness, and 10 sessions were conducted for the taste alteration and burning mouth sensation. Regardless of the limitations of this case series, PBM can be considered safe, time saving, and a promising approach for the management of the oral complications due to cancer therapy and the quality of life of cancer patients.


Assuntos
Transtornos de Deglutição/radioterapia , Terapia com Luz de Baixa Intensidade , Neoplasias/terapia , Estomatite/radioterapia , Xerostomia/radioterapia , Adulto , Transtornos de Deglutição/etiologia , Humanos , Lasers Semicondutores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Saliva , Estomatite/etiologia , Paladar , Xerostomia/etiologia
5.
Head Neck ; 41(10): 3594-3603, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31329343

RESUMO

BACKGROUND: Acute and late toxicity after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC) impacts on patient quality of life; yet, very late toxicity data remain scarce. This study assessed dysphagia, xerostomia, and neck fibrosis 3-8 years after IMRT. METHODS: A retrospective analysis using generalized estimated equations was performed on 60 patients with HNC treated with fractionated IMRT between 2000 and 2015 who had a follow-up ≥8 years. Toxicity was scored using LENT-SOMA scales. RESULTS: A trend towards a nonlinear global time effect (P = .05) was noted for dysphagia with a decrease during the 5 years post-treatment and an increase thereafter. A significant decrease in xerostomia (P = .001) and an increase in neck fibrosis (P = .04) was observed until 8 years. CONCLUSIONS: Dysphagia, xerostomia, and neck fibrosis do not appear stable over time and remain highly prevalent in the very late follow-up. Our findings support the need for prospective trials investigating very late toxicity in patients with HNC.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Transtornos de Deglutição/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Pescoço/patologia , Radioterapia de Intensidade Modulada/efeitos adversos , Xerostomia/etiologia , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Fibrose/epidemiologia , Fibrose/etiologia , Fibrose/fisiopatologia , Seguimentos , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Xerostomia/epidemiologia , Xerostomia/fisiopatologia
6.
Cardiovasc Intervent Radiol ; 42(8): 1142-1152, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31144010

RESUMO

PURPOSE: To assess the efficacy and safety of a newly developed fully covered irradiation stent (FCIS) compared with a partially covered irradiation stent (PCIS) in patients with unresectable malignant dysphagia. MATERIALS AND METHODS: Data of 195 patients [158 (81.0%) males, median age of 75 years (range 49-89 years)] who underwent FCIS or PCIS placement for unresectable malignant dysphagia from January 2012 to November 2017 were retrospectively analyzed. The median follow-up time was 181 days (range 4-547 days). Outcomes were measured in terms of recurrent dysphagia (primary), technical success, clinical success, overall survival, and adverse events. Recurrent dysphagia was analyzed by Fine-Gray regression model. RESULTS: The technical success rate was 97.8% (87/89) in the FCIS group and 99.1% (105/106) in the PCIS group (P = 0.59). The clinical success rate was 100.0% in both groups. There was no statistically significant difference in the recurrent dysphagia rate between the FCIS and PCIS groups (21.8% vs. 28.6%; P = 0.12). Compared with PCISs, FCISs were associated with a decrease in tissue/tumor growth rate (11.5% vs. 21.9%; P = 0.01), while stent migration rates were statistically comparable (11.5% vs. 5.7%; P = 0.23). The median overall survivals were comparable between the FCIS and PCIS groups (164 days vs. 162 days; P = 0.70). A dysphagia score of 4 and metastasis were risk factors for survival. No significant differences were observed in the rates of adverse events, including chest pain, fistula formation, hemorrhage, and aspiration pneumonia (P > 0.05). CONCLUSION: For patients with unresectable malignant dysphagia, this newly developed FCIS can provide efficacy and safety comparable to those of a PCIS. Compared with PCIS, this FCIS is more successful in preventing tissue/tumor growth, with a comparable stent migration rate.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/radioterapia , Desenho de Equipamento/métodos , Neoplasias Esofágicas/complicações , Stents , Neoplasias Gástricas/complicações , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos Retrospectivos , Resultado do Tratamento
7.
Clin Oncol (R Coll Radiol) ; 31(7): e87-e93, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30982667

RESUMO

Dysphagia in people with advanced oesophageal cancer can be treated by oesophageal stents, external beam radiotherapy (EBRT) and intraluminal brachytherapy. Despite guidelines recommending brachytherapy for patients with a predicted life expectancy exceeding 3 months, its uptake in the UK has been limited. Here we examine the strength of the evidence supporting the use of brachytherapy compared with oesophageal stents and EBRT and possible reasons for its limited uptake. Trials and observational studies suggest brachytherapy alone confers a benefit to patients, but its impact is less immediate than oesophageal stents; the evidence on effectiveness and value-for-money is limited. Moreover, stronger evidence will probably be insufficient to increase uptake, due to the extra complexity of delivery compared with stents and EBRT and a lack of experience among specialists.


Assuntos
Braquiterapia/métodos , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Dis Esophagus ; 32(12)2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-30888392

RESUMO

Iodine-125 (125I) seed-loaded stent placement has served as an effective palliation for malignant esophageal strictures in China. We performed a retrospective study to identify the prognostic factors of this irradiation stent placement in advanced esophageal cancer patients. A total of 201 patients who underwent 125I seed-loaded stent placement were included in this study from June 2012 to March 2016 at five hospitals in China. The Cox regression models adjusted for stratification factors were used, and a stepwise multivariate analysis was performed to predict the overall survival and relief of dysphagia on the basis of pretreatment clinical characteristics, respectively. Three independent prognostic factors were identified for overall survival: histopathological subtype (squamous cell carcinoma vs. adenocarcinoma, hazard ratio [HR] 1.45, 95% confidence interval [CI95%]: 1.01-2.09, P = 0.046), serum total protein (≥66 g/L vs. <66 g/L, HR 0.61, CI95%: 0.48-0.59, P = 0.023), and performance status (<2 vs. ≥2, HR 1.57, CI95%: 1.09-2.08, P = 0.013). Four factors were significantly associated with the relief of dysphagia: T stage (T3 vs. T4, P = 0.003), tumor location (superior vs. inferior, P = 0.049), tumor-node-metastasis classification (IV vs. II, P = 0.025), and age (≥71 years vs. <71 years, P = 0.029). Prognostic factors identified from this analysis can be used to aid clinical decision-making and design future clinical trials.


Assuntos
Adenocarcinoma/mortalidade , Carcinoma de Células Escamosas/mortalidade , Transtornos de Deglutição/mortalidade , Neoplasias Esofágicas/mortalidade , Radioisótopos do Iodo/administração & dosagem , Stents , Adenocarcinoma/complicações , Adenocarcinoma/radioterapia , Idoso , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/radioterapia , China , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/radioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do Tratamento
9.
Anticancer Res ; 37(6): 3085-3092, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28551648

RESUMO

AIM: To clarify the role of external-beam radiotherapy in the local management of state IVB esophageal cancer. PATIENTS AND METHODS: We reviewed records of 31 patients with histopathologically-proven squamous cell carcinoma who underwent radiotherapy for their primary lesion. The change in dysphagia score from before to after treatment was assessed. Nutritional support-free survival (NSFS) was also evaluated. RESULTS: The median overall survival was 6 months. The overall rate of improvement in dysphagia score was 73% (23/31). The median NSFS was 5 months. Age at presentation <67 years, tumor location in the middle thoracic esophagus, and tumor length <7 cm were associated with significant improvement in swallowing scores. Responders to radiotherapy had significantly longer NSFS than non-responders (p=0.04). CONCLUSION: Palliative radiotherapy in the local management of stage IVB esophageal cancer is an effective treatment option for dysphagia. Factors highly associated with improvement of swallowing are age, tumor location, and tumor length. Response to radiotherapy is the most important factor in improving NSFS.


Assuntos
Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos , Idoso , Idoso de 80 Anos ou mais , Deglutição/efeitos da radiação , Neoplasias Esofágicas/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Apoio Nutricional
10.
Radiother Oncol ; 122(3): 332-339, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28104297

RESUMO

BACKGROUND: The management of dysphagia owing to esophageal cancer is challenging. Brachytherapy has been proposed as an alternative option to stent placement. We performed a systematic review to examine its efficacy and safety in the resolution of dysphagia. METHODS: Prospective studies recruiting at least 20 patients with malignant dysphagia and published up to April 2016 were eligible. The dysphagia-free survival (DFS) and adverse event rates were pooled by means of a random effect model. RESULTS: Six studies for a total of 9 treatment arms (623 patients) were eligible for inclusion. After 1month since treatment, the DFS rate was 86.9% [95%CI: 76.0-93.3%]; after 3months, it was 67.2% [95%CI: 56.1-76.7%]; after 6months, it was 47.4% [95%CI: 38.5-56.5%]; after 9months, it was 37.6% [95%CI:30.0-45.9%]; and, finally, after 12months, it was 29.4% [95%CI: 21.6-38.7%]. The heterogeneity between studies was high at 1-, 3- and 6-month assessment; the values of I2 were 86.3%, 80.0% and 57.8%, respectively. The meta-regression analysis showed total radiation dose and number of fractions as the only positively influencing factors. Severe adverse event rate was 22.6% (95%CI 19.4-26.3). The main reported adverse events were brachytherapy-related stenosis (12.2%) and fistula development (8.3%). Two cases (0.3%) of deaths were reported due to esophageal perforation. CONCLUSION: Brachytherapy is a highly effective and relatively safe treatment option therefore its underuse is no longer justified. Further studies should investigate the optimal radiation dose and number of fractions able to achieve the highest DFS rates.


Assuntos
Braquiterapia/métodos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/complicações , Cuidados Paliativos/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos
11.
Dig Liver Dis ; 48(10): 1233-6, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27476465

RESUMO

BACKGROUND: International guidelines strongly recommend brachytherapy as valid alternative or in addition to stenting in patients with dysphagia owing to esophageal cancer. However, for not well understood reasons, brachytherapy is definitively underused for the palliative treatment of malignant dysphagia. Aim of the current survey was to investigate the use of brachytherapy for the treatment of malignant dysphagia in Italy. METHODS: A structured questionnaire was submitted to the 1510 members of the Italian Association of Radiation Oncologists (AIRO). These members refer to 177 centres of radiotherapy across Italy and in 68 (38.4%) of them brachytherapy is routinely performed. RESULTS: Of the 1510 invited members, 178 completed the survey (11.7%). The answers provided by the 178 participants allowed to get information on 40 out of 68 brachytherapy centres (58.8%). Seven out of 40 (17.5%) centres perform brachytherapy of the oesophagus, in 3 out of 40 (7.5%) centres brachytherapy represents the first line of treatment. The main reason why brachytherapy is not routinely performed is the lack of experience. CONCLUSION: Despite the strong recommendations of the international guidelines and the wide diffusion of brachytherapy centres across Italy, only very few of them routinely considered brachytherapy for the treatment of dysphagia due to esophageal cancer.


Assuntos
Braquiterapia/estatística & dados numéricos , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/complicações , Fidelidade a Diretrizes/estatística & dados numéricos , Cuidados Paliativos/métodos , Humanos , Itália , Oncologia , Médicos , Guias de Prática Clínica como Assunto , Sociedades Médicas , Inquéritos e Questionários
12.
Brachytherapy ; 14(1): 84-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25447340

RESUMO

BACKGROUND AND PURPOSE: Esophageal neoplasm has a poor prognosis, and palliative care remains an important goal of treatment. The purpose of this study was to assess the ability of high-dose-rate brachytherapy (HDRB) to improve dysphagia in 115 patients treated at our institution. METHODS AND MATERIALS: Patients previously submitted to external beam radiotherapy that at least, 1 month after, presented with residual disease and persistent dysphagia, were given HDRB as palliative treatment. Patients with tumors extending to the level of cardia and those with cervical esophageal lesions were also eligible. HDRB consisted of three fractions of 500 cGy given weekly. Dysphagia was assessed using a food texture-based scale classified according to the type of food patients were able to swallow (absent, solid, pasty, or liquid). At the end of treatment, a single-category shift in dysphagia classification was scored as +1 (e.g., liquid to pasty) or -1 (e.g., solid to pasty), and a dual-category shift was scored as +2 (e.g., liquid to solid) or -2 (e.g., absent to pasty). RESULTS: Most patients (51.1%) had improvement of dysphagia, and 55.3% of this group experienced one-point improvement. Procedural complications included stricture (38.2%), bleeding (7%), and fistula (8.7%). In the present study, 13 patients with cervical esophageal lesions underwent HDRB without fistula formation. CONCLUSIONS: Esophageal HDRB effectively reduces dysphagia. Tumor location was not related to development of complications.


Assuntos
Braquiterapia/métodos , Carcinoma de Células Escamosas/radioterapia , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Carcinoma de Células Escamosas/complicações , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/complicações , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
13.
Cancer Radiother ; 17(2): 159-61, 2013 Apr.
Artigo em Francês | MEDLINE | ID: mdl-23603254

RESUMO

The main indication of oesophageal brachytherapy is palliative: it can improve dysphagia in patients with a tumor not suitable for surgery or chemoradiotherapy. A randomized clinical trial showed that survival without dysphagia and quality of life was improved by endoluminal brachytherapy in comparison to self-expansible metallic stents. It also increases the duration of palliation after laser deobstruction. Its role as a curative treatment of locally advanced tumors is still discussed: in combination with external beam radiotherapy, it seems that brachytherapy increased the rate of severe toxicity (haemorrhages, fistula, stenosis). In superficial lesions, brachytherapy with or without external beam radiotherapy seems logical but large prospective studies are missing in this setting.


Assuntos
Braquiterapia/métodos , Neoplasias Esofágicas/radioterapia , Antimetabólitos Antineoplásicos/uso terapêutico , Braquiterapia/efeitos adversos , Quimiorradioterapia , Ensaios Clínicos Fase II como Assunto , Terapia Combinada , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/radioterapia , Transtornos de Deglutição/cirurgia , Fístula Esofágica/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/terapia , Fluoruracila/uso terapêutico , Humanos , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Cuidados Paliativos , Qualidade de Vida , Lesões por Radiação/etiologia , Radiometria , Dosagem Radioterapêutica , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents
14.
Dis Esophagus ; 26(1): 57-60, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22404484

RESUMO

Esophageal cancer tends to present with advanced disease, and the majority of patients are suitable only for palliative treatment at diagnosis. Dysphagia is the most common presenting symptom and significantly undermines quality of life. High-dose-rate intraluminal brachytherapy (ILBT) has been an option for the palliation of dysphagia for many years and has been used at our center since 2006. Experience was presented in terms of improvement of dysphagia and survival. Patients were identified from the local radiotherapy database. Original treatment sheets and clinical notes were reviewed retrospectively to obtain treatment details, pretreatment and post-treatment dysphagia scores, and survival information. Between January 2006 and January 2010, 21 patients of median age 77 years with a mean pretreatment dysphagia score of 2.5 underwent ILBT for esophageal cancer. All received 12 Gy in a single fraction. Thirteen (62%) had adenocarcinoma and eight (38%) squamous cell carcinoma. Four (19%) tumors were in the mid-esophagus and 17 (81%) in the lower esophagus. Eight had extension of tumor into the gastroesophageal junction. Seven patients (33%) received chemotherapy as first-line treatment prior to brachytherapy. Nineteen patients had clear documentation of dysphagia scores both pretreatment and post-treatment, and the improvement overall was significant (P= 0.04). Ten patients (53%) had an improvement in dysphagia score. Five of these (50%) went on to require further endoscopic intervention due to disease progression. Median duration of response was 4 months. Of the nonresponders, six (67%) went on to require further endoscopic intervention. No patients experienced documented toxicity aside from a short-lived acute esophagitis. Median survival from date of diagnosis was 12 months and from treatment date was 5 months (1-32 months). In our series of elderly patients with significant dysphagia, ILBT was a well-tolerated and effective treatment. It should be considered as a palliative option in esophageal cancer.


Assuntos
Braquiterapia/métodos , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/mortalidade , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Estudos de Coortes , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Relação Dose-Resposta à Radiação , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Dosagem Radioterapêutica , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do Tratamento , Reino Unido
15.
J BUON ; 17(3): 508-11, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23033290

RESUMO

PURPOSE: Dysphagia is a prominent symptom of oesophageal cancer which may be palliated by stent, external beam radiation (EBRT) or intraluminal brachytherapy (ILBT). Brachytherapy is not widely practised in the UK. The aim of this study was to compare the efficacy of ILBT and EBRT in relieving malignant dysphagia. METHODS: The radiotherapy database at Northampton Cancer Centre (NCC) was used to identify patients who underwent ILBT or EBRT for malignant dysphagia between 1.1.2008 and 31.3 2010. Data was collected on patient demographics, tumour characteristics, treatment received and dysphagia score pre- and post- treatment. Serial assessment of dysphagia was used to determine the duration of symptomatic improvement. EBRT involved 20-30 Gy in 5-10 fractions. Brachytherapy applicator placement was done by an experienced endoscopist at the high dose rate (HDR) suite and a single treatment dose of 12 Gy was prescribed at 1 cm depth. Oesophageal dilation was performed prior to brachytherapy treatment if needed. RESULTS: 44 patients were included in this study (EBRT: 21; ILBT: 23). Patient characteristics were well balanced between the two groups. The average dysphagia scores in the EBRT group prior to treatment were 3, and at 4, 8 and 16 weeks following treatment they were 3.4, 2.4, 2.1 and 2.1, respectively. The corresponding dysphagia scores in the ILBT group were 3.5 before treatment and 2.2, 2.1 and 2.3 following treatment, respectively. There was significant improvement in dysphagia in both groups at 4 weeks (p<0.0001), and the benefit was sustained after 8 and 16 weeks. No major complications were reported from either EBRT or oesophageal brachytherapy. CONCLUSION: ILBT is an effective alternative to multifractionated EBRT for palliation of malignant dysphagia providing a convenient one-stop treatment for patients who live a long distance from their cancer centre. Our model of performing the endoscopically guided procedure in the brachytherapy unit is comparable in cost to fractionated EBRT and can be adopted by other centres.


Assuntos
Braquiterapia , Transtornos de Deglutição/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Asia Pac J Clin Oncol ; 8(4): e82-8, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22897905

RESUMO

AIMS: To evaluate palliative outcomes of patients with extrinsic malignant tracheobronchial or esophageal stenosis treated with radiation. Mediastinal or hilar lymphadenopathy surrounding the tracheobronchi or esophagus may cause compression, presenting as dyspnea and dysphagia respectively. Treatment is important for symptom relief and maintaining patients' quality of life. METHODS: Dyspnea and dysphagia were assessed using the Hugh-Jones score and a modified dysphagia scale, respectively. A total of 13 patients (median age, 60 years) with dyspnea received palliative radiotherapy. The primary organs were lung (n = 6), colorectum (n = 5), hypopharynx (n = 1) and uterine cervix (n = 1). Three patients received concurrent chemotherapy. The median time-adjusted biological effective dose (BED) was 33.0 Gy(10) . Ten patients (median age, 61) with dysphagia received palliative radiotherapy. The primary organs were lung (n = 7), esophagus (n = 2) and hypopharynx (n = 1). Three patients received concurrent chemotherapy. The median time-adjusted BED was 32.1 Gy(10) . RESULTS: Palliation of dyspnea and dysphagia occurred in seven (54%) and five (50%) patients, respectively. Patients treated with doses over 35 Gy(10) had greater score improvements than those treated with less than 35 Gy(10) in both groups. Patients who received concurrent chemoradiotherapy had greater score improvements than those treated with radiotherapy alone. Dyspnea patients with pretreatment scores of 2 (n = 5) had greater score improvements than those with scores of 3 or more (n = 8). CONCLUSION: External beam radiotherapy should be considered for patients with tracheobronchial or esophageal stenosis before their symptoms worsen. The prescription dose should be over 35 Gy(10) .


Assuntos
Obstrução das Vias Respiratórias/radioterapia , Broncopatias/radioterapia , Transtornos de Deglutição/radioterapia , Esôfago/patologia , Neoplasias Pulmonares/patologia , Cuidados Paliativos/métodos , Estenose Traqueal/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/patologia , Broncopatias/patologia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Estenose Traqueal/patologia
17.
Gastrointest Endosc ; 76(2): 267-74, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22695208

RESUMO

BACKGROUND: For the palliative treatment of dysphagia, esophageal stent placement provides immediate improvement, whereas brachytherapy offers better long-term relief. OBJECTIVE: To evaluate safety and efficacy of concurrent brachytherapy and biodegradable stent placement. DESIGN: Prospective, single-arm study. SETTING: Two tertiary-care referral centers. PATIENTS: Nineteen consecutive patients with significant dysphagia resulting from unresectable esophageal cancer, with a life expectancy of more than 3 months. INTERVENTION: Single-dose brachytherapy (12 Gy) on day 1 followed by biodegradable stent placement on day 2. MAIN OUTCOME MEASUREMENTS: Intervention-related major complications (determined by an expert panel) and dysphagia. RESULTS: Nineteen patients (13 men, median age 66 years [interquartile range (IQR) 59-71] years) were included; 7 patients (37%) also received palliative chemotherapy. After inclusion of 19 patients, the study was ended prematurely because the safety threshold was exceeded. In total, 28 major complications occurred in 17 patients (89%). In 9 patients (47%), major complications were determined intervention-related (severe retrosternal pain with or without vomiting [n = 6], hematemesis [n = 1], recurrent dysphagia [n = 2]. Dysphagia scores decreased significantly from a median of 3 (IQR 3-4) to a median of 1 (IQR 0-3) after 1 month (P < .001). Despite adequate luminal patency in 17 patients (89%), normal diet could not be tolerated in 7 patients (37%) because of retrosternal pain and vomiting. LIMITATIONS: Lack of routine endoscopy or contrast esophagram to evaluate recurrent dysphagia during follow-up. CONCLUSION: Despite restoration of luminal patency, a combined treatment of brachytherapy and biodegradable stent placement cannot be recommended for the palliative treatment of esophageal cancer because of an unacceptably high intervention-related major complication rate.


Assuntos
Implantes Absorvíveis/efeitos adversos , Braquiterapia/efeitos adversos , Transtornos de Deglutição/terapia , Neoplasias Esofágicas/complicações , Esofagoscopia , Cuidados Paliativos/métodos , Stents/efeitos adversos , Dor Aguda/epidemiologia , Dor Aguda/etiologia , Adenocarcinoma/complicações , Idoso , Braquiterapia/métodos , Carcinoma de Células Escamosas/complicações , Terapia Combinada , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/radioterapia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/epidemiologia , Náusea/etiologia , Estudos Prospectivos , Resultado do Tratamento , Vômito/epidemiologia , Vômito/etiologia
18.
Cancer Treat Rev ; 38(8): 1033-49, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22542950

RESUMO

PURPOSE: Dysphagia is a debilitating complication in head and neck cancer patients (HNCPs) that may cause a high mortality rate for aspiration pneumonia. The aims of this paper were to summarize the normal swallowing mechanism focusing on its anatomo-physiology, to review the relevant literature in order to identify the main causes of dysphagia in HNCPs and to develop recommendations to be adopted for radiation oncology patients. The chemotherapy and surgery considerations on this topic were reported in recommendations only when they were supposed to increase the adverse effects of radiotherapy on dysphagia. MATERIALS AND METHODS: The review of literature was focused on studies reporting dysphagia as a pre-treatment evaluation and as cancer and cancer therapy related side-effects, respectively. Relevant literature through the primary literature search and by articles identified in references was considered. The members of the group discussed the results and elaborated recommendations according to the Oxford CRBM levels of evidence and recommendations. The recommendations were revised by external Radiation Oncology, Ear Nose and Throat (ENT), Medical Oncology and Speech Language Pathology (SLP) experts. RESULTS: Recommendations on pre-treatment assessment and on patients submitted to radiotherapy were given. The effects of concurrent therapies (i.e. surgery or chemotherapy) were taken into account. CONCLUSIONS: In HNCPs treatment, disease control has to be considered in tandem with functional impact on swallowing function. SLPs should be included in a multidisciplinary approach to head and neck cancer.


Assuntos
Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/radioterapia , Neoplasias de Cabeça e Pescoço/fisiopatologia , Neoplasias de Cabeça e Pescoço/radioterapia , Transtornos de Deglutição/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Radioterapia (Especialidade)/métodos
19.
J Indian Med Assoc ; 110(7): 449-52, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23520668

RESUMO

Oesophageal cancer, a disease with high morbidity and mortality, has a relatively high incidence in eastern India, usually presenting at advanced stage. The main aim of treatment for majority of patients remains palliation of dysphagia, which can be effectively done by intraluminal brachytherapy with or without external radiotherapy. Between January 2006 to January 2010 a total of 35 patients with advanced/metastatic (24/35) or recurrent (11/35) oesophageal carcinoma were treated with intraluminal high dose rate (HDR) iridium192 source brachytherapy at Medical College Hospitals, Kolkata. Selection for palliative brachytherapy includes one or more of the following criteria: Lesion more than 5 cm long on imaging studies or upper GI endoscopy, Karnofsky performance status < or = 50%, Locoregional recurrence. Palliative external radiotherapy (20 Gy/5# or 30 Gy/10#) was given to 11 patients (31.42%) before brachytherapy. All patients treated with 2 fractions of high dose rate-intraluminal brachytherapy (HDR-ILRT) one week apart with 600 cGy per fraction at 1 cm off axis. Thirty-five patients were treated with palliative HDR-ILRT. Significant improvement in swallowing status was seen in 20 patients (57.14%) since just after treatment up to 7.5 months. However, 9 patients (25.71%) showed no improvement, and 6 patients (17.14%) showed no changes in dysphagia scoring. Only 3 patients developed ulceration and 2 developed fistula immediately after treatment and 5 patients developed stricture. Median dysphagia-free survival was 6 months. Median overall survival was 8 months. It is concluded that intraluminal brachytherapy is an effective method for palliation of dysphagia for reasonably prolonged period.


Assuntos
Braquiterapia/métodos , Transtornos de Deglutição/radioterapia , Neoplasias Esofágicas/radioterapia , Recidiva Local de Neoplasia/radioterapia , Cuidados Paliativos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/patologia , Neoplasias Esofágicas/patologia , Feminino , Seguimentos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Lesões por Radiação/etiologia , Dosagem Radioterapêutica
20.
Laryngorhinootologie ; 90(11): 657-62, 2011 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-22083858

RESUMO

Altered fractionated radiotherapy and concurrent chemoradiation could improve local control and survival for patients with locally advanced head and neck cancer. However, intensified treatment seems to increase late toxicity. Late swallowing dysfunction is common and has a large impact on quality of life and can get life-threatening character. Recent studies could show interrelations between the radiation dose to certain anatomical structures involved in the swallowing process and the risk of swallowing dysfunction. Important structures seem to be the pharyngeal constrictors and the supraglottic and glottic larynx. Further prospective clinical validations using standardized diagnostic protocols for dysphagia are necessary to establish dose constraints to anatomical structures involved in swallowing.


Assuntos
Transtornos de Deglutição/radioterapia , Glote/efeitos da radiação , Laringe/efeitos da radiação , Neoplasias Otorrinolaringológicas/radioterapia , Músculos Faríngeos/efeitos da radiação , Lesões por Radiação/prevenção & controle , Radioterapia de Intensidade Modulada , Quimiorradioterapia Adjuvante , Terapia Combinada , Transtornos de Deglutição/diagnóstico por imagem , Fracionamento da Dose de Radiação , Glote/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Laringe/diagnóstico por imagem , Neoplasias Otorrinolaringológicas/tratamento farmacológico , Músculos Faríngeos/diagnóstico por imagem , Lesões por Radiação/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador , Tomografia Computadorizada por Raios X
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