RESUMO
PURPOSE: The delineation of volumes of interest can be a source of significant interobserver variability. The purpose of this study was to improve the homogeneity of delineation between oncologist-radiotherapists in the territorial departments of Nord and Pas-de-Calais (France) through discussions of clinical cases and the adoption of common published reference documents. MATERIALS AND METHODS: All eleven radiotherapy centres in the Nord and Pas-de-Calais departments of France participated. The localizations assessed to date included prostate, head and neck, breast and brain cancers. For each localization, the junior or senior physician(s) in charge of pathology delineated the volumes of interest according to their usual practices. Validated indices, including the Dice similarity coefficient, were used to quantify the delineation differences. The anonymized results were presented at two to three annual meetings. A second delineation of the clinical cases was then carried out to quantify homogenization. An evaluation of dosimetry practices was also conducted for prostate cancer. Wilcoxon assay matched data were used. RESULTS: Our work showed either satisfactory delineation concordance after the initial assessment or improved delineation concordance. For prostate cancer, the Dice similarity coefficient values were greater than 0.6 initially in two of the three clinical cases. For head and neck cancers, a statistically significant improvement was observed for only one of the clinical target volumes. More than half of the Dice similarity coefficient values were greater than 0.6 in the first comparison. The study of clinical cases of breast cancer allowed a homogenization of the delineation of five of the six lymph node clinical target volumes. The dosimetry study of prostate cancer allowed for a homogenization of practices. CONCLUSION: This work makes it possible to harmonize the delineation practices around validated standards. An extension to the entire Hauts-de-France region is planned.
Assuntos
Neoplasias/radioterapia , Dosagem Radioterapêutica/normas , Planejamento da Radioterapia Assistida por Computador/normas , Institutos de Câncer , Feminino , França , Humanos , Masculino , Neoplasias/patologia , Variações Dependentes do ObservadorRESUMO
OBJECTIVES: To assess the feasibility and morbidity of surgical management by combined laparoscopic and vaginal approach after cervical cancer diagnosed at the time of simple hysterectomy. PATIENTS AND METHODS: From 2000 to 2005, 10 patients were referred with occult cervical cancer discovered after simple hysterectomy. All these patients had laparoscopy for surgical staging. RESULTS: Eight on ten patients had complete laparoscopic staging: pelvic lymphadenectomy (N=8), radical colpectomy (N=5). Operative time, pelvic lymph nodes resected, postoperative stay were respectively 261.3 minutes (200-400), 27 (23-38), 4.4 days. There were 2 symptomatic lymphocysts. Pelvic lymph nodes were positive for 1 patient with negative paraaortic nodes. Residual disease was present in 2 cases: 1 parametrial and vaginal involvement, 1 ovarian metastasis. 5 patients had adjuvant treatment: 2 combined pelvic external radiotherapy and brachytherapy, 1 pelvic external radiotherapy, 1 pelvic concurrent chemoradiation and 1 brachytherapy only. Two on ten patients needed a laparoconversion, one for ovarian involvement and one for technical failure. With a median follow-up of 29.7 months (4-63), 3 patients recurred. 3 patients recurred above 5 patients with pelvic lymphadenectomy but without parametrectomy versus no recurrence above 5 patients with pelvic lymphadenectomy and parametrectomy. DISCUSSION AND CONCLUSION: Surgical staging of occult cervical cancer discovered after simple hysterectomy is necessary for indication of adjuvant treatment. Laparoscopy combined with vaginal surgery is feasible and safe, inducing fewer adhesions which is important for adjuvant radiotherapy. The realization of a radical parametrectomy seems to offer a local control of the disease and a decrease in the risk of recurrence, which need to be confirmed by conducting a study with more patients. This emphasize the necessity of creating a national record to register all women managed for occult cervical cancer.
Assuntos
Laparoscopia/métodos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Antineoplásicos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Histerectomia , Tempo de Internação , Linfonodos/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Radioterapia Adjuvante , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/radioterapiaRESUMO
PURPOSE: This paper presents a new optimization method of treatment planning in linac stereotactic radiosurgery. METHODS AND MATERIALS: On a workstation integrating x-rays, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtracted angiography (DSA) images, we first determine the outlines of the target volume and surrounding healthy tissues to spare. To achieve complete optimization of the treatment plans, this method decomposes the optimization process in two steps. The position of the isocenters and the diameter of the collimators are first deduced by a conjugate gradients method, from the position and size of ellipsoids or spheres modeling the target volume. The other irradiation parameters, such as the isocenter dose, the aperture, and the weight of each irradiation plane and of their irradiation sectors are finally deduced by a simulated annealing optimization algorithm. RESULTS: The system can perform multitarget/multisector treatment plans that are automatically obtained in a satisfactory time (as a rule, 20 min for a two-target irradiation), much faster than the time needed for a manual treatment planning. We present the results in two cases: the simulation of a single-target treatment and a two-target real treatment with constraints. In these two cases, we can control the dose received by target and sensitive volumes. CONCLUSION: This method achieves an excellent conformation of the estimated isodose curves with the outlines of the target volume, which allows us to avoid the surrounding healthy tissues, thanks to the different weighting factors given on each volume concerned according to the importance we grant to each of them.
Assuntos
Radiocirurgia/métodos , Angiografia Digital , Neoplasias Encefálicas/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Neuroma Acústico/cirurgia , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios XRESUMO
From January 1980 to December 1984, 186 patients with non-metastatic primary adenocarcinoma of the lung were treated in 10 different French Cancer Institutes. All patients have a minimal 5-year follow-up. There were 19 Stage I, 58 Stage II, and 109 Stage III. Survival was correlated with treatment modality. Survival rates for patients treated with surgery (36 pts), surgery and radiotherapy (65 pts), or radiotherapy with or without chemotherapy (80 pts) were 44.7%, 28.5%, and 6%, respectively. In the group of patients who were operated on, local control rate was improved by adjunctive radiotherapy delivering more than 50 Gy in 5 weeks. The cumulative risk of developing distant metastasis was 37% at the end of the first year following diagnosis and 68% at 5 years. Stage of the disease, nodal involvement, and location of the primary were the main factors of prognosis.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias Pulmonares/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Seguimentos , França/epidemiologia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Taxa de SobrevidaRESUMO
PURPOSE: To prospectively evaluate the feasibility of pulsed dose rate (PDR) brachytherapy to mimic the continuous low dose rate (cLDR) iridium wire technique in head and neck carcinomas. MATERIALS AND METHODS: A series of 30 patients were included from June 1995 to May 1998. The primaries were located in the oral cavity (four T1, seven T2 and two T3), the velotonsillar arch (eight T1 and eight T2) and the posterior wall (one T3). Thirteen were irradiated by exclusive brachytherapy (dose, > or =45 Gy). The PDR delivered 0.5 Gy/pulse, one pulse/h, day and night, to mimic cLDR irradiation. RESULTS: The implantation was feasible for all the patients, usually easy and of good quality. The mean duration/pulse was 13 min, with a mean source activity of 171 mCi. Patient tolerance was poor in nine cases. Sixteen patients could receive the whole PDR treatment with a total ranging from 30 to 120 pulses without any problem. Seven had short breakdowns (< or =6 h). Seven had definitive breakdowns, but could end the irradiation by manual afterloading of iridium 192 wires. The radioprotection was better (or complete), except for one patient. Most of the breakdowns were related to kinking or flattering of the tube. CONCLUSIONS: PDR is feasible in head and neck carcinomas, but necessitates improvement of the quality and control of the plastic tubes.
Assuntos
Braquiterapia/métodos , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Braquiterapia/efeitos adversos , Relação Dose-Resposta à Radiação , Estudos de Viabilidade , Humanos , Radioisótopos de Irídio/uso terapêutico , Estudos Prospectivos , Dosagem RadioterapêuticaRESUMO
According to respective proportions of evolutive status groups, results of multivariate studies are difficult to interpret. Among the 1099 cases of local form of prostate cancer, treated by radiotherapy from 1975 to 1982 in 16 French Anticancer Institutes, we can observe two homogeneous status groups of patients: disease-free survivors (285 cases) and patients who died of prostate cancer (278 cases). These correspond to 51% of the whole population. Among other things, they are comparable in size, for age at the beginning of radiotherapy and for delay between histologic diagnostic and radiotherapy. We chose to analyse them using multivariate analysis. To take survival into account, we used a Cox model and Kaplan-Meier curves; the group deceased of prostate cancer was further analyzed by a tree-structured regression method. The Cox model and the Kaplan-Meier curves confirmed two main explicative factors: Stage (p < 0.0001) and tumor grade (p < 0.001). Poorer evolution occurs in extracapsular forms and grade I has better survival than others. The tree-structured regression method indicates two other pejorative factors: hormonotherapy prior to radiotherapy and the presence of cardiovascular pathology. Though the pelvic dose does not appear to be a main explicative factor, it seems to improve survival and delay between radiotherapy and recurrence or metastasis in some categories of cases. Other factors such as tumor dose, age and delay between diagnosis and radiotherapy were not found to be significant. These results cannot be extended to the whole population for which they do not constitute a predictive study. We consider them as "baseline data".(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Neoplasias da Próstata/radioterapia , Idoso , Terapia Combinada , Seguimentos , Humanos , Masculino , Análise Multivariada , Estadiamento de Neoplasias , Próstata/patologia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Dosagem Radioterapêutica , Análise de Regressão , Análise de Sobrevida , Fatores de TempoRESUMO
BACKGROUND AND PURPOSE: To evaluate the feasibility of pulsed dose rate (PDR) brochytherapy in squamous cell anal canal carcinoma (SCACC). MATERIALS AND METHODS: In this study a series of 19 patients with SCACC were included between 1995 and 1997. All patients were treated with curative intent with external beam radiotherapy (EBRT) (44-50 Gy) and one or two cycles of concomitant fluorouracilcisplatinum. After a gap of 2-3 weeks PDR interstitial brachytherapy was performed with a rigid needles technique. The dose was between 10-25 Gy (PARIS system). RESULTS: All patients are alive. No severe grade 3-4 toxicity was encountered. One local relapse one metastatis were seen in two distinct patients. There was no dysfunction of the after loading machine. CONCLUSION: The feasibility of PDR brachytherapy appears good in SCACC. It is an attractive alternative to low dose rate brachytherapy.
Assuntos
Neoplasias do Ânus/radioterapia , Braquiterapia , Carcinoma de Células Escamosas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Ânus/tratamento farmacológico , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Carcinoma de Células Escamosas/tratamento farmacológico , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Radioisótopos de Irídio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Lesões por Radiação , Dosagem RadioterapêuticaRESUMO
Hypopharynx (HC: pyriform fossa, postcricoïd area, and posterior wall) and lateral epilarynx carcinomas (LEC: aryepiglottic fold, pharyngoepiglottic fold, and arytenoïd) have a high tendency to cervical lymph node invasion. Such nodal extension is a well-known prognostic factor. This study is based on a retrospective review of 884 clinical records of previously untreated HC or LEC. Seventy percent of patients revealed palpable nodes at their first examination, with a higher percentage for HC (73%) than LEC (62%). The 5-year survival rate was divided by three in the presence of contralateral, bilateral, or fixed nodes, or in cases of nodes exceeding 3 cm. Multiple positive nodes, extracapsular spread, or lower-neck positive nodes significantly decreased survival, doubled the number of neck recurrences, and tripled the number of distant metastases while control at the primary site remained unvaried.
Assuntos
Neoplasias Hipofaríngeas/patologia , Neoplasias Laríngeas/patologia , Metástase Linfática , Neoplasias Faríngeas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/terapia , Masculino , Pessoa de Meia-Idade , Pescoço , Prognóstico , Estudos RetrospectivosRESUMO
The records of 4 patients treated for a spermatocytic seminoma between 1974 and 1993 were reviewed. We described pathological and clinical features of this entity of seminoma which differs from those of classic seminoma. Spermatocytic seminoma is an essentially non metastasizing neoplasm unless complicated by the rare development of a sarcomatous component or metastatic spread.
Assuntos
Seminoma/patologia , Neoplasias Testiculares/patologia , Adulto , Fatores Etários , Idoso , Diagnóstico Diferencial , Humanos , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Orquiectomia , Prognóstico , Dosagem Radioterapêutica , Seminoma/radioterapia , Seminoma/cirurgia , Neoplasias Testiculares/radioterapia , Neoplasias Testiculares/cirurgia , Resultado do TratamentoRESUMO
During the last two years, we have used a pectoralis major myocutaneous flap in 42 cases (28 after radiotherapy). The immediate post-operative periods were very simple and the flap reliability was remarkable: only three partial necrosis and no total necrosis were observed. This technique seems to be an important contribution in the field of buccopharyngeal surgery, especially in the case of extensive tumors involving the tongue. In that case, initial radiotherapy followed by extensive surgery with myocutaneous flap reconstruction seems to be the best therapeutic strategy. It is the authors' feelings that local control will probably be better but long term results will be still poor. Effectively, in case of extended tumors general prognosis has to be taken in account as well as local prognosis.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Músculos Peitorais/transplante , Retalhos Cirúrgicos , Adulto , Idoso , Bochecha/cirurgia , Feminino , Sobrevivência de Enxerto , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Laringectomia , Masculino , Mandíbula/cirurgia , Pessoa de Meia-Idade , Faringectomia , Cuidados Pós-Operatórios , Cuidados Pré-OperatóriosRESUMO
The authors present the general results of a retrospective study on 2418 patients treated between 1976 and 1980. Primaries were located on buccopharynx in 51% of cases, pharyngolarynx in 45% and nasopharynx or nasal and paranasal cavities in 4%. Two out of 3 tumours were classified T3 T4 (UICC 1979) and 1 out of 2 patients presented with palpable cervical lymph nodes. Taking into account persistent diseases and recurrences, failure at primary sites occurred in 40% of patients, in the neck in 20%, distant metastases in 10%. Synchronous and/or metachronous cancers were observed in 1 out of 3 patients. Actuarial survival rates were 2/3 at 1 year, 1/3 at 3 years, 1/4 at 5 years and 1/7 at 8 years. Endolaryngeal tumours had the best prognosis while hypopharyngeal tumours had the worst prognosis.
Assuntos
Neoplasias de Cabeça e Pescoço/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Neoplasias Laríngeas/epidemiologia , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/epidemiologia , Neoplasias Bucais/mortalidade , Neoplasias Bucais/terapia , Neoplasias Nasofaríngeas/epidemiologia , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/terapia , Neoplasias dos Seios Paranasais/epidemiologia , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/terapia , Neoplasias Faríngeas/epidemiologia , Neoplasias Faríngeas/mortalidade , Neoplasias Faríngeas/terapia , Prognóstico , Estudos RetrospectivosRESUMO
Since January 2001, radiotherapy treatments with modulated intensity beams (IMRT) have started at the Centre Oscar-Lambret. This paper presents the tests and measurements made before the clinical implementation as well the quality control performed before each routine treatment. We use the treatment planning system Helax-TMS (MDS-Nordion) and the Primus accelerator (Siemens) linked to the Lantis network with Primeview and Simtec modules (Siemens) allowing to deliver intensity modulated beams with Step-and-Shoot technique. A prostate case and a head and neck case have been studied and have permitted to evaluate the benefit of IMRT compared to a "classical" conformal radiotherapy. In a second time, we have tested the accelerator's capabilities to deliver these intensity modulated beams, id-est, the accuracy of the leaf positions and the linearity of the monitor chamber. The third step has been the verification of the dose distributions calculated by Helax-TMS, id-est, the dose for different segment sizes, the dose profiles for an intensity modulated beam and the dose distribution for all the traitment beams. The used phantom has been especially developed at the Centre Oscar-Lambret for IMRT. The results have allowed to start clinical treatments and to establish a quality control set for this technique. The next step is the real time dosimetry with a portal imager.
Assuntos
Dosagem Radioterapêutica/normas , Radioterapia/normas , Humanos , Aceleradores de Partículas , Imagens de Fantasmas , Controle de QualidadeRESUMO
Pulse Dose Rate (PDR) brachytherapy presents the potential radiobiological advantages of low dose rate and the technical and radiation protection advantages of high dose rate remote afterloading technology. The different algorithms provided by the treatment planning systems allow dose rate and isodose shape optimization regarding the volumes defined by the radiologist and the radiation oncologist. The contribution of imaging together with these new optimization tools should improve brachytherapy practice and the therapeutic ratio. These new evolutions of brachytherapy will be presented here.
Assuntos
Algoritmos , Braquiterapia/métodos , Humanos , Neoplasias/radioterapia , Radioterapia (Especialidade)/tendências , Planejamento da Radioterapia Assistida por ComputadorRESUMO
During more than a half of century, numerous compounds have been tested in different models against radiation-induced cataract. In this report, we will review the radioprotectors that have been already tested for non-human crystalline lens protection. We will focus on the most important published studies in this topic and the mechanisms of cytoprotection reported in vitro and in vivo from animals. The most frequent mechanisms incriminated in the cytoprotective effect are: free radical scavenging, limitation of lipid peroxidation, modulation of cycle progression increase of intracellular reduced glutathion pool, reduction of DNA strand breaks and limitation of apoptotic cell death. Amifostine (or Ethyol) and anethole dithiolethione (or Sulfarlem), already used clinically as chemo- and radioprotectants, could be further tested for ocular radioprotection particularly for radiation-induced cataract.
Assuntos
Amifostina/farmacologia , Anetol Tritiona/farmacologia , Catarata/etiologia , Cristalino/efeitos dos fármacos , Cristalino/efeitos da radiação , Lesões por Radiação/prevenção & controle , Protetores contra Radiação/farmacologia , Radioterapia/efeitos adversos , Animais , Apoptose , Catarata/prevenção & controle , Bovinos , Ciclo Celular/efeitos da radiação , Células Cultivadas/efeitos dos fármacos , Células Cultivadas/efeitos da radiação , Ensaios Clínicos como Assunto , Citoproteção , Dano ao DNA , Olho/efeitos da radiação , Feminino , Fluorometria , Sequestradores de Radicais Livres , Humanos , Peroxidação de Lipídeos , Masculino , Microscopia de Fluorescência , Doses de Radiação , Lesões por Radiação/etiologia , Lesões Experimentais por Radiação/prevenção & controle , Dosagem Radioterapêutica , Ratos , Fatores de TempoRESUMO
Typical dosimeters used in stereotactic radiation therapy, such as ionization chambers, films, and thermoluminescent diodes, allow basic physical measurements. They are, however, neither well suited to discern small target volumes with high dose gradient, nor suitable for three-dimensional (3D) dose measurements. Gel dosimetry is becoming more and more interesting, owing to magnetic resonance imaging (MRI). It permits isocenter position planning verification of accuracy and the precision of the 3D dose mapping in the brain (when irradiated in realistic conditions), especially when several different targets are concerned. Many authors have assessed stereotactic radiation therapy quality control using different gels, and different irradiation procedures. This paper consists of the review of these different methods to assess quality control. Gel dosimetry cannot provide absolute dose measurements. However, gels can be used to check the 3D dose mapping with a high degree of detail. In our experiment, the difference between the stereotactic frame center and the isocenter is about 1 mm. The difference between the theoretical isodoses obtained by the treatment planning system and the experimental isodoses obtained by the MRI gray level calibration is also about 1 mm, the order of magnitude of the MRI pixel size.
Assuntos
Géis , Imagens de Fantasmas , Radiocirurgia/normas , Dosagem Radioterapêutica/normas , Géis/efeitos da radiação , Imageamento por Ressonância Magnética , Controle de QualidadeRESUMO
PURPOSE: We prospectively compared a conventional treatment planning (PT2D) and 3-dimensional conformal treatment planning (PT3D) for radiotherapy of cerebral tumours. PATIENTS AND METHODS: Patients treated between 1/10/98 and 1/4/99 by irradiation for cerebral tumours were analysed. For each case, we planned PT2D using conventional orthogonal x-ray films, and afterward, PT3D using CT scan. Gross tumor volume, planning target volume and normal tissue volumes were defined. Dose was prescribed according to report 50 of the International Commission on Radiation Units and Measurements (ICRU). We compared surfaces of sagittal view targets defined on PT2D and PT3D and called them S2D and S3D, respectively. Irradiated volumes by 90% isodoses (VE-90%) and normal tissue volumes irradiated by 20, 50, 90% isodoses were calculated and compared using Student's paired t-test. RESULTS: There was a concordance of 84% of target surfaces defined on PT2D and PT3D. Percentages of target surface under- or-over defined by PT2D were 16 and 13% respectively. VE-90% was decreased by 15% (p = 0.07) with PT3D. Normal brain volume irradiated by 90% isodose was decreased by 27% with PT3D (p = 0.04). CONCLUSION: For radiotherapy of cerebral tumors using only coplanar beams, PT3D leads to a reduction of normal brain tissue irradiated. We recommend PT3D for radiotherapy of cerebral tumors, particularly for low-grade or benign tumors (meningiomas, neuromas, etc.).
Assuntos
Neoplasias Encefálicas/radioterapia , Radioterapia Assistida por Computador , Radioterapia Conformacional , Humanos , Estudos Prospectivos , Dosagem Radioterapêutica , Resultado do TratamentoRESUMO
INTRODUCTION: Verification of absorbed dose in target volume is a key factor for quality assurance in radiotherapy. In vivo measurements allow evaluation of the variations in dose with time and variations between measured doses and calculated doses by TPS. The aim of this work were to evaluate reproducibility of patient positioning and to compare calculated doses by 2 different TPS. PATIENTS AND METHODS: Twenty patients were divided in 2 groups according to the thickness of their breast (mean SSD = 92.9 cm). In vivo measurement was performed within the first two sessions. RESULTS: Reproducibility of SSD evaluation was made on 12 beams between 2 fractions. With a tolerance margin of 0.5 cm, positioning errors were present in 33% (4/12). The 2 TPS were in agreement in 75% (30/40). CONCLUSION: In vivo dosimetry can be a very interesting tool to assess patients positioning variations and TPS dose calculation.
Assuntos
Neoplasias da Mama/radioterapia , Mama/patologia , Dosagem Radioterapêutica , Mama/anatomia & histologia , Neoplasias da Mama/patologia , Feminino , Humanos , Planejamento de Assistência ao Paciente , Reprodutibilidade dos Testes , Pele/efeitos da radiaçãoRESUMO
At the turn of this century, the evidence of the benefits of a concurrent chemo-radiotherapy in locally advanced tumors and the development of mini-invasive surgery (laparoscopic and radical vaginal surgery) are the two main advances in the management of cervical carcinomas. From a personal experience of 304 cervical carcinomas, the different techniques of laparoscopy used in cervical carcinomas are addressed and discussed. Their long-term results when involved in the management protocols of cervical carcinomas at different stages are reported. From this series, some conclusions are drawn: 1) laparoscopy can spare a laparotomy in early-stage node-negative patients with low tumoral volume; 2) it can spare a systematic extended-field radiation therapy in high-risk patients with node-negative para-aortic exploration; 3) it can spare surgery in patients with a centro-pelvic advanced stage or recurrence, possibly candidates for an exenterative procedure, if occult spread is found in the intra- or retroperitoneal areas. The more and more frequent combination of the mini-invasive surgery for staging and treatment and radiotherapy or chemotherapy explains the need for new protocols of a more and more complex and specialized management.
Assuntos
Adenocarcinoma/cirurgia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/cirurgia , Laparoscopia , Excisão de Linfonodo , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/radioterapia , Adulto , Antineoplásicos/uso terapêutico , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma Adenoescamoso/mortalidade , Carcinoma Adenoescamoso/radioterapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/radioterapia , Quimioterapia Adjuvante , Cisplatino/uso terapêutico , Terapia Combinada , Feminino , Humanos , Histerectomia , Recidiva Local de Neoplasia/cirurgia , Ovário/cirurgia , Probabilidade , Prognóstico , Radioterapia Adjuvante , Análise de Sobrevida , Fatores de Tempo , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapiaRESUMO
OBJECTIVES: Results of a retrospective paired study comparing the outcome of patients irradiated for lymph node involvement according to the method of node assessment: laparotomy or laparoscopy. MATERIAL AND METHODS: Twenty-six patients with cervical cancer managed by postoperative radiation therapy for pelvic node involvement during the Wertheim-Meigs operation (historical group) were compared to 26 patients in whom lymph node involvement was discovered at the time of laparoscopy and managed by definitive radiation therapy without hysterectomy (laparoscopy group). The patients were matched according to age, stage, tumor histology and tumoral volume. RESULTS: No difference was observed in the five-year survivals. Although it was not significant there were more grade 3-4 radio-induced complications in the historical group. CONCLUSIONS: The introduction of laparoscopy and the absence of hysterectomy did not impair the outcome of our patients. Laparoscopic lymphadenectomy reduces the risk of radio-induced adverse effects.
Assuntos
Metástase Linfática/radioterapia , Neoplasias do Colo do Útero/patologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Pelve , Resultado do Tratamento , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgiaRESUMO
OBJECTIVES: New and much debated data of the endometrial cancer concerning the preoperative assessment of myometrial invasion, the surgical staging, and the adjuvant treatment. PATIENTS AND METHODS: Medline (1998-2002): searching for "endometrial carcinoma". RESULTS: The pap smears are useful when it is difficult to have a transvaginal ultrasonography or an MRI. We can perform the pap smears and the endometrial biopsy in the clinic. If a patient has pap smears with malignant cells or elevated preoperative CA 125, it probably is a cancer with poor prognostic factors. Surgical staging with abdominal and node evaluation is necessary. The MRI seems to be the best preoperative imaging because we have information about adnexal and abdominal metastases, pelvic or aortic nodes and the invasion of the myometrium. So it gives us information on the surgical route, and provides indication for a lymphadenectomy. The surgical staging is a part of the treatment of the endometrial cancer: an exploration of the peritoneal cavity, a pelvic lymphadenectomy, a para-aortic lymphadenectomy if the pelvic nodes are positive or if there are factors of bad prognosis (deep stage IC, grade 3, adnexal or abdominal involvement, serous carcinoma of the endometrium). It can be performed if technical conditions are correct. The adjuvant teletherapy in the documented stage IpN0 (surgical staging with pelvic lymphadenectomy) does not seem to be necessary. But we can perform an adjuvant brachytherapy (high-dose rate if it is possible) in patients with a high local recurrence (stage IC, stage I with grade 3, stage IB grade 2). CONCLUSION: The preoperative MRI is useful choosing the surgical approach, and the depth of the myometrial invasion, which can be an indication for a pelvic lymphadenectomy. The surgical staging must be a part of the treatment of the endometrial cancer. So the adjuvant teletherapy in patients with stage IpN0 documented should not be used.