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[PMID]:28463588
[Au] Autor:Judge JL; Lacy SH; Ku WY; Owens KM; Hernady E; Thatcher TH; Williams JP; Phipps RP; Sime PJ; Kottmann RM
[Ad] Endereço:a Department of Environmental Medicine, University of Rochester, Rochester, New York.
[Ti] Título:The Lactate Dehydrogenase Inhibitor Gossypol Inhibits Radiation-Induced Pulmonary Fibrosis.
[So] Source:Radiat Res;188(1):35-43, 2017 07.
[Is] ISSN:1938-5404
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Exposure of the lung to ionizing radiation that occurs in radiotherapy, as well as after accidental or intentional mass casualty incident can result in pulmonary fibrosis, which has few treatment options. Pulmonary fibrosis is characterized by an accumulation of extracellular matrix proteins that create scar tissue. Although the mechanisms leading to radiation-induced pulmonary fibrosis remain poorly understood, one frequent observation is the activation of the profibrotic cytokine transforming growth factor-beta (TGF-ß). Our laboratory has shown that the metabolite lactate activates latent TGF-ß by a reduction in extracellular pH. We recently demonstrated that lactate dehydrogenase-A (LDHA), the enzyme that produces lactate, is upregulated in patients with radiation-induced pulmonary fibrosis. Furthermore, genetic silencing of LDHA or pharmacologic inhibition using the LDHA inhibitor gossypol prevented radiation-induced extracellular matrix secretion in vitro through inhibition of TGF-ß activation. In the current study, we hypothesized that LDHA inhibition in vivo prevents radiation-induced pulmonary fibrosis. To test this hypothesis, C57BL/6 mice received 5 Gy total-body irradiation plus 10 Gy thoracic irradiation from a Cs source to induce pulmonary fibrosis. Starting at 4 weeks postirradiation, mice were treated with 5 mg/kg of the LDHA inhibitor gossypol or vehicle daily until sacrifice at 26 weeks postirradiation. Exposure to radiation resulted in pulmonary fibrosis, characterized by an increase in collagen content, fibrosis area, extracellular matrix gene expression and TGF-ß activation. Irradiated mice treated with gossypol had significantly reduced fibrosis outcomes, including reduced collagen content in the lungs, reduced expression of active TGF-ß, LDHA and the transcription factor hypoxia-inducible factor-1 alpha (HIF-1α). These findings suggest that inhibition of LDHA protects against radiation-induced pulmonary fibrosis, and may be a novel therapeutic strategy for radiation-induced pulmonary fibrosis.
[Mh] Termos MeSH primário: Gossipol/administração & dosagem
L-Lactato Desidrogenase/antagonistas & inibidores
Fibrose Pulmonar/imunologia
Fibrose Pulmonar/prevenção & controle
Pneumonite por Radiação/imunologia
Pneumonite por Radiação/prevenção & controle
[Mh] Termos MeSH secundário: Animais
Citocinas/imunologia
Relação Dose-Resposta a Droga
Masculino
Camundongos
Camundongos Endogâmicos C57BL
Fibrose Pulmonar/patologia
Dose de Radiação
Pneumonite por Radiação/patologia
Proteção Radiológica/métodos
Tolerância a Radiação/efeitos dos fármacos
Protetores contra Radiação/administração & dosagem
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Cytokines); 0 (Radiation-Protective Agents); EC 1.1.1.27 (L-Lactate Dehydrogenase); KAV15B369O (Gossypol)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM; S
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1667/RR14620.1


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[PMID]:28886981
[Au] Autor:Blais E; Pichon B; Mampuya A; Antoine M; Lagarde P; Kantor G; Breton-Callu C; Lefebvre C; Gerard M; Aamarcha A; Ozsahin M; Bourhis J; Maingon P; Troussier I; Pourel N
[Ad] Endereço:Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France. Electronic address: eivind.blais@gmail.com.
[Ti] Título:[Lung dose constraints for normo-fractionated radiotherapy and for stereotactic body radiation therapy].
[Ti] Título:Doses aux organes à risque en radiothérapie conformationnelle et en radiothérapie stéréotaxique : les poumons..
[So] Source:Cancer Radiother;21(6-7):584-596, 2017 Oct.
[Is] ISSN:1769-6658
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Radiation-induced lung disease (RILD) is common after radiation therapy and represents cornerstone toxicities after treatment of thoracic malignancies. From a review of literature, the objective of this article was to summarize clinical and non-clinical parameters associated with the risk of RILD in the settings of normo-fractionated radiotherapy and stereotactic body radiation therapy (SBRT). For the treatment of lung cancers with a normo-fractionated treatment, the mean lung dose (MLD) should be below 15-20Gy. For a thoracic SBRT, V20Gy<10% and MLD<6Gy are recommended. One should pay attention to central tumors and respect specific dose constraints to the bronchial tree. The recent technological improvements may represent an encouraging way to decrease lung toxicities. Finally, our team developed a calculator in order to predict the risk of radiation pneumonitis.
[Mh] Termos MeSH primário: Fracionamento de Dose
Pneumopatias/etiologia
Neoplasias Pulmonares/radioterapia
Pulmão/efeitos da radiação
Órgãos em Risco/efeitos da radiação
Radiocirurgia/métodos
[Mh] Termos MeSH secundário: Seres Humanos
Pneumonite por Radiação/etiologia
Neoplasias Torácicas/radioterapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170910
[St] Status:MEDLINE


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[PMID]:28871994
[Au] Autor:Wijsman R; Dankers FJWM; Troost EGC; Hoffmann AL; van der Heijden EHFM; de Geus-Oei LF; Bussink J
[Ad] Endereço:Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: robin.wijsman@radboudumc.nl.
[Ti] Título:Inclusion of Incidental Radiation Dose to the Cardiac Atria and Ventricles Does Not Improve the Prediction of Radiation Pneumonitis in Advanced-Stage Non-Small Cell Lung Cancer Patients Treated With Intensity Modulated Radiation Therapy.
[So] Source:Int J Radiat Oncol Biol Phys;99(2):434-441, 2017 Oct 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To evaluate whether inclusion of incidental radiation dose to the cardiac atria and ventricles improves the prediction of grade ≥3 radiation pneumonitis (RP) in advanced-stage non-small cell lung cancer (AS-NSCLC) patients treated with intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). METHODS AND MATERIALS: Using a bootstrap modeling approach, clinical parameters and dose-volume histogram (DVH) parameters of lungs and heart (assessing atria and ventricles separately and combined) were evaluated for RP prediction in 188 AS-NSCLC patients. RESULTS: After a median follow-up of 18.4 months, 26 patients (13.8%) developed RP. Only the median mean lung dose (MLD) differed between groups (15.3 Gy vs 13.7 Gy for the RP and non-RP group, respectively; P=.004). The MLD showed the highest Spearman correlation coefficient (Rs) for RP (Rs = 0.21; P<.01). Most Rs of the lung DVH parameters exceeded those of the heart DVH parameters. After predictive modeling using a bootstrap procedure, the MLD was always included in the predictive model for grade ≥3 RP, whereas the heart DVH parameters were seldom included in the model. CONCLUSION: Incidental dose to the cardiac atria and ventricles did not improve RP risk prediction in our cohort of 188 AS-NSCLC patients treated with IMRT or VMAT.
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/radioterapia
Neoplasias Pulmonares/radioterapia
Órgãos em Risco/efeitos da radiação
Pneumonite por Radiação/etiologia
Radioterapia de Intensidade Modulada/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Átrios do Coração/efeitos da radiação
Ventrículos do Coração/efeitos da radiação
Seres Humanos
Pulmão/efeitos da radiação
Masculino
Meia-Idade
Valor Preditivo dos Testes
Dose de Radiação
Radioterapia de Intensidade Modulada/métodos
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


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[PMID]:28871982
[Au] Autor:Faught AM; Miyasaka Y; Kadoya N; Castillo R; Castillo E; Vinogradskiy Y; Yamamoto T
[Ad] Endereço:Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: austin.faught@ucdenver.edu.
[Ti] Título:Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy.
[So] Source:Int J Radiat Oncol Biol Phys;99(2):325-333, 2017 Oct 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Computed tomographic (CT) ventilation imaging is a new modality that uses 4-dimensional (4D) CT information to calculate lung ventilation. Although retrospective studies have reported on the reduction in dose to functional lung, no work to our knowledge has been published in which the dosimetric improvements have been translated to a reduction in the probability of pulmonary toxicity. Our work estimates the reduction in toxicity for CT ventilation-based functional avoidance planning. METHODS AND MATERIALS: Seventy previously treated lung cancer patients who underwent 4DCT imaging were used for the study. CT ventilation maps were calculated with 4DCT deformable image registration and a density change-based algorithm. Pneumonitis was graded on the basis of imaging and clinical presentation. Maximum likelihood methods were used to generate normal tissue complication probability (NTCP) models predicting grade 2 or higher (2+) and grade 3+ pneumonitis as a function of dose (V5 Gy, V10 Gy, V20 Gy, V30 Gy, and mean dose) to functional lung. For 30 patients a functional plan was generated with the goal of reducing dose to the functional lung while meeting Radiation Therapy Oncology Group 0617 constraints. The NTCP models were applied to the functional plans and the clinically used plans to calculate toxicity reduction. RESULTS: By the use of functional avoidance planning, absolute reductions in grade 2+ NTCP of 6.3%, 7.8%, and 4.8% were achieved based on the mean fV20 Gy, fV30 Gy, and mean dose to functional lung metrics, respectively. Absolute grade 3+ NTCP reductions of 3.6%, 4.8%, and 2.4% were achieved with fV20 Gy, fV30 Gy, and mean dose to functional lung. Maximum absolute reductions of 52.3% and 16.4% were seen for grade 2+ and grade 3+ pneumonitis for individual patients. CONCLUSION: Our study quantifies the possible toxicity reduction from CT ventilation-based functional avoidance planning. Reductions in grades 2+ and 3+ pneumonitis were 7.1% and 4.7% based on mean dose-function metrics, with reductions as high as 52.3% for individual patients. Our work provides seminal data for determining the potential toxicity benefit from incorporating CT ventilation into thoracic treatment planning.
[Mh] Termos MeSH primário: Neoplasias Pulmonares/radioterapia
Pulmão/efeitos da radiação
Tratamentos com Preservação do Órgão/métodos
Pneumonite por Radiação/diagnóstico por imagem
Pneumonite por Radiação/prevenção & controle
Respiração
[Mh] Termos MeSH secundário: Algoritmos
Tomografia Computadorizada Quadridimensional/métodos
Seres Humanos
Funções Verossimilhança
Neoplasias Pulmonares/diagnóstico por imagem
Neoplasias Pulmonares/patologia
Modelos Estatísticos
Lesões por Radiação/diagnóstico por imagem
Lesões por Radiação/prevenção & controle
Planejamento da Radioterapia Assistida por Computador/métodos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


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[PMID]:28870955
[Au] Autor:Tamiya A; Tamiya M; Nakahama K; Taniguchi Y; Shiroyama T; Isa SI; Inoue T; Okishio K; Nishino K; Kumagai T; Suzuki H; Hirashima T; Imamura F; Atagi S
[Ad] Endereço:Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan atamiya@kch.hosp.go.jp.
[Ti] Título:Correlation of Radiation Pneumonitis History Before Nivolumab with Onset of Interstitial Lung Disease and Progression-free Survival of Patients with Pre-treated Advanced Non-small Cell Lung Cancer.
[So] Source:Anticancer Res;37(9):5199-5205, 2017 09.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: Nivolumab has a promising efficacy for patients with non-small-cell lung cancer (NSCLC) as second-line or later treatment, and after radiotherapy as abscopal effect. However, the effects of radiation pneumonitis history before nivolumab have not been clarified. Therefore, we retrospectively analyzed the correlation of a history of radiation pneumonitis before nivolumab with onset of interstitial lung disease (ILD) and progression-free survival (PFS) after nivolumab treatment in patients with previously treated NSCLC. PATIENTS AND METHODS: A total of 201 patients treated with nivolumab were retrospectively reviewed. We collected clinical data of patients at the time of starting nivolumab and we evaluated ILD incidence and PFS in relation to patient characteristics, including radiation pneumonitis history. RESULTS: The median age was 68 years; 135 patients were men, 157 had a smoking history, and 153 had performance status of 0 or 1. Thirty-four patients experienced radiation pneumonitis before nivolumab, and 50 patients received radiotherapy to the chest (31 patients received curative radiotherapy). The overall median PFS was 2.8 months and the overall ILD rate was 12.4%. Higher ILD incidence was observed in the group with a history of radiation pneumonitis (26.5%) compared to the group without radiation pneumonitis (9.6%). The median PFS was 3.6 and 2.3 months, respectively. On multivariate analysis, a history of radiation pneumonitis was also significantly correlated with good PFS (p=0.023). CONCLUSION: Although increasing the risk of ILD, a history of radiation pneumonitis before nivolumab also contributes to the prolongation of PFS after nivolumab.
[Mh] Termos MeSH primário: Anticorpos Monoclonais/uso terapêutico
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico
Doenças Pulmonares Intersticiais/etiologia
Neoplasias Pulmonares/tratamento farmacológico
Pneumonite por Radiação/complicações
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Carcinoma Pulmonar de Células não Pequenas/patologia
Intervalo Livre de Doença
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Análise Multivariada
Estadiamento de Neoplasias
Modelos de Riscos Proporcionais
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 31YO63LBSN (nivolumab)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


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[PMID]:28816162
[Au] Autor:Yorke ED; Jackson A; Kuo LC; Ojo A; Panchoo K; Adusumilli P; Zauderer MG; Rusch VW; Shepherd A; Rimner A
[Ad] Endereço:Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: yorkee@mskcc.org.
[Ti] Título:Heart Dosimetry is Correlated With Risk of Radiation Pneumonitis After Lung-Sparing Hemithoracic Pleural Intensity Modulated Radiation Therapy for Malignant Pleural Mesothelioma.
[So] Source:Int J Radiat Oncol Biol Phys;99(1):61-69, 2017 Sep 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To determine clinically helpful dose-volume and clinical metrics correlating with symptomatic radiation pneumonitis (RP) in malignant pleural mesothelioma (MPM) patients with 2 lungs treated with hemithoracic intensity modulated pleural radiation therapy (IMPRINT). METHODS AND MATERIALS: Treatment plans and resulting normal organ dose-volume histograms of 103 consecutive MPM patients treated with IMPRINT (February 2005 to January 2015) to the highest dose ≤50.4 Gy satisfying departmental normal tissue constraints were uniformly recalculated. Patient records provided maximum RP grade (Common Terminology Criteria for Toxicity and Adverse Event version 4.0) and clinical and demographic information. Correlations analyzed with the Cox model were grade ≥2 RP (RP2+) and grade ≥3 RP (RP3+) with clinical variables, with volumes of planning target volume (PTV) and PTV-lung overlap and with mean dose, percent volume receiving dose D (V ), highest dose encompassing % volume V, (D ), and heart, total, ipsilateral, and contralateral lung volumes. RESULTS: Twenty-seven patients had RP2+ (14 with RP3+). The median prescription dose was 46.8 Gy (39.6-50.4 Gy, 1.8 Gy/fraction). The median age was 67.6 years (range, 42-83 years). There were 79 men, 40 never-smokers, and 44 with left-sided MPM. There were no significant (P≤.05) correlations with clinical variables, prescription dose, total lung dose-volume metrics, and PTV-lung overlap volume. Dose-volume correlations for heart were RP2+ with V (35 ≤ D ≤ 47 Gy, V strongest at P=.003), RP3+ with V (31 ≤ D ≤ 45 Gy), RP2+ with D (5 ≤ V ≤ 30%), RP3+ with D (15 ≤ V ≤ 35%), and mean dose. Significant for ipsilateral lung were RP2+ with V (38 ≤ D ≤ 44 Gy), RP3+ with V , RP2+ and RP3+ with minimum dose, and for contralateral lung, RP2+ with maximum dose. Correlation of PTV with RP2+ was strong (P<.001) and also significant with RP3+. CONCLUSIONS: Heart dose correlated strongly with symptomatic RP in this large cohort of MPM patients with 2 lungs treated with IMPRINT. Planning constraints to reduce future heart doses are suggested.
[Mh] Termos MeSH primário: Coração/efeitos da radiação
Pulmão/efeitos da radiação
Mesotelioma/radioterapia
Tratamentos com Preservação do Órgão/efeitos adversos
Órgãos em Risco/efeitos da radiação
Neoplasias Pleurais/radioterapia
Pneumonite por Radiação/etiologia
Radioterapia de Intensidade Modulada/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Coração/diagnóstico por imagem
Seres Humanos
Estimativa de Kaplan-Meier
Pulmão/diagnóstico por imagem
Masculino
Mesotelioma/diagnóstico por imagem
Meia-Idade
Tratamentos com Preservação do Órgão/métodos
Órgãos em Risco/diagnóstico por imagem
Neoplasias Pleurais/diagnóstico por imagem
Modelos de Riscos Proporcionais
Pneumonite por Radiação/diagnóstico por imagem
Dosagem Radioterapêutica
Planejamento da Radioterapia Assistida por Computador/métodos
Radioterapia de Intensidade Modulada/métodos
Respiração
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE


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[PMID]:28816147
[Au] Autor:Faught AM; Yamamoto T; Castillo R; Castillo E; Zhang J; Miften M; Vinogradskiy Y
[Ad] Endereço:Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: austin.faught@ucdenver.edu.
[Ti] Título:Evaluating Which Dose-Function Metrics Are Most Critical for Functional-Guided Radiation Therapy.
[So] Source:Int J Radiat Oncol Biol Phys;99(1):202-209, 2017 Sep 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Four-dimensional (4D) computed tomography (CT) ventilation imaging is increasingly being used to calculate lung ventilation and implement functional-guided radiation therapy in clinical trials. There has been little exhaustive work evaluating which dose-function metrics should be used for treatment planning and plan evaluation. The purpose of our study was to evaluate which dose-function metrics best predict for radiation pneumonitis (RP). METHODS AND MATERIALS: Seventy lung cancer patients who underwent 4D CT imaging and pneumonitis grading were assessed. Pretreatment 4D CT scans of each patient were used to calculate ventilation images. We evaluated 3 types of dose-function metrics that combined the patient's 4D CT ventilation image and treatment planning dose distribution: (1) structure-based approaches; (2) image-based approaches using the dose-function histogram; and (3) nonlinear weighting schemes. Log-likelihood methods were used to generate normal tissue complication probability models predicting grade 3 or higher (ie, grade 3+) pneumonitis for all dose-function schemes. The area under the curve (AUC) was used to assess the predictive power of the models. All techniques were compared with normal tissue complication probability models based on traditional, total lung dose metrics. RESULTS: The most predictive models were structure-based approaches that focused on the volume of functional lung receiving ≥20 Gy (AUC, 0.70). Probabilities of grade 3+ RP of 20% and 10% correspond to V20 (percentage of volume receiving ≥20 Gy) to the functional subvolumes of 26.8% and 9.3%, respectively. Imaging-based analysis with the dose-function histogram and nonlinear weighted ventilation values yielded AUCs of 0.66 and 0.67, respectively, when we evaluated the percentage of functionality receiving ≥20 Gy. All dose-function metrics outperformed the traditional dose metrics (mean lung dose, AUC of 0.55). CONCLUSIONS: A full range of dose-function metrics and functional thresholds was examined. The calculated AUC values for the most predictive functional models occupied a narrow range (0.66-0.70), and all showed notable improvements over AUC from traditional lung dose metrics (0.55). Identifying the combinations most predictive of grade 3+ RP provides valuable data to inform the functional-guided radiation therapy process.
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/radioterapia
Tomografia Computadorizada Quadridimensional
Neoplasias Pulmonares/radioterapia
Pulmão/efeitos da radiação
Órgãos em Risco/efeitos da radiação
Pneumonite por Radiação/etiologia
Respiração
[Mh] Termos MeSH secundário: Algoritmos
Área Sob a Curva
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem
Carcinoma Pulmonar de Células não Pequenas/patologia
Carcinoma Pulmonar de Células não Pequenas/fisiopatologia
Relação Dose-Resposta à Radiação
Seres Humanos
Pulmão/diagnóstico por imagem
Pulmão/fisiopatologia
Neoplasias Pulmonares/diagnóstico por imagem
Neoplasias Pulmonares/patologia
Neoplasias Pulmonares/fisiopatologia
Órgãos em Risco/diagnóstico por imagem
Órgãos em Risco/fisiopatologia
Probabilidade
Dose de Radiação
Pneumonite por Radiação/diagnóstico por imagem
Pneumonite por Radiação/fisiopatologia
Planejamento da Radioterapia Assistida por Computador
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE


  8 / 1134 MEDLINE  
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[PMID]:28739765
[Au] Autor:Wang Y; Xu G; Wang J; Li XH; Sun P; Zhang W; Li JX; Wu CY
[Ad] Endereço:Department of Radiation Oncology, Affiliated People's Hospital, Jiangsu University, Zhenjiang, P.R. China.
[Ti] Título:Relationship of Th17/Treg Cells and Radiation Pneumonia in Locally Advanced Esophageal Carcinoma.
[So] Source:Anticancer Res;37(8):4643-4647, 2017 08.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: Radiation pneumonia is a main side-effect that has limited the clinical usage of radiotherapy in locally advanced esophageal carcinoma. T helper cells 17 (Th 17) and T regulatory cells (Tregs) play an important role in inflammatory diseases. The balance between Treg and Th17 cells is a key factor in the progression of many inflammatory and autoimmune diseases. Whether Tregs and Th17 cells are predictive factors of radiation pneumonia has not yet been reported. In this study, we investigated the relationships of Treg/Th17 cells and radiation pneumonia in patients with locally advanced esophageal cancer who received radiotherapy. PATIENTS AND METHODS: One hundred and forty-eight patients with locally advanced esophageal cancer who received radical and palliative radiotherapy were enrolled. The levels of Th17 and Treg cells in the blood of patients were detected using flow cytometry at the time point of pre-radiotherapy, 1st, 2nd, 3rd, 4th, 5th and 6th week from the start of radiation and 4 weeks after completion of radiotherapy. Radiation pneumonia was evaluated according to Radiation Therapy Oncology Group's acute radiation pneumonia standards, with the endpoint being grade 2 or above radiation pneumonia. RESULTS: There were 24 cases of radiation pneumonia in 148 cases of locally advanced esophageal cancer patients who underwent radiotherapy. Th17 cells increased and, in contrast, Treg cells decreased in the radiation pneumonia group. The change in the ratio of Th17/Treg was more pronounced and the difference was statistically significant from the 5th week after irradiation compared to patients with no radiation pneumonia (p<0.05). There was no significant difference in dosimetric parameters, including V5, V20, V30 and mean lung dose (MLD) and clinical factors, such as gender, age, smoking history, history of surgery and chemotherapy. CONCLUSION: The ratio of Th17/Treg cells may be an effective predictive factor of radiation pneumonia.
[Mh] Termos MeSH primário: Neoplasias Esofágicas/complicações
Neoplasias Esofágicas/imunologia
Pneumonite por Radiação/etiologia
Linfócitos T Reguladores/imunologia
Células Th17/imunologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Neoplasias Esofágicas/diagnóstico
Neoplasias Esofágicas/radioterapia
Feminino
Seguimentos
Seres Humanos
Imunofenotipagem
Incidência
Contagem de Linfócitos
Masculino
Meia-Idade
Estadiamento de Neoplasias
Fenótipo
Pneumonite por Radiação/diagnóstico
Pneumonite por Radiação/epidemiologia
Fatores de Risco
Linfócitos T Reguladores/metabolismo
Células Th17/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:28678434
[Au] Autor:Rwigema JM; Verma V; Lin L; Berman AT; Levin WP; Evans TL; Aggarwal C; Rengan R; Langer C; Cohen RB; Simone CB
[Ad] Endereço:Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
[Ti] Título:Prospective study of proton-beam radiation therapy for limited-stage small cell lung cancer.
[So] Source:Cancer;123(21):4244-4251, 2017 Nov 01.
[Is] ISSN:1097-0142
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Existing data supporting the use of proton-beam therapy (PBT) for limited-stage small cell lung cancer (LS-SCLC) are limited to a single 6-patient case series. This is the first prospective study to evaluate clinical outcomes and toxicities of PBT for LS-SCLC. METHODS: This study prospectively analyzed patients with primary, nonrecurrent LS-SCLC definitively treated with PBT and concurrent chemotherapy from 2011 to 2016. Clinical backup intensity-modulated radiotherapy (IMRT) plans were generated for each patient and were compared with PBT plans. Outcome measures included local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates and toxicities. RESULTS: Thirty consecutive patients were enrolled and evaluated. The median dose was 63.9 cobalt gray equivalents (range, 45-66.6 cobalt gray equivalents) in 33 to 37 fractions delivered daily (n = 18 [60.0%]) or twice daily (n = 12 [40.0%]). The concurrent chemotherapy was cisplatin/etoposide (n = 21 [70.0%]) or carboplatin/etoposide (n = 9 [30.0%]). In comparison with the backup IMRT plans, PBT allowed statistically significant reductions in the cord, heart, and lung mean doses and the volume receiving at least 5 Gy but not in the esophagus mean dose or the lung volume receiving at least 20 Gy. At a median follow-up of 14 months, the 1-/2-year LC and RFS rates were 85%/69% and 63%/42%, respectively. The median OS was 28.2 months, and the 1-/2-year OS rates were 72%/58%. There was 1 case each (3.3%) of grade 3 or higher esophagitis, pneumonitis, anorexia, and pericardial effusion. Grade 2 pneumonitis and esophagitis were seen in 10.0% and 43.3% of patients, respectively. CONCLUSIONS: In the first prospective registry study and largest analysis to date of PBT for LS-SCLC, PBT was found to be safe with a limited incidence of high-grade toxicities. Cancer 2017;123:4244-4251. © 2017 American Cancer Society.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias Pulmonares/tratamento farmacológico
Neoplasias Pulmonares/radioterapia
Terapia com Prótons/métodos
Radioterapia de Intensidade Modulada/métodos
Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico
Carcinoma de Pequenas Células do Pulmão/radioterapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Carboplatina/administração & dosagem
Cisplatino/administração & dosagem
Fracionamento de Dose
Esofagite/epidemiologia
Esofagite/etiologia
Esôfago/efeitos da radiação
Etoposídeo/administração & dosagem
Feminino
Coração/efeitos da radiação
Seres Humanos
Pulmão/efeitos da radiação
Neoplasias Pulmonares/mortalidade
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Órgãos em Risco/efeitos da radiação
Estudos Prospectivos
Terapia com Prótons/efeitos adversos
Pneumonite por Radiação/epidemiologia
Planejamento da Radioterapia Assistida por Computador/métodos
Radioterapia de Intensidade Modulada/efeitos adversos
Carcinoma de Pequenas Células do Pulmão/mortalidade
Carcinoma de Pequenas Células do Pulmão/patologia
Medula Espinal/efeitos da radiação
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
6PLQ3CP4P3 (Etoposide); BG3F62OND5 (Carboplatin); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170706
[St] Status:MEDLINE
[do] DOI:10.1002/cncr.30870


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[PMID]:28642008
[Au] Autor:Faivre-Finn C; Snee M; Ashcroft L; Appel W; Barlesi F; Bhatnagar A; Bezjak A; Cardenal F; Fournel P; Harden S; Le Pechoux C; McMenemin R; Mohammed N; O'Brien M; Pantarotto J; Surmont V; Van Meerbeeck JP; Woll PJ; Lorigan P; Blackhall F; CONVERT Study Team
[Ad] Endereço:Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK. Electronic address: corinne.finn@christie
[Ti] Título:Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial.
[So] Source:Lancet Oncol;18(8):1116-1125, 2017 Aug.
[Is] ISSN:1474-5488
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Concurrent chemoradiotherapy is the standard of care in limited-stage small-cell lung cancer, but the optimal radiotherapy schedule and dose remains controversial. The aim of this study was to establish a standard chemoradiotherapy treatment regimen in limited-stage small-cell lung cancer. METHODS: The CONVERT trial was an open-label, phase 3, randomised superiority trial. We enrolled adult patients (aged ≥18 years) who had cytologically or histologically confirmed limited-stage small-cell lung cancer, Eastern Cooperative Oncology Group performance status of 0-2, and adequate pulmonary function. Patients were recruited from 73 centres in eight countries. Patients were randomly assigned to receive either 45 Gy radiotherapy in 30 twice-daily fractions of 1·5 Gy over 19 days, or 66 Gy in 33 once-daily fractions of 2 Gy over 45 days, starting on day 22 after commencing cisplatin-etoposide chemotherapy (given as four to six cycles every 3 weeks in both groups). The allocation method used was minimisation with a random element, stratified by institution, planned number of chemotherapy cycles, and performance status. Treatment group assignments were not masked. The primary endpoint was overall survival, defined as time from randomisation until death from any cause, analysed by modified intention-to-treat. A 12% higher overall survival at 2 years in the once-daily group versus the twice-daily group was considered to be clinically significant to show superiority of the once-daily regimen. The study is registered with ClinicalTrials.gov (NCT00433563) and is currently in follow-up. FINDINGS: Between April 7, 2008, and Nov 29, 2013, 547 patients were enrolled and randomly assigned to receive twice-daily concurrent chemoradiotherapy (274 patients) or once-daily concurrent chemoradiotherapy (273 patients). Four patients (one in the twice-daily group and three in the once-daily group) did not return their case report forms and were lost to follow-up; these patients were not included in our analyses. At a median follow-up of 45 months (IQR 35-58), median overall survival was 30 months (95% CI 24-34) in the twice-daily group versus 25 months (21-31) in the once-daily group (hazard ratio for death in the once daily group 1·18 [95% CI 0·95-1·45]; p=0·14). 2-year overall survival was 56% (95% CI 50-62) in the twice-daily group and 51% (45-57) in the once-daily group (absolute difference between the treatment groups 5·3% [95% CI -3·2% to 13·7%]). The most common grade 3-4 adverse event in patients evaluated for chemotherapy toxicity was neutropenia (197 [74%] of 266 patients in the twice-daily group vs 170 [65%] of 263 in the once-daily group). Most toxicities were similar between the groups, except there was significantly more grade 4 neutropenia with twice-daily radiotherapy (129 [49%] vs 101 [38%]; p=0·05). In patients assessed for radiotherapy toxicity, was no difference in grade 3-4 oesophagitis between the groups (47 [19%] of 254 patients in the twice-daily group vs 47 [19%] of 246 in the once-daily group; p=0·85) and grade 3-4 radiation pneumonitis (4 [3%] of 254 vs 4 [2%] of 246; p=0·70). 11 patients died from treatment-related causes (three in the twice-daily group and eight in the once-daily group). INTERPRETATION: Survival outcomes did not differ between twice-daily and once-daily concurrent chemoradiotherapy in patients with limited-stage small-cell lung cancer, and toxicity was similar and lower than expected with both regimens. Since the trial was designed to show superiority of once-daily radiotherapy and was not powered to show equivalence, the implication is that twice-daily radiotherapy should continue to be considered the standard of care in this setting. FUNDING: Cancer Research UK (Clinical Trials Awards and Advisory Committee), French Ministry of Health, Canadian Cancer Society Research Institute, European Organisation for Research and Treatment of Cancer (Cancer Research Fund, Lung Cancer, and Radiation Oncology Groups).
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias Pulmonares/terapia
Carcinoma de Pequenas Células do Pulmão/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Quimiorradioterapia/efeitos adversos
Quimiorradioterapia/métodos
Cisplatino/administração & dosagem
Fracionamento de Dose
Esofagite/etiologia
Etoposídeo/administração & dosagem
Feminino
Seguimentos
Seres Humanos
Análise de Intenção de Tratamento
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Estadiamento de Neoplasias
Neutropenia/etiologia
Pneumonite por Radiação/etiologia
Carcinoma de Pequenas Células do Pulmão/patologia
Taxa de Sobrevida
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
6PLQ3CP4P3 (Etoposide); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170624
[St] Status:MEDLINE



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