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[PMID]:29222650
[Au] Autor:Lowe NM; Bernstein JM; Mais K; Garcez K; Lee LW; Sykes A; Thomson DJ; Homer JJ; West CM; Slevin NJ
[Ad] Endereço:Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester, England, M20 4BX, UK. nataliemarielowe@gmail.com.
[Ti] Título:Taxane, platinum and 5-FU prior to chemoradiotherapy benefits patients with stage IV neck node-positive head and neck cancer and a good performance status.
[So] Source:J Cancer Res Clin Oncol;144(2):389-401, 2018 Feb.
[Is] ISSN:1432-1335
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The benefit of adding docetaxel, cisplatin and 5-fluorouracil (TPF) induction chemotherapy to chemoradiotherapy (CRT) in head and neck squamous cell carcinoma (HNSCC) remains uncertain. We aimed to investigate whether ICT is well tolerated when given with prophylactic treatment against predicted adverse effects and which patients benefit most. METHODS: A single-centre audit identified 132 HNSCC patients with stage IVa/b neck node-positive disease, prescribed TPF followed by CRT. TPF involved three cycles of docetaxel (75 mg/m IV) and cisplatin (75 mg/m IV) on day 1 plus 5-FU (750 mg/m IV) on days 2-5. Planned CRT was 66 Gy in 30 fractions of intensity-modulated radiotherapy with concurrent cisplatin (100 mg/m IV) at the beginning of week 1 and 4 (days 1 and 22). All patients received prophylactic antibiotics and granulocyte colony-stimulating factor. RESULTS: Median follow-up was 39.5 months. 92.4% of patients completed three cycles of TPF; 95.5% of patients started chemoradiotherapy. Grade 3/4 adverse events were low (febrile neutropenia 3.0%), with no toxicity-related deaths. 3-year overall survival was 67.2%; disease-specific survival was 78.7%; locoregional control was 78.3%. Distant metastases rate was 9.8% (3.0% in those without locoregional recurrence). Good performance status (p = 0.002) and poor tumour differentiation (p = 0.018) were associated with improved overall survival on multivariate analysis. CONCLUSION: With prophylactic antibiotics and granulocyte colony-stimulating factor TPF was well tolerated with good survival outcomes. TPF should remain a treatment option for stage IV neck node-positive patients with a good performance status. The use of tumour grade to aid patient selection for TPF warrants investigation.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Carcinoma de Células Escamosas/tratamento farmacológico
Carcinoma de Células Escamosas/radioterapia
Neoplasias de Cabeça e Pescoço/tratamento farmacológico
Neoplasias de Cabeça e Pescoço/radioterapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Carcinoma de Células Escamosas/patologia
Quimiorradioterapia
Cisplatino/administração & dosagem
Cisplatino/efeitos adversos
Esquema de Medicação
Feminino
Fluoruracila/administração & dosagem
Fluoruracila/efeitos adversos
Neoplasias de Cabeça e Pescoço/patologia
Seres Humanos
Quimioterapia de Indução
Metástase Linfática
Masculino
Meia-Idade
Estadiamento de Neoplasias
Estudos Retrospectivos
Taxoides/administração & dosagem
Taxoides/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Taxoids); 15H5577CQD (docetaxel); Q20Q21Q62J (Cisplatin); U3P01618RT (Fluorouracil)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171210
[St] Status:MEDLINE
[do] DOI:10.1007/s00432-017-2553-9


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[PMID]:29429177
[Au] Autor:Jiang L; Lou JL; Wang KJ; Fang MY; Fu ZF
[Ad] Endereço:Department of Head and Neck Surgery.
[Ti] Título:[Planned neck dissection in the treatment of locally advanced head and neck squamous cell carcinoma].
[So] Source:Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi;53(2):92-96, 2018 Feb 07.
[Is] ISSN:1673-0860
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the value of planned neck dissection combined with induction chemotherapy and concurrent chemoradiotherapy in regional control and the outcome of locally advanced head and neck squamous cell carcinoma. A prospective randomized controlled study totally enrolled sixty-four patients of head and neck squamous cell carcinomas(include oropharynx, hypopharynx, and larynx) in stages â…£a-â…£b with lymph node metastase was were N2-N3. All patients firstly received 2-3 cycles of induction chemotherapy(ICT), then divided into two groups randomly, according to the efficacy of ICT. Group A(the study group) received planned neck dissection(PND) and concurrent chemoradiotherapy(CCRT). Group B(the control group) received concurrent chemoradiotherapy(CCRT). The differences in clinicopathologic features, local recurrence(LR), regional recurrence(RR), disease-free survival(DFS), and overall survival(OS) between the two groups were estimated. SPSS 19.0 software was used to analyze the data. Group A enrolled twenty-one patients, and group B enrolled forty-three patients.The follow-up of all patients were 4-55 months, median follow-up time was 22 months. In study group, two-year OS and DFS were 80.9% and 68.3%, respectively. In control group, two-year OS and DFS were 90.7% and 67.1%, respectively. There was no significant difference in gender( =0.215), age( =0.828), primary tumor site( =0.927), LR( =0.126), DFS( =0.710), and OS( =0.402) between the two groups, while the RR(χ(2)=5.640, <0.05) and distant metastasis(χ(2)=10.363, <0.01) showed significant differences between the two groups. The ICT+ PND+ CCRT treatment model has benefit on regional control of locally advanced head and neck squamous cell carcinoma.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/terapia
Quimiorradioterapia/métodos
Neoplasias de Cabeça e Pescoço/terapia
Esvaziamento Cervical/métodos
[Mh] Termos MeSH secundário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Carcinoma de Células Escamosas/patologia
Carcinoma de Células Escamosas/cirurgia
Terapia Combinada
Intervalo Livre de Doença
Neoplasias de Cabeça e Pescoço/patologia
Neoplasias de Cabeça e Pescoço/cirurgia
Seres Humanos
Quimioterapia de Indução/métodos
Linfonodos
Metástase Linfática
Recidiva Local de Neoplasia
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180213
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1673-0860.2018.02.003


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[PMID]:28453815
[Au] Autor:Xi M; Zhang P; Zhang L; Yang YD; Liu SL; Li Y; Fu JH; Liu MZ
[Ad] Endereço:State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou.
[Ti] Título:Comparing docetaxel plus cisplatin versus fluorouracil plus cisplatin in esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy.
[So] Source:Jpn J Clin Oncol;47(8):683-689, 2017 Aug 01.
[Is] ISSN:1465-3621
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: The optimal neoadjuvant chemoradiotherapy (CRT) regimen in esophageal cancer has not yet been defined. This study was aimed to compare the differences in pathologic response and survival between docetaxel/cisplatin and fluorouracil/cisplatin as neoadjuvant CRT in locally advanced esophageal squamous cell carcinoma (SCC). Methods: We retrospectively analyzed patients with thoracic esophageal SCC who received neoadjuvant CRT followed by esophagectomy from 2000 to 2014. After adjusting for sex, age, performance status, tumor length, tumor location and clinical TNM stage, 32 docetaxel/cisplatin-treated patients were matched to 62 patients who received fluorouracil/cisplatin at a ratio of 1:2. Treatment toxicity, pathologic complete response (pCR) and survival outcomes were compared between groups. Results: Baseline characteristics were well balanced between groups. The pCR rate in the docetaxel/cisplatin group was higher than that in the fluorouracil/cisplatin group but without significant difference (40.6% vs. 30.6%, P = 0.333). The 3-year overall survival rate in the docetaxel/cisplatin group was 64.9% versus 46.0% in the fluorouracil/cisplatin group (P = 0.039). There were no significant differences in incidence of treatment toxicity during CRT or surgical complications between groups, with the exception of Grade 3-4 hematologic toxicity (37.5% vs. 17.7%, P = 0.035), which was more frequent in the docetaxel/cisplatin group. Conclusions: Docetaxel/cisplatin might be associated with more favorable survival than fluorouracil/cisplatin in esophageal SCC treated with neoadjuvant CRT. Prospective validation is warranted.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Carcinoma de Células Escamosas/tratamento farmacológico
Quimiorradioterapia/métodos
Cisplatino/uso terapêutico
Neoplasias Esofágicas/tratamento farmacológico
Fluoruracila/uso terapêutico
Terapia Neoadjuvante/métodos
Taxoides/uso terapêutico
[Mh] Termos MeSH secundário: Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia
Carcinoma de Células Escamosas/mortalidade
Carcinoma de Células Escamosas/patologia
Cisplatino/administração & dosagem
Cisplatino/farmacologia
Neoplasias Esofágicas/mortalidade
Neoplasias Esofágicas/patologia
Feminino
Fluoruracila/administração & dosagem
Fluoruracila/farmacologia
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Taxa de Sobrevida
Taxoides/administração & dosagem
Taxoides/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Taxoids); 15H5577CQD (docetaxel); Q20Q21Q62J (Cisplatin); U3P01618RT (Fluorouracil)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/jjco/hyx060


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[PMID]:28453703
[Au] Autor:Guberina M; Eberhardt W; Stuschke M; Gauler T; Heinzelmann F; Cheufou D; Kimmich M; Friedel G; Schmidberger H; Darwiche K; Jendrossek V; Schuler M; Stamatis G; Pöttgen C
[Ad] Endereço:Department of Radiotherapy, University of Duisburg-Essen, University Hospital Essen, Essen.
[Ti] Título:Heart dose exposure as prognostic marker after radiotherapy for resectable stage IIIA/B non-small-cell lung cancer: secondary analysis of a randomized trial.
[So] Source:Ann Oncol;28(5):1084-1089, 2017 05 01.
[Is] ISSN:1569-8041
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: Heart exposure to ionizing irradiation can cause ischaemic heart disease. The partial heart volume receiving ≥5 Gy (heartV5) was supposed to be an independent prognostic factor for survival after radiochemotherapy for locally advanced non-small-cell lung cancer (NSCLC). But validation of the latter hypothesis is needed under the concurrent risks of lung cancer patients. Patients and methods: The ESPATUE phase III trial recruited patients with potentially operable IIIA(N2)/selected IIIB NSCLC between 01/2004 and 01/2013. Cisplatin/paclitaxel induction chemotherapy was given followed by neoadjuvant radiochemotherapy (RT/CT) to 45 Gy (1.5 Gy bid/concurrent cisplatin/vinorelbine). Operable patients were randomized to definitive RT/CT(arm A) or surgery (arm B) and therefore were treated at two different total dose levels of radiotherapy. HeartV5 and mean heart dose (MHD) were obtained from the 3D radiotherapy plans, the prognostic value was analysed using multivariable proportional hazard analysis. Results: A total of 161 patients were randomized in ESPATUE, heartV5 and MHD were obtained from the 3D radiotherapy plans for 155 of these [male/female:105/50, median age 58 (33-74) years, stage IIIA/IIIB: 54/101]. Power analysis revealed a power of 80% of this dataset to detect a prognostic value of heartV5 of the size found in RTOG 0617. Multivariable analysis did not identify heartV5 as an independent prognostic factor for survival adjusting for tumour and clinical characteristics with [hazard ratio 1.005 (0.995-1.015), P = 0.30] or without lower lobe tumour location [hazard ratio 0.999 (0.986-1.012), P = 0.83]. There was no influence of heartV5 on death without tumour progression. Tumour progression, and pneumonia were the leading causes of death representing 65% and 14% of the observed deaths. Conclusions: HeartV5 could not be validated as an independent prognostic factor for survival after neoadjuvant or definitive conformal radiochemotherapy. Tumour progression was the predominant cause of death. Register No: Z5 - 22461/2 - 2002-017 (German Federal Office for Radiation Protection).
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/terapia
Neoplasias Pulmonares/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Carcinoma Pulmonar de Células não Pequenas/mortalidade
Carcinoma Pulmonar de Células não Pequenas/patologia
Quimiorradioterapia/efeitos adversos
Relação Dose-Resposta à Radiação
Feminino
Coração/efeitos da radiação
Seres Humanos
Neoplasias Pulmonares/mortalidade
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Miocárdio/patologia
Estadiamento de Neoplasias
Prognóstico
Modelos de Riscos Proporcionais
Lesões por Radiação/diagnóstico
Lesões por Radiação/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/annonc/mdx069


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[PMID]:29480952
[Au] Autor:Loveday BPT; Knox JJ; Dawson LA; Metser U; Brade A; Horgan AM; Gallinger S; Greig PD; Moulton CA
[Ad] Endereço:Department of Surgery, Toronto General Hospital, Ontario, Canada.
[Ti] Título:Neoadjuvant hyperfractionated chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma in Canada.
[So] Source:J Surg Oncol;117(2):213-219, 2018 Feb.
[Is] ISSN:1096-9098
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Neoadjuvant chemoradiation and liver transplantation may be offered for unresectable perihilar cholangiocarcinoma (pCCA). This study aimed to determine the dropout rate and survival of patients who entered a national tri-modality protocol. METHOD: Patients enrolled Jan 2009-Aug 2015 were included. Enrolment criteria: ≤65 years, brush biopsy-proven unresectable pCCA <3.5 cm diameter. Conformal radiotherapy was given concurrently with Capecitabine. Following surgical staging, patients received maintenance Cisplatin and Gemcitabine until transplant or progression. Time to event analyses were performed from start of neoadjuvant therapy. RESULTS: Of 43 patients screened, 18 started treatment; median age 53.9 (26.7-62.8) years, tumour diameter 2.7 (2.0-3.4) cm. 11/18 dropped out due to metastatic disease identified during chemoradiation (n = 2), surgical staging (n = 6), or maintenance chemotherapy (n = 3). Six patients underwent transplantation. Median follow up was 17.6 (4.9-57.7) months and overall survival 16.4 months. One and two year survival was 70.6% and 35.3%, respectively. One and 2 year post transplant survival was 83.3% and 55.6%. Median progression free survival was 11.5 months. CONCLUSION: Neoadjuvant chemoradiation and liver transplantation for unresectable early stage pCCA is feasible, although with high rates of dropout and disease progression. Further research is required to determine factors to help select patients for treatment.
[Mh] Termos MeSH primário: Neoplasias dos Ductos Biliares/terapia
Quimiorradioterapia
Tumor de Klatskin/terapia
Transplante de Fígado
Terapia Neoadjuvante
[Mh] Termos MeSH secundário: Adulto
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias dos Ductos Biliares/patologia
Cisplatino/administração & dosagem
Terapia Combinada
Desoxicitidina/administração & dosagem
Desoxicitidina/análogos & derivados
Feminino
Seguimentos
Seres Humanos
Tumor de Klatskin/patologia
Masculino
Meia-Idade
Prognóstico
Estudos Prospectivos
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0W860991D6 (Deoxycytidine); B76N6SBZ8R (gemcitabine); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1002/jso.24833


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[PMID]:29268274
[Au] Autor:Saito G; Sadahiro S; Ogimi T; Miyakita H; Okada K; Tanaka A; Suzuki T
[Ad] Endereço:Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan.
[Ti] Título:Relations of Changes in Serum Carcinoembryonic Antigen Levels before and after Neoadjuvant Chemoradiotherapy and after Surgery to Histologic Response and Outcomes in Patients with Locally Advanced Rectal Cancer.
[So] Source:Oncology;94(3):167-175, 2018.
[Is] ISSN:1423-0232
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The histologic response to neoadjuvant chemoradiotherapy (nCRT) has been intimately related to outcomes in locally advanced rectal cancer. Serum carcinoembryonic antigen (CEA) levels change after nCRT and after surgery as compared with before nCRT. METHODS: The subjects were 149 patients with locally advanced rectal cancer who received nCRT between 2005 and 2013. The patients were divided into 4 groups according to the serum CEA levels: group 1, 55 patients with negative serum CEA levels before nCRT; group 2, 41 patients with positive serum CEA levels before nCRT that became negative after nCRT; group 3, 37 patients with positive serum CEA levels after nCRT that became negative after surgery; and group 4, 16 patients with positive serum CEA levels after nCRT as well as after surgery. RESULTS: Pathological complete response, T downstaging, and tumor shrinkage were significantly higher in group 1 than in other groups. Disease-free survival was significantly poorer in group 4. The lack of a decrease in the serum CEA level in group 4 was most likely attributed to the persistence of micrometastases outside the resection field. CONCLUSIONS: Changes in serum CEA levels measured before nCRT, after nCRT, and after surgery can be used to reliably predict the histologic response to nCRT and outcomes.
[Mh] Termos MeSH primário: Antígeno Carcinoembrionário/sangue
Neoplasias Retais/sangue
Neoplasias Retais/patologia
[Mh] Termos MeSH secundário: Adenocarcinoma/sangue
Adenocarcinoma/patologia
Adenocarcinoma/cirurgia
Adenocarcinoma/terapia
Adulto
Idoso
Idoso de 80 Anos ou mais
Biomarcadores Tumorais/sangue
Quimiorradioterapia/métodos
Intervalo Livre de Doença
Feminino
Seres Humanos
Masculino
Meia-Idade
Terapia Neoadjuvante/métodos
Neoplasias Retais/cirurgia
Neoplasias Retais/terapia
Reto/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers, Tumor); 0 (Carcinoembryonic Antigen)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1159/000485511


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[PMID]:29275831
[Au] Autor:Troussier I; Klausner G; Morinière S; Blais E; Jean-Christophe Faivre; Champion A; Geoffrois L; Pflumio C; Babin E; Maingon P; Thariat J
[Ad] Endereço:CHRU Pitié-Salpêtrière, radiothérapie, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
[Ti] Título:[Advances in the management of cervical lymphadenopathies of unknown primary: advances in diagnostic imaging and surgical modalities and new international staging system].
[Ti] Título:Évolutions dans la prise en charge des métastases ganglionnaires cervicales sans cancer primitif retrouvé : avancées diagnostiques et nouvelle classification TNM..
[So] Source:Bull Cancer;105(2):181-192, 2018 Feb.
[Is] ISSN:1769-6917
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:INTRODUCTION: Cervical lymphadenopathies of unknown primary represent 3 % of head and neck cancers. Their diagnostic work up has largely changed in recent years. This review provides an update on diagnostic developments and their potential therapeutic impact. MATERIALS AND METHODS: This is a systematic review of the literature. RESULTS: In recent years, changes in epidemiology-based prognostic factors such as human papilloma virus (HPV) cancers, advances in imaging and minimally invasive surgery have been integrated in the management of cervical lymphadenopathies of unknown primary. In particular, systematic use of PET scanner and increasing practice of robotic or laser surgery have contributed to increasing detection rate of primary cancers. These allow more adapted and personalized treatments. The impact of changes in the eighth TNM staging system is discussed. CONCLUSION: The management of cervical lymphadenopathies of unknown primary cancer has changed significantly in the last 10 years. On the other hand, practice changes will have to be assessed.
[Mh] Termos MeSH primário: Carcinoma/diagnóstico por imagem
Carcinoma/terapia
Metástase Linfática/diagnóstico por imagem
Neoplasias Primárias Desconhecidas/diagnóstico por imagem
Neoplasias Primárias Desconhecidas/terapia
[Mh] Termos MeSH secundário: Antineoplásicos/uso terapêutico
Biópsia por Agulha Fina
Carcinoma/secundário
Carcinoma de Células Escamosas/diagnóstico
Carcinoma de Células Escamosas/patologia
Carcinoma de Células Escamosas/terapia
Carcinoma de Células Escamosas/virologia
Quimiorradioterapia
Terapia Combinada/métodos
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem
Neoplasias de Cabeça e Pescoço/patologia
Neoplasias de Cabeça e Pescoço/terapia
Neoplasias de Cabeça e Pescoço/virologia
Seres Humanos
Metástase Linfática/patologia
Pescoço
Estadiamento de Neoplasias/métodos
Neoplasias Primárias Desconhecidas/patologia
Papillomaviridae/isolamento & purificação
Tonsilectomia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE


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[PMID]:29260225
[Au] Autor:Stupp R; Taillibert S; Kanner A; Read W; Steinberg DM; Lhermitte B; Toms S; Idbaih A; Ahluwalia MS; Fink K; Di Meco F; Lieberman F; Zhu JJ; Stragliotto G; Tran DD; Brem S; Hottinger AF; Kirson ED; Lavy-Shahaf G; Weinberg U; Kim CY; Paek SH; Nicholas G; Burna J; Hirte H; Weller M; Palti Y; Hegi ME; Ram Z
[Ad] Endereço:Lou and Jean MalnatiBrain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Título:Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With Glioblastoma: A Randomized Clinical Trial.
[So] Source:JAMA;318(23):2306-2316, 2017 12 19.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Tumor-treating fields (TTFields) is an antimitotic treatment modality that interferes with glioblastoma cell division and organelle assembly by delivering low-intensity alternating electric fields to the tumor. Objective: To investigate whether TTFields improves progression-free and overall survival of patients with glioblastoma, a fatal disease that commonly recurs at the initial tumor site or in the central nervous system. Design, Setting, and Participants: In this randomized, open-label trial, 695 patients with glioblastoma whose tumor was resected or biopsied and had completed concomitant radiochemotherapy (median time from diagnosis to randomization, 3.8 months) were enrolled at 83 centers (July 2009-2014) and followed up through December 2016. A preliminary report from this trial was published in 2015; this report describes the final analysis. Interventions: Patients were randomized 2:1 to TTFields plus maintenance temozolomide chemotherapy (n = 466) or temozolomide alone (n = 229). The TTFields, consisting of low-intensity, 200 kHz frequency, alternating electric fields, was delivered (≥ 18 hours/d) via 4 transducer arrays on the shaved scalp and connected to a portable device. Temozolomide was administered to both groups (150-200 mg/m2) for 5 days per 28-day cycle (6-12 cycles). Main Outcomes and Measures: Progression-free survival (tested at α = .046). The secondary end point was overall survival (tested hierarchically at α = .048). Analyses were performed for the intent-to-treat population. Adverse events were compared by group. Results: Of the 695 randomized patients (median age, 56 years; IQR, 48-63; 473 men [68%]), 637 (92%) completed the trial. Median progression-free survival from randomization was 6.7 months in the TTFields-temozolomide group and 4.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.52-0.76; P < .001). Median overall survival was 20.9 months in the TTFields-temozolomide group vs 16.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.53-0.76; P < .001). Systemic adverse event frequency was 48% in the TTFields-temozolomide group and 44% in the temozolomide-alone group. Mild to moderate skin toxicity underneath the transducer arrays occurred in 52% of patients who received TTFields-temozolomide vs no patients who received temozolomide alone. Conclusions and Relevance: In the final analysis of this randomized clinical trial of patients with glioblastoma who had received standard radiochemotherapy, the addition of TTFields to maintenance temozolomide chemotherapy vs maintenance temozolomide alone, resulted in statistically significant improvement in progression-free survival and overall survival. These results are consistent with the previous interim analysis. Trial Registration: clinicaltrials.gov Identifier: NCT00916409.
[Mh] Termos MeSH primário: Antineoplásicos Alquilantes/uso terapêutico
Dacarbazina/análogos & derivados
Terapia por Estimulação Elétrica
Glioblastoma/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Antineoplásicos Alquilantes/efeitos adversos
Quimiorradioterapia
Dacarbazina/efeitos adversos
Dacarbazina/uso terapêutico
Intervalo Livre de Doença
Feminino
Seguimentos
Glioblastoma/radioterapia
Glioblastoma/cirurgia
Seres Humanos
Quimioterapia de Manutenção
Masculino
Meia-Idade
Mitose
Análise de Sobrevida
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antineoplastic Agents, Alkylating); 7GR28W0FJI (Dacarbazine); YF1K15M17Y (temozolomide)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.18718


  9 / 7380 MEDLINE  
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[PMID]:28463161
[Au] Autor:Basch E; Pugh SL; Dueck AC; Mitchell SA; Berk L; Fogh S; Rogak LJ; Gatewood M; Reeve BB; Mendoza TR; O'Mara AM; Denicoff AM; Minasian LM; Bennett AV; Setser A; Schrag D; Roof K; Moore JK; Gergel T; Stephans K; Rimner A; DeNittis A; Bruner DW
[Ad] Endereço:Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Electronic address: ebasch@med.unc.edu.
[Ti] Título:Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial.
[So] Source:Int J Radiat Oncol Biol Phys;98(2):409-418, 2017 06 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). METHODS AND MATERIALS: Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. RESULTS: Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling "too sick." CONCLUSIONS: Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between visits, and by using central compliance monitoring. These approaches are being incorporated into ongoing studies.
[Mh] Termos MeSH primário: Quimiorradioterapia/efeitos adversos
Esofagite/complicações
Neoplasias Pulmonares/terapia
Microcomputadores/estatística & dados numéricos
Dor/prevenção & controle
Cooperação do Paciente/estatística & dados numéricos
Medidas de Resultados Relatados pelo Paciente
Autorrelato/utilização
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Apiterapia/métodos
Transtornos de Deglutição/etiologia
Transtornos de Deglutição/terapia
Estudos de Viabilidade
Feminino
Mel
Seres Humanos
Internet
Masculino
Meia-Idade
National Cancer Institute (U.S.)
Avaliação de Sintomas/estatística & dados numéricos
Fatores de Tempo
Estados Unidos
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28463160
[Au] Autor:Olsen JR; Moughan J; Myerson R; Abitbol A; Doncals DE; Johnson D; Schefter TE; Chen Y; Fisher B; Michalski J; Narayan S; Chang A; Crane CH; Kachnic L
[Ad] Endereço:University of Colorado Denver, Aurora, Colorado. Electronic address: Jeffrey.R.Olsen@ucdenver.edu.
[Ti] Título:Predictors of Radiation Therapy-Related Gastrointestinal Toxicity From Anal Cancer Dose-Painted Intensity Modulated Radiation Therapy: Secondary Analysis of NRG Oncology RTOG 0529.
[So] Source:Int J Radiat Oncol Biol Phys;98(2):400-408, 2017 06 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: NRG Oncology RTOG 0529 assessed the feasibility of dose-painted intensity modulated radiation therapy (DP-IMRT) to reduce the acute morbidity of chemoradiation with 5-fluorouracil (5FU) and mitomycin-C (MMC) for T2-4N0-3M0 anal cancer. This secondary analysis was performed to identify patient and treatment factors associated with acute and late gastrointestinal (GI) adverse events (AEs). METHODS AND MATERIALS: NRG Oncology RTOG 0529 treatment plans were reviewed to extract dose-volume data for tightly contoured small bowel, loosely contoured anterior pelvic contents (APC), and uninvolved colon outside the target volume (UC). Univariate logistic regression was performed to evaluate association between volumes of each structure receiving doses ≥5 to 60 Gy (V5-V60) in 5-Gy increments between patients with and without grade ≥2 acute and late GI AEs, and grade ≥3 acute GI AEs. Additional patient and treatment factors were evaluated in multivariate logistic regression (acute AEs) or Cox proportional hazards models (late AEs). RESULTS: Among 52 evaluable patients, grade ≥2 acute, grade ≥2 late, and grade ≥3 acute GI AEs were observed in 35, 17, and 10 patients, respectively. Trends (P<.05) toward statistically significant associations were observed between grade ≥2 acute GI AEs and small bowel dose (V20-V40), grade ≥2 late GI AEs and APC dose (V60), grade ≥3 acute GI AEs and APC dose (V5-V25), increasing age, tumor size >4 cm, and worse Zubrod performance status. Small bowel volumes of 186.0 cc, 155.0 cc, 41.0 cc, and 30.4 cc receiving doses greater than 25, 30, 35, and 40 Gy, respectively, correlated with increased risk of acute grade ≥2 GI AEs. CONCLUSIONS: Acute and late GI AEs from 5FU/MMC chemoradiation using DP-IMRT correlate with radiation dose to the small bowel and APC. Such associations will be incorporated in the dose-volume normal tissue constraint design for future NRG oncology anal cancer studies.
[Mh] Termos MeSH primário: Antineoplásicos/efeitos adversos
Neoplasias do Ânus/terapia
Carcinoma de Células Escamosas/terapia
Quimiorradioterapia/efeitos adversos
Intestino Delgado/efeitos da radiação
Radioterapia de Intensidade Modulada/efeitos adversos
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Antineoplásicos/uso terapêutico
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias do Ânus/diagnóstico por imagem
Neoplasias do Ânus/patologia
Carcinoma de Células Escamosas/patologia
Quimiorradioterapia/métodos
Colo/diagnóstico por imagem
Estudos de Viabilidade
Feminino
Fluoruracila/administração & dosagem
Fluoruracila/efeitos adversos
Seres Humanos
Intestino Delgado/diagnóstico por imagem
Masculino
Meia-Idade
Mitomicina/administração & dosagem
Mitomicina/efeitos adversos
Órgãos em Risco/diagnóstico por imagem
Órgãos em Risco/patologia
Órgãos em Risco/efeitos da radiação
Pelve/diagnóstico por imagem
Modelos de Riscos Proporcionais
Curva ROC
Dosagem Radioterapêutica
Radioterapia de Intensidade Modulada/métodos
Análise de Regressão
Carga Tumoral
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Antineoplastic Agents); 50SG953SK6 (Mitomycin); U3P01618RT (Fluorouracil)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE



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