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[PMID]:28869396
[Au] Autor:Franzese C; Fogliata A; Comito T; Tozzi A; Iftode C; Clerici E; Franceschini D; Navarria P; Ascolese AM; Di Brina L; De Rose F; D'Agostino GR; Cozzi L; Scorsetti M
[Ad] Endereço:1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.
[Ti] Título:Stereotactic/hypofractionated body radiation therapy as an effective treatment for lymph node metastases from colorectal cancer: an institutional retrospective analysis.
[So] Source:Br J Radiol;90(1079):20170422, 2017 Nov.
[Is] ISSN:1748-880X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The colorectal cancer (CRC) might present loco-regional recurrence, including lymph-node metastasis. Stereotactic body radiotherapy (SBRT) is a non-invasive and well-tolerated ablative treatment. Aim of the present study is to evaluate efficacy and toxicity of SBRT with volumetric modulated arc therapy (VMAT) in this setting. METHODS: 35 patients presenting a total of 47 nodal recurrences from CRC, treated with VMAT-SBRT from 2008 to 2015, were selected. About three fourth of the treatments delivered 45 Gy in 6 daily fractions. End-points were the detection of toxicities, overall survival (OS), local control (LC), disease progression free incidence (DPFI) and disease free survival (DFS). Tumour response was assessed according to the RECIST criteria. RESULTS: Only Grade 1 and 2 toxicities were recorded. Median follow-up was 15 months (range 2-68). Local relapse was reported in 6 patients, regional relapse in 10 patients. Complete remission was reported in 20 cases (53%), partial remission in 14 (37%). Rates of LC at 1, 2 and 3 years were 85.3, 75.0 and 75.0%, respectively. At 1 year the actuarial OS was 100%, at 2 and 3 years was 81.4%. Median DFS was estimated in 16 months, with an incidence of 69.4, 33.3 and 19.4% at 1, 2 and 3 years, respectively. CONCLUSION: The use of the VMAT-SBRT in lymph-node recurrence of CRC could prevent severe complications and achieve satisfying rates of disease control. Advances in knowledge: The use of VMAT-SBRT is a viable approach for lymph-node recurrence of CRC.
[Mh] Termos MeSH primário: Neoplasias do Colo/radioterapia
Neoplasias Colorretais/radioterapia
Irradiação Linfática/métodos
Radiocirurgia/métodos
Radioterapia de Intensidade Modulada/métodos
Neoplasias Retais/radioterapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Aorta
Neoplasias do Colo/mortalidade
Neoplasias do Colo/patologia
Neoplasias Colorretais/mortalidade
Neoplasias Colorretais/patologia
Intervalo Livre de Doença
Fracionamento de Dose
Feminino
Seguimentos
Seres Humanos
Estimativa de Kaplan-Meier
Irradiação Linfática/efeitos adversos
Masculino
Meia-Idade
Pelve
Lesões por Radiação/patologia
Radiocirurgia/efeitos adversos
Planejamento da Radioterapia Assistida por Computador
Radioterapia de Intensidade Modulada/efeitos adversos
Neoplasias Retais/mortalidade
Neoplasias Retais/patologia
Recidiva
Critérios de Avaliação de Resposta em Tumores Sólidos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE
[do] DOI:10.1259/bjr.20170422


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[PMID]:28869198
[Au] Autor:Blanchard P; Foulon S; Louvel G; Habibian M; Fizazi K
[Ad] Endereço:Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France. Electronic address: pierre.blanchard@gustaveroussy.fr.
[Ti] Título:[A randomized controlled trial of metastases-directed treatment in patients with metastatic prostate cancer using stereotactic body irradiation: A GETUG-AFU trial].
[Ti] Título:Rôle de la radiothérapie ablative des métastases chez les patients atteints de cancer de la prostate oligométastatique hormonosensible : un essai du Groupe d'étude des tumeurs urogénitales et de l'Association française d'urologie..
[So] Source:Cancer Radiother;21(6-7):491-494, 2017 Oct.
[Is] ISSN:1769-6658
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:The goal of treatment of metastatic prostate cancer remains palliation. The oligometastatic state could be the right time to intensify therapy by introducing metastases directed treatments. The aim of this trial was to evaluate the benefit of radiotherapy to all macroscopic metastatic sites and to the primary disease in patients with hormone sensitive oligometastatic prostate cancer.
[Mh] Termos MeSH primário: Neoplasias Ósseas/radioterapia
Neoplasias Ósseas/secundário
Irradiação Linfática
Neoplasias da Próstata/patologia
Neoplasias da Próstata/radioterapia
Radiocirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Masculino
Metástase Neoplásica
Projetos de Pesquisa
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[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:170905
[St] Status:MEDLINE


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[PMID]:28847462
[Au] Autor:Supiot S; Doré M; Rio E
[Ad] Endereço:Département de radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France. Electronic address: stephane.supiot@ico.unicancer.fr.
[Ti] Título:[Radiotherapy of oligometastatic pelvic node relapses in patients with prostate cancer].
[Ti] Título:Rechutes oligométastatiques ganglionnaires pelviennes au cours des cancers de la prostate : rôle de la prise en charge par radiothérapie..
[So] Source:Cancer Radiother;21(6-7):495-497, 2017 Oct.
[Is] ISSN:1769-6658
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:The Oligopelvis 2 studies is based on the assumption that salvage pelvic radiotherapy may prolong the interval between the first and the second intermittent hormone therapy sequence in pelvic lymph node oligometastatic prostate cancer. This phase 3 study will compare intermittent hormone therapy (standard arm) alone or combined with salvage pelvic radiotherapy (experimental arm).
[Mh] Termos MeSH primário: Irradiação Linfática
Recidiva Local de Neoplasia/radioterapia
Neoplasias da Próstata/patologia
Neoplasias da Próstata/radioterapia
[Mh] Termos MeSH secundário: Seres Humanos
Metástase Linfática
Masculino
Pelve
Projetos de Pesquisa
Terapia de Salvação
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE
[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:170830
[St] Status:MEDLINE


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[PMID]:28665042
[Au] Autor:Jing Z; Chen T; Zhang X; Wu S
[Ad] Endereço:Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China.
[Ti] Título:Long-term outcome of concurrent chemoradiotherapy with elective nodal irradiation for inoperable esophageal cancer.
[So] Source:Cancer Sci;108(9):1828-1833, 2017 Sep.
[Is] ISSN:1349-7006
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Elective nodal irradiation (ENI) might improve overall survival in patients with inoperable esophageal cancer. We conducted a retrospective analysis to assess the long-term survival and toxicity of esophageal cancer patients treated with ENI versus conventional-field irradiation (CFI). All data in the present study were based on our institutional experience from 2000 to 2005 of patients with inoperable esophageal cancer treated with ENI or CFI plus two concurrent cycles of paclitaxel/cisplatin. Based on the inclusion and exclusion criteria, 89 patients were included in the analysis. Of these patients, 51 were treated with ENI, whereas 38 were treated with CFI. For the per-protocol population, the patients in the ENI group significantly improved in terms of their 10-year disease-specific overall survival (43.1% vs 10.5%, P = 0.019), 10-year disease-free survival (36.7% vs 10.2%, P = 0.040) and 10-year local recurrence-free survival (47.2% vs 17.2%, P = 0.018) compared with the CFI group. Aside from radiation esophagitis, the incidence of grade 3 or greater acute toxicities did not differ between the two groups. Multivariate analysis showed that radiation field, tumor length and clinical stage were independent prognostic factors associated with OS. Concurrent chemoradiotherapy with ENI improves both disease-specific overall survival and loco-regional control in patients with inoperable esophageal cancer receiving per-protocol treatment. The regimen has a manageable tolerability profile.
[Mh] Termos MeSH primário: Adenocarcinoma/terapia
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Carcinoma de Células Escamosas/terapia
Neoplasias Esofágicas/terapia
[Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade
Adenocarcinoma/secundário
Idoso
Carcinoma de Células Escamosas/mortalidade
Carcinoma de Células Escamosas/secundário
Quimiorradioterapia
Cisplatino/administração & dosagem
Intervalo Livre de Doença
Neoplasias Esofágicas/mortalidade
Neoplasias Esofágicas/patologia
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Linfonodos/patologia
Irradiação Linfática
Metástase Linfática
Masculino
Meia-Idade
Análise Multivariada
Paclitaxel/administração & dosagem
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Terapia de Salvação
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
P88XT4IS4D (Paclitaxel); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170701
[St] Status:MEDLINE
[do] DOI:10.1111/cas.13308


  5 / 1138 MEDLINE  
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[PMID]:28633075
[Au] Autor:Al-Mamgani A; Verheij M; van den Brekel MWM
[Ad] Endereço:Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands. Electronic address: a.almamgani@nki.nl.
[Ti] Título:Elective unilateral nodal irradiation in head and neck squamous cell carcinoma: A paradigm shift.
[So] Source:Eur J Cancer;82:1-5, 2017 Sep.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:There is a long-standing convention to irradiate the great majority of head and neck squamous cell carcinoma (HNSCC) electively to both sides of the neck, to reduce the theoretically increased risk of contralateral regional failure (cRF). With the currently available diagnostic imaging techniques this treatment paradigm means, in our opinion, an overtreatment in considerable proportion of these patients. From all the published studies (n = 11, with 1116 patients treated in total), the incidence of cRF in patients with oropharyngeal cancer treated to one side of the neck is 2.4%. The incidence was higher in patients with tumours involving the midline (12.1%). The low incidence of cRF was also seen in patients with HNSCC treated by local excision combined with unilateral neck dissection or sentinel node procedure. It seems clear from the aggregated data of these studies that a less conservative approach with regard to the selection of patients for unilateral elective nodal irradiation is justified. The fear of leaving the contralateral neck untreated in well-selected groups of patients with HNSCC needs nowadays to be mitigated since the incidence of cRF in lateralised tumours extending to but not crossing the midline is low. Furthermore, the obviously improved diagnostic imaging nowadays could help us to guide the selection of considerable proportion of patients with lateralised HNSCC for unilateral elective nodal irradiation with significant reduction of radiation-related toxicity and improved quality of life.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/radioterapia
Neoplasias de Cabeça e Pescoço/radioterapia
Irradiação Linfática/métodos
Radioterapia Conformacional/métodos
[Mh] Termos MeSH secundário: Carcinoma de Células Escamosas/diagnóstico por imagem
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem
Seres Humanos
Qualidade de Vida
Fatores de Risco
Linfonodo Sentinela/diagnóstico por imagem
Tomografia Computadorizada de Emissão de Fóton Único/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170621
[St] Status:MEDLINE


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[PMID]:28586961
[Au] Autor:Grellier Adedjouma N; Chevrier M; Fourquet A; Costa E; Xu H; Berger F; Campana F; Laki F; Beuzeboc P; Lefeuvre D; Fournier-Bidoz N; Kirova YM
[Ad] Endereço:Department of Radiation Oncology, Institut Curie, Paris, France. Electronic address: grellier.noemie@gmail.com.
[Ti] Título:Long-Term Results of a Highly Performing Conformal Electron Therapy Technique for Chest Wall Irradiation After Mastectomy.
[So] Source:Int J Radiat Oncol Biol Phys;98(1):206-214, 2017 May 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To evaluate locoregional control and survival after mastectomy, as well as toxicity, in patients irradiated by a previously described postmastectomy highly conformal electron beam radiation therapy technique (PMERT). METHODS AND MATERIALS: We included all women irradiated by postmastectomy electron beam radiation therapy for nonmetastatic breast cancer between 2007 and 2011 in our department. Acute and late toxicities were retrospectively assessed using Common Terminology Criteria for Adverse Events version 3.0 criteria. RESULTS: Among the 796 women included, 10.1% were triple-negative, 18.8% HER2-positive, and 24.6% received neoadjuvant chemotherapy (CT). Multifocal lesions were observed in 51.3% of women, and 64.6% had at least 1 involved lymph node (LN). Internal mammary chain, supraclavicular, infraclavicular, and axillary LNs were treated in 85.6%, 88.3%, 77.9%, and 14.9% of cases, respectively. With a median follow-up of 64 months (range, 6-102 months), 5-year locoregional recurrence-free survival and overall survival were 90% (95% confidence interval 88.1%-92.4%) and 90.9% (95% confidence interval 88.9%-93%), respectively. Early skin toxicity was scored as grade 1 in 58.5% of patients, grade 2 in 35.9%, and grade 3 in 4.5%. Concomitant CT was associated with increased grade 3 toxicity (P<.001). At long-term follow-up, 29.8% of patients presented temporary or permanent hyperpigmentation or telangiectasia or fibrosis (grade 1: 23.6%; grade 2: 5.2%; grade 3: 1%), with higher rates among smokers (P=.06); 274 patients (34.4%) underwent breast reconstruction. Only 24 patients (3%) had early esophagitis of grade 1. Only 3 patients developed ischemic heart disease: all had been treated by anthracycline-based CT with or without trastuzumab, all had been irradiated to the left chest wall and LN, and all presented numerous cardiovascular risk factors (2-4 factors). CONCLUSIONS: This study demonstrated the good efficacy of this technique in terms of locoregional control and survival, and good short-term and long-term safety. Longer follow-up is required to analyze chronic cardiac events.
[Mh] Termos MeSH primário: Neoplasias da Mama/radioterapia
Neoplasias da Mama/cirurgia
Elétrons/uso terapêutico
Mastectomia
Radioterapia Conformacional/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Neoplasias da Mama/mortalidade
Neoplasias da Mama/patologia
Intervalos de Confiança
Intervalo Livre de Doença
Elétrons/efeitos adversos
Feminino
Seguimentos
Seres Humanos
Irradiação Linfática
Meia-Idade
Tolerância a Radiação
Radiodermatite/patologia
Radioterapia Conformacional/efeitos adversos
Estudos Retrospectivos
Parede Torácica
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170721
[Lr] Data última revisão:
170721
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE


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[PMID]:28514301
[Au] Autor:Kuo DY; Chang MH; Wang SY; Hsieh PY; Shueng PW
[Ad] Endereço:aDivision of Radiation Oncology bDepartment of Anatomical Pathology cDivision of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City dDepartment of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei eDivision of Medical Oncology, Far Eastern Memorial Hospital, New Taipei City fFaculty of Medicine, School of Medicine, National Yang-Ming University, Taipei gDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
[Ti] Título:Unusual axillary metastasis of recurrent nasopharyngeal cancer: A case report.
[So] Source:Medicine (Baltimore);96(20):e6854, 2017 May.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Nasopharyngeal carcinoma (NPC) has a high propensity of metastasis. The most commonly described sites of distant metastasis are the bones, lungs, and liver, whereas axillary metastasis is seldom reported. PATIENT CONCERNS: We hereby present the case of a 66-year-old man with NPC, cT2N2M0, at diagnosis. He had completed chemoradiotherapy and been disease-free for 7 years. DIAGNOSES: After that period, late recurrence in the form of a solitary axillary lymph node metastasis was detected and confirmed by core-needle biopsy. INTERVENTIONS: The lesion was chemoresistant but responded to salvage radiotherapy at a dose of 65 Gy in 21 fractions. OUTCOMES: Post-radiotherapy positron emission tomography scan showed no evidence of disease. LESSONS: We suggested that long-term follow-up of NPC patients is important because a late relapse may occur at an unusual site. Aggressive management of solitary metastasis may achieve good outcome.
[Mh] Termos MeSH primário: Carcinoma/patologia
Metástase Linfática
Neoplasias Nasofaríngeas/patologia
[Mh] Termos MeSH secundário: Idoso
Biópsia por Agulha
Carcinoma/diagnóstico por imagem
Carcinoma/terapia
Quimiorradioterapia
Seres Humanos
Irradiação Linfática
Metástase Linfática/diagnóstico por imagem
Metástase Linfática/patologia
Metástase Linfática/radioterapia
Masculino
Neoplasias Nasofaríngeas/diagnóstico por imagem
Neoplasias Nasofaríngeas/terapia
Terapia de Salvação
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170613
[Lr] Data última revisão:
170613
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006854


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[PMID]:28376188
[Au] Autor:Gingras I; Holmes E; De Azambuja E; Nguyen DH; Izquierdo M; Anne Zujewski J; Inbar M; Naume B; Tomasello G; Gralow JR; Wolff AC; Harris L; Gnant M; Moreno-Aspitia A; Piccart MJ; Azim HA
[Ad] Endereço:Hematology/Oncology Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
[Ti] Título:Regional Nodal Irradiation After Breast Conserving Surgery for Early HER2-Positive Breast Cancer: Results of a Subanalysis From the ALTTO Trial.
[So] Source:J Natl Cancer Inst;109(8), 2017 08 01.
[Is] ISSN:1460-2105
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: Two randomized trials recently demonstrated that regional nodal irradiation (RNI) could reduce the risk of recurrence in early breast cancer; however, these trials were conducted in the pretrastuzumab era. Whether these results are applicable to human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with anti-HER2-targeted therapy is unknown. Methods: This retrospective analysis was performed on patients with node-positive breast cancer who were enrolled in the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization phase III adjuvant trial and subjected to BCS. The primary objective of the present study was to examine the effect of RNI on disease-free survival (DFS). A multivariable cox regression analysis adjusted for number of positive lymph nodes, tumor size, grade, age, hormone receptors status, presence of macrometastatis, treatment arm, and chemotherapy timing was carried out to investigate the relationship between RNI and DFS. Results: One thousand six hundred sixty-four HER2-positive breast cancer patients were included, of whom 878 (52.8%) had received RNI to the axillary, supraclavicular, and/or internal mammary lymph nodes. Patients in the RNI group had higher nodal burden and more frequently had tumors larger than 2 cm. At a median follow-up of 4.5 years, DFS was 84.3% in the RNI group and 88.3% in the non-RNI group. No differences in regional recurrence (0.9 % vs 0.6 %) or in overall survival (93.6% vs 95.3%) were observed between the two groups. After adjustment in multivariable analysis, there was no statistically significant association between RNI and DFS (hazard ratio = 0.96, 95% confidence interval = 0.71 to 1.29). Conclusions: Our analysis did not demonstrate a DFS benefit of RNI in HER2-positive, node-positive patients treated with adjuvant HER2-targeted therapy. The benefit of RNI in HER2-positive breast cancer needs further testing within randomized clinical trials.
[Mh] Termos MeSH primário: Neoplasias da Mama/terapia
Linfonodos/patologia
Irradiação Linfática
Recidiva Local de Neoplasia
Radioterapia Conformacional
[Mh] Termos MeSH secundário: Antineoplásicos/uso terapêutico
Axila
Mama
Neoplasias da Mama/química
Neoplasias da Mama/patologia
Quimioterapia Adjuvante
Intervalo Livre de Doença
Feminino
Seguimentos
Seres Humanos
Irradiação Linfática/estatística & dados numéricos
Metástase Linfática
Mastectomia Segmentar
Meia-Idade
Recidiva Local de Neoplasia/diagnóstico
Quinazolinas/uso terapêutico
Radioterapia Adjuvante
Receptor ErbB-2/análise
Estudos Retrospectivos
Taxa de Sobrevida
Trastuzumab/uso terapêutico
Carga Tumoral
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Quinazolines); 0VUA21238F (lapatinib); EC 2.7.10.1 (ERBB2 protein, human); EC 2.7.10.1 (Receptor, ErbB-2); P188ANX8CK (Trastuzumab)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170726
[Lr] Data última revisão:
170726
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1093/jnci/djw331


  9 / 1138 MEDLINE  
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[PMID]:28366576
[Au] Autor:Monten C; Lievens Y; Olteanu LAM; Paelinck L; Speleers B; Deseyne P; Van Den Broecke R; De Neve W; Veldeman L
[Ad] Endereço:Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. Electronic address: chris.monten@uzgent.be.
[Ti] Título:Highly Accelerated Irradiation in 5 Fractions (HAI-5): Feasibility in Elderly Women With Early or Locally Advanced Breast Cancer.
[So] Source:Int J Radiat Oncol Biol Phys;98(4):922-930, 2017 Jul 15.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To investigate, in a prospective phase 1 to 2 trial, the safety and feasibility of delivering external beam radiation therapy in 5 fractions to the breast or thoracic wall, including boost and/or lymph nodes if needed, to women aged ≥65 years with breast cancer. METHODS AND MATERIALS: Ninety-five patients aged ≥65 years, referred for adjuvant radiation therapy, were treated in 5 fractions over 12 days with a total dose of 28.5 Gy/5.7 Gy to the breast or thoracic wall and, if indicated, 27 Gy/5.4 Gy to the lymph node regions and 32.5 Gy/6.5 Gy to 34.5 Gy/6.9 Gy to the tumor bed. The primary endpoint was clinically relevant dermatitis (grade ≥2). RESULTS: Mean follow-up time was 5.6 months, and mean age was 73.6 years. Clinically relevant dermatitis was observed in 11.6% of patients and only occurred in breast irradiation with boost (17.5% grade 2-3 vs 0% in the no-boost group). Although doses were high, treatment delivery with intensity modulated radiation therapy was swift, except for complex treatments, including lymph nodes for which single-arc volumetric modulated arc therapy was needed to reduce beam-on time. CONCLUSION: Accelerated radiation therapy in 5 fractions was technically feasible and resulted in low acute toxicity. Clinically relevant erythema was only observed in patients receiving a boost, but still at an acceptable rate. Although the follow-up is still short, the results on acute toxicity after accelerated radiation therapy were encouraging. A 5-fraction schedule is well tolerated in the elderly and may lower the threshold for radiation therapy in this population.
[Mh] Termos MeSH primário: Neoplasias da Mama/patologia
Neoplasias da Mama/radioterapia
Radioterapia de Intensidade Modulada/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Neoplasias da Mama/diagnóstico por imagem
Fracionamento de Dose
Estudos de Viabilidade
Feminino
Seguimentos
Seres Humanos
Irradiação Linfática/efeitos adversos
Irradiação Linfática/métodos
Mastectomia
Estudos Prospectivos
Radiodermatite/etiologia
Radiodermatite/patologia
Radioterapia Adjuvante/efeitos adversos
Radioterapia Adjuvante/métodos
Radioterapia de Intensidade Modulada/efeitos adversos
Fatores de Tempo
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE I; CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170728
[Lr] Data última revisão:
170728
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE


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[PMID]:28351935
[Au] Autor:E S; Seth A; Vogel P; Sommers M; Ong T; Pillai AB
[Ad] Endereço:Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN.
[Ti] Título:Bidirectional immune tolerance in nonmyeloablative MHC-mismatched BMT for murine ß-thalassemia.
[So] Source:Blood;129(22):3017-3030, 2017 Jun 01.
[Is] ISSN:1528-0020
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Nonmyeloablative conditioning using total lymphoid irradiation (TLI) and rabbit antithymocyte serum (ATS) (the murine preclinical equivalent of antithymocyte globulin [ATG]) facilitates immune tolerance after bone marrow transplantation (BMT) across major histocompatibility complex (MHC) disparities and may be a useful strategy for nonmalignant disorders. We previously reported that donor effector T-cell function and graft-versus-host disease (GVHD) are regulated via recipient invariant natural killer T-cell (iNKT) interleukin-4-driven expansion of donor Foxp3 naturally occurring regulatory T cells (Tregs). This occurs via recipient iNKT- and STAT6-dependent expansion of recipient myeloid dendritic cells (MDCs) that induce contact-dependent expansion of donor Treg through PD-1/PD ligand signaling. After TLI/ATS + BMT, Gr-1 CD11c MDCs and Gr-1 CD11c myeloid-derived suppressor cells (MDSCs) were enriched in GVHD target organs. We now report that the recovery of both recipient MDSCs ( < .01) and MDCs ( < .01) is significantly increased when the alkylator cyclophosphamide (CTX) is added to TLI/ATS conditioning. In a BALB/c → B6 lethal GVHD model, adoptive transfer of MDSCs from TLI/ATS/CTX-conditioned recipients is associated with significantly improved GVHD colitis and survival ( < .001), conversion of MDSCs to PD ligand-expressing MDCs, and increased donor naturally occurring Treg recovery ( < .01) compared with control treatment. Using BALB/c donors and ß-thalassemic HW-80 recipients, we found significantly improved rates of engraftment and GVHD following TLI/ATS/CTX compared with TLI/ATS, lethal or sublethal total body irradiation/ATS/CTX, or CTX/ATS conditioning. These data provide preclinical support for trials of TLI/ATG/alkylator regimens for MHC-mismatched BMT for hemoglobinopathies. The data also delineate innate immune mechanisms by which TLI/ATS/CTX conditioning may augment transplantation tolerance.
[Mh] Termos MeSH primário: Transplante de Medula Óssea/métodos
Tolerância Imunológica
Condicionamento Pré-Transplante/métodos
Talassemia beta/imunologia
Talassemia beta/terapia
[Mh] Termos MeSH secundário: Transferência Adotiva
Animais
Soro Antilinfocitário/uso terapêutico
Ciclofosfamida/uso terapêutico
Modelos Animais de Doenças
Sobrevivência de Enxerto
Doença Enxerto-Hospedeiro/prevenção & controle
Irradiação Linfática
Complexo Principal de Histocompatibilidade
Camundongos
Camundongos Endogâmicos BALB C
Camundongos Mutantes
Modelos Imunológicos
Células Supressoras Mieloides/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antilymphocyte Serum); 8N3DW7272P (Cyclophosphamide)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170330
[St] Status:MEDLINE
[do] DOI:10.1182/blood-2016-03-704387



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