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[PMID]:29360138
[Au] Autor:Lawrie TA; Green JT; Beresford M; Wedlake L; Burden S; Davidson SE; Lal S; Henson CC; Andreyev HJN
[Ad] Endereço:Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, 1st Floor Education Centre, Royal United Hospital, Combe Park, Bath, UK, BA1 3NG.
[Ti] Título:Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers.
[So] Source:Cochrane Database Syst Rev;1:CD012529, 2018 Jan 23.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: An increasing number of people survive cancer but a significant proportion have gastrointestinal side effects as a result of radiotherapy (RT), which impairs their quality of life (QoL). OBJECTIVES: To determine which prophylactic interventions reduce the incidence, severity or both of adverse gastrointestinal effects among adults receiving radiotherapy to treat primary pelvic cancers. SEARCH METHODS: We conducted searches of CENTRAL, MEDLINE, and Embase in September 2016 and updated them on 2 November 2017. We also searched clinical trial registries. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of interventions to prevent adverse gastrointestinal effects of pelvic radiotherapy among adults receiving radiotherapy to treat primary pelvic cancers, including radiotherapy techniques, other aspects of radiotherapy delivery, pharmacological interventions and non-pharmacological interventions. Studies needed a sample size of 20 or more participants and needed to evaluate gastrointestinal toxicity outcomes. We excluded studies that evaluated dosimetric parameters only. We also excluded trials of interventions to treat acute gastrointestinal symptoms, trials of altered fractionation and dose escalation schedules, and trials of pre- versus postoperative radiotherapy regimens, to restrict the vast scope of the review. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. We used the random-effects statistical model for all meta-analyses, and the GRADE system to rate the certainty of the evidence. MAIN RESULTS: We included 92 RCTs involving more than 10,000 men and women undergoing pelvic radiotherapy. Trials involved 44 different interventions, including radiotherapy techniques (11 trials, 4 interventions/comparisons), other aspects of radiotherapy delivery (14 trials, 10 interventions), pharmacological interventions (38 trials, 16 interventions), and non-pharmacological interventions (29 trials, 13 interventions). Most studies (79/92) had design limitations. Thirteen studies had a low risk of bias, 50 studies had an unclear risk of bias and 29 studies had a high risk of bias. Main findings include the following:Radiotherapy techniques: Intensity-modulated radiotherapy (IMRT) versus 3D conformal RT (3DCRT) may reduce acute (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.26 to 0.88; participants = 444; studies = 4; I = 77%; low-certainty evidence) and late gastrointestinal (GI) toxicity grade 2+ (RR 0.37, 95% CI 0.21 to 0.65; participants = 332; studies = 2; I = 0%; low-certainty evidence). Conformal RT (3DCRT or IMRT) versus conventional RT reduces acute GI toxicity grade 2+ (RR 0.57, 95% CI 0.40 to 0.82; participants = 307; studies = 2; I = 0%; high-certainty evidence) and probably leads to less late GI toxicity grade 2+ (RR 0.49, 95% CI 0.22 to 1.09; participants = 517; studies = 3; I = 44%; moderate-certainty evidence). When brachytherapy (BT) is used instead of external beam radiotherapy (EBRT) in early endometrial cancer, evidence indicates that it reduces acute GI toxicity (grade 2+) (RR 0.02, 95% CI 0.00 to 0.18; participants = 423; studies = 1; high-certainty evidence).Other aspects of radiotherapy delivery: There is probably little or no difference in acute GI toxicity grade 2+ with reduced radiation dose volume (RR 1.21, 95% CI 0.81 to 1.81; participants = 211; studies = 1; moderate-certainty evidence) and maybe no difference in late GI toxicity grade 2+ (RR 1.02, 95% CI 0.15 to 6.97; participants = 107; studies = 1; low-certainty evidence). Evening delivery of RT may reduce acute GI toxicity (diarrhoea) grade 2+ during RT compared with morning delivery of RT (RR 0.51, 95% CI 0.34 to 0.76; participants = 294; studies = 2; I = 0%; low-certainty evidence). There may be no difference in acute (RR 2.22, 95% CI 0.62 to 7.93, participants = 110; studies = 1) and late GI toxicity grade 2+ (RR 0.44, 95% CI 0.12 to 1.65; participants = 81; studies = 1) between a bladder volume preparation of 1080 mls and that of 540 mls (low-certainty evidence). Low-certainty evidence on balloon and hydrogel spacers suggests that these interventions for prostate cancer RT may make little or no difference to GI outcomes.Pharmacological interventions: Evidence for any beneficial effects of aminosalicylates, sucralfate, amifostine, corticosteroid enemas, bile acid sequestrants, famotidine and selenium is of a low or very low certainty. However, evidence on certain aminosalicylates (mesalazine, olsalazine), misoprostol suppositories, oral magnesium oxide and octreotide injections suggests that these agents may worsen GI symptoms, such as diarrhoea or rectal bleeding.Non-pharmacological interventions: Low-certainty evidence suggests that protein supplements (RR 0.23, 95% CI 0.07 to 0.74; participants = 74; studies = 1), dietary counselling (RR 0.04, 95% CI 0.00 to 0.60; participants = 74; studies = 1) and probiotics (RR 0.43, 95% CI 0.22 to 0.82; participants = 923; studies = 5; I = 91%) may reduce acute RT-related diarrhoea (grade 2+). Dietary counselling may also reduce diarrhoeal symptoms in the long term (at five years, RR 0.05, 95% CI 0.00 to 0.78; participants = 61; studies = 1). Low-certainty evidence from one study (108 participants) suggests that a high-fibre diet may have a beneficial effect on GI symptoms (mean difference (MD) 6.10, 95% CI 1.71 to 10.49) and quality of life (MD 20.50, 95% CI 9.97 to 31.03) at one year. High-certainty evidence indicates that glutamine supplements do not prevent RT-induced diarrhoea. Evidence on various other non-pharmacological interventions, such as green tea tablets, is lacking.Quality of life was rarely and inconsistently reported across included studies, and the available data were seldom adequate for meta-analysis. AUTHORS' CONCLUSIONS: Conformal radiotherapy techniques are an improvement on older radiotherapy techniques. IMRT may be better than 3DCRT in terms of GI toxicity, but the evidence to support this is uncertain. There is no high-quality evidence to support the use of any other prophylactic intervention evaluated. However, evidence on some potential interventions shows that they probably have no role to play in reducing RT-related GI toxicity. More RCTs are needed for interventions with limited evidence suggesting potential benefits.
[Mh] Termos MeSH primário: Trato Gastrointestinal/efeitos da radiação
Neoplasias Pélvicas/radioterapia
Lesões por Radiação/prevenção & controle
Radioterapia Conformacional/efeitos adversos
[Mh] Termos MeSH secundário: Diarreia/etiologia
Diarreia/prevenção & controle
Fármacos Gastrointestinais/uso terapêutico
Trato Gastrointestinal/efeitos dos fármacos
Seres Humanos
Efeito Placebo
Radioterapia de Intensidade Modulada/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Gastrointestinal Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012529.pub2


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[PMID]:29398305
[Au] Autor:Aghili M; Barzegartahamtan M; Alikhassi A; Mohammadpour R
[Ad] Endereço:Radiation Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
[Ti] Título:Investigation of electron boost radiotherapy in patients with breast cancer: Is a direct electron field optimal?
[So] Source:Cancer Radiother;22(1):52-56, 2018 Feb.
[Is] ISSN:1769-6658
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Historically, electron boost dose mainly was delivered by a direct field in adjuvant radiotherapy of breast cancer. In this prospective study, we investigated direct electron field, in terms of optimal coverage of tumour bed volume following localization using ultrasound and surgical clips. MATERIAL AND METHODS: First, for all 24 patients, a breast sonographer drew perimeter of tumour bed on the breast skin. Then an electron boost field was outlined on the demarcated territory, and a lead wire marker compatible with CT scan was placed on the field borders by a 2cm margin. After CT scan simulation, all patients underwent adjuvant whole breast irradiation with 3D-conformal radiotherapy to 50Gy in 25 fractions. Then for boost radiotherapy, lead wire in CT images was countoured as electron boost field. Also, the tumour bed was contoured based on surgical clips (true clinical target volume and true planning target volume). Electron treatment planning was done for electron boost field. Finally isodose coverages for true planning target volume investigated. RESULTS: On average, 16.68% of clips planning target volume (true planning target volume; range: 0.00 to 95%) received 90% oor more of the prescribed dose when the electron treatment plan was made. Isodose curves does not provide adequate coverage on the tumour bed (clips planning target volume) when electron boost treatment planning was generated for electron boost field (en face electron field). In fact, a part of target (planning target volume-c) is missed and more doses is absorbed in normal tissue. CONCLUSIONS: Electron boost treatment planning (an en face electron field) following tumour bed localization using ultrasonography does not provide an optimized coverage of tumour bed volume.
[Mh] Termos MeSH primário: Neoplasias da Mama/radioterapia
Dosagem Radioterapêutica
Radioterapia Conformacional/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Imagem Tridimensional
Meia-Idade
Estudos Prospectivos
Radioterapia Adjuvante
Radioterapia Guiada por Imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE


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[PMID]:29195796
[Au] Autor:Sarkar B; Munshi A; Manikandan A; Roy S; Ganesh T; Mohanti BK; Pradhan A
[Ad] Endereço:Radiation oncology, Fortis Memorial Research Institute, 122002 Gurgaon, Haryana, India; Department of Physics, GLA University, Mathura, Uttar Pradesh, India. Electronic address: biplabphy@gmail.com.
[Ti] Título:A low gradient junction technique of craniospinal irradiation using volumetric-modulated arc therapy and its advantages over the conventional therapy.
[So] Source:Cancer Radiother;22(1):62-72, 2018 Feb.
[Is] ISSN:1769-6658
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:A technique using volumetric-modulated arc therapy (VMAT) fields for craniospinal irradiation with low dose gradients at the field junction was tested for its sensitivity to positional inaccuracy. It was compared against the conventional three-dimensional (3D) conformal radiotherapy in terms of dose uniformity at the junction. Treatment plans generated for ten patients who received craniospinal irradiation (35Gy in 21 fractions) by VMAT technique at our centre were included in this study. For these patients, 3D conformal radiotherapy plans were also generated in addition to the VMAT treatment plans. Intentional shifting of the cranial field in the superior and then in the inferior directions was done, creating a gap or overlap between the fields. Consequent changes in dose distributions in these two plans to positional inaccuracies were studied. The 3D conformal radiotherapy plans showed large dose variations at the junction due to positional shifts as compared to the VMAT plans. With a 5mm superior shift of the cranial field isocentre creating a gap between the cranial and spinal fields, the magnitudes of under-dosing were 13.9±3.6Gy and 4.8±2.0Gy for 3D conformal radiotherapy and VMAT respectively. When the cranial field was moved by 5mm inferiorly creating an overlap between the fields, overdose to the effects of 10.3±4.0Gy and 4.9±1.3Gy were observed for the 3D conformal radiotherapy plans and VMAT plans respectively. The VMAT technique is insensitive to longitudinal setup errors (1-3mm) in patients because of the existence of low dose gradients at the junction between fields. This is unlike the 3D conformal radiotherapy plans which have steep dose gradients at the field edges and thus are highly sensitive to setup errors. Such an advantage for VMAT circumvents the need for dose feathering often practiced with the 3D conformal radiotherapy technique and makes the technique simpler to follow.
[Mh] Termos MeSH primário: Radiação Cranioespinal/métodos
Radioterapia de Intensidade Modulada/métodos
[Mh] Termos MeSH secundário: Criança
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Tomografia Computadorizada Multidetectores
Órgãos em Risco
Dosagem Radioterapêutica
Planejamento da Radioterapia Assistida por Computador
Radioterapia Conformacional
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:28464748
[Au] Autor:Jensen CA; Acosta Roa AM; Lund JÅ; Frengen J
[Ad] Endereço:a Department of Oncology , Ålesund Hospital , Ålesund , Norway.
[Ti] Título:Intrafractional baseline drift during free breathing breast cancer radiation therapy.
[So] Source:Acta Oncol;56(6):867-873, 2017 Jun.
[Is] ISSN:1651-226X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intrafraction motion in breast cancer radiation therapy (BCRT) has not yet been thoroughly described in the literature. It has been observed that baseline drift occurs as part of the intrafraction motion. This study aims to measure baseline drift and its incidence in free-breathing BCRT patients using an in-house developed laser system for tracking the position of the sternum. MATERIALS AND METHODS: Baseline drift was monitored in 20 right-sided breast cancer patients receiving free breathing 3D-conformal RT by using an in-house developed laser system which measures one-dimensional distance in the AP direction. A total of 357 patient respiratory traces from treatment sessions were logged and analysed. Baseline drift was compared to patient positioning error measured from in-field portal imaging. RESULTS: The mean overall baseline drift at end of treatment sessions was -1.3 mm for the patient population. Relatively small baseline drift was observed during the first fraction; however it was clearly detected already at the second fraction. Over 90% of the baseline drift occurs during the first 3 min of each treatment session. The baseline drift rate for the population was -0.5 ± 0.2 mm/min in the posterior direction the first minute after localization. Only 4% of the treatment sessions had a 5 mm or larger baseline drift at 5 min, all towards the posterior direction. Mean baseline drift in the posterior direction in free breathing BCRT was observed in 18 of 20 patients over all treatment sessions. CONCLUSIONS: This study shows that there is a substantial baseline drift in free breathing BCRT patients. No clear baseline drift was observed during the first treatment session; however, baseline drift was markedly present at the rest of the sessions. Intrafraction motion due to baseline drift should be accounted for in margin calculations.
[Mh] Termos MeSH primário: Neoplasias da Mama/radioterapia
Movimento/efeitos da radiação
Órgãos em Risco/efeitos da radiação
Posicionamento do Paciente
Planejamento da Radioterapia Assistida por Computador/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Neoplasias da Mama/diagnóstico por imagem
Fracionamento de Dose
Feminino
Seres Humanos
Processamento de Imagem Assistida por Computador/métodos
Meia-Idade
Dosagem Radioterapêutica
Radioterapia Conformacional/métodos
Respiração
Tomografia Computadorizada por Raios X/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1080/0284186X.2017.1288924


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[PMID]:29277803
[Au] Autor:Ishibashi N; Maebayashi T; Aizawa T; Sakaguchi M; Okada M; Matsushita J
[Ad] Endereço:Department of Radiology, Nihon University School of Medicine, Tokyo, Japan ishibashi.naoya@nihon-u.ac.jp.
[Ti] Título:Computed Tomography Density Change in the Thyroid Gland Before and After Radiation Therapy.
[So] Source:Anticancer Res;38(1):417-421, 2018 01.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: Hypothyroidism is an established adverse effect of radiation therapy for head and neck cancer, and computed tomography (CT) density of the thyroid gland is lower in hypothyroid than euthyroid individuals. No previous studies have evaluated changes in CT densities of the thyroid gland caused by radiation therapy. The aim was to investigate the relationship between the change in CT density of the thyroid gland before and after radiation therapy for head and neck cancer and hypothyroidism. MATERIALS AND METHODS: This retrospective study analyzed data of 24 patients treated by radiation therapy for head and neck cancers. After dosimetric analysis of received radiation therapy, a Picture Archiving and Communication System was used to manually contour the thyroid on pre-treatment CT images to enable determination of mean thyroid gland CT densities and received radiation doses. Pre- and post-treatment thyroid function was assessed on the basis of serum TSH concentrations. Multivariate and univariate analyses were used to determine what clinical factors are associated with post-radiation therapy decrease in CT density of the thyroid and Pearson's χ test was used to assess correlations between these densities and TSH concentrations. RESULTS: Mean CT densities of the thyroid gland decreased from before to after radiation therapy in 73.9% of our patients (median decrease 16.8 HU). Serum TSH concentrations were significantly higher in patients with greater then median decreases in CT density than in those with lesser or no decreases. CONCLUSION: Post-radiation therapy hypothyroidism may be predicted by significant decreases in CT density of the thyroid gland.
[Mh] Termos MeSH primário: Neoplasias de Cabeça e Pescoço/radioterapia
Hipotireoidismo/etiologia
Lesões por Radiação/etiologia
Radioterapia Conformacional/efeitos adversos
Glândula Tireoide/diagnóstico por imagem
Glândula Tireoide/efeitos da radiação
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem
Neoplasias de Cabeça e Pescoço/patologia
Seres Humanos
Masculino
Meia-Idade
Dose de Radiação
Radiometria
Estudos Retrospectivos
Glândula Tireoide/fisiopatologia
Tiroxina/sangue
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
Q51BO43MG4 (Thyroxine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE


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[PMID]:29277799
[Au] Autor:Sasaki N; Yamazaki H; Shimizu D; Suzuki G; Masui K; Nakamura S; Okabe H; Nishikawa T; Yoshida K
[Ad] Endereço:Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
[Ti] Título:Long-term Outcomes of a Dose-reduction Trial to Decrease Late Gastrointestinal Toxicity in Patients with Prostate Cancer Receiving Soft Tissue-matched Image-guided Intensity-modulated Radiotherapy.
[So] Source:Anticancer Res;38(1):385-391, 2018 01.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: We experienced an unexpected high incidence of gastrointestinal (GI) toxicity in patients undergoing image-guided intensity-modulated radiotherapy (IG-IMRT) using helical tomotherapy in our initial 2.2 Gy/fraction schedule for prostate cancer; hence, a dose-reduction trial from 2.2 Gy to 2 Gy/fraction was conducted using modified planning target volume (PTV) contouring. PATIENTS AND METHODS: We compared 130 patients treated using 2.2 Gy/fraction (Group A) and 144 treated using the 2 Gy/fraction (Group B) with modified PTV (excluding rectal volume) with a median follow-up period of 62 months. Prescribed dose was 72.6-74.8 Gy in 33-34 fractions (Group A) and 72-74 Gy in 36-37 fractions (Group B). RESULTS: Patients in Group B had a reduced rectal and bladder V10-V70 and were irradiated at the maximal dose. Their cumulative incidence of grade ≤2 GI toxicity at 5 years improved from 10.1% [95% confidence interval (CI), 4.9-15.3%] to 1.4% (0-3.3%). Grade 2≤ urinary toxicity also decreased from 5.5% (1.5-9.4%) in Group A to 1.4% (0-3.3%, p=0.0167) in Group B. The biochemical failure-free 5-year survival rate was 89.1% (95%CI=83.6-95.4%) and 87.5% (82.0-92.9%, p=0.75) in groups A and B, respectively. CONCLUSION: The reduced dose fraction schedule decreased the incidence of late GI toxicity without compromising prostate-specific antigen control. Careful target volume definition and fraction size are important even for IG-IMRT.
[Mh] Termos MeSH primário: Gastroenteropatias/prevenção & controle
Neoplasias da Próstata/radioterapia
Lesões por Radiação/prevenção & controle
Dosagem Radioterapêutica
Radioterapia Conformacional/efeitos adversos
Radioterapia Guiada por Imagem/efeitos adversos
Radioterapia de Intensidade Modulada/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Gastroenteropatias/etiologia
Trato Gastrointestinal/patologia
Trato Gastrointestinal/efeitos da radiação
Seres Humanos
Masculino
Meia-Idade
Antígeno Prostático Específico/sangue
Resultado do Tratamento
Sistema Urinário/patologia
Sistema Urinário/efeitos da radiação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
EC 3.4.21.77 (Prostate-Specific Antigen)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE


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[PMID]:29208438
[Au] Autor:Spratt DE; Beeler WH; de Moraes FY; Rhines LD; Gemmete JJ; Chaudhary N; Shultz DB; Smith SR; Berlin A; Dahele M; Slotman BJ; Younge KC; Bilsky M; Park P; Szerlip NJ
[Ad] Endereço:Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA. Electronic address: sprattda@med.umich.edu.
[Ti] Título:An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report.
[So] Source:Lancet Oncol;18(12):e720-e730, 2017 Dec.
[Is] ISSN:1474-5488
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Spinal metastases are becoming increasingly common because patients with metastatic disease are living longer. The close proximity of the spinal cord to the vertebral column limits many conventional therapeutic options that can otherwise be used to treat cancer. In response to this problem, an innovative multidisciplinary approach has been developed for the management of spinal metastases, leveraging the capabilities of image-guided stereotactic radiosurgery, separation surgery, vertebroplasty, and minimally invasive local ablative approaches. In this Review, we discuss the variables that should be considered during the management of these patients and review the role of each discipline and their respective management options to provide optimal care. This work is synthesised into a practical algorithm to aid clinicians in the management of patients with spinal metastasis.
[Mh] Termos MeSH primário: Radiocirurgia/métodos
Radioterapia Conformacional/métodos
Compressão da Medula Espinal/cirurgia
Neoplasias da Coluna Vertebral/secundário
Neoplasias da Coluna Vertebral/terapia
[Mh] Termos MeSH secundário: Algoritmos
Terapia Combinada
Congressos como Assunto
Descompressão Cirúrgica/métodos
Eletromiografia/métodos
Feminino
Seres Humanos
Comunicação Interdisciplinar
Internacionalidade
Imagem por Ressonância Magnética/métodos
Masculino
Compressão da Medula Espinal/diagnóstico por imagem
Neoplasias da Coluna Vertebral/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


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[PMID]:29187490
[Au] Autor:Masui T; Takaori K; Anazawa T; Sato A; Nakano K; Uchida Y; Yogo A; Goto Y; Matsumoto S; Kodama Y; Kanai M; Isoda H; Mizumoto M; Kawaguchi Y; Shibuya K; Itasaka S; Uemoto S
[Ad] Endereço:Department of Surgery, Kyoto University, Kyoto, Japan tmasui@kuhp.kyoto-u.ac.jp.
[Ti] Título:A Prospective Study of Intensity-modified Radiation Therapy in Comparison with Conventional 3D-RT for BR Pancreatic Cancer Patients with Arterial Involvement.
[So] Source:Anticancer Res;37(12):7023-7030, 2017 12.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: Intensity-modulated radiation therapy (IMRT) is a form of radiation therapy that allows accurate irradiation with reduced damage to surrounding tissues. Here, we analyzed borderline-resectable pancreatic cancer (BRPC) with arterial abutment (BR-A) patients with IMRT as neoadjuvant therapy and performed comparisons with patients with conventional RT to clarify the advantages of IMRT as a neoadjuvant therapy. PATIENTS AND METHODS: Thirty BR-A patients treated at our hospital between January 2012 and December 2015 were divided into two groups: 12 patients underwent conventional 3D-RT before resection (RT group); and 18 patients underwent IMRT before resection (IMRT group). We analyzed safety, tumor resection rate, histological classification of the tumor and overall survival. RESULTS: The R0 rate was 84% for the IMRT group and 83% for the RT group. Local therapeutic effects as assessed by Evans classification showed a higher local control rate in the IMRT group (Grade: 1, 0%; 2a, 25%; 2b, 41.6%; 3, 17%; 4, 8%) than in the RT group (Grade: 1, 17%; 2a, 50%; 2b, 17%; 3, 17%; 4, 0%). The cumulative dose of S1 treatment as adjuvant therapy was much smaller in the RT group (18.3%) compared to that in the IMRT group (57.1%, p=0.047), and with better subsequent overall survival rate (MST 32 months vs. 13.8 months, p=0.0273). CONCLUSION: The IMRT group showed a better control rate than the RT group. The neoadjuvant IMRT has advantages of higher completion rate of adjuvant chemotherapy with better nutritional status and better subsequent overall survival rate (OS).
[Mh] Termos MeSH primário: Artérias/efeitos da radiação
Neoplasias Pancreáticas/radioterapia
Radioterapia Conformacional/métodos
Radioterapia de Intensidade Modulada/métodos
[Mh] Termos MeSH secundário: Idoso
Artérias/patologia
Quimiorradioterapia
Feminino
Seres Humanos
Masculino
Meia-Idade
Terapia Neoadjuvante
Pâncreas/efeitos dos fármacos
Pâncreas/efeitos da radiação
Pâncreas/cirurgia
Neoplasias Pancreáticas/irrigação sanguínea
Estudos Prospectivos
Análise de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE


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[PMID]:28748453
[Au] Autor:Holzhäuser E; Berlin M; Wollschläger D; Bezold T; Mayer A; Heß G; Schmidberger H
[Ad] Endereço:Department of Radiation Oncology and Radiotherapy, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. eva.holzhaeuser@unimedizin-mainz.de.
[Ti] Título:Patterns of failure of diffuse large B­cell lymphoma patients after involved-site radiotherapy.
[Ti] Título:Rezidivmuster bei Patienten mit diffusem großzelligem B­Zell-Lymphom nach "Involved-site"-Radiotherapie..
[So] Source:Strahlenther Onkol;193(12):1014-1023, 2017 Dec.
[Is] ISSN:1439-099X
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Radiotherapy (RT) in combination with chemoimmunotherapy is highly efficient in the treatment of diffuse large B­cell lymphoma (DLBCL). This retrospective analysis evaluated the efficacy of the treatment volume and the dose concept of involved-site RT (ISRT). PATIENTS AND METHODS: We identified 60 histologically confirmed stage I-IV DLBCL patients treated with multimodal cytotoxic chemoimmunotherapy and followed by consolidative ISRT from 2005-2015. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method. Univariate analyses were performed by log-rank test and Mann-Whitney U­test. RESULTS: After initial chemoimmunotherapy (mostly R­CHOP; rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), 19 (36%) patients achieved complete response (CR), 34 (64%) partial response (PR) or less. Excluded were 7 (12%) patients with progressive disease after chemoimmunotherapy. All patients underwent ISRT with a dose of 40 Gy. After a median follow-up of 44 months, 79% of the patients remained disease free, while 21% presented with failure, progressive systemic disease, or death. All patients who achieved CR after chemoimmunotherapy remained in CR. Of the patients achieving PR after chemotherapy only 2 failed at the initial site within the ISRT volume. No marginal relapse was observed. Ann Arbor clinical stage I/II showed significantly improved PFS compared to stage III/IV (93% vs 65%; p ≤ 0.021). International Prognostic Index (IPI) score of 0 or 1 compared to 2-5 has been associated with significantly increased PFS (100% vs 70%; p ≤ 0.031). Postchemoimmunotherapy status of CR compared to PR was associated with significantly increased PFS (100% vs 68%; p ≤ 0.004) and OS (100% vs 82%; p ≤ 0.026). Only 3 of 53 patients developed grade II late side effects, whereas grade III or IV side effects have not been observed. CONCLUSION: These data suggest that a reduction of the RT treatment volume from involved-field (IF) to involved-site (IS) is sufficient because no marginal failures occurred. The concept of IS will likely reduce the risk for late sequelae of RT.
[Mh] Termos MeSH primário: Linfoma Difuso de Grandes Células B/mortalidade
Linfoma Difuso de Grandes Células B/radioterapia
Recidiva Local de Neoplasia/mortalidade
Recidiva Local de Neoplasia/prevenção & controle
Radioterapia Conformacional/mortalidade
Falha de Tratamento
[Mh] Termos MeSH secundário: Adulto
Distribuição por Idade
Idoso
Idoso de 80 Anos ou mais
Intervalo Livre de Doença
Feminino
Alemanha/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Prevalência
Radioterapia Conformacional/estatística & dados numéricos
Fatores de Risco
Distribuição por Sexo
Taxa de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1007/s00066-017-1186-x


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[PMID]:29060966
[Au] Autor:Du XX; Yang H; Zhang HJ; Li LA; Fan WS; Meng YG
[Ad] Endereço:Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China.
[Ti] Título:[Clinical study of intensity modulated radiotherapy and three-dimensional conformal radiotherapy with three-dimensional brachytherapy and concurrent chemotherapy for patients with advanced cervical cancer].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(10):679-686, 2017 Oct 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To compare the dose, clinical efficacy and acute adverse reactions of intensity modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) combined with three-dimensional brachytherapy (3D-BT) in the treatment of concurrent radiotherapy and chemotherapy for advanced stage cervical cancer patients. Data collection was performed from January 2011 to November 2015 in Chinese PLA General Hospital and Inner Mongolia Cancer Hospital. All 89 patients with advanced stage (â…¡ b-â…¢ b) cervical cancer were treated by pelvic radiotherapy and concurrent chemotherapy, 46 cases of them received IMRT and 3D-BT (IMRT group) , 43 cases received 3D-CRT and 3D-BT (3D-CRT group) , along with cisplatin chemotherapy. The dose accumulation of external beam radiotherapy and 3D-BT was calculated by deformable image registration to analyze clinical efficacy, acute adverse reactions and prognosis of the two groups. (1) Dose of radiotherapy: planning target volume (PTV) coverage of IMRT group and 3D-CRT group were respectively (95.4±4.7)% and (95.1±5.1)%, without significant differences ( 0.289, 0.773). Compared with the patients treated with 3D-CRT, the volumn receiving at least 30 Gy ( (30)), (50) of rectum, colon, bladder and small intestine and (20) of bone marrow in the IMRT group were significantly decreased ( 0.05). Regarding the combined dose, the maximum dose (D(max)) and the minimum dose received by the most exposed 2 cm(3) volume of the analyzed organ (D(2CC)) of rectum, colon, bladder and small intestine of IMRT group were significantly lower than those of 3D-CRT group ( 0.05). (2) Short-term efficacy: the effective rate of IMRT and 3D-CRT group were respectively 93% (43/46) and 91% (39/43), with no significant differences (χ(2)=0.237, 0.626). (3) Acute adverse reactions: compared with 3D-CRT, IMRT could significantly reduce grade 1-2 acute toxicity in gastrointestinal [63%(29/46) vs 84%(36/43)], genitourinary [17%(8/46) vs 37%(16/43)] and hematologic [57%(26/46) vs 79%(34/43)] system (all 0.05). There were no significant differences of grade 3 acute adverse reactions of gastrointestinal, genitourinary and hematologic system between two groups (all 0.05). No grade 4 acute adverse reactions were observed. (4) Prognosis: the overall survival rate at 1, 2-year of IMRT and 3D-CRT group were respectively 95.6%, 89.1% and 93.1%, 86.1%. The progression-free survival rateat 1, 2-year of IMRT and 3D-CRT group were 91.1%, 89.1% and 88.4%, 86.1%, respectively. There were no significant differences in overall survival rate and progression-free survival rate between two groups ( 0.05). Compared with 3D-CRT, IMRT combined with 3D-BT has dosimetry advantages based on dose accumulation algorithms by deformable image registration. IMRT could ensure clinical efficacy and significantly reduce the incidence rate of acute toxicities.
[Mh] Termos MeSH primário: Braquiterapia
Cisplatino/uso terapêutico
Planejamento da Radioterapia Assistida por Computador/métodos
Radioterapia Conformacional/métodos
Radioterapia de Intensidade Modulada/métodos
Neoplasias do Colo do Útero/terapia
[Mh] Termos MeSH secundário: China
Intervalo Livre de Doença
Feminino
Seres Humanos
Pelve
Prognóstico
Dosagem Radioterapêutica
Radioterapia Conformacional/efeitos adversos
Radioterapia de Intensidade Modulada/efeitos adversos
Reto/efeitos da radiação
Índice de Gravidade de Doença
Taxa de Sobrevida
Bexiga Urinária/efeitos da radiação
Sistema Urogenital/efeitos da radiação
Neoplasias do Colo do Útero/mortalidade
Neoplasias do Colo do Útero/patologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171025
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567X.2017.10.007



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