RESUMEN
PURPOSE: To report survival outcomes and identify prognostic factors of salvage re-irradiation (re-RT) in recurrent/progressive glioma. METHODS: Medical records of patients treated with high-dose re-RT as part of multi-modality salvage therapy for recurrence/progression of adult diffuse glioma from 2010 to 2019 were analyzed retrospectively. RESULTS: A total of 111 patients developing recurrent/progressive high-grade glioma after adequate upfront treatment at initial diagnosis were included. The first course of radiotherapy (RT) had been delivered to a median dose of 59.4 Gy with an inter-quartile range (IQR) of 54-60 Gy. Median time to recurrence/progression was 4.3 years (IQR = 2.3-7.4 years) while the median time to re-RT was 4.8 years (IQR = 3.6-7.9 years). Re-RT was delivered with intensity-modulated radiation therapy (IMRT) using 1.8 Gy/fraction to a median dose of 54 Gy (IQR = 50.4-55.8 Gy) for a cumulative median equivalent dose in 2-Gy fractions (EQD2) of 104.3 Gy (IQR = 102.6-109.4 Gy). At a median follow-up of 14 months after re-RT, the 1-year Kaplan-Meier estimates of post-re-RT progression-free survival (PFS) and overall survival (OS) were 42.8 and 61.8%, respectively. Univariate analysis identified histological grade at recurrence/progression; histological subtype; disease-free interval (DFI) and time interval between both courses of RT; performance status at re-RT; dose at re-RT and cumulative EQD2; isocitrate dehydrogenase (IDH) mutation; and O6-methyl-guanine DNA methyl transferase (MGMT) gene promoter methylation as significant prognostic factors. Preserved performance status, longer DFI, prolonged time interval between both courses of RT, and presence of IDH mutation were associated with significantly improved PFS on multi-variate analysis. However, only performance status retained independent prognostic significance for OS on multi-variate analysis. Post-treatment changes were seen in 33 (30%) patients on follow-up imaging, with higher cumulative dose (EQD2 ≥ 104.3 Gy) being associated with increased risk of post-re-RT pseudo-progression. CONCLUSION: This clinical audit reports encouraging survival outcomes and identifies key prognostic factors associated with high-dose salvage re-RT in recurrent/progressive glioma.
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Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/radioterapia , Glioma/mortalidad , Glioma/radioterapia , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/radioterapia , Reirradiación , Adolescente , Adulto , Neoplasias Encefálicas/patología , Progresión de la Enfermedad , Femenino , Glioma/patología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Dosificación Radioterapéutica , Reirradiación/efectos adversos , Reirradiación/métodos , Estudios Retrospectivos , Terapia Recuperativa , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Pasteurised milk--120 samples--was analysed (in Santa Fe City, Argentina) to determine organochlorinated pesticides. Almost all samples showed the presence of such residues; the compounds more frequently detected being: heptachlor and its epoxide (98%) and hexachlorocyclohexane .HCH. alpha and gamma isomers. Residues of aldrin and dieldrin; chlordane (alpha and gamma); endosulfan (I and II); DDT (o,p-DDT, p,p'-DDE, o,p-DDD, p,p'-DDD) as well as hexachlorocyclobenzene (HCB) were also found. Despite their presence high concentrations are sporadic, the mean values being less than FAO/OMS tolerance limits. Relations between maxima concentrations and seasons were not found.
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Hidrocarburos Clorados , Insecticidas/análisis , Leche/química , Residuos de Plaguicidas/análisis , Animales , Argentina , Concentración Máxima AdmisibleRESUMEN
PURPOSE: To analyse the transseptal catheterization technique, its indications and possible complications. METHODS: The transseptal catheterization has been undertaken in 233 patients, 202 children (aged 0.1 to 16 years) with congenital heart disease and 31 adults (aged 37 to 73 years) submitted to mitral valvuloplasty. The Mullins technique was employed to access left heart chambers. RESULTS: In the pediatric group, the indications for transseptal catheterization were coarctation of the aorta and valvular or subvalvular aortic stenosis. By this technique, multiple diagnostic analysis and therapeutic procedures, such as blade atrioseptostomy and mitral valvuloplasty, became available. Among the complications in the 2 groups, pericardial perforation was the most frequent, depending on the laboratory practice with this technique. CONCLUSION: The transseptal cardiac catheterization is a safe and effective technique to investigate hemodynamic data in several congenital heart diseases and is essential to many therapeutic procedures. The technique has a low incidence of complications when employed by experienced teams.
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Cateterismo Cardíaco/métodos , Cateterismo , Cardiopatías Congénitas/terapia , Tabiques Cardíacos/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Cardiopatías Congénitas/diagnóstico , Hemodinámica/fisiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/terapiaRESUMEN
Presentamos 12 casos de rabdomioma intracardíaco. Revisamos la edad, formas clínicas de presentación y los hallazgos en las exploraciones complementarias. El diagnóstico de tumor intracardíaco se hizo por ecocardiografía en 11 casos; un caso con afectación miocárdica difusa fue diagnosticado inicialmente de miocardiopatía hipertrófica. Se indicó tratamiento quirúrgico en 8 casos, por presentar distintas formas de obstrucción al flujo sanguíneo intracardíaco, realizándose en 7. El diagnóstico de rabdomioma se confirmó en 9 casos por estudio histológico. De los 12 casos viven actualmente 8, 5 operados y 3 sin operar, todos asintomáticos cardiológicamente; 5 (62%) presentan manifestaciones neurocutáneas de esclerosis tuberosa
Asunto(s)
Humanos , Neoplasias Cardíacas/diagnóstico , Rabdomioma/diagnóstico , Ecocardiografía , Neoplasias Cardíacas/cirugía , Rabdomioma/cirugíaRESUMEN
Presentamos 12 casos de rabdomioma intracardíaco. Revisamos la edad, formas clínicas de presentación y los hallazgos en las exploraciones complementarias. El diagnóstico de tumor intracardíaco se hizo por ecocardiografía en 11 casos; un caso con afectación miocárdica difusa fue diagnosticado inicialmente de miocardiopatía hipertrófica. Se indicó tratamiento quirúrgico en 8 casos, por presentar distintas formas de obstrucción al flujo sanguíneo intracardíaco, realizándose en 7. El diagnóstico de rabdomioma se confirmó en 9 casos por estudio histológico. De los 12 casos viven actualmente 8, 5 operados y 3 sin operar, todos asintomáticos cardiológicamente; 5 (62%) presentan manifestaciones neurocutáneas de esclerosis tuberosa (AU)