RESUMEN
BACKGROUND AND PURPOSE: To evaluate the feasibility of low-dose preoperative prophylactic liver irradiation (PLI) combined with preoperative accelerated hyperfractionated pelvic irradiation (HART) in patients with locally advanced rectal cancer. PATIENTS AND METHODS: Between 1999 and 2003 62 patients were enrolled: 38 (61%) received HART and 24 (39%) HART+PLI. The pelvis was irradiated twice a day, with a minimal interfraction interval of 6h: the total dose of 42 Gy was given in 1.5 Gy per fractions over 18 days. The PLI (14 Gy in 10 daily fractions of 1.4 Gy) was given simultaneously with the morning fraction of HART. Twenty patients (32%), including 7 in PLI group, received 5-Fu based postoperative chemotherapy. RESULTS: In general, acute normal tissue reactions appeared tolerable irrespectively of PLI. Six to twelve months after completion of combined therapy the mean ALAT levels in patients treated with HART alone (25 pts), HART+chemotherapy (13 pts), HART+PLI (17 pts), and HART+PLI+chemotherapy (7 pts) were 15, 21, 26 and 55 IU/l, respectively. A mild increase of ALAT levels observed in the HART+PLI+chemotherapy sub-group was non-symptomatic. Three-year actuarial loco-regional control rate in a group of 62 patients was 94%. None of the patients who received PLI developed metastases during the follow-up, compared to 10 out of 38 patients (26%) with no PLI. A difference in metastases-free survival in favor of HART+PLI can be, however, attributed to selection of patients for PLI who were in better general health and stage of disease than those treated with HART. CONCLUSIONS: Further use of PLI may be limited due to asymptomatic, but detectable biochemical changes of liver function when PLI is sequentially combined with chemotherapy. HART, on the other hand, provides acceptable rate of local control, and is well tolerated, also when combined with postoperative chemotherapy.
Asunto(s)
Fraccionamiento de la Dosis de Radiación , Hígado/efectos de la radiación , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Anciano , Biopsia , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Metástasis de la Neoplasia , Proyectos Piloto , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of the study was the qualitative and quantitative evaluation of acute radiation-induced rectal changes in patients who underwent preoperative radiotherapy according to two different irradiation protocols. PATIENTS AND METHODS: Sixty-eight patients with rectal adenocarcinoma underwent preoperative radiotherapy; 44 and 24 patients underwent hyperfractionated and hypofractionated protocol, respectively. Fifteen patients treated with surgery alone served as a control group. Five basic histopathologic features (meganucleosis, inflammatory infiltrations, eosinophils, mucus secretion, and erosions) and two additional features (mitotic figures and architectural glandular abnormalities) of radiation-induced changes were qualified and quantified. RESULTS: Acute radiation-induced reactions were found in 66 patients. The most common were eosinophilic and plasma-cell inflammatory infiltrations (65 patients), erosions, and decreased mucus secretion (54 patients). Meganucleosis and mitotic figures were more common in patients who underwent hyperfractionated radiotherapy. The least common were the glandular architectural distortions, especially in patients treated with hypofractionated radiotherapy. Statistically significant differences in morphologic parameters studied between groups treated with different irradiation protocols were found. CONCLUSION: The system of assessment is a valuable tool in the evaluation of radiation-induced changes in the rectal mucosa. A greater intensity of regenerative changes was found in patients treated with hyperfractionated radiotherapy.
Asunto(s)
Adenocarcinoma/radioterapia , Mucosa Intestinal/efectos de la radiación , Traumatismos por Radiación/patología , Neoplasias del Recto/radioterapia , Recto/efectos de la radiación , Adenocarcinoma/cirugía , Adulto , Anciano , Terapia Combinada/métodos , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Mucosa Intestinal/patología , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Neoplasias del Recto/cirugía , Recto/patologíaRESUMEN
The first case of osseous metaplasia in rectal cancer is described. The authors present the diagnostic evaluation based on the transrectal ultrasound examination, determination of neoplastic markers, pathological examination, treatment, and follow-up in a 69-year-old man.
Asunto(s)
Osificación Heterotópica/patología , Neoplasias del Recto/patología , Anciano , Humanos , Masculino , Metaplasia , Osificación Heterotópica/diagnóstico por imagen , Neoplasias del Recto/diagnóstico por imagen , UltrasonografíaRESUMEN
UNLABELLED: The progress of operative technique, introduction of new drugs, modernizing of medical equipment are the cause of long and complicated operations. For that reason, the number of patients, who need the catheterization of the urinary bladder is increasing. The use of the vesical catheter over 5 days is the cause of the urinary tract infection (bacterial and mycotic), the bacteraemia and the extension of the time of recovery. The aim of the study was the estimation of the usefulness of the preparation Instillagel used at the time of the urinary bladder catheterization in the patients before an operation, in aspect of frequency of urinary tract infection. Between January and December 2000, 59 patients were selected for the study. The patients were divided into two groups. In the first group, the preparation Instillagel was used at the time of the catheterization. In the control group 2% Lignocainum hydrochloricum was used at the time of the catheterization. The study was prospective and randomized. The usefulness of the preparation Insillagel was estimated through the comparison of frequency of the urinary tract infection in both groups. The catheterization of the urinary bladder was performed according to aseptic principle. The difference between number and age of the patients in both groups was not statistically significant (p = 0.8538). The time of the keeping of the vesical catheter was similar in both groups (p = 0.576635). The urinary tract infection estimated on the basis of clinical symptoms and laboratory findings was diagnosed in 13 patients (5 patients in the first group, and 8 patients in the control group). The frequency of urinary tract infection was not statistically significant in both groups. CONCLUSIONS: The urinary tract infection is frequent complication in patients with catheter in the urinary bladder, before operation. The frequency of urinary tract infection was not statistically significant in both groups. The discomfort and pain occurred with the same frequency in both groups.