RESUMO
BACKGROUND: There is growing evidence that the subventricular zone (SVZ) may be involved in both the initiation and progression of glioblastoma (GB). We aimed to assess tumor proximity to the SVZ as a potential prognostic factor in GB. METHOD: Retrospective study of 133 patients diagnosed with primary GB who underwent surgery followed by temozolomide-based chemoradiation between 2010 and 2016. All lesions were classified according to their anatomic relation with the SVZ. We determined the effect of tumor contact with the SVZ on progression-free survival (PFS), overall survival (OS), type, and patterns of recurrence. RESULTS: At a median follow-up of 18.6 months (95% CI 15.9-21.2), PFS and OS were 7.5 (95% CI 6.7-8.3) and 13.9 (95% CI 10.9-16.9) months, respectively. On the univariate analyses, initial contact with the SVZ was a factor for poor prognosis for both PFS (6.1 vs. 8.7 months; p = 0.006) and OS (10.6 vs. 17.9 months; p = 0.037). On the multivariate analysis, tumor contact with the SVZ remained statistically significant for PFS, but not OS. Patients with SVZ-contacting tumors presented a higher rate of aggressive clinical progression (30.9% vs. 11.3%; p = 0.007) and contralateral relapse patterns (23.4% vs. 9.1%; p = 0.048). CONCLUSIONS: Our results suggest that glioblastoma contact with the SVZ appears to be an independent prognostic factor for poor PFS. The presence of an SVZ-contacting tumor was associated with more aggressive recurrences and a higher rate of contralateral relapses. These findings suggest that this variable may be a new prognostic factor in glioblastoma.
Assuntos
Neoplasias Encefálicas/patologia , Glioblastoma/patologia , Ventrículos Laterais/patologia , Recidiva Local de Neoplasia , Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/terapia , Quimiorradioterapia , Intervalos de Confiança , Feminino , Seguimentos , Glioblastoma/etiologia , Glioblastoma/mortalidade , Glioblastoma/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Prognóstico , Intervalo Livre de Progressão , Dosagem Radioterapêutica , Estudos Retrospectivos , Temozolomida/uso terapêuticoRESUMO
Marco teórico: La infección por VIH es una pandemia en aumento en el mundo. Con el advenimiento de la Terapia Antirretroviral (TARV), la sobrevida de los pacientes infectados por VIH en Unidades de Cuidados Intensivos (UCI) ha aumentado significativamente. Dado que existe escasa literatura nacional respecto a estos pacientes en UCI, a través del presente estudio se buscó determinar si existen diferencias en el pronóstico de los pacientes con diagnóstico VIH respectode pacientes sin diagnóstico de infección por VIH que ingresan a la UCI del Hospital Dr. Gustavo Fricke (HGF). Materiales y métodos: Se realizó un estudio observacional de cohorte prospectiva en todos los pacientes hospitalizados en la UCI del hospital Dr. Gustavo Fricke, entre febrero y mayo del 2016. Resultados: Se incluyeron un total de 136 pacientes, de los cuales 10 (7,35%) eran portadores de infección por VIH cuyo motivo de ingreso más frecuente fue insuficiencia respiratoria (n=5, 50%); de estos, el 60% (n=6) falleció durante su estadia en UCI. Hubo diferencias estadísticamente significativas en la mortalidad entre ambos grupos(p<0,01) y en la mediana de edad, siendo esta menor en el grupo de los pacientes con infección por VIH. Conclusiones: En el presente estudio se observó que existen diferencias en el pronóstico de pacientes con diagnóstico VIH(+) con respecto a los pacientes sin diagnóstico de VIH en la UCI del HGF. La mortalidad es significativamente mayor en el grupo VIH (+), sin embargo, parece necesario extender el tiempo de recolección de datos para poder establecer más asociaciones.
Background: The HIV pandemic infection rates are increasing worldwide. With the advent of antiretroviral therapy, the HIV infected patient's survival in intensive care units has improved significantly. As there is little national literature about these intensive care patients, we plan, with this study, to determine if there are differences between the prognoses of HIV infected and non-HIV patients admitted to the Dr Gustavo Fricke Hospital ICU. Methods: From February 1st through to May 20th, we conducted an observational prospective cohort study in the Dr Gustavo Fricke Hospital ICU. Results: A total of 136 patients were included. 10 (7.35%) were HIV infected, their most frequent cause for admission being respiratory failure (n=5. 50%). Of these 60% (n=6) died during their ICU stay. There was a statistically significant difference (p<0.01) in mortality between the groups and in the median age which was lower in HIV patients. Conclusions: There were differences in the prognosis of HIV (+) patients in contrast with HIV (-) patients in the Dr Gustavo Fricke Hospital ICU. Mortality rates were significantly higher in the HIV (+) group. Nevertheless, it is necessary to extend the data collection period in order to establish more associations.
RESUMO
BACKGROUND: The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus. METHODS: Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m2/week (days 1, 8, 15), LDCI-FU 300 mg/m2/day (days 1-21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy. RESULTS: From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3-4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4-35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04). CONCLUSIONS: Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.