RESUMO
PURPOSE: Metastasis-directed therapy (MDT) is an investigational treatment option in patients with oligorecurrent prostate cancer (PCa). The aim of this retrospective study is to report oncologic outcome and toxicity of elective nodal radiotherapy (ENRT) in PCa patients affected by pelvic nodal oligorecurrence. METHODS: 41 consecutive patients were treated with salvage radiotherapy. At biochemical recurrence after primary treatment, oligorecurrent disease was detected by positron emission tomography (PET) in 94% of the patients. Image-guided intensity modulated radiation therapy (IMRT) was delivered using tomotherapy. 83% of the patients received androgen deprivation therapy (ADT) in combination with ENRT. Survival analysis was performed with Kaplan-Meier method, log-rank test was used to analyze associations between survival end-points and clinical parameters. Multivariate analysis was performed using Cox proportional hazards regression models. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. RESULTS: The median at follow-up was 33.6 months. At 3 years, overall survival (OS), cancer-specific survival (CSS), and biochemical progression-free survival (b-PFS) were 89%, 92%, and 53%, respectively. At univariate analysis, all survival end-points were correlated with the number of positive pelvic lymph nodes at oligorecurrence (≤ 3 vs > 3). Biochemical-PFS was correlated with PSA (p = 0.034) and PSA doubling time (p = 0.004) at oligorecurrence. At multivariate analysis, no independent variable was statistically significant. No patient experienced grade ≥ 2 late toxicity after radiotherapy. CONCLUSIONS: The number of metastatic lymph nodes and PSA doubling time seems to be important prognostic factors in the pelvic oligorecurrent setting. Salvage radiotherapy combined with short-course ADT might be a valid treatment strategy.
Assuntos
Irradiação Linfática , Recidiva Local de Neoplasia/radioterapia , Neoplasias da Próstata/radioterapia , Terapia de Salvação/métodos , Idoso , Antagonistas de Androgênios/uso terapêutico , Terapia Combinada/métodos , Humanos , Estimativa de Kaplan-Meier , Linfonodos/patologia , Irradiação Linfática/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/tratamento farmacológico , Estudos Retrospectivos , Terapia de Salvação/efeitos adversosRESUMO
O Brasil é rico em frutas de sabores característicos, destacando-se a região nordeste como grande produtora de frutas tropicais. Visando encontrar alternativas tecnológicas que proporcionasse o aproveitamento integral desta matéria prima, utilizou-se a combinação do iogurte com polpas de frutas regionais no desenvolvimento de uma sobremesa. Esta se apresentou como um produto saboroso e ao mesmo tempo nutritivo. Foram elaboradas sobremesas nos sabores: acerola, cajá, caju goiaba, graviola, manga, mangaba, pitanga, seriguela e umbu, misturando-se o iogurte com a polpa de cada fruta e adicionando-se gelatina como agente geleificante. Estas sobremesas foram processadas, acondicionadas em potes plásticos, previamente esterilizados, e armazenadas à 10ºC. Posteriormente, realizou-se caracterização e comparação das sobremesas com produto similar industrializado, nos sabores de limão e maracujá. As análises físico-químicas realizadas foram pH, acidez total titulável e sólidos solúveis (°Brix), segundo as Normas Analíticas do Instituto Adolfo Lutz (1985). Determinou-se também a composição centesimal e o valor calórico total de três sabores de sobremesas. A comparação dos resultados físico-químicos mostrou não haver diferença entre os produtos obtidos no laboratório e o industrializado, com a diferença dos primeiros serem isentos de aditivos, entre eles aromatizante, corante, espessante, conservante e acidulante.(AU)
Brazil is rich in fruit of characteristic flavors, highlighting the northeast region as great producer of tropical fruit. In order to obtain technological options that provided the integral utilization of this raw material, it used the yogurt combination of the with pulps of regional I fruit in the development of a dessert. This I were found as a tasty and at the same I time nutritious product. In this study was used the pulp of the following fruits: acerola, cajá, cashew, guava, graviola, mango, mangaba, seriguela and umbu. The desserts were produced by adding the pulp of the cited fruits to yogurt and gelatin, which was used as geleifing agent. These desserts were processed, packed in plastic's pots, previously sterilized, and stored at 10°C. The physical chemical characterization of each fruit dessert, two commercial dairy desserts (lemon ad passion fruit) were analyzed in order to obtain comparative results. The physical chemical analyses were pH, total acidity and soluble solids, according to Normas Analiticas do Instituto Adolfo Lutz (1985). AIso, the centesimal composition and the total caloric value of three desserts flavors were analyzed, No differences between the physical chemical results were found when compared the marketed and experimental formulations. lt's worth to note that the experimental desserts are additives free. (AU)