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
ABSTRACT Objective: To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer. Methods: Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose. Results: The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis. Conclusions: In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.
RESUMO Objetivo: Avaliar o impacto da radioterapia torácica na função respiratória e capacidade de exercício em pacientes com câncer de mama. Métodos: Pacientes com câncer de mama com indicação de radioterapia torácica após tratamento cirúrgico e quimioterápico foram submetidas a TCAR, avaliação respiratória e avaliação da capacidade de exercício antes da radioterapia torácica e três meses após o término do tratamento. Foram realizados teste de força muscular respiratória, medição da mobilidade torácica e prova de função pulmonar completa para a avaliação respiratória; realizou-se teste de exercício cardiopulmonar para avaliar a capacidade de exercício. A dose total de radioterapia foi de 50,4 Gy (1,8 Gy/fração) na mama ou na parede torácica, incluindo ou não a fossa supraclavicular (FSC). Histogramas dose-volume foram calculados para cada paciente com especial atenção para o volume pulmonar ipsilateral que recebeu 25 Gy (V25), em números absolutos e relativos, e a dose pulmonar média. Resultados: O estudo incluiu 37 pacientes. Após a radioterapia, observou-se diminuição significativa da força muscular respiratória, mobilidade torácica, capacidade de exercício e resultados da prova de função pulmonar (p < 0,05). A DLCO permaneceu inalterada. A TCAR mostrou alterações relacionadas à radioterapia em 87% das pacientes, o que foi mais evidente nas pacientes submetidas à irradiação da FSC. O V25% correlacionou-se significativamente com a pneumonite por radiação. Conclusões: Em nossa amostra de pacientes com câncer de mama, a radioterapia torácica parece ter causado perdas significativas na capacidade respiratória e de exercício, provavelmente por causa da restrição torácica; a irradiação da FSC representou um fator de risco adicional para o desenvolvimento de pneumonite por radiação.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/radioterapia , Volume Expiratório Forçado/efeitos da radiação , Tolerância ao Exercício/efeitos da radiação , Pneumonite por Radiação/diagnóstico por imagem , Músculos Respiratórios/efeitos da radiação , Músculos Respiratórios/fisiopatologia , Irradiação Linfática/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Estudos Prospectivos , Relação Dose-Resposta à RadiaçãoRESUMO
OBJECTIVE: To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer. METHODS: Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose. RESULTS: The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis. CONCLUSIONS: In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.
Assuntos
Neoplasias da Mama/radioterapia , Tolerância ao Exercício/efeitos da radiação , Volume Expiratório Forçado/efeitos da radiação , Pneumonite por Radiação/diagnóstico por imagem , Relação Dose-Resposta à Radiação , Feminino , Humanos , Irradiação Linfática/efeitos adversos , Pessoa de Meia-Idade , Estudos Prospectivos , Músculos Respiratórios/fisiopatologia , Músculos Respiratórios/efeitos da radiação , Tomografia Computadorizada por Raios X/métodosAssuntos
Neoplasias da Mama/radioterapia , Linfonodos/patologia , Irradiação Linfática/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Axila , Neoplasias da Mama/patologia , Intervalo Livre de Doença , Feminino , Humanos , Irradiação Linfática/efeitos adversos , Linfedema/etiologia , Mastectomia , Pneumonite por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Taxa de SobrevidaRESUMO
A case of retro-uterine bilateral ovarian medial transposition in a 24-year-old women with Hodgkin's IIIB disease with bilateral compromised para-iliac ganglia is presented. A laparoscopic ovarian transposition toward a retro-uterine location out of the reach of the main radiation beam was made. The proximal pole of both ovaries was fixed to the ipsilateral uterosacral ligament. Two metallic clips were used to mark each distal ovarian pole to verify final position with x-rays. Preservation of the ovarian function was documented by hormonal levels 3 months after completing radiotherapy and regular yearly follow-up, until now. Normal menstruation patterns, similar to pretreatment history were recorded.
Assuntos
Doença de Hodgkin/radioterapia , Laparoscopia , Irradiação Linfática/efeitos adversos , Ovário/cirurgia , Insuficiência Ovariana Primária/prevenção & controle , Feminino , Doença de Hodgkin/cirurgia , Humanos , Insuficiência Ovariana Primária/etiologia , Técnicas de Sutura , Adulto JovemRESUMO
In 18 years of experience in the use of combined chemotherapy in Hodgkin's disease at the Instituto Nacional de la Nutrición Salvador Zubirán, the first case of non-Hodgkin's lymphoma secondary to Hodgkin's disease was identified. The patient was a 23 year old male who initially developed a nodular sclerosis type of Hodgkin's disease. Three years later, the biopsies showed lymphocyte predominance type of Hodgkin's disease. Finally, one year later, the patient developed a diffuse small cleaved cell lymphoma. Non-Hodgkin's lymphoma occurring in patients treated with combined chemotherapy and radiotherapy after Hodgkin's disease is a rare complication. We believe that the genesis of a second neoplasm in these cases may be due to both disturbances in the cellular immunity intrinsic to Hodgkin's disease and the treatment with combined chemotherapy and radiotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Doença de Hodgkin/terapia , Irradiação Linfática/efeitos adversos , Linfoma de Células B/etiologia , Linfoma não Hodgkin/etiologia , Segunda Neoplasia Primária/etiologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Terapia Combinada/efeitos adversos , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Doxorrubicina/administração & dosagem , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/radioterapia , Humanos , Hospedeiro Imunocomprometido , Leucovorina/administração & dosagem , Masculino , Mecloretamina/administração & dosagem , Mecloretamina/efeitos adversos , Metotrexato/administração & dosagem , Neoplasias Induzidas por Radiação/etiologia , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Procarbazina/administração & dosagem , Procarbazina/efeitos adversos , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
Two hundred and sixty-four patients with Hodgkin's disease (HD) forming the basis of our 15 year experience are retrospectively analyzed. Three therapeutic periods are recognizable. 1. The 1974-76 period was characterized by the increasing knowledge of staging procedures and therapeutic approaches. The 81 patients treated in this period experience 67 and 60% survival at 5 and 10 years, respectively. 2. The 1977-80 period was characterized by a large combination of MOPP and radiotherapy. The 87 patients who entered this period experienced 75 and 72% survival at 5 and 10 years, respectively. 3. The last therapeutic period 1981-84 is characterized by the increasing relevance of prognostic factors and alternating the use of MOPP and ABVD as non-cross resistant regimen. The 96 patients who entered this period showed 96% survival at 4 years. Both survival and disease-free survival were positively influenced by the change of therapeutic strategies during the three periods (p less than .005). Although better results have been recorded moving from one to the next therapeutic period, the present policy has been also based on the recognition of a high number of late complications due to therapy. Preliminary results about the present therapeutic experience seem to indicate both a good remission rate and low incidence of complications.