Is paclitaxel less cardiotoxic in the treatment of breast cancer before or after doxorubicin? / Qual estratégia terapêutica é menos cardiotóxica no tratamento do câncer de mama: uso de paclitaxel antes ou depois da doxorrubicina?

Background: The combination of doxorubicin (DOX) with paclitaxel (PTX) effectively treats breast cancer (BC). However, DOX-associated cardiotoxicity (CTX) is aggravated by the use of PTX. Consensus is lacking about which drug sequence involves the most CTX. Objectives: To evaluate whether DOX followed by PXT or the reverse sequence has the greatest cardiotoxic potential in the treatment of BC. Methods: Prospective study of women with primary BC who received four cycles of DOX and 12 infusions of PTX. Participants were divided into Group 1 (G1; PXT before DOX) and Group 2 (G2; DOX before PXT) at the discretion of the oncologist. CTX was defined as an absolute reduction in left ventricular ejection fraction (LVEF) > 10% to a value <53%. Patients underwentclinical evaluations and echocardiography before treatment (Phase 1) and one year after treatment (Phase 2). Results: Sixty-nine women were evaluated: 19 in G1 and 50 in G2. The groups had similar clinical characteristics. The doses of radiation, DOX, and PTX used were similar. Eight (11.6%) patients developed CTX: two (10.5%) in G1 and six (12.0%) in G2 (p=0.62). The mean LVEF was similar between groups in Phase 1 (G1=65.1±3.5%; G2=65.2±3.9%; p=0.96), with a significant reduction noted after one year in both groups: G1=61.4±8.1% (p=0.021) and G2=60.8±7.6% (p<0,001). Although lower, mean LVEF remained similar between groups after Phase 2 (p=0.79). Conclusions: In women with BC who underwent chemotherapy, the incidence of CTX at the end of the first year of treatment was similar regardless of whether DOX was used before or after PTX. (AU)

Qualidade de Vida Associada ao Tratamento com Radioterapia em Mulheres Acometidas pelo Câncer do Colo do Útero: Revisão Integrativa da Literatura / Quality of Life Associated with Radiotherapy Treatment in Women Affected by Cervical Cancer: Integrative Literature Review / Calidad de Vida Asociada al Tratamiento con Radioterapia en Mujeres Afectadas por Cáncer de Cuello Uterino: Revisión Integrativa de la Literatura

Introdução: O câncer do colo do útero (CCU) está entre os cinco tipos de cânceres mais frequentes em mulheres. Inicialmente, o tratamento indicado é a cirurgia. Já, quando a paciente apresenta fatores de risco associados à recidiva local, é feita a radioterapia pélvica adjuvante. Investigar o impacto do tratamento na Qualidade de Vida (QV) das mulheres com CCU pode auxiliar o planejamento de ações no sentido de reduzir ou evitar danos. Objetivo: Compilar as repercussões e os fatores que influenciam a QV de mulheres com CCU submetidas ao tratamento radioterápico. Método: Foi realizada uma revisão integrativa da literatura nas bases de dados MEDLINE (PubMed), LILACS e SciELO. Os critérios de inclusão foram artigos dos últimos cinco anos, de acesso aberto, escritos em português, inglês ou espanhol e que abordassem o tema definido total ou parcialmente. Resultados: Foram selecionados 17 artigos, entre os quais predominaram os estudos longitudinais prospectivos (n=9), seguidos dos estudos transversais (n=5) e estudos longitudinais retrospectivos (n=3). Ademais, houve a utilização de 15 diferentes questionários, sendo mais frequente o European Organization for Research And Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30), que integrou oito estudos. Conclusão: A QV das mulheres submetidas à radioterapia foi influenciada por fatores socioeconômicos, educacionais, relações matrimoniais e modalidade da radioterapia. Apesar de os métodos de tratamento terem influenciado fatores individuais, como sintomas físicos e emocionais, não tiveram relação significativa com a QV geral. Estudos devem ser realizados para avaliar os efeitos da radioterapia em longo prazo

Introduction: Cervical cancer (CC) is among the five most common cancers in women. Initially, the treatment indicated is surgery. When the patient has risk factors associated with local recurrence, adjuvant pelvic radiotherapy is performed. Investigating the impact of treatment on the quality of life (QoL) of women with CC can help planning actions to reduce or prevent harm. Objective: Compile the repercussions and factors that influence the QoL of women with CC undergoing radiotherapy. Method: A integrative review of the literature was conducted in the MEDLINE (PubMed), LILACS and SciELO databases. The inclusion criteria were articles from the last five years, open access, written in Portuguese, English or Spanish, addressing the theme defined totally or partially. Results: 17 articles were selected, among which prospective longitudinal studies (n=9) predominated, followed by cross-sectional studies (n=5) and retrospective longitudinal studies (n=3). In addition, 15 different questionnaires were used, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) was more frequent, integrating 8 studies. Conclusion: The QoL of women submitted to radiotherapy was influenced by socioeconomic and educational factors, marital relationships, and the modality of radiotherapy. Although the treatment methods have influenced individual factors, such as physical and emotional symptoms, they had no significant relationship with general QoL. Studies should be conducted to assess the long-term effects of radiotherapy

Introducción: El cáncer de cuello uterino (CC) se encuentra entre los cinco cánceres más comunes en las mujeres. Inicialmente, el tratamiento indicado es la cirugía. Cuando el paciente presenta factores de riesgo asociados a recidiva local, se realiza radioterapia pélvica adyuvante. Investigar el impacto del tratamiento en la calidad de vida (CV) de las mujeres con CC puede ayudar a planificar acciones para reducir o prevenir daños. Objetivo: Recopilar las repercusiones y factores que influyen en la CV de las mujeres con CC sometidas a radioterapia. Método: Se realizó una revisión integradora de la literatura en las bases de datos MEDLINE (PubMed), LILACS y SciELO. Los criterios de inclusión fueron artículos de los últimos cinco años, de acceso abierto, escritos en portugués, inglés o español y que abordaron la temática total o parcialmente definida. Resultados: Se seleccionaron 17 artículos, entre los que predominaron los estudios longitudinales prospectivos (n=9), seguidos de los estudios transversales (n=5) y los estudios longitudinales retrospectivos (n=3). Además, se utilizaron 15 cuestionarios diferentes, siendo más frecuente el Cuestionario de Calidad de Vida de la Organización Europea para la Investigación y el Tratamiento del Cáncer (EORTC-QLQ-C30), que integró 8 estudios. Conclusión: La CV de las mujeres sometidas a radioterapia estuvo influenciada por factores socioeconómicos, educativos, relaciones maritales y el tipo de radioterapia. Aunque los métodos de tratamiento han influido en factores individuales, como los síntomas físicos y emocionales, no tienen una relación significativa con la CV general. Se deben realizar estudios más amplios para evaluar los efectos a largo plazo de la radioterapia