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1.
Bol. méd. postgrado ; 36(2): 21-25, dic.2020. tab, graf
Article in Spanish | LILACS (Americas), LIVECS | ID: biblio-1117893

ABSTRACT

El síndrome de lisis tumoral (SLT) es una complicación potencialmente letal provocada por la liberación masiva de ácidos nucleicos, potasio y fosfato hacia la circulación sistémica lo cual se asocia a graves trastornos del metabolismo hidroelectrolítico. Se realizó una revisión retrospectiva de historias clínicas con el objetivo de describir las características clínicas de los pacientes con sospecha de SLT que ingresaron al Servicio de Medicina Interna del Hospital General Universitario Dr. Luis Gómez López durante el lapso 2017-2018. El 50% de los pacientes tenían una edad comprendida entre 51 y 70 años, siendo el 65% de sexo femenino. Los canceres más frecuentemente encontrados fueron el cáncer de mama (29%), cáncer gástrico (15%) y el linfoma no Hodgkin (12%). Todos los pacientes presentaron al menos tres de las manifestaciones clínicas asociadas al SLT entre las cuales se encuentran náuseas, vómitos, anorexia, debilidad, calambres, hiperreflexia, oliguria, anuria, hematuria, hipotensión, convulsiones y deshidratación. El 46% de los pacientes presentaron hiperpotasemia, mientras que 36% mostraron hipocalcemia y 18% hiperfosfatemia. El 76% de los pacientes cursaron con una creatinina > 1,4 mg/dl. El diagnóstico definitivo de SLT no fue posible realizarlo en ninguno de los pacientes incluidos en este estudio debido a la falta de estudios paraclínicos necesarios para satisfacer los criterios según los lineamientos internacionales(AU)


Tumor lysis syndrome (TLS) is a potentially lethal complication due to massive release of nucleic acids, potassium and phosphate into the systemic circulation which is associated with severe hydroelectrolitic metabolic disorders. A retrospective review of clinical charts was performed in order to describe clinical characteristics of patients with possible TLS that were admitted to the Servicio de Medicina Interna of the Hospital General Universitario Dr. Luis Gómez López during the period 2017-2018. The results show that 50% of patients were between 51 and 70 years old and 65% were female. Breast cancer (29%), stomach cancer (15%) and Non-Hodgkin lymphoma (12%) were more frequent in patients with possible TLS. All patients showed at least three of the clinical features commonly associated with TLS such as nausea, vomiting, anorexia, weakness, cramps, hyperreflexia, oliguria, anuria, hematuria, hypotension, convulsion and dehydration. 46% of patients had hyperkalemia, 36% hypocalcemia and 18% hyperphosphatemia. Creatinine levels > 1,4 mg/dl were seen in 76% of patients. Definitive diagnosis of TLS was not possible in any of the patients included in this study due to the lack of laboratory studies required according to international guidelines(AU)


Subject(s)
Humans , Phosphates , Potassium , Radiotherapy , Breast Neoplasms , Nucleic Acids , Tumor Lysis Syndrome/physiopathology , Drug Therapy , Drug Prescriptions , Critical Care , Hematology , Internal Medicine , Medical Oncology
2.
An. Fac. Cienc. Méd. (Asunción) ; 53(2): 165-168, 20200800.
Article in Spanish | LILACS (Americas) | ID: biblio-1119717

ABSTRACT

La enteritis por radiación o enteritis actínica es una complicación secundaria al uso de radioterapia para tratamiento de tumores pélvicos, que puede afectar con mayor frecuencia al intestino delgado (principalmente íleon) y al colon. La cirugía en pacientes con enteritis por radiación crónica debe reservarse ante la presencia de complicaciones, ya que está relacionada con una alta morbilidad y estancia hospitalaria prolongadas, así como posibilidad de re operación. Exponemos el caso de una paciente con oclusión intestinal secundaria a enteritis por radiación que desarrolló años después de la conclusión de su tratamiento por cáncer de cuello uterino, con el objetivo de que esta enfermedad sea sospechada en pacientes con antecedentes de radiación.


Radiation enteritis or actinic enteritis is a complication secondary to the use of radiotherapy to treat pelvic tumors, which can more frequently affect the small intestine (mainly ileum) and the colon. Surgery in patients with chronic radiation enteritis should be reserved in the presence of complications, since it is related to high morbidity and prolonged hospital stay, as well as the possibility of reoperation. We present the case of a patient with intestinal occlusion secondary to radiation enteritis who developed years after the conclusion of her treatment due to cervical cancer, with the objective that this disease has to be suspected in patients with history of radiation.


Subject(s)
Gastrointestinal Tract/radiation effects , Enteritis , Radiation , Radiotherapy/adverse effects
3.
J. nurs. health ; 10(2): 20102009, mai.2020.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1104137

ABSTRACT

Objetivo: analisar e categorizar o método de uso e benefícios e principais considerações sobre uso do laser em lesões induzidas por radiação. Método: revisão sistemática desenvolvidas em Public Medline, Literatura Latino-Americana do Caribe em Ciências da Saúde, Cumulative Index to Nursing and Allied Health Literature, SCOPUS e Biblioteca Virtual de Saúde. Resultados: analisou-se sete estudos. Observou-se em 86% (6) desses estudos uma conclusão positiva à terapêutica de laser de baixa intensidade, relatando: 43% (3) diminuição significativa e regressão da dor; 29% (2) redução significativa na duração e gravidade da mucosite e 29% (2) redução da inflamação e cicatrização. Conclusão: evidenciou-se melhora da cicatrização, da dor local e da capacidade anti-inflamatória. É necessário realizar mais pesquisas com amostras robustas que comparem os tipos de lasers, o comprimento das ondas e sua intensidade, para o seu uso como terapêutica.(AU)


Objective: to analyze and categorize the method of use and benefits and main considerations on the use of laser in radiation-induced injuries. Method: systematic review developed in the databases Public Medline, Latin American Caribbean Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature, SCOPUS and Virtual Health Library. Results: seven studies were analyzed. A positive conclusion to low-level laser therapy was observed in 86% (6) of these studies, reporting: 43% (3) significant decrease and regression of pain; 29% (2) significant reduction in the duration and severity of mucositis and 29% (2) reduction in inflammation and healing. Conclusion: there was an improvement in healing, local pain and anti-inflammatory capacity. More research is needed with robust samples that compare the types of lasers, the length of the waves and their intensity, for their use as therapy.(AU)


Objetivo: analizar y clasificar el método de uso y los beneficios y las principales consideraciones sobre el uso del láser en lesiones inducidas por radiación. Método: revisión sistemática desarrollada en Public Medline, Literatura Latinoamericana del Caribe en Ciencias de la Salud, Índice acumulativo de literatura de enfermería y salud aliada, SCOPUS y Biblioteca Virtual en Salud. Resultados: se analizaron siete estudios. Se observó una conclusión positiva de la terapia con láser de bajo nivel en el 86% (6) de estos estudios: 43% (3) disminución significativa y regresión del dolor; 29% (2) reducción significativa en la duración y gravedad de la mucositis y 29% (2) reducción en la inflamación y la curación. Conclusión: hubo una mejora en la curación, dolor local y capacidad antiinflamatoria. Se necesita investigación con muestras robustas que comparen los tipos de láser, la longitud de las ondas y su intensidad, para su uso como terapia.(AU)


Subject(s)
Radiation Effects , Radiodermatitis , Radiotherapy , Low-Level Light Therapy
4.
Rev. argent. coloproctología ; 31(1): 31-33, mar. 2020. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1102182

ABSTRACT

El sinus pilonidal es una patología frecuente cuya malignización es infrecuente aunque su pronóstico puede ser fatal. El objetivo de esta publicación es presentar un caso de un paciente intervenido en múltiples ocasiones de escisiones de sinus pilonidal con degeneración maligna del mismo y evolución fatal, con el fin de recalcar la importancia del examen anatomopatológico sistemático de todas las muestras de escisión quirúrgica. (AU)


The pilonidal sinus is a frequent pathology whose malignization is uncommon although its prognosis can be fatal. The objective of this publication is to present a case of a patient intervened on multiple occasions of pilonidal sinus excisions with malignant degeneration and fatal evolution, in order to emphasize the importance of the systematic pathological examination of all surgical excision samples. (AU)


Subject(s)
Humans , Male , Middle Aged , Pilonidal Sinus/surgery , Pilonidal Sinus/pathology , Carcinoma, Squamous Cell/pathology , Neoplasms, Second Primary/surgery , Pilonidal Sinus/mortality , Radiotherapy , Recurrence , Reoperation , Cisplatin/administration & dosage , Neoplasms, Second Primary/mortality , Chemotherapy, Adjuvant/methods , Antineoplastic Agents/administration & dosage
5.
J. Health Biol. Sci. (Online) ; 8(1): 1-9, 20200101. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1118061

ABSTRACT

Objetivo: verificar os principais agravos bucais e o desenvolvimento da dentição em indivíduos diagnosticados com leucemia e submetidos às terapias antineoplásicas. Métodos: trata-se de uma revisão integrativa da literatura fundamentada em artigos científicos, classificados de acordo com o nível de evidência (NE) científica proposto pelo Oxford Centre Evidence Based Medicine, 2009. A pergunta norteadora do presente estudo compreende: Quais as principais manifestações orais e alterações no desenvolvimento da dentição em pacientes com leucemia? Resultados: 14 estudos foram incluídos, publicados entre os anos de 2003 e 2019. As principais alterações bucais apresentadas foram morfologia anormal do esmalte e das raízes (taurodontia, hipodontia, microdontia, hipoplasia, raízes curtas), agenesias, sangramento gengival, mucosites, xerostomia e desenvolvimento dental tardio. Conclusões: torna-se necessário o acompanhamento multidisciplinar em face da condução do tratamento leucêmico, na qual a presença do cirurgião-dentista é crucial para a manutenção da saúde bucal.


Objective: To verify the main oral diseases and the development of dentition in individuals diagnosed with leukemia and submitted to antineoplastic therapies. Methods: This is an integrative review of the literature based on scientific articles, classified according to the level of scientific evidence (NE) proposed by Oxford Center Evidence Based Medicine, 2009. The guiding question of the present study comprises: What are the main oral manifestations disorders and changes in teething development in patients with leukemia? Results: A total of fourteen studies were included, published between 2003 and 2019. The main oral alterations presented were: abnormal enamel and root morphology (taurodontics, hypodontia, microdontia, hypoplasia, short roots), agenesis, gingival bleeding, mucositis, xerostomia and late dental development. Conclusions: It is necessary to have multidisciplinary follow-up when conducting leukemic treatment, in which the presence of the dental surgeon is crucial for maintaining oral health.


Subject(s)
Leukemia , Radiotherapy , Bone Marrow Transplantation , Drug Therapy
6.
Article in English | WPRIM (Western Pacific) | ID: wprim-811215

ABSTRACT

OBJECTIVE: Programmed cell death-ligand 1 (PD-L1) is expressed in tumor cells and has been shown to predict clinical outcomes of several types of malignancies. The aim of this study was to investigate the effects of carbon-ion (C-ion) beam irradiation on PD-L1 expression in human uterine cervical adeno/adenosquamous carcinoma (UCAA) cells and clinical samples and to identify the prognostic factors for outcomes after C-ion radiotherapy (CIRT).METHODS: The effects of C-ion irradiation on PD-L1 expression in human UCAA and cervical squamous cell carcinoma cells were examined by flow cytometry. We examined PD-L1 expression in UCAA biopsy specimens from 33 patients before CIRT started (pre-CIRT) and after 12 Gy (relative biological effectiveness [RBE]) irradiation (post-12Gy-C) in 4 fractions of CIRT to investigate the correlation between PD-L1 status and clinical outcomes.RESULTS: The PD-L1 expression was upregulated by C-ion beam in a dose-dependent manner in HeLa and SiHa cells through phosphorylated Chk1. The overall frequencies of pre-CIRT and post-12Gy-C PD-L1 positivity were 45% (15/33) and 67% (22/33), respectively. The post-12Gy-C PD-L1 expression was significantly elevated compared to the pre-CIRT PD-L1 expression. There was no significant relationship between the pre-CIRT PD-L1 status and clinical outcomes, such as local control (LC), progression-free survival (PFS), and overall survival (OS). However, the post-12Gy-C PD-L1 expression had better correlation with PFS, but not with LC and OS.CONCLUSION: CIRT can induce PD-L1 expression in UCAA and we propose that PD-L1 expression after starting CIRT may become as a predictive prognostic marker in CIRT for UCAA.


Subject(s)
B7-H1 Antigen , Biopsy , Carcinoma, Squamous Cell , Disease-Free Survival , Flow Cytometry , Heavy Ion Radiotherapy , Humans , Radiotherapy , Treatment Outcome , Uterine Cervical Neoplasms
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-811214

ABSTRACT

OBJECTIVE: The causal association of human papillomavirus (HPV) in uterine cervical cancer was well established and this oncogenic virus was reported to be a biomarker for overall recurrence and central pelvic recurrence. The objective of the present systematic review and meta-analysis was to assess the role of HPV DNA testing in early detection of recurrence among cervical cancer survivors after radiotherapy.METHODS: We performed a systematic review and meta-analysis by means of searching electronic databases for published articles between January 1984 and June 2018, on the basis of standard systematic review guidelines prescribed by major agencies namely Cochrane Collaboration (https://www.cochrane.org) and Campbell Collaboration (https://www.campbellcollaboration.org). The meta-analysis component was further modified appropriately for the synthesis of sensitivity and specificity results.RESULTS: A total of 1,055 cervical cancer cases who had received pelvic radiation with or without chemotherapy from ten cohort studies were evaluated. The overall pooled sensitivity and specificity of HPV DNA testing was 0.84 (95% confidence interval [CI]= 0.66–0.94) and 0.35 (95% CI=0.20–0.54) respectively. The positive likelihood ratio was 1.3 (95% CI=1.0–1.7) and the negative likelihood ratio was 0.45 (95% CI=0.18–1.10) with an estimated diagnostic odds ratio of 3 (95% CI=1–9).CONCLUSION: The screening for HPV DNA testing during follow-up facilitates early detection of recurrence after radiotherapy.


Subject(s)
Cervix Uteri , Cohort Studies , Cooperative Behavior , DNA , Drug Therapy , Female , Follow-Up Studies , Human Papillomavirus DNA Tests , Humans , Mass Screening , Odds Ratio , Oncogenic Viruses , Radiotherapy , Recurrence , Sensitivity and Specificity , Survivors , Uterine Cervical Neoplasms
8.
Article in English | WPRIM (Western Pacific) | ID: wprim-811213

ABSTRACT

OBJECTIVE: To evaluate survival and recurrence in stage II endometrial cancer in relation to uterine risk stratification. Outcome for stage II was compared before and after the introduction of lymph node (LN) resection and omission of all postoperative radiotherapy.METHODS: The cohort consisted of 4,380 endometrial carcinoma patients radically operated (no visual tumor, all distant metastasis removed) (2005–2012) including 461 stage II. Adjusted Cox regression was used to compare survival and actuarial recurrence rates.RESULTS: Uterine risk factors (low-, intermediate-, and high-) were the strongest predictors of survival and recurrence in stage II. Stage II low-risk having a prognosis comparable to low-risk stage I (grade 1–2, <50% myometrial invasion), whereas cervical invasion significantly increased the risk of recurrence and decreased cancer-specific survival in intermediate- and high-risk compared to the corresponding stage I risk groups. In 355 cases of 708 with cervical stromal invasion, LN-resection showed 27.9% with LN metastasis and upstaged 18.1% from stage II to IIIC resulting in longer survival and lower recurrence in LN-resected compared to non-LN resected stage II. Radical as compared to simple hysterectomy did not alter survival. Treatment with external beam radiotherapy decreased local recurrence without affecting survival.CONCLUSION: Uterine risk groups are the strongest predictors for survival and recurrence in stage II patients and should be considered when advising adjuvant therapy. LN-resected stage II had increased survival and decreased recurrence. Omitting radiotherapy increase vaginal recurrence without affecting survival.


Subject(s)
Cohort Studies , Endometrial Neoplasms , Female , Humans , Hysterectomy , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Prognosis , Radiotherapy , Recurrence , Risk Factors
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-811108

ABSTRACT

PURPOSE: The rare incidence of isolated para-aortic lymph node (PALN) recurrence of colorectal cancer has precluded the formulation of treatment guidelines. This study evaluated and compared the effects of different treatment modalities on survival outcomes in patients with PALN recurrence.METHODS: Patients diagnosed with isolated PALN recurrence after curative resection for primary colorectal cancer from January 2004 to December 2014 were evaluated retrospectively. Patients with isolated recurrence were selected using imaging modalities. Overall survival (OS) and survival after recurrence (SAR) were analyzed and compared between different treatments using the Kaplan-Meier method.RESULTS: The median OS was 64 months with a median follow-up time of 50 months. Of the 46 patients with PALN recurrence, 35 (76.1%) had isolated recurrences. Of these 35 patients, 16 underwent PALN resection and 19 received chemotherapy. Median SAR was significantly longer in patients who did than did not undergo resection (71 months vs. 39 months, P = 0.017). Median OS tended to be longer in patients who did than did not undergo resection (77 months vs. 62 months, P = 0.055). SAR was similar in patients who received radiotherapy and those who underwent resection (34 months vs. 46 months, P = 0.146). Three of 16 patients (18.8%) who underwent resection were found to be recurrence-free.CONCLUSION: Surgical resection of isolated PALN recurrence may benefit patients, with favorable survival outcomes and by providing definitive diagnosis for proper treatment planning.


Subject(s)
Colorectal Neoplasms , Diagnosis , Drug Therapy , Follow-Up Studies , Humans , Incidence , Lymph Node Excision , Lymph Nodes , Methods , Mortality , Radiotherapy , Recurrence , Retrospective Studies
11.
Arq. odontol ; 56: 1-11, jan.-dez. 2020. tab, graf
Article in Portuguese | LILACS (Americas), BBO | ID: biblio-1103999

ABSTRACT

Objetivo: Avaliar a internação hospitalar por câncer de boca e faringe no Brasil no período de 2008 a 2017. Métodos: Estudo das internações por estas neoplasias registradas no Sistema de Informação Hospitalar disponíveis no DATASUS/MS entre 2008 e 2017. Resultados: Foram registradas 263.556 mil internações por câncer de boca e faringe. O Sudeste apresentou a maior frequência de casos (44,3%). A maior taxa de internação ocorreu no Sul (19,6/100 mil habitantes). As maiores taxas de letalidade encontradas foram no Norte (12,7%) e Sudeste (12,3%). Houve um predomínio de internações em regime privado (53,5%) e em caráter de urgência no Brasil (53,5%). A média de permanência hospitalar foi de 6,4 dias. A taxa de letalidade em caráter de urgência foi maior do que em caráter eletivo. A taxa de internação apresentou tendência decrescente e a taxa de letalidade hospitalar, tendência de incremento de 0,2% a cada ano. A análise de índice de desenvolvimento humano médio e taxa de internação mostrou correlação moderada positiva entre essas variáveis e as regiões do país. Houve maior custo médio em reais por internação hospitalar em caráter eletivo e a região Centro-Oeste obteve maior média de custo financeiro (por guia autorizada) nesta modalidade. Conclusão: Observa-se um elevado número de internações por estes tipos de câncer no Brasil, além de um acentuado custo e alta média de permanência hospitalar, sendo variável entre as regiões do país.


Aim: To analyze hospital admission for oral and pharyngeal cancer in Brazil and regions from 2008 to 2017. Methods: This study analyzed the hospitalizations for this neoplasm registered in the Hospital Information System available in DATASUS/MS between 2008 and 2017. Results: A total of 263,556 hospitalizations were registered. The Southeast presented the highest frequency of cases (44.3%). The highest hospitalization rate occurred in the South (19.6/100 thousand). The highest rates of lethality were found in the North (12.7%) and Southeast (12.3%). There was a predominance of hospitalizations in the private care (53.5%) and emergency care (53.5%) sectors in Brazil. The mean hospital stay was 6.4 days. The case fatality rate was higher than the elective rate. The hospitalization rate declined, and the hospital lethality rate showed a tendency toward an increase of 0.2% per year. The correlation analysis of the average human development index and the hospitalization rates were moderately positive between the variables and the regions of the country. There was a higher average cost in reais for hospital admission on an elective basis, and the Mid-West region obtained a higher average financial cost (per authorized guide) in this modality. Conclusion: It was possible to verify a high number of hospitalizations for these types of cancer in Brazil, in addition to a high cost and average hospital stay, which tend to vary throughout the country.


Subject(s)
Therapeutics , Mouth Neoplasms , Pharyngeal Neoplasms , Mortality , Hospitalization , Radiotherapy , Drug Therapy , Surgical Oncology
12.
Rev. bras. cancerol ; 66(1)20200129.
Article in Portuguese | LILACS (Americas) | ID: biblio-1094999

ABSTRACT

Introdução: A qualidade de vida de pacientes oncológicos tem sido objeto de estudo em muitos trabalhos brasileiros. Contudo, apesar da alta prevalência de indivíduos submetidos à radioterapia, poucos estudos com ênfase nesse grupo de pacientes foram identificados. Objetivo: Avaliar a qualidade de vida e a prevalência de sintomas depressivos em pacientes com neoplasias malignas durante o tratamento radioterápico. Método: Estudo transversal quantitativo realizado com 153 pacientes oncológicos em vigência de tratamento radioterápico em um centro especializado em oncologia e radioterapia, localizado no Noroeste do Estado do Paraná. Os dados foram coletados entre março e setembro de 2018. O European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) e o Inventário de Depressão de Beck foram utilizados para avaliar a qualidade de vida e os sintomas depressivos, respectivamente. Resultados: Os domínios "qualidade de vida", "função cognitiva" e "função social" foram os que menos se mostraram prejudicados na amostra estudada, enquanto "insônia", "perda de apetite" e "dificuldades financeiras" destacaram-se entre os maiores preditores de baixa qualidade de vida. Ademais, contatou-se que 22% dos indivíduos avaliados apresentaram algum grau de transtorno de humor, sendo 11% diagnosticados com depressão. Conclusão: O declínio na qualidade de vida e a prevalência de sintomas depressivos em pacientes oncológicos, mesmo os em vigência de radioterapia, enaltecem a importância de intervenções precoces que visem a restabelecer a funcionalidade e o bem-estar.


Introduction: The quality of life of cancer patients has been studied in many Brazilian papers. However, despite the high prevalence of individuals undergoing radiotherapy, few studies with emphasis in this group of patients have been identified. Objective: To evaluate the quality of life and the prevalence of depressive symptoms in patients with malignant neoplasms undergoing radiotherapy treatment. Method: Quantitative cross-sectional study with 153 cancer patients undergoing radiotherapy treatment at an oncology and radiotherapy specialized center, located in the northwest of Paraná state. Data were collected between March and September 2018. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Beck Inventory were used to assess quality of life and depressive symptoms, respectively. Results: The domains "quality of life", "cognitive function" and "social function" were the least affected in the studied sample, while "insomnia", "loss of appetite" and "financial difficulties" stood out among the higher predictors of poor quality of life. In addition, it was found that 22% of the individuals evaluated had some degree of mood disorder, 11% being diagnosed with depression. Conclusion: The decline in quality of life and the prevalence of depressive symptoms in cancer patients, even those undergoing radiotherapy, emphasize the importance of early interventions aimed at restoring functionality and well-being.


Introducción: La calidad de vida de los pacientes con cáncer se ha estudiado en muchos estudios brasileños. Sin embargo, a pesar de la alta prevalencia de individuos sometidos a radioterapia, se han identificado pocos estudios con énfasis en este grupo de pacientes. Objetivo: Evaluar la calidad de vida y la prevalencia de síntomas depresivos en pacientes con neoplasias malignas sometidas a radioterapia. Método: Estudio transversal cuantitativo realizado con 153 pacientes con cáncer sometidos a tratamiento de radioterapia en un centro especializado en oncología y radioterapia, ubicado en el Noroeste del Estado de Paraná. Los datos se recopilaron entre marzo y septiembre de 2018. El European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) y el Inventario Beck se utilizaron para evaluar la calidad de vida y los síntomas depresivos, respectivamente. Resultados: Los dominios "calidad de vida", "función cognitiva" y "función social" fueron los menos afectados en la muestra estudiada, mientras que el "insomnio", la "pérdida de apetito" y las "dificultades financieras" se destacaron entre los dominios. predictores más altos de mala calidad de vida. Además, se encontró que el 22% de los individuos evaluados tenían algún grado de trastorno del estado de ánimo, y el 11% fue diagnosticado con depresión. Conclusión: La disminución de la calidad de vida y la prevalencia de síntomas depresivos en pacientes con cáncer, incluso en aquellos que reciben radioterapia, enfatizan la importancia de las intervenciones tempranas destinadas a restaurar la funcionalidad y el bienestar.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Quality of Life , Depression/epidemiology , Neoplasms/psychology , Neoplasms/radiotherapy , Radiotherapy/adverse effects , Brazil , Cross-Sectional Studies , Psycho-Oncology
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-762476

ABSTRACT

Hereditary breast cancer is known for its strong tendency of inheritance. Most hereditary breast cancers are related to BRCA1/BRCA2 pathogenic variants. The lifelong risk of breast cancer in pathogenic BRCA1 and BRCA2 variant carriers is approximately 65% and 45%, respectively, whereas that of ovarian cancer is estimated to be 39% and 11%, respectively. Therefore, understanding these variants and clinical knowledge on their occurrence in breast cancers and carriers are important. BRCA1 pathogenic variant breast cancer shows more aggressive clinicopathological features than the BRCA2 pathogenic variant breast cancer. Compared with sporadic breast cancer, their prognosis is still debated. Treatments of BRCA1/BRCA2 pathogenic variant breast cancer are similar to those for BRCA-negative breast cancer, mainly including surgery, radiotherapy, and chemotherapy. Recently, various clinical trials have investigated poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor treatment for advanced-stage BRCA1/BRCA2 pathogenic variant breast cancer. Among the various PARP inhibitors, olaparib and talazoparib, which reached phase III clinical trials, showed improvement of median progression-free survival around three months. Preventive and surveillance strategies for BRCA pathogenic variant breast cancer to reduce cancer recurrence and improve treatment outcomes have recently received increasing attention. In this review, we provide an information on the clinical features of BRCA1/BRCA2 pathogenic variant breast cancer and clinical recommendations for BRCA pathogenic variant carriers, with a focus on treatment and prevention strategies. With this knowledge, clinicians could manage the BRCA1/BRCA2 pathogenic variant breast cancer patients more effectively.


Subject(s)
Breast Neoplasms , Breast , Disease-Free Survival , Drug Therapy , Humans , Ovarian Neoplasms , Poly(ADP-ribose) Polymerase Inhibitors , Prognosis , Radiotherapy , Recurrence , Wills
14.
Blood Research ; : 49-56, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-820803

ABSTRACT

BACKGROUND: Human immunodeficiency virus (HIV)-negative plasmablastic lymphoma (PBL) is a rare entity of diffuse large B-cell lymphoma (DLBCL). The clinicopathological features of and optimal treatment for HIV-negative PBL remain largely unknown.METHODS: To gain insight into this distinct lymphoma, we summarized the clinicopathologic characteristics of 8 unpublished HIV-negative PBLs and performed a comprehensive review of 394 published cases.RESULTS: Of the 8 unpublished PBLs, the median patient age was 53.0 years. Four patients presented with stage IV disease. All 8 patients showed a plasma cell-like immunophenotype. Of the six patients who received anthracycline-based chemotherapy, including two who received bortezomib, three patients achieved a continuous complete response, two patients died due to disease progression, and one patient was lost to follow-up. The other two patients achieved continuous complete response after receiving chemotherapy combined with radiotherapy and surgery. Of the 402 patients, the majority were male, with a mean age of 58.0 years. EBV infection was detected in 55.7% of the patients. The median survival times of the patients who received CHOP or CHOP-like regimens and intensive regimens were not reached and 23.0 months, respectively, and the intensive regimen did not improve the survival outcome (P=0.981). Multivariate analysis showed that EBER remained the only independent factor affecting overall survival (OS).CONCLUSION: HIV-negative PBL is a distinct entity with a predilection for elderly and immunosuppressed individuals. Intensive chemotherapy had no apparent survival benefits over the CHOP regimen in terms of OS; the prognosis of this disease is poor with current chemotherapy methods, and treatment remains a challenge.


Subject(s)
Aged , Bortezomib , Disease Progression , Drug Therapy , Epstein-Barr Virus Infections , HIV , Humans , Lost to Follow-Up , Lymphoma , Lymphoma, B-Cell , Male , Multivariate Analysis , Plasma , Plasmablastic Lymphoma , Prognosis , Radiotherapy
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-782100

ABSTRACT

OBJECTIVE: To observe the safety and short-term efficacy of apatinib in the treatment of recurrent, metastatic cervical cancer in patients who have already received more than two kinds of comprehensive treatment.METHODS: Forty-eight patients with recurrent or metastatic cervical cancer after radiotherapy or surgery who received apatinib between June 2016 and June 2017 were involved in this study. These patients experienced progression after first-line or second-line chemotherapy. There were 38 patients with cervical squamous cell carcinoma, 8 with adenocarcinoma, and 2 with adenosquamous carcinoma. Progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (AEs) were reviewed and evaluated.RESULTS: All patients had complete follow-up records, and the median follow-up time was 14.5 months (5.5–20.5 months). Among the 48 patients, 14.58% achieved a partial response and 52.08% achieved stable disease. The overall response rate and disease control rate were 14.58% and 66.67%, respectively. The median time that the 48 patients received oral apatinib was 8.2 months. The median PFS was 4.6 months (95% confidence interval [CI]=3.31–5.26) and OS was 13.9 months (95% CI=8.37–17.96). The main apatinib-related adverse reactions were leukopenia (37.5%), neutropenia (41.67%), hemorrhage (37.5%), hypertension (33.33%), proteinuria (12.5%), fatigue (37.5%), and hand-foot syndrome (27.08%). Most of them were grade 1–2, and no drug-related death occurred.CONCLUSIONS: Apatinib can improve the disease control rate of recurrent and metastatic cervical cancer when chemotherapy has failed, and the treatment is well tolerated. This represents that apatinib may be a new treatment option for metastatic cervical cancer patients.


Subject(s)
Adenocarcinoma , Carcinoma, Adenosquamous , Carcinoma, Squamous Cell , Disease-Free Survival , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Fatigue , Follow-Up Studies , Hand-Foot Syndrome , Hemorrhage , Humans , Hypertension , Leukopenia , Molecular Targeted Therapy , Neutropenia , Proteinuria , Radiotherapy , Retrospective Studies , Uterine Cervical Neoplasms
16.
J. coloproctol. (Rio J., Impr.) ; 39(4): 309-318, Oct.-Dec. 2019. tab, ilus
Article in English | LILACS (Americas) | ID: biblio-1056647

ABSTRACT

Abstract Background: Rectal cancer is one of the most common malignant tumors of gastrointestinal tract. Combining chemotherapy with radiotherapy has a sound effect on its management. Objectives: Assessment the patterns of characterizations of rectal cancer. Evaluation of the efficacy, and long-term survival of pre-/ postoperative chemoradiation. Collecting all eligible evidence articles and summarize the results. Methods: By this systematic review and meta-analysis study, we include data of chemoradiation of rectal cancer articles from 2015 until 2019. The research was carried out at Baghdad Medical City oncology centers. Accordance with the PRISMA guidelines, and the Newcastle-Ottawa Scale used. Results: Starting with gender distribution as M:F ratio of 0.94:1.06. Regarding the age, recorded mean ± SD of 48.7 ± 14.2 years. Rectosigmoid represented the most common site as 50(49.5%), and adenocarcinoma was common histopathology as 76(75.2%) of patients, with localized stage in 50(49.5%). The moderate differentiation was most grade as 65(64.4%). The distant from anal verge mostly seen was 5-10 cm in 59(58.4%). The pulmonary was commonest site of metastasis in 11(10.9%). Most patients undergo APR operation, which has done in 41(40.6%). Adjuvant chemoradiation received by 40(39.6%) patients, whereas neoadjuvant chemoradiation gave to 25 patients. A total of 2609 articles from 12 databases met our search strategies. The highest Newcastle-Ottawa score (8) demonstrated in three studies, and median score (7) calculated in five studies. Conclusions: The incidence belonged to 5th and 6th decade of life. Rectosigmoid represented the most common site. Mostly, the 5-10 cm distant of tumor from anal verge was common finding. The pulmonary was most site of metastasis. We concluded the formulation of a novel point that survival benefit found in many pre or postoperative chemoradiation trials in rectal cancer.


Resumo Introdução: O câncer retal é um dos tumores malignos mais comuns do trato gastrointestinal. A combinação de quimioterapia e radioterapia em seu tratamento é eficaz. Objetivos: Avaliar os padrões de caracterização do câncer retal. Avaliar a eficácia e sobrevida a longo prazo em pacientes submetidos a quimiorradioterapia pré- ou pós-operatória. Coletar todos os artigos de evidências qualificados e resumir os resultados. Métodos: Esta revisão sistemática e metanálise incluiu dados de ensaios clínicos randomizados por cluster de 2015 até 2019. A pesquisa foi realizada nos centros de oncologia do Baghdad Medical City. As diretrizes PRISMA e a escala de Newcastle-Ottawa foram utilizadas para avaliar os estudos. Resultados: Quanto à distribuição por sexo, observou-se uma relação homem:mulher de 0,94:1,06. Em relação à idade, a média ± DP foi de 48,7 ± 14,2 anos. O retossigmoide fpo o local mais comum em 50 pacientes (49,5%); a histopatologia mais comum foi adenocarcinoma, observada em 76 pacientes (75,2%), com estágio localizado em 50 (49,5%). Diferenciação moderada foi observada em 65 pacientes (64,4%). A distância da borda anal variou entre 5 e 10 cm em 59 pacientes (58,4%). O pulmão foi o local mais comum de metástase, sendo observado em 11 pacientes (10,9%). A maioria dos pacientes (41 [40,6%]) foi submetida à ressecção abdominoperineal. Um total de 40 pacientes (39,6%) foram submetidos a quimiorradioterapia adjuvante e 25, a quimiorradioterapia neoadjuvante. Na revisão da literatura, foram encontrados 2.609 artigos que atendiam aos critérios de pesquisa utilizados em 12 bancos de dados. Três estudos atingiram o escore máximo na escala de Newcastle-Ottawa (8); cinco estudos atingiram o escore mediano (7). Conclusões: No presente estudo, a maior incidência de câncer retal foi observada entre a quinta e sexta décadas de vida. O retossigmoide foi o sítio tumoral mais comum. A maioria dos tumores estava localizado entre 5 a 10 cm de distância da margem anal. O pulmão foi o local mais importante de metástase. No presente estudo, quimiorradioterapia pré- ou pós-operatória estava relacionada a uma maior sobrevida em casos de câncer retal.


Subject(s)
Humans , Male , Female , Rectal Neoplasms , Rectal Neoplasms/drug therapy , Chemoradiotherapy, Adjuvant , Radiotherapy , Drug Therapy , Chemoradiotherapy
17.
Int. j. morphol ; 37(4): 1564-1571, Dec. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1040170

ABSTRACT

Las glándulas salivales humanas pueden ser gravemente lesionadas por la radioterapia utilizada contra neoplasias de cabeza y cuello, produciendo hiposialia y xerostomía, las cuales afectan la salud oral y sistémica, mermando la calidad de vida de la persona. Los tratamientos convencionales actuales están diseñados para disminuir los síntomas, sin actuar sobre los cambios fisiopatológicos que se dan a nivel glandular. Esta revisión intenta analizar aquellas terapias preventivas y/o curativas que están desarrollándose en el campo biomolecular y que tienen un futuro prometedor por sus características innovadoras: terapia génica, terapia con células madre y terapia con factores de crecimiento. Se evidencia un aporte adicional de la nanotecnología, la cual está mejorando las vías de aplicación de los tratamientos.


Human salivary glands can be seriously injured by the radiotherapy used against head and neck neoplasms, producing hyposialia and xerostomy, which affect oral and systemic health, diminishing the person's quality of life. Current conventional treatments are designed to reduce symptoms, without acting on the pathophysiological changes that occur at the glandular level. This review attempts to analyze those preventive and /or curative therapies that are developing in the biomolecular field and that have a promising future due to their innovative features: Gene therapy, stem cell therapy and growth factor therapy. An additional contribution of nanotechnology is evident, which is improving the routes of treatment application.


Subject(s)
Humans , Radiotherapy/adverse effects , Salivary Gland Diseases/prevention & control , Stem Cells/physiology , Genetic Therapy/methods , Intercellular Signaling Peptides and Proteins/therapeutic use , Radiation Injuries/prevention & control , Radiation-Protective Agents/therapeutic use , Salivary Gland Diseases/therapy , Salivary Glands/radiation effects , Xerostomia/prevention & control , Nanotechnology
18.
J. coloproctol. (Rio J., Impr.) ; 39(3): 262-264, June-Sept. 2019. ilus
Article in English | LILACS (Americas) | ID: biblio-1040332

ABSTRACT

ABSTRACT Paget's disease most commonly affects the breast. Extramammary involvement is rare, and the most commonly affected sites are the vulva, anus, perianal region, and axilla. The disease may progress to invasive adenocarcinoma or synchronous cancers. Due to the lack of distinctive features and nonspecific presenting symptoms, Paget's disease may be misdiagnosed as other conditions, thus delaying the correct diagnosis. We report a case of extramammary Paget's disease in the perianal region that initially presented as an irregular, circumferential, scaling lesion with eczematous eruptions. Immunology and immunohistochemistry confirmed the diagnosis. Although surgery is the standard treatment, the patient opted for pelvic radiotherapy associated with radiosensitizing chemotherapy.


RESUMO A doença de Paget acomete mais comumente a mama. Os focos extramamários são raros e os locais mais habitualmente acometidos são vulva, ânus, região perianal e axila. A patologia envolve a evolução da doença para adenocarcinoma invasivo ou neoplasias sincrônicas. Devido à singularidade e sua aparência inespecífica, a doença pode ser confundida com outras comorbidades, retardando o diagnóstico. O objetivo foi relatar um caso de doença de Paget extramamária na região perianal, a qual inicialmente apresentou lesão circunferencial com erupção eczematosa, descamativa e irregular. A confirmação diagnóstica foi por meio de exames imuno-histoquímico e imunológico. O tratamento padrão da doença é cirúrgico, porém optou-se por radioterapia pélvica associada à quimioterapia radiossensibilizante.


Subject(s)
Humans , Female , Anus Neoplasms , Paget Disease, Extramammary/drug therapy , Radiotherapy , Skin Neoplasms , Paget Disease, Extramammary/diagnosis , Paget Disease, Extramammary/pathology
19.
J. coloproctol. (Rio J., Impr.) ; 39(2): 178-183, Apr.-June 2019.
Article in English | LILACS (Americas) | ID: biblio-1012583

ABSTRACT

ABSTRACT Study objectives: To evaluate the ideal timing between neoadjuvant therapy and surgical treatment of rectal cancer, as well as the influence on treatment outcomes. Methods: Using PubMed, a systematic literature search was made on the influence of surgery timing after chemoradiotherapy in treating rectal cancer. Results and discussion: A total of 34 articles published until April 2017 were analyzed. Nine of them were randomized clinical trials, one was a non-randomized trial, 23 were retrospective studies, and one was a meta-analysis. These studies compared treatment intervals varying between two and 19 weeks. Intervals of nine to 14 weeks showed increased tumor downstaging and higher rates of complete pathological response. These intervals shown safety for patients. Nonetheless, few studies showed differences in overall survival. The most used intervals between neoadjuvant chemoradiotherapy are six to eight weeks. Despite that, intervals longer than these show potential benefits for patients without putting them at risk of disease progression. Studies evaluating the effect of overall survival and long-term recurrence are scarce. Conclusion: Programming surgery more than eight weeks after chemoradiotherapy seems preferable to the six to eight weeks most recently practiced, increasing tumor downstaging and having higher complete pathological response rates.


RESUMO Objetivos do estudo: Avaliar o timing ideal entre a terapêutica neoadjuvante e cirúrgica no carcinoma do reto e a sua influência nos outcomes de tratamento. Material e métodos: Utilizando a "PubMed", foi feita uma revisão sistemática da literatura disponível acerca da influência do timing cirúrgico após quimiorradioterapia neoadjuvante no tratamento do carcinoma do reto. Resultados e discussão: Foram analisados 34 artigos publicados até Abril de 2017, sendo que destes nove foram ensaios clínicos randomizados, um foi ensaio clínico não randomizado, 23 foram estudos retrospetivos e um foi uma meta-análise. Estes estudos compararam intervalos de tratamento que variaram entre 2 e 19 semanas. Intervalos entre as 9-14 semanas demonstraram aumento do downstaging tumoral e da taxa de resposta patológica completa. Estes intervalos demonstraram segurança para os doentes. Contudo, poucos estudos demonstraram diferenças na sobrevida dos doentes. Os intervalos mais usados entre a QRT neoadjuvante e o tratamento cirúrgico são de 6-8 semanas. Apesar disso, intervalos superiores às 6-8 semanas demonstram potenciais benefícios para os pacientes sem os colocar em risco de progressão da doença. São limitados os estudos que avaliam o efeito na sobrevida e recorrência em longo prazo. Conclusão: A programação da cirurgia superior às 8 semanas após quimiorradioterapia parece ser preferível às 6-8 semanas até recentemente praticada, aumentando o downstaging tumoral e a taxa de resposta patológica completa.


Subject(s)
Humans , Rectal Neoplasms/surgery , Rectal Neoplasms/therapy , Radiotherapy , Surgical Procedures, Operative , Neoadjuvant Therapy , Drug Therapy
20.
J. bras. econ. saúde (Impr.) ; 11(1): 96-102, Abril/2019.
Article in Portuguese | LILACS (Americas), ECOS | ID: biblio-1005740

ABSTRACT

Objetivos: Comparar os resultados de controle local e sobrevida global e fazer uma análise econômica comparativa da radioterapia intraoperatória com elétrons (IOeRT) para o tratamento da neoplasia de mama inicial, em comparação à radioterapia conformacional de toda a mama (RT 3D). Métodos: Foi feita revisão sistemática da literatura e, posteriormente, considerando-se os resultados comparáveis de eficácia, análise de minimização de custos, comparando as técnicas mencionadas anteriormente. Resultados: Foi incluído um estudo randomizado. Observou-se pequeno aumento do número de falhas locais em cinco anos (4,4 vs. 0,4%), sem alteração, porém, na sobrevida global. Quando se restringiu o estudo às mulheres com tumores de até 2,0 cm de diâmetro, grau I ou II, com axila negativa ou com até três linfonodos comprometidos e com tumores não classificados como triplos-negativos, chegou-se a um nível comparável de controle local (1,5% de recidivas em cinco anos), sem diferenças significativas no tocante aos efeitos secundários ao tratamento. Em análise econômica posterior, optou-se, então, pelo estudo de minimização de custos, sob a perspectiva das operadoras de saúde do sistema de saúde privado brasileiro, tendo como base os custos dos procedimentos descritos na Classificação Brasileira Hierarquizada de Procedimentos Médicos (CBHPM), 5ª edição. Nesta análise, observou-se que a aplicação da IOeRT implica uma economia de recursos da ordem de 51,5% por tratamento. Conclusão: Conclui-se que a IOeRT é opção que leva à economia de recursos quando utilizada no tratamento de mulheres com câncer de mama inicial, sob a perspectiva das operadoras de saúde do Brasil, quando observados os critérios de inclusão descritos previamente.


Objectives: To compare local control and overall survival and perform an economic analysis between intraoperative electron beam radiation therapy (IOeRT) and conformal radiotherapy, directed to the whole breast (RT 3D), for the treatment of early breast cancer. Methods: A systematic review of the literature was performed, with the inclusion of 1 controlled randomized study, comparing IOeRT with standard treatment ­ RT 3D, in early breast cancer. Posteriorly, due to comparable results between the studied techniques, a cost-minimization analysis was executed. Results: There was a small increase in the number of local failures, in 5 years (4.4 vs. 0.4%), but with no changes in overall survival. When the analysis was restricted to women with tumors up to 2.0 cm, grades I or II, with negative axilla or with up to 3 compromised lymph nodes and with tumors not classified as triple-negative, a comparable level of local control was reached (1.5% over 5 years), without significant differences in treatment side effects. In the following economic analysis, a cost minimization study was chosen, once both treatments were equivalent, considering local control and overall survival. The perspective was that of the Brazilian private healthcare system, based on the costs of the procedures according to the Brazilian Hierarchical Classification of Medical Procedures (CBHPM), 5th edition. In this analysis, it was observed that the delivery of IOeRT implies a resource saving of 51.5% per treatment. Conclusion: We conclude that IOeRT is a very interesting option, that leads to resource savings, when used in the treatment of women with early breast cancer, observing the inclusion criteria previously described, in the Brazilian health care payer's perspective.


Subject(s)
Humans , Radiotherapy , Breast Neoplasms , Efficacy , Costs and Cost Analysis
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