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1.
São Paulo; s.n; 20240104. 86 p.
Thesis in Portuguese | LILACS, BBO | ID: biblio-1524408

ABSTRACT

Os pacientes portadores de câncer de cabeça e pescoço realizam tratamento, de radioterapia podendo ou não estar associados à quimioterapia e/ou cirurgias. A qualidade de vida dos mesmos é afetada em função dos efeitos colaterais causados pelos tratamentos. Mucosite, hiposalivação, perda do paladar, trismo e osteorradionecrose são os efeitos colaterais que mais acomentem os pacientes em tratamento para câncer de cabeça e pescoço. A osteorradionecrose é considerada um evento tardio e a maior complicação pós tratamento de radioterapia. Foi realizada uma busca sistemática nas bases de dados eletrônicas MEDLINE / PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Open Gray e busca manual, sem restrição de idioma e tempo. Os critérios de elegibilidade foram os seguintes: 1) ser revisão sistemática; 2) abordar sobre os efeitos orais e complicações após quimioterapia e/ou radioterapia em pacientes adultos portadores de câncer de cabeça e pescoço e 3) RS baseadas em estudos clínicos prospectivos/ retrospectivos e ECR (estudo clínico randomizado). A elegibilidade foi determinada de acordo com os critérios de exclusão para:1) RS que descrevessem a o tratamento para as sequelas da ORN; 2) as RS baseadas em relatos de casos ou estudos in vitro sobre ORN; 3) ORN em ossos não gnáticos (temporal); 4) não abordarem sobre incidência, tratamento ou prevenção da ORN e 5) revisão da classificação da ORN. Foram identificados 1321 artigos, mas apenas 13 foram considerados elegíveis. A fase de elegibilidade, qualidade metodológica (AMSTAR 2) foi conduzida por dois examinadores independentes e calibrados (RMS e GS), e um terceiro examinador (MSANM) foi consultado para a resolução de incongruências. O número de pacientes avaliados para o desenvolvimento de ORN ao longo do tratamento foi 33.762 sendo que desses, 2.094 desenvolveram a lesão, representando uma incidência de 6,2%. Quanto a localização a mandíbula é o local de maior acometimento. A exodontia após a radioterapia foi apontada como o maior fator causal para o desenvolvimento de ORN. A abordagem de tratamento para a ORN com pentoxifilina e tocoferol demonstrou eficácia superior em relação ao uso de antibioticoterapia e câmera hiperbárica. Baseado no risco de viés, é baixo o nível atual de evidência para as abordagens preventivas e curativas da ORN.


Subject(s)
Osteoradionecrosis , Systematic Review , Head and Neck Neoplasms , Radiotherapy
2.
Braz. j. oral sci ; 23: e246798, 2024. tab
Article in English | LILACS, BBO | ID: biblio-1527028

ABSTRACT

Aim: Hyposalivation and dry mouth affect the quality of life in patients with Head and Neck Cancer, who did the treatment with radiotherapy. Thus this study has the objective to evaluate the dosimetric relationship between 3D radiotherapy and changes in salivary flow, xerostomia and quality of life in patients with head and neck cancer according to the volume of the irradiated parotid gland. Methods: 23 patients with cancer in the head and neck area and in need of 3D radiotherapy were followed up during radiotherapy treatment, and the parotid gland (PG) design was also performed in radiotherapy planning. Questionnaires were carried out to determine xerostomia and quality of life, while the salivary flow was determined through calculations regarding the collection and weighing of saliva. Such data were collected in three moments: before the beginning of the radiotherapy treatment (D0), in the middle of the treatment (D1) and at the end of it (D2). The numerical variables are represented by measures of central tendency and measures of dispersion. Results: when associating the salivary flow, the xerostomia questionnaire and the OHIP-14, a statistically significant difference was found (p-value <0.001), as well as when comparing some volumes of irradiated PG with the OHIP-14. However, no relationship was found between dosimetric data, xerostomia and hyposalivation. Conclusion: patients undergoing 3D radiotherapy for malignant neoplasms in the head and neck region had decreased salivary flow, increased complaints of dry mouth and decreased quality of life. However, it was not possible to establish a statistically significant correlation between these findings and the volumes of irradiated parotids


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Parotid Gland , Quality of Life , Radiotherapy , Xerostomia , Head and Neck Neoplasms
3.
Rev Enferm UFPI ; 12(1): e4010, 2023-12-12. tab e graf
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1523661

ABSTRACT

Objetivo: Caracterizar as metástases ósseas e os eventos relacionados ao esqueleto associando-os ao tempo de sobrevida em pessoas submetidas a radioterapia. Métodos Trata-se de um estudo retrospectivo, descritivo e transversal. Foi realizado em um Centro de Alta Complexidade em Oncologia, com prontuários de pessoas diagnosticadas com metástases ósseas. Resultados: Foram analisados 122 prontuários, a maioria dos pacientes era do sexo feminino (59,02%), com média de idade de 58,86 anos (±14,54). Os sítios primários mais incidentes foram a mama (43,44%) e a próstata (30,33%). O número de osso ou grupo de ossos atingidos foi, em média, de 3,09 (±2,14). A coluna vertebral foi a mais acometida (80,33%). Esta região também foi a mais irradiada no tratamento radioterápico (55,74%). A maioria dos pacientes recebeu 10 sessões de radioterapia (70,49%), em média 9,05 (±2,89). Quanto aos eventos relacionados ao esqueleto, 100% dos pacientes apresentavam registros de dor óssea, 32,78% sofreram fratura patológica, com tempo de sobrevida de 32,53 meses, e 10,65% apresentaram compressão medular, com sobrevida média de 41,52 meses. Conclusão: As metástases ósseas foram mais comuns na coluna vertebral. Todos os pacientes apresentaram registros de dor óssea, e a fratura patológica foi associada à menor sobrevida dos indivíduos. Descritores: Metástase Neoplásica; Osso e Ossos; Radioterapia; Enfermagem.


Objective: To characterize bone metastases and skeleton-related events associating them with survival time in people subjected to radiotherapy. Methods:This is a retrospective, descriptive and cross-sectional study. It was conducted in a High-Complexity Oncology Center with medical records of people diagnosed with bone metastases. Results:A total of 122 medical records were analyzed and most of the patients were female (59.02%), with a mean age of 58.86 years old (±14.54). The most incident primary sites were breast (43.44%) and prostate (30.33%). The mean number of bones or bone groups affected was 3.09 (±2.14). The spine was the most affected area (80.33%). This region was also the most irradiated in the radiotherapy treatments (55.74%). Most of the patients (70.49%) underwent 10 radiotherapy sessions, with a mean of 9.05 (±2.89). With regard to the skeleton-related events, 100% of the patients reported pain, 32.78% suffered pathological fractures with a survival time of 32.53 months, and 10.65% presented spine compression with a mean survival of 41.52 months. Conclusion:Bone metastases were more common in the spine. All the patients presented bone painrecords, and pathological fractures were associated with lower survival among the individuals. Descriptors: Neoplasm Metastasis; Bone and Bones; Radiotherapy; Nursing.


Subject(s)
Radiotherapy , Bone and Bones , Nursing , Neoplasm Metastasis
4.
Rev. bras. ortop ; 58(3): 368-377, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1449823

ABSTRACT

Abstract The increase in life expectancy of the world population has led to a concomitant increase in the prevalence of multiple myeloma (MM), a disease that usually affects the elderly population. Bone lesions are frequent in patients with this condition, demanding an early approach, from drug treatment, through radiotherapy to orthopedic surgery (prophylactic or therapeutic) with the objective of preventing or delaying the occurrence of fracture, or, when this event has already occurred, treat it through stabilization or replacement (lesions located in the appendicular skeleton) and/or promote stabilization and spinal cord decompression (lesions located in the axial skeleton), providing rapid pain relief, return to ambulation and resocialization, returning quality of life to patients. The aim of this review isto update the reader on the findings of pathophysiology, clinical, laboratory and imaging, differential diagnosis and therapeutic approach of multiple myeloma multiple myeloma bone disease (MMBD).


Resumo O aumento da expectativa devida da população mundial levou a incremento concomitante na prevalência de mieloma múltiplo (MM), patologia que geralmente afeta a população idosa. Lesões ósseas são frequentes nos portadores desta condição, demandando abordagem precoce, desde o tratamento medicamentoso, passando pela radioterapia até a cirurgia ortopédica (profilática ou terapêutica) com os objetivos de prevenir ou retardar a ocorrência de fratura, ou, quando este evento já ocorreu, tratá-la mediante estabilização ou substituição (lesões situadas no esqueleto apendicular) e/ou promover estabilização e descompressão medular (lesões situadas no esqueleto axial), proporcionando rápido alívio da dor, retorno à deambulação e ressocialização, devolvendo a qualidade de vida aos pacientes. O objetivo desta revisão é atualizar o leitor sobre a fisiopatologia, a clínica, exames laboratoriais e de imagem, diagnóstico diferencial e abordagem terapêutica da doença óssea no mieloma múltiplo (DOMM).


Subject(s)
Humans , Radiotherapy , Orthopedic Procedures , Diphosphonates , Prophylactic Surgical Procedures , Fractures, Spontaneous , Multiple Myeloma
5.
Rev. cuba. med ; 62(1)mar. 2023.
Article in Spanish | LILACS, CUMED | ID: biblio-1450009

ABSTRACT

Introducción: El uso clínico de la ozonoterapia se incrementa cada día. Abarca disímiles especialidades médicas como la oncología. En Cuba las investigaciones que evalúan el empleo de la ozonoterapia en pacientes con cáncer son escasas, se precisan estudios científicos que demuestren su eficacia clínica. Objetivo: Explicar los mecanismos farmacológicos y bioquímicos de la ozonoterapia y su uso en el cáncer como terapia complementaria. Métodos: Se consultaron bases de datos disponibles a través de la red de Infomed. Se utilizaron como palabras clave: cáncer, ozonoterapia y estrés oxidativo. Se seleccionaron artículos originales y de revisión sistemáticos de los últimos diez años que evaluaron la utilización de la ozonoterapia en el tratamiento del cáncer. Resultados: El cáncer es per se una enfermedad inductora de estrés oxidativo. La ozonoterapia respalda su utilización como una terapia adyuvante mediante el preacondicionamiento oxidativo que estimula los sistemas antioxidantes de la célula contra la acción de los radicales libres. Así, se logra neutralizar la acción nociva del estrés oxidativo. El ozono incrementa la eficacia de la radio - quimioterapia y ayuda a reducir los efectos secundarios de estos tratamientos al activar los sistemas antioxidantes de la célula. La ozonoterapia se caracteriza por la simplicidad de su aplicación, bajos costos, alta efectividad y prácticamente ausencia de efectos colaterales en comparación con otros tratamientos adyuvantes. Conclusiones: El uso de la ozonoterapia en oncología como una terapia adyuvante representó un recurso terapéutico de gran valor dado por su perfil de efectividad y seguridad. Su uso podría extenderse para disminuir los efectos secundarios y mejorar la calidad de vida de los pacientes(AU)


Introduction: The clinical use of ozone therapy is increasing every day worldwide and it covers different medical specialties, including oncology. However, in Cuba, the investigations that evaluate the use of ozone therapy in cancer patients are scarce, so scientific studies are needed to demonstrate its clinical efficacy. Objective: To explain the pharmacological and biochemical mechanisms of ozone therapy and its use in cancer as a complementary therapy. Methods: Databases available through Infomed Network were consulted. Key words used were cancer, ozone therapy and oxidative stress. Original and systematic review articles from the last ten years that evaluated the use of ozone therapy in the treatment of cancer were selected. Results: Cancer is, as such, a disease that induces oxidative stress. Ozone therapy supports its use as an adjuvant therapy through oxidative pre-conditioning that stimulates the cell's antioxidant systems against the action of free radicals. Thus, it is possible to neutralize the harmful action of oxidative stress. Ozone increases the efficacy of radio-chemotherapy and helps reducing the side effects of these treatments by activating the cell's antioxidant systems. Ozone therapy is characterized by the simplicity of its application, low costs, high effectiveness and with practically no side effects, compared to other adjuvant treatments. Conclusions: The use of ozone therapy in oncology as an adjuvant therapy represented a therapeutic resource of great value given its effectiveness and safety profile. Its use could be extended to improve tissue oxygenation and thus enhance the efficacy of radiochemotherapy, reducing side effects and improving the patients's quality of life(AU)


Subject(s)
Humans , Male , Female , Quality of Life , Radiotherapy/methods , Oxidative Stress , Drug Therapy/methods , Ozone Therapy , Neoplasms/therapy
6.
São Paulo; s.n; 2023. 75 p. ilus, tab.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1434399

ABSTRACT

Introdução: Padrões atípicos de cárie dentária em pacientes submetidos a radioterapia para o tratamento do câncer de cabeça e pescoço podem estar associados aos efeitos da radiação sobre as glândulas salivares e tecidos dentários duros. Somados, podem contribuir para a cárie relacionada a radiação. Embora haja evidências sobre alterações sofridas pelos tecidos dentários duros após radioterapia, não há consenso na literatura sobre a gravidade destas alterações. Objetivo: avaliar a microestrutura, composição química e microdureza do esmalte e da dentina de dentes permanentes submetidos a doses terapêuticas de radioterapia in vitro. Material e métodos: estudo experimental, qualitativo, quantitativo e semiquantitativo. Foram obtidos fragmentos coronários de 24 terceiros molares. Constituiuse 2 grupos: NIR (controle): formado por fragmentos de dentes não irradiados e IVT (irradiado): formado por fragmentos de dentes irradiados in vitro (2 Gy/dia 5 vezes por semana, totalizando 70 Gy). Os fragmentos foram submetidos a análise da microdureza (n=24), Espectroscopia de Infravermelho com Transformada de Fourier (FTIR) (n=24), análise morfológica através de Microscopia Eletrônica de Varredura (MEV) (n=19) e análise de elementos químicos por Espectroscopia de Dispersão de Energia de Raio X (EDX) (n=19). As análises foram feitas antes e após a irradiação. Os dados foram testados para distribuição normal (teste de Shapiro-Wilk, α = 0,05) e igualdade de variâncias (teste de Levene, α = 0,05), seguido de testes estatísticos paramétricos. Para a comparação das variáveis quantitativas foi aplicado o teste T de Student. Um valor de p <0,05 (5%) foi considerado estatisticamente significativo. Resultados: em relação as propriedades mecânicas observamos redução significativa da microdureza do esmalte e dentina após irradiação (p<0,001). A análise da composição química por FTIR mostrou que no esmalte não houve alteração da razão matriz/mineral (M:M) no grupo irradiado (p<0,821), mas houve redução significativa do teor relativo de carbonato (RCC) após irradiação (p<0,039). Na dentina observamos redução significativa da razão matriz/mineral (M:M) e carbonato/mineral (C:M) no grupo irradiado (p<0,001), enquanto a razão amida I/amida III, não sofreu alteração significativa após irradiação (p<0,536). Na análise de EDX realizadas no esmalte, não observamos variação no conteúdo de cálcio e fósforo após radiação, mas a razão Ca/P mostrou-se significantemente mais elevada no grupo irradiado (p<0,001). Na dentina, não houve alteração do teor de cálcio e fósforo, assim como da razão Ca/P após irradiação (p<0,267). A análise morfológica através de MEV pós irradiação, mostrou que no esmalte a maioria das amostras apresentaram uma alteração das características microestruturais com a presença de microporosidades, perda de padrões regulares das áreas prismáticas e interprismáticas e presença de áreas amorfas. Na dentina observamos manutenção do padrão de dentina peritubular e intertubular, com a presença de túbulos dentinários desobliterados e com a rede de fibras colágenas mais evidente grupo irradiado. Conclusão: as doses terapêuticas de radioterapia provocaram redução da microdureza, alterações na microestrutura e composição química do esmalte e da dentina. Assim, inferimos que doses terapêuticas de radiação exercem um impacto negativo sobre as propriedades mecânicas, químicas e micro-morfológicas dos tecidos dentários duros aumentando a vulnerabilidade destes tecidos à cárie relacionada a radiação.


INTRODUCTION: Atypical patterns of dental caries in patients undergoing radiotherapy to treat head and neck cancer may be associated with the effects of radiation on salivary glands and dental hard tissues. Together, they can contribute to radiation-related caries. Although there is evidence of changes in hard dental tissues after radiotherapy, there is no agreement in the literature on the severity of these changes. PURPOSE: This study aims to evaluate the microstructure, chemical composition, and microhardness of enamel and dentin in permanent teeth subject to therapeutic doses of in vitro radiotherapy. MATERIAL AND METHODS: This is an experimental, qualitative, quantitative, and semi-quantitative study. Coronary fragments were obtained from 24 third molars. Two groups were created: NIR (control), including fragments of non-irradiated teeth, and IVT (irradiated), including fragments of in vitro irradiated teeth (2Gy/day five times a week, totaling 70Gy). The fragments underwent microhardness analysis (n =24), Fourier-transform Infrared Spectroscopy (FTIR) (n=24), morphological analysis by Scanning Electron Microscope (SEM) (n=19), and analysis of chemical elements by Energy-dispersive X-Ray Spectroscopy (EDX) (n=19). The analyses were performed before and after irradiation. Data were tested for normal distribution (ShapiroWilk test, α = 0.05) and equality of variances (Levene test, α = 0.05), followed by parametric statistical tests. The Student's T test was applied to compare the quantitative variables. A pvalue < 0.05 (5%) was considered statistically significant. RESULTS: Concerning the mechanical properties, we observed a significant reduction in enamel and dentin microhardness after irradiation (p<0.001). The analysis of the chemical composition by FTIR showed no change in the mineral/matrix ratio (M:M) in enamel in the irradiated group (p<0.821), but there was a significant reduction in the relative carbonate content (RCC) after irradiation (p<0.039). In dentin, we observed a significant reduction in the mineral/matrix ratio (M:M) and carbonate/mineral ratio (C:M) in the irradiated group (p<0.001). In contrast, the amide I/amide III ratio showed no significant change after irradiation (p<0.536). In the EDX analysis performed on enamel, we did not observe any calcium and phosphorus content variation after radiation. However, the Ca/P ratio was significantly higher in the irradiated group (p<0.001). In dentin, there was no change either in calcium and phosphorus contents or in the Ca/P ratio after irradiation (p<0.267). The morphological analysis through SEM after irradiation showed that there is a loss in the characteristics of the enamel surface of most fragments, with the presence of microporosities, loss of regular patterns of the prismatic and interprismatic areas, and the presence of amorphous areas. In dentin, we observed maintenance of the peritubular and intertubular dentin patterns, with the presence of unobliterated dentinal tubules and with the most evident network of collagen fibers in the irradiated group. CONCLUSION: Therapeutic doses of radiotherapy caused a reduction in microhardness and changes in the microstructure and chemical composition of enamel and dentin. Thus, we conclude that therapeutic doses of radiation have a negative impact on the mechanical, chemical, and micromorphological properties of hard dental tissues, increasing the vulnerability of these tissues to radiation-related caries


Subject(s)
Humans , Male , Female , Radiotherapy/adverse effects , Dental Enamel/radiation effects , Dentin/radiation effects , Head and Neck Neoplasms
7.
Rev. Bras. Cancerol. (Online) ; 69(3)jul-set. 2023.
Article in Spanish, Portuguese | LILACS, SES-SP | ID: biblio-1512795

ABSTRACT

Introdução: O câncer surge a partir de séries de mutações genéticas em razão da exposição a agentes cancerígenos que comprometem a defesa imunológica e, com seu avanço, são utilizados tratamentos como a quimioterapia e a radioterapia. Entretanto, ambos os tratamentos provocam efeitos adversos. Dessa forma, a fisioterapia tem o intuito de reabilitar as disfunções cinético-funcionais provenientes desses efeitos. Objetivo: Sistematizar as condutas fisioterapêuticas mais utilizadas para tratar os principais efeitos adversos oriundos da quimioterapia e radioterapia em pacientes oncológicos. Método: Revisão sistemática nas bases de dados PubMed, LILACS, PEDro e SciELO no período de 2017 a 2022. Resultados: Dos 4.190 artigos, foram selecionados 13 que preencheram os critérios de inclusão e nota 6/10 pela Escala PEDro. As condutas fisioterapêuticas relatadas nos estudos foram acupuntura, laser, led, massagem terapêutica, auriculoterapia, crioterapia e osteopatia, que promoveram diminuição e alívio dos efeitos adversos, podendo atuar como atenuantes na ocorrência desses sintomas. Conclusão: Os efeitos adversos como náuseas e vômitos, mucosite, e fadiga, secundários à quimioterapia e radioterapia, poderão ser tratados com condutas fisioterapêuticas como acupuntura, laser, led, massagem terapêutica, auriculoterapia, crioterapia e osteopatia, que são seguras e efetivas para esse perfil de pacientes, além de proporcionar alívio dos sintomas, prevenir e diminuir os processos inflamatórios, aumentar o apetite, melhorar a função gastrointestinal e o condicionamento físico.


Introduction: Cancer arises from a series of genetic mutations due to exposure to carcinogens that compromise the immune defenses and, as it progresses, treatments as chemotherapy and radiotherapy are adopted. However, both treatments cause adverse effects and physiotherapy has the objective of rehabilitating functional kinetic dysfunctions resulting from these effects. Objective: To systematize the most utilized physiotherapeutic approaches to treat the main adverse effects arising from chemotherapy and radiotherapy in cancer patients. Method: A systematic review was carried out in the PubMed, LILACS, PEDro and SciELO databases from 2017 to 2022. Results: Of the 4,190 articles, 13 were selected that met the inclusion criteria and scored 6/10 on the PEDro Scale. The physiotherapeutic procedures reported in the studies were acupuncture, laser, led, therapeutic massage, auriculotherapy, cryotherapy and osteopathy, which promoted a decrease and relief of adverse effects and could act as mitigating factors in the occurrence of these symptoms. Conclusion: Adverse effects as nausea and vomiting, mucositis and fatigue secondary to chemotherapy and radiotherapy can be treated with physiotherapeutic procedures as acupuncture, laser, led, therapeutic massage, auriculotherapy, cryotherapy and osteopathy, which are safe and effective for this profile of patient, in addition to providing symptoms relief, preventing and reducing inflammatory processes, increasing appetite, improving gastrointestinal function and physical conditioning.


Introducción: El cáncer surge de una serie de mutaciones genéticas debidas a la exposición a agentes cancerígenos que comprometen las defensas inmunitarias, y a medida que avanza se utilizan tratamientos como la quimioterapia y la radioterapia. Sin embargo, ambos tratamientos provocan efectos adversos. De esta forma, la fisioterapia surge con la intención de rehabilitar las disfunciones cinéticas funcionales resultantes de estos efectos. Objetivo: Sistematizar los enfoques fisioterapéuticos más utilizados para tratar los principales efectos adversos derivados de la quimioterapia y radioterapia en pacientes oncológicos. Método: Revisión sistemática en las bases de datos PubMed, LILACS, PEDro y SciELO de 2017 a 2022. Resultados: De los 4190 artículos, solo se seleccionaron 13 que cumplieron con los criterios de inclusión y recibieron una puntuación de 6/10 en la escala PEDro. Los procedimientos fisioterapéuticos reportados en los estudios fueron acupuntura, láser, led, masaje terapéutico, auriculoterapia, crioterapia y osteopatía, que promovieron una disminución y alivio de los efectos adversos y podrían actuar como mitigantes en la aparición de estos síntomas. Conclusión: Los efectos adversos como náuseas y vómitos, mucositis y cansancio secundarios a la quimioterapia y radioterapia pueden ser tratados con procedimientos fisioterapéuticos como acupuntura, láser, led, masaje terapéutico, auriculoterapia, crioterapia y osteopatía, los cuales son seguros y efectivos. en estos perfiles de pacientes, además de proporcionar alivio de síntomas, prevenir y reducir procesos inflamatorios, aumentar el apetito, mejorar la función gastrointestinal y la condición física


Subject(s)
Radiotherapy , Physical Therapy Modalities , Drug Therapy , Neoplasms
8.
Acta Medica Philippina ; : 34-40, 2023.
Article in English | WPRIM | ID: wpr-980234

ABSTRACT

Background@#To respond to the pandemic, many societies, including the American Society for Radiation Therapy (ASTRO), the United Kingdom’s National Institute for Health and Care Excellence (NICE), and the Philippine Radiation Oncology Society (PROS), recommended guidelines to allow for continued safe delivery of oncologic services. Yet, the delivery of radiotherapy during the COVID-19 pandemic remains a challenge.@*Objective@#To describe the situation of radiotherapy delivery in Metro Manila (NCR) during the COVID-19-related quarantine. Specifically, the objectives were to determine: (1) how the radiotherapy providers implemented the recommended changes, (2) if these implemented changes allowed the hospitals to operate with pre-COVID capacities, and (3) the causative factors of treatment interruptions if these were present. Additionally, in the face of treatment interruptions, the authors sought to put forth recommendations to decrease treatment interruptions.@*Methods@#Investigators gathered data on the prevailing situation of RT services in their respective institutions during the strictest period of quarantine — Enhanced Community Quarantine (ECQ). Patients aged 18-70 years old who missed at least one fraction during the ECQ from March 16 – April 15, 2020, were invited to participate in a phone survey to determine factors contributing to treatment interruptions.@*Results@#All the institutions implemented global recommendations to adapt to the pandemic, including infection control measures, telemedicine, and modification of RT plans. Despite this, most institutions had increased treatment interruptions during ECQ. The percentage of patients with interruptions was also much higher during the ECQ (66.37%) than during the pre-COVID month (30.56%). Among 142 patients unable to continue treatment, there were no significant differences in demographic variable and oncologic profile rates. The majority were more worried about getting COVID-19 than missing RT. The most common factor for treatment interruptions was transportation, followed by fear of getting COVID-19.@*Conclusion@#Compliance with global recommendations is not enough to ensure that the patients who require radiotherapy will receive it. Based on institutional and patient results, the causative factors of interruptions included suspension of services, lack of transportation, and anxiety of patients and staff. Especially in low-resource settings, recommendations are to use available resources as efficiently as possible by having an organized referral system, providing transportation or nearby accommodation for patients and staff, and communicating effectively to reassure patients that radiotherapy can be continued safely.


Subject(s)
Radiotherapy , Radiotherapy , Radiation Oncology
9.
Belo Horizonte; s.n; 2023. 141 p. ilus, tab.
Thesis in Portuguese | LILACS, BBO | ID: biblio-1509350

ABSTRACT

O câncer de cabeça e pescoço (CCP) é uma das principais causas de morbidade e mortalidade em todo mundo. Cirurgia, radioterapia (RT) e quimioterapia (QT) são os principais tratamentos empregados. Contudo, pacientes submetidos a RT e QT podem apresentar complicações como mucosite oral (MO). A terapêutica mais recomendada para MO é a fotobiomodulação (FTBM). Há diversas escalas para graduação da MO, entretanto elas apresentam limitações quando aplicadas em pacientes com CCP. Por esse motivo, foi desenvolvido uma revisão da literatura para descrever as escalas mais utilizadas e apontar as limitações. Microrganismos podem agravar a cicatrização da MO. Diante disso, a terapia fotodinâmica antimicrobiana (aPDT), poderia complementar a ação da FTBM. Assim, foi realizado estudo comparativo entre o uso da FTBM isolada e FTBM + aPDT no tratamento da MO. Mudanças no microbioma oral induzidas pela RT e seu papel no agravamento das complicações, como MO, vem sendo descrito. Em razão disso, amostras da cavidade oral dos pacientes com CCP foram coletadas com swab antes da RT (T0), entre 12 e 16 Grays (Gy) (T1), entre 30 e 36 Gy (T2) e acima de 60 Gy (T3) para caracterização molecular por meio da amplificação e sequenciamento das regiões v1-v2 do gene 16S rRNA. As escalas da World Health Organization - WHO, Radiation Therapy Oncology Group - RTOG e National Cancer Institute ­ NCI foram as mais utilizadas e todas apresentaram limitações associadas principalmente com a dificuldade de diferenciar entre os sinais e sintomas da MO e os do tumor, como por exemplo a disfagia. O estudo comparativo (FTBM isolada X FTBM + aPDT) foi composto por 14 pacientes, com câncer de boca e orofaringe submetidos a RT e QT concomitantes, com 6 pacientes no grupo FTBM isolada e 8 no grupo FTBM + aPDT. A média de redução no tamanho da MO no grupo intervenção foi de 0,70 cm2 (±0,35) e 0,30 cm2 (±1,10) no grupo controle. A média de duração foi de 18,37 dias (±12,12) para o grupo intervenção e 23 dias (±14,78) para o grupo controle. O grupo intervenção teve redução média de 3,40 pontos na escala de dor (±2,44), enquanto o grupo controle teve 0,17 (±2,28). O estudo prospectivo que avaliou o microbioma oral (filo e gênero) ao longo da RT foi composto por 49 pacientes com CCP. Intrigantemente não foi observado diferença no microbioma oral dos pacientes que apresentaram MO (n=31) daqueles que não apresentaram (n=18). Interessantemente foi observado ao final da RT (T3) diminuição de Porphyromonas (p=<0.0001), Prevotella (p=0.010), Fusobacterium (p=<0.0001), gêneros associados ao câncer. Não há uma escala ideal para a avaliação da mucosite oral em pacientes com CCP. A mensuração das lesões de MO associada aos dados de dor e duração da MO pode ser uma forma mais eficaz de avaliação. A combinação de FTBM + aPDT parece ser uma abordagem promissora para descontaminar lesões de MO. Não foi observado diferença no microbioma oral de pacientes com e sem MO. Mudanças na composição do microbioma oral foram observadas durante a RT.


Head and neck cancer (HNC) is one of the main causes of morbidity and mortality worldwide. Surgery, radiotherapy (RT) and chemotherapy (CT) are the main treatments used. However, patients undergoing RT and CT may present complications such as oral mucositis (OM). The most recommended therapy for OM is photobiomodulation (PBM-T). There are several scales for grading OM, however they have limitations when applied to patients with HNC. For this reason, a literature review was developed to describe the most used scales and point out the limitations. Microorganisms can aggravate OM healing. Therefore, antimicrobial photodynamic therapy (aPDT) could complement the action of PBM-T. Thus, a comparative study was carried out between the use of PBM-T alone and PBM-T + aPDT in the treatment of OM. RT-induced changes in the oral microbiome and its role in worsening complications such as OM have been described. For this reason, samples from the oral cavity of patients with HNC were collected with a swab before RT (T0), between 12 and 16 Grays (Gy) (T1), between 30 and 36 Gy (T2) and above 60 Gy (T3) for molecular characterization through amplification and sequencing of regions v1-v2 of the 16S rRNA gene. The World Health Organization - WHO, Radiation Therapy Oncology Group - RTOG and National Cancer Institute - NCI scales were the most used and all had limitations mainly associated with the difficulty of differentiating between the signs and symptoms of OM and those of the tumor, such as example dysphagia. The comparative study (isolated PBM-T X PBM-T + aPDT) consisted of 14 patients with oral and oropharyngeal cancer who underwent concomitant RT and CT, with 6 patients in the isolated PBM-T group and 8 in the PBM-T + aPDT group. The mean reduction in OM size in the intervention group was 0.70 cm2 (±0.35) and 0.30 cm2 (±1.10) in the control group. The mean duration was 18.37 days (±12.12) for the intervention group and 23 days (±14.78) for the control group. The intervention group had an average reduction of 3.40 points on the pain scale (±2.44), while the control group had 0.17 (±2.28). The prospective study that evaluated the oral microbiome (phylum and genus) during RT consisted of 49 patients with HNC. Intriguingly, no difference was observed in the oral microbiome of patients who had OM (n=31) and those who did not (n=18). Interestingly, a decrease in Porphyromonas (p=<0.0001), Prevotella (p=0.010), Fusobacterium (p=<0.0001) was observed at the end of RT (T3), genera associated with cancer. There is no ideal scale for assessing oral mucositis in patients with HNC. Measurement of OM lesions associated with data on pain and duration of OM may be a more effective form of evaluation. The combination of PBM- T + aPDT appears to be a promising approach to decontaminate OM lesions. No difference was observed in the oral microbiome of patients with and without OM. Changes in oral microbiome composition were observed during RT.


Subject(s)
Radiotherapy , Mucositis , Laser Therapy , Head and Neck Neoplasms
10.
Cienc. Salud (St. Domingo) ; 7(1): [75-84], 2023.
Article in Spanish | LILACS | ID: biblio-1444364

ABSTRACT

Introducción: es bien conocida la utilidad del strain global longitudinal (SGL) del ventrículo izquierdo (VI) en pacientes que reciben antineoplásicos. Estudios recientes sugieren una conducta similar del strain longitudinal de la pared libre (SLPL) del ventrículo derecho (VD), pero en la literatura aún existen muchas controversias que limitan su valoración, por lo que este estudio es un aporte a esta necesidad de practicidad. Objetivo: evaluar el comportamiento del SLPL del VD en los pacientes tratados con quimioterapia y/o radioterapia, y su correlación con el SGL del VI. Metodología: se aplicó un protocolo de recolección de datos que incluía variables demográficas y antecedentes de pacientes con diagnóstico de cáncer, tratados con quimioterapia y/o radioterapia, que acudieron a realizarse un ecocardiograma con strain, desde noviembre 2020 a marzo 2021. El ecocardiograma se hizo acorde con los estándares de las guías de la Sociedad Americana de Ecocardiografía, que incluyera SGL del VI y el SLPL del VD. Los datos fueron analizados en programa SPSS. Resultados: de 90 pacientes, 6 excluidos para un total de 84 recopilados. 89 % mujeres, edad promedio 59 ±11 años, 73 % cáncer de mama. 54 % hipertensos, 27 % obesos, 23 % con dislipidemia, 19 % diabéticos y 11 % eran o fueron fumadores. 46 % había recibido quimioterapia y radioterapia concomitantes y el 48 % había recibido tratamiento hace más de un año. En hallazgos ecocardiográficos: fracción de eyección del VI (FE) promedio 64±7; sin embargo, 82 % tenía SGL del VI reducido (44 % menor a -15 %). De manera similar, el 74 % tenía reducción del SLPL del VD, pero solo el 15 % de la onda S del Doppler tisular del VD estaba anormal, 7 % del TAPSE estaba reducido y 6 % el cambio del área fraccional (CAF). El coeficiente de correlación de Pearson entre el SGL del VI y el SLPL del VD fue de 0.463, con un valor de p <.001, indicando una significativa relación lineal positiva moderada. Conclusión: nuestro estudio sugiere que el SLPL del VD tiene un comportamiento similar al SGL del VI y es un mejor predictor de disfunción ventricular derecha, por encima de los parámetros convencionales. Por esta razón, debería incorporarse como una medida rutinaria en la evaluación ecocardiográfica de los pacientes que reciben terapias antineoplásicas.


Introduction: It is well known the usefulness of left ventricle (LV) longitudinal global strain (GLS) in patients receiving antineoplastic therapy. Recent studies suggested a similar behavior of the right ventricle (RV) free wall longitudinal strain (FWLS), but in the literature there are still many controversies that limit its evaluation, so this study is a contribution to this need for practicality. Objective: To assess the behavior and usefulness of RV FWLS in patients treated with chemotherapy and/or radiotherapy and its correlation with the LV GLS. Method: A data collection protocol that included demographic variables and personal history was applied to patients diagnosed with cancer treated with chemotherapy and/ or radiotherapy who underwent an echocardiogram with strain from November 2020 to March 2021. The echocardiogram was performed accordingly with American Society of Echocardiography guidelines standards, including a LV GLS and a RV FWLS. The data was analyzed in the SPSS program. Results: Of 90 patients, 6 excluded for a total of 84 collected. 89% were women, mean age 59 ±11 years, 73% breast cancer. 54% had hypertension, 27% obesity, 23% dyslipidemia, 19% were diabetic and 11% are or use to be smokers. 46% had received concomitantly chemotherapy and radiotherapy and 48% were treated more than a year ago. In echocardiographic findings, mean LV ejection fraction (EF) was 64±7 %, however, 82% had reduced LV GLS (44% being less than -15%). Similarly, 74% of RV FWLS was reduced, but only 15% of the S wave of the RV by tissue Doppler was abnormal, 7% of TAPSE was reduced, and 6% of fractional area change (FAC). The Pearson correlation coefficient between LV GLS and RV FWLS was of 0.463 with a p value of <.001 indicating a significant moderate positive linear relationship. Conclusion: Our study suggests that RV FWLS has a similar behavior as LV GLS and is a better predictor of right ventricular dysfunction over conventional parameters. Whereby should be incorporated as a routine measurement in the echocardiographic evaluation of patients receiving antineoplastic therapy.


Subject(s)
Humans , Female , Middle Aged , Radiotherapy , Ventricular Function , Drug Therapy , Global Longitudinal Strain , Patients
11.
Rev. bras. hipertens ; 30(3): 78-83, set. 2023. tab
Article in Portuguese | LILACS | ID: biblio-1517121

ABSTRACT

Embora pacientes submetidas ao tratamento cirúrgico para Neoplasia de Mama, de modo geral e frequente, recebam orientações para não medir a pressão arterial no braço homolateral ao seu tratamento, devemos reavaliar contemporaneamente e cientificamente estas recomendações. O propósito deste trabalho é demonstrar os dados de Medicina Baseada em Evidências e considerar a evolução da abordagem cirúrgica neste grupo de pacientes, atualizando estas recomendações e demostram dados de enquete sobre o assunto entre médicos de diferentes especialidades. Há suficiente suporte científico e explicações para que orientemos de forma individualizada e coerentemente estas pacientes em relação a medida da pressão arterial e consequentemente sua relação com o aparecimento do linfedema no braço homolateral, porém a Sociedade Brasileira de Cardiologia, pelo seu Departamento de Hipertensão Arterial não tem recomendações sobre este assunto. Que deve ser contextualizado devido a má percepção sobre o assunto, em repostas a uma enquete feita com Cardiologistas e Mastologistas sobre este tema (AU)


Although patients undergoing surgical treatment for breast cancer are often advised against measuring blood pressure in the arm on the same side as their treatment, it is crucial to reevaluate these recommendations using contemporary and scientific evidence. The objective of this study is to present empirical data on Evidence-Based Medicine and explore the evolving surgical approaches in this patient population. By updating these recommendations and showcasing survey results from physicians across different specialties, we aim to provide comprehensive guidance on the topic. While there is ample scientific support and explanations to individually and coherently guide these patients regarding blood pressure measurement and its potential association with lymphedema in the affected arm, it is important to note that the Brazilian Society of Cardiology, specifically its Department of Arterial Hypertension, does not currently offer recommendations on this matter. This contextualization is necessary due to the limited awareness and understanding of the subject, as revealed through responses obtained from Cardiologists and Mastologists participating in our survey.


Subject(s)
Humans , Female , Radiotherapy , Hypertension
12.
Braz. j. oral sci ; 22: e238447, Jan.-Dec. 2023.
Article in English | LILACS, BBO | ID: biblio-1512212

ABSTRACT

To discuss important topics regarding the dental procedures performed in patients before, during and after the radiotherapy treatment. The biological effects of ionizing radiation on bone tissue focusing on clinical care will be described. The invasive and not invasive procedures after radiotherapy treatment in the head and neck region will be addressed using scientific evidences to determine the appropriate moment for tooth extractions, periodontal management, and preventive procedures for osteoradionecrosis. Methods: Thirty-three studies including original studies and reviews were selected in MEDLINE database (PubMed). No year of publication restriction was applied. Language was restricted to the English, and the following Medical Subject Heading terms were used: radiotherapy, osteoradionecrosis, dental management. Studies of osteoradionecrosis involving clinical management of irradiated patients, with an emphasis on updated guidelines and protocols were selected. Results: Care in dental procedures were related about restorative treatment, endodontic treatment, rehabilitation for edentulous regions using prostheses and implants and periodontal procedures before, during and after RTX treatment. Conclusions: The dental procedures should and can be performed before, during but also after radiotherapy. However, the clinical procedures should be less invasive as possible. A maintenance plan that reduces the necessity for major and more invasive treatments after radiotherapy is recommended


Subject(s)
Osteoradionecrosis , Radiotherapy , Critical Pathways , Dentistry , Head and Neck Neoplasms
13.
Health sci. dis ; 24(1): 109-112, 2023. figures, tables
Article in French | AIM | ID: biblio-1411349

ABSTRACT

Introduction. Le cancer du col utérin est le deuxième cancer de la femme au Cameroun. La radiothérapie reste une des modalités thérapeutiques phares dans la prise en charge de cette pathologie et l'État participe en y apportant une subvention. Toutefois, plusieurs patientes n'accèdent pas au traitement en raison des difficultés financières. Notre objectif était d'évaluer le coût réel de la prise en charge afin de servir de support aux politiques d'aide aux patientes. Méthodologie. Uneétude descriptive, transversale portant sur les patientes traitées en radiothérapie à l'Hôpital Général de Douala pour cancer du col de l'utérus a été réalisée d'octobre 2020 à janvier 2021.Résultats. Au total 35 dossiers de patientes ont été inclus. Lespatientes avaient de faibles revenus (<108.810 XAF /mois, 51,3%), étaient sans assurance maladie (88,6%), provenant en majorité des villes hors de Douala (54,3%), avec des cancers localement évolués. Le coût global moyen du traitement était de 511 264 XAF+/-103479 XAF (779,42 +/-157,75 euros) pour chaque patiente. La durée moyenne de traitement était de 57,34 jours, avec un nombre médian de 27 séances. Les frais supplémentaires pendant le traitement provenaient de la chimiothérapie, de la gestion des effets secondaires, notamment des transfusions sanguines, et du bilan de suivi. Plus de la moitié des patientes ont eu besoin d'une prise en charge supplémentaire par chimiothérapie ou chirurgie. Conclusion. La prise en charge du cancer du col utérin par radiothérapie est coûteuse et peu accessible à la majorité des patientes Camerounaises.


Introduction.Cervix cancer is the second cancer among women in Cameroon. Radiotherapy is often warranted in its management. Many patients do not access treatment due to financial difficulties. Our objective was to assess the real cost of care in order to support patient assistance policies. Methodology. A descriptive cross over study of women treated by radiotherapy at the Douala General Hospital from October 2020 to January 2021 was conducted. Results. A total number of 35 patient files were included in the study. Patients generally had low income (<108.810 XAF /month), without medical insurance, lived out of Douala, and were diagnosed at locally advanced stages of their disease. Average cost of treatment for radiotherapy alone was 511,264 XAF +/-103,479 XAF. Average duration of treatment was 57.34 days, with a median number of 27 sessions. Extra cost came from chemotherapy, management of side effects especially from blood transfusions, and imaging. More than half of the patients required additional expense for adjunct chemotherapy or surgery. Conclusion. The total cost of treatment for cervix cancer by radiotherapy is quite expensive, and not accessible to the average Cameroonian


Subject(s)
Humans , Female , Radiotherapy , Uterine Cervical Neoplasms , Health Care Costs , Disease Management , Costs and Cost Analysis
14.
J. Health Biol. Sci. (Online) ; 10(1): 1-7, 01/jan./2022. tab, ilus
Article in Portuguese | LILACS | ID: biblio-1411521

ABSTRACT

Objetivo: analisar o perfil epidemiológico dos casos de neoplasia do sistema respiratório que foram diagnosticados e tratados nos anos de 2017 a 2019 e comparar com os casos ocorridos durante a pandemia da COVID-19 no Brasil. Método: estudo transversal com dados de neoplasia maligna da traqueia, dos brônquios e dos pulmões fornecidos pelo Departamento de Informática do Sistema Único de Saúde. Os casos foram coletados e analisados conforme a modalidade terapêutica e o sexo, por meio da incidência anual para cada região brasileira, comparando-se o período da pandemia e os anos de 2017, 2018 e 2019. Resultados: durante a pandemia, nos casos de neoplasias do sistema respiratório, que acometeram o sexo masculino, foram observadas reduções da realização de procedimentos terapêuticos em todas as regiões brasileiras, notando-se, principalmente, diminuições de 68,22%, 19,58% e 57,24% dos casos tratados com cirurgias, quimioterapia e radioterapia na Região Nordeste. Nos casos de neoplasias que acometeram o sexo feminino, foram detectados aumentos de cirurgias e reduções de radioterapia em todas as regiões federativas, notando-se, principalmente, um aumento de 64,03% e uma redução de 59,73%, respectivamente, dos casos tratados com cirurgia no Centro-Oeste e com radioterapia no Sudeste. Conclusão: o remanejamento dos tratamentos está correlacionado aos aumentos e às reduções dos casos tratados de neoplasias do sistema respiratório. Nesse contexto, os serviços de saúde devem adotar medidas para reduzir a exposição e a contaminação dos indivíduos com a COVID-19, de modo que os tratamentos oncológicos não sejam afetados, e evitar desfechos graves.


Objective: to analyze the epidemiological profile of cases of neoplasms of the respiratory system, which were diagnosed and treated in the years 2017 to 2019, and to compare with the cases that occurred during the COVID-19 pandemic in Brazil. Method: a cross-sectional study with data on the malignant neoplasm of the trachea, bronchi, and lungs provided by the Department of Informatics of the Unified Health System. The cases were collected and analyzed according to the therapeutic modality and sex through the annual incidence for each Brazilian region, comparing the period of the pandemic and the years 2017, 2018, and 2019. Results: during the pandemic, cases of respiratory system neoplasms that affected males and reductions in the performance of therapeutic procedures were observed in all Brazilian regions, noting mainly, decreases of 68.22%, 19.58%, and 57.24% of cases treated with surgeries, chemotherapy, and radiotherapy in the Northeast region. In the cases of neoplasms that affected females, increases in surgeries and reductions in radiotherapy were detected in all federative regions, noting, mainly, an increase of 64.03% and a reduction of 59.73%, respectively, of the cases treated with surgery in the Midwest and with radiotherapy in the Southeast. Conclusion: the relocation of treatments is correlated with increases and decreases in cases of treated respiratory system neoplasms. In this context, health services must adopt measures to reduce the exposure and contamination of individuals with COVID-19 so that cancer treatments are not affected and avoid serious outcomes.


Subject(s)
COVID-19 , Lung Neoplasms , Radiotherapy , Respiratory System , Thoracic Surgery , Bronchi , Outcome Assessment, Health Care , Pandemics , International Cooperation , Lung , Neoplasms
15.
Rev. Hosp. Ital. B. Aires (2004) ; 42(4): 209-213, dic. 2022. ilus, tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1418135

ABSTRACT

Introducción: la radiodermitis es uno de los efectos secundarios más frecuentes de la radioterapia y afecta aproximadamente al 95% de los pacientes que la reciben. La radiodermitis aguda se presenta dentro de los 90 días posteriores al inicio del tratamiento, tiene un profundo impacto en la calidad de vida de los pacientes y puede ser la causa de la interrupción prematura de la radioterapia. Su tratamiento es complejo y el papel de los corticoides sistémicos en él aún no ha sido evaluado. Materiales y métodos: estudio descriptivo de 6 pacientes mayores de 18 años con radiodermitis grave, tratados con corticoides sistémicos al no responder a la terapia tópica inicial. Hubo un seguimiento de 6 meses, entre el 1 de junio de 2019 y el 30 de mayo de 2020, en el Servicio de Dermatología de un hospital de alta complejidad. Resultados: se indicó tratamiento con corticoides sistémicos en dosis de meprednisona 40 mg/día o equivalentes, durante 5 días, con resolución completa del cuadro en un período máximo de 15 días. Discusión: en la bibliografía no hemos encontrado trabajos científicos que comuniquen o evalúen la utilidad de los corticoides sistémicos en la radiodermitis grave. Proponemos, entonces, demostrar su utilidad en esta patología. Conclusión: el objetivo de este trabajo es comunicar nuestra experiencia en pacientes con radiodermitis aguda grave, con gran repercusión en el estado general, que evolucionaron con una rápida resolución del cuadro y un adecuado manejo sintomático, mediante el uso de corticoides sistémicos. (AU)


Introduction: radiodermitis is one of the most frequent side effects of radiotherapy and affects approximately 95% of the patients who receive it. Acute radiodermitis occurs within 90 days after the start of treatment, has a profound impact on the quality of life of patients and may be the cause of premature discontinuation of radiotherapy. Its treatment is complex and the role of systemic corticosteroids in it has not yet been evaluated. Materials and methods: descriptive study of 6 patients older than 18 years with severe radiodermatitis, treated with systemic corticosteroids when they did not respond to initial topical therapy. With a 6-month follow-up, between June 1, 2019 and May 30, 2020 at the Dermatology Service of a high complexity hospital. Results: treatment with systemic corticosteroids was indicated at a dose of meprednisone 40 mg/day or equivalent, for 5 days, with complete resolution of the symptoms in a maximum period of 15 days. Discussion: in the literature, we have not found scientific papers that report or evaluate the usefulness of systemic corticosteroids in severe radiodermatitis. We propose to demonstrate their usefulness in this pathology. Conclusion: the objective of this work is to communicate our experience in patients with severe acute radiodermatitis, with great repercussions on the general state, who evolved with rapid resolution of the symptoms and adequate symptomatic management, with the use of systemic corticosteroids. (AU)


Subject(s)
Humans , Male , Female , Adult , Young Adult , Radiation Injuries/drug therapy , Radiodermatitis/drug therapy , Adrenal Cortex Hormones/therapeutic use , Radiotherapy/adverse effects , Prednisone/administration & dosage , Adrenal Cortex Hormones/pharmacology
16.
Rev. colomb. cir ; 38(1): 176-181, 20221230. fig
Article in Spanish | LILACS | ID: biblio-1417733

ABSTRACT

Introducción. El angiosarcoma primario de la mama es una neoplasia maligna derivada de las células endoteliales de los vasos sanguíneos, potencialmente agresiva independientemente de su grado histológico, por lo que su pronóstico es malo. Su diagnóstico prequirúrgico es difícil, ya que las características clínicas e imagenológicas son inespecíficas, y el diagnóstico definitivo únicamente se realiza por estudios de patología. Para su tratamiento generalmente se requiere de resección quirúrgica, radioterapia y, ocasionalmente, quimioterapia.Caso clínico. Paciente de 49 años sin antecedentes, que consultó por cuadro clínico de 5 meses de evolución de aparición y rápido crecimiento de masa en mama izquierda. Se realizaron estudios imagenológicos que reportaron lesión BIRADS 4a y diagnóstico histológico de lesión vascular con atipía, por lo cual fue llevada a mastectomía simple, con informe final de patología de angiosarcoma primario de mama; tuvo que ser reintervenida por márgenes positivos. Completó 33 ciclos de radioterapia y dos años después de la cirugía presentó cambios inflamatorios en la cicatriz quirúrgica, de la cual se tomó biopsia con reporte de lesión vascular atípica, por lo que fue operada nuevamente, con reporte histológico negativo para angiosarcoma residual. Actualmente la paciente está en seguimiento imagenológico, sin evidencia de recaída tumoral. Conclusión. Los angiosarcomas primarios de la mama son neoplasias raras y muy agresivas, independientemente de su grado histológico, por lo cual es importante hacer un diagnóstico histológico y tratamiento oncológico oportunos.


Introduction. Primary breast angiosarcoma is a malignant pathology derived from the endothelial cells of the blood vessels of the breast. They are potentially aggressive regardless of histological grade, reason why its prognosis is poor and treatment requires surgical resection plus radiation therapy and occasionally chemotherapy depending on the degree. Its pre-surgical diagnosis is difficult since the clinical and imaging characteristics are nonspecific, and the definitive diagnosis is only made by means of pathology studies. Clinical case. A 49-year-old patient was admitted to the breast surgery outpatient clinic due to clinical symptoms of 5 months of evolution consisting of the appearance of a painful mass in the left breast. Imaging of the lesion with ultrasound report BIRADS 4a and a tricot biopsy was taken with histological diagnosis of vascular lesion with atypia. It was decided to take the patient to a simple mastectomy, with a final report of breast angiosarcoma but with a margin compromised by a tumor for which she was reoperated. She received 33 cycles of radiotherapy and continued in follow-up for two years. During this period, the patient presented inflammatory changes in the surgical scar for which a punch biopsy was done with histological report of vascular atypical lesion. Surgical resection was performed with final report of negative pathology for residual angiosarcoma. Nowadays the patient continues imaging follow-up without evidence of a tumour relapse. Conclusion. Primary breast angiosarcomas are a rare malignant pathology, very aggressive regardless of its histological grade, for which it is important to perform a timely histological diagnosis and oncological treatment


Subject(s)
Humans , Hemangiosarcoma , Radiotherapy , Breast Neoplasms , Immunohistochemistry , Mastectomy
17.
Odovtos (En línea) ; 24(3)dic. 2022.
Article in English | LILACS, SaludCR | ID: biblio-1406165

ABSTRACT

Abstract This study investigated the shear bond strength (SBS) of a universal adhesive to enamel/dentin; 1) that had undergone radiotherapy (RT) and 2) that were readily restored and had undergone RT. Enamel and dentin surfaces were obtained from 90 intact human molars. They were randomly divided into six groups according to the presence and timing of irradiation (RT0:no radiotherapy/control, RT1:RT before restoration, RT2:RT after restoration groups) and adhesive application modes (etch&rinse/ER, self-etch/SE)(n=15). A universal adhesive and resin composites were applied. The radiotherapy protocol was conducted with 60 Gy. The SBS test was subjected (1mm/min) and failure type analysis was performed. The resin-enamel/dentin interfaces were examined. Data were statistically analyzed. For enamel and dentin, the presence and timing of irradiation did not significantly influence the SBS values (p>0.05). For enamel, significantly higher SBS values were obtained using etch&rinse mode than self-etch mode (p<0.05). The predominant failure was mixed type. Loss of enamel prisms and obliterated irregular dentinal tubules were found for the radiotherapy-treated specimens. Resin tags were clearer in the irradiated enamel treated with ER than SE. Irradiation with different timings did not influence the bond strength to enamel and dentin, negatively. Irrespective of radiotherapy, the etch&rinse mode caused higher bond strength to enamel than self-etch mode.


Resumen Este estudio investigó la fuerza de unión al cizallamiento (SBS) de un adhesivo universal al esmalte/dentina en piezas que se habían sometido a radioterapia (RT). Se obtuvieron superficies de esmalte y dentina de 90 molares humanos intactos. Se dividieron aleatoriamente en seis grupos según la presencia y el momento de la irradiación (RT0: sin radioterapia/control, RT1: RT antes de la restauración, RT2: RT después de la restauración considerando los modos de aplicación del adhesivo (n=15). Se aplicó un adhesivo universal y resinas compuestas. El protocolo de radioterapia se realizó con 60 Gy. Se sometió a la prueba adhesiva (1mm/min) y se realizó análisis del tipo de falla. Se examinaron las interfases resina-esmalte/dentina. Los datos fueron analizados estadísticamente. Para el esmalte y la dentina, la presencia y el momento de la irradiación no influyeron significativamente en los valores adhesivos (p>0,05). Para el esmalte, se obtuvieron valores adhesivos significativamente más altos utilizando el modo de grabado y enjuague que el modo de autograbado (p<0,05). La falla predominante fue de tipo mixto. Se encontró pérdida de prismas de esmalte y túbulos dentinarios irregulares obliterados en las muestras tratadas con radioterapia. La irradiación con diferentes tiempos no influyó negativamente en la fuerza de unión al esmalte ni a la dentina. Independientemente de la radioterapia, el modo de grabado ácido y enjuague provocó una mayor fuerza de adhesión al esmalte que el modo de autograbado.


Subject(s)
Humans , Radiotherapy/adverse effects , Turkey , Dental Cementum/drug effects , Head and Neck Neoplasms
18.
Arq. ciências saúde UNIPAR ; 26(3): 927-948, set-dez. 2022.
Article in Portuguese | LILACS | ID: biblio-1399509

ABSTRACT

Cuidados paliativos são um conjunto de procedimentos ofertados ao paciente por uma equipe multidisciplinar com objetivo de garantir bem-estar, autonomia,conforto e alívio de sintomas decorrentes de doença ou tratamento quando a cura é impossibilitada. O câncer representa uma das doenças que possuem chances de evoluir o paciente ao estágio terminal, momento em que cuidados paliativos são indicados e necessários. Dentro da equipe responsável, o cirurgião-dentista atua na prevenção, diagnóstico e tratamento de lesões expressas no sistema estomatognático que se manifestam estimuladas pelo câncer ou pelos tratamentos utilizados. O objetivo desta pesquisa é destacar a função do odontólogo dentro da equipe multidisciplinar paliativista para pacientes oncológicos. Trata-se de uma revisão bibliográfica sistemáticada literatura. Foram feitas buscas nas plataformas Biblioteca Virtual em Saúde (BVS) e Scientific Electronic Library Online (SciELO) e após aplicação dos critérios de inclusão e exclusão foram selecionados 14 artigos. A literatura evidencia que alterações orais estão relacionadas com o curso da neoplasia ou seu tratamento; as lesões mais descritas foram: mucosite, xerostomia, candidíase, cárie, periodontite e osteorradionecrose. Isso faz com que o paciente sofra limitações em realizar atividades básicas, alterando negativamente a sua qualidade de vida. A complexidade da manifestação oral pode interromper o tratamento antineoplásico. As medidas de enfrentamento mais empregadas para a saúde bucal do paciente oncológico são a laserterapia, bochechos com clorexidina 0,12%, instrução de higiene oral, uso de anti-inflamatórios, analgésicos e antifúngicos. A atuação do odontólogo na equipe multidisciplinar oncológica paliativista é indispensável para o controle das manifestações orais.


Palliative care comprises a set of procedures offered by a multidisciplinary team to patients who cannot be cured, aiming to restore and ensure well-being, autonomy, independence, comfort and relief from symptoms resulting from illness or treatments. Cancer commonly leads the patient to the terminal stage, and at this stage palliative care is indicated and necessary. Composing the multidisciplinary team, the dentist works in the prevention, diagnosis and treatment of injuries that arise in the stomatognathic system, which manifest themselves due to cancer or its treatments. The objective of this research was to highlight the work of the dentist in the multidisciplinary team of palliative care for cancer patients. This is a systematic bibliographic review of the literature, with an integrative character. Study searches were performed in the Virtual Health Library (VHL) and Scientific Electronic Library Online (SciELO). After applying the inclusion and exclusion criteria, 14 articles were selected. Results showed that oral alterations are completely related to the development of the neoplasm or its treatment; the most described lesions were: mucositis, xerostomia, candidiasis, osteoradionecrosis, radiation caries and periodontitis. These injuries make the patient suffer limitations to perform basic activities, such as eating or communicating, negatively altering their quality of life. The complexity of the oral manifestation can determine the interruption of the anticancer treatment. The most used coping measures for the oral healthof cancer patients are: low- potency laser therapy, mouthwash with 0.12% chlorhexidine, instructionin oral hygiene and use of anti-inflammatory, analgesic and antifungal drugs. The role of dentists in the multidisciplinary palliative oncology team is essential for the control of oral lesions.


Los cuidados paliativos son un conjunto de procedimientos ofrecidos al paciente por un equipo multidisciplinar con el objetivo de garantizar el bienestar, la autonomía, el confort y el alivio de los síntomas derivados de la enfermedad o del tratamiento cuando la curación es imposible. El cáncer representa una de las enfermedades que tienen posibilidades de evolucionar al paciente hasta la fase terminal, momento en el que los cuidados paliativos son indicados y necesarios. Dentro del equipo responsable, el cirujano dentista actúa en la prevención, diagnóstico y tratamiento de las lesiones expresadas en el sistema estomatognático que se manifiestan estimuladas por el cáncer o por los tratamientos utilizados. El objetivo de esta investigación es destacar la función del odontólogo dentro del equipo paliativo multidisciplinar para pacientes oncológicos. Se trata de una revisión bibliográfica sistemática. Se realizaron búsquedas en las plataformas Virtual Health Library (BVS) y Scientific Electronic Library Online (SciELO) y tras aplicar los criterios de inclusión y exclusión, se seleccionaron 14 artículos. La literatura muestra que las alteraciones orales están relacionadas con el curso del cáncer o su tratamiento; las lesiones más comúnmente descritas fueron: mucositis, xerostomía, candidiasis, caries, periodontitis y osteorradionecrosis. Esto hace que el paciente sufra limitaciones para realizar actividades básicas, alterando negativamente su calidad de vida. La complejidad de la manifestación oral puede interrumpir el tratamiento antineoplásico. Las medidas de afrontamiento más utilizadas para la salud bucodental de los pacientes con cáncer son la terapia láser, los enjuagues bucales con clorhexidina al 0,12%, las instrucciones de higiene bucodental y el uso de fármacos antiinflamatorios, analgésicos y antifúngicos. La actuación del odontólogo en el equipo multidisciplinar de oncología paliativa es fundamental para el control de las manifestaciones orales.


Subject(s)
Palliative Care , Dentists , Medical Oncology/instrumentation , Patient Care Team/organization & administration , Radiotherapy/instrumentation , Stomatitis/complications , Stomatitis/diagnosis , Stomatognathic System , Mouth Neoplasms/diagnosis , Mouth Neoplasms/drug therapy , Mouth Neoplasms/radiotherapy , Oral Medicine/instrumentation , Drug Therapy/instrumentation
19.
Oncología (Guayaquil) ; 32(2): 224-246, 2 de Agosto del 2022.
Article in Spanish | LILACS | ID: biblio-1391912

ABSTRACT

Introducción: Las metástasis cerebrales (MC) representan una problemática importante de la salud pública, en promedio el 30% de los pacientes oncológicos desarrollarán MC siendo importante causa de morbilidad, ansiedad y mortalidad. El tratamiento con radioterapia, cirugía y sistémico son los pilares para el tratamiento y han tenido una evolución importante en la última década. Propósito de la revisión: Se proporciona información actualizada en relación a epidemiología, diagnóstico, pronóstico y tratamiento de metástasis cerebrales desde un enfoque multidisciplinariopara lograr individualizar su abordaje con el objetivo de proporcionar control oncológico y calidad de vida. También se discuten el acceso a nuevas terapias sistémicas, técnicas quirúrgicas y disponibilidad de tecnología para ofrecer técnicas avanzadas de radioterapia.Men saje principal: Conocer mutaciones específicas y receptores diana de los tumores permite elegir quimio-inmunoterapia o terapias dirigidas actuales que ofrecen mejor potencial de control tanto a nivel sistémico como intracraneal. La secuenciación de los tratamientos sistémicos y locales (cirugía, radio-cirugía, radioterapia holocraneal) deben ser discutidos desde un enfoque multidisciplinario Conclusión: Es importante poder estimar el pronóstico de los pacientes con MC, esto determinarla conducta terapéutica que puede variar desde cuidados sintomáticos hasta tratamientos más agresivos como resección neuroquirúrgica o radiocirugía.


In troduction:Brain metastases (BMs) represent a significant public health problem. An average of 30% of cancer patients develop BM, which is a significant cause of morbidity, anxiety, and mortality. Radio-therapy, surgery, and systemic treatment are the mainstays of treatment and have evolved significantly in the last decade.Pu rpose of the review: Updated information on the epidemiology, diagnosis, prognosis, and treatment of brain metastases from a multidisciplinary approach is provided to enable an individualized approach aimed at cancer control and quality of life. Access to new systemic therapies, surgical techniques, and availability of technology for advanced radiotherapy techniques are also discussed.Mai n message: Knowledge of specific mutations and targets of tumor receptors allows the selection of chemoimmunotherapy or current targeted therapies that offer better control potential at the systemic and intracranial levels. The sequence of systemic and local treatments (surgery, radiosurgery, whole brain radiation therapy) should be discussed as part of a multidisciplinary approach.C o nclusion: It is essential to estimate the prognosis of patients with BM, given that this will determine the therapeuticbehavior that can range from symptomatic care to more aggressive treatments such as neurosurgical resection or radiosurgery


Subject(s)
General Surgery , Brain Neoplasms , Immunotherapy , Prognosis , Radiotherapy , Therapeutics , Radiosurgery
20.
Oncología (Guayaquil) ; 32(2): 253-265, 2 de Agosto del 2022.
Article in Spanish | LILACS | ID: biblio-1392104

ABSTRACT

Introducción: El tumor de Buschke ­ Lowenstein (TBL) es enfermedad de transmisión sexual causada por el virus del papiloma humano (VPH), descrita como una forma intermedia entre un condiloma acuminado y un carcinoma de células escamosas. Afecta principalmente al área genital y anorrectal, posee capacidad de transformación maligna y una alta tasa de recurrencia. La cirugía es el tratamiento de primera línea. Caso clínico: Presentamos el caso de un paciente masculino de 27 años con lesiones verrucosas de crecimiento progresivo en el área inguinal y genital. Mediante la correlación clínico-patológica se llegó al diagnóstico de TBL. Tras discusión en comité multidisciplinario se declaró irresecable y se resolvió tratamiento con radioterapia, además vacunación terapéutica contra el VPH, tanto sistémica como intralesional. Conclusión: El TBL es localmente agresivo y de difícil tratamiento, por lo que la prevención contra el VPH es fundamental. La vacunación terapéutica en conjunto con la radioterapia ofreció mejoría clínica.


Introduction: Buschke-Lowenstein tumor (BLT) is a sexually transmitted disease caused by the human papillomavirus (HPV), described as an intermediate form between condyloma acuminata and squamous cell carcinoma. It mainly affects the genital and anorectal areas and has the capacity for malignant transformation and a high recurrence rate. Surgery is the first-line treatment. Clinical case: We present the case of a 27-year-old male patient with warty lesions of progressive growth in the inguinal and genital areas. Through the clinical-pathological correlation, the diagnosis of BLT was reached. After discussion in a multidisciplinary committee, it was declared unresectable, and treatment with radiotherapy was resolved, in addition to therapeutic vaccination against HPV, both systemic and intralesional. Conclusion: BLT is locally aggressive and challenging to treat, so prevention against HPV is essential. Therapeutic vaccination in conjunction with radiotherapy offered clinical improvement.


Subject(s)
Humans , Adult , Condylomata Acuminata , Buschke-Lowenstein Tumor , Radiotherapy , Vaccines, Combined , Human papillomavirus 6 , Human papillomavirus 11
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