Lung cancer and the COVID-19 pandemic: recommendations from the brazilian thoracic oncology group

New cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.

Stereotactic body radiotherapy in lung cancer: an update / Radioterapia estereotáxica extracraniana em câncer de pulmão: atualização

AbstractFor early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique.

ResumoO tratamento de escolha para o câncer de pulmão em estádio inicial é a cirurgia. Para os pacientes sem condições clínicas ou que recusam a cirurgia, a radioterapia é a principal opção terapêutica. Apresentamos uma revisão sobre radioterapia estereotáxica extracraniana, uma técnica que vem apresentando resultados bastante promissores nesse grupo de pacientes e que, se disponível, deve ser o tratamento de escolha. Também são apresentados as principais indicações, os aspectos técnicos, resultados e situações especiais relacionados à técnica.

The role of radiotherapy in urinary bladder cancer: current status

The role of radiotherapy (RT) in the treatment of urinary bladder cancer has undergone several modifications along the last decades. In the beginning, definitive RT was used as treatment in an attempt to preserve the urinary bladder; however, the results were poor compared to those of radical surgery. Recently, many protocols have been developed supporting the use of multi-modality therapy, and the concept of organ preservation began to be reconsidered. Although phase III randomized clinical studies comparing radical cystectomy with bladder preservation therapies do not exist, the conservative treatment may present low toxicity and high indexes of complete response for selected patients. The aim of this study was to review the literature on the subject in order to situate RT in the current treatment of urinary bladder cancer.

Efeitos adversos da poliquimioterapia em pacientes com hanseníase: um levantamento de cinco anos em um Centro de Saúde da Universidade Federal de Uberlândia / Adverse effects of multidrug therapy in leprosy patients: a five-year survey at a Health Center of the Federal University of Uberlandia

The introduction of multidrug therapy (WHO/MDT)-composed by the drugs dapsone, clofazimine and rifampicin has enabled the cure of Hansen's disease, however, the adverse effects of these drugs were not given priority by the health team. Aiming to determine MDT's adverse effects' magnitude and relate them to the non-adhesion of patients to the treatment, a study of 187 charts of patients treated with MDT from January of 1995 to May 2000, was carried out at a Health Center of the Federal University of Uberlandia. Side effects were recorded in 71 patients' charts. Among the 113 side effects found, 80 (70.7 per cent) were related to dapsone, 7 (6.2 per cent) were caused by rifampicin and 26 (20.5 per cent) were attributed to clofazimine. These effects induced 28 (14.9 per cent), patients to change the therapeutic scheme, representing 39.4 per cent from the 71 patients with adverse effects. Throughout this study, the importance is discussed of considering MDT's adverse effects when training the health team to heighten the patient's adhesion to the treatment and thereby collaborating to eliminate Hansen's disease as a public health problem.

Efeitos adversos da poliquimioterapia em pacientes com hanseníase: um levantamento de cinco anos em um Centro de Saúde da Universidade Federal de Uberlândia / Adverse effects of multidrug therapy in leprosy patients: a five-year survey at a Health Center of the Federal University of Uberlândia

A implementaçäo da poliquimioterapia (PQT/OMS) - composta pelas drogas dapsona, clofazimina e rifampicina - possibilitou a cura da hanseníase, porém näo foram priorizados o manejo dos efeitos adversos pelas equipes de saúde. Objetivando determinar a magnitude dos efeitos adversos da poliquimioterapia para hanseníase e relacioná-los como possível causa de näo adesividade do paciente ao tratamento, revisou-se prontuários de 187 pacientes tratados com PQT, de 1995 a 2000, no Centro de Saúde Escola (CSE) -UFU, com registro de efeitos colaterais em 71 pacientes (37,9 por cento). Dentre os 113 efeitos adversos, 80 (70,7 por cento) relacionaram-se à dapsona, 7 (6,2 por cento) à rifampicina, 26 (20,5 por cento) à clofazimina. Esses efeitos levaram à mudança de esquema terapêutico em 28 (14,9 por cento) dos 187 pacientes ou 39,4 por cento dos 71 com efeitos adversos. Discute-se a importância de considerar os efeitos adversos da PQT na capacitaçäo das equipes de saúde para maior adesäo do paciente ao tratamento, colaborando para eliminar a hanseníase como problema de saúde pública