Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis

ABSTRACT Purpose: To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy). Material and methods: A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998). Results: Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD −0.13; 95%CI, −0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD −0.45; 95%CI −0.84, −0.05; I2=93%; P=0.03). Conclusion: Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.

Complicaciones de la laringectomía total: experiencia de 7 años en un hospital universitario de Paraguay / Complications of total laryngectomy: a 7-year experience in a university hospital in Paraguay

Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas superiores. La laringectomía total es el tratamiento de elección en casos avanzados, pero se asocia a una alta tasa de complicaciones. Objetivos: Conocer la prevalencia de las complicaciones posquirúrgicas de la laringectomía total y los factores asociados en pacientes con cáncer de laringe. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal, revisando el comportamiento de la laringectomía total y sus principales complicaciones en la Cátedra y Servicio de Otorrinolaringología del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, Paraguay, de 2015 a 2022. Se incluyeron pacientes mayores de 18 años, de ambos sexos, postoperados de laringectomía total, con diagnóstico anatomopatológico de neoplasia de laringe. Se excluyeron pacientes no operados, con fichas incompletas o que abandonaron el tratamiento. Se analizaron variables demográficas, clínicas, quirúrgicas y anatomopatológicas. Resultados: Se incluyeron 10 pacientes, todos varones, con edad media de 56,3 ± 10,2 años. El 90% presentaba hábitos tóxicos. La complicación más frecuente fue la fístula faringocutánea (70%), seguida por infección del sitio quirúrgico (10%) y sangrado posoperatorio (10%). El 71,4% de las fístulas se resolvieron con medidas conservadoras. El 30% tenía afectación supraglótica y el 57,1% de los que presentaron complicaciones recibieron radioterapia previa. Conclusión: Las complicaciones de la laringectomía total son frecuentes, principalmente la fístula faringocutánea. La afectación supraglótica y la radioterapia previa se asociaron a mayor tasa de complicaciones. Se requieren estudios prospectivos con muestras más grandes para confirmar estos hallazgos.

Introduction: Laryngeal cancer is the most common malignant neoplasm of the upper aerodigestive tract. Total laryngectomy is the treatment of choice in advanced cases, but it is associated with a high rate of complications. Objectives: To determine the prevalence of postoperative complications of total laryngectomy and associated factors in patients with laryngeal cancer. Materials and methods: Observational, descriptive, retrospective, cross-sectional study, reviewing the behavior of total laryngectomy and its main complications in the Department of Otorhinolaryngology of the Hospital de Clínicas, Faculty of Medical Sciences, National University of Asunción, Paraguay, from 2015 to 2022. Patients over 18 years of age, of both sexes, who underwent total laryngectomy, with anatomopathological diagnosis of laryngeal neoplasm were included. Non-operated patients, those with incomplete records or who abandoned treatment were excluded. Demographic, clinical, surgical and anatomopathological variables were analyzed. Results: Ten patients were included, all male, with a mean age of 56.3 ± 10.2 years. Ninety percent had toxic habits. The most frequent complication was pharyngocutaneous fistula (70%), followed by surgical site infection (10%) and postoperative bleeding (10%). Conservative measures resolved 71.4% of the fistulas. Thirty percent had supraglottic involvement and 57.1% of those who presented complications received previous radiotherapy. Conclusion: Complications of total laryngectomy are frequent, mainly pharyngocutaneous fistula. Supraglottic involvement and previous radiotherapy were associated with a higher rate of complications. Prospective studies with larger samples are required to confirm these findings.

Radionecrosis cerebral en un adulto

Se presenta el caso clínico de un paciente de 37 años de edad con el antecedente de haber recibido radioterapia por una lesión tumoral en la región frontal derecha, el cual acudió a consulta en el Instituto de Neurología y Neurocirugía de Cuba por presentar cefalea intensa y hemiparesia izquierda. Luego de realizados los exámenes necesarios, se estableció el diagnóstico clínico-imagenológico de lesión por radionecrosis en el hemisferio contralateral, que fue corroborado en el estudio anatomopatológico una vez que se extirpó el tumor; seguidamente, se indicó inmunoterapia. La evolución del paciente fue satisfactoria, pues se logró el control de la enfermedad y la resolución de los síntomas.

The case report of a 37-year-old patient with history of having received radiotherapy due to a tumor lesion in the right frontal region is presented, who attended to the Institute of Neurology and Neurosurgery in Cuba because of intense headache and left hemiparesis. After carrying out the necessary examinations, the clinical-imaging diagnosis of a radionecrosis lesion in the contralateral hemisphere was established, which was corroborated in the pathological examination once the tumor was removed; then, immunotherapy was indicated. The patient had a favorable clinical course because the control of the disease was achieved as well as the resolution of symptoms.

Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: a cohort study

Abstract Background: One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. Objective: To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. Methods: Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. Results: The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR = 1.14 [95% CI 1.04-1.26]; p = 0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR = 4.27 [95% CI 1.11-16.42]; p = 0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR = 0.55 [95% CI 0.36-0.82]; p = 0.004). Study limitations: The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. Conclusions: There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.

Poliposis colorrectal malignizada: a propósito de un caso

Introducción: Los pólipos son excrecencias benignas de la mucosa colónica y otras partes del aparato gastrointestinal, que pueden ser: según sus formas sésiles o pediculados y según sus números únicos o múltiples. Se presentan a cualquier edad, pero son más frecuentes en la infancia. Objetivo: Presentar el caso de un paciente diagnosticado y tratado con una poliposis colónica malignizada. Caso clínico: Paciente de raza blanca femenina, de 25 años de edad, sin antecedentes de salud, que acudió a la consulta de Coloproctología del Hospital Docente Oncológico María Curie en el mes enero del año 2023. Al interrogatorio manifestó dolor abdominal localizado hacia la región de flanco y fosa ilíaca izquierda de gran intensidad, intermitente y solo se aliviaba con la administración de analgésicos en altas dosis e irradiado de forma asimétrica hacia otras regiones del abdomen y presencia de otros síntomas generales como: diarreas mucosanguinolentas, pérdida peso y anorexia, por lo que se decidió indicar estudios complementarios y tratamiento al paciente. Conclusiones: El resultado del estudio histológico fue pólipos neoplásicos del tipo adenomatoso a nivel del recto bajo, tumor maligno del tipo adenocarcinoma bien diferenciado y ulcerado. Ahora con evolución favorable y mejoría de su sintomatología.

Introduction: Polyps are benign excrescences of the colonic mucosa and other parts of the gastrointestinal tract that can be sessile or pedunculated according to their forms and according to their single or multiple numbers. They occur at any age, but are more frequent in childhood. Objective: To present the case of a patient diagnosed and treated with a malignant colonic polyposis. Case report: White, 25-year-old female patient, with no previous health history, attended the Coloproctology consultation of the María Curie Oncology Teaching Hospital in January 2023. On interrogation, she manifested abdominal pain located towards the flank region and left iliac fossa of great intensity, intermittent and only relieved with the administration of analgesics in high doses and radiated asymmetrically to other regions of the abdomen and presence of other general symptoms such as: mucus diarrhea, weight loss and anorexia, so it was decided to indicate complementary studies and treatment to the patient. Conclusions: The result of the histological study was neoplastic polyps of the adenomatous type, at the level of the rectum under a malignant tumor of the well-differentiated, ulcerated adenocarcinoma type. Now with favorable evolution and improvement of her symptoms.

Acid challenge exacerbates activation of matrix metalloproteinases in permanent teeth undergoing radiotherapy

Abstract The aim of this study was to investigate the effect of acid challenge on the activation of matrix metalloproteinases (MMPs) in the Dentinoenamel junction of primary and permanent teeth submitted to radiotherapy. For this purpose, a total of 178 dental fragments obtained from molars were used, and randomly divided into 2 groups (primary and permanent teeth) / 4 experimental subgroups (irradiated and non-irradiated, demineralized and non-demineralized). The fragments were exposed to radiation, with a dose fraction of 2 Gy, for 5 consecutive days, until a total dose of 60 Gy was reached, with a total of 30 cycles, for 6 weeks. To determine the activity of MMPs on the dentinoenamel junction (DEJ), in situ zymography assays on 0.6mm dental fragments were performed. To assess whether MMP activity would be impacted by an acidic environment, the fragments were placed in a demineralizing solution (pH of 4.8). The finding was that irradiation activated MMPs in DEJ and these effects were more evident in permanent when compared with primary teeth. When the effect of an acid challenge on MMPs activity was investigated, demineralization was observed not to increase MMPs activity in non-irradiated teeth, but it did increase MMPs activity in irradiated teeth. In conclusion, an acid challenge was found to exacerbate activation of MMPs in DEJ of permanent teeth submitted to irradiation, but not in primary teeth.

Riesgo de osteorradionecrosis de los maxilares según el tipo de radioterapia

Introducción: El cáncer de cabeza y cuello es el séptimo más común a nivel mundial. Las opciones terapéuticas para su manejo incluyen la radioterapia, la cual debe procurar un equilibrio entre la eliminación del tumor y la preservación del tejido sano porque su aplicación implica el riesgo de desarrollar una osteorradionecrosis de los maxilares. Objetivo: Valorar si el riesgo de que se produzca osteorradionecrosis de los maxilares varía en función del tipo de radioterapia. Métodos: Diseño documental, retrospectivo basado en los principios de las revisiones sistemáticas exploratorias según lo establece la lista de chequeo PRISMA Extension for Scoping Reviews (PRISMA-ScR). Se realizaron búsquedas en inglés y español en PubMed, LILACS, ScienceDirect, Tripdatabase y Epistemonikos. Resultados: En total se incluyeron 12 estudios publicados entre 2016 y 2022 con diversos diseños de investigación; el estudio de cohorte retrospectivo fue el que tuvo mayor representación. Se analizaron distintas opciones de radioterapia y sus protocolos, entre ellos, la radioterapia de intensidad modulada, la terapia de protones de intensidad modulada, la radioterapia corporal estereotáctica y la radioterapia tridimensional. La literatura refiere que los protocolos que implican dosis totales más bajas representan un menor riesgo de osteorradionecrosis. Conclusiones: El riesgo de osteorradionecrosis de los maxilares debe atribuirse, en mayor medida, a la dosis total de radiación recibida por el paciente y a la dosis por fracción que al tipo de radioterapia.

Introduction: Head and neck cancer is the seventh most common cancer worldwide. Therapeutic options for its management include radiotherapy, which should seek a balance between tumor elimination and preservation of healthy tissue because its application implies the risk of developing osteoradionecrosis of the jaws. Objective: To assess whether the risk of developing osteoradionecrosis of the jaws varies according to the type of radiotherapy. Methods : Documentary, retrospective design based on the principles of exploratory systematic reviews as established by the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed, LILACS, ScienceDirect, Tripdatabase and Epistemonikos were searched in English and Spanish. Results: In total, 12 studies published between 2016 and 2022 with various research designs were included; the retrospective cohort study had the highest representation. Different radiotherapy options and their protocols were analyzed, including intensity-modulated radiotherapy, intensity-modulated proton therapy, stereotactic body radiotherapy, and three-dimensional radiotherapy. The literature refers that protocols involving lower total doses represent a lower risk of osteoradionecrosis. Conclusions: The risk of osteoradionecrosis of the jaws should be attributed, to a greater extent, to the total radiation dose received by the patient and the dose per fraction than to the type of radiotherapy.

Factors associated with the quality of life of women undergoing radiotherapy / Factores asociados a la calidad de vida de mujeres en radioterapia / Fatores associados à qualidade de vida de mulheres submetidas à radioterapia

ABSTRACT Objective: To evaluate the skin characteristics and quality of life of patients with breast cancer undergoing radiotherapy. Method: Cross-sectional study conducted with 60 women. The classification scales of skin changes resulting from exposure to ionizing radiation (RTOG) and the validated versions in Portuguese of those that classified skin types (Fitzpatrick), symptoms (RISRAS) and quality of life (DLQI) were applied. in the period between December 2021 and October 2022. For data analysis, Fisher's Exact Test, Chi-Square and Asymptotic General Independence Test were used. Results: 100% of patients had skin irritation. As the treatment progressed and the radiodermatitis appeared or worsened, there was a tendency for the intensity of signs and symptoms to increase, such as: sensitivity, discomfort or pain, itching, burning and heat, dry and wet desquamation, which may have impacted the quality of life and reflected in other aspects, such as: shopping activities or outings (p=0.0020), social activities or leisure activities (p=0.0420). Conclusion: Radiodermatitis is a common condition that affects women with breast cancer undergoing radiotherapy, skin characteristics and quality of life of patients affected during this treatment.

RESUMEN Objetivo: Evaluar las características de la piel y la calidad de vida de pacientes con cáncer de mama en tratamiento con radioterapia. Método: Estudio transversal con 60 mujeres. Se aplicaron la escala de clasificación de alteraciones cutáneas por exposición a radiaciones ionizantes (RTOG) y las versiones validadas en portugués de las que clasificaban tipos de piel (Fitzpatrick), síntomas (RISRAS) y calidad de vida (DLQI) en el período comprendido entre diciembre 2021 y octubre de 2022. Para el análisis de los datos se utilizaron el Test Exacto de Fisher, Chi-Cuadrado y el Test de Independencia General Asintótica. Resultados: El 100% de los pacientes evaluados sobre la piel. A medida que avanzaba el tratamiento y aparecía o empeoraba la radiodermatitis, hubo tendencia a aumentar la intensidad de los signos y síntomas, tales como: sensibilidad, malestar o dolor, visualización, ardor y calor, descamación seca y húmeda, que pudieron haber tenido una impacto en la calidad de vida y reflejado en otros aspectos, como: actividades de compra o salidas (p=0,0020), actividades sociales o de ocio (p=0,0420). Conclusión: La radiodermatitis es una afección común que afecta a mujeres con cáncer de mama, sometidas a radioterapia, las características de la piel y la calidad de vida de las pacientes afectadas durante este tratamiento.

RESUMO Objetivo: Avaliar as características da pele e a qualidade de vida de pacientes com câncer de mama submetidas à radioterapia. Método: Estudo transversal com 60 mulheres. Foram aplicadas as escalas de classificação das alterações cutâneas decorrentes da exposição à radiação ionizante (RTOG) e as versões validadas em português das que classificaram os tipos de pele (Fitzpatrick), os sintomas (RISRAS) e a qualidade de vida (DLQI), no período entre dezembro de 2021 e outubro de 2022. Para a análise de dados, foram utilizados os Testes Exato de Fisher, Qui-Quadrado e Teste de Independência Geral Assintótica. Resultados: 100% das pacientes apresentaram irritação na pele. À medida que o tratamento avançou e que a radiodermatite surgiu ou se agravou, houve maior tendência de intensidade de sinais e sintomas, como: sensibilidade, desconforto ou dor, coceira, queimação e calor, descamação seca e úmida, o que pode ter impactado na qualidade de vida e refletido em outros aspectos, como: atividades de compras ou passeios (p=0,0020), programação social ou atividade de lazer (p=0,0420). Conclusão: A radiodermatite é uma condição comum que afeta as mulheres com câncer de mama submetidas à radioterapia, as características da pele e a qualidade de vida das pacientes são afetadas durante esse tratamento.

Clinical manifestations of I-131 induced salivary gland dysfunction in patients with thyroid carcinoma

Aim: To carry out a retrospective analysis of the frequency and severity of clinical signs of radioiodine (131I)-induced damage to the salivary glands in the early and long-term post-radiation periods, and identify risk factors for their occurrence in patients with differentiated thyroid carcinomas. Methods: A total of 330 patients underwent thyroidectomy with dissection of lymphatic nodes. One month after surgery, all the patients received radioiodine therapy. The dose and number of courses varied depending on the stage and morphological type of the tumor. In the late post-radiation period, the patients were surveyed with the use of a standard questionnaire, which allowed retrospective assessment of the nature and severity of symptoms of radiationinduced damage, as well as the time of their onset/subsidence. Results: Radiation-induced sialoadenitis of the salivary glands was observed in 51.2% of patients treated with 131I. The main symptoms included pain and discomfort in the salivary glands (51.2% of patients), swelling (48.8%), transient or permanent dry mouth (38%), and distortion of taste (38%). There were statistically significant correlations between the presence and severity of the main clinical symptoms of salivary gland irradiation. A significant relationship (r = 0.91, p < 0.001) was found between swelling of the salivary glands and the feeling of pain or discomfort, which was indicative of inflammation and retention of saliva. Conclusion: The main factors influencing the formation of chronic radiation-induced sialoadenitis and the severity of the inflammatory process included the tumor stage, the total dose of radiopharmaceuticals, and the duration following radioiodine therapy

Sobrevida del cáncer glótico en estadio inicial en 4 centros hospitalarios de Uruguay / Survival of glottic cancer in the initial stage in 4 hospital centers in Uruguay / Sobrevivência de câncer glótico em estágio inicial em 4 hospitais uruguaios

Introducción: El cáncer de laringe es el tumor maligno de mayor prevalencia en la Otorrinolaringología. La topografía glótica es la más frecuente en Uruguay y suele detectarse en estadios tempranos dada la manifestación precoz y sostenida de disfonía. El objetivo de este estudio es describir la sobrevida libre de enfermedad (SLE) y la sobrevida global (SG) de los pacientes con cáncer de laringe glótico en estadio T1N0M0 en 4 instituciones de Montevideo. Metodología: Se analizó de forma retrospectiva la SG y SLE de 55 pacientes diagnosticados con cáncer de glotis T1 entre los años 2009 y 2019. Para el cálculo de la sobrevida se utilizó el método de Kaplan-Meier. Se estudió además el efecto de variables pronósticas de interés sobre la SG mediante análisis univariado y multivariado. Resultados: En la muestra analizada la SG de los pacientes con cáncer glótico T1N0M0 fue como media de 7.706 años (IC 95% 6.63 - 8.78). A los 5 años, la SG fue de 77.5% (± 7%) y de 62% (± 9.8%) a los 10 años. La SLE para todos los pacientes correspondió al 74.6% (± 7.5%) y 63.1% (± 9.8%), a 5 y 10 años respectivamente. No se alcanzaron las medianas de SG ni de SLE para los grupos. Conclusiones: Los valores de SG y SLE medios obtenidos en nuestro medio son comparables a los valores reportados en la bibliografía internacional. No se alcanzó la mediana de SG ni de SLE, por lo que se puede afirmar que ésta enfermedad tiene, cuando se realiza el tratamiento adecuado, un buen pronóstico vital a los 10 años. Se requiere un seguimiento más largo para determinar las medianas de SG y SLE de los grupos en estudio.

Introduction: Laryngeal cancer is the most prevalent malignant tumor in Otorhinolaryngology. Glottic topography is the most frequent in Uruguay and is usually detected in early stages given the early and sustained manifestation of dysphonia. The objective of this study is to analyze disease-free survival (DFS) and overall survival (OS) of patients with stage T1N0M0 glottic laryngeal cancer at 4 institutions in Montevideo. Methodology: The mean OS and DFS of 55 patients diagnosed with T1 glottic cancer between 2009 and 2019 were retrospectively analyzed. Kaplan-Meier method was used to calculate survival. The prognostic effect of certain variables of interest on OS was also studied using univariate and multivariate analysis. Results: In this study, mean odds survival (OS) for T1N0M0 glottic cancer was 7.706 years (CI 95% 6.63 - 8.78). At 5 years, OS was 77.5% (± 7%) and at 10 years was 62% (± 9.8%). Disease free survival (DFS) was 74.6% ± (7.5%) at 5 years and 63.1% (± 9.8%), at 10 years. Median OS and DFS for the groups were not reached. Conclusions: OS and DFS in our medium is comparable to that reported in the international literature. The median OS and DFS were not reached, so it can be stated that this disease has, when appropriate treatment is performed, a good vital prognosis at 10 years. Longer follow-up is required to determine the median OS and DFS of the study groups.

Introdução: O câncer de laringe é o tumor maligno mais prevalente na Otorrinolaringologia. A topografia glótica é a mais frequente no Uruguai e geralmente é detectada em estágios iniciais devido à manifestação precoce e sustentada da disfonia. O objetivo deste estudo é analisar a sobrevida livre de doença (DFS) e a sobrevida global (OS) de pacientes com câncer de laringe glótico estágio T1N0M0 em 4 instituições em Montevidéu. Metodologia: Foram analisados retrospectivamente o OS e DFS de 55 pacientes diagnosticados com câncer glótico T1 entre 2009 e 2019. O método de Kaplan-Meier foi usado para calcular a sobrevida. Resultados: Na amostra, a sobrevida global (OS) do câncer glótico T1N0M0 foi em média de 7.706 anos (IC 95% 6,63 - 8,78). Aos 5 anos, a OS foi de 77,5% (± 7%) e 62% (± 9,8%) aos 10 anos. A DFS para todos os pacientes correspondeu a 74,6% (± 7,5%) e 63,1% (± 9,8%), aos 5 e 10 anos, respectivamente. As medianas de OS e DFS para os grupos não foram alcançadas. Conclusões: OS e DFS em nosso ambiente é comparável ao relatado na literatura internacional. As medianas de SG e SLD não foram alcançadas, pelo que se pode afirmar que esta doença apresenta, quando realizado tratamento adequado, um bom prognóstico vital aos 10 anos. É necessário um acompanhamento mais longo para determinar a mediana da SG e da SLD dos grupos de estudo.

Advances in Head-and-Neck Interventional Radiotherapy (Brachytherapy)

@#Interventional radiotherapy, also known as brachytherapy, is the use of sealed radioactive sources that directly deliver radiation to the tumor or tumor bed. Its unique dose distribution profile allows for high conformality, making it a very useful modality in the treatment of cancers in the head and neck, where different organs and substructures that serve various but related functions are situated close to each other. In recent years, we have seen several important technological breakthroughs in the field, especially regarding its application in head and neck cancers. These include advances in treatment delivery, dosimetry planning , image guidance , and catheter positioning techniques . These innovations, which often require interdisciplinary interventions, have resulted in enhanced treatment accuracy, and therefore, major clinical advantages in terms of increased local control and decreased toxicity, as well as economic benefits. In order to highlight the differences from old brachytherapy techniques, a more appropriate terminology should perhaps be adopted, to signify these advancements that resulted in new opportunities, approaches and better outcomes – interventional radiotherapy (IRT). Such a change in terminology will not only allow recognition of these advances, but also a meaningful distinction from obsolete techniques and suboptimal outcomes that are associated with traditional brachytherapy. This is very important in increasing awareness among professionals outside the field of radiation oncology. We briefly review these recent advances, the current indications, and future directions for IRT in head-and-neck cancers.

Study on relationship of target organ injury of mechanism and "structure-effect-dose" of Hedysari Radix during radiotherapy-chemotherapy induced / 中国药理学通报

Aim To explore the possible mechanism of "component-target-pathway" of Radix Hedysari against target organ damage caused by radiotherapy and chemotherapy, and to verify the " dose-effect" relationship of the main active components. Methods TCMSP, Uniprot, Swiss Target Prediction, GeneCards, Cytoscape, Omicshare and other platforms were used for network pharmacology analysis. Autodock, Pymol and Ligplot were used for molecular docking. The water extract of Radix Hedysari was used for animal experiment verification. The contents of eight main components were determined by HPLC. Results Four active components, eight key targets and four key pathways of Radix Hedysari were identified to resist the damage of target organs caused by radiotherapy and chemotherapy. Molecular docking showed that formononetin and quercetin had good binding activity with HSP90AA1, naringenin and MAPK3, and ursolic acid and TP53. Animal experiments showed that gastrointestinal factors MTL and VIP increased significantly, liver and kidney factors Cr, BUN, AST and ALT decreased significantly, inflammatory factor IL-10 increased significantly and TNF-a decreased significantly. The content of ononm was the highest (2 . 884 8 µg • g "

Self-sufficient nanoparticles with dual-enzyme activity trigger radical storms and activate cascade-amplified antitumor immunologic responses

Radiotherapy (RT) can potentially induce systemic immune responses by initiating immunogenic cell death (ICD) of tumor cells. However, RT-induced antitumor immunologic responses are sporadic and insufficient against cancer metastases. Herein, we construct multifunctional self-sufficient nanoparticles (MARS) with dual-enzyme activity (GOx and peroxidase-like) to trigger radical storms and activate the cascade-amplified systemic immune responses to suppress both local tumors and metastatic relapse. In addition to limiting the Warburg effect to actualize starvation therapy, MARS catalyzes glucose to produce hydrogen peroxide (H2O2), which is then used in the Cu+-mediated Fenton-like reaction and RT sensitization. RT and chemodynamic therapy produce reactive oxygen species in the form of radical storms, which have a robust ICD impact on mobilizing the immune system. Thus, when MARS is combined with RT, potent systemic antitumor immunity can be generated by activating antigen-presenting cells, promoting dendritic cells maturation, increasing the infiltration of cytotoxic T lymphocytes, and reprogramming the immunosuppressive tumor microenvironment. Furthermore, the synergistic therapy of RT and MARS effectively suppresses local tumor growth, increases mouse longevity, and results in a 90% reduction in lung metastasis and postoperative recurrence. Overall, we provide a viable approach to treating cancer by inducing radical storms and activating cascade-amplified systemic immunity.

R-CHOP and consolidation radiotherapy for limited-stage and low-IPI high-grade b-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements: A single-center case series and review of literature

@#High-Grade B-Cell Lymphoma (HGBCL) with gene rearrangements in MYC and BCL2 and/or BCL6 is an aggressive malignancy usually presenting in advanced stages. Current recommendations suggest the use of regimens more intensive than R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone), which are based on retrospective studies and single-arm prospective trials that included patients who are mostly in the advanced stage, and did not receive consolidation radiotherapy. The optimal approach and treatment of HGBCL, whether limited-stage (LS) or advanced-stage, remains to be determined. Here we describe the promising outcomes of three patients with LS and low IPI HGBCL with the use of R-CHOP as induction chemotherapy regimen, which was followed by consolidation radiotherapy. Three women, 54-, 60-, and 64-years of age diagnosed to have HGBCL with MYC, and BCL2 and/or BCL6 rearrangements, with Ann Arbor stages I-IIE were included in this case series. All three patients had complete metabolic response to 6 cycles of R-CHOP and was subsequently treated with consolidation involved site radiotherapy (ISRT; total dose 30-36 Gy). Chemotherapy and radiotherapy were tolerated very well. All patients remain to be in remission, with the longest being at 23 months. Outcomes of patients with HGBCL generally remain to be poor, but this may not be the case for patients with limited-stage disease and favorable clinicopathologic risk profile. Nevertheless, the treatment of HGBCL is currently evolving and more studies are needed to determine the ideal approach and preferred chemotherapy regimen. Also, more studies are needed to elucidate the potential role of consolidation radiotherapy in patients with limited-stage HGBCL to improve survival outcomes. Findings of this case series suggest that patients with LS HGBCL may still derive benefit from R-CHOP followed by consolidation ISRT, but prospective trials are needed to confirm this.

Carcinoma adenoide quístico traqueal: presentación de caso clínico y revisión de literatura / Tracheal cystic adenoid carcinoma: Case report presentation and literature review

RESUMEN Introducción: El carcinoma adenoide quístico de la vía aérea es un tumor poco común, que se origina de las glándulas submucosas del árbol traqueobronquial. Por el usual retraso entre los síntomas y el diagnóstico, y por la propensión de este tumor para expandirse a través de los haces perineurales y submucosa, el tratamiento recomen dado es la resección quirúrgica con radioterapia posoperatoria. La supervivencia está determinada por la presencia de metástasis a distancia. Caso clínico: Paciente de sexo femenino de 70 años de edad con antecedentes de hipertensión arterial, EPOC (extabaquista 34 paquetes/año) que acude a servicio de urgencias con episodios de hemoptisis y disnea mMRC 3-4 previa. Discusión: Las neoplasias malignas de la tráquea son muy raras y los datos rela cionados con ellos son limitados. Los más importantes factores pronósticos en las enfermedades primarias malignas de la tráquea constituyen el diagnóstico temprano, estadiaje del tumor, histología y opciones de tratamiento. Conclusiones: La detección temprana puede estar asociada con el incremento de las tasas de resecabilidad e, incluso, supervivencia prolongada.

ABSTRACT Introduction: Adenoid cystic carcinoma of the airway is a strange tumor that arises from the submucosal glands of the tracheobronchial tree. For the usual delay between symptoms and diagnosis, and for the propensity of this tumor to expand through the perineural fibers and submucosa, the recommended treatment is surgical resection with postoperative radiation therapy. Survival is determined by the presence of distance metastases. Clinical case: 70 year-old female patient with a history of hypertension, COPD (former smoker 34 pack/year) who came to the emergency room with episodes of hemoptysis and previous dyspnea mMRC 3-4. Discussion: Malignant neoplasms of the trachea are very strange and data related to them is limited. The most important prognostic factors in primary malignant diseases of the trachea are early diagnosis, tumor stating, histology, and treatment options. Conclusions: Early detection may be associated with increased resectability rates and even prolonged survival.

Effect of Survivin Down-Regulation by Egr1-Survivin shRNA Combined with Radiotherapy on Radiosensitivity of Esophageal Squamous Carcinoma / Efecto de la Regulación Negativa de Survivina por shRNA de Egr1-Survivina Combinado con Radioterapia sobre la Radiosensibilidad del Carcinoma Escamoso de Esófago

SUMMARY: This study is to investigate the effect of survivin down-regulation by Egr1-survivin shRNA combined with radiotherapy on the apoptosis and radiosensitivity of esophageal squamous cell carcinoma ECA109 and KYSE150 cells. ECA109 and KYSE150 cells were transfected with Egr1-survivin shRNA, and then treated with radiotherapy. After 24 h, the mRNA and protein levels of Egr1-survivin were detected by qPCR and Western-Blot. Cell cycle and apoptosis were detected by flow cytometry. Western blot also detected levels of cleavaged Caspase 3 and Caspase 9. YM155 was used as a positive control to inhibit survivin expression. The levels of survivin mRNA and protein in ECA109 and KYSE150 cells treated with Egr1-survivin shRNA combined with radiotherapy were significantly lower than those of the blank control group, the empty vector control group, and, the YM155 + radiotherapy group (P<0.05). Meanwhile, after survivin down-regulation, the ratio of G2 to S phase of ECA109 and KYSE150 cells increased significantly, leading to significant G2 and S phase arrest. Additionally, apoptosis of ECA109 and KYSE150 cells increased significantly (P <0.01). Further, protein levels of cleavaged Caspase 3 and Caspase 9 significantly increased in Egr1-survivin shRNA combined with radiotherapy group. Egr1-survivin shRNA combined with radiotherapy can down-regulate survivin expression, which further increases the apoptosis, and enhances the radiosensitivity of ECA109 and KYSE150 cells.

Este estudio tuvo como objetivo investigar el efecto de la regulación negativa de survivina por el shRNA de Egr1-survivina combinado con radioterapia sobre la apoptosis y la radiosensibilidad del carcinoma de células escamosas de esófago Células ECA109 y KYSE150. Las células ECA109 y KYSE150 se transfectaron con shRNA de survivina Egr1 y luego se trataron con radioterapia. Después de 24 h, los niveles de ARNm y proteína de Egr1-survivina se detectaron mediante qPCR y Western-Blot. El ciclo celular y la apoptosis se detectaron mediante citometría de flujo. La transferencia Western también detectó niveles de Caspasa 3 y Caspasa 9 escindidas. Se usó YM155 como control positivo para inhibir la expresión de survivina. Los niveles de ARNm y proteína de survivina en células ECA109 y KYSE150 tratadas con shRNA de survivina Egr1 combinado con radioterapia fueron significativamente más bajos que los del grupo control en blanco, el grupo control de vector vacío y el grupo de radioterapia YM155 + (P <0,05). Mientras tanto, después de la regulación negativa de survivina, la proporción entre las fases G2 y S de las células ECA109 y KYSE150 aumentó significativamente, lo que llevó a una detención significativa de las fases G2 y S. Además, la apoptosis de las células ECA109 y KYSE150 aumentó significativamente (P <0,01). Además, los niveles de proteína de Caspasa 3 y Caspasa 9 escindidas aumentaron significativamente en el shRNA de Egr1- survivina combinado con el grupo de radioterapia. El shRNA de survivina de Egr1 combinado con radioterapia puede regular negativamente la expresión de survivina, lo que aumenta aún más la apoptosis y mejora la radiosensibilidad de las células ECA109 y KYSE150.

Uso de barreras primarias en función del ángulo del gantry en búnker de radioterapia / Uso de barreiras primárias em função do ângulo do gantry em bunkers de radioterapia / Use of primary barriers as a function of gantry angle in radiotherapy bunker

Introducción: el diseño de los búnkeres de radioterapia es de vital importancia no solo por la seguridad radiológica, sino también por el costo que implican. Los cálculos de blindaje de las paredes primarias de los búnkeres de los aceleradores lineales de radioterapia se determinan a partir del factor de uso de estas paredes. Los documentos internacionales como el NCRP 151 utilizan para el cálculo de estas barreras un factor de uso igual a 0.25. Objetivo: estudiar la distribución del uso de las barreras primarias en función de los tratamientos realizados buscando contrastar la homogeneidad en el uso de las barreras. Material y Métodos: con los datos de pacientes realizados durante un año (2021) en dos aceleradores lineales, uno dual y otro monoenergético, se generó una base de datos con la que se calculó la frecuencia de uso de las paredes primarias. En el presente trabajo se evalúa la diferencia entre el uso dado de las barreras y las estimaciones de uso internacional. Resultados: se encuentra que en el acelerador dual en la energía de 15X los campos más usados tienen ángulos de gantry 0º, 90º, 180º, 270º, teniendo un peso acumulado aproximado al 65% al igual que la carga de trabajo para esos ángulos, esto implica que los ángulos diferentes a estos tienen un uso muy inferior al previsto por el cálculo inicial. En el acelerador dual en la energía de 6X el campo más usado es a 0º teniendo un peso aproximado al 14%, pero la carga de trabajo a 0º no se diferencia apreciablemente del resto de los ángulos ya que la distribución no tiene direcciones preferenciales, ninguno de los valores llega a 10% que concuerda con el uso homogéneo de la barrera. En el acelerador monoenergético el peso relativo de los ángulos de 90º y 270º en el uso de las barreras es aproximadamente 34% para cada una, superior al 25% estimado inicialmente. Conclusiones: las barreras primarias de los búnkeres de radioterapia tienen espesores marcados por el cálculo de blindaje, los cuales se pueden hacer basados en documentos internacionales que son referencia del tema. Se considera en las referencias para la barrera primaria un factor de uso igual para las mismas, sin embargo en la práctica clínica se pueden tener un factor de uso no uniforme respondiendo a los tipos de tratamientos que se designen realizar en el equipo. Esta realidad abre la puerta para plantear blindajes optimizados que podrían generar búnkeres más económicos y mejor utilización del espacio de acuerdo a las condiciones dadas para cada caso en particular.

Introduction: The design of radiotherapy bunkers is of vital importance not only for radiation safety, but also for the cost involved. The shielding calculations of the primary walls of radiotherapy linear accelerator bunkers are determined from the use factor of these walls. International documents such as NCRP 151 use for the calculation of these barriers a usage factor equal to 0.25. Objective: to study the distribution of the use of primary barriers according to the treatments performed, seeking to contrast the homogeneity in the use of the barriers. Material and Methods: with the data of patients performed during one year (2021) in two linear accelerators, one dual and the other monoenergetic, a database was generated with which the frequency of use of the primary walls was calculated. The present work evaluates the difference between the given use of the barriers and the estimates of international use. Results: it is found that in the dual accelerator at 15X energy the most used fields have gantry angles 0º, 90º, 180º, 270º, having an accumulated weight of approximately 65% as well as the workload for those angles, this implies that the angles different from these have a use much lower than the one foreseen by the initial calculation. In the dual accelerator at 6X energy the most used field is at 0º having an approximate weight of 14%, but the workload at 0º is not appreciably different from the rest of the angles since the distribution does not have preferential directions, none of the values reaches 10% which is consistent with the homogeneous use of the barrier. In the monoenergetic accelerator, the relative weight of the 90º and 270º angles in the use of the barriers is approximately 34% for each one, higher than the 25% initially estimated. Conclusions: the primary barriers of radiotherapy bunkers have thicknesses marked by the shielding calculation, which can be made based on international documents that are a reference on the subject. It is considered in the references for the primary barrier an equal use factor for them, however in clinical practice they can have a non-uniform use factor responding to the types of treatments that are designed to be performed in the equipment. This reality opens the door to propose optimized shielding that could generate more economical bunkers and better use of space according to the conditions given for each particular case.

Introdução: O projeto de bunkers de radioterapia é de vital importância não apenas para a segurança da radiação, mas também para o custo envolvido. Os cálculos de blindagem para as paredes primárias dos bunkers de aceleradores lineares de radioterapia são determinados com base no fator de uso dessas paredes. Documentos internacionais, como o NCRP 151, usam um fator de uso igual a 0,25 para o cálculo dessas barreiras. Objetivo: estudar a distribuição do uso de barreiras primárias de acordo com os tratamentos realizados, buscando contrastar a homogeneidade no uso das barreiras. Material e métodos: com os dados de pacientes tratados durante um ano (2021) em dois aceleradores lineares, um dual e outro monoenergético, foi gerado um banco de dados com o qual foi calculada a frequência de uso das paredes primárias. Este artigo avalia a diferença entre o uso determinado de barreiras e as estimativas internacionais de uso. Resultados: verifica-se que no acelerador duplo com energia de 15X os campos mais utilizados são os ângulos de pórtico 0º, 90º, 180º, 270º, com um peso acumulado de aproximadamente 65%, assim como a carga de trabalho para esses ângulos, o que implica que os ângulos diferentes desses têm um uso muito menor do que o previsto pelo cálculo inicial. No acelerador duplo a 6X de energia, o campo mais utilizado é o de 0º com um peso aproximado de 14%, mas a carga de trabalho em 0º não é sensivelmente diferente do resto dos ângulos, já que a distribuição não tem direções preferenciais, nenhum dos valores chega a 10%, o que é consistente com o uso homogêneo da barreira. No acelerador de monoenergia, o peso relativo dos ângulos de 90º e 270º no uso das barreiras é de aproximadamente 34% para cada um, superior aos 25% estimados inicialmente. Conclusões: as barreiras primárias dos bunkers de radioterapia têm espessuras balizadas pelo cálculo de blindagem, que pode ser feito com base em documentos internacionais que são referência no assunto. As referências para a barreira primária consideram um fator de uso igual para elas, mas na prática clínica elas podem ter um fator de uso não uniforme, dependendo do tipo de tratamento que o equipamento foi projetado para realizar. Essa realidade abre as portas para uma blindagem otimizada que poderia gerar bunkers mais econômicos e melhor uso do espaço de acordo com as condições dadas para cada caso específico.

Fracture in Irradiated Rat Femur: A Description of an Experimental Model and Evaluation of its Effectiveness / Fratura em fêmur irradiado de rato: Descrição de um modelo experimental e avaliação de sua eficácia

Abstract Objective We aim to describe an experimental model for studying femoral fractures in rats after exposure to ionizing radiation, demonstrating a way to apply a substance for analysis, the method for patterning fracture and irradiation, and how to evaluate its effectiveness based on radiographic studies. Methods We used 24 rats divided into 2 groups of 12 animals each. The STUDY group was exposed to ionizing radiation and treated with saline solution, and the CONTROL group was not exposed to radiation and was treated with saline solution. All animals were subjected to standardized fracture of the right femur that was fixed with intramedullary wire. The efficiency of the bone union was assessed by radiographic exam. Results Fracture healing was more efficient in bones not exposed to ionizing radiation (p = 0.012). All fractures met the criteria of being simple, diaphyseal, transverse or short oblique. Conclusion The experimental model presented is an efficient alternative for the study of fractures in irradiated bones in rats.

Resumo Objetivo Nosso objetivo é descrever um modelo experimental para estudo de fraturas de fêmur em ratos após exposição a radiação ionizante, demonstrando uma forma de aplicação de uma substância para análise, o método de padronização de fratura e irradiação e a forma de avaliação de sua eficácia com base em estudos radiográficos. Métodos Utilizamos 24 ratos divididos em dois grupos de 12 animais cada. O grupo ESTUDO foi exposto à radiação ionizante e tratado com soro fisiológico, enquanto o grupo CONTROLE não foi exposto à radiação e foi tratado com soro fisiológico. Todos os animais foram submetidos à fratura padronizada do fêmur direito e sua fixação com fio intramedular. A eficácia da consolidação óssea foi determinada por exame radiográfico. Resultados A cicatrização de fraturas foi mais eficiente em ossos não expostos à radiação ionizante (p = 0,012). Todas as fraturas atenderam aos critérios de serem simples, diafisárias, transversas ou oblíquas curtas. Conclusão O modelo experimental apresentado é uma boa alternativa para o estudo de fraturas em ossos irradiados em ratos.

Valor de la elastografía por patrones de colores en la reestadificación del cáncer de recto / Value of elastography by color patterns in the restaging of rectal cancer i: en

Introducción: La elastografía cualitativa por ecografía endoscópica es una técnica para examinar las propiedades elásticas de los tejidos, que puede distinguir la fibrosis del tumor mediante patrones de colores. Objetivo: Determinar el valor de la elastografía por patrones de colores en la reestadificación del cáncer de recto. Métodos: Se efectuó un estudio observacional y descriptivo (serie de casos) de 54 pacientes con cáncer de recto atendidos en el Centro Nacional de Cirugía de Mínimo Acceso, en La Habana, entre septiembre del 2018 y diciembre del 2022, a quienes se les realizó elastografía por ecografía endoscópica para la reevaluación del tumor. Para determinar el valor de dicha técnica se calculó la sensibilidad, la especificidad, los valores predictivos positivo y negativo, las razones de verosimilitud positiva y negativa, así como el índice de Youden. Se estableció la concordancia diagnóstica según el índice kappa y el estudio histológico de la muestra tomada fue el estándar de referencia. Resultados: La concordancia de la elastografía con el resultado anatomopatológico fue buena (κ=0,84). La especificidad y el índice de validez resultaron ser de 91,7 y 94,4 %, respectivamente; mientras que el valor predictivo negativo fue de 84,6 %. Los 16 pacientes con patrón elastográfico mixto (ye3) tenían tumor residual localizado en alguna de las capas de la pared del recto. El índice de Youden alcanzó valores cercanos a 1. Conclusiones: El valor de esta técnica radica en su especificidad diagnóstica y en el valor predictivo negativo al diferenciar la fibrosis del tumor residual en la pared rectal.

Introduction: The qualitative elastography by endoscopic echography is a technique to examine the elastic properties of tissues that can distinguish the fibrosis of the tumor by means of color patterns. Objective: To determine the value of elastography by color patterns in the reestadification of the rectum cancer. Methods: An observational and descriptive study (serial cases) of 54 patients with rectum cancer was carried out, who were assisted in the National Center of Minimum Access Surgery, in Havana, between September, 2018 and December, 2022 to whom elastography by endoscopic echography were carried out for the reevaluation of the tumor. To determine the value of this technique the sensibility, specificity, the predictive positive and negative values, the positive and negative true ratio, as well as the index of Youden were calculated. The diagnostic consistency was established according to the kappa index and the histologic study of the sample was the reference standard. Results: The elastography consistency with the pathologic result was good (ĸ=0.84). The specificity and the index of validity were 91.7 and 94.4%, respectively; while the negative predictive value was 84.6%. The 16 patients with mixed elastographic pattern (ye3) had residual tumor located in some of the layers of the rectum wall. The Youden index reached values close to 1. Conclusions: The value of this technique resides in its diagnostic specificity and negative predictive value when differentiating fibrosis from the residual tumor in the rectal wall.

Uso de imágenes KV CBCT del acelerador lineal Halcyon para la planificación de tratamientos de metástasis óseas con intensión paliativa / Use of KV CBCT images from the Halcyon linear accelerator for treatment planning of bone metastases with palliative intent

Las nuevas tecnologías para el tratamiento del cáncer con radiación ionizante tienen especial interés en mejorar la calidad de las imágenes para el posicionamiento adecuado del paciente con sistemas de radioterapia guiada por imagen IGRT. El sistema Halcyon cuenta con imágenes de tomografía computarizada de haz de cono CBCT. Estas imágenes podrían ser una opción para escenarios donde no se cuente con una Tomografía Computarizada CT o el equipo se encuentre en reparación o mantenimiento especialmente para escenarios de intensión paliativa. La diferencia en la distribución de dosis en imágenes CT y CBCT fue analizada en este estudio. Los resultados mostraron diferencias en las unidades Hounsfield UH, aunque no fueron estadísticamente significativas, el volumen irradiado mostro diferencias máximas de 3,92% que no supera el 4% permitido para tratamientos de intensión paliativa. En cuanto a las dosis dispersas al tejido sano la diferencia tampoco supera el 4%. Nuestro estudio mostro que las imágenes CBCT pueden ser una alternativa para el tratamiento de metástasis óseas, sin embargo, estas imágenes todavía no pueden remplazar las imágenes CT utilizadas para el cálculo de dosis en radioterapia

New technologies for the treatment of cancer with ionizing radiation are of particular interest in improving image quality for proper patient positioning with image-guided radiation therapy IGRT systems. IGRT image-guided radiation therapy systems. The Halcyon system features cone beam computed tomography CBCT imaging. These images could be an option for scenarios where a CT scan is not available or the equipment is under repair or maintenance especially for is under repair or maintenance, especially for palliative scenarios. The difference in the The difference in dose distribution in CT and CBCT images was analyzed in this study. The results showed differences in Hounsfield UH units, although not statistically significant, the irradiated volume showed maximum differences of 3.92%, which is the maximum difference of 3.92%. Differences of 3.92%, which does not exceed the 4% allowed for palliative treatments. As for the doses dispersed to healthy tissue the difference does not exceed the 4% allowed for palliative treatments. Our study showed that CBCT imaging can be an alternative for the treatment of metastases. an alternative for the treatment of bone metastases, however, these images cannot yet replace the CT images used for dose calculation. CT images used for dose calculation in radiotherapy