ABSTRACT
BACKGROUND: The aim of this study was to identify factors predictive of a complete endoscopic/histopathological response to chemoradiotherapy in patients with esophageal cancer. PATIENTS: Clinical and histopathological factors (Ki67, p53 and EGFR expression) were studied in 56 patients presenting with esophageal cancer between September 2000 and March 2006 (35 squamous cell carcinomas, 20 adenocarcinomas, one undifferentiated carcinoma). The response to chemoradiotherapy was evaluated endoscopically and by histological examination in 16 patients who underwent surgical resection. RESULTS: Independent factors predictive of a complete endoscopic response were good performance status (RR=15.75; CI: 1.74-142.58; P=0.01) and overexpression of Ki67 (RR=4.46; CI: 1.08-18.31; P=0.04). In patients who underwent surgery, a major histopathological response was associated with complete endoscopic response (P<0.01), complete CT-scan response (P=0.04) and good performance status (WHO=0) (P=0.04). The mean survival was 40 months. Adenocarcinoma histology (RR=3.18, CI: 1.13-8.54; P=0.02) and an impaired performance status (RR=4.79; CI: 1.07-21.41; P=0.04) were independently associated with poor survival. CONCLUSION: In the present study, good performance status and overexpression of Ki67 were two independent factors for complete endoscopic response after chemoradiotherapy for esophageal cancer. Independent risk factors for poor survival were adenocarcinoma histological type and impaired performance status. Further prospective studies are necessary to complete the present results.
Subject(s)
Carcinoma/drug therapy , Carcinoma/radiotherapy , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Carcinoma/metabolism , Carcinoma/mortality , Combined Modality Therapy , ErbB Receptors/biosynthesis , Esophageal Neoplasms/metabolism , Esophageal Neoplasms/mortality , Female , Humans , Ki-67 Antigen/biosynthesis , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate , Tumor Suppressor Protein p53/biosynthesisABSTRACT
CONTEXTUALIZAÇÃO: A avaliação postural bem como a mensuração da amplitude articular são instrumentos fundamentais para o diagnóstico, planejamento e acompanhamento da evolução e dos resultados de um tratamento fisioterapêutico. Elas podem ser realizadas tanto pela goniometria - método mais utilizado na clínica fisioterapêutica - como, com o avanço tecnológico, pela fotogrametria. OBJETIVOS: Verificar a confiabilidade paralela da fotogrametria computadorizada, utilizando dois softwares, o Corel Draw e o SAPo, em relação à goniometria para quatro ângulos nos membros inferiores. CASUÍSTICA E MÉTODOS:Foram estudados 26 voluntários de ambos os sexos, assintomáticos, com idade entre 18 e 45 anos, sem anisomelia de membros inferiores maior que 1 cm. Foram mensurados os ângulos tíbio-társico (TT), de flexo/extensão do joelho (flex/ext), ângulo Q (Q) e ângulo do retropé, inicialmente, com um goniômetro manual e, posteriormente, pela fotogrametria digital por meio dos softwares Corel Draw v. 12 e SAPo v.0.63. RESULTADOS: Os ângulos TT (p= 0,9991), do retropé (p= 0,2159) e de flexo/extensão do joelho (p= 0,4027) não foram estatisticamente diferentes entre os 3 métodos de avaliação. Já o ângulo Q foi significativamente diferente entre a goniometria e os dois softwares usados na fotogrametria (p= 0,0067), embora os valores obtidos pelos mesmos não tenham diferido entre si (p= 0,9920), demonstrando que os resultados da fotogrametria não foram influenciados pelos softwares utilizados. CONCLUSÃO: Para os ângulos avaliados em sujeitos jovens assintomáticos, a fotogrametria computadorizada é confiável paralelamente à goniometria, exceto para o ângulo Q. Portanto, na clínica fisioterapêutica, deve-se ter cautela no uso de medidas de ângulo Q provenientes de diferentes métodos de avaliação postural.
BACKGROUND: Postural assessment and joint range-of-motion measurements are fundamental in diagnosing, planning and following up the evolution and results from physical therapy treatment. These can be done with the aid of goniometry the most common method in physical therapy practice - and also, through technological advances, by means of photogrammetry. OBJECTIVE: To investigate the parallel reliability of computerized photogrammetry, using two software tools (Corel Draw and SAPo), in relation to goniometry, in four angles of the lower limbs. METHOD: Twenty-six asymptomatic volunteers of both sexes, aged between 18 and 45 years, were studied. None of them had leg length discrepancy greater than 1 cm. The tibiotarsal angle (TT), knee flexion/extension angle (F/E), quadriceps angle (Q) and subtalar angle (S) were measured. The measurement was done first with a manual goniometer and then with digital photogrammetry by means of the Corel Draw v. 12 and SAPo v.0.63 software. RESULTS: There were no statistical differences between the three evaluation methods for the TT (p= 0.9991), S (p= 0.2159) and F/E (p= 0.4027) angles. However, for the Q angle there was a significant difference between goniometry and the software used in photogrammetry (p= 0.0067), although there was no significant difference between two software tools (p= 0.9920). This showed that the photogrammetry results were not influenced by the software used. CONCLUSION: In these healthy young subjects, computerized photogrammetry showed good parallel reliability in comparison with goniometry, for all the angles evaluated except for the Q angle. Therefore, in physical therapy practice, caution is needed in using Q angle measurements coming from different postural assessment methods.
