ABSTRACT
Objetivo Valorar la utilidad clínica de los criterios PERCIST, Hopkins y de los cambios en los parámetros cuantitativos de la PET/TC con [18F]FDG como factores pronósticos para la supervivencia libre de progresión (SLP) y la supervivencia cáncer específica (SCE) en pacientes con cáncer escamoso de cabeza y cuello tratados mediante quimiorradioterapia. Material y métodos Se valoraron retrospectivamente 40 pacientes (34 hombres) diagnosticados de cáncer escamoso de cabeza y cuello durante un intervalo de 8 años. Se utilizaron los criterios PERCIST y Hopkins para determinar la respuesta al tratamiento. Así mismo, se cuantificaron las variaciones de los parámetros metabólicos SUV máximo (ΔSUVmax), volumen metabólico tumoral (ΔMTV) y glicólisis tumoral total (ΔTLG) entre los estudios PET/TC pre- y postratamiento. El modelo de regresión de Cox, las curvas ROC y el método de Kaplan-Meier se aplicaron para el análisis de factores pronósticos y curvas de supervivencia. Resultado El seguimiento medio fue de 39,4 meses produciéndose 24 recidivas-progresiones y 22 muertes. Tanto los criterios PERCIST y Hopkins como los tres parámetros metabólicos fueron factores predictivos en análisis univariante y solo el ΔSUVmax en el multivariante. El análisis de supervivencia mostró curvas de SLP y SCE significativamente diferentes para los cinco parámetros considerados. Conclusión La aplicación de los criterios PERCIST y Hopkins, así como los ΔSUVmax, ΔMTV y ΔTLG de los estudios PET/TC demostraron ser factores pronósticos para la supervivencia en pacientes de nuestro entorno tratados por cáncer de cabeza y cuello. Los resultados podrían ayudar a personalizar el tratamiento (AU)
Aim To assess the clinical utility of PERCIST and Hopkins criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival (PFS) and cancer-specific survival (CSS) in patients with head and neck squamous cell carcinoma treated by chemoradiotherapy. Material and methods Forty patients (34 men) diagnosed with head and neck squamous cell carcinoma were retrospectively assessed over an interval of 8 years. PERCIST and Hopkins criteria were used to assess response to treatment. Variations in the metabolic parameters maximum SUV (ΔSUVmax), metabolic tumor volume (ΔMTV) and total lesion glycolysis (ΔTLG) between pre- and post-treatment PET/CT studies were also determined. Cox regression model, ROC curves and Kaplan-Meier method were used for the analysis of prognostic factors and survival curves. Results The average follow-up was 39.4 months, with 24 progressions and 22 deaths. Both PERCIST and Hopkins criteria and the three metabolic parameters were predictive factors in the univariate analysis and only ΔSUVmax in the multivariate analysis. Survival analysis showed statistically significant differences in PFS and CSS curves for the five parameters considered. Conclusion Application of PERCIST and Hopkins criteria as well as ΔSUVmax, ΔMTV and ΔTLG from PET/CT studies proved to be prognostic factors for survival in patients in our setting treated for head and neck cancer. The results could help to personalize treatment (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Carcinoma, Squamous Cell/metabolism , Carcinoma, Squamous Cell/mortality , Head and Neck Neoplasms/metabolism , Head and Neck Neoplasms/mortality , Positron Emission Tomography Computed Tomography , Fluorodeoxyglucose F18 , Retrospective Studies , Kaplan-Meier Estimate , Follow-Up Studies , PrognosisABSTRACT
Radiotherapy plays a key role in the treatment of head and neck cancer. However, irradiation of the head and neck region is associated with high rates of acute and chronic toxicity. Technological advances have led to better visualisation of target volumes and critical structures and improved dose conformality in the treatment volume. Despite this, acute toxicity has not been substantially reduced and late toxicity has a significant impact on patients' quality of life. The greater radiosensitivity of tumours associated with the HPV and the development of new imaging techniques have encouraged research into new deintensified strategies to reduce the side effects of radiotherapy. The aim of this paper is to review the literature on the strategies of de-escalated treatment in dose and/or volume in head and neck cancer.
Subject(s)
Head and Neck Neoplasms , Quality of Life , Humans , Radiotherapy Dosage , Head and Neck Neoplasms/radiotherapy , Radiation ToleranceABSTRACT
AIM: To assess the clinical utility of PERCIST and Hopkins criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival (PFS) and cancer-specific survival (CSS) in patients with head and neck squamous cell carcinoma treated by chemoradiotherapy. MATERIAL AND METHODS: Forty patients (34 men) diagnosed with head and neck squamous cell carcinoma were retrospectively assessed over an interval of 8 years. PERCIST and Hopkins criteria were used to assess response to treatment. Variations in the metabolic parameters maximum SUV (ΔSUVmax), metabolic tumor volume (ΔMTV) and total lesion glycolysis (ΔTLG) between pre- and post-treatment PET/CT studies were also determined. The Cox regression model, ROC curves and the Kaplan-Meier method were used for the analysis of prognostic factors and survival curves. RESULTS: The mean follow-up was 39.4 months, with 24 progressions and 22 deaths. Both PERCIST and Hopkins criteria and the three metabolic parameters were predictive factors in the univariate analysis and only ΔSUVmax was in the multivariate analysis. Survival analysis showed statistically significant differences in PFS and CSS curves for the five parameters considered. CONCLUSION: Application of PERCIST and Hopkins criteria as well as ΔSUVmax, ΔMTV and ΔTLG from PET/CT studies proved to be prognostic factors for survival in patients in our setting for treating head and neck cancer. The results may help to personalize treatment.
Subject(s)
Head and Neck Neoplasms , Positron Emission Tomography Computed Tomography , Male , Humans , Prognosis , Squamous Cell Carcinoma of Head and Neck/diagnostic imaging , Squamous Cell Carcinoma of Head and Neck/therapy , Retrospective Studies , Fluorodeoxyglucose F18 , Radiopharmaceuticals , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/therapySubject(s)
Lung Neoplasms/diagnostic imaging , Lung Neoplasms/therapy , Radiology/methods , Humans , RadiographyABSTRACT
El cáncer orofaríngeo ha experimentado un aumento de su incidencia durante los últimos 20 años en contraste con el ligero descenso global del carcinoma de células escamosas de cabeza y cuello. Dicho aumento se ha producido en un subgrupo de pacientes con unas características diferentes al perfil clínico habitual, fundamentalmente más jóvenes y con baja exposición a alcohol y tabaco. La relación entre el carcinoma de células escamosas y ciertas cepas del virus del papiloma humano no sólo es un hecho constatado en los últimos años, sino que además ha originado un cambio en el perfil molecular, epidemiológico y clínico. El objetivo de este artículo es aportar una amplia revisión bibliográfica realizada sobre los trabajos más recientes que relacionan el carcinoma de células escamosas oral con la infección por el virus del papiloma humano. Asimismo, pretendemos plantear las tendencias en su manejo clínico y la repercusión en el perfil epidemiológico que dicha infección está representando (AU)
The oropharyngeal cancer incidence has increased over the past 20 years in contrast to the slight overall decrease of squamous cell carcinoma of head and neck. This increase has occurred in a subgroup of patients with different characteristics to the usual clinical profile, mainly younger and low exposure to alcohol and smoke. The relationship between squamous cell carcinoma and certain strains of human papilloma virus is not only a fact in recent years, also caused a change in the molecular, epidemiological and clinical profile. The aim of this paper is to provide an extensive literature review on recent work linking oral squamous cell carcinoma with human papillomavirus infection. Also, try to create trends in clinical management and the impact on the epidemiological profile that the infection is representing (AU)
Subject(s)
Humans , Mouth Neoplasms/diagnosis , Papillomaviridae/pathogenicity , Papillomavirus Infections/complications , Carcinoma, Squamous Cell/diagnosis , Risk Factors , PrognosisABSTRACT
We report on the appearance of two new cases of radio-induced bullous pemphigoid (BP), a rare complication of radiotherapy. Both were elderly women, were treated for breast cancer and suffered (BP) during the irradiation, the evolution was favorable with steroid therapy (AU)
Subject(s)
Humans , Female , Aged, 80 and over , Carcinoma, Ductal, Breast/radiotherapy , Pemphigoid, Bullous/etiology , Radiation Injuries/diagnosis , Breast Neoplasms/radiotherapy , Pemphigoid, Bullous/diagnosis , Radiation Injuries/etiology , Radiotherapy DosageABSTRACT
Extrapulmonary small cell carcinoma in breast and prostate are uncommon neoplasms. In the literature most of the data come from case reports and these show that these tumours are highly aggressive. Histologically, they bear striking similarities to small cell carcinomas of the lung and usually show evidence of additional histologies. Treatment, which may include surgery, radiotherapy and chemotherapy, is based on the clinical stage. We present the evolution of two cases (AU)
No disponible
Subject(s)
Humans , Male , Female , Adult , Aged , Carcinoma, Small Cell/pathology , Breast Neoplasms/pathology , Prostatic Neoplasms/pathology , Carcinoma, Small Cell/therapy , Breast Neoplasms/therapy , Combined Modality Therapy/methods , Combined Modality Therapy , Prostatic Neoplasms/therapy , Treatment OutcomeSubject(s)
Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Carcinoma, Non-Small-Cell Lung/pathology , Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic , Combined Modality Therapy , Humans , Lung Neoplasms/pathology , Meta-Analysis as TopicABSTRACT
No disponible
Subject(s)
Humans , Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic , Combined Modality Therapy , Carcinoma, Non-Small-Cell Lung , Lung NeoplasmsABSTRACT
OBJECTIVE: To report the presence of an uncommon adverse effect, pain in the tumor location, during the administration of the cytostatic agent vinorelbine. METHOD: Twenty-seven patients with non operable relapses of epidermoid carcinomas of the head and neck were treated with two combinations of cytostatics: mitomycin-c 10 mg/m2 on day 1 plus vinorelbine 25 mg/m2 on days 1, 8 and 15 in twelve patients or carboplatin 300 mg/m2 on day 1 plus vinorelbine 25 mg/m2 on days 1, 8 and 15 in fifteen patients. RESULTS: Six patients had moderate/severe pain in the tumor location; concomitantly, one patient had chest pain. Four patients required major opiates. The clinical picture reverted and no patient had acute or chronic neurotoxicity. The readministration of vinorelbine triggered pain again, and all patients refused to continue the therapeutic program. CONCLUSION: Vinorelbine can cause pain at tumor location, a nonserious adverse effect which, nevertheless, prevented the continuation of therapy.
Subject(s)
Antineoplastic Agents, Phytogenic/adverse effects , Carcinoma, Squamous Cell/drug therapy , Head and Neck Neoplasms/drug therapy , Pain , Vinblastine/analogs & derivatives , Acute Disease , Adult , Aged , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Humans , Male , Middle Aged , Vinblastine/administration & dosage , Vinblastine/adverse effects , VinorelbineABSTRACT
We present seven cases of congenital absence of pulmonary valve observed during a 15 years period. There are five females and two males, aged from one day to six years. Three patients with a birth weight under 1.500 g died in the first 24 hours. All the patients had a systolic diastolic murmur and a single second sound. Two dimensional echocardiography was the procedure that allowed a definite diagnosis. In the valvular ring area a fixed ecogenic image was observed during the cardiac cycle. The pulmonary trunk and branches were dilated and the valvular ring was normal or small. In four patients the study was completed with catheterism and angiocardiography. Two were operated upon, with closing of the ventricular septal defect, aortic hemograft in pulmonary situation and reduction of pulmonary artery branches size.
