Real-world evidence of outcomes of oligometastatic hormone-sensitive prostate cancer patients treated with metastasis-directed therapy.

OBJECTIVE: To investigate characteristics and outcomes of oligometastatic hormone-sensitive prostate cancer (mHSPC) patients undergoing metastases-directed therapy (MDT) with external beam radiation therapy (EBRT). MATERIALS AND METHODS: We relied on an institutional tertiary-care database to identify mHSPC patients who underwent EBRT as MDT between 12/2019 and 12/2022. Main outcomes consisted of progression to metastatic castration-resistant prostate cancer (mCRPC) and overall mortality (OM). Oligometastatic was defined as ≤3 metastases and bone and/or lymph node deposits were treated with conventional doses up to 54 Gy or with hypofractionated stereotactic regimes of median 24 Gy (20-27 Gy). RESULTS: Overall, 37 patients treated with EBRT as MDT were identified. The median follow-up was 13 months. Median age at MDT was 71 years and 84% exhibited ECOG performance status 0. The median baseline PSA at diagnosis was 10 ng/mL. Overall, primary local therapy consisted of radical prostatectomy (65%), followed by external beam radiation therapy to the prostate (11%), focal therapy (8%), and palliative transurethral resection of the prostate (5%). Overall, 32% exhibited de novo oligometastatic mHSPC. Bone metastases were present in 78% versus 19% lymph node metastases versus 3% both. The distribution of targeted oligo-metastases was 62% versus 38% for respectively one metastasis versus more than one metastasis. Androgen deprivation therapy (ADT) was combined with MDT in 84%. Moreover, 19% received combination therapy with apalutamide/enzalutamide and 12% with abiraterone or docetaxel. The median time to mCRPC was 50 months. In incidence analyses, 13% developed mCRPC after 24 months. OM after 24 months was 15% in mHSPC patients receiving MDT. Significant OM differences were observed after stratification into targeted metastatic burden (<0.05). No high-grade adverse events were recorded during MDT. CONCLUSION: Our real-world data suggest that MDT represents a safe treatment option for well-selected oligometastatic mHSPC patients.

Slope variation and population structure of tree species from different ecological groups in South Brazil

Size structure and spatial arrangement of 13 abundant tree species were determined in a riparian forest fragment inParaná State, South Brazil (23"16'S and 51"01'W). The studied species were Aspidosperma polyneuron Müll. Arg., Astronium graveolens Jacq. and Gallesia integrifolia (Spreng) Harms (emergent species); Alseis floribunda Schott, Ruprechtia laxiflora Meisn. and Bougainvillea spectabilis Willd. (shade-intolerant canopy species); Machaerium paraguariense Hassl, Myroxylum peruiferum L. and Chrysophyllum gonocarpum (Mart. & Eichler ex Miq.) Engl. (shade-tolerant canopy species); Sorocea bonplandii (Baill.) Bürger, Trichilia casaretti C. Dc, Trichilia catigua A. Juss. and Actinostemon concolor (Spreng.) Müll. Arg. (understory small trees species). Height and diameter structures and basal area of species were analyzed. Spatial patterns and slope correlation were analyzed by Moran's / spatial autocorrelation coefficient and partial Mantel test, respectively. The emergent and small understory species showed the highest and the lowest variations in height, diameter and basal area. Size distribution differed among emergent species and also among canopy shade-intolerant species. The spatial pattern ranged among species in all groups, except in understory small tree species. The slope was correlated with spatial pattern for A. polyneuron, A. graveolens, A. floribunda, R. laxiflora, M. peruiferum and T. casaretti. The results indicated that most species occurredin specific places, suggesting that niche differentiation can be an important factor in structuring the tree community.

Visando contribuir para o conhecimento das estratégias devida de espécies em fragmentos florestais, foram determinadas as estruturas de tamanho e espacial de 13 espécies arbóreas do remanescente de floresta ciliar no Estado do Paraná, no Sul do Brasil (23"16'S e 51"01'W). Foram analisadas as espécies: Aspidosperma polyneuron Müll. Arg., Astronium graveolens Jacq. e Gallesia integrifolia (Spreng) Harms, (emergentes); Alseis floribunda Schott, Ruprechtia laxiflora Meisn. e Bougainvillea spectabilis Willd. (dossel, intolerantes à sombra); Machaerium paraguariense Hassl, Myroxylum peruiferum L. e Chrysophyllum gonocarpum (Mart. & Eichler exMiq.) Engl. (dossel, tolerantes à sombra); Sorocea bonplandii (Baill.) Bürger, Trichilia casaretti C. Dc, Trichilia catigua A. Juss. e Actinostemon concolor (Spreng.) Müll. Arg. (subosque). Analisou-se a estrutura de diâmetro de cada espécie. Para a análise do padrão espacial e correlação com adeclividade foram utilizados o Índice de Autocorrelação espacial de Moran e o Teste Parcial de Mantel, respectivamente. Os grupos das árvores emergentes e das espécies de subosque apresentaram as maiores e as menores variações na altura e no diâmetro e maior e menor área basal, respectivamente. Diferenças nas estruturas de diâmetro foram observadas entre as espécies emergentes e entre as espécies de dossel intolerantes à sombra. O padrão espacial variou entre as espécies de todos os grupos, exceto as espécies de subosque tolerantes à sombra. A topografia estava relacionada com a distribuição espacial de A. polyneuron, A. graveolens, A. floribunda, R. laxiflora, M. peruiferum e T. casaretti. A análise dos resultados indicou que para cada espécie a maioria dos indivíduos ocorriam em locais específicos, sugerindo que a diferenciação de nicho pode estar relacionada à estruturação desta comunidade arbórea.

Slope variation and population structure of tree species from different ecological groups in South Brazil.

Size structure and spatial arrangement of 13 abundant tree species were determined in a riparian forest fragment in Paraná State, South Brazil (23°16'S and 51°01'W). The studied species were Aspidosperma polyneuron Müll. Arg., Astronium graveolens Jacq. and Gallesia integrifolia (Spreng) Harms (emergent species); Alseis floribunda Schott, Ruprechtia laxiflora Meisn. and Bougainvillea spectabilis Willd. (shade-intolerant canopy species); Machaerium paraguariense Hassl, Myroxylum peruiferum L. and Chrysophyllum gonocarpum (Mart. & Eichler ex Miq.) Engl. (shade-tolerant canopy species); Sorocea bonplandii (Baill.) Bürger, Trichilia casaretti C. Dc, Trichilia catigua A. Juss. and Actinostemon concolor (Spreng.) Müll. Arg. (understory small trees species). Height and diameter structures and basal area of species were analyzed. Spatial patterns and slope correlation were analyzed by Moran's / spatial autocorrelation coefficient and partial Mantel test, respectively. The emergent and small understory species showed the highest and the lowest variations in height, diameter and basal area. Size distribution differed among emergent species and also among canopy shade-intolerant species. The spatial pattern ranged among species in all groups, except in understory small tree species. The slope was correlated with spatial pattern for A. polyneuron, A. graveolens, A. floribunda, R. laxiflora, M. peruiferum and T. casaretti. The results indicated that most species occurred in specific places, suggesting that niche differentiation can be an important factor in structuring the tree community.

Patologias associadas e prognósticos de eventos com aparente risco de vida (ALTE) / Associated and prognosis in apparent life threatening events (ALTE)

Objetivo: Verificar a etiologia e o prognóstico dos episódios de ALTE na infância e sua possível relaçäo com a Síndrome da Morte Súbits do Lactente. Métodos: Estudo de uma coorte de crianças que apresentaram episódios de ALTE e foram avaliadas no serviço de Neurologia do Hospital Säo Lucas da PUCRS. Primeiramente foram revisados os prontuários contendo a avaliaçäo clínica e as polissonografias. Prospectivamente os pacientes foram contatados e reavaliados através de questionário. Resultados: Foram incluídos neste estudo 56 pacientes investigados entre os anos de 1985 a 1996. Em 92 por cento dos casos o episódio ocorreu nos primeiros seis meses de vida, 83 por cento antes dos três meses. Houve um predomínio de episódios sintomáticos (71 por cento) em relaçäo aos idiopáticos. A patologia mais freqüentemente associada aos episódios de ALTE foi refluxo gastro-esofágico, seguido de causas neurógicas. No seguimento dessas crianças, 51,5 por cento foram consideradas normais, quatro repetiram outros episódios de ALTE, nenhuma evoluiu para Síndrome da Morte Súbita do Lactente (SMSL). Conclusöes: Nossos resultados sugerem que a etiologia dos episódios de ALTE pode estar associada a inúmeros distúrbios, e o prognósticos está associado à patologia de base. Näo observamos relaçäo entre ALTE e SMSL considerando-se uma popuaçäo com episódios de ALTE predominantemente sintomáticos