RESUMO
PURPOSE: To evaluate acute and late skin/subcutaneous toxicities and radiation-induced lung fibrosis (RILF) in patients treated with adjuvant radiotherapy (RT) for synchronous bilateral breast cancers (SBBC), after conservative surgery. METHODS/PATIENTS: Twenty-five patients were treated with volumetric-modulated arc therapy (VMAT/RapidArc®) on both breasts, and checked clinically for detecting RT toxicities during and after treatment. A high-resolution computed tomography (HRCT) was performed, for detecting RILF during follow-up. RESULTS: We registered acute Grade-1 skin toxicity in 18 patients (72%), while six patients (24%) experienced Grade-2 toxicity. No breath symptoms were reported during and after RT. Late Grade-1 subcutaneous toxicity and late Grade-2 skin toxicity were registered in four patients (16%) and one patient (4%), respectively, at a mean follow-up of 36 months. Grade-1 RILF was detected in six patients (30%). The median volume of fibrosis area was 6.5 cc (range 1.3-21.5 cc). The partial volumes receiving a specified dose (V20, V30, V40, and V50) in patients who developed lung fibrosis were significantly bigger than who did not (p < 0.01). We showed that the mean volume of the tumour boost of patients who developed fibrosis (77.7 cc) was not significantly different from the other patients (90.8 cc) (p = 0.5). CONCLUSION: The clinical impact of this technique is favourable, and this is the first clinical study showing RILF by HRCT in a setting of SBBC. Further study with larger accrual is mandatory.
Assuntos
Neoplasias da Mama/radioterapia , Pulmão/efeitos da radiação , Neoplasias Primárias Múltiplas/radioterapia , Pneumonite por Radiação/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Pele/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Pneumonite por Radiação/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
Extra-cranial metastases of glioblastoma (GBM) represent a rare event, and the biological-genetic mechanisms involved in the pathogenesis have not yet been determined. We report the case of a young patient with multiple visceral and osseous metastases occurred after 4 years after first diagnosis of GBM. The strangeness as well as the rarity of this event does not allow to identify an effective treatment for GBM metastases, making the management of this ominous tumor an even greater challenge.
