Navegando por Palavras-chave "Radioterapia"

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    Agente único versus combinação de agentes quimioterápicos durante a radioterapia pré-operatória para o tratamento do câncer de reto ressecável: revisão sistemática de ensaios clínicos randomizados
    (Universidade Federal de São Paulo (UNIFESP), 2016-09-27) Resende, Heloisa Magda [UNIFESP]; Silva, Edina Mariko Koga da [UNIFESP]; http://lattes.cnpq.br/0262292376123164; http://lattes.cnpq.br/7279033081732789; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Colorectal cancer represents the third more common neoplasms and acconts for 49.190 deaths for year in the United States. Almost two-thirds of the large intestine tumors are the colon and a third is about the rectum, including anus. Surgery is curative basis of the treatment of rectal cancer. Total mesorectal excision reduces the local recurrence rate, improving the prognosis, but a lot of investment in research has been done to improve the overall results, which are very impacted by still high relapse rates in the distance. Currently rectal cancer is covered with neoadjuvant radiotherapy and chemotherapy fluoropyrimidine-based, followed by surgery, however the distance the recurrence rate is around 30%. chemotherapy regimens in combination of two drugs, similar to what has been used in metastatic and adjuvant therapy have improved the prognosis and have been tested in neoadjuvant character. Objectives: To compare outcomes of patients (overall survival, disease-free survival, and toxicity) between two chemotherapy regimens for patients with rectal cancer stage II and III will receive neoadjuvant treatment with radiotherapy and chemotherapy. Interventions were radiotherapy, fluoropyrimidine and additional drugs, excluding biological agents. The control arm was radiotherapy and chemotherapy with a single agent (fluoropyrimidine) SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE and LILACS (last search onSeptember 2014). Completed searching through lists of references, record of "clinical trials" and manual search for relevant papers. There was no language restriction. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing single-agent chemotherapy (fluoropyrimidine) versus the combination of chemotherapeutic agents (fluoropyrimidine more other agent including but not limited to oxaliplatin) during the pre-operative treatment in patients with rectal unresectable cancer . Collection and analysis of data: Two reviewers (HMR, EMKS) independently extracted data and assessed the quality of RCT. When necessary we request additional information and clarifications to the authors about the published data. Main results: Four RCTs were included totaling 3875 patients with resectable rectal cancer. RCTs were classified between low to moderate risk of bias. In the preoperative period the participants of these RCTs were randomized to receive chemotherapy and radiotherapy both with fluoropyrimidine or a combination of agents (fluoropyrimidine and a second agent). The only study that has reported data of overall survival and progression-free found no differences between the groups compared. For complete pathological response (ypCR) there was a statistically significant difference favoring the experimental group OR = 1.23 (95% CI: 1:04, 1:46), but there were also significantly more acute toxicity in this arm OR = 2.07 (95% CI: 1.31, 3.27). The control group had greater adherence to treatment radiotherapy and chemotherapy, OR = 0:32 (95% CI: 12:14, 0.75) and OR = 0:24 (95% CI: 0.07 to 0.77), respectively. There was no difference between groups with respect to mortality within 60 days, postoperative morbidity, resection margin, abdominal-perineal resection and Hartmann procedure. AUTHORS 'CONCLUSIONS: There is low quality evidence that patients with resectable rectal cancer who receive combination chemotherapy agents preoperatively have no benefit in overall survival and progression-free. There is high quality evidence that combination of chemotherapeutic agents with oxaliplatin can improve local tumor control in these patients, but the regime also cause greater toxicity. Therefore the existing evidence to date does not support the use of oxaliplatin in this context. The publications of more progress in studies of survival data will contribute to further analysis.
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    Alterações morfológicas dentais analisadas por meio de radiografias panorâmicas em crianças portadoras de câncer após tratamento por quimioterapia e/ou radioterapia
    (Universidade Federal de São Paulo (UNIFESP), 2005) Lopes, Nilza Nelly Fontana [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]
    Objetivo: Avaliar, por meio de radiografia panorâmica, a prevalência das alterações morfológicas dentais em crianças portadoras de câncer que foram submetidas à quimioterapia isolada e/ou quimioterapia mais radioterapia. Métodos: pacientes com câncer matriculados no 10P-GRAACC-UNIFESP/EPM, no período de março de 1996 a fevereiro de 2004, foram admitidos neste estudo retroprospectivo, não randomizado, uninstitucional. Neste período, radiografias de 310 pacientes foram solicitadas e 183 pacientes preencheram os critérios de elegibilidade. Foi avaliada a freqüência radiográfica de microdontia, taurodontia, anodontia, macrodontia, raiz rombuda e raiz atilada. Resultados: 137 (74,9 por cento) pacientes foram considerados avaliáveis e 46 (25,1 por cento) não avaliáveis. Os pacientes avaliáveis foram distribuídos em dois grupos: o de neoplasias linfoproliferativas (60,6 por cento) e o de portadores de tumores sólidos (39,4 por cento). Quanto ao sexo, 79 eram do sexo feminino e 58, do masculino. A idade média, ao início do tratamento, foi de 5 anos e seis meses. Foram encontradas anomalidades dentais em 39 (28,5 por cento) pacientes e em 98 (71,5 por cento) não se encontrou nenhuma anomalidade. As anomalidades encontradas foram: microdontia 7,3 por cento (n=10); anodontia 5,8 por cento (n=8); taurodondia 13,9 por cento (n=19); macrodontia 5,1 por cento (n=7); raiz rombuda 1,5 por cento (n=2) e raiz afilada 3,6 por cento (n=5). Destes pacientes, 21,9 por cento (n=30) tinham uma alteração; 4,4 por cento (n=6), duas alterações e 2,2 por cento (n=3), três alterações. Conclusão: a taurodontia foi a alteração mais freqüente nas crianças e adolescentes que receberam tratamento antineoplásico, sendo suas taxas significativamente superiores às da população saudável. As alterações dentais reforçam a necessidade de o odontólogo pesquisar, sistematicamente, estas alterações neste grupo especial de paciente.
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    Alterações Orais Tardias em Pacientes Submetidos a Radioterapia e/ou Quimioterapia em Cabeça e Pescoço
    (Universidade Federal de São Paulo (UNIFESP), 2011-02-22) Deboni, Aline Lima da Silva [UNIFESP]; Segreto, Helena Regina Comodo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To assess the late oral complications (LOC) in non surgical head and neck cancer (HNC) patients, submitted to radiotherapy (RT) with or without chemotherapy (chemo). Materials and Methods: The average follow-up for HNC patients was 17.1 months. Five hundred fifteen charts from patients treated for HNC between 2005 and 2009 were reviewed and 41 non surgical HNC patients met the inclusion criteria. Salivary glands function was assessed using a simplified new grading system (NGSX) (Esibruch et al. 2003) and sialometry. Late effects were assessed using the Common Toxicity Criteria (CTC) - Radiotherapy and Oncology Group /European Organization for Research and Treatment of Cancer (RTOG/EORTC) - Late Radiation Morbidity Scale. Data were submitted to statistical analysis. Results: There was a predominance of mild LOC complications among the variables studied. A statistical correlation was found for both unstimulated/stimulated salivary flow rates and the average CTC – RTOG/EORTC grades for the mucous membrane. The low salivary flow rates (<0.03 mL/min e <0.09 mL/min) were identified as a potential risk factor (p <0.005) and an independent predictor for mucous membrane toxicity (for ≥2 grades). A significant correlation was also found between objective NGSX scores (p = 0.001) and CTC – RTOG/EORTC grades for salivary glands. Eighty five percent of the patients were classified as suffered from hyposalivation as well as 58,7% considered the dryness in the mouth the most debilitating complication. Conclusions: Considering the late effects assessed, the majority of patients presented mild graduation (0 and 1) according to CTC – RTOG/EORTC criteria; the demographic, tumor and treatment variables were not statistically significant for the development and severity of late oral complication; the salivary hipofunction increased from 4.3 to 8.3 times the RR for the occurrence of severe late mucosal reaction; xerostomia was considered the most debilitating complication after treatment. Data show the role of salivary hypofunction as an independet predictor for the severity of late mucous membrane complication.
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    Análise comparativa dos histogramas de dose e volume entre planejamentos tridimensionais conformados e convencionais não conformados na radioterapia do câncer de próstata
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2009-04-01) Feitosa, Sílvia Moreira [UNIFESP]; Giordani, Adelmo José [UNIFESP]; Dias, Rodrigo Souza [UNIFESP]; Segreto, Helena Regina Comodo [UNIFESP]; Segreto, Roberto Araujo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: The present study was aimed at comparing conformal and non-conformal radiotherapy plans designed for patients with prostate cancer, by analyzing radiation doses in target volumes and organs at risk. MATERIALS AND METHODS: Radiotherapy plans for 40 patients with prostate cancer were analyzed. Conformal, conformal isocentric and non-conformal plans utilizing the source-surface distance were simulated for each of the patients for comparison of radiation dose in target volumes and organs at risk. For comparison purposes, dose-volume histograms for target volumes and organs at risk were analyzed. RESULTS: Median doses were significantly lower in the conformal planning, with 25%, 40% and 60% volumes in the rectum and 30% and 60% in the bladder. The median doses were significantly lower in the conformal planning analyzing the right and left coxofemoral joints. Maximum, mean and median doses in the clinical target volume and in the planned target volume were significantly higher in the conformal planning. CONCLUSION: The present study has demonstrated that the conformal radiotherapy planning for prostate cancer allows the delivery of higher doses to the target volume and lower doses to adjacent healthy tissues.
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    Analise histopatlogica e imunohistoquimica (antigeno nuclear de prolideracao celular) de pacientes com carcinoma cervical invasor antes e pos radioterapia e cirurgia
    (Universidade Federal de São Paulo (UNIFESP), 1999) Rosal, Marta Alves [UNIFESP]
    E comum a combinacao de radioterapia e cirurgia no tratamento do cancer do colo uterino. No entanto,, ha controversias quanto aos resultados da associacao de radioterapia pre-operatoria e cirurgia. No presente estudo realizou-se estudo histopatologico e imuno-histoquimico (PCNA) em 16 casos de carcinoma espinocelular nos estadios E3 a III]31, tratados com irradiacao pre-operatoria e cirurgia. Procedeu-se a revisao histopatologica dos especimes obtidos das biopsias previas a radioterapia, e de todas as pecas cirurgicas. O exame imuno-histoquimico para verificar a expressao do antigeno nuclear de proliferacao celular (PCNA) foi processado no material de todas as biopsias e nas pecas cirurgicas com neoplasia residual. Utilizou-se o anticorpo primario monoclonal anti-PCNA [Mouse x PCNA (PCIO)-DAKO-M 0879, lote 016 92011. A analise histopatologica , das pecas de histerectomia apos a radioterapia revelou presenca de neoplasia residual em, 50 por cento dos casos, sendo 25 por cento em pacientes tratadas com dose total, de radioterapia e 25 por cento em mulheres com dose parcial. Em 18,75 por cento dos casos houve completa remissao do tumor apenas com dose parcial. O valor medio do PCNA anterior a radioterapia nos casos com persistencia tunoral foi de 61,56 por cento e, nos casos sem neoplasia residual, de 60 por cento. A sua expressao antes da radioterapia esteve entre 27,91 por cento e 89,93 por cento (media de 60 por cento) e apos a radioterapia entre 55,8 por cento e 86,73 por cento (media de 74 por cento). Com uma casuistica maior e mais homogenea sera possivel, em futuros estudos, melhor entendimento da resposta do tumor a radioterapia,, e assim, elevar os indices de sobrevida e controle local da doenca
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    Análise histopatológica e imuno-histoquímica (antígeno nuclear de proliferação celular) de pacientes com carcinoma cervical invasor antes e após radioterapia e cirurgia
    (Associação Médica Brasileira, 2002-03-01) Rosal, Marta Alves [UNIFESP]; Goncalves, Wagner Jose [UNIFESP]; Alves, Maria Teresa de Seixas [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Lima, Geraldo Rodrigues de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To search for residual disease and to analyse the Proliferating Cellular Nuclear Antigen (PCNA) status, in patients with cervical squamous cell carcinoma, treated with both radiotherapy and surgery. METHODS: Histological slides from 16 patients with uterine cervix cancer, treated between April 1986 and August 1998, with preoperative radiotherapy and surgery, were reviewed. PCNA imunohistochemical reactivity of these samples was evalued, using the IMAGELAB 2.3 computer image analysis system. RESULTS: Residual carcinoma were found in eight cases (50%) and no malignant features was found in eight cases (50%). The mean value of PCNA before radiotherapy in patients with residual cancer was 61.56% and in cases without residual cancer was 60%. Its expression before radiotherapy was between 27.91% and 89.93% (60% average), while after radiotherapy it varied between 55.80% and 86.73% (74% average). CONCLUSIONS: The association between preoperative radiotherapy followed by surgery is adequated to treat patients with cervical cancer, when radical treatment is not possible. Meanwhile, exclusive radiotherapy shows a significant failure rate, detected after surgery and PCNA analysis.
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    Aspectos morfologicos e morfometricos dos raios beta em feridas provocadas na pele de ratos
    (Universidade Federal de São Paulo (UNIFESP), 1992) Silvado, Rubens Augusto Brasil [UNIFESP]
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    Avaliação da reprodutibilidade do posicionamento de pacientes submetidos à radioterapia utilizando-se o planejamento digital, e o filme radiológico em procedimentos específicos utilizados na rotina
    (Universidade Federal de São Paulo (UNIFESP), 2007) Giordani, Adelmo José [UNIFESP]; Segreto, Helena Regina Comodo [UNIFESP]
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    Avaliação da resposta bioquímica no câncer inicial de próstata: experiência uninstitucional comparando teleterapia exclusiva ou associada à braquiterapia de alta taxa de dose
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2004-08-01) Castro, Douglas Guedes De; Pellizzon, Antônio Cássio Assis; Chen, Michael Jenwei; Nishimoto, Inês Nobuko; Maia, Maria Aparecida Conte; Novaes, Paulo Eduardo Ribeiro Dos Santos; Fogaroli, Ricardo César; Ferrigno, Robson; Salvajoli, João Victor [UNIFESP]; Hospital do Câncer A.C. Camargo Departamento de Radioterapia; Universidade de São Paulo (USP); Hospital do Câncer A.C. Camargo Centro de Estudos; Universidade Metodista de Santos Faculdade de Medicina; Hospital do Câncer A.C. Camargo; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina de Marília
    OBJECTIVE: To compare the biochemical response in patients with locally advanced prostate cancer treated with external beam radiation therapy alone or in combination with conformal brachytherapy boost. MATERIALS AND METHODS: From November 1997 to January 2000, 74 patients received 45 Gy of pelvic external irradiation and four were treated with high dose rate iridium-192 conformal boost implants of 4 Gy each (BT). These were compared with 29 other patients treated with 45 Gy of pelvic external irradiation followed by a 24 Gy of bilateral ARC boost (RT) from October 1996 to February 2000. Some patients received neoadjuvant androgen deprivation therapy. Three-year actuarial biochemical control rates (BC3) and pretreatment biochemical response predictors such as prostate-specific antigen pretreatment (PSAi), Gleason score (GS) and clinical stage (CS), were evaluated. RESULTS: Median follow-up was of 25 months for the RT group and 37 months for the BT group. BC3 was 51% versus 73% (p = 0.032) for RT and BT, respectively. Comparisons of biochemical control by treatment group stratified by PSAi showed that BC3 for RT versus BT was 85.7% versus 79.1% (p = 0.76) for PSAi < 10 ng/mL and 38% versus 68% (p = 0.023) for PSAi > 10 ng/mL, respectively. For patients with GS < 6, BC3 was 37% versus 80% (p = 0.001) for RT versus BT and, for patients with GS > 6, BC3 was 78% versus 55% (p = 0.58) for RT versus BT, respectively. For patients with CS < T2a, BC3 was 36% versus 74% (p = 0.018) for RT versus BT and, for patients with CS > T2a, BC3 was 73% versus 69% (p = 0.692) for RT versus BT, respectively. The relative risk of biochemical relapse was 2.3 (95% IC: 1.0-5.1) for patients in RT group compared to the BT group. When adjusted for PSAi and GS, the relative risk of biochemical relapse was 2.4 (95% IC: 1.0-5.7). CONCLUSION: The treatment modality was an independent prognostic factor for biochemical relapse, with a significant improvement in the biochemical control with BT. These early results suggest that this treatment was most beneficial in patients with PSAi > 10 ng/mL, CS < T2a and GS < 6.
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    Avaliação da vitalidade pulpar em pacientes com rabdomiossarcoma ou carcinoma de rinofaringe, que receberam radioterapia para controle local da neoplasia
    (Universidade Federal de São Paulo (UNIFESP), 2021) Lopes, Rafael Paiva [UNIFESP]; Caran, Eliana Maria Monteiro [UNIFESP]; Universidade Federal de São Paulo
    With the advancement of technology and scientific development, the survival of children undergoing cancer treatment has increased significantly. However, treatment sequelae can manifest even y ears after the end of therapy. Objective: To evaluate the dental pulp vitality of patients with head and neck parameningeal rhabdomyosarcoma and rhinopharyngeal carcinoma who received radiotherapy for local control of the neoplasia. Methodology: Fifteen pa tients were admitted to the study group and thirty patients to the control group. A total of 494 anterior teeth were analyzed. To assess the pulp vitality, use the pulse oximeter apparatus adapted for dental use (which has a sensor "Y"), it being possible to position the buccal and lingual or tongue of the dental element. The pulp sensitivity test was performed by cooling the dental surface, using the refrigerant gas applied with cotton swab to the tooth surface. Results: Student's t test (alpha = 0.05) was used to analyze the mean% SpO2 of the teeth of the study (N = 158) and control (N = 336) groups. The average oxygen saturation obtained in the teeth of the study group was 86.06%, and 90.05% in the control group. Demonstrating a statistically significant difference between groups (p <0.0001). Pearson's correlation test with 0.05 alpha adjustment was used to assess the correlation between the results obtained with pulse oximetry and the degree of sensitivity. The results demonstrate a negative correlation (r = 0.8525; p <0.0001) between the mean% SpO2 and the degree of sensitivity reported by the patients. Conclusions: The levels of pulp oxygenation saturation in irradiated patients were lower when compared to the control group. There seems to be a relatio nship between pulp oxygenation and tooth sensitivity. The lower the oxygen rate, the greater the sensitivity.
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    Avaliação das reações agudas da pele e seus fatores de risco em pacientes com câncer de mama submetidas a radioterapia
    (Universidade Federal de São Paulo (UNIFESP), 2007) Pires, Ana Maria Teixeira [UNIFESP]; Segreto, Helena Regina Comodo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivos: avaliar e classificar as reações de pele segundo os critérios Radiation Therapy Oncology Group (RTOG) e caracterizar fatores que possam interferir nessas reações (incidência e/ou gravidade da reação de pele). Métodos: estudo prospectivo, com 86 mulheres com câncer de mama operadas, estadios iniciais, submetidas à radioterapia adjuvante na Universidade Federal de São Paulo e no Hospital Alemão Oswaldo Cruz. A radioterapia foi realizada em região da mama, campos tangentes e paralelos opostos, dose total de 5040 cGy (180 cGy dose/dia), com Acelerador Linear de 6 MV. Os dados foram coletados conforme instrumento de avaliação e TCLE assinado. Além dos dados pessoais, foi medido o tamanho da mama, a partir do desenho do contorno da mesma. Mediu-se a distância entre a separação dos campos e a altura da mama. A avaliação da pele da área de tratamento foi realizada semanalmente e as reações foram classificadas a partir do RTOG. Resultados: a medida da altura da mama e a técnica de tratamento foram significantes na análise univariada, para incidência de reação de pele grau 3. Porém, apenas a altura da mama foi fator significante na análise multivariada para a gravidade da reação de pele. Observamos que a chance de ocorrer reação grau 3 aumenta 2,61 vezes à cada aumento de 1 unidade da altura (cm). Estes achados permitem ao enfermeiro programar condutas mais adequadas e individualizadas para cada paciente e contribuir para a otimização do tratamento. Conclusão: Quanto maior a altura da mama, a chance da ocorrência de reação de pele grau 3 é significantemente maior.
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    Avaliação do perfil de expressão de microRNAs como marcadores prognósticos em tumores iniciais de laringe tratados com radioterapia exclusiva.
    (Universidade Federal de São Paulo (UNIFESP), 2013) Maia, Danielle Calheiros Campelo [UNIFESP]; Vettore, André Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    O cancer de laringe estagio clinico inicial apresenta indices de cura acima de 80% com radioterapia exclusiva. Entretanto, quando estes tumores recorrem, a cirurgia de resgate e a principal opcao de tratamento, sendo que cerca de 50% dos casos necessitarao de laringectomia total. A identificacao de marcadores que possam predizer as chances de sucesso com a radioterapia reduzindo as recaidas tumorais e reduzindo a necessidade de resgates cirurgicos que afetam a fonacao e impactam negativamente na qualidade de vida e de suma importancia para o tratamento destes pacientes. Neste cenario, o objetivo deste estudo foi identificar microRNAs que possam segregar tumores radiorresistentes dos radiossensiveis, prognosticar os tumores pre-tratamento e predizer falha ao tratamento radioterapico exclusivo para os carcinomas de celulas escamosas estadio clinico I e II primarios de laringe. Para isto, analisamos o perfil de expressao de 667 microRNAs utilizando-se o Taqman low density array (TLDA). Desta forma, cinco microRNAs foram selecionados (miR-296, miR-452, miR-183*, miR-16*, miR-200c) com base na diferenca de expressao e revisao de literatura para terem sua expressao avaliada em amostras de carcinoma de celulas escamosas de laringe em 34 pacientes, 20 radiorresistentes e 14 radiossensiveis, por qRT-PCR. O miR-296 apresentou uma distribuicao diferencial entre os grupos radiorresistente e radiossensivel estatisticamente significante (p=0,002), tendo associando-se com radiorresistencia (p= 0,01) com um odds-ratio de 8,556 e intervalo de confianca variando entre 1,7 e 42,2
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    Avaliação Dos Marcadores Hematológicos Como Possíveis Fatores Prognósticos No Câncer De Cabeça E Pescoço
    (Universidade Federal de São Paulo (UNIFESP), 2018-05-31) Padua, Tiago Costa De [UNIFESP]; Baiocchi, Otavio Cesar Carvalho Guimaraes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Valor Prognóstico Dos Marcadores Hematológicos Em Cabeça E Pescoço Escamoso Carcinoma De Células: Experiência De Um Hospital Público Brasileiro Finalidade / Objetivo (S): O Objetivo De Nosso Estudo Foi Investigar A Papel Prognóstico Potencial De Marcadores Hematológicos Pré-Tratamento, Neutrófilos A Rácio Linfocitário (Nlr) E Relação Plaqueta / Linfócitos (Plr), Em Doentes Com Carcinoma Espinocelular De Cabeça E Pescoço (Hnscc) Tratado Com Quimiorradioterapia (Crt). Materiais / Métodos: Analisamos Retrospectivamente Prontuários De 52 Pacientes Com Diagnóstico De Cec De Cabeça E Pescoço E Tratados Com Trc Definitiva Em Nosso Instituição. Pré-Tratamento Nlr E Plr ""Foram Calculados Retrospectivamente E Investigado Para Correlação Com A Sobrevivência Global (Os) Usando O Kaplan-Meier Método. A Análise Univariada Para Variáveis ""Categóricas E Descritivas Também Foi Realizado. Resultados: Na População Geral, A Mediana Do Os (Mos) Foi De 28 Meses. Em Análise Univariada, Estágio Tumoral (T2 Vs T4a- T4b), Estágio No
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    Causas de interrupção não-programadas da radioterapia
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2008-04-01) Diegues, Sylvia Suelotto; Ciconelli, Rozana Mesquita [UNIFESP]; Segreto, Roberto Araujo [UNIFESP]; Hospital Alemão Oswaldo Cruz; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate the occurrence and causes of unplanned interruption of radiotherapy. MATERIALS AND METHODS: Retrospective study developed in the Division of Radiotherapy of Hospital Alemão Oswaldo Cruz in São Paulo, SP, Brazil, with data collected from 560 dossiers of patients submitted to radiotherapy in the period between January 1, 2005 and December 31, 2005. Chi-squared and Student t tests were utilized in the data analysis, and p < 0.05 was considered as statistically significant. RESULTS: Interruption of treatment was identified in 350 cases, corresponding to 62.5% of the patients. The reasons for treatment interruption were the following: preventive device maintenance (55%), patient's own private reasons (13%), adverse reactions to the treatment or to combined radiotherapy/chemotherapy (6%), clinical worsening (3%), two or more combined reasons (23%). The interruption time interval ranged between 1 and 24 days (mean 1.4 day). One-day interruption was mostly due to preventive device maintenance (84.4%); two-five-day interruption was due to combined reasons (48.28%). CONCLUSION: The most frequent cause of interruption was preventive device maintenance, with maximum two-day time interval.
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    Comportamento do tecido ósseo medular após radioterapia utilizando implantes de superfície tratada
    (Universidade Federal de São Paulo (UNIFESP), 2013) Mandia Junior, Jose [UNIFESP]; Abrahão, Marcio [UNIFESP] ; : http://lattes.cnpq.br/4440305851848835; http://lattes.cnpq.br/2663251175282655; Universidade Federal de São Paulo (UNIFESP)
    Neste trabalho procuramos observar o efeito da radiacao no processo de reparacao do tecido osseo medular nas espirais de implantes com superficie tratada. Para este estudo foram utilizados 24 ratos. A tibia direita de todos os animais foi irradiada (grupo irradiado) com dose unica de 30Gy, e a tibia esquerda nao recebeu irradiacao (grupo controle). Apos o periodo de trinta dias todos os animais receberam implantes, sendo superficie torneada (controle) em 12 animais e tratada nos outros 12. Os animais foram sacrificados apos os periodos de 28 e 84 dias (seis de cada grupo por periodo) e foi realizada a analise histomorfometrica do contato osso/implante na cavidade medular. A analise estatistica demonstrou que nao houve diferenca estatisticamente significante do contato osso/implante para implantes de superficie torneada e tratada na cavidade medular. O percentual de contato osso/implante foi estatisticamente significante em relacao ao tempo, sendo mais elevado para o periodo de 84 dias, assim como para o fator irradiacao, sendo menor para o grupo irradiado (p<0,001). A analise dos resultados leva a concluir que a irradiacao realizada em um periodo de 30 dias antes da colocacao dos implantes, afeta a reparacao do tecido osseo medular independente da superficie do implante, sendo o tempo um fator importante para a reparacao do tecido (p=0,023).
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    Cordomas da base do crânio
    (Universidade Federal de São Paulo (UNIFESP), 1998) Borba, Luis Alencar Biurrum [UNIFESP]; Braga, Fernando Menezes [UNIFESP]
    Cordomas sao tumores raros, agressivos, de crescimento lento, os quais originam-se de restos da notocorda primitiva. Devido a sua localizacao e padrao de expansao, o tratamento destes tumores e considerado muito dificil. A sua raridade, faz com que poucos centros mundiais adquiram larga experiencia. Com isto, inumeras taticas e tecnicas sao preconizadas. Nesta dissertacao, analisamos todos os fatores envolvidos no diagnostico e manejo dos cordomas da base do cranio, assim como as varias abordagens cirurgicas utilizadas para remocao cirurgica radical do tumor. O papel da radioterapia em suas mais variadas modalidades serao discutidas, quanto a sua indicacao, resultados e complicacoes. A analise critica da literatura permite-nos concluir que com o advento da cirurgia da base do cranio e modernas modalidades radioterapicas, com o emprego de particulas pesadas, lesoes consideradas incontrolaveis, hoje podem ser tratadas com uma mortalidade e morbidade baixa. No entanto, outros fatores, tais como o comportamento imprevisivel de certos cordomas, faz com que em certas situacoes o prognostico nao possa ser feita baseada somente nos achados anatomopatologicos, amplitude da resseccao e terapia complementar
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    Acesso aberto (Open Access)
    Craniofaringioma na infância e adolescência: repercussões endócrino-metabólicas
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-07) Hernandez, Patricia Debora Cavalcanti Tosta [UNIFESP]; Castro, Angela Maria Spinola e [UNIFESP]; Siviero-Miachon, Adriana Aparecida [UNIFESP]; http://lattes.cnpq.br/2051040617850849; http://lattes.cnpq.br/8489881363515207; http://lattes.cnpq.br/2615946074156109; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the clinical and anthropometric characteristics and adiposity indexes of patients with craniopharyngioma and to correlate these parameters with the type of treatment performed, growth hormone deficiency (GHD), recombinant human growth hormone (rhGH) replacement therapy and adiposity at diagnosis. To analyze the risk factors associated with the evolution of obesity from diagnosis to the present moment. Methods: Fifty seven patients treated for craniopharyngioma underwent transversal evaluation (MAE) and survival analysis. Clinical characteristics, hormone replacement, type of treatment, anthropometric variables (Z score of weight and stature, at diagnosis and in MAE), adiposity indexes (Z BMI category at diagnosis and in MAE - overweight or obesity, percentage body fat (%BF), visceral and subcutaneous adipose tissue - VAT and SAT), criteria for metabolic syndrome (MS) were analysed by multiple regression and logistic models. The sample was divided according to GHD and rhGH replacement therapy: GHD with growth without GH, GHD using rhGH in MAE, GHD with prior rhGH use, GHD in programation of use rhGH and non-GHD. Survival analysis assessed the worsening of the Z BMI category according to adiposity indexes at diagnosis, treatment and rhGH replacement. Results: The medium age at diagnosis was 9.6 years-old and in MAE 16.6, 61.4% men. Surgery and radiotherapy (RT) was the most frequent combination of treatment (24/57; 42.1%) were treated with and 54/57 (94.7%) received at least two hormone replacements. Twenty-six of the 57 patients (45.6%) presented GHD with growth without GH. In the survival analysis, median time to worsening Z BMI category was 3.2 years after first treatment, with patients receiving both RT and α-interferon taking longer to worsen. Z BMI worsened equaly over time, regardless of the category at diagnosis. There was no influence of Z stature on Z BMI. The Z BMI at diagnosis worsened the Z BMI in the MAE (p=0.005). %BF was higher in patients with higher Z BMI at diagnosis (p <0.001) and %BF and VAT were lower in patients using rhGH in MAE (p <0.05). Obese patients at diagnosis presented more alteration in waist circumference (WC) (p=0.019) and more occurrence of MS (p=0.031). Conclusions: Patients with craniopharyngioma worsened the category of Z BMI with a median of 3.2 years after the first treatment. Regarding treatment, Z BMI category worsened less with α-interferon and RT use. Regardless of Z BMI category at diagnosis, there was an increase in Z BMI due to real weight gain, without height loss. The higher Z BMI at diagnosis, the higher the Z BMI and the %BF at the MAE. Replacement of rhGH at MAE had a beneficial effect on adiposity, decreasing %BF and VAT.
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    Somente Metadadados
    Desenvolvimento de API gráfico para processamento de imagens e script para segmentação automática da cabeça femoral em ambiente eclipse®
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-10) Silva, Bruno Assumpcao Gomes Da [UNIFESP]; Paixao, Fabiano Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Cancer is the second leading cause of death globally behind cardiovascular disease, approximately 18.1 million new causes and 9.4 million deaths related in 2018. Treatment against cancer is chosen by a medical team according cancer type, affected organs, and disease stage, and it is usually composed by association between surgery, chemotherapy, and radiotherapy. Radiotherapy employs ionizing radiation, produced by linear accelerators or radioactive material seeds, aiming to kill patient’s carcinogenic cells or slows their growth by damaging their DNA. The radiation oncologist must delineate target volume and organs-at-risk to deliver a high dose on the diseased tissue while missing dose to surrounding healthy structures, maximizing the effects of the treatment and minimizing side effects. Accurate delineation of volumes is a crucial step in radiotherapy treatment, however, it is the most time-consuming task for clinicians. Several authors proposed automatic segmentation methods for those structures, although manual contouring still remain the gold-standard method among the experts. Objective: The goal of this work is to develop an auto-segmentation algorithm of the femoral head to be used by radiation oncologists within a scripting tool inside Eclipse® Treatment Planning System, software developed by Varian® for radiotherapy treatments. Methodology: A software composed by a set of routines, protocols and tools, developed in C# as a platform entirely visual for image segmentation without the need of compiling numerous algorithms individually was developed. The developed script was successful characterized using pelvic CT scan in eleven prostate patients from Sao Paulo Hospital database (n=5) and AC Camargo Cancer Center (n=6). The automatic delineation was compared with manual delineation through blind test assessed by a panel of senior oncologists (n=9) from both hospitals and quantitative measurement was obtained through similarity delineation analysis using Dice Similarity Coefficient (DSC) for three distinct femoral head parts (lesser trochanter, femoral neck, and femoral head). Results: Specialists considered that none correction was needed at 77.8% of manual delineation and 67.8% of automatic delineation. Similarity of 0.94 ± 0,07 was achieved between manual and automatic for lesser trochanter, 0.91 ± 0.07 for femoral neck and 0.86 ± 0.08 for femoral head. The results showed that the automatic delineation was reproductible in all patients and its performance was similar to manual delineation done by their own specialists. Conclusion: In conclusion, the developed script is capable of reduce the contouring time in femoral head (only 1.3 ± 0.1 seconds each patient) and shows great potential to be applied in automatic segmentation of pelvic organs-at-risk as well as other anatomical regions.
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    Acesso aberto (Open Access)
    Efeito da oxigenação hiperbárica nas lesões imediatas provocadas pela radiação ionizante, no íleo de camundongos
    (Universidade Federal de São Paulo (UNIFESP), 2005) Carvalho, Adriana Ivete Cornita de [UNIFESP]; Gomes, Paulo de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJETIVO:Avaliar os efeitos da OHB em células caliciformes de íleo de camundongos após a exposição à radiação ionizante. MÉTODO: Foram utilizados 35 camundongos machos da linhagem C57BL, randomizados e distribuídos em quatro grupos: Grupo I, Controle (GC): 5 animais não irradiados ,submetidos à observação por 24hs, seguidos de eutanásia e ressecção de um segmento de 2cm do íleo terminal. Grupo II, Irradiado (GRT): 10 animais submetidos a uma sessão de radioterapia com dose única de 5Gy e após 24hs de observação foram submetidos à de eutanásia e ressecção de um segmento de 2cm do íleo terminal. Grupo III, Irradiado/ Oxigenação hiperbárica (GRT/OHB): 10 animais submetidos a uma sessão de radioterapia com dose única de 5Gy, após 24hs foram expostos a cinco sessões diárias de 90’ de OHB, foram submetidos à eutanásia no 7°dia após a sessão de radioterapia, seguido de ressecção de um segmento de 2 cm do íleo terminal. Grupo IV, Irradiado/ Sem Oxigenação hiperbárica (GRT/SOHB): 10 animais submetidos a uma sessão de radioterapia com dose única de 5 Gy e no 7° dia após a sessão radioterápica foram submetidos a eutanásia e ressecção de um segmento de 2 cm do íleo terminal. Foram avaliadas as células caliciformes.Os testes estatísticos utilizados foram, análise de variância de Kruskal-Wallis e teste de Mann-Whitney, com p ≤ 0,05 . RESULTADOS: Ao comparar o número de células encontrados, pode-se observar que o Grupo IV >I >II > III, sendo que não existe diferença entre o grupo I e III. A média de células caliciformes encontradas nos grupos foram GI 6,21; GII 5,01; GIII 6,09; GIV 16,06. Os estudos demonstraram que o grupo IV apresentou uma hiperplasia das células caliciformes (p ≤ 0,05). CONCLUSÃO: A exposição às radiações ionizantes provoca hiperplasia das células caliciformes. A oxigenação hiperbárica diminui as alterações encontradas nas células caliciformes do íleo de camundongos submetidos à radioterapia.
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    Acesso aberto (Open Access)
    Efeito do intervalo para início da radioterapia em pacientes com glioblastoma
    (Universidade Federal de São Paulo (UNIFESP), 2017-08-22) Loureiro, Luiz Victor Maia [UNIFESP]; Malheiros, Suzana Maria Fleury [UNIFESP]; http://lattes.cnpq.br/9037639757788410; http://lattes.cnpq.br/8995517859449263; Universidade Federal de São Paulo (UNIFESP)
    Objective: to evaluate the effect of waiting time between the neurosurgical intervention and the starting of radiotherapy on overall survival of Glioblastoma patients as an independent prognostic variable. Methods: two different methods were applied: 1) cohort study; 2) systematic review and meta-analysis. Cohort of 115 Glioblastoma patients from two different health-care institutions (one public and one private) who underwent post-operative radiotherapy. A systematic review of studies published between 1975 and 2015 reporting on the waiting time to radiotherapy for Glioblastoma patients who underwent a neurosurgical procedure. The meta-analysis was performed by converting the waiting time to radiotherapy studies intervals into a regression coefficient (β) and standard error expressing the effect size on overall survival per week of delay. Results: for the entire cohort the median waiting time to radiotherapy was 6 weeks (range, 1.3 – 17.6). The median overall survival for waiting time < 6 weeks was 13.5 months (95% CI, 9.1 – 17.9) and for those > 6 weeks was 14.2 months (95% CI, 11.2 – 17.2) (HR 1.16, 95% CI 0.77 – 1.76; p = 0.47). The waiting time to radiotherapy had no significant effect on overall survival even when compared to well- known prognostic variables (HR 1.32, 95% CI, 0.73 – 2.39; p = 0.35). Data required to calculate the effect size on overall survival were available for 14 studies retrieved for systematic review, including 5,429 patients. The combined analysis showed a median waiting time to radiotherapy of 37 days (ranges, 1 – 232) and provided no evidence for an association between waiting time to radiotherapy, per week of delay, and overall survival (HR 0.98, 95% CI, 0.89 – 1.07; p = 0.61). Conclusions: the waiting time to radiotherapy was not an independent prognostic variable for overall survival of Glioblastoma patients and had no significant effect on overall survival even when compared to well-known prognostic variables. The meta-analysis provided no evidence of a true effect on overall survival by delaying radiotherapy.