Adding external beam to intra-luminal brachytherapy improves palliation in obstructive squamous cell oesophageal cancer: A prospective multi-centre randomized trial of the International Atomic Energy Agency
Rosenblatt E.,International Atomic Energy Agency |
Jones G.,Peel Regional Oncology Program |
Sur R.K.,McMaster University |
Sur R.K.,Juravinski Cancer Center |
And 7 more authors.
Radiotherapy and Oncology | Year: 2010
Background: Whether the combination of high dose-rate brachytherapy (HDRBT) and External Beam Radiation Therapy (EBRT) is superior to HDRBT alone for the palliation of oesophageal cancer has only been explored in a previous IAEA pilot randomized trial. Methods: Two hundred and nineteen patients were randomized to adding EBRT or not, after receiving two fractions of HDRBT within 1 week. Each HDRBT consisted of 8 Gy prescribed at 1 cm from source centre. Patients randomized to EBRT received 30 Gy in 10 fractions. The primary outcome was dysphagia-relief experience (DRE). Additional outcomes included various scores, performance status, weight and adverse events. A majority of charts, imaging and radiotherapy plans were externally audited. Results: Median follow-up was 197 days, with a median OS of 188 days and an 18% survival rate at 1 year. DRE was significantly improved with combined therapy, for an absolute benefit of +18% at 200 days from randomization (p = 0.019). In longitudinal regression analyses, scores for dysphagia (p = 0.00005), odynophagia (p = 0.006), regurgitation (p = 0.00005), chest pain (p = 0.0038) and performance status (p = 0.0015) were all significantly improved. In contrast, weight, toxicities and overall survival were not different between study arms. Conclusion: Symptom improvement occurs with the addition of EBRT to standard HDRBT. The combination is well tolerated and relatively safe. © 2010 Elsevier Ireland Ltd. All rights reserved.
Boing A.F.,Federal University of Santa Catarina |
Antunes J.L.F.,Federal University of Santa Catarina |
Antunes J.L.F.,University of Sao Paulo |
de Carvalho M.B.,Hospital Heliopolis |
And 6 more authors.
Journal of Epidemiology and Community Health | Year: 2011
Background A higher burden of head and neck cancer has been reported to affect deprived populations. This study assessed the association between socioeconomic status and head and neck cancer, aiming to explore how this association is related to differences of tobacco and alcohol consumption across socioeconomic strata. Methods We conducted a case-control study in São Paulo, Brazil (1998e2006), including 1017 incident cases of oral, pharyngeal and laryngeal cancer, and 951 sexand age-matched controls. Education and occupation were distal determinants in the hierarchical approach; cumulative exposure to tobacco and alcohol were proximal risk factors. Outcomes of the hierarchical model were compared with fully adjusted ORs. Results Individuals with lower education (OR 2.27; 95% CI 1.61 to 3.19) and those performing manual labour (OR 1.55; 95% CI 1.26 to 1.92) had a higher risk of disease. However, 54% of the association with lower education and 45% of the association with manual labour were explained by proximal lifestyle exposures, and socioeconomic status remained significantly associated with disease when adjusted for smoking and alcohol consumption.
Neto J.P.D.,Hospital Do Cancer AC Camargo |
Oliveira F.,Hospital Do Cancer AC Camargo |
Bertolli E.,Hospital Do Cancer AC Camargo |
Molina A.S.,Hospital do Cancer A.C. |
And 3 more authors.
Clinics | Year: 2012
OBJECTIVE: Isolated limb perfusion combined with melphalan is an accepted treatment for obtaining locoregional control in advanced melanoma of the extremities and other malignant neoplasias restricted to the limb. This study aims to examine the factors associated with toxicity caused by the regional method. We considered the technical aspects of severe complications associated with the procedure in an attempt to diminish the patient morbidity that occurs during the learning curve. METHODS: We conducted a retrospective analysis of the records of patients who underwent perfusion at the AC Camargo Hospital in São Paulo, Brazil between January 2000 and January 2009. The Wieberdink scale was applied to classify local toxicity and its relation to clinical and laboratory variables. RESULTS: Fifty-eight perfusions were performed in 55 patients. Most patients (86.2%) presented a toxicity level between I and III. Grade V toxicity was seen in five cases (8.6%), four of which occurred in the first 2 years. Creatine phosphokinase, an important predictive factor for toxicity, had an average value of 231.8 for toxicity grades I-III and 1286.2 for toxicity grades IV-V (p = 0.001). There was a relationship between the melphalan dose and toxicity, which was 77 mg (25 to 130 mg) for toxicity grades I-II and 93.5 mg (45 to 120 mg) for toxicity grades IV-V (p = 0.0204). CONCLUSION: It is possible to prevent the toxicity associated with melphalan by adjusting the dose according to the patient's body weight (especially for women and obese patients) and the creatine phosphokinase values in the postoperative period. © 2012 CLINICS.
Milani C.,University of Sao Paulo |
Welsh J.,University at Albany |
Katayama M.L.H.,University of Sao Paulo |
Lyra E.C.,Instituto Brasileiro Of Controle Do Cancer |
And 3 more authors.
Journal of Steroid Biochemistry and Molecular Biology | Year: 2010
While many studies have addressed the direct effects of 1α,25(OH)2D3 on breast cancer (BC) cells, stromal-epithelial interactions, which are important for the tumor development, have been largely ignored. In addition, high concentrations of the hormone, which cannot be attained in vivo, have been used. Our aim was to establish a more physiological breast cancer model, represented by BC tissue slices, which maintain epithelial-mesenchymal interactions, cultured with a relatively low 1α,25(OH)2D3 concentration, in order to evaluate the vitamin D pathway. Freshly excised human BC samples were sliced and cultured in complete culture media containing vehicle, 0.5nM or 100nM 1α,25(OH)2D3 for 24h. BC slices remained viable for at least 24h, as evaluated by preserved tissue morphology in hematoxylin and eosin (HE) stained sections and bromodeoxyuridine (BrdU) incorporation by 10% of tumor cells. VDR mRNA expression was detected in all samples and CYP24A1 mRNA expression was induced by 1α,25(OH)2D3 in both concentrations (but mainly with 100nM). Our results indicate that the vitamin D signaling pathway is functional in BC slices, a model which preserves stromal-epithelial interactions and mimics in vivo conditions. © 2010 Elsevier Ltd.
Duprat J.P.,Hospital Do Cancer AC Camargo |
Landman G.,Hospital AC Camargo Post Graduation |
Landman G.,Federal University of Sao Paulo |
Salvajoli J.V.,Instituto Do Cancer Do Estado Of Sao Paulo Octavio Frias Of Oliveira Icesp |
Brechtbuhl E.R.,Hospital Do Cancer AC Camargo
Clinics | Year: 2011
Merkel cell carcinoma is a very rare and aggressive neoplasm. Due to its rarity, therapeutic guidelines are not well established, especially for regionally advanced disease. Articles in English, French, Italian, Portuguese, and Spanish from the last 20 years were identified in MEDLINE and reviewed. The key word ''Merkel'' was used for the search, relevant articles were selected, and their references were examined. The most important articles related to epidemiology, genesis and treatment were reviewed. The incidence of Merkel cell carcinoma is increasing due to the advancing age of the population, higher rates of sun exposure and an increasing number of immunocompromised individuals. With regard to etiology, the recently described Merkel Cell polyomavirus is thought to play a role. Either local or regional surgical intervention remains the standard of care, but adjuvant radiotherapy or radiotherapy as a primary treatment have been discussed as reasonable therapeutic options. An update on this rare neoplasia is essential because of its increasing incidence and changing treatment options. Copyright © 2011 CLINICS.