INTRODUCTION: Radiation-associated angiosarcoma (RAAS) is a rare and serious complication of breast irradiation. Due to the rarity of the condition, clinical experience is limited and publications on this topic include only retrospective studies or case reports. MATERIALS AND METHODS: All patients diagnosed with RAAS between January 2000 and December 2017 in twelve centers across the Czech Republic and Slovakia were evaluated. RESULTS: Data of 53 patients were analyzed. The median age at diagnosis was 72 (range 44-89) years. The median latency period between irradiation and diagnosis of RAAS was 78 (range 36-172) months. The median radiation dose was 57.6 (range 34-66) Gy. The whole breast radiation therapy with radiation boost to the tumor bed was the most common radiotherapy regimen. Total mastectomy due to RAAS was performed in 43 patients (81%), radical excision in 8 (15%); 2 patients were not surgically treated due to unresectable disease. Adjuvant chemotherapy followed surgical therapy of RAAS in 18 patients, 3 patients underwent adjuvant radiotherapy. The local recurrence rate of RAAS was 43% and the median time from surgery to the onset of recurrence was 7.5 months (range 3-66 months). The 3-year survival rate was 56%, the 5-year survival rate was only 33%. 46% of patients died during the follow-up period. CONCLUSION: The present data demonstrate that RAAS is a rare condition with high local recurrence rate (43%) and mortality (the 5-year survival rate was 33%.). Early diagnosis of RAAS based on biopsy is crucial for treatment with radical intent. Surgery with negative margins constitutes the most important part of the therapy; the role of adjuvant chemotherapy and radiotherapy is still unclear.
- MeSH
- adjuvantní radioterapie * škodlivé účinky MeSH
- dospělí MeSH
- hemangiosarkom * radioterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- mastektomie MeSH
- nádory prsu * radioterapie MeSH
- nádory vyvolané zářením * epidemiologie MeSH
- následné studie MeSH
- retrospektivní studie MeSH
- segmentální mastektomie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Shear wave elastography (SWE) is a non-invasive diagnostic imaging technique that maps the elastic properties of tissues. This modality is being increasingly developed in other areas of medicine, offering a new type of high-quality ultrasound examination, since it increases specificity and thus improves diagnostic accuracy. This method is similar to manual palpation, showing the elastic properties of biological tissues and providing a kind of reconstruction of the internal structure of soft tissues based on measurement of the response to tissue compression. In ophthalmology, it already appears promising for diagnosis and in evaluating changes in extraocular muscles and orbital tissues in patients with endocrine orbitopathy. Shear wave elastography offers three main innovations: the quantitative aspect, dimensional resolution, and real-time imaging ability. Determination of the utilization rate of this method and its inclusion in the diagnosis of endocrine orbitopathy is still a question and the object of clinical studies currently under way.
BACKGROUND: The aim of this prospective study was to assess whether [18 F]fluorodeoxyglucose PET can be used to predict histopathological response early in the course of neoadjuvant chemotherapy in patients with adenocarcinoma of the oesophagus and oesophagogastric junction. METHODS: Following the PET response criteria in solid tumours (PERCIST 1.0) as a standardized method for semiquantitative assessment of metabolic response, FDG-PET/CT was performed before (PET1) and after (PET2) initiation of the first cycle of chemotherapy. The relative changes in the peak standardized uptake value (ΔSUL) and total lesion glycolysis (ΔTLG) between PET1 and PET2 were correlated with histopathological response, defined as less than 50 per cent viable tumour cells in the resection specimen. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value with the highest accuracy of histopathological response prediction. RESULTS: PET2 was performed a median of 16 (range 12-22) days after the start of chemotherapy. Some 27 of 90 patients who underwent surgery had a histopathological response. There was no association between the median ΔSUL or median ΔTLG and the histopathological response. A post hoc analysis in 47 patients with PET2 performed 16 days or less after the start of chemotherapy showed that ΔTLG, but not ΔSUL, was associated with the histopathological response (P = 0·009). The optimal cut-off value of ΔTLG was 66 per cent or more. CONCLUSION: FDG-PET/CT after the first cycle of chemotherapy does not predict histopathological response in patients with adenocarcinoma of the oesophagus and oesophagogastric junction.
- MeSH
- adenokarcinom diagnostické zobrazování farmakoterapie patologie chirurgie MeSH
- adjuvantní chemoterapie MeSH
- dospělí MeSH
- fluorodeoxyglukosa F18 * MeSH
- gastroezofageální junkce diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory jícnu diagnostické zobrazování farmakoterapie patologie chirurgie MeSH
- neoadjuvantní terapie MeSH
- PET/CT * MeSH
- prospektivní studie MeSH
- protinádorové látky terapeutické užití MeSH
- protokoly protinádorové kombinované chemoterapie terapeutické užití MeSH
- radiofarmaka * MeSH
- ROC křivka MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- multicentrická studie MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Patients with advanced renal cell carcinoma in routine clinical practice can differ considerably from those in phase III studies. PATIENTS AND METHODS: PREDICT (Patient characteristics in REnal cell carcinoma and Daily practICe Treatment with sorafenib) was a prospective, noninterventional study of open-label sorafenib for the treatment of advanced RCC conducted in 18 countries. Patient characteristics, therapy duration, tumor status, and tolerability were assessed at baseline and during routine follow-up. RESULTS: Overall, 2599 patients were evaluable for safety and 2311 for efficacy. The diverse population included patients with brain metastases (5%), non-clear-cell histologies (17%), high Memorial Sloan-Kettering Cancer Center risk score (11%), poor Eastern Cooperative Oncology Group performance status (PS ≥ 2, 29%), and patients with no previous nephrectomy (16%) or no previous systemic therapy (37%). The median duration of sorafenib therapy was 7.3 months and was similar in clinically relevant subgroups (eg, patients with PS 2, brain metastases, or concomitant hypertension or diabetes [range, 6.7-7.0 months]). The median duration of therapy was shorter for patients with PS 3 or non-clear-cell histologies (4.6 and 4.8 months, respectively). The most common drug-related adverse events were hand-foot skin reaction (20%), diarrhea (17%), and rash (8%). CONCLUSION: Sorafenib was generally well tolerated and provided clinical benefit in a large, diverse population of patients with advanced RCC treated in routine clinical practice.
- MeSH
- ambulantní zařízení MeSH
- dospělí MeSH
- fenylmočovinové sloučeniny aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- karcinom z renálních buněk farmakoterapie etnologie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory ledvin farmakoterapie etnologie patologie MeSH
- niacinamid aplikace a dávkování škodlivé účinky analogy a deriváty terapeutické užití MeSH
- prospektivní studie MeSH
- protinádorové látky aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
Východiská: V súčasnosti sa predoperačná rádioterapia považuje za štandardnú liečbu lokálne pokročilého karcinómu rekta. Správne načasovanie a dávkovanie rádioterapie s alebo bez chemoterapie zostáva sporné. Cieľom tejto štúdie je zhodnotiť príslušné klinické výsledky dvoch predoperačných rádioterapeutických režimov, krátkodobej a dlhodobej rádioterapie s alebo bez chemoterapie u pacientov s lokálne pokročilým karcinómom rekta. Pacienti a metódy: Do štúdie bolo zaradených 151 pacientov s karcinómom rekta v II. a III. štádiu (103 mužov a 48 žien), ktorí boli liečení predoperačnou rádioterapiou v čase 1/1999–1/2008. Analyzovalo sa zachovanie zvierača, downstaging nádoru a patologická kompletná remisia, počet lokálnych recidív, akútna a neskorá toxicita, perioperačné komplikácie, celkové a bezrelapsové prežívanie. Výsledky: Downstaging nádoru sa dosiahol len v prípade dlhodobej rádioterapie, pri samotnej v 46 %, pri kombinovanej s chemoterapiou (5-FU alebo kapecitabin) u 61 % pacientov. Patologická kompletná remisia sa dosiahla iba v skupine pacientov liečených dlhodobou rádioterapiou (13 %). Dlhodobá rádioterapia s konkomitantnou chemoterapiou výrazne znížila výskyt lokálnych recidív (5 % oproti 15 % v skupine po samotnej dlhodobej rádioterapii, p = 0,0132). Štatisticky významný rozdiel sa dosiahol v celkovom prežívaní medzi pacientmi, ktorí sa liečili dlhodobou rádioterapiou kombinovanou s chemoterapiou a samotnou dlhodobou rádioterapiou (p = 0,015). Nezistil sa štatisticky významný rozdiel v miere perioperačných komplikácií, akútnej a neskorej toxicity, v 3- a 5-ročnom celkovom prežívaní medzi pacientmi liečenými krátkodobou a dlhodobou rádioterapiou. Záver: Dosiahnuté výsledky poskytujú presvedčivý dôkaz o tom, že v porovnaní s predoperačnou krátkodobou rádioterapiou je predoperačná dlhodobá rádioterapia v kombinácii s chemoterapiou najúčinnejší spôsob liečby u pacientov s lokálne pokročilým operabilným karcinómom rekta z hľadiska vplyvu na downstaging a dosiahnutie patologickej kompletnej remisie. Zvýšením miery celkového prežívania, ako aj znížením miery lokálnych recidív je táto metóda výhodnejšia ako iné spôsoby predoperačnej rádioterapie. Kľúčové slová: rektum – karcinóm – rádioterapia Obdrženo: 11. 6. 2012 Přijato: 7. 7. 2012
Background: Preoperative radiotherapy is considered to be standard treatment for locally advanced rectal cancer. The timing and dosage of radiotherapy with or without preoperative chemotherapy remain controversial issues. The objective of this study was to evaluate relevant clinical outcomes of two preoperative radiotherapy regimens – the short-course and long-course radiotherapy with or without chemotherapy for patients with locally advanced rectal cancer. Patients and Methods: 151 patients with stage II–III rectal cancer (103 males and 48 females) treated with preoperative radiotherapy between 01/1999 and 01/2008 were involved in this study. Analysed patterns included sphincter preservation, tumor downstaging, pathological complete remission, frequency of local recurrence, acute and late toxicity, perioperative complications, overall survival and disease-free survival. Results: Tumor downstaging has been achieved by long-course radiotherapy alone (46%) or in combination with chemotherapy (5-FU or capecitabine, 61%). Pathological complete remission has also been achieved only in the group with long-course radiotherapy (13%). Long-course radiotherapy combined with chemotherapy significantly decreased post treatment local recurrence rates (5% versus 15% in the group after long-course radiotherapy alone, p = 0.0132). Statistically significant difference was confirmed in overall survival of patients treated with long-course radiotherapy combined with chemotherapy vs long-course radiotherapy alone (p = 0.015). Significant difference between the rate of perioperative complications, of acute and late toxicity, 3 and 5 years disease-free survival of treated patients after short-course radiotherapy and long-course radiotherapy was not confirmed. Conclusion: Our findings provide convincing evidence that in comparison to preoperative short-course radiotherapy, the preoperative long-course radiotherapy in combination with chemotherapy is the most effective treatment modality for patients with operable locally advanced rectal cancer in terms downstaging and pathologic complete response. Increase in overall survival time as well as lower local recurrence rate makes this modality superior to other preoperative radiotherapy alternatives.
- MeSH
- adjuvantní chemoradioterapie * MeSH
- adjuvantní radioterapie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- nádory rekta * chirurgie mortalita patologie radioterapie MeSH
- předoperační péče * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakt z konference MeSH
