Reports of Practical Oncology and Radiotherapy最新文献

Reduction of postoperative analgesic consumption in breast cancer patients is of significant clinical interest. Some studies have demonstrated promising results related to the efficacy of liposomal bupivacaine (LB), a long-acting local analgesic used intraoperatively, in reducing opioid consumption after aesthetic breast surgery. The purpose of this review is to evaluate postoperative opioid consumption when using LB in aesthetic breast surgery vs oncologic breast surgery to help clinicians better understand trends in pain outcomes in breast cancer patients. A literature search was conducted to identify records reporting postoperative opioid consumption for patients undergoing oncologic mastectomy with and without breast reconstruction (BR) and aesthetic breast surgery. Of the 779 records reviewed, 15 met inclusion criteria representing 2,453 patients. Of these, none of the oncologic procedures without BR showed reduced opioid consumption with LB. A meta-analysis of oncologic procedures with BR and aesthetic breast procedures showed significant effect size (ES) estimates of reduced postoperative opioid consumption when using LB compared to control anesthetics [ES: 1.698 ± 0.8624; 95% confidence interval (CI): 0.005, -3.390; p = 0.049 and ES: 1.212 ± 0.3053; 95% CI: 1.810-0.613; p < 0.001, respectively). In conclusion, intraoperative LB reduces postoperative opioid consumption for oncologic breast surgery with BR and aesthetic breast procedures. LB is understudied in mastectomy without BR and more research is needed. Neoadjuvant treatment and procedural differences could contribute to different pain outcomes. Further investigation could help uncover the etiology of post mastectomy pain syndromes.

Background: Breast cancer is the most common cancer in women worldwide, with 73,610 new cases expected annually in Brazil between 2023 and 2025. Post-operative radiation therapy (PORT) is a critical component of treatment, and recent advances have allowed for shorter treatment times that can help overcome shortages in low- and middle-income countries. The Brazilian Society of Radiotherapy (SBRT) updated its consensus on hypofractionated whole-breast radiotherapy and included recommendations for partial breast irradiation.

Materials and methods: The SBRT convened a national panel of experts to develop updated recommendations. Using a modified Delphi method, the panel reached a consensus through structured rounds of voting. Recommendations were categorized based on the strength of available evidence.

Results: The consensus supports hypofractionation, which offers shorter, cost-effective treatment schedules, and partial breast irradiation (PBI), which targets high-risk areas while sparing healthy tissue. Despite high-quality evidence, adopting these techniques has been inconsistent. The panel's recommendations provide evidence-based guidance to clinicians, tailored to the Brazilian context, emphasizing safety and efficacy.

Conclusion: The updated SBRT consensus presents hypofractionation and PBI as practical alternatives to conventional radiation therapy, offering improved access and reduced costs. These recommendations aim to guide clinicians in adopting these approaches and help address barriers to access.

Background: The aim of the study was to evaluate Gafchromic films as in-vivo detectors for intensity modulated radiation therapy for patients with sarcomas and to assess the quality of irradiation in these patients.

Materials and methods: Phantom measurements were used to validate the measurements performed with the Gafchromic. The uncertainty of the measurement method and that in determining the reference dose value obtained from the treatment planning system (TPS) were independently estimated. In-vivo measurements were performed in 21 patients with sarcomas who were irradiated with dynamic techniques using a 5 × 5 Gy. For each patient, measurements were taken at four points using films placed on the skin under a 1 cm bolus. The results of the measurements obtained in the 96 treatment sessions were analysed. The treatment quality was assessed based on the differences between the doses calculated using the TPS and those measured.

Results: The uncertainty of measurements was less than 0.8% (one standard deviation). Owing to differences in the dose gradient, the uncertainty of the reference dose reading from the TPS had an individual value at each measurement point. The uncertainties were less than 3% for more than 95% of the points; 93% of the in vivo measurements showed a difference of less than 7% between the measurements and calculations.

Conclusions: Gafchromic films can be used for in vivo dosimetry using dynamic techniques. This method made it possible to detect errors of 7% with a probability of approximately 95%. The results obtained for 21 patients with sarcoma demonstrated high-quality preparation and delivery of irradiation.

Background: The gold-standard of treatment for oral cavity squamous cell carcinoma (OCSCC) is surgery and adjuvant chemoradiotherapy (CRT) in the sub-group of high-risk patients. In this group of patients, treatment time is an important factor in clinical outcomes. We aim to study the influence of the treatment package time (TPT).

Materials and methods: We conducted a retrospective study of patients with high-risk OCSCC managed with surgery followed by adjuvant CRT between January 2017 and December 2020. TPT was defined as the time between surgery and the last fraction of radiotherapy. We categorized TPT according to an optimal cut-off point. The Kaplan-Meier methodology was used to calculate 5-year survival.

Results: We included 79 patients, median age: 60 years (range: 39-70 years), majority were male (84.8%, n = 67) and smokers (73.4%, n = 58). Extra-nodal extension (ENE) and positive resection/< 1 mm margin were found in 51.9% (n = 41) and 84.8% (n = 67) of cases, respectively. Median radiotherapy dose: 66 Gy. Median cisplatin dose: 300 mg/m². Median TPT time was 109 days. The optimal cut-off point was 104 days. 5-year overall survival (OS) with TPT ≤ 104 days was 77.4% and 46.7% with TPT > 104 days, with similar results for disease-free survival (DFS).

Conclusions: Our institution cohort of high risk OCSSC treated with surgery followed by adjuvant CRT had a prolonged TPT (median 109 days). Within our cohort, a TPT > 104 days was found to have a worse OS and DFS, with a nonsignificant impact on locoregional or distant disease-free survival. This highlights the need to optimize the multimodal cancer care pathway.

Background: The pan-immune-inflammation value (PIV) has been associated with survival outcomes across various cancer types. This study investigates the association between PIV and overall and progression-free survival in endometrial cancer patients receiving adjuvant chemotherapy.

Materials and methods: A retrospective analysis was conducted on 138 endometrial cancer patients treated at our center between January 2014 and January 2024. Eligible patients received adjuvant chemotherapy following surgery and had preoperative blood tests available for PIV calculation. PIV was calculated as neutrophil count × platelet count × monocyte count/lymphocyte count. Survival outcomes were analyzed using Kaplan-Meier and Cox regression methods.

Results: The median PIV was 352 [interquartile range (IQR): 199-600], with higher scores significantly associated with advanced International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.007) and extensive lymphovascular invasion (LVI) (p = 0.03). Multivariate analysis identified PIV [hazard ratio (HR): 1.001, p = 0.015], FIGO stage III-IV (HR: 5.957, p < 0.001), adjuvant radiotherapy (HR: 0.288, p = 0.002), and extensive LVI (HR: 2.295, p = 0.014) as independent prognostic factors for overall survival (OS). A PIV greater than 350 was linked to a 3.2-fold increase in mortality risk (p < 0.001). Additionally, radiotherapy in conjunction with adjuvant chemotherapy significantly improved OS in patients with a high PIV (> 350), but not in those with a low PIV (≤ 350).

Conclusion: The PIV score is a significant prognostic marker for survival in endometrial cancer patients receiving adjuvant chemotherapy. Patients with a high PIV score may benefit from the addition of radiotherapy to their treatment regimen. Further studies are needed to validate the PIV score as a predictive marker for adjuvant radiotherapy in this population.

Background: In definitive radiotherapy for localized prostate cancer, the seminal vesicle is included in the target volume for intermediate- and high-risk cases, though this increases the risk of toxicity to the bowel and rectum. This study retrospectively examined clinicopathological data to assess the absence of seminal vesicle invasion (SVI) in prostate cancer patients without radiological evidence of SVI using preoperative magnetic resonance imaging (MRI).

Materials and methods: Patients with cT1c-cT3a prostate cancer who underwent radical prostatectomy between March 2010 and February 2024 were retrospectively selected, excluding those with distant metastasis, missing MRI data, preoperative systemic therapy, or delayed surgery post-biopsy. Preoperative risk factors [age, initial prostate-specific antigen (PSA), grade group (GG), clinical T stage, positive core ratio] and postoperative pathology were analyzed to assess SVI risk. The impact of GG changes between biopsy and postoperative pathology on risk classification and SVI treatment intensity in radiotherapy was also examined.

Results: Of 368 patients, 308 met the inclusion criteria. SVI was observed in 26 patients (8.4%). Significant predictors of SVI included GG, initial PSA ≥ 8.6, and positive core ratio, with a positive core ratio < 0.5 and GG ≤ 3 indicating an SVI risk under 10%. GG discrepancies between biopsy and surgery were noted in 182 cases (59.1%), but had minimal impact on risk classification and SVI risk.

Conclusions: Patients with a positive core ratio <0.5 had a low risk of SVI. GG discrepancies did not significantly underestimate prostate cancer risk, minimizing the risk of failing to treat true SVI.

Background: The rising incidence of oral tongue squamous cell carcinoma (OTSCC) among younger patients has raised concerns about a distinct clinical course in younger adults. This study investigated differences in demographics, clinicopathological profiles, and outcomes, such as locoregional control (LRC), distant metastasis-free survival (DMFS) and overall survival (OS), between younger (≤ 40 years) and older (> 40 years) OTSCC patients.

Materials and methods: A retrospective analysis of 650 OTSCC patients treated between 2008 and 2022 at a cancer centre was conducted. Patients were categorized into younger (≤ 40 years, n = 189) and older (> 40 years, n = 461) groups. All patients underwent upfront surgery followed by adjuvant treatment. Univariate and multivariate analyses were performed to identify prognostic factors for LRC, DMFS and OS.

Results: There was no significant difference in 3-year LRC (younger: 53.7%, older: 56.5%, p = 0.300), DMFS (younger: 57.9%, older: 61.5%, p = 0.339), and OS (younger: 59.4%, older: 62.7%, p = 0.397), median LRC (younger: 49.1 months, older: 55.7 months, p = 0.863), median DMFS (younger: 75.4 months, older: 69.1 months, p = 0.749) or median OS (younger: 75.4 months, older: 72.4 months, p = 0.831). Tumour grade, margin status, perineural invasion (PNI), nodal stage (pN), and extracapsular extension (ECE) were significant predictors of LRC and OS, but age was not.

Conclusion: Age is not an independent prognostic factor for OTSCC outcomes. Younger patients should not receive more aggressive treatment solely based on age. Treatment should follow standard care protocols for all OTSCC patients.

Glioblastoma (GBM) is the most prevalent and deadliest form of primary malignant brain tumor in adults. Radiation associated with chemotherapy following maximal feasible surgery is the standard of care. However, it remains an incurable disease with inexorable recurrence after multimodal therapy due to several factors including tumor aggressiveness with high degree of tumor cell infiltration into surrounding brain tissue, high proliferation, molecular heterogeneity and radioresistance. A better understanding of the tumor biology may allow development of new strategies to overcome treatment resistance. Overcoming radioresistance in GBM has been considered as a challenge for decades. In this systematic review we aim to summarize biologic pathways and mechanisms of therapeutic resistance involved in GBM and try to define some potential future therapeutic perspectives. The main mechanisms of radioresistance that we will discuss are hypoxia, the subpopulation of cancer stem cells in GBM, and the epidermal growth factor receptor (EGFR) expression. We will also focus on the potential role of innovative approaches, such as targeted therapy, nanoparticles and non-photon radiotherapy.

Sentinel lymph node (SLN) identification plays a crucial role in the diagnosis and management of gynecological cancers, particularly in the context of lymph node metastases that often remain undetectable through standard imaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET). Therefore, surgical assessment of lymph nodes remains an essential component of diagnostic procedures. SLN biopsy enables the detection of small metastatic deposits while reducing the need for extensive lymphadenectomy and minimizing associated complications. Lymphoscintigraphy using technetium-99m (Tc-99m) is one of the most commonly applied techniques for lymphatic mapping and is considered the standard method for SLN identification. In clinical practice, Tc-99m is frequently combined with indocyanine green (ICG) or methylene blue (MB) to allow dual visualization. The dye method, despite its simplicity, has certain limitations, such as shorter retention time in lymph nodes and the risk of diffusion into capillaries, which may reduce detection efficiency. Lymphoscintigraphy with Tc-99m provides precise visualization of lymphatic drainage pathways and SLNs, contributing to a more accurate determination of cancer staging and reducing the number of unnecessary lymphadenectomies. The appropriate application of this technique lowers the risk of complications, such as lymphedema, while maintaining high diagnostic accuracy. This review summarizes current evidence on the clinical application of Tc-99m in SLN detection for gynecological cancers, analyzing both its advantages and the challenges related to its practical implementation. Additionally, it discusses the technical aspects of Tc-99m use and its role as a reliable tool for optimizing oncological outcomes.

Background: Combined external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) are the standard treatments for cancer cervix. 3D-based image-guided brachytherapy has changed the face of intracavitary applications and allowed better dosimetric outcomes. While magnetic resonance imaging (MRI)-based therapy is the current standard, computed tomography (CT) with ultrasound measurements could represent an acceptable alternative with less cost and real-time imaging advantage.

Material and methods: Our study included sixty-four patients with uterine cervix cancer (stages IB to IVA) who underwent concurrent chemoradiotherapy (CCRT), followed by high dose rate (HDR)-ICBT 8 GY/FR/weekly. Patients were randomized into two arms: Arm A (application done ultrasound-guided with each fraction in 32 cases) and Arm B (without image guidance). The rate of optimal insertion is defined as tandem centralized within the uterine cavity without perforation; the needle insertion rate is also calculated between both arms.

Results: Ultrasound guidance significantly improved the rate of optimal insertion and reduced the rate of uterine perforation by 12% (from 14.6% to 1.8%). Optimal insertion positively impacted isodose distribution, resulting in numerically higher Dmax values for organs at risk (OARs) in the non-ultrasound-guided group. However, it was not statistically significant. On the other hand, MRI and US measurements were found to be comparable, with the largest mean difference being 2.3 mm, which is not found to be clinically significant.

Conclusion: The use of ultrasound is strongly recommended during brachytherapy as it minimizes the rate of suboptimal insertions. Also, US measurement strongly correlated with MRI, which may support its use in a radiotherapy setting with a lack of MRI availability.