<b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain meta... more <b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain metastases from breast cancer: estimation of survival using two stratification systems"BMC Cancer 2007;7():53-53.Published online 26 Mar 2007PMCID:PMC1851018.
<b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain meta... more <b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain metastases from breast cancer: estimation of survival using two stratification systems"BMC Cancer 2007;7():53-53.Published online 26 Mar 2007PMCID:PMC1851018.
Objective: To characterize the hearing loss after cancer treatment, according to the type of trea... more Objective: To characterize the hearing loss after cancer treatment, according to the type of treatment, with identification of predictive factors. Methods: Two hundred patients who had cancer in childhood were prospectively evaluated. The mean age at diagnosis was 6 years, and at the audiometric assessment, 21 years. The treatment of the participants included chemotherapy without using platinum derivatives or head and neck radiotherapy in 51 patients; chemotherapy using cisplatin without radiotherapy in 64 patients; head and neck radiotherapy without cisplatin in 75 patients; and a combined treatment of head and neck radiotherapy and chemotherapy with cisplatin in ten patients. Patients underwent audiological assessment, including pure tone audiometry, speech audiometry, and immittancemetry. Results: The treatment involving chemotherapy with cisplatin caused 41.9% and 47.3% hearing loss in the right and left ear, respectively, with a 11.7-fold higher risk of hearing loss in the right ear and 17.6-fold higher in the left ear versus patients not treated with cisplatin (p < 0.001 and p < 0.001, respectively). Children whose cancer diagnosis occurred after the age of 6 have shown an increased risk of hearing loss vs. children whose diagnosis occurred under 6 years of age (p = 0.02).
Posters report the spatial and temporal distribution of dose to target volume, partial target str... more Posters report the spatial and temporal distribution of dose to target volume, partial target structures and structures at risk. Acknowledgement: these recommendations are now part of the recommendations of the DGMP report 16: guideline for Medical Physical Aspects of Intrasvascular Srachytherapy (www.dgmp.de), those of the revision draft of the AAMP TG 60 Report (AAPM Subcommittee Intrasvascular Brachytherapy Physics) and of those recommendations of GEC-ESTRO (EVA).
To evaluate the impact on biochemical control (bNED), acute and late gastro-intestinal (GI) and u... more To evaluate the impact on biochemical control (bNED), acute and late gastro-intestinal (GI) and urological (GU) morbidity of initial and locally advanced prostate cancer treated with fractionated transrectal ultrasound-guided (TRUS) high dose rate after loading brachytherapy (HDR-B) as a boost to conventional external beam radiation therapy (EBRT). From March 1997 to February 2000 a total of 119 patients with any of the following characteristics were eligible for study entry: biopsy proven adenocarcinoma Gleason scored (GS), initial prostatic specific antigen (PSA) level dosage 1992 AJCC clinical stage T3a or less, and prostatic volume &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 cc. All patients had prior to HDR-B a course of EBRT 6 MV photons to a median dose of 45 Gy, in 1.8 Gy fractions, to the prostate and seminal vesicles only. HDR-B treatment planning and dosimetric calculations were generated with the Nucletron Planning System. Patients were grouped into two groups, according to their risk for biochemical failure: low-risk group without (LR) or with neoadjuvant total androgen deprivation (AD) prior to EBRT (LR+AD) and high-risk group without (HR) or with neoadjuvant AD (HR+AD), for bNED and dose-escalation protocol. LR encompassed patients who presented GS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6, T1 or T2a and or initial PSA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 ng/ml, who were treated with 16 Gy (4 Gy fractions, b.i.d.) HDR-B. The remaining patients were grouped into HR or HR+AD and received 20 Gy (5 Gy fractions, b.i.d.) HDR-B. The planning was optimized using the standard geometric optimization. Biological effective doses (BED) for tumor control and late responding tissue were calculated using a alpha/beta ratio of 1.5 and 3 Gy, respectively. They were matched with bNED, acute and late gastrointestinal (GI) and urological (GU) morbidity, according to the RTOG/EORTC scoring criteria. Median age of patients was 68 years (range 47-83), with a median follow-up of 41 months (range 18-48). The crude and actuarial biochemical controls (bNED) in 48 months for all patients were 69.5 and 75.3%, respectively. When grouped into LR, LR+AD, HR and HR+AD the actuarial bNED were 78.2, 76, 76 and 72.3% (P=0.89), respectively. Acute GU and GI morbidity G1-2 were seen in 18.5% (20/108) and 10.2% (11/108) of patients with spontaneous regression. Late GI and GU morbidity G1-2 were seen in 12% (13/108) and 4.6 (5/108) of patients, with no need of intervention. No acute or late G3-4 GU or GI morbidity was seen. There are many advantages in HDR-B, but the most important ones are the capability of on-line dosimetry, quality control and the procedure being very conformal. There is a low incidence of GU and GI acute and late morbidity with acceptable bNED when treating initial and locally advanced prostate cancer with HDR-B as a boost to EBRT, but we still need to wait for results of phase III open trials that analyze HDR-B and conformal therapy.
ranged from 50 to 60 gy. Remissions of dysphagia and other clinical and radiological factors were... more ranged from 50 to 60 gy. Remissions of dysphagia and other clinical and radiological factors were assessed 4 weeks after the end of treatment, and then 2, 3 and 6 months later. Results: average period of observation carried out 6 of months. Total remission rated in 4 weeks after end of the treatment was acertained in 4 (10.8%) cases, partial remission in 25 (67.6%) cases, lack of remission in 8 (21.6%) cases. After 3 and 6 months remission was observed in 2/3 of patients staying in observation. In group of patients treated both with brachytherapy and teletherapy total remission was ascertained in 2 (20%) cases, partial remission in 6 (60%) cases. In 4 cases (10.8%) during supervisory investigations and esophago-bronchial fistula was detected. Conclusions: 1. HDR brachytherapy of advanced esophageal cancer allowed for improvement of dysphagia in most of patients. 2. In some patients we obtained total remission confirmed radiologically and staying longer than half of year. 3. Tolerance of treatment was good, and number of complications did not run away from obtained by other authors. 126 poster Interstitial High Dose Rate B r a c h y t h e r a p y : R a d i o b i o l o g i c a l and clinical points of v i e w of m u l t i p l e f r a c t i o n a t i o n schedule in clinical practice.
Posters planning should be performed in order to produce the best coverage of the prostate. Futur... more Posters planning should be performed in order to produce the best coverage of the prostate. Future developments including dynamic dosimetry may improve results even more.
Trilateral retinoblastoma (TRB) is a syndrome consisting of unilateral or bilateral hereditary re... more Trilateral retinoblastoma (TRB) is a syndrome consisting of unilateral or bilateral hereditary retinoblastoma (Rb) associated with an intracranial neuroblastic tumor. Although its incidence is low, the prognosis is very poor. This article reports four cases of TRB and discusses the role of neuroimaging screening for early detection. From January 1986 to December 2003, 470 children with Rb were admitted to the Pediatrics and Ophthalmology Departments, A C Camargo Hospital, São Paulo, Brazil. There were four patients with pineoblastoma, two of whom had a positive familial history. The age at diagnosis of Rb was 4, 6, 10, and 24 months while the age of diagnosis of TRB was 10, 25, 57, and 72 months. One patient presented TRB at initial diagnosis of Rb. Three patients had bilateral disease and all of them had one eye enucleated, followed by chemotherapy and/or external beam radiation therapy (EBRT). One child with unilateral disease was only submitted to enucleation. In spite of intensive treatment, all patients died with progressive disease within 7, 8, 12, and 12 months after diagnosis of TRB. Early diagnosis as well as new therapeutic approaches are needed to achieve better results.
Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagno... more Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagnosed before age 4, with a median age at diagnosis of 2 years. To determine characteristics and prognosis of retinoblastoma in children older than 5 years. From 1986 to 2002, medical records of 16 patients out of 453 cases referred to Hospital do Câncer AC Camargo, São Paulo, Brazil. Median age at diagnosis was 73.7 months (range 65-144) and there was an equal gender distribution. Fifteen patients presented with unilateral disease. The mean time between first symptoms and diagnosis was 9.6 months (range 0-48). Most cases were diagnosed in advanced stages and 15 eyes were enucleated. Eleven patients presented with intraocular tumor (1 Reese II and 10 Reese V) and five presented with extraocular disease (one CCG II and four CCG III). Twelve patients are still alive with a median follow-up of 92 months (range 65-199). Because of its low incidence at this age, diagnosis of retinoblastoma is usually delayed due to low level of suspicion. Therefore, it is important that physicians are aware of this disease in order to perform an earlier diagnosis, and decrease treatment-related morbidity.
To evaluate the efficacy of conservative management of intraocular retinoblastoma with chemoreduc... more To evaluate the efficacy of conservative management of intraocular retinoblastoma with chemoreduction combined with local therapy with or without plaque radiation in the preservation of the eye, and avoidance of external beam radiation therapy (EBRT) (success rate). From 1995 to 2000, 84 newly diagnosed patients with intraocular retinoblastoma were admitted to the Pediatric Department of the Hospital do Cancer A.C. Camargo, São Paulo, Brazil. All children were treated with 2 to 6 cycles of chemotherapy (carboplatin, vincristine, and etoposide) plus local therapy (cryotherapy, laser photocoagulation, and thermotherapy), or plaque radiation therapy during and/or after the chemotherapy. The Mann-Whitney test was used to compare means of quantitative variables. The chi test or the Fisher exact test were employed to verify the association between the outcome and the independent variables. For all tests alpha=5% was adopted. Success rate was higher for patients with bilateral tumors (54%) than for children with unilateral tumors (19%) (P=0.003). For patients with Reese-Ellsworth stages I, II, and III, no statistically significant differences in the success rates were noted in the group of unilateral (50%) and bilateral tumors (79.1%) (P=0.179). Among children with Reese-Ellsworth stages IV and V, the success rate was significantly higher for patients with bilateral tumors (40.7%) than for those with unilateral (0%) (P=0.012). Chemoreduction combined with local therapy, with or without plaque radiotherapy, is efficacious in avoiding enucleation and the use of external beam radiation therapy for children with intraocular retinoblastoma.
This study aimed to determine the impact of the addition of ifosfamide/etoposide to a regimen con... more This study aimed to determine the impact of the addition of ifosfamide/etoposide to a regimen containing cisplatin/teniposide on the survival of patients with retinoblastoma with orbital involvement. Thirty patients were treated at the A. C. Camargo Hospital, Brazil, from 1986 to 2002. From 1986 to April 1992 (period I, n = 12), treatment consisted of 3 cycles of induction chemotherapy with cisplatin and teniposide, followed by maintenance with same drugs alternating with cyclophosphamide, vincristine, and doxorubicin every 21 days for 60 weeks. Since April 1992 (period II, n = 18), the treatment consisted of 3 cycles of ifosfamide and etoposide followed by maintenance with same drugs, alternating with cisplatin and teniposide every 21 days for 36 weeks. In both periods, children were submitted to exenteration with eyelid preservation and orbital radiation therapy with 45 cGy, and also received intrathecal therapy with methotrexate plus dexamethasone and cytarabine. Kaplan-Meier method was used for survival analysis. The median age was 31 months. Most patients (86.7%) presented unilateral tumors. The 3-year overall survival was 34.4% and 72.2%, respectively, for patients treated during periods I and II (P = 0.061). The addition of ifosfamide/ etoposide to chemotherapy with cisplatin/teniposide improves survival in these patients, but further studies are still necessary.
International Journal of Radiation Oncology*Biology*Physics, 1996
To show the retrospective results of intraocular tumors, including uveal melanomas and retinoblas... more To show the retrospective results of intraocular tumors, including uveal melanomas and retinoblastomas treated by exclusive brachytherapy with cobalt plaques.The goal was to keep the vision Rmction with not compromising the chance of cure.
International Journal of Radiation Oncology*Biology*Physics, 2007
Background/Purpose: Prognosis of stage IIIb adenocarcinoma of the uterine cervix has been reporte... more Background/Purpose: Prognosis of stage IIIb adenocarcinoma of the uterine cervix has been reported to be much worse than that of squamous cell carcinoma because optimal treatment has not been established for them. High-dose rate intracavitary brachytherapy (HDR-ICBT) combined with external radiotherapy (ER) for stage IIIb adenocarcinoma of the uterine cervix is the community standard treatment in Japan. Then, the purpose of the current study is to explore the optimal dose on the basis of biological effective dose (BED) and prognostic factors for stage IIIb adenocarcinoma of the uterine cervix treated with HDR-ICBT combined with ER in Japan. Patients/Methods: Sixty-one patients in stage IIIb adenocarcinoma of the uterine cervix were treated with HDR-ICBT combined with ER in 19 Japanese university hospitals and cancer centers between 1990 and 2000. All these patients were registered in the current multi-institutional study. Median age was 61.5 years (range; 30-86 years). Fifty had only adenocarcinoma components and 11 had adenosquamous cell carcinoma components. Median tumor diameter was 6.0 cm (range; 2-15 cm). Fortyeight patients had no vaginal invasion, 13 patients had vaginal invasion. All patients were treated with HDR-ICBT combined with ER. Total BED (T-BED10) was calculated from BED of the ER (E-BED10) plus BED of the HDR-ICBT (A-BED10). Median T-BED10 was 106.3 Gy (range; 66.9-115.2 Gy). Median overall treatment time (OTT) was 53 days (range; 37-153 days). Thirty-two patients received adjuvant, neoadjuvant or concurrent chemotherapy and 29 patients received no chemotherapy. Results: The 5-year overall survival rate (OS) of all patients was 20.2% and the 5-year relapse free survival rate (RFS) was 13.4%.
International Journal of Radiation Oncology*Biology*Physics, 2007
analyzed by Principle Component Analysis (PCA). Scores for factors were used for classification a... more analyzed by Principle Component Analysis (PCA). Scores for factors were used for classification and results were correlated with clinically assessed radiation response. Results: PCA of spectra of 2 nd-fraction-of-radiotherapy tissues gave three clusters corresponding to complete response (CR), partial response (PR) and no response (NR), (Figure 1a). In this analysis we could discriminate no response and partial response conditions but there exists an overlap between complete and partial response conditions. We are also pursued predictive studies using tissues collected after 5 th fraction of EBRT in order to explore better discrimination between PR and CR conditions. The available results so for show good correlation with clinical response (Figure 1b). Conclusions: The findings of the study thus suggest the feasibility of Raman spectroscopic prediction of tumor response to radiotherapy.
<b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain meta... more <b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain metastases from breast cancer: estimation of survival using two stratification systems"BMC Cancer 2007;7():53-53.Published online 26 Mar 2007PMCID:PMC1851018.
<b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain meta... more <b>Copyright information:</b>Taken from "Whole brain radiotherapy for brain metastases from breast cancer: estimation of survival using two stratification systems"BMC Cancer 2007;7():53-53.Published online 26 Mar 2007PMCID:PMC1851018.
Objective: To characterize the hearing loss after cancer treatment, according to the type of trea... more Objective: To characterize the hearing loss after cancer treatment, according to the type of treatment, with identification of predictive factors. Methods: Two hundred patients who had cancer in childhood were prospectively evaluated. The mean age at diagnosis was 6 years, and at the audiometric assessment, 21 years. The treatment of the participants included chemotherapy without using platinum derivatives or head and neck radiotherapy in 51 patients; chemotherapy using cisplatin without radiotherapy in 64 patients; head and neck radiotherapy without cisplatin in 75 patients; and a combined treatment of head and neck radiotherapy and chemotherapy with cisplatin in ten patients. Patients underwent audiological assessment, including pure tone audiometry, speech audiometry, and immittancemetry. Results: The treatment involving chemotherapy with cisplatin caused 41.9% and 47.3% hearing loss in the right and left ear, respectively, with a 11.7-fold higher risk of hearing loss in the right ear and 17.6-fold higher in the left ear versus patients not treated with cisplatin (p < 0.001 and p < 0.001, respectively). Children whose cancer diagnosis occurred after the age of 6 have shown an increased risk of hearing loss vs. children whose diagnosis occurred under 6 years of age (p = 0.02).
Posters report the spatial and temporal distribution of dose to target volume, partial target str... more Posters report the spatial and temporal distribution of dose to target volume, partial target structures and structures at risk. Acknowledgement: these recommendations are now part of the recommendations of the DGMP report 16: guideline for Medical Physical Aspects of Intrasvascular Srachytherapy (www.dgmp.de), those of the revision draft of the AAMP TG 60 Report (AAPM Subcommittee Intrasvascular Brachytherapy Physics) and of those recommendations of GEC-ESTRO (EVA).
To evaluate the impact on biochemical control (bNED), acute and late gastro-intestinal (GI) and u... more To evaluate the impact on biochemical control (bNED), acute and late gastro-intestinal (GI) and urological (GU) morbidity of initial and locally advanced prostate cancer treated with fractionated transrectal ultrasound-guided (TRUS) high dose rate after loading brachytherapy (HDR-B) as a boost to conventional external beam radiation therapy (EBRT). From March 1997 to February 2000 a total of 119 patients with any of the following characteristics were eligible for study entry: biopsy proven adenocarcinoma Gleason scored (GS), initial prostatic specific antigen (PSA) level dosage 1992 AJCC clinical stage T3a or less, and prostatic volume &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 cc. All patients had prior to HDR-B a course of EBRT 6 MV photons to a median dose of 45 Gy, in 1.8 Gy fractions, to the prostate and seminal vesicles only. HDR-B treatment planning and dosimetric calculations were generated with the Nucletron Planning System. Patients were grouped into two groups, according to their risk for biochemical failure: low-risk group without (LR) or with neoadjuvant total androgen deprivation (AD) prior to EBRT (LR+AD) and high-risk group without (HR) or with neoadjuvant AD (HR+AD), for bNED and dose-escalation protocol. LR encompassed patients who presented GS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6, T1 or T2a and or initial PSA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 ng/ml, who were treated with 16 Gy (4 Gy fractions, b.i.d.) HDR-B. The remaining patients were grouped into HR or HR+AD and received 20 Gy (5 Gy fractions, b.i.d.) HDR-B. The planning was optimized using the standard geometric optimization. Biological effective doses (BED) for tumor control and late responding tissue were calculated using a alpha/beta ratio of 1.5 and 3 Gy, respectively. They were matched with bNED, acute and late gastrointestinal (GI) and urological (GU) morbidity, according to the RTOG/EORTC scoring criteria. Median age of patients was 68 years (range 47-83), with a median follow-up of 41 months (range 18-48). The crude and actuarial biochemical controls (bNED) in 48 months for all patients were 69.5 and 75.3%, respectively. When grouped into LR, LR+AD, HR and HR+AD the actuarial bNED were 78.2, 76, 76 and 72.3% (P=0.89), respectively. Acute GU and GI morbidity G1-2 were seen in 18.5% (20/108) and 10.2% (11/108) of patients with spontaneous regression. Late GI and GU morbidity G1-2 were seen in 12% (13/108) and 4.6 (5/108) of patients, with no need of intervention. No acute or late G3-4 GU or GI morbidity was seen. There are many advantages in HDR-B, but the most important ones are the capability of on-line dosimetry, quality control and the procedure being very conformal. There is a low incidence of GU and GI acute and late morbidity with acceptable bNED when treating initial and locally advanced prostate cancer with HDR-B as a boost to EBRT, but we still need to wait for results of phase III open trials that analyze HDR-B and conformal therapy.
ranged from 50 to 60 gy. Remissions of dysphagia and other clinical and radiological factors were... more ranged from 50 to 60 gy. Remissions of dysphagia and other clinical and radiological factors were assessed 4 weeks after the end of treatment, and then 2, 3 and 6 months later. Results: average period of observation carried out 6 of months. Total remission rated in 4 weeks after end of the treatment was acertained in 4 (10.8%) cases, partial remission in 25 (67.6%) cases, lack of remission in 8 (21.6%) cases. After 3 and 6 months remission was observed in 2/3 of patients staying in observation. In group of patients treated both with brachytherapy and teletherapy total remission was ascertained in 2 (20%) cases, partial remission in 6 (60%) cases. In 4 cases (10.8%) during supervisory investigations and esophago-bronchial fistula was detected. Conclusions: 1. HDR brachytherapy of advanced esophageal cancer allowed for improvement of dysphagia in most of patients. 2. In some patients we obtained total remission confirmed radiologically and staying longer than half of year. 3. Tolerance of treatment was good, and number of complications did not run away from obtained by other authors. 126 poster Interstitial High Dose Rate B r a c h y t h e r a p y : R a d i o b i o l o g i c a l and clinical points of v i e w of m u l t i p l e f r a c t i o n a t i o n schedule in clinical practice.
Posters planning should be performed in order to produce the best coverage of the prostate. Futur... more Posters planning should be performed in order to produce the best coverage of the prostate. Future developments including dynamic dosimetry may improve results even more.
Trilateral retinoblastoma (TRB) is a syndrome consisting of unilateral or bilateral hereditary re... more Trilateral retinoblastoma (TRB) is a syndrome consisting of unilateral or bilateral hereditary retinoblastoma (Rb) associated with an intracranial neuroblastic tumor. Although its incidence is low, the prognosis is very poor. This article reports four cases of TRB and discusses the role of neuroimaging screening for early detection. From January 1986 to December 2003, 470 children with Rb were admitted to the Pediatrics and Ophthalmology Departments, A C Camargo Hospital, São Paulo, Brazil. There were four patients with pineoblastoma, two of whom had a positive familial history. The age at diagnosis of Rb was 4, 6, 10, and 24 months while the age of diagnosis of TRB was 10, 25, 57, and 72 months. One patient presented TRB at initial diagnosis of Rb. Three patients had bilateral disease and all of them had one eye enucleated, followed by chemotherapy and/or external beam radiation therapy (EBRT). One child with unilateral disease was only submitted to enucleation. In spite of intensive treatment, all patients died with progressive disease within 7, 8, 12, and 12 months after diagnosis of TRB. Early diagnosis as well as new therapeutic approaches are needed to achieve better results.
Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagno... more Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagnosed before age 4, with a median age at diagnosis of 2 years. To determine characteristics and prognosis of retinoblastoma in children older than 5 years. From 1986 to 2002, medical records of 16 patients out of 453 cases referred to Hospital do Câncer AC Camargo, São Paulo, Brazil. Median age at diagnosis was 73.7 months (range 65-144) and there was an equal gender distribution. Fifteen patients presented with unilateral disease. The mean time between first symptoms and diagnosis was 9.6 months (range 0-48). Most cases were diagnosed in advanced stages and 15 eyes were enucleated. Eleven patients presented with intraocular tumor (1 Reese II and 10 Reese V) and five presented with extraocular disease (one CCG II and four CCG III). Twelve patients are still alive with a median follow-up of 92 months (range 65-199). Because of its low incidence at this age, diagnosis of retinoblastoma is usually delayed due to low level of suspicion. Therefore, it is important that physicians are aware of this disease in order to perform an earlier diagnosis, and decrease treatment-related morbidity.
To evaluate the efficacy of conservative management of intraocular retinoblastoma with chemoreduc... more To evaluate the efficacy of conservative management of intraocular retinoblastoma with chemoreduction combined with local therapy with or without plaque radiation in the preservation of the eye, and avoidance of external beam radiation therapy (EBRT) (success rate). From 1995 to 2000, 84 newly diagnosed patients with intraocular retinoblastoma were admitted to the Pediatric Department of the Hospital do Cancer A.C. Camargo, São Paulo, Brazil. All children were treated with 2 to 6 cycles of chemotherapy (carboplatin, vincristine, and etoposide) plus local therapy (cryotherapy, laser photocoagulation, and thermotherapy), or plaque radiation therapy during and/or after the chemotherapy. The Mann-Whitney test was used to compare means of quantitative variables. The chi test or the Fisher exact test were employed to verify the association between the outcome and the independent variables. For all tests alpha=5% was adopted. Success rate was higher for patients with bilateral tumors (54%) than for children with unilateral tumors (19%) (P=0.003). For patients with Reese-Ellsworth stages I, II, and III, no statistically significant differences in the success rates were noted in the group of unilateral (50%) and bilateral tumors (79.1%) (P=0.179). Among children with Reese-Ellsworth stages IV and V, the success rate was significantly higher for patients with bilateral tumors (40.7%) than for those with unilateral (0%) (P=0.012). Chemoreduction combined with local therapy, with or without plaque radiotherapy, is efficacious in avoiding enucleation and the use of external beam radiation therapy for children with intraocular retinoblastoma.
This study aimed to determine the impact of the addition of ifosfamide/etoposide to a regimen con... more This study aimed to determine the impact of the addition of ifosfamide/etoposide to a regimen containing cisplatin/teniposide on the survival of patients with retinoblastoma with orbital involvement. Thirty patients were treated at the A. C. Camargo Hospital, Brazil, from 1986 to 2002. From 1986 to April 1992 (period I, n = 12), treatment consisted of 3 cycles of induction chemotherapy with cisplatin and teniposide, followed by maintenance with same drugs alternating with cyclophosphamide, vincristine, and doxorubicin every 21 days for 60 weeks. Since April 1992 (period II, n = 18), the treatment consisted of 3 cycles of ifosfamide and etoposide followed by maintenance with same drugs, alternating with cisplatin and teniposide every 21 days for 36 weeks. In both periods, children were submitted to exenteration with eyelid preservation and orbital radiation therapy with 45 cGy, and also received intrathecal therapy with methotrexate plus dexamethasone and cytarabine. Kaplan-Meier method was used for survival analysis. The median age was 31 months. Most patients (86.7%) presented unilateral tumors. The 3-year overall survival was 34.4% and 72.2%, respectively, for patients treated during periods I and II (P = 0.061). The addition of ifosfamide/ etoposide to chemotherapy with cisplatin/teniposide improves survival in these patients, but further studies are still necessary.
International Journal of Radiation Oncology*Biology*Physics, 1996
To show the retrospective results of intraocular tumors, including uveal melanomas and retinoblas... more To show the retrospective results of intraocular tumors, including uveal melanomas and retinoblastomas treated by exclusive brachytherapy with cobalt plaques.The goal was to keep the vision Rmction with not compromising the chance of cure.
International Journal of Radiation Oncology*Biology*Physics, 2007
Background/Purpose: Prognosis of stage IIIb adenocarcinoma of the uterine cervix has been reporte... more Background/Purpose: Prognosis of stage IIIb adenocarcinoma of the uterine cervix has been reported to be much worse than that of squamous cell carcinoma because optimal treatment has not been established for them. High-dose rate intracavitary brachytherapy (HDR-ICBT) combined with external radiotherapy (ER) for stage IIIb adenocarcinoma of the uterine cervix is the community standard treatment in Japan. Then, the purpose of the current study is to explore the optimal dose on the basis of biological effective dose (BED) and prognostic factors for stage IIIb adenocarcinoma of the uterine cervix treated with HDR-ICBT combined with ER in Japan. Patients/Methods: Sixty-one patients in stage IIIb adenocarcinoma of the uterine cervix were treated with HDR-ICBT combined with ER in 19 Japanese university hospitals and cancer centers between 1990 and 2000. All these patients were registered in the current multi-institutional study. Median age was 61.5 years (range; 30-86 years). Fifty had only adenocarcinoma components and 11 had adenosquamous cell carcinoma components. Median tumor diameter was 6.0 cm (range; 2-15 cm). Fortyeight patients had no vaginal invasion, 13 patients had vaginal invasion. All patients were treated with HDR-ICBT combined with ER. Total BED (T-BED10) was calculated from BED of the ER (E-BED10) plus BED of the HDR-ICBT (A-BED10). Median T-BED10 was 106.3 Gy (range; 66.9-115.2 Gy). Median overall treatment time (OTT) was 53 days (range; 37-153 days). Thirty-two patients received adjuvant, neoadjuvant or concurrent chemotherapy and 29 patients received no chemotherapy. Results: The 5-year overall survival rate (OS) of all patients was 20.2% and the 5-year relapse free survival rate (RFS) was 13.4%.
International Journal of Radiation Oncology*Biology*Physics, 2007
analyzed by Principle Component Analysis (PCA). Scores for factors were used for classification a... more analyzed by Principle Component Analysis (PCA). Scores for factors were used for classification and results were correlated with clinically assessed radiation response. Results: PCA of spectra of 2 nd-fraction-of-radiotherapy tissues gave three clusters corresponding to complete response (CR), partial response (PR) and no response (NR), (Figure 1a). In this analysis we could discriminate no response and partial response conditions but there exists an overlap between complete and partial response conditions. We are also pursued predictive studies using tissues collected after 5 th fraction of EBRT in order to explore better discrimination between PR and CR conditions. The available results so for show good correlation with clinical response (Figure 1b). Conclusions: The findings of the study thus suggest the feasibility of Raman spectroscopic prediction of tumor response to radiotherapy.
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