RESUMO
El carcinoma escamoso de nasofaringe es responsable del 0,7% del total de tumores malignos a nivel mundial, siendo la mayor incidencia vista en la población del sur de china y sudeste asiático. El tratamiento estándar para la enfermedad localmente avanzada consiste en la combinación de radioterapia y quimioterapia en diferentes secuencias. Dentro de ellas, la quimioterapia de inducción seguida de radio quimioterapia concomitante ha demostrado durante los últimos años ser una opción terapéutica estándar con altas tasas de control locorregional y sobrevida global. El presente trabajo tiene como objetivo revisar la evidencia actual relacionada al tratamiento del cáncer de nasofaringe con quimioterapia de inducción y radio quimioterapia, su efectividad y los aspectos técnicos para su aplicabilidad.
Squamous cell carcinoma of the nasopharynx is responsible for 0.7% of all malignant tumors worldwide, with the highest incidence in the population of southern China and Southeast Asia. The standard treatment for locally advanced disease consists of a combination of radiotherapy and chemotherapy in different schedules. Among them, induction chemotherapy followed by concomitant radio-chemotherapy has shown in recent years to be a standard therapeutic option with high rates of locoregional control and overall survival. This paper aims to review the current evidence related to treatment with induction chemotherapy and subsequent radio-chemotherapy in nasopharyngeal cancer, its effectiveness, and the technical aspects of its applicability.
RESUMO
Squamous cell carcinoma of the nasopharynx is responsible for 0.7% of all malignant tumors worldwide, with the highest incidence in the population of southern China and Southeast Asia. The standard treatment for locally advanced disease consists of a combination of radiotherapy and chemotherapy in different schedules. Among them, induction chemotherapy followed by concomitant radio-chemotherapy has shown in recent years to be a standard therapeutic option with high rates of locoregional control and overall survival. This paper aims to review the current evidence related to treatment with induction chemotherapy and subsequent radio-chemotherapy in nasopharyngeal cancer, its effectiveness, and the technical aspects of its applicability.
Assuntos
Quimiorradioterapia , Quimioterapia de Indução , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Humanos , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/radioterapia , Quimioterapia de Indução/métodos , Quimiorradioterapia/métodos , Carcinoma Nasofaríngeo/tratamento farmacológico , Carcinoma Nasofaríngeo/terapia , Carcinoma Nasofaríngeo/radioterapia , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma/terapia , Carcinoma/tratamento farmacológico , Carcinoma/radioterapia , Resultado do TratamentoRESUMO
BACKGROUND: Cervical cancer is a public health problem in Latin America. Radiotherapy plays a fundamental role both as definitive or adjuvant treatment. There are important intra and inter-country differences regarding access and availability of radiotherapy facilities in this region. The aim of a study was to standardize the basic clinical and technical criteria for the radiation treatment of patients with CC in Chile and provide a guide for Latin American Radiation Oncologists. MATERIALS AND METHODS: Forty-one expert radiation oncologists from the Chilean Radiation Oncology Society made a consensus using the Delphi methodology. RESULTS: There was a high degree of agreement for each of the recommendations. Those with the lowest percentage were related to the definition of the conformal 3D technique as the standard for definitive external radiotherapy (81%) and the criteria for extended nodal irradiation (85%). CONCLUSIONS: These recommendations present an updated guide for radiotherapy treatment of patients with cervical cancer for Latin America. Those should be implemented according to local resources of each institution.
RESUMO
Glioblastoma (GB) is the most frequent and aggressive primary tumor of the central nervous system (CNS) in adults. Standard treatment is complete tumor resection followed by concomitant radiochemotherapy (RCT) and subsequent adjuvant temozolomide (TMZ). Information about brain tumors statistics in Latin American countries is scarce, so we aimed to measure the overall survival (OS) of patients with resected GB in a single institution in Chile. This is a retrospective report of 67 patients treated between 2012 and 2019 with resected GB and who received adjuvant treatment with radiotherapy (RT) with and without TMZ during 2012-2019 in this center (Chilean NCI). Most of them were men (72%), ages > 50 years old (57%), with Karnofsky performance status (KPS) scale ≥ 70% (94%) and recursive partitioning analysis-IV (RPA-IV) (60%). Some 54% received concomitant TMZ and RT. Median OS was 11.4 months, with 1-, 2-, and 5-year OS of 48%,15%, and 3% respectively. In conclusion, in patients with GB treated with RCT at the NCI, OS was the same as expected from international articles. Adjuvant RCT therefore is considered the standard of care at NCI.
RESUMO
Resumo Fundamento Múltiplos sistemas de pontuação têm sido elaborados para calcular o risco de eventos cardiovasculares adversos maiores (MACE) em pacientes com dor no peito. Não há dados que avaliem se o escore HEART tem um desempenho superior a TIMI e GRACE para a predição de MACE, especialmente na era de troponina I de alta sensibilidade e em uma população exclusivamente latino-americana. Objetivo Comparar o desempenho dos escores HEART, TIMI e GRACE para a predição de MACE em 30 dias de acompanhamento, em pacientes atendidos com dor no peito no departamento de emergência. Métodos Os escores HEART, TIMI e GRACE foram analisados em 519 pacientes com dor no peito no departamento de emergência. O desfecho primário foi a ocorrência de MACE no período de 30 dias. O desempenho do escore HEART foi comparado com o dos escores TIMI e GRACE utilizando o teste de DeLong, considerando estatisticamente significativos os valores de p de 0,05. Resultados Um total de 224 pacientes (43%) apresentaram MACE no período de 30 dias. A estatística C para os escores HEART, TIMI e GRACE foi de 0,937, 0,844 e 0,797 respectivamente (p < 0,0001). Uma pontuação de 3 ou menos no escore HEART apresentou uma sensibilidade de 99,5% e um valor preditivo negativo de 99% para classificar pacientes de baixo risco de maneira correta; ambos os valores foram mais elevados do que aqueles obtidos pelos outros escores. Conclusão O escore HEART, em um período de 30 dias, prediz eventos cardiovasculares, mais eficazmente, em comparação com os outros escores. Troponinas de alta sensibilidade mantêm a superioridade previamente demonstrada deste escore. Este escore oferece uma identificação mais precisa dos pacientes de baixo risco. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Abstract Background Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. Objective To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. Methods HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. Results A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. Conclusion The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Assuntos
Humanos , Masculino , Feminino , Dor no Peito/diagnóstico , Doenças Cardiovasculares/diagnóstico , Medição de Risco/métodos , Síndrome Coronariana Aguda/diagnóstico , Cardiopatias/diagnóstico , Troponina , Índice de Gravidade de Doença , Valor Preditivo dos Testes , Estudos Prospectivos , Triagem/métodos , Serviço Hospitalar de EmergênciaRESUMO
BACKGROUND: Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. OBJECTIVE: To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. METHODS: HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. RESULTS: A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. CONCLUSION: The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
FUNDAMENTO: Múltiplos sistemas de pontuação têm sido elaborados para calcular o risco de eventos cardiovasculares adversos maiores (MACE) em pacientes com dor no peito. Não há dados que avaliem se o escore HEART tem um desempenho superior a TIMI e GRACE para a predição de MACE, especialmente na era de troponina I de alta sensibilidade e em uma população exclusivamente latino-americana. OBJETIVO: Comparar o desempenho dos escores HEART, TIMI e GRACE para a predição de MACE em 30 dias de acompanhamento, em pacientes atendidos com dor no peito no departamento de emergência. MÉTODOS: Os escores HEART, TIMI e GRACE foram analisados em 519 pacientes com dor no peito no departamento de emergência. O desfecho primário foi a ocorrência de MACE no período de 30 dias. O desempenho do escore HEART foi comparado com o dos escores TIMI e GRACE utilizando o teste de DeLong, considerando estatisticamente significativos os valores de p de 0,05. RESULTADOS: Um total de 224 pacientes (43%) apresentaram MACE no período de 30 dias. A estatística C para os escores HEART, TIMI e GRACE foi de 0,937, 0,844 e 0,797 respectivamente (p < 0,0001). Uma pontuação de 3 ou menos no escore HEART apresentou uma sensibilidade de 99,5% e um valor preditivo negativo de 99% para classificar pacientes de baixo risco de maneira correta; ambos os valores foram mais elevados do que aqueles obtidos pelos outros escores. CONCLUSÃO: O escore HEART, em um período de 30 dias, prediz eventos cardiovasculares, mais eficazmente, em comparação com os outros escores. Troponinas de alta sensibilidade mantêm a superioridade previamente demonstrada deste escore. Este escore oferece uma identificação mais precisa dos pacientes de baixo risco. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).