Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/secundário , Irradiação Craniana , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/prevenção & controle , Relação Dose-Resposta à Radiação , Humanos , Neoplasias Pulmonares/prevenção & controle , Qualidade de Vida , Lesões por Radiação , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de RiscoRESUMO
PURPOSE: To analyze the efficacy and toxicity of adjuvant whole abdomen irradiation (WAI) and concomitant chemotherapy in the treatment of completely resected, high-risk gastric cancer. METHODS AND MATERIALS: Between October 1990 and September 1997, 52 patients with completely resected gastric cancer, with lymph node and/or serosal involvement, were treated. Ages were 16-78 (median, 53.5) years. Treatment was either total- or sub-total gastrectomy, followed by WAI, 2100 cGy/21 fractions plus a 2400 cGy/16 fractions boost to the tumor bed. Chemotherapy consisted of either 5-fluorouracil (5-FU) 450-500 mg/m(2) i.v. for 5 days first and 5th week or 200-300 mg/m(2) continuous infusion during irradiation. No further chemotherapy was given. RESULTS: With a minimum follow-up of 30 months and a median follow-up of 43.5 months, 25 of the 52 patients have died. Overall 5-year survival rate is 54%. Three patients sustained Grade 3-5 complications. Two patients with Grade 5 complications (malabsorption syndrome) died 31 and 56 months after the beginning of the treatment, respectively, with no evidence of recurrent tumor. For patients with involvement of the lymph nodes alone (n = 19) the 5-year survival was 69%, which was significantly better than the 36% 5-year survival observed for those patients with both serosal and lymph node involvement (n = 26, p = 0.004). CONCLUSION: Adjuvant radiochemotherapy, WAI, and concomitant 5-FU, is a feasible and a fairly well-tolerated treatment for patients with locally advanced (involvement of the lymph nodes or serosa) gastric carcinoma who undergo complete resection. The 54% overall 5-year survival compares favorably with the survival reported after surgery alone for those patients.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Fluoruracila/uso terapêutico , Neoplasias Gástricas/radioterapia , Adulto , Idoso , Antimetabólitos Antineoplásicos/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Fracionamento da Dose de Radiação , Feminino , Fluoruracila/efeitos adversos , Gastrectomia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Radioterapia Adjuvante/efeitos adversos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Taxa de SobrevidaRESUMO
BACKGROUND: Since the widespread use of mammography, the incidence of ductal carcinoma in situ of the breast has increased. Until few years ago the standard treatment was mastectomy, however, from the analysis of conservative treatment trials for invasive carcinoma, it was evident that ductal carcinoma in situ could also be treated conservatively. This was confirmed later by randomized trials. AIM: To analyze the experience of our Institution with conservative treatment of ductal carcinoma in situ of the breast. PATIENTS AND METHODS: A search through the data base of our Institution found 69 patients treated with lumpectomy and radiotherapy between the years 1976 and 1997. RESULTS: Twenty three of 69 patients (33%) were diagnosed because of a palpable mass. Eleven of twelve were diagnosed prior to 1990 and 12 of 57 after 1990. With a median follow-up of 48 months local control and overall survival is 97%. None of the patients underwent mastectomy. CONCLUSIONS: Conservative treatment of ductal carcinoma in situ of the breast is a reasonable alternative, mainly if we realize that with increasing frequency--the diagnosis is made through mammography and with non-palpable lesions. The results reported in this study are similar to those reported by other centers.
Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/radioterapia , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/radioterapia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Mamografia , Mastectomia Segmentar , Pessoa de Meia-Idade , Radioterapia AdjuvanteRESUMO
The results of curative radiotherapy in 59 patients with non-small-cell carcinoma of the lung treated from 1977 to 1988 are reported. Squamous cell carcinoma without evidence of metastatic disease was present in 28 patients. Radiotherapy alone was used in 43 patients; 13 patients received either pre or post operative radiotherapy. Complications developed in 6 patients, only 1 had esophageal stenosis deemed important. The first site of failure was extrathoracic in 76% of patients, the brain being the most frequently involved site (41%). Brain failure rate was greater for squamous cell carcinoma than for other tumors. The 5 year survival rate was 20% with a minimum follow up period of 24 months (median 57). Better results were obtained in patients receiving high dose continuous radiotherapy and in those with associated surgery. Thus, radiotherapy is an alternative therapy for patients with lung carcinoma, with a reasonable survival rate and few complications.
Assuntos
Carcinoma Broncogênico/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Análise Atuarial , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Broncogênico/epidemiologia , Carcinoma Broncogênico/secundário , Carcinoma Broncogênico/cirurgia , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Chile/epidemiologia , Terapia Combinada , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Dosagem Radioterapêutica , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Postoperative radiotherapy was performed in 58 patients with pituitary adenomas from 1977 to 1987. There were 21 non functioning adenomas and 22 growth hormone producing tumors. Extrasellar extension was found in 59% of patients. Radiotherapy was performed electively in 38 patients and due to tumor recurrence in 20. Megavoltage radiation was used in all patients. A dose of 5000 cGy in 5 weeks was attained in 54 of 58 patients. The recurrence free survival was 81% after a median follow-up of 6.8 years. Hypopituitarism developed in 13 of 58 patients. These findings confirm that external radiotherapy offers a real curative alternative for patients with macroadenomas of the pituitary gland.
Assuntos
Adenoma/radioterapia , Neoplasias Hipofisárias/radioterapia , Adenoma/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Período Pós-Operatório , Radioterapia de Alta Energia , Análise de SobrevidaRESUMO
From November 1976 until September 1987, 59 patients with Hodgkin's disease have been admitted and treated with radiotherapy alone or radiotherapy plus elective chemotherapy after been staged according to Stanford's guidelines and following the Ann Arbor's classification. 33 patients were staged I or II, and 26 as stage III or IV. Patients in earlier stages received preferentially radiotherapy alone and those in more advanced stages received radio and chemotherapy. After a median follow-up of 39 months, 100% of patients in stage I, 81.5% of patients in stages II and III A and 45% of patients in stages III B and IV were alive and well. The relapse free survival for patients in stages II and III A was 48.4%, rising to 81.5% after rescue. The use of elective chemotherapy made no difference in survival for stages II B and III A.
Assuntos
Doença de Hodgkin/terapia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Feminino , Seguimentos , Doença de Hodgkin/mortalidade , Humanos , Masculino , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Taxa de SobrevidaRESUMO
At our Institution, the treatment policy for early carcinoma of the breast (T1-2, NO, AJC) is lumpectomy followed by radiotherapy to the breast and peripheral lymphatics. From October 1976 until December 1982, 171 patients have been admitted and treated. Radiotherapy was administered with 60 Co, 5.000 cGy in 5 weeks to the breast and lymphatics plus a boost to the scar giving q.s.p. 6.400 cGy at maximum tumor depth. With a minimum follow-up of 3 years and a median follow-up of 61.7 months the locoregional control was 94.2% and survival at 8 years with no evidence of disease (NED) was 77.2% with an overall survival rate of 90%. No difference in NED survival rate was found between Stage I and II. There was a tendency to better survival rate in those patients older than 50 years and also for post menopausal patients, however the difference did not reach statistical significance (66.7% NED survival at 8 years for premenopausal and 81.8% NED survival for post menopausal, also at 8 years, p = 0.056 Gehan). The time elapsed between surgery and radiation therapy (between 1 and 2 months) was found to be nonsignificant. Only 1 out of 171 patients had axillary dissection. The importance or lack of it, is discussed.