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2.
Nutr Hosp ; 20(5): 320-5, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16229399

RESUMO

Malnutrition is commonly associated with head and neck cancer, due especially to anorexia, which is aggravated by radiotherapy. The objective of this study was to evaluate modifications to nutritional ingestion following three types of nutritional intervention. Sixty-four male out-patients (62.1 +/- 1.5 years) were divided into three groups: oral group, (n=32) that received an adapted oral diet; feeding tube group, (n=16) under home enteral nutrition via a nasoenteral feeding tube (6x/day); and supplement group, (n=16) with oral diet associated to oral alimentary supplement between meals (3x/day). The groups were homogeneous and counseled to maintain a caloric ingestion of 40 kcal/kg. The diet for the oral group was adapted to the age and to the side effects of radiotherapyThe nutritional state of the three groups was evaluated for the caloric-proteic ingestion, anthropometric indicators (body weight, body mass index, triceps skinfold thickness, midarm muscle area), laboratorial indicators (total proteins, albumin, hematocrit, hemoglobin and total lymphocytes count), The results showed that all of the groups presented an increase in the ingestion of calories and proteins (p < 0.001). The nutritional therapy support for patients with head and neck cancer under radiotherapy, whether exclusive oral diet, enteral through a feeding tube, or with alimentary supplement associated to an oral diet achieved a significant increase in the total caloric ingestion. It is recommended that programs be implemented-to improve the ingestion of foods among these patients.


Assuntos
Nutrição Enteral , Neoplasias de Cabeça e Pescoço/terapia , Terapia Nutricional , Administração Oral , Índice de Massa Corporal , Interpretação Estatística de Dados , Dieta , Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Radioterapia/efeitos adversos , Dosagem Radioterapêutica
3.
Dis Colon Rectum ; 43(2): 257-60, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10696901

RESUMO

We report a case of a highly recurrent giant perianal condyloma, or Buschke-Lowenstein tumor, which was successfully treated by telecobalt therapy. We conclude that radiation therapy is an optional treatment modality for the management of giant perianal condylomata in selected cases.


Assuntos
Doenças do Ânus/radioterapia , Condiloma Acuminado/radioterapia , Adulto , Doenças do Ânus/patologia , Biópsia , Condiloma Acuminado/patologia , Humanos , Masculino , Recidiva
5.
Dis Colon Rectum ; 41(9): 1087-96, 1998 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9749491

RESUMO

INTRODUCTION: The aim of this study was to evaluate the impact of combined radiotherapy and chemotherapy (leucovorin and 5-fluorouracil) on the treatment of potentially resectable low rectal cancer using the following end points: 1) toxicity of this combined modality regimen; 2) clinical and pathologic response rate and local control; 3) down-staging of the tumor and its influence on the number of sphincter-saving operations; 4) disease-free interval, patterns of relapse, and overall survival. METHODS: From 1991 to 1996, 118 patients with potentially resectable cases of histologically proven adenocarcinoma and no distant metastases were enrolled into this protocol. All patients were evaluated by clinical and proctologic examination, abdominal computed tomography, transrectal ultrasound, and chest radiography. Therapy consisted of 5,040 cGy (6 weeks) and concurrent leucovorin (20/mg/m2/day) with bolus doses of 5-fluorouracil administered intravenously at 425 mg/m2/day for three consecutive days on the first and last three days of radiation therapy. After two months, all patients underwent repeat evaluation and biopsy of any suspected residual lesions or scar tissue. RESULTS: Median follow-up was 36 months. Toxicity of chemotherapy regimen was minimum. Thirty-six patients (30.5 percent) were classified as being complete responders. In six of these patients, complete response was confirmed by the absence of tumor in the surgical specimens (3 abdominoperineal resections and 3 proctosigmoidectomies with coloanal anastomosis). In the remaining 30 patients, confirmation of a complete response was made by the absence of symptoms, negative findings on physical examination, and biopsy, transrectal ultrasound, and pelvic computed tomographic test results during follow-up. Eighty-two patients (69.4 percent) were considered incomplete responders. Residual lesions had already been identified during the first examination in 74 patients. In the other eight patients, residual tumor was only identified after 3 to 14 months. All patients underwent surgical treatment, except one patient who refused surgery. Eighty-seven patients underwent 90 surgical procedures: local excision, 9; coloanal anastomosis, 36; abdominoperineal resection, 4; Hartmann's procedure, 1. Isolated local recurrences occurred in five patients (4.3 percent) and combined local and distant failure in eight patients (6.7 percent). Ninety patients are alive and disease-free at a median follow-up of 36 months. CONCLUSIONS: Combined up-front chemoradiotherapy was associated with tolerable and acceptable side effects. A significant number of patients had complete disappearance of their tumors (30.5 percent) within a median follow-up of 36 months. This regimen spared 26.2 percent of patients from surgical treatment and allowed sphincter-saving management in 38.1 percent of patients who may have required abdominoperineal resection. Preliminary results of this trial suggests a reduction in the number of local recurrences and reinforces the concept that infiltrative low rectal cancer may be initially treated by chemoradiotherapy.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Retais/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Seguimentos , Humanos , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radioterapia Adjuvante , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/mortalidade , Neoplasias Retais/radioterapia , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
6.
Artigo em Português | MEDLINE | ID: mdl-9008933

RESUMO

With the aim of assessing the possible benefits of nutritional therapy, 140 patients were prospectively studied during radiotherapy of the head and neck (81%) and esophageal cancer (19%). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 +/- 45 days. Tube feeding was the primary modality in 50.7% of the population, and oral regimens in the remaining 49.3%, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100%, and a lymphocyte count diminished along this period (1933 +/- 1033 vs 1265 +/- 688, p. 0.001). A subjective improvement was reported by 84% of the population, and total calorie intake, that was below 60% of estimated needs in 100% of the cases initially, significantly improved to just 40% inadequate at the end of the observations. Radiotherapy was associated with mucositis in 21% of the patients, taste changes in 79%, xerostomy in 81%, anorexia in 66% and odinophagia in 59%. In the individuals selected for enteral feeding, side-effects were represented by technical problems (20%) and gastrointestinal disorders (13%). All patients completed the nutritional support program and there was no mortality in this series. It is concluded that; 1) Early nutritional support during radiotherapy was able to maintain or improve the nutritional status; 2) Tube feeding, alone or in combination with oral diets, was indicated whenever appropriate and contributed to fulfillment of the energy requirements; 3) Reduction of total lymphocytes could not be prevented by the mentioned therapy; 4) Complications of enteral alimentation were mild and affected a small proportion of the population; 5) Troubles induced by radiotherapy were as frequent as expected, and tended to disturb the intake of food; 6) The compliance to the therapeutic plan was excellent and can be attributed to the efforts of the multidisciplinary team as well as to the help of the specialized home alimentation unit (PROSNED): Diet therapy. Cancer. Nutritional assessment. Radiotherapy. Nutritional support.


Assuntos
Neoplasias Esofágicas/dietoterapia , Neoplasias de Cabeça e Pescoço/dietoterapia , Distúrbios Nutricionais/prevenção & controle , Apoio Nutricional , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/radioterapia , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Nutricional , Estudos Prospectivos , Albumina Sérica/análise
7.
Rev Hosp Clin Fac Med Sao Paulo ; 50(3): 133-5, 1995.
Artigo em Português | MEDLINE | ID: mdl-8525253

RESUMO

Antioxidants and free radical scavengers are molecules endowed with the ability of neutralizing reactive oxygen species that may accumulate in the organism during various pathologic processes. In circumstances of peroxidation of lipids and damage to enzymatic chains, cell membranes and other structures may be followed by functional losses and even cell death. Many antioxidants are normal constituents of the diet in the form of vitamins, trace elements and amino acids, and other useful properties cannot be easily distinguished from their free-radical scavenging abilities. Much controversy surrounds also the indications of these substances, both for prophylactic and therapeutic purposes. The first large-scale population studies have only recently been arranged, and additional investigations are required in many promising areas, including cancer patients undergoing chemo and radiotherapy.


Assuntos
Antioxidantes/uso terapêutico , Neoplasias/terapia , Apoio Nutricional , Consumo de Oxigênio , Radicais Livres/metabolismo , Humanos
8.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 40(3): 143-9, jul.-set. 1994. tab
Artigo em Português | LILACS | ID: lil-143886

RESUMO

O emprego da radioterapia abdominal pode ocasionar a enterite actínica aguda. A utilizaçäo de formulaçöes nutricionais especiais tem sido proposta a fim de proteger o intestino durante e após a irradiaçäo. OBJETIVO. Avaliar histologicamente o efeito protetor de dietas polimétricas e elementares enriquecidas com glutamina na prevençäo da enterite actínica aguda. MÉTODOS. Foram estudados 65 ratos machos, adultos, da raça Wistar, monitorizados diariamente quanto à ingestäo e às variaçöes de peso corpóreo. Os animais foram randomizados em três grupos e alimentados com dietas isocalóricas e isonitrogenadas: 1) CRt - dieta polimérica com caseína enriquecida com glutamina a 2 por cento; e 3) ERt - dieta elementar enriquecida com glutamina a 2 por cento. O experimento constou de períodos de adaptaçäo (7 dias), de irradiaçäo (5 dias) e de recuperaçäo (3 dias). Após a adapataçäo alimentar, todos os ratos receberam irradiaçäo abdominal fracionada em 5 doses diárias de 300cGy.quatro dias após o término da irradiaçäo, os ratos foram operados para ressecar o intestino delgado e o cólon para estudo histopatológico. RESULTADOS. Os grupos ERt e GRt apresentaram número significativamente maior de ratos com aumento da celularidade, do número de mitoses e médias superiores de altura das vilosidades em comparaçäo à CRt no intestino delgado. O grupo ERt apresentou, ainda maior número de ratos com relaçäo das alturas vilosidade-cripta normal do que os grupos CRt ou GRt, que näo apresentaram diferença estatística entre si. No intestino grosso, as médias de altura das criptas dos grupos ERt e GRt foram iguais e superiores às de CRt; os três grupos näo apresentaram, porém, diferença significante em relaçäo à celularidade epitelial e ao número de mitoses nas criptas do cólon. CONCLUSAO. Nas condiçöes do presente trabalho, a suplementaçäo alimentar com glutamina antes, durante e após a irradiaçäo abdominal em ratos, em dieta polimérica ou elementar, determinou efeitos protetores sobre o intestino irradiado, preservando sua arquitetura morfológica e a capacidade de recuperaçäo, sobretudo no intestino delgado


Assuntos
Ratos , Animais , Masculino , Enterocolite/tratamento farmacológico , Glutamina/uso terapêutico , Radioterapia/efeitos adversos , Alimentos Formulados/efeitos adversos , Ratos Wistar , Doença Aguda
9.
Rev Assoc Med Bras (1992) ; 40(3): 143-9, 1994.
Artigo em Português | MEDLINE | ID: mdl-7787863

RESUMO

Radiotherapy plays nowadays an important role in malignancies treatment. However, collateral effects and severe complications owing to cellular damage of peritumoral tissues may occur. Different nutritional resources have been recently indicated to achieve intestinal protection during cancer irradiation. PURPOSE--The aim of this study was to set the role of glutamine and elemental diets in acute actinic enteritis prevention. METHOD--Sixty-five adult male Wistar rats with average weight of 200g were maintained in individual metabolic cages; daily body weight and food ingestion were carefully monitored. The animals were randomized into three groups and fed isocaloric and isonitrogenous diets: 1) CRt-polymeric-casein diet; 2) GRt-polymeric-casein diet supplemented with 2% glutamine and 3) ERt-elemental diet supplemented with 2% glutamine. After an adaptation period (seven days), all rats received abdominal radiation in five daily doses of 300cGy. Four days after the rats were operated on to resect the small intestine and colon for histological evaluation. RESULTS--Small intestine histological data in ERt and GRt rats were better than CRt rats, by preserving mucosal cellularity and increasing mitosis number and villi length. Simultaneously, ERt group had greater number of rats with normal villus-crypt relation than CRt or GRt groups. Large intestine histological data showed that the average crypts length in ERt and GRt rats were greater than in CRt ones. CONCLUSION--Glutamine-supplemented polymeric or elemental diets given to rats before, during and after abdominal radiotherapy showed protective effects against radiation injury, by supporting mucosal structure and recovery.


Assuntos
Enterocolite/prevenção & controle , Alimentos Formulados , Glutamina/uso terapêutico , Doença Aguda , Animais , Caseínas/uso terapêutico , Enterocolite/etiologia , Intestino Grosso/citologia , Intestino Delgado/citologia , Masculino , Mitose , Lesões Experimentais por Radiação/prevenção & controle , Radioterapia/efeitos adversos , Ratos , Ratos Wistar
10.
Dis Colon Rectum ; 32(9): 773-7, 1989 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-2503342

RESUMO

Thirty consecutive patients with epidermoid carcinomas of the anal canal larger than 2 cm were treated with the concomitant application of radiation and two cycles of chemotherapy (5FU and mitomycin-C) between January 1982 and January 1988. Twenty-eight patients were treated with curative intention and two for palliation only. All patients were reexamined after a period of one to 2 months, under light general anesthesia, and any residual tumor or scar tissue was biopsied. Control biopsy was positive in eight patients. Three of six patients who had abdominoperineal excision died from locoregional recurrence; the remaining are alive and cancer free after 1 to 4 years. Two patients had local excision; one is alive and the other died of other cancer metastasis four years later. Seventeen patients who had negative biopsies are alive and free of disease after 1 to 5 years; two died of unrelated causes, two died with distant metastasis (present prior to treatment), and one died with locoregional recurrence. Locoregional failures occurred in four patients (13.3 percent) in the entire series. Individualization of each patient, adjustment of doses, and carefully executed radiation and chemotherapy are the most important points for the success of treatment.


Assuntos
Neoplasias do Ânus/tratamento farmacológico , Neoplasias do Ânus/radioterapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina , Mitomicinas/administração & dosagem , Metástase Neoplásica , Recidiva Local de Neoplasia , Prognóstico
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