RESUMO
PURPOSE: Analyse outcomes of stage-I inoperable endometrial cancer (EC) patients from seven European centres treated with 3D-image-guided brachytherapy (IGBT) alone. MATERIALS AND METHODS: From 2004 to 2018, 62 patients (41 stage-IA and 21 IB) were retrospectively studied, analysing anaesthetic procedure, applicator type, BT-planning imaging, clinical target volume (CTV), BT schedule, overall daily-dose equivalent to 2 Gy (EQD2(α/ß=4.5 or 3)) to the CTV(α/ß=4.5) and D2 cm3(α/ß=3) for organs at risk. Complications were evaluated using CTCAEv4 scores. The 2 and 5 year survival was calculated [cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS)]. Descriptive analysis and the Kaplan-Meier method were used for survival analysis. RESULTS: Mean follow-up: 32.8 months (SD 33.7). Spinal anaesthesia (38/62) followed by none (16/62) were the most common. Y-shaped Rotte applicators were used in 74% of patients. High-dose rate brachytherapy was administered in 89%. Median D90 to the CTV was 58.9 Gy (8.66-144 Gy). Eight patients presented relapse: four uterine, four nodal and four distant. The 2 and 5 year CSS was 93.3 and 80.5%, DFS 84.8 and 80.5%, LRFS was 93.1 and 88.7%, LRRFS was 91 and 91% and DMFS was 90.2 and 90.2%, respectively, CSS was better in stage-IA vs. IB (p = 0.043). Late vaginal and bladder G3-complication rates were 2.1%, respectively. CONCLUSION: Inoperable EC patients can be safely treated by BT with 2 and 5 year CSS of 93 and 80.5%, respectively, with even better results for IA cases. Prospective studies on 3D-IGBT are necessary to better analyse EC patient outcomes based on dose and treated volumes.
Assuntos
Braquiterapia/métodos , Neoplasias do Endométrio/radioterapia , Imageamento Tridimensional , Radioterapia Guiada por Imagem , Neoplasias Uterinas/radioterapia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
PURPOSE: Radiotherapy (RT) causes an inflammatory reaction of the tissue which leads to fibrosis and reduced functioning of the pelvic organs. Few studies have shown significant relationships between side effects and RT in uterine tumors. Here, the urological, lymphedema, pelvic pain and gastrointestinal (GI) symptoms were studied before and after RT in patients with primary uterine tumors using the EORTC QLQ-EN24, specifically designed for uterine cancer patients. METHODS: This prospective cohort study comprised patients with primary uterine tumors who received pelvic radiotherapy (RT). A total of 43 patients were included from May 2014 to February 2019. Patients completed the questionnaires for global health status and functioning before the start of RT and at 3 and 12 months after RT. RESULTS: We found a significant worsening of the urological symptoms 3 months after RT which persisted up to 12 months after RT compared to baseline values prior to start of RT (p = 0.007). An exacerbation of the urinary symptoms was seen in patients with vaginal brachytherapy/boost compared to patients with pelvic RT at 12 months after RT (p = 0.053). The severity of lymphedema symptoms increased from RT start to 12 months after RT (p = 0.019) and the pelvic pain were higher at 3 months after RT compared to before RT (p = 0.004). Also, the level of GI symptoms was significantly higher 12 months after RT compared to the RT start (p < 0.001). CONCLUSIONS: The urologic, lymphedema, pelvic pain and GI symptoms all increase after RT.
Assuntos
Diarreia/etiologia , Linfedema/etiologia , Dor Pélvica/etiologia , Transtornos Urinários/etiologia , Neoplasias Uterinas/radioterapia , Adulto , Idoso , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Fracionamento da Dose de Radiação , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Radioterapia/efeitos adversos , Reirradiação/efeitos adversos , Suécia , Avaliação de Sintomas , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologiaRESUMO
BACKGROUND: Synchronous multiple primary malignancies in the female genital tract are infrequent. From 50 to 70% of them corresponds to synchronous cancers of the endometrium and ovary. To our knowledge, this is only the third case report in the international literature of three concurrent gynaecological cancers of epithelial origin. A case is presented, as well as a literature review due to the infrequency of its diagnosis and the lack of information on the subject. CLINICAL CASE: A 49-year-old woman, with previous gynaecological history of ovarian endometriosis. She underwent a hysterectomy and bilateral oophorectomy, as she had been diagnosed with endometrial hyperplasia with atypia. The final histopathology reported synchronous ovarian, Fallopian tube, and endometrial cancer. An extension study and complete surgical staging was performed, both being negative. She received adjuvant treatment of chemotherapy and radiotherapy. She is currently free of disease. CONCLUSIONS: The aetiology is uncertain. There is controversy relating to increased susceptibility of synchronous neoplasms to pelvic endometriosis and inherited genetic syndromes. Its diagnosis needs to differentiate them from metastatic disease. Additionally, they are problematical from a clinical, diagnostic, therapeutic, and prognostic point of view. The presentation of more cases of triple synchronous cancers is necessary for a complete adjuvant and surgical treatment.
Assuntos
Adenocarcinoma , Neoplasias das Tubas Uterinas , Neoplasias Primárias Múltiplas , Neoplasias Ovarianas , Neoplasias Uterinas , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Carcinoma Endometrioide/tratamento farmacológico , Carcinoma Endometrioide/radioterapia , Carcinoma Endometrioide/cirurgia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Terapia Combinada , Endometriose/complicações , Endometriose/tratamento farmacológico , Endometriose/radioterapia , Endometriose/cirurgia , Neoplasias das Tubas Uterinas/tratamento farmacológico , Neoplasias das Tubas Uterinas/radioterapia , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/radioterapia , Neoplasias Primárias Múltiplas/cirurgia , Doenças Ovarianas/complicações , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/radioterapia , Doenças Ovarianas/cirurgia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/radioterapia , Neoplasias Ovarianas/cirurgia , Ovariectomia , Paclitaxel/administração & dosagem , Radioterapia Adjuvante , Salpingectomia , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/radioterapia , Neoplasias Uterinas/cirurgiaRESUMO
OBJECTIVE: To give validity to the claim that Eva Perón underwent a prefrontal lobotomy and/or another neurosurgical procedure. METHODS: 1) Press interviews given by Dr. George Udvarhelyi, who passed away in 2010, were read and his statements were crosschecked with excerpts of his memoirs; 2) Searched for other oral and written evidence in Argentina; 3) Reviewed radiological evidence and recent revelations about her illness and death; and 4) Carried out historic review of prefrontal lobotomy as an accepted and established surgical treatment during the relevant time period and place. RESULTS: Udvarhelyi's assertion in a press interview that a prefrontal lobotomy was performed on Eva Perón is consistent with the history he penned in his memoirs. Interviews with individuals close to Eva conducted by historians, revealed a clinical picture compatible with side effects from such an operation. Comments from surgeon Dr. Ricardo Finochietto, leader of the group of physicians involved in Eva's medical care, provide further support that a neurosurgical procedure was performed. President Perón's orders and instructions to the medical team also support this allegation. Review of skull radiographs show findings compatible with burr holes. Photographs of the patient at the end of her illness show indentation at the coronal level. The alleged procedure was cutting edge of surgery in 1952. The Argentine neurosurgical establishment was up to par in psychosurgical developments and there were neurosurgeons close to Perón that could have performed the procedure in those circumstances. CONCLUSIONS: Evidence was found that gives validity to Dr. George Udvarhelyi's claim that Eva Perón underwent a neurosurgical prefrontal lobotomy in Buenos Aires, Argentina. This was done for treatment of pain, anxiety, and agitation secondary to uterine metastatic cancer before her death in 1952. Neurosurgeon Dr. James L. Poppen appears to have been involved in the case.
Assuntos
Neurocirurgia/história , Psicocirurgia/história , Ansiedade/psicologia , Argentina , Biópsia , Pessoas Famosas , Feminino , História do Século XX , Humanos , Pessoa de Meia-Idade , Manejo da Dor , Agitação Psicomotora/psicologia , Psicocirurgia/efeitos adversos , Radiografia , Crânio/diagnóstico por imagem , Neoplasias Uterinas/complicações , Neoplasias Uterinas/radioterapiaRESUMO
Metastasis of uterine leiomyosarcoma to the pancreas is rare. A 46-year-old woman was diagnosed with uterine leiomyosarcoma and underwent surgery. Thereafter, recurrences in the lung and subsequently in the pancreas were diagnosed. These lesions were resected and diagnosed as metastasis of uterine leiomyosarcoma. We report a rare case of uterine leiomyosarcoma with metastasis to the lung and pancreas, both of which were resected using aggressive surgery.
Assuntos
Leiomiossarcoma/secundário , Neoplasias Pancreáticas/secundário , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Neoplasias Uterinas/patologia , Feminino , Humanos , Leiomiossarcoma/radioterapia , Leiomiossarcoma/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Neoplasias Uterinas/radioterapia , Neoplasias Uterinas/cirurgiaRESUMO
PURPOSE: Uterine tumours with a sarcomatous component are rare neoplasms with a wide pathologic heterogeneity in which the stage is the main prognostic factor. These aspects and their aggressiveness make the analysis of prognostic factors and radiotherapy difficult. The aim of this study was to evaluate the prognostic factors by stages and to assess the impact of prognostic factors and the effect of radiotherapy on the outcome of the disease. METHODS AND MATERIALS: Eighty-one patients diagnosed and treated for uterine tumours with a sarcomatous component at the Hospital Clinic in Barcelona between 1975 and 2003 were retrospectively studied; 76/81 patients underwent surgery (total hysterectomy plus bilateral salpingo-oophorectomy, and in 13/76 of these patients an additional pelvic lymphadenectomy was performed). All 76 patients were staged after pathological evaluation of the surgical specimen by FIGO classification with 54 patients being stages I-II and 27 patients stages III-IVA. Only 5 patients were clinically staged as III-IVA. Radiotherapy was administered in 21 women with early-stage tumours and in 16 with advanced neoplasms. 5/81 patients received complementary chemotherapy to the surgery and 5 patients received chemotherapy as treatment of local and distant relapse (All the patients were treated with a different chemotherapy schedule). The impact of pathologic prognostic factors and radiotherapy on specific overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) were analysed by Log Rank test and Cox proportional risk models. The effect of each risk factor was studied by the hazard ratio and 95% confidence interval. RESULTS: An increased frequency of several adverse prognostic factors was observed in tumours with advanced stages compared to early neoplasms in deep myometrial invasion (83% vs. 27%), VLSI (75% vs. 29%), tumour size >8 cm (50% vs. 30%) and multicentricity (36% vs. 10%), and similar values were found for necrosis (79% vs. 78%) and high mitotic index (78% vs. 80%). For pathological type the frequency by advanced vs. early stages was 54% vs. 52% for carcinosarcomas, 33.5% vs. 17.5% for leiomyosarcoma, and 30.5% and 12.5% for adenosarcoma and endometrial stromal sarcoma, respectively. Univariate analysis showed that the stage was the only independent prognostic factor. Stratification by early (I-II) and advanced stages (III, IV) revealed tumour size >8 cm was the only prognostic factor significantly associated with OS, DFS, LRFS and DMFS on univariate analysis for early stages (HR: OS 2.52, DFS 3.10, LRFS 3.10 and DMFS 2.63). For advanced stages, radiotherapy was the only prognostic factor associated with OS, DFS, LRFS and DMFS on multivariate analysis (HR: OS 4.26, DFS 3.14, LRFS 3.25 and DMFS 3.66). CONCLUSIONS: Uterine tumours with a sarcomatous component have a poor outcome in spite of treatment in comparison to endometrial carcinoma, probably due to the higher frequency of adverse prognostic factors. In early stages tumour size was the most determining factor for OS, DFS, LRFS and DMFS. Radiotherapy significantly improved these survivals in advanced cases.
Assuntos
Carcinossarcoma/radioterapia , Leiomiossarcoma/radioterapia , Neoplasias Uterinas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinossarcoma/secundário , Feminino , Humanos , Leiomiossarcoma/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias Uterinas/patologiaRESUMO
This is a qualitiative study that aimed to know the perception of women with uterine-cervical cancer on the radiotherapy, describing the physical and daily alterations they suffered and evidencing the their coping to face these adversities and their expectations about the treatment. 20 women in a specialized hospital had been interviewed, located in the city of Teresina-PI. The results showed that they perceive the radiotherapy as a good treatment, although the fear ahead of the stranger and the limitations in the daily one, had to the side-effects, that are faced with support in the religious and the social-familiar scope, increasing the cure expectation. The importance of the orientation to these women for the multiprofessional team showed, especially the Nurse, in all the phases of the treatment.
Assuntos
Neoplasias do Colo do Útero/psicologia , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Uterinas/psicologia , Neoplasias Uterinas/radioterapia , Adulto JovemRESUMO
Realizou-se um estudo qualitaitvo com objetivo de conhecer a percepção das mulheres com câncer cérvico-uterino sobre a radioterapia, descrevendo as alterações físicas e cotidianas sofridas e evidenciando meios de enfrentamento e expectativas em relação ao tratamento. Foram entrevistadas 20 mulheres em um hospital especializado, localizado na cidade de Teresina-PI. Os resultados mostraram que elas percebem a radioterapia como um bom tratamento, apesar do medo diante do desconhecido e das limitações no cotidiano, devido aos efeitos colaterais, que são enfrentados com suporte na religiosidade e no âmbito sócio-familiar, aumentando a expectativa de cura. Revelou-se a importância da orientação a essas mulheres pela equipe multiprofissional, especialmente o Enfermeiro, em todas as fases do tratamento.
This is a qualitiative study that aimed to know the perception of women with uterine-cervical cancer on the radiotherapy, describing the physical and daily alterations they suffered and evidencing the their coping to face these adversities and their expectations about the treatment. 20 women in a specialized hospital had been interviewed, located in the city of Teresina-PI. The results showed that they perceive the radiotherapy as a good treatment, although the fear ahead of the stranger and the limitations in the daily one, had to the side-effects, that are faced with support in the religious and the social-familiar scope, increasing the cure expectation. The importance of the orientation to these women for the multiprofessional team showed, especially the Nurse, in all the phases of the treatment.
Se realizó un estudio con abordaje cualitativo objetivando conocer la percepción de las mujeres con cáncer cérvico-uterino sobre la radioterapia, describiendo las alteraciones físicas y cotidianas sufridas y evidenciando el medio utilizado para que enfrenten esas adversidades y sus expectativas con relación al tratamiento. Fueron entrevistadas 20 mujeres en un hospital especializado, localizado en la ciudad de Teresina-PI. Los resultados mostraron que ellas perciben la radioterapia como un buen tratamiento, a pesar del miedo delante de lo desconocido y de las limitaciones en el cotidiano, debido a los efectos colaterales, que son enfrentados con base en la religiosidad y en el ámbito socio-familiar, aumentando la expectativa de cura. Se reveló la importancia de la orientación a esas mujeres por el equipo multiprofesional, especialmente el Enfermero, en todas las fases del tratamiento.
Assuntos
Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias do Colo do Útero/psicologia , Neoplasias do Colo do Útero/radioterapia , Neoplasias Uterinas/psicologia , Neoplasias Uterinas/radioterapia , Adulto JovemRESUMO
Neste estudo, busquei compreender as vivências de mulheres portadoras de câncer uterino antes de submeterem ao tratamento braquiterápico. Trata-se de uma pesquisa qualitativa embasada na fenomenologia existencial de Martin Heidegger que possibilitou a apreensão dos momentos vividos por esses seres. Para participar dessa pesquisa, procurei por mulheres que haviam iniciado algum tipo de tratamento para câncer uterino. Selecionei aquelas que se submeteram à radioterapia em uma clínica de radioterapia situada no noroeste do Paraná, e, a posteriori, seriam submetidas à braquiterapia no período compreendido entre os meses de abril a maio de 2006. Foram entrevistadas quatro mulheres em um hospital especialista em oncologia no norte do Paraná, antes de iniciarem a braquiterapia. Para buscar os discursos dos sujeitos, utilizei a seguinte questão norteadora: "O que você sente antes de vivenciar a braquiterapia?" Da interpretação emergiram três temáticas: O ser-com-o-outro inautêntico no convívio do hospital; angústia ante o desconhecimento do tratamento; religiosidade: o caminho da esperança. Os resultados obtidos revelam a importância do cuidado holístico ao Ser que vivencia esta facticidade, pois, muitas vezes, a subjetividade do cuidado fica absorvida pela massificação das regras e normas institucionais.
Experiences of females with uterine cancer have been analyzed prior to brachytherapy treatment. The qualitative research has been foregrounded on Martin Heideggerïs existential phenomenology which favors the understanding of instances experienced by the patients. Females who had already initiated some type of treatment for uterine cancer were investigated, although only those undertaken radiotherapy in a specific radiotherapy clinic in the northwestern section of the state of Paraná/Brazil, have been selected. They would later have to undergo brachytherapy treatment which occurred between April and May 2006. Four females were interviewed in an oncology hospital in the north of the state of Paraná, Brazil, prior to brachytherapy treatment. The following question was asked to elicit the subjectsï discourse: "What are your feelings prior to brachytherapy?" Three themes were categorized: the non-authentic being-with-the-other in the hospital; anxiety in the face of the unknown therapy; religiosity or the way to hope. Results show the importance of holistic care to the person experiencing the facts since the subjectivity of care is absorbed by the huge number of rules and institutional norms.
Resumen: En este estudio, busqué comprender las vivencias de mujeres portadoras de cáncer uterino antes de someterse al tratamiento braquiterápico. Se trata de una investigación cualitativa embasada en la fenomenología existencial de Martín Heidegger que posibilitó la aprensión de los momentos vividos por esos seres. Para participar de esa investigación, busqué por mujeres que habían iniciado algún tipo de tratamiento para cáncer uterino. Seleccioné aquellas que se sometieron a la radioterapia en una clínica de radioterapia situada en el noroeste de Paraná, y, después, serían sometidas a braquiterapia en el período comprendido entre los meses de abril y mayo de 2006. Fueron encuestadas cuatro mujeres en un hospital especialista en oncología en el norte del Paraná, antes de iniciar la braquiterapia. Para buscar los discursos de los sujetos, utilicé la pregunta clave: "¿Qué siente usted antes de vivenciar la braquiterapia?" De la interpretación emergieron tres temáticas: El ser-con-el-otro inauténtico en el convivencia del hospital; angustia frente al desconocimiento del tratamiento; religiosidad: el camino de la esperanza. Los resultados obtenidos enseñaron la importancia del cuidado holístico al Ser que vivencia esta fatalidad, pues, muchas veces, la subjetividad del cuidado queda absorbida por la masificación de las reglas y normas institucionales.
Assuntos
Humanos , Feminino , Acontecimentos que Mudam a Vida , Braquiterapia/enfermagem , Braquiterapia/psicologia , Neoplasias Uterinas/radioterapiaRESUMO
Malignant mixed Mullerian tumours (MMMTs) are rare neoplasms, highly aggressive and with an extremely poor prognosis, usually arising in elderly postmenopausal women and presenting at an advanced stage. MMMTs derive from the mullerian mesodermus that differentiates in epithelial and stromal elements, both malignant elements. The clinic pathological features of 3 uterine MMMTs are reported here. The patients ranged in age from 25 to 69 years. The initial manifestations were mainly bloody discharge, abdominal pain and increase of the volume of the uterus. Treatment in 2 patients was hysterectomy with double ooforectomy, and resection of the pelvic mass was the treatment in the third case. Adjuvant radio chemotherapy was administrated in 2 of the 3 cases. Follow-up revealed recurrent pelvic tumour in 1 patient at 59 months, and breast metastases at 20 months in the second one. Because of the high incidence of recurrence and poor prognosis of these tumours, they should be studied and managed by a multidisciplinary team composed by surgeons, oncologists, radiotherapists and pathologists.