1
|
Pra AD, Lyness J, Pollack A, Tran PT, Koontz BF, Abramowitz MC, Mahal BA, Martin AG, Michalski JM, Balogh A, Lukka H, Faria SL, Rodrigues G, Beauchemin MC, Lee RJ, Seaward SA, Coen SD, Allen AM, Pugh S, Feng FY. Impact of Testosterone Recovery on Clinical Outcomes of Patients Treated with Salvage Radiotherapy and Androgen Suppression: A Secondary Analysis of the NRG/RTOG 0534 Sport Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:S82-S83. [PMID: 37784585 DOI: 10.1016/j.ijrobp.2023.06.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Testosterone (T) kinetics and its relationship with clinical outcomes has not been studied in trials using salvage radiotherapy and androgen deprivation therapy (ADT). We performed a secondary analysis of the NRG Oncology/RTOG 0534 SPPORT trial, which compared prostate bed radiotherapy (PBRT) (arm 1), PBRT + short-term androgen deprivation therapy (ADT) (arm 2), or PBRT + pelvic lymph node radiotherapy (PLNRT) + short-term ADT (arm 3). We assessed longitudinal serum T levels and the impact of testosterone recovery (TR) on clinical outcomes. MATERIALS/METHODS ADT was given for 4-6 months in arms 2 and 3, starting 2 months prior to radiotherapy. The trial excluded patients with baseline T < 40% of the lower limit of normal. TR was defined in 3 ways: 1) return to non-castrate level (>50 ng/dL), 2) return to normal level (>300 ng/dL), and 3) return to baseline level. Time to TR was estimated using cumulative incidence and death without an event considered a competing risk. Unadjusted and adjusted hazard ratios and 95% confidence intervals (CIs) were calculated using Cox proportional hazards model. Freedom from progression (FFP) was defined as biochemical failure according to the Phoenix definition (PSA ≥2 ng/mL over the nadir PSA), clinical failure (local, regional, or distant), or death from any cause. RESULTS A total of 1699 patients with T at baseline and at least 1 follow-up assessment were included. The median age was 64 years (IQR 59 - 69), 12.8% were black, 14.9% had diabetes, and 54.1% were former or current smokers. Median baseline T in arms 1, 2 and 3 was 320 ng/dL (IQR 239 - 424), 319 ng/dL (IQR 237 - 438) and 330 ng/dL (IQR 252 - 446), respectively. At 6 months, median T in arms 1, 2 and 3 was 290 ng/dL (IQR 210 - 390), 190.4 ng/dL (IQR 66 - 296) and 191 ng/dL (IQR 40.5 - 313). At 2 years, in arms 2 and 3, TR to non-castrate, normal and baseline levels were 95%, 55% and 23%, respectively. At 5 years, in arms 2 and 3, TR to non-castrate, normal and baseline levels were 98%, 73% and 42%, respectively. FFP was superior in arms 2 and 3 vs. arm 1 in patients with TR by all three definitions. In patients with recovered T to normal levels by 2 years (n = 904), the 5-year FFP rates were 71.8% (95% CI 66.9-76.6) in arm 1, 77.2% (72.1-82.2) in arm 2, and 86.3% (82.3-90.3) in arm 3 (arm 2 vs arm 1: HR 0.74, 95% CI 0.56-0.98, p = 0.034; arm 3 vs arm 1: HR 0.54, 95% CI 0.40-0.72, p<.0001). CONCLUSION This work represents the largest study of T kinetics in patients treated with salvage radiation and ADT. Approximately half of patients did not normalize their T levels by 2 years. Our data validate an incremental and meaningful FFP benefit of adding short-term ADT and PLNRT to PBRT independent of T recovery.
Collapse
Affiliation(s)
- A Dal Pra
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - J Lyness
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - A Pollack
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - M C Abramowitz
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - B A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - A G Martin
- Department of Radiation Oncology CHU de Québec-Université Laval, Québec, QC, Canada
| | - J M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - A Balogh
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | - H Lukka
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - S L Faria
- McGill University Health Centre, Montreal, QC, Canada
| | - G Rodrigues
- London Health Sciences Centre, London, ON, Canada
| | - M C Beauchemin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - R J Lee
- Intermountain Medical Center, Murray, UT
| | | | - S D Coen
- Southeast Clinical Oncology Research Consortium, Winston Salem, NC
| | - A M Allen
- Rabin Medical Center - Beilinson Hospital, Petah Tickva, Israel
| | - S Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| |
Collapse
|
2
|
Lee WR, Dignam JJ, Amin M, Bruner DW, Low D, Swanson GP, Shah AB, D'Souza DP, Michalski JM, Dayes I, Seaward SA, Hall WA, Nguyen PL, Pisansky TM, Faria SL, Chen Y, Rodgers J, Sandler HM. Long-Term Follow-Up Analysis of NRG Oncology RTOG 0415: A Randomized Phase III Non-Inferiority Study Comparing Two Fractionation Schedules in Patients with Favorable-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S3-S4. [PMID: 37784471 DOI: 10.1016/j.ijrobp.2023.06.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess whether the efficacy of a hypofractionated (H) schedule is no worse than a conventional (C) schedule in men with low-risk prostate cancer. MATERIALS/METHODS Accrual began April 2006 and ended in December 2009. 1115 men with favorable-risk prostate cancer were randomly assigned 1:1 to a conventional (C) schedule (73.8 Gy in 41 fractions over 8.2 weeks) or to a hypofractionated (H) schedule (70 Gy in 28 fractions over 5.6 weeks). The trial was designed to establish with 90% power and alpha = 0.05 that (H) results in 5-year disease-free survival (DFS) that is not lower than (C) by more than 7% (hazard ratio (HR) < 1.52). Protocol specified secondary endpoints evaluated for noninferiority include: biochemical recurrence (BR), local progression, disease-specific survival, and overall survival. RESULTS One thousand ninety-two protocol eligible men were analyzed: 542 to C and 550 to H. Median follow-up is 12.75 years. Baseline characteristics were not different according to treatment arm. The estimated 12-year DFS is 56.1% (95% CI 51.5, 60.5) in the C arm and 61.8% (57.2, 66.0) in the H arm. The DFS hazard ratio (H/C) is 0.85 (0.71-1.03), confirming non-inferiority (p<0.001). Twelve-year cumulative incidence of biochemical recurrence (BR) was 17.0% (CI 13.8, 20.5) in the C-RT and 9.9% (CI 7.5, 12.6) in the H-RT arm; (HR = 0.56, (0.40-0.78) suggesting improved efficacy with H. Additional pre-specified secondary endpoints were non-inferior Late Grade ≥ 3 GI toxicity is 3.2% (C) vs. 4.4% (H), Relative risk (RR) for H vs. C 1.39 (CI 0.75, 2.55) Late Grade ≥ 3 GU toxicity is 3.4% (C) vs. 4.2% (H), RR = 1.26 (CI 0.69, 2.30). CONCLUSION In men with favorable-risk prostate cancer, long-term disease-free survival is non-inferior with 70 Gy in 28 fractions compared to 73.8 Gy in 41 fractions. The risk of BR is reduced with moderate hypofractionation. No differences in late Grade ≥3 GI/GU toxicity were observed between the arms. (ClinicalTrials.gov identifier: NCT00331773).
Collapse
Affiliation(s)
- W R Lee
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - J J Dignam
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - M Amin
- University of Tennessee Health Science Center, Memphis, TN
| | | | - D Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | | | - A B Shah
- York Cancer Center, York, PA, United States
| | - D P D'Souza
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - J M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - I Dayes
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - P L Nguyen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - T M Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S L Faria
- McGill University Health Centre, Montreal, QC, Canada
| | - Y Chen
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - J Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - H M Sandler
- Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
3
|
Asso RN, Kopek N, Duclos M, Abdulkarim BS, Connel T, Ramia P, Saidi A, Faria SL. Toxicity of Patients with Ultra-Central Thoracic Tumors Treated with Stereotactic Body Radiotherapy (SBRT) with Dose of 50 Gy in 5 Fractions. Int J Radiat Oncol Biol Phys 2023; 117:e4. [PMID: 37785333 DOI: 10.1016/j.ijrobp.2023.06.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The ideal regimen for stereotactic body radiotherapy (SBRT) in ultra-central lung tumors is still to be defined, mostly due to the risk of unacceptable or fatal toxicity. There is not much information on outcomes after SBRT for this group of patients. We summarize here our experience with ultra-central lung cancer patients treated with the dose of 50 Gy delivered in 5 fractions. MATERIALS/METHODS This study is a retrospective review of all cases of ultra-central thoracic tumors treated with SBRT with the dose of 50 Gy in 5 fractions, delivered every other day, at our institution. In all cases, as we defined ultra-central lung tumor, the PTV overlapped or touched one or more of the following structures: bronchial tree, trachea, great vessels, heart, and esophagus. Metastatic and primary lung lesions were included. The volumes of treatment were defined by 4D-CT to consider breathing motion. Normal organs constraints followed the recommendations of the RTO 0813 trial as follows: Spinal cord: max 30 Gy. Lung right or lung left: V13 Gy[cc] < 1500. Esophagus: max 52 Gy and nonadjacent esophagus: V27.5 Gy[cc] < 5. Heart: V32 Gy[cc] < 15; max 52 Gy. Great vessels: max 52 Gy and non-adjacent great vessels V47 Gy[cc] < 10. Trachea plus bronchus: max 52 Gy and non-adjacent V18 Gy[cc] < 4. Follow-up, at the discretion of the treating MD, included periodic CT scans of the thorax after SBRT and assessment of radiation-induced toxicity scored with CTCv3.0. RESULTS Between December 2015 and February 2022, 86 patients were eligible for this review. Median follow-up was 17 months (range: 1-76 months); the median age was 74 years (range: 37-98 years). Histology was as follows: 50 patients had biopsy proved NSCLC, 16 had no biopsy, and 20 had metastatic non-lung primaries. Overlapped structures were as follows: with great vessels in 46 cases, heart in 20 cases, trachea/branchial tree in 18 cases, and esophagus in 2 cases. In 16 patients the overlap was present in more than one structure. Overall, 68.6% did not report acute toxicity. The most common acute side effects were fatigue (15.1%), coughing (8.1%), shortness of breath (6.9%), esophagitis (2.3%), and dysphagia (1.1%). No grade 3 or more significant toxicity was described. As acute side effects, many patients had exacerbations of the previous condition, such as shortness of breath (16 pts) or coughing (4 pts) during follow-up. Pneumonitis was found as a late side effect in four cases. One patient had empyema associated with a fistula in the non-irradiated lung, where the patient had previous surgery, but in the irradiated lung no severe complication was detected. There were no deaths attributed to the SBRT treatment. 67.5% of 86 patients were alive at the time of the review; 87.2% had local control, and 65.1% had metastases-free survival. CONCLUSION In this cohort of patients, no death or even severe acute or chronic toxicity was attributed to SBRT. SBRT seems safe for ultra-central lesions using the regimen of 50 Gy in 5 fractions with the constraints of the RTOG 0813 trial.
Collapse
Affiliation(s)
- R N Asso
- McGill University Health Centre, Montreal, QC, Canada
| | - N Kopek
- McGill University Health Centre, Division of Radiation Oncology, Montreal, QC, Canada
| | - M Duclos
- McGill University Health Centre, Division of Radiation Oncology, Montreal, QC, Canada
| | - B S Abdulkarim
- McGill University Health Centre, Division of Radiation Oncology, Montreal, QC, Canada
| | - T Connel
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - P Ramia
- American University of Beirut Medical Center, Beirut, Lebanon
| | - A Saidi
- McGill University Health Centre, Department of Radiation Oncology, Montreal, QC, Canada
| | - S L Faria
- McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
4
|
Turgeon GA, Souhami L, Kopek N, Hirsh V, Ofiara L, Faria SL. Thoracic irradiation in 3weeks for limited-stage small cell lung cancer: Is twice a day fractionation really needed? Cancer Radiother 2017; 21:89-98. [PMID: 28325618 DOI: 10.1016/j.canrad.2016.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/07/2016] [Accepted: 09/11/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Many Canadian institutions treat limited-disease small cell lung cancer with 40Gy in 15 fractions delivered once-a-day in 3weeks concomitantly with chemotherapy. This regimen is convenient and seems to be effective. Here, we report and compare with a literature review the outcomes of patients with limited-stage small cell lung cancer treated in our institution with this hypofractionated regimen. PATIENTS AND METHODS From January 2004 to December 2012, patients with limited-stage small cell lung cancer treated curatively with platinum-based chemotherapy and concurrent thoracic radiotherapy at a dose of 40Gy in 16 fractions once-a-day were eligible for this review. RESULTS Sixty-eight patients fit the analysis criteria, including ten patients with small pleural effusion. The median age was 66years old. After a median follow-up of 77months for those alive, the median survival was 28months. At 3 and 5years respectively, the locoregional control rates were 67 and 64%, while the overall survival rates were 40 and 35%. Prophylaxis cranial irradiation was delivered to 68% of the patients. Grade 2 and 3 acute esophagitis occurred in respectively 49 and 9% of the patients. There was no grade 4 radiation-induced toxicity. All patients, except for one, completed their thoracic irradiation course without interruption. CONCLUSION Once-a-day hypofractionated radiation with concurrent chemotherapy followed by prophylactic cranial irradiation is a practical regimen. Based on our experience and the published literature, it appears to be similarly effective as regimens using twice-daily fractionation in 3weeks, or once-daily in 6 to 7weeks with higher radiotherapy doses. Further prospective comparisons of hypofractionation with the current recommendations are needed.
Collapse
Affiliation(s)
- G A Turgeon
- Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada
| | - L Souhami
- Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada
| | - N Kopek
- Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada
| | - V Hirsh
- Department of Oncology, Division of Medical Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada
| | - L Ofiara
- Division of Respiratory Medicine, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada
| | - S L Faria
- Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
| |
Collapse
|
5
|
Faria SL, Ferrigno R. Hyperfractionated external radiation therapy in stage IIIB carcinoma of uterine cervix: a prospective pilot study. Int J Radiat Oncol Biol Phys 1997; 38:137-42. [PMID: 9212015 DOI: 10.1016/s0360-3016(97)00247-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Brazil has one of the highest incidence of carcinoma of the cervix in the world. Half of the patients have advanced stages at the diagnosis. Due to this large number of patients we decided to conduct a prospective pilot study to investigate the tolerance to and survival rate with hyperfractionated external radiotherapy only in patients with Stage IIIB carcinoma of the uterine cervix. METHODS AND MATERIALS Between January 1991 and December 1993, 23 patients underwent hyperfractionated external beam radiotherapy without brachytherapy. All cases were biopsy proven squamous cell carcinoma of cervix clinically Staged as IIIB (FIGO). Hyperfractionation (HFX) was given with 1.2 Gy doses, twice daily at 6-h interval, 5 days/week, to the whole pelvis up to 72 Gy within 30 working days. Complications were evaluated by an adaptation ot the RTOG Radiation Morbidity Scoring Table graded as 1 = none/mild; 2 = moderate, and 3 = severe. RESULTS Follow-up ranged from 27 to 50 months (median 40 months) on the 9 to 23 living patients at the time of the analysis in December 1995. There was no severe acute toxicity, but moderate acute reaction was high: 74%. The commonest site of complication was the intestine where severe late toxicity occurred in 2 of 23 (9%). Overall survival rate at 27 months was 48% and at 40 months was 43%. DISCUSSION There is little information in literature about HFX in carcinoma of the cervix. This is the third published study about it and the one that gave the highest total dose with external HFX of 60 x 1.2 Gy = 72 Gy. Theoretically, through the linear quadratic formula this schedule of HFX would be equivalent to 30 x 2 Gy = 60 Gy of standard fractionation, both treatments given in 30 working days. HFX schedules must be tested to establish their safety. Present results suggest being possible to further increase the total dose in the pelvis with hyperfractionated irradiation.
Collapse
Affiliation(s)
- S L Faria
- Hospital Dr. Mario Gatti and Pontificia Universidade Catolica de Campinas, Servico de Radioterapia, Campinas-SP, Brazil
| | | |
Collapse
|
6
|
Affiliation(s)
- S L Faria
- Department of Radiation Oncology, Universidade Católica de Campinas, São Paulo, Brazil
| | | |
Collapse
|
7
|
Abstract
PURPOSE Little clinical information about Hodgkin's disease in children is available from poor countries. The object of this study is to evaluate our data in Campinas, Brazil and hope "to make one dot on the geographic map of this disease more clear." PATIENTS AND METHODS Between 1978 and 1988, 46 patients under the age of 17 years with biopsy-proven Hodgkin's Disease (HD) were referred for evaluation at Centro Boldrini in Campinas, São Paulo state, in Brazil. Thirty-seven of them were treated and followed-up only at this Center and are the subjects of this analysis. All the original histological slides were obtained, reviewed, and classified according to the Rye system. Staging procedures included exploratory laparotomy in 33 of 37 children, but none had lymphangiography. Treatment was individualized until January 1986 when the German protocol was adopted. RESULTS Nineteen cases were classified as nodular sclerosis, 14 as mixed cellularity, and three as lymphocyte depleted. Mean age was 7 years; male/female ratio was 2:1. Fifty percent were advanced stages III and IV and 46% (17/37) had at least one of the systemic B symptoms. Mean follow-up was 81 months (range from 41 to 174 months). Five-year actuarial overall survival was 78%. Two children (5%) had acute myeloid leukemia at 25 and 49 months after diagnosis. CONCLUSIONS Although distribution of histological subtypes of our cases is similar to other reports in developed countries, as well as percentage of advanced stages III/IV, our patients fared worse when compared to those reports. The reason for this continues to remain unclear but it does not seem to be related to histology subtypes.
Collapse
Affiliation(s)
- S L Faria
- Centro de Investigações Hematológicas Dr. Domingos Boldrini, State University of Campinas, UNICAMP, Brazil
| | | | | | | |
Collapse
|
8
|
Faria SL, Souhami L, Bahary JP, Caron JL, Villemure JG, Olivier A, Clark B, Podgorsak EB. [Brain metastasis. Palliative treatment with radiosurgery]. Arq Neuropsiquiatr 1995; 53:570-6. [PMID: 8585812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This is a retrospective review of 52 patients with metastatic brain disease who underwent stereotactic radiosurgery at McGill University in Montreal. The radiosurgical treatment was performed with the dynamic rotation technique in which there is continuous and simultaneous movement of treatment couch and machine gantry of a 10 MV linac. All patients were treated with a single isocenter and a median dose of 1800 cGy was delivered. In 88% of the cases radiosurgery was given after failure from whole brain conventional irradiation. All 52 cases were assessed with brain CT post radiosurgery. The median follow up time was 6 months (range 1-37 months) and the response rate (partial or complete) was 64%. Only 4 patients (7%) developed late complications related to the treatment. These findings are similar to the literature. Stereotactic radiosurgery is a well tolerated, effective and minimally invasive treatment technique which has a high response rate in selected patients with small, well delineated metastatic brain lesion. Its definitive value as a single therapy or combined with whole brain conventional radiotherapy is being studied in prospective and randomized trials.
Collapse
Affiliation(s)
- S L Faria
- Departamento de Oncologia (Divisão de Radioterapia, McGill University, Montreal, Canada
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Faria SL. [Physicians in the State of São Paulo: how many and what kind?]. Rev Paul Med 1989; 107:183-5. [PMID: 2634879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
10
|
Faria SL, Schlupp WR, Chiminazzo Júnior H, de Oliveira Filho JA. [Axillary dissection in cancer of the breast: a conservative approach]. Rev Paul Med 1989; 107:75-82. [PMID: 2629057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
It is common in oncology to have more than one alternative treatment for the same clinical situation. This is particularly true in breast cancer. Traditional treatments such as Halsted Radical Mastectomies are difficult to change. It is not uncommon to see this approach in Brazil, even in initial tumors, although it is considered unnecessary unless the pectoralis muscle is involved. Radical dissection of the axilla is another controversial issue in breast cancer today. Recent publications have given support to question the routine recommendation of axillary dissection in breast cancer. It is reasonable, under certain circumstances, not to perform axillary dissection or treat the axilla with other methods. Limited axillary dissection, for instance, may present good results with less risk of arm lymphedema. This paper illustrates this point showing preliminary results of 147 breast cancer patients with local tumor treated with conservative management. Half of the patients (74) had axillary surgery while the other 73 did not. Multivariate analysis using Cox's regression was performed and showed that axillary dissection did not change survival. This information confirms similar data published in the literature.
Collapse
|
11
|
Faria SL, Chiminazzo Júnior H, Koseki N, de Oliveira Filho JA. [Conservative surgery and radiotherapy in the treatment of cancer of the breast. Preliminary results in 148 patients]. AMB Rev Assoc Med Bras 1986; 32:54-60. [PMID: 3491392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
12
|
Faria SL. [Cancer of the breast]. Rev Paul Med 1985; 103:104. [PMID: 4081485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
13
|
Abstract
Symptomatic vertebral hemangiomas are not common. Although radiotherapy has been used as treatment, the data are sparse concerning total dose, fractionation and results. We report nine patients with vertebral hemangioma treated with 3000-4000 rad, 200 rad/day, 5 fractions per week, followed from 6 to 62 months. Seventy-seven percent had complete or almost complete disappearance of the symptoms. Radiotherapy schedules are discussed.
Collapse
|
14
|
Faria SL, Chiminazzo Júnior H, Schllup WR, da Cunha LS. [Actinic pneumonitis: not to be confused with tuberculosis]. Rev Paul Med 1985; 103:46. [PMID: 4035184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
15
|
Faria SL. [Concerning the patient with cancer...]. AMB Rev Assoc Med Bras 1984; 30:121-4. [PMID: 6333052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
16
|
Faria SL, Alvarenga M, Prando A, Télis CM, Oliveira Filho JA, Chiminazzo Júnior H. [Non-Hodgkin's lymphoma in adults. Critical review of the patients treated at the Campinas Oncology Center]. AMB Rev Assoc Med Bras 1984; 30:85-90. [PMID: 6332348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
17
|
Faria SL, Chiminazzo Júnior H, Schlupp WR, Leite MT, Oliveira Filho JA. [Breast cancer: conservative treatment]. Rev Paul Med 1983; 101:34. [PMID: 6879032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
18
|
Lederman MV, Faria SL, Malzyner A, Vizeu DM. Time, dose and fractionation factor as an indicator of fibrosis of the abdominopelvic subcutaneous tissue. Int J Radiat Oncol Biol Phys 1982; 8:1447-8. [PMID: 7141923 DOI: 10.1016/0360-3016(82)90598-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ninety-six patients treated with irradiation for epidermoid carcinoma of the uterine cervix were evaluated for the occurrence of subcutaneous tissue fibrosis of the hypogastrium. They were retrospectively stratified according to time, dose and fractionation (TDF) factors of the subcutaneous tissue, total dose delivered and treatment techniques. In our study only the TDF value of the subcutaneous tissue was unequivocally related to the occurrence of fibrosis. The numerical value of the TDF was found to be 110, above which 88.2% of the patients displayed fibrosis.
Collapse
|
19
|
Faria SL, Lederman MV, Vizeu DM. [Effects of radiation on the embryo and gonads]. Rev Hosp Clin Fac Med Sao Paulo 1979; 34:1-5. [PMID: 472602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|