9 research outputs found
Role of Brachytherapy in the Postoperative Management of Endometrial Cancer: Decision-Making Analysis among Experienced European Radiation Oncologists.
BACKGROUND
There are various society-specific guidelines addressing adjuvant brachytherapy (BT) after surgery for endometrial cancer (EC). However, these recommendations are not uniform. Against this background, clinicians need to make decisions despite gaps between best scientific evidence and clinical practice. We explored factors influencing decision-making for adjuvant BT in clinical routine among experienced European radiation oncologists in the field of gynaecological radiotherapy (RT). We also investigated the dose and technique of BT.
METHODS
Nineteen European experts for gynaecological BT selected by the Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology provided their decision criteria and technique for postoperative RT in EC. The decision criteria were captured and converted into decision trees, and consensus and dissent were evaluated based on the objective consensus methodology.
RESULTS
The decision criteria used by the experts were tumour extension, grading, nodal status, lymphovascular invasion, and cervical stroma/vaginal invasion (yes/no). No expert recommended adjuvant BT for pT1a G1-2 EC without substantial LVSI. Eighty-four percent of experts recommended BT for pT1a G3 EC without substantial LVSI. Up to 74% of experts used adjuvant BT for pT1b LVSI-negative and pT2 G1-2 LVSI-negative disease. For 74-84% of experts, EBRT + BT was the treatment of choice for nodal-positive pT2 disease and for pT3 EC with cervical/vaginal invasion. For all other tumour stages, there was no clear consensus for adjuvant treatment. Four experts already used molecular markers for decision-making. Sixty-five percent of experts recommended fractionation regimens of 3 × 7 Gy or 4 × 5 Gy for BT as monotherapy and 2 × 5 Gy for combination with EBRT. The most commonly used applicator for BT was a vaginal cylinder; 82% recommended image-guided BT.
CONCLUSIONS
There was a clear trend towards adjuvant BT for stage IA G3, stage IB, and stage II G1-2 LVSI-negative EC. Likewise, there was a non-uniform pattern for BT dose prescription but a clear trend towards 3D image-based BT. Finally, molecular characteristics were already used in daily decision-making by some experts under the pretext that upcoming trials will bring more clarity to this topic
Gene expression profiling reveals activation of the FA/BRCA pathway in advanced squamous cervical cancer with intrinsic resistance and therapy failure
Local experience in cervical cancer imaging: Comparison in tumour assessment between TRUS and MRI
ObjectiveThe aim of study was to analyze the accuracy of TRUS (transrectal ultrasound) vs. MRI (magnetic resonance imaging) and clinical gynecological examination estimation in the evaluation of tumor dimensions.MethodsThe patients inclusion criterion included primarily pathologically squamous cell carcinoma, but excluded were patients who had not undergone BT (brachytherapy) and treated with palliative intent. We offer two types of treatment for locally advanced cervical cancer: (a) radiochemotherapy followed by surgery and (b) exclusive radiochemotherapy. Imaging tests follow the presence of tumor and tumor size (width and thickness). Each examination was performed by a different physician who had no knowledge of the others’ findings. All patients underwent MRI prior to EBRT (external beam radiation therapy) while 18 of them also at the time of the first brachytherapy application. For the analysis we used the r-Pearson correlation coefficient.ResultsIn 2013, 26 patients with cervical cancer were included. A total of 44 gynecological examinations were performed, 44 MRIs and 18 TRUSs. For the comparisons prior to EBRT the correlation coefficient between TRUS vs. MRI was r[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.79 for AP and r[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.83 for LL, for GYN vs. MRI was r[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.6 for AP and r[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.75 for LL. Prior to BT for GYN vs. MRI, r values were 0.60 and 0.63 for AP and LL, respectively; for GYN vs. TRUS, r values were 0.56 and 0.78 for AP and LL, respectively.ConclusionsA high correlation between the three examinations was obtained. As such, TRUS can be considered a suitable method in the evaluation of tumor dimensions
Impact of exposure to tobacco smoke, arsenic, and phthalates on locally advanced cervical cancer treatment—preliminary results
Background Cancer research is a national and international priority, with the efficiency and effectiveness of current anti-tumor therapies being one of the major challenges with which physicians are faced. Objective To assess the impact of exposure to tobacco smoke, arsenic, and phthalates on cervical cancer treatment. Methods We investigated 37 patients with locally advanced cervical carcinoma who underwent chemotherapy and radiotherapy. We determined cotinine and five phthalate metabolites in urine samples collected prior to cancer treatment, by gas chromatography coupled to mass spectrometry, and urinary total arsenic by atomic absorption spectrometry with hydride generation. We used linear regression to evaluate the effects of cotinine, arsenic, and phthalates on the change in tumor size after treatment, adjusted for confounding variables. Results We detected no significant associations between urinary cotinine, arsenic, or phthalate monoesters on change in tumor size after treatment, adjusted for urine creatinine, age, baseline tumor size, and cotinine (for arsenic and phthalates). However, higher %mono-ethylhexyl phthalate (%MEHP), a putative indicator of phthalate diester metabolism, was associated with a larger change in tumor size (β = 0.015, 95% CI [0.003–0.03], P = 0.019). Conclusion We found no statistically significant association between the urinary levels of arsenic, cotinine, and phthalates metabolites and the response to cervical cancer treatment as measured by the change in tumor size. Still, our results suggested that phthalates metabolism may be associated with response to treatment for locally advanced cervical cancer. However, these observations are preliminary and will require confirmation in a larger, more definitive investigation
Risk Factors in a Sample of Patients with Advanced Cervical Cancer
The estimated burden of neoplasia of uterine cervix in the 27 EU member states sums up to 34300 cases and 16200 death, with higher incidence and mortality in eastern countries. A number of risk factors increase the likelihood of developing cervical cancer. Even if the risk factors significantly increase the chances of developing cervical cancer, a large number of women with risk factors do not develop the disease, and when a woman develops cancer or precancerous lesions in the cervix may be difficult to establish the causal relationship with certain risk factors. The present study aimed to appreciate the presence and magnitude of risk factors for patients diagnosed with advanced cervical cancer and to outline best strategies to reduce the incidence of this neoplasia, and improve prognosis. Risk factors have been investigated in 42 patients diagnosed with advanced cervical cancer using HPV genotyped determination and a questionnaire for the evaluation of cervical cancer risk factors. In our sample of patients a high risk profile is shaping for low socio-economical level, modulated by the impact of HPV infection with high risk stains of virus, overweight-obesity, smoking and inadequate cervical cancer screening. In this frame a special alarm signal is represented by the very high percentage of patients with overweight and obesity. From the public health perspective, we consider that efforts should be focused on preventing weight gain, regular screening and health education field
Role of Brachytherapy in the Postoperative Management of Endometrial Cancer: Decision-Making Analysis among Experienced European Radiation Oncologists
Background: There are various society-specific guidelines addressing adjuvant brachytherapy (BT) after surgery for endometrial cancer (EC). However, these recommendations are not uniform. Against this background, clinicians need to make decisions despite gaps between best scientific evidence and clinical practice. We explored factors influencing decision-making for adjuvant BT in clinical routine among experienced European radiation oncologists in the field of gynaecological radiotherapy (RT). We also investigated the dose and technique of BT. Methods: Nineteen European experts for gynaecological BT selected by the Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology provided their decision criteria and technique for postoperative RT in EC. The decision criteria were captured and converted into decision trees, and consensus and dissent were evaluated based on the objective consensus methodology. Results: The decision criteria used by the experts were tumour extension, grading, nodal status, lymphovascular invasion, and cervical stroma/vaginal invasion (yes/no). No expert recommended adjuvant BT for pT1a G1-2 EC without substantial LVSI. Eighty-four percent of experts recommended BT for pT1a G3 EC without substantial LVSI. Up to 74% of experts used adjuvant BT for pT1b LVSI-negative and pT2 G1–2 LVSI-negative disease. For 74–84% of experts, EBRT + BT was the treatment of choice for nodal-positive pT2 disease and for pT3 EC with cervical/vaginal invasion. For all other tumour stages, there was no clear consensus for adjuvant treatment. Four experts already used molecular markers for decision-making. Sixty-five percent of experts recommended fractionation regimens of 3 × 7 Gy or 4 × 5 Gy for BT as monotherapy and 2 × 5 Gy for combination with EBRT. The most commonly used applicator for BT was a vaginal cylinder; 82% recommended image-guided BT. Conclusion: There was a clear trend towards adjuvant BT for stage IA G3, stage IB, and stage II G1–2 LVSI-negative EC. Likewise, there was a non-uniform pattern for BT dose prescription but a clear trend towards 3D image-based BT. Finally, molecular characteristics were already used in daily decision-making by some experts under the pretext that upcoming trials will bring more clarity to this topic
Role of Brachytherapy in the Postoperative Management of Endometrial Cancer: Decision-Making Analysis among Experienced European Radiation Oncologists
Simple Summary There are various society-specific guidelines addressing
adjuvant brachytherapy (BT) after surgery for endometrial cancer (EC).
However, these recommendations are not uniform. Against this background,
clinicians need to make decisions despite gaps between best scientific
evidence and clinical practice. We analysed decision criteria
influencing the selection for adjuvant radiotherapy among European
radiation oncology experts. For this, GEC-ESTRO provided 19 European
radiation oncology experts on gynaecological brachytherapy for
decision-making analyses. The manuscript presents patterns in
decision-making among these experts and demonstrates areas of
consensus/discrepancies. We also analysed dose prescription and
techniques of brachytherapy. This analysis is of special value as the
objective approach enabled us to obtain an unbiased description of
decision-making among the specialists (the study was not aimed to create
or enforce a consensus). The manuscript provides valuable insight into
clinical decision-making with a high impact on treatment selection, as
expected differences between experts were observed. With this manuscript
we are able to visualize and quantify these. This information is
relevant for interdisciplinary discussions. Background: There are
various society-specific guidelines addressing adjuvant brachytherapy
(BT) after surgery for endometrial cancer (EC). However, these
recommendations are not uniform. Against this background, clinicians
need to make decisions despite gaps between best scientific evidence and
clinical practice. We explored factors influencing decision-making for
adjuvant BT in clinical routine among experienced European radiation
oncologists in the field of gynaecological radiotherapy (RT). We also
investigated the dose and technique of BT. Methods: Nineteen European
experts for gynaecological BT selected by the Groupe Europeen de
Curietherapie and the European Society for Radiotherapy & Oncology
provided their decision criteria and technique for postoperative RT in
EC. The decision criteria were captured and converted into decision
trees, and consensus and dissent were evaluated based on the objective
consensus methodology. Results: The decision criteria used by the
experts were tumour extension, grading, nodal status, lymphovascular
invasion, and cervical stroma/vaginal invasion (yes/no). No expert
recommended adjuvant BT for pT1a G1-2 EC without substantial LVSI.
Eighty-four percent of experts recommended BT for pT1a G3 EC without
substantial LVSI. Up to 74% of experts used adjuvant BT for pT1b
LVSI-negative and pT2 G1-2 LVSI-negative disease. For 74-84% of
experts, EBRT + BT was the treatment of choice for nodal-positive pT2
disease and for pT3 EC with cervical/vaginal invasion. For all other
tumour stages, there was no clear consensus for adjuvant treatment. Four
experts already used molecular markers for decision-making. Sixty-five
percent of experts recommended fractionation regimens of 3 x 7 Gy or 4 x
5 Gy for BT as monotherapy and 2 x 5 Gy for combination with EBRT. The
most commonly used applicator for BT was a vaginal cylinder; 82%
recommended image-guided BT. Conclusions: There was a clear trend
towards adjuvant BT for stage IA G3, stage IB, and stage II G1-2
LVSI-negative EC. Likewise, there was a non-uniform pattern for BT dose
prescription but a clear trend towards 3D image-based BT. Finally,
molecular characteristics were already used in daily decision-making by
some experts under the pretext that upcoming trials will bring more
clarity to this topic
The Physicochemical and Antimicrobial Properties of Silver/Gold Nanoparticles Obtained by “Green Synthesis” from Willow Bark and Their Formulations as Potential Innovative Pharmaceutical Substances
Green chemistry is a pharmaceutical industry tool, which, when implemented correctly, can lead to a minimization in resource consumption and waste. An aqueous extract of Salix alba L. was employed for the efficient and rapid synthesis of silver/gold particle nanostructures via an inexpensive, nontoxic and eco-friendly procedure. The nanoparticles were physicochemically characterized using ultraviolet–visible spectroscopy (UV–Vis), Fourier transform infrared spectroscopy (FT-IR), dynamic light scattering (DLS), X-ray diffraction (XRD) and scanning electron microscopy (SEM), with the best stability of up to one year in the solution obtained for silver nanoparticles without any chemical additives. A comparison of the antimicrobial effect of silver/gold nanoparticles and their formulations (hydrogels, ointments, aqueous solutions) showed that both metallic nanoparticles have antibacterial and antibiofilm effects, with silver-based hydrogels having particularly high antibiofilm efficiency. The highest antibacterial and antibiofilm efficacies were obtained against Pseudomonas aeruginosa when using silver nanoparticle hydrogels, with antibiofilm efficacies of over 75% registered. The hydrogels incorporating green nanoparticles displayed a 200% increased bacterial efficiency when compared to the controls and their components. All silver nanoparticle formulations were ecologically obtained by “green synthesis” and were shown to have an antimicrobial effect or potential as keratinocyte-acting pharmaceutical substances for ameliorating infectious psoriasis wounds