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Clinical & Translational Oncology :... Aug 2017To review the use of brachytherapy as an adjuvant therapy to reduce recurrences after sublobar resections and as a palliation to patients with inoperable disease. Α... (Review)
Review
To review the use of brachytherapy as an adjuvant therapy to reduce recurrences after sublobar resections and as a palliation to patients with inoperable disease. Α review of all published studies was performed to identify the recurrence rate after brachytherapy adjuvant to sublobar resection and assess the palliation of symptoms and the complications of brachytherapy as a palliative treatment. Most of the studies that we found about brachytherapy as an adjuvant therapy to sublobar resection due to patient's poor cardiopulmonary reserve showed that brachytherapy offered low recurrence rate with low toxicity. Ten studies concerning palliative brachytherapy showed improvement of symptoms with good tolerance and good endoscopic response rates. Literature suggests that brachytherapy for inoperable symptomatic disease can be delivered for symptom improvement with acceptable toxicity. Brachytherapy as an alternative treatment option for lung cancer needs more investigation with more prospective trials.
Topics: Brachytherapy; Humans; Lung Neoplasms; Prognosis
PubMed: 28255649
DOI: 10.1007/s12094-017-1635-0 -
Applied Radiation and Isotopes :... Apr 2016The present review article aims to provide an overview of the available radionuclides for palliative treatment of bone metastases beyond (89)Sr and (153)Sm. In addition,... (Review)
Review
PURPOSE
The present review article aims to provide an overview of the available radionuclides for palliative treatment of bone metastases beyond (89)Sr and (153)Sm. In addition, it aims to review and summarize the clinical outcomes associated with the palliative treatment of bone metastases using different radiopharmaceuticals.
MATERIALS AND METHODS
A literature search was conducted on Science Direct and PubMed databases (1990 - 2015). The following search terms were combined in order to obtain relevant results: "bone", "metastases", "palliative", "care", "therapy", "treatment", "radiotherapy", "review", "radiopharmaceutical", "phosphorus-32", "strontium-89", "yttrium-90", "tin-117m", "samarium-153", "holmium-166", "thulium-170", "lutetium-177", "rhenium-186", "rhenium-188" and "radium-223". Studies were included if they provided information regarding the clinical outcomes.
RESULTS AND CONCLUSIONS
A comparative analysis of the measured therapeutic response of different radiopharmaceuticals, based on previously published data, suggests that there is a lack of substantial differences in palliative efficacy among radiopharmaceuticals. However, when the comparative analysis adds factors such as patient's life expectancy, radionuclides' physical characteristics (e.g. tissue penetration range and half-life) and health economics to guide the rational selection of a radiopharmaceutical for palliative treatment of bone metastases, (177)Lu and (188)Re-labeled radiopharmaceuticals appear to be the most suitable radiopharmaceuticals for treatment of small and medium/large size bone lesions, respectively.
Topics: Bone Neoplasms; Female; Humans; Male; Pain Management; Palliative Care; Radioisotopes; Radiopharmaceuticals; Samarium; Strontium Radioisotopes
PubMed: 26773820
DOI: 10.1016/j.apradiso.2016.01.003 -
International Journal of Clinical... Jul 2024Anticipatory chemotherapy-induced nausea and vomiting (CINV) is a conditioned response influenced by the severity and duration of previous emetic responses to... (Meta-Analysis)
Meta-Analysis
Non-pharmacological treatments for anticipatory nausea and vomiting during chemotherapy: a systematic review and meta-analysis of the Clinical Practice Guidelines for Antiemesis 2023.
BACKGROUND
Anticipatory chemotherapy-induced nausea and vomiting (CINV) is a conditioned response influenced by the severity and duration of previous emetic responses to chemotherapy. We aimed to evaluate the efficacy of non-pharmacologic interventions for anticipatory CINV among patients with cancer.
METHODS
We conducted a systematic search in databases, including PubMed, the Cochrane Library, CINAHL, and Ichushi-Web, from January 1, 1990, to December 31, 2020. Randomized controlled trials, non-randomized designs, observational studies, or case-control studies that utilized non-pharmacological therapies were included. The primary outcomes were anticipatory CINV, with an additional investigation into adverse events and the costs of therapies. The risk-of-bias for each study was assessed using the Cochrane risk-of-bias tool, and meta-analysis was performed using Revman 5.4 software.
RESULTS
Of the 107 studies identified, six met the inclusion criteria. Three types of non-pharmacological treatments were identified: systematic desensitization (n = 2), hypnotherapy (n = 2), and yoga therapy (n = 2). Among them, systematic desensitization significantly improved anticipatory CINV as compared to that in the control group (nausea: risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.49-0.72, p < 0.00001; vomiting: RR = 0.54, 95% CI = 0.32-0.91, p = 0.02). However, heterogeneity in outcome measures precluded meta-analysis for hypnotherapy and yoga. Additionally, most selected studies had a high or unclear risk of bias, and adverse events were not consistently reported.
CONCLUSIONS
Our findings suggest that systematic desensitization may effectively reduce anticipatory CINV. However, further research is warranted before implementation in clinical settings.
Topics: Humans; Antineoplastic Agents; Nausea; Neoplasms; Vomiting; Practice Guidelines as Topic; Vomiting, Anticipatory; Hypnosis; Yoga; Antiemetics
PubMed: 38722486
DOI: 10.1007/s10147-024-02536-w -
Evidence-based Dentistry Dec 2021Purpose This meta-analysis assessed the efficacy of antimicrobial photodynamic therapy (aPDT) compared to conventional nystatin therapy (NYT) in reducing Candida colony... (Review)
Review
Efficacy of antimicrobial photodynamic therapy compared to nystatin therapy in reducing Candida colony count in patients with Candida-associated denture stomatitis: a systematic review and meta-analysis.
Purpose This meta-analysis assessed the efficacy of antimicrobial photodynamic therapy (aPDT) compared to conventional nystatin therapy (NYT) in reducing Candida colony count in patients with Candida-associated denture stomatitis (CADS) and critically appraised the available literature.Methods This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) updated guidelines. A literature search was performed in four electronic databases to identify relevant articles up to 15 August 2021. Randomised controlled trials (RCTs) that assessed the efficacy of aPDT compared to NYT in reducing Candida colony count in patients with CADS were investigated. The weighted mean difference (MD) and 95% confidence interval were calculated. The I2 statistic was used to determine heterogeneity at the level of α = 0.10. The Cochrane risk of bias (RoB 2) tool was used to assess the risk of bias. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) ranking system.Results Only three eligible RCTs with 141 participants were included in this systematic review and meta-analysis. Based on the pooled results, NYT compared to aPDT generally performed better in reducing Candida colony count (Log CFU/mL) in patients' palate and patients' denture. The included studies had a moderate risk of bias and the certainty of the evidence was low.Conclusion Although still inconclusive, based on the current evidence, aPDT may be effective in reducing Candida colony count and treating CADS. Nonetheless, it does not appear to be more effective than conventional NYT in this regard. According to the limited number of included studies, more well-designed RCTs with larger sample sizes and standardised methodology should be conducted to validate this conclusion.
PubMed: 34862461
DOI: 10.1038/s41432-021-0208-9 -
The British Journal of Radiology Jan 2019Conventional fractionation for half a century has been justified on the basis that 2.0 Gy fractions spare dose-limiting late-responding normal tissues to a greater...
Conventional fractionation for half a century has been justified on the basis that 2.0 Gy fractions spare dose-limiting late-responding normal tissues to a greater degree than cancerous tissues. Early indications that breast cancer responds more strongly to fraction size than many other common cancers were followed several decades of investigation, but there is now reliable Level I evidence that this is the case. Four randomised trials testing fraction sizes in the range 2.7-3.3 Gy have reported 10-year follow up in almost 8000 patients, and they provide robust estimates of α/β in the range of 3 Gy. The implication is that there are no advantages in terms of safety or effectiveness of persisting with 2.0 Gy fractions in patients with breast cancer. 15- or 16-fraction schedules are replacing the conventional 25-fraction regimen as a standard of care for adjuvant therapy in an increasing number of countries. A number of concerns relating to the appropriateness of hypofractionation in patient subgroups, including those treated post-mastectomy, advanced local-regional disease and/or to lymphatic pathways are addressed. Meanwhile, hypofractionation can be exploited to modulate dose intensity across the breast according to relapse risk by varying fraction size across the treatment volume. The lower limits of hypofractionation are currently being explored, one approach testing a 5-fraction schedule of local-regional radiotherapy delivered in 1 week.
Topics: Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Mastectomy; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Radiation Dose Hypofractionation; Radiotherapy, Adjuvant
PubMed: 29345152
DOI: 10.1259/bjr.20170849 -
Child's Nervous System : ChNS :... Jun 2024Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to... (Review)
Review
OBJECTIVE
Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to preserve visual function in these patients remains controversial. We sought to investigate visual outcomes of children with craniopharyngiomas based on treatment modality.
METHODS
A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Scopus databases were searched in December 2022 for relevant articles. Articles were screened by title/abstract for relevance, then by full-text. Relevant demographic, intervention, and outcome data were extracted from included studies.
RESULTS
A total of 59 studies were included, representing 2655 patients. The overall visual status (OVS) of patients receiving surgery alone was improved in 27.6% of reported outcomes, unchanged in 50.3%, and deteriorated in 22.1%. The OVS for patients receiving radiation alone was improved in 21.1%, unchanged in 42.1%, and deteriorated in 36.8%. Patients receiving surgery plus adjuvant radiotherapy had OVS improvement in 27.4%, unchanged in 63.2%, and deteriorated in 9.4%. Of those receiving intracystic bleomycin, 23.1% had improvement in OVS, 46.2% remained unchanged, and 30.8% deteriorated. Of patients receiving interferon-α, 34.8% improved, 54.5% remained unchanged, and 10.6% deteriorated.
CONCLUSION
OVS most frequently remained unchanged regardless of intervention. The greatest improvement in OVS was seen in those receiving interferon-α or surgery alone. The greatest OVS deterioration was noted with radiation alone. Future standardized, randomized, large-scale studies with focused assessment of ophthalmologic findings are key to further understanding the impact different interventions have on visual outcomes in these children.
Topics: Child; Humans; Craniopharyngioma; Neurosurgical Procedures; Pituitary Neoplasms; Treatment Outcome; Vision Disorders
PubMed: 38416204
DOI: 10.1007/s00381-024-06328-5 -
World Journal of Urology Nov 2023Doses delivered to the urethra have been associated with an increased risk to develop long-term urinary toxicity in patients undergoing stereotactic body radiotherapy...
PURPOSE
Doses delivered to the urethra have been associated with an increased risk to develop long-term urinary toxicity in patients undergoing stereotactic body radiotherapy (SBRT) for prostate cancer (PCa). Aim of the present systematic review is to report on the role of urethra-sparing SBRT (US-SBRT) techniques for prostate cancer, with a focus on outcome and urinary toxicity.
METHOD
A systematic review of the literature was performed on the PubMed database on May 2023. Based on the urethra-sparing technique, 13 studies were selected for the analysis and classified in the two following categories: "urethra-steering" SBRT (restriction of hotspots to the urethra) and "urethra dose-reduction" SBRT (dose reduction to urethra below the prescribed dose).
RESULTS
By limiting the urethra D to 90GyEQD2 (α/β = 3 Gy) with urethra-steering SBRT techniques, late genitourinary (GU) grade 2 toxicity remains mild, ranging between 12.1% and 14%. With dose-reduction strategies decreasing the urethral dose below 70 GyEQD2, the risk of late GU toxicity was further reduced (< 8% at 5 years), while maintaining biochemical relapse-free survival rates up to 93% at 5 years.
CONCLUSION
US-SBRT techniques limiting maximum doses to urethra below a 90Gy (α/β = 3 Gy) threshold result in a low rate of acute and late grade ≥ 2 GU toxicity. A better understanding of clinical factors and anatomical substructures involved in the development of GU toxicity, as well as the development and use of adapted dose constraints, is expected to further reduce the long-term GU toxicity of prostate cancer patients treated with SBRT.
Topics: Male; Humans; Urethra; Radiosurgery; Neoplasm Recurrence, Local; Prostatic Neoplasms; Urogenital System
PubMed: 37668718
DOI: 10.1007/s00345-023-04579-6 -
Marine Pollution Bulletin Dec 2020The omnipresence of plastic particles in marine ecosystems, a.k.a. Marine Plastic Pollution (MPP) constitutes a major environmental and socioeconomic threat. In the last... (Meta-Analysis)
Meta-Analysis
The omnipresence of plastic particles in marine ecosystems, a.k.a. Marine Plastic Pollution (MPP) constitutes a major environmental and socioeconomic threat. In the last decade, the realization of the severity of the MPP problem by international organizations, governments and policy makers worldwide, has triggered the publication of a large number of review papers studying the current state of the art of MPP, from a plethora of different perspectives. This study attempts to classify the existing review efforts, by conducting a systematic analysis of review papers on MPP, published from 2000 to 2019. A sample of 114 review studies, retrieved from the SCOPUS database, are classified based on a number of carefully selected coding criteria and processed in order to produce a set of meaningful descriptive statistics and visualizations. Ultimately, the objective of this paper is to synthesize the different perspectives on MPP, assess the research progress and highlight future research directions.
Topics: Ecosystem; Environmental Monitoring; Environmental Pollution; Plastics; Waste Products; Water Pollutants, Chemical
PubMed: 33039791
DOI: 10.1016/j.marpolbul.2020.111690 -
Journal of Cancer Research and Clinical... Aug 2023The existence of cancer stem cells (CSCs) is closely related to tumor recurrence, metastasis, and resistance to chemoradiotherapy. In addition, given the unique physical... (Review)
Review
PURPOSE
The existence of cancer stem cells (CSCs) is closely related to tumor recurrence, metastasis, and resistance to chemoradiotherapy. In addition, given the unique physical and biological advantages of charged particle, we hypothesized that charged particle irradiation would produce strong killing effects on CSCs. The purpose of our systematic review is to evaluate the biological effects of CSCs irradiated by charged particle, including proliferation, invasion, migration, and changes in the molecular level.
METHODS
We searched PubMed, EMBASE, and Web of Science until 17 march 2022 according to the key words. Included studies have to be vitro studies of CSCs irradiated by charged particle. Outcomes included one or more of radiation sensitivity, proliferation, metastasis, invasion, and molecular level changes, like DNA damage after been irradiated.
RESULTS
Eighteen studies were included in the final analysis. The 18 articles include 12-carbon ion irradiation, 4-proton irradiation, 1 α-particle irradiation, 1-carbon ion combine proton irradiation.
CONCLUSION
Through the extraction and analysis of data, we came to this conclusion: CSCs have obvious radio-resistance compared with non-CSCs, and charged particle irradiation or in combination with drugs could overcome this resistance, specifically manifested in inhibiting CSCs' proliferation, invasion, migration, and causing more and harder to repair DNA double-stranded breaks (DSB) of CSCs.
Topics: Humans; Protons; Neoplasm Recurrence, Local; DNA Damage; Neoplastic Stem Cells; Carbon
PubMed: 36611110
DOI: 10.1007/s00432-022-04561-6 -
International Journal of Radiation... Dec 2018The aims of this study were to systematically review tolerance doses for late distinct gastrointestinal (GI), genitourinary (GU), and sexual dysfunction (SD) symptoms...
PURPOSE
The aims of this study were to systematically review tolerance doses for late distinct gastrointestinal (GI), genitourinary (GU), and sexual dysfunction (SD) symptoms after external beam radiation therapy (EBRT) alone and treatments involving brachytherapy (BT) for prostate cancer after Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) and ultimately to perform quantitative syntheses of identified dose/volume tolerances represented by dose-volume histogram (DVH) thresholds, that is, statistically significant (P ≤ .05) cutoff points between symptomatic and asymptomatic patients in a certain study.
METHODS AND MATERIALS
PubMed was scrutinized for full-text articles in English after QUANTEC (January 1, 2010). The inclusion criteria were randomized controlled trials, case-control studies, or cohort studies with tolerance doses for late distinct symptoms ≥3 months after primary radiation therapy for prostate cancer (N > 30). All DVH thresholds were converted into equivalent doses in 2-Gy fractions (EQD2) and were fitted with a linear or linear-quadratic function (goodness of fit, R). The review was registered on PROSPERO (CRD42016042464).
RESULTS
From 33 identified studies, which included 36 to 746 patients per symptom domain, the majority of dose/volume tolerances were derived for GI toxicity after EBRT alone (GI, 97 thresholds; GU, 8 thresholds; SD, 1 threshold). For 5 symptoms (defecation urgency, diarrhea, fecal incontinence, proctitis, and rectal bleeding), relationships between dose/volume tolerances across studies (R = 0.93 [0.82-1.00]), and across symptoms, leading to a curve for overall GI toxicity (R = 0.98), could be determined. For these symptoms, mainly rectal thresholds were found throughout low and high doses (10 Gy ≤ equivalent dose in 2-Gy fractions using α/β = 3Gy (EQD2) ≤ 50 Gy and 55 Gy ≤ EQD2 ≤ 78 Gy, respectively). For BT with or without EBRT, dose/volume tolerances were also mainly identified for GI toxicity (GI, 14 thresholds; GU, 4 thresholds; SD, 2 thresholds) with the largest number of DVH thresholds concerning rectal bleeding (5 thresholds).
CONCLUSIONS
Updated dose/volume tolerances after QUANTEC were found for 17 GI, GU, or SD symptoms. A DVH curve described the relationship between dose/volume tolerances across 5 GI symptoms after EBRT alone. Restricting treatments for EBRT alone using the lower boundaries of this curve is likely to limit overall GI toxicity, but this should be explored prospectively. Dose/volume tolerances for GU and SD toxicity after EBRT alone and after BT with or without EBRT were scarce and support further research including data-sharing initiatives to untangle the dose/volume relationships for these symptoms.
Topics: Humans; Male; Prostatic Neoplasms; Radiation Dosage; Radiotherapy; Radiotherapy Dosage; Safety
PubMed: 30125635
DOI: 10.1016/j.ijrobp.2018.08.015