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Abdominal Radiology (New York) Jun 2020This an interesting case of an asymptomatic 60-year-old postmenopausal patient with an incidental pelvic mass mimicking a pelvic malignancy on imaging. Biopsy revealed...
This an interesting case of an asymptomatic 60-year-old postmenopausal patient with an incidental pelvic mass mimicking a pelvic malignancy on imaging. Biopsy revealed findings consistent with polypoid endometriosis. After discontinuation of hormone replacement therapy, the mass showed decrease in size on follow-up imaging. Polypoid endometriosis is a rare but distinct variant of endometriosis with histopathologic features akin to an endometrial polyp. Clinical and imaging features of polypoid endometriosis differ from classic endometriosis. While classic endometriosis predominates in premenopausal women, polypoid endometriosis more commonly affects peri- to postmenopausal women and is associated with the exposure to Tamoxifen or hormone replacement therapy. Imaging features that aid in the diagnosis of polypoid endometriosis are a T2 hyperintense polypoid mass with signal characteristics similar to endometrium, a T2 hypointense peripheral rim, contrast enhancement pattern mirroring the enhancement of the endometrium, and lack of diffusion restriction. Radiologists should be familiar with polypoid endometriosis because this clinically and morphologically distinct variant may mimic malignant neoplasms on imaging.
Topics: Diagnosis, Differential; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Pelvic Neoplasms; Polyps
PubMed: 31372776
DOI: 10.1007/s00261-019-02143-8 -
International Journal of Environmental... Aug 2022Cancer patients experience pain not only in its physical dimension, but also in a broader context that includes psychological, social, and spiritual aspects due to a...
Cancer patients experience pain not only in its physical dimension, but also in a broader context that includes psychological, social, and spiritual aspects due to a higher level of anxiety and stress. The present prospective, longitudinal study examined the relationship between total pain and illness acceptance among pelvic cancer patients, taking into consideration the moderated mediation effects of self-efficacy and stress. The study involved a sample of pelvic cancer patients receiving radiotherapy treatment. Assessments were completed at T1 (before radiotherapy), T2 (after 3-4 weeks), and T3 (after radiotherapy) to assess the psychosocial dynamics of illness acceptance ( = 267). The more physical, psychological, social, and spiritual pain symptoms the patients experienced, the less they accepted negative health conditions and the effects of their illness. Stress moderated the indirect effect between total pain dimensions and illness acceptance through self-efficacy, but it did not moderate the relationship between total pain and illness acceptance. The relationships between total pain dimensions and illness acceptance thus depend on both the mediating effect of self-efficacy and the moderating effect of stress. This highlights the need to control one's motivation and behavior and manage emotional strain or tension.
Topics: Humans; Longitudinal Studies; Pain; Pelvic Neoplasms; Prospective Studies; Self Efficacy; Stress, Psychological; Surveys and Questionnaires
PubMed: 35954987
DOI: 10.3390/ijerph19159631 -
Archives of Gynecology and Obstetrics Feb 2023Uterine leiomyosarcoma (uLMS) may show loss of expression of B-cell lymphoma-2 (Bcl-2) protein. It has been suggested that Bcl-2 loss may both be a diagnostic marker and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Uterine leiomyosarcoma (uLMS) may show loss of expression of B-cell lymphoma-2 (Bcl-2) protein. It has been suggested that Bcl-2 loss may both be a diagnostic marker and an unfavorable prognostic marker in uLMS.
OBJECTIVE
To define the diagnostic and prognostic value of Bcl-2 loss in uLMS through a systematic review and meta-analysis.
METHODS
Electronic databases were searched from their inception to May 2020 for all studies assessing the diagnostic and prognostic value of Bcl-2 loss of immunohistochemical expression in uLMS. Data were extracted to calculate odds ratio (OR) for the association of Bcl-2 with uLMS vs leiomyoma variants and smooth-muscle tumors of uncertain malignant potential (STUMP), and hazard ratio (HR) for overall survival; a p value < 0.05 was considered significant.
RESULTS
Eight studies with 388 patients were included. Loss of Bcl-2 expression in uLMS was not significantly associated with a diagnosis of uLMS vs leiomyoma variants and STUMP (OR = 2.981; p = 0.48). Bcl-2 loss was significantly associated with shorter overall survival in uLMS (HR = 3.722; p = 0.006). High statistical heterogeneity was observed in both analyses.
CONCLUSION
Loss of Bcl-2 expression appears as a significant prognostic but not diagnostic marker in uLMS. The high heterogeneity observed highlights the need for further research and larger studies.
Topics: Female; Humans; Leiomyosarcoma; Prognosis; Uterine Neoplasms; Leiomyoma; Pelvic Neoplasms
PubMed: 35344084
DOI: 10.1007/s00404-022-06531-2 -
Revista de Investigacion Clinica;... 2018In cancer patients treated with radiotherapy to the abdominopelvic region, dietary modifications and the use of functional foods (fortified food with added ingredients... (Review)
Review
In cancer patients treated with radiotherapy to the abdominopelvic region, dietary modifications and the use of functional foods (fortified food with added ingredients to provide specific health improving benefits, such as antioxidants, omega-3 fatty acids, and glutamine), may contribute to the improvement of the toxic effects of treatment, including nausea, diarrhea, and constipation, among others. With the aim of analyzing which coadjuvant foods benefit these patients, scientific evidence was gathered by a group of experts. For these patients, the authors recommend a diet that includes sufficient foods rich in antioxidants and polyphenols instead of supplements. Docosahexaenoic and eicosapentaenoic acids have proven useful for the management of anorexia/cachexia in pancreatic cancer patients. Probiotics composed of Lactobacillus spp. and Bifidobacterium spp. are regarded as safe even in patients with neutropenia and have been proven to decrease gastrointestinal symptoms. Several factors should be considered before probiotic supplementation, these include the stage of the disease, radiation dose, and symptomatology of each patient. There is no demonstrated clear benefit to the use of glutamine, so it is not recommended due to its high cost.
Topics: Anorexia; Cachexia; Diet; Dietary Supplements; Functional Food; Humans; Pelvic Neoplasms; Probiotics; Radiation Dosage; Radiation Injuries
PubMed: 29943769
DOI: 10.24875/RIC.18002527 -
Image-Guided Radiotherapy for Pelvic Cancers: A Review of Current Evidence and Clinical Utilisation.Clinical Oncology (Royal College of... Dec 2020The meticulous selection and utilisation of image-guided radiotherapy (IGRT) are essential for optimal radiotherapy treatment delivery when using highly conformal... (Review)
Review
The meticulous selection and utilisation of image-guided radiotherapy (IGRT) are essential for optimal radiotherapy treatment delivery when using highly conformal treatment techniques in pelvic radiotherapy. Pelvic IGRT has several general IGRT issues to consider (such as choice of match strategy, prioritisation between multiple treatment targets and margin estimates) as well as issues specific to pelvic radiotherapy, in particular large inter-fraction organ variation. A range of interventions, including adaptive treatment strategies, have been developed to address these challenges. This review covers general considerations for the clinical implementation of pelvic IGRT in routine practice and provides an overview of current knowledge regarding pelvic inter-fraction organ motion. Published IGRT evidence for each of the major tumour sites (gynaecological, prostate, bladder, rectal and anal cancer) is summarised, as are state-of-the-art adaptive approaches. General recommendations for the implementation of an institutional pelvic IGRT strategy include. •Ensuring consistency between treatment intent and the IGRT approach utilised. •Ensuring minimum national and international IGRT guidance is followed while considering the benefit of daily volumetric IGRT. •Ensuring the appropriate allied health professionals (namely therapy radiographers/radiation therapists) lead on undertaking IGRT. •Ensuring the IGRT workflow procedure is clear and includes an escalation process for difficult set-ups. •Ensuring a robust IGRT service is in place before implementing advanced adaptive approaches.
Topics: Humans; Organs at Risk; Pelvic Neoplasms; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated
PubMed: 33071029
DOI: 10.1016/j.clon.2020.09.010 -
Revista de Investigacion Clinica;... 2018Mexico has seen an increase in cancer prevalence in its entire population as well as particular age ranges, predominantly the older segment. The most frequently reported... (Review)
Review
Mexico has seen an increase in cancer prevalence in its entire population as well as particular age ranges, predominantly the older segment. The most frequently reported pelvic cancers in Mexico are cervical, endometrial, bladder, prostate, rectum, and anal canal. Approximately 80% of the population diagnosed with pelvic cancers present with locally advanced tumors and require concomitant chemoradiotherapy, sequential chemoradiotherapy, or radiotherapy alone. The toxicity of any of these treatment modalities may be manifested as intestinal injury, a significant problem that can compromise the response to treatment, the patient's nutritional state, quality of life, and survival. In this article, we will approach key aspects in nutrition as well as the epidemiological characteristics and toxicities in patients affected by these pelvic tumors.
Topics: Chemoradiotherapy; Gastrointestinal Diseases; Humans; Mexico; Pelvic Neoplasms; Prevalence; Quality of Life; Radiation Injuries
PubMed: 29943771
DOI: 10.24875/RIC.18002528 -
International Journal of Radiation... Mar 2020Older patients undergoing radiation therapy (RT) for pelvic malignancies are at increased risk for pelvic fracture, which is associated with significant morbidity and... (Observational Study)
Observational Study
PURPOSE
Older patients undergoing radiation therapy (RT) for pelvic malignancies are at increased risk for pelvic fracture, which is associated with significant morbidity and mortality. RT techniques such as brachytherapy or intensity modulated RT (IMRT) allow for more conformal dose distributions, but it is not known whether the risk for pelvic fracture varies by RT modality.
METHODS AND MATERIALS
This observational cohort study involved 28,354 patients ≥65 years old, treated with RT for pelvic malignancies. We evaluated the relative risk of pelvic fracture by type of RT when accounting for baseline factors. To test for nonspecific effects, we also evaluated risk of nonpelvic fractures in the same population.
RESULTS
The 5-year incidence of pelvic fractures was 12.7% (95% confidence interval [CI], 11.6%-13.8%), 11.8% (10.8%-12.8%), and 3.7% (3.4%-4.0%) for patients with gastrointestinal, gynecologic, and prostate cancer, respectively. On multivariable analysis, being treated with IMRT (hazard ratio, 0.85; 95% CI, 0.73-0.99) or brachytherapy therapy alone (hazard ratio, 0.43; 95% CI, 0.34-0.54) was associated with a reduced hazard for pelvic fractures compared with 3D conformal radiation therapy in female patients. In contrast, there was no association with RT modality and the hazard for nonpelvic fractures among females. There was no significant association between pelvic fractures and IMRT or brachytherapy for male patients. White race, advanced age, and higher comorbidity were associated with an increased hazard for pelvic fracture.
CONCLUSIONS
IMRT and brachytherapy were associated with a reduced risk of pelvic fractures in older women undergoing RT for pelvic malignancies. Pelvic insufficiency fracture risk should be considered when treating with pelvic RT.
Topics: Age Factors; Aged; Brachytherapy; Cohort Studies; Confidence Intervals; Female; Fractures, Bone; Gastrointestinal Neoplasms; Genital Neoplasms, Female; Humans; Incidence; Male; Pelvic Bones; Pelvic Neoplasms; Prostatic Neoplasms; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated; Regression Analysis; Risk; Sex Factors; White People
PubMed: 31610251
DOI: 10.1016/j.ijrobp.2019.10.006 -
PloS One 2017Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term...
BACKGROUND AND OBJECTIVES
Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients.
METHODS
Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewing's Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints.
RESULTS
The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p = 0.038; HR = 1.01), margin (p = 0.043; HR = 0.51) and grade (p = 0.001; HR = 2.27) on OS. Considering the multivariable model, grade (p = 0.005; HR = 3.04) and tumor volume (p = 0.014; HR = 1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p = 0.001).
CONCLUSIONS
Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Disease-Free Survival; Female; Hemipelvectomy; Humans; Infections; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Neoplasms; Postoperative Complications; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk; Sarcoma; Survival Rate; Treatment Outcome; Vascular Diseases; Young Adult
PubMed: 28199377
DOI: 10.1371/journal.pone.0172203 -
Cell Death & Disease Aug 2015Although radiotherapy is effective in managing abdominal and pelvic malignant tumors, radiation enteropathy is still unavoidable. This disease severely affects the... (Review)
Review
Although radiotherapy is effective in managing abdominal and pelvic malignant tumors, radiation enteropathy is still unavoidable. This disease severely affects the quality of life of cancer patients due to some refractory lesions, such as intestinal ischemia, mucositis, ulcer, necrosis or even perforation. Current drugs or prevailing therapies are committed to alleviating the symptoms induced by above lesions. But the efficacies achieved by these interventions are still not satisfactory, because the milieus for tissue regeneration are not distinctly improved. In recent years, regenerative therapy for radiation enteropathy by using mesenchymal stem cells is of public interests. Relevant results of preclinical and clinical studies suggest that this regenerative therapy will become an attractive tool in managing radiation enteropathy, because mesenchymal stem cells exhibit their pro-regenerative potentials for healing the injuries in both epithelium and endothelium, minimizing inflammation and protecting irradiated intestine against fibrogenesis through activating intrinsic repair actions. In spite of these encouraging results, whether mesenchymal stem cells promote tumor growth is still an issue of debate. On this basis, we will discuss the advances in anticancer therapy by using mesenchymal stem cells in this review after analyzing the pathogenesis of radiation enteropathy, introducing the advances in managing radiation enteropathy using regenerative therapy and exploring the putative actions by which mesenchymal stem cells repair intestinal injuries. At last, insights gained from the potential risks of mesenchymal stem cell-based therapy for radiation enteropathy patients may provide clinicians with an improved awareness in carrying out their studies.
Topics: Abdominal Neoplasms; Animals; Duodenal Ulcer; Gamma Rays; Humans; Intestinal Perforation; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Mesenteric Ischemia; Mice; Mucositis; Pelvic Neoplasms; Quality of Life; Radiation Injuries; Regeneration; Treatment Outcome
PubMed: 26247725
DOI: 10.1038/cddis.2015.189 -
The British Journal of Radiology Dec 2019Personalized medicine aims at offering optimized treatment options and improved survival for cancer patients based on individual variability. The success of precision... (Review)
Review
Personalized medicine aims at offering optimized treatment options and improved survival for cancer patients based on individual variability. The success of precision medicine depends on robust biomarkers. Recently, the requirement for improved non-biologic biomarkers that reflect tumor biology has emerged and there has been a growing interest in the automatic extraction of quantitative features from medical images, denoted as radiomics. Radiomics as a methodological approach can be applied to any image and most studies have focused on PET, CT, ultrasound, and MRI. Here, we aim to present an overview of the radiomics workflow as well as the major challenges with special emphasis on the use of multiparametric MRI datasets. We then reviewed recent studies on radiomics in the field of pelvic oncology including prostate, cervical, and colorectal cancer.
Topics: Algorithms; Colorectal Neoplasms; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Neoplasm Grading; Pelvic Neoplasms; Precision Medicine; Prostatic Neoplasms; Radiation Oncology; Reproducibility of Results; Tumor Burden; Uterine Cervical Neoplasms
PubMed: 31538516
DOI: 10.1259/bjr.20190105