NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY TRANSHITAL ESOPHAGECTOMY IN LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: IMPACT OF PATHOLOGICAL COMPLETE RESPONSE

BACKGROUND

Multimodal therapy with neoadjuvant chemoradiotherapy, followed by esophagectomy has offered better survival results, compared to isolated esophagectomy, in advanced esophageal cancer. In addition, patients who have a complete pathological response to neoadjuvant treatment presented greater overall survival and longer disease-free survival compared to those with incomplete response.

AIM

To compare the results of overall survival and disease-free survival among patients with complete and incomplete response, submitted to neoadjuvant chemoradiotherapy, with two therapeutic regimens, followed by transhiatal esophagectomy.

METHODS

Retrospective study, approved by the Research Ethics Committee, analyzing the medical records of 56 patients with squamous cell carcinoma of the esophagus, divided into two groups, submitted to radiotherapy (5040 cGY) and chemotherapy (5-Fluorouracil + Cisplatin versus Paclitaxel + Carboplatin) neoadjuvants and subsequently to surgical treatment, in the period from 2005 to 2012, patients.

RESULTS

The groups did not differ significantly in terms of gender, race, age, postoperative complications, disease-free survival and overall survival. The 5-year survival rate of patients with incomplete and complete response was 18.92% and 42.10%, respectively (p> 0.05). However, patients who received Paclitaxel + Carboplatin, had better complete pathological responses to neoadjuvant, compared to 5-Fluorouracil + Cisplatin (47.37% versus 21.62% - p = 0.0473, p <0.05).

CONCLUSIONS

There was no statistical difference in overall survival and disease-free survival for patients who had a complete pathological response to neoadjuvant. Patients submitted to the therapeutic regimen with Paclitaxel and Carboplastin, showed a significant difference with better complete pathological response and disease progression. New parameters are indicated to clarify the real value in survival, from the complete pathological response to neoadjuvant, in esophageal cancer.

Chemoradiotherapy With or Without Surgery for Esophageal Squamous Cancer According to Hospital Volume

PURPOSE

Esophageal squamous cell cancer (ESCC) is still associated with a dismal prognosis. However, surgical series have shown that high-volume hospitals have better outcomes and that the impact of center volume on definitive chemoradiotherapy (dCRT) or CRT plus surgery (CRT + S) remains unknown.

METHODS

We performed a retrospective analysis of patients with locally advanced stage II-III (non-T4) ESCC treated with dCRT or CRT + S in São Paulo state, Brazil. Descriptive variables were assessed with the χ² test after categorization of hospital volume (high-volume [HV] center, top 5 higher volume, or low-volume [LV] center). Overall survival (OS) was assessed with Kaplan-Meier curves, log-rank tests, and Cox proportional hazards. Finally, an interaction test between each facility's treatments was performed.

RESULTS

Between 2000 and 2013, 1,347 patients were analyzed (77% treated with dCRT and 65.7% in HV centers) with a median follow-up of 23.7 months. The median OS for dCRT was 14.1 months (95% CI, 13.3 to 15.3 months) and for CRT + S, 20.6 months (95% CI, 16.1 to 24.9 months). In the multivariable analysis, dCRT was associated with worse OS (hazard ratio [HR], 1.38; 95% CI, 1.19 to 1.61; P < .001) compared with CRT + S. HV hospitals were associated with better OS (HR, 0.82; 95% CI, 0.71 to 0.94; P = .004) compared with LV hospitals. Importantly, CRT + S superiority was restricted to HV hospitals (dCRT v CRT + S: HR, 1.56; 95% CI, 1.29 to 1.89; P < .001), while in LV hospitals, there was no statistically significant difference (HR, 1.23; 95% CI, 0.88 to 1.43; P = .350), with a significant interaction test (P_interaction = .035).

CONCLUSION

Our data show that CRT + S is superior to dCRT in the treatment of ESCC exclusively in HV hospitals, which favors the literature trend to centralize the treatment of ESCC in HV centers.

Arrabidaea chica for oral mucositis in patients with head and neck cancer: a protocol of a randomised clinical trial

INTRODUCTION

Oral mucositis is an iatrogenic condition of erythematous inflammatory changes which tends to occur on buccal and labial surfaces, the ventral surface of the tongue, the floor of the mouth and the soft palate of patients receiving chemotherapy. This protocol of ongoing randomised parallel group clinical trial aims to access the therapeutic effect of an herbal gel containing 2.5% Arrabidaea chica Verlot standardised extract on oral mucositis in patients with head and neck cancer compared with low-level laser therapy.

METHODS AND ANALYSIS

Patients with head and neck cancer held at Clinics Hospital of University of Campinas, Sao Paulo, who develop early signs/symptoms of oral mucositis are eligible. Baseline characteristics of participants include oral mucositis grade and quality of life assessments. Enrolment started in November 2017 with allocation of patients to one of the study groups by means of randomisation. Patients will be treated either with Arrabidaea chica or laser until wound healing. Monitoring includes daily assessment of mucositis grade and diameter measurement by photographs and millimetre periodontal probe. Treatments will be concluded once mucositis is healed. A blinded assessor will evaluate mucositis cure after referred by the study team. At this point, the gel tube will be weighed to indirectly assess patient's compliance. At close-out, data will be analysed by a blinded researcher following the procedures described in the statistical analyses.

ETHICS AND DISSEMINATION

This clinical trial was approved by the ethics committee of research in humans at the Faculty of Medical Sciences of University of Campinas (report no. 1,613,563/2016). Results from this trial will be communicated in peer-reviewed publications and scientific presentations.

TRIAL REGISTRATION NUMBER

RBR-5×4397.

Stereotactic radiosurgery for spinal metastases: a literature review

OBJECTIVE

The spine is the most common location for bone metastases. Since cure is not possible, local control and relief of symptoms is the basis for treatment, which is grounded on the use of conventional radiotherapy. Recently, spinal radiosurgery has been proposed for the local control of spinal metastases, whether as primary or salvage treatment. Consequently, we carried out a literature review in order to analyze the indications, efficacy, and safety of radiosurgery in the treatment of spinal metastases.

METHODS

We have reviewed the literature using the PubMed gateway with data from the MEDLINE library on studies related to the use of radiosurgery in treatment of bone metastases in spine. The studies were reviewed by all the authors and classified as to level of evidence, using the criterion defined by Wright.

RESULTS

The indications found for radiosurgery were primary control of epidural metastases (evidence level II), myeloma (level III), and metastases known to be poor responders to conventional radiotherapy--melanoma and renal cell carcinoma (level III). Spinal radiosurgery was also proposed for salvage treatment after conventional radiotherapy (level II). There is also some evidence as to the safety and efficacy of radiosurgery in cases of extramedullar and intramedullar intradural metastatic tumors (level III) and after spinal decompression and stabilization surgery.

CONCLUSION

Radiosurgery can be used in primary or salvage treatment of spinal metastases, improving local disease control and patient symptoms. It should also be considered as initial treatment for radioresistant tumors, such as melanoma and renal cell carcinoma.

Kinetic studies of lipase from Candida rugosa: a comparative study between free and immobilized enzyme onto porous chitosan beads

The search for an inexpensive support has motivated our group to undertake this work dealing with the use of chitosan as matrix for immobilizing lipase. In addition to its low cost, chitosan has several advantages for use as a support, including its lack of toxicity and chemical reactivity, allowing easy fixation of enzymes. In this article, we describe the immobilization of Candida rugosa lipase onto porous chitosan beads for the enzymatic hydrolysis of olive oil. The binding of the lipase onto the support was performed by physical adsorption using hexane as the dispersion medium. A comparative study between free and immobilized lipase was conducted in terms of pH, temperature, and thermal stability. A slightly lower value for optimum pH (6.0) was found for the immobilized form in comparison with that attained for the soluble lipase (7.0). The optimum reaction temperature shifted from 37 degrees C for the free lipase to 50 degrees C for the chitosan lipase. The patterns of heat stability indicated that the immobilization process tends to stabilize the enzyme. The half-life of the soluble free lipase at 55 degrees C was equal to 0.71 h (Kd = 0.98 h(-1)), whereas for the immobilized lipase it was 1.10 h (Kd = 0.63 h(-1)). Kinetics was tested at 37 degrees C following the hydrolysis of olive oil and obeys the Michaelis-Menten type of rate equation. The Km was 0.15 mM and the Vmax was 51 micromol/(min x mg), which were lower than for free lipase, suggesting that the apparent affinity toward the substrate changes and that the activity of the immobilized lipase decreases during the course of immobilization.

Radon flux at King George Island, Antarctic Peninsula

Fluxes of 222Rn from the ice-free terrain to the atmosphere were measured directly, for the first time, at the Brazilian Antarctic Station Ferraz during the summer field campaign of 1998/99. Average value for the flux was 7.7 +/- 4.8 x 10(-2) atoms cm(-2) s(-1) and it ranged between 0.21 x 10(-2) atoms cm(-2) s(-1) and 28 x l0(-2) atoms cm(-2) s(-1). The average flux of 220Rn was estimated to be 23 atoms cm(-2) s(-1), using a combination of two techniques: nuclear track detection and alpha spectrometry of radon daughters. It was found that the production of radon by uranium (41.54 + /-7.17 Bq kg(-1)) and thorium (57.97 +/- 12.14 Bq kg(-1)) equivalent soil contents, and a diffusion coefficient derived from experimental data for the local terrain could account for this average flux. Nevertheless, the large surges of 222Rn in the atmosphere frequently observed for that area could not be explained by this flux only.

Radon dynamics and reduction in an underground mine in Brazil. Implications for workers' exposure

This work was aimed at studying the behaviour of 222Rn in an experimental underground copper mine in Brazil with a single entrance. The 222Rn concentrations, meaured by using a dynamic radon measuring technique. varied between 30.5 Bq.m(-3), during ventilated conditions applied to the mine galleries, and 19.4 x 10(3) Bq.(-3) for non-ventilated conditions and when operational mining activities were conducted inside. High radon concentration surges were observed after blasting and drilling activities. In the cases of inadequate ventilation, it was estimated that workers could be subjected to exposures as high as 10 microSv.h(-1), only due to 222Rn and its short-lived progeny. The results show the importance of real-time measurements to evaluate radon dynamics during mining operations.

[Nutrition for 0-1 year-old infants]

RESUMO Os autores fazem uma análise suscinta dos componentes alimentares e de suas funções principais no organismo humano. Mostram a seguir a importância da alimentação adequada no crescimento da criança, apontando os requisitos básicos e condições a serem considerados na boa alimentação: quantidade, horário e número de refeições, apresentação, dosagem, dieta equilibrada e condições ambientais. Enfatizam o valor do aleitamento materno. A higiene alimentar é tratada visando principalmene a criança no 1.° mês de vida, quando os erros alimentares podem prejudicar muito o processo de crescimento. Os problemas da alimentação do lactente são tratados especificamente incluindo sugestões e recomendações sobre a prática da amamentação.