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Gouveia AG, Viani GA, Bratti VF, Marta GN, Hanna SA, Jacinto AA, Silva MS, Hamamura AC, Rosa AA, Castilho MS, Carson L, Hopman WM, Sullivan R, Booth CM, Aggarwal A, Hanna TP, Moraes FY. Challenges in building radiotherapy capacity: A longitudinal study evaluating eight years of the Brazilian radiotherapy expansion plan. J Cancer Policy 2024; 39:100459. [PMID: 38029960 DOI: 10.1016/j.jcpo.2023.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In 2012, the Brazilian government launched a radiotherapy (RT) expansion plan (PER-SUS) to install 100 linear accelerators. This study assesses the development of this program after eight years. METHODS Official reports from the Ministry of Health (MoH) were reviewed. RT centres projects status, timeframes, and cost data (all converted to US dollars) were extracted. The time analysis was divided into seven phases, and for cost evaluation, there were five stages. The initial predicted project time (IPPT) and costs (estimated by the MoH) for each phase were compared between the 18 operational RT centres (able to treat patients) and 30 non-operational RT centres using t-tests, ANOVA, and the Mann-Whitney U. A p-value < 0.05 indicates statistical significance. RESULTS A significant delay was observed when comparing the IPPT with the overall time to conclude each 48 RT centres project (p < 0.001), with considerable delays in the first five phases (p < 0.001 for all). Moreover, the median time to conclude the first 18 operational RT centres (77.4 months) was shorter compared with the 30 non-operational RT centres (94.0 months), p < 0.001. The total cost of 48 RT services was USD 82,84 millions (mi) with a significant difference in the per project median total cost between 18 operational RT centres, USD1,34 mi and 30 non-operational RT centres USD2,11 mi, p < 0.001. All phases had a higher cost when comparing 30 non-operational RT centres to 18 operational RT centres, p < 0.001. The median total cost for expanding existing RT centres was USD1,30 mi versus USD2,18 mi for new RT services, p < 0.0001. CONCLUSION After eight years, the PER-SUS programs showed a substantial delay in most projects and their phases, with increased costs over time. POLICY SUMMARY Our findings indicate a need to act to increase the success of this plan. This study may provide a benchmark for other developing countries trying to expand RT capacity.
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Affiliation(s)
- Andre G Gouveia
- Department of Oncology, Division of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Gustavo A Viani
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Vanessa F Bratti
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Gustavo N Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Sírio Libanes Hospital, São Paulo, Brazil
| | - Samir A Hanna
- Department of Oncology, Division of Radiation Oncology, Sírio Libanes Hospital, São Paulo, Brazil
| | - Alexandre A Jacinto
- Radiation Oncology Department, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Mauricio S Silva
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Unit, Santa Maria Federal University, Santa Maria; and Clínica de Radioterapia de Santa Maria, Brazil
| | - Ana C Hamamura
- Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Arthur A Rosa
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiotherapy Department Oncoclinicas Salvador and Hospital Santa Izabel, Salvador, BA, Brazil
| | - Marcus S Castilho
- Radiotherapy Department of the Felicio Rocho Hospital, Belo Horizonte, MG, Brazil; President, Brazilian Radiotherapy Society - SBRT, Brazil
| | - Laura Carson
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Wilma M Hopman
- Kingston General Health Research Institute; Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, Global Oncology Group, King's College London, London, UK
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ajay Aggarwal
- Department of Oncology, Queen's University, Kingston, ON, Canada; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada; Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
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de Sousa CFPM, Pereira AAL, Gouveia AG, Hanna SA, Moraes FY, Arruda GV, Marta GN. Does Endocrine Therapy for DCIS Patients Treated with Breast-Conserving Surgery Followed by Postoperative Radiation Therapy is Needed? A Brazilian Retrospective Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e173. [PMID: 37784785 DOI: 10.1016/j.ijrobp.2023.06.1016] [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) International previous clinical trials have demonstrated increased local control. Adjuvant endocrine therapy (ET) is a component of hormone receptor-positive breast ductal carcinoma in situ (DCIS) treatment. Previous trials have shown local control benefits. However, there are still questions regarding the reproducibility of those results in real-life scenarios and for different populations, especially in patients who received breast-conserving surgery followed by postoperative radiation therapy. Therefore, we retrospectively evaluated the impact of adjuvant ET for CDIS from a large State database in Brazil. MATERIALS/METHODS We retrospectively evaluated the Fundação Oncocentro de São Paulo (FOSP) database, which collects information on hospitals and oncology departments in the State of São Paulo, Brazil. The endpoints were local control (LC), disease-specific survival (DSS), and overall survival (OS). Moreover, we investigated the influence of medical practice (public health care system, insurance, private) and educational level (illiterate and incomplete middle school were grouped as low; complete middle school, high school, and undergraduate were grouped as medium/high). RESULTS Data from 2,192 patients who underwent breast-conserving surgery and postoperative radiotherapy and were treated between 2000 and 2020 were analyzed. The median follow-up time was 48.99 months (IQR 29.93 - 88.67). In the cohort, 53.33% (n = 1169) of patients received adjuvant ET, and 46.67% did not (n = 1023). Overall, patients not receiving adjuvant ET tend to be older (p = 0.021) and have a lower educational level (p < 0.001). Median OS and DSS were not reached. The 10-year OS and DSS for patients receiving adjuvant ET versus those not receiving it was 89.36% vs. 91.47% and 97.54% vs. 98.48%, respectively. The HR for OS for adjuvant ET vs. no ET was 0.96 (95% CI 0.63 - 1.4; p = 0.83). The HR for DSS for adjuvant ET vs. no ET was 0.79 (95% CI 0.29 - 2.12; p = 0.63). The only variable associated with survival was educational level. The 10-year OS was significantly higher for patients with medium/high educational levels (93.25% vs. 87.31%). The HR for death for medium/high versus low educational level was 0.51 (95% CI 0.32 - 0.83; p = 0.007). Recurrence rates were low in the cohort. Only 1.5% of patients had local recurrence, and 0.2% had a regional recurrence. There was no significant difference between recurrence rates for adjuvant ET (p = 0.19 and p = 0.78, respectively). CONCLUSION The benefits of adjuvant ET in DCIS patients found in international clinical trials could not be demonstrated in a Brazilian cohort. Educational level significantly impacted survival and ET usage, reflecting the influence of socioeconomic factors. Identifying these more vulnerable populations can allow for more precise interventions.
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Affiliation(s)
- C F P M de Sousa
- Department of Radiation Oncology, Hospital Sírio Libanês, Sao Paulo, Brazil
| | | | - A G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - S A Hanna
- Hospital Sírio-Libanês, São Paulo, Sao Paulo, Brazil
| | - F Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - G V Arruda
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Starling MTM, Pereira AAL, de Sousa CFPM, Restini F, Hanna SA, Gouveia AG, Moraes FY, Arruda GV, Marta GN. Brazilian Pediatric Patients with Gliomas: Treatment Characteristics and Survival Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e531-e532. [PMID: 37785649 DOI: 10.1016/j.ijrobp.2023.06.1814] [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) Despite being the second most frequent tumors in children, pediatric central nervous system (CNS) tumors are rare, and there are limited epidemiological data. The current study aimed to determine the survival rates of patients diagnosed with pediatric gliomas in Brazil, accounting for the influence of age, treatment modalities, and tumor site using population-based national database. MATERIALS/METHODS Patients diagnosed with pediatric gliomas of CNS from 1999-2020 were identified from The Fundação Oncocentro de São Paulo database. The Kaplan-Meier and the log-rank test were used for survival analysis. RESULTS A total of 1296 patients were included. The most common histologic tumor type were glioblastomas (38.27%; n = 496), pilocytic astrocytoma (32.87%; n = 426) and astrocytoma grade II (20.76%; n = 269) A total of 379 (29.24%) had brainstem tumor. The 1-year, 3-year 5-year OS for pilocytic astrocytoma were 93.72%, 89.98%, and 88.97%; for grade II 80,36%, 71,89%, 68,60%; for grade III 53,72%; 31,87%, 28,33%; and for glioblastoma 52,90%, 28,76%, 25,20%, respectively. Brainstem tumors had the worse OS compared to no brainstem tumors (p = 0.001). For high-grade glioma (grade III and IV) excluding brainstem tumors (n = 570), young patients had greater median OS (0 to 3 years: 22 months; 4 to 18 years: 13 months - p = 0.005). Regarding the treatment modalities, combined treatments were associated with higher median survival compared to less intensive therapy (surgery: 11 months; surgery and chemotherapy: 16 months; surgery, radiotherapy, and chemotherapy: 20 months; p = 0.005) CONCLUSION: In our cohort, low-grade gliomas had favorable prognoses and outcomes. Patients diagnosed with glioblastomas and brainstem gliomas had the worst OS. For high-grade gliomas, undergoing treatment de-intensification in the Brazilian pediatric population is associated with worse survival.
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Affiliation(s)
| | | | - C F P M de Sousa
- Department of Radiation Oncology, Hospital Sírio Libanês, Sao Paulo, Brazil
| | - F Restini
- Hospital Sirio Libanes, Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - S A Hanna
- Hospital Sírio-Libanês, São Paulo, Sao Paulo, Brazil
| | - A G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - F Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - G V Arruda
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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de Sousa CFPM, Moraes FY, Gouveia AG, Hanna SA, Arruda GV, Marta GN. Timely Access to Oncological Treatment in Brazil: Analysis of the 60-Law Compliance in a State Database. Int J Radiat Oncol Biol Phys 2023; 117:S79-S80. [PMID: 37784577 DOI: 10.1016/j.ijrobp.2023.06.397] [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) In oncology, time from diagnosis to treatment has already been shown to impact outcomes. In 2012, the Brazilian Government issued the 60-day Law, which stated that cancer treatment should start no longer than 60 days after histopathological diagnosis. However, there is scarce information on the effectiveness of the Law in improving timely access to treatment. MATERIALS/METHODS We retrospectively evaluate the Fundação Oncocentro de São Paulo (FOSP) database, which collects information on hospitals and oncology departments in the State of São Paulo, Brazil. The primary endpoint was time from diagnosis to first treatment (TDT), and we investigated the influence of medical practice (public health care system - SUS, insurance, private) and year of diagnosis (before and after 2012) on TDT. A sensitivity analysis was performed to evaluate information bias. RESULTS The database included 943,660 cancer patients diagnosed between 2000 and 2020. The median age was 62 years (range 0 - 113). The mean TDT was 65.95 days (SD 149.36), and the median time was 32 days (range 0 - 6891). Data was extremely skewed to the left, reflecting the fact that for 30.76% of patients (n = 290,262), the TDT was equal to 0 days. After excluding those patients, the mean TDT was 99.03 days (SD 173.85). Mean TDT was higher after the institution of the Law (63.1 versus 70.2 days, p < 0.001). On univariable analysis, there was a significant difference between mean times between medical practice (p < 0.001), and patients in the public health care system consistently showed longer intervals (82.1 days versus 58.3 and 39.3 for SUS, insurance, and private, respectively). This pattern remained in the sensitivity analysis. Overall, 59.9% of patients began treatment up to 60 days after diagnosis. However, 30.76% of these patients had TDT equal to zero. The proportion of patients with a TDT > 60 days was higher for SUS patients (39.52%). After the Law, the proportion of patients with a TDT > 60 days increased from 28.8% to 37.95%. CONCLUSION The approved and instituted 60-day Law did not improve timely access to treatment. Patients in the Public Healthcare System have experienced longer TDT, which could reflect barriers to access to care. The significant proportion of patients with a TDT of 0 days suggests information bias, which means that the actual scenario might be worse. There is an urgent need for public policies to ensure compliance with the Law.
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Affiliation(s)
- C F P M de Sousa
- Department of Radiation Oncology, Hospital Sírio Libanês, Sao Paulo, Brazil
| | - F Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - A G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - S A Hanna
- Hospital Sírio-Libanês, São Paulo, Sao Paulo, Brazil
| | - G V Arruda
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Degrande FAM, Marta GN, Alves TMMT, Ferreira GBS, Dumaszak FV, Carvalho HA, Hanna SA. Deep inspiration breath hold: dosimetric benefits to decrease cardiac dose during postoperative radiation therapy for breast cancer patients. Rep Pract Oncol Radiother 2023; 28:172-180. [PMID: 37456706 PMCID: PMC10348328 DOI: 10.5603/rpor.a2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/23/2023] [Indexed: 07/18/2023] Open
Abstract
Background Postoperative radiation therapy (RT) is the standard treatment for almost all patients diagnosed with breast cancer. Even with modern RT techniques, parts of the heart may still receive higher doses than those recommended by clinically validated dose limit restrictions, especially when the left breast is irradiated. Deep inspiration breath hold (DIBH) may reduce irradiated cardiac volume compared to free breathing (FB) treatment. This study aimed to evaluate the dosimetric impact on the heart and left anterior descending coronary artery (LAD) in FB and DIBH RT planning in patients with left breast cancer. Materials and methods A retrospective cohort study of women diagnosed with left-sided breast cancer submitted to breast surgery followed by postoperative RT from 2015 to 2019. All patients were planned with FB and DIBH and hypofractionated dose prescription (40.05 Gy in 15 fractions). Results 68 patients were included in the study. For the coverage of the planned target volume evaluation [planning target volume (PTV) eval] there was no significant difference between the DIBH versus FB planning. For the heart and LAD parameters, all constraints evaluated favored DIBH planning, with statistical significance. Regarding the heart, median V16.8 Gy was 2.56% in FB vs. 0% in DIBH (p < 0.001); median V8.8 Gy was 3.47% in FB vs. 0% in DIBH (p < 0.001) and the median of mean heart dose was 1.97 Gy in FB vs. 0.92 Gy in DIBH (p < 0.001). For the LAD constraints D2% < 42 Gy, the median dose was 34.87 Gy in FB versus 5.8 Gy in DIBH (p < 0.001); V16.8 Gy < 10%, the median was 15.87% in FB versus 0% in DIBH (p < 0.001) and the median of mean LAD dose was 8.13Gy in FB versus 2.92Gy in DIBH (p < 0.001). Conclusions The DIBH technique has consistently demonstrated a significant dose reduction in the heart and LAD in all evaluated constraints, while keeping the same dose coverage in the PTV eval.
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Affiliation(s)
| | | | | | | | | | - Heloisa A. Carvalho
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Department of Radiotherapy, Universidade de São Paulo Instituto de Radiologia, Sao Paulo, Brazil
| | - Samir A. Hanna
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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de Sousa CFPM, de Castro Junior G, Starling MTM, Restini FCF, Rodrigues AN, de Castro Ribeiro HS, Arruda GV, Hanna SA, de Moraes FY, Marta GN. Impact of the COVID-19 Outbreak on Cancer Staging in Brazil. Clin Oncol (R Coll Radiol) 2023; 35:e404-e406. [PMID: 36997457 PMCID: PMC10030257 DOI: 10.1016/j.clon.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Affiliation(s)
- C F P M de Sousa
- Department of Radiation Oncology, Hospital Sírio Libanês, São Paulo, Brazil.
| | - G de Castro Junior
- Department of Medical Oncology, Hospital Sírio Libanês, São Paulo, Brazil
| | - M T M Starling
- Department of Radiation Oncology, Hospital Sírio Libanês, São Paulo, Brazil
| | - F C F Restini
- Department of Radiation Oncology, Hospital Sírio Libanês, São Paulo, Brazil
| | - A N Rodrigues
- Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | - G V Arruda
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil
| | - S A Hanna
- Department of Radiation Oncology, Hospital Sírio Libanês, São Paulo, Brazil
| | - F Y de Moraes
- Department of Oncology, Queen's University, Kingston, Canada
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio Libanês, São Paulo, Brazil
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de Siqueira GS, Hanna SA, de Moura LF, Miranda FA, Carvalho HDA, Marta GN. Moderately hypofractionated radiation therapy for breast cancer: A Brazilian cohort study. Lancet Reg Health Am 2022; 14:100323. [PMID: 36777384 PMCID: PMC9903971 DOI: 10.1016/j.lana.2022.100323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Results from numerous clinical trials have led to a consensus that moderately hypofractionated radiation therapy is the ideal postoperative irradiation treatment plan in patients with breast cancer (BC). However, there are specific situations such as chest wall (with or without breast reconstruction) and regional node irradiation that still face obstacles in its widespread use. There is a lack of evidence supporting the use of moderately hypofractionated irradiation from the Latin American context. This study aims to describe the profile and clinical outcomes of patients treated with moderate hypofractionation for both early-stage (Stage I and II) and locally advanced BC (Stage III) regardless of the type of surgery in a Brazilian Oncology Center. Methods All patients with non-metastatic BC who were treated with moderately hypofractionated schedules of 40Gy in 15 fractions or 42.4Gy in 16 fractions between 2010 to 2019 at Hospital Sírio-Libanês, Brazil were retrospectively analyzed. The rates of local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distance recurrence-free survival (DRFS) and overall survival (OS) were estimated. Acute and late toxicity profiles were accessed for the entire cohort. Findings A total of 670 patients were included. The median age was 57 years and the median follow-up time was 31 months. Most of the patients had stage I and II breast cancer, and 81.6% underwent breast-conserving surgery. Of the 123 women who underwent mastectomy treatment, 29% (n = 37) had immediate reconstruction with implants and 28% (n = 35) with autologous tissue. Seventy-one per cent of the patients presented luminal subtype tumour and 84.3% received adjuvant hormonal therapy. Chemotherapy was administered to almost half of the patients and all 80 patients with Her-2 positive disease received trastuzumab-based systemic therapy. One-third of patients received regional node irradiation; boost was performed in 41.1% of treatments. The 5-year LRFS, RRFS, DRFS and OS was 95.6%, 97.6%,92.2% and 95.9%, respectively. Acute and late side effects profile were mild and only 2.9% of patients developed grade 3 dermatitis. Among patients with breast implants, 11.4% had capsular contracture. Interpretation In this Brazilian institution experience, moderately hypofractionated irradiation to the breast, chest wall (with or without breast reconstruction), and regional lymph nodes was safe and with an acceptable toxicity profile. Funding None.
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Affiliation(s)
| | - Samir A. Hanna
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil
| | | | | | - Heloísa de Andrade Carvalho
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil,Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil,Latin American Cooperative Oncology Group, Porto Alegre, Brazil,Corresponding author at: Department of Radiation Oncology, Hospital Sírio, Libanês, Rua Dona Adma Jafet 91. Sao Paulo, SP. Brazil. 01308-050.
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Asso RN, Mancini A, Palhares DMF, Neves Junior WFP, Marta GN, Da Silva JLF, Ramos BFG, Gadia R, Hanna SA. Radiosurgery for multiple brain metastases using volumetric modulated arc therapy: a single institutional series. Rep Pract Oncol Radiother 2022. [DOI: 10.5603/por.a2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Marta GN, de Arruda FF, Miranda FA, Silva ARNS, Neves-Junior WFP, Mancini A, Hanna SA, Abreu CECV, da Silva JLF, Nascimento JEV, Haddad CMK, Moraes FY, Gadia R. Stereotactic ablative radiation therapy for spinal metastases: experience at a single Brazilian institution. Rep Pract Oncol Radiother 2021; 26:756-763. [PMID: 34760310 DOI: 10.5603/rpor.a2021.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/09/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to assess the clinical outcomes of patients with spine metastases who underwent stereotactic ablative radiation therapy (SABR) as part of their treatment. SABR has arisen as a contemporary treatment option for spinal metastasis patients with good prognoses. Materials and methods Between November 2010 and September 2018, Spinal SABR was performed in patients with metastatic disease in different settings: radical (SABR only), postoperative (after decompression and/or fixation surgery), and reirradiation. Local control (LC), pain control, overall survival (OS) and toxicities were reported. Results Eighty-five patients (corresponding to 96 treatments) with spine metastases were included. The median age was 59 years (range, 23-91). In most SA BR (82.3%, n = 79) was performed as the first local spine treatment, while in 12 settings (12.5%), fixation and/or decompression surgery was performed prior to SABR. Two-year overall survival rate was 74.1%, and median survival was 19 months. The LC rate at 2 years was 72.3%. With regard to pain control, among 67 patients presenting with pain before SA BR, 83.3% had a complete response, 12.1% had a partial response, and 4.6% had progression. Vertebral compression fractures occurred in 10 patients (11.7%), of which 5 cases occurred in the reirradiation setting. Radiculopathy and myelopathy were not observed. No grade III or IV toxicities were seen. Conclusion This is the first study presenting a Brazilian experience with spinal SA BR, and the results confirm its feasibility and safety. SABR was shown to produce good local and pain control rates with low rates of adverse events.
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Affiliation(s)
- Gustavo N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Fabiana A Miranda
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Alice R N S Silva
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Anselmo Mancini
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Samir A Hanna
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Carlos E C V Abreu
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | | | | | - Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Queen's University - Kingston Health Science Centre, Kingston, ON, Canada
| | - Rafael Gadia
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Mano MS, Oliveira LJC, Hanna SA. Integrating Adjuvant Radiation with Post-Neoadjuvant Therapies in Early Breast Cancer. Curr Oncol Rep 2021; 23:58. [PMID: 33770260 DOI: 10.1007/s11912-021-01050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Because of the strong prognostic value of pathologic complete response (pCR) in early breast cancer (EBC), patients who fail to achieve this outcome have increasingly been eligible to a new treatment modality, namely post-neoadjuvant systemic therapy (PNT). However, adjuvant radiation therapy (RT) retains a crucial role in EBC, and also needs to be timely administered to patients. To address how modern PNT optimally integrates with adjuvant RT is therefore the purpose of this review. RECENT FINDINGS How PNT administration optimally integrates with adjuvant RT has varied depending on the type of systemic therapy employed. The introduction of novel "targeted" agents has created new challenges, as for many of them limited information is available on the feasibility of concurrent systemic and RT administration or their optimal sequencing. PNT and RT are both of utmost importance to the management of EBC and need to be timely and safely administered to patients. The optimal strategy to integrate these modalities may vary according to the type of PNT agent and other factors.
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Affiliation(s)
- Max S Mano
- Centro Paulista de Oncologia (CPO) - Unidade Faria Lima Endereço, Av. Brigadeiro Faria Lima, 4300 Grupo Oncoclínicas (GOC), São Paulo, SP, 04538-132, Brazil.
| | - Leandro Jonata C Oliveira
- Centro Paulista de Oncologia (CPO) - Unidade Faria Lima Endereço, Av. Brigadeiro Faria Lima, 4300 Grupo Oncoclínicas (GOC), São Paulo, SP, 04538-132, Brazil
| | - Samir A Hanna
- Department of Radiation Oncology - Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Oncology Center, São Paulo, 01308-050, Brazil
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Spencer RMSSB, de Camargo VP, Silva MLG, Pinto FFE, Costa FD, Cequeira WS, Munhoz RR, Mello CA, Schmerling RA, Filho WJD, Coelho TM, Ambrosio AVA, Leite ETT, Hanna SA, Nakagawa SA, Baptista AM, Pinheiro RN, de Oliveira JL, de Araújo MS, de Araujo RLC, Laporte GA, de Almeida Quadros C, de Oliveira AF, Lopes A. Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas. J Surg Oncol 2020; 121:743-758. [PMID: 31970785 DOI: 10.1002/jso.25847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/08/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are rare tumors and constitute only 1% of all tumors in adults. Indeed, due to their rarity, most cases in Brazil are not treated according to primary international guidelines. METHODS This consensus addresses the treatment of STSs in the extremities. It was made by workgroups from Brazilian Societies of Surgical Oncology, Orthopaedics, Clinical Oncology, Pathology, Radiology and Diagnostic Imaging, and Radiation Oncology. The workgroups based their arguments on the best level of evidence in the literature and recommendations were made according to diagnosis, staging, and treatment of STSs. A meeting was held with all the invited experts and the topics were presented individually with the definition of the degree of recommendation, based on the levels of evidence in the literature. RESULTS Risk factors and epidemiology were described as well as the pathological aspects and imaging. All recommendations are described with the degree of recommendation and levels of evidence. CONCLUSION Recommendations based on the best literature regional aspects were made to guide professionals who treat STS. Separate consensus on specific treatments for retroperitoneal, visceral, trunk, head and neck sarcomas, and gastrointestinal stromal tumor, are not contemplated into this consensus.
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Affiliation(s)
- Ranyell M S S B Spencer
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Veridiana P de Camargo
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Maria L G Silva
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Fabio F E Pinto
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | | | - Wagner S Cequeira
- AC Camargo Cancer Center, Department of Diagnosis and Imaging, São Paulo, Brazil
| | - Rodrigo R Munhoz
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Celso A Mello
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Rafael A Schmerling
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Waldec J D Filho
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Tharcisio M Coelho
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Alexandre V A Ambrosio
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Elton T T Leite
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Samir A Hanna
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Sueli A Nakagawa
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Andre M Baptista
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Rodrigo N Pinheiro
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Jadivan L de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Marcelo Sá de Araújo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Raphael L C de Araujo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Gustavo A Laporte
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | | | - Alexandre F de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Ademar Lopes
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
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Walters S, Prasad A, Guevel B, Sarraf KM, Achan P, Dawson-Bowling S, Millington S, Hanna SA. Systematic review of the outcome of cemented versus uncemented total hip arthroplasty following pelvic irradiation. Musculoskelet Surg 2019; 103:221-230. [PMID: 30937859 DOI: 10.1007/s12306-019-00597-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/04/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The objective of this study is to evaluate the outcomes of total hip arthroplasty (THA) in patients with radiation-related changes to the bone, and specifically whether there is a difference in outcomes between cemented and uncemented acetabular components. METHODS A database search was performed to identify available studies reporting adults undergoing THA who have previously had pelvic irradiation. Data were extracted and analysed with respect to the use of cemented versus uncemented acetabular components. Statistical analysis was performed using the Chi-square test for independence. RESULTS The all-cause revision rate was 24% in the cemented THA group (27/111), compared with 15% of uncemented THAs (22/143) (p = 0.073). Revision for acetabular aseptic loosening occurred in 16% of cases (18/111) in the cemented group and 10% (15/143) in the uncemented group (p = 0.178). Acetabular aseptic loosening was reported in 24% of cemented THAs (27/111) and 14% of uncemented THAs (20/143), which was statistically significant (p = 0.035). Not all of these went on to have revision THA. The Incidence of prosthetic joint infection was similar in both groups. CONCLUSION Overall outcomes appear to be better for uncemented THAs in post-radiotherapy patients, with a significantly lower rate of aseptic loosening and an appreciable (but not statistically significant) reduction in revision rate. The best outcomes seem to be associated with the use of acetabular reinforcement across both cemented and uncemented groups, but further work is needed to evaluate this.
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Affiliation(s)
- S Walters
- Health Education England, London, UK
| | - A Prasad
- Imperial College London, London, UK
| | - B Guevel
- Health Education England, London, UK
| | - K M Sarraf
- Imperial Healthcare NHS Trust, London, UK
| | - P Achan
- Barts Health NHS Trust, London, UK
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Affiliation(s)
- L D Jones
- Department of Orthopaedic Surgery, Stanford University, California, USA
| | - D Golan
- Department of Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S A Hanna
- Department of Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Ramachandran
- Department of Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
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Hanna SA, Somerville L, McCalden RW, Naudie DD, MacDonald SJ. Highly cross-linked polyethylene decreases the rate of revision of total hip arthroplasty compared with conventional polyethylene at 13 years' follow-up. Bone Joint J 2016; 98-B:28-32. [PMID: 26733512 DOI: 10.1302/0301-620x.98b1.36527] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS The purpose of this study was to compare the long-term results of primary total hip arthroplasty (THA) in young patients using either a conventional (CPE) or a highly cross-linked (HXLPE) polyethylene liner in terms of functional outcome, incidence of osteolysis, radiological wear and rate of revision. METHODS We included all patients between the ages of 45 and 65 years who, between January 2000 and December 2001, had undergone a primary THA for osteoarthritis at our hospital using a CPE or HXLPE acetabular liner and a 28 mm cobalt-chrome femoral head. From a total of 160 patients, 158 (177 hips) were available for review (CPE 89; XLPE 88). The mean age, body mass index (BMI) and follow-up in each group were: CPE: 56.8 years (46 to 65); 30.7 kg/m(2) (19 to 58); 13.2 years (2.1 to 14.7) and HXLPE: 55.6 years (45 to 65); BMI: 30 kg/m(2) (18 to 51); 13.1 years (5.7 to 14.4). RESULTS The mean Harris hip score (HHS) at final follow-up was 89.3 for the CPE group and 90.9 for the HXLPE group (p = 0.078). Osteolysis was present around 15 acetabular (17%) and 16 femoral (18%) components in the CPE hips compared with none (0%) in the HXLPE hips. The mean radiological linear wear of the CPE liners was 0.11 mm/year compared with 0.035 mm/year for the HXLPE liners (p = 0.006). The cumulative implant survival, with revision for polyethylene wear as the endpoint, was 86% (95% confidence interval 78 to 94) in the CPE group and 100% in the HXLPE group at 13 years (numbers at risk at 13 years - CPE: 65, XLPE: 61). DISCUSSION This study shows that HXLPE liners are associated with significantly less osteolysis and a lower rate of revision THA than CPE liners at long-term follow-up. TAKE HOME MESSAGE The findings of this study highlight the clinical benefits of using HXLPE liners in THA and support the routine use of the material in order to improve implant longevity and to decrease the number of patients needing revision for aseptic osteolysis.
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Affiliation(s)
- S A Hanna
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - L Somerville
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - R W McCalden
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - D D Naudie
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - S J MacDonald
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
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15
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Weltman E, Marta GN, Baraldi HS, Pimentel L, Castilho M, Maia MAC, Lundgren MSFS, Chen MJ, Novaes PERS, Gadia R, Ferrigno R, Motta R, Hanna SA, Almeida W. Treatment of abdominal tumors using radiotherapy. Rev Assoc Med Bras (1992) 2015; 61:108-13. [DOI: 10.1590/1806-9282.61.02.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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16
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Bernardo WM, Weltman E, Marta GN, Baraldi HS, Pimentel L, Castilho M, Maia MAC, Lundgren MSFS, Chen MJ, Novaes PERS, Gadia R, Ferrigno R, Motta R, Hanna SA, Almeida W. Update of treatment of abdominal tumor using radiotherapy. Rev Assoc Med Bras (1992) 2015. [DOI: 10.1590/1806-9282.61.02.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Marta GN, Hanna SA, Gadia R. Treatment with intensity-modulated radiation therapy (IMRT) for breast cancer. Rev Assoc Med Bras (1992) 2014; 60:508-11. [DOI: 10.1590/1806-9282.60.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Kayani B, Hanna SA, Sewell MD, Saifuddin A, Molloy S, Briggs TWR. A review of the surgical management of sacral chordoma. Eur J Surg Oncol 2014; 40:1412-20. [PMID: 24793103 DOI: 10.1016/j.ejso.2014.04.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [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: 01/16/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sacral chordomas are rare low-to-intermediate grade malignant tumours, which arise from remnants of the embryonic notochord. This review explores prognostic factors in the management of sacral chordomas and provides guidance on the optimal treatment regimens based on the current literature. PATIENTS AND METHODS Electronic searches were performed using MEDLINE, Embase and the Cochrane library to identify studies on prognostic factors in the management of sacral chordomas published between January 1970 and December 2013. The literature search and review process identified 100 articles that were included in the review article. This included both surgical and non-surgical studies on the management of sacral chordomas. RESULTS Sacrectomy with wide resection margins forms the mainstay of treatment but is associated with high risk of disease recurrence and reduced long-term survival. Adequate resection margins may require sacrifice of adjacent nerve roots, musculature and ligaments leading to functional compromise and mechanical instability. Large tumour size (greater than 5-10 cm in diameter), dedifferentiation and greater cephalad tumour extension are associated with increased risk of disease recurrence and reduced survival. Chordomas are poorly responsive to conventional radiotherapy and chemotherapy. CONCLUSION Operative resection with wide resection margins offers the best long-term prognosis. Inadequate resection margins, large tumour size, dedifferentiation, and greater cephalad chordoma extension are associated with poor oncological outcomes. Routine long-term follow-up is essential to enable early detection and treatment of recurrent disease.
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Affiliation(s)
- B Kayani
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - S A Hanna
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - M D Sewell
- The Royal National Orthopaedic Hospital, Stanmore, UK.
| | - A Saifuddin
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - S Molloy
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - T W R Briggs
- The Royal National Orthopaedic Hospital, Stanmore, UK
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19
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Hanna SA, Carvalho HA, Andrade FEM, Bevilacqua JLB, Piato JRM, Docema MFL, Barros ASCD. Abstract P5-14-10: Adjuvant intra-operative electron-beam therapy for early invasive breast carcinoma using non-dedicated linear accelerator: Toxicity, efficacy, and aesthetic satisfaction. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-14-10] [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: 11/16/2022]
Abstract
Abstract
INTRODUCTION: In May 2004 we started a prospective trial on adjuvant intraoperative electron-beam therapy (IORT) in early invasive breast cancer, but instead of a dedicated machine, we used a non-dedicated linear accelerator (NDLA).
OBJECTIVES: To analyze early and late complications, cosmetic satisfaction of patients, and recurrence rates.
METHODS: Patients with the following characteristics were included: invasive breast ductal carcinoma, local staging with mammogram, ultrasound and magnetic resonance imaging showing uni-central and uni-focal tumor, age≥40 years, T1N0. The procedure is done according to the following steps on table 1:
PROTOCOL STEPS1Surgery performed in an operative room close to linear accelerator suite2Wide local excision with frozen sections of surgical margins and sentinel lymph node biopsy3If positive margins, they are expanded until negativity. If sentinel node positive, or multicentric/multifocal tumor, IORT is aborted4With both margins and sentinel lymph node free, the parenchyma round the surgical cavity is detached from skin and pectoralis major muscle. A shield (lead/aluminum/silicone disc) is placed underneath the breast parenchyma to avoid foward radiation5The breast parenchyma is sutured above the shield surface6The parenchyma thickness is measured for selection of the suitable electron energy7A collimator (cilindrical radiation applicator) is chosen for entire coverage of parenchyma8The patient is transferred from operative room to linear accelerator room and the collimator is attached to the machine9A portal-film (6MV photon-beam) is taken to check the alignment between the shield and applicator10If portal-film shows unfavorable positioning, the shield is realigned and a new portal-film is taken. Upon satisfactory condition, a single dose of 21Gy is delivered at 90% isodosis11After IORT completion the surgical procedure is ended
RESULTS: Initially 194 patients were included, but due to intraoperative exclusion criteria (positive sentinel lymph nodes or margins), 159 were analyzed. The median age was 57.9 (40 to 85.4) years and the median follow-up was 56.6 (1 to 103.2) months. Seven patients recurred (4 local and 3 regional). The average estimates for overall and event-free survival were respectively 95.4 (CI 95% 93.1-97.6) months and 90.1 (CI 95% 85.8-94.5) months. The crude incidences for acute (up to one month after surgery) and late (after one month) toxicities were respectively 8.2% and 26.2%. Excellent, good, fair and bad cosmetic outcomes (Harvard/NSABP/RT OG scale) were observed in 70.9%, 14.2%, 3.7% and 3.0%, respectively. Collimator sizes were 4cm in 18.7%, 5cm in 80.6%, and 7cm in 0.7% of cases. The electron energy chosen for treatment was 6MeV in 7.4%, 9MeV in 52.2%, 12MeV in 35.8%, 15MeV in 3.7% and 18MeV in 0.7%. The alignment between the shield and the collimator was appropriate in 72.4% (27.6% of patients required repositioning). No infection cases were related to peri-hospitalar time.
CONCLUSIONS: IORT using NDLA has shown low toxicity profile, high favorable aesthetics outcomes, and good oncologic efficacy. The use of NDLA may be usefull in settings without dedicated equipment for breast IORT.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-10.
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Affiliation(s)
- SA Hanna
- Hospital SirioLibanês, Sao Paulo, SP, Brazil
| | - HA Carvalho
- Hospital SirioLibanês, Sao Paulo, SP, Brazil
| | - FEM Andrade
- Hospital SirioLibanês, Sao Paulo, SP, Brazil
| | | | - JRM Piato
- Hospital SirioLibanês, Sao Paulo, SP, Brazil
| | - MFL Docema
- Hospital SirioLibanês, Sao Paulo, SP, Brazil
| | - ASCD Barros
- Hospital SirioLibanês, Sao Paulo, SP, Brazil
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20
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Gadia R, Leite ÉT, Gabrielli FG, Marta GN, Arruda FF, Abreu CV, Hanna SA, Haddad CK, Silva JF, Carvalho HA, Garicochea B. Outcomes of high-dose intensity-modulated radiotherapy alone with 1 cm planning target volume posterior margin for localized prostate cancer. Radiat Oncol 2013; 8:285. [PMID: 24314072 PMCID: PMC3996204 DOI: 10.1186/1748-717x-8-285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 11/13/2013] [Indexed: 11/23/2022] Open
Abstract
Background Clinically localized prostate cancer may be treated by different approaches of radiation therapy. The aim of this study was to report the results of disease control and toxicity in patients with clinically localized prostate cancer treated with high dose IMRT alone with 1 cm PTV posterior margin. Methods From September 2001 to April 2008, 140 patients with localized prostate cancer were treated with definitive IMRT (dose ≥ 74 Gy) without hormone therapy. Outcomes were measured from the conclusion of radiotherapy. Biochemical failure was defined as PSA nadir + 2.0 ng/dL. Toxicities were assessed using the NCI-CTCAE-version 3.0. Median follow-up was 58 months. Results Biochemical failure occurred in 13.6% of patients. Actuarial 5-year biochemical control rates were 91.7%, 82.5% and 85.9% for low-, intermediate-, and high-risk patients, respectively. Stage T2 patients presented a risk of biochemical failure almost three times higher than stage T1 (RR = 2.91; 95% CI: 1.04; 8.17). Distant metastases occurred in 3 (2%) patients. Five-year metastasis-free and overall survivals were 96% and 97.5%, respectively. Late grade 3 genitourinary and gastrointestinal toxicity rates were, respectively, 1.6% and 3%. Conclusion High-dose IMRT alone with 1 cm posterior PTV margin was effective and safe for patients with localized prostate cancer.
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Affiliation(s)
- Rafael Gadia
- Department of Radiation Oncology, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, Brazil.
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21
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Hanna SA, Marta GN, Riera R, da Silva JLF, de Andrade Carvalho H, De Barros ACSD. Intensity-modulated versus conventional radiotherapy for breast cancer. Cochrane Database Syst Rev 2013. [DOI: 10.1002/14651858.cd010420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Samir A. Hanna
- Hospital Sirio Libanes; Radiation Oncology Department; Sao Paulo Brazil
| | - Gustavo N Marta
- Hospital Sirio Libanes; Radiation Oncology Department; Sao Paulo Brazil
| | - Rachel Riera
- Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; R. Borges Lagoa, 564 cj 63 São Paulo São Paulo Brazil 04038000
| | - Joao LF da Silva
- Hospital Sirio Libanes; Radiation Oncology Department; Sao Paulo Brazil
| | - Heloisa de Andrade Carvalho
- Hospital Sirio Libanes; Radiation Oncology Department; Sao Paulo Brazil
- Faculdade de Medicina, Universidade de Sao Paulo; Radiation Oncology Department; Sao Paulo Brazil
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Sewell MD, Al-Hadithy N, Hanna SA, Al-Khateeb H, Carrington RWJ, Blunn GW, Skinner JA, Briggs TWR. Custom rotating-hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction. Arch Orthop Trauma Surg 2012; 132:1321-5. [PMID: 22718075 DOI: 10.1007/s00402-012-1539-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Indexed: 11/24/2022]
Abstract
Spina bifida (SB) is a congenital disorder which may result in a number of musculoskeletal problems. Total knee replacement (TKR) in this patient group is technically demanding due to bone deformity, soft tissue contracture, muscle tone abnormality and ligament insufficiency. This is a retrospective review of three patients with SB and disabling knee arthritis who were managed with a custom rotating-hinge (RHK) total knee system. All patients reported an improvement in knee pain and stability at mean follow-up 47 months (43-53). Mean Oxford Knee score improved from 21 preoperatively to 32 at final follow-up. One patient required revision of tibial and patella components at 37 months for lateral patella instability and excessive wear. Custom RHK for patients with SB, severe neuromuscular dysfunction and bone deformity relieves pain, restores stability and improves early knee function; however there is a significant risk of extensor mechanism complications and functional outcome is worse than primary TKR in the general population.
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Affiliation(s)
- M D Sewell
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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23
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Hanna SA, Sewell MD, Aston WJS, Pollock RC, Skinner JA, Cannon SR, Briggs TWR. Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bone tumours. ACTA ACUST UNITED AC 2010; 92:867-74. [PMID: 20513887 DOI: 10.1302/0301-620x.92b6.23449] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Segmental resection of malignant bone disease in the femoral diaphysis with subsequent limb reconstruction is a major undertaking. This is a retrospective review of 23 patients who had undergone limb salvage by endoprosthetic replacement of the femoral diaphysis for a primary bone tumour between 1989 and 2005. There were 16 males and seven females, with a mean age of 41.3 years (10 to 68). The mean overall follow-up was for 97 months (3 to 240), and 120 months (42 to 240) for the living patients. The cumulative patient survival was 77% (95% confidence interval 63% to 95%) at ten years. Survival of the implant, with failure of the endoprosthesis as an endpoint, was 85% at five years and 68% (95% confidence interval 42% to 92%) at ten years. The revision rate was 22% and the overall rate of re-operation was 26%. Complications included deep infection (4%), breakage of the prosthesis (8%), periprosthetic fracture (4%), aseptic loosening (4%), local recurrence (4%) and metastases (17%). The 16 patients who retained their diaphyseal endoprosthesis had a mean Musculoskeletal Tumour Society score of 87% (67% to 93%). They were all able to comfortably perform most activities of daily living. Femoral diaphyseal endoprosthetic replacement is a viable option for reconstruction following segmental resection of malignant bone disease. It allows immediate weight-bearing, is associated with a good long-term functional outcome, has an acceptable complication and revision rate and, most importantly, does not appear to compromise patient survival.
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Affiliation(s)
- S A Hanna
- The Sarcoma Unit Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4 LP, UK.
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Neves-Junior WFP, Hanna SA, Mancini A, Pelosi EL, Haddad CMK. SU-GG-J-115: IGRT with Megavoltage Cone Beam CT for Prostate Patients with Fiducial Markers: Action Levels and Population Margins. Med Phys 2010. [DOI: 10.1118/1.3468339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hanna SA, Marta GN, Neves-Junior WF, Haddad CM, Luis F. da Silva J. Transperineal Implantation of Gold Fiducial Markers for Image-Guided Radiotherapy for Prostate Cancer. Brachytherapy 2010. [DOI: 10.1016/j.brachy.2010.02.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sewell MD, Spiegelberg BGI, Hanna SA, Aston WJS, Bartlett W, Blunn GW, David LA, Cannon SR, Briggs TWR. Total femoral endoprosthetic replacement following excision of bone tumours. ACTA ACUST UNITED AC 2009; 91:1513-20. [PMID: 19880899 DOI: 10.1302/0301-620x.91b11.21996] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We undertook a retrospective review of 33 patients who underwent total femoral endoprosthetic replacement as limb salvage following excision of a malignant bone tumour. In 22 patients this was performed as a primary procedure following total femoral resection for malignant disease. Revision to a total femoral replacement was required in 11 patients following failed segmental endoprosthetic or allograft reconstruction. There were 33 patients with primary malignant tumours, and three had metastatic lesions. The mean age of the patients was 31 years (5 to 68). The mean follow-up was 4.2 years (9 months to 16.4 years). At five years the survival of the implants was 100%, with removal as the endpoint and 56% where the endpoint was another surgical intervention. At five years the patient survival was 32%. Complications included dislocation of the hip in six patients (18%), local recurrence in three (9%), peri-prosthetic fracture in two and infection in one. One patient subsequently developed pulmonary metastases. There were no cases of aseptic loosening or amputation. Four patients required a change of bushings. The mean Musculoskeletal Tumour Society functional outcome score was 67%, the mean Harris Hip Score was 70, and the mean Oxford Knee Score was 34. Total femoral endoprosthetic replacement can provide good functional outcome without compromising patient survival, and in selected cases provides an effective alternative to amputation.
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Affiliation(s)
- M D Sewell
- Institute of Orthopaedics and Musculoskeletal Science, The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
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Shekkeris AS, Hanna SA, Sewell MD, Spiegelberg BGI, Aston WJS, Blunn GW, Cannon SR, Briggs TWR. Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours. ACTA ACUST UNITED AC 2009; 91:1378-82. [PMID: 19794176 DOI: 10.1302/0301-620x.91b10.22643] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Endoprosthetic replacement of the distal tibia and ankle joint for a primary bone tumour is a rarely attempted and technically challenging procedure. We report the outcome of six patients treated between 1981 and 2007. There were four males and two females, with a mean age of 43.5 years (15 to 75), and a mean follow-up of 9.6 years (1 to 27). No patient developed a local recurrence or metastasis. Two of the six went on to have a below-knee amputation for persistent infection after a mean 16 months (1 to 31). The four patients who retained their endoprosthesis had a mean musculoskeletal tumour society score of 70% and a mean Toronto extremity salvage score of 71%. All were pain free and able to perform most activities of daily living in comfort. A custom-made endoprosthetic replacement of the distal tibia and ankle joint is a viable treatment option for carefully selected patients with a primary bone tumour. Patients should, however, be informed of the risk of infection and the potential need for amputation if this cannot be controlled.
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Affiliation(s)
- A S Shekkeris
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, England
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Hanna SA, Whittingham-Jones P, Sewell MD, Pollock RC, Skinner JA, Saifuddin A, Flanagan A, Cannon SR, Briggs TWR. Outcome of intralesional curettage for low-grade chondrosarcoma of long bones. Eur J Surg Oncol 2009; 35:1343-7. [PMID: 19570648 DOI: 10.1016/j.ejso.2009.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 05/30/2009] [Accepted: 06/02/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Different treatment strategies for low-grade chondrosarcomas are reported in the literature with variable outcomes. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage and cementation of the lesion as a treatment strategy. PATIENTS AND METHODS We performed a retrospective review of 39 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and cementation at our institution between 1999 and 2005. RESULTS There were 10 males and 29 females with a mean age of 55.5 years (32-82), and a mean follow-up of 5.1 years (3-8.7). Local recurrence occurred in two patients (5%) within the first two years following index surgery. Both were treated by re-curettage and cementation of the resultant defects. A second local recurrence developed a year later in one of these two patients, for which a further curettage followed by local liquid nitrogen treatment was performed. Overall, there were no cases of post-operative complications or metastases. The patients were assessed using the Musculoskeletal Tumour Society scoring system (MSTS) to determine limb function. The average score achieved was 94% (79-100%). CONCLUSION Intralesional curettage is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones, with excellent oncological and functional results. Careful case selection with stringent clinical and radiographic follow-up is recommended.
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Affiliation(s)
- S A Hanna
- Department of Orthopaedic Oncology, London Bone and Soft Tissue Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom.
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Hanna SA, David LA, Gikas PD, Tindall AJ, Cannon SR, Briggs TWR. Very late local recurrence of Ewing's sarcoma--can you ever say 'cured'? A report of two cases and literature review. Ann R Coll Surg Engl 2009; 90:W12-5. [PMID: 18831863 DOI: 10.1308/147870808x303146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report two rare cases of very late local recurrence of Ewing's sarcoma, occurring 16 years and 19 years after treatment of the primary tumour. In both cases, disease remission had been achieved. Both patients originally underwent non-surgical combined modality therapy following initial diagnosis and both were rendered disease-free. After a long latent phase, both started experiencing unexplained local symptoms. These were investigated at their local hospital but tumour recurrence was not initially considered as a cause of these symptoms. The two patients were eventually referred back to our institution after the diagnosis of recurrent Ewing's sarcoma was established. Both have successfully undergone complete excision of the recurrences and are receiving postoperative adjuvant therapy. These cases highlight the need to remain vigilant for local recurrence, however long after the initial diagnosis.
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Affiliation(s)
- S A Hanna
- London Bone and Soft Tissue Tumour Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
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Mendes-Giannini MJ, Taylor ML, Bouchara JB, Burger E, Calich VL, Escalante ED, Hanna SA, Lenzi HL, Machado MP, Miyaji M, Monteiro Da Silva JL, Mota EM, Restrepo A, Restrepo S, Tronchin G, Vincenzi LR, Xidieh CF, Zenteno E. Pathogenesis II: fungal responses to host responses: interaction of host cells with fungi. Med Mycol 2001; 38 Suppl 1:113-23. [PMID: 11204137] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Most of our knowledge concerning the virulence determinants of pathogenic fungi comes from the infected host, mainly from animal models and more recently from in vitro studies with cell cultures. The fungi usually present intra- and/or extracellular host-parasite interfaces, with the parasitism phenomenon dependent on complementary surface molecules. Among living organisms, this has been characterized as a cohabitation event, where the fungus is able to recognize specific host tissues acting as an attractant, creating stable conditions for its survival. Several fungi pathogenic for humans and animals have evolved special strategies to deliver elements to their cellular targets that may be relevant to their pathogenicity. Most of these pathogens express surface factors that mediate binding to host cells either directly or indirectly, in the latter case binding to host adhesion components such as extracellular matrix (ECM) proteins, which act as 'interlinking' molecules. The entry of the pathogen into the host cell is initiated by fungal adherence to the cell surface, which generates an uptake signal that may induce its cytoplasmic internalization. Once this is accomplished, some fungi are able to alter the host cytoskeletal architecture, as manifested by a rearrangement of microtubule and microfilament proteins, and this can also induce epithelial host cells to become apoptotic. It is possible that fungal pathogens induce modulation of different host cell pathways in order to evade host defences and to foster their own proliferation. For a number of pathogens, the ability to bind ECM glycoproteins, the capability of internalization and the induction of apoptosis are considered important factors in virulence. Furthermore, specific recognition between fungal parasites and their host cell targets may be mediated by the interaction of carbohydrate-binding proteins, e.g., lectins on the surface of one type of cell, probably a parasite, that combine with complementary sugars on the surface of host-cell. These interactions supply precise models to study putative adhesins and receptor-containing molecules in the context of the fungus-host interface. The recognition of the host molecules by fungi such as Aspergillus fumigatus, Paracoccidioides brasiliensis and Histoplasma capsulatum, and their molecular mechanisms of adhesion and invasion, are reviewed in this paper.
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Affiliation(s)
- M J Mendes-Giannini
- Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista, Araraquara, SP, Brazil.
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Abstract
Paracoccidioides brasiliensis is a dimorphic fungus known to produce invasive systemic disease in humans. The 43-kDa glycoprotein of P. brasiliensis is the major diagnostic antigen of paracoccidioidomycosis and may act as a virulence factor, since it is a receptor for laminin.Very little is known about early interactions between this fungus and the host cells, so we developed in vitro a model system employing cultured mammalian cells (Vero cells), in order to investigate the factors and virulence mechanisms of P.brasiliensis related to the adhesion and invasion process. We found that there is a permanent interaction after 30 min of contact between the fungus and the cells. The yeasts multiply in the cells for between 5 and 24 h. Different strains of P. brasiliensis were compared, and strain 18 (high virulence) was the most strongly adherent, followed by strain 113 (virulent), 265 (considered of low virulence) and 113M (mutant obtained by ultraviolet radiation, deficient in gp43). P. brasiliensis adhered to the epithelial cells by a narrow tube, while depressions were noticed in the cell surface, suggesting an active cavitation process. An inhibition assay was performed and it was verified that anti-gp43 serum and a pool of sera from individuals with paracoccidioidomycosis were able to inhibit the adhesion of P. brasiliensis to the Vero cells. Glycoprotein 43 (gp43) antiserum abolished 85% of the binding activity of P. brasiliensis. This fungus can also invade the Vero cells, and intraepithelial parasitism could be an escape mechanism in paracoccidioidomycosis.
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Affiliation(s)
- S A Hanna
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas UNESP, Rua Expedicionários do Brasil, Araraquara
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Shibley GP, Tanner JE, Hanna SA. United States Department of Agriculture licensing requirements for feline leukemia virus vaccines. J Am Vet Med Assoc 1991; 199:1402-6. [PMID: 1666091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- G P Shibley
- United States Department of Agriculture Animal and Plant Health Inspection Service, Biotechnology, Biologics, and Environmental Protection, Hyattsville, MD 20782
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Hanna SA. REVIEWS: Formulation of Veterinary Dosage Forms. J Pharm Sci 1983. [DOI: 10.1002/jps.2600721041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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