pela orientação, apoio e amizade, sem os quais eu não teria terminado minha dissertação. Á Profª. Ms. Maria Linarelli, por acompanhar este trabalho desde o início, pelo estímulo e apoio inestimáveis. À veterinária e mestre Karin Maia Monteiro, pelo apoio e compartilhamento de dados. Ao Sr. Paul Huber pela confiança e apoio e por acreditar sempre neste projeto. A Sra. Suely Francisco, bibliotecária do Hospital A. C. Camargo em São Paulo, pelo capricho e paciência na formatação desta tese. vi RESUMO Segundo estimativas da Organização Mundial de Saúde, surgem a cada ano dez milhões de novos casos e cinco milhões de pessoas vão a óbito em decorrência do câncer. Apesar do aumento da especificidade de inúmeros novos quimioterápicos sobre as células tumorais, seus efeitos colaterais sobre células normais ainda representam um grande entrave no tratamento de portadores de câncer. Sinais e sintomas como alopecia, náuseas, vômitos, diarréia e adinamia tornam o tratamento muitas vezes inviável para muitos pacientes. Alguns suplementos nutricionais, como o selênio e a glutamina, foram descritos como eficientes para reduzir ou abolir os efeitos adversos da quimioterapia. O objetivo geral deste estudo é o de verificar se o suplemento nutricional TK3 (triptofano e timina), reduz as seguintes toxicidades: mucosite, diarréia, náuseas, vômitos, constipação intestinal, alopecia, dermatite, eritrodisestesia, anemia e astenia apresentadas por pacientes com câncer de mama metastático, câncer de cabeça e pescoço e câncer colorretal que receberam, em caráter adjuvante ou paliativo, os quimioterápicos cisplatina, doxorrubicina e 5-fluorouracil. Foi realizado um estudo duplo-cego, randomizado, prospectivo, com administrações diárias de TK3 (n=9) e placebo (n=11) e avaliações a cada três semanas, de acordo com as sessões de quimioterapia. Os efeitos colaterais foram avaliados por meio de um questionário específico e exame físico. A qualidade de vida foi avaliada por meio do questionário WHOQOL-bref. Não foi observada redução significativa da toxicidade da quimioterapia em pacientes que receberam TK3. Encontrouse uma melhor qualidade de vida, no domínio psicológico na segunda visita, em pacientes com câncer de cabeça e pescoço que receberam TK3.
14641 Objective: To evaluate the value of neoadjuvant (NHT) and concomitant hormonal therapy (CHT) for high risk prostate cancer patients treated with conformal radiotherapy (3DCRT). Methods: From October 1997 to January 2002, 116 patients with high risk prostate cancer were submitted to 3DCRT and were analyzed retrospectively. High risk patients were defined as patients with PSA >20 ng/ml, and/or T3 clinical stage and/or Gleason score >7, or two factors of intermediate risk (PSA ≥10 and <20 ng/ml, T2b-T2c and Gleason score >7). The NHT and CHT were performed on 69 (59.5%) and 79 (68.1%) patients, respectively. The prostate and seminal vesicles median doses were 81 Gy (72–82.8) and 61.2 Gy (45–77.4) respectively. The median time from diagnosis to 3DCRT was 2,9 months (0.9–134.9). Results: On median follow-up of 54.5 months (13.5–93.9), the 5-year actuarial overall (OS) and 5-year biochemical progression-free survival (BPFS) were 84.3% and 64.7% respectively. The OS for patients submitted to NHT was 89.8% versus 76.4% for patients that were not submitted to (p = 0.0139). Patients that received CHT had an OS of 89.6% versus 73.4% for patients that did not receive CHT (p = 0.0201). Gleason score, clinical stage and seminal vesicles irradiation were significant to BPFS (p = 0.0372, p = 0.0412 and p = 0.0321 respectively). Conclusions: NHT and CHT increased OS of high risk prostate cancer of patients. Gleason score and clinical stage were important prognostic factors to BPFS. Seminal vesicles irradiation is recommended for high risk patients. No significant financial relationships to disclose.
15614 Background: It is not well documented on medical literature the value of time to treat prostate cancer. This study was performed to evaluate the value of treatment time with conformal radiotherapy (3DCRT) in high-risk prostate cancer patients. Methods: From October 1997 to January 2002, 116 patients with high-risk prostate cancer were submitted to 3DCRT and were analyzed retrospectively. The median age was 65 years-old. High risk patients were defined as patients with PSA > 20 ng/ml, and/or T3 clinical stage and/or Gleason score > 7, or two factors of intermediate risk (PSA >= 10 and < 20 ng/ml, T2b-T2c and Gleason score = 7). The median time from diagnosis to 3DCRT was 2.9 months (0.9–134.9). The median doses of radiation on prostate and on seminal vesicles were 81 Gy (72–82.8) and 61.2 Gy (45–77.4), respectively. The neoadjuvant and concomitant androgen suppression therapy were performed on 69 (59.5%) and 79 (68.1%) patients, respectively. Results: On median follow-up of 54.5 months (13.5–93.9), the 5-year actuarial overall survival, the 5-year actuarial biochemical progression-free survival and the 5-year actuarial distant metastases free survival were 84.3%, 64.7% and 88.6%, respectively. The 5-year actuarial distant metastases free survival for patients treated with 3DCRT less than or equal to 5 months was 92.5% versus 72.1% for patients treated with 3DCRT > 5 months (p=0.0076). The 5-year actuarial distant metastases free survival for patients with biochemichal progression was 68.8% versus 100% for patients with no biochemical progression (p 65 years-old (p=0.0160). Conclusions: The study suggests that delaying 3DCRT in high-risk prostate cancer patients lowers the actuarial distant metastases free survival. Biochemical progression may be a strong prognostic factor for distant metastases and, consequently, poor quality of life. No significant financial relationships to disclose.
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