<p>Standard dosing of chemotherapy based on body surface area (BSA) results in large individual differences in toxicity due to a large inter-patient variability in pharmacokinetics (PK) and pharmacodynamics (PD). This results in under-dosing in certain patients with a potentially weaker antitumoral effect.</p><p>Three clinical studies of individually tailored dosing of chemotherapy, based on haematological toxicity were conducted. In the first study, 26 women with metastatic breast cancer were treated with tailored and dose-escalated 5-fluorouracil, epirubicin and cyclophosphamide, supported by G-CSF (dFEC). In the second study 525 patients with high-risk primary breast cancer were randomised between dFEC and high-dose chemotherapy with autologous bone-marrow transplantation. The feasibility of a FEC regimen with doubled cyclophosphamide dose to mobilise peripheral stem cells was investigated. In the third study, 44 metastatic patients were treated with tailored epirubicin and docetaxel (ET). PK and PD were also investigated in these patients. The potential effects of G-CSF on MRI tumour evaluation were studied in 18 patients with skeletal metastases.</p><p>Toxicity-based dosing entailed an evenly distributed two- to three-fold range of tolerated doses in all three studies. Efficacy and toxicity were not correlated to tolerated dose-levels. Tailored dFEC resulted in a response rate of 81% and the same regimen resulted in fewer breast cancer relapses compared with standard FEC followed by high-dose therapy. Toxicity was manageable except for an increased rate of secondary leukaemia. The modified FEC could safely mobilise sufficient numbers of stem-cells. Tailored ET resulted in a response rate of 63%. The inter-individual variability in drug clearance was larger than the inter-occasion variability and a semi-physiological model of PK and PD could predict leukocyte nadir and duration. An increased diffuse MR signal in the long TE IR-TSE sequence was observed in normal bone-marrow during G-CSF treatment; this could be mistaken as disseminated metastatic disease and could obscure focal metastases.</p><p>In conclusion, the concept of individually tailored toxicity-based dosage of chemotherapy was equally feasible in primary and metastatic breast cancer, in two different chemotherapy regimens and in treatment with or without G-CSF support and may provide a pragmatic way of overcoming the shortcomings of standard BSA-based dosing.</p>

Standard dosing of chemotherapy based on body surface area (BSA) results in large individual differences in toxicity due to a large inter-patient variability in pharmacokinetics (PK) and pharmacodynamics (PD). This results in under-dosing in certain patients with a potentially weaker antitumoral effect. Three clinical studies of individually tailored dosing of chemotherapy, based on haematological toxicity were conducted. In the first study, 26 women with metastatic breast cancer were treated with tailored and dose-escalated 5-fluorouracil, epirubicin and cyclophosphamide, supported by G-CSF (dFEC). In the second study 525 patients with high-risk primary breast cancer were randomised between dFEC and high-dose chemotherapy with autologous bone-marrow transplantation. The feasibility of a FEC regimen with doubled cyclophosphamide dose to mobilise peripheral stem cells was investigated. In the third study, 44 metastatic patients were treated with tailored epirubicin and docetaxel (ET). PK and PD were also investigated in these patients. The potential effects of G-CSF on MRI tumour evaluation were studied in 18 patients with skeletal metastases. Toxicity-based dosing entailed an evenly distributed two- to three-fold range of tolerated doses in all three studies. Efficacy and toxicity were not correlated to tolerated dose-levels. Tailored dFEC resulted in a response rate of 81% and the same regimen resulted in fewer breast cancer relapses compared with standard FEC followed by high-dose therapy. Toxicity was manageable except for an increased rate of secondary leukaemia. The modified FEC could safely mobilise sufficient numbers of stem-cells. Tailored ET resulted in a response rate of 63%. The inter-individual variability in drug clearance was larger than the inter-occasion variability and a semi-physiological model of PK and PD could predict leukocyte nadir and duration. An increased diffuse MR signal in the long TE IR-TSE sequence was observed in normal bone-marrow during G-CSF treatment; this could be mistaken as disseminated metastatic disease and could obscure focal metastases. In conclusion, the concept of individually tailored toxicity-based dosage of chemotherapy was equally feasible in primary and metastatic breast cancer, in two different chemotherapy regimens and in treatment with or without G-CSF support and may provide a pragmatic way of overcoming the shortcomings of standard BSA-based dosing.

No description available.

Recently a powerful electron accelerator, 50 MeV race-track microtron, has been taken into clinical use. This gives the opportunity to treat patients with higher x-ray and electron energies than before. Furthermore, treatments can be performed were the entire fractional dose can be delivered in parts of a second. The relative biological effectiveness (RBE) of high energy photons (up to 50 MV) was studied in vitro and in vivo. Oxygen enhancement ratio (OER) of 50 MV photons and RBE of 50 MeV electrons were investigated in vitro. Single-fraction experiments, in vitro, using V-79 Chinese hamster fibroblasts showed an RBE for 50 MV x-rays of approximately 1.1 at surviving fraction 0.01, with reference to the response to 4 MV x- rays. No significant difference in OER could be demonstrated. Fractionation experiments were carried out to establish the RBE at the clinically relevant dose level, 2 Gy. The RBE calculated for the 2 Gy/fraction experiments was 1.17. The RBEs for 20 MV x-rays and 50 MeV electrons were equal to one. In order to investigate the validity of these results, the jejunal crypt microcolony assay in mice was used to determine the RBE of 50 MV x-rays. The RBE for 50 MV x-rays in this case was estimated to be 1.06 at crypt surviving fraction 0.1. Photonuclear processes are proposed as one possible explanation to the higher RBE for 50 MV x-rays. Several studies of biological response to ionizing radiation of high absorbed dose rates have been performed, often with conflicting results. With the aim of investigating whether a difference in effect between irradiation at high dose rates and at conventional dose rates could be verified, pulsed 50 MeV electrons from a clinical accelerator were used for experiments with ultra high dose rates (mean dose rate: 3.8 x 10^ Gy/s) in comparison to conventional (mean dose rate: 9.6 x 10"^ Gy/s). V-79 cells were irradiated in vitro under both oxic and anoxic conditions. No significant difference in relative biological effectiveness (RBE) or oxygen enhancement ratio (OER) was observed for ultra high dose rates compared to conventional dose rates. A central issue in clinical radiobiological research is the prediction of responses to different radiation qualities. The choice of cell survival and dose response model greatly influences the results. In this context the relationship between theory and model is emphasized. Generally, the interpretations of experimental data are dependent on the model. Cell survival models are systematized with respect to their relations to radiobiological theories of cell kill. The growing knowledge of biological, physical, and chemical mechanisms is reflected in the formulation of new models. This study shows that recent modelling has been more oriented towards the stochastic fluctuations connected to radiation energy deposition. This implies that the traditional cell survival models ought to be complemented by models of stochastic energy deposition processes at the intracellular level. / <p>S. 1-44: sammanfattning, s. 47-130: 5 uppsatser</p> / digitalisering@umu

The event TC1507 maize with cry1F gene from the bacterium Bacillus thuringiensis Berliner (Bt) was approved for commercial release in Brazil in 2008. The evolution of pest resistance to Bt plants has been a great concern to preserve the lifetime of this technology. Therefore, in this study we assess the risk of evolution of resistance to Cry1F protein in Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) populations from major maize-growing regions in Brazil. The baseline susceptibility to Cry1F was detemined with diet overlay bioassay for susceptible reference population and four field populations of S. frugiperda. Then, we monitored 43 populations of S. frugiperda sampled in nine different States of Brazil during 2010/2011, 2011/2012 and 2012/2013 crop seasons. Only 4-fold variation in susceptibility to Cry1F was detected among S. frugiperda from field populations in the baseline susceptibility study. Diagnostic concentration of 2,000 ng cm-2 was defined for monitoring the susceptibility to Cry1F in S. frugiperda populations. Survival at 2,000 ng cm-2 of Cry1F protein increased significantly throughout crop seasons in populations from São Paulo, Santa Catarina, Rio Grande do Sul, Bahia, Mato Grosso, Goiás, Mato Grosso do Sul, and Paraná, but not in Minas Gerais. We also sampled a population of S. frugiperda in TC1507 field failures in Bahia in October, 2011. This population was selected in laboratory with Cry1F protein up to 20,000 ng cm-2 and the resistance ratio of the selected resistant population (BA25R) was > 5,000-fold. This resistant population was able to survive in Cry1F maize from neonate till pupa and produce normal adult. The inheritance of S. frugiperda resistance to Cry1F protein was autosomal. To test the functional dominance, neonate larvae obtained from the cross of resistant and susceptible populations were tested in leaf bioassay, and around 8% of heterozygotes were able to survive and complete the larval development and produce normal adults on TC1507 leaves while susceptible larvae could not survive for up to five days after infestation. Dominance was estimated to be 0.15 ± 0.09, suggesting that resistance to Cry1F in TC1507 maize was incompletely recessive. We also conducted resistance selection studies in other seven S. frugiperda populations from six different Brazilian states to test whether the resistance alleles were at same locus or not. The F1 larvae obtained from the cross between resistant population (BA25R) and each of the seven selected resistant populations were able to survive at 2,000 ng cm-2 of Cry1F protein in diet bioassay, and therefore they shared the same locus of resistance to Cry1F protein. We estimated the frequency of resistance allele to Cry1F protein in populations of S. frugiperda of main crop season 2011/2012 from five states. We stablished 517 isofemale lines using F2 screen method. The total frequency of Cry1F resistance allele in Brazil was 0.088 with 95% confidence interval between 0.077 and 0.100. Based on results obtained in this study, the risk of resistance evolution to Cry1F protein by S. frugiperda is high in Brazil. / O evento de milho TC1507 com gene cry1F da bactéria Bacillus thuringiensis Berliner foi aprovado comercialmente no Brasil em 2008. A evolução da resistência de pragas a plantas Bt tem sido uma grande preocupação na preservação desta tecnologia. Portanto, neste estudo foi avaliado o risco de evolução da resistência à proteína Cry1F em populações de Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) das principais regiões de cultivo de milho no Brasil. A linha-básica de suscetibilidade à proteina Cry1F foi determinada em bioensaio de aplicação superfícial na dieta para a população suscetível de referência e quatro populações de campo de S. frugiperda. Posteriormente, a suscetibilidade a Cry1F foi monitorada em 43 populações de S. frugiperda coletadas em nove Estados do Brasil nas safras agrícolas de 2010/2011, 2011/2012 e 2012/2013. A variação na suscetibilidade foi de apenas quatro vezes para Cry1F entre as populações de campo na linha-básica de suscetibilidade. A concentração diagnóstica de 2.000 ng cm-2 de proteína Cry1F foi definida para o monitoramento da suscetibilidade. A sobrevivência em 2.000 ng cm-2 de proteína Cry1F aumentou significativamente no decorrer das safras em populações de São Paulo, Santa Catarina, Rio Grande do Sul, Bahia, Mato Grosso, Goiás, Mato Grosso do Sul e Paraná, mas não em Minas Gerais. Além disso, uma população de S. frugiperda foi coletada em milho TC1507 com falha de controle na Bahia em outubro de 2011. Esta população foi selecionada no laboratório com a proteína Cry1F até 20.000 ng cm-2, obtendo-se uma população resistente (BA25R) com razão de resistência >5000 vezes. Esta população resistente foi capaz de sobreviver no milho TC1507 desde larva neonata até a fase de pupa e com emergência de adultos normais. O padrão de herança da resistência de S. frugiperda a Cry1F foi autossômica. Para testar a dominância funcional, as larvas neonatas do cruzamento entre a população resistente e suscetível foram testadas em folhas do evento TC1507 e cerca de 8% dos heterozigotos foram capazes de sobreviver, completar o desenvolvimento e produzir adultos normais, enquanto as larvas da linhagem suscetível não sobreviveram por mais de cinco dias após a infestação. A dominância foi estimada em 0,15 ± 0,09; portanto, a resistência à proteína Cry1F no milho TC1507 foi incompletamente recessiva. A resistência foi selecionada para outras sete populações de seis Estados brasileiros para testar se os alelos de resistência estavam no mesmo locus. As larvas F1 obtidas do cruzamento entre a população resistente (BA25R) e cada uma das sete populações selecionadas sobreviveram na concentração de 2,000 ng cm-2 de proteína Cry1F e, portanto, essas populações compartilharam o mesmo locus de resistência à proteína Cry1F. A freqüência do alelo resistente à proteína Cry1F foi estimada em populações de S. frugiperda coletadas em cinco Estados na safra 2011/2012. Foram estabelecidas 517 isolinhas utilizando o método de \"F2 screen\". A freqüência total do alelo de resistência à proteína Cry1F no Brasil foi de 0,088, com intervalo de confiança de 95% entre 0,077 e 0,100. Com base nos resultados, o risco de evolução da resistência à proteína Cry1F por S. frugiperda é elevada no Brasil.

No description available.

Bei Patienten mit Keimzelltumoren werden Mobilisation und Separation peripherer Blut-stammzellen durch das Alter, die zytostatische Vorbehandlung und Art der Mobilisations-chemotherapie statistisch signifikant beeinfluát. Der beste pr diktive Parameter f r die gesammelten Stamm- und Vorl uferzellen ist die Anzahl der peripheren CD34+ Zellen, die am Tag der Leukapherese im Blutkreislauf zirkulieren. F r die Rekonstitution der Granulo- und Thrombozytopoese nach Hochdosischemotherapie ist die Dosis der trans-fundierten CD34+ Zellen von signifikantem Wert. Bei der Transplantation von mehr als 2,5 x 10 hoch 6 CD34+ Zellen/kg kann mit einer schnellen und sicheren Regeneration der H matopoese, einem niedrigeren Bedarf an Antibiotika, Erythrozyten- und Thrombozy-tenkonzentraten sowie einem k rzeren Krankenhausaufenthalt gerechnet werden. / In patients with germ cell cancer the mobilization and collection of peripheral blood progenitor cells are significantly influenced by patient's age, cytotoxic pretreatment and the mobilization chemotherapy used. The best predictive factor for harvested progenitor cells is the number of CD34+ cells circulating in the peripheral blood on the day of leukapheresis. The dose of transfused CD34+ cells has a significant impact on the reconstitution of granulocytes and platelets after high-dose chemotherapy. Transplantation of more than 2,5 x 10 to the power of 6 CD34+ cells/kg results in a rapid and safe regeneration of hematopoiesis, less antibiotics and transfusion requirements (red blood cell and platelet concentrates) and a shorter hospital stay.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-02-07T13:06:22Z No. of bitstreams: 1 ANA CAROLINA MASSAROTTO.pdf: 924874 bytes, checksum: 09a1ac55208a09df27e003db121d89d6 (MD5) / Made available in DSpace on 2018-02-07T13:06:22Z (GMT). No. of bitstreams: 1 ANA CAROLINA MASSAROTTO.pdf: 924874 bytes, checksum: 09a1ac55208a09df27e003db121d89d6 (MD5) Previous issue date: 2017-12-15 / Breast cancer is the second most common type of cancer in the world, and the most common among women, affecting men who account for 1% of all cases of the disease. The risk factors of the disease are related to age, endocrine / reproductive history, behavioral / environmental factors, and genetic / hereditary factors. The prognosis of the disease depends on its extension (staging), with greater curative potential when diagnosed at baseline.Among the types of treatment of breast cancer stand out surgery, radiotherapy, chemotherapy, hormone therapy and biological therapy. It is highlighted in the radiotherapy modality, Brachytherapy, which is the application of radiation in a more precise and localized way in the tumor. In this work we will focus on high-grade interstitial brachytherapy dose rate, partial and accelerated breast irradiation (IPAM), which has been shown to have better esthetic results, lower risk of injury from radiation from healthy adjacent tissues, shorter duration of treatment, and low recurrence rates. This is a retrospective, longitudinal, descriptive, analytical study, with a review of medical records of patients diagnosed with breast cancer, stages 0-I-II, between the years 2004 and 2013 who received IPAM using brachytherapy after conservative surgery of the breast at the Radium Institute of Campinas, Campinas-SP, Brazil.This work aims to report and evaluate the viability, acute and chronic toxicity, aesthetic aspects, efficacy and factors related to the use of Partial and Accelerated Breast Irradiation with high dose rate brachytherapy for patients with early stage of breast cancer. In addition to assessing recurrence rates and local control of the disease. / O c?ncer de mama ? o segundo tipo de c?ncer mais comum no mundo,e o mais frequente entre as mulheres, acometendo tamb?m homens que representam 1% do total de casos da doen?a. Os fatores de risco da doen?a est?o relacionados com idade, fatores end?crinos/hist?ria reprodutiva, fatores comportamentais/ambientais e fatores gen?ticos/heredit?rios. O progn?stico da doen?a depende da sua extens?o (estadiamento), com maior potencial curativo quando diagnosticada no in?cio. Entre os tipos de tratamento do c?ncer de mama destacam-se a cirurgia, radioterapia , quimioterapia, hormonioterapia e terapia biol?gica. Apresenta destaque na modalidade radioter?pica, a Braquiterapia, que trata-se da aplica??o de radia??o de forma mais precisa e localizada no tumor. Neste trabalho teremos como enfoque a braquiterapia intersticial de alta taxa de dose, irradia??o parcial e acelerada da mama (IPAM), que vem apresentando melhores resultados est?ticos, menor risco de les?o pela radia??o de tecidos adjacentes saud?veis, menor dura??o do tratamento, e baixas taxas de recorr?ncia. Trata-se de um estudo retrospectivo, longitudinal, descritivo, anal?tico, com revis?o de prontu?rios de pacientes com diagn?stico de c?ncer de mama, est?dios 0-I-II , entre os anos de 2004 e 2013 que receberam IPAM utilizando braquiterapia ap?s a cirurgia conservadora da mama no Instituto do Radium de Campinas, Campinas-SP, Brasil. Tal trabalho objetiva relatar e avaliar a viabilidade, toxicidade aguda e cr?nica, aspectos est?ticos, efic?cia e fatores relacionados com utiliza??o de Irradia??o Parcial e Acelerada da Mama com braquiterapia de alta taxa de dose para pacientes com est?dio inicial de c?ncer de mama. Al?m de avaliar as taxas de recorr?ncia e controle local da doen?a.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-02-15T12:50:05Z No. of bitstreams: 1 VANDERLEI JOSE JUNIOR.pdf: 1351825 bytes, checksum: 599d050ec951a6a8e7497a0cea5d2e17 (MD5) / Made available in DSpace on 2018-02-15T12:50:05Z (GMT). No. of bitstreams: 1 VANDERLEI JOSE JUNIOR.pdf: 1351825 bytes, checksum: 599d050ec951a6a8e7497a0cea5d2e17 (MD5) Previous issue date: 2017-12-15 / Introduction: Prostate cancer is one of the most prevalent diseases in the male population, occupying the second position among malignant neoplasms. There are several therapeutic options for the treatment of localized prostate cancer, ranging from conservative behaviors to interventional treatments such as radical prostatectomy or external radiotherapy, associated or not with brachytherapy. Objective: To identify the factors that can predict biochemical recurrence and to evaluate treatment toxicity. METHOD: This is a retrospective and longitudinal study of 162 patients diagnosed with prostate cancer treated with conformational external radiotherapy associated with high dose rate brachytherapy (BTATD) between 2005 and 2014. The database was used of the Radium ? Campinas Oncology Institute, collected prospectively. Results: The mean follow-up time was 57 months. No grade 3 late toxicity was observed in the gastrointestinal tract, with only 1 patient (0.6%) genitourinary tract. The only categorical variable that presented statistical significance for biochemical relapse was the Nadir PSA <1 ng / ml (p = 0.018). The biochemical recurrence rate found was 96.3%, based on the Phoenix criteria (PSA nadir + 2 ng / ml). Conclusions: This study demonstrated that in the treatment of localized prostate cancer, the association of external radiotherapy with BATD is a safe therapeutic option, with a low degree 3 late toxicity and a biochemical recurrence of only 3.7% (with HF = 95 %). / Introdu??o: O c?ncer de pr?stata ? uma das doen?as mais prevalentes na popula??o masculina, ocupando a segunda posi??o entre as neoplasias malignas. H? v?rias op??es terap?uticas para o tratamento do c?ncer de pr?stata localizado, podendo variar de condutas conservadoras ? tratamentos intervencionistas como a prostatectomia radical ou a radioterapia externa, associada ou n?o ? braquiterapia. Objetivo: Identificar os fatores que possam predizer recidiva bioqu?mica e avaliar a toxicidade do tratamento. M?todo: Tratase de um estudo retrospectivo e longitudinal, com 162 pacientes diagnosticados com c?ncer de pr?stata, tratados com radioterapia externa conformacional associada ? braquiterapia de alta taxa de dose (BATD), entre 2005 e 2014. Utilizou-se o banco de dados do Radium - Instituto de Oncologia de Campinas, coletados prospectivamente. Resultados: O tempo m?dio de seguimento foi de 57 meses. N?o foi observada toxicidade tardia grau 3 no trato gastrointestinal, sendo apenas 1 paciente (0,6%) trato genitourin?rio. A ?nica vari?vel categ?rica que apresentou signific?ncia estat?stica para recidiva bioqu?mica foi o PSA Nadir <1 ng/ ml (p = 0,018). A taxa de recidiva bioqu?mica encontrada foi de 96,3%, baseando-se nos crit?rios de Phoenix (PSA nadir + 2 ng/ml). Conclus?es: Esse estudo demonstrou que, no tratamento de c?ncer de pr?stata localizado, a associa??o de radioterapia externa com BATD ? uma op??o terap?utica segura, com baixa taxa de toxicidade tardia grau 3 e recidiva bioqu?mica de apenas 3,7% (com I.C = 95%).

L’objectif général de cette thèse a été de mettre en évidence la contribution de l’approche transcriptomique dans la physiopathologie et le traitement des hémopathies malignes. En particulier, comment la technologie des microarrays nous a aidée à étudier diverses problématiques en onco-hématologie.Dans la première partie, notre objectif était d’étudier les cellules Natural killer (Nk) chez les patients atteints de leucémie aiguë myéloïde (LAM). Nous avons comparé la signature transcriptomique des cellules Nk de patients LAM à celle des cellules Nk de sujet sains et suggéré que le facteur de transcription ETS-1 est un bon candidat capable de réguler les récepteurs activateurs NCR (natural cytotoxicity receptors) dont les gènes sont situés sur deux chromosomes différents, même si leur expression reste fortement cordonnée.Dans la seconde partie, nous nous sommes intéressés à la prédiction du sepsis en utilisant une approche transcriptomique dans le cadre de l’autogreffe de cellules souches hématopoïétiques (auto-CSH). En utilisant le même modèle, dans la troisième partie, nous avons mis en évidence l’effet du melphalan en tant que chimiothérapie de conditionnement sur les cellules mononuclées du sang périphérique et identifié un marqueur potentiel de rechute précoce chez les patients atteints de myélome dans le cas de l’auto-CSH. Enfin, dans la dernière partie, notre objectif a été d’analyser le profil d’expression génique des lymphomes B diffus à grandes cellules liés à l’infection par le VIH afin de vérifier ou pas l’existence des sous-types décrits chez les patients immunocompétents. / The aim of this research is to demonstrate transcriptomic approach contribution in the physiopathology and treatment of hematological malignancies. In particular, how microarrays technology is used to study several oncohematology difficulties; which remain deaths-related infection, as well as the failure to obtain remission and death related relapse. In the first part, our focus was to study natural killer cells (Nks) in patients affected with acute myeloid leukemia (AML). We compared transcriptomic AML-NKs signature with healthy donors-NKs signature and suggested that ETS-1 transcription factor is a good candidate able to regulate the natural cytotoxicity receptors (NCRs), whose coding genes, are located on two different chromosomes even if their expression remain strongly coordinated.Our second part, aimed to predict sepsis using a transcriptomic approach in the case of autologous stem cell transplantation (auto-HSCT). Using the same model, in the third part, we highlighted the melphalan high-dose chemotherapy effect on peripheral blood mononuclear cells and identified a potential good biomarker of early relapse in patients affected by myeloma in the case of auto-HSCT.Our final focus was to analyze gene expression profile of HIV-related large diffuse B-cell lymphoma type in order to verify the existence of subgroups described in immune-competent patients.