M.Tech. / The aim of this study was to determine the effects of the application of therapeutic reflexology as a complementary medicine, in women with cervical cancer who were receiving radiation therapy with curative intent. Therapeutic reflexology is a therapy that involves stimulating specific reflexes in the hands, feet, body and ears by applying pressure to these reflexes with the thumbs and fingers, using specific techniques. All the body’s organs, glands and other parts of the body are reflected in the feet, body, hands and ears can be stimulated by working over the skin surface with the thumbs and fingers for a specific effect. These specific reflexes have been mapped in miniature on the feet, hands, body and ears (Graham, 1998: 5). Therapeutic reflexology promotes homeostasis within the body, by stimulating reflexes pertaining to organs and glands, and achieving normalisation of organs and glands in the receiver of the treatment. The therapy is non - invasive and non - pharmacological, and has no contra-indications (Graham, 1998: 8). Therapeutic reflexology is often used as a complementary or alternative medicine, yet very little information is available on its effects, which requires further research (Milligan, 2002: 489-96). The number of cancer patients using reflexology as a complementary therapy to allopathic medicine is rapidly rising (Apostolides, 1998: 71-95) It is because of this rise in the number of patients seeking complementary therapy that it is of vital importance that more accurate, results-orientated information is made available to both the patient and the medical practitioner. These findings will allow the patient and medical practitioner to make an informed decision regarding the choices available to complement allopathic medicine, to enhance wellbeing, and achieve better results for the allopathic protocol. A sample group of forty-four women were chosen by simple random selection. Twenty three were treated with therapeutic reflexology, and twenty one were given the placebo treatment for six weeks, while undergoing radiation therapy. The patients chosen for the sample group had stage IIIb as well as stage IIb cervical cancer, and were receiving radiation treatment. The result of the study has been determined by evaluating a questionnaire answered by each patient, after each treatment. The control group who received placebo treatment answered the same questionnaire, formulated in accordance with the Likert Scale, for means of comparison.

M.Tech. (Radiography) / Cervical cancer is the most frequently diagnosed cancer among women in Zambia. More recently, improved cure rates have been obtained with the concomitant use of radiotherapy and chemotherapy in locally advanced cancer of the cervix. However, the side effects associated with the treatment have a major impact on the quality of life (QoL) of these women. Prior to this study, QoL in Zambian women treated for cervical cancer with chemo-radiation had not been assessed thus creating a gap in the literature and hampering an attempt to improve QoL in this cohort of patients. The aim of this study was therefore to evaluate the impact of chemo-radiation treatment on QoL and to determine what socioeconomic and demographic factors are closely related with QoL decrements in Zambian women treated for cervical cancer at Cancer Diseases Hospital. This would then facilitate the introduction of intervention programmes aimed at improving QoL in these patients. The study was prospective and explored the phenomenon of QoL with the use of the European Organization for Research and Treatment of Cancer (EORTC) questionnaire and a demographics questionnaire answered by 45 women treated for cervical cancer with chemo-radiotherapy at Cancer Diseases Hospital. The use of the EORTC quality of life questionnaire added validity and reliability to the study as it is used extensively to measure health-related quality of life in cancer survivors worldwide. Analysis of the data indicates that patients with advanced cervical cancer treated with chemo-radiotherapy generally experienced a favourable QoL, and treatment was considered worthwhile by the majority of patients. However, women described problems with sexuality and marital relationships. Low education and living without a partner were depicted as risk factors for the development of the reported problems. To improve QoL in survivors, interventions focusing on more social support, education to improve patients’ understanding of their disease and treatment effects as well as physical rehabilitation through exercise interventions are recommended as mandatory.

M.Tech. (Radiography) / This was a prospective, quantitative comparative study. The aim of the study was to evaluate acute toxicity of radical combination therapy, in the form of radiotherapy and chemotherapy, in HIV +ve patients on HAART and HIV -ve patients for cervical cancer at CDH, Lusaka, Zambia. The specific objectives were to compare acute toxicity in HIV +ve on HAART and HIV -ve patients and to assess the level of severity in the levels of toxicity. The study was conducted from January 2010 to December 2010. A hundred and twenty stage IB₂-IIIB cervical cancer patients were serially recruited and assigned study numbers for identification and confidentiality. Participants received Cisplatin based radical chemoradiation for five to six weeks during which time they were assessed for acute reactions and data was prospectively collected. Four systems namely Genitourinary, Haematopoietic, Skin, and Gastrointestinal were used for the assessment of toxicity in the study. Toxicity was scored using the NCI CTC v2.0. The results of this study showed that, major acute reactions in the CDH study participants were grade 3 leucopoenia (five in each study arm) and one grade 3 acute skin toxicity in the HIV +ve arm. Results also revealed that there were three HIV +ve study participants with grade 3 vomiting and one HIV –ve. There was one grade 3 anaemia in the HIV +ve arm, one grade 3 anaemia in the HIV –ve arm and one grade 4 anaemia in the HIV +ve arm. However, only the incidence of grade 3 leucopoenia in both study arms and vomiting in the HIV +ve study participants was significantly higher. This study demonstrated that radical chemoradiation is well tolerated by HIV +ve patients with intact immunity. Toxicity was usually mild and reversible and no exaggerated toxicities beyond those generally associated with single-agent Cisplatin were observed in the HIV +ve study participants. Therefore, radical chemoradiation in conventional doses can safely be given to cervical cancer HIV +ve patients who are on HAART.

Orientador: Cesar Cabello dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:24:06Z (GMT). No. of bitstreams: 1 Feijo_LuizFernandoAndrade_M.pdf: 3050164 bytes, checksum: 672560c57474869fce1041591b88e14b (MD5) Previous issue date: 2005 / Resumo: Objetivo: Avaliar as taxas de recidiva local após o tratamento cirúrgico conservador de câncer de mama em mulheres submetidas à radioterapia complementar sem reforço. Pacientes e métodos: Foi realizado um estudo de coorte reconstituído com 128 pacientes portadoras de câncer de mama estádios I e 11,que foram tratadas com cirurgia conservadora e radioterapia sem reforço, no período de janeiro de 1989 a dezembrode 1996, no Setor de Mastologia do Centro de Atenção Integral à Saúde da Mulher (CAISM) da Universidade Estadualde Campinas (UNICAMP).A cirurgia da mama foi a quadrantectomiacom axilectomia,seguida de radioterapiacom 25 frações diárias de 2Gy ou 1,8Gy, cinco dias por semana. As pacientes receberam dose total de 50 ou 45Gy, respectivamente. Foi considerada recidiva local a presença de carcinoma (invasivo ou ductal in situ), confirmado através de exame anátomo-patológico, na mama tratada em qualquer momento do período de seguimento. As pacientes foram estudadas segundo os seguintes critérios: faixa etária, tamanho do tumor, presença de gânglios linfáticos axilares comprometidos e intervalo entre a data da cirurgia e a data do início da radioterapia. A análise estatística foi realizada utilizando Curvas de Kaplan Meyer para apresentar as taxas de recidivas locais e os testes de Log Rank, Wilcoxon e razão de risco para avaliar a relação entre os valores de recidiva local e as variáveis: faixa etária, tamanho do tumor, gânglios linfáticos comprometidos e intervalo entre a data da cirurgia e a data do início da radioterapia. Foi também realizada uma análise multivariada para avalia a independênciae a associação entre as variáveis estudadas e a recidiva local. Resultados: A taxa de recidiva local na população geral foi de 28% em 12 anos de seguimento. As pacientes com idade abaixo de 35 anos apresentaram risco de recidiva local três vezes maior do que as com idade acima de 35. Esses valores encontraram-seno limite da significância (p=0,05); (HR=3,0; 95%IC=1,0 - 9,0).Os tumores com tamanho maior de dois centímetros apresentaram risco de recidiva local três vezes maior do que os tumores menores. Esses valores também se encontraram no limite da significância (p=0,05); (HR=3,0; 95%IC=1,0 - 9,0).As taxas de recidivas locais não se associaram ao estado dos gânglios linfáticos axilares (p=0,09); (HR=1,9; 95%IC=0,8-4,9),assim como não se associaram ao intervalo entre a data da cirurgia e a data do início da radioterapia (p=0,5); (HR=0,9; 95%IC=0,3-2,8).Segundo a análise multivariada,a idade abaixo de 35 anos foi a que apresentou a maior associação às recidivas locais (HR=5,0; 95%IC=1,6-18), seguida dos tumores maiores de dois centímetros (HR= 4,0 - IC= 1,2 - 14). Conclusão:As pacientes tratadas de forma conservadora por câncer de mama e submetidas à radioterapia complementar com dose de 45 ou 50GY sem reforço apresentaram 28% de recidivas locais após 12 anos. Essa taxa foi mais elevada do que as observadasem outros estudos que utilizaram radioterapia com reforço.As com idade abaixo de 35 anos, bem como as portadoras de tumores maiores de dois centímetros, associaram-se a um maior risco de recidivas locais. Esses dados sugerem que essa forma de radioterapia seja insuficiente para o tratamento local dessas mulheres, principalmente nos casos de pacientes com idade inferior a 35 anos ou com tumores maiores de dois centímetros / Abstract: Purpose: To evaluate local recurrence rates after breast-conserving surgery for breast cancer treatment in women undergoing adjuvant radiotherapy without a boost. Patients and methods: A retrospective cohort study was conducted on 128 patients diagnosed with stages I and 11breast cancer, who were treated with conservative surgery and radiotherapy without a boost dose in the Division of Senology at the Women's Integral Health Care Center (CAISM) of the Campinas State University (Unicamp) from January 1989 to December 1996. The type of breast surgery was quadrantectomy with axillary Iymph node dissection, followed by radiotherapy delivered in 25 daily fractions of 2 Gy or 1.8 Gy, tive days a week. The patients received a total radiation dose of 50 or 45 Gy, respectively. Local recurrence was defined as the presence of carcinoma (invasive or ductal in situ) in the treated breast, confirmed by histopathologic exam, at any given time during the follow-up period. The patients were studied according to the following criteria: age range, tumor size, presence of involved axillary Iymph nodes and the interval between the date of surgery and the date when radiotherapy began. Statistical analysis was performed using Kaplan Meyer curves to show local recurrence rates. The log-rank test, the Wilcoxon test and risk ratio were used to evaluate the relationship between local recurrence values and variables, e.g. age range, tumor size, Iymph node involvement and the interval between date of surgery and date when radiotherapy began. Multivariate analysis was also performed to evaluate independence and the association between the variables studied and local recurrence. Results: The local recurrence rate was 28% in the general population at twelve years of follow-up. Patients under 35 years had three times more risk of developing local recurrence than those older than 35 years. These values were found within the significance limit (p=0.05); (HR=3.0; 95%CI=1.0 - 9.0). Women with tumors larger than 2 centimeters had three times more risk of developing local recurrence than those with smaller tumors. These values were also found within the significance limit (p=0.05);(HR=3.0; 95%CI=1.0 - 9.0). Local recurrence rates were neither associated with axillary Iymph node status (p=0.09); (HR=1.9; 95%CI=0.8-4.9), nor with the interval between the date of surgery and the date when radiotherapy began (p=0.5); (HR=0.9; 95%CI=0.3- 2.8). According to multivariate analysis, age under 35 years was most strongly associated with local recurrences (HR=5.0; 95%CI=1.6-18), followed by tumors larger than 2 centimeters (HR= 4.0; 95%CI= 1.2 - 14). Conclusion: Patients treated conservatively for breast cancer and undergoing adjuvant radiotherapy in doses of 45 or 50 Gy without a boost had local recurrence rates of 28% afier 12 years. This rate was higher than those observed in other studies using radiotherapy with a boost. Age under 35 years and tumors larger than 2 centimeters were associated with a higher risk of local recurrences. Our data suggest that this type of radiotherapy was insufficient for the local treatment of these women, especially patients under 35 years of age or those with tumors larger than two centimete / Mestrado / Tocoginecologia / Tocoginecologia

Purpose: In the contemporary management of early-stage lung cancer with RadiationTherapy (RT), there is increased imaging utilization for the diagnosis and treatment and follow-up after completion of treatment. We evaluated whether this increased radiation exposure to patients with early-stage lung cancer that receive stereotactic body radiotherapy (SBRT) significantly increases the risk of radiation-induced carcinogenesis (RIC). Methods: Following IRB approval, one hundred and ninety-six consecutively treated lung cancer patients treated with SBRT were selected for analysis. Information collected included demographics and all ionizing imaging scans one year before SBRT treatment and one year following treatment. These included chest X-rays (CXR), computerized tomography scan (CT scan), positron emission tomography scan (PET-CT scan), bone scan, ventilation-perfusion scan (VQ scan), cone-beam CT scans. In addition to the lung cancer patients, comparative data on ten prostate and breast cancer patients each was collected to get an estimate of the radiation-induced risk (RIC) in other common malignancies. For each patient, the total effective dose (mSv) was calculated by the sum of all effective doses for all scans (1 year before SBRT to 1-year post-SBRT). After calculating the total effective dose, the summed dose was used to calculate the RIC using the RadRat tool. For the study, we decided that a 1% increase in the baseline risk of radiation-induced lung cancer will be considered a significant increase. Results: Among lung cancer patients, there were 87 males (44.4%) and 109 females (55.6%). The median number of Pre-SBRT CXRs (PA/lateral) was 2 (Range: 1-22), the median number of pre-SBRT CT scans was 2 (Range: 1-6), the median number of pre-SBRT PET-CT scans was 1 (Range: 1-4), the median number of Bone Scans or VQ scans pre-SBRT was 1. The median effective exposure dose from all scans was 72mSv (Range: 24-140.36mSv). The median excess lifetime risk (ELR) of developing lung cancer (a chance in 100,000) with a 90% uncertainty range was 57.15. The Excess Future risk (EFR), the risk from 2019 to the end of the expected lifetime of developing cancer (a chance in 100,000), showed a median of EFR mean of 73.75 (Range: 8.45- 416). The total future risk (TFR, a sum of baseline and excess risk) of developing cancer, from 2019 to end of an expected lifetime was 2732.5 (Range: 808-8290), the median of TFR upper bound was 2785.5 (Range: 856-8400) and median of TFR lower bound was 2679.5 (Range: 761- 8183). At 6 months, survival was 94.7% (144/152), at 1 year, 79% (94/119), at 3 years 32.5% (27/83). At five years, with survival data on 77 patients available, 9 (11.6%) were alive. Regarding the comparison of RIC from imaging before RT for patients with prostate cancer, the median total effective radiation dose from all pre-SBRT and post-SBRT scans was 20mSv (Range: 20-30mSv), and the median of mean ELR for development of RIC prostate cancer was 4.24 (per 100,000). Regarding early-stage breast cancer, the median total effective radiation dose from all pre-RT and post-RT scans was 16.56mSv (Range: 10.52-31.48mSv), and the median of mean ELR for development of RIC was 35.95 (per 100,000). Conclusion: The median excess cancer lifetime radiation-induced cancer risk for the lung cancer cohort was 0.05%, which is significantly less than the 1% risk that was determined to be clinically significant as per our study objective. The survival in this cohort of patients was poor. Enhanced imaging to enhance staging accuracy, safety during SBRT treatment, and adequate follow-up outweigh the RIC risk.

No description available.

Salivary glands (SGs) are important exocrine glands of the craniofacial region, whose main role is to produce and secrete saliva, a seromucous solution necessary for a diverse spectrum of critical functions, such as the preliminary digestion and swallowing of solid food, the articulation of speech, the maintenance of dental enamel and the prevention of oral infections. The production and secretion of saliva is orchestrated by a large and diverse collection of epithelial cell populations. Although many of the cell types that form the SG epithelium can be recognized morphologically and investigated using histological assays, it is currently impossible to achieve their differential purification from primary tissues as live cells, due to the lack of surface markers known to be either selectively or preferentially expressed by various cell subsets. This critical gap in knowledge limits our capacity to conduct functional studies in many areas of SG biology, including studies aimed at elucidating the developmental relationships that link different cell types (e.g. testing whether selected cell types can act as progenitors for the generation of others), studies elucidating the roles played by different cell types during regeneration of the SG epithelium following injury (e.g. radiotherapy), and studies investigating the biology of SG malignancies characterized by a heterogeneous cell composition, such as Adenoid Cystic Carcinomas (ACCs). In this work, we aimed to advance our understanding of the cell composition of the salivary gland epithelium and to identify surface markers that enable the differential purification of its various cell types by fluorescence-activated cell sorting (FACS), in order to facilitate functional investigations of their individual capacity to act as stem/progenitor cells in prospective assays. In the first portion of our studies, we leveraged single-cell RNA sequencing (scRNA-seq) to dissect the transcriptional identities of various epithelial cell populations found in normal murine SGs, and discovered surface markers that allowed us to purify eight distinct cell types by FACS. We then used bulk RNA sequencing to generate high-resolution transcriptomic profiles of seven of these populations, and annotated their identity (e.g. acinar, ductal, basal, myoepithelial) in terms of anatomical location and differential expression of lineage-specific biomarkers. Furthermore, using a three-dimensional (3D) in vitro organoid tissue culture assay, we tested each of the newly identified SG populations for stem/progenitor properties, and demonstrated that organoid forming capacity is primarily restricted to only one of them, characterized by a basal phenotype, and able to function as a bipotent progenitor in vitro. Finally, we used FACS to examine the effects of radiotherapy on the cell composition of the mouse SG epithelium, and demonstrated that, of the eight newly identified populations, at least four display preferential sensitivity to radiation injury. In the second portion of our studies, we tested whether the surface markers that we identified as differentially expressed between different subtypes of SG epithelial cells could also be leveraged to achieve the purification of the two subsets of malignant cells known to co-exist in Adenoid Cystic Carcinoma (ACC), one of the most common and lethal forms of human SG malignancy. A defining feature of ACC is the presence of two distinct cell populations, resembling myoepithelial and ductal cell types found in the normal salivary gland epithelium. However, little is known about the developmental relationship linking these two cell populations, their individual capacity to sustain the growth of malignant tissues upon xeno-transplantation, as well as their distinct behavior in terms of responses to therapeutic manipulations. By utilizing cell surface markers identified as differentially expressed in the mouse SG epithelium, we developed a sorting strategy that enabled us to isolate the two major subtypes of malignant cells found in ACCs. By conducting prospective xeno-transplantation experiments in immunodeficient mice, we demonstrated that, contrary to common belief, myoepithelial-like cells are highly tumorigenic (i.e. do not represent an indolent component of the tumor) and can act as progenitors of ductal-like cells. Furthermore, by investigating differences in the transcriptional profiles of myoepithelial-like and ductal-like cells, we discovered that the two cell types differ in the expression of multiple components of the biochemical pathways that control retinoic acid (RA) signaling. We find that RA direct and inverse agonism have opposing effects on cell composition through distinct molecular mechanisms, whereby direct agonism facilitates differentiation of myoepithelial-like to ductal-like cells, and inverse agonism induces selective cell death of ductal-like cells. Finally, we demonstrate that inhibition of RA signaling with inverse agonists is able to profoundly impair in vivo growth of human ACCs implanted in immunodeficient mice. Overall, the findings reported in this study advance our understanding of the cellular composition of both normal and malignant SG epithelia, establish novel and robust analytical assays for the purification of multiple subtypes of SG epithelial cells, and reveal novel strategies for the therapeutic manipulation of differentiation programs in human ACCs.

No description available.

Thesis (M. Tech.) - Central University of Technology, Free State, 2009

The goal of this study was to improve dosimetry for pelvic, lung, head and neck, and other cancers sites with aspherical planning target volumes (PTV) using a new algorithm for collimator optimization for intensity modulated radiation therapy (IMRT) that minimizes the x-jaw gap (CAX) and the area of the jaws (CAA) for each treatment field. A retroactive study on the effects of collimator optimization of 20 patients was performed by comparing metric results for new collimator optimization techniques in Eclipse version 11.0. Keeping all other parameters equal, multiple plans are created using four collimator techniques: CA0, all fields have collimators set to 0°, CAE, using the Eclipse collimator optimization, CAA, minimizing the area of the jaws around the PTV, and CAX, minimizing the x-jaw gap. The minimum area and the minimum x-jaw angles are found by evaluating each field beam’s eye view of the PTV with ImageJ and finding the desired parameters with a custom script. The evaluation of the plans included the monitor units (MU), the maximum dose of the plan, the maximum dose to organs at risk (OAR), the conformity index (CI) and the number of fields that are calculated to split. Compared to the CA0 plans, the monitor units decreased on average by 6% for the CAX method with a p-value of 0.01 from an ANOVA test. The average maximum dose remained within 1.1% difference between all four methods with the lowest given by CAX. The maximum dose to the most at risk organ was best spared by the CAA method, which decreased by 0.62% compared to the CA0. Minimizing the x-jaws significantly reduced the number of split fields from 61 to 37. In every metric tested the CAX optimization produced comparable or superior results compared to the other three techniques. For aspherical PTVs, CAX on average reduced the number of split fields, lowered the maximum dose, minimized the dose to the surrounding OAR, and decreased the monitor units. This is achieved while maintaining the same control of the PTV. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection