RESUMO: O objetivo deste estudo foi analisar a prevalência e significância clínica de interações medicamentosas identificadas nas prescrições de pacientes idosos hipertensos. Trata-se de um estudo descritivo,

BackgroundMany studies have demonstrated in the last years that once medulloblastoma has recurred, the probability of regaining tumor control is poor despite salvage therapy. Although re-irradiation has an emerging role in other relapsed brain tumors, there is a lack of strong data on re-irradiation for medulloblastoma. MethodsThis is a retrospective cohort study of patients aged 18 years or under, treated at least by a second course of external beam for recurrence medulloblastoma at Garrahan Hospital between 2009 and 2020. Twenty-four patients met eligibility criteria for inclusion. All patients received upfront radiotherapy as part of the curative-intent rst radiotherapy, either craniospinal irradiation (CSI) followed by posterior fossa boost in 20 patients or focal posterior fossa radiation in 4 infants. The second course of radiation consisted of CSI in 15 and focal in 9. The 3-year post rst failure OS (50% vs. 0%; p = 0.0010) was signi cantly better for children who received re-CSI compared to children who received focal re-irradiation. Similarly, the 3-year post-re-RT PFS (31% vs. 0%; p = 0.0005) and OS (25% vs. 0%; p = 0.0003) was signi cantly improved for patients who received re-CSI compared to patients who received focal re-irradiation. No symptomatic intratumoral haemorrhagic events or symptomatic radionecrosis were observed. Survivors fell within mild to moderate intellectual disability range, with a median IQ at last assessment of 58 (range 43-69). ConclusionRe-irradiation with CSI is a safe and effective treatment for children with relapsed medulloblastoma; improves disease control and survival compared with focal re-irradiation. However this approach carries a high neurocognitive cost.All radiation treatments were given at Garrahan Hospital, Buenos Aires, Argentina. Photon external beam therapy was used for all patients. All but four patients received CSI as part of the rst radiation course (RT1), followed by a boost to the entire posterior fossa. Standard risk (SR) patients received CSI 23.4Gy followed by posterior fossa boost 30.6Gy and high-risk (HR) patients received CSI 36Gy followed by posterior fossa boost 19.8Gy. Except for one, all of them received maintenance platinum based chemotherapy; SR as per ACNS0331 (N=2) and COG 9961 (regimen A=3, regimen B= 6); HR as per ACNS0332 (Regimen A=4, Regimen B=4). Four patients received upfront posterior fossa radiotherapy (54 Gy) due to the young age at diagnosis as per standard of care treatment administered between 2002 and 2020 at Hospital Garrahan, based on a modi ed POG-9934 strategy (15). Upon recurrence, most patients with brain solitary lesions were offered surgery followed by metronomic chemotherapy and a second course of irradiation (RT2), while those with multifocal disease received chemotherapy followed by radiotherapy. CSI was administered using standard beam's eye-view treatment planning techniques. Boost treatment and focal radiotherapy was administered using 3D-conformal radiation therapy methods. Hypofractionated stereotactic radiother...

Background Retinoblastoma survivors in low‐ and middle‐income countries are exposed to high‐intensity treatments that potentially place them at higher risk of early subsequent malignant neoplasms (SMNs). Methods We followed 714 (403 [56.4%] nonhereditary and 311 [43.5%] hereditary) retinoblastoma survivors diagnosed from August 1987 to December 2016, up to the age of 16 years. We quantified risk of SMNs with cumulative incidence (CI) and standardized incidence ratios (SIR) analysis. Multivariate regression Cox model was used to determine the association of treatments and risk of SMNs. Results Median follow‐up was of 9 years (range: 0.18–16.9) and 24 survivors (3.36%) developed 25 SMNs (n = 22 hereditary, n = 2 nonhereditary). SMNs included sarcomas (osteosarcomas, Ewing sarcomas, rhabdomyosarcomas; n = 12), leukemias (n = 5), and central nervous system tumors (CNS; n = 3). All cases of acute myeloid leukemia (AML) and most of Ewing sarcomas occurred within 5 years of retinoblastoma diagnosis. The type of SMN was the main indicator of mortality (five of five patients with leukemias, six of 12 with sarcomas, and zero of three with CNS tumors died). Compared to the general population, radiation increased the risk of Ewing sarcoma in hereditary survivors by 700‐fold (95% CI = 252–2422.6) and chemotherapy increased the risk of AML by 140‐fold (95% CI = 45.3–436). The CI of SMNs for hereditary survivors was 13.7% (95% CI = 8.4–22.1) at 15 years. Conclusion Retinoblastoma survivors from Argentina are at higher risk of developing SMNs early in life compared to the general Argentinean population, especially those treated with radiation plus chemotherapy. AML and Ewing sarcoma presented within 5 years of retinoblastoma diagnosis are associated with chemotherapy and radiation exposure.

A percepção do enfermeiro diante da pessoa com câncer sob cuidados paliativos, e o cuidado à criança e/ou adolescente com câncer, requerem além da inclusão de terapias curativas, e do alívio da dor, um apoio à família, uma vez que ao ser diagnosticado o câncer, a proporção da notícia causa um choque desesperador nos pais, por acreditarem em ser uma doença incurável relacionando-a com a morte.O câncer infanto-juvenil, é caracterizado como uma doença rara, correspondendo entre 1 e 3% de todos os tumores malignos na maioria da população brasileira; quando diagnosticado precocemente, a chance de cura varia em torno de 70%, entretanto, quando as opções de tratamentos curativos se esgotam, a proposta do tratamento passa a ser paliativo (MINISTÉRIO DA SAÚDE (BR). INSTITUTO NACIONAL DO CÂNCER; 2014; SOARES VA; et al. 2014)Visto que o número de casos de câncer infantil tem aumentado e a importância do tema papel do enfermeiro nos cuidados paliativos e na atenção à criança com câncer na atualidade, desenvolvemos este projeto para que assim seja possível a atualização e divulgação de informações desse contexto de saúde tão relevante. Dessa maneira, o objetivo do estudo é realizar uma revisão da literatura acerca da atuação do enfermeiro na atenção aos cuidados paliativos na criança com câncer.

Background: Intracranial germ cell tumor (iGCT) represents a rare and heterogeneous group, with variable incidence and diverse treatment strategies. Although multiagent chemotherapy with reduced radiotherapy strategy has been applied by several cooperative groups in North America and Western Europe, there is a paucity of data to understand if this combined regimen issuitable in low-middle income countries (LMIC). Methods: We evaluate the outcome in a cohort of iGCT treated by SIOP-CNS-GCT-96 strategy at Hospital J.P Garrahan in Argentinaover the last 20 years. Radiation field and dose included focal radiotherapy (FRT) before 2009 or focal radiotherapy plus whole ventricular radiotherapy (WVRT) after 2009 for localized germinoma and FRT or FRT plus WVRT or CSI for non germinomatous germ cell tumors (NGGCT) Results: Sixty iGCT were identified; 39 germinoma and 21 NGGCT. Median follow-up was 6.57 years (range 0.13-20.5). Five-year PFS and OS were 83.5% (95% CI [165.53-223.2]) and 88.7% (95% CI [169.84-223.2]) for the germinoma group, while for the NGGCT group were 75% (95% CI [133.27-219.96]) and 64.2% (95% CI [107.38-201.81]) respectively. The localized germinoma group showed poor results between 2000-2009 with 5-year PFS and OS of 69% and 75% respectively, and an excellent outcome between 2010-2019 with a 5-years PFS and OS of 92.8% and 100%. A univariable analysis identified this difference in survival as related to the field of radiotherapy, specifically whole ventricular radiotherapy. FRT increased the risk of recurrence in localized germinoma, involving not only 4 ventricular relapses; but spinal cord and disseminated disease as well. There were no relapses of localized NGGCT after FRT and FRT plus WVRT. Conclusion: Herein we demonstrate that intensive chemotherapy followed by FRT plus WVRT for germinoma is a feasible and effective strategy, warranting further study in the developing world.