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Aims To summarise and evaluate the current literature in gynaecological tumours treated with stereotactic ablative body radiotherapy (SABR) through a systematic review using the Preferred Reported Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. Materials and methods A literature search through Medline, EMBASE and Cochrane databases resulted in 22 pertinent manuscripts. Selected studies evaluated the locoregional role of SABR in gynaecological tumours, regardless of SABR clinical indication. Data on local control, toxicity and SABR dose and technique were extracted by at least two investigators. Results In total, 330 patients received locoregional SABR for gynaecological tumour and had measurable clinical outcomes. Six different clinical scenarios were identified: (i) boost to external beam radiotherapy (EBRT) for cervical cancer as radical treatment; (ii) boost to EBRT for non-operable endometrial cancer; (iii) treatment for pelvic and/or para-aortic node metastases; (iv) adjuvant treatment after surgery in uterine/cervix cancers; (v) salvage of non-nodal pelvic recurrences and (vi) vulvar or vaginal malignancies. Except for SABR as a boost for non-operable endometrial cancer, local control over 80% was found in a range of median follow-up of 4–132 months. Local control in non-operable endometrial tumours receiving SABR was 53%. In salvage treatments for non-nodal pelvic relapses, SABR was associated with about a 20% grade 3–4 gastrointestinal toxicity. Conclusion There is no clear consensus or evidence on the defined role of SABR in gynaecological tumours. Local control and toxicity associated with SABR seems reasonable for most clinical indications found by this review with a short median follow-up. When used for salvage of non-nodal pelvic recurrences, SABR may be associated with high rates of grade 3–4 late gastrointestinal toxicity.

Purpose : To evaluate tumor shrinking kinetics in order to implement image-guided brachytherapy (IGBT) for the treatment of patients with cervix cancer. Material and methods : This study has prospectively evaluated tumor shrinking kinetics of thirteen patients with uterine cervix cancer treated with combined chemoradiation. Four high dose rate brachytherapy fractions were delivered during the course of pelvic external beam radiation therapy (EBRT). Magnetic resonance imaging (MRI) exams were acquired at diagnosis (D), first (B1), and third (B3) brachytherapy fractions. Target volumes (GTV and HR-CTV) were calculated by both the ellipsoid formula (VE) and MRI contouring (VC), which were defined by a consensus between at least two radiation oncologists and a pelvic expert radiologist. Results: Most enrolled patients had squamous cell carcinoma and FIGO stage IIB disease, and initiated brachytherapy after the third week of pelvic external beam radiation. Gross tumor volume volume reduction from diagnostic MRI to B1 represented 61.9% and 75.2% of the initial volume, when measured by VE and VC, respectively. Only a modest volume reduction (15-20%) was observed from B1 to B3. Conclusions : The most expressive tumor shrinking occurred in the first three weeks of oncological treatment and was in accordance with gynecological examination. These findings may help in IGBT implementation.

Background: Cervical cancer collects the highest survival benefit from radiotherapy (RT) among all malignancies. A large gap between oncological demand and RT availability exists for cervical cancer in Brazilian Public Health System (BPHS). Aim: To evaluate cost-effectiveness of universal access to RT and chemo-radiation (CRT) for untreated cervical cancer patients in the BPHS. Methods: The incremental cost was calculated based on the direct medical cost from a payer's perspective and the proportion of new cases with unmet RT/CRT needs in 2016. The incremental effectiveness was evaluated by life-year (LY) gain based on life expectancy, cervical cancer incidence and the number of cancer deaths due to lack of RT/CRT access as previously described. The incremental cost-effectiveness ratio (ICER) was calculated from direct medical costs and LYs. The indirect costs from mortality-related productivity loss (MRPL) were estimated based on life expectancy, wage and labor force participation rate. The MRPL was compared with direct medical cost. All costs and effectiveness were age-adjusted based on 2016 Brazilian data and discounted at 3% per year. Costs were adjusted to 2016 U.S. dollars. One-way sensitivity analysis was performed to assess the robustness of the model. Results: The annual cost to close RT gap was $14.3 million, with additional cost of $4.1 million to close the CRT gap. The average years of potential life lost per death was 20.5. Cost per life saved was $10,820 for RT alone (ICER: $528/LY) and $18,919 for CRT (ICER: $584/LY), respectively. The MRPL due to shortage of RT/CRT were 70/81 million respectively. Conclusion: Providing universal access to RT/CRT for cervical cancer patients in the BPHS will incur low cost per life-year saved and provide large economical gain by saving thousands of lives.

This study investigates the effects of granulocyte colony-stimulating factor (G-CSF) therapy in experimental chronic chagasic cardiomyopathy. Chagas disease is one of the leading causes of heart failure in Latin America and remains without an effective treatment other than cardiac transplantation. C57BL/6 mice were infected with 10(3) trypomastigotes of Trypanosoma cruzi, and chronic chagasic mice were treated with G-CSF or saline (control). Evaluations following treatment were functional, immunological, and histopathological. Comparing hearts of G-CSF-treated mice showed reduced inflammation and fibrosis compared to saline-treated chagasic mice. G-CSF treatment did not alter the parasite load but caused an increase in the number of apoptotic inflammatory cells in the heart. Cardiac conductance disturbances in all infected animals improved or remained stable due to the G-CSF treatment, whereas all of the saline-treated mice deteriorated. The distance run on a treadmill and the exercise time were significantly greater in G-CSF-treated mice when compared to chagasic controls, as well as oxygen consumption (VO(2)), carbon dioxide production (VCO(2)), and respiratory exchange ration (RER) during exercise. Administration of G-CSF in experimental cardiac ischemia had beneficial effects on cardiac structure, which were well correlated with improvements in cardiac function and whole animal performance.

Squamous cell carcinoma is responsible for 90% of the head and neck cancers affecting over 600,000 people worldwide. Radiation therapy, surgery and chemotherapy are the most important treatment modalities in head and neck squamous cell carcinoma. The aim of this review is to summarize the recent innovations in head and neck radiation therapy, which intends to appreciate the cutting-edge intensity-modulated radiation therapy strategies to mitigate long-term toxicities and evaluate promising technologies in the field as adaptive treatment, dose painting and proton therapy.

CBA mouse macrophages effectively control Leishmania major infection, yet are permissive to Leishmania amazonensis. It has been established that some Leishmania species are destroyed by reactive oxygen species (ROS). However, other species of Leishmania exhibit resistance to ROS or even down-modulate ROS production. We hypothesized that L. amazonensis-infected macrophages reduce ROS production soon after parasite-cell interaction. Employing a highly sensitive analysis technique based on chemiluminescence, the production of superoxide (O(·-)(2)) and hydrogen peroxide (H(2)O(2)) by L. major- or L. amazonensis-infected CBA macrophages were measured. L. major induces macrophages to release levels of (O(·-)(2)) 3·5 times higher than in uninfected cells. This (O(·-)(2)) production is partially dependent on NADPH oxidase (NOX) type 2. The level of accumulated H(2)O(2) is 20 times higher in L. major-than in L. amazonensis-infected cells. Furthermore, macrophages stimulated with L. amazonensis release amounts of ROS similar to uninfected cells. These findings support previous studies showing that CBA macrophages are effective in controlling L. major infection by a mechanism dependent on both (O(·-)(2)) production and H(2)O(2) generation. Furthermore, these data reinforce the notion that L. amazonensis survive inside CBA macrophages by reducing ROS production during the phagocytic process.