INTRODUCTION:The Brazilian Society of Surgical Oncology (SBCO) developed national guidelines for the rational use of blood concentrates in surgical procedures. METHODS:Between June and December 2024, a multidisciplinary team of 42 experts formulated 48 key questions on the rational use of blood concentrates in surgery. The guidelines were structured in three phases: preoperative, intraoperative, and postoperative. Expert groups performed literature reviews and proposed preliminary recommendations, which were later refined by the coordinators. An adapted grading system was used to assess the level of evidence, and an online voting process determined consensus among experts. CONCLUSION:Implementing a bloodless surgery protocol requires a meticulous and coordinated approach across multiple medical disciplines. Essential elements for success include patient and staff education, comprehensive preparation, and the use of advanced surgical techniques and technologies to optimize outcomes.
Despite apparent cure after treatment of localized prostate cancer (PC), a significant proportion of patients who undergo radical prostatectomy (RP) or radiotherapy (RT) will experience biochemical recurrence (BCR) within 10 years. This study was conducted to evaluate the main aspects of BCR after primary definitive treatment in a real-world setting in Brazil. In this retrospective, single-center, observational cohort study, data were extracted from electronic medical records of patients aged ≥18 years with PC, treated at one clinical site in Brazil, who underwent definitive curative-intent treatment during January 1, 2005–December 31, 2018. The primary objective was to estimate 5-year BCR rate, defined per European Association of Urology (EAU) criteria as PSA >0.2 ng/mL after RP, or PSA nadir + 2 ng/mL above nadir after RT. Of 971 patients included, 131 (13.5
IntroductionGiven the high disparities present in cancer care worldwide and even more challenging infrastructure and access for low- and middle-income countries, adhering precisely to international guidelines has become a challenging and complex task. Recommendations from an independent multidisciplinary panel of experts from 13 countries, including medical oncologists, pathologists, surgeons, and radiation oncologists, who met during IGCS to address some of these challenges.MethodsThe panel met in New York City in September of 2022 during the International Gynecological Cancer Society Congress and was composed of specialists from developing countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East. The panel addressed 103 questions and provided recommendations for the management of early, locally advanced, recurrent, and/or metastatic endometrial cancer. The questions were carefully developed by the group and specifically directed to, and answered by, specialists according to their respective areas of expertise. Consensus was defined as at least 75% of the voting members selecting a particular recommendation, whereas a majority vote was considered when one option garnered between 50.0% and 74.9% of votes. Resource limitation was defined as any issues limiting access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or funding for providing modern medical care.ResultsEighteen of the 109 (16.5%) questions presented to the panel reached consensus, whereas a majority vote was reached for 43 (39.4%) additional questions. The recommendations for the remaining questions were considerably heterogeneous and were considered experts opinion only.ConclusionEstablishing guidelines with recommendations in areas with resource limitations may help healthcare providers and improve patient care around the world.
Hyposalivation is a common complication in patients undergoing head and neck radiotherapy. It negatively affects quality of life and increases the risk of secondary conditions such as dental caries, opportunistic infections, and nutritional impairment. Photobiomodulation (PBM) has been proposed as a preventive strategy; however, there is no consensus regarding the optimal protocol or the most appropriate route of application. This pilot study aims to compare the efficacy of intraoral and transcutaneous PBM in preventing radiotherapy-induced hyposalivation. The intraoral protocol will use a 660 nm red laser (100 mW, 1 J, 10 s per point, 10.02 J/cm², total 44 points). The transcutaneous protocol will use an 808 nm infrared laser (100 mW, 1 J, 10 s per point, total 32 points). The intraoral approach will deliver targeted irradiation to oral tissues, while the transcutaneous approach will deliver infrared irradiation externally, taking advantage of its greater tissue penetration and potentially improved patient comfort. The primary outcome will be the incidence of stimulated salivary flow rate (salivary flow rate < 0.7 mL/min). Secondary outcomes will include patient-reported xerostomia and quality of life, assessed using validated instruments. This study will provide comparative data on two PBM delivery approaches for the prevention of radiotherapy-induced hyposalivation and may contribute to the optimization of clinical protocols in oncological care.
