Exceso de mortalidad durante la pandemia de COVID-19, revisión narrativa

Capturing all the deaths caused by COVID-19 through epidemiologic surveillance based on individual case notification is difficult, therefore, all-cause excess mortality (EM) is an appropriate measure for geographic comparisons and monitoring of the application of non-pharmacological sanitary measures. This is a narrative review of the literature about the observed EM during the COVID-19 pandemic. A research was made on scientific databases (Google Scholar, Pubmed, Virtual Health Library) using the terms "excess mortality", "excess deaths", "COVID-19", "coronavirus", "SARS-CoV-2". It included publications between 2019 and June 16, 2020. Twenty-seven articles were selected from 116 publications found. Most of them correspond to original articles with an analytical ecological study design. They confirm EM in the locations studied, with higher proportion of men and older people and with remarkable spatial heterogeneity. The need to optimize the standardization and updating of mortality registration and reporting mechanisms is highlighted. At a local level, data about EM that will allow these analyses is incipiently becoming available.

[Excess mortality during the COVID-19 pandemic, a narrative review]. / Exceso de mortalidad durante la pandemia de COVID-19, revisión narrativa.

Capturing all the deaths caused by COVID-19 through epidemiologic surveillance based on individual case notification is difficult, therefore, all-cause excess mortality (EM) is an appropriate measure for geographic comparisons and monitoring of the application of non-pharmacological sanitary measures. This is a narrative review of the literature about the observed EM during the COVID-19 pandemic. A research was made on scientific databases (Google Scholar, Pubmed, Virtual Health Library) using the terms "excess mortality", "excess deaths", "COVID-19", "coronavirus", "SARS-CoV-2". It included publications between 2019 and June 16, 2020. Twenty-seven articles were selected from 116 publications found. Most of them correspond to original articles with an analytical ecological study design. They confirm EM in the locations studied, with higher proportion of men and older people and with remarkable spatial heterogeneity. The need to optimize the standardization and updating of mortality registration and reporting mechanisms is highlighted. At a local level, data about EM that will allow these analyses is incipiently becoming available.

Mapping of failures after radiochemotherapy in patients with non-metastatic esophageal cancer: A posteriori analysis of the dose distribution in the sites of loco-regional relapse.

BACKGROUND AND PURPOSE: We aimed to evaluate the patterns of loco-regional failure (LRF) after exclusive chemoradiotherapy (eCRT) for esophageal cancer with respect to planned dose and/or the incidental (unplanned) dose outside target volumes. MATERIALS AND METHODS: Co-image registration of CT or (18)F-FDG PET-CT at the time of failure (tf) and at the time of CRT (t0) was performed in 34 patients with LRF. Dosimetric parameters with regard to local failure (LF), nodal failure (NF) and involved nodal stations (NS) were derived. RESULTS: Twenty-two patients (64.7%) had LF, the majority of which (95.5%) were located at the epicenter of the GTV of the primary tumor. The mean doses recalculated to the NS at tf were more likely to be lower than the planned dose delivered to the PTV at t0: Dmean=33.9 ± 20.8 Gy vs 52.2 ± 8.5 Gy (p=0.0009), D95%=27.5 ± 21 Gy vs 46.1 ± 4.8 Gy (p=0.004). Among the 12 patients with NF outside the elective nodal irradiation (ENI) volume, Dmean of NS outside the ENI was significantly lower (19.4 ± 21.4 Gy) than the Dmean of NS with failure within the ENI (45.1 ± 6.1 Gy, p=0.01). CONCLUSION: Loco-regional failure after exclusive chemoradiotherapy for esophageal cancer may be due to an inadequately low dose.

A rationale for chemoradiation (vs radiotherapy) in salivary gland cancers? On behalf of the REFCOR (French rare head and neck cancer network).

BACKGROUND: Salivary gland carcinomas constitute a heterogeneous group of tumors, with over 20 histological subtypes of various prognoses. The mainstay of treatment is surgery, with radiotherapy advocated for unresectable disease or postoperatively in case of poor prognostic factors such as high grade, locally advanced and/or incompletely resected tumors. Concurrent chemotherapy is sometimes advocated in routine practice based on criteria extrapolated from squamous cell carcinomas of the head and neck, on radioresistance of salivary gland tumors and on results obtained in the metastatic setting. The aim of this review was to identify situations where chemotherapy is advocated. MATERIAL AND METHODS: A search of literature was performed with the following key words: parotid, salivary gland, neoplasm, cancer, malignant tumor, chemoradiation, chemotherapy, radiotherapy and treatment. Case report and studies published before 2000 were not included. RESULTS: Platinum-based regimens were the most frequent. Other regimens were reported and seemed dependent on histology. The level of evidence for the concurrent delivery of chemotherapy with radiation therapy is supported by a low level of evidence. Prescribing chemotherapy mostly relies on poor prognostic factors similar to those used to indicate high dose radiotherapy. Protocols vary with histology. CONCLUSION: The rationale for adding chemotherapy to radiotherapy remains to be demonstrated prospectively. Although the type of systemic treatments used may be adapted on histology, the strongest rationale remains in favor of cisplatin.