Treatment of Basal Cell Carcinoma of the Lower Eyelid With High-Dose-Rate Brachytherapy.

Objective To report the outcomes with high-dose-rate (HDR) brachytherapy (BT) treatment in patients with lower eyelid basal cell carcinoma (BCC) and to evaluate the relationship between dosimetric parameters and acute and late toxicities. Material and methods A retrospective unicentric study with patients diagnosed with lower eyelid biopsy-proven BCC treated with HDR BT between January 2012 and December 2019. The prescribed dose was 36 Gy to 40 Gy in 9 to 10 fractions, twice daily, over five days. The primary endpoint was local control, and the secondary endpoints were acute and late toxicities, registered according to CTCAE v4.0. The cosmetic result was evaluated on a qualitative scale (the CAIB scale). Local control was calculated according to the Kaplan-Meier test. Two sample T-tests and a Wilcoxon signed-rank test were used to determine the association between dosimetric parameters and side effects. Results Fifty-eight patients with a median age of 76 years were included. Among these patients, 55.2% received adjuvant HDR BT and 44.8% received radical HDR BT. At a median follow-up of 44 months, there were four local relapses, achieving a probability of local control at four years of 95% and 100% in the adjuvant and radical groups, respectively. Acute toxicity occurred in 76% of patients with only one grade 3 event (radiation dermatitis). Late toxicity was present in 56%. Eight patients underwent treatment for grade 3 cataracts during follow-up. Cosmetic results were excellent or very good in 93% of patients. Acute conjunctival hyperemia is strongly associated with the dose received by the ocular globe (volumes of 0.1cc, 1cc, and 2 cc) (p<0.05). Conclusion Lower eyelid BCC treatment with interstitial HDR BT is associated with excellent local control, acceptable long-term side effects, and good cosmetic results.

Portuguese consensus on the prevention and treatment of nausea and vomiting induced by cancer treatments.

Chemotherapy-induced nausea and vomiting (CINV) and radiotherapy-induced nausea and vomiting (RINV) strongly affect the quality of life of patients with cancer. Inadequate antiemetic control leads to the decline of patients' quality of life, increases rescue interventions, and may even compromise adherence to cancer treatment. Although there are international recommendations for controlling CINV and RINV, these recommendations focus mainly on pharmacological management, with scarce information on additional measures that patients may adopt. Moreover, the prophylaxis and management of CINV/RINV are not always applied. Thus, we identified the need to systematize the strategies for preventing and managing CINV/RINV and the associated risk factors to implement and promote effective prophylactic antiemetic regimens therapy in patients with cancer. This review sought to create a set of practical recommendations for managing and controlling CINV/RINV, according to the current international recommendations for antiemetic therapy and the main risk factors. Conclusively, we intended to produce a patient-centered guidance document for health care professionals focused on the awareness, monitoring, and treatment of CINV/RINV.

Surgery versus radiotherapy: Long term outcomes of T1 glottic cancer.

AIM: The aim of this study was to compare the outcomes, patterns of failure and laryngeal preservation rates in patients with T1N0 glottic cancer treated with surgery or radiotherapy. MATERIALS/METHODS: Retrospective study of T1N0 glottic cancer patients treated in our institution between January 2007 and December 2017. Histologically proven squamous cell carcinoma patients, treated with upfront cordectomy/partial laryngectomy (S group) or radiotherapy (RT group) were included. Elective treatment of the neck was not permitted. Local failure (LF), disease-free survival (DFS), ultimate disease-free survival (UDFS), laryngectomy-free survival (LFS), disease-specific mortality (DSM) and overall survival (OS) were evaluated. RESULTS: Two hundred and one patients were eligible (172 S group, 29 RT group), with a median follow-up of 38.8 months. Overall, 33 (16%) patients had a recurrence, 30 (17%) in the S group and 3 (10%) in the RT group. Local failure was the predominant site of failure (28 S, 2 RT). Overall, of all those that were salvaged, 17 (8%) underwent total laryngectomy (15 S, 2 RT). There was no significant difference in the 5-year cumulative incidence of LF (20.8% S, 8.1% RT, p = 0.138), 5-y LFS (85.0% vs. 91.7%, p = 0.809), 5-y DFS (67.5% vs. 82.1%, p = 0.343), 5-y UDFS (82.5% vs. 90.3%, p = 0.647) and 5-y OS (84.5% vs. 90.3%, p = 0.892). Multivariate analysis showed no correlation between initial treatment and the analyzed outcomes. CONCLUSION: Primary surgery or radiotherapy were similar first line options, since they do not differ in all outcomes. Patients' and physician's preferences must be considered when choosing first treatment.

Improved long-term results of intensity-modulated radiotherapy for a non-endemic European nasopharyngeal carcinoma cohort: single-center retrospective study.

PURPOSE: Report our matured outcomes of European nasopharyngeal carcinoma (NPC) treatment from a non-endemic region in the IMRT era. METHODS: We reviewed 109 consecutive patients with biopsy proven NPC treated between 2009 and 2013. All received IMRT as per RTOG 0615. Toxicity was scored accordingly to CTCAE 4.03. Platinum-based chemotherapy was delivered following the Intergroup 0099. RESULTS: Median age of 53 years; 97% Caucasian; 74% male; 72% WHO grade III; 43% T1; 14% T2; 18% T3, 25% T4; 17% N0; 17% N1; 39% N2; 27% N3. Compliance to adjuvant chemotherapy was 88%. With a median follow up of 56 months, the 4-year local control was 90.2% (88.6% for T1; 100% for T2; 85% for T3; and 91.7% for T4), the 4-year distant metastases-free survival was 86% and an overall survival rate was 77%. Local control and survival were better in G3 (p < 0.001 and p = 0.032, respectively). Xerostomia was the most frequent late toxicity in 55% (n = 60). Hypothyroidism requiring hormonal reposition occurred in 15.5% (n = 17). From the 36 deaths, 20 were due to distant metastases, 3 grade 5 toxicity, 2 from local progression, 5 non-cancer deaths and unknown cause in the remaining 6. On multivariable analysis, age (p = 0.017), local recurrence and distant metastases were associated with death (p < 0.001, both). CONCLUSION: Our matured data from the IMRT era showed a major improvement from our 3D cohort series reaching excellent local and regional control, even in T4. Local recurrences, despite few, and distant metastases were correlated with the risk of death.

Low rectal cancer treatment strategies: a cohort study assessing watch and wait.

PURPOSE: Treatment strategies for low rectal cancer have been evolving toward achieving less treatment morbidity with the same oncological success-we aimed to assess the results of the new watch and wait (W&W) strategy in our cohort. METHODS: A tertiary care cohort study was conducted. New patients with rectal adenocarcinoma up to 6 cm from the anal margin, cM0, locally staged higher than cT1N0, evaluated between November 2014 and October 2018, were included. All 93 patients received neoadjuvant radiotherapy ± chemotherapy. Re-evaluation was planned 8-12 weeks after the end of treatment. Patients showing clinical complete response (cCR) were given the choice of either to proceed to surgery or to enter W&W. RESULTS: Of the 93 patients, 82.8% were re-evaluated and 20.8% had cCR. Patients in clinical stages II/III were significantly less likely to achieve cCR than those in stage I (p = 0.017). After a mean follow-up of 17.44 months, there were 4 regrowths in the 16 patients under W&W, all submitted to R0 surgery, ypN0; there were no deaths or local recurrences; one patient with regrowth had distant recurrence. Sixty patients underwent direct surgery after a mean follow-up of 16.23 months; 3 patients had local and distant recurrences; 7 others had only distant recurrences; there were 8 deaths. There were no statistically significant differences between patients under W&W and patients who underwent direct surgery regarding local or distant recurrences, or death (p > 0.9; p = 0.44; p = 0.19, respectively). CONCLUSION: The W&W strategy for low rectal cancer achieved the same oncological outcomes as the traditional strategy while sparing some patients from surgery.

Surgery vs. primary radiotherapy in early-stage oropharyngeal cancer.

BACKGROUND: Early-stage oropharyngeal squamous cell carcinoma (OPSCC) can currently be treated by surgical resection or definitive radiotherapy (RT). The aim of this study is to review the outcomes of early-stage OPSCC submitted to surgery or primary RT. Preliminary results have shown similar overall survival (OS) and locoregional recurrence-free survival (LRFS). MATERIAL/METHODS: Retrospective study of patients with cT1-T2 cN0-N1 OPSCC, diagnosed between January 2009 and December 2014, treated with surgery or primary RT. RESULTS: 61 patients with cT1-T2 cN0-N1 OPSCC were included. Forty-two (69%) were submitted to surgical resection, of which 37 (88%) had adjuvant treatment (24 received RT and 13 chemoradiotherapy). Nineteen (31%) were treated with primary RT, and 3 of them had concurrent chemotherapy. RT was given with intensity-modulated radiation therapy (IMRT) (71%) or three-dimensional conformal radiation therapy (3D-CRT) (29%). At a median follow-up of 5.4 years, there were 3 tumor persistences, 5 local failures, 2 regional failures and no distant metastasis. The 3-year and 5-year OS were 77% and 71% in the RT group vs. 71% and 59% in the surgery group, respectively (HR 0.60, 95% CI 0.22-1.61; p = 0.30). The 3-year and 5-year LRFS were 71% and 64% in the RT group vs. 66% and 50% in the surgery group, respectively (HR 0.59, 95% CI 0.24-1.45; p = 0.24). Up to 34% had acute grade 3 toxicity and 11% had grade 4 osteoradionecrosis of the jaw. CONCLUSIONS: Longer follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.