Comparison between Accelerated Partial Breast Irradiation with multicatheter interstitial brachytherapy and Whole Breast Irradiation, in clinical practice.

PURPOSE: The aim of this study was to compare accelerated partial breast irradiation (APBI) with multicatheter interstitial brachytherapy (BT) and whole breast irradiation (WBI), in terms of toxicity, aesthetic result, quality of life and survival, in clinical practice. MATERIALS AND METHODS: A comparative study of two prospectively recorded cohorts of 76 breast cancer patients who complied with the recommendations of GEC-ESTRO for APBI was conducted. The main objective was toxicity, quality of life measured through validated questionnaires and the aesthetic results. Secondary objectives were overall survival and disease-free survival. RESULTS: Seventy-six stage I/II breast cancer patients, with a mean age of 66 years entered the study. APBI group showed less acute G1-2 dermatitis (51.4 vs 94.9%, p < 0.001) and late hyperpigmentation (0 vs 17.9%, p = 0.04). There were no differences in aesthetic results, both assessed by the patient herself and by the doctor. Statistically significant differences in measures of quality of life were observed in favour of the APBI, both in EORTC QLQ-BR23 and body image scale questionnaires. With a median follow-up of 72 months (6 years), the estimated overall survival at 5 and 10 years was 96.8 and 77.7%, respectively, and disease-free survival at 5 and 10 years was 91.1 and 69.4%, respectively, without statistically significant differences between groups. DISCUSSION: APBI is an attractive alternative in candidate patients with initial breast cancer, with benefits in acute toxicity and quality of life and fewer visits to the hospital, without compromising tumor control or survival.

Análisis descriptivo del tratamiento quirúrgico del cáncer de pulmón en los centros del sistema sanitario público de Andalucía. Proyecto vara II / Descriptive analysis of the surgical treatment of lung cancer at Public Health Hospitals in Andalusia: VARA Project II

Introducción: El cáncer de pulmón es el responsable de unas 3000 muertes cada año en Andalucía y, aunque la cirugía es el tratamiento de elección en estadios iniciales, menos del 20-25% son intervenidos. La Dirección del Plan Integral de Oncología de Andalucía (PIOA) realizó un estudio (Proyecto VARA I) sobre variabilidad y accesibilidad al tratamiento de radioterapia en 2003, observando una infrautilización manifiesta de este recurso en cáncer de pulmón. Esto motivó la puesta en marcha de un 2º estudio (VARA II) para evaluar el tratamiento locorregional, radioterapia y cirugía, del cáncer de pulmón en esta Comunidad. Material y métodos: Se evaluaron retrospectivamente las historias clínicas de los pacientes intervenidos en 2007 por cáncer de pulmón en los Hospitales Públicos de Andalucía. Se realizaron análisis descriptivos y de variabilidad entre los distintos equipos quirúrgicos. Resultados: Se evaluaron 418 pacientes, de los que 303 ofrecieron datos suficientes para el análisis. La edad media fue de 64 años (94% varones) con la siguiente distribución por estadios: I (60%), II (13%), III (21%), IV (6%). Se practicó tomografía de emisión de positrones (PET) en el 75% y mediastinoscopia en el 5%. La tasa de cirugía fue del 17% del total de casos esperados de cáncer de pulmón no células pequeñas. En el 97% de los casos se practicó linfadenectomía, la mayoría de ellas (72%) con un número de (..) (AU)

Introduction: Lung cancer is responsible of 3000 deaths every year in Andalusia. Although surgery is the elective treatment in early stages, less than 20-25% are operated on. The Direction of the Comprehensive Cancer Plan of Andalusia (PIOA) performed a study (VARA I Project) about variability and accessibility to radiation therapy in Andalusia in 2003, finding a clear infra utilisation in lung cancer. This motivated a second study (VARA II) to evaluate the locoregional treatment, both radiotherapy and surgery, of lung cancer in this region. Material and methods: Medical Records of patients operated in 2007 for lung cancer in Andalusian Public Hospitals were retrospectively evaluated. Descriptive analysis and studies of variability between surgical teams were performed. Results: Medical records of 418 patients were evaluated, 303 of them showing sufficient data for the analysis. Mean age was 64 (94% males), with the following stage distribution: I (60%), II (13%), III (21%), IV (6%). A PET was realized in 75% and mediastinoscopy in 5%. Surgery rate was 17% of the total expected cases of non small cell lung cancer. A lymphadenectomy was performed in 97%, the majority of them (72%) with less than 10 nodes resected. A good clinical and pathological concordance was demonstrated and low values of perioperative mortality (6%). Inter-hospitals variability study showed significant differences on histology, PET use, number of mediastinal nodes resected and reintervention rate. Discussion: The estimated surgical rate is similar to the published by other authors, although with a larger percentage of advanced stages III-IV. An important variability in patterns of care is demonstrated. Last, a low use of diagnostic mediastinoscopy is highlighted, while the use of PET for preoperative mediastinal evaluation is increasing, especially when the hospital owns the technique (AU)