ABSTRACT
BACKGROUND AND PURPOSE: Radiation oncology guidelines favour hypofractionated whole-breast radiotherapy (HWBRT) over more conventional schemes in the conservative treatment of breast cancer, but its adoption still varies in clinical practice. This study assessed the patterns of HWBRT adoption in Catalonia (Spain). MATERIAL AND METHODS: We used a mixed-methods approach based on an explanatory sequential design, first collecting and analysing quantitative data on HWBRT use (>2.5Gy per fraction) in 11 public radiotherapy centres (2005-2015) and then performing 25 semi-structured interviews with all department heads and reference radiation oncologist/s. RESULTS: Of the 34,859 patients fulfiling the study criteria over the study period, just 12% were hypofractionated, reaching a percentage of 29% in 2015 (p<0.001). Our analysis showed a narrowing age gap between patients receiving conventional fractionation and hypofractionation in centres leading adoption. However, there were important differences in clinicians' interpretation of evidence (e.g. regarding the perceived risk of long-term toxicity) and selection of patients for specific indications, both within and between departments. CONCLUSIONS: Differences observed in the rate of adoption of HWBRT could not be tackled only using a rational, evidence-based approach. Factors related to the management of radiotherapy departments play a major role in the diffusion of therapeutic strategies.
Subject(s)
Breast Neoplasms/radiotherapy , Radiation Dose Hypofractionation , Aged , Female , Humans , Middle Aged , Spain , Treatment OutcomeABSTRACT
INTRODUCTION: Concurrent chemotherapy and radiotherapy is recommended for the treatment of locally advanced unresectable head and neck (H&N) cancer. OBJECTIVE: The primary purpose of the Phase I part of the study was to determine the maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and recommended dose (RD) of docetaxel with hyperfractionation radiotherapy. The primary objective of the Phase II part was to determine the response rate to the RD of treatment and, secondarily, to assess the toxicity of the schedule, time to progression, duration of response and overall survival (OS). MATERIALS AND METHODS: Patients (n=9 in Phase I; n=19 in Phase II) had unresectable H&N cancer. The starting docetaxel dose was 20 mg/m(2) plus hyperfractionated radiotherapy. Ramping of docetaxel was 5 mg/m(2) if MTD was not reached. RESULTS: MTD of docetaxel was 20 mg/m(2). Limiting toxicities were grade 4 pneumonia and grade 4 mucositis. The RD was 15 mg/m(2). Phase II initial response was 76% (CR=18%; PR=9%); updated response was 89% (CR=59%; PR=29%). The median progression-free survival was 7.8 months (95%CI: 0-22.3) and the median OS was 15.1 months (95%CI: 0-35.9). Grade 3-4 toxicities included mucositis (91%), pneumonia (27%) and fatigue (27%). There were 5 toxic deaths (2 from intestinal perforation, 3 from pneumonia). CONCLUSIONS: Weekly docetaxel+hyperfractionation radiotherapy is active but with high toxicity rates and, hence, this treatment regimen would be difficult to justify.
Subject(s)
Antineoplastic Agents/therapeutic use , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Taxoids/therapeutic use , Adult , Aged , Combined Modality Therapy/adverse effects , Docetaxel , Dose Fractionation, Radiation , Dose-Response Relationship, Drug , Dose-Response Relationship, Radiation , Female , Head and Neck Neoplasms/pathology , Humans , Male , Maximum Tolerated Dose , Middle Aged , Neoplasm Staging , Radiotherapy/adverse effectsABSTRACT
Purpose. To evaluate the cosmetic outcome of breastconservative therapy and to examine the degree ofagreement between the patients and oncologistsratings. We also analyze the influence of severalfactors on cosmesis.Methods and materials.We retrospectively evaluated145 patients with primary breast cancer treatedby local excision and radiotherapy between January2000 and May 2001. Cosmetic outcome wasevaluated by doctors and patients and was scoredas excellent, good, fair or poor.Results. 73% of patients rated cosmesis as excellentor good while the percentage was 71% when ratedby radiation oncologists. The degree of cosmesisconcordance evaluated by oncologists and patientswas low (kappa = 0.3). In our study the variableswhich significantly influence on the cosmetic outcomewere concomitant adjuvant chemotherapy(p = 0.04) and radiation therapy boost, either byelectron beam or brachytherapy (p = 0.013).Conclusion. The cosmetic outcome of breast conservingtherapy was good. There was a similar ratingby the patient and radiation oncologist, but thelevel of concordance between patients and doctorswas low. Factors that significantly influence thecosmesis appear to be concomitant adjuvant chemotherapyand radiation therapy boost
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