BACKGROUND: Image-guided intensity-modulated radiotherapy (IG-IMRT) is increasingly being used to treat patients with soft-tissue sarcoma (STS) of the head and neck. Although there is no comparison between IMRT and conventional radiation therapy (CRT) concerning their efficacy. In this analysis, we compared CRT and IMRT outcomes for head and neck STS. PATIENTS AND METHODS: Sixty-seven patients who underwent radiotherapy between 1994 and 2017 were identified. RESULTS: The median follow-up was 31 months. Of the 67 patients, 34% were treated with CRT technique and 66% with IG-IMRT. The locoregional relapse rate following IMRT was 21% versus 70% with CRT (p<0.001) and the 5-year locoregional control was 69% versus 28%, respectively (p=0.01). IG-IMRT was associated with non-significant, less acute, and chronic adverse events. In the multivariate analysis, a significant influence of radiation technique on locoregional control was confirmed (p=0.04). CONCLUSION: IG-IMRT seems to be associated both with higher locoregional control as well as lower acute and chronic toxicities.
Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/radiotherapy , Radiotherapy, Image-Guided , Radiotherapy, Intensity-Modulated , Soft Tissue Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/radiotherapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Head and Neck Neoplasms/mortality , Humans , Male , Middle Aged , Multimodal Imaging/methods , Neoplasm Grading , Neoplasm Staging , Radiotherapy Dosage , Radiotherapy, Image-Guided/adverse effects , Radiotherapy, Image-Guided/methods , Radiotherapy, Intensity-Modulated/adverse effects , Radiotherapy, Intensity-Modulated/methods , Retrospective Studies , Survival Analysis , Treatment Outcome , Young Adult
The Mais Médicos (More Doctors) Program seeks to broaden access to health by providing medical professionals, investments in health units and multi-professional integration geared to the Family Health Strategy. Vale do Ribeira includes 25 cities and is among the most vulnerable regions in São Paulo. It has been allocated 41 physicians from the Program. This study is to evaluate access to health, comparing health indicators before and after the Program. We collected data from DATASUS, SIAB, and the Ministry of Health. There was a marked increase in the number of appointments for infants under one year of age, adults, the elderly, STD/HIV patients and group patient care. There was a decrease in appointments outside the catchment area, as well as hospital admissions for other causes, mothers exclusively breastfeeding their infants up to four months. We concluded that after deployment of the Program, there was an increase in health access and health promotion focused on an area that presents an enormous challenge for Primary Health Care (PHC). It would seem that, since this is a high vulnerability area with a large area for care, hospital admissions for PHC care-sensitive conditions, as well as referrals for secondary services, did not decrease.
Delivery of Health Care , Government Programs , Health Services Accessibility/organization & administration , Physicians/supply & distribution , Vulnerable Populations , Adolescent , Adult , Brazil , Child , Child, Preschool , Cross-Sectional Studies , Humans , Infant , Middle Aged , Workforce , Young Adult
Resumo O Programa Mais Médicos visa ampliar o acesso à saúde em áreas provendo profissionais médicos, investimentos nas unidades de saúde e integração multiprofissional voltada à Estratégia de Saúde da Família. O Vale do Ribeira abriga 25 municípios e figura entre as regiões mais vulneráveis do estado e recebeu 41 médicos do PMM. O objetivo deste estudo é avaliar o acesso à saúde, comparando indicadores de produção, marcadores e situação de saúde antes e depois da implementação do PMM. Foram coletados dados do DATASUS, SIAB e Ministério da Saúde. Houve aumento em número de consultas de crianças menores de um ano, adultos, idosos, DST/AIDS e atendimento em grupos. Houve redução no número de consultas fora de área de abrangência, de hospitalizações por outras causas e no aleitamento materno exclusivo até quatro meses. Concluímos que após a implementação do programa houve melhora no acesso à saúde e no trabalho de promoção de saúde focado no território, um grande desafio na Atenção Primária à Saúde (APS). Supõe-se que por se tratar de área de alta vulnerabilidade e pressão assistencial, as internações por causas sensíveis à APS, assim como o encaminhamento aos serviços secundários, não tenham sido reduzidas a curto prazo.
Abstract The Mais Médicos (More Doctors) Program seeks to broaden access to health by providing medical professionals, investments in health units and multi-professional integration geared to the Family Health Strategy. Vale do Ribeira includes 25 cities and is among the most vulnerable regions in São Paulo. It has been allocated 41 physicians from the Program. This study is to evaluate access to health, comparing health indicators before and after the Program. We collected data from DATASUS, SIAB, and the Ministry of Health. There was a marked increase in the number of appointments for infants under one year of age, adults, the elderly, STD/HIV patients and group patient care. There was a decrease in appointments outside the catchment area, as well as hospital admissions for other causes, mothers exclusively breastfeeding their infants up to four months. We concluded that after deployment of the Program, there was an increase in health access and health promotion focused on an area that presents an enormous challenge for Primary Health Care (PHC). It would seem that, since this is a high vulnerability area with a large area for care, hospital admissions for PHC care-sensitive conditions, as well as referrals for secondary services, did not decrease.
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Physicians/supply & distribution , Delivery of Health Care , Vulnerable Populations , Government Programs , Health Services Accessibility/organization & administration , Brazil , Cross-Sectional Studies
