ABSTRACT
PURPOSE: Quality of Life in Adult Cancer Survivors (QLACS) scale is one of the most commonly used and validated measures to assess the Health-Related Quality of Life (HRQoL) in this population. However, there are some aspects related to its structure that still deserve consideration. The aim of this study was to test the substantive improvement over the original QLACS structure resulting from several proposals reflected in the literature. METHOD: Using a cross-sectional design and Confirmatory Factorial Analysis, we explored those proposals. Reliability, convergent validity, and factor invariance across three cancer survivorships phases (re-entry, early, and long term) were also analyzed. 1.862 post-treatment survivors of diverse cancer types completed the Spanish versions of QLACS, Brief Symptom Inventory-18 (BSI-18), and Subjective Happiness Scale (SHS). RESULTS: The original model with twelve domains, grouped (with the exception of benefits) into a single total score, versus two subtotal (Generic and Cancer-specific) obtained a good fit. The values of Cronbach's alpha, Composite reliability, Average Variance Extracted indexes, and Pearson correlations supported the internal consistency and temporal stability (interval of 2-3 weeks) of the QLACS. Results also showed its adequate convergent validity and an invariant factor structure across survival periods (re-entry survivorship, early survivorship, long-term survivorship). CONCLUSION: In its original structure, albeit the replacement of the scores on the two subscales by a total score, our results support QLACS as a valid and useful tool for the assessment of HRQoL in post-treatment cancer survivors throughout the different survival phases.
Subject(s)
Cancer Survivors , Neoplasms , Adult , Cross-Sectional Studies , Humans , Psychometrics/methods , Quality of Life/psychology , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
Objetivo. La recaída local en el carcinoma de mama precoz puede quedar limitada a la zona próxima al tumor, por lo que puede no ser necesario irradiar la mama entera (WBI), que es, actualmente, el tratamiento conservador estándar. Métodos. Se ha revisado la literatura buscando los trabajos aleatorizados de las distintas modalidades de irradiación parcial acelerada para una puesta al día. Resultados. La irradiación intraoperatoria en sesión única ha dado resultados inadecuados con electrones (estudio ELIOT) por una selección inapropiada de los pacientes. El estudio TARGIT con Rx de 50kV en sesión única añadiendo WBI cuando se demuestran factores de riesgo resulta eficaz cuando se administra durante la primera cirugía conservadora, y no en un segundo tiempo. Los sistemas intracavitarios con balón o similar dan buenos resultados a corto plazo, pero se debe tratar de usar múltiples canales para reducir las complicaciones. Las técnicas de irradiación parcial con radioterapia externa 3D pueden aumentar ligeramente las complicaciones locales, no así la radioterapia de intensidad modulada, y en ambos casos resultan eficaces, pero debe esperarse más tiempo y un mayor número de pacientes para confirmarse. La braquiterapia intersticial con multicatéter se ha demostrado igual de eficaz que la WBI y con menos complicaciones. Conclusiones. Hay pacientes con cáncer de mama de bajo riesgo que no requieren WBI. La irradiación parcial acelerada es equivalente, especialmente con técnica intersticial multicatéter, y probablemente con otras técnicas que requieren más seguimiento, con menor dosis de irradiación a pulmón y corazón, por lo que debe ofrecerse como alternativa a la WBI en casos seleccionados (AU)
Objective. Local relapse in early breast carcinoma may be limited to the area around the tumour. Consequently, whole breast irradiation (WBI), which is currently the standard conservative treatment, may not be required. Methods. We reviewed the literature through a search for randomized trials of the different types of accelerated partial breast irradiation in order to provide an update. Results. Intraoperative irradiation with electrons in a single session (ELIOT study) provided suboptimal results due to improper patient selection. The TARGIT trial reported that 50kV x-rays in a single session, with the addition of WBI in patients with risk factors, was effective when administered during the first conservative surgery, rather than in a second intervention. Intracavitary balloon or similar systems offer good short-term results but attempts should be made to use multiple channels to reduce complications. Partial irradiation techniques with 3D-external beam radiation therapy, except for intensity-modulated radiotherapy, may slightly increase local complications. Both are effective, but this finding requires confirmation in studies with a longer follow-up and more patients. Multicatheter interstitial brachytherapy has been demonstrated to be as effective as WBI and has fewer complications. Conclusions. Some patients with low-risk breast cancer do not require WBI. Accelerated partial breast irradiation is equivalent, especially with the multicatheter interstitial technique, and probably with other techniques requiring more follow-up, and delivers a lower radiation dose to the lung and heart. Accelerated partial breast irradiation should be offered as an alternative to WBI in selected patients (AU)
Subject(s)
Humans , Female , Middle Aged , Aged , Breast Neoplasms , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Radiotherapy/methods , Risk Factors , Brachytherapy/methods , Risk Groups , Carcinoma in Situ/radiotherapyABSTRACT
Glioblastoma (GB) represents the most aggressive glioma in the adult population. Despite recent research efforts, the prognosis of patients with GB has remained dismal. Lately, the knowledge of genetic information about gliomagenesis has increased; we even have a classification of the genetic expression of the tumour. The main problem is that at the moment we do not have any therapeutical resources to help us better treat these tumours, as we can do, with others tumours like breast, lung and colorectal cancer. We have also improved on diagnostic imaging, especially with the new MRI sequences; we can now better define the characteristics of the tumour area and the surrounding brain structures, allowing us to adjust resections. Thanks to the most advanced surgery techniques, such as neuronavigation, intraoperative control of the nervous function and the tumour volume, the neurosurgeon is able to complete tumour exeresis with less morbidity. These imaging techniques allow the radiation oncologist to better contour the irradiation target volume, the structures and the organs at risk, to diminish the irradiation of apparently healthy tissue. Nowadays, knowledge of brain stem cells provides new expectations for future treatments. Novel targeted agents such as bevacizumab, imatinib, erlotinib, temsirolimus, immunotherapy, cilengitide, talampanel, etc. are helping classical chemotherapeutic agents, like temozolomide, to achieve an increase in overall survival. The main objective is to improve median overall survival, which is currently between 9 and 12 months, with a good quality of life, measured by the ability to carry out daily life activities.
Subject(s)
Brain Neoplasms/diagnosis , Brain Neoplasms/therapy , Glioblastoma/diagnosis , Glioblastoma/therapy , Adult , Aged , Antineoplastic Agents/therapeutic use , Brain Neoplasms/genetics , Combined Modality Therapy , Glioblastoma/genetics , Humans , Neurosurgical Procedures/methods , Radiotherapy/methodsABSTRACT
INTRODUCTION: We evaluated the effectiveness of interstitial high dose rate brachytherapy as a single fraction boost to the surgical bed in patients with breast cancer undergoing conservative treatment. The comparison was with the alternative of electron boost. MATERIALS AND METHODS: Between April 1999 and December 2000, we conducted a prospective study of 84 patients with infiltrative breast carcinoma treated with conservative surgery, with free margins. This was followed by external radiotherapy to the breast of up to 46 Gy and one application of brachytherapy with needles inserted into the surgical bed, and administering 7 Gy to 90% with high dose rate (HDR). RESULTS: With a mean follow-up of 43 months, only one patient had therapeutic failure in the implant area, and local control was 98.5%. Another patient had a 2nd tumour in a different quadrant and 3 developed metastasis. Survival at 5 years was 98.7%. Acute toxicity was minimal, with excellent or good cosmetic appearance in 95%. CONCLUSIONS: Brachytherapy with high dose rate as single fraction boost in conservative treatment of breast carcinoma is simple, fast, well tolerated, with excellent local control, good cosmetic appearance, and with minimal late-onset toxicity.
Subject(s)
Brachytherapy/methods , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Mastectomy, Segmental/methods , Adult , Aged , Aged, 80 and over , Breast Neoplasms/mortality , Disease-Free Survival , Female , Humans , Middle Aged , Neoplasm Staging , Prospective Studies , Radiotherapy DosageABSTRACT
Introducción. Evaluamos la eficacia de la sobreimpresión del lecho quirúrgico con braquiterapia intersticial de alta tasa de dosis, en fracción única en pacientes con cáncer de mama, tratadas con tratamiento conservador, como alternativa a la sobreimpresión con electrones. Material y métodos. Entre abril de 1999 y diciembre de 2000, hemos realizado un estudio prospectivo sobre 84 pacientes con carcinoma infiltrante de mama sometidas a cirugía conservadora, con márgenes libres, seguida de radioterapia externa sobre la mama hasta 46 Gy y una aplicación de braquiterapia con agujas en el lecho quirúrgico, dando 7 Gy al 90% con alta tasa. Resultados. Con un seguimiento medio de 43 meses, sólo una paciente ha recaído en zona de implante siendo el control local del 98,5%. Otra paciente presentó un segundo tumor en un cuadrante distinto y tres desarrollaron metástasis. La supervivencia a 5 años es del 98,7%. La toxicidad aguda ha sido mínima, con estética excelente o buena en el 95%. Conclusiones. La braquiterapia con alta tasa en fracción única, como sobreimpresión en el tratamiento conservador del cáncer de mama, es bien tolerada, sencilla y rápida, consiguiendo un control local excelente, con buen resultado estético y una mínima toxicidad tardía
Introduction. We evaluated the effectiveness of interstitial high dose rate brachytherapy as a single fraction boost to the surgical bed in patients with breast cancer undergoing conservative treatment. The comparison was with the alternative of electron boost. Materials and methods. Between April 1999 and December 2000, we conducted a prospective study of 84 patients with infiltrative breast carcinoma treated with conservative surgery, with free margins. This was followed by external radiotherapy to the breast of up to 46 Gy and one application of brachytherapy with needles inserted into the surgical bed, and administering 7 Gy to 90% with high dose rate (HDR). Results. With a mean follow-up of 43 months, only one patient had therapeutic failure in the implant area, and local control was 98.5%. Another patient had a 2nd tumour in a different quadrant and 3 developed metastasis. Survival at 5 years was 98.7%. Acute toxicity was minimal, with excellent or good cosmetic appearance in 95%. Conclusions. Brachytherapy with high dose rate as single fraction boost in conservative treatment of breast carcinoma is simple, fast, well tolerated, with excellent local control, good cosmetic appearance, and with minimal late-onset toxicity