ABSTRACT
BACKGROUND AND PURPOSE: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. RESULTS: Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. CONCLUSION: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
Subject(s)
Breast Neoplasms/radiotherapy , Axilla , Breast Neoplasms/pathology , Consensus , Female , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/prevention & control , Observer Variation , Radiography, Interventional/methods , Radiotherapy, Image-Guided/methods , Tomography, X-Ray Computed/standardsABSTRACT
Introducción: Muchas usuarias del sistema público de salud español contratan además un seguro privado para mejorar los controles ginecológicos y exploraciones rutinarias como mamografía anual. Analizamos retrospectivamente el pronóstico de estas pacientes cuando son diagnosticadas de cáncer de mama y se tratan con cirugía de intención curativa. Material y métodos: Se analizan la supervivencia global y los factores pronósticos de pacientes diagnosticadas de cáncer de mama sin metástasis tratadas con cirugía curativa en el contexto de un tratamiento multidisciplinario, remitidas a una consulta de oncología médica dentro de un sistema sanitario privado extra. Resultados: Entre 1994 y 2009 se analizaron 395 pacientes con cáncer de mama. Treinta y ocho tenían metástasis al diagnóstico y 357 pudieron tratarse con cirugía curativa: conservadora en 265 casos y mastectomía en 92. Con mediana de seguimiento de 64 meses, la tasa de supervivencia a 5 años era 91%: 97% para estadios I, 94% para estadios II, y 77% para estadios III. En las que se diagnosticaron por mamografía sistemática fue del 96 frente al 86% en las que acudieron al ginecólogo por autopalpación de tumor u otros síntomas (p = 0,0159). En el 74% se realizo ́ tratamiento conservador con mejor supervivencia frente al 26% que se realizó mastectomía (p = 0,0024). Pacientes con receptores positivos tuvieron mejor supervivencia que con receptores negativos (p = 0,0264) y este fue el único factor pronóstico independiente en el análisis multivariado de Cox. Conclusiones: Las pacientes con cáncer de mama tratadas con cirugía de intención curativa en un sistema sanitario privado tienen alta tasa de curación probablemente por tener un diagnóstico en fase precoz (AU)
Introduction: Many women enrolled in the Spanish National Health Service also take out private health insurance to improve gynecological follow-up and complementary examinations, such as annual mammograms. We analyzed the cure rate of these patients when diagnosed with breast cancer and treated with surgery with curative intent. Material and methods: Both overall survival and prognosis were analyzed in patients with breast cancer without metastases referred to a private oncology facility and treated with definitive surgery in the context of multidisciplinary treatment. Results: Between 1994 and 2009, 395 patients with breast cancer were analyzed. Thirty- eight had metastases at diagnosis and 357 could be treated with definitive surgery: conservative in 265 patients and mastectomy in the remaining 92. The median follow-up was 64 months and the 5-year survival rate was 91%: 97% for stage I, 94% for stage II and 77% for stage III. In women diagnosed by mammography, the 5-year survival rate was 96% versus 86% for women consulting a gynecologist after self palpation or for other symptoms (p = 0.0159). Treatment was conservative in 74%, with better survival than in the remaining 26% who were treated with mastectomy (p = 0.0024). Survival was greater in patients with positive hormone receptors than in those with negative hormone receptors (p = 0.0264). Hormone receptor status was the only independent prognostic factor in multivariate Cox analysis. Conclusions: Patients with breast cancer treated with definitive surgery in a private health insurance system have high cure rate, possibly because they are diagnosed in an early stage (AU)
Subject(s)
Female , Humans , Pregnancy , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Hospitals, Private/economics , Hospitals, Private , /standards , Cell Biology , Vaginal Diseases/metabolism , Vaginal Diseases/pathology , Pharmaceutical Preparations/administration & dosage , Pharmaceutical Preparations/metabolism , Breast Neoplasms/rehabilitation , Breast Neoplasms/therapy , Hospitals, Private/classification , Hospitals, Private/standards , Cell Biology/standards , Vaginal Diseases/complications , Vaginal Diseases/diagnosis , Pharmaceutical Preparations/supply & distribution , Pharmaceutical Preparations/standards , Retrospective StudiesABSTRACT
BACKGROUND AND OBJECTIVE: We intended to assess the impact of age on radiation outcome in patients treated for prostate cancer with 2D planning radiation therapy in clinical practice at the Hospital Clínic of Barcelona Radiation Oncology Department. PATIENTS AND METHOD: One hundred eighty three patients, treated from November 1993 to April 1999, were included. Median follow-up was 41.8 months and median age was 70 years old. Median dose to prostate was 70 Gy. Univariate (Kaplan-Meier with log rank test comparison) and multivariate analysis (Cox's regression models) were done to assess the effect of age on toxicity and to study prognostic factors for disease control, survival and radiation treatment toxicity. RESULTS: Five years disease free survival probability was 61.94%, with an overall survival probability of 82.83%. Although comorbidity increased significantly with age, reduced overall survival by a factor of 0.4, from 94.85% to 78.55% at 5 years. No differences were seen with regard to age in acute or late toxicity. Five years toxicity free probability was 66.46%. CONCLUSIONS: Comorbidities decrease life expectancy in prostate cancer patients treated with radiation. Age does not necessarily suppose an increased risk of late toxicity for selected patients.
Subject(s)
Prostatic Neoplasms/mortality , Prostatic Neoplasms/radiotherapy , Radiation Injuries/epidemiology , Age Distribution , Aged , Comorbidity , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Prostate-Specific Antigen/immunology , Prostatic Neoplasms/immunology , Radiotherapy/adverse effects , Radiotherapy Dosage , Survival Rate , Time FactorsABSTRACT
Fundamento y objetivo: Determinar la influencia de la edad en el momento del diagnóstico en la evolución clínica de los pacientes tratados con radioterapia en 2 dimensiones en el Hospital Clínic de Barcelona por un cáncer de próstata. Pacientes y método: Se incluyó a 183 pacientes tratados desde noviembre de 1993 hasta abril de 1999. La mediana de seguimiento fue de 41,8 meses y la mediana de la edad se situó en los 70 años. La dosis mediana administrada a la próstata fue de 70 Gy. Se realizaron análisis univariado (Kaplan-Meier, comparación mediante rangos logarítmicos) y multivariado (modelos de regresión de Cox) para valorar la influencia de la edad en la toxicidad y el estudio de factores pronóstico para el control de la enfermedad, supervivencia y toxicidad. Resultados: La supervivencia libre de enfermedad alcanzó un 61,94% a los 5 años, con una supervivencia global del 82,83%. La comorbilidad, que se incrementó significativamente con la edad, redujo la supervivencia global en un factor de 0,4, de modo que pasó del 94,85 al 78,55% a los 5 años. La probabilidad de estar libre de toxicidad a los 5 años fue del 66,46%, sin observar diferencias significativas en función de la edad. Conclusiones: La comorbilidad reduce la esperanza de vida de los pacientes tratados con radioterapia por un cáncer de próstata. La edad no incrementa necesariamente la toxicidad
Background and objective: We intended to assess the impact of age on radiation outcome in patients treated for prostate cancer with 2D planning radiation therapy in clinical practice at the Hospital Clínic of Barcelona Radiation Oncology Department. Patients and method: One hundred eighty three patients, treated from November 1993 to April 1999, were included. Median follow-up was 41.8 months and median age was 70 years old. Median dose to prostate was 70 Gy. Univariate (Kaplan-Meier with log rank test comparison) and multivariate analysis (Cox's regression models) were done to assess the effect of age on toxicity and to study prognostic factors for disease control, survival and radiation treatment toxicity. Results: Five years disease free survival probability was 61.94%, with an overall survival probability of 82.83%. Although comorbidity increased significantly with age, reduced overall survival by a factor of 0.4, from 94.85% to 78.55% at 5 years. No differences were seen with regard to age in acute or late toxicity. Five years toxicity free probability was 66.46%. Conclusions: Comorbidities decrease life expectancy in prostate cancer patients treated with radiation. Age does not necessarily suppose an increased risk of late toxicity for selected patients
