High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years—single institution experience

PurposeOur center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients.Methods/patientsWe planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold.ResultsSeventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2.ConclusionsHigh-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years-single institution experience.

PURPOSE: Our center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients. METHODS/PATIENTS: We planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold. RESULTS: Seventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2. CONCLUSIONS: High-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

Influence of incidental radiation dose in the subventricular zone on survival in patients with glioblastoma multiforme treated with surgery, radiotherapy, and temozolomide

Purpose. To determine if there is an association between the incidental radiation dose to the subventricular zone and survival in patients with glioblastoma multiforme treated with surgery, radiotherapy and temozolomide. Methods and materials. Sixty-five patients, treated between 2006 and 2015, were included in this retrospective study. The doses (75th percentile; p75) administered to the ipsilateral, contralateral and bilateral subventricular zone were compared to overall survival and progression-free survival using Cox proportional hazards models. Covariates included: age, sex, surgery, tumor location, and concomitant and adjuvant temozolomide. Results. Median progression-free survival and overall survival were 11.5 ± 9.96 and 18.8 ± 18.5 months, respectively. The p75 doses to the ipsilateral, contralateral and bilateral subventrivular zone were, respectively, 57.30, 48.8, and 52.7 Gy. Patients who received a dose ≥48.8 Gy in the contralateral subventricular zone had better progression-free survival than those who received lower doses (HR 0.46; 95% CI 0.23-0.91 P = 0.028). This association was not found for overall survival (HR 0.60; 95% CI 0.30-1.22 P = 0.16). Administration of adjuvant temozolomide was significantly associated with improved progression-free survival (HR 0.19; 95% CI 0.09-0.41 P < 0.0001) and overall survival (HR 0.11; 95% CI 0.05-0.24 P = 0.001). In the subgroup of 46 patients whose O6-methylguanine-DNA methyltransferase gene promoter status was known, the methylation had no effect on either progression-free survival (P = 0.491) or overall survival (P = 0.203). Conclusion. High-dose radiation in the contralateral subventricular zone was associated with a significant improvement in progression-free survival but not overall survival in patients treated for glioblastoma multiforme (AU)

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Influence of incidental radiation dose in the subventricular zone on survival in patients with glioblastoma multiforme treated with surgery, radiotherapy, and temozolomide.

PURPOSE: To determine if there is an association between the incidental radiation dose to the subventricular zone and survival in patients with glioblastoma multiforme treated with surgery, radiotherapy and temozolomide. METHODS AND MATERIALS: Sixty-five patients, treated between 2006 and 2015, were included in this retrospective study. The doses (75th percentile; p75) administered to the ipsilateral, contralateral and bilateral subventricular zone were compared to overall survival and progression-free survival using Cox proportional hazards models. Covariates included: age, sex, surgery, tumor location, and concomitant and adjuvant temozolomide. RESULTS: Median progression-free survival and overall survival were 11.5 ± 9.96 and 18.8 ± 18.5 months, respectively. The p75 doses to the ipsilateral, contralateral and bilateral subventrivular zone were, respectively, 57.30, 48.8, and 52.7 Gy. Patients who received a dose ≥48.8 Gy in the contralateral subventricular zone had better progression-free survival than those who received lower doses (HR 0.46; 95% CI 0.23-0.91 P = 0.028). This association was not found for overall survival (HR 0.60; 95% CI 0.30-1.22 P = 0.16). Administration of adjuvant temozolomide was significantly associated with improved progression-free survival (HR 0.19; 95% CI 0.09-0.41 P < 0.0001) and overall survival (HR 0.11; 95% CI 0.05-0.24 P = 0.001). In the subgroup of 46 patients whose O6-methylguanine-DNA methyltransferase gene promoter status was known, the methylation had no effect on either progression-free survival (P = 0.491) or overall survival (P = 0.203). CONCLUSION: High-dose radiation in the contralateral subventricular zone was associated with a significant improvement in progression-free survival but not overall survival in patients treated for glioblastoma multiforme.

Association between single-nucleotide polymorphisms in DNA double-strand break repair genes and prostate cancer aggressiveness in the Spanish population.

BACKGROUND: Novel predictors of prognosis and treatment response for prostate cancer (PCa) are required to better individualize treatment. Single-nucleotide polymorphisms (SNPs) in four genes directly (XRCC5 (X-ray repair complementing defective repair in Chinese hamster cells 5) and XRCC6 (X-ray repair complementing defective repair in Chinese hamster cells 6)) or indirectly (PARP1 and major vault protein (MVP)) involved in non-homologous end joining were examined in 494 Spanish PCa patients. METHODS: A total of 22 SNPs were genotyped in a Biotrove OpenArray NT Cycler. Clinical tumor stage, diagnostic PSA serum levels and Gleason score at diagnosis were obtained for all participants. Genotypic and allelic frequencies were determined using the web-based environment SNPator. RESULTS: (XRCC6) rs2267437 appeared as a risk factor for developing more aggressive PCa tumors. Those patients carrying the GG genotype were at higher risk of developing bigger tumors (odds ratio (OR)=2.04, 95% confidence interval (CI) 1.26-3.29, P=0.004), present higher diagnostic PSA levels (OR=2.12, 95% CI 1.19-3.78, P=0.011), higher Gleason score (OR=1.65, 95% CI 1.01-2.68, P=0.044) and D'Amico higher risk tumors (OR=2.38, 95% CI 1.24-4.58, P=0.009) than those patients carrying the CC/CG genotypes. Those patients carrying the (MVP) rs3815824 TT genotype were at higher risk of presenting higher diagnostic PSA levels (OR=4.74, 95% CI 1.40-16.07, P=0.013) than those patients carrying the CC genotype. When both SNPs were analyzed in combination, those patients carrying the risk genotypes were at higher risk of developing D'Amico higher risk tumors (OR=3.33, 95% CI 1.56-7.17, P=0.002). CONCLUSIONS: We believe that for the first time, genetic variants at XRCC6 and MVP genes are associated with risk of more aggressive disease, and would be taken into account when assessing the malignancy of PCa.

Prevention of acute radiation enteritis: efficacy and tolerance of glutamine.

PURPOSE Our primary endpoint is to determine the effect of L-glutamine Resource (Nestlé Healthcare Nutrition) in the prevention of induced enteritis after pelvic radiotherapy (RT). METHODS We observed the incidence of diarrhoea during and after pelvic radiation therapy in patients receiving L-glutamine Resource (Nestlé Healthcare Nutrition) supplementation. To assess results, patients were stratified according to prior treatment (prior surgery and/or concomitant chemotherapy, or no prior or concomitant treatment). RESULTS Incidence of diarrhoea observed is similar to published series in which glutamine is not administered. Grade 1 intestinal toxicity was observed in 4 patients (15.4%), grade 2 in 10 patients (38.4%) and grade 3 in 5 patients (19.2%). Mean dose of RT at the start of enteritis was 23.55 Gy (12-40). No grade 4 toxicity occurred and in 7 patients (27%) no toxicity was reported. No differences in toxicity incidence were observed between RT dose levels. CONCLUSIONS Administration of glutamine to patients during pelvic RT does not appear to prevent the incidence of enteritis (diarrhoea). No differences were observed between patients who underwent concomitant chemotherapy (where you would expect an increase in toxicity) and those who did not.

Prevention of acute radiation enteritis: efficacy and tolerance of glutamine

PURPOSE Our primary endpoint is to determine the effect of L-glutamine Resource (Nestlé Healthcare Nutrition) in the prevention of induced enteritis after pelvic radiotherapy (RT). METHODS We observed the incidence of diarrhoea during and after pelvic radiation therapy in patients receiving L-glutamine Resource (Nestlé Healthcare Nutrition) supplementation. To assess results, patients were stratified according to prior treatment (prior surgery and/or concomitant chemotherapy, or no prior or concomitant treatment). RESULTS Incidence of diarrhoea observed is similar to published series in which glutamine is not administered. Grade 1 intestinal toxicity was observed in 4 patients (15.4%), grade 2 in 10 patients (38.4%) and grade 3 in 5 patients (19.2%). Mean dose of RT at the start of enteritis was 23.55 Gy (12-40). No grade 4 toxicity occurred and in 7 patients (27%) no toxicity was reported. No differences in toxicity incidence were observed between RT dose levels. CONCLUSIONS Administration of glutamine to patients during pelvic RT does not appear to prevent the incidence of enteritis (diarrhoea). No differences were observed between patients who underwent concomitant chemotherapy (where you would expect an increase in toxicity) and those who did not (AU)

Neuroendocrine small cell carcinoma of the uterine cervix

Neuroendocrine small cell carcinoma of the uterine cervix (SCC) is a rare disease that mixes clinical and biological characteristics of both cervical neoplasms and neuroendocrine small cell cancer. The prognosis is poor and the optimal treatment has not yet been clarified. Multimodality treatment, with surgery and concurrent chemoradiation has recently been shown to improve local control and survival rates (AU)

Breast metastases from a floor of the mouth carcinoma

Metastases to the breast from extramammary tumours are uncommon and metastatis of floor of the mouth carcinoma to the breast is extremely rare. The clinical outcome of these patients remains dismal. We report the case of breast metastases from a floor of the mouth carcinoma successfully treated by conservative surgery and adjuvant radiotherapy with no demonstrable metastases 33 months after the initial diagnosis (AU)

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Use of radiation treatment units in breast cancer. Changes in the last 15 years.

INTRODUCTION: Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. OBJECTIVE: The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units. METHODS AND MATERIAL: From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. RESULTS: An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. CONCLUSIONS: An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in postmastectomy irradiation and palliative treatments is shown.

Use of radiation treatment units in breast cancer. Changes in the last 15 years

INTRODUCTION: Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. OBJECTIVE: The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units.METHODS AND MATERIAL: From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. RESULTS: An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. CONCLUSIONS: An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in postmastectomy irradiation and palliative treatments is shown (AU)

Risk factors of local relapse in breast cancer: the importance of age.

PURPOSE: The objective of the present analysis is to know what risk factors affect local relapse in breast cancer. METHODS AND MATERIALS: A total of 1165 patients diagnosed with early breast cancer were included. Boost dose was modulated in the presence of risk factors. Patients with one risk factor received a boost of 10 Gy, while 20 Gy was administered in those with two risk factors. RESULTS: Median follow-up was of 60 months. Mean age of patients was 56.7+/-10.8 years. Local risk factors were present in 82.8% of patients. The probability of remaining free of local recurrence at 5 and 10 years is 97.7% (CI 95%: 96.7-98.7) and 94.5% (CI 95%: 92.1-96.9). Only age showed an impact in local relapse on multivariate analysis. Patients 40 years or younger had a relative risk of local relapse of 5.27 and patients 41-50 of 3.7 with respect to patients older than 50 years. CONCLUSION: Patients 40 years or younger have a higher risk of local failure than older patients. Other risk factors such as tumour size, intraductal carcinoma or margin status could be masked by an increase of radiation dose.

Risk factors of local relapse in breast cancer: the importance of age

PURPOSE: The objective of the present analysis is to know what risk factors affect local relapse in breast cancer. METHODS AND MATERIALS: A total of 1165 patients diagnosed with early breast cancer were included. Boost dose was modulated in the presence of risk factors. Patients with one risk factor received a boost of 10 Gy, while 20 Gy was administered in those with two risk factors. RESULTS: Median follow-up was of 60 months. Mean age of patients was 56.7+/-10.8 years. Local risk factors were present in 82.8% of patients. The probability of remaining free of local recurrence at 5 and 10 years is 97.7% (CI 95%: 96.7-98.7) and 94.5% (CI 95%: 92.1-96.9). Only age showed an impact in local relapse on multivariate analysis. Patients 40 years or younger had a relative risk of local relapse of 5.27 and patients 41-50 of 3.7 with respect to patients older than 50 years. CONCLUSION: Patients 40 years or younger have a higher risk of local failure than older patients. Other risk factors such as tumour size, intraductal carcinoma or margin status could be masked by an increase of radiation dose (AU)

Atención a los efectos secundarios de la radioterapia / Management of side effects of radiotherapy

Más del 50 per cent de pacientes con cáncer precisarán tratamiento con radioterapia para el control tumoral o como terapia paliativa. Pese a ello la radioterapia y sus efectos secundarios son poco conocidos para la mayoría de los profesionales de la Atención Primaria. Los efectos secundarios pueden ser agudos o crónicos y están relacionados con la dosis y su fraccionamiento, con el tamaño del tumor y extensión, volumen de tejido normal irradiado, tratamientos concomitantes y variables individuales del paciente. El objetivo de este artículo es informar al profesional de Atención Primaria de los principales efectos secundarios y su manejo (AU)

[Rectal cancer. The effect of the clinical stage and the degree of lymphatic invasion on local recurrence and survival. An analysis of 168 patients]. / Cáncer de recto. Influencia del estadio clínico y grado de invasión ganglionar en la recidiva local y en la supervivencia. Análisis de 168 pacientes.

INTRODUCTION: Surgery is the most important therapeutic means for treatment of rectal carcinoma. Nevertheless, from stage B2, relapse rates are high and it is therefore necessary to use supplemental treatments such as radiotherapy associated or not with chemotherapy OBJECTIVE: To assess the likelihood of being free of local, local and distant disease and overall and specific survival in function of clinical stage and degree of lymph node involvement among patients diagnosed with colo-rectal adenocarcinoma treated with radical surgery and radiotherapy associated or not with chemotherapy. MATERIALS AND METHODS: Since January 1990 up to December 1997, all patients with rectal adenocarcinoma treated with radical surgery and postoperative radiotherapy, with or without chemotherapy, were prospectively included in a database which was analyzed. RESULTS: The crude actuarial survival at five years was 61.1 +/- 9.2% and specific survival 64.2 +/- 9.2%. As for stages: B (84.1 +/- 10.1%) and C (49.9 +/- 3.3%) (p < 0.001). Likewise, for N0 84.1 +/- 10.1%, for N1 62.2 +/- 13.5% and for N2 13.7 +/- 22.3% (p < 0.001). The likelihood of being in complete remission for the overall patient population was 50.2 +/- 9.2%: B (67.5 +/- 13.5%) and C (37.9 +/- 11.9%) (p < 0.001). Likewise, for N0 67.5 +/- 13.5%, for N1 47.8 +/- 13.5%, and for N2 9.9 +/- 17% (p < 0.001). CONCLUSIONS: Given the poor results obtained in stages C, particularly stage N2 and also that a better local control is obtained with good tolerance when preoperative radiotherapy is administered, we believe that in order to improve the results it is necessary to initiate preoperative radiotherapy.

[Local control and the esthetic results in the conservative treatment of breast cancer. An analysis of 397 consecutive cases]. / Control local y resultado estético en el tratamiento conservador del cáncer de mama. Análisis de 397 casos consecutivos.

Conservative therapy has been the therapy of choice for patients with breast cancer in early stage. The results of 397 patients treated with conservative therapy and radiotherapy over the breast and lymph node areas (when necessary) are analyzed. The results obtained in the different risk groups and according to the irradiation mode of the tumoral bed are compared. The likelihood of remaining local disease free at 7 years was 94.9 (95% CI: 90.7-99.1). No significant differences were observed regarding the mode of overprinting the tumoral bed: external radiotherapy or brachytherapy, regarding control and aesthetic result; also, no differences were observed between the different risk groups. The existence of a subgroup of patients with contraindication for conservative therapy is currently not demonstrated.

[Early diagnosis by opportunistic screening in cancer of the prostate. Results of a 1-year protocol. Comparison with historical data]. / Diagnóstico precoz por cribado oportunístico en cáncer de próstata. Resultados de un año de protocolo. Comparación con datos históricos.

RATIONALE: The high prevalence of Prostate Cancer (PC) and long survival of patients with advanced disease, added to the high cost of palliative treatment (hormone therapy), versus the existence of curative therapies at earlier stages, fully justify the campaigns for early diagnosis. The objective of the study was to increase the number of cases diagnosed at local stages, using an opportunistic screening methodology. METHODS: All male patients between 50-70 years of age, seen over one year in Urology and primary care in CAP-Barceloneta because of urinary symptomatology, were included in a screening program. This cohort were performed total PSA determination and digital rectal examination. When digital rectal examination was suspicious and/or PSA values higher than 4 ng/ml, they underwent echo-guided prostate biopsy. RESULTS: A total of 595 male were seen; 43.9% met the inclusion criteria; 39.4% were rated as suspicious, neoplasia being confirmed in 51% of these. Prevalence of PC in this cohort was 20.1%, half of them in local stage. CONCLUSIONS: Populational screening in PC has proven to be ineffective from a health care standpoint, as opposed to opportunistic screening. Overdiagnosis was not significant, although there were more cases diagnosed in organ-confined stages, this is, eligible for curative therapy; thus, hormone therapy and the resulting morbidity were significantly decreased; quality of life of patients under curative treatment was improved; there was a large reduction of health care costs and, although it will have to be further confirmed in large multicentre series, we believe survival was improved.