Organ preservation and oncological outcomes in early laryngeal cancer: a propensity score-based study.

BACKGROUND: The rates of laryngeal preservation according to therapeutic modality in patients with initial laryngeal squamous cell carcinoma (LSCC) are still controversial. This study evaluated the rates of laryngeal preservation in patients who underwent treatment with surgery or radiotherapy. METHODS: This retrospective cohort study evaluated 151 patients with stage I or II LSCC. Ninety-six patients were matched using a propensity-score and outcomes were compared within this group. RESULTS: Regarding overall, cancer-specific survival and larynx preservation, no differences were observed according to the therapeutic modalities, but patients who underwent radiotherapy had a higher rate of local recurrence than those who underwent surgery. Patients classified as ASA 3 or 4 and treated with radiotherapy showed a tendency of higher risk of larynx loss. CONCLUSIONS: Patients with stage I or II laryngeal tumours can be submitted to surgery or radiotherapy with similar rates of laryngeal preservation.

Partial breast irradiation: when less could be more.

Breast cancer is the most commonly diagnosed cancer in Brazilian women and the leading causing of cancer death among them. Breast-conserving surgery (BCS) followed by whole breast radiotherapy has become the standard care for early breast cancer. Although the omission of adjuvant breast radiotherapy has been associated with worse oncological outcomes, distance from treatment centers directly affects the employment of adjuvant breast irradiation. In addition to distance, patients from low- and middle-incoming countries suffers from a paucity of radiotherapy centres. It was estimated that 46.6% of the oncological patients requiring radiation therapy for a new primary cancer in 2016 did not received this treatment in the Brazilian public health system. Accelerated partial breast irradiation significantly reduces the treatment time and have the potential to overcome the logistics and social barriers related to adjuvant breast irradiation. During the lasts 30 years, 8 randomized phase III clinical trials showed that partial breast irradiation is a safe, effective, and convenient treatment for selected early breast cancer patients. At AC Camargo Cancer Center experience, for selected patients, partial breast irradiation achieved a 10 years local control of 95.6%. At Angelina Caron Hospital, a regional reference for cancer treatment in the state of Paraná, the median traveled distance from patients home to the radiotherapy department is 24 Km (11-287 Km). The implementation of partial breast irradiation, specially the intraoperative technique, could save patients a median of 1,440 traveled distance.

Detection of air gaps around the cylinder by postinsertion computed tomography in vaginal cuff brachytherapy: A prospective series, systematic review, and meta-analysis.

PURPOSE: Postinsertion computed tomography (CT) can identify air gaps (AGs) around the cylinder in vaginal cuff brachytherapy (VCB). This study investigates the incidence and location of AGs. METHODS AND MATERIALS: Planning CTs of 22 prospectively recruited patients (NCT02091050) treated with 2.6 cm (n = 8) and 3.0 cm (n = 14) cylinders were evaluated. In addition, a systematic literature review and meta-analysis was performed (PubMed and EMBASE). The pooled incidence of AGs was calculated by using the random-effects model weighted by inverse variance. RESULTS: In 18 cases (82%), a total of 45 AGs were found: 26 within the 2 cm cranial length and 19 between 2 and 4 cm of the cylinder. The mean AG diameter was 3.7 mm (range: 1.3-11.8). Cylinder diameter, primary tumor site, and use of external beam radiotherapy were not associated with AG incidence. Systematic literature review revealed nine additional relevant studies, totaling 657 patients. The pooled incidence of patients with ≥1 AG was 67% (95% confidence interval: 50-83). AGs were located at the apex in 43.4%-94.4% of cases. In patients with ≥1 AG (n = 244), the pooled mean number of AGs was 2.18 per patient. The mean dose reduction varied from 9.6% to 29.3%. CONCLUSION: More than two-thirds of VCB cases present with AGs, which are most commonly at the apex and can potentially reduce mucosal dose. By identifying AGs, postinsertion CT can facilitate selection of optimal cylinder size in VCB.

Altered-fractionation radiotherapy improves local control in early-stage glottic carcinoma: A systematic review and meta-analysis of 1762 patients.

OBJECTIVES: To perform a systematic review of 1762 patients to comprehensively assess the benefit of altered-fractionation radiotherapy (ART) in early stage glottic carcinoma (ESGC). MATERIALS AND METHODS: Studies were identified in PubMed and EMBASE. Inclusion criteria were: (1) diagnosis of squamous cell ESGC (Tis, T1, T2); (2) ART versus conventionally-fractionationated radiotherapy (CRT); and (3) provision of number of local recurrence events and total numbers per fractionation arm. The random-effects model was fitted to estimate the pooled hazard ratio (HR). Subgroup sensitivity analyses were performed based on ART strategy (hypo- versus hyperfractionation), treatment-day reductions, machine type, tumor stage, and anterior commissure involvement. RESULTS: Eleven studies met inclusion criteria: 4 randomized controlled trials (RCTs) and 7 two-arm retrospective studies. ART was associated with 38% fewer (HR 0.62; 95% CI: 0.46-0.82, p = 0.0009) and 60% fewer (HR 0.40; 95% CI: 0.24-0.66, p = 0.0003) local failure events in pooled analyses of the RCTs and retrospective studies, respectively. Both hyperfractionation (HR 0.65; 95% CI: 0.43-0.97, p = 0.03) and hypofractionation (HR 0.55; 95% CI: 0.33-0.91, p = 0.02) strategies were superior to CRT. The benefit persisted for all treatment- and tumor-related parameters, including anterior commissure involvement, with the exception of a pooled analysis of studies with predominantly T2 (<50% T1) cases (HR 0.60, 95% CI: 0.30-1.20, p = 0.15). CONCLUSION: Both hypofractionation and hyperfractionation improve local control in ESGC, including T1 tumors and for anterior commissure involvement. However, this benefit may not persist for T2 tumors, for which alternative strategies should be considered.

Short-course palliative radiation therapy leads to excellent bleeding control: A single centre retrospective study.

PURPOSE: To compare and evaluate the utility of varying hemostatic radiotherapy prescriptions for emergent palliation of bleeding tumors. MATERIALS AND METHODS: This retrospective study analyzed 112 consecutive patients treated with radiotherapy for emergent palliation of bleeding tumors at an academic institution. Study endpoints included: primary bleeding control; re-bleeding rate after initial control; treatment interruption rate; overall survival; and death within 30 days of treatment. RESULTS: The most commonly prescribed fractionations were: 20 Gy in 5 fractions, 30 Gy in 10 fractions, and 8 Gy in a single fraction. The overall primary bleeding control rate was 89%. By location, primary bleeding control rates were 89% (31/35), 80% (16/20), 88% (14/16), 93% (13/14), 100% (9/9), and 100% (6/6) for gastrointestinal, genitourinary, head and neck, thoracic, extremity, and gynecologic sites, respectively. The overall re-bleeding rate following initial bleeding control was 25%. Female patients had a significantly reduced risk of bleeding recurrence (HR 0.18 [0.04-0.79], p = 0.02). Longer fractionation regimens (>5 fractions) were not associated with a reduced incidence of re-bleeding (p = 0.65), but were associated with more treatment interruptions (p = 0.02). The 1-year overall survival rate in this population was 24%, with mortality greater in patients with poor performance status (HR 2.99 [1.36-6.58], p = 0.007). CONCLUSIONS: Regardless of prescription, palliative radiotherapy is highly effective for primary bleeding control, with both long and short regimens demonstrating equal hemostatic effect and durability in the emergent setting. Longer radiotherapy regimens (>5 fractions), however, are accompanied by increased treatment interruptions and hospital days. Therefore, shorter hemostatic regimens (<5 fractions) are preferable in this palliative setting, with respect to minimizing treatment burden for patients while achieving symptomatic relief.

Bladder (ICRU) dose point does not predict urinary acute toxicity in adjuvant isolated vaginal vault high-dose-rate brachytherapy for intermediate-risk endometrial cancer.

PURPOSE: High-dose-rate brachytherapy (HDR-BT) alone is an adjuvant treatment option for stage I intermediaterisk endometrial cancer after complete surgical resection. The aim of this study was to determine the value of the dose reported to ICRU bladder point in predicting acute urinary toxicity. Oncologic results are also presented. MATERIAL AND METHODS: One hundred twenty-six patients were treated with postoperative HDR-BT 24 Gy (4 × 6 Gy) per ICRU guidelines for dose reporting. Cox analysis was used to identify variables that affected local control. The mean bladder point dose was examined for its ability to predict acute urinary toxicity. RESULTS: Two patients (1.6%) developed grade 1 gastrointestinal toxicity and 12 patients (9.5%) developed grades 1-2 urinary toxicity. No grade 3 or greater toxicity was observed. The mean bladder point dose was 46.9% (11.256 Gy) and 49.8% (11.952 Gy) for the asymptomatic and symptomatic groups, respectively (p = 0.69). After a median follow-up of 36.8 months, the 3-year local failure and 5-year cancer-specific and overall survival rates were 2.1%, 100%, and 94.6%, respectively. No pelvic failure was seen in this cohort. Age over 60 years (p = 0.48), lymphatic invasion (p = 0.77), FIGO histological grade (p = 0.76), isthmus invasion (p = 0.68), and applicator type (cylinder × ovoid) (p = 0.82) did not significantly affect local control. CONCLUSIONS: In this retrospective study, ICRU bladder point did not correlate with urinary toxicity. Four fractions of 6 Gy HDR-BT effected satisfactory local control, with acceptable urinary and gastrointestinal toxicity.

Hearing loss and complaint in patients with head and neck cancer treated with radiotherapy.

OBJECTIVE: To investigate occurrences of hearing loss and hearing complaints among patients with head and neck tumors who underwent radiotherapy. DESIGN: Prospective case-control study. SETTING: Tertiary care hospital. PARTICIPANTS: Two hundred eighty-two participants underwent evaluation, including 141 with head and neck tumors and 141 as an age-matched control group. The controls had never undergone oncological treatment that put their hearing at risk. MAIN OUTCOME MEASURES: Results of audiological evaluation, including the Hearing Handicap Inventory for the Elderly questionnaire and pure-tone, speech, and immittance audiometry, and radiation dose received by the auditory system (based on the percentage of the external auditory canal included in the radiation field). RESULTS: We observed occurrences of hearing loss in 102 (72.3%) of the participants exposed to radiotherapy and 69 (48.9%) of the control group (P < .001). Hearing losses were mostly sensorineural and of mild degree, but those exposed to radiotherapy more frequently presented with severe and mixed-type hearing losses (P < .001). Of the participants exposed to radiotherapy, 19.1% had a severe handicap (P < .001). CONCLUSION: Patients undergoing radiotherapy in the head and neck region have a higher incidence of hearing loss and more severe hearing handicap. Trial Registration  clinicaltrials.gov Identifier: NCT01102621.

Radioterapia adjuvante no tratamento do câncer de endométrio: experiência com a associação de radio-terapia externa e braquiterapia de alta taxa de dose / Adjuvant radiation therapy for the treatment of endometrial cancer: experience with combination of external radiation therapy and high-dose rate brachytherapy

OBJETIVO: Analisar, retrospectivamente, os resultados da radioterapia externa (RT) combinada a braquiterapia de alta taxa de dose (BATD), adjuvantes à cirurgia para o carcinoma de endométrio. MATERIAIS E MÉTODOS: Avaliamos 141 pacientes tratados com RT e BATD adjuvantes à cirurgia, no período de janeiro de 1993 a janeiro de 2001. RT pélvica foi realizada com dose mediana de 45 Gy, e BATD realizada na dose mediana de 24 Gy, em quatro inserções semanais de 6 Gy. A idade mediana das pacientes foi de 63 anos e a distribuição por estádio clínico (EC) foi: EC I (FIGO), 52,4 por cento; EC II, 13,5 por cento; EC III, 29,8 por cento; EC IV, 4,3 por cento. RESULTADOS: Com seguimento mediano de 53,7 meses, a sobrevida livre de doença (SLD) em cinco anos foi: EC I, 88,0 por cento; EC II, 70,8 por cento; EC III, 55,1 por cento; EC IV, 50,0 por cento (p = 0,0003). A sobrevida global em cinco anos foi: EC I, 79,6 por cento; EC II, 74,0 por cento; EC III, 53,6 por cento; EC IV, 100,0 por cento (p = 0,0062). Fatores que influíram na SLD foram grau histológico e histologia seropapilífera. Dos 33 casos que apresentaram recidiva da doença, em 13 (9,2 por cento) esta ocorreu na pelve, vagina ou cúpula vaginal. RT + BATD do fundo vaginal permitiram o controle da doença em 90,8 por cento dos casos. CONCLUSÃO: A RT exerce papel fundamental no controle loco-regional do câncer de endométrio e permite excelentes taxas de cura nos estádios iniciais. Para os estádios mais avançados, a falha terapêutica tende a ser a distância, sugerindo a necessidade de complementação terapêutica sistêmica, com introdução de novas modalidades de tratamento, em particular a quimioterapia.