Once-weekly hypofractionated radiotherapy for breast cancer: First results of a phase II clinical trial.

Hypofractionated radiotherapy (HF) in 15 or 16 daily fractions is well established as an alternative in early breast cancer after breast-conserving surgery. Evidences for a whole-breast treatment even shorter, in 5-10 fractions, are still scarce. Women 50 years or older, with early breast tumor (pT1-2pN0), after breast-conserving surgery were eligible to enter in this phase II trial and received whole breast once-weekly hypofractionated radiotherapy (wHF-RT) to a total dose of 30 Gy, in 5 fractions of 6 Gy. During treatment and in post-treatment follow-up the toxicity was assessed and graduated according to the "Common Terminology Criteria for Adverse Events" (CTCAE), v3.0. Breast pictures for esthetic comparison were taken in 5 timepoints and 2 breast surgeons independently graduated the cosmetics changes. The trial was registered with ClinicalTrials.gov, number NCT01965483. From October 2013 to November 2015, 44 patients were enrolled in the trial and treated according to the protocol of wHF-RT. The median age was 70.5 years (51-88 years), and the median follow-up was 22 months (9-33 months). Skin erythema was the most common acute adverse event. At the end of radiation, 30 patients (68.2%) had any grade of radiation dermatitis. Concerning cosmetic appearance, there was no significant difference between pretreatment and 1 year assessments. The 2-year overall survival and disease-free survival were, respectively 96.8% and 97.7%. There was only one distant recurrence and no local or regional recurrence. Once-weekly hypofractionated radiotherapy is a feasible and well tolerated alternative for early breast cancer adjuvant management with acceptable acute toxicity and esthetic outcomes.

How to become a breast cancer specialist in 2018: The point of view of the second cohort of the Certificate of Competence in Breast Cancer (CCB2).

Breast cancer (BC) is the most frequent cancer in women and the leading cause of cancer death in females worldwide. Rapid research advancements add to the complexity of treatment options for this disease. It is known that the quality of patients' care is deeply affected by healthcare professionals following these advancements. There is a growing need for academic education to increase clinical knowledge and skills of physicians treating BC patients. The certificate of Competence in Breast Cancer Program (CCB) is a Certificate in Advanced Studies (CAS) organized by the European School of Oncology in cooperation with Ulm University (Germany), which focuses on both the clinical and scientific competence required for improving quality in the management of BC patients. This paper describes the experience of the second CCB cohort (CCB2), which brought together 24 physicians from four continents who shared the common will to improve their competence and skills in BC treatment.

Avaliação da sobrevida das pacientes portadoras de câncer de colo uterino IIIB tratadas com radioterapia exclusiva e radioquimioterapia / Evaluation of the overall survival rates in locally advanced cervix cancer patients treated with radiotherapy alone and chemoradiation

Introdução: O câncer avançado do colo uterino é um importante problema de Saúde Pública mundial. O tratamento inclui obrigatoriamente a radioterapia. Objetivo: Avaliar a sobrevida das pacientes portadoras de câncer de colo uterino localmente avançado e identificar os fatores prognósticos relacionados à paciente e ao tratamento, para o controle local e sobrevida. Metodologia: Uma coorte retrospectiva foi realizada com 493 pacientes estádio IIIB, sendo que 232 pacientes receberam a radioterapia externa pélvica (RTE), 59,4 Gy e 24 Gy com braquiterapia de alta taxa de dose (HDR), sem quimioterapia (grupo 1); 164 pacientes receberam 54 Gy RTE e 30 Gy de HDR (grupo 2); e, 97 pacientes receberam 54 Gy RTE, 30 Gy de HDR e cisplatina 40mg/m² EV semanal (grupo 3), de janeiro de 1996 a junho de 2004, no Hospital Haroldo Juaçaba. O tempo médio de “follow-up” foi de 50 meses. O método de Kaplan-Meier foi utilizado para o cálculo de sobrevida. A regressão de Cox foi utilizada na avaliação multivariada e o nível de significância aceito foi de p =< 0,05. Resultados: O controle local global foi 41,2% e a sobrevida global 35% em 5 anos. O controle local foi 38,4% para o grupo 1; 39,6% para o grupo 2 e 50,5% para o grupo 3 (p = 0,11). A sobrevida mediana global para o grupo 1 foi de 35%; o grupo 2, 30% e, o grupo, 44% (p = 0,67). Tanto o controle local quanto a sobrevida global foram afetados pela idade, pelo acometimento parametrial e pela semana de realização da braquiterapia de alta taxa de dose (p < 0,05). Conclusão: O início da braquiterapia de alta taxa de dose posterior à quinta semana da radioterapia externa tem influência negativa na sobrevida (Hazard Ratio = 1,33 IC 95% 1,02-1,70). Os resultados foram de não inferioridade da radioterapia exclusiva.