Disability, support and long-term social care of an elderly Spanish population, 2008-2009: an epidemiologic analysis.

BACKGROUND: Though poorly known, relationships between disability, need of help (dependency) and use of social services are crucial aspects of public health. The objective of this study was to describe the links between disability, officially assessed dependency, and social service use by an industrial population, and identify areas of inequity. METHODS: We took advantage of a door-to-door survey conducted in the Cinco Villas district, Spain, in 2008-2009, which provided data on disability, morbidity, and service use among 1216 residents aged ≥50 years, and officially assessed dependency under the 2006 Dependency Act (OAD). Using logistic regression, we combined data collected at homes/residences on 625 disability screened-positive participants, and administrative information on degree of OAD and benefits at date of visit. RESULTS: Based on 163 disabled persons, the prevalence of residential/community-care users was 13.4% overall, with 6.0% being market-provided, 2.5% supported by the 2006 Act, and 4.9% supported by other public funds. Of 111 OAD applicants, 30 had been assigned an OAD degree; in 29 cases this was the highest OAD degree, with 12 receiving direct support for residential care and 17 receiving home care. Compared to unassessed dependency, the highest OAD degree was linked to residential care (OR and 95% CI) 12.13 (3.86-38.16), declared non-professional care 10.99 (1.28-94.53), and publicly-funded, non-professional care 26.30 (3.36-205.88). In contrast, 43 persons, 58% of the severely/extremely disabled, community-dwelling sample population, 81% of whom were homebound, including 10 persons with OAD but no implemented service plan, made no use of any service, and of these, 40% lacked a non-professional carer. CONCLUSIONS: Formal service use in the Cinco Villas district attained ratios observed for established welfare systems but the publicly-funded proportion was lower. The 2006 Act had a modest, albeit significant, impact on support for non-professional carers and residential care, coexisting with a high prevalence of non-use of social services by severely disabled persons.

Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software.

PURPOSE: We measured the amount of hemoglobin at the optic nerve head of fibromyalgia (FM) patients using new colorimetric analysis software. We also investigated whether perfusion defects of the optic nerve head in patients with FM lead to tissue atrophy and corresponding retinal nerve fiber layer (RNFL) thinning measured by optical coherence tomography (OCT). METHODS: We recruited for this cross-sectional study 118 FM patients and 76 sex- and age-matched healthy controls. All subjects underwent a complete neuro-ophthalmologic examination, which also included visual field testing using the Spark strategy in an Easyfield perimeter, and OCT examinations using the Spectralis. One photograph of the optic disc was obtained using a Cirrus™ Photo 800 multi-modality imager. We analyzed fundus photographs using Laguna ONhE software, a new method that allows hemoglobin levels to be measured at the optic nerve head. We compared hemoglobin percentages in different sectors of the nerve head and RNFL thicknesses between the two groups. RESULTS: Mean hemoglobin percentages and hemoglobin content in all optic nerve head sectors calculated by the Laguna ONhE program were significantly lower in FM patients than in healthy controls, and the main differences were detected in the outer ring, which corresponds with the neuroretinal rim. However, only the differences in the superotemporal RNFL were statistically significant. Correlations between the RNFL thickness and the percentage of hemoglobin in the different sectors were weak. CONCLUSION: Optic disc perfusion was decreased in patients with FM, especially within the neuroretinal rim, without clear involvement in the RNFL.

Validación de la cordancia electroencefálica en la evaluación, pronóstico y tipología de fibromialgia / Validation of electroencephalic cordance for evaluation, prognosis and classification of fibromyalgia

Objetivo: Determinar los indicadores específicos para mejorar el diagnóstico y la evaluación de la gravedad de la fibromialgia, buscando la relación con distintos aspectos psíquicos. Material y método: En el primer estudio se comparó un grupo de 13 pacientes de fibromialgia con un grupo control de 13 individuos. En el segundo estudio se analizaron 56 pacientes antes y después del tratamiento psicoterapéutico ACT. Se calcularon los valores de intensidad de cordancia y se les evaluó mediante diversos cuestionarios psicológicos. Se obtuvieron, mediante el EEG cuantitativo, los valores de cordancia para los distintos electrodos y bandas de frecuencias, así como las correlaciones con los resultados de las pruebas psicológicas. Resultados: Los pacientes con mayor gravedad clínica mostraron valores de la cordancia prefrontal en la banda theta significativamente mayores que los enfermos menos graves. Encontramos una correlación negativa entre los valores prefrontal izquierdo y derecho de la cordancia en la banda theta (Fp1 y Fp2) y el estado global de salud (SF-36). Tras la terapia se observó una disminución significativa de la cordancia de los pacientes en varias regiones, fundamentalmente en prefrontales. Conclusión: Este estudio pone de manifiesto el interés de estudiar la cordancia como método de diagnóstico y tipificación de la fibromialgia (AU)

Objective: The main goal has been to determine specific indicators and to contribute to the diagnosis and assessment of severity of fibromyalgia, also looking for establishing its relationship with several psychological and neuropsychiatric tests. Material and method: In the first study a group of 13 patients with fibromyalgia was compared with a control group of 13 subjects. In the second study, we compared a group of 56 patients before and after Psychotherapy ACT. We calculated the intensity values of cordance and the correlations with various psychological questionnaires. The values of cordance for the different electrodes and frequency bands, as well as the correlations with the results of psychological tests, were obtained from EEG recordings. Results: Patients with clinical severity showed higher values of the prefrontal cordances in the theta band, significantly higher than less severe patients. There is also a strong negative correlation between left and right prefrontal values of concordance in the theta band (Fp1 and Fp2) and global health status (SF-36). After therapy, there was a significant decrease in the cordance of patients in several regions, particularly in the prefrontal regions. Conclusion: This study is the first step for the acceptance of cordance as a new tool for diagnostic and classification of fibromyalgia and other neuropsychiatric disorders (AU)

Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations.

PURPOSE: This paper presents a three-year teledermatology evaluation experience. The aim is to explain the methodology followed, present the evaluation results, discuss critically the issues that emerged during the experience and report the main lessons learned. METHODS: A complete design and evaluation methodology was conducted to fully address significant issues arising from other previous teledermatology experiences. First, system-design requirements and image quality issues were studied. Then, a detailed clinical concordance study was undertaken to determine the accuracy of diagnoses made using teledermatology in order to assess different dermatological clinics. Finally, an impact study on the health system was performed. Furthermore, clinical, technical, social and alignment outcomes were analyzed during the study and at the end of it, in order to understand how emerging factors affected the final setup of the teledermatology system. RESULTS: The most important results reported in this study can be summarized as follows. (1) A complete web-based environment for teledermatology support was developed as a result of a dynamic evaluation process with clinical personnel. (2) A total of 120 teleconsultations (82 pediatric and 28 adult) were made during the clinical concordance study. Concordance analysis was carried out for each dermatological disease group. High concordance rates were found in pediatrics for inflammatory dermatoses (76%) and also for adults (75%) with infections and infestations. (3) Physicians were satisfied with the teledermatology system but the time dedicated to consultation in primary care was a limiting factor (19min for each teleconsultation). (4) An extensive discussion about the successful and the limiting aspects of the teledermatology experience revealed the reasons behind the final decision not to proceed with its implementation. It was considered not to be aligned with Health Care Organization (HCO) strategy and consequently did not achieve high-level support for its long-term implementation. CONCLUSIONS: A high degree of diagnostic accuracy both for pediatric and adult consultations was achieved using the teledermatology system with affordable technical requirements. Its usefulness for filtering dermatological referrals was also demonstrated in the study. Nevertheless, other factors such as the reorganization required for the physicians' time schedule, remuneration issues, absence of EHR (electronic health record) integration and lack of interaction with the HCO were important limiting factors. This led to the conclusion that under the evaluation conditions long-term set-up was not possible. It was also concluded that HCO participation would have been essential for both the evaluation study and the long-term set-up of the system.

Cerebellar involvement in Hodgkin's lymphoma: an atypical site of relapse

The presentation of intracranial metastases from Hodgkin's lymphoma is an infrequent event that worsens clinical outcome. A case of Hodgkin's lymphoma relapse in the cerebellum is described in a 70-year-old woman with a previously treated stage IVA Hodgkin's lymphoma. Diagnostic workup and treatment strategies for central nervous system relapses are reviewed and discussed. A combination of surgery, radiotherapy and occasionally chemotherapy remains the most appropriate approach to intracranial Hodgkin's lymphoma (AU)

Consejo breve para la prevención del tabaquismo en escolares de 2º a 4º de Educación Secundaria Obligatoria de Zaragoza / No disponible

Se realizó una intervención en el ámbito escolar para administrar consejo breve antitabacoa escolares de la Educación Secundaria Obligatoria (ESO) en Zaragoza durante los cursos2006-2007 y 2007-2008. Los objetivos del estudio fueron medir la efectividad del consejobreve apoyado por material escrito y estudiar la progresión del tabaquismo. El estudióincluyó una encuesta autoadministrada y una coximetría, así como una reevaluación un añodespués.Se estudiaron 15 centros escolares, 8 del grupo intervención y 7 de control. Se administróconsejo apoyado con un folleto frente al control en el que no se utilizaba el folleto. Laasignación a los grupos no fue aleatoria.Se evaluaron 1.720 estudiantes entre los dos cursos 2006-07 y 2007-08 de los cuales51,95% fueron hombres y 48,5% mujeres. La edad media fue 14,6 años (desviación estándar[DE] = 1,36) y fueron fumadores el 19,7%. Entre las mujeres fueron fumadoras el24,7% frente al 18,3% de los hombres (p < 0,0001). No hubo diferencias significativas parael tabaquismo según grupo de intervención o control. La progresión del tabaquismo crecióun 8,8% en el grupo intervención frente a un 12% en el de control entre 2.º y 3.º. Las diferenciasfueron 3% para el grupo intervención frente al 1,1% en el de control entre 3.º y 4.º,no siendo estas diferencias estadísticamente significativas. Conclusiones: el porcentaje de fumadores en escolares de ESO es del 19,7%. La escaladade consumo se produce entre 2.º y 3.º. No se demostró una mayor efectividad del consejobreve mediante el uso de un folleto(AU)

Authors report a community school study about smoking adolescent behaviour, 8º, 9º,and 10 º year in Zaragoza (Spain). The study was implemented in the 2006-2007 and 2007-2008 courses respectively. The study’s objectives were to asses the effectiveness of smokingcounselling with the aid of a specifically designed leaflet. The study also included an evaluationof expired CO. The authors surveyed on smoking behaviour as well as on personaldetails of the students.The study includes 8 intervention schools and 7 control schools. Allocation wasn’t randomizeddue to logistic reasons. The interventional group received advice against smokingby means of spoken counsel from a professional supported by a leaflet. The control grouponly received the spoken counsel. The expired CO was assessed in each group. The counselwas repeated in each group one year later to the same students.In all 1,720 students were assessed: 51.95% men and 48.5% women. The median ageof the students was 14.6 years SD: 1.36. The authors found that 19.7% of the students weresmokers. The distribution of smokers by sex was 24.7% of women versus 15.3% of men X2= 24.1 p < 0.0001. Smoking behaviour between interventional or control group wasn’t statisticallydifferent.Conclusions: There wasn’t any evidence of effectiveness in using a leaflet added to thespoken counsel. Prevalence of smoking was very high: 19.7% among adolescents of Zaragoza.The study shows a increase of smoking between 8º and 10º(AU)

Estudio epidemiológico sobre el consumo de tabaco en adolescentes de 2º y 3º de ESO en Zaragoza / No disponible

Objetivo: analizar el consumo de tabaco en adolescentes de Zaragoza de 2.º y 3.º de laEducación Secundaria Obligatoria (ESO).Material y métodos: población diana: adolescentes de 2.° y 3.° de ESO. Ámbito: centros escolares.Consejo impartido de forma grupal por profesionales de Atención Primaria: pediatras ymédicos de familia. Marco: 14 centros escolares de la ciudad de Zaragoza. Participación voluntariay de asignación no aleatoria de los Centros. Muestra: 881 adolescentes. Actividad en elGrupo Intervención: consejo grupal apoyado con material escrito específico; folleto encuesta decinco preguntas y coximetría. Reevaluación: encuesta y coximetría un año después a los mismoscentros y en los cursos 3.° y 4.° de ESO.Resultados principales: se objetivó un porcentaje de fumadores de un 18,8% en el totalde la muestra (IC 95% 16,3%-21,6%). La media de edad de los fumadores es de 14,8 años yla de los no fumadores de 14,2 años. El consumo de las mujeres es mucho mayor que el delos hombres, 24,6% frente al 14%. El ascenso en las cifras de consumo es mayor en las mujeres,alcanzando porcentajes de un 40% a los 16 años. Un 34% de los 166 fumadores piensanno fumar el próximo año. Los centros públicos tienen unas cifras de consumo superior al delos concertados y al de los privados (13,6% tanto para centros privados como concertados, y 22,9% para los públicos), siendo estas diferencias significativas (X2=11,5; p=0,003). Sin embargo,si analizamos el caso de las mujeres de 3.° de ESO vemos que estas diferencias sonmenores y no alcanzan significación estadística. El patrón de consumo en fin de semana esmás acentuado para los hombres que para las mujeres. Cuando las lecturas de monóxido decarbono superan los valores de 5 partes por millón (ppm) la probabilidad de ser fumador esde alrededor del 80%

Objective: to evaluate the adolescent smoking habit in a whole group at school by primary health care practitioners.Target population: students of 2nd and 3rd level of High Education (Obligatory SecondaryEducation). Scenary: 14 High Schools in Zaragoza city. The recruitment was not randomisedand students have participated voluntarily. Professionals: General Pactitioners and Pediatricians.Sample: 881 students. Activities: groupal antismoking advice, leaflet, five questions inquiryand coximetry. Reevaluation: one year later inquiry and coximetry.Main results: the authors report 18.80% (CI 95% 16.3%-21.6%) of smokers in all thesample. Women smoke more than men 24.60% versus 14%. Smoking is a crescent phenomenonin young women 40% at sixteen years of age. 34% of smokers do not have the intention ofsmoking next year. Students in Public High Schools smoke more than students in Private andConcerted High Schools, 22.90% versus 13.70% (X2=11.5; p=0.003). Otherwise women behavein a similar way in both kinds of schools. Smoker students are 14.8 years old and no smokerstudents are 14.2 years old. The patern of consume of men is mainly at weekends. When coximetryis more than 5 ppm, the probability of being a smoker is 80%

Experience in management of 51 non-functioning pituitary adenomas: indications for post-operative radiotherapy.

OBJECT: The indications for additional radiotherapy (RT) after surgery for non-functioning pituitary adenoma are controversial. The goal of this retrospective study was to evaluate the outcome of surgically treated patients, with or without post- operative irradiation. METHODS: Review of cases treated for non-functioning pituitary adenoma. Fifty-one patients were identified, with a mean post-operative follow-up of 6.4+/-3.5 yr. Twenty-nine patients showed residual tumor after surgery and 22 did not. Serial endocrine, visual and radiological evaluations were made after treatment to assess the efficacy and toxicity of surgery and RT. Twenty-seven patients with residual tumor after surgery received RT (22 of them during the post-operative period and 5 after an interval of several yr: 3 because of increased tumor size and 2 with stable residual lesion); tumors in 14 of these patients decreased in size, 11 appeared to be stable on imaging and one patient showed some increase in tumor size (one patient was not followed-up). The residual tumors of the 2 non-irradiated patients remained stable after 5 and 7 yr, respectively. Twenty-two patients without residual disease after surgery (11 with post-operative irradiation, 1 with RT 5 yr after transsphenoidal surgery because of tumor recurrence, and 10 without RT) have shown no evidence of tumor regrowth on serial images. CONCLUSIONS: Radiotherapy can be avoided in patients with complete macroscopic resection and absence of residual tumor in post-operative images; they must be carefully followed using imaging techniques and, in the case of recurrence, they should be re-operated and/or irradiated.

Radioterapia paliativa en niños: presentación de un caso clínico y recuerdo de sus indicaciones / Palliative radiotherapy in children: presentation of a clinical case and recall of indications

- Propósito: conocer el papel de la radioterapia como tratamiento paliativo en la patología oncológica pediátrica.- Caso clínico: se comenta el caso de un niño de 10 años con neuroblastoma estadio IV de inicio que a pesar de sucesivos esquemas de tratamiento por progresión presentó metástasis cerebral única a los tres años del diagnóstico.- Resultados y conclusiones: revisada la literatura, se puede afirmar que la radioterapia es un tratamiento paliativo eficaz y adecuado cuando nuestro objetivo es controlar síntomas y ofrecer calidad de vida (AU)

Observación frente al tratamiento electivo en cáncer de lengua móvil con cuello clínicamente negativo: resultados de una serie de 243 pacientes / Observations about the elective treatment of mobile tongue cancer with clinically negative neck: results of a series of 243 patients

- Objetivo: determinar el valor del tratamiento electivo del cuello y el riesgo de enfermedad microscópica en pacientes sin adenopatías al diagnóstico (N0).- Material y métodos: de 318 pacientes con diagnóstico histológico de carcinoma epidermoide de lengua móvil, tratados entre 1967 y 1997, 247 presentaron un estadio N0. Características: 187 varones y 56 mujeres; edad mediana: 57 años (24-89); estadios I: 69 pacientes, II: 101 pacientes, III: 39 pacientes, IV: 11 pacientes y 23 pacientes recidivas postquirúrgicas. El tumor primario fue tratado con braquiterapia (121 pacientes), irradiación externa (17 pacientes) o combinación de ambas (105 pacientes). Las áreas ganglionares se trataron con cirugía electiva en 13 pacientes, irradiación electiva en 127 pacientes (dosis mediana: 50 Gy), y 103 pacientes fueron sometidos a observación. Análisis estadístico: test Kaplan-Meier y Log-rank para comparación de curvas de supervivencia.- Resultados: la supervivencia causa específica y el control local actuarial a 5 años fue 65,3 por ciento y 66,9 por ciento, respectivamente. El intervalo libre de enfermedad locorregional a 5 años fue del 52,1 por ciento. La tasa de recidiva ganglionar según la modalidad de tratamiento cervical fue 0 por ciento, 21,3 por ciento y 25,7 por ciento para cirugía electiva, irradiación electiva y observación, respectivamente. El control ganglionar actuarial a 5 años fue para los mismos grupos del 100 por ciento, 78,7 por ciento y 74,3 por ciento (p=NS). Para evaluar el riesgo de enfermedad microscópica, analizamos la influencia de las variables pronósticas en el subgrupo de 93 pacientes con estadios precoces sometidos a observación. La única variable identificada como factor pronóstico independiente en el análisis multivariante fue el espesor tumoral, con un control ganglionar actuarial a 5 años del 16,7 por ciento vs. 86,7 por ciento, para espesores mayores y menores de 1 cm, respectivamente (p=0,0003).- Conclusiones: dada la alta incidencia de recidiva ganglionar y la baja supervivencia en los pacientes con esta recidiva, consideramos aconsejable el tratamiento electivo del cuello en pacientes con tumores de lengua móvil (AU)

Lesión hepática indeterminada por RMN: aportación de la PET-FDG / Undetermined MRI hepatic lesion: contribution of PET-FDG

Propósito: En los pacientes oncológicos, es de extrema importancia descartar un origen secundario de las lesiones hepáticas indeterminadas por Resonancia Magnética Nuclear (RMN) mediante Tomografía por Emisión de Positrones con 18-fluoro-2-desoxi-D-glucosa (PET-FDG). La PET-FDG permite diferenciar con mayor exactitud diagnóstica la etiología de estas lesiones, así como detectar la existencia de recurrencia extrahepática.• Material y métodos: Presentamos el caso clínico de un paciente con antecedentes de melanoma y carcinoma de próstata remitido para valoración por PET-FDG de una lesión hepática indeterminada por RMN e inaccesible a PAAF.• Resultados: La PET-FDG identificó una lesión hepática hipermetabólica sugerente de malignidad, efectuándose una exéresis quirúrgica que confirmó la existencia de metástasis secundaria a melanoma.• Conclusiones: Creemos que la PET-FDG puede aportar una información diagnóstica complementaria de gran valor, colaborando en la re-estadificación de este tipo de pacientes, así como en la definición de una terapia con intención curativa o paliativa de la enfermedad. (AU)

Phase II study of radiochemotherapy with UFT and low-dose oral leucovorin in patients with unresectable rectal cancer.

PURPOSE: To determine the activity and evaluate the toxicity of uracil and tegafur in a 4:1 molar concentration (UFT) plus low-dose leucovorin administered concomitantly with pelvic irradiation in patients with unresectable or recurrent rectal cancer. METHODS AND MATERIALS: Thirty-five patients (22 with primary unresectable tumors and 13 with locally recurrent tumors) were enrolled in the trial. Thirty-five patients were evaluable for toxicity and 32 of these were evaluable for clinical response. Patients received 300 mg/m2/day UFT and 30 mg/day leucovorin on days 8-35 concomitantly with pelvic radiotherapy, to a total dose of 45 Gy. RESULTS: Eight of the 35 (23%) patients developed Grade 3 diarrhea and were treated with radiotherapy alone after this event. Of the 22 patients with unresectable primary tumors, 17 underwent surgery, and resection was feasible in 15 cases (88%). Of the 32 patients evaluable for clinical response, 4 (13%) had a complete clinical response (CR) and 22 (69%) a partial response (PR). A complete pathologic response was observed in 3 cases (18%) and, a PR in 11 cases (65%). CONCLUSION: The response rates achieved with this schedule seem comparable to those obtained with 5-FU and radiotherapy. These results warrant further evaluation of this combination in patients with unresectable or locally advanced tumors.

The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing's disease.

BACKGROUND: Irradiation of the pituitary is widely considered the most appropriate treatment for patients with Cushing's disease in whom transsphenoidal microsurgery has been unsuccessful. However, there is little information about the long-term efficacy of this treatment. METHODS: We used external pituitary radiation to treat 30 adult patients with persistent or recurrent Cushing's disease after unsuccessful transsphenoidal surgery. The mean (+/-SD) dose of radiation was 50+/-1 Gy. Pituitary and adrenal function was assessed every six months after radiation therapy. Remission was defined as the regression of symptoms and signs of Cushing's syndrome, normal urinary cortisol excretion, and a low plasma cortisol concentration in the morning after the administration of 1 mg of dexamethasone at midnight. RESULTS: Twenty-five patients (83 percent) had remissions during a median follow-up of 42 months (range, 18 to 114). The remissions began 6 to 60 months after radiation therapy, but in most cases (22 patients) remission occurred during the first 2 years. None of the 25 patients had a relapse of Cushing's disease after remission was achieved. There was no relation between the response to radiotherapy and sex, age, urinary cortisol excretion before radiotherapy, the interval between surgery and radiotherapy, whether a pituitary adenoma was found by pathological examination, or tumor size. Seventeen patients had a deficiency of growth hormone after radiation therapy, 10 had a deficiency of gonadotropins, 4 had a deficiency of thyrotropin, and 1 had a deficiency of corticotropin. CONCLUSIONS: Pituitary irradiation is an effective and well-tolerated treatment for patients with Cushing's disease in whom transsphenoidal surgery is unsuccessful.

Salvage brachytherapy and salvage surgery for recurrent oropharyngeal carcinoma following radiotherapy.

We reviewed 21 patients who underwent salvage treatment after a biopsy of proven locally recurrent carcinoma of the oropharynx. Two of these patients underwent a second salvage treatment after failure of the first. Treatment was performed with Ir192 interstitial implant in 17 cases (13 rT1 and 4 rT2); by surgery in five cases (3 rT1, 1 rT2, 1 rTx), including two patients who had relapsed after salvage treatment with Ir192 implant; and by hyperfractionated external beam irradiation plus concomitant Tegafur chemotherapy in one case (rT3). The primary tumour was controlled in four of the 17 cases (23 per cent) treated with Ir192 implant. Of these four patients, two remained disease-free 42 and 59 months after treatment, one died of nodal metastases eight months after treatment and another of distant metastases 19 months after treatment. Four of the five cases (80 per cent) treated with surgery, including two patients who relapsed after salvage brachytherapy, remained free from local, regional and distant relapse 21, 25, 31 and 56 months after treatment.

Influence of boost technique (external beam radiotherapy or brachytherapy) on the outcome of patients with carcinoma of the base of the tongue.

We reviewed 90 patients with squamous cell carcinoma of the base of the tongue. Fifty-three patients were treated with external beam radiotherapy alone (3 T1, 11 T2, 21 T3, and 18 T4 tumors) and thirty-seven patients were treated with external beam radiotherapy plus brachytherapy boost (4 T1, 15 T2, 11 T3, and 7 T4 tumors). For patients with T1, T2 and T3 primaries, the actuarial 3-year local relapse-free survival was 42% following external beam radiotherapy alone and 67% following external beam radiotherapy plus brachytherapy (p < 0.05). The actuarial 3-year cause specific survival for these T-stages was 37% for patients treated with external beam radiotherapy alone and 53% for patients treated with external beam radiotherapy plus brachytherapy (p = 0.1). In the Cox multivariate analyses restricted patients with T1, T2 and T3 staged tumors, treatment modality was the only predictor for local control but no influence on specific survival was found. The trend towards significant differences in specific survival found in the univariate comparison of both treatment modalities was probably due to the significantly higher number of N-positive patients treated with external beam radiotherapy alone. When all stages were included in the Cox analysis, low hemoglobin level, invasion of deep muscle, number of palpable nodes, and history of weight loss significantly influenced the outcome. Soft tissue necrosis occurred more frequently in patients treated with external beam radiotherapy plus brachytherapy (33% vs. 10%, p = 0.52).

Episcleral iridium-192 wire therapy for choroidal melanomas.

PURPOSE: To evaluate the effectivity of high-dose episcleral iridium-192 wires in the treatment of choroidal melanoma. METHODS AND MATERIALS: In 1983, the Departments of Radiation Oncology and Ophthalmology at the Clínica Puerta de Hierro, Madrid, Spain, initiated a clinical study using removable episcleral iridium-192 wires in the treatment of choroidal melanoma. Sixty-six evaluable patients were treated from January 1983 through July 1992. Two patients had a small sized tumor (3%), 28 had a medium sized tumor (42%), and 36 patients had a large tumor (54%). The mean follow-up was 40 months (6-118 months). The dose to the apex of the tumor ranged from 66 to 97 Gy (mean 76.6 Gy), and the doses at 2 mm depth ranged from 77 to 433 Gy (mean 200 Gy). RESULTS: Tumor regression or stabilization was observed in 53 of the 66 patients (90%). Visual acuity improved following treatment in 5 out of 54 patients (9%), remaining unchanged in 30 out of 54 (56%), and decreased in 19 out of 54 (35%) patients. The remaining seven patients had undergone enucleation. Late complications have been documented in 20 out of 66 patients (30%), including 6 patients in whom enucleation was required because of radiation-related complications. The probability of survival and survival free of local progression was 93% at 5 years and 79% at 10 years. The probability of retaining the treated eye is 82% after the fifth year posttreatment. CONCLUSIONS: Treatment of choroidal melanomas with episcleral iridium-192 wires is as effective as treatment with other radioactive applications. We feel that our results using iridium-192 wires are comparable to the other methods. However, we think that our technique is simple to implement, relatively inexpensive, and well tolerated.

Medulloblastoma in adulthood: prognostic factors influencing survival and recurrence.

Thirty adult patients presenting with medulloblastoma between 1974 and 1991 were studied and treated at Puerta de Hierro Clinic. After diagnosis, all patients were treated by surgery followed by radiotherapy and eight of them received adjuvant chemotherapy. We have studied the influence of some factors such as age, sex, location of tumour in the cerebellum, amount of surgical resection and histological variants on survival and recurrence of the disease. Only the histological type has a statistically significant influence on survival and recurrence: we have found that patients presenting classic medulloblastoma have a long survival and a long relapse-free interval.

Prognostic factors for local control, regional control and survival in oropharyngeal squamous cell carcinoma.

We have performed univariate and multivariate analysis to identify the clinical and treatment-related prognostic factors in a series of 254 patients with newly diagnosed, histologically proven, oropharyngeal squamous cell carcinoma treated with radical radiation therapy. The probabilities of local control, regional control, disease-free survival (DFS) and adjusted survival (AS) were calculated using the Kaplan-Meier method and differences between curves were evaluated by the Mantel-Cox test. The obtained significant variables in the univariate analysis were analysed using the Cox proportional hazards model. In the Cox multivariate analysis, four variables significantly influenced local control probability in the following order: tumour diameter, N stage, alcohol intake and weight loss. N stage significantly influenced the probability of regional control. Five variables influenced both DFS and AS: N stage, tumour diameter, weight loss, alcohol intake and tumour origin within the posterior oropharyngeal wall.