RESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Braquiterapia/instrumentação , Neoplasias Cutâneas/radioterapia , Desenho de Equipamento , Estudos RetrospectivosRESUMO
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.
Assuntos
Braquiterapia/instrumentação , Neoplasias Cutâneas/radioterapia , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Introduction. Neoadjuvant radiochemotherapy followed by radical surgery is the standard approach in advanced rectal carcinoma. Tumor response is determined in histological specimen. Objective. To assess predictive factors for survival in 115 patients. Patients and Method. 115 patients treated with neoadjuvant radiochemotherapy followed by radical surgery with total mesorectal excision, in our hospital from January 2007 to December 2014. All patients received pelvic radiotherapy with concomitant chemotherapy, followed by radical surgery and in some adjuvant chemotherapy. Results. In univariate analysis, distance to anal verge, radial margin, perineural invasion, and good grade regression are predictive factors for both, specific and disease free survival; and in multivariant, only radial margin and perineural invasion were predictive factors for survival. We found distance to anal verge (<5 cm) as the only clinical factor to predict a positive margin in the histologic specimen. Conclusions. Perineural invasion and positive radial margin are predictive factors for both specific and disease free survival (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Terapia Neoadjuvante/métodos , Quimiorradioterapia/métodos , Valor Preditivo dos Testes , Neoplasias Retais/cirurgia , Neoplasias Retais , Estudos Retrospectivos , Estimativa de Kaplan-Meier , Análise MultivariadaRESUMO
INTRODUCTION: Neoadjuvant radiochemotherapy followed by radical surgery is the standard approach in advanced rectal carcinoma. Tumor response is determined in histological specimen. OBJECTIVE: To assess predictive factors for survival in 115 patients. PATIENTS AND METHOD: 115 patients treated with neoadjuvant radiochemotherapy followed by radical surgery with total mesorectal excision, in our hospital from January 2007 to December 2014. All patients received pelvic radiotherapy with concomitant chemotherapy, followed by radical surgery and in some adjuvant chemotherapy. RESULTS: In univariate analysis, distance to anal verge, radial margin, perineural invasion, and good grade regression are predictive factors for both, specific and disease free survival; and in multivariant, only radial margin and perineural invasion were predictive factors for survival. We found distance to anal verge (<5 cm) as the only clinical factor to predict a positive margin in the histologic specimen. CONCLUSIONS: Perineural invasion and positive radial margin are predictive factors for both specific and disease free survival.
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Adenocarcinoma/mortalidade , Quimiorradioterapia Adjuvante/mortalidade , Terapia Neoadjuvante/mortalidade , Neoplasias Retais/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
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.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Diarreia/prevenção & controle , Glutamina/uso terapêutico , Neoplasias Pélvicas/complicações , Doença Aguda , Cisplatino/administração & dosagem , Diarreia/tratamento farmacológico , Diarreia/etiologia , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Neoplasias Pélvicas/terapia , Prognóstico , Estudos Prospectivos , Qualidade de VidaRESUMO
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)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Diarreia/prevenção & controle , Glutamina/uso terapêutico , Doença Aguda , Cisplatino/administração & dosagem , Diarreia/tratamento farmacológico , Diarreia/etiologia , Fluoruracila/administração & dosagem , Dose Máxima Tolerável , Estudos Prospectivos , Prognóstico , Qualidade de VidaRESUMO
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)
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Humanos , Feminino , Adulto , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/terapia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/terapia , Neoplasias Uterinas/patologia , Colo do Útero/patologia , Neoplasias Uterinas/terapia , Neoplasias UterinasRESUMO
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.
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Neoplasias da Mama/radioterapia , Feminino , Humanos , Cuidados PaliativosRESUMO
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)
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Humanos , Feminino , Neoplasias da Mama/radioterapia , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Cuidados Paliativos , Radioterapia/tendências , RadioterapiaRESUMO
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.
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Adenocarcinoma/epidemiologia , Adenocarcinoma/radioterapia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/radioterapia , Recidiva Local de Neoplasia/epidemiologia , Fatores Etários , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
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)
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Humanos , Feminino , Pessoa de Meia-Idade , Adenocarcinoma/epidemiologia , Adenocarcinoma/radioterapia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/radioterapia , Recidiva Local de Neoplasia/epidemiologia , Fatores Etários , Seguimentos , Fatores de Risco , Relação Dose-Resposta à RadiaçãoRESUMO
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.
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Recidiva Local de Neoplasia/patologia , Neoplasias Retais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Neoplasias Retais/complicações , Neoplasias Retais/mortalidade , Neoplasias Retais/terapiaRESUMO
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.