Quality of Life After Stereotactic Body Radiation therapy Versus Video-Assisted Thoracic Surgery in Early stage Non-small Cell Lung Cancer. Is there Enough Data to Make a Recommendation?

BACKGROUND AND AIM: Health reported quality of life test (HRQOLT) in oncologic patients has become a major concern. Early stage in non-small cell lung cancer has two options for treatment in fragile population: Stereotactic body radiation therapy (SBRT) and video-assisted thoracic surgery (VATS). Which option should be recommended in daily clinical practice remains a challenging question. The current review is addressing this concern. Among 1256 articles, 19 met the inclusion criteria and 2034 patients were analyzed treated either with VATS or SBRT. Eleven manuscripts in SBRT, five VATS studies, and three reviews were summarized in the present review. In fragile population, SBRT seems to be a valuable option of treatment with minor or no changes in HRQOLT. However, baseline quality of life status or geriatric assessment tools before treatment could be a good strategy to select appropriate population for undergoing SBRT or surgery. RELEVANCE FOR PATIENTS: In this paper, we present a systematic review where we compare the current evidence of two options for treatment in fragile population: SBRT and VATS.

Prognostic factors for acute toxicity in prostate cancer patients treated with high-dose hypofractionated radiotherapy

PURPOSE: To prospectively study acute genitourinary (GU) and gastrointestinal (GI) toxicity during hypofractionated radiotherapy. PATIENTS AND MATERIALS: One-hundred and seventy-one consecutive men with cT1-T3cN0cM0 prostate cancer were treated at 2.6 Gy/fraction to a total dose of 67.6 for low risk (EQD2 = 79 Gy) and 70.2 Gy for intermediate-high risk (EQD2 = 82 Gy) over 5.2-5.4 weeks (α/β 1.5). Acute toxicity was scored according to RTOG/EORTC toxicity extended criteria after completing a 22-item questionnaire (basal, weekly, at 6 months). RESULTS: Minimum and median follow-up were 36 and 54.2 months, respectively. GU toxicity grades 0, 1, 2 and 3 were found in 30.4, 37, 32 and 0.6 % of patients, respectively. The figures for grades 0, 1, 2 and 3 GI toxicity were 66, 24, 10 and 0 %. The highest degree of acute reactions was reached at 4-5 weeks. At 6 months, 15 % of patients had GU toxicity (11 % grade 1, 4 % grade 2) and 5.8 % GI toxicity (5.3 % grade 1, 0.5 % grade 2). Multivariate analysis shows that bladder volume receiving ≥65 Gy (V 65) is associated with an increased risk of GU complications (p = 0.017, HR = 1.143, 95 % CI = 1.025-1.276), while history of TURP is linked to lower risk (p = 0.002, HR = 0.310, 95 % CI 0.004-0.370). Mean rectal dose (p = 0.013, HR = 1.089, 95 % CI 1.018-1.116) and total dose (p = 0.019, HR = 0.734, 95 % CI 0.567-0.950) are significantly related to GI toxicity. CONCLUSIONS: This 5-week dose-escalation hypofractionated radiotherapy schedule that uses 3D-conformal radiotherapy without IGRT has resulted in <1 % grade 3 acute complications. Our study suggests that reducing the mean rectal dose and the bladder V 65 helps prevent acute toxicity. TURP before radiotherapy was associated with lower acute GU toxicity (AU)

Prognostic factors for acute toxicity in prostate cancer patients treated with high-dose hypofractionated radiotherapy.

PURPOSE: To prospectively study acute genitourinary (GU) and gastrointestinal (GI) toxicity during hypofractionated radiotherapy. PATIENTS AND MATERIALS: One-hundred and seventy-one consecutive men with cT1-T3cN0cM0 prostate cancer were treated at 2.6 Gy/fraction to a total dose of 67.6 for low risk (EQD2 = 79 Gy) and 70.2 Gy for intermediate-high risk (EQD2 = 82 Gy) over 5.2-5.4 weeks (α/ß 1.5). Acute toxicity was scored according to RTOG/EORTC toxicity extended criteria after completing a 22-item questionnaire (basal, weekly, at 6 months). RESULTS: Minimum and median follow-up were 36 and 54.2 months, respectively. GU toxicity grades 0, 1, 2 and 3 were found in 30.4, 37, 32 and 0.6 % of patients, respectively. The figures for grades 0, 1, 2 and 3 GI toxicity were 66, 24, 10 and 0 %. The highest degree of acute reactions was reached at 4-5 weeks. At 6 months, 15 % of patients had GU toxicity (11 % grade 1, 4 % grade 2) and 5.8 % GI toxicity (5.3 % grade 1, 0.5 % grade 2). Multivariate analysis shows that bladder volume receiving ≥65 Gy (V 65) is associated with an increased risk of GU complications (p = 0.017, HR = 1.143, 95 % CI = 1.025-1.276), while history of TURP is linked to lower risk (p = 0.002, HR = 0.310, 95 % CI 0.004-0.370). Mean rectal dose (p = 0.013, HR = 1.089, 95 % CI 1.018-1.116) and total dose (p = 0.019, HR = 0.734, 95 % CI 0.567-0.950) are significantly related to GI toxicity. CONCLUSIONS: This 5-week dose-escalation hypofractionated radiotherapy schedule that uses 3D-conformal radiotherapy without IGRT has resulted in <1 % grade 3 acute complications. Our study suggests that reducing the mean rectal dose and the bladder V 65 helps prevent acute toxicity. TURP before radiotherapy was associated with lower acute GU toxicity.

Chylothorax due to metastatic prostate carcinoma: an unusual complication

Chylothorax, the abnormal accumulation of lymphatic fluid within the pleural space, is an infrequent complication of tumours affecting the mediastinum. The development of chylothorax is extraordinary in association with prostate cancer, although it has been described before. Adequate treatment of malignant chylothorax comprises both a conservative approach, including dietary and hormonal manipulations, and mechanic intercostal drainage that have been demonstrated to be effective in the management of chylothorax of malignant origin. Radiation therapy has been used for the treatment of neoplasic chylothorax but with inconsistent results. We present a new case of chylothorax associated to prostate adenocarcinoma and review the existing evidence for its treatment (AU)

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