Synchronous bilateral breast cancer treated with a 3-week hypofractionated radiotherapy schedule: clinical and dosimetric outcomes

Background and purpose Synchronous bilateral breast cancer (SBBC) accounts for 1–3.5% of breast cancer patients. The aim of this study was to evaluate dosimetric issues, clinical outcomes, and acute toxicities for SBBC patients receiving synchronous bilateral hypofractionated radiotherapy (SBHRT) and to compare them with patients treated with synchronous bilateral normofractionated RT schedule (SBNRT). Materials and methods From April 2016 to March 2020, 39 SBBC patients were referred to our institution. Patients were divided according to their prescription dose: Group A: 50 Gy/25fx (fractions), B: 60–64 Gy/25fx, C: 40.05 Gy/15fx; D: 48 Gy/15fx. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE)v.5.0. Results 34 patients were finally evaluated. Median follow-up was 24 months for NF schedule and 9 months for HF schedule. In the HF schedule, no acute side-effects > G2 were observed and no dermatitis was reported in 6th month´s assessments. 95% of patients have no evidence of disease and only 1 patient presented local relapse in the first mammography after RT. No distant failures or deaths were observed. Regarding dosimetric issues, the inter-patient average Dmean for the heart was: Group A: 5.0 Gy (4.6–5.5), Group B: 4.4 Gy (4.1–5.4), Group C: 4.8 Gy (4.5–5.1) and Group D: 5.3 Gy (4.4–5.6). For the lungs, the inter-patient average Dmean was: Group A: 10.8 Gy (9.8–12.2), Group B: 11.5 Gy (11.3–12), Group C: 9.8 Gy (9.3–10.5) and Group D: 10.5 Gy (10–11.3). Conclusions This is the first study reporting the safety, feasibility, and tolerability of 40.05 Gy/15fx over 3 weeks for the treatment of SBBC patients. Further study with larger accrual is mandatory (AU)

Synchronous bilateral breast cancer treated with a 3-week hypofractionated radiotherapy schedule: clinical and dosimetric outcomes.

BACKGROUND AND PURPOSE: Synchronous bilateral breast cancer (SBBC) accounts for 1-3.5% of breast cancer patients. The aim of this study was to evaluate dosimetric issues, clinical outcomes, and acute toxicities for SBBC patients receiving synchronous bilateral hypofractionated radiotherapy (SBHRT) and to compare them with patients treated with synchronous bilateral normofractionated RT schedule (SBNRT). MATERIALS AND METHODS: From April 2016 to March 2020, 39 SBBC patients were referred to our institution. Patients were divided according to their prescription dose: Group A: 50 Gy/25fx (fractions), B: 60-64 Gy/25fx, C: 40.05 Gy/15fx; D: 48 Gy/15fx. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE)v.5.0. RESULTS: 34 patients were finally evaluated. Median follow-up was 24 months for NF schedule and 9 months for HF schedule. In the HF schedule, no acute side-effects > G2 were observed and no dermatitis was reported in 6th month´s assessments. 95% of patients have no evidence of disease and only 1 patient presented local relapse in the first mammography after RT. No distant failures or deaths were observed. Regarding dosimetric issues, the inter-patient average Dmean for the heart was: Group A: 5.0 Gy (4.6-5.5), Group B: 4.4 Gy (4.1-5.4), Group C: 4.8 Gy (4.5-5.1) and Group D: 5.3 Gy (4.4-5.6). For the lungs, the inter-patient average Dmean was: Group A: 10.8 Gy (9.8-12.2), Group B: 11.5 Gy (11.3-12), Group C: 9.8 Gy (9.3-10.5) and Group D: 10.5 Gy (10-11.3). CONCLUSIONS: This is the first study reporting the safety, feasibility, and tolerability of 40.05 Gy/15fx over 3 weeks for the treatment of SBBC patients. Further study with larger accrual is mandatory.

Effectiveness of fentanyl pectin nasal citrate in controlling episodes of breakthrough cancer pain triggered by routine radiotherapy procedures.

PURPOSE: The aim of the study was to evaluate the effectiveness of fentanyl pectin nasal spray (FPNS) in controlling procedural breakthrough cancer pain (BTCP) in advanced cancer patients undergoing radiotherapy. MATERIALS AND METHODS: This study involved 62 advanced cancer patients, with well-controlled background pain, who presented BTCP associated to routine radiotherapy procedures, treated with FPNS according to our protocol of administration. The BPE intensity was measured using a visual analog scale (VAS). RESULTS: The BTCP was triggered during the computed tomography simulation (79.3%) or treatment delivery (20.7%). Patients indicated a mean VAS of 8.8 (range 7-10) when attempting the procedure. After 4.5 min (range 2-10) of the first FPNS dose, the majority of patients (85.5%) indicated a VAS of 4.3 (range 2-6). 15.5% of the patients did not respond after 15 min; requiring a second dose. All these patients responded, reporting a mean VAS of 4.2 (range 4-6) after 3.0 min (range 2-5) of the second dose. None of the patients required a third dose, nor reported an AE after the administration of FPNS. CONCLUSIONS: In our knowledge, our study is the one of highest recruitment, and with the fastest response of BTCP treated with FPNS reported in advanced cancer patients undergoing radiotherapy. FPNS has proven to be highly effective in reducing the intensity of procedural BTCP in a very short period of time.

Nodal FDG-PET/CT uptake influences outcome and relapse location among esophageal cancer patients submitted to chemotherapy or radiochemotherapy.

PURPOSE: Our aim was investigate whether lymph node uptake is associated with survival and regional relapses, and relapse patterns with respect to the radiotherapy fields in esophageal cancer (EC). MATERIALS AND METHODS: The FDG-PET/CT image datasets of 56 patients were analyzed. All patients underwent definitive or neoadjuvant radio/chemotherapy (RCT). All patients suffering from persistent or recurrent local/regional-only disease after RCT were considered for salvage resection. Patients with adenocarcinoma without metastatic disease were considered for planned resection (usually within 3 months of treatment). RESULTS: Patients with PET-positive lymph nodes before treatment had a worse overall survival and a shorter disease-free survival than those without PET-positive nodes. They also had worse node and metastatic relapse-free survival. N2 patients had statistically significant poorer outcomes than N1-N0 patients and a better survival if the involved nodes were closer to the esophageal tumor. Involved node location by PET/CT also affected global, nodal and metastatic relapses. In addition, an increment of SUVmax value increased relative risk of death and increased relative risk of node and metastatic relapses. The first site of relapse was metastatic recurrence and, second, local recurrence. The most frequent were "in-field" loco/regional recurrence. We observed a relationship between patients classified-N1 and out-field nodal recurrence (p = 0.024), and between patients-N2 and in-field nodal recurrence. The number of PET-positive nodes was an independent significant prognostic predictor for relapse (p < 0.001). CONCLUSION: Our study shows that only FDG-PET/CT can provide prognostic information in EC. Nodal PET/CT uptake influences outcome and relapse location among EC patients.

Radiotherapy volume delineation using 18F-FDG-PET/CT modifies gross node volume in patients with oesophageal cancer

Purpose: Evidence supporting the use of 18F-FDG-PET/CT in the segmentation process of oesophageal cancer for radiotherapy planning is limited. Our aim was to compare the volumes and tumour lengths defined by fused PET/CT vs. CT simulation. Materials and methods: Twenty-nine patients were analyzed. All patients underwent a single PET/CT simulation scan. Two separate GTVs were defined: one based on CT data alone and another based on fused PET/CT data. Volume sizes for both data sets were compared and the spatial overlap was assessed by the Dice similarity coefficient (DSC). Results: The gross tumour volume (GTVtumour) and maximum tumour diameter were greater by PET/CT, and length of primary tumour was greater by CT, but differences were not statistically significant. However, the gross node volume (GTVnode) was significantly greater by PET/CT. The DSC analysis showed excellent agreement for GTVtumour, 0.72, but was very low for GTVnode, 0.25. Conclusions: Our study shows that the volume definition by PET/CT and CT data differs. CT simulation, without taking into account PET/CT information, might leave cancer-involved nodes out of the radiotherapy-delineated volumes

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Radiotherapy volume delineation using 18F-FDG-PET/CT modifies gross node volume in patients with oesophageal cancer.

PURPOSE: Evidence supporting the use of 18F-FDG-PET/CT in the segmentation process of oesophageal cancer for radiotherapy planning is limited. Our aim was to compare the volumes and tumour lengths defined by fused PET/CT vs. CT simulation. MATERIALS AND METHODS: Twenty-nine patients were analyzed. All patients underwent a single PET/CT simulation scan. Two separate GTVs were defined: one based on CT data alone and another based on fused PET/CT data. Volume sizes for both data sets were compared and the spatial overlap was assessed by the Dice similarity coefficient (DSC). RESULTS: The gross tumour volume (GTVtumour) and maximum tumour diameter were greater by PET/CT, and length of primary tumour was greater by CT, but differences were not statistically significant. However, the gross node volume (GTVnode) was significantly greater by PET/CT. The DSC analysis showed excellent agreement for GTVtumour, 0.72, but was very low for GTVnode, 0.25. CONCLUSIONS: Our study shows that the volume definition by PET/CT and CT data differs. CT simulation, without taking into account PET/CT information, might leave cancer-involved nodes out of the radiotherapy-delineated volumes.

Human prostasomes express CD48 and interfere with NK cell function.

Prostasomes are small vesicles secreted by the prostate gland to the seminal fluid. In male fertility, the fusion of prostasomes to sperm has been associated with an enhancement of sperm function. Prostasomes also contribute to sperm protection within the female reproductive tract and immunologically relevant proteins have been identified on the prostasomal membrane that may prevent immune-mediated destruction of the sperm.The female genital tract is a potentially hostile environment for spermatozoa and a large number of NK cells have been found in the female reproductive tract. Since it has been suggested that NK cells may represent an important component of innate immunity in the female reproductive tract, we have analyzed the role of prostasomes in the regulation of NK cell activity.Flow cytometric analysis revealed that prostasomes expressed high levels of CD48, the ligand for the activating receptor CD244. The interactions between NK cells and purified prostasomes resulted in a decrease of CD244 expression. Moreover, the decreased NK cell activity observed in NK cells cultured in the presence of prostasomes suggests that prostasomes may immunomodulate the local environment within the female reproductive tract preventing immune-mediated sperm destruction and prolonging their survival rate.

[Program of sanitary education for people with autistic spectrum disorder]. / Programa de educación sanitaria para personas con trastornos del espectro autista.

INTRODUCTION: Autism is a developmental disorder that it is characterized by a qualitative alteration of social interaction, communication and repetitive and stereotyped behaviours, interests and activities. Recent studies about health are showing that people with autism have lower hope of life. Among other causes, difficulty to identify and to communicate uneasiness and resistance to allow medical explorations are important factors to consider. AIMS: To design and to implant a specific program for people with Autistic Spectrum Disorder (ASD) with the objective of habituating them to the medical explorations so that they admit it and collaborate, facilitating the sanitary personnel's work. Our aim was to evaluate the effectiveness of the program and the maintenance of the potentials improvements. METHOD: Our sample was formed by twenty-two children with ASD (mean chronological age, 9;10 years). A quasi-experimental design of interrupted temporary series was carried out. VARIABLES: two grouping variables (clinical characteristics of the groups about QI and about linguistic abilities) as dependent variable a measure of percentage of success has been used through an observation protocol designed for this program. RESULTS: Improvements in all the groups. Results are not conditioned neither for the level of intellectual abilities (IQ) neither for the existence or not of linguistic abilities. Likewise, it is found that carrying out maintenance sessions in period of seven weeks allows to maintain long term achievements reached by the program. However, we found that those children which were severely impaired could obtain more benefit from more frequent maintenance sessions.

Programa de educación sanitaria para personas con trastornos del espectro autista / Program of sanitary education for people with autistic spectrum disorder

Introducción: El autismo es un trastorno del desarrollo que se caracteriza por la presencia de una alteración cualitativa de la interacción social, de la comunicación y por patrones de comportamiento, intereses y actividades restringidos, repetitivos y estereotipados. Los escasos estudios sobre salud apuntan que estos pacientes pueden tener una esperanza de vida inferior a la población normal. Entre otras causas, la dificultad para identificar y comunicar malestar y la resistencia a permitir exploraciones médicas son factores que hay que considerar. Objetivo: Diseñar e implantar un programa específico para personas con trastorno del espectro autista (TEA) con el objetivo de habituarles a las exploraciones médicas para que las permitan y colaboren, facilitando el trabajo del personal sanitario. El objetivo es evaluar la eficacia del programa y el mantenimiento de las potenciales mejoras. Método: La muestra está compuesta por 22 niños con TEA (edad media, 9; 10 años). Se ha realizado un diseño cuasi-experimental de series temporales interrumpidas. Las variables utilizadas son: dos variables agrupadoras (características clínicas de los grupos en función del cociente intelectual y de las habilidades lingüísticas), y como variable dependiente se ha utilizado una medida de porcentaje de éxito a través de un protocolo de observación diseñado para este programa. Resultados: Mejoras en todos los grupos. Los resultados no se ven condicionados ni por el nivel de competencia intelectual ni por la existencia o no de habilidades lingüísticas. Asimismo, se indica que realizar sesiones de mantenimiento con una periodicidad de 7 semanas de media permite mantener a largo plazo los logros alcanzados por el programa. No obstante, se detecta que aquellos niños afectados de mayor gravedad podrían necesitar sesiones de recuerdo más frecuentes (AU)

Introduction: Autism is a developmental disorder that it is characterized by a qualitative alteration of social interaction, communication and repetitive and stereotyped behaviours, interests and activities. Recent studies about health are showing that people with autism have lower hope of life. Among other causes, difficulty to identify and to communicate uneasiness and resistance to allow medical explorations are important factors to consider. Aims: To design and to implant a specific program for people with Autistic Spectrum Disorder (ASD) with the objective of habituating them to the medical explorations so that they admit it and collaborate, facilitating the sanitary personnel's work. Our aim was to evaluate the effectiveness of the program and the maintenance of the potentials improvements. Method: Our sample was formed by twenty-two children with ASD (mean chronological age, 9; 10 years). A quasi-experimental design of interrupted temporary series was carried out. Variables: two grouping variables (clinical characteristics of the groups about QI and about linguistic abilities) as dependent variable a measure of percentage of success has been used through an observation protocol designed for this program. Results: Improvements in all the groups. Results are not conditioned neither for the level of intellectual abilities (IQ) neither for the existence or not of linguistic abilities. Likewise, it is found that carrying out maintenance sessions in period of seven weeks allows to maintain long term achievements reached by the program. However, we found that those children which were severely impaired could obtain more benefit from more frequent maintenance sessions (AU)