Tratamiento no quirúrgico en cáncer epidermoide de orofaringe avanzado: análisis de resultados oncológicos en función del subsitio tumoral y fraccionamiento de radioterapia / Nonsurgical treatment in advanced oropharyngeal squamous cell cancer

Objetivo: Reportar resultados de nuestro protocolo de radioquimioterapia concomitante exclusiva en el cáncer de orofaringe avanzado. Materiales y métodos: Estudio retrospectivo que incluyó 87 pacientes. Se realizó radioterapia concomitante con cisplatino semanal. Se aceptó la realización de fraccionamiento convencional (FC), hiperfraccionamiento (Hfx) o fraccionamiento acelerado tipo boost concomitante (FABC). Se revisó la sobrevida global (SG), sobrevida libre de enfermedad (SLE), sobrevida libre de recidiva local (SLRL) y regional (SLRR) según subsitio y fraccionamiento. Resultados: Ingresaron 87 pacientes. Mediana de seguimiento: 120 meses. El 53, 30 y 17% recibieron FC, FABC y Hfx respectivamente. La SG a 2, 5 y 10 años fue de un 73, 61 y 43% respectivamente. La SG a 5 años según subsitio anatómico fue: amígdala 74%, paladar blando 33%, base de lengua 33%, y pared faríngea posterior 33%. Al comparar la SG de amígdala versus otros subsitios se alcanza una diferencia estadísticamente significativa (p < 0,001). La mediana de SG para amígdala no fue alcanzada, mientras que en otros subsitios fue de 22 meses. La SLE fue diferente en los distintos subsitios, superior en amígdala y diferente entre los distintos fraccionamientos, a favor de Hfx, alcanzando diferencias significativas. Las mismas tendencias se demostraron en SLRL y SLRR. Observamos un 23% de segundos primarios, siendo el pulmón el sitio más frecuente. Conclusión: La radioterapia concomitante con cisplatino semanal es un tratamiento adecuado para el cáncer de orofaringe. Ofrece excelentes resultados en cáncer de amígdala, especialmente con fraccionamiento modificado. Para los otros subsitios nos parece recomendable explorar nuevas estrategias de tratamiento.

Objective: To report results of our concomitant radiochemotherapy protocol for advanced oropharyngeal cancer. Materials and methods: Retrospective study. Concomitant radiochemotherapy was performed with weekly cisplatin. Conventional fractionation (CF), hyperfractionation (Hfx) or accelerated fractionation with concomitant boost (FABC) were accepted. Overall survival (OS), Disease-free survival (RFS), Local relapse-free survival (LRFS) and Regional relapse-free survival (RRFS) were calculated, according subsite and radiotherapy fractionation. Results: We found 87 patients. Median follow-up: 120 months. 53%, 30% and 17% received FC, FABC, Hfx respectively. OS at 2, 5 and 10 years was 73%, 61% and 43% respectively. The 5-year OS was, by anatomic subsite: Tonsillar 74%, 33% soft palate, base of tongue 33%, and 33% for posterior pharyngeal wall. By comparing the OS in tonsil versus other subsites we found statistically significant difference in favor of tonsillar cancer (P < .001). Median OS for tonsillar cancer was not achieved, while in other subsites was 22 months. DFS was different in different subsites, better for amygdala and different among different fractionations, better for Hfx, reaching significant differences. The same trends were demonstrated in LRFS and RRFS. We observed a 23% of second cancers, being lung the most common site. Conclusion: Concomitant radiotherapy with weekly cisplatin is an appropriate treatment for oropharyngeal cancer. It provides excellent outcomes in tonsillar cancer, especially with modified fractionation and Hfx type. For other subsites it seems advisable to explore a new treatment approach.

Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

To evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes.

Evaluation of Acute Toxicity and Symptoms Palliation in a Hypofractionated Weekly Schedule of External Radiotherapy for Elderly Patients with Muscular Invasive Bladder Cancer

Aim To evaluate acute toxicity and symptoms palliation of a weekly hypofractionated 3DCRT schedule as radical treatment in elderly patients with organ confined bladder cancer cT1-2N0. Materials and Methods Between February 2005 and June 2011, 58 prospectively selected patients diagnosed with organ confined bladder cancer were treated with external 3DCRT (4-field arrangement). All candidates were medically inoperable, with poor performance status, and with age ranged from 75 to 88 years (median 78). A dose of 36 Gy in 6 weekly fractions was prescribed. The primary study endpoints were the evaluation of haematuria, dysuria, frequency and pain palliation as well as the acute toxicity according to the RTOG/EORTC scale: an assessment was performed at baseline, during and 3 months after radiotherapy, while the maximum reported score was taken into account. Results The gastrointestinal acute toxicities were 13/58 (22.4%) and 5/58 (5.6%), for grade I and II respectively. The genitourinary acute toxicities were 19/58 (32.7%) and 10/58 (17.2%), for grade I and II respectively. In terms of clinical outcome, 55/58 patients (94.8%) reported palliation of haematuria, while 19 out of 58 reported no change in frequency and dysuria. All patients reported significant improvement (P < 0.01) for pain, concerning the visual analogue score before and after radiotherapy. The median progression free survival was 14 months. CONCLUSIONS The incidence of patient-reported acute toxicity following weekly hypofractionated external 3DCRT is low while the symptom palliation compares very favorably with other reported outcomes. .

High dose-rate brachytherapy as a treatment option in primary tracheal tumors

OBJETIVO: Apresentar a experiência do tratamento de 4 pacientes com tumores primários de traquéia, não operados, submetidos à braquiterapia endobrônquica de alta taxa de dose. PACIENTES E MÉTODOS: Dois casos de carcinoma espinocelular, uma recidiva de carcinoma adenóide cístico e uma recidiva de plasmocitoma primário da traquéia. Todos receberam braquiterapia endobrônquica, exclusiva ou como reforço de dose da radioterapia externa. Foram administradas 3 ou 4 frações de 7,5 Gy cada, calculados a 1 cm de profundidade. O seguimento foi considerado a partir do término da braquiterapia. RESULTADOS: Em todos os casos houve resposta completa. Dois pacientes com carcinoma espinocelular evoluíram a óbito em 6 e 33 meses após a braquiterapia, o primeiro, sem evidência de doença e o outro por recidiva local, respectivamente. As outras 2 pacientes encontravam-se vivas após 64 e 110 meses de seguimento, sem evidência de doença. Esses 2 casos apresentaram estenose traqueal em 22 e 69 meses após a braquiterapia, sendo necessária a colocação de prótese traqueal apenas na paciente com carcinoma adenóide cístico. CONCLUSÕES: A braquiterapia endobrônquica de alta taxa de dose pode ser utilizada tanto como reforço de dose da irradiação externa quanto em recidivas. O controle local obtido em 3 de 4 pacientes indica que casos individuais podem se beneficiar desse procedimento. Sobrevida a longo prazo pode ser observada, principalmente nos casos de histologia adenóide cística.