Phase II trial: concurrent radio-chemotherapy with weekly docetaxel for advanced squamous cell carcinoma of head and neck.

INTRODUCTION: Standard fractionation radiation therapy (RT) combined with concomitant chemotherapy (CT) based on cisplatin schemes is actually the standard treatment for locally advanced non-resectable squamous cell carcinoma of head and neck (SCCHN). The appearance of taxoids has introduced a new kind of treatment with high antitumoral power. The aim of this study is to add more information about the role of this new approach. MATERIALS AND METHODS: Twenty-six patients with locally advanced non-resectable SCCHN were recruited at six institutions in Spain, between January 2001 and January 2003. Docetaxel was administered weekly, for 6 weeks, concurrently with RT. RESULTS: The mean total delivered dose of RT was 70'2 Gy (range 64-74 Gy). The median and mean duration of time were 63 days and 61 days (range 49-103 days) respectively. After a median time control of 19 months (range 3.3-42.2 months), the response rate was 83.4%. The median time to local progression was 16.4 months (95% confidence interval [CI]=4.4-28.4 months). The median survival time was 26.9 months, with one- and two-year overall survival of 66.9% (95% CI=48.1-85.7%) and 57.5% (95% CI=37.3-77.7%) respectively. The median duration time response was 15.1 months (95% CI=3.7-26.5 months). The median time until treatment failure was 9.4 months (95% CI=4.7-14.1). Incidence of grade III-IV mucositis was 88%, neutropenia 72% and skin toxicity 92% (24% grade III-IV). The incidence of severe late toxicity (grade III and IV) due to RT/CT was 31.4%. CONCLUSIONS: Although therapeutics results are equivalent to cisplatin schemes of concurrent CT-RT, mucositis and cutaneous toxicity registered in this trial must be considered as limiting factors to application of this new approach.

Predictors of urinary and rectal toxicity after external conformed radiation therapy in prostate cancer: Correlation between clinical, tumour and dosimetric parameters and radical and postoperative radiation therapy. / Factores predictivos de toxicidad urinaria y rectal tras radioterapia externa conformada en el cáncer de próstata: correlación de parámetros clínicos, tumorales y dosimétricos con radioterapia radical y postoperatoria.

OBJECTIVE: To determine rectal and urinary toxicity after external beam radiation therapy (EBRT), assessing the results of patients who undergo radical or postoperative therapy for prostate cancer (pancreatic cancer) and their correlation with potential risk factors. METHOD: A total of 333 patients were treated with EBRT. Of these, 285 underwent radical therapy and 48 underwent postoperative therapy (39 cases of rescue and 9 of adjuvant therapy). We collected clinical, tumour and dosimetric variable to correlate with toxicity parameters. We developed decision trees based on the degree of statistical significance. RESULTS: The rate of severe acute toxicity, both urinary and rectal, was 5.4% and 1.5%, respectively. The rate of chronic toxicity was 4.5% and 2.7%, respectively. Twenty-seven patients presented haematuria, and 9 presented haemorrhagic rectitis. Twenty-five patients (7.5%) presented permanent limiting sequela. The patients with lower urinary tract symptoms prior to the radiation therapy presented poorer tolerance, with greater acute bladder toxicity (P=0.041). In terms of acute rectal toxicity, 63% of the patients with mean rectal doses >45Gy and anticoagulant/antiplatelet therapy developed mild toxicity compared with 37% of the patients with mean rectal doses <45 Gy and without anticoagulant therapy. We were unable to establish predictors of chronic toxicity in the multivariate analysis. The long-term sequelae were greater in the patients who underwent urological operations prior to the radiation therapy and who were undergoing anticoagulant therapy. CONCLUSIONS: The tolerance to EBRT was good, and severe toxicity was uncommon. Baseline urinary symptoms constitute the predictor that most influenced the acute urinary toxicity. Rectal toxicity is related to the mean rectal dose and with anticoagulant/antiplatelet therapy. There were no significant differences in severe toxicity between radical versus postoperative radiation therapy.

[Preservation of the bladder in rectal cancer with prostatic invasion]. / Preservación de la vejiga en el cáncer de recto con invasión de la próstata.

Colorectal cancer in the 2nd commonest cancer in Europe. In 5-10% of cases there is infiltration of urological organs. When infiltration affects the bladder or the prostate, anterior pelvic exenteration is the treatment that achieves the largest percentage of tumor free margins and the best 5-year survival. In very select cases of prostatic infiltration, the bladder can be preserved and prostatectomy and abdominoperineal block resection are carried out fulfilling oncological surgical requirements and producing an important improvement in the patient's quality of life. Owing to the very scarce published literature (two articles with three cases) we contribute our experience of 2 patients who received cytoreducing preoperative radiochemotherapy, prostatectomy and block abdominoperineal amputation and intraoperative radiotherapy. We describe the surgical technique used, which is substantially different from standard prostatectomy and requires good coordination between surgeons and urologists.

[Hodgkin's disease and pregnancy]. / Enfermedad de Hodgkin y embarazo.

This is a short communication in which 2 cases of familiar Hodgkin's disease are reported. The first case is a 27 years old woman with the diagnosis of Hodgkin's disease, nodular sclerosis, stage III-B (with mediastinal, para-aortic and right supraclavicular involvement), treated initially with radical radiotherapy. She was pregnant at the time of diagnosis. The second case is a 15 years old woman with similar diagnosis of Hodgkin's disease stage II-A (with mediastinal and right supraclavicular involvement) and identical histology. She was the daughter of case 1. The observation of familiar Hodgkin's disease and its possible biological implications are discussed.

[Intraoperative radiotherapy in the multidisciplinary treatment of malignant tumors in children. Preliminary results]. / Radioterapia intraoperatoria en el tratamiento multidisciplinario de tumores malignos infantiles. Resultados preliminares.

From September 1984 to March 1989, 57 children received intraoperative radiotherapy as part of a multidisciplinary tumor treatment. Their age ranged from 2 to 18 years. Tumor types: osteosarcoma, 21; Ewing's sarcoma, 19; soft tissue sarcomas, 6; neuroblastoma, 5; Wilm's tumor, 3; Hodgkin, 1; glioma, 1, and malignant pheochromocytoma, 1. In 44 patients the disease was localized while 13 had distant metastases. Intraoperative radiotherapy was used in 48 previously untreated patients as part of a radical treatment program and in 9 cases as an effort to rescue local failures (5 in previously irradiated areas). The intraoperative radiation field included the surgically exposed tumor or tumor bed, and the single doses ranged from 10 to 20 Gy, with 6-20 MeV electrons. With a median follow up time of 25 months (4 to 51 + months) 44 out of 57 patients are alive without local recurrence and 13 have died from tumor (6 with local progression). Intraoperative radiotherapy seems to be a feasible treatment which might promote local control in pediatric tumors.

Preservación de la vejiga en el cáncer de recto con invasión de la próstata / Preservation of the bladder in rectal cancer with prostatic invasion

El cáncer colo-rectal es el 2º tumor en frecuencia en Europa. En el 5-10% de los casos existe infiltración de órganos urológicos. Cuando la infiltración afecta a la vejiga o a la próstata, la exenteración pelviana anterior es el tratamiento con el que se consiguen mayor porcentaje de márgenes quirúrgicos libres de tumor y mayores probabilidades de supervivencia a los 5 años. En casos muy seleccionados de infiltración prostática es posible preservar la vejiga, realizando una prostatectomía y amputación abdominoperineal en bloque cumpliendo con los requisitos quirúrgicos oncológicos y mejorando de forma importante la calidad de vida del paciente. Debido a la escasa bibliografía existente (dos artículos con 3 casos) presentamos nuestra experiencia en 2 pacientes a los que se les realizó radioquimioterapia preoperatoria citoreductora, prostatectomía y amputación abdominoperineal en bloque y radioterapia intraoperatoria. Describimos la técnica quirúrgica utilizada, que presenta diferencias sustanciales con la prostatectomía estándar y precisa de una buena coordinación entre el equipo de cirujanos y el de urólogos

Colorectal cancer in the 2nd commonest cancer in Europe. In 5-10% of cases there is infiltrationof urological organs. When infiltration affects the bladder or the prostate, anterior pelvic exenterationis the treatment that achieves the largest percentage of tumor free margins and the best 5-yearsurvival. In very select cases of prostatic infiltration, the bladder can be preserved and prostatectomyand abdominoperineal block resection are carried out fulfilling oncological surgical requirementsand producing an important improvement in the patient’s quality of life.Owing to the very scarse published literature (two articles with three cases) we contribute ourexperience of 2 patients who received cytoreducing preoperative radiochemotherapy, prostatectomyand block abdominoperineal amputation and intraoperative radiotherapy. We describe the surgicaltechnique used, which is substantially different from standard prostatectomy and requires goodcoordination between surgeons and urologists

Oncología Radioterápica en el Hospital. Un modelo viable para la integración en gestión, asistencia, docencia e investigación / Radiotherapeutic Oncology in the Hospital. A viable model for integration in management, care, teaching and investigation

La gestión clínica en Oncología Radioterápica (OR) debe organizar la práctica asistencial, la docencia y la investigación desde un compromiso de innovación permanente. Su ámbito de actuación, estrictamente hospitalario, unido a una práctica sujeta a una exigente normativa legal, hacen de la OR una especialidad exigente en su compromiso asistencial. En el presente capítulo, se analizan las características diferenciadoras de la OR, así como la integración en la gestión de la asistencia, la docencia y la investigación, sin olvidar sus limitaciones y la necesaria relación con otras especialidades (AU)

This work analyses the differentiating characteristic of Radiotherapeutic Oncology, as well as its integration in the management of care, teaching and investigation, without forgetting its limitations and the necessary relation with other specialties (AU)