Late toxicity for prostate cancer patients treated with hypofractionated helical tomotherapy.

AIM: The purpose of this study is to evaluate the long term tolerability of hypofractionated helical tomotherapy (HT) in localized prostate cancer patients. BACKGROUND: Previous hypofractionated schedules with conventional RT were associated with excessive toxicity, likely due to inadequate sophistication of treatment delivery. There are few data about late toxicity after HT. MATERIALS AND METHODS: We evaluated 38 patients with primary adenocarcinoma of the prostate. There were 9 (24%), 15 (39%), and 14 (37%) patients with high, intermediate, and low risk, respectively. Patients were treated with hypofractionated HT from May 2008 to February 2011. Hypofractionation regimens included: 68.04 Gy at 2.52 Gy/fraction (N = 25; 66%), 70 Gy at 2.5 Gy/fraction (N = 4; 11%) and 70.2 Gy at 2.6 Gy/fraction (N = 9; 23%). Late genitourinary (GU) and gastrointestinal (GI) toxicity was scored using the Radiation Therapy Oncology Group scoring system. RESULTS: Median age at diagnosis was 70 years (range 49-80) and median follow-up, 5.8 years. Late grade 1, 2 and 3 GI toxicity were 13%, 24%, and 2.6%, respectively. Late grade 1, 2, 3 GU toxicity were 29%, 21%, and 8%, respectively. Sexual toxicity was evaluated in 19 patients to be grade 1, 2 in 11% and grade 3 in 16%. Multivariate analysis showed that patients with higher values of rectum V50 associated with late GI toxicity (P = 0.025). Patients with PSA ≤8 (P = 0.048) or comorbidities (P = 0.013) at diagnosis were associated with higher late GU toxicity. Additionally, PSA ≤8 also associated with moderate (grade ≥2) late GU toxicity in the multivariate analysis (P = 0.028). CONCLUSIONS: Hypofractionated HT can be delivered safely with limited rates of moderate and severe late toxicity. The proportion of the rectum that receives a moderate and high dose, having comorbidities, and PSA at diagnosis seem to associate with long term toxicity.

Patients' Perceived Valorization Toward Ringing the Cancer Bell at the End of Their Radiation Therapy.

PURPOSE: In recent times, "ringing the bell" at the end of cancer treatment has attracted the attention of health care providers with regard to how this experience impacts patients' mental and emotional health. In this context, a study was conducted at a radiation oncology center in Santiago, Chile, to assess the perceived valorization of patients toward "ringing the bell" at the end of their treatment. It was further determined whether this experience had a positive or negative impact on their mental health. METHODS AND MATERIALS: Two hundred thirty-six patients were invited to respond to a printed anonymous survey that used a Likert scale to evaluate their perceived valorization of "ringing the bell" after radiation therapy. In this survey, patients were also asked questions regarding their background to examine possible trends related to different lifestyles and socioeconomic status. RESULTS: The results showed that 93.6% of participants classified the experience as "positive" or "very positive." There were 6 "negative" responses out of 708 (0.8%) to the 3 questions regarding perceived valorization of the experience and no "very negative" responses. CONCLUSIONS: "Ringing the bell" at the end of radiation therapy can be considered a psychological comfort that positively impacts patients' mental health. No trends related to socioeconomic status were observed.

Clinical decision making in postmastectomy radiotherapy in node negative breast cancer.

For decades, postmastectomy radiotherapy (PMRT) has been recommended for node positive [N(+)] breast cancer patients; nevertheless, the beneficial effect of PMRT for treatment of node negative [N(-)] disease remains under discussion. Nowadays, the biology of breast cancer and the risk factors (RFs) for locoregional failure (LRF) must be included in the decision on whether or not to carry out PMRT. For these reasons, the present review aims to evaluate the rationale use of PMRT in N(-) patients and discuss which subgroups may further benefit from the treatment in present times where the decision must be personalised, according to the RFs of locoregional recurrence (LRR). To perform the analysis, we ponder that LRR of over 10% should be considered unacceptable due to the fact that LRRs generate great morbidity in patients. For this purpose, we consider that routine RT in these patients is not recommended, although there are subgroups of patients with high LRR, in which PMRT could be beneficial.