ABSTRACT
Introduction: Due to their location, tumors of the trunk (TT) present a high surgical risk and the diagnosis is usually made by imaging. In Chile, these cases are treated according to the PINDA Program (national treatment guide for pediatric tumors). All patients receive radiotherapy (RT) after diagnosis. The aim of this study is to evaluate the treatment results for TT at the National Cancer Institute (NCI) between 1993 and 2011. Patients and Method: A retrospective review of patients diagnosed with TT at NCI was conducted. Patient population, symptoms, treatment received and overall survival are described. Prognostic factors were analyzed. Results: From November 1993 to December 2011, 70 children were referred for possible RT, 68 of them actually received it. The median age at diagnosis was 7 years old. In June 2012, out of 70 patients, 60 were deceased, all due to disease progression. The median survival of patients who received RT (68 patients) was 8.5 months from the end of treatment; the survival rates at 1, 2 and 3 years was 31.5 percent 14.3 percent and 12.8 percent respectively. Univariate analysis showed that survival was affected by the MRN high resolution imaging (p = 0.07) and by the diffuse tumor pattern (p = 0.025). Multivariate analysis showed survival is affected by the MRN high resolution imaging (p = 0.011) and a higher dose of RT protector (p = 0.015). Conclusions: The poor results obtained in the treatment of TT with RT at the INC are similar to those reported by other centers. Further explorations regarding other treatment options based on combined therapy using RT are needed.
Introducción: Los tumores de tronco (TT), por su ubicación, conllevan un alto riesgo quirúrgico, por lo que generalmente el diagnóstico se realiza por imágenes. En Chile se tratan según el programa PINDA (guía para tratamiento de tumores pediátricos nacional). Todos reciben radioterapia (RT) luego del diagnóstico. El objetivo de esta publicación es evaluar los resultados de tratamiento de los TT en el Instituto Nacional del Cáncer (INC) en el período 1993-2011. Pacientes y Método: Revisión retrospectiva de los pacientes tratados con el diagnóstico de TT en el INC. Se describe la población de pacientes, síntomas de presentación, tratamientos recibidos y sobrevida global. Se exploraron factores pronósticos. Resultados: Desde noviembre de 1993 hasta diciembre de 2011 fueron derivados para consideración de RT 70 niños, de ellos 68 la recibieron. La mediana de edad al diagnóstico fue de 7 años. A junio de 2012, del total de 70 pacientes, 60 se encontraban fallecidos, todos por progresión de enfermedad. La mediana de sobrevida, de los pacientes que recibieron RT (68 pacientes), fue de 8,5 meses desde el fin de esta; la sobrevida a 1, 2 y 3 años fue de 31,5 por ciento, 14,3 por ciento, 12,8 por ciento respectivamente. Al análisis univariado, fue peor para la sobrevida, el alto grado a la imagen de RNM (p = 0,07) y el patrón tumoral difuso (p = 0,025). Al análisis multivariado, es peor para la sobrevida el alto grado a la imagen de RNM (p = 0,011) y protector una mayor dosis de RT (p = 0,015). Conclusiones: Los pobres resultados obtenidos en el tratamiento con RT de TT en el INC son similares a los reportados por los otros centros. Sería sin duda interesante explorar otras alternativas de tratamiento en base a tratamientos combinados con RT.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Brain Stem Neoplasms/mortality , Brain Stem Neoplasms/radiotherapy , Chile , Cancer Care Facilities/statistics & numerical data , Multivariate Analysis , Brain Stem Neoplasms/pathology , Prognosis , Retrospective Studies , Survival AnalysisABSTRACT
Background: Gastric cancer is one of the most lethal tumors in the Chilean population. Aim: To report the results of adjuvant chemoradiotherapy in advanced gastric cancer. Material and Methods: Review of medical records of patients with locoregionally advanced gastric cancer, subjected to a curative resection and treated with adjuvant chemoradiotherapy. The treatment was based on the INT 0116/SWOG protocol, which includes 5-fuorouracil as a single agent. Patients were followed for a median of 58 months. Results: the records of 168 patients (99 men) treated between 2004 and 2011, were reviewed. Median survival was 41 months. Median lapses between surgery and onset of chemo and radiotherapy were 12 and 17 weeks, respectively. Overall three and five years survival was 53 and 41%, respectively. On multivariate analysis the factors associated with a lower survival were an antral location of the tumor, presence of signet ring cells and more than 15 involved lymph nodes. Conclusions: Three and five years survival of gastric cancer patients subjected to adjuvant chemoradiotherapy was 53 and 41% respectively. These results are similar to those reported elsewhere.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Antimetabolites, Antineoplastic/administration & dosage , Chemoradiotherapy, Adjuvant , Fluorouracil/administration & dosage , Leucovorin/administration & dosage , Stomach Neoplasms/therapy , Vitamin B Complex/administration & dosage , Disease-Free Survival , Lymphatic Metastasis , Neoplasm Recurrence, Local , Neoplasm Staging , Neoplasm, Residual , Prognosis , Retrospective Studies , Stomach Neoplasms/pathology , Treatment OutcomeABSTRACT
Introducción: El tumor de Wilms (TW) es el tumor renal maligno más frecuente en la infancia, su tratamiento incluye, según su estadio y forma de presentación, cirugía precoz, radioterapia (RT) y quimioterapia (QT) según el protocolo PINDA. El objetivo es conocer los resultados de la serie histórica del Instituto Nacional del Cáncer (INC). Pacientes y Método: Revisión retrospectiva de todos los pacientes tratados con el diagnóstico de TW en el INC. Se describe la población de pacientes, tratamiento de RT recibidos, resultados de sobrevida global y factores pronósticos. Resultados: Desde septiembre de 1993 hasta diciembre de 2010 se trataron con RT 110 niños. La mediana de edad al diagnóstico fue de 3,6 años. La mediana de seguimiento fue de 128 meses desde el fin de RT. A junio de 2012, del total de 107 pacientes con seguimiento, 22 habían fallecido, 19 por progresión de enfermedad. Todos los pacientes que fallecieron lo hicieron antes de tres años desde el tratamiento. La sobrevida global a 2, 4, 12 años fue de 82 por ciento, 78 por ciento, 78 por ciento respectivamente. En análisis multivariado, cada día después de la cirugía sin comenzar la RT disminuye las probabilidades de sobrevida (p = 0,04). Conclusiones: El tratamiento del TW tiene un excelente pronóstico. La sobrevida, luego de los 3 años se estabiliza sin presentar eventos, indistintamente del grupo al que pertenezca el paciente. Dentro de los factores pronósticos, en pacientes con indicación de RT, esta se debe iniciar precozmente, al parecer lo más cercano a la cirugía.
Introduction: Wilms tumor (WT) is the most common form of malignant kidney tumor in childhood. According to PINDA protocols, its treatment includes, depending on stage and presentation, early surgery, radiotherapy (RT) and chemotherapy (CT). The objective of this work is to review the results of all patients of the National Cancer Institute (NCI) with this condition. Patients and Method: A retrospective review of all patients diagnosed with WT at the NCI was conducted. Patient population, RT treatment received and overall survival results were described and prognostic factors were searched. Results: From September 1993 to December 2010, 110 children were treated with RT. The median age at diagnosis was 3.6 years old. Median follow-up was 128 months after RT. In June 2012, out of a total of 107 patients with follow up, 22 had died, 19 due to disease progression. All deaths occurred within three years of treatment. Overall survival at 2, 4 and 12 years old was 82 percent, 78 percent, 78 percent respectively. A multivariate analysis showed that each day after surgery and without starting RT, the chances of survival decreased (p = 0.04). Conclusions: WT treatment has an excellent prognosis. Survival after 3 years stabilizes without presenting complications, regardless of the group to which the patient belongs. Among the prognostic factors for patients with RT prescription, this radiation should be started early, as close to the surgery as possible.