ABSTRACT
SUMMARY OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.
Subject(s)
Prostatic Neoplasms/radiotherapy , Radiotherapy, Intensity-Modulated , Brazil , Prospective Studies , Treatment Outcome , Radiation Dose HypofractionationABSTRACT
SUMMARY This recommendation consensus for hypofractionated whole-breast radiotherapy (RT) was organized by the Brazilian Society of Radiotherapy (SBRT) considering the optimal scenario for indication and safety in the technology applied. All controversies and contraindication matters (hypofractionated RT in patients who underwent chemotherapy [CT], hypofractionated RT in lymphatic drainage, hypofractionated RT after mastectomy with or without immediate reconstruction, boost during surgery, hypofractionated RT in patients under 50 years old, hypofractionated RT in large breasts, hypofractionated RT in histology of carcinoma in situ [DCIS]) was discussed during a meeting in person, and a consensus was reached when there was an agreement of at least 75% among panel members. The grade for recommendation was also suggested according to the level of scientific evidence available, qualified as weak, medium, or strong. Thus, this consensus will aid Brazilian radiotherapy experts regarding indications and particularities of this technique as a viable and safe alternative for the national reality.
RESUMO Este consenso de recomendações para a radioterapia (RT) hipofracionada de toda a mama foi organizado pela Sociedade Brasileira de Radioterapia (SBRT) considerando o cenário ideal para indicação e segurança na tecnologia aplicada. Questões de controvérsias e contraindicações (RT hipofracionada em pacientes submetidas à quimioterapia [QT], RT hipofracionada nas drenagens linfáticas, RT hipofracionada após mastectomia com ou sem reconstrução imediata, a realização de reforço de dose em leito cirúrgico [ou boost], RT hipofracionada em pacientes com idade menor que 50 anos, RT hipofracionada em mamas volumosas, RT hipofracionada em histologia de carcinoma in situ [CDIS]) foram discutidas em encontro presencial, sendo o consenso atingido quando existisse concordância de pelo menos 75% dos panelistas. O grau de recomendação foi também sugerido de acordo com o nível de evidência científico disponível, qualificado entre fraco, médio ou forte. Assim, este consenso deverá servir para auxiliar os especialistas da radioterapia brasileira em relação às indicações e particularidades dessa técnica, como uma alternativa segura e viável para a realidade nacional.
Subject(s)
Humans , Female , Breast Neoplasms/radiotherapy , Carcinoma/radiotherapy , Radiation Dose Hypofractionation/standards , Brazil , Breast/radiation effects , Breast Neoplasms/pathology , Carcinoma/pathology , Risk Factors , Evidence-Based MedicineABSTRACT
Este estudo objetiva avaliar o perfil sociodemográfico e clínico dos pacientes com metástase cerebral submetidos à radiocirurgia estereotáxica (RCE) no serviço de radioterapia de um hospital da região sul de Santa Catarina. Foram estudados dados de prontuários digitais de todos os pacientes submetidos à RCE como tratamento de metástase cerebral, de agosto de 2015 a agosto de 2016. Foram excluídos aqueles que realizaram RCE por outro motivo ou fora do período estudado. Dos 27 pacientes incluídos, 14 eram do sexo feminino e, 13, do masculino. O tumor primário mais encontrado foi o de pulmão (12 casos, 44,4%). A maioria dos pacientes apresentou uma lesão cerebral (16 casos, 59,3%), e a média de tamanho da lesão foi de 1,5 ± 0,86 cm. Em muitos pacientes a radiociurgia foi o único tratamento realizado para a metástase cerebral. Dos pacientes que haviam feito seguimento no hospital estudado (n = 14), nove apresentaram progressão da doença (64,3%), três obtiveram resposta parcial (21,4%) e dois permaneceram com doença estável (14,3%). A principal causa de progressão foi o aparecimento de novas lesões cerebrais (6 casos, 66,7%). A média de tamanho das lesões pósradiocirurgia foi de 1,28 ± 0,57 cm. A diferença do tamanho médio das lesões pré e pós-radiciurgia foi de 0,22 cm (p = 0,593). Grande parte dos resultados encontrados é condizente com os dados já encontrados na literatura. Sugere-se que novos estudos sejam realizados no serviço, principalmente para avaliar a resposta à RCE.
This study aims to evaluate the sociodemographic and clinical profile of patients with cerebral metastases submitted to stereotatic radiosurgery (SRS) in the radiotherapy service of a hospital in the southern region of Santa Catarina. Data from digital files of all patients submitted to the SRS as treatment of cerebral metastases from August 2015 to August 2016 were studied. Those who performed SRS for another reason and out of the study period were excluded. From the 27 patients included, 14 were female and 13 were male. The most common primary tumor was lung cancer (12 cases, 44.4%). Most of the patients had one brain lesion (16 cases, 59.3%), and the average lesion size was 1.5 ± 0.86 cm. In many patients, radiosurgery was the only treatment performed for brain metastases. From the patients who had been followed at the hospital studied (n = 14), nine had progression of the disease (64.3%), three had partial response (21.4%) and two remained with stable disease (14.3%). The main cause of progression was the appearance of new brain lesions (6 cases, 66.7%). The average size of lesions after radiosurgery was 1.28 ± 0.57 cm. The difference in average pre-and post-radiosurgery lesion size was 0.22 cm (p = 0.593). Most of the results found are consistent with data already available in the literature. It is suggested that the study be amplified, mainly to evaluate the response to the SRS.