Research on the application of Media studio pro editing technology based on WeChat platform in radiation therapeutics teaching / 中华医学教育探索杂志

Objective:To explore the effect of constructing WeChat platform and introducing PPT (PowerPoint) optimized by Media studio pro editing technology in the teaching of radiation therapeutics.Methods:Sixty undergraduates of medical imaging technology in Fujian Medical University were randomly divided into experimental group and control group in average. The experimental group set up a WeChat group and acquired the optimized PPT before class; control group received classroom teaching and clinical practice according to the traditional teaching mode. Twenty-four items of MCTQ (Maastricht clinical teaching questionnaire) were selected and translated. A total of 30 teachers majoring in tissue radiation oncology and medical imaging were randomly divided into two groups. The questionnaire was used to evaluate the two teaching models. To examine the academic performance of the two groups of students. SPSS 23.0 software was used for independent sample t-test. Results:By comparing the scores of MCTQ questionnaire between the two groups, it was concluded that the teaching mode of the experimental group had significant advantages in 11 aspects, such as clinical practice, obtaining more learning opportunities and so on ( P < 0.05). The scores of practice [(84.67±7.29) vs. (80.03±8.97)] and final evaluation [(81.53±8.78) vs. (76.77±9.49)] of the students in the experimental group were better than those in the control group ( P < 0.05). Conclusion:The application of optimized PPT by Media studio pro editing technology based on WeChat platform is worth popularizing in the teaching of radiation therapeutics.

Uso de antitranspirante en pacientes en tratamiento de radioterapia por cáncer de mama / Use of antiperspirant in patients undergoing radiotherapy treatment for breast cancer / Uso de antitranspirante em pacientes submetidos a tratamento radioterápico para câncer de mama

Patients who are diagnosed with breast cancer face multiple challenges and fears: from the diagnosis, the acceptance of the diagnosis and the beginning of the treatments, as well as the side effects that they entail, the most worrying for the patients being the possible anatomical alterations due to surgery, alopecia due to chemotherapy treatment, and radiodermatitis due to radiant treatment. A systematic review was carried out in MedLine/Pubmed following the PRISMA 2020 criteria on the use of antiperspirant during radiant treatment in the axilla and its relationship or not with the increase in acute adverse effects. Based on the analysis of the results of this search and with emphasis on: dosimetric aspects, psychological impact, treatment acceptance, feeling of well-being and adherence. We justify its use.

As pacientes diagnosticadas com câncer de mama enfrentam múltiplos desafios e medos: desde o diagnóstico, a aceitação do diagnóstico e o início do tratamento, bem como os efeitos colaterais que estes acarretam, o mais preocupante para as pacientes são as possíveis alterações anatômicas devidas à cirurgia, alopecia devido ao tratamento quimioterápico e a radiodermatite devido ao tratamento radiante. Foi realizada uma revisão sistemática no MedLine/Pubmed seguindo os critérios do PRISMA 2020 sobre o uso de antitranspirante durante o tratamento radiante na axila e sua relação ou não com o aumento dos efeitos adversos agudos. Com base na análise dos resultados desta busca e com ênfase em: aspectos dosimétricos, impacto psicológico, aceitação do tratamento, sensação de bem-estar e aderência. Justificamos seu uso.

Las pacientes que son diagnosticadas con cáncer de mama se enfrentan a múltiples desafíos y temores: desde el diagnóstico, la aceptación del mismo y el inicio de los tratamientos, así como los efectos secundarios que ellos conllevan, siendo los más preocupantes para las pacientes las posibles alteraciones anatómicas por cirugía, la alopecia por el tratamiento quimioterápico, y la radiodermitis por el tratamiento radiante. Se realizó una revisión sistematizada en MedLine/Pubmed, Google Académico, EMBASE, SciELO y Epistemonikos, siguiendo los criterios PRISMA 2020 del uso de antitranspirante durante el tratamiento radiante en axila y su relación o no con el aumento de efectos adversos agudos. En función del análisis de los resultados de dicha búsqueda y con énfasis en: aspectos dosimétricos, impacto psicológico, la aceptación al tratamiento, el sentimiento de bienestar y la adherencia. Justificamos su uso.

Investigation of Chinese residency training program of radiation oncology / 中华放射肿瘤学杂志

Objective:To evaluate the compliance with Chinese Residency Training Program of radiation oncology and provide reference for the improvement of system reform and base construction.Methods:An survey was conducted among residents who had completed residency training program of radiation oncology by online questionnaires in four dimensions, including the fulfillment of training center in hardware, personnel and procedures, the compliance with syllabuses, mechanism of trainee evaluation, and the passing rate and satisfaction degree of trainees.Results:The results showed that most training centers fulfilled the requirement of equipment, mentoring personnel and procedures. The training syllabuses had been followed and integrated with organization multi-modalities. The trainees with high degree of satisfaction accounted for 65.6%, and the final qualification passing rate reached 75.5%. However, there were less reference textbooks, insufficient training in general medicine, limited clinical practice, and low output in academic publication.Conclusions:The residency training program of radiation oncology has been established in China and achieved notable progress. For the further improvement, quantitative optimization of procedures, increasing opportunity of practice and strengthening scientific research involvement would be beneficial.

The teaching practice and exploration of the course of New Technology of Radiotherapy and Oncology / 中华放射肿瘤学杂志

Objective:To evaluate and summarize the teaching effect of" New Technology of Radiotherapy and Oncology" in the form of questionnaire, understand the degree of demand for the course of all kinds of medical students and improve the teaching contents and methods.Methods:The course of" New Technology of Radiotherapy and Oncology" was a specialized elective course in Peking Union Medical College. After two rounds of teaching practices, we evaluated the students participating in the course or non-course participants by anonymous questionnaire. The questionnaire items include the course content, setting, teachers and improvement suggestions.Results:A total of 73 questionnaires were sent out, and the recovery rate was 100%. Among them, 52(71%) were from students who chose the courses. 83% of the students" strongly agree" that the teaching content of this course is the latest development, the latest achievement or the problem to be solved, 94% were" satisfied" or" very satisfied" with their learning effect, and 92% and 83% were satisfied with the teachers and teaching plan, respectively. After taking the course, students rated" broadening of mind" (96%) as the biggest gain, followed by" facilitating interdisciplinary collaboration" (79%). 86% of the non-course participants felt the need to supplement the existing curriculum with new techniques in oncology radiotherapy, hoping that the curriculum would" broaden the mind" (76%), improve clinical application (81%) and facilitate interdisciplinary collaboration (71%).Conclusion:The questionnaire results show that the teaching practice of this course covers the different needs of all kinds of students, which is worthy of implementation and further improvement.

Atualização do processo de trabalho do enfermeiro nas consultas de teleterapia: readaptando fluxos e requisitos para futura modelagem de um Sistema de Informação para enfermagem / Updating the nurse's work process in teletherapy consultations: readapting flows and requirements for future modeling of an Information System for nursing

O presente estudo apresenta como cenário o ambulatório de radioterapia de um hospital de referência em Oncologia situado no Estado do Rio de Janeiro, Brasil, em que se realiza a consulta de enfermagem e teve como objetivos específicos: (1) Descrever o trabalho do enfermeiro em teleterapia; (2) Analisar o fluxo de pacientes nas consultas de enfermagem com base em Pavani Junior e Scucuglia (2011); (3) Identificar no mapa do serviço de teleterapia de modo a facilitar o fluxo no atendimento ao paciente; (4) Elaborar o novo fluxo para o atendimento às consultas de enfermagem em teleterapia; (5) Apresentar requisitos para propor o módulo de enfermagem em teleterapia. A investigação foi de abordagem qualitativa e natureza descritiva a partir da observação do fluxo no atendimento do paciente em teleterapia. Os dados foram obtidos por meio da técnica de observação sistemática segundo Gerhardt e Silveira (2009). Os resultados revelaram: fragilidade no fluxo de atendimento do paciente, ocasionado por retrabalho no agendamento das consultas, das movimentações desnecessárias dos pacientes e familiares às consultas de enfermagem por conta da necessidade de trazer a pasta de planejamentos na avaliação dos pacientes, e após entregar no setor de origem, e um sistema de informação que não atende às características de avaliação de enfermagem. Conclui-se que o fluxo existente é inadequado, assim como o processo de informação. Destaca-se a necessidade de organização do fluxo de atendimento ao paciente em teleterapia. Recomenda-se a proposição de um módulo de enfermagem, para ser utilizado no sistema informação existente, de modo a organizar as atividades do enfermeiro nas consultas de teleterapia.

The present study presents as a setting the radiotherapy outpatient clinic of a reference hospital in Oncology, located in the State of Rio de Janeiro, Brazil, where nursing consultations take place. The general objective is to analyze the work process of nurses in teletherapy, to update the information system, in order to improve patient care. And as specific objectives: (1) Describe the work of nurses in teletherapy; (2) A Analyze the flow of patients to nursing consultations based on Pavani Junior and Scucuglia (2011); (3) Identify the teletherapy service map in order to facilitate the flow of patient care; (4) Develop the new flow for attending nursing consultations in teletherapy; (5) Present requirements to propose the teletherapy nursing module. The investigation was based on a qualitative descriptive approach, based on the observation of the flow in patient care in teletherapy. Data were obtained through the systematic observation technique according to Gerhardt e Silveira (2009). The results reveal: weakness in the flow of patient care, caused by rework in scheduling appointments, unnecessary movement of patients and families to nursing appointments due to the need to bring the planning folder in the assessment of patients and after delivering it to the sector origin and an information system that does not meet the characteristics of nursing assessment. It is concluded that the existing flow is inadequate, as well as the information process. The need to organize the flow of care for patients in teletherapy is highlighted. It is recommended to propose a nursing module, to be used in the existing information system, in order to organize the activities of nurses in teletherapy consultations.

Guiding role of constructivism theory in the teaching of standardized residency training of radiation oncology / 中华医学教育探索杂志

According to the subject characteristics of radiation oncology, three teaching practices were carried out in the teaching of standardized residency training: teaching situation transformation under the guidance of constructivism theory, expanding teaching with points to areas, and organ system-centered medical classroom under the guidance of case analysis. At the same time, it combines the guidance of the residents' active exploration, integrated thinking and cooperative learning. Through the modulation of teaching and learning practices guided by constructivism, the residents' learning and understanding of radiation oncology knowledge and the integration and construction ability of "organ system-centered" medical knowledge are promoted, their active learning potential and innovative thinking ability are stimulated, and finally the teaching quality of this specialty is improved.

Data Analysis of Ovarian Cancer Patients for Feasibility of Treatment in a Radiation Oncology Department

Introduction: Ovarian cancer is not only the most common but also the most lethal gynecological malignancy, partly, becausethe majority of patients present with advanced disease. However, as is true for so many cancers, the management of patientswith ovarian neoplasms has changed substantially, and outcome results have improved considerably over the years.The reasonsfor this are many. For example, major advances in chemotherapy have resulted in improved survival, and the role of surgeryis constantly evolving and being refined.Purpose: A retrospective data analyses of ovarian cancer patients to observe their contemporary management in a radiationoncology departmental set up and the post-treatment outcome of these patients.Materials and Methods: The case records of 117 ovarian neoplasm patients registered in our department from 2011 to 2018were analyzed. The clinical, histopathological, and treatment details were noted. Contemporary treatment protocols were used.Results: Of the 117 patients of ovarian cancer treated in our department with conventional diagnostic, imaging, surgical, andcontemporary chemotherapy protocols, we found management of such patients is possible with optimum outcomes.Conclusion: Ovarian cancer patients can safely and optimally be treated in a radiation oncology department.

Successful definitive concurrent chemoradiotherapy in a patient with esophageal cancer and Child–Pugh B cirrhosis of the liver

This case report demonstrates successful concurrent chemoradiotherapy for esophageal cancer without severe adverse events in a patient with cirrhotic disease. A 63-year-old Japanese male with alcoholic liver cirrhosis was referred to our hospital for treatment of superficial esophageal cancer. Endoscopic submucosal dissection was performed and the patient was diagnosed as having squamous cell carcinoma of the esophagus that was pathologically staged as pT1bN0M0. When a superficial tumor involves the submucosa, esophagectomy is usually recommended. However, the patient was at high risk of perioperative morbidity and mortality because of impaired liver function. As an alternative to esophagectomy, the patient received concurrent chemoradiotherapy, comprising nedaplatin 64 mg/m2 on days 1 and 34 and S-1 80 mg/body orally on days 1–14 and 34–47 with concurrent radiotherapy of 50 Gy in daily fractions of 2 Gy. He has shown no signs of recurrence in the 30 months since his treatment.

Research on modes and methods of radiotherapy teaching centering on target delineation / 中华医学教育探索杂志

Target delineation is the key and difficult point in radiation oncology teaching. Combined with the teaching experience in department of cancer radio-chemotherapy, Zhongnan hospital of Wuhan university, this study focused on target delineation to explore the teaching mode and method of radiation oncology. Self-directed learning was combined with teacher's lecturing and guiding. By enhancing tumor imaging teaching and basic theory of tumor radiotherapy, students can grasp the essence and detail of target delineation and build individualized and precise radiotherapy. Finally, a new teaching mode combining students' autonomous learning with teachers' teaching and guide is established. Taking the radiation therapy of breast cancer as an example, We briefly described the concrete application of this teaching system.

Research on modes and methods of radiotherapy teaching centering on target delineation / 中华医学教育探索杂志

Target delineation is the key and difficult point in radiation oncology teaching. Combined with the teaching experience in department of cancer radio-chemotherapy , Zhongnan hospital of Wuhan university , this study focused on target delineation to explore the teaching mode and method of radiation oncology. Self-directed learning was combined with teacher's lecturing and guiding. By enhancing tumor imaging teaching and basic theory of tumor radiotherapy, students can grasp the essence and detail of target delineation and build individualized and precise radiotherapy. Finally, a new teaching mode combining students' autonomous learning with teachers' teaching and guide is established. Taking the radiation therapy of breast cancer as an example, We briefly described the concrete application of this teaching system.

The NEAT Predictive Model for Survival in Patients with Advanced Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We previously developed a model to more accurately predict life expectancy for stage IV cancer patients referred to radiation oncology. The goals of this study are to validate this model and to compare competing published models. MATERIALS AND METHODS: From May 2012 to March 2015, 280 consecutive patientswith stage IV cancerwere prospectively evaluated by a single radiation oncologist. Patients were separated into training, validation and combined sets. TheNEAT model evaluated number of active tumors (“N”), Eastern Cooperative Oncology Group performance status (“E”), albumin (“A”) and primary tumor site (“T”). The Odette Cancer Center model validated performance status, bone only metastases and primary tumor site. The Harvard TEACHH model investigated primary tumor type, performance status, age, prior chemotherapy courses, liver metastases, and hospitalization within 3 months. Cox multivariable analyses and logisticalregressionwere utilized to compare model performance. RESULTS: Number of active tumors, performance status, albumin, primary tumor site, prior hospitalizationwithin the last 3 months, and liver metastases predicted overall survival on uinvariate and multivariable analysis (p < 0.05 for all). The NEAT model separated patients into four prognostic groups with median survivals of 24.9, 14.8, 4.0, and 1.2 months, respectively (p < 0.001). The NEAT model had a C-index of 0.76 with a Nagelkerke’s R2 of 0.54 suggesting good discrimination, calibration and total performance compared to competing prognostic models. CONCLUSION: The NEAT model warrants further investigation as a clinically useful approach to predict survival in patients with stage IV cancer.

Researching on training mode of practical talents for tumor radiotherapy based on interdisciplinary collaborative teaching / 中华医学教育探索杂志

Radiation oncology is a multidisciplinary clinical subject.It is necessary to focus on cultivating practical talents in the development of radiation oncology disciplines.The traditional teacheroriented teaching methods ignore the students' overall learning status and the ability of innovation and thinking.This paper explores improvement measures of training talents from multiple perspectives through an integrative system,which includes interdisciplinary collaborative teaching methods that are supplemented by group discussions,and an open examination way centering on the medical record.Meanwhile,its practical application has also been explored.

Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

ABSTRACT Context Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors. Objective To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa. Materials and Methods Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT). Results 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I2=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I2=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I2=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I2=67%) presented better outcomes. Conclusion LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.

Analysis on setup errors of volumetric modulated arc therapy in pelvic tumors based on X-ray volumetric images / 医疗卫生装备

Objective To acquire setup error with X-ray volumetric images (XVI) technique during volumetric modulated arc therapy (VMAT) of pelvic tumors in order to provide guidance for the doctor to determine the interval between clinical target volume (CTV) and planning target volume (PTV).~ Totally 20 pelvic tumor patients accepting radiation oncology underwent CBCT scan before the first treatment,and auto registration was executed between CBCT images and planning CT images to determine the setup errors at X,Y and Z directions.Then the patients experienced another CBCT scan to obtain residual setup errors,VMAT was carried out after auto on-line correction by the treatment couch,and the third CBCT scan was performed after the treatment.Totally three times of CBCT scans were implemented every week hereafter.The setup errors were analyzed before and after the treatment,and the target volume margin (MPTV) was calculated accordingly.Results The setup errors at X,Y and Z directions were significantly decreased after correction.The values of MPTV at X,Y and Z directions before correction were 3.89,6.20 and 5.24 mm respectively,and the ones after correction were 1.42,2.42 and 2.40 mm respectively.The decreased values of MPTV were between 2.47 and 3.78 mm,which showed the most significant trend at Y direction.Conclusion VMAT of pelvic tumors based on XVI contributes to decreasing the setup errors and enhancing treatment quality.

Emerging radiotherapy technology in a developing country: A single Brazilian institution assessment of stereotactic body radiotherapy application / Tecnologias emergentes em radioterapia em um país em desenvolvimento: perfil do uso de radiocirurgia extracraniana em uma instituição filantrópica privada

Summary Objective: To provide a quantitative profile of the indications and use of stereotactic body radiotherapy (SBRT) in a developing country oncology-based institution. In addition, to describe the patients' and treatment characteristics, and to provide a temporal analysis. Method: SBRT patients treated from 2007 to 2015 were retrospectively evaluated by two independently investigators. Data were stratified and compared in two periods: first experience (FE) (May 2007 to April 2011), and following experience (FollowE) (May 2011 to April 2015). The following parameters were compared between the groups: total number of treated patients and lesions, treatment site, additional image fusion used, formal protocol adoption, and SBRT planning technique. Results: One hundred and seventy-six (176) patients with 191 lesions were treated: 34 (18%) lesions in the FE and 157 (82%) lesions in FollowE. The majority of lesions were metastases (60.3%), and lung (60.2%) was the most common treatment site, followed by spine (31%), and others (8.8%). An average of 1.4 (±0.6) additional imaging exams for delineation was performed. Conformal 3D radiotherapy planning technique was used in 64.4%, and intensity modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) in the remaining 35.6% (p=0.0001). Higher rates of curative treatments were observed in FE, as well as more lung lesions, patients ≥ 70 years, 3D conformal, number of additional images and ECOG 0, and all presented p<0.05. The global rate of protocol statement was 79%, lung treatment being the most stated. Conclusion: SBRT application is rapidly increasing in our setting. Treatment sites and planning techniques are becoming more diversified and complex.

Resumo Objetivo: realizar uma análise quantitativa das indicações e do uso de SBRT (stereotactic body radiotherapy) em uma instituição filantrópica. Além disso, descrever temporalmente as características dos pacientes e tratamentos. Método: retrospectivamente, foram coletados, por dois investigadores independentes, os dados de todos os pacientes tratados com SBRT na instituição no período de maio de 2007 a fevereiro de 2015. Dados foram estratificados e comparados em dois períodos: inicial (P1) (maio de 2007 a abril de 2011) e período seguinte (P2) (maio de 2011 a abril de 2015). Os seguintes parâmetros foram comparados entre os grupos: número total de pacientes e lesões tratadas, local de tratamento, uso de imagens adicionais, adoção formal de protocolo e técnica de planejamento. Resultados: foram avaliados 176 pacientes e 191 lesões, sendo 34 (18%) no P1 e 157 (82%) no P2, tratados com SBRT. A maioria das lesões eram metastáticas (60,3%), sendo pulmão o sítio mais prevalente, contabilizando 115/191 (60,2%) lesões, seguida de lesões ósseas (30,8%). Uma média de 1,4 (±0,6) exame de imagem adicional foi usada para o delineamento. Uso formal de protocolo/recomendações foi descrito em 79% das lesões. A técnica 3D-conformada (3DCRT - three-dimensional conformal radiotherapy) foi a mais utilizada para planejamento [123/191 (64,4%) lesões] quando comparada à intensidade modulada e ao arco dinâmico (p=0.0001). O P1 esteve associado a maior número de lesões primárias tratadas (OR 2,09; p=0,0005), lesões pulmonares (OR 3,85; p=0,0198), pacientes ≥ 70 anos (OR 2,77; p=0,0005), uso de planejamento 3D (OR 16; p=0,0001), menor uso de imagens adicionais [0 ou 1 (versus > 1)] (OR 7,5; p=0,0001) e ECOG 0 (vs. > 0) (OR 0,21; p=0,0431). Conclusão: o uso de SBRT aumentou ao longo do tempo na instituição. No P2, notou-se uma evolução técnica, com indicações mais diferenciadas, maior uso de imagens auxiliares para definição do alvo e técnicas de planejamento mais sofisticadas.

A brief history of Macau radiotherapy development / 中华放射肿瘤学杂志

Review the history of radiation therapy service in Macau,and the evolution of radiation technology,equipment and staffs of past and now were included.We hope provide an clear understanding of cancer radiotherapy condition in Macau and looking forward to academic exchange in radiation oncology in future.

Is There Any Age Cutoff to Treat Elderly Patients with Head and Neck Cancer? Comparing with Septuagenarians and Octogenarians

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.

Is There Any Age Cutoff to Treat Elderly Patients with Head and Neck Cancer? Comparing with Septuagenarians and Octogenarians

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.

Stereotactic body radiotherapy in lung cancer: an update / Radioterapia estereotáxica extracraniana em câncer de pulmão: atualização

AbstractFor early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique.

ResumoO tratamento de escolha para o câncer de pulmão em estádio inicial é a cirurgia. Para os pacientes sem condições clínicas ou que recusam a cirurgia, a radioterapia é a principal opção terapêutica. Apresentamos uma revisão sobre radioterapia estereotáxica extracraniana, uma técnica que vem apresentando resultados bastante promissores nesse grupo de pacientes e que, se disponível, deve ser o tratamento de escolha. Também são apresentados as principais indicações, os aspectos técnicos, resultados e situações especiais relacionados à técnica.

The first private-hospital based proton therapy center in Korea; status of the Proton Therapy Center at Samsung Medical Center

PURPOSE: The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. MATERIALS AND METHODS: The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. RESULTS: The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. CONCLUSION: The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.