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
PURPOSE: To analyze the impact of postmastectomy radiotherapy on locoregional control and overall survival in patients with carcinoma breast. MATERIALS AND METHODS: Between 1995 and 2000, 688 patients of carcinoma breast were analyzed. Out of these, 608 received postmastectomy radiotherapy and 80 patients were not given any radiation therapy. At a median follow-up of 67 months, the outcomes studied were locoregional recurrence (LRR), distant metastases, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. RESULTS: The frequency of LRR with or without distant metastases was 8.5%, and distant metastases was seen in 18.7% of patients. On univariate analyses, factors affecting LRR were age < 40 years (0.019), tumor stage ( P = 0.001 ), grade ( P = 0.027 ), pathological nodal status ( P ), deep resection plane (0.041), ER/PR status ( P = 0.032 ) and postmastectomy radiation therapy (PMRT) ( P ). DFS rate was 69% at 5 years. Factors affecting distant metastases were age < 40 years (0.005), tumor stage ( P ), grade ( P = 0.0007 ), pathological nodal status ( P ), extra capsular extension (ECE) ( P = 0.002 ), hormonal therapy ( P ) and PMRT ( P ). The OS rate was 81% at 5 years. Factors affecting OS were tumor stage ( P ), grade ( P = 0.0001 ), pathological nodal status ( P ), ECE ( P = 0.002 ) ER/PR status ( P = 0.008 ), hormonal therapy ( P = 0.001 ) and PMRT ( P = 0.004 ). On multivariate analysis, factors affecting LRR were age ( P = 0.001 ), tumor stage ( P = 0.021 ), deep resection plane (0.003), ECE ( P = 0.022 ) and PMRT ( P = 0.047 ). Factors affecting distant metastases were menopause ( P = 0.044 ), grade ( P = 0.012 ), ECE ( P = 0.017 ) and PMRT ( P = 0.012 ). Factors affecting OS were menopausal status ( P = 0.017 ), tumor stage ( P = 0.029 ), pathological nodal status ( P = 0.011 ) and PMRT ( P = 0.002 ). CONCLUSION: PMRT improves LRR as well as OS in patients with carcinoma breast. Other factors of prognostic importance were menopausal status, tumor stage and pathological nodal status.