Cervical Cancer in Mexico: From a Renowned Vaccination Program to Unfulfilled Needs in Treatment Access.

Mexico's national human papillomavirus (HPV) vaccination program was established in 2008, providing free access to HPV vaccines and quickly becoming an immense success story, achieving significant coverage among young Mexican females. However, despite these efforts and notable achievements, cervical cancer caused mainly by HPV remains a challenging issue among Mexican women aged 15 years or older. A critical obstacle faced by women in the country is a lack of early detection and screening resources, coupled with delays in diagnosis and treatment, exacerbated by the poor distribution of already insufficient healthcare resources. This situation creates adverse conditions for the female demographic in the country. Our editorial aims to draw attention to the urgent need to improve access to adequate prevention, screening, and treatment for cervical cancer patients in Mexico, advocating for a collective effort between the Mexican government, public health professionals, and civil society.

Radiotherapy for the treatment of pituitary adenomas: A dosimetric comparison of three planning techniques.

AIM: Our goal was to compare conformal 3D (C3D) radiotherapy (RT), modulated intensity RT (IMRT), and volumetric modulated arc therapy (VMAT) planning techniques in treating pituitary adenomas. BACKGROUND: RT is important for managing pituitary adenomas. Treatment planning advances allow for higher radiation dosing with less risk of affecting organs at risk (OAR). MATERIALS AND METHODS: We conducted a 5-year retrospective review of patients with pituitary adenoma treated with external beam radiation therapy (C3D with flattening filter, flattening filter-free [FFF], IMRT, and VMAT). We compared dose-volume histogram data. For OARs, we recorded D2%, maximum, and mean doses. For planning target volume (PTV), we registered V95%, V107%, D95%, D98%, D50%, D2%, minimum dose, conformity index (CI), and homogeneity index (HI). RESULTS: Fifty-eight patients with pituitary adenoma were included. Target-volume coverage was acceptable for all techniques. The HI values were 0.06, IMRT; 0.07, VMAT; 0.08, C3D; and 0.09, C3D FFF (p < 0.0001). VMAT and IMRT provided the best target volume conformity (CI, 0.64 and 0.74, respectively; p < 0.0001). VMAT yielded the lowest doses to the optic pathway, lens, and cochlea. The position of the neck in extreme flexion showed that it helps in planning mainly with VMAT by allowing only one arc to be used and achieving the desired conformity, decreasing the treatment time, while allowing greater protection to the organs of risk using C3D, C3DFFF. CONCLUSIONS: Our results confirmed that EBRT in pituitary adenomas using IMRT, VMAT, C3D, C3FFF provide adequate coverage to the target. VMAT with a single arc or incomplete arc had a better compliance with desired dosimetric goals, such as target coverage and normal structures dose constraints, as well as shorter treatment time. Neck extreme flexion may have benefits in treatment planning for better preservation of organs at risk. C3D with extreme neck flexion is an appropriate treatment option when other treatment techniques are not available.

[Clinical evaluation of patients with breast cancer and pregnancy]. / Evaluación clínica de pacientes con cáncer de mama asociado con el embarazo.

BACKGROUND: Breast cancer is the second most common malignancy diagnosed in pregnancy. Breast cancer in pregnancy represents a challenge in diagnosis as well as in treatment. OBJECTIVE: To evaluate clinically patients with breast cancer in pregnancy. METERIAL AND METHODS: Retrospective, transversal, descriptive study was done in which we enrolled women with breast cancer and pregnancy from the outpatient clinic of medical oncology of a tertiary care center hospital. Statistical analysis: descriptive statistics. RESULTS: The variables of 15 clinical records were examined, median age 33.3 ± 5.5 years, tobacco use 3/15, oral contraceptives use 2/15, age at first birth 25.8 ± 7 years, breastfed 4/15. The initial medical evaluation was done 7.5 ± 7.7 months after the onset of symptoms, the diagnosis was made with trucut biopsy in 9/15 of patients, excisional biopsy 4/15 and fine needle aspiration biopsy 2/15. Clinical stage was IIA 3/15, IIIA 8/15, IIIB 3/15 and IV 1/15. Six patients were treated with chemotherapy during pregnancy in the second and third trimester and three with surgical treatment. There were no fetal deaths related to treatment. Response to treatment: 8/15 are disease-free, 5/15 progressed to death and 2/15 had bone metastasis. CONCLUSION: Even major cancer centers have limited experience with breast cancer in pregnancy. Medical and surgical treatment should not be differed. More prospective studies are needed to assess factors related to treatment and prognosis.