Factores predictivos del síndrome de retirada de abirateron / Predictive factors for abiraterone withdrawal syndrome

Introducción y objetivo: El síndrome de retirada de abiraterona (SRA) se caracteriza por un descenso transitorio de PSA tras la discontinuación del tratamiento con acetato de abiraterona (AA) en los pacientes diagnosticados de cáncer de próstata resistente a castración metastásico (CPRCm). El objetivo de nuestro estudio es identificar posibles factores predictivos al diagnóstico que puedan influir en el SRA. Materiales y métodos: Se realizó un estudio retrospectivo de los pacientes que recibieron tratamiento con AA en el Institut Català d'Oncologia - L'Hospitalet entre 2015 y 2017, obteniendo una muestra de 70 pacientes. Resultados: Presentaron SRA 11 pacientes. La edad media al diagnóstico fue 65,73 años y la edad media de presentación 74,18 años. El número de ciclo de tratamiento fue el noveno. La mediana de PSA al diagnóstico fue de 30,5ng/ml; la mediana de PSA en el SRA, 33,24 ng/ml; y la mediana de PSA antes de iniciar otro tratamiento, 15,78 ng/ml. La media de seguimiento tras SRA fue de 8,2 meses. Los factores predictivos del SRA serían PSA elevado (p = 0,002), ISUP ≥ 4 (p = 0,002) y estadio IV al diagnóstico (p < 0,001). El estadio T presenta un riesgo elevado, pero sin significación estadística. Se obtuvo una ABC ROC de 0,84, con un IC 95% entre 0,77 y 0,92 (p < 0,001). Conclusiones: La incidencia del SRA no es despreciable, describiendo respuestas prolongadas tras la retirada del AA, incluso la posibilidad de una mejoría en la supervivencia global. Estos resultados podrían suponer un cambio en el esquema de tratamiento del CPRCm

Introduction and objective: Abiraterone withdrawal syndrome (AWS) is characterized by a transient decrease in the PSA after abiraterone acetate (AA) treatment discontinuation in patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC). The aim of our study is to identify the possible predictive factors of AWS at diagnosis. Materials and methods: We performed a retrospective study of 70 patients treated with AA at the Institut Català d'Oncologia - L'Hospitalet between 2015 and 2017. Results: Eleven patients presented AWS. The mean age at diagnosis was 65.73 years and the mean age of presentation was 74.18 years. Patients were in the ninth treatment cycle. The median PSA was: 30.5 ng/ml at diagnosis, 33.24 ng/ml in the AWS, and 15.78 ng/ml before starting another treatment. The median follow-up period after AWS was 8.2 months. The predictive factors of AWS would be: high PSA (p = 0.002), ISUP ≥ 4 (p = 0.002) and stage IV at diagnosis (p<0.001). Patients with a T stage present high risk, but without statistical significance. An AUC of 0.84 was obtained, with a 95% CI between 0.77 and 0.92 (p < 0.001). Conclusions: The incidence of AWS is not negligible, describing prolonged responses after AA withdrawal, including the possibility of increased overall survival. These results could entail new treatment schemes for mCRPC

Gynecological brachytherapy for postoperative endometrial cancer: dosimetric analysis (Ir-192 vs Co-60)

Introduction. Endovaginal brachytherapy treatment dosimetry differences were studied using Ir-192 or Co-60 sources for postoperative endometrial cancer. Materials and methods. A prospective descriptive study was conducted. Thirty-six dosimetry plans of different patients were studied (15 by Ir-192 and 21 by Co-60). Variables studied included D2cc Rectum, D2cc Bladder, D2cc Sigmoid, dose percentage at point 0 (applicator surface on the top of the cylinder) and dose percentage at point 1 (5 mm deep on the top of the cylinder). A comparative analysis was performed of the values obtained from each variable between Ir-192 and Co-60 treatments. We compared average of each variables between Iridium and Cobalt by T Student for independent samples (SPSS 22). Results. here were no significant differences on using Ir-192 or Co-60 by variables, except for dose percentage at point 1 in which we detected significant differences (Table 1). Discussion. Brachytherapy treatment dosimetry plans are similar using Ir-192 or Co-60, except dose percentage at point 1. In the scientific literature, some differences exist and there are some advantages in using cobalt (AU)

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