ABSTRACT
Background. The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR) + TME. Methods. We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2 years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0-20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V20, V30, V40, V50, mean dose (Dmean), minimum dose (Dmin), D90 (dose received by 90% of the sphincter) and D98. Statistical analysis. The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann-Whitney test. Results. Mean Wexner score was 5.5 points higher in those patients with V20 > 0 compared to those for which V20 = 0 (p = 0.008). In a multivariate regression model, results suggest that the effect of V20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42. Conclusions. In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy (AU)
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Subject(s)
Humans , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Fecal Incontinence/complications , Anal Canal/radiation effects , Chemoradiotherapy/methods , Capecitabine/therapeutic use , Quality of Life , Rectal Neoplasms/complications , Rectal Neoplasms/surgery , Fecal Incontinence/radiotherapy , Anal Canal/pathology , Retrospective Studies , Multivariate AnalysisABSTRACT
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Subject(s)
Adult , Female , Humans , Pregnancy Complications/diagnosis , Lymphangioma, Cystic/complications , Lymphangioma, Cystic/diagnosis , Lymphangioma, Cystic/surgery , Tomography, Emission-Computed/methods , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Complications, Neoplastic , Ultrasonography, Prenatal/methods , Pregnancy Trimester, Second , Retroperitoneal Neoplasms/complications , Retroperitoneal Neoplasms/diagnosisABSTRACT
La metástasis axilar de un carcinoma de mama oculto es una particular forma de presentación del cáncer de mama que ocurre en menos del 1 por ciento de los casos. Su tratamiento todavía es controvertido. La mastectomía, considerada clásicamente el tratamiento de elección, va siendo sustituída por la radioterapia con o sin quimioterapia, con tasas de supervivencia a 5 y 10 años similares. Presentamos dos casos de carcinoma oculto de mama tratados en nuestro hospital. Ambos recibieron radioterapia y quimioterapia tras la linfadenectomía axilar y ambos permanecen asintomáticos y sin evidencia de enfermedad tras un seguimiento de 66 y 42 meses. (AU)
