ABSTRACT
PURPOSE: To determine retrospectively 2-3 year local and regional control (LRC), free-of-disease survival (FDS) and overall survival (OS), as well as summarized toxicities in a group of 31 advanced head-and-neck cancer patients, treated at our institution between 2004 and 2011 with definitive IMRT low-dose concomitant boost, the majority of them with concurrent chemotherapy based on cisplatin. The results are also shown in the sub-group of nasopharyngeal cancer patients (NPC: 15 cases). PATIENTS AND METHODS: Radiological basal and contrasted CT series, MR-CT or PET/CT fused images in the setup position with immobilization mask were registered in simulation therapy patients. Planed doses were: 70 Gy in primary tumor and positive nodes >1 cm; 63 Gy in high-risk areas of microscopic diseases +10 mm safety margin; and 56 Gy in low risk of diseases regional lymph nodes. Treatment was delivered using a Varian 2100 Clinac with sliding windows IMRT. Spinal cord doses were limited to a strict maximum of 45 Gy, and optimization aimed for mean doses in parotid glands below 26 Gy, especially in the contralateral parotid gland. Online DRR-portal X-ray comparison images were taken every day with a deviation module tolerance ≤3 mm. RESULTS: The mean follow-up since IMRT was 34 months (interval: 8-89; median 31 months). Median follow-up in living patients was 22 months. The 2-year rate for global LRC was 64 %, for FDS 61 % and OS 77 %. For the NPC group after 2 years, LRC was 73 %, FDS 73 % and OS 93 %. The 3-year rates were similar. Seven patients died as a consequence of local and/or regional progression (mean time 10 months). Relapses were observed in eight patients (26 %), but only seven could be confirmed by biopsy (22.6 %; mean time to relapse: 8.6 months). Global acute mucositis was 61 % and chronic mucositis was shown in six cases which developed xerostomia (19 %) in the first control after IMRT, but 1 year later it was reduced to only four patients, two Grade 2 and two Grade 1. CONCLUSIONS: No excessive, unwarranted toxicities were observed using concomitant low doses boost in IMRT. High rates of compliance to concurrent chemotherapy were achieved. Late xerostomia associated with this regime decreased 1 year after conclusion of treatment. The implementation of IMRT requires advances in imaging for better tumor delineation; otherwise the physician loses the advantage of dose modulation or faces a risk of geographical miss (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Carcinoma, Squamous Cell/radiotherapy , Head and Neck Neoplasms/radiotherapy , Nasopharyngeal Neoplasms/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Intensity-Modulated , Antineoplastic Agents/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/mortality , Chemoradiotherapy , Cisplatin/therapeutic use , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/mortality , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/mortality , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/mortality , Neoplasm Staging , Retrospective StudiesABSTRACT
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Subject(s)
Humans , Drug Prescriptions , Primary Health Care , Anti-Bacterial Agents , HospitalsABSTRACT
AIMS: To evaluate how well blood pressure (BP) is controlled in the population of persons with hypertension alone and with diabetes, and to evaluate the influence of characteristics of the health care center on the degree of control of BP. Design. Descriptive, cross-sectional, multicenter, retrospective study. SETTING: 31 health centers in Catalonia (Northeastern Spain). Participants. Random sample of 2240 clinical records of patients with hypertension who were seen at 31 different primary care centers in Catalonia between January and December 1996. MAIN OUTCOME MEASURES: Audit of clinical records. We recorded the two most recent BP measurements, and annotations regarding screening for and diagnosis of other cardiovascular risk factors. We also recorded health center and physician characteristics. RESULTS: 495 patients (22.1%) had diabetes in addition to hypertension. 61.2% were women. Mean age was 64.9 years (95% CI, 64.4-65.4 years). In 25.7% of the patients, BP was below 140/90 mmHg (95% CI, 23.9-27.5%), but among patients with diabetes only 6.7% had BP below 130/85 mmHg (95% CI, 4.5-8.9%). Mean systolic and diastolic BP at the end of the study period were higher at teaching centers. Diastolic BP was significantly higher at urban centers and in patients younger than 65 years. Diastolic BP was also higher in patients with at least one associated cardiovascular risk factor, and at centers less than 6 years old, although these differences were not statistically significant. We found no differences according to physician characteristics. CONCLUSIONS: Blood pressure was adequately controlled in few patients with hypertension and diabetes in Catalonia. Associated cardiovascular risk factors, age less than 65 years, and being a patient at a teaching center or an urban center, were associated with a worse degree of BP control.
Subject(s)
Diabetes Complications , Hypertension/complications , Hypertension/prevention & control , Aged , Cross-Sectional Studies , Female , Health Facilities , Humans , Male , Middle Aged , SpainABSTRACT
Objetivo. Valorar el grado de control de la presión arterial (PA) en la población hipertensa e hipertensa y diabética, así como la influencia de las características del centro en este control. Diseño. Estudio descriptivo, transversal, multicéntrico, retrospectivo. Emplazamiento. Un total de 31 centros de salud de Cataluña. Participantes. Muestra aleatoria de 2.240 historias clínicas de pacientes hipertensos de 31 centros de atención primaria de Cataluña, atendidos entre enero y diciembre de 1996.Mediciones principales. Auditoría de historias clínicas. Se recogieron los dos últimos valores de PA y el registro de cribado y diagnóstico de otros factores de riesgo cardiovascular. También se recogieron las características del centro de salud y del médico. Resultados. Cuatrocientos noventa y cinco pacientes (22,1 por ciento) eran además diabéticos. Un 61,2 por ciento era de sexo femenino. La media de edad es de 64,9 años (IC del 95 por ciento, 64,465,4). El 25,7 por ciento de los pacientes presentaba cifras de PA por debajo de 140/90 mmHg (IC del 95 por ciento, 23,9-27,5 por ciento), pero solamente en un 6,7 por ciento de diabéticos eran menores de 130/85 mmHg (IC del 95 por ciento, 4,5-8,9 por ciento). Las cifras de PA sistólica (PAS) y diastólica (PAD) medias al final del período de estudio fueron mayores en los centros docentes. Se observaron PAD significativamente superiores en los centros urbanos y en los pacientes menores de 65 años. También fueron mayores en aquellos pacientes que tenían algún factor de riesgo cardiovascular asociado y en los centros con menos de 6 años de funcionamiento, aunque las diferencias no fueron estadísticamente significativas. No se observaron diferencias según las características del médico. Conclusiones. Existe un bajo grado de reducción de las cifras de PA entre la población hipertensa y diabética de Cataluña. Presentar otros factores de riesgo cardiovascular asociados, tener menos de 65 años y ser atendido en un centro docente y urbano se asocian a peor control tensional (AU)