Pattern of care in radiotherapy at a University Hospital in Spain: the RENORT project

Purpose RENORT is a novel data mining application developed to extract relevant clinical data from oncology information systems (OIS; ARIA and Mosaiq) used in radiation oncology (RO). Methods/patients We used RENORT to extract demographic and clinical data from the OIS of all patients treated at the RO Department at the General Hospital of Valencia during the year 2019. Results A total of 1158 treatments were performed. The female/male ratio was 39.3%/60.7%, with a mean age of 66 years. The mean waiting time between the treatment decision/proposal to the first visit was 10.1 days. Mean duration of the treatment preparation process was 21 days. Most patients (90.4%) completed treatment within the prescribed time ± 7 days. The most common sites/treatment types were: metastatic/palliative treatments (n = 300; 25.9%), breast (209; 18.0%), genitourinary (195; 16.8%), digestive (116; 10.0%), thoracic (104; 9.0%), head and neck (62; 5.4%), and skin cancer (51; 4.4%). The distribution according to treatment intent was as follows: palliative (n = 266; 23.0%), adjuvant curative (335; 28.9%), radical without adjuvant treatment (229; 19.8%), radical with concomitant treatment (188; 16.2%), curative neoadjuvant (70; 6.0%), salvage radiotherapy (61; 5.3%); and reirradiation (9; 0.8%). The most common treatment techniques were IMRT/VMAT with IGRT (n = 468; 40.4%), 3D-CRT with IGRT (421; 36.4%), SBRT (127; 11.0%), 2DRT (57; 4.9%), and SFRT (56; 4.8%). A mean of 15.9 fractions were administered per treatment. Hypofractionated schemes were used in 100% of radical intent breast and prostate cancer treatments. Conclusions The RENORT application facilitates data retrieval from oncology information systems to allow for a comprehensive determination of the real role of radiotherapy in the treatment of cancer patients. This application is valuable to identify patterns of care and to assess treatment efficacy (AU)

Patterns of treatment failure in patients with prostate cancer treated with 76 80 radiotherapy to the prostate and seminal vesicles

Purpose To assess the pattern of treatment failure in patients with prostate cancer (PCa) treated with radiotherapy (76–80 Gy) ± hormone therapy (HT). We also evaluated the influence of treatment failure on survival outcomes. Methods Retrospective study of patients with PCa (n = 302) treated with radiotherapy (RT) ± HT at our centre between November 1999 and July 2007. The mean patient age was 70.2 years (range 51–87). Distribution by NCCN risk group was low (n = 80, 26.5%), intermediate (n = 86, 28.5%), high (n = 77, 25.5%), and very high (n = 49, 16.2%). Most patients (n = 273, 90.4%) received IMRT at a dose of 76–80 Gy. HT was administered in 237 patients (78.5%), in most cases (n = 167, 55.3%) for < 7 months Results Survival rates at 10 years were: overall survival (OS), 64.3%; biochemical disease-free survival, 83.9%; disease-free survival, 92.5%; and metastasis-free survival (MFS), 94.3%. Biochemical failure (BF) was observed in 55 cases (18.2%), 32 of whom subsequently developed clinical recurrence: metastasis (n = 17, 5.6%), local failure (n = 11, 3.6%), and regional failure (n = 4, 1.3%). The cause of death (n = 159) was intercurrent disease in 115 cases (72.3%), second cancer in 27 (17.0%), and PCa in 17 (10.7%). Biochemical failure-free survival ≤ 24 months was significantly associated with worse OS and MFS (p = 0.0001). Late genitourinary and gastrointestinal toxicity grade ≥ 3 (RTOG) was observed in 18 (6.0%) and 7 (2.3%) patients, respectively. Conclusions The main type of treatment failure after 76–80 Gy of radiotherapy ± HT is local or metastatic. In all cases, biochemical failure occurred prior to treatment failure. BF within 24 months of treatment completion was significantly associated with worse OS and MFS (AU)

Pattern of care in radiotherapy at a University Hospital in Spain: the RENORT project.

PURPOSE: RENORT is a novel data mining application developed to extract relevant clinical data from oncology information systems (OIS; ARIA and Mosaiq) used in radiation oncology (RO). METHODS/PATIENTS: We used RENORT to extract demographic and clinical data from the OIS of all patients treated at the RO Department at the General Hospital of Valencia during the year 2019. RESULTS: A total of 1158 treatments were performed. The female/male ratio was 39.3%/60.7%, with a mean age of 66 years. The mean waiting time between the treatment decision/proposal to the first visit was 10.1 days. Mean duration of the treatment preparation process was 21 days. Most patients (90.4%) completed treatment within the prescribed time ± 7 days. The most common sites/treatment types were: metastatic/palliative treatments (n = 300; 25.9%), breast (209; 18.0%), genitourinary (195; 16.8%), digestive (116; 10.0%), thoracic (104; 9.0%), head and neck (62; 5.4%), and skin cancer (51; 4.4%). The distribution according to treatment intent was as follows: palliative (n = 266; 23.0%), adjuvant curative (335; 28.9%), radical without adjuvant treatment (229; 19.8%), radical with concomitant treatment (188; 16.2%), curative neoadjuvant (70; 6.0%), salvage radiotherapy (61; 5.3%); and reirradiation (9; 0.8%). The most common treatment techniques were IMRT/VMAT with IGRT (n = 468; 40.4%), 3D-CRT with IGRT (421; 36.4%), SBRT (127; 11.0%), 2DRT (57; 4.9%), and SFRT (56; 4.8%). A mean of 15.9 fractions were administered per treatment. Hypofractionated schemes were used in 100% of radical intent breast and prostate cancer treatments. CONCLUSIONS: The RENORT application facilitates data retrieval from oncology information systems to allow for a comprehensive determination of the real role of radiotherapy in the treatment of cancer patients. This application is valuable to identify patterns of care and to assess treatment efficacy.

Patterns of treatment failure in patients with prostate cancer treated with 76-80 Gy radiotherapy to the prostate and seminal vesicles ± hormonotherapy.

PURPOSE: To assess the pattern of treatment failure in patients with prostate cancer (PCa) treated with radiotherapy (76-80 Gy) ± hormone therapy (HT). We also evaluated the influence of treatment failure on survival outcomes. METHODS: Retrospective study of patients with PCa (n = 302) treated with radiotherapy (RT) ± HT at our centre between November 1999 and July 2007. The mean patient age was 70.2 years (range 51-87). Distribution by NCCN risk group was low (n = 80, 26.5%), intermediate (n = 86, 28.5%), high (n = 77, 25.5%), and very high (n = 49, 16.2%). Most patients (n = 273, 90.4%) received IMRT at a dose of 76-80 Gy. HT was administered in 237 patients (78.5%), in most cases (n = 167, 55.3%) for < 7 months RESULTS: Survival rates at 10 years were: overall survival (OS), 64.3%; biochemical disease-free survival, 83.9%; disease-free survival, 92.5%; and metastasis-free survival (MFS), 94.3%. Biochemical failure (BF) was observed in 55 cases (18.2%), 32 of whom subsequently developed clinical recurrence: metastasis (n = 17, 5.6%), local failure (n = 11, 3.6%), and regional failure (n = 4, 1.3%). The cause of death (n = 159) was intercurrent disease in 115 cases (72.3%), second cancer in 27 (17.0%), and PCa in 17 (10.7%). Biochemical failure-free survival ≤ 24 months was significantly associated with worse OS and MFS (p = 0.0001). Late genitourinary and gastrointestinal toxicity grade ≥ 3 (RTOG) was observed in 18 (6.0%) and 7 (2.3%) patients, respectively. CONCLUSIONS: The main type of treatment failure after 76-80 Gy of radiotherapy ± HT is local or metastatic. In all cases, biochemical failure occurred prior to treatment failure. BF within 24 months of treatment completion was significantly associated with worse OS and MFS.

Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 2).

Head and neck cancer is one of the most frequent malignances worldwide. Despite the site-specific multimodality therapy, up to half of the patients will develop recurrence. Treatment selection based on a multidisciplinary tumor board represents the cornerstone of head and neck cancer, as it is essential for achieving the best results, not only in terms of outcome, but also in terms of organ-function preservation and quality of life. Evidence-based international and national clinical practice guidelines for head and neck cancer not always provide answers in terms of decision-making that specialists have to deal with in their daily practice. This is the first Expert Consensus on the Multidisciplinary Approach for Head and Neck Squamous Cell Carcinoma (HNSCC) elaborated by the Spanish Society for Head and Neck Cancer and based on a Delphi methodology. It offers a number of specific recommendations based on the available evidence and the expertise of our specialists to facilitate decision-making of all health-care specialists involved.

Afectación ganglionar como factor pronóstico en el carcinoma localmente avanzado de cérvix / Lymph node involvement as a prognostic factor in locally advanced cervix carcinoma

Propósito: Estudiar los resultados del tratamiento con radioterapia y braquiterapia del carcinoma de cérvix avanzado en función de la afectación ganglionar. Material y métodos: Se analizan 68 pacientes en estadio IIB y IIIB, 16 con ganglios pélvicos afectos por TAC o linfografía, 33 sin afectación y 19 sin estudio previo. Se dieron 50 Gy en pelvis con fotones de 10 MV y dos aplicaciones con braquiteropia de baja tasa. Sólo en 6 casos se hizo RT paraaórtica. Resultados: La supervivencia global a 5 años es 57 por ciento. Con ganglios positivos es 43 por ciento, frente a 60 por ciento sin ganglios afectos (p<0,1). En estadios IIB N + es 15 por ciento frente a 76 por ciento (p<0,01). En estadios IIIB no hay diferencias. El control loco-regional a 5 años es de 60 por ciento en ambos estadios. Con ganglios positivos es 44 por ciento frente a 60 por ciento (p<0,1). En estadio IIB N + es 20 por ciento, y en N - 76 por ciento (p<0,01). En estadio IIIB no hay diferencias significativas. Cuando hay N + hay mayor afectación paraaórtica (44 por ciento frente a 18 por ciento), pero no aumentan las metástasis a distancia (25 por ciento y 24 por ciento), que sí aumentan en estadios IIIB respecto a IIB (29 por ciento frente a 18 por ciento)Conclusiones: Cuando hay ganglios pélvicos afectos se recomienda añadir RT paraaórtica. Con enfermedad voluminosa es preferible asociar RT con QT concomitante para intentar mejorar el control locoregional (AU)

[Pre-operative radiotherapy, conventional or accelerated, for invasive bladder cancer. Objectives and radiation modalities. Results and complications]. / Radioterapia pre-operatoria, convencional o acelerada, en el cáncer vesical invasor. Objectivos y modalidades de irradiación. Resultados y complicaciones.

OBJECTIVE: To present the experience of La Fe Hospital and the Institute of Oncology of Valencia with preoperative radiotherapy for bladder cancer and review the literature. METHODS: The principles of radiotherapy are discussed and the most important series reported in the English literature (Memorial Sloan Kettering, M.D. Anderson, London Institute of Urology and Rotterdam Radiotherapy Institute) and the largest published Spanish series (Ramón y Cajal Hospital) are reviewed. Furthermore, the results achieved in 123 patients treated between 1982 and 1989 at the Urology and Radiotherapeutic Oncology services of La Fe Hospital and the IVO experience with accelerated radiotherapy (20 Gy in 5 fractions) immediately followed by radical cystectomy are presented. RESULTS: The five-year survival ranged from 39% to 66%. Distant metastasis, which occurred in more than 50% of the patients, was the most common cause of failure. Comparison of the complication rates of the different series is difficult to perform. The operative mortality ranged from 2.4% to 10% and was 8% in our series. Preoperative radiotherapy does not appear to increase the number of postoperative complications. By multivariate analysis, lymph node involvement was the only significant factor that influenced survival in our series. CONCLUSIONS: It cannot be concluded from the analysis of the prospective and randomized studies that preoperative radiotherapy improves survival in patients with invasive bladder cancer. However, some authors have reported that patients with T3b tumor might benefit from this therapeutic modality.