Clinical validation of a capnodynamic method for measuring end-expiratory lung volume in critically ill patients.

RATIONALE: End-expiratory lung volume (EELV) is reduced in mechanically ventilated patients, especially in pathologic conditions. The resulting heterogeneous distribution of ventilation increases the risk for ventilation induced lung injury. Clinical measurement of EELV however, remains difficult. OBJECTIVE: Validation of a novel continuous capnodynamic method based on expired carbon dioxide (CO2) kinetics for measuring EELV in mechanically ventilated critically-ill patients. METHODS: Prospective study of mechanically ventilated patients scheduled for a diagnostic computed tomography exploration. Comparisons were made between absolute and corrected EELVCO2 values, the latter accounting for the amount of CO2 dissolved in lung tissue, with the reference EELV measured by computed tomography (EELVCT). Uncorrected and corrected EELVCO2 was compared with total CT volume (density compartments between - 1000 and 0 Hounsfield units (HU) and functional CT volume, including density compartments of - 1000 to - 200HU eliminating regions of increased shunt. We used comparative statistics including correlations and measurement of accuracy and precision by the Bland Altman method. MEASUREMENTS AND MAIN RESULTS: Of the 46 patients included in the final analysis, 25 had a diagnosis of ARDS (24 of which COVID-19). Both EELVCT and EELVCO2 were significantly reduced (39 and 40% respectively) when compared with theoretical values of functional residual capacity (p < 0.0001). Uncorrected EELVCO2 tended to overestimate EELVCT with a correlation r2 0.58; Bias - 285 and limits of agreement (LoA) (+ 513 to - 1083; 95% CI) ml. Agreement improved for the corrected EELVCO2 to a Bias of - 23 and LoA of (+ 763 to - 716; 95% CI) ml. The best agreement of the method was obtained by comparison of corrected EELVCO2 with functional EELVCT with a r2 of 0.59; Bias - 2.75 (+ 755 to - 761; 95% CI) ml. We did not observe major differences in the performance of the method between ARDS (most of them COVID related) and non-ARDS patients. CONCLUSION: In this first validation in critically ill patients, the capnodynamic method provided good estimates of both total and functional EELV. Bias improved after correcting EELVCO2 for extra-alveolar CO2 content when compared with CT estimated volume. If confirmed in further validations EELVCO2 may become an attractive monitoring option for continuously monitor EELV in critically ill mechanically ventilated patients. TRIAL REGISTRATION: clinicaltrials.gov (NCT04045262).

Efficacy and safety of combined 27-G vitrectomy and Ahmed valve using same sclerotomy site for the tube placement: A case series.

We report a retrospective case series describing the feasibility and outcomes of combined 27-G minimally invasive vitrectomy surgery (MIVS) and Ahmed® Glaucoma Valve (AGV) placement. Four eyes of four patients underwent a combined MIVS using 27-G technology and AGV implantation with the tube placement in the vitreous cavity. Preoperative and postoperative data up to 12 months were collected including the type of glaucoma, intraocular pressure (IOP), glaucoma medications, and complications. All AGVs tubes were placed in the vitreous cavity using the same sclerotomy, although a slight wound enlargement was required. After one year, IOP and glaucoma medications were reduced (41.5 ±â€¯19.1-14.5 ±â€¯3.1 mmHg and from 3(3-3) to 1.5 (1.5-3.5). Three patients developed cystoid macular edema. The first-reported cases of combined MIVS-27-G and AGV showed a reduction of IOP and antiglaucoma medication. Placing the tube using the same sclerotomy location is feasible but a slight enlargement may be required.

Randomized placebo-controlled phase II trial of high-dose melatonin mucoadhesive oral gel for the prevention and treatment of oral mucositis in patients with head and neck cancer undergoing radiation therapy concurrent with systemic treatment.

PURPOSE: The objective of this trial was to evaluate the safety and efficacy of melatonin oral gel mouthwashes in the prevention and treatment of oral mucositis (OM) in patients treated with concurrent radiation and systemic treatment for head and neck cancer. METHODS: Randomized, phase II, double-blind, placebo-controlled trial (1:1 ratio) of 3% melatonin oral gel mouthwashes vs. placebo, during IMRT (total dose ≥ 66 Gy) plus concurrent Q3W cisplatin or cetuximab. Primary endpoint: grade 3-4 OM or Severe Oral Mucositis (SOM) incidence by RTOG, NCI, and a composite RTOG-NCI scales. Secondary endpoints: SOM duration and grade 2-4 OM or Ulcerative Oral Mucositis (UOM) incidence and duration. RESULTS: Eighty-four patients were included in the study. Concurrent systemic treatments were cisplatin (n = 54; 64%) or cetuximab (n = 30; 36%). Compared with the placebo arm, RTOG-defined SOM incidence was numerically lower in the 3% melatonin oral gel arm (53 vs. 64%, P = 0.36). In patients treated with cisplatin, assessed by the RTOG-NCI composite scale, both SOM incidence (44 vs. 78%; P = 0.02) and median SOM duration (0 vs. 22 days; P = 0.022) were significantly reduced in the melatonin arm. Median UOM duration assessed by the RTOG-NCI scale was also significantly shorter in the melatonin arm (49 vs. 73 days; P = 0.014). Rate of adverse events and overall response rate were similar between the two arms. CONCLUSIONS: Treatment with melatonin oral gel showed a consistent trend to lower incidence and shorter SOM duration and shorter duration of UOM. These results warrant further investigation in phase III clinical trial.

Eficacia de la hipnosis en psicologia del deporte. Importancia de la comunicación y estudio de casos / Eficácia da hipnose na psicologia do esporte. Importância da comunicação e estudos de caso / Efficacy of hypnosis in sports psychology. Importance of communication and study of cases

En la historia del desarrollo de los procedimientos médicos y psicológicos, la hipnosis ha protagonizado un papel destacado, siendo una intervención clínica valiosa en el tratamiento de una extensa variedad de problemas. A pesar de ello no se ha librado de controversias y mitos acerca de su naturaleza. En el presente trabajo se revisa el desarrollo histórico de la hipnosis y los modelos explicativos más relevantes, desde aquellos que la consideran un estado alterado de conciencia hasta los que defienden que los fenómenos hipnóticos pueden ser explicados por las mismas variables que la conducta y la experiencia no hipnótica. También se revisan algunas de las definiciones que han surgido desde los distintos paradigmas, así como la evidencia empírica de su eficacia, comprobándose que cuando es utilizada como coadyuvante de los tratamientos médicos y psicológicos incrementa la eficacia de los mismos, siendo de especial relevancia la relación de comunicación que se establece entre clínico y paciente. Se finaliza con una revisión de su aplicación en el ámbito del deporte y la presentación de un estudio de casos (3 atletas y 1 futbolista) en los que se utiliza hipnosis coadyuvante con otras técnicas. En todos los casos se logran resultados óptimos (AU)

In the history of the development of medical and psychological procedures, hypnosis has played a prominent role, being a valuable clinical intervention in the treatment of a wide variety of problems. However, it has not been spared controversy and myths about its nature. In the present work we review the historical development of hypnosis and the most relevant explanatory models from those who consider it an altered state of consciousness to those who argue that hypnotic phenomena can be explained by the same variables as behavior and experience Not hypnotic. We also review some of the definitions that have emerged from the different paradigms, as well as the empirical evidence of their effectiveness, proving that when used as an adjunct to medical and psychological treatments increases their effectiveness, being of special relevance the relationship Of communication between clinician and patient. It ends with a review of its application in the field of sport and the presentation of a case study (3 athletes and 1 player) in which hypnosis is used adjuvant with other techniques. In all cases optimal results are achieved (AU)

Na história do desenvolvimento de procedimentos médicos e psicológicos, a hipnose tem desempenhado um papel proeminente, sendo uma intervenção clínica valiosa no tratamento de uma grande variedade de problemas. Apesar disso, não foi poupado controvérsias e mitos sobre sua natureza. No presente trabalho, analisamos o desenvolvimento histórico da hipnose e os modelos explicativos mais relevantes, daqueles que a consideram um estado de consciência alterado para aqueles que defendem esses fenômenos hipnóticos podem ser explicados pelas mesmas variáveis que o comportamento e a experiência. não hipnótico. Também analisamos algumas das definições que surgiram de diferentes paradigmas, bem como a evidência empírica de sua eficácia, provando que, quando utilizado como coadjuvante de tratamentos médicos e psicológicos, aumenta a eficácia deles, sendo de relevância especial o relacionamento de comunicação estabelecida entre clínico e paciente. Ele termina com uma revisão de sua aplicação no campo do esporte e a apresentação de um estudo de caso (3 atletas e 1 jogador de futebol) em que a hipnose é usada em conjunto com outras técnicas. Em todos os casos, resultados óptimos são alcançados (AU)

Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1).

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 must 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 several specific recommendations based on the available evidence and the expertise of our specialists to facilitate decision-making of all health-care specialists involved.

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.

Estudio comparativo en la definición del volumen de tratamiento en radioterapia con «Slow TC Scan» vs. 4D PET/TC Scan en estadios iniciales de cáncer de pulmón de célula no pequeña / A comparative study of the target volume definition in radiotherapy with «Slow CT Scan» vs. 4D PET/CT Scan in early stages non-small cell lung cancer

Objetivos. Evaluar el uso de la 4D PET/TC para capturar el movimiento respiratorio en comparación con la «slow»-TC (TCs), en el procedimiento de planificación de radioterapia. Material y métodos. Se ha incluido a 25 pacientes diagnosticados de estadio inicial de cáncer de pulmón de célula no pequeña (NSCLC) médicamente inoperable. A cada paciente se le realizó una TCs (4 s/corte) y una 4D PET/TC. La idoneidad de cada técnica en la captura del movimiento respiratorio fue evaluada comparando el volumen definido por cada una de ellas: internal target volumen (ITV) 4D y el ITVslow, con relación a la suma de los volúmenes de la 4D PET/TC y la TCs (ITVsuma). La máxima diferencia entre el volumen definido por cada técnica respecto al volumen suma fue evaluada en una proyección antero-posterior y otra lateral. Resultados. Los volúmenes generados con 4D PET/TC consiguen una definición más precisa del ITV que los volúmenes obtenidos con TCs (ITV4D/ITVsuma 78% vs. ITVslow/ITVsuma 63%). En general, los volúmenes de la 4D PET/TC son de mayor tamaño (19,9 vs. 16,3 cc). El ITV4D muestra menor diferencia con el ITVsuma en los ejes cráneo-caudal y antero-posterior respecto al ITVslow y capta el movimiento de forma más exacta. La máxima diferencia observada es de 0,36mm en la 4D PET/TC y de 0,57mm en la TCs en el eje antero-posterior. Conclusiones. La planificación con 4D PET/TC en comparación con TCs permite cuantificar el movimiento respiratorio del tumor y mejorar la planificación de radioterapia en estadios iniciales de NSCLC (AU)

Objectives. To evaluate the use of 4D PET/CT to quantify tumor respiratory motion compared to the «Slow»-CT (CTs) in the radiotherapy planning process. Material and methods. A total of 25 patients with inoperable early stage non small cell lung cancer (NSCLC) were included in the study. Each patient was imaged with a CTs (4s/slice) and 4D PET/CT. The adequacy of each technique for respiratory motion capture was evaluated using the volume definition for each of the following: Internal target volume (ITV) 4D and ITVslow in relation with the volume defined by the encompassing volume of 4D PET/CT and CTs (ITVtotal). The maximum distance between the edges of the volume defined by each technique to that of the total volume was measured in orthogonal beam's eye view. Results. The ITV4D showed less differences in relation with the ITVtotal in both the cranio-caudal and the antero-posterior axis compared to the ITVslow. The maximum differences were 0.36mm in 4D PET/CTand 0.57mm in CTs in the antero-posterior axis. 4D PET/CT resulted in the definition of more accurate (ITV4D/ITVtotal 0.78 vs. ITVs/ITVtotal 0.63), and larger ITVs (19.9 cc vs. 16.3 cc) than those obtained with CTs. Conclusion. Planning with 4D PET/CT in comparison with CTs, allows incorporating tumor respiratory motion and improving planning radiotherapy of patients in early stages of lung cancer (AU)

A comparative study of the target volume definition in radiotherapy with «Slow CT Scan¼ vs. 4D PET/CT Scan in early stages non-small cell lung cancer. / Estudio comparativo en la definición del volumen de tratamiento en radioterapia con «Slow TC Scan¼ vs. 4D PET/TC Scan en estadios iniciales de cáncer de pulmón de célula no pequeña.

OBJECTIVES: To evaluate the use of 4D PET/CT to quantify tumor respiratory motion compared to the «Slow¼-CT (CTs) in the radiotherapy planning process. MATERIAL AND METHODS: A total of 25 patients with inoperable early stage non small cell lung cancer (NSCLC) were included in the study. Each patient was imaged with a CTs (4s/slice) and 4D PET/CT. The adequacy of each technique for respiratory motion capture was evaluated using the volume definition for each of the following: Internal target volume (ITV) 4D and ITVslow in relation with the volume defined by the encompassing volume of 4D PET/CT and CTs (ITVtotal). The maximum distance between the edges of the volume defined by each technique to that of the total volume was measured in orthogonal beam's eye view. RESULTS: The ITV4D showed less differences in relation with the ITVtotal in both the cranio-caudal and the antero-posterior axis compared to the ITVslow. The maximum differences were 0.36mm in 4D PET/CTand 0.57mm in CTs in the antero-posterior axis. 4D PET/CT resulted in the definition of more accurate (ITV4D/ITVtotal 0.78 vs. ITVs/ITVtotal 0.63), and larger ITVs (19.9 cc vs. 16.3 cc) than those obtained with CTs. CONCLUSION: Planning with 4D PET/CT in comparison with CTs, allows incorporating tumor respiratory motion and improving planning radiotherapy of patients in early stages of lung cancer.

RAS mutations and cetuximab in locally advanced rectal cancer: results of the EXPERT-C trial.

BACKGROUND: RAS mutations predict resistance to anti-epidermal growthfactor receptor (EGFR) monoclonal antibodies in metastatic colorectal cancer. We analysed RAS mutations in 30 non-metastatic rectal cancer patients treated with or without cetuximab within the 31 EXPERT-C trial. METHODS: Ninety of 149 patients with tumours available for analysis were KRAS/BRAF wild-type, and randomly assigned to capecitabine plus oxaliplatin (CAPOX) followed by chemoradiotherapy, surgery and adjuvant CAPOX or the same regimen plus cetuximab (CAPOX-C). Of these, four had a mutation of NRAS exon 3, and 84 were retrospectively analysed for additional KRAS (exon 4) and NRAS (exons 2/4) mutations by using bi-directional Sanger sequencing. The effect of cetuximab on study end-points in the RAS wild-type population was analysed. RESULTS: Eleven (13%) of 84 patients initially classified as KRAS/BRAF wild-type were found to have a mutation in KRAS exon 4 (11%) or NRAS exons 2/4 (2%). Overall, 78/149 (52%) assessable patients were RAS wild-type (CAPOX, n=40; CAPOX-C, n=38). In this population, after a median follow-up of 63.8months, in line with the initial analysis, the addition of cetuximab was associated with numerically higher, but not statistically significant, rates of complete response (15.8% versus 7.5%, p=0.31), 5-year progression-free survival (75.5% versus 67.5%, hazard ratio (HR) 0.61, p=0.25) and 5-year overall survival (83.8% versus 70%, HR 0.54, p=0.20). CONCLUSIONS: RAS mutations beyond KRAS exon 2 and 3 were identified in 17% of locally advanced rectal cancer patients. Given the small sample size, no definitive conclusions on the effect of additional RAS mutations on cetuximab treatment in this setting can be drawn and further investigation of RAS in larger studies is warranted.

Historia natural del macroaneurisma arterial de nervio óptico / Natural history of an optic disc macroaneurysm

CASO CLÍNICO: Varón de 76 años con agudeza visual (AV) de 0,05, que presentaba retinopatía hipertensiva, con hemorragias y manchas algodonosas en haz papilomacular y edema macular. La angiografía fluoresceínica mostró una dilatación sacular hiperfluorescente arterial correspondiente con un macroaneurisma papilar y la tomografía de coherencia óptica (OCT), edema macular. A los 2 meses, la AV mejoró a 0,7, con cierre espontáneo del macroaneurisma y resolución del edema macular. DISCUSIÓN: Los macroaneurismas papilares son infrecuentes y presentan dificultades en su diagnóstico. No existe ningún tratamiento seguro y eficaz y, en concordancia con los pocos casos publicados, la involución espontánea permite la recuperación visual

CASE REPORT: A 75-year old man with reduced vision in his left eye (0.05) presented with hypertensive retinopathy, retinal haemorrhages and cotton wool spots in the papillomacular bundle, as well as macular oedema. Fluorescein angiography showed a saccular hyperfluorescent lesion corresponding to arterial macroaneurysm on the optic disc, with the optical coherence tomography demonstrating macular oedema. At 2 months follow-up, vision had improved to 0.7 with spontaneous closure of the macroaneurysm and resolution of the macular oedema. DISCUSSION: Arterial macroaneurysms on the optic disc are unusual and are difficult to diagnose clinically. There is no safe and effective treatment, and our case, as the few single cases reported, showed that they can spontaneously close and enable visual function to recover

[Natural history of an optic disc macroaneurysm]. / Historia natural del macroaneurisma arterial de nervio óptico.

CASE REPORT: A 75-year old man with reduced vision in his left eye (0.05) presented with hypertensive retinopathy, retinal haemorrhages and cotton wool spots in the papillomacular bundle, as well as macular oedema. Fluorescein angiography showed a saccular hyperfluorescent lesion corresponding to arterial macroaneurysm on the optic disc, with the optical coherence tomography demonstrating macular oedema. At 2 months follow-up, vision had improved to 0.7 with spontaneous closure of the macroaneurysm and resolution of the macular oedema. DISCUSSION: Arterial macroaneurysms on the optic disc are unusual and are difficult to diagnose clinically. There is no safe and effective treatment, and our case, as the few single cases reported, showed that they can spontaneously close and enable visual function to recover.

Diagnóstico tardío de obstrucción de arteria oftálmica por mixoma atrial / Delayed diagnosis of ophthalmic artery obstruction due to atrial myxoma

Caso clínico: Una mujer de 56 años con mixoma atrial presentó una agudeza visual de no percepción luminosa tras la obstrucción aguda de la arteria oftálmica (OAO) asociada a accidente vascular cerebral. Tardíamente desarrolló cambios pigmentarios retinianos por infartos coroideos, una característica que diferencia la OAO de la obstrucción de arteria central de la retina. Discusión: La obstrucción simultánea de las circulaciones retiniana y coroidea se observa en la OAO. Debe sospecharse la presencia de un mixoma atrial en aquellos pacientes con una OAO asociada a accidente vascular cerebral. Deben realizarse estudios sistémicos para encontrar la etiología de la OAO (AU)

Case report: A 56 year old woman with atrial myxoma presented with a visual acuity of no light perception after acute ophthalmic artery obstruction (OAO) associated with stroke. She developed late retinal pigmentary changes due choroidal infarction, typical of the OAO. Discussion: Simultaneous obstruction of the retinal and choroidal circulation was observed in the OAO. Atrial myxoma should be suspected in patients who suffer from OAO associated with stroke. Systemic studies should be performed to find the origin of OAO (AU)

[Delayed diagnosis of ophthalmic artery obstruction due to atrial myxoma]. / Diagnóstico tardío de obstrucción de arteria oftálmica por mixoma atrial.

CASE REPORT: A 56 year old woman with atrial myxoma presented with a visual acuity of no light perception after acute ophthalmic artery obstruction (OAO) associated with stroke. She developed late retinal pigmentary changes due choroidal infarction, typical of the OAO. DISCUSSION: Simultaneous obstruction of the retinal and choroidal circulation was observed in the OAO. Atrial myxoma should be suspected in patients who suffer from OAO associated with stroke. Systemic studies should be performed to find the origin of OAO.

Rupatadine improves nasal symptoms, quality of life (ESPRINT-15) and severity in a subanalysis of a cohort of Spanish allergic rhinitis patients.

BACKGROUND: According to current guidelines, new second-generation oral Hi-antihistamines, as well as intranasal corticosteroids (ICSs), are recommended for the treatment of allergic rhinitis (AR) in adults and children. OBJECTIVE: To assess changes in AR severity, in addition to nasal symptoms and health-related quality of life (HRQoL), after 4 weeks of treatment with rupatadine in a cohort of AR patients. METHODS: A subanalysis of a longitudinal, observational, prospective, multicenter Spanish study was carried out in spring-summer 2007. Enrolled patients had a clinical diagnosis of AR of at least 2 years' evolution, a total nasal symptom score (TNSS) of at least 5, and had not received antihistamines in the previous week or ICSs in the previous 2 weeks. HRQoL (ESPRINT-15 questionnaire), disease severity (using both the original and modified Allergic Rhinitis and its Impact on Asthma [ARIA] classifications), and nasal symptoms (TNSS) were measured at baseline and after 4 weeks of rupatadine treatment. RESULTS: Data from a cohort of 360 patients treated with rupatadine were analyzed (57.2% women, 42.5% with intermittent AR, 36.4% with asthma, and 61.7% with conjunctivitis). After 4 weeks of treatment, the patients showed a significantly lower mean (SD) TNSS (8.2 [1.9] vs 3.1 [2.1], P < .001), a significant improvement in HRQoL (3.0 [1.2] vs 1.0 [0.9], P < .001) and significantly reduced AR severity (P < .0001). CONCLUSIONS: In addition to an improvement in nasal symptoms and HRQoL, rupatadine reduced AR severity after 4 weeks of treatment.

Evidence in medulloblastomas.

Medulloblastoma is the most common infratentorial malignant tumour under 15 years of age. In recent protocols, the patients are stratified for treatment in standard risk or high risk, according to the clinical variables as age, localized or disseminated disease, degree of surgical resection and more recently expected biological behaviour based on retrospective and prospective studies of former samples analyzed. The objectives for future treatments are reduce morbidity without jeopardizing survival.

Evidence in medulloblastomas

Medulloblastoma is the most common infratentorial malignant tumour under 15 years of age. In recent protocols, the patients are stratified for treatment in standard risk or high risk, according to the clinical variables as age, localized or disseminated disease, degree of surgical resection and more recently expected biological behaviour based on retrospective and prospective studies of former samples analyzed. The objectives for future treatments are reduce morbidity without jeopardizing survival (AU)

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Out-of-protocol concurrent use of cisplatin and radiation therapy in locally advanced cervical cancer: feasibility and survival.

PURPOSE OF INVESTIGATION: We assessed the feasibility, response rates, and overall survival of patients with locally advanced cervical cancer treated with cisplatin-based chemotherapy during radiation therapy on an out-of-protocol basis. METHODS: Sixty-nine consecutive newly diagnosed untreated patients with locally advanced cervical cancer who received chemoradiation between 1999 and 2003 were retrospectively reviewed. Treatment consisted in external beam radiation followed by one 137-cessium intracavitary application. Cisplatin was administered for six weeks during external beam radiation. RESULTS: Treatment was well tolerated, although 52 patients presented some degree of acute adverse toxicity (gastrointestinal 65%, hematological 48%, genitourinary 10%). The 3-year survival rate was 61.8% (95% CI 54.5-69.0), with a mean 41.8 months (95% CI 35.7-48.3). Overall survival after adjusting by FIGO Stage IB2-IIA and IIB-IVA was 73.9% and 50%, respectively (p = 0.1839). Overall survival according to Stages IB2-IIb and III-IVA was 74.8% and 34.9%, respectively (P = 0.0376). CONCLUSION: In patients with locally advanced cervical cancer, adding a weekly regimen of cisplatin to standard pelvic radiation in an out-of-protocol basis is feasible, effective, and showed no unexpected toxicity.