Comparison of different breast planning techniques and algorithms for radiation therapy treatment.

This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques--forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT--and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques--f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART - were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.

International exchange program between medical schools: the relevance of a clinical research training in nutrition / Programa de intercambio internacional entre estudiantes de medicina: la relevancia de la formación en investigación clínica en nutrición

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Tracheal chondrosarcoma

Tracheal chondrosarcoma are rare diseases, with only 15 cases previously described in the literature between 1959 and 2008. Here we present a rare case of tracheal chondrosarcoma and a review of the literature. Our patient, a 72-year-old man, had progressive throat pain for 2 years before diagnosis. Clinical and imaging investigation revealed a giant tracheal mass that was partially debulked by laser for symptomatic relief. Histologically, the mass was characterized as a low-grade tracheal chondrosarcoma. The patient underwent external-beam radiotherapy (EBRT) and received 60 Gy. At the time this report was written, 7 years after the end of the treatment, the patient was alive and asymptomatic without evidence of locoregional disease. This case and some described in the literature demonstrate the value of EBRT as a single treatment modality in achieving local control. More experience is required to establish the definitive role of radiotherapy in low-grade tracheal chondrosarcoma (AU)

Nutritional status and eating pattern in prostate cancer patients.

BACKGROUND: Prostate cancer is the second most common cancer in men worldwide. Differences in prostate cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among men diagnosed with prostate cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. PATIENTS & METHODS: Throughout 2006, 87 men with prostate cancer were included. EVALUATIONS: weight & height to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bioimpedance analysis (BF-306), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. RESULTS: Mean age was 69+/-7 (46-85) years; 74 (84.1%) patients were in stage II, 5 (5.7%) in stage I & 9 (10.2%) in stage III; 39(45%) patients had a Gleason score>or=7. Regarding nutritional status, 78 (89%) patients were overweight/obese, 84 (97%) had a body fat above the maximum limit (>25%) and 43 (49%) had a waist circumference>102 cm (prevalence analysis: p<0.05). Univariate analysis did not show any association between Gleason Score, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat and aggressive Gleason scores (p<0.002), such variables worsened with age. Food frequency analysis showed a low consumption of n-3 fatty acids sources as well as vegetables and whole grain cereals and a correlation between low yogurt and vegetables intake with more aggressive Gleason scores was found (p<0.05). CONCLUSION: Our findings show a high prevalence of obesity, excessive body and abdominal fat and diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase!

Body fat and poor diet in breast cancer women.

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Differences in breast cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity, excess body fat and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among women diagnosed with breast cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. PATIENTS AND METHODS: Throughout 2006, 71 consecutive women with breast cancer were included. EVALUATIONS: weight (kg) & height (m), determined with a SECA(R) floor scale+stadiometer to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bio-impedance analysis (BF-306), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. RESULTS: Mean age was 60+/-12 (36-90) years. Invasive ductal carcinoma was the most frequent histology (68%), p<0.05. Most patients were in stage I (30%) or stage IIA (25%) of disease vs IIB (10%), IIIB (4%), IV (4%) or others (21%), p<0.05. Regarding nutritional status, 82% were overweight/obese; 89% of patients had a %body fat mass above the maximum limit of 30% vs only 8 (11%) with %body fat within normal range (p<0.002); 62% pts had a waist circumference>88 cm (prevalence analysis: p<0.04), and 61% of pts had gained weight after diagnosis. Univariate analysis did not show any association between histology, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat & aggressive histologies (p<0.005). Food frequency analysis showed a low intake of vegetables and whole grain cereals rich in complex carbohydrates (sources of fibre and phytochemicals), of fatty fish & nuts, primary sources of n-3 PUFA's and a high intake of saturated fat; more aggressive histologies were correlated with low intake of green leafy vegetables (p=0.05) and n-3 fatty acids food sources (p=0.01). CONCLUSIONS: Our findings show a vast prevalence & homogeneous pattern of overweight/obesity, excessive body and abdominal fat, as well as weight gain after diagnosis, combined with diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase.

Nutritional status and eating pattern in prostate cancer patients / Estado nutricional y tipo de alimentación en pacientes con cáncer de próstata

Background: Prostate cancer is the second most common cancer in men worldwide. Differences in prostate cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among men diagnosed with prostate cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. Patients & methods: Throughout 2006, 87 men with prostate cancer were included. Evaluations: weight & height to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bioimpedance analysis (BF-306®), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. Results: Mean age was 69 ± 7 (46-85) years; 74 (84.1%) patients were in stage II, 5 (5.7%) in stage I & 9 (10.2%) in stage III; 39(45%) patients had a Gleason score ≥ 7. Regarding nutritional status, 78 (89%) patients were overweight/obese, 84 (97%) had a body fat above the maximum limit (> 25%) and 43 (49%) had a waist circumference > 102 cm (prevalence analysis: p < 0.05). Univariate analysis did not show any association between Gleason Score, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat and aggressive Gleason scores (p < 0.002), such variables worsened with age. Food frequency analysis showed a low consumption of n-3 fatty acids sources as well as vegetables and whole grain cereals and a correlation between low yogurt and vegetables intake with more aggressive Gleason scores was found (p < 0.05). Conclusion: Our findings show a high prevalence of obesity, excessive body and abdominal fat and diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase! (AU)

Introducción: el cáncer de próstata es el segundo en frecuencia en hombres en el mundo. Las diferencias en la incidencia del cáncer de próstata sugieren un papel significativo de los factores ambientales en su etiología: se ha sugerido la obesidad, adiposidad central y algunos factores dietéticos como factores de riesgo. Objetivos: este estudio piloto se proponía analizar el patrón del estado nutricional, la grasa corporal y el consumo dietético habitual en hombres diagnosticados de cáncer de próstata y remitidos de forma consecutiva al Servicio de Radioterapia del Hospital Universitario de Santa María. Pacientes y métodos: a lo largo de 2.006, se incluyeron 87 hombres con cáncer de próstata. Evaluaciones: peso y talla para calcular el índice de masa corporal (IMC), la circunferencia de la cintura, el % de grasa corporal mediante análisis bipolar manual de bioimpedancia (BF-306®), el cuestionario Food Frequency Questionnaire validado en su versión portuguesa para valorar el consumo dietético habitual. Se emplearon los análisis de frecuencia y la prueba U de Mann-Whitney para evaluar la prevalencia y las asociaciones. Resultados y discusión: la edad media fue de 69 ± 7 (46-85) años; 74 (84,1%) pacientes estaban en estadio II, 5 (5,7%), en estadio I y 9 (10,2%) en estadio III; 39 (45%) pacientes tenían una puntuación de Gleason ≥ 7. Con respecto al estado nutricional, 78 (89%) pacientes eran obesos o tenían sobrepeso, 84 (97%) tenían grasa corporal por encima del límite máximo (>25%) y en 43 (49%) la circunferencia de la cintura era > 102 cm (análisis de prevalencia: p < 0,05). El análisis univariable no mostró ninguna asociación entre la puntuación de Gleason, el IMC, el % de grasa corporal ni la circunferencia de la cintura; el análisis multivariado mostró una asociación entre un mayor IMC, el % de grasa corporal y puntuaciones de Gleason malas (p < 0,002); estas variables empeoraban con al edad. El análisis de frecuencia de alimentos mostró un consumo bajo de fuentes de ácidos grasos n-3 así como de vegetales y de cereales integrales, y se encontró una correlación entre un consumo bajo de yogur y vegetales y unas peores puntuaciones de Gleason (p < 0,05). Conclusión: nuestros hallazgos muestran un prevalencia elevada de obesidad, exceso de grasa corporal y abdominal y las dietas deficientes en nutrientes protectores. ¡Se requieren investigaciones adicionales puesto que las tasas de cáncer en Portugal siguen aumentando! (AU)

Body fat and poor diet in breast cancer women / Grasa corporal y mala alimentación en mujeres con cáncer de mama

Background: Breast cancer is the most common cancer in women worldwide. Differences in breast cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity, excess body fat and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among women diagnosed with breast cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. Patients and methods: Throughout 2006, 71 consecutive women with breast cancer were included. Evaluations: weight (kg) & height (m), determined with a SECA® floor scale + stadiometer to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bio-impedance analysis (BF-306®), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. Results: Mean age was 60 ± 12 (36-90) years. Invasive ductal carcinoma was the most frequent histology (68%), p < 0.05. Most patients were in stage I (30%) or stage IIA (25%) of disease vs IIB (10%), IIIB (4%), IV (4%) or others (21%), p < 0.05. Regarding nutritional status, 82% were overweight/obese; 89% of patients had a %body fat mass above the maximum limit of 30% vs only 8 (11%) with %body fat within normal range (p < 0.002); 62% pts had a waist circumference > 88 cm (prevalence analysis: p < 0.04), and 61% of pts had gained weight after diagnosis. Univariate analysis did not show any association between histology, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat & aggressive histologies (p < 0.005). Food frequency analysis showed a low intake of vegetables and wholegrain cereals rich in complex carbohydrates (sources of fibre and phytochemicals), of fatty fish & nuts, primary sources of n-3 PUFA's and a high intake of saturated fat; more aggressive histologies were correlated with low intake of green leafy vegetables (p =0.05) and n-3 fatty acids food sources (p = 0.01). Conclusions: Our findings show a vast prevalence & homogeneous pattern of overweight/obesity, excessive body and abdominal fat, as well as weight gain after diagnosis, combined with diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase (AU)

Antecedentes: el cáncer de mama es el cáncer más frecuente en mujeres en todo el mundo. Las diferencias en la incidencia de cáncer de mama sugieren un papel significativo de los factores ambientales en su etiología: se han propuesto la obesidad, la adiposidad central, el exceso de grasa corporal y algunos factores dietéticos como factores de riesgo. El propósito de este estudio piloto fue analizar el patrón del estado nutricional, la grasa corporal y consumo dietético habitual en mujeres diagnosticadas de cáncer de mama y remitidas de forma consecutiva al Servicio de Radioterapia del Hospital Universitario de Santa María. Pacientes y métodos: A lo largo de 2.006, se incluyeron 71 mujeres consecutivas con cáncer de mama. Evaluaciones: peso (kg) & talla (m), determinados mediante una báscula + estadiómetro SECA® para calcular el índice de masa corporal (IMC), la circunferencia de la cintura, el porcentaje de grasa corporal con el análisis bipolar manual de bioimpedancia (BF-306®), el cuestionario Food Frequency Questionnaire validado en versión portuguesa para evaluar el consumo dietético habitual. Se emplearon el análisis de frecuencia y la prueba U de Mann-Whitney para evaluar la prevalencia y las asociaciones. Resultados: la edad media fue 60 ± 12 (36-90) años. La histología más frecuente fue el carcinoma ductal invasivo (68%), p < 0,05. La mayoría de las pacientes estaba en estadio I (30%) o estadio IIA (25%) de la enfermedad frente a los estadios IIB (10%), IIIB (4%), IV (4%) y otros (21%), p < 0,05. Con respecto al estado nutricional, el 82% tenía sobrepeso / obesidad; el 89% de las pacientes tenía un % de grasa corporal por encima del límite máximo de 30% frente a sólo (11%) con un % de grasa corporal dentro del rango normal (p < 0,002); 62% pacientes tenían una circunferencia de la cintura > 88 cm (análisis de prevalencia: p < 0,04) y 61% de ellas había ganado peso tras el diagnóstico. El análisis univariado no mostró asociación alguna entre la histología, el IMC, el % de grasa corporal ni la circunferencia de la cintura; mediante el análisis multivariado se mostró una asociación entre un mayor IMC, el % de grasa corporal e histologías agresivas (p < 0,005). El análisis de frecuencia de alimentos mostró un consumo bajo de vegetales y cereales integrales ricos en complejos carbohidratados (fuentes de fibra o histoquímicos) o de ácidos grasos de pescados o frutos secos, fuentes primarias de ácidos grasos poliinsaturados n-3 y un consumo elevado de grasas saturadas; las histologías más agresivas se correlacionaban con un consumo bajo de verduras (p = 0,05) y de fuentes de ácidos grasos n-3 (p = 0,01). Conclusiones: nuestros hallazgos muestran una amplia prevalencia y un patrón homogéneo de sobrepeso/obesidad, y una cantidad excesiva de grasa corporal y abdominal, así como de ganancia de peso tras el diagnóstico, junto con deficiencias dietéticas en nutrientes protectores. ¡Se requiere investigación adicional puesto que las tasas de cáncer siguen aumentando en Portugal! (AU)

Nutritional risks and colorectal cancer in a Portuguese population.

BACKGROUND: Food and nutrition as major causes of colorectal cancer (CRC) are still debatable. AIM OF THE STUDY: This cross-sectional study in a Portuguese population aimed to characterize and identify "high-risk" diets/life-styles and explore their associations with colorectal cancer. METHODS: In 70 colorectal cancer patients and 70 sex, age-matched subjects without cancer history, we evaluated: diet history and detailed nutrient intake (DIET-PLAN5 2002, UK), alcohol (amount, type, years), smoking (number packages/year, years), physical activity, co-morbidities and body mass index. Age-adjusted Relative Risks were calculated, Proportional Hazards models adjusted the analysis for multiple risk factors. RESULTS: Smoking was a risk factor (1.90). Increased colorectal cancer risk regarding the lowest vs the highest intake quartile emerged for: vitamin B12 (3.41), cholesterol (3.15), total fat (2.87), saturated fat (1.98), animal protein (1.95), energy (1.85), alcohol (1.70), iron (1.49), refined carbohydrates (1.39). Reduced colorectal cancer risk for the highest vs the lowest intake quartile was found for: n-3 fatty acids (0.10), insoluble fiber/folate (0.15), flavonoids/vitamin E (0.25), isoflavones/beta-carotene (0.30), selenium (0.36), copper (0.41), vitamin B6 (0.46). CONCLUSION: Our results corroborated well-established risk factors and identified emergent nutrients. Prolonged excessive intake of macronutrients and some micronutrients concurrent with marked deficits of fiber and protective compounds were dominant in colorectal cancer and more significant than alcohol and smoking. The interaction diet-colorectal cancer is consistent and the relevance of new nutrients is emerging.

Nutritional risks and colorectal cancer in a portuguese population / Riesgos nutricionales y cáncer colorrectal en una población portuguesa

Background: Food and nutrition as major causes of colorectal cancer (CRC) are still debatable. Aim of the Study: This cross-sectional study in a Portuguese population aimed to characterize and identify “high-risk” diets/life-styles and explore their associations with colorectal cancer. Methods: In 70 colorectal cancer patients and 70 sex, age-matched subjects without cancer history, we evaluated: diet history and detailed nutrient intake (DIETPLAN52002, UK), alcohol (amount, type, years), smoking(number packages/year, years), physical activity, co-morbidities and body mass index. Age-adjusted Relative Risks were calculated, Proportional Hazards models adjusted the analysis for multiple risk factors. Results: Smoking was a risk factor (1.90). Increased colorectal cancer risk regarding the lowest vs the highest intake quartile emerged for: vitamin B12 (3.41), cholesterol (3.15), total fat (2.87), saturated fat (1.98), animal protein (1.95), energy (1.85), alcohol (1.70), iron (1.49), refined carbohydrates (1.39). Reduced colorectal cancer risk for the highest vs the lowest intake quartile was found for: n-3 fatty acids (0.10), insoluble fiber/folate (0.15), flavonoids/vitamin E (0.25), isoflavones/beta-carotene(0.30), selenium (0.36), copper (0.41), vitamin B6(0.46). Conclusion: Our results corroborated well-established risk factors and identified emergent nutrients. Prolonged excessive intake of macronutrients and some micronutrients concurrent with marked deficits of fiber and protective compounds were dominant in colorectal cancer and more significant than alcohol and smoking. The interaction diet- colorectal cancer is consistent and the relevance of new nutrients is emerging

Antecedentes: Se sigue debatiendo el que los alimentos y la nutrición sean causas principales en el cáncer colorrectal (CCR). Objetivo del estudio: Este estudio transversal en una población portuguesa tenía como objetivo caracterizare identificar las dietas/estilos de vida de “riesgo elevado” y explorar sus asociaciones con el cáncer colorrectal. Métodos: En 70 pacientes con cáncer colorrectal y en70 individuos sin antecedentes de cáncer, emparejados por edad y sexo, evaluamos: los antecedentes dietéticos y la ingestión detallada de nutrientes (DIETPLAN5 2002,RU), alcohol (cantidad, tipo, años), tabaquismo (número de paquetes/año, años), la actividad física, las enfermedades concomitantes, y el índice de masa corporal. Se calcularon los riesgos relativos ajustados por edad, y los modelos de riesgos proporcionales ajustaron el análisis para múltiples factores de riesgo. Resultados: El tabaquismo fue un factor de riesgo (1,90). Destacaba un riesgo aumentado para cáncer colorrectal con respecto a los cuartiles de ingestión inferior frente al superior para: vitamina B12 (3,41), colesterol (3,15), grasa total (2,87), grasa saturada (1,98), proteína animal (1,95), energía (1,85), alcohol (1,70), hierro (1,49), carbohidratos refinados (1,39). Se halló un riesgo disminuido para cáncer colorrectal con respecto al cuartil de ingestión superior frente al inferior para: ácidos grasosn-3 (0,10), fibra insoluble/folatos (0,15), flavonoides/vitamina E (0,25), isoflavonas/beta-caroteno (0,30), selenio(0,36), cobre (0,41), vitamina B6 (0,46).Conclusiones: Nuestros resultados corroboraban los factores de riesgo bien establecidos e identificaron nuevos nutrientes. La ingestión excesiva prolongada de macronutrientes y algunos micronutrientes concomitantemente con deficiencias marcadas de fibra y componentes protectores eran dominantes en el cáncer colorrectal y más significativos que el alcohol y el tabaquismo. La interacción dieta-cáncer colorrectal es coherente y emerge la relevancia de nuevos nutrientes

The effect of locoregional recurrence on survival and distant metastasis after conservative treatment for invasive breast carcinoma.

AIMS: Patients with invasive breast cancer submitted to conservative treatment must be followed for a long period of time to study locoregional control. In this study, we analysed the outcome and relationships between locoregional recurrence (LRR), distant metastases and survival. MATERIALS AND METHODS: A 15-year study, including 470 women with early breast cancer, stage I and II, who underwent breast conservative treatment. Tumour size, nodal status, age, menopausal status, histological grade and LRR were analysed for their ability to predict overall survival, disease-specific survival and distant disease-free survival. RESULTS: With a median follow-up time of 6.6 years (3 months to 19.1 years), there were 19 LRR at their first site of recurrence and 53 distant metastases. Tumour size greater than 2 cm, positive lymph nodes and histological grade III were significantly related to lower overall and distant metastases-free survival. On multivariate analysis, nodal status, histological grade III and LRR (coded as a time-dependent variable) were significantly related to overall, specific and distant metastases-free survival, whereas tumour size had only a borderline effect on specific and distant disease-free survival. Landmark analysis showed that women who presented an LRR within 2 years after surgery had significantly lower distant disease-free survival (hazard ratio [HR]: 8.39; 95% CI 2.56-27.47; P < 0.001), specific survival (HR: 8.19; 95% CI 2.45-27.41; P < 0.001) and overall survival (HR: 6.02; 95% CI 2.25-16.11; P < 0.005). CONCLUSIONS: LRR seems to be a significant predictor of distant metastases and survival, and patients who sustain early LRR tend to display a more aggressive clinical course.

Nutritional deterioration in cancer: the role of disease and diet.

AIMS: Under-nutrition is a major source of morbidity and mortality in cancer patients. This prospective, cross-sectional study aimed to evaluate the relative contributions of cancer staging, duration and diet on patients' nutritional deterioration. MATERIALS AND METHODS: We included 205 consecutive patients (133 men and 72 women) with head and neck, gastro-oesophageal, colon and rectum cancer, age 53 +/- 12 (33-86) years, referred for radiotherapy (primary, adjunctive to surgery, combined with chemotherapy or with palliative intent). We registered clinical variables, nutritional status (percentage of weight loss, Patient-Generated Subjective Global Assessment and body mass index), nutritional requirements, usual diet intake (diet history) and current intake (24-h recall). RESULTS: In stage III and IV, we observed a significant decrease of usual and current energy and protein intake (P=0.002), which were not observed in stage I and II. Reduction in nutritional intake was influenced by disease duration (P=0.04), but when the latter was evaluated in a multivariate analysis, current dietary intake was associated only with staging (P=0.004), thus disclosing a distinct pattern of nutritional intake between stages and diagnosis. Using a general linear model, advanced staging showed the most significant association with nutritional depletion (P=0.0001). We also found significant associations for tumour location (P=0.001), disease duration (P=0.002), nutritional intake (P=0.003) and previous surgery or chemotherapy (P=0.02). Percentage weight loss showed a consistently superior performance with regard to clinical variables and ability to detect mild to extreme nutritional changes. Patient-Generated Subjective Global Assessment had a very high sensitivity and specificity, and a strong capacity for detecting patients at nutritional risk compared with body mass index. CONCLUSIONS: Nutritional depletion is multifactorial, dependent mainly on the tumour burden of the host. Percentage weight loss is a sensitive and specific tool that can screen and identify malnutrition effectively. Its joint use with Patient-Generated Subjective Global Assessment, which establishes boundaries for nutritional therapy, will optimise the efficacy of nutritional assessment and support in cancer patients.

Postoperative irradiation of primary or recurrent pterygium: results and sequelae.

PURPOSE: To evaluate the efficacy of postoperative beta irradiation and to analyze treatment sequelae in patients with primary and recurrent pterygium. METHODS AND MATERIALS: From June 1986 to June 1998, 94 patients corresponding to 100 eyes received postoperative beta irradiation. Two groups of patients were treated: 37 eyes with primary pterygium (Group I) and 63 eyes with recurrent pterygium (Group II). Terson technique surgery was used in the majority of patients. Time between surgery and beta irradiation ranged from 2 to 48 h. Radiation doses and fractionation consisted of 30 Gy/3 fractions/5 days in 17 cases, 60 Gy/6 fractions/6 weeks in 80 cases, and 20 Gy/1 fraction in 3 patients. RESULTS: Fourteen of the 100 cases (14%) treated with surgery and adjuvant irradiation recurred. The overall crude local recurrence rates were 5.4% for Group I and 19% for Group II patients. The 5-year probability of local tumor control was 83.5% for the whole group of patients, 94% for Group I, and 76.9% for Group II (p = 0.04). The early sequelae related to surgery or irradiation were self limited and disappeared by 6 months after the end of the treatment: ocular irritation (14 cases), scleral atrophy (5 cases), and neovascularization (7 cases). A greater incidence of sequelae was observed in Group II patients, but the difference between the groups was not statistically significant (p = 0.15). No significant correlation between treatment sequelae and treatment dose was noted: 29% sequelae with 30 Gy vs. 18.7% sequelae with 60 Gy (p = 0.32). No late complications have been observed. CONCLUSION: Adjuvant beta irradiation provides effective therapy for primary pterygium, is somewhate less effective in patients with recurrent pterygium, and is associated with a moderate rate of early and transient sequelae.