ABSTRACT
La radioterapia es una terapéutica curativa en cáncer de próstata localizado en sus modalidades de braquiterapia (BT) y radioterapia externa (EBRT). Una elevación temporal del antígeno prostático específico (PSA) después de un tratamiento radioterápico, con un descenso sin intervención terapéutica, puede ocurrir en el 30% de los pacientes. Este fenómeno es conocido como rebote de PSA y carece de efecto pronóstico en relación con el control del tumor. Genera ansiedad en el paciente por el miedo al fracaso y en el médico por la incertidumbre sobre el estado del tumor. Su etiología y patogénesis son aún desconocidas. Varios factores relacionados con el tumor y el tratamiento se han evaluado en los estudios que analizan este fenómeno: la edad es el único factor observado con mayor consistencia como predictor de rebote. La definición de fracaso biológico (BF), según criterios Phoenix, después de EBRT o BT con o sin de privación androgénica (ADT), como una elevación de, al menos, 2 ng/ml sobre el nadir de PSA, permite tener en cuenta mejor el fenómeno de rebote aunque no está libre de falsos BF que pueden afectar a la supervivencia libre de fracaso en pacientes con seguimientos inferiores a 3 años(AU)
Radiotherapy is a curative treatment for localized prostate cancer in its modalities of brachytherapy (BT) and external beam radiotherapy (EBRT). A temporary increase in prostate- specific antigen (PSA) values following a radiotherapy treatment coupled with a decrease without therapeutic intervention may happen in 30% of the patients. This phenomenon is known as PSA bounce and lacks prognostic effect in relation to tumor control. Additionally, it produces anxiety in the patient because of the fear of failure, and in the physicists due to the uncertainty about the state of the tumor. The etiology and pathogenesis are still unknown. Several factors associated with the tumor and the treatments have been evaluated in the studies which analyze this phenomenon, the age is the only observed factor with the highest consistency as a bounce predictor. The definition of biologic failure (BF) after EBRT or BT with or without androgenic deprivation (ADT) according to Phoenix criteria, which considers an increase of at least 2 ng/ml over PSA nadir, enables better taking the bounce phenomenon into account, although is not free from false BF that may affect to the relapse-free survival in patients with follow-up shorter than 3 years(AU)
Subject(s)
Humans , Male , Prostatic Neoplasms/complications , Prostatic Neoplasms/radiotherapy , Brachytherapy/methods , Brachytherapy , Prostate-Specific Antigen/administration & dosage , Prostate-Specific Antigen/metabolism , Brachytherapy/statistics & numerical data , Brachytherapy/trendsABSTRACT
INTRODUCTION: Anemia is the most common haematological complication in cancer patients. OBJECTIVE: Analysis of the incidence, prevalence and treatment of anemia in oncologic patients treated in Radiation Oncology Departments in Spain (ROD) and monitoring of the existing recommendations for the treatment of anemia. MATERIAL AND METHODS: Observational, prospective, multicenter study which involved 19 Spanish ROD. The study was approved by the CEIC Central Defense Hospital. 477 patients with solid tumors, subsidiary of RT with radical intent referred to such centers within a period of one month (5/5/09 to 5/6/09) and gave their consent to participate in the study. We gathered the main characteristics of patients and their oncologic disease. All patients underwent a determination of Hb levels before RT, upon reaching 25-35 Gy and at the end treatment. In patients with anemia we assessed the existence of related symptoms and its treatment. RESULTS: Basal situation: The prevalence of anemia was 34.8% (166 patients). Mean Hb in patients with anemia was 11.17 ± 1.07 g/dl. Anemia-related symptoms were present in 34% of the patients. Anemia predisposing factors were: stage of the disease, previously received chemotherapy, and hormonal therapy. 39% (66 patients) received anemia treatment, with a mean Hb of 10.43 ± 1.04 g/dl. During RT: The prevalence of anemia was 38.9% (182 patients) with a mean Hb of 11.24 ± 1.21 g/dl. Predisposing factors for anemia during RT treatment were: age, male sex, chemotherapy prior to RT, basal anemia and chemotherapy during RT. 36.3% (66 patients) had anemia-related symptoms. 34.6% (63 patients) with a mean Hb of 10.5 ± 1.37 g/dl received treatment for anemia. The prevalence of anemia at the end of the RT was 38.1% (177 patients) with a mean Hb of 11.19 ± 1.18 g/dl. The predisposing factors for the appearance of anemia at the end of RT were: male sex, anemia at basal situation and during treatment and chemotherapy during RT. 34% (61 patients) had anemia-related symptoms and 73 patients (41.2%) with a mean Hb of 10.5 ± 1.22 g/dl received treatment for anemia. The presence of anemia-related symptoms was significantly correlated with the beginning of treatment for anemia. The incidence of anemia (new cases) during radiotherapy was 17.5%. CONCLUSION: The prevalence of anemia in basal situation, during RT and at the end of RT is 34.8%, 38.9% and 38.1%. During RT the incidence of anemia is 17.5%. 39.8%-41.2% of patients with anemia and 64.2%-68% of patients with anemia-related symptoms received treatment. Treatment of anemia starts with Hb<11 g/dl and the goal is to achieve Hb 12 g/dl. In our Radiotherapy Oncology Departments, the treatment of anemia complies with the current recommendations and guidelines in use (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Multicenter Studies as Topic/methods , Anemia/epidemiology , Anemia/etiology , Neoplasms/complications , Neoplasms/radiotherapy , Radiotherapy/adverse effects , Anemia/therapy , Incidence , Medical Oncology/methods , Prevalence , Prospective Studies , Radiotherapy/methods , Radiotherapy , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Radiation Injuries/diagnosis , Body Burden , Intestines/radiation effects , Radiation Tolerance , Maximum Tolerated Dose , Genitalia/radiation effects , Pelvic Neoplasms/radiotherapy , Abdominal Neoplasms/radiotherapyABSTRACT
No disponible
