ABSTRACT
PURPOSE: Mexico and Central America have the highest childhood cancer incidence in the West. Pediatric-specific oncology knowledge contributes to the disparity. We sought to (1) determine the self-identified treatment patterns and needs of Mexican pediatric radiation oncologists and (2) pilot a workshop to improve contouring accuracy. MATERIALS AND METHODS: Partnering with local experts and the Sociedad Mexicana de Radioterapeutas (SOMERA), a 35-question survey was designed to ascertain pediatric radiotherapy capacity and distributed through the SOMERA listserv. The most challenging malignancies were selected for workshop. Participants received precontouring and postcontouring homework to assess improvement per the Dice metric. The Wilcoxon sign-rank test was used for comparative statistics. RESULTS: Ninety-four radiation oncologists attempted and 79 completed the survey. Forty-four (76%) felt comfortable treating a pediatric patient, and 36 (62%) were familiar with national protocols for pediatric treatment. Most had access to nutrition, rehabilitation, endocrinology, and anesthesia; 14% had access to fertility services and 27% to neurocognitive support; 11% noted no support, and only one respondent had child-life support. The postsurvey contouring workshop was conducted for high-grade glioma, medulloblastoma, and Hodgkin lymphoma. Significant improvements were seen in all target volumes. CONCLUSION: We present the first national survey of Mexico's pediatric radiotherapy capacity and Latin American e-contouring educational intervention with preworkshop and postworkshop Dice metrics, noting statistically significant improvement in all target volumes. Participation improved compared with prior experience through SOMERA partnership and Continuing Medical Education incentivization.
Subject(s)
Radiation Oncology , Humans , Child , Mexico/epidemiology , Medical OncologyABSTRACT
BACKGROUND: Bilateral retinoblastoma (Rb) treatment remains a challenge for ophthalmologists and pediatric oncologists despite new therapeutic strategies for eye preservation. The purpose of this work is to evaluate treatment outcomes in patients who underwent eye salvage treatment at a single-center prior to the chemotherapy in situ era. PROCEDURE: We followed a cohort of 88 consecutive Rb patients diagnosed at Hospital Infantil de México between November 2000 and June 2014. Eye salvage treatment consisted of systemic chemotherapy plus focal therapy planned by a multidisciplinary team. Unresponsive tumors were treated with episcleral brachytherapy and external beam radiotherapy (EBRT). RESULTS: A total of 96 eyes underwent eye salvaging therapy. Seventy-eight eyes (81%) were salvaged. Seven patients (8%) required brachytherapy and 34 patients (39%) underwent EBRT. Thirty-three of 78 preserved eyes (42%) achieved normal visual acuity: 5/27 (20%) in radiated patients and 28/51 (61%) in nonradiated patients. Eight patients developed secondary primary malignancies; however, those treated with EBRT did not have a significantly increased risk when compared with nonirradiated patients (OR: 1.66; P = 0.492). The overall survival rate was 86% (95% CI, 76%-92%) after a mean follow-up of 10 years. CONCLUSIONS: Eye preservation, long-term tumor control, and functional visual acuity could be maintained in many child and adolescent Rb survivors. Our data suggest that ocular radiotherapy can be used as consolidation treatment when other recently developed therapies with potentially fewer side effects are not available. Multidisciplinary management of Rb is mandatory to obtain cancer control during eye salvage treatment.
Subject(s)
Eye/drug effects , Eye/radiation effects , Orbital Neoplasms/therapy , Organ Sparing Treatments/methods , Retinal Neoplasms/therapy , Retinoblastoma/therapy , Salvage Therapy , Chemoradiotherapy/methods , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Mexico , Orbital Neoplasms/pathology , Prognosis , Retinal Neoplasms/pathology , Retinoblastoma/pathology , Visual AcuityABSTRACT
Se presenta un análisis de los factores que influyeron en el pronóstico de 64 pacientes con cáncer epidermoide de vulva, tratadas con cirugía en el Servicio de Ginecología de la Unidad de Oncología del Hospital General de México, S.S.;las que mostraron una edad media de 65 años, un 51%de metástasis ganglionares y un 71.85 de estadios III y IV. Se señala que 24 de 47 enfermas, (51%) tuvieron una media de seguimiento de 3 años sin evidencia de enfermedad y que evolucionaron sin actividad tumoral, 1 de 1 enferma con Ca. in situ, 3 de 3 en etapa I; 6 de 7, (85.7%) en estadio II; 12 de 27, (44.4%) en estadio III y 1 de 6, (l6.6%) en estadio IV. Asimismo, 8 de 14, (57.1%) pacientes tratadas con vulvectomía más linfadenectomía inguinal y pélvica y 1 de 6, (16.6%) de las manejadas con cirugías aun más radicales. Se destaca que en las pacientes tratadas con vulvectomía simple, debieron efectuarse ulteriromente disecciones ganglionares para el control de la enfermedad y que en esta serie los factores pronósticos más importantes fueron, la presencia o ausencia de metástasis ganglionares, pues evolucionaron sin cáncer 7 de 18, (38.8%) pacientes del primer grupo vs 10 del 13, (76.9%) de las del segundo grupo, P<0.05; y el tamaño del primario: con lesiones de menos de 5 cms,evolucionaron sin tumor 9 de 12 enfermas, (75.0%y con lesiones mayores, 8 de 23, (34.7%). P<0.05 .
