[Brachytherapy results in prostatic cancer]. / Resultados de la braquiterapia en el cáncer de próstata.

OBJECTIVE: To analyze the 15-year results of external irradiation combined with radioactive gold grain implantation (Au198) in the treatment of adenocarcinoma of the prostate and to discuss the therapeutic perspectives. METHODS: The present study was conducted on 23 patients with localized prostate carcinoma (17 stage B; 6 stage C) that had been diagnosed and treated at our department from February 1981 to October 1986. The mean patient follow-up was 90.96 months. Au198 implantation (mean dose 3347.6 cGy) was performed through the abdominal approach prior to external irradiation (mean dose 39 Gy) with Co-60 (19 patients) or the 18-MV photon linear accelerator (4 patients). The mean fractionated dose was 180.43 cGy/day. RESULTS: Overall the 15-year locoregional control rate was 61% and disease-free survival was 38%. The overall survival rate was 25%, regardless of the cause of death. The tumor control rate was 61% for stage B and 83% for stage C lesions at 15 years. The disease-free survival rate was 40% for stage B and 50% for stage C tumors. The local control and disease-free survival rates were worse for patients in whom the diagnosis had been made by TUR (p = not significant). CONCLUSIONS: The locoregional tumor control and disease-free survival rates for this group of 23 patients who received combined therapy with external irradiation and radioactive gold grain implantation (Au198) were slightly lower than those obtained in another group of 104 patients treated at our Service of Radiotherapeutic Oncology with radical external radiation therapy and can be ascribed mainly to poor patient selection and inadequate radiation dose.

[Treatment results with external radiotherapy in prostate cancer]. / Resultados del tratamiento con radioterapia externa en el cáncer de próstata.

OBJECTIVE: External irradiation is an accepted curative treatment modality for patients with localized prostatic tumor. The 15-year results in patients treated by radical irradiation alone are presented. The determinant prognostic factors for local tumor control and disease free survival are analyzed. METHODS: 135 patients with a histologically confirmed localized carcinoma of the prostate were treated at our department from May 1972 to January 1998. Fifty patients received Co-60 therapy; the linear accelerator and high energy photons were utilized in the remaining 80 patients. By tumor stage, 53 patients were B1, 49 B2 and 33 C. The mean follow-up was 61 months (range 1-180). Most patients were exposed to localized fields of irradiation; dose ranged from 50-74 Gy, fractionated at a dose of 180-200 cGy/day. RESULTS: Overall local tumor control was 77% at 5 years and 73% at 15 years, with a disease free survival of 63% and 45% at 5 and 15 years, respectively. Local tumor control at 13 years was 71% for stage B1, 82% for B2 and 70% for C. The disease free survival at 13 years for stages B1, B2 and C were 46%, 49% and 36%, respectively. The BD and MD tumors had a 15-year disease free survival of 48% vs 32% for the PD tumors (p = 0.005). Patients with PSA < or = 20 ng/ml before treatment showed a disease free survival of 87% vs 48% for those with PSA > 20 ng/ml ((p = 0.011). Multivariate analysis showed dose to be a determinant prognostic factor for local tumor control (0.0432); dose and histological grade were determinants for disease free survival (p = 0.029 and 0.033). CONCLUSIONS: This retrospective study found dose to be a determinant prognostic factor for local tumor control and both dose and histological grade were determinants for disease free survival. Radiotherapy is a therapeutic option for these patients. The results can be enhanced if the dose delivered to the prostate can be increased while maintaining the complication rate within the same ranges.

Control of neck nodes in squamous cell carcinoma of the head and neck by radiotherapy: prognostic factors.

313 patients with cervical metastases from a squamous carcinoma of the head and neck treated with radiotherapy, were studied by means of a multivariant analysis in order to determine the prognostic factors for cure. These were: lymph node response to irradiation (P = 0.0000), size of node (P = 0.0000), radiotherapy dose (P = 0.0037), condition of the primary (controlled vs non-controlled) (P = 0.0015), recurrent cervical metastases post-surgery (P = 0.0286).

[The radiotherapy control of cervical adenopathies in undifferentiated epithelial tumors of the head and neck. The prognostic factors]. / Control con radioterapia de adenopatías cervicales en tumores epiteliales indiferenciados de cabeza y cuello. Factores pronósticos.

A total of 90 patients with undifferentiated carcinomas tumors the head and neck with clinical neck nodes who received intended radical irradiation, were studied by means of a multivariant analysis of 9 variables which defined cervical lymph node disease in oder to determine the prognostic factors for the control of the above mentioned adenopathy. The factors were as follows: lymph node response post-irradiation (p = 0.0000), condition of the primary (controlled-non controlled) (p = 0.0208).

[Radiotherapy as the definitive treatment of patients with carcinoma of the bladder]. / Radioterapia como tratamiento definitivo en pacientes con carcinoma de vejiga.

Sixty-one patients, who refused surgery or whose overall medical status advised against radical cystectomy, were submitted to radical radiotherapy at the Oncology Radiotherapy Service of the General Hospital of Asturias. Irradiation was performed in a cobalt therapy unit. Radiation dose ranged from 50-70 Gy, with a daily dose of 190-200 cGy. Local control was achieved in 71% for stage A, 68% for B1. 17% for B2, and 0% for stage C. Disease-free survival was 63% for stage A, 48% for B1, 14% for B2, 0% for C, and 17% for D1. Overall disease-free survival was 20%, and the morbidity and mortality rates were 11.4% and 3.2%, respectively. In view of the poor results achieved in our setting, we have considered using combined external and interstitial radiation for tumors localized in the muscle layer, and adjuvant chemotherapy for stage C tumors (or those infiltrating perivesical fat).