ABSTRACT
PURPOSE: To determine retrospectively 2-3 year local and regional control (LRC), free-of-disease survival (FDS) and overall survival (OS), as well as summarized toxicities in a group of 31 advanced head-and-neck cancer patients, treated at our institution between 2004 and 2011 with definitive IMRT low-dose concomitant boost, the majority of them with concurrent chemotherapy based on cisplatin. The results are also shown in the sub-group of nasopharyngeal cancer patients (NPC: 15 cases). PATIENTS AND METHODS: Radiological basal and contrasted CT series, MR-CT or PET/CT fused images in the setup position with immobilization mask were registered in simulation therapy patients. Planed doses were: 70 Gy in primary tumor and positive nodes >1 cm; 63 Gy in high-risk areas of microscopic diseases +10 mm safety margin; and 56 Gy in low risk of diseases regional lymph nodes. Treatment was delivered using a Varian 2100 Clinac with sliding windows IMRT. Spinal cord doses were limited to a strict maximum of 45 Gy, and optimization aimed for mean doses in parotid glands below 26 Gy, especially in the contralateral parotid gland. Online DRR-portal X-ray comparison images were taken every day with a deviation module tolerance ≤3 mm. RESULTS: The mean follow-up since IMRT was 34 months (interval: 8-89; median 31 months). Median follow-up in living patients was 22 months. The 2-year rate for global LRC was 64 %, for FDS 61 % and OS 77 %. For the NPC group after 2 years, LRC was 73 %, FDS 73 % and OS 93 %. The 3-year rates were similar. Seven patients died as a consequence of local and/or regional progression (mean time 10 months). Relapses were observed in eight patients (26 %), but only seven could be confirmed by biopsy (22.6 %; mean time to relapse: 8.6 months). Global acute mucositis was 61 % and chronic mucositis was shown in six cases which developed xerostomia (19 %) in the first control after IMRT, but 1 year later it was reduced to only four patients, two Grade 2 and two Grade 1. CONCLUSIONS: No excessive, unwarranted toxicities were observed using concomitant low doses boost in IMRT. High rates of compliance to concurrent chemotherapy were achieved. Late xerostomia associated with this regime decreased 1 year after conclusion of treatment. The implementation of IMRT requires advances in imaging for better tumor delineation; otherwise the physician loses the advantage of dose modulation or faces a risk of geographical miss (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Carcinoma, Squamous Cell/radiotherapy , Head and Neck Neoplasms/radiotherapy , Nasopharyngeal Neoplasms/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Intensity-Modulated , Antineoplastic Agents/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/mortality , Chemoradiotherapy , Cisplatin/therapeutic use , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/mortality , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/mortality , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/mortality , Neoplasm Staging , Retrospective StudiesABSTRACT
Propósito: El cáncer de endometrio es la neoplasia más frecuente del aparato genital femenino, diagnosticándose la mayoría en estadios iniciales. Aunque el tratamiento de elección es la cirugía, se plantea controversia en cuanto a las indicaciones de la terapia complementaria con radioterapia. Queremos, aquí, aportar nuestra experiencia. Material y métodos: Se ha llevado a cabo una revisión retrospectiva de 369 pacientes, diagnosticadas de carcinoma de endometrio y sometidas a cirugía y radioterapia postoperatoria, en estadios I, II y III, en un período de tiempo comprendido entre marzo 1984 y enero 1998. Se ha valorado las supervivencias global, específica, libre de enfermedad y control local y a distancia a los 5 años, estudiándose también estos parámetros en función de los estadios, tipos anatomopatológicos y grado de diferenciación tumoral e invasión miometrial, así como la afectación ganglionar. Resultados: Se ha obtenido a los 5 años una supervivencia global del 96 por ciento, específica 97 por ciento, libre de enfermedad 90 por ciento, control local 97 por ciento y control a distancia 94 por ciento, y han demostrado tener una implicación pronóstico el estadio, sobre las supervivencias global, específica y libre de enfermedad, la anatomía patológica (adenocarcinoma versus restantes tipos de carcinoma) sobre las supervivencias global y libre de enfermedad, y la invasión miometrial para la supervivencia libre de enfermedad. Asimismo, se analiza la tasa de complicaciones agudas y crónicas atribuibles a la radioterapia y se ha hecho una revisión de la Bibliografía publicada sobre el tema. Conclusión: Nuestros resultados se muestran acordes con los publicados en la literatura tanto en cifras de supervivencia y control local como en los factores identificados con influencia pronóstico (AU)