Primary bone lymphoma.

Primary bone lymphoma is a rare condition which represents a low percentage of both the malignant primary bone tumours and the non-Hodgkin extranodal lymphoma. This explains the lack of publications, lines of investigations, and specific diagnostic and treatment protocols. In the following article we will carry out a revision of the existing literature on this rare subject, using as argument a clinical case of left femoral location stage IE treated with CHOP chemotherapy and radiotherapy.

Cáncer de mama: papel de la radioterapia / Breast cancer: role of radiotherapy

El cáncer de mama es la primera causa de muerte por cáncer en la mujer y la principal causa de muerte en la mujer entre los 40 y 44 años. En la actualidad se están consiguiendo importantes logros en su curación, debido a destacados avances diagnósticos y terapéuticos, así como a los programas de screenning, que hace que cada vez el diagnóstico se haga en las fases más tempranas de la enfermedad. Su tratamiento requiere una actuación multidisciplinar en la que participan cirujanos, oncólogos radioterápicos y médicos. En este capítulo, los autores realizan una puesta al día del papel de la radioterapia en el tratamiento del cáncer de mama en las diferentes etapas de la enfermedad (AU)

Aspectos generales del dolor por cáncer. Experiencia del Grupo Andaluz-Extremeño / General aspects of cancer pain. Experience of the Andalusian-Extremaduran Group

Objetivos: Establecer la incidencia de dolor en los pacientes con cáncer en los Servicios de Oncología Radioterápica, así como su control siguiendo las recomendaciones de la Organización Mundial de la Salud (OMS). Material y métodos: Se analizó la incidencia de dolor y su tratamiento en pacientes sometidos a radioterapia o en revisión, reclutados durante 2 semanas en diferentes Servicios de la Comunidad Autónoma Andaluza y Extremeña. Para evaluar la intensidad del dolor se utilizó la Escala Analógica Visual (EVA). Resultados: De los 544 pacientes sometidos al estudio el dolor estuvo presente, en diferentes intensidades, en el 39,7 por ciento, siendo más frecuente en el grupo sometido a tratamiento que en aquellos en revisiones periódicas, correspondiendo el mayor número a pacientes con EVA < 3 (dolor débil o moderado). Conclusiones: El dolor es un síntoma frecuente en los pacientes con cáncer, afectando al 40 por ciento de los pacientes de nuestro estudio. A pesar de ello un amplio número de pacientes no reciben analgesia (19,4 por ciento) y de los que la reciben, en un alto porcentaje no se hace siguiendo las recomendaciones de la OMS, ya sea por exceso o por defecto. Ello hace necesario la creación de grupos –Alleviare– para extender su conocimiento y tratamiento adecuado (AU)

Relationship between degree of cellular differentiation in colorectal cancer and topographical distribution.

OBJECTIVES: To demonstrate the relationship between degree of cellular differentiation in colorectal cancer and topographical distribution in 215 patients diagnosed with colorectal cancer from 1997 to 2000. MATERIAL AND METHODS: 215 patients (129 men and 86 women) were studied prospectively with a mean age of 64 years (range: 23-84 years). In all patients we performed a full colonoscopy with several biopsies (in patients with colon stenosis we used barium enema), radiographic studies (CT, abdominal ultrasounds), and laboratory tests for serum tumour markers (CEA, Ca 19-9, alpha-fetoprotein). The topographic location of colorectal cancer was: rectum 35%, sigmoid colon 31%, descending colon 10%, transverse colon 6%, ascending colon 9%, caecum 5%, and we included anorectal cancer 4%. RESULTS: According to histological differentiation we found: A) well-differentiated tumours 101/215 (47%); B) moderately-differentiated tumours 98/215 (45.5%), and C) poorly-differentiated tumours 16/215 (7.5%). We found no significant association among histological differentiation, topographic location, stage according to the Astler-Coller classification, sex or age (p = ns). The prevalence of well-differentiated tumours in men was 49% and 43% in women; of moderately-differentiated cancers in men was 43%, and 49% in women; for poorly-differentiated tumours in men was 7.5%, and 7.2% in women. Regarding tumour location, 165 cancers were found in the left colon: 80 were well differentiated, 77 moderately differentiated and 8 poorly differentiated. In the transverse colon we found 12 tumours: 7 well differentiated, 3 moderately differentiated and 2 poorly differentiated. 30 cancers were localized in the right colon: 11 well differentiated, 15 moderately differentiated and 4 poorly differentiated. In the anorectum 8 tumours were found: 3 well differentiated, 3 moderately differentiated and 2 poorly differentiated. According to staging classification, well differentiated tumours (101/215) were more common in Dukes' C2 (20.7%) and B1 (32.6%), moderately differentiated cancers (98/215) were in B1 (28.5%) and C2 (20.4%), and poorly differentiated tumours (16) were more common in Dukes' C2 (25%), without differences among other stages (p = ns). CONCLUSIONS: According to our results we have found that histological differentiation of colorectal cancer has no association with topographic location, and it is independent of sex or age. We have not found any relationship either between histological differentiation and stage in the Astler-Coller classification, but well differentiated cancers were more common at any location, age or sex.

Sinonasal radiation-associated osteosarcoma after combined therapy for rhabdomyosarcoma of the nose.

Radiation-associated (RA) osteosarcomas (OS) are exceptional in children, presenting more frequently in middle-aged and elderly patients. This is a case report of RA-OS of the sinonasal cavities in a 13-yr-old girl after combined therapy for rhabdomyosarcoma (RMS) of the nose diagnosed at the age of five. The treatment of choice is radical surgery with wide margins and postoperative adjuvant chemotherapy and radiotherapy. Despite an episode of recurrence, at the present time the patient is alive and free of disease 5 yr after the initial treatment of OS. The association between radiation, chemotherapy and sarcomas is reviewed and discussed.

A Monte Carlo approach for small electron beam dosimetry.

BACKGROUND AND PURPOSE: In treatments where it is necessary to conform the field shape yielding a very small effective beam area, dosimetry and conventional treatment planning may be inaccurate. The Monte Carlo (MC) method can be an alternative to verify dose calculations. A conjunctival mucosa-associated lymphoid tissues lymphoma is presented, to show the importance of an independent assessment in critical situations. MATERIALS AND METHODS: In this work, the MC technique has been employed using the program BEAM (based on EGS4 code). Electron beam simulation has been performed and the results have been compared with those obtained with films. The patient dose distribution has been obtained by two methods: the full Monte Carlo (FMC) simulation and a conventional planning system (PLATO). RESULTS: Concerning dosimetry, some differences have been observed in the comparison of profiles obtained with film and those obtained with the MC method. Moreover, significant differences were found in the patient isodose distribution between both calculation methods. CONCLUSIONS: The results highlight that, in treatments where small beams are needed, conventional dosimetry and planning systems have some limitations. Therefore, an independent and more accurate assessment, such as MC, would be desirable.

[Palliative radiotherapy of bladder cancer]. / Radioterapia paliativa y cáncer de vejiga.

OBJECTIVE: To present the results of a retrospective study which was conducted to analyze the utility of palliative radiotherapy in advanced bladder cancer and to evaluate the results of the different fractionation regimens in relation to the response rate and its duration, overall survival and side effects. METHODS: During a 10-year period, 56 patients with locally advanced bladder cancer received palliative external radiotherapy for the symptoms arising from their condition. The following fractionation schedules were mainly used: conventional irradiation with 40-60 Gy in 22-23 fractions in 20 cases and a low dose of 30 Gy in 10 fractions in 23. Other fractionation modalities were used in 6 patients. Eight patients received radiotherapy for symptomatic relief of pain from bony metastasis. RESULTS: 28 patients (50%) achieved complete remission of the initial symptoms and 15 (26.8%) showed a partial remission. The mean duration of response was 4 months (range 1-108). The overall uncorrected survival rate was 26.7% at one year (15 patients), 12.5% at three years (7 patients) and 7.1% at five years (4 patients), for a mean survival of 7.5 months (range 1-109). CONCLUSION: Radiotherapy is effective in the management of symptoms, specially hematuria, in patients with advanced carcinoma of the urinary bladder. Short fractionation regimens that achieve the same therapeutic results are preferred since visits to the hospital or long hospitalization can be avoided, thereby improving patient quality of life.

A conformal technique for a ring shaped conjunctive lymphoma treatment.

Radiotherapy is commonly utilised as standard treatment in the so called mucosa-associated lymphoid tissues (MALT), due to the low probability of distant relapse. The particularities of the lesion, make necessary both energy degradation and beam conformation. To keep homogeneity within acceptable limits, a lengthener attached to the electron applicator has been devised to closely fit the anatomy of the patient. Considering the small area of the outcoming field, film dosimetry is preferred, since the dimensions of an ionisation chamber and even of a semiconductor probe might be comparable to the field size.