Long-Term Outcomes of an International Cooperative Study of Intraoperative Radiotherapy Upfront Boost With Low Energy X-Rays in Breast Cancer.

Purpose: The purpose of this study was to assess the effectivity of upfront kilovoltage intraoperative radiotherapy (IORT) as a boost in high-risk early-stage breast cancer patients from an international pooled cohort. Materials/Methods: Patients from four centers in three different countries were retrospectively screened. Those with a minimum 1-year follow-up were included. Cumulative local (LR), regional (RR), and distant metastasis rates (DM) were analyzed. Additionally, the estimated overall survival (OS) was assessed. The Cox regression analysis was performed to identify failure predicting factors. Results: A total of 653 patients from centers in Peru, Spain, and Germany were included. The median follow-up was 55 (12-180) months, and age was 58 (27-86) years. Clinical tumor (T) staging was T1 65.85%, T2 30.17%, and T3 3.98%. Positive margins were found in 7.9% and in-situ component in 20.06%. The median IORT dose was 20 (6-20). The median time from IORT to EBRT was 74.5 (13-364) days. An overall 3.4% (n = 22) of patients developed local recurrence at some point during follow-up. The 12-, 60-, and 120-month cumulative LR were 0.3%, 2.3%, and 7.9%, respectively. After multivariate analysis, only age <50 remained to be a significant prognostic factor for local recurrence (HR 0.19, 95% CI 0.08-0.47; p < 0.05). The 10-year estimated OS was 81.2%. Conclusion: Upfront boost with IORT yields similar local control outcomes to those EBRT-based reports. Results from prospective trials, regarding toxicity, cosmesis, and effectivity are awaited to confirm these findings.

Situación actual de los sarcomas de partes blandas: registro de un instituto oncológico de Latinoamérica / Current situation of soft tissue sarcomas: Registry of a Latin American cancer institute

Objetivo: Los sarcomas de partes blandas (SFTS) conforman un grupo de neoplasias poco frecuentes y heterogéneas (menos del 1% en adultos y 15% en pediátricos), de los cuales no se cuenta con registros actualizados en población latinoamericana. El estudio tiene como objetivo describir la situación actual de los pacientes tratados en un instituto oncológico de Latinoamérica. Métodos: Se obtuvo un registro de 250 pacientes con diagnóstico de SFTS, tratados en el Instituto de Enfermedades Neoplásicas del Perú (INEN), durante el periodo 2009-2013, con una media de seguimiento de 62 meses, registrándose datos: epidemiológicos, clínicos, tratamiento y seguimiento; realizándose el análisis de sobrevida global mediante el modelo proporcional de Cox. Resultados: Los SFTS mostraron una mayor frecuencia en género masculino (60,8%), con un pico incidencia a partir de los 50 años (69,6%), la localización tumoral predominante fue en extremidades inferiores (64,4%), siendo los subtipos histológicos más frecuentes: sarcoma pleomórfico indiferenciado (34%) y liposarcomas (25,6%); el estadio clínico iii es el de mayor registro (30,8%). Se obtuvo una tasa de sobrevida global a 5 años del 63,9%, encontrándose en el análisis estadístico asociación significativa entre la sobrevida global y las variables: edad (> 50 años), tamaño tumoral (> 5cm), profundidad (subfascial), grado histológico (G3), recurrencia local y a distancia, mostrando en este grupo rangos menores de sobrevida. Conclusiones: Se ha logrado precisar la epidemiología, el tratamiento y el pronóstico, así como las variables que repercuten en la sobrevida de los pacientes latinoamericanos con SFTS estudiados

Introduction: Soft tissue sarcomas (SFT) are a group of rare and heterogeneous neoplasms (representing less than 1% of cancer in adults and 15% in pediatric patients), for which there is no updated records in the Latin American population. This study aims to describe the current situation of patients treated at a cancer institute in Latin America. Methods: We obtained records from 250 patients with a diagnosis of SFT, treated at the National Institute of Neoplastic Diseases of Peru (INEN) during the period 2009-2013, with a mean follow-up of 62 months. The following data were recorded: epidemiological, clinical, treatment and follow-up. The analysis of global survival was done with the Cox proportional hazards model. Results: SFT showed a greater frequency in males (60.8%), with a peak incidence after 50 years of age (69.6%). Tumor location was predominantly in the lower extremities (64.4%), and the most frequent histologic subtypes were: undifferentiated pleomorphic sarcoma (34%) and liposarcomas (25.6%); clinical stage iii was the most frequent (30.8%). The 5-year overall survival rate was 63.9%, while the statistical analysis found a significant association between global survival and the variables: age (>50 years), tumor size (>5cm), depth (subfascial), histologic grade (G3), local and distant recurrence, showing shorter survival times in these groups. Conclusions: This study has clarified the epidemiology, treatment and prognosis, as well as the variables that have an impact on the survival of the Latin American patients with SFT studied

Current situation of soft tissue sarcomas: Registry of a Latin American cancer institute. / Situación actual de los sarcomas de partes blandas: registro de un instituto oncológico de Latinoamérica.

INTRODUCTION: Soft tissue sarcomas (SFT) are a group of rare and heterogeneous neoplasms (representing less than 1% of cancer in adults and 15% in pediatric patients), for which there is no updated records in the Latin American population. This study aims to describe the current situation of patients treated at a cancer institute in Latin America. METHODS: We obtained records from 250 patients with a diagnosis of SFT, treated at the National Institute of Neoplastic Diseases of Peru (INEN) during the period 2009-2013, with a mean follow-up of 62 months. The following data were recorded: epidemiological, clinical, treatment and follow-up. The analysis of global survival was done with the Cox proportional hazards model. RESULTS: SFT showed a greater frequency in males (60.8%), with a peak incidence after 50 years of age (69.6%). Tumor location was predominantly in the lower extremities (64.4%), and the most frequent histologic subtypes were: undifferentiated pleomorphic sarcoma (34%) and liposarcomas (25.6%); clinical stage iii was the most frequent (30.8%). The 5-year overall survival rate was 63.9%, while the statistical analysis found a significant association between global survival and the variables: age (>50 years), tumor size (>5cm), depth (subfascial), histologic grade (G3), local and distant recurrence, showing shorter survival times in these groups. CONCLUSIONS: This study has clarified the epidemiology, treatment and prognosis, as well as the variables that have an impact on the survival of the Latin American patients with SFT studied.

Resultados oncológicos de la cirugía oncoplástica: seguimiento a largo plazo de pacientes tratados en un instituto oncológico de Latinoamérica. Un análisis de cohortes / Oncological results of oncoplastic surgery: Long-term follow-up of patients treated in an oncology institute in Latin America. A cohort analysis

Objetivo. La cirugía oncoplástica forma parte del grupo de cirugías de conservación mamaria, la cual permite la resección oncológica y la remodelación mamaria en el mismo acto quirúrgico. Actualmente es ampliamente usada en Latinoamérica, sin embargo, no cuentan con grandes reportes de resultados oncológicos. El propósito del estudio es evaluar la seguridad de la cirugía oncoplástica en el tratamiento del cáncer de mama invasivo. Método. Se comparan de forma retrospectiva 124 pacientes que recibieron cirugía oncoplástica por cáncer de mama invasivo no metastásico (grupo de estudio) con 302 pacientes que recibieron cirugía de conservación mamaria convencional (no oncoplástica; grupo control) durante el periodo 2007-2015. Resultados. El tiempo medio de seguimiento fue de 61 meses, la sobrevida global fue mayor en el grupo de cirugía oncoplástica frente al grupo control a 10 años (97,7 vs. 89.8%, p=0,04), así como la sobrevida libre de enfermedad (93 vs. 86,7% a 10 años, p=0,05). Discusión. Se han comparado pacientes que tuvieron cirugía primaria oncoplástica por cáncer de mama invasivo no metastásico (124) con un grupo control (302), realizándose un seguimiento por un periodo prolongado de tiempo, proporcionando el presente estudio evidencia para plantear que la cirugía oncoplástica es una opción de tratamiento seguro y confiable en pacientes con cáncer de mama en Latinoamérica (AU)

Objective. Oncoplastic surgery is a type of breast conservation surgery, which allows oncologic resection and breast remodelling in the same surgical procedure. It is now widely used in Latin America, but large studies of its results are lacking. The aim of this study was to evaluate the safety of oncoplastic surgery in the treatment of invasive breast cancer. Method. A total of 124 patients who underwent oncoplastic surgery between 2007 and 2015 for non-metastatic invasive breast cancer (study group) were retrospectively compared with 302 patients who underwent conventional (non-oncoplastic surgery) breast conservation surgery (control group) in the same period. Results. The mean length of follow-up was 61 months. Overall survival and disease-free survival was higher in the oncoplastic surgery group than in the control group at 10 years (97.7 vs. 89.8%, P=.04; 93 vs. 86.7% at 10 years, P=.05). Discussion. We compared patients who had oncoplastic primary surgery for non-metastatic invasive breast cancer (n=124) with a control (n=302) group who were followed-up for a long period, providing evidence to suggest that oncoplastic surgery is a safe and reliable treatment option in patients with breast cancer in Latin America (AU)