"Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study".

BACKGROUND: Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce. METHODS: This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival. RESULTS: Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p = 0.008) and elevated CEA levels (HR = 1.9, 95% CI 1.0-3.7, p = 0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95%-CI 1.05-41.09; p < 0.001) and ASA III-IV (HR = 2.0; 95%-CI 1.4-2.9; p < 0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%. CONCLUSIONS: The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemo-radiotherapy is excellent in the long term.

Effectiveness of hexaminolevulinate fluorescence cystoscopy for the diagnosis of non-muscle-invasive bladder cancer in daily clinical practice: a Spanish multicentre observational study.

OBJECTIVE: To assess the sensitivity and specificity of blue-light cystoscopy (BLC) with hexaminolevulinate as an adjunct to white-light cystoscopy (WLC) vs WLC alone for the detection of non-muscle-invasive bladder cancer (NMIBC), in routine clinical practice in Spain. PATIENTS AND METHOD: An intra-patient comparative, multicentre, prospective, observational study. Adults with suspected or documented primary or recurrent NMIBC at eight Spanish centres were included in the study. All patients were examined with WLC followed by BLC with hexaminolevulinate. We evaluated the detection rate of bladder cancer lesions by WLC and BLC with hexaminolevulinate, overall and by tumour stage and compared with histological examination of the biopsied lesions. Sensitivity and specificity was calculated. RESULTS: In all, 1,569 lesions were identified from 283 patients: 621 were tumour lesions according to histology and 948 were false-positives. Of the 621 tumour lesions, 475 were detected by WLC (sensitivity 76.5%, 95% confidence interval [CI] 73.2-79.8) and 579 were detected by BLC (sensitivity 93.2%, 95% CI 91.0-95.1; P < 0.001). There was a significant improvement in the sensitivity in the detection of all types of NMIBC lesions with BLC compared with WLC. Of 219 patients with tumours, 188 had NMIBC [highest grade: carcinoma in situ (CIS), n = 36; Ta, n = 87; T1, n = 65). CIS lesions were identified more with BLC (n = 27) than with WLC [n = 19; sensitivity: BLC 75.0% (95% CI 57.8-87.9) vs WLC 52.8% (95% CI 35.5-69.6); P = 0.021]. Results varied across centres. CONCLUSIONS: This study shows that improvement in diagnosis of NMIBC, mainly CIS and Ta tumours, obtained with BLC with hexaminolevulinate as an adjunct to WLC vs WLC alone can be shown in routine clinical practice.

Cáncer de recto: qué pacientes se benefician de la radioterapia / Rectal cancer: Which patients benefit from radiotherapy

El pronóstico de los pacientes con cáncer de recto ha mejorado en los últimos años, sobre todo en relación con la menor probabilidad de recidiva local. Estos resultados se consiguen con una correcta estadificación preoperatoria, una adecuada escisión quirúrgica de la lesión y un abordaje terapéutico multidisciplinar. Basándonos en la evidencia científica disponible, nuestro propósito es tratar de clarificar el marco en el cual se toman las decisiones terapéuticas, especialmente en relación con la estadificación preoperatoria y sus limitaciones y con el tratamiento con radioterapia y sus indicaciones, así como resaltar la necesidad de un enfoque individualizado en cada caso (AU)

The prognosis of patients with rectal cancer has improved in recent years, particularly as regards the lower probability of local recurrence. These positive results are obtained through correct preoperative staging and an adequate surgical resection of the affected lesion, as well as a multidisciplinary therapeutic approach. Based on the available scientific evidence, our aim is to clarify the framework in which options for the right therapy can be taken, especially in relation to the preoperative staging and its limitations, with regards to radiotherapy and its indications. We also emphasize the need of a tailor-made approach for each case (AU)

[Rectal cancer: which patients benefit from radiotherapy?]. / Cáncer de recto: qué pacientes se benefician de la radioterapia.

The prognosis of patients with rectal cancer has improved in recent years, particularly as regards the lower probability of local recurrence. These positive results are obtained through correct preoperative staging and an adequate surgical resection of the affected lesion, as well as a multidisciplinary therapeutic approach. Based on the available scientific evidence, our aim is to clarify the framework in which options for the right therapy can be taken, especially in relation to the preoperative staging and its limitations, with regards to radiotherapy and its indications. We also emphasize the need of a tailor-made approach for each case.

[Oral autopsy in dead women from breast cancer]. / Autopsia verbal de mujeres fallecidas por cáncer de mama en Baja California.

OBJECTIVE: To discover, through the use of verbal autopsies, the primary characteristics of patients who have died of breast cancer (BCa). METHODS: We reviewed 105 death certificates where BCa was registered as the cause of death in a one-year period. A verbal autopsies instrument was designed for BCa, it was validated through expert consultation. A test-retest and Spearman coefficient were applied. The instrument explored sociodemographic, biological, life-style and health services variables. Data was obtained from patients' relatives. Any patient whose family could not be located or declined to participate was excluded from the study. RESULTS: Eighty-one verbal autopsies were applied (77%). The mean age at the time of death was 53 +/- 15. There was a direct family history of BCa in 25%; and in 31 % there was overweight or obesity. Only 17% of the tumors were discovered by health care workers, and the mean survival after diagnosis was 2.3 +/- 2 years. CONCLUSION: The verbal autopsy for BCa is a useful tool. It showed that 83 % of the deceased women identified the tumor by themselves. The health services must reinforce programs for BCa early detection.

Manual para el diseño libre de barreras arquitectónicas / Free design manual to architectonic barriers

Normas que establecen los requisitos mínimos de diseño en obras urbanas y de seguridad y funcionalidad en las edificaciones para las personas incapacitadas, inspiradas en las consideraciones que los expertos de las Naciones Unidas emitieron en 1974