Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation

PurposeTo present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes.Materials and methodsEighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits.ResultsThirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group.ConclusionIORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation.

PURPOSE: To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes. MATERIALS AND METHODS: Eighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits. RESULTS: Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group. CONCLUSION: IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

Predictive factors for survival in neoadjuvant radiochemotherapy for advanced rectal cancer

Introduction. Neoadjuvant radiochemotherapy followed by radical surgery is the standard approach in advanced rectal carcinoma. Tumor response is determined in histological specimen. Objective. To assess predictive factors for survival in 115 patients. Patients and Method. 115 patients treated with neoadjuvant radiochemotherapy followed by radical surgery with total mesorectal excision, in our hospital from January 2007 to December 2014. All patients received pelvic radiotherapy with concomitant chemotherapy, followed by radical surgery and in some adjuvant chemotherapy. Results. In univariate analysis, distance to anal verge, radial margin, perineural invasion, and good grade regression are predictive factors for both, specific and disease free survival; and in multivariant, only radial margin and perineural invasion were predictive factors for survival. We found distance to anal verge (<5 cm) as the only clinical factor to predict a positive margin in the histologic specimen. Conclusions. Perineural invasion and positive radial margin are predictive factors for both specific and disease free survival (AU)

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Predictive factors for survival in neoadjuvant radiochemotherapy for advanced rectal cancer.

INTRODUCTION: Neoadjuvant radiochemotherapy followed by radical surgery is the standard approach in advanced rectal carcinoma. Tumor response is determined in histological specimen. OBJECTIVE: To assess predictive factors for survival in 115 patients. PATIENTS AND METHOD: 115 patients treated with neoadjuvant radiochemotherapy followed by radical surgery with total mesorectal excision, in our hospital from January 2007 to December 2014. All patients received pelvic radiotherapy with concomitant chemotherapy, followed by radical surgery and in some adjuvant chemotherapy. RESULTS: In univariate analysis, distance to anal verge, radial margin, perineural invasion, and good grade regression are predictive factors for both, specific and disease free survival; and in multivariant, only radial margin and perineural invasion were predictive factors for survival. We found distance to anal verge (<5 cm) as the only clinical factor to predict a positive margin in the histologic specimen. CONCLUSIONS: Perineural invasion and positive radial margin are predictive factors for both specific and disease free survival.

Long-term results and prognostic factors of patients with cervical carcinoma treated with concurrent chemoradiotherapy

AIMS AND BACKGROUND: To evaluate the predictive factors of recurrence in cervical cancer treated with radical radiochemotherapy. METHODS: A retrospective analysis of 56 women was performed. Response was assessed using the RECIST response. Overall survival and disease-free survival curves were estimated by the Kaplan-Meier method and the Cox proportional hazards model was used to analyse predictors of recurrence. RESULTS: Local recurrence was documented in 16 patients and distant metastases in 15. The Kaplan-Meier survival probabilities were 95.1 ± 6.4% at 3 years and 80.4 ± 13.1% at 5 years and the Kaplan-Meier curve values for disease-free survival were 60.3 ± 14.3% at 3 years and 53.0 ± 15.7% at 5 years. Thirty-five patients were alive and 21 patients died, 19 from metastatic disease and 2 from other causes. Complete response after chemoradiation therapy, squamous cell carcinoma and tumour size ≤ 4 cm were significantly associated with outcome. In the Cox regression model, tumour size > 4 cm (hazard ratio 7.48; 95% CI 2.71-20.6; p < 0.001) and partial response (hazard ratio 7.09; 95% CI 2.82-17.8; p < 0.001) were predictive factors for disease-free survival and partial response (hazard ratio 3.7; 95% CI 1.3-10.1; p < 0.001) and non-squamous cell carcinoma (hazard ratio 3.5; 95% CI 1.2-9.7; p < 0.001) were predictive factors for overall survival. CONCLUSIONS: Non-squamous histology and partial response were independent prognostic factors for overall survival and tumour size and partial response were independent prognostic variables for 5-year disease survival (AU)

Variación en las indicaciones de irradiación externa en el cáncer de mama. Análisis de 4.545 casos (1990-2005) / No disponible

Introducción: Los cambios en el diagnóstico precoz, la cirugía,el tratamiento sistémico y los avances tecnológicos de laradioterapia han provocado un cambio, cualitativo y cuantitativo,en la utilización de las radiaciones en el tratamiento de laneoplasia de mama.Objetivo: Analizar los cambios en las indicaciones de irradiaciónexterna por neoplasia de mama desde el año 1990hasta la actualidad.Resultados: De enero 1990 a diciembre 2005 se realizaron4.545 irradiaciones por cáncer de mama, que representanel 29% del total. En el año 1990, el 43% de las indicacioneseran radicales y el 56% paliativas y actualmente el 82%son radicales y el 18% paliativas. También se constata un aumentodel tratamiento conservador, del 14 al 61%. Por elcontrario el resto de indicaciones, tras mastectomía, paliativosistémico o local disminuyen.Conclusiones: Actualmente el 29% de los tratamientos deun servicio de radioterapia son por cáncer de mama. Se detectaun aumento de la incidencia de la irradiación tras tratamientoconservador. Por el contrario, destaca una disminución dela irradiación tras mastectomía y de los tratamientos paliativos,tanto generales como locales, probablemente debido al aumentode la utilización de los tratamientos sistémicos(AU)

Introduction: Changes in early diagnosis, surgery, sistemictreatment and technological radiotherapy developments havemade a qualitative and quantitative changes, in the use of radiationin the treatment of breast cancer.Objective: Analyze the changes in the indication of radiationtherapy for breast cancer, since 1990 to nowadays.Results: From january 1990 to december 2005 we underwent4.545 irradiations for breast cancer (29% of total irradiations).In 1990, 43% of indications were radicals and 56% werepalliatives. Nowadays 82% are radicals and 18% are palliatives.Also, we can see an increase of the conservative treatment,from 14 to 61%. On the contrary, the rest of indications dicrease:after mastectomy, sistemic, palliative or local palliative.Conclusion: An increase in the incidence of breast canceris observed at the present time correspondig to 29% amountof treatments in a radiation in department. Also an increase ofincidence of the radiation after conservative treatment is confirmed.On the contrary, the incidence of the radiation aftermastectomy and palliative treatments decreases, probably dueto the use of the sistemic treatments(AU)

Presentación de un modelo de programa de optimización en la gestión interna de pacientes / Presentation of a model for an optimisation in the internal management of patients

La complejidad de los circuitos de los servicios de radioterapia, donde intervienen distintos departamentos, el carácter secuencial del tratamento con un elevado número de pacientes en cada una de las diferentes fases del proceso, y la obligada optimización en el uso de los aceleradores debido a la creciente presión asistencias, requieren un control de calidad exhaustivo en la gestión interna de los pacientes. Los programas comerciales presentes en mercado acostumbran a ser cerrados, inaccesibles y no adaptables a la realidad de cada centro. En el Institut d´Oncologia Radioteràpica (IOR) hemos desarrollado un modelo de programa informático que permite garantizar un riguroso control sobre estos aspectos y elimina el uso de las engorrosas listas en papel

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Legislación actual en Radioterapia y su contribución al nivel de calidad y seguridad / Current legislation in Radiotherapy and its contribution to the level of quality and safety

La radioterapia es una especialidad médica de gran complejidad técnica y que conlleva un cierto grado de riesgo en su aplicación. Por este motivo es objeto de una extensa y restrictiva regulación legal. En el presente artículo se analizan las consecuencias que tienen sobre ella las distintas disposiciones legales, haciendo especial hincapié en el Real Decreto de los Criterios de Calidad en Radioterapia (AU)

Because of the great technical complexity and the degree of risk in its application, Radiotherapy is a unique medical speciality with extensive and restrictive legal regulations. This work analyses the consequences of the different legal provisions, with special emphasis on the Royal Decree establishing the Quality Criteria in Radiotherapy (AU)