Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer

PurposeRadiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer.MethodsPatients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration.ResultsIn 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively).ConclusionsThe multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.

Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer.

PURPOSE: Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. METHODS: Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. RESULTS: In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively). CONCLUSIONS: The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.

Long-term results of a randomized partial irradiation trial compared to whole breast irradiation in the early stage and low-risk breast cancer patients after conservative surgery

Purpose To report long-term results of a randomized trial comparing accelerated partial breast irradiation (APBI) to whole-breast irradiation (WBI) in terms of efficacy, toxicity, and cosmesis. Methods and materials WBI group was treated with 3D conformal external irradiation, 2 Gy daily/fraction, 5 fractions/week, to a total dose of 50 Gy. APBI group was treated with 3D conformal external irradiation 3.75 Gy/fraction, twice a day, 5 fractions/week, to a total dose of 37.5 Gy in the APBI group. Patients were followed up every 6 months up to 5 years and yearly thereafter. During follow-up visits, the clinician evaluated chronic toxicity and scored cosmetic results with a four-scale system. Results After a median follow-up of 10.3 years, 43 patients in each group (84%) are alive without disease. One patient died after disease progression in the APBI arm, and there was no death in the WBI arm. The rest of the patients died from another disease different than breast cancer, similarly between groups. There was greater fibrosis in the APBI group (9 patients grade 1 and one grade 2) compared to WBI (3 patients grade 1 and one grade 2); p = 0.18. Regarding cosmesis, in APBI group, 19 and 21 (43.2 and 47%) patients had excellent or good results, similar to the WBI group with 18 patients (40.9%) in each cosmesis outcome. The WBI group did not have any patient with poor cosmesis but the APBI had 3 (6.8%; p = 0.24). Conclusion After a follow-up of 10 years, there were no differences in efficacy between the 2 treatment arms. Despite slight greater toxicity in the APBI group, the cosmesis was similar and satisfactory in both groups (AU)

Effects of radiation on toxicity, complications, revision surgery and aesthetic outcomes in breast reconstruction: An argument about timing and techniques.

BACKGROUND: Radiotherapy (RT) combined with breast reconstruction can reduce the risk of cancer recurrence and increase the survival rate. However, this approach seems to worsen aesthetic outcomes and increase complication rates. The impact of breast reconstruction timing and techniques on clinical outcomes, however, remains unclear. For this reason, we aimed to perform a more comprehensive analysis of a series of patients undergoing RT and breast reconstruction. METHODS: Patients were divided into 4 groups according to the timing of reconstruction (before RT and after RT) and surgical technique (heterologous reconstruction and autologous reconstruction (AR)). The median time between RT and reconstruction, number of revision surgeries, incidence of complications, toxicity, aesthetics and associated clinical risk factors were used to assess the clinical outcomes. An objective system of skin toxicity evaluation was performed. RESULTS: Ninety-five patients were included in this study. No significant differences in the median time between RT and reconstruction, incidence of complications, toxicity or aesthetics were noted between different timings or techniques of reconstruction. Patients undergoing AR needed more revision surgeries to complete reconstruction. However, the total number of surgical procedures was similar between the groups. In a comparison between the treated and untreated breasts by an objective system, RT produced an increase in erythema and pigmentation and a decrease in elasticity in the treated breast (p<0.05 for all parameters). On multivariate analysis, smoking was a significant predictor associated with complications. CONCLUSIONS: Combined breast reconstruction and RT seem to be successful regardless of the order of treatment or the type of reconstruction.

Long-term results of a randomized partial irradiation trial compared to whole breast irradiation in the early stage and low-risk breast cancer patients after conservative surgery.

PURPOSE: To report long-term results of a randomized trial comparing accelerated partial breast irradiation (APBI) to whole-breast irradiation (WBI) in terms of efficacy, toxicity, and cosmesis. METHODS AND MATERIALS: WBI group was treated with 3D conformal external irradiation, 2 Gy daily/fraction, 5 fractions/week, to a total dose of 50 Gy. APBI group was treated with 3D conformal external irradiation 3.75 Gy/fraction, twice a day, 5 fractions/week, to a total dose of 37.5 Gy in the APBI group. Patients were followed up every 6 months up to 5 years and yearly thereafter. During follow-up visits, the clinician evaluated chronic toxicity and scored cosmetic results with a four-scale system. RESULTS: After a median follow-up of 10.3 years, 43 patients in each group (84%) are alive without disease. One patient died after disease progression in the APBI arm, and there was no death in the WBI arm. The rest of the patients died from another disease different than breast cancer, similarly between groups. There was greater fibrosis in the APBI group (9 patients grade 1 and one grade 2) compared to WBI (3 patients grade 1 and one grade 2); p = 0.18. Regarding cosmesis, in APBI group, 19 and 21 (43.2 and 47%) patients had excellent or good results, similar to the WBI group with 18 patients (40.9%) in each cosmesis outcome. The WBI group did not have any patient with poor cosmesis but the APBI had 3 (6.8%; p = 0.24). CONCLUSION: After a follow-up of 10 years, there were no differences in efficacy between the 2 treatment arms. Despite slight greater toxicity in the APBI group, the cosmesis was similar and satisfactory in both groups.

Weekly radiotherapy in elderly breast cancer patients: a comparison between two hypofractionation schedules

Purpose Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations. Materials and methods 47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups. Results After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters. Conclusion Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation (AU)

Weekly radiotherapy in elderly breast cancer patients: a comparison between two hypofractionation schedules.

PURPOSE: Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations. MATERIALS AND METHODS: 47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups. RESULTS: After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters. CONCLUSION: Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation.

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)

No disponible

Accelerated hypofractionated radiation therapy (AHRT) for non-small-cell lung cancer: can we leave standard fractionation?

Purpose. To report interim results from a single-institution study conducted to assess accelerated hypofractionated radiotherapy (AHRT) delivered with 3D conformal radiotherapy in two groups of patients with non-small cell lung cancer: (1) patients with early stage disease unable to tolerate surgery and ineligible for stereotactic body radiation therapy, and (2) patients with locally advanced disease unsuitable for concurrent chemoradiotherapy. Methods/patients. A total of 83 patients (51 stage I-II, 32 stage III) were included. Radiotherapy targets included the primary tumor and positive mediastinal areas identified on the pre-treatment PET-CT. Mean age was 77.8 ± 7.8 years. ECOG performance status (PS) was ≥2 in 50.6 % of cases. Radiotherapy was delivered in daily fractions of 2.75 Gy to a total dose of 66 Gy (BED10 84 Gy). Acute and late toxicities were evaluated according to NCI CTC criteria. Results. At a median follow-up of 42 months, median overall survival (OS) and cause-specific survival (CSS) were 23 and 36 months, respectively. On the multivariate analysis, PS [HR 4.14, p = 0.0001)], stage [HR 2.51, p = 0.005)], and maximum standardized uptake values (SUVmax) [HR 1.04, p = 0.04)] were independent risk factors for OS. PS [HR 5.2, p = 0.0001)] and stage [HR 6.3, p = 0.0001)] were also associated with CSS. No cases of severe acute or late treatment-related toxicities were observed. Conclusions. OS and CSS rates in patients treated with AHRT for stage I-II and stage III NSCLC were good. Treatment was well tolerated with no grade three or higher treatment-related toxicity. PS, stage, and SUV max were predictive for OS and CSS (AU)

No disponible

Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis

Purpose. To evaluate the impact of hypofractionated boost after hypofractionated whole breast irradiation in breast carcinoma. Methods and materials. Patients after breast conservative surgery were treated all time with hypofractionation of 2.67 Gy/day. Whole breast dose was 40.05 Gy followed in case of risk of local relapse by a boost of 16.02 Gy or 8.01 Gy. Acute and chronic toxicity results were evaluated including cosmetic software-assisted assessment and objective evaluation of fibrosis parameters (elasticity and hydration) by means of a skin tester. Results. A total of 362 patients were evaluated. Acute toxicities comprised grade 1 dermatitis in 48.1 %, grade 2 in 44.5 % and grade 3 in 17 patients 4.7 %, respectively. After a median follow-up of 4.5 years, in 308 cases (86.6 %) there was no chronic skin or subcutaneous changes. In the first consecutive 50 patients, measures with skin tester showed no statistical differences in parameters for skin and subcutaneous fibrosis. Cosmetic results were considered excellent and good in 26 and 62 %, respectively. Conclusions. Boost to tumour bed with hypofractionated doses is well tolerated and acute and chronic toxicities are mild with good cosmetic results. Objective systems are encouraging methods to assess skin quality and cosmesis (AU)

No disponible

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.

Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis.

PURPOSE: To evaluate the impact of hypofractionated boost after hypofractionated whole breast irradiation in breast carcinoma. METHODS AND MATERIALS: Patients after breast conservative surgery were treated all time with hypofractionation of 2.67 Gy/day. Whole breast dose was 40.05 Gy followed in case of risk of local relapse by a boost of 16.02 Gy or 8.01 Gy. Acute and chronic toxicity results were evaluated including cosmetic software-assisted assessment and objective evaluation of fibrosis parameters (elasticity and hydration) by means of a skin tester. RESULTS: A total of 362 patients were evaluated. Acute toxicities comprised grade 1 dermatitis in 48.1 %, grade 2 in 44.5 % and grade 3 in 17 patients 4.7 %, respectively. After a median follow-up of 4.5 years, in 308 cases (86.6 %) there was no chronic skin or subcutaneous changes. In the first consecutive 50 patients, measures with skin tester showed no statistical differences in parameters for skin and subcutaneous fibrosis. Cosmetic results were considered excellent and good in 26 and 62 %, respectively. CONCLUSIONS: Boost to tumour bed with hypofractionated doses is well tolerated and acute and chronic toxicities are mild with good cosmetic results. Objective systems are encouraging methods to assess skin quality and cosmesis.

Accelerated hypofractionated radiation therapy (AHRT) for non-small-cell lung cancer: can we leave standard fractionation?

PURPOSE: To report interim results from a single-institution study conducted to assess accelerated hypofractionated radiotherapy (AHRT) delivered with 3D conformal radiotherapy in two groups of patients with non-small cell lung cancer: (1) patients with early stage disease unable to tolerate surgery and ineligible for stereotactic body radiation therapy, and (2) patients with locally advanced disease unsuitable for concurrent chemoradiotherapy. METHODS/PATIENTS: A total of 83 patients (51 stage I-II, 32 stage III) were included. Radiotherapy targets included the primary tumor and positive mediastinal areas identified on the pre-treatment PET-CT. Mean age was 77.8 ± 7.8 years. ECOG performance status (PS) was ≥2 in 50.6 % of cases. Radiotherapy was delivered in daily fractions of 2.75 Gy to a total dose of 66 Gy (BED10 84 Gy). Acute and late toxicities were evaluated according to NCI CTC criteria. RESULTS: At a median follow-up of 42 months, median overall survival (OS) and cause-specific survival (CSS) were 23 and 36 months, respectively. On the multivariate analysis, PS [HR 4.14, p = 0.0001)], stage [HR 2.51, p = 0.005)], and maximum standardized uptake values (SUVmax) [HR 1.04, p = 0.04)] were independent risk factors for OS. PS [HR 5.2, p = 0.0001)] and stage [HR 6.3, p = 0.0001)] were also associated with CSS. No cases of severe acute or late treatment-related toxicities were observed. CONCLUSIONS: OS and CSS rates in patients treated with AHRT for stage I-II and stage III NSCLC were good. Treatment was well tolerated with no grade three or higher treatment-related toxicity. PS, stage, and SUV max were predictive for OS and CSS.

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)

Radioterapia hipofraccionada semanal en pacientes de edad avanzada con cáncer de mama / No disponible

Objetivo: En pacientes de edad avanzada no es factibleplantear un tratamiento convencional en ocasiones por razónde la edad, patología concomitante o problemas socio-familiares.El objetivo del presente estudio es analizar los resultadosdel tratamiento hipofraccionado semanal en estas pacientes.Material y métodos: Se incluyeron pacientes mayores de 70años, con patología asociada o bajo grado funcional. De 1992hasta 2005 tratamos 262 pacientes con una edad media de82,5 ± 7,2 años. El 66,4% de las pacientes fueron sometidas acirugía conservadora, 25,2% a mastectomía y 8,4% se practicósólo biopsia. La dosis media fue de 37,5 Gy a un fraccionamientode 6,25 Gy /día, 1 vez por semana, de forma que laspacientes recibieron en total 6 sesiones, un número inferior alos tratamientos estándar.Resultados: Tras un seguimiento medio de 42 meses la supervivenciaglobal según el método de Kaplan-Meier fue de90,4 ± 5,2% para las pacientes con tratamiento conservador,85 ± 10,6% para las mastectomizadas y 60,8 ± 23,4% paralas pacientes no intervenidas. La supervivencia específica paralos mismos grupos es de 97 ± 3%, 91,4 ± 8,5% y 81,8 ±18% respectivamente, lo que se explica por el hecho de quelas pacientes mueren por causa diferente a su neoplasia. Un66,4% de las pacientes presentaron dermitis grado I-II y sóloun 19% fibrosis crónica.Conclusiones: El tratamiento en el cáncer de mama en pacientesde edad avanzada con esquemas de radioterapia hipofraccionada,resulta una opción válida y cómoda con resultadossimilares en supervivencia, control local y toxicidad. Losefectos secundarios agudos y tardíos son aceptables(AU)

Objective: In patients with advanced age conventional treatmentis frequently not feasible depending of age, concomitantdisease or social or family problems. The objective of presentstudy is to analyse the results of weekly hypofractionatedtreatment in these patients.Patients and methods: Patients older than 70 years withassociated diseases or low performance status were included.From 1992 to 2005 an amount of 262 patients were treated,with a mean age of 82.5 ± 7.2 years. The 66.4% of patientsunderwent conservative surgery, 25.2% a mastectomy wasperformed and the remaining 8.4% only a diagnostic biopsywas undertaken. The mean dose was 37.5 Gy with a weekly6.25 Gy fractionation. So, patients received only 6 sessionsoverall, clearly lower than standard treatments.Results: After a follow up period of 42 months the overallsurvival by Kaplan-Meier method was 90.4 ± 5.2% in patientswith conservative surgery, 85 ± 10.6% in mastectomized patients,and 60.8 ± 23.4% in not operated patients. Specificsurvival for the same groups is 97± 3%, 91.4 ± 8.5% and81.8 ± 18% respectively, according to the fact that patientsdie of another disease but not by their tumour. In 66.4% ofpatients a mild dermitis degree I or II was present and only in19% of cases a chronic fibrosis occurred.Conclusions: Treatment of advanced age breast cancer patientswith weekly hypofractionated irradiation is a valid andcomfortable option with similar results in terms of survival, localcontrol and toxicity. Acute and chronic secondary effectsare acceptable(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)

Certificación ISO del Institut d´Oncología Radioteràpica del Hospital de l`Esperança / ISO certification of the Radiotherapeutic Oncology Institute of the Hospital de l'Esperança

El IOR (Institut d´Oncología Radioterápica) nació con la misión de tratar de forma eficaz y segura a los pacientes. En este artículo nos detallan los pasos a seguir y el tiempo empleado para con seguir la certificación ISO para establecer un plan de calidad para el Servicio (AU)

The IOR (Radiotherapeutic Oncology Institute) was set up with the mission of treating patients in an effective and safe way. This article explain the steps followed and the time required for obtaining the ISO certification in order to establish a quality plan for the Service (AU)

Actividad asistencial de un servicio de oncología radioterápica. Análisis de 4.600 tratamientos en un período de ocho años / Current practice in radiotherapy unit. Analysis of 4,600 procedures in an 8-year period

Introducción: El análisis de los datos objetivos que cuantifican la actividad asistencial de un servicio de radioterapia, nos puede proporcionar las herramientas adecuadas y necesarias para planificar los cambios y tendencias en el tratamiento del cáncer. Al mismo tiempo, nos puede servir para identificar parcelas deficitarias, y llevar a cabo acciones puntuales para recuperar pacientes que en la actualidad son tratados por medios diferentes. Objetivo: Analizar nuestra práctica asistencial durante un período de 8 años, sobre un total de 4.600 tratamientos llevados a cabo durante el mismo. Métodos: Todos los tratamientos llevados cabo durante el período enero 1990-abril 1997, fueron informatizados y recogidos en una base de datos para ordenador personal. Los datos acumulados de 4.600 procedimientos fueron analizados con el programa estadístico SPSS, comparados con los datos del resto de Catalunya y Suecia, y son presentados en forma de tablas. Resultados: A lo largo del período se han tratado un número creciente de pacientes, entre los que predominan ligeramente los varones, con un aumento gradual de la edad. El 44,3 por ciento de nuestra actividad ha consistido en irradiar pacientes con cáncer de mama y de pulmón. Mientras que los tumores pulmonares permanecen estables al igual que los digestivos, ORL, ginecológicos y del SNC, el número de tratamientos por cáncer de mama y urológicos ha experimentado un aumento. En la intencionalidad del tratamiento, predominan los tratamientos radicales, y a lo largo del tiempo se observa un moderado aumento en la media de los volúmenes tratados, del número de campos utilizados y las sesiones administradas, acompañado de un aumento en la dosis por fracción y la dosis total. Los datos más sobresalientes de la comparación con la información de Catalunya y Suecia, indican que estamos tratando una población parecida, pero con predominio de los tratamientos radicales, especialmente en el resto de Catalunya. De la misma manera y en relación a la finalidad del tratamiento, las características de los de nuestro centro se parecen más a las de Suecia que a las del resto de Catalunya, con un número de fracciones, dosis por fracción y dosis total, muy diferentes de estos últimos. Conclusiones: Como resultados más relevantes cabe señalar la importancia de realizar trabajos de análisis como el actual, que nos permite comprobar, el importante protagonismo de los tumores de mama y pulmón en el ámbito de la radioterapia, la necesidad de estar preparados para un aumento del protagonismo de los tumores urológicos, y la imperiosa necesidad de revisar nuestro concepto de tratamiento radical, especialmente en los tumores broncopulmonares, urológicos y digestivos (AU)

Efecto del fraccionamiento de la dosis sobre la DL50/30 por irradiación corporal total en el ratón / The dose fractionation effect on LD50/30 after total body irradiation in mice

Introducción: El efecto del fraccionamiento de la dosis sobre la eficacia biológica de las radiaciones es conocido. Sin embargo, su importancia sobre las células hemopoyéticas siempre ha sido considerada como poco relevante, en base a su escasa capacidad de reparación de daño subletal. Propósito: Evaluar la variación de la DL50/30 en un modelo murino, en función del intervalo entre dos fracciones de irradiación corporal total. Material y métodos: Hemos utilizado ratones hembra, de la cepa B6D2F1, de 8 semanas de edad y un peso medio de 20 g, que fueron mantenidas en ambiente estéril hasta el final de la experiencia, y sometidas a una irradiación corporal total mediante fotones gamma de Co-60, con una dosis total de 10 Gy en dos fracciones de 5 Gy, separadas por intervalos de tiempo crecientes, comprendidos entre 0 y 50 minutos. La curva de mortalidad se obtuvo con el porcentaje de animales fallecidos de cada grupo para cada intervalo, durante los 40 días siguientes al tratamiento. Resultados: A medida que el intervalo entre las dos fracciones aumenta, la mortalidad decrece: pasa del 78,89 por ciento para un intervalo entre fracciones de 0 minutos al 19,04 por ciento para un intervalo de 50 minutos. Conclusiones: Las células hemopoyéticas responsables de la mortalidad de los animales, tienen una capacidad de reparación del daño subletal, que se manifiesta cuando el intervalo entre fracciones aumenta (AU)