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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.
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A retrospective study was performed to assess the outcomes of a single-fraction adjuvant electronic brachytherapy (e-BT) approach for patients with squamous cell conjunctival carcinoma (SCCC). Forty-seven patients with T1-T3 SCCC were included. All patients underwent surgery followed by a single-fraction adjuvant e-BT with a porTable 50-kV device. Depending on margins, e-BT doses ranged between 18 to 22 Gy prescribed at 2 mm depth, resembling equivalent doses in 2 Gy (EQD2) per fraction of 46-66 Gy (α/ß ratio of 8-10 Gy and a relative biological effect (RBE) of 1.3). The median age was 69 (29-87) years. Most tumors were T1 (40.4%) or T2 (57.5%) with a median size of 7 mm (1.5-20). Margins were positive in 40.4% of cases. The median time from surgery to e-BT was nine weeks (0-37). After a median follow-up of 24 (17-40) months, recurrence occurred in only two patients (6 and 7 months after e-BT), yielding a median disease-free survival (DFS) of 24 (6-40) months and DFS at two years of 95.7%. Acute grade 2 conjunctivitis occurred in 25.5%. E-BT is a safe and effective for SCCC treatment, with clinical and logistic advantages compared to classical methods. Longer follow-up and prospective assessment are warranted.
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RESUMEN Introducción. En Perú, el cáncer de mama representa el tipo de cáncer más frecuente en mujeres y el sexto tipo de cáncer más letal en la población general. La sobreexpresión del receptor del factor de crecimiento epidérmico (HER2+) ocurre en 20% a 30% de los cánceres de mama, y se asocia con tumores más agresivos, con mayor recurrencia y mayor mortalidad. Objetivo. Elaborar un conjunto de recomendaciones basadas en evidencias para el diagnóstico y tratamiento del cáncer de mama HER2+, con la finalidad de contribuir a reducir la mortalidad, progresión de la enfermedad y mejorar la calidad de vida. Métodos. Se conformó un panel de especialistas clínicos y metodólogos, quienes identificaron preguntas clínicas relevantes sobre el diagnóstico y tratamiento del cáncer de mama HER2+. Se desarrolló una búsqueda sistemática de GPC en Medline (PubMed), y en organismos elaboradores y recopiladores. Para la formulación de recomendaciones, el panel de especialistas discutió la evidencia y elementos del contexto de implementación de la recomendación, siguiendo la metodología propuesta por el Ministerio de Salud del Perú. Resultados. Se priorizó nueve preguntas clínicas. Se formuló un total de 25 recomendaciones clínicas. Conclusiones. Se elaboró una GPC basada en evidencias, a través de un proceso sistemático, riguroso y transparente desarrollado por un equipo multidisciplinario.
ABSTRACT Introduction. In Peru, breast cancer represents the most common type of cancer in women and the sixth most lethal type of cancer in the general population. Overexpression of the epidermal growth factor receptor (HER2 +) occurs in 20% to 30% of breast cancers, and is associated with more aggressive tumors, with greater recurrence and greater mortality. Objective. Prepare a set of evidence-based recommendations for the diagnosis and treatment of HER2 + breast cancer, in order to help reduce mortality, disease progression and improve quality of life. Methods. A panel of clinical specialists and methodologists was formed, who identified relevant clinical questions about the diagnosis and treatment of HER2 + breast cancer. A systematic search for CPGs was carried out in Medline (PubMed), and in developing and compiling agencies. For the formulation of recommendations, the panel of specialists discussed the evidence and elements of the context of implementation of the recommendation, following the methodology proposed by the Ministry of Health of Peru. Results. Nine clinical questions were prioritized. A total of 25 clinical recommendations were made. Conclusions. An evidence-based CPG was developed through a systematic, rigorous and transparent process developed by a multidisciplinary team.
RESUMO
El Glioblastoma Multiforme (GBM) es el tumor cerebral primario más común en los adultos, la metástasis extra-craneal de GBM detectada clínicamente es bastante rara, debido a la ausencia de linfáticos en el cerebro y a la dificultad de los tumores en penetrar los vasos sanguíneos. Se producen entre el 0,2 a 2% según 10 reportado en la literatura disponible. Se reporta un caso de rara presentación de una paciente de 53 añ os con diagnóstico de Glioblastoma multiforme localizado en región interparietal derecha y otra lesion en region fronto-parietal derecha (multifocal). Se le realiza biopsia estereotáxica para diagnóstico y recibio tratamiento con radioterapia conformada en 3D al primario. Posteriormente a los 2 meses presenta metástasis linfática en ganglio cervical derecho, diagnosticado por citología y biopsia incisional. Así mismo se realiza revisión de la literatura. Se discuten el impacto de la cirugía en la diseminación tumoral y las posibles vías de diseminación.
Glioblastoma multiforme (GBM) is the most common and most aggressive primary brain tumor in adults. The presence of extra-cranial GBM metastasis is very rare, because the absence of brain lympha- tics and the difficulty of tumors cells to penetrate into blood vessels, occurring only between 0.2 to 2% of the cases reported in the available literature. A case of extreme rarity is presented: A female 53 year old patient, with diagnosis ofGliobastoma multiforme localized in the right interparietal region and another lesion in the rightfrontal-parietal region (multifocal). She underwent diagnostic stereotactic biopsy and was treated with 3D conformal radiotherapy in the primary. Two months later the patient presents lymphatic metastasis in the right cervical lymph node, diagnosed by cytology and incisional biopsy. A review of the literature is presented. The impacts of surgery in tumor dissemination and possible tumor dissemination schemes are discussed.
