[Compliance of patients concerning recommended radiotherapy in breast cancer : Association with recurrence, age, and hormonal therapy]. / Compliance der Patientinnen in Bezug zur empfohlenen Strahlentherapie beim Mammakarzinom : Zusammenhang mit Rezidiv, Alter und Hormontherapie.

BACKGROUND AND PURPOSE: In this study, we investigated how often guidelines for radiation therapy in patients with breast cancer are not complied with, which patient group is mostly affected, and how this influences local recurrence. PATIENTS AND METHODS: All patients (n = 1,903) diagnosed between November 2003 and December 2008 with primary invasive or intraductal breast cancer in the interdisciplinary breast center of the Charité Hospital Berlin were included and followed for a median 2.18 years. RESULTS: Patients who, in contrast to the recommendation of the interdisciplinary tumor board, did not undergo postoperative radiation experienced a fivefold higher local recurrence rate (p < 0.0005), corresponding to a 5-year locoregional recurrence-free survival of 74.5% in this group. The 5-year locoregional recurrence-free survival of patients following the recommendations was 93.3%. Guideline compliance was dependent on age of patients, acceptance of adjuvant hormonal treatment or chemotherapy, and increased diameter of the primary tumor. Multiple logistic regression analysis showed an association between compliance and age or hormonal therapy. CONCLUSION: In order to avoid local recurrence patients should be motivated to comply with guideline driven therapy. Since a higher number of local recurrences is observed in health services research compared to clinical research, studies on the value of adjuvant treatment following local recurrence should be performed.

Virtual simulation in patients with breast cancer.

BACKGROUND: Investigation of the feasibility and effectiveness of virtual simulation in patients receiving radiotherapy of the breast. METHODS: Twenty-three patients were included in the study. All of them underwent a course of postoperative tangential breast irradiation. The patients were prospectively randomised into two groups. Group A patients (n=11) received a conventional computed tomography -based treatment planning, group B patients (n=12) a virtual simulation. The results of both treatment planning procedures were compared. RESULTS: The treatment planning was feasible in all patients. The time expenditure could be reduced from a median of 45.0 to 16.5 min and from 55.0 to 32.0 min for the technician and physician, respectively, using virtual simulation. Furthermore the treatment planning for the patient could be reduced from a median of 45.0 min in two sessions to 16.5 min in one session. The image quality of the digital reconstructed radiographs was satisfying compared to the simulation films. The incidence and extension of set-up corrections for the patients at the first treatment were comparable in both groups. The time interval between the planning CT and the first treatment could be reduced by 31% using virtual simulation due to the omission of the conventional simulation. CONCLUSION: The virtual simulation is a feasible tool for the treatment planning of patients undergoing tangential irradiation of the breast. Compared with the conventional simulation procedure virtual simulation is superior regarding to the precision of patients marking, the quality of the reference images and, the time expenditure for the patients and medical staff.

Radiotherapy-induced emesis. An overview.

BACKGROUND: A significant number of patients receiving radiotherapy experience the distressing side effects of emesis and nausea. These symptoms are some of the most distressing problems for the patients influencing their quality of life. METHODS: International study results concerning radiotherapy-induced emesis are demonstrated. A German multicenter questionnaire examining the strategies to prevent or to treat radiotherapy-induced nausea and emesis is presented. An international analysis concerning incidence of emesis and nausea in fractionated radiotherapy patients is discussed. Finally the consensus of the consensus conference on antiemetic therapy from the Perugia International Cancer Conference V is introduced. RESULTS: Untreated emesis can lead to complications like electrolyte disorders, dehydration, metabolic disturbances and nutrition problems with weight loss. Prophylactic antiemetics are often given to patients receiving single high-dose radiotherapy to the abdomen. A survey has revealed that antiemetic prophylaxis is not routinely offered to the patients receiving fractionated radiotherapy. However, there is a need for an effective treatment of emesis for use in this group of patients, too. In 20% of patients nausea and emesis can cause a treatment interruption because of an inadequate control of symptoms. Like in chemotherapy strategies there exists high, moderate, and low emetogenic treatment regimens in radiotherapy as well. The most emetogenic potential has the total body irradiation followed by radiotherapy to the abdomen. Radiotherapy induced emesis can be treated effectively with conventional antiemetics up to 50%. CONCLUSION: Studies with total body irradiation, fractionated treatment and high-dose single exposures have clearly demonstrated the value of 5-HT3-receptor antagonist antiemetics. There is a response between 60 and 97%. There is no difference in the efficacy of the different 5-HT3-antagonists. High-risk patients should be prophylactic treated with 5-HT3-antagonists. The additional administration of glucocorticoids and benzodiazepins can optimize the response.