Conservative surgery, external radiotherapy, and HDR brachytherapy in a single fraction of 7 Gy in early breast cancer: long-term toxicity and esthetic assessment.

INTRODUCTION: The essential issue in conservative treatment is the quality in breast preservation. When risk factors for local relapse exist, a tumour bed boost is required, but the boost choice remains controversial. Prospectively, we studied long-term toxicity, cosmetic outcome and prognostic factors. MATERIALS AND METHODS: After conservative treatment, 115 patients received a single dose of 7 Gy HDR-brachytherapy (HDR-BT) boost between June 1996 and December 2005. Late toxicity was assessed using the LENT-SOMA scale. For esthetic assessment, a subjective scale was used for patients and a modified Fehlauer scale for physicians. Mean age was 56.6 years. Invasive ductal carcinoma (78 %) and lumpectomy (60 %) were predominantly reported. 48 % received chemotherapy (CT). RESULTS: Regarding toxicity, 39 % of patients reported breast pain, 75 % fibrosis, 56 % telangiectasias, 19 % lymphoedema, and 51 % retraction/atrophy. Concerning management, 22 % of patients with pain and 45 % with lymphoedema were treated. The esthetic result was found satisfactory by 96 % of the patients and 85 % of the physicians. Fibrosis was influenced by CT and a larger irradiated volume and telangiectasias by a greater implant volume. CONCLUSIONS: HDR-BT boost shows good cosmetic effects with acceptable toxicity. Patients overestimate the esthetic outcome. LENT/SOMA is useful to assess chronic toxicity.

Early-stage breast cancer conservative treatment: high-dose-rate brachytherapy boost in a single fraction of 700 cGy to the tumour bed.

BACKGROUND AND PURPOSE: Conservative treatment represents the current therapy for early-stage breast cancer. When risk factors for local relapse exist, a tumour bed boost is required. Retrospectively, we evaluated the prognostic factors influencing local recurrence (LR), overall survival (OS) and disease-free survival (DFS). MATERIAL AND METHODS: After conservative treatment, 210 patients received a single-dose HDR brachytherapy (HDRBT) boost between June 1996 and December 2005. Mean age was 57 years; 75% had invasive ductal carcinoma. The most frequent surgery was lumpectomy (55.7%); 39.4% were G3, 18.6% intraductal component >25% and only 22% had negative margins. RESULTS: With a mean follow-up of 85 months, at 5 and 10 years the OS was 93% and 88%, DFS 92% and 89%, and LR 3.6% and 5.3%, respectively. For LR, the risk factors were carcinoma in situ, N+ and involved margins, whereas for metastasis, the risk factors were T2 tumours, stage III, N+ and the presence of local recurrence. CONCLUSIONS: HDR-BT boost in one fraction is an effective, simple and safe method for reducing LR. The outpatient setting and shorter treatment duration represent undeniable advantages.

Serum C-telopeptide levels predict the incidence of skeletal-related events in cancer patients with secondary bone metastases.

INTRODUCTION: We evaluated serum C-telopeptides (CTX) to see whether they may be useful as predictive markers for disease progression in cancer patients with bone metastases who are being treated with zoledronic acid (ZA). PATIENTS AND METHODS: This was a prospective, nonrandomised study in which 26 patients with solid tumours and confirmed bone metastases were treated with ZA (4 mg every 3-4 weeks) for 24 months or until a skeletal-related event (SRE) was observed. Serum CTX levels were determined at baseline and 6, 12, 18 and 24 months after study initiation. SRE were evaluated using bone scintigraphy. RESULTS: Study participants had prostate (50%), breast (31%), lung (11%) or bladder (8%) tumours. Mean age was 69 (range 52-84) years, and 65% men. At baseline, overall mean CTX levels were 562.47 ± 305.17 pg/dl. Patients who showed disease progression during the study period showed significantly higher CTX levels at baseline and after 18 months of ZA treatment than patients who did not progress (p = 0.040 and p = 0.006, respectively). Patients with ≥ 5 bone metastases at diagnosis had significantly higher CTX levels after 18 months of ZA treatment than patients with < 5 bone metastasis (p = 0.001). Similarly, at 12 and 18 months, patients without SRE had significantly lower CTX levels than patients in whom a SRE was observed (p = 0.005 and p = 0.001, respectively). CONCLUSIONS: Changes in serum CTX levels seem to predict the potential for tumour control and the likelihood of developing an SRE in a sample of patients with solid tumours and bone metastases treated with ZA.

Granulocytic sarcoma of the right humerus in a non-leukaemia patient.

Granulocytic sarcoma (GS), an uncommon solid extramedullary tumour, should be considered even in the absence of leukaemia, as delay in diagnosis and treatment worsens the prognosis. We present a GS (single humeral bone lesion) in a non-leukaemia patient, treated with intensive AML (Acute Myeloid Leukaemia) chemotherapy and sequential radiotherapy, in complete response 26 months after diagnosis, confirmed by histopathology and without leukaemia progression.

Superoxidase dismutase (SOD) topical use in oncologic patients: treatment of acute cutaneous toxicity secondary to radiotherapy.

OBJECTIVE: The objective of this study is to evaluate the efficiency of SOD applied topically in oncologic patients affected by acute radiodermatitis. MATERIALS AND METHOD: This study includes 57 patients who showed a dermatitis grade 2 or superior; they were administered SOD ointment b.i.d. (40 mg, weekly) and follow-up continued for 12 weeks. RESULTS: At the end of radiotherapy, 77.1% of the patients ameliorated completely or partially, and at the end of the 12-week period 100% of patients were free of toxicity. No acute toxicity relapses were reported. Response time reduced during radiotherapy, as well as the treatment time at the end of it. CONCLUSIONS: The employment of SOD topically is efficient in the treatment of radiodermatitis, which is an acute side effect of radiotherapy.

Early stage breast cancer conserving treatment: high dose rate brachytherapy boost to the tumour bed.

INTRODUCTION: The dose administered to the tumour bed is a risk-factor for local recurrence in localised breast cancer following breast-conserving surgery. MATERIALS AND METHODS: All patients (n=94) received 50 Gy external beam radiotherapy and one application of 700 cGy at 85% isodose with high dose rate brachytherapy. RESULTS: Of the cases, 84% were infiltrating ductal carcinoma; 31.2% were G3; 28% were intraductal component > 25%; 54% had margin < 1 cm or unknown. With a mean follow-up of 65 months (range: 36-107 months), the overall actuarial survival at 5 and 8 years was 93.2% and 84.2%, respectively; disease-free survival was 88.3% and 84.6%, respectively; local control was 92.2% and 88.75%, respectively. Local recurrence rate was 5.3%, and distant dissemination rate was 8.5%. Among the risk-factors analysed, only the presence of 4 or more lymph node involvement implied a higher risk for local recurrence (p =0.0001). For distant dissemination, the risk-factors were: 4 or more lymph nodes involved (p = 0.0001),G3 (p =0.029), tumour >3 cm (p = 0.001), irradiation volume with external beam radiotherapy (p =0.0001), and presence of local recurrence (p = 0.001). CONCLUSION: High dose rate brachytherapy is an effective method for reducing local recurrence, and increasing local control.

Early stage breast cancer conserving treatment: high dose rate brachytherapy boost to the tumour bed

Introduction. The dose administered to the tumour bed is a risk-factor for local recurrence in localised breast cancer following breast-conserving surgery. Materials and Methods. All patients (n=94) received 50 Gy external beam radiotherapy and one application of 700 cGy at 85% isodose with high dose rate brachytherapy. Results. Of the cases, 84% were infiltrating ductal carcinoma; 31.2% were G3; 28% were intraductal component > 25%; 54% had margin 3 cm (p = 0.001), irradiation volume with external beam radiotherapy (p = 0.0001), and presence of local recurrence (p = 0.001). Conclusion. High dose rate brachytherapy is an effective method for reducing local recurrence, and increasing local control

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