Hypofractionation with concomitant boost using intensity-modulated radiation therapy in early-stage breast cancer in Mexico.

AIM: To evaluate whether hypofractionation with integrated boost to the tumour bed using intensity-modulated radiation therapy is an acceptable option and to determine whether this treatment compromises local control, toxicity and cosmesis. BACKGROUND: Retrospective studies have demonstrated that patients who are treated with HF and integrated boost experience adequate local control, a dosimetric benefit, decreased toxicity and acceptable cosmesis compared with conventional fractionation. MATERIALS AND METHODS: A retrospective, observational and longitudinal study was conducted from January 2008 to June 2015 and included 34 patients with breast cancer (stage 0-II) who were undergoing conservative surgery.The prescribed doses were 45 Gy in 20 fractions (2.25 Gy/fraction) to the breast and 56 Gy in 20 fractions (2.8 Gy/fraction) to the tumour bed. RESULTS: Thirty-four patients were included. The mean follow-up was 49.29 months, and the mean age was 52 years. The mean percentage of PTV from the mammary region that received 100% of the prescribed dose was 97.89% (range 95-100), and the mean PTV percentage of the tumour bed that received 100% of the dose was 98% (95-100).The local control and the overall survival were 100%, and the cosmesis was good in 82% of the patients. Grade 1 acute toxicity was present in 16 patients (47%), and grade 1 chronic toxicity occurred in 6 cases (18%). CONCLUSION: The results of the present study demonstrate that hypofractionation with integrated boost using intensity-modulated radiation therapy is an acceptable option that provides excellent local control and low toxicity.

[Stereotactic radiosurgery with linear accelerator (LINAC). Report of the technical experience in 100 cases treated at the Mexico General Hospital]. / Radiocirugía estereotáxica con acelerador lineal (LINAC). Informe de la experiencia técnica en el manejo de 100 casos en el Hospital General de México.

UNLABELLED: Stereotactic radiosurgery consists of the release and high dose radiation inside the intracraneal, small, well defined and stereotactic localized injury. OBJECTIVE: In this study we describe the technical aspects, clinical results and dose radiation levels used in 100 patients treated with LINAC. METHODS: One hundred patients received treatment with LINAC stereotactic radiosurgery, 34 AVM, 22 meningiomas, 18 astrocytomas, 11 pituitary adenomas, 5 cavernous malformations, 3 acoustic neuromas, 3 craniopharyngiomas, 2 cases of epilepsy, one brain metastasis and one ependymoma. The radiation dose changed in each case. Studied variables: response of the injury, toxicity, in target dose, number of isocenters, number of treatment arcs, number o fcollimators, dose of risk organ, homogeneity of target, margin of error, target, diameter of collimator and location of target. We applied the chi2 test with statistical significance of p < 0.05. RESULTS: The median follow-up was 17.7 months. We had 3 cases of minor toxicity. We confirmed that for a greater target volume, greater number of treatment arcs were necessary, with greater margins of errors and greater number of isocenters. CONCLUSIONS: Radiosurgery is a safe and reliable technique to treat benign and malignant intracraneal lesions.

Radiocirugía estereotáxica con acelerador lineal (LINAC): Informe de la experiencia técnica en el manejo de 100 casos en el Hospital General de México / Stereotactic radiosurgery with linear accelerator (LINAC): Report of the technical experience in 100 cases treated at the Mexico General Hospital

La radiocirugía estereotáxica consiste en la liberación de una dosis única y grande de radiación a una lesión intracraneal, pequeña, bien definida y localizada estereotáxicamente. Objetivo: El objetivo de este estudio es detallar las consideraciones técnicas y correlacionarlas con los resultados clínicos, así como reportar los márgenes de dosis utilizados. Métodos: Fueron tratados 100 pacientes mediante radiocirugía estereotáxica con LINAC. Treinta y cuatro casos de malformaciones arteriovenosas, 22 meningiomas, 18 astrocitomas, 11 adenomas hipofisiarios, 5 angiomas cavernosos, 3 neurinomas del acústico, 3 craneofaringiomas, 2 casos de epilepsia, una metástasis cerebral y un ependimoma. Las dosis de radiación utilizadas variaron en cada caso. Variables estudiadas: respuesta de la lesión, toxicidad, dosis al volumen blanco, número de isocentros, número de arcos de tratamiento, número de colimadores, dosis a órganos riesgo, homogeneidad volumen blanco, margen de error, volumen blanco, diámetro de colimadores y localización del volumen blanco. Se realizó la prueba x² con significancia estadística p <0.05. La media seguimiento fue de 17.7 meses. Resultados: Se presentaron tres casos de toxicidad menor. Se confirmó que a mayor volumen blanco tratado será necesario mayor número de arcos de tratamiento, con amplio margen de error y mayor número de isocentros. Conclusión: La radiocirugía es un método seguro y confiable para el manejo de entidades patológicas benignas y malignas intracraneales.

Stereotactic radiosurgery consists of the release and high dose radiation inside the intracraneal, small, well defined and stereotactic localized injury. Objective: In this study we describe the technical aspects, clinical results and dose radiation levels used in 100 patients treated with LINAC. Methods: One hundred patients received treatment withe LINAC stereotactic radiosurgery, 34 AVM, 22 meningiomas, 18 astrocytomas, 11 pituitary adenomas, 5 cavernous malformations, 3 acoustic neuromas, 3 craniopharyngiomas, 2 cases of epilepsy, one brain metastases and one ependymoma. The radiation dose changed in each case. Studied variables: response of the injury, toxicity, in target dose, number of isocenters, number of treatment arcs, number of collimators, dose of risk organ, homogeneity of target, margin of error, target, diameter of collimator and location of target. We applied the %2 test with statistical significance of p < 0.05. Results: The median follow up was 17.7 months. We had 3 cases of minor toxicity. We confirmed that for a greater target volume, greater number oftreatment arcs were necessary, with greater margins of errors and greater number of isocenters. Conclusions: Radiosurgery is a safe and reliable technique to treat benign and malignant intracranial lesions.

Amiloidosis larnngea. reporte de un caso tratado exitosamente con radioterapia extenaa

La amiloidosis laríngea es una enfermedad poco común que representa sólo el 0.68% de los tumores benignos de la laringe. Se presenta como un tumor nodular o como depósitos difusos subepiteliales formando masas y causando disfonía, disfagia y en ocasiones, obstrucción de la vía aérea. Históricamente el tratamiento se ha enfocado a resección quirúrgica, ablación mediante láser, colocación de stent y en algunos casos medicamentos como colchicina, melfalán y prednisona. En este artículo presentamos un caso de amiloidosis laríngea persistente a manejo mediante ablación con láser y melfalán/prednisona, que fue manejado exitosamente con radioterapia externa. Catorce meses después de haber recibido dosis moderadas de radiación, el paciente se ha mantenido sin datos clínicos y por imagen de enfermedad. El papel que desempeña la radioterapia en el manejo de la amiloidosis laríngea es revisado en la literatura.

Laryngeal amyloidosis is an uncommon disease accounting for 0.68% of benign tumors of the larynx. It can present as a nodular tumor or diffuse subepithelial deposition forming a mass and causing hoarseness, dysphagia or even airway obstruction. Treatment has historically focused on debridement, laser ablation, stent placement and in some cases colchicine, melphalan and prednisone. We present a case of laryngeal amyloidosis persistent to management with laser ablation and melphalan/prednisone, successfully managed with external beam radiation therapy. Fourteen months after a moderate radiation dose, the patient remained without symptomatic or image data of disease. The literature concerning the role of radiation therapy in the treatment of laryngeal amyloidosis is reviewed.