The elective treatment for noninvasive breast carcinoma has not yet been established. As a result... more The elective treatment for noninvasive breast carcinoma has not yet been established. As a result of mammographic screening programs, the incidence of noninvasive tumors has increased and has lead to the same controversy already present had with invasive carcinomas: mastectomy or conserving therapy. Since 1990, 101 patients with noninvasive breast cancer were treated with irradiation following breast-conserving surgery. All the patients had irradiation of the whole breast (mean dose, 47.6 +/- 1.2 Gy). The radiation dose boost to the tumor bed was delivered in 28.7% of the cases (mean dose, 21.03 +/- 3.06 Gy), and in 71.3%, the boost was not administered. With a median follow-up of 34 months, survival is 100%. The disease-free survival at 5 years by the Kaplan-Meier method is 93.6 +/- 8.65. The conserving treatment is a valid option for treatment of patients with ductal carcinoma in situ.
ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast... more ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast hypofractionated radiotherapy and report patient tolerance of this procedure.Material and methodPatients were included after conservative surgery and underwent adjuvant therapy. The whole breast was treated at 2.67 Gy per fraction up to 40 Gy. The boost was performed at different dose levels (16 or 8 Gy) according to the presence of risk factors for local recurrence (tumor size, histologic grade, margin status or the presence of carcinoma in situ) or nothing in case of their absence.ResultsA total of 110 patients were treated. The distribution into high-, middle- and low-risk groups was 51, 54 and 5 patients, respectively. There was no toxicity in 4.5% of the patients. Grade i or ii dermatitis was found in 38.2 and 47.3%, respectively. No differences were observed in acute dermatitis depending on boost doses. After a follow-up of 2 years, there were no chronic skin or subcutaneous changes in 79 patients (71.8%). Mild fibrosis occurred in 24 patients (21.8%) and grade ii fibrosis occurred in 7 patients.Conclusions Hypofractionated boost seems to be well tolerated. Acute and chronic toxicities are mild. The cumulative dose does not seem to increase the incidence of fibrosis at the boost area compared with the whole breast.
ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast... more ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast hypofractionated radiotherapy and report patient tolerance of this procedure.Material and methodPatients were included after conservative surgery and underwent adjuvant therapy. The whole breast was treated at 2.67 Gy per fraction up to 40 Gy. The boost was performed at different dose levels (16 or 8 Gy) according to the presence of risk factors for local recurrence (tumor size, histologic grade, margin status or the presence of carcinoma in situ) or nothing in case of their absence.ResultsA total of 110 patients were treated. The distribution into high-, middle- and low-risk groups was 51, 54 and 5 patients, respectively. There was no toxicity in 4.5% of the patients. Grade i or ii dermatitis was found in 38.2 and 47.3%, respectively. No differences were observed in acute dermatitis depending on boost doses. After a follow-up of 2 years, there were no chronic skin or subcutaneous changes in 79 patients (71.8%). Mild fibrosis occurred in 24 patients (21.8%) and grade ii fibrosis occurred in 7 patients.Conclusions Hypofractionated boost seems to be well tolerated. Acute and chronic toxicities are mild. The cumulative dose does not seem to increase the incidence of fibrosis at the boost area compared with the whole breast.
Reports of Practical Oncology & Radiotherapy, 2013
This article is a summary of the conference &... more This article is a summary of the conference "Clinical and technological transition in breast cancer" that took place in the Congress of the Spanish Society of Radiation Oncology, placed in Vigo (Spain) on June 21, 2013. Hugo Marsiglia and Philip Poortmanns were the speakers, the first discussed about "Clinical and technological transition" and the second about "EORTC clinical trials and protocols".
... Martí Lacruz (Barcelona, 1962) és llicenciat en Ciències Fí- siques per la Universitat de Bar... more ... Martí Lacruz (Barcelona, 1962) és llicenciat en Ciències Fí- siques per la Universitat de Barcelona i especialista en radiofísica hospitalària. ... Page 3. Figura 3: Isodosis de referència incorrecta doncs no engloba completament el tumor ICRTOG = VIR VVB , (1) ...
International Journal of Radiation Oncology*Biology*Physics, 2014
To assess the correlation of radiation-induced apoptosis in vitro of CD4 and CD8 T lymphocytes wi... more To assess the correlation of radiation-induced apoptosis in vitro of CD4 and CD8 T lymphocytes with late toxicity of prostate cancer patients treated with radiation therapy. 214 patients were prospectively included in the study. Peripheral blood was drawn from patients before treatment and irradiated with 8 Gy. The percentage of CD4+ and CD8+ T lymphocytes that underwent radiation-induced apoptosis was assessed by flow cytometry. Toxicity and mortality were correlated in 198 cases with pretreatment apoptosis and clinical and biological variables by use of a Cox proportional hazards model. The mean percentage of CD4+ and CD8+ T lymphocyte radiation-induced apoptosis was 28.58% (±14.23) and 50.76% (±18.9), respectively. Genitourinary (GU) toxicity was experienced by 39.9% of patients, while gastrointestinal (GI) toxicity was experienced by 19.7%. The probability of development of GU toxicity was nearly doubled (hazard ratio [HR] 1.99, P=.014) in those patients in whom the percentage of in vitro radiation-induced apoptosis of CD4+ T-lymphocytes was ≤28.58%. It was also almost double in patients who received doses ≥50 Gy in 65% of the bladder volume (V65 ≥50) (HR 1.92, P=.048). No correlation was found between GI toxicity and any of the variables studied. The probability of death during follow-up, after adjustment for different variables, was 2.7 times higher in patients with a percentage of CD8+ T lymphocyte apoptosis ≤50.76% (P=.022). In conclusion, our study shows, in the largest prospective cohort of prostate cancer patients undergoing radiation therapy, that in vitro radiation-induced apoptosis of CD4+ T lymphocytes assessed before radiation therapy was associated with the probability of developing chronic GU toxicity. In addition, the radiation dose received in the urinary bladder (V65 ≥50) affected the occurrence of GU toxicity. Finally, we also demonstrate that radiation-induced apoptosis of CD8+ T lymphocytes was associated with overall survival, although larger series are needed to confirm this finding.
International Journal of Radiation Oncology*Biology*Physics, 2009
To evaluate the risk factors for acute esophagitis (AET) in lung cancer patients treated with con... more To evaluate the risk factors for acute esophagitis (AET) in lung cancer patients treated with concurrent 3D-CRT and chemotherapy. Data from 100 patients treated with concurrent chemoradiotherapy with a mean dose of 62.05 +/- 4.64 Gy were prospectively evaluated. Esophageal toxicity was graded according to criteria of the Radiation Therapy Oncology Group. The following dosimetric parameters were analyzed: length and volume of esophagus in treatment field, percentage of esophagus volume treated to >or=10, >or=20,…
Allogeneic bone marrow transplantation in patients with leukaemia is an aggressive therapeutic pr... more Allogeneic bone marrow transplantation in patients with leukaemia is an aggressive therapeutic procedure which implies high early mortality. Current opinion trends attribute the greater part of the procedure toxicity to the preparative regimen. The results of a multivariate analysis on data of 174 leukaemia patients conditioned with total body irradiation (TBI), 10-12 Gy, single dose or fractionated, and lung shielding at 8 Gy, plus chemotherapy: cyclophosphamide 120 mg/kg, before or after TBI, are presented. The variables statistically related with early mortality are age, Karnofsky index (KI) and acute graft-versus-host disease (GvHD). No variable depending on radiotherapy reached the significance level. The relative risk of early mortality for patients older than 26 years, in bad general condition (KI < 90%), or developing acute severe (grades II-IV)GvHD, is 3.99, 5.68, and 6.71, respectively. We conclude that in the range of TBI schedules analysed, radiation therapy is not an important factor in early death, but acute severe GvHD, or recipient's bad general condition are factors to be improved by bone marrow transplantation teams if they want to improve the therapeutic index of the procedure.
Standard locoregional treatment of early-stage breast cancer currently consists of the conservati... more Standard locoregional treatment of early-stage breast cancer currently consists of the conservative surgery and sentinel lymph node biopsy. In the event of positive sentinel node biopsy, an axillary level I-II lymphadenectomy should be carried out. However, recent publications have increasingly supported a tendency not to apply the surgical lymphadenectomy, but simultaneously, it has been developed a new role of regional radiotherapy, even if there is only 1-3 axillary lymph nodes involved. Given these new trends, radiation oncologists are facing the dilemma with regard to deciding about regional irradiation of breast cancer. For such purpose, The Spanish Group of Breast Cancer Radiation Oncology (GEORM as per its Spanish acronym) decided to reach a consensus to issue the respective guidelines for such types of cases. GEORM Managing Commission, gathering 13 members of different Spanish regional communities, issued a questionnaire including different clinical situations. These questions were set as key questions seeking responses, which were answered by 66 % out of the 75 members of the group. Following the response, the guidelines were drafted based on the replies to the mentioned questionnaire. All the respective issues were discussed by means of a virtual platform. In this article, we show the levels of consensus for different clinical situations, depending on the number of nodes involved and the type of surgical procedure performed on the axillary lymph nodes. The ongoing evolution of the oncological treatments obliges the radiation oncologists to take decisions without any existing clarifying evidence, and therefore, the consensus is necessary, which can assist in the decision-making process by the practitioners in such kinds of clinical situations.
To evaluate the predictive factors of recurrence in cervical cancer treated with radical radioche... more To evaluate the predictive factors of recurrence in cervical cancer treated with radical radiochemotherapy. 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. 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. 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.
The elective treatment for noninvasive breast carcinoma has not yet been established. As a result... more The elective treatment for noninvasive breast carcinoma has not yet been established. As a result of mammographic screening programs, the incidence of noninvasive tumors has increased and has lead to the same controversy already present had with invasive carcinomas: mastectomy or conserving therapy. Since 1990, 101 patients with noninvasive breast cancer were treated with irradiation following breast-conserving surgery. All the patients had irradiation of the whole breast (mean dose, 47.6 +/- 1.2 Gy). The radiation dose boost to the tumor bed was delivered in 28.7% of the cases (mean dose, 21.03 +/- 3.06 Gy), and in 71.3%, the boost was not administered. With a median follow-up of 34 months, survival is 100%. The disease-free survival at 5 years by the Kaplan-Meier method is 93.6 +/- 8.65. The conserving treatment is a valid option for treatment of patients with ductal carcinoma in situ.
ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast... more ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast hypofractionated radiotherapy and report patient tolerance of this procedure.Material and methodPatients were included after conservative surgery and underwent adjuvant therapy. The whole breast was treated at 2.67 Gy per fraction up to 40 Gy. The boost was performed at different dose levels (16 or 8 Gy) according to the presence of risk factors for local recurrence (tumor size, histologic grade, margin status or the presence of carcinoma in situ) or nothing in case of their absence.ResultsA total of 110 patients were treated. The distribution into high-, middle- and low-risk groups was 51, 54 and 5 patients, respectively. There was no toxicity in 4.5% of the patients. Grade i or ii dermatitis was found in 38.2 and 47.3%, respectively. No differences were observed in acute dermatitis depending on boost doses. After a follow-up of 2 years, there were no chronic skin or subcutaneous changes in 79 patients (71.8%). Mild fibrosis occurred in 24 patients (21.8%) and grade ii fibrosis occurred in 7 patients.Conclusions Hypofractionated boost seems to be well tolerated. Acute and chronic toxicities are mild. The cumulative dose does not seem to increase the incidence of fibrosis at the boost area compared with the whole breast.
ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast... more ABSTRACT IntroductionWe present the results of adding a hypofractionated boost after whole-breast hypofractionated radiotherapy and report patient tolerance of this procedure.Material and methodPatients were included after conservative surgery and underwent adjuvant therapy. The whole breast was treated at 2.67 Gy per fraction up to 40 Gy. The boost was performed at different dose levels (16 or 8 Gy) according to the presence of risk factors for local recurrence (tumor size, histologic grade, margin status or the presence of carcinoma in situ) or nothing in case of their absence.ResultsA total of 110 patients were treated. The distribution into high-, middle- and low-risk groups was 51, 54 and 5 patients, respectively. There was no toxicity in 4.5% of the patients. Grade i or ii dermatitis was found in 38.2 and 47.3%, respectively. No differences were observed in acute dermatitis depending on boost doses. After a follow-up of 2 years, there were no chronic skin or subcutaneous changes in 79 patients (71.8%). Mild fibrosis occurred in 24 patients (21.8%) and grade ii fibrosis occurred in 7 patients.Conclusions Hypofractionated boost seems to be well tolerated. Acute and chronic toxicities are mild. The cumulative dose does not seem to increase the incidence of fibrosis at the boost area compared with the whole breast.
Reports of Practical Oncology & Radiotherapy, 2013
This article is a summary of the conference &... more This article is a summary of the conference "Clinical and technological transition in breast cancer" that took place in the Congress of the Spanish Society of Radiation Oncology, placed in Vigo (Spain) on June 21, 2013. Hugo Marsiglia and Philip Poortmanns were the speakers, the first discussed about "Clinical and technological transition" and the second about "EORTC clinical trials and protocols".
... Martí Lacruz (Barcelona, 1962) és llicenciat en Ciències Fí- siques per la Universitat de Bar... more ... Martí Lacruz (Barcelona, 1962) és llicenciat en Ciències Fí- siques per la Universitat de Barcelona i especialista en radiofísica hospitalària. ... Page 3. Figura 3: Isodosis de referència incorrecta doncs no engloba completament el tumor ICRTOG = VIR VVB , (1) ...
International Journal of Radiation Oncology*Biology*Physics, 2014
To assess the correlation of radiation-induced apoptosis in vitro of CD4 and CD8 T lymphocytes wi... more To assess the correlation of radiation-induced apoptosis in vitro of CD4 and CD8 T lymphocytes with late toxicity of prostate cancer patients treated with radiation therapy. 214 patients were prospectively included in the study. Peripheral blood was drawn from patients before treatment and irradiated with 8 Gy. The percentage of CD4+ and CD8+ T lymphocytes that underwent radiation-induced apoptosis was assessed by flow cytometry. Toxicity and mortality were correlated in 198 cases with pretreatment apoptosis and clinical and biological variables by use of a Cox proportional hazards model. The mean percentage of CD4+ and CD8+ T lymphocyte radiation-induced apoptosis was 28.58% (±14.23) and 50.76% (±18.9), respectively. Genitourinary (GU) toxicity was experienced by 39.9% of patients, while gastrointestinal (GI) toxicity was experienced by 19.7%. The probability of development of GU toxicity was nearly doubled (hazard ratio [HR] 1.99, P=.014) in those patients in whom the percentage of in vitro radiation-induced apoptosis of CD4+ T-lymphocytes was ≤28.58%. It was also almost double in patients who received doses ≥50 Gy in 65% of the bladder volume (V65 ≥50) (HR 1.92, P=.048). No correlation was found between GI toxicity and any of the variables studied. The probability of death during follow-up, after adjustment for different variables, was 2.7 times higher in patients with a percentage of CD8+ T lymphocyte apoptosis ≤50.76% (P=.022). In conclusion, our study shows, in the largest prospective cohort of prostate cancer patients undergoing radiation therapy, that in vitro radiation-induced apoptosis of CD4+ T lymphocytes assessed before radiation therapy was associated with the probability of developing chronic GU toxicity. In addition, the radiation dose received in the urinary bladder (V65 ≥50) affected the occurrence of GU toxicity. Finally, we also demonstrate that radiation-induced apoptosis of CD8+ T lymphocytes was associated with overall survival, although larger series are needed to confirm this finding.
International Journal of Radiation Oncology*Biology*Physics, 2009
To evaluate the risk factors for acute esophagitis (AET) in lung cancer patients treated with con... more To evaluate the risk factors for acute esophagitis (AET) in lung cancer patients treated with concurrent 3D-CRT and chemotherapy. Data from 100 patients treated with concurrent chemoradiotherapy with a mean dose of 62.05 +/- 4.64 Gy were prospectively evaluated. Esophageal toxicity was graded according to criteria of the Radiation Therapy Oncology Group. The following dosimetric parameters were analyzed: length and volume of esophagus in treatment field, percentage of esophagus volume treated to >or=10, >or=20,…
Allogeneic bone marrow transplantation in patients with leukaemia is an aggressive therapeutic pr... more Allogeneic bone marrow transplantation in patients with leukaemia is an aggressive therapeutic procedure which implies high early mortality. Current opinion trends attribute the greater part of the procedure toxicity to the preparative regimen. The results of a multivariate analysis on data of 174 leukaemia patients conditioned with total body irradiation (TBI), 10-12 Gy, single dose or fractionated, and lung shielding at 8 Gy, plus chemotherapy: cyclophosphamide 120 mg/kg, before or after TBI, are presented. The variables statistically related with early mortality are age, Karnofsky index (KI) and acute graft-versus-host disease (GvHD). No variable depending on radiotherapy reached the significance level. The relative risk of early mortality for patients older than 26 years, in bad general condition (KI < 90%), or developing acute severe (grades II-IV)GvHD, is 3.99, 5.68, and 6.71, respectively. We conclude that in the range of TBI schedules analysed, radiation therapy is not an important factor in early death, but acute severe GvHD, or recipient's bad general condition are factors to be improved by bone marrow transplantation teams if they want to improve the therapeutic index of the procedure.
Standard locoregional treatment of early-stage breast cancer currently consists of the conservati... more Standard locoregional treatment of early-stage breast cancer currently consists of the conservative surgery and sentinel lymph node biopsy. In the event of positive sentinel node biopsy, an axillary level I-II lymphadenectomy should be carried out. However, recent publications have increasingly supported a tendency not to apply the surgical lymphadenectomy, but simultaneously, it has been developed a new role of regional radiotherapy, even if there is only 1-3 axillary lymph nodes involved. Given these new trends, radiation oncologists are facing the dilemma with regard to deciding about regional irradiation of breast cancer. For such purpose, The Spanish Group of Breast Cancer Radiation Oncology (GEORM as per its Spanish acronym) decided to reach a consensus to issue the respective guidelines for such types of cases. GEORM Managing Commission, gathering 13 members of different Spanish regional communities, issued a questionnaire including different clinical situations. These questions were set as key questions seeking responses, which were answered by 66 % out of the 75 members of the group. Following the response, the guidelines were drafted based on the replies to the mentioned questionnaire. All the respective issues were discussed by means of a virtual platform. In this article, we show the levels of consensus for different clinical situations, depending on the number of nodes involved and the type of surgical procedure performed on the axillary lymph nodes. The ongoing evolution of the oncological treatments obliges the radiation oncologists to take decisions without any existing clarifying evidence, and therefore, the consensus is necessary, which can assist in the decision-making process by the practitioners in such kinds of clinical situations.
To evaluate the predictive factors of recurrence in cervical cancer treated with radical radioche... more To evaluate the predictive factors of recurrence in cervical cancer treated with radical radiochemotherapy. 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. 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. 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.
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