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Background: In 2015, the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) called for 80% of National Cancer Control Plans (NCCP) to include radiotherapy by 2020. As part of the ongoing ESTRO Global Impact of Radiotherapy in Oncology (GIRO) project, we assessed whether inclusion of radiotherapy in NCCPs correlates with radiotherapy machine availability, national income, and geographic region. Methods: A previously validated checklist was used to determine whether radiotherapy was included in each country's NCCP. We applied the CCORE optimal radiotherapy utilisation model to the GLOBOCAN 2020 data to estimate the demand for radiotherapy and compared this to the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres (DIRAC) supply data, stratifying by income level and world region. World regions were defined according to the IAEA. Findings: Complete data (including GLOBOCAN 2020, DIRAC and NCCP) was available for 143 countries. Over half (55%, n = 79) included a radiotherapy-specific checklist item within the plan. Countries which included radiotherapy services planning in their NCCP had a higher median number of machines (1.68 vs 0.75 machines/1000 patients needing radiotherapy, p < 0.001). There was significant regional and income-level heterogeneity in the inclusion of radiotherapy-related items in NCCPs. Low-income and Asia-Pacific countries were least likely to include radiation oncology services planning in their NCCP (p = 0.06 and p = 0.003, respectively). Few countries in the Asia-Pacific (18.6%) had a plan to develop or maintain radiation services, compared to 57% of countries in Europe. Interpretation: Only 55% of current NCCPs included any information regarding radiotherapy, below the GTFRCC's target of 80%. Prioritisation of radiotherapy in NCCPs was correlated with radiotherapy machine availability. There was regional and income-level heterogeneity regarding the inclusion of specific radiotherapy checklist items in the NCCPs. Ongoing efforts are needed to promote the inclusion of radiotherapy in future iterations of NCCPs in order to improve global access to radiation treatment.

Introduction Laryngeal squamous cell carcinoma is the second most prevalent malignancy among head and neck tumors, and the treatment of patients with stage I or II disease can be performed with surgery or radiation therapy. National population studies describing therapeutic results comparing these modalities are unusual, but they can be very important to direct treatment guidelines. Objective To evaluate the survival results of patients with laryngeal squamous cell carcinoma at clinical stages I or II, according to the main therapeutic modalities used. Methods Cross-sectional, population-based study using the database of Fundação Oncocentro de São Paulo from January 2000 to March 2019. Inclusion criteria were patients with laryngeal squamous cell carcinoma in clinical stages cT1-2N0. To compensate for the non-random allocation of patients and the imbalance between confounding variables between groups, we used the propensity score methodology. Results A total of 3786 patients met the inclusion criteria. Regarding the cT stage, there were 2171 patients (57.3%) with cT1 tumors. Patients in the public health system had a longer time between diagnosis and treatment (p< 0.001). The analysis by propensity score showed that patients treated with surgery had a tendency towards better disease-specific survival (p = 0.012). Comparing radiotherapy alone versus its combination with radiochemotherapy, radiotherapy alone showed a tendency towards a better survival rate (p< 0.001). Conclusion Analysis by propensity score identified better results for disease-specific survival in patients with laryngeal squamous cell carcinoma at clinical stages I and II treated by surgery when compared to radiotherapy. Resumo Introdução O carcinoma epidermoide de laringe é o segundo mais prevalente entre os tumores de cabeça e pescoço e o tratamento dos pacientes com doença em estádio I ou II pode ser feito com cirurgia ou radioterapia. Estudos populacionais nacionais que descrevem os resultados terapêuticos e compararam essas modalidades são poucos frequentes, mas podem ser muito importantes para orientar diretrizes de tratamento. Objetivo Avaliar os resultados de sobrevida dos pacientes com carcinoma epidermoide de laringe em estádios clínicos I ou II de acordo com as principais modalidades terapêuticas usadas. Método Estudo transversal de base populacional com a base de dados da Fundação Oncocentro de São Paulo de janeiro de 2000 a março de 2019. Os critérios de inclusão foram pacientes com carcinoma epidermoide de laringe em estádios clínicos cT1-2N0. Para compensar pela alocação não randômica dos pacientes e pelo desequilíbrio entre variáveis confundidoras entre os grupos, usamos a metodologia do escore de propensão. Resultados Preencheram os critérios de inclusão 3.786 pacientes. Em relação ao estádio cT, houve 2.171 pacientes (57,3%) com tumores cT1. Os pacientes do sistema único de saúde (SUS) apresentaram um maior tempo entre o diagnóstico e o tratamento (p < 0,001). A análise por escore de propensão mostrou que os pacientes submetidos a cirurgia apresentaram uma tendência de melhor sobrevida doença específica (p = 0,012). Comparando-se radioterapia isolada versus combinação com radioquimioterapia, o tratamento isolado demonstrou tendência a melhor taxa de sobrevida (p< 0,001). Conclusão A análise por escore de propensão identificou melhores resultados de sobrevida doença específica em pacientes com carcinoma epidermoide de laringe estádios clínicos I e II tratados por cirurgia quando comparados a radioterapia.

In the management of prostate cancer , few treatments have caused as much controversy as adjuvant radiotherapy (ART) after radical prostatectomy in high-risk patients In the present article, we assess the exclusion and inclusion criteria of the 6 randomised trials and 5-year biochemical relapse-free survival and overall survival rates in order to identify the patient subgroups most likely to benefit from ART. We also evaluate treatment-related toxicity and the indications for androgen deprivation therapy . The main aim of this analysis was to determine whether the available evidence, which previously appeared to support ART, now favours early salvage radiotherapy. If so, perhaps we can finally resolve the controversy surrounding the optimal timing of postoperative radiotherapy. Sin financiación 2.954 JCR (2021) Q3, 47/90 Urology & Nephrology 0.818 SJR (2021) Q1, 19/108 Urology No data IDR 2021 UEM

Introduction: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. Conclusions: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy. Resumo: Introdução: A fístula faringocutânea é a complicação mais significativa após laringectomia total de resgate em pacientes que receberam tratamento prévio com radioterapia com ou sem quimioterapia. Objetivo: Revisar a taxa de fístula em pacientes irradiados submetidos a laringectomia total de resgate, para determinar se o uso de interposição de retalho do peitoral maior reduz a incidência e a duração da fístula e examinar outros fatores de risco. Método: Fizemos uma revisão retrospectiva de pacientes submetidos à laringectomia total de resgate para câncer exclusivamente laríngeo após falha da radioterapia curativa primária entre 2000 e 2017. Dados gerais dos pacientes, fatores de risco e outras complicações foram analisados. Resultados: Foram identificados 27 pacientes com média de 66,4 anos, principalmente do sexo masculino (92,5%). O grupo de fechamento primário sem retalho de peitoral maior incluiu 14 pacientes e o grupo de fechamento com retalho de peitoral maior incluiu 13 pacientes. Fístula faringocutânea esteve presente em 15 pacientes (55,5%). A taxa global de fístula faringocutânea foi maior no grupo de pacientes sem retalho de peitoral maior em comparação com aqueles que receberam o retalho (78,6% vs. 30,8%, p = 0,047). Além disso, as fístulas faringocutâneas que precisaram ser reparadas através de cirurgia (64,3% vs. 7,7%, p = 0,03) e grandes faringostomias (64,3% vs. 0%, p = 0,0004) apresentaram uma taxa mais alta no grupo fechado primariamente sem retalho do peitoral maior. Não encontramos outros fatores de risco com significância estatística. O início da dieta oral (84 dias vs. 21,5 dias, p = 0,039) e a duração da internação (98,3 dias vs. 27,2 dias, p = 0,0041) foram muito menores nos pacientes com uso preventivo do retalho do peitoral maior. Dois pacientes morreram em consequência de complicações de grandes faringostomias. Conclusões: O uso profilático do retalho do peitoral maior reduziu a incidência, a gravidade e a duração da fístula e deve ser considerado durante a laringectomia total de resgate. Keywords: Salvage total laryngectomy, Pectoralis major flap, Pharyngocutaneous fistula, Radiotherapy, Palavras-chave: Laringectomia total de resgate, Retalho do peitoral maior, Fístula faringocutânea, Radioterapia

Radiotherapy interventions are rapidly evolving and improving, holding promise for better patient outcomes, yet at the possible detriment of higher societal costs. The ESTRO-HERO value-based radiotherapy project aims to develop a framework defining and assessing the value of radiotherapy innovations, to support clinical implementation and equitable access, within a sustainable healthcare system. (c) 2021 The Authors. Published by Elsevier B.V. Radiotherapy and Oncology 160 (2021) 236-239 This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Sin financiación No data JCR 2020 0.169 SJR (2020) Q3, 31/43 Family Practice No data IDR 2019 UEM

Introduction: Survival after hematopoietic stem cell transplantation has improved dramatically in recent years. Unfortunately, there is an increased risk of subsequent malignant neoplasms (SMN) in this population and this represents a significant cause of late mortality. Patients and methods: In this study, we analysed the incidence of SMN and the associated risk factors in patients referred at a paediatric age for hematopoietic stem cell transplantation (allogeneic or autologous) in our centre. Results: We observed 19 cases of SMN in a cohort of 371 patients, with a cumulative incidence of 6, 12, and 36% at 15, 20, and 30 years of follow-up, respectively. The solid tumours were the most prevalent malignancies. The risk was significantly higher than expected in the general population for each tumour type and in the different age ranges (P

This work reports the experimental development of an integral Gd-infused dosimeter suitable for Gd dose enhancement assessment along with Monte Carlo simulations applied to determine the dose enhancement by radioactive and X-ray sources of interest in conventional and electronic brachytherapy. In this context, capability to elaborate a stable and reliable Gd-infused dosimeter was the first goal aimed at direct and accurate measurements of dose enhancement due to Gd presence. Dose-response was characterized for standard and Gd-infused PAGAT polymer gel dosimeters by means of optical transmission/absorbance. The developed Gd-infused PAGAT dosimeters demonstrated to be stable presenting similar dose-response as standard PAGAT within a linear trend up to 13 Gy along with good post-irradiation readout stability verified at 24 and 48 hours. Additionally, dose enhancement was evaluated for Gd-infused PAGAT dosimeters by means of Monte Carlo (PENELOPE) simulations considering scenarios for isotopic and X-ray generator sources. The obtained results demonstrated the feasibility of obtaining a maximum enhancement around of (14±1)% for 192Ir source and an average enhancement of (70±13)% for 241Am. However, dose enhancement up to (267±18)% may be achieved if suitable filtering is added to the 241Am source. On the other hand, optimized X-ray spectra may attain dose enhancements up to (253±22) %, which constitutes a promising future alternative for replacing radioactive sources by implementing electronic brachytherapy achieving high dose levels. Este trabajo informa sobre el desarrollo experimental de un dosímetro integral infundido con Gd adecuado para la evaluación de aumento de dosis de Gd junto con simulaciones de Monte Carlo aplicadas para determinar el aumento de dosis por fuentes radiactivas y de rayos X de interés en braquiterapia convencional y electrónica. En este contexto, la capacidad de elaborar un dosímetro infundido con Gd estable y confiable fue el primer objetivo destinado a las mediciones directas y precisas de la mejora de la dosis debido a la presencia de Gd. La dosis-respuesta se caracterizó para dosímetros de gel de polímero PAGAT estándar y con infusión de Gd por medio de transmisión óptica/absorbancia. Los dosímetros PAGAT infundidos con Gd desarrollados demostraron ser estables y presentaron una respuesta de dosis similar a la del PAGAT estándar dentro de una tendencia lineal de hasta 13 Gy junto con una buena estabilidad de lectura posterior a la irradiación verificada a las 24 y 48 horas. Además, se evaluó la mejora de la dosis para dosímetros PAGAT infundidos con Gd mediante simulaciones de Monte Carlo (PENÉLOPE) considerando escenarios para fuentes isotópicas y generadoras de rayos X. Los resultados obtenidos demostraron la factibilidad de obtener una mejora máxima en torno al (14±1)% para la fuente de 192Ir y una mejora media del (70±13)% para la fuente de 241Am. Sin embargo, se puede lograr una mejora de la dosis de hasta (267±18) % si se agrega un filtrado adecuado a la fuente de 241Am. Por otro lado, los espectros de rayos X optimizados pueden lograr aumentos de dosis de hasta (253±22) %, lo que constituye una prometedora alternativa de futuro para reemplazar las fuentes radiactivas mediante la implementación de braquiterapia electrónica logrando niveles de dosis altos. Universidad Nacional, Costa Rica Departamento de Física

Radiotherapy is a treatment with curative intent, both in patients with primary diagnosis of prostate cancer (PCa) and in patients presenting with biochemical recurrence after radical prostatectomy (RP). Moreover, the use of stereotactic body radiotherapy as a metastasis directed therapy in patients with oligometastatic PCa has significantly increased in the recent years. Conventional imaging techniques, including transrectal ultrasound, computed tomography (CT), morphologic magnetic resonance and bone scintigraphy have traditionally played a minor role in all those clinical scenarios due to its low diagnostic accuracy. The recent development of the positron emission tomography (PET) radiotracer 68Ga-PSMA binding to the prostate specific membrane antigen (PSMA), a transmembrane glycoprotein overexpressed in PCa cells, has shown promising results. Detection rates for PCa lesions are higher than CT and higher than the best technique available, the PET/CT with choline. Its superiority has been demonstrated even at very low PSA levels (

BACKGROUND: In Alpharadin in Symptomatic Prostate Cancer (ALSYMPCA) trial, radium-223 versus placebo prolonged overall survival with favorable safety in castration-resistant prostate cancer patients with symptomatic bone metastases. Long-term radium-223 monitoring underlies a comprehensive safety and risk/benefit assessment.OBJECTIVE: To report updated ALSYMPCA safety, including long-term safety up to 3 yr after the first injection.DESIGN, SETTING, AND PARTICIPANTS: Safety analyses from phase 3 randomized ALSYMPCA trial included patients receiving ≥1 study-drug injection (600 radium-223 and 301 placebo). Patients (405 radium-223 and 167 placebo) entered long-term safety follow-up starting 12 wk after the last study-drug injection, to 3 yr from the first injection. Forty-eight of 405 (12%) radium-223 and 12/167 (7%) placebo patients completed follow-up, with evaluations every 2 mo for 6 mo, then every 4 mo until 3 yr.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: All adverse events (AEs) were collected until 12 wk after the last injection; subsequently, only treatment-related AEs were collected. Additional long-term safety was assessed by development of acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), aplastic anemia, and secondary malignancies. Data analysis used descriptive statistics.RESULTS AND LIMITATIONS: During treatment to 12 wk following the last injection, 564/600 (94%) radium-223 and 292/301 (97%) placebo patients had treatment-emergent AEs (TEAEs). Myelosuppression incidence was low. Grade 3/4 hematologic TEAEs in radium-223 and placebo groups were anemia (13% vs 13%), neutropenia (2% vs 1%), and thrombocytopenia (7% vs 2%). Ninety-eight of 600 (16%) radium-223 and 68/301 (23%) placebo patients experienced grade 5 TEAEs. Long-term follow-up showed no AML, MDS, or new primary bone cancer; secondary non-treatment-related malignancies occurred in four radium-223 and three placebo patients. One radium-223 patient had aplastic anemia 16 mo after the last injection. No other cases were observed. Limitations include short (3-yr) follow-up.CONCLUSIONS: Final long-term safety ALSYMPCA analysis shows that radium-223 remained well tolerated, with low myelosuppression incidence and no new safety concerns.PATIENT SUMMARY: Updated Alpharadin in Symptomatic Prostate Cancer (ALSYMPCA) trial findings show that radium-223 remained well tolerated during treatment and up to 3 yr after each patient's first injection.

Purpose Our purpose was to assess the dosimetric effect of switching from the analytical anisotropic algorithm (AAA) to Acuros XB (AXB), with dose-to-medium (Dm) and dose-to-water (Dw) reporting modes, in lung stereotactic body radiation therapy patients and determine whether planning-target-volume (PTV) dose prescriptions and organ-at-risk constraints should be modified under these circumstances. Methods and Materials We included 54 lung stereotactic body radiation therapy patients. We delineated the PTV, the ipsilateral lung, the contralateral lung, the heart, the spinal cord, the esophagus, the trachea, proximal bronchi, the ribs, and the great vessels. We performed dose calculations with AAA and AXB, then compared clinically relevant dose-volume parameters. Paired t tests were used to analyze differences of means. We propose a method, based on the composition of the involved structures, for predicting differences between AXB Dw and Dm calculations. Results The largest difference between the algorithms was 4%. Mean dose differences between AXB Dm and AXB Dw depended on the average composition of the volumes. Compared with AXB, AAA underestimated all PTV dose-volume parameters (-0.7 Gy to -0.1 Gy) except for gradient index, which was significantly higher (4%). It also underestimated V5 of the contralateral lung (-0.3%). Significant differences in near-maximum doses (D2) to the ribs were observed between AXB Dm and AAA (1.7%) and between AXB Dw and AAA (-1.6%). AAA-calculated D2 was slightly higher in the remaining organs at risk. Conclusions Differences between AXB and AAA are below the threshold of clinical detectability (5%) for most patients. For a small subgroup, the difference in maximum doses to the ribs between AXB Dw and AXB Dm may be clinically significant. The differences in dose volume parameters between AXB Dw and AXB Dm can be predicted with reference to structure composition

RESUMEN Los tumores primarios del cerebro requieren un manejo multidisciplinario. En este articulo se presenta un modelo de tratamiento de los tumores mas frecuentes del adulto, siendo el objetivo primordial alcanzar el equilibrio entre sobrevida y calidad de vida. Para este efecto, son agrupados segun su clasificacion de la Organizacion Mundial de la Salud (OMS) y se analizan cirugia, radioterapia y quimioterapia segun corresponda. Se discute el tratamiento de cada una de estas lesiones considerando el estado clinico del paciente, la localizacion y tamano de la lesion y el riesgo de dano funcional del sistema nervioso. En especial, se considera la utilidad de diferentes tecnicas que permiten proteger al cerebro durante el tratamiento.

Purpose or Objective: Non-adherence to external radiotherapy is an aspect of treatment which has not been fully explored. The objective of this study is to analyse the relevance of this problem and its impact on 1-year survival

Purpose or Objective: Planning for radiotherapy services requires evidence based information on the optimum and the actual use of this therapy in a population in order to assess the potential gaps in the utilization of external beam radiotherapy.

Purpose or ObjectiveExtracranial stereotactic body radiation therapy (SBRT) allows delivering high doses per fraction with high accuracy to the prostatic gland in a low number of fractions.Dose escalation in normofractionaded radiation prostate cancer trials showed an increased toxicity.In order to evaluate the feasibility and toxicity of a regimen of a single dose hypofractionated prostate stereotactic boost a phase II study was undertaken. Self-reported quality of life (QOL) measures were also obtained in order to better define the possible deleterious effect of treatment.

Purpose or Objective: To evaluate the changes in immune-cell phenotype in peripheral blood following intraoperative radiotherapy (IORT) in breast cancer patients.

ResumenIntroducciónPresentamos a un paciente que recibió tratamiento radioterápico en la infancia por un retinoblastoma. Como principal secuela presenta una severa hipoplasia ósea hemifacial, alteración de la dentición y atrofia muscular. Se realiza cirugía correctora facial mediante distracción ósea, cirugía ortognática y lipoescultura facial con un resultado estético y funcional excelente y estable hasta el momento actual.Caso clínicoVarón de 15 años con hipoplasia témporo-parieto-frontal, orbitaria izquierda y del tercio medio facial con un plano oclusal inclinado, resalte de más de 25mm y múltiples piezas dentales con microdoncia y rizólisis. A los 19 años, inicia ortodoncia prequirúrgica y la colocación de distractores tipo Zurich en el maxilar superior. Se consigue un avance maxilar de 25mm. A los 21 años se realiza cirugía ortognática bimaxilar y lipoescultura facial.ResultadosPaciente con mejoría de la simetría facial, oclusión en clase i con plano oclusal alineado. Resultados estables hasta el momento actual, con 23 años. Continúa con ortodoncia posquirúrgica y rehabilitación dental.DiscusiónSe obtuvo una buena consolidación, con una calidad ósea excelente desde el punto de vista clínico y radiológico, sin presentar complicaciones. Otro beneficio de la distracción es el efecto expansor de los tejidos blandos. La distracción ósea y la cirugía ortognática bimaxilar son métodos prometedores en la reconstrucción del territorio maxilofacial en pacientes radiados con una deformidad dentofacial como secuela oncológica.AbstractIntroductionWe report the case of a patient who received radiotherapy in childhood for retinoblastoma. The main sequelae of this was, severe bone hemifacial hypoplasia, abnormal dentition, and muscle atrophy. Corrective facial surgery was performed through bone distraction, orthognathic surgery, and facial liposuction, with excellent and stable aesthetic and functional results to date.Casereport A 15 year-old patient with left temporo-parieto-frontal and orbital hypoplasia and midface hypoplasia with an inclined occlusal plane, overjet more than 25mm and multiple teeth with microdontia and rhizolysis. At 19 years old, presurgical orthodontics and placement of Zurich type maxillar distractors were started. An advancing of 25mm was achieved. At 21years old, bimaxillary orthognathic surgery and facial liposuction was performed.ResultsPatient improvement in facial symmetry, occlusion type i of Angle classification with inclined occlusal plane. Stable results to date on a 23 year-old patient. Continues with post-surgical orthodontic and dental rehabilitation.DiscussionGood bone consolidation was obtained, with excellent bone quality from a clinical and radiological point of view, with no complications. Another benefit is the distraction expanding effect of the soft tissue. Osteogenesis distraction and bimaxillary orthognathic surgery are promising methods in maxillofacial reconstruction on irradiated patients with dentofacial deformity as oncology sequelae.

INTRODUCTION: Most patients with laryngeal carcinoma present tumors in the glottis that can be treated by different treatment modalities. Some authors consider open partial laryngectomy as obsolete, while others still deem this as a viable and cost-efficient option. OBJECTIVES: To compare the oncological and functional results of a series of patients undergoing partial laryngectomy vs. external radiotherapy for the treatment of glottic cancer. METHODS: Historical cohort study with a series of glottic carcinoma patients undergoing partial laryngectomy or external radiotherapy during a period of ten years. RESULTS: Sixty-two patients with glottic carcinoma were included. Group A comprised those submitted to partial laryngectomy (n = 30), and Group B, those who underwent radiotherapy (n = 32). They were homogeneous in the comparison of mean age, 56.4 vs. 60.4 years (p = 0.12) and distribution in pathological stage (p = 0.91). With regard to oncological outcome, there were no differences in distant metastasis rates, or second primary tumor between groups (p = 1.0), as well as in disease-free time, laryngeal rescue-free time, and overall five-year survival. Severe complication rates were also similar between groups. CONCLUSION: Open partial laryngectomy had complication rates and oncological results similar to those of radiotherapy for patients with glottic carcinomas and should still be considered among the main available therapeutic options.

Radiation therapy is a standard treatment for brain tumor patients. However, it comes with side effects, such as neurological deficits. While likely multi-factorial, the effect may in part be associated with the impact of radiation on the neurogenic niches. In the adult mammalian brain, the neurogenic niches are localized in the subventricular zone (SVZ) of the lateral ventricles and the dentate gyrus of the hippocampus, where the neural stem cells (NSCs) reside. Several reports showed that radiation produces a drastic decrease in the proliferative capacity of these regions, which is related to functional decline. In particular, radiation to the SVZ led to a reduced long-term olfactory memory and a reduced capacity to respond to brain damage in animal models, as well as compromised tumor outcomes in patients. By contrast, other studies in humans suggested that increased radiation dose to the SVZ may be associated with longer progression-free survival in patients with high-grade glioma. In this review, we summarize the cellular and functional effects of irradiating the SVZ niche. In particular, we review the pros and cons of using radiation during brain tumor treatment, discussing the complex relationship between radiation dose to the SVZ and both tumor control and toxicity., This research was supported by the National Institutes of Health — RO1 NS070024 (AQH), the Instituto de Salud Carlos III — RD12/0019/0028 (VCG), and the Fundación Progreso y Salud of the Andalusian Regional Ministry of Health — PI01092014 (VCG).

ResumoO câncer não é incomum nem incurável: 85% dos doentes com menos de 45 anos diagnosticados nos EUA em 2002 sobreviveram mais de 10 anos. As maiores taxas de sobrevivência verificam‐se nos doentes jovens com câncer da mama, testicular e hematológico. Contudo, é para tratar estes tumores que são usados os fármacos mais gonadotóxicos, assim como doenças hematológicas e autoimunes também requerem terapêuticas potencialmente lesivas para as gônadas para o seu controle. O comité ético da Sociedade Americana de Medicina da Reprodução considera que “existem fortes argumentos para a preservação da fertilidade em doentes jovens com cânceres tratáveis”. Cabe ao médico assistente (oncologista, hematologista, cirurgião, internista) decidir o tratamento do paciente e considerar: o risco de falência ovárica/testicular; o prognóstico e o timing para iniciar tratamentos. Por outro lado, ao especialista em medicina da reprodução cabe desenvolver estratégias para preservar gâmetas/embriões de acordo com idade, tempo disponível até início do tratamento, tipo de câncer, status marital e risco de infertilidade com a terapêutica proposta. A colaboração contínua entre esses especialistas, incluindo os doentes e os parceiros, é a chave para a tomada de decisões que permitam a preservação da função reprodutiva após controle da doença de base.AbstractCancer is not unusual neither incurable: in USA 85% of patients under 45 years diagnosed in 2002 survived more than 10 years. The highest survival rates occur in young patients with breast, testicular and hematologic cancer. However, these tumors are treated with drugs wich most affect fertility and there is evidence that the discussion of preserving fertility is of great importance. Moreover, hematologic and autoimmune diseases may also require the use of potentially gonadotoxic drugs for their control. The ethics committee of the American Society for Reproductive Medicine believes that “there are strong arguments for the preservation of fertility in young patients with treatable cancers”. It is up to the physician (oncologist, hematologist, surgeon, internist) to decide the best treatment to the patient evaluating the risk of ovarian/testicular failure; the prognosis and the timing to start treatments. Moreover, the specialist in reproductive medicine should develop strategies to preserve gametes/embryos according to: age; time to treatment; type of cancer; marital status and risk of infertility, with the proposed therapy. The ongoing collaboration between these specialists, including patients and partners in the discussion, is the key to making decisions that allow the preservation of reproductive function after control of the primary disease.

ResumenLa mielofibrosis primaria es un padecimiento de la médula ósea caracterizado por fibrosis, asociado a esplenomegalia y hematopoyesis extramedular. En sangre periférica se observa un patrón de leucoeritroblastosis y dacriocitos, así como niveles elevados de citocinas inflamatorias y proangiogénicas.Existen dos tipos: la mielofibrosis primaria, la cual no se asocia a ningún padecimiento medular, y la secundaria, que se asocia a patologías del síndrome mieloproliferativo como tombocitosis esencial o policitemia vera.La incidencia en Estados Unidos es de 0.21-0.25 casos por cada 100 mil habitantes, se asocia con mayor frecuencia al sexo masculino y la media de edad al diagnóstico es de 67 años.El tratamiento de la mielofibrosis primaria puede llevarse a cabo con diferentes modalidades, dependiendo del objetivo de tratamiento, ya sea con finalidad curativa o paliativa. Dentro de las modalidades se encuentran la cirugía con esplenectomía, el manejo farmacológico a base de medicamentos para producir inhibición celular como hidroxicarbamina, inmunomoduladores como talidomida, o terapia dirigida como ruxolitinib. La radioterapia generalmente es empleada para tratar la esplenomegalia refractaria al tratamiento médico o en aquellos pacientes con alguna contraindicación quirúrgica y, finalmente, el trasplante de médula ósea ha mostrado ser el único tratamiento que modifica la supervivencia.AbstractPrimary myelofibrosis is a disease of the bone marrow characterized by fibrosis, associated with splenomegaly and extramedullary haematopoiesis. In peripheral blood, a pattern of leucoerythroblastosis and tear drop cells, as well as elevated levels of pro-inflammatory and angiogenic cytokines is observed.There are two types: primary myelofibrosis, which is not associated with any bone marrow condition, and secondary disease, which is associated with myeloproliferative syndrome conditions such as essential thrombocytosis or polycythaemia vera.The incidence in the United States ranges from 0.21 to 0.25 cases per 100 thousand inhabitants, it is associated more often with the male gender, and mean age at diagnosis is 67 years.The treatment of primary myelofibrosis can be in different forms, depending on the goal of treatment, with curative or palliative intent. Treatment modalities include surgical procedures with splenectomy, pharmacological treatment with drugs to produce cell inhibition such as hydroxycarbamide, immunomodulators such as thalidomide, or targeted therapy such as ruxolitinib; radiation therapy is generally used to treat medical treatment-refractory splenomegaly or in those patients with any surgical contraindication and, finally, bone marrow transplantation has proven to be the only treatment that modifies survival.

ResumoNas últimas três décadas a taxa de sobrevivência de crianças diagnosticadas com neoplasia maligna aumentou dramaticamente e resultou numa grande população de sobreviventes de doença oncológica na idade pediátrica. Atualmente, com a ajuda de quimioterapia, radioterapia, cirurgia e outros tratamentos, estima‐se uma taxa de sobrevida global aos cinco anos de cerca de 80%.No caso concreto de Portugal existem por ano cerca de 350 novos casos de cancro em crianças e adolescentes até 18 anos e a taxa de sobrevivência é de cerca de 75%.Assim, impõe‐se saber reconhecer e tratar os efeitos secundários dos tratamentos empregados, tanto precoces como tardios; os problemas endócrinos encontram‐se entre os mais frequentes, com repercussão em nível de crescimento, puberdade, fertilidade, composição corporal, densidade mineral óssea e da glândula tiroidea.O objetivo dos autores é fazer uma breve revisão da literatura no que diz respeito às sequelas endocrinológicas em longo prazo dos vários tipos de tratamento e estabelecer um esquema de rastreio e seguimento para esses doentes.AbstractIn the last three decades the survival rate of children diagnosed with cancer improved dramatically, resulting in a large population of childhood cancer survivors. Currently, with the help of chemotherapy, radiotherapy, surgery and other treatments the global 5‐year survival rate approaches 80%.In the case of Portugal there are about 350 new cases of cancer diagnosed in children between 0 and 18 years and the survival rate is about 75%.So it must be able to recognize and treat the therapy‐related early and late effects; the endocrine disturbs are very frequent, with repercussion in growth, puberty, fertility, corporal composition, bone density and thyroid gland.The aim of the authors is to do a brief revision of the literature regarding the late endocrine sequelae of the several kinds of treatments and to establish a screening and follow‐up scheme to these patients.

ResumenEl linfoma no Hodgkin de la zona marginal de tejido linfoide asociado a las mucosas (MALT, en inglés Mucosa-Associated Lymphoid Tissue) es un linfoma extraganglionar compuesto morfológicamente por células de inmunofenotipo B pequeñas y heterogéneas, entre las cuales se encuentran las células de la zona marginal (tipo centrocítico). La infiltración se presenta en el epitelio formando lesiones linfoepiteliales.Los linfomas tipo MALT (maltomas) dan cuenta del 7-8% de todos los linfomas de células B y hasta de un 50% de los linfomas primarios de estómago. La mayoría de los casos se presenta en adultos con una media de 61 años, con una muy discreta predominancia en mujeres (proporción hombre: mujer: 1:1.2).Hussell et al. han demostrado que una estimulación celular constante por el bacilo Helicobacter pylori activa células T linfoides. En el caso de los linfomas tipo MALT de anexos oculares, estos han sido asociados a infecciones por Chlamydophila psittaci.El 50% de este tipo de linfomas corresponde a maltomas gástricos, en tanto que los maltomas no gástricos son más frecuentes en la cabeza, el cuello, el pulmón y en la órbita ocular.Se presenta un caso de un paciente con un linfoma no Hodgkin tipo MALT de localización orbitaria que fue tratado con radioterapia.AbstractThe mucosa-associated lymphoid tissue (MALT) non-Hodgkin lymphoma of the marginal zone is an extranodal lymphoma morphologically comprised by small and heterogeneous B-immunophenotype cells, including cells of the marginal zone (centroblastic type). Infiltration occurs at the epithelium level, resulting in lymphoepithelial lesions.MALT lymphomas account for 7-8% of all B-cell lymphomas, and for up to 50% of primary lymphomas of the stomach. Most cases occur in adults with a mean of 61 years, with a slight predominance in women (male: female ratio: 1:1.2).Hussell et al. have demonstrated that constant cell stimulation by H. pylori activates lymphoid T-cells. In the case of ocular annexes MALT lymphomas, C. psittaci-associated infections have been associated.Fifty percent of this type of lymphomas account for gastric maltomas, whereas non-gastric maltomas are more common in the head, neck, lung, and ocular orbit.A case report is presented of a patient with an orbital non-Hodgkin MALT-type lymphoma who was treated with radiotherapy.

ResumenLa radioterapia es la aplicación de radiaciones ionizantes para el tratamiento del cáncer, incluyendo la paliación del dolor y de otros efectos nocivos tumorales, y también de algunas enfermedades benignas. El efecto principal de la radiación es el daño del ADN que condiciona la muerte de las células cancerosas. La radioterapia presenta hoy avances tecnológicos importantes en la generación, precisión y calidad de la irradiación. Se describe el proceso que debe seguir un paciente para su tratamiento y los efectos adversos que puede producir la irradiación de los diferentes territorios del cuerpo.SummaryRadiotherapy is used for cancer treatment, including palliation of pain and other harmful tumor effects, through the application of ionizing radiation to the sick tissues. The principal consequence of the ionizing radiation is DNA damage that results in tumor cell death. Radiotherapy presents today important technological advances in generation, precision and quality of irradiation. The patient’s treatment process is described including the side effects produced by the irradiation of different parts of the body.

ObjectiveTo assess the impact of early introduction of enteral nutrition therapy on morbidity and mortality reduction in a pediatric intensive care unit.MethodsA search was performed in the literature of the last 10 years in English, with the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the PubMed, Lilacs and Embase databases using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition.ResultsDespite advances in the quality of clinical care, the prevalence of malnutrition in hospitalized children remains unchanged in the last 20 years (15-30%) and has implications for the time of admission, course of illness and morbidity. Malnutrition is common and is often poorly recognized and therefore, untreated. Nutritional therapy is an essential part in the treatment of severely ill pediatric patients who have hypercatabolic protein state, which can be minimized with an effective nutritional treatment plan. In this study, we reviewed publications which have shown that there is still a paucity of randomized and controlled studies with good statistical treatment in relation to enteral nutritional therapy with outcomes related to morbidity and mortality. The current guidelines for nutritional therapy in these patients are largely based on expert opinion and data extrapolated from adult studies and studies in healthy children.ConclusionThe scientific evidence on the use of enteral nutrition therapy in improving the development of critically ill pediatric patients is still scarce and further studies are needed focusing on it, and better guidelines must be formulated.

ResumenAntecedentesLa fístula rectovaginal (FRV) es una patología de origen muy variado y el tratamiento representa un verdadero desafío terapéutico. No existen estudios prospectivos que orienten sobre el manejo de estas lesiones.ObjetivoEvaluar los resultados del tratamiento quirúrgico de las pacientes con una FRV.Material y métodoEstudio descriptivo retrospectivo en el cual se incluyen todas las pacientes intervenidas en un periodo de 25 años.ResultadosSe trata de 63 pacientes con una FRV, la mitad secundaria a una neoplasia y un 27% secundaria al tratamiento radiante de tumores pélvicos. El trauma local y las FRV postoperatorias representan el 28% de los casos. El abordaje de la FRV fue abdominal en 26 pacientes (41%), resecando la FRV neoplásica en 11 y efectuando una cirugía reconstructiva en 15 actínicas. En 17 pacientes con una FRV por persistencia tumoral solo se efectuó una desfuncionalización proximal. De las 5 pacientes con una FRV iatrogénica, en 4 se logró el cierre espontáneo mediante una ostomía transitoria y los 7 casos de FRV posparto fueron reparadas con un abordaje local con resultados satisfactorios en 6.ConclusionesEn este estudio el abordaje local de la FRV se utilizó en 12 casos; el 33% (21/63) de los casos necesitó una ostomía definitiva y en el 40% de las fístulas complejas se logró el cierre de la fístula con conservación esfinteriana. Las series de FRV publicadas son muy heterogéneas, probablemente debido a patrones de referencia muy variables, lo que hace muy difícil realizar un análisis comparativo.AbstractBackgroundRectovaginal fistula (RVF) is a distressing condition with no generally accepted standard surgical management.AimTo assess results of surgery for RVF.Material and methodThis is a descriptive retrospective analysis of 63 patients operated on consecutively for RVF in a period of 25 years.ResultsHalve of the cases were secondary to a pelvic malignancy and 27% due to radiotherapy of pelvic tumors. RVFs were associated with local (obstetrical) trauma and postsurgical complications in 28% of the cases. High RVFs were approached through abdominal procedures in 26 patients (41%), including radical resection of the primary tumor in 11 cases and coloanal sleeve anastomosis procedure in 15 patients with a RVF due to pelvic radiation. Seventeen patients with persistent pelvic tumors after radiotherapy and/or surgery were handled with a colostomy or ileostomy to improve quality of life. Four of five cases with postsurgical RVF closed spontaneously with a proximal colostomy and, in seven patients with obstetrical RVF, an advancement flaps were performed, with success in 6.ConclusionsIn this study local repair of RVF was employed in 12 cases, one third of the cases needed a permanent ostomy, and 40% of the complex cases of RVF were successfully repaired with sphincter preservation. Comparisons with other studies are precluded because of heterogeneity of published RVF series, probably due to different patterns of reference.

Objetivo: conocer la incidencia de la estenosis de la anastomosis vesicouretral en pacientes con cáncer de próstata tratados con prostatectomía radical. El objetivo secundario fue analizar si la radioterapia postoperatoria incrementa el riesgo de presentar una estenosis de la anastomosis. Material y métodos: se revisaron retrospectivamente las historias de los pacientes sometidos a prostatectomía radical como tratamiento primario entre enero 2000 y diciembre del 2008, con un seguimiento clínico mínimo de 12 meses. Del total de pacientes 258 cumplían los requisitos anteriores. De ellos 25 (9,6%) recibieron radioterapia postoperatoria, 12 (48%) de forma adyuvante y 13 (52%) de rescate. La edad media de los pacientes irradiados fue 64 (46-77) años. La mediana del PSA pre-radioterapia fue 2,3 (0,04-26,1) ng/ ml. El tiempo medio entre la cirugía y la radioterapia fue 17,4 (3-72) meses. La dosis media administrada fue 68 (58-70) Gy. El seguimiento medio fue 50,5 (15-117) meses. Resultados: de 25 pacientes prostatectomizados que recibieron radioterapia 4 (16%) desarrollaron estenosis de la anastomosis vesicouretral. El tiempo medio desde la finalización de la radioterapia hasta la aparición de la estenosis fue de 4 meses (1-22). Por otro lado, 36 (15,4%) pacientes prostatectomizados que no recibieron radioterapia postoperatoria presentaron esta misma complicación. Comparativamente no se apreciaron diferencias significativas entre ambos grupos (p=0,599). Conclusiones: en nuestra revisión retrospectiva, la radioterapia postoperatoria no incrementó de forma significativa la incidencia de estenosis de la anastomosis vesicouretral. Objective: To know the incidence of vesicourethral anastomotic stricture in patients with prostate cancer treated with radical prostatectomy. Our secondary aim was to verify if postoperative radiotherapy increases the risk of presenting anastomotic stricture. Materials and methods: We retrospectively checked the clinical records of patients that had undergone radical prostatectomy as their primary treatment between January 2000 and December 2008, with a minimum clinical follow-up of 12 months. Of the total patients, 258 met the foregoing requirements. Of them, 25 (9.6%) received postoperative radiotherapy, 12 (48%) received adjuvant radiotherapy and 13 (52%) received salvage radiotherapy. The mean age of the patients that received radiotherapy was 64 (46-77) years. The mean pre-radiotherapy PSA was 2.3 (0.04-26.1) ng/ ml. The mean time between surgery and radiotherapy was 17.4 (3-72) months. The mean dosage administered was 68 (58-70) Gy. The mean follow-up was 50.5 (15-177) months. Results: Of 25 prostatectomized patients that received radiotherapy, four (16%) developed vesicourethral anastomotic stricture. The mean time from the completion of the radiotherapy until the appearance of the stricture was 4 months (1-22). On the other hand, 36 (15.4%) of the prostatectomized patients that did not receive postoperative radiotherapy presented the same complication. Comparatively, we did not note significant differences between both groups (p=0.599). Conclusions: In our retrospective review, postoperative radiotherapy did not significantly increase the incidence of vesicourethral anastomotic stricture.

Introducción: Una opción de tratamiento del cáncer de próstata localmente avanzado es la radioterapia combinada con la ablación androgénica. Revisamos los resultados de eficacia y toxicidad del tratamiento combinado en un grupo de pacientes tratados con esta terapia combinada en nuestra institución. Material y método: Estudio retrospectivo de 80 pacientes con cáncer prostático localmente avanzado tratados con radioterapia externa y hormonoterapia neoadyuvante (dos meses) y adyuvante (24 meses). Se realiza un estudio descriptivo de las variables clínico-patológicas y de los efectos secundarios. Evaluamos la respuesta al tratamiento mediante el PSA nadir y recidiva bioquímica. Analizamos la toxicidad aguda y crónica genitourinaria, intentando establecer qué factores influyen en su aparición mediante análisis uni y multivariante (regresión logística múltiple). Resultados: La media de edad fue 68 ± 5,81 años, el PSA inicial 20,05 ±1 6,27 ng/ ml y el volumen prostático medio 43,7 ± 27,57 cc. El 33% fueron estadio T3a y el 66% T3b. El Gleason fue < 7 en el 39%, 7 en el 46% y > 8 en el 15%. Tras un seguimiento medio de 44,4 meses se detectó recidiva bioquímica en tres casos. La toxicidad aguda postirradiación genitourinaria apareció en el 90% (35% tardía) y gastrointestinal en el 75% (32% tardía). El análisis univariante muestra relación entre el volumen prostático y los síntomas urinarios previos con la toxicidad genitourinaria aguda y crónica. Estos se confirman como factores predictivos independientes de toxicidad geniturinaria en el análisis de regresión logística. Conclusiones: La hormono-radioterapia es una opción válida para el tratamiento del cáncer localmente avanzado con resultados óptimos a corto plazo, aunque no está exenta de efectos secundarios. La sintomatología urinaria previa y el volumen prostático pueden predecir la toxicidad genitourinaria. Introduction: Radiotherapy and androgen deprivation are an established treatment option for locally advanced prostate cancer. We evaluate outcomes in efficacy and toxicity for patients treated with this combined therapy at our institution. Methods: A retrospective study of 80 patients with locally advanced prostate cancer treated with radiotherapy combined with neo-adjuvant (2 months) and adjuvant (24 months) androgen deprivation. We studied the clinical variables and side effects. We evaluated treatment outcomes using PSA nadir and biochemical failure, and recorded acute and late gastrointestinal and urinary toxicity. We assessed the correlation between clinical variables and urinary toxicity by means of univariate and multivariate analyses (multiple logistic regression). Results: The mean patient age was 68 ± 5.81 years; the initial PSA was 20.05 ± 16.27 ng/ ml and the mean prostate volume 43.7 ± 27.57 cc. The clinical stage was T3a in 33% and T3b in 66%. The Gleason score was 8 in 15%. The mean follow-up was 44.4 months and biochemical failure was observed in 3 cases. Acute urinary toxicity was recorded in 90% of the patients (chronic in 35%) and acute gastrointestinal toxicity in 75% (late in 32%). In a univariate analysis, prostate volume and urinary symptoms were statistically correlated to acute and late urinary toxicity. Both prostate volume and urinary symptoms were independently associated with an increase in urinary toxicity in the logistic regression analysis. Conclusions: Hormone-radiotherapy is a valid option to locally treat advanced prostate cancer with optimal short-term outcomes, although it is not devoid of side effects. Prostate volume and urinary symptoms before treatment can predict genitourinary toxicity.

The aim of this work is the characterization and application of silicon diode detectors for in vivo dosimetry in total body irradiation (TBI) treatments. It was evaluated the diode response with temperature, dose rate, gantry angulations and field size. A maximum response variation of 2.2% was obtained for temperature dependence. The response variation for dose rate and angular was within 1.2%. For field size dependence, the detector response increased with field until reach a saturation region, where no more primary radiation beam contributes for dose. The calibration was performed in a TBI setup. Different lateral thicknesses from one patient were simulated and then the calibration factors were determined by means of maximum depth dose readings. Subsequent to calibration, in vivo dosimetry measurements were performed. The response difference between diode readings and the prescribed dose for all treatments was below 4%. This difference is in agreement as recommended by the International Commission on Radiation Units and Measurements (ICRU), which is ±5%. The present work to test the applicability of a silicon diode dosimetry system for performing in vivo dose measurements in TBI techniques presented good results. These measurements demonstrated the value of diode dosimetry as a treatment verification method and its applicability as a part of a quality assurance program in TBI treatments.

Resumen Objetivo Evaluar la respuesta y la supervivencia libre de progresion (SLP) en pacientes diagnosticados de carcinoma vesical infiltrante tratados con RTU-quimioterapia-radioterapia y compararlos con una serie no aleatorizada de pacientes tratados con cistectomia radical. Material y metodos Analisis retrospectivo de 43 pacientes con carcinoma vesical infiltrante tratados entre 1994–2007 con dos pautas de conservacion vesical y estudio comparativo con pacientes sometidos a cistectomia radical (145 casos) en el mismo periodo. Las variables pronosticas para estudio fueron estadio y grado clinico, presencia o no de hidronefrosis, tratamiento quimioterapeutico recibido, dosis de radioterapia y alteraciones en p53 y Ki67. Resultados La media y la mediana de los pacientes sometidos a conservacion vesical fueron de 51 y de 39 meses, respectivamente. El 72% de los pacientes con conservacion vesical obtuvo respuesta completa (RC) al finalizar el tratamiento. Solo la hidronefrosis tuvo influencia pronostica (OR: 7,3; p=0,02). Al final del estudio, el 74% de los que obtuvieron RC mantenia la respuesta. Ninguna de las variables analizadas fueron predictoras del mantenimiento de la respuesta. La SLP en el grupo fue del 69±7 y del 61±7% a 3 y a 5 anos. La dosis de radioterapia >60 Gy (OR: 6,1; p=0,001) y la ausencia de hidronefrosis (OR 7,5; p=0,02) fueron las unicas variables influyentes. La SLP del grupo con RC fue del 80±7 y del 58±10% a 3 y a 5 anos. Al concluir el estudio, 23/43 (53,5%) conservaban la vejiga y estaban libres de enfermedad. Se realizaron 145 cistectomias radicales a pacientes diagnosticados de carcinoma vesical infiltrante. La media y la mediana de seguimiento de este grupo fueron de 29 y 18 meses, respectivamente. El analisis estadistico reflejo que los pacientes que se habian sometido a conservacion vesical presentaban unicamente peor estadio clinico que los pacientes sometidos a cistectomia radical (p=0,17). La SLP a 3 y a 5 anos de los pacientes sometidos a cistectomia radical fue del 72±5 y del 63±7%, no evidenciando diferencias estadisticamente significativas (p=0,83) con respecto a los pacientes sometidos a pauta de conservacion vesical. Conclusiones Los pacientes sometidos a conservacion vesical obtienen una supervivencia similar a la de los pacientes a los que se les ha realizado cistectomia radical. La dosis de radioterapia >60 Gy y la ausencia de hidronefrosis son factores de influencia independiente en la SLP.

IntroductionOsteoradionecrosis (ORN) is characterized as one of radiotherapy's late adverse effects which causes great suffering and compromises patient's quality of life. The classical treatments for ORN are the hyperbaric therapy and surgery (mandibulectomy), quite expensive procedures with controversial indication. Conversely, the effectiveness of conservative treatments, such as topical chlorhexidine mouthwashes, is not well established in the literature.ObjectiveTo report the clinical case and the results in the conservative treatment and control protocols of the ORN in mandible established in a public health service.Case reporta black 45-year-old female patient was treated for squamous cell carcinoma in the past 3 years. She underwent partial glossectomy and adjuvant radiotherapy (7500Cg) on primary tumor area and neck. Patient was referred with a painful condition exhibiting multiple areas of bone exposure of about 2.5cm in its longest axis. Three-times a day mouthwashes with aqueous chlorhexidine gluconate solution 0.12% was prescribed for an indefinite period associated with rigorous oral hygiene and elimination possible oral irritants. Clinical follow was performed weekly until early response and monthly after this period. Two weeks after initial treatment there was complete remission of prodromal symptoms, and after six months sequestrectomy treatment was indicated under antibiotic prophylaxis. Total mucosa covered the bone defect 4 weeks after surgery.Discussion and ConclusionThe treatment was effective. The institution of conservative therapy avoided the necessity of hyperbaric therapy or surgical resection block (mandibulectomy). The results offered less morbidity to the patient and rationalization of the public health resources.ResumoIntroduçãoA osteorradionecrose (ORN) é caracterizada como um dos efeitos adversos tardios da radioterapia que causa grande sofrimento e compromete a qualidade de vida do paciente. Os tratamentos clássicos para a ORN são a terapia hiperbárica e a excisão cirúrgica (mandibulectomia), procedimentos caros e de indicações controversas. Por outro lado, a eficácia de tratamentos conservadores, como a aplicação tópica de clorhexidina, ainda não é bem estabelecida na literatura.ObjectivoRelatar um caso clínico e os resultados obtidos com o uso do tratamento conservador e protocolo de controle da ORN mandibular em um serviço público de saúde.Caso ClínicoPaciente negra, do sexo feminino, 45 anos foi tratada por carcinoma epidermóide há 3 anos. Foi submetida a glossectomia parcial e radioterapia adjuvante (7500Cg) na região do tumor primário e no pescoço. A paciente foi encaminhada com condição dolorosa exibindo múltiplas áreas de exposição óssea com cerca de 2,5cm no seu maior eixo. Foram prescritos bochechos de solução aquosa de gluconato de chorhexidina a 0,12% três vezes ao dia por período indefinido associado com higiene oral rigorosa e remoção de possíveis irritantes locais. O acompanhamento clínico foi realizado semanalmente até observarem-se as primeiras melhoras e, posteriormente, foi realizado mensalmente. Após duas semanas de tratamento houve remissão completa dos sintomas prodrómicos e, após seis meses, foi indicada sequestrectomia com antibioticoterapia profilática. O recobrimento total com mucosa do defeito ósseo ocorreu quatro semanas após a cirurgia.Discussão e ConclusãoO tratamento proposto foi eficaz. A instituição da terapêutica conservadora evitou o uso da terapia hiperbárica e da ressecção cirúrgica. Os resultados ofereceram menor morbilidade à paciente e a racionalização de recursos do Sistema Público de Saúde.

Objetivo: Establecer una pauta de actuación y un algoritmo terapéutico ante la aparición de hematuria en pacientes con antecedentes de radioterapia pélvica, revisando para ello las diferentes opciones de tratamiento reflejadas en la literatura médica. Material y métodos: A través de PubMed se realiza una revisión bibliográfica de artículos relacionados con la cistitis rádica, incluyendo términos de búsqueda referidos a las diferentes opciones de tratamiento: ácido hialurónico endovesical; estrógenos conjugados, pentosan polisulfato, ácido aminocaproico oral, factor VIIa recombinante, cámara hiperbárica, embolización, aluminio endovesical, balón Helmstein y formolización. Se limita la búsqueda a publicaciones en castellano e inglés y se excluyen aquellas referidas a la experimentación animal. Resultados: Se expone cada una de las opciones citadas, haciendo referencia al mecanismo de acción, pauta y dosis de administración, efectos secundarios y prevención de los mismos si es posible así como eficacia del tratamiento. Tras conseguir estabilizar hemodinamicamente al paciente y descartar la presencia de lesiones neoformativas vesicales y/o hematurias originadas en tramo urinario superior, se debe iniciar un tratamiento escalonado. Conclusiones: El conocer diferentes opciones de tratamiento y sus pautas de administración permitirá al urólogo obtener una mayor tasa de éxitos en el difícil manejo de esta patología. Objective: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. Material and methods: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. Results: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. Conclusions: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

ResumoA radioterapia tem sido uma opção entre as terapias disponíveis para o tratamento das neoplasias malignas. Porém, apesar de sua eficácia, essa modalidade terapêutica também promove alguns efeitos adversos que podem atingir a cavidade oral quando esses tumores estão localizados na região de cabeça e pescoço. Nesses casos, é preciso um acompanhamento contínuo por um estomatologista ou médico dentista, para que sejam dadas as orientações adequadas capazes de prevenir e atenuar esses efeitos. Esse estudo tem como objectivo, realizar uma revisão de literatura acerca dos principais efeitos adversos oriundos da radioterapia na região de cabeça e pescoço que acometem a cavidade oral, além de enfocar a importância da inserção do médico dentista na equipa multidisciplinar de acompanhamento desses pacientes.AbstractThe radiation is been an option among the available therapies for treatment of malignancies. Despite its effectiveness, this therapy also promotes adverse effects that can reach oral cavity when these tumors are located in the region of head and neck. In such cases, a continuous monitoring by dentist to appropriate tokowup to prevent and mitigate such effects, and treatment less unpleasant radiotherapy. It aims to study, conduct a review of literature on the main adverse effects from the radiation in the region of head and neck that affect the oral cavity of patients involved, and focus on the importance of integration of the dentist in multidisciplinary team of monitoring the same.

Objetivos: Presentar un resumen de la versión del 2007 de la guía de la Asociación Europea de Urología (EAU) para el cáncer de próstata (CaP). Métodos: Se realizó por un grupo de trabajo una revisión de los nuevos datos presentes desde 2004 hasta 2007 en la literatura. Las guías han sido actualizadas y el nivel de evidencia/grado de recomendación ha sido añadido al texto basándose en una revisión sistemática de la literatura, que incluía una búsqueda de las bases de datos online y revisiones bibliográficas. Resultados: Una versión completa está disponible en la EAU Office o en www.uroweb.org. El método diagnóstico de elección es la biopsia sistematizada de la próstata bajo control ecográfico. El tratamiento activo es el recomendado en la mayoría de los pacientes con enfermedad localizada y una larga esperanza de vida, siendo la prostatectomía radical superior a la vigilancia ("watchful waiting") en un ensayo randomizado prospectivo. La prostatectomía radical con preservación de bandeletas es la técnica de elección en la enfermedad órgano-confinada; el bloqueo androgénico neoadyuvante no ha demostrado una mejoría en las variables de resultados. La radioterapia debe realizarse con al menos 72 Gy en el CaP de bajo riesgo y con 78 Gy en el de intermedio - alto riesgo. El bloqueo androgénico en monoterapia es el estándar del tratamiento en el CaP metastásico; el bloqueo androgénico intermitente podría ser un tratamiento alternativo en pacientes seleccionados. El seguimiento se basa principalmente en los niveles de PSA y en la anamnesis específica de la enfermedad, estando las pruebas de imagen sólo indicadas cuando aparecen los síntomas. La quimioterapia con docetaxel ha surgido como el tratamiento de referencia para el CaP metastásico hormonorefractario. Conclusiones: El conocimiento en el campo del CaP está rápidamente cambiando. Estas guías de la EAU resumen los hallazgos más recientes y los aplican a la práctica clínica. Objectives: To present a summary of the 2007 version of the European Association of Urology (EAU) guidelines on prostate cancer (PCa). Methods: A literature review of the new data emerging from 2004 to 2007 was performed by the working panel. The guidelines have been updated, and the level of evidence/grade of recommendation was added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. Results: A full version is available at the EAU Office or at www.uroweb.org. Systemic prostate biopsy under ultrasound guidance is the preferred diagnostic method. Active treatment is mostly recommended for patients with localized disease and a long life expectancy, with radical prostatectomy being shown to be superior to watchful waiting in a prospective randomized trial. Nerve-sparing radical prostatectomy represents the approach of choice in organ-confined disease; neoadjuvant androgen deprivation demonstrates no improvement of outcome variables. Radiation therapy should be performed with at least 72 and 78 Gy in low-risk and intermediate- to high-risk PCa, respectively. Monotherapeutic androgen deprivation is the standard of care in metastatic PCa; intermittent androgen deprivation might be an alternative treatment option for selected patients. Follow-up is largely based on prostate-specific antigen and a disease-specific history with imaging only indicated when symptoms occur. Cytotoxic therapy with docetaxel has emerged as the reference treatment for metastatic hormone-refractory PCa. Conclusions: The knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice.

Resumo: Introdução: Os tumores epiteliais tímicos (TET), a maioria timomas, são neoplasias desenvolvidas a partir das células epiteliais do timo e constituem cerca de 30% das massas do mediastino anterior em adultos. Os timomas são constituídos por células sem características citológicas de malignidade, sendo o comportamento maligno determinado pela invasão da cápsula e estru-turas adjacentes. Estes tumores apresentam um amplo espectro de características clínicas e morfológicas, e as pequenas séries de doentes conhecidas tornam difícil o estabelecimento de um tratamento standard.Material e métodos: Efectuouse um estudo retrospectivo dos doentes admitidos com diagnóstico de ti moma no Instituto Português de Oncologia - Centro do Porto (IPO-Porto), de 1983 a 2004. Foram anali-sadas as suas características clínicas, classificação histológica segundo a OMS, o estadiamento de Masaoka, e a sua relação com as modalidades de tratamento. Procedeu-se à revisão dos registos clínicos destes doentes e revisão do material histológico para a classificação segundo critérios da OMS de 1999.Resultados: No IPO-Porto, entre 1983 e 2004, fo-ram tratados 28 doentes com TET. Destes, 21 eram timomas invasivos, sendo estes o objecto deste estudo. Dos dados demográficos salienta-se que eram 11 homens, 10 mulheres, com uma idade mediana de 55 anos (24-79 anos). A classificação histológica da OMS foi a seguinte: 2 doentes (9,5%) Tipo A, 6 (28,6%) tipo AB, 4 (19%) tipo B1, 2 (9,5%) tipo B2, 7 (33,4%) tipo B3. O estadiamento segundo Masaoka foi 9 doentes (42,8%) com estádio II, 6 (28,6%) com estádio III e 6 (28,6%) com estádio IVa. A maioria dos doentes apresentava sintomas locais à apresen-tação, com apenas 1 doente com diagnóstico de aplasia eritrocitária e 5 com Mastenia gravis (MG).Os 6 doentes submetidos apenas a ressecção cirúrgica completa não tiveram evidência de recorrência da doença (2 tipo A-II, 2 tipo AB-II, 1 tipo B1-II, 1 tipo B2-IVa), com follow-up variando entre 8 e 144 meses. 10 doentes com ressecção completa receberam tratamento adjuvante, 6 radioterapia (4 doentes B3-II, 2 doentes B3-III), 2 quimioterapia (AB-IVa) e 2 radioterapia e quimioterapia (B1-IVa, B2-III). Apenas os 2 doentes que efectuaram quimioterapia adjuvante reci-divaram, aos 168 e 46 meses, e morreram aos 168 e 49 meses. Os restantes doentes que efectuaram tratamento adjuvante encontram-se sem evidência de doença. Dos 5 doentes com ressecção incompleta seguido de tratamento complementar (2 doentes AB-III, 2 B1-IVa, 1 B3-III), 3 morreram aos 11 meses (B3-III), aos 12 meses (B1-IVa) e aos 241 meses (AB-III), este últi-mo por MG.Conclusões: Apesar de se tratar de uma pequena série, os factores preditivos de mau prognóstico foram a ressecção incompleta, estádio avançado e o subtipo histológico B3. à necessário investigar o papel do tratamento adjuvante e neoadjuvante no grupo de doentes com doença avançada e subtipo histológico B3.Rev Port Pneumol 2007; XIII (4): 553-585 Abstract: Introduction: Epithelial thymic tumours (ETT), which comprise the majority of thymomas, are neoplasias developed from the epithelial cells of the thymus and constitute around 30% of anterior mediastinal masses in adults. Thymomas consist of cells with no cytological characteristics of malignity; malignant behaviour is determined by invasion of the capsule and adjacent structures. These tumours present a broad spectrum of clinical and morphological characteristics and the small series of known patients makes establishing a standard treatment difficult.Material and methods: A retrospective study was made into thymoma diagnosed patients admitted to the Portuguese Oncology Institute in Porto (IPO-Porto) from 1983 to 2004. Clinical characteristics were analysed and a histological classification made in accordance with World Health Organization criteria, Masaoka staging, and their relation to treatment methods. A review of the clinical records of these patients was then made, as well as a review of histological material for classification in line with 1999 WHO criteria.Results: Twenty-eight ETT patients were treated at the IPO-Porto between 1983 and 2004. Of these, 21 had invasive thymomas and these are the subject of this study. Eleven subjects were male and 10 female, with a median age of 55 years (24-79 years). The WHO histological classification was as follows: 2 patients (9.5%) type A, 6 (28.6%) type AB, 4 (19%) type B1, 2 (9.5%) type B2, 7 (33.4%) type B3. Masaoka staging was 9 patients (42.8%) with stage II, 6 (28.6%) with stage III and 6 (28.6%) with stage IVa. The majority of patients had local symptoms, with only one subject diagnosed with erythrocyte aplasia and five with Myasthenia Gravis (MG).The 6 patients who were given complete surgical resection only showed no evidence of disease recurrence (2 type A-II, 2 type AB-II, 1 type B1-II, 1 type B2-IVa), with follow-up from 8-144 months. Ten patients with complete resection received adjuvant treatment; 6 radiotherapy (4 B3-II patients, 2 B3-III patients), 2 chemotherapy (AB-IVa) and 2 chemo and radiotherapy (B1-IVa, B2-III). Only the 2 patients who under-went adjuvant chemotherapy relapsed, at 168 and 46 months, dying at 168 and 49 months, respectively. The remaining patients who were given adjuvant treatment did not present signs of disease. Of the 5 subjects having incomplete resection followed by complementary treatment (2 AB-III patients, 2 B1-IVa patients, 1 B3-III patient), 3 died, at 11 months (B3-III), 12 months (B1-IVa) and 241 months (AB-III), the latter with MG.Conclusions: Predictive factors of bad prognosis here were incomplete resection, advanced staging and B3 histological subtype, the smallness of this series not-withstanding. It is necessary to investigate the role of adjuvant and neoadjuvant treatment in a group of subjects with advanced disease of the B3 histological subtype.Rev Port Pneumol 2007; XIII (4): 553-585 Palavras-chave: Tumores epiteliais tímicos, timomas, Miastenia gravis, quimioterapia, radioterapia, Key-words: Epithelial thymic tumours, thymomas, Myasthenia gravis, chemotherapy, radiotherapy

Resumen Introduccion y objetivos El cancer de prostata localmente avanzado supone una condicion de alto riesgo de progresion bioquimica post-tratamiento debido a la situacion limite que representa. Nos planteamos analizar los factores pronosticos clinicos en funcion de la probabilidad de progresion tras emplear un tratamiento con fuente radioterapeutica externa en pacientes con este tipo de tumores. Material y metodos Revisamos retrospectivamente una serie de 128 pacientes sometidos a linfadenectomia pelvica de estadiaje como metodo de estadiaje previo a la realizacion de el tratamiento radioterapico. Empleamos las curvas de Kaplan-Meier para estudiar la probabilidad de progresion, el test de rangos logaritmicos para la demostracion de posibles diferencias estadisticamente significativas y el modelo de riesgos proporcionales de Cox para estudiar los posibles factores pronosticos implicados. Resultados La probabilidad de no progresion a 5 anos ha sido del 49,93%; a pesar de apreciar diferencias importantes en los grupos estratificados por las variables predictivas empleadas (PSA total, gleason de biopsia, estadio patologico y % de cilindros afectos en biopsia), ninguna de ellas alcanzo significacion estadistica, siendo el nivel de PSA t el mas proximo a la misma. Conclusiones La radioterapia externa representa una alternativa valida en el tratamiento del cancer de prostata localmente avanzado con un tolerable indice de secundarismos. Debe emplearse en tratamiento combinado junto a la hormonoterapia. Parece que el empleo de unas dosis mas altas de radiacion, posible de manera segura gracias a la radioterapia conformada 3D, permiten alcanzar una mayor eficacia. Es probable que el indicador clinico con mayores implicaciones pronosticas sea el nivel de PSA total.

PURPOSE: To present experience with high dose-rate endobronchial brachytherapy in the treatment of primary tracheal tumors. PATIENTS AND METHODS: Four patients with nonresected primary tracheal tumors are presented: 2 cases of squamous cell carcinoma of the trachea, 1 of recurrent adenoid cystic carcinoma, and 1 with recurrent plasmacytoma. All received brachytherapy, alone or as a boost for primary irradiation, in 3 or 4 fractions of 7.5 Gy, calculated at a depth of 1 cm. Follow-up was considered to start from the end of brachytherapy. RESULTS: Local control was achieved in all cases at the time of first bronchoscopic evaluation. Two patients with squamous cell carcinoma died at 6th and 33rd months after brachytherapy, respectively. The first had no evidence of disease, and the latter had local recurrence. The other 2 patients were alive after 64 and 110 months of follow-up, respectively, both with no evidence of disease. Tracheal stenosis developed in these 2 cases, 22 and 69 months after brachytherapy. Tracheal stent placement was needed only for the patient with an adenoid cystic carcinoma. CONCLUSIONS: Endobronchial high dose-rate brachytherapy may be used for tracheal tumors, even as a boost for external beam irradiation, or in recurrences. Local control in 3 out of 4 patients indicates that individual cases may benefit from the treatment. Long-term survival may also be expected, mainly for tumors with adenoid cystic histology. OBJETIVO: Apresentar a experiência do tratamento de 4 pacientes com tumores primários de traquéia, não operados, submetidos à braquiterapia endobrônquica de alta taxa de dose. PACIENTES E MÉTODOS: Dois casos de carcinoma espinocelular, uma recidiva de carcinoma adenóide cístico e uma recidiva de plasmocitoma primário da traquéia. Todos receberam braquiterapia endobrônquica, exclusiva ou como reforço de dose da radioterapia externa. Foram administradas 3 ou 4 frações de 7,5 Gy cada, calculados a 1 cm de profundidade. O seguimento foi considerado a partir do término da braquiterapia. RESULTADOS: Em todos os casos houve resposta completa. Dois pacientes com carcinoma espinocelular evoluíram a óbito em 6 e 33 meses após a braquiterapia, o primeiro, sem evidência de doença e o outro por recidiva local, respectivamente. As outras 2 pacientes encontravam-se vivas após 64 e 110 meses de seguimento, sem evidência de doença. Esses 2 casos apresentaram estenose traqueal em 22 e 69 meses após a braquiterapia, sendo necessária a colocação de prótese traqueal apenas na paciente com carcinoma adenóide cístico. CONCLUSÕES: A braquiterapia endobrônquica de alta taxa de dose pode ser utilizada tanto como reforço de dose da irradiação externa quanto em recidivas. O controle local obtido em 3 de 4 pacientes indica que casos individuais podem se beneficiar desse procedimento. Sobrevida a longo prazo pode ser observada, principalmente nos casos de histologia adenóide cística.

OBJETIVOS: Identificar as características das pacientes com câncer de mama que desenvolveram neutropenia febril, estabelecer fatores de risco para a sua ocorrência e indicadores de evolução desfavorável. MÉTODOS: Realizamos um estudo caso-controle com 65 pacientes. Foram incluídas 13 pacientes que desenvolveram neutropenia febril e quatro controles por caso pareados por data e número de ciclos de quimioterapia prévios, drogas e doses empregadas. Os dados clínicos e laboratoriais foram obtidos dos prontuários médicos. Utilizamos odds ratio (OR) e intervalo de confiança (IC) de 95% para estimar a significância dos fatores de risco. RESULTADOS: Identificamos dois fatores de risco associados à ocorrência de neutropenia febril: a realização de quimioterapia nas primeiras 24 horas após a cirurgia (OR: 159,9 IC 95%: 9,5 a 2699) e a realização concomitante de quimioterapia e radioterapia da mama (OR: 108,3 IC 95%: 4,9 a 2391). Não observamos diferenças significativas entre casos e controles quanto à idade, índice de massa corporal e contagem de neutrófilos e monócitos antes da quimioterapia. Três pacientes foram a óbito (23,1%). Duas delas tinham idade superior a 60 anos, não apresentavam comorbidades, tinham recebido o primeiro ciclo de CMF nas primeiras 24 horas após a cirurgia e tiveram infecção de sítio cirúrgico. CONCLUSÕES: Os principais fatores de risco associados a neutropenia febril em pacientes com câncer de mama foram quimioterapia nas primeiras 24 horas após a cirurgia, e uso concomitante de quimioterapia e radioterapia da mama. Nosso estudo mostra, portanto, que estas situações devem ser evitadas. PURPOSE: To identify the characteristis of patients with breast cancer who developed febrile neutropenia and to establish risk factors for its incidence and parameters for an unfavorable evolution. PATIENTS AND METHODS: A case-control study was performed and included 65 patients: 13 patients presented febrile neutropenia and four controls per case matched by: date and number of previous chemotherapy cycles, drugs and doses used. The clinical and laboratory data were obtained from medical records. We utilized the odds ratio (OR) and the 95% confidence interval (CI) to estimate the significance of risk factors. RESULTS: We identified two risk factors associated to occurrence of febrile neutropenia: use of chemotherapy within the first 24 hours post surgery (OR: 159.9 95% CI: 9.5 to 2699), and the concomitant use of chemotherapy and breast radiotherapy (OR: 108.3 95%CI: 4.9 to 2391). We did not observe a significant difference between cases and controls regarding age, body mass index, neutrophils and monocytes count prior to chemotherapy. Three patients died (23.1%), two of them were more than 60 years old, had no comorbidities, had received the first CMF within the first post surgery day and had surgical site infection. CONCLUSIONS: The main risk factors associated with febrile neutropenia in patients with breast cancer were: chemotherapy within the first 24 hours post surgery, and concomitant chemotherapy and breast radiotherapy. As such, our study shows that these situations must be avoided.

StreszczenieWstępLeczenie promieniami jonizującymi powoduje pojawienie się i/lub nasilenie zakażenia grzybiczego. Celem pracy była ocena występowania zmian grzybiczych w jamie ustnej u chorych objętycń radioterapią z powodu nowotworów głowy i szyi oraz stwierdzenie, czy istnieje zależność pomiędzy liczbą limfocytów i granulocytówobojętnocńłonnycń a zwiększeniem się liczby kolonii Candida albicans.Materiał i metodaMateriał z jamy ustnej pobrano od 50 pacjentów leczonych w Wielkopolskim Centrum Onkologii w Poznaniu promieniami jonizującymi w dawce 60–70 Gy przez okres 6–7 tygodni z powodu nowotworów głowy i szyi. Grupę kontrolną stanowiło 20 chorych leczonych w tym Ośrodku z powodu innych nowotworów. U tych osób nie zastosowano radioterapii. U wszystkich wykonano posiew w kierunku zakażenia grzybiczego jak również oceniono stan odporności na podstawie całkowitej liczby limfocytów (CLL), jak i poziomu granulocytów obojętnocńłonnycń.WynikiWyniki wykazały, że po przeprowadzonym leczeniu wzrosła liczba osób z dodatnim wynikiem posiewów w kierunku Candida. Jednocześnie stwierdzono spadek CLL, u 34% chorych po radioterapii CLL w 1 mm3 był mniejszy niż 1 000, a liczba kolonii Candida powyżej 5 w porównaniu z 4% badanych przed radioterapią. Poziom granulocytów obojętnocńłonnycń u żadnego z chorych nie obniżył się poniżej 2 000 w 1 mm3.PodsumowaniePrzeprowadzone badania sugerują, że radioterapia może mieć wpływ na rozwój zakażeń grzybiczych m.in. poprzez spadek odpomości.SummaryObjectivesRadiation therapy induces and/or exacerbates mycotic infection. The purpose of the present work was to determine the exis-tence of mycological changes in the oral cavity in patients (pts) treated by radiotherapy because of head and neck neoplasms, and to determine the existence of dependence between the number of lymphocytes and neutrocytes and the increase in the number of Candida albicans.Materials and methodThe material from the oral cavity was taken from 50 pts with head and neck neoplasms treated at the Wielkopolskie Centrum Onkologii (Great Poland Cancer Centre) in Poznań. Patients received radiotherapy in a dose of 6 000 – 7 000 cGy over a period of 6 – 7 weeks. The control group consisted of 20 pts treated at the same hospital for cancer other than head and neck cancer. The patients did not receive radiotherapy treatment. In all pts mycological culture was carried out and the condition of immunity was examined on the basis of the total number of lymphocytes (CLL) and the level of neutrocytes.ResultsThe data showed that after treatment the number of pts with positive results of the mycologically cultured examinations on Candida ID increased. At the same time a decrease in CLL was observed. After radiotherapy CLL per 1 mm3 was less than 1000, and the number of Candida more then 5, compared with 4% of pts before radiotherapy. The level of neutrocytes in non of the pts decreased to less than 2 000 per 1 mm3.ConclusionOur study suggess that radiotherapy may have an effect on the development of mycological infection, among other things, through the decreace in immunity.

OBJETIVOS: Avaliar a influência do tratamento neoadjuvante (quimioterápico e/ou radioterápico) nas complicações pós-operatórias e letalidade hospitalar de pacientes com câncer de esôfago submetidos a esofagectomia com linfadenectomia em dois campos. MÉTODOS: Estudo retrospectivo de 132 pacientes com câncer de esôfago admitidos no Departamento de Cirurgia do Hospital Erasto Gaertner de janeiro de 1987 a janeiro de 1998, divididos de acordo com a realização ou não de tratamento neoadjuvante. Analisaram-se as variáveis relativas ao paciente (sexo, idade, estado geral, perda ponderal, co-morbidades, tabagismo, risco pulmonar), ao tumor (tipo histológico, localização, estádio clínico) e ao procedimento cirúrgico (local e tipo da anastomose, tempo cirúrgico, tempo de permanência hospitalar), relacionando-as com as complicações e mortalidade pós-operatórias. RESULTADOS: Noventa e quatro pacientes (71,2%) eram do sexo masculino. O tipo histológico predominante foi o CEC em 94,7% e oito pacientes (66,6%) eram tabagistas, e as principais co-morbidades anotadas foram: DPOC (29,55%) e HAS (15,15%). A principal localização do tumor foi o segmento torácico inferior (56,06%), com extensão tumoral média de 47,72 (8-70) mm. Seis pacientes (4,54%) eram EC I, 44 (33,33%) IIA, 24 (18,18%) IIB, 38 (28,80%) III e 17 (12,90%) IV. Quanto ao tratamento neoadjuvante, 39 pacientes (29,54%) foram submetidos a quimioterapia e 22 (16,67%) a radioterapia. As complicações pós-operatórias foram de 74,35% (p=0,0002) e 72,73% (p=0,0037), respectivamente. A taxa de complicações foi de 39,3% e a letalidade hospitalar 13,70%, representadas mais freqüentemente pelas causas pleuropulmonares. CONCLUSÕES: O tratamento neoadjuvante quimioterápico e radioterápico foi relacionado com maior ocorrência de complicações pós-operatórias, sem influência na letalidade hospitalar.

RESUMO: No presente artigo de revisão os autores analisam os principais mecanismos da anemia no doente oncológico, a sua metodologia diagnóstica e as opções terapêuticas, nomeadamente as indicações da transfusão de concentrado eritrocitário e da utilização da eritropoietina recombinante. É também discutido o impacto da anemia na qualidade de vida dos doentes, na evolução e no tratamento da doença oncológica.REV PORT PNEUMOL 2003; IX (2): 117-128 ABSTRACT: In this paper the authors reviews the anaemia in cancer patients, its mechanisms, diagnosis, and therapeutics, especially the indications for blood transfusion and the use of recombinant human erythropoietin. Also, the author reviews the impact of anaemia in quality of life and in the outcome of therapy and of cancer itself.REV PORT PNEUMOL 2003; IX (2): 117-128 Palavras-chave: Anemia, neoplasia, quimioterapia, radioterapia, qualidade de vida, RhEPO, Key-words: Anaemia, cancer, chemotherapy, radiotherapy, quality of life, RhEPO

StreszczenieCelOcena toksyczności i efektywności napromieniania 2 x dziennie u chorych z przerzutami nowotworu złośliwego do mózgu.Materiał / metodaW tym celu dokonano prospektywnej oceny napromieniania u 116 chorych leczonych w Klinice Radioterapii Centrum Onkologii Oddział w Krakowie w okresie od 1992 do 2000 r. Napromienianie prowadzono dwa razy dziennie podwyższoną dawką dzienną wynoszącą 3 Gy z minimalną przerwą 6 godzin do dawki całkowitej 39 Gy. Chorzy zakwalifikowani do badania byli w stanie ogólnym wynoszącym przynajmniej 50 według skali Karnofskiego. Średni wiek chorych wynosił 55 lat.WynikiWczesna tolerancja leczenia była dobra, jedynie 20 chorych wymagało leczenia przeciwobrzękowego. Ocena efektywności wykazała, że w 22% (26/116) stwierdzono poprawę stanu neurologicznego. U 86 chorych stan neurologiczny nie uległ zmianie, a jedynie u 3 chorych uległ pogorszeniu. Przeżycie ogólne 12-miesięczne oraz 12-miesięczne przeżycie bez objawów progresji objawów neurologicznych wyniosły odpowiednio 21% i 10%. Najlepsze rokowanie zaobserwowano u chorych, u których radioterapia była poprzedzona operacyjnym usunięciem ogniska przerzutowego w mózgu.PodsumowanieNapromienianie dwa razy dziennie podwyższoną dawką frakcyjną jest metodą leczenia o akceptowalnej toksyczności leczenia i charakteryzującą się dobrą skutecznością.AbstractAimTo evaluate the morbidity and effectivness of twice a day hypofractionation in patients with brain metastases.Material / methodsBetween 1992 and 2000, 116 patients with brain metastases have been treated with whole brain radiotherapy alone and only in 33 patients radiotherapy was applied as adjuvant treatment after surgery. Radiotherapy was given in two of 3 Gy fractions daily with minimum 6 hours intervals between fractions to total dose of 39 Gy. Mean age of treated patients was 55 years. All patients were in general performance status evaluated according to the Karnofsky Performance Scale of at least 50.ResultsEarly tolerance of treatment was acceptable. Of 116 patients only 20 patients were treated with supportive treatment (anti-oedema drugs). Improvement of the neurological status was obtained in 26 patients (22%). The one-year overall survival was 21%. The one–year survival without clinical progression of disease was observed in 10% of all treated patients. Patients with solitary brain metastases treated with surgery and radiotherapy showed the best results.ConclusionsOur results showed that twice a day hypo-fractionation radiotherapy for patients with brain metastases is well tolerated and may provides benefit.

El cáncer de próstata es una causa común de muerte en hombres occidentales. La morbimortalidad asociada suele ser consecuencia directa de la diseminación ósea, presente en hasta un 50% de los pacientes en el momento del diagnóstico. El objetivo del tratamiento de estos enfermos metastásicos es la prevención o paliación de los síntomas y de las complicaciones. El arsenal terapéutico es amplio e incluye hormonoterapia, radioterapia externa, radiofármacos, cirugía, quimioterapia, bisfosfonatos y nuevos fármacos (inhibidores de la angiogénesis, inmunoterapia y fármacos que actúan sobre la diferenciación celular). En la elección del tratamiento se deben considerar múltiples factores: la condición de andrógeno-dependiente o andrógeno-independiente, ya que la terapia hormonal constituye el primer escalón del tratamiento; la localización y extensión de la destrucción ósea; la gravedad del cuadro; la disponibilidad de las diferentes terapias; el estado del paciente; el pronóstico de supervivencia y la relación coste-efecto. Las indicaciones de algunas de estas terapias están claramente establecidas mientras que otras están todavía en estudio para determinar su eficacia, la pauta de tratamiento y las indicaciones. En este artículo se realiza una revisión y actualización de dichos tratamientos.

OBJETIVO: Avaliar a existência de tumor residual e o índice de proliferação celular (PCNA) em pacientes com carcinoma espinocelular do colo uterino, tratadas com a combinação de radioterapia e cirurgia. MÉTODOS: Avaliamos 16 pacientes com carcinoma do colo uterino atendidas no período de abril de 1986 a agosto de 1998, tratadas com irradiação pré-operatória e cirurgia. Após revisão histopatológica do material das biópsias e peças cirúrgicas, procedeu-se ao exame imuno-histoquímico para avaliar a expressão do PCNA. A imuno-expressão do PCNA foi analisada através do programa de análise gráfica por computador IMAGELAB 2.3. RESULTADOS: Em oito (50%) casos detectou-se persistência de neoplasia e em outros oito (50%) houve ausência de neoplasia residual. O valor médio do índice de PCNA anterior à radioterapia nos casos com tumor residual foi de 61,56% e, nos casos sem tumor residual, de 60%. A avaliação da expressão do PCNA nas 16 biópsias prévias à radioterapia mostrou valor médio de 60%. Nas peças de histerectomia com neoplasia residual a expressão do PCNA foi, em média, 74%. CONCLUSÕES: A associação de radioterapia pré-operatória e cirurgia no carcinoma do colo uterino permite adequada terapêutica em pacientes sem condições para a cirurgia radical. Outrossim, a radioterapia exclusiva apresenta percentagem relevante de insucessos detectados pela cirurgia e pela análise do PCNA. OBJECTIVE: To search for residual disease and to analyse the Proliferating Cellular Nuclear Antigen (PCNA) status, in patients with cervical squamous cell carcinoma, treated with both radiotherapy and surgery. METHODS: Histological slides from 16 patients with uterine cervix cancer, treated between April 1986 and August 1998, with preoperative radiotherapy and surgery, were reviewed. PCNA imunohistochemical reactivity of these samples was evalued, using the IMAGELAB 2.3 computer image analysis system. RESULTS: Residual carcinoma were found in eight cases (50%) and no malignant features was found in eight cases (50%). The mean value of PCNA before radiotherapy in patients with residual cancer was 61.56% and in cases without residual cancer was 60%. Its expression before radiotherapy was between 27.91% and 89.93% (60% average), while after radiotherapy it varied between 55.80% and 86.73% (74% average). CONCLUSIONS: The association between preoperative radiotherapy followed by surgery is adequated to treat patients with cervical cancer, when radical treatment is not possible. Meanwhile, exclusive radiotherapy shows a significant failure rate, detected after surgery and PCNA analysis.

RESUMO: O carcinoma primário da traqueia é uma entidade rara, cuja abordagem terapêutica clássica consiste na exérese cirúrgica da lesão com margens adequadas.Contudo, devido ás características intrinsecas destas lesões, nem sempre é possível a realização deste tratamento com intuito curativo. A radioterapia assume-se hoje em dia como uma alternativa válida na terapêutica destas lesões. Os autores descrevem 2 casos clínicos de carcinoma primário da traqueia tratados com radioterapia no Instituto Português de Oncologia â Centro do Porto, fazendo uma revisão da literatura sobre este assunto.REV. PORT. PNEUMOL 1999; V (3): 313-320 ABSTRACT: Primary carcinoma of the trachea is a rare malignancy. Classic therapeutic management usually consisted in surgical excision with wide margins. The characteristics of these lesions make this treatment approach a difficult task. some times impossible to perform with curative intent. Radiation therapy presents as the alternative treatment of choice in these cases. The authors describe two clinical cases of primary tracheal carcinoma treated with radiation therapy alone in Instituto Português de Oncologia â Centro do Porto, and also make a literature revue on this subject.REV. PORT. PNEUMOL 1999; V (3): 313-320 Palavras-chave: Carcinoma primário da traqueia, Tratamento, Radioterapia, Key-words: Primary tracheal carcinoma, Treatment, Radiation therapy

Los cuadros de necrolisis epidérmica tóxica (NET)-síndrome de Stevens-Johnson (SSJ) se han asociado al consumo de algunos fármacos, en especial a la toma de antiepilépticos como fenitoína. Algunos autores han planteado un incremento en el riesgo de padecer NET/SSJ cuando la fenitoína se asocia con radioterapia craneal. Se presenta el caso de una paciente diagnosticada de adenocarcinoma de mama con metástasis cerebrales en tratamiento con fenitoína que poco después de recibir radioterapia cerebral presenta un cuadro de NET. Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) have been associated with some drugs, particularly anticonvulsants such as phenytoin. Some authors have pointed out an increased risk of TEN/SJS when phenytoin is associated with whole brain radiotherapy. We report a patient diagnosed with breast adenocarcinoma and brain metastases that was on treatment with phenytoin and, shortly after receiving whole brain radiotherapy, developed toxic epidermal necrolysis. Sin financiación 0.166 SJR (2007) Q3, 79/117 Dermatology, 119/159 Pathology and Forensic Medicine; Q4, 39/46 Histology UEM

O objetivo foi analisar a sobrevida específica de cinco anos e fatores associados para câncer de boca no Brasil. Trata-se de coorte retrospectiva, cuja fonte de dados foi a Base Onco, que realizou o relacionamento probabilístico-determinístico de todos os registros de autorização para radioterapia e/ou quimioterapia pelo Sistema Único de Saúde, entre 2000 e 2006, gerando-se cadastro único para cada paciente. O presente estudo incluiu os pacientes diagnosticados entre 2002 e 2003 com câncer de boca, exceto lábio, e idade entre 19 e 100 anos (N = 6.180). A taxa de sobrevida específica em cinco anos foi de 60%. Foram associados à menor sobrevida específica: ter idade > 40 anos; apresentar estádio III ou IV; localização em língua, assoalho de boca e base de língua; não realizar tratamento cirúrgico, realizar somente quimioterapia ou radioterapia e quimioterapia e residir em determinados estados do Brasil. Os resultados reforçam a necessidade de incluir a avaliação das disparidades dos territórios de planejamento como possibilidade para incrementar as ações de saúde e melhorar os indicadores de sobrevida. This study aimed to analyze the specific five-year oral cancer survival rate and associated factors in Brazil. This was a retrospective cohort study using the Oncological Database as the source, with probabilistic-deterministic linkage of all the records for authorization of radiotherapy and/or chemotherapy in the Unified National Health System from 2000 to 2006, generating a single record for each patient. The current study included patients diagnosed with oral cancer from 2002 to 2003 (except for cancer of lip), and ranging from 19 to 100 years of age (N = 6,180). Specific five-year survival was 60%. Decreased specific survival was associated with: age > 40 years; stages III or IV; location on the tongue, floor of the mouth, or base of the tongue; not performing surgical treatment, performing only chemotherapy or radiotherapy and chemotherapy; and residence in certain States of Brazil. The results emphasize the need to include assessment of regional disparities as a possibility for increasing health interventions and improving survival. El objetivo fue analizar la supervivencia específica a cinco años y los factores asociados al cáncer oral en Brasil. Se trata de una cohorte retrospectiva cuya fuente de datos fue la “Base Onco”, que reúne todos los registros de autorización para radioterapia y quimioterapia en el sistema de salud público en Brasil entre 2000 y 2006. Este estudio incluyó a pacientes diagnosticados con cáncer de la boca –exceptuando el de labio– entre 2002 y 2003 y una edad entre 19 y 100 años (N = 6.180). La tasa de supervivencia específica a los cinco años fue del 60%. Se asociaron con una menor supervivencia específica factores como: edad > 40 años; estadio III o IV; la localización del tumor en la lengua, suelo de la boca y base de la lengua; no realizar una cirugía para el tratamiento del cáncer oral; realizar sólo quimioterapia o radioterapia y quimioterapia conjuntamente; además de residir en ciertos estados brasileños. La inclusión de este enfoque refuerza la necesidad de incluir la evaluación de las disparidades en estos territorios como una oportunidad para mejorar las acciones de salud.

Resumen Introduccion y objetivo la cistitis actinica (CAH) secundaria a la radioterapia pelvica ocurre en 2-8% de los pacientes. Se han descrito multiples tratamientos con resultados variables, habitualmente frustrantes. Nuestro objetivo fue evaluar la eficacia de la oxigenoterapia hiperbarica (OHB) como tratamiento de la CAH. Material y metodos analisis retrospectivo de los pacientes con CAH secundaria a radioterapia pelvica que recibieron OHB entre enero de 2002 y enero de 2010. Los pacientes recibieron 40 sesiones de OHB en una camara hiperbarica multiplaza, respirando 90 minutos de oxigeno al 100% a 2,2 atm. Se evaluo la respuesta con relacion al cese total o parcial de la hemorragia. Resultados veinticinco pacientes fueron tratados (21 varones y 4 mujeres), con edad promedio de 66,7 anos. Veinte hombres fueron irradiados por cancer de prostata y uno por cancer de vejiga. Tres mujeres tenian cancer de cuello uterino y una cancer de endometrio. En todos los pacientes habian fracasado los tratamientos conservadores previos y la OHB fue considerada solo tras fallar otras medidas. Todos los pacientes respondieron al tratamiento con OHB y ninguno ha presentado recidiva despues de terminar el tratamiento en un periodo de seguimiento promedio de 21,2 meses. No hubo complicaciones graves. Conclusion la OHB es un tratamiento no-invasivo, altamente eficaz y seguro para el tratamiento de la CAH secundaria a radioterapia pelvica, por lo que debe considerarse como alternativa de primera eleccion en estos complejos casos.

Introducción y objetivos: Algunos de los pacientes candidatos a la braquiterapia presentan historia previa de resección transuretral de la próstata (RTUP). La RTUP, sin embargo, crea una cavidad que puede llevar a algunas dificultades técnicas para la realización de braquiterapia. Tales condiciones tornan a la RTUP, previa a la braquiterapia, una contraindicación relativa a la realización de ésta. El objetivo del presente trabajo es evaluar las tasas de incontinencia urinaria en pacientes submetidos a braquiterapia despues de una RTUP por medio de análisis retrospectiva. Materiales y métodos: En nuestro estudio analizamos 16 pacientes sometidos a RUTP previa a braquiterapia. Tras braquiterapia los pacientes fueron evaluados sobre síntomas del tracto urinario inferior a través del cuestionario ICSmaleSF. El intervalo de tiempo entre la RTUP y el tratamiento braquiterápico varió de 30 a 90 días, (media= 60 días). El seguimiento post braquiterapia varió entre 3 a 60 meses, (media= 30 meses). Resultados: Ninguno de los 16 pacientes evaluados presentó síntomas del tracto urinario inferior o incontinencia urinaria. Con el cuestionario ICSmaleSF la puntuación de interferencia en la calidad de vida obtuvo una media de 0,18 antes de la braquiterapia (variando de 0 a 1) y después de la braquiterapia de 0,20 (variando de 0 a 1) (p< 0,001), donde las diferencias de los resultados no fue estadísticamente significativa. Algunas complicaciones fueron observadas como: disfunción eréctil, equimosis escrotal y retención urinaria. Los casos de disuria, equimosis escrotal y retención urinaria fueron de corta duración y resolución espontánea, éste último tras cateterismo vesical por 7 días. El paciente portador de disfunción eréctil presentó buena respuesta al uso semanal (3x/semana) de inhibidor de fosfodiesterasa tipo 5, después de un periodo de 6 meses. Conclusión: En concordancia con otros estudios, nosotros creemos que con alguna estrategia la RTUP no debería ser considerada una contraindicación relativa para la braquiterapia.