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INTRODUCTION Extreme hypofractionation in patients with early-stage breast cancer has been studied in randomized phase III non-inferiority trials. There is scarce data on this strategy in Latin American patients. OBJECTIVES To describe the profile of patients diagnosed with breast cancer treated with radiotherapy with an ultra-hypofractionated regimen (5 fractions of 5.2 Gy, in one week), as well as the dosimetric aspects and acute toxicity related to the treatment. METHOD Retrospective cohort through a Brazilian uni-institutional series, with analysis of pathological, dosimetric, and toxicity variables. RESULTS Between May 2020 and March 2022, 67 patients were included, with a median age at diagnosis of 71 years (41-93). Regarding staging, 25.8% had in situ tumors, 60.6% of patients were IA, and only 3% were stage IIA. Nineteen percent of patients had histological grade 3; 24.6%, had nuclear grade 3. Hormone receptors were positive in 92.1% of patients. The mean ki67 was 19%, and HER2 was negative at 84.5%. All patients underwent conservative surgery, and 5 underwent reconstruction with autologous flaps. Fifty-one patients underwent hormone therapy and only 2 underwent adjuvant chemotherapy. All but two patients were treated with the conformal technique (VMAT was used due to unfavorable anatomy). The mean volume of the irradiated breast was 926 cm3 (ranging from 920 to 932 cm3). Regarding the constraints of the organs at risk, the average V8Gy of the ipsilateral lung was 11.4%, ranging from 0 to 24%. In the heart, the average volumes receiving 1.5Gy and 7Gy were, respectively, 9.2% and 0.7%. No patient had acute toxicity greater than grade 2. The effects on the skin appeared on average 20 days after the end of treatment, with resolution in a maximum of 3 months. The median follow-up time was 10 months (3 - 26). We did not observe any case of local-recurrence, of breast-cancer-related death. CONCLUSION Although our follow-up time is premature, we have found that ultra-hypofractionated radiotherapy was feasible, tolerable, and safe, for patients with early breast cancer. Also, the constraints on the organs at risk were respected. There were no high-grade acute toxicities. Besides convenience, ultra-hypofractionation can improve access to radiotherapy in resource-scarce settings. Citation Format: Leticia Hernandes de Brito, Felipe Cicci Farinha Restini, Maria Thereza Mansur Starling, Gabriela Silva Moreira de Siqueira, Gustavo Nader Marta, Heloisa de Andrade Carvalho, Samir Abdallah Hanna. Ultra-hypofractionated Radiotherapy for Breast Cancer: A Brazilian Single-Institutional Series [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-03.

IntroductionMale breast cancer (MBC) is uncommon tumor that represents only 0,5% of all tumor diagnoses in men. In general, the age of incidence of MBC is, on average, 5-10 years later than women and have more advanced stage at diagnosis and worse prognosis. International recommendations for staging and treatment for MBC are the same as female breast cancer. Due to the rarity of the tumor, few data are available related to MBC. The aim of this study was to evaluate the clinicopathological characteristics, treatment trends and survival outcomes in MBC in Sao Paulo State of Brazil.MethodsThis population-based study had included men diagnosed with invasive breast cancer between January 2000 and June 2020 from Fundação Oncocentro de Sao Paulo. Patients were described according to age, education level, treatment modalities and medical practice. Categorical variables are described as percentages and frequencies. The association between demographic and treatment factors and overall survival was evaluated using a Cox Proportional Hazard (PH) regression model while accounting for different lengths of participant follow-up. Uni- and multivariable Cox proportional-hazards model were used to estimate hazard ratios with corresponding 95% confidence intervals for OS. The Kaplan-Meier (KM) curves were used to visually display survival curves, and the log-rank test were used to compare the estimated KM curves. ResultsA total of 907 MBC patients were included (825 patients had invasive ductal carcinoma; 64, had invasive lobular carcinoma;18, had especial subtypes). The age at diagnosis were 70y in 12.2%, 51.5% and 27.1% of patients, respectively. The proportion of stage I, II, III and IV were 19.5%, 36.6%, 31,5% and 12.3%, respectively (Table 1). OS by stage at diagnosis was presented in the Figure 1. For each stage I, II, III and IV, 5- and 10-years OS were, respectively, 87.9% and 77.8%, 79.9% and 58.9%, 51.6% and 24.5%, 20.0% and 5.6%. In the multivariable analyses adjusted for practice (public or private), education (low or medium/high), age, stage at diagnosis and treatment. modalities, the significant independent predictor for OS was stage at diagnosis only Figure 2. ConclusionMBC tends to be diagnosed at a more advanced stage and older age at the time of diagnosis. Type of practice, age, treatment modalities and educational level did not influence survival outcomes. Stage at diagnosis was the most important factor related to the OS. Citation Format: Ridânia de Oliveira Frederice, Allan AndressonLima Pereira, Felipe EduardoMartins de Andrade, Samir Abdallah Hanna, Heloisa de Andrade Carvalho, Gustavo Nader Marta. Characteristics and survival outcomes of male breast cancer in Sao Paulo state of Brazil: A population-based study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-27.

Background: This study aimed to validate the Brazilian version of EORTC CAT Core and compare the Brazilian results with those from the original European EORTC CAT Core validation study. Methods: After validated translation, 168 cancer patients from Brazil receiving radiation therapy with or without chemotherapy was assessed. Translated EORTC CAT Core and all QLQ-C30 items were administered to patients using CHES (Computer-Based Health Evaluation System) before (T0) and after (T1) treatment initiation. The association between QLQ-C30 and CAT scores and ceiling/floor effects were estimated. Based on estimates of relative validity (cross-sectional, known-group differences and changes over time), relative sample-size requirements for CAT compared to QLQ-C30 were estimated. Results: Correlation coefficients between CAT and QLQ-C30 domains ranged from 0.63 to 0.93, except for dyspnoea, all coefficients were &gt, 0.82 (corresponding figures were 0.81–0.93 in the European study). On average across domains, floor/ceiling was reduced by 10% using CAT (9% in the European study) corresponding to a relative reduction of 32% (37% in the European study). Analyses of known-group validity and responsiveness indicated that, on average across domains, the sample-size requirements may be reduced by 17% using CAT rather than QLQ-C30, without loss of power (28% in the European study). The Brazilian sample had less symptom/quality of life impairment than the European sample, which likely explains the lower sample-size reduction using CAT when comparing with the European sample. Conclusions: The results in the Brazilian cohort were generally similar to those from the European sample and confirm the validity and usefulness of the EORTC CAT Core.

Aim To show three patients with soft tissue sarcomas of distal extremities conservatively treated after tumor-board discussion, involving margin-free surgery, exclusive intraoperative radiotherapy, and immediate reconstruction. Background Current guidelines show clear and robust recommendations regarding the composition of the treatment of sarcomas of extremities. However, little evidence exists regarding the application of these treatments depending on the location of the primary neoplasia. Tumors that affect the distal extremities present different challenges and make multidisciplinary discussions desirable. Methods/Results We reported 3 patients who were approached with a conservative intention, after tumor board recomendation. The goals from the treatment performed were aesthetic and functional preservation, while enruring locoregional control. We had wound healing complications in 2 of the cases, requiring additional reconstruction measures. Patients are followed up for 24, 20 and 10 months; local control is 100%, and functional preservation is 100%. Conclusions Despite being a small series, it was sufficient to illustrate successful multidisciplinary planning, generating a therapeutic result with improved quality of life for patients who had an initial indication for extremity amputation.

Background: Recent medical literature reports that mastectomy rates are increasing in early breast cancer. The reasons for this have not yet been elucidated and appear to be complex and can be related to: availability of immediate reconstruction, expertise of the surgeon, increment of genetic tests and beliefs, unwillingness or impossibility of receipting radiotherapy, and information of the patients themselves. The present study aimed to demonstrate mastectomy rates throughout the years from a single Brazilian institution and to correlate it with age, neoadjuvant therapies and tumor staging. Methods: A retrospective analysis of breast cancer surgeries from patients treated at Hospital Sírio-Libanês cancer center from 2005 to 2018 was performed. The institutional database electronically of physically registered in this period included pathology, radiology, and clinical information. Chi-squared coefficient of correlation was applied for categorical variables analysis of association, and for significant findings a multivariate regression analysis was performed. All statistical analyses were performed in STATA version 15.1C. Results: Medical records from 2,942 patients treated were analyzed. 1,798 mastectomies (including nipple-sparing mastectomies and skin-sparing mastectomies) were performed against 1,144 conservative surgeries (61.11% x 38.89%). The range of mastectomy rates varied from 73.04% (2007) to 48.8% (2018) and mastectomy rates showed a slight decrease (53.84% in 2005 and 48.14% in 2018). Type of surgery (conservative, mastectomy, skin-sparing mastectomy) was associated with neoadjuvant treatment (p Conclusions: These results demonstrate that our mastectomy rates, differently from global trends, did not increase through the past 15 years. These findings are probably related to impossibility of genetic tests in this population, accurate diagnostic techniques and the achievement of higher response rates with neoadjuvant treatment. Interestingly, breast-conserving surgery rates were inversely correlated with older age, which can reflect an individualized therapeutic approach among a subgroup of patients potentially vulnerable to chemo-related toxicity. Citation Format: Thatyane EspósitoGallo Cunha, Thamyse FernandaSá Dassie, Julianne MariaSilva Lima, Max Senna Mano, Lincon Jo Mori, Samir Abdallah Hanna, Sandro ViniciusMachado Melo, Gustavo Nader Marta, Felipe EduardoMartins Andrade. Mastectomy rates in a single Brazilian institution through the past 15 years: Are we following the global trend? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-29.

Background: This study aims to assess the clinical outcomes of patients with spine metastases who underwent stereotactic ablative radiation therapy (SABR) as part of their treatment. SABR has arisen as a contemporary treatment option for spinal metastasis patients with good prognoses. Materials and methods: Between November 2010 and September 2018, Spinal SABR was performed in patients with metastatic disease in different settings: radical (SABR only), postoperative (after decompression and/or fixation surgery), and reirradiation. Local control (LC), pain control, overall survival (OS) and toxicities were reported. Results: Eighty-five patients (corresponding to 96 treatments) with spine metastases were included. The median age was 59 years (range, 23–91). In most SABR (82.3%, n = 79) was performed as the first local spine treatment, while in 12 settings (12.5%), fixation and/or decompression surgery was performed prior to SABR. Two-year overall survival rate was 74.1%, and median survival was 19 months. The LC rate at 2 years was 72.3%. With regard to pain control, among 67 patients presenting with pain before SABR, 83.3% had a complete response, 12.1% had a partial response, and 4.6% had progression. Vertebral compression fractures occurred in 10 patients (11.7%), of which 5 cases occurred in the reirradiation setting. Radiculopathy and myelopathy were not observed. No grade III or IV toxicities were seen. Conclusion: This is the first study presenting a Brazilian experience with spinal SABR, and the results confirm its feasibility and safety. SABR was shown to produce good local and pain control rates with low rates of adverse events.

SUMMARY

Background: The majority of patients diagnosed with glioblastoma develop recurrent disease resulting in poor prognoses. The current study aimed to determine the survival rates of patients diagnosed with glioblastoma in Brazil accounting for the influence of age, treatment modalities, public and private practices, and educational level using a population-based national database. Methods: Patients diagnosed with glioblastoma from 1999-2020 were identified from The Fundação Oncocentro de São Paulo database to create a retrospective cohort. Patients were described according to age, education level treatment modalities and medical practice. In a Cox proportional hazards model, controlled for confounding factors for overall survival, the hazard ratio and 95% CI of overall survival in adults was evaluated. Findings: A total of 4,511 patients were included. The median lengths of survival for patients treated in the public and private settings were 8 and 17 months (p

SUMMARY OBJECTIVE: To assess the cosmetic satisfaction of patients diagnosed with breast cancer submitted to the hypofractionated radiotherapy with IMRT (hIMRT) technique and its correlation with dosimetric data of the radiotherapy planning. MATERIALS AND METHODS: The retrospective cohort study that assessed women with a diagnosis of malignant breast neoplasia submitted to the conservative treatment or radical mastectomy and treated with hIMRT. In the period between August 2007 to December 2014, in a philanthropic / private institution, 170 records were selected. The cosmetic assessment was carried out by means of the Harvard/RTOG/NSABP scale with one-year minimum range after treatment. The collected dosimetric data were: breast / chest wall volume, volume that received 95% (V95%) and 107% (V107%) of the prescribed dose. RESULTS: The volume of the treated breasts ranged from 169 to 2.103 ml (median = 702; IQR: 535 to 914 ml). Median V95% was 86.7% (54.6-96.6%; IQR: 80.0% to 90.6%); eight (5.7%) patients had V95% higher than 95%. Median V107% was 0% (0%-16.3%; IQR: 0.0% to 0.3% and 13); 9.3% patients had V107% higher than 2%. One hundred and thirty-three (78.2%) patients responded to the cosmetic assessment: 99 (74.4%) considered the cosmetic results excellent. Significant associations between cosmetic assessment and breast volume (p=0.875), V95% (p=0.294) e V107% (p=0.301) were not found. CONCLUSION: The cosmetic results showed favorable when using hIMRT, and the lack of correlation with usual the dosimetric data illustrates the capacity of hIMRT to minimize the heterogeneity of the dose in this endpoint, even in voluminous breasts. RESUMO OBJETIVO: Avaliar a satisfação cosmética de pacientes diagnosticadas com câncer de mama submetidas à radioterapia hipofracionada com técnica IMRT (hIMRT) e sua correlação com dados dosimétricos do planejamento radioterápico. MATERIAIS E MÉTODOS: Estudo de coorte retrospectivo que avaliou mulheres com diagnóstico de neoplasia maligna de mama submetidas a tratamento conservador ou mastectomia radical e tratadas com hIMRT. No período de agosto de 2007 a dezembro de 2014, em uma instituição filantrópica/particular, foram selecionados 170 prontuários. A avaliação cosmética foi feita por meio da escala de Harvard/RTOG/NSABP com um intervalo mínimo de um ano após o tratamento. Dados dosimétricos coletados foram: volume da mama/plastrão, volume que recebeu 95% (V95%) e 107% (V107%) da dose prescrita. RESULTADOS: O volume das mamas tratadas variou de 169 a 2.103 ml (mediana = 702; IQR: 535 a 914 ml). O V95% mediano foi 86,7% (54,6-96,6%; IQR: 80,0% a 90,6%); oito (5,7%) pacientes tiveram o V95% superior a 95%. O V107% mediano foi 0% (0%-16,3%; IQR: 0,0% a 0,3% e 13); 9,3% pacientes tiveram o V107% superior a 2%. Cento e trinta e três (78,2%) pacientes responderam à avaliação cosmética: 99 (74,4%) consideraram o resultado cosmético excelente. Não foram encontradas associações significativas entre a avaliação cosmética e o volume da mama (p=0,875), V95% (p=0,294) e V107% (p=0,301). CONCLUSÕES: Os resultados cosméticos mostraram-se favoráveis com o uso de hIMRT, e a ausência de correlação com os dados dosimétricos usuais ilustra a capacidade do hIMRT em minimizar a heterogeneidade da dose neste desfecho, mesmo em mamas volumosas.

Introduction. Chordomas are rare malignancies of bone origin that occur in the axial skeleton, typically the skull base and lumbar/sacral regions. Although often classified as low-grade neoplasms, its locally infiltrative behavior may result in significant morbidity and mortality. Optimal surgical resection may be curative, but up to 50% of the cases relapse within 5 years, and currently there are no systemic treatments approved in this setting. A large proportion of these tumors express stem-cell factor receptor (c-KIT) and platelet-derived growth factor receptors (PDGFRs), providing a rationale for the use of tyrosine-kinase inhibitors (TKIs). Case report. A 27-year-old male presented with recurrent chordoma of the lumbar spine 4 years after initial diagnosis. Salvage therapies in the interval included repeat resections and radiation therapy. He ultimately developed multifocal recurrence not amenable to complete excision or reirradiation. A comprehensive genomic profiling assay was performed and revealed nondrugable alterations. Decision was made to proceed with systemic treatment with pazopanib 800 mg/day, resulting in tumor reduction (−23.1% reduction in size) and prolonged disease control. Conclusion. For this patient with a multiple recurrent chordoma and limited treatment options, pazopanib resulted in sustained clinical benefit following initial tumor reduction.

This article provides description about acute toxicity and early follow-up of one patient treated for breast cancer and Schnitzler syndrome. There are no previously reported cases exploring this interaction on medical literature. The expected radiodermitis to occur in the region treated with radiotherapy along with urticarial-like lesions might be challenging in view of the interaction between symptoms and therapeutic measures. (C) 2017 Greater Poland Cancer Centre. Published by Elsevier Sp. z o.o. All rights reserved. Hosp Sirio Libanes, Sao Paulo, Brazil Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, Brazil Hosp Sirio Libanes, Oncol Ctr, Sao Paulo, Brazil Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, Brazil Web of Science

Purpose We aim to assess any association between study and self-reported conflict of interest (COI) or trial sponsorship in breast cancer radiation clinical trials. Materials and methods We searched PubMed for all clinical trials (CTs) published between 09/2004 and 09/2014 related to breast cancer. We included only radiotherapy CTs with primary clinical endpoints. We classified eligible trials according to the funding source, presence or absence of conflict of interest, study conclusion and impact factor (IF). Results 1,603 CTs were retrieved. 72 randomized clinical trials were included for analysis. For-profit (PO), not for profit organization (nPO), none and not reported sponsorship rates were 9/72 (12.5%), 35/72 (48.6%), 1/72 (1.4%), 27/72 (37.5%), respectively. Present, absent or not reported COI were found in 6/72 (8.3%), 43/72 (59.7%) and 23/72 (32%) of the CTs, respectively. Conclusion was positive, neutral and negative in 57/72 (79.1%), 9/72 (12.5%) and 6/72 (8.4%) of the trials, respectively. Positive conclusion was reported in 33/44 (75%) funded trials (PO and nPO) and 5/6 (83.3%) CTs with reported COI. On univariate analysis no association with funding source (P=0.178), COI (P=0.678) or trial region (P=0.567) and trial positive conclusion was found. Sponsored trials (HR 4.50, 95CI-0.1.23-16.53;P=0.0023) and positive trials (HR 4.78, 95CI- 1.16-19.63;P=0.030) were more likely to be published in higher impact factor journals in the multivariate analysis. Conclusions nPO funding was reported in almost 50% of the evaluated CTs. No significant association between study conclusion and funding source, COI or trial region was identified. Sponsored trials and positive trials were more likely to be published in higher impact factor journals.

Summary Objective: To provide a quantitative profile of the indications and use of stereotactic body radiotherapy (SBRT) in a developing country oncology-based institution. In addition, to describe the patients' and treatment characteristics, and to provide a temporal analysis. Method: SBRT patients treated from 2007 to 2015 were retrospectively evaluated by two independently investigators. Data were stratified and compared in two periods: first experience (FE) (May 2007 to April 2011), and following experience (FollowE) (May 2011 to April 2015). The following parameters were compared between the groups: total number of treated patients and lesions, treatment site, additional image fusion used, formal protocol adoption, and SBRT planning technique. Results: One hundred and seventy-six (176) patients with 191 lesions were treated: 34 (18%) lesions in the FE and 157 (82%) lesions in FollowE. The majority of lesions were metastases (60.3%), and lung (60.2%) was the most common treatment site, followed by spine (31%), and others (8.8%). An average of 1.4 (±0.6) additional imaging exams for delineation was performed. Conformal 3D radiotherapy planning technique was used in 64.4%, and intensity modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) in the remaining 35.6% (p=0.0001). Higher rates of curative treatments were observed in FE, as well as more lung lesions, patients ≥ 70 years, 3D conformal, number of additional images and ECOG 0, and all presented p 1)] (OR 7,5; p=0,0001) e ECOG 0 (vs. > 0) (OR 0,21; p=0,0431). Conclusão: o uso de SBRT aumentou ao longo do tempo na instituição. No P2, notou-se uma evolução técnica, com indicações mais diferenciadas, maior uso de imagens auxiliares para definição do alvo e técnicas de planejamento mais sofisticadas.

Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.

A questão do término da vida é fonte de reflexões desde os primórdios da civilização e demanda diligências para a tentativa de seu enquadramento social ao longo da história do pensamento humano. Com o desenvolvimento e aprimoramento da medicina, podese modificar, na maioria das vezes, a história natural das doenças. É possível prolongar a vida e adiar o processo do morrer. Isso engendrou um novo protótipo médico em que há necessidade de se conviver e cuidar de pacientes gravemente enfermos, situação muitas vezes acompanhada de árduo sofrimento. A sociedade atribui ao médico a função de ser o responsável por debelar e vencer a morte. No contexto oncológico, essas questões surgem de forma salutar, uma vez que, em diversas situações, não há possibilidade de se oferecer uma terapêutica curativa aos enfermos. O objetivo do presente artigo é debater as relações que norteiam a temática proposta, baseando-se em uma revisão de literatura. Busca-se, assim, uma perspectiva que figura como um caminho argumentativo que conduz evidências a esse debate.The issue of life-ending has been a source of considerations since the dawn of civilization, and calls for great circumspection when one attempts to fit it socially throughout the history of human thinking. The development and improvement of Medicine might modify, in most cases, the natural history of disease. We have managed to prolong life and the process of dying. This has created a new medical prototype that needs to care for terminally-ill patients, a situation often accompanied by severe suffering. Society attributes to the physician the role of being responsible for conquering and overcoming death. In the oncology context, these questions are well addressed, as in many situations there is no possibility to offer a curative treatment to the patients. The objective of the present study was to discuss the relations that guide the proposed theme, based on a medical literature review. Therefore, a perspective is sought as an argumentative alternative that brings evidence to the proposed debate.

O câncer de mama é a neoplasia maligna mais frequente entre as mulheres. A escolha terapêutica depende do estádio clínico da doença, das características anatomopatológicas, idade, entre outros. O objetivo do presente estudo é apresentar uma atualização dos conceitos e definições da radioterapia (RT) no tratamento conservador do câncer de mama estádio inicial, enfatizando as indicações, contraindicações, dose e fracionamento da RT (esquema clássico, hipofracionado e irradiação parcial da mama), RT adjuvante no carcinoma ductal in situ (CDIS), irradiação das cadeias linfonodais e relação da RT com preditores moleculares de recorrência. Foram utilizadas as bases de dados MEDLINE, SciELO e Cochrane para a seleção dos principais artigos disponíveis sobre a temática proposta. A RT adjuvante tem um papel definido na abordagem das pacientes com câncer da mama submetidas à terapia cirúrgica conservadora. Em pacientes selecionadas, podem-se empregar esquemas de RT hipofracionada ou irradiação parcial das mamas. Todas as pacientes com CDIS devem receber RT adjuvante. Não se sabe a correlação do papel da RT com preditores moleculares de recorrência local e sistêmica.Breast cancer (BC) is the most common malignancy among women. Therapeutic options are based on disease staging, histopathological characteristics, age, and others. The objective of the present study is to carry out an update of the concepts and definitions of radiotherapy (RT) in conservative treatment of early-stage breast cancer, with emphasis on indications, contraindications, RT dose fractionation schedules (classic, hypofractionated and partial breast irradiation), adjuvant RT in ductal carcinoma in situ (DCIS) and molecular predictors of recurrence. MEDLINE, SciELO and Cochrane databases were used for article selection. Adjuvant RT is indicated for patients with BC who underwent conservative breast surgery. In selected patients, hypofractionated or partial breast irradiation can be used. Adjuvant RT should be provided for all patients with DCIS. The correlation of RT and molecular predictors of local and systemic recurrence are not yet well-known.

SummaryBreast cancer (BC) is the most common malignancy among women. Therapeutic options are based on disease staging, histopathological characteristics, age, and others. The objective of the present study is to carry out an update of the concepts and definitions of radiotherapy (RT) in conservative treatment of early-stage breast cancer, with emphasis on indications, contraindications, RT dose fractionation schedules (classic, hypofractionated and partial breast irradiation), adjuvant RT in ductal carcinoma in situ (DCIS) and molecular predictors of recurrence. MEDLINE, SciELO and Cochrane databases were used for article selection. Adjuvant RT is indicated for patients with BC who underwent conservative breast surgery. In selected patients, hypofractionated or partial breast irradiation can be used. Adjuvant RT should be provided for all patients with DCIS. The correlation of RT and molecular predictors of local and systemic recurrence are not yet well-known.

O carcinoma epidermoide de palato mole (CEPM) é uma neoplasia de baixa prevalência que representa a minoria dos tumores que podem acometer a orofaringe. Quando diagnosticados em estádios iniciais, as opções de radioterapia ou cirurgia são aventadas para abordagem terapêutica com taxas de controle locorregional e sobrevida semelhantes. Este estudo tem como objetivo: relatar o caso de um paciente encaminhado ao Departamento de Radioterapia do Centro de Oncologia do Hospital Sírio-Libanês com diagnóstico de CEPM e tratado de forma curativa com radioterapia (teleterapia com técnica de modulação de intensidade de feixe e braquiterapia de altas doses com irídio -192).

INTRODUÇÃO: A razão para a radioterapia parcial da mama em comparação ao tratamento convencional da mama inteira baseia-se em 3 pontos: a) cerca de 90% das recidivas locais ocorre na adjacência do tumor primário; b) é possível estabelecer a equivalência de efetividade entre a dose única e o tratamento fracionado convencional; e c) existem dificuldades logísticas, financeiras e emocionais no tratamento fracionado convencional (falta da disponibilidade do aparelho de radioterapia em muitos municípios e desistência de tratamento das mulheres que iniciam a radioterapia convencional). Em maio de 2004 iniciou-se um estudo prospectivo com a eletronterapia intraoperatória adjuvante no carcinoma inicial invasor de mama, porém com sistemática de tratamento diferente de outras técnicas: ao invés de se usar um acelerador linear portátil e dedicado, utilizou-se o acelerador linear estático convencional. Neste trabalho, buscou-se analisar a frequência de complicações imediatas e tardias; o grau de satisfação estética das pacientes com as mamas após o tratamento; e as taxas de sobrevida livre de doença e sobrevida livre de falha local. MÉTODOS: Coletaram-se dados dos prontuários, buscando informações demográficas, do estadiamento inicial, da avaliação histopatológica intraoperatória (margens cirúrgicas e linfonodo sentinela), dados técnicos da eletronterapia e os achados finais em exame de parafina. Além disso, a frequência de complicações imediatas (até um mês de cirurgia) e tardias (depois de um mês), a estética (um ano da cirurgia, usando a escala de Harvard/NSABP/RTOG) e finalmente os índices de sobrevida global e livre de evento. RESULTADOS: Foram incluídas 169 pacientes e destas 35 foram excluídas devido a critérios intraoperatórios (linfonodo sentinela positivo ou margens positivas). Assim, 134 foram analisadas com idade mediana de 57,9 (40-85,4) anos, em um seguimento mediano de 50,6 (1-97,2) meses. Quatro pacientes desenvolveram recidiva local e três tiveram recorrência regional. As estimativas actuariais em 5 anos de sobrevida global, livre de eventos e livre de falha local foram respectivamente 97, 90,5 e 93,6%. A incidência cumulativa de falha local em 5 anos foi de 3,7%. A incidência global de toxicidade aguda foi de 8,2% e tardia de 26,2%. Os resultados estéticos excelentes, bons, regulares e ruins observados foram respectivamente 70,9%, 14,2%, 3,7% e 3,0%. Os tamanhos de colimador utilizados foram 4 cm em 18,7%, 5 cm em 80,6% e 7 cm de 0,7% dos casos. A energia de elétrons escolhida para tratamento foi de 6 MeV em 7,4%, 9 MeV em 52,2%, 12 MeV em 35,8%, 15 MeV em 3,7%, e 18 MeV em 0,7%. Os aceleradores lineares dedicados apresentam opção de energia de elétron variando até 9 MeV. Sendo assim, 40,29% dessa amostra provavelmente seria sub-tratada em equipamentos dedicados, pois foram necessários valores maiores de energia de elétrons para um tratamento adequado. Todas as pacientes fizeram portal-filme para checagem antes do tratamento e em 72,4% o alinhamento entre o disco de proteção e o colimador foi suficiente. No entanto, 27,6% das pacientes tiveram que ter os discos reposicionados. Nenhum caso de infecção no período perihospitalar fora observado. CONCLUSÕES: A eletronterapia intraoperatória com acelerador linear convencional apresentou baixa frequência de complicações e resultados estéticos desfavoráveis, e foi oncologicamente efetiva INTRODUCTION: The rationale for partial breast radiation therapy when compared to conventional whole breast treatment is based on three points: a) about 90% of local recurrences occur in the adjacent area of the primary tumor, b) it is possible to establish equivalence between the effectiveness of single dose and fractionated conventional treatment, and c) there are logistical, financial and emotional difficulties related to conventional fractionated treatment (lack of availability of radiotherapy facilities in many cities and the high dropout rate of women who start conventional radiotherapy). In May 2004 we started a prospective trial using adjuvant intraoperative electron-beam therapy in early invasive breast cancer, but instead of a dedicated linear accelerator, we used the static conventional linear accelerator. In this study, we aimed to analyze the frequency of early and late complications, the cosmetic satisfaction of patients after treatment, and freedom from disease and local recurrence rates. METHODS: Data were collected from medical records, looking for demographic information, the initial stage, intraoperative and definitive histopathological evaluation of surgical margins and sentinel lymph node, technical data and pathologic staging, and follow-up data. In addition, the frequency of immediate (up to one month of surgery) and late (after one month) complications, aesthetics (one year of surgery, using the scale of Harvard/NSABP/RTOG), and finally the event-free and overal survival were obtained. RESULTS: We included 169 patients and 35 of these were excluded due to intraoperative criteria (positive sentinel lymph nodes or margins). Thus, 134 were analyzed. The median age was 57.9 (40 to 85.4) years and the median follow-up was 50.6 (1 to 97.2) months. Four patients developed local recurrence and three had regional recurrence. The actuarial estimates for overall, event-free, and local failure-free survivals were respectively 97, 90.5, and 93.6%. The crude incidence of local failure at 5 years was 3.7%. The overall incidences of acute and late toxicities were respectively 8.2% and 26.2%. The cosmetic results as excellent, good, fair and bad respectively were observed in 70.9%, 14.2%, 3.7% and 3.0%. Collimator sizes were 4 cm in 18.7%, 5 cm in 80.6%, and 7 cm in 0.7% of cases. The electron energy chosen for treatment was 6 MeV in 7.4%, 9 MeV in 52.2%, 12 MeV in 35.8%, 15 MeV in 3.7% and 18 MeV in 0.7%. The dedicated linear accelerators have electron beam energy ranging up to 9 MeV. Thus, 40.29% of these patients probably would not be treated adequately in dedicated equipment due to the need for higher values of electron energy. All patients underwent portal-film and in 72.4% the alignment between the shielding disc and the collimator was enough. However, in 27.6% of patients it had to be repositioned. No case of infection was observed during perihospitalar time. CONCLUSIONS: Intraoperative electrontherapy using conventional linear accelerator has shown low complications and worsening aesthetics rates, and oncologic efficacy

CONTEXT AND OBJECTIVE: To the best of our knowledge, there has been no systematic assessment of the classification of scientific production within the scope of radiation oncology relating to central nervous system tumors. The aim of this study was to systematically assess the status of evidence relating to the central nervous system and to evaluate the geographic origins and major content of these published data.DESIGN AND SETTING: Descriptive critical appraisal study conducted at a private hospital in São Paulo, Brazil.METHODS: We evaluated all of the central nervous system studies published in the journal Radiotherapy & Oncology between 2003 and 2012. The studies identified were classified according to their methodological design and level of evidence. Information regarding the geographical location of the study, the institutions and authors involved in the publication, main condition or disease investigated and time of publication was also obtained.RESULTS: We identified 3,004 studies published over the 10-year period. Of these, 125 (4.2%) were considered eligible, and 66% of them were case series. Systematic reviews and randomized clinical trials accounted for approximately 10% of all the published papers. We observed an increase in high-quality evidence and a decrease in low-quality published papers over this period (P = 0.036). The inter-rater reliability demonstrated significant agreement between observers in terms of the level of evidence.CONCLUSIONS: Increases in high-level evidence and in the total number of central nervous system papers were clearly demonstrated, although the overall number of such studies remained relatively small.

The role of radiotherapy (RT) in the approach of renal cellular carcinoma, renal pelvis and ureter is quite restricted. The aim of this study is to present a systematic review in order to situate the current status of RT in the management of these entities.

Purpose. To assess feasibility, efficacy, toxicity, and cosmetic results of intraoperative radiotherapy (IORT) with electrons delivered by standard linear accelerators (Linacs) during breast conserving surgeries for early infiltrating breast cancer (BC) treatment.Materials and Methods. A total of 152 patients with invasive ductal carcinoma (T≤3.0 cm) at low risk for local relapses were treated. All had unicentric lesions by imaging methods and negative sentinel node. After a wide local excision, 21 Gy were delivered on the parenchyma target volume with electron beams. Local recurrences (LR), survival, toxicity, and cosmetic outcomes were analyzed.Results. The median age was 58.3 years (range 40–85); median follow-up was 50.7 months (range 12–101.5). There were 5 cases with LR, 2 cases with distant metastases, and 2 cases with deaths related to BC. The cumulative incidence rates of LR, distant metastases, and BC death were 3.2%, 1.5%, and 1.5%, respectively. Complications were rare, and the cosmetic results were excellent or good in most of the patients.Conclusions. IORT with electrons delivered by standard Linacs is feasible, efficient, and well tolerated and seems to be beneficial for selected patients with early infiltrating BC.

Background Clinically localized prostate cancer may be treated by different approaches of radiation therapy. The aim of this study was to report the results of disease control and toxicity in patients with clinically localized prostate cancer treated with high dose IMRT alone with 1 cm PTV posterior margin. Methods From September 2001 to April 2008, 140 patients with localized prostate cancer were treated with definitive IMRT (dose ≥ 74 Gy) without hormone therapy. Outcomes were measured from the conclusion of radiotherapy. Biochemical failure was defined as PSA nadir + 2.0 ng/dL. Toxicities were assessed using the NCI-CTCAE-version 3.0. Median follow-up was 58 months. Results Biochemical failure occurred in 13.6% of patients. Actuarial 5-year biochemical control rates were 91.7%, 82.5% and 85.9% for low-, intermediate-, and high-risk patients, respectively. Stage T2 patients presented a risk of biochemical failure almost three times higher than stage T1 (RR = 2.91; 95% CI: 1.04; 8.17). Distant metastases occurred in 3 (2%) patients. Five-year metastasis-free and overall survivals were 96% and 97.5%, respectively. Late grade 3 genitourinary and gastrointestinal toxicity rates were, respectively, 1.6% and 3%. Conclusion High-dose IMRT alone with 1 cm posterior PTV margin was effective and safe for patients with localized prostate cancer.

The role of radiotherapy (RT) in the treatment of urinary bladder cancer has undergone several modifications along the last decades. In the beginning, definitive RT was used as treatment in an attempt to preserve the urinary bladder; however, the results were poor compared to those of radical surgery. Recently, many protocols have been developed supporting the use of multi-modality therapy, and the concept of organ preservation began to be reconsidered. Although phase III randomized clinical studies comparing radical cystectomy with bladder preservation therapies do not exist, the conservative treatment may present low toxicity and high indexes of complete response for selected patients. The aim of this study was to review the literature on the subject in order to situate RT in the current treatment of urinary bladder cancer.

ResumoA questão do término da vida é fonte de reflexões desde os primórdios da civilização e demanda diligências para a tentativa de seu enquadramento social ao longo da história do pensamento humano. Com o desenvolvimento e aprimoramento da medicina, podese modificar, na maioria das vezes, a história natural das doenças. É possível prolongar a vida e adiar o processo do morrer. Isso engendrou um novo protótipo médico em que há necessidade de se conviver e cuidar de pacientes gravemente enfermos, situação muitas vezes acompanhada de árduo sofrimento. A sociedade atribui ao médico a função de ser o responsável por debelar e vencer a morte. No contexto oncológico, essas questões surgem de forma salutar, uma vez que, em diversas situações, não há possibilidade de se oferecer uma terapêutica curativa aos enfermos. O objetivo do presente artigo é debater as relações que norteiam a temática proposta, baseando-se em uma revisão de literatura. Busca-se, assim, uma perspectiva que figura como um caminho argumentativo que conduz evidências a esse debate.SummaryThe issue of life-ending has been a source of considerations since the dawn of civilization, and calls for great circumspection when one attempts to fit it socially throughout the history of human thinking. The development and improvement of Medicine might modify, in most cases, the natural history of disease. We have managed to prolong life and the process of dying. This has created a new medical prototype that needs to care for terminally-ill patients, a situation often accompanied by severe suffering. Society attributes to the physician the role of being responsible for conquering and overcoming death. In the oncology context, these questions are well addressed, as in many situations there is no possibility to offer a curative treatment to the patients. The objective of the present study was to discuss the relations that guide the proposed theme, based on a medical literature review. Therefore, a perspective is sought as an argumentative alternative that brings evidence to the proposed debate.

ResumoO câncer de mama é a neoplasia maligna mais frequente entre as mulheres. A escolha terapêutica depende do estádio clínico da doença, das características anatomopatológicas, idade, entre outros. O objetivo do presente estudo é apresentar uma atualização dos conceitos e definições da radioterapia (RT) no tratamento conservador do câncer de mama estádio inicial, enfatizando as indicações, contraindicações, dose e fracionamento da RT (esquema clássico, hipofracionado e irradiação parcial da mama), RT adjuvante no carcinoma ductal in situ (CDIS), irradiação das cadeias linfonodais e relação da RT com preditores moleculares de recorrência. Foram utilizadas as bases de dados MEDLINE, SciELO e Cochrane para a seleção dos principais artigos disponíveis sobre a temática proposta. A RT adjuvante tem um papel definido na abordagem das pacientes com câncer da mama submetidas à terapia cirúrgica conservadora. Em pacientes selecionadas, podem-se empregar esquemas de RT hipofracionada ou irradiação parcial das mamas. Todas as pacientes com CDIS devem receber RT adjuvante. Não se sabe a correlação do papel da RT com preditores moleculares de recorrência local e sistêmica.SummaryBreast cancer (BC) is the most common malignancy among women. Therapeutic options are based on disease staging, histopathological characteristics, age, and others. The objective of the present study is to carry out an update of the concepts and definitions of radiotherapy (RT) in conservative treatment of early-stage breast cancer, with emphasis on indications, contraindications, RT dose fractionation schedules (classic, hypofractionated and partial breast irradiation), adjuvant RT in ductal carcinoma in situ (DCIS) and molecular predictors of recurrence. MEDLINE, SciELO and Cochrane databases were used for article selection. Adjuvant RT is indicated for patients with BC who underwent conservative breast surgery. In selected patients, hypofractionated or partial breast irradiation can be used. Adjuvant RT should be provided for all patients with DCIS. The correlation of RT and molecular predictors of local and systemic recurrence are not yet well-known.

Micose fungoide é um tipo de linfoma não Hodgkin de células T raro que acomete primariamente a pele. Caracteriza-se pela presença de placas eritematosas que evoluem para lesões ulceradas, tumores em toda a pele ou ainda infiltração de medula óssea em estágios avançados. Como opção de tratamento para os casos iniciais, tem-se quimioterapia e corticoterapia tópica, fototerapia e radioterapia. Este estudo relata o caso de um doente com múltiplas lesões tumorais na pele já biopsiadas com diagnóstico de micose fungoide. O paciente foi refratário ao tratamento com quimioterapia tópica e fototerapia, sendo então indicada irradiação total da pele com elétrons Mycosis fungoides is a rare type of non-Hodgkin's lymphoma of T cells that primarily affects the skin. It is characterized by the presence of erythematous plaques that evolve into ulcerated lesions, tumors throughout the skin or even bone marrow infiltration in advanced stages. Chemotherapy and topical steroids, phototherapy and radiotherapy are treatment options for early cases. This study reports the case of patient with multiple tumor lesions in the skin already biopsied with diagnosis of mycosis fungoides. The patient was refractory to both treatments with topical chemotherapy and phototherapy. It was then indicated total skin irradiation with electrons

Considering the psychosocial beneits obtained with immediate breast reconstruction (IBR), this procedure has been increasingly applied in Brazil, mainly in the immediate surgical context. he two main modalities of IBR used are the ones that employ autogenous tissue or artiicial breast implants or expanders. here is no consensus regarding the ideal time to carry out the IBR within the multimodal context of oncological treatment, especially when there is indication of radiotherapy (RT) ater the mastectomy – which depends on the surgical specimen – and also considering the lack of randomized studies comparing RT preand post-plasty. here is a rationale followed by many large American centers, to choose RT before IBR for two main reasons: Ater the procedure, tissue that does not belong to the breast bed (muscle laps, skin and prosthesis) would be irradiated without need. he IBR carried out before the RT can lead to inadequate planning, either with excessive irradiation of adjacent organs, or insuicient irradiation of the surgical bed and/or lymph node draining. Other obstacles to be faced are related to the size of breast reconstruction that is carried out, which very oten modiies the patient’s anatomy due to the large-volume plasty and the use of expanders with metallic components within the irradiation ield, which can result in regions of under and overdose, clinically translating as a higher chance of developing complications ater the RT. Moreover, breast medialization, symmastia and lat chest naturally impair radiotherapy planning. On the other hand, in addition to the aforementioned psychological gain with the immediate breast reconstruction, another justiication by those supporting this technique is that RT can compromise the skin and subjacent tissue quality, thus impairing the plasty, consequently afecting the cosmetic results. In this context, complications can arise ater IBR folGUSTAVO NADER MARTA, SAMIR ABDALLAH HANNA, EDUARDO MARTELLA, JOAO LUIS FERNANDES DA SILVA

Mycosis fungoides is a rare type of non-Hodgkin's lymphoma of T cells that primarily affects the skin. It is characterized by the presence of erythematous plaques that evolve into ulcerated lesions, tumors throughout the skin or even bone marrow infiltration in advanced stages. Chemotherapy and topical steroids, phototherapy and radiotherapy are treatment options for early cases. This study reports the case of patient with multiple tumor lesions in the skin already biopsied with diagnosis of mycosis fungoides. The patient was refractory to both treatments with topical chemotherapy and phototherapy. It was then indicated total skin irradiation with electrons.