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Resumen Introducción: La medición de la calidad de vida (CV) en el paciente oncológico permite establecer una percepción del individuo sobre su estado de salud-enfermedad y el tratamiento instaurado. El objetivo del presente estudio es analizar la influencia de la situación nutricional en la CV de los pacientes. Material y Métodos: Se llevó a cabo un estudio transversal en el Hospital Ramón y Cajal en 53 pacientes oncológicos durante un periodo de 6 meses. A estos pacientes se les realizó la valoración global subjetiva (VGS), un recuerdo 24h de la ingesta del día anterior y se les administró el cuestionario European Organisation for Research and Treatment of Cancer quality of Life Questionnaire Core 30 (EORTC QLQ-C30). De estos 53 pacientes, 9 fueron excluidos debido a una incompleta cumplimentación del cuestionario EORTC QLQ C-30. De los 44 pacientes restantes, el 52,3% pertenecía al grupo de normonutridos sin riesgo (VGS A); el 27,3 % al grupo de pacientes en riesgo de desnutrición o desnutrición moderada (VGS B) y el 20,5% restantes al grupo de pacientes con grave desnutrición (VGS C). Resultados: Las escalas funcionales (funcionamiento físico, social, emocional y cognitivo) fueron las menos afectadas por la situación nutricional de los pacientes, con valor de p>0,05, mientras que la escala funcional o de rol (p=0,002), junto con la escala global de salud (p=0,049), así como los síntomas de fatiga (p=0,011), náuseas y vómitos (p=0,004) y el ítem simple de pérdida de apetito (p=0,001) son las que mostraron una asociación estadísticamente significativa con la situación nutricional. Conclusiones: La desnutrición afecta negativamente a la CV de los pacientes oncológicos especialmente en las escalas de funcional, escala global de salud y de síntomas. Son necesarios más estudios para evaluar si la intervención nutricional precoz puede revertir esta influencia negativa de la desnutrición.

BACKGROUND:Circulatory shock is a life-threatening disorder that is associated with high mortality, with a state of systemic and tissue hypoperfusion that can lead to organ failure, including the brain, where altered mental state is often observed. We hypothesized that cerebral autoregulation (CA) is impaired in patients with circulatory shock. METHODS:Adult patients with circulatory shock and healthy controls were included. Cerebral blood flow velocity (CBFV, transcranial Doppler ultrasound) and arterial blood pressure (BP, Finometer or intra-arterial line) were continuously recorded during 5-minutes in both groups. Autoregulation Index (ARI) was estimated from the CBFV response to a step change in BP, derived by transfer function analysis; ARI ≤ 4 was considered as impaired CA. The relationship between organ dysfunction, assessed with the Sequential Organ Failure Assessment (SOFA) score and the ARI was assessed with linear regression. RESULTS:Twenty-five shock patients and 28 age-matched healthy volunteers were studied. The mean ± SD SOFA score was 10.8 ± 4.3. Shock patients compared to control subjects had lower ARI values (4.0 ± 2.1 vs. 5.9 ± 1.5, p = 0.001). Impaired CA was more common in shock patients (44.4% vs. 7.1%, p = 0.003). There was a significant inverse relationship between the ARI and the SOFA score (R = -0.63, p = 0.0008). CONCLUSIONS:These results suggest that circulatory shock is often associated with impaired CA and that the severity of CA alterations are correlated with the degree of multiple organ failure, reinforcing the need to monitor cerebral hemodynamics in patients with circulatory shock.

Aim: This study was designed to evaluate the role of magnetic resonance imaging (MRI) on preoperative restaging of locally advanced rectal cancer after neoadjuvant chemoradiotherapy (CRT), in order to facilitate individualization of surgical management. Method: We analyzed 117 patients who had received neoadjuvant CRT, underwent a MRI before and after CRT. All patients underwent restaging MRI followed by surgery after the end of CRT. The primary end point of this study was to estimate the accuracy of post-CRT MRI as compared with pathologic staging. Results: Pathologic T classification matched the post-CRT MRI findings in 44 (37.6%) of 117 patients. Sensitivity in T0, T1, T2, T3 and T4 was 23.8%, 16.7%, 25.6%, 48.9% and 83.3% respectively. Specificity in T0, T1, T2, T3 and T4 were 87.5%, 93.7%, 79.5%, and 64% and 88.3% respectively. Sensitivity in N0 and N1 were 82% and 20% respectively. Specificity was 88% in N0 and 87% in N1. Fifty two (44.4%) of 117 patients were downstaged in T classification. Pathologic N classification matched the post-CRI MRI findings in 73 (62.4%) of 117 patients. Twenty one (17.9%) were overstaged in N classification. Twenty seven (23%) of 117 patients who had been down staged on MRI after CRT were confirmed on the pathological staging with same stage (T and N). 17p with ypT0 were correlated with MRI after CRT in 5 patients (4.3%). Conclusion: MRI has low accuracy for restaging locally advanced rectal cancer after preoperative CRT so it is currently not consistent enough for clinical application.

Purpose Standard of care for locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. This study identified predictive factors for tumour response in our series. Patients and methods Between January 2005 and December 2018, 292 patients with locally advanced rectal cancer treated by preoperative chemo-radiation before surgery were retrospectively analyzed. The radiation dose was 50.4 Gy with fluoropyrimidine-based chemotherapy regimens. Patients-tumour and treatment-factors were tested for influence on tumour down staging and regression grade using Mandard scoring system on surgical specimens (TRG). Results Median age was 69 years (range 39-87); 33.9% of patients was Stage II and 54.5% Stage IIIB. Tumour down staging occurred in 211 patients (73%), including 63 patients (21.6%) with ypT0 (documented T0 at surgery) and 148 patients (50.7%) with a satisfactory tumour regression grade defined as TRG2‒3. Upper rectal tumours were identified to predictive factors for pathologic complete response by univariate analysis (p = 0.002). TRG1‒3 was associated with intervals from chemo-radiation to surgery (p = 0.004); TRG1‒3 rates were higher with longer intervals: 1.71% in ≤ 5 weeks, 23.63% in 6-8 weeks and 46.9% in ≥ 9 weeks; and PTV 50.4 ≥ 800cc (p = 0.06); 3 and 5 years survivals were 85% and 90% for the group as a whole. Among ypT0 cases, the overall survival was 91.1% without significantly different (p = 0.25) compared with the remaining group, 87.2%. Among ypT0 cases, the relapse-free survival was 94.5%, with significantly different (p = 0.03) compared with the remaining group 78.2%. There were no treatment-associated fatalities. Thirty-two patients (10.96%) experienced Grade III/IV toxicities (proctitis, ephitelitis and neutropenia). Conclusions Tumour localization was identified as predictive factors of pathologic complete response for locally advanced rectal cancer treated with preoperative chemo-radiation. Upper rectal tumours are more likely to develop complete responses. Delay in surgery was identified as a favorable predictive factor for TRG1‒3. The relapse-free survival in pathologic complete response group was higher compared with non-pathologic complete response. RESUMO Objetivo O tratamento padrão para o câncer retal localmente avançado é a quimiorradioterapia neoadjuvante, seguida de cirurgia. Este estudo identificou fatores preditivos de resposta tumoral em nossa série. Pacientes e métodos Entre janeiro de 2005 e dezembro de 2018, 292 pacientes com câncer retal localmente avançado, tratados com quimiorradiação pré-operatória, foram retrospectivamente analisados. O tratamento quimioterápico foi à base de fluoropirimidina e a dose de radiação foi de 50,4 Gy. Os tumores dos pacientes e os fatores do tratamento foram testados quanto à influência no estadiamento do tumor e no grau de regressão usando o sistema de classificação de Mandard em espécimes cirúrgicos (TRG). Resultados A mediana das idades foi 69 anos (variação de 39 a 87); 33,9% dos pacientes estavam no estágio II e 54,5% no estágio IIIB. O estadiamento do tumor ocorreu em 211 pacientes (73%), incluindo 63 pacientes (21,6%) com ypT0 (T0 documentado na cirurgia) e 148 pacientes (50,7%) com grau satisfatório de regressão do tumor, definido como TRG2‒3. Os tumores retais superiores foram identificados como fatores preditivos de resposta patológica completa por análise univariada p = 0,002. TRG1‒3 foi associado aos intervalos entre a quimioterapia e a cirurgia p = 0,004; As taxas de TRG1‒3 foram maiores com intervalos mais longos: 1,71% em ≤ 5 semanas, 23,63% em 6-8 semanas e 46,9% em ≥ 9 semanas; e PTV 50,4 ≥ 800cc (p = 0,06); as sobrevidas de 3 e 5 anos foram de 85% e 90% para o grupo em geral. Entre os casos de ypT0, a sobrevida global foi de 91,1%, sem diferença significativa (p = 0,25) na comparação com o grupo restante (87,2%). Entre os casos de ypT0, a sobrevida livre de recidiva foi de 94,5%, com diferença significativa (p = 0,03) na comparação com o grupo restante (78,2%). Não houve fatalidades associadas ao tratamento. Trinta e dois pacientes (10,96%) apresentaram toxicidade de grau III/IV (proctite, efitelite e neutropenia). Conclusões A localização do tumor foi identificada como fator preditivo de resposta patológica completa para o câncer retal localmente avançado tratado com quimiorradiação pré-operatória. Os tumores retais superiores têm mais probabilidade de desenvolver respostas completas. O atraso da cirurgia foi identificado como um fator preditivo favorável para o TRG1‒3. A sobrevida livre de recidiva no grupo com resposta patológica completa à quimiorradioterapia pré-operatória foi maior comparado ao grupo com resposta patológica incompleta.

Introduction/Background Our purpose is to evaluate the influence of surgical management and the prognostic factors for Disease-Free Survival (DFS) and Overall Survival (OS) in endometrial cancer (EC). Methodology Retrospective review of 180 patients underwent standard surgical staging with pelvic and para-aortic lymphadenectomy in 130 cases. Mean age was 63 years (27–94). Mean BMI 30 kg/m2 (15–51). Mean Ca 1.25 prior to surgery was 61 U/dL (2–4,228). Mean removed nodes was 21 pelvic nodes (9–56, involved nodes 12.3%) and 19 para-aortic nodes (7–51, involved nodes 14.8%). A laparoscopic approach was performed in 65% patients. Mean follow-up was 46 months. The factors that impact on survival were compared using univariate and multivariate analysis. Results The estimated 5-year DFS and OS comparated rates were respectively, according to FIGO local stages (I) 93.9 and 90.2%, vs advanced stages (II–IV) 0 and 53.7% (p=0.00 Hazard ratio 5.58 (CI 95%, 2.74–11.35) and p=0.00 Hazard ratio 4.19 (CI 95%, 2.11–8.34); obesity BMI 30 82.7 and 80.8 (p=0.61 and p=0.38); preoperative Ca125 levels Conclusion DFS and OS increased in case of complete debulking, low Ca12.5 leves prior to surgery, the abscence of lymph involvement and patients who underwent lymphadenectomy. Disclosure Nothing to disclose.

Introduction/Background To evaluate the influence of surgical strategy on survival for patients with stage III or IV epithelial ovarian cancer (EOC). Methodology Retrospective data collection in a single and reference cancer center. Currently the strategies in advanced ovarian cancer are changing. Our purpose was to analyse the Overall Survival (OS) and Disease Free Survival (DFS) comparing the ‘state of the art’ procedures, Primary Debulking Surgery (PDS) and interval surgery after 3–6 cycles of Neoadjuvant Chemotherapy (NAC). Incidentally, we tested the risk factors for recurrence. Results Median age was 59 years (40–80). Exploratory laparoscopy was performed in 52 patients, 28 underwent PDS and 24 NAC. Median Laparoscopic Predictive Score (Fagotti) was 2.2 (0–6) and 5.8 (2–10) (p=0.00), median Peritoneal Carcinomatosis Index was 12.5 (2–18) y 18.3 (10–24) (p=0.00) and mean of Ca125 prior to surgery was 489 y 949 U/dL (p=0.00) respectively. Pelvic and para-aortic lymphadenectomy was performed in 20 patients during PDS (14 cases with involved nodes, 48%) and 19 patients during interval surgery NAC (in 6 cases with involved nodes, 25%) (p=0.11). The median Surgical Complexity Score (Aletti) was 5 and 6.5 (p=0.21), with 80 and 24 points in the Comprehensive Compilation Index (modified from Clavien-Dindo Classification) for complications respectively (p=0.13). There were not significant differences in the complete resection rate (61 vs 63%, p=0.99), DFS (12 vs 15 months, p=0.80), and 5-years OS (59 vs 25%, p=0.32). Complete surgery were significantly associated with a better OS in univariate analysis (Hazard ratio 3.34 (95% CI, 1.19–9.40, p=0.015). Conclusion A significative improvement of OS has been observed in relation with complete tumour resection (microscopial residual tumor). In this study, NAC is non-inferior to PDS and is an acceptable standard of treatment of advanced and bulky EOC. Disclosure Nothing to disclose.

PURPOSE To propose adaptive setup protocols using Bayesian statistics that facilitate, based on a prediction of coverage probability, making a decision on which patients should follow daily imaging prior to treatment delivery. MATERIALS AND METHODS The suitability of the treatment margins was assessed combining interfraction variability measurements of the first days of treatment with previous data gathered from our patient population. From this information, we decided if a patient needs an online imaging protocol to perform daily isocenter correction before each treatment fraction. We applied our method to five different datasets. Protocol parameters were selected from each dataset based on coverage probability, the expected imaging workload of the treatment unit, and the accuracy of patient classification. Time trends were assessed and included in the proposed protocols. To validate the accuracy of the protocols, they were applied to a validation dataset of prostate cancer patients. RESULTS Adaptive setup protocols lead expected population coverage >97% in all datasets analyzed when time trends were considered. The reduction in imaging workload ranged from 40% in lung treatments to 28.5% in prostate treatments. Results of the protocol on the validation dataset were very similar to those previously predicted. CONCLUSIONS The adaptive setup protocols based on Bayesian statistics presented in this study enable the optimization of imaging workload in the treatment unit ensuring that appropriate dose coverage remains unchanged.

Background A better knowledge of the dynamic biological changes that the skin undergoes in response to ionizing radiation is advisable to improve the management of radiation dermatitis, allowing selection of patients needing treatment or close monitoring. Objective To describe the evolution of the skin in response to ionizing radiation through the reflectance confocal microscopy (RCM) features of acute radiation dermatitis. Methods In this prospective descriptive study, six women (median age, 55 years; range, 45‐80 years) diagnosed with breast cancer in stages IA-IB undergoing adjuvant radiotherapy were included in the study through consecutive sampling. Clinical, dermoscopic and RCM evaluation of the skin were performed prior to treatment and on days 1, 15, 30 and 45 after radiotherapy. Results While clinical features of radiation dermatitis emerged after 30 days on average, histopathological changes were detectable by RCM after a mean time of 15 days. The main RCM features included initial appearance of spongiosis, exocytosis and inflammatory cells followed by the presence of dendritic-shaped cells, ‘streaming-like figures’, ‘broken geographic papillae’, epidermal architectural disarray, effacement of rete ridges, melanophages and, finally, hyperpigmentation of the basal layer. Conclusions RCM may safely detect the dynamic biological changes that the skin undergoes in response to ionizing radiation, even before than clinical onset of acute radiation dermatitis. Therefore, RCM may be useful to make an early and non-invasive diagnosis of radiation dermatitis during radiotherapy, allowing an early selection of patients needing treatment or close monitoring and avoiding skin biopsies.

The aims of this study were to compare the clinical and microbiological characteristics from patients with polymicrobial bloodstream infections (BSI) to those from patients with monomicrobial BSI and to determine their influence on the prognosis. A prospective study was conducted on 371 nosocomial BSI in an intensive care unit (ICU). Seventy-five (20.2%) of them were polymicrobial. The mean APACHE II score at the onset of bacteremia in polymicrobial and monomicrobial BSI were 17.7 ± 6.6 and 18.9 ± 7.5, respectively (p = 0.228). Severe sepsis and septic shock were present in 68.0% and 50.6% of polymicrobial BSI and in 73.9% and 55.1% of monomicrobial BSI, respectively (p = 0.298 and p = 0.494, respectively). The length of stay and the length of stay post-infection were significantly longer in patients with polymicrobial BSI. APACHE II score at the onset of BSI, high-risk microorganisms, and septic shock were predictors of related mortality, but polymicrobial BSI and inadequate empirical antimicrobial treatment were not. Our findings suggest that the clinical and microbiological characteristics of polymicrobial BSI are not different from monomicrobial BSI, and polymicrobial BSI do not have any influence on the related mortality. However, they occurred in patients with a longer length of stay in the hospital and were associated with longer stays in the hospital after the episode of BSI.