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Purpose Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. Methods Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. Results In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p p p p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p p p = 0.016, p = 0.005, respectively). Conclusions The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.

Purpose Our center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients. Methods/patients We planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold. Results Seventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2. Conclusions High-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

Background The use of low dose radiotherapy (LD-RT) for the treatment of COVID-19 pneumonia is supported by biological rationale for its immunomodulatory effect. Some institutions have started to treat these patients showing encouraging results. To shorten procedure times is crucial for the comfort of symptomatic patients receiving respiratory support and to optimize institutional facilities. Patients and methods At our institution, LD-RT is offered to hospitalized patients with COVID-19 pneumonia and signs of early cytokine-released syndrome on behalf of a multicenter study. We designed a coordinated process flow starting from the patient transfer to the simulation CT-scan (first-step), to the end of the LD-RT treatment (last step). The times spent on each step of the process flow were evaluated. Results Mean age of treated patients was 83 (72–91) years-old. The timing parameters of the first 10 consecutive patients were analyzed. Except for the first (dummy run), patients were managed from the first to the last step in a median of 38 min (25–58, SD 10.67). The most time-consuming sub-process was the contouring of the treatment volumes and dosimetry. Conclusions LD-RT is not only an encouraging option for COVID-19 pneumonia patients, but a convenient and feasible procedure if performed in a coordinated way by reducing procedure times.

We are facing a pandemic that is going to affect a significant part of the population. At the end of April in the world there are about 3,000,000 cases, with 205,000 deaths and 860,000 patients recovered. The response to this pandemic has in many cases led to a significant change in the daily work of caring for cancer patients, the good results of which depend largely on time-adjusted protocols and multidisciplinary treatments. We present a review of local, surgical and radiotherapy treatment together with authors’ recommendations made from personal experience on ways to act in the diagnosis and surgical treatment of breast cancer during the COVID-19 pandemic. The multidisciplinary Breast Committees must continue to meet weekly in videoconference format. All surgical actions and irradiations must be carried out with maximum safety for both the patients and the participating teams. Hypofractionation in radiation therapy should be the standard treatment. Sometimes it is recommended to apply a primary systemic treatment or even a primary irradiation. Great coordination between the surgical and oncology teams, both medical and radiotherapeutic, is essential.

Introduction The role of radiation therapy (RT) for patients with bone-only metastatic (BOM) breast cancer has not been investigated sufficiently. The aim of this survey was to evaluate current clinical practice in treating breast cancer patients with BOM in Radiation Therapy Departments in Catalonia and Occitania within the scope of the GOCO group. Materials and methods An electronic questionnaire was completed by experienced radiation oncologists from fourteen RT centers. The items surveyed the professional experience, therapeutic approach, technique, dose stereotactic body RT (SBRT) availability. Results All Radiation Oncology Departments (ROD) in Catalonia (12) and Occitania (2) responded to the survey. Eleven (78.5%) of the RODs advise RT for BOM as initial treatment in the oligometastatic setting. RT to asymptomatic bone oligometastases is more often restricted for “risky lesions”. The most inconsistent approaches were the treatment for asymptomatic lesions, when to treat bone metastases with respect to systemic treatment (ST) and the indication for RT after a complete response to ST. Conclusion While BOM breast cancer patients have a relatively good prognosis, there is a lack of consistency in their approach with RT. This can be explained by the absence of evidence-based guidelines and an incomplete availability of SBRT.

Our center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients.We planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold.Seventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2.High-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

To report long-term results of a randomized trial comparing accelerated partial breast irradiation (APBI) to whole-breast irradiation (WBI) in terms of efficacy, toxicity, and cosmesis.WBI group was treated with 3D conformal external irradiation, 2 Gy daily/fraction, 5 fractions/week, to a total dose of 50 Gy. APBI group was treated with 3D conformal external irradiation 3.75 Gy/fraction, twice a day, 5 fractions/week, to a total dose of 37.5 Gy in the APBI group. Patients were followed up every 6 months up to 5 years and yearly thereafter. During follow-up visits, the clinician evaluated chronic toxicity and scored cosmetic results with a four-scale system.After a median follow-up of 10.3 years, 43 patients in each group (84%) are alive without disease. One patient died after disease progression in the APBI arm, and there was no death in the WBI arm. The rest of the patients died from another disease different than breast cancer, similarly between groups. There was greater fibrosis in the APBI group (9 patients grade 1 and one grade 2) compared to WBI (3 patients grade 1 and one grade 2); p = 0.18. Regarding cosmesis, in APBI group, 19 and 21 (43.2 and 47%) patients had excellent or good results, similar to the WBI group with 18 patients (40.9%) in each cosmesis outcome. The WBI group did not have any patient with poor cosmesis but the APBI had 3 (6.8%; p = 0.24).After a follow-up of 10 years, there were no differences in efficacy between the 2 treatment arms. Despite slight greater toxicity in the APBI group, the cosmesis was similar and satisfactory in both groups.

Dosi; Radioteràpia externa; Supervivència Dosis; Radioterapia externa; Supervivencia Dose; External radiotherapy; Survival Background This study aims to assess the effects of non-adherence to external beam radiation therapy in cancer patients receiving treatment with a curative. Methods This retrospective cohort study collected health records data for all cancer patients treated with external beam radiotherapy with curative intent in 2016 in Catalonia, Spain. Adherence was defined as having received at least 90% of the total dose prescribed. A logistic regression model was used to assess factors related to non-adherence, and its association with one-year survival was evaluated using Cox regression. Results The final sample included 8721 patients (mean age 63.6 years): breast cancer was the most common tumour site (38.1%), followed by prostate and colon/rectum. Treatment interruptions prolonged the total duration of therapy in 70.7% of the patients, and 1.0% were non-adherent. Non-adherence was associated with advanced age, female gender, and some localization of primary tumour (head and neck, urinary bladder, and haematological cancers). The risk of death in non-adherent patients was higher than in adherent patients (hazard ratio [HR] 1.63, 95% confidence interval 0.97–2.74), after adjusting for the potential confounding effect of age, gender, tumour site and comorbidity. Conclusion Non-adherence to radiotherapy, as measured by the received dose, is very low in our setting, and it may have an impact on one-year survival. We thank CERCA Programme/Generalitat de Catalunya for institutional support (AGAUR 2017SGR735). This study has been funded by the project PI15/00945, (Co-funded by European Regional Development Fund. ERDF, a way to build Europe).

The Spanish Society of Oncology and Radiotherapy (SEOR) Analysis Group: Ortiz, Mª José; Exposito, José; Palacios, Amalia; Herruzo, Ismael; Medina, José Antonio; Martínez, Miguel; Bayo, Eloisa; Jaén, Javier; Peracaula, Francisco José; Pérez, Carolina; Ramos, Mª Isabel; González, José Antonio; Begara, José; Nuno, Cristina; Bezares, Ana Belén; Serradilla, Ana; Lazo, Antonio; Tejedor, Martin; Méndez, Lucia; Juan, German; Olay, Luis; Pardo, José; Noe, Alberto; Mestre, Francisco; Oton, Claudio; Fuentes, Claudio; Prada, Pedro; Pérez, Leopoldo; Lozano, Eva; Villas, Mª victoria; Tripero, Juana; Lobo, Rosabel; Muñoz, Manuel; Tisaire, José Luis; Fernández, Jesús; Teijeira, Mercedes; Reyes Rodríguez, José; Pérez-Romasanta, Luis; López, Francisco; Rodríguez, Daniel; Ceballos, Amelia; Cantalapiedra, Rocio; Biete, Albert; Craven, Jordi; Pedro, Agusti; Giralt, Jordi; Guedea, Ferran; Villa, Salvador; Sole, Josep M.; Eraso, Arantxa; Carceller, José Antonio; Guix, Benjamin; Miralbell, Ramón; Casals, Joan; González, Pedro; Duarte, Mª Isabel; Jerez, Juan Pablo; Marino, Alfonso; Gómez-Caamano, Antonio; Muñoz, Victor; López, Mª Dolores; Zugazabeitia, Luis; Torrado-Moya, Laura; Ossola, Gustavo; Morera, Rosa Mª; Murillo, Mª Teresa; Sancho, Sonsoles; Pérez-Regadera, José; Lozano, Miguel Angel; Vázquez, Gonzalo; López, Escarlata; Fuente, Cristina de la; Samper, Pilar; Ludena, Blanca; Dios Saez, Juan de; Azinovic, Ignacio; Rubio, Carmen; Cerro, Elia del; Carballo, Natalia; Sotoca-Ruiz, Amalia; García, Ramón; Salinas, Juan; Fondevilla, Adriana; Martínez-Monge, Rafael; Martínez, Enrique; Alia, Avelino; Ciria, Juan Pablo; Rosa, Jesús; Bilbao, Pedro; Martín, Juan Carlos; Casquero, Francisco; Arribas, Leo; Tormo, Alejandro; Ferrer, Eduardo; Larrea, Luis; Soler, Miguel; García, Enrique; Soler, Pablo; Santos, Manuel; Vázquez, Gabriel; Canon, Rosa Mª; Miro, Antonio, [Aim] Radiation oncology services in Spain are undergoing a process of technical modernization, but—in a context of increasing demand by an ageing population—it is unclear whether there are enough radiation oncologists to staff the newly equipped units. This study aims to assess the number of specialists working in radiation oncology services in Spain relative to current and future needs. [Materials and methods] In the second half of 2017, the Commission on Infrastructures of the Spanish Society for Radiation Oncology (SEOR) sent a questionnaire on radiation oncology staff to the heads of all 122 public (n = 76, 62%) and private (n = 46, 38%) radiation oncology services in Spain. Data collected were the number of professionals, their position, and their year of birth for specialists and residents in each service. In the descriptive analysis, for continuous variables we calculated means, standard deviations and ranges for each Spanish region and work post. For qualitative variables, we constructed frequency tables. All analyses were performed with R statistical software, version 3.5.1. [Results]The survey response rate was 100% among service heads across all 122 centers. The total number of radiation oncologists working in these centers is 721, or 15.4 per million population, with considerable variations between regions. Given the national recommendations to have 20 radiation oncologists per million population, there is currently a deficit of 204 specialists. If the 163 upcoming retirements are also taken into account, there will be 367 fewer radiation oncologists than required to meet the 25% increase in indications for radiotherapy projected for 2025. [Conclusions] The classic model for calculating staff needs based on the number of treatments is outdated, and recommendations should be revised to reflect the current reality. A new model should integrate the most complex technological advances and emerging plans in radiotherapy, without neglecting the other activities carried out in radiation oncology services that are not directly linked to patient care.

The B cell receptor immunoglobulin (Ig) gene repertoires of marginal zone (MZ) lymphoproliferations were analyzed in order to obtain insight into their ontogenetic relationships. Our cohort included cases with MZ lymphomas (n = 488), i.e. splenic (SMZL), nodal (NMZL) and extranodal (ENMZL), as well as provisional entities (n = 76), according to the WHO classification. The most striking Ig gene repertoire skewing was observed in SMZL. However, restrictions were also identified in all other MZ lymphomas studied, particularly ENMZL, with significantly different Ig gene distributions depending on the primary site of involvement. Cross-entity comparisons of the MZ Ig sequence dataset with a large dataset of Ig sequences (MZ-related or not; n = 65 837) revealed four major clusters of cases sharing homologous (‘public’) heavy variable complementarity-determining region 3. These clusters included rearrangements from SMZL, ENMZL (gastric, salivary gland, ocular adnexa), chronic lymphocytic leukemia, but also rheumatoid factors and non-malignant splenic MZ cells. In conclusion, different MZ lymphomas display biased immunogenetic signatures indicating distinct antigen exposure histories. The existence of rare public stereotypes raises the intriguing possibility that common, pathogen-triggered, immune-mediated mechanisms may result in diverse B lymphoproliferations due to targeting versatile progenitor B cells and/or operating in particular microenvironments. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Background Perianal Crohn’s disease (pCD) is difficult to treat. Although anti-TNF, are the medical mainstay in fistula treatment, many patients become refractory. Recent data suggested that ustekinumab (UST) might be effective in pCD. This study aims to assess the effectiveness of UST in refractory pCD in the real-world practice. Methods This is a retrospective cohort of patients with pCD treated with UST in our IBD Unit between march 2015 and october 2020. We analyze demographics, disease charactersistics, surgical for pCD and prior exposure including inmunomodulators and biologic agents. The success of UST was defined on the physician judgment (improvement or absence of drainage). In patients with inactive pCD we analyzed rate of relapse. To analyze predictive factors of treatment success we performed a univariate and multivariable analysis. Results Fifty three patients were included (54.72 % female). Twenty four of them were smokers. The median age was 54 years (45–62). The mean duration of CD was 19 years and 50.94% had an intestinal resection. Fifty one patients (96,22%) had been treated with at least 1 anti-TNF and 38 (71.7%) with at least 2 anti-TNF. Sixteen had failed to vedolizumab. The median follow-up was 26 months (15–36). Twenty two (22/53) had active pCD. Eleven (50%) had intensified UST out of technical sheet (8 with 90 mg sc every 4 to 6 w, and 3 had 130 mg iv every 4 w). Fifteen patients (68.18 %; p Two of 32 patients (6.45%) with inactive pCD relapsed during the follow-up. Eleven patients (20.75%) discontinued UST: 6/53 (11.3%) due to adverse events (infections and arthralgia), 4/53 (7,54) patient′s choice or physician judment. One patient who had been treated with four biologics before UST developed a pleomorphic cutaneous sarcoma Conclusion Ustekinumab might by an effective treatment in refractory pCD. More studies are needed to confirm our data

Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS). The Sociedad Espaola de Oncologia Radioterapica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old. The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate. Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.

The increased incidence and decreased mortality of breast cancer have produced an increased number of breast cancer survivors. The type of sequelae and comorbidities that these patients present call for a collaborative follow-up by hospital-based specialized care and primary care. In this document, we present a guideline drafted and agreed among scientific societies whose members care for breast cancer survivors. The purpose of this guideline is to achieve the shared and coordinated follow-up of these patients by specialized care and primary care professionals. In it, we review the health issues derived from the treatments performed, with recommendations about the therapeutic approach to each of them, as well as a proposal for joint follow-up by primary and specialized care.

To analyse the perception about the information and communication received to evaluate oncologic care of breast cancer patients in Spain. Qualitative study based on conducting in-depth interviews. An inductive thematic analysis of the illness narratives was performed. Intentional theoretical sampling of 41 people diagnosed with breast cancer. The information provided during care process is assessed as appropriate, as it includes personalised skills focused on communication and considers organisational and contextual issues. In some cases, the information was considered partial, heterogeneous and at times contradictory, which revealed a lack of continuity. To provide and adequately cover information needs from the patient perspective, it is necessary to ensure access, both in its physical (material) and intellectual (comprehension) dimension, keeping in mind elements of social capital (social networks) and cultural capital (values, beliefs, non-verbal language) that facilitate or hinder access. The current state of transition to a horizontal model in the doctor-patient relationship, could account for the difficulties, deficits and contradictions in communication and information that breast cancer patients perceive in many contexts.

Background and purpose: Radiation oncology guidelines favour hypofractionated whole-breast radiotherapy (HWBRT) over more conventional schemes in the conservative treatment of breast cancer, but its adoption still varies in clinical practice. This study assessed the patterns of HWBRT adoption in Catalonia (Spain). Material and methods: We used a mixed-methods approach based on an explanatory sequential design, first collecting and analysing quantitative data on HWBRT use (>2.5 Gy per fraction) in 11 public radiotherapy centres (2005-2015) and then performing 25 semi-structured interviews with all department heads and reference radiation oncologists. Results: Of the 34,859 patients fulfiling the study criteria over the study period, just 12% were hypofractionated, reaching a percentage of 29% in 2015 (p < 0.001). Our analysis showed a narrowing age gap between patients receiving conventional fractionation and hypofractionation in centres leading adoption. However, there were important differences in clinicians' interpretation of evidence (e.g. regarding the perceived risk of long-term toxicity) and selection of patients for specific indications, both within and between departments. Conclusions: Differences observed in the rate of adoption of HWBRT could not be tackled only using a rational, evidence-based approach. Factors related to the management of radiotherapy departments play a major role in the diffusion of therapeutic strategies. (C) 2017 Elsevier B.V. All rights reserved.

Resumen Objetivo En los ultimos anos, ha cambiado la indicacion de la linfadenectomia axilar como gesto integrante del manejo del cancer de mama, sobre todo desde la introduccion de la biopsia del ganglio centinela. El objetivo es conocer la actitud actual en funcion de los hallazgos de enfermedad en este. Pacientes y metodos Se realizo un estudio descriptivo a partir de datos obtenidos de una encuesta, dirigida especificamente a unidades de mama espanolas, sobre las consideraciones que, en el tratamiento quirurgico y adyuvante, supone el hallazgo de metastasis en el ganglio centinela dependiendo de su carga tumoral. Resultados Se recibieron un total de 66 encuestas cumplimentadas de 110 solicitadas (60%). El estudio del ganglio centinela se hace mayoritariamente de forma intraoperatoria (84,8%) y mediante la tecnica de OSNA (69,7%). El hallazgo de celulas tumorales aisladas no conlleva linfadenectomia, aunque hay mas variabilidad ante el hallazgo de macrometastasis y, sobre todo, de micrometastasis (en las que se realiza en un 86,3 y un 33,3%, respectivamente). En este sentido resulta llamativa la falta de uniformidad en los criterios para indicar o no la linfadenectomia y la asociacion de tratamientos adyuvantes. Conclusiones En la actualidad existe una gran variabilidad en la actitud ante el hallazgo de enfermedad ganglionar en el ganglio centinela en el cancer de mama, especialmente en el caso de enfermedad considerada de baja carga tumoral (micrometastasis). Esta variabilidad se refiere tanto a la indicacion de completar la linfadenectomia, como a la indicacion de tratamientos adyuvantes en esos casos concretos.

The objective of the present analysis is to know what risk factors affect local relapse in breast cancer. A total of 1165 patients diagnosed with early breast cancer were included. Boost dose was modulated in the presence of risk factors. Patients with one risk factor received a boost of 10 Gy, while 20 Gy was administered in those with two risk factors. Median follow-up was of 60 months. Mean age of patients was 56.7±10.8 years. Local risk factors were present in 82.8% of patients. The probability of remaining free of local recurrence at 5 and 10 years is 97.7% (CI 95%: 96.7–98.7) and 94.5% (CI 95%: 92.1–96.9). Only age showed an impact in local relapse on multivariate analysis. Patients 40 years or younger had a relative risk of local relapse of 5.27 and patients 41–50 of 3.7 with respect to patients older than 50 years. Patients 40 years or younger have a higher risk of local failure than older patients. Other risk factors such as tumour size, intraductal carcinoma or margin status could be masked by an increase of radiation dose.

Introduccion La cirugia es el medio terapeutico mas importante en el tratamiento de la neoplasia rectal. Sin embargo, a partir del estadio B2 los indices de recidiva son altos, por lo que es necesario aplicar tratamientos complementarios tales como radioterapia asociada o no a quimioterapia. Objetivo Valorar la probabilidad de estar libre de enfermedad local, local y a distancia, y la supervivencia global y especifica, en funcion del estadio clinico y grado de afectacion ganglionar en pacientes diagnosticados de adenocarcinoma rectal tratados con cirugia radical y radioterapia asociada o no a quimioterapia. Material y metodos Desde enero de 1990 hasta diciembre de 1997 todos los pacientes afectos de un adenocarcinoma rectal tratados con cirugia radical y radioterapia postoperatoria, con o sin quimioterapia, fueron incluidos de forma prospectiva en una base de datos que en la actualidad analizamos. Resultados La supervivencia actuarial bruta a los cinco anos fue de 61,1 ± 9,2% y la especifica de 64,2 ± 9,2%. Por estadios: B (84,1 ± 10,1%) y C (49,9 ± 3,3%) (p Conclusiones Ante los pobres resultados obtenidos en los estadios C, especialmente en los N2, y dado que con radioterapia preoperatoria se consigue un mejor control local con buena tolerancia, creemos necesario iniciar la aplicacion de radioterapia preoparatoria para mejorar los resultados.

Introduccion: La ultrasonografia endoanal (USEA) es una tecnica sencilla y de gran utilidad en el diagnostico y manejo terapeutico de las enfermedades anorrectales, mejorando su resolucion espacial con el uso de la sonda en 3D. Objetivo: Estudiar la utilidad de la USEA con la sonda rigida 3D desde su implantacion en nuestro hospital. Material y Metodo: Estudio retrospectivo de las USEA-3D realizadas en nuestro centro desde noviembre-2008 hasta junio-2013. Analizamos las caracteristicas demograficas de los pacientes, indicaciones y diagnosticos. Resultados: Se realizaron 755 USEA (exploraciones/ano: 116/2009; 146/2010; 183/2011; 195/2012; 114/junio-2013); 58% mujeres/42% varones; edad 47 ± 14 anos. Motivos de solicitud: sepsis perianal (fistula y/o absceso) (49%; 367/755); incontinencia (32%; 241/755); proctalgia (6%; 42/755); neoplasia anal (1%; 7/755); otros (12%; 92/755). Procedencia de peticiones: Ap. Digestivo (57%), Cirugia General (39%). Diagnosticos: sepsis perianal (41%); normalidad (25%); defectos esfinterianos (13%); cicatriz obstetrica (9%); otros (12%). La incontinencia se asocio a USEA normal en el 44% de casos; Caracteristicas de las fistulas: transesfinterianas (44%; 140/316); interesfinterianas (32%; 101/316); extraesfinterianas (10%; 32/316); supraesfinterianas (6%; 19/316); otras (8%; 24/316); complejas 59% (186/316); asociadas a Crohn (22%; 71/316). Se inyecto H2O2 en 259/316 (82%), identificandose el orificio fistuloso interno (OFI) en 77% (199/259); Localizacion de abscesos: peri/postanal 66% (93/141), isquiorrectal 24% (34/141), otras 10% (14/141). Conclusiones: 1. En nuestro hospital, el numero de solicitudes de USEA ha aumentado progresivamente (fundamentalmente desde gastroenterologia y cirugia general); 2. La principal indicacion de USEA en nuestra serie ha sido la sepsis perianal; 3. Cerca de la mitad de los pacientes con incontinencia fecal no presentaron alteraciones en la USEA; 4. La fistula perianal fue el diagnostico mas frecuente en nuestro centro; 5. La inyeccion de H2O2 permitio localizar el OFI en el 77% de los casos; 6. El 66% de abscesos se localizaron en el espacio peri/postanal.

The demand for breast cancer care has increased as cancer treatment innovations have proliferated. Adjuvant radiotherapy to the breast is considered to be part of the standard treatment in breast cancer. The role of radiotherapy in terms of reducing loco-regional recurrence and increased survival after conservative surgery, and also after a mastectomy in selected cases, has been previously shown in several randomized trials. Patterns of radiotherapy commonly used for breast cancer comprise a period of approximately five weeks, frequently with the addition of an additional 1-1.5 weeks of a radiation boost to the primary tumour area. In last years, there has been a renewed interest in hypofractionated and accelerated radiotherapy schedules that reduce the overall treatment time to barely three weeks, leading to an improvement in quality of life for patients and also optimizing workload of radiation oncology departments. However, despite the existing evidence supporting the use of hypofractionated treatment regimens, their widespread is still far from complete. Many questions have generated resistance among clinical oncologists for their regular use. The aim of this review is to answer those questions that may arise with the use of moderate hypofractionation in breast cancer.