Un médico sevillano edita una guía de Urgencias para tratar casos de cáncer.

El manual de Oncología ofrece las claves para mejorar la asistencia a enfermos que sufren tumores y está dirigido a los medicos de Atención Primaria y a los MIR.







Diario de Sevilla 18 de Noviembre de 2012

Hypofractionated stereotactic radiotherapy and continuous low-dose temozolomide in patients with recurrent or progressive malignant gliomas

Giuseppe Minniti • Claudia Scaringi • Vitaliana De Sanctis • Gaetano Lanzetta •
Teresa Falco • Domenica Di Stefano • Vincenzo esposito • Riccardo Maurizi Enrici
J Neurooncol Received: 23 August 2012 / Accepted: 31 October 2012

To evaluate the efficacy of reirradiation and systemic chemotherapy as salvage treatment in patients with recurrent malignant glioma. Between May 2006 and December 2011, 54 patients with recurrent malignant glioma received hypofractionated stereotactic radiotherapy (HSRT) plus systemic therapy at University of Rome Sapienza, Sant’ Andrea Hospital. All patients had Karnofsky performance score C60 and were previously treated with standard conformal RT (60 Gy) with concomitant and adjuvant temozolomide (TMZ) up to 12 cycles. Thirtyeight patients had a GBM and 16 patients had a grade 3 glioma. The median time interval between primary RT and reirradiation was 15.5 months. At the time of recurrence all patients received HSRT (30 Gy in 6-Gy fractions) plus concomitant TMZ (75 mg/m2/day) followed by continuous TMZ at 50 mg/m2 everyday up to 1 year or until progression. Median overall survival after HSRT was 12.4 months, and the 12- and 24-month survival rates were 53 and 16 %, respectively. The median progression-free survival (PFS) was 6 months, and the 12- and 24-month PFS rates were 24 and 10 %, respectively. KPS [70 (P = 0.04) and grade 3 glioma were independent favourable prognostic factors for survival. In general chemoradiation regimen was well tolerated with relatively low treatment-related toxicity. HSRT plus concomitant TMZ followed by continuous dose-intense TMZ is a feasible treatment option associated with survival benefits and low risk of complications in selected patients with recurrent malignant glioma. The potential advantages of combined chemoradiation schedules in patients with recurrent malignant gliomas need to be explored in future studies.

Manual de Urgencias Oncológicas para Especialistas Internos Residentes y Médicos de Atención Primaria

CONFERENCE REPORT ASTRO: Many Terminal Lung Cancer Patients Believe Palliative Radiation Therapy Is a Cure

By Dave Levitan | 31 de octubre de 2012

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A significant portion of patients with incurable lung cancer believe that palliative radiation therapy will cure the disease or at least help them live longer, according to a new study. Only about one-third of patients acknowledged that the treatment was not at all likely to cure their cancer.

“Our study found that, though most lung cancer patients are optimistic about the effectiveness of radiation therapy in relieving symptoms and prolonging life, many have inaccurate beliefs about the ability of palliative radiation therapy to cure their cancer,” said Aileen B. Chen, MD, in a press release. Dr. Chen presented results from the study at the recent American Society for Radiation Oncology (ASTRO) annual meeting in Boston.

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The Cancer Care Outcomes Research and Surveillance Consortium study enrolled 5,013 patients with newly diagnosed lung cancer. Patients were at least 21 years of age at diagnosis, and were enrolled from five different geographic regions, 10 Veterans Administration sites, and five large health maintenance organizations between 2003 and 2005. Of this total cohort, 832 patients had stage wet IIIB or IV lung cancer at diagnosis and were due to undergo radiation therapy; 384 (46%) of those completed surveys on their beliefs about the treatment. The median survival among these patients was 11.5 months.

More than three-quarters of patients (78%) said it was either very likely or somewhat likely that radiation therapy would help them live longer. Similarly, 67% said it was very or somewhat likely that the treatment would help with problems from the cancer. Perhaps most importantly, 19% said it was very likely and 24% said it was somewhat likely that radiation therapy would actually cure their cancer; 9% said it was a little likely while only 36% said it was not at all likely for the treatment to represent a cure.

Two-thirds of patients (66%) did acknowledge that it was very or somewhat likely for radiation to have side effects, while only 11% said it was not at all likely, and 10% said it was a little likely.

“In order to help patients make informed decisions about radiation treatments near the end of life, health care providers need to improve communication and understanding about the goals and limitations of palliative radiation therapy,” Dr. Chen said. “While palliative radiation therapy can be very effective at relieving symptoms from cancer, overly intensive care can also reduce patients’ quality of life and lead to significant time and financial burdens for patients and their families.”

Results of consevative treatment of breast cancer in low risk women with hypofractionated radiotherapy

Revista de Senología y Patología Mamaria
www.elsevier.es/senologia

 E. Bayo Lozano, M. Domínguez Rodríguez, M.J. Fernández Cordero, M.M. Delgado Gil, M.J. Ortega Rodríguez, M. Márquez García-Salazar y David-M Muñoz Carmona

Servicio de Oncología Radioterápica, Hospital Juan Ramón Jiménez, Huelva, España 

Resumen
Objetivos: Actualmente la irradiación de toda la mama después de una intervención quirúrgica conservadora sigue siendo un procedimiento estándar en el cáncer de mama, en la que clásicamente se administra una dosis de 50 Gy con fraccionamiento de 2 Gy. Sin embargo, diferentes dosis y fraccionamiento han demostrado al menos la misma eficacia. El objetivo principal del estudio fue determinar la tasa de recurrencia local en pacientes sometidas a cirugía conservadora y radioterapia postoperatoria hipofraccionada. Los objetivos secundarios fueron la incidencia y el grado de toxicidad aguda y tardía. Pacientes y métodos: Desde enero de 2004 a diciembre de 2006, se seleccionó a 122 pacientes para radioterapia hipofraccionada con las características siguientes: edad ≥ 50 años, estadio temprano, margen de resección libre de tumor y espesor de la mama < 23 cm. La dosis administrada fue 42,5 Gy con fraccionamiento de 2,66 Gy por sesión. Resultados: Con una mediana de seguimiento de 58,29 meses, 116 (95,08%) pacientes están vivas: 114 libres de enfermedad y 2 con metástasis óseas. La recidiva local a 5 años fue 1,64% y sólo un caso (0,81%) presentó recidiva regional. Hubo un 2,46% de pacientes con segundo tumor primario y un 4,91% con metástasis. La toxicidad, tanto aguda como tardía, ha sido leve. Conclusiones: La radioterapia hipofraccionada en pacientes de riesgo bajo proporciona los mismos beneficios que el tratamiento clásico con una baja toxicidad aguda y tardía. 

Results of consevative treatment of breast cancer in low risk women with hypofractionated radiotherapy
Abstract
Aims: Whole breast irradiation, typically administered at a dose of 50 Gy in 2 Gy fractions after conservative surgery, continues to be a standard procedure in breast cancer. However, different doses and fractionation have shown to be at least as effective. The main objective of this study was to determine the rate of local recurrence in patients undergoing conservative surgery and hypofractionated postoperative radiotherapy. The secondary objectives were to determine the incidence and grade of both acute and delayed toxicity.

Patients and methods: From January 2004 to December 2006, 122 patients who had the following characteristics were selected to receive hypofractionated radiotherapy to the whole breast: age ≥ 50 years, early stage, tumour free resection margins ≥ 10 mm, thickness of the breast ≤ than 23 cm. The total dose was 42.5 Gy with fractionation of 2.66.
Results: With a median follow up of 58.29 months, 116 (95.08%) patients were alive: 114 were free of disease and 2 had metastases. The 5 year local recurrence rate was 1.64%, and only in one case (0.81%) there was a regional recurrence. Only 2.46% of the patients developed a second primary tumour. Distant metastases were present in 4.91%. Toxicity, both acute and late, was mild (grade 1-2).
Conclusions: Hypofractionated radiotherapy, in patients with low risk breast cancer after conservative surgery, provides the same benefits as the classical treatment with a low acute, as well as and delayed, toxicity.