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Gulliford S.L.,National Health Research Institute | Foo K.,Wollongong Hospital | Morgan R.C.,Cancer Group | Aird E.G.,Mount Vernon Hospital | And 11 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: Radical radiotherapy for prostate cancer is effective but dose limited because of the proximity of normal tissues. Comprehensive dose-volume analysis of the incidence of clinically relevant late rectal toxicities could indicate how the dose to the rectum should be constrained. Previous emphasis has been on constraining the mid-to-high dose range (≥50 Gy). Evidence is emerging that lower doses could also be important. Methods and Materials: Data from a large multicenter randomized trial were used to investigate the correlation between seven clinically relevant rectal toxicity endpoints (including patient- and clinician-reported outcomes) and an absolute 5% increase in the volume of rectum receiving the specified doses. The results were quantified using odds ratios. Rectal dose-volume constraints were applied retrospectively to investigate the association of constraints with the incidence of late rectal toxicity. Results: A statistically significant dose-volume response was observed for six of the seven endpoints for at least one of the dose levels tested in the range of 30-70 Gy. Statistically significant reductions in the incidence of these late rectal toxicities were observed for the group of patients whose treatment plans met specific proposed dose-volume constraints. The incidence of moderate/severe toxicity (any endpoint) decreased incrementally for patients whose treatment plans met increasing numbers of dose-volume constraints from the set of V30≤80%, V40≤65%, V50≤55%, V60≤40%, V65≤30%, V70≤15%, and V75≤3%. Conclusion: Considering the entire dose distribution to the rectum by applying dose-volume constraints such as those tested here in the present will reduce the incidence of late rectal toxicity. © 2010 Elsevier Inc. All rights reserved.

Berlin A.,Servicio de Radioterapia | Berlin A.,Princess Margaret Cancer Center | Berlin A.,University of Toronto | Fernandez M.I.,Servicio de Urologia | Fernandez M.I.,University for Development
Revista Medica de Chile | Year: 2015

Prostate cancer represents the second cancer-related cause of death in North American and Chilean men. The main treatment for incurable stages of disease is surgical or pharmacological castration. However, with time and despite the addition of anti-androgens, the disease progresses to a clinical state that has been commonly referred to as “hormone refractory”. In recent years, the concept of hormone refractoriness has been challenged and replaced by “castration resistance”, acknowledging that further and optimal hormonal manipulation can be attained, beyond achieving testosterone levels at castration range. The purpose of this review is to summarize the recent therapeutic breakthroughs in the management of metastatic castrate resistant prostate cancer (mCRPC), with greater emphasis in the newer hormonal therapy agents such as Abiraterone and Enzalutamide. Future combination and sequential treatment strategies are contextualized in the current era of personalized cancer medicine and genomic characterization of prostate cancer. © 2015 Sociedad Medica de Santiago. All rights reserved.

Medina-Sanson A.,Hospital Infantil de Mexico Federico Gomez | Pazos-Alvarado E.,Servicio de Anestesiologia | Perez-Villanueva H.,Servicio de Radioterapia | Salgado-Arroyo B.,Servicio de Gastroenterologia y Nutricion
Gaceta Mexicana de Oncologia | Year: 2013

Palliative Care is a component of the integral therapy of children and adolescents with cancer. Some experts in Palliative Care Medicine, recommend the introduction of such measures when cancer diagnosis is established, especially in those cases with little prospect of cure. In fact, the model that has been more successful for pediatric cancer patients, is based on the early introduction of palliative therapy, regardless the outcome. Before starting Palliative Care for children with terminal cancer, a comprehensive assessment is mandatory in order to define the medical, psychological and social condition and provi de maximum benefit to the patient and family. Ideally, Palliative Care should be provided by an interdisciplinary team; however this is not a necessary condition to ensure palliative care for those patients who need them. Palliative care interventions are diverse, but it is always important to distinguish between the practice of palliative care and a therapeutic excess, taking into account that palliative care give priority to the welfare of the patient. © 2013 Gaceta Mexicana de Oncología. Publicado por Masson Doyma México S.A.

Background: Aging is the main risk factor to acquire breast cancer (BC). Nevertheless BC in elderly patients is sub-represented in clinical trials. Aim: To describe the clinical characteristics and long term treatment results of localized BC in older women. Material and Methods: Review of medical records of 65 women aged 70 to 88 years, with localized BC, treated with surgery, postoperative radiotherapy or systemic therapy at a Clinical Hospital in Chile. Results: The presence of symptoms or abnormal findings on physical examination were the main reasons for consulting in 65% of cases. Compared with tumors detected on physical examination, those detected using screening mammogram were smaller and were in stage 1 with a higher frequency (18 and 59% respectively, p < 0.01). The pathological type was luminal in 80% of cases. Overall survival was better for luminal pathological type. All patients completed radiotherapy without interruptions developing minor acute toxicity. The most common co-morbidity was high blood pressure occurring in 46% of patients. Thirteen percent of patients had three or more co-morbidities. After a median follow up of 7 years, 23 (35%) patients had died and the cause of death was BC in 43% of cases. Two patients died of lung cancer. No patient had a local breast relapse. Conclusions: Screening mammogram in older women detected smaller tumors and it was associated with a better survival. BC is the ultimate cause of death in approximately half of cases.

Pelayo Besa D.C.,Servicio de Radioterapia | Roberto Rosso A.,Servicio de Radioterapia | Marisa Bustos C.,Servicio de Radioterapia | Borghero Y.,Servicio de Radioterapia | And 2 more authors.
Revista Medica de Chile | Year: 2011

Background: Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment. Aim: To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses. Patients and Methods: From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse. Results: Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients. Conclusions: IMRT for prostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates.

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