Irradiación parcial acelerada de mama con braquiterapia de alta tasa de dosis con 18 gy.

RESUMEN: OBJETIVOS: evaluar la factibilidad así como los resultados de toxicidad aguda, crónica y objetivos oncológicos en pacientes candidatas a recibir irradiación parcial acelerada de mama con braquiterapia multicatéter de alta tasa de dosis con 18 Gy. MATERIAL Y MÉTODOS: entre septiembre de 2014 y marzo de 2016 tratamos a 20 pacientes con carcinoma infiltrante de bajo riesgo o carcinoma intraductal con braquiterapia de alta tasa de dosis con una fracción única de 18 Gy. RESULTADOS: la mediana de edad fue de 63,5 años (rango de 51-79). Objetivamos toxicidad aguda en 7 pacientes en forma de molestias locales autolimitadas y hematoma en cuatro de las pacientes. Con una mediana de seguimiento fue de 25 meses (22-42 meses) la toxicidad crónica objetivada fue de una paciente con fibrosis g2 y dos pacientes con necrosis grasa (g1: 1 y g2: 1). La supervivencia global y el control local fueron del 100%. La supervivencia libre de enfermedad y el control regional fueron del 95%. La cosmesis fue catalogada como excelente/buena en el 80% (80%) de las pacientes y regular en 4 (20%). CONCLUSIONES: este es el primer trabajo en el que se demuestra la factibilidad y la toxicidad aguda y crónica con una mediana de seguimiento de 25 meses. El protocolo es viable y conveniente. Sin embargo, es necesario un mayor seguimiento para contrastar los datos de toxicidad crónica y objetivos oncológicos.ABSTRACT: Purpose: To evaluate the feasibility of acute and chronic toxicity in patients suitable for accelerated partial breast irradiation (APBI) in a single 18 Gy fraction with multicatheter high-dose-rate (HDR) brachytherapy, as well as cosmetic and oncological outcomes. Material and methods: Between September 2014 and March 2016, twenty consecutive patients with low-risk invasive and ductal carcinoma in situ were treated with interstitial multicatheter HDR brachytherapy in a single 18 Gy fraction. Results: Median age was 63.5 years (range, 51-79). Acute toxicity was observed in seven patients, while the pain during following days and hematoma were seen in four patients. With a median follow-up of 25 months (range, 20-40), late toxicity was found in two patients with fat necrosis (g1:1 and g2:1) and fibrosis g2 in another patient. The overall survival (OS) and locoregional control (LC) was 100%. Disease-free survival (DFS) and distant control was 95%. Good to excellent cosmetic outcomes were noted in 80% of patients and fair in 4 patients (20%). Conclusions: This is the first report in the medical literature that focuses on feasibility and acute and chronic toxicity, with a median follow-up of 24 months. The protocol is viable and convenient. However, a longer follow-up is needed to know chronic toxicity and oncologic outcomes

Comparison of Conventional vs. Oncoplastic Breast-Conserving Surgery in a Breast Unit with Oncoplastic Training

Purpose: Oncoplastic Breast Conserving Surgery (OBCS) has been tested in oncological terms demonstrating that it is as effective as Standard Lumpectomy (SL) nowadays; Patients-Reported Outcomes (PRO) have become a relevant way to assess breast cancer treatment. The aim of this work was to compare OBCS with SL using a PRO measurement, BREAST-Q Breast Conserving Therapy (BCT) module. Methods: One hundred and sixty-five patients with early primary breast cancer treated with BCT were questioned using BREAST-Q Version 2.0 BCT Module, postoperative scales, in Spanish, after radiotherapy treatment was administered. The patients filled in the questionnaire in a paper-andpencil format at our breast unit. The sample size was estimated to observe differences of 7 points in the satisfaction with breast domain (postoperative scale) between both approaches. This difference is slightly higher than 10% of the median of satisfaction with breast domain reported in published studies. An analysis was done to compare statistics. Results: SL was used in 108 patients and OBCS in 57. Patients treated with OCBS had a larger radiological lesion than patients treated with SL (median 20 mm vs. 15 mm) corresponding with a higher pathological tumor (17 mm vs. 13 mm). The time from the radiotherapy end date to when the questionnaire was filled in was longer in those patients treated with OBCS (mean 8 vs. 15.5 months). No significant statistical differences were found in the BREAST-Q postoperative domain scores between both approaches. Conclusion: The quality of life and the satisfaction with the oncoplastic breast conserving approach or the standard lumpectomy evaluated by the BREAST-Q were similar in our breast unit

Influence of hyperbaric oxygen therapy on bone metabolism in patients with neoplasm

Background: Hyperbaric oxygen therapy (HBOT) is useful in the treatment of complications due to radiotherapy in patients with neoplasm. Its effects on bone metabolism are unclear. In our study, we analyzed the effects of HBOT on bone remodeling in oncological patients with radiotherapy. Materials and methods: Prospective clinical study in 23 patients with neoplasms undergoing treatment with HBOT due to complications of radiotherapy (hemorrhagic cystitis, proctitis or radionecrosis) and 25 patients with chronic anal fissure. The average number of HBOT sessions was 20 ± 5 (100% oxygen, 2.3 atmospheres and 90 min per day). Serum levels of aminoterminal propeptide of type I collagen (P1NP), C terminal telopeptide of type I collagen (CTX), alkaline phosphatase (AP), 25hydroxyvitamin D (25-OHD), parathyroid hormone (PTH), were measured at 3 time points: T0 (before beginning HBOT), T1 (at the end of HBOT) and T2 (6 months after HBOT). Results: At baseline, the patients with neoplasm have higher bone turnover than those with anal fissure. These differences were 41% in CTX (0.238 ± 0.202 ng/mL in neoplasm and 0.141 ± 0.116 ng/mL in fissure; p = 0.04), 30% for PTH (46 ± 36 pg/mL in neoplasm and 32 ± 17 pg/mL in fissure; p = 0.04) and 15% for alkaline phosphatase (80 ± 24 U/L in neoplasm and 68 ± 16 U/L in fissure; p = 0.04). In the group with neoplasm, the values of P1NP decreased 6% after HBOT (T0: 49 ± 31 ng/mL, T2: 46 ± 12 ng/mL; p = 0.03). Also, there were non-significant decreases in PTH (–34%) and CTX (–30%). Conclusions: Patients with neoplasm and complications with radiotherapy have an increase in bone remodeling that may be diminished after HBOT

Hyperbaric Oxygen Therapy Does Not Have a Negative Impact on Bone Signaling Pathways in Humans

Introduction: Oxygen is emerging as an important factor in the local regulation of bone remodeling. Some preclinical data suggest that hyperoxia may have deleterious effects on bone cells. However, its clinical relevance is unclear. Hence, we studied the effect of hyperbaric oxygen therapy (HBOT) on serum biomarkers reflecting the status of the Wnt and receptor activator of NF-?B ligand (RANKL) pathways, two core pathways for bone homeostasis. Materials and methods: This was a prospective study of 20 patients undergoing HBOT (mean age 58 yrs., range 35?82 yrs.) because of complications of radiotherapy or chronic anal fissure. Patients were subjected to HBOT (100% oxygen; 2.4 atmospheres absolute for 90 min). The average number of HBOT sessions was 20 ± 5 (range 8?31). Serum hypoxia-inducible factor 1-? (HIF1-?), osteoprotegerin (OPG), RANKL, and the Wnt inhibitors sclerostin and dickkopf-1 (DKK1) were measured at baseline and after HBOT by using specific immunoassays. Results: HIF-1? in eight patients with measurable serum levels increased from 0.084 (0.098) ng/mL at baseline to 0.146 (0.130) ng/mL after HBOT (p = 0.028). However, HBOT did not induce any significant changes in the serum levels of OPG, RANKL, sclerostin or DKK1. This was independent of the patients? diagnosis, either neoplasia or benign. Conclusion: Despite the potential concerns about hyperoxia, we found no evidence that HBOT has any detrimental effect on bone homeostasis

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

ABSTRACT Objectives We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy. Methods and Materials From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the “Phoenix consensus”. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition. Results The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function. Conclusions The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer

Hyperbaric Oxygen Therapy Does Not Have a Negative Impact on Bone Signaling Pathways in Humans

Introduction: Oxygen is emerging as an important factor in the local regulation of bone remodeling. Some preclinical data suggest that hyperoxia may have deleterious effects on bone cells. However, its clinical relevance is unclear. Hence, we studied the effect of hyperbaric oxygen therapy (HBOT) on serum biomarkers reflecting the status of the Wnt and receptor activator of NF-κB ligand (RANKL) pathways, two core pathways for bone homeostasis. Materials and methods: This was a prospective study of 20 patients undergoing HBOT (mean age 58 yrs., range 35–82 yrs.) because of complications of radiotherapy or chronic anal fissure. Patients were subjected to HBOT (100% oxygen; 2.4 atmospheres absolute for 90 min). The average number of HBOT sessions was 20 ± 5 (range 8–31). Serum hypoxia-inducible factor 1-α (HIF1-α), osteoprotegerin (OPG), RANKL, and the Wnt inhibitors sclerostin and dickkopf-1 (DKK1) were measured at baseline and after HBOT by using specific immunoassays. Results: HIF-1α in eight patients with measurable serum levels increased from 0.084 (0.098) ng/mL at baseline to 0.146 (0.130) ng/mL after HBOT (p = 0.028). However, HBOT did not induce any significant changes in the serum levels of OPG, RANKL, sclerostin or DKK1. This was independent of the patients’ diagnosis, either neoplasia or benign. Conclusion: Despite the potential concerns about hyperoxia, we found no evidence that HBOT has any detrimental effect on bone homeostasis

Intraoperative Neurovascular Bundle Preservation with Hyaluronic Acid during Radical Brachytherapy for Localized Prostate Cancer: Technique and MicroMosfet In Vivo Dosimetry

Purpose: To evaluate the reduction in the absorbed dose delivered to the neurovascular bundle (NB) in patients with localized prostate cancer treated with only HDR brachytherapy and NB protection with hyaluronic acid (HA) on the side of the prostate to increase the distance from NB to the radioactive sources. Methods: This is the first published report in the medical literature that studies a new approach to decrease neurovascular bundle toxicity and improve quality of life for patients with prostate cancer treated with radical brachytherapy as monotherapy. Transperineal HA injection on the side of the prostate into the lateral aspect of the prostate fat was used to consistently displace several autonomic fibers and vessels on the lateral wall of the prostate away from radiation sources. Results: When a protection in the form of an HA layer is placed, the reduction effect at the maximum dose is between 46% and 54% (calculated values), which means that the method for protection is highly recommended. The values of the absorbed dose calculated in this project have been compared with the ones given by the treatment planning system. Conclusions: This newly created space decreases absorbed dose in the NB, calculated with the TPS and measured by microMOSFET due to the thickness of HA