Quality of life impact of primary treatments for localized prostate cancer patients without hormonal treatment

Purpose Earlier studies evaluating the effect on quality of life (QoL) of localized prostate cancer interventions included patients receiving adjuvant hormone therapy, which could have affected their outcomes. Our objective was to compare the QoL impact of the three most common primary treatments on patients who were not receiving adjuvant hormonal treatment. PATIENTS AND METHODS: This was a prospective study of 435 patients treated with radical prostatectomy, external-beam radiotherapy, or brachytherapy. QoL was assessed before and after treatment with the Short Form-36 and the Expanded Prostate Cancer Index Composite. Differences between groups were tested by analysis of variance. Distribution of outcome at 3 years was examined by stratifying according to baseline status. Generalized estimating equation models were constructed to assess the effect of treatment over time. RESULTS: Compared with the brachytherapy group, the prostatectomy group showed greater deterioration on urinary incontinence and sexual scores but better urinary irritative-obstructive results (-18.22, -13.19, and +6.38, respectively, at 3 years; P < .001). In patients with urinary irritative-obstructive symptoms at baseline, improvement was observed in 64% of those treated with nerve-sparing radical prostatectomy. Higher bowel worsening (-2.87, P = .04) was observed in the external radiotherapy group, with 20% of patients reporting bowel symptoms. CONCLUSION: Radical prostatectomy caused urinary incontinence and sexual dysfunction but improved pre-existing urinary irritative-obstructive symptoms. External radiotherapy and brachytherapy caused urinary irritative-obstructive adverse effects and some sexual dysfunction. External radiotherapy also caused bowel adverse effects. Relevant differences between treatment groups persisted for up to 3 years of follow-up, although the difference in sexual adverse effects between brachytherapy and prostatectomy tended to decline over long-term follow-up. These results provide valuable information for clinical decision making

Adaptation and validation of the Spanish version of the patient-oriented prostate utility scale (PORPUS)

Objective: the Patient-Oriented Prostate Utility Scale (PORPUS) is a combined profile and utility-based quality of life measure for prostate cancer patients. Our objectives were to adapt the PORPUS into Spanish and to assess its acceptability, reliability, and validity. Methods: the PORPUS was adapted into Spanish using forward and back translations and cognitive debriefing. PORPUS was administered jointly with the SF-36 and the Expanded Prostate Index Composite (EPIC) to 480 Spanish prostate cancer patients treated with radical prostatectomy or radiotherapy. The Spanish PORPUS scores' distribution and reliability were examined and compared with the original instrument. To evaluate construct validity, relationships were assessed between PORPUS and other instruments (testing hypotheses of the original PORPUS study), and among known groups defined by side effect severity. Results: reliability coefficient was 0.76 (similar to the original PORPUS' 0.81). Spanish PORPUS items presented correlations ranging 0.57-0.88 with the corresponding EPIC domains, as in the original PORPUS study (0.60-0.83). Both PORPUS-P and PORPUS-U showed significant differences and large effect sizes (0.94-1.90) when comparing severe versus no problem groups on urinary, bowel, sexual and hormonal side effects defined by EPIC. Conclusions: a conceptually equivalent Spanish version was obtained, with high reliability and good construct validity, similar to the original Canadian PORPUS version. It can therefore be used to measure health-related quality of life and utilities in Spanish prostate cancer patients

Early experience and quality of life in SBRT prostate cancer boost of 9 Gy in a phase II trial

Purpose or ObjectiveExtracranial stereotactic body radiation therapy (SBRT) allows delivering high doses per fraction with high accuracy to the prostatic gland in a low number of fractions.Dose escalation in normofractionaded radiation prostate cancer trials showed an increased toxicity.In order to evaluate the feasibility and toxicity of a regimen of a single dose hypofractionated prostate stereotactic boost a phase II study was undertaken. Self-reported quality of life (QOL) measures were also obtained in order to better define the possible deleterious effect of treatment

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres

To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5-87.5% of cases); presentation to multidisciplinary tumour board (2.5-100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42-102.5 days); number of treatment interruptions ≥ 1 day (7.5-97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures

Clinical relevance of histologic subtypes in locally advanced esophageal carcinoma treated with pre-operative chemoradiotherapy: Experience of a monographic oncologic centre

Background: Locally advanced esophageal carcinoma (LAEC) represents less than 30% of all diagnosed esophageal carcinoma worldwide. The standard of care for resectable tumours consists of preoperative chemoradiotherapy (CRT) followed by surgery. Despite the curative intent, the prognosis is still poor mainly due to relapse. A multidisciplinary approach is required in order to optimize the therapeutic strategy and follow-up. Differences in outcomes between the two main histological subtypes, adenocarcinoma (ADC) and squamous cell carcinoma (SCC), have been reported. Nevertheless, the heterogeneity in trials design and data available have hampered the achievement of clear conclusions. The purpose of this study is to report the outcomes from a cohort of patients with LAEC treated with a multidisciplinary approach and to remark the differences observed between the two main histologic subtypes and their clinical implications. Methods: We retrospectively reviewed 100 patients diagnosed with LAEC that were treated with preoperative CRT at our institution and integrated centres. Histopathological characteristics and toxicities during treatment were recorded. Patterns of recurrence at the first relapse were analysed. Survival curves were plotted using the Kaplan Meier method and multivariate Cox proportional hazards models were used. Results: Among the patients who received preoperative CRT, 83% underwent surgery. The median overall survival (mOS) was 31.7 months, 26.9 months for ADC and 45.5 for SCC (p-value = 0.33). In the multivariate Cox regression analysis, ypN+ was the only factor that negatively influenced in OS (OR = 4.1, p-value = 0.022). Patterns of recurrence differed according to histologic subtype. Distant relapse was more frequent in ADC (62%), whereas locoregional relapse was higher in SCC (50%) (p-value = 0.027). Second line therapeutic strategies could be offered to 50% of those patients who relapsed. Conclusions: Differences in outcomes and recurrence pattern could be observed between the two main histologic subtypes of LAEC. A better molecular characterization, adapted therapeutic regimens and follow up strategies should be adopted in order to improve survival of these patients

Improving radiation oncology through clinical audits: Introducing the IROCA project

As radiotherapy practice and processes become more complex, the need to assure quality control becomes ever greater. At present, no international consensus exists with regards to the optimal quality control indicators for radiotherapy; moreover, few clinical audits have been conducted in the field of radiotherapy. The present article describes the aims and current status of the international IROCA “Improving Radiation Oncology Through Clinical Audits” project. The project has several important aims, including the selection of key quality indicators, the design and implementation of an international audit, and the harmonization of key aspects of radiotherapy processes among participating institutions. The primary aim is to improve the processes that directly impact clinical outcomes for patients. The experience gained from this initiative may serve as the basis for an internationally accepted clinical audit model for radiotherapy

ICO-ICS Praxi per al tractament mèdic i amb irradiació de càncer gàstric i d'unió esofagogàstrica

Tractament mèdic; Tractament amb irradiació; Càncer de la unió esofagogàstricaTratamiento médico; Tratamiento con irradiación; Cáncer de la unión esofagogástricaMedical treatment; Irradiation treatment; Esophagogastric union cancerEl càncer gàstric (CG) és actualment el vuitè tipus de càncer més prevalent a la Unió Europea on, segons les estimacions, el 2018 es calculen 80.211 casos diagnosticats en ambdós sexes amb una taxa estimada d'incidència estandarditzada per edat de 6,4 casos per cada 100.000 habitants. En el cas d'Espanya, segons dades d'incidència i mortalitat del projecte GLOBOCAN i de l'Observatori Europeu del Càncer, se situa en novè lloc, després del càncer de bufeta i el càncer uterí, pel que fa a freqüència. Els objectius d'aquesta guia són: Desenvolupar, difondre, implementar i avaluar resultats de l'ICO-ICSPraxi de càncer gàstric i d'unió esofagogàstrica. Disminuir la variabilitat terapèutica entre els pacients tractats als diferents centres d'aquesta institució. Implementar els resultats de la terapèutica en els pacients amb càncer gàstric i d'unió esofagogàstrica tractats d'acord amb les recomanacions d'aquesta guia.El cáncer gástrico (CG) es actualmente el octavo tipo de cáncer más prevalente en la Unión Europea donde, según las estimaciones, el 2018 se calculan 80.211 casos diagnosticados en ambos sexos con una tasa estimada de incidencia estandarizada por edad de 6,4 casos por cada 100.000 habitantes. En el caso de España, según datos de incidencia y mortalidad del proyecto GLOBOCAN y del Observatorio Europeo del Cáncer, se sitúa en noveno lugar, después del cáncer de vejiga y el cáncer uterino, en cuanto a frecuencia. Los objetivos de esta guía son: Desarrollar, difundir, implementar y evaluar resultados del ICO-ICSPraxi de cáncer gástrico y de unión esofagogástrica. Disminuir la variabilidad terapéutica entre los pacientes tratados en los diferentes centros de esta institución. Implementar los resultados de la terapéutica en los pacientes con cáncer gástrico y de unión esofagogástrica tratados de acuerdo con las recomendaciones de esta guía.Gastric cancer (GC) is currently the eighth most prevalent type of cancer in the European Union where, according to estimates, 80,211 cases diagnosed in both sexes are estimated at an estimated rate of incidence standardized by age of 6.4 cases per 100,000 people. In the case of Spain, according to the incidence and mortality data of the GLOBOCAN project and the European Cancer Observatory, it is placed ninth, after bladder cancer and uterine cancer, as it happens frequently. The objectives of this guide are: Developing, disseminating, implementing and evaluating the results of the ICO-ICSPraxi of gastric cancer and esophagogastric binding. Decrease the therapeutic variability between patients treated at the different centers of this institution. Implement the results of therapeutic treatment in patients with gastric cancer and esphagogastric binding treated in accordance with the recommendations of this guide

Guix

Resumen basado en el de la publicaciónDesde hace años, en la escuela Virgen de la Montaña, de Esparreguera (Barcelona), se lleva a cabo una experiencia donde los padres y las madres comparten diferentes actividades con sus hijos en las aulas. El éxito de la actividad lleva a presentar cómo surgió la propuesta y mostrar cómo se ha concretado.Universitat de Barcelona. Biblioteca del Campus de Mundet ; Passeig de la Vall d'Hebron 171; 08035 Barcelona; Tel. +34934021035; Fax +34934021034ES