Incidencia y supervivencia del cáncer de colon y recto en la provincia de Tarragona (1980-1998)

Introducción: Se estima que en el año 2000 se diagnosticaron más de 10 millones de cánceres colorectales en el mundo y más de 6 millones murieron por esta causa. En Europa se ha observado un aumento de la incidencia desde los años 60 así como una mejora de la supervivencia. En su etiología, además de una causa genética, se ha evidenciado el estilo de vida occidentalizado y, dentro de él, la dieta como principal factor ambiental. Está en debate la mejor estrategia de cribado a nivel poblacional para este cáncer. El tratamiento de elección es la cirugía. Desde 1990 está demostrado el beneficio de la quimioterapia y radioterapia adyuvantes. Asimismo, la poliquimioterapia en la enfermedad avanzada aumenta la supervivencia. Objetivo:Conocer la incidencia y la supervivencia poblacional del cáncer colorectal en Tarragona por género, edad, sublocalización, histología y estadio.Estudiar la evolución temporal de estos indicadores.Comparar los resultados obtenidos con los de otros registros de cáncer de base poblacional.Construir un patrón epidemiológico del cáncer colorectal para la provinvia de Tarragona.Material y métodos:Se trata de un estudio epidemiológico poblacional descriptivo del cáncer colorectal a partir de la información del Registro de Cáncer de Tarragona desde el año 1980 al 1998. Se estiman las tasas de incidencia brutas, ajustadas por edad a la población mundial estándar, truncadas y acumuladas así como las tasas específicas por edad, global y por género, edad, sublocalización, histología y estadio. Se realiza un análisis de la tendencia temporal utilizando los modelos de regresión de Poisson y de Join Point, y se estiman los porcentajes anuales de cambio y su significación estadística.En cuanto a la supervivencia, se calcula la supervivencia observada global (método no paramétrico de Kaplan y Meier) y la supervivencia relativa global (método de Ederer) por género, edad, sublocalización, histología y estadio. Se determina la asociación de diversas variables con el tiempo de supervivencia utilizando el método de riesgos proporcionales de Cox, y se estudia la evolución de la supervivencia desde 1985 hasta 1998 por períodos. Los resultados de incidencia se han comparado con los publicados por diferentes registros de cáncer de todo el mundo y los de supervivencia con los de registros europeos.Resultados:La tasa bruta de incidencia es de 56,5 para ambos géneros juntos. Las tasas ajustadas son de 61,7 en hombres y 51,3 en mujeres. Las sublocalizaciones por orden de frecuencia son: recto, colon izquierdo y colon derecho en hombres, y colon izquierdo, colon derecho y recto en mujeres. La distribución porcentual por estadios (clasificación de Dukes) es: A 13%, B 27%, C 27% y D 22%. La incidencia ha aumentado un 3,3% anual en hombres y un 2,5% anual en mujeres de forma constante a lo largo de todo en período. El cáncer de colon derecho es el que más aumenta en hombres (6,5% anual) y en mujeres (5,2% anual).La supervivencia observada a 5 años es de 40,4% y la relativa de 49,0% (47,6% en hombres y 50,7% en mujeres). Por edades, las supervivencias relativas a 5 años son: 60% entre los de 35 y 54 años, 53% entre los de 55 y 74 años, y 45% en los mayores de 74 años. Por estadios, la supervivencia a 5 años es: A 90%, B 68%, C 47% y D 3%. El estadio es el factor pronóstico más importante, delante de la edad. La supervivencia relativa a 5 años pasó de 42% entre los casos diagnosticados en el periodo 1985-89 a 49% en el periodo 1990-94.Conclusiones:En Tarragona el cáncer colorectal es el cáncer más frecuente en ambos géneros juntos y presenta una incidencia media-baja con respecto a otros registros de Europa pero con una tendencia rápidamente ascendente y continua, muy probablemente debida a la adopción de un estilo de vida occidentalizado y, sobre todo, al cambio de la dieta. Las tasas de supervivencia alcanzadas se pueden considerar medio-altas en el contexto europeo, y han aumentado de forma similar a la de la mayoría de países de Europa.Introduction: It was estimated, for year 2000, that more than ten million people would be diagnosed of colorectal cancers in the world and more than six million people would die of it. In Europe, the incidence of colorectal cancer has been growing since 1960 and the survival has also improved. In its etiology, next to a genetic base, is the westernized way of life the most important factor (mainly a diet rich in proteins and fats and poor in fruits and vegetables). The adenoma is the precancerous lesion. There's controversy about the best population screening strategy for this cancer. The standard treatment is surgery. Since 1990, is the benefit of adjuvant therapies (chemotherapy and radiotherapie) confirmed. Also, the polichemotherapie has shown a survival benefit for the patients with advanced disease. Objetives:To know the incidence and survival, at a population level, of colorectal cancer in Tarragona according to gender, age, subsite of origin, histology and stage. To study the temporal trends of these sanitary indicators: incidence and survival.To compare our results with the results of other population-based cancer registries of the world.To describe an epidemiological pattern for colorectal cancer in Tarragona.Methods:Descriptive epidemiological study of colorectal cancer in Tarragona between 1980 and 1998. The data come from the population-based Cancer Registry of Tarragona. Incidence rates: normal, rates and standard rates, adjusted to the world population (Segi, 1950) have been calculated, according to gender, age, subsite of origin, histology and stage. For the temporal trends study (1980-1998) we used the Poisson model and the joinpoint model and calculated the anual percentage of change for each category. The data have been compared with the data of other registries published in Cancer Incidence Five Continents.Survival rates: observed survival rate (Kaplan and Meier model) and relative survival rate (Ederer model) have been calculated, according to gender, age, subsite of origin, histology and stage. The Cox model was uded to study the association between the different variables and the time of survival for the years 1996 and 1997. A study of the evolution of survival rates was also made (1985-1998). The data have been compared with the data of other registries published in EUROCARE-3 and the data of the SEER Programm in USA..Resultados:The normal incidence rate is 56,5 cases/100.000 inhabitants*year for both genders together. The adjusted incidence rate is 61,7 for men and 51,3 for women. The most frequent subsite of origin is left colon cancer. After this comes rectal cancer and right colon cancer. The distribution according to stages (Dukes classification) is: A (13%), B (27%), C (27%), D (22%). The incidence rates have grown 3,3% each year in men and 2,5% in women. The trend is constant between 1980 and 1998. The subsite of origin with a fastest growth is right colon cancer (6,5% in men and 5,2% in women). The 5-years observed survival rate is 40,4% and the 5-year relative survival rate is 49%. According to age-groups, the 5-year relative survival rates are: 60% for people between 35-55 years old; 53% for the ones between 55-75 years old and 45% for the people older than 74 years old. According to stages, the 5-year relative survival rates are: A (90%), B (68%), C (47%) and D (3%). The stage is the most important prognostic factor, next to the age. Between 1985 and 1994 the 5-year relative survival rate has improved from 42% to 49%.Conclusions:Colorectal cancer is the most frequent cancer in Tarragona for both genders together and the incidence rates are in the average in comparison to other European countries. The incidence has grown fast and constant. The cause of this change is probably the most westernized way of life with the time (for example: the changes in the diet). The survival rates are also in the average of the European countries and have grow from 1985 till 1994, like in the other countries, probably because of improvements in the therapies

Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers: a survey by the SIOPE radiation oncology working group

Pediatric; Radiotherapy; Stem cell transplantationPediatria; Radioteràpia; Trasplantament de cèl·lules marePediatría; Radioterapia; Trasplante de células madreBackground and purpose To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. Methods An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. Results From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated ≤10 pediatric patients annually (range: 1–2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8–10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. Conclusion Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI

ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children

Consensus recommendations; Pediatric; Total Body IrradiationRecomanacions de consens; Pediatria; Irradiació corporal totalRecomendaciones de consenso; Pediatría; Irradiación corporal totalBackground and purpose Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children. Material and methods The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established. Results Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3–4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III–IV evidence. Preferential TBI dose in children is 12–14.4 Gy in 1.6–2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies. Conclusions These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities

Recurrence after pituitary surgery in adult Cushing's disease: a systematic review on diagnosis and treatment

PURPOSE Recurrence after pituitary surgery in Cushing's disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. METHODS We systematically screened the literature regarding recurrent and persistent Cushing's disease using the MESH term Cushing's disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. RESULTS AND CONCLUSIONS Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient

Eicosapentaenoic acid/docosahexaenoic acid 1:1 ratio improves histological alterations in obese rats with metabolic syndrome

Background Marine polyunsaturated fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been associated with improvement in the Metabolic Syndrome (MS). The aim of this study is to evaluate how three fish-oil diets with different eicosapentaenoic acid/docosahexaenoic acid ratios (EPA/DHA ratio) affect the histology of liver, kidney, adipose tissue and aorta in a preliminary morphological study. This work uses an animal model of metabolic syndrome in comparison with healthy animals in order to provide information about the best EPA:DHA ratio to prevent or to improve metabolic syndrome symptoms. Methods 35 Wistar rats, as a control, and 35 spontaneously hypertensive obese rats (SHROB) were fed for 13 weeks with 3 different suplemmentation of fish oil containing EPA and DHA ratios (1:1, 2:1 and 1:2, respectively). All samples were stained with haematoxylin/eosin stain, except aorta samples, which were stained also with Verhoeff and van Gieson’s stain. A histological study was carried out to evaluate changes. These changes were statistically analyzed using SPSS IBM 19 software. The quantitative data were expressed by mean ± SD and were compared among groups and treatments using ANOVA with post-hoc tests for parametric data and the U-Mann–Whitney for non-parametric data. Qualitative data were expressed in frequencies, and compared with contingency tables using χ2 statistics. Results EPA:DHA 1:1 treatment tended to improve the density and the wrinkling of elastic layers in SHROB rats. Only Wistar rats fed with EPA:DHA 1:1 treatment did not show mast cells in adipose tissue and has less kidney atrophy. In both strains EPA:DHA 1:1 treatment improved inflammation related parameters in liver and kidney. Conclusions EPA:DHA 1:1 treatment was the most beneficial treatment since improved many histological parameters in both groups of rats.This investigation was supported, in part, by the Spanish Ministry of Science and Innovation (Grants AGL2009-12374-C03-01,-02 and -03). EM acknowledges the Panamanian government (SENACYT / IFARHU) for her pre-doctoral fellowship. We thank URV’s Language Service for rewriting the English version of this paper. SUPPORTED BY: Proyectos de Investigación Fundamental, Ministerio Español de Ciencia e Innovación, Plan Nacional 2009.Referencia: AGL2009-12374-C03-01, -02 and -03.Peer Reviewe

Una experiencia de investigación inclusiva. Personas con discapacidad intelectual como asesoras en una investigación sobre transición a la edad adulta

A pesar del creciente reconocimiento de la inclusión social de las personas con discapacidad, su participación en las investigaciones sobre temas que las preocupan aún es un tema pendiente. El objetivo de este artículo es presentar una investigación desarrollada de forma inclusiva a través de la participación de personas con discapacidad intelectual en un Comité Asesor. Se contextualizan los planteamientos de la Investigación Inclusiva, para presentar seguidamente el proceso llevado a cabo para la constitución, puesta en marcha y desarrollo del Consejo Asesor que participa en una investigación sobre transición a la vida adulta. A partir de esta experiencia, se aportan diversas reflexiones sobre las aportaciones de la incorporación de las personas con discapacidad en la investigación y se valora la necesidad de su inclusión para mejorar las investigaciones sobre discapacidad.. Con este trabajo se pretende contribuir a difundir información sobre las acciones a emprender para facilitar la participación de las personas con discapacidad intelectual en los procesos de investigación sobre temas que las afectan

Diagnosis delay and follow-up strategies in colorectal cancer. Prognosis implications: a study protocol

<p>Abstract</p> <p>Background</p> <p>Controversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate.</p> <p>Methods/Design</p> <p>Multi-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragón and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953).</p> <p>At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients.</p> <p>Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out.</p> <p>Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables.</p> <p>Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed.</p> <p>Discussion</p> <p>This study will make it possible to verify if the different components of delay have an impact on survival rate in colon cancer and rectal cancer. In consequence, this multi-centre study will be able to detect the variability present in the follow-up of patients with colorectal cancer, and if this variability modifies the prognosis. Ideally, this study could determine which follow-up strategies are associated with a better prognosis in colorectal cancer.</p

Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

BACKGROUND AND PURPOSE: To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. METHODS: An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. RESULTS: From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated ≤10 pediatric patients annually (range: 1-2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8-10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. CONCLUSION: Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

BACKGROUND: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. METHODS: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. RESULTS: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091. CONCLUSION: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect. TRIAL REGISTRATION: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009)