RESUMEN
INTRODUCTION: We sought to assess the cosmetic outcomes and the proportion of patients with late radiotherapy toxicity in a group of women with early-stage breast cancer treated with breast-conserving surgery (BCS) and adjuvant radiotherapy using a simultaneous integrated boost (SIB) technique. METHODS AND MATERIALS: Female patients with early-stage breast cancer (pT1-2 N0-1) treated with BCS and radiotherapy using an SIB technique were identified retrospectively from the departmental database. Radiotherapy consisted of 45 Gy in 25 fractions delivered to the whole breast with a simultaneous forward-planned conformal boost to the tumour bed of 60 Gy in 25 fractions. Demographic data, as well as prospectively collected measures of toxicity and cosmesis, were recorded and analysed. RESULTS: Fifty-five eligible patients were treated between 2009 and 2011. The median age was 61 years (range, 31 to 81 years). Median follow-up was 13.3 months. Late toxicities (including oedema, pigmentation, telangiectasia, fibrosis, osteonecrosis and pain) were graded using Common Terminology Criteria for Adverse Events v3.0 criteria. Grade 0, 1 and 2 toxicities were assigned to 52.8%, 43.4% and 3.8% of patients, respectively. There were no cases of grade 3 or greater toxicity. Ninety-eight per cent had a good or excellent cosmetic outcome based on independent assessment by both the patient and physician. One patient developed a second primary contralateral breast cancer. There were no cases of local recurrence. CONCLUSION: The use of a conformal SIB technique is proposed as a mode of delivering adjuvant radiotherapy in early-stage breast cancer. This schedule is convenient for the patient given the shortened overall treatment time. Additionally, the SIB technique seems to be well tolerated, with minimal toxicity and acceptable cosmetic outcomes. Finally, there are dosimetric benefits with respect to target coverage and reduction of dose and dose per fraction to organs at risk.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/radioterapia , Fraccionamiento de la Dosis de Radiación , Satisfacción del Paciente , Traumatismos por Radiación/etiología , Radioterapia Adyuvante/efectos adversos , Radioterapia Adyuvante/métodos , Adulto , Anciano , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/prevención & control , Dosificación Radioterapéutica , Resultado del TratamientoRESUMEN
BACKGROUND: Preoperative radiotherapy (RT) is an important component of the management of retroperitoneal sarcoma (RPS). We aimed to establish the feasibility of this approach by determining the accuracy of computed tomography (CT)-guided core biopsy, proportion of patients completing treatment, rates of acute toxicity and surgical complications, and treatment outcomes. METHODS: This is a retrospective review. Consecutive patients presenting between January 1999 and December 2009 with a diagnosis of either primary or recurrent RPS were identified. Those patients suitable for preoperative RT and surgery were included. Exclusions included presence of metastatic disease, age under 18 years and/or paediatric histology, and treatment with palliative intent. RESULTS: Twenty-four patients were included, 14 were males. Median age was 61.4 years. Twenty-three patients had Stage T2b, high-grade disease. Twenty patients were treated at initial presentation and four at first local recurrence. Five-year progression-free survival, overall survival and local recurrence rates were 48.9, 53.7 and 22%, respectively. A malignant diagnosis was confirmed in all patients who underwent CT-guided core biopsy; a diagnosis of sarcoma was reached in 90%, histological subtype correctly identified in 66%. All patients in the cohort completed preoperative RT. Grade 3 toxicity occurred in 4% of patients (n = 1). Seventy-five per cent (n = 18) proceeded to radical resection, where complete macroscopic excision was achieved in all cases. There was no perioperative mortality. CONCLUSION: Preoperative RT has low levels of Grades 3 or 4 toxicity, and does not adversely impact surgical management. CT-guided core biopsy is an accurate means of confirming a diagnosis of RPS prior to definitive treatment.
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Neoplasias Retroperitoneales/radioterapia , Neoplasias Retroperitoneales/cirugía , Sarcoma/radioterapia , Sarcoma/cirugía , Adulto , Anciano , Biopsia con Aguja Gruesa , Fraccionamiento de la Dosis de Radiación , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Complicaciones Posoperatorias , Radiografía Intervencional , Radioterapia Adyuvante , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/patología , Estudios Retrospectivos , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: Preoperative radiotherapy provides advantages in the management of retroperitoneal sarcoma (RPS). We describe our experience treating a cohort who underwent pre- and post-radiotherapy functional imaging with FDG-PET scan. METHODS AND MATERIALS: Consecutive patients presenting between January 1999 and December 2009 with a diagnosis of either primary or recurrent RPS were identified from the hospital patient record database using ICD codes, and cross-referenced with the completed radiotherapy course database. Those patients suitable for preoperative radiotherapy and surgery who underwent both pre- and post-radiotherapy FDG-PET were included. Exclusions included presence of metastatic disease, age under 18 years and/or paediatric histology, and treatment with palliative intent. RESULTS: Eleven patients were included, of whom six were male. Median age was 63 years (range, 38-78 years). The majority of patients had Stage T2b, high-grade disease. Ten patients were treated at initial presentation and one at first local recurrence. A malignant diagnosis was confirmed in all patients who underwent CT-guided core biopsy; a diagnosis of sarcoma was reached in 91%. Sensitivity of FDG-PET imaging was 100%. Metabolic partial or complete response did not correlate with change in tumour size, nor pathological response assessment. Pulmonary and hepatic metastatic disease was detected in one patient on post-treatment imaging. All patients in the cohort completed preoperative radiotherapy. There was no grade 3 or 4 toxicity. Sixty-four percent proceeded to radical resection. Complete macroscopic excision was achieved in all cases. There was no perioperative mortality. CONCLUSION: Combined therapy with preoperative radiotherapy and surgery has acceptable levels of toxicity. CT-guided core biopsy is an accurate means of confirming a diagnosis of RPS prior to definitive treatment. Utility of PET scan in the management of RPS is evolving and further investigation is warranted.
Asunto(s)
Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/radioterapia , Tomografía de Emisión de Positrones/métodos , Sarcoma/diagnóstico por imagen , Sarcoma/radioterapia , Adulto , Anciano , Estudios de Cohortes , Femenino , Fluorodesoxiglucosa F18 , Humanos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/cirugía , Cuidados Posoperatorios , Cuidados Preoperatorios/métodos , Pronóstico , Radioterapia Adyuvante , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Sarcoma/mortalidad , Sarcoma/cirugía , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The aim of this study was to investigate the association of recalled childhood sexual and physical abuse with current sexual functioning in mid-life. The sample was participants in the longitudinal population-based cohort of mid-aged women, The Melbourne Women's Midlife Health Project. Three hundred sixty two of the women (92% of the available cohort) were administered the Violence Questionnaire in the sixth year of follow-up. This included questions on physical abuse and sexual abuse experienced in childhood. We used the Short Personal Experiences Questionnaire (Dennerstein, Anderson-Hunt, & Dudley, 2002) to assess current sexual functioning. Forty eight percent of the women had no experience of childhood sexual abuse, 42% had experienced noncontact sexual abuse, 36% had experienced contact sexual abuse, and 7% had experienced penetrative sexual abuse. Nine percent of the women had experienced physical abuse in childhood. Women who had experienced penetrative childhood sexual abuse were significantly more likely to have fewer children (median 2) than women who had not experienced penetrative childhood sexual abuse (median 3) (P < 0.05). The only area of sexual or relational functioning significantly affected by childhood sexual abuse was that of feelings for partner (P < 0.05). Those who experienced penetrative childhood sexual abuse had, on average, significantly shorter current relationships (P < 0.05). Women who had experienced both childhood sexual and physical abuse reported a lower frequency of current sexual activities (P < 0.05). This study of mid-aged women found that the major impact of childhood sexual abuse is on the quality of relationship with the partner.