RESUMEN

Antecedentes: El cáncer de cérvicouterino continúa siendo una enfermedad prevalente en Chile. Es frecuente recibir pacientes en etapas IIB y IIIB donde el riesgo de compromiso ganglionar pelviano y lumbo-aórtico es elevado y el tratamiento es radioquimioterapia. Objetivo: Análisis retrospectivo de pacientes con cáncer cérvicouterino que recibieron radioterapia que incluía los territorios lumboaórticos. Método: Revisión de pacientes con cáncer cérvicouterino tratadas entre 1995 y 2007 en el Instituto Nacional del Cáncer, Santiago, Chile. En 39 pacientes el tratamiento incluyó las cadenas lumboaórticas. Se analizó toxicidad y evolución. Se utilizaron dos técnicas de radioterapia: la primera durante la década del 90, donde se empleaban dos campos paralelos y opuestos (anterior y posterior) y una segunda actual, donde se irradian en conjunto la pelvis y los lumboaórticos a través de 4 campos (laterales y AP-PA). Resultados: El análisis dosimétrico de las dos técnicas confirma un mayor volumen irradiado de tejidos normales con la técnica de dos campos, fundamentalmente intestino delgado. La toxicidad fue significativamente diferente, siendo la que utilizamos hoy menos tóxica y con bajas complicaciones gastrointestinales, a pesar de recibir un tratamiento de radio-quimioterapia concomitante (55 por ciento vs 0 por ciento). Conclusión: La radioterapia lumboaórtica es un tratamiento con una tolerancia aceptable incluso con quimioterapia concomitante. Esta revisión nos obliga a elaborar un nuevo trabajo para evaluar si la radioterapia lumboaórtica reduce el riesgo de recidiva y aumenta la sobrevida.

Background: Uterine cancer is still a prevalent disease in Chile. Is common to treat patients with tumors in stages IIB and IIIB where the risk of pelvic and paraortic limph node involvement is very high. Its treatment is radio-chemotherapy. Objective: To present a retrospective analysis of patients that suffered cervix-uterine cancer who were treated with radiotherapy including the aortic-lumbar area. Methods: From the revision of patients who were treated of cervix-uterine cancer between the years 1995 and 2007, 39 were treated including aortic-lumbar chains. Evolution and toxicity were analyzed. Two radiotherapy techniques were used. The first one, during the nineties, included two parallel previous and later and opposed fields, and a second technique, currently used, where pelvis and paraortic are radiated at the same time through four lateral (AP-PA) fields. Results: The dosimeter analysis of both techniques shows that there is a higher volume of radiated normal tissue with the two fields techniques, mainly in the small bowel. On the other hand, the toxicity was significantly different being today's technique less toxic and showing low gastrointestinal side effects, despite receiving a simultaneous radio-chemotherapy (55 percent vs 0 percent). Conclusion: The paraortic radiotherapy treatment has an acceptable level of tolerance even under simultaneous radio-chemotherapy. Given the results of this study, we see the need for undergoing a new research project in order to evaluate if the aortic-lumbar radiotherapy may reduce the risk of relapse and increase in survival rate.

Asunto(s)

RESUMEN

OBJECTIVE: To retrospectively evaluate the toxicity of low-dose-rate brachytherapy and to relate it to the dose-volume to organs at risk. MATERIAL AND METHODS: We study 160 patients with early prostate cancer, treated with (125)-I implants. Most of them were T1c (63.1%), T2a (35.6%) and Gleason < or =6 (96.2%). Median PSA was 7.2 ng/ml (2.3-13.5); 85.6% were lowrisk cases and 14.4% high-risk cases. Mean follow-up was 24 months (7-48). RESULTS: Acute urinary toxicity related to urological quality of life (UQL=CVU) was tolerable in 75% and unsatisfactory in 25%. Urinary retention was present in 6.9%. IPSS, V100 and D90 were related to the urinary toxicity grade. Rectal toxicity (RTOG) G2 was 0.6%. Sexual potency showed no changes with regard to the basal in 69%. Actuarial biochemical control was 89.8% at four years. CONCLUSIONS: Brachytherapy with (125)-I seeds yields acceptable toxicity and excellent biochemical control.

Asunto(s)

RESUMEN

The aim of this retrospective analysis was to evaluate bowel and urinary acute and late morbidity in patients with low to intermediate risk endometrial carcinoma, submitted to total abdominal hysterectomy and bilateral salpingo-oophorectomy, without lymphadenectomy, and postoperative high-dose-rate brachytherapy (HDR-B) as the sole treatment. From March 1996 to June 1998, 70 patients were treated on an outpatient basis, to a total dose of 30-50 Gy, given in two fractions per week. A total of 4-5 fractions of 6-10 GY was delivered. Three patients (4.2%) developed severe bowel complications, with one patient experiencing severe rectal bleeding. Local control was observed in 68 (97.1%) patients. Five-year actuarial disease and complication-free survival were 94.3% and 96.8%, respectively. In conclusion, it seems that a modest dose fraction schedule of HDR-B yields very high local control rates and low morbidity rates.

Asunto(s)

RESUMEN

Las neoplasias ginecológicas suelen tratarse mediante radioterapia y cirugía, ya sea aisladamente o en combinación. Sus resultados son buenos en cuanto al control de la enfermedad, y en la literatura internacional se informa que sus complicaciones son raras. Este estudio se realizó a causa de la elevada demanda de consultas y hospitalizaciones en el servicio en que trabajan los autores por parte de pacientes complicadas. Se revisaron los expedientes de 136 pacientes con una o varias complicaciones relacionadas con la radioterapia con el fin de identificar la incidencia de complicaciones, los tipos de tratamiento recibidos y las intervenciones quirúrgicas realizadas para resolverlas. Se encontraron diez complicaciones, las tres principales cistitis hemorrágicas, estenosis ureteral y estenosis uretral, con 118, 56 y 32 casos respectivamente, para una incidencia global de 4.8, 2.3 y 1.3 en cada variedad. Se otorgaron 1 640 consultas (12 por paciente en promedio) y la hospitalización sumó 2 382 días (17.5 por paciente). Además, se realizaron 571 intervenciones quirúrgicas mayores o menores por esta causa durante un periodo de siete años. Se presentan los resultados y las experiencias en el hospital en que trabajan los autores

Asunto(s)