RESUMO
INTRODUCTION: Hypofractionated radiation therapy for breast cancer requires highly precise delivery through the use of image-guided radiotherapy (IGRT). Surface-guided radiation therapy (SGRT) is being increasingly used for patient positioning in breast radiotherapy. We aimed to assess the role of SGRT for verification of breast radiotherapy and the tumour bed. MATERIALS AND METHODS: Prospective study of 252 patients with early stage breast cancer. A total of 1170 determinations of daily positioning were performed. Breast surface positioning was determined with SGRT (AlignRT) and correlated with the surgical clips in the tumour bed, verified by IGRT (ExacTrac). RESULTS: SGRT improved surface matching by a mean of 5.3 points compared to conventional skin markers (98.0 vs. 92.7), a statistically significant difference (p < 0.01, Wilcoxon Test). For surface matching values > 95%, ≥ 3 clips coincided in 99.7% of the determinations and all markers coincided in 92.5%. For surface matching rates > 90%, the location of ≥ 3 clips coincided in 99.55% of determinations. CONCLUSIONS: SGRT improves patient positioning accuracy compared to skin markers. Optimal breast SGRT can accurately verify the localisation of the tumour bed, ensuring matching with ≥ 3 surgical clips. SGRT can eliminate unwanted radiation from IGRT verification systems.
Assuntos
Neoplasias da Mama/radioterapia , Posicionamento do Paciente/métodos , Radioterapia Guiada por Imagem/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Marcadores Fiduciais , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Estudos Prospectivos , Hipofracionamento da Dose de Radiação , Estatísticas não Paramétricas , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: RENORT is a novel data mining application developed to extract relevant clinical data from oncology information systems (OIS; ARIA and Mosaiq) used in radiation oncology (RO). METHODS/PATIENTS: We used RENORT to extract demographic and clinical data from the OIS of all patients treated at the RO Department at the General Hospital of Valencia during the year 2019. RESULTS: A total of 1158 treatments were performed. The female/male ratio was 39.3%/60.7%, with a mean age of 66 years. The mean waiting time between the treatment decision/proposal to the first visit was 10.1 days. Mean duration of the treatment preparation process was 21 days. Most patients (90.4%) completed treatment within the prescribed time ± 7 days. The most common sites/treatment types were: metastatic/palliative treatments (n = 300; 25.9%), breast (209; 18.0%), genitourinary (195; 16.8%), digestive (116; 10.0%), thoracic (104; 9.0%), head and neck (62; 5.4%), and skin cancer (51; 4.4%). The distribution according to treatment intent was as follows: palliative (n = 266; 23.0%), adjuvant curative (335; 28.9%), radical without adjuvant treatment (229; 19.8%), radical with concomitant treatment (188; 16.2%), curative neoadjuvant (70; 6.0%), salvage radiotherapy (61; 5.3%); and reirradiation (9; 0.8%). The most common treatment techniques were IMRT/VMAT with IGRT (n = 468; 40.4%), 3D-CRT with IGRT (421; 36.4%), SBRT (127; 11.0%), 2DRT (57; 4.9%), and SFRT (56; 4.8%). A mean of 15.9 fractions were administered per treatment. Hypofractionated schemes were used in 100% of radical intent breast and prostate cancer treatments. CONCLUSIONS: The RENORT application facilitates data retrieval from oncology information systems to allow for a comprehensive determination of the real role of radiotherapy in the treatment of cancer patients. This application is valuable to identify patterns of care and to assess treatment efficacy.
Assuntos
Mineração de Dados/métodos , Neoplasias/radioterapia , Radioterapia (Especialidade)/estatística & dados numéricos , Distribuição por Idade , Idoso , Fracionamento da Dose de Radiação , Feminino , Hospitais Universitários , Humanos , Masculino , Metástase Neoplásica/radioterapia , Cuidados Paliativos/estatística & dados numéricos , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Radioterapia Adjuvante/estatística & dados numéricos , Reirradiação/estatística & dados numéricos , Terapia de Salvação/estatística & dados numéricos , Distribuição por Sexo , Espanha , Tempo para o Tratamento/estatística & dados numéricosRESUMO
PURPOSE: To assess the pattern of treatment failure in patients with prostate cancer (PCa) treated with radiotherapy (76-80 Gy) ± hormone therapy (HT). We also evaluated the influence of treatment failure on survival outcomes. METHODS: Retrospective study of patients with PCa (n = 302) treated with radiotherapy (RT) ± HT at our centre between November 1999 and July 2007. The mean patient age was 70.2 years (range 51-87). Distribution by NCCN risk group was low (n = 80, 26.5%), intermediate (n = 86, 28.5%), high (n = 77, 25.5%), and very high (n = 49, 16.2%). Most patients (n = 273, 90.4%) received IMRT at a dose of 76-80 Gy. HT was administered in 237 patients (78.5%), in most cases (n = 167, 55.3%) for < 7 months RESULTS: Survival rates at 10 years were: overall survival (OS), 64.3%; biochemical disease-free survival, 83.9%; disease-free survival, 92.5%; and metastasis-free survival (MFS), 94.3%. Biochemical failure (BF) was observed in 55 cases (18.2%), 32 of whom subsequently developed clinical recurrence: metastasis (n = 17, 5.6%), local failure (n = 11, 3.6%), and regional failure (n = 4, 1.3%). The cause of death (n = 159) was intercurrent disease in 115 cases (72.3%), second cancer in 27 (17.0%), and PCa in 17 (10.7%). Biochemical failure-free survival ≤ 24 months was significantly associated with worse OS and MFS (p = 0.0001). Late genitourinary and gastrointestinal toxicity grade ≥ 3 (RTOG) was observed in 18 (6.0%) and 7 (2.3%) patients, respectively. CONCLUSIONS: The main type of treatment failure after 76-80 Gy of radiotherapy ± HT is local or metastatic. In all cases, biochemical failure occurred prior to treatment failure. BF within 24 months of treatment completion was significantly associated with worse OS and MFS.
Assuntos
Próstata/efeitos da radiação , Neoplasias da Próstata/radioterapia , Glândulas Seminais/efeitos da radiação , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Terapia Combinada , Intervalo Livre de Doença , Humanos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/mortalidade , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Falha de TratamentoRESUMO
PURPOSE: Total skin electron irradiation (TSEI) is a radiotherapy technique which consists of an homogeneous body surface irradiation by electrons. This treatment requires very strict technical and dosimetric conditions, requiring the implementation of multiple controls. Recently, the Task Group 100 report of the AAPM has recommended adapting the quality assurance program of the facility to the risks of their processes. MATERIALS AND METHODS: A multidisciplinary team evaluated the potential failure modes (FMs) of every process step, regardless of the management tools applied in the installation. For every FM, occurrence (O), severity (S) and detectability (D) by consensus was evaluated, which resulted in the risk priority number (RPN), which permitted the ranking of the FMs. Subsequently, all the management tools used, related to the TSEI process, were examined and the FMs were reevaluated, to analyze the effectiveness of these tools and to propose new management tools to cover the greater risk FMs. RESULTS: 361 FMs were identified, 103 of which had RPN ≥80, initially, and 41 had S ≥ 8. Taking this into account the quality management tools FMs were reevaluated and only 30 FMs had RPN ≥80. The study of these 30 FMs emphasized that the FMs that involved greater risk were related to the diffuser screen placement and the patient's position during treatment. CONCLUSIONS: The quality assurance program of the facility has been adapted to the risk of this treatment process, following the guidelines proposed by the TG-100. However, clinical experience continually reveals new FMs, so the need for periodic risk analysis is required.
Assuntos
Elétrons/uso terapêutico , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Radioterapia/normas , Humanos , Micose Fungoide/radioterapia , Controle de Qualidade , Radiometria , Radioterapia/métodos , Pele/efeitos da radiação , Neoplasias Cutâneas/radioterapiaRESUMO
INTRODUCTION: Radiotherapy (RT) is an essential part of the patient's treatment diagnosed with cancer. Determination of the most common RT secondary effect, the cutaneous toxicity, is usually based on visual rating scales, like Common Terminology Criteria for Adverse Events with an inherent subjectivity. The aim of this work is to perform an objective method to evaluate the radiodermatitis using a non-invasive imaging technique based on laser Doppler flowmetry (LDF). MATERIALS AND METHODS: A prospective study was performed analysing 1,824 measurements. A LDF was used to measure the cutaneous microcirculation in real time. A basal measurement was taken prior to radiotherapy treatment. To be able to observe the microcirculation changes related to the delivered dose, several sets of measurements were taken in the irradiated area along the RT treatment and in the contralateral non-irradiated area. RESULTS: A relative increase in blood flow at all measured points was found in the irradiated area. This relative increase in blood flow increases with the dose administered. In the non-irradiated contralateral area, the relative increase in blood flow is not significant and is independent of the dose administered. After treatment, a decrease in blood flow was detected with a trend towards returning to the baseline measurements. CONCLUSIONS: LDF is an objective technique that assesses early radiodermatitis. This method is useful to develop strategies to prevent onset of radiation dermatitis in patients irradiated, such as the modification and individualization of fractionation parameters of the RT. This allows the reduction of radiation morbidities and maintains patient quality of life.