Background: Recent studies have shown preliminary evidence that vaccination against human papillomavirus (HPV) could decrease the risk of persistent/recurrent HSIL in women treated for high-grade cervical intraepithelial lesion (HSIL). We aimed to determine the benefits of HPV vaccination in patients undergoing conization for HSIL in real-life conditions and evaluate vaccination compliance associated with different funding policies. Methods: From January 2013 to July 2018, 265 women underwent conization in our center. From January 2013 to July 2017, treated patients (n = 131) had to pay for the vaccine, whereas after July 2017 the vaccine was publicly funded and free for treated women (n = 134). Post-conization follow-up controls were scheduled every six months with a Pap smear, HPV testing, and a colposcopy. Results: 153 (57.7%) women accepted vaccination (vaccinated group), and 112 (42.3%) refused the vaccine (non-vaccinated group). Persistent/recurrent HSIL was less frequent in vaccinated than in non-vaccinated women (3.3% vs. 10.7%, p = 0.015). HPV vaccination was associated with a reduced risk of persistent/recurrent HSIL (OR 0.2, 95%CI: 0.1–0.7, p = 0.010). Vaccination compliance increased when the vaccine was publicly funded (from 35.9% [47/131] to 79.1% [106/134], p < 0.001). Conclusions: HPV vaccination in women undergoing conization is associated with a 4.5-fold reduction in the risk of persistent/recurrent HSIL. Vaccination policies have an important impact on vaccination compliance.
Background: Adjuvant radiotherapy and hormonotherapy after breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) have been shown to reduce the risk of local recurrence. To predict the risk of ipsilateral breast tumor relapse (IBTR) after BCS, the Memorial Sloan Kettering Cancer Center (MSKCC) developed a nomogram to analyze local recurrence (LR) risk in our cohort and to assess its external validation. Methods: A historical cohort study using data from 296 patients treated for DCIS at the Hospital Clínic of Barcelona was carried out. Patients who had had a mastectomy were excluded from the analysis. Results: The mean age was 58 years (42–75), and the median follow-up time was 10.64 years. The overall local relapse rate was 13.04% (27 patients) during the study period. Actuarial 5- and 10-year IBTR rates were 5.8 and 12.9%, respectively. The external validation of the MSKCC nomogram was performed using a multivariate logistic regression analysis on a total of 207 patients, which did not reach statistical significance in the studied population for predicting LR (p = 0.10). The expression of estrogen receptors was significantly associated with a decreased risk of LR (OR: 0.25; p = 0.004). Conclusions: In our series, the LR rate was 13.4%, which was in accordance with the published series. The MSKCC nomogram did not accurately predict the IBTR in this Spanish cohort of patients treated for DCIS (p = 0.10).
Background: While advances in breast radiotherapy (RT) are commonly studied with respect to clinician-reported adverse events (CTCAE), implications from a patient perspective require consideration. We report one of the first analyses of PRO-CTCAE for BC patients with curative intent RT from a large, single-institution prospective registry.Methods: PRO-CTCAE questionnaires were administered at baseline, end-of-treatment, 3, 6, 12 months, then annually for all patients treated with curative RT. Patients must have a baseline and at least one post-RT survey. Patient, treatment, toxicity, and outcome characteristics were extracted from the registry. Logistic regression was utilized for univariate (UVA) and multivariate (MVA) analyses.Results: Three-hundred thirty-one (331) patients were analyzed from 2016-2019. Majority of the baseline patient/tumor characteristics included the following: ECOG 0 (66%), hormone receptor + (80%), Her2 + (23%), right-sided (50%), lumpectomy (75%), invasive ductal carcinoma (86%), pathologic T1-2 (94%), N0 (71%), grade 1-2 (66%). Radiotherapy characteristics include: photon RT (85%), boost (40%), whole breast RT (77%), lymph node RT (36%), median dose 40 Gy. Grade 2+ ("Moderate" or worse bother/severity) PRO-CTCAE occurred in 247 (75%) and grade 3+ ("Severe" or worse bother/severity) in 106 (32%). MVA revealed that grade 2+ and 3+ PRO-CTCAE were associated with ECOG ≥1 ( p = 0.01, 0.02) and increasing dose per fraction with grade 3+ PRO-CTCAE ( p < 0.01).
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