Aim: Describe the anatomical changes and tumor displacement due to a rapid response of a patient's small cell lung cancer (SCLC) during definitive chemoradiotherapy (CRT). Background: The treatment for SCLC is based on CRT. If interfractional changes during RT are incorrectly assessed they might compromise adequate coverage of the tumor or increase dose to organs at risk. Image guided RT with cone-beam computed tomography (CBCT) allows to identify daily treatment variations. Material and methods: Describe a SCLC case with rapid changes in size, shape and location of the primary tumor during RT. Case report: A 62-year-old woman was diagnosed with SCLC with complete obstruction of the anterior and lingular bronchi and incomplete left thorax expansion due to a 12 × 15 cm mass. During CRT (45 Gy in 1.5 Gy per fraction, twice daily) the patient presented rapid tumor response, leading to resolution of bronchi obstruction and hemithorax expansion. Tumor shifted up to 4 cm from its original position. The identification of variations led to two new simulations and planning in a 3-week treatment course. Conclusions: The complete radiological response was possible due to systematic monitoring of the tumor during CRT. We recommend frequent on-site image verification. Daily CBCT should be considered with pretreatment tumor obstruction, pleural effusion, atelectasis, large volumes or radiosensitive histology that might resolve early and rapidly and could lead to a miss of the tumor or increased toxicity. Further research should be made in replanning effect in coverage of microscopic disease since it increases uncertainty in this scenario.
El objetivo del estudio fue evaluar la respuesta de la pilocarpina en la xerostomía inducida por radioterapia en cabeza y cuello. El diseño de estudio fue descriptivo, prospectivo de corte longitudinal, doble ciego. Los pacientes se distribuyeron aleatoriamente en dos grupos. El grupo 1 (n = 10) de control recibió placebo. Al grupo 2 (n = 10) de estudio se le administró 5 mg diarios de pilocarpina cada 8 h por vía oral. Se realizaron tres cuantificaciones del flujo salival; al inicio del tratamiento, a la quinta y a la séptima semana, por el método de diferenciación de pesos. En la primera cuantificación, al inicio del tratamiento de radioterapia, los pacientes no habían recibido ningún tipo de medicamento, en ningún grupo. Comparando ambos grupos se obtuvo t = 0.525, P = 0.606, por lo que no existía diferencia estadísticamente significativa, en el flujo salival. A la quinta semana se observó en ambos grupos disminución del flujo salival, comparándolos se obtuvo t = 0.481, P = 0.636, por lo que no se encontró diferencia estadísticamente significativa. Sin embargo, el grupo de estudiotuvo un incremento estadísticamente significativo a la séptima semana , del flujo salival, donde se obtuvo una media 0.651 y d.s 0.380, mientras el grupo control mostró una media 0.256, d.s 0.251 al aplicar una t de Student se obtuvo t = 2.743, P = de 0.013. Concluyendo que la pilocarpina es un tratamiento alternativo, viable, seguro y económico, para la xerostomía inducida por radioterapia.
Purpose The safety and effectiveness of moderately hypofractionated post-operative radiation therapy for breast cancer were demonstrated by several trials. This study aimed to evaluate the current patterns of practice and to assess possible aspects that affect the decision-making process regarding the use of fractionation in breast cancer patients in Latin America and the Caribbean (LAC). Methods Radiation oncologists from LAC were invited to contribute to this this study. A 38-question survey was used to evaluate their opinions. Results A total of 173 radiation oncologists from 13 countries answered the questionnaire. The majority of respondents (84.9%) preferred moderately hypofractionated post-operative radiation therapy as their first choice in cases of whole breast irradiation. For whole breast plus regional nodal irradiation, post-mastectomy (chest wall and regional nodal irradiation) without reconstruction, and post-mastectomy (chest wall and regional node irradiation) with reconstruction hypofractionated post-operative radiation therapy was preferred by 72.2% 71.1%, and 53.7% of respondents, respectively. Breast cancer stage, and flap-based breast reconstruction were the factors associated with absolute contraindications for the use of hypofractionated schedules. Conclusion Even though moderately hypofractionated post-operative radiation therapy for breast cancer is considered a new standard to the vast majority of the patients, its unrestricted application in clinical practice across LAC still faces reluctance.
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