Andrés Vargas

Background: Several measurements defining the expected 30-day mortality (30-DM) to use in audit of radiation oncology departments have been proposed. However, its external validity is limited because of the lack of data from non-English speaking countries. This study assessed 30-DM in patients treated with palliative radiotherapy (PRT) in a Chilean-reference radiotherapy centre and explored if there had been tailored treatment at the end of life. Materials and methods: Retrospective data collection was carried out for all patients treated at our institution between 1st January 2018 and 31^st December 2021. Individual factors were modelled first to check for univariate association with 30-DM, those variables with a significance level of < 0.05 were considered for the final multivariable model. Results: 3,357 patients were included. The most common primary malignancies were breast (22%) and lung (16.1%). The most common treatment sites were bone (47.7%) and brain (12.2%). Overall, 30-DM was 14.7%, this rate was higher in patients treated for brain metastases (25.7%) and thoracic palliation (22.1%). 30-DM was associated with poor performance status (p < 0.01), lung and esophageal-gastric cancer (p = 0.04 and p = 0.02, respectively), metastases other than bone (p < 0.01), brain metastases (p < 0.01) and private health insurance (p Conclusions: In patients treated for brain metastasis and thoracic palliation 30-DM was higher than suggested benchmarks. Moreover, in these groups long courses of PRT were often performed. Audit data should be useful for planning interventions that improve selection of patients and prompting review of policies for indication and fractionation schedules of PRT. Keywords: palliative radiotherapy prognosis audit 30-day-mortality

Background Breast cancer (BC) prevalence steadily increases in older patients but their treatment is based on the geriatric evaluations of comorbidities and potential benefits proved in clinical trials with younger patients. The lack of better decision-making tools urges to promote the search for new prognostic markers. The association between inflammation, aging and cancer may be crucial for better treatment selection. We sought to analyze its impact on the survival of older BC patients, evaluating the interaction with age and comorbidities. Methods We evaluated the relationship between inflammatory biomarkers at BC diagnosis (circulating blood cell counts and inflammatory indexes) and BC-related and not related mortality rate, evaluating the influence of comorbidities and age through the competitive risks assessment. Results We analyzed 148 consecutive BC patients aged ≥ 70 years old, diagnosed with BC and regional lymph node metastases. After the median follow-up of 51.5 months, 59 patients died (28 due to breast cancer progression and 31 because of other causes). Increased levels of circulating monocytes, neutrophils and neutrophil-to-lymphocytes ratio and decreased level of eosinophils and eosinophil multiple by neutrophils-to-lymphocytes ratio were associated with higher probability of BC-related death but not with death related to other causes. Conclusion Our data suggest a role of inflammatory parameters as a possible prognostic tool in therapeutic decision-making process in older patients with BC, as increased level of inflammation was associated with cancer-specific mortality. Prospective studies may give the possibility of refining the geriatric evaluation for BC treatment in elderly.

We retrospectively reviewed the data from patients ≥ 70 years old treated between January 2012 and January 2017. Axillary staging was scarcely used in the therapeutic algorithm but arm lymphedema was significantly associated to axillar dissection (p=0.04) and regional nodal irradiation (p = 0.02). Aggressive management of axilla did not provide relevant information for deciding chemotherapy but added morbidity.

Introduction: Single fraction radiotherapy (SFR) is effective in palliation of symptoms related to advanced cancer. Despite this, several studies have shown that the trend towards multiple fraction treatment (MFR) is largely maintained. Even in patients with limited life expectancy, SFR is significantly underutilized in current practice. Cases description: Four patients diagnosed with advanced cancer who developed soft tissue lesions were treated with SFR due to frailty and/or a poor performance status. Conclusion: Despite the effectiveness of SFR is well-established in BM, its use in symptoms caused by soft tissue lesions have been underreported. SFR could be a good option for providing palliation in some patients, particularly in those who are frail or have a poor performance status.

La forma clásica se manifiesta principalmente en población de origen judío, de Europa del este y mediterránea, aparece hacia la séptima década de la vida y afecta principalmente a hombres¹. Frecuentemente se localiza a nivel de extremidades inferiores. Tiende a ser una condición crónica, por lo que los pacientes pueden alcanzan largas supervivencias.