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Biomedical subjects

A Zapatero

Publications and source records attributed to A Zapatero.

At least 19 recordsLinked to original sources
PubMed2006

Dose escalation with three-dimensional conformal radiotherapy for prostate cancer. Is more dose really better in high-risk patients treated with androgen deprivation?

AIMS: To determine the effect of radiation dose on biochemical control in prostate cancer patients treated in a single institution with three-dimensional conformal radiotherapy (3DCRT) and the additional effect of androgen deprivation in prostate cancer patients. MATERIALS AND METHODS: In total, 363 men with T1-T3b prostate cancer treated in a sequential radiation dose-escalation trial from 66.0 to 84.1 Gy (International Commission Radiation Units and Measurement [ICRU] reference point) between 1995 and 2003, and with a minimum follow-up of 24 months, were included in the analysis. One hundred and forty-eight (41%) men were treated with 3DCRT alone; 74 (20%) men received neoadjuvant androgen deprivation (NAD) 4-6 months before and during 3DCRT; and 141 (39%) men received NAD and adjuvant androgen deprivation (AAD) 2 years after 3DCRT. Univariate, stratified and multivariate analyses were carried out separately for defined risk groups (low, intermediate and high) to determine the effect of radiation dose on biochemical control and its interaction with hormonal manipulation and clinical prognostic variables. RESULTS: The median follow-up was 59 months (range 24-147 months). The actuarial biochemical disease-free survival (bDFS) at 5 years for all patients was 75% (standard error 3%). For low-risk patients, the bDFS was 82% (standard error 5%), for intermediate-risk patients it was 64% (standard error 6%) and for high-risk patients it was 77% (standard error 3%) (P = 0.031). In stratified and multivariate analyses, high-dose 3DCRT for all risk groups, and for high-risk patients, the use of long-term AAD vs NAD, contributed independently and significantly to improve the outcome of prostate cancer patients. CONCLUSION: The present study indicates an independent benefit on biochemical outcome of high-dose 3DCRT for low-, intermediate- and high-risk patients and of long-term AAD in high-risk prostate cancer patients.

Aged↗
PubMed2006

Mortality among adult patients admitted to the hospital on weekends.

BACKGROUND: Some reports have shown that the risk of death is higher for patients admitted on weekends than for patients who go into the hospital on weekdays. This study was conducted to assess what independent influence, if any, weekend admission might have on mortality in our hospital. METHODS: The clinical data of 35,993 adult (>14 years) patients admitted to the emergency department of Fundación Hospital Alcorcón from 1999 to 2003 were analyzed. We compared global mortality and mortality within the first 48 h according to whether the patients were admitted on the weekend or on a weekday. Elective admissions, critical care patients, children under 14 and births were not included. RESULTS: Global mortality was similar in both groups, but mortality within the first 48 h was higher for patients admitted on the weekend (OR 1.40, 95% CI 1.18-1.62, P<0.001), even after controlling for age, gender and comorbidity (weight of diagnosis-related group and Charlson comorbidity index). CONCLUSION: The risk of mortality within the first 48 h is higher for patients admitted on weekends than for patients admitted on a weekday.

Journal Article↗
PubMed2005

[Dose escalation with three dimensional conformal radiotherapy for prostate cancer: more is better?].

PURPOSE: The present study was undertaken to determine the effect of radiation dose on biochemical control and morbidity in prostate cancer patients. MATERIALS AND METHODS: Between 1995 and 2003, 360 patients with T1-T3b prostate cancer were treated in a sequential radiation dose escalation trial from 66.0 to 82.6 Gy. These patients were prospectively assigned to 1 of 3 prognostic groups according to risk factors: a) low risk patients were treated with 3DCRT alone; b) intermediate risk patients were allocated to receive neoadjuvant AD (NAD) 4-6 months prior and during 3DCRT; and c) high-risk received NAD and adjuvant AD (AAD) 2 years after 3DCRT. RTOG/EORTC toxicity score was used to analyze late complications RESULTS: Median follow-up was 48 months (12-138). The actuarial biochemical disease free survival (bDFS) at 4 years for low risk, intermediate risk and high risk patients was 88%, 68% and 79% respectively. Stratified and multivariate analysis showed that higher radiation dose (>76 Gy) (p=0.0053) and the use of AAD for high risk patients (p=0.0046) correlated significantly with an improvement of bDFS for all patients. The incidence of late grade 2 rectal and urinary bleeding were 7% and 11% respectively. CONCLUSION: The present study confirms an independent benefit of high-dose (> 76 Gy) radiation therapy and long-term AAD in high-risk prostate cancerpatients.

Aged↗
PubMed2000

Invasive bladder cancer: a single-institution experience with bladder-sparing approach.

Our objective was to assess the efficacy and safety of a selective bladder-preserving approach by transurethral resection and sequential chemoradiotherapy in patients with muscle-invasive bladder cancer. From 1989 through 1997, 40 patients with biopsy-confirmed bladder cancer, clinical stages T2-4NxM0, were treated with induction by aggressive transurethral resection (TUR) and three cycles of methotrexate, cisplatin, and vinblastine (MCV) chemotherapy. Tumor response was evaluated by cystoscopy and biopsy. In complete responders, the treatment was continued by radiotherapy (60 Gy to the bladder and 50 Gy to pelvic lymph nodes). Radical cystectomy was recommended to patients with residual tumor. Clinical complete response rate to TUR and MCV chemotherapy was 70%. The 4-year actuarial overall survival rate for the whole series was 80.5%. Among 36 patients who completed chemotherapy and radiotherapy, the 4-year actuarial survival was 84%, with 82.6% surviving with their bladders intact. Freedom from local failure in complete responders to TUR-chemotherapy was 84%. Multivariate analysis revealed that the extent of initial TUR and status after TUR-chemotherapy were independent prognostic factors associated with survival and disease-free survival. This study confirms that the combination of aggressive TUR and sequential chemoradiotherapy with bladder preservation is an alternative treatment option to primary cystectomy for selected patients with invasive bladder carcinoma.

Aged↗
PubMed1997

[Conservative treatment with chemotherapy and radiotherapy in bladder cancer invading the muscle: preliminary results of a prospective study].

OBJECTIVE: To analyze the possibility and safety of conservative treatment of muscle-invasive bladder cancer and to identify the prognostic factors for survival. METHODS: A total of 33 patients with invasive bladder cancer, clinical stages T2-4NxM0, were treated with aggressive transurethral resection (TUR) followed by three cycles of neoadjuvant methotrexate, cisplatin and vinblastine (MCV) chemotherapy and radiotherapy (60 Gy to the bladder). Cystectomy was recommended to patients without complete response to TUR and MCV chemotherapy. RESULTS: 31 of the 33 patients included in the study completed the protocol and were evaluable. The clinical complete response rate to TUR and MCV chemotherapy was 68% (21/31 Pts.). With a median follow-up of 39 months (range 12-78), 25/31 patients (81%) are alive and 24 (77%) have functioning preserved bladders. Four out of 31 patients (13%) developed distant metastases. The 5-year overall survival and disease free interval was 74.6% and 53.5%, respectively. By multivariate analysis response after TUR and chemotherapy (p = 0.022) was the more important risk factor associated with survival. CONCLUSION: These results indicate that MCV chemotherapy followed by radiotherapy may be effective in preserving bladder function in a high number of patients, with a survival rate comparable to that reported after cystectomy. The true efficacy of neoadjuvant chemotherapy remains to be proven by ongoing randomized trials.

Aged↗
PubMed1996

Successful bone marrow transplantation in sensitized aplastic anemia patients using total lymphoid irradiation for conditioning: long-term follow-up.

Between June 1986 and November 1994, 22 previously transfused patients with severe aplastic anemia (SAA) were treated with high-dose cyclophosphamide (CY) (50 mg/kg over 4 consecutive days) and 7 Gy total lymphoid irradiation (TLI) in two fractions before allogeneic bone marrow transplantation (BMT) from HLA-identical sibling. Graft-versus-host-disease (GVHD) prophylaxis included the combination of methotrexate and cyclosporine A in all cases. Actuarial survival at 5 years is 73 +/- 9 per cent for the entire group and 86 +/- 13 per cent for the seven patients < or = 18 years. The incidence of graft failure was 0 per cent, and of acute GVHD and chronic GVHD was 31.5 per cent and 24 per cent respectively. Prolonged interval from diagnosis to BMT adversely influenced survival (P = 0.03). No hypothyroidism or secondary malignancies have been documented in this series. Our findings indicate that survival with CY-TLI is comparable to that obtained using preparative regimens without radiation. The changing role of radiotherapy in pretransplant immunosuppression for SAA is discussed.

Adolescent↗
PubMed1996

Prognostic factors affecting leukemia relapse after allogeneic BMT conditioned with cyclophosphamide and fractionated TBI.

Between June 1985 and May 1992, 94 consecutive patients with acute myeloid leukemia (AML = 28), acute lymphoblastic leukemia (ALL = 27) and chronic myelogenous leukemia (CML = 39), were transplanted using genotypically HLA-identical marrow donors. All were conditioned with cyclophosphamide (CY) plus 12 Gy fractionated TBI. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A alone in nine patients and methotrexate-cyclosporin A in 85 patients. Forty-eight patients developed grades II-IV acute GVHD and 24 of 68 patients who survived at least 100 days developed chronic GVHD. The 5-year actuarial probability of survival, event-free survival and relapse were 41 +/- 5%, 37 +/- 5% and 37 +/- 6%, respectively. In multivariate analysis, an increased risk of leukemia relapse was associated with (1) absence of chronic GVHD (P = 0.017), (2) advanced disease at transplant (P = 0.034) and (3) diagnosis of AML (P = 0.047). Our results confirm that disease status at transplant and chronic GVHD are the more important risk factors associated with leukemia relapse, and suggest that CY-TBI has only a partial role in eradicating leukemia in AML.

Adolescent↗
PubMed1995

[A comparative study in rectal adenocarcinoma: preoperative or postoperative radiotherapy].

PURPOSE: To compare the results of preoperative and postoperative radiotherapy in rectal adenocarcinoma, in terms of overall survival and disease-free survival. PATIENTS AND METHODS: From 1989 to 1993, 52 patients with clinically operable rectal cancer were retrospectively analyzed. Two groups were compared: Patients in Group I received postoperative radiotherapy and those in Group II preoperative radiotherapy. Patients with a Karfnosky index > 70%, no evidence of distant disease and no major systemic problems were included in this study. RESULTS: The overall 5-year actuarial survival was 75% in Group I and 83% in Group II. The 5-year disease-free survival was 52% in Group I compared to 86% in Group II, a statistically significant difference (p = 0.025). A reduction in all Dukes' stages was observed in the preoperative radiation group, allowing preservation of the anorectal function in an increased number of patients. CONCLUSIONS: We observed better results with preoperative radiotherapy and conclude that this treatment might be justified in rectal carcinoma.

Adenocarcinoma↗
PubMed1991

[Chronic eosinophilic pneumonia. Presentation of 2 cases].

Two cases of patients with chronic eosinophilic pneumonia are presented. We highlight the possibility to obtain the diagnosis without lung biopsy, as well as the spectacular response to steroid treatment which has to be continued for a long period in order to avoid relapses.

Adult↗