IntroductionTo report a single-institutional experience with the use of Superficial X-Ray Therapy (SXRT) for head and neck non-melanoma skin cancer (N-MSC) and to compare outcomes by prescribed fractionation schedules.Materials and MethodsThe medical records of 597 patients with 1021 lesions (720 BCC, 242 SCC, 59 SCC in situ) treated with kilovoltage radiation from 1979–2013 were retrospectively reviewed. The majority of patients were treated according to 1 of 3 institutional protocols based on the discretion of the radiation oncologist: 1) 22 x 2.5 Gy; 2) 20 x 2.5 Gy; 3) 30 x 2.0 Gy. "T" stage at first presentation was as follows: Tis (59); T1 (765); T2 (175); T3 (6), T4 (9); Tx, (7). All patients were clinical N0 and M0 at presentation. Chi-square test was used to evaluate any potential association between variables. The Kaplan-Meier method was used to analyze survival with the Log Rank test used for comparison. A Cox Regression analysis was performed for multivariate analysis.ResultsThe median follow up was 44 months. No significant difference was observed among the 3 prescribed fractionation schemes (p = 0.78) in terms of RTOG toxicity. There were no failures among SCC in situ, 37 local failures (23 BCC, 14 SCC), 5 regional failures (all SCC) and 2 distant failures (both SCC). For BCC, the 5-year LC was 96% and the 10-year LC was 94%. For SCC the corresponding rates of local control were 92% and 87%, respectively (p = 0.03). The use of >2.0 Gy daily was significantly associated with improved LC on multivariate analysis (HR: 0.17; CI 95%: 0.05–0.59).ConclusionSXRT for N-MSC of the head and neck is well tolerated, achieves excellent local control, and should continue to be recommended in the management of this disease. Fractionation schedules using >2.0 Gy daily appear to be associated with improved LC.

O câncer de próstata é o segundo tumor maligno mais comum entre os homens, com uma incidência estimada de 65.840 novos casos em 2020, cujo principal fator de risco é a idade acima dos 65 anos. O tratamento do câncer de próstata pode ser realizado por meio de terapia hormonal, cirurgia e radioterapia. Diante disso, o tratamento com radioterapia convencional é realizado em 37 sessões diárias de segunda a sexta-feira. Já a radioterapia hipofracionada tem apenas 20 sessões, pois a dose total de radiação destinada ao paciente é dividida em uma quantidade menor de aplicação. Assim, o tratamento hipofracionado proporciona aplicações com doses mais altas de radiação, consequentemente diminuindo o número total de sessões. Visto que a cidade de Cascavel-PR é considerada um polo médico oncológico, muitos pacientes moram temporariamente na cidade ou percorrem centenas de quilômetros todos os dias em busca de tratamento. O objetivo desse projeto foi verificar como o tratamento de radioterapia hipofracionada influencia positivamente na logística dos pacientes.  Teve como resultado que dos 77 pacientes entrevistados, 62 são oriundos de 48 cidades diferentes pertencentes a 5 estados. Contudo, 96% dos pacientes relataram que o tratamento mais curto foi relevante em suas vidas.

EditorialCervical cancer is the third leading cause of female cancer worldwide and is the second most common cause of cancer related deaths in women in undeveloped countries. 1 The incident rate varies with the prevalence of risk factors and the lack of adequate screening programs, reaching 80 cases per 100,000 inhabitants in Recife, Brazil. 2 Despite advances in treatment, cervical cancer still maintains high rates of morbidity and mortality -the recurrence rate and associated death is approximately 30%. Data from the UK show that one third of patients will die within 5 years of diagnosis. 3 For all these reasons cervical cancer can be considered a public health issue especially in developing countries.The International Federation of Gynecology and Obstetrics (FIGO) stage system is the most widely used for cervical cancer. This system emphasizes the clinical parameters at the expense of morphological and functional examinations, which facilitates its applicability in developing countrieswhere additional tests are expensive and not available. The main limitations are the fact that this system is examiner dependent, difficult to reproduce, and difficult to perform in obese patients or those with unfavorable anatomy.Although without altering the classification proposed by FIGO, exams are valuable in this disease as they tend to guide the practitioner toward more accurate treatment. Furthermore, they are important to assess the response to treatment, which is of paramount importance since additional therapies (i.e. hysterectomy) may be used in cases of persistent disease.The 18-FDG PET stands out as the most used and studied functional test in cervical cancer. Unfortunately, PET is not available to many treatment centers around the world, especially in those that have the highest incidence rates -as the funds needed to obtain its tracer make it cost prohibitive.In this context, a much more cost effective relation is the MRI. Stenstedt et al. 4 studied the impact of MRI in staging and follow-up of cervical lesions and concluded that the addition of this examination alter the staging proposed by FIGO and changes the treatment plan in many cases. In 2013, Kraljevic et al. 5 performed a study comparing the FIGO staging and MRI preoperatively and correlated these findings with the pathological outcome in patients treated surgically. They concluded that MRI is better than clinical staging (accuracy of 90.9% versus 79.0%). 5 Novel advances such as diffusion weighted image (DWI) (sequence that is sensitive to the random motion of water molecules -i.e., Brownian motion) allow us to evaluate changes during therapy. Restriction to this diffusion movement is directly associated to the degree of cellularity of the tissue and thus is related to primary malignancy and metastasis. 6 An actual issue is whether its changes are predictive of response: the DWI derived apparent diffusion coefficient (ADC) is capable to quantify the magnitude of this water diffusion and has been used extensively as a biomarker for therapeutic respon...