Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution

Introduction A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. Method A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities’ recommendations. The temporary trends of patients care and research projects proposals were registered. Results 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability (AU)

Terapia ultrasonido focalizado de alta intensidad (HIFU) para el tratamiento del cáncer de próstata: Experiencia a medio plazo / High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience

Introducción: Hoy en día, el tratamiento del cáncer de próstata localizado busca minimizar el impacto en la función sexual y la continencia urinaria. En este sentido, la terapia con ultrasonido de alta intensidad ofrece resultados interesantes. Presentamos nuestra experiencia con esta técnica en 2 centros españoles. Material y métodos: Revisión retrospectiva de 75 pacientes con cáncer de próstata localizado tratados con terapia con ultrasonido de alta intensidad entre marzo de 2007 y julio de 2016. Se evaluaron los resultados oncológicos y las complicaciones perioperatorias, así como el impacto en la función sexual y la continencia. Resultados: Sesenta y siete pacientes fueron analizados. El seguimiento medio fue de 7,2 años. El PSA nadir fue de 0,2 ng/ml (0-3); 24 pacientes (35,5%) presentaron recidiva bioquímica y en 18 se realizó una nueva biopsia, evidenciando 10 casos (55,5%) con recidiva anatomopatológica. La supervivencia libre de recidiva bioquímica global a 5 y 8 años fue de 93,2 y 80,5%, respectivamente. La supervivencia específica para cáncer a 5 y 8 años fue en ambos casos de un 96%. En el postoperatorio, 50 pacientes (74,6%) eran continentes, 16 (23,9%) reportaban incontinencia leve y uno (1,5%), moderada. La mediana del International Index of Erectile Function-5 previa y postratamiento fue de 17 (5-25) y 16 (2-23) puntos, respectivamente. Reportaron disfunción eréctil de novo 9 pacientes (13,5%). Conclusión: La terapia con ultrasonido de alta intensidad parece ser una alternativa segura para el tratamiento del cáncer de próstata localizado, especialmente de bajo riesgo. En nuestra experiencia, esta técnica ofrece ventajas en la conservación de la continencia urinaria, y los resultados oncológicos parecen ser alentadores a medio plazo. Dada la evolución natural del cáncer de próstata, se requieren estudios a largo plazo y con mayor casuística que corroboren estos resultados

Introduction: The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. Material and methods: We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. Results: A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2 ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). Conclusion: High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results

Complementariedades clínicas entre tratamientos con protones y tratamientos con iones de carbón / No disponible

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