GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is a rare tumor with poor prognosis and rising incidence. Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensive locoregional involvement. Numerous therapeutic advances have been made in recent years, including the use of less aggressive surgical techniques associated with lower morbidity and mortality (e.g., pleurectomy/decortication), technological advancements in the field of radiotherapy (intensity-modulated radiotherapy, image-guided radiotherapy, stereotactic body radiotherapy, proton therapy), and developments in systemic therapies (chemotherapy and immunotherapy). These improvements have had as yet only a modest effect on local control and survival. Advances in the management of MPM and standardization of care are hampered by the evidence to date, limited by high heterogeneity among studies and small sample sizes. In this clinical guideline prepared by the oncological group for the study of lung cancer of the Spanish Society of Radiation Oncology, we review clinical, histologic, and therapeutic aspects of MPM, with a particular focus on all aspects relating to radiotherapy, including the current evidence base, associations with chemotherapy and surgery, treatment volumes and planning, technological advances, and reradiation.

Linfoma de Burkitt esporádico en cavidad bucal: caso clínico / Sporadic Burkitt´s lymphoma in the oral cavity: a clinical case report

Objetivo: Presentar un caso clínico de Linfoma de Burkitt esporádico en cavidad bucal como manifestación inicial en un paciente adulto joven, tratado en el Hospital Interzonal General de Agudos "General José de San Martín" de La Plata. Caso clínico: Un paciente masculino de 20 años de edad se presenta con una lesión tumoral localizada en sector posterior de reborde mandibular, pérdida espontánea de piezas dentarias y parestesia del nervio dentario inferior. Acompañado de un aumento de volumen testicular, compromiso intestinal y poliadenopatías. El cuadro morfológico y de inmuno-marcación confirma un Linfoma de Células B "agresivo". El paciente fue tratado con esquema intensivo de 6 bloques de quimioterapia y terapia intratecal. No se observaron señales de recurrencia durante el período de seguimiento de 12 meses. Las manifestaciones bucales iniciales del Linfoma de Burkitt deben considerarse en el diagnóstico diferencial de las enfermedades bucales benignas. Debido a su naturaleza agresiva, el reconocimiento temprano y rápido de este linfoma es esencial para la administración oportuna de la terapia adecuada y mejora el pronóstico del paciente (AU)

Aim: To present a case of sporadic Burkitt's lymphoma with oral initial manifestatios in a young adult patient, who received treatment at the Hospital Interzonal General de Agudos "General José de San Martín", La Plata. Clinical case: A 20-year-old male patient presents with a tumor lesion located in the posterior area of the mandibular ridge, spontaneous loss of teeth and paresthesia of the inferior dental nerve, increase in testicular volume, intestinal compromise and polyadenopathy. The morphological and immunostaining conditions confirm an "aggressive" B-Cell Lymphoma. The patient received an intensive scheme of 6 blocks of chemotherapy and intrathecal therapy. No signs of recurrence were observed during the 12-month follow-up period. Oral manifestations of Burkitt´s lymphoma in the initial stages should be considered in the differential diagnosis of benign oral diseases. Due to its aggressive nature, early and rapid recognition of these this lymphoma is essential for the timely administration of adequate therapy and for a patient's better prognosis (AU)

[Allergy to vegetables belonging to the Solanaceae family]. / Alergia a vegetales pertenecientes a la familia de las solanáceas.

BACKGROUND: Although cross-reactivity with other plant-based foods and latex has been described, allergies to potatoes and tomatoes are uncommon. OBJECTIVE: To study the different sensitization patterns in patients who are allergic to potatoes and/or tomatoes. METHODS: Skin prick tests were carried out with fresh foods and extracts, specific IgE determination and allergen detection by SDS-PAGE and IgE-Immunoblotting with both raw and heated potato and tomato extracts. RESULTS: In 10 patients, two thermostable allergens to potato extract were detected; the first one with a molecular weight that is compatible with Sola t 1 (43 kDa, patatin) and the second one with a molecular weight of 14-22 kDa, which could correspond to the allergens Sola t 4 (16 kDa) and Sola t 2 and Sola t 3 (21 kDa); in two patients who are allergic to potatoes and two patients who are allergic to tomatoes, a thermostable allergen that is compatible to Sola I 2 (50 kDa) was detected. The patient had presented oral allergy syndrome with some types of potatoes and showed higher IgE reactivity to two thermostable potato allergens. CONCLUSIONS: The allergen sensitization patterns were similar in all the patients that had been studied, regardless of the symptoms. A new allergen involved in the allergy to solanaceae plants has been detected.

Antecedentes: Aunque se ha descrito reactividad cruzada con alimentos vegetales y látex, la alergia a la papa y al tomate es infrecuente. Objetivo: Estudiar los diferentes patrones de sensibilización en pacientes alérgicos a la patata o tomate. Métodos: Se realizaron pruebas de punción cutánea con extractos y alimentos frescos, determinación de IgE específica y detección de alérgenos mediante SDS-PAGE e IgE-Immunoblotting con extractos de patata y tomate crudos y calientes. Resultados: En 10 pacientes se detectaron alérgenos termoestables a extracto de patata, uno de peso molecular compatible con Sola t 1 (43 kDa, patatina) y otro de 14-22 kDa que podría corresponder a los alérgenos Sola t 4 (16 kDa), Sola t 2 y Sola t 3 (21 kDa); en dos pacientes alérgicos a la patata y dos alérgicos al tomate se detectó un alérgeno termoestable de aproximadamente 42 kDa. En un paciente alérgico al tomate se detectó un alérgeno termoestable compatible con Sola l 2 (50 kDa); había presentado síndrome de alergia oral con algunos tipos de patatas y mostró mayor reactividad IgE a dos alérgenos termoestables de la patata. Conclusiones: Los patrones de sensibilización a los alérgenos fueron similares en los pacientes, independientemente de los síntomas. Se ha detectado un nuevo alérgeno implicado en la alergia a las solanáceas.

Thermal response test data of five quadratic cross section precast pile heat exchangers.

This data article comprises records from five Thermal Response Tests (TRT) of quadratic cross section pile heat exchangers. Pile heat exchangers, typically referred to as energy piles, consist of traditional foundation piles with embedded heat exchanger pipes. The data presented in this article are related to the research article entitled "Comparing heat flow models for interpretation of precast quadratic pile heat exchanger thermal response tests" (Alberdi-Pagola et al., 2018) [1]. The TRT data consists of measured inlet and outlet temperatures, fluid flow and injected heat rate recorded every 10 min. The field dataset is made available to enable model verification studies.

Manejo de criptococosis meníngea refractaria: a propósito de un caso / Management of refractory cryptococcal meningitis: report of a case

La criptococosis es una de las infecciones oportunistas más frecuentes en pacientes con infección por HIV. La toxicidad de la anfotericina B y el aislamiento de un número creciente de cepas resistentes a fluconazol determinan la necesidad de tratamientos alternativos y estrategias novedosas. Este artículo presenta un paciente HIV positivo con criptococosis meníngea sin negativización de los aislamientos de Cryptococcus neoformans con el tratamiento convencional de inducción con anfotericina B más fluconazol, y respuesta favorable al sustituir este último antifúngico por voriconazol...

Cryptococcosis is one of the most common opportunistic infections in patientes with HIV infection. The toxicity of amphotericin B and isolation of an increasing number of strains resistant to fluconazole dictate the need for alternative treatments and novel strategies. This paper presents an HIV positive patient with cryptococcal meningitis without negativisation Cryptococcus neoformans isolates with conventional induction therapy with amphotericin B plus fluconazole, and favorable to the latter replaced by voriconazole antifungal response...

Manejo de criptococosis meníngea refractaria: a propósito de un caso / Management of refractory cryptococcal meningitis: report of a case

La criptococosis es una de las infecciones oportunistas más frecuentes en pacientes con infección por HIV. La toxicidad de la anfotericina B y el aislamiento de un número creciente de cepas re-sistentes a fluconazol determinan la necesidad de tratamientos alter-nativos y estrategias novedosas. Este artículo presenta un pacien-te HIV positivo con criptococosis meníngea sin negativización de los aislamientos de Cryptococcus neoformans con el tratamiento con-vencional de inducción con anfotericina B más fluconazol, y respues-ta favorable al sustituir éste último antifúngico por voriconazol

Cryptococcosis is one of the most common opportunistic infections in patients with HIV infection. The toxicity of amphotericin B and isolation of an increasing number of strains resistant to fluconazole dictate the need for alternative treatments and novel strategies. This paper presents an HIV positive patient with cryptococcal meningitis without negativisation Cryptococcus neoformans isolates with conventional induction therapy with amphotericin B plus fluconazole, and favorable to the latter replaced by voriconazole antifungal response

Comparison of limited-volume perioperative high-dose-rate brachytherapy and wide-field external irradiation in resected head and neck cancer.

BACKGROUND: This study aimed to test the safety of using perioperative high-dose-rate brachytherapy (PHDRB) in resected head and neck cancer. METHODS: From 2000 to 2008, 97 patients received PHDRB after complete macroscopic resection. Group 1 (previously irradiated patients) received 32 to 40 Gray (Gy) of PHDRB in 8 to 10 twice-daily (bid) treatments (R0-R1 resections). Group 2 (unirradiated patients) received 16 to 24 Gy of PHDRB in 4 to 6 bid treatments (R0-R1 resections) followed by external beam irradiation (EBRT) of 45 Gy/25 daily fractions ± concomitant chemotherapy. RESULTS: The median follow-up was 4.3 years. The cumulative hazard of 2-year grade ≥ 3 complications in group 1 was 45.9%, and the rate of grade ≥ 3 complications in group 2 was 24.6%. Actuarial locoregional control at 2 and 5 years for group 1 was 60.9% and for group 2, 84.1% and 79.4%. CONCLUSIONS: Complications and locoregional failure rates were similar to those reported in the reference standards despite a much smaller treatment volume.

Determinants of toxicity, patterns of failure, and outcome among adult patients with soft tissue sarcomas of the extremity and superficial trunk treated with greater than conventional doses of perioperative high-dose-rate brachytherapy and external beam radiotherapy.

PURPOSE: The present study was undertaken to determine factors predictive of toxicity, patterns of failure, and survival in 60 adult patients with soft tissue sarcomas of the extremity and superficial trunk treated with combined perioperative high-dose-rate brachytherapy and external beam radiotherapy. METHODS AND MATERIALS: The patients were treated with surgical resection and perioperative high-dose-rate brachytherapy (16 or 24 Gy) for negative and close/microscopically positive resection margins, respectively. External beam radiotherapy (45 Gy) was added postoperatively to reach a 2-Gy equivalent dose of 62.9 and 72.3 Gy, respectively. Adjuvant chemotherapy with ifosfamide and doxorubicin was given to patients with advanced high-grade tumors. RESULTS: Grade 3 toxic events were observed in 18 patients (30%) and Grade 4 events in 6 patients (10%). No Grade 5 events were observed. A location in the lower limb was significant for Grade 3 or greater toxic events on multivariate analysis (p = .013), and the tissue volume encompassed by the 150% isodose line showed a trend toward statistical significance (p = .086). The local control, locoregional control, and distant control rate at 9 years was 77.4%, 69.5%, and 63.8%, respectively. On multivariate analysis, microscopically involved margins correlated with local control (p = .036) and locoregional control (p = .007) and tumor size correlated with distant metastases (p = .004). The 9-year disease-free survival and overall survival rate was 47.0% and 61.5%, respectively. Multivariate analysis showed poorer disease-free survival rates for patients with tumors >6 cm (p = .005) and microscopically involved margins (p = .043), and overall survival rates decreased with increasing tumor size (p = .011). CONCLUSIONS: Grade 3 or greater wound complications can probably be decreased using meticulous treatment planning to decrease the tissue volume encompassed by the 150% isodose line, especially in lower limb locations. Microscopically involved margins remain a predictor of local and locoregional failure, despite radiation doses >70 Gy. Patients with tumors ≥6 cm and microscopically involved margins are at high risk of treatment failure and death from the development of distant metastases.

CT-guided permanent brachytherapy for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC).

Seven patients with early stage T1N0M0 NSCLC who had medical contraindications for surgical resection were treated with CT-guided percutaneous implantation of (103)Pd or (125)I seeds. After the procedure, two patients developed pneumothorax and hemo/pneumothorax that was managed with aspirative drainage. One patient developed a focal pneumonitis 3 months after the procedure. After a median follow-up of 13 months (4.6-41.0+ months), no patient has developed local or regional failure.