RESUMEN
Stereotactic ablative body radiotherapy (SABR) is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer (NSCLC) and pulmonary metastasis. Several fractionation schemes have proven to be safe and effective, including the single fraction (SF) scheme. SF is an option cost-effectiveness, more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments. The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm, recommending this option to minimize patients' visits to hospital. SF SABR already has a long experience, strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases, making it a valid treatment option; although its use in central locations, synchronous and recurrencies tumors requires more prospective safety and efficacy studies. The SABR radiobiology study, together with the combination with systemic therapies, (targeted therapies and immunotherapy) is a direction of research in both advanced disease and early stages whose future includes SF.
RESUMEN
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.
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Head Neck Cancer of Unknown Primary (HNCUP) is a rare condition, representing approximately 5-10% of all head neck cancers. Radiotherapy, adjuvant or radical, is usually employed in the treatment of those patients. To date, no specific guidelines for the optimal definition of the target volume to be irradiated have been published. In recent years, there have been advances in the knowledge of the molecular biology of HNCUP, its diagnostic imaging and the implementation of sophisticated radiotherapy techniques with enhanced precision in target localization and treatment delivery. These progresses have provided valuable information about the natural history of HNCUP that will allow for establishment of the best treatment for each patient, including standardized, consistent and reproducible target volumes definitions. Several recommendations regarding how to choose volumes when contouring HNCUP in clinical practice are reported, in order to achieve a high rate of loco-regional control while avoiding unnecessary toxicity.
Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias Primarias Desconocidas/radioterapia , Guías de Práctica Clínica como Asunto/normas , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia de Intensidad Modulada/métodos , Humanos , Dosificación RadioterapéuticaAsunto(s)
Neoplasias del Oído/secundario , Melanoma/secundario , Adulto , Antineoplásicos/uso terapéutico , Terapia Combinada , Irradiación Craneana , Neoplasias del Oído/complicaciones , Neoplasias del Oído/diagnóstico por imagen , Neoplasias del Oído/terapia , Resultado Fatal , Pérdida Auditiva Sensorineural/etiología , Humanos , Interferón-alfa/uso terapéutico , Metástasis Linfática , Imagen por Resonancia Magnética , Masculino , Melanoma/diagnóstico por imagen , Melanoma/terapia , Neuroimagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiocirugia , Hombro , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Neoplasias de la Vejiga Urinaria/secundario , Neoplasias de la Vejiga Urinaria/cirugía , Vértigo/etiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Metástasis de la Neoplasia/patología , Melanoma/patología , Neoplasias Cutáneas/patología , Neoplasias del Oído/secundario , Oído Interno/patologíaRESUMEN
We report on the appearance of two new cases of radio-induced bullous pemphigoid (BP), a rare complication of radiotherapy. Both were elderly women, were treated for breast cancer and suffered (BP) during the irradiation, the evolution was favorable with steroid therapy.
Asunto(s)
Penfigoide Ampolloso/etiología , Traumatismos por Radiación/diagnóstico , Anciano de 80 o más Años , Neoplasias de la Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Femenino , Humanos , Penfigoide Ampolloso/diagnóstico , Traumatismos por Radiación/etiología , Dosificación RadioterapéuticaRESUMEN
Extrapulmonary small cell carcinoma in breast and prostate are uncommon neoplasms. In the literature most of the data come from case reports and these show that these tumours are highly aggressive. Histologically, they bear striking similarities to small cell carcinomas of the lung and usually show evidence of additional histologies. Treatment, which may include surgery, radiotherapy and chemotherapy, is based on the clinical stage. We present the evolution of two cases.
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Neoplasias de la Mama/patología , Carcinoma de Células Pequeñas/patología , Neoplasias de la Próstata/patología , Adulto , Anciano , Neoplasias de la Mama/terapia , Carcinoma de Células Pequeñas/terapia , Terapia Combinada , Femenino , Humanos , Masculino , Neoplasias de la Próstata/terapia , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Tomografía de Emisión de Positrones , Neoplasias PulmonaresRESUMEN
Objetivo: La mayoría de los pacientes con carcinoma de pulmón no microcítico y estadio III no son candidatos a cirugía y pueden beneficiarse del tratamiento combinado con quimioterapia (QT) y radioterapia (RT). En este trabajo se han analizado los resultados de una pauta combinada secuencial y el valor pronóstico de variables clínicas y analíticas iniciales. Pacientes y métodos: Se ha realizado un estudio retrospectivo de 92 pacientes con carcinoma de pulmón no microcítico y estadio III tratados con una pauta secuencial combinada de QT (3 combinaciones diferentes de carboplatino: con etopósido, con gencitabina y con paclitaxel) y RT (6.000 cGy: 200 cGy diarios, 5 días/semana). Se evaluaron la respuesta, la supervivencia global y el valor pronóstico de variables epidemiológicas, clínicas y analíticas mediante análisis univariante y multivariante. Resultados: La supervivencia mediana fue de 14 meses, con una supervivencia a los 3 años del 16,1%. El mal estado general grado 2 de la escala del Eastern Cooperative Oncological Group (ECOG), la anemia y las concentraciones séricas elevadas de antígeno carcinoembrionario fueron predictivos de peor supervivencia en el modelo multivariante. Además, en el análisis univariante la pérdida de peso y los diagnosticados antes del año 2000 también se asociaron a peor pronóstico (p < 0,01). El grado TNM no alcanzó la significación estadística (p = 0,08). La toxicidad fue escasa; hubo una muerte y pocos casos de grados III y IV de la Organización Mundial de la Salud. Conclusiones: Un mal estado general (ECOG 2) debe considerarse una contraindicación para el uso de pautas combinadas de QT y RT. La pérdida de peso, las concentraciones séricas elevadas de antígeno carcinoembrionario y una cifra de hemoglobina igual o inferior a 12 g/dl conllevan peor pronóstico
Objective: Most patients with stage III non-small cell lung cancer (NSCLC) are not candidates for surgery but can benefit from chemotherapy combined with radiation therapy. The objective of the present study was to analyze the results of sequential chemotherapy and radiation therapy and the prognostic value of initial clinical and laboratory variables. Patients and methods: We carried out a retrospective study of 92 patients with stage III NSCLC treated with a sequential regimen of chemotherapy (carboplatinetoposide, carboplatingemcitabine, and carboplatinpaclitaxel), and radiation therapy (6000 cGy in daily doses of 200 cGy, 5 d/wk). Response to therapy, overall survival, and the prognostic value of epidemiological, clinical, and laboratory variables were evaluated using univariate and multivariate analyses. Results: Median survival time was 14 months, with a 3-year survival rate of 16.1%. Poor performance status (score of 2 on the Eastern Cooperative Oncologic Group [ECOG] scale), anemia, and elevated serum concentrations of carcinoembryonic antigen were predictive of poorer survival in the multivariate analysis. In the univariate analysis, weight loss and diagnosis before the year 2000 were also associated with poorer prognosis (P<.01). TNM stage was not significantly correlated (P=.08). Toxicity was low, with 1 death and few cases of grade 3 or 4 toxicity according to World Health Organization criteria. Conclusions: The use of chemotherapy combined with radiation therapy should be considered contraindicated in cases of poor performance status (ECOG scale score of 2). Weight loss, an elevated serum concentration of carcinoembryonic antigen, and a hemoglobin concentration of 12 g/dL or less carry a poor prognosis