Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015-2020

Purpose. Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS). Materials and methods. The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old. Results. The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate. Conclusion. Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity (AU)

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Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015-2020.

PURPOSE: Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS). MATERIALS AND METHODS: The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old. RESULTS: The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate. CONCLUSION: Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.

Acute Exercise and Oxidative Stress: CrossFit(™) vs. Treadmill Bout.

CrossFit(™), a popular high-intensity training modality, has been the subject of scrutiny, with concerns of elevated risk of injury and health. Despite these concerns empirical evidence regarding physiologic stresses including acute oxidative stress is lacking. Therefore, the purpose of this investigation was to examine the acute redox response to a CrossFit(™) bout. Furthermore, these findings were compared to a high-intensity treadmill bout as a point of reference. Ten males 26.4 ± 2.7 yrs having three or more months of CrossFit(™) experience participated in the present study. Blood plasma was collected at four time points: Pre-exercise (PRE), immediately-post-exercise (IPE), 1 hr-post (1-HP) and 2 hr-post (2-HP), to examine oxidative damage and antioxidant capacity. Regarding plasma oxidative damage, CrossFit(™) and Treadmill elicited a time-dependent increase of lipid peroxides 1-HP (CrossFit(™)=+143%, Treadmill=+115%) and 2-HP (CrossFit(™)=+256%, Treadmill+167%). Protein Carbonyls were increased IPE in CF only (+5%), while a time-dependent decrease occurred 1-HP (CrossFit(™)=-16%, Treadmill=-8%) and 2-HP (CF=-16%, TM=-1%) compared to IPE. Regarding antioxidant capacity, Ferric Reducing Antioxidant Power also demonstrated a time-dependent increase within CrossFit(™) and Treadmill: IPE (CrossFit(™)=+25%, Treadmill=+17%), 1-HP (CrossFit(™)=+26%, Treadmill=+4.8%), 2-HP (CrossFit(™)=+20%, Treadmill=+12%). Total Enzymatic Antioxidant Capacity showed a time-dependent decrease in IPE (CrossFit(™)=-10%, Treadmill=-12%), 1-HP (CrossFit(™)=-12%, Treadmill=-6%), 2-HP (CrossFit(™)=-7%, Treadmill=-11%). No trial-dependent differences were observed in any biomarker of oxidative stress. The CrossFit(™) bout elicited an acute blood oxidative stress response comparable to a traditional bout of high-intensity treadmill running. Results also confirm that exercise intensity and the time course of exercise recovery influence oxidative responses.

Randomised study of single dose (8 Gy vs. 6 Gy) of analgesic radiotherapy plus zoledronic acid in patients with bone metastases.

OBJECTIVE: To assess the effectiveness of a single dose of radio therapy (8 Gy vs. 6 Gy) plus zoledronic acid in cancer patients with bone metastases in treating pain; quality of life, time to onset of skeletal events and functional status. MATERIAL AND METHODS: A total of 139 patients from 22 Spanish hospitals were randomly assigned to: Group A, administered a single dose of 8 Gy+zoledronic acid (4 mg iv, in 15-min infusions), and Group B, administered a single dose of 6 Gy+zoledronic acid (4 mg iv, in 15-min infusions). The main variable was pain, which was assessed with the Visual Analogue Pain Scale (VAS) in supine, seated and standing positions. RESULTS: There was a total of 118 patients for intention to treat (n=67 in Group A and n=51 in Group B). The most frequent primary neoplasms were the lung (29.66%), prostate (22.03%) and breast (21.19%). Sixty patients were analysed per protocol, n=34 in group A and n=26 in group B. Improvements were observed in the VAS scores for pain in all three positions. The mean time to onset of the event was greater (p=0.0211) in Group A than in Group B (122 vs. 81.62 days). Functional status improved in Group A, and quality of life improved in both groups. CONCLUSION: The two groups achieved similar levels of pain control in supine, seated and standing positions. Quality of life also improved in both groups. However, the higher dose (8 Gy dose) in combination with zoledronic acid is associated with a longer period without skeletal events.

Randomised study of single dose (8 Gy vs. 6 Gy) of analgesic radiotherapy plus zoledronic acid in patients with bone metastases

OBJECTIVE: To assess the effectiveness of a single dose of radio therapy (8 Gy vs. 6 Gy) plus zoledronic acid in cancer patients with bone metastases in treating pain; quality of life, time to onset of skeletal events and functional status. MATERIAL AND METHODS: A total of 139 patients from 22 Spanish hospitals were randomly assigned to: Group A, administered a single dose of 8 Gy+zoledronic acid (4 mg iv, in 15-min infusions), and Group B, administered a single dose of 6 Gy+zoledronic acid (4 mg iv, in 15-min infusions). The main variable was pain, which was assessed with the Visual Analogue Pain Scale (VAS) in supine, seated and standing positions. RESULTS: There was a total of 118 patients for intention to treat (n=67 in Group A and n=51 in Group B). The most frequent primary neoplasms were the lung (29.66%), prostate (22.03%) and breast (21.19%). Sixty patients were analysed per protocol, n=34 in group A and n=26 in group B. Improvements were observed in the VAS scores for pain in all three positions. The mean time to onset of the event was greater (p=0.0211) in Group A than in Group B (122 vs. 81.62 days). Functional status improved in Group A, and quality of life improved in both groups. CONCLUSION: The two groups achieved similar levels of pain control in supine, seated and standing positions. Quality of life also improved in both groups. However, the higher dose (8 Gy dose) in combination with zoledronic acid is associated with a longer period without skeletal events (AU)

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Cálculo de costes en Radioterapia según el modelo ABC / Cost calculation in Radiotherapy according to the ABC model

El aumento de los costes en sanidad require un uso racional de los recursos disponibles. Para la evaluación precisa del coste efectividad de un tratamiento con radioterapia externa, es necesario efectuar una estimación precisa del coste. Uno de los métodos más comunes para el cálculo de los costes es el método ABC. Una vez calculados los costes se podrán efectuar los distintos análisis de costes para las diferentes situaciones clínicas (minimización de costes, coste efectividad, coste beneficio, coste utilidad). La evaluación económica de las diferentes opciones terapéuticas será necesaria para el ajuste de los beneficios conseguidos en términos de control tumoral, complicaciones de los tejidos normales y calidad de vida del paciente, a los recursos económicos (AU)

This article presents one of the methods for calculating costs in Radiotherapy, the ABC method. Because health costs increasingly require a rational use of the available resources, with this system, once the costs have been calculated, different financial analyses can be conducted for different clinical situations (AU)

Toxicidad de piel. Prevencion y tratamiento / No disponible

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Radioterapia y citoprotección. Estado actual / No disponible

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Resultados a largo plazo del tratamiento del estesioneuroblastoma. Experiencia en Aragón (1981- / Long term results of the esthesioneuroblastoma treatment. Experience in Aragón (1981-2003)

Propósito: el estesioneuroblastoma o neuroblastoma olfatorio es un tumor infrecuente. Se han publicado sólo un millar de casos en la literatura médica. La edad media de presentación es a los 50 años, no teniendo predilección por ningún sexo. Es un tumor de agresividad local con recidivas locales tardías. Se han descrito metástasis a distancia, frecuentemente pulmón y hueso. Presentamos nuestra experiencia en el manejo y tratamiento de este tipo de tumor.- Material y métodos: entre 1981 y 2003, 8 casos de estesioneuroblastoma fueron diagnosticados en el Hospital Clínico Universitario de Zaragoza, un hospital terciario con 882 camas, que es referencia para radioterapia de alta energía en todo Aragón, por lo que con toda probabilidad, este número de casos corresponde al de diagnósticos en la Comunidad Autónoma de Aragón en ese período. Cinco varones y 3 mujeres con una mediana de edad de 60 años (rango 49-82). Los síntomas más frecuentes a la presentación incluyeron: obstrucción nasal, epistaxis, anosmia, exoftalmus, edema palpebral y tumefacción local. El estadio de Kadish al diagnóstico fue: 3 pacientes estadio B, 2 estadio C y 3 estadio D. Cirugía, radioterapia y quimioterapia fueron frecuentemente combinadas. En dos pacientes el tratamiento fue cirugía, sola en un paciente y en otro con radioterapia radical. Tres pacientes recibieron quimioterapia, sola en dos pacientes y combinada con radioterapia en el otro. Tres pacientes fueron tratados con radioterapia sólo.- Resultados: dos pacientes están vivos sin enfermedad tras 87 y 108 meses del diagnóstico y uno más está actualmente en tratamiento. Cuatro pacientes murieron con progresión a los 6, 8, 38 y 63 meses del diagnóstico. Un paciente falleció por un segundo tumor a los 36 meses del diagnóstico.- Conclusión: el control local es un requisito esencial para obtener supervivencias a largo plazo en el estesioneuroblastoma (AU)

Infrastructure of radiotherapy in Spain: a minimal standard of radiotherapy resources.

PURPOSE: To assess the state of our specialty, the Spanish Society of Radiotherapy and Oncology ordered a survey of all Spanish services of radiation oncology. METHODS AND MATERIALS: In June 1999, the Society ordered an analysis of the state of radiation oncology. It created a survey that was sent to all radiotherapy units in Spain. A database was created in which 230 variables were analyzed. RESULTS: Eighty-four centers were analyzed, and 157 external beam irradiation, megavoltage units were counted, of which 67 were cobalt units and 90 were linear accelerators. The cobalt units worked an average of 11.4 h daily and the linear accelerators 11.6 h. The number of patients/unit/y was 472 for the cobalt units and 442 for the linear accelerators. The number of patients by physician and year was 179. Each center received a mean of 958 new patients annually. The average between the reception and start of treatment was 25.52 days (maximum 60), and it was estimated that only 38.1% of cancers were irradiated. The number of radiation oncologists working was 392. Spain has a deficit of 297 radiation oncologists. CONCLUSION: There is a need for 44 MV units and for the replacement of 67 cobalt units. The present lack of units has had an impact on palliative treatment, which has resulted in pharmacy costs. As long as these instrumental deficiencies are not solved, waiting lists will continue to be inherent to the system. There are also important staff deficiencies, in that about 297 radiation oncologists would be needed to cover the needs.

Radioterapia y citoprotección. Mecanismo de acción. Bases

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Radiation myelopathy in over-irradiated patients: MR imaging findings.

The objective of this work is to report the MRI findings in patients with radiation myelopathy due to accidental local over-irradiation syndrome. Eight patients (seven males and one female) were suffering from over-irradiation syndrome as a result of treatments from a malfunctioning linear electron accelerator. The mean accidental estimated dose was 136 Gy delivered to the "open-neck" (seven cases) and to the thoracic wall (one case), during a mean of 5.4 sessions (range 1-9 sessions). Paresthesia and weakness in the upper extremities were the earliest symptoms (87.5 %), with evolution to paralysis in all patients. No patient is alive (mean survival time 64 days). In all cases MRI was negative for neurologic lesions in the acute phase ( < 90 days from irradiation; Radiation Therapy Oncology Group scoring system). Late signs of radiation myelitis manifested as high-intensity signals on T2-weighted images in three patients, and as Gd-DTPA enhancement of T1-weighted images in one case. Autopsies performed on four patients who died in acute phase showed morphologic alterations in white matter: edema in 75 %, and necrosis and glial reaction as well as obliterative vasculitis in all cases. In cases of over-irradiation, MRI may be normal in acute phase even if the patients have severe neurologic deficit, as positive MRI findings appear only in delayed radiation myelitis.

Lymphangiosarcoma in a chronic lymphedematous limb: a case report.

A 69-year-old-woman developed a lymphangiosarcoma of the limb on chronic lymphedema after radical mastectomy and radiotherapy for primary breast cancer 12 years before. Since 1948, when Stewart and Treves described this entity, 200 cases have been described. We report this case because of its extremely rare frequency. Concepts of etiology, treatment and prognosis are reviewed.

[Combined concomitant chemotherapy and radiotherapy with or without surgery in the treatment of non-metastatic squamous carcinoma of the esophagus]. / Combinación de quimioterapia y radioterapia concomitantes con o sin cirugía en el tratamiento del carcinoma escamoso de esófago no metastásico.

Between June 1986 and October 1992 two prospective non-randomized and consecutive therapeutic schemes with a curative intent of non-metastatic squamous cell carcinoma of the esophagus were developed. The first scheme consisted of concomitant administration of chemotherapy (cisplatin and 5-fluorouracil, 2 cycles) and radiotherapy (30 Gys) after surgery (esophagectomy) (14 evaluable patients). Without surgery, a higher dose of chemotherapy (4 cycles) and radiotherapy (55 Gys) was given on the second scheme (12 evaluable patients). Complete histological response was 42.6% for the first scheme and 50% for the second one. Toxicity was moderate in both schemes. Palliation was important in the second scheme. Actuarial survival was 28% at 1 year for the first scheme and 71% for the second one. Operative mortality was 27%. Concomitant chemoradiotherapy might be a therapeutic choice for locoregional control of squamous esophageal carcinoma.

Accidental overirradiation syndrome.

Between the 10th and 20th December 1990, there was a malfunction in the operation of the Electron Linear Accelerator (ELA) at the Hospital Clínico Universitario in Zaragoza (Spain), which led to irradiation with the highest beam energy. This situation shows the existence of a latent period between the irradiation and the appearance of the symptoms, even in situations involving much higher than normal doses in cases of localized irradiation.