Quality indicators in radiation oncology: proposal of the Spanish Society of Radiation Oncology (SEOR) for a continuous improvement of the quality of care in oncology.

PURPOSE: Current cancer treatment options include surgical intervention, radiotherapy, and chemotherapy. The quality of the provision of each of them and their effective coordination determines the results in terms of benefit/risk. Regarding the radiation oncology treatments, there are not stabilised quality indicators to be used to perform control and continuous improvement processes for healthcare services. Therefore, the Spanish Society of Radiation Oncology has undertaken a comprehensive project to establish quality indicators for use with the information systems available in most Spanish healthcare services. METHODS: A two-round Delphi study examines consensus of several possible quality indicators (n = 28) in daily practice. These indicators were defined after a bibliographic search and the assessment by radiation oncology specialists (n = 8). They included aspects regarding treatment equipment, patient preparation, treatment, and follow-up processes and were divided in structure, process, and outcome indicators. RESULTS: After the evaluation of the defined quality indicators (n = 28) by an expert panel (38 radiation oncologist), 26 indicators achieved consensus in terms of agreement with the statement. Two quality indicators did not achieve consensus. CONCLUSIONS: There is a high degree of consensus in Spanish Radiation Oncology specialists on which indicators in routine clinical practice can best measure quality. These indicators can be used to classify services based on several parameters (patients, equipments, complexity of the techniques used, and scientific research). Furthermore, these indicators allow assess our current situation and set improvements' objectives.

Spanish Society of Radiation Oncology clinical guidelines for stereotactic body radiation therapy in lymph node oligometastases.

Data in the literature support the existence of a state of limited metastases or oligometastases. Favorable outcomes have been observed in selected patients with such oligometastases that are treated with local ablative therapies, which include surgical extirpation, stereotactic body radiation therapy (SBRT), and radiofrequency ablation. The role of SBRT in the setting of lymph node oligometastases is still emerging but the early results for local control are promising. However, the biggest challenge is to identify patients who will benefit from treatment of their oligometastatic disease with local aggressive therapy. Patients are initially categorized based upon examination of the initial biopsy, location, stage, and previous treatments received. Appropriate patient management with SBRT requires an understanding of several clinicopathological features that help to identify several subsets of patients with more responsive tumors and a good tolerance to SBRT. In an effort to incorporate the most recent evidence, here the Spanish Society of Radiation Oncology presents guidelines for using SBRT in lymph node oligometastases.

Reacción medicamentosa tipo enfermedad del suero / Pharmacological reaction like serum sickness

Presentamos un caso de enfermedad del suero en una paciente de 3 años de edad que, tras realizar tratamiento con amoxicilina-clavulánico durante 7 días, mostró clínica de urticaria y artralgias

We report a case of serum sickness in a 3-year-old patient who presented urticaria and arthralgias after seven days of treatment with amoxicillin-clavulanic

Uveítis por cotrimoxazol / Cotrimoxazole-induced uveitis

Niño de 10 años de edad que presenta hiperemia conjuntival bilateral, dolor ocular y visión borrosa tras la administración de trimetoprim-sulfametoxazol (TMP-SMX) por vía oral

The patient was a 10-year-old boy who developed bilateral conjunctival hyperemia, ocular pain and blurred vision following the administration of trimethoprim-sulfamethoxazole

Meningioma de la Vaina del Nervio Optico (MVNO). ¿La radioterapia es el actual patrón de cuidados? A propósito de un caso y revisión de la literatura / Optic nerve sheat meningioma (ONSM). Role of radiotherapy: a case report and literature review

El meningioma primario de la vaina del nervio óptico es un tumor raro, cuyo manejo diagnóstico yterapéutico ha variado de manera sustancial en los últimos años. La aparición y desarrollo de las técnicas dediagnóstico por imagen, como son la Tomografía Computerizada de Alta Resolución y la ResonanciaMagnética Nuclear, han permitido diagnósticos más precoces y precisos.La introducción de la Radioterapia Convencional (RT) a finales de los años 70, sola o en combinación conla cirugía, pero sobre todo la introducción de la Radioterapia Extereotáxica Fraccionada (RTEF) y laRadioterapia Conformacional Tridimensional (RTC3D), ha supuesto una alternativa terapéutica sumamenteeficaz y con una toxicidad relativamente baja.En este artículo revisamos en primer lugar el desarrollo embriológico, anatomía, la historia natural, eltratamiento quirúrgico, así como el papel de la RT en esta entidad, y su integración en el patrón de cuidadosactual. Analizamos las diferentes técnicas radioterápicas desde las más elementales como la RadioterapiaConvencional (RT), siguiendo con la Radioterapia Conformada 3 D (RTC3D), hasta las más sofisticadas comola Radioterapia Exterotáxica Fraccionada (RTEF), todo ello a propósito de nuestra experiencia en un caso

Primary optic nerve sheat meningioma (ONSM) is a rare tumor, whose diagnosis and therapeuticmanagement have varied in a substantial manner over the last few years. The appearance and development ofdiagnostic imaging techniques such as High Resolution Computerized Tomography and Nuclear MagneticResonance have allowed earlier and more precise diagnoses.The introduction of conventional radiation therapy in the late 1970s, alone or in combination with surgery,and above all the introduction of Fractionated Stereotactic Radiotherapy and Three-Dimensional ConformalIntensity-Modulated Radiotherapy (3DCRT) have provided very efficient alternative therapies with arelatively low toxicity.In this article we first review the embryological development, anatomy, natural history, and surgicaltreatment, and then describe the role of radiotherapy (RT) in the considered entity, indicating how it can beintegrated in the pattern of present day care.We analyse the different radiotherapy techniques, from the most elementary, such as conventional RT,followed by 3DCRT up to the most sophisticated such as Stereotactic Fractionated Radiotherapy, all based onour experience in one case

[A comparative study in rectal adenocarcinoma: preoperative or postoperative radiotherapy]. / Estudio comparativo en el adenocarcinoma de recto: radioterapia preoperatoria o postoperatoria.

PURPOSE: To compare the results of preoperative and postoperative radiotherapy in rectal adenocarcinoma, in terms of overall survival and disease-free survival. PATIENTS AND METHODS: From 1989 to 1993, 52 patients with clinically operable rectal cancer were retrospectively analyzed. Two groups were compared: Patients in Group I received postoperative radiotherapy and those in Group II preoperative radiotherapy. Patients with a Karfnosky index > 70%, no evidence of distant disease and no major systemic problems were included in this study. RESULTS: The overall 5-year actuarial survival was 75% in Group I and 83% in Group II. The 5-year disease-free survival was 52% in Group I compared to 86% in Group II, a statistically significant difference (p = 0.025). A reduction in all Dukes' stages was observed in the preoperative radiation group, allowing preservation of the anorectal function in an increased number of patients. CONCLUSIONS: We observed better results with preoperative radiotherapy and conclude that this treatment might be justified in rectal carcinoma.