Advances in Cranial Surgery.

The landscape of the cranial neurosurgery has changed tremendously in past couple of decades. The main frontiers including introduction of neuro-endoscopy, minimally invasive skull base approaches, SRS, laser interstitial thermal therapy and use of tubular retractors have revolutionized the management of intracerebral hemorrhages, deep seated tumors other intracranial pathologies. Introduction of these novel techniques is based on smaller incisions with maximal operative corridors, decreased blood loss, shorter hospital stays, decreased post-operative pain and cosmetically appealing scars that improves patient satisfaction and clinical outcomes. The sophisticated tools like neuroendoscopy have improved light source, and better visualization around the corners. Advanced navigated tools and channel-based retractors help us to target deeply seated lesions with increased precision and minimal disruption of the surrounding neurovascular tissues. Advent of stereotactic radiosurgery has provided us alternative feasible, safe and effective options for treatment of patients who are otherwise not medically stable to undergo complex cranial surgical interventions. This paper review advances in treatment of intracranial pathologies, and how the neurosurgeons and other medical providers at the University of Missouri-Columbia (UMC) are optimizing these treatments for their patients.

Changes in inpatient brain arteriovenous malformation management in the United States following the ARUBA trial: analysis of an interrupted time series design.

The November 2013 online publication of ARUBA, the first multi-institutional randomized controlled trial for unruptured brain arteriovenous malformations (AVMs), has sparked over 100 publications in protracted debates METHODS: This study sought to examine inpatient management patterns of brain AVMs from 2009 to 2016 and observe if changes in U.S. inpatient management were attributable to the ARUBA publication using interrupted time series of brain AVM studies from the National Inpatient Sample data 2009-2016. Outcomes of interest were use of embolization, surgery, combined embolization and microsurgery, radiotherapy, and observation during that admission. An interrupted time series design compared management trends before and after ARUBA. Segmented linear regression analysis tested for immediate and long-term impacts of ARUBA on management. RESULTS: Elective and asymptomatic patient admissions declined 2009-2016. In keeping with the ARUBA findings, observation for unruptured brain AVMs increased and microsurgery decreased. However, embolization, radiosurgery, and combined embolization and microsurgery also increased. For ruptured brain AVMs, treatment modality trends remained positive with even greater rates of observation, embolization, and combined embolization and microsurgery occurring after ARUBA (data on radiosurgery were scarce). None of the estimates for the change in trends were statistically significant. CONCLUSIONS: The publication of ARUBA was associated with a decrease in microsurgery and increase in observation for unruptured brain AVMs in the US. However, inpatient radiotherapy, embolization, and combined embolization and surgery also increased, suggesting trends moved counter to ARUBA's conclusions. This analysis suggested that ARUBA had a small impact as clinicians rejected ARUBA's findings in managing unruptured brain AVMs.

Radiosurgical thalamotomy for essential tremor: state of the art, current challenges and future directions.

INTRODUCTION: Essential tremor (ET) is the most frequent movement disorder, affecting up to 5% of adults > 65 years old. In 30-50% of cases, optimal medical management provides insufficient tremor relief and surgical options are considered. Thalamotomy is a time-honored intervention, which can be performed using radiofrequency (RF), stereotactic radiosurgery (SRS), or magnetic resonance-guided focused ultrasounds (MRgFUS). While the latter has received considerable attention in the last decade, SRS has consistently been demonstrated as an effective and well-tolerated option. AREAS COVERED: This review discusses the evidence on SRS thalamotomy for ET. Modern workflows and emerging techniques are detailed. Current outcomes are analyzed, with a specific focus on tremor reduction, complications and radiological evolution of the lesions. Challenges for the field are highlighted. EXPERT OPINION: SRS thalamotomy improves tremor in > 80% patients. The efficacy appears comparable to other modalities, including DBS, RF and MRgFUS. Side effects result mostly from idiosyncratic hyper-responses to radiation, which occur in up to 10% of treatments, are usually self-resolving, and are symptomatic in < 4% of patients. Future research should focus on accumulating more data on bilateral treatments, collecting long-term outcomes, refining targeting, and improving lesion consistency.

Stereotactic arrhythmia radioablation and its implications for modern cardiac electrophysiology: results of an EHRA survey.

Stereotactic arrhythmia radioablation (STAR) is a treatment option for recurrent ventricular tachycardia/fibrillation (VT/VF) in patients with structural heart disease (SHD). The current and future role of STAR as viewed by cardiologists is unknown. The study aimed to assess the current role, barriers to application, and expected future role of STAR. An online survey consisting of 20 questions on baseline demographics, awareness/access, current use, and the future role of STAR was conducted. A total of 129 international participants completed the survey [mean age 43 ± 11 years, 25 (16.4%) female]. Ninety-one (59.9%) participants were electrophysiologists. Nine participants (7%) were unaware of STAR as a therapeutic option. Sixty-four (49.6%) had access to STAR, while 62 (48.1%) had treated/referred a patient for treatment. Common primary indications for STAR were recurrent VT/VF in SHD (45%), recurrent VT/VF without SHD (7.8%), or premature ventricular contraction (3.9%). Reported main advantages of STAR were efficacy in the treatment of arrhythmias not amenable to conventional treatment (49%) and non-invasive treatment approach with overall low expected acute and short-term procedural risk (23%). Most respondents have foreseen a future clinical role of STAR in the treatment of VT/VF with or without underlying SHD (72% and 75%, respectively), although only a minority expected a first-line indication for it (7% and 5%, respectively). Stereotactic arrhythmia radioablation as a novel treatment option of recurrent VT appears to gain acceptance within the cardiology community. Further trials are critical to further define efficacy, patient populations, as well as the appropriate clinical use for the treatment of VT.

Emerging radiotherapy technology in a developing country: A single Brazilian institution assessment of stereotactic body radiotherapy application / Tecnologias emergentes em radioterapia em um país em desenvolvimento: perfil do uso de radiocirurgia extracraniana em uma instituição filantrópica privada

Summary Objective: To provide a quantitative profile of the indications and use of stereotactic body radiotherapy (SBRT) in a developing country oncology-based institution. In addition, to describe the patients' and treatment characteristics, and to provide a temporal analysis. Method: SBRT patients treated from 2007 to 2015 were retrospectively evaluated by two independently investigators. Data were stratified and compared in two periods: first experience (FE) (May 2007 to April 2011), and following experience (FollowE) (May 2011 to April 2015). The following parameters were compared between the groups: total number of treated patients and lesions, treatment site, additional image fusion used, formal protocol adoption, and SBRT planning technique. Results: One hundred and seventy-six (176) patients with 191 lesions were treated: 34 (18%) lesions in the FE and 157 (82%) lesions in FollowE. The majority of lesions were metastases (60.3%), and lung (60.2%) was the most common treatment site, followed by spine (31%), and others (8.8%). An average of 1.4 (±0.6) additional imaging exams for delineation was performed. Conformal 3D radiotherapy planning technique was used in 64.4%, and intensity modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) in the remaining 35.6% (p=0.0001). Higher rates of curative treatments were observed in FE, as well as more lung lesions, patients ≥ 70 years, 3D conformal, number of additional images and ECOG 0, and all presented p<0.05. The global rate of protocol statement was 79%, lung treatment being the most stated. Conclusion: SBRT application is rapidly increasing in our setting. Treatment sites and planning techniques are becoming more diversified and complex.

Resumo Objetivo: realizar uma análise quantitativa das indicações e do uso de SBRT (stereotactic body radiotherapy) em uma instituição filantrópica. Além disso, descrever temporalmente as características dos pacientes e tratamentos. Método: retrospectivamente, foram coletados, por dois investigadores independentes, os dados de todos os pacientes tratados com SBRT na instituição no período de maio de 2007 a fevereiro de 2015. Dados foram estratificados e comparados em dois períodos: inicial (P1) (maio de 2007 a abril de 2011) e período seguinte (P2) (maio de 2011 a abril de 2015). Os seguintes parâmetros foram comparados entre os grupos: número total de pacientes e lesões tratadas, local de tratamento, uso de imagens adicionais, adoção formal de protocolo e técnica de planejamento. Resultados: foram avaliados 176 pacientes e 191 lesões, sendo 34 (18%) no P1 e 157 (82%) no P2, tratados com SBRT. A maioria das lesões eram metastáticas (60,3%), sendo pulmão o sítio mais prevalente, contabilizando 115/191 (60,2%) lesões, seguida de lesões ósseas (30,8%). Uma média de 1,4 (±0,6) exame de imagem adicional foi usada para o delineamento. Uso formal de protocolo/recomendações foi descrito em 79% das lesões. A técnica 3D-conformada (3DCRT - three-dimensional conformal radiotherapy) foi a mais utilizada para planejamento [123/191 (64,4%) lesões] quando comparada à intensidade modulada e ao arco dinâmico (p=0.0001). O P1 esteve associado a maior número de lesões primárias tratadas (OR 2,09; p=0,0005), lesões pulmonares (OR 3,85; p=0,0198), pacientes ≥ 70 anos (OR 2,77; p=0,0005), uso de planejamento 3D (OR 16; p=0,0001), menor uso de imagens adicionais [0 ou 1 (versus > 1)] (OR 7,5; p=0,0001) e ECOG 0 (vs. > 0) (OR 0,21; p=0,0431). Conclusão: o uso de SBRT aumentou ao longo do tempo na instituição. No P2, notou-se uma evolução técnica, com indicações mais diferenciadas, maior uso de imagens auxiliares para definição do alvo e técnicas de planejamento mais sofisticadas.

Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions

Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.

Estimulación cerebral para el trastorno obsesivo-compulsivo resistente a tratamiento médico / Deep brain stimulation for drug-resistant obsessive-compulsive disorder

Aproximadamente un 10% de los pacientes con trastorno obsesivo-compulsivo tienen formas crónicas muy incapacitantes de la enfermedad, resistentes a las terapias conservadoras actuales, lo que conlleva un deterioro significativo para su calidad de vida y altas tasas de suicidio. Para estos pacientes se dispone de nuevas terapias efectivas mediante tratamiento neuroquirúrgico. A continuación revisamos de forma exhaustiva las técnicas neuroquirúrgicas actuales y las tasas de remisión y efectos adversos, con sus aspectos metodológicos fundamentales. La realización de pequeñas lesiones en dianas específicas del circuito límbico, como la cingulotomía, la capsulotomía, la tractotomía subcaudada o la leucotomía límbica, está siendo sustituida por la estimulación cerebral profunda mediante electrodos en estas dianas, lo que permite efectuar una terapia reversible y adaptable a las necesidades del paciente. Además, el desarrollo de la neuroimagen y el mejor conocimiento de los circuitos cerebrales han permitido la identificación de nuevas dianas para la neuroestimulación en este trastorno, con buenos resultados. La investigación debe continuar progresando para mejorar el tratamiento de los pacientes con trastorno obsesivo-compulsivo resistente (AU)

Approximately 10% of patients with obsessive-compulsive disorder have very disabling chronic forms of the disease, which are resistant to all current conservative therapies. These patients experience a significant deterioration in their quality of life and high rates of suicide. The development of new effective neurosurgical treatments has led to an improvement in a significant percentage of patients that would otherwise have remained severely disabled. We comprehensively review remission rates, adverse effects and fundamental methodological aspects of the current neurosurgical techniques for medication resistant obsessive-compulsive disorder. The making of small lesions in specific targets of the limbic circuit, such as cingulotomy, capsulotomy, limbic leucotomy and subcaudate tractotomy, is being replaced by deep brain stimulation through electrodes located in these targets, which is reversible and adaptable to every patient's need. Furthermore, the development of neuroimaging techniques and a better understanding of brain circuits in the last decades, have allowed the identification of new targets for neurostimulation in this disorder, with good results. Research must continue in order to help in the treatment of medication-resistant obsessive-compulsive disorder (AU)

Stereotactic body radiation therapy for spinal metastases

The goal of this paper is to expose the clinical results and review of the literature of the treatment of spinal metastases with Stereotactic Body Radiation Therapy (SBRT) presenting one case. A spinal metastases from rectal cancer treated with a single dose of 18Gy is presented. The following physics aspects are exposed: Treatment volume, tumor volume marginal doses and maximum doses in organs at risk. Clinical and radiographic follow up is presented. Local control and pain relief after one year of follow up was excellent. In properly selected patients, the treatment of limited metastatic disease with SBRT appears to be feasible and safe (AU)

Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) is increasing in incidence and the majority of patients are not candidates for radical therapies. Therefore, interest in minimally invasive therapies in growing. METHODS: A Phase I dose escalation trial was conducted at Indiana University to determine the feasibility and toxicity of stereotactic body radiation therapy (SBRT) for primary HCC. Eligible patients had Child-Turcotte-Pugh's Class (CTP) A or B, were not candidates for resection, had 1-3 lesions and cumulative tumour diameter less than or equal to 6 cm. Dose escalation started at 36 Gy in 3 fractions (12 Gy/fraction) with a subsequent planned escalation of 2 Gy/ fraction/level. Dose-limiting toxicity (DLT) was defined as Common Terminology Criteria for Adverse Events v3.0 grade 3 or greater toxicity. RESULTS: Seventeen patients with 25 lesions were enrolled. Dose was escalated to 48 Gy (16 Gy/fraction) in CTP-A patients without DLT. Two patients with CPC-B disease developed grade 3 hepatic toxicity at the 42-Gy (14 Gy/fraction) level. The protocol was amended for subsequent CTP-B patients to receive a regimen of 5 fractions starting at 40 Gy (8 Gy/fraction) with one patient experiencing progressive liver failure. Four additional patients were enrolled (one died of unrelated causes after an incomplete SBRT course) without DLT. The only factor related to more than one grade 3 or greater liver toxicity or death within 6 months was the CTP score (p=0.03). Six patients underwent a liver transplant. Ten patients are alive without progression with a median FU of 24 months (10-42 months), with local control/stabilisation of the disease of 100%. One and two-year Kaplan-Meier estimates for overall survival are 75% and 60%, respectively. CONCLUSIONS: SBRT is a non-invasive feasible and well tolerated therapy in adequately selected patients with HCC. The preliminary local control and survival are encouraging. A confirmatory Phase II trial is currently open to accrual (AU)

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Gamma Knife radiosurgery for occipital condyle metastasis

We present a 45 year old female with right occipital condylar metastases who was treated at William Beaumont Hospital in the Gamma Knife Unit. Clinical results at 17 months follow-up and MRI are expose (AU)

Estudio descriptivo de las pacientes sometidas a biopsia radioquirúrgica de mama en los últimos 3 años / No disponible

Objetivos: Analizar el papel actual que desempeña la biopsiaradioquirúrgica (BRQ) en el diagnóstico y tratamiento delcáncer de mama subclínico.Pacientes y métodos: Análisis retrospectivo de 100 mujeressometidas a BRQ entre enero de 2004 y mayo de 2008.Resultados: En 57% de las pacientes el diagnóstico finalfue de patología maligna, 32% invasores y 25% intraductales.Otro 17% correspondió a lesiones premalignas. En 62 casosse realizó punción biopsia histológica previa a la BRQ. Las pacientescon patología maligna que previamente realizaron unapunción biopsia histológica, requirieron menos procedimientosquirúrgicos para obtener márgenes libres, especialmenteen caso de carcinoma ductal in situ.Conclusión: En los últimos años se optimizó el diagnósticode las lesiones no palpables de la mama, logrando reducir elnúmero de cirugías innecesarias(AU)

Objectives: To analyze the current role of needle localizationbreast biopsy (NLBB) in the diagnosis and treatment ofearly breast cancer.Patients and methods: A retrospective analysis of 100women undergoing NLBB between January 2004 and May2008.Results: In 57% of the patients, the final diagnosis was amalignant disease, 32% invasive and 25% intraductal tumours.Another 17% were promalignant lesions. In 62 cases percutaneousneedle biopsy was performed prior to the NLBB. Breastcancer patients which previously received a percutaneousbiopsy, required less surgical procedures to obtain free margins,specially in ductal carcinoma in situ cases.Conclusion: In recent years, the diagnosis of nonpalpablelesions of the breast were optimized, reducing the number ofunnecessary surgeries(AU)

Malformaciones arteriovenosas durales en el ámbito de la ORL / Arterioveinous dural malformation in ENT

La Malformación Arteriovenosa Dural (MAVD) es una entidad rara dentro de las anomalías vasculares intracraneales, con etiología nobien conocida y variabilidad en sus tratamientos. Presentamos once casos de MAVDs de entre los cuales 5 presentaban el acúfeno como síntoma de aparición. La importancia de esta patología hace necesario descartarla ante un paciente que consulta por un acúfeno pulsátil con otoscopia normal

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy

Terapias físicas en psiquiatría. Estimulación cerebral profunda y trastorno obsesivo compulsivo / Physical therapies in psychiatry. Deep cerebral stimulation and obsessive-compulsive disorder

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El proceso tecnológico en Radioterapia. Su relevancia clínica / The technological process in Radiotherapy. Its clinical relevance

El objetivo de este trabajo e sir desarrollando y comentando los diversos avances que se han producido en las fases fundamentales del tratamiento de radioterapia así como señalar cuales pueden ser los futuros posibles desarrollos de los mismos. De una forma clara y simple se abordan los grandes avances tecnológicos producidos en los últimos años y s repercusión en la mejora y precisión de la radioterapia (AU)

This work mentions the different developments produced in the fundamental phases of Radiotherapy treatment, as well as the possible developments which may be produced in the future (AU)

Tratamiento quirúrgico: técnicas, indicaciones, resultados y complicaciones / Surgical treatment: techniques, indications, results and complications

En el momento actual, el tratamiento electivo de la acromegalia consiste en la resección quirúrgica del adenoma productor de hormona del crecimiento con conservación de la función hipofisaria. La mayoría de los casos son intervenidos mediante un abordaje transesfenoidal, que puede ser sublabial o intranasal. El endoscopio puede mejorar la visión de algunos aspectos de la resección quirúrgica realizada con un microscopio y es útil como adyuvante de la microcirugía. La resección quirúrgica de un adenoma con técnica endoscópica exclusiva puede presentar serias limitaciones en los campos quirúrgicos con hemorragia, lo que añade riesgo y en ningún caso mejora los resultados endocrinológicos que ofrece la microcirugía. Estos resultados guardan relación con el tamaño del tumor y los criterios de curación utilizados, así como con el tiempo de evolución postoperatoria. En general se puede esperar una remisión de la enfermedad en más del 90% de los casos intervenidos por tumores < 1 cm de diámetro, pero también se puede obtener la remisión de la enfermedad en al menos un 15% de los casos con adenomas invasivos. El porcentaje de complicaciones es bajo, con insuficiencia de la función hipofisara secundaria al acto quirúrgico en alrededor del 1% de los casos (AU)

Transsphenoidal microsurgery remains the most valid and widely used method of treating acromegaly. This procedure that has been proved relatively safe, achieves selective adenomectomy in a great number of cases and a successful outcome in about 90% of patients with microadenomas. Pituitary insuficiency surgically realated in less than 1% of the cases. 90% of all pituitary adenomas can be treated via the transphenoidal approach using different entry sites: sublabial, pernasal, endonasal. The use of endoscopes is very helpful for better visualization within the sphenoid sinus, especially within the sella, but does not seem to improve the final endocrinological results. Acurate endocrinological diagnosis and early surgical treatment lead to prevent tumor growth and possible focal or general invasion. An other surgical point, is the the prevention of the possibility of pituitary apoplexy rare but life threatening (AU)

Radioterapia en el tratamiento de la acromegalia: técnicas, indicaciones, resultados y complicaciones / Radiotherapy in the treatment of acromegaly: techniques, indications, results and complications

El tratamiento de la acromegalia incluye cirugía, medicación y radioterapia. El objetivo común es normalizar la hipersecreción hormonal, reducir los síntomas y controlar el tamaño tumoral. Esto debería cumplirse manteniendo, además, la función hipofisaria normal y con la menor morbilidad posible. La radioterapia esta indicada en los casos de rechazo a la cirugía y/o fracaso del tratamiento médico o quirúrgico. Una radioterapia convencional con dosis de al menos 45 Gy pueden normalizar las concentraciones de hormona del crecimiento y factor de crecimiento similar a la insulina tipo I, pero se requiere un tiempo prolongado, de 6 a 10 años para conseguirlo. La complicación más frecuente es el hipopituitarismo. Nuevas técnicas de alta precisión en las que se utilizan varias fracciones (radioterapia estereotáxica) o altas dosis en una única fracción (radiocirugía) son efectivas, con el beneficio potencial de reducir el volumen de tejido sano irradiado. La comparación de resultados en la probabilidad de normalización bioquímica entre radiocirugía y radioterapia es muy compleja por los diferentes valores utilizados en las diversas series. Con radiocirugía, los porcentajes de curación son muy dispares (20-80%), pero en los trabajos en los cuales los datos son examinados por los mismos autores, la respuesta es significativamente más rápida con radiocirugía. El momento adecuado para administrar el tratamiento médico en relación con la fecha y la irradiación debe ser definido debido al efecto negativo que ejerce con la radioterapia. Para conocer la verdadera ventaja de estas nuevas modalidades en la curación y la reducción de los efectos secundarios es necesario que se empleen los criterios de curación correctos y que se realicen estudios amplios, prospectivos y con seguimientos prolongados (AU)

Currently available therapies for acromegaly are surgery, medical therapy and radiotherapy. The goals of these therapies are normalize excessive hormone secretion, to reduce the clinical signs and symptoms and to control tumour size. These goals should be accomplished while preserving pituitary function and with a few side effects as possible. Indications for radiotherapy include patients refusing surgery or in whom medical and surgical therapies failed. Conventionally fractionated radiotherapy at least 45 Gy can lower GH levels and normalize IGF-I, but there is a long lag time 5-10 years, before this effect is achieved. The most common complications are the development of new hipopituitarism. New high precision techniques using several fractions (stereotactic radiotherapy) or high doses in single fraction (radiosurgery) are an effective procedure in acromegaly with the potential benefit in reducing the volume of normal brain irradiated. Comparison of results of hormone normalization in radiosurgery series to radiotherapy series is made difficult by the different values used by investigators, and endocrine cure rates whit radiosurgery fairly wide variations (20-80%) but in reports in which the data are examined by the same authors, the response is significantly faster with radiosurgery. The optimal timing of administration of antisecretory medications with respect to the date of radiation needs to be clarified for the negative effect in radiation response. To know the real advantages of new techniques in endocrine cure rate and toxicity level is necessary to use correct cure criteria and long-term prospective studies (AU)

Qué aporta la Radioterapia Oncológica a la oncología. Una visión actual y una aproximación al mañana / How does Radiotherapy Oncology benefit Oncology? An overview of the current situation and a look at tomorrow

En este artículo se hace una revisión general de la contribución de la oncología radioterápica a la disciplina de la oncología. Se detalla en diversos apartados como son las aportaciones en el campo de los avances tecnológicos, los avances en radiobiología que han permitido mejorar el índice terapéutico y la asociación con fármacos antineoplásicos en esquemas de radioquimioterapia. Finalmente se destacan los progresos futuros en la utilización de irradiación con hadrones (protones, iones acelerados, etc) y la sinergia terapéutica con fármacos dirigidos a las nuevas dianas moleculares (AU)

This article offers a general overview of Radiotherapy Oncology´s contribution to Oncology, with detail insight into the aspects of technological improvements, breakthrough improvements in radiobiology that have raised therapeutic standards, and the association of antineoplasic drugs in radiochemotheerapy programmes (AU)

Integración de la Radioterapia Oncológica en un sistema de salud y un Plan de cáncer. La experiencia en Cataluña / The integration of Radiotherapy Oncology in Health Systems and Cancer Units. The experience of Catalonia

En este artículo se describen los principios y características generales de la integración de la oncología radioterápica dentro de una atención oncológica global en la Comunidad Autónoma de Catalunya y dentro del modelo sanitario específico promovido por el Servei Catalá de la Salut. Se describen en detalle las tendencias de la organización del sistema sanitario en los próximos años y como se deben adecuar al Plan de Cáncer de Catalunya. Finalmente se comentan los retos específicos de la oncología radioterápica concretamente relacionados con la planificación de recursos sanitarios (AU)

The authors of this paper outline the integration of Radiotherapy Oncology within the global oncological service provided by the Autonomous Community of Catalonia health care system and the specific health care model promoted by the Catalan Health Care System (AU)

Bases físicas y diferencias de la planificación en RT conformacional, radiocirugía, radioterapia estereotáxica y RTD. Implicaciones terapéuticas

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