Feasibility of integrating a multi-camera optical tracking system in intra-operative electron radiation therapy scenarios.

Intra-operative electron radiation therapy (IOERT) combines surgery and ionizing radiation applied directly to an exposed unresected tumour mass or to a post-resection tumour bed. The radiation is collimated and conducted by a specific applicator docked to the linear accelerator. The dose distribution in tissues to be irradiated and in organs at risk can be planned through a pre-operative computed tomography (CT) study. However, surgical retraction of structures and resection of a tumour affecting normal tissues significantly modify the patient's geometry. Therefore, the treatment parameters (applicator dimension, pose (position and orientation), bevel angle, and beam energy) may require the original IOERT treatment plan to be modified depending on the actual surgical scenario. We propose the use of a multi-camera optical tracking system to reliably record the actual pose of the IOERT applicator in relation to the patient's anatomy in an environment prone to occlusion problems. This information can be integrated in the radio-surgical treatment planning system in order to generate a real-time accurate description of the IOERT scenario. We assessed the accuracy of the applicator pose by performing a phantom-based study that resembled three real clinical IOERT scenarios. The error obtained (2 mm) was below the acceptance threshold for external radiotherapy practice, thus encouraging future implementation of this approach in real clinical IOERT scenarios.

Surgery and intraoperative electron radiotherapy in recurrent or metastatic oligotopic extrapelvic cancer: long-term outcome.

PURPOSE: To evaluate the feasibility and long-term outcome of surgery combined with intraoperative electron radiotherapy (IOERT) as rescue treatment in patients with recurrent and/or metastatic oligotopic extrapelvic cancer. METHODS AND MATERIALS: From April 1996 to April 2010, we treated 28 patients using 34 IOERT procedures. The main histopathology findings were adenocarcinoma (39%) and squamous cell carcinoma (29%). The original cancer sites were gynecologic (67%), urologic (14%) and colorectal (14%). The location of recurrence was the para-aortic region in 53.5% of patients. RESULTS: Median follow-up was 39 months (1-84 months), during which time 14% of patients experienced local recurrence and 53.5% developed distant metastasis. Overall survival at 2 and 5 years was 57% and 35% respectively. At the time of the analysis, 13 patients were alive, 6 for more than 55 months of follow-up. Local control was not significantly affected by the following histopathologic characteristics of the resected surgical specimen: number of fragments submitted for pathology study (1 to >6), maximal tumor dimension (≤ 2 to ≥ 6 cm), rate of involved nodes (0-100%) and involved resection margin (local recurrence 23% vs 7%; p = 0.21). Local recurrence was significantly affected by microscopic cancer in more than 50% of specimen fragments (38% vs 9%, p = 0.02). CONCLUSIONS: IOERT for recurrence of oligotopic extrapelvic cancer increased long-term survival in patients with controlled cancer and appears to compensate for some adverse prognostic features in local control. Individualized treatment strategies for this heterogeneous category of patients with recurrent cancer will make it possible to optimize results.

Immune system-tumour efficiency ratio as a new oncological index for radiotherapy treatment optimization.

A dynamical system model for tumour-immune system interaction together with a method to mimic radiation therapy are proposed. A large population of virtual patients is simulated following an ideal radiation treatment. A characteristic parameter, the immune system-tumor efficiency ratio (ISTER) is introduced. ISTER dependence of treatment success and other features are studied. Radiotherapy treatment dose optimization, following ALARA (As Low As Reasonably Achievable) criterion, as well as a patient classification are drawn from the statistics results.

[Splenic irradiation: apropos of 8 cases. Clinical indications and literature review]. / Radioterapia esplénica: a próposito de 8 casos. Indicaciones y revisión de la literatura.

Clinical indications of splenic irradiation in haematological disorders include the irradiation in lymphoproliferative disorders with spleen infiltration, palliative treatment of splenomegaly in malignant diseases like chronic lymphocytic leukaemia or myeloproliferative disorders, with the purpose of relief from abdominal pain associated with capsular enlargement size and decrease cytopenias secundaries to hypersplenism.This paper reports our experience with spleen irradiation in the Hospital General Universitario Gregorio Marañón in the last five years, and analyzes indications, results and toxicity, and an actual review of the literature.

Radioterapia esplénica: a propósito de 8 casos. Indicaciones y revisión de la literatura / Splenic irradiation: a proposal of 8 cases. Clinical indications and literature review

Las indicaciones de la radioterapia (RT) esplénica en los desórdenes hematológicos incluye la irradiación del bazo en aquellos procesos linfoproliferativos, que cursan con infiltración del mismo, el tratamiento paliativo de la esplenomegalia en las enfermedades malignas como la leucemia linfoide crónica o los síndromes mieloproliferativos, que cursan con dolor por la distensión capsular del bazo, y las citopenias secundarias al hiperesplenismo. En este trabajo presentamos la experiencia acumulada en el tratamiento de la esplenomegalia con RT del Hospital General Universitario Gregorio Marañón en los últimos 5 años, analizando sus indicaciones, resultados y toxicidad así como una revisión actualizada de la literatura

Clinical indications of splenic irradiation in haematological disorders include the irradiation in lymphoproliferative disorders with spleen infiltration, palliative treatment of splenomegaly in malignant diseases like chronic lymphocytic leukaemia or myeloproliferative disorders, with the purpose of relief from abdominal pain associated with capsular enlargement size and decrease cytopenias secundaries to hypersplenism. This paper reports our experience with spleen irradiation in the Hospital General Universitario Gregorio Marañón in the last five years, and analizes indications, results and toxicity, and an actual review of the literature

Informed consent in radiation oncology: is consenting easier than informing?

The patient's right to be informed has been universally recognized and reflected in the legal system of many countries. This right to correct and complete information on behalf of the patient and his admission to proceed with the recommended diagnostic or therapeutic procedure is formalized in the document commonly known as informed consent. Although the legal and bioethical considerations regarding this document have been exhaustively discussed and consensuated, its content continues to create certain doubts and uncertainties. The formal content and the manner in which the consent is obtained are the most difficult aspects. In this article, we analyze what should be included in the written informed consent, with regard to the totality of the information which the patient receives, who should inform, and how the consent should be obtained, as well as how to reflect the different aspects of the variety of radiotherapeutic procedures in the informed consent (AU)

Oncología Radioterápica en el Hospital. Un modelo viable para la integración en gestión, asistencia, docencia e investigación / Radiotherapeutic Oncology in the Hospital. A viable model for integration in management, care, teaching and investigation

La gestión clínica en Oncología Radioterápica (OR) debe organizar la práctica asistencial, la docencia y la investigación desde un compromiso de innovación permanente. Su ámbito de actuación, estrictamente hospitalario, unido a una práctica sujeta a una exigente normativa legal, hacen de la OR una especialidad exigente en su compromiso asistencial. En el presente capítulo, se analizan las características diferenciadoras de la OR, así como la integración en la gestión de la asistencia, la docencia y la investigación, sin olvidar sus limitaciones y la necesaria relación con otras especialidades (AU)

This work analyses the differentiating characteristic of Radiotherapeutic Oncology, as well as its integration in the management of care, teaching and investigation, without forgetting its limitations and the necessary relation with other specialties (AU)

Patterns of failure after prophylactic cranial irradiation in small-cell lung cancer: analysis of 505 randomized patients.

BACKGROUND: Prophylactic cranial irradiation (PCI) has a beneficial effect on overall survival in patients with small-cell lung cancer (SCLC) in complete remission as shown in a worldwide meta-analysis. The current analysis aimed to evaluate PCI effects on patterns of failure in this patient category. PATIENTS AND METHODS: The Institut Gustave-Roussy coordinated two parallel randomized studies including a total of 511 patients with SCLC. Patients were randomly assigned to either PCI (24 Gy in eight fractions and 12 days) or no PCI. Patterns of failure were analyzed according to (i) total event rates and (ii) isolated first site of relapse using a competing risk approach. RESULTS: Five hundred and five patients were analyzed. The 5-year cumulative rate of brain metastasis as an isolated first site of relapse was 37% in the control group and 20% in the PCI group (P < 0.001). The overall 5-year rates of brain metastasis were 59% and 43%, respectively [relative risk (RR) 0.50; P < 0.001]. The 5-year overall survival rates were 15% in the control group and 18% in the PCI group (RR 0.84; P = 0.06). CONCLUSIONS: PCI decreased significantly the risk of brain metastasis. Other events were not influenced. The relative death risk reduction was of borderline significance. Results reported as isolated first cause of failure and subsequent competing events may explain why a major treatment effect on brain metastases rate has a rather moderate effect on survival.

Papel actual de la radioterapia en el tratamiento de la enfermedad de Hodgkin / Current role of radiation therapy in the management of Hodgkin’s disease

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Cronificar el cáncer: ¿a quién beneficia? / Making cancer chronic: whom deles it benefit?

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Efectos de los tratamientos citotóxicos sobre los tejidos, curvas de supervivencia celular a los citostáticos y radiaciones

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[Breast metastases from embryonal rhabdomyosarcoma: apropos 2 cases and a review of the literature]. / Metástasis mamarias de rabdomiosarcoma embrionario: a propósito de dos casos y revisión de la literatura.

The presence of breast metastases is uncommon in oncology. In children and young adults, the most common type of primary tumour is rhabdomyosarcoma, and primary breast rhabdomyosarcomas are exceptional. Two cases are reported of breast metastatic rhabdomyosarcoma in two adolescents with several atypical characteristics in their presentation forms: the embryonal variety and the primary location at maxillary sinus. The cases reported in the literature up to now were reviewed, with a special emphasis on epidemiologic, clinical, diagnostic, and therapeutic data of this rare entity.

Los tratamientos combinados en la terapéutica de inducción del cáncer de pulmón: ¿Cuántos se quedan en el camino? / The combined treatment as inductino therapy for non-samll cell lung cancer: how many persih along the way?

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Metástasis mamarias de rabdomiosarcoma embrionario: a propósito de dos casos y revisión de la literatura / Metastases to the breast of embryonal rhabdomyosarcoma: report of two cases and review of the literature

La presencia de metástasis mamarias es un hecho poco frecuente en Oncología. En los niños y adultos jóvenes el tumor primario más frecuente es el rabdomiosarcoma, siendo los rabdomiosarcomas primarios de mama excepcionales. Se describen dos casos de rabdomiosarcoma metastásico en mama en dos adolescentes con varias características atípicas en su presentación: la variedad embrionaria y la localización primaria en seno maxilar. Se analizan los casos descritos en la literatura hasta la actualidad, estudiando los datos epidemiológicos, clínicos, diagnósticos y terapéuticos de esta rara entidad (AU)

Controlled clinical trial of prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission.

We conducted a randomised clinical trial on 211 patients with small-cell lung cancer in complete remission (CR). The aim of this trial was to evaluate the effect of prophylactic cranial irradiation (PCI) on overall survival. Eligible patients were randomly assigned to receive either PCI (100 patients) or no PCI (111 patients). Each centre was allowed to use its own PCI protocol as long as the total dose was within the range of 24-30 Gy and delivered in less than 3 weeks with fractions of 3 Gy or less. The mean follow-up is 5 years. The survival curves do not differ significantly (P = 0.25) between the two groups. The 4-year overall survival rate (95% confidence interval) is 22% [15-32%] in the PCI group versus 16% [10-25%] in the control group. The relative risk of death in the PCI group compared to the control group is 0.84 (95% CI = [0.62-1.13]). The incidence of brain metastasis is lower in the PCI group, but the difference is not statistically significant (P = 0.14). The 4-year cumulative rate of brain metastasis is 44% [32-57%] in the PCI group compared to 51% [38-63%] in the control group. In conclusion, in this study, which had to be closed prematurely, no significant difference was found in terms of the incidence of brain metastases nor in survival.