Stereotactic body radiotherapy for early-stage non-small cell lung cancer: a multicentre study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)

Purpose/objective(s)Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC.Materials/methodsRetrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses.ResultsComplete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity ≥ grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%.ConclusionSBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.

Stereotactic body radiotherapy for early-stage non-small cell lung cancer: a multicentre study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society).

PURPOSE/OBJECTIVE(S): Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC. MATERIALS/METHODS: Retrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses. RESULTS: Complete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity ≥ grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%. CONCLUSION: SBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.

Tetrahydronaphthyridine and dihydronaphthyridinone ethers as positive allosteric modulators of the metabotropic glutamate receptor 5 (mGlu5).

Positive allosteric modulators (PAMs) of metabotropic glutamate receptor 5 (mGlu5) represent a promising therapeutic strategy for the treatment of schizophrenia. Starting from an acetylene-based lead from high throughput screening, an evolved bicyclic dihydronaphthyridinone was identified. We describe further refinements leading to both dihydronaphthyridinone and tetrahydronaphthyridine mGlu5 PAMs containing an alkoxy-based linkage as an acetylene replacement. Exploration of several structural features including western pyridine ring isomers, positional amides, linker connectivity/position, and combinations thereof, reveal that these bicyclic modulators generally exhibit steep SAR and within specific subseries display a propensity for pharmacological mode switching at mGlu5 as well as antagonist activity at mGlu3. Structure-activity relationships within a dihydronaphthyridinone subseries uncovered 12c (VU0405372), a selective mGlu5 PAM with good in vitro potency, low glutamate fold-shift, acceptable DMPK properties, and in vivo efficacy in an amphetamine-based model of psychosis.

Xerostomía postradioterapia. Eficacia de tratamientos tópicos basados en aceite de oliva, betaína y xilitol / Xerostomia post-radiation therapy. Efficacy of topical treatments based on olive oil, betaine and xylitol

La xerostomía es la complicación más frecuente en los pacientes que reciben radioterapia para el cáncer oral. La reducción en la tasa de flujo salival y una disminución de su pH están directamente relacionado con un cambio en la composición de la saliva y el desplazamiento de la microflora oral hacia especies bacterianas cariogénicas. Por otro lado sabemos que la xerostomía se asocia a dificultad para el habla, la masticación, la deglución, cambios en el sabor, caries dentales, sensación de ardor, infecciones microbianas y un deterioro de la calidad de vida. El manejo de la xerostomía incluye la prevención, la estimulación y el tratamiento sintomático. La prevención no siempre es posible a pesar de que con radioterapia de intensidad modulada (IMRT), se puede administrar dosis más bajas de radiación a las glándulas parótidas. Los fármacos estimuladores, como los agonistas colinérgicos, han demostrado mejorar la xerostomía, sin embargo tienen efectos secundarios y están contraindicados en algunas patologías. Hoy disponemos de una gran variedad de productos tópicos para el alivio de los síntomas de la boca seca, como la goma de mascar, pastillas sin azúcar, sustitutos salivales, cremas hidratantes o pastas dentales. Un trabajo previo nos indica que el uso diario de productos de boca seca tópicos que contienen aceite de oliva, betaína y xilitol es seguro y eficaz en el alivio de los síntomas de xerostomía en pacientes con xerostomía inducida por fármacos. En este trabajo se revisa la eficacia de las diversas opciones de tratamiento para la hiposalivación inducida por la radiación y presentamos nuestros resultados con el uso de productos tópicos específicos en estos pacientes (AU)

Xerostomia is the most frequent complication among patients who receive radiotherapy for oral cancers. A reduction in salivary flow rate and decrease of its pH is paralleled with a change in saliva competence and shifting of oral microflora to cariogenic bacterial spices. Therefore difficulties in speech, mastication, swallowing, changes in taste, dental caries, burning sensation, microbial infections and a compromised quality of life are associated with the presence of xerostomia. Studies have led to three therapeutic approach for xerostomia treatment: prevention, stimulation and symptomatic treatment. Prevention it is not always possible, although intensity modulated radiation therapy (IMRT) technique, gives the ability to delivering lower doses of radiation to parotid glands. Stimulation agents as cholinergic agonist have all demonstrated some ability to improve xerostomia, however have side effects and are contraindicated for certain medical disorders. There are a huge variety of products for relief dry mouth symptoms as Chewing gum, sugarfree lozenges, salivary substitutes and moisturizers, toothpastes. A previous study report that the daily use of topical dry mouth products containing olive oil, betaine and xilitol is safe and effective in relieving symptoms of xerostomia in a population with polypharmacy-induced xerostomia. The objective of this study is to review efficacy of various treatment options for radiation-induced hyposalivation and present our results with the use of specific topical products in this patients (AU)

Neck dissection after radiochemotherapy in patients with locoregionally advanced head and neck cancer

BACKGROUND: Primary chemoradiation is a frequent treatment for locoregionally advanced head and neck squamous cell carcinoma. Some authors claim that a neck dissection (ND) is necessary in N2/N3 disease after this treatment in order to avoid regional recurrences. The aim of this study was to determine the incidence of isolated nodal failure in patients with N2/N3 disease who achieved a complete clinical and radiological response (CR) after chemoradiation, when no planned ND was performed. METHODS: We retrospectively analysed the survival rates, nodal response and subsequent neck nodal control of 28 patients with locally advanced oropharynx, hypopharynx or larynx squamous cell carcinoma disease, treated with primary chemoradiation. RESULTS: With a median follow-up of 28 months, 2-year global survival was 73% and disease-free survival 60%. Patients who had complete local and regional response after chemoradiotherapy were followed, with 100% neck nodal control. CONCLUSION: Patients with N2/N3 disease who obtained a clinical and radiological CR to chemoradiation had a zero incidence of isolated neck failure without a planned ND. The continued use of planned NDs in this patient subset may not be justified. This can be further confirmed in randomised prospective trials (AU)

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[Study of the personality of patients with spontaneous pneumothorax]. / Estudio de personalidad de los pacientes con neumotórax espontáneo.

INTRODUCTION: Medical psychology has contributed to a greater understanding of many diseases that are predominantly medical and has also helped to improve prognosis. This study explores a surgical entity, namely spontaneous pneumothorax. OBJECTIVES: The aim was to compare the personality, depression, anxiety and type-A behavior pattern in a group of 34 patients with spontaneous pneumothorax to a group of 33 control patients admitted for a variety of minor surgical procedures. MATERIAL AND METHODS: The following objective assessment instruments were used: Trait Anxiety Inventory, Beck Depression Inventory, Jenkins Activity Inventory, Eysenck Personality Questionnaire. The questionnaires were administered before the intervention of the surgeon and after an informative interview. RESULTS: The rate of type-A behavior was statistically different in the two groups. No differences were seen for personality, depression or anxiety. CONCLUSION: We conclude that type-A behavior patterns should be reduced in patients who suffer spontaneous pneumothorax in order to improve outcome.

Estudio de personalidad de los pacientes con neumotórax espontáneo / Study of the personality of patients with spontaneous pneumothorax

INTRODUCCIÓN: La psicología médica ha ayudado a profundizar en el conocimiento y mejor evolución de diversas enfermedades en su mayoría médicas. En el presente trabajo se pretende profundizar en una afección quirúrgica como el neumotórax espontáneo. OBJETIVOS: El objetivo de este estudio ha sido comparar la personalidad, la patología afectiva, la ansiedad y el patrón de conducta tipo A de un grupo de 34 pacientes con neumotórax espontáneo con un grupo control de 33 pacientes hospitalizados por afecciones quirúrgicas menores. MATERIAL Y MÉTODOS: Se han aplicado a los sujetos pruebas objetivas de valoración: Trait Anxiety Inventory, Beck Depression Inventory, Jenkins Activity Inventory, Eysenck Personality Questionary. Los cuestionarios se administraron antes de la intervención quirúrgica y tras una entrevista informativa. RESULTADOS: Se han encontrado diferencias estadísticamente significativas entre los grupos en patrón de conducta tipo A, no siendo así en rasgos de personalidad, estado de ánimo y ansiedad. CONCLUSIÓN: Podemos concluir que para la mejor evolución de los pacientes con neumotórax espontáneo sería necesario reducir sus características del patrón de conducta tipo A (AU)

Single-step gas chromatography-mass spectrometry analysis of glycolipid constituents as heptafluorobutyrate derivatives with a special reference to the lipid portion.

In a previous work (Zanetta et al. Glycobiology 9, 255-266 (1999)), it was reported that all constituents of gangliosides could be obtained as heptafluorobutyrate derivatives after methanolysis in a single gas chromatography analysis. This report demonstrates that gas chromatography coupled with mass spectrometry in the electron impact mode allows identification and quantification of long-chain bases and fatty acids without interference from monosaccharides. On the basis of ions specific for families and for individual compounds, sphingosines, sphinganines, and phytosphingosines (including ramified, unsaturated, hydroxylated, and etherified compounds) can be identified. Fatty acid methyl esters, including linear, ramified, unsaturated, and hydroxylated species, are identified and quantified in the same way. Possible extensions of this method to the fatty moiety of other lipids (alkylacylglycerol and dimethyl acetal) are discussed.

A Lost Realm in the Internal Domains of the Betic-Rif Orogen (Spain and Morocco): Evidence from Conglomerates and Consequences for Alpine Geodynamic Evolution.

The Malaguide-Ghomaride Complex is capped by Upper Oligocene-Aquitanian clastic deposits postdating early Alpine orogenesis but predating the main tectonic-metamorphic evolution, end of nappe emplacement, unroofing, and exhumation of the metamorphic units of the Betic-Rif Orogen. Two conglomerate intervals within these deposits are characterized by clasts of sedimentary, epimetamorphic, and mafic volcanic rocks derived from Malaguide-Ghomaride units and by clasts of acidic magmatic and orthogneissic rocks of unknown provenance, here studied. Magmatic rocks originated from late-Variscan two-mica cordierite-bearing granitoids and, subordinately, from aplitic dikes. Orthogneisses derive from similar plutonic rocks but are affected by an Alpine metamorphic overprint evolving from greenschist (T=510&j0;-530 degrees C and P=5-6 kbar) to low-temperature amphibolite facies (T>550&j0;C and P<3 kbar). Such a plutonic rock suite is unknown in any Betic-Rif unit or in the basement of the Alboran Sea, and the metamorphic evolution in the orthogneisses is different from (and older than) that of Alpujarride-Sebtide rocks to which they were formerly ascribed. Magmatic and metamorphic rocks very similar to those studied characterize the basements of some Kabylia and Calabria-Peloritani units. Therefore, the source area is a currently lost continental-crust realm of Calabria-Peloritani-Kabylia type, located to the ESE of the Malaguide-Ghomaride Domain and affected by a pre-latest Oligocene Alpine metamorphism. Increasingly active tectonics transformed this realm into rising areas from which erosion fed small subsiding synorogenic basins formed on the Malaguide-Ghomaride Complex. This provenance analysis demonstrates that all these domains constituted a single continental-crust block until Aquitanian-Burdigalian times, before its dispersal around nascent western Mediterranean basins.

Trombosis de la vena central de la retina. Evolución oftalmoscópica / Central retinal vein thrombosis: ophthalmoscopic evolution

La trombosis de la vena central de la retina es una de las múltiples causas de disminución de la agudeza visual. El deterioro de la visión se instaura de forma continuada durante unas horas o pocos días. Es más frecuente en varones con una edad media de 65 años. El diagnóstico se establece principalmente a través de la visión del fondo de ojo mediante el oftalmoscopio, y el tratamiento se encamina sobre todo a evitar complicaciones como la neovascularización del iris, que puede desencadenar un glaucoma neovascular. Presentamos el caso de un varón de 50 años con disminución de la agudeza visual en el ojo derecho, de inicio brusco y una semana de evolución. En la imagen del fondo de ojo se aprecia la vena central de la retina tortuosa y dilatada, un importante componente hemorrágico y algún exudado algodonoso. Tras la fotocoagulación panrretiniana la evolución oftalmoscópica fue favorable, observándose el fondo de ojo con buen aspecto, sin aparición de neovasos y con resolución del componente hemorrágico (AU)