SBRT-SG-01: final results of a prospective multicenter study on stereotactic body radiotherapy for liver metastases.

OBJECTIVE: This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases. METHODS: Patients with up to 5 liver metastases were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0. RESULTS: A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4-30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed. CONCLUSIONS: This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.

Stereotactic body radiation therapy (SBRT) for spinal metastases: 12 years of a single center experience.

OBJECTIVE: To assess the clinical outcomes of patients with spine metastases treated with SBRT at our institution. MATERIALS AND METHODS: Patients with spine metastases treated with SBRT (1 fraction/18 Gy or 5 fractions/7 Gy) during the last 12 years have been analyzed. All patients were simulated supine in a vacuum cushion or with a shoulder mask. CT scans and MRI image registration were performed. Contouring was based on International Spine-Radiosurgery-Consortium-Consensus-Guidelines. Highly conformal-techniques (IMRT/VMAT) were used for treatment planning. Intra and interfraction (CBCT or X-Ray-ExacTrac) verification were mandatory. RESULTS: From February 2010 to January 2022, 129 patients with spinal metastases were treated with SBRT [1 fraction/18 Gy (75%) or 5 fractions/7 Gy] (25%). For patients with painful metastases (74/129:57%), 100% experienced an improvement in pain after SBRT. With a median follow-up of 14.2 months (average 22.9; range 0.5-140) 6 patients (4.6%) experienced local relapse. Local progression-free survival was different, considering metastases's location (p < 0.04). The 1, 2 and 3 years overall survival (OS) were 91.2%, 85.1% and 83.2%, respectively. Overall survival was significantly better for patients with spine metastases of breast and prostate cancers compared to other tumors (p < 0.05) and significantly worse when visceral metastases were present (p < 0.05), when patients were metastatic de novo (p < 0.05), and in those patients receiving single fraction SBRT (p: 0.01). CONCLUSIONS: According to our experience, SBRT for patients with spinal metastases was effective in terms of local control and useful to reach pain relief. Regarding the intent of the treatment, an adequate selection of patients is essential to propose this ablative approach.

Intrafraction target shift comparison using two breath-hold systems in lung stereotactic body radiotherapy.

Background and purpose: In lung Stereotactic Body Radiotherapy (SBRT) respiratory management is used to reduce target motion due to respiration. This study aimed (1) to estimate intrafraction shifts through a Cone Beam Computed Tomography (CBCT) acquired during the first treatment arc when deep inspiration breath-hold (DIBH) was performed using spirometry-based (SB) or surface-guidance (SG) systems and (2) to analyze the obtained results depending on lesion localization. Material and methods: A sample of 157 patients with 243 lesions was analyzed. A total of 860 and 410 fractions were treated using SB and SG. Averaged intrafraction shifts were estimated by the offsets obtained when registering a CBCT acquired during the first treatment arc with the planning CT. Offsets were recorded in superior-inferior (SI), left-right (LR) and anterior-posterior (AP). Significance tests were applied to account for differences in average offsets and variances between DIBH systems. Systematic and random errors were computed. Results: Average offset moduli were 2.4 ± 2.2 mm and 3.5 ± 2.6 mm for SB and SG treatments (p < 0.001). When comparing SB and SG offset distributions in each direction no differences were found in average values (p > 0.3). However, variances were statistically smaller for SB than for SG (p < 0.001). The number of vector moduli offsets greater than 5 mm was 2.1 times higher for SG. Compared to other locations, lower lobe lesions moduli were at least 2.3 times higher. Conclusions: Both systems were accuracy-equivalent but not precision-equivalent systems. Furthermore, the SB system was more precise than the SG one. Despite DIBH, patients with lower lobe lesions had larger offsets than superior lobe ones, mainly in SI.

Análisis de la eficacia de dos modalidades de tratamiento cognitivo-conductual grupal para el juego patológico / Analysis of the effectiveness of two types of group cognitive-behavioral treatment of pathological gambling

El presente estudio se ha dirigido a analizar la eficacia y la eficiencia de dos programas de tratamiento grupa cognitivo-conductual, así como a determinar los factores predictores de respuesta al tratamiento, en una muestra de jugadores patológicos. Para ello, se incluyeron 194 sujetos que acudieron al Hospital Universitario de Bellvitge (HUB) solicitando tratamiento por su problema. Los resultados evidenciaron que el tratamiento cognitivo-conductual grupal mostraba ser eficaz en la mayoría de pacientes, siendo la tasa de abandonos para la muestra total del 33,0% y la de recaídas del 24,5%. Se observaron, asimismo, cambios significativos entre el pre y el post-test en las medidas de psicopatología y gravedad de la conducta de juego. Se evidenció que el riesgo de abandono y recaída decrecía significativamente tras la quinta sesión de terapia. Finalmente, se identificaron como factores de pobre respuesta al tratamiento la gravedad del problema de juego, la elevada impulsividad y búsqueda de sensaciones, así como la gravedad de la psicopatología asociada. Sin embargo, la persistencia como rasgo de temperamento pareció actuar como factor protector de recaída

The present study aimed to analyze the efficacy and efficiency of two cognitive-behavioral group treatment programs, as well as to determine which factors predict response to treatment, in a sample of pathological gamblers. We included 194 subjects seeking treatment for pathological gambling at Bellvitge University Hospital. The results indicated that our cognitive-behavioral group treatment was efficacious in most patients. The dropout rate for the total sample was 33,0% and the relapse rate was 24,5%. In addition, we observed statistically significant pretreatment- post- treatment changes in some measures of psychopathological state and severity of gambling behavior. The risk of dropouts and relapses decreased significantly after the fifth session of therapy. Finally, severity of gambling behavior, high impulsivity, high novelty seeking, and severity of the psychopathological state were identified as factors predicting poor response to treatment. However, persistence seemed to act as a temperamental protective factor for relapse