Age, Gleason Score, and PSA are important prognostic factors for survival in metastatic castration-resistant prostate cancer. Results of The Uroncor Group (Uro-Oncological Tumors) of the Spanish Society of Radiation Oncology (SEOR).

INTRODUCTION: The treatment of metastatic castration-resistant prostate cancer (mCRPC) has changed significantly in recent years. Inhibitors of androgen receptors have shown especially significant benefits in overall (OS) and progression-free survival (PFS), with a good toxicity profile. Treatment selection depends on the patient's individual clinical, radiological, and biological characteristics. OBJECTIVE: To describe treatment outcomes (efficacy, toxicity) in a cohort of patients with mCRPC in Spain. MATERIALS AND METHODS: Multicenter, retrospective study of patients with mCRPC included in a database of the Urological Tumour Working Group (URONCOR) of the Spanish Society of Radiation Oncology (SEOR). Metastatic CRPC was defined according to the prostate cancer working group 3 (PCWG3) criteria. The Kaplan-Meier technique was used to evaluate OS and the Common Terminology Criteria for Adverse Events (CTCAE, v.4.0) were used to assess toxicity. Univariate and multivariate Cox regression analyses were performed to identify the factors significantly associated with OS. RESULTS: A total of 314 patients from 17 hospitals in Spain diagnosed with mCRPC between June 2010 and September 2017 were included in this study. Mean age at diagnosis was 68 years (range 45-89). At a median follow-up of 35 months, OS at 1, 3, and 5 years were 92%, 38%, and 28%, respectively. Grades 1-2 and grade 3 toxicity rates were, respectively, 68% and 19%. No grade 4 toxicities were observed. On the multivariate analysis, the following factors were significantly associated with OS: age (hazard ratio [HR] 0.42, p = 0.010), PSA value at diagnosis of mCRPC (HR 0.55, p = 0.008), and Gleason score (HR 0.61, p = 0.009). CONCLUSIONS: Age, Gleason score, and PSA at diagnosis of mCRPC are independently associated with overall survival in patients with mCRPC. The efficacy and toxicity outcomes in this patient cohort treated in radiation oncology departments in Spain are consistent with previous reports.

Anxiety in adolescence. Can we prevent it?

BACKGROUND: Emotions are potent modulators and motivators of the behaviour that the individual displays in the different situations they have to live and they can act as a protection factor or vulnerability of the adapted or maladaptive behaviour. This study focuses on anxiety in adolescence. OBJECTIVES: The objective is, through a longitudinal study, to analyse the psychological processes and emotions that facilitate the symptoms of anxiety and those which protect the adolescent from these symptoms. MATERIAL AND METHODS: 417 adolescents (192 boys and 225 girls) participated in a three-wave longitudinal study in Valencia, Spain. In the first wave, adolescents were either in the third year of secondary school (81 boys and 85 girls) or the fourth year of secondary school (111 boys and 140 girls). The mean age was 14.70 (SD = 0.68; range = 13-17 years). This study monitored participating adolescents for three years. RESULTS: The results indicate a differential profile in the evaluated emotions according to sex, with the girls being the ones to experiment more anxiety and more empathy, while the boys show more emotional instability and aggression. CONCLUSIONS: It is concluded that the best predictors for anxiety are anger state, aggressive behaviour, empathic concern together with the lack of coping mechanisms focused on problem solving and the perception of stress as a threat.

The role of emotions in depression and aggression.

BACKGROUND: Depression is a broad and heterogeneous diagnostic grouping, central to which is depressed mood or inability to enjoy most activities. Depressive symptoms are frequently accompanied by conduct problems stemming from anger. It is very important to know the interrelation of these emotions very well to be able to help adolescents to manage them more easily. The main aim of this article is to present the problem of interaction between negative affects (emotional instability, anger state and trait, physical and verbal aggression and depression) analyzing the different relationship through the time in spanish sample. MATERIAL AND METHODS: The sample included 470 adolescents (192 boys and 225 girls) in a three-wave longitudinal study in Valencia (Spain). The mean age was 14.70 in the first wave. Structural equations modelling was employed to explore two longitudinal models. RESULTS: The results show differences based on sex, and that an internalised variable, like emotional instability, is relevant to prevent the appearance of depression directly in girls and also the later appearance of aggression as long as anger mediates, in both boys and girls, so the control of anger becomes an important goal to control the rest of the negative affects. CONCLUSIONS: This results has consequences in the preparation of all programmes that try to establish an emotional control on adolescents, as not only has to be taken into account as a direct goal the control of externalised emotions like anger, but internalised emotions like emotional instability have to be taken into account also. Furthermore, it is also made apparent that not only the punctual explosions and externalisation of anger have to be worked on, but the temperamental aspects which are the base of anger trait have to be worked on too.

Infrastructures, treatment modalities, and workload of radiation oncology departments in Spain with special attention to prostate cancer.

AIM: The purpose of the study was to describe infrastructures, treatment modalities, and workload in radiation oncology (RO) in Spain, referred particularly to prostate cancer (PC). METHODS: An epidemiologic, cross-sectional study was performed during 2008-2009. A study-specific questionnaire was sent to the 108 RO-registered departments. RESULTS: One hundred and two departments answered the survey, and six were contacted by telephone. Centers operated 236 treatment units: 23 (9.7 %) cobalt machines, 37 (15.7 %) mono-energetic linear accelerators, and 176 (74.6 %) multi-energy linear accelerators. Sixty-one (56.4 %) and 33 (30.5 %) departments, respectively, reported intensity-modulated radiation therapy (IMRT) and image-guided RT (IGRT) capabilities; three-dimensional-conformal RT was used in 75.8 % of patients. Virtual simulators were present in 95 departments (88.0 %), 35 use conventional simulators. Fifty-one departments (47.2 %) have brachytherapy units, 38 (35.2 %) perform prostatic implants. Departments saw a mean of 24.9 new patients/week; the number of patients treated annually was 102,054, corresponding to 88.4 % of patients with a RT indication. In 56.5 % of the hospitals, multidisciplinary teams were available to treat PC. CONCLUSIONS: Results provide an accurate picture of current situation of RO in Spain, showing a trend toward the progressive introduction of new technologies (IMRT, IGRT, brachytherapy).

Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study.

BACKGROUND: Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). METHODS: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4 mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (ß-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. RESULTS: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with ß-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. CONCLUSION: In patients with PCa and bone metastases treated with ZA, ß-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially important.

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study.

BACKGROUND: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). METHODS: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxy-terminal telopeptide of type I collagen (ß-CTX) were analysed. RESULTS: Patients with RCC who died or progressed had higher baseline ß-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline ß-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that ß-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. CONCLUSION: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOL.

The white book of radiation oncology in Spain

The White Book of Radiation Oncology provides a comprehensive overview of the current state of the speciality of radiation oncology in Spain and is intended to be used as a reference for physicians, health care administrators and hospital managers. The present paper summarises the most relevant aspects of the book's 13 chapters in order to bring the message to a wider audience. Among the topics discussed are the epidemiology of cancer in Spain, the role of the radiation oncologist in cancer care, human and material resource needs, new technologies, training of specialists, clinical and cost management, clinical practice, quality control, radiological protection, ethics, relevant legislation, research & development, the history of radiation oncology in Spain and the origins of the Spanish Society of Radiation Oncology (SEOR) (AU)

Inestabilidad emocional y agresividad: factores predictors / Emotional instability and aggressiveness: Predicting factors

Este artículo persigue un doble objetivo, analizar la interrelaciones paterno-filiales y su vinculación al desarrollo de los hijos, así como las conexiones entre la agresión y la inestabilidad emocional de los menores. En el estudio participaron 2.747 personas de 10 a 15 años, escolarizados en 36 centros educativos de la Comunidad Valenciana. El 50,6% son chicos, y el 49,$% chicas. Los resultados muestran fuertes conexiones entre la agresividad física y verbal y la inestabilidad emocional. Además los individuos más prosociales suelen ser menos agresivos en sus relaciones con los demás y, por último, la crianza está asociada a la inestabilidad emocional y a las conductas agresivas de los hijos/as. En este sentido, los factores que tiene mayor peso son la permisividad y la hostilidad de la madre, en el extremo negativo, y el amor y la autonomía que la madre es capaz de ofrecer, en el positivo (AU)

This article pursues a double aim: to analyse parent-child relationships and how it affects child development, as well as the association between aggression and emotional instability. Sample consisted of 2,747 students, aged 10 to 15 years old, from 36 education centres of the Valencian Community (50,6% boys and 40,4% girls). Results show a strong connection between students ‘physical and verbal aggressiveness and their emotional instability. Prosocial individuals tend to be less aggressive in their relationships with others. In addition, certain types of rearing are associated with emotional instability and aggressive behavior in the child. The main negative factors identified are mothers ´permissiveness and hostility. In contrast, positive factors are love and autonomy offered by the mother (AU)

Radiosurgery and whole brain therapy in the treatment of brainstem metastases

PURPOSE: The incidence of brainstem metastasis (BSM) accounts for 1-3% of brain metastases (BM). They are often associated with multiple BM and produce significant neurological symptoms. We retrospectively analyse the results of treatment with stereotactic radiosurgery (SRS). METHODS AND MATERIAL: We included the medical records of 28 patients aged 52.86+/-11.29 years; 17 (60.7%) were women. The most frequent primary tumours were breast (n=11), lung (n=9) and melanoma (n=4). A total of 30 BSM were treated with radiosurgery (SRS) with a linear accelerator (Linac Scalpel, University of Florida). The 3D planning was with image fusion. RESULTS: The mean time from the diagnosis of the primary tumour to the BM was 3+/-3.35 years; 5 cases were diagnosed simultaneously. Twenty-seven patients (96.4%) received whole brain radiotherapy, 19 before SRS and 8 after. The most usual dose was 30 Gy. Three patients underwent another SRS for other BM. The medium volume of BSM was 1.86+/-2.31 cc. The mean prescribed dose was 1114.33+/-315.6 cGy. The tumour volume did not change significantly with SRS but there was neurological improvement in 13 patients (41.9%). Twenty-four patients (85.7%) died, 22 (78.5%) due to the primary tumour: 12 cases (42.8%) due to progression of BM, 1 case due to progression of BSM and 10 due to local tumour progression or extra-cerebral metastases. Mean survival from diagnosis of BM was 22.8+/-32.4 months and from SRS of BSM, 16.8+/-31.56 months (1 month to 13.54 years). CONCLUSION: The combined treatment of SRS and whole brain radiotherapy treatment is effective in the control of BSM (only one patient died due to progression of BSM), improving the neurological symptoms in 41.9% of patients; therefore an early diagnosis and treatment is important. Many patients die due to causes other than the BSM (AU)

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Tratamiento de la anorexia y pérdida de peso con acetato de megestrol en pacientes en tratamiento radioterápico. Resultados preliminares / Treatment of anorexia and weight loss with megestrol acetate in patients under radiation therapy. Preliminary results

- Introducción: Las alteraciones nutricionales son un problema frecuente en el paciente oncológico. El tratamiento con acetato de megestrol puede controlar la anorexia, conseguir ganancia de peso y mejorar la calidad de vida. Presentamos los resultados de un estudio prospectivo de pacientes con cáncer, en tratamiento radioterápico (RT) con anorexia y pérdida de peso, que recibieron tratamiento farmacológico con acetato de megestrol.- Material y métodos: 26 pacientes con anorexia y pérdida de peso > 5 por ciento, en tratamiento radioterápico, recibieron tratamiento con acetato de megestrol 800 mg/día durante 3 meses.- Resultados: Con el tratamiento con acetato de megestrol todos los pacientes dejaron de presentar anorexia. El peso medio al inicio del tratamiento fue 63,6 ñ 10,5 Kg. A pesar del tratamiento, el peso descendió durante la RT a 62.5 ñ 11,2 Kg (p n.s.) y posteriormente aumentó a 67,5 ñ 13,2 Kg, al final del estudio (p=0,04). Sólo un paciente (3,8 por ciento) presentó una tromboflebitis y otro una reacción alérgica. El estado general y la capacidad funcional empeoraron durante la RT y posteriormente mejoraron aunque sin diferencias estadísticas significativas (0,88 ñ 0,82 basal, 1,2 ñ 0,96 fin RT y 0,46 ñ 0,66 fin estudio). La puntuación del cuestionario de calidad de vida mejoró durante el estudio pero sólo se observaron diferencias significativas al comparar la puntuación basal con la del fin del estudio (p<0,005) (79,04 ñ 13,95 basal, 86,47 ñ 18,71 fin RT y 95,29 ñ 15,77 fin estudio). La puntuación de la escala analógico visual aumentó durante el estudio pero sin observar diferencias estadísticamente significativas. (16,86 ñ 4,8 basal, 19,18 ñ 7,4 fin RT y 19,18 ñ 7,4 fin estudio). - Conclusiones: El tratamiento con acetato de megestrol es eficaz para controlar la anorexia; consigue aumentar el peso una vez finalizada la radioterapia y mejora la calidad de vida (AU)

Vigilancia de los valores de colesterol sérico en una población de Cataluña. Resultados del año 2001 / Watching the levels of serum cholesterol in a town in Catalonia. Results from the year 2001

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Evidencias para un uso razonado de la asociación de hormonoterapia y radioterapia radical en el tratamiento del cáncer de próstata localizado / Evidence based medicine supporting the reasoned association of hormone therapy and radical radiotherapy in the treatment of localized prostate cancer

El cáncer de próstata es la tercera causa de cáncer en la Comunidad Europea y su incidencia continúa en aumento. Uno de los tratamientos radicales utilizados es la radioterapia y en la actualidad la escalada de dosis está demostrando un aumento significativo en los resultados de control local y supervivencia, pero ello conlleva un aumento en la toxicidad. La asociación de hormonoterapia puede conseguir una disminución del volumen blanco y en consecuencia una disminución de la toxicidad; por otro lado, estudios recientes han demostrado que el tratamiento combinado puede mejorar la supervivencia. En este estudio realizamos una revisión bibliográfica de la asociación de hormonoterapia en el tratamiento radical con radioterapia del cáncer de próstata localizado (AU)

Three decades of psychological research in the journal Cognitive Psychology (1979-1999).

We examined the journal Cognitive Psychology, as representative of the evolution of cognitive psychology during the last three decades (1979-1999). Analysis of changes in the impact factor defined according to the Social Science Citation Index (SSCI) is an indication of the ranking of this journal both in the general classification of archival research journals as well as in relation to other periodicals in the area of cognitive psychology. This single quantitative measure of articles published in Cognitive Psychology indicates a change in the topics of interest. An analysis of the research topics and identification of the most productive authors identifies important indicators of the psychological topics of primary interest during this time.

Evaluación del uso de Fentanilo transdérmico en el tratamiento del dolor crónico en pacientes que reciben radioterapia paliativa / Evaluation of the use of transdermic fentanyl treatment in chronic pain of patients under palliative radiotherapy

Propósito: Se ha evaluado el uso de fentanilo transdérmico en el tratamiento del dolor crónico en pacientes subsidiarios de tratamiento radioterápico paliativo. Material y métodos: Entre Enero de 2001 y Mayo de 2002, 224 pacientes fueron tratados con fentanilo transdérmico y Radioterapia externa, empleando fraccionamientos habituales. Se evaluó el control del dolor mediante EVA ( escala visual analógica) y los efectos secundarios producidos. Resultados: Se observó una reducción del EVA del 85 por ciento en la primera semana de tratamiento y un EVA medio de 3 al mes de tratamiento. Se observó un incremento significativo de los efectos secundarios. Conclusiones: El fentanilo transdérmico consiguió un excelente control del dolor en el 46,43 por ciento de los pacientes. Los efectos secundarios fueron principalmente estreñimiento, hipotensión y sudoración, y su incidencia se puede paliar con el empleo de antieméticos y laxantes (AU)

Psychology's Evolution through its texts: Analysis of E. R. Hilgard's Introduction to Psychology / Evolución de la Psicología a través de sus textos: Análisis de Introducción a la Psicología de E. R. Hilgard

Introductory textbooks may be considered as testimonials to the level of a science at a given time. Hilgard’s Introduction to Psychology has been published in 13 editions, the first in 1953 and the last in the year 2000. The analysis of the successive editions of this text provides information regarding the changes that have taken place within the field of psychology during the last half of the 20th century. The contents of the text that are analyzed in this study include the definition of psychology that appears throughout this period, the emphasis that is given to the various psychological processes and the areas of psychology, and the presence of authors with a large number of works cited in the successive editions (AU)

Los manuales introductorios pueden ser considerados como testimonios del nivel de ciencia de un momento dado. La introducción a la Psicología de Hilgard ha sido publicada en 13 ediciones, la primera en 1953 y la última en el año 2000. El análisis de las sucesivas ediciones de este testo proporciona información en relación a los cambios que han tenido lugar dentro del campo de la psicología durante la última parte del siglo XX. Los contenidos del texto que se han analizado en el estudio incluyen la definición de psicología que aparece a través de este período, el énfasis que se ha dado a los diversos procesos psicológicos y las áreas de la psicología, y la presencia de autores con un gran número de trabajos citados en las sucesivas ediciones (AU)

[Levels of serum cholesterol in a catalan population. Evolution over a 6- year period (1994-1996)]. / Niveles de colesterol sérico en una población de Cataluña. Evolución en un período de 6 años (1994-1999).

OBJECTIVE: To study the evolution of the serum levels of cholesterol in a population over 6 years. Design. cross-sectional observational study.Setting. Primary and specialist care in the county of Osona (Barcelona). PARTICIPANTS: Study of those patients attending for health consultations in the county, whether at primary or hospital level, and who had their cholesterol level determined. MAIN MEASUREMENTS: The levels of serum cholesterol of the 7882 patients studied during September to December 1994 was compared with those of the 10 319 patients analysed during the same months of 1999. RESULTS: The mean levels of cholesterol increased steadily in both sexes with age, up to the fifth or sixth decade of life, at which point a slow descent started. Cholesterolaemia was higher in men than in women in the third and fourth decades of life; but from this age on, mean levels are higher in women than in men. Cholesterol levels in both sexes were higher in the 1999 period studied than in 1994. During 1999, 52.7% of men and 52.3% of women had serum cholesterol levels above 200 mg/dL, whereas in 1994 these figures were 49.1% and 49.2%, respectively. CONCLUSIONS: Mean levels of serum cholesterol in the population under study are high and increased between the two sampling years. Preventive and hygiene-diet measures need to be fomented among the general population in order to improve control of cholesterolaemia.

Niveles de colesterol sérico en una población de Cataluña. Evolución en un período de 6 años (1994-1999) / Levels of serum cholesterol in a catalan populatin.Evolution over a 6- year period (1994-1996)

Objetivo. Estudiar la evolución de las concentraciones séricas de colesterol de una población en un intervalo de 6 años. Diseño. Estudio observacional, transversal. Emplazamiento. Atención primaria y especializada de la comarca de Osona (Barcelona). Intervenciones. Estudio realizado sobre pacientes que se han visitado en centros sanitarios de la comarca, tanto de atención primaria como hospitalarios, y a los que se les ha practicado una determinación de colesterol. Mediciones principales. Se compararon las cifras de colesterol sérico de los 7.882 pacientes estudiados durante los meses de septiembre a diciembre del año 1994 con las de los 10.319 pacientes analizados durante los mismos meses del año 1999. Resultados. Los niveles medios de colesterol se incrementan en ambos sexos de forma progresiva con la edad hasta la quinta y sexta décadas de la vida, y a partir de esta última se observa un descenso paulatino. La colesteremia es más elevada en los varones que en las mujeres en la tercera y cuarta décadas de la vida, y a partir de este grupo de edad los valores medios son más altos en las mujeres que en los varones. En ambos sexos las cifras de colesterol son más altas en el período estudiado de 1999 que en el correspondiente al año 1994. Durante 1999 se observó que un 52,7 por ciento de los varones y el 52,3 por ciento de las mujeres presentaban unas cifras de colesterol sérico > 200 mg/dl, mientras que en 1994 estos porcentajes eran de 49,1 por ciento y 49,2 por ciento, respectivamente. Conclusiones. Los valores medios de colesterol sérico en la población estudiada son altos y se incrementan en los años observados. Se hace necesario potenciar las medidas preventivas e higiénico-dietéticas sobre la población para mejorar el control de la colesteremia. (AU)

Radioterapia en el tratamiento conservador del cáncer del seno / X-ray in the preservative processing of the cancer of the sine

Presenta la experiencia del Hospital 12 de Octubre sobre el tratamiento conservador del cáncer del seno, durante el período de observación de 1978 a 1990 que alcanza 218 pacientes. Propicia este tratamiento como la línea más racional, como garantía de la calidad asistencial, ya que mutilación no es sinónimo de curación y la extirpación contribuye a crear insatisfacción e imperfección. Apoyábamos el tratamiento no mutilante en los resultados obtenidos por otros autores, así como en nuestra propia experiencia, pero no consignábamos todavía los resultados de estudios randomizados. Considerábamos la terapéutica conservadora como la sumación de esfuerzos quirúrgicos (tumurectomía y vaciamiento axilar) y radioterápicos (irradicación de la mama y en ocasiones de las áreas ganglionares) e implicábamos los tratamientos sistémicos en dependencia de factores pronósticos específicos para cada caso...