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.

Diagnostic performance of 18F-choline PET-CT in prostate cancer.

OBJECTIVES: To evaluate the diagnostic performance of 18F-choline PETCT in staging prostate cancer (PC) and whether the use of this imaging modality changes the therapeutic decision in patients previously staged by conventional imaging. The secondary aim was to determine the prognostic factors associated with positive choline PETCT findings in both detection of disseminated disease and in changes in the therapeutic indication. MATERIALS AND METHODS: Multicentre, retrospective, observational study of 269 patients diagnosed with PC. Mean age was 69 ± 9.2 years. Of the 269 patients, 62 (23%) had high-risk localized PC (group 1), 118 (43.9%) biochemical failure after radical prostatectomy (group 2), and 89 (33.1%) biochemical failure after radiotherapy (group 3). None of the patients showed clear evidence of distant disease on computed tomography or bone scans. The following potential prognostic factors were assessed: PSA level at diagnosis; primary and secondary Gleason; Gleason score (GS); clinical and pathologic T and N stage; number of positive cylinders in the biopsy; presence of vascular or lymphatic invasion; status of surgical margins; androgen deprivation therapy (ADT); time to biochemical recurrence; and PSA, PSA doubling time (PSADT), and PSA velocity (PSAV) at failure. Univariate and multivariate analyses were performed, and receiver-operating curves calculated. RESULTS: The mean PSA by groups was, group 1: 31.22 ng/ml, group 2: 2.52 ng/ml and group 3: 5.85 ng/ml. The tumor detection rate with 18F-choline PETCT was 74% (group 1: 85.5%, group 2: 55.1% and group 3: 91%). Prognostic factors for positive 18F-choline PETCT were identified only in group 2: PSA at failure and PSADT. 18F-choline PETCT changed the therapeutic indication in 62.8% (group 1: 71%, group 2: 55.2% and group 3: 70.1%). The prognostic factors for a change in treatment were identified only in group 1: secondary Gleason ≤ 4 and GS ≤ 7 and in group 2: PSA at failure, PSA nadir after surgery and pathologic stage N0. 18F-choline PETCT identified lymph node and/or metastatic disease in 32.7% (group 1: 25.8%, group 2: 29.7% and group 3: 41.6%). Prognostic factors for detecting lymph node/metastasis were identified in the group 2: PSA failure ≥ 1.37 ng/ml and PSADT < 4 months and in the group 3: PSADT < 4.6 months and time to failure < 5 years. CONCLUSION: These findings support the clinical use de 18F-choline PET-CT in staging high-risk patients with a secondary Gleason ≤ 4 and GS ≤ 7, in restaging patients with biochemical recurrence after RP if PSA at failure ≥ 1.37 ng/ml or PSADT ≤ 4 months and in patients with biochemical failure after RT, if PSADT ≤ 4.6 months and time to failure < 5 years, because it determines a change in the therapeutic indication.

Radioquimioterapia preoperatoria en estadio III de cáncer de recto. Comparación de dos esquemas de radioterapia / Chemoradiotherapy in stage III rectal cancer. A comparison of two radiotherapy schemes

Objetivo: Analizar la respuesta del tumor y la evolución de los pacientes con cáncer rectal en estadío III que reciben dos esquemas diferentes de quimiorradioterapia preoperatoria. Pacientes y métodos: Un total de 85 pacientes con estudio histológico de adenocarcinoma de recto clasifi cado como T3N0/N+ fueron tratados con dos dosis diferentes de la radioterapia: 40 pacientes fueron irradiados con 41,40 Gy/23 fracciones), y 45 pacientes fueron irradiados con 50,4 cGy/28 fracciones. En ambos grupos, la quimioterapia se administró simultáneamente con la radioterapia y consistió en dos esquemas diferentes: a) fl uoropirimidina oral y leucovorina, b) infusión continua de 5-fl uorouracilo. La cirugía fue realizada entre 3 y 6 semanas después de la fi nalización de la quimiorradioterapia. Se analizó la respuesta patológica completa, tasa de respuesta, la toxicidad aguda, el patrón de recurrencia y la supervivencia. Resultados: la respuesta patológica completa (PCR) se logró en el 12,5% en el grupo de 41,40 Gy, así como en el 25% del grupo de 50,40 Gy (p = 0,22). La respuesta tumoral fue de 62,5%. La toxicidad digestiva grado 3 se desarrolló en 3 pacientes y de grado 4 en 1 paciente con 41,40 Gy, y Grado 3 en 3 pacientes con 50,40 Gy. Ochenta pacientes (94,1%) fueron seguidos durante un promedio de 48 meses (rango, 4-88 m). La recurrencia local fue de 10,85% y 23,52% presentaron metástasis a distancia. La supervivencia global a los cinco años de fue de 69,7% y la supervivencia libre de enfermedad 69,7% similar en ambos grupos. Los pacientes que alcanzaron la PCR han tenido una supervivencia libre de enfermedad del 87,5% vs 69,8%, p = 0,36. Conclusión: la quimiorradioterapia preoperatoria es un tratamiento neoadyuvante seguro, bien tolerado y efectivo para el cáncer de recto localmente avanzado. Aunque este estudio fue retrospectivo, la dosis de radiación ha logrado un aumento considerable de respuesta patológica completa del tumor. No hubo diferencias signifi cativas entre ambos grupos de pacientes (AU)

Purpose: To analyse the tumor response and outcome of patients with stage III rectal cancer receiving two different schedules of preoperative chemoradiation. Patients and methods: A total of 85 patients with histological diagnostic of rectal adenocarcinoma and staging like T3N0/N+ were treated with two different doses of radiotherapy: 40 patients 41.40 Gy/23 fractions) and 45 patients were irradiated with 50.4 cGy/28 fractions. In both groups, the chemotherapy was administered concurrent with radiotherapy and consisted of two different schedules: a) oral fl uoropirimidin and leucovorin, b) continuous infusion 5-fl uorouracil. Surgery was performed between 3 and 6 weeks after the completion of chemoradiation. We analyzed pathologic complete response, downstaging rate, acute toxicity, recurrence pattern and survival. Results: Pathologic complete response (PCR) was achieved in 12,5% in group of 41.40 Gy, as well as in 25% of the group 50.40 Gy (p=0,22). Tumor downstaging was 62.5% Grade 3 digestive toxicity was developed in 3 patients and Grade 4 in 1 patient with 41.40 Gy, and Grade 3 in 3 patients with 50.40 Gy. 80 patients (94.1%) had been followed for a median of 48 months (range, 4-88 m). The local recurrence was 10.85% and of distant metastases 23.52%. Five-year overall survival was 69.7% and disease-free survival 69.7% similar in both groups. The patientswho achieved PCR had a longer disease-free survival (87.5% vs 69.8%; p=0.36). Conclusion: Preoperative chemoradiation is a safe, welltolerated and effective neoadjuvant treatment for locally advanced rectal cancer. Although this study was retrospective, increasing radiation dose has achieved a considerable pathologic complete tumor response. There was no signifi cant differences between both groups of patients (AU)

Radiation therapy for the treatment of benign vascular, skeletal and soft tissue diseases.

The concept of radiation therapy for the treatment of benign diseases refers to the use of moderate to high-energy ionising radiation as part of the treatment of non-malignant, but not necessarily harmless, diseases. The usefulness of radiation therapy, based on the anti-inflammatory properties of ionising radiation, has long been known. Apart from the treatment of intracranial benign tumours, such as meningiomas and neurinomas, the prevention of cardiovascular restenosis or treatment of skeletal degenerative diseases are, without doubt, the main fields of action for radiation therapy in benign conditions. Nonetheless, many other non-cancer entities may benefit from ionising radiation therapy treatment. The purpose of this review is to highlight and update indications for treatment with radiation therapy in benign conditions, focusing on skeletal degenerative processes, vascular conditions and soft tissue diseases.

Radiation therapy for the treatment of benign vascular, skeletal and soft tissue diseases

The concept of radiation therapy for the treatment of benign diseases refers to the use of moderate to high-energy ionising radiation as part of the treatment of non-malignant, but not necessarily harmless, diseases. The usefulness of radiation therapy, based on the anti-inflammatory properties of ionising radiation, has long been known. Apart from the treatment of intracranial benign tumours, such as meningiomas and neurinomas, the prevention of cardiovascular restenosis or treatment of skeletal degenerative diseases are, without doubt, the main fields of action for radiation therapy in benign conditions. Nonetheless, many other non-cancer entities may benefit from ionising radiation therapy treatment. The purpose of this review is to highlight and update indications for treatment with radiation therapy in benign conditions, focusing on skeletal degenerative processes, vascular conditions and soft tissue diseases (AU)

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Superoxidase dismutase (SOD) topical use in oncologic patients: treatment of acute cutaneous toxicity secondary to radiotherapy

OBJECTIVE: The objective of this study is to evaluate the efficiency of SOD applied topically in oncologic patients affected by acute radiodermatitis. MATERIALS AND METHOD: This study includes 57 patients who showed a dermatitis grade 2 or superior; they were administered SOD ointment b.i.d. (40 mg, weekly) and follow-up continued for 12 weeks. RESULTS: At the end of radiotherapy, 77.1% of the patients ameliorated completely or partially, and at the end of the 12-week period 100% of patients were free of toxicity. No acute toxicity relapses were reported. Response time reduced during radiotherapy, as well as the treatment time at the end of it. CONCLUSIONS: The employment of SOD topically is efficient in the treatment of radiodermatitis, which is an acute side effect of radiotherapy (AU)

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Importancia del estado nutricional en el paciente con cáncer / Importance of the nutritional status in the cancer patient

La incapacidad para mantener un adecuado estado de nutrición es un problema común en el paciente oncológico. Tanto la enfermedad como su tratamiento, conducen a una desnutrición calóricoproteica severa, con importancia pronóstica. Revisamos en este artículo la fisiopatología de la caquexia tumoral, cuáles son los efectos locales y sistémicos del tumor, así como los efectos secundarios que sobre el estado nutricional produce el tratamiento oncológico. A pesar de la controversia sobre el beneficio final del apoyo terapéutico de la nutrición, valoramos los posibles métodos de administración para dicho apoyo y concluimos que la evaluación nutricional debe formar parte de la terapéutica del cáncer para mejorar la respuesta y disminuir las complicaciones, disponiendo de un método sencillo, sensible y específico para estimarla que es la Valoración Global Subjetiva (AU)

[Paratesticular rhabdomyosarcoma]. / Rabdomiosarcoma paratesticular.

Presentation of one case of embryonic paratesticular rhabdomyosarcoma in a 19-year old male. Following high inguinal radical orchiectomy, he required hemiscrotectomy, and it was found to be a foreign body granuloma. Prior to staging lymphadenectomy, therapy was complemented with radiotherapy and polychemotherapy according to a VAC protocol. The patient shows clinical remission at two and a half years after being diagnosed and one and a half years after completion of treatment.