Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect.

Background: Oligo-recurrent disease has a consolidated evidence of long-term surviving patients due to the use of intense local cancer therapy. The latter combines real-time surgical exploration/resection with high-energy electron beam single dose of irradiation. This results in a very precise radiation dose deposit, which is an essential element of contemporary multidisciplinary individualized oncology. Methods: Patient candidates to proton therapy were evaluated in Multidisciplinary Tumor Board to consider improved treatment options based on the institutional resources and expertise. Proton therapy was delivered by a synchrotron-based pencil beam scanning technology with energy levels from 70.2 to 228.7 MeV, whereas intraoperative electrons were generated in a miniaturized linear accelerator with dose rates ranging from 22 to 36 Gy/min (at Dmax) and energies from 6 to 12 MeV. Results: In a period of 24 months, 327 patients were treated with proton therapy: 218 were adults, 97 had recurrent cancer, and 54 required re-irradiation. The specific radiation modalities selected in five cases included an integral strategy to optimize the local disease management by the combination of surgery, intraoperative electron boost, and external pencil beam proton therapy as components of the radiotherapy management. Recurrent cancer was present in four cases (cervix, sarcoma, melanoma, and rectum), and one patient had a primary unresectable locally advanced pancreatic adenocarcinoma. In re-irradiated patients (cervix and rectum), a tentative radical total dose was achieved by integrating beams of electrons (ranging from 10- to 20-Gy single dose) and protons (30 to 54-Gy Relative Biological Effectiveness (RBE), in 10-25 fractions). Conclusions: Individual case solution strategies combining intraoperative electron radiation therapy and proton therapy for patients with oligo-recurrent or unresectable localized cancer are feasible. The potential of this combination can be clinically explored with electron and proton FLASH beams.

Four-fraction ultra-accelerated minimal breast irradiation in early breast cancer: The initial feasibility results of an institutional experience.

PURPOSE: To evaluate the feasibility, early toxicity, and clinical outcomes of early-breast cancer patients in a single-arm, phase I/II study of an ultra-accelerated, four-fraction schedule of minimal breast irradiation (4f-AMBI) using a multicatheter, minimally-invasive, intraoperative tumor bed implant (MITBI) during breast-conserving surgery (BCS). METHODS AND MATERIALS: Eligible women aged >40 years with clinically and radiologically confirmed, unifocal invasive or in situ ≤3 cm tumors were considered as potential candidates for MITBI during BCS. After the pathology report, patients who met APBI criteria received ultra-accelerated four-fractions irradiation (6.2 Gy BID x 4fx over 2 days) with perioperative HDR-brachytherapy (PHDRBT). Early complications, toxicity, clinical outcomes, and cosmetic results were analyzed. RESULTS: Of 89 patients initially implanted, 60(67.4%) were definitively included in the 4f-AMBI-protocol. The median age was 64.4 years; the median CTV was 32.1 cc (6.9-75.4 cc), and the external-V100 was 43.1 cc (12.87-107 cc), representing 5% of the breast tissue irradiated with a median CTV D90 of 6.2 Gy (5.6-6.28 Gy). The entire local treatment (BCS&MITBI-4f-AMBI) was completed at a median of 8 days (4-10 days). The rate of early complications was 11%. There were no major complications. Acute skin-subcutaneous G1 toxicity was reported in 11.7%, and late G1 toxicity on 36.7%. After a median follow-up of 27 months (11-51 months), the local, elsewhere, locoregional and distant-control rates were 100%, 98.3%, 100%, and 100% respectively. The early-cosmetic evaluation was excellent-good in 94.5% of patients evaluated. CONCLUSIONS: Ultra-accelerated, four-fraction, minimal breast irradiation (4f-AMBI) using a minimally-invasive tumor bed implant procedure is safe, dosimetrically feasible, and shows small irradiated volumes. This program provides low toxicity rates and excellent short-term clinical and cosmesis outcomes.

Corrigendum: Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect.

[This corrects the article DOI: 10.3389/fonc.2022.1037262.].

Impacto de la capacidad física sobre la calidad de vida en un ámbito laboral / The impact of physical exercise on quality of life examined in a work environment

El objetivo del presente trabajo es estudiar la relación de los componentes de la capacidad física (fuerza, flexibilidad y resistencia) con la calidad de vida en un ámbito laboral. Material y Métodos: Ensayo de campo aleatorizado y controlado de un año de seguimiento. Se midió la calidad de vida (cuestionario validado SF-36) y la capacidad física (resistencia, mediante prueba cardiopulmonar de esfuerzo; fuerza muscular y flexibilidad analizadas por la Batería Eurofit18). El grupo Intervención recibió seguimiento personalizado con ejercicio físico y el Control una charla con pautas generales.Resultados: Ambos grupos mejoraron su capacidad física siendo superior en el grupo Intervención 48,7 respecto al control 40,87 (p=0,03). Los trabajadores con mayor capacidad física presentan mejor calidad de vida (OR:6,69; IC95%:1,48-30,20) siendo la capacidad de resistencia la más influyente (OR:8,64; IC95%:1,69-44,04). Conclusiones: La mayor capacidad física en trabajadores, se asocia a mejor calidad de vida (AU)

The aim of this study is to analyse the correlation between the main components of physical activity (strength, flexibility and resistance) and quality of life examined in a work environment. Method:In a randomized, controlled trial throughout one year of follow-up patients were evaluated by their quality of life (SF-36 health survey) and their physical exercise (resistance measured by cardiopulmonary stress test; strength and flexibility based on Eurofit Fitness Test Battery). The intervention group received a personalized exercise plan and the control group attended an informative talk with general guidelines.Results: Both groups improved their physical activity, however, Intervention group had better results 48,7 than Control group 40,87 (p=0,03). Workers with better physical activity proved a greater quality of life (OR:6,69; IC95%:1,48-30,20), being the resistance the major contributing component (OR:8,64; IC95%:1,69-44,04). Conclusion:Workers with a higher level of physical exercise are associated with improved quality of life (AU)