Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus

PurposeMalnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients.MethodsA Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients.ResultsThe panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment.ConclusionsThere is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.

Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus.

PURPOSE: Malnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients. METHODS: A Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients. RESULTS: The panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment. CONCLUSIONS: There is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.

Multidisciplinary consensus statement on the clinical management of patients with pancreatic cancer.

Pancreatic cancer (PC) remains one of the most aggressive tumors with an increasing incidence rate and reduced survival. Although surgical resection is the only potentially curative treatment for PC, only 15-20% of patients are resectable at diagnosis. To select the most appropriate treatment and thus improve outcomes, the diagnostic and therapeutic strategy for each patient with PC should be discussed within a multidisciplinary expert team. Clinical decision-making should be evidence-based, considering the staging of the tumor, the performance status and preferences of the patient. The aim of this guideline is to provide practical and evidence-based recommendations for the management of PC.

Aldehyde dehydrogenase isoform 1 (ALDH1) expression as a predictor of radiosensitivity in laryngeal cancer

Background: Aldehyde dehydrogenase isoform 1 (ALDH1) has been shown to be a marker of cancer stem cells (CSCs). These stem cells may be responsible for tumour perpetuation as well as local and distant invasion. Several studies have shown that CSCs are more chemoradiotherapy (CRT)-resistant and may be responsible for tumour recurrence. Other studies, in contrast, have found ALDH1 expression to be indicative of a better prognosis. Methods: We retrospectively evaluated 84 patients diagnosed and treated for laryngeal cancer between 2006 and 2011. All patients underwent curative-intent radiotherapy or CRT at our institution. 57 of the 84 tumour samples contained sufficient material for ALDH1 assessment. Results: ALDH1 expression was detected in 17.5 % (10/ 57) of the tissue samples. None of the tumours from stage I patients tested positive for ALDH1. The relapse rate in ALDH1 + patients was 10 versus 51.2 % for ALDH1-. No differences in overall survival were observed between the groups; however, disease-free survival was 90 % for the ALDH1 ? group versus 48.9 % for ALDH1- patients (p = 0.034). Conclusion: The patients in this study with ALDH1 ? tumours had better outcomes than their counterparts with ALDH1- tumours. This finding suggests that not all CSCs are resistant to conventional cancer treatments. It may also imply that new methods of correctly identifying these cells are needed (AU)

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Aldehyde dehydrogenase isoform 1 (ALDH1) expression as a predictor of radiosensitivity in laryngeal cancer.

BACKGROUND: Aldehyde dehydrogenase isoform 1 (ALDH1) has been shown to be a marker of cancer stem cells (CSCs). These stem cells may be responsible for tumour perpetuation as well as local and distant invasion. Several studies have shown that CSCs are more chemoradiotherapy (CRT)-resistant and may be responsible for tumour recurrence. Other studies, in contrast, have found ALDH1 expression to be indicative of a better prognosis. METHODS: We retrospectively evaluated 84 patients diagnosed and treated for laryngeal cancer between 2006 and 2011. All patients underwent curative-intent radiotherapy or CRT at our institution. 57 of the 84 tumour samples contained sufficient material for ALDH1 assessment. RESULTS: ALDH1 expression was detected in 17.5 % (10/57) of the tissue samples. None of the tumours from stage I patients tested positive for ALDH1. The relapse rate in ALDH1 + patients was 10 versus 51.2 % for ALDH1-. No differences in overall survival were observed between the groups; however, disease-free survival was 90 % for the ALDH1 + group versus 48.9 % for ALDH1- patients (p = 0.034). CONCLUSION: The patients in this study with ALDH1 + tumours had better outcomes than their counterparts with ALDH1- tumours. This finding suggests that not all CSCs are resistant to conventional cancer treatments. It may also imply that new methods of correctly identifying these cells are needed.

Estudio Cualitativo: uso de la guía para la estimación del riesgo cardiovascular global en la práctica clínica / Pesquisa Qualitativa: Uso Dos Guias Para A Estimativa De Risco Cardiovascular Global Na Prá- Tica Clínica / Qualitative Study: The Use Of The Guidelines For The Assessment Of Absolute Cardiovascular Disease Risk In Clinical Pracice

El Ministerio de Salud, a través del Programa Remediar y con la participación de 24 Facultades de Medicina, implementa un Programa de Capacitación en Terapéutica Racional de Atención Primaria de la Salud (TRAPS) destinado a médicos/as que se desempeñan en el primer nivel de atención (PNA). En el Curso sobre Riesgo Cardiovascular Global (RCVG) se promueve la utilización de la Guía de la OMS adaptada para Argentina para la estimación del riesgo. Objetivo. Presentar los resultados de un estudio cualitativo que indaga, entre los profesionales que habían asistido al curso, el conocimiento y la utilización de la Guía. Material y Método. Población: médicos/as que se desempeñan en Centros de Salud en las provincias de Catamarca y La Rioja...

The Ministry of Health, through a Program called “Remediar” and with the participationof 24 Schools of Medicine, is implementing a Training Program on Rational Therapeuticsin Primary Health Care intended for doctors working in the fi rst level of care. In theCourse on Absolute Cardiovascular Disease Risk (ACVDR), the use of WHO Guidelinesfor the Assessment of Risk adapted for Argentina is promoted.Objective: To present the results of a qualitative study enquiring professionals who attendedthe course, regarding the knowledge and use of the Guidelines.Material and Method: Semi-structured deep interviews to explore dimensions such as patient-doctorrelationship, the approach to people with cardiovascular disease risk and thefactors involved in the process of patient care.Population: Doctors who work in Health Centers in the provinces of Catamarca and LaRioja and took the course on ACVDR.Results: Interviews took place between...

O Ministério da Saúde, por meio do Programa “Remediar” e com a participação de 24Faculdades de Medicina, implementa um Programa de Treinamento sobre Terapêutica Racionalde CuIdados Primários da Saúde (TRAPS) para médicos as que servem no primeiro nível de cuidados (PNA). No curso sobre Risco Cardiovascular Global (RCVG) é promovidaa utilização do Guia da OMS adaptado para a Argentina para a estimativa de risco.Escopo: Apresentar os resultados de um estudo qualitativo que questiona, entre os profi ssionaisque participaram do curso, sobre o conhecimento e o uso do Guia.Material e métodos: Entrevistas em profundidade semi-estruturadas, através das quais sãopesquisadas as dimensões, tais como relação médico-paciente, a abordagem de pessoascom risco cardiovascular e dos fatores institucionais envolvidos no processo dos cuidadosPopulação: Médicos que trabalham em centros de saúde nas províncias de Catamarca e LaRioja, e que fi zeram o curso em RCVG...

Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology

PURPOSE: To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS: From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS: 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS: In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue (AU)

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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)

Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology.

PURPOSE: To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS: From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS: 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS: In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue.

Oropharyngeal cancer related to Human Papilloma Virus: incidence and prognosis in Madrid, Spain

PURPOSE: To report the incidence of HPV-related oropharyngeal cancer (OC) in our region, and determine the influence of HPV status on survival among patients treated with chemoradiation (CRT). METHODS: A total of 102 patients with stage II-IV OC treated by CRT at four hospitals in Madrid, Spain were retrospectively reviewed. Immunohistochemistry analysis was performed to evaluate p16 expression in pretreatment tumor block samples obtained from these patients. HPV-positive and HPV-negative patients were compared to assess differences in overall survival (OS), loco-regional control and disease-free survival. RESULTS: Of the tumor samples evaluated, 26.7 % were p16 positive. HPV-positive patients were younger (median age, 56 vs 59 years; p = 0.052). No significant differences were observed in terms of tumor stage, gender, or smoking habit between HPV+ and HPV- patients. HPV+ patients showed a trend towards better OS (67.4, vs 49.7 %; hazard ratio, 0.55; p = 0.095). CONCLUSIONS: Incidence of HPV-related OC in our region is similar to that reported in other regions in Europe, yet lower than in North America. We observed a trend for improved OS in patients with HPV+ oropharyngeal cancer (AU)

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Oropharyngeal cancer related to Human Papilloma Virus: incidence and prognosis in Madrid, Spain.

PURPOSE: To report the incidence of HPV-related oropharyngeal cancer (OC) in our region, and determine the influence of HPV status on survival among patients treated with chemoradiation (CRT). METHODS: A total of 102 patients with stage II-IV OC treated by CRT at four hospitals in Madrid, Spain were retrospectively reviewed. Immunohistochemistry analysis was performed to evaluate p16 expression in pretreatment tumor block samples obtained from these patients. HPV-positive and HPV-negative patients were compared to assess differences in overall survival (OS), loco-regional control and disease-free survival. RESULTS: Of the tumor samples evaluated, 26.7 % were p16 positive. HPV-positive patients were younger (median age, 56 vs 59 years; p = 0.052). No significant differences were observed in terms of tumor stage, gender, or smoking habit between HPV+ and HPV- patients. HPV+ patients showed a trend towards better OS (67.4, vs 49.7 %; hazard ratio, 0.55; p = 0.095). CONCLUSIONS: Incidence of HPV-related OC in our region is similar to that reported in other regions in Europe, yet lower than in North America. We observed a trend for improved OS in patients with HPV+ oropharyngeal cancer.

Uso racional de medicamentos: Evaluación de un curso de capacitación / Uso racional de medicamentos: avaliação de um curso de formação / Rational use of drugs: assessment of a training course

El Programa Remediar del Ministerio de Salud de la Naciónimplementó, entre 2006 y 2008 un Curso en Uso Racionalde Medicamentos destinado a médicos y odontólogos quese desempeñaban en los Centros de Atención Primaria dela Salud que recibían el botiquín con los medicamentosdel Programa Remediar. El Curso tenía como propósitogeneral promover el uso racional de medicamentos entrelos profesionales prescriptores del primer nivel de atención.Se establecieron acuerdos entre el Ministerio de Salud de laNación (MSAL), los Ministerios de Salud Provinciales y 23Facultades de Medicina. La política del MSAL fue involucrara la comunidad académica en un trabajo conjunto orientadoa jerarquizar la Atención Primaria de la Salud (APS). Elcurso se dictó para tres cohortes, en total 4463 profesionalesiniciaron el curso y 2776 lo completaron aprobando unexamen final. Funcionaron 118 sedes-aulas; participarontodas las jurisdicciones del país. El curso URM fue evaluadopor el Área de Monitoreo y Evaluación del Remediar usandolos registros de datos administrativos sobre rendimientoacadémico por provincia y realizando 15 grupos focales endistintas localidades. El objetivo del presente artículo es dara conocer la metodología utilizada y los resultados obtenidos en la Evaluación del Curso URM con el propósito de hacer un a contribución para elmejoramiento de futuras intervenciones.

Remediar Program of the National Ministry of Health implemented between 2006 and 2008Rational Use of Drugs’ Courses for doctors and dentists who worked in the Primary CareCenters Health receiving the kit with medicines from Remediar. The training was intendedgenerally to promote rational use of medicines for professional primary care prescribers.Agreements were established between the National Health Ministry, Provincial HealthMinistries and 23 medical schools. The Health Ministry policy was to involve the academiccommunity in a joint effort aimed at prioritizing the Primary Health Care. The course washeld for three cohorts, totaling 4463 professional, 2776 started the course and completed itby passing a final exam. They ran 118 seats of classrooms, involving all jurisdictions. URMCourse was evaluated by the Monitoring and Evaluation Area using administrative data onacademic performance by province and conducting 15 focus groups in different locations.The aim of this paper is to present the methodology used and the results obtained in theURM Course Evaluation in order to make a contribution to improve future interventions.

Polymorphisms in HIF-1 alpha affect presence of lymph node metastasis and can influence tumor size in squamous-cell carcinoma of the glottic larynx

BACKGROUND: HIF-1alpha plays a key role in the development and progression of cancer. Its polymorphic variants C1772T and G1790A have been associated with greater susceptibility to cancer and increased tumor progression. METHODS: We determined the distribution of these polymorphisms among 121 patients with glottic cancer and 154 healthy volunteers by PCR-RFLP. We also analyzed the relationship between the presence of these polymorphisms and various clinicopathologic variables. RESULTS: Advanced tumors (T3-T4) were associated with the TT variant (p = 0.036), which was present in 75 % of T4 tumors (p = 0.008). Among patients with nodal metastasis (N+), 41.7 and 22 % were carrying the TT and GA variants, respectively, compared with 9.4 and 2 % of the patients with no metastasis (N0), (p = 0.006 and p = 0.032). CONCLUSIONS: The presence of the TT and GA variants were associated with lymph node metastasis, while the presence of the TT variant can be associated with larger tumor size (AU)

Polymorphisms in HIF-1alpha affect presence of lymph node metastasis and can influence tumor size in squamous-cell carcinoma of the glottic larynx.

BACKGROUND: HIF-1alpha plays a key role in the development and progression of cancer. Its polymorphic variants C1772T and G1790A have been associated with greater susceptibility to cancer and increased tumor progression. METHODS: We determined the distribution of these polymorphisms among 121 patients with glottic cancer and 154 healthy volunteers by PCR-RFLP. We also analyzed the relationship between the presence of these polymorphisms and various clinicopathologic variables. RESULTS: Advanced tumors (T3-T4) were associated with the TT variant (p = 0.036), which was present in 75 % of T4 tumors (p = 0.008). Among patients with nodal metastasis (N+), 41.7 and 22 % were carrying the TT and GA variants, respectively, compared with 9.4 and 2 % of the patients with no metastasis (N0), (p = 0.006 and p = 0.032). CONCLUSIONS: The presence of the TT and GA variants were associated with lymph node metastasis, while the presence of the TT variant can be associated with larger tumor size.

Novel adipokine fibroblast growth factor 21 is increased in rheumatoid arthritis.

Fibroblast growth factor-21 (FGF-21) has been recently characterized as a new adipokine. The aim of this study was to assess FGF-21 levels in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) and to study the relationship between FGF-21, disease activity and metabolic status. The levels of FGF-21 in serum and synovial fluid samples from 38 patients with RA and 42 control individuals with OA were determined by ELISA. Patients were assessed for disease activity using the disease activity score (DAS28), a serum glucose and lipid profile. Age, sex and BMI-adjusted FGF-21 levels in the serum (p=0.024) and synovial fluid (p=0.010) samples were significantly higher in patients with RA when compared with OA. The levels of FGF-21 in the serum significantly correlated with the levels in the synovial fluid. Serum and synovial fluid FGF-21 levels adjusted for confounders correlated positively with C-reactive protein. The levels of FGF-21 were positively correlated with BMI in patients with RA; however, the levels were not associated with disease activity or lipid profiles. Furthermore, serum FGF-21 levels were significantly higher in seropositive compared with seronegative RA patients. This work shows that patients with seropositive RA have increased levels of FGF-21. The results suggest that FGF-21 is related to BMI but not disease activity or lipid profiles in patients with RA.

Low circulating Dickkopf-1 and its link with severity of spinal involvement in diffuse idiopathic skeletal hyperostosis.

OBJECTIVE: Dickkopf-1 (DKK-1) is an inhibitor of osteoblastogenesis, and its lower levels are linked to new bone formation. The aim of this study was therefore to explore serum levels of DKK-1 and to evaluate DKK-1's association with the severity of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). METHODS: Serum levels of total and functional DKK-1 and C-reactive protein (CRP) were measured in 37 patients with DISH and 22 healthy age and sex-matched controls. Plain radiographs of the cervical and thoracic spine were performed, and the diagnosis of DISH was defined using the Resnick criteria. Patients were divided into three groups based on spinal involvement. Bone mineral density (BMD) and bone turnover markers were evaluated in patients with DISH. RESULTS: The levels of total serum DKK-1 were significantly lower in patients with DISH than in healthy controls (p<0.0001). Importantly, low serum levels of DKK-1 were associated with more severe spinal involvement in DISH, independent of age, sex, disease duration, CRP, bone turnover markers or BMD. However, these findings were less significant for functional DKK-1. CONCLUSION: These observations indicate that DKK-1 may play a significant role in bone formation during DISH.

Unknown primary cancer of the head and neck: a multidisciplinary approach

The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors (AU)

[Radiotherapy in dermatology]. / Radioterapia en Dermatología.

Ionizing radiation causes cell death through DNA damage and has a stronger effect on undifferentiated tumor cells with a high mitotic rate. The use of a fractionated radiotherapy regimen improves both efficacy and tolerance. In addition, greater fractionation, with lower doses per session, minimizes adverse effects. In the majority of tumors treated with radical radiotherapy, the tumor cells do not disappear immediately after treatment, and assessment of the final response to treatment before three months is premature. Radiotherapy is an important treatment modality in selected patients with skin cancer. Modern radiotherapy equipment and techniques achieve excellent rates of tumor control, associated with good cosmetic results, preserved function, and a low rate of complications. The choice of technique is determined by tumor size and site and the thickness. The techniques most widely used at the present time include external beam radiotherapy with linear accelerators and high-dose-rate brachytherapy.

Radioterapia en Dermatología / Radiotherapy in Dermatology

El mecanismo por el cual las radiaciones ionizantes producen muerte celular es el daño al ADN, que afecta más a las células tumorales de mayor actividad mitótica e indiferenciadas. La administración de radioterapia en dosis fraccionadas aumenta la eficacia y la tolerabilidad del tratamiento; esquemas más fraccionados en dosis bajas por sesión minimizan los efectos secundarios. La mayoría de los tumores irradiados en dosis radical no desaparecen de forma rápida al final del tratamiento. Una valoración de la respuesta definitiva antes de los tres meses es prematura. La radioterapia es un tratamiento importante en pacientes seleccionados con cáncer de piel. Se obtienen excelentes tasas de control tumoral, con buen resultado cosmético, preservación funcional e infrecuentes complicaciones con los modernos equipos y las técnicas de radioterapia. La elección de la técnica se determina por el tamaño, el espesor y la localización anatómica del tumor. Las técnicas actualmente más extendidas para el tratamiento del cáncer de piel son la radioterapia externa con electrones de acelerador lineal y la braquiterapia de alta tasa de dosis (AU)

Ionizing radiation causes cell death through DNA damage and has a stronger effect on undifferentiated tumor cells with a high mitotic rate. The use of a fractionated radiotherapy regimen improves both efficacy and tolerance. In addition, greater fractionation, with lower doses per session, minimizes adverse effects. In the majority of tumors treated with radical radiotherapy, the tumor cells do not disappear immediately after treatment, and assessment of the final response to treatment before three months is premature. Radiotherapy is an important treatment modality in selected patients with skin cancer. Modern radiotherapy equipment and techniques achieve excellent rates of tumor control, associated with good cosmetic results, preserved function, and a low rate of complications. The choice of technique is determined by tumor size and site and the thickness. The techniques most widely used at the present time include external beam radiotherapy with linear accelerators and high-dose-rate brachytherapy (AU)

Diagnóstico del estado nutricional y su impacto en el tratamiento del cáncer / No disponible

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