Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015-2020

Purpose. Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS). Materials and methods. The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old. Results. The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate. Conclusion. Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity (AU)

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Deprivación andrógenica en cáncer de próstata y riesgo de fractura a largo plazo / Androgen deprivation in prostate cancer and the long-term risk of fracture

Objetivos: Determinar el porcentaje de pérdida de masa ósea y el riesgo de fractura inducido por la terapia de deprivación androgénica en pacientes con cáncer de próstata. Material y métodos: Estudio prospectivo en 2 fases. En la primera se recogieron variables demográficas, FRAX(R), densidad mineral ósea y fracturas clínicas antes de iniciar la terapia y hasta un año después de finalizada. En la segunda se realizó una entrevista telefónica una media de 8,5 años después del inicio del estudio para evaluar nuevas fracturas. Resultados: Se incluyeron 150 pacientes con una edad media de 67 años y duración media de la terapia de 24 meses. Antes del inicio del tratamiento 62 pacientes (41%) presentaban osteoporosis o baja masa ósea en la densitometría. Después del primer año de tratamiento la densidad mineral ósea descendió una media de 3,7% y 2,1% en la columna lumbar y el cuello femoral, respectivamente. Al final del segundo y tercer año el porcentaje de pérdida fue menor. Durante la primera fase del estudio 4 pacientes (2,7%) sufrieron una fractura. En la entrevista telefónica a 80 pacientes (53%) solo uno había sufrido una fractura. Conclusiones: En los pacientes con cáncer de próstata y terapia de deprivación androgénica la mayor pérdida ósea se produce durante el primer año. Cuando el tratamiento no supera los 2 años el riesgo absoluto de fractura es bajo, y la fractura clínica infrecuente a corto y a largo plazo

Objectives: To determine the rate of bone mass loss and the risk of fracture induced by androgen deprivation therapy in patients with prostate cancer. Material and methods: Prospective study in 2 phases. In the first phase, demographic variables, FRAX(R), bone mineral density and clinical fractures were collected, before starting the therapy and up to 1 year after ending the therapy. In the second phase, we conducted a telephone interview a mean of 8.5 years after the start of the study to assess new fractures. Results: We included 150 patients with a mean age of 67 years and a mean therapy duration of 24 months. Before starting the treatment, 62 patients (41%) showed osteoporosis or low bone mass in the densitometry. After the first year of treatment, the bone mineral density decreased a mean of 3.7% and 2.1% in the lumbar spine and femoral neck, respectively. At the end of the second and third year, the loss rate was lower. During the first phase of the study, 4 patients (2.7%) experienced a fracture. In the telephone interviews with 80 patients (53%), only 1 had experienced a fracture. Conclusions: In the patients with prostate cancer and androgen deprivation therapy, greater bone loss occurred during the first year. When the treatment did not exceed 2 years, the absolute risk of fracture was low, and clinical fractures were uncommon in the short and long term

Demand for radiotherapy in Spain

Aim. Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. Material and methods. We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. Results. About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. Conclusions. Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning (AU)

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New biological markers in the decision of treatment of head and neck cancer patients

Head and neck squamous cell carcinoma is the sixth most common cancer type worldwide. Also the 5-year survival rate of less than 50 % seems to be lower than other cancer types. There are some reasons behind this high mortality rate; one of them is the lack of knowledge about the biology and genomic instability behind the carcinogenic processes. These biological features could condition the failure of frontline treatment, in which case rescue treatment should be used, representing an overtreatment for the patients. For years many biological factors have been tested as prognostic and predictive factors in relation to treatment with a modest success. To find appropriate tests which could be used in the context of the individualized treatment decision, we have reviewed new biological markers, not only in tumor tissue, but also in normal tissue from head and neck carcinoma patients (AU)

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Molecular biomarkers in the decision of treatment of cervical carcinoma patients

Cervical carcinoma is the third most common cancer in women worldwide. The programs developed for early detection have made that most patients are diagnosed in early stages. Treatment for those patients consists of conservative techniques as surgery or radical radiotherapy; however, the decision between those two therapies is still controversial. Even though in many cases this decision varies according to classical associated risk factors (i.e. tumor stage or age), in the clinical practice, a significant number of patients treated by surgery also receive post-surgery radiotherapy, with the consequent over-treatment and toxic effects. Since response to treatments is conditioned by individual factors, the use of new biological markers as novel predictive factors for both tumor and normal tissues could help clinicians to choose the best treatment schedule for each patient individually. Based on the experience of our institution, we have reviewed the new biological markers in cervical carcinoma patients treated by radiotherapy (AU)

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.

Carcinoma epidermoide de cérvix tratado con radioterapia radical: factores clásicos de pronóstico y resultados / Epidermoid carcinoma of the cervic treated with radical radiotherapy: classical prognostic factors and results

Objetivo: El estudio en una serie homogénea de pacientes, de la influencia de factores clásicos de pronóstico (edad, estadio clínico, tamaño tumoral, grado histológico, afectación ganglionar) en relación con la respuesta, control local y supervivencia, nos permitirá la identificación de factores que deberían ser controlados en el diseño de futuros estudios.Sujetos y métodos: Se han incluido entre diciembre de 1977 y abril de 1999 204 pacientes diagnosticadas de carcinoma epidermoide de cérvix y tratadas con RT radical. Cincuenta y cuatro pacientes (26 por ciento) eran estadio Ib, 112 (55 por ciento) estadio II y 38 (19 por ciento) estadio III. El tamaño medio tumoral fue 4,11 cm (1-9). La mayoría presentaban tumores grado II (43 por ciento) o III (45 por ciento). En 152 pacientes se evaluó la afectación ganglionar mediante TAC, que estuvo presente en 20 casos (13 por ciento). Resultados: El tamaño tumoral se relacionó directamente con el estadio (p < 0,015), y de forma inversa con la edad (p < 0,0001). Se observó diferencia significativa en la afectación ganglionar entre los estadios I vs II-III (p < 0,02). Ciento cincuenta y tres pacientes tuvieron respuesta completa (75 por ciento). El control local fue del 74, 67 y 65 por ciento a 1, 5 y 10 años, respectivamente. Tanto la respuesta como el control local se relacionaron estrechamente con el estadio y el tamaño tumoral en el análisis multivariante (AM). La supervivencia causa-específica fue del 85, 67 y 62 por ciento a 1, 5 y 10 años, respectivamente. La respuesta fue el principal factor predictivo de supervivencia en el AM seguida del estadio.Conclusiones: La extensión de la enfermedad (estadio clínico, tamaño tumoral) es el factor predictivo más relevante de respuesta completa, y ésta a su vez es el principal factor pronóstico de supervivencia por su impacto en la esfera local del proceso. Sin embargo, pacientes con idéntica extensión y volumen de la enfermedad muestran evoluciones diferentes, por lo que la importancia de otras características biológicas tumorales en la respuesta a RT y en la supervivencia será motivo de estudios posteriores (AU)