[The impact of the first wave of the COVID-19 pandemic on oncological patients in a tertiary hospital]. / Impacto de la primera ola de la pandemia de COVID-19 en la atención a pacientes oncológicos en un hospital terciario.

BLACKGROUND: The COVID-19 pandemic has over-burdened the Spanish health service and, as a result, affected the treatment and management of oncological patients. The aim of this study is to make a descriptive analysis of the management of oncological patients and the functioning of the tumour committees in the University Hospital La Paz (Madrid) during the first wave of the pandemic. MATERIALS AND METHODS: A descriptive analysis was made, based on the results of a questionnaire given to all 18 adult tumour committees and 3 paediatric tumour committees in the University Hospital La Paz. Further information was obtained from all the hospital services involved in the diagnosis and treatment of oncological patients. RESULTS: During the first wave of the pandemic, there was a significant decrease in diagnostic tests. For many weeks, the majority of oncological surgical procedures were delayed or referred to other hospitals. Highly beneficial systemic and radiotherapeutic treatments were maintained and preoperative treatment was increased. The diagnosis and treatment of paediatric tumours was unaltered. Tumour committees were affected but each one adjusted in a different way. All the departments involved in the diagnosis and treatment of oncological patients made contingency plans to minimalize the effect on patients. CONCLUSION: This study shows how the management of oncological patients and the functioning of tumour committees was affected during the COVID-19 pandemic.

Impacto de la primera ola de la pandemia de COVID-19 en la atención a pacientes oncológicos en un hospital terciario / The impact of the first wave of the COVID-19 pandemic on oncological patients in a tertiary hospital

Introducción: La pandemia de COVID-19 ha puesto en una situación de sobrecarga al sistema sanitario español y, como consecuencia, la atención al paciente oncológico se ha visto afectada. El objetivo de este estudio es realizar un análisis descriptivo de la atención al paciente oncológico y del funcionamiento de los Comités de Tumores en el Hospital Universitario la Paz durante la primera ola de la pandemia. Material y métodos: Análisis descriptivo basado en los resultados obtenidos a través de una encuesta realizada a los 18 comités de tumores del adulto y a los tres comités de tumores infantiles del Hospital Universitario La Paz. El estudio se completó con la información obtenida a partir de los servicios implicados en el diagnóstico y tratamiento de pacientes oncológicos. Resultados: Durante la primera ola se disminuyó significativamente la realización de técnicas diagnósticas. Se suspendió la cirugía de la mayoría de tumores en el hospital durante varias semanas, retrasándose o derivándose a otro centro. Se mantuvieron los tratamientos sistémicos y radioterápicos asociados a un mayor beneficio, incrementándose la frecuencia de la administración preoperatoria. Sin embargo, el diagnóstico y tratamiento de los tumores infantiles no sufrió alteraciones. El funcionamiento de los comités de tumores se vio afectado, y cada uno de ellos llevó a cabo ajustes diferentes. Los diferentes servicios implicados realizaron planes de contingencia para minimizar el impacto sobre los pacientes. Conclusión: Este estudio muestra cómo la atención al paciente oncológico y el funcionamiento de los comités de tumores se vio afectado de forma generalizada durante la pandemia por COVID-19.(AU)

Background: The COVID-19 pandemic has over-burdened the Spanish health service and, as a result, affected the treatment and management of oncological patients. The aim of this study is to make a descriptive analysis of the management of oncological patients and the functioning of the tumour committees in the University Hospital La Paz (Madrid) during the first wave of the pandemic. Materials and methods: A descriptive analysis was made, based on the results of a questionnaire given to all 18 adult tumour committees and 3 paediatric tumour committees in the University Hospital La Paz. Further information was obtained from all the hospital services involved in the diagnosis and treatment of oncological patients. Results: During the first wave of the pandemic, there was a significant decrease in diagnostic tests. For many weeks, the majority of oncological surgical procedures were delayed or referred to other hospitals. Highly beneficial systemic and radiotherapeutic treatments were maintained and preoperative treatment was increased. The diagnosis and treatment of paediatric tumours was unaltered. Tumour committees were affected but each one adjusted in a different way. All the departments involved in the diagnosis and treatment of oncological patients made contingency plans to minimalize the effect on patients. Conclusion: This study shows how the management of oncological patients and the functioning of tumour committees was affected during the COVID-19 pandemic.(AU)

Relación entre marcadores hematológicos y la respuesta patológica completa al tratamiento neoadyuvante en cáncer de recto localmente avanzado / Relationship between haematological markers and patological complete response to neoadjuvant treatment in locally advanced rectal cancer

INTRODUCCIÓN: Múltiples marcadores hematológicos de inflamación pueden tener relación con un peor pronóstico en los pacientes oncológicos. PROPÓSITO: Este estudio evaluó si los cambios en marcadores hematológicos antes y después del tratamiento quimio-radioterápico (QT-RT) en cáncer de recto pueden estar asociados con la respuesta patológica completa. MATERIAL Y MÉTODO: Se revisaron retrospectivamente las historias clínicas de 140 pacientes con cáncer de recto que recibieron tratamiento radioterápico neoadyuvante seguido de resección quirúrgica fueron revisados retrospectivamente. Se realizó analítica completa antes y después del tratamiento QT-RT. Se evaluaron leucocitos, hemoglobina, neutrófilos, linfocitos, monocitos, ratio neutrófilo-linfocitos (NLR), ratio plaqueta-linfocitos (PLR) y ratio linfocitos-monocitos (LMR). RESULTADOS: La respuesta patológica completa fue de 17,5%. Los marcadores hematológicos tuvieron una disminución significativa tras el tratamiento de QT-RT (p < 0,05), sin embargo en nuestro análisis no se relacionó con la respuesta patológica completa, salvo el PLR (p = 0,027). CONCLUSIÓN: Los marcadores hematológicos antres y después del tratamiento neoadyuvante no predicen la respuesta tumoral tras QT-RT en este estudio. Sin embargo una muestra mayor puede presentar resultados estadísticamente signifiacativos, especialmente con los monocitos

INTRODUCTION: Multiple haematological markers of inflammation might be related with poor prognosis in oncological patients. PURPOSE: This study evaluated whether changes of haematological markers before and after chemo-radiotherapy treatment in rectal cancer might be associated to pathological complete response. MATERIAL AND METHODS: Medical records of 140 patients with rectal cancer who received neoadjuvant radiotherapy followed by surgical resection were retrospectively review. Complete bloods counts (CBC) was measured days before and after period of RT. We assessed white blood cells count (WBC), hemoglobin levels (Hb), neutrophils count, lymphocytes count, monocytes count, neutrophil-to-lymphocye ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). RESULTS: The overall rate of pCR was 17,5%. Hematological markers had a statistically significant decrease after CRT treatment (p < 0,05), however in our analysis they do not predict complete pathological response. CONCLUSION: Haematological markers before and after neoadjuvant treatment do not predict tumor responses in this study. However, a larger sample can show statistically significant results, especially in monocytes ratio

Quimioradioterapia en cáncer de recto y tasa de respuesta patológica / Chemoradiotherapy in rectal cancer and pathological response

INTRODUCCIÓN: El tratamiento neoadyuvante con radioterapia y quimioterapia radiosensibilizante en el cáncer de recto localmente avanzado (CRLA) disminuye significativamente las tasas de recurrencia local. Por tanto el objetivo de este estudio es analizar la respuesta patológica completa (RPC) y parcial (RPP) tras el tratamiento neoadyuvante con quimioradioterapia en pacientes con CRLA. MATERIAL Y MÉTODO: Se realizó un estudio descriptivo, retrospectivo en pacientes con diagnóstico de CRLA desde enero 2016 a diciembre 2018 en el Servicio de Oncología-Radioterápica del Hospital Universitario La Paz. Se incluyeron 140 pacientes. Un grupo de pacientes (92,9%) se trató con radioterapia 3D conformada con una dosis de 45Gy sobre pelvis y una sobreimpresión de 5,4Gy sobre tumor primario y otro grupo (7,1%) se trató con radioterapia con técnica volumétrica y en arcoterapia (VMAT) guiado por imagen (IGRT) con una dosis de 53,7Gy en pelvis con sobreimpresión concurrente al tumor. La dosis de capecitabina oral fue de 850mg/m2 dos veces al día durante el tratamiento. Todos los pacientes fueron reevaluados con resonancia magnética (RM) post-neoadyuvancia. Los pacientes se operaron entre 6-8 semanas tras quimioradioterapia. RESULTADOS: Se obtuvo una RPC de 17,1% y RPP de 80,1% con una tasa global de downstaging de 31,8%. CONCLUSIÓN: Se concluye que la quimioradioterapia neoadyuvante es un tratamiento seguro con aceptables tasas de control local en los pacientes con CRLA

INTRODUCTION: Neoadjuvant treatment with radiotherapy and radiosensitizing chemotherapy in locally advanced rectal cancer (LARC) significantly decreases local recurrence rates. Therefore the objective of this study is to analyze the pathological complete response (PCR) and partial response (PPR) of neoadjuvant treatment with exclusive chemoradiotherapy in patients with locally advanced rectal cancer. MATERIAL AND METHOD: It has been made a study descriptive, retrospective in a cohort of patients with LARC in the January 2016 to December 2018 period in the Radiation-Oncology Department of Hospital Universitario La Paz. 140 patients were included. A group of patients (92,9%) received treatment with radiotherapy 3D conformed technique with a dose administered the 45 Gy on pelvis and a boost of 5,4 Gy on tumor and other group (7,1%) received treatment with volumetric archotherapy radiotherapy (VMAT) guided by image (IGRT) with a dose administered of 53,7% on pelvis with concurrent boost and. The dose of capecitabine was 850 mg/m2, twice a day during the treatment. The patients were re-evaluated with post-neoadjuvant MRI. Patients were operated 6 to 8 weeks post chemoradiotherapy. RESULTS: CPR was obtained of 17,1% and pPR of 80,1% with a global rate downstaging of 31,8%. CONCLUSION: It concludes that chemoradiotherapy neoadjuvant is a safe treatment with acceptable rates of local control in patients with LARC

Randomized phase II trial of non-platinum induction or consolidation chemotherapy plus concomitant chemoradiation in stage III NSCLC patients: mature results of the Spanish Lung Cancer Group 0008 study.

The optimal schedule and regimen of chemotherapy (CT) in association with chemoradiation has not been established in stage III non-small-cell lung cancer (NSCLC). We have compared three schedules of non-platinum-based CT plus either radiotherapy or chemoradiation. From May 2001 to June 2006, 158 patients with unresectable stage III NSCLC were enrolled in a randomized phase II trial with overall response rate (ORR) as the primary endpoint. The initial design included three arms: sequential CT followed by thoracic radiation (TRT); concurrent CT/TRT followed by consolidation CT; and induction CT followed by concurrent CT/TRT. However, based on the preliminary results of the RTOG 9410 trial, the sequential arm was closed when 19 patients had been enrolled. All patients received two cycles of docetaxel 40 mg/m(2) days 1 and 8 plus gemcitabine 1200 mg/m(2) days 1 and 8, as either induction or consolidation therapy. Concurrent CT/TRT consisted of docetaxel 20 mg/m(2) and carboplatin AUC 2 weekly plus 60 Gy TRT. No differences were found in ORR between the two arms (56% and 57%). Hematological toxicity was mild but significantly superior with consolidation CT; the esophagitis rate was similar in both arms (16% and 15%). With a median follow-up of 57 months, no differences were found in median survival (13.07 and 13.8 months) or 5-year survival (16.4% and 22%). This regimen cannot be recommended as an alternative to platinum-based CT/TRT although it has an acceptable toxicity profile and encouraging long-term survival data (ClinicalTrials.gov NCT01652820).

Extracranial stereotactic body radiotherapy. Review of main SBRT features and indications in primary tumors.

AIM: Review of main SBRT features and indications in primary tumors. BACKGROUND: Stereotactic body radiotherapy has been developed in the last few years. SBRT allows the hypofractionated treatment of extra cranial tumors, using either a single or limited number of dose fractions, and resulting in the delivery of a high biological effective dose with low toxicity. MATERIAL AND METHODS: SBRT REQUIRES A HIGH LEVEL OF ACCURACY FOR ALL PHASES OF THE TREATMENT PROCESS: effective patient immobilization, precise target localization, highly conformed dosimetry and image guided systems for treatment verification. The implementation of SBRT in routine requires a careful considering of organ motion. Gating and tracking are effective ways to do so, and less invasive technologies "fiducials free" have been developed. Due to the hypofractionated scheme, the physician must pay attention to new dosimetric constraints in organ at risk and new radiobiological models are needed to assess the optimal fractionation and dose schemes. RESULTS: Currently, SBRT is safe and effective to treat primary tumors, which are otherwise untreatable with conventional radiotherapy or surgery. SBRT has quickly developed because of its excellent results in terms of tolerance and its high locoregional control rates. SBRT indications in primary tumors, such as lung primary tumors, have become a standard of care for inoperable patients. SBRT seems to be effective in many others indications in curative or palliative intent such as liver primary tumors, and novel indications and strategies are currently emerging in prostate cancer, head and neck tumor recurrences or pelvis reirradiations. CONCLUSION: Currently, SBRT is mainly used when there is no other therapeutic alternative for the patient. This is due to the lack of randomized trials in these settings. However, the results shown in retrospective studies let us hope to impose SBRT as a new standard of care for many patients in the next few years.