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González-Viguera J, Martínez-Pérez E, Pérez-Montero H, Arangüena M, Guedea F, Gutiérrez-Miguélez C. Hype or hope? A review of challenges in balancing tumor control and treatment toxicity in breast cancer from the perspective of the radiation oncologist. Clin Transl Oncol 2024; 26:561-573. [PMID: 37505372 DOI: 10.1007/s12094-023-03287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
The aim of this article is to discuss the challenges and new strategies in managing breast cancer patients, with a specific focus on radiation oncology and the importance of balancing oncologic outcomes with quality of life and post-treatment morbidity. A comprehensive literature review was conducted to identify advances in the management of breast cancer, exploring de-escalation strategies, hypofractionation schemes, predictors and tools for reducing toxicity (radiation-induced lymphocyte apoptosis, deep inspiration breath-hold, adaptive radiotherapy), enhancer treatments (hyperthermia, immunotherapy) and innovative diagnostic modalities (PET-MRI, omics). Balancing oncologic outcomes with quality of life and post-treatment morbidity is crucial in the era of personalized medicine. Radiotherapy plays a critical role in the management of breast cancer patients. Large randomized trials are necessary to generalize some practices and cost remains the main obstacle for many innovations that are already applicable.
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Affiliation(s)
- Javier González-Viguera
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Evelyn Martínez-Pérez
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Héctor Pérez-Montero
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marina Arangüena
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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Garcia-Tejedor A, Ortega-Exposito C, Salinas S, Luzardo-González A, Falo C, Martinez-Pérez E, Pérez-Montero H, Soler-Monsó MT, Bajen MT, Benitez A, Ortega R, Petit A, Guma A, Campos M, Plà MJ, Pernas S, Peñafiel J, Yeste C, Gil-Gil M, Guedea F, Ponce J, Laplana M. Axillary lymph node dissection versus radiotherapy in breast cancer with positive sentinel nodes after neoadjuvant therapy (ADARNAT trial). Front Oncol 2023; 13:1184021. [PMID: 37621686 PMCID: PMC10446877 DOI: 10.3389/fonc.2023.1184021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/04/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Breast cancer surgery currently focuses on de-escalating treatment without compromising patient survival. Axillary radiotherapy (ART) now replaces axillary lymph node dissection (ALND) in patients with limited sentinel lymph node (SLN) involvement during the primary surgery, and this has significantly reduced the incidence of lymphedema without worsening the prognosis. However, patients treated with neoadjuvant systemic treatment (NST) cannot benefit from this option despite the low incidence of residual disease in the armpit in most cases. Data regarding the use of radiotherapy instead of ALND in this population are lacking. This study will assess whether ART is non-inferior to ALND in terms of recurrence and overall survival in patients with positive SLN after NST, including whether it reduces surgery-related adverse effects. Methods and analyses This multicenter, randomized, open-label, phase 3 trial will enroll 1660 patients with breast cancer and positive SLNs following NST in approximately 50 Spanish centers over 3 years. Patients will be stratified by NST regimen and nodal involvement (isolated tumoral cells or micrometastasis versus macrometastasis) and randomly assigned 1:1 to ART without ALND (study arm) or ALND alone (control arm). Level 3 and supraclavicular radiotherapy will be added in both arms. The primary outcome is the 5-year axillary recurrence determined by clinical and radiological examination. The secondary outcomes include lymphedema or arm dysfunction, quality of life based (EORTC QLQ-C30 and QLQ-BR23 questionnaires), disease-free survival, and overall survival. Discussion This study aims to provide data to confirm the efficacy and safety of ART over ALND in patients with a positive SLN after NST, together with the impact on morbidity. Ethics and dissemination The Research Ethics Committee of Bellvitge University Hospital approved this trial (Protocol Record PR148/21, version 3, 1/2/2022) and all patients must provide written informed consent. The involvement of around 50 centers across Spain will facilitate the dissemination of our results. Trial registration ClinicalTrials.gov, identifier number NCT04889924.
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Affiliation(s)
- Amparo Garcia-Tejedor
- Department of Gynaecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Carlos Ortega-Exposito
- Department of Gynaecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Sira Salinas
- Rehabilitation Service, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Ana Luzardo-González
- Rehabilitation Service, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Catalina Falo
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d’Oncología, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Evelyn Martinez-Pérez
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit. Institut Català d’Oncología, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Héctor Pérez-Montero
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit. Institut Català d’Oncología, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - M. Teresa Soler-Monsó
- Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Maria-Teresa Bajen
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Ana Benitez
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Raul Ortega
- Department of Radiology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Anna Petit
- Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Anna Guma
- Department of Radiology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Miriam Campos
- Department of Gynaecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Maria J. Plà
- Department of Gynaecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Sonia Pernas
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d’Oncología, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Judith Peñafiel
- Biostatistics Unit, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Carlos Yeste
- Degree in Biology, Monitoring, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Miguel Gil-Gil
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d’Oncología, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Ferran Guedea
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit. Institut Català d’Oncología, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynaecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Maria Laplana
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit. Institut Català d’Oncología, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
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Pérez-Montero H, Lozano A, de Blas R, Sánchez JJ, Martínez E, Laplana M, Gil-Gil M, Garcia-Tejedor A, Pernas S, Falo C, Godino Ó, Pla MJ, Guedea F, Navarro-Martin A. Ten-year experience of bone SBRT in breast cancer: analysis of predictive factors of effectiveness. Clin Transl Oncol 2023; 25:1756-1766. [PMID: 36645616 DOI: 10.1007/s12094-023-03073-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Data on the benefit of stereotactic body radiation therapy (SBRT) in patients with breast cancer (BC) and bone metastases remain limited. The purpose of this study is to report our 10-year experience of bone SBRT, analyzing toxicity and prognostic factors for local control (LC); progression-free survival, and overall survival (OS). METHODS/PATIENTS We analyzed all spine and non-spine bone SBRT performed in patients with BC during the 2012-2022 period at our institution. Treatments carried out with ablative intent in stereotactic conditions with dose/fraction ≥ 5 Gy in 5 or fewer sessions were considered. Demographic, treatment, and toxicity data were recorded according to CTCAEv4. Risk factors were assessed through univariate and multivariate analysis by Cox regression. RESULTS 60 bone SBRT treatments were performed during the study period. 75% were spine SBRT and 25% were non-spine SBRT (median BED4Gy was 80 Gy4). The median age was 52.5 years (34-79). The median tumor volume was 2.9 cm3 (0.5-39.4). The median follow-up was 32.4 months (1.2-101.7). 1 and 2 years LC were 92.9 and 86.6%, respectively. 1 and 2 years OS were 100 and 90.6%, respectively. Multivariate analysis (MVA) associated volume of the treated lesion ≥ 13 cm3 with worse LC (p = 0.046; HR 12.1, 95%CI = 1.1-140.3). In addition, deferring SBRT > 3 months after lesion diagnosis to prioritize systemic treatment showed a significant benefit, improving the 2 years LC up to 96.8% vs. 67.5% for SBRT performed before this period (p = 0.031; HR 0.1, 95%CI = 0.01-0.8). Hormonal receptors, the total number of metastases, and CA15-3 value were significantly associated with OS in MVA. During follow-up, three non-spine fractures (5%) were observed. CONCLUSIONS According to our data, bone SBRT is a safe and effective technique for BC. Upfront systemic treatment before SBRT offers a benefit in LC. Therefore, SBRT should be considered after prior systemic treatment in this population.
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Affiliation(s)
- Héctor Pérez-Montero
- Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain
| | - Alicia Lozano
- Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain
| | - Rodolfo de Blas
- Medical Physics and Radiation Protection Department, Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain
| | - Juan José Sánchez
- Radiodiagnostic Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga, S/N, 08907, Barcelona, Spain
| | - Evelyn Martínez
- Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain
| | - María Laplana
- Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain
| | - Miguel Gil-Gil
- Medical Oncology Department, Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Amparo Garcia-Tejedor
- Gynecology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga, S/N, 08907, Barcelona, Spain
| | - Sonia Pernas
- Medical Oncology Department, Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Catalina Falo
- Medical Oncology Department, Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Óscar Godino
- Neurosurgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga, S/N, 08907, Barcelona, Spain
| | - Maria J Pla
- Gynecology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga, S/N, 08907, Barcelona, Spain
| | - Ferrán Guedea
- Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain.
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Stefanovic M, Calvet G, Pérez-Montero H, Esteve A, Bujalance MV, Navarro-Martín A, Fernández MDA, González FF, Borras SM, Borbalas AL, Fernandez MN, Garau MM, Calduch AL, Edo FG. Stereotactic body radiation therapy in the treatment of cancer patients with oligometastatic disease: a real world study. Clin Transl Oncol 2023; 25:199-206. [PMID: 36068449 DOI: 10.1007/s12094-022-02923-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is a treatment modality with curative intent for oligometastatic cancer patients, commonly defined by a low-burden metastatic disease with 1-5 systemic metastases. Better knowledge of the clinical profile and prognostic factors in oligometastatic cancer patients could help to improve the selection of candidates who may obtain most benefits from SBRT. The objective of this study was to describe the clinical data and outcome in term of overall survival (OS) of patients with oligometastatic disease treated with SBRT over a 6-year period. METHODS From 2013 to 2018, 284 solid tumor cancer patients with 1-5 oligometastases underwent SBRT at a large university-affiliated oncological center in Barcelona, Spain. Variables related to the patient profile, tumor, oligometastatic disease, and treatment were evaluated. RESULTS A total of 327 metastatic tumors were treated with SBRT. In 65.5% of cases, metachronous tumors were diagnosed at least 1 year after diagnosis of the primary tumor. The median age of the patients was 73.9 years and 66.5% were males. The median follow-up was 37.5 months. The most common primary tumors were lung and colorectal cancer, with lung and bone as the most commonly treated metastatic sites. Ninety-three percent of patients showed a Karnofsky score (KPS) between 80 and 100. Adenocarcinoma was the most common histological type. The median overall survival was 53.4 months, with 1-, 2- and 5-year survival rates of 90.5%, 73.9% and 43.4%, respectively. Overall survival rates of breast (67.6 months, 95% CI 56.4-78.9), urological (63.3 months, 95% CI 55.8-70.8), and colorectal (50.8 months, 95% CI 44.2-57.4) tumors were higher as compared with other malignancies (20 months, 95% CI 11.2-28.8 months) (p < 0.001). Patients with Karnofsky score (KPS) of 90 and 100 showed a significantly better survival than those with impaired performance status (p = 0.001). CONCLUSION SBRT appears to be well tolerated and safe approach in oligometastatic patients. Patients with good performance status and with primary breast, urological and colorectal cancer have higher OS compared with other malignancies. More studies are necessary to evaluate the prognostic factors in oligometastatic disease (OMD) in order to select patients who could benefit more from this therapeutic approach.
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Affiliation(s)
- Milica Stefanovic
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain. .,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.
| | - Gemma Calvet
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Héctor Pérez-Montero
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Anna Esteve
- Badalona Applied Research Group in Oncology (B·ARGO), Oncology Data Analytics Program (ODAP), Institut Català d'Oncologia (ICO), Institut Català d'Oncologia (ICO Badalona), Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Montse Ventura Bujalance
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Arturo Navarro-Martín
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Maria Dolores Arnaiz Fernández
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Ferran Ferrer González
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Susanna Marin Borras
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Alicia Lozano Borbalas
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Miriam Nuñez Fernandez
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Miquel Macia Garau
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Anna Lucas Calduch
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Ferran Guedea Edo
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
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5
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Lopez-Campos F, Cacicedo J, Couñago F, García R, Leaman-Alcibar O, Navarro-Martin A, Pérez-Montero H, Conde-Moreno A. SEOR SBRT-SG stereotactic body radiation therapy consensus guidelines for non-spine bone metastasis. Clin Transl Oncol 2021; 24:215-226. [PMID: 34633602 DOI: 10.1007/s12094-021-02695-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022]
Abstract
The use of stereotactic body radiation therapy (SBRT) to treat non-spine bone metastases (NSBM) is becoming increasingly common in clinical practice. The clinical advantages of SBRT include good pain control and high local control rates, although only limited data are available. The Spanish Society of Radiation Oncology (SEOR) SBRT group recently convened a task force of experts in the field to address key questions related to SBRT for NSBM, including treatment indications, planning, techniques, and dose fractionation. The task force reviewed the available literature to develop evidence-based recommendations for the safe application of NSBM SBRT and to standardize and optimize SBRT processes. The present document provides a comprehensive analysis of the available data, including ongoing clinical trials and controversies, providing clinically applicable recommendations.
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Affiliation(s)
- F Lopez-Campos
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J Cacicedo
- Radiation Oncology Department, Osakidetza/Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Spain.,Department of Surgery, Radiology and Physical Medicine of the University of the Basque Country (UPV/EHU), Vizcaya, Spain
| | - F Couñago
- Radiation Oncology Department, Hospital Universitario Quirón Salud, Hospital La Luz, Madrid, Universidad Europea de Madrid (UEM), Madrid, Spain
| | - R García
- Radiation Oncology Department, Hospital Ruber Internacional Madrid, Madrid, Spain
| | - O Leaman-Alcibar
- Radiation Oncology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - A Navarro-Martin
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - H Pérez-Montero
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - A Conde-Moreno
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, CEU Cardenal Herrera University, Castellón, Spain
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6
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Salinas-Huertas S, Luzardo-González A, Vázquez-Gallego S, Pernas S, Falo C, Pla MJ, Gil-Gil M, Beranuy-Rodriguez M, Pérez-Montero H, Gomila-Sancho M, Manent-Molina N, Arencibia-Domínguez A, Gonzalez-Pineda B, Tormo-Collado F, Ortí-Asencio M, Terra J, Martinez-Perez E, Mestre-Jane A, Campos-Varela I, Jaraba-Armas M, Benítez-Segura A, Campos-Delgado M, Fernández-Montolí ME, Valverde-Alcántara Y, Rodríguez A, Campos G, Guma A, Ponce-Sebastià J, Planas-Balagué R, Catasús-Clavé M, García-Tejedor A. Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy. Breast Dis 2021; 41:97-108. [PMID: 34542055 DOI: 10.3233/bd-210043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1-54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92-18.16) and 3.9 (1.60-9.49) respectively. CONCLUSIONS The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment.
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Affiliation(s)
- S Salinas-Huertas
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A Luzardo-González
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - S Vázquez-Gallego
- Department of Rehabilitation, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - S Pernas
- Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - C Falo
- Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - M J Pla
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Gil-Gil
- Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - M Beranuy-Rodriguez
- Department of Rehabilitation, Hospital de la Santa Creu i Sant Pau, Universitat de Barcelona, Barcelona, Spain
| | - H Pérez-Montero
- Department of Oncologic Radiotherapy, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - M Gomila-Sancho
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - N Manent-Molina
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A Arencibia-Domínguez
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - B Gonzalez-Pineda
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - F Tormo-Collado
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Ortí-Asencio
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - J Terra
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - E Martinez-Perez
- Department of Oncologic Radiotherapy, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - A Mestre-Jane
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - I Campos-Varela
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Jaraba-Armas
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A Benítez-Segura
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - M Campos-Delgado
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M E Fernández-Montolí
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - Y Valverde-Alcántara
- Department of Cancer Prevencion and Control, Institut Català d'Oncología, Barcelona, Spain
| | - A Rodríguez
- Breast Functional Unit, Institut Català d'Oncología, Barcelona, Spain
| | - G Campos
- Breast Functional Unit, Institut Català d'Oncología, Barcelona, Spain
| | - A Guma
- Department of Radiology, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - J Ponce-Sebastià
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - R Planas-Balagué
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Catasús-Clavé
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A García-Tejedor
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
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Pérez-Montero H, Godino O, Lozano A, Asiáin L, Martínez I, Sánchez JJ, de BlasFernández R, Fernández E, Stefanovic M, García N, Martínez J, Guedea F, Navarro-Martin A. Long-term outcomes of spinal SBRT. Is it important to select the treatment time? Clin Transl Oncol 2021; 24:276-287. [PMID: 34342817 DOI: 10.1007/s12094-021-02684-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE SBRT (stereotactic body radiation therapy) is widely used as a curative treatment in tumoral lesions and has become a fundamental tool for the treatment of spine metastasis. In this study, we present survival and toxicity outcomes of spine SBRT after a 2-year follow-up. METHODS/PATIENTS Data from spine SBRT treatments performed at our institution between March 2012 and February 2020 was collected. Medical records, including demographic, primary tumor, and treatment characteristics were reviewed. Patient follow-up included clinical evaluation, imaging, and blood tests. Toxicity was recorded according to CTCAE v4.0. RESULTS We analyzed 73 consecutive spine SBRT treatments in 60 patients. 39.7% of the cases had primary breast cancer and 23.3% had prostate cancer. Most cases (87.7%) were treated with a single SBRT fraction of 16 Gy. Median follow-up was 26.1 months (range 1.7-78.6), and 1- and 2-year overall survival (OS) rates were 96.9% and 84.2%, respectively. Local control (LC) rates at 1- and 2-years were 76.3% and 70.6%, respectively. Multivariate analysis identified histology as a prognostic factor for both OS and LC. Patients who underwent spine SBRT 6 months after the spinal lesion diagnosis had LC at 2 years of 88%, vs 61.7% for those who underwent SBRT before this period. No grade III or higher toxicity was reported. The vertebral compression fracture (VCF) rate was 4.1%. CONCLUSION Spine SBRT at our institution showed a 2-year LC of 70.6%, without G3 toxicities. Delaying SBRT at least 6 months to administer systemic treatment was related to an improvement in local control.
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Affiliation(s)
- H Pérez-Montero
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - O Godino
- Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Lozano
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - L Asiáin
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - I Martínez
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - J J Sánchez
- Radiodiagnostic Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - R de BlasFernández
- Medical Physics and Radiation Protection Department, Institut Català D'Oncologia, Barcelona, Spain
| | - E Fernández
- Physical Medicine and Rehabilitation Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Stefanovic
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - N García
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - J Martínez
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - F Guedea
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain
| | - A Navarro-Martin
- Radiation Oncology Department, Institut Català D'Oncologia, Barcelona, Spain.
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Linares-Galiana I, Berenguer-Frances MA, Cañas-Cortés R, Pujol-Canadell M, Comas-Antón S, Martínez E, Laplana M, Pérez-Montero H, Pla-Farnós MJ, Navarro-Martin A, Nuñez M, Both B, Guedea F. Changes in peripheral immune cells after intraoperative radiation therapy in low-risk breast cancer. J Radiat Res 2021; 62:110-118. [PMID: 33006364 PMCID: PMC7779348 DOI: 10.1093/jrr/rraa083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/07/2020] [Indexed: 05/15/2023]
Abstract
A detailed understanding of the interactions and the best dose-fractionation scheme of radiation to maximize antitumor immunity have not been fully established. In this study, the effect on the host immune system of a single dose of 20 Gy through intraoperative radiation therapy (IORT) on the surgical bed in low-risk breast cancer patients undergoing conserving breast cancer has been assessed. Peripheral blood samples from 13 patients were collected preoperatively and at 48 h and 3 and 10 weeks after the administration of radiation. We performed a flow cytometry analysis for lymphocyte subpopulations, natural killer cells (NK), regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSCs). We observed that the subpopulation of NK CD56+high CD16+ increased significantly at 3 weeks after IORT (0.30-0.42%, P < 0.001), while no changes were found in immunosuppressive profile, CD4+CD25+Foxp3+Helios+ Treg cells, granulocytic MDSCs (G-MDSCs) and monocytic MDSCs (Mo-MDSCs). A single dose of IORT may be an effective approach to improve antitumor immunity based on the increase in NK cells and the non-stimulation of immunosuppressive cells involved in immune escape. These findings support future combinations of IORT with immunotherapy, if they are confirmed in a large cohort of breast cancer patients.
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Affiliation(s)
- Isabel Linares-Galiana
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Miguel Angel Berenguer-Frances
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Rut Cañas-Cortés
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Monica Pujol-Canadell
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Silvia Comas-Antón
- Radiation Oncology Department, Hospital Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Carretera de Canyet, s/n, 08916 Badalona, Spain
| | - Evelyn Martínez
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Maria Laplana
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Héctor Pérez-Montero
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - María Jesús Pla-Farnós
- Gynecology Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Miriam Nuñez
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Brigitte Both
- Medical Affairs & Professional Education, Business Sector Radiotherapy, Medical Technology Business Group, Carl Zeiss Meditec AG, ZEISS Group, Rudolf-Eber-Straße 11 Oberkochen, Germany
| | - Ferran Guedea
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
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9
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Linares I, Berenguer Frances M, Cañas-Cortés R, Pujol-Canadell M, Nuñez M, Comas Antón S, Martinez E, Laplana M, Pérez-Montero H, Pla Farnós M, Both B, Guedea F. PO-1812: Peripheral immune cells and intraoperative radiation in low-risk breast cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Rodríguez A, Arenas M, Lara PC, López-Torrecilla J, Algara M, Conde A, Pérez-Montero H, Muñoz JL, Peleteiro P, Pérez-Calatayud MJ, Contreras J, Ferrer C. Are there enough radiation oncologists to lead the new Spanish radiotherapy? Clin Transl Oncol 2019; 21:1663-1672. [DOI: 10.1007/s12094-019-02095-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
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Linares I, Berenguer M, Martínez E, Laplana M, Cañas R, Comas S, Pérez-Montero H, Ventura M, Guedea F. PO-1072 INTRABEAM: precision hypo-fractionated radiotherapy with a systemic immune response. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Rodríguez A, Algara M, Monge D, López-Torrecilla J, Caballero F, Morera R, Escó R, Pérez-Montero H, Ferrer C, Lara PC. Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015-2020. Clin Transl Oncol 2017; 20:402-410. [PMID: 28776310 DOI: 10.1007/s12094-017-1727-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- A Rodríguez
- Department of Radiation Oncology, Hospital Ruber Internacional, Calle de la Masó, 38, 28034, Madrid, Spain.
| | - M Algara
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona, Spain.,Universitat Pompeu Fabra, San José de la Montaña 12, 08024, Barcelona, Spain
| | - D Monge
- Facultad de Medicina, Universidad Francisco de Vitoria, Ctra Pozuelo-Majadahonda km 1.800, Pozuelo de Alarcón, 28223, Madrid, Spain
| | - J López-Torrecilla
- Department of Radiation Oncology, ERESA Hospital General Universitario, Calle de la Casa Misericordia 12, 46014, Valencia, Spain
| | - F Caballero
- Facultad de Medicina, Universidad Francisco de Vitoria, Ctra Pozuelo-Majadahonda km 1.800, Pozuelo de Alarcón, 28223, Madrid, Spain
| | - R Morera
- Department of Radiation Oncology, Hospital Universitario de La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - R Escó
- Department of Radiation Oncology, Hospital Quirón Zaragoza, Paseo Mariano Renovales, 50006, Saragossa, Spain
| | - H Pérez-Montero
- Department of Radiation Oncology, Hospital Universitario Doce de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - C Ferrer
- Department of Radiation Oncology, Consorcio Hospitalario Provincial de Castellón, Avda del Dr Clará 19, 12002, Castellón, Spain
| | - P C Lara
- Department of Radiation Oncology, Hospital Universitario Dr Negrín, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain.,Clinical Oncology, Universidad de Las Palmas, Las Palmas, Spain
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