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Antelo G, Valduvieco I, Comas S, Serrano S, Molero J, Balañá C, Villà S, Moreno S, Mollà M, Gomà C. P11.36.A Could a transcriptome profile predict local control for glioblastoma? Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Glioblastoma (GB) is the most frequent and aggressive primary brain tumor in adults. The standard of care is surgery followed by radiotherapy in combination with temozolomide. GB molecular subtypes (Classical [CL], Mesenchimal [MES] and Proneural [PN]) have been correlated with prognosis. In the preclinical setting, CL and MES glioma stem-like initiating cells have also been shown to be more radioresistant than PN subtype. If confirmed in patients, the molecular subtype could predict the specific benefit of adjuvant treatment. The aim of this work is therefore to investigate whether GB molecular profiles are associated with treatment resistance in vivo.
Material and Methods
We analyzed the spatiotemporal pattern of recurrence (progression-free survival [PFS] and local control) in 37 GB patients treated with adjuvant radiotherapy (30 x 2 Gy, following EORTC contouring guidelines) plus temozolomide in the context of a multi-centric study. Relapse was defined following the RANO criteria (gadolinium enhanced area on MRI T1 sequence) and classified into 3 groups: in-field relapse (Dmean > 57 Gy), out-of-field relapse (Dmean < 48 Gy) and not-defined relapse (no follow-up MR data or marginal relapse). We used three different classification algorithms (SVM, K-Nearest Neighbor and single sample gene set enrichment analysis) for the transcriptomic classification of tumor samples, and we only assigned a molecular profile when all three classifications agreed, otherwise we called it Mixed profile. Patients with a not-defined spatial pattern of recurrence were included in the PFS analysis, but excluded from the local control analysis.
Results
The transcriptomic classification resulted in 14 CL, 1 MES, 9 PN and 13 Mixed. Median PFS after radiotherapy was 6 months, with a mean follow-up of 11 months. No differences in PFS were found between CL, PN and Mixed groups (the single MES case was excluded). Local control was analyzed in 24 patients (10 CL, 4 PN, 10 Mixed). Non- statistically significant differences were found between PN/Mixed and CL subtypes, with a median in-field relapse-free survival of 6.9 months (PN), 6.3 months (Mixed) and 4.7 months (CL).
Conclusion
Although there is no difference in PFS among GB molecular subtypes, these results suggest that the Classical subtypes seem to relapse faster inside the radiotherapy field. This would suggest a higher radioresistance compared to Proneural and Mixed subtypes, in agreement with preclinical data. Due to the low number of patients these differences are statistically non-significant, but they provide the rationale for further investigation in a larger patient cohort. Grant: Marató -TV3
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Affiliation(s)
- G Antelo
- Radiation Oncology Department, Hospital Clinic Barcelona , Barcelona , Spain
| | - I Valduvieco
- Radiation Oncology Department, Hospital Clinic Barcelona , Barcelona , Spain
| | - S Comas
- Radiation Oncology department, Institut Catalá d'Oncologia , Barcelona , Spain
| | - S Serrano
- Radiation Oncology Department, Hospital Clinic Barcelona , Barcelona , Spain
| | - J Molero
- Radiation Oncology department, Institut Catalá d'Oncologia , Barcelona , Spain
| | - C Balañá
- Medical Oncology Department, Institut Catalá d'Oncologia , Barcelona , Spain
| | - S Villà
- Radiation Oncology department, Institut Catalá d'Oncologia , Barcelona , Spain
| | - S Moreno
- Radiation Oncology department, Institut Catalá d'Oncologia , Barcelona , Spain
| | - M Mollà
- Radiation Oncology Department, Hospital Clinic Barcelona , Barcelona , Spain
| | - C Gomà
- Radiation Oncology Department, Hospital Clinic Barcelona , Barcelona , Spain
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Comas Antón S, Moreno S, Molina G, Ballester R, Montes E, Luna M, Pascual M, Villalobos M, Meca G, Villà S. PO-1207 Partial breast irradiation with IORT using Xoft®. Experience at Catalan Institute of Oncology. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03171-1] [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: 11/26/2022]
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3
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Roth P, Pace A, Le Rhun E, Weller M, Ay C, Cohen-Jonathan Moyal E, Coomans M, Giusti R, Jordan K, Nishikawa R, Winkler F, Hong JT, Ruda R, Villà S, Taphoorn MJB, Wick W, Preusser M. Neurological and vascular complications of primary and secondary brain tumours: EANO-ESMO Clinical Practice Guidelines for prophylaxis, diagnosis, treatment and follow-up. Ann Oncol 2021; 32:171-182. [PMID: 33246022 DOI: 10.1016/j.annonc.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- P Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Pace
- Neuroncology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - E Le Rhun
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland; Université Lille, U-1192, Lille, France; Inserm, U-1192, Lille, France; Centre Hospitalier Universitaire CHU, Lille, General and Stereotaxic Neurosurgery Service, Lille, France; Oscar Lambret Center, Breast Cancer Department, Lille, France
| | - M Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - C Ay
- Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - E Cohen-Jonathan Moyal
- Radiation Oncology Department, Institut Claudius Regaud, Université Paul Sabatier, Toulouse, France; Institut Universitaire du Cancer de Toulouse IUCT Oncopole, Toulouse, France
| | - M Coomans
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Rome, Italy
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - R Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - F Winkler
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - J T Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, Seoul, The Catholic University of Korea, Republic of Korea
| | - R Ruda
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - S Villà
- Catalan Institute of Oncology, HU Germans Trias, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - W Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Lopes de Castro C, Fundowicz M, Roselló A, Jové J, Deantonio L, Aguiar A, Pisani C, Villà S, Boladeras A, Konstanty E, Kruszyna-Mochalska M, Milecki P, Jurado-Bruggeman D, Lencart J, Modolell I, Muñoz-Montplet C, Aliste L, Torras M, Puigdemont M, Carvalho L, Krengli M, Guedea F, Malicki J. PO-1174: Results of a multinational clinical audit for prostate cancer radiotherapy: the IROCA project. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01192-0] [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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Notario L, Piulats J, Sala N, Ferrándiz U, González A, Etxániz O, Villà S, Buisan O, Boladeras A, Heras L, Del Carpio L, Roselló A, Barretina P, Fina C, Pardo J, Suárez J, Comet J, Garcia del Muro X, Esteve A, Font A. 655P Prognostic significance of docetaxel (D) plus androgen-deprivation therapy (ADT) in patients (p) with metastatic castration-sensitive prostate cancer (mCSPC) according to extent of disease: A study of real-world data. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.914] [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: 10/23/2022] Open
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Comas S, Luguera E, Molero J, Balaña C, Estival A, Castañer S, Carrato C, Hostalot C, Teixidor P, Villà S. Influence of glioblastoma contact with the subventricular zone on survival and recurrence patterns. Clin Transl Oncol 2020; 23:554-564. [PMID: 32728970 DOI: 10.1007/s12094-020-02448-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/02/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is growing evidence that the subventricular zone (SVZ) may be involved in both the initiation and progression of glioblastoma (GB). We aimed to assess tumor proximity to the SVZ as a potential prognostic factor in GB. METHOD Retrospective study of 133 patients diagnosed with primary GB who underwent surgery followed by temozolomide-based chemoradiation between 2010 and 2016. All lesions were classified according to their anatomic relation with the SVZ. We determined the effect of tumor contact with the SVZ on progression-free survival (PFS), overall survival (OS), type, and patterns of recurrence. RESULTS At a median follow-up of 18.6 months (95% CI 15.9-21.2), PFS and OS were 7.5 (95% CI 6.7-8.3) and 13.9 (95% CI 10.9-16.9) months, respectively. On the univariate analyses, initial contact with the SVZ was a factor for poor prognosis for both PFS (6.1 vs. 8.7 months; p = 0.006) and OS (10.6 vs. 17.9 months; p = 0.037). On the multivariate analysis, tumor contact with the SVZ remained statistically significant for PFS, but not OS. Patients with SVZ-contacting tumors presented a higher rate of aggressive clinical progression (30.9% vs. 11.3%; p = 0.007) and contralateral relapse patterns (23.4% vs. 9.1%; p = 0.048). CONCLUSIONS Our results suggest that glioblastoma contact with the SVZ appears to be an independent prognostic factor for poor PFS. The presence of an SVZ-contacting tumor was associated with more aggressive recurrences and a higher rate of contralateral relapses. These findings suggest that this variable may be a new prognostic factor in glioblastoma.
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Affiliation(s)
- S Comas
- Radiation Oncology, Institut Català D'Oncologia, c/ del Canyet SN, 08916, Badalona, Catalonia, Spain
| | - E Luguera
- Physics, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - J Molero
- Physics, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - C Balaña
- Medical Oncology, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - A Estival
- Medical Oncology, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - S Castañer
- Neuroradiology, Institut de Diagnòstic Per La Imatge, Badalona, Catalonia, Spain
| | - C Carrato
- Pathology. Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - C Hostalot
- Neurosurgery. Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - P Teixidor
- Neurosurgery. Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - S Villà
- Radiation Oncology, Institut Català D'Oncologia, c/ del Canyet SN, 08916, Badalona, Catalonia, Spain.
- Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain.
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Torras MG, Canals E, Muñoz-Montplet C, Vidal A, Jurado D, Eraso A, Villà S, Caro M, Molero J, Macià M, Puigdemont M, González-Muñoz E, López A, Guedea F, Borras JM. Improving quality of care and clinical outcomes for rectal cancer through clinical audits in a multicentre cancer care organisation. Radiat Oncol 2020; 15:28. [PMID: 32005123 PMCID: PMC6995177 DOI: 10.1186/s13014-020-1465-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/14/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction Colorectal cancer treatment requires a complex, multidisciplinary approach. Because of the potential variability, monitoring through clinical audits is advisable. This study assesses the effects of a quality improvement action plan in patients with locally advanced rectal cancer and treated with radiotherapy. Methods Comparative, multicentre study in two cohorts of 120 patients each, selected randomly from patients diagnosed with rectal cancer who had initiated radiotherapy with a curative intent. Based on the results from a baseline clinical audit in 2013, a quality improvement action plan was designed and implemented; a second audit in 2017 evaluated its impact. Results Standardised information was present on 77.5% of the magnetic resonance imaging (MRI) staging reports. Treatment strategies were similar in all three study centres. Of the patients whose treatment was interrupted, just 9.7% received a compensation dose. There was an increase in MRI re-staging from 32.5 to 61.5%, and a significant decrease in unreported circumferential resection margins following neoadjuvant therapy (ypCRM), from 34.5 to 5.6% (p < 0.001). Conclusions The comparison between two clinical audits showed improvements in neoadjuvant radiotherapy in rectal cancer patients. Some indicators reveal areas in need of additional efforts, for example to reduce the overall treatment time.
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Affiliation(s)
- M G Torras
- Clinical Management Department, Institut Català d'Oncologia, Barcelona, Spain.
| | - E Canals
- Radiation Oncology Department, Institut Català d'Oncologia, Girona, Spain
| | - C Muñoz-Montplet
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Girona, Spain
| | - A Vidal
- Quality and Results Department, Institut Català d'Oncologia, Girona, Spain
| | - D Jurado
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Girona, Spain
| | - A Eraso
- Radiation Oncology Department, Institut Català d'Oncologia, Girona, Spain
| | - S Villà
- Radiation Oncology Department, Institut Català d'Oncologia, Badalona, Spain
| | - M Caro
- Radiation Oncology Department, Institut Català d'Oncologia, Badalona, Spain
| | - J Molero
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Girona, Spain
| | - M Macià
- Radiation Oncology Department, Institut Català d'Oncologia, Hospitalet del Llobregat, Barcelona, Spain
| | - M Puigdemont
- Hospital Tumor Registry, Institut Català d'Oncologia, Girona, Spain
| | - E González-Muñoz
- Quality and Results Department, Institut Català d'Oncologia, Girona, Spain
| | - A López
- Cancer Prevention and Control Program, Institut Català d'Oncologia, Hospitalet del Llobregat, Barcelona, Spain
| | - F Guedea
- Radiation Oncology Department, Institut Català d'Oncologia, Barcelona, Spain
| | - J M Borras
- Department of Clinical Sciences, IDIBELL, University of Barcelona, Barcelona, Spain
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Panciroli C, Lucente G, Vidal L, Carcereny E, Quiroga V, Pardo JC, Romeo M, Estival A, Manzano JL, Pardo B, Velarde JM, Esteve AM, Lopez D, Mañes A, Tuset V, Villà S, Quintero CB. Assessment of neurocognitive decline in cancer patients, except brain cancer, under long-term treatment with bevacizumab. Clin Transl Oncol 2019; 22:411-419. [PMID: 31144211 DOI: 10.1007/s12094-019-02143-6] [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: 02/13/2019] [Accepted: 05/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE We performed a cross-sectional study of neurocognitive function in non-brain cancer patients treated with long-term bevacizumab. METHODS/PATIENTS From 2015 to 2017, we included patients with different types of cancer treated with bevacizumab with or without chemotherapy (BEV; N = 20) or only chemotherapy (ChT; N = 19) for at least 34 weeks, patients who received non-brain radiotherapy (RxT; N = 19), and healthy controls (HC; N = 19) were assessed once at week 34 of treatment (BEV and ChT) or at completion of radiotherapy. Neurocognition was evaluated with the Hopkins Verbal Learning Test-Revised (HVLT-R) total and delayed recall, the Trail Making Test A and B, and the Controlled Oral Word Association Test in the four groups. Non-parametric tests were used to assess differences between groups. RESULTS The BEV, ChT, and RxT groups scored significantly lower than the HC group on all tests and especially on the HVLT-R total recall. In no case were the mean scores of the BEV group significantly lower than those of the ChT or RxT groups. CONCLUSIONS Neurocognitive impairment was seen even in patients treated with local non-brain radiotherapy. Treatment with bevacizumab for a long period of time does not seem to worsen neurocognitive function to a greater extent than chemotherapy.
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Affiliation(s)
- C Panciroli
- Badalona Applied Research Group in Oncology (B-ARGO Group) - Institut Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
- University of Barcelona (UB), Barcelona, Spain
| | - G Lucente
- Neurology Service - Neuroscience Department, Hospital Germans Trias i Pujol - Institut Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain
- Universitat Automa de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - L Vidal
- Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Carcereny
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - V Quiroga
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - J C Pardo
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - M Romeo
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - A Estival
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - J L Manzano
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - B Pardo
- Medical Oncology Service, Hospital Duran i Reynals - Institut Catalá d'Oncologia (ICO), Barcelona, Spain
| | - J M Velarde
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - A M Esteve
- Tumor Hospital Registry, Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - D Lopez
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - A Mañes
- Radiation Oncology Service, Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - V Tuset
- Radiation Oncology Service, Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - S Villà
- Radiation Oncology Service, Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain
| | - C B Quintero
- Medical Oncology Service - Badalona Applied Research Group in Oncology (B-ARGO Group), Hospital Germans Trias i Pujol - Institut Catalá d'Oncologia (ICO), Badalona, Barcelona, Spain.
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Rosales Gonzalez H, Perez Montero H, Alvarez A, Mañes A, Comas Anton S, Luguera E, Antelo G, Baena E, Villalobos M, Villà S. EP-1251 focal hypofractionated stereotactic radiation therapy for brain metastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31671-8] [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: 11/16/2022]
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Durà Mata M, Molleda Marzo M, Teixidor P, Caceres C, Enseñat A, Boldó M, Martínez S, Sanchez-Carrion R, Ruiz-Almazán I, Balaña C, Villà S. Randomized controlled trial on the impact of cognitive telerehabilitation on cognition and quality of life in glioma patients. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.631] [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: 11/29/2022]
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Balaña C, Estival A, Teruel I, Hardy-Werbin M, Sepulveda J, Pineda E, Martinez-García M, Gallego O, Luque R, Gil-Gil M, Mesia C, Del Barco S, Herrero A, Berrocal A, Perez-Segura P, De Las Penas R, Marruecos J, Fuentes R, Reynes G, Velarde JM, Cardona A, Verger E, Panciroli C, Villà S. Delay in starting radiotherapy due to neoadjuvant therapy does not worsen survival in unresected glioblastoma patients. Clin Transl Oncol 2018; 20:1529-1537. [PMID: 29737461 DOI: 10.1007/s12094-018-1883-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We retrospectively examined the potential effect on overall survival (OS) of delaying radiotherapy to administer neoadjuvant therapy in unresected glioblastoma patients. PATIENTS AND METHODS We compared OS in 119 patients receiving neoadjuvant therapy followed by standard treatment (NA group) and 96 patients receiving standard treatment without neoadjuvant therapy (NoNA group). The MaxStat package of R identified the optimal cut-off point for waiting time to radiotherapy. RESULTS OS was similar in the NA and NoNA groups. Median waiting time to radiotherapy after surgery was 13 weeks for the NA group and 4.2 weeks for the NoNA group. The longest OS was attained by patients who started radiotherapy after 12 weeks and the shortest by patients who started radiotherapy within 4 weeks (12.3 vs 6.6 months) (P = 0.05). OS was 6.6 months for patients who started radiotherapy before the optimal cutoff of 6.43 weeks and 19.1 months for those who started after this time (P = 0.005). Patients who completed radiotherapy had longer OS than those who did not, in all 215 patients and in the NA and NoNA groups (P = 0.000). In several multivariate analyses, completing radiotherapy was a universally favorable prognostic factor, while neoadjuvant therapy was never identified as a negative prognostic factor. CONCLUSION In our series of unresected patients receiving neoadjuvant treatment, in spite of the delay in starting radiotherapy, OS was not inferior to that of a similar group of patients with no delay in starting radiotherapy.
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Affiliation(s)
- C Balaña
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona (Barcelona), Spain.
| | - A Estival
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona (Barcelona), Spain
| | - I Teruel
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona (Barcelona), Spain
| | - M Hardy-Werbin
- Cancer Research Programm, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J Sepulveda
- Medical Oncology Service, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - E Pineda
- Medical Oncology Service, Hospital Clinic Provincial, Barcelona, Spain
| | | | - O Gallego
- Medical Oncology Service, Hospital de Sant Pau, Barcelona, Spain
| | - R Luque
- Medical Oncology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M Gil-Gil
- Medical Oncology Service, Institut Català d'Oncologia-IDIBELL, Hospitalet de Llobregat, Spain
| | - C Mesia
- Medical Oncology Service, Institut Català d'Oncologia-IDIBELL, Hospitalet de Llobregat, Spain
| | - S Del Barco
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - A Herrero
- Medical Oncology Service, Hospital Miguel Servet, Saragossa, Spain
| | - A Berrocal
- Medical Oncology Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - P Perez-Segura
- Medical Oncology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - R De Las Penas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - J Marruecos
- Radiation Oncology Service, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - R Fuentes
- Radiation Oncology Service, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - G Reynes
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - J M Velarde
- Institut Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Badalona, Spain
| | - A Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia.,Biology Systems Department, Universidad el Bosque, Bogotá, Colombia
| | - E Verger
- Radiation Oncology Service, Hospital Clinic Provincial, Barcelona, Spain
| | - C Panciroli
- Institut Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Badalona, Spain
| | - S Villà
- Radiation Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Martinez-Garcia M, Pineda E, Del Barco S, Estival A, Verger E, Marruecos J, Gallego O, Gil M, Fuentes R, de Grigno JCBL, Lucas A, Macia M, Mesía C, Velarde J, García N, Villà S, Balana C. Concomitant chemoradiation (Ch-RT) in elderly newly diagnosed glioblastoma (GB) patients. Updated clinical outcome and molecular characteristics from the GLIOCAT study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw367.23] [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: 11/14/2022] Open
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13
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Gallego O, Estival A, Martinez-Garcia M, Pineda E, Gil M, Del Barco S, Marruecos J, Verger E, Fuentes R, Velarde J, Mesía C, Craven J, Rosell SB, Quintana C, De Huerta LP, Granell E, Gómez B, García N, Villà S, Balana C. Characteristics of gliobastomas (GBM) not resected (only biopsied) homogeneosuly treated with Stupp regimen. Results from the GLIOCAT study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw367.26] [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: 11/13/2022] Open
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14
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Estival A, Pineda E, Martinez-Garcia M, Marruecos J, Mesía C, Lucas A, Macia M, Gil M, Gallego O, Verger E, Del Barco S, Fuentes R, Craven J, García N, Villà S, Velarde J, Carrato C, Ribalta T, Arpi O, Balana C. MGMT methylated (Met) patients (p) with glioblastoma (GBM) have a better prognosis with an earlier response (ER) than those who have a late response or pseudoprogression (LR/PsP). Results of the Gliocat study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw367.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pineda E, Martinez-Garcia M, Estival A, Gil-Gil M, Del Barco S, Gallego O, Verger E, Marruecos J, Fuentes R, de Grigno JCB, Mesía C, García N, Alameda F, Velarde J, Pujol T, Oleaga L, Carrato C, Capellades J, Villà S, Balana C. Long-term survivors (LTS) in glioblastoma (GBM) patients (pts) homogeneously treated with the Stupp regimen, clinical and molecular characteristics (MGMT and IDH1 status). Initial results from the GLIOCAT study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw367.25] [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: 11/14/2022] Open
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Gil-Gil MJ, Martinez-Garcia M, Sierra A, Conesa G, Del Barco S, González-Jimenez S, Villà S. Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline. Clin Transl Oncol 2013; 16:436-46. [PMID: 24277572 PMCID: PMC3983876 DOI: 10.1007/s12094-013-1110-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/10/2013] [Indexed: 01/19/2023]
Abstract
Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10–30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.
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Affiliation(s)
- M J Gil-Gil
- Breast Cancer Unit and Neurooncology Unit, Institut Català d'Oncologia (ICO), IDIBELL, Gran Via 199-203, L'Hospitalet, 08908, Barcelona, Spain,
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Comas S, Villà S, Etxaniz O, Domènech S, Hostalot C, Carrato C, Bugès C, Balañá C. Patterns of relapse in glioblastoma after neoadjuvancy and radiation therapy. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Jove J, Arellano A, Ballester R, Tuset V, Caro M, Luguera E, Planas I, Mañes A, Villà S, Moretones C, Melero A, Molero J, Antón JA. Use of 8-Gy radiotherapy fractions for the treatment of lung cancer in fragile patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e17504] [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: 11/20/2022] Open
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Matzinger O, Duclos F, Bergh AVD, Carrie C, Villà S, Kitsios P, Poortmans P, Sundar S, van der Steen-Banasik E, Gulyban A, Collette L, Bolla M. Acute toxicity of curative radiotherapy for intermediate- and high-risk localised prostate cancer in the EORTC trial 22991. Eur J Cancer 2009; 45:2825-34. [DOI: 10.1016/j.ejca.2009.07.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/14/2009] [Accepted: 07/17/2009] [Indexed: 11/24/2022]
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Garcia AM, Villà S, Balañàa C, Teixidor P, Puyalto P, García-Armengol R, Carrato C, Sanz C, Domènech S, Arellano A. 8717 Short course of hypofractionated radiotherapy and concomitant temozolomide in patients affected with glioblastoma with V-VI prognostic classes – a pilot study. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71691-x] [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: 11/26/2022] Open
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Matzinger O, Duclos F, van den Bergh A, Carrie C, Kitsios P, Villà S, Poortmans P, Sundar S, Collette L, Bolla M. 2001 Acute toxicity of curative radiotherapy for intermediate risk localized prostate cancer in the EORTC trial 22991. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70517-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Weber D, Miller R, Taghian A, Hanssens P, Villà S, Ozsahin M, Mirimanoff R, Nishioka H, Castadot P, Rutz H. 2076. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.479] [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: 11/30/2022]
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Plans G, Brell M, Cabiol J, Villà S, Torres A, Acebes JJ. Intracranial retrograde dissemination in filum terminale myxopapillary ependymomas. Acta Neurochir (Wien) 2006; 148:343-6; discussion 346. [PMID: 16362177 DOI: 10.1007/s00701-005-0693-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 10/18/2005] [Indexed: 12/26/2022]
Abstract
Myxopapillary ependymomas (ME) are considered benign tumours (WHO grade I) of the central nervous system with long term survival rates and a tendency to local recurrence. However an aggressive course has occasionally been described, leading to CSF dissemination and even systemic metastases. We describe the case of a 23-year-old man diagnosed with intracranial subarachnoid dissemination of a filum terminale ME three years after the initial diagnosis. We have performed a careful review of the literature on CSF dissemination in ME and finally propose treatment of these cases.
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Affiliation(s)
- G Plans
- Department of Neurosurgery, University of Barcelona, Hospital Universitari de Bellvitge, Spain.
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Ozsahin M, Weber D, Ketterer N, Dietrich P, Belkacémi Y, Villà S, Scandolaro L, Bieri S, Studer G, Delacretaz F, Girardet C, Zouhair A. Outcome and patterns of failure in testicular lymphoma: A multicenter Rare Cancer Network study. Int J Radiat Oncol Biol Phys 2000. [DOI: 10.1016/s0360-3016(00)80226-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Ozsahin M, Zouhair A, Villà S, Storme G, Chauvet B, Taussky D, Gouders D, Ries G, Bontemps P, Coucke PA, Mirimanoff RO. Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network study. Eur J Cancer 1999; 35:738-43. [PMID: 10505034 DOI: 10.1016/s0959-8049(99)00012-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To assess the prognostic factors in patients with transitional-cell carcinoma of the renal pelvis and/or ureter, a series of 138 patients with transitional-cell carcinoma of the renal pelvis and/or ureter was collected in a retrospective multicentre study. 12 patients with distant metastases were excluded from the statistical evaluation. All but 3 patients underwent radical surgery: nephroureterectomy (n = 71), nephroureterectomy and lymphadenectomy (n = 20), nephroureterectomy and partial bladder resection or transurethral resection (n = 20), nephrectomy (n = 10), and ureterectomy (n = 5). Sixty-one per cent (n = 77) of the tumours were located in the renal pelvis, and 21% (n = 27) in the ureter (both in 22 [17%]). Following surgery, residual tumour was still present in 33 patients (16 microscopic and 17 macroscopic). Postoperative radiotherapy was given to 45 (36%) patients. The median follow-up period was 39 months. In a median period of 9 months, 66% of the patients relapsed (34 local, 7 locoregional, 16 regional, and 24 distant). The 5- and 10-year survival were 29% and 19%, respectively, in all patients. In univariate analyses, statistically significant factors influencing the outcome were Karnofsky index, pT-classification, pN-classification, tumour localisation, grade, and residual tumour after surgery. Multivariate analysis revealed that independent prognostic factors influencing outcome were pT-classification, the existence of residual tumour, and tumour localisation. In patients with urothelial renal pelvis and/or ureter tumours, a radical surgical attitude is mandatory; and the presence of tumour in the ureter is associated with a poorer prognosis.
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Affiliation(s)
- M Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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Villà S, Viñolas N, Verger E, Yaya R, Martínez A, Gil M, Moreno V, Caral L, Graus F. Efficacy of radiotherapy for malignant gliomas in elderly patients. Int J Radiat Oncol Biol Phys 1998; 42:977-80. [PMID: 9869218 DOI: 10.1016/s0360-3016(98)00356-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Age above 65 years is a strong negative prognostic factor for survival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the survival of elderly patients with malignant gliomas. METHODS AND MATERIALS We examined 85 consecutive elderly patients with a histological diagnosis of MG. Age ranged from 65 to 81 years (median 70 years). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%). Surgical treatment included needle biopsy in 32 patients (37.6%). Median postoperative Karnofsky Performance Status (KPS) was 60 (range: 30-100). Survival probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox's regression models. RESULTS Median survival time for all patients was 18.1 weeks. In multivariate analysis, RT was the only independent prognostic variable for survival (HR: 9.1 [95% CI: 4.5-18.7]). Forty-two patients did not start RT mostly due to low KPS (<50). The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that age was independently associated with prolonged survival (HR: 2.85 [95% CI 1.31-6.19]). Median survival of patients age 70 years and younger was 55 weeks compared with 34 weeks for patients older than 70 years. CONCLUSIONS The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter.
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Affiliation(s)
- S Villà
- Service of Radiation Oncology, Institut Català d'Oncologia, L'Hospitalet, University of Barcelona, Spain
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Villegas E, Villà S, López-Guillermo A, Petit J, Ribalta T, Graus F. Primary central nervous system lymphoma of T-cell origin: description of two cases and review of the literature. J Neurooncol 1997; 34:157-61. [PMID: 9210063 DOI: 10.1023/a:1005754212792] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Primary lymphomas of the central nervous system (PLCNS) of T-cell lineage are unusual. It has been suggested that T-cell PLCNS, compared to those of B-cell origin, present some differences in relation to age of presentation, gender, location of the tumor and survival. We describe two cases with T-cell PLCNS and review 22 parenchymatous T-cell PLCNS reported in the English literature. Age, gender and survival of the whole series of 24 T-cell PLCNS did not differ from that reported in large series of PLCNS where the great majority were of B-cell origin. In contrast, a location in the posterior fossa was found in 54% of T-cell PLCNS, whereas this location ranged from 12 go 29% in series of, mostly B-cell, PLCNS. T-cell PLCNS had a higher frequency (33%) of the histologic low grade small lymphocytic lymphoma than B-cell PLCNS (5%). Analysis of six T-cell PLCNS long-term survivors showed that half of them had low grade lymphomas. We conclude that T-cell PLCNS do not differ from those of B-cell origin in age of presentation or gender, but they have a preference to develop in the posterior fossa and a higher frequency of low grade histology which would probably explain the longer survival in some patients.
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Affiliation(s)
- E Villegas
- Services of Internal Medicine, Hospital Clínic, Barcelona, Spain
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Villà S, Viñolas N, Verger E, Gil M, Caralt L, Moreno V, Graus F. 2067 Malignant gliomas (MG) in the elderly. A study of 85 consecutive patients in two institutions. Int J Radiat Oncol Biol Phys 1997. [DOI: 10.1016/s0360-3016(97)80836-x] [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: 11/30/2022]
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Ozsahin M, Zouhair A, Villà S, Storme G, Chauvet B, Taussky D, van Houtte P, Ries G, Bontemps P, Coucke P, Mirimanoff R. 2099 Prognostic factors in urothelial renal pelvis and ureter tumors: A multicenter Rare Cancer Network study. Int J Radiat Oncol Biol Phys 1997. [DOI: 10.1016/s0360-3016(97)80867-x] [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: 11/28/2022]
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Yaya R, Martínez A, Viñolas N, Villà S, Graus F, Gil M, Verger E, Caralt M. 693High grade gliomas in old patients. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80702-x] [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: 11/26/2022]
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Villà S, Lizuain M, Twose J, Ferrán E, Pera J, De Miquel A, Rubio F, Conesa G, Acebes J, Isamat F. 275 Stereotactic RT (SRT) for intracranial tumours. Preliminary experience in Barcelona. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95533-c] [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: 11/15/2022]
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Pétrix L, Cinos C, Fernández M, Gutiérrez C, Cambray M, Villà S, Marín S, Pera J. 9 Estimation of the dose the bladder receives in gynecologic brachytherapy with complete colpostat (Selectron type). Radiother Oncol 1994. [DOI: 10.1016/0167-8140(94)91107-x] [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: 10/25/2022]
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Villà S, Cinos C, Pétriz L, Gutiérrez C, Acebes JJ, Ferrán E, Pera J. Adult medulloblastoma: The experience of a single institution. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91691-d] [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: 11/16/2022]
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Villà S, Pera J, López L, Pétriz L, Twose J, Menéndez JC. Low grade astrocytoma: Post surgical irradiation. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91679-f] [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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