Comprometidos con la formación
La actividad docente de la Fundación GenesisCare se integra y coordina con la actividad clínico-asistencial e investigadora, involucrando a todos los profesionales de GenesisCare, así como a grandes expertos. La Fundación aporta los recursos necesarios para potenciar la formación de los profesionales que trabajan en el campo de la Oncología, como un requisito imprescindible para mejorar la calidad asistencial.
Comprometidos con la investigación
La investigación como vía de mejora de los tratamientos y de la supervivencia frente al cáncer es otro de los ejes en los que se centra la Fundación GenesisCare. A través de distintos canales promueve proyectos de investigación y actividades científicas, realiza estudios dirigidos a evaluar el impacto y los resultados del tratamiento del cáncer, así como de los efectos secundarios y la calidad de vida del paciente.
Desde la Fundación GenesisCare se potencia la actividad investigadora de nuestros profesionales, fomentando la divulgación de sus avances.
El éxito en el tratamiento contra el cáncer sólo se puede conseguir dedicando una cantidad importante de recursos para alcanzar adelantos terapéuticos.
Publicación de artículos
National societies’ needs as assessed by the ESTRO National Societies Committee survey: A European perspective
Cristina Garibaldi, Nuria Jornet, Li Tee Tan, Annette Boejen, Pierfrancesco Franco, Johan Bussink, Esther G.C. Troost, Bartosz Bak , Jean-Emmanuel Bibault, Maia Dzhugashvili, Ludwig Van den Berghe, Lara Fizaine, Arta Leci, Umberto Ricardi, Barbara A. Jereczek-Fossa.
Radiother Oncol 2020 Oct; 151:176-181. doi: 10.1016/j.radonc.2020.08.001. Epub 2020 Aug 7.
To determine how ESTRO can collaborate with Radiation Oncology National Societies (NS) according to its mission and values, and to define the new roadmap to strengthen the NS network role in the forthcoming years.
Materials and methods:
The ESTRO NS committee launched a survey addressed to all European National Societies, available online from June 5th to October 30th 2018. Questions were divided into three main sections: (1) general information about NS; (2) relevant activities (to understand the landscape of each NS context of action); (3) relevant needs (to understand how ESTRO can support the NS). Eighty-nine European NS were invited to participate. Respondents were asked to rank ESTRO milestones in order of importance, indicating the level of priority to their society.
A total of 58 out of 89 NS (65.2%) from 31 European countries completed the questionnaire. The majority of NS ranked “Optimal patient care to cure cancer and to reduce treatment-related toxicity” as the highest level of priority. This aligns well with the ESTRO vision 2030 “Optimal health for all together.” NS also indicated a high need for more consensus guidelines and exchange of best practices, access to high quality accredited education, implementation of the ESTRO School Core Curriculum at the national level, and defining quality indicators and standard in Radiation Oncology, improved communication and increased channelling of information.
The results of this survey will be used to strengthen the relations between ESTRO and European NS to promote and develop initiatives to improve cancer care.
SARS-CoV-2 Antigen Testing Program (COVID-ATP): A longitudinal study in 14 UK cancer centers
P. Kechagioglou, C.Hatton, K. Ramasamy, A. Schuh, J. Parmar, B. Lubowa, J. Crombie, E. Moreno-Olmedo, E. Lopez, JA. Gonzalez Ferreira, D. Rivas, Simon Lewi.
Infectious Diseases Diagnosis &Treatment. 4: 164. DOI:10.29011/2577- 1515.100164.
The COVID-19 pandemic has had a profound impact on population health, with the prevalence and severity of the illness being higher in cancer patients due to their immunosuppressive state. Cancer clinics should consider routine staff and patient testing as people infected with COVID-19 may have very mild or no symptoms while they can still transmit the virus to others, acting as super spreaders. The study aim is to assess the prevalence of SARS-CoV-2 in asymptomatic healthcare workers and patients and the impact of preventative measures in a UK private oncology provider.
Asymptomatic staff and patients enter a prospective screening program, the SARS-CoV-2 Antigen Testing Program (COVID-ATP), consisting of the nationally approved real time Polymerase-Chain-Reaction (RT-PCR) nasopharyngeal swab test looking for SARS-CoV-2 viral RNA. The program runs April to December 2020 and covers the period of the 1st lockdown, the summer period of viral remission and the second wave in autumn/winter 2020. Here we present our preliminary results between April and October 2020.
Asymptomatic staff working across 14 centres are tested weekly and cancer patients are tested at specific intervals depending on their treatment plan. The COVID-ATP testing program is complemented by staff and patient adherence to infection prevention control (IPC) procedures, social distancing, clinic spacing, virtual clinics, intense cleaning routines and appropriate Personal Protective Equipment (PPE) use.
204 healthcare workers and 21 patients are tested on average each week. The prevalence of asymptomatic staff infection was 0.8% shortly after the first lockdown in April/May 2020, reduced to 0% between June/July 2020, increased to 1% in August/ September and was 0.8% in September/October 2020. Two asymptomatic patients tested positive on routine testing, towards the end of the 1st lockdown.
This is the first longitudinal study in a UK private healthcare group, who applied a systematic testing program to assess the prevalence of asymptomatic COVID-19 in healthcare workers and patients. The prevalence of asymptomatic COVID-19 in staff is similar to the community prevalence in England at the time of testing and the temporal prevalence reflects the community prevalence trends. The protective measures taken within centres and the self-isolation of staff testing positive, resulted in lack of viral spread.
How to Optimise Oncological Treatments: Lessons Learned from the First Covid-19 wave
López E, Kechagioglou P., O’Brien P., Moreno-Olmedo E, Gonsalves-Pieretti D, Suárez-Gironzini V, Fusco JP, Lewi SI.
International Journal of Clinical Studies & Medical Case Reports
JCMCR. 2020; 7(3): 002 DOI: 10.46998/IJCMCR.2020.07.000162
Despite the local idiosyncrasies and different viral disease epidemiology resulting in country specific governmental measures, our 70 centers located in Australia (32), United Kingdom (15) and Spain (21) joined forces and shared knowledge and experiences, which supported an appropriate clinical strategy for each country. The supply of Radio Therapy (RT) and/or Chemo Therapy (CT), and the safeguard of patients and staff in regard to their infectious status have been our priorities. In order to classify the changes in practice made during this pandemic we divide them into four major pillars that have impacted our culture and processes: oncology treatment, infection control, Information Technology (IT) infrastructure and staff connectedness. Facing a health crisis, the doctor leadership should be consolidated and for this reason, a high engagement of our doctors across the network is an essential key point. The oncology sanitary system should be continuously reinforced and should also be flexible plus so lid.
COVID-19 and information and communication technology in radiation oncology: A new paradigm
Castalia Fernández , Virginia Ruiz , Felipe Couñago.
World J Clin Oncol 2020 Dec 24; 11(12): 968-975 doi: 10.5306/wjco.v11.i12.968
Due to coronavirus disease 2019 pandemic caused by severe acute respiratory syndrome coronavirus 2, there has been a major rea llocation of resources that has impacted the treatment of many diseases, including cancer. The growing use of information and communication technologies (ICT), together with a new approach to work aimed at ensuring the safety of health care professionals and patients alike, has allowed us to maintain the quality of care while ensuring biosecurity. The application of ICT to health care (eHealth) aims to significantly improve the quality, access to, and effectiveness of medical care. In fact, the expanded use of ICT has been recognized as a key, cost effective priority for health care by the World Health Organisation. The medical speciality of radiation oncology is closely linked to technology and as a consequence of coronavirus disease 2019, ICT has been widely employed by radiation oncologists worldwide, providing new opportunities for interaction among professionals, including telemedicine and e-learning, while also minimizing treatment interruptions. Future research should concentrate on this emerging paradigm, which offers new opportunities, including faster and more diverse exchange of scientific knowledge, organizational improvements, and more efficient workflows. Moreover, these efficiencies will allow professionals to dedicate more time to patient care, with a better work life balance. In the present editorial, we discuss the opportunities provided by these digital tools, as well as barriers to their implementation, and a vision of the future.
COVID-19 pneumonia treated with ultra low doses of radiotherapy (ULTRA-COVID study): a single institution report of two cases
Elena Moreno-Olmedo, Vladimir Suárez-Gironzini, Manuel Pérez, Teresa Filigheddu, Cristina Mínguez, Phys., Alba Sanjuan-Sanjuan, José A. González, Daniel Rivas, Luis Gorospe, Luis Larrea, and Escarlata López.
Clinical Trial Strahlenther Onkol. 2021 May 197(5):429 437. doi: 10.1007/s00066-020-01743-4. Epub 2021 Jan 27. ClinicalTrials.gov Identifier: NCT04394182
Since the outbreak of coronavirus disease 2019 (COVID 19) pandemic, healthcare systems have focused their efforts into finding a treatment to avoid the fatal outcomes of severe acute respiratory syndrome due to coronavirus 2 (SARS CoV 2). Benefits and risks of systemic treatments remain unclear, with multiple clinical trials still ongoing. Radiotherapy could play a role in reducing the inflammatory response in the lungs and relieve life threatening symptoms.
We designed a prospective study of Ultra Low Doses of Therapy with Radiation Applied to COVID-19 (ULTRA-COVID) for patients who suffer pneumonia, are not candidates for invasive mechanical ventilation and show no improvement with medical therapy.
We present the preliminary results of two patients diagnosed with COVID-19 pneumonia treated with ULTRA-COVID. After one radiotherapy session, significant clinical response and a good radiological response was observed in both cases, resulting in both patients being discharged from hospital in less than 2 weeks after radiation treatment.
Preliminary clinical and radiological results suggest a potential benefit of treating COVID-19 pneumonia with ULTRA-COVID.
New challenges for psycho-oncology during COVID-19 pandemic. Urgent Implementation of Telepsychology
Ana Sanz, Ruth Marín, Cristina Martínez-Ríos, Penny Kechagioglou, Escarlata López.
Journal of Cancer Therapy Vol.12 No.2, February 2021
The health and assistance crisis generated by the SARS-CoV2 pandemic has been a serious health problem and a major disruption to the general population, specifically to the most vulnerable groups as cancer patients. This situation is forcing health professionals to face and take on major challenges to maintain the necessary care.
The main objective of this study is to maintain specialized psychological care for oncology patients, and in addition, to describe the principal psychological difficulties of our series of cases.
Before the alarm state in Spain, the therapy was changed from face to face to telephone attendance and an e-mail account was opened for specific consultations in which a psycho-oncologist was present in GenesisCare Spain. The psychological interventions carried out during this time have had two characteristics: 1) Cognitive-behavioral theerapeutic framework 2) Targeted and specific interventions on issues associated with the COVID-19 pandemic.
From March 10 to April 30 (8 weeks patients and families have been attended to by 2.5 senior psycho-oncologists. A total of 369 psychological services have been attended in Spain in 142 patients. The number of services per patient has ranged from 1 to 4. The median of the long consultation has been 45 minutes. A qualitative analysis, based on a psychological interview, was conducted on the areas of intervention and concerns of the patients served. All patients presented with difficulties in more than one area and the main concerns were related to quarantine (emotional distress associated overload of information) and on aspects specific to the oncological disease (fear of death and disease recurrence).
A field is opening up to improve psychological care for cancer patients thanks to Telepsychology, which can remain as a model of comprehensive care and improve access to a wide range of users. Oncological patients have shown highly structured negative emotional responses to COVID-19 but 20% have shown a resilient response to this stressful situation.
Whole exome sequencing characterization of individuals presenting extreme phenotypes of high and low risk of developing tobacco induced lung adenocarcinoma
Ana Patiño-García; Elizabeth Guruceaga; Victor Segura; Rodrigo Sánchez Bayona; Maria Pilar Andueza; Ibon Tamayo Uria; Guillermo Serrano; Juan Pablo Fusco ; María José Pajares; Alfonso Gurpide; Marimar Ocón; Miguel F. Sanmamed; María Rodríguez Ruiz; Ignacio Melero; Maria Dolores Lozano; Carlos de Andrea; Guillermo Pita; Anna Gonzalez-Neira; Alvaro Gonzalez; Javier J. Zulueta; Luis M. Montuenga; Ruben Pio; Jose Luis Perez-Gracia.
Transl Lung Cancer Res. 2021 Mar;10(3):1327-1337. doi: 10.21037/tlcr-20-1197.
Tobacco is the main risk factor for developing lung cancer. Yet, some heavy smokers do not develop lung cancer at advanced ages while others develop it at young ages. Here, we assess for the first time the genetic background of these clinically relevant extreme phenotypes using whole exome sequencing (WES).
We performed WES of germline DNA from heavy smokers who either developed lung adenocarcinoma at an early age (extreme cases, n=50) or did not present lung adenocarcinoma or other tumors at an advanced age (extreme controls, n=50). We selected non synonymous variants located in exonic regions and consensus splice sites of the genes that showed significantly different allelic frequencies between both cohorts. We validated our results in all the additional extreme cases (i.e., heavy smokers who developed lung adenocarcinoma at an early age) available from The Cancer Genome Atlas (TCGA).
The mean age for the extreme cases and controls was respectively 49.7 and 77.5 years. Mean tobacco consumption was 43.6 and 56.8 pack years. We identified 619 significantly different variants between both cohorts, and we validated 108 of these in extreme cases selected from TCGA. Nine validated variants, located in relevant cancer related genes, such as PARP4 HLA A or NQO1 , among others, achieved statistical significance in the False Discovery Rate test. The most significant validated variant (P=4.48×1 0-5.) was located in the tumor suppressor gene ALPK2.
We describe genetic variants associated with extreme phenotypes of high and low risk for the development of tobacco induced lung adenocarcinoma. Our results and our strategy may help to identify high risk subjects and to develop new therapeutic approaches.
Radiotherapy guidelines for small-cell lung cancer
Felipe Couñago, Carolina de la Pinta, Susana Gonzalo, Castalia Fernández, Piedad Almendros, Patricia Calvo, Begoña Taboada, Antonio Gómez-Caamaño, José Luis López Guerra, Marisa Chust, José Antonio González Ferreira, Ana Álvarez González, Francesc Casas.
GOECP/SEOR World J Clin Oncol. Mar 24, 2021; 12(3): 115-143 doi: 10.5306/wjco.v12.i3.115
Small cell lung cancer (SCLC) accounts for approximately 20% of all lung cancers. The main treatment is chemotherapy (Ch). However, the addition of radiotherapy significantly improves overall survival (OS) in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch. Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non metastatic patients. The 5 year OS rate in patients with limited stage disease (non-metastatic) is slightly higher than 30%, but less than 5% in patients with extensive stage disease (metastatic). The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis, planning, and treatment of SCLC. These guidelines emphasise treatment fields, radiation techniques, fractionation, concomitant treatment, and the optimal timing of Ch and radiotherapy. Finally , we discuss the main indications for reirradiation in local recurrence.
Impact of covid-19 on patients in radiotherapy oncology departaments in Spain
Pilar M. Samper Ots, José Zapatero Ortuño, Sara Pedraza Fernández, Esther Mayrata Canellas, Carmen González San Segundo, Maider Campo Vargas, Begoña Caballero, Mónica Ramos Albiac, Gonzalo Vázquez Masedo, Beatriz Álvarez, Silvia Rodríguez Villalba, Teresa Muñoz Miguelañez, Patricia Diezhandino García, Gemma Sancho, Laura Guzmán Gómez, Juana Tripero Oter, Mikel Rico Rico Oses,Carmen Ibañez Villoslada, Ana María Soler Soler Rodríguez, María Luisa Chust, Adriana Fondevilla Soler,Eva Maria Lozano Martín,Virginia Morillo Macias, Claudio Fuentes Sánchez, Laura Torrado Moya, Jesús Fernández López, Josep María Solé, Marcos Guijarro Verdú, Moisés Mira Flores, Amadeo Wals, José Expósito Hernández.
Radiother Oncol . 2021 Aug;161: 148 151. Published online 2021 Jun 10. doi: 10.1016/j.radonc.2021.06.001.
On December 31, 2019 a cluster of cases of pneumonia were first described in Wuhan, caused by a novel type of coronavirus called SARS CoV 2. This virus causes various clinical manifestations encompassed under the term COVID-19.
On March 11, 2020 the World Health Organization declared COVID-19 a global pandemic. In Spain, the most critical period was between February 15 and May 15, 2020. During this time, various different case definitions were provided. Initial data showed that patients with cancer are at highest risk of developing severe COVID-19 disease.
In this pandemic context, risks and benefits of receiving cancer treatment should be carefully weighted. Treatment RT delays and interruptions can negatively impact outcome and long-term survival. Another fact to consider is that in a ROD protective measures among staff and changes in its r egular workflow must be implemented when treating COVID-19 patients.
The objectives of this study are to analyze the incidence of COVID-19 in patients referred to RODs in Spain, subsequent treatment modifications and to determine death-related risk factors due to COVID-19.
Identification of mutations associated with acquired resistance to sunitinib in renal cell cancer.
Elgendy M, Fusco JP, Segura V, Lozano MD, Minucci S, Echeveste JI, Gurpide A, Andueza M, Melero I, Sanmamed MF, et al.
Int J Cancer. 2019, Oct 1; 145-7. Doi: 10.1002/ ijc.32256. Epub 2019 Mar 30
Sunitinib is one of the most widely used targeted therapeutics for renal cell carcinoma (RCC), but acquired resistance against targeted therapies remains a major clinical challenge. To dissect mechanisms of acquired resistance and unravel reliable predictive biomarkers for sunitinib in RCC, we sequenced the exons of 409 tumor-suppressor genes and oncogenes in paired tumor samples from an RCC patient, obtained at baseline and after development of acquired resistance to sunitinib. From newly arising mutations, we selected, using in silico prediction models, six predicted to be deleterious, located in G6PD, LRP1B, SETD2, TET2, SYNE1, and DCC. Consistently, immunoblotting analysis of lysates derived from sunitinib-desensitized RCC cells and their parental counterparts showed marked differences in the levels and expression pattern of the proteins encoded by these genes. Our further analysis demonstrates essential roles for these proteins in mediating sunitinib cytotoxicity and shows that their loss of function renders tumor cells resistant to sunitinib in vitro and in vivo. Finally, sunitinib resistance induced by continuous exposure or by inhibition of the six proteins was overcome by treatment with cabozantinib or a low-dose combination of lenvatinib and everolimus. Collectively, our results unravel novel markers of acquired resistance to sunitinib and clinically relevant approaches for overcoming this resistance in RCC.
Human Mesenchymal Stem Cells Prevent Neurological Complications of Radiotherapy.
Soria B, Martin-Montalvo A, Aguilera Y, Mellado-Damas N, López-Beas J, Herrera-Herrera I, López E, Barcia JA, Alvarez-DoladoM, Hmadcha A, Capilla-González V.
Frontiers in Cellular Neuroscience, 16. Mayo 2019 doi: 10.3389/fncel.2019.00204
Radiotherapy is a highly effective tool for the treatment of brain cancer. However, radiation also causes detrimental effects in the healthy tissue, leading to neurocognitive sequelae that compromise the quality of life of brain cancer patients. Despite the recognition of this serious complication, no satisfactory solutions exist at present. Here we investigated the effects of intranasal administration of human mesenchymal stem cells (hMSCs) as a neuroprotective strategy for cranial radiation in mice. Our results demonstrated that intranasally delivered hMSCs promote radiation-induced brain injury repair, improving neurological function. This intervention confers protection against inflammation, oxidative stress, and neuronal loss. hMSC administration reduces persistent activation of damage-induced c-AMP response element-binding signaling in irradiated brains. Furthermore, hMSC treatment did not compromise the survival of glioma-bearing mice. Our findings encourage the therapeutic use of hMSCs as a non-invasive approach to prevent neurological complications of radiotherapy, improving the quality of life of brain tumor patients.
Outcome and toxicity of intensity-modulated radiotherapy with simultaneous integrated boost in patients with pharyngo-laryngeal cancer.
Fondevilla A, López-Guerra JL, García Fernández A, Samaniego Conde MA, Belmonte González MJ, Praena-Fernández JM, Rivin del Campo E, Alcaraz M, Azinovic I.
Clin Trans Oncol. 2019; 21: 881–90. PMID: 30506131 DOI: 10.1007/s12094-018-1995-0
The present work aims at evaluating intensity-modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) in squamous cell carcinomas (SCC) of the larynx and hypopharynx.
Methods/patients: We performed a single institutional retrospective analysis on 116 pharyngo (29%)-laryngeal (71%) SCC patients (93% male) treated with IMRT-SIB to 66-69.96 Gy in 33 fractions between 2008 and 2016. Those who underwent surgery (54%) received adjuvant radiation of 66 Gy at 2 Gy/fraction to the surgical bed. 16 patients (14%) were treated for a local recurrence after prior surgery. High-risk lymph node regions received 59.4 Gy at 1.8 Gy/fraction and low risk regions 54.12 Gy at 1.64 Gy/fraction. The median age was 60 years and 95% of patients had an ECOG performance status 0-2. Most had advanced stage disease (III 22%, IV 74%). Chemotherapy was delivered in 74% of cases.
Median follow-up was 32 months. Two and three-year overall survival for all patients was 87% and 82%, respectively. There were 28 (24%) locoregional recurrences and 19 (16%) distant failures. Grade 3 mucositis, dermatitis, and xerostomy were observed in 12%, 10%, and 3%, respectively. A longer IMRT-SIB overall treatment time was associated with a higher risk of mortality (HR 1.09, CI 1.01-1.17, P = 0.02). Postoperative IMRT-SIB associated with a significantly lower risk of any recurrence (HR 0.34, CI 0.18-0.64, P = 0.001) and higher local control (HR 0.06, CI 0.01-0.24, P < 0.01). Additionally, it associated with a lower risk of mucositis (P = 0.029) compared with definitive radio (chemo) therapy.
IMRT-SIB is a safe and feasible radiation treatment technique for pharyngo-laryngeal SCC patients with a tolerable acute toxicity profile.
Tailored exercise as a protective tool in cardio-oncology rehabilitation: a narrative review.
García González D, Pérez Bilbao T, de la Torre-Luque A, López E, García-Foncillas J, San Juan A.
Archivos de Medicina del Deporte 2020; 37(2): 125-135.
Cardiovascular disease is the leading cause of long-term morbidity and death among cancer survivors, after second malignancies. Preventing cancer treatment-induced cardiotoxicity (CTC) constitutes a crucial endpoint in oncology, from oncology treatment implementation. The American Association of Clinical Oncology has recently highlighted the role of physical exercise as an essential component of co-adjuvant cancer treatment and cancer survivor care programs. Exercise training may protect from cardiotoxicity on a molecular and physiological basis. Two major types of training in this field are: cardiovascular and resistance/strength training. Little is known about the effects of these modalities of exercise on CTC. This narrative review aimed to gather evidence and extract conclusions about the effectiveness of exercise training on CTC. To do so, we reviewed scientific literature under a sophisticated approach in line with the PRISMA project guidelines. Studies on physical training exercise effects and cardiac-related measures throughout the cancer stages (cancer treatment and survivorship) were selected.
Data collection comprised extracting information of study features, exercise training characteristics and related effects. As a result, 1087 studies were retrieved from database search and 33 studies were selected, comprising 2778 participants. Most of the studies (n = 29) examined the effects of cardiovascular training on CTC. No studies analysed the effects of resistance-based training. We observed a lack of systematic effect of exercise across studies due to the high heterogeneity (e.g., many studies did not follow the guidelines for training interventions in cancer settings). However, studies combining both cardiovascular and resistance components showed promising results. To sum up, higher adherence to clinical guides should be encouraged to implement physical exercise interventions in medical settings and to ensure intervention effectiveness. Moreover, personalized protocols and routines should be implemented in Cardio-Oncology Rehabilitation Units. Finally, it is mandatory to avoid physical inactivity in patients with cancer.
Treatment completion rates and toxicity of 5 fractions of adjuvant radiotherapy over one week in elderly breast cancer patients treated with lumpectomy.
Álvaro Flores Sánchez, Jorge Contreras Martínez, Remedios Priego.
Translational Cancer Research (Radiotherapy for Breast Cancer in Advanced Age), Vol 9, Supplement 1 (January 2020)
Elderly patients are usually frail and cannot attend a prolonged radiotherapy course. Many of them undergo mastectomy to avoid adjuvant radiotherapy thinking that they are not going to complete at least 15 fractions. Many studies have suggested hypofractionated radiotherapy in 5 days. We would like to describe the treatment completion rates and toxicity of 5 fractions of 520 cGy delivered within one week in patients over 70 years old treated with tumorectomy.
Between June 2016 and May 2019 we have analyzed retrospectively 23 patients treated with lumpectomy plus 5 fractions adjuvant radiotherapy. All patients had negative SLNB and aged between 70 and 93 years old. After finishing the RT treatment, follow up was made at 1 month, 3 months, 6 months and a year. This follow up was based on an interview and physical examination.
Independently of their age, the treatment completion rate was 100%. Every patient finished the whole treatment with no interruptions. Regarding cosmetic or toxicity outcomes within one year, there was only one patient with grade I radiation induced dermatitis and 2 patients with pruritus.
Five fractions schedule within one week is well tolerated with no important severe side effects after one year. Elderly patients appreciate to make as short as possible the number of fractions, decreasing the number of days days they have to come to clinic, improving patient satisfaction and treatment completion rates.
Emotional distress among long-term breast cancer survivors: the role of insomnia and worry.
De la Torre-Luque A, Cerezo MV, López E, Sibole JV.
Behavioral Psychology-Psicología Conductual
December 2020. Behavioral Psychology-Psicología Conductual 28(3):533-549
Breast cancer constitutes a challenge for survival and wellbeing. Emotional distress may persist many years after cancer being cured. This study aimed to analyse how emotional symptomatology was present in breast cancer survivors. Additionally, it aimed to study the role of sleep difficulty and worry on symptom maintenance. A sample of 206 women (M= 56.07 years, SD= 11.56) was selected to form four groups: healthy controls, breast cancer patients, short-term and long-term survivors. Emotional distress, worry and sleep problems were assessed. Long-term survivors showed significantly higher levels of anxiety (p< .05). Anxiety was predicted by worry for all groups but with higher variance in long-term survivors (R 2 adj= .47). Insomnia and age predicted depression in this group (R 2 adj= .40). To conclude, long-term emotional distress was observed even after the threat of cancer passed. Our findings confirm the need to extend supportive care to meet survivors’ needs. KEY WORDS: anxiety, breast cancer, survivor, depression, sleep, pathological worry.
Alpha and Omega: from the Sagrada Familia to Placenta and Cancer.
January 2020 .Journal of Science Humanities and Arts – JOSHA, 2020; 7(3) DOI: 10.17160/josha.7.3.677
The links between architecture and the sciences are as old as both of these human achievements. But modern scientific thought and methods are far more recent than architecture. On 30th November, 1660, Christopher Wren (the architect of Saint Paul’s cathedral in London, among other endeavours) delivered a lecture at one of the regular meetings of the natural philosophers who used to meet at Gresham College in the City of London, and at that meeting it was decided to form a society for the promotion of ‘Physico-Mathematical Experimental Learning’. Two years later, King Charles II granted the new body his personal imprimatur in the form of a charter, and so the Royal Society was born. Today the Royal Society is the United Kingdom’s National Academy of Science, and it recently celebrated its 350th anniversary. The Catalan architect Antoni Gaudi was more interested in geometry and God than in scientific research, but he conceived a large part of his Sagrada Familia in 1911 when seriously ill with brucellosis (also known as Malta fever, or Mediterranean fever). His obsession with the Alpha and the Omega (the Beginning and the End) is patently visible in many of his works. Here we briefly review its impact on his masterpiece in Barcelona, and a certain symbolic conceptual parallelism with the hypothesis that some placental immune escape mechanisms (physiologically leading to Birth) may perhaps be redeployed by cancerous cells to avoid immune vigilance (pathologically leading to Death).
EANO Guideline on the diagnosis and treatment of Vestibular Schwanoma.
Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D, Evans DG, Lefranc F, Sallabanda K et al.
Neuro Oncol 2020, 22 (1): 31-45.
The level of evidence to provide treatment recommendations for vestibular schwannoma is low compared with other intracranial neoplasms. Therefore, the vestibular schwannoma task force of the European Association of Neuro-Oncology assessed the data available in the literature and composed a set of recommendations for health care professionals. The radiological diagnosis of vestibular schwannoma is made by magnetic resonance imaging. Histological verification of the diagnosis is not always required. Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery. The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center. In small tumors, observation has to be weighed against radiosurgery, in large tumors surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery. Except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy.
Stereotactic radiosurgery for the treatment of recurrent High-grade Gliomas: long-term follow-up.
Sallabanda K, Yañez L, Sallabanda M, Santos M, Calvo FA, Marsiglia H.
Cureus 2019, 11 (12): e6527.
High-grade gliomas (HGG) are the most frequent primary central nervous system tumors; treatment of HCGs includes surgery and post-operative conformal radiotherapy associated with temozolomide (TMZ or procarbazine/lomustine/vincristine [PCV], specifically in patients with anaplastic oligodendrogliomas or anaplastic oligoastrocytomas). However, recurrence is common. Re-irradiation has been utilized in this setting for years and remains a feasible option, although there is always a concern regarding toxicity. Modern high-precision conformal techniques, including stereotactic radiosurgery (SRS), could improve the therapeutic ratio by delivering high biologically equivalent doses while reducing high-dose radiotherapy (RT) to normal brain tissue. In this paper, we present the results obtained after prolonged follow-up in patients who underwent SRS as a treatment for recurrent high-grade gliomas at San Francisco Hospital in Madrid, Spain.
Spanish Risk Management Framework across 17 Radiation Oncology Centers during COVID-19 pandemic.
Vladimir Suárez, Elena Moreno-Olmedo, María Pérez, José González, Daniel Rivas, Juan Fusco, Penny Kechagioglou, Escarlata López.
Radiatherapy Et Oncology, May 28, 2020. 148: 267-269
The COVID-19 pandemic has impacted our healthcare systems and the rapid introduction of new protocols that have been required to keep patients and workforce safe. In order to maintain activity with radiotherapy clinical assistance, we have implemented different measures in our centers from a patient and staff safety perspective.
Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and prediction of survival.
M. Sallabanda, M.I. García-Berrocal, J. Romero, V. García-Jarabo, M.J. Expósito, D.F. Rincón, I. Zapata, M.R. Magallón.
Clinical and Translational Oncology, 2019
To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT).
This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15-21 Gy) or 5-10 fractions (25-40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done.
Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (p 0.004), RPA I-II (p < 0.001) initial surgery (p < 0.001), absence of extracranial disease (p 0.023), and good disease control (p 0.002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression.
SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients.
Trigeminal Trophic Syndrome Secondary to Refractory Trigeminal Neuralgia Treated with CyberKnife® Radiosurgery.
Kita Sallabanda, Morena Sallabanda, Hernán Dario Barrientos, Iciar Santaolalla, Rafel García.
Cureus 2020 12(4): e7670. DOI 10.7759/cureus.7670
Trigeminal trophic syndrome (TTS) is a rare condition in which there is the involvement of the skin innervated by branches of the trigeminal nerve. Because of an alteration in the sensory function of the trigeminal nerve, an exaggerated manipulation of the skin by the patient occurs, with secondary ulcers in the affected areas. They are usually unilateral and located mainly at the beginning of the nose wing. There are very few publications in the current literature, so it is in the interest of doctors to know this rare pathology.