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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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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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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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