[Show abstract][Hide abstract] ABSTRACT: Radiotherapy (RT) has played a significant role in treating non melanoma skin cancer (NMSC). High-dose-rate brachytherapy (HDR-BT) approaches have a paramount relevance due to their adaptability, patient protection, and variable dose fractionation schedules. Several innovative applicators have been introduced to the brachytherapy community. The Valencia applicator is a new superficial device that improves the dose distribution compared with the Leipzig applicator. The purpose of this work is to assess the tumor control, cosmesis, and toxicity in patients with NMSC treated with the Valencia applicator and a new regimen of hypofractionation.
Journal of Contemporary Brachytherapy 06/2014; 6(2):167-72.
[Show abstract][Hide abstract] ABSTRACT: Neoadjuvant 5-FU-based chemoradiotherapy in resectable rectal cancer (RC) is a standard of treatment. The use of oral fluoropyrimidines and new agents such as oxaliplatin may improve efficacy and tolerance.
Between 1999 and 2009, 126 RC patients with T3-T4 and/or N+ disease were given three successive protocols: UFT (32), UFT-oxaliplatin (75) and capecitabine-oxaliplatin (19), alongside 45 Gy of radiotherapy; with surgery 4-6 weeks after. Adjuvant treatment was given in all patients. The primary objective was pathologic complete response (pCR).
Preoperative therapy was well tolerated, with no toxic deaths and a 15% grade 3-4 toxicity rate. Eighty-five percent of patients received the full chemotherapy dose, 56% had an abdominoperineal resection, 6% reinterventions and 57% received the full adjuvant chemotherapy planned. The pCR rate was 13%. The downstaging rate was 80%; 8% had progression of disease. The relapse rate was 20%, with local relapse in 6%. By 5 years of followup, 92% of relapses had occurred. Median follow-up was 73 months, 5- and 10-year disease-free survival rates were 75% and 50%, and 5- and 10-year overall survival rates were 79% and 66% respectively. There was no benefit from the use of oxaliplatin regarding survival or pCR rates. Older patients had worse long-term outcomes.
Neoadjuvant chemoradiotherapy with oral fluoropyrimidines and oxaliplatin is feasible and well tolerated. The risk of early progression is low. However, there was no added benefit with the use of oxaliplatin. There were no relapses in patients with pCR. The role of adjuvant chemotherapy is unclear.
Clinical and Translational Oncology 06/2012; 14(6):471-80. · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A new titanized breast mesh, TiLOOP Bra, is currently available for implantation in patients who require radiotherapy. The purpose of this work is to study the dosimetric effect of the presence of a TiLOOP Bra mesh on breast radiation treatment and radiographic imaging. The dosimetric effects have been measured for three X-ray energies: 1.25 MeV, 6 MV and 18 MV, using radiochromic films placed at three different depths. These depths are representative of mesh location in breast during the radiotherapy treatment and hence, are of interest in this study. In order to assess the disturbance in a radiographic image, different computed tomographic (CT) studies of the mesh have been performed. The absorbed dose differences with and without the mesh are less than 1%. No metallic artifacts have been observed in radiographic images associated with the mesh, nor significant disturbances in Hounsfield Units. The TiLOOP Bra mesh does not disturb the dosimetry of a typical radiotherapy treatment and its influence in the quality of the CT scan required for planning is negligible.
Journal of Applied Clinical Medical Physics 01/2012; 13(2):3667. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The common use of nomograms in Low Dose Rate (LDR) permanent prostate brachytherapy (BT) allows to estimate the number of seeds required for an implant. Independent dosimetry verification is recommended for each clinical dosimetry in BT. Also, nomograms can be useful for dose calculation quality assurance and they could be adapted to High Dose Rate (HDR). This work sets nomograms for LDR and HDR prostate-BT implants, which are applied to three different institutions that use different implant techniques.
Patients treated throughout 2010 till April 2011 were considered for this study. This example was chosen to be the representative of the latest implant techniques and to ensure consistency in the planning. A sufficient number of cases for both BT modalities, prescription dose and different work methodology (depending on the institution) were taken into account. The specific nomograms were built using the correlation between the prostate volume and some characteristic parameters of each BT modality, such as the source Air Kerma Strength, number of implanted seeds in LDR or total radiation time in HDR.
For each institution and BT modality, nomograms normalized to the prescribed dose were obtained and fitted to a linear function. The parameters of the adjustment show a good agreement between data and the fitting. It should be noted that for each institution these linear function parameters are different, indicating that each centre should construct its own nomograms.
Nomograms for LDR and HDR prostate brachytherapy are simple quality assurance tools, specific for each institution. Nevertheless, their use should be complementary to the necessary independent verification.
Journal of Contemporary Brachytherapy 09/2011; 3(3):121-4.
[Show abstract][Hide abstract] ABSTRACT: We present the case of a 46-year-old woman diagnosed with a primary oesophageal melanoma (PEM), who was treated with radical surgery followed by combined chemoimmunotherapy (interferon, carboplatin, dacarbazine and external radiotherapy) and who achieved a complete response after this treatment. PEMs are rare malignancies, with less than 300 cases described in the literature. The main differential diagnosis is with metastases of skin or ocular malignant melanomas. They are usually diagnosed at advanced stages and prognosis is typically poor. The main treatment modality should be radical surgery. The role of adjuvant treatment is uncertain, although some long responses have been seen with the use of chemotherapy or immunotherapy alongside surgery.
Clinical and Translational Oncology 04/2010; 12(4):306-9. · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gynaecologic brachytherapy (BT) is a fundamental part of the treatment of gynaecologic carcinomas, especially if it is not
possible to perform surgery. Traditionally, low-dose-rate BT and planning by orthogonal X-rays have been used. Nowadays, high-dose-rate
BT is available in most centres, enabling it to enhance the dose optimisation, radiation protection and comfort of patients.
Technical advantages in image and dosimetry have enabled the switch to CT and MRI as a means to define the tumour and the
organs at risk, and to perform realistic anatomical-based planning. However a general consensus about the way the dose should
be prescribed has not yet been reached. Some centres still use the Manchester points A as the reference to specify the dose.
It was imperative to work towards a consensus and for this reason the VII Consensus Meeting of the Radiation Oncology Spanish
Society (SEOR) Brachytherapy Group was organised. We agreed that some imaging system, CT or MRI, rather than the traditional
system with orthogonal X-rays, should always be used for treatment planning. The dose should be prescribed by volume instead
of points. And the given dose should be reported by adding external beam radiotherapy dose and BT dose as EQD2 (isoeffective
dose). Caution is also recommended in changing the mode of planning and prescription, taking into account previous experience
with points A.
KeywordsBrachytherapy-3D treatment planning-Gynaecologic tumours-Cervix-High dose rate-Clinical dosimetry
Clinical and Translational Oncology 03/2010; 12(3):181-187. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gynaecologic brachytherapy (BT) is a fundamental part of the treatment of gynaecologic carcinomas, especially if it is not possible to perform surgery. Traditionally, low-dose-rate BT and planning by orthogonal X-rays have been used. Nowadays, high-dose-rate BT is available in most centres, enabling it to enhance the dose optimisation, radiation protection and comfort of patients. Technical advantages in image and dosimetry have enabled the switch to CT and MRI as a means to define the tumour and the organs at risk, and to perform realistic anatomical-based planning. However a general consensus about the way the dose should be prescribed has not yet been reached. Some centres still use the Manchester points A as the reference to specify the dose. It was imperative to work towards a consensus and for this reason the VII Consensus Meeting of the Radiation Oncology Spanish Society (SEOR) Brachytherapy Group was organised. We agreed that some imaging system, CT or MRI, rather than the traditional system with orthogonal X-rays, should always be used for treatment planning. The dose should be prescribed by volume instead of points. And the given dose should be reported by adding external beam radiotherapy dose and BT dose as EQD2 (isoeffective dose). Caution is also recommended in changing the mode of planning and prescription, taking into account previous experience with points A.
Clinical and Translational Oncology 03/2010; 12(3):181-7. · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neoadjuvant chemoradiotherapy before surgery is an option in the treatment of locally advanced resectable oesophageal cancer (EC). However toxicity is substantial and the improvement in overall survival (OS) with this approach is controversial.
This was a prospective, single-centre study of neoadjuvant chemotherapy and concomitant chemoradiotherapy with CDDP and 5-FU and 50.4 Gy of external radiotherapy before possible radical surgery in patients with locally advanced resectable EC. If surgery was not possible, a second-phase radiotherapy boost of 10 Gy and one cycle of modified dose chemotherapy were used.
Seventy-three patients included between 1998 and 2007: 96% males, median age 61, 83% squamous cell carcinomas, 23% lower third tumours, 36% stage II and 54% stage III and 47% local lymph node involvement. Eighty-six percent completed the combined protocol. Main grade 3-4 toxicities: mucositis (19%) and infections (8%); 4 toxic deaths. Clinical response rates: complete response 54%, partial response 27%, stable disease 8%. Twenty-five patients proceeded to surgery, with radical resection in 24. Pathological response rate: complete response 32%, partial response 52%, progression 16%. There were 7 postoperative deaths and 16 of 34 patients that did not have surgery received the second-phase RT boost. Survival analysis: Median follow-up of 64 months (range 6-134 months). Median OS of 10.33 months. 2-year and 5-year OS of 22 and 16%. The only significant prognostic factor in OS is the clinical complete response rate: 13.9 vs. 7.7 months (p=0.0049).
Our protocol offers a high rate of clinical activity although it is relatively toxic and seems to increase the postoperative mortality, which would blunt any small improvement in survival. The achievement of a complete response is a powerful prognostic factor.
Clinical and Translational Oncology 12/2009; 11(12):835-41. · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: According to the GYN GEC-ESTRO Recommendations, MRI is needed with the modality of T2 weighted. CT-MR compatible tandem plus colpostats (T/C) (Nucletron) is widely used in cervical brachytherapy. The major challenge of MRI is the lack of dummy catheters. Therefore, an additional imaging modality is usually required. One disadvantage of sliced-based reconstruction is that resolution in longitudinal directions can be affected by the slice thickness. The aim of this study is to present a modified T/C applicator in which the catheter visibility is significantly improved.
A modification to the existing T/C applicator has been made available, increasing the catheter entrance diameter. It allows a greater dummy catheter diameter, and consequently it can be filled with more material per unit length. Visibility was studied with different materials.
The catheter filled with saline water plus iodine compound was clearly seen in both axial and longitudinal acquisitions. To avoid uncertainties introduced by the slice thickness, a simple procedure is presented using longitudinal acquisitions.
The modified applicator plus catheter allows a powerful signal in T2 weighted MRI, using a very simple and accessible material. Also, a method is proposed to solve the problem of the uncertainty derived from slice thickness using few longitudinal acquisitions.
Radiotherapy and Oncology 11/2008; 91(2):181-6. · 4.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess tolerance and efficacy of preoperative treatment with uracil/tegafur and radiotherapy (RT) followed by surgery and postoperative flurouracil (FU)/leucovorin (LV) in patients with rectal cancer.
Patients (n = 94) with potentially resectable tumors, ultrasound at stages T2N+ (n = 4), T3 (n = 77), T4 (n = 13) were treated with UFT (400 mg/m2/d, 5 days a week for 5 weeks) and concomitant RT to the pelvis (45 Gy; 1.8 Gy/d over 5 weeks). Patients underwent surgery 5 to 6 weeks later followed by four cycles of FU/LV. Primary end points included downstaging, pathologic responses, and sphincter-preserving surgery. Secondary end points were recurrence-free survival and overall survival.
All patients received the full RT dose. Fifteen patients (16%) needed UFT dose reduction. Preoperative G3+ toxicities included diarrhea (14%), leukopenia (1%), thrombocytopenia (1%), and nausea (4%). The downstaging rate was 54%, pathologic complete response (pCR) was 9% and, in an additional 23%, there were only residual microscopic foci. When cellular viability criteria were taken into account, the pCR was 15%. From 43 patients with abdominoperineal resection indication, 11 (25%) had sphincter-preserving surgery performed. Postoperative scheduled chemotherapy dose was not administered to 24% of patients because of G3+ toxicity (diarrhea, 8%; mucositis, 9%; and leukopenia, 7%). Patients with downstaging had significantly higher survival and recurrence-free survival rates than those without. At 3 years, actuarial patterns of failure were pelvic, 5% and distant, 11%. OS was 75%.
UFT combined with RT is safe and effective. In resectable rectal cancer, if preoperative treatment is considered, this approach can be an option.
Journal of Clinical Oncology 09/2004; 22(15):3016-22. · 17.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BackgroundModern imaging systems and three-dimensional (3-D) treatment planning systems have led to the development of virtual simulation.
PurposeTo report our five-year experience of working with virtual simulation and to evaluate whether conventional simulation can
be completely substituted by virtual simulation.
Materials and methodsThe methodology and clinical implementation of virtual simulation procedures based on a virtual simulation chain manufactured
by General Electric Medical Systems and carried out in our department were carefully analyzed.
ResultsAverage time for virtual simulation was not longer than that required for conventional simulation while the quality of the
plans generated was greatly increased. In our experience, the only practical limitation was computed tomography tunnel aperture,
which was restrictive with certain patient positions. Changing patient treatment position almost always solved this problem
ConclusionsVirtual simulation procedures are feasible, accurate, and able to substitute conventional simulation with great advantage.
AntecedentesLas modernas técnicas de imagen y los sistemas de planificación tridimensionales de radioterapia han conducido al desarrollo
de la simulación virtual.
PropósitoLos procedimientos de simulación virtual, basados en una cadena de simulación virtual de la empresa General Electric Medical
Systems, han sido cuidadosamente analizados en nuestro servicio con referencia a la metodología e implementación clínica.
ResultadosEl tiempo medio de la simulación virtual no es superior al de la simulación convencional, mientras que la calidad de las planificaciones
realizadas por el método virtual se ha incrementado notablemente. La Única limitación práctica, en nuestra experiencia, es
la derivada de la limitada abertura del tÚnel del tomögrafo axial computarizado, que es restrictiva para ciertas posiciones
del paciente, aunque el cambio de la posición del tratamiento de éste resuelve casi siempre el problema
ConclusionesEl procedimiento de simulación virtual es factible, preciso y capaz de sustituir ventajosamente a la simulación convencional.
Clinical and Translational Oncology 01/2000; 2(4):213-222. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To present the experience of La Fe Hospital and the Institute of Oncology of Valencia with preoperative radiotherapy for bladder cancer and review the literature.
The principles of radiotherapy are discussed and the most important series reported in the English literature (Memorial Sloan Kettering, M.D. Anderson, London Institute of Urology and Rotterdam Radiotherapy Institute) and the largest published Spanish series (Ramón y Cajal Hospital) are reviewed. Furthermore, the results achieved in 123 patients treated between 1982 and 1989 at the Urology and Radiotherapeutic Oncology services of La Fe Hospital and the IVO experience with accelerated radiotherapy (20 Gy in 5 fractions) immediately followed by radical cystectomy are presented.
The five-year survival ranged from 39% to 66%. Distant metastasis, which occurred in more than 50% of the patients, was the most common cause of failure. Comparison of the complication rates of the different series is difficult to perform. The operative mortality ranged from 2.4% to 10% and was 8% in our series. Preoperative radiotherapy does not appear to increase the number of postoperative complications. By multivariate analysis, lymph node involvement was the only significant factor that influenced survival in our series.
It cannot be concluded from the analysis of the prospective and randomized studies that preoperative radiotherapy improves survival in patients with invasive bladder cancer. However, some authors have reported that patients with T3b tumor might benefit from this therapeutic modality.
Archivos españoles de urología 01/1999; 52(6):586-94.