Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution.

INTRODUCTION: A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. METHODS: A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities' recommendations. The temporary trends of patients care and research projects proposals were registered. RESULTS: 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. CONCLUSIONS: Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.

18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) predictive score for complete resection in primary cytoreductive surgery.

OBJECTIVE: To assess the value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan, combined with clinical variables, in predicting complete cytoreduction in selected patients with advanced ovarian cancer. METHODS: We carried out a multicenter, observational, retrospective study evaluating patients who underwent primary cytoreductive surgery for advanced ovarian cancer in two Spanish centers between January 2017 and January 2022. Inclusion criteria were histological confirmation of invasive epithelial ovarian carcinoma; preoperative International Federation of Gynecology and Obstetrics (FIGO) stage III or IV; upfront cytoreductive surgery; and 18F-FDG PET/CT performed 1 month prior to surgery. A modified 18F-FDG PET/CT peritoneal cancer index score was calculated for all patients. Clinical variables and preoperative 18F-FDG PET/CT findings were analyzed and a multivariate model was constructed. A predictive score based on the odds ratio of the variables was calculated to determine patient selection. RESULTS: A total of 45 patients underwent primary cytoreductive surgery. Complete resection was achieved in 36 (80%) patients. On multivariate analysis, two clinical variables (age ≥58 years and American Society of Anesthesiology score ≥3) and two preoperative 18F-FDG PET/CT scan findings (presence of extra-abdominal lymph node involvement and modified peritoneal cancer index value of 6 or more) were associated with gross residual disease. For this multivariate model predictive of non-complete cytoreduction, the area under the curve was 0.881. A predictive value of ≥5 was the most predictive cut-off for gross residual disease. Complete resection rate was 91.7% in patients with a score of ≤4 and 33.3% in patients with a score of ≥5 points on the predictive score. CONCLUSIONS: In selected patients, a predictive score value ≥5 may be consider as a cut-off point for triaging patients to diagnostic laparoscopy before the primary surgery or neoadjuvant chemotherapy.

Patterns of use, effectiveness and safety of gadolinium contrast agents: a European prospective cross-sectional multicentre observational study.

BACKGROUND: The EU gadolinium-based contrast agents (GBCA) market has changed in recent years due to the European Medicines Agency decision to suspend the marketing authorisation of linear GBCA and the marketing authorisation of new generic macrocyclic GBCA. The study aims to understand the patterns of (GBCA) use, and to study the effectiveness and safety of GBCA in routine practice across Europe. METHODS: Prospective, cross-sectional, multicentre, observational study in patients undergoing contrast-enhanced magnetic resonance. Reported usage patterns included indication, referral and examination details. Assessment of effectiveness included changes in radiological diagnosis, diagnostic confidence and image quality. Safety data were collected by spontaneous patient adverse event (AE) reporting. RESULTS: 2118 patients were included from 8 centres across 5 European countries between December 2018 and November 2019. Clariscan, Dotarem (gadoteric acid), Gadovist (gadobutrol) and ProHance (gadoteridol) were utilised in 1513 (71.4%), 356 (16.8%), 237 (11.2%) and 12 (0.6%) patients, respectively. Most were performed in CNS-related indications (46.2%). Mean GBCA doses were 0.10 mmol/kg body weight, except for Gadovist (mean 0.12 mmol/kg). GBCA use increased confidence in diagnosis in 96.2% of examinations and resulted in a change in radiological diagnosis in 73.9% of patients. Image quality was considered excellent or good in 96.1% of patients and across all GBCA. Four patients reported AEs (0.19%), with only 1 (0.05%) considered serious. CONCLUSIONS: This European study confirmed that GBCAs are used appropriately in Europe for a wide range of indications. The study demonstrated a significant increase in diagnostic confidence after GBCA use and confirmed the good safety profile of GBCAs, with comparable results for all agents used.

Tomosíntesis de mama: mamografía sintetizada versus mamografía digital. Impacto en la dosis / Breast tomosynthesis: synthesized versus digital mammography. Impact on dose

Objetivo. Comparar la detectabilidad y la visibilidad de las lesiones en la imagen sintetizada y en la mamografía digital. Estimar el ahorro de dosis que supondría utilizar la imagen sintetizada en los exámenes de tomosíntesis. Pacientes y métodos. Siete observadores evaluaron la detectabilidad y la visibilidad de objetos similares a microcalcificaciones sobre las imágenes sintetizadas y mamografías digitales de un maniquí. Cuatro observadores evaluaron retrospectivamente las imágenes de 20 pacientes con lesiones histológicamente corroboradas. Se estimaron retrospectivamente los valores de dosis glandular promedio en una muestra de 50 pacientes. Resultados. La detectabilidad y la visibilidad de las microcalcificaciones sobre el fondo estructural de las imágenes del maniquí fue del 50 y del 100%, respectivamente, superior en la imagen sintetizada. La visibilidad de los hallazgos en las imágenes clínicas fue similar en ambos tipos de imagen, exceptuando las distorsiones, mejor visualizadas en la imagen sintetizada (p = 10−5). Un 16% de hallazgos malignos no se detectaron en las imágenes de mamografía digital y un 7% en las imágenes sintetizadas. La dosis glandular promedio por mama para un examen de 2 proyecciones (mama promedio) fue de 3,2 mGy (mamografía digital), 4,1 mGy (tomosíntesis) y 7,3 mGy (mamografía digital + tomosíntesis). Conclusiones. La detectabilidad y la visibilidad de la imagen sintetizada es equiparable a la mamografía digital. La sustitución de la mamografía digital por la imagen sintetizada supondría un ahorro de dosis del 44% (mama promedio) (AU)

Objective. To compare the detectability and visibility of lesions in synthesized and digital mammography. To estimate the dose saving due to the use of synthesized images in tomosynthesis examinations. Patients and methods. Seven observers scored the detectability and visibility of objects simulating microcalcifications in digital and synthesized images of a phantom. Four observers retrospectively assessed the images from a sample of 20 patients with histologically confirmed lesions. Mean glandular dose values were retrospectively estimated in a sample of 50 patients. Results. The detectability and visibility of microcalcifications in the structural background of phantom images were 50% and 100% higher, respectively, for synthesized images. The visibility of the findings in the clinical images was similar for both types of images, except for distortions, which were better visualized on synthesized images (p = 10−5). Sixteen percent of malignant findings were not detected in digital images and 7% were undetected in synthesized images. The mean glandular dose per breast for a two-view examination (average breast) was 3.2 mGy (digital mammography), 4.1 mGy (tomosynthesis) and 7.3 mGy (digital mammography + tomosynthesis). Conclusions. The detectability and visibility of synthesized images was comparable to that of digital mammography. Replacing digital mammography with synthesized imaging would result in a dose saving of 44% (average breast) (AU)

Hematoma epidural espontáneo, una causa infrecuente de dolor cervicodorsal / No disponible

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