Terapia de radiación corporal estereotáctica en pacientes con cáncer de próstata oligorrecurrente metacrónico. Experiencia de un centro / Stereotactic body radiation therapy in patients with metachronous oligorecurrent prostate cancer: A single-center experience

Introducción y objetivo: La oligorrecurrencia metacrónica en el cáncer de próstata (CaP) la constituyen los pacientes que empezaron con enfermedad localizada y que, tras un tratamiento radical fallido, desarrollan oligometástasis. La radioterapia estereotáctica (SBRT) dirigida a las metástasis busca retrasar el inicio de la privación androgénica. En este estudio, mostramos nuestra experiencia para elucidar el papel de la SBRT en una población seleccionada de pacientes con oligorrecurrencia metacrónica.Material y métodos: Análisis retrospectivo de pacientes tratados con SBRT por CaP oligorrecurrente entre noviembre de 2015 y diciembre de 2020. Detallamos las características clinicopatológicas al inicio de la enfermedad (edad, PSA, estadificación, tratamiento primario), escenario clínico al diagnóstico de la oligorrecurrencia (PSA, velocidad del PSA, características de las metástasis), supervivencia libre de progresión, supervivencia hasta la resistencia a la castración, dosis y toxicidad de la SBRT. Solo 2pacientes presentaron toxicidad de grado 1.Conclusiones: La SBRT en pacientes con CaP en situación de oligorrecurrencia metacrónica constituye un tratamiento seguro y efectivo que permite retrasar el inicio de la terapia de radiación androgénica y el tiempo hasta la resistencia a la castración, con niveles bajos de toxicidad. (AU)

Introduction and objective: Metachronous oligorecurrence in prostate cancer (PCa) occurs in patients with localized disease who, after failed radical treatment, develop oligometastases. Metastasis-directed stereotactic radiotherapy (SBRT) aims to delay androgen deprivation therapy. In this study, we report our experience to elucidate the role of SBRT in a selected population of patients with metachronous oligorecurrence.Material and methods: Retrospective analysis of patients treated with SBRT for oligorecurrent PCa between November 2015 and December 2020. We detailed clinicopathological characteristics at disease onset (age, PSA, stage, primary treatment), clinical scenario at diagnosis of oligorecurrence (PSA, PSA velocity, metastases characteristics), progression-free survival, castration resistance-free survival, dose, and toxicity of SBRT.Results: Thirty-eight SBRT treatments were applied to 13 lymph node and 25 bone metastases in a total of 28 patients. After a follow-up of 34.57 months (21.17-57.59), 17 patients had radiological progression of the disease and 11 presented castration resistant PCa. PFS and CRFS were 21.93 and 44.13 months, respectively. Only 2patients presented grade 1 toxicity.ConclusionsIn patients with metachronous oligorecurrent PCa, SBRT constitutes a safe and effective treatment that allows delaying the onset of androgen deprivation therapy and the time to castration resistance, assuming low levels of toxicity. (AU)

Stereotactic body radiation therapy in patients with metachronous oligorecurrent prostate cancer: A single-center experience.

INTRODUCTION AND OBJECTIVE: Metachronous oligorecurrence in prostate cancer (PCa) occurs in patients with localized disease who, after failed radical treatment, develop oligometastases. Metastasis-directed stereotactic radiotherapy (SBRT) aims to delay androgen deprivation therapy. In this study, we report our experience to elucidate the role of SBRT in a selected population of patients with metachronous oligorecurrence. MATERIAL AND METHODS: Retrospective analysis of patients treated with SBRT for oligorecurrent PCa between November 2015 and December 2020. We detailed clinicopathological characteristics at disease onset (age, PSA, stage, primary treatment), clinical scenario at diagnosis of oligorecurrence (PSA, PSA velocity, metastases characteristics), progression-free survival, castration resistance-free survival, dose, and toxicity of SBRT. RESULTS: Thirty-eight SBRT treatments were applied to 13 lymph node and 25 bone metastases in a total of 28 patients. After a follow-up of 34.57 months (21.17-57.59), 17 patients had radiological progression of the disease and 11 presented castration resistant PCa. PFS and CRFS were 21.93 and 44.13 months, respectively. Only 2 patients presented grade 1 toxicity. CONCLUSIONS: In patients with metachronous oligorecurrent PCa, SBRT constitutes a safe and effective treatment that allows delaying the onset of androgen deprivation therapy and the time to castration resistance, assuming low levels of toxicity.

Glioblastoma: changing expectations?

Glioblastoma (GB) represents the most aggressive glioma in the adult population. Despite recent research efforts, the prognosis of patients with GB has remained dismal. Lately, the knowledge of genetic information about gliomagenesis has increased; we even have a classification of the genetic expression of the tumour. The main problem is that at the moment we do not have any therapeutical resources to help us better treat these tumours, as we can do, with others tumours like breast, lung and colorectal cancer. We have also improved on diagnostic imaging, especially with the new MRI sequences; we can now better define the characteristics of the tumour area and the surrounding brain structures, allowing us to adjust resections. Thanks to the most advanced surgery techniques, such as neuronavigation, intraoperative control of the nervous function and the tumour volume, the neurosurgeon is able to complete tumour exeresis with less morbidity. These imaging techniques allow the radiation oncologist to better contour the irradiation target volume, the structures and the organs at risk, to diminish the irradiation of apparently healthy tissue. Nowadays, knowledge of brain stem cells provides new expectations for future treatments. Novel targeted agents such as bevacizumab, imatinib, erlotinib, temsirolimus, immunotherapy, cilengitide, talampanel, etc. are helping classical chemotherapeutic agents, like temozolomide, to achieve an increase in overall survival. The main objective is to improve median overall survival, which is currently between 9 and 12 months, with a good quality of life, measured by the ability to carry out daily life activities (AU)

[Contribution of PET in the follow-up of cerebral metastases in non-small cell lung cancer. A clinical case valuation]. / Aportación de la PET en el seguimiento de las metástasis cerebrales del cáncer de pulmón no microcítico. Valoración de un caso clínico.

We report a clinical case of a male 44 years old with lung adenocarcinoma with a single brain metastases treated with surgery and radiotherapy. The different PET studies performed during the evolution of the disease were very useful and crucial, firstly in the detection of radiation necrosis and after that when cerebral metastases recurrent appeared twice. The radiographic technique (Brain MRI) and the histopathology after the surgical removal confirmed the PET results. PET imaging is helpful in selected patients with brain metastases in lung cancer.

Aportación de la PET en el seguimiento de las metástasis cerebrales del cáncer de pulmón no microcítico. Valoración de un caso clínico / Contribution of PET in the follow-up of cerebral metastases in non-small cell lung cancer. A clinical case valuation

Presentamos el caso clínico de un varón de 44 años diagnosticado de adenocarcinoma pulmonar con metástasis única cerebral tratada con cirugía y radioterapia. Los estudios con PET realizados durante el curso evolutivo de la enfermedad fueron muy útiles y decisivos en la detección primero de radionecrosis, y posteriormente de recidiva de la metástasis cerebral en dos ocasiones que se confirmó por los hallazgos radiológicos (RMN cerebral) y la anatomía patológica tras su extirpación quirúrgica. La PET ofrece una ayuda importante en casos seleccionados de pacientes con metástasis cerebrales de cáncer de pulmón

We report a clinical case of a male 44 years old with lung adenocarcinoma with a single brain metastases treated with surgery and radiotherapy. The different PET studies performed during the evolution of the disease were very useful and crucial, firstly in the detection of radiation necrosis and after that when cerebral metastases recurrent appeared twice. The radiographic technique (Brain MRI) and the histopathology after the surgical removal confirmed the PET results. PET imaging is helpful in selected patients with brain metastases in lung cancer

[Radiation-induced infiltrating transitional cell carcinoma]. / Tumor transicional infiltrante de urotelio radioinducido.

INTRODUCTION: The increased risk of developing a transitional cell carcinoma (TCC) among patients irradiated for other pathologies in a known fact, but many times forgotten due to its low incidence. Our aim is to review the association between radiotherapy (RT) and muscle-infiltrating TCC among our patients. MATERIAL AND METHODS: Clinical survey among our muscle-infiltrating TCC data base since 1975. Descriptive analysis of found cases. RESULTS: We found 5 patients who developed muscle-infiltrating TCC with a mean time of 19.2 years since radiotherapy (three of them more than 20 years and the other two less than 10 years). Three patients also developed other tumours or pathologies related to radiotherapy. Two of them had an upper tract muscle-infiltrating TCC and required nephroureterectomy. All of them had high risk TCC of the bladder and one developed distant metastasis. CONCLUSIONS: Patients under abdomino-pelvic RT and a prolongued follow-up, can be considered a risk group for developing muscle-infiltrating TCC. Thus, either micro or macrohaematuria or irritative symptoms should lead us to think in this possibility, demanding complete and exhaustive study to rule out TCC in all the urothelium.

[Adjuvant and salvage radiotherapy after radical prostatectomy]. / Tratamiento adyuvante y de rescate tras prostatectomía radical.

After radical prostatectomy is important to identify patients who have a high risk of microscopic residual disease without micrometastatic disease. Adjuvant RT, in retrospective studies, reduce the risk of recurrence and is more efficacious than salvage RT and can improve PSA relapse-free survival and should have an impact on long-term overall survival. The benefit of androgen suppression could be due to a synergistic interaction and may possibly eliminate occult systemic disease. Appropriate selection to identify subgroups of patients who may benefit from salvage RT, even for those patients at the highest risk; and whether some form of hormone ablation should accompany. To predict the biochemical failure and the risk of metastatic disease after salvage RT. We analyze the references to select an appropriate therapy. Improved outcomes will need to be tested in randomized trials.

Tratamiento adyuvante y de rescate tras prostatectomía radical / Adyuvant and salvage radiotherapy after radical prostatectomy

Tras la prostatectomía radical es importante identificar pacientes con alto riesgo de enfermedad microscópica residual en ausencia de enfermedad micrometastásica. La radioterapia adyuvante en estudios retrospectivos reduce las recurrencias locales y es más eficaz que la RT de rescate, aportando mejor supervivencia libre de recaída bioquímica y un potencial impacto en la supervivencia global. La supresión androgénica puede posiblemente eliminar la enfermedad oculta y aportar un efecto aditivo sobre el control local. Es posible identificar y seleccionar los pacientes que pueden beneficiarse de la Radioterapia de rescate, incluso los de alto riesgo. Se puede determinar la predicción de la progresión de PSA tras rescate con radioterapia y el riesgo de metástasis. Analizamos la bibliografía para un mejor enfoque terapéutico, basándonos en los datos actuales conocidos, a la espera de realización de nuevos ensayos clínicos (AU)

After radical prostatectomy is important to identify patients who have a high risk of microscopic residual disease without micrometastatic disease. Adyuvant RT, in retrospective studies, reduce the risk of recurrence and is more efficacious than salvage RT and can improve PSA relapse-free survival and should have an impact on long-term overall survival. The benefit of androgen suppresion could be due to a synergistic interaction and may possibly eliminate occult systemic disease. Appropiate selection to identify subgroups of patients who may benefit from salvage RT, even for those patients at the highest risk; and whether some form of hormone ablation should accompany. To predict the biochemical failure and the risk of metastasic disease after salvage RT. We analize the references to selection an appropiate therapy. Improves outcomes will need to be tested in randomized trials (AU)

Tumor transicional infiltrante de urotelio radioinducido / Radiation-induced infiltrating transitional cell carcinoma

Introducción; El incremento del riesgo de desarrollar un tumor de células transicionales (TCT) en los pacientes tratados con radioterapia y quimioterapia por otras patologías es un hecho conocido, pero muchas veces no tenido en cuenta por su rareza. Nuestro objetivo es revisar el comportamiento clínico de esta asociación en nuestro centro. Material y métodos; Nuestra casuística de TCT infiltrante con antecedentes de irradiación abdómino pélvica desde 1975. Análisis descriptivo de los casos encontrados con dichos antecedentes. Resultados; Encontramos 5 pacientes que desarrollaron TCT infiltrante a una media de 19,2 años tras radioterapia (tres de ellos con un seguimiento superior a 20 años y los dos restantes inferior a 10 años). Tres pacientes desarrollaron otro tipo de tumores o lesiones radio inducidas. En dos de ellos coexisten un TCT infiltrante detracto urinario superior que requirió nefroureterectomía. Los 5 casos desarrollaron TCT de vejiga de alto grado y un paciente desarrolló metástasis por TCT. Conclusiones; Los pacientes con irradiación abdómino pélvica con un seguimiento prolongado constituyen un grupo de riesgo para el desarrollo de TCT infiltrante. Por tanto, la presencia de hematuria debe alertarnos y exige completar los algoritmos validados para el diagnóstico de TCT en todo el urotelio (AU)

Introduction: The increased risk of developing a transitional cell carcinoma (TCC) among patients irradiated for other pathologies in a known fact, but many times forgotten due to its low incidence. Our aim is to review the association between radiotherapy (RT) and muscle-infiltrating TCC among our patients. Material and methods: Clinical survey among our muscle-infiltrating TCC data base since 1975. Descriptive analysis of found cases. Results: We found 5 patients who developed muscle-infiltrating TCC with a mean time of 19.2 years since radiotherapy (three of them more than 20 years and the other two less than 10 years). Three patients also developed other tumours or pathologies related to radiotherapy. Two of them had an upper tract muscle- infiltrating TCC and required nephroureterectomy. All of them had high risk TCC of the bladder and one developed distant metastasis. Conclusions: Patients under abdomino-pelvic RT and a prolongued follow-up, can be considered a risk group for developing muscle-infiltrating TCC. Thus, either micro or macrohaematuria or irritative symptoms should lead us to think in this possibility, demanding complete and exhaustive study to rule out TCC in all the urothelium (AU)

[S100 protein in tumours of the central nervous system]. / Proteína S100 en tumores del sistema nervioso central.

OBJECTIVE: S100 protein has been detected in glials cells. The subject of this study is to evaluate the usefulness of serum levels of S100 as tumor marker for the screening diagnosis and follow up in patients with CNS tumors. PATIENTS AND METHODS: 57 patients were studied with tumors of the CNS: 24 multiform glioblastomas (GM), 11 anaplastic astrocytomas (AA), 3 oligodedrogliomas, 1 pinealoblastoma, 3 neurinomas, 1 low grade glioma and 13 brain metastasis of other extraneural primary tumors. 25 healthy people have been taken as control group. The S100 was analyzed by an immunoradiometric assay (IRMA) with 125 Iode. The cut off value was 0.2 g/L. RESULTS: The presurgical mean serum values of S100 didn t differ of the mean values of the control group (0.08 and 0.07 g/L, respectively). In the surgical treated patients with residual tumoral or recurrent tumors, the values of S100 increases to 38.9% in GM, 57.11% in AA and 76.9% in brain metastasis. In GM the serum values are significantly higher in patients with active tumor before receiving treatment with chemotherapy, radiotherapy or radiosurgery (p < 0.05). The values decreses to normal levels after response to oncological therapies. During the follow up (mean 551 days), the global sensitivity of S100 for progression of the disease was 47.5% and specificity was 90% with a correspondence between S100 and disease s evolution of 56%. CONCLUSIONS: S100 protein is not useful in the initial diagnosis of tumoral disease but it could be of help in the follow up of the disease because it decreases with successful treatments and increases at the time when the tumor progress.

Proteína S100 en tumores del sistema nervioso central / S100 protein in tumours of the central nervous system

Objetivo. La proteína S100 se detecta en las células gliales. El propósito de este estudio es evaluar la utilidad de la S100 sérica como marcador tumoral en el diagnóstico, seguimiento y monitorización de pacientes con tumores del sistema nervioso central (SNC). Pacientes y métodos. Se han estudiado 57 pacientes con tumores del SNC: 24 glioblastomas multiformes (GM), 11 astrocitomas anaplásicos (AA), tres oligodendrogliomas, un pinealoblastoma, tres neurinomas,ungliomade bajo grado y 13 metástasis cerebrales de otros tumores primarios. Se ha analizado la S100 en 25 personas sanas que se han tomado como grupo control. La determinación de S100 se ha realizado mediante un ensayo inmunorradiométrico (IRMA) con yodo 125, y se ha tomado como valor de corte 0,2 µg/L. Resultados. Los valores medios de la concentración sérica de S100 preoperatorios no difieren de los del grupo control (0,08 y 0,07µg/L, respectivamente). En los pacientes operados con restos tumorales y en los pacientes recidivados, la S100 se eleva: 38,9 por ciento en los GM, 57,11 en los AA y 76,9 por ciento en las metástasis cerebrales de otros tumores. En los GM, los valores séricos de S100 se elevan más significativamente en los pacientes con tumorantes de recibir tratamiento con quimioterapia, radioterapia o radiocirugía (p < 0,05). Los valores se normalizan con la respuesta a las terapias. Durante el seguimiento (media de 551 días), la sensibilidad global de la S100 para la progresión de la enfermedad fue del 47,5 por ciento, con una especificidad del 90 por ciento y una concordancia de S100 con la situación de la enfermedad del orden del 56 por ciento. Conclusiones. La S100 sérica no es útil en el diagnóstico inicial del tumor, pero podría ayudar en el seguimiento de la enfermedad, ya que su concentración disminuye con los tratamientos efectivos y se eleva cuando la enfermedad progresa (AU)