Prospective study on stereotactic body radiotherapy for small pancreatic neuroendocrine tumors: tolerance and effectiveness analysis.

INTRODUCTION: Surgery is the standard treatment for pancreatic neuroendocrine tumors (pNETs), obtaining favorable results but associating high morbidity and mortality rates. This study assesses stereotactic body radiation therapy (SBRT) as a radical approach for small (< 2 cm) nonfunctioning pNETs. MATERIALS AND METHODS: From January 2017 to June 2023, 20 patients with small pNETs underwent SBRT in an IRB-approved study. Endpoints included local control, tolerance, progression-free survival, and overall survival (OS). Diagnostic assessments comprised endoscopy, CT scans, OctreScan or PET-Dotatoc, abdominal MRI, and histological confirmatory samples. RESULTS: In a 30-month follow-up of 20 patients (median age 55.5 years), SBRT was well-tolerated with no grade > 2 toxicity. 40% showed morphological response, 55% remained stable. Metabolically, 50% achieved significant improvement. With a median OS of 41.5 months, all patients were alive without local or distant progression or need for surgical resection. CONCLUSION: SBRT is a feasible and well-tolerated approach for small neuroendocrine pancreatic tumors, demonstrating effective local control. Further investigations are vital for validation and extension of these findings.

Interdisciplinary Spanish consensus on a watch-and-wait approach for rectal cancer / Consenso español interdisciplinar sobre un enfoque de vigilancia y espera en el cáncer de recto

Watch-and-wait has emerged as a new strategy for the management of rectal cancer when a complete clinical response is achieved after neoadjuvant therapy. In an attempt to standardize this new clinical approach, initiated by the Spanish Cooperative Group for the Treatment of Digestive Tumors (TTD), and with the participation of the Spanish Association of Coloproctology (AECP), the Spanish Society of Pathology (SEAP), the Spanish Society of Gastrointestinal Endoscopy (SEED), the Spanish Society of Radiation Oncology (SEOR), and the Spanish Society of Medical Radiology (SERAM), we present herein a consensus on a watch-and-wait approach for the management of rectal cancer. We have focused on patient selection, the treatment schemes evaluated, the optimal timing for evaluating the clinical complete response, the oncologic outcomes after the implementation of this strategy, and a protocol for surveillance of these patients.(AU)

Interdisciplinary Spanish consensus on a watch-and-wait approach for rectal cancer.

Watch-and-wait has emerged as a new strategy for the management of rectal cancer when a complete clinical response is achieved after neoadjuvant therapy. In an attempt to standardize this new clinical approach, initiated by the Spanish Cooperative Group for the Treatment of Digestive Tumors (TTD), and with the participation of the Spanish Association of Coloproctology (AECP), the Spanish Society of Pathology (SEAP), the Spanish Society of Gastrointestinal Endoscopy (SEED), the Spanish Society of Radiation Oncology (SEOR), and the Spanish Society of Medical Radiology (SERAM), we present herein a consensus on a watch-and-wait approach for the management of rectal cancer. We have focused on patient selection, the treatment schemes evaluated, the optimal timing for evaluating the clinical complete response, the oncologic outcomes after the implementation of this strategy, and a protocol for surveillance of these patients.

Ibero-American Consensus Review and Incorporation of New Biomarkers for Clinical Practice in Colorectal Cancer.

Advances in genomic technologies have significantly improved the management of colorectal cancer (CRC). Several biomarkers have been identified in CRC that enable personalization in the use of biologic agents that have shown to enhance the clinical outcomes of patients. However, technologies used for their determination generate massive amounts of information that can be difficult for the clinician to interpret and use adequately. Through several discussion meetings, a group of oncology experts from Spain and several Latin American countries reviewed the latest literature to provide practical recommendations on the determination of biomarkers in CRC based on their clinical experience. The article also describes the importance of looking for additional prognostic biomarkers and the use of histopathology to establish an adequate molecular classification. Present and future of immunotherapy biomarkers in CRC patients are also discussed, together with several techniques for marker determination, including liquid biopsy, next-generation sequencing (NGS), polymerase chain reaction (PCR), and fecal immunohistochemical tests. Finally, the role of Molecular Tumor Boards in the diagnosis and treatment of CRC is described. All of this information will allow us to highlight the importance of biomarker determination in CRC.

Unravelling oligometastatic disease from the perspective of radiation and medical oncology. Part I: non-small cell lung cancer and breast cancer

Oligometastatic disease (OMD) defines a cancer status that is intermediate between localized and widely spread metastatic disease, and can be treated with curative intent. While diagnostic imaging tools have considerably improved in recent years, unidentified micrometastases can still evade current detection techniques, allowing the disease to progress. The various OMD scenarios are mainly defined by the number of metastases, the biological and molecular tumour profiles, and the timing of the development of metastases. Increasing knowledge has contributed to the earlier and improved detection of OMD, underlining the importance of early disease control. In view of increasing OMD detection rates in current real-world clinical practice and the lack of standardized evidence-based guidelines to treat this cancer status, a board of experts from the Spanish Societies of Radiation Oncology (SEOR) and Medical Oncology (SEOM) organized a series of sessions to update the current state-of-the-art on OMD from a multidisciplinary perspective, and to discuss how results from clinical studies might translate into promising treatment options. This expert review series summarizes what is known and what it is pending clarification in the context of OMD in the scenarios of non-small cell lung cancer and breast cancer (Part I), and prostate cancer and colorectal cancer (Part II), aiming to offer specialists a pragmatic framework to help improve patient management (AU)

Unravelling oligometastatic disease from the perspective of radiation and medical oncology. Part II: prostate cancer and colorectal cancer

Oligometastatic disease (OMD) defines a status of cancer that is intermediate between localized and widely spread metastatic disease, and can be treated with curative intent. While imaging diagnostic tools have considerably improved in recent years, unidentified micrometastases can still escape from current detection techniques allowing disease to progress. The variety of OMD scenarios are mainly defined by the number of metastases, the biological and molecular tumour profiles, and the timing of the development of metastases. Increasing knowledge has contributed to the earlier and improved detection of OMD, underlining the importance of an early disease control. Based on increasing detection rates of OMD in the current real clinical practice and the lack of standardized evidence-based guidelines to treat this cancer status, a board of experts from the Spanish Societies of Radiation Oncology (SEOR) and Medical Oncology (SEOM) organized a series of sessions to update the current state-of-the-art on OMD from a multidisciplinary perspective, and to discuss how results from clinical studies may translate into promising treatment options. This experts’ review series summarizes what is known and what it is pending clarification in the context of OMD in the scenarios of Non-Small Cell Lung Cancer and Breast Cancer (Part I), and Prostate Cancer and Colorectal Cancer (Part II), aiming to offer specialists a pragmatic framework that might contribute to the improved management of patients (AU)

Unravelling oligometastatic disease from the perspective of radiation and medical oncology. Part I: non-small cell lung cancer and breast cancer.

Oligometastatic disease (OMD) defines a cancer status that is intermediate between localized and widely spread metastatic disease, and can be treated with curative intent. While diagnostic imaging tools have considerably improved in recent years, unidentified micrometastases can still evade current detection techniques, allowing the disease to progress. The various OMD scenarios are mainly defined by the number of metastases, the biological and molecular tumour profiles, and the timing of the development of metastases. Increasing knowledge has contributed to the earlier and improved detection of OMD, underlining the importance of early disease control. In view of increasing OMD detection rates in current real-world clinical practice and the lack of standardized evidence-based guidelines to treat this cancer status, a board of experts from the Spanish Societies of Radiation Oncology (SEOR) and Medical Oncology (SEOM) organized a series of sessions to update the current state-of-the-art on OMD from a multidisciplinary perspective, and to discuss how results from clinical studies might translate into promising treatment options. This expert review series summarizes what is known and what it is pending clarification in the context of OMD in the scenarios of non-small cell lung cancer and breast cancer (Part I), and prostate cancer and colorectal cancer (Part II), aiming to offer specialists a pragmatic framework to help improve patient management.

Low-dose radiation therapy for hand osteoarthritis: shaking hands again?

BackgroundHand osteoarthritis (HOA) is one of the most common causes of pain and functional disability in western countries and there is still no definitive cure. Low-dose radiation therapy (LDRT) has anti-inflammatory properties that have shown to be effective in the symptomatic relief of various degenerative musculoskeletal disorders. We designed a clinical protocol using LDRT for symptomatic HOA and present results and tolerance in the first 100 patients included.Materials and methodsBetween April 2015 and March 2021, 100 patients with a median age of 60 were treated. Fifty-seven patients suffering from proximal/distal interphalangeal joint pain, 40 patients with thumb arthritis, 2 patients with radiocarpal joint affection and 1 patient with metacarpophalangeal joint pain were enrolled. LDRT comprised of 6 fractions of 0.5–1 Gy on every other day up to a total dose of 3–6 Gy. Clinical response was evaluated according to the visual analog scale (VAS) for pain level and the von Pannewitz score (VPS) for joint functionality. Any patients not achieving subjective adequate pain relief after 8 weeks of treatment were offered a second identical LDRT course.ResultsWith a median follow-up of 10.5 months (range 7.55–12.45), 94% reported an improvement in the pain, with a significant reduction in the VAS level after 3, 6 and 12 months (p < 0.001). Sixty-three patients needed a second course of treatment at a median time interval of 12 weeks (range 9–14). The mean VAS score before treatment was 8 (range 3–10). After treatment, it was 5 (range 1–10). After 3, 6 and 12 months, the mean VAS scores were 4 (range 0–9), 3 (range 0–9) and 3.5 (range 0–9), respectively. Seventy patients reported functionality improvements after LDRT according to the von Pannewitz score. No acute or late complications were observed.

Extreme Hypofractionation with SBRT in Localized Prostate Cancer.

Prostate cancer is the most commonly diagnosed cancer among men around the world. Radiotherapy is a standard of care treatment option for men with localized prostate cancer. Over the years, radiation delivery modalities have contributed to increased precision of treatment, employing radiobiological insights to shorten the overall treatment time, improving the control of the disease without increasing toxicities. Stereotactic body radiation therapy (SBRT) represents an extreme form of hypofractionated radiotherapy in which treatment is usually delivered in 1-5 fractions. This review assesses the main efficacy and toxicity data of SBRT in non-metastatic prostate cancer and discusses the potential to implement this scheme in routine clinical practice.

[Mediterranean diet and cancer]. / Dieta mediterránea y cáncer.

INTRODUCTION: Introduction: cancer remains one of the main causes of death worldwide, representing a major health issue. Mediterranean diet (MD) can have an important role in lowering cancer incidence. Objectives/Methods: we performed a bibliographic review searching for evidence demonstrating the protective role of MD against cancer, and herein discuss our main findings. Results: several studies show evidence on the protective effect of the Mediterranean diet against cancer development. As a lifestyle, MD includes healthy dietary and social habits, and is linked to frequent physical activity. All of this, when sustained over time, has a preventing role on the appearance of cancer. The antioxidants and anti-inflammatory effects of certain products frequently found in the MD are responsible for this protection. Moreover, MD also prevents overweight and obesity, which are also directly related to the development of certain cancer types. Conclusion: there is scientific evidence on the protective role of the Mediterranean diet on cancer prevention.

INTRODUCCIÓN: Introducción: el cáncer sigue siendo un importante problema de salud a nivel mundial, por lo que su prevención es algo prioritario a nivel sanitario. La dieta mediterránea (DM) puede prevenir su aparición. Objetivos/Métodos: realización de una búsqueda de evidencia científica sobre el papel protector de la DM frente a la aparición del cáncer y exposición de los hallazgos más relevantes. Resultados: varios estudios presentan evidencia sobre el papel de la DM en la protección contra el cáncer. Como estilo de vida, la DM incluye unos hábitos dietéticos y unas costumbres sociales muy favorables; además, va ligada a la realización de actividad física frecuente. Todo esto, mantenido en el tiempo, tiene una influencia positiva sobre la prevención del desarrollo de tumores. El efecto protector es mediado por la presencia de múltiples antioxidantes y antiinflamatorios ligados a los productos de consumo frecuente en esta dieta; además, como estilo de vida, la DM representa una forma de prevenir el sobrepeso y la obesidad, que son también causantes directos del desarrollo de neoplasias. Conclusión: existe evidencia científica sobre el papel protector de la DM contra la aparición de algunos tumores.

Dieta mediterránea y cáncer / Mediterranean diet and cancer

Introducción: el cáncer sigue siendo un importante problema de salud a nivel mundial, por lo que su prevención es algo prioritario a nivel sanitario. La dieta mediterránea (DM) puede prevenir su aparición. Objetivos/métodos: realización de una búsqueda de evidencia científica sobre el papel protector de la DM frente a la aparición del cáncer y exposición de los hallazgos más relevantes. Resultados: varios estudios presentan evidencia sobre el papel de la DM en la protección contra el cáncer. Como estilo de vida, la DM incluye unos hábitos dietéticos y unas costumbres sociales muy favorables; además, va ligada a la realización de actividad física frecuente. Todo esto, mantenido en el tiempo, tiene una influencia positiva sobre la prevención del desarrollo de tumores. El efecto protector es mediado por la presencia de múltiples antioxidantes y antiinflamatorios ligados a los productos de consumo frecuente en esta dieta; además, como estilo de vida, la DM representa una forma de prevenir el sobrepeso y la obesidad, que son también causantes directos del desarrollo de neoplasias. Conclusión: existe evidencia científica sobre el papel protector de la DM contra la aparición de algunos tumores. (AU)

Introduction: cancer remains one of the main causes of death worldwide, representing a major health issue. Mediterranean diet (MD) can have an important role in lowering cancer incidence. Objectives/methods: we performed a bibliographic review searching for evidence demonstrating the protective role of MD against cancer, and herein discuss our main findings. Results: several studies show evidence on the protective effect of the Mediterranean diet against cancer development. As a lifestyle, MD includes healthy dietary and social habits, and is linked to frequent physical activity. All of this, when sustained over time, has a preventing role on the appearance of cancer. The antioxidants and anti-inflammatory effects of certain products frequently found in the MD are responsible for this protection. Moreover, MD also prevents overweight and obesity, which are also directly related to the development of certain cancer types. Conclusion: there is scientific evidence on the protective role of the Mediterranean diet on cancer prevention. (AU)

[Nutrition impact on insomnia treatment]. / Impacto de la alimentación en la lucha contra el insomnio.

INTRODUCTION: Introduction: insomnia represents a growing and important health problem. If it persists, it could have a negative impact in people's welfare. Nowadays we have a wide range of techniques to measure and analyze sleep quality and quantity. Objectives: to demonstrate the impact of nutrition in sleep disorders. Methods: bibliographic review selecting the most relevant papers related to nutrition and its impact on sleep. Results: there is a direct correlation between some food or supplements and sleep quality and quantity. In addition, there exist some nutritional maneuvers that can help to prevent or solve some sleep disorders. The relationship between tryptophan and melatonin with the induction and maintenance of the sleep is clear, but vitamins, minerals, macronutrients and some dietetic habits can also have an impact. Conclusions: nutrition can have a relevant effect in the prevention and resolution of sleep disorders. Further studies are necessary to assess the real impact of nutritional treatments in insomnia.

INTRODUCCIÓN: Introducción: el insomnio representa un creciente problema de salud, con repercusiones importantes si es mantenido a largo plazo, ya que puede impactar en la salud del individuo. Actualmente se dispone de técnicas de registro del sueño y cuestionarios de análisis que facilitan la realización de estudios de calidad del sueño. Objetivos: demostrar el impacto de la nutrición en los trastornos del sueño. Métodos: revisión bibliográfica con selección de los artículos más relevantes relacionados con la nutrición y el insomnio. Resultados: existe una relación directa entre ciertos alimentos o suplementos y la calidad y cantidad del sueño, de esta manera se identifican actuaciones nutricionales que pueden ayudar a resolver o a prevenir ciertos trastornos del sueño. Parece clara la relación del triptófano y la melatonina con la inducción y el mantenimiento del sueño, pero las vitaminas, los minerales, los macronutrientes y ciertos hábitos dietéticos pueden influir también de forma directa. Conclusiones: la nutrición parece tener un papel relevante en la prevención y resolución del insomnio, si bien futuros estudios dirigidos han de aportar más evidencia al respecto.

Lung Adenocarcinoma during Pregnancy: 11-Year Follow-Up.

The incidence of lung cancer during pregnancy is rising due to the high rate of smokers in young women and the late mean age of pregnancy; in addition, considering that the patients are young women with a higher incidence of molecular alterations, molecular testing in lung adenocarcinoma should always be performed, even in pregnancy. Here, we report the case of a lung adenocarcinoma diagnosed during pregnancy with a long survival who benefitted from brain radiotherapy, conventional chemotherapy, and ALK TKI-targeted treatment. It reveals the safety of whole brain radiotherapy during pregnancy and consideration of other brain radiation techniques even in palliative cases, which should be personalized and managed by a multidisciplinary team. However, upfront management of brain metastasis in ALK-positive patients remains unresolved.

[Nutrition as an epigenetic factor in develops of cancer]. / Nutrición como factor epigenético regulador del cáncer.

INTRODUCTION: Introduction: the incidence and prevalence of cancer disease is growing in the last years, cancer is currently the second cause of death in Spain. For years nutrition has been linked with cancer as etiologic factor, but evidence levels are poorer than expected. With science advances, epigenetic have became a large field in nutrition to try to find solid relationships between nutrition and cancer development. Objectives: this paper reviews the scientific evidence and the possible links between cancer etiology and nutrition. Methods: bibliographic review and selection of the most relevant studies found. Results and discussion: there is a relationship between nutrition and epigenetic modifications that can cause or prevent different types of cancer, by knowing those alterations we will be able to perform some primary prevention strategies trying to reduce cancer incidence. There is evidence that folates, polyphenols, selenium, isothiocyanates and Vitamin D, among others, can be related with cancer development. With a growing knowledge on the relationship between cancer, nutrition and epigenetics we will have the opportunity to use it as an important protective factor for the general population.

INTRODUCCIÓN: Introducción: el cáncer es una enfermedad de incidencia y prevalencia crecientes en los últimos años. Es la segunda causa de muerte en nuestro país. La nutrición ha demostrado ser un factor importante en el desarrollo del cáncer, si bien el nivel de evidencia clásico no ha alcanzado el nivel esperado. La epigenética en los últimos años se ha desarrollado para intentar buscar una relación sólida entre la nutrición y las posibles alteraciones que dan lugar al desarrollo de una neoplasia. Objetivos: se ha llevado a cabo una revisión de la evidencia de la relación que existe entre la nutrición y el cáncer en base a cambios epigenéticos. Métodos: búsqueda bibliográfica y selección de aquellos estudios más relevantes. Resultados y discusión: existe una relación entre la nutrición y las alteraciones epigenéticas que pueden provocar o proteger de ciertos tipos de cáncer. El conocimiento de dichas alteraciones puede ser un excelente método de prevención primaria que intente reducir la incidencia de ciertos tipos de cáncer. Existen estudios que relacionan los folatos, los polifenoles, el selenio, los isotiocianatos y la vitamina D, entre otros, con enfermedades neoplásicas. El mayor conocimiento de la relación nutrición-epigenética-cáncer, se presentará como una oportunidad para disponer de un importante factor de protección para la población general.

Nutrición como factor epigenético regulador del cáncer / Nutrition as an epigenetic factor in develops of cancer

Introducción: el cáncer es una enfermedad de incidencia y prevalencia crecientes en los últimos años. Es la segunda causa de muerte en nuestro país. La nutrición ha demostrado ser un factor importante en el desarrollo del cáncer, si bien el nivel de evidencia clásico no ha alcanzado el nivel esperado. La epigenética en los últimos años se ha desarrollado para intentar buscar una relación sólida entre la nutrición y las posibles alteraciones que dan lugar al desarrollo de una neoplasia. Objetivos: se ha llevado a cabo una revisión de la evidencia de la relación que existe entre la nutrición y el cáncer en base a cambios epigenéticos. Métodos: búsqueda bibliográfica y selección de aquellos estudios más relevantes. Resultados y discusión: existe una relación entre la nutrición y las alteraciones epigenéticas que pueden provocar o proteger de ciertos tipos de cáncer. El conocimiento de dichas alteraciones puede ser un excelente método de prevención primaria que intente reducir la incidencia de ciertos tipos de cáncer. Existen estudios que relacionan los folatos, los polifenoles, el selenio, los isotiocianatos y la vitamina D, entre otros, con enfermedades neoplásicas. El mayor conocimiento de la relación nutrición-epigenética-cáncer, se presentará como una oportunidad para disponer de un importante factor de protección para la población general

Introduction: the incidence and prevalence of cancer disease is growing in the last years, cancer is currently the second cause of death in Spain. For years nutrition has been linked with cancer as etiologic factor, but evidence levels are poorer than expected. With science advances, epigenetic have became a large field in nutrition to try to find solid relationships between nutrition and cancer development. Objectives: this paper reviews the scientific evidence and the possible links between cancer etiology and nutrition. Methods: bibliographic review and selection of the most relevant studies found. Results and discussion: there is a relationship between nutrition and epigenetic modifications that can cause or prevent different types of cancer, by knowing those alterations we will be able to perform some primary prevention strategies trying to reduce cancer incidence. There is evidence that folates, polyphenols, selenium, isothiocyanates and Vitamin D, among others, can be related with cancer development. With a growing knowledge on the relationship between cancer, nutrition and epigenetics we will have the opportunity to use it as an important protective factor for the general population

Image guided SBRT for multiple liver metastases with ExacTrac® Adaptive Gating.

AIM: To report the outcome and toxicity of sequential stereotactic body radiotherapy (SBRT) for multiple liver metastases in patients treated with ExacTrac Adaptive Gating. BACKGROUND: In selected patients with a limited number of liver metastases, SBRT has been evaluated as a safe and effective treatment, with minimal toxicity and high rates of local control. MATERIALS AND METHODS: From April 2008 to October 2013, 21 patients with multiple (3-14) liver metastases (n = 101) were treated sequentially with SBRT at our institution. Maximum tumor diameter was 7.5 cm. Prior to treatment, internal markers were placed inside or near the tumor. CT or PET-CT simulation was used for the definition of gross tumor volume (GTV). Median planning target volume was 32.3 cc (3.6-139.3 cc). Treatment consisted of 3 fractions (12-20 Gy/fraction) or 5 fractions (10 Gy/fraction), prescribed to the 90-95% of the PTV volume. Daily intra-fraction image guidance was performed with ExacTrac Adaptive Gating. Regular follow-up included CT or PET-CT imaging. RESULTS: After a median of 23.2 months, the estimated local control rate was 94.4%, 80.6%, 65% and 65% after 1, 2, 3 and 4 years; the median overall survival was 62 months (95% CI 49.12-74.87) and the actuarial survival reached at 60 months was 57.6%. The univariate data analysis revealed that only primary histology other than colorectal adenocarcinoma was shown as an independent significant prognostic factor for local control (p = 0.022). Number of treated metastases did not modify significantly the overall survival (p = 0.51). No toxicity higher than G3 (1 patient with chest wall pain) and no radiation-induced liver disease were observed. CONCLUSIONS: Sequential SBRT with ExacTrac Adaptive Gating for multiple liver metastases can be considered an effective, safe therapeutic option, with a low treatment-related toxicity. Excellent rates of local control and survival were obtained.

[Nutrition and cancer]. / NUTRICIÓN Y CÁNCER.

INTRODUCTION: It is known how diet plays an important role either in cancer occurrence or its prevention. METHODS: A complete revision on the literature has been performed trying to gain knowledge on the diets that can prevent for cancer occurrence, or those that can cause malignancies. RESULTS: Fruits and vegetables are the foods that can prevent from cancer disease, soya and fishes also have demonstrated as preventive from some types of malignancies. Clear factors causing cancer are red meat and processed meat, dairy products and alcohol. The protective roles of vitamins, antioxidants and micronutrients still have to be deeply investigated. Obesity is a clear risk factor for cancer, calorie reduction has been proposed as a factor that has protective properties in laboratory studies, but this has to be demonstrated in a clinical scenario. CONCLUSION: The diet surveillance and an adequate selection of foods can be a useful and cheap method for malignant disease prevention in the general population.

Introducción: hoy día se conoce cómo la dieta juega un importante papel tanto en la producción como en la prevención del cáncer. Métodos: se ha realizado una completa revisión bibliográfica para intentar conocer mejor aquellas dietas que pueden ser protectoras contra el cáncer o aquellas con más riesgo de producir cáncer. Resultados: entre los alimentos que pueden proteger de la aparición del cáncer destacan las frutas y verduras, también la soja y sus derivados y los pescados han mostrado protección frente a algunos tipos de tumores. Como claros factores que aumentan el riesgo de cáncer caben destacar la carne roja o procesada, los lácteos y el alcohol. El papel protector de vitaminas, antioxidantes y otros micronutrientes ha de ser explorado más a fondo. La obesidad parece un factor etiológico claro, asimismo la restricción calórica podría, de forma antagónica a la obesidad, proteger contra la aparición de tumores en estudios de laboratorio, pero se requerirán estudios clínicos para validar esta hipótesis. Conclusiones: el control de la dieta y la selección adecuada de los alimentos sería un método muy útil y de bajo coste en la prevención de tumores.

Nutrición y cáncer / Nutrition and cáncer

Introducción: hoy día se conoce cómo la dieta juega un importante papel tanto en la producción como en la prevención del cáncer. Métodos: se ha realizado una completa revisión bibliográfica para intentar conocer mejor aquellas dietas que pueden ser protectoras contra el cáncer o aquellas con más riesgo de producir cáncer. Resultados: entre los alimentos que pueden proteger de la aparición del cáncer destacan las frutas y verduras, también la soja y sus derivados y los pescados han mostrado protección frente a algunos tipos de tumores. Como claros factores que aumentan el riesgo de cáncer caben destacar la carne roja o procesada, los lácteos y el alcohol. El papel protector de vitaminas, antioxidantes y otros micronutrientes ha de ser explorado más a fondo. La obesidad parece un factor etiológico claro, asimismo la restricción calórica podría, de forma antagónica a la obesidad, proteger contra la aparición de tumores en estudios de laboratorio, pero se requerirán estudios clínicos para validar esta hipótesis. Conclusiones: el control de la dieta y la selección adecuada de los alimentos sería un método muy útil y de bajo coste en la prevención de tumores (AU)

Introduction: it is known how diet plays an important role either in cancer occurrence or its prevention. Methods: a complete revision on the literature has been performed trying to gain knowledge on the diets that can prevent for cancer occurrence, or those that can cause malignancies. Results: fruits and vegetables are the foods that can prevent from cancer disease, soya and fishes also have demonstrated as preventive from some types of malignancies. Clear factors causing cancer are red meat and processed meat, dairy products and alcohol. The protective roles of vitamins, antioxidants and micronutrients still have to be deeply investigated. Obesity is a clear risk factor for cancer, calorie reduction has been proposed as a factor that has protective properties in laboratory studies, but this has to be demonstrated in a clinical scenario. Conclusion: the diet surveillance and an adequate selection of foods can be a useful and cheap method for malignant disease prevention in the general populatio (AU)

Alternativas nutricionales en el síndrome de caquexia tumoral / Nutritional approaches to cancerrelated cachexia

El síndrome de caquexia tumoral es una complicación frecuente en el paciente oncológico, además su aparición puede mermar la tolerancia y respuesta al tratamiento médico o quirúrgico, alterar la calidad de vida e incluso influir negativamente en la supervivencia de los pacientes. Se ha realizado una completa revisión en bases médicas sobre la epidemiología, fisiopatología, diagnóstico y tratamiento del síndrome de caquexia tumoral para intentar buscar una actitud terapéutica adecuada que corrija las alteraciones metabólicas, base de esta complicación, y restaure el estado nutricional del paciente. Hasta la fecha, no disponemos de un tratamiento estándar que aplicar a estos pacientes, ya que opciones válidas para un grupo de enfermos no han demostrado validez al estudiarse en grupos con otras condiciones. Lo que si queda claro es que el tratamiento multidisciplinar y multimodal es necesario para revertir las alteraciones producidas en el síndrome de caquexia tumoral, y que cada paciente o grupo de pacientes debe ser estudiado y tratado dentro de una terapia individualizada (AU)

The cancer-related cachexia syndrome is a frequent complication in oncology; its presence can cause intolerance and failure of oncologic treatment, worsen quality of live and decrease survival. In this paper, a complete revision was made taking into account data on epidemiology, physiopathology, diagnosis and treatment on cancer cachexia, trying to find out a standard approach to correct the metabolic abnormalities underlying this complication and improve the patient s nutritional status. To date there is no standard treatment and the different options that have been used, have shown variable results depending on the population of study. Moreover we know that multidisciplinary and multimodal treatment is necessary for the treatment of cancer cachexia and thus, that individualized therapies are the endpoint for further studies (AU)

Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation.

BACKGROUND AND PURPOSE: To analyze the efficacy and safety of a new preoperative intensity-modulated radiotherapy (IMRT) and integrated-boost chemoradiation scheme. PATIENTS AND METHODS: In all, 74 patients were treated with IMRT and concurrent standard dose capecitabine. The dose of the planning target volume (PTV) encompassing the tumor, mesorectum, and pelvic lymph nodes was 46 Gy in 23 fractions; the boost PTV, at a dose of 57.5 Gy in 23 fractions, included the macroscopic primary tumor and pathological lymph nodes. The patients underwent surgery 6-8 weeks after chemoradiation. RESULTS: The complete treatment data of 72 patients were analyzed. Tumor downstaging was achieved in 55 patients (76.38 %) and node downstaging in 34 (47.2 %). In 22 patients (30.6 %), there was complete pathological response (ypCR). The circumferential resection margin was free of tumor in 70 patients (97.2 %). The 3-year estimated overall survival and disease-free survival rates were 95.4 and 85.9 % respectively, and no local relapse was found; however, ten patients (13.8 %) developed distant metastases. High pathologic tumor (pT) downstaging was shown as a favorable prognostic factor for disease-free survival. No grade 4 acute radiotherapy-related toxicity was found. CONCLUSIONS: The IMRT and integrated-boost chemoradiation scheme offered higher rates of ypCR and pT downstaging, without a significant increase in toxicity. The circumferential margins were free of tumors in the majority of patients. Primary tumor regression was associated with better disease-free survival.