Real-world effectiveness and safety of stereotactic body radiotherapy for liver metastases with different respiratory motion management techniques.

PURPOSE: Stereotactic body radiotherapy (SBRT) has been firmly established as a treatment choice for patients with oligometastases, as it has demonstrated both safety and efficacy by consistently achieving high rates of local control. Moreover, it offers potential survival benefits for carefully selected patients in real-world clinical settings. METHODS: Between January 2008 and May 2020, a total of 149 patients (with 414 liver metastases) received treatment. The Active Breathing Coordinator device was used for 68 patients, while respiratory gating was used for 65 and abdominal compression was used for 16 patients. The most common histological finding was colorectal adenocarcinoma, with 37.6% of patients having three or more metastases, and 18% having two metastases. The prescribed dose ranged from 36 to 60 Gy, delivered in 3-5 fractions. RESULTS: Local control rates at 2 and 3 years were 76.1% and 61.2%, respectively, with no instances of local recurrence after 3 years. Factors negatively impacting local control included colorectal histology, lower prescribed dose, and the occurrence of new liver metastases. The median overall survival from SBRT was 32 months, with the presence of metastases outside the liver and the development of new liver metastases after SBRT affecting survival. The median disease-free survival was 10 months. No substantial differences in both local control and survival were observed between the respiratory motion control techniques employed. Treatment tolerance was excellent, with only one patient experiencing acute grade IV thrombocytopenia and two patients suffering from ≥ grade II chronic toxicity. CONCLUSION: For radical management of single or multiple liver metastases, SBRT is an effective and well-tolerated treatment option. Regardless of the technology employed, experienced physicians can achieve similarly positive outcomes. However, additional studies are required to elucidate prognostic factors that can facilitate improved patient selection.

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

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

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

Tratamiento de lesiones pulmonares mediante radioterapia estereotáxica extracraneal tras colocación guiada por tomografía computarizada de marcador Visicoil (R): experiencia inicial / Treatment of lung lesions by stereotactic body radiation therapy after computed tomography guided placement of a Visicoil ® marker: initial experience

Objetivo. Describir la técnica de radioterapia estereotáxica extracraneal (RTEE) de lesiones pulmonares tras colocar un marcador interno guiada por tomografía computarizada (TC) y valorar los resultados, complicaciones y efectos secundarios de estos procedimientos. Material y método. Analizamos una serie de 39 lesiones en 25 pacientes (8 primarias y 31 metastásicas) tratadas mediante este procedimiento. Se realizó una punción percutánea transtorácica guiada por TC para la colocación de un marcador interno en la lesión o próximo a ella. El procedimiento no requiere sedación. El marcador sirve de guía para el tratamiento de la lesión mediante RTEE con sincronismo respiratorio que permite controlar el movimiento del tumor y disminuir el volumen de irradiación administrando con precisión dosis altas al tumor y mínimas a los tejidos sanos circundantes. Resultados. La única complicación de las punciones transtorácicas fue el neumotórax en 6 pacientes (24%). Fue necesaria la colocación de un drenaje pleural en tres pacientes. Se consiguió el control local en el 96,7% de las lesiones. La irradiación produjo astenia grado 1 en un paciente, neumonitis grado 2 en un paciente y neumonitis grado 1 en el resto. Conclusiones. La colocación guiada por TC de marcadores internos en las lesiones pulmonares es una técnica segura que se puede realizar de forma ambulante. La RTEE con sincronismo respiratorio permite aumentar la dosis al tumor y reducir el volumen de pulmón sano tratado con pocos efectos secundarios (AU)

Objective. To describe the technique of stereotactic body radiation therapy (SBRT) of lung lesions after the computed tomography (CT) guided placement of an internal fiducial marker and to assess the results, complications and secondary effects of these procedures. Material and method. A series of 39 lesions (8 primary and 31 metastases) in 25 patients treated using this procedure were analysed. A CT-guided percutaneous transthoracic puncture was performed for placing the internal marker in the lesion or near to it. The procedure did not require sedation. The marker serves as a guide for the treatment of the lesion using SBRT with respiratory synchronism, which allows the movement of the tumour to be controlled and to decrease the radiation volume, giving high doses withe precision to the tumour, and minimal to the surrounding healthy tissue. Results. The only complication of the percutaneous fiducial placement was a pneumothorax in 6 (24%) patients. A pleural drain had to be placed in 3 patients. Local control was achieved in 96.7% of the lesions. The radiation produced a grade 1 asthenia in 1 patient, a grade 2 pneumonitis in one patient and a grade 1 pneumonitis in the remainder. Conclusions. The CT-guided placement of internal markers in lung lesions is a safe technique that may be performed as ambulatory procedure. SBRT with respiratory synchronism allows the dose to the tumour to be increased, and reduces the volume of healthy lung treated, with few secondary effects (AU)

[Treatment of lung lesions by stereotactic body radiation therapy after computed tomography guided placement of a Visicoil(®) marker: initial experience]. / Tratamiento de lesiones pulmonares mediante radioterapia estereotáxica extracraneal tras colocación guiada por tomografía computarizada de marcador Visicoil(®): experiencia inicial.

OBJECTIVE: To describe the technique of stereotactic body radiation therapy (SBRT) of lung lesions after the computed tomography (CT) guided placement of an internal fiducial marker and to assess the results, complications and secondary effects of these procedures. MATERIAL AND METHOD: A series of 39 lesions (8 primary and 31 metastases) in 25 patients treated using this procedure were analysed. A CT-guided percutaneous transthoracic puncture was performed for placing the internal marker in the lesion or near to it. The procedure did not require sedation. The marker serves as a guide for the treatment of the lesion using SBRT with respiratory synchronism, which allows the movement of the tumour to be controlled and to decrease the radiation volume, giving high doses with precision to the tumour, and minimal to the surrounding healthy tissue. RESULTS: The only complication of the percutaneous fiducial placement was a pneumothorax in 6 (24%) patients. A pleural drain had to be placed in 3 patients. Local control was achieved in 96.7% of the lesions. The radiation produced a grade 1 asthenia in 1 patient, a grade 2 pneumonitis in one patient and a grade 1 pneumonitis in the remainder. CONCLUSIONS: The CT-guided placement of internal markers in lung lesions is a safe technique that may be performed as ambulatory procedure. SBRT with respiratory synchronism allows the dose to the tumour to be increased, and reduces the volume of healthy lung treated, with few secondary effects.