Tailored exercise as a protective tool in cardio-oncology rehabilitation: a narrative review / Ejercicio individualizado como herramienta protectora en la rehabilitación cardio-oncológica: revisión narrativa

Cardiovascular disease is the leading cause of long-term morbidity and death among cancer survivors, after second malignancies. Preventing cancer treatment-induced cardiotoxicity (CTC) constitutes a crucial endpoint in oncology, from oncology treatment implementation. The American Association of Clinical Oncology has recently highlighted the role of physical exercise as an essential component of co-adjuvant cancer treatment and cancer survivor care programs. Exercise training may protect from cardiotoxicity on a molecular and physiological basis. Two major types of training in this field are: cardiovascular and resistance/strength training. Little is known about the effects of these modalities of exercise on CTC. This narrative review aimed to gather evidence and extract conclusions about the effectiveness of exercise training on CTC. To do so, we reviewed scientific literature under a sophisticated approach in line with the PRISMA project guidelines. Studies on physical training exercise effects and cardiac-related measures throughout the cancer stages (cancer treatment and survivorship) were selected. Data collection comprised extracting information of study features, exercise training characteristics and related effects. As a result, 1087 studies were retrieved from database search and 33 studies were selected, comprising 2778 participants. Most of the studies (n = 29) examined the effects of cardiovascular training on CTC. No studies analysed the effects of resistance-based training. We observed a lack of systematic effect of exercise across studies due to the high heterogeneity (e.g., many studies did not follow the guidelines for training interventions in cancer settings). However, studies combining both cardiovascular and resistance components showed promising results. To sum up, higher adherence to clinical guides should be encouraged to implement physical exercise interventions in medical settings and to ensure intervention effectiveness. Moreover, personalized protocols and routines should be implemented in Cardio-Oncology Rehabilitation Units. Finally, it is mandatory to avoid physical inactivity in patients with cancer

La patología cardiovascular es la primera causa de morbilidad y muerte entre los pacientes supervivientes de cáncer, después de segundas neoplasias. La prevención de cardiotoxicidades inducidas por tratamientos oncológicos constituye una meta en la Oncología. La Asociación Americana de la Oncología Clínica recientemente ha destacado la importancia del ejercicio físico como componente coadyuvante esencial en el tratamiento contra el cáncer. El ejercicio físico puede dar protección en la cardiotoxicidad desde un punto de vista molecular y fisiológico. Dos tipos de entrenamiento destacan: entrenamiento cardiovascular y de fuerza. Esta revisión pretende recoger evidencia y extraer conclusiones sobre la efectividad del ejercicio físico ante la cardiotoxicidad. Para ello revisamos la literatura científica bajo criterios PRISMA. Estudios basados en el efecto del ejercicio físico y mediciones cardiacas a lo largo de procesos oncológicos (tratamiento oncológicos y supervivientes) fueron seleccionados. Como resultado, 1087 estudios fueron recuperados y 33 estudios fueron seleccionados, comprendiendo 2778 sujetos. La mayoría de los estudios (n=29) examinaron el efecto del entrenamiento cardiovascular en la cardiotoxicidad. No hubo estudios que analizaran exclusivamente el entrenamiento de Fuerza. Observamos una escasez de efecto sistémico a lo largo debido a la alta heterogeneidad. De cualquier modo, los estudios combinando entrenamiento cardiovascular y de fuerza parecen demostrar resultados prometedores. En resumen, las guías clínicas deberían animar a implementar programas de ejercicio físico en el entorno médico y garantizar intervenciones efectivas. Asimismo, deberían implementarse protocolos individualizados en unidades de Rehabilitación Cardio-Oncológica. Finalmente, resulta imperativo promover el mensaje de evitar la inactividad física en el paciente oncológico

Treatment of acute and chronic focal neuropathic pain in cancer patients with lidocaine 5 % patches. A radiation and oncology department experience.

PURPOSE: This study aims to evaluate the utility of a new technology, Lidocaine 5 % patch (L5%P), for providing analgesia without other sensory deficit in cancer patients with focal neuropathic pain (NP) related or not with cancer. METHODS: During the period February 2011 to July 2011, 83 patients were seen for the first time in our department and L5%P were prescribed to 15 of those patients (18.07 %). Information recorded in relation to the L5%P included the following: (a) Nature of NP, (b) medications tested, (c) drug combinations, (d) L5%P therapy duration, (e) efficacy, and (f) undesirable effects. RESULTS: Forty percent of the patients (n = 6) in our series had NP related to their cancer and 60 % (n = 9), chronic NP not related to their cancer diagnosis, but all referred to our Radiotherapy and Oncology Department for radiotherapy. The analgesic effect of the L5%P was potent in eight cases (53.33 %) and partial in four cases (26.66 %). This represents 79.99 % efficacy in selected patients. There were no serious adverse events reported in any of the patients. CONCLUSION: The results indicate that there are patients with NP within a cancer setting who are suitable for treatment and successfully managed with topical L5%P, alone or in combination with other drugs.

Spinal cord astrocytoma: multidisciplinary experience.

BACKGROUND: Astrocytomas of the spinal cord have rarely been reported. We examined our experience, treatment and outcome of patients treated during the last four years. MATERIAL AND METHODS: We reviewed the charts from patients treated for this neoplasm in a multidisciplinary team of Granada, Spain. The information was retrospectively obtained from the patients' hospital records. The patients were evaluated with clinical history, physical exam, spinal magnetic resonance (MR), surgery, location and histology, treatment, and follow-up. RESULTS: In the last four years, we have treated 37 astrocytomas, of which only 3 were intramedullary. All patients underwent surgery, radiotherapy and chemotherapy. Two patients died, but one is alive and practically asymptomatic. CONCLUSION: The optimal treatment remains controversial. Radiotherapy should be considered for tumors with high-grade histopathology, clinically progressive and when a substantial resection cannot be achieved. New therapeutic strategies need to be studied to improve survival.

Diagnostic accuracy of 201Thallium-SPECT and 18F-FDG-PET in the clinical assessment of glioma recurrence.

PURPOSE: Reliable differential diagnosis between tumour recurrence and treatment-induced lesions is required to take advantage of new therapeutic approaches to recurrent gliomas. Structural imaging methods offer a high sensitivity but a low specificity, which might be improved by neurofunctional imaging. This study aimed to test the hypothesis that incorporation of 18-fluoro-deoxy-glucose positron emission tomography (FDG-PET) increases the accuracy of this differential diagnosis obtained with 201Tl chloride-single-photon emission computed tomography (201Tl-SPECT). MATERIALS AND METHODS: Seventy-six patients (mean age 47.72 +/- 16.19 years) under suspicion of glioma recurrence, 42% with low-grade and 58% with high-grade lesions, were studied by (201)Tl-SPECT and FDG-PET, reporting results under blinded conditions using visual analysis. Tumour was confirmed by histological confirmation (23 patients) or clinical and structural neuroimaging follow-up (mean of 2.6 years). RESULTS: This population had a high disease prevalence (72%). Globally, highest sensitivity was obtained using 201Tl-SPECT assessed with MRI (96%) and highest specificity using FDG-PET + MRI (95%). FDG-PET appeared slightly better for confirming tumour recurrence, whereas 201Tl-SPECT was superior for ruling out possible recurrence (disease present in 38% of FDG-PET negative explorations). In the high-grade subgroup, there were no false-positive examinations (specificity: 100%), but sensitivity differed among techniques (201Tl-SPECT : 94%; 201Tl-SPECT + MRI: 97%; FDG-PET + MRI: 83%). In the low-grade subgroup, 201Tl-SPECT + MRI showed highest sensitivity (95%) and lowest posttest negative probability (9%); FDG-PET + MRI offered highest specificity (92%) with a posttest negative probability of 35%. CONCLUSIONS: FDG-PET does not clearly improve the diagnostic accuracy of (201)Tl-SPECT, which appears to be a more appropriate examination for the diagnosis of possible brain tumour recurrence, especially for ruling it out.

(201)Tl-SPECT in low-grade gliomas: diagnostic accuracy in differential diagnosis between tumour recurrence and radionecrosis.

PURPOSE: The aim of this work was to describe the usefulness of a simple (201)Tl single-photon emission computed tomography (SPECT) technique in the differential diagnosis between tumour recurrence and radionecrosis during the follow-up of patients treated for low-grade gliomas. METHODS: The study population comprised 84 patients treated for low-grade gliomas who showed suspicion of tumour recurrence during their follow-up. All patients were examined by neuro-anatomical imaging procedures (CT, MRI) and (201)Tl-SPECT. (201)Tl-SPECT images were assessed by visual analysis based only on the information on the prescription form and by estimation of the uptake index (ratio of mean counts in the lesion to those in the contralateral mirror area). Examiners were blinded to the results of other tests. RESULTS: Under these conditions, the neuro-anatomical procedures yielded 26.2% inconclusive reports, with a global diagnostic accuracy of 0.61, a sensitivity of 0.63 and a specificity of 0.59. The global diagnostic accuracy for (201)Tl-SPECT was 0.83, with a sensitivity of 0.88 and a specificity of 0.76. Diagnostic pitfalls were observed in regions with physiological (201)Tl uptake, i.e. the posterior cranial fossa, diencephalon, lateral ventricles and cavernous and longitudinal venous sinuses. An uptake index cut-off value of 1.25 showed a sensitivity of 0.90 and specificity of 0.80 for detection of tumour activity. CONCLUSION: (201)Tl-SPECT has adequate diagnostic accuracy to be part of routine algorithms in the follow-up of patients with low-grade glioma suspected of tumour recurrence, as an alternative to neuro-anatomical procedures and not solely as a complementary test.