Clinical settings with tofacitinib in ulcerative colitis.

There are aspects of Janus kinase (JAK) inhibitors, specifically tofacitinib, that distinguish them from other drugs used in the treatment of ulcerative colitis (UC), such as their oral administration, their short half-life and their lack of immunogenicity. With the available evidence, we can highlight tofacitinib's quick action and flexibility of use, and its efficacy in patients, irrespective of whether or not they have previously been exposed to TNF inhibitors (anti-TNF drugs) and other biologic agents. Moreover, their safety profile is known and manageable, with certain considerations and precautions being factored in before and during treatment. In this review, we have defined various scenarios pertaining to this drug, e.g. its use in the event of failure or intolerance to previous treatment with biologics, when a quick response is required or in patients with other concurrent immune-mediated diseases.

Admission Time Deep Swab Specimens Compared With Surgical Bone Sampling in Hospitalized Individuals With Diabetic Foot Osteomyelitis and Soft Tissue Infection.

Whether deep swab cultures taken at admission reliably identify pathogens compared to surgical bone specimens in hospitalized individuals with diabetic foot osteomyelitis and soft tissue infection is unclear. Comparison of microbiological isolates between a deep wound swab (DWS) taken at the time of admission through the actively infected, discharging ulcer probing to the bone and the subsequent surgical bone sample (SBS) taken during surgical debridement was made. A total of 63 subjects (age 60.8 ± 13.5 years, 75% male, 80% Type 2 diabetes, HbA1C 8.9%±2.2%) were included. The proportion of Gram-positive (DWS 49% v SBS 52%) and Gram-negative (DWS 60% v SBS 60%) isolates was similar between the techniques. However, the overall concordance of isolates between the two techniques was only fair (κ=0.302). The best concordance was observed for Staphylococcus aureus (κ=0.571) and MRSA (κ=0.644). There was a correlation between number of isolates in SBS with prior antibiotic therapy of any duration (r= -0.358, p=0.005) and with the duration of ulceration (r=0.296, p=0.045); no clinical correlations were found for DWS. Prior antibiotic therapy (p=0.03) and duration of ulceration <8 weeks (p=0.025) were predictive of negative growth on SBS. In conclusion, we found only a fair concordance between deep wound swabs acquired at admission and surgical bone specimens in those presenting with a severe diabetic foot infection and features of osteomyelitis. Ensuring early surgical debridement of all infected tissue and obtaining bone specimens should be considered a clinical priority, which may also reduce the likelihood of negative growth on SBS.

Prevalence and characterization of breakthrough pain in patients with cancer in Spain: the CARPE-DIO study.

We aimed to evaluate the prevalence, characteristics and impact of breakthrough pain (BTP) in patients with cancer attending the main specialties involved in the diagnosis and management of BTP in Spain using a multicenter, observational, cross-sectional, multidisciplinary study. Investigators had to record all patients seen at the clinic during 1 month, determine whether the patients had cancer pain, and apply the Davies algorithm to ascertain whether the patients were suffering from BTP. Of the 3,765 patients with cancer, 1,117 (30%) had cancer-related pain, and of these patients, 539 had BTP (48%, 95%CI:45-51). The highest prevalence was found in patients from palliative care (61%, 95%CI:54-68), and the lowest was found in those from hematology (25%, 95%CI:20-31). Prevalence varied also according to sex and type of tumor. According to the Alberta Breakthrough Pain Assessment Tool duration, timing, frequency, location, severity, quality, causes, and predictability of the BTP varied greatly among these patients. BTP was moderate (Brief Pain Inventory [BPI]-severity median score = 5.3), and pain interference was moderate (BPI-interference median score = 6.1) with a greater interference with normal work, general activity, and enjoyment of life. Patients with BTP showed a mean ± standard deviation score of 28.5 ± 8.0 and 36.9 ± 9.5 in the physical and mental component, respectively, of the SF-12 questionnaire. In conclusion, prevalence of BTP among patients exhibiting cancer-related pain is high. Clinical presentation is heterogeneous, and therefore, BTP cannot be considered as a single entity. However, uniformly BTP has an important impact on a patient's functionality, which supports the need for early detection and treatment.

Topical R1 and R2 Prophylactic Treatment of Acute Radiation Dermatitis in Squamous Cell Carcinoma of the Head and Neck and Breast Cancer Patients Treated With Chemoradiotherapy.

OBJECTIVE: A clinical study was conducted on the use of the topical Lactokine-based R1 and R2 system as a prophylactic treatment of acute radiation dermatitis in patients with squamous cell cancer of the head and neck and breast cancer treated with chemoradiotherapy. METHODS: Ninety-eight patients were studied who attended the Radiation Oncology Services, La Paz University Hospital, Madrid, for treatment with chemoradiotherapy for head and neck cancer (n = 19) and breast cancer (n = 79). The treatment group (R1 and R2) included 51 patients; 47 control patients were given the local standard topical treatment (5% wt/wt urea lotion). At 3 postradiotherapy follow-up clinics, radiation dermatitis was graded, if present. All patients were administered with "quality-of-life" questionnaires. RESULTS: Treatment with R1 and R2 significantly reduced the grade of radiation dermatitis in patients treated with chemoradiotherapy. At the fourth (last) clinic visit, at 2 weeks following the end of radiation treatment, 66.7% of patients in the treated group (R1 and R2) were free from radiation dermatitis compared with 34% in those given the center's usual skin care (topical urea lotion). There were no reported side effects, and quality of life improved for patients treated with R1 and R2. CONCLUSION: Topical skin treatment with the R1 and R2 system has been shown to be effective in preventing, reducing the onset, and reducing the degree (grade) of radiation dermatitis in head and neck and breast cancer patients treated with chemoradiation.

Breakthrough cancer pain - still a challenge.

Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%-95%). According to the American Pain Foundation, breakthrough pain is observed in 50%-90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough cancer pain should involve an interdisciplinary and multimodal approach. The introduction of new fentanyl formulations has represented a great advance and has notably improved treatment. Among these, the pectin-based intranasal formulation adjusts very well to the profile of breakthrough pain attacks, is effective, has a good toxicity profile, and allows for convenient dosing - affording rapid and effective analgesia with the added advantage of being easily administered by caregivers when patients are unable to collaborate.

Epidemiology and prevalence of oropharyngeal candidiasis in Spanish patients with head and neck tumors undergoing radiotherapy treatment alone or in combination with chemotherapy.

OBJECTIVE: To describe the oropharyngeal candidiasis (OPC) prevalence in Spanish patients with head and neck cancer undergoing radiotherapy, alone or combined with chemotherapy. Secondary objectives were to determine the prevalence of Candida species colonization, and to explore whether different Candida species colonizing the oral cavity and the treatment were associated with a higher prevalence of OPC. METHODS: This is an observational, cross-sectional, multicentre study, conducted in Spanish radiation oncology units. Patients were diagnosed with head and neck cancer and started a radiotherapy treatment alone or combined with chemotherapy at the moment of their inclusion (N = 92). RESULTS: The OPC prevalence was 26 %. The identification of colonizing pathogens was performed in 49 patients, and Candida albicans was the dominant yeast (69 %), while non-albicans Candida was only found in 15 patients (31 %). Patients with C. albicans colonization had a significant higher prevalence of OPC compared to patients colonized by non-albicans Candida (p = 0.0273), but no difference was found regarding the OPC prevalence in patients receiving only radiotherapy compared to patients with both radiotherapy and chemotherapy treatments. CONCLUSIONS: Our data represent a step further in the knowledge of Candida species present in Spanish patients with head and neck tumors under radiation therapy. This is an essential step to manage the prophylaxis and treatment of OPC, since it might lead to severe clinical complications causing treatment interruption and, thus, representing a reduction in anti-tumor efficacy.

Post hoc analysis of pregabalin vs. non-pregabalin treatment in patients with cancer-related neuropathic pain: better pain relief, sleep and physical health.

BACKGROUND AND PURPOSE: A previous study of cancer-related neuropathic pain (NP) found that a 10-fold increase in pregabalin (PGB) use increased patients' satisfaction with treatment. Further research of PGB vs. non-pregabalin (non-PGB) treatment was carried out to assess if the use of more specific NP-targeting drugs, such as PGB, in combined therapy, in patients with cancer-related NP, provides better health outcomes. PATIENTS AND METHODS: Post hoc analysis of PGB- vs. non- PGB-treated patients in a 2-month epidemiological, prospective, multicentre study to assess NP prevalence and management in cancer pain patients visiting radiotherapy oncologic units. Patients undertook the Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), the Medical Outcomes Sleep Scale (MOS-Sleep) and the short form (SF-12) Health Survey. RESULTS: A total of 273 patients with no previous PGB treatment: 162 were treated with PGB polytherapy and 111 with other treatments. At 8 weeks, satisfaction with treatment was 92.6% (PGB) vs. 78.9% (non-PGB), p=0.0024, and benzodiazepine use 37.8% (non-PGB) vs. 19.8% (PGB), p=0.0009. The decreases in BPI total pain intensity and total interference with activities and in MOS overall sleep problems index were significantly larger in the PGB group. CONCLUSIONS: The addition of more specific NP-targeting drugs to usual treatment, such as PGB, in NP cancer patients provides more satisfaction with treatment and better outcomes in terms of pain intensity, interference with activities and sleep than treatments without specific NP-targeting drugs. Anxiolytic profile of PGB could allow for less use of benzodiazepines.

The white book of radiation oncology in Spain.

The White Book of Radiation Oncology provides a comprehensive overview of the current state of the speciality of radiation oncology in Spain and is intended to be used as a reference for physicians, health care administrators and hospital managers. The present paper summarises the most relevant aspects of the book's 13 chapters in order to bring the message to a wider audience. Among the topics discussed are the epidemiology of cancer in Spain, the role of the radiation oncologist in cancer care, human and material resource needs, new technologies, training of specialists, clinical and cost management, clinical practice, quality control, radiological protection, ethics, relevant legislation, research & development, the history of radiation oncology in Spain and the origins of the Spanish Society of Radiation Oncology (SEOR).

Prevalence of neuropathic pain in radiotherapy oncology units.

PURPOSE: Neuropathic pain (NP) in cancer patients severely impacts quality of life. Radiotherapy (RT) may cause NP, and at the same time, cancer patients visit RT units for pain relief. NP prevalence at these sites and current analgesic treatment should be assessed to improve management. METHODS AND MATERIALS: This epidemiological, prospective, multicenter study was undertaken to assess NP prevalence, according to Douleur Neuropathique 4 questions questtionaire (DN4) test results, and analgesic management in cancer pain patients visiting RT oncologic units. Secondary analyses assessed NP etiology and pain intensity (using the Brief Pain Inventory-Short Form) and impact (using the Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study [MOS] for Sleep, and the Health Survey Short Form-12). RESULTS: A total of 1,098 patients with any kind of pain were registered. NP prevalence was 31.1% (95% confidence interval, 28.4%--33.9%); 291 NP patients (mean age, 62.2 ±12.5 years and 57.7% men) were eligible for study; 49% of patients were overweight. The most frequent tumors were those of breast and lung, and stage IIIB was the most common cancer stage. The tumors caused 75% of NP cases. Anxiety, sleepiness, and depression were common. At 8 weeks, pain intensity and interference with daily activities decreased significantly for 50.8% of responders. Depression and anxiety (p < 0.0001) scores on the Physical Component Summary and Mental Component Summary measures (p < 0.0001) and all MOS-Sleep subscales, except for snoring, improved significantly. The percentage of satisfied patients increased from 13.8% to 87.4% (p < 0.0001) with the current analgesic treatment, which meant a 1.2- and 6-fold increase (p < 0.0001) in narcotic analgesics and anticonvulsants, respectively, compared to previous treatment. CONCLUSIONS: NP is highly prevalent at RT oncology units, with sleepiness, anxiety, and depression as frequent comorbidities. There is a need to improve management of NP with increased use of more specific NP-targeting drugs.

Incidence of oral mucositis, its treatment and pain management in patients receiving cancer treatment at Radiation Oncology Departments in Spanish hospitals (MUCODOL Study).

OBJECTIVE: To estimate the incidence of oral mucositis (OM) in patients receiving radiotherapy, describe the treatments used to manage pain in OM grades 3 and 4 and assess relief of pain and patient satisfaction. PATIENTS AND METHODS: All patients older than 18 years consecutively attending a Radiation Oncology Department over 5 working days were included in a cross-sectional study. The data recorded were RTOG scale of OM (1, 2, 3 or 4), age and sex. In a second stage, a clinical cohort was followed for 2 months. Pain management was assessed in patients with grades 3 and 4. RESULTS: Two thousand and forty-seven patients (98.5%) from 55 participating centres were eligible for the fi rst stage. The overall risk of OM was 16.4% (95% CI 14.8- 18.1); prevalence was 26.4%. In the second stage, 282 (91.6%) of the patients recruited were eligible. At the baseline visit, 95.7% of the population had OM grade 3 and 4.3% grade 4. At two months, OM was resolved in 62.3%, grade 1 in 20%, grade 2 in 10.3% and grade 3 in only 7.4% (p<0.05). 98.9% of the patients had head and neck cancer. From baseline to the two-months session, reported pain fell from 96.1% of affected patients to 39.8%(p<0.01), while chronic pain increased (19.5% vs. 38.2%, p<0.05). Verbal scale OM pain intensity indicated intense pain at baseline in 42.2% and a mean visual analogue scale (VAS) score of 5.6 (2.3). Mean VAS scores fell significantly according to pain intensity due to the OM and cancer (p<0.01). CONCLUSIONS: Pain due to OM, a common complication of chemotherapy and radiation, limits nutritional intake and oral function. Analgesia protocols need to be assessed to improve the quality of life of these patients.

Salud sexual y reproductiva a través de internet. Análisis de una web dirigida a jóvenes y adolescentes / Sexual and reproductive health through the internet. Analysis of a website aimed at adolescents and young adults

Introducción: Para mejorar la educación sexualentre los jóvenes, es fundamental investigar en losmedios de comunicación más utilizados por ellos.Internet se perfila como uno de los principalessistemas de información sexual, planificación familiar y métodos anticonceptivos en la población menor de 29 años.Objetivos: 1) Analizar las inquietudes y los problemas más frecuentes entre los menores de 29 años que acceden a una web de información sexual y planificación familiar; 2) valorar la evolución histórica de las visitas a esa web, así como de las consultas en línea realizadas en los últimos 9 años.Material y métodos: Estudio transversal, descriptivo y retrospectivo sobre la población que accedió a la web del Centro Joven de Anticoncepción y Sexualidad (CJAS) de Madrid durante el año 2005. La muestra estudiada estuvo formada por todos los individuos menores de 29años que accedieron al consultorio en línea de laweb (www.centrojoven.org) y realizaron algún tipode consulta. Se analizaron principalmente 5variables: edad, sexo, procedencia, canal de accesoy motivo de consulta. Se realizaron comparacionescon respecto a años anteriores y se analizó laprogresión de la web desde su creación en 1997.Resultados: En el año 2005, la web del CJAS deMadrid recibió 74.313 visitas. El servicio de consultaen línea tuvo 2.386 consultas, con una media de198,8 consultas por mes; 1.611 (67,5%) consultas lasrealizaron mujeres. El grupo de edad con máspresencia en el consultorio se sitúa en la franja de18-20 años (29,7%); la edad media del total de losindividuos que consultaron fue de 27,1 años.El principal motivo de consulta es informaciónsobre sexualidad (22,8%) y los buscadores internosde la red son el principal canal de acceso alconsultorio (67,6%). Se realizaron 1.556 (48,4%)consultas desde territorio nacional y 1.040 (43,5%)desde otras partes del mundo.Conclusiones: Internet es un instrumentofundamental para informar sobre sexualidad y métodos anticonceptivos a jóvenes menores de 29 años. Es necesario implicar más a los jóvenes varones en las responsabilidades sexuales y anticonceptivas. Es recomendable reforzar la información sobre prevención de enfermedades de transmisión sexual e insistir a los menores sobre su importancia. Deben constituirse comisiones de calidad que evalúen las diferentes webs sobre información sexual. De este modo, padres,educadores y sanitarios podrán recomendar a losjóvenes de forma validada y específica sobre lasmás seguras

Introduction: Examining the media most frequently used by young people is essential to improve their sexual education. The Internet appears to be one of the main sources of information on sexual matters, family planning and contraceptive methods among persons aged less than 29 years old.Objectives: To analyze the concerns and mostfrequent problems among people aged less than29 years old accessing a website on sexual information and family planning. To evaluate changing patterns in visits to the website, as well as the on-line consultations carried out throughout the previous 9 years.Material and methods: We performed a crosssectional,descriptive, retrospective study of the population accessing the website of the Youth Center for Contraception and Sexuality [Centro Joven de Anticoncepción y Sexualidad (CJAS)] throughout 2005. The sample studied was composed of all individuals aged less than 29 years old who accessed the on-line advice center of the web site (www.centrojoven.org) and made any typeof query. Five principal variables were analyzed:age, sex, geographical origin, means of access, andreason for seeking advice. Comparisons were madewith respect to previous years, and changes in theweb site since its creation in 1997 were analyzed.Results: In 2005, there were 74,313 visits to theYouth Center’s website. There were 2,386 consultations to the on-line advice service, reaching an average of 198.8 per month. A total of 1,611 (67.5%) consultations were made by women. The age group most frequently visiting the center was that aged between 18 and 20 yearsold (29.7 %). The mean age of individuals seekingconsultations was 27.1 years. The principal reasonfor seeking advice was to obtain information onsexuality (22.8%). The main method of accessingthe advice center was through a browser (67.6%).There were 1,556 (48.4%) consultations from within Spain and 1,040 (43.5%) from other parts of the world.Conclusions: The Internet is a major instrumentfor informing young people under the age of 29 about sexuality and contraception methods. Young men should be encouraged to be more involved in the responsibilities concerning sexuality and contraception. More information should be provided on transmission of sexual diseases andyoung people should be made aware of the importance of these diseases. Quality committees should be formed to evaluate the different websites providing sexual information. Thus, parents, teachers, and health workers would be able to recommend the best and safest web sites to young people

Indicaciones del tratamiento radioterápico en el cáncer de mama / Indications for radiotherapy treatment of breast cancer

Objetivo: El cáncer de mama es la primera causa de muerte por cáncer en la mujer en Estados Unidos. Esta patología es igualmente frecuente en Europa y forma parte de las consultas diarias de los Servicios dedicados a la oncología (Oncología Radioterápica, Cirugía General, Ginecología, y Oncología Médica), aunque cada vez hay más Servicios implicados en el manejo de estas pacientes (Atención Primaria, Nutrición, Psico-oncología, Rehabilitación, Unidad del Dolor, Enfermería): La revisión de las indicaciones del tratamiento radioterápico permite acercar esta modalidad terapéutica al resto de Especialidades Método: Exposición de todas las situaciones clínicas susceptibles de radioterapia. Resultado: Existe evidencia científica que demuestra la necesidad de administrar radioterapia para disminuir el riesgo de recidiva loco-regional y ello influye en la supervivencia global. Conclusiones: El cáncer de mama precisa un abordaje terapéutico multidisciplinar siendo la radioterapia indispensable en el tratamiento conservador y en otros muchos casos (AU)

Purpose: Breast cancer is the first leading cancer-related cause of death among USA women. In Europe, breast cancer occurs as frequently as in the United States an thus we encounter this pathology on a regular basis in Oncology Services such as Radiation Oncology, General Surgery, Gynecology and Medical Oncology. Nevertheless, the number of services working with this kind of patients is increasing; Primary Health Care, Nutrition, Psycho-oncology, Rehabilitation centers, Pain Clinics and Nursing among others. Reviewing radiotherapy treatment indications shall bring this modality and its procedures closer to other medical specialties. Methods: Exposition of all clinical indications that might include radiotherapy treatment. Results: There is scientific evidence that proves that radiotherapy is needed in order to reduce locoregional risk of recurrence, which shall determine global survival. Conclusions: Breast cancer requires a multidisciplinary therapeutic approach for which radiotherapy is essential in the conservative treatment as well as in other cancer cases (AU)

Prevention of urinary tract infections in palliative radiation for vertebral metastasis and spinal compression: a pilot study in 71 patients.

PURPOSE: To assess the impact of bladder instillations of hyaluronic acid (HA) on the prevalence of urinary tract infection (UTI) in patients receiving emergency radiotherapy for metastatic spinal cord compression. METHODS AND MATERIALS: Patients were recruited consecutively at one center and assigned to usual care (UC) (n = 34, mean age 62.2 years) or UC with once-weekly HA instillation (UC + HA) (Cystistat: 40 mg in 50 mL phosphate-buffered saline) (n = 37; mean age, 63.1 years). All patients had an indwelling catheter and received radiotherapy. UTI status was assessed at baseline and during hospitalization. RESULTS: At baseline, patient groups were comparable, except for the prevalence of UTI at baseline, which was 11.8% and 0% in the UC and UC + HA patients, respectively (p = 0.0477). During hospitalization, 76.5% (vs. 11.8% at baseline, p < 0.0001) of the UC patients had a UTI compared with 13.5% (vs. 0% at baseline, p = 0.0541) of the UC + HA patients (p < 0.0001). Both groups were hospitalized for similar periods (19.8 days [UC] vs. 18.5 days, p = 0.4769) and received equivalent radiotherapy sessions (4.6 [UC] vs. 5.8 sessions, p = 0.2368). CONCLUSIONS: Patients receiving UC + HA had a 5.7-fold decrease in UTI prevalence over the hospitalization period compared to UC patients, suggesting that bladder instillations of HA effectively prevent UTI in patients with indwelling catheters receiving radiotherapy for nerve compression.

[Fractionated stereotactic-guided radiotherapy in the treatment of pituitary adenomas]. / Radioterapia estereotáxica fraccionada en adenomas de hipófisis: resultados y factores pronósticos.

AIMS: To evaluate the survival rates, prognostic factors and adverse events in patients with pituitary adenomas following fractionated stereotactic-guided radiotherapy (FSRT). MATERIAL AND METHODS: Fifty-six patients with pituitary adenomas were treated with FSRT; 23 patients (41.1%) had primary adenomas, 33 had recurrent disease; 24 (42.9%) with non-functional and 32 (57.1%) with functional adenomas. Using conventional fractionation, median total dose administered was 54 Gy (range: 24-56 Gy). RESULTS: The median follow-up was 51 months (range: 9-102) and, at the time of analysis, 49 patients were alive and disease-free, 1 patient was alive with reduced visual acuity and biochemical indications of recurrence, 2 patients had died from the disease and 1 patient had died from unrelated causes. Overall survival was 94% (50/53) and overall local tumour control was 92% (49/53). Univariate analysis indicated hormonal secretion (ACTH) and previous radiotherapy as being statistically significant. Fourteen patients (25%) had minor side-effects during treatment and 3 patients (5.4%) had late-onset events; 2 with optical neuropathy (both patients had other relevant co-existing diseases) and 1 patient had brain necrosis (re-irradiation). CONCLUSION: Fractionated stereotactic-guided radiotherapy is an effective modality for the treatment of pituitary adenomas. Care is required in patients with co-morbidities and/or previously-irradiated recurrent tumour so as to minimise late-onset secondary effects.

Radioterapia estereotáxica fraccionada en adenomas de hipófisis: resultados y factores pronósticos / Fractionated stereotactic-guided radiotherapy in the treatment of pituitary adenomas

Introducción. Se analizan retrospectivamente la supervivencia global (SG), control local, factores pronóstico y toxicidad, de pacientes con adenoma de hipófisis tratados con radioterapia estereotáxica fraccionada (REF). Material y métodos. Entre mayo de 1994 y junio de 2001 se trataron 56 pacientes con adenomas de hipófisis, 23 (41,1%) primarios y 33 recidivas. Veinticuatro (42,9%) casos fueron adenomas no funcionantes, y 32 (57,1%) funcionantes. La mediana de dosis administrada fue 54 Gy (rango 24-56 Gy), 2 Gy/día, 5 días/semana. Resultados. Con un seguimiento de 51 meses (9-102 meses), al cierre del estudio, 49 pacientes están vivos sin evidencia de enfermedad, una paciente viva, con pérdida de visión y progresión hormonal, 2 pacientes han fallecido con progresión y uno falleció por otra causa. La supervivencia global fue de 94% (50/53), con una supervivencia libre de fallo del 92% (49/53). En análisis univariado sólo el tipo de hormona secretada (ACTH) y la irradiación previa resultaron de mal pronóstico. Catorce pacientes (25%) presentaron síntomas leves de toxicidad aguda durante la radioterapia estereotáxica fraccionada y 3 (5,4%) desarrollaron toxicidad tardía, neuropatía óptica (2 pacientes, multipatología asociada) y radionecrosis (1 paciente, reirradiación). Conclusiones. La radioterapia estereotáxica fraccionada es eficaz para adenomas de hipófisis, aunque es preciso valorar individualmente a aquellos pacientes con patologías concomitantes, o con tratamientos de radioterapia previa, con objeto de minimizar la aparición de efectos adversos a largo plazo

Aims. To evaluate the survival rates, prognostic factors and adverse events in patients with pituitary adenomas following fractionated stereotactic-guided radiotherapy (FSRT). Material and methods. Fifty-six patients with pituitary adenomas were treated with FSRT; 23 patients (41.1%) had primary adenomas, 33 had recurrent disease; 24 (42.9%) with non-functional and 32 (57.1%) with functional adenomas. Using conventional fractionation, median total dose administered was 54 Gy (range: 24-56 Gy). Results. The median follow-up was 51 months (range: 9-102) and, at the time of analysis, 49 patients were alive and disease-free, 1 patient was alive with reduced visual acuity and biochemical indications of recurrence, 2 patients had died from the disease and 1 patient had died from unrelated causes. Overall survival was 94% (50/53) and overall local tumour control was 92% (49/53). Univariate analysis indicated hormonal secretion (ACTH) and previous radiotherapy as being statistically significant. Fourteen patients (25%) had minor side-effects during treatment and 3 patients (5.4%) had late-onset events; 2 with optical neuropathy (both patients had other relevant co-existing diseases) and 1 patient had brain necrosis (re-irradiation). Conclusion. Fractionated stereotactic-guided radiotherapy is an effective modality for the treatment of pituitary adenomas. Care is required in patients with co-morbidities and/or previously-irradiated recurrent tumour so as to minimise late-onset secondary effects