Hospital Clinica Benidorm

Benidorm, Spain

Hospital Clinica Benidorm

Benidorm, Spain

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Banos R.M.,University of Valencia | Banos R.M.,CIBER ISCIII | Espinoza M.,University of Valencia | Garcia-Palacios A.,Jaume I University | And 6 more authors.
Supportive Care in Cancer | Year: 2013

Purpose: This study presents data on the feasibility and possible benefits of a psychological intervention that uses virtual reality to induce positive emotions on adult hospitalized patients with metastatic cancer. The patient's satisfaction and perceived utility was also examined. Method: The sample was composed of 19 patients (53 % men, aged from 29 to 85 years old; x = 60.9; standard deviation = 14.54). The intervention consisted of four 30-min sessions during 1 week in which patients navigated through virtual environments designed to induce joy or relaxation. Mood was assessed before and after each session using the Visual Analog Scale. Patient satisfaction was assessed after each session and at the end of the intervention. Qualitative data were also collected with open-ended questions. Results: There were no major difficulties with the use of devices, and any difficulties that did arise were solved through practice. There were adequate levels of pleasantness and perceived utility of the proposed intervention. The main perceived benefits were distraction, entertainment, and promotion of relaxation states. Regarding mood changes, an increase in positive emotions and a decrease in negative emotions were also detected. Conclusions: The intervention was positively assessed and rated as minimally uncomfortable. Future actions are discussed as well as the need to implement brief interventions that take into account the patients' medical state and physical discomfort level, especially with those in the advanced stages of disease. © 2012 Springer-Verlag.


PubMed | Arizona Cancer Center, Aegis Oncology, Banner Anderson Cancer Center, Sloan Kettering Cancer Center and 10 more.
Type: | Journal: Brachytherapy | Year: 2016

The aim of this study was to define current patterns of care among radiation oncologists who use skin surface brachytherapy for the treatment of cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) in academic and community settings.A 30-question electronic survey was administered to clinician members of the American Brachytherapy Society. The respondents were asked to provide details regarding their clinical practice and their approach to skin surface brachytherapy.A total of 16 surveys were returned. Among the respondents, aggregate experience varied from 8 to 1800 cases. Most preferred brachytherapy over external beam radiation because of shorter treatment course, conformality of treatment for irregular or curved targets, and shallow dose deposition. Of the total, 60% of respondents routinely estimated lesion depth via ultrasound before initiating treatment. Treatment margin on gross disease varied widely (range, 3-15mm; median, 5mm). Hypofractionation was the preferred dose schedule. Prescribed doses ranged from 30Gy in five fractions to 64Gy in 32 fractions (EQD2, 40Gy-65Gy). There was a tendency to increase the number of fractions for larger targets, although some used the same fractionation regardless of anatomic location or lesion size. There was no consensus on dosimetric constraints, and some respondents reported cases of severe toxicity, particularly when treating the pretibial skin.This pattern of care study suggests that skin brachytherapy can be a convenient and safe tool for treatment of BCC and cSCC. Prospective trials and the development of expert consensus guidelines would be beneficial for optimizing skin surface brachytherapy and reducing practice variation.


Ouhib Z.,Lynn Cancer Institute | Kasper M.,Lynn Cancer Institute | Perez Calatayud J.,Hospital La Fe | Perez Calatayud J.,Hospital Clinica Benidorm | And 4 more authors.
Brachytherapy | Year: 2015

Purpose: Nonmelanoma skin cancers (NMSCs) are the most common type of human malignancy. Although surgical techniques are the standard treatment, radiation therapy using photons, electrons, and brachytherapy (BT) (radionuclide-based and electronic) has been an important mode of treatment in specific clinical situations. The purpose of this work is to provide a clinical and dosimetric summary of the use of BT for the treatment of NMSC and to describe the different BT approaches used in treating cutaneous malignancies. Methods and Materials: A group of experts from the fields of radiation oncology, medical physics, and dermatology, who specialize in managing cutaneous malignancies reviewed the literature and compiled their clinical experience regarding the clinical and dosimetric aspects of skin BT. Results: A dosimetric and clinical review of both high dose rate (192Ir) and electronic BT treatment including surface, interstitial, and custom mold applicators is given. Patient evaluation tools such as staging, imaging, and patient selection criteria are discussed. Guidelines for clinical and dosimetric planning, appropriate margin delineation, and applicator selection are suggested. Dose prescription and dose fractionation schedules, as well as prescription depth are discussed. Commissioning and quality assurance requirements are also outlined. Conclusions: Given the limited published data for skin BT, this article is a summary of the limited literature and best practices currently in use for the treatment of NMSC. © 2015 American Brachytherapy Society.


Vijande J.,University of Valencia | Granero D.,Hospital General Universitario | Perez-Calatayud J.,Hospital Clinica Benidorm | Perez-Calatayud J.,Polytechnic University of Valencia | Ballester F.,University of Valencia
Applied Radiation and Isotopes | Year: 2013

The 137Cs medium dose rate (MDR) CSM40 source model (Eckert & Ziegler BEBIG, Germany) is in clinical use but no dosimetric dataset has been published. This study aims to obtain dosimetric data for the CSM40 source for its use in clinical practice as required by the American Association of Physicists in Medicine (AAPM) and the European Society for Radiotherapy and Oncology (ESTRO). Penelope2008 and Geant4 Monte Carlo codes were used to characterize this source dosimetrically. It was located in an unbounded water phantom with composition and mass density as recommended by AAPM and ESTRO. Due to the low photon energies of 137Cs, absorbed dose was approximated by collisional kerma. Additional simulations were performed to obtain the air-kerma strength, sK. Mass-energy absorption coefficients in water and air were consistently derived and used to calculate collisional kerma. Results performed with both radiation transport codes showed agreement typically within 0.05%. Dose rate constant, radial dose function and anisotropy function are provided for the CSM40 and compared with published data for other commercially available 137Cs sources. An uncertainty analysis has been performed. The data provided by this study can be used as input data and verification in the treatment planning systems. © 2013 Elsevier Ltd.


Granero D.,Hospital General Universitario | Perez-Calatayud J.,Hospital Clinica Benidorm | Perez-Calatayud J.,Hospital La Fe | Ballester F.,University of Valencia | Ouhib Z.,Lynn Cancer Institute of Boca Raton Regional Hospital
Physica Medica | Year: 2013

Introduction and purpose: The Valencia applicators which are accessories of the microSelectron-HDR afterloader (Nucletron, Veenendaal, The Netherlands) are designed to treat skin lesions. These cup-shaped applicators are an alternative to superficial/orthovoltage x-ray treatment units. They limit the irradiation to the required area using tungsten-alloy shielding, and are equipped with a tungsten-alloy flattering filter allowing the treatment of skin tumors, the oral cavity, vaginal cuff, etc. The tungsten-alloy thickness to shield radiation is not the same in all parts of the applicators. This fact led us to question whether the leakage radiation differs depending on where it is measured, and whether this may be relevant in some clinical cases. The purpose of this work is to study from the radiation protection point of view the radiation leakage of the Valencia applicators, and provide a solution for current users and for the manufacturer. Methods and materials: Simulations based on the Monte Carlo (MC) method using the Geant4 code have been realized studying the dose rate distribution in air around the cup of the Valencia applicators. An experimental study with radiochromic film has also been done to measure the dose distribution in the back side of the applicators and to compare it with MC results. Results and conclusions: Radiation leakage of up to 170% of the prescribed dose has been found at the back surface of these applicators. Although this side is not usually directed to the patient, in some applications such as the treatment of a lesion on the nose, special care must be taken to avoid unexpected and unnecessary irradiation of the eyes. A possible solution could be to add additional shielding to the applicator in order to reduce this leakage or to put some shielding to protect the eyes. Additionally, a new concept design of the Valencia applicators using more shielding material in the applicator backside is proposed. © 2011 Associazione Italiana di Fisica Medica.


Solves-Llorens J.A.,Polytechnic University of Valencia | Ruperez M.J.,Polytechnic University of Valencia | Monserrat C.,Polytechnic University of Valencia | Feliu E.,Hospital Clinica Benidorm | And 2 more authors.
Medical Physics | Year: 2014

Purpose: This work presents a complete and automatic software application to aid radiologists in breast cancer diagnosis. The application is a fully automated method that performs a complete registration of magnetic resonance (MR) images and x-ray (XR) images in both directions (from MR to XR and from XR to MR) and for both x-ray mammograms, craniocaudal (CC), and mediolateral oblique (MLO). This new approximation allows radiologists to mark points in the MR images and, without any manual intervention, it provides their corresponding points in both types of XR mammograms and vice versa. Methods: The application automatically segments magnetic resonance images and x-ray images using the C-Means method and the Otsu method, respectively. It compresses the magnetic resonance images in both directions, CC and MLO, using a biomechanical model of the breast that distinguishes the specific biomechanical behavior of each one of its three tissues (skin, fat, and glandular tissue) separately. It makes a projection of both compressions and registers them with the original XR images using affine transformations and nonrigid registration methods. Results: The application has been validated by two expert radiologists. This was carried out through a quantitative validation on 14 data sets in which the Euclidean distance between points marked by the radiologists and the corresponding points obtained by the application were measured. The results showed a mean error of 4.2 ± 1.9 mm for the MRI to CC registration, 4.8 ± 1.3 mm for the MRI to MLO registration, and 4.1 ± 1.3 mm for the CC and MLO to MRI registration. Conclusions: A complete software application that automatically registers XR and MR images of the breast has been implemented. The application permits radiologists to estimate the position of a lesion that is suspected of being a tumor in an imaging modality based on its position in another different modality with a clinically acceptable error. The results show that the application can accelerate the mammographic screening process for high risk populations or for dense breasts. © 2014 American Association of Physicists in Medicine.


PubMed | Hospital Clinica Benidorm
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

e19714 Background: The EORTC (European Organisation for Research and Treatment of Cancer) recommends that, in cancer patients receiving chemotherapy (CT) or CT +radiotherapy, treatment with erythropoietic agents should be initiated at a hemoglobin (Hb) level of 9-11 g/dL based on anemia-related symptoms. Likewise, EORTC recommends further studies on predictive factors that could anticipate response. Among possible response predictors, C-reactive protein (CRP) is mentioned. Primary study objective was to determine the correlation between CRP level and response to CT-induced anemia treatment in cancer patients.This is a prospective observational study of patients 18 years with solid tumours who developed CT-induced anemia. Response to anemia therapy and CRP levels at baseline, and weeks 6, 9, 12 and 16 of treatment were registered. Tests for normality and correlation were performed.A total of 98 patients with solid tumours were included. Median age was 62.5 years, 64% were male, 57% had ECOG 0-1, 84% had III-IV stage cancer. Lung (31.6%), gastrointestinal (27.6%) and genitourinary (25.5%) were the most common tumour types. At study initiation, 63.8% had mild anemia (9.5 g/dLHb10.9 g/dL, WHO definition), 21.3% had moderate anemia (8 g/dLHb9.4 g/dL, WHO definition) and median CRP was 16.4 (Q1:3.9-Q3:76.7) mg/L. At weeks 6, 9, and 12 after treatment initiation, median Hb levels were 10.8 (Q1:10.1-Q3:11.9) g/dL, 11.2 (Q1:10.1-Q3:12.5) g/dL and 11.4 (Q1:10.3-Q3:11.9) g/dL. Median CRP level registered at same time-endpoints was 10.1 (Q1:2.1-Q3:46.3) mg/L, 9.6 (Q1:2.4-Q3:39.3) mg/L and 9.1(Q1:4.3-Q3:14.0) mg/L. During overall study, 68.35% of patients had a response to anemia-therapy defined as Hb >11 g/dL in absence of transfusions, which showed a weak correlation with CRP at baseline (rs = -0.3, p<0.05). At week 16 after treatment initiation, there were few patients for analysis of Hb and CRP.Baseline CRP is a possible predictive factor for response to treatment of chemotherapy-induced anemia in patients with solid tumors. This study was supported by AMGEN S.A.


PubMed | Hospital Clinica Benidorm
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

15114 Background: Bevacizumab (BEV) is a monoclonal antibody that inhibits tumour angiogenesis by targeting VEGF. In a phase III trial, BEV significantly improved overall (OS) and progression-free survival (PFS) when combined with first-line irinotecan plus bolus 5-fluorouracil (5-FU)/leucovorin (LV) (IFL) in patients with metastatic colorectal cancer (mCRC).Patients had to have: mCRC; no surgery within 28 days; no prior CT for metastatic disease; ECOG PS 0/1, adequate organ function. CT consisted in Xelox (oxaliplatine 130 mg/mBy July, 2006, 35 pts had been enrolled. Male 71%; median age 64 years; PS 0-1 (88,6%). The most common site of metastases was liver (100%). Among the 35p. Related grade 3-4 AEs were reported in 10 (28,6%) pts. GI perforation 3%, diarrhea 8,6%, hypertension 3%; neuropathy 6%. Overal response was observed in 63% pts (CR 3%; PR 60%).The scarce toxicity, the efffectiveness and the non requirement of central venous access, make it an interesting alternative to the first line treatment of colorectal cancer. No significant financial relationships to disclose.


PubMed | Polytechnic University of Valencia and Hospital Clinica Benidorm
Type: Journal Article | Journal: Journal of contemporary brachytherapy | Year: 2015

To describe the potential clinical use of a new brachytherapy applicator for gynecological tumors, with special attention to locally advanced cervical carcinoma. This device allows the combination of intracavitary radiotherapy and MRI-compatible transperineal interstitial needles. The design of this template addresses the disadvantages of currently commercially available templates: the inability of the intracavitary component to reach deep into the cervix (MUPIT), and the MRI-incompatibility of these templates (MUPIT and Syed), which necessitates use of CT imaging for the dosimetry.The newly developed Benidorm Template applicator allows titanium needles in a template with straight and angled holes to provide different angles of divergence to be used with currently existing MRI-compatible intrauterine tubes. It can provide total coverage of the craniocaudal and lateral extension of the tumor (intrautherus, parametrial, and paravaginal). This method is mainly indicated in advanced cervical carcinoma with bulky parametrial invasion (medial or distal), with bulky primary disease that responds poorly to external beam radiotherapy extensive paravaginal involvement (tumor thickness greater than 0.5 cm) extending to the middle or lower third of the vagina, or for disease that has invaded the bladder or rectum (stage IVA).Between April 2013 until December 2014, we treated 15 patients with locally advanced cervical carcinoma employing the Benidorm Template. The median dose at D90 for the CTV was 79.8 Gy (71.5-89.9 Gy), at D2cc for the bladder it was 77.6 Gy (69.8-90.8 Gy), and at D2cc for the rectum it was 71.9 Gy (58.3-83.7 Gy). Values expressed in EQD2, assuming / of 10 for CTV and 3 for OAR.This new applicator allows the use of MRI-based dosimetry, thus providing the advantages of MRI volume definition. As such, it facilitates determination of complete intracavitary and interstitial CTV coverage and the sparing of normal tissues.


To study outcome and toxicity in 59 patients with locally advanced cervix carcinoma treated with computed tomography (CT)-based Martinez universal perineal interstitial template (MUPIT) and the new magnetic resonance imaging (MRI)-compatible template Benidorm (TB).From December 2005 to October 2015, we retrospectively analyzed 34 patients treated with MUPIT and 25 treated with the TB. Six 4 Gy fractions were prescribed to the clinical target volume (CTV) combined with external beam radiotherapy (EBRT). The organs at risk (OARs) and the CTV were delineated by CT scan in the MUPIT implants and by MRI in the TB implants. Dosimetry was CT-based for MUPIT and exclusively MRI-based for TB. Dose values were biologically normalized to equivalent doses in 2 Gy fractions (EQDMedian CTV volumes were 163.5 cmTemplate Benidorm treatment using MRI-based dosimetry provides advantages of MRI volume definition, and allows definition of smaller volumes that result in statistically significant decreased rectal toxicity compared to that seen with CT-based MUPIT treatment.

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