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Viña del Mar, Chile

Etxano J.,University of Navarra | Insausti L.P.,University of Navarra | Elizalde A.,University of Navarra | Lopez Vega J.M.,Hospital Universitario Marques Of Valdecilla | And 2 more authors.
Acta Radiologica | Year: 2015

Background Antiangiogenic drugs are being used in the treatment of locally advanced breast cancer. The effect of these drugs can be monitorized using high temporal resolution dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Purpose To evaluate changes in tumor microvasculature induced by bevacizumab and the usefulness of these changes predicting response to further neoadjuvant therapy. Material and Methods Seventy patients with locally advanced breast cancers were treated with one cycle of bevacizumab followed by neoadjuvant therapy, combining bevacizumab and cytotoxic chemotherapy. Two DCE-MRI were performed before and after bevacizumab. Changes in tumoral volume, pharmacodynamic curves, and pharmacokinetic variables (Ktrans, Kep, Ve, AUC90) in a ROI (ROI 1) encompassing the entire tumor and in another ROI (ROI 2) in the area of higher values of Ktrans were analyzed. Correlations with pathological response were made: parametrical and non-parametrical statistical analysis and ROC curves were used; a P < 0.05 was considered significant. Results Significant changes in tumoral volume (-4%), pharmacodynamic curves, and pharmacokinetic variables in ROI 1 Ktrans (-45%), Kep (-38%), Ve (-11%), and AUC90 (-44%) and ROI 2 Ktrans (-43%), Kep (-39%), Ve (-5%), and AUC90 (-45%) were observed after bevacizumab (P < 0.05). The effect of bevacizumab was not different between responders and non-responders (P > 0.05), and these changes could not predict response to further neoadjuvant therapy. Conclusion Bevacizumab induces remarkable tumoral volume, pharmacodynamics, and pharmacokinetic changes. However, these changes could not be used as early predictors for response to further neoadjuvant therapy. © The Foundation Acta Radiologica 2014.

Calvo F.A.,Complutense University of Madrid | Sole C.,Instituto Madrileno Of Oncologia | Ferrer C.,Instituto Oncologico | Garcia-Sabrido J.L.,Complutense University of Madrid
Revisiones en Cancer | Year: 2012

Adenocarcinoma of the exocrine pancreas is a disease model of particular interest and opportunities for radiotherapy. In comparison has a high morbidity and mortality in the context of intensive multimodal therapy. Radical resection is feasible in only 15-20% of patients, and only 3-4% of all patients presenting with this condition achieve long-term control and cure. Various strategies in the form of neoadjuvant and adjuvant treatment have been employed over the years to improve outcome, with limited success. The contribution of radiotherapy, remains controversial and is an area of active innovation that merits further research in well-conducted multicenter trials at various stages of the disease in combination with systemic agents and exploiting recent advances in the delivery of super-precise radiotherapy. An update of the published literature on the use components of radiotherapy or chemoradiation as an integrated modality in the interdisciplinary approach of various stages of pancreatic adenocarcinoma is reported. A highlight of areas that future trials in this field should target to move forward the efficient treatment in this malignancy are suggested. Copyright © 2012 Aran Ediciones, s. l.

Gonzalez Domingo M.,Instituto Oncologico | Gonzalez San Segundo C.,Hospital General Universitario Gregorio Maranon
Archivos Espanoles de Urologia | Year: 2011

Penile cancer is a radiocurable disease. The different types of radiotherapy (RT)-brachytherapy, plesiotherapy, external beam radiation therapy-have proven valid in the treatment of the primary tumor allowing preservation of the penis and sexual function. RT is even an option in candidates for surgery who reject surgery for clinical or personal reasons. A high nodal recurrence rate has been observed after inguinal lymphadenectomy, specially in patients at high risk of relapse. Technological advances in the field of RT, new imaging techniques, and more modern equipment enable RT to enhance local control and improve survival in patients with this condition. Palliative RT can exercise a decompressive effect that makes possible tumor size reduction in cases of inguinal-pelvic recurrence in patients with lymphedema and thus improve quality of life. In this article, we review the current role of RT in the treatment of penile cancer. We also present two cases that illustrate the main indications.

Calvo F.A.,Hospital General Universitario Gregorio Maranon | Calvo F.A.,Complutense University of Madrid | Gonzalez M.E.,Instituto Oncologico | Gonzalez-San Segundo C.,Hospital General Universitario Gregorio Maranon | And 10 more authors.
European Journal of Surgical Oncology | Year: 2012

Purpose: To evaluate the feasibility and long-term outcome of surgery combined with intraoperative electron radiotherapy (IOERT) as rescue treatment in patients with recurrent and/or metastatic oligotopic extrapelvic cancer. Methods and materials: From April 1996 to April 2010, we treated 28 patients using 34 IOERT procedures. The main histopathology findings were adenocarcinoma (39%) and squamous cell carcinoma (29%). The original cancer sites were gynecologic (67%), urologic (14%) and colorectal (14%). The location of recurrence was the para-aortic region in 53.5% of patients. Results: Median follow-up was 39 months (1-84 months), during which time 14% of patients experienced local recurrence and 53.5% developed distant metastasis. Overall survival at 2 and 5 years was 57% and 35% respectively. At the time of the analysis, 13 patients were alive, 6 for more than 55 months of follow-up. Local control was not significantly affected by the following histopathologic characteristics of the resected surgical specimen: number of fragments submitted for pathology study (1 to >6), maximal tumor dimension (≤2 to ≥6 cm), rate of involved nodes (0-100%) and involved resection margin (local recurrence 23% vs 7%; p = 0.21). Local recurrence was significantly affected by microscopic cancer in more than 50% of specimen fragments (38% vs 9%, p = 0.02). Conclusions: IOERT for recurrence of oligotopic extrapelvic cancer incresead long-term survival in patients with controlled cancer and appears to compensate for some adverse prognostic features in local control. Individualized treatment strategies for this heterogeneous category of patients with recurrent cancer will make it possible to optimize results. © 2012 Elsevier Ltd. All rights reserved.

Calvo F.A.,Hospital General Universitario Gregorio Maranon | Calvo F.A.,Complutense University of Madrid | Sole C.V.,Hospital General Universitario Gregorio Maranon | Sole C.V.,Complutense University of Madrid | And 10 more authors.
Clinical and Translational Oncology | Year: 2013

The reality of intraoperative radiation therapy (IORT) practice is consistent with an efficient and highly precise radiation therapy technique to safely boost areas at risk for local recurrence. Long-term clinical experience has shown that IORT-containing multi-modality regimens appear to improve local disease control, if not survival in many diseases. Research with IORT is a multidisciplinary scenario that covers knowledge from radiation beam adapted development to advance molecular biology for bio-predictability of outcome. The technical parameters employed in IORT procedures are important information to be recorded for quality assurance and clinical results analysis. In addition, specific treatment planning systems for IORT procedures are available, to help in the treatment decision-making process. A systematic revision of opportunities for research and innovation in IORT is reported including radiation beam modulation, delivery, dosimetry and planning; infrastructure and treatment factors; experimental and clinical radiobiology; clinical trials, innovation and translational research development. © 2013 Federación de Sociedades Españolas de Oncología (FESEO).

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