510 results on '"Felipe A. Calvo"'
Search Results
2. Corrigendum: Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect
- Author
-
Felipe A. Calvo, Adriana Ayestaran, Javier Serrano, Mauricio Cambeiro, Jacobo Palma, Rosa Meiriño, Miguel A. Morcillo, Fernando Lapuente, Luis Chiva, Borja Aguilar, Diego Azcona, Diego Pedrero, Javier Pascau, José Miguel Delgado, Javier Aristu, Alberto Alonso, and Yolanda Prezado
- Subjects
electron FLASH ,proton therapy FLASH ,cancer ,reirradiation ,oligorrecurrent ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2023
- Full Text
- View/download PDF
3. Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect
- Author
-
Felipe A. Calvo, Adriana Ayestaran, Javier Serrano, Mauricio Cambeiro, Jacobo Palma, Rosa Meiriño, Miguel A. Morcillo, Fernando Lapuente, Luis Chiva, Borja Aguilar, Diego Azcona, Diego Pedrero, Javier Pascau, José Miguel Delgado, Javier Aristu, Alberto Alonso, and Yolanda Prezado
- Subjects
electron FLASH ,proton therapy FLASH ,cancer ,reirradiation ,oligorrecurrent ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundOligo-recurrent disease has a consolidated evidence of long-term surviving patients due to the use of intense local cancer therapy. The latter combines real-time surgical exploration/resection with high-energy electron beam single dose of irradiation. This results in a very precise radiation dose deposit, which is an essential element of contemporary multidisciplinary individualized oncology.MethodsPatient candidates to proton therapy were evaluated in Multidisciplinary Tumor Board to consider improved treatment options based on the institutional resources and expertise. Proton therapy was delivered by a synchrotron-based pencil beam scanning technology with energy levels from 70.2 to 228.7 MeV, whereas intraoperative electrons were generated in a miniaturized linear accelerator with dose rates ranging from 22 to 36 Gy/min (at Dmax) and energies from 6 to 12 MeV.ResultsIn a period of 24 months, 327 patients were treated with proton therapy: 218 were adults, 97 had recurrent cancer, and 54 required re-irradiation. The specific radiation modalities selected in five cases included an integral strategy to optimize the local disease management by the combination of surgery, intraoperative electron boost, and external pencil beam proton therapy as components of the radiotherapy management. Recurrent cancer was present in four cases (cervix, sarcoma, melanoma, and rectum), and one patient had a primary unresectable locally advanced pancreatic adenocarcinoma. In re-irradiated patients (cervix and rectum), a tentative radical total dose was achieved by integrating beams of electrons (ranging from 10- to 20-Gy single dose) and protons (30 to 54-Gy Relative Biological Effectiveness (RBE), in 10–25 fractions).ConclusionsIndividual case solution strategies combining intraoperative electron radiation therapy and proton therapy for patients with oligo-recurrent or unresectable localized cancer are feasible. The potential of this combination can be clinically explored with electron and proton FLASH beams.
- Published
- 2022
- Full Text
- View/download PDF
4. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in primary locally advanced rectal cancer
- Author
-
Felipe A. Calvo, Claudio V. Sole, Harm J. Rutten, Philip Poortmans, Jose M. Asencio, Javier Serrano, Javier Aristu, Falk Roeder, and Wim J Dries
- Subjects
Rectal cancer ,Locally advanced disease ,Intraoperative radiotherapy ,Radical surgery ,Electron beam ,Neoadjuvant treatment ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Summary: Carcinoma of the rectum is a heterogeneous disease. The clinical spectrum identifies a subset of patients with locally advanced tumours that are close to or involve adjoining structures, such as the sacrum, pelvic sidewalls, prostate or bladder. Within this group of patients categorized as “locally advanced”, there is also variability in the extent of disease with no uniform definition of resectability. A practice-oriented definition of a locally advanced tumour is a tumour that cannot be resected without leaving microscopic or gross residual disease at the resection site. Since these patients do poorly with surgery alone, irradiation and chemotherapy have been added to improve the outcome. Intraoperative irradiation (IORT) is a component of local treatment intensification with favourable results in this subgroup of patients.International guidelines (National Comprehensive Cancer Network (NCCN) guidelines) currently recommend the use of IORT for rectal cancer resectable with very close or positive margins, especially for T4 and recurrent cancers.We report the ESTRO-ACROP (European Society for Radiotherapy and Oncology - Advisory Committee on Radiation Oncology Practice) recommendations for performing IORT in primary locally advanced rectal cancer.
- Published
- 2020
- Full Text
- View/download PDF
5. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in locally recurrent rectal cancer
- Author
-
Felipe A. Calvo, Claudio V. Sole, Harm J. Rutten, Wim J. Dries, Miguel A. Lozano, Mauricio Cambeiro, Philip Poortmans, and Luis González-Bayón
- Subjects
Rectal cancer ,Recurrent disease ,Oligo-recurrence ,Intraoperative radiotherapy ,Rescue surgery ,Electron beam ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Multimodal strategies have been implemented for locally recurrent rectal cancer scheduled for complete surgical resection. Irradiation and systemic therapy have been added to improve the oncological outcome, as surgery alone was associated with a poor prognosis. Intraoperative irradiation (IORT) is a component of irradiation intensification. Long-term cancer control and a higher survival rate were consistently reported in patients who had IORT as a component of their multidisciplinary treatment. The experience reported by expert IORT groups is reviewed and recommendations to guide clinical practice are explained in detail.
- Published
- 2020
- Full Text
- View/download PDF
6. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer
- Author
-
Felipe A. Calvo, Jose M. Asencio, Falk Roeder, Robert Krempien, Philip Poortmans, Frank W. Hensley, and Marco Krengli
- Subjects
Pancreatic cancer ,Borderline ,Intraoperative radiotherapy ,IORT ,IOERT ,Electron beam ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise RT modality to intensify the irradiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoradiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemotherapy followed by chemoradiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer.
- Published
- 2020
- Full Text
- View/download PDF
7. A New Workflow for Image-Guided Intraoperative Electron Radiotherapy Using Projection-Based Pose Tracking
- Author
-
Subhra S. Goswami, Juan E. Ortuno, Andres Santos, Felipe A. Calvo, Javier Pascau, and Maria J. Ledesma-Carbayo
- Subjects
3D-2D registration ,IGIOERT ,image guided intra operative electron radiotherapy ,IOERT ,IORT ,Electrical engineering. Electronics. Nuclear engineering ,TK1-9971 - Abstract
A new workflow is proposed to update the intraoperative electron radiotherapy (IOERT) planning refreshing the position and orientation (pose) of a virtual applicator with respect to the preoperative computed tomography (CT) with the actual pose during surgery. The workflow proposed relies on a robust registration of the preoperative CT and intraoperative projection radiographs acquired with a C-arm system. The workflow initially performs a geometric calibration of the C-arm using fiducials placed on the applicator. In the next step, a point-based 2D-3D registration based on fiducials positioned on the patient's skin is performed, followed by an intensity-based registration that refines the point-based registration result. The performance of the workflow has been evaluated using a realistic physical phantom consisting of a pig lower limb and its corresponding CT and 7 C-arm projections at different poses. The accuracy has been measured with respect to the applicator origin and axis before and after the registration refinement process. A feasibility study with human data is also included. Error analysis revealed angular accuracy of 0.9 ± 0.7 degrees and translational accuracy of 1.9 ± 1 mm. Our experiments demonstrated that the proposed workflow can achieve subdegree angular accuracy in locating the applicator with respect to the preoperative CT to update and supervise the IOERT planning right before radiation delivery. The proposed workflow could be easily implementable in a routine, corresponding to a significant improvement in quality assurance during IOERT procedures.
- Published
- 2020
- Full Text
- View/download PDF
8. Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival
- Author
-
Alessio G. Morganti, Francesco Cellini, Milly Buwenge, Alessandra Arcelli, Sergio Alfieri, Felipe A. Calvo, Riccardo Casadei, Savino Cilla, Francesco Deodato, Giancarmine Di Gioia, Mariacristina Di Marco, Lorenzo Fuccio, Federica Bertini, Alessandra Guido, Joseph M. Herman, Gabriella Macchia, Bert W. Maidment, Robert C. Miller, Francesco Minni, Paolo Passoni, Chiara Valentini, Alessia Re, William F. Regine, Michele Reni, Massimo Falconi, Vincenzo Valentini, and Gian Carlo Mattiucci
- Subjects
Pancreatic neoplasm ,Radiotherapy ,Adjuvant ,Dose effect ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). Methods A multicenter retrospective analysis on 514 patients with PDAC (T1–4; N0–1; M0) treated with surgical resection with macroscopically negative margins (R0–1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1:
- Published
- 2019
- Full Text
- View/download PDF
9. Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis
- Author
-
Gian Carlo Mattiucci, Alessio G. Morganti, Francesco Cellini, Milly Buwenge, Riccardo Casadei, Andrea Farioli, Sergio Alfieri, Alessandra Arcelli, Federica Bertini, Felipe A. Calvo, Silvia Cammelli, Lorenzo Fuccio, Lucia Giaccherini, Alessandra Guido, Joseph M. Herman, Gabriella Macchia, Bert W. Maidment, III, Robert C. Miller, Francesco Minni, William F. Regine, Michele Reni, Stefano Partelli, Massimo Falconi, and Vincenzo Valentini
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter 353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and 30 mm (P50.0 Gy showed improved OS (P
- Published
- 2019
- Full Text
- View/download PDF
10. Surface scanning for 3D dose calculation in intraoperative electron radiation therapy
- Author
-
Verónica García-Vázquez, Begoña Sesé-Lucio, Felipe A. Calvo, Juan J. Vaquero, Manuel Desco, and Javier Pascau
- Subjects
IOERT ,Intraoperative radiotherapy ,Surface scanning ,Conoscopic holography ,Structured-light 3D scanner ,Dose distribution ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Dose calculations in intraoperative electron radiation therapy (IOERT) rely on the conventional assumption of water-equivalent tissues at the applicator end, which defines a flat irradiation surface. However, the shape of the irradiation surface modifies the dose distribution. Our study explores, for the first time, the use of surface scanning methods for three-dimensional dose calculation of IOERT. Methods Two different three-dimensional scanning technologies were evaluated in a simulated IOERT scenario: a tracked conoscopic holography sensor (ConoProbe) and a structured-light three-dimensional scanner (Artec). Dose distributions obtained from computed tomography studies of the surgical field (gold standard) were compared with those calculated under the conventional assumption or from pseudo-computed tomography studies based on surfaces. Results In the simulated IOERT scenario, the conventional assumption led to an average gamma pass rate of 39.9% for dose values greater than 10% (two configurations, with and without blood in the surgical field). Results improved when considering surfaces in the dose calculation (88.5% for ConoProbe and 92.9% for Artec). Conclusions More accurate three-dimensional dose distributions were obtained when considering surfaces in the dose calculation of the simulated surgical field. The structured-light three-dimensional scanner provided the best results in terms of dose distributions. The findings obtained in this specific experimental setup warrant further research on surface scanning in the IOERT context owing to the clinical interest of improving the documentation of the actual IOERT scenario.
- Published
- 2018
- Full Text
- View/download PDF
11. Reseña de 'Psico-Oncología' de MARÍA DIE TRILL
- Author
-
Felipe A. Calvo
- Subjects
Psychology ,BF1-990 - Published
- 2005
12. Tumor localization using prone to supine surface based registration for breast cancer surgical planning.
- Author
-
Felicia Alfano, F. Perez Garcia, Juan Enrique Ortuño Fisac, Mercedes Herrero Conde, Oscar Bueno Zamora, Felipe A. Calvo, Serafín Lizarraga, Andrés Santos, Javier Pascau, and María J. Ledesma-Carbayo
- Published
- 2018
- Full Text
- View/download PDF
13. Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution
- Author
-
Felipe A. Calvo, Jacobo Palma, Javier Serrano, Mauricio Cambeiro, Rosa Meiriño, Santiago Martin, Diego Azcona, Diego Pedrero, Borja Aguilar, Jose Miguel Delgado, Verónica Moran, Alberto Viñals, Pablo Cabello, Elena Panizo, Alvaro Lassaletta, Carlota Gibert, Lidia Sancho, Jose Maria Fernandez de Miguel, Beatriz Alvarez de Sierra, Andres Alcázar, Victor Suarez, Alberto Alonso, Guillermo Gallardo, and Javier Aristu
- Subjects
Cancer Research ,Oncology ,General Medicine - Abstract
Introduction A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. Methods A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities’ recommendations. The temporary trends of patients care and research projects proposals were registered. Results 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. Conclusions Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.
- Published
- 2023
14. Supplementary figure 2 from TGFβ Blockade Enhances Radiotherapy Abscopal Efficacy Effects in Combination with Anti-PD1 and Anti-CD137 Immunostimulatory Monoclonal Antibodies
- Author
-
Ignacio Melero, Jose L. Perez-Gracia, Mary Helen Barcelos-Hoff, Felipe A. Calvo, Pedro Berraondo, Miguel F. Sanmamed, Elixabet Bolaños, Arantza Azpilikueta, Mariano Ponz-Sarvise, Iñaki Etxeberria, Benigno Barbes, Tania Labiano, Lina Mayorga, Inmaculada Rodríguez, and María E. Rodríguez-Ruiz
- Abstract
Experimental treatments (A) and tumor size follow-up until sacrifice (B) of tumors used to prepare cell suspensions for figures 3, 5 and supplementary figure 4. (C) Shows individual tumor lesion weights used to calculate lymphocytes/gram densities.
- Published
- 2023
15. Supplementary figure 3 from TGFβ Blockade Enhances Radiotherapy Abscopal Efficacy Effects in Combination with Anti-PD1 and Anti-CD137 Immunostimulatory Monoclonal Antibodies
- Author
-
Ignacio Melero, Jose L. Perez-Gracia, Mary Helen Barcelos-Hoff, Felipe A. Calvo, Pedro Berraondo, Miguel F. Sanmamed, Elixabet Bolaños, Arantza Azpilikueta, Mariano Ponz-Sarvise, Iñaki Etxeberria, Benigno Barbes, Tania Labiano, Lina Mayorga, Inmaculada Rodríguez, and María E. Rodríguez-Ruiz
- Abstract
FACS analyses on cell suspensions (n=4) derived from non-irradiated MC38-derived tumors
- Published
- 2023
16. Supplementary figure 4 from TGFβ Blockade Enhances Radiotherapy Abscopal Efficacy Effects in Combination with Anti-PD1 and Anti-CD137 Immunostimulatory Monoclonal Antibodies
- Author
-
Ignacio Melero, Jose L. Perez-Gracia, Mary Helen Barcelos-Hoff, Felipe A. Calvo, Pedro Berraondo, Miguel F. Sanmamed, Elixabet Bolaños, Arantza Azpilikueta, Mariano Ponz-Sarvise, Iñaki Etxeberria, Benigno Barbes, Tania Labiano, Lina Mayorga, Inmaculada Rodríguez, and María E. Rodríguez-Ruiz
- Abstract
Myeloid cell content (density per gram) in cell suspension from non-irradiated tumors as those in figure 5. Macrophages are defined as CD45+ CD11b+ F4/80+; Dendritic cells (DC) as CD45+CD11b+CD11c+; myeloid-derived suppressor cells (MDSC) as CD45+CD11b+Ly6C+ or CD45+CD11b+Ly6G+ to estimate monocytic (M-MDSC) and granulocytic (G-MDSC) subtypes.
- Published
- 2023
17. Data from TGFβ Blockade Enhances Radiotherapy Abscopal Efficacy Effects in Combination with Anti-PD1 and Anti-CD137 Immunostimulatory Monoclonal Antibodies
- Author
-
Ignacio Melero, Jose L. Perez-Gracia, Mary Helen Barcelos-Hoff, Felipe A. Calvo, Pedro Berraondo, Miguel F. Sanmamed, Elixabet Bolaños, Arantza Azpilikueta, Mariano Ponz-Sarvise, Iñaki Etxeberria, Benigno Barbes, Tania Labiano, Lina Mayorga, Inmaculada Rodríguez, and María E. Rodríguez-Ruiz
- Abstract
Radiotherapy can be synergistically combined with immunotherapy in mouse models, extending its efficacious effects outside of the irradiated field (abscopal effects). We previously reported that a regimen encompassing local radiotherapy in combination with anti-CD137 plus anti–PD-1 mAbs achieves potent abscopal effects against syngeneic transplanted murine tumors up to a certain tumor size. Knowing that TGFβ expression or activation increases in irradiated tissues, we tested whether TGFβ blockade may further enhance abscopal effects in conjunction with the anti–PD-1 plus anti-CD137 mAb combination. Indeed, TGFβ blockade with 1D11, a TGFβ-neutralizing mAb, markedly enhanced abscopal effects and overall treatment efficacy against subcutaneous tumors of either 4T1 breast cancer cells or large MC38 colorectal tumors. Increases in CD8 T cells infiltrating the nonirradiated lesion were documented upon combined treatment, which intensely expressed Granzyme-B as an indicator of cytotoxic effector capability. Interestingly, tumor tissue but not healthy tissue irradiation results in the presence of higher concentrations of TGFβ in the nonirradiated contralateral tumor that showed smad2/3 phosphorylation increases in infiltrating CD8 T cells. In conclusion, radiotherapy-induced TGFβ hampers abscopal efficacy even upon combination with a potent immunotherapy regimen. Therefore, TGFβ blockade in combination with radioimmunotherapy results in greater efficacy.
- Published
- 2023
18. Supplementary figure 1 from TGFβ Blockade Enhances Radiotherapy Abscopal Efficacy Effects in Combination with Anti-PD1 and Anti-CD137 Immunostimulatory Monoclonal Antibodies
- Author
-
Ignacio Melero, Jose L. Perez-Gracia, Mary Helen Barcelos-Hoff, Felipe A. Calvo, Pedro Berraondo, Miguel F. Sanmamed, Elixabet Bolaños, Arantza Azpilikueta, Mariano Ponz-Sarvise, Iñaki Etxeberria, Benigno Barbes, Tania Labiano, Lina Mayorga, Inmaculada Rodríguez, and María E. Rodríguez-Ruiz
- Abstract
Assessment of spontaneous lung metastases of 4T1 tumors in the indicated treatment groups corresponding to mice treated as in figure 2A. Metastases were detected and quantitated -number of lesions in the surface of the lung counted upon inspection under a magnification lens (left) and by real time RT-PCR for tumor specific gp70 RNA (right)-.
- Published
- 2023
19. Interactive Deformation of Heterogeneous Volume Data.
- Author
-
Rosell Torres, José Miguel Espadero, Felipe A. Calvo, and Miguel A. Otaduy
- Published
- 2014
- Full Text
- View/download PDF
20. High-dose radiotherapy and risk-adapted androgen deprivation in localised prostate cancer (DART 01/05): 10-year results of a phase 3 randomised, controlled trial
- Author
-
Almudena Zapatero, Araceli Guerrero, Xavier Maldonado, Ana Álvarez, Carmen González San-Segundo, María Ángeles Cabeza Rodríguez, Josep María Solé, Agustí Pedro Olivé, Francesc Casas, Ana Boladeras, Carmen Martín de Vidales, María Luisa Vázquez de la Torre, Susana Vara, Juan Luis Sanz, and Felipe A Calvo
- Subjects
Male ,Oncology ,Androgens ,Goserelin ,Humans ,Prostatic Neoplasms ,Androgen Antagonists ,Neoplasm Staging - Abstract
The optimal duration of androgen deprivation combined with high-dose radiotherapy in prostate cancer remains controversial. The DART 01/05 trial was designed to determine whether long-term androgen deprivation is superior to short-term androgen deprivation when combined with high-dose radiotherapy. The 5-year results showed that 2 years of adjuvant androgen deprivation combined with high-dose radiotherapy significantly improved biochemical control, metastasis, and overall survival, especially in patients with high-risk disease. In this report, we present the 10-year final results of the trial.This open-label, phase 3, randomised, controlled trial was done in ten hospitals in Spain. The eligibility criteria included patients aged 18 years or older with histologically confirmed T1c to T3, N0, and M0 adenocarcinoma of the prostate, according to the 2002 classification of the American Joint Committee on Cancer, with intermediate-risk and high-risk factors, prostate-specific antigen (PSA) less than 100 ng/mL, and a Karnofsky performance score of at least 70%. Patients were randomly assigned (1:1) to receive 4 months of neoadjuvant and concomitant short-term androgen deprivation (STAD) plus high-dose radiotherapy (minimum dose 76 Gy; median dose 78 Gy) or to receive the same treatment followed by 24 months of adjuvant long-term androgen deprivation (LTAD), via a randomisation scheduled generated by Statistical Analysis Software programme (version 9.1) and an interactive web response system. Patients assigned to the STAD group received 4 months of neoadjuvant and concomitant androgen deprivation (oral flutamide 750 mg per day or oral bicalutamide 50 mg per day) with subcutaneous goserelin (2 months before and 2 months combined with high-dose radiotherapy). Anti-androgen therapy was added during the first 2 months of treatment. Patients assigned to LTAD continued with goserelin every 3 months for another 24 months. The primary endpoint was biochemical disease-free survival at 5 years. For this 10-year study we analysed overall survival, metastasis-free survival, biochemical disease-free survival, and cause-specific survival. Analysis was by intention to treat. This trial is closed and is registered at ClinicalTrials.gov (NCT02175212) and in the EU Clinical Trials Register (EudraCT 2005-000417-36).Between Nov 7, 2005, and Dec 20, 2010, 355 patients were enrolled. One patient in the STAD group withdrew from the trial, hence 354 participants were randomly assigned to STAD (n=177) or LTAD (n=177). The median follow-up was 119·4 months (IQR 100·6-124·3). The 10-year biochemical disease-free survival for LTAD was 70·2% (95% CI 63·1-77·3) and for STAD was 62·3% (54·9-69·7; hazard ratio [HR] 0·84; 95% CI 0·50-1·43; p=0·52). At 10 years, overall survival was 78·4% (72·1-84·8) for LTAD and 73·3% (66·6-80·0) for STAD (HR 0·84; 95% CI 0·55-1·27; p=0·40), and metastasis-free survival was 76·0% (69·4-82·7) for LTAD and 70·9% (64·0-77·8) for STAD (HR 0·90; 95% CI, 0·37-2·19; p=0·81). For the subgroup of high-risk patients, the 10-year biochemical disease-free survival was 67·2% (57·2-77·2) for LTAD and 53·7% (43·3-64·1) for STAD (HR 0·90; 95% CI 0·49-1·64; p=0·73), the 10-year overall survival was 78·5% (69·6-87·3) for LTAD and 67·0% (57·3-76·7) for STAD (HR 0·58; 95% CI 0·33-1·01; p=0·054), and the 10-year metastasis-free survival was 76·6% (95% CI 67·6-85·6) for LTAD and 65·0% (55·1-74·8) for STAD (HR 0·89; 95% CI 0·33-2·43; p=0·82). Only 11 (3%) of 354 patients died from prostate cancer, all of them in the high-risk subgroup (five in the LTAD group and six in the STAD group). 76 (21%) patients died from other causes (mainly second malignancies in 31 [9%] and cardiovascular disease in 21 [6%]). No treatment-related deaths were observed.After an extended 10-year follow-up, we were unable to support the significant benefit of LTAD reported at 5 years. However, the magnitude of the benefit was clinically relevant in high-risk patients. Intermediate-risk patients treated with high-dose radiotherapy do not benefit from LTAD. A biological characterisation with the inclusion of genomic testing is needed in the decision-making process.Grupo de Investigación en Oncología Radioterápica and Sociedad Española de Oncología Radioterápica, the National Health Investigation Fund, and AstraZeneca.
- Published
- 2022
21. Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development
- Author
-
Felipe Ángel Calvo Manuel, Javier Serrano, Claudio Solé, Mauricio Cambeiro, Jacobo Palma, Javier Aristu, Jose Luis Garcia-Sabrido, Miguel Angel Cuesta, Emilio del Valle, Fernando Lapuente, Bernardino Miñana, Miguel Ángel Morcillo, Jose Manuel Asencio, Javier Pascau, Ministerio de Ciencia e Innovación (España), and Surgery
- Subjects
Cancer Research ,Telecomunicaciones ,Cancer surgery ,Materiales ,Oncology ,Intraoperative radiation therapy ,Medicina ,Electron beams ,Robotic surgery ,General Medicine ,Laparoscopic surgery ,FLASH ,Biología y Biomedicina - Abstract
Background Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. Methods Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. Results In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. Conclusions Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.
- Published
- 2023
22. Prognostic value of testosterone castration levels following androgen deprivation and high-dose radiotherapy in localized prostate cancer: Results from a phase III trial
- Author
-
Xavier Maldonado, Carmen Martín de Vidales, Felipe A. Calvo, A. Guerrero, Almudena Zapatero, M.A. Cabeza, Ana Boladeras, Susana Vara, Ana Alvarez, Francesc Casas, Carmen González San Segundo, J.M. Solé, Agustí Pedro Olive, and Maria Luisa Vazquez de la Torre
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Urology ,030218 nuclear medicine & medical imaging ,Androgen deprivation therapy ,03 medical and health sciences ,chemistry.chemical_compound ,Prostate cancer ,0302 clinical medicine ,medicine ,Humans ,Testosterone ,Radiology, Nuclear Medicine and imaging ,Castration ,Serum testosterone ,business.industry ,Prostatic Neoplasms ,Androgen Antagonists ,Testosterone (patch) ,Hematology ,Prognosis ,Androgen ,medicine.disease ,Radiation therapy ,Testosterone level ,Oncology ,chemistry ,030220 oncology & carcinogenesis ,Androgens ,business - Abstract
The optimal prognostic value of testosterone following androgen deprivation therapy (ADT) is controversial. We studied the effect of serum testosterone levels on clinical outcome in localized prostate cancer (PCa) treated with ADT and high-dose radiotherapy (HRT).The DART01/05 trial randomized 355 men with intermediate and high-risk PCa to 4 months of ADT plus HRT (STADT, N = 178) or the same treatment followed by 24 months of ADT (LTADT, N = 177). This study included patients treated with LTADT who had at least 3 determinations of testosterone during ADT (N = 154). Patients were stratified into 3 subgroups by testosterone level: minimum20 ng/dL; median 20-49 ng/dL; and maximum ≥50 ng/dL. Kaplan-Meyer and Cox regression analysis were used for overall survival (OS) and FineGray regression model for metastasis free survival (MFS), biochemical disease-free survival (bDFS) and time to TT recovery.There were no statistically significant differences in 10-year bDFS, MFS, or OS between the20 ng/mL and 20-49 ng/dL subgroups. Multivariate analysis showed that a median testosterone ≥50 ng/dL was significantly associated with a decrease in bDFS (HR: 6.58, 95%CI 1.28-33.76, p = 0.03). Time to testosterone recovery after ADT did not correlate with bDFS, MFS, or OS and was not significantly associated with any of the testosterone subgroups.Our results do not support the concept that additional serum testosterone suppression below 20 ng/dL is associated with better outcomes than 20-49 ng/dL. Time to testosterone recovery after ADT and HRT did not impact clinical failure.
- Published
- 2021
23. Reply to Leonard P. Bokhorst and Berdine L. Heesterman’s Words of Wisdom re: High-dose Radiotherapy and Risk-adapted Androgen Deprivation in Localised Prostate Cancer (DART 01/05): 10-Year Results of a Phase 3 Randomised, Controlled Trial. Eur Urol. 2022;82:441
- Author
-
Almudena Zapatero, Felipe A. Calvo, Carmen Gonzalez San-Segundo, and Ana Alvarez
- Subjects
Urology - Published
- 2022
24. Intra-operative electron radiation therapy: an update of the evidence collected in 40 years to search for models for electron-FLASH studies
- Author
-
Felipe A. Calvo, Javier Serrano, Mauricio Cambeiro, Javier Aristu, Jose Manuel Asencio, Isabel Rubio, Jose Miguel Delgado, Carlos Ferrer, Manuel Desco, Javier Pascau, and Ministerio de Ciencia e Innovación (España)
- Subjects
Intraoperative ,Cancer Research ,Telecomunicaciones ,Oncology ,Radiotherapy ,Medicina ,IORT ,Ingeniería Naval ,Ciencias de la Información ,Electrons ,Flash ,Biología y Biomedicina ,IOERT - Abstract
Introduction: The clinical practice and outcome results of intraoperative electron radiation therapy (IOeRT) in cancer patients have been extensively reported over 4 decades. Electron beams can be delivered in the promising FLASH dose rate. Methods and Materials: Several cancer models were approached by two alternative radiobiological strategies to optimize local cancer control: boost versus exclusive IOeRT. Clinical outcomes are revisited via a bibliometric search performed for the elaboration of ESTRO/ACROP IORT guidelines. Results: In the period 1982 to 2020, a total of 19,148 patients were registered in 116 publications concerning soft tissue sarcomas (9% of patients), unresected and borderline-resected pancreatic cancer (22%), locally recurrent and locally advanced rectal cancer (22%), and breast cancer (45%). Clinical outcomes following IOeRT doses in the range of 10 to 25 Gy (with or without external beam fractionated radiation therapy) show a wide range of local control from 40 to 100% depending upon cancer site, histology, stage, and treatment intensity. Constraints for normal tissue tolerance are important to maintain tumor control combined with acceptable levels of side effects. Conclusions: IOeRT represents an evidence-based approach for several tumor types. A specific risk analysis for local recurrences supports the identification of cancer models that are candidates for FLASH studies. This research has been funded in part by grants from: Instituto de Salud Carlos III, Asociación Española Contra el Cáncer, ERAPERMED PerPlanRT, AC20/00103, AC20/00102, 2020-110-1). Ministry of Science, Innovation and Education PID 2019-104558RB-100, Grant PID2019-110369RB-I00 (RADHOR), funded by MCIN/AEI/10.13039/501100011033
- Published
- 2022
25. Minimally invasive tumor bed implant (MITBI) and peri-operative high-dose-rate brachytherapy (PHDRBT) for accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost) in breast-conserving surgery for ductal carcinoma in situ
- Author
-
Mauricio Cambeiro, Felipe Angel Calvo Manuel, Rafael Martínez-Monge, Natalia Rodriguez-Spiteri, Luis Isaac Ramos, Luis Pina, Marta Abengozar, Carolina Sobrido Sampedro, Arlette Elizalde, Marta Gimeno Morales, Miguel Angel Idoate, Antonio Esgueva, B. Olartecoechea, Isabel T. Rubio, and Fernando Martínez-Regueira
- Subjects
Original Paper ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,partial breast irradiation ,medicine.medical_treatment ,Brachytherapy ,Partial Breast Irradiation ,Perioperative ,Ductal carcinoma ,High-Dose Rate Brachytherapy ,dcis ,Oncology ,high-dose-rate brachytherapy ,Biopsy ,Breast-conserving surgery ,medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,External beam radiotherapy ,business - Abstract
Purpose To evaluate our institutional experience of minimally invasive tumor bed implantation (MITBI) during breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) to deliver peri-operative high-dose-rate brachytherapy (PHDRBT) as accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost). Material and methods Patients older than 40, with clinical and radiological unifocal DCIS < 3 cm were considered potential candidates for accelerated partial breast irradiation (APBI) and were implanted during BCS using MITBI-technique. Patients who in final pathology reports showed free margins and no other microscopic tumor foci, received AMBI with PHDRBT (3.4 Gy BID in 5 days). Patients with adverse features received A-PHDRBT-boost with post-operative external beam radiotherapy (EBRT). Results Forty-one patients were implanted, and 36 were treated and analyzed. According to final pathology, 24 (67%) patients were suitable for AMBI and 12 (33%) were qualified for A-PHDRBT-boost. Reoperation rate for those with clear margins was 16.6% (6/36); this rate increased to 33% (4/12) for G3 histology, and 66% (4/6) were rescued using AMBI. Early complications were documented in 5 patients (14%). With a median follow-up of 97 (range, 42-138) months, 5-year rates of local, elsewhere, locoregional, and distant control were all 97.2%. 5-year ipsilateral breast tumor recurrence rates (IBTR) were 5.6% (2/36), 8.3% (2/24) for AMBI, and 0% (0/12) for A-PHDRBT-boost patients. Both instances of IBTR were confirmed G3 tumors in pre-operative biopsies; no IBTR was documented in G1-2 tumors. Cosmetic outcomes were excellent/good in 96% of AMBI vs. 67% in A-PHDRBT-boost (p = 0.034). Conclusions The MITBI-PHDRBT program allows selection of patients with excellent prognoses (G1-2 DCIS with negative margins and no multifocality), for whom AMBI could be a good alternative with low recurrence rate, decrease of unnecessary radiation, treatment logistics improvement, and over-treatment reduction. Patients whose pre-operative biopsy showed G3 tumor, presents with inferior local control and more risk of reoperation due to positive margins.
- Published
- 2020
26. Modelo de impresión 3D para planificación quirúrgica en trasplante hepático con donante vivo adulto-adulto
- Author
-
Nicolás Jarufe, Erwin Buckel Schaffner, Carlos Montoya Moya, Brenda Andrea Gamez del Mauro, Erwin Gunter Buckel Gonzalez, and Luís Felipe Puelma Calvo
- Subjects
General Engineering - Abstract
Gracias a los grandes avances de la tecnología, los últimos diez años, la impresión en tres dimensiones (3D) se ha convertido en una herramienta accesible, útil e innovadora para distintas áreas de la medicina. Entre ellas; planificación quirúrgica, creación de implantes y prótesis, educación médica e incluso comunicación médico-paciente.Con respecto a planificación quirúrgica, la impresión 3D cobra especial relevancia en cirugías de alta complejidad. En el caso del trasplante hepático con donante vivo, donde es prioritario garantizar la máxima seguridad para el donante, al mismo tiempo que la mejor calidad del injerto para el receptor, la planificación quirúrgica es mandatoria. En este aspecto, la impresión 3D de un modelo de hígado, anatómicamente comparable al del donante, entrega al cirujano la posibilidad de obtener una imagen más clara, directa y tangible, desde cualquier ángulo del órgano, que una imagen virtual tradicional. De esta forma, el cirujano tiene a su alcance una herramienta adicional para plantear el mejor abordaje quirúrgico, anticipar variaciones anatómicas e incluso, cuando el material de impresión lo permite, practicar el procedimiento.En Clínica Las Condes, el centro de trasplante junto al Centro de Innovación, trabajaron en conjunto en la impresión 3D de dos modelos de hígado, utilizados para la planificación quirúrgica de los primeros dos trasplantes hepáticos con donante vivo adulto-adulto realizados en Latinoamérica, donde la hepatectomia del donante se realizó de manera totalmente laparoscópica. El objetivo de este trabajo es describir el proceso de impresión 3D y analizar las dificultades y beneficios del proceso y sus resultados. Palabras clave: Impresión 3D, planificación quirúrgica, donante vivo, trasplante de hígado.
- Published
- 2022
27. Segmentectomía lateral izquierda laparoscópica en donante vivo para trasplante hepático adulto-pediátrico
- Author
-
Mario Uribe Maturana, Francisco Riquelme, Sebastián Uribe Echevarría, Brenda Andrea Gamez del Mauro, Cristian Astudillo, Felipe Puelma Calvo, Felipe Catán, and Gloria González García
- Subjects
General Engineering - Abstract
Introducción: La segmentectomía lateral izquierda es el procedimiento más empleado para la cirugía del donante en trasplante hepático con donante vivo adulto-pediátrico (THDVA-P), y ha demostrado ser seguro y reproducible. Sin embargo, la información aún es escasa respecto al abordaje laparoscópico. El objetivo de este artículo es dar a conocer los resultados postoperatorios de la segmentectomía lateral izquierda laparoscópica (SLI-L) para THDVA-P. Materiales y método: Realizamos un estudio retrospectivo, observacional, de un solo centro, Hospital del Salvador; con vasta experiencia en trasplante hepático y en resecciones hepáticas laparoscópicas. Se ofreció realizar el procedimiento de SLI-L para la cirugía del donante vivo. Se describe la técnica quirúrgica y los resultados postoperatorios de los donantes. Resultados: Entre abril 2015 y enero 2021, 36 pacientes, 25 de ellos hombres, fueron sometidos a SLI-L. El 86% eran madre o padre del receptor, con una mediana de 30 años (19-45). Mediana de tiempo operatorio de 360 min (240-480). Hubo conversión en un caso debido a sangrado venoso de difícil manejo y en dos oportunidades se utilizó técnica mano asistida por la misma causa. Morbilidad Clavien-Dindo III en un paciente debido a fuga biliar precoz, manejada con colangiopancreatografía retrógrada endoscópica exitosamente. La mediana de hospitalización fue de 4 días (3-12) y no hubo mortalidad. Conclusión: La SLI-L ha evolucionado, desde un procedimiento innovador hasta convertirse en el actual procedimiento estándar para THDVA-P. Los buenos resultados en términos de morbimortalidad sugieren que podría ser una técnica segura y reproducible en contextos similares al del centro.
- Published
- 2022
28. Intraoperative radiation therapy (IORT) for soft tissue sarcoma – ESTRO IORT Task Force/ACROP recommendations
- Author
-
Falk Roeder, Philip Poortmans, Felipe A. Calvo, Ladan Saleh-Ebrahimi, Carlos Ferrer Albiach, and Virginia Morillo
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Soft Tissue Neoplasms ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Retroperitoneal Neoplasms ,Intraoperative radiation therapy ,Randomized Controlled Trials as Topic ,Retrospective Studies ,High rate ,Intraoperative Care ,business.industry ,Task force ,Soft tissue sarcoma ,Sarcoma ,Retrospective cohort study ,Hematology ,medicine.disease ,Combined Modality Therapy ,Radiation therapy ,Systematic review ,Oncology ,030220 oncology & carcinogenesis ,Radiology ,Neoplasm Recurrence, Local ,business - Abstract
Purpose To describe guidelines for the use of intraoperative radiation therapy (IORT) in the treatment of soft-tissue sarcomas (STS). Methods A panel of experts in the field performed a systematic literature review, supplemented their clinical experience and developed recommendations for the use of IORT in the treatment of STS. Results Based on the evidence from the systematic literature review and the clinical experience of the panel members, recommendations regarding patient selection, incorporation into multimodal treatment concepts and the IORT procedure itself are made. The rationale for IORT in extremity and retroperitoneal STS is summarized and results of the major series in terms of patient and treatment characteristics, oncological outcome and toxicity are presented. We define surgical factors, volumes for irradiation, technical requirements, dose prescription, recording and reporting, treatment delivery and care during the course of IORT covering the main IORT techniques used for the treatment of STS. In extremity STS, evidence originates from a few small prospective and mainly from retrospective single centre studies. Based on those reports, IORT containing-approaches result in very high local control rates with low rates of acute and late toxicity. In retroperitoneal sarcomas, evidence is derived from one prospective randomized trial, a few prospective and a large number of retrospective studies. The randomized trial compared IORT combined with moderate doses of postoperative external-beam radiation therapy (EBRT) to high-dose postoperative EBRT alone after gross total resection, clearly favouring the IORT-containing approach. These results have been confirmed by the prospective and retrospective studies, which similarly showed high local control rates with acceptable toxicity, mainly favouring combinations of preoperative EBRT and IORT. Conclusions IORT-containing approaches result in high rates of local control with low to acceptable toxicity rates. Based on the available evidence, we made recommendations for the use of IORT in STS. Clinicians and researchers are encouraged to use these guidelines in clinical routine as well as in the design of future trials.
- Published
- 2020
29. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in locally recurrent rectal cancer
- Author
-
M.A. Lozano, Claudio V. Sole, Philip Poortmans, Felipe A. Calvo, L. Gonzalez-Bayon, Harm J. T. Rutten, Wim Dries, Mauricio Cambeiro, Surgery, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy
- Subjects
Surgical resection ,Electron beam ,medicine.medical_specialty ,Intraoperative radiotherapy ,Colorectal cancer ,SURGERY ,medicine.medical_treatment ,Brachytherapy ,R895-920 ,Systemic therapy ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,CHEMORADIATION ,Medical physics. Medical radiology. Nuclear medicine ,0302 clinical medicine ,medicine ,Recurrent disease ,Radiology, Nuclear Medicine and imaging ,MULTIMODALITY TREATMENT ,Rectal cancer ,Rescue surgery ,Intraoperative radiation therapy ,Survival rate ,RC254-282 ,Recurrent Rectal Cancer ,RADIOTHERAPY IORT ,business.industry ,BRACHYTHERAPY ,Intraoperative irradiation ,Oligo-recurrence ,SURGICAL RESECTION ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,ELECTRON-BEAM ,IRRADIATION ,Oncology ,030220 oncology & carcinogenesis ,PELVIC RECURRENCE ,Radiology ,business ,REIRRADIATION - Abstract
Highlights • Radiation dose escalation with intraoperative electron beam is feasible in the pelvic region. • IORT is an option to minimize radiation toxicity to ureters, bladder, prostate, vagina, uterus, small bowel. • Preoperative therapy, including a re-irradiation component, allows selection of patient candidates for local treatment intensification. • R0 status IOERT results supports individualized recommendation in expert clinical practice. • Survival contribution is described in oligo-recurrent patients amenable for radical rescue surgery without previous pelvic radiotherapy., Multimodal strategies have been implemented for locally recurrent rectal cancer scheduled for complete surgical resection. Irradiation and systemic therapy have been added to improve the oncological outcome, as surgery alone was associated with a poor prognosis. Intraoperative irradiation (IORT) is a component of irradiation intensification. Long-term cancer control and a higher survival rate were consistently reported in patients who had IORT as a component of their multidisciplinary treatment. The experience reported by expert IORT groups is reviewed and recommendations to guide clinical practice are explained in detail.
- Published
- 2020
30. Hepatectomía derecha totalmente laparoscópica para trasplante hepático con donante vivo adulto-adulto. Técnica quirúrgica y experiencia inicial en Chile
- Author
-
Brenda Andrea Gamez del Mauro, Erwin Buckel Gonzalez, Felipe Puelma Calvo, Erwin Buckel Schaffner, Cristian Astorga Larrondo, and Nicolas Jarufe Cassis
- Subjects
General Engineering - Abstract
El trasplante hepático con donante vivo (THDV) es un procedimiento complejo y desafiante para el cirujano, ya que exige garantizar tanto la máxima seguridad para el donante, así como también, la mejor calidad del injerto para el receptor. Debido a lo anterior, la implementación de la cirugía mini-invasiva ha sido lenta en esta área. Sin embargo, los ultimos 10 años, gracias a los avances que ha experimentado la cirugía hepática laparoscópica, ha aumentado el interés de algunos grupos altamente especializados por incorporar la cirugía mini-invasiva a la cirugía del donante, principalmente en trasplante hepático donante vivo adulto-pediatrico (THDVA-P). Los favorables resultados obtenidos en esta área, incluso han llevado a los expertos en el tema, a categorizar el abordaje laparoscópico para la cirugía del donante como el procedimiento estandar en THDVA-P. Contrario a lo anterior, la implementación de la laparoscopía para trasplante hepático donante vivo adulto-adulto (THDVA-A), es más compleja y requiere en su mayoría, una hepatectomía de lóbulo derecho o izquierdo para cumplir con las necesidades volumétricas del receptor. Esta cirugía es de mayor dificultad y riesgo para el donante, por lo que su indicación por vía mini-invasiva está limitada a centros de alto volumen y preparación, tanto en laparoscopía, como en trasplante hepático. En este trabajo, se busca dar a conocer la técnica quirúrgica y nuestra experiencia inicial con la primera hepatectomía derecha totalmente laparoscópica (HDTL) para THDVA-A realizada en Chile. Palabras clave: Trasplante hepático; Donante vivo; Hepatectomía derecha; Laparoscopía
- Published
- 2022
31. Current practice in proton therapy delivery in adult cancer patients across Europe
- Author
-
Makbule Tambas, Hans Paul van der Laan, Roel J.H.M. Steenbakkers, Jerome Doyen, Beate Timmermann, Ester Orlandi, Morten Hoyer, Karin Haustermans, Petra Georg, Neil G Burnet, Vincent Gregoire, Valentin Calugaru, Esther G.C. Troost, Frank Hoebers, Felipe A. Calvo, Joachim Widder, Fabian Eberle, Marco van Vulpen, Philippe Maingon, Tomasz Skóra, Damien C. Weber, Kjell Bergfeldt, Jiri Kubes, Johannes A. Langendijk, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, and Radiotherapie
- Subjects
Adult ,Male ,SELECTION ,Medizin ,610 Medicine & health ,030218 nuclear medicine & medical imaging ,Central Nervous System Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Patient selection ,NECK-CANCER ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,HEAD ,BEAM THERAPY ,Gastrointestinal Neoplasms ,Adult patients ,Hematology ,Proton therapy ,Reimbursement ,3. Good health ,Europe ,MODEL ,Oncology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Clinical studies ,Model-based approach ,RADIOTHERAPY - Abstract
BACKGROUND AND PURPOSE: Major differences exist among proton therapy (PT) centres regarding PT delivery in adult cancer patient. To obtain insight into current practice in Europe, we performed a survey among European PT centres. MATERIALS AND METHODS: We designed electronic questionnaires for eight tumour sites, focusing on four main topics: 1) indications and patient selection methods; 2) reimbursement; 3) on-going or planned studies, 4) annual number of patients treated with PT. RESULTS: Of 22 centres, 19 (86%) responded. In total, 4233 adult patients are currently treated across Europe annually, of which 46% consists of patients with central nervous system tumours (CNS), 15% head and neck cancer (HNC), 15% prostate, 9% breast, 5% lung, 5% gastrointestinal, 4% lymphoma, 0.3% gynaecological cancers. CNS are treated in all participating centres (n = 19) using PT, HNC in 16 centres, lymphoma in 10 centres, gastrointestinal in 10 centres, breast in 7 centres, prostate in 6 centres, lung in 6 centres, and gynaecological cancers in 3 centres. Reimbursement is provided by national health care systems for the majority of commonly treated tumour sites. Approximately 74% of centres enrol patients for prospective data registration programs. Phase II-III trials are less frequent, due to reimbursement and funding problems. Reasons for not treating certain tumour types with PT are lack of evidence (30%), reimbursement issues (29%) and/or technical limitations (20%). CONCLUSION: Across European PT centres, CNS tumours and HNC are the most frequently treated tumour types. Most centres use indication protocols. Lack of evidence for PT and reimbursement issues are the most reported reasons for not treating specific tumour types with PT. ispartof: RADIOTHERAPY AND ONCOLOGY vol:167 pages:7-13 ispartof: location:Ireland status: published
- Published
- 2022
32. Intraoperative Radiotherapy in Lung Cancer: Methodology (Electrons or Brachytherapy), Clinical Experiences, and Long-Term Institutional Results
- Author
-
Felipe A. Calvo, Javier Aristu, Javier Serrano, Mauricio Cambeiro, Rafael Martinez-Monge, and Rosa Cañón
- Published
- 2022
33. 589 Variables that modify the survival after recurrence in patients with early cervical cancer
- Author
-
I Brotons, L Sánchez Lorenzo, N Manzour, E Chacon, José Manuel Aramendía, Nerea Martín-Calvo, T Castellano, Diego Salas, R Martínez Monge, Mauricio Cambeiro, M Gimeno, J Vara, Felipe A. Calvo, Antonio González-Martín, A Lopez Picazo, D Vazquez, F Boria, J. L. Alcazar, Luis Chiva, and José Ángel Mínguez
- Subjects
Oncology ,Cervical cancer ,medicine.medical_specialty ,education.field_of_study ,medicine.diagnostic_test ,Bevacizumab ,Proportional hazards model ,business.industry ,Population ,Physical examination ,Odds ratio ,medicine.disease ,Internal medicine ,medicine ,Adenocarcinoma ,Stage (cooking) ,education ,business ,medicine.drug - Abstract
Introduction/Background* The primary objective of this project was to identify the independent clinical-pathological variables associated with the death after relapse in patients with stage IB1 cervical cancer who underwent radical hysterectomy. The secondary objective was to analysis survival post-relapse in these patients. Methodology Based on the SUCCOR study’s database . Patients were eligible if they had a relapse (local, distant or both) after underwent a radical hysterectomy in a European Institution for stage IB1 cervical cancer (FIGO 2009), from January 1st, 2013 to December 31st, 2014. To identify variables independently associated with death in these patients, we calculated the odds ratio using simple logistic regression models and subsequently a multivariate backward stepwise procedure. For the secondary end point we calculated Kaplan-Meyer and Cox regression using the results of the univariate and multivariate analysis . Result(s)* A total of 126 patients were selected, women who died were more likely to have tumors >2cm on the clinical examination (OR, 3.50; 95% CI, 1.35- 9.08) and to have a stromal infiltration higher than 1/3 (OR, 6.30; 95% CI, 1.31- 30.00). In contrast, the histologic subtype of adenocarcinoma and treatment with Bevacizumab were found as protective factors against death (OR, 0.32; 95% CI, 0.11- 0.95) and (OR, 0.23; 95% CI, 0.05- 0.99) respectively. The mean time of relapse of our population was 22.94 months and the median of survival after relapse was 18.5 months. Patients with tumors > 2cm on the clinical examination had a 3.39-times higher hazard of death after relapse (HR, 3.39; 95% CI, 1.52- 7.53) and the distant/both location of relapse had 2.23- times higher hazard of death (HR, 2.23; 95% CI, 1.14- 4.36) The 2-years survival rates after relapse were 76% for tumors 2cm on the clinical examination, 76% for local relapse and 47% for distant/both location relapse. Conclusion* The tumor size on clinical examination, the location of relapse, the histologic subtype and the treatment with Bevacizumab, modify the risks of death after relapse on patients with cervical cancer IB1. Tumor >2cm on clinical examination and distant recurrences have a shorter survival time after relapse
- Published
- 2021
34. 779 Surgery in cervical cancer observational prospective (SUCCOP), an ESGO survey: is it a place for another european prospective study?
- Author
-
A Lopez-Picazo, I Brotons, E Chacon, D Vazquez, M Gimeno, N Manzour, Diego Salas, L Sánchez Lorenzo, Mauricio Cambeiro, José Ángel Mínguez, Antonio González-Martín, T Castellano, Felipe A. Calvo, J Vara, Luis Chiva, Nerea Martín-Calvo, J. L. Alcazar, F Boria, Jaime Espinós, and José Manuel Aramendía
- Subjects
Cervical cancer ,medicine.medical_specialty ,Surgical approach ,medicine.diagnostic_test ,business.industry ,General surgery ,Retrospective cohort study ,medicine.disease ,Exact test ,medicine ,Observational study ,Statistical analysis ,Prospective cohort study ,Laparoscopy ,business - Abstract
Introduction/Background* The study attempts to understand the impact of the different retrospective studies conducted by the SUCCOR group on the daily surgical practice among ESGO members. We intend to propose a new observational prospective European study, the SUCCOP study. We aim to know if the implementation of protective maneuvers in minimally invasive surgery (MIS) improves the outcome of patients with early cervical cancer (ECC). In this scenario, supported by the ESGO council, we have conducted a multinational survey to assess our ESGO members’ perspectives from the ethical and investigational viewpoints on this new observational prospective study. Methodology A 32-item questionnaire addressing multiple issues related to the SUCCOR study and surgical management of ECC was designed and sent from the ESGO account through a newsletter on February 23rd to all ESGO members from 54 countries of the ESGO directory. The survey was completely confidentially and could be completed in less than 5 minutes. Responses from 353 members were obtained. Descriptive statistical analysis and frequency tables, as well as two-sided Fisher’s exact test, were used. Result(s)* 92.9% of responders were aware of the findings of the SUCCOR study. 73.4% expected the results obtained. 5 out of 10 of members confirmed that have changed their practice after the publication of the manuscript. Currently, 34.8% of responders admit that they usually perform MIS (laparoscopy/robotic) for cervical tumours smaller than 2 cm, while for tumours larger than 2 cm (FIGO IB2) 15.1% state that they continue to carry out MIS. Between 63 and 64.1% apply protective maneuvers during this procedure. In ECC who have undergone conization, 56.1% would performed MIS for tumours smaller than 2 cm while only 30% would offer it for tumours larger than 2 cm. Finally, 84.1% of ESGO members consider ethically acceptable the development of a new European prospective observational study (Image 1) to evaluate the surgical approach in ECC (IB1-IB2). Conclusion* According to the ESGO members’ perspectives regarding the approach to ECC, it seems that MIS still has an important role to play, which should be evaluated in a new prospective study that reflects the European reality (Image 2).
- Published
- 2021
35. Prevalence of nodal involvement in rectal cancer after chemoradiotherapy
- Author
-
Doenja M. J. Lambregts, Salvatore Pucciarelli, Hester E. Haak, Javier Suárez, Li Jen Kuo, Rob Glynne-Jones, Regina G. H. Beets-Tan, Patricia J. Nelemans, Julio Garcia-Aguilar, V. Valentini, S Biondo, Geerard L. Beets, Felipe A. Calvo, Monique Maas, Koen C.M.J. Peeters, George Theodoropoulos, Claus Rödel, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Surgery, Faculteit FHML Centraal, RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie
- Subjects
Male ,Colorectal cancer ,Kaplan-Meier Estimate ,030230 surgery ,Gastroenterology ,PREDICT ,0302 clinical medicine ,TUMOR ,80 and over ,PREOPERATIVE CHEMORADIATION THERAPY ,DISEASE-FREE SURVIVAL ,PATHOLOGICAL COMPLETE RESPONSE ,Adjuvant ,Aged, 80 and over ,Proctectomy ,Chemoradiotherapy ,Middle Aged ,Total mesorectal excision ,Pooled analysis ,Local ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Regression Analysis ,Female ,ORGAN PRESERVATION ,medicine.medical_specialty ,Locally advanced ,LOCAL RECURRENCE ,03 medical and health sciences ,Aged ,Chemoradiotherapy, Adjuvant ,Humans ,Lymph Nodes ,Neoplasm Invasiveness ,Neoplasm Recurrence, Local ,Rectal Neoplasms ,NEOADJUVANT CHEMORADIATION ,Internal medicine ,medicine ,Nodal involvement ,Proportional hazards model ,business.industry ,Original Articles ,medicine.disease ,Confidence interval ,Neoplasm Recurrence ,GRECCAR 2 ,PROGNOSTIC-FACTOR ,Surgery ,business - Abstract
Background: The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data.Methods: Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS).Results: Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219)months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P
- Published
- 2021
36. Management plan for breast cancer during the COVID‐19 pandemic. A single‐institution alternative to treat early breast cancer patients in a short time
- Author
-
Karla Torzsok, Felipe A. Calvo, Filippo Marangoni, Luis Marin, Ariel Fariña, Hugo Marsiglia, Badir Chahuan, Ana María Ciudad, Mabel Hurtado, and Cristian Soza-Ried
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,MEDLINE ,Breast Neoplasms ,Electrons ,Mastectomy, Segmental ,Betacoronavirus ,Breast cancer ,Pandemic ,Internal Medicine ,medicine ,Humans ,Combined Modality Therapy ,Single institution ,Intensive care medicine ,Pandemics ,Early breast cancer ,biology ,SARS-CoV-2 ,business.industry ,COVID-19 ,biology.organism_classification ,medicine.disease ,Oncology ,Commentary ,Female ,Surgery ,Coronavirus Infections ,business - Published
- 2020
37. TGFβ Blockade Enhances Radiotherapy Abscopal Efficacy Effects in Combination with Anti-PD1 and Anti-CD137 Immunostimulatory Monoclonal Antibodies
- Author
-
Mary Helen Barcelos-Hoff, Tania Labiano, Pedro Berraondo, Iñaki Etxeberria, Lina Mayorga, Benigno Barbés, Elixabet Bolaños, Mariano Ponz-Sarvise, Arantza Azpilikueta, Miguel F. Sanmamed, Ignacio Melero, Jose Luis Perez-Gracia, Felipe A. Calvo, Maria E. Rodriguez-Ruiz, and Inmaculada Rodriguez
- Subjects
0301 basic medicine ,Cancer Research ,medicine.drug_class ,medicine.medical_treatment ,Programmed Cell Death 1 Receptor ,CD8-Positive T-Lymphocytes ,Monoclonal antibody ,Granzymes ,Mice ,Tumor Necrosis Factor Receptor Superfamily, Member 9 ,03 medical and health sciences ,0302 clinical medicine ,Transforming Growth Factor beta ,Cell Line, Tumor ,medicine ,Animals ,Humans ,Cytotoxic T cell ,business.industry ,CD137 ,Antibodies, Monoclonal ,Immunotherapy ,Radioimmunotherapy ,Combined Modality Therapy ,Blockade ,Gene Expression Regulation, Neoplastic ,Radiation therapy ,Disease Models, Animal ,030104 developmental biology ,Oncology ,Cell culture ,030220 oncology & carcinogenesis ,Cancer research ,Female ,Colorectal Neoplasms ,business - Abstract
Radiotherapy can be synergistically combined with immunotherapy in mouse models, extending its efficacious effects outside of the irradiated field (abscopal effects). We previously reported that a regimen encompassing local radiotherapy in combination with anti-CD137 plus anti–PD-1 mAbs achieves potent abscopal effects against syngeneic transplanted murine tumors up to a certain tumor size. Knowing that TGFβ expression or activation increases in irradiated tissues, we tested whether TGFβ blockade may further enhance abscopal effects in conjunction with the anti–PD-1 plus anti-CD137 mAb combination. Indeed, TGFβ blockade with 1D11, a TGFβ-neutralizing mAb, markedly enhanced abscopal effects and overall treatment efficacy against subcutaneous tumors of either 4T1 breast cancer cells or large MC38 colorectal tumors. Increases in CD8 T cells infiltrating the nonirradiated lesion were documented upon combined treatment, which intensely expressed Granzyme-B as an indicator of cytotoxic effector capability. Interestingly, tumor tissue but not healthy tissue irradiation results in the presence of higher concentrations of TGFβ in the nonirradiated contralateral tumor that showed smad2/3 phosphorylation increases in infiltrating CD8 T cells. In conclusion, radiotherapy-induced TGFβ hampers abscopal efficacy even upon combination with a potent immunotherapy regimen. Therefore, TGFβ blockade in combination with radioimmunotherapy results in greater efficacy.
- Published
- 2019
38. PH-0328 Current practice for selection of adult patients for proton therapy across Europe
- Author
-
Karen J. Kirkby, Joachim Widder, Beate Timmermann, Esther G.C. Troost, Tomasz Skóra, D.C. Weber, J. Kubes, J.A. Langendijk, Frank J. P. Hoebers, K. Bergfeldt, M. van Vulpen, Vincent Grégoire, Valentin Calugaru, Morten Høyer, Jérôme Doyen, K. Haustermans, Ester Orlandi, Petra Georg, F. Eberle, Felipe A. Calvo, Neil G. Burnet, Makbule Tambas, H. P. van der Laan, R.J.H.M. Steenbakkers, and P. Maingon
- Subjects
medicine.medical_specialty ,Adult patients ,business.industry ,Medizin ,Hematology ,Oncology ,Current practice ,medicine ,Radiology, Nuclear Medicine and imaging ,ComputingMethodologies_GENERAL ,Intensive care medicine ,business ,Proton therapy ,Selection (genetic algorithm) - Abstract
Poster-Abstract
- Published
- 2021
39. Ten-Year Results of a Phase III Randomised Trial of High-Dose Radiotherapy and Risk-Adapted Androgen Deprivation in Localised Prostate Cancer
- Author
-
Almudena Zapatero, Araceli Guerrero, Xavier Maldonado, Ana Álvarez, Carmen González San-Segundo, María Ángeles Cabeza Rodríguez, Josep María Solé, Agustí Pedro Olive, Francesc Casas, Ana Boladeras, Carmen Martín de Vidales, María Luisa Vázquez de la Torre, Susana Vara, Juan Luis Sanz, and Felipe A. Calvo
- Subjects
History ,Polymers and Plastics ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2021
40. Proton Cancer Therapy: Synchrotron-Based Clinical Experiences 2020 Update
- Author
-
Javier Aristu, Elena Panizo, Felipe Angel Calvo Manuel, Daniel Zucca, Mauricio Cambeiro, Diego Azcona, Santiago M. Martin, Alvaro Lassaletta, Javier Serrano, and Borja Aguilar
- Subjects
medicine.medical_specialty ,Proton ,business.industry ,InformationSystems_INFORMATIONSTORAGEANDRETRIEVAL ,Cancer therapy ,Synchrotron ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,030220 oncology & carcinogenesis ,Data_FILES ,Medicine ,Medical physics ,business ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) - Abstract
Proton therapy is an efficient high-precision radiotherapy technique. The number of installed proton units and the available medical evidence has grown exponentially over the last 10 years. As a technology driven cancer treatment modality, specific sub-analysis based on proton beam characteristics and proton beam generators is feasible and of academic interest. International synchrotron technology-based institutions have been particularly active in evidence generating actions including the design of prospective trials, data registration projects and retrospective analysis of early clinical results. Reported evidence after 2010 of proton therapy from synchrotron based clinical results are reviewed. Physics, molecular, cellular, animal investigation and other non-clinical topics were excluded from the present analysis. The actual literature search (up to January 2020) found 192 publications, including description of results in over 29.000 patients (10 cancer sites and histological subtypes), together with some editorials, reviews or expert updated recommendations. Institutions with synchrotron-based proton therapy technology have shown consistent and reproducible results along the past decade. Bibliometrics of reported clinical experiences from 2008 to early 2020 includes 58% of publications in first quartile (1q) scientific journals classification and 13% in 2q (7% 3q, 5% 4q and 17% not specified). The distribution of reports by cancer sites and histological subtypes shown as dominant areas of clinical research and publication: lung cancer (23%), pediatric (18%), head and neck (17%), central nervous system (7%), gastrointestinal (9%), prostate (8%) and a miscellanea of neplasms including hepatocarcinoma, sarcomas and breast cancer. Over 50% of lung, pediatric, head and neck and gastrointestinal publications were 1q.
- Published
- 2020
41. Multimodality image integration for radiotherapy treatment: an easy approach.
- Author
-
Andrés Santos, Javier Pascau, Manuel Desco, Juan A. Santos, Felipe A. Calvo, Carlos Benito, and Rafael García-Barreno
- Published
- 2001
- Full Text
- View/download PDF
42. PO-1051 Proton versus photon craniospinal irradiation in Pediatric patients with high-risk medulloblastoma
- Author
-
A. Lassaletta, Felipe A. Calvo, C. Gonzalez-San Segundo, Javier Aristu, E. Panizo, F. Serrano, E. Carceller, and F. Vazquez
- Subjects
Medulloblastoma ,Photon ,Materials science ,Oncology ,Proton ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Hematology ,medicine.disease ,Nuclear medicine ,business ,Craniospinal Irradiation - Published
- 2021
43. OC-0338 Prognostic value of testosterone following androgen deprivation and high-dose radiotherapy in prostate cancer
- Author
-
Almudena Zapatero, Anton Alvarez, A. Guerrero, C. Martin de Vidales, A. Pedro Olive, M.L. Vázquez de la Torre, C. González San Segundo, Juan Solé, Xavier Maldonado, Francesc Casas, A. Boladeras, Felipe A. Calvo, and M.A. Cabeza Rodriguez
- Subjects
medicine.medical_specialty ,medicine.drug_class ,business.industry ,medicine.medical_treatment ,Urology ,Hematology ,Androgen ,medicine.disease ,Radiation therapy ,Prostate cancer ,Oncology ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,Value (mathematics) ,Testosterone - Published
- 2021
44. In response to Haas RL et al
- Author
-
Felipe A. Calvo, José Manuel Asencio, Philip Poortmans, C. Ferrer Albiach, and Falk Roeder
- Subjects
Oncology ,business.industry ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Sarcoma ,Soft Tissue Neoplasms ,Hematology ,business - Published
- 2020
45. International expert consensus statement regarding radiotherapy treatment options for rectal cancer during the COVID 19 pandemic
- Author
-
Krzysztof Bujko, Karin Haustermans, Bengt Glimelius, Marianne Grønlie Guren, David Sebag-Montefiore, Rob Glynne-Jones, Claus Rödel, Karen-Lise Garm Spindler, Oriol Pares, Emmanouil Fokas, Felipe A. Calvo, V. Valentini, Corrie A.M. Marijnen, Femke P. Peters, and Philippe Maingon
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Radiotherapy ,Colorectal cancer ,Statement (logic) ,business.industry ,medicine.medical_treatment ,Expert consensus ,Hematology ,medicine.disease ,Article ,Radiation therapy ,Oncology ,Radiology Nuclear Medicine and imaging ,Pandemic ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiotherapy treatment ,Rectal cancer ,Intensive care medicine ,business ,COVID 19 ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA - Abstract
ispartof: RADIOTHERAPY AND ONCOLOGY vol:148 pages:213-215 ispartof: location:Ireland status: published
- Published
- 2020
46. The role of the radiation oncologist in quality and patient safety: A proposal of indicators and metrics
- Author
-
Felipe A. Calvo, K. Akbarov, May Abdel-Wahab, Aldo Quarneti, Rajiv Ranjan Prasad, Pierre Scalliet, Bhishamjit S. Chera, and Eduardo Zubizarreta
- Subjects
0301 basic medicine ,Teamwork ,medicine.medical_specialty ,Practice setting ,business.industry ,media_common.quotation_subject ,Control (management) ,Radiation Oncologists ,Hematology ,03 medical and health sciences ,Patient safety ,Benchmarking ,030104 developmental biology ,0302 clinical medicine ,Oncology ,Multidisciplinary approach ,030220 oncology & carcinogenesis ,Medicine ,Humans ,Quality (business) ,Medical physics ,business ,Quality assurance ,Radiation oncologist ,media_common - Abstract
This manuscript represents a collaboration from an international group of quality and safety expert radiation oncologists. It is a position/review paper with the specific aim of defining the role of the radiation oncologist in quality and safety management. This manuscript is unique in that we recommend specific quality assurance/control tasks and correlated quality and indicators and safety measures that are the responsibility of the radiation oncologist. The article addresses the role of the radiation oncologist in quality and safety from a strong perspective of multidisciplinarity and teamwork. Our manuscript is "cross-cutting" and applicable to radiation oncologist in any practice setting (i.e. low middle-income countries).
- Published
- 2020
47. Intraoperative computed tomography imaging for dose calculation in intraoperative electron radiation therapy: Initial clinical observations
- Author
-
Javier Pascau, Verónica García-Vázquez, Maria J. Ledesma-Carbayo, Manuel Desco, Felipe A. Calvo, Claudio V. Sole, José Antonio Calvo-Haro, Ministerio de Economía y Competitividad (España), Ministerio de Ciencia, Innovación y Universidades (España), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Instituto de Salud Carlos III, Comunidad de Madrid (España), and Fundación ProCNIC
- Subjects
Dose calculation ,medicine.medical_treatment ,Image Processing ,Cancer Treatment ,Irradiated Volume ,Computed tomography ,Biochemistry ,030218 nuclear medicine & medical imaging ,Diagnostic Radiology ,Radiotherapy, High-Energy ,Intraoperative Period ,0302 clinical medicine ,Breast cancer ,Breast Tumors ,Medicine and Health Sciences ,Medicine ,Tissue Distribution ,Tomography ,Surgical and invasive medical procedures ,Multidisciplinary ,medicine.diagnostic_test ,Radiology and Imaging ,Radiotherapy Dosage ,Sarcoma ,Radiation therapy ,Surgical Oncology ,Tissue distribution ,Oncology ,030220 oncology & carcinogenesis ,Cancer treatment ,Surgical oncology ,Preoperative Period ,Computed axial tomography ,Engineering and Technology ,Female ,Intraoperative electron radiation therapy ,Algorithms ,Research Article ,Clinical Oncology ,Patient Transfer ,Imaging Techniques ,Science ,Radiation Therapy ,Neuroimaging ,Surgical and Invasive Medical Procedures ,Breast Neoplasms ,Research and Analysis Methods ,03 medical and health sciences ,Tissue heterogeneity ,Image processing ,Diagnostic Medicine ,Breast Cancer ,Humans ,Pharmacokinetics ,Retroperitoneal Neoplasms ,Biología y Biomedicina ,Pharmacology ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Biology and Life Sciences ,Cancers and Neoplasms ,Computed Axial Tomography ,Signal Processing ,Feasibility Studies ,Clinical Medicine ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,Neuroscience - Abstract
In intraoperative electron radiation therapy (IOERT) the energy of the electron beam is selected under the conventional assumption of water-equivalent tissues at the applicator end. However, the treatment field can deviate from the theoretic flat irradiation surface, thus altering dose profiles. This patient-based study explored the feasibility of acquiring intraoperative computed tomography (CT) studies for calculating three-dimensional dose distributions with two factors not included in the conventional assumption, namely the air gap from the applicator end to the irradiation surface and tissue heterogeneity. In addition, dose distributions under the conventional assumption and from preoperative CT studies (both also updated with intraoperative data) were calculated to explore whether there are other alternatives to intraoperative CT studies that can provide similar dose distributions. The IOERT protocol was modified to incorporate the acquisition of intraoperative CT studies before radiation delivery in six patients. Three studies were not valid to calculate dose distributions due to the presence of metal artefacts. For the remaining three cases, the average gamma pass rates between the doses calculated from intraoperative CT studies and those obtained assuming water-equivalent tissues or from preoperative CT studies were 73.4% and 74.0% respectively. The agreement increased when the air gap was included in the conventional assumption (98.1%) or in the preoperative CT images (98.4%). Therefore, this factor was the one mostly influencing the dose distributions of this study. Our experience has shown that intraoperative CT studies are not recommended when the procedure includes the use of shielding discs or surgical retractors unless metal artefacts are removed. IOERT dose distributions calculated under the conventional assumption or from preoperative CT studies may be inaccurate unless the air gap (which depends on the surface irregularities of the irradiated volume and on the applicator pose) is included in the calculations. This study was supported by Ministerio de Ciencia, Innovacion y Universidades (http://www.ciencia.gob.es) [grant number TEC2013–48251-C2 to JP, VG-V and MJL-C], co-funded by European Regional Development Fund (ERDF), “A way of making Europe” (https://ec.europa.eu/regional_policy/en/funding/erdf); by Ministerio de Ciencia, Innovacion y Universidades (http://www.ciencia.gob.es), Instituto de Salud Carlos III (https://www.isciii.es) [grant numbers DTS14/00192 to JP, VG-V and FAC; PI15/02121 to FAC and JC-H; PI18/01625 to JP], co-funded by European Regional Development Fund (ERDF), “A way of making Europe” (https://ec.europa.eu/regional_policy/en/funding/erdf); and by Comunidad de Madrid (http://www.comunidad.madrid) [grant number TOPUS-CM S2013/ MIT3024 to JP], co-funded by European Structural and Investment Fund (https://ec.europa.eu/info/funding-tenders/funding-opportunities/fundingprogrammes/overview-funding-programmes_en). The CNIC is supported by the Ministerio de Ciencia, Innovacion y Universidades (http://www.ciencia.gob.es) and the Pro CNIC Foundation (https://www.fundacionprocnic.es) [to MD], and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Sí
- Published
- 2020
48. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in unresected pancreatic cancer
- Author
-
Felipe A. Calvo, José Manuel Asencio, Frank W. Hensley, Falk Roeder, Philip Poortmans, Javier Serrano, Robert Krempien, and Marco Krengli
- Subjects
medicine.medical_specialty ,Neoplasm, Residual ,Intraoperative radiotherapy ,medicine.medical_treatment ,IORT ,Context (language use) ,Systemic therapy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Unresected ,Pancreatic cancer ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radical surgery ,Radiation Injuries ,Intraoperative radiation therapy ,business.industry ,Cancer ,Reproducibility of Results ,Hematology ,medicine.disease ,Combined Modality Therapy ,IOERT ,Radiation therapy ,Pancreatic Neoplasms ,Oncology ,030220 oncology & carcinogenesis ,Locally advanced ,Unresected disease ,Radiology ,Neoplasm Recurrence, Local ,business - Abstract
Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise sub-component of RT that can intensify the irradiation effect for cancer involving an anatomically well-defined volume, generally delivered with electrons (IOERT). Unresectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Long-term survivors were observed among unresected patients treated with external beam RT and an IOERT boost (OS 6% at 3 years; 3% >5 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted asset in the clinical scenario (maturity and reproducibility of results, albeit of low official level of evidence) and extremely accurate in terms of dose-deposit characteristics and normal tissue sparing. It is a technique that can be integrated with systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend the use of IOERT in cases of close surgical margins and residual disease. We report the ESTRO/ACROP recommendations for performing IOERT in unresected pancreatic cancer.
- Published
- 2020
49. Postoperative Radiation Therapy in Patients with Extracranial Chondrosarcoma: A Joint Study of the French Sarcoma Group and Rare Cancer Network
- Author
-
Ange Mampuya, Julia Salleron, Cécile Le Péchoux, Marco Krengli, Thomas Zilli, Paul Sargos, Sébastien Salas, Mahmut Ozsahin, Marie Pierre Sunyach, Florian Baumard, Myroslav Lutsyk, Berardino De Bari, Guillaume Vogin, Juliette Thariat, Justine Attal, Anne Gomez-Brouchet, Vardouhie Karahissarlian, M. Terlizzi, Goulven Rochcongar, Felipe A. Calvo, C. Solé, Delphine Lerouge, Céline Bazille, Etienne Rapeaud, Vincent Roth, Laboratoire de physique corpusculaire de Caen (LPCC), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), and Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Chondrosarcoma ,Bone Neoplasms ,mesenchymal ,bone ,survival ,ddc:616.0757 ,030218 nuclear medicine & medical imaging ,surgery ,03 medical and health sciences ,0302 clinical medicine ,Port (medical) ,adjuvant ,medicine ,postoperative ,Humans ,Radiology, Nuclear Medicine and imaging ,Postoperative Period ,radiotherapy ,Retrospective Studies ,[PHYS]Physics [physics] ,Radiation ,business.industry ,chondrosarcoma ,myxoid ,radioresistance ,soft tissue ,Standard treatment ,Incidence (epidemiology) ,Hazard ratio ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Confidence interval ,3. Good health ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Female ,Radiology ,Sarcoma ,France ,business - Abstract
International audience; PurposePostoperative radiation therapy (poRT) of intracranial/skull base chondrosarcomas (CHSs) is standard treatment. However, consensus is lacking for poRT in extracranial CHS (eCHS) owing to their easier resectability and intrinsic radioresistance. We assessed the practice and efficacy of poRT in eCHS.Methods and MaterialsThis multicentric retrospective study of the French Sarcoma Group/Rare Cancer Network included patients with eCHS who were operated on between 1985 and 2015. Inverse propensity score weighting (IPTW) was used to minimize poRT allocation biases.ResultsOf 182 patients, 60.4% had bone and 39.6% had soft-tissue eCHS. eCHS were of conventional (31.9%), myxoid (28.6%; 41 extraskeletal, 11 skeletal), mesenchymal (9.9%), or other subtypes. En-bloc surgery with complete resection was performed in 52.6% and poRT in 36.8% of patients (median dose, 54 Gy). Irradiated patients had unfavorable initial characteristics, with higher grade and incomplete resection. Median follow-up time was 61 months. Five-year incidence of local relapse was 10% with poRT versus 21.6% without (P = .050). Using the IPTW method, poRT reduced the local relapse risk (hazard ratio, 0.27; 95% confidence interval, 0.14-0.52; P < .001). Five-year disease-free survival (DFS) was 71.8% with poRT and 64.2% without (P = .680). Using the IPTW method, poRT improved DFS (hazard ratio, 0.51; 95% confidence interval, 0.30-0.85; P = .010). The benefit of poRT on local relapse and DFS was confirmed after exclusion of the extraskeletal subtype. There was no difference in overall survival. Prognostic factors of poorer DFS in multivariate analysis were deeper location, higher grade, incomplete resection, and no poRT.ConclusionspoRT should be offered in patients with eCHS and high-grade or incomplete resection, regardless of the histologic subtype.
- Published
- 2020
50. Association of visual and quantitative heterogeneity of 18F-FDG PET images with treatment response in locally advanced rectal cancer: A feasibility study
- Author
-
M. Elena Martino, Felipe A. Calvo, Arrate Muñoz-Barrutia, Paula Martin-Gonzalez, Manuel Desco, Javier Pascau, Estibaliz Gomez de Mariscal, Isabel Peligros, José Luis Carreras, Pedro M. Gordaliza, Ministerio de Economía y Competitividad (España), Instituto de Salud Carlos III - ISCIII, European Regional Development Fund (ERDF/FEDER), Fundación BBVA, Ministerio de Educación, Cultura y Deporte (España), Ministerio de Economía, Industria y Competitividad (España), Fundación ProCNIC, Instituto de Salud Carlos III, Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), and European Commission
- Subjects
Metabolic Processes ,Male ,Multivariate statistics ,Colorectal cancer ,medicine.medical_treatment ,Cancer Treatment ,Logistic regression ,Biochemistry ,Diagnostic Radiology ,Breast Tumors ,Medicine and Health Sciences ,Medicine ,Tomography ,Neoadjuvant therapy ,Tumor Regression Grade ,Multidisciplinary ,medicine.diagnostic_test ,Radiology and Imaging ,Middle Aged ,Neoadjuvant Therapy ,Treatment Outcome ,Oncology ,Positron emission tomography ,Female ,Radiology ,Glycolysis ,Research Article ,medicine.medical_specialty ,Imaging Techniques ,Science ,Neuroimaging ,Research and Analysis Methods ,Rectal Cancer ,Malignant Tumors ,Breast cancer ,Diagnostic Medicine ,Fluorodeoxyglucose F18 ,Gastrointestinal Tumors ,Breast Cancer ,Humans ,Clinical significance ,Immunohistochemistry Techniques ,Aged ,Radiotherapy ,business.industry ,Rectal Neoplasms ,Cancers and Neoplasms ,Biology and Life Sciences ,medicine.disease ,Histochemistry and Cytochemistry Techniques ,Metabolism ,Positron-Emission Tomography ,Immunologic Techniques ,Feasibility Studies ,business ,Positron Emission Tomography ,Neuroscience - Abstract
Background and purposeFew tools are available to predict tumor response to treatment. This retrospective study assesses visual and automatic heterogeneity from 18F-FDG PET images as predictors of response in locally advanced rectal cancer.MethodsThis study included 37 LARC patients who underwent an 18F-FDG PET before their neoadjuvant therapy. One expert segmented the tumor from the PET images. Blinded to the patient¿s outcome, two experts established by consensus a visual score for tumor heterogeneity. Metabolic and texture parameters were extracted from the tumor area. Multivariate binary logistic regression with cross-validation was used to estimate the clinical relevance of these features. Area under the ROC Curve (AUC) of each model was evaluated. Histopathological tumor regression grade was the ground-truth.ResultsStandard metabolic parameters could discriminate 50.1% of responders (AUC = 0.685). Visual heterogeneity classification showed correct assessment of the response in 75.4% of the sample (AUC = 0.759). Automatic quantitative evaluation of heterogeneity achieved a similar predictive capacity (73.1%, AUC = 0.815).ConclusionA response prediction model in LARC based on tumor heterogeneity (assessed either visually or with automatic texture measurement) shows that texture features may complement the information provided by the metabolic parameters and increase prediction accuracy. This work was partially supported by the Spanish Ministry of Economy and Competitiveness (TEC2016–78052-R, PID2019-109820RB-I00) (to AMB) and TEC2013-48251-C2 (to JP), Instituto de Salud Carlos III and European Regional Development Fund (FEDER) Funds from the European Commission, “A way of making Europe” (PI15/02121) and a Leonardo grant to Researchers and Cultural Creators 2017, BBVA Foundation (to AMB). PMG is supported by ‘Beca de Colaboración’ of the Spanish Ministry of Education, Culture and Sports. The CNIC is supported by the Ministry of Economy, Industry and Competitiveness (MEIC) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.