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Background: For the management of locally advanced rectal cancer (LARC), initial treatment with neoadjuvant chemoradiotherapy followed by surgery and chemotherapy in selected patients is considered one of the recommended options by the main international clinical guidelines. Nonetheless, the administration of all chemotherapy before definitive treatment (total neoadjuvant therapy [TNT]) is an optimal alternative with a growing level of evidence that must be evaluated in multidisciplinary boards. This review summarizes the available data and controversies in this scenario. Summary: We have analyzed the characteristics of the main published studies that assess the use of TNT in patients with LARC, evaluating their inclusion criteria and distinguishing between the employed radiotherapy fractionations, systemic agents, timing, and the implications of these treatments with regard to surgery and long-term oncological results. Our aim was to describe the evidence that supports the use of a specific regime in everyday clinical practice. Key Points: There is solid evidence for the use of TNT in patients with LARC. There are no data indicating the superiority of one specific TNT scheme among all the existing options. International clinical guidelines leave the door open to choose the most adequate treatment based on the clinical and pathological characteristics of each patient. This review shows the different approaches to TNT and assesses the best options based on clinical evidence. [ABSTRACT FROM AUTHOR]

Spinal metastasis may occur in 40–70% of patients with cancer. Symptoms can vary from pain to spinal cord compression (SCC) and can affect their quality of life (QoL). Stereotactic body radiotherapy (SBRT) allows dose escalation of spinal tumor metastases, minimizing doses to organs at risk and improving pain control. The aim of this study is to retrospectively describe our institution's experience with robotic SBRT (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA) for spinal metastases, in terms of feasibility, oncological results, toxicities, and pain relief observed. In total, 25 patients with 43 lesions were assessed, most of them with dorsal metastases (48.8%). The median total dose was 27 Gy (16–35 Gy), the median number of fractions administered was 3 (1–5), and the median dose per fraction was 9 Gy. Pain was evaluated using the visual analogue scale at baseline and at the end of treatment. The statistically significant reduction in pain (p < 0.01) was associated with the total dose of radiotherapy delivered (p < 0.01). Only one patient developed grade 3 dermatitis. Female gender, adenocarcinoma tumors, and lack of previous surgery were associated with better response to SBRT (p < 0.05). Robotic spine SBRT is feasible, well-tolerated, and improves patients' QoL through a statistically significant reduction in pain, so it should be offered to patients at an early stage in their process. [ABSTRACT FROM AUTHOR]

Introduction: Stereotactic Body Radiotherapy (SBRT) has become a technique increasingly used for the treatment of spine metastases versus conventional radiotherapy. The objective of this technique is to improve local control, relieve symptoms quickly, restore neurological status, prevent spine instability and the reirradiation. Objective: To evaluate our clinical outcomes in selected spine metastases patients (KPS >70% and three vertebral locations but no more than two consecutive lesions) treated with LINAC SBRT plus Image Guided Radiotherapy (IGRT) (Elekta Synergy ®). Patients and Methods: In ONCOSUR-Granada-Cordoba, between August 2010 and April 2016, we have treated 15 patients (8 women and 7 men) with 24 locations (1-3 metastases) and a mean age of 64 years (42-82). The protocol includes a 2-mm CT with oral contrast to the esophagus and MR study of 2 mm. The bone has been outlined in T2 (6 mm above and below the afected vertebral body). Volumes have been identified following the criteria of the International Spine Radiosurgery Consortium (ISRC). We have evaluated the clinical and therapeutic data. Results: Primary tumors were: breast (4), lung (2), kidney (2), colon (2), sarcoma (2), prostate (2), and unknown primary (1). Radiation therapy techniques used were: 22 locations with Volumetric Modulated Arc Therapy (VMAT); 2 Intensity Modulated Radiation Therapy Step-and-Shoot (IMRT SS). The hypofractionated schemes used were: 9 Gy x 3 fractions (15 locations), 8 Gy x 3 fractions (2); 6 Gy x 5 fractions (2), 5 Gy x 8 fractions (1) and 6 Gy x 4 fractions (2). All patients received sessions on alternate days. No acute side effects (mielitis or spine fractures) were detected. With a median follow-up of 11 months (4-28). Two patients are still under treatment. Nine patients are alive (60%), 4 with over 1 year survival and two of them free of disease. Conclusions: The spine SBRT is effective for local control and a safe and comfortable treatment of spine metastases. SBRT must be promoted for selected patients with oligometastatic disease, tumors resistant to the standard fractionations and higher probability of survival at one year (breast and prostate). [ABSTRACT FROM AUTHOR]

Introduction: Frameless radiosurgery has become a technique increasingly used for the treatment of brain metastases. A non-invasive system mask with Image Guided Radiation Therapy (IGRT) is a very attractive and comfortable alternative (Elekta ® system). Objective: We evaluate our clinical results in brain metastases treated with frameless radiosurgery plus IGRT. Patients and Methods: In ONCOSUR-Granada, between August 2010 and April 2016, we have treated 40 patients (50% male) with 131 brain metastases (1-11) and a mean age of 58.68 years (33-83). We have performed a total of 62 treatments. Our PTV margin was 2-3 mm. We have evaluated the clinical and therapeutic data. Results: Primary tumors were 17 lung, 10 breast, 5 melanomas, 2 kidneys, 1 cervix, 1 esophagus, 1 rectum, 1 ovary, 1 unknown primary, and 1 bladder. Only 16 patients were also treated with whole brain radiotherapy (WBRT). Radiation therapy techniques used were: 41 Volume Modulated Arc Therapy (VMAT); 21 Intensity Modulated Radiation Therapy Step-and-Shoot (IMRT SS). The hypofractionation schemes used were: 6 x 6 Gy fractions (8 cases) and 10 Gy x 3 fractions (16 cases). All patients received 2-3 weekly fractions. In the literature the positioning accuracy was between 1 to 4 mm for frameless stereotactic systems. In our series, the variation in repositioning with IGRT was: X = 0.24 mm (0.01- 0.65); Y = 0.23 mm (0.06-0.66); and Z = 0.23 mm (0.01-0.45). No severe side effects were detected. With a mean follow-up of 11.1 months (1-102), 7 patients are alive, 32 died (19 of them without WBRT). Our local control was 60% (treated patients have an average of 3.3 lesions). The causes of death were: brain progression in 16 patients; lung progression in 8 patients; liver progression in 2 patients; unknown reason in 4 patients and general deterioration in 3 patients. Conclusions: Frameless radiosurgery is effective for local control and a comfortable treatment in the treatment of brain metastases. The noninvasive mask system plus IGRT is associated with a highly accurate repositioning. [ABSTRACT FROM AUTHOR]

Background: The current treatment for head and neck cancer involves radiotherapy, systemic therapy and surgery in a multidisciplinary approach. Unfortunately, cancer therapies can lead to local and systemic complications or side effects such as mucositis, which is the most common dose-dependent complication in the oral cavity and gastrointestinal tract. Mucositis can cause a considerably reduced quality of life in cancer patients already suffering from physical and psychological exhaustion. Moreover, radiotherapy interruptions due to toxicity can impact negatively in local control and survival. The main purpose of this study was to analyze patient satisfaction of Ectoin solution use in radiotherapy or radiochemotherapy-induced oral mucositis., Material and Methods: This is an institutional prospective analysis including 15 patients, conducted by two Spanish centers, between October 2019 and May 2020. Patients were treated with Ectoin solution during Radiotherapy and one month after the end of the treatment, three times per day. A seven-ítem Likert scale was used. We present our descriptive statistic regarding doctors and patients´s satisfaction., Results: Our results suggest that Ectoin solution relieves mucositis and is well tolerated by patients., Conclusions: We observed a favorable repercussion in the oral mucositis management and suggest a potential benefit of treating it. Key words: Radiotherapy, oral mucositis, head and neck cancer, ectoine, oral care., Competing Interests: Conflicts of interest None declared., (Copyright: © 2022 Medicina Oral S.L.)

Aim: To evaluate the influence of (11)C-choline PET/CT on radiotherapy planning in prostate cancer patients., Background: Precise information on the extension of prostate cancer is crucial for the choice of an appropriate therapeutic strategy. (11)C-choline positron emission tomography ((11)C-choline PET/CT) has two roles in radiation oncology (RT): (1) patient selection for treatment and (2) target volume selection and delineation. In conjunction with high-accuracy techniques, it might offer an opportunity of dose escalation and better tumour control while sparing healthy tissues., Materials and Methods: We carried out a retrospective study in order to analyse RT planning modification based on (11)C-choline PET/CT in 16 prostate cancer patients. Patients were treated with hypofractionated step-and-shoot Intensity Modulated Radiotherapy (IMRT), or Volumetric Modulated Arc Therapy (VMAT), and a daily cone-beam CT for Image Guided Radiation Therapy (IGRT). All patients underwent a (11)C-choline-PET/CT scan prior to radiotherapy., Results: In 37.5% of cases, a re-delineation and new dose prescription occurred. Data show good preliminary clinical results in terms of biochemical control and toxicity. No gastrointestinal (GI)/genitourinary (GU) grade III toxicities were observed after a median follow-up of 9.5 months., Conclusions: In our experience, concerning the treatment of prostate cancer (PCa), (11)C-choline PET/CT may be helpful in radiotherapy planning, either for dose escalation or exclusion of selected sites.

Purpose: The purpose of this study was to determine whether the distribution of sensitivities in breast cancer patients, measured using a DNA damage assay on lymphocytes, is likely to provide sufficient discrimination to enable the reliable identification of patients with abnormal sensitivities., Material and Methods: Radiosensitivity (x) was assessed in 226 samples of lymphocytes from unselected women with breast cancer and was quantified as the initial number of DNA double-strand breaks (dsb) induced per Gy and per DNA unit (200 Mbp)., Results: The existence of an inter-individual variation in the parameter (x) is described through the range (0.40-4.72 dsb/Gy/DNA unit) of values found, which have been fitted to the mathematical model defined by the log-normal distribution (mu = 0.42+/-0.03; sigma = 0.52+/-0.03; R(2)=0.9475). A total of 189 patients received radiotherapy after surgical treatment. Among them, we have detected 15 patients who developed severe skin reactions and we have compared their radiosensitivity values with the rest of patients treated., Conclusions: Our results suggest that DNA initial damage measured on lymphocytes offers an approach to predict the acute response of human normal tissues prior to radiotherapy. Values of x higher than 3.20 dsb/Gy/DNA unit theoretically should correspond to the highly radio-sensitive patients. Using the experimental results, we have calculated the strength of the test by means of the area under the receiver operator characteristic curves (A(Z)) to determine whether the radiosensitivity assay can discriminate between patients according to their radiation response. The value found (A(Z)=0.675+/-0.072) is indicative of a fair-poor discriminating capacity of the test to identify the patients with higher risk of developing a severe acute reaction during the radiotherapy treatment.