Publication: Implementación de radioterapia estereotáxica torácica en un hospital terciario: resultados preliminares
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2018-04-04
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Universidad Complutense de Madrid
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Abstract
La RT estereotáxica extracraneal (SBRT) es el tratamiento de elección para pacientes con carcinoma de pulmón no microcítico (CPNM) en estadios iniciales (T1-2N0M0) inoperables o que rechazan ser intervenidos, y es una alternativa a la cirugía para pacientes de alto riesgo quirúrgico. Mediante SBRT torácica se administran altas dosis de radiación en muy pocas fracciones, sobre un volumen pulmonar relativamente pequeño. La pérdida de exactitud en su administración provoca drásticos cambios en la posibilidad de cura y toxicidad. Exige por tanto una cuidadosa planificación y administración del tratamiento, teniendo en cuenta el movimiento respiratorio. Su alta eficacia y baja toxicidad ha motivado que su implementación crezca de forma exponencial. 2 OBJETIVO Implementar la SBRT torácica en el Hospital Clínico San Carlos de Madrid (HCSC) para el tratamiento de pacientes con CPNM en estadio inicial, y para nódulos pulmonares sin diagnóstico histológico pero con alta probabilidad de malignidad, sin tumor activo extratorácico. Se describen los protocolos diseñados para su implementación, adaptados a las características del HCSC. Para evaluar la técnica implementada se han analizado los siguientes objetivos secundarios en los primeros 20 tratamientos: precisión en el control del movimiento tumoral, toxicidad aguda y subaguda, impacto del tratamiento en la calidad de vida, y cambios morfo-funcionales en la 18F-FDG PET/TC realizada a las 24-96 horas y a las 8-10 semanas tras finalizar el tratamiento, frente a los parámetros basales en la 18F-FDG PET/TC de planificación...
Stereotactic Body Radiation (SBRT) or Stereotactic Ablative Radiation (SABR) is the primary treatment option for non-small cell lung cancer T1-2N0M0 that is not suitable for surgery or where patients have declined surgical treatment. It is also considered an alternative to surgery for high-risk and elderly patients. SBRT delivers high doses of radiation in a few fractions to a relatively small extracraneal target. This is important as reduction in accuracy during radiation treatment translates into loss of tumor control and / or higher toxicity. Therefore, careful planning and delivery of radiation including tumor movement control is needed. The good results achieved in terms of tumor control and toxicity profile have motivated the quick implementation of lung SBRT over the world. 2 PURPOSE To implement lung SBRT at Hospital Clínico San Carlos (HCSC) for initial stage non-small cell lung cancer and lung nodules with high risk features, without active extra-thoracic disease. SBRT protocols were adapted to HCSC features and are described. In order to evaluate the implemented treatment, the following secondary objectives were analyzed on the first 20 treatments performed: assessment of tumor movement control, short term toxicity, impact of lung SBRT on quality of life, and changes in size, SUVmax and MTV on 18F-FDG PET/CT at 24-96 hours and at 8-10 weeks after finishing lung SBRT compared to planning 18F-FDG PET/CT...
Stereotactic Body Radiation (SBRT) or Stereotactic Ablative Radiation (SABR) is the primary treatment option for non-small cell lung cancer T1-2N0M0 that is not suitable for surgery or where patients have declined surgical treatment. It is also considered an alternative to surgery for high-risk and elderly patients. SBRT delivers high doses of radiation in a few fractions to a relatively small extracraneal target. This is important as reduction in accuracy during radiation treatment translates into loss of tumor control and / or higher toxicity. Therefore, careful planning and delivery of radiation including tumor movement control is needed. The good results achieved in terms of tumor control and toxicity profile have motivated the quick implementation of lung SBRT over the world. 2 PURPOSE To implement lung SBRT at Hospital Clínico San Carlos (HCSC) for initial stage non-small cell lung cancer and lung nodules with high risk features, without active extra-thoracic disease. SBRT protocols were adapted to HCSC features and are described. In order to evaluate the implemented treatment, the following secondary objectives were analyzed on the first 20 treatments performed: assessment of tumor movement control, short term toxicity, impact of lung SBRT on quality of life, and changes in size, SUVmax and MTV on 18F-FDG PET/CT at 24-96 hours and at 8-10 weeks after finishing lung SBRT compared to planning 18F-FDG PET/CT...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Radiología y Medicina Física, leída el 06-06-2017