Browsing by Subject "VMAT"

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    Arco terapia volumétrica modulada para el abordaje de metástasis cerebrales : aspectos radio-oncológicos y manejo terapéutico de la epilepsia en el paciente neuro-oncológico
    (Universidad de Murcia, 2023-11-23) Sánchez Villalobos, José Manuel; Alcaraz Baños, Miguel; Serna Berná, Alfredo; Martínez Alonso, Emma; Escuela Internacional de Doctorado
    Introducción: en la actualidad, las MCs representan el tumor intracraneal más frecuente, y se presentan en aproximadamente el 20-40% de los pacientes con cáncer. La mejora de las técnicas de diagnóstico por imagen y la mayor eficacia de los regímenes de tratamiento han contribuido al aumento en la incidencia de las MCs, por lo que el abordaje terapéutico de las mismas representa en un nuevo desafío. La radioterapia holocraneal y la radiocirugía estereotáxica son dos modalidades de tratamiento utilizadas habitualmente para el tratamiento de las MCs. La técnica de radiocirugía consiste en la administración de una dosis de radiación concentrada en la lesión, con un elevado gradiente de dosis en la zona circundante con la finalidad de minimizar los efectos secundarios en el tejido cerebral sano así como un menor impacto neurocognitivo. Objetivo: esta memoria de tesis a modo de compendio de publicaciones pretende analizar la respuesta al tratamiento radioquirúrgico en una población de pacientes con MCs, y el manejo terapéutico de la epilepsia relacionada con los tumores cerebrales. Material y métodos: Se trata de un estudio de diseño observacional transversal con revisión retrospectiva de historias clínicas de pacientes con metástasis cerebrales tratados con VMAT-RS. Se analizaron los datos clínicos y demográficos, con especial atención al tumor primario, la epilepsia relacionada con tumores cerebrales (BTRE), la comorbilidad psiquiátrica, el tipo de crisis epilépticas, los fármacos antiepilépticos (FAEs) utilizados, el número y la localización cerebral de las MCs, el índice de Karnofsky (KPS), el índice pronóstico DS-GPA actualizado y la supervivencia estimada según el modelo de Kaplan-Meier desde la fecha de la radiocirugía. Resultados: Las publicaciones que conforman la unidad temática presentada en esta Tesis Doctoral defendida en la modalidad por compendio de publicaciones son las siguientes: 1º. Sánchez-Villalobos JM, Serna-Berna A, Salinas-Ramos J, Escolar-Pérez PP, Martínez-Alonso E, Achel DG, Alcaraz M. Volumetric modulated arc radiosurgery for brain metastases from breast cancer: A single-center study. Colomb Méd (Cali), 2021; 52(3):e2004567. 2º. Sánchez-Villalobos JM, Aledo-Serrano Á, Serna-Berna A, Salinas-Ramos J, Martínez-Alonso E, Pérez-Vicente JA, Alcaraz-Baños M. Antiseizure medication for brain metastasis-related epilepsy: Findings of optimal choice from a retrospective cohort. Epilepsy Res. 2021 Dec;178:106812. 3º. Sánchez-Villalobos JM, Aledo-Serrano Á, Villegas-Martínez I, Shaikh MF, Alcaraz M. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Front Pharmacol. 2022; 13:991244. 4º. Sánchez-Villalobos, JM, Serna-Berna, A, Salinas-Ramos, J, Escolar-Pérez, PP, Andreu-Gálvez, M, Martínez-Alonso, E, Pérez-Vicente, JA, Alcaraz M. Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study. Appl. Sci. 2023; 13(18):10097. Conclusión: La VMAT-RS es una técnica con una supervivencia global comparable a otras técnicas de radiocirugía. La situación basal en el momento del tratamiento, el DS-GPA y los subtipos moleculares del cáncer de mama, son factores que influyen significativamente en la supervivencia de los pacientes. En cuanto al tratamiento farmacológico en pacientes con BTRE, el levetiracetam es el FAE más utilizado en pacientes con BTRE tratados con VMAT-RS. Sin embargo, la presencia de comorbilidades psiquiátricas, comunes en esta población, podrían cambiar la toma de decisiones sobre la elección del FAE. Por último, el tratamiento antiepiléptico debe personalizarse en función de las características del paciente, especialmente en algunas situaciones especiales como pacientes con comorbilidad psiquiátrica, pacientes de edad avanzada y mujeres con deseos genésicos o en situación de embarazo.
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    Safety and effectiveness of volumetric modulated arc therapy-based stereotactic radiosurgery for posterior fossa brain metastases: a single-centre experience
    (MDPI, 2025-12-02) Sánchez-Villalobos, José Manuel ; Serna-Berna, Alfredo ; Salinas-Ramos, Juan ; Escolar-Pérez, Pedro Pablo ; Luengo-Gil, Ginés ; Andreu-Gálvez, Marina ; Martínez Alonso, Emma; Alcaraz Baños, Miguel; Biología Celular e Histología; Facultad de Medicina
    Background/Objectives: Posterior fossa brain metastases (PFBMs) pose particular risks owing to their proximity to the brainstem and fourth ventricle. We evaluated the safety (treatment-related complications), local effectiveness, and procedural efficiency of volumetric modulated arc therapy (VMAT)-based stereotactic radiosurgery (VMAT-SRS) for PFBMs. Methods: This single-centre, retrospective study derived a PFBM subgroup from an overall institutional cohort of 123 patients treated with VMAT-RapidArc SRS/fSRS. The doses were 12–20 Gy (single fraction) or 5 × 6 Gy (selected cases). Local response (mRECIST) and predefined safety endpoints (symptomatic oedema with brainstem/IV-ventricle compromise, obstructive hydrocephalus, haemorrhagic transformation, CSF diversion, and urgent neurosurgery) were assessed. Overall survival and procedural time were analysed. Results: Thirty-one patients (39 lesions) were included; 76.9% of them received single-fraction SRS. In addition, 74.2% of patients had supratentorial metastases with posterior fossa involvement. Kaplan–Meier overall survival at 6, 12, 24, and 48 months was 74%, 58%, 26%, and 9.7%, respectively; the median survival time was 12.6 months. Among evaluable lesions, local control was 84.5% (per-lesion response: 15.5% PD, 28.1% SD, 34.4% PR, and 22.0% CR). No clinically significant posterior fossa local complications were observed. Three patients developed radiation-induced leukoencephalopathy after whole-brain radiotherapy (WBRT) and radiosurgery for synchronous supratentorial metastases. The median procedural time was 25.0 min (IQR 9.0) with one isocentre versus 52.5 min (IQR 9.75) with two. Conclusions: VMAT-SRS/fSRS for PFBMs achieved high local control, very low posterior fossa toxicity, and favourable procedural efficiency, supporting its use as a safe, rapid, frameless alternative to WBRT and other radiosurgical platforms such as Gamma Knife in appropriately selected patients.
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    Volumetric modulated arc therapy for radiosurgery of brain metastases: a single-center study
    (MDPI, 2023-09-07) Sánchez-Villalobos, José Manuel; Serna-Berna, Alfredo; Salinas-Ramos, Juan; Escolar-Pérez, Pedro Pablo; Andreu-Gálvez, Marina; Martínez Alonso, Emma; Pérez-Vicente, José Antonio; Alcaraz Baños, Miguel; Biología Celular e Histología; Facultad de Medicina
    Whole-brain radiation therapy and stereotactic radiosurgery are two treatment modalities commonly utilized to treat brain metastases (BMs). The aim of this study is to retrospectively analyze the main radio-oncologic and clinical-demographic aspects of a cohort of BM patients treated with Volumetric Modulated Arc Therapy for radiosurgery (VMAT-RS). This is a cross-sectional observational design study with a retrospective review of the medical records of patients with brain metastases treated with VMAT-RS between 2012 and 2018. Clinical and demographic data, with special attention to sex, age, primary tumor, brain tumor-related epilepsy (BTRE), number and brain location of BMs, Karnofsky Performance Status (KPS), the updated DS-GPA prognostic index, and the survival estimated according to the Kaplan–Meier model from the date of radiosurgery, were analyzed. One hundred and twenty-one patients with 229 BMs were treated with VMAT-RS. Patients presented 1–4 BMs, which were treated with five non-coplanar VMAT arcs. Sixty-eight percent of the patients had lung cancer, and 35% of the BMs were in the frontal lobe. The proportion of local control was 88.5%. BTRE prevalence was 30.6%. The median survival time (MST) was 7.7 months. In the multivariate analysis of the Cox regression model, KPS ≥ 70 (HRKPS < 70 = 2.59; p = 0.001) and higher DS-GPA (HRDS-GPAII = 0.55, p = 0.022; HRDS-GPAIII-IV = 0.38, p = 0.006) were associated with improved survival. In the univariate analysis, primary tumor, age, and the presence of metastases in the posterior fossa (PFBMs) were also significant. In conclusion, the VMAT-RS is a technique with an overall survival rate comparable to other radiosurgery techniques. The median survival is significantly longer for those with higher KPS and DS-GPA. Other variables, such as the type of primary tumor, age, and PFBMs, could also influence survival, although further studies are needed.