Meiriño, R. (Rosa)
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- Valor clínico de la tomografía de emisión de positrones con F-18-FDG en el seguimiento de pacientes con cáncer de ovario(Gobierno de Navarra. Departamento de Salud, 2002) Boan, J. (J.); Lopez-Garcia, G. (Guillermo); Meiriño, R. (Rosa); Richter, J.A. (José Ángel); Garcia-Velloso, M. J. (María José); Galan, M.J. (M. J.); Marti, J.M. (J.M.)Background. Positron emission tomography with fluor- 18-deoxyglucose (PET-FDG) is an efficient technique for the detection of tumoural tissue. The aim of the paper is to evaluate the PET-FDG in the diagnosis of residual disease or relapse in patients with cancer of the ovary. Methods. A total of 24 patients, diagnosed and treated for cancer of the ovary with surgery and subsequent chemotherapy, were included. With 12 patients the study was carried out prior to second-look surgery, and with the other 12 after objectivising an increase of the tumoural marker in the follow up. Abdominal-pelvic CAT, determination of the seric levels of CA-125 and PET-FDG of thorax, abdomen and pelvis were carried out on all patients. The PET-FDG was evaluated in a qualitative way through the visual study of the images, and quantitatively through the SUV or standard uptake value. The definitive diagnosis was confirmed through an anatomopathological study in 13 cases and through clinical follow up in the rest with an average of 11.2±5.4 months (range 6-24). Results. A CA-125 value higher than 35 UI/ml was considered positive, obtaining a sensitivity of 77% and a specificity of 100%. The sensitivity of the CAT was 23% and the specificity 91%. With the FDG-PET sensitivity was 92% and the specificity 90%. A SUV value ≥ 3 was considered pathological, obtaining the same results as with the visual evaluation. The FDG-PET was positive in 5 patients with non-conclusive CAT, 4 with negative CAT and 2 with negative CA-125. Conclusion. These preliminary results suggest that the FDG-PET could be useful in the follow up of patients treated for cancer of the ovary. The FDG-PET could be efficient in the differentiation between residual disease or recurrence, as opposed to sequels to the treatment, when the CAT is not conclusive due to anatomical distortion. The FDG-PET could be more sensitive than an increased marker value, and facing an increase of the latter it permits a non-invasive localisation of the disease.
- Inoculum at the time of SARS-CoV-2 exposure and risk of disease severity(2020) Guallara, M.P. (María Pilar); Corral, O. (Octavio); Meiriño, R. (Rosa); Soriano, V. (Vincente); Jouvé, N. (Nicolás); Donat-Vargas, C.L. (Carolina Luisa)A relationship between the infecting dose and the risk of disease severity has not been demonstrated for SARS-CoV-2 infection. Here, we report three clusters of individuals that were potentially exposed to distinctinoculum in Madrid. Overall each group developed divergent clinical forms of COVID-19. Our data support that a greater viral inoculum at the time of SARS-CoV-2 exposure might determine a higher risk of severe COVID-19.
- Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution(Springer, 2023) Aguilar, B. (Borja); Suarez, V. (Victor); Cabello, P. (Pablo); Sancho, L. (Lidia); Pedrero, D. (Diego); Aristu-Mendioroz, J.J. (José Javier); Lassaletta, Á. (Álvaro); Fernández-de-Miguel, J.M. (José María); Álvarez-de-Sierra, B. (Beatriz); Panizo, E. (Elena); Alonso, A. (Alberto); Meiriño, R. (Rosa); Palma, J. (Jacobo); Gallardo-Madueño, G. (Guillermo); Calvo, F.A. (Felipe A.); Moran, V. (Verónica); Cambeiro, M. (Mauricio); Serrano-Andreu, J. (Javier); Azcona-Armendariz, J.D. (Juan Diego); Martin, S. (Santiago); Alcázar, A. (Andrés); Viñals, A. (Alberto); Delgado, J.M. (José Miguel); Gibert, C. (Carlota)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 efcient 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 staf 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 scientifc production was adapted to the pandemic evolution and its infuence 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 benefts of online learning will shape the future of proton therapy education.
- 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(Frontiers, 2022) Aguilar, B. (Borja); Pedrero, D. (Diego); Aristu-Mendioroz, J.J. (José Javier); Ayestaran, A. (Adriana); Alonso, A. (Alberto); Meiriño, R. (Rosa); Palma, J. (Jacobo); Calvo, F.A. (Felipe A.); Lapuente, F. (Fernando); Chiva, L. (Luis); Pascau, J. (Javier); Cambeiro, M. (Mauricio); Morcillo, M.A. (Miguel Ángel); Prezado, Y. (Yolanda); Serrano-Andreu, J. (Javier); Delgado, J.M. (José Miguel); Azcona-Armendariz, J.D. (Juan Diego)Background: Oligo-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. Methods: Patient 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. Results: In 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). Conclusions: Individual 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.