Beorlegui, C. (Carmen)
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- Is a Technetium-99m Macroaggregated Albumin Scan Essential in the Workup for Selective Internal Radiation Therapy with Yttrium-90? An Analysis of 532 Patients(Elsevier, 2017) Sancho, L. (Lidia); Sangro, B. (Bruno); Iñarrairaegui, M. (Mercedes); Moran, V. (Verónica); Bilbao, J.I. (José I.); Rodriguez-Fraile, M. (Macarena); Beorlegui, C. (Carmen)Purpose: To determine if baseline patient, tumor, and pretreatment evaluation characteristics could help identify patients who require technetium-99m (99mTc) macroaggregated albumin (99mTc MAA) imaging before selective internal radiation therapy (SIRT). Materials and methods: In this retrospective analysis, 532 consecutive patients with primary (n = 248) or metastatic (n = 284) liver tumors were evaluated between 2006 and 2015. Variables were compared between patients in whom 99mTc MAA imaging results contraindicated/modified SIRT administration with yttrium-90 (90Y) resin microspheres and those who were treated as initially planned. The 99mTc MAA findings that contraindicated/modified SIRT were a lung shunt fraction (LSF) > 20%, gastrointestinal 99mTc MAA uptake, or a mismatch between 99mTc MAA uptake and intrahepatic tumor distribution. Results: LSF > 20% and gastrointestinal MAA uptake were observed in 7.5% and 3.9% of patients, respectively, and 11% presented a mismatch. Presence of a single lesion (odds ratio [OR] = 2.4) and vascular invasion (OR = 5.5) predicted LSF > 20%, and GI MAA uptake was predicted by the presence of liver metastases (OR = 3.7) and 99mTc MAA injection through the common/proper hepatic artery (OR = 4.7). Vascular invasion (OR = 4.1) was the only predictor of LSF > 20% and/or GI MAA uptake (sensitivity = 49.2%, specificity = 80.3%, negative predictive value = 92.4%). Previous antiangiogenic treatment (OR = 2.4) and presence of a single lesion (OR = 2.6) predicted mismatch. Conclusions: Imaging with 99mTc MAA is essential in SIRT workup because baseline characteristics may not adequately predict 99mTc MAA results. Nevertheless, the absence of vascular invasion potentially identifies a group of patients at low risk of SIRT contraindication/modification in whom performing SIRT in a single session (ie, pretreatment evaluation and SIRT on the same day) should be explored.
- Impact of Perineural and Lymphovascular Invasion on Oncological Outcomes in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy and Surgery(2015) Pastor, C. (Carlos); Rotellar, F. (Fernando); Baixauli-Fons, J. (Jorge); Arbea, L. (Luis); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Arredondo, J. (Jorge); Beorlegui, C. (Carmen); Sola, J.J. (Jesús Javier)Background The prognostic significance of perineural and/or lymphovascular invasion (PLVI) and its relationship with tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT) and surgery. Methods A total of 324 patients with LARC were treated with CRT and operated on between January 1992 and June 2007. Tumors were graded using a quantitative 5-grade TRG classification and the presence of PLVI was histologically studied. Results At a median follow-up of 79.0 months (range 3–250 months), a total of 80 patients (24.7 %) relapsed. The observed 5- and 10-year overall survival (OS) was 83.2 and 74.9 %, respectively. The 5- and 10-year disease-free survival (DFS) was 75.1 and 71.4 %, respectively. A significant correlation was found between the TRG and survival (log rank, p < 0.001). The 10-year OS was 32.7 % for grade 1, 63.8 % for grade 2, 75.0 % for grade 3, 90.4 % for grade 3+, and 96.0 %,for grade 4. The 10-year DFS was 31.8 % for grade 1, 58.6 % for grade 2, 70.4 % for grade 3, 88.4 % for grade 3+, and 97.1 % for grade 4. In patients with PLVI, the TRG had no impact on survival. When excluding patients with PLVI, the TRG was an independent prognostic factor for OS and DFS. Conclusions The presence of PLVI is a more powerful prognostic factor than TRG in LARC patients treated with neoadjuvant CRT followed by surgery. PLVI denotes an aggressive phenotype, suggesting that these patients may benefit from adjuvant systemic therapy.
- A study of the variability of the in vitro component-based microarray ISAC CDR 103 technique(ESMON Publicidad, 2011) Goikoetxea-Lapresa, M.J. (María José); Gamboa, P.M. (P. M.); Martinez-Aranguren, R. (R.); Cabrera-Freitag, P. (Paula); Fernandez, J. (Javier); Sanz, M.L. (María Luisa); Beorlegui, C. (Carmen)
- Diagnostic value of quantitative SPECT/CT in assessing active sacroiliitis in patients with axial spondylarthritis and/or inflammatory low back pain(Gobierno de Navarra, 2022) Cuadrado, M.J. (M.J); Prieto, E. (Elena); Bondia, J.M. (J. M.); Ribelles, M.J. (María Jesús); Aquerreta, D. (Dámaso); Richter, J.A. (José Ángel); Ornilla-Laraudogoitia, E.T. (Enrique Tomás); Sancho, L. (Luis); Beorlegui, C. (Carmen)Background. The diagnostic accuracy of bone scintigraphy (BS) increases with SPECT/CT imaging. It would therefore be appropriate to reassess the diagnostic utility of scintigraphy in sacroiliitis with axial spondyloarthritis (SpA). The aim of this study was to compare the diagnostic performance of MRI, SPECT/CT and a combination of both techniques in sacroiliitis, and to evaluate the correlation between quantitative SPECT/CT indices and quantitative MRI inflammatory lesion scores. Methods. Thirty-one patients with active SpA and 22 patients with inflammatory low back pain underwent MRI and SPECT/CT of the sacroiliac joints. The diagnostic accuracy of both techniques was calculated using clinical diagnosis as the gold standard. The correlation between MRI and SPECT/CT was calculated by comparing the SPECT/CT activity indices and the Berlin/SPARCC scoring systems for MRI. Results. The sensitivity and specificity values in quantitative SPECT/CT, taking the sacroiliac/promontory ratio of >1.36 as the cut-off value, were close to those from MRI published in the literature. The combination of both techniques increased sensitivity while maintaining high specificity. There was a moderate correlation between SPECT/CT and MRI total scores. This correlation was improved by using solely the MRI inflammation scores. Conclusion. Quantitative SPECT/CT showed better diagnostic accuracy than planar scintigraphy and showed a moderate correlation with MRI scores in active sacroiliitis. The combination of both tests increased the diagnostic accuracy. Quantitative SPECT/CT could play a relevant role in the diagnosis of active sacroiliitis in patients with high a suspicion of SpA and a negative/inconclusive MRI test or in patients with whom MRI studies cannot be carried out.
- Production of regulatory factors in the respiratory system of vertebrates(Brill Academic Publishers, 1994) Sesma, M.P. (María Pilar); Villaro, A.C. (Ana Cristina); Montuenga-Badia, L.M. (Luis M.); Guembe, L. (L.); Bodegas-Frías, E. (Elena); Beorlegui, C. (Carmen)Among the different cell types present in the respiratory tract of the vertebrates, some (epithelial, endothelial, neural) specialise in the production of regulatory factors. Endocrine cells occur either single, spread throughout the epithelial lining, or in innervated groups, called 'neuroepithelial bodies' (NEBs). In mammals, these endocrine cells may be involved in lung maturation during perinatal life and in chemoreception. A neuroendocrine diffuse system is present in the respiratory organs of all classes of vertebrates. In amphibians and reptiles, single endocrine cells as well as NEBs are located in the apices of the lung septa. The respiratory tract shows nerve fibres immunoreactive to several neuropeptides. Since some neurons and fibres contain NO synthase a broad evolutionary presence of NO-releasing neurons, probably involved in the control of relaxation, is suggested.
- Análisis de la morbilidad postoperatoria en pacientes con adenocarcinoma gástrico tratados según protocolo de quimiorradioterapia preoperatoria y cirugía(Elsevier, 2009-12) Valenti, V. (Víctor); Blasco-Blanco, M. (Manuel); Bueno, A. (Álvaro); Martinez-Regueira, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Hernandez-Lizoain, J.L. (Jose Luis); Gil, A. (Aurora); Marti-Cruchaga, P. (Pablo); Pedano, N. (Nicolás); Beorlegui, C. (Carmen)Introducción El impacto del tratamiento neoadyuvante sobre las complicaciones postoperatorias en el cáncer de estómago es motivo de controversia. El objetivo de este trabajo es analizar la morbilidad y la mortalidad postoperatoria en un grupo de pacientes a los que se les había aplicado un protocolo de quimiorradioterapia preoperatoria, así como identificar posibles factores de riesgo que se asocian al desarrollo de complicaciones. Material y métodos Entre junio de 2005 y junio de 2008, pacientes diagnosticados de adenocarcinoma gástrico localmente avanzado se intervinieron en nuestro Centro tras haber seguido un protocolo de quimiorradioterapia preoperatoria. Se recogieron prospectivamente los datos sobre morbilidad y mortalidad postoperatoria y se analizaron las variables dependientes relacionadas con los pacientes, con el tipo de intervención y las características tumorales. Resultados Se evaluaron 40 pacientes. La morbilidad y la mortalidad global fue del 32,5% (13 pacientes) y del 2,5% (un paciente), respectivamente. Las complicaciones más frecuentes fueron la neumonía en el 12,9% y la sepsis por catéter en el 9,7% de los pacientes. Los factores de riesgo para el desarrollo de complicaciones fueron el índice de masa corporal (>25 kg/m2) y la inclusión en la resección del páncreas o del bazo. Conclusiones El tratamiento preoperatorio con quimiorradioterapia en pacientes con cáncer de estómago localmente avanzado no incrementa la incidencia de complicaciones postoperatorias. La condición preoperatoria del paciente (índice de masa corporal) y la extensión de la cirugía del bazo y del páncreas son factores pronósticos de complicaciones postoperatorias precoces. Abstract Introduction The impact of neoadjuvant treatment on the postoperative complications in stomach cancer is a subject of controversy. The aim of this study is to analyse the post-surgical morbidity and mortality in a group of patients who were treated using a chemoradiotherapy protocol before surgery, as well as to identify the possible risk factors that may be associated with the development of complications. Material and methods Patients diagnosed with locally advanced gastric adenocarcinoma between June 2005 and June 2008 were operated on in our Centre after having followed a preoperative chemoradiotherapy protocol. Data on postoperative morbidity and mortality were collected retrospectively and the dependent variables associated with the patients, the type of intervention and the tumour characteristics were analysed. Results A total of 40 patients were evaluated. The overall morbidity and mortality was 32.5% (13 patients) and 2.5% (1 patient), respectively. The most frequent complications were pneumonia in 12.9% and sepsis due to the catheter in 9.7% of the patients. The risk factors for the development of complications were the body mass index (BMI 25 kg/m2) and the inclusion of the pancreas and/or spleen in the resection. Conclusions Preoperative treatment with chemoradiotherapy in patients with locally advanced stomach cancer does not increase the incidence of post-surgical complication. The preoperative condition of the patient (BMI) and extending the surgery to the spleen and pancreas are prognostic factors of early postoperative complications.
- 3D voxel-based dosimetry to predict contralateral hypertrophy and an adequate future liver remnant after lobar radioembolization(Springer, 2021) Sancho, L. (Lidia); Prieto-Azcárate, E. (Elena); Sangro, B. (Bruno); Iñarrairaegui, M. (Mercedes); Grisanti-Vollbracht, F. (Fabiana); Bastidas, J.F. (Juan Fernando); Bilbao, J.I. (José I.); Rodrigo, P. (Pablo); Rodriguez-Fraile, M. (Macarena); Beorlegui, C. (Carmen)Introduction Volume changes induced by selective internal radiation therapy (SIRT) may increase the possibility of tumor resection in patients with insufficient future liver remnant (FLR). The aim was to identify dosimetric and clinical parameters associated with contralateral hepatic hypertrophy after lobar/extended lobar SIRT with 90Y-resin microspheres. Materials and methods Patients underwent 90Y PET/CT after lobar or extended lobar (right + segment IV) SIRT. 90Y voxel dosimetry was retrospectively performed (PLANET Dose; DOSIsoft SA). Mean absorbed doses to tumoral/non-tumoral-treated volumes (NTL) and dose-volume histograms were extracted. Clinical variables were collected. Patients were stratified by FLR at baseline (T0-FLR): < 30% (would require hypertrophy) and ≥ 30%. Changes in volume of the treated, non-treated liver, and FLR were calculated at < 2 (T1), 2–5 (T2), and 6–12 months (T3) post-SIRT. Univariable and multivariable regression analyses were performed to identify predictors of atrophy, hypertrophy, and increase in FLR. The best cut-off value to predict an increase of FLR to ≥ 40% was defined using ROC analysis. Results Fifty-six patients were studied; most had primary liver tumors (71.4%), 40.4% had cirrhosis, and 39.3% had been previously treated with chemotherapy. FLR in patients with T0-FLR < 30% increased progressively (T0: 25.2%; T1: 32.7%; T2: 38.1%; T3: 44.7%). No dosimetric parameter predicted atrophy. Both NTL-Dmean and NTL-V30 (fraction of NTL exposed to ≥ 30 Gy) were predictive of increase in FLR in patients with T0 FLR < 30%, the latter also in the total cohort of patients. Hypertrophy was not significantly associated with tumor dose or tumor size. When ≥ 49% of NTL received ≥ 30 Gy, FLR increased to ≥ 40% (accuracy: 76.4% in all patients and 80.95% in T0-FLR < 30% patients). Conclusion NTL-Dmean and NTL exposed to ≥ 30 Gy (NTL-V30) were most significantly associated with increase in FLR (particularly among patients with T0-FLR < 30%). When half of NTL received ≥ 30 Gy, FLR increased to ≥ 40%, with higher accuracy among patients with T0-FLR < 30%.
- Carcinomas renales con rasgos sarcomatoides y rabdoides: estudio clínico-patológico de 74 casos(2018) Dolezal, P. (P.); Velis, J.M. (José María); Panizo, A. (Ángel); Pardo-Mindan, F.J. (Francisco Javier); Queipo, F.J. (Francisco Javier); Beorlegui, C. (Carmen); Sola, J.J. (Jesús Javier)Fundamento. Nuestro objetivo fue comparar las variables clínico-patológicas de los carcinomas renales (CCR) con fenotipos sarcomatoide y rabdoide. Material y métodos. Se revisaron 1.258 CCR de pacientes consecutivos nefrectomizados entre 1988 y 2015, y se seleccionaron aquellos con ≥1% de cambio sarcomatoide y/o rabdoide. Se clasificaron como sarcomatoide o rabdoide según el fenotipo predominante, considerándose componente desdiferenciado la suma del porcentaje de ambos. Se recopilaron: sexo y edad de los pacientes, síntomas y existencia de metástasis al diagnóstico, parámetros del protocolo de CCR del Colegio Americano de Patólogos, patrón de crecimiento tumoral, invasión perineural, porcentaje de necrosis tumoral y características del infiltrado inflamatorio. Se describieron mediante la media/mediana o el porcentaje y se compararon mediante t de Student/U de MannWhitney o χ2 /F de Fisher. Resultados. Se identificaron 45 CCR con predominio sarcomatoide (3,6%) y 29 con rabdoide (2,3%); los primeros mostraron mayor componente indiferenciado e invasión perineural respecto a los CCR con rasgos rabdoides (27,5 vs. 13,5%; p=0,003 y 28,9 vs. 3,4%, p=0,006, respectivamente), mientras que estos mostraron doble frecuencia de inflamación neutrofílica (44,8 vs. 22,2%, p=0,04) y surgieron más frecuentemente sobre un CCR de alto grado (55,9 vs. 90,5%, p<0,001). Conclusiones. Los CCR con fenotipos sarcomatoide y rabdoide compartieron características clínico-patológicas, excepto para componente desdiferenciado, invasión perineural, inflamación neutrofílica y origen en CCR de alto grado. Esta similitud sugiere la presencia de un mecanismo común, la transición epitelio-mesénquima, con una expresión morfológica doble que, de confirmarse, podría suponer la posibilidad de seleccionar pacientes para tratamiento o seguimiento a partir de sus características moleculares.
- Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer(Wiley-Blackwell, 2009) Gil-Rendo, A. (A.); Zornoza, G. (Gerardo); Martinez-Regueira, F. (Fernando); Rodriguez-Spiteri, N. (Natalia); Garcia-Velloso, M. J. (María José); Beorlegui, C. (Carmen)Positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) is recognized to be an accurate, non-invasive imaging modality for the diagnosis and staging of many malignancies, including breast cancer. Studies performed on different cancers have shown that hypermetabolic tumours usually have a poorer prognosis than hypometabolic tumours1. Oshida and colleagues2 have reported that a high uptake of FDG in tumour tissue can serve as a risk factor for recurrence in women with breast cancer. There are various prognostic factors related to breast cancer. Some provide important information that can affect management, such as axillary lymph node status, presence of metastases, and oestrogen and progesterone receptor status. Others such as p53 immunoreactivity are relevant clinically, but are still not used routinely for risk stratification. Most factors can be assessed only after surgery1. Preoperative prediction of patient prognosis is becoming more important because an increasing number of women with breast cancer have neoadjuvant chemotherapy with the aim of downstaging their disease, and increasing the feasibility of breast-conserving surgery. It may also be possible to evaluate the chemosensitivity of the breast tumour; FDG–PET seems to be promising for this purpose3. FDG–PET before surgery may provide important information about tumour metabolism and its proliferation rate which could be of prognostic significance. Calculating FDGuptake bymeans of a simple method, the standardized uptake value (SUV), can be done before surgery, andmight be associated with the biological aggressiveness of breast cancer. The aim of this study was to determine the possible correlation between FDG uptake and well established prognostic markers in women with breast cancer.
- Patterns and management of distant failure in locally advanced rectal cancer a cohort study(2016) Baixauli-Fons, J. (Jorge); Arbea-Moreno, L. (Leire); Rodriguez, J. (Javier); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Torre-Buxalleu, W. (Wenceslao); Hernandez-Lizoain, J.L. (Jose Luis); Arredondo, J. (Jorge); Beorlegui, C. (Carmen)Purpose To determine the long-term outcomes of locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation (CRT) and surgery, and to analyze the management and survival once distant failure has developed. Methods Data from LARC patients treated from 2000 to 2010 were retrospectively reviewed. CRT protocols were based on fluoropirimidines ± oxaliplatin. Follow-up consisted of physical examination, carcinoembryonic antigen levels, and chest-abdominal-pelvic CT scan. Results The study included 228 patients with a mean age of 59 years. Forty-eight (21.1 %) patients had distant recurrence and 6 patients (2.6 %) had local recurrence. Median follow-up was 49 months. The 5- and 10-year actuarial disease free survival was 75.3 and 65.0 %, respectively. The 5- and 10-year actuarial overall survival (OS) was 89.6 and 71.2 %, respectively. Patients were classified as having liver (14 patients) or lung (27 patients) relapse according to the organ firstly metastasized. The variables significantly associated by univariate Cox analysis to survival were the achievement of an R0 metastases resection and the Köhne risk index, while the metastatic site showed a statistical trend. By multivariate Cox analysis, the only variable associated with survival was a R0 resection (HR = 16.3, p < 0.001). Median OS for patients undergoing a R0 resection was 73 months (95 % CI 67.8–78.2) compared to 25 months (95 % CI 5.47–44.5) in those non-operated patients (p < 0.001). Conclusions Combined treatment for LARC obtains a 5-year OS rounding 90 %. Follow-up based on thoracic-abdominal CT scan allows an early diagnosis of metastatic lesions. Surgical resection of metastases, regardless of their location, greatly increases the patient’s survival rate.