Aim: To evaluate dose differences in lung metastases treated with stereotactic body radiotherapy (SBRT), and the correlation with local control, regarding the dose algorithm, target volume and tissue density. Background: Several studies showed excellent local control rates in SBRT for lung metastases, with different fractionation schemes depending on the tumour location or size. These results depend on the dose distributions received by the lesions in terms of the tissue heterogeneity corrections performed by the dose algorithms. Materials and methods: Forty-seven lung metastases treated with SBRT, using intrafraction control and respiratory gating with internal fiducial markers as surrogates (ExacTrac, Brain-LAB AG), were calculated using Pencil Beam (PB) and Monte Carlo (MC) (iPlan, BrainLAB AG). Dose differences between both algorithms were obtained for the dose received by 99% (D 99%) and 50% (D 50%) of the planning treatment volume (PTV). The biologically effective dose delivered to 99% (BED 99%) and 50% (BED 50%) of the PTV were estimated from the MC results. Local control was evaluated after 24 months of median follow-up (range: 3-52 months). Results: The greatest variations (40.0% in D 99% and 38.4% in D 50%) were found for the lower volume and density cases. The BED 99% and BED 50% were strongly correlated with observed local control rates: 100% and 61.5% for BED 99% > 85 Gy and <85 Gy (p < 0.0001), respectively, and 100% and 58.3% for BED 50% > 100 Gy and <100 Gy (p < 0.0001), respectively.

Conflictos de interés: los autores declaran no tener conflictos de interés. RESUMENIntroducción: el cáncer sigue siendo un importante problema de salud a nivel mundial, por lo que su prevención es algo prioritario a nivel sanitario. La dieta mediterránea (DM) puede prevenir su aparición.Objetivos/Métodos: realización de una búsqueda de evidencia científica sobre el papel protector de la DM frente a la aparición del cáncer y exposición de los hallazgos más relevantes.Resultados: varios estudios presentan evidencia sobre el papel de la DM en la protección contra el cáncer. Como estilo de vida, la DM incluye unos hábitos dietéticos y unas costumbres sociales muy favorables; además, va ligada a la realización de actividad física frecuente. Todo esto, mantenido en el tiempo, tiene una influencia positiva sobre la prevención del desarrollo de tumores. El efecto protector es mediado por la presencia de múltiples antioxidantes y antiinflamatorios ligados a los productos de consumo frecuente en esta dieta; además, como estilo de vida, la DM representa una forma de prevenir el sobrepeso y la obesidad, que son también causantes directos del desarrollo de neoplasias.Conclusión: existe evidencia científica sobre el papel protector de la DM contra la aparición de algunos tumores.

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The incidence of lung cancer during pregnancy is rising due to the high rate of smokers in young women and the late mean age of pregnancy; in addition, considering that the patients are young women with a higher incidence of molecular alterations, molecular testing in lung adenocarcinoma should always be performed, even in pregnancy. Here, we report the case of a lung adenocarcinoma diagnosed during pregnancy with a long survival who benefitted from brain radiotherapy, conventional chemotherapy, and ALK TKI-targeted treatment. It reveals the safety of whole brain radiotherapy during pregnancy and consideration of other brain radiation techniques even in palliative cases, which should be personalized and managed by a multidisciplinary team. However, upfront management of brain metastasis in ALKpositive patients remains unresolved.

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