No abstract

Stereotactic body radiotherapy (SBRT) allowshigh doses of radiation to be administered in a limited number of fractions. The high doses per session might allow the theoretical radioresistance of renal carcinoma to be overcome. SBRT may be a therapeutic alternative in inoperable patients with localized renal carcinoma. This review studied the available literature on the use of SBRT in inoperable localized renal carcinoma. The review including data from English-language studies was conducted in PubMed and MEDLINE between January 2010 and December 2020. Articles were included with data from patients with renal carcinoma treated with SBRT, their indications, simulation, dose and fractionation, local control, survival and side effects, comparison with other treatments, response assessment and radioimmunotherapy. The articles included were evaluated for content and validation. The immobilization systems were variable between studies. Doses and fractions were variable from 25-26 Gy in single fractions to 21-48 Gy in 3-5 fractions, with local control being around 90% with a low rate of side-effects. We review the state of the art in SBRT for renal cell carcinoma. More research is needed to determine optimal doses and fractionation, and to develop a reliable response assessment tool. The role of radioimmunotherapy in renal carcinoma is being studied.Renal carcinoma is the sixth most common tumor in men and the 10 th in women. Its incidence is increasing (1). The median age at diagnosis is 64 years. The World Health Organization subdivides renal carcinomas into more than 40 subtypes (2). Approximately 90% of renal tumors are carcinomas and out of these, 80% are clear-cell carcinomas; other less common types include papillary renal carcinoma, chromophobic carcinoma, transitional cell carcinoma of the renal pelvis and Bellini's duct carcinoma. Renal carcinomas most often originate in the renal cortex. Their diagnosis has been increased by the advancement of diagnostic imaging. Risk factors involved in their development include smoking, hypertension, obesity, dialysis, chronic pain medication use, chemotherapy, and infection with hepatitis C virus (2-4). The most important prognostic factors that determine 5-year survival are the tumor stage, grade and local extent, the presence of involved nodes and the presence of metastases (5).The 5-year survival rate for patients with localized lesions is greater than 90%. Traditionally, renal carcinoma is considered resistant to radiotherapy and chemotherapy. The development of targeted treatments such as sunitinib, temsirolimus, bevacizumab, interferon alpha or sorafenib has improved the outcomes. There are alternatives in patients considered non-surgical due to their comorbidities or unresectable tumors, such as active surveillance, cryotherapy, radiofrequency or microwave ablation, and, more recently, stereotactic body radiotherapy (SBRT). Active surveillance would include patients with small, inoperable tumors with limited life expectancy. Radiofrequency ablation is used for tumors ...

Pancreatic ductal adenocarcinoma (PDAC) presents many challenges in the clinic and there are many areas for improvement in diagnostics and patient management. The five-year survival rate is around 7.2% as the majority of patients present with advanced disease at diagnosis that is treatment resistant. Approximately 10–15% of PDAC cases have a hereditary basis or Familial Pancreatic Cancer (FPC). Here we demonstrate the use of circulating free DNA (cfDNA) in plasma as a prognostic biomarker in PDAC. The levels of cfDNA correlated with disease status, disease stage, and overall survival. Furthermore, we show for the first time via BEAMing that the majority of hereditary or familial PDAC cases (around 84%) are negative for a KRAS somatic mutation. In addition, KRAS mutation negative cases harbor somatic mutations in potentially druggable genes such as KIT, PDGFR, MET, BRAF, and PIK3CA that could be exploited in the clinic. Finally, familial or hereditary cases have a longer overall survival compared to sporadic cases (10.2 vs. 21.7 months, respectively). Currently, all patients are treated the same in the clinic with cytotoxic agents, although here we demonstrate that there are different subtypes of tumors at the genetic level that could pave the way to personalized treatment.

patient continues in treatment with bevacizumab progression-free and keeps without ulcers.We describe the first case of ulceration of the striae distensae associated with bevacizumab resolved without disrupting the drug.The results obtained with topical diltiazem are promising to handle new cases.