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Vol. 42. Num. 9.
Pages e23-e28 Pages 517-572 (December 2018)
Vol. 42. Num. 9.
Pages e23-e28 Pages 517-572 (December 2018)
Letter to the Editor
DOI: 10.1016/j.medine.2018.05.012
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Intensive care in cancer patients in the age of the multidisciplinary approach of cancer treatments: The radiotherapy perspective
Cuidados intensivos de pacientes oncológicos en la era del tratamiento multidisciplinar: la perspectiva desde la oncología radioterápica
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A. Illescas-Vacas
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aillesva@gmail.com

Corresponding author.
, N. Abu-Omar, C. Míguez, E. Bayo-Lozano
Unidad de Oncología Radioterápica, Unidad de Gestión Clínica de Oncología Radioterápica y Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Med Intensiva 2018;42:363-910.1016/j.medine.2018.07.001
A. Carmona-Bayonas, F. Gordo, C. Beato, J. Castaño Pérez, P. Jiménez-Fonseca, J. Virizuela Echaburu, J. Garnacho-Montero
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Dear Editor,

We have been following with great interest Carmona-Bayonas et al.’s paper on the multidisciplinary approach that needs to be taken into account in the prognosis of cancer patients who are experiencing reversible critical conditions.1 We are on the same page with the authors when they talk about the progress made in the management of multiorgan failure in intensive care units (ICU), added to the revolution we have experienced in the anti-tumor therapeutic arsenal, which leads to re-think the real possibilities of patients with severe acute conditions with neoformative processes.

However, when it comes to describing the therapeutic advances made in the management of cancer patients, the authors do not mention the use of radiotherapy (RT). As a matter of fact, there has been a revolution in the field of cancer radiotherapy during the last few years and this is something that should be taken into consideration, since this also contributes to increasing the life expectancy of patients with neoplastic diseases who can end up in the ICU.

As Atun et al.2 put it “Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care”. As a matter of fact, the new modalities of RT including its applications in intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), high dose-rate brachytherapy (HDR), stereotactic body radiation therapy (SBRT), stereotactic radiosurgery (SRS), proton therapy, and carbon ion radiotherapy (CIRT) have significantly improved local control, the possibilities of survival, and the quality of life of patients, and all thanks to optimizing the distribution of the radiation dose absorbed in the tissues with millimetric accuracy. A recent example includes the use of SBRT for the management of non-small cell lung cancer in early stages, where dose hypofractionation significantly increased local control and the overall survival of these patients.3 Also, during the last few years, it has gained special interest the immunomodulating effect of RT, that has been enhanced when adding the immunotherapy drugs described by Carmona-Bayonas et al.1 Such an effect increases antigen expression giving immune cells more capability to recognize and destroy the tumor. Surprising findings such as the response of non-irradiated metastatic lesions at a distance from the tumor treated with RT have already been reported. This effect known as the abscopal effect is part of the actual experimental lines and future progress of this type of cancer treatment.4

Lastly, and as it was already exposed by the scientific journal Nature back in September 2015, if we want our initiatives to successfully impact health and improve scientific knowledge, a multidisciplinary approach of medical conditions is essential, where each specialist plays a particular and fundamental role to improve our results.5

References
[1]
A. Carmona-Bayonas, F. Gordo, C. Beato, J. Castaño Perez, P. Jimenez-Fonseca, J. Virizuela Echaburu, et al.
Intensive care in cancer patients in the age of immunotherapy and molecular therapies: commitment of the SEOM-SEMICYUC.
Med Intensiva, 42 (2018), pp. 363-369
[2]
R. Atun, D.A. Jaffray, M.B. Barton, F. Bray, M. Baumann, B. Vikram, et al.
Expanding global access to radiotherapy.
Lancet Oncol, 16 (2015), pp. 1153-1186
[3]
P. Iyengar, R.D. Timmerman.
Stereotactic ablative radiotherapy for non-small cell lung cancer: rationale and outcomes.
J Natl Compr Canc Netw, 10 (2012), pp. 1514-1520
[4]
L. de la Cruz-Merino, A. Illescas-Vacas, A. Grueso-López, A. Barco-Sánchez, C. Míguez-Sánchez, Cancer Immunotherapies Spanish Group (GETICA).
Radiation for awakening the dormant immune system, a promising challenge to be explored.
Front Immunol, 5 (2014), pp. 102
[5]
[No authors listed] Why interdisciplinary research matters. Nature. 2015;525:305.

Please cite this article as: Illescas-Vacas A, Abu-Omar N, Míguez C, Bayo-Lozano E. Cuidados intensivos de pacientes oncológicos en la era del tratamiento multidisciplinar: la perspectiva desde la oncología radioterápica. Med Intensiva. 2018;42:569–570.

Copyright © 2018. Elsevier España, S.L.U. and SEMICYUC
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