Letter to the Editor
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
A. Illescas-Vacas
, N. Abu-Omar, C. Míguez, E. Bayo-Lozano
Corresponding author
Unidad de Oncología Radioterápica, Unidad de Gestión Clínica de Oncología Radioterápica y Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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"apellidos" => "Garnacho-Montero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0210569118300196" "doi" => "10.1016/j.medin.2018.01.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118300196?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718301280?idApp=WMIE" "url" => "/21735727/0000004200000006/v1_201807240414/S2173572718301280/v1_201807240414/en/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Intensive care in cancer patients in the age of the multidisciplinary approach of cancer treatments: The radiotherapy perspective" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "569" "paginaFinal" => "570" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Illescas-Vacas, N. Abu-Omar, C. Míguez, E. Bayo-Lozano" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Illescas-Vacas" "email" => array:1 [ 0 => "aillesva@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Abu-Omar" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Míguez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Bayo-Lozano" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Oncología Radioterápica, Unidad de Gestión Clínica de Oncología Radioterápica y Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuidados intensivos de pacientes oncológicos en la era del tratamiento multidisciplinar: la perspectiva desde la oncología radioterápica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> 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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As Atun et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Lastly, and as it was already exposed by the scientific journal <span class="elsevierStyleItalic">Nature</span> 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.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care in cancer patients in the age of immunotherapy and molecular therapies: commitment of the SEOM-SEMICYUC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Carmona-Bayonas" 1 => "F. Gordo" 2 => "C. Beato" 3 => "J. Castaño Perez" 4 => "P. Jimenez-Fonseca" 5 => "J. Virizuela Echaburu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.01.008" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" "volumen" => "42" "paginaInicial" => "363" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29519710" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expanding global access to radiotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Atun" 1 => "D.A. Jaffray" 2 => "M.B. Barton" 3 => "F. Bray" 4 => "M. Baumann" 5 => "B. Vikram" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(15)00222-3" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "1153" "paginaFinal" => "1186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26419354" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stereotactic ablative radiotherapy for non-small cell lung cancer: rationale and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Iyengar" 1 => "R.D. Timmerman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Natl Compr Canc Netw" "fecha" => "2012" "volumen" => "10" "paginaInicial" => "1514" "paginaFinal" => "1520" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23221789" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiation for awakening the dormant immune system, a promising challenge to be explored" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Cancer Immunotherapies Spanish Group (GETICA)" "etal" => false "autores" => array:5 [ 0 => "L. de la Cruz-Merino" 1 => "A. Illescas-Vacas" 2 => "A. Grueso-López" 3 => "A. Barco-Sánchez" 4 => "C. Míguez-Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fimmu.2014.00102" "Revista" => array:5 [ "tituloSerie" => "Front Immunol" "fecha" => "2014" "volumen" => "5" "paginaInicial" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24672524" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "[No authors listed] Why interdisciplinary research matters. Nature. 2015;525:305." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000009/v1_201811250605/S2173572718301188/v1_201811250605/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000009/v1_201811250605/S2173572718301188/v1_201811250605/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718301188?idApp=WMIE" ]
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| 2023 August | 22 | 14 | 36 |
| 2023 July | 29 | 28 | 57 |
| 2023 June | 21 | 16 | 37 |
| 2023 May | 35 | 26 | 61 |
| 2023 April | 22 | 18 | 40 |
| 2023 March | 27 | 26 | 53 |
| 2023 February | 28 | 24 | 52 |
| 2023 January | 21 | 12 | 33 |
| 2022 December | 40 | 27 | 67 |
| 2022 November | 33 | 28 | 61 |
| 2022 October | 42 | 31 | 73 |
| 2022 September | 30 | 23 | 53 |
| 2022 August | 34 | 48 | 82 |
| 2022 July | 22 | 29 | 51 |
| 2022 June | 23 | 17 | 40 |
| 2022 May | 29 | 34 | 63 |
| 2022 April | 24 | 32 | 56 |
| 2022 March | 33 | 41 | 74 |
| 2022 February | 21 | 24 | 45 |
| 2022 January | 25 | 26 | 51 |
| 2021 December | 30 | 44 | 74 |
| 2021 November | 26 | 39 | 65 |
| 2021 October | 84 | 66 | 150 |
| 2021 September | 30 | 27 | 57 |
| 2021 August | 22 | 28 | 50 |
| 2021 July | 16 | 18 | 34 |
| 2021 June | 18 | 23 | 41 |
| 2021 May | 43 | 36 | 79 |
| 2021 April | 59 | 83 | 142 |
| 2021 March | 60 | 23 | 83 |
| 2021 February | 62 | 33 | 95 |
| 2021 January | 40 | 29 | 69 |
| 2020 December | 31 | 13 | 44 |
| 2020 November | 18 | 15 | 33 |
| 2020 October | 27 | 21 | 48 |
| 2020 September | 20 | 11 | 31 |
| 2020 August | 19 | 17 | 36 |
| 2020 July | 22 | 19 | 41 |
| 2020 June | 16 | 9 | 25 |
| 2020 May | 27 | 8 | 35 |
| 2020 April | 23 | 10 | 33 |
| 2020 March | 13 | 8 | 21 |
| 2020 February | 22 | 14 | 36 |
| 2020 January | 24 | 19 | 43 |
| 2019 December | 13 | 16 | 29 |
| 2019 November | 21 | 23 | 44 |
| 2019 October | 25 | 14 | 39 |
| 2019 September | 23 | 18 | 41 |
| 2019 August | 16 | 17 | 33 |
| 2019 July | 21 | 19 | 40 |
| 2019 June | 15 | 9 | 24 |
| 2019 May | 32 | 29 | 61 |
| 2019 April | 20 | 20 | 40 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 0 | 9 | 9 |
| 2019 January | 2 | 9 | 11 |
| 2018 December | 6 | 4 | 10 |
| 2018 November | 2 | 4 | 6 |
Show all
