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Papers by Luis Fernández-Morales

Current Oncology

Since the beginning of the COVID-19 pandemic, the use of telehealth was rapidly implemented witho... more Since the beginning of the COVID-19 pandemic, the use of telehealth was rapidly implemented without previous evidence. The ONCOTELEMD study aimed to evaluate the opinion of patients attended via telemedicine during this period and to study factors that condition patient preferences on its use. Included patients had a confirmed cancer diagnosis and were contacted by telephone between 13 March and 30 April 2020, in the Medical Oncology Service of Hospital Parc Taulí, Sabadell. A 12-question survey was presented to them between 4 February and 19 April 2021. Statistical analysis was carried out using chi-square and multivariable logistic regression tests. Six hundred forty-six patients were included; 487 responded to the survey. The median age was 68 years (27–90), 55.2% were female. Most patients had a surveillance visit (65.3%) and were diagnosed with colorectal or breast cancer (43% and 26.5%, respectively); 91.8% of patients were satisfied, and 60% would accept the use of telemedici...

Medicine, 2017

The main objective of the study was to evaluate the efficacy and safety of dabrafenib alone or co... more The main objective of the study was to evaluate the efficacy and safety of dabrafenib alone or combined with trametinib for compassionate use in patients with metastatic melanoma.This retrospective, observational study involved 135 patients with unresectable stage IIIC or stage IV melanoma from an expanded-access program at 30 Spanish centers.Forty-eight patients received dabrafenib monotherapy and 87 received combination dabrafenib and trametinib; 4.4% and 95.6% of the patients had stage IIIC and IV melanoma, respectively. All patients showed BRAF mutations in their primary or metastatic lesions; 3 were positive for V600K while the remainder had V600E or V600+. A positive response to treatment was reported in 89.3% of the patients. Overall survival rates at 12 and 24 months were 59.6% (95% confidence interval [CI], 52.5-68.9%) and 36.4% (95% CI, 27.8-45%), respectively. Progression-free survival rates at 12 and 24 months were 39.3% (95% CI, 31.1-47.5%) and 21.6% (95% CI, 14.5-28.7%...

Radiotherapy and Oncology, 2015

Purpose/Objective: Use of stereotactic radiotherapy (SRT) is increasingly common practice in radi... more Purpose/Objective: Use of stereotactic radiotherapy (SRT) is increasingly common practice in radiation therapy for the adult population, but there is little consensus regarding its application in pediatrics. We evaluated clinical patterns of pediatric SRT practice through an international pediatrics consortium comprised of institutions using either photon or proton radiotherapy. Materials and Methods: Seven international institutions with dedicated pediatric expertise completed a 124-item survey evaluating patterns of SRT use in definitive and palliative radiation therapy for patients ≤21 years old. One institution uses proton SRT for children and all others use photon therapy. Descriptive statistics including frequencies of SRT use and median doses and margins applied with and without SRT by institution and treatment site were calculated. Results: Across institutions, 71% reported utilizing SRT in pediatrics. Definitions of SRT varied by institution, with providers specifying that a minimum fractional dose ranging from 1.80-6 Gy with delivery in a maximum of 5-33 fractions could be classified as SRT. A median of 11.2 (range 0-13) pediatric patients are treated with SRT of any fractionation regimen annually across institutions, with median 7 (range 0-10) treated with hypofractionated SRT (hSRT). hSRT is used in an average of 1% of brain, 17% of spine, 21% of other bone, and <1% of abdomen or pelvis, head and neck, lung, and liver radiotherapy cases across institutions. Half of the cases treated with hSRT are performed with palliative intent. Ranges of total dose reported for hSRT are 12-30 Gy in 1-5 fractions for brain, 14-40 Gy in 1-5 fractions for spine and other bone, 10-30 Gy in 2-5 fractions for abdomen or pelvis, and 10-50 Gy in 1-5 fractions for lung sites. Although immobilization and simulation procedures vary by treatment site and institution, daily IGRT is utilized in nearly 100% of cases. The median total GTV-PTV margins for SRT vs. non-SRT plans are 0.2 vs.1.4 cm for brain, 0.15 vs. 1.5 cm for spine, 0.35 vs. 1.5 cm for other bone, 0.5 vs. 2 cm for abdomen or pelvis, 0.3 vs. 1.5 cm for head and neck, 0.5 vs. 1.7 cm for lung, and 0.5 vs. 2 cm for liver sites, respectively. Conclusions: Use of SRT in children was prevalent at all consortium institutions, with variation in site-specific definitions and procedures utilized for this technique. GTV-PTV margins used for SRT are up to 4 times smaller than for non-SRT planning, highlighting the utility of this approach in reducing volume of normal tissue irradiated in the pediatrics population.

Clinical Breast Cancer, 2007

Locally advanced breast cancer (LABC) includes large primary tumors (> 5 cm), tumors of any size ... more Locally advanced breast cancer (LABC) includes large primary tumors (> 5 cm), tumors of any size associated with skin or chest wall involvement, tumors with fixed or matted axillary lymph nodes, and those with involvement of the ipsilateral subclavicular and supraclavicular lymph nodes. Thus, all stage III disease is considered locally advanced, as is a subset of stage IIB disease (T3 N0). 1 Operationally, even moderately sized tumors (3-5 cm) located in a small breast behave like LABC and are best treated with similar combined-modality approaches. 2,3 Neoadjuvant chemotherapy or primary chemotherapy has an established role in the multimodality treatment of LABC, and its use is increasing in earlier stages of disease. 4,5 The response to primary chemotherapy, especially the achievement of pathologic complete response (CR; pCR), is a predictor of outcome.

Reports of Practical Oncology & Radiotherapy, 2015

The aim of the present study was to analyze the age of breast cancer patients managed with curati... more The aim of the present study was to analyze the age of breast cancer patients managed with curative approach at the time of treatment with radiotherapy. Background: Breast cancer is the most frequent neoplasm in women. Little is known with regard to the age of patients at diagnosis, and some authors have suggested that breast cancer is now affecting women who are younger than before. Materials and methods: We performed a descriptive study of our series of breast cancer patients from 1998 to 2011. The age of patients, city of residence, year of treatment and uni-or bilateral location were extracted from the administrative database of the Radiation Oncology Department. The demographical and reference populational data were extracted from the Catalan Institute of Statistics. Results: 3382 patients were obtained. The mean age was 57.79 years. No statistical differences were observed in the mean age during the period of study (p > 0.05), nor in patients with bilateral neoplasias with regard to unilateral tumours (p > 0.5). Patients aged less than 30, 40, 50 and 65 years were 0.3%, 6.3%, 27.0% and 69.1%, respectively. The proportion of patients aged less, equal or more than 40 and 50 years was not statistically different.

Journal of Clinical Oncology

Current Oncology

Since the beginning of the COVID-19 pandemic, the use of telehealth was rapidly implemented witho... more Since the beginning of the COVID-19 pandemic, the use of telehealth was rapidly implemented without previous evidence. The ONCOTELEMD study aimed to evaluate the opinion of patients attended via telemedicine during this period and to study factors that condition patient preferences on its use. Included patients had a confirmed cancer diagnosis and were contacted by telephone between 13 March and 30 April 2020, in the Medical Oncology Service of Hospital Parc Taulí, Sabadell. A 12-question survey was presented to them between 4 February and 19 April 2021. Statistical analysis was carried out using chi-square and multivariable logistic regression tests. Six hundred forty-six patients were included; 487 responded to the survey. The median age was 68 years (27–90), 55.2% were female. Most patients had a surveillance visit (65.3%) and were diagnosed with colorectal or breast cancer (43% and 26.5%, respectively); 91.8% of patients were satisfied, and 60% would accept the use of telemedici...

Medicine, 2017

The main objective of the study was to evaluate the efficacy and safety of dabrafenib alone or co... more The main objective of the study was to evaluate the efficacy and safety of dabrafenib alone or combined with trametinib for compassionate use in patients with metastatic melanoma.This retrospective, observational study involved 135 patients with unresectable stage IIIC or stage IV melanoma from an expanded-access program at 30 Spanish centers.Forty-eight patients received dabrafenib monotherapy and 87 received combination dabrafenib and trametinib; 4.4% and 95.6% of the patients had stage IIIC and IV melanoma, respectively. All patients showed BRAF mutations in their primary or metastatic lesions; 3 were positive for V600K while the remainder had V600E or V600+. A positive response to treatment was reported in 89.3% of the patients. Overall survival rates at 12 and 24 months were 59.6% (95% confidence interval [CI], 52.5-68.9%) and 36.4% (95% CI, 27.8-45%), respectively. Progression-free survival rates at 12 and 24 months were 39.3% (95% CI, 31.1-47.5%) and 21.6% (95% CI, 14.5-28.7%...

Radiotherapy and Oncology, 2015

Purpose/Objective: Use of stereotactic radiotherapy (SRT) is increasingly common practice in radi... more Purpose/Objective: Use of stereotactic radiotherapy (SRT) is increasingly common practice in radiation therapy for the adult population, but there is little consensus regarding its application in pediatrics. We evaluated clinical patterns of pediatric SRT practice through an international pediatrics consortium comprised of institutions using either photon or proton radiotherapy. Materials and Methods: Seven international institutions with dedicated pediatric expertise completed a 124-item survey evaluating patterns of SRT use in definitive and palliative radiation therapy for patients ≤21 years old. One institution uses proton SRT for children and all others use photon therapy. Descriptive statistics including frequencies of SRT use and median doses and margins applied with and without SRT by institution and treatment site were calculated. Results: Across institutions, 71% reported utilizing SRT in pediatrics. Definitions of SRT varied by institution, with providers specifying that a minimum fractional dose ranging from 1.80-6 Gy with delivery in a maximum of 5-33 fractions could be classified as SRT. A median of 11.2 (range 0-13) pediatric patients are treated with SRT of any fractionation regimen annually across institutions, with median 7 (range 0-10) treated with hypofractionated SRT (hSRT). hSRT is used in an average of 1% of brain, 17% of spine, 21% of other bone, and <1% of abdomen or pelvis, head and neck, lung, and liver radiotherapy cases across institutions. Half of the cases treated with hSRT are performed with palliative intent. Ranges of total dose reported for hSRT are 12-30 Gy in 1-5 fractions for brain, 14-40 Gy in 1-5 fractions for spine and other bone, 10-30 Gy in 2-5 fractions for abdomen or pelvis, and 10-50 Gy in 1-5 fractions for lung sites. Although immobilization and simulation procedures vary by treatment site and institution, daily IGRT is utilized in nearly 100% of cases. The median total GTV-PTV margins for SRT vs. non-SRT plans are 0.2 vs.1.4 cm for brain, 0.15 vs. 1.5 cm for spine, 0.35 vs. 1.5 cm for other bone, 0.5 vs. 2 cm for abdomen or pelvis, 0.3 vs. 1.5 cm for head and neck, 0.5 vs. 1.7 cm for lung, and 0.5 vs. 2 cm for liver sites, respectively. Conclusions: Use of SRT in children was prevalent at all consortium institutions, with variation in site-specific definitions and procedures utilized for this technique. GTV-PTV margins used for SRT are up to 4 times smaller than for non-SRT planning, highlighting the utility of this approach in reducing volume of normal tissue irradiated in the pediatrics population.

Clinical Breast Cancer, 2007

Locally advanced breast cancer (LABC) includes large primary tumors (> 5 cm), tumors of any size ... more Locally advanced breast cancer (LABC) includes large primary tumors (> 5 cm), tumors of any size associated with skin or chest wall involvement, tumors with fixed or matted axillary lymph nodes, and those with involvement of the ipsilateral subclavicular and supraclavicular lymph nodes. Thus, all stage III disease is considered locally advanced, as is a subset of stage IIB disease (T3 N0). 1 Operationally, even moderately sized tumors (3-5 cm) located in a small breast behave like LABC and are best treated with similar combined-modality approaches. 2,3 Neoadjuvant chemotherapy or primary chemotherapy has an established role in the multimodality treatment of LABC, and its use is increasing in earlier stages of disease. 4,5 The response to primary chemotherapy, especially the achievement of pathologic complete response (CR; pCR), is a predictor of outcome.

Reports of Practical Oncology & Radiotherapy, 2015

The aim of the present study was to analyze the age of breast cancer patients managed with curati... more The aim of the present study was to analyze the age of breast cancer patients managed with curative approach at the time of treatment with radiotherapy. Background: Breast cancer is the most frequent neoplasm in women. Little is known with regard to the age of patients at diagnosis, and some authors have suggested that breast cancer is now affecting women who are younger than before. Materials and methods: We performed a descriptive study of our series of breast cancer patients from 1998 to 2011. The age of patients, city of residence, year of treatment and uni-or bilateral location were extracted from the administrative database of the Radiation Oncology Department. The demographical and reference populational data were extracted from the Catalan Institute of Statistics. Results: 3382 patients were obtained. The mean age was 57.79 years. No statistical differences were observed in the mean age during the period of study (p > 0.05), nor in patients with bilateral neoplasias with regard to unilateral tumours (p > 0.5). Patients aged less than 30, 40, 50 and 65 years were 0.3%, 6.3%, 27.0% and 69.1%, respectively. The proportion of patients aged less, equal or more than 40 and 50 years was not statistically different.

Journal of Clinical Oncology