Brachytherapy in the Treatment of Anorectal Cancer

Brachytherapy in the Treatment of Anorectal Cancer. Nowadays in the treatment of Malignant diseases, besides therapeutically results, the patient’s quality of life is considered very important and needs special attention. It is imperative to develop a therapy method that will yield results which gives more comfort to the patient, in particular concerning Malignancies in organs with important functions and having cosmetic aspects. One modality, which can be used in special cases, that gives good results and good quality of life for the patient is brachytherapy. Brachytherapy is a method of radiotherapy by placing or inserting a radiation source in the target area in order to give a radiation dose enough to kill cancer cells but with a low dosage for the surrounding important organs. The use of brachytherapy has flourished by the findings of several radiation sources such as iridium, which can be implanted in several Malignant locations. In anorectal Malignancy, implantation and intracavity brachytherapy with or without external radiation give good results in saving the anal sphincter and its function

The Role of Irradiation in Hypophyseal Adenoma

Pituitary adenomas are histopathologically benign, however the clinical presentations are often quite severe. These clinical signs are due to the tumor mass effect, hormonal disturbances or both. Besides that, these tumors often recurred after treatment. The treatment of pituitary tumors have developed greatly with the improvement of techniques of several modalities such as surgery, radiation and medication. Multimodality treatment is often used for optimal results in treating these tumors. Radiotherapy is a cytotoxic agent using ion radiation for the treatment of pituitary tumors in combination with other methods. Post-surgical radiotherapy has shown to decrease the recurrence rate significantly (22-71% vs 8-23%). At present there has been rapid improvements in radiation techniques for pituitary tumors. These developments are not only based upon the increase of know-how in computer technology and radiation instruments, but are also based upon the development of cellular and molecular biology in connection with normal and tumor tissues. The objective in developing radiation methods and techniques is to create a high radiation dose, homogeneous in the target area with low radiation dose in normal tissue. The development in science and technology, in particular concerning computer science, have created the development of radiation techniques and methods. This paper elaborates on several aspects of radiation in the treatment of pituitary

Stereotactic Ablative Body Radiotherapy (SABR) in the Management Spinal Metastases: a Brief Overview*

It is well known that radiotherapy provides successful pain relief in bone metastases. Advancements in imaging and radiotherapy delivery technology have enabled safe delivery of higher dose radiotherapy, which will produce more durable tumor control. Over the last decades stereotactic radiosurgery (SRS), which delivers high dose radiation, has been successfully used for the treatment of intracranial lesions. The good results obtained in SRS have led to development of extra cranial stereotactic radiosurgery known as stereotactic ablative body radiotherapy (SABR). This review paper enlightens indication, target definition, efficacy and toxicity in spinal SABR

The Physician Tendency in Stereotactic Radiosurgery Dose Prescription in Benign Intracranial Tumor at Dr. Cipto Mangunkusumo National Hospital, Jakarta

Stereotactic radiosurgery (SRS) is one of the treatment modalities for benign intra-cranial tumor, especiallyfor the tumor located next to the critical neural structure. The prescribed dose for radiosurgery depends onthe maximal tumor diameter and surrounding normal tissue tolerance dose. This cross sectional study wasconducted to evaluate the physician’s tendency in radiosurgery dose prescription. We observed treatmentplanning data of 32 patients with benign intra-cranial tumor, which had been treated with SRS at Dr. CiptoMangunkusumo National Hospital in 2009-2010. The peripheral dose, organ at risk (OAR) dose limitiationand maximum tumor diameter were recorded. We compared our SRS dose with dose limitation, whichallowed safer dosing based on maximal tumor diameter perspective and the nearest OAR dose constraint.From maximal tumor diameter perspective, we prescribed mean±SD radiosurgery doses, which were11.63±2.21Gy, 10.21±1.29Gy and 9.88±1.07Gy for the tumor size ≤2cm, 2.01-3cm and 3,01-4cm respectively.Our radiosurgery dose was the lowest than dose limitation based on the nearest OAR perspective, followedby maximal tumor diameter perspective. It was concluded that radiosurgery dose had the tendency to beinfluenced by surrounding healthy tissue tolerance rather than maximal tumor diameter

History and growth of radiation oncology in Indonesia

In order to assess its progress, and to obtain a snapshot of the current situation, the Indonesian Radiation Oncology Society has routinely conducted annual surveys since 2004 to assess the current condition of resources for equipment and staffing in all radiation oncology centres in the country. Based on these routine surveys, the society has made recommendations to the government about providing cancer patients with better and more affordable access to radiotherapy services

Keamanan dan Efisiensi Fakoemulsifikasi Torsional

Purpose: To evaluate the safety and efficiency of torsional phacoemulsification on senile dense cataract Setting: Jakarta Eye Centre, Jakarta, Indonesia Materials & Methods: Prospective, randomized single blind clinical trial. Twenty-four eyes with hard cataract were randomly divided into 2 groups: 10 eyes had torsional (Group 1) and 14 eyes had longitudinal phacoemulsification (Group 2). Measurement of endothelial cell count (ECC), corneal thickness (CT) and flare at 1 day after the operation are the safety indicators. Effective phacoemulsification time (EPT) and balanced saline solution (BSS) used, as an efficiency indicators, was monitored on the day of surgery. p value of <0.05 was considered statistically significant. Results: The mean ECC was lower in Group 1 [(2306.0 cell/mm2 ± 348.3 (SD)] than Group 2 [(1997.2 cell/mm2 ± 459.1 (SD)] (p>0.05). The mean CT and flare were, respectively, 601.4 µm±59.39SD) and 8.82 photoncount/sec±4.70 in Group 1; and 606.7±74.9(SD), 12.8 photoncount/sec±7.22 in Group 2 (p>0.05). Three subjects with cataract grade 5 in Group 2 had severe corneal edema. The mean EPT was 17.85 seconds±8.39 (SD) and BSS usage was 45.5 mL±8.8 (SD) in Group 1; and 33.81 seconds ±24.53 (SD), 83.6mL±46.7 SD, respectively, in Group 2. The difference was statistically significant. Conclusions: This study indicates that torsional phacoemulsification is more efficient in patients with a hard lens nucleus. Phacoemulsification safety also could be increased and patients outcome improved with this modality

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score (OTS) and Pediatric Ocular Trauma Score (POTS) for closed and open globe injuries in the pediatric group. METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted. Medical records were collected, and injuries were classified using Birmingham Eye Trauma Terminology System (BETTS). The predictive value and applicability of both OTS and POTS to final visual acuity (VA) were analyzed. RESULTS: Of 84 patients, 59 (70.2%) presented with closed globe injuries (CGI) and 25 (29.8%) with open globe injuries (OGI). The mean of initial VA was 0.832±0.904 logMAR. OTS and POTS was calculated. Initial VA (P<0.001) and traumatic cataract (P<0.001) were significantly associated with visual outcome, followed by organic/unclean wound (P=0.001), delay of surgery (P=0.001), iris prolapse (P=0.003), and globe rupture (P=0.008). A strong correlation between OTS and POTS and final VA (r=-0.798, P<0.001; r=-0.612, P<0.001) was found. OTS was more applicable in all age group of pediatric and in contrast to POTS, it was designed for 0-15 years old. POTS requires eleven parameters and OTS six parameters. Even though initial VA was not available, we could still calculate into POTS equation. CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children

Practical Guidelines Management of Graves Ophthalmopathy

Graves’ ophthalmopathy is the most common extra-thyroid manifestation in patients with Graves’ disease, based on inflammatory and autoimmune conditions in orbital tissue. This practical guideline was formed by a multidiciplinary team, and is intended to provide guidance for diagnosis and management of Graves’ ophthalmopathy in daily clinical practice to improve quality of care and treatment outcome