309 research outputs found
Radial shortening for the treatment of Kienböck's disease
Twelve patients with Kienbock's disease were treated by radial shortening. Eight
patients were in stage II and four in stage III. After an average of 5 years,
relief of pain was satisfactory in 10 patients; 8 were in stage II before
operation and 2 in stage III. Two patients were dissatisfied because they had
persistent pain; both were in stage III before surgery. The range of motion
improved moderately. Nonunion at the site of radial osteotomy did not occur.
Radiographs at follow up showed consolidation and healing of the lunate in 2
patients, nonprogression of the disease in 9 and increase of the carpal collapse
in 1. The procedure helps to prevent further collapse of the lunate especially in
stage II and in some patients in stage III
Use of brachytherapy in children with cancer: the search for an uncomplicated cure
Brachytherapy is a sophisticated radiation method in which radioisotopes are
placed inside or at a short distance from the tumour. The volume of tissue that
receives the prescribed dose of radiotherapy is therefore fairly small compared
with that used in standard radiotherapy techniques. In paediatric oncology, this
method of radiation delivery can have a favourable effect on several undesirable
long-term side-effects that sometimes develop in children who receive
radiotherapy, such as growth retardation and development of second primary
tumours. Here, we describe the rationale for use of brachytherapy in children
with cancer, the methods of the different brachytherapy techniques available, and
the results obtained with several brachytherapy regimens in expert institutions
throughout the world
A case of capecitabine-induced coronary microspasm in a patient with rectal cancer
5-Fluorouracil (5-FU) is the most frequently used chemotherapy agent concomitant with radiotherapy in the management of patients with rectal cancer. Capecitabine is an oral fluoropyrimidine that mimics the pharmaconkinetics of infusional 5-FU. This new drug is replacing 5-FU as a part of the combined-modality treatment of a number of gastrointestinal cancers. While cardiac events associated with the use of 5-FU are a well known side effect, capecitabine-induced cardiotoxicity has been only rarely reported. Here, we reviewed the case of a patient with rectal cancer who had a capecitabine-induced coronary vasospasm. The most prominent mutation of the dihydropyrimidine dehydrogenase gene was also analyzed
Tratamiento radioterápico del cáncer mama: estándares y nuevas tendencias. Irradiación parcial acelerada de la mama
Radiotherapy as a part of the breast cancer treatment has evolved in the last decades. Post-mastectomy radiotherapy produces a substantial reduction in the risk of local recurrence as well as a moderate, but definitive reduction in long-term breast cancer mortality in women at high risk of locoregional failure. Whole-breast irradiation, as part of breast-conservation therapy, has well-established results with good cosmesis, and low toxicity. Results from the BCT trials suggest that the risk for ipsilateral breast cancer recurrence resides within close proximity to the original tumor site. This has led investigators to consider the role of an accelerated and more tumor bed-focused course of radiotherapy. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than whole breast irradiation (from 6-6.5 weeks to 1 week). Early results of this approach have demonstrated excellent local control, minimal acute toxicity, and are more convenient for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities. APBI extend the choise of breast conservatio
Feasibility report of conservative surgery, perioperative high-dose-rate brachytherapy (PHDRB), and low-to-moderate dose external beam radiation therapy (EBRT) in pediatric sarcomas
This study was undertaken to determine the feasibility of perioperative
high-dose-rate brachytherapy (PHDRB) as an accelerated boost in patients with
pediatric sarcomas. METHODS AND MATERIALS: Five pediatric patients (ages 7-16)
with soft tissue sarcomas (STS) or soft tissue recurrences of previously treated
osteosarcomas were treated with surgical resection and PHDRB (16-24 Gy) for R0-R1
resections. Patients with STS and osteosarcomas received 27 Gy and 45 Gy of EBRT
postoperatively. RESULTS: After a median follow-up of 27 months (range, 12-50)
all the patients remain locally controlled. Only 1 patient developed regrowth of
pulmonary metastases and died of distant disease at 16 months. CONCLUSIONS: The
use of PHDRB is safe in the short-term in this pediatric population. Only 1
patient suffered a partial wound dehiscence that may not be entirely related to
PHDRB. Patients with recurrent osteosarcomas can be treated in a fashion similar
to their adult soft tissue counterparts and avoid limb amputation. Younger
patients with STS may achieve local control and prevent growth retardation with a
combination of PHDRB and moderate doses of EBR
Bone HDR brachytherapy in a patient with recurrent Ewing’s sarcoma of the acetabulum: Alternative to aggressive surgery
A 17-year-old girl diagnosed with a previously irradiated, locally recurrent
Ewing's sarcoma involving the puboischiatic rami and the adjacent acetabulum was
referred to our institution for consideration of salvage hindquarter resection. A
conservative resection with implantation of the acetabular remnant for high-dose
rate brachytherapy was performed instead. The patient died 11 months after
surgery without signs or symptoms of bony damage and retained the ability to walk
for the remainder of her life
Multiple cycles of dose-intensive chemotherapy with repeated stem cell support as induction treatment in metastatic breast cancer: a feasibility study
The purpose of this trial was to study feasibility and tolerance of a dose-intensive multicyclic alternating induction chemotherapy with repeated stem cell support in a series of 43 metastatic breast cancer patients. Anthracycline-naive patients (n = 21) received cyclophosphamide 2.5 g/m2 plus doxorubicin 80 mg/m2 alternating every 14 days with paclitaxel 200-350 mg/m2 plus cisplatin 120 mg/m2. Patients who had previously received anthracyclines (n = 22) received cisplatin 120 mg/m2 plus etoposide 600 mg/m2 alternating with paclitaxel 200-350 mg/m2 plus ifosfamide 8 g/m2. Peripheral blood stem cells were infused after every course except the first, with a median CD34+ dose of 2.1 ´ 106/kg per cycle. Positive selection of CD34+ cells was performed in good mobilizers. The median number of cycles administered was six (4-8), and the time interval between them was 17 days. Median summation dose intensities (SDI) actually administered for the CA-TP and PE-TI protocol were 4.95 and 4.69, respectively (87% of scheduled SDI). There were 15 complete (35%) and 21 partial responses (49%), for an overall response rate of 84% (95% CI, 73%-95%). Infection or neutropenic fever occurred in 50% of the cycles. There was one treatment-related death. After a median follow-up of 26 months, the median event-free-survival was 12 months (95% CI: 10-14) and overall survival was 31 months. These high dose-intensity induction treatments seem to be feasible with sequential stem cell support
Valor de la PET en la recurrencia del cáncer de próstata con PSA < 5 ng/ml
We intend to evaluate the usefulness of PET scans in diagnosing recurrent prostate cancer after a curative attempt using radical treatment.
MATERIAL AND METHODS:
92 consecutive prostate cancer patients in biochemical progression following radical surgery (63) or radiation treatment (29) were studied with positron emission tomography (PET). In all cases two scans were performed in the same day (11C-choline and 18F-FDG). PET efficacy was evaluated both globally (by employing the results achieved with both 11C-choline and 18F-FDG) and using both radiotracers independently to detect recurrence in patients with biochemical progression. For this purpose, we used comparison of means for k-independent samples, 2 x 2 and 2 x X contingency tables and ROC curves.
RESULTS:
1. Global PET: there is evidence of PET alteration regarding the PSA level (P=.003): the clinical stage (P=.01). There are no statistically significant PET alterations regarding the affected biopsy (uni or bilateral), surgical margins, pathological stage and time to progression. ROC curve PET-PSA is statistically significant (P< .0001) permitting calculation of different cut-off points, with a specificity of 91% (highest) for a PSA of 4.3 ng/ml. 2. PET 18FDG: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 6.51 ng/ml. 3. PET 11choline: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 5.15 ng/ml.
CONCLUSIONS:
PET is a useful tool for diagnosing prostate cancer recurrence after a curative attempt using radical treatment
Radioterapia en cáncer de recto localmente avanzado: situación actual y desarrollo terapéutico
La radioterapia es uno de los elementos integrantes del tratamiento radical del cáncer de recto localmente avanzado. La radioterapia preoperatoria y la radioterapia postoperatoria en combinación con quimioterapia han demostrado aumento del control local y la supervivencia. La tendencia actual es el uso de quimioirradiación preoperatoria por su mejor tolerancia y porque a los beneficios en control local y supervivencia se le podrían añadir los de mayor tasa de respuesta (downstaging) y un aumento de cirugía preservadora del esfínter anal. El desarrollo terapéutico en cáncer de recto localmente avanzado se sitúa en conseguir una mayor intensificación terapéutica sobre el tumor y las regiones de riesgo de recidiva sin aumentar la toxicidad sobre los tejidos sanos: esquemas de radioterapia con fraccionamientos modificados, radioterapia intraoperatoria, radioterapia con intensidad modulada de dosis, nuevos agentes quimioterápicos en combinación con radioterapia. En el presente artículo se revisan los datos más relevantes de esta modalidad terapéutica.Radiotherapy is one of the integral elements of the radical treatment of locally advanced rectal cancer. Combined chemotherapy and postoperative radiotherapy or preoperative radiotherapy has demonstrated an increase in local control and survival. The present trend is the use of preoperative chemoradiotherapy: this scheme seems to have a better tolerance and downstaging with an increase in sphincter-preserving surgery rates. Current therapeutic development in locally advanced rectal cancer focuses on obtaining a greater therapeutic ratio: with modified fractionation, intraoperative radiation therapy, intensity modulated radiation therapy, new chemoradiation regimens. The present work reviews the state of the art and the most significant advances in radiation in rectal cancer
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