Technologie frézování s využitím CAD/CAM systému Esprit - X

Import 20/04/2006Prezenční výpůjčkaVŠB - Technická univerzita Ostrava. Fakulta strojní. Katedra (346) obrábění a montáž

Internal mammary node management in breast cancer. A review

Background. Internal mammary nodes visualized during sentinel node biopsy for breast cancer, remain an unresolved management issue. Further, both internal mammary node (IMN) radiotherapy and biopsy have attendant risks and hence should be used with caution. The purpose of this review is to highlight the available data and evidence. Methods and Results. A PubMed database from 1960 to 2012 using key words: internal mammary nodes, breast cancer radiotherapy planning, adjuvant radiotherapy, sentinel node biopsy in breast cancer and selected publications on the significance of internal mammary nodes in breast cancer treatment, published data and approaches used. We found 14513 relevant papers and we selected 30 that clearly investigated the management of internal mammary nodes during sentinel node search. We focused on the incidence of IMN metastasis (6 papers), risk factors associated with IMN drainage (9 reports), management of IMN and the impact on disease free and overall patient survival (15 papers). Conclusions. The evidence for breast cancer axillary nodes management is good but the data for other draining nodes such as internal mammary nodes are far less conclusive and further research is needed

Additional value of the coronary artery calcium score in patients for whom myocardial perfusion imaging is challenging

Background: Determination of prognosis based on ischemia detection, using single‑photon emission computed tomography myocardial perfusion imaging (SPECT‑MPI), can be challenging in patients with multiple affected coronary arteries. Aims: The aim of the study was to examine the outcomes of SPECT‑MPI combined with the coronary artery calcium score (CACS) to identify predictors of adverse cardiac events (ACEs) in patients for whom ischemia detection may be difficult using SPECT‑MPI. Methods: The study group included 195 patients with a history of chronic kidney disease, suspected ischemic cardiomyopathy, or left bundle branch block. All patients underwent SPECT‑MPI and CACS evaluation. During the follow‑up, ACEs were recorded. Perfusion and functional parameters as well as the CACS were analyzed to find the predictors of ACEs. Results: The ACEs were recorded in 58 individuals (29.7%) and were significantly associated with ischemia (P < 0.001), abnormal functional parameters (P = 0.04), and higher CACSs (P < 0.001). The optimal cutoff value of the CACS to predict an ACE was 530. Cox proportional hazards models revealed that age, mild and severe ischemia, functional abnormalities, and a CACS of 530 or higher were significant predictors of ACEs. In the subgroup of individuals without ischemia, a CACS of 530 or higher was significantly associated with poor outcome, while we recorded only 3 ACEs in these patients when the CACS was lower than 530. Conclusions: The addition of the CACS to SPECT‑MPI improves the identification of patients at higher risk for ACEs, even in individuals for whom SPECT‑MPI is challenging

FMISO-Based Adaptive Radiotherapy in Head and Neck Cancer

Concurrent chemoradiotherapy represents one of the most used strategies in the curative treatment of patients with head and neck (HNC) cancer. Locoregional failure is the predominant recurrence pattern. Tumor hypoxia belongs to the main cause of treatment failure. Positron emission tomography (PET) using hypoxia radiotracers has been studied extensively and has proven its feasibility and reproducibility to detect tumor hypoxia. A number of studies confirmed that the uptake of FMISO in the recurrent region is significantly higher than that in the non-recurrent region. The escalation of dose to hypoxic tumors may improve outcomes. The technical feasibility of optimizing radiotherapeutic plans has been well documented. To define the hypoxic tumour volume, there are two main approaches: dose painting by contour (DPBC) or by number (DPBN) based on PET images. Despite amazing technological advances, precision in target coverage, and surrounding tissue sparring, radiation oncology is still not considered a targeted treatment if the “one dose fits all” approach is used. Using FMISO and other hypoxia tracers may be an important step for individualizing radiation treatment and together with future radiomic principles and a possible genome-based adjusting dose, will move radiation oncology into the precise and personalized era

Prognostic influence of internal mammary node drainage in patients with early-stage breast cancer

Background: The management of internal mammary nodes (IMNs) during multidisciplinary treatment of breast cancer has been debated for the last four decades without unequivocal conclusion. Patients and Methods: We retrospectively reviewed patients with breast cancer who underwent sentinel lymph node biopsy at our center from 2008 until 2012. IMN drainage was assessed as a potential risk factor for local and distant disease recurrence. Results: We identified 712 patients, with incidence of drainage to IMNs of 18.4%. No detrimental effect of the pattern of drainage to IMNs was found after a median follow-up of 58 months. A similar outcome was observed when drainage to IMNs was evaluated as a risk factor for patient survival. The potential risk factors for drainage to IMNs during sentinel lymph node biopsy were younger age (p=0.002) and tumor location in lower-outer, lower-inner, and upper-inner versus upper-outer quadrant (p<0.0001). Conclusion: The drainage to IMNs is unlikely to have a detrimental effect on patient outcome.[LO1304