Romanian Journal of Clinical and Experimental Dermatology, 2014
54 Melanomul malign are o tendinţă mare de metastazare la nivel cerebral, la 37% dintre pacienţi ... more 54 Melanomul malign are o tendinţă mare de metastazare la nivel cerebral, la 37% dintre pacienţi putându-se diagnostica metastaze cerebrale, însă în seriile de autopsie 75% dintre pacienţii decedaţi prin evoluţia bolii au metastaze la nivel cerebral. Cefaleea și crizele comiţiale sunt principalele manifestări clinice, dar se pot descrie de asemenea și tulburări cognitive și de vorbire, precum și deficite motorii. Metastazele cerebrale sunt bogat vascularizate, au tendiţa de sângerare intratumorală și prezintă niveluri diferite de melanină. Există mai multe scoruri de clasificare prognostică, supravieţuirea medie situându-se între 2 și 13 luni. Tratamentele sistemice sunt reprezentate de Dacarbazină sau derivaţi de Nitrozo-uree, medicamente cu eficacitate limitată și de noile molecule precum inhibitorii de B-RAF sau anticorpii monoclonali care modulează răspunsul imun, molecule care determină răspunsuri mai bune și evoluţii favorabile. Tratamentele locale sunt chirurgia, radioterapia pan-encefalică sau cea stereotactică. Rezecţia chirurgicală sau radiochirurgia sunt considerate egal eficace atât în ceea ce privește controlul local (60-90%), cât și supravieţuirea, alegerea tratamentului depinzând de factorii de prognostic și de complicaţiile locale ale metastazei. Iradierea întregului encefal, fie după chirurgie, fie după radiochirurgie, reduce semnificativ rata recidivelor cerebrale atât la locul iniţial, cât și în alte teritorii cerebrale, însă fără a aduce un beneficiu semnificativ de independenţă funcţională sau supravieţuire. brAIN metAStASeS IN mALIgNANt meLANomA treAtmeNt optIoNS ANd recommeNdAtIoNS metAStAZeLe cerebrALe îN meLANomuL mALIgN opţIuNI terApeutIce şI recomANdărI
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2013
External beam radiotherapy alone is a standard treatment for prostate cancer. According to clinic... more External beam radiotherapy alone is a standard treatment for prostate cancer. According to clinical, histological and biological characteristics of the tumour, lymph node irradiation can be done in combination with irradiation of the prostate. The completion of pelvic irradiation remains controversial and may cause complications by increasing volumes of irradiated healthy tissues. The accuracy of the delineation of lymph node becomes an important issue. This article proposes to take on the characteristics of the pelvic lymph node drainage of the prostate, to review the literature on pelvic irradiation and the definition of volumes to be irradiated.
ABSTRACT PURPOSE: The aim of this study was to evaluate the contribution of an injection of hyalu... more ABSTRACT PURPOSE: The aim of this study was to evaluate the contribution of an injection of hyaluronic acid (HA) between the rectum and the prostate for reducing the dose to the rectal wall in a hypofractionated irradiation for prostate cancer. METHODS AND MATERIALS: In a phase 2 study, 10 cc of HA was injected between the rectum and prostate. For 16 patients, the same intensity modulated radiation therapy plan (62 Gy in 20 fractions) was optimized on 2 computed tomography scans: CT1 (before injection) and CT2 (after injection). Rectal parameters were compared: dose to 2.5 cc (D2.5), 5 cc (D5), 10 cc (D10), 15 cc (D15), and 20 cc (D20) of rectal wall and volume of rectum covered by the 90% isodose line (V90), 80% (V80), 70% (V70), 60% (V60), and 50% (V50). RESULTS: The mean V90, V80, V70, V60, and V50 values were reduced by 73.8% (P<.0001), 55.7% (P=.0003), 43.0% (P=.007), 34% (P=.002), and 25% (P=.036), respectively. The average values of D2.5, D5, D10, D15, and D20 were reduced by 8.5 Gy (P<.0001), 12.3 Gy (P<.0001), 8.4 Gy (P=.005), 3.7 Gy (P=.026), and 1.2 Gy (P=.25), respectively. CONCLUSIONS: The injection of HA significantly limited radiation doses to the rectal wall.
The stereotactic irradiation is a new approach for low-risk prostate cancer. The aim of the prese... more The stereotactic irradiation is a new approach for low-risk prostate cancer. The aim of the present study was to evaluate a schema of stereotactic irradiation of the prostate with an integrated-boost into the tumor. The prostate and the tumor were delineated by a radiologist on CT/MRI fusion. A 9-coplanar fields IMRT plan was optimized with three different dose levels: 1) 5 × 6.5 Gy to the PTV1 (plan 1), 2) 5 × 8 Gy to the PTV1 (plan 2) and 3) 5 × 6.5 Gy on the PTV1 with 5 × 8 Gy on the PTV2 (plan 3). The maximum dose (MaxD), mean dose (MD) and doses received by 2% (D2), 5% (D5), 10% (D10) and 25% (D25) of the rectum and bladder walls were used to compare the 3 IMRT plans. A dose escalation to entire prostate from 6.5 Gy to 8 Gy increased the rectum MD, MaxD, D2, D5, D10 and D25 by 3.75 Gy, 8.42 Gy, 7.88 Gy, 7.36 Gy, 6.67 Gy and 5.54 Gy. Similar results were observed for the bladder with 1.72 Gy, 8.28 Gy, 7.01 Gy, 5.69 Gy, 4.36 Gy and 2.42 Gy for the same dosimetric parameters. An integrated SBRT boost only to PTV2 reduced by about 50% the dose difference for rectum and bladder compared to a homogenous prostate dose escalation. Thereby, the MD, D2, D5, D10 and D25 for rectum were increased by 1.51 Gy, 4.24 Gy, 3.08 Gy, 2.84 Gy and 2.37 Gy in plan 3 compared to plan 1. The present planning study of an integrated SBRT boost limits the doses received by the rectum and bladder if compared to a whole prostate dose escalation for SBRT approach.
Romanian Journal of Clinical and Experimental Dermatology, 2014
54 Melanomul malign are o tendinţă mare de metastazare la nivel cerebral, la 37% dintre pacienţi ... more 54 Melanomul malign are o tendinţă mare de metastazare la nivel cerebral, la 37% dintre pacienţi putându-se diagnostica metastaze cerebrale, însă în seriile de autopsie 75% dintre pacienţii decedaţi prin evoluţia bolii au metastaze la nivel cerebral. Cefaleea și crizele comiţiale sunt principalele manifestări clinice, dar se pot descrie de asemenea și tulburări cognitive și de vorbire, precum și deficite motorii. Metastazele cerebrale sunt bogat vascularizate, au tendiţa de sângerare intratumorală și prezintă niveluri diferite de melanină. Există mai multe scoruri de clasificare prognostică, supravieţuirea medie situându-se între 2 și 13 luni. Tratamentele sistemice sunt reprezentate de Dacarbazină sau derivaţi de Nitrozo-uree, medicamente cu eficacitate limitată și de noile molecule precum inhibitorii de B-RAF sau anticorpii monoclonali care modulează răspunsul imun, molecule care determină răspunsuri mai bune și evoluţii favorabile. Tratamentele locale sunt chirurgia, radioterapia pan-encefalică sau cea stereotactică. Rezecţia chirurgicală sau radiochirurgia sunt considerate egal eficace atât în ceea ce privește controlul local (60-90%), cât și supravieţuirea, alegerea tratamentului depinzând de factorii de prognostic și de complicaţiile locale ale metastazei. Iradierea întregului encefal, fie după chirurgie, fie după radiochirurgie, reduce semnificativ rata recidivelor cerebrale atât la locul iniţial, cât și în alte teritorii cerebrale, însă fără a aduce un beneficiu semnificativ de independenţă funcţională sau supravieţuire. brAIN metAStASeS IN mALIgNANt meLANomA treAtmeNt optIoNS ANd recommeNdAtIoNS metAStAZeLe cerebrALe îN meLANomuL mALIgN opţIuNI terApeutIce şI recomANdărI
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2013
External beam radiotherapy alone is a standard treatment for prostate cancer. According to clinic... more External beam radiotherapy alone is a standard treatment for prostate cancer. According to clinical, histological and biological characteristics of the tumour, lymph node irradiation can be done in combination with irradiation of the prostate. The completion of pelvic irradiation remains controversial and may cause complications by increasing volumes of irradiated healthy tissues. The accuracy of the delineation of lymph node becomes an important issue. This article proposes to take on the characteristics of the pelvic lymph node drainage of the prostate, to review the literature on pelvic irradiation and the definition of volumes to be irradiated.
ABSTRACT PURPOSE: The aim of this study was to evaluate the contribution of an injection of hyalu... more ABSTRACT PURPOSE: The aim of this study was to evaluate the contribution of an injection of hyaluronic acid (HA) between the rectum and the prostate for reducing the dose to the rectal wall in a hypofractionated irradiation for prostate cancer. METHODS AND MATERIALS: In a phase 2 study, 10 cc of HA was injected between the rectum and prostate. For 16 patients, the same intensity modulated radiation therapy plan (62 Gy in 20 fractions) was optimized on 2 computed tomography scans: CT1 (before injection) and CT2 (after injection). Rectal parameters were compared: dose to 2.5 cc (D2.5), 5 cc (D5), 10 cc (D10), 15 cc (D15), and 20 cc (D20) of rectal wall and volume of rectum covered by the 90% isodose line (V90), 80% (V80), 70% (V70), 60% (V60), and 50% (V50). RESULTS: The mean V90, V80, V70, V60, and V50 values were reduced by 73.8% (P<.0001), 55.7% (P=.0003), 43.0% (P=.007), 34% (P=.002), and 25% (P=.036), respectively. The average values of D2.5, D5, D10, D15, and D20 were reduced by 8.5 Gy (P<.0001), 12.3 Gy (P<.0001), 8.4 Gy (P=.005), 3.7 Gy (P=.026), and 1.2 Gy (P=.25), respectively. CONCLUSIONS: The injection of HA significantly limited radiation doses to the rectal wall.
The stereotactic irradiation is a new approach for low-risk prostate cancer. The aim of the prese... more The stereotactic irradiation is a new approach for low-risk prostate cancer. The aim of the present study was to evaluate a schema of stereotactic irradiation of the prostate with an integrated-boost into the tumor. The prostate and the tumor were delineated by a radiologist on CT/MRI fusion. A 9-coplanar fields IMRT plan was optimized with three different dose levels: 1) 5 × 6.5 Gy to the PTV1 (plan 1), 2) 5 × 8 Gy to the PTV1 (plan 2) and 3) 5 × 6.5 Gy on the PTV1 with 5 × 8 Gy on the PTV2 (plan 3). The maximum dose (MaxD), mean dose (MD) and doses received by 2% (D2), 5% (D5), 10% (D10) and 25% (D25) of the rectum and bladder walls were used to compare the 3 IMRT plans. A dose escalation to entire prostate from 6.5 Gy to 8 Gy increased the rectum MD, MaxD, D2, D5, D10 and D25 by 3.75 Gy, 8.42 Gy, 7.88 Gy, 7.36 Gy, 6.67 Gy and 5.54 Gy. Similar results were observed for the bladder with 1.72 Gy, 8.28 Gy, 7.01 Gy, 5.69 Gy, 4.36 Gy and 2.42 Gy for the same dosimetric parameters. An integrated SBRT boost only to PTV2 reduced by about 50% the dose difference for rectum and bladder compared to a homogenous prostate dose escalation. Thereby, the MD, D2, D5, D10 and D25 for rectum were increased by 1.51 Gy, 4.24 Gy, 3.08 Gy, 2.84 Gy and 2.37 Gy in plan 3 compared to plan 1. The present planning study of an integrated SBRT boost limits the doses received by the rectum and bladder if compared to a whole prostate dose escalation for SBRT approach.
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