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1.
BMC Nephrol ; 21(1): 373, 2020 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-32854640

RESUMEN

BACKGROUND: Acute kidney injury (AKI) remains a frequent complication in children undergoing hematopoietic stem cell transplantation (HSCT) and an independent risk factor of the patient's survival and a prognostic factor of progression to chronic kidney disease (CKD). However, the causes of these complications are diverse, usually overlapping, and less well understood. METHODS: This retrospective analysis was performed in 43 patients (28 boys, 15 girls; median age, 5.5 years) undergoing HSCT between April 2006 and March 2019. The main outcome was the development of AKI defined according to the Pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria as ≥ 25% decrease in estimated creatinine clearance. The secondary outcome was the development of CKD after a 2-year follow-up. RESULTS: AKI developed in 21 patients (49%) within 100 days after HSCT. After adjusting for possible confounders, posttransplant AKI was associated with matched unrelated donor (MUD) (HR, 6.26; P = 0.042), but not total body irradiation (TBI). Of 37 patients who were able to follow-up for 2 years, 7 patients died, but none had reached CKD during the 2 years after transplantation. CONCLUSIONS: Posttransplant AKI was strongly associated with HSCT from MUD. Although the incidence of AKI was high in our cohort, that of posttransplant CKD was lower than reported previously in adults. TBI dose reduced, GVHD minimized, and infection prevented are required to avoid late renal dysfunction after HSCT in children since their combinations may contribute to the occurrence of AKI.


Asunto(s)
Lesión Renal Aguda/epidemiología , Inhibidores de la Calcineurina/uso terapéutico , Enfermedad Injerto contra Huésped/prevención & control , Trasplante de Células Madre Hematopoyéticas , Insuficiencia Renal Crónica/epidemiología , Irradiación Corporal Total/estadística & datos numéricos , Lesión Renal Aguda/terapia , Adolescente , Niño , Preescolar , Estudios de Cohortes , Familia , Femenino , Humanos , Masculino , Modelos de Riesgos Proporcionales , Terapia de Reemplazo Renal , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Acondicionamiento Pretrasplante/estadística & datos numéricos , Trasplante Autólogo
2.
Phys Eng Sci Med ; 43(3): 825-835, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32613526

RESUMEN

Total body irradiation (TBI) is an important treatment modality for the preparation of patients for bone marrow transplants. It is technically challenging and the actual delivery may vary from clinic to clinic. Knowledge of the pattern of practice may be helpful for clinics to determine future practice. We carried out an email survey from April to September 2019 sending 48 TBI related questions to all radiotherapy clinics in Australia and New Zealand via the Australasian College of Physical Scientists in Medicine email distribution list. Centres not performing TBI were not expected to complete the survey and centres that had participated in a previous survey, or that were known to perform the treatment, were followed up if no response was received. Of a total of approximately 70 centres, 14 clinics responded to the survey. The vast majority of clinics use conventional lateral and/or anterior-posterior beams at extended SSD for TBI treatment delivery. However, treatment planning, ancillary equipment (used for immobilisation/modulation), beam energy and prescribed lung doses vary considerably-with some clinics delivering the prescription dose to the lungs and some aiming to deliver a lung dose which is lower than the prescription dose. Only one clinic reported using an advanced delivery technique with modulated arcs at extended SSD. Centres either said they had no access to outcome data or did not answer this question. Compared with an earlier survey from 2005, 3 clinics have lowered their linac dose rate and 7 are the same or similar. The TBI practice in Australia and New Zealand remains varied, with considerable differences in treatment planning, beam energy, accepted lung doses and delivered dose rates.


Asunto(s)
Pautas de la Práctica en Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Irradiación Corporal Total/estadística & datos numéricos , Australia , Relación Dosis-Respuesta en la Radiación , Humanos , Nueva Zelanda , Dosificación Radioterapéutica
3.
J Clin Oncol ; 38(25): 2872-2882, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32673169

RESUMEN

PURPOSE: To examine the association between total body irradiation (TBI) and subsequent breast cancer in women treated with blood or marrow transplantation (BMT) for hematologic malignancies. PATIENTS AND METHODS: Participants were drawn from the BMT Survivor Study (BMTSS), a retrospective cohort study that included patients who underwent transplantation between 1974 and 2014 and survived for ≥ 2 years after BMT. Patients with pre-BMT chest radiation or a history of breast cancer were excluded. Participants completed the BMTSS survey, which included details regarding breast cancer diagnosis. Subsequent breast cancer was confirmed by pathology report review or physician notes. Cox proportional hazards models assessed the association between TBI and subsequent breast cancer. Standardized incidence ratios were calculated to determine the excess risk of subsequent breast cancer compared with that in the general population. RESULTS: A total of 1,464 female BMT survivors (allogeneic: n = 788; autologous: n = 676) participated, with a median follow-up of 9.3 years from BMT. TBI was used in 660 patients (46%). Thirty-seven women developed subsequent breast cancer (allogeneic: n = 19; autologous: n = 18). Multivariable analysis revealed that exposure to TBI was associated with an increased risk of subsequent breast cancer among allogeneic BMT survivors (hazard ratio [HR], 3.7 [95% CI, 1.2 to 11.8]; P = .03) and autologous BMT survivors (HR, 2.6 [95% CI, 1.0 to 6.8]; P = .048). Pre-BMT exposure to alkylating agents was associated with an increased risk of subsequent breast cancer among autologous BMT survivors (HR, 3.3 [95% CI, 1.0 to 9.0]; P = .05). Compared with that in the general population, exposure to TBI at age < 30 years was associated with a 4.4-fold higher risk of subsequent breast cancer in allogeneic BMT survivors and a 4.6-fold higher risk in autologous BMT survivors. CONCLUSION: The association between TBI and subsequent breast cancer, especially among those exposed at a young age, as well as pre-BMT exposure to alkylating agents, should inform breast cancer screening for early detection.


Asunto(s)
Trasplante de Médula Ósea/estadística & datos numéricos , Neoplasias de la Mama/epidemiología , Neoplasias Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Neoplasias Inducidas por Radiación/epidemiología , Irradiación Corporal Total/estadística & datos numéricos , Adulto , Alabama/epidemiología , Trasplante de Médula Ósea/efectos adversos , Trasplante de Médula Ósea/métodos , Neoplasias de la Mama/mortalidad , Estudios de Cohortes , Femenino , Neoplasias Hematológicas/epidemiología , Neoplasias Hematológicas/radioterapia , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Persona de Mediana Edad , Minnesota/epidemiología , Neoplasias Inducidas por Radiación/etiología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Riesgo , Irradiación Corporal Total/efectos adversos , Irradiación Corporal Total/métodos
4.
Support Care Cancer ; 28(11): 5117-5124, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32043175

RESUMEN

PURPOSE: Thyroid cancer is a common subsequent malignant neoplasm in childhood cancer survivors (CCS). Patients who received radiotherapy (RT) to the head, neck, upper thorax, or total body irradiation (TBI) are considered to be at risk for subsequent thyroid cancer. Current Children's Oncology Group screening guidelines recommend annual neck palpation. Our objective was to determine if ultrasound (US) is more sensitive and specific than palpation to detect thyroid cancer in high-risk CCS and bone marrow transplant (BMT) survivors. METHODS: Electronic medical records of patients followed in a longitudinal survivorship clinic from January 1, 2010 to December 31, 2017 were reviewed. Inclusion criteria included history of RT to the head, neck, upper thorax, or TBI for primary therapy or preparation for BMT prior to the age of 20 years. RESULTS: Two hundred and twenty-five patients had documented palpation and 144 (64%) also had US evaluation. Mean radiation dose was 28.6 Gy. Sixteen of 225 patients (7.1%) developed a subsequent thyroid cancer at a mean of 9.7 years from the completion of RT. Sensitivity of US was 100% compared with 12.5% for palpation. US demonstrated higher accuracy, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.87 versus 0.56 for palpation (P < 0.0001). CONCLUSION: Routine screening with US was more sensitive than palpation for detection of subsequent thyroid cancer after high-risk RT in CCS and BMT survivors. Screening US may lead to earlier detection of thyroid cancer in this population. Earlier diagnosis has the potential to decrease operative complexity, and earlier definitive therapy reduces the likelihood of metastatic disease.


Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/epidemiología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/epidemiología , Adolescente , Adulto , Trasplante de Médula Ósea/efectos adversos , Trasplante de Médula Ósea/estadística & datos numéricos , Niño , Detección Precoz del Cáncer , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Neoplasias Primarias Secundarias/diagnóstico por imagen , Neoplasias Primarias Secundarias/etiología , Palpación , Estudios Retrospectivos , Factores de Riesgo , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/etiología , Ultrasonografía/métodos , Irradiación Corporal Total/efectos adversos , Irradiación Corporal Total/estadística & datos numéricos , Adulto Joven
5.
Eur J Cancer Care (Engl) ; 28(4): e13059, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30993779

RESUMEN

AIMS: The role of selected treatments for brain metastases (BM) is well documented; however, the prevalence of these is not. We report on the patterns of care in the management of BM in a large oncology centre. MATERIALS AND METHODS: We retrospectively audited 236 cases of newly diagnosed BM from January 2016 to December 2017 by looking at 2 years of radiology reports and gathered data on primary site, survival, treatment received, palliative care input and brain metastases-related admissions. RESULTS: Eighty-two per cent of cases were related to lung, breast and melanoma primaries. Half of patients received a form of treatment with the other half receiving best supportive care. Of these, whole-brain radiotherapy (39%) and stereotactic radiosurgery (40%) were the most common treatment modalities. Most common reasons for admissions were headaches, seizures, weakness and confusion. CONCLUSION: This is the first study in the UK that gives an in-depth overview of the real-world management of brain metastases. We have demonstrated the prevalence of treatment across the spectrum of brain metastases patients. Radiotherapy is the mainstay of treatment in nearly 80% of cases; however, care needs to be taken in ensuring that SRS is offered to those who are suitable.


Asunto(s)
Neoplasias Encefálicas/secundario , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/terapia , Neoplasias de la Mama/mortalidad , Instituciones Oncológicas , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Melanoma/mortalidad , Persona de Mediana Edad , Cuidados Paliativos/estadística & datos numéricos , Radiocirugia/estadística & datos numéricos , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Irradiación Corporal Total/estadística & datos numéricos
6.
Health Phys ; 116(5): 577-581, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30908317

RESUMEN

The 11 March 2011 Fukushima nuclear accident in Japan resulted in widespread radioactive contamination within the 20 km evacuation zone. Japanese field mice (Apodemus speciosus) living within the contaminated region received radiation doses from external environmental contamination as well as internally deposited radionuclides. Cataract formation in the lens of eyes of these mice is a possible deterministic effect of ionizing radiation; however, determination of actual doses is difficult. Since no dose conversion factors currently exist for the lens of the eyes of Japanese field mice, lens dose conversion factors were created using a Monte Carlo N-Particle simulation and compared to the International Commission on Radiological Protection Publication 108 reference rat whole-body dose conversion factors. Monte Carlo N-Particle simulations included doses to the lens of the eyes from external sources (received while both above and below ground), as well as doses from internal contamination. Although the Publication 108 reference rat is almost twice the average mass of the Japanese field mouse, all dose conversion factor calculations using Monte Carlo N-Particle methods were within approximately 37% of the Publication 108 values for the reference rat.


Asunto(s)
Accidente Nuclear de Fukushima , Cristalino/efectos de la radiación , Exposición a la Radiación/análisis , Monitoreo de Radiación/métodos , Contaminantes Radiactivos del Suelo/análisis , Irradiación Corporal Total/estadística & datos numéricos , Animales , Japón , Ratones , Método de Montecarlo , Dosis de Radiación , Ratas
7.
Int J Radiat Oncol Biol Phys ; 100(3): 710-718, 2018 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-29413283

RESUMEN

PURPOSE: To analyze effects of closure of an academic proton treatment center (PTC) on pediatric case volume, distribution, and resident education. METHODS AND MATERIALS: This was a review of 412 consecutive pediatric (age ≤18 years) cases treated at a single institution from 2012 to 2016. Residents' Accreditation Council for Graduate Medical Education case logs for the same years were also analyzed. Characteristics of the patient population and resident case volumes before and after closure of the PTC are reported. RESULTS: Overall pediatric new starts declined by approximately 50%, from 35 to 70 per 6 months in 2012 to 2014 to 22 to 30 per 6 months in 2015 to 2016. Central nervous system (CNS) case volume declined sharply, from 121 patients treated in 2012 to 2015 to 18 patients in 2015 to 2016. In 2012 to 2014 our institution treated 36, 24, and 17 patients for medulloblastoma/intracranial primitive neuroectodermal tumor, ependymoma, and low-grade glioma, respectively, compared with 0, 1, and 1 patient(s) in 2015 to 2016. Forty-nine patients were treated with craniospinal radiation (CSI) from 2012 to 2014, whereas only 2 patients underwent CSI between 2015 and 2016. Hematologic malignancy patient volume and use of total body irradiation remained relatively stable. Patients treated when the PTC was open were significantly younger (9.1 vs 10.7 years, P=.010) and their radiation courses were longer (35.4 vs 20.9 days, P<.0001) than those treated after its closure. Resident case logs showed only a small decline in total pediatric cases, because the percentage of pediatric cases covered by residents increased after PTC closure; however, residents logged fewer CNS cases after PTC closure versus before. CONCLUSIONS: Overall pediatric case volume decreased after PTC closure, as did the number of patients treated for potentially curable CNS tumors. Our findings raise important questions regarding resident training in pediatric radiation oncology as these cases become increasingly concentrated at specialized centers.


Asunto(s)
Instituciones Oncológicas/estadística & datos numéricos , Neoplasias del Sistema Nervioso Central/radioterapia , Clausura de las Instituciones de Salud/estadística & datos numéricos , Neoplasias Hematológicas/radioterapia , Internado y Residencia/estadística & datos numéricos , Terapia de Protones/estadística & datos numéricos , Oncología por Radiación/estadística & datos numéricos , Adolescente , Niño , Craneofaringioma/radioterapia , Irradiación Craneoespinal/estadística & datos numéricos , Ependimoma/radioterapia , Humanos , Internado y Residencia/organización & administración , Meduloblastoma/radioterapia , Tumores Neuroectodérmicos Primitivos/radioterapia , Radiocirugia/estadística & datos numéricos , Irradiación Corporal Total/estadística & datos numéricos
8.
Int J Radiat Oncol Biol Phys ; 97(2): 270-277, 2017 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-28068235

RESUMEN

PURPOSE: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated. METHODS AND MATERIALS: We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI. RESULTS: Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03). CONCLUSIONS: Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neuroblastoma/diagnóstico por imagen , Neuroblastoma/radioterapia , Neuroblastoma/secundario , Irradiación Corporal Total , 3-Yodobencilguanidina , Adolescente , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/radioterapia , Neoplasias de las Glándulas Suprarrenales/terapia , Niño , Preescolar , Protocolos Clínicos , Terapia Combinada/métodos , Femenino , Humanos , Quimioterapia de Inducción/métodos , Lactante , Estimación de Kaplan-Meier , Masculino , Neuroblastoma/terapia , Radiofármacos , Estudios Retrospectivos , Riesgo , Estadísticas no Paramétricas , Trasplante de Células Madre , Trasplante Autólogo , Irradiación Corporal Total/estadística & datos numéricos
9.
Cancer Radiother ; 20(4): 304-7, 2016 Jun.
Artículo en Francés | MEDLINE | ID: mdl-27342946

RESUMEN

A survey was conducted in 2015 in France on the care of children in radiotherapy services. We present the results for total body irradiation in children, a specific technique of radiation treatment, which needs dedicated controls for this particular population. Of the 17 centres interviewed, 16 responded, and 13 practiced total body irradiation. Patients are positioned in lateral decubitus in 11 centres and supine/prone in two centres. Doses used for total body irradiation in myeloablative bone marrow transplantation are the same in all centres (12Gy); treatments are always fractionated. Lung shielding is positioned to limit the dose at an average of 8Gy with extremes ranging from 6 to 10Gy. The shape of the shieldings varies depending on departments' protocol, with a smaller size in case of mediastinal mass. Four centres have experience of total body irradiation under general anaesthesia, despite twice-daily fractions. In total, practice is relatively homogeneous throughout France and is inspired by the knowledge obtained in adults.


Asunto(s)
Pautas de la Práctica en Medicina/estadística & datos numéricos , Irradiación Corporal Total/estadística & datos numéricos , Anestesia General/estadística & datos numéricos , Niño , Francia , Humanos , Órganos en Riesgo , Posicionamiento del Paciente/estadística & datos numéricos , Protección Radiológica/estadística & datos numéricos , Dosificación Radioterapéutica , Encuestas y Cuestionarios
10.
Int J Radiat Biol ; 92(2): 59-70, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26857121

RESUMEN

PURPOSE: An interlaboratory comparison of radiation dosimetry was conducted to determine the accuracy of doses being used experimentally for animal exposures within a large multi-institutional research project. The background and approach to this effort are described and discussed in terms of basic findings, problems and solutions. METHODS: Dosimetry tests were carried out utilizing optically stimulated luminescence (OSL) dosimeters embedded midline into mouse carcasses and thermal luminescence dosimeters (TLD) embedded midline into acrylic phantoms. RESULTS: The effort demonstrated that the majority (4/7) of the laboratories was able to deliver sufficiently accurate exposures having maximum dosing errors of ≤5%. Comparable rates of 'dosimetric compliance' were noted between OSL- and TLD-based tests. Data analysis showed a highly linear relationship between 'measured' and 'target' doses, with errors falling largely between 0 and 20%. Outliers were most notable for OSL-based tests, while multiple tests by 'non-compliant' laboratories using orthovoltage X-rays contributed heavily to the wide variation in dosing errors. CONCLUSIONS: For the dosimetrically non-compliant laboratories, the relatively high rates of dosing errors were problematic, potentially compromising the quality of ongoing radiobiological research. This dosimetry effort proved to be instructive in establishing rigorous reviews of basic dosimetry protocols ensuring that dosing errors were minimized.


Asunto(s)
Laboratorios/estadística & datos numéricos , Exposición a la Radiación/análisis , Recuento Corporal Total/instrumentación , Irradiación Corporal Total/instrumentación , Absorción de Radiación , Animales , Diseño de Equipo , Análisis de Falla de Equipo , Ratones , Exposición a la Radiación/estadística & datos numéricos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Recuento Corporal Total/métodos , Recuento Corporal Total/estadística & datos numéricos , Irradiación Corporal Total/estadística & datos numéricos
11.
Magy Onkol ; 59(2): 85-94, 2015 Jun.
Artículo en Húngaro | MEDLINE | ID: mdl-26035155

RESUMEN

The purpose of the study is to report the status of Hungarian radiotherapy (RT) based on the assessment of treatment data in years 2012 to 2014, available infrastructure, and RT staffing. Between December 2014 and January 2015, a RT questionnaire including 3 parts (1. treatment data; 2. infrastructure; 3. staffing) was sent out to all Hungarian RT centers (n=12). All RT centers responded to all questions of the survey. 1. Treatment data: In 2014, 33,162 patients were treated with RT: 31,678 (95.5%) with teletherapy, and 1484 (4.5%) with brachytherapy (BT). Between 2012 and 2014, the number of patients treated with radiotherapy increased with 6.6%, but the number of BT patients decreased by 11%. Forty-two percent of all patients were treated in the two centers of the capital: 9235 patients (28%) at the National Institute of Oncology (NIO), and 4812 (14%) at the Municipial Oncoradiology Center (MOC). Out of the patients treated on megavoltage RT units (n=22,239), only 901 (4%) were treated with intensity-modulated RT (IMRT), and 2018 (9%) with image-guided RT (IGRT). In 2014, 52% of all BT treatments were performed in Budapest: NIO - 539 patients (36%); MOC - 239 patients (16%); and BT was not available in 3 RT centers. Prostate I-125 seed implants and interstitial breast BT was utilized in one, prostate HDR BT in two, and head&neck implants in three centers. 2. Infrastructure: Including ongoing development projects funded by the European Union, by the end of year 2015, 39 megavoltage teletherapy units, and 12 HDR BT units will be in use in 13 available Hungarian RT centers. 3. Staffing: Actually, 92 radiation oncologists (RO), 29 RT residents, 61 medical physicists, and 229 radiation therapy technologists are working in 12 RT centers. There are 23 vacant positions (including 11 RO positions) available at the Hungarian RT centers. According to the professional minimal requirements and WHO guidelines, the implementation of 11 new linear accelerators, and 1 BT units are needed in Hungary. Further resources for the development and upgrade of RT infrastructure and capacity should be allocated to RT centers in Budapest. Brachytherapy and modern teletherapy (e.g. IMRT and IGRT) are underutilized in Hungary compared to other European countries. Implementation of continuous education and practical training programs in leading Hungarian and international RT centers are suggested in an effort to a wider implementation of modern RT techniques in Hungarian RT centers.


Asunto(s)
Instituciones Oncológicas/estadística & datos numéricos , Aceleradores de Partículas/estadística & datos numéricos , Oncología por Radiación/estadística & datos numéricos , Radioterapia/estadística & datos numéricos , Braquiterapia/estadística & datos numéricos , Neoplasias de la Mama/radioterapia , Instituciones Oncológicas/organización & administración , Instituciones Oncológicas/provisión & distribución , Unión Europea , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Encuestas de Atención de la Salud , Personal de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Hungría , Masculino , Neoplasias de la Próstata/radioterapia , Oncología por Radiación/organización & administración , Oncología por Radiación/tendencias , Radiocirugia/estadística & datos numéricos , Radioterapia/instrumentación , Radioterapia/métodos , Radioterapia de Alta Energía/estadística & datos numéricos , Radioterapia Guiada por Imagen/estadística & datos numéricos , Radioterapia de Intensidad Modulada/estadística & datos numéricos , Encuestas y Cuestionarios , Irradiación Corporal Total/estadística & datos numéricos , Recursos Humanos
12.
Radiat Res ; 183(2): 233-9, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25635344

RESUMEN

Space radiation, which is comprised of high-energy charged (HZE) particles with different high-linear energy transfer (LET), induces more severe biological effects than the Earth's radiation. NASA has mandated that risk estimates of carcinogenesis induced by exposure to HZE particles with different LET be determined before conducting human explorations of Mars. Because lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in humans, it is critical the risk of that radiation-induced lung tumorigenesis be included when estimating the risks of space radiation to astronauts. To address this, we examined the incidence of lung tumorigenesis in wild-type C57BL/6 mice at 1.5 years after 1 Gy exposure (single or fractionated dose) to different types of radiation with different LET (iron, silicon, oxygen and X ray). We chose wild-type mice for this study because previous studies of radiation-induced lung tumorigenesis using mutant mice models (either downregulated tumor suppressors or upregulated oncogenes) may not accurately reflect the response of healthy individuals (astronauts) to space radiation. Our study clearly showed that HZE particles (iron, silicon and oxygen) induced a higher incidence of lung tumorigenesis than X rays, and that their relative effectiveness at 1 Gy was >6. In addition, we found that silicon exposure appears to induce more aggressive lung tumors. These results provide valuable information for future followup experiments to study the underlying mechanism of lung tumorigenesis, which will improve risk estimation of space radiation-induced lung tumorigenesis and help in the development of mitigators to reduce risk if it exceeds NASA guidelines.


Asunto(s)
Radiación Cósmica , Fraccionamiento de la Dosis de Radiación , Neoplasias Pulmonares/epidemiología , Neoplasias Inducidas por Radiación/epidemiología , Irradiación Corporal Total/estadística & datos numéricos , Enfermedad Aguda , Animales , Femenino , Iones Pesados , Incidencia , Transferencia Lineal de Energía , Estudios Longitudinales , Masculino , Ratones , Ratones Endogámicos C57BL , Dosis de Radiación , Factores de Riesgo , Estados Unidos
13.
Pediatr Radiol ; 43(9): 1152-8, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23539148

RESUMEN

BACKGROUND: Children undergoing total body irradiation (TBI) often develop delayed skeletal complications. Bone-age studies in these children often reveal subtle paraphyseal changes including physeal widening, metaphyseal irregularity and paraphyseal exostoses. OBJECTIVE: To investigate whether paraphyseal changes on a bone-age study following TBI indicate a predisposition toward developing other radiation-associated skeletal complications. MATERIALS AND METHODS: We retrospectively reviewed medical records and bone-age studies of 77 children receiving TBI at our institution between 1995 and 2008 who had at least 2 years of clinical follow-up and one bone-age study after TBI. We graded bone-age studies according to the severity of paraphyseal changes. All documented skeletal complications following TBI were tabulated. Kendall's tau-b was used to examine associations between degree of paraphyseal change and development of a skeletal complication. RESULTS: Kendall's tau analyses showed that physeal widening and metaphyseal irregularity/sclerosis (tau = 0.87, P < 0.001) and paraphyseal exostoses (tau = 0.68, P < 0.001) seen on bone-age studies were significantly positively associated with the development of delayed skeletal complications following TBI. Thirty percent of children with no or mild paraphyseal changes developed a delayed skeletal complication, compared with 58% of children with moderate paraphyseal changes and 90% of children with severe paraphyseal changes. CONCLUSION: Paraphyseal changes identified on a bone-age study correlate positively with the development of delayed skeletal complications elsewhere in the skeleton following TBI.


Asunto(s)
Determinación de la Edad por el Esqueleto/estadística & datos numéricos , Placa de Crecimiento/diagnóstico por imagen , Placa de Crecimiento/efectos de la radiación , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/epidemiología , Irradiación Corporal Total/estadística & datos numéricos , Adolescente , Causalidad , Niño , Preescolar , Femenino , Humanos , Incidencia , Masculino , Pennsylvania/epidemiología , Prevalencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Resultado del Tratamiento
14.
Int J Radiat Biol ; 89(6): 391-400, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23362954

RESUMEN

PURPOSE: Life shortening and pathological complications in similarly irradiated cohorts of the laboratory mouse Mus musculus and the white-footed mouse Peromyscus leucopus were recorded in the course of the Janus studies conducted at Argonne National Laboratory from 1970-1992. This study examines how lifespan, tumor and non-tumor disease incidence, and tumor multiplicity are differentially affected by gamma-rays and neutron radiation exposure in two different animal species. MATERIALS AND METHODS: Survival analyses examined differences in lifespan across species, while decision tree analyses examined statistically significant associations between lifespan, radiation exposure, and specific diseases. Logistic regression models were generated to examine the likelihood of disease incidence in these two species following gamma-ray or neutron radiation exposure. RESULTS: Life shortening in response to radiation was more significant in Peromyscus leucopus than in Mus musculus, irrespective of radiation quality. Many types of tumor and non-tumor diseases were found to be consistently species specific. Tumor multiplicity was observed in both species in response to radiation, although more pronounced in Mus musculus. CONCLUSION: The response to radiation was highly species specific, highlighting the difficulty in extrapolating conclusions from one species to another, irrespective of their phenotypic similarities and ecologic niches.


Asunto(s)
Mortalidad Prematura , Traumatismos por Radiación/mortalidad , Tasa de Supervivencia , Irradiación Corporal Total/estadística & datos numéricos , Animales , Relación Dosis-Respuesta en la Radiación , Técnicas In Vitro , Incidencia , Masculino , Ratones , Ratones Endogámicos C57BL , Dosis de Radiación , Factores de Riesgo , Especificidad de la Especie
15.
J Radiol Prot ; 32(1): N9-N13, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22395124

RESUMEN

Effects and risk from exposure to ionising radiation depend upon the absorbed dose, dose rate, quality of radiation, specifics of the tissue irradiated and other factors such as the age of the individual. Effects may be apparent almost immediately or may take decades to be manifest. Cancer is the most important stochastic effect at absorbed doses of less than 1 Gy. The risk of cancer induction varies widely across different tissues; however, the risk of fatal radiation-induced cancer for a general population following chronic exposure is about 5% Sv(-1). Quantification of cancer risk at doses of less than 0.1 Gy remains problematic. Hereditary risks from irradiation that might result in effects to offspring of humans appear to be much lower and any such potential risks can only be estimated from animal models. At high doses (over 1 Gy) cell killing and modification causes deterministic effects such as skin burns, and bone marrow depression, in which case immunosuppression becomes a critical issue. Acute whole body penetrating gamma irradiation at doses in excess of 2 Gy results in varying degrees of acute radiation sickness and doses over 10 Gy are usually lethal as a result of combined organ injury.


Asunto(s)
Síndrome de Radiación Aguda/epidemiología , Carga Corporal (Radioterapia) , Exposición a Riesgos Ambientales/estadística & datos numéricos , Neoplasias Inducidas por Radiación/epidemiología , Modelos de Riesgos Proporcionales , Recuento Corporal Total/estadística & datos numéricos , Irradiación Corporal Total/estadística & datos numéricos , Humanos , Prevalencia , Medición de Riesgo , Factores de Riesgo
16.
Pak J Pharm Sci ; 25(1): 169-73, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22186326

RESUMEN

We examined time-dependent changes in plasma lipids of rats given total body irradiation (TBI) with X-rays at 3 Gy. for consecutive periods. Animals were exposed to x ray radiations consecutively for 20 days at 5 day interval thereafter five animals were picked at random and sacrificed (5, 10, 15 and 20 days after beginning the exposure). The triacylglycerols and total cholesterol serum levels were significant differences between control and experimental groups after the first exposure (5 days), values for the triacylglcerols were significantly higher with the second (day 10) and third (day 15) radiation exposures but not with the fourth radiation exposures (day 20) (p<0.05). However, the serum cholesterol values were not found to be significant with the second and third exposures but with the fourth exposure (day 20) (p<0.05). The serum HDL-C concentrations were not significantly different between control and experimental groups at any time analyzed. But the LDL cholesterol was found to decrease on days 5 and 20 of the experimental period. Our results indicate that the applied long term exposure to x rays ionization radiations exposure may induce slight but statistically significant alterations in some serum lipids profile of rats, within the physiological range. The mechanisms for the effects of these ionizing radiations on serum lipid profile are not well understand yet, we suggest that the changes could be due to some non-specific stress reactions. The consequences of our observation are not known yet, but could point to some possible clinical intervention.


Asunto(s)
Ácidos Grasos/sangre , Metabolismo de los Lípidos/efectos de la radiación , Lípidos/sangre , Irradiación Corporal Total/métodos , Animales , Colesterol/sangre , Ratas , Ratas Wistar , Factores de Tiempo , Irradiación Corporal Total/estadística & datos numéricos
17.
Radiat Res ; 177(2): 220-8, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22149958

RESUMEN

Whole-body and thoracic ionizing radiation exposure are associated with increased cardiovascular disease (CVD) risk. In atomic bomb survivors, radiation dose is also associated with increased hypertension incidence, suggesting that radiation dose may be associated with chronic renal failure (CRF), thus explaining part of the mechanism for increased CVD. Multivariate Poisson regression was used to evaluate the association of radiation dose with various definitions of chronic kidney disease (CKD) mortality in the Life Span Study (LSS) of atomic bomb survivors. A secondary analysis was performed using a subsample for whom self-reported information on hypertension and diabetes, the two biggest risk factors for CRF, had been collected. We found a significant association between radiation dose and only our broadest definition of CRF among the full cohort. A quadratic dose excess relative risk model [ERR/Gy(2) = 0.091 (95% CI: 0.05, 0.198)] fit minimally better than a linear model. Within the subsample, association was also observed only with the broadest CRF definition [ERR/Gy(2) = 0.15 (95% CI: 0.02, 0.32)]. Adjustment for hypertension and diabetes improved model fit but did not substantially change the ERR/Gy(2) estimate, which was 0.17 (95% CI: 0.04, 0.35). We found a significant quadratic dose relationship between radiation dose and possible chronic renal disease mortality that is similar in shape to that observed between radiation and incidence of hypertension in this population. Our results suggest that renal dysfunction could be part of the mechanism causing increased CVD risk after whole-body irradiation, a hypothesis that deserves further study.


Asunto(s)
Carga Corporal (Radioterapia) , Enfermedades Cardiovasculares/mortalidad , Traumatismos por Radiación/mortalidad , Insuficiencia Renal/mortalidad , Irradiación Corporal Total/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Lactante , Recién Nacido , Japón/epidemiología , Masculino , Persona de Mediana Edad , Guerra Nuclear , Prevalencia , Dosis de Radiación , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Sobrevivientes , Adulto Joven
18.
J Radiol Prot ; 31(1): 83-93, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21346283

RESUMEN

Children with malignant lymphoma undergo many diagnostic procedures that involve exposure to ionising radiation. In addition, many, but by no means all, undergo further exposure to ionising radiation during radiotherapy. While therapeutic radiation exposures are prescribed, the extent of radiation exposure arising from diagnostic procedures utilised in such children is largely unknown. We completed an audit of the radiation doses arising from diagnostic imaging procedures performed in a cohort of children with malignant lymphoma. The cumulative effective radiation dose associated with radiographic and radioisotopic procedures was derived for 81 children and adolescents with malignant lymphoma during their diagnosis, treatment and follow-up. Thirty-eight of the 42 patients (90%) with Hodgkin lymphoma were alive at study termination, with follow-up periods ranging from 1.9 to 11.7 years (median 5.3). Thirty-three of the 39 patients (85%) with non-Hodgkin lymphoma were alive at study termination with follow-up periods ranging from 2.4 to 12.3 years (median 7.5). The median effective dose was 518 mSv for patients with Hodgkin lymphoma and 309 mSv for those with non-Hodgkin lymphoma. The maximum effective dose was 1.7 Sv. The principal contributors to the effective dose were computed tomography (CT) and nuclear medicine imaging procedures using (67)Ga. Protocols for the management of children and adolescents with malignant lymphoma should be reviewed in order to reduce the radiation detriment without loss of essential diagnostic information.


Asunto(s)
Carga Corporal (Radioterapia) , Linfoma/diagnóstico , Linfoma/mortalidad , Dosis de Radiación , Irradiación Corporal Total/estadística & datos numéricos , Adolescente , Niño , Preescolar , Diagnóstico por Imagen , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Ontario/epidemiología , Prevalencia , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Adulto Joven
19.
J Radiat Res ; 52(1): 24-31, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21127390

RESUMEN

We evaluated the efficacy and safety of stereotactic body radiation therapy (SBRT) for patients with head and neck tumors. From April 2005 through April 2008, 34 patients with head and neck tumors were treated with CyberKnife SBRT. Twenty-one of them had prior radiotherapy. Treatment sites were orbit (n = 7), cervical lymph nodes (n = 6), nasopharynx (n = 5), oropharynx (n = 4) and others (n = 12). The prescribed dose ranged from 19.5 to 42 Gy (median, 30 Gy) in 3-8 fractions for consecutive days. The target volume ranged from 0.7 to 78.1 cm(3) (median, 11.6 cm(3)). The median follow-up was 16 months. Treatment was well tolerated without significant acute complications in any cases. Complete response rate and partial response rate were 32.4% and 38.6%, respectively. The overall survival rates were 70.6% and 58.3% at 12 and 24 months, respectively. The overall survival was better in patients without prior radiotherapy within the previous 24 months or in case of smaller target volume. Six patients suffered severe late complications. All these patients had prior radiotherapy, and 2 of them developed massive hemorrhage in the pharynx and both died of this complication 5 and 28 months, respectively, after SBRT. Our preliminary results suggest that SBRT is an effective treatment modality for head and neck tumors. However, re-irradiation has significant risk of severe and even fatal late complications in the form of necrosis and hemorrhage in re-irradiated areas.


Asunto(s)
Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/cirugía , Radiocirugia/estadística & datos numéricos , Irradiación Corporal Total/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del Tratamiento , Adulto Joven
20.
Wiad Lek ; 64(3): 164-9, 2011.
Artículo en Polaco | MEDLINE | ID: mdl-22335138

RESUMEN

BACKGROUND: Graft-versus-host disease (GVHD) is the most common and most serious complication of allogeneic hematopoetic stem cell transplantation (HSCT). The aim of this study was to assess the incidence of GVHD after allogeneic HSCT depending on the diagnosis and risk factors. MATERIAL AND METHODS: The study group comprised 78 patients aged 18 to 61 in whom allogeneic transplantation of hematopoietic stem cell in the Department and Clinic of Hematology, Oncology and Internal Diseases of Medical University in Warsaw (Poland) was performed. RESULTS: Acute form of GVHD was significantly more often occurred after total body irradiation (TBI) for patients with TBI who did not (p < 0.05). CONCLUSIONS: Risk factors for aGVHD were: age of the recipient, acute myeloid leukemia, myeloablative conditioning, TBI and unrelated donor.


Asunto(s)
Enfermedad Injerto contra Huésped/epidemiología , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Trasplante de Células Madre/estadística & datos numéricos , Trasplante Homólogo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Causalidad , Femenino , Enfermedad Injerto contra Huésped/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Factores de Riesgo , Trasplante de Células Madre/efectos adversos , Trasplante Homólogo/efectos adversos , Irradiación Corporal Total/efectos adversos , Irradiación Corporal Total/estadística & datos numéricos , Adulto Joven
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