Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver.

BACKGROUND: Radio(chemo)therapy is often required in pelvic malignancies (cancer of the anus, rectum, cervix). Direct irradiation adversely affects ovarian and endometrial function, compromising the fertility of women. While ovarian transposition is an established method to move the ovaries away from the radiation field, surgical procedures to displace the uterus are investigational. This study demonstrates the surgical options for uterine displacement in relation to the radiation dose received.  METHODS: The uterine displacement techniques were carried out sequentially in a human female cadaver to demonstrate each procedure step by step and assess the uterine positions with dosimetric CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetric scans (1. anatomical position, 2. uterine suspension of the round ligaments to the abdominal wall 3. ventrofixation of the uterine fundus at the umbilical level, 4. uterine transposition). Treatments were planned on Eclipse® System (Varian Medical Systems®,USA) using Volumetric Modulated Arc Therapy. Data about maximum (Dmax) and mean (Dmean) radiation dose received and the volume receiving 14 Gy (V14Gy) were collected. RESULTS: All procedures were completed without technical complications. In the rectal cancer simulation with delivery of 50 Gy to the tumor, Dmax, Dmean and V14Gy to the uterus were respectively 52,8 Gy, 34,3 Gy and 30,5cc (1), 31,8 Gy, 20,2 Gy and 22.0cc (2), 24,4 Gy, 6,8 Gy and 5,5cc (3), 1,8 Gy, 0,6 Gy and 0,0cc (4). For anal cancer, delivering 64 Gy to the tumor respectively 46,7 Gy, 34,8 Gy and 31,3cc (1), 34,3 Gy, 20,0 Gy and 21,5cc (2), 21,8 Gy, 5,9 Gy and 2,6cc (3), 1,4 Gy, 0,7 Gy and 0,0cc (4). CONCLUSIONS: The feasibility of several uterine displacement procedures was safely demonstrated. Increasing distance to the radiation field requires more complex surgical interventions to minimize radiation exposure. Surgical strategy needs to be tailored to the multidisciplinary treatment plan, and uterine transposition is the most technically complex with the least dose received.

[Advances in research on organ-at-risk protection in pelvic tumor external beam radiotherapy].

The simultaneous objectives of destroying tumor cells while protecting normal pelvic organs present a dual clinical and technical challenge within the realm of pelvic tumor radiotherapy. This article reviews the latest literatures, focusing on technological innovations in key aspects of radiotherapy such as positioning, planning, and delivery. These include positioning fixation techniques, organ-at-risk avoidance irradiation, non-coplanar irradiation techniques, as well as organ displacement protection and image-guided adaptive techniques. It summarizes and discusses the research progress made in the protection of critical organs during pelvic tumor radiotherapy. The paper emphasizes technological advancements in the protection of critical organs throughout the processes of radiotherapy positioning, planning, and implementation, aiming to provide references for further research on the protection of critical organs in the external irradiation treatment of pelvic tumors.

Emergent radiotherapy for pelvic malignancies: a narrative review.

BACKGROUND AND OBJECTIVE: Patients with primary genitourinary (GU), gynecologic (GYN) and gastrointestinal (GI) cancers can develop life-threatening or critical function-threatening symptoms that necessitate emergent intervention with palliative radiotherapy (RT). Unfortunately, research describing the use of RT in this critical setting is lacking. We aimed to review literature describing emergent palliative RT for primary pelvic malignancies and provide a narrative synthesis of relevant studies. METHODS: A medical librarian searched Ovid MEDLINE, Embase Classic, and Embase databases for relevant English language references from 1946-2022. No restrictions were placed on study type, publication type or date. References for GU, GYN and GI cancers were grouped and synthesized separately. KEY CONTENT AND FINDINGS: The treatment of bleeding from primary pelvic tumors was the only indication for emergent RT identified, however, no references reported dedicated cohorts of patients treated for bleeding in the emergent setting. Most references were retrospective single institution studies describing various dose fractionation schemes for non-emergent palliative RT. Outcome measures and response assessment times varied. The latency to hemostasis after RT commencement was not well described; most studies reported outcomes captured weeks or months following treatment. In general, high rates of hemostasis for GU, GYN and GI tumors have been reported following RT schedules ranging from a single fraction to many weeks of fractionated treatments. Bleeding seems to respond more favorably than other symptoms including pain and obstruction. CONCLUSIONS: Managing bleeding was the only indication for emergent RT identified in our search. Scant data exist that describe the latency to a hemostatic response following RT. This is an important knowledge gap in the literature given how commonly patients are affected by this complication of primary pelvic malignancies.

Managing menopause in an irradiated pelvis - uncharted territory.

Radiotherapy is an effective cancer treatment, particularly for pelvic tumours. The number of patients with pelvic cancer being diagnosed and successfully treated is growing. Radiotherapy to the pelvis causes lasting side-effects collectively referred to as pelvic radiation disease (PRD), including bowel, bladder, sexual dysfunction, vaginal and cervical stenoses, and menopause. There is growing interest in management of menopause in cancer survivors, with the primary focus on the oncologic risk of hormone replacement therapy (HRT). Research examining if the modality with which the cancer was treated causes menopause-specific side effects is rare; however, malabsorption syndromes and anatomical changes in the pelvis post-radiotherapy may complicate effective delivery and monitoring of HRT. Consideration of these changes may significantly benefit patients in this young and growing cohort; thus, there is an urgent need to raise awareness of PRD among all clinicians, including those providing menopause care.

Interventions for Managing Late Gastrointestinal Symptoms Following Pelvic Radiotherapy: a Systematic Review and Meta-analysis.

AIMS: Pelvic radiotherapy can induce gastrointestinal injury and symptoms, which can affect quality of life. We assessed interventions for managing these symptoms. MATERIALS AND METHODS: A review of randomised controlled trials published between January 1990 and June 2023 from databases including MEDLINE, EMBASE, CENTRAL, CINAHL, clinicaltrials.gov, ISRCTN and grey literature sources was conducted. Meta-analyses were carried out using the DerSimonian and Laird random effects model to produce overall treatment differences with 95% confidence intervals. RESULTS: Twenty-eight studies (2392 participants) of varying methodological quality were included. 4% formalin was superior to sucralfate for improving gastrointestinal symptom score (standardised mean difference [SMD] -1.07, 95% confidence interval -1.48 to -0.65). Argon plasma coagulation (APC) was inferior to sucralfate (SMD 1.22, 95% confidence interval 0.84 to 1.59). Counselling positively influenced symptom score (SMD -0.53, 95% confidence interval -0.76 to -0.29), whereas hyperbaric oxygen therapy showed conflicting results. Sucralfate combined with APC increased endoscopic markers of moderate-severe bleeding versus APC alone (risk ratio 2.26, 95% confidence interval 1.12 to 4.55). No definite conclusions on pain, incontinence, diarrhoea, tenesmus or quality of life interventions were confirmed. CONCLUSIONS: Small study sizes, methodological quality and heterogeneity limit support of any individual intervention. APC and 4% formalin seem to be promising interventions, with further larger randomised controlled trials now warranted.

Efficacy and Safety of 125I Seed Implantation in the Treatment of Pelvic Recurrent Cervical Cancer Following Radiotherapy: A Single-Arm Meta-Analysis of Chinese Patients.

BACKGROUND: The study aimed to assess the efficacy and safety of 125I seed implantation in the treatment of pelvic recurrent cervical cancer following radiotherapy. This meta-analysis was registered in PROSPERO. We looked up relevant studies in the databases of CNKI, Wanfang, CBM, PubMed, Embase, Cochrane Library, and Web of Science. The endpoint measures include the objective response rate, disease control rate, progression-free survival, overall survival, and adverse events. RECENT FIDINGS: The meta-analysis included six studies and a total of 246 patients. The pooled ORR of tumor response was 63%, and the DCR was 87%. The median PFS was 9.09 months, and the median OS was 13.46 months. The incidence of adverse events of Grade ≥III was 6%. CONCLUSION: In conclusion, this meta-analysis confirmed that 125I seed implantation has a good local control rate and high safety in the treatment of pelvic recurrent cervical cancer following radiotherapy, and can be used as a remedial treatment for pelvic recurrent cervical cancer following radiotherapy to prolong the survival time of patients. TRIAL REGISTRATION: PROSPERO: CRD42023423857.

Dose-Volume Parameters of Spared Magnetic Resonance Imaging-Defined Active Bone Marrow Predict Hematologic Toxicity in Pelvic Malignancies Patients Undergoing Radiotherapy: A Cohort Study.

Background: The objective of this investigation is to evaluate the superiority of dose-volume parameters relying on magnetic resonance imaging (MRI)-defined active bone marrow (ABM) over those based on total bone marrow (TBM) contoured via CT in the prediction of hematologic toxicity (HT) occurrence among patients with pelvic malignancies undergoing radiotherapy. Methods: The clinical data of 116 patients with pelvic malignancies treated with pelvic radiotherapy were analyzed retrospectively. The ABM areas on T1-weighted MRI were contoured. The statistical significance between TBM and ABM dose-volume measures was assessed through the utilization of either Student's t-test or Wilcoxon signed rank test. Logistic and linear regression models were employed to analyze the correlation between dose-volume parameters (V5-V50) and HT occurrence in pelvic ABM and TBM. Receiver operating characteristic (ROC) curves were used to compare predictors of HT2+. Results: There were significant differences in dosimetric parameters between ABM and TBM. Logistic regression analysis showed that ABM V5, ABM V10, ABM V15, ABM V20, and TBM V5 were significantly associated with the occurrence of HT2+ in pelvic malignancies. Linear regression analysis showed that ABM V5, ABM V10, and ABM V15 were significantly associated with white blood cell (WBC), absolute neutrophil count (ANC), hemoglobin (Hb), and lymphocyte (Lym) nadir. ABM V5, ABM V10, ABM V15, and ABM V30 were predictive of HT2+. Conclusions: More accurate prediction of HT in patients receiving pelvic radiotherapy may be achieved by relying on dose-volume parameters of MRI-based ABM. Further prospective studies are needed to confirm this.

125I seed brachytherapy for non-central pelvic recurrence of cervical cancer after external beam radiotherapy.

OBJECTIVE: To investigate the efficacy of 125I seed brachytherapy for non-central pelvic recurrence of cervical cancer after external beam radiotherapy, and to analyze the clinical influential factors. METHODS: Between June 2015 and April 2022, 32 patients with 41 lesions were treated with 125I seed brachytherapy. The seeds were implanted under the guidance of CT and/or 3D-printed template images at a median dose of 100 Gy (range, 80-120 Gy), and the local control rate (LCR) and survival rates were calculated. We used multivariate logistic regression to identify prognosis predictors, and receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off values. RESULTS: The median follow-up was 48.52 months (range, 4-86 months), and the 6-, 12-, and 24-month LCR was 88.0%, 63.2%, and 42.1%, respectively. The 1- and 2-year survival rates were 36% and 33%, respectively, and the median survival time was 13.26 months. No significant adverse events occurred. Multivariate regression analysis showed that tumor diameter, tumor stage, and LCR were independent factors influencing survival. ROC curve analysis showed that the area under the curve for tumor diameter and D90 were 0.765 and 0.542, respectively, with cut-off values of 5.3 cm and 108.5 Gy. CONCLUSIONS: The present findings indicate that 125I seed brachytherapy is feasible for treating non-central pelvic recurrence of cervical cancer after external beam radiotherapy. Further, tumor diameter < 5.3 cm and immediate postoperative D90 > 108.5 Gy were associated with better efficacy.

Educational telerehabilitation program for women with pelvic floor dysfunctions after gynecological pelvic cancer treatment: protocol study for a randomized and controlled clinical trial.

BACKGROUND: Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical-emotional factors of participants post-treatment for gynecological pelvic cancer. METHODS: Two-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results. DISCUSSION: Activities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women's quality of life.

Using Nerve Blocks for Addressing Radiation-Induced Pain During Pelvic Cancer Treatment.

This Viewpoint discusses the use of nerve blocks for pain during pelvic cancer treatment.

Therapeutics in radiation-induced proctopathy: a systematic review

Malignant neoplasms are increasingly prevalent in the daily clinical practice. Up to 61% of patients with pelvic malignancies undergo pelvic radiotherapy in different doses, which may cause intestinal damage, and the rectum is the segment most frequently affected due to its fixed position in the pelvis. Currently, there are several strategies to minimize the effects of radiation on the tissues surrounding the neoplastic site; despite those strategies, radiotherapy can still result in serious damage to organs and structures, and these injuries accompany patients throughout their lives. One of the most common damages resulting from pelvic radiotherapy is acute proctitis.The diagnosis is confirmed by visualizing the rectal mucosa through rigid or flexible rectosigmoidoscopy and colonoscopy. The objective of the present study was to review the forms of radiation-induced proctopathytherapy, and to evaluate the results of each method to propose a standardization for the treatment of this pathology. Despite the prevalence of radiation-induced proctopathy, there is no definitive standardized treatment strategy so far. The first approach can be tried with local agents, such as mesalazine and formalin. For refractory cases, control can usually be achieved with argon plasma coagulation, hyperbaric oxygen, and radiofrequency ablation therapies. Regarding the study of radiation-induced proctopathy, there is a lack of robust studies with large samples and standardized therapies to be compared. There is a lack of double-blinded, randomized controlled studies to determine a definitive standard treatment algorithm. (AU)

Aplicación de formalina al 4 para el tratamiento de la rectitis actínica hemorragia refractaria: variantes, técnicas y resultados / Application of formalin to 4 for the treatment of actinic rectitis refractory hemorrhage: variants, techniques and results

Introducción: Varios tratamientos se utilizan para la rectitis actínica hemorrágica, entre ellos corticoides, sucralfato, mezalasina y distintas variantes de cauterización endoscópica, aunque ninguno puede considerarse de elección. En este contexto, la aplicación local de formalina al 4% ha demostrado ser efectiva y segura cuando han fracasado otros tratamientos conservadores. Objetivo: Comunicar nuestra experiencia en el tratamiento de la rectitis actínica sangrante con formalina, describiendo las variantes técnicas de su aplicación y los resultados. Diseño: Observacional retrospectivo. Lugar de aplicación: Hospital público de la Ciudad de Buenos Aires. Pacientes y Método: Se revisaron registros hospitalarios de 10 pacientes (7 mujeres) de edad promedio 61,1±15,6 (rango 28-81) años, con rectitis sangrante posterior a radioterapia pelviana. La dosis osciló entre 7400 y 8000 cGy y el sangrado comenzó en promedio 7,2±3,1 (rango 2-12) meses luego de finalizada la misma. Todos los pacientes presentaban anemia y habían recibido uno o más tratamientos conservadores previos sin respuesta, tres de los cuales habían requerido transfusiones. La terapia con formalina se realizó con dos modalidades: Grupo I: hisopo embebido en formalina al 4% a ph 7 puesto en contacto con la superficie sangrante durante 1-2 minutos. Grupo II: instilación de un volumen de 100-200 ml, en bolos de 30-40 ml por área sangrante, mantenidos en contacto durante 30-60 segundos con posterior aspiración y lavado con solución fisiológica entre los bolos y al final del procedimiento. La respuesta fue considerada completa cuando el sangrado cesó por completo o sólo hubo esporádicas y escasas pérdidas hemáticas, que no requirieron ningún tratamiento. La respuesta parcial se definió como la mejoría en frecuencia y magnitud del sangrado que no requirió otra terapia agresiva. Resultados: Se trataron 10 pacientes (Grupo I: 8 y Grupo II: 2)... (TRUNCADO)...

Background: Several treatments are used for radiation-induced hemorrhagic proctitis, among these corticosteroids, sucralfate, mezalasina, and cauterization endoscopic variants, but none can be considered of choice. With varying results are described. In this context, the local application of 4% formalin has proven to be effective and safe when other conservative treatments have failed. Objective: To report on our experience in the treatment of radiation-induced hemorrhagic proctitis, describing the technical variants of its implementation and results. Design: Observational retrospective study. Setting: Public Hospital of the City of Buenos Aires. Patients and Methods: Hospital records of 10 patients (7 women), average age 61.1 ± 15.6 (range 28-81) years, with radiation-induced hemorrhagic proctitis after pelvic radiotherapy were reviewed. The doses ranged from 7400 to 8000 cGy and the bleeding started on average 7.2 ± 3.1 (range 2-12) months after it ended. All patients had anemia and had received one or more previous conservative treatments with no response, and three of them had required transfusions. Formalin therapy was performed in two ways: Group I: swab with 4% formalin at pH 7 in contact with the bleeding surface for 1-2 minutes. Group II: instillation of a volume of 100-200 ml, in 30-40 ml bolus by bleeding area, maintained in contact with that area for 30-60 seconds, with subsequent aspiration and washing with saline solution between the boluses and the end of the procedure. Treatment response was considered complete when the bleeding stopped completely or there was sporadic and limited blood loss not merequiring any treatment. Partial response was defined as improvement in the frequency and magnitude of bleeding not requiring other aggressive therapy... (TRUNCATED)...

Overexposure of radiation therapy patients in Panama: problem recognition and follow-up measures

This report summarizes and analyzes the responses of various organizations that provided assistance to the National Oncology Institute (Instituto Oncológico Nacional, ION) of Panama following the overexposure of 28 radiation therapy patients at the ION in late 2000 and early 2001. The report also looks at the long-term measures that were adopted at the ION in response to the overexposure incident, as well as implications that the incident has for other cancer treatment centers worldwide. In March 2001, the director of the ION was notified of serious overreactions in patients undergoing radiation therapy for cancer treatment. Of the 478 patients treated for pelvic cancers between August 2000 and March 2001, 3 of them had died, possibly from an overdose of radiation. In response, the Government of Panama invited international experts to carry out a full investigation of the situation. Medical physicists from the Pan American Health Organization (PAHO) were among those invited. They ascertained that 56 patients treated with partially blocked teletherapy fields for cancers of the uterine cervix, endometrium, prostate, or rectum, had had their treatment times calculated using a computerized treatment planning system. PAHO's medical physicists calculated the absorbed doses received by the patients and found that, of these 56 patients, only 11 had been treated with acceptable errors of ±5 percent. The doses received by 28 of the 56 patients had errors ranging from +10 to +105 percent. These are the patients identified by ION physicists as overexposed. Twenty-three of the 28 overexposed patients had died by September 2005, with at least 18 of the deaths being from radiation effects, mostly rectal complications. The clinical, psychological, and legal consequences of the overexposures crippled cancer treatments in Panama and prompted PAHO to assess radiation oncology practices in the countries of Latin American and the Caribbean. ION clinicians...

Este informe resume y analiza la respuesta de varias organizaciones que brindaron asistencia al Instituto Oncológico Nacional (ION) de Panamá después de la sobreexposición de 28 pacientes sometidos a radioterapia que ocurrió en el ION a finales de 2000 y principios de 2001. Además, se examinan las medidas de largo plazo adoptadas en el ION en respuesta al accidente de sobreexposición y las implicaciones que tiene este accidente para todos los centros de tratamiento oncológico en el mundo. En marzo de 2001 se le comunicaron al director del ION las reacciones adversas graves sufridas por algunos pacientes sometidos a radioterapia contra el cáncer. De los 478 pacientes tratados entre agosto de 2000 y marzo de 2001 por cánceres localizados en la región pélvica, tres habían fallecido, presumiblemente por sobredosis de radiación. A raíz de ello, el Gobierno de Panamá invitó a expertos internacionales a realizar una investigación a fondo de la situación. Entre los especialistas invitados se encontraban físicos médicos de la Organización Panamericana de la Salud (OPS), quienes comprobaron que 56 pacientes con cáncer cérvico-uterino, de endometrio, de próstata o de recto tratados mediante campos de teleterapia parcialmente bloqueados recibieron dosis calculadas mediante un sistema computarizado de planificación de tratamientos. Los físicos médicos de la OPS comprobaron que solo 11 de esos 56 pacientes recibieron una dosis absorbida dentro de los límites aceptables de ±5 por ciento. Veintiocho de los 56 pacientes recibieron dosis con errores entre +10 y +105 por ciento. De esos 28 pacientes que fueron sobreexpuestos, según los físicos del ION, 23 murieron antes de septiembre de 2005; de ellos, 18 murieron a causa de los efectos de las radiaciones, principalmente complicaciones rectales. Las consecuencias clínicas, psicológicas y jurídicas de esta sobreexposición menoscabaron gravemente los tratamientos contra el cáncer en Panamá y llevaron...

Radioterapia: lesões inflamatórias e funcionais de órgãos pélvicos / Radiotherapy: inflammatory and functional lesions of pelvic organs

A radioterapia pélvica tem sido cada vez mais indicada, em doses crescentes,como coadjuvante no tratamento das neoplasias pélvicas, com resultados cada vez melhores, mas com efeitos colaterais significativos. O advento da radioterapia tridimensional conformal estabelece um método que permite a mais precisa seleção de direção e de intensidade de raios emitidos para alvos pontuais, objetivando quase que exclusivamente o tumor, com a conseqüente preservação dos tecidos vizinhos, portanto com maior efetividade e com o mínimo de efeitos colaterais crônicos e insolúveis. Essas são as possibilidades teóricas que precisam ser comprovadas na prática.Elas envolvem um campo de observação cujos resultados reais tem sido subestimados, principalmente quando referidos a efeitos adversos. Esses não se limitam exclusivamente às mucosites, mas, também, a aspectos funcionais envolvendo incapacidades que vão, quando se trata do reto, além do que sempre foi atribuído à suposta síndrome da ressecção anterior 58, para abranger danos diretos da radiação sobre os complexos esfincterianos e os nervos dos plexos lombo-sacrais 21,22,59-63. Por enquanto, seja para o câncer de reto, para o câncer ginecológico e para o câncer de próstata, somos conclamados a investir no modelo mais preventivo do que curativo, ainda que o preventivo signifique apenas a mais precoce ação, pois para essas doenças de altas incidências e mortalidades "prevenir" no sentido de ação mais precoce é, sem dúvida, bem melhor que remediar, principalmente quando se faz uso das terapias neo-adjuvantes que poderiam ser dispensadas, em casos selecionados, para não somar ao desconforto emocional do portador do câncer todas as impossibilidades das iatrogenias inerentes ao tratamento que objetiva a cura. Assim, precisamos encontrar os fatores preditivos que nos permitam escolher os pacientes com probabilidade de cura apenas com o tratamento cirúrgico, para que eles fiquem livres da radioterapia e, por outro lado, buscar o...

Radiotherapy reducing local failure rates and improving overall survival has a favorable impact on the primary treatment of rectal cancer. However, radiation as an adjuvant therapy for that purpose and other pelvic malignances has been shown to increase long-term morbidity causing severe rectal or vesical mucositis, sometimes stenosis, undistensibler rectum with reduced capacity and/or anorectal dysfunction due lombosacralneuropathy with physiologic changes whose interaction remains poorly understood 60,63. Those iatrogenic outcomes stress the need for finding predictive factors for local recurrence to exclude patients with very high probability for cure with surgery alone and to use optimized radiation techniques22,64.

Dosimetria in vivo com uso de detectores semicondutores aplicada ao tratamento de câncer na região pélvica e de cabeça e pescoço

Entre os tipos de tratamentos utilizados no tratamento do câncer, a radioterapia é um procedimento terapêutico que se utiliza da radiação ionizante. Devido a sua importância no sistema de saúde, torna-se necessário um controle rigoroso das diversas etapas que devolvem o planejamento radioterápico até a entrega da dose ao paciente. O trabalho apresentado avalia, por meio da dosimetria in vivo, a dose de radiaçãoadministrada aos pacientes do Instituto Nacional de Câncer (INCA) do Rio de Janeiro, submetidos aos tratamentos radioterápicos da região pélvica e de cabeça e pescoço, utilizando detectores diodos semicondutores Isorad-p e Qed de 1-4 MV e 6-12 MV respectivamente. Aplicando os protocolos recomendados pela International Atomic Energy Agency (IAEA), os diodos Isorad-p e Qed foram testados quanto ao seu desempenho para as medidas in vivo no simulador antropomórfico Rando Alderson eadaptados para serem utilizados na medição de dose nos pacientes. Com um total de 68 medidas in vivo dentro do limite máximo de ±5% de dose, recomendada pela International Comission on Radiation Units and Measurements (ICRU), entre a doseabsorvida num dado ponto do tumor e a dose prescrita pelo radioterapeuta para o mesmo, estes diodos passam a ser uma segurança a mais na administração da dose ao paciente, pois oferecem a vantagem de uma leitura imediata e a possibilidade de intervenção no caso de uma discordância entre a dose prescrita e a dose administrada.

Transposição ovariana em pacientes com neoplasia pélvica / Ovarian transposition in patients with pelvic neoplasms

Os Autores apresentam revisão da literatura e concluem que a transposição ovariana laparoscópica é procedimento efetivo de preservação ovariana e que deve ser oferecido a pacientes jovens submetidas à radioterapia pélvica. É frequente a utilização de irradiação pélvica no tratamento de neoplasias em mulheres jovens, incluindo neoplasias ginecológicas, neoplasias de reto e ânus, doença de Hodgkin e outras de apresentação mais rara. Dependendo da extensão e sítio da doença esta terapêutica pode ser bastante deletéria, causando infertilidade e falência ovariana. A transposição de ovários previamente à irradiação pélvica tem sido realizada para minimizar estes efeitos no aparelho reprodutor feminino e até possibilitar gestação futura

Atualizaçäo: complicaçöes actínicas do sistema genital e urinário / Atualization: actinics complications of genitourinary system

A radioterapia é empregada em várias neoplasias malignas pélvicas. Näo infreqüentemente, verifica-se complicaçöes actínicas em vários órgäos dos sistemas genital e urinário com intensidade variável. Nos casos mais graves, os pacientes mesmo com câncer controlado podem ter comprometidas de maneira significativa sua qualidade de vida e suas funçöes sexuais e reprodutivas. O risco da ocorrência de um segundo tumor primário, radioinduzido, deve ser lembrado. Os autores discutem de maneira individualizada essas complicaçöes, enfatizando aspectos de seu tratamento.