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Métodos Terapéuticos y Terapias MTCI
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1.
Cancer Radiother ; 25(3): 237-241, 2021 May.
Artículo en Francés | MEDLINE | ID: mdl-33419606

RESUMEN

PURPOSE: Stereotactic body radiotherapy (SBRT) of prostate cancer is associated with rectal toxicities, which can be reduced by using a hydrogel spacer. The object of this retrospective study was to show the feasibility of spacer placement under local anesthesia and utility of hydrogel spacer to reduce the dose to the rectal wall. MATERIAL AND METHODS: We collected data from all patients with localised prostate cancer treated with SBRT (40Gy in 5 fractions) between 2018 and 2020. A hydrogel spacer (SpaceOAR®) was placed depending on the availability of the product. We collected dosimetric data for target volumes and organs at risk. We calculated mean values, which were compared using non-parametric tests. RESULTS: Among 35 patients, mean age was 75 years. Seventeen had a spacer placed, with a mean space created of 10mm. No complication was reported during the intervention. High doses to the rectal wall were significantly lower in spacer group (V38: 0.39 cm3 vs. 0.72 cm3; P=0.02). PTV were better covered in spacer group (P=0.07). Doses to the bladder wall were similar in both groups. CONCLUSION: Spacer procedure under local anesthesia was well tolerated. Hydrogel spacer allowed to reduce doses to the rectum while improving PTV coverage.


Asunto(s)
Hidrogeles/administración & dosificación , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/prevención & control , Radiocirugia/métodos , Recto/efectos de la radiación , Anciano , Anciano de 80 o más Años , Anestesia Local , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Órganos en Riesgo/efectos de la radiación , Neoplasias de la Próstata/patología , Radiocirugia/efectos adversos , Dosificación Radioterapéutica , Estudios Retrospectivos , Estadísticas no Paramétricas , Vejiga Urinaria/efectos de la radiación
2.
Cancer Radiother ; 14(6-7): 488-92, 2010 Oct.
Artículo en Francés | MEDLINE | ID: mdl-20724190

RESUMEN

Brachytherapy techniques by permanent implant of radioactive sources or by temporary high-dose-rate (HDR) fractions are nowadays extensively used for the treatment of prostatic carcinoma. Long-term results (at 20 years) concerning large amount of patients have been published by major centers confirming both in terms of efficacy and toxicities that permanent implant of radioactive iodine-125 seeds yields at least the same good results of surgery and of external beam irradiation when proposed to patients affected by low-risk disease. For intermediate to high-risk tumors, HDR temporary implants are proposed as a boost for dose escalation. For both techniques, several topics still need to be clarified dealing with a recent enlargement of indications (HDR alone for low-risk, iodine-125 seeds boost for intermediate-high-risk cancers), or with technical aspects (loose seeds versus linked ones, number of fractions and dose for HDR protocols), while dosimetric issues have only recently been addressed by cooperatives groups. Last but not least, there is a real need to address and clearly characterize the correct definition of biochemical disease control both for iodine permanent implant and for HDR implant. New challenges are facing the prostate-brachytherapy community in the near future: local relapse after external beam radiotherapy are currently managed by several salvage treatments (prostatectomy, cryo, high intensity focused ultrasounds [HIFU]) but the role of reirradiation by brachytherapy is also actively investigated. Focal therapy has gained considerable interest in the last 5 years aiming at treating only the area of cancer foci inside the prostate and preserving nearby healthy tissues. Encouraging results have been obtained with the so-called "minimally invasive" approaches and both permanent seed implantation and HDR brachytherapy techniques may be worthwhile testing in this setting because of their capability of exactly sculpting the dose inside the prostatic gland.


Asunto(s)
Adenocarcinoma/radioterapia , Braquiterapia/métodos , Neoplasias de la Próstata/radioterapia , Ensayos Clínicos como Asunto , Fraccionamiento de la Dosis de Radiación , Implantes de Medicamentos , Estudios de Seguimiento , Humanos , Radioisótopos de Yodo/administración & dosificación , Radioisótopos de Yodo/uso terapéutico , Masculino , Estudios Multicéntricos como Asunto , Recurrencia Local de Neoplasia/terapia , Dosificación Radioterapéutica , Riesgo , Terapia Recuperativa , Resultado del Tratamiento
3.
Ann Oncol ; 19(7): 1308-1311, 2008 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-18356135

RESUMEN

BACKGROUND: Chemotherapy has emerged as a standard treatment in patients with castration-refractory prostate cancer (CRPC). Consensus criteria are available to define response in CRPC as at least a 50% decline in serum prostate-specific antigen (PSA) confirmed 4 weeks later. The objective of this work was to study early serum PSA changes in patients under chemotherapy and to correlate these changes with subsequent response assessment. PATIENTS AND METHODS: Serum PSA levels were monitored every 3 weeks in 79 patients with CRPC treated with chemotherapy and a time course of serum PSA levels was obtained. Correlation with response was studied. RESULTS: According to consensus criteria, 21 (40%) and 20 (38%) patients achieved a PSA response and stabilization, respectively, after first-line chemotherapy. Among patients who achieved either a response or a stabilization, 8 of 41 (20%) had a serum PSA rise during the first 8 weeks of chemotherapy, followed by a subsequent decline in serum PSA. The same observation was made in patients receiving second-line chemotherapy: 6 of 20 patients achieving a response or stabilization had an initial serum PSA rise. The postchemotherapy increase in serum PSA could reach more than twice the baseline value. The duration of the PSA surge ranged from 1 to 8 weeks. When considering responders only, 6 of 30 (20%) had a postchemotherapy serum PSA surge, followed by a drop. CONCLUSION: Postchemotherapy PSA surges occur not infrequently in patients with CRPC who respond to chemotherapy. Physicians should be aware of this effect to avoid inadequate early discontinuation of chemotherapy.


Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/secundario , Orquiectomía , Antígeno Prostático Específico/efectos de los fármacos , Neoplasias de la Próstata/tratamiento farmacológico , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/administración & dosificación , Antineoplásicos/administración & dosificación , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Hormonales/administración & dosificación , Docetaxel , Estramustina/administración & dosificación , Hormona Liberadora de Gonadotropina/administración & dosificación , Humanos , Cinética , Masculino , Persona de Mediana Edad , Mitoxantrona/administración & dosificación , Metástasis de la Neoplasia/tratamiento farmacológico , Metástasis de la Neoplasia/patología , Prednisona/administración & dosificación , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Sesquiterpenos/administración & dosificación , Síndrome , Taxoides/administración & dosificación , Resultado del Tratamiento
4.
Pacing Clin Electrophysiol ; 12(4 Pt 2): 705-8, 1989 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-2470054

RESUMEN

Epidural spinal electrostimulatory system (ESES) or dorsal column stimulation (DCS) may be used for the treatment of peripheral vascular diseases of the lower extremities. ESES has been used in our metabolic and surgical department as a way to ameliorate inadequate blood supply in patients suffering from diabetic foot (seven patients), painful chronic arterial narrowing, or inoperable occlusions (25 patients). The continuous stimulation by an implantable apparatus (Medtronic model Itrel, Medtronic, Inc., Minneapolis, MN, USA) led to a reduction or disappearance of pain, an improvement in plethysmographic curves, functional performance, and trophic lesions in about 75% of the patients. The system is safe and well-tolerated by patients.


Asunto(s)
Arteriosclerosis/terapia , Angiopatías Diabéticas/terapia , Terapia por Estimulación Eléctrica , Enfermedades del Pie/terapia , Claudicación Intermitente/terapia , Cuidados Paliativos/métodos , Médula Espinal/fisiología , Anciano , Espacio Epidural , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad
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