Feasibility and potential advantages using VMAT in SRS metastasis treatments.

BACKGROUND: Utilization of stereotactic radiosurgery (SRS) for brain metastases (BM) has become the technique of choice as opposed to whole brain radiation therapy (WBRT). The aim of this work is to evaluate the feasibility and potential benefits in terms of normal tissue (NT) and dose escalation of volumetric modulated arc therapy (VMAT) in SRS metastasis treatment. A VMAT optimization procedure has therefore been developed for internal dose scaling which minimizes planner dependence. MATERIALS AND METHODS: Five patient-plans incorporating treatment with frame-based SRS with dynamic conformal arc technique (DA) were re-planned for VMAT. The lesions selected were between 4-6 cm3. The same geometry used in the DA plans was maintained for the VMAT cases. A VMAT planning procedure was performed attempting to scale the dose in inner auxiliary volumes, and to explore the potential for dose scaling with this technique. Comparison of dose-volume histogram (DVH) parameters were obtained. RESULTS: VMAT allows a superior NT sparing plus conformity and dose scaling using the auxiliary volumes. The VMAT results were significantly superior in NT sparing, improving both the V10 and V12 values in all cases, with a 2-3 cm3 saving. In addition, VMAT improves the dose coverage D95 by about 0.5 Gy. The objective of dose escalation was achieved with VMAT with an increment of the Dmean and the Dmedian of about 2 Gy. CONCLUSIONS: This work shows a benefit of VMAT in SRS treatment with significant NT sparing. A VMAT optimization procedure, based on auxiliary inner volumes, has been developed, enabling internal dose escalation.

A single center, inter-observer evaluation of vestibular schwannoma stereotactic radiosurgery and its dosimetric impact.

The aim of this work was to evaluate the inter- and intra-observer variation in contouring vestibular schwannoma (VS) and the organs-at-risk (OAR), and its dosimetric impact in Volumetric Modulated Arc Therapy (VMAT). Three VS typical cases were contoured by four clinicians. The Agreement Volume Index (AVI) appeared to be notably higher in VS than in OARs, such that the dose coverage of VS is fairly robust. In OARs, the largest variation was +1.02Gy in dmax for the brainstem, +0.78Gy in dmean for the cochlea and +1.05Gy in dmax of the trigeminal nerve. Accordingly, it was decided that all VS delineations for stereotactic radiosurgery (SRS), and all frame-based SRS contouring in general, should always be reviewed by a second physician. In addition, the retrospective presentation of VS cases at daily peer review meetings has also been adopted to ensure that the consensus is constantly updated, as well as for training purposes.

Non surgical treatment of vestibular schwannoma.

INTRODUCTION AND OBJECTIVES: To evaluate the results of local control and complications in the treatment of vestibular schwannoma treated with radiation. METHODS: A retrospective study of 194 patients diagnosed with vestibular schwannoma, treated consecutively with radiation (either stereotactic radiosurgery or fractionated radiotherapy) from 1997 to 2012. We analyze the local control of tumors, as well as secondary complications to treatment with radiation. RESULTS: A total of 132 (68%) tumors 68% are grade I-II tumors of the Koos classification, 40 (19%) are grade III, and 22 (13%) are grade IV. The tumors associated with neurofibromatosis (NF2), are 3.6% (6 tumors in 4 patients). The tumor control for the overall serie is 97% at 5 years, with a median follow-up of 80.4 months. For large tumors the local control is 91% at 5 years. Free survival of chronic complications is 89% at 5 years. Additionally, 50 tumors were subjected to regular follow-up with MRI without treatment, and 28 (58%) did not experienced tumor growth. CONCLUSIONS: Radiation and follow up with MRI, are an alternative to surgery in the treatment of vestibular schwannoma, with a low level of complications inside of multidisciplinary approach.

[Acute knee pain in pregnancy. Case report of Regional Transient Osteoporosis]. / Gonalgia aguda en el embarazo: reporte de un caso de osteoporosis regional transitoria.

The article presents the case of a patient who after her first pregnacy, during the immediate postpartum period, suffered a femoral supracondylar fracture complicated by bone marrow edema syndrome (BMES), also known as regional temporary osteoporosis (RTO). The fracture of the distal femur was treated with an open reduction and internal fixation of the distal femur by means of a minimally invasive procedure.

Tratamiento no quirúrgico del schwannoma vestibular / Non surgical treatment of vestibular schwannoma

Introducción y objetivos: Valorar los resultados de control local y complicaciones en el tratamiento del schwannoma vestibular tratado con radiaciones. Métodos: Estudio retrospectivo de 194 pacientes diagnosticados de schwannoma vestibular, tratados de manera consecutiva bien con observación o bien con radiaciones (bien radiocirugía o radioterapia esterotáctica fraccionada) de 1997 a 2012. Analizamos el control local de los tumores, así como de las complicaciones secundarias al tratamiento con radiocirugía. Resultados: El 68% (132 tumores) son inferiores a 2 cm es decir grado I-II de la clasificación de Koos, 22 pacientes (13%) con tumores grandes grado IV, el resto (40 pacientes) son grado III. Los tumores relacionados con la neurofibromatosis (NF2) representan el 3,6% (6 tumores en 4 pacientes). El control tumoral para los pacientes tratados con radiaciones es del 97% a 5 años, con un seguimiento mediano de 80,4 meses. Para los tumores grandes el control local es del 91% a 5 años. La supervivencia libre de complicaciones crónicas es del 89% a 5 años. De los 50 tumores a los que se realizó seguimiento, 28 (58%) continúan en seguimiento al no haberse objetivado crecimiento alguno. Conclusiones: La radiación y el seguimiento con RM, dentro de un enfoque multidisciplinar, es una alternativa a la cirugía en el tratamiento del schwannoma vestibular, con un bajo nivel de complicaciones (AU)

Introduction and objectives: To evaluate the results of local control and complications in the treatment of vestibular schwannoma treated with radiation. Methods: A retrospective study of 194 patients diagnosed with vestibular schwannoma, treated consecutively with radiation (either stereotactic radiosurgery or fractionated radiotherapy) from 1997 to 2012. We analyze the local control of tumors, as well as secondary complications to treatment with radiation. Results: A total of 132 (68%) tumors 68% are grade I-II tumors of the Koos classification, 40 (19%) are grade III, and 22 (13%) are grade IV. The tumors associated with neurofibromatosis (NF2), are 3.6% (6 tumors in 4 patients). The tumor control for the overall serie is 97% at 5 years, with a median follow-up of 80.4 months. For large tumors the local control is 91% at 5 years. Free survival of chronic complications is 89% at 5 years. Aditionally, 50 tumors were subjected to regular follow-up with MRI without treatment, and 28 (58%) did not experienced tumor growth. Conclusions: Radiation and follow up with MRI, are an alternative to surgery in the treatment of vestibular schwannoma, with a low level of complications inside of multidisciplinary approach (AU)

Gonalgia aguda en el embarazo: reporte de un caso de osteoporosis regional transitoria / Acute knee pain in pregnancy. Case report of Regional Transient Osteoporosis

Se presenta el caso de una paciente que en el posparto inmediato de su primer embarazo sufrió una fractura supracondílea del fémur en el contexto de una osteoporosis regional transitoria (ORT), tratada mediante reducción y osteosíntesis por técnica mínimamente invasiva (MIPO) (AU)

The article presents the case of a patient who after her first pregnancy, during the immediate postpartum period, suffered a femoral supracondylar fracture complicated by bone marrow edema syndrome (BMES), also known as regional temporary osteoporosis (RTO). The fracture of the distal femur was treated with an open reduction and internal fixation of the distal femur by means of a minimally invasive procedure (AU)

Reporte de un caso de síndrome de klinefelter verdadero / s. t

Presentamos un caso de síndrome de Klinefelter verdadero, comprobado por la observación clínica y exámenes complementarios (gonadotropina hipofisaria, biopsia testicular bilateral, 17-Ketosteroides, biopsia de mucosa bucal, frotis de leucocitos para determinar cromatina S positiva, etc)....(AU)

Purificación de la hecogenina con el reactivo de Girard T / Hecogenin cleansing with Girard T reagent

En el presente trabajo se describe un método sencillo de separación de mezclas de hecogenina y tigogenina, basado en la formación de la hidrazona de la hecogenina con el reactivo de Girard T. Empleando mezclas artificiales, se comprobó que la recuperación de las sapogeninas es superior al 95

Purificación de la hecogenina con el reactivo de Girard T / Hecogenin cleansing with Girard T reagent

En el presente trabajo se describe un método sencillo de separación de mezclas de hecogenina y tigogenina, basado en la formación de la hidrazona de la hecogenina con el reactivo de Girard T. Empleando mezclas artificiales, se comprobó que la recuperación de las sapogeninas es superior al 95