Dosimetric impact of bone marrow sparing for robustly optimized IMPT for locally advanced cervical cancer.

BACKGROUND AND PURPOSE: To investigate the trade-off between bone marrow sparing (BMS) and dose to organs at risk (OARs) for intensity modulated proton therapy (IMPT) for women with locally advanced cervical cancer (LACC). MATERIALS AND METHODS: Twenty LACC patients were retrospectively included. IMPT plans were created for each patient using automated treatment planning. These plans progressively reduced bone marrow mean doses by steps of 1 GyRBE, while constraining target coverage and conformality. The relation between bone marrow dose and bladder, small bowel, rectum, and sigmoid doses was evaluated. RESULTS: A total of 140 IMPT plans were created. Plans without BMS had an average [range] bone marrow mean dose of 17.3 [14.7-21.6] GyRBE , which reduced to 12.0 [10.0-14.0] GyRBE with maximum BMS. The mean OAR dose [range] increased modestly for 1 GyRBE BMS: 0.2 [0.0 - 0.6] GyRBE for bladder, 0.3 [-0.2 - 0.7] GyRBE for rectum, 0.4 [0.1 - 0.8] GyRBE for small bowel, and 0.2 [-0.2 - 0.4] GyRBE for sigmoid. Moreover, for maximum BMS, mean OAR doses [range] escalated by 3.3 [0.1 - 6.7] GyRBE for bladder, 5.8 [1.8 - 12.4] GyRBE for rectum, 3.9 [1.6 - 5.9] GyRBE for small bowel, and 2.7 [0.6 - 5.9] GyRBE for sigmoid. CONCLUSION: Achieving 1 GyRBE BMS for IMPT is feasible for LACC patients with limited dosimetric impact on other OARs. While further bone marrow dose reduction is possible for some patients, it may increase OAR doses substantially for others. Hence, we recommend a personalized approach when introducing BMS into clinical IMPT treatment planning to carefully assess individual patient benefits and risks.

[Spontaneous splenorenal and splenocaval shunts studied by echotomography]. / Dérivations spléno-rénales et spléno-caves spontanées explorées par échotomographie.

Spontaneous spleno-renal and spleno-caval shunts may be anatomically and functionally important in portal hypertension syndromes, as demonstrated by the distinct opacification of the inferior vena cava observed after portal venography with iodine contrast media. Part of the course of these porto-caval anastomotic vessels can be visualized by ultrasonography opposite the left adrenal gland and in the space between the spleen and the left kidney. The images obtained are characteristic enough for the diagnosis of spleno-renal shunt to be suspected before it is confirmed by portal venography, as was the case in the four patients with hepatic cirrhosis reported by the authors.

[Hyperselective arteriography value in pancreatic pathology. A retrospective study of 47 cases by 3 different investigations without any clinical information (author's transl)]. / Valeur de l'artériographie hypersélective en pathologie pancréatique. Etude rétrospective de 47 dossiers par 3 observateurs différents sans connaissance du dossier clinique.

Between January 1965 and February 2978, this 47 arteriographies of pancreas retrospective study has been achieved by three investigators expounding each case without clinical information. The authors observe that arteriography is a sensitive and specific investigation for pancreatic cancer (more than 90% correct diagnosis). They insist on its real interest into the cancer extension balance. So the achieved arterial mapping is also very useful to the surgeons before surgical intervention. In return, its interest is more limited for investigation of non tumorous pancreas and especially the chronical pancreatitis. Through the late data of the literature concerning the different technics especially echotomography and total body scanner, a strategy is revealed by the pancreatic cancers exploration.

[Haemorrhage from the duct of Wirsung : emergency arteriographic diagnosis. One case (author's transl)]. / Wirsungorragie, diagnostic artériographique en urgence. A propos d'un cas.

The authors report a case of haemorrhage from the duct of Wirsung related to a pseudocyst of the pancreas ulcerating into a branch of the splenic artery. The diagnosis was made as an emergency by arteriography. 45 cases exist in the literature. Arteriography was performed in 10 cases. An arterio-canalar communication was demonstrated in only 3 cases.

[Post-traumatic stenosis of the small intestine with double contrast radiological study after duodenal intubation. One case (author's transl)]. / Rétrécissement post-traumatique de l'intestin grêle avec étude radiologique en double contraste après intubation duodénale. A propos d'une observation.

The authors present a clinical case of post-traumatic stenosis of the small intestine. The improvement in the quality of radiological diagnosis by the use of double contrast study of the small bowel after duodenal intubation is emphasised. On the basis of this case, together with a review of the literature, they review the various problems of diagnosis, physiopathology and histology which may be posed by these stenoses, which it would seem possible to integrate into a wider physiopathological group: ischaemic stenoses of the digestive tract.

[Double-contrast radiography of the small intestine]. / Examen radiologique de l'intestin grêle en double contraste

On the basis of 170 double-contrast radiographic examinations of the small intestine, a description is given, in the first part of this paper, of the technique employed. Emphasis is laid, on the one hand, on duodenal intubation, which is easily effected with a Dotter-Bilbao tube and, on the other, on a study obtained by filling with a continuous barium column, the double-contrast being merely an adjunct. In the second part of the paper the results are analysed from a photographic and diagnostic standpoint: Photographically, duodenal intubation affords a clearer visualization of the jejunum but the chief merit of double-contrast radiography lies in the visualization of the ileum and the study it makes possible of the last ileal fold. With regard to diagnosis, from personal series, 20 % of organic lesions have been observed, although it must be admitted that this figure is certainly boosted by the selectivity of a specialized gastroenterologic unit. The interest of this technique rests also on the fact that the examination is very well tolerated by the patient and does not last more than two hours on an average.

[Substraction in gastrointestinal angiography (author's transl)]. / La soustraction en angiographie digestive

On the basis of a comparative study of 100 angiograms, the authors stress the value of photographic substraction in gastrointestinal angiography. From a technical viewpoint, after a brief review of the theoretical background, the authors emphasise the need to use reproductions of different tonality, and the problems of blurring due to movement, which may be overcome by the use of an effective premedication (diazepam) and by limiting the substraction to a very limited arca. From the standpoint of results, photographic substraction gives improved radiological data in the arterial phase in 60% of cases. This improvement concerns the prevertebral vessels. During the venous phase, in all cases there is an improvement in mesenterico-portal return and the visualisation of oesophageal varices. In all, photographic substraction, a simple technique, appears to be of value in gastrointestinal angiography essentially in the arteriographic study of the pancreas and of spleno-portal and mesenterico-portal venous return.