RESUMEN
PURPOSE: We assessed a novel Food and Drug Administration-approved hydrogel, synthesized as absorbable iodinated particles, in gynecologic-cancer patients undergoing computed tomography (CT) or magnetic resonance (MR) based brachytherapy after external beam radiation. METHODS AND MATERIALS: Nineteen patients underwent CT-guided (n = 13) or MR-guided (n = 6) brachytherapy for gynecologic cancers. Seventy-seven hydrogel injections were placed. The hydrogel material was injected into gross residual disease and/or key anatomic landmarks in amounts ranging from 0.1 to 0.4 mL. The visibility of the tracer was scored on CT and on MR images using a 5-point scoring scale. A Cohen's kappa statistic was calculated to assess interobserver agreement. To assess the unadjusted effects of baseline parameters on hydrogel visibility, we modeled visibility using a linear mixed-effect model. RESULTS: Injections were without complication. The kappa statistic was 0.77 (95% confidence interval [CI], 0.68-0.87). The volume of hydrogel injected was significantly associated with visibility on both CT (p = 0.032) and magnetic resonance imaging (p = 0.016). We analyzed visibility by location, controlling for amount. A 0.1-cc increase in volume injected was associated with increases of 0.54 (95% CI = 0.05-1.03) in the CT visibility score and 0.83 (95% CI = 0.17-1.49) in the MR visibility score. Injection of 0.4 cc or more was required for unequivocal visibility on CT or MR. No statistically significant correlation was found between tumor type, tumor location, or anatomical location of injection and visibility on either CT or magnetic resonance imaging. CONCLUSIONS: In this first report of an injectable radiopaque hydrogel, targets were visualized to assist with three-dimensional-based brachytherapy in gynecologic malignancies. This marker has potential for several applications, is easy to inject and visualize, and caused no acute complications.
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Braquiterapia/métodos , Medios de Contraste , Marcadores Fiduciales , Neoplasias de los Genitales Femeninos/radioterapia , Hidrogel de Polietilenoglicol-Dimetacrilato , Radioterapia Guiada por Imagen/métodos , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasia Residual , Variaciones Dependientes del Observador , Polímeros , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: NUT midline carcinoma is a rare poorly differentiated aggressive subtype of squamous cell carcinoma. To date, fewer than 100 total cases have been reported. CONCLUSION: Given the rarity of this disease process and lack of pathognomonic imaging findings, a definitive diagnosis based solely on imaging findings alone is untenable. Select cases are used to emphasize the particularly infiltrative and aggressive nature of NUT midline carcinoma, which shows a complete disregard for normal tissue boundaries and rapid progression during brief intervals.
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Carcinoma de Células Escamosas/diagnóstico , Diagnóstico por Imagen/métodos , Neoplasias de los Tejidos Blandos/diagnóstico , Adulto , Carcinoma de Células Escamosas/genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas de Neoplasias , Proteínas Nucleares/genética , Proteínas Oncogénicas/genética , Neoplasias de los Tejidos Blandos/genética , Adulto JovenRESUMEN
PURPOSE: To investigate the dosimetric variability associated with interobserver organ-at-risk delineation differences on computed tomography in patients undergoing gynecologic interstitial brachytherapy. METHODS AND MATERIALS: The rectum, bladder, and sigmoid of 14 patients treated with gynecologic interstitial brachytherapy were retrospectively contoured by 13 physicians. Geometric variability was calculated using κ statistics, conformity index (CIgen), and coefficient of variation (CV) of volumes contoured across physicians. Dosimetric variability of the single-fraction D0.1cc and D2cc was assessed through CV across physicians, and the standard deviation of the total EQD2 (equivalent dose in 2 Gy per fraction) brachytherapy dose (SD(TOT)) was calculated. RESULTS: The population mean ± 1 standard deviation of κ, CIgen, and volume CV were, respectively: 0.77 ± 0.06, 0.70 ± 0.08, and 20% ± 6% for bladder; 0.74 ± 06, 0.67 ± 0.08, and 20% ± 5% for rectum; and 0.33 ± 0.20, 0.26 ± 0.17, and 82% ± 42% for sigmoid. Dosimetric variability was as follows: for bladder, CV = 31% ± 19% (SD(TOT) = 72 ± 64 Gy) for D0.1cc and CV = 16% ± 10% (SD(TOT) = 9 ± 6 Gy) for D2cc; for rectum, CV = 11% ± 5% (SD(TOT) = 16 ± 17 Gy) for D0.1cc and CV = 7% ± 2% (SD(TOT) = 4 ± 3 Gy) for D2cc; for sigmoid, CV = 39% ± 28% (SD(TOT) = 12 ± 18 Gy) for D0.1cc and CV = 34% ± 19% (SD(TOT) = 4 ± 4 Gy) for D2cc. CONCLUSIONS: Delineation of bladder and rectum by 13 physicians demonstrated substantial geometric agreement and resulted in good dosimetric agreement for all dose-volume histogram parameters except bladder D0.1cc. Small delineation differences in high-dose regions by the posterior bladder wall may explain these results. The delineation of sigmoid showed fair geometric agreement. The higher dosimetric variability for sigmoid compared with rectum and bladder did not correlate with higher variability in the total brachytherapy dose but rather may be due to the sigmoid being positioned in low-dose regions in the cases analyzed in this study.
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Braquiterapia/métodos , Colon Sigmoide/diagnóstico por imagen , Neoplasias de los Genitales Femeninos/radioterapia , Órganos en Riesgo/diagnóstico por imagen , Radioterapia Guiada por Imagen/métodos , Recto/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Vejiga Urinaria/diagnóstico por imagen , Braquiterapia/efectos adversos , Femenino , Humanos , Variaciones Dependientes del Observador , Dosificación Radioterapéutica , Estudios RetrospectivosRESUMEN
PURPOSE/OBJECTIVES: To determine if intensity modulated radiation therapy (IMRT) in the post-operative setting for gastric cancer was associated with reduced toxicity compared to 3D conformal radiation therapy (3DCRT). MATERIALS/METHODS: This retrospective study includes 24 patients with stage IB-IIIB gastric cancer consecutively treated from 2001-2010. All underwent surgery followed by adjuvant chemoradiation. Concurrent chemotherapy consisted of 5-FU/leucovorin (nâ=â21), epirubicin/cisplatin/5FU (nâ=â1), or none (nâ=â2). IMRT was utilized in 12 patients and 3DCRT in 12 patients. For both groups, the target volume included the tumor bed, anastomosis, gastric stump, and regional lymphatics. RESULTS: Median follow-up for the entire cohort was 19 months (range 0.4-8.5 years), and 49 months (0.5-8.5 years) in surviving patients. The 3DCRT group received a median dose of 45 Gy, and the IMRT group received a median dose of 50.4 Gy (pâ=â0.0004). For the entire cohort, 3-year overall survival (OS) was 40% and 3-year disease free survival (DFS) was 41%. OS and DFS did not differ significantly between the groups. Acute toxicity was similar. Between 3DCRT and IMRT groups, during radiotherapy, median weight lost (3.2 vs. 3.3 kg, respectively; pâ=â0.47) and median percent weight loss were similar (5.0% vs. 4.3%, respectively; pâ=â0.43). Acute grade 2 toxicity was experienced by 8 patients receiving 3DCRT and 11 receiving IMRT (pâ=â0.32); acute grade 3 toxicity occurred in 1 patient receiving 3DCRT and none receiving IMRT (pâ=â1.0). No patients in either cohort experienced late grade 3 toxicity, including renal or gastrointestinal toxicity. At last follow up, the median increase in creatinine was 0.1 mg/dL in the IMRT group and 0.1 mg/dL in the 3DCRT group (pâ=â0.78). CONCLUSION: This study demonstrates that adjuvant chemoradiation for gastric cancer with IMRT to 50.4 Gy was well-tolerated and compared similarly in toxicity with 3DCRT to 45 Gy.
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Quimioradioterapia Adyuvante , Radioterapia Conformacional , Radioterapia de Intensidad Modulada , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/radioterapia , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/radioterapia , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Cardiomegalia/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Cardiopatía Reumática/complicaciones , Dolor en el Pecho/etiología , Disnea/etiología , Femenino , Prótesis Valvulares Cardíacas , Humanos , Persona de Mediana Edad , Válvula Mitral/cirugía , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Calcificación Vascular/diagnóstico por imagenRESUMEN
A 23-year-old man with fevers, night sweats, lymphadenopathy, worsening vision, and aphthous ulcers was diagnosed with Behçet's disease. Multiple diagnostic imaging modalities were used to identify various multisystem complications associated with Behçet's disease including vascular thomboses, mediastinal fibrosis, chylothoraces, chylopericardium and coronary artery aneurysms.