Intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in a patient with left breast cancer and pectus excavatum

INTRODUCTION: Pectus excavatum is a frequent anomaly. It represents a challenge for adjuvant radiotherapy in the conservative treatment of breast cancer. Primary objective of this study is to compare dosimetric outcomes, normal tissue complication probability (NTCP), and integral dose using four radiation techniques. Secondary objective is to describe acute toxicity and setup errors. METHODS AND MATERIALS: A 57-year-old female patient with an inner quadrant, left breast, ductal carcinoma in situ, was identified. Whole breast was prescribed with 50 Gy in 25 fractions. Boost planning target volume (PTV) was prescribed with 60 Gy in 30 fractions for sequential boost (SB) plans or 57.5 Gy in 25 fractions in the simultaneous integrated boost (SIB) plan. All plans were normalized to deliver 47.5 Gy to 95 % of the breast PTV. Daily image-guided radiotherapy (IGRT) was performed. Setup deviations were described. RESULTS: Constraints were not accomplished for heart when using intensity modulated radiotherapy (IMRT) + SB or conformal radiotherapy with three photon fields and SB. Left lung constraint was not achieved by any of the techniques in comparison. IMRT + SIB and conformal photons and electrons + SB plan were closer to the objective. Integral doses were lower with IMRT for heart and ipsilateral lung; however, it were higher for contralateral breast and lung. Coverage and tumoral conformity indexes were similar for all techniques in comparison. Greater inhomogeneity was observed with the photons and electrons + SB. IMRT + SIB treatment was administered daily with grade I skin toxicity. The highest setup error was observed in Y direction. CONCLUSION: Planning target volume coverage was similar with the four techniques. Homogeneity was superior with both IMRT plans. A good balance between dose constraints for organs at risk, PTV coverage, homogeneity, and NTCP was observed with IMRT + SIB. The documented daily setup error justifies the use of online IGRT (AU)

Helical tomotherapy in patients with breast cancer and complex treatment volumes

PURPOSE: To describe early clinical results of tomotherapy treatment in patients with breast cancer and complex treatment volumes. METHODS AND MATERIALS: Ten patients were treated with tomotherapy between January 2009 and March 2010. Treatment planning objectives were to cover at least 95% of the planning target volume with the 95% isodose; to have a minimum dose of 90% and a maximum dose of 105%. All treatments included daily CT/megavoltage image guidance. Acute toxicity was recorded weekly. RESULTS: Six patients were treated because constraints were not accomplished for heart, lung or contralateral breast in a previous three-dimensional conformal plan; two for preexisting cardiac or pulmonary disease, and two more for bilateral breast irradiation. Treatment volumes included the whole breast in the majority of patients, as well as the supraclavicular and the internal mammary chain nodes when indicated. Most patients were older than 50 years, and had an early breast cancer, with positive oestrogen receptors, negative HER2 expression and a poorly differentiated, infiltrating ductal carcinoma. The majority of patients had received neoadjuvant chemotherapy associated to breast-conserving surgery and adjuvant hormonotherapy. Median homogeneity index was 1.09; median coverage index was 0.81. Median V20Gy and V10Gy for ipsilateral lung was 20% and 37.1% respectively. Median V25 and V35 for heart was 15% and 4% respectively. Median dose for contralateral breast was 7 Gy. Skin acute toxicity was grade 1 in 41.7% and grade 2 in 58.3%. CONCLUSION: Tomotherapy is a technique capable of delivering a well tolerated treatment with high homogeneity and coverage indexes and high capabilities for sparing the organs at risk in patients with anatomically complex breast cancer, bilateral breast cancer, indication for internal mammary chain node irradiation, cardiac toxicity derived from chemotherapy, or preexisting cardiac or pulmonary disease. Further studies are required to evaluate local control and late toxicity (AU)

[The Latin American Psychiatrist: profile and degree of satisfaction with the specialty]. / El médico psiquiatra latinoamericano: su perfil y su grado de satisfacción con la especialidad.

OBJECTIVES: The primary objective is to describe the profile of the psychiatric members of a national psychiatry association in 19 Latin American countries (Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Chile, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru, Panama, Paraguay, Uruguay, and Venezuela). Secondary objectives are to evaluate job satisfaction and examine the factors related with job satisfaction. METHODS AND MATERIALS: A total of 8,028 psychiatrists, members of a national psychiatry association in Latin America, were identified. A probabilistic stratified sample of 2465 psychiatrists was designed and they were asked to fill out an anonymous electronic survey. RESULTS: A sample of 1,292 Latin American psychiatrists was obtained between April 2005 and July 2006 (52.4% of the designed sample). Response rates were superior to 70% in 11 countries. Mean age was 48.2 years, mean experience was 18.2 years; 63.8% were male and 99.9% of the surveyed psychiatrists were working as psychiatrists. Most of the respondents declared being satisfied with their quality of life (70.8%), a slightly larger percentage reported they were satisfied with their work (86.4%). However, 35.3% of the psychiatrists reported being unsatisfied with the income perceived for their economic activity as psychiatrists. Factors associated with job dissatisfaction are described. CONCLUSIONS: In Latin America, there is lower satisfaction with the incomes obtained from psychiatric practice and with the quality of life level. Nonetheless, the level of commitment with the profession in itself and job satisfaction remain similar to those reported in developed countries.

El médico psiquiatra latinoamericano: su perfil y su grado de satisfacción con la especialidad / The Latin American Psychiatrist: profile and degree of satisfaction with the specialty

Objetivo. Describir el perfil de los psiquiatras afiliados a las sociedades nacionales de psiquiatría de 19 países latinoamericanos (Argentina, Bolivia, Brasil, Colombia, Costa Rica, Cuba, República Dominicana, Ecuador, Chile, El Salvador, Guatemala, Honduras, México, Nicaragua, Perú, Panamá, Paraguay, Uruguay y Venezuela); evaluar su nivel de satisfacción laboral y explorar los factores asociados con el mismo. Materiales y métodos. Se identificaron 8.028 psiquiatras afiliados en las sociedades nacionales de psiquiatría; se diseñó una muestra probabilística y estratificada de 2.465 psiquiatras a quienes se les solicitó que cumplimentaran un formulario electrónico anónimo. Resultados. Entre abril de 2005 y julio de 2006 se pudo ejecutar una muestra de 1.292 psiquiatras (52,4%). Once países tuvieron tasas de respuesta superiores al 70%. La media de edad fue de 48,2 años; la media de experiencia fue de 18,2 años; el 63,8% fueron hombres y un 99,3% de los encuestados ejercen actualmente. La mayoría de los encuestados se declararon satisfechos con su nivel de calidad de vida (70,8%), un porcentaje ligeramente mayor se declaró satisfecho con el quehacer diario de la práctica psiquiátrica (86,4%); sin embargo, un 35,3% declaró que los ingresos obtenidos a partir de su actividad como psiquiatras no satisfacían sus necesidades. Se describen los factores que se encontraron asociados con la insatisfacción laboral. Conclusiones. En Latinoamérica hay menos satisfacción con los ingresos obtenidos de la práctica y con el nivel de calidad de vida, pero la satisfacción laboral y el grado de compromiso con la profesión permanecen similares a los hallados en países desarrollados (AU)

Objectives. The primary objective is to describe the profile of the psychiatric members of a national psychiatry association in 19 Latin American countries (Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Chile, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru, Panama, Paraguay, Uruguay, and Venezuela). Secondary objectives are to evaluate job satisfaction and examine the factors related with job satisfaction. Methods and materials. A total of 8,028 psychiatrists, members of a national psychiatry association in Latin America, were identified. A probabilistic stratified sample of 2465 psychiatrists was designed and they were asked to fill out an anonymous electronic survey. Results. A sample of 1,292 Latin American psychiatrists was obtained between April 2005 and July 2006 (52.4% of the designed sample). Response rates were superior to 70% in 11 countries. Mean age was 48.2 years, mean experience was 18.2 years; 63.8% were male and 99.9% of the surveyed psychiatrists were working as psychiatrists. Most of the respondents declared being satisfied with their quality of life (70.8%), a slightly larger percentage reported they were satisfied with their work (86.4%). However, 35.3% of the psychiatrists reported being unsatisfied with the income perceived for their economic activity as psychiatrists. Factors associated with job dissatisfaction are described. Conclusions. In Latin America, there is lower satisfaction with the incomes obtained from psychiatric practice and with the quality of life level. Nonetheless, the level of commitment with the profession in itself and job satisfaction remain similar to those reported in developed countries (AU)