RESUMO
By now therapy decision taken by a multi-disciplinary oncology team in cancer care has become a routine method in worldwide. However, multi-disciplinary oncology team has to face more and more difficulties in keeping abreast with the fast development in oncology science, increasing expectations, and financial considerations. Naturally the not properly controlled decision mechanisms, the permanent lack of time and shortage of professionals are also hindering factors. Perhaps it would be a way out if the staff meetings and discussions of physicians in the oncology departments were transformed and provided with administrative, legal and decision credentials corresponding to those of multi-disciplinary oncology team. The new form of the oncotherapy oncoteam might be able to decide the optimal and particular treatment after previous consultation with the patient. The oncotherapy oncoteam is also suitable to carry out training and tasks of a cancer centre and by diminishing the psychological burden of the doctors it contributes to an improved patient care. This study presents the two-level multi-disciplinary and oncotherapy oncology team system at the University of Pécs including the detailed analysis of the considerations above.
Assuntos
Tomada de Decisões , Comunicação Interdisciplinar , Oncologia/normas , Neoplasias/terapia , Equipe de Assistência ao Paciente , Participação do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/normas , Ensaios Clínicos como Assunto/tendências , Humanos , Oncologia/tendências , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Neoplasias/cirurgia , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/tendênciasRESUMO
PURPOSE: Using three-dimensional conformal radiation therapy (3D-CRT) and multisegmented conformal radiation therapy (MS-CRT) for breast cancer treatment, the dose coverage of the planning target volume (PTV) and the radiation burden on the organs at risk (OARs) were evaluated. MATERIAL AND METHODS: 3D-CRT and MS-CRT were planned for 436 unilateral breasts (217 left). All patients were treated with MS-CRT between 2005 and 2007. For PTV delineation and beam orientation, supportive structures were applied. The mean PTV was 1,130 cm3 (in ten patients > 2,200 cm3). Three-dimensional planning with weight-optimized medial and lateral open fields at a total dose of 50.4/1.8 Gy was followed by multisegmented planning with a reasonably high-dose-level dose cloud to define the medial subfield, and renewed optimization. This was repeated for the lateral subfield with a final optimization. For PTV coverage evaluation, the ICRU 50 was considered: the PTV portions receiving 95-107%, < 95% and > 107% of the prescribed dose (PTVD95- 107%, PTV
Assuntos
Neoplasias da Mama/radioterapia , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos , Radioterapia de Intensidade Modulada/métodos , Tomografia Computadorizada por Raios X/métodos , Carga Corporal (Radioterapia) , Mama/efeitos da radiação , Feminino , Coração/efeitos da radiação , Humanos , Pulmão/efeitos da radiação , Dosagem RadioterapêuticaAssuntos
Neoplasias da Mama/economia , Neoplasias da Mama/mortalidade , Neoplasias Colorretais/economia , Neoplasias Colorretais/mortalidade , Custos de Cuidados de Saúde , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/terapia , Criança , Pré-Escolar , Neoplasias Colorretais/terapia , Feminino , Alocação de Recursos para a Atenção à Saúde , Humanos , Hungria/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To investigate the pathophysiology of the radiation-induced, chronic Lhermitte's sign (LS) on the basis of long-standing case histories with partial functional recovery. PATIENTS AND METHODS: As radiotherapy in two nasopharyngeal cancer patients, a biologically effective dose (BED) of 103.8 Gy(2) (case 1) and 94.8 Gy(2) (case 2) was delivered to the cervical spinal cord. Neurologic signs relating to the irradiated spinal cord segments developed after 2 months (case 1) and 5 years (case 2), with radiation-induced damage equivalent to grade 3 (case 1) and grade 2 (case 2) toxicity (Common Toxicity Criteria, Version 2.0). The clinical status improved to grade 2 (case 1) and grade 1 (case 2). Positron emission tomography (PET) and fibroblast clonogen assay were applied 25 and 7 years postirradiation, respectively, to characterize this rare clinical picture. RESULTS: PET demonstrated increased [(18)F]fluorodeoxyglucose (FDG) accumulation and [(15)O]butanol perfusion, but negligible [(11)C]methionine uptake in the irradiated spinal cord segments in both patients. In clonogenic assays, fibroblasts from case 1 displayed much higher radiation sensitivity than in healthy controls, while in case 2 the fibroblasts sensitivity was normal. CONCLUSIONS: These data suggests a close direct relationship between regional perfusion and metabolism of the spinal cord, similarly as in the brain. The postirradiation recovery may be related to energy-demanding conduction, explaining the increased metabolism and perfusion. The increased radiosensitivity and higher spinal cord BED may have contributed to the more severe sequelae in case 1.
Assuntos
Doença de Hodgkin/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/etiologia , Medula Espinal/metabolismo , Medula Espinal/efeitos da radiação , Adulto , Feminino , Fibroblastos/efeitos da radiação , Fluordesoxiglucose F18 , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Metionina/metabolismo , Lesões por Radiação/diagnóstico por imagem , Tolerância a Radiação , Compostos Radiofarmacêuticos , Dosagem Radioterapêutica , Doenças da Medula Espinal/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada de EmissãoRESUMO
Radiation myelopathy is a rare, but extremely serious side-effect of radiotherapy. Recovery from radiation-induced motor sequelae is rare, whereas, the regeneration of sensory losses is relatively frequent. Among the sensory radiogenic injuries of the spinal cord, Lhermitte's sign (LS) is most frequent. This review describes the clinical picture and diagnostic imaging signs of radiogenic LS. There have been only a few studies on large patient groups with radiogenic LS, demonstrating a rate of occurrence of 3.6-13%, relating mainly to mantle irradiation or the radiotherapy of head and neck tumors. These cases typically manifest themselves 3 months following radiotherapy and gradually disappear within 6 months. Only 3 LS cases have been described in the English literature with extraordinarily severe symptoms lasting for more than 1 year. MRI, a sensitive tool in the detection of demyelination, failed to reveal any pathological sign accompanying radiogenic LS. However, positron emission tomography demonstrated increased [18F]fluorodeoxyglucose accumulation and [15O]butanol perfusion, but a negligible [11C]methionine uptake in the irradiated spinal cord segments in patients with long-standing LS. These imaging data are suggestive of a close direct relationship between the regional perfusion and metabolism of the spinal cord, very much like the situation in the brain. We postulate that an altered, energy-demanding conduction along the demyelinated axons of patients with chronic radiogenic LS may explain the increased metabolism and perfusion.