Predicting the necessity of adding catheters to intracavitary brachytherapy for women undergoing definitive chemoradiation for locally advanced cervical cancer.

PURPOSE: To identify if baseline patient or magnetic resonance imaging (MRI) features can predict which women are at risk for inadequate tumor coverage with only intracavitary tandem and ovoid (T + O) brachytherapy and to correlate tumor coverage with clinical outcomes. METHODS AND MATERIALS: We performed a retrospective study of 50 women with cervical cancer treated with chemoradiation at a single institution between January 2014 and December 2015. All patients had a 3T-MRI performed at baseline (MRI1) and at the completion of external beam radiation therapy (MRI2). Gross tumor volume initial (GTV-Tinit) was measured on MRI1 and high-risk clinical tissue volume (CTVHR) on MRI2. CTVHR extending beyond point A was classified as too large for adequate coverage with T + O and requiring interstitial needles. Multivariate analysis was performed to determine predictive factors of inadequate coverage. Kaplan-Meier and Cox Regression were performed to correlate inadequate coverage with outcomes. RESULTS: Mean patient age was 49.2 ± 13.2 years, and 84% had Federation of Gynecology and Obstetrics IIB/IIIB disease. Forty-two percent of women were estimated to have inadequate tumor coverage with T + O brachytherapy. The GTV-Tinit volume and dimensions (superior-inferior, left-right, anterior-posterior) on MRI1 were all important predictive factors of inadequate coverage on multivariate analysis. Receiver operating characteristics curves identified optimal thresholds of superior-inferior ≥ 4.5 cm (area under the curve [AUC] = 0.718), left-right ≥ 4.5 cm (AUC = 0.745), anterior-posterior ≥ 5.0 cm (AUC = 0.767), and GTV-Tinit ≥ 85 cm3 (AUC = 0.842). Patients with inadequate coverage had worse clinical outcomes. CONCLUSIONS: Baseline MRI tumor size may predict inadequate CTVHR coverage at the time of brachytherapy (i.e., the need for interstitial needles). This may help identify a subset of women requiring early referral to adequately resourced centers to improve clinical outcomes.

Refluxo gastroesofágico: estudo comparativo da receptividade e sensibilidade entre seriografia e ultrassonografia / Gastroesophageal reflux: a comparative study of receptiveness and sensitivity of upper gastrointestinal series and ultrasonography

OBJETIVO: Estudo comparativo da receptividade (colaboração) e sensibilidade da seriografia do esôfago, estômago e duodeno em relação à ultrassonografia do esôfago intra-abdominal em pacientes com suspeita de refluxo gastroesofágico. MATERIAIS E MÉTODOS: Foram incluídos no estudo 42 pacientes pediátricos (26 masculinos, com idade média de 33,64 ± 34,33 meses, e 16 femininos, com idade média de 31,02 ± 35,56 meses) com suspeita de refluxo gastroesofágico, os quais foram submetidos, inicialmente, a seriografia do esôfago, estômago e duodeno, e posteriormente, a ultrassonografia do esôfago intra-abdominal. RESUL-TADOS: A análise estatística comparativa entre os sexos e as idades sugere não haver evidência de associação com a colaboração, tanto para a seriografia do esôfago, estômago e duodeno como para a ultrassonografia do esôfago intra-abdominal. Entretanto, na classificação quanto ao tipo de colaboração, a técnica de seriografia do esôfago, estômago e duodeno apresentou menos de 50 por cento de colaboração, enquanto 80,49 por cento dos pacientes colaboraram com a ultrassonografia do esôfago intra-abdominal. Quanto à sensibilidade do diagnóstico de refluxo gastroesofágico, a técnica de ultrassonografia do esôfago intra-abdominal (85,7 por cento) foi significativamente superior à de seriografia do esôfago, estômago e duodeno (47,6 por cento). CONCLUSÃO: O presente estudo sugere que se proceda a ultrassonografia do esôfago intra-abdominal, mesmo na ausência de refluxo gastroesofágico na seriografia do esôfago, estômago e duodeno.

OBJECTIVE: Comparative study of receptiveness (cooperation) and sensitivity of upper gastrointestinal series and intraabdominal esophagus ultrasonography in patients with suspicion of gastroesophageal reflux. MATERIALS AND METHODS: The present study included 42 pediatric patients (26 male, with mean age of 33.64 ± 34.33 months, and 16 female, with mean age of 31.02 ± 35.56 months) with suspicion of gastroesophageal reflux, who were initially submitted to upper gastrointestinal series and subsequently to intraabdominal esophagus ultrasonography. RESULTS: The statistical comparative analysis covering sexes and ages suggests no evidence of association with cooperation, both for the upper gastrointestinal series and the intraabdominal esophagus ultrasonography. However, in the classification of the patients' cooperation, the technique of upper gastrointestinal series presented less than 50 percent of cooperation, while 80.49 percent of patients cooperated in the intraabdominal esophagus ultrasonography examinations. As regards the methods sensitivity for the diagnosis of gastroesophageal reflux, the technique of intraabdominal esophagus ultrasonography was significantly superior (85.7 percent) to the upper gastrointestinal series (47.6 percent). CONCLUSION: The present study suggests that an intraabdominal esophagus ultrasonography should be performed even if gastroesophageal reflux even if it is not detected at the upper gastrointestinal series.