ABSTRACT
Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.
Subject(s)
Humans , Radiosurgery/methods , Radiotherapy, Image-Guided/methods , Radiotherapy, Intensity-Modulated/methods , Spinal Neoplasms/surgery , Clinical Trials as Topic , Immobilization , Pain/radiotherapy , Radiosurgery/trends , Spinal Neoplasms/secondaryABSTRACT
A formação inicial e continuada de profissionais de física médica possui características peculiares por ser uma área interdisciplinar, de evolução tecnológica constante. Em países como o Brasil, existem barreiras como: pequeno número de profissionais, geograficamente mal distribuídos, baixos recursos financeiros, e poucas opções em termos de acesso à informação, dificultando a incorporação e disseminação de novas técnicas que impactam na qualidade do atendimento em saúde. Esta revisão da literatura se propôs a avaliar o papel da EaD na educação de físicos médicos, retratando sua aplicabilidade mediante a identificação de experiências relevantes. Os trabalhos mostram que a EaD tem características interessantes para a área, tais como alta efetividade pedagógica e eficiência econômica, possibilitando o uso massivo de recursos multimídia, com grande abrangência geográfica e de forma gerenciável. Portanto tem potencial para superar as barreiras e suprir carências da área.
Pre-service and in-service education relating to medical physics have peculiar characteristics since this is an interdisciplinary field with constant technological evolution. In countries like Brazil, several barriers exist, such as small numbers of professionals who are geographically poorly distributed, low financial resources and few options for information access, thereby hindering and delaying the incorporation and dissemination of new techniques that could have an impact on healthcare quality. This literature review evaluated the role of distance education within medical physics, and portrayed its applicability through identifying relevant experiences. Studies have shown that distance education within this field presents interesting characteristics, such as high pedagogical effectiveness and economic efficiency, which enables massive use of multimedia resources with wide geographical coverage, in a manageable way. Therefore, distance education has potential to overcome the barriers and meet the needs.
La formación y la educación continua de profesionales en física médica tiene características únicas, es un campo interdisciplinario, donde la tecnología está en evolución constante. Países como Brasil, tienen barreras como: número reducido de profesionales, geográficamente distribuidos de forma desigual, escasos recursos financieros y pocas opciones en términos de acceso a información, dificultando la incorporación y difusión de nuevas técnicas que afectan la calidad de atención en salud. Esta revisión de literatura evalúa el papel de EaD en la educación de físicos médicos, retratando su aplicabilidad mediante identificación de experiencias relevantes. Artículos muestran que EaD tiene características interesantes para la física médica, como alta eficacia pedagógica y eficiencia económica, permitiendo uso masivo de recursos mediáticos, con amplia cobertura geográfica y de forma manejable. Por lo tanto, la herramienta tiene potencial para superar los obstáculos y satisfacer las necesidades del área.