Recomendações para o rastreamento do câncer de mama no Brasil do Colégio Brasileiro de Radiologia, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia / Recommendations for breast cancer screening in Brazil from the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations

Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline, EMBASE, Cochrane Library, EBSCO, CINAHL e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos, deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos ou, ainda, portadoras de mutação genética ou com forte história familiar, beneficiam-se do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível. (AU)

Objective: To present the update of the recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published in Medline, Embase, Cochrane Library, Ebsco, Cinahl and Lilacs between January 2012 and July 2022 was searched. Recommendations were based on this evidence, by consensus of the expert committee of the three entities. Recommendations: Annual mammographic screening is recommended for women aged between 40 and 74 years old. Above 75 years should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast câncer, chest irradiation before age 30, carriers of genetic mutation or with a strong family history, benefit from complementary screening, being considered individually. Tomosynthesis is an evolution of mammography and should be considered in screening, whenever accessible and available. (AU)

Cardiotoxicidad por irradiación en pediatría / Cardiotoxicity by irradiation in Pediatrics

Introducción: La cardiotoxicidad depende de varios factores y se manifiesta por las alteraciones cardiovasculares inducidas por los tratamientos oncoespecíficos en la función y morfología del corazón. Objetivo: Determinar las manifestaciones de cardiotoxicidad en pacientes pediátricos. Métodos: Estudio descriptivo transversal en el que se incluyeron 79 pacientes tratados en el Instituto de Oncología y Radiobiología de Cuba con irradiación tórax-mediastino, entre enero 2008 a diciembre 2014. La enfermedad de Hodgkin estaba presente en 54 pacientes y en 25, tumores del sistema nervioso central: meduloblastomas en 19 y tumores primarios neuroectodérmicos en 6 pacientes. A todos se les hizo historia clínica con examen físico, electrocardiograma de 12 derivaciones y ecocardiograma 2D pre- y postratamientos. Se analizaron las características demográficas y clínicas. Los enfermos con Hodgkin recibieron irradiación con intensidad de 2 400 centigray y de 2 340 los pacientes con tumores del sistema nervoso central; la poliquimioterapia se realizó con antraciclinas, vincristina, vinblastina y otros. Resultados: La edad promedio de todos los pacientes fue de 7 años con predominio del sexo masculino. No se registraron síntomas o signos de cardiotoxicidad. Conclusiones: En nuestra serie de pacientes la irradiación del área cardiaca aparentemente es bien tolerada, sin aparición temprana de cardiotoxicidad, ni en periodos de seguimiento de hasta 9 años. Aparecieron naúseas y leucopenias transitorias en algunos casos. No existió diferencias en las toxicidades en los grupos de tumores estudiados Es necesario mantener un seguimiento estrecho para descartar la aparición de cardiotoxicidad en años siguientes(AU)

Introduction: Cardiotoxicity depends on various factors and it is evident in cardiovascular alterations induced by oncologic treatments directed to the heart´s function and morphology. Objective: To determine the symptoms of cardiotoxicity in pediatric patients. Methods: Descriptive and cross-sectional study in which there were included 79 patients treated in the Cuban Institute of Oncology and Radiobiology with thorax-mediastine irradiation from January 2008 to December 2014. Hodgkin disease was present in 54 patients, tumors of the central nervous system in 25, medulloblastomas in 19, and neuroectodermic primary tumors in 6. All the patients underwent physical examination, 12 -lead electrocardiogram and pre- and post-treatment 2D echocardiograms to include in the clinical records. The demographic and clinic characteristics were analyzed. Hodgkin disease's patients received irradiation with 2 400 cGy intensity and the patients presenting tumors in the central nervous system with 2 340 cGy. Polychemotherapy was carried out with antracyclines, vincristine, vinblastine and others. Results: Average age of all patients was 7 years with predominance of male sex. Symptoms of cardiotoxicity were not recorded. Conclusions: In the serie of analyzed patients, irradiation in the heart area was apparently well beared by the patients, without early appearance of cardiotoxicity, not even in follow up periods of 9 years. Transitory nausea and leucopenia appeared in some cases. There are no differences in the toxicities of the different tumour's groups studied. It is necessary to keep the regular follow up to rule out the appearence of cardiotoxicity in the next years(AU)

Toxic epidermal necrolysis in a patient receiving concurrent phenytoin and whole brain and thoracic radiotherapy

Toxic epidermal necrolysis [TEN] is a severe drug induced type IV hypersensitivity syndrome that can be caused by anticonvulsant drugs, especially the aromatic anticonvulsants such as phenytoin. Most patients with brain metastasis receive whole brain radiotherapy along with anti-edema measures and anticonvulsants either as prophylactic or for symptom control; phenytoin being the most commonly used drug. In a subset of patients, cranial irradiation may act as a precipitating factor along with anticonvulsants for the development of TEN. We report a 54-year-old patient with metastatic non-small cell lung cancer treated with palliative whole brain and mediastinal radiotherapy with concurrent phenytoin-developing TEN, which started within the radiation portals with subsequent generalization. Though a rare, but serious complication, avoidance of the use of phenytoin concurrent with radiotherapy, replacing phenytoin with newer anticonvulsants, early recognition, aggressive management and awareness of this possible complication has been implied upon in this report

Experimental evaluation of midline dose calculation methods in In vivo dosimetry using anatomic thorax phantom

In vivo dosimetry is a method for estimation of overall error in the delivered dose to the patients at the end of radiotherapy process. In this research, two methods for target dose calculation were evaluated on midline and central axis of photon beams in in vivo dosimetry of thorax fields. Entrance and exit doses for anterior and lateral fields of thorax were measured in thorax phantom using diode dosimeter. Also, the doses of some points on midline and central axis were measured in thorax phantom using ionization chamber. The dose at these points was calculated using entrance and exit doses by geometric and arithmetic mean methods. The calculated doses were compared with measured doses. In all cases, arithmetic mean method showed errors from%8.8 to 19% for points on midline and central axis in comparison to measurements. The range of errors for geometric method was from%1.5 to%8 depending on distance from midline. The results showed that doses of points on midline and central axis can be calculated with acceptable accuracy from entrance and exit doses using geometric mean in thorax fields

Extensive acute lung injury following limited thoracic irradiation: radiologic findings in three patients

The aim of our study was to describe the radiologic findings of extensive acute lung injury associated with limited thoracic irradiation. Limited thoracic irradiation occasionally results in acute lung injury. In this condition, chest radiograph shows diffuse ground-glass appearance in both lungs and thin-section CT scans show diffuse bilateral ground-glass attenuation with traction bronchiectasis, interlobular septal thickening and intralobular smooth linear opacities.

Role of chest wall irradiation in T2 breast cancer cases following mastectomy

This prospective study included 204 breast cancer cases with PT2 primary tumors out of 802 breast cancer cases who attended at NEMROCK over 3-year period [1993-1995]. Patients with PT2 tumors did not receive chest wall irradiation after radical or modified radical mastectomy irrespective of any risk factor according to breast unit protocol adopted in NEMROCK. The overall recurrence rate was 10.29%, a multivariate analysis was done to identify the significant predictors influencing chest wall recurrence concluded that +ve axillary lymph nodes, high tumors grade and inner quadrant site in age <35 years are significant predictors of chest wall recurrence in patients with PT2 breast cancer cases that require postoperative chest wall irradiation according to this study

Avaliaçäo das doses de radiaçäo X recebidas por pacientes em estudos radiológicos / Evaluation of radiation X doses received by patients in radiological studies

Avaliamos a dose absorvida na pele de pacientes submetidos a exames radiológicos de tórax, seios da face e coluna lombar, através da dosimetria termoluminescente, em condições técnico-operacionais variadas. Os resultados mostraram diferenças relevantes na dose absorvida para as alternativas técnicas empregadas.

Observaçöes preliminares da relaçäo entre técnica radiográfica e doses em pacientes submetidos a exames radiográficos convencionais / Preliminary observations of relationship between radiographic technique and doses in patients submitted to conventional radiographic examination

Este trabalho apresenta uma avaliação da dose de entrada à superfície em pacientes submetidos a exames reais, proporcionada pela técnica radiográfica presente em 10 salas da cidade de Curitiba - PR no período de 12/95 a 04/96. Objetiva delinear as bases para estudos mais extensos, de nível local ou regional. É resultado da cooperação entre a SESA-PR e CIDRA-USP no desenvolvimento de pesquisa e capacitação técnica em saúde pública.

This work presents an evaluation of entrance skin dose in patients submitted at real examinations, arising from present radiographic technic in 1 O rooms of county of Curitiba - PR, between 12/95 and 04/96. Objectify outline the basis for extensive studies, on local or regional levei. Is the result of cooperation between the SESA-PR and CIDRA-USP in development of research and technical capacitation on public health.

Dose distribution in thorax using measured and calculation algorithm method

In This study a trial has been done to verify the treatment planning algorithm implemented on the theraplan TP-11 system. To achieve this goal the thorax part of a humanoid [Rando] Phantom is used. The thorax part is irradiated using 10 Mev electron beam from varian accelerator and the dose distribution is monitored by Lif [700] TLD. The experimental results are compared with the results of the algorithm of the theraplan TP-11 System. The study revealed that the results due to the algorithm at the penumbral region of the radiation field, [area under rib and area between ribs] can vary and read as much as 23%. A discussion of the results is also presented

physical and equivalent biologic dose received by the spinal cord during thoracic irradiation

The anteroposterior separation at the level of the thoracic vertebrae 4 and 5 and the depth of the spinal cord from the posterior chest wall were measured for a random sample of 50 Egyptian patients referred to Kasr El-Eini Center of Radiation Oncology and Nuclear Medicine [NEMROCK]. Assuming that the spinal cord is at the central axis beam, the dose received by the spinal cord was calculated using the percentage depth dose tables for Cobalt-60 [SSD-80] and 10 MV linear accelerator [FSD=100]. For two parallel opposed fields techniques of irradiation, it was found that the spinal cord received a higher dose [up to 10%] than that prescribed at the reference point [midline]. The larger the separation, the higher the dose received by the thoracic spinal cord. For internal mammary field, [in breast cancer cases] it was found that the spinal cord received about 50% or more of the prescribed dose. Moreover, the biological equivalence of the physical dose absorbed at the spinal cord was calculated using the linear Quadratic Model