[Radiation exposure in children undergoing diagnostic imaging: a study of Pamplona County]. / Exposición a la radiación de la población pediátrica en radiodiagnóstico. Un estudio de Pamplona y su comarca.

OBJECTIVE: To describe a method of calculating and registering the dose of radiation used in Pamplona County in pediatric examinations, and to show the results obtained one year after its implementation. MATERIAL AND METHODS: The effective dose was calculated by a program that uses the pediatric files of the United Kingdom's National Radiation Protection Board. This program, incorporated into the Computerized Clinical History, enables an Individual Dosimetric History to be calculated for the entire pediatric population. The effective dose figures were correlated with the risk of radio induced mortal cancer using the estimations of the International Commission on Radiological Protection. RESULTS AND DISCUSSION: In one year, 9681 children received 22667 exposures to X-rays in Pamplona County. The annual collective dose on the population of children in the area was 3.1 sieverts, and the mean dose per inhabitant was 0.054 millisieverts. We report the number of each kind of examination for the year, together with the resulting mean effective dose and the risk of mortal cancer it involves. The largest doses were obtained from CT examinations, gastroduodenal studies, and telemetry of the entire spine. We describe and discuss the risk involved in radiological examinations. CONCLUSIONS: Modern information technology techniques enable individual dosimetric histories to be created using the most modern systems of measurement and registration.

Chemoradiotherapy for muscle invading bladder carcinoma. Final report of a single institutional organ-sparing program.

PURPOSE: Chemoradiotherapy is becoming an alternative to radical cystectomy among patients with muscle invading bladder cancer. We began a prospective study in 1988 to determine the possibilities of conservative treatment and aiming to improve the results obtained by cystectomy alone in invasive bladder cancer. A combination of methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC), followed by radiotherapy and concomitant cisplatin was used. METHODS: Fifty patients with good performance status and with stages T2 to T4 operable untreated invasive bladder cancer were entered in the study. Treatment protocol was as follows: (i) cytoreductive transurethral resection; (ii) two cycles of M-VAC chemotherapy; (iii) radiotherapy, 45 Gy on pelvic volume and, at the same time, 20 mg/m(2) cisplatin on days 1 to 5. Cystoscopic evaluation: if there was a complete response, radiotherapy was completed up to 65 Gy; if there was not a complete response, a cystectomy was performed. Median follow-up of the series was 73 months (18-180 m). RESULTS: Tumor response was as follows: 34 complete responses (68%), 9 partial responses (18%), and 7 nonresponses (14%) were observed. The 5-year overall survival and local control were 48% and 47%, respectively. For the complete responder patient, 5-year survival and local control were 65% and 70%, respectively. Severe toxicity was uncommon. The most frequent were leucopenia and cystitis. No treatment-related deaths occurred with either treatment protocol. CONCLUSIONS: Conservative combination treatment may be an acceptable alternative to immediate cystectomy in selected patients with bladder cancer, although a randomized clinical trial would be required to produce definitive results.