ABSTRACT
Objetivos. Evaluar la exactitud diagnóstica de la tomografía por emisión de positrones con fluorodeoxiglucosa (FDG-PET) en el cáncer de pulmón de células no pequeñas (CPCNP) y analizar la validez diagnóstica de la tomografía axial computarizada (TAC) y la tomografía por emisión de positrones (PET) en su estadificación. Material y métodos. Se estudiaron prospectivamente 108 pacientes con sospecha clínica de CPCNP potencialmente resecable, siguiendo el protocolo de nuestro hospital y un estudio FDG-PET. El estándar de referencia ha sido la anatomía patológica de la pieza en aquellos pacientes que fueron operados y en el resto de los casos mediante técnicas de imagen específicas y biopsia. Resultados. En el 13% de los pacientes, la FDG-PET fue negativa y tampoco se evidenció tumor en el estudio histológico de la pieza. En el 22% de los pacientes, la FDG-PET detectó enfermedad metastásica (pacientes M0 por TAC). Para la afectación mediastínica, la validez diagnóstica global fue de 0,90 con FDG-PET y de 0,59 con TAC. La FDG-PET clasificó mal lesiones secundarias a fenómenos inflamatorios, de escaso tamaño o muy próximas a la lesión primaria. La estadificación mediastínica fue correcta en el 56% y en el 87% de los pacientes mediante TAC y FDG-PET, respectivamente. Conclusiones. Aunque complementarias, la evaluación funcional (FDG-PET) es significativamente superior a los métodos estructurales (TAC) en la valoración de la afectación mediastínica de pacientes con CPCNP (AU)
Purpose. To evaluate diagnostic accuracy of FDG-PET in the definition of non-small cell lung cancer (NSCLC) and analyze diagnostic validity of CT scan and FDG-PET in its staging. Methods. Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT scan and FDG-PET. Gold standard was histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. Results. In 13% of patients, the FDG-PET findings were negative and no tumor was observed in the histological study of the piece. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT scan). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT scan. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumor. Mediastinal staging by CT scan and FDG-PET was correct in 56% and 87% of patients, respectively. Conclusions. Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumor disease (AU)
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Neoplasm Staging , Carcinoma, Non-Small-Cell Lung/pathology , Lung Neoplasms/pathology , Tomography, Emission-Computed , Tomography, X-Ray Computed , Sensitivity and Specificity , Reproducibility of Results , Prospective Studies , Cohort StudiesABSTRACT
PURPOSE: To evaluate diagnostic accuracy of FDG-PET in the definition of non-small cell lung cancer (NSCLC) and analyze diagnostic validity of CT scan and FDG-PET in its staging. METHODS: Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT scan and FDG-PET. Gold standard was histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. RESULTS: In 13% of patients, the FDG-PET findings were negative and no tumor was observed in the histological study of the piece. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT scan). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT scan. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumor. Mediastinal staging by CT scan and FDG-PET was correct in 56% and 87% of patients, respectively. CONCLUSIONS: Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumor disease.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Fluorodeoxyglucose F18 , Lung Neoplasms/diagnosis , Positron-Emission Tomography , Radiopharmaceuticals , Tomography, X-Ray Computed , Adult , Aged , Female , Humans , Male , Middle Aged , Neoplasm Staging/methods , Prospective Studies , Reproducibility of ResultsABSTRACT
Major changes in cancer radiotherapy have followed a greater understanding of the biological effects of radiation on tumours and normal tissues. Clinical radiotherapy is today a solid body of knowledge with well defined scientific foundations. Key concepts in current radiobiology include lethal and sublethal injuries, dose-effect coefficients, alpha/beta ratios, acute and late response, biologically equivalent dose, fraction dose, irradiation time and tumour regeneration between others. Effects of irradiation time and dose per fraction on tumours versus normal tissues are of special importance. Dose per fraction must be considered for analysis of effects in normal late-responding tissues. In contrast, both dose per fraction and irradiation time influence the response to radiation of malignant tumours and acute-responding tissues. Finally, the ability to quantify relationships between radiation dose and biological effect has been of particular value in the development of radiotherapy. This is illustrated by the growing use of high doses per fraction for the treatment of some cancers (AU)
Subject(s)
Humans , Male , Female , Dose Fractionation, Radiation , Neoplasms/radiotherapy , Radiobiology/methods , Radiobiology/trends , Radiotherapy/instrumentation , Radiotherapy/methodsABSTRACT
PURPOSE: To evaluate the efficacy of FDG-PET in the definition of tumour lung node lesions and to compare the diagnostic validity of CT and FDGPET in the staging of patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT and FDG-PET. PET images were analysed by researchers blinded to results of other imaging modalities. Definitive tumour diagnosis was by histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. Diagnostic accuracy was evaluated by comparing CT/PET results with the definitive diagnosis. RESULTS: In 13% of patients, no FDG-PET findings were observed and the histological study was negative for tumour. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumour. Mediastinal staging by CT and FDG-PET was correct in 56% and 87% of patients, respectively. CT indicated mediastinal invasion in 17% of patients with no FDG-PET finding of mediastinal involvement. Conversely, mediastinal spread was undetected by CT in 14% of patients with FDG-PET findings of mediastinal involvement. CONCLUSIONS: Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumour disease (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed , Carcinoma, Non-Small-Cell Lung , Fluorodeoxyglucose F18 , Lung Neoplasms/diagnosis , Positron-Emission Tomography/psychology , Positron-Emission Tomography/standards , Positron-Emission Tomography/trends , Tomography, X-Ray Computed/instrumentation , RadiopharmaceuticalsABSTRACT
La oncología radioterápica forma parte del dispositivo nacional de asistencia médica especializada oficialmente establecido en España y exige que los especialista en ella tengan acceso directo a la evaluación de paicentes, participen desde el principio en el conjunto de decisiones conducente a la aproximación terapéutica multidisciplinar de los mismos, promuevan acciones encaminadas al desarrollo de la investigación y colaboren en la formación pre y postgraduada impartida por las instituciones académicas y sanitarias. Las actividades a realizar por los especialistas en oncología radioterápica aconsejan la inclusión en su proceso educativo de contenidos de naturaleza básica y clínica. Así se ha hecho en el nuevo programa formativo de la especialidad. Por otra parte, la especialización en oncología radioterápica impone el conocimiento y la manipulación experta de los dispositivos técnicos necesarios para el tratamiento con radiación ionizante del cáncer y otros procesos benignos. Una parte importante del periodo formativo de los especialistas debe dedicarse a la adquisición de competencia y aptitud técnica suficientes en el manejo de tales dispositivos, punto fuerte del proceso de especialización que nos distingue de otros especialistas y refuerza nuestra posición en el sistema de salud (AU)
In this paper, the author proposes that specialists should have direct Access to assessment detail for oncological patients, and that they should participate in decision taking processes from the outset, promote actions conductive to furthering research, and collaborate in undergraduate and postgraduate training courses offered by academic bodies and health institutions (AU)
Subject(s)
Humans , Radiotherapy/methods , Education/ethics , Education/methods , Medical Oncology/education , Medical Oncology/methods , Radiation Oncology/education , Radiation Oncology/methods , Radiobiology/methods , Education, Medical, Graduate/methods , Neoplasms/epidemiology , Radiation Oncology/organization & administration , Radiation Oncology/standards , Radiation Oncology/trends , Oncology Service, Hospital , Radiobiology/education , Radiobiology/trends , Education, Continuing/methods , Education, Continuing/trends , Scientific Research and Technological DevelopmentABSTRACT
No disponible
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Humans , Specialization/trends , Radiation Oncology/education , Curriculum , Educational Measurement , Professional Training , Aptitude , Professional CompetenceABSTRACT
No disponible
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Primary Health Care , Primary Health Care , Spain , Schools, Medical , Education, Medical, Graduate , Faculty, Medical , Biomedical ResearchSubject(s)
Delivery of Health Care , Education, Medical/statistics & numerical data , Physicians/supply & distribution , Students, Medical/statistics & numerical data , European Union/statistics & numerical data , Health Care Reform , Humans , Personnel Selection/statistics & numerical data , Population Density , Spain , WorkforceSubject(s)
Education, Medical/standards , Social Change , Curriculum , Delivery of Health Care , Education, Premedical , SpainABSTRACT
OBJECTIVE: To determine the efficacy of postoperative irradiation for locoregional tumor recurrence and in the prevention of distant metastasis in patients with upper urinary tract tumor treated by radical surgery. METHODS: 51 urothelial tumors of the upper urinary tract, most of which had been treated by radical surgery (nephroureterectomy with resection of bladder cuff were analyzed. Since 1989 an adjuvant postoperative radiotherapy protocol (55 Gy) has been included for high grade and stage tumors. Tumor staging was done according to the Jewett-Marshall classification and the Mostoffi cytological grading. RESULTS: Of the total number of cases analyzed, 16 received postoperative irradiation; of these, 5 (31%) showed recurrence. The recurrence rate was 47% for those treated by radical surgery alone. In patients with stage C tumors, 5 out of 12 cases (41.6%) showed recurrence. The recurrence rate was higher (83%) for patients with stage C tumors treated by radical surgery alone. CONCLUSIONS: Adjuvant postoperative radiotherapy is advocated for high grade and stage upper urinary tract tumors. This therapeutic approach has been found to reduce the number of recurrences and, consequently, morbidity. Although the overall survival rate did not increase, a larger series may show more consistent results in this regard.
Subject(s)
Postoperative Care/methods , Urinary Bladder Neoplasms/radiotherapy , Urinary Bladder Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Neoplasm Metastasis/prevention & control , Neoplasm StagingABSTRACT
This study compared the tensile bond strength of brackets adhered to laser-etched enamel with that of brackets adhered to acid-etched enamel. Forty extracted, intact bovine teeth were treated with either 37 percent phosphoric acid for 15 seconds or neodymium:yttrium-aluminumgarnet laser on black-ink-coated enamel. After thermocycling, tensile stress was applied to the bonded specimens at a 0.1 millimeter/minute orosshead speed. A t-test comparison of means showed a significant difference between the laser-etched and acid-etched teeth, with the acid-etched teeth demonstrating significantly more tensile bond strength at a 95 percent level of significance.
Subject(s)
Dental Bonding/methods , Lasers , Orthodontic Brackets , Acid Etching, Dental , Animals , Bisphenol A-Glycidyl Methacrylate , Cattle , Dental Enamel/drug effects , Dental Enamel/radiation effects , Dental Stress Analysis , Materials Testing , Phosphoric Acids/pharmacology , Tensile StrengthABSTRACT
Based on data about illness-free survival obtained studying a group of 192 patients affected by breast cancer, we have made some calculations about tumoral growth kinetics, using the theoretical presumptions of the exponential model. Tumoral recurrence in the different stages (S-I = 35%, S-II = 38%, S-III = 53% y S-IV = 72%) were valued. Also the theoretical mean time of tumoral relapse was determined for each clinical stage of the illness (S-I = 4.6 years, S-II = 2.6 years, S-III = 1.9 years and S-IV = 1.2 years). Knowledge of these relapse time values makes it finally possible to value the residual tumoral mass after treating the primary in each clinical stage under study (S-I = 1.2 X 10(6) cells, S-II = 8.1 X 10(7) cells, S-III = 3.6 X 10(8) cells and E-IV = 1.6 X 10(9) cells). Comparison of the theoretical data obtained with the corresponding clinical data (real appearance time of relapses, percentage of patients of each Stage that have metastasis, etc.) shows that the formulations and theoretical concepts used, describe, with a certain degree of preciseness, the ordinary clinical observations phenomena that characterize the evolutive course of the breast carcinoma.
Subject(s)
Breast Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Breast Neoplasms/mortality , Cell Division , Female , Follow-Up Studies , Humans , Kinetics , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Neoplasm Staging , Time FactorsABSTRACT
In breast cancer, under rigorous and normalized conditions, the blood levels of carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA) allow us: to differentiate with enough precision, in treated patients, the presence of tumour (EP) from illness-free situation (NED); to alert about the appearance of metastases and/or local relapse in patients put under systematic postoperative evolutional control; to evaluate the systemic palliative treatment response in patients with metastatic breast cancer and to formulate, in this case, prognostic predictions. Blood levels of CEA and TPA are, otherwise, unsuitable: to detect with accuracy the primary tumour presence; to warn about the risk of subclinical tumour existence (in treated patients in NED situation); to predict, in this last case, the chemotherapeutic treatment response, and to prevent about local relapses development. The independent but combined use of both antigens, appreciably raises the diagnostic success percentage with regard to that obtained when only one tumour marker was used.
