RESUMO
PURPOSE: To describe our experience with a novel technique for total skin irradiation using helical TomoTherapy (Accuray, Sunnyvale, CA). METHODS AND MATERIALS: An infant with refractory acute myelogenous leukemia with extensive cutaneous involvement was given total skin irradiation using inverse-planned helical tomotherapy. Quality assurance tests to determine the deliverability of the technique and the accuracy of dose estimation at the superficial skin level were devised and performed. Daily megavoltage imaging, tomotherapy plan adaptive evaluation, in vivo skin dose measurements, and cumulative dose summation were tools employed to assess the quality of treatment and positioning reproducibility on a daily basis. RESULTS: The quality assurance checks showed that tomotherapy can indeed be used for total skin irradiation in cases where conventional electron treatment delivery is not possible. However, the overestimation of absorbed dose near surface by the treatment planning software must be quantified and taken into account using in-phantom and in vivo dosimetry techniques with appropriate detectors. Daily imaging allows for superior positioning, while daily plan adaptive and dose summations based on the plan adaptive calculations allow for evaluation of the treatment delivery. CONCLUSIONS: An infant has been treated successfully using helical TomoTherapy for total skin irradiation prior to allogeneic stem cell transplant. The course of treatment was uncomplicated and the patient is doing well more than 15 months following therapy.
Assuntos
Exantema/radioterapia , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Humanos , Lactente , Masculino , Órgãos em Risco , Posicionamento do Paciente , Imagens de Fantasmas , Prognóstico , Dosagem Radioterapêutica , SoftwareAssuntos
Exantema/etiologia , Exantema/patologia , Glândulas Sebáceas/patologia , Síndrome de Stevens-Johnson/complicações , Adolescente , Biópsia por Agulha , Exantema/radioterapia , Dermatoses Faciais/etiologia , Dermatoses Faciais/patologia , Dermatoses Faciais/radioterapia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Lamotrigina , Terapia com Luz de Baixa Intensidade/métodos , Medição de Risco , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/fisiopatologia , Resultado do Tratamento , Triazinas/efeitos adversos , Triazinas/uso terapêuticoRESUMO
Describimos el caso de una mujer de raza blanca, VIH positiva, que inició erupción cutánea fotosensible coincidiendo con el deterioro de su situación inmune marcada por la disminución de linfocitos CD4 y elevada carga viral. Su evolución clínica fue paralela a la inmunitaria con importante mejoría después de recibir triple tratamiento antiretroviral. Discutimos los aspectos patogénicos de estas fotoerupciones que pueden suponer un marcador clinico de la infección VIH y su progresión. Comentamos la importancia del control de la radiación ultravioleta y puvaterapia en pacientes VIH positivos (AU)
