Cancer during pregnancy is a challenge for multi- and interdisciplinary collaboration due to the diagnostic, prognostic and therapeutic implications, the need for an integrated harmonization of medical action for the pregnant patient and the embryo or foetus and the characteristics of each gestational period, which will determine the protocol to be proposed and its limitations. For this reason, a group of experts appointed by participating scientific societies, which includes the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica—SEOM), the Spanish Association of Surgeons (Asociación Española de Cirujanos—AEC), the Spanish Society of Gynaecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia—SEGO), the Spanish Society of Nuclear Medicine and Molecular Imaging (Sociedad Española de Medicina Nuclear e Imagen Molecular—SEMNIM), the Spanish Society of Oncological Radiotherapy (Sociedad Española de Oncología Radioterápica—SEOR) and the Spanish Society of Medical Radiology (Sociedad Española de Radiología Médica—SERAM), have worked together to establish consensus recommendations that allow the harmonization of management and ultimately the optimization of the healthcare of pregnant patients with cancer. When cancer is detected in a pregnant woman, the week of gestation in which the diagnosis is made must be considered, as well as the characteristics of the tumour. It is strongly recommended that a multidisciplinary team assesses the situation and guides the patient and her family during the informing, diagnosis and treatment process. Likewise, the foetus should be monitored and managed by specialized obstetricians who are part of a multidisciplinary cancer committee.
ResUmenFundamento. La biopsia selectiva del ganglio centinela (BSGC) ha reemplazado a la linfadenectomía axilar (LA), como procedimiento de elección, en el estadiaje del cán-cer de mama en estadios iniciales y axila clínicamente negativa. El objetivo de este trabajo es comparar la supervivencia global y libre de eventos de aquellas pacientes a las que se realizó, en el periodo de validación de la técnica, BSGC seguida de LA respecto a las que se practicó BSGC y LA si el ganglio centinela (GC) presentaba metástasis. material y métodos. Se han incluido 148 pacientes, 81 pertenecientes al periodo de validación y 67 al grupo de aplicación clínica. El radiocoloide se administró intraperitumoralmente, obteniéndose imágenes hasta la visualización del GC, posteriormente en la intervención quirúrgica se procedió a su identificación y extirpación.Resultados. En el grupo de validación, la eficacia de la técnica ha sido del 92,5%, la sensibilidad del 95,6% y la tasa de falsos negativos del 4%. De las 81 pacientes, 75 se encuentran libres de enfermedad (92,6%). De las 67 pacientes pertenecientes al grupo de aplicación clínica, 63 (94%) viven libres de enfermedad. Ninguna paciente ha presentado recurrencia ganglionar axilar.Conclusiones. En la validación de la técnica hemos obtenido unos valores que se hallan dentro de las exigencias de calidad generalmente aceptadas. Con una media de seguimiento de 6 años no hemos observado recurrencia axilar en ninguno de los dos grupos. No existe diferencia estadísticamente significativa en la supervivencia global y libre de eventos entre ambos grupos.Palabras clave. Ganglio centinela. Cáncer de mama. Linfogammagrafía. Supervivencia global. Supervivencia libre de enfermedad. aBsTRaCTBackground. Selective biopsy of the sentinel ganglion (SBSG) has replaced axillary lymphadectomy (AL) as the procedure of choice in staging breast cancer in its initial stages and in clinically negative axilla. The aim of this study is to compare global event-free survival of those patients subjected to SBSG followed by AL, during the period of validation of the technique, with respect to those subjected to SBSG and AL if the sentinel ganglion (SG) showed metastasis. methods. One hundred and forty-eight patients were included, 81 belonging to the period of validation and 67 to the clinical application group. Radiocoloid was administered intraperitumorally, obtaining images up until the visualisation of the SG; its identification and extirpation were carried out subsequently in the surgical intervention.Results. The efficacy of the technique in the validation group was 92.5%, sensitivity was 95.6% and the rate of false negatives was 4%. Of the 81 patients, 75 are free of disease (92.6%). Of the 67 patients belonging to the clinical application group, 63 (94%) are free of disease. No patient has presented axillary ganglion recurrence. Conclusion.In the validation of the technique we obtained values that fall within the demands of generally accepted quality. With an average follow up of 6 years we did not observe ...
Conflicts of interest and sources of funding: none declared.
Dosimetry in liver radioembolization with Y microspheres is a fundamental tool, both for the optimization of each treatment and for improving knowledge of the treatment effects in the tissues. Different options are available for estimating the administered activity and the tumor/organ dose, among them the so-called partition method. The key factor in the partition method is the tumor/normal tissue activity uptake ratio (T/N), which is obtained by a single-photon emission computed tomography (SPECT) scan during a pre-treatment simulation. The less clear the distinction between healthy and tumor parenchyma within the liver, the more difficult it becomes to estimate the T/N ratio; therefore the use of the method is limited. This study presents a methodology to calculate the T/N ratio using global information from the SPECT. The T/N ratio is estimated by establishing uptake thresholds consistent with previously performed volumetry. This dose calculation method was validated against 3D voxel dosimetry, and was also compared with the standard partition method based on freehand regions of interest (ROI) outlining on SPECT slices. Both comparisons were done on a sample of 20 actual cases of hepatocellular carcinoma treated with resin microspheres. The proposed method and the voxel dosimetry method yield similar results, while the ROI-based method tends to over-estimate the dose to normal tissues. In addition, the variability associated with the ROI-based method is more extreme than the other methods. The proposed method is simpler than either the ROI or voxel dosimetry approaches and avoids the subjectivity associated with the manual selection of regions.
Fundamento. La biopsia selectiva del ganglio centinela (BSGC) ha reemplazado a la linfadenectomía axilar (LA), como procedimiento de elección, en el estadiaje del cán-cer de mama en estadios iniciales y axila clínicamente negativa. El objetivo de este trabajo es comparar la supervivencia global y libre de eventos de aquellas pacientes a las que se realizó, en el periodo de validación de la técnica, BSGC seguida de LA respecto a las que se practicó BSGC y LA si el ganglio centinela (GC) presentaba metástasis. Material y métodos.Se han incluido 148 pacientes, 81 pertenecientes al periodo de validación y 67 al grupo de aplicación clínica. El radiocoloide se administró intraperitumoralmente, obteniéndose imágenes hasta la visualización del GC, posteriormente en la intervención quirúrgica se procedió a su identificación y extirpación.resultados. En el grupo de validación, la eficacia de la técnica ha sido del 92,5%, la sensibilidad del 95,6% y la tasa de falsos negativos del 4%. De las 81 pacientes, 75 se encuentran libres de enfermedad (92,6%). De las 67 pacientes pertenecientes al grupo de aplicación clínica, 63 (94%) viven libres de enfermedad. Ninguna paciente ha presentado recurrencia ganglionar axilar.conclusiones. En la validación de la técnica hemos obtenido unos valores que se hallan dentro de las exigencias de calidad generalmente aceptadas. Con una media de seguimiento de 6 años no hemos observado recurrencia axilar en ninguno de los dos grupos. No existe diferencia estadísticamente significativa en la supervivencia global y libre de eventos entre ambos grupos.Palabras clave. Ganglio centinela. Cáncer de mama. Linfogammagrafía. Supervivencia global. Supervivencia libre de enfermedad. aBstractBackground. Selective biopsy of the sentinel ganglion (SBSG) has replaced axillary lymphadectomy (AL) as the procedure of choice in staging breast cancer in its initial stages and in clinically negative axilla. The aim of this study is to compare global event-free survival of those patients subjected to SBSG followed by AL, during the period of validation of the technique, with respect to those subjected to SBSG and AL if the sentinel ganglion (SG) showed metastasis. Methods.One hundred and forty-eight patients were included, 81 belonging to the period of validation and 67 to the clinical application group. Radiocoloid was administered intraperitumorally, obtaining images up until the visualisation of the SG; its identification and extirpation were carried out subsequently in the surgical intervention.results. The efficacy of the technique in the validation group was 92.5%, sensitivity was 95.6% and the rate of false negatives was 4%. Of the 81 patients, 75 are free of disease (92.6%). Of the 67 patients belonging to the clinical application group, 63 (94%) are free of disease. No patient has presented axillary ganglion recurrence.conclusion. In the validation of the technique we obtained values that fall within the demands of generally accepted quality. With an average follow up of 6 years we did not observe axillary ...
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