Squamous cell cancer of the head and neck (SCCHN) often requires adjuvant radiotherapy. Radiotherapy for SCCHN is a challenge because the head and neck contain several critical organs that should receive minimal doses of radiation. These organs include the eyes, parotid glands, brainstem, spinal cord, mandible, and thyroid gland. Approaches like image-guided radiotherapy (IGRT) combined with volumetric modulated arc therapy hold the promise to focus radiation to the planning target volume and spare nearby structures while observing potential changes to patient anatomy during treatment to determine whether replanning is required. IGRT, however, requires the frequent imaging of patients to update the treatment plan. In this retrospective study, we present our findings of SCCHN patients treated in a public hospital in Peru. The patients reflected overall demographic trends associated with SCCHN. Each patient was imaged using computed tomography once before radiotherapy and once by cone-beam computed tomography (CBCT) during treatment, for a total of two images. Tumor displacement, planning target volume, gross tumor volume, and neck diameter were compared between the two images. Among the measurements, only a small statistically significant increase in gross tumor volume was observed between the images. However, a minority of patients did experience changes to anatomy, which highlights the need for continued research into criteria to determine which patients are likely to benefit from treatment replanning due to intratreatment anatomical changes. Alternatively, a lack of frequent CBCT imaging before each session, due to high patient flows and limited staff resources, made it difficult to observe transient changes and trends in each patient. We conclude that the treatment and outcome improvements associated with IGRT are likely associated with frequent imaging during radiotherapy and properly selecting which patients will benefit most from this resource-intensive technique.
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, created a rapidly unfolding health crisis, especially in the initial phases of the pandemic. In the early stages of the pandemic, various strategies were proposed for COVID-19 prophylaxis and treatment with very little scientific evidence available. Among these proposed treatments were ivermectin and chlorine dioxide, which were both used widely in Peru for both disease prevention and treatment without considering their problematic side effects. For instance, ivermectin was part of an approved therapeutic scheme based on in vitro data, although its efficacy in humans was not demonstrated. In addition, chlorine dioxide was never shown to be effective but causes threatening side effects. In this article, we discuss current information regarding chlorine dioxide and ivermectin in the context of the COVID-19 pandemic, with a focus on experiences in Peru.
Background Intracranial germinomas (GN) are rare cancers that primarily affect children, making them rarer still in adults. Standard treatment for this neoplasm includes neoadjuvant chemotherapy (NC) followed by radiotherapy (RT) or RT at a higher dose and larger field. These recommendations are based on studies focused mostly on children; it is currently unclear whether this treatment is applicable to adults. Case We present a case of a 23‐year‐old adult male with no underlying pathologies, drug allergies, or family history of cancer, who presented for medical evaluation with blurred vision, diplopia, forgetfulness, and weight loss starting 3–4 months before the evaluation. Clinical examination indicated Parinaud's Syndrome. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a pineal tumor with ependymal dissemination in both lateral ventricles, which was causing obstructive hydrocephalus. The patient had surgery consisting of ventriculostomy, Holter shunt insertion, cisternal ventricular intubation, and cisterna magna anastomosis to improve ventricular drainage. Pathology confirmed pineal germinoma. Cerebrospinal fluid cytology and MRI of the axis were negative. Four cycles of NC were given to the patient (carboplatin, etoposide, and ifosfamide), with reduced dosage. Once a partial volumetric response was confirmed, whole‐ventricular radiotherapy (WVR) was initiated with a total tumor bed dose of 45 Gy over 25 sessions in 5 weeks. Optimum clinical results were observed, and no short‐term (<90 day) radiation toxicity was observed. The patient was able to resume his normal activities soon after treatment. Follow‐ups over 2 years post‐surgery indicated continued control of the lesion and absence of symptoms except for mild diplopia. Conclusion Although this is a case report, these data suggest that a reduced NC course and WVR may effectively treat adult GN. This protocol likely decreases the risk of undesirable NC and RT secondary effects, while providing excellent local control; however, using a narrower RT field is not recommended.
Lip cancer (LC) is the most common cancer of the oral cavity and is the second most common in the head and neck. Brachytherapy (BT) is a good treatment option for this type of cancer because it administers high doses of radiation to the target. BT has similar cure and survival rates as surgery for the same type of cancer, but it often produces more favourable aesthetic results, especially when the tumour is treated in its early stages. We present a case of a patient diagnosed with stage II lower LC who refused surgical treatment. Instead, highdose-rate interstitial BT was performed with 192 Ir. A 2-year post-treatment follow-up indicated there were neither serious complications nor recurrence of cancer during that period.
Arterial blood gas is a procedure that allows knowing the internal environment of a person through an arterial puncture; however, its results are different according to altitude and barometric pressure. The objective was to evaluate the differences in arterial blood gas (AGA) values of healthy adult inhabitants in Florencia de Mora (FM) at 115 and in Huamachuco (H) at 3164 meters above sea level. Descriptive, cross‐sectional and comparative study. 114 samples were analyzed, made up of two independent groups that met the selection criteria, of 57 inhabitants each, during the months of April and May 2019. A GPS altimeter was used to determine the altitude level. International research guidelines were met. Of the 114, 64 (56%) were women and 50 (44%) were men, with a mean age in FM of 34 and 21 years in H. The pH corrected to the temperature was 7.412 in FM and 7.428 in H (p <0.001). The following means were obtained: PO2 in FM was 110.7 and in H was 69.9 mmHg (p<0.001); pCO2 in FM was 36.0 and in H 32.2 mmHg (p<0.001); HCO3‐ in FM was 23.12 and in H it was 21.37 mmol/L (p<0.001); BE (B), in FM it was 1.3 and in H it was ‐2.2 mmol/L (p<0.001); SatO2 in FM was 95.2 and in H 94.2% (p <0.001); A‐aDO2 in FM was 35.8 and in H 41.2 mmHg (p<0.001); THbc in FM of 14.6 g/dL and in H of 15.5 g/dL (p<0.001); lactate in FM of 2.1 and in H of 2.4 mmol/L (p<0.001). There are significant differences when comparing AGA values. The 5th and 95th percentiles of the AGA obtained in the total population and according to sex of H.
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