IntroductionIn this study, we undertake a dosimetric comparison of whole abdominal treatment plans of patients diagnosed with stage 3 Wilms tumour, to assess the benefits of treating these patients with volumetric arch therapy (VMAT) versus 3D conformal radiotherapy.Material and methodsA retrospective study was undertaken on 23 patients receiving either VMAT or 3D conformal radiotherapy during 2013–2017. A dosimetric comparison was undertaken for both techniques, measuring planning target volume (PTV), conformity index (CI), homogeneity index (HI) and organs at risk (OAR).ResultsThe dosimetric parameters for the PTV dose in the VMAT and 3D conformal technique showed no statistical difference (1,289·17 cGy versus 1,357·13 cGy, respectively, p=0·404). However, the VMAT technique had a better CI (1·04 VMAT versus 1·26 3D, p=0·004), and there was little difference in the HI (1·13 VMAT versus 1·15 3D, p=0·1606). In the statistical analysis, the decrease in dose to OAR for the VMAT technique is statistically significant for doses to lung and kidney (p=0·011 and p=0·002, respectively). Between the two techniques, there was no statistical significance in dose difference to the other OAR.ConclusionThis work proposes using the VMAT technique in whole abdominal irradiation to improve conformity, without affecting the quality of the PTV coverage, when compared with the 3D conformal technique. In addition, VMAT reduces the doses to OAR such as the remaining kidney and lungs that are important to preserve to reduce the probability of radiation toxicity in these patients.
Intussusception is defined as telescoping of a proximal segment of the gastrointestinal tract into a distal
segment caused by an organic lesion usually on the bowel that functions as a guiding point been pulled
towards a distal segment due to normal peristalsis. It is rare in adults, and it represents only 5% of all
intussusceptions which for the most part has been reported in the rectosigmoid colon and mostly diagnosed
during surgery. We present a patient with intermittent abdominal pain and intermittent mild symptoms of
bowel obstruction who reveals in imaging studies an ileocecal intussusception and due to his age, loss of
weight, and a palpable tumor, a malignancy as the cause of intussusception was suspected. The
histopathological study reported a colon adenocarcinoma. Although it is possible to reduce an
intussusception, this should be avoided in adults due to a high malignancy rate and a perforation risk of the
piece that might cause tumor cell dissemination. Taking in consideration what has been reported in literature
and the colon cancer epidemiology, we should always keep in mind the possibility of a malignant tumor in
a colonic intussusception finding, regardless if it is diagnosed during preoperative by imaging studies in a
scheduled patient or if it is found during an emergency laparotomy.
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