Intensity-modulated radiation therapy (IMRT) uses solid compensators or multileaf collimators to modulate the intensity of radiation in each field, delivering highly conformal dose distributions. This technique allows treating volumes with concave shapes when the target is close to a critical structure. The movement of multileaf collimator under computer control can modulate the dose in 3 main ways: IMRT with static field with segments, IMRT with dynamic delivery, and IMRT rotational therapy. Volumetric modulated arc therapy (VMAT) is a novel radiation technique that creates conformal distributions with variable gantry speed, dynamic movements of multileaf collimator, and variations in dose rate. The purpose of this study was to review the basis of VMAT, highlighting the differences with other IMRT techniques.
Background: In patients with nutritional risk, the European Society for Clinical Nutrition and Metabolism (ESPEN) recommends nutritional supplements during cancer treatment to prevent weight loss. Objectives: Our goal is to determine the acceptability, compliance and tolerance of a hyperproteic, high-calorie, omega-3 enriched supplement in cancer patients. Methods: Unicentric, prospective observational study in cancer patients with hyperproteic, high-calorie, rich in omega 3 and low volume nutritional supplement. Thirty patients with malnutrition or risk of malnutrition were included. Supplementation lasted six days. Compliance (packaging used), acceptability (Madrid scale), anthropometric variables and gastrointestinal adverse events (AEs) were evaluated. Results: Seventy per cent were men, with an average age of 60 years (range 32-79), with lung (43.3%), ENT (26.7%) and breast neoplasms (13.3%), stage III-IV (56.7%), and treated with radiotherapy (93.3%), chemotherapy (60%) and surgery (16.7%). The product was accepted by all patients. A compliance rate of 100% was observed. Gastrointestinal AE (grade II) related to the supplement was observed in two patients (6.7%). Both subjects had previous gastrointestinal diseases. The median weight, body mass index (BMI) and protein intake increased during supplementation (0.2 kg, 0.1 kg/m2 and 6.2 g). No differences were observed regarding calorie, fat and carbohydrates intake. Conclusion: The high acceptance and compliance with the specific nutritional supplement was associated with an improved nutritional status for cancer patients, and reversed the weight loss without severe gastrointestinal problems, or producing intake displacement.
patients gynecologic examination revealed pigmented lesion from which a biopsy was taken. Histologic examination indicated the diagnose of a melanoma. The mean tumor's size was 3.5 ± 2.1 cm with clinically negative nodes and a mean Breslow depth 11.2 ± 8.7 mm. PET-CT was solicited as presurgical imaging workup.According to the AJCC Cancer Staging Manual, 3/7 (42.8%) of patients were diagnosed at IIC stage, 1/7 (14.3%) at IIIB stage, 2/7 (28.6%) at IIIC stage and 1/7 (14.3%) at IV stage. The treatment was surgery: 3/7 (42.8%) of patients underwent wide local excision and 4/7 (57.2%) of patients underwent hemivulvectomy. Negative margins were obtained in 4/7 (57.2%) of surgerys. Sentinel lymph node (SLN) biopsy was performed in 5/7 (71.4%) of patients and SLN confirmed nodal metastases in 4/5 (80%) of patients. Immunotherapy was the adjuvant treatment for patients with ! IIIB stage (4/ 7), one of them combined with radiotherapy.During the follow up, 5/7 (71.4%) of patients relapsed. The mean time to relapsed was 5.5± 2.3 months. The treatment for the recurrences was 3/5 (60%) cytoreductive surgery combined with immunotherapy in two patients. One woman (20%) received a combination of radiotherapy and immunotherapy and other woman (20%) received palliative treatment. At the time of last follow up, 4/7 (57.2%) women died because of melanoma, 2/7 (28.6%) was tumor free and 1/7 (14.3%) was alive with the disease. Conclusion* As reported in literature, primary vulvar melanomas have biologically aggressive characteristics. The treatment consists of a surgery with appropriate free surgical margins. However, early recognition is what brings the maximal benefit to survival.
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