There are only scarce data on the place of brachytherapy (BT) for treatment of vulvar carcinoma. Our institutional experience of interstitial BT for vulvar carcinoma patients is reported.
Clinical ...records of patients receiving low-dose-rate or pulsed-dose-rate BT as part of the primary treatment for primary/recurrent vulvar squamous cell carcinoma or as part of postoperative treatment between 2000 and 2015 were included. Patients, tumors, and treatment characteristics as well as clinical outcome were examined.
A total of 26 patients treated with BT were identified. BT was delivered as part of primary intent treatment for locally advanced/recurrent cancer in 11 patients and as part of postoperative treatment in 15 patients. Median age at time of BT was 63 years (range, 41-88 years). Pulsed-dose-rate and low-dose-rate were used in 15 patients and 11 patients, respectively. BT was performed as a boost to the tumor bed following external beam radiotherapy (n = 13) or as the sole irradiation modality (n = 13). Total median dose at the level of primary tumor was 60 GyEQD2 (range, 55-60 GyEQD2). With mean followup of 41 months (range, 5 months-11.3 years), 11 patients experienced tumor relapse, and in two of them, site of relapse was only local. Three-year estimated disease-free survival and overall survival rates were 57% (95% confidence interval: 45-69%) and 81% (95% confidence interval: 72-90%), respectively. All toxicities were Grade 2 or less.
Interstitial BT used as part of the primary or postoperative treatment of vulvar carcinoma is feasible with a satisfactory toxicity profile. Prognosis remains, however, dismal, with a high frequency of failures in patients with locally advanced tumors.
In SOLEIL, 5 solid state amplifiers provide the required rf power at 352MHz : 1×35kW in the booster and 4×190kW in the storage ring. They consist in a combination of a large number of 330 W ...elementary modules (1×147 in the booster and 4×724 in the storage ring), based on a design developed in-house, with MOSFETs (metal-oxide-semiconductor field-effect transistors), integrated circulators, and individual power supplies. Although quite innovative and challenging for the required power range, this technology is very attractive and presents significant advantages as compared to the more conventional vacuum tubes, klystrons, or inductive output tubes (IOTs). The booster and two of the storage ring power plants have been successfully commissioned and the first operational experience is quite satisfactory. The amplifiers proved to be very reliable as well as easy and flexible in operation; they have not been responsible for any beam time loss.
More than 50 years after the laser discovery, X-ray free electron lasers (FEL), the first powerful tuneable, short pulse lasers in the X-ray spectral range, are now blooming in the world, enabling ...new discoveries on the ultra-fast dynamics of excited systems and imaging. LUNEX5 demonstrator project aims at investigating paths towards advanced and compact FELs. Two strategies are adopted. The first one concerns the FEL line where seeding and echo harmonic generation are implemented together with compact cryogenic in-vacuum undulators. In the second one, the electron beam is no longer provided by a conventional linear accelerator but by a laser plasma process, while a necessary particular electron beam manipulation is required to handle the electron properties to enable FEL amplification.
Imaging of the postoperative knee Viala, P; Marchand, P; Lecouvet, F ...
Diagnostic and interventional imaging,
07/2016, Letnik:
97, Številka:
7-8
Journal Article
Recenzirano
Odprti dostop
Abstract On sagittal images after anterior cruciate ligament (ACL) reconstructions, the femoral tunnel aperture should be at the junction of the line drawn along the posterior femoral cortex and the ...line drawn along the roof of the intercondylar notch (Bluemensaat line). The tibial tunnel aperture should be in the anterior portion of the second third, i.e. anterior aspect of the middle of the tibial epiphysis. An inaccurate placement of the femoral tunnel affects the graft isometry. A tibial tunnel too anteriorly placed results in intercondylar notch roof impingement. After meniscus surgery, first-line MRI is often sufficient to diagnose new tears; however, sometimes it is necessary to perform CT arthrography or MR arthrography. Surgical cartilage repair is evaluated based on articular congruity and on the appearance of the subchondral bone.
Linear erosion (LE) induced either by piping or overland flow is one of the most active factors in the evolution of soils. During single storm events LE may remove enormous amounts of soil material ...from the uplands to the bottomlands and has thus become a broad challenge for food supply, food security, and human health. Recent and rapid changes in land-use and climate patterns in the sloping lands of tropical areas may dramatically increase LE. Our main objective was to investigate to what extent one could use direct flow velocity estimations from dynamic models for predicting LE initiation and development at the event level. The second objective was to estimate the impact of expected land-use and climate changes on LE. The study was conducted in the 0.62 km
2 watershed of northern Laos presented in
Chaplot et al. (2005). Field observations of the formation and the development of LE features throughout 2001 were compared to flow velocity estimations from an existing surface water routing algorithm developed at Utrecht University (De Roo, A.P.J., Wesseling, C.G. and Ritsema, C.J. 1996. LISEM: a single event physically based hydrologic and soil erosion model for drainage basins. I: theory, input and output. hydrological processes 10 (8): 1107–1117.). In 2001, two main rainfall events were responsible for the formation or development of 14 linear features with a total length of 972 m and an erosion rate of 3.5 Mg ha
−
1
. The water routing algorithm was calibrated using the water and the sediment hydrographs observed at the watershed outlet during the first rainfall event. Assuming realistic estimations of flow velocity in hillslopes, a threshold of 0.062 m s
−
1
for linear erosion estimated over 10-m cells was defined. This threshold, validated using the remaining rainfall event, accurately predicted the length (mean error of estimate of less than 15%) and location of LE features. Using this simulation tool, an increase of the percentage of land under cultivation from 9% to 100% resulted in 600% increase in linear erosion. The tested scenarios of climate changes had less impact on linear erosion.
Objectif Décrire les caractéristiques de l'autogestion des patients diabétiques de type 1 au Moyen Orient et en Afrique du Nord et identifier les profils patients associés. Patients et Méthodes ...L'International Diabètes Management Practices Survey (IDMPS) est une étude internationale, observationnelle, transversale conduite annuellement pour investiguer la prise en charge thérapeutique des patients diabétiques de type 1 et 2. Les données de 2042 patients inclus en Algérie, au Maroc, en Tunisie et en Égypte, au cours des vagues 2, 3, 5 et 6 (2006-2014) ont été poolées et analysées. L'autogestion était définie comme l'autosurveillance de la glycémie et l'autoadaptation des doses d'insuline. La recherche de profils patients a été réalisée par régression logistique avec ajustement sur le pays. Résultats L'âge moyen des patients était de 34,3 ± 13,4 ans, 50,2 % étaient des femmes. L'ancienneté moyenne du diagnostic de diabète était de 11,9 ± 8,8 ans. L'autogestion était observée chez 57,1 % des patients (auto-surveillance de la glycémie : 81,9 % ; autoadaptation des doses d'insuline : 63,1 %). L'HbA1c moyenne était de 8,3 ± 1,9 %, 23,3 % des patients avaient une HbA1c < 7 % (autogestion : 28,4 %, absence d'autogestion : 15,2 %). 40,7 % des patients présentaient des complications liées au diabète (complications microvasculaires : 38,5 % ; complications macrovasculaires : 7,6 %). L'analyse multivariée, incluant 1 642 patients, montrait que l'autogestion était significativement associée avec l'ancienneté du diagnostic de diabète (accroissement de 5 ans : OR = 1,22), insuline basale/prandiale ( vs insu-line basale seule : OR = 1,53, vs insuline premix seule : OR = 2.33 et vs autres : OR = 1,69), éducation thérapeutique ( vs aucune éducation thérapeutique : OR = 1,82), enseignement secondaire ou supérieur ( vs illettré/enseignement primaire : OR = 2.49 et OR = 3,87 respectivement), et milieu urbain/suburbain ( vs rural : OR = 1,58). L'autogestion était également associée à un meilleur contrôle glycémique (HbA1c < 7 % vs HbA1c ≥ 7 % : OR = 1,90). Conclusions Cette étude confirme le rôle de l'autogestion dans l'amélioration du contrôle glycémique chez les patients diabétiques de type 1 au Moyen Orient et en Afrique du Nord. Les profils patients identifiés pourraient faire l'objet de mesures d'éducations particulières pour améliorer l'autogestion chez ces patients.
Concomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to ...incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate salvage surgery following radiation therapy in incomplete responders.
Among the patients with locally advanced cervical cancer treated with concomitant chemoradiation followed by 3D image-guided adaptive brachytherapy and hysterectomy, cases with genuine macroscopic remnant, defined as at least 1cm in width, were identified. Their clinical data and outcomes were retrospectively reviewed and compared to the patients treated with the same modalities.
Fifty-eight patients were included, with a median follow-up of 4.2 years. After hysterectomy, 9 patients had macroscopic residual disease, 10 microscopic and the remaining 39 patients were considered in complete histological response. The 4-year overall survival and disease-free survival rates were significantly decreased in patients with macroscopic residual disease: 50 and 51% versus 92% and 93%, respectively. Intestinal grades 3–4 toxicities were reported in 10.4% and urinary grades 3–4 in 8.6% in the whole population without distinctive histological features. Planning aims were reached in only one patient with macroscopic residuum (11.1%). In univariate analysis, overall treatment time (>55 days) and histological subtype (adenocarcinomas or adenosquamous carcinomas) appeared to be significant predictive factors for macroscopic remnant after treatment completion (P=0.021 and P=0.017, respectively). In multivariate analysis, treatment time was the only independent factor (P=0.046, odds ratio=7.0).
Although immediate salvage hysterectomy in incomplete responders provided a 4-year disease-free survival of 51%, its impact on late morbidity is significant. Efforts should focus on respect of treatment time and dose escalation. Adenocarcinoma might require higher high-risk clinical target volume planning aims.
La chimioradiothérapie concomitante suivie de curiethérapie utérovaginale est le traitement standard des cancers du col utérin localement évolués. La place de l’hystérectomie adjuvante reste incertaine mais tend à se limiter aux réponses incomplètes et aux rechutes locales. L’objectif de l’étude était d’analyser le bénéfice de la chirurgie de rattrapage immédiate après radiothérapie.
Parmi les patientes atteintes de cancer du col utérin localement évolué dont le traitement a été une chimioradiothérapie suivie de curiethérapie adaptative guidée par l’image et hystérectomie, les cas avec résidu postopératoire macroscopique, défini comme au moins 1cm de grand axe, ont été identifiés. Leurs données ont été revues rétrospectivement et comparées à celles des patientes traitées selon les mêmes modalités.
Cinquante-huit patientes ont été incluses, avec un suivi médian de 4,2ans. Après hystérectomie, neuf patientes étaient atteintes d’une maladie résiduelle macroscopique, dix microscopique, et les 39 autres étaient en situation de réponse histologique complète. Les probabilités de survie globale et de survie sans récidive à 4ans étaient significativement plus faibles en cas de résidu macroscopique : respectivement 50 et 51 % contre 92 et 93 %. Une toxicité intestinale de grades 3–4 a été rapportée dans 10,4 %, et urinaire dans 8,6 %, dans l’ensemble de la population, sans distinction en fonction du groupe de réponse. Les objectifs de planification n’ont été atteints que pour une seule patiente, chez qui a été mis en évidence un résidu macroscopique (11,1 %). En analyse unifactorielle, l’étalement du traitement (plus de 55jours) et le sous-type histologique (adénocarcinomes et carcinomes adénosquameux) semblaient être des facteurs prédictifs significatifs d’un résidu macroscopique (p=0,021 et p=0,017, respectivement). En analyse multifactorielle, l’étalement était le seul facteur indépendant (p=0,046, odds ratio=7,0).
Bien que l’hystérectomie immédiate de rattrapage ait permis d’obtenir une probabilité de survie sans rechute de 51 % à 4ans, son impact sur la morbidité tardive est significatif, et les efforts doivent se concentrer sur l’optimisation des plans de traitement et le respect de l’étalement. Les adénocarcinomes pourraient requérir des objectifs de planification plus élevés.
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