Complejo Hospitalario Universitario Of Albacete Chua

Albacete, Spain

Complejo Hospitalario Universitario Of Albacete Chua

Albacete, Spain
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PubMed | University of Cantabria, Hospital Nacional Of Paraplejicos Hnp, Hospital Complex of Navarre, University of Castilla - La Mancha and 3 more.
Type: Journal Article | Journal: PloS one | Year: 2015

The decrease of volume estimates in different structures of the medial temporal lobe related to memory correlate with the decline of cognitive functions in neurodegenerative diseases. This study presents data on the association between MRI quantitative parameters of medial temporal lobe structures and their quantitative estimate in microscopic examination. Twelve control cases had ex-vivo MRI, and thereafter, the temporal lobe of both hemispheres was sectioned from the pole as far as the level of the splenium of the corpus callosum. Nissl stain was used to establish anatomical boundaries between structures in the medial temporal lobe. The study included morphometrical and stereological estimates of the amygdaloid complex, hippocampus, and temporal horn of the lateral ventricle, as well as different regions of grey and white matter in the temporal lobe. Data showed a close association between morphometric MRI images values and those based on the histological determination of boundaries. Only values in perimeter and circularity of the piamater were different. This correspondence is also revealed by the stereological study, although irregular compartments resulted in a lesser agreement. Neither age (< 65 yr and > 65 yr) nor hemisphere had any effect. Our results indicate that ex-vivo MRI is highly associated with quantitative information gathered by histological examination, and these data could be used as structural MRI biomarker in neurodegenerative diseases.


Sabater S.,Complejo Hospitalario Universitario Of Albacete Chua | Arenas M.,Hospital Universitari Sant Joan | Berenguer R.,Complejo Hospitalario Universitario Of Albacete Chua | Machin-Hamalainen S.,C.S. General Ricardos | And 6 more authors.
Brachytherapy | Year: 2015

Purpose: Several studies have analyzed the effect of bladder filling during vaginal cuff brachytherapy (VCB), but the effect of rectum filling has not been studied. We sought to evaluate the effects of rectal volume on rectal doses during postoperative VCB. Methods and Materials: Brachytherapy planning CT scans (334 sets) obtained from 92 consecutive patients treated with VCB were resegmented (bladder and rectum) and replanned retrospectively using the same parameters to homogenize data and improve analysis. Rectal volume and a set of values derived from dose-volume histograms (DVHs) were extracted (maximal dose [Dmax], D0.1cc, D1cc, and D2cc). Univariate and multivariate analyses were carried out to evaluate the association between rectal volume and DVH metrics after adjusting for other clinical factors. Results: A positive significant correlation was observed between rectal volume correlated and Dmax, D0.1cc, D1cc, and D2cc. Multiple linear regression models found that rectal volume, cylinder angle position, and cylinder diameter variables correlated significantly with the different DVH parameters analyzed. These variables explained the 14.5% and 18% of variance on regression models. Conclusions: Larger rectal volumes are associated with higher rectal dose parameters during VCB fractions. Prospective studies are needed to investigate whether these data are linked to differences in rectal toxicity. © 2015 American Brachytherapy Society.


PubMed | Complejo Hospitalario Universitario Of Albacete Chua, C.S. General Ricardos, Hospital Universitari Sant Joan, Hospital Son Espases and Hospital Central Of Asturias
Type: Journal Article | Journal: Brachytherapy | Year: 2015

Several studies have analyzed the effect of bladder filling during vaginal cuff brachytherapy (VCB), but the effect of rectum filling has not been studied. We sought to evaluate the effects of rectal volume on rectal doses during postoperative VCB.Brachytherapy planning CT scans (334 sets) obtained from 92 consecutive patients treated with VCB were resegmented (bladder and rectum) and replanned retrospectively using the same parameters to homogenize data and improve analysis. Rectal volume and a set of values derived from dose-volume histograms (DVHs) were extracted (maximal dose [Dmax], D0.1cc, D1cc, and D2cc). Univariate and multivariate analyses were carried out to evaluate the association between rectal volume and DVH metrics after adjusting for other clinical factors.A positive significant correlation was observed between rectal volume correlated and Dmax, D0.1cc, D1cc, and D2cc. Multiple linear regression models found that rectal volume, cylinder angle position, and cylinder diameter variables correlated significantly with the different DVH parameters analyzed. These variables explained the 14.5% and 18% of variance on regression models.Larger rectal volumes are associated with higher rectal dose parameters during VCB fractions. Prospective studies are needed to investigate whether these data are linked to differences in rectal toxicity.


Sabater S.,Complejo Hospitalario Universitario Of Albacete Chua | Sevillano M.M.,Complejo Hospitalario Universitario Of Albacete Chua | Andres I.,Complejo Hospitalario Universitario Of Albacete Chua | Berenguer R.,Complejo Hospitalario Universitario Of Albacete Chua | And 3 more authors.
Strahlentherapie und Onkologie | Year: 2013

Objective: The goal of this work was to evaluate whether the volume reduction related to removal of gas in the rectum could be translated in lower doses to organs at risk (OAR) during vaginal cuff brachytherapy (VBT). Material and methods: Fourteen pairs of brachytherapy planning CT scans derived from 11 patients were re-segmented and re-planned using the same parameters. The only difference between pairs of CTs was the presence or lack of gas in the rectum. The first CT showed the basal status and the second was carried out after gas removal with a tube. A set of values derived from bladder and rectum dose-volume histograms (DVH) and dose-surface histograms (DSH) were extracted. Moreover the cylinder position related to the patient craniocaudal axis was recorded. Results: Rectum volume decreased significantly from 77.8 ± 45 to 55.43 ± 17.6 ml (p = 0.0052) after gas removal. Such volume diminution represented a significant reduction on all rectal DVH parameters analyzed except D25 % and D50 %. DSH parameter results were similar to previous ones. A nonsignificant increase of the bladder volume was observed and was associated with an increase of the DVH metrics analyzed. Conclusion: Removal of gas pockets is a simple and inexpensive maneuver that decreases rectal dose parameters on VBT, which can be translated as a better therapeutic ratio. It also suggests that other actions directed to empty the rectum could have a similar effect. © 2013 Springer Heidelberg Berlin.


Sabater S.,Complejo Hospitalario Universitario Of Albacete Chua | Andres I.,Complejo Hospitalario Universitario Of Albacete Chua | Sevillano M.,Complejo Hospitalario Universitario Of Albacete Chua | Berenguer R.,Complejo Hospitalario Universitario Of Albacete Chua | And 2 more authors.
Brachytherapy | Year: 2014

Purpose: To compare dose summation using a single plan (SP) approach for vaginal cuff brachytherapy (VBT) against dose summation after a rigid or deformable registration for each VBT fraction, in women with early stage endometrial cancer receiving postoperative VBT. Methods and Materials: A retrospective analysis of 19 patients who received VBT as the sole adjuvant treatment was undertaken. For the purposes of the study, every VBT fraction was re-segmented and re-planned under the same conditions. CT-planning images were registered, initially following a rigid method and then using deformable registration. The transformation vectors were reused to warp the dose files, followed by the dose summation. Three dose accumulation scenarios were studied: (1) an SP approach, (2) a rigid dose warping summation (RDWS), (3) a deformable dose warping summation (DDWS). Each scenario was analyzed for 3 and 5 fractions to evaluate the effect of fractionation. D0.1cc, D1cc, D2cc, D5cc, D5%, and Dmean values were compared for organs at risk, such as the rectum and bladder. Results: No statistical significances were observed in rectal parameters between SP and RDWS or between SP and DDWS. Significant SP, RDWS and DDWS Dmean, D0.1cc, and D2cc metric differences for the 5 fractions bladder scenario were observed (p=0.0242, 0.0196, and 0.0242, respectively). Conclusions: A multi-image planning procedure for a VBT course leads to limited differences between different summation methods. SP is an effective and acceptable surrogate for absorbed doses in organs at risk. © 2014 American Brachytherapy Society.


PubMed | Complejo Hospitalario Universitario Of Albacete Chua, C.S. General Ricardos and Hospital Universitari Sant Joan
Type: Evaluation Studies | Journal: Brachytherapy | Year: 2014

To compare dose summation using a single plan (SP) approach for vaginal cuff brachytherapy (VBT) against dose summation after a rigid or deformable registration for each VBT fraction, in women with early stage endometrial cancer receiving postoperative VBT.A retrospective analysis of 19 patients who received VBT as the sole adjuvant treatment was undertaken. For the purposes of the study, every VBT fraction was re-segmented and re-planned under the same conditions. CT-planning images were registered, initially following a rigid method and then using deformable registration. The transformation vectors were reused to warp the dose files, followed by the dose summation. Three dose accumulation scenarios were studied: (1) an SP approach, (2) a rigid dose warping summation (RDWS), (3) a deformable dose warping summation (DDWS). Each scenario was analyzed for 3 and 5 fractions to evaluate the effect of fractionation. D0.1cc, D1cc, D2cc, D5cc, D5%, and Dmean values were compared for organs at risk, such as the rectum and bladder.No statistical significances were observed in rectal parameters between SP and RDWS or between SP and DDWS. Significant SP, RDWS and DDWS Dmean, D0.1cc, and D2cc metric differences for the 5 fractions bladder scenario were observed (p=0.0242, 0.0196, and 0.0242, respectively).A multi-image planning procedure for a VBT course leads to limited differences between different summation methods. SP is an effective and acceptable surrogate for absorbed doses in organs at risk.


PubMed | Hospital Clinic Barcelona, Rovira i Virgili University, Institute Oncologic del Valles IOV and Complejo Hospitalario Universitario Of Albacete Chua
Type: Journal Article | Journal: Brachytherapy | Year: 2015

Nonmelanoma skin cancer (NMSC) is the commonest cancer in humans. NMSC treatment currently includes surgery, radiation therapy, and topical approaches. The objective was to analyze and compare the outcomes, toxicity, and cosmesis of NMSC treated by two hypofractionated high-dose-rate (HDR) plesiotherapy techniques.A retrospective institutional clinical study of 134 basal cell or squamous cell skin carcinomas treated at Radiation Oncology Department. Lesions were treated from November 2006 to December 2011 with a moderate hypofractionated HDR plesiotherapy using a fixed applicator or a customized mold.After a median follow-up of 33 months, overall disease-free survival at 3 and 5 years was 95.12% and 93.36%, respectively. For Leipzig applicator, disease-free survival at 3 years was 94.9% and 94.9% at 5 years, for customized mold was 93.1% at 3 years and 88% at 5 years. Complete regression was achieved in 98% of lesions. Two lesions persisted after treatment; both had been treated by a Leipzig applicator. Six lesions suffered local recurrence (five Leipzig applicators and three molds, p = 0.404). Grade <2 acute toxicity noted in 57.3% of patients. Only 2.2% of lesions had Grade 4 acute toxicity. Borderline significant increase of toxicity was associated with customized molds (p = 0.067). Larger tumors were associated with higher acute skin toxicity. The cosmesis outcomes were excellent or good in 82% of patients, fair in 13%, and not available in 5%.Hypofractionated HDR plesiotherapy is an effective and well-tolerated treatment for NMSC with different toxicity levels depending on the plesiotherapy technique used.


PubMed | Complejo Hospitalario Universitario Of Albacete Chua, University of Barcelona and Hospital Universitari Sant Joan
Type: Journal Article | Journal: Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] | Year: 2016

To evaluate the effects of rectal enemas on rectal doses during postoperative high-dose-rate (HDR) vaginal cuff brachytherapy (VCB).This prospective trial included 59patients. Two rectal cleansing enemas were self-administered before the second fraction, and fraction1 was considered the basal status. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Statistical analyses used paired and unpaired t-tests.Despite a significant 15% reduction in mean rectal volume (44.07 vs. 52.15cc, p=0.0018), 35.6% of patients had larger rectums after rectal enemas. No significant rectal enema-related DVH differences were observed compared to the basal data. Although not statistically significant, rectal cleansing-associated increases in mean rectal DVH values were observed: D0.1cc: 6.6 vs. 7.21Gy; D1cc: 5.35 vs. 5.52Gy; D2cc: 4.67 vs. 4.72Gy, before and after rectal cleaning, respectively (where Dxcc is the dose to the most exposed xcm(3)). No differences were observed in DVH parameters according to rectal volume increase or decrease after the enema. Patients whose rectal volume increased also had significantly larger DVH parameters, except for D5%, D25%, and D50%. In contrast, in patients whose rectal volume decreased, significance was only seen for D25% and D50% (Dx% dose covering x% of the volume). In the latter patients, nonsignificant reductions in D2cc, D5cc and V5Gy (volume receiving at least 5Gy) were observed.The current rectal enemas protocol was ineffective in significantly modifying rectal DVH parameters for HDR-VCB.


PubMed | University of Castilla - La Mancha, Complejo Hospitalario Universitario Of Albacete Chua, Hospital Son Espases, University of Barcelona and Hospital Universitari Sant Joan
Type: Journal Article | Journal: Brachytherapy | Year: 2016

To evaluate the impact of rectal dose on rectal contrast use during vaginal cuff brachytherapy (VCB).A retrospective review of gynecology patients who received some brachytherapy fractions with and without rectal contrast was carried out. Rectal contrast was instilled at the clinicians discretion to increase rectal visibility. Thirty-six pairs of CT scans in preparation for brachytherapy were analyzed. Pairs of CTs were segmented and planned using the same parameters. The rectum was always defined from 1 cm above the cylinder tip up to 1.5 cm below the last activated dwell source position. An individual plan was computed at every VCB fraction. A set of values (Dmax, D(0.1cc), D(1cc), and D(2cc)) derived from dose-volume histograms were extracted and compared according to the rectal status.Rectal volume was 26.7% larger in the fractions with rectal contrast. Such an increase in volume represented a significant increase from 7.7% to 10.4% in all parameters analyzed except Dmax dose-volume histogram.Avoiding rectal contrast is a simple way of decreasing the rectal dose parameters of VCB, which would mean a better therapeutic ratio. Results also suggest that action directed at maintaining the rectum empty might have the same effect.


PubMed | University of Castilla - La Mancha, Complejo Hospitalario Universitario Of Albacete Chua, Hospital Son Espases, University of Barcelona and Hospital Universitari Sant Joan
Type: Journal Article | Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology | Year: 2016

Our aim was to analyse the feasibility of integrating an MRI acquired in a non-radiotherapy set-up into the prostate cancer radiotherapy workflow.The MRIs of 15 prostate cancer patients, acquired with a flat table-top (MRI-flat), and with a curved tabletop (MRI-curve) were analysed. MRIs were rigidly (RIR) and non-rigidly registered (DIR) with CT images. The prostate and rectum were contoured in each image set and translated to the CT, and IMRT plans were computed taking into account structural changes after RIR and DIR (P-flatRIR, P-curveRIR and P-curveDIR). In addition the P-curveDIR was overlaid with RIR structures. Spatial overlap parameters and dose-volume histogram metrics were generated.No significant differences were observed among P-flatRIR and P-curveRIR or P-flatRIR and P-curveDIR. Median gamma-values: P-curveRIR, 95.3%; P-curveDIR, 96%, translated-P-curveDIR, 95%. DVH metrics for translated-P-curveDIR were: Dmin, 64.5Gy; Dmean, 70.06Gy; V95%, 100%. No statistically significant differences were found in the dosimetric MRI-flatDIR values.The dosimetric reproduction of treatment position image following image registration of non-radiotherapy set-up images suggests that it is feasible to integrate these images into the radiotherapy workflow.

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