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Madrid, Spain

Sanz Cortes A.,Grupo IMO | Olivares Crespo M.E.,Complutense University of Madrid
Psicooncologia | Year: 2013

Cognitive deficits are one of the most common symptoms in patients with brain tumors, especially in attention, memory and executive functions. These changes impact negatively on the quality of life of patients and their return to their daily activities. In recent years, they are developing Neuropsychological Rehabilitation programs in adult patients with brain tumors, with positive results.The authors recommend that interventions include psychoeducation techniques, recovery strategies of different attentional and executive processes (planning and organization) and compensatory techniques for memory. The studies published to date show improvement immediately after surgery in attention and memory. However, there are not data exist on the impact of these programs on performance rehabilitation of these patients in the medium and long term (over six months). The future studies need to evaluate the effectiveness of this intervention in elderly patients with brain tumors, and the results differ depending on the type of tumor and cancer treatments applied, as these two features can significantly affect the data obtained. Source

Bueno G.,University of Castilla - La Mancha | Deniz O.,University of Castilla - La Mancha | Salido J.,University of Castilla - La Mancha | Carrascosa C.,Hospital General de Ciudad Real | Delgado J.M.,Grupo IMO
International Journal of Computer Assisted Radiology and Surgery | Year: 2011

Purpose: Organ motion should be taken into account for image-guided fractionated radiotherapy. A deformable segmentation and registration method was developed for inter-and intra-fraction organ motion planning and evaluation. Methods: Energy minimizing active models were synthesized for tracking a set of organs delineated by regions of interest (ROI) in radiotherapy treatment. The initial model consists of a surface deformed to match the ROI contour by geometrical properties, following a heat flow model. The deformable segmentation model was tested using a Shepp-Logan head CT simulation, and different quantitative metrics were applied such as ROC analysis, Jaccard index, Dice coefficient and Hausdorff distance. Results: Experimental evaluation of automated versus manual segmentation was done for the cardiac, thoracic and pelvic regions. The method has been quantitatively validated, obtaining an average of 93.3 and 99.2% for the sensitivity and specificity, respectively, 90.79% for the Jaccard index, 95.15% for the Dice coefficient and 0.96% mm for the Hausdorff distance. Conclusions: Model-based deformable segmentation was developed and tested for image-guided radiotherapy treatment planning. The method is efficient, robust and has sufficient accuracy for 2D CT data without markers. © 2010 CARS. Source

Xhumari A.,University Hospital Center Mother Teresa | Rroji A.,University of Tirana | Enesi E.,University of Tirana | Bushati T.,University of Tirana | And 3 more authors.
Acta Neurochirurgica | Year: 2015

Background: Stereotactic radiosurgery (SRS) is considered to be a relatively safe procedure in cerebral arteriovenous malformation management. There are very few reported cases of SRS-associated/induced malignancies. Methods: We show the case of a 21-year-old female who presented with a 21-mm3 ruptured AVM in the right mesial frontocallosal region. Embolization and/or radiosurgery was proposed. She preferred radiosurgery. The AVM was treated with CyberKnife® SRS. Results: She presented behavior changes 6 years after SRS. MRI showed a right subcortical frontal lesion with increased perfusion, more consistent with high-grade glioma. The lesion’s center was within the irradiated region of the previous SRS, having received an estimated radiation dose of 4 Gy. Pathological examination noted a hypercellular tumor showing astrocytic tumor cells with moderate pleomorphism in a fibrillary background, endothelial proliferation, and tumor necrosis surrounded by perinecrotic pseudopalisades. Numerous mitotic figures were seen. The appearances were those of glioblastoma, WHO grade IV, with neuronal differentiation. SRS-associated/-induced GBM after treatment of a large AM is exceptional. SRS-associated/-induced malignancies are mostly GBMs and occur on average after a latency of 9.4 years, within very low-dose peripheral regions as well as the full-dose regions; 33.3 % of patients were under 20 years at the time of SRS, and in 66 % the lesion treated was a vascular pathology. Conclusion: Although it is unlikely that the risk of radiation-induced cancer will change the current standard of practice, patients must be warned of this potential possibility before treatment. © 2015, Springer-Verlag Wien. Source

Lopez Guerra J.L.,University of Houston | Lopez Guerra J.L.,Grupo IMO | Gomez D.,University of Houston | Zhuang Y.,University of Houston | And 7 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: We investigated prognostic factors associated with survival in patients with non-small cell lung cancer (NSCLC) and oligometastatic disease at diagnosis, particularly the influence of local treatment to the primary site on prognosis. Methods and Materials: From January 2000 through June 2011, 78 consecutive patients with oligometastatic NSCLC (<5 metastases) at diagnosis underwent definitive chemoradiation therapy (≥45 Gy) to the primary site. Forty-four of these patients also received definitive local treatment for the oligometastases. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Univariate Cox proportional hazard analysis revealed better overall survival (OS) for those patients who received at least 63 Gy of radiation to the primary site (P=.002), received definitive local treatment for oligometastasis (P=.041), had a Karnofsky performance status (KPS) score >80 (P=.007), had a gross tumor volume ≤124 cm 3 (P=.002), had adenocarcinoma histology (P=.002), or had no history of respiratory disease (P=.016). On multivariate analysis, radiation dose, performance status, and tumor volume retained significance (P=.004, P=.006, and P<.001, respectively). The radiation dose also maintained significance when patients with and without brain metastases were analyzed separately. Conclusions: Tumor volume, KPS, and receipt of at least 63 Gy to the primary tumor are associated with improved OS in patients with oligometastatic NSCLC at diagnosis. Our results suggest that a subset of such patients may benefit from definitive local therapy. © 2012 Elsevier Inc. All rights reserved. Source

Sanz A.,Grupo IMO | Olivares M.E.,Complutense University of Madrid | Barcia J.A.,Complutense University of Madrid
Psicooncologia | Year: 2011

The increased survival of patients with low grade gliomas generated increased interest in the neurotoxic effects associated with treatment, especially radiotherapy. Currently, the radiotherapy is associated with visual memory failures in this population. On the contrary, some authors postulate that radiotherapy, as well as other treatments, helps control the disease and preserves the neuropsychological performance. However, methodological limitations of these studies and the difficulty in monitoring these patients could be causing this divergence in the results found in this research field. Therefore, we note the need for studies that use radiation therapy treatment techniques current, which increase safety and reduce neurological side effects, and apply appropriate questionnaires with a sensitivity to the neurotoxic effects of adjuvant treatments. Source

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