presentacion sarcomas pdf
TRANSCRIPT
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¿Qué ventajas aporta la Braquiterapia?Dr. Barrondo AzcorraHospital Universitario Basurto (Bilbao)/OsakidetzaSº Onc. Radioterapica - Secc. Braquiterapia
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nervio tibial
vaso tributario tumoral
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vaso tributario tumoral
nervio tibial
vena poplítea
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nervio tibial
arteria poplítea
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nervio tibial
vena y arteria poplítea
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nervio tibial
vena y arteria poplítea
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nervio tibial
arteria poplítea
vena poplítea
cara posterior hueso tibial
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arteria poplíteavena poplítea
nervio tibial
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nervio tibialvena poplítea
arteria poplítea
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Fuente radiactiva cerca, en contacto o dentro del volumen blanco (Inside Out)
Concepto
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Ventajas
Alta eficacia biológica
Alto gradiente de dosis
Toxicidad aguda aceptable (HDR)
Bajo riesgo repoblación tumoral
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Limitaciones/Desventajas
Accesibilidad / Invasivo
Inhomogeneidad?
Tamaño?
Mayor conformación?/ Errores?
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Radioterapia externa
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Evidencia
Local control comparision of adjuvant brachytherapy to IMRT in primarty high grade sarcoma of the extremity (K. Alektiar, et al/MSKCC)
1995 2006, 134pts
IMRT LC92%, BRT LC81%. p0,04 71ptes Braqui exclusiva(LDR)
53ptes postop IMRT
10ptes preop IMRT
QT en 31% ptes
Critica personal = dosis y volúmenes y además...
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Evidencia
Influence of age on morbidity in primary high grade of sarcoma of the extremity (K. Alektiar, et al/MSKCC)
1982 2006, 274pts!239ptes Braqui exclusiva
35 combinada con RTE
QT 32%
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BRT EBRT pComp herida 9% 3% 0,05Fractura 2% 8% 0,03Rigidez 5% 22% 0,005Edema 6% 14% 0,009Neuropatía 8% 10% 0,7
EvidenciaMorbilidad < 70 años
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BRT EBRT pComp Herida 11% 13% 0,9Fractura 2% 5% 0,7Rigidez 6% 28% 0,006Edema 11% 28% 0,07Neuropatía 1% 6% 0,7
EvidenciaMorbilidad > 70 años
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Conclusiones
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Selección
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Romper barreras
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COLABORACION EXPERIENCIA
COORDINACIONY
PLANIFICACION
Ballo and Lee Curr Opin Oncol, 2003
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Todos somos unos ignorantes...Lo que ocurre es que no todos ignoramos las mismas cosas.
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Muchas gracias, ¿Preguntas?
@Bitorbar