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4 results

  • Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure

  • Hamid Reza Baghani, Hajar Moradmand, Seyed Mahmoud Reza Aghamiri
  • Journal:
    Journal of Radiotherapy in Practice / Volume 18 / Issue 1 / March 2019
    Published online by Cambridge University Press:
    31 August 2018, pp. 98-106
  • Background

    Breast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied.

    Materials and Methods

    A computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles.

    Results

    IORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT.

    Conclusion

    Although the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.

  • Chapter 45 - Nocturnal wanderings and an arachnoid cyst

  • from Section 5 - Neuroimaging of sleep disorders
  • Edited by Eric Nofzinger, University of Pittsburgh, Pierre Maquet, Université de Liège, Belgium, Michael J. Thorpy
  • Book:
    Neuroimaging of Sleep and Sleep Disorders
    Published online:
    05 March 2013
    Print publication:
    07 March 2013, pp 352-354

  • Summary

    This chapter focuses on upper airway imaging, and examines risk factors for obstructive sleep apnea (OSA) (both static and dynamic) and the anatomical factors that are changed when successful treatment modalities are applied. OSA is known to have a significant familial component. Volumetric magnetic resonance imaging (MRI) has been employed to investigate whether or not oropharyngeal soft tissue structures segregate in a familial fashion. These data implicate that changes in airway conformation and the size of structures surrounding the oropharynx are important identifiable risk factors for the development of OSA. Interventions which successfully improve sleep disordered breathing often have positive impacts on these same factors, which may contribute to the reduction in airway collapsibility. Imaging can be used to classify patients for the purpose of targeting treatment modalities in order to enhance the success in treating sleep disordered breathing especially in patients undergoing upper airway surgery.

  • 29 - Trophic factor delivery by gene therapy

  • from Section B3 - Promotion of regeneration in the injured nervous system
    • By Ken Nakamura, Department of Neurology, University of California, San Francisco, CA, Un Jung Kang, Department of Neurology, University of Chicago, Chicago, IL, USA
  • Edited by Michael Selzer, University of Pennsylvania, Stephanie Clarke, Université de Lausanne, Switzerland, Leonardo Cohen, National Institute of Mental Health, Bethesda, Maryland, Pamela Duncan, University of Florida, Fred Gage, Salk Institute for Biological Studies, San Diego
  • Book:
    Textbook of Neural Repair and Rehabilitation
    Published online:
    05 March 2012
    Print publication:
    16 February 2006, pp 532-547

  • Summary

    This chapter examines the rational, therapeutic potential, strategies, and obstacles to the delivery of neurotrophic factors using gene therapy for the treatment of neurologic diseases. Two general approaches are used for gene therapy. In ex vivo approaches, cells are genetically modified in vitro to express relevant genes, and then delivered to target areas. The chapter reviews the application of neurotrophic factor gene therapy to animal models of selected neurologic diseases, in which clinical applications are being investigated. In order to maximize the effectiveness of neurotrophic factors, other components of growth factor signaling pathways such as receptor expression can also be targeted. Even if neurotrophic factors are found to protect against degenerative processes in humans, these protective effects may be unrelated to underlying disease pathophysiology. As a result, there may be continued degeneration that negates any protective effects over time.

  • 8 - The challenges of meeting the unmet need for treatment: economic perspectives

  • from Part II - Unmet need: general problems and solutions
  • Edited by Gavin Andrews, University of New South Wales, Sydney, Scott Henderson, Australian National University, Canberra
  • Book:
    Unmet Need in Psychiatry
    Published online:
    21 August 2009
    Print publication:
    06 January 2000, pp 119-131

  • Summary

    This chapter focuses on economic perspectives, and tries to demonstrate how researchers from different disciplines can work together to assist decision makers to formulate mental health policy. Defining the need for treatment is the first requirement, which can be objectively addressed with epidemiological and utilization data on a population-wide basis. From the economic point of view, the purpose of treating mental disorders is to reduce the economic burden of illness on the individual, the family, the community, and on society as a whole. The economic literature has developed three basic methodologies which are used to evaluate the effectiveness of various treatment modalities. These methodologies include: cost-benefit analysis; cost-effectiveness analysis; and cost-utility analysis. Cost comparisons and cost-effectiveness studies in relation to location of care have been undertaken, but more rigorous and complete ones are still required. Cost-benefit, cost-effectiveness, and cost-utility analyses are crucial to decisions about resource allocation in medical care.