{"id":117780,"date":"2015-03-07T00:00:00","date_gmt":"2015-03-07T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/radiociruga%c2%ada-con-arco-terapia-de-intensidad-modulada-comparaciones-dosimetricas-y-resultados-cla%c2%adnicos-en-el-tratamiento-de-metastasis-intracraneales\/"},"modified":"2015-03-07T00:00:00","modified_gmt":"2015-03-07T00:00:00","slug":"radiociruga%c2%ada-con-arco-terapia-de-intensidad-modulada-comparaciones-dosimetricas-y-resultados-cla%c2%adnicos-en-el-tratamiento-de-metastasis-intracraneales","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/tecnologia-medica\/radiociruga%c2%ada-con-arco-terapia-de-intensidad-modulada-comparaciones-dosimetricas-y-resultados-cla%c2%adnicos-en-el-tratamiento-de-metastasis-intracraneales\/","title":{"rendered":"Radiocirugia con arco terapia de intensidad modulada: comparaciones dosim\u00e9tricas y resultados cl\u00ednicos en el tratamiento de met\u00e1stasis intracraneales"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Alfredo Serna Berna <\/strong><\/h2>\n<p>Resumen introducci\u00f3n: entre el 20 % y el 40 % de los pacientes oncol\u00f3gicos desarrollan met\u00e1stasis cerebrales y supone un incremento significativo de la morbilidad y mortalidad en los pacientes afectados. La t\u00e9cnica de radiocirug\u00eda consiste en la administraci\u00f3n de una dosis de radiaci\u00f3n muy localizada en la lesi\u00f3n y con un elevado gradiente de dosis alrededor del volumen de tratamiento con objeto de minimizar los efectos secundarios en el tejido cerebral sano adyacente. Debido a que la dosis administrada en una \u00fanica sesi\u00f3n es muy alta, tanto el posicionamiento del paciente como la precisi\u00f3n dosim\u00e9trica deben cumplir unos requisitos de calidad muy superiores a los exigidos en radioterapia convencional.  la arco terapia volum\u00e9trica modulada (vmat) es la t\u00e9cnica que mayor grado de conformaci\u00f3n de dosis permite en los tratamientos de oncolog\u00eda radioter\u00e1pica. Esta t\u00e9cnica, al no requerir equipamiento adicional al utilizado en los tratamientos radioter\u00e1picos habituales, podr\u00eda potencialmente extender su utilizaci\u00f3n a nuevos centros que quisieran implementar esta nueva tecnolog\u00eda. Sin embargo, al ser una t\u00e9cnica de radiocirug\u00eda novedosa es necesario que sea sometida a estrictos controles de calidad y sus resultados comparados con el resto de t\u00e9cnicas de radiocirug\u00eda existentes demostrando sus posibles ventajas en el tratamiento oncol\u00f3gico de los pacientes. objetivos: esta memoria de tesis por compendio de publicaciones presenta la comparaci\u00f3n dosim\u00e9trica, radiobiol\u00f3gica y t\u00e9cnica que muestran las ventajas de la t\u00e9cnica vmat; adem\u00e1s, pretende que los resultados cl\u00ednicos de nuestra serie de pacientes tratados por met\u00e1stasis cerebrales puedan confirmar las ventajas de la vmat respecto a otras t\u00e9cnicas, en el tratamiento radioter\u00e1pico de las met\u00e1stasis cerebrales.  material y m\u00e9todo: en los servicios de radiof\u00edsica y protecci\u00f3n radiol\u00f3gica y de oncolog\u00eda radioter\u00e1pica del hospital general universitario santa luc\u00eda de cartagena se dispone de dos aceleradores lineales de electrones, ambos con capacidad para administrar tratamientos vmat, la posibilidad de realizar tratamientos guiados con imagen mediante cone beam ct y el equipamiento de planificaci\u00f3n de los tratamientos y control de calidad empleado habitualmente en oncolog\u00eda radioter\u00e1pica, con los que se han realizado los an\u00e1lisis dosim\u00e9tricos y radiobiol\u00f3gicos presentados en el estudio. Adem\u00e1s, se presentan 52 pacientes oncol\u00f3gicos con met\u00e1stasis cerebrales tratados con radiocirug\u00eda en sesi\u00f3n \u00fanica con la t\u00e9cnica vmat consistente en 5 arcos no coplanares, y dosis de radiaci\u00f3n comprendidas entre 12-20 gy tras la correspondiente aprobaci\u00f3n del comit\u00e9 \u00e9tico de investigaci\u00f3n cl\u00ednica, evalu\u00e1ndose el control local de la enfermedad as\u00ed como la supervivencia global de los pacientes tratados. resultados: los resultados obtenidos permiten determinar que todas las pruebas experimentales, dosim\u00e9tricas y radiobiol\u00f3gicas realizadas en cada plan de tratamiento alcanzan los requisitos previamente establecidos para este tipo de tratamiento radioter\u00e1pico; y, adem\u00e1s, que los resultados cl\u00ednicos obtenidos, tanto de control local de la enfermedad como de supervivencia global del paciente, son comparables a los previamente descritos en la literatura cient\u00edfica empleando cualquier otra t\u00e9cnica de radiocirug\u00eda.  conclusiones: la arco terapia volum\u00e9trica modulada (vmat) es una t\u00e9cnica eficiente, pues el coste por procedimiento es muy inferior al de otros sistemas dedicados exclusivamente al tratamiento de radiocirug\u00eda; y sus resultados cl\u00ednicos son perfectamente comparables al descrito por otras t\u00e9cnica de radiocirug\u00eda. Dado que tanto las unidades de tratamiento, el equipamiento de medida de la radiaci\u00f3n y control de calidad como el sistema de planificaci\u00f3n para el c\u00e1lculo de dosis de radiaci\u00f3n son productos f\u00e1cilmente disponibles en la mayor\u00eda de las nuevas unidades de oncolog\u00eda radioter\u00e1pica nuestro estudio posibilita la incorporaci\u00f3n de la t\u00e9cnica de arco terapia volum\u00e9trica modulada al resolver los problemas de implementaci\u00f3n de esta nueva t\u00e9cnica de tratamiento oncol\u00f3gico.   abstract  introduction: around 20 % to 40 % of oncology patients develop brain metastasis, thus significantly increasing both morbidity and mortality. Radiosurgical techniques involve the administration of a highly localized dose of radiation in the lesion, with a steep dose gradient surrounding the target volume in order to minimize unwanted side effects in adjacent healthy brain tissue. Given that the dose administered in a single session is very high, both the positioning of the patient and the dosimetric precision must comply with quality assurances well above those required in conventional radiotherapy. volumetric modulated arc therapy (vmat) provides the highest degree of dose conformity among oncological radiotherapy techniques. This technique could potentially see its use extended to further oncology treatment units wishing to implement this new technology, since it requires no additional equipment to that utilized in regular radiotherapy treatments. However, due to its novelty status, strict quality assurances are to be met and results are to be compared with other existing radiosurgery techniques in order to demonstrate its potential advantages for oncology patients. aims: this thesis memorandum as a compendium of publications presents dosimetric, radiobiological and technical comparisons which demonstrate the advantages of the vmat technique; furthermore, it is intended that the clinical results achieved in our study group of patients treated for brain metastasis will confirm the advantages of vmat over other radiosurgical techniques.  materials and methods: the medical physics, radiation protection and radiation oncology services of the santa lucia general university hospital in cartagena has two linear electron accelerators at their disposal, both with the capacity to administer vmat treatments, as well as to perform image-guided radiation therapy via cone beam ct and the equipment for treatment planning and quality control habitually used in oncological radiotherapy, with which the dosimetric and radiobiological analysis of the present study were performed.  herein, 52 oncology patients with brain metastasis were treated via radiotherapy in a single vmat session consisting of 5 non-coplanar arcs and radiation doses of 12-20 gy, following approval by the ethics and research committee. Both local control of lesions and global survival rates of treated patients were evaluated. results: the results obtained show that all the experimental, dosimetric and radiobiological tests performed, for all the treatment plans, meet the previously established requirements for this type of radiotherapy treatment; and furthermore, the clinical results obtained both for local control of lesions as well as for global survival of patients are comparable to those previously described in scientific literature for any other type of radiosurgery. conclusions: volumetric modulated arc therapy (vmat) is an efficient radiosurgical technique, since the cost per procedure is well below that of other systems dedicated exclusively to radiosurgery; and the clinical results are perfectly comparable to those describe for other radiosurgical techniques. Given that the oncology treatment units, radiation-measuring and quality-control equipment, as well as the planning systems used for calculating radiation doses, are readily available at most new oncological radiotherapy units, the present study facilitates the incorporation of the vmat technique by resolving matters regarding the implementation of this new oncological treatment technique.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Radiocirugia con arco terapia de intensidad modulada: comparaciones dosim\u00e9tricas y resultados cl\u00ednicos en el tratamiento de met\u00e1stasis intracraneales<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Radiocirugia con arco terapia de intensidad modulada: comparaciones dosim\u00e9tricas y resultados cl\u00ednicos en el tratamiento de met\u00e1stasis intracraneales <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Alfredo Serna Berna <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 03\/07\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Miguel Alcaraz Ba\u00f1os<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: manuel De las heras gonzalez <\/li>\n<li>octavio Caballero carpena (vocal)<\/li>\n<li>Manuel Pardo rios (vocal)<\/li>\n<li>Alberto Lopez najera (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Alfredo Serna Berna Resumen introducci\u00f3n: entre el 20 % y el 40 % de los pacientes oncol\u00f3gicos 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