RESUMEN
Objetivo: Demostrar la utilidad de la radioterapia intraoperatoria (RIO) en el tratamiento de los niños con neuroblastoma en estadios avanzados. Casos clínicos: Presentamos 7 casos de pacientes con neuroblastoma en estadios III (n=1) y (n=6), con amplificación N-myc en 6 de ellos, tratados desde 1997 hata 2004. Dos de los pacientes presentaron tumores irresecables, con restos tumorales macroscópicos tras la intervención. Resultados: La supervivencia en nuestra serie de pacientes ha sido del 71,4%. No hemos registrado ninguna complicación asociada a la RIO. El tiempo medio de seguimiento es de 44 meses (margen: 7 meses-7 años). En el tratamiento del neuroblastoma de grados III-IV se ha observado una mejora de la supervivencia cuando se controla la enfermedad local primaria. Conclusión: La RIO facilita este control, con la concentración de la radioterapia directamente sobre el lecho tumoral y respetando los campos de irradación colaterales
Objective: To report our experience with intraoperative radiotherapy (IORT) in the treatment of advanced-stage neuroblastoma in children. Cases report: Seven pediatric patients with a diagnosis of advanced-stage neuroblastoma (stage III and IV) treated with IORT between 1997 and 2004 were reviewed retrospectively. All of them received chemotherapy after biopsy of the tumour mass (HR-NBL ESIOP protocol), with good response. All seven underwent surgical resection of the tumour, with a single IORT dose of 5 to 15 grays. Results: The initial biopsy showed N-mycamplification in all the patients. Chemotherapy was delivered prior to surgical resection. Gross total resection was performed in five patients. In the other two patients, surgery involved only a debulking procedure. Five patients (71,4%) were alive and continued to be disease-free after 44 months of follow-up, with no IORT associated complications. The two patients with unresectable disease had a fatal outcome. Coclucion: total surgical excision is one of the best prognostic factors in advanced-stage neuroblastoma disease. Intraoperative radiotherapy is a safe procedure that appears to enhance local control with improved survival
Asunto(s)
Masculino , Femenino , Recién Nacido , Lactante , Humanos , Radioterapia Adyuvante/métodos , Neuroblastoma/radioterapia , Biopsia/métodos , Neuroblastoma/diagnóstico , Hemorragia/complicaciones , Hemorragia/diagnóstico , Cuidados Posoperatorios/métodos , Metástasis de la Neoplasia/diagnóstico , Metástasis de la Neoplasia/patología , Radioterapia Adyuvante/tendencias , Radioterapia Adyuvante , Periodo Intraoperatorio/métodos , Periodo Intraoperatorio/tendencias , Monitoreo Intraoperatorio/métodos , Estudios Retrospectivos , Indicadores de MorbimortalidadRESUMEN
Description of the accidental finding of a renal adenocarcinoma in a 10-year old boy, after abdominal trauma and with a good evolutive behaviour. The clinical, diagnostic, therapeutical and survival aspects are analyzed, including a literature update of a renal neoformation which shows lower paediatric incidence than Wilm's Tumour or Neuroblastoma.
Asunto(s)
Adenocarcinoma , Neoplasias Renales , Adenocarcinoma/diagnóstico , Niño , Humanos , Neoplasias Renales/diagnóstico , MasculinoRESUMEN
Cisplatin is an inorganic platinum compound used in the treatment of solid tumors. Clinical trials have proved its efficacy whilst recognising the nephrotoxicity of the drug. We report the case of a 14 1/2 year old female with an epidermoid carcinoma of the lung, who developed acute renal failure following two courses of Cisplatin. The predominant features were symptomatic hypomagnesaemia, hypocalcaemia and hypokalaemia which were corrected following the administration of intravenous magnesium. Renal failure persisted for several months and the patient died due to her primary disease. Electrolyte disturbances should be anticipated when high dose Cisplatin is used.