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The present document includes consensus-based recommendations from the Brachytherapy Group (GEB) of the Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM) for interstitial high-dose-rate (HDR) brachytherapy (BT) for gynaecologic malignancies. A nine-item survey-which included questions on experience with interstitial BT; indications and technique; applicator type; magnetic resonance imaging (MRI)-based planning; dose; fractionation schedule; and treatment planning-was sent to all radiation oncology departments (n = 174) in Spain in 2021. Responses were received from 36 centres (50% of all centres [n = 72] with a BT unit). The consensus-based recommendations presented here are based on a review of the available literature, professional experience among the group of experts, and in-person discussions held during the annual meeting of these two societies. We describe the results of the survey and the following: indications; contraindications; patient selection; description of applicators; role of imaging in planning; contouring; dose prescription; dosimetric reconstruction; optimisation; and dose indications for cancers of the cervix, vagina, and vulva. The various clinical scenarios in which interstitial BT is used in the treatment of gynaecological tumours are described in detail, including cervix intracavitary/interstitial hybrid HDR-BT; cervix perineal templates/freehand implants; primary vaginal malignancies/vaginal recurrences; and vulvar interstitial implants.

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Es un período de dos años se realizaron 759 ECOF (ecografía fetal) en mujeres embarazadas que fueron referidas al Hospital Nacional de Niños. Los datos recolectados incluyeron los siguientes ítem: edad de la madre, edad gestacional, número de gestaciones, partos, ces reas, abortos, lugar de procedencia, patología materna asociada, historia familiar de cardiopatía congénita, diagnóstico final hecho por el cardiólogo pediatra. La mayoría de las madres fueron referidas por diabetes gestacional. En el 21 por ciento de los casos se encontraron alteraciones cardiacas. La edad de las madres varió, desde los 13 a los 46 años. El grupo más grande estuvo comprendido entre los 20-40 años (83.7 por ciento). Durante el segundo trimestre se realizó el 49 por ciento de los exámenes y la gran mayoría a las 24 semanas de gestación. En el tercer trimestre se hizo el 47.4 por ciento de los exámenes, la mayoría a los 34 semanas de gestación. El 29 por ciento de las madres eran primigestas y el 24 por ciento segunda gesta. La alteración cardiaca más frecuentemente encontrada fue la extrasístole sobre todo supraventricular representada por un 20 por ciento en segundo lugar se presenta el síndrome del corazón izquierdo hipoplásico con un 18 por ciento y en tercer lugar la comunicación interventricular con un 16.4 por ciento. En conclusión, el porcentaje de alteraciones cardiacas detectadas con la ECOF sigue siendo muy bajo, ya que, solo se refiere a las madres con alto riesgo y aquellas de bajo riesgo, no se les realiza en el ultrasonido obstétrico la vista de cuatro cámaras y el estudio de los tractos de salida del corazón.

In a period of two years were performed 759 ECOF in pregnant women who were referred to the National Children’s Hospital. Data collected included the following items: maternal age, gestational age, number of pregnancies, births, cesarean sections, abortions, site from which they came, maternal pathology associated, family history of congenital heart disease, final diagnosis made by a pediatric cardiologist. Most mothers were referred for gestational diabetes. In 21% of cases, cardiac abnormalities were found. The age of mothers ranged from 13 to 46 years. The largest group was between 20-40 years (83.7%). During the second trimester were made 49% of the examinations and the vast majority at 24 weeks gestation. In the third trimester was 47.4% performed the most examinations at 34 weeks gestation. 29% of mothers were primiparous and 24% second quest. The most frequently encountered cardiac disorders were especially supraventricular extrasystoles with 20%, followed by hypoplastic left heart syndrome with 18% and ventricular septal defect with 16.4%. In conclusion, the percentage of cardiac abnormalities detected with ECOF remains very low because it only refers to mothers with high risk and those at low risk were not performed in the obstetric ultrasound the four-chamber view and the study of the outflow tracts of the heart.

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INTRODUCTION: It has been well documented that the outcome of prostate cancer treatment depends on the dose administered. Hence, techniques have been developed that allow high-dose administration without increasing the complications, e.g. external radiotherapy combined with high-dose radiation (HDR) brachytherapy. In this article we analyse the technique and protocol of real-time HDR brachytherapy together with the preliminary results that support its use. Materials and methods. Between June 1998 and December 2004, 100 patients with adenoma of the prostate were treated with 46 Gy of external irradiation to the pelvis and 2 HDR brachytherapy fractions (each of 1150 cGy) at the end of weeks 1 and 3 of a 5-week radiotherapy course. The 1997 American Joint Commission on Cancer (AJCC) system was used to establish disease stage. Patients with intermediate-risk (PSA 10-20 ng/ml or Gleason = 7 or T2c) and high-risk (two intermediate risk factors or PSA > 20 ng/ml or Gleason > 7 or > T2c) without metastases were eligible for the brachytherapy. Biochemical failure was defined according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus panel statement. SPSS statistical package was used to quantify survival (Kaplan-Meier method). Toxicity was scored according to RTOG guidelines. RESULTS: The mean age of patients was 67 years (range 49-78). Clinical stage was T2a in 22% of the patients, 26% T2b and 52% T3. Initial PSA was = 10 ng/ml in 22% of the patients and > 10 ng/ml in 78%. Median follow-up was 28 months (range: 12-79). The 5-year overall survival and actuarial biochemical control were 99% and 87% respectively. No chronic severe complications were noted. CONCLUSIONS: The good results of local control, disease-free survival and few complications that the external radiotherapy combined with HDR brachytherapy have shown suggest that the method should be considered as first-choice in the treatment of prostate tumours of high- and intermediate-risk.

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En la actualidad los grupos para el manejo del SIDA deben primero que todo tratar de hacer el diagnóstico precoz en la mujer embarazada para implementar la utilización del protocolo ACTG 076 de prevención de la transmisión perinatal. Una vez recibido el recién nacido se debe intentar hacer el diagnóstico de infección por VIH lo más pronto posible. En el caso en el que el diagnóstico se establezca después del período neonatal se debe ir de igual modo en la búsqueda del estado infeccioso del paciente, para ofrecer el tratamiento combinado lo más pronto posible

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