RESUMEN
Over the years, major advances have occurred in radiotherapy techniques, delivery, and treatment planning. Although radiotherapy is an integral treatment component of pediatric solid tumors, it is associated with potential acute and long-term untoward effects and risk of secondary malignancy particularly in growing children. Two major advances in external beam radiotherapy are intensity-modulated radiotherapy (IMRT) and proton beam radiotherapy. Their use in the treatment of children with cancer has been steadily increasing. IMRT uses multiple modulated radiation fields that enhance the conformality of the dose distribution to the target volume and avoid high doses to normal tissues. However, IMRT may be associated with increased volume of normal tissue that receives low doses and potential risk of secondary malignancy. Contrary to IMRT, proton beam radiotherapy uses a few beams and a fast dose fall-off distal to the target volume. Although both modalities require substantial personnel time and effort, the very high cost and limited availability of proton radiotherapy have constrained its widespread use. It is anticipated that both modalities may markedly improve tumor control and quality of life for long-term cancer survivors. Clinical trials with long-term follow-up are needed to confirm the premise that proton beam therapy will decrease late effects and secondary malignancies without compromising local control in pediatric patients with cancer.
Asunto(s)
Neoplasias/radioterapia , Fotones/uso terapéutico , Terapia de Protones , Radioterapia de Intensidad Modulada , Animales , Niño , Preescolar , Análisis Costo-Beneficio , Costos de la Atención en Salud , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Lactante , Neoplasias/economía , Neoplasias/historia , Neoplasias/patología , Fotones/efectos adversos , Fotones/historia , Terapia de Protones/efectos adversos , Terapia de Protones/economía , Terapia de Protones/historia , Protones/efectos adversos , Protones/historia , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/efectos adversos , Radioterapia de Intensidad Modulada/economía , Radioterapia de Intensidad Modulada/historia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Maria Goeppert-Mayer (19061972) created the theoretic basis for investigations using the double-photon effect. She was also involved in work on the Manhattan Project for the development of the atomic bomb. In 1963, she received the Nobel Prize in physics for her discoveries concerning nuclear shell structure. Her theoretic results on double-photon absorption are directly used today in dermatology in nonlinear microscopy, multiphoton tomography, and photodynamic therapy.
Asunto(s)
Dermatología/historia , Premio Nobel , Fotones/historia , Física/historia , Historia del Siglo XX , Humanos , Microscopía de Fluorescencia por Excitación Multifotónica/historia , Fotones/uso terapéutico , Polonia , Enfermedades de la Piel/historia , Enfermedades de la Piel/terapiaRESUMEN
El encargo de este pequeño artículo me sumió en la duda. En primer lugar debo confesar que no encuentro excusa para saltarse esta parte si alguien quiere profundizar mínimamente en el conocimiento de los efectos biológicos de esta fuente de energía. En segundo lugar, cuando hablamos de los resultados, usamos términos acuñados y definidos por la física. A menudo polemizamos sobre resultados y lo que en realidad ocurre es que no nos ponemos de acuerdo porque nos referimos a términos distintos para explicar una misma observación; en definitiva, no logramos entendernos porque no conocemos los términos adecuados; por ejemplo, hipoxemia como déficit de oxígeno, que tanto es verdad en un paciente anémico como en una baja saturación de oxígeno. En consecuencia, me parece imprescindible un buen repaso a estos conceptos. La tercera razón es el confusionismo que existe en nuestro medio, a veces pienso que interesado, sobre propiedades y efectos de diferentes tipos de láser. Solo un mínimo conocimiento de la física nos ayudará a sentar las bases científicas para entendernos. Los problemas, sin embargo, se acumulan, dado que el universo al que va dirigido este pequeño artículo está formado por urólogos. ¿Qué formación en física debemos suponerles? ¿Superficial? ¿Media? ¿Será un colectivo con un conocimiento uniforme, sea éste el que sea? La implicación es clara. La profundidad del artículo dependerá de las respuestas que demos a las preguntas anteriores. No obstante, el ánimo de los autores consiste en dar una base suficiente como para entender qué es y cómo actúa el láser. Por ello, la respuesta que me he dado es que el lector debe entender el artículo, y tener una base suficiente, como mínimo para leer críticamente los artículos sobre láser que se publican en las revistas urológicas (AU)
The commission of this article plunged me into doubt. First I should confess that I don't find excuse to escape this part if somebody wants to minimally deepen in the knowledge of the biological effects of this energy source. Secondly, when we talk about results, we use terms made and defined by Physics. Often we have polemics about results, and what really happens is that we don't reach agreements because we refer to different terms to explain the same observation; in conclusion we cannot understand each other because we do not know the adequate terms; for example, hypoxemia as oxygen deficit, which is true in an anemic patient as well as in a low oxygen saturation rate. In consequence, a good review of these concepts seems necessary to me. The third reason is the confusion that exists in our environment, I think sometimes of interest, about properties and effects of different types of laser. Only a minimal knowledge of physics will help us to state the scientific basis for understanding. The problems, nevertheless, accumulate due to the fact that the universe to which this article is directed is formed by urologists. What Physics education should we suppose they have? Superficial? Medium? Is it a collective with a uniform knowledge, being it whatever it is? The implication is clear. The article depth will depend on the answers to these questions. Nevertheless, the aim of the authors is to give a base enough to know what the laser is and how it acts. For that, the answer I gave to my questions is that the reader should understand the article and have enough base for, at least, reading critically the articles about laser published in urological journals (AU)