This document discusses the role of radiation therapy in treating pediatric brain tumors. It begins by outlining common pediatric brain tumor types like astrocytomas, ependymomas, medulloblastomas, germ cell tumors, and craniopharyngiomas. For each tumor type, it describes characteristics, management principles, and how radiation therapy is used as an important part of treatment. Throughout, it emphasizes the importance of reducing radiation dose and volume to minimize long-term side effects while still effectively treating the cancer.
The combined use of radiation therapy and chemotherapy in cancer treatment is a logical and reasonable approach that has already proven beneficial for several malignancies.
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
The combined use of radiation therapy and chemotherapy in cancer treatment is a logical and reasonable approach that has already proven beneficial for several malignancies.
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Accelerated partial breast irradiation is an alternative to whole breast irradiation in carcinoma breast patients Post breast conserving surgery with equivalent outcome, less duration & less burden on the patient.
Accelerated partial breast irradiation is an alternative to whole breast irradiation in carcinoma breast patients Post breast conserving surgery with equivalent outcome, less duration & less burden on the patient.
Stereotactic Radiosurgery and Radiotherapy of Pituitary Adenomas Clinical Whi...Brainlab
Learn more: https://www.brainlab.com/iplan-rt
Pituitary adenomas (PAs) are the third most common intracranial tumors in surgical practice, accounting for approximately 10 to 25% of all intracranial neoplasms. Radiological series suggest that unsuspected PAs may be present in one out of six people and autopsy specimens reveal a prevalence of 14%. Histopathologically, PAs are mostly benign lesions located on the anterior lobe of the pituitary gland. Because of their invasive growth tendency, these adenomas may cause significant morbidity in affected patients, expressed by visual, endocrinologic and neurologic symptoms.
Yan Carlos Vargas Caycho
Pediatric Malignant Gliomas
Radioterapia en Gliomas de Alto Grado en Pediatria
Radioterapia en Glioblastoma Multiforme
Radioterapia en Astrocitoma Anaplasico
Radioterapia en Tumores del Sistema Nervioso Central
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Role of radiation in pediatric brain tumors16 5-2014
1. Role of Radiation in PediatricRole of Radiation in Pediatric
Brain TumorsBrain Tumors
Dr. Ram Madhavan
2. CNS tumors account for 20-25% of all
malignancies
Radiation therapy is an important
component in therapy of brain tumors.
Indeed the recent developments in
radiation technology improved targeting
and significantly reduced long term
sequelae.
3. WHO classification of CNS tumorsWHO classification of CNS tumors
Tumors of neuro epithelial tissue
Astrocytic tumors
Oligodendroglial
Mixed gliomas
Ependymal tumors
Choroid plexus tumors.
Neuronal and mixed neuronal glial tumors.
Pineal tumors
Embryonal tumors
Tumors of meninges
Germ cell tumors
Tumors of sellar region
Metastatic tumors.
4. Distribution of primary brain andDistribution of primary brain and
CNS tumors by histology (0-14CNS tumors by histology (0-14
years)years)
5. Distribution of primary brain and CNSDistribution of primary brain and CNS
tumors by histology (15-19 years)tumors by histology (15-19 years)
8. Low grade AstrocytomasLow grade Astrocytomas
Indolent clinical course
OS at 10 and 15 years – 80-100%
Most common type is Pilocytic astrocytoma
(grade 1)
Accounting for almost all of LGA at certain
sites [ anterior optic pathway & cerebellum]
Well circumscribed and frequently
associated with cystic component.
Hall mark microscopic feature is Rosenthal
fibres.
10. Diffuse Fibrillary astrocytomasDiffuse Fibrillary astrocytomas
Little enhancement
with contrast.
T2 weighted or
FLAIR MRI best
demonstrate the
extent of disease.
11. Management of Low gradeManagement of Low grade
AstrocytomasAstrocytomas
Some children may not require any
tumor specific treatment.
Small asymptomatic tumors like optic
pathway gliomas detected on routine
imaging.
Active intervention is required when
there is progression or symptoms.
12. Management of Low gradeManagement of Low grade
AstrocytomasAstrocytomas
Surgery is the mainstay of treatment.
Complete resection is more likely in
smaller tumors and those arising from
non-eloquent parts of brain.
Long term OS and DFS is 80 – 100%.
Post OP adjuvant therapy not indicated.
13. Algorithm for incompletelyAlgorithm for incompletely
resected gliomasresected gliomas
Maximal surgical resection compactable with
good neurological outcome.
Follow up with routine imaging.
Second surgical resection if feasible at the time
of progressive disease.
Radiotherapy or chemotherapy at the time of
progressive disease that is not resectable.
14. Indications for Radiation therapyIndications for Radiation therapy
Radiotherapy is not indicated after
complete resection.
RT may be indicated following
incomplete resection when tumor
progression compromise neurologic
function.
50 – 54Gy depending upon the age of the
child , location of the tumor and its
relation to critical normal structures.
15. Brain stem gliomasBrain stem gliomas
Constitutes 20% of childhood tumors.
Most common in children between 3-10
years.
Tissue confirmation is frequently not
feasible in infiltrating lesions.
Associated with poor prognosis.
20. Diffuse pontine gliomasDiffuse pontine gliomas
Typically present
with short history.
Surgery including
biopsy not feasible.
Mostly fibrillary
Direct RT in view of
clinical radiological
picture.
21. EpendymomaEpendymoma
Third most common CNS tumor in
children.
Can occur at any site in ventricular
system or spinal canal.
5-10% has leptomeningeal seeding at time
of diagnosis.
Gadolinium enhanced MRI of whole CNS
and CSF cytology are essential
components of work up.
22. Management principlesManagement principles
Maximum surgical resection.
Post OP radiation therapy is the standard is
the standard of care for all children with
ependymoma. RT dose – 54 Gy
Post OP RT can be avoided in
1. completely resected Ependymoma of spinal
cord
2. Supraventricular ependymomas resected
with wider margin.
23. MedulloblastomaMedulloblastoma
Most common malignant brain tumor in
Children.
Belongs to the family of small blue round
cell tumor.
Median age at presentation is 5- 8 years.
High propensity for CSF dissemination
[20-30%]
Hence contrast MRI of spinal axis and
CSF cytology is essential.
25. Risk stratificationRisk stratification
Initial surgical resection is the standard.
Standard risk
<1.5 cm2 of residual tumor after resection.
No CSF dissemination.
High risk
>1.5 cm2 of residual tumor after resection.
CSF dissemination present.
26. Craniospinal Irradiation [CSI]Craniospinal Irradiation [CSI]
Target volume
Whole brain with its meninges.
Spinal cord down to the caudal end of
the thecal sac(usually S2 but should be
verified by saggital MRI)
Primary tumour
27. RT doseRT dose
Standard risk
CSI 23.4 Gy followed by tumor bed
boost of 54 Gy.
High risk
CSI 36 Gy followed by posterior fossa
boost of 54 Gy
31. ChemotherapyChemotherapy
Vincristine weekly during Radiation.
Followed by adjuvant PCV regimen for 6
cycles
POG protocol
Vincristine 1.4mg/m2
CCNU 75 mg/m2
Cisplatin 75mg/m2
In some protocols CCNU was replaced by
Cisplatin.
32. Germ cell tumorsGerm cell tumors
More common in Asia
Accounts for 15 – 18% of all CNS tumors
in children.
Peak incidence is 10 -12 years.
Boys affected more frequently than girls.
Arise from primordial germ cells around
third ventricle.
33. Germ cell tumorsGerm cell tumors
Non germinomatous germ cell tumors
more common in pineal gland region.
Germinomas more common in supra
sellar region.
Leptomeningeal spread is <10% with
germinomas and 10-15% with NGGCT.
CSF tumor markers [B HCG in
germinomas and choriocarcinomas AFP in
yolk sac tumors] is essential.
34. Management of GerminomasManagement of Germinomas
Very radiosensitive tumor
CSI 21 Gy followed by boost to primary
site 40-45 Gy.
Dose per fraction 1.5 Gy can be used to
decrease injury to normal cells.
Instead of CSI whole ventricular
Radiation can be used for used for
unifocal germinomas.
Cisplatin based chemotherapy is used.
37. NSGCTNSGCT
Initial maximum safe surgical resection
for tissue diagnosis.
The current standard of care consists of
platinum based chemotherapy followed
by radiotherapy.
RT consists of CSI 36 Gy followed by
boost 54 Gy to primary site.
41. Role of RadiationRole of Radiation
Complete surgical resection is the standard of
care.
Indications of RT
Incomplete resection
Progression
Recurrence.
Dose is 54 Gy in 30 fractions over a period of 6
weeks.
DFS 80-100% in most series.
43. General principles of RT in PediatricGeneral principles of RT in Pediatric
brain tumorsbrain tumors
Avoidance of RT altogether if possible.
Delay RT in young children [3-8 years] by
the use of chemotherapy.
Use focal than Extended field RT
Daily anesthesia and better immobilization
helps to reduce planning target volume.
44. General principles of RT in PediatricGeneral principles of RT in Pediatric
brain tumorsbrain tumors
Use Image based treatment planning
[3DCRT/IMRT]
Reduce the total dose of RT
Use smaller fraction size where
appropriate
45. General principles of RT in PediatricGeneral principles of RT in Pediatric
brain tumorsbrain tumors
Field size a little generous as kids may be
un cooperative
Conventional 3D conformal Radiation
therapy.
No great benefit with hi-fi techniques.
IMRT/SRT may be beneficial in the setting
of reirradiation.
46. Long term effects of pediatric brainLong term effects of pediatric brain
irradiationirradiation
Neurocognitive and neurophysiological
dysfunction.
Endocrine abnormalities and hormonal
imbalance
Growth retardation – spinal component.
Ototoxicity – especially with platinum based
chemotherapy.
Gonadal toxicity and reduced fertility
Cerebrovascular accidents
Second malignancies.
47. Does reduction in dose andDoes reduction in dose and
volume impact upon long-termvolume impact upon long-term
outcomesoutcomes
Neuro-cognitive dysfunction: YES (Reduced )
Neuro-physiologic dysfunction: YES (Reduced)
Endocrine dysfunction: YES (Lesser )
Oto-toxicity: EQUIVOCAL (Reduced cochlear dose offset
by addition of platinum
Hematologic: YES (Significantly incresed with CT)
GI toxicity: YES (Significantly increased with CT)
Second malignant neoplasms: EQUIVOCAL (conflicting
data)
48. Follow up during and after RTFollow up during and after RT
Acute side effects like nausea and
vomiting can be prevented by 5HT 3
antagonists.
Head ache is not common and should be
investigated for raised ICT if present.
Steroids can be tapered by third or
fourth week of treatment.
Get back to their routine 6 weeks to 2
months following RT
49. Long term follow upLong term follow up
Hormonal deficits especially GH deficit
secondary to Hypothalamo-pituitary axis
irradiation [CSI] and hypothyroidism
should be closely monitored.
Access neuropsychologist for evaluation
of any special needs.
May require vocational assessment and
counseling.
50. ConclusionConclusion
Management of pediatric brain tumors has
improved a lot in past three decades.
Improved imaging, newer techniques in
pathology, better neurosurgical techniques and
evolution of high precision radiotherapy
revolutionized the treatment
Currently 5 year survival rate is estimated at
75% for all CNS tumors in 0-19 years age
group.