While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
A short overview of Image Guided Radiotherapy process in Lung Cancer presented at TMC Kolkata circa 2016. Basic principles and concepts as well as examples are outlined.
While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
A short overview of Image Guided Radiotherapy process in Lung Cancer presented at TMC Kolkata circa 2016. Basic principles and concepts as well as examples are outlined.
While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali
Techniques for Inguinal/Groin IrradiationAjeet Gandhi
Inguinal radiotherapy delivery is many a times a complex dosimetric uncertainty and we need to judiciously choose the technique for best patient outcome
Incorporating data for management of breast cancerAjeet Gandhi
The guidelines are mostly western and in many scenarios, it is difficult to apply them to Indian population. We need to take in to consideration many factors while applying the data
Controversies in the management of rectal cancersAjeet Gandhi
Management of rectal cancers have undergone a huge paradigm shift over the last decade. One the one hand, it has opened up new avenues; it also has thrown up new challenges and controversies
T4 Larynx cancer can be treated with ChemoradiotherapyAjeet Gandhi
Traditionally, T4 larynx cancers are recommended to undergo surgery as the primary modality of treatment. However, a select group of patients may be treated with CTRT
Advances in radiation oncology:Cancer careAjeet Gandhi
Radiation therapy has tremendous capacity for cancer cure. Advancement in last few decades have further enhanced its outcome. Global access would save many lives
A novel technique of radiation delivery with ultrahigh dose rate radiation therapy delivered in milisecond of time. Although, still in investigational phase
Management of Anemia in cancer patientsAjeet Gandhi
Anemia in cancer patients are important both in terms of quality of life as well as response to therapy. Cause of anemia is multi-factorial and its management is critical in optimizing best outcomes of cancer patients
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Role of radiotherapy in recurrent carcinoma cervix
1. Is there a role of radiation in
management of recurrent cervical
cancer??
Dr Ajeet Kumar Gandhi
MD (AIIMS), DNB, UICCF (MSKCC,USA)
Assistant professor, Radiation oncology
Dr RMLIMS, Lucknow
2. Recurrent cervical cancer
Pelvic relapse rates* in definitively treated
patients: 20-40%
Approximately 60-80% are pelvic failures
Approximately 80% are in the irradiated field
and 20% outside this
Treatment is very challenging, limited
options
Limited literature and ultimate outcome of is
poor.
*Andreu Martinez FJ et al. Clin Transl Oncol 2005;7:323-331
3. Treatment options
Surgery, radiotherapy, systemic therapy,
Palliative care
Patient`s suitability
Performance status
Symptomatolgy
Previous treatment
Toxicities of previous therapy
Present disease extent
Patient selection remains the key
6. Recurrence after surgery with no
prior RT
Explore surgery for very limited disease
Usually a combination of EBRT and Brachytherapy
Brachytherapy (Interstitial) recommended for
patients with >5 mm thickness of recurrence
Concurrent chemotherapy should be combined in
suitable patients
7. Recurrence after prior RT
Surgery
Central limited
volume disease
Reirradiation
Systemic therapy
9. Reirradiation: Which patients??
Central recurrences* (inoperable/unwilling for
surgery)
Volume of disease**: <2-4 cm, <100 cc
Disease free interval**
Longer the better
At least > 6-12 month; >2 years
Squamous histology
Non-para-aortic location
Good KPS with limited toxicities from prior RT
*Mahantshetty U. Brachytherapy 2014
**Zolciak Sivinska. Gynec Oncol 2014
13. 52 patients treated with HDR-
ISBT based Reirradiation
Local control rate: 76%
Grade ¾ toxicities: 25%
Tumour size (>4 cm) and DFI (<6
months) important prognostic
factors
14. Image guided HDR ISBT in PIRCC
AIIMS experience of 23 recurrent patients
N=33; recurrent=23 and residual=10
1 or 2 session of ISBT was done with a dose of 8 Gy/# followed by
EBRT depending upon the interval of recurrence,
total 52 procedures
2 year pelvic disease control rate 63%
Grade ¾ complication rates: 6%
Sharma DN; RSNA 2008; Oral abstract
15. Indiana university experience of 19
patients (6 cervix patients)
Median RT dose=50 Gray
Median tumour volume=3.3 cm3
2 year local control rates=52.6%
16. N=50
3 year OS and loco-regional
control: 56% and 59%
Median RT dose=50 Gray (45-64
Gray)
No Grade 3 or greater acute
GI/GU
Grade 3 late toxicity <10%
Poorer OS for DFI <2 years and
non-squamous histology (p<0.05)
17. Patients Rectum-4, Anal canal-6,
Cervix-4, Endometrium-
1, UB-1
All patients previously
treated with RT
Median previous RT
dose- 45 Gy
36 Gy/ 6 fractions in 3
weeks
Median FU- 11 months
LR- 51 %, Median DFS-
8 months
One year OS- 46%
No grade 3 acute
toxicity
21. Re-irradiation: What Technique??
Minimize volume of irradiation: Conformal
Avoid OARs
Brachytherapy preferred for central, accessible site
EBRT for very lateralized disease/para-aortic
IORT for patients suitable for surgical salvage
22. Radiation: What doses??
Without prior RT
EBRT 45-50 Gray + Brachytherapy (total EQD2
65-75 Gray)
For ReRT
EBRT
IMRT/3DCRT: 40-50 Gray (20-25#)
SBRT: 20-36 Gray in 3-6 fractions
Brachytherapy alone
20-25 Gray HDR in 4-5 fractions BID
IORT: 10-30 Gray
For palliative RT
20-30 Gray in 5-10 fractions
23. Clinical outcome after RT
Local control
Interstitial Brachytherapy= 25-80%
EBRT + Brachytherapy =40-80%
IORT + Surgery=20-70%
EBRT=50-60%
3-5 year Overall survival: 30-70%
25. Take home message!!
Radiation therapy yields descent outcomes in
recurrent cervical cancer patients naïve to RT
Reirradiation has become less morbid with better
outcomes owing to technological advancement in RT
Conformal techniques like brachytherapy with or
without EBRT should be used
IMRT/SBRT should be used when using EBRT alone
Role of concurrent chemotherapy is not well defined
Patient selection remains the key for optimizing the
best outcomes