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Critical Reviews in Oncology/hematology Jun 2015Radiation therapy has long played a major role in the treatment of gynecological malignancies. There is increasing interest in the utility of intensity-modulated... (Review)
Review
Radiation therapy has long played a major role in the treatment of gynecological malignancies. There is increasing interest in the utility of intensity-modulated radiotherapy (IMRT) and its application to treat gynecological malignancies. Herein, we review the state-of-the-art use of IMRT for gynecological malignancies and report how it is being used alone as well as in combination with chemotherapy in both the adjuvant and definitive settings. Based on dosimetric and clinical evidence, IMRT can reduce gastrointestinal, genitourinary, and hematological toxicities compared with 3D-conformal radiotherapy for gynecologic malignancies. We discuss how these attributes of IMRT may lead to improvements in disease outcomes by allowing for dose escalation of radiation therapy, intensification of chemotherapy, and limiting toxicity-related treatment breaks. Currently accruing trials investigating pelvic IMRT for cervical and endometrial cancers are discussed.
Topics: Female; Genital Neoplasms, Female; Humans; Pelvis; Radiometry; Radiotherapy Dosage; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated; Treatment Outcome
PubMed: 25600840
DOI: 10.1016/j.critrevonc.2014.12.015 -
BMJ Case Reports Dec 2019Pelvic trauma is complex, most of current work centres around pelvic haemorrhage and fractures. It is important to remember that there is more anatomy in the pelvis than...
Pelvic trauma is complex, most of current work centres around pelvic haemorrhage and fractures. It is important to remember that there is more anatomy in the pelvis than bones and vessels. A 29-year-old male patient was admitted after an Road Traffic Collision (RTC) where his motorbike T-boned a car. He was noted to have a traumatic dislocation of his right testicle, which spontaneously reduced in the emergency department and he was admitted for scrotal exploration and observation. Due to difficulty in mobilising postoperatively, he underwent an MRI, which showed diastasis of his pubis symphysis as well as left-sided adductor tendon rupture, not evident on his initial CT scan, and underwent pelvic fixation. Why should an emergency physician be aware of this? This case emphasises the alternate differentials with pelvic trauma in a haemodynamically stable patient, and the requirement for continuous reassessment in patients failing to improve.
Topics: Accidents, Traffic; Adult; Diagnosis, Differential; Fractures, Bone; Humans; Male; Motorcycles; Pelvic Bones; Pelvis; Pubic Bone; Radiography; Tomography, X-Ray Computed
PubMed: 31806634
DOI: 10.1136/bcr-2019-232622 -
Radiation Oncology (London, England) Jun 2022Delineation of organs at risk (OAR) for anal cancer radiation therapy treatment planning is a manual and time-consuming process. Deep learning-based methods can...
Pelvic U-Net: multi-label semantic segmentation of pelvic organs at risk for radiation therapy anal cancer patients using a deeply supervised shuffle attention convolutional neural network.
BACKGROUND
Delineation of organs at risk (OAR) for anal cancer radiation therapy treatment planning is a manual and time-consuming process. Deep learning-based methods can accelerate and partially automate this task. The aim of this study was to develop and evaluate a deep learning model for automated and improved segmentations of OAR in the pelvic region.
METHODS
A 3D, deeply supervised U-Net architecture with shuffle attention, referred to as Pelvic U-Net, was trained on 143 computed tomography (CT) volumes, to segment OAR in the pelvic region, such as total bone marrow, rectum, bladder, and bowel structures. Model predictions were evaluated on an independent test dataset (n = 15) using the Dice similarity coefficient (DSC), the 95th percentile of the Hausdorff distance (HD), and the mean surface distance (MSD). In addition, three experienced radiation oncologists rated model predictions on a scale between 1-4 (excellent, good, acceptable, not acceptable). Model performance was also evaluated with respect to segmentation time, by comparing complete manual delineation time against model prediction time without and with manual correction of the predictions. Furthermore, dosimetric implications to treatment plans were evaluated using different dose-volume histogram (DVH) indices.
RESULTS
Without any manual corrections, mean DSC values of 97%, 87% and 94% were found for total bone marrow, rectum, and bladder. Mean DSC values for bowel cavity, all bowel, small bowel, and large bowel were 95%, 91%, 87% and 81%, respectively. Total bone marrow, bladder, and bowel cavity segmentations derived from our model were rated excellent (89%, 93%, 42%), good (9%, 5%, 42%), or acceptable (2%, 2%, 16%) on average. For almost all the evaluated DVH indices, no significant difference between model predictions and manual delineations was found. Delineation time per patient could be reduced from 40 to 12 min, including manual corrections of model predictions, and to 4 min without corrections.
CONCLUSIONS
Our Pelvic U-Net led to credible and clinically applicable OAR segmentations and showed improved performance compared to previous studies. Even though manual adjustments were needed for some predicted structures, segmentation time could be reduced by 70% on average. This allows for an accelerated radiation therapy treatment planning workflow for anal cancer patients.
Topics: Anus Neoplasms; Attention; Humans; Neural Networks, Computer; Organs at Risk; Pelvis; Semantics
PubMed: 35765038
DOI: 10.1186/s13014-022-02088-1 -
International Journal of Environmental... May 2022Pregnancy-related lumbopelvic pain is a common musculoskeletal problem, and postural changes are believed to be involved in these disorders. However, the lumbopelvic...
Pregnancy-related lumbopelvic pain is a common musculoskeletal problem, and postural changes are believed to be involved in these disorders. However, the lumbopelvic alignment changes in postpartum women remain unclear. This study aimed to determine whether there are changes in lumbopelvic alignment following vaginal or cesarean delivery and when these alignment changes occur after delivery. Thirty postpartum females (PP group) and 20 nulliparous female controls (CTL group) underwent anteroposterior, lateral pelvic, and lower-back X-ray in a static upright position. Digital radiographic images were analyzed and three radiographic variables, the pelvic incidence, pubic symphysis width, and sacral slope, were measured. The pubic symphysis width of the PP group was significantly larger immediately and one month after childbirth (PP group: 6.0 ± 1.1 mm (immediately), 5.0 ± 1.2 mm (one month); CTL group: 3.4 ± 0.4 mm; F = 31.79, p < 0.001). The sacrum slope in the PP group was significantly larger than in the CTL group 1 month after childbirth (PP group: 39.9 ± 6.6°; CTL group: 32.8 ± 5.1°; F = 2.59, p = 0.05). A two-way analysis of variance indicated no statistically significant main effects or interaction effects between the delivery modes on the pubic symphysis width or the sacrum slope. This study suggested that the course of lumbopelvic alignment progressed towards recovery for at least one month, and that these changes were independent of the delivery method.
Topics: Female; Humans; Parturition; Pelvis; Postpartum Period; Pregnancy; Pubic Symphysis; Spine
PubMed: 35627342
DOI: 10.3390/ijerph19105807 -
Annals of Palliative Medicine Jun 2022Preoperative whole pelvic radiation therapy (RT) is used commonly for rectal cancer and is the standard field postoperatively in gynecological cancer. However, the ideal...
BACKGROUND
Preoperative whole pelvic radiation therapy (RT) is used commonly for rectal cancer and is the standard field postoperatively in gynecological cancer. However, the ideal field (local vs. whole pelvis) has not been determined for local recurrence of these cancers.
METHODS
We retrospectively reviewed the data for 52 patients who developed local tumor recurrence of rectal or gynecological cancer treated from 2013 to 2021. The initial treatment for all patients was total excision of the primary tumors without radiation therapy. Radiation therapy targets were surgical stumps, perianastomosis sites, and pelvic lymph nodes, classified according to the pelvic nodal volume atlas for radiation therapy. Patients were divided into the local recurrent tumor only radiation therapy group and the whole pelvis radiation therapy group. Whole pelvis radiation therapy included the common iliac lymph nodes or prophylactic lymph nodes below the L5/S1 junction. We recorded second recurrence after RT and the affected site(s) in each group. We also compared disease-specific survival using uni- and multivariate analyses.
RESULTS
We found no significant differences between the groups regarding second recurrence or regarding the site(s) of recurrence. We also found no significant differences in disease-specific survival between the two RT groups. However, patients who did not receive chemotherapy after the initial surgery and before RT had significantly longer survival (P=0.015).
CONCLUSIONS
In patients with locally recurrent rectal or gynecological cancer, we found no significant difference in second recurrence or survival between the local tumor only RT field and the whole pelvic RT field.
Topics: Humans; Lymph Nodes; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvis; Rectal Neoplasms; Retrospective Studies
PubMed: 35272473
DOI: 10.21037/apm-21-2950 -
Turkish Neurosurgery 2021To find out the anatomical changes in spine and pelvis, and the impact of various breast sizes of women on the quality of life.
AIM
To find out the anatomical changes in spine and pelvis, and the impact of various breast sizes of women on the quality of life.
MATERIAL AND METHODS
Sixty women with back pain volunteered to participate in this study. Their body mass index (BMI) was calculated. Clinical evaluation of the pain was assessed using the Oswestry Disability Index and visual analogue scale. Breast volumes were measured using the Grossman Rounder device. Scoliosis radiograms were obtained, and the cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence and pelvic tilt angles were measured in patients. The relationship between the increasing breast size and BMI was investigated through all these parameters.
RESULTS
Increase in breast size positively changes the sagittal balance (r=0.356, p=0.005) and increases cervical lordosis (r=0.300, p=0.020). Increase in BMI leads to a positive sagittal balance (r=0.329, p=0.010) and increases the pelvic tilt (r=0.460, p=0.000). In patients with a positive sagittal balance, the sacral slope (r=-0.350, p=0.006) and the lumbar lordosis angle decrease (r=-0.552, p=0.000), whereas the pelvic tilt increases (r=0.298, p=0.021).
CONCLUSION
Macromastia has an impact on cervical lordosis and sagittal balance, while indirectly impacting the pelvic tilt rather than the thoracic kyphosis and lumbar lordosis.
Topics: Female; Humans; Kyphosis; Lordosis; Lumbar Vertebrae; Pelvis; Quality of Life; Sacrum; Scoliosis
PubMed: 33978220
DOI: 10.5137/1019-5149.JTN.30936-20.2 -
Diagnostic and Interventional Radiology... 2016Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and... (Review)
Review
Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.
Topics: Adult; Cesarean Section; Early Diagnosis; Female; Humans; Multidetector Computed Tomography; Pelvis; Postoperative Complications
PubMed: 27756714
DOI: 10.5152/dir.2016.15593 -
Anatomical Science International Jan 2021The classical surgical anatomy of the female pelvis is limited by its gynecological oncological focus on the parametrium and burdened by its modeling based on personal...
The classical surgical anatomy of the female pelvis is limited by its gynecological oncological focus on the parametrium and burdened by its modeling based on personal techniques of different surgeons. However, surgical treatment of pelvic diseases, spreading beyond the anatomical area of origin, requires extra-regional procedures and a thorough pelvic anatomical knowledge. This study evaluated the feasibility of a comprehensive and simplified model of pelvic retroperitoneal compartmentalization, based on anatomical rather than surgical anatomical structures. Such a model aims at providing an easier, holistic approach useful for clinical, surgical and educational purposes. Six fresh-frozen female pelves were macroscopically and systematically dissected. Three superficial structures, i.e., the obliterated umbilical artery, the ureter and the sacrouterine ligament, were identified as the landmarks of 3 deeper fascial-ligamentous structures, i.e., the umbilicovesical fascia, the urogenital-hypogastric fascia and the sacropubic ligament. The retroperitoneal areolar tissue was then gently teased away, exposing the compartments delimited by these deep fascial structures. Four compartments were identified as a result of the intrapelvic development of the umbilicovesical fascia along the obliterated umbilical artery, the urogenital-hypogastric fascia along the mesoureter and the sacropubic ligaments. The retroperitoneal compartments were named: parietal, laterally to the umbilicovesical fascia; vascular, between the two fasciae; neural, medially to the urogenital-hypogastric fascia and visceral between the sacropubic ligaments. The study provides the scientific rational for a model of pelvic retroperitoneal anatomy based on identifiable anatomical structures and suitable for surgical planning and training.
Topics: Anatomy; Fascia; Fasciotomy; Feasibility Studies; Female; General Surgery; Humans; Models, Anatomic; Pelvis
PubMed: 32529339
DOI: 10.1007/s12565-020-00553-z -
Scientific Reports Mar 2022Low anterior resections (LAR) are frequently associated with complications such as urinary and fecal incontinence as well as sexual disorders. Typical risk factors are...
Low anterior resections (LAR) are frequently associated with complications such as urinary and fecal incontinence as well as sexual disorders. Typical risk factors are rectal cancer with low tumor location, preoperative radiotherapy, and surgery-related damage of pelvic autonomic nerves. As preserving the pelvic autonomic nerves without any technical assistance is challenging, the objective of this preclinical study was to investigate the technical feasibility of a new method for intraoperative pelvic neuromonitoring. Twelve female pigs undergoing low anterior resections were involved in a prospective preclinical study. Intraoperative pelvic neuromonitoring included direct pelvic nerve stimulation and tissue impedance measurement on the urinary bladder and the rectum for the identification of efferent pelvic nerves in the surgical area. Immunohistochemistry was used to verify the results. Smooth muscle contraction of the urinary bladder and/or the rectum in response to direct stimulation of the innervating nerves was detectable with impedance measurement. The macroscopic contraction of both the urinary bladder and the rectum correlated with a change in tissue impedance compared to the status before contraction. Thus, it was possible to identify pelvic nerves in the surgical area, which allows the nerves to be preserved. The results indicate a reliable identification of pelvic autonomic nerves, which allows nerve damage to be prevented in the future.
Topics: Animals; Feasibility Studies; Female; Humans; Pelvis; Prospective Studies; Rectal Neoplasms; Rectum; Swine
PubMed: 35256643
DOI: 10.1038/s41598-022-07576-8 -
The American Journal of Case Reports Nov 2023BACKGROUND Surgery for locally advanced rectal cancer with frozen pelvis is challenging. Therefore, we designed the "modular pelvic exenteration" surgical strategy to...
BACKGROUND Surgery for locally advanced rectal cancer with frozen pelvis is challenging. Therefore, we designed the "modular pelvic exenteration" surgical strategy to achieve better radical resection. CASE REPORT A 51-year-old man with rectal cancer refused surgery and received chemotherapy and radiotherapy. He was intolerant to chemotherapy and did not respond well to radiotherapy. With cancer progression, he presented at our hospital with emaciation, fatigue, dysuria, bloody urine, bloody stool, and anal pain. Computed tomography and magnetic resonance imaging revealed the rectal tumor involved multiple adjacent organs and caused rectovesical fistula, bilateral hydronephrosis, hydroureterosis, and local pelvic infection. The rectal tumor was fixed in the pelvic cavity, presenting a frozen pelvis pattern. There was no distant metastasis. As the patient could not tolerate chemotherapy, was unsuitable for immune-check point inhibitor because the tumor had microsatellite stability, and did not respond well to radiotherapy, surgical resection seemed the most suitable treatment option. After the patient's anemia and malnutrition improved, our designed modular pelvic exenteration surgery was performed. In this strategy, we divided pelvic organs and tissues into 4 independent modules. After combining the modules planned to be resected, we delineated the pre-resection margin. By this strategy, the tumor was removed en bloc, with a clear resection margin. The patient was discharged 13 days after the operation, without complications. Follow-up for 24 months revealed no signs of tumor recurrence. CONCLUSIONS For locally advanced rectal cancer with frozen pelvis, the modular pelvic exenteration strategy may help to achieve satisfactory surgical effects in selected patients.
Topics: Male; Humans; Middle Aged; Pelvic Exenteration; Margins of Excision; Neoplasm Recurrence, Local; Rectal Neoplasms; Pelvis
PubMed: 37968899
DOI: 10.12659/AJCR.941684