Person: Puente Vallejo, Raúl
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Puente Vallejo
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Raúl
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- PublicationTechnological Improvements in Low- and Middle-Income Countries (LMICs): A Review of the Literature and the “Sociedad de Lucha Contra el Cáncer” (SOLCA) Institutional Experience in Neuro-Radiosurgery During the Coronavirus Disease 2019 (COVID-19) Pandemic(World Neurosurgery, 2022-06-18) Ochoa, Pamela; Loza, Felipe; Cueva, Fiorella; Leon Rojas, Jose; Puente Vallejo, RaúlOBJECTIVE: Neurosurgery is a medical field that requires specialized professionals and equipment, 2 important but scarce resources in low- and middle-income countries. Our goal was to report our experience with the replacement and implementation of linear accelerators with radiosurgery capabilities at “Sociedad de Lucha Contra el Cáncer” (SOLCA) Hospital in Quito, Ecuador, and give some recommendations for future technological replacements (TRs). - METHODS: Two surveys were performed in SOLCA’s radiosurgery department, one before the TR was finalized and one after, consisting of an open and multiple-choice questionnaire. Questions focused on the performance of the new equipment, perceptions regarding the training, and the influence of the pandemic on the whole process. In addition, we share our experience regarding the difficulties and benefits of TR at SOLCA. - RESULTS: The most-reported limitation was lack of training (48%). By the time of the second survey, 95.2% of the staff had already treated patients or planned a radiosurgical procedure; 42.9% considered training to have been adequate, and 76.2% felt that the pandemic hindered the training process. Currently, 33 radiosurgeries have been done (26 for the central nervous system and 7 stereotactic radiation body therapies). - CONCLUSIONS: The TR in SOLCA had similarities with other experiences in low- and middle-income countries, but the pandemic brought additional limitations, mainly complicating the staff training. Nevertheless, those limitations can be resolved with a structured training program and international collaboration. Overall, the benefits obtained from a TR result in exponentially better medical care and accessibility to novel treatments.
- PublicationManagement of an Unusual Metastasis of Cervical Cancer in the Adrenal Bed With Stereotactic Ablative Body Radiation Therapy(Cureus, 2022-02-13) Ochoa, Pamela; Nuñez Silva, Cristina; De Los Reyes, Luis; Puente Vallejo, RaúlUterine cervical carcinoma is an important type of cancer among Ecuadorian women, especially in adult women. Survival rates have improved with the development of radiotherapy, surgical techniques, and chemotherapy. However, recurrence and/or metastasis are not unusual phenomena. Frequent sites of metastasis are the lungs, regional lymph nodes, and bones. Atypical locations can also occur on solid organs, such as adrenal glands. Treatment for the rare complication that is adrenal metastasis is individualized, it can include surgical resection, chemotherapy, local ablation, or different types of radiotherapy. We aimed to report a case of an Ecuadorian woman from Quito city with a diagnosis of cervical carcinoma diagnosed in 2009, treated surgically and with adjuvant chemotherapy. Her progression was monitored with medical controls with no recurrence until 2018, when she relapsed with a metastatic invasion of the pelvic ganglia and the surroundings of the abdominal aorta, with a histopathologic diagnosis of adenocarcinoma. She was then treated with chemotherapy and radiotherapy until June 2019. In 2020, she went through a splenectomy and left adrenalectomy to treat vascular thrombosis. In 2021, 37 x 15 mm mass was discovered in the surgical bed of the previously removed adrenal gland. It was treated as an oligometastatic carcinoma with stereotactic body radiotherapy (SBRT) by a linear accelerator.
- PublicationManagement of an Unusual Central Nervous System Metastasis With Linear Accelerator Radiosurgery in a Low-Middle Income Country(Cureus, 2021-11-22) Mosquera, Martín; Leon Rojas, Jose; Puente Vallejo, RaúlLarge cell neuroendocrine carcinoma, a type of non-small cell lung cancer, is quite rare and has been associated with brain metastasis, mainly to the cerebral hemispheres. However, the rate of cerebellar metastasis is underreported in the literature and appears to be quite rare. Despite the rarity of this metastasis, treatment guidelines for both supratentorial and cerebellar lesions have been established by using either radiosurgery or whole-brain radiation therapy. The choice of modality must take into consideration the vicinity of relevant structures such as the brainstem and its multiple nuclei. Here we report the case of a 68-year-old male, resident of a rural community in the Andean region of Ecuador, a lowmiddle income country; with the diagnosis of a large cell neuroendocrine carcinoma of the lung with dual central nervous system metastasis treated with linear particle accelerator radio-surgery due to its versatility and cost-effectiveness in a resource-limited setting. We showcase the rarity of the metastatic lesions as well as the utility of linear accelerators and their versatility to perform precise radiosurgical procedures in two simultaneous locations.
- PublicationTema 1. Radioterapia externa en el cáncer de tiroides(SOLCA, Núcleo de Quito, 2023-05-18) Puente Vallejo, Raúl
- PublicationCáncer de próstata: diagnóstico y nuevas alternativas de tratamiento(SOLCA, Núcleo de Quito, 2022-07-06) Carrión, Cecilia; Molina, Mayra; Puente Vallejo, Raúl
- PublicationAnatomía Radiológica: Una visión para el estudiante(SOLCA, Núcleo de Quito, UIDE., 2021-09-08) Puente Vallejo, Raúl; Leon Rojas, Jose; Rivas, GabrielaEl libro presenta una visión clara y estructurada de los principios físicos de los principales estudios de imagen, además de la aplicación del lenguaje radiológico, complementado con un atlas descriptivo de las estructuras anatómicas desde las diferentes modalidades de estudios.
- PublicationAnatomía Radiológica: Una visión para el estudiante(2da Ed.)(SOLCA, Núcleo de Quito., 2023-05) Puente Vallejo, Raúl; Leon Rojas, Jose; Rivas, Gabriela; Acosta Freire, MishelleLa segunda edición contempla una visión más amplia de la Anatomía Radiológica, generada desde la posibilidad que brinda la virtualidad de manipular las imágenes presentadas en el libro. El enfoque pensado en el estudiante así como la rigurosidad científica con la que se ha escrito, hacen de esta segunda edición un elemento de mucha ayuda en la formación académica de todos los profesionales de la salud.
- PublicationReduciendo el impacto de COVID-19 sobre la radioterapia oncológica en países en desarrollo: revisión rápida y consenso de expertos(MEDwave, 2020-07-09) Montero Oleas, Nadia; Imbaquingo Cabrera, Andrés; Silva, Mónica; Gamarra, Elizabeth; Álvarez Rodas, Byron; Segovia, Nelson; Aldaz Roldan, Pablo; Nuñez Silva, Cristina; Zurita Vivero, Karina; Carrión, Alex; Molina Jaramillo, José; Rodiriguez Balarezo, Andrés; Betancourt, Yuri; De Los Reyes, Luis; Puente Vallejo, RaúlObjetivo Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados. Métodos A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento. Resultados Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible. Conclusión Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19