Synchronous colon and renal cancer : case report

Background: Primary cancer may occur synchronously in two different organs. We present an example of pathologically proven, coexistent renal and colony double malignant tumors. Case Report: A 59 year old man, was admitted to the Institute of Oncology due to left renal lesion, discovered during a routine abdominal ultrasound examination. The CT exam was performed before surgery. The CT scans reveled a second abnormality, presenting irregular shaped and thickened to 20 mm intestinal wall within a patient's large bowel. As a next diagnostic step a CT-colonoscopy was undertaken, which confirmed the presence of an exophytic sigmoid lesion, eccentrically affecting the colonic wall and protruding into the lumen moderately narrowing it, placed about 50 cm from the external rectal sphincter. Patient underwent simultaneous radical left nephrectomy and sigmoidectomy. Both tumors were confirmed in pathologic evaluation, reveling renal clear cell carcinoma (Fuhrman G II) and colonic adenocarcinoma (Astler-Coller B2). Conclusions: Preoperative careful imaging studies reveled neoplastic tumors in two different organs, allowing for radical resection at the same surgical procedure

Development of J-PEM for breast cancer detection and diagnosis using positronium imaging

The purpose of the presented investigations is to design, construct and establish the characteristic performance of the Jagiellonian Positron Emission Mammography (J-PEM), being designed for the detection and diagnosis of breast cancer. Its construction is based on a novel idea of PET tomography based on plastic scintillators and wavelength shifter (WLS), and a new concept of positronium imaging. We have prepared a simulation program based on Monte Carlo methods for optimizing the geometry and material of the J-PEM prototype. Here, we present the first results from the simulations and a brief review of the state of art of breast imaging modalities and their characteristics motivating our investigation

Rak wewnątrzprzewodowy, a rak naciekający u chorych z rakiem piersi usuniętym po oznakowaniu igłą lokalizacyjną

Background: Early diagnosis of a breast cancer is very important and challenging aspect in imaging the lesion in the breast. The small lesions visible in imaging exams, in majority of cases are not palpable in clinical testing. The aim of the work is to make a comparison between the clinical features and radiological image in patients with impalpable breast cancer in clinical testing. Material/Methods: 338 operating procedures of the breast tumors removal were conducted after preliminary marking them by the localized needle. The lesion in the breast was shown in the mammography or ultrasonography exam. Results: In histopathology exam the breast cancer was confirmed in 131 women. The ductal carcinoma in situ (DCIS) occurred in 41 (31 %) women and the invasive ductal carcinoma (IDC) in 91 (69 %) women. Microcalcifications find out to be characteristic for the DCIS. The shape of the spicular lesion is characteristic for the invasive carcinoma. DCIS in mammography exam is bigger than invasive carcinoma. Conclusions: 1. The mammography exam is the basic method for the detection of the breast cancer and the best method for the detection of DCIS, which is often visible in the form of microcalcifications. 2. The average size of the DCIS in mammography exam is twice as large than in ultrasonography and three times larger than in histopathology exam. 3. Size of the lesion in microscopic and macroscopic exam is equal with size of the lesion in ultrasound exam and the diameter of the solid center in the mammography and because of that reason, presence of the processes around the malignant tumor, which is visible in mammography exam should not have influenced the qualification for the surgical treatment

Pulmonary complications in patients with complete remission after radio-chemotherapy for localized stage small-cell lung cancer

Cel. Celem pracy jest przedstawienie wyników analizy wpływu wybranych czynników na częstość rozwoju powikłań płucnych u chorych z całkowitą remisją (CR) po radiochemioterapii (RT-ChT) stosowanej z powodu drobnokomórkowego raka płuca w ograniczonej postaci (DKRP OP).Materiał i metody. W latach 2000–2010 u 286 chorych na DKRP OP zastosowano leczenie skojarzone RT-ChT jako leczenie równoczesne (157 chorych — 54,9%) lub w układzie sekwencyjnym (129 chorych — 45,1%). Uwzględniając czas rozpoczęcia radioterapii obszaru klatki piersiowej w stosunku do prowadzenia chemioterapii, wyróżniono: RT rozpoczynaną po 1–2 cyklu chemioterapii (zastosowana u 104 chorych — 36,4%) oraz RT rozpoczynaną po 3. cyklu lub później (przeprowadzona u pozostałych 182 chorych — 63,4%). Powikłania w płucach oceniono u chorych, u których po RT-ChT uzyskano CR, a minimalny okres obserwacji po leczeniu wynosił 6 miesięcy. Radiologiczne badania obrazowe klatki piersiowej były podstawą do stwierdzenia obecności rozwoju powikłań w płucach, do których wykorzystano klasyfikację proponowaną przez Fleischner Society. Stopień nasilenia powikłań oceniony został według Common Terminology Criteria for Adverse Events (CTCAE). Przeprowadzono analizę wpływu terapeutycznych i klinicznych czynników na częstość rozwoju powikłań. Ponadto oszacowano odsetek przeżycia bez objawów nowotworu w odniesieniu do tych czynników, które okazały się istotnymi dla rozwoju powikłań.Wyniki. Spośród wszystkich chorych u 187 (65,4%) po RT-ChT uzyskano CR. Okres obserwacji wynoszący przynajmniej6 miesięcy dotyczył 152 chorych (81,3%). Spośród tych chorych u 132 (86,8%) stwierdzono rozwój powikłań w płucach. Stanowili oni 70,6% chorych z CR. Zwłóknienie płuc stwierdzono u 91 chorych (48,7% ogólnej liczby i 48,7% chorych z CR). Innymi objawami radiologicznymi stwierdzanymi w płucach były: zagęszczenie pęcherzykowo-zrębowe (74 chorych — 56,1%) i pogrubienie rysunku zrębu (24 chorych — 18,2%), które współistniały ze zwłóknieniem (54 chorych) lub występowały samodzielnie (41 chorych). Wykazano, że rozwój powikłań w płucach istotnie zależał od sposobu zastosowania RT-ChT (93,3% vs 80,5% odpowiednio dla równoczesnej i sekwencyjnej) oraz od czasu rozpoczynania RT obszaru klatki piersiowej (95,6% vs 79,8% odpowiednio dla RT po 1–2 cyklu i RT po 3 cyklu lub później). Po uwzględnieniu powyższych czynników wykazano istotny wpływ maksymalnej dawki w płucach, średniej dawki w płucach oraz wartości V20 na rozwój powikłań w płucach.Wnioski. Schemat Rt-ChT oraz czas rozpoczynania radioterapii względem chemioterapii są istotnymi czynnikami wpływającymi nie tylko na wyniki leczenia (przeżycia bez objawów nowotworu), ale również na rozwój powikłań w płucach.Aim. The study aimed to analyse the effects of selected factors on the frequency of pulmonary complications in patientswith localized stage small-cell lung cancer (LS SCLC) in complete remission (CR) following radio-chemotherapy (RT-ChT).Material and methods. Between 2000 and 2010, 286 patients with LS SCLC received RT-ChT. Treatment was given sequentially (157 patients — 54.9%) or concurrently (129 patients — 45.1%). According to the start of thoracic radiotherapy (RT) in relation to chemotherapy, the two groups were selected: RT started immediately after 1–2 cycles of chemotherapy (it was applied in 104 patients — 36.4%). The other 182 patients (63.4%) received RT after 3 or cycles of chemotherapy or later. Pulmonary complications were evaluated in patients with complete remission (CR) with a minimum follow-up period of 6 months. These complications found on radiological chest examinations were assessed according to classification proposed by the Fleischner Society. The severity of these pulmonary changes was assessed according to Common Terminology Criteria for Adverse Events (CTCAE). The frequency of lung complications and the influence of some therapeutic and clinical parameters to the development of pulmonary complications were evaluated. In addition the disease-free survival (DFS) rate was estimated in relation to factors that significantly influenced the frequency of pulmonary complications.Results. A total of 187 patients (65.4%) achieved CR following RT-ChT. For 152 patients (81.3%) the duration of follow-up was at least 6 months. Pulmonary complications were observed in 132/152 patients (86.8%). These patients accounted for 70.6% of those with CR. Pulmonary fibrosis was observed in 91 patients (48.7%) and these patients accounted for 48.7% of those with CR. Other signs of lung complications were ground-glass opacities (74 patients — 56.1%) and interlobular septal thickening (24 patients — 18.2%). These changes were either accompanied by fibrosis (54 patients) or appeared independently (41 pts.). The incidence of pulmonary complications significantly correlated with the schedule of RT-ChT (93.3% vs 80.5% for concurrent vs sequential) and the beginning of thoracic RT (95.6% vs 79.8% for RT after 1–2 cycles ChT vs RT after 3 or later). The significant differences related to maximum lung dose, mean lung dose and V20 were demonstrated after taking into account the schedule of RT-ChT and the start of thoracic RT.Conclusions. In patients with LS SCLC the schedule of radio-chemotherapy and timing of thoracic radiotherapy have a significant impact not only on the results of treatment (disease-free survival rate) but also on the incidence of pulmonary complications in patients with LS SCLC

Health-promoting value of cow, sheep and goat milk and yogurts

Svrha ovog rada bila je odrediti sastav masnih kiselina te lipida s povoljnim zdravstvenim učincima kao i odabranih mikro- i makroelemenata u kravljem, ovčjem i kozjem mlijeku i jogurtu. Sastav masnih kiselina određivan je GC-FID metodom pomoću 100-m kapilarne kolone s CP Sil 88 fazom. Makroelementi (željezo, cink, bakar i mangan) i mikroelementi (magnezij i kalcij) određivani su primjenom plamene atomske apsorpcijske spektrometrije, dok su natrij i kalij određivani emisijskom metodom. Udio fosfora određen je kolorimetrijskom metodom. Ovo istraživanje pokazalo je da ovčje, kravlje i kozje mlijeko te jogurti sadrže različite količine masnih kiselina, mikro- i makroelemenata. Ovčje mlijeko i jogurt su se pokazali boljim izvorom višestruko nezasićenih masnih kiselina (PUFA) (4,41 odnosno 4,35 % ukupnih masnih kiselina) i n-3 masnih kiselina (1,05 % ukupnih masnih kiselina). U usporedbi s ostalim uzorcima mlijeka i jogurta, ovi uzorci također su imali manji omjer n6/n3 masnih kiselina (1,93, odnosno 1,92) kao i najniži indeks trombogenosti (TI). S druge strane kozje mlijeko i jogurt sadržavali su najviše koncentracije kratkolančanih masnih kiselina (SCFA), (18,07 odnosno 18,17 % ukupnih masnih kiselina), najniže koncentracije zasićenih masnih kiselina (SFA), (54,62 odnosno 54,93 %, ukupnih masnih kiselina) i najniži indeks aterogenosti (AI) (2,79 odnosno 2,84). Koncentracije svih određivanih mikro- i makroelemenata bile su značajno (P<0,05) više u jogurtu nego u mlijeku. Kozji jogurt sadržavao je više koncentracije bakra, željeza i kalija u odnosu na ovčji i kravlji jogurt. S druge strane, ovčji jogurt je sadržavao više cinka, magnezija, kalcija i fosfora u odnosu na ostale vrste analiziranih jogurta.The purpose of the presented study was to determine the fatty acid composition, health lipid indices content and selected micro and macronutrients in cow, sheep and goat milk and yogurts produced there of. Fatty acid composition was determined by the GC-FID method using a 100-m capillary column with CP Sil 88 phase. Microelements (iron, zinc, copper and manganese) and macroelements (magnesium and calcium) were analysed using flame atomic absorption spectrometry, whereas sodium and potassium were determined by the emission method. Phosphorus was analysed by the colorimetric method. The conducted study demonstrated that sheep, cow and goat milks and yogurts were characterized by different contents of fatty acids, micro- and macroelements. Sheep milk and yogurts could be regarded as richer sources of polyunsaturated fatty acids (PUFA), (4.41 and 4.35 % of total fatty acids, respectively), n-3 fatty acids (1.05 % of total fatty acids). These samples also had lower n6/n3 ratio (1.93 and 1.92, respectively) and the lowest value index of Thrombogenicity (TI) in comparison to the other analyzed milk and yogurt samples. In turn, goat milk and yogurts were characterized by the highest content of short-chain fatty acids (SCFA), (18.07 and 18.17 % of total fatty acids, respectively) the lowest content of saturated fatty acids (SFA), (54.62 and 54.93 %, respectively) and the lowest value index of Atherogenicity (AI) (2.79 and 2.84, respectively). Concentrations of all analyzed microand macroelements were significantly (P<0.05) higher in yogurts than in milk samples used for their production. Goat yogurts contained higher concentrations of copper, iron, and potassium compared to sheep and cow yogurts. In turn, sheep yogurts had more zinc, magnesium, calcium, and phosphorus than the other analyzed yogurt samples

The retrospective evaluation of prophylactic cranial irradiation in patients treated for limited stage small-cell lung cancer — a single centre study

Introduction. The standard treatment for patients with LD SCLC (limited stage small-cell lung cancer) is combined modality therapy that includes chemotherapy (ChT) with platinum-based regimens and thoracic radiotherapy (RT), followed by prophylactic cranial irradiation (PCI) in patients with a response in the thorax. Objectives. The evaluation of PCI in patients with LD SCLC and the analysis of the effects of certain therapeutic factors on the frequency and occurrence of brain metastases. Materials and methods. Between 2002 and 2015, a total of 271 patients with LD SCLC received chemo-radiotherapy (concurrently in 122 pts — 45% and sequential in 149 pts — 55%). PCI was administered in 167 pts (61.6%) with total dose of 30 Gy given to the whole brain; 86 pts (51.1%) received PCI after completed chemo-radiotherapy and in 81 pts (48.9%) PCI was administered immediately after the end of thoracic irradiation. The following statistical methods were used: Kaplan-Meier method (evaluation of survival rates: overall survival — OS, and brain metastases-free survival — BMFS), log-rank test (for comparison of survival rates), Cox’ proportional hazard model (for multivariate analysis), Pearson chi2 test for independence (for categorized variables comparison) and variance analysis (for continuous variables comparison). All the calculations were performed using Statistica v. 13.3 software (TIBCO Software Inc.) and the significance level for all the statistical methods was p &lt; 0.05. Results. Complete response in thorax was observed in 172 pts (63.5%) and remaining 99 pts (36.5%) developed partial response. During follow-up, 120 pts (44.3%) developed distant metastases from which brain metastases were most frequent (61 cases — 60.8%). The cumulative 5-year incidence of brain metastases amounted to 18.9% (when PCI was administered) and 45.9% (when PCI was omitted) and these differences were significant (p &lt; 0.0001). PCI was an independent prognostic factor for BMFS and for OS. Omitted PCI is related with HR amounted: 6.25 for BMFS and 1.81 for OS. Conclusions. PCI significantly reduces the incidence of brain metastases and delays the development of brain metastases in patients treated for LD SCLC. PCI is a significant independent prognostic factor for brain metastases-free survival and overall survival. The development of brain metastases is the most common type of failure in patients with LD SCLC and 90% of such relapses occurred during the 24 months following the completion of chemo-radiotherapy

The retrospective evaluation of prophylactic cranial irradiation in patients treated for limited stage small-cell lung cancer — a single centre study

Introduction. The standard treatment for patients with LD SCLC (limited stage small-cell lung cancer) is combined modality therapy that includes chemotherapy (ChT) with platinum-based regimens and thoracic radiotherapy (RT), followed by prophylactic cranial irradiation (PCI) in patients with a response in the thorax. Objectives. The evaluation of PCI in patients with LD SCLC and the analysis of the effects of certain therapeutic factors on the frequency and occurrence of brain metastases. Materials and methods. Between 2002 and 2015, a total of 271 patients with LD SCLC received chemo-radiotherapy (concurrently in 122 pts — 45% and sequential in 149 pts — 55%). PCI was administered in 167 pts (61.6%) with total dose of 30 Gy given to the whole brain; 86 pts (51.1%) received PCI after completed chemo-radiotherapy and in 81 pts (48.9%) PCI was administered immediately after the end of thoracic irradiation. The following statistical methods were used: Kaplan-Meier method (evaluation of survival rates: overall survival — OS, and brain metastases-free survival — BMFS), log-rank test (for comparison of survival rates), Cox’ proportional hazard model (for multivariate analysis), Pearson chi2 test for independence (for categorized variables comparison) and variance analysis (for continuous variables comparison). All the calculations were performed using Statistica v. 13.3 software (TIBCO Software Inc.) and the significance level for all the statistical methods was p &lt; 0.05. Results. Complete response in thorax was observed in 172 pts (63.5%) and remaining 99 pts (36.5%) developed partial response. During follow-up, 120 pts (44.3%) developed distant metastases from which brain metastases were most frequent (61 cases — 60.8%). The cumulative 5-year incidence of brain metastases amounted to 18.9% (when PCI was administered) and 45.9% (when PCI was omitted) and these differences were significant (p &lt; 0.0001). PCI was an independent prognostic factor for BMFS and for OS. Omitted PCI is related with HR amounted: 6.25 for BMFS and 1.81 for OS. Conclusions. PCI significantly reduces the incidence of brain metastases and delays the development of brain metastases in patients treated for LD SCLC. PCI is a significant independent prognostic factor for brain metastases-free survival and overall survival. The development of brain metastases is the most common type of failure in patients with LD SCLC and 90% of such relapses occurred during the 24 months following the completion of chemo-radiotherapy

Ocena wartości prognostycznej wybranych cech klinicznych i objawów mammograficznych w raku piersi

Background: The aim of the work is to assess the probability of the breast cancer occurrence on the basis of analysis of the clinical and mammographical factors in women with unpalpable breast tumor. Material/Methods: In the period from the 1st February 1995 to the 31st August 2000, 163 surgical procedures for the removal of any lesions in the breasts were conducted, after being previously marked by localized needle, in women who earlier underwent mammography exam.Following data was taken into consideration: patients age, type of the breast structure; side of the breast, where the lesion was localized in the mammography exam; localized lesions depending on the quadrant; shape of the lesion; size of the lesion in millimeters; presence and the type of microcalcifications. Results/Conclusions: 1. The only one population factor, which can be distinguished as characteristic for the women suffering from the breast cancer impalpable in clinical testing, is the age of the patient, because the breast cancer in these women more frequently occurs after 53 years of age. 2. On the basis of our own material the following radiological symptoms characteristic for the breast cancer in mammography exam were stated: the breast cancer is more frequently found in the upper external quadrant; all lesions, which in mammography exam were identified as multifocal and radiologicaly suspected in histopathology exam turned out to be the cancer; pleomorphic microcalcifications are characteristic for the malignant lesions; external outline and the shape of the lesion are the features, which allow to differentiate malignant and benign lesions. 3. The analysis of the material indicates that the greatest probability of the breast cancer occurrence is in case of the four risk factors occurrence simultanosly, and the smallest in case of only one risk factor occurrence

Clinical features and disease course in patients with BRCA1-dependent ovarian cancer

f the disease and prognosis of BRCA1-dependent OC vary between sporadic cases. Aim of the study: To analyze clinical features and disease courses of BRCA1-dependent OC in the material from Center of Oncology, Cracow Branch. Material and methods: Between 2004 and 2008, 66 mutations of BRCA1 gene were found in patients with OC. All patients were treated with primary surgery followed by platinum-based chemotherapy. Outcomes were assessed by means of clinical examination and imaging tests. Patients with complete response were followed up in the outpatient office. Secondary chemotherapy was administered if persistent or progressive disease was diagnosed. Results: In the analyzed group of 66 (100%) patients, the following mutations of BRCA1 gene were found: in 31 (47%) – C61G (exon 5), in 21 (31,8%) – 5382insC (exon 20), in 6 (9.1%) – 185delAG and in 8 (12.1%) – other (exon 11). Mean patient age was 48. FIGO stage I and stage II were diagnosed in 7 (10,6%), stage III in 58 (89,9%) and stage IV in 1 patient (1,5%). Twenty five (37.9%) patients underwent complete macroscopic primary cytoreduction. Platinum-based chemotherapy was administered to all 66 patients after surgery. Complete response (CR), partial response (PR) and progressive disease (PD) was achieved in 31 (46.9%), 30 (45,5%) and 5 (7.6%) patients, respectively. Secondary surgery was performed in 29 (43.9%) of patients after completion of adjuvant therapy. Second-line chemotherapy was administered in 40 (60.6%) patients due to residual or progressive disease. Mean time of follow-up was 65 months. Forty one (62.1%) patients died due to OC progression. Conclusions: Clinical features and disease courses in BRCA1-dependent OC patients in the analyzed group were similar to other results reported in the literature

Powikłania radioterapii u chorych na pierwotnego inwazyjnego raka pochwy

Objectives: The aim of the study was to estimate acute and late complications of radiation therapy in primary invasive vaginal carcinoma (PIVC) patients. Material and methods: The analysis was performed for the group of 152 PIVC patients given radical radiotherapy in the Krakow Branch of Centre of Oncology during the 1967–2005 period. Twenty five (16.5%) patients in I stage with primary tumour of the thickness not larger than 0.5 cm were treated with intracavitary brachytherapy alone; for 120 (78.9%) patients (stages I – IVA) intracavitary brachytherapy was combined with external radiation therapy; and 7 (4.6%) patients in stage IVA were given only external radiotherapy. In total, 145 (95.4%) patients were treated with intracavitary LDR brachyterapy by means of Ra-226 or afterloaded Cs-137 sources, and 127 (83.5%) received external radiation therapy using Co-60 and linac 10MV or 6MV photon beams. Results: Early radiotherapy tolerance was good in the investigated group; 146 (96.1%) patients completed full planned radiation therapy treatment. Late complications of radiation therapy were observed in 21 (13.8%) patients: 3 (2%) patients reported mild complications, 12 (7.9%) moderate complications, and 6 (3.9%) severe complications. Severe complications of radiation therapy in the investigated group included: recto-vaginal fistula (5 patients) and vesico-vaginal fistula (1 patient). None of the patients in the group died of radiation therapy complications. Conclusions: Early tolerance of radiotherapy in PIVC patients is generally good. Late radiation therapy complications, particularly the severe, are rare and can be efficiently managed with conservative therapy or surgical treatment.Cel pracy: Celem pracy była ocena wczesnych i późnych powikłań radioterapii chorych na pierwotnego inwazyjnego raka pochwy (PIVC). Materiał i metody: Przedmiotem analizy była grupa 152 chorych na PIVC napromienianych radykalnie w krakowskim Oddziale Centrum Onkologii w latach 1967-2005. U 25 (16,5%) chorych na PIVC w I0 zaawansowania, ze zmianą pierwotną nieprzekraczającą 0,5cm grubości przeprowadzono wyłącznie brachyterapię dojamową, u 120 (78,9%) chorych (I0- IVA0) brachyterapię dojamową skojarzoną z teleradioterapią, a u 7 (4,6%) chorych w IVA0 zaawansowania wyłącznie teleradioterapię. W sumie, u 145 (95,4%) chorych zastosowano brachyterapię dojamową LDR radem-226 lub cezem-137, a u 127 (83,5%) teleradioterapię w warunkach telegammaterapii kobaltem-60 lub promieniowania X o energii 10MeV lub 6MeV z akceleratorów liniowych. Wyniki: Bezpośrednia tolerancja radioterapii w badanej grupie chorych była dobra; pełną zaplanowaną radioterapię przeprowadzono u 146 (96,1%) chorych. Późne powikłania napromieniania stwierdzono u 21 (13,8%) chorych: u 3 (2%) były to powikłania o średnim nasileniu, u 12 (7,9%) znacznym nasileniu i u 6 (3,9%) – o bardzo ciężkim nasileniu. Ciężkie powikłania radioterapii w badanej grupie chorych to: przetoka pochwowo-odbytnicza (5 chorych) i przetoka pochwowo-pęcherzowa (1 chora). Żadna chora z badanej grupy nie zmarła z powodu powikłań radioterapii. Wnioski: Bezpośrednia tolerancja radioterapii chorych na PIVC jest zasadniczo dobra. Późne powikłania radioterapii, szczególnie ciężkie są rzadkie i mogą być skutecznie leczone zachowawczo lub operacyjnie