PDR brachytherapy: a report on one – year clinical experience at the Medical University of Gdańsk

PurposeOne-year clinical experience with pulse dose rate (PDR) brachytherapy is presented.Material and methodsBetween March 1999 and June 2000 intracavitary, intraluminal, and interstitial PDR brachytherapy was performed in 119 patients with a variety of malignancies. The dose per pulse of 0.5–4 Gy, repeated each hour, or 6 Gy per application was administered, up to the total dose of 6–70 Gy, using a microSelectron-PDR remote afterloading system with a 192Ir source of 1 Ci nominal activity. The planning system PLATO BPS (version 13) was used for dose calculations. Depending on individual applications, the algorithms of the dose point, the geometrical volume, or the geometrical point dose distribution optimization in PDR treatment planning were performed. In 40 patients therapy was given with a curative intent, and 74 cases were treated palliatively. In the remaining five patients PDR was applied as salvage therapy in the previously irradiated area.ResultsWith a median follow-up of 11 months (range 1–18 months) local control was maintained until the last follow-up or death in 39 out of 40 patients treated with radical intent. The subjective improvement was achieved in more than a half of patients with advanced esophageal and lung carcinomas presenting dysphagia and dyspnoe. Significant acute toxicity (severe esophagitis precluding subsequent POR application) occurred in only one patient. Delayed vaginal cuff necrosis was observed in one woman who received prior pelvic irradiation for gynaecological cancer.ConclusionThe PDR brachytherapy is a safe and clinically effective method in a variety of malignancies. The possibility of programme optimization combined with the use of relatively wide range of pulse doses makes it possible to deliver an optimal brachytherapy scheme

Ocena wyników skojarzonego leczenia raka płaskonabłonkowego piersiowego odcinka przełyku

Praca wykonana w Katedrze i Klinice Chirurgii Onkologicznej

A foreign body (a fish bone) in the esophagus translocating into soft tissues of the neck – a case report

Background: Patients with foreign bodies in upper digestive tract not infrequently trigger many diagnostic and treatment challenges, especially when foreign bodies translocate and are lodged outside the esophagus. Case report: We present a case of a foreign body in esophagus 56-years old woman who had developed persistent sensation of an obstacle in her throat after eating fish (Atlantic cod). She has initially dismissed her symptoms and refused medical treatment. Subsequently, a neck CT done one week later showed a 20-milimeter long fish bone in the soft tissues on the left side of her neck (between pharynx and vertebral column). Few attempts of endoscopic removal were unsuccessful. Despite antibiotic prophylaxis and due to the fish bone translocation into soft tissues of the neck and its location close to a common carotid artery and an internal jugular vein a decision was made to remove it from the external approach. The foreign body was successfully removed without any esophageal damages. Conclusions: Foreign bodies in digestive tract may result in many life-threatening complications. The fundamental management is based on the endoscopic removal of a foreign body and the antibiotic prophylaxis. In case of foreign bodies lodged in soft tissues open surgery is recommended. Key words: foreign body in the esophagus; fish bone; paraesophageal abscess ; treatmen

Ciało obce przełyku (ość) penetrujące do tkanek miękkich szyi – opis przypadku

Wstęp: Pacjenci z ciałami obcymi górnych dróg pokarmowych, często spotykani w codziennej praktyce otorynolaryngologicznej, nierzadko wywołują znaczne trudności diagnostyczne i lecznicze. Opis przypadku: Prezentujemy przypadek ciała obcego przełyku u 56-letniej kobiety, która po spożyciu ryby (dorsza atlantyckiego) miała utrzymujące się uczucie przeszkody w gardle. Chora w pierwszym okresie zbagatelizowała objawy dysfagii i nie podjęła leczenia. W wykonanym po tygodniu badaniu TK szyi uwidoczniono ość ryby (wym. 20 x 1,5 mm) w tkankach miękkich szyi po stronie lewej. Kilkukrotne endoskopowe próby usunięcia ciała obcego zakończyły się niepowodzeniem. Pomimo leczenia antybiotykami i w związku z przemieszczeniem się ciała obcego w głąb tkanek miękkich szyi, powstania ropnia okołoprzełykowego i bliskiego sąsiedztwa tętnicy szyjnej wspólnej i żyły szyjnej wewnętrznej, podjęto decyzję o usunięciu ości z dostępu zewnętrznego. Usunięto pomyślnie ciało obce bez następstw związanych z uszkodzeniem przełyku. Wnioski: Ciała obce dróg pokarmowych niosą za sobą ryzyko wystąpienia wielu zagrażających życiu powikłań. Podstawowym sposobem leczenia jest usunięcie ciała obcego przełyku drogą endoskopową oraz antybiotykoterapia. Przy ciałach obcych penetrujących do tkanek miękkich szyi metodą z wyboru jest usunięcie ciała obcego z dostępu zewnętrznego

Primary Ewing Sarcoma of the Thyroid—Eight Cases in a Decade: A Case Report and Literature Review

Sarcomas represent less than 1% of all malignant tumors found in the thyroid. Of these, primary extraosseoussarcoma has been reported only a few times in the past decade. We present the case of a 34-year-old male who had a fast-growing hard mass in the lower left neck. FNA was inconclusive. Core needle biopsy revealed the diagnosis of an Ewing sarcoma/primitive neuroectodermal tumor. Mutation of EWSR1 was confirmed using the FISH method. Following treatment by neoadjuvant chemotherapy, we observed clinical, radiological, and finally histopathological remission. This was followed by a left-sided isthmolobectomy with unilateral cervical lymph node dissection by lateral lymphadenectomy, which revealed no residual disease. Posttreatment radiotherapy was administered but discontinued upon the patient’s request. After 18 months of observation, the patient had no recurrence or metastasis and required l-thyroxine supplementation. We discuss our case using a comparative literature review to the few other known case reports

PDR brachytherapy: a report on one – year clinical experience at the Medical University of Gdańsk

SummaryPurposeOne-year clinical experience with pulse dose rate (PDR) brachytherapy is presented.Material and methodsBetween March 1999 and June 2000 intracavitary, intraluminal, and interstitial PDR brachytherapy was performed in 119 patients with a variety of malignancies. The dose per pulse of 0.5–4 Gy, repeated each hour, or 6 Gy per application was administered, up to the total dose of 6–70 Gy, using a microSelectron-PDR remote afterloading system with a 192Ir source of 1 Ci nominal activity. The planning system PLATO BPS (version 13) was used for dose calculations. Depending on individual applications, the algorithms of the dose point, the geometrical volume, or the geometrical point dose distribution optimization in PDR treatment planning were performed. In 40 patients therapy was given with a curative intent, and 74 cases were treated palliatively. In the remaining five patients PDR was applied as salvage therapy in the previously irradiated area.ResultsWith a median follow-up of 11 months (range 1–18 months) local control was maintained until the last follow-up or death in 39 out of 40 patients treated with radical intent. The subjective improvement was achieved in more than a half of patients with advanced esophageal and lung carcinomas presenting dysphagia and dyspnoe. Significant acute toxicity (severe esophagitis precluding subsequent POR application) occurred in only one patient. Delayed vaginal cuff necrosis was observed in one woman who received prior pelvic irradiation for gynaecological cancer.ConclusionThe PDR brachytherapy is a safe and clinically effective method in a variety of malignancies. The possibility of programme optimization combined with the use of relatively wide range of pulse doses makes it possible to deliver an optimal brachytherapy scheme