Brain metastases

Brain metastases are the most common intracranial tumors and the most frequent neurologic complication of disseminated cancer. Diagnosis and differentiation are based on imaging studies (computed tomography, magnetic resonance imaging) and in doubtful cases — brain biopsy. Corticosteroids and, according to patient’s specific circumstances, radiotherapy (whole brain radiotherapy, radiosurgery, brachytherapy), surgery and chemotherapy are methods of treatment. The most effective therapeutical strategy in respect of median survival is surgical resection or radiosurgery in conjunction with whole brain radiotherapy. Bringing into treatment new cytotoxic drug - temozolomide - promises an improvement of the treatment efficacy in patients qualified to chemotherapy.Przerzuty do mózgu są najczęściej rozpoznawanymi guzami śródczaszkowymi i najczęstszym powikłaniem neurologicznym rozsianej choroby nowotworowej. Podstawą rozpoznania i różnicowania są badania obrazowe (tomografia komputerowa, jądrowy rezonans magnetyczny), a w przypadkach wątpliwych - biopsja mózgu. W leczeniu wykorzystuje się kortykosteroidy oraz, zależnie od sytuacji klinicznej, radioterapię (napromienianie całego mózgu, radiochirurgia, brachyterapia), metody chirurgiczne i chemioterapię. Największe korzyści, mierzone średnim czasem przeżycia, odnoszą pacjenci poddani resekcji chirurgicznej lub radiochirurgii w skojarzeniu z radioterapią całego mózgu. Wprowadzenie do leczenia nowego leku cytotoksycznego - temozolomidu - budzi nadzieję na poprawę efektów leczenia u pacjentów kwalifikowanych do chemioterapii

Spinal cord compression as an emergency in oncology

Ucisk rdzenia stanowi częste powikłanie neurologiczne zaawansowanej choroby nowotworowej. Wczesne rozpoznanie i leczenie decydują o rokowaniu. Wywiad i objawy neurologiczne sugerujące zespół zobowiązują do diagnostyki obrazowej. Metodą z wyboru jest badanie rezonansem magnetycznym, wykorzystywane także do planowania leczenia. Postępowanie terapeutyczne należy podejmować w trybie nagłym i różnicować zależnie od sytuacji klinicznej. Do stosowanych metod leczenia należą: podawanie kortykosteroidów, radioterapia, chemioterapia oraz leczenie chirurgiczne.Spinal cord compression (SCC) is the most frequent neurological complication of systemic cancer. Early diagnosis and treatment are the most important factors influencing on prognosis. Diagnostics should be performed immediately when the history and neurological examination suggest SCC. The modality of choice is magnetic resonance imaging which is also extremely useful in treatment planning. The management of SCC should be undertaken promptly and individualized according to patient’s specific circumstances. Corticosteroids, radiotherapy, chemotherapy and surgery are the conventional treatment methods

Differential relationship between two hypoxia markers: HIF-1α and GLUT1 and classic prognostic factors in invasive breast carcinoma

Background: Tumor hypoxia is an adverse prognostic factor which promotes cancer aggressiveness and limits its radio- and chemosensitivity. The aim of our study was to explore the relationship between endogenous hypoxia markers and classic prognostic factors, including clinical stage and the expression of ER, PR, and HER2 in primary untreated breast carcinoma. Methods: A retrospective immunohistochemical analysis of archived tissue blocks collected from 153 women, who underwent total mastectomy and lymph node dissection, included the expression of two hypoxia-related proteins: HIF-1α and GLUT1. Results: GLUT1 labelling index (LI) showed a positive correlation with T stage (R = 0.18, p = 0.026) and HER2 status (R = 0.25, p = 0.002), and a negative correlation with the expression of ER (R = −0.19, p = 0.017) and PR (R = −0.17, p = 0.032). HIF-1α LI showed a positive correlation with ER expression (R = 0.16, p = 0.045). In the multivariate regression analysis, a different relationship between classic prognostic factors and the two tested hypoxia proteins was proven. Higher GLUT1 expression correlated with ER and PR negativity (p = 0.02 and p = 0.01, respectively) as well as with higher expression of HER2 (p = 0.04). HIF-1α showed no association with PR and HER2, but a positive correlation with ER (p = 0.02). Neither of the hypoxia proteins was associated with a tumor grade. Only one clinical feature, T stage, correlated with both of the hypoxia markers: positively with GLUT1 (p = 0.049) and negatively with HIF-1α (p = 0.01) expression. Conclusions: In breast cancer, GLUT1 expression may be considered an additional prognostic factor which correlates with an adverse status of HER2 and hormonal receptors, and indicates a more hypoxic, radio- and chemotherapy refractory profile of carcinoma

Diagnosis and treatment of breast cancer in pregnancy

Pregnancy-associated breast cancer accounts for 10–20% of all breast cancers in women under the age of 30 years. The diagnosis and treatment of this type of cancer require an assessment of the risk of different management methods for the embryo or fetus. Computed tomography and positron emission tomography are absolutely contraindicated in pregnancy. Surgical management, i.e. radical mastectomy, which may be performed at any stage of pregnancy, or breast conserving treatment, which is recommended only in the third trimester, is standard treatment. Doxorubicin/anthracycline-based chemotherapy is considered relatively safe in the second and the third trimester. Hormonal treatment, trastuzumab and bisphosphonates are contraindicated. Special restrictions have been introduced for radiation therapy. The consequences of intrauterine exposure to radiation depend on the stage of pregnancy, radiation dose and dose rate. Preimplantation radiation can cause death of the embryo or radiation-induced carcinogenesis. There is a risk of delayed fetal growth and organ malformations in the period of organogenesis. Exposure to radiation between 8 and 25 weeks gestation is associated with the risk of intellectual disability, microcephaly and carcinogenesis. Exposure after 25 weeks gestation is associated only with the risk of carcinogenesis. It was estimated that targeting the chest with therapeutic radiation doses during pregnancy causes unacceptable fetal exposure to radiation. Electron beam intraoperative irradiation of the breast tumor bed is the only acceptable radiation method in the first and the second trimester. The decision on initiation and continuation of cancer therapy in a pregnant patient should be based on a detailed analysis of potential benefits and risks as well as patient's will

Tumour surface area as a prognostic factor in primary and recurrent glioblastoma irradiated with Ir implantation

BackgroundTo evaluate the impact of tumour surface area (TSA) on survival of patients treated with 192Ir implantation for glioblastoma multiforme (GBM).Methods/MaterialsThe analysis of survival and prognostic factors was performed based on a retrospective study group of 120 patients (74 males and 46 females; mean age 53 years; mean KPS score 74.6) irradiated with 192Ir for GBM between 1999 and 2003. There were 72 (60%) patients with recurrent and 48 (40%) with primary inoperable tumour. Patients with recurrences were initially treated with surgery and external beam radiotherapy (EBRT; mean total dose (MTD) 53.5Gy). Individuals with primary inoperable glioblastoma underwent EBRT (MTD 37.2Gy) after brachytherapy completion. All patients were irradiated with 192Ir with a total dose of 15Gy given in 5 fractions.ResultsFor the total group of patients 1-year and 2-year survival were 22% and 11%, respectively, with a median survival time (MST) of 6.1 months. The multivariate Cox analysis of the best fit (Chi2=22.98, p=0.000041) distinguished such variables as: patient age (p=0.002), performance status (p=0.04) and tumour surface area (p=0.04) to significantly affect survival. Patients with TS

Measurement of tumour volume by MRI to evaluate risk of pelvic nodal metastases in early cervical carcinoma patients

BackgroundApart from the FIGO staging system there are several other factors, including tumour volume and lymph node status, which considerably influence local tumour control and survival of cervical carcinoma patients.AimThe study aimed to determine the prognostic value of cervical tumour volume measured on the basis of MRI in terms of pelvic nodal metastases prediction in early cervical carcinoma patients.MethodsThe records of 49 early stage cervical carcinoma patients treated with preoperative brachytherapy and radical hysterectomy were analyzed. All patients underwent diagnostic MRI, which was the basis for tumour volume calculations as well as the evaluation of pelvic lymph nodes status and parametrial invasion. In each case the postoperative pathological diagnosis was obtained. The correlation between the occurrence of nodal metastases and such variables as tumour histology, grade and tumour volume, FIGOMRI stage IIB, and patients' age was evaluated. Logistic regression analysis was employed to determine correlations between tumour volume and histological pelvic nodal involvement.ResultsA statistically significant correlation between pelvic lymph node involvement and such parameters as tumour volume and parametrial invasion was proven. The probability of lymph node metastasis is 20% for tumour volume of 17 cm3 and increases up to 50% for tumour volume of 40 cm3. An increase of tumour volume by 1 cm3 increased the risk of lymph node disease by 6.2%.ConclusionsThe study demonstrates that tumour volume may be considered a predicting factor in early cervical carcinoma patients, since it strongly correlates with pelvic lymph node histological status

Transplantacje allogenicznych komórek hematopoetycznych w ostrej białaczce limfoblastycznej u dzieci i młodzieży

Background. ALL is the most common indication for allogeneic hematopoietic stem cell transplantation (allo- HSCT) in children.Objective. The analysis of results of therapy in children and adolescents treated for ALL with allo-HSCT.Patients and methods. A total number of 41 patients undergoing allo-HSCT due to ALL between 2003 and 2012. In 17 patients HSCT was performed from related donor and in 24 from unrelated donor. A source of hematopoietic stem cells was peripheral blood in 21 patients, bone marrow in 18 patients and cord blood in 2 patients.Results. At present, 27 (65.8%) patients stay alive. Among 14 deaths, 8 were regarded as transplant-related mortality, and 6 as a relapse of disease. Transplant-related mortality was 8/41 (19.5%), including 7 (17%) in early posttransplant period (before day +100). Probability of survival for all patients was: pDFS=0.652±0.091 (mean disease-freesurvival was 3.8 years, 95%CI=2.7-4.8), pOS=0.630±0.080 (mean survival 3.9 years, 95%CI=3.0-4.8). The only factor predicting overall survival was time of pre-transplant relapse: for very early relapses pOS=0.333±0.157, for early relapses pOS=0.666±0.272 and for late relapses pOS=0.833±0.152 (p=0.010).Conclusions. Allo-HSCT from well-matched unrelated donors or genoidentical sibling donors is an effective treatment with acceptable toxicity in pediatric ALL. Precise HLA typing and matching resulted in a low incidence of acute and extensive chronic GVHD which is an important achievement for the quality of life in children and adolescents. The results from this study demonstrate the feasibility of a harmonized HSCT approach in pediatric ALL.Wstęp. Ostra białaczka limfoblastyczna (ALL) jest najczęstszym wskazaniem do przeszczepiania allogenicznych hematopoetycznych komórek macierzystych (allo-HSCT) u dzieci.Celem pracy była analiza wyników leczenia ALL u dzieci poddawanych allo-HSCT w ośrodku bydgoskim.Pacjenci i metodyka. Badaniami objęto 41 pacjentów leczonych w latach 2003-2012. W 17 przypadkach wykonano transplantację od dawcy rodzinnego, a w 24 od dawcy niespokrewnionego. Źródłem komórek hematopoetycznych była krew obwodowa u 21 pacjentów, szpik kostny u 18 pacjentów oraz krew pępowinowa u 2 pacjentów.Wyniki. W momencie zakończenia analizy żyło 27 (65,8%) pacjentów. Spośród 14 zgonów, 8 było zależnych od procedur transplantacyjnych, a 6 od wznowy choroby podstawowej. Śmiertelność zależna od powikłań transplantacyjnych wyniosła 8/41 (19,5%), w tym 7 (17%) we wczesnym okresie poprzeszczepowym (do dnia +100). Prawdopodobieństwo przeżycia dla całej badanej grupy wyniosło: pDFS=0,652±0,091 (średnie przeżycie bez wznowy 3,8 lat, 95%CI=2,7-4,8 lat), pOS=0,630±0,080 (średnie przeżycie 3,9 lat, 95%CI=3,0-4,8 lat). Jedynym czynnikiem prognostycznym terapii był czas wystąpienia wznowy kwalifikującej do transplantacji: dla wznów bardzo wczesnych pOS=0,333±0,157, dla wznów wczesnych pOS=0,666±0,272 i dla późnych pOS=0,833±0,152 (p=0,010).Wnioski. Allo-HSCT od zgodnych dawców rodzinnych lub niespokrewnionych jest efektywną terapią o akceptowalnej toksyczności w ALL. Precyzyjny dobór dawcy skutkuje niskim odsetkiem ostrej i przewlekłej GVHD, co może wpływać na jakość życia. Wyniki przeprowadzonej analizy pokazują kierunki terapii z zastosowaniem HSCT w ALL u dzieci i młodzieży

Allogeneic hematopoietic stem cell transplantations in acute lymphoblastic leukemia in children and adolescents

Background. ALL is the most common indication for allogeneic hematopoietic stem cell transplantation (allo- HSCT) in children. Objective. The analysis of results of therapy in children and adolescents treated for ALL with allo-HSCT. Patients and methods. A total number of 41 patients undergoing allo-HSCT due to ALL between 2003 and 2012. In 17 patients HSCT was performed from related donor and in 24 from unrelated donor. A source of hematopoietic stem cells was peripheral blood in 21 patients, bone marrow in 18 patients and cord blood in 2 patients. Results. At present, 27 (65.8%) patients stay alive. Among 14 deaths, 8 were regarded as transplant-related mortality, and 6 as a relapse of disease. Transplant-related mortality was 8/41 (19.5%), including 7 (17%) in early posttransplant period (before day +100). Probability of survival for all patients was: pDFS=0.652±0.091 (mean disease-freesurvival was 3.8 years, 95%CI=2.7-4.8), pOS=0.630±0.080 (mean survival 3.9 years, 95%CI=3.0-4.8). The only factor predicting overall survival was time of pre-transplant relapse: for very early relapses pOS=0.333±0.157, for early relapses pOS=0.666±0.272 and for late relapses pOS=0.833±0.152 (p=0.010). Conclusions. Allo-HSCT from well-matched unrelated donors or genoidentical sibling donors is an effective treatment with acceptable toxicity in pediatric ALL. Precise HLA typing and matching resulted in a low incidence of acute and extensive chronic GVHD which is an important achievement for the quality of life in children and adolescents. The results from this study demonstrate the feasibility of a harmonized HSCT approach in pediatric ALL.Wstęp. Ostra białaczka limfoblastyczna (ALL) jest najczęstszym wskazaniem do przeszczepiania allogenicznych hematopoetycznych komórek macierzystych (allo-HSCT) u dzieci. Celem pracy była analiza wyników leczenia ALL u dzieci poddawanych allo-HSCT w ośrodku bydgoskim. Pacjenci i metodyka. Badaniami objęto 41 pacjentów leczonych w latach 2003-2012. W 17 przypadkach wykonano transplantację od dawcy rodzinnego, a w 24 od dawcy niespokrewnionego. Źródłem komórek hematopoetycznych była krew obwodowa u 21 pacjentów, szpik kostny u 18 pacjentów oraz krew pępowinowa u 2 pacjentów. Wyniki. W momencie zakończenia analizy żyło 27 (65,8%) pacjentów. Spośród 14 zgonów, 8 było zależnych od procedur transplantacyjnych, a 6 od wznowy choroby podstawowej. Śmiertelność zależna od powikłań transplantacyjnych wyniosła 8/41 (19,5%), w tym 7 (17%) we wczesnym okresie poprzeszczepowym (do dnia +100). Prawdopodobieństwo przeżycia dla całej badanej grupy wyniosło: pDFS=0,652±0,091 (średnie przeżycie bez wznowy 3,8 lat, 95%CI=2,7-4,8 lat), pOS=0,630±0,080 (średnie przeżycie 3,9 lat, 95%CI=3,0-4,8 lat). Jedynym czynnikiem prognostycznym terapii był czas wystąpienia wznowy kwalifikującej do transplantacji: dla wznów bardzo wczesnych pOS=0,333±0,157, dla wznów wczesnych pOS=0,666±0,272 i dla późnych pOS=0,833±0,152 (p=0,010). Wnioski. Allo-HSCT od zgodnych dawców rodzinnych lub niespokrewnionych jest efektywną terapią o akceptowalnej toksyczności w ALL. Precyzyjny dobór dawcy skutkuje niskim odsetkiem ostrej i przewlekłej GVHD, co może wpływać na jakość życia. Wyniki przeprowadzonej analizy pokazują kierunki terapii z zastosowaniem HSCT w ALL u dzieci i młodzieży

Fertility impairment in radiotherapy

Infertility as a result of antineoplastic therapy is becoming a very important issue due to the growing incidence of neoplastic diseases. Routinely applied antineoplastic treatments and the illness itself lead to fertility disorders. Therapeutic methods used in antineoplastic treatment may cause fertility impairment or sterilization due to permanent damage to reproductive cells. The risk of sterilization depends on the patient’s sex, age during therapy, type of neoplasm, radiation dose and treatment area. It is known that chemotherapy and radiotherapy can lead to fertility impairment and the combination of these two gives an additive effect. The aim of this article is to raise the issue of infertility in these patients. It is of growing importance due to the increase in the number of children and young adults who underwent radiotherapy in the past. The progress in antineoplastic therapy improves treatment results, but at the same time requires a deeper look at existential needs of the patient. Reproductive function is an integral element of self-esteem and should be taken into account during therapy planning