Przyzwojak kłębka szyjnego. Opis przypadku dwóch chorych poddanych radioterapii z modulacją intensywności dawki (IMRT)

Paraganglioma of the head and neck is a very rare tumor originating from paraganglionic cells of the chemoreceptor system. The disease has a rich symptomatology. The article presents two patients treated with intensity modulated radiation therapy (IMRT). In one patient paraganglioma was localized bilaterally, which is a particularly rare occurrence. We also presented current literature on paraganglioma treatment, addressing the effectiveness of radiotherapy compared to surgery. Onkol. Prak. Klin. 2011; 7, 5: 274–277Przyzwojak (paraganglioma) to bardzo rzadki nowotwór wywodzący się z komórek przyzwojowych układu chemoreceptorowego. Choroba posiada bogatą symptomatologię. W artykule przedstawiono dwa przypadki chorych na przyzwojaka szyi poddanych radioterapii techniką modulacji intensywności dawki (IMRT). U jednego z chorych guz był zlokalizowany obustronnie, co jest szczególnie rzadkim zjawiskiem. Omawiane przypadki przedstawiono na tle doniesień dotyczących skuteczności radioterapii przyzwojaka w porównaniu z leczeniem chirurgicznym. Onkol. Prak. Klin. 2011; 7, 5: 274–27

Survival analysis of patients with locally advanced non-small cell lung cancer treated at the Nu-Med Radiotherapy Center in Elbląg

Introduction.  The study aimed to report the efficiency of radical radiotherapy and chemoradiotherapy in patients with non-small cell lung cancer (NSCLC) treated in the Nu-Med Radiotherapy Center in Elbląg. Material and methods.  Ninety-two patients diagnosed with NSCLC treated between 2013 and 2016 were included in the analysis. Overall survival (OS) was estimated by the Kaplan-Meier method. Results.  The 2-year OS for all patients was 36% (median 1.5 years). Two prognostic factors had a significant impact: tre­atment method and performance status (PS). Patients who underwent concurrent radiochemotherapy and were treated sequentially had a better 2-year OS in comparison with those treated with radiotherapy alone (respectively 46% and 37% vs. 25%, p ≤ 0.05). Patients with PS 0–1 had better OS (median 1.6 years) compared with PS 2 (median 0.7 years, p = 0.04). Other prognostic factors analysed had no impact on OS in our study. Conclusions.  The treatment results of our patients are comparable to those in published trials and meta-analyses

The last months of lung cancer patients’ lives, in the memory of their relatives. A qualitative study based on in-depth interviews with family members

Background. The aim of the study was to assess how family members remember the final months of their loved ones 2–8 years after their death. We focused particularly on their recognition of the patients’ physical, psychosocial and spiritual needs. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with two researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire. Results. Almost all the relatives interviewed in our study were able to recognize the beginning of the terminal phase. They connected the beginning of dying with the deterioration of the physical and/or psychological status of patients, such as the exacerbation of weakness and/or other symptoms or with clearly distinguished incidents such as cancer recurrence or hip fracture. The majority were able to define the length of this phase as being several months (median = 3, range 1–11 months). The most common physical symptoms mentioned by the relatives interviewed were, in sequential order: pain (n = 13) and fatigue (n = 13), anorexia (n = 9), dyspnoea (n = 7) and cachexia (n = 7). Of the 20 decedents, 18 regularly received painkillers at least at some period during their final months. Apart from medicines prescribed by the doctors, 9 patients were treated with “anticancer” herbs, or homeopathy, or by bioenergotherapy. From the relatives’ perspectives, the main approach was focused on the physical aspects of care while there was a lack of psychological and social support, the latter often causing severe financial burden. Most relatives believed that chaplains are the main source of spiritual comfort and there was easy access to such a service both in their parish and in the hospice or hospitals. Conclusion. Our study showed that the families remembered feelings of loneliness and helplessness when confronted with the psychological suffering of their loved ones and the financial burdens caused by the caregivers. Professionals involved in palliative care should acknowledge that holistic care requires sensitivity, not only to the physical but also to the psychosocial and spiritual aspects of end-of-life care.Background. The aim of the study was to assess how family members remember the final months of their loved ones 2–8 years after their death. We focused particularly on their recognition of the patients’ physical, psychosocial and spiritual needs. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with two researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire. Results. Almost all the relatives interviewed in our study were able to recognize the beginning of the terminal phase. They connected the beginning of dying with the deterioration of the physical and/or psychological status of patients, such as the exacerbation of weakness and/or other symptoms or with clearly distinguished incidents such as cancer recurrence or hip fracture. The majority were able to define the length of this phase as being several months (median = 3, range 1–11 months). The most common physical symptoms mentioned by the relatives interviewed were, in sequential order: pain (n = 13) and fatigue (n = 13), anorexia (n = 9), dyspnoea (n = 7) and cachexia (n = 7). Of the 20 decedents, 18 regularly received painkillers at least at some period during their final months. Apart from medicines prescribed by the doctors, 9 patients were treated with “anticancer” herbs, or homeopathy, or by bioenergotherapy. From the relatives’ perspectives, the main approach was focused on the physical aspects of care while there was a lack of psychological and social support, the latter often causing severe financial burden. Most relatives believed that chaplains are the main source of spiritual comfort and there was easy access to such a service both in their parish and in the hospice or hospitals. Conclusion. Our study showed that the families remembered feelings of loneliness and helplessness when confronted with the psychological suffering of their loved ones and the financial burdens caused by the caregivers. Professionals involved in palliative care should acknowledge that holistic care requires sensitivity, not only to the physical but also to the psychosocial and spiritual aspects of end-of-life care

How do relatives remember the dying of lung cancer patients after 2-8 years? A qualitative study based on in-depth interviews with family members

Background. The aim of our study was to assess how relatives remember the dying of lung cancer patients several years after their death. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with 2 researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire and to score the Quality of Dying Apgar. Results. Family members of 15 of the patients stated recognizing the dying of their loved one. They concluded this on the basis of exacerbation of symptoms, "typical" appearance, change in behaviour or particular words the patient said to them. The median score of the quality of dying was 6.5/10 (range 3-9). Lower scoring was observed for patients who died in hospital, without the family present at the moment of death and with uncontrolled symptoms. Only 5 of the relatives assessed pain and other symptom control as satisfactory. Other family members remembered pain (n = 9), dyspnoea (n = 8), delirium (n = 4) and other symptoms as disturbing the dying in a severe or moderate way. Three relatives assessed that their loved one's dying was not "dignified", mostly due to the severe physical suffering, the nursing being crucially remiss at the hospital and the patient's being alone at the moment of death. All family members were able to describe the healthcare professionals' attitudes and even repeat the statements they heard from them. Conclusion. We have demonstrated that several years after death many of the words and the behaviour of the dying patients were still alive in their relatives' memories. The family members remember how the healthcare professionals behaved and what they said to them. While caring for dying people, we should bear in mind that the way in which we behave may either give strength to the family or destroy their peace of mind for many years.Background. The aim of our study was to assess how relatives remember the dying of lung cancer patients several years after their death. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with 2 researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire and to score the Quality of Dying Apgar. Results. Family members of 15 of the patients stated recognizing the dying of their loved one. They concluded this on the basis of exacerbation of symptoms, "typical" appearance, change in behaviour or particular words the patient said to them. The median score of the quality of dying was 6.5/10 (range 3-9). Lower scoring was observed for patients who died in hospital, without the family present at the moment of death and with uncontrolled symptoms. Only 5 of the relatives assessed pain and other symptom control as satisfactory. Other family members remembered pain (n = 9), dyspnoea (n = 8), delirium (n = 4) and other symptoms as disturbing the dying in a severe or moderate way. Three relatives assessed that their loved one's dying was not "dignified", mostly due to the severe physical suffering, the nursing being crucially remiss at the hospital and the patient's being alone at the moment of death. All family members were able to describe the healthcare professionals' attitudes and even repeat the statements they heard from them. Conclusion. We have demonstrated that several years after death many of the words and the behaviour of the dying patients were still alive in their relatives' memories. The family members remember how the healthcare professionals behaved and what they said to them. While caring for dying people, we should bear in mind that the way in which we behave may either give strength to the family or destroy their peace of mind for many years

Palliative irradiation of bone metastases: patterns of care with focus on single fraction treatment

ObjectivesTo evaluate the pattern of care in a large consecutive series of patients irradiated for bone metastates in one institution.Materials and methodThis series included 1754 bone metastases in 1165 patients treated between 1995 and 2002. The proportion of lesions assigned to one fraction or to fractionated radiotherapy was assessed in relation to periods of treatment and to clinical variables.ResultsSingle fraction irradiation (8 Gy or 10 Gy) was applied in 327 locations (19%). The proportion of patients treated with one fraction was 28% in 2001–2002 as compared to 15–20% in previous periods (

Jak najbliżsi pamiętają umieranie chorych na raka płuca po 2-8 latach? Badanie jakościowe oparte na wywiadach z członkami rodzin

Wstęp. Celem badania była ocena, jak bliscy pamiętają umieranie chorych na raka płuca kilka lat po ich śmierci. Materiał i metody. Zaproszenie do udziału w badaniu przekazano telefonicznie rodzinom 45 chorych, którzy zmarli do 7 lat po radykalnej resekcji niedrobnokomórkowego raka płuca. Tylko 20 z zaproszonych osób zgodziło się rozmawiać o umieraniu i śmierci ich najbliższych. Dla pozostałych ten temat był ciągle zbyt bolesny. Podczas spotkania z dwoma badaczami uczestników poproszono, aby w swobodny sposób odnieśli się do problemów poruszonych w kwestionariuszu Oceny Umierania Chorych na Raka Płuca oraz spróbowali okreslić jakość umierania według skali The Quality of Dying Apgar (QODA). Wyniki. Krewni 15 pacjentów uważali, że byli w stanie rozpoznać okres umierania ich bliskich na podstawie nasilenia objawów, „typowego” wyglądu, zmiany zachowania lub szczególnych słów, jakie od nich usłyszeli. Mediana punktacji w skali oceniającej jakość umierania według QODA wynosiła 6,5/10 (przedział 3-9). Niższe oceny zanotowano w przypadku pacjentów umierających w szpitalu, których rodziny były nieobecne w czasie zgonu, a także jeśli objawy leczono w niedostateczny sposób. Jedynie rodziny 5 pacjentów uważały łagodzenie bólu i innych objawów w ostatnich dniach życia za zadowalające. Pozostali pamiętali, że ból (n = 9), duszność (n = 8), splątanie (n = 4) lub inne objawy zaburzały umieranie w znacznym lub bardzo nasilonym stopniu. Krewni 3 chorych stwierdzili, że umieranie ich bliskich nie było „pełne godności” przede wszystkim z powodu bardzo nasilonych objawów fizycznych, drastycznych zaniedbań pielęgnacyjnych w szpitalu i poczucia opuszczenia w momencie zgonu. Wszyscy uczestnicy badania byli w stanie opisać postawę lekarzy i pielęgniarek, a nawet powtórzyć wypowiedzi, które od nich usłyszeli. Wnioski. W badaniu pokazano, że nawet po kilku latach wiele słów, gestów i zachowań chorych z okresu ich umierania przechowywanych jest w pamięci ich rodzin. Członkowie rodzin pamiętają też, jak zachowywał się personel medyczny i jakich słów używał. Opiekując się umierającymi, należy uwzględnić, że sposób, w jaki się to robi, ma dla ich bliskich duże znaczenie i może ich albo wzmacniać, albo osłabiać na długie lata

Kliniczne znaczenie stopnia ekspresji cyklooksygenazy-2 (COX-2) w niedrobnokomórkowym raku płuca (NDRP)

Praca wykonana w: Katedra i Klinika Onkologii i Radioterapii

The Impact of the COVID-19 Pandemic on the Number of Cancer Patients and Radiotherapy Procedures in the Warmia and Masuria Voivodeship

(1) Background: It was suspected that the COVID-19 pandemic would negatively affect health care, including cancer treatment. The aim of the study was to assess the impact of the COVID-19 pandemic on the number of radiotherapy procedures and patients treated with radical and palliative radiotherapy in Poland. (2) Methods: The study was carried out in Warmia and Masuria voivodeship. The number of procedures and treated patients one year before and in the first year of the COVID-19 pandemic were compared. (3) Results: In the first year of the COVID-19 pandemic, the number of radiotherapy procedures and cancer patients treated with radiotherapy in Warmia and Masuria voivodeship in Poland was stable compared to the period before the pandemic. The COVID-19 pandemic has not affected the ratio of palliative to radical procedures. The percentage of ambulatory and hostel procedures significantly increased with the reduction of inpatient care in the first year of the COVID-19 pandemic. (4) Conclusion: No significant decrease in patients treated with radiotherapy during the first year of the pandemic in Warmia and Masuria voivodeship in Poland could indicate the rapid adaptation of radiotherapy centers to the pandemic situation. Future studies should be carried out to monitor the situation because the adverse effects of the pandemic may be delayed

Survival analysis of patients with locally advanced non-small cell lung cancer treated at the Nu-Med Radiotherapy Center in Elbląg

Introduction.  The study aimed to report the efficiency of radical radiotherapy and chemoradiotherapy in patients with non-small cell lung cancer (NSCLC) treated in the Nu-Med Radiotherapy Center in Elbląg. Material and methods.  Ninety-two patients diagnosed with NSCLC treated between 2013 and 2016 were included in the analysis. Overall survival (OS) was estimated by the Kaplan-Meier method. Results.  The 2-year OS for all patients was 36% (median 1.5 years). Two prognostic factors had a significant impact: tre­atment method and performance status (PS). Patients who underwent concurrent radiochemotherapy and were treated sequentially had a better 2-year OS in comparison with those treated with radiotherapy alone (respectively 46% and 37% vs. 25%, p ≤ 0.05). Patients with PS 0–1 had better OS (median 1.6 years) compared with PS 2 (median 0.7 years, p = 0.04). Other prognostic factors analysed had no impact on OS in our study. Conclusions.  The treatment results of our patients are comparable to those in published trials and meta-analyses.Introduction.  The study aimed to report the efficiency of radical radiotherapy and chemoradiotherapy in patients with non-small cell lung cancer (NSCLC) treated in the Nu-Med Radiotherapy Center in Elbląg. Material and methods.  Ninety-two patients diagnosed with NSCLC treated between 2013 and 2016 were included in the analysis. Overall survival (OS) was estimated by the Kaplan-Meier method. Results.  The 2-year OS for all patients was 36% (median 1.5 years). Two prognostic factors had a significant impact: tre­atment method and performance status (PS). Patients who underwent concurrent radiochemotherapy and were treated sequentially had a better 2-year OS in comparison with those treated with radiotherapy alone (respectively 46% and 37% vs. 25%, p ≤ 0.05). Patients with PS 0–1 had better OS (median 1.6 years) compared with PS 2 (median 0.7 years, p = 0.04). Other prognostic factors analysed had no impact on OS in our study. Conclusions.  The treatment results of our patients are comparable to those in published trials and meta-analyses