The future of Radiation Oncology: Considerations of Young Medical Doctor

Radiation therapy plays an increasingly important role in the management of cancer. Currently, more than 50% of all cancer patients can expect to receive radiotherapy during the course of their disease, either in a primary management (radical or adjuvant radiotherapy) or for symptom control (palliative radiotherapy).Radiation oncology is a very unique branch of medicine connected with clinical knowledge and also with medical physics. In recent years, this approach has become increasingly absorbed with technological advances. This increasing emphasis on technology, together with other important changes in the health-care economic environment, now place the specialty of radiation oncology in a precarious position. New treatment technologies are evolving at a rate unprecedented in radiation therapy, paralleled by improvements in computer hardware and software. These techniques allow assessment of changes in the tumour volume and its location during the course of therapy (interfraction motion) so that re-planning can adjust for such changes in an adaptive radiotherapy process.If radiation oncologists become simply the guardians of a single therapeutic modality they may find that time marches by and, while the techniques will live on, the specialty may not. This article discusses these threats to the field and examines strategies by which we may evolve, diversify, and thrive

Hematological toxicity of mTOR inhibitors is mild and dose-dependent in patients with tuberous sclerosis and subependymal giant cell astrocytoma

Introduction: Everolimus is the primary therapeutic option for patients with tuberous sclerosis complex (TSC) and subependymal giant astrocytoma (SEGA). This study aimed to assess the effect of everolimus, a mammalian-target-of-rapamycin (mTOR) inhibitor, on complete blood count (CBC) parameters in patients with TSC and SEGA. Material and methods: The study included 18 pediatric patients with TSC-associated SEGA tumors as indications for everolimus treatment. During the standard dose therapy and maintenance phase (<50% of standard dose), CBC results and everolimus whole blood concentrations were collected at five study time points. Results: Everolimus contributed to decreasing almost all blood cell values. The most severe toxicity occurred six months after therapy commenced. Dose reduction resulted in slightly normalizing parameters, but they did not return to the initial ones in all cases. During the study, only a few instances of cytopenia were reported. The most common abnormality was granulocytopenia, observed in one in three patients. Almost all cytopenias occurred during the standard treatment phase, and none were classified as severe. Hematological toxicity was not the reason for therapy interruption or withdrawal. Conclusions:A decrease in almost all hematological parameters is widespread during everolimus therapy. Hematological toxicities are rare and mild. The unique abnormality for mTOR inhibitors is microcytosis. Reduction of mTOR inhibitor dose results in a lower frequency of hematological side effects

Zastosowanie hodowli i multiplex PCR w diagnostyce drobnoustrojów wywołujących zapalenie pochwy u kobiet z rakiem szyjki macicy

Background: Bacterial vaginosis (BV) and vaginitis in cervical cancer patients might becaused by mixed aerobic, anaerobic, and atypical bacteria. Since genital tract infections can be complicated, early and accurate identification of causal pathogens is vital. Objectives:The purpose of this study was i) to determinate if currently used aerobic culture methods are sufficiently sensitive to identify pathogens that can appear in the cervix of women after cancer treatment; ii) to investigate if molecular methods can improve the diagnostic process of BV and vaginitis, as well as broaden the range of detectable pathogens that would otherwise be difficult to cultivate. Methods: A one-year hospital-based study was conducted in 2011/2012. Cervical swabs from 130 patients were examined by microbiological culture and multiplex PCR. Results: Swab samples were positive for 107 and 93 women by microbiological culture and multiplex PCR, respectively. The most common bacteria isolated from culture were: Escherichia coli, Enterococcus faecalis, Streptococcus agalactiae, and Staphylococcus aureus, and using the molecular technique were: Gardnerella vaginalis, Bacteroides fragilis, Ureoplasma ureoliticum/parvum, Mobiluncus curtisii and Atopobium vaginae. Conclusions: Multiplex PCR might contribute to the diagnosis of genital tract infections and it broadens the number of detectable microorganisms responsible for BV. Combination of these two methods may become the basis for standardized diagnosis of BV and vaginitis.Bakteryjne zapalenie pochwy u pacjentów chorych na raka szyjki macicy może być spowodowane przez bakterie beztlenowe, tlenowe i atypowe. Ponieważ infekcje narządów płciowych mogą doprowadzić do poważnych komplikacji, wczesna i odpowiednia identyfikacja źródła infekcji jest bardzo ważna. Cel pracy: 1) określenie, czy obecnie używane metody hodowli tlenowej w pracowni mikrobiologicznej są wystarczające do identyfikacji patogenów, które mogą pojawić się w szyjce macicy po leczeniu nowotworowym; 2) zbadanie, czy molekularne metody mogą polepszyć diagnostykę bakteryjnych zapaleń pochwy i zwiększyć zakres wykrywanych patogenów o te, które są trudne w hodowli. Metodyka: Materiałem do badań były wymazy z szyjki macicy, pobrane od 130 kobiet z nowotworem szyjki macicy hospitalizowanych w Wielkopolskim Centrum Onkologii w latach 2011-2012. Identyfikacji mikroorganizmów dokonano tradycyjną metodą hodowlaną i metodą molekularną- multiplex PCR. Wyniki: Hodowla mikrobiologiczna zdiagnozowała 107 pozytywnych przypadków, zaś multiplex PCR- 93. Najczęściej izolowanymi patogenami metodą mikrobiologiczną były: Escherichia coli, Enterococcus faecalis, Streptococcus agalactiae i Staphylococcus aureus, a techniką molekularną: Gardnerella vaginalis, Bacteroides fragilis, Ureoplasma ureoliticum/parvum, Mobiluncus curtisii i Atopobium vaginae. Wnioski: Multiplex PCR mógłby pomóc w diagnostyce infekcji narządów płciowych i powiększyć zakres wykrywanych mikroorganizmów. Połączenie tych dwóch technik może stanowić podstawę standaryzacji diagnostyki zapalenia dróg rodnych kobiet

Przydatność badań scyntygraficznych w diagnostyce autoprzeszczepów śledzionowych do płuc - opis przypadku

Thoracic splenosis of the left lung and upper abdominal area was described. Left minithoracotomy was performed due to unclear results from a fine needle biopsy and following the suggestion to obtain a tissue sample. Clinical findings were similar to neoplasmatic disease; intraoperative extension of the disease was larger than CT view and correlated with postoperative assessment with 99mTc sulphur colloid. This confirmed the usefulness of scintigraphic assessment in preoperative diagnosis in order to avoid thoracotomy in such cases.W pracy przedstawiono rzadki przypadek pourazowych autoprzeszczepów tkanki śledzionowej przebiegających pod postacią obwodowego cienia płuca lewego, którego obraz sugerował charakter nowotworowy. Wynik biopsji cienkoigłowej był niejednoznaczny i wymagał potwierdzenia otwartą biopsją płuca. Obraz śródoperacyjny wykazał większe rozprzestrzenienie zmian niż w tomografii komputerowej i korelował z wynikiem wykonanej w okresie późniejszym scyntygrafii z użyciem koloidu siarczkowego znakowanego 99mTc, potwierdzając jej przydatność, zwłaszcza w diagnostyce przedoperacyjnej

Erotetic Reasoning Corpus. A data set for research on natural question processing

The aim of this paper is to present the Erotetic Reasoning Corpus (ERC) which constitutes a data set for research on natural question processing. We describe the theoretical background, linguistic data and tags used for the annotation process. We also discuss potential areas of ERC exploitation

What challenges does the humanitarian crisis and large number of refugees from Ukraine pose for Polish oncology?

The war in Ukraine has led to a massive influx of refugees into Poland, posing a major challenge for the health care system. The large number of refugees will undoubtedly lead to a substantial increase in the number of patients requiring treatment for a wide range of conditions, including cancer. In the present article, we describe and discuss the many difficulties faced by cancer treatment centres in Poland due to these circumstances. Key issues include the lack of proper diagnostic testing in this population and differences in oncological practices between Poland and Ukraine. Other problems include difficulties in obtaining patients’ medical records and communication issues caused by the language barrier. In addition, in the context of the ongoing COVID-19 pandemic, the low vaccination rate among Ukrainian refugees is also a significant risk factor. Addressing these challenges will require a comprehensive approach involving the national health care agency and individual cancer centres. This is especially important in oncology due to the interdisciplinary nature of the field, which requires the contribution of specialists from many different fields as well as appropriate funding

The application of manual techniques in masticatory muscles relaxation as adjunctive therapy in the treatment of temporomandibular joint disorders

Temporomandibular disorders (TMD) are primarily characterized by pain as well as disorders concerning the proper functioning of individual elements of the stomatognathic system (SS). The aim of the study was to compare the degree of relaxation of the anterior part of the temporal muscles and the masseter muscles, achieved through the use of post-isometric relaxation and myofascial release methods in patients requiring prosthetic treatment due to temporomandibular joint disorders with a dominant muscular component. Sixty patients who met the inclusion criteria were alternately assigned to one of the two study groups, either group I—patients received post-isometric relaxation treatment (PIR), or group II—patients received myofascial release treatment (MR). The series of ten treatments were performed in both groups. The comparative assessment was based on physiotherapeutic examination, a surface electromyography (sEMG) of the anterior temporal and masseter muscles and the intensity of spontaneous masticatory muscle pain, assessed using the Visual Analogue Scale (VAS). We observed a significant decrease in the electrical activity of examined muscles and a significant drop in the intensity of spontaneous pain in the masticatory muscles both in group I and II. There were no significant differences between groups. Both therapeutic methods may be used as successful forms of adjunctive therapy in the prosthetic treatment of TMD. The trial was registered with an international clinical trials register

Strategy and early results of treatment of advanced cervical cancer patients with synchronous cancers observed in PET-CT imaging

Objectives: The aim of this study was to present strategy and early results of treatment of advanced cervical cancer patients with synchronous cancers observed in PET-CT imaging, treated at the Greater Poland Cancer Center. Material and methods: The study included a group of 200 patients with diagnosed stage IIB-IIIB cervical cancer who received PET-CT for the purpose of radiotherapy treatment planning. Results: Among our study group, four patients (2%) were found to have a synchronous cancer. Two of the cases were diagnosed as breast cancer. However, cancers diagnosed in the other two patients were head and neck malignancies — hypopharyngeal and laryngeal cancer. The choice of an optimal therapeutic approach requires taking into account characteristics of particular malignancies, their stage and histopathology. The whole therapy included radiotherapy of cervical cancer with various combinations of systemic treatment, radiotherapy or surgery of synchronous cancer. According to treatment results, patients diagnosed with breast cancer and hypopharyngeal cancer achieved complete remission of both primary and secondary tumour. Patient diagnosed with laryngeal malignancy, despite achieving complete remission of cervical cancer, finished radiotherapy of the synchronous cancer at a palliative dose. Conclusions: The growing availability of PET-CT and other imaging methods in cancer diagnosis will increase the number of diagnosed synchronous cancers. Second primary cancers are often detected at an early stage, where radical treatment can be performed for both primary and secondary tumour. However, treatment of such complicated clinical cases as synchronous cancers should be carried out by multidisciplinary teams

Daily and school physical activity of 16 year-old girls and boys

The aim of the work was to determine the relationship between school and all-day physical activity of 16-year-old girls and boys based on weekly monitoring using pedometers. The research also took into account the level of all-day physical activity of less and more active pupils before school classes. 169 people were examined, including 93 girls and 76 boys from secondary schools of the Silesian region. The subjects wore a pedometer for 5 school days, recording the number of steps performed in individual segments of the day (time before classes at school, during classes at school and time after completing classes at school) in specially prepared tables. The research results indicated that girls are more active in terms of the number of steps taken on school days from boys. Girls and boys meet the recommendation of the school number of steps in the dimension of 3 000. However, the difference in physical activity was observed, considering the division of respondents into less and more active in time before school classes. Students who are less active in terms of the number of steps taken before the start of classes at school do not meet the recommended school recommendation of physical activity. It is necessary to look for reserves of physical activity throughout the day. In addition to physical education lessons, the school should promote activity during breaks, mid-term exercises or encourage active locomotion before and after school classes. Encouraging an increased number of walks, active transport to/from school, cycling, roller skating among children and adolescents is an important element in the preparation for lifelong activity and a healthy lifestyle.Celem pracy było określenie zależności pomiędzy szkolną a całodniową aktywnością fizyczną 16-letnich dziewcząt i chłopców na podstawie tygodniowego monitoringu z wykorzystaniem krokomierzy. W badaniu uwzględniono również poziom całodziennej i szkolnej aktywności fizycznej uczniów mniej i bardziej aktywnych w czasie przed zajęciami w szkole.Przebadano 169 osób, w tym 93 dziewczęta i 76 chłopców ze szkół ponadgimnazjalnych regionu śląskiego. Badani nosili krokomierz przez 5 dni szkolnych zapisując liczbę wykonanych kroków w poszczególnych segmentach dnia (czas przed zajęciami w szkole, zajęcia w szkole i czas po zakończeniu zajęć w szkole) w specjalnie przygotowanych tabelach. Wyniki badań wskazały, że dziewczęta są bardziej aktywne pod względem liczby wykonywanych kroków w dni szkolne od chłopców. Dziewczęta i chłopcy spełniają rekomendację szkolnej liczby kroków w wymiarze 3 000. Zaobserwowano natomiast różnicę w aktywności fizycznej uwzględniając podział badanych na mniej i bardziej aktywnych w czasie przed zajęciami szkolnymi. Uczniowie mniej aktywni pod względem liczby kroków wykonanych przed rozpoczęciem zajęć w szkole nie spełniają zalecanej szkolnej rekomendacji aktywności fizycznej. Poszukiwanie rezerw aktywności fizycznej w całym dniu jest konieczne. Oprócz lekcji wychowania fizycznego szkoła powinna popularyzować aktywność podczas przerw międzylekcyjnych, ćwiczeń śródlekcyjnych, czy też zachęcać do aktywnej lokomocji przed i po zajęciach w szkole. Zachęcanie do zwiększonej liczby spacerów, aktywnego transportu do/ze szkoły, jazdy na rowerze, łyżworolkach wśród dzieci i młodzież jest ważnym elementem w przygotowaniu do całożyciowej aktywności i zdrowego stylu życia