Controversy over radiotherapy in 1 stage seminomas

In the past years efforts have been made to find the least eradicating methods of complementary therapy in the treatment of 1 st stage seminomas.In the Polish centers, as in the majority of centers of the world, complementary irradiation of the lymphatic system is applied. The efficiency of this procedure (almost 100% of cured cases) causes that few centers decide to change the treatment.Objectivecomparison of the treatment of 1 st stage seminomas preceded by orchidectomya)selective irradiationb)withdrawal from irradation – observation.Group A – 75 patients treated between 1977 and 1986 were irradiated.Group B – 31 patients treated between 1987 and 1991 were under constant observation.The percentage of cases with a 5-year survival is convergent and independent of the applied method. Considering the fact that mainly young men are affected (18–35 years) treatment should be optimized during the most active part of their lives; after performing orchidectomy and detailed examinations (histopathology, CT, ultrasonography, markers) that is after excluding high risk factors – the patients should remain under observation.!

69 Wstępna ocena wyników leczenia oszczędzającego w latach 1993–1995 w Wielkopolskim Centrum Onkologii

W latach 1993–1995 w Wielkopolskim Centrum Onkologii leczonych było metodą oszczędzającą gruczoł piersiowy 66 kobiet. Wiek chorych wahał się od 28–73 lat, średni 40,8. Do leczenia były kwalifikowane chore z guzem w piersi do 3 cm i niepalpacyjnymi węzłami pachowymi. Nowotwór u 37 chorych zlokalizowany był w piersi prawej, u 29 w piersi lewej. Najczęściej był umiejscowiony w kwadracie górnym zewnętrznym. W 53 przypadkach stwierdzono raka przewodowego, 4 DCIS, 4 molekularnego, 7 zrazikowego.U 18 pacjentek stwierdzono w ocenie histologicznej przerzuty w węzłach dołu pachowego. Okres obserwacji naszych chorych jest jeszcze stosunkowo krótki. Wśród naszych pacjentek u 4 powodu wznowy miejscowej konieczne mastectomii, 3 kobiety zmarły z powodu przerzutów odległych (jedna w 1 roku obserwacji, dwie w 2 roku obserwacji)

45. Impact of Hb level during postoperative radiotherapy of patients with larynx cancer

AimAssessment the influence of low level of Hgb on the locoregional outcome of postoperative radiotherapy patients with advanced cancer of larynx.Material and methodsAn retrospective analysis of two hundred fifty four patients with larynx carcinoma with stage III or IV squamous cell carcinoma of larynx who were treated between January 1993 and December 1996 was performed. Postoperative radiotherapy was performed in coventional way to total dose of 60 Gy, 5 times a week. Of 254 patients, 86 patients (34%) were considered to have a low level of hemoglobin (below 13 g/dl) prior the beginning of radiotherapy and 56 patients (22%) at the end of treatment. We have noted also 38 patients (15%) of 254 patients, with deacresing hemoglobin level during treatment higher than 1 g/dl.ResultsNo impact on outcome of treatment was observed in the group of patients with low level of Hgb before irradiation. Inrease of locoregional failure of postoperative radiotherapy was noted in group of patients with Hgb level at the end of irradiation below 13 g/dl (p = 0,004) and also in group of patients with decreasing of Hgb level during treatment (p = 0,038).ConclusionsLow Hgb levels at the end of postoperative irradiation and decreasing during irradiation were associated with a statistically significant an increase in locoregional failure of patients with advanced carcinoma of larynx

91. Early toxicity in 3 D CRT of lung cancer

AimEvaluation the influence of irradiated volume of lung on pneumonitis in 3D radiotherapy.Material/methods and ResultsWe evaluated 49 patients with diagnosis of non-small-cell lung cancer (NSCLC) who were treated in our department between 1999 and 2000. The mean age of patinets was 62 years. The Karnofsky index was documented in all patients before, during and after completion of irradiation. All patients represented IIIA clinical stage of lung cancer. Fourteen patients were irradiated postoperatively due to the residual tumour or massive nodal involvment. Thirty five patients were treated with exclusive radiotherapy. No patients have been treated by chemotherapy. We performed 3D CRT with total dose in range 60 to 66 Gy in daily fractions of 2 Gy prescribed to isocentric point. Clinical and radiological evaluation of pneumonitis was performed. 21 patients of 49 had radiation pneumonitis, but intensity of pneumonitis was moderate. For better estimation the toxicity the dose volume histograms (DVH) were used. The volume of irradiated lung was an important factor for pneumonitis progress.ConclusionsDose volume histograms (DVH) with clinical evaluation can predict pulmonary toxicity (pneumonitis) and colud allow us to evaluate volume of irradiated lung with the highest acceptable dose

88. Comparison results of different strategies of radiotherapy in nasopharyngeal carcinoma

Aim: Evaluation results of radiotherapy in nasopharyngeal carcinoma in years; 1980–1990 (before CT era) vs 1991–1995.Material/methods: One hundred eighty eight patients treated in our centre were included in this analysis. Two groups of patients were distinguished: I-st – 128 patients (treated between 1980–1990) and II-nd – 60 (treated between 1991–1995). The possibilities of diagnosis and radiotherapy techniques were diffrent in both groups. In the II-nd group; the shrinking field technique, CT in diagnosis and target delineation and also higher total dose (mean 66 Gy) were applied.Results: For all patients 5-years disease free-survival was 30%. During follow-up the first two years were crucial, because 80% of failures occured. The causes of failures were as follow: the local recurrence (43%), metastases to lymph nodes (39%) and distant metastases (18%).Conclusions: Introducing CT into diagnosis and target delineation, the shrinking field technique and higher total dose of irradiation caused in improvement of results of radiotherapy in nasopharyngeal carcinoma

89. Results of the breast conserving therapy in early breast cancer

AimEvaluation outcome of treatment (surgery and radiotherapy) in early breast cancer.Material and methodsWe performed this analysis on sixty eight women with clinical and pathological diagnosis of the early breast cancer (tumour up to 3 cm and without metastases to the axillary lymph nodes) who were treated in our centre between 1993 and 1995. For all patients in the first phase of treatment the breast conserving surgery (quadrantectomy and axillary dissection) was performed. All patients received radiotherapy (Co60 or photons 6 MeV) to total dose 50,4 Gy, daily fractionation 1,8 Gy prescribed to ICRU point. The electron boost to the tumour bed in some cases was applied. The acute and late morbidity were good, without any grade III (RTOG scale). The follow-up was in range 5 – years.Results5 (7%) patients of 68 patients had local recurrence and in these cases total mastectomy was performed. 7 (10%) of 68 patients had distant metastases without locoregional recurrence and chemotherapyin these cases were introduced chemotherapy. Patients with the local recurrence only still alive, but 7 patients with distant metastases died.ConclusionsCrucial for the outcome of treatment early breast cancer is presence of micrometastases before or during local treatment. The results of combined local treatment were good and in case of local relapse the additional surgery give a chance for cure

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres

To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5\u201387.5% of cases); presentation to multidisciplinary tumour board (2.5\u2013100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42\u2013102.5\ua0days); number of treatment interruptions 65 1 day (7.5\u201397.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures