Nasljedni karcinom dojke i jajnika - iskustva Kliničkog bolničkog centra Split

Aim: To investigate the clinical and pathohistological tumor characteristics, treatment, and treatment outcomes in patients with hereditary breast and ovarian cancer who were diagnosed, treated, and monitored at the University Hospital of Split from October 1999 to April 2021. Methods: The data were collected retrospectively from the medical history of 15 patients. They included the patient’s age at diagnosis, family history of malignancies, histological subtype, grade, breast cancer immunophenotype, stage of disease, status and types of BRCA mutations, type of surgical and oncological treatment, the specifics of metachronous bilateral breast cancers, the specifics of synchronous breast and ovarian cancers, and the outcome of treatment through overall survival (OS). Results: The median age of patients at the time of diagnosis of breast cancer was 53 years, and for ovarian cancer it was 56 years. A positive family history was confirmed in 13 patients (87%). All ovarian cancer patients had a high-grade serous histologic type, most often diagnosed in FIGO stages III and IV. Breast cancers were most commonly diagnosed in stages IA and IIA, with equally represented triple-negative and luminal immunophenotypes. The most common mutation was BRCA1 c.5266dup. The median OS of our patients was not reached. Conclusion: The clinical features of patients, pathohistological characteristics of tumors, and treatment outcomes in our study population are comparable with reports in the literature, respecting the specifics of different nations and races.Cilj: Istražiti kliničke osobitosti, patohistološke karakteristike tumora, način i ishode liječenja bolesnica s nasljednim karcinomom dojke i jajnika koje su dijagnosticirane, liječene i praćene u Kliničkom bolničkom centru Split od listopada 1999. do travnja 2021. godine. Metode: Podatci su prikupljeni retrospektivno iz povijesti bolesti 15 bolesnica. Uključivali su dob bolesnica kod dijagnoze bolesti, obiteljsku anamnezu za zloćudne bolesti, histološki podtip, gradus, imunofenotip karcinoma dojke, stadij bolesti, status i tip BRCA mutacija, osobitosti kirurškog i onkološkog liječenja, specifičnosti metakrono nastalih bilateralnih karcinoma dojke, specifičnosti sinkrono nastalih karcinoma dojke i jajnika te ishod liječenja kroz ukupno preživljenje. Rezultati: Medijan dobi bolesnica u trenutku dijagnoze raka dojke bio je 53 godine, a za karcinom jajnika 56 godina. Pozitivna obiteljska anamneza potvrđena je u 13 (87%) bolesnica. Karcinom jajnika je kod svih bolesnica bio seroznog papilarnog histološkog podtipa visokog gradusa i najčešće dijagnosticiran u FIGO stadiju III i IV. Karcinom dojke je najčešće dijagnosticiran u stadiju IA i IIA, jednake zastupljenosti trostruko negativnog i luminalnog imunofenotipa. Najčešća mutacija je bila BRCA1 c.5266dup. Medijan ukupnog preživljenja naših bolesnica nije dosegnut. Zaključak: Kliničke osobitosti bolesnica, patohistološke karakteristike tumora kao i ishodi liječenja u našoj studijskoj populaciji su usporedivi s izvješćima iz literature, respektirajući specifičnosti različitih naroda i rasa

Assessment of computed tomography simulators used in radiotherapy treatment planning in Serbia, Croatia, and Bosnia and Herzegovina

The purpose of this work was to evaluate computed tomography simulators used in radio-therapy treatment planning in Serbia, Croatia, and Bosnia and Herzegovina. A survey of quality assurance programmes of 24 computed tomography simulators in 16 facilities was conducted. A dedicated CT-to-ED phantom was scanned at 120 kV and 140 kV, to obtain CT-to-ED conversion curves as well as CTDIvol. Thoracal phantoms were scanned in the standard and extended field of view to evaluate the dosimetric effect on treatment planning and delivery. The mean age of the measured scanners was 5.5 years. The mean water HU value was –6.5 (all scanners, all voltages) and air HU value was –997. Extended field of view computed tomography data differ from the standard field of view and differences between conversion curves have significant dosimetric impact. The CTDI data showed a large range of values between centers. Better quality assurance of computed tomography simulators in all countries is recommended. The CT-to-ED curve could be used as default at one voltage and per manufacturer. Extended field of view imaging can be used, but treatment planning should be avoided in the regions out of the standard field of view

Experience of Department of oncology and radiotherapy in threedimensional conformal chemoradiotherapy of non-small cell lung cancer - dosimetric study

Cilj: Ispitati dozimetrijske trendove na organe od rizika i akutnu toksičnost u pacijenata s karcinomom pluća nemalih stanica liječenih trodimenzionalnom konformalnom kemoradioterapijom u jednom onkološkom centru. Metode: Ovo je retrospektivna studija provedena na Klinici za onkologiju i radioterapiju KBC-a Split. Prikupljeni su podatci oboljelih od lokalno uznapredovalog nesitnostaničnog karcinoma pluća liječenih trodimenzionalnom konformalnom radioterapijom od 2011. godine do početka 2019. godine. Prikupljeni su podatci pacijenata koji su se zračili primarno, adjuvantno i/ili neoadjuvantno. Uključeni pacijenti primili su najmanje jedan ciklus kemoterapije. Ciljni volumeni i organi od rizika ocrtani su prema radioterapijskim smjernicama. Rezultati: Medijan doze na “planing treatment volume” bio je 56 Gy. Najčešća akutna radijacijska toksičnost bila je akutni ezofagitis. Nije zabilježen nijedan slučaj akutnog radijacijskog pneumonitisa. Nije pokazana korelacija između prekoračenja doze na zadane volumene organa od rizika i toksičnosti istih, te smo ukazali na trend poboljšanja dozimetrijskih rezultata kroz godine liječenja. Zaključak: Toksičnost liječenja 3D KRT-om lokalno uznapredovalog raka pluća u Klinici za onkologiju i radioterapiju KBC-a Split usporediva je s objavljenim rezultatima drugih svjetskih institucija. S duljim vremenom primjene trodimenzionalne konformalne radioterapije u kliničkoj praksi postiže se optimalna raspodjela doza zračenja na rizične organe.Aim of the study: To investigate organs-at-risk toxicity with concomitant chemo radiotherapy in non-small cell lung cancer patients, and to explore dosimetry trends for organs-at-risk over the years. To investigate the rates of acute toxicities and to compare the results with the worldwide literature. Subjects and methods: This is a retrospective study conducted at the Department of Oncology and Radiotherapy at University Hospital of Split. Data were collected from patients with locally advanced non-small cell lung cancer treated with three-dimensional conformal chemo radiotherapy from 2011 to early 2019. Data were collected from patients who were treated with primary, adjuvant, and/or neoadjuvant radiotherapy. The patients received at least one cycle of chemotherapy. The target volumes and organs of risk were delineated according to radiotherapy guidelines. Results: The median dose on planning treatment volume was 56 Gy. The most common acute radiation toxicity was radiation esophagitis. No cases of acute radiation pneumonitis were noted. No correlation has been noted between dose override on organsat- risk volumes and toxicity, and we have shown a trend of improved dosimetry results through the years. Conclusion: The toxicity of treatment with 3D conformal radiotherapy for locally advanced lung cancer at the Department of Oncology and Radiotherapy at University Hospital of Split is comparable to the published results of other worldwide institutions. With longer use of 3D conformal radiotherapy we have seen improved dosimetry results over the years

Ishodi liječenja bolesnica s BRCA mutiranim recidivom karcinoma jajnika u Kliničkom bolničkom centru Split

Aim: To evaluate the treatment outcomes, with emphasis on the efficacy and safety of olaparib, in patients with platinum-sensitive, BRCA-mutated, recurrent ovarian cancer treated at the University Hospital Center Split in the period from June 2016 to April 2021. Methods: Data were collected retrospectively from a medical history of 28 patients with platinum-sensitive, BRCAmutated, recurrent ovarian cancer. Medical records were reviewed for clinico-pathological characteristics, number of previous chemotherapy lines and platinum-free interval before olaparib, response to olaparib, survival outcomes (time to disease progression, time from first cycle of olaparib to the first cycle of chemotherapy for the first and second relapse / progression, overall survival) and safety. Median follow up time was 27 months. Results: All patients were BRCA mutated, with a 75% predominance of BRCA1 mutation. The median platinum-free interval was 13 months. Most patients were treated after the first relapse (64%) with a three weekly TC protocol (68%). Olaparib maintenance therapy provided clinical control rate in 43% of cases. The median progression free survival was 24 months. Discontinuation of olaparib treatment was reported due to disease progression in 16 patients. The median time to first subsequent chemotherapy was 31 months and time to second subsequent chemotherapy was 38 months. The tolerability of olaparib was good and the side effects were low intensity. The median overall survival is not reached. Conclusion: This retrospective analysis of patients with platinum-sensitive, BRCA-mutated, recurrent ovarian cancer showed that the treatment outcomes, ie efficacy and tolerability of olaparib after platinum based chemotherapy in everyday clinical practice, are comparable to those observed in clinical trials with olaparib in the same indications.Cilj: Ispitati ishode liječenja, s naglaskom na učinkovitost i sigurnost olapariba, kod ispitanica s platina-osjetljivim, BRCA mutiranim recidivom karcinoma jajnika liječenih u Kliničkom bolničkom centru Split u razdoblju od lipnja 2016. do travnja 2021. godine. Metode: Retrospektivno su prikupljeni podatci iz povijesti bolesti 28 bolesnica s platina-osjetljivim, BRCA mutiranim recidivom karcinoma jajnika. Iz medicinske dokumentacije pregledane su kliničko-patološke karakteristike, broj prethodnih linija kemoterapije i interval bez platine prije olapariba, odgovor na olaparib, ishodi preživljavanja (preživljenje do progresije bolesti, preživljenje od prvog ciklusa olapariba do prvog ciklusa kemoterapije za prvi i drugi recidiv/progresiju, ukupno preživljenje) i podnošljivost liječenja olaparibom. Medijan praćenja bio je 27 mjeseci. Rezultati: Sve bolesnice su bile BRCA mutirane, sa 75% prevlasti BRCA1 mutacije. Medijan platina slobodnog intervala iznosio je 13 mjeseci. Većina bolesnica liječena je nakon prvog relapsa (64%) trotjednim TC protokolom (68%). Terapija održavanja olaparibom osigurala je kliničku kontrolu bolesti u 43% slučajeva. Medijan preživljavanja bez progresije bio je 24 mjeseca. Prekid liječenja olaparibom prijavljen je zbog progresije bolesti u 16 bolesnica. Medijan vremena do prve sljedeće kemoterapije bio je 31 mjesec, a do druge sljedeće kemoterapije bilo je 38 mjeseci. Podnošljivost olapariba bila je dobra, a nuspojave slabog intenziteta. Medijan ukupnog preživljenja nije postignut. Zaključak: Ova retrospektivna analiza liječenja bolesnica s platina-osjetljivim, BRCA mutiranim recidivom karcinoma jajnika je pokazala da su ishodi liječenja, odnosno učinkovitost i podnošljivost olapariba nakon kemoterapije temeljene na platini u svakodnevnoj kliničkoj praksi, usporedivi s rezultatima kliničkih istraživanja s olaparibom u istoj indikaciji

Hereditary breast and ovarian cancer – University Hospital of Split experiences

Aim: To investigate the clinical and pathohistological tumor characteristics, treatment, and treatment outcomes in patients with hereditary breast and ovarian cancer who were diagnosed, treated, and monitored at the University Hospital of Split from October 1999 to April 2021. Methods: The data were collected retrospectively from the medical history of 15 patients. They included the patient’s age at diagnosis, family history of malignancies, histological subtype, grade, breast cancer immunophenotype, stage of disease, status and types of BRCA mutations, type of surgical and oncological treatment, the specifics of metachronous bilateral breast cancers, the specifics of synchronous breast and ovarian cancers, and the outcome of treatment through overall survival (OS). Results: The median age of patients at the time of diagnosis of breast cancer was 53 years, and for ovarian cancer it was 56 years. A positive family history was confirmed in 13 patients (87%). All ovarian cancer patients had a high-grade serous histologic type, most often diagnosed in FIGO stages III and IV. Breast cancers were most commonly diagnosed in stages IA and IIA, with equally represented triple-negative and luminal immunophenotypes. The most common mutation was BRCA1 c.5266dup. The median OS of our patients was not reached. Conclusion: The clinical features of patients, pathohistological characteristics of tumors, and treatment outcomes in our study population are comparable with reports in the literature, respecting the specifics of different nations and races

National reference levels of CT procedures dedicated for treatment planning in radiation oncology

Objective: To present results of the first national survey on reference levels of CT imaging performed for the treatment planning purposes in radiation oncology in Croatia. Methods: Data for CT protocols of five anatomical regions including head, head and neck, pelvis, breast, and thorax were collected at eight radiation oncology departments in Croatia. Data included volume CT dose index (CTDIvol), dose-length product (DLP), scan length and set of acquisition and reconstruction parameters. Data on a total of 600 patients were collected. Median values of scan length, DLP and CTDIvol were calculated for each acquisition protocol. Third quartiles of the median CTDIvol and DLP values were proposed as the national radiotherapy planning reference levels (RPRL). Results: The largest CoV were assessed for RT Breast (63.8% for CTDIvol), RT Thorax (79.7% for DLP) and RT H&N (21.2% for scan length). RT Head had the lowest CoV for CTDIvol (1,9%) and DLP (17,2%), while RT Breast had the lowest coefficient of variation for scan length (12.8%). Proposed national RPRLs are: for RT Head CTDIvol16cm = 62 mGy and DLP16cm = 1738 mGy.cm; for RT H&N CTDIvol16cm = 35 mGy and DLP16cm = 1444 mGy.cm; for RT Breast CTDIvol32cm = 16 mGy and DLP32cm = 731 mGy.cm; for RT Thorax CTDIvol32cm = 17 mGy and DLP32cm = 865 mGy.cm; for RT Pelvis CTDIvol32cm = 20 mGy and DLP32cm = 1133 mGy.cm. Conclusions: Results of this study show variations in CT imaging for treatment planning practice at the national level which call for optimization of procedures