67. Radical radiotherapy of muscle-invading bladder cancer (BC): a retrospective analysis of 49 patients

Growing interest in the use of combined modality approaches for bladder-sparing procedures force radiation oncologists to optimise methods of radical radiotherapy. Since treatment policies have changed considerably over the last years, in this retrospective study we analysed feasibility of radical radiotherapy and outcomes of patients treated in our institution between 1992 and 2000. Study group comprised 49 consecutive BC patients aged 43 to 80 years (median 71), including three cases with clinically involved pelvic lymph nodes. There were 45 urothelial, and four other types of cancer (grade 1- four, 2 – 21, 3-nine, and unknown -14 cases). Six patients were referred for radiotherapy after nonradical operation. Treatment was delivered with the use of 60Co or LA five days a week, without planned interruptions. Thirty-two patients received elective irradiation of the pelvic lymph nodes to the dose 40 to 48 Gy, followed by the boost to the bladder to the total dose 60 to 66 Gy. Seventeen patients received total dose of 58 to 62 Gy to the bladder and perivesical tissue. Fraction doses ranged from 1.8 to 2.0 Gy. Treatment was prematurely stopped due to disease progression (PD), patient refusal, uraemia, in one case each, and intractable diarrhoea in six cases. After a median follow-up of 14 months (range 1 – 102) 23 patients died of PD. Median survival in the entire group is 159 months. Results of this study confirm relative efficacy of radiotherapy in BC. Further refinement of radiotherapy techniques is warranted to improve the outcome

Surgery followed by irradiation in glioblastoma multiforme. A report of 28 cases

Treatment results in glioblastoma multiforme, irrespective of the management, are poor. Median survival in patients managed with surgery alone is 4 months and in those treated with surgery and adjuvant radiotherpy -9 months.Twenty eight patients with glioblastoma multiforme were treated at the Department of Oncology and Radiotherapy, Medical University of Gdańsk between 1991 to 1995. There were females and 20 males and the median age was 58 years (range 18 to 75 years). In 22 cases (78%) diagnosis was confirmed by histology, and in the remaining six cases biopsy was not taken due to the deep localization of the tumour; in all these patients diagnosis was based on CT imaging. All patients were irradiated with cobalt unit and received conventional radiotherapy, 5 days a week, 1.8 Gy per fraction. The first part of treatment included whole brain irradiation (40 Gy) delivered through lateral parallel opposed fields. Thereafter in all instances a brain CT was done and in case of regression or stabilisation (23 pts), a boost dose of 15–22 Gy with reduced portals was delivered. Total dose delivered to the tumor bed was 55–62 Gy. Radiotherapy tolerance was satisfactory and there were no serious complications and interruptions of treatment.Median local recurrence-free survival was 5.3 months, and a median survival – 9.9 months (range, 1.6 to 31.2 months). There was no correlation between survival and radiotherapy dose, sex, pretreatment WHO performance status and tumor localization.Our results confirm poor prognosis in glioblastoma multitorme. New more effective therapeutic approaches are sorely needed in this tumour

36 Ocena porównawcza dwu metod obliczania dawek w odbytnicy podczas śródjamowej brachyterapii (BT) chorych na raka szyjki i trzonu macicy

Radioterapia nowotworów ginekologicznych wiąże się z wysokim ryzykiem uszkodzeń popromiennych pęcherza i odbytnicy. W skojarzonym leczeniu napromienianiem dawka, jaką otrzymuje pkt referencyjny w odbytnicy stanowi sumę dawek fizycznych z BT śródjamowej oraz napromieniania wiązką zewnętrzną. W Klinice Onkologii i Radioterapii AMG, rozkład dawki w miednicy małej podczas BT obliczany jest komputerowo dla każdej chorej. Punktową dawkę maksymalną w odbytnicy wyznacza się na podstawie wprowadzonego doodbytniczo ołowianego drucika w osłonie plastikowej (R1).Od 1995 roku dodatkowo dawkę tę wyznacza się w punkcie referencyjnym, zgodnie z zaleceniami ICRU (raport Nr 38) lokalizując tylną ścianę pochwy gazikami zawierającymi cieniującą na radiogramach nitkę (R2). Ponadto u wszystkich chorych obliczane są równoważne dawki biologiczne wyliczane z zastosowaniem modelu liniowo-kwadratowego (α/β=4).Celem pracy było porównanie dawek fizycznych i odpowiadających im dawek biologicznych (r1 i r2) obliczonych przy użyciu obu wymienionych metod. Analiza dotyczyła 124 aplikacji cezu u 102 chorych na raka szyjki lub trzonu macicy, leczonych śródjamowo podczas skojarzonego lub pooperacyjnego napromieniania.W 83% przypadków wartość bezwzględna dawek R1 była niższa od R2. Wartości średnie dawek R1 i R2 nosiły odpowiednio: 13,2±4,3 Gy i 16,4±4,4 Gy. Różnica między średnimi wynosząca 3,7 Gy jest zamienna statystycznie (test t-Studenta dla danych sparowanych, p=0,000), zarówno w przypadkach stosowania wyłącznie owoidów jak i pełnego układu (owoidów i sondy domacicznej). Różnica średnich pozostawała znamienna (p=0,016) przy uwzględnieniu 10% błędu metody. Wartości średnie dawek biologicznych r1 i r2 wynosiły odpowiednio: 16,8±8,0 Gy i 24,0±9,6 Gy, a średnia różnica dawek wynosiła 7,2 Gy (p=0,000).WnioskiWykazano istotną różnicę między dawkami wyznaczonymi dwiema metodami. W większości przypadków dawki w odbytnicy wyznaczone przy użyciu doodbytniczego drucika były niższe od dawek obliczonych w punkcie referencyjnym wg ICRU. Wprowadzenie osłon obszaru brachyterapii podczas leczenia wiązką zewnętrzną na podstawie obliczeń dawek R1 oznacza możliwość podania zbyt wysokiej dawki całkowitej na odbytnicę, co zwiększa ryzyko wystąpienia powikłań popromiennych. Z tego powodu metoda obliczenia dawki w odbytnicy przy użyciu doodbytniczego drucika nie powinna być zalecana

BRCA1: A Novel Prognostic Factor in Resected Non-Small-Cell Lung Cancer

BACKGROUND: Although early-stage non-small-cell lung cancer (NSCLC) is considered a potentially curable disease following complete resection, patients have a wide spectrum of survival according to stage (IB, II, IIIA). Within each stage, gene expression profiles can identify patients with a higher risk of recurrence. We hypothesized that altered mRNA expression in nine genes could help to predict disease outcome: excision repair cross-complementing 1 (ERCC1), myeloid zinc finger 1 (MZF1) and Twist1 (which regulate N-cadherin expression), ribonucleotide reductase subunit M1 (RRM1), thioredoxin-1 (TRX1), tyrosyl-DNA phosphodiesterase (Tdp1), nuclear factor of activated T cells (NFAT), BRCA1, and the human homolog of yeast budding uninhibited by benzimidazole (BubR1). METHODOLOGY AND PRINCIPAL FINDINGS: We performed real-time quantitative polymerase chain reaction (RT-QPCR) in frozen lung cancer tissue specimens from 126 chemonaive NSCLC patients who had undergone surgical resection and evaluated the association between gene expression levels and survival. For validation, we used paraffin-embedded specimens from 58 other NSCLC patients. A strong inter-gene correlation was observed between expression levels of all genes except NFAT. A Cox proportional hazards model indicated that along with disease stage, BRCA1 mRNA expression significantly correlated with overall survival (hazard ratio [HR], 1.98 [95% confidence interval (CI), 1.11-6]; P = 0.02). In the independent cohort of 58 patients, BRCA1 mRNA expression also significantly correlated with survival (HR, 2.4 [95%CI, 1.01-5.92]; P = 0.04). CONCLUSIONS: Overexpression of BRCA1 mRNA was strongly associated with poor survival in NSCLC patients, and the validation of this finding in an independent data set further strengthened this association. Since BRCA1 mRNA expression has previously been linked to differential sensitivity to cisplatin and antimicrotubule drugs, BRCA1 mRNA expression may provide additional information for customizing adjuvant antimicrotubule-based chemotherapy, especially in stage IB, where the role of adjuvant chemotherapy has not been clearly demonstrated

Primary cancer of the fallopian tube: report of 26 patients

Background. Due to rarity of fallopian tube cancer most series on this tumor are small and many problems have remained unsolved. The aim of this report is to review our experience with this neoplasm and to compare it with previously published data. Methods. Retrospective study of 26 patients with fallopian tube cancer treated in one institution between 1974 and 1994. All patients underwent primary surgical treatment and 18 received adjuvant therapy including pelvic irradiation in 14 cases and chemotherapy in four. Results. Relapse occurred in 18 out of 25 followed up patients. Upper abdominal component of relapse was encountered in 12 patients (67%), pelvic component - in eight (44%) and extraperitoneal component - in six (33%). Pelvic relapse occurred in two out of 13 followed up patients treated with postoperative irradiation and in six out of 12 who did not receive postoperative radiotherapy. Survival ranged from 6 to 218+months (median 23 months). Five-year actual survival was 33%. There were no 2-year survivors in patients presenting with stage II-IV disease. No correlation was found between tumor grade and survival. Conclusions. Fallopian tube cancer is a treatable disease but cure can be only achieved in patients with early tumor. Postoperative radiotherapy may result in better local control but does not preclude extrapelvic dissemination, therefore adjuvant chemotherapy should be considered in high risk patients. Registration of all new cases as well as prospective multicenter studies are warranted to establish optimal management

The measurement of displacement with the use of MEMS sensors : accelerometer, gyroscope and magnetometer

The paper presents the method of determining the global orientation of links of the measuring arm by gauging the angles of the links relative to the vector of the gravitational and magnetic field using inertial sensors. A method of using Kalman filter to average the results is presented as a test on two-links measuring arm equipped with accelerometers and magnetometers placed on each of the links and analysis of measurement results in terms of repeatability. There was demonstrated the ability of creating kinematic chain. Instead of determining the position of the final link on the basis of the measurement of angles in relation to the previous links from the end to the base of the arm, it is possible to define links global orientation by measuring angles of links in reference to the vectors of the gravity field and the magnetic field, in global coordinate system

Novel biocompatible transversal pneumatic artificial muscles made of PDMS/PET satin composite

In this study novel transversal pneumatic artificial muscles (TPAM), made from composite – poly(dimethylsiloxane) (PDMS) matrix membrane and poly(ethylene terephthalate) (PET) satin reinforcement, are presented. Miniature TPAM consists of a flexible internal braid (IB) reinforcing the membrane and the external braid (EB). EB, with fibers arranged transversely to the IB, is placed laterally. Differently prepared TPAMs were tested for their effectiveness as actuators for robot drive and the PDMS/PET composite suitability was evaluated for applications in human gastrointestinal tract (chemical resistance, thermal characteristic). FT-IR spectra of the composite were compared for study PDMS impregnation process of PET satin and effect of immersion in selected solution. The composite shows outstanding biocompatibility and the muscles have competitive static load characteristics in comparison with other pneumatic artificial muscles (PAM). These results lead to believe, that in the near future painless examination of the gastrointestinal tract using a secure robot will be possible