Bone marrow sparing RT in era of immunotherapy

  Recent advances in the field of immunotherapy have changed the perception of cancer treatment to complex model with host immunity in the spotlight. Potential synergy of immunotherapy drugs [aiming cytotoxic T cell antigen 4 (CTLA-4) or programmed cell death-1/ligand (PD-1/PD-L1)] and radiotherapy (RT) have established basis for ongo­ing clinical trials testing combined treatment. It was shown that complete blood cell counts (CBC) parameters may correlate with cancer survival, toxicity and outcomes of treatment. Therefore, reduction of hematologic toxicity of cancer treatment may gain in significance. Modern dose delivery techniques compromise dose reduction in critical organs (like bone marrow — BM) with adequate irradiation of target volumes. In addition, usage of modern imaging like positron emission tomography (PET), magnetic resonance imaging (MRI) allows to divide the volume of BM to active and inactive one. In this review, we discuss the synergy of RT and immunity and techniques of Bone Marrow Sparing RT (BMS-RT)

Bone marrow sparing RT in era of immunotherapy

Recent advances in the field of immunotherapy have changed the perception of cancer treatment to complex model with host immunity in the spotlight. Potential synergy of immunotherapy drugs [aiming cytotoxic T cell antigen 4 (CTLA-4) or programmed cell death-1/ligand (PD-1/PD-L1)] and radiotherapy (RT) have established basis for ongo­ing clinical trials testing combined treatment. It was shown that complete blood cell counts (CBC) parameters may correlate with cancer survival, toxicity and outcomes of treatment. Therefore, reduction of hematologic toxicity of cancer treatment may gain in significance. Modern dose delivery techniques compromise dose reduction in critical organs (like bone marrow — BM) with adequate irradiation of target volumes. In addition, usage of modern imaging like positron emission tomography (PET), magnetic resonance imaging (MRI) allows to divide the volume of BM to active and inactive one. In this review, we discuss the synergy of RT and immunity and techniques of Bone Marrow Sparing RT (BMS-RT)

Intake of folic acid by Polish women with higher education — a survey research: can we do more?

Objectives: The objective of the study is to determine efficacy of the Primary Prevention Program of Neural Tube Defects in Polish women with higher education in 5-year interval. Material and methods: Survey research was conducted twice (in 2008 and 2013) in 630 female students of universities: 305 female medical students and 325 female non-medical students. The survey was also done among women aged 27– 35 who graduated from medical or non-medical universities and have at least one child. Questions concerned knowledge about prophylaxis and periconceptional folic acid intake. Chi square test was used to assess the significance. Results: Knowledge concerning prophylaxis was significantly higher in female medical students comparing to non-medical ones, both in 2008 (p < 0,001), and in 2013 (p < 0,001). 92.9% in 2008 and 93.9% in 2013 of medical students knew about the necessity of periconceptional folic acid intake. Awareness of female non-medical students was lower (2008 — 35.3% and 2013 — 41.1%) and did not change in the 5-year long period (p = 0.3). There was no significant difference in preconceptional folic acid intake among mothers with medical and non-medical education (53.3% vs. 45% p = 0.4). However, the highest folic acid intake was among mothers –medical doctors who treat children with neural tube defect. Conclusions: Difference between medical and non-medical students shows that better educational programs may improve knowledge about prophylaxis. Aside from knowledge, compliance with recommendations of Primary Prevention Program of Neural Tube Defects is unsatisfactory

Hypoxia in prostate cancer

Most human solid tumours contain areas which are less oxygenated than normal tissues. Hypoxia increases resistance to radiotherapy, surgery and chemotherapy, and directly alters the function of tumour cells, stimulating them to de-differentiate and to release angiogenic factors with a view to increasing the blood and oxygen supply. Tumour hypoxia promotes malignant progression and metastasis formation. HIF-1 is a heterodimeric transcription factor composed of regulated HIF-1α and constitutively expressed HIF-1β. Tumour-associated activation of HIF-1α seems to be primarily, however the result of adaptation to oxygen shortage. The presence of the HIF-1α subunit overexpression has been confirmed in many tumours, in prostate cancer, among others; the role it plays in its progression is yet to be explained. Numerous studies strongly emphasize the importance of evaluating the status of the HIF-1α transcription factor in predicting the clinical and biochemical recurrence of prostate cancer and its resistance to castration

Synchronous occurrence of four malignancies in a 55-year-old woman with uterine cervical cancer. Case report and review of literature

Mnogie nowotwory pierwotne przestają być rzadkością w codziennej praktyce klinicznej. Nowoczesne metody leczenia i diagnostyki chorób nowotworowych oraz ogólne wydłużenie średniej długości życia pacjentów spowodowały zwiększoną częstość występowania mnogich nowotworów pierwotnych. Celem pracy jest prezentacja przypadku 55-letniej chorej z rakiem szyjki macicy, rakiem piersi, chłoniakiem/białaczką B-komórkową (CLL/SLL) (Chronic lymphocytic leukemia/Small lymphocytic lymphoma) i oponiakiem występującymi synchronicznie. Opisany przypadek udowadnia, że rozpoznanie raka szyjki macicy nie wyklucza współistnienia innych nowotworów złośliwych. Podkreśla również, że każdy przypadek raka szyjki macicy, o nietypowym obrazie klinicznym powinien być wnikliwie analizowany celem uniknięcia pomyłek diagnostycznych skutkujących pogorszeniem rokowania.Multiple primary malignancies are no longer rare in clinical practice. The incidence of multiple primary malignant neoplasms is the consequence of progress in oncological treatment and diagnostic methods, as well as the higher overall survival rate and life expectancy rate. We present a case of a patient who synchronously developed four malignancies: cervical cancer, breast cancer, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and an olfactory groove meningioma. This case proves that the diagnosis of the cervical cancer does not exclude the occurrence of other malignancies. It also emphasizes the fact that every case of uterine cervical cancer with atypical clinical presentation should be thoroughly analyzed to avoid diagnostic mistakes, which in turn may worsen the prognosis

Hipoksja w raku gruczołu krokowego

Ekspresja HIF-1α została udokumentowana w większości guzów litych, w tym w raku gruczołu krokowego. Hipoksja jest negatywnym czynnikiem prognostycznym efektów leczenia nie tylko za pomocą radioterapii, ale również chirurgii i chemioterapii. Niedotlenienie zmienia funkcje komórek nowotworowych, stymulując je do odróżnicowywania i uwalniania czynników angiogennych w celu zwiększenia dopływu krwi i tlenu. Hipoksja komórek nowotworowych przyczynia się do dynamicznego rozwoju choroby. Białko HIF-1 (hypoxia induced factor) jest heterodimerycznym czynnikiem transkrypcyjnym zbudowanym z dwóch podjednostek α i β. Obecność nadekspresji czynnika transkrypcyjnego HIF-1α została potwierdzona w wielu nowotworach, również w raku stercza, natomiast jego rola w progresji choroby pozostaje niewyjaśniona. Liczne badania wyraźnie podkreślają istotność oceny statusu czynnika transkrypcyjnego HIF-1α w przewidywaniu wystąpienia wznowy klinicznej i biochemicznej raka gruczołu krokowego oraz oporności na kastrację.

Promising Immune Treatment of Advanced Cutaneous Squamous Cell Carcinoma with Cemiplimab—Real-World Experience in the Global SARS-CoV-2 Pandemic

Cutaneous squamous cell carcinoma (cSCC) is the second most frequent non-melanoma skin cancer. The standard curative treatment is surgical resection, but the treatment of locally advanced and metastatic disease apart from radiotherapy is currently based on cemiplimab. Cemiplimab has demonstrated efficacy in the treatment of advanced and metastatic cSCC in clinical trials, although real-world data are still limited. We present four cases of cSCC, which showed a tremendous response to cemiplimab—one patient achieved complete response and three of them achieved partial response. Immunotherapy with cemiplimab, a recently approved PD1 inhibitor, is an important addition to the cutaneous oncology therapeutic options that may be considered in patients with advanced disease not amenable to surgery or radiotherapy. In all four cases, the patients postponed visits to the doctor because of the fear of SARS-CoV-2 infection or for administrative and organizational reasons declared difficult access to doctors caused by the pandemic

Risk Factors and Clinicopathological Features for Developing a Subsequent Primary Cutaneous Squamous and Basal Cell Carcinomas

Background: Patients with diagnosed keratinocyte carcinomas (KCs) have an increased risk of subsequent skin cancers development. Current studies indicate that patients with subsequent tumors should be followed up regularly. However, none of the studies indicate the connection between the specific subtypes and an increased risk for further KCs development. The study assesses the differences in the risk of developing a subsequent skin cancer after a previous diagnosis of KC, especially considering individual types of skin malignances, and identifies potential factors associated with an increased risk of new cutaneous tumor describing non-invasive diagnosis and monitoring. Methods: Pathology and medical records were examined to identify the characteristics of patients with multiple KCs diagnosed between 1999 and 2019. Results: The study group comprised 13,913 KCs occurring in 10,083 patients. Multiple KCs were observed in 2300 patients (22.8%). The analysis showed aggressive subtypes, multiple tumors, and male sex as significant prognostic factors. Conclusions: The most crucial risk factors for developing subsequent KC are being of a male gender, an aggressive tumor subtype, and previous history of multiple skin cancers. Basal cell carcinoma subtypes, such as infiltrative basosquamous, with aggressive growth patterns predispose not only to increased risk for the recurrence but are also expected to be at higher risk of subsequent KCs