Proton radiotherapy for treating the most common carcinomas

A literature review is presented on proton radiotherapy when used for treating the most common carcinoma types such as cancer of the lung, breast and prostate. This is based on analytic parameters of dosimetry and clinical outcomes (efficacy and toxicity), along with studies on cost-effectiveness as compared to those achieved by conventional photon radiotherapy

Radioterapia protonowa w leczeniu najczęstszych nowotworów złośliwych

Przedstawiono przegląd piśmiennictwa dotyczący zastosowania radioterapii protonowej w leczeniu chorych na najczęstsze nowotwory złośliwe, tj. raka płuca, raka piersi i raka stercza. Dokonano tego w oparciu o prezentowane w piśmiennictwie analizy parametrów dozymetrycznych, wyników klinicznych (skuteczność i toksyczność) oraz przeprowadzone analizy opłacalności w porównaniu z konwencjonalną radioterapią fotonową

Czynniki prognostyczne u chorych na pierwotnego inwazyjnego raka pochwy

Aim of the study: Aim of the study was the assessment of prognostic factors in the group of primary invasive vaginal carcinoma (PIVC) patients subjected to radical radiation therapy. Material and methods: The analysis was performed for the group of 152 PIVC patients treated with intracavitary brachytherapy alone (16.5%), the combination of brachytherapy and external radiotherapy (78.9%), or external radiotherapy alone (4.6%). The relationship was investigated between treatment outcome and the following demographic, clinical and histopathological features: age, duration of pathological symptoms, number of births given, prior hysterectomy, haemoglobin level, Karnofsky performance status score, primary tumour location in vagina, length of vagina involved, FIGO stage, gross appearance, histological type, and tumour grade. Results: Five-year disease-free survival was observed in 46.1% of the patients (70/152). Patients below 60 years of age, with Karnofsky score of 80-90, diagnosed with PIVC in stage I0 or II0, and with tumour of grade G1 or G2 had significantly higher 5-year disease-free survival. Multifactoral analysis showed that age below 60 and FIGO stage I0 and II0 are independent favourable prognostic factors. Conclusions: The independent prognostic factors in PIVC patients treated with radical radiotherapy are patient age and FIGO stage.Cel pracy: Celem pracy była ocena czynników prognostycznych w grupie chorych na pierwotnego inwazyjnego raka pochwy (PIVC) poddanych radykalnej radioterapii. Materiał i metody: Przedmiotem analizy była grupa 152 chorych na PIVC poddanych: samodzielnej brachyterapii dojamowej (16,5%), brachyterapii dojamowej skojarzonej z teleradioterapią (78,9%) lub samodzielnej teleradioterapii (4,6%). Przeprowadzono analizę zależności pomiędzy wynikami leczenia, a następującymi cechami populacyjnymi, klinicznymi i mikroskopowymi: wiek, czas trwania objawów chorobowych, liczba porodów, uprzednio wykonana histerektomia, poziom hemoglobiny, stopień sprawności wg skali Karnofskiego, punkt wyjścia raka w obrębie pochwy, długość pochwy zajętej przez raka, zaawansowanie raka wg FIGO, postać makroskopowa guza, postać mikroskopowa i zróżnicowanie raka. Wyniki: 5 lat bez objawów nowotworu przeżyło 46,1% chorych (70/152). Statystycznie znamiennie wyższe bezobjawowe przeżycie 5-letnie uzyskano u chorych poniżej 60 roku życia, w stopniu sprawności Karnofskiego 80-90, chorych na PIVC w I0 i II0 zaawansowania oraz chorych na PIVC G1 i G2. W analizie wielocechowej niezależnymi, korzystnymi czynnikami prognostycznymi były: wiek poniżej 60 lat oraz I0 i II0 zaawansowania raka wg FIGO. Wnioski: Niezależnymi czynnikami prognostycznymi u chorych na PIVC poddanych radykalnej radioterapii są wiek i stopień zaawansowania raka wg FIGO

Powikłania radioterapii u chorych na pierwotnego inwazyjnego raka pochwy

Objectives: The aim of the study was to estimate acute and late complications of radiation therapy in primary invasive vaginal carcinoma (PIVC) patients. Material and methods: The analysis was performed for the group of 152 PIVC patients given radical radiotherapy in the Krakow Branch of Centre of Oncology during the 1967–2005 period. Twenty five (16.5%) patients in I stage with primary tumour of the thickness not larger than 0.5 cm were treated with intracavitary brachytherapy alone; for 120 (78.9%) patients (stages I – IVA) intracavitary brachytherapy was combined with external radiation therapy; and 7 (4.6%) patients in stage IVA were given only external radiotherapy. In total, 145 (95.4%) patients were treated with intracavitary LDR brachyterapy by means of Ra-226 or afterloaded Cs-137 sources, and 127 (83.5%) received external radiation therapy using Co-60 and linac 10MV or 6MV photon beams. Results: Early radiotherapy tolerance was good in the investigated group; 146 (96.1%) patients completed full planned radiation therapy treatment. Late complications of radiation therapy were observed in 21 (13.8%) patients: 3 (2%) patients reported mild complications, 12 (7.9%) moderate complications, and 6 (3.9%) severe complications. Severe complications of radiation therapy in the investigated group included: recto-vaginal fistula (5 patients) and vesico-vaginal fistula (1 patient). None of the patients in the group died of radiation therapy complications. Conclusions: Early tolerance of radiotherapy in PIVC patients is generally good. Late radiation therapy complications, particularly the severe, are rare and can be efficiently managed with conservative therapy or surgical treatment.Cel pracy: Celem pracy była ocena wczesnych i późnych powikłań radioterapii chorych na pierwotnego inwazyjnego raka pochwy (PIVC). Materiał i metody: Przedmiotem analizy była grupa 152 chorych na PIVC napromienianych radykalnie w krakowskim Oddziale Centrum Onkologii w latach 1967-2005. U 25 (16,5%) chorych na PIVC w I0 zaawansowania, ze zmianą pierwotną nieprzekraczającą 0,5cm grubości przeprowadzono wyłącznie brachyterapię dojamową, u 120 (78,9%) chorych (I0- IVA0) brachyterapię dojamową skojarzoną z teleradioterapią, a u 7 (4,6%) chorych w IVA0 zaawansowania wyłącznie teleradioterapię. W sumie, u 145 (95,4%) chorych zastosowano brachyterapię dojamową LDR radem-226 lub cezem-137, a u 127 (83,5%) teleradioterapię w warunkach telegammaterapii kobaltem-60 lub promieniowania X o energii 10MeV lub 6MeV z akceleratorów liniowych. Wyniki: Bezpośrednia tolerancja radioterapii w badanej grupie chorych była dobra; pełną zaplanowaną radioterapię przeprowadzono u 146 (96,1%) chorych. Późne powikłania napromieniania stwierdzono u 21 (13,8%) chorych: u 3 (2%) były to powikłania o średnim nasileniu, u 12 (7,9%) znacznym nasileniu i u 6 (3,9%) – o bardzo ciężkim nasileniu. Ciężkie powikłania radioterapii w badanej grupie chorych to: przetoka pochwowo-odbytnicza (5 chorych) i przetoka pochwowo-pęcherzowa (1 chora). Żadna chora z badanej grupy nie zmarła z powodu powikłań radioterapii. Wnioski: Bezpośrednia tolerancja radioterapii chorych na PIVC jest zasadniczo dobra. Późne powikłania radioterapii, szczególnie ciężkie są rzadkie i mogą być skutecznie leczone zachowawczo lub operacyjnie

Methods and results of locoregional treatment of brain metastases in patients with non-small cell lung cancer

This article presents methods and results of surgery and radiotherapy of brain metastases from non-small cell lung cancer (BMF-NSCLC). Patients with single BMF-NSCLC, with Karnofsky score ≥ 70 and controlled extracranial disease are the best candidates for surgery. Stereotactic radiosurgery (SRS) is recommended in patients with 1-3 BMF-NSCLC below 3–3.5 cm, with minor neurological symptoms, located in parts of the brain not accessible to surgery, with controlled extracranial disease. Whole brain radiotherapy (WBRT) following SRS reduces the risk of local relapse; in selected patients median survival reaches more than 10 months. Whole brain radiotherapy alone is a treatment in patients with multiple metastases, poor performance status, uncontrolled extracranial disease, disqualified from surgery or SRS with median survival 3 to 6 months. There is no doubt that there are patients with BMF-NSCLC who should receive only the best supportive care. There is a debate in the literature on how to select these patients

Typical medullary breast carcinoma : clinical outcomes and treatment results

Typical medullary breast carcinoma (T-MBC) accounts for less than 1% of all malignant breast neoplasms, and immunohistochemically is characteristic of “triple-negative” breast carcinoma. The purpose of this study was to describe the clinical characteristics and treatment results for patients with T-MBC treated at a single institution, and discuss the controversial aspects of this very rare form of breast cancer. Analyses was performed in 120 patients with T-MBC who were treated between 1970 and 2005. These cases represent 1.1% of all (11 270) patients treated for breast cancer during this period. According to TNM classification, 26 patients (21.6%) were in stage I, 80 patients (66.7%) in stage II and 14 (11.7%) in stage III of clinically advanced breast cancer. Involved axillary lymph nodes occurred in just 10 (8.3%) of the patients, and in all cases metastases were observed in 1–3 lymph nodes. All the patients underwent primary surgery. Radical mastectomies were performed on 98 (81.6%) patients, while the other 22 (18.4%) underwent breast-conserving surgery (BCS). Radiotherapy was performed in 36 patients (22 after BCS and 14 after mastectomy). Patients with nodal involvement (10 patients) received adjuvant chemotherapy, and 8 patients with hormone receptor expression received hormonotherapy with tamoxifen. The 10-year DFS rate was 90%. Out of 120 patients with T-MBC, only 4 (3.3%) died from this cancer. We showed that none of the population, neither clinical nor microscopic, had a statistically significant influence on the 10-year disease-free survival rate. Our results are similar to others presented in literature

Prognostic factors of brain metastases in patients with breast cancer

Wystąpienie przerzutów do mózgu u chorych na raka piersi (BMBC — brain metastases from breast cancer) związane jest z wyraźnie niekorzystnym rokowaniem. Mediana przeżycia u takich chorych waha się od 2 do 16 miesięcy, w zależności od wielu czynników prognostycznych oraz związanych z nimi możliwości leczenia. W piśmiennictwie prezentowane są czynniki prognostyczne ujawniające się w badaniach jedno- lub wieloośrodkowych, głównie, choć nie jedynie, w analizach wieloczynnikowych, oraz czynniki uwzględnione w indeksach prognostycznych, opracowanych dla chorych z przerzutami do mózgu z różnych nowotworów lub — w szczególności — dla chorych z BMBC. Zebrane i zweryfikowane dane piśmiennictwa pozwalają uznać, że na chwilę obecną podstawowymi, powszechnie uznanymi czynnikami prognostycznymi u chorych z BMBC są: stan sprawności chorych oraz stan procesu nowotworowego poza mózgiem w momencie ujawnienia się przerzutów do mózgu (BM — brain metastases). Stan sprawności chorych oceniany jest prawie wyłącznie skalą Karnofsky'ego, natomiast stan procesu nowotworowego jest różnie definiowany: czynny vs nieobecny, kontrolowany vs niekontrolowany, obecność przerzutów odległych poza mózgiem vs brak tych przerzutów itp. Niestety, stwarza to możliwość różnych interpretacji. Potencjalnymi czynnikami prognostycznymi prezentowanymi przez wielu autorów, ale nieuznawanymi powszechnie, są: wiek chorych, podtyp molekularny raka piersi oraz liczba BM. Wyniki przeprowadzonych analiz oceniających wartości poszczególnych indeksów prognostycznych wskazują, że pomimo niewątpliwych ich zalet, w praktyce klinicznej winny być stosowane z rozwagą u chorych z BMBC.The development of brain metastases from breast cancer (BMBC) relates to poor prognosis. The median survival rate averages from 2 to 16 months and depends on various prognostic factors and therapeutic possibilities. There are some prognostic factors which were found in trials as a results of multivariate analyses and factors from prognostic scores in patients with brain metastases. According to the literature the important prognostic factors are performance status and status of the disease outside the brain. Performance status usually is evaluated according to the Karnofsky scale. Whereas the disease status is estimated variously as: presence versus no disease, controlled or uncontrolled disease, presence or not of distant metastases outside the brain. Many authors revealed that age, molecular type of breast cancer and number of brain metastases are potential prognostic factors. Published results of analyses showed that the role of some prognostic factors is limited in patients with BMBC

Typical medullary breast carcinoma: clinical outcomes and treatment results

Typical medullary breast carcinoma (T-MBC) accounts for less than 1% of all malignant breast neoplasms, and immu­nohistochemically is characteristic of “triple-negative” breast carcinoma. The purpose of this study was to describe the clinical characteristics and treatment results for patients with T-MBC treated at a single institution, and discuss the controversial aspects of this very rare form of breast cancer. Analyses was performed in 120 patients with T-MBC who were treated between 1970 and 2005. These cases represent 1.1% of all (11 270) patients treated for breast cancer during this period. According to TNM classification, 26 patients (21.6%) were in stage I, 80 patients (66.7%) in stage II and 14 (11.7%) in stage III of clinically advanced breast cancer. Involved axillary lymph nodes occurred in just 10 (8.3%) of the patients, and in all cases metastases were observed in 1–3 lymph nodes. All the patients un­derwent primary surgery. Radical mastectomies were performed on 98 (81.6%) patients, while the other 22 (18.4%) underwent breast-conserving surgery (BCS). Radiotherapy was performed in 36 patients (22 after BCS and 14 after mastectomy). Patients with nodal involvement (10 patients) received adjuvant chemotherapy, and 8 patients with hormone receptor expression received hormonotherapy with tamoxifen. The 10-year DFS rate was 90%. Out of 120 patients with T-MBC, only 4 (3.3%) died from this cancer. We showed that none of the population, neither clinical nor microscopic, had a statistically significant influence on the 10-year disease-free survival rate. Our results are similar to others presented in literature

Typical medullary breast carcinoma: clinical outcomes and treatment results

Typical medullary breast carcinoma (T-MBC) accounts for less than 1% of all malignant breast neoplasms, and immu­nohistochemically is characteristic of “triple-negative” breast carcinoma. The purpose of this study was to describe the clinical characteristics and treatment results for patients with T-MBC treated at a single institution, and discuss the controversial aspects of this very rare form of breast cancer. Analyses was performed in 120 patients with T-MBC who were treated between 1970 and 2005. These cases represent 1.1% of all (11 270) patients treated for breast cancer during this period. According to TNM classification, 26 patients (21.6%) were in stage I, 80 patients (66.7%) in stage II and 14 (11.7%) in stage III of clinically advanced breast cancer. Involved axillary lymph nodes occurred in just 10 (8.3%) of the patients, and in all cases metastases were observed in 1–3 lymph nodes. All the patients un­derwent primary surgery. Radical mastectomies were performed on 98 (81.6%) patients, while the other 22 (18.4%) underwent breast-conserving surgery (BCS). Radiotherapy was performed in 36 patients (22 after BCS and 14 after mastectomy). Patients with nodal involvement (10 patients) received adjuvant chemotherapy, and 8 patients with hormone receptor expression received hormonotherapy with tamoxifen. The 10-year DFS rate was 90%. Out of 120 patients with T-MBC, only 4 (3.3%) died from this cancer. We showed that none of the population, neither clinical nor microscopic, had a statistically significant influence on the 10-year disease-free survival rate. Our results are similar to others presented in literature