Radiochirurgia stereotaktyczna w praktyce klinicznej

W pracy omówiono podstawowe warunki fizyczne i techniczne radiochirurgii stereotaktycznej (RCHS). Głównymiwskazaniami do RCHS są: malformacje tętniczo-żylne, nieoperacyjne przerzuty do mózgu, nerwiaki nerwu VIII,oponiaki i mikrogruczolaki przysadki. Jedynym bezdyskusyjnym czynnikiem predykcyjnym tych zmian w RCHSjest wielkość leczonego ogniska. Najlepsze wyniki dotyczą zmian o średnicy nieprzekraczającej 3 cm — kontrolamiejscowa w tych przypadkach sięga 90–95% przy odsetku powikłań nieprzekraczającym 7%. Radiochirurgiastereotaktyczna znajduje również zastosowanie w paliatywnej radioterapii chorych na raka trzustki i z przerzutaminowotworowymi do płuc. Do innych wskazań należy uporczywa neuralgia nerwu trójdzielnego

Radiation-induced anaplastic astrocytoma following treatment of medulloblastoma

We hereby report a case of a 10-year-old girl in whom neurosurgery was performed for cerebellar vermis medulloblastoma in April 2000. After resection the patient underwent chemotherapy followed by radiotherapy, receiving 53.07 Gy to posterior fossa and 35.07 Gy to the rest of the craniospinal axis. In 2012, she was diagnosed with anaplastic astrocytoma, which was located within the high-dose region. Surgical resection of the tumour was performed. Postoperatively, the patient received radiation therapy (50.4 Gy) with concurrent temozolomide, followed by 6 cycles of adjuvant temozolomide. Five years after the diagnosis of anaplastic astrocytoma, the patient remains asymptomatic

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

Results of the treatment of adrenocortical cancer patients at the Maria Sklodowska-Curie National Research Institute of Oncology – Krakow Branch

Introduction.Adrenocortical carcinoma (ACC) has an incidence of 1–2 cases per million and the 5-year overall survival (OS) is 16–47%. Surgery is the treatment of choice. Post-operative radiotherapy has been shown to prolong overall survival and the purpose of this work was to show our own, first time in Poland, results of adjuvant radiotherapy in tre­ating this disease. Material and methods.Between 2012 and 2021, 12 patients with ACC were treated. The analyzed group included 9 women and 3 men at a mean age of 44 years (range: 33 to 76 years). A significant increase of tumor size was found in 30% of the subjects. In the analyzed group, 12 patients were qualified to adjuvant radiotherapy, but it was feasible only in 7 patients. The other 5 patients did not undergo radiotherapy. Two patients were disqualified due to metastatic disease and in 3 patients radiotherapy could not be performed due to excessive tumor size and too high a risk of com­plications within the critical organs. Results.3 out of 7 patients who received adjuvant radiotherapy are still alive and 4 of them died. Mean overall survival time was 32 months. The 12-month overall survival rate was 80%. In the group of 5 patients who have not received radiotherapy, 2 patients are still alive. The mean overall survival time is 13.5 months and the 12-month overall survival rate is 60%. Conclusions.Due to rapid disease progression and poor prognosis associated with ACC, patients with tumors located in the adrenal gland require urgent surgical treatment at a reference center. Adjuvant radiotherapy improves treatment results significantly, but is not feasible in some patients due to cancer progression or the tumor location. In patients with ACC, it is important to diagnose the disease and to start adequate treatment as early as possible

Results of the treatment of adrenocortical cancer patients at the Maria Sklodowska-Curie National Research Institute of Oncology – Krakow Branch

Introduction.Adrenocortical carcinoma (ACC) has an incidence of 1–2 cases per million and the 5-year overall survival (OS) is 16–47%. Surgery is the treatment of choice. Post-operative radiotherapy has been shown to prolong overall survival and the purpose of this work was to show our own, first time in Poland, results of adjuvant radiotherapy in tre­ating this disease. Material and methods.Between 2012 and 2021, 12 patients with ACC were treated. The analyzed group included 9 women and 3 men at a mean age of 44 years (range: 33 to 76 years). A significant increase of tumor size was found in 30% of the subjects. In the analyzed group, 12 patients were qualified to adjuvant radiotherapy, but it was feasible only in 7 patients. The other 5 patients did not undergo radiotherapy. Two patients were disqualified due to metastatic disease and in 3 patients radiotherapy could not be performed due to excessive tumor size and too high a risk of com­plications within the critical organs. Results.3 out of 7 patients who received adjuvant radiotherapy are still alive and 4 of them died. Mean overall survival time was 32 months. The 12-month overall survival rate was 80%. In the group of 5 patients who have not received radiotherapy, 2 patients are still alive. The mean overall survival time is 13.5 months and the 12-month overall survival rate is 60%. Conclusions.Due to rapid disease progression and poor prognosis associated with ACC, patients with tumors located in the adrenal gland require urgent surgical treatment at a reference center. Adjuvant radiotherapy improves treatment results significantly, but is not feasible in some patients due to cancer progression or the tumor location. In patients with ACC, it is important to diagnose the disease and to start adequate treatment as early as possible

Differences in the prognosis of HPV16-positive patients with squamous cell carcinoma of head and neck according to viral load and expression of P16

Purpose To evaluate the impact of HPV16 load (VL-the number of virus genome copies per cell) and P16 expression on prognosis of patients with squamous cell carcinomas (SCCs) of head and neck (HN). Materials and methods HPV16 presence was assessed in the group of 109 patients with HNSCCs by quantitative polymerase chain reaction (qPCR). VL (assessed by qPCR) and P16 expression (evaluated by immunohistochemistry) were analysed only in the subgroup of HPV16-positive tumours. These features were correlated with 5-year overall survival (OS) and disease-free survival (DFS). Results HPV16 infection was found in 36 tumours (33.0%). Virus-positive patients had better OS and DFS than those without infection (P = 0.041 and 0.005). Among HPV16-positive HNSCCs, 18 (50.0%) had higher VL (median value > 6764.3 copies/cell) and 25 (73.5%) P16 over expression. The significant differences in OS and DFS (P = 0.008 and 0.004) were noticed according to VL, wherein 100% DFS was found for patients with higher VL. According to P16 expression, significant difference was found only for OS (P = 0.020). In multivariate analysis, VL (P = 0.045; HR = 2.795; CI 0.121-1.060) and the level of smoking (P = 0.023, HR = 2.253; CI 1.124-4.514) were independent factors affecting DFS of HPV16-positive patients. Conclusion On the basis of viral load, it is possible to differentiate prognosis of patients with HPV16-positive HNSCCs. In this subgroup, viral load has stronger prognostic potential than P16 expression

Kontrowersje w postępowaniu z chorymi na nasieniaka jądra w I stopniu zaawansowania klinicznego

Osiemdziesiąt procent nasieniaków sklasyfikowanych jest w I stopniu zaawansowania klinicznego, stanowiąc około40% wszystkich guzów jądra. Postępowanie z tą grupą chorych po pierwotnym leczeniu polegającym na orchiektomiijest przedmiotem kontrowersji. Rozpatrywane są trzy opcje: obserwacja, radioterapia oraz chemioterapia.Aktywna obserwacja z leczeniem wdrażanym w przypadku wznowy, uzupełniające napromienianie lub adiuwantowamonochemioterapia karboplatyną pozwalają na uzyskanie około 100% przeżyć całkowitych i są alternatywnymi,równoważnymi metodami postępowania. Na podstawie aktualnych danych z literatury przedstawiono zalety i wadykażdej z trzech omawianych opcji

Postoperative treatment of patients with anaplastic oligodendrogliomas. Thirty years' experience of the Maria Sklodowska-Curie Memorial Centre in Kraków, 1975–2000

BackgroundAnaplastic oligodendrogliomas (AO) are infiltrative, mostly supratentorial tumours, often bilaterally affecting the white matter. Radiotherapy alone or in combination with chemotherapy have a role in the adjuvant treatment of AO, but currently the efficacy of various treatment modalities could not be definitively determined because of the heterogeneity of the therapies used.AimAssessment of the efficacy of altered therapy schedules in postoperative treatment of patients with anaplastic oligodendrogliomasMaterials/MethodsBetween 1975 and 2000, 101 adult patients with anaplastic oligodendrogliomas were postoperatively treated in our institution. During this period patients received conventional radiation therapy and chemotherapy (CRT/CH), conventional radiation therapy (CRT), and split course hypofractionated radiation therapy (SCHRT).Between 1975 and 1985, CRT/CH was applied in 42 patients. Whole brain irradiation was delivered; the tumour dose of 5Gy in 25 fractions over 5 weeks was calculated at the midplane of the skull. Then treatment fields were reduced and a 10Gy boost was given in 5 fractions over 5 days to the known tumour bearing area. On the last day of irradiation patients began the first of six planned series of chemotherapy with CCNU, given 100mg/2, orally every 8 weeks. From 1986 to 1990, CRT was received by 27 patients. Irradiation was only as described above. Between 1991 and 2000, 32 patients were given SCHRT. There were 3 courses of irradiation separated by a one-month interval. In each of the two first series patients received 20Gy in 5 fractions in five days to the whole brain, and in the third course a 20Gy boost in 5 fractions over 5 days was given as in the CRT regimen.ResultsActuarial overall survival rates at two and five years were 38% and 10% respectively for patients treated with CRT/CH, 36% and 11% for the CRT group, and 23% and 6% for the SCHRT option. Multivariate analysis revealed that only age was a significant factor. Patients aged 45 years or less carried the best prognosis.ConclusionsThe efficacy of different postoperative treatments administered to our patients with anaplastic oligodendrogliomas gave approximately comparable and unrewarding poor results

Zastosowanie fentanylu podawanego drogą podjęzykową u pacjenta z zaawansowanym rakiem gruczołu krokowego i skrzywieniem przegrody nosa

W pracy przedstawiono opis pacjenta z rozsiewem raka gruczołu krokowego do kości. U chorego zastosowanoleczenie hormonalne oraz paliatywne napromienianie nacieku żeber. Pomimo wskazań do leczeniastrontem radioaktywnym nie udało się przeprowadzić zabiegu z uwagi na sytuację epidemiologicznązwiązaną z pandemią wirusa SARS-CoV-2. Ze względu na dolegliwości bólowe kośćca, spowodowanezmianami przerzutowymi, włączono leczenie preparatami fentanylu. Skrzywienie przegrody nosa utrudniałopodawanie formy donosowej leku, zmieniono więc formę donosową fentanylu na tabletki podjęzykowe.Uzyskano zadowalający efekt przeciwbólowy