Methods and results of local treatment of brain metastases in patients with breast cancer

This article presents methods and results of surgical treatment and radiation therapy of brain metastases in breast cancer patients (brain metastases from breast cancer BMFBC). Based on the literature data, it was shown that patients with single BMF-BC, aged less than 65 years, with Karnofsky score (KPS) of 70 or more and with cured or controlled extracranial disease are the best candidates to surgical treatment. Irrespective of the extracranial disease control status, there are indications for surgery in patients with symptomatic mass effect (tumour diameter larger than 3 cm) and patients with obstructive hydrocephalus from their BMF-BC. Stereotactic radiosurgery (SRS) has some advantages over surgery, with similar effectiveness: it may be used in the treatment of lesions inaccessible to surgery, the number of lesion is not a limiting factor if each lesion is small (< 3) and adequate doses can be delivered, it is not contraindicated in patients with active extracranial disease, it does not interfere with ongoing systemic treatment, and it does not require general anaesthesia or hospitalisation. A disadvantage of SRS, as compared to whole brain radiotherapy (WBRT), in patients with BMF-BC is the possibility of subsequent development of new lesion in the non-irradiated field. Thus the majority of the BMF-BC patients are not good candidates to surgery or SRS; WBRT alone or combined with a systemic treatment still plays a major role in the treatment of these patient

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

Prognostic factors in Polish patients with BRCA1-dependent ovarian cancer

Background: Treatment outcomes appear to be better for ovarian cancer (OC) patients carrying the BRCA1/2 germline mutation than for patients with sporadic OC. However, most published data are for North American, British and Jewish populations. There have been very few studies on treatment outcomes in Central and Eastern European patients with OC. The aim of this study was to analyse prognostic factors in Polish patients with BRCA1-dependent OC (BRCA1-OC). Methods: The records of patients with OC treated with surgery and chemotherapy at the Centre of Oncology in Kraków, Poland, between 2004 and 2009 were reviewed. Based on family history, a group of 249 consecutive patients fulfilling the criteria for risk of hereditary OC were selected and tested for the germline BRCA1 mutation. Response to combination therapy (surgery and chemotherapy) in the BRCA1-OC group was assessed based on clinical examination, imaging and serum CA125. Results: Germline BRCA1 mutations were detected in 69 of the 249 patients, but three of these patients failed to complete the study. Finally, 66 patients with BRCA1-OC were included in the study group. The median age of the study patients was 49.5 years. All had undergone primary or interval cytoreductive surgery and chemotherapy. Progression occurred in 48 (72.7 %) of the 66 patients and median time to progression was 20 months. The 5-year overall survival rate in was 43.9 % and median survival time was 32.3 months. On multivariate analysis, the endometrial subtype of OC and serum CA125 < 12.5 U/ml at the end of treatment were independent, positive prognostic factors for 5-year overall survival. Conclusion: Prognostic factors for favourable treatment outcomes in Polish patients with BRCA1-OC do not appear to differ from those in patients with sporadic OC. The incidence of the endometrial subtype of OC was relatively high (34.9 %) among women in the study. This was unexpected and has not been reported previously. This subtype of OC was an independent prognostic factor for favourable treatment outcomes

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

Management of extremity soft tissue sarcomas

Postępowaniem z wyboru u chorych na mięsaki tkanek miękkich kończyn w stopniach zaawansowania I-III jest oszczędzający narząd zabieg chirurgiczny (LSS) skojarzony z pooperacyjnym napromienianiem, najczęściej teleradioterapią. Wyniki uzyskane tą metodą leczenia są porównywalne z wynikami radioterapii przed- lub śródoperacyjnej. Dotychczas jednoznacznie nie ustalono roli leczenia systemowego w tej grupie chorych. Przegląd piśmiennictwa wskazuje, że chemioterapia u części leczonych wydłuża czas do wystąpienia wznowy miejscowej, ale nie ma znamiennego wpływu na czas przeżycia całkowitego. U chorych z nowotworem w IV stopniu zaawansowania chemioterapia jest wyłącznie postępowaniem paliatywnym.Limb sparing surgery and adjuvant radiation therapy is the treatment of choice in patients with soft tissue sarcomas of extremities, stages I-III. The results obtained by preoperative or intraoperative irradiation are judged to be similar, as compared to postoperative radiotherapy. The role of chemotherapy in this group of patients remains controversial, analysis in the literature demonstrates that its use as an adjunct to local therapies may prolong a time to relapse but does not give a benefit in overall survival. In stage IV patients, chemotherapy plays a palliative role only

Combined therapy of patients with uterine sarcomas – evaluation of treatment results and analysis of prognostic factors

Objectives: The aim of the study was to assess the efficacy of combined therapy (surgery plus radiotherapy) and reasons of treatment failure in patients with uterine sarcoma. Material and methods: The analyzed clinical material involved 95 patients with uterine sarcoma (US) treated in the Cracow Branch of the Center of Oncology between 1980 and 1999. The studied group consisted of 70 patients with leiomyosarcoma (LS) and 25 patients with endometrial stromal sarcoma (ESS). Seventy-three women were diagnosed with stage I and II and 22 with stage III and IVA US. All patients in this group underwent radical hysterectomy with salpingooophorectomy followed by postoperative irradiation consisting of vaginal brachytherapy and external beam radiotherapy of the small pelvic area. Results: Out of 95 patients in the tested group, 46 (48.4%) patients survived 5 years with no evidence of disease. In the group of early-stage US there were 60.3% 5-year disease-free survivals. None of 9 patients with stage IVA was cured. In 36 among 47 uncured patients (76.6%) distant metastases was found. Conclusion: Combined surgery plus radiotherapy treatment was effective therapy in patients with early-stage US, nevertheless, it was ineffective in the group with advanced US, as none of the 9 patients with grade IVA was cured. The basic cause of treatment failure in the LS group was the spread of malignancy, whereas in the ESS group – locoregional recurrence.Cel: Celem pracy była ocena skuteczności leczenia skojarzonego (chirurgia + napromienianie) i analiza przyczyn niepowodzenia leczenia chorych na mięsaka macicy. Materiał i metody: Przeprowadzono analizę materiału klinicznego obejmującego 95 chorych na mięsaka macicy (MM) leczonych w Centrum Onkologii, Oddział Kraków w latach 1980-1999. W skład badanej grupy weszło 70 chorych na leiomyosarcoma (LS) oraz 25 chorych na endometrial stromal sarcoma (ESS). U 73 pacjentek rozpoznano MM w I i II, a u 22 w III i IVA stopniu zaawansowania. W badanej grupie u wszystkich chorych wykonano zabieg radykalnego usunięcia macicy wraz z przydatkami, a następnie przeprowadzono uzupełniające pooperacyjne napromienianie składające się z brachyterapii dopochwowej i teleradioterapii terenu miednicy mniejszej. Wyniki: Spośród 95 chorych z badanej grupy 5 lat bez objawów nowotworu przeżyło 46, tzn. 48,4% chorych. W grupie osób z niezaawansowanym MM uzyskano 60,3% bezobjawowych przeżyć 5-letnich. Skojarzone leczenie chirurgiczne z pooperacyjnym napromienianiem okazało się nieskuteczne w grupie chorych na zaawansowanego MM – nie wyleczono żadnej spośród 9 chorych w IVA stopniu zaawansowania. U 36 spośród 47 chorych (76,6%) z niewyleczonym procesem nowotworowym stwierdzono przerzuty odległe. Wnioski: Skojarzone leczenie chirurgiczne z pooperacyjnym napromienianiem było skuteczne u chorych na niezaawansowanego MM, natomiast u chorych na zaawansowanego MM skojarzone leczenie okazało się nieskuteczne, ponieważ żadna z 9 chorych na MM w stopniu IVA nie została wyleczona. Głównym powodem niepowodzenia leczenia w grupie chorych na LS były przerzuty odległe, a w grupie chorych na ESS – wznowa lokoregionalna

Detection and Removal of Priority Substances and Emerging Pollutants from Stormwater: Case Study of the Kołobrzeska Collector, Gdańsk, Poland

Progressive urban development affects environmental balance and disrupts the hydrologic cycle, in which rainfall plays a significant role. Since rainwater is considered a valuable resource of the environment, many technical solutions are implemented that enable effective rainwater management. On the other hand, stormwater runoff from urban areas contains numerous (also toxic) substances, and therefore should be properly treated. In this study, a multistage constructed wetland (MCW) pilot installation was used to remove selected groups of priority substances and emerging pollutants from rainwater discharged from the urbanized catchment of the Kołobrzeska stormwater collector in Gdańsk, Poland. The obtained results show that rainwater runoff was characterized by a variable concentrations of heavy metals (Zn, Cd, Cu, Ni, Pb, Hg), polycyclic aromatic hydrocarbons (benzo(a)pyrene, benzo(b)fluoranthene, phenanthrene, fluoranthene and pyrene) and microplastics. Depending on the hydraulic load of the bed, the reduction efficiency for heavy metals ranged from 26.19 to 100%, and for microplastics from 77.16 to 100%, whereas for polycyclic aromatic hydrocarbons it was consistently high, and equaled 100%

Uterine sarcomas : an evaluation of treatment results and prognostic factors

Introduction: The objective of this study was to evaluate the efficacy of surgery plus adjuvant radiotherapy in 98 uterine sarcoma (US) patients and to analyse reasons for treatment failure and the prognostic factors in those patients. Material and methods: Between 1980 and 2000, 98 patients with uterine sarcoma were treated with surgery followed by postoperative radiotherapy. This group consisted of 70 patients with leiomyosarcoma (LMS) and 28 patients with endometrial stromal sarcoma (ESS). Results: Five-year survival rate with no evidence of disease (NED) was 49% for 98 US patients. In the ESS subgroup, 5 year survival rate with NED was 75% and in the LMS subgroup only 38.6%. Analysis of the outcomes based on stage of disease revealed that in the early stage group (FIGO stages I and II) 60.8% of US patients survived for 5 years with NED, whereas in locally advanced stages (stages III, IVA) only 12.5% survived for 5 years with NED. In the LMS subgroup the dominant reason for treatment failure was distant metastases, while in the ESS subgroup, there were locoregional recurrences. Conclusions: Combined surgery plus radiotherapy was a relatively effective therapy only in the treatment of early stage US (stages I and II). Independent prognostic factors in this group of patients were stage and microscopic type of sarcoma. The basic reason for failure of combined treatment in the group of LMS patients was the spread of malignancy, while in ESS patients it was regional recurrence

Detection and Removal of Priority Substances and Emerging Pollutants from Stormwater: Case Study of the Ko&#322;obrzeska Collector, Gda&#324;sk, Poland

Progressive urban development affects environmental balance and disrupts the hydrologic cycle, in which rainfall plays a significant role. Since rainwater is considered a valuable resource of the environment, many technical solutions are implemented that enable effective rainwater management. On the other hand, stormwater runoff from urban areas contains numerous (also toxic) substances, and therefore should be properly treated. In this study, a multistage constructed wetland (MCW) pilot installation was used to remove selected groups of priority substances and emerging pollutants from rainwater discharged from the urbanized catchment of the Ko&#322;obrzeska stormwater collector in Gda&#324;sk, Poland. The obtained results show that rainwater runoff was characterized by a variable concentrations of heavy metals (Zn, Cd, Cu, Ni, Pb, Hg), polycyclic aromatic hydrocarbons (benzo(a)pyrene, benzo(b)fluoranthene, phenanthrene, fluoranthene and pyrene) and microplastics. Depending on the hydraulic load of the bed, the reduction efficiency for heavy metals ranged from 26.19 to 100%, and for microplastics from 77.16 to 100%, whereas for polycyclic aromatic hydrocarbons it was consistently high, and equaled 100%