Partial breast irradiation

Za delno obsevanje dojke se v zadnjem desetletju povečuje zanimanje in je predmet številnih raziskav. V primerjavi s standardnim obsevanjem, ki lahko traja 5–7 tednov, je njegova prednost predvsem v krajšem zdravljenju, ki traja le 1–3 tedne. Kot že ime pove, se po operaciji obseva le manjši del dojke in sicer področje ležišča tumorja z varnostnim robom. Zaenkrat se na takšen način zdravi bolnice le znotraj nadzorovanih kliničnih raziskav, izven tega pa le kot možnost dopolnilnega obsevalnega zdravljenja za skrbno izbrano skupino bolnic.Throughout the last decade, partial breast irradiation has grown increasingly interesting and been the subject of numerous studies. Compared to standard irradiation which can take anywhere from 5 to 7 weeks, it bears the advantage of shorter treatment that lasts only from 1 to 3 weeks. As the term itself suggests, only a small part of the breast is irradiated following the surgical procedure, namely the area of the tumor bed and the surgical margin. For now, this method is only used in treating patients within the frameworks of controlled clinical research, while outside these frameworks it is only available to a carefully selected group of individuals as an optional supplementary irradiation treatment

Delno obsevanje dojke

Throughout the last decade, partial breast irradiation has grown increasingly interesting and been the subject of numerous studies. Compared to standard irradiation which can take anywhere from 5 to 7 weeks, it bears the advantage of shorter treatment that lasts only from 1 to 3 weeks. As the term itself suggests, only a small part of the breast is irradiated following the surgical procedure, namely the area of the tumor bed and the surgical margin. For now, this method is only used in treating patients within the frameworks of controlled clinical research, while outside these frameworks it is only available to a carefully selected group of individuals as an optional supplementary irradiation treatment.Za delno obsevanje dojke se v zadnjem desetletju povečuje zanimanje in je predmet številnih raziskav. V primerjavi s standardnim obsevanjem, ki lahko traja 5–7 tednov, je njegova prednost predvsem v krajšem zdravljenju, ki traja le 1–3 tedne. Kot že ime pove, se po operaciji obseva le manjši del dojke in sicer področje ležišča tumorja z varnostnim robom. Zaenkrat se na takšen način zdravi bolnice le znotraj nadzorovanih kliničnih raziskav, izven tega pa le kot možnost dopolnilnega obsevalnega zdravljenja za skrbno izbrano skupino bolnic

Obsevanje v globokem zadržanem vdihu po operaciji raka dojk

Breast cancer has high incidence and prevalence. Long-termcause-specific survival of breast cancer patients has increased overthe past decades primarily due to early detection, advanced surgical techniques, systemic therapy and new radiation techniques. Due to higher share of patients who receive radiation and longer survival,ever more patients risk the occurrence of late unwanted effects of the treatment. For the majority of patients, the benefits of radiation with lower chance of disease recurrence greatly surpass the risk of developing cardiovascular complications, the cumulative incidence of which increases with every received dose per heart. Preventing late heart damage has become an important part of comprehensive treatment of breast cancer patients. When planning the therapy, benefits of supplementary radiotherapy and potential risk of side effects are assessed for each patient individually by taking into account dose volume parameters of the radiotherapy plan and existing risk factors for cardiovascular disease, since the presence of these indicates higher absolute risk of late heart damage. The latest radiotherapy techniques are gaining importance, as they allow us to improve dose-volume parameters of radiotherapy plans. Deep inspiration breath-hold radiotherapy technique allows us to significantly lower the average dose of ionizing radiation received by the heart, lung, and liver compared to traditional radiation technique, while the radiation dose per planned target volume remains the same. When taking a deep breath, the diaphragm pulls the heart posteriorly, mediallyand inferiorly – away from the thoracic wall. Deep inspiration breath-hold radiotherapy technique is recommended for all patients with indications for radiation therapy after breast-conserving surgery or mastectomy of the left breast, with or without simultaneous radiation of local lymph nodes, in the event of unfavorable anatomy and when parasternal lymph nodes are included in the radiation field after cancer surgery of the right breast. This paper describes a new radiotherapy method – the deep inspiration breath-hold techniqueRak dojk ima visoko incidenco in prevalenco. Dolgoročno vzročno specifično preživetje bolnic z rakom dojk se je v zadnjih desetletjih izboljšalo predvsem zaradi zgodnjega odkrivanja, naprednih kirurških tehnik, sistemske terapije in novih tehnik obsevanja. Zaradi večjega deleža obsevanih bolnic in daljšega preživetja je več bolnic izpostavljenih tveganju za razvoj poznih neželenih učinkov zdravljenja. Za večino obsevanih bolnic je dobrobit obsevanja z zmanjšanim tveganjem ponovitve bolezni veliko večja od tveganja za razvoj poznih srčno-žilnih zapletov, katerih kumulativna incidenca se povečuje z vsako dodatno prejeto dozo na srce. Preprečevanje poznih okvar srca postaja pomemben del celostne obravnave bolnic z rakom dojk. Ob načrtovanju zdravljenja ocenjujemo koristi dopolnilnega obsevanja in možna tveganja za pojav neželenih učinkov za vsako posamezno bolnico: upoštevamo dozno-volumske parametre obsevalnega načrta in individualne že obstoječe dejavnike tveganja za srčno-žilne bolezni, saj prisotnost le teh napoveduje višje absolutno tveganje za pozno okvaro srca. Moderne obsevalne tehnike imajo vedno večji pomen, saj omogočajo izboljšanje dozno-volumskih parametrov obsevalnih načrtov. Obsevanje v globokem zadržanem vdihu v primerjavi s standardnim obsevanjem značilno zniža povprečno prejeto dozo ionizirajočega sevanja na srce, pljuča in jetra, ob sicer nespremenjeni obsevalni dozi, na planirni tarčni volumen v prsnem košu. Pri globokem vdihu trebušna prepona odmakne srce posteriorno, medialno in inferiorno: stran od stene prsnega koša. Obsevanje v globokem vdihu je priporočeno za vse bolnice, pri katerih obstaja indikacija za obsevanje po ohranitveni operaciji ali mastektomiji zaradi raka leve dojke z ali brez sočasnega obsevanja regionalnih bezgavk, v primeru neugodne anatomije in ko so po operaciji raka desne dojke v obsevalno polje zajete tudi parasternalne bezgavke. V prispevku je opisana nova metoda obsevanja - obsevanje v globokem zadržanem vdihu. ; slv - slovensk

The impact of high and low cardiac substructure dose levels on cardiac toxicity in lung and breast cancer radiotherapy

Izhodišča: Z daljšanjem preživetja bolnikov z rakom so srčno- -žilne bolezni postale pomemben del morbiditete in mortalitete teh bolnikov. V zadnjih letih je v literaturi veliko zanimanja na področju vpliva radioterapije na pozne posledice na srcu. Metode: Literaturo smo poiskali s pomočjo spletnega iskalnika PubMed / MEDLINE z uporabo kombinacij ustreznih ključnih besed. V postopku ocenjevanja smo preučili grobe rezultate iskanja in izključili članke, ki niso pomembni za to temo. Upoštevali smo le literaturo v angleškem jeziku. Rezultati: Objavljene so različne doznovolumske omejitve na srce v povezavi s srčno-žilnimi obolenji in smrtnostjo, vendar te omejitve niso enotno veljavne. Pri dopolnilnem obsevanju raka dojk je celotno srce izpostavljeno nizki dozi in se pomembne srčne okvare najpogosteje izrazijo desetletje po zdravljenju ali še pozneje, pri visokodozni izpostavljenosti pri radikalnem obsevanju pljuč pa se smrtnost zaradi srčno-žilnih dogodkov poveča že v prvih letih po zdravljenju. Zaključek: Z nižanjem doze na srce lahko še dodatno vplivamo na preživetje bolnikov po obsevanju, kar nam že omogočajo boljše obsevalne tehnike in slikovno vodena radioterapija. Dodatno korist lahko dosežemo še z boljšim razumevanjem in upoštevanjem vpliva obsevanja na posamezne srčne strukture, tudi v povezavi z pridruženimi boleznimi, in z usmerjenim kardiološkim spremljanjem bolnikov po obsevanju prsnega koša.Background: With improved survival outcomes for patients with cancer, cardiovascular disease has become an important part of morbidity and mortality. In recent years, there has been much interest in the literature on the impact of radiotherapy on late cardiac toxicity. Methods: Published manuscripts were identified through a PubMed/MEDLINE search of the National Library of Medicine using combinations of relevant keywords. In the evaluation round, we examined rough search results and excluded articles not relevant for the topic. We considered only English language literature. Results: Various cardiac dose-volume constraints have been reported in association with cardiovascular events and mortality, but without consistent constraints. Low-dose heart exposure in adjuvant breast cancer radiotherapy can lead to important cardiac events a decade or more after treatment. However, in radical lung cancer radiotherapy, high-dose heart exposure can lead to increased cardiovascular mortality in the first few years after treatment. Conclusion: We can further influence the survival of patients with cancer after chest irradiation by lowering the absorbed dose to the heart, which is already made possible by better irradiation techniques and image-guided radiotherapy. Additional benefits can be gained by better understanding and considering the impact of radiation on individual cardiac structures, also in connection with other patients’ comorbidities, and by the close cardiac follow-up of patients after chest radiation therapy

Karcinoza možganskih ovojnic in rak dojk: 11-letni rezultati zdravljenja z obsevanjem

Introduction: Leptomeningeal carcinomatosis (LMC) develops with infiltration of leptomeninges by malignant cells and means poor prognosis. Radiotherapy presents one of the treatment options for neurological symptom relief. Methods: We retrospectively analyzed 423 patients with breast cancer (BC) and brain metastasis (BM) or LMC, who received radiotherapy of the brain between the years 2005–2015 at the Institute of Oncology Ljubljana. We analyzed patients with LMC in more detail and performed a validation of prognostic survival indexes, namely Breast Graded Prognostic Assessment (Breast-GPA) and Simple Survival Score for Brain Metastases (SS-BM). Results: Seventy patients with LMC were treated with whole-brain radiotherapy in observed time. Median time from BC diagnosis to LMC appearance was 4,3 years and was shortest in triple-negative and longest in luminal A BC subtype. Median overall survival for patients with BM and LMC was 7,5 (95 % confidence interval, CI; 6,3–8,8) and 2,3 months (95 % CI; 1,5–3,2), respectively (p < 0,005), and it varied depending on molecular BC subtype. Survival was not affected by a higher total dose of radiation received (≤ 20 Gy vs. > 20 Gy) or by the immediate start of radiotherapy within two weeks from LMC diagnosis. Breast-GPA (p < 0,005) and SS-BM (p = 0,044) indexes predicted survival with statistical significance. Conclusions: Performance status, BC molecular subtype, time from LMC diagnosis till the start of radiotherapy and prognostic indexes were all factors which influenced expected survival in our group of analyzed LMC patients.Uvod: Karcinoza mening (LMK) nastane z zasevanjem tumorskih celic na možganske ovojnice in pomeni slabo prognozo. Obsevanje je ena izmed možnosti zdravljenja za ublažitev nevroloških simptomov. Metode: V retrospektivno analizo smo vključili 423 bolnic z rakom dojk (RD) in možganskimi zasevki (MZ) ali LMK, ki so se v obdobju med 2005 in 2015 z obsevanjem glave zdravile na Onkološkem inštitutu Ljubljana. Podrobneje smo analizirali skupino bolnic z LMK, za katere smo tudi preverili uporabnost prognostičnih indeksov preživetja Breast Graded Prognostic Assessment (Breast-GPA) in Simple Survival Score for Brain Metastases (SS-BM). Rezultati: Z obsevanjem glave smo v analiziranem obdobju zdravili 70 bolnic z LMK. Srednji čas od diagnoze RD do pojava LMK je znašal 4,3 leta, vendar je bil ta čas najkrajši pri trojno negativnem in najdaljši pri luminal A podtipu RD. Srednje celokupno preživetje je za bolnice z MZ in LMK znašalo 7,5 (95 % interval zaupanja, IZ; 6,3–8,8) ter 2,3 meseca (95 % IZ; 1,5–3,2) (p < 0,005), in se je razlikovalo tudi glede na molekularni podtip RD. Na daljše preživetje ni vplivala višja prejeta doza obsevanja (≤ 20Gy vs. > 20Gy), kakor tudi ne hiter pričetek obsevanja znotraj prvih dveh tednov po postavitvi diagnoze LMK. Indeksa Breast-GPA (p < 0,005) in SS-BM (p = 0,044) sta statistično značilno napovedala razlike v preživetju. Zaključki: Pričakovano preživetje se je v naši skupini analiziranih bolnic z LMK razlikovalo glede na stanje zmogljivosti, molekularni podtip RD, čas od diagnoze LMK do pričetka z obsevanjem ter točke prognostičnih lestvic