Protokół terapeutyczny w dokumentowaniu procesu napromieniania pacjentów w zakładzie radioterapii

SummaryA decision to start radiotherapy should be based on at least two documents:1.Written standards of obligatory clinical procedures which are in fact radiotherapeutic schemes.2.Therapeutic protocols describing all mandatory procedures performed to ensure a safe and proper treatment of the patient.The range of activities described in the therapeutic protocol is very wide.It includes all initial procedures implemented in the simulation room, the CT scanner, in the treatment planning system and the mould- room, and it describes the verification process of the treatment plan, mandatory to start radiotherapy.The therapeutic protocol describes in details what and how should be checked by an internal control system and it qualifies the demands required to sum up the treatment and its’ accordance with the planned radiotherapy scheme.All the activities performed are recorded in a QA protocol, which is an integral part of the therapeutic protocol.In this paper we present the therapeutic protocol in force in the Regional Oncological Hospital in Szczecin and the QA and in-vivo protocols, which assure safe radiotherapy of the patient

A radiotherapy protocol to document the process of irradiation of patients at the radiotherapy department

A decision to start radiotherapy should be based on at least two documents:1.Written standards of obligatory clinical procedures which are in fact radiotherapeutic schemes.2.Therapeutic protocols describing all mandatory procedures performed to ensure a safe and proper treatment of the patient.The range of activities described in the therapeutic protocol is very wide.It includes all initial procedures implemented in the simulation room, the CT scanner, in the treatment planning system and the mould- room, and it describes the verification process of the treatment plan, mandatory to start radiotherapy.The therapeutic protocol describes in details what and how should be checked by an internal control system and it qualifies the demands required to sum up the treatment and its’ accordance with the planned radiotherapy scheme.All the activities performed are recorded in a QA protocol, which is an integral part of the therapeutic protocol.In this paper we present the therapeutic protocol in force in the Regional Oncological Hospital in Szczecin and the QA and in-vivo protocols, which assure safe radiotherapy of the patient

Therapeutic Drug Monitoring of Tacrolimus Based on Volumetric Absorptive Microsampling Technique (VAMS) in Renal Transplant Pediatric Recipients—LC-MS/MS Method Development, Hematocrit Effect Evaluation, and Clinical Application

Tacrolimus (TAC) is post-transplant pharmacotherapy’s most widely used immunosuppressant. In routine clinical practice, frequent uncomfortable venipuncture is necessary for whole-blood (WB) collection to check trough TAC levels. Volumetric absorptive microsampling (VAMS) is an alternative strategy to WB collection. In this study, we aimed to validate and develop a liquid chromatography–tandem mass spectrometry (LC-MS/MS) method for TAC quantification in WB and VAMS samples. After extraction with water and protein precipitation, the samples were directly analyzed using LC-MS/MS. Whole-blood and VAMS capillary-blood samples were collected from 50 patients treated with TAC during the follow-up visits. The cross-correlation between the developed methods was evaluated using Passing–Bablok regression and a Bland–Altman bias plot. The matrix effect (ME) and carry-over were insignificant for both scenarios. There was a high correlation between the processes and no significant clinical deviation. LC-MS/MS methods were successfully developed and validated in the 0.5–60 ng/mL calibration range. This study demonstrated and confirmed the utility of VAMS-based TAC monitoring in the pediatric population. This is the first study to directly develop and validate the VAMS LC-MS/MS method for evaluating the hematocrit effect in the pediatric population. The statistical correlation between immunochemical and VAMS-based methods was satisfactory

Analiza czynników rokowniczych u chorych z miejscowo zaawansowanym rakiem krtani

Purpose. Results of treatment of locally advanced larynx cancer T3-4No-4 are unsatisfied. The aim of study is analysis of risk factors. Methods and Materials. 112 patients with larynx cancer after radical surgical treatment had postoperative radiotherapy (conventional or accelarated). Results. The 3-year overall survival (OS) was 58%. Margin status and numer of risk factors had impast on OS. The 3-year locoregional control (LRC) was 80%. Number of risk factors, level of hemoglobin, overall treatment time and dose were significantly associated with LRC. Incidence of distant metastases was asssociated with G3 suamous cell carcinoma and index of nalignancy H. Glanz

Risk factors for seroma evacuation in breast cancer patients treated with intraoperative radiotherapy

BackgroundNovel techniques in oncology provide new treatment opportunities but also introduce different patterns of side effects. Intraoperative radiotherapy (IORT) allows a shortened overall treatment time for early breast cancer either combined with whole breast radiotherapy (WBRT), or alone. Although the early side effects of IORT are well known, data on clinically important late side effects, which require medical intervention, are scarce.AimIn this study, we analyze risk factors for seroma evacuation more than 6 months after IORT.Materials and methodsWe evaluated 120 patients with a mean follow-up of 27.8 months (range: 7–52 months). Fifty-one patients received IORT only and 69 were additionally treated with WBRT.ResultsSeroma evacuation was performed 6–38 months after IORT. Two (3.9%) events were observed in the IORT group and 14 (20%) in the IORT[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]WBRT group. Univariate (Kaplan–Meier) analysis showed that addition of WBRT to IORT increased the risk of seroma evacuation [hazard ratio[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]5.5, 95% confidence interval: 2.0–14.7, P[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.011]. In a multivariate analysis (Cox proportional hazards regression), WBRT and axillary lymph node dissection were significant risk factors for seroma evacuation (model P value[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.0025).ConclusionsWBRT applied after IORT is associated with increased risk of seroma evacuation, which might be considered as a late side effect

Hyperparathyroidism is an independent risk factor for allograft dysfunction in pediatric kidney transplantation

INTRODUCTION: Little is known about the consequences of deranged chronic kidney disease–mineral and bone disorder (CKD-MBD) parameters on kidney allograft function in children. We examined a relationship between these parameters over time and allograft outcome. METHODS: This registry study from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) collected data at baseline, months 1, 3, 6, 9, and 12 after transplant; and every 6 months thereafter up to 5 years. Survival analysis for a composite end point of graft loss or estimated glomerular filtration rate (eGFR) ≤30 ml/min per 1.73 m(2) or a ≥50% decline from eGFR at month 1 posttransplant was performed. Associations of parathyroid hormone (PTH), calcium, phosphate, and 25-hydroxyvitamin D (25(OH)D) with allograft outcome were investigated using conventional stratified Cox proportional hazards models and further verified with marginal structural models with time-varying covariates. RESULTS: We report on 1210 patients (61% boys) from 16 European countries. The composite end point was reached in 250 grafts (21%), of which 11 (4%) were allograft losses. In the conventional Cox proportional hazards models adjusted for potential confounders, only hyperparathyroidism (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.82–4.74) and hyperphosphatemia (HR, 1.94; 95% CI, 1.28–2.92) were associated with the composite end point. Marginal structural models showed similar results for hyperparathyroidism (HR, 2.74; 95% CI, 1.71–4.38), whereas hyperphosphatemia was no longer significant (HR, 1.35; 95% CI, 0.87–2.09), suggesting that its association with graft dysfunction can be ascribed to a decline in eGFR. CONCLUSION: Hyperparathyroidism is a potential independent risk factor for allograft dysfunction in children

Metabolic syndrome is associated with similar long-term prognosis in non-obese and obese patients. An analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 cohort studies

Aims We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. Methods The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006 and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III) and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS and obese patients with MetS. Differences in all-cause mortality was analyzed using Kaplan-Meier and Cox regression analyses. Results 45,615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14,202 (31%) by NCEP/ATP III criteria, and 17,216 (37.7%) by JIS criteria. Follow-up was available for 44,620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese (hazard ratio, HR: 1.88 [95% CI, 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively) and non-obese individuals (HR: 2.11 [95% CI 1.85-2.40] and 1.7 [95% CI, 1.56-1.85] according to NCEP/ATP III and JIS criteria respectively). Obese patients without MetS had a higher mortality risk than non-obese patients without MetS (HR: 1.16 [95% CI 1.10-1.23] and HR: 1.22 [95%CI 1.15-1.30], respectively in subgroups with NCEP/ATP III and JIS criteria applied). Conclusions MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised