Radiotherapy and immunotherapy

Radiation therapy is one of the standard treatment method in cancer patients. Apart from exerting the killing effect towards cancer cells it produces modulation effect on local and systemic disease. Recently, immunotherapy, aiming mainly to immune checkpoint blockade, has become widely used in many clinical situations. Experimental and clinical studies indicate that the combination of both radiation therapy and immunotherapy may be beneficial in cancer patient population in different clinical scenarios. Durvalumab maintenance therapy after radiochemotherapy in stage III NSCLC patients was introduced to the standard clinical care. The paper discusses shortly the pathogenesis of the mutual interaction between radiation therapy and immunotherapy as well available preclinical and clinical data concerning this promising treatment combination

Radiotherapy and immunotherapy

Radiation therapy is one of the standard treatment methods for cancer patients. Apart from killing cancer cells, it produces a modulation effect on local and systemic disease. Recently, immunotherapy, aiming mainly to immune checkpoint blockade, has become widely used in many clinical situations. Experimental and clinical studies indicate that the combination of both radiation therapy and immunotherapy may be beneficial in the cancer patient population in different clinical scenarios. Durvalumab maintenance therapy after radiochemotherapy in stage III non-small-cell lung cancer (NSCLC) patients was introduced to standard clinical care. The paper discusses the pathogenesis of the mutual interaction between radiation therapy and immunotherapy, as well available preclinical and clinical data concerning this promising treatment combination

Methods of anatomical and metabolic imaging in head and neck region tumors

The incidence of head and neck cancer (HNC) ranges from 5.5% to 6.2% of general cancer incidence in Poland as well as in other European countries and in the US. Precise evaluation of the clinical stage in this group of patients allows for personalized treatment, inter alia, to choose proper surgery technique, to plan and verify radiation therapy. It is a result of availability of wide spectrum of imaging methods currently used in oncology. These methods are also used in the suitable assessment of antineoplastic therapy effects, which gives the chance of early detection of cancer progression. Methods of imaging diagnostics — anatomical and metabolic — differ in terms of sensitivity, specificity and diagnostic accuracy. Each of them has advantages and disadvantages in imaging of HNC, hence, choice of treatment method should not be made based on single imaging modality. Increasingly, information obtained from alternative imaging studies support optimal decision in everyday clinical practice. This review describes clinical usefulness of currently available morphological and metabolic imaging methods in HNC patients, with particular emphasis on innovative technologies, like PET/MR hybrid

Hippocampal sparing in brain radiotherapy

Radiotherapy is one of the principal methods for treating brain cancer. Over recent years, a decline in patient quality of life has increasingly been observed in those undergoing brain irradiation, where hippocampal-dependent cognitive function has become impaired. The hippocampus is a paired structure of the limbic system situated in the medial temporal lobes of the telencephalon. Preliminary findings suggest that irradiation damaged neural stem cells in the hippocampus undergo apoptosis, resulting in deteriorating cognitive function. Despite the technical aspects for affording hippocampal avoidance during irradiation, much controversy still surrounds the techniques that shield the hippocampus without reducing the benefits of the intended radiotherapy for a given clinical condition. Furthermore, a tolerated radiation dose sufficient for preserving neural stem cell function has not been yet established. Delivering a method for an unequivocal assessment of cognitive function, post-irradiation, is also fraught with difficulty. Hitherto, only subjective psychological testing have been applied such as MMSE, HVLT or AVLT methods. Objective methods for optimally determining radiation-induced injury to the hippocampal region are still being investigated.

Quality of nursing care of colorectal cancer patients undergoing first line palliative chemotherapy — a questionnaire study in a single institution in Poland

Background. The diagnosis of colorectal cancer initiates a process of dealing with the disease and various treatments. An effective psycho-social help from a specialized nurse can alleviate suffering and improve the quality of a patient’s life. The purpose of the study was to evaluate the quality of nursing care provided to patients undergoing first line cytotoxic treatment for metastatic colorectal cancer (mCRC). Material and methods. The study group consisted of 50 mCRC patients diagnosed at an advanced stage of the disease, who underwent first line palliative chemotherapy at the Department of Clinical Oncology in Comprehensive Cancer Centre in Bialystok, Poland. The method of survey was a diagnostic poll with a questionnaire prepared especially for the study. Results. The nursing care was assessed as efficient. Metastatic CRC patients consider nurses as trustworthy, highly qualified, supportive, informative and communicative. The patients experienced psychological comfort and emotional support during the treatment. Conclusions. The study exhibited that changes in medical care model are crucial to further improve the quality of nursing care at the Department of Clinical Oncology. One of the concepts is to increase the number of nurses working (employed) int the ward which would give them opportunities and time to pay more attention to particular mCRC patients and, a possibility to create good, positive atmosphere in the ward to make the patients more willing to ask for help. Adv. Pall. Med. 2011; 10, 2: 65–72Background. The diagnosis of colorectal cancer initiates a process of dealing with the disease and various treatments. An effective psycho-social help from a specialized nurse can alleviate suffering and improve the quality of a patient’s life. The purpose of the study was to evaluate the quality of nursing care provided to patients undergoing first line cytotoxic treatment for metastatic colorectal cancer (mCRC). Material and methods. The study group consisted of 50 mCRC patients diagnosed at an advanced stage of the disease, who underwent first line palliative chemotherapy at the Department of Clinical Oncology in Comprehensive Cancer Centre in Bialystok, Poland. The method of survey was a diagnostic poll with a questionnaire prepared especially for the study. Results. The nursing care was assessed as efficient. Metastatic CRC patients consider nurses as trustworthy, highly qualified, supportive, informative and communicative. The patients experienced psychological comfort and emotional support during the treatment

Pathophysiological basis of combination of radiotherapy and therapy directed to EGFR inhibition

Radiotherapy plays an import ant role in the treatment of cancer patients. Frequently failure of the treatment (locoregional progression) is observed. Overactivity of EGFR-depentent intracellular signaling contributes to tumor progression and radioresistance. Therapeutic strategies aimed at inhibition EGFR activity are an attractive perspective in terms of increasing radiosensitivity of neoplastic cells. Numerous experimental studies allowed for identification of several mechanisms underlying local tumor control after combinainterfetion of radiotherapy and therapy directed to EGFR inhibition, including: direct kill of cancer stem cells by EGFR inhibitors, cellular radiosensitization through modified signal transduction, inhibition of radiation induced-DNA damage repair, reduced repopulation or improved reoxygenation of tumor cells during fractionated radiotherapy. Clinical effects of the combined treatment are heterogeneous and depend among others on histopathological type of cancer, type of administered EGFR inhibitor, its dosage, and treatment sequence. To date, mechanism underlying these variations are not well understood. Predictive factors of such combined treatment are scant. Additional studies aimed at better understanding of efficacy and mechanisms of activity of radiotherapy combined with EGFR inhibitors with local control as an endpoint are warranted. Potential toxicity towards normal tissues of such treatment should be also assessed. Onkol. Prak. Klin. 2010; 6, 5: 255–263Radioterapia odgrywa ważną rolę w leczeniu chorych na nowotwory. Niejednokrotnie jednak obserwuje się niepowodzenia leczenia pod postacią progresji miejscowej i/lub regionalnej. Nadmierna aktywność szlaku przekaźnictwa wewnątrzkomórkowego zależnego od funkcji receptora czynnika wzrostu naskórka (EGFR) przyspiesza progresję nowotworu i przyczynia się do oporności na działanie promieniowania jonizującego. Strategie terapeutyczne polegające na interferowaniu z funkcją EGFR stanowią atrakcyjną perspektywę w kontekście zwiększenia wrażliwości komórek nowotworowych na cytotoksyczne działanie promieniowania jonizującego. W licznych badaniach eksperymentalnych zidentyfikowano różne mechanizmy leżące u podstaw poprawy miejscowej kontroli nowotworu po zastosowaniu radioterapii w skojarzeniu z terapią anty-EGFR, między innymi bezpośredni efekt toksyczny inhibitorów EGFR w stosunku do nowotworowych komórek macierzystych, efekt radiouczulający poprzez zmodyfikowanie przekaźnictwa wewnątrzkomórkowego, zahamowanie naprawy uszkodzeń DNA wywołanych działaniem energii jonizującej, zmniejszenie repopulacji komórek nowotworowych czy poprawę ich utlenowania pod wpływem radioterapii frakcjonowanej. Efekty kliniczne kojarzenia radioterapii i leczenia interferującego z aktywnością EGFR są zróżnicowane w zależności między innymi od typu histopatologicznego nowotworu, rodzaju zastosowanego leku, jego dawki oraz sekwencji leczenia. Dotychczas w pełni nie poznano mechanizmów tych odrębności. Brakuje też czynników predykcyjnych odpowiedzi na wymienione leczenie. Istnieje potrzeba przeprowadzenia dalszych badań nad skutecznością tej terapii skojarzonej, w których punktem końcowych byłaby miejscowa kontrola nowotworu. Ponadto ważne jest pełne poznanie mechanizmów interferowania obu metod leczenia oraz potencjalnej toksyczności tej terapii w stosunku do prawidłowych tkanek. Onkol. Prak. Klin. 2010; 6, 5: 255–26

Is AIO belly board device advantageous in all rectal cancer patients irradiated in the pelvic area?

Purpose. To compare the prone position on a flat table vs an “All in one” belly board device (AIO BBD) in rectal cancer patients (RCPs). Material and methods. Fifteen RCPs scheduled for irradiation were scanned in the two evaluated positions. After tomography, they completed a questionnaire concerning positioning. The dose-volume histograms (DVHs) for the small bowel and bladder were compared for both immobilization methods and setup accuracy was analyzed in electronic portal imaging devices (EPIDs) and X-ray volume imaging (XVI) procedures. Results. AIO BBD was accepted by the majority of RCPs and provided better DVHs for the small bowel than the prone position on a flat table. The setup reproducibility was within tolerance limit for patients with BMI ≤ 29 kg/m2. Patients with obesity regarded AIO BBD as uncomfortable and they presented mean setup shifts out of the tolerance limit in the Y axis — 5.9 mm. Conclusions. The AIO BBD should be recommended for RCPs, especially for those with BMI ≤ 29 kg/m2

Podstawy terapii antyangiogennej u chorych na nowotwory

New vessel formation facilitates local tumor progression and distant metastases formation. Angiogenesis is a very complex process, which demands well-coordinated activity of various factors during consecutive steps. The balance between pro- and antiangiogenic factors shifted towards the former ones is a prerequisite for the initiation of angiogenesis. VEGF is the most important factor contributing to the new vessel formation. Its biological activity depends on the presence and activity of different receptors, eg. VEGFR-2, VEGFR-1, neuropilin 1, Tie2 receptor system, ephrin system, etc. In experimental models blocking VEGF activity results in diminished interstitial pressure and improved cytotoxic drugs tissue penetration. In clinical settings, interfering with VEGF activity allowed for improved treatment outcomes in cancer patients. However, despite promising results, many questions remain opened, eg. the optimal selection of cancer patients for such a treatment, the way of therapy monitoring as well as the length of antiangiogenic treatment.Powstanie nowych naczyń krwionośnych w nowotworze umożliwia jego progresję miejscową i powstawanie przerzutów odległych. Angiogeneza jest niezwykle złożonym procesem, który wymaga skoordynowanej aktywności różnych czynników na poszczególnych jej etapach. Za pobudzenie angiogenezy odpowiada zaburzenie równowagi pomiędzy czynnikami stymulującymi i hamującymi ten proces na korzyść tych pierwszych. Najważniejszym czynnikiem wpływającym na tworzenie nowych naczyń krwionośnych jest czynnik wzrostu śródbłonka naczyń (VEGF). Aktywność angiogenna zależy od obecności i działania różnych receptorów i ich ligandów, między innymi VEGFR-2, VEGFR-1, neuropiliny 1, receptora Tie2, receptorów efryn. W badaniach doświadczalnych zahamowanie aktywności VEGF doprowadza do zmniejszenia ciśnienia śródtkankowego i poprawy penetracji cytostatyków do tkanek. W warunkach klinicznych zastosowanie strategii mających na celu interferowanie z aktywnością VEGF pozwoliło na poprawę wyników leczenia chorych na nowotwory. Pomimo zachęcających wyników terapii z wykorzystaniem leków antyangiogennych wciąż wiele pytań dotyczących tego sposobu postępowania pozostaje bez odpowiedzi, między innymi selekcja chorych do takiego leczenia, sposób monitorowania terapii czy czas trwania terapii antyangiogennej