Squamous cell oesophageal cancer in retinoblastoma survivor: does germinal RB1 mutation influence chemo- and radiosensitivity?

The case of complete response of squamous cell oesophageal cancer to radiochemotherapy in patient previously operated due to hereditary retinoblastoma is presented. Second cancers in retinoblastoma survivors are the main cause of death in that group of patients in developed countries. There is little data on the outcome of treatment in those patients but the few papers available suggest rather poor prognosis. However, it is not clear whether the biology of cancer determined by RB gene mutation is responsible for that. The data suggesting decreased radio- and chemoresistance in cancers with decreased RB gene expression is discussed in the present paper. The role of that gene in the response to cancer treatment was showed in lung, breast and bladder cancer. Moreover, laboratory studies seem to confirm clinical observations and show that RB gene inhibition leads to increased cytotoxic effect of cisplatin, etoposide and 5-fluorouracil. It seems that without the incorporation of gene expression profiling into clinical practice further improvement in cancer treatment will be difficult to achieve

Early closure of phase II prospective study on acute and late tolerance of hypofractionated radiotherapy in low-risk prostate cancer patients

AimTo assess acute and late toxicity of hypofractionated radiotherapy, its efficacy and impact on quality of life in patients with low-risk prostate cancer.Materials and methodsSince August 2006 to October 2007, 15 prostate cancer patients with favorable clinical features, aged 54–74 years (mean 67 years) entered the study. Tumor stage in the majority (73%) of patients was T2a, the mean pretreatment PSA value was 7.2[[ce:hsp sp="0.25"/]]ng/ml (range 5–10.9[[ce:hsp sp="0.25"/]]ng/ml). The study group was treated 3 times a week with 4[[ce:hsp sp="0.25"/]]Gy per fraction to the total dose of 60[[ce:hsp sp="0.25"/]]Gy within 5 weeks. 3D conformal treatment planning was used with no fiducial markers. Acute and late toxicity was evaluated using modified EORTC/RTOG/LENT scoring systems. Patients regularly filled the EORTC QLQ-PR25 questionnaires.ResultsAll patients completed radiotherapy according to the plan. During radiotherapy, 26% of patients had grade 1–2 rectal symptoms. The incidence of acute urinary toxicity score was 26%, 60%, and 14% for grade 0–1, 2 and 3, respectively. One year after RT, the incidence of grade 2 GI toxicity was 27%, which was the reason for an early closure of the accrual. Grade 2 late urinary toxicity was noted in 20% of patients. The mean PSA level was 0.61[[ce:hsp sp="0.25"/]]ng/ml after 24 months and 0.47[[ce:hsp sp="0.25"/]]ng/ml after 36 months (range: 0.06–1.54[[ce:hsp sp="0.25"/]]ng/ml).ConclusionsLow number of patients does not allow to determine the influence of hypofractionation on unsatisfactory tolerance of this regimen. Suboptimal (from the present day's perspective) target localization (no fiducial markers) could potentially explain higher than expected late GI reactions in our series

Tolerability and toxicity of prophylactic cranial irradiation in patients with non-small cell lung cancer – Results of a phase II study (with estimation of hematological toxicity, pituitary function and magnetic resonance spectra changes)

AimTo evaluate the tolerability and toxicity of PCI in patients with NSCLC.BackgroundProphylactic cranial irradiation (PCI) is a standard treatment for patients with small cell lung cancer. There are data showing a decreasing ratio of brain metastases after PCI for non-small cell lung cancer (NSCLC-non small cell lung cancer) patients but, so far, there is no evidence for increasing overall survival. The main concern in this setting is the tolerance and toxicity of the treatment.Materials and methodsFrom 1999 to 2007, 50 patients with NSCLC treated with radical intent underwent PCI (30[[ce:hsp sp="0.25"/]]Gy in 15 fractions). Mean follow-up was 2.8 years. The tolerability and hematological toxicity were evaluated in all patients, a part of participants had done neuropsychological tests, magnetic resonance imaging with 1H nuclear magnetic resonance spectra, and estimation of pituitary function.ResultsDuring follow-up, 20 patients developed distant metastases, 4-brain metastases. Fourteen (30%) patients had acute side effects: (headache, nausea, erythema of the skin). The symptoms did not require treatment breaks. Six patients complained of late side effects (vertigo, nausea, anxiety, lower extremity weakness, deterioration of hearing and olfactory hyperesthesia). Hematological complications were not observed. Testosterone levels tended to decrease (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.062). Visual-motor function deteriorated after treatment (p[[ce:hsp sp="0.25"/]