Possibilities of using radiotherapy in the treatment of vaginal recurrence in patients with uterine cancers

A major problem in cancer treatment is disease recurrence, i.e. a situation in which the standard procedures turned out to be ineffective and the previously used therapy significantly limits its next use. Vaginal recurrence is found in 2.4–15% of patients with uterine cancer. For large recurrent tumors radical treatment involves surgical pelvic exenteration. However, indications for this procedure are significantly limited; in addition, it is associated with a high risk of complications and a significantly compromised quality of life. For this reason, brachytherapy and/or another course of radiotherapy are administered, which until recently were used as a further-line treatment option or as palliative care. Over the last few years extension of indications for radiotherapy and brachytherapy has been noted due to the dynamic development of new techniques for planning and conducting treatment. These allow for the irradiation of the target volume which causes radiation-related reactions that are acceptable for the patient while protecting critical organs. The introduction of new therapeutic devices allowed for the use of different treatment techniques, including intensity-modulated radiation therapy, image-guided radiotherapy, RapidArc, tomotherapy, intraoperative radiotherapy and stereotactic body radiotherapy, which contributed to a significant increase in the role of repeat radiotherapy. One needs to remember about the possibilities of systemic treatment, although it is usually palliative in nature. Brachytherapy may be considered for the treatment of recurrent disease if the lesions are located in the region of the vagina or vaginal stump or if infiltration is found in the parametria; in other situations treatment combined with external beam radiotherapy should always be considered. The choice of brachytherapy method depends on the location of the lesion and the extent of infiltration. If the infiltration is up to 5 mm deep, intracavitary brachytherapy is performed. If the infiltration is deeper, the use of interstitial brachytherapy is indicated

The analysis of the level of Treg lymphocytes in the blood of patients with endometrial cancer before and after the surgery — preliminary study

Introduction. The progression of cancer is a complex process involving host-tumour interactions taking place in cancer and in the cancer microenvironment. The tumour remodels the microenvironment into the suppressive profile by various mechanisms. One of the most important elements of this mechanism is the inducing of the infiltration of Treg lymphocytes into cancer and its microenvironment. The aim of the present study was to evaluate the alterations of the Treg cell population in the peripheral blood of patients before and after the surgical treatment for endometrial cancer. Material and methods. For the present study 24 patients with endometrial cancer were recruited. All the patients were treated surgically. The peripheral blood samples were collected from the endometrial cancer patients before operation and three days after the surgical procedure and evaluated using flow cytometry method. Results. CD25+ CD4+ FOXP3+ T cells were found in all the examined peripheral blood samples derived from the endometrial cancer patients in the days before and following applied surgery. We observed differences before and after the applied surgical procedure in patients treated for uterine cancer. The highest number of Treg cells in the peripheral blood was demonstrated before the surgical procedure; it diminished statistically significantly following the surgery. Conclusions. The decrease of the percentage of Treg cells in blood sera in patients following radical surgical treatment might be useful in measuring the radicalism of the treatment. The monitoring of the level of selective immune system suppression related to Treg cell blood serum levels during cancer therapy might support a decision to supplement the standard therapy with immunotherapy or to increase the degree of radicalism of the applied therapy.

Fertility impairment in radiotherapy

Infertility as a result of antineoplastic therapy is becoming a very important issue due to the growing incidence of neoplastic diseases. Routinely applied antineoplastic treatments and the illness itself lead to fertility disorders. Therapeutic methods used in antineoplastic treatment may cause fertility impairment or sterilization due to permanent damage to reproductive cells. The risk of sterilization depends on the patient’s sex, age during therapy, type of neoplasm, radiation dose and treatment area. It is known that chemotherapy and radiotherapy can lead to fertility impairment and the combination of these two gives an additive effect. The aim of this article is to raise the issue of infertility in these patients. It is of growing importance due to the increase in the number of children and young adults who underwent radiotherapy in the past. The progress in antineoplastic therapy improves treatment results, but at the same time requires a deeper look at existential needs of the patient. Reproductive function is an integral element of self-esteem and should be taken into account during therapy planning