Radiotherapy- radiobiological and fiscal bases, therapy of breast cancer

Radioterapija ima objedinjavajuću ulogu u kurativnom liječenju raka dojke. Nakon poštednog operativnog zahvata intraduktalnog ili invazivnog karcinoma dojke, radioterapija jamačno produžuje razdoblje bez lokoregionalnih znakova bolesti i poboljšava izglede sačuvanja dojke. Nakon mastektomije pažljivo izabranih bolesnica, lokoregionalna radioterapija će smanjiti mogućnost recidiva i produljiti srednje preživljenje. Budući je danas timski pristup liječenju raka dojke vrlo poželjan, liječnici u timu imaju veliku odgovornost pa osim svoje struke moraju imati uvid i u struke drugih kolega, kao što su principi radioterapije, kriteriji selekcije, tehnike, rezultate i nuspojave zračenja itd. Cilj ovog rada je upoznavanje čitatelja s temeljnim znanjima o radioterapiji i radiobiologiji, te radioterapijskom liječenju raka dojke, danas najčešće zloćudne bolesti u žena. S poboljšanim tehnikama planiranja i provođenja zračenja došlo je do značajnih dostignuća u smanjenju lokalnog recidiva, preživljenju bez znakova bolesti, te, možda, i ukupnom preživljenju, bez uzrokovanja većih oštećenja na normalnom tkivu.Radiation therapy has an integral role in the curative treatment of breast cancer. After conservative surgery for ductal carcinoma in situ or invasive carcinoma, radiation therapy of the breast improves the likelihood of locoregional freedom from disease and thereby anchances the long-term possibility of breast preservation. After mastectomy, in carefully selected patients, locoregional radiation therapy will reduce the risk of recurrence and possibly prolong survival. Therefore, clinicians caring for patients who have breast cancer require a clear understanding of the pertinent principles of radiation therapy: selection criteria, techniques of treatment, beneficial results, and side effects

Erdheim-Chester Disease and Concomitant Tuberculosis Successfully Treated with Chemotherapy and Long-Term Steroids

Erdheim-Chester disease (ECD) is a rare histiocytosis usually affecting the skeletal system, but visceral organs and central nervous system involvement are common as well. Probability exists that immunomodulatory therapies and disorders can play a role in clinical course of the disease. Because of rarity of the disorder, it is hard to classify it and standardize the treatment options, but, according to published material and our experience, cytotoxic chemotherapy and long-term steroids have therapeutic benefit. Although this approach can probably be accepted as standard of care management, novel therapeutic modalities should be explored, and pathogenesis and disorder classification should be cleared out as well. The case of ECD affecting skeletal system and lungs and concomitant laryngeal tuberculosis successfully treated with chemotherapy and long-term steroid therapy is presented

Evaluation of a Saliva Substitute Developed for Postiradiation Xerostomia Treatment 2. Five-Year Experience

Umjetnu slinu naše proizvodnje, na bazi karboksimetilceluloze prema prilagođenom receptu uz dodatak Na-fluorida, napravili smo radi smanjenja kserostomije i remineralizacije cakline. Prospektivno je ispitano 50 bolesnika s postiradijacijskom kserostomijom. Suhoća usta nastupila je prosječno osam dana nakon početka zračenja. Uz uporabu umjetne sline, subjektivno, stanje se poboljšalo u 94% bolesnika, 26% ispitanika izjavilo je da im je “mnogo bolje ”, 68% ispitanika izjavilo je da im je “bolje ”, a 6% nije zamijetilo ni poboljšanje ni pogoršanje nakon uporabe umjetne sline. Učinak na suhoću usta traje i do šest sati, a do poboljšanja dolazi prosječno pet dana nakon primjene umjetne sline. Uz umjetnu slinu statistički se značajno (p<0,005) poboljšala vlažnost usta, govor, gutanje i žvakanje.A carboxymethylcellulosa-containing saliva substitute with inclusion of Na-fluoride developed for use by xerostomic patients undergoing radiotherapy for malignancies of the head and neck, was evaluated. The questionnaire was used to obtain subjective responses regarding its use and effectiveness. Fifty patients were prospectively evaluated. Xerostomia developed approximately 8 days after radiotherapy had started. After the treatment, 94% of the patients reported relief of intraoral soft tissue problems approximately 5 days after the use. The condition was reported as “much better” by 26% and “better” by 68% of the patients. The duration of relief varied from 1-6 h. A statistically significant improvement was recorded in surface wetting, speech, swallowing and chewing (p<0.005)

Model of Total Skin Electron Treatment Using the \u27Six-Dual–Field\u27 Technique

During implementation of the total skin electron treatment, using six-dual-field technique, at radiotherapy department a large number of measurements are needed. To assess depth dose curve required by clinicians and dose uniformity over a whole treatment plane, combinations of different irradiation parameters are used (electron energy, beam angle, scatterers). Measurements for each combination must be performed. One possible way to reduce number of measurements is to model the treatment using the Monte Carlo simulation of electron transport. We made a simplified multiple-source Monte Carlo model of electron beam and tested it by comparing calculations and experimental results. Calculated data differs less than 5 percent from measurements in the treatment plane. During the treatment patient can be approximated using cylinders with different diameters and orientations. We tried to model the depth dose variations in the total skin electron treatment not just around the body cross-section (simplified to cylinders of different diameters), but also along the body to account for the variations in body curvature longitudinally. This effect comes down to the problem of modeling distribution in different cylinders, but varying the longitudinal orientation of those cylinders. We compared Monte Carlo calculations and film measurements of depth dose curves for two orientations of the cylindrical phantom, which were the simplest for experimental arrangement. Comparison of the results proved accuracy of the model and we used it to calculate depth dose curves for a number of other cylinder orientations

Visoka stopa uspješnog liječenja zloćudnih limfoma u djece

Malignant diseases are one of the most common causes of mortality in children in Europe and America. In the past ten years, considerable advancement has been achieved in both the diagnosis and treatment of these diseases, malignant lymphoma in particular. With the introduction of new therapeutic modalities (new combinations of cytostatics, radiotherapy, surgery, monoclonal antibodies, and bone marrow transplantation), a high rate of long-term remission and recovery is now possible to achieve.Maligne bolesti su jedan od vodećih uzroka smrtnosti djece u Europi i Americi. Posljednjih desetak godina učinjen je bitan napredak kako u dijagnostici tako i u njihovom liječenju, naročito u liječenju malignih limfoma. Uvođenjem novih metoda liječenja (nove kombinacije citostatika, zračenja, kirurškog zahvata, monoklonskih antitijela te transplantacije koštane srži) i u ovih bolesnika danas je moguće postići visok postotak dugotrajnih remisija i izlječenja

Possible Prognostic Significance of P53 and Ki 67 in Inverted Sinonasal Papilloma

The aim of this study is to test the possible prognostic significance of p53 and Ki67 expression in inverted papilloma of the lateral nasal wall and adjacent sinuses regarding their malignant potential and recurrence. 49 biopsies of the lateral nasal wall and adjacent sinuses obtained from 41 patients from three hospitals were investigated. Immunohistochemically demonstrated p53 and Ki67 expression was measured and statistically valuated. p53 immunoreactivity was demonstrated in most of papillomas with carcinomas but only in two benign papillomas, while Ki67 demonstrated stronger immunoreactivity in carcinomas and surrounding epithelium. Immunohistochemical staining of inverted sinonasal papillomas for p53 and Ki67 can give useful information concerning the existence of synchronous carcinoma and, in case of high Ki67, a hint toward possible recurrence

Possible Prognostic Significance of P53 and Ki 67 in Inverted Sinonasal Papilloma

The aim of this study is to test the possible prognostic significance of p53 and Ki67 expression in inverted papilloma of the lateral nasal wall and adjacent sinuses regarding their malignant potential and recurrence. 49 biopsies of the lateral nasal wall and adjacent sinuses obtained from 41 patients from three hospitals were investigated. Immunohistochemically demonstrated p53 and Ki67 expression was measured and statistically valuated. p53 immunoreactivity was demonstrated in most of papillomas with carcinomas but only in two benign papillomas, while Ki67 demonstrated stronger immunoreactivity in carcinomas and surrounding epithelium. Immunohistochemical staining of inverted sinonasal papillomas for p53 and Ki67 can give useful information concerning the existence of synchronous carcinoma and, in case of high Ki67, a hint toward possible recurrence

CLINICAL GUIDELINES FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH NON-INVASIVE BREAST CANCER

Rak dojke najčešća je maligna bolest u žena. Ranom dijagnostikom i sve uspješnijim liječenjem invazivnog raka dojke postignut je značajan pad mortaliteta, produljenje preživljenja i poboljšanje kvalitete života bolesnica. Postupak s neinvazivnim rakom dojke međutim povezan je s nekim dvojbama i sviješću o problemu predijagnosticiranja i pretjeranog liječenja nekih bolesnica. U tekstu koji slijedi multidisciplinarni tim stručnjaka donosi prve hrvatske smjernice čija je svrha standardizacija i optimalizacija kriterija i postupaka dijagnostike, liječenja i praćenja bolesnica s neinvazivnim rakom dojke u Republici Hrvatskoj.Breast cancer is the most common malignancy in women. Early diagnosis and more effective treatment of invasive breast cancer resulted in significant mortality reduction, improvement of survival and the quality of life of the patients. The management od non-invasive breast cancer, on the contrary, is still controversial and the problem of overdiagnosis and overtreatment of patients come to evidence. In the following text a multidisciplinary team of experts brings the first consensus guidelines aimed to standardize and optimize the criteria and management in diagnosis, treatment and monitoring of non-invasive breast cancer patients in the Republic of Croatia