Hyperthermia in cervical cancer – current status

BackgroundThis article reviews the salient features of recent results of clinical studies. It puts a special emphasis on technical aspects, mechanisms of action together with radiotherapy and chemotherapy and points out areas for additional investigation.AimTo present the current state of knowledge on hyperthermia (HT) and to highlight its role in the treatment of cervical cancer.Materials and methodsThe literature on the clinical use of combined hyperthermia for cervical cancer was analyzed. Clinical outcomes together with the technical aspects and the role of HT were also evaluated.ResultsClinically randomized trials have demonstrated benefit including survival with the addition of hyperthermia to radiation or chemotherapy in the treatment of cervical cancer without significant acute or late morbidities. The technological advances have led to an effective and safer treatment delivery, thermal treatment planning, thermal dose monitoring and online adaptive temperature modulation.ConclusionsDue to rapid development over the last decade of hyperthermia systems and new studies at the basic science and clinical level, the perception of hyperthermia as a part of multimodality treatment in cervical cancer has been changed. However, there is still a need for multicentre randomized clinical trials

Does conformal therapy improve dose distribution in comparison to old techniques in teleradiotherapy of cervical cancer patients?

SummaryBackgroundThe use of a combined modality approach – chemotherapy and radiation therapy – in the treatment of patients with cervical cancer is associated with significant toxicity, mainly haematological and gastrointestinal. Conformal radiotherapy has the potential to deliver an adequate dose to the target structures while sparing the normal tissue. Both the radiation dose to the small bowel and the volume are factors known to influence the risk of complications.AimThe aim of this study was to determine whether the implementation of conformal modality can reduce the volume of normal tissue included in the RT field.Methods and Materials14 cervical cancer patients (FIGO IIB and IIIB) treated with conformal radiotherapy concurrently with cisplatin (40 mg/m2) administration once a week were analyzed. According to ICRU 50 recommendations target volumes and the organs at risk were contoured on CT slices. For the gross tumour volume (GTV) the tumour of the uterus and cervix was traced. The clinical target volume (CTV) was defined as the vessels and lymph nodes from the obturator level to the aortic bifurcation, presacral region, and upper 1/3 of the vagina. The margin for planning target volume (PTV) was added. The normal tissue region included the small bowel, large bowel and bladder. Using a 3D system and multi-leaf collimator a four-field treatment plan was performed for each patient. All 14 patients were treated with radiotherapy using these conformal 3D plans. Additionally (just for study purposes) for each patient we prepared two simpler plans with (1) two-field: anterior-posterior (A-P) and posterior-anterior (P-A); and (2) four-field box techniques. Dose-volume histograms of target volumes and organs at risk were calculated for each three plans for every patient and compared. Analysis of variance was performed to compute the statistical significance.ResultsThere is no statistical difference between doses received by target volumes – in each plan PTV is covered by the 95% isodose. Significantly different volumes of critical organs were included in the treatment field, depending on radiotherapy technique (conformal 3D method vs AP–PA two-field method): rectum 96.82% vs 38.23%, bowels 61.37% vs 30.79%.ConclusionThese data suggest that implementation of conformal radiotherapy can reduce the irradiated volume in all the contoured critical organs, especially the bowels, compared to old techniques

Multiple sclerosis: oral health, behaviours and limitations of daily oral hygiene — a questionnaire study

Clinical rationale for the study. Neurological deficits and progressing disability in patients with multiple sclerosis (MS) may hamper daily oral hygiene, but their relations with oral problems have not yet been clearly determined.Aim of the study. The aim of this study was to identify the most significant dental problems and limitations of daily oral hygiene in Polish patients with MS.Material and methods. 199 patients with diagnosed MS (median age 37 years) treated in the neurological outpatient clinic were interviewed using a paper-based questionnaire. They provided answers on oral health, behaviours and the limitations of their daily oral hygiene. Clinical information regarding symptoms, MS phenotype, relapses, medication and degrees of disability was based on medical records.Results. The most frequent symptoms were dry mouth (43.2%) and bleeding from gums (28.1%). Dry mouth was more frequent in patients with secondary-progressive MS (SPMS) than relapsing-remitting MS (65.4% vs 41.3%, p = 0.023). Patients with bleeding from gums had had MS for a longer duration (median 6 vs 4 years, p = 0.002). Difficulties in daily oral hygiene were more frequent in patients with SPMS (24.0% vs 8.1%; p = 0.016). Greater proportions of patients with muscle weakness of limbs, imbalance or pain brushed their teeth irregularly. Frequent (i.e. at least every six months) visits to the dentist’s surgery were uncommon in patients with SPMS (12.0% vs 39.7%, p = 0.010).Conclusions and clinical implications. Dry mouth and bleeding from gums are more frequent in patients with longer lasting and more advanced types of MS. Daily oral hygiene and oral health self-control is limited in patients with MS, mainly due to motor deficits, balance problems and pain, and this becomes worse with disease duration. To minimise the burden of the disease, patients with MS require better education and improvement in their awareness regarding proper oral health control, such as the use of electric toothbrushes. In addition, patients with chronic and progressive disability from multiple sclerosis may benefit from better organised access to dental care

Does conformal therapy improve dose distribution in comparison to old techniques in teleradiotherapy of cervical cancer patients?

BackgroundThe use of a combined modality approach – chemotherapy and radiation therapy – in the treatment of patients with cervical cancer is associated with significant toxicity, mainly haematological and gastrointestinal. Conformal radiotherapy has the potential to deliver an adequate dose to the target structures while sparing the normal tissue. Both the radiation dose to the small bowel and the volume are factors known to influence the risk of complications.AimThe aim of this study was to determine whether the implementation of conformal modality can reduce the volume of normal tissue included in the RT field.Methods and Materials14 cervical cancer patients (FIGO IIB and IIIB) treated with conformal radiotherapy concurrently with cisplatin (40 mg/m2) administration once a week were analyzed. According to ICRU 50 recommendations target volumes and the organs at risk were contoured on CT slices. For the gross tumour volume (GTV) the tumour of the uterus and cervix was traced. The clinical target volume (CTV) was defined as the vessels and lymph nodes from the obturator level to the aortic bifurcation, presacral region, and upper 1/3 of the vagina. The margin for planning target volume (PTV) was added. The normal tissue region included the small bowel, large bowel and bladder. Using a 3D system and multi-leaf collimator a four-field treatment plan was performed for each patient. All 14 patients were treated with radiotherapy using these conformal 3D plans. Additionally (just for study purposes) for each patient we prepared two simpler plans with (1) two-field: anterior-posterior (A-P) and posterior-anterior (P-A); and (2) four-field box techniques. Dose-volume histograms of target volumes and organs at risk were calculated for each three plans for every patient and compared. Analysis of variance was performed to compute the statistical significance.ResultsThere is no statistical difference between doses received by target volumes – in each plan PTV is covered by the 95% isodose. Significantly different volumes of critical organs were included in the treatment field, depending on radiotherapy technique (conformal 3D method vs AP–PA two-field method): rectum 96.82% vs 38.23%, bowels 61.37% vs 30.79%.ConclusionThese data suggest that implementation of conformal radiotherapy can reduce the irradiated volume in all the contoured critical organs, especially the bowels, compared to old techniques

Pro Libris: Lubuskie Pismo Literacko-Kulturalne, nr 4 (2010)

145 s. : il., portr.

We Do Not Like It: A Likert-Type Scale Survey on the Attitudes of a Young Population towards the Transhumanistic Theory of Education

Transhumanists assume that future education may be purely based on technological stimulation. The question is: Do potential clients of education “like” such vision? In order to check this, we asked over one thousand two hundred young Poles to evaluate their identification with the transhumanistic theory of education. The results are quite surprising: its show that they disagree with the assumptions of this theory, while they rather agree with the postulates of more traditional (and no technology-based) concepts of education

Strategy and early results of treatment of advanced cervical cancer patients with synchronous cancers observed in PET-CT imaging

Objectives: The aim of this study was to present strategy and early results of treatment of advanced cervical cancer patients with synchronous cancers observed in PET-CT imaging, treated at the Greater Poland Cancer Center. Material and methods: The study included a group of 200 patients with diagnosed stage IIB-IIIB cervical cancer who received PET-CT for the purpose of radiotherapy treatment planning. Results: Among our study group, four patients (2%) were found to have a synchronous cancer. Two of the cases were diagnosed as breast cancer. However, cancers diagnosed in the other two patients were head and neck malignancies — hypopharyngeal and laryngeal cancer. The choice of an optimal therapeutic approach requires taking into account characteristics of particular malignancies, their stage and histopathology. The whole therapy included radiotherapy of cervical cancer with various combinations of systemic treatment, radiotherapy or surgery of synchronous cancer. According to treatment results, patients diagnosed with breast cancer and hypopharyngeal cancer achieved complete remission of both primary and secondary tumour. Patient diagnosed with laryngeal malignancy, despite achieving complete remission of cervical cancer, finished radiotherapy of the synchronous cancer at a palliative dose. Conclusions: The growing availability of PET-CT and other imaging methods in cancer diagnosis will increase the number of diagnosed synchronous cancers. Second primary cancers are often detected at an early stage, where radical treatment can be performed for both primary and secondary tumour. However, treatment of such complicated clinical cases as synchronous cancers should be carried out by multidisciplinary teams

Tumour-Related Parameters as a Prognostic Factor in Patients with Advanced Cervical Cancer: 20-Year Follow-Up of Diagnostic and Treatment Changes during Chemioradiotherapy

Concurrent radiochemotherapy (RCHT) has been the standard treatment for locally advanced cervical cancer since 1999. During this 20-year period, both diagnostic and radiotherapy techniques have developed, such as positron emission tomography (PET) or brachytherapy (BT) planning. The aim of the study was to assess the relationships between prognostic factors and the results of treatment in patients with advanced cervical cancer independent of these changes. The analysis included 266 patients with stage IIB or IIIB FIGO 2009 cervical cancer divided into two groups: one including 147 patients diagnosed with physical examination and ultrasonography (USG) and treated with RCHT with 2D BT from 2001 to 2005; another including 119 patients with metastatic pelvic lymph node diagnosed with PET and treated from 2010 to 2016 with RCHT and 3D BT. The mean five-year overall survival (OS) rate was 59.2% in the first vs. 65.5% in the second group (p = 0.048). However, in both groups, stage IIB patients had a significantly higher 5-year OS rate, despite the presence of nodal metastases in group 2. In the first group it was 75.1% in IIB vs. 54.8% in IIIB (p = 0.040) 5-year OS and 77.5% vs. 55.8% (p = 0.034) in the second group. Important was also a significant association between the dose of BT and survival in group 2: 45.7% vs. 69.2% for dose <28 Gy and 28 Gy (p = 0.018). Evolution in the diagnosis and treatment of patients with cervical cancer had led to improvement in the survival of patients and precise treatment with an appropriate stage assessment. However local advance of the tumour is still the most important prognostic factor