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Background. Publication of the results of the randomised ACOSOG Z0011 trial concerning the possibilities of conservative treatment of breast cancer patients with macrometastasis in the sentinel lymph node (SLN) increased the interest in this therapeutic option. The objective of the study was to assess the practical effects of the implementation of conclusions from the aforementioned study as well as clinical consequences of abandoning intraoperative verification of sentinel lymph nodes resected during the surgical procedure. Material and methods. A prospective analysis was made for 567 breast cancer patients subjected to sentinel node biopsy in the period 1 January to 31 October 2014. In the case of the group undergoing breast conserving treatment (BCT), routine intraoperative assessment of SLN was abandoned. The decision regarding potential radicalisation of the surgical procedure was delayed until final histopathological results were obtained. The results were compared with data from the period preceding the implementation of changes. Results. BCT was used in 73.4% of study subjects while breast amputation was performed in the remaining patients. Presence of metastatic lesions within the SLNs was detected in 23.5% of patients. In 31.8% of patients with SLN metastases, radicalisation of the surgery was abandoned versus 18.3% in the control group, 22.2% versus 5.1% in case of macrometastases; 28.0% versus 6.5% in patients undergoing BCT. These are significant results, p < 0.05). The percentage of patients subjected to reoperation was 6.9% versus 3.6% in the control group. Conclusions. Postponing the decision regarding the potential radicalisation of surgical treatment until the receipt of the final result of the histopathological sentinel node assessment may facilitate the choice of further treatment. Abandonment of routine intraoperative assessment of SLN allowed for a statistically significant increase in the percentage of follow-up axillary lymph node resection being abandoned. At the same time, no significant increase in the rate of reoperations was observed. © Polskie Towarzystwo Onkologiczne.


Lynch T.J.,Smilow Cancer Hospital | Bondarenko I.,City Clinical Hospital | Luft A.,Leningrad Regional Clinical Hospital | Serwatowski P.,Oddzial Chemioterapii | And 7 more authors.
Journal of Clinical Oncology | Year: 2012

Purpose: Ipilimumab, which is an anti-cytotoxic T-cell lymphocyte-4 monoclonal antibody, showed a survival benefit in melanoma with adverse events (AEs) managed by protocol-defined guidelines. A phase II study in lung cancer assessed the activity of ipilimumab plus paclitaxel and carboplatin. Patients and Methods: Patients (N = 204) with chemotherapy-naive non-small-cell lung cancer (NSCLC) were randomly assigned 1:1:1 to receive paclitaxel (175 mg/m 2) and carboplatin (area under the curve, 6) with either placebo (control) or ipilimumab in one of the following two regimens: concurrent ipilimumab (four doses of ipilimumab plus paclitaxel and carboplatin followed by two doses of placebo plus paclitaxel and carboplatin) or phased ipilimumab (two doses of placebo plus paclitaxel and carboplatin followed by four doses of ipilimumab plus paclitaxel and carboplatin).Treatment was administered intravenously every 3 weeks for ≥ 18 weeks (induction). Eligible patients continued ipilimumab or placebo every 12 weeks as maintenance therapy. Response was assessed by using immune-related response criteria and modified WHO criteria. The primary end point was immune-related progression-free survival (irPFS). Other end points were progression-free survival (PFS), best overall response rate (BORR), immune-related BORR (irBORR), overall survival (OS), and safety. Results: The study met its primary end point of improved irPFS for phased ipilimumab versus the control (hazard ratio [HR], 0.72; P = .05), but not for concurrent ipilimumab (HR, 0.81; P = .13). Phased ipilimumab also improved PFS according to modified WHO criteria (HR, 0.69; P = .02). Phased ipilimumab, concurrent ipilimumab, and control treatments were associated with a median irPFS of 5.7, 5.5, and 4.6 months, respectively, a median PFS of 5.1, 4.1, and 4.2 months, respectively, an irBORR of 32%, 21% and 18%, respectively, a BORR of 32%, 21% and 14%, respectively, and a median OS of 12.2, 9.7, and 8.3 months. Overall rates of grade 3 and 4 immune-related AEs were 15%, 20%, and 6% for phased ipilimumab, concurrent ipilimumab, and the control, respectively. Two patients (concurrent, one patient; control, one patient) died from treatment-related toxicity. Conclusion: Phased ipilimumab plus paclitaxel and carboplatin improved irPFS and PFS, which supports additional investigation of ipilimumab in NSCLC. © 2012 by American Society of Clinical Oncology.


Styczynski J.,Nicolaus Copernicus University | Gil L.,University Medyczny | Piatkowska M.,Oddzial Chemioterapii | Wlodarczyk Z.,Szpital Uniwersytecki nr 1 Im. dr Jurasza | Wlodarczyk Z.,Nicolaus Copernicus University
Acta Haematologica Polonica | Year: 2010

EBV disease develops after infection with Epstein-Barr virus (EBV). Clinically it may manifest as various syndromes related to primary (lytic) infection or reactivation (EBV-DNA-emia), previously known as latent infection. Post-transplant lymphoproliferative disorder (PTLD), developing after hematopoietic stem cell (HSCT) or solid organ transplantation (SOT) is the most aggressive form of EBV disease. It usually presents as a tumor or infiltration of lymphocytes B transformed by EBV, caused by lack of control of lymphocytes T. The diagnosis of PTLD can be made at a probable or proven level. Probable PTLD is defined as significant lymphadenopathy (or other endorgan disease) with high EBV blood load, in the absence of other etiologic factors or established diseases. Diagnosis of proven PTLD is made when EBV is detected from an organ by biopsy or other invasive procedures with a test with appropriate sensitivity and specificity together with symptoms and/or signs from the affected organ. Among patients after HSCT following risk factors of PTLD development are recognized: unrelated or HLA-mismatched transplant, cord blood transplant, T-cell depletion in vitro or in vivo, the use of thymoglobulin or anti-CD3 antibodies, serological EBV incompatibility between donor and recipient, splenectomy. PTLD after SOT occurs more often than after HSCT, and risk factors include: younger donor age, multiple organ transplantation, and high intensity of immunosuppressive therapy. This review presents similarities and differences in biology, course and therapy of PTLD after HSCT and SOT. Possibilities of prophylaxis, pre-emptive therapy and therapy of probable or proven PTLD are discussed.


Biedka M.,Oddzial Radioterapii 1 | Biedka M.,University Im pernika runiu | Kuzba-Kryszak T.,Zaklad Teteterapii | Makarewicz A.,Oddzial Chemioterapii
Onkologia i Radioterapia | Year: 2013

The estimated incidence of urachal carcinoma in the general population is reported to be 1 in 5 million individuals with a peak incidence at 40-70 years of age, two thirds of patients being men. Urachal carcinoma may arise from any of the segments of persisting urachal remnants. Histopathologically, most urachal carcinomas are adenocarcinomas (accounting for 90%). The recommended treatment is major surgery - wide en bloc resection of the tumour with the urachus and the adjacent organs: the bladder, bilateral pelvic lymph nodes, brown tissue, surrounding ligaments, the sigmoid, the umbilicus and part of the anterior abdominal wall. The attempts of combining surgery with radiotherapy do not deliver the anticipated results. Similarly, minimal or no benefit has been reported for systemic therapy. In conclusion, we wish to emphasise the significance of the need for a careful preliminary analysis of urachal carcinoma patients and the pivotal role of radical surgery in the successful treatment of this disease.


Posttransplant lymphoproliferative disorders (PTLD) are uncommon but a serious complication after solid organ or hematopoietic stem cell transplantation. The incidence is the highest during the first year after transplantation and varies according to the type of transplanted organ, type of immunosupression and status for Epstein-Barr virus (EBV) infection. The majority of PTLD belongs to high-grade B-cell lymphomas, EBV-positive. The transformation of B lymphocytes usually by EBV infection uncontrolled by T cells is responsible for the development of PTLD. However, more EBV-negative cases have been noted recently. It is estimated that PTLD occurs after a heart transplant in 1.0-6.3% of patients (pts), lung in 4.2-10% pts, heart and lungs in 2.4-5.8% pts, kidney 1-2.3% pts, liver 1-2.8% pts and as many as in 20% in patients after small bowel transplant. Treatment of PTLD begins with reduction of immunosuppression. If no response is achieved within 2-4 weeks, pharmacological treatment is necessary. Here we present and discuss a protocol of PTLD treatment recommended by the Polish Lymphoma Research Group, consisting of a sequential administration of rituximab in monotherapy and in combination with CHOP chemotherapy.


Wichtowski M.,Oddzial Chirurgii Onkologicznej i Ogolnej i | Murawa D.,Oddzial Chirurgii Onkologicznej i Ogolnej i | Litwiniuk M.,Oddzial Chemioterapii | Kufel-Grabowska J.,Oddzial Chemioterapii | And 2 more authors.
Nowotwory | Year: 2016

Introduction. Electrochemotherapy (ECT) is an ablation method based on a reversible electroporation combination with concurrent chemotherapy (intravenous administration or directly into the tumour). This method has been used in the treatment of primary skin tumours (carcinomas, melanomas) and secondary malignancies (e.g. breast cancer metastases) which were unfit or unresponsive to a different type of treatment. It is a palliative method aimed at improving the quality of life. Material and methods. Between February and May 2015 seven patients with metastatic breast cancer to the skin and subcutaneous tissue, and one patient with recurrent melanoma in the skin after groin lymphadenectomy, underwent the ECT procedure. Results. For the patients treated by ECT, there were a total of 10 procedures for 50 target lesions. Seven patients underwent one course, one patient received three courses because of extension of the lesions. In 87.5% of the lesions good local effect as a complete or partial remission was observed. Patients remain under close observation and control. Conclusions. The results show that ECT is an effective and safe therapeutic option for the treatment of unresectable skin malignances, especially in the case of prior use of other available methods of cancer treatment. © Polskie Towarzystwo Onkologiczne.


Andryszak P.,University Kazimierza Wielkiego | Izdebski P.,University Kazimierza Wielkiego | Tujakowski J.,Oddzial Chemioterapii
Nowotwory | Year: 2012

In recent years attention has been paid to the occurrence of deterioration of cognitive functioning after chemotherapy. The aim of this work is to analyze results of previously conducted studies of the effects of adjuvant chemotherapy on cognitive performance of women treated for breast cancer. We have analyzed the results of 40 neuropsychological studies published to June 2011. Women with breast cancer who were treated with chemotherapy were found to experience some kind of deterioration in attention, memory and language skills. The results indicate that subjectively perceived cognitive deficits are associated with distress accompanying cancer and its treatment. In the majority of studies of cognitive functioning using neuropsychological tests deterioration in attention, processing speed, memory, visuo-spatial functions and language skills has been demonstrated. No correlation has been found between deterioration of cognitive functioning and level of depression and anxiety, fatigue, hormonal status and quality of life. © Polskie Towarzystwo Onkologiczne.


Mackiewicz J.,University Medyczny im Karola Marcinkowskiego znaniu | Kwinta L.,Oddzial Chemioterapii
Wspolczesna Onkologia | Year: 2010

The incidence of melanoma is increasing rapidly both in Poland and worldwide. In Poland melanoma is a rare malignancy with about 2200 new cases annually. Results of the treatment at the time of inoperable metastases occurrence (stage IV) are unsatisfactory. Completed phase III clinical trials evaluating the efficacy of several cytotoxic agents and biological therapies did not produce the intended result. In daily oncological practice the most commonly used agent in the treatment of metastatic melanoma is still dacarbazin, with the median overall survival equal 6 months. High expectations are connected with targeted therapy - kinase inhibitors, monoclonal antibodies, antisense therapy and PARP inhibitors. Ipilimumab (antibody anti-CTLA4) and oblimersen sodium (oligodeoksynucleotide targeted against Bcl-2 gen) are currently being evaluated in phase III clinical trials. Molecules targeting MEK kinase (AZD6244), mTOR (everolimus, temsirolimus) and VEGFR (axitinib) or monoclonal antibodies directed against VEGF (bevacizumab) or α5β1 integrin (volociximab) are demonstrating some activity in the early phase trials. Multiple new molecules have demonstrated some efficacy (MDX-1106; BMS-66353; CP 870.893; PLX4032) in phase I trials, which activity will have to be confirmed in the next phase trials. Some receptor tyrosine-kinase inhibitors (imatinib, dasatinib or sunitinib) may play a role in the treatment of melanoma patients with c-KIT mutation. The future of the rational use of new targeted agents will depend on the possibility of selecting groups of patients responding to personalized treatment.


Wisniewska M.,Oddzial Chemioterapii | Wisniewski M.,Centrum Onkologii im. F. Lukaszczyka
Onkologia i Radioterapia | Year: 2014

Breast cancer is the most common malignancy in women. The terms gestational breast cancer (GBC) and pregnancy-associated breast cancer are given to breast cancer that occurs during pregnancy and up to one year after delivery. We report a case of a 32 year old woman diagnosed with breast cancer during pregnancy. She was diagnosed with ductal invasive ER(-), PR(-), HER2(+) breast cancer in clinical stage IIA. The patient received neoadjuvant chemotherapy (four courses of doxorubicin and cyclophosphamide every three weeks) and had a cesarean section in 36 weeks of pregnancy. The male infant was healthy. Then the patient underwent radical modified mastectomy. Subsequently she received adjuvant chemotherapy (twelve courses of weekly paclitaxel), radiotherapy and immunotherapy with trastuzumab (seventeen courses every three weeks). There were not any side effects of the treatment and in control imaging examination there were not any abnormalities. Chemotherapy can be safely administered to women during the second and third trimesters of pregnancy. © Onkologia I Radioterapia 1 (26-27) 2014.


Kuzba-Kryszak T.,Zaklad Teleradioterapii | Biedka M.,Katedra Onkologii i Klinika Brachyterapii UMK w Toruniu | Ziolkowski S.,Zaklad Teleradioterapii | Makarewicz A.,Oddzial Chemioterapii
Onkologia i Radioterapia | Year: 2015

Initiation of mammographic screening and increase of patient's oncology knowledge make more and more diagnosis of breast cancer in early stages. The conventional treatment for early breast cancer includes breast-conserving surgery and radiotherapy to the whole breast with boost to the tumor bed. Approximately 80% of the breast recurrences after breast irridiation occur in the area of the original tumor site; the relapses observed in a different quadrant are likely to be regarded as a new ipsilateral carcinoma instead of a true relapse of the primary tumor. According to this observation, irradiation of the whole mammary gland could be avoided in select patients and adjuvant radiotherapy could be limited to the sterilization of residual cancer in the immediate vicinity of the tumor bed. In APBI currently are applied several techniques: 1) Interstitial brachytherapy (HDR, PDR, permanent implants); 2) Brachytherapy using the balloons (Mammosite, Contura,); 3) Hybrid brachytherapy devices (SAVI applicator); 4) External beam radiotherapy (3D, IMRT); 5) IORT (intraoperative radiotherapy) with electrons or X-rays. Results of trials in intraoperative radiotherapy show that treating with a single dose, during surgery can become new standard in selected group of patients with early stage breast cancer. Proceeding like that bring us closer to a scenerio in which a patient with early breast cancer might complete all her local treatment at 2 visits in reference hospital. © 2015, Medical Project Poland. All rights reserved.

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