Oncology and Radiotherapy Institute

Islamabad, Pakistan

Oncology and Radiotherapy Institute

Islamabad, Pakistan
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Borut K.,Oncology and Radiotherapy Institute | Lijana Z.-K.,University of Ljubljana
Radiotherapy and Oncology | Year: 2012

Tolerability to gemcitabine radiochemotherapy was evaluated in 33 patients with inoperable, locally advanced transitional-cell bladder cancers. The dose of 75 mg/m 2 gemcitabine once a week, concurrently with standard radiotherapy of 60 Gy/6 weeks, was found to be acceptable. Eighty-one percentage of 3-year local progression-free survival suggests efficiency warranting further studies. © 2011 Elsevier Ireland Ltd. All rights reserved.

Erculj N.,University of Ljubljana | Kovac V.,Oncology and Radiotherapy Institute | Hmeljak J.,University of Primorska | Dolzan V.,University of Ljubljana
Annals of Oncology | Year: 2012

Background: Platinum-based therapy is widely used in the treatment of malignant mesothelioma (MM); however, the efficacy and toxicity of platinum agents vary greatly between patients. The aim of our study was to evaluate the influence of platinum pathway polymorphisms on treatment outcome in patients with MM. Patients and methods: In total, 133 patients with MM treated with (n = 97) or without (n = 36) platinum-based therapy were genotyped for common XPD, ERCC1, and GSTP1 polymorphisms, as well as for GSTM1 and GSTT1 gene deletion. Haplotype analysis was carried out to assess the combined effect of nucleotide excision repair (NER) polymorphisms. Results: GST polymorphisms were not associated with treatment outcome in patients with MM. In the group of platinum-treated patients with MM, ERCC1 8092C/C wild-type genotype significantly influenced progression-free survival (PFS) in multivariable analysis accounting for clinical variables (P = 0.034). XPD 312Asp/Asp and ERCC1 8092C/C wild-type genotypes also increased the odds of treatment-related toxic effects in univariable as well as multivariable analysis. The association of wild-type NER genotypes with better PFS and higher susceptibility to treatment-related toxic effects was confirmed in haplotype analysis. Conclusions: Our results suggest that polymorphisms in NER pathway influence platinum-treatment efficacy and toxicity; therefore, these should be further evaluated as potential markers for the prediction of clinical outcome in patients with MM. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Riboldi M.,Polytechnic of Milan | Riboldi M.,Bioengineering Unit | Orecchia R.,CNAO Foundation | Orecchia R.,Oncology and Radiotherapy Institute | And 3 more authors.
The Lancet Oncology | Year: 2012

A key challenge in radiation oncology is accurate delivery of the prescribed dose to tumours that move because of respiration. Tumour tracking involves real-time target localisation and correction of radiation beam geometry to compensate for motion. Uncertainties in tumour localisation are important in particle therapy (proton therapy, carbon-ion therapy) because charged particle beams are highly sensitive to geometrical and associated density and radiological variations in path length, which will affect the treatment plan. Target localisation and motion compensation methods applied in x-ray photon radiotherapy require careful performance assessment for clinical applications in particle therapy. In this Review, we summarise the efforts required for an application of real-time tumour tracking in particle therapy, by comparing and assessing competing strategies for time-resolved target localisation and related clinical outcomes in x-ray radiation oncology. © 2012 Elsevier Ltd.

Kovacs G.,University of Lübeck | Cosset J.-M.,Oncology and Radiotherapy Institute | Carey B.,University of Leeds
Current Opinion in Urology | Year: 2014

PURPOSE OF REVIEW: Focal radiotherapy treatment procedures play an increasingly important role in function-preservation and organ-preservation treatment techniques. As an alternative to traditional whole-gland radiotherapy regimes, focal prostate radiotherapy may be of benefit for both primary tumor as well as locally recurrent disease. This is a review of the current literature on the topic, including patient selection, preliminary toxicity, and outcome data as well as a technical overview on treatment delivery techniques. RECENT FINDINGS: Partial organ treatment in early prostate cancer (PCa) is now technically feasible with both newer external-beam and brachytherapy technology. To date, only small and generally monoinstitutional series have been published in the literature. Early feasibility and toxicity data are encouraging, and demonstrate potential advantages for the role of focal brachytherapy in early PCa. Although some advanced external-beam techniques can also be used to deliver focal therapy within the prostate, there is no relevant publication in the literature. SUMMARY: Radiotherapy, especially interventional radiotherapy (brachytherapy), is a technically feasible treatment technique to deliver focal radiotherapy for PCa. To date, only preliminary results are available for all forms of interventional radiotherapy (high dose rate, low dose rate, and pulsed dose rate) for focal PCa treatment and no large cohort comparative results are published. As interventional radiotherapy (brachytherapy) as yet lacks any such long-term studies, comparative outcome data are not available to suggest differences in efficacy for one form of brachytherapy or another. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Polgar C.,Oncology and Radiotherapy Institute | Fodor J.,Oncology and Radiotherapy Institute | Major T.,Oncology and Radiotherapy Institute | Sulyok Z.,National Institute of Oncology | Kasler M.,National Institute of Oncology
Radiotherapy and Oncology | Year: 2013

Background and purpose To report the long-term results of a single-institution randomized study comparing the results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI). Patients and methods Between 1998 and 2004, 258 selected women with pT1 pN0-1mi M0, grade 1-2, non-lobular breast cancer without the presence of extensive intraductal component and resected with negative margins were randomized after BCS to receive 50 Gy WBI (n = 130) or PBI (n = 128). The latter consisted of either 7 × 5.2 Gy high-dose-rate (HDR) multi-catheter brachytherapy (BT; n = 88) or 50 Gy electron beam (EB) irradiation (n = 40). Primary endpoint was local recurrence (LR) as a first event. Secondary endpoints were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and cosmetic results. Results After a median follow up of 10.2 years, the ten-year actuarial rate of LR was 5.9% and 5.1% in PBI and WBI arms, respectively (p = 0.77). There was no significant difference in the ten-year probability of OS (80% vs 82%), CSS (94% vs 92%), and DFS (85% vs 84%), either. The rate of excellent-good cosmetic result was 81% in the PBI, and 63% in the control group (p < 0.01). Conclusions Partial breast irradiation delivered by interstitial HDR BT or EB for a selected group of early-stage breast cancer patients produces similar ten-year results to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with HDR BT implants compared with the outcome after WBI. © 2013 Elsevier Ireland Ltd. All rights reserved.

Miszczyk L.,Oncology and Radiotherapy Institute | Tukiendorf A.,Cardiff Research Consortium
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: An evaluation of dose-response relationship and an attempt to define predictive factors. Methods and Materials: A total of 137 cases of painful vertebral hemangioma irradiations (101 patients). Fraction dose (fd) varied from 2 to 15 Gy (123 fractionated and 14 radiosurgical treatments), and total dose (TD) from 8 to 30 Gy (111 cases irradiated with fd of 2 GY to TD of 24 Gy). We evaluated pain relief, changes in analgesic requirements, and reossification. Results: Means of pain relief 1, 6, 12, and 18 months after radiotherapy (defined as a decrease of primary pain level expressed in percent) were 60.5%, 65.4%, 68.3%, and 78.4%, respectively. Proportion of patients with no need for analgesics and patients using tramadol were 39%, 40%, 44%, 57%, and 20%, 17%, 22%, and 11% in these times. The proportion of patients experiencing complete/partial pain relief changed from 36/48% 1 month, to 64/22% 1.5 years after radiotherapy. No impact of radiotherapy on reossification was found. The positive impact of fd and TD increase for analgesics uptake reduction and pain relief was found. An increase of the fd by 1 Gy results in 27% chance of analgesics uptake reduction and 3.8% reduction of pain, whereas 14% analgesics uptake reduction and 2.2% of pain reduction in case of the TD. The predictive factors improving results were found: female gender, older age, better performance states (the chance of the lower analgesic treatment decreases over 2.5 times in comparison to the higher Zubrod degree), bigger Hb concentration, shorter symptoms duration and lower analgesics uptake before radiotherapy. Conclusions: The obtained data support the efficacy of radiotherapy in improving pain secondary to vertebral hemangioma, with the degree of pain amelioration being related to increasing fd and TD. The positive predictive factors were defined: female gender, older age, better performance status, increased Hb concentration, shorter symptoms duration, and lower analgesics uptake before radiotherapy. © 2012 Elsevier Inc.

Khan A.U.,Oncology and Radiotherapy Institute | Khan M.R.,University of Peshawar
Journal of Radioanalytical and Nuclear Chemistry | Year: 2011

Nitrofurantoin (NFN) radiolabeling with technetium-99m (99mTc) was investigated using different concentration of the NFN, sodium pertechnetate (Na99mTcO4), reducing agent (SnCl2) at different pH ranges (5.1-6.00). The suitability of the 99mTc-NFN was evaluated in terms of the radiochemical purity (RCP) yield, in vitro stability in saline, serum, in vitro binding with E. coli, biodistribution in E. coli infected model rat (ERT), and scintigraphic accuracy in E. coli infected model rabbit (EBT). The superlative radiochemical succumb at 2.5 mg NFN, 125 μL of SnCl2 (1 μg/μL in 0.01 N HCl), 2.5 mCi of Na 99mTcO4, at pH 5.2 at 30, 60, 90, and 120 min after reconstitution was 64.50 ± 0.11, 97.50 ± 0.16, 94.25 ± 0.10, 92.15 ± 0.14 and 90.75 ± 0.0.13%. The complex was found stable in saline and serum for 90% up to 120 min and showed 50-65% in vitro binding with E. coli. The absorption of the 99mTc-NFN, primarily at E. Coli infected (ECT) muscle of ERT was lower but after 60 min it went up to 7.25 ± 0.17%. The absorption in the blood, liver, spleen, stomach, intestines, inflamed muscle (N.T1) and normal muscle (N.T2) went down while in the kidney and urine it went up with time. The ratio of the ECT/N.T1 was 7:1 and N.T2/N.T1 was 2:1. The Whole Body Static (WBS) imaging of the ERB confirmed the suitability of the 99mTc-NFN as radiotracer. The superlative radiochemical succumb, significant in vitro stability in saline and serum, in vitro binding with E. coli, ideal biodistribution and scintigraphic accuracy confirmed the viability of the 99mTc-NFN as radiotracer for infection. © 2010 Akadémiai Kiadó, Budapest, Hungary.

Khan A.U.,Oncology and Radiotherapy Institute | Khan M.R.,University of Peshawar
Journal of Radioanalytical and Nuclear Chemistry | Year: 2011

Sitafloxacin dithocarbamate (SFDE) was synthesized, radiolabeled with technetium-99m (99mTc) using [99mTc-N]2+ core and evaluated its biological efficacy as a potential radiotracer for Staphylococcus aureus (S. aureus) infection in artificially infected rats (AIRT) and rabbits (AIRB). The radiochemical stability of the 99mTc labeled SFDE (99mTcN-SFDE) in saline and serum was determined by radio-HPLC and TLC methods, respectively. After, 1 min of reconstitution the value of radiochemical purity (RCP) was 99.00 ± 0.20% and was remained more than 90% unwavering even after 240 min of the radiolabeling. The 99mTcN- SFDE complex showed similar radiochemical permanence behavior in serum at 37 °C. The complex showed almost six fold higher specific in vitro binding with living than heat killed S. aureus. Biodistribution behavior was evaluated in S. aureus AIRT and whole body imaging (WBI) in AIRB, respectively. Seven fold up take was observed in infected muscle of the AIRT as compared to inflamed and normal muscles. The disappearance of activity from blood and appearance in urinary system indicated normal route of excretion of the complex. Scintigraphically, it was confirmed that the labeled SFDE was higher accumulated in the infected muscle higher than in inflamed and normal muscle. The high radiochemical stability in saline and serum, specific in vitro binding with S. aureus, precise in vivo distribution in S. aureus AIRT and targeted WBI in AIRB confirmed the possibility of the 99mTcN-SFDE complex as a potential and promising S. aureus infection radiotracer. © 2010 Akadémiai Kiadó, Budapest, Hungary.

Blamek S.,Oncology and Radiotherapy Institute | Grzadziel A.,Oncology and Radiotherapy Institute | Miszczyk L.,Oncology and Radiotherapy Institute
Radiation Oncology | Year: 2013

Background: Stereotactic irradiation of large or critically located arteriovenous malformations (AVMs) is a special challenge for clinicians and radiation physicists. To date, no comprehensive comparison of two linac-based radiosurgery systems used for hypofractionated radiotherapy of large AVMs was published. The aim of the study was to compare dose distributions between CyberKnife (CK) system and linac with a micro-multileaf collimator (L-mMLC) in high-grade or critically located cerebral AVMs.Methods: Two sets of plans made for 15 different patients with at least 95% target coverage were selected for comparisons. Conformity (CI), homogeneity (HI) and gradient score (GSI) indices, conformity index proposed by Lomax (CIL), conformation number (CN), quality of coverage (Q), volumes of brain receiving 12,10,8,6,4, and 2 Gy, minimum and maximum doses for critical structures in both treatment planning systems (TPS) were compared. Finally, the number of monitor units needed to deliver the prescribed dose was compared.Results: The mean minimum doses in the target volume were 93.3% (CK) and 90.7% (L-mMLC),p=n.s, maximum: 119.7 and 110%, respectively (p=0.004). The mean CI was 1.46 and 1.86, HI: 1.2, and 1.11, CIL 0.7, and 0.6, CN: 0.68 and 0.58 for CK and mMLC, respectively (p<0.05). The values of GSI and Q were not significantly different. The volumes of the brain receiving low doses (4 Gy and 2 Gy) were significantly lower in the CK system. The number of monitor units necessary to deliver the prescribed dose was significantly greater in case of the CK system.Conclusions: Better conformity can favor the CK system for treatment of large AVMs at the cost of higher maximum doses and worse homogeneity. L-mMLC is superior when shorter treatment time is required. Neither system can assure satisfying dose gradients outside large targets surrounded by numerous critical structures. © 2013 Blamek et al.; licensee BioMed Central Ltd.

Velenik V.,Oncology and Radiotherapy Institute
Radiology and Oncology | Year: 2010

Background. Though the post treatment surveillance of patients with colorectal cancer (CRC) treated with curative intent is common practice, its value is controversial. In the absence of conclusive clinical data, various modalities for the routine follow-up of patients with CRC have been proposed. In practice, the guidelines across countries and regions differ and are influenced by different health care policies, resource availability and doubts about effectiveness of follow-up.Conclusions. The results of metaanalyses of available clinical trials demonstrated a survival benefit of intensified monitoring, but the questions regarding the optimal frequency of visits and the examinations to be performed remain unanswered. Furthermore, intensive monitoring of CRC survivors may be difficult to be administrated, causes discomfort and morbidity to the patient and can have serious cost-implications to the healthcare system. However, as it seems from available data, a comprehensive surveillance program does not affect the quality of patients' life. Ongoing large prospective multi-institutional randomised trials might elucidate some of the crucial questions and existing dilemmas to establish adequate surveillance strategy for CRC patients.

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