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PubMed | Sofia City Cancer Center, Specialized Hospital for Active Treatment in Oncology and Sofia University
Type: Journal Article | Journal: Radiation protection dosimetry | Year: 2015

The aim of this work is to estimate patient doses from hybrid single-photon emission computed tomography (SPECT) and computed tomography (CT) procedures. The study involved all four SPECT-CT systems in Bulgaria. Effective dose was estimated for about 100 patients per system. Ten types of examinations were considered, representing all diagnostic procedures performed in the SPECT-CT systems. Effective doses from the SPECT component were calculated applying the ICRP 53 and ICRP 80 conversion coefficients. Computed tomography dose index and dose length product were retrospectively obtained from the archives of the systems, and effective doses from the CT component were calculated with CT-Expo software. Parallel estimation of CT component contribution with the National Radiological Protection Board (NRPB) conversion coefficients was performed where applicable. Large variations were found in the current practice of SPECT-CT imaging. Optimisation actions and diagnostic reference levels were proposed.


PubMed | Serbian Institute for Oncology and Radiology of Serbia, University of Latvia, University of Szeged, University of Zagreb and 10 more.
Type: Journal Article | Journal: European journal of public health | Year: 2014

Reducing treatment delay improves outcomes in breast cancer. The aim of this study was to determine factors influencing patient- and system-related delays in commencing breast cancer treatment in different countries.A total of 6588 female breast cancer patients from 12 countries were surveyed. Total delay time was determined as the sum of the patient-related delay time (time between onset of the first symptoms and the first medical visit) and system-related delay time (time between the first medical visit and the start of therapy).The average patient-related delay time and total delay time were 4.7 (range: 3.4-6.2) weeks and 14.4 (range: 11.5-29.4) weeks, respectively. Longer patient-related delay times were associated with distrust and disregard, and shorter patient-related delay times were associated with fear of breast cancer, practicing self-examination, higher education level, being employed, having support from friends and family and living in big cities. The average system-related delay time was 11.1 (range: 8.3-24.7) weeks. Cancer diagnosis made by an oncologist versus another physician, higher education level, older age, family history of female cancers and having a breast lump as the first cancer sign were associated with shorter system-related delay times. Longer patient-related delay times and higher levels of distrust and disregard were predictors of longer system-related delay times.The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.


PubMed | Specialized Hospital for Active Treatment in Oncology, Malinov Hospital, Medical University-Sofia and Bulgarian Academy of Science
Type: Journal Article | Journal: Molecular and clinical oncology | Year: 2014

Breast cancer is currently the most common type of cancer in females. The majority of the hereditary forms of breast cancer are caused by mutations in the


Chilingirova N.,Specialized Hospital for Active Treatment in Oncology
Revmatologiia (Bulgaria) | Year: 2013

The aim of this article was to review the role of tumor markers and their application in the clinical practice. The classic tumor marker is a protein that can be found in the blood in higher than normal amounts when a certain type of cancer is present. Some tumor markers are specific for certain tumor types, others could be found in most oncologic conditions. The ideal tumor marker would be one that could be used as a cancer screening blood test for the whole population, but would only be found in people with cancer. It would correlate with stage of the disease and response to therapy and could be measured safely and accurately. At this time there are no tumor marker tests that work like this. The possible role of tumor markers is in screening for certain cancer types in the healthy and high-risk population; for determining the risk of recurrence and prognosis of the patient; for monitoring the response to treatment; for differential diagnosis; for follow-up, or used with a predictive value. Tumor markers could not be usually used alone to diagnose oncologic diseases, but could help in the diagnostic process. Recently, while looking for a better tumor marker, even bigger attention is paid to genomics and proteomics.


Marinova L.,Medical University-Varna | Mihaylova I.,Specialized Hospital for Active Treatment in Oncology | Georgiev R.,Medical University-Varna
Rentgenologiya i Radiologiya | Year: 2015

We present a clinical case of 9 years old girl with concomitant brain tumors - choroid plexus carcinoma and craniopharyngioma diagnosed in 2009. After three operations, cranio-spinal irradiation with boost for the remaining tumor located in left ventricular trigonum to a total dose of 55 Gy and 7 courses chemotherapy, local tumor control was achieved for the choroid plexus carcinoma. Four years following the achievement of local tumor control of the choroid plexus carcinoma, an increase of the tumor formation located in the left side of the pituitary was reported. The diagnosis cystic craniopharyngeoma was found during the surgical operation. With this clinical case we would like to stress on the achieved local tumor control following the complex treatment of carcinoma of the choroid plexus, as well as on the slow growth of simultaneously diagnosed craniopharyngeoma. This case report raises the question of the genetic predisposition of the brain tumors in children, as well as possibility of malignant transformation of craniopharyngeoma following radiotherapy. The differential diagnosis of neuroectodermal brain tumors requires immunohistochemical analysis and if necessary genetic analysis.


Marinova L.,Cancer Center | Mihaylova I.,Specialized Hospital for Active Treatment in Oncology | Georgiev R.,Medical University-Varna
Rentgenologiya i Radiologiya | Year: 2015

We present a rare case of brain pineal neoplasm in 14 years old girl - pinealobastoma - brain primitive neuroectodermal tumor (PNET).The tumor in the pineal region causes occlusive hydrocephaly, not cured following ventriculostomy of the 3rd ventricle. After liquor-draining valve (ventriculoperitoneal drain) was applied hyperfractionated cranio-spinal irradiation (cranio-spinal irradiation), which was needed due to the high risk of leptomeningeal and spinal liquor metastases. Unfavorable prognosis requires postoperative hyperfractionated cranio-spinal irradiation twice daily whit daily dose of 1,5 Gy in 6 hours interval to total dose of 36 Gy in CNS and spinal; at second step boost - hyperfractionated in 6 hours interval to total dose 48 Gy in the ventricles and of 58-60 Gy in pineal tumor. In addition to cranio-spinal irradiation was applied Dexometasone 1 amp. daily i.m. and Ecomer 3×1-2 caps, daily per os. Hyperfractionated cranio-spinal irradiation was required in pinealobastoma with hydrocephaly, followed by chemotherapy after ventriculo-peritoneal liquor drain and biopsy. This complex treatment approach significantly improves free of disease survival through minimization of local leptomeningeal and spinal recurrences.


PubMed | Specialized Hospital for Active Treatment in Oncology
Type: Journal Article | Journal: Journal of B.U.ON. : official journal of the Balkan Union of Oncology | Year: 2015

To classify ipsilateral in-breast cancer recurrences (IBCR) in patients treated with conservative surgery and radiation therapy, either as new primary tumor (NP) or true recurrence (TR) and to assess the prognostic and therapeutic importance of this classification.The records of 107 patients treated for local tu- mor recurrence after breast-conserving therapy (BCT) at the National Cancer Center, Sofia, between March 1999 and May 2011 were retrospectively analysed. The patientsprimary tumors were up to 2 cm in size. For their primary tumors all patients underwent quadrantectomy, axillary lymph node dissection and postoperative radiotherapy (RT) up to 50 Gy. In cases with nodal metastasis additional RT has been used. Adjuvant chemotherapy and hormonotherapy have been used according to the clinical indications and depending of the patients condition. Every attempt was made to define a tumor as a TR or NP, based on the changes in location and histology. (99m)Tc-MIBI SPECT-CT was used to localize the site of recurrence.Forty-four (41.1%) of the relapses were TR and 63 (58.9%) NPs. Out of 63 relapses defined as NPs, 54 (85.7%) changed the location and 49 (68.3%) had a different histology. The age of patients with TR and with NP did not differ significantly at the time of diagnosis of the primary tumor (TR 48.810.45 years vs NP 50.810.56; p<0.330), but those who developed TR were significantly younger than those with NP at the time of recurrence (TR 53 years, 6611.1 vs NP 58.15+10.6; p<0.05). Recurrences defined as NPs, developed after a significantly longer period of time in comparison to the TRs (7.42.6 years vs 4.82.2 years; p<0.0001). Five-year overall survival of patients with TR was significantly lower compared to patients with NP (31.8% vs 96.7% p=0.0001).Recurrences developing after BCT represent different clinical events, having different origin, prognosis and, therefore, requiring different type of treatment. It seems that a significant part of the recurrences that develop in the residual parenchyma, following BCT, are new carcinomas.


PubMed | Medical University-Varna, Specialized Hospital for Active Treatment in Oncology, Sofia University and Specialized Hospital for Active Treatment in Pediatric Onco hematology Disease
Type: Journal Article | Journal: Radiation protection dosimetry | Year: 2015

Ewings sarcoma in childhood is a disease from family of the peripheral primitive neuroectodermal tumours. For a period of 16 y (1984-2000), 34 children with Ewings sarcoma were treated and followed in our department. Twenty-seven of these patients were without distant metastases. Complex treatment was applied to all these patients-chemotherapy VACA (vincristine, actinomycin D, cyclophosphamide, adriamycin), local radiotherapy to a total dose of 50-56 Gy +/- surgery. After, a local tumour control was achieved in 11 children with non-metastatic Ewings sarcoma, elective whole lung irradiation to a total dose of 12-15 Gy was applied. Our experience in these 11 patients with non-metastatic Ewings sarcoma, in whom elective lung irradiation was applied, showed significant reduction in the lung metastases, improved free of disease survival and overall survival. The achieved good treatment results necessitate extending this treatment approach through defining the risk groups of patients, suitable for elective lung radiotherapy combined with chemotherapy in non-metastatic Ewings sarcoma.


Tzonevska A.,Specialized Hospital for Active Treatment in Oncology | Chakarova A.,Specialized Hospital for Active Treatment in Oncology | Tzvetkov K.,Specialized Hospital for Active Treatment in Oncology
Journal of B.U.ON. | Year: 2014

Purpose: To use gated (G) 99mTc-Tetrofosmin single photon emission computed tomography (SPECT)-CT combined with coronary calcium (Ca) scores to assess and differentiate patients with left-sided breast cancer, after surgery and doxorubicin (DOX)-based chemotherapy and who had cardiac risk factors and needed to adapt radiotherapy (RT) in order to prevent cumulative cardiac side effects caused by RT.Methods: Included were 28 female patients (mean age 49±16 years) with asymptomatic left-sided breast cancer, one month after DOX-based chemotherapy (mean 522±36mg) and before RT. A group of 18 patients (study group) with cardiovascular risk factors was included, while a group of 10 patients with no cardiovascular risk factors served as control. 99mTc-Tetrofosmin GSPECT-CT with Ca scores on Symbia T16 (Siemens Medical Solutions Ine, USA), using standard stress protocol was performed. QGS/QPS quantitative analysis of the myocardial perfusion and function was used.Results: 26 patients had normal perfusion images based on QPS. Hypoperfused defects with mild hypoperfusion and slightly increased Ca scores had 2 (11%) patients from the study group and no patient in the control group: the 2 patients were determined as having coronary atherosclerosis and silent coronary artery disease. Twenty three patients had normal parameters based on QGS. Diastolic and segmental dysfunction had 4 (14%) patients from the study group and one (4%) patient from the controls, determined as caused by chemotherapy-induced cardiotoxicity. Very high hazard for cardiac damage if standard RT was to be performed had 6 (21%) patients in the study group and one (4%) from the controls. These patients received RT, in order to prevent cardiac damage.Conclusion: 99mTc-Tetrofosmin GSPECT-CT plus Ca scores provide combined cardiac assessment and can serve as a reliable screening method to prevent cardiac damage caused by RT in left-sided breast cancer patients, who have cardiac risk factors and have been administered DOX-based chemotherapy.


PubMed | Specialized Hospital for Active Treatment in Oncology
Type: Journal Article | Journal: Journal of B.U.ON. : official journal of the Balkan Union of Oncology | Year: 2014

To use gated (G) 99mTc-Tetrofosmin single photon emission computed tomography (SPECT)-CT combined with coronary calcium (Ca) scores to assess and differentiate patients with left-sided breast cancer, after surgery and doxorubicin (DOX)-based chemotherapy and who had cardiac risk factors and needed to adapt radiotherapy (RT) in order to prevent cumulative cardiac side effects caused by RT.Included were 28 female patients (mean age 4916 years) with asymptomatic left-sided breast cancer, one month after DOX-based chemotherapy (mean 52236mg) and before RT. A group of 18 patients (study group) with cardiovascular risk factors was included, while a group of 10 patients with no cardiovascular risk factors served as control. 99mTc-Tetrofosmin GSPECT-CT with Ca scores on Symbia T16 (Siemens Medical Solutions Inc, USA), using standard stress protocol was performed. QGS/QPS quantitative analysis of the myocardial perfusion and function was used.26 patients had normal perfusion images based on QPS. Hypoperfused defects with mild hypoperfusion and slightly increased Ca scores had 2 (11%) patients from the study group and no patient in the control group: the 2 patients were determined as having coronary atherosclerosis and silent coronary artery disease. Twenty three patients had normal parameters based on QGS. Diastolic and segmental dysfunction had 4 (14%) patients from the study group and one (4%) patient from the controls, determined as caused by chemotherapy-induced cardiotoxicity. Very high hazard for cardiac damage if standard RT was to be performed had 6 (21%) patients in the study group and one (4%) from the controls. These patients received RT, in order to prevent cardiac damage.99mTc-Tetrofosmin GSPECT-CT plus Ca scores provide combined cardiac assessment and can serve as a reliable screening method to prevent cardiac damage caused by RT in left-sided breast cancer patients, who have cardiac risk factors and have been administered DOXbased chemotherapy.

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