Gliwice, Poland
Gliwice, Poland

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Sas-Korczynska B.,Klinika Onkologii | Stelmach A.,Klinika Chirurgii Onkologicznej | Skotnicki P.,Oddzial Chirurgiczny Zabiegowy | Mitus J.W.,Klinika Chirurgii Onkologicznej | And 5 more authors.
Onkologia i Radioterapia | Year: 2016

The second part of the publication presents treatment methods that can be applied in patients with medullary breast carcinoma (MBC) based on literature reports and authors’ own observations. It has been demonstrated that the basic management is breast-conserving therapy (BCT) combined with postoperative radiotherapy. Patients with typical MBC (T-MBC) and no lymph node involvement (pN0) do not require adjuvant systemic treatment. However, if lymph nodes are involved (pN+) and when patients are diagnosed with atypical MBC (A-MBC), adjuvant systemic treatment is conducted in accordance with current principles regarding therapy for invasive carcinoma of no special type (IC-NST). The analysis of treatment outcomes has shown that 10-year survival is observed in over 90% of patients with T-MBC whereas in those with A-MBC, the outcome is much worse. This paper discusses A-MBC in detail and puts an emphasis on the fact that a diagnosis of A-MBC may carry prognostic information but does not affect therapeutic decisions. © Oncology and Radiotherapy.


Rutkowski P.,Klinika Nowotworow Tkanek Miekkich I Kosci | Kulig J.,I Katedra Chirurgii Ogolnej I Klinika Chirurgii Gastroenterologicznej | Krzakowski M.,Klinika Nowotworow Pluca I Klatki Piersiowej | Osuch C.,I Katedra Chirurgii Ogolnej I Klinika Chirurgii Gastroenterologicznej | And 17 more authors.
Nowotwory | Year: 2011

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Over the last years advances in the understanding of the molecular mechanisms of GIST pathogenesis have resulted in the emerging of GIST as a distinct sarcoma entity. This paper presents the guidelines for diagnostics and therapy of these tumors based on scientific research and experts' experience, These guidelines are commonly accepted and worthy of recommendation. Overexpression of the KIT receptor, as a consequence of mutation of the KITprotooncogene is highly specific for GIST and enables immunohistochemilcal detection staining (CD117) in tumor specimens. It is the most important criterion in microscopic diagnostics and for indicating treatment with small-molecule tyrosine kinase inhibitors. Sending material for molecular analysis is strongly recommended (for KIT and PDGFRA genotyping). Radical surgery is still the mainstay treatment for primary, localized, resectable GISTs, although although a significant ratio of patients after potentially curative operations develop recurrent or metastatic disease. In inoperable/metastatic lesions the treatment of choice is a tyrosine kinase inhibitor - imatynib mesylate - the first effective systemic therapy in advanced CD117(+) GIST. The recommended initial dose should be 400 mg daily (800 mg for exon 9 KIT mutants). Tretament monitoring should be based on serial computed tomography imaging of the abdominal cavity with the assessment of changes of tumor size and density. In case of disease progression the increase of imatynib dose to 800 mg daily is recommended and - if progression maintains - sunitinib in the initial dose of 50 mg daily should be introduced. Clinical trials evaluating the role of surgery combined with imatynib and the efficacy of other molecular targeted drugs in resistant cases are ongoing. Existing data indicate the beneficial role of adjuvant imatynib therapy in terms of relapse-free survival, especially in the group of patients with a significant risk of relapse. The presented recommendations for the diagnostics and therapy of GIST should be practically implemented by physicians involved in the management of GIST patients in Poland. Entering all GIST cases in the National Clinical Registry (http:// gist.coi.waw.pl) and standardising patient treatment in multidisciplinary teams with expertise in GIST therapy, as well as enrollment of new cases into prospective clinical trials, are recommended.


Kaspera W.,laski University Medyczny | Majchrzak K.,laski University Medyczny | Bobek-Billewicz B.,Zaklad Radiodiagnostyki | Hebda A.,Zaklad Radiodiagnostyki | And 4 more authors.
Neurologia i Neurochirurgia Polska | Year: 2013

Background and purpose:Reoperations of patients with recurrent low-grade gliomas (LGG) are not always recommended due to a higher risk of neurological deficits when compared to initial surgery. The purpose of the present study was to evaluate surgical outcomes of patients operated on for recurrent LGG. Material and methods: Sixteen patients who had surgery for recurrent LGG out of 68 LGG patients who underwent surgery at the Department of Neurosurgery in Sosnowiec, Poland between 2005 and 2011 were enrolled in the study. Results: A large tumour volume prior to the initial surgery was the most significant parameter influencing LGG progression (96.6 cm3 vs. 47.9 cm3, p = 0.01). Increased incidence of epileptic seizures and decreased mental ability ac - cording to Karnofsky score were the most common symptoms associated with tumour recurrence. In the group of patients with malignant transformation, the relative cerebral blood volume (rCBV) was considerably increased (1.21 vs. 2.41, p < 0.01). No statistically significant difference was found in terms of the extent of resection between initial surgery and reoperation. Similarly, no significant difference was found in the number of patients with a permanent neurological deficit after initial surgery and reoperation. Conclusions: Reoperations of the patients with recurrent LGG are not burdened with a higher risk of neurological sequelae when compared to initial surgery. The extent of resection during the surgery for LGG recurrence is comparable to initial surgery. The increase of rCBV seems to be a significant biomarker that indicates malignant transformation.


Maciejewski B.,Zaklad Radioterapii | Krzakowski M.,Klinika Nowotworow Pluca I Klatki Piersiowej | Bobek-Billewicz B.,Zaklad Radiodiagnostyki
Nowotwory | Year: 2010

Present paper is the review of actual knowledge in the field of molecular biology, radiobiology and therapy of malignant tumours and individual heterogeneity of molecular signatures, and chemo- and radiosensitivity is documented. Clinical applicability some of the "evidence based" standards protocols and dogmas is questioned. It is pointed out that equal doses of radiation or chemotherapeutic agents do always not kill the same rate of cancer cells and a large variations in the initial tumours volume within a given TNM stage of disease need different, but not the same, doses of radiation or chemotherapy. Actual knowledge and experience lead to the suggestion that a key factor for effective therapy is its intensity. Classic sequential treatment modalities with unprogrammed time intervals between respective methods of therapy should be replaced by individually planned integrated combined therapy with a known sequence and timing. This is called "theragnostic oncology", which means the use of knowledge and experience to establish individual combined therapy producing the highest therapeutic gain and the lowest risk of serious late complications.


D'Amico A.,Zaklad Diagnostyki PET | Przeorek C.,Zaklad Diagnostyki PET | Siewinska J.,Zaklad Diagnostyki PET | Gorczewski K.,Zaklad Diagnostyki PET | And 6 more authors.
Nuclear Medicine Review | Year: 2012

BACKGROUND: CT scan provides information about the anatomy and morphology, may confirm whether the change is single or has multifocal character and may suggest the probability of malignancy. Due to increased metabolism, at PET examination malignant tissues usually show a greater uptake of 18F-FDG than benign changes and healthy tissue. In several cases, PET-CT is described only by a specialist in nuclear medicine without consulting a radiologist. The aim of this study is to evaluate the accuracy of PET with assessment performed by a single nuclear medicine specialist and multidisciplinary assessment by both nuclear medicine and radiology specialists. MATERIALS AND METHODS: PET-CT was performed in 58 consecutive patients referred from John Paul II Hospital in Cracow because of radiologically diagnosed solitary pulmonary nodule (SPN) with diameter > 1 cm. An histopatological specimen was obtained in 37 patients. In 17 cases PET-CT images were evaluated by a single nuclear medicine specialist (group A), while for the remaining 20 cases, the image evaluation was performed shoulder-to-shoulder by a nuclear medicine specialist and a radiologist (group B). ANALYSIS OF DATA: Overall PET sensitivity, specificity, positive and negative predictive value and accuracy were calculated on the basis of anatomopathologic results. These data were also calculated separately for groups A and B. RESULTS: The histopatologic examination demonstrated the non neoplastic character of 7/37 lesions. The sensitivity, specificity, accuracy, positive and negative predictive values for group A were 85.7%, 100%, 100%, 33.3% and 88% while for group B were 92.8%, 83.3%, 92.8%, 83.3% and 90% respectively. CONCLUSION: PET-CT is an accurate diagnostic method to assess the nature of solitary pulmonary nodules. The consultation with radiologist does not substantially affect the PET-CT diagnostic accuracy, but can lead to a higher negative predictive value. Copyright © 2012 Via Medica.


Grzesiakowska U.,Zaklad Radiodiagnostyki | Jezierski A.,Zaklad Radiodiagnostyki | Smorczewska M.,Zaklad Radiodiagnostyki | Brzeska B.,Zaklad Radiodiagnostyki | Olszewski M.,Zaklad Radiodiagnostyki
Nowotwory | Year: 2011

Methods and materials. 15 patients aged between 43 and 72 years were treated because of primary orbit lymphoma. CT and MRI were applied for diagnosis and follow-up. Both tests were performed before and after intravenous contrast administration. Microscopic examination confirmed 5 cases of B-type lymphoma, 5 cases of MALT lymphoma and a single case of lymphocytic lymphoma. Results. In 12 CT examinations the lesion density was almost identical as the density of extraocular muscles. 5 lesions indicated postcontrast enhancement. 3 MRI tests were performed. In both T1- and T2-weighted images lesion signal intensity was similar to extraocular muscles intensity. All lesions enhanced after i.v. contrast administration. In 9 cases we observed complete response. In 6 cases we detected residual lesions, stable over a 3 to 8 year follow-up. We didn't observe recurrence. Conclusions. The diagnosis and follow-up of primary orbit lymphomas can be performed both through computed tomography (CT) and magnetic resonance imaging (MRI).


Rutkowski P.,Centrum Onkologii Instytut im. Marii Sklodowskiej Curie | Nowecki Z.I.,Centrum Onkologii Instytut im. Marii Sklodowskiej Curie | Dziewirski W.,Centrum Onkologii Instytut im. Marii Sklodowskiej Curie | Siedlecki J.A.,Zaklad Biologii Molekularnej | And 2 more authors.
Nowotwory | Year: 2010

Aim. The aim of the study was to assess the frequency and results of disease/treatment-related emergency operations during molecular targeted therapy of advanced gastrointestinal stromal tumors (GISTs). Methods. We analyzed emergency operations in patients with metastatic/inoperable GISTs treated with 1st-line imatinib - IM (group I: 232 patients; median follow-up time 31 months) and 2nd-line sunitinib - SU (group II: 43 patients; median follow-up 13 months; 35 patients in trial A6181036) enrolled into the Polish Clinical GIST Registry. Results. In group 13 patients (1.3%) underwent emergency surgery due to disease/treatment related complications: one due to bleeding from a ruptured liver tumor (1 month after IM onset) and two due to bowel perforation on the tumor with subsequent intraperitoneal abscess (both 2 months after IM onset). IM was restarted 5-8 days after surgery and no complications in wound healing were observed. In group II 4 patients (9.5%) underwent emergency operations due to disease/treatment related complications: three due to bowel perforations on the tumor (2 days, 20 days and 10 months after SU onset; 1 subsequent death) and one due to intraperitoneal bleeding from ruptured, necrotic tumor (3.5 months after SU start). SU was restarted 12-18 days after surgery and no complications in wound healing were observed. Conclusions. Emergency operations associated with disease or therapy during imatinib treatment of advanced GISTs are rare. The frequency of emergency operations during sunitinib therapy is considered to be higher than during first line therapy with imatinib which may be associated with more advanced and more resistant disease or to the direct mechanism of sunitinib action, i.e. combining cytotoxic and antiangiogenic activity and thus leading to dramatic tumor response. Molecular targeted therapy in GISTs should always be conducted in cooperation with an experienced surgeon.


Majchrzak K.,Medical University of Silesia, Katowice | Bobek-Billewicz B.,Zaklad Radiodiagnostyki | Tymowski M.,Medical University of Silesia, Katowice | Adamczyk P.,Medical University of Silesia, Katowice | And 2 more authors.
Neurologia i Neurochirurgia Polska | Year: 2011

Background and purpose: Surgical treatment of insular tumours carries significant risks of limb paresis or speech disturbances due to their localization. The development of intraoperative neuromonitoring techniques that involve evoked motor potentials induced via both direct and transcranial cortical electrical stimulation as well as direct subcortical white matter stimulation, intraoperative application of preoperative tractography and functional magnetic resonanceimaging (fMRI) in conjunction with neuronavigation resulted in significant reduction of postoperative disabilities that enabled widening of indications for surgical treatment. The aim of this study was to present the authors' own experience with surgical treatment of insular gliomas. Material and methods:Our cohort comprises 30 patients with insular gliomas treated at the Department of Neurosurgery in Sosnowiec. Clinical symptoms included sensorimotor partial seizures in 86.6%; generalized seizures in 23.3%; persistent headaches in 16.6% and hemiparesis in 6.6%. All the patients were operated on with intraoperative neuromonitoring that included transcranial cortical stimulation, direct subcortical white matter stimulation as well as tractography and fMRI concurrently with neuronavigation. The analysis in - cluded postoperative neurological evaluation along with the assessment of the radicalism of resection evaluated based on postoperative MRI. Results: Postoperatively, four patients had permanent hemiparesis (13.3%); importantly, two out of those patients had preoperative deficits (6.6%). Persistent speech disturbances were present in four patients (13.3%). Partial sensorimotor seizures were noted in two patients (6.6%). Seizures in the other patients receded. Intraoperative transcranial electrical stimulation as well as direct subcortical white matter stimulation along with tractography (DTI) and fMRI facilitated gross total resection of insular gliomas in 53.5%, subtotal in 13.3% and partial resection in 33.1%. Conclusions: Implementation of TES, direct subcortical white master stimulation, DTI and fMRI into the management protocol of the surgical treatment of insular tumours resulted in total and subtotal resections in 66% of cases with permanent motor disability in 6.6% of patients. Poor prognosis for independent living after surgery mainly affects patients with WHO grade III or IV.


Tymowski M.,Medical University of Silesia, Katowice | Majchrzak K.,Medical University of Silesia, Katowice | Bobek-Billewicz B.,Zaklad Radiodiagnostyki | Ladzinski P.,Medical University of Silesia, Katowice | Majchrzak H.,Medical University of Silesia, Katowice
Neurologia i Neurochirurgia Polska | Year: 2013

Background and purpose: The purpose of the study was to compare the results of operative treatment of tumours located in the sensory-motor cortex guided with functional magnetic resonance imaging (fMRI) combined with the neurona vigation system to the results of classical operative treatment. Material and methods: The studied group comprised 28 patients with a tumour located in the sensory-motor cortex area who underwent surgery guided with fMRI and the neuro-na vigation system. A control group comprised 30 patients with the same clinical diagnosis, operated on without functional neuronavigation. Results: The use of functional neuronavigation allowed for an 18% reduction in the intensity of neurological deficits after surgical treatment in patients from the studied group, compared to the subjects from the control group (p= 0.0001). In the patients with diagnosed high-grade glioma, improvement in the neurological condition in the studied group was 16% (p = 0.03). The initial neurological condition and the results of surgical treatment in patients with a tumour located less than 5 mm from the sensory-motor cortex, determined in fMRI examination, are worse than in patients with a tumour located more than 5 mm. Conclusions: In patients with a diagnosed brain tumour in the sensory-motor cortex who have neurological deficits, fMRI provides valuable imaging data on active areas. Tumour location of more than 5 mm from the fMRI active area of the sensory-motor cortex is connected with a considerably lower risk of postoperative neurological deficits. Removing a tumour in the sensory-motor cortex region, guided with fMRI and the neuronavigation system, considerably lowers the risk of postoperative development or exacerbation of neurological deficits.

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