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Marii, Poland

Introduction. Patients suffering from pancreatic cancer have very poor prognoses, and the use of different treatment modalities has only a limited impact on OS. Material and methods. 64 patients with pancreatic cancer were irradiated between January 2009 and August 2010 (33 F, 31 M). The most common tumour location was the head of the pancreas (45 cases) and the most common histopathological diagnosis was adenocarcinoma (47 cases). 53 patients underwent surgery (21 with radical intention). Tumour size varied from 1 to 15 cm (mean 4.5). 33 patients had dissemination before radiotherapy (RTH), and eight patients had neoadjuvant chemotherapy (CTH). 36 patients were irradiated with palliative and 28 with radical intention. In 25 cases, concurrent CTH was delivered. Patients were irradiated using a fd of 1.8-4 Gy up to the TD varying from 8 Gy (stopped treatment) to 59.4 Gy. OTT varied from 5-52 days (mean 24). Adjuvant CT was used in 12 cases. Follow-up period (FU) and overall survival (OS) had ranges of 19 months (mean 3.9 and 5.0 respectively). The survival analysis of each particular subgroup was based on which treatment modality was performed. The logit analysis of dependency between the risk of death, fd and TD was used. Correlations between different biological and physical factors dependent on tumour, treatment and treatment results were also calculated. Results. There were statistically significant differences between OS of radically and palliatively treated patients (increased OS of radically treated patients; p = 0.0015 and p = 0.0005 for RTH and surgery respectively), and between patients who underwent concurrent treatment and RTH alone (increased OS for combined treatment; p = 0.001). A significant impact of neoadjuvant CTH, operation and adjuvant CTH was also found (OS for neoCTH patients was shorter). There was little impact of fd (p = 0.08) and a significant impact on TD (p = 0.04) for risk of death. Different correlations between biological, physical features and treatment results were also found. Conclusion. The obtained results indicate the necessity of carefully considering the two schools of thought currently existing in pancreatic cancer patients' treatment: the need for surgery and adjuvant chemotherapy. On the basis of these results, we can conclude that surgery is necessary only if there is a high probability of being radical, and that systemic treatment is significant as a concurrent treatment. However, additional factors (e.g. the risk of dissemination) should be the final determinant. © Polskie Towarzystwo Onkologiczne. Source

Kozakiewicz B.,Zaklad Radioterapii | Kaczmarczyk M.,Wydzial Chemii Uniwersytetu Warszawskiego
Current Gynecologic Oncology | Year: 2012

The paper is an overview of metal-containing compounds, i.e. platinum derivatives, used to create extremely active oncologic drugs. Platinum derivatives are in use for about 40 years in the treatment of most (nearly 80%) malignant tumors. Among metal-containing drugs, platinum derivatives are longest in use; they are very active tumor-destroying agents, have a potent antitumor effect and are the basis of several multidrug protocols. Unfortunately, apart of their antitumor effect, cisplatin has also considerable toxicity manifesting in many organ systems. Second- and third-generation platinum derivatives are being developed, aiming at reduction of these unfavorable effects while preserving or even enhancing its antitumor activity. In order to reduce platinum-related toxicity, such modalities as cytoprotection, pharmacogenetics and molecular biology are resorted to, aiming at isolation of active genes participating in the development of drug resistance. The aim of cytoprotection is to protect and strengthen normal tissues against deleterious impact of chemotherapy by rapid regeneration of healthy tissue, with no reduction of activity of cytostatic drugs. Pharmacogenetics aims at discovery of genes, their interactions and responses to particular cytostatic agents used in oncology. The goal is to point-out patients most at risk of developing unacceptable toxicity, even before application of the drug. History of use of cisplatin in the treatment of tumors indicates that improvement of treatment outcomes is the sum-total of inputs of interdisciplinary teams: chemists, biologists and oncologists. © Curr. Gynecol. Oncol. 2012. Source

The use of fiducial markers in patients undergoing teleradiotherapy increases the precision of treatment under the condition that the marker does not displace itself during this treatment. In order to determine the accuracy of the verification method used to establish patient position, it is necessary to establish the possible marker migration range during planning and treatment with radiation therapy. An analysis of the migration of GoldAnchorTM fiducial markers implanted in the prostate conducted on a group of 29 patients treated with image-guided radiation therapy at the Radiotherapy Department of the Cancer Centre and Institute of Oncology in Gliwice. The migration value was determined based on a comparison of the marker's location with the use of spiral computer tomography and cone-beam computer tomography done on the treatment device. The average values of the given fiducial marker's migration in the superior-inferior (SI), left-right (LR) and anterior-posterior (AP) directions were: 0.07 cm (SD=0.1 cm); 0.06 cm (SD=0.07 cm) and 0.11 cm (SD=0.11 cm), respectively. The average value of the displacement vector computed according to the Pythagorean theorem and using the Euclidean norm was 0.17 cm with SD= 0.13 cm. The analysis indicates that migration of markers implanted in the prostate occurs during radiation treatment planning but probably it is not clinically relevant. Because a correlation was determined between the migration value and the time of carrying out the CT as well as the time that had passed from the implantation to the CBCT examination, it is reasonable to start radiation therapy promptly and to control the marker's location during radiation therapy. Source

Namysl-Kaletka A.,Zaklad Radioterapii | Tukiendorf A.,Zaklad Epidemiologii i Slaski Rejestr Nowotworow | Wydmanski J.,Zaklad Radioterapii
Onkologia i Radioterapia | Year: 2015

The aim. The aim of this paper was to compare the methods of specifying margins in patients with gastric cancer. Material and methods. The material included 57 patients with gastric cancer during chemoradiotherapy in whom the positioning in the therapeutic system was verified using 2 kV images prior to each radiotherapy fraction. Subsequently, shifts in three axes were assessed. Based on the shifts obtained, systematic and random errors were calculated in given axes and margins were specified using the van Herk, Stroom and ICRU 62 formulae. Results. The margins resulting from the interfraction motion based of the van Herk, Stroom and ICRU formulae were as follows: 9 mm, 7 mm and 6 mm in the lateral axis, 16 mm, 14 mm and 11 mm in the craniocaudal axis as well as 8 mm, 7 mm and 5 mm in the anteroposterior axis, respectively for each formula. The lowest percentage of shifts that were greater than the calculated margin was observed in the van Herk method (1.5% in the lateral axis, 3.3% in the craniocaudal axis and 1.9% in the anteroposterior axis). Conclusions. Based on the material investigated, the margin recommended for centers in which daily patient position verification is not possible is the one calculated with the use of the van Herk formula. © ONKOLOGIA I RADIOTERAPIA 2015. Source

Purpose. This study was conducted to analyze the efficacy of radiotherapy within the combined treatment of children with intracranial ependymoma and also to determine prognostic factors, patterns of failure and late effects after therapy. Methods and materials. Between 1984 and 2005, 115 children with intracranial ependymoma received radiotherapy after surgery in the Department of Radiation Oncology of the Cancer Center and Institute of Oncology. During this time the radiotherapy protocol was changed. Most patients were treated with craniospinal radiotherapy followed by a boost to the primary site. The remaining patients were treated with conformal local radiotherapy. A new chemotherapy regime was used after 1997. The Kaplan-Meier method was used to estimate survival. Multivariate analysis was performed with the Cox proportional hazards model to study prognostic factors. The risk of occurrence of complications including impairment of intellectual functions, growth, endocrine deficits and hearing loss were analyzed. Results. The 5-year overall survival and survival without progression were 69% and 62% respectively. A better overall outcome: survival and progression-free survival rates were observed, for patients who were treated with 3D radiotherapy 1997-2005, but this was not a statistically significant difference. As calculated by multivariate analysis an age of less than 4 years had was associated with a significantly worse outcome. There were no significant influences of other factors such as extent of resection, leptomeningeal spread, sex and neurological condition patients, tumour grade, location and size. In the analysis of patterns of failure no statistical significant differences between incidence dissemianation after craniospinal radiation versus local irradiation were observed. The probability of late effects such as cognitive and growth dysfunction in the patients treated with 2D irradiation were observed twice as much than with those after 3D irradiation. More frequently impairment of intellectual function in children younger than 4 years and more growth dysfunction in children under the age of 9 years were observed. Conclusion. The results of combined treatment of the children with intracranial ependymoma, obtained in our Radiotherapy Department are comparable to those published in other centers. The use of 3D conformal radiotherapy causes a trend towards improvement in outcome. The improvement of treatment results after 1997 is due to advances in diagnosis and treatment. The use of conformal local irradiation does not increase the risk of spreading disease and reduces incidence late complications. © Polskie Towarzystwo Onkologiczne. Source

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