Biedka M.,Nicolaus Copernicus University |
Biedka M.,Bydgoszcz Cancer Center |
Kuzba-Kryszak T.,Zaklad Radioterapii |
Kuzba-Kryszak T.,Bydgoszcz Cancer Center |
Koper K.,Nicolaus Copernicus University
Current Gynecologic Oncology | Year: 2016
A major problem in cancer treatment is disease recurrence, i.e. a situation in which the standard procedures turned out to be ineffective and the previously used therapy significantly limits its next use. Vaginal recurrence is found in 2.4-15% of patients with uterine cancer. For large recurrent tumors radical treatment involves surgical pelvic exenteration. However, indications for this procedure are significantly limited; in addition, it is associated with a high risk of complications and a significantly compromised quality of life. For this reason, brachytherapy and/or another course of radiotherapy are administered, which until recently were used as a further-line treatment option or as palliative care. Over the last few years extension of indications for radiotherapy and brachytherapy has been noted due to the dynamic development of new techniques for planning and conducting treatment. These allow for the irradiation of the target volume which causes radiation-related reactions that are acceptable for the patient while protecting critical organs. The introduction of new therapeutic devices allowed for the use of different treatment techniques, including intensity-modulated radiation therapy, image-guided radiotherapy, RapidArc, tomotherapy, intraoperative radiotherapy and stereotactic body radiotherapy, which contributed to a significant increase in the role of repeat radiotherapy. One needs to remember about the possibilities of systemic treatment, although it is usually palliative in nature. Brachytherapy may be considered for the treatment of recurrent disease if the lesions are located in the region of the vagina or vaginal stump or if infiltration is found in the parametria; in other situations treatment combined with external beam radiotherapy should always be considered. The choice of brachytherapy method depends on the location of the lesion and the extent of infiltration. If the infiltration is up to 5 mm deep, intracavitary brachytherapy is performed. If the infiltration is deeper, the use of interstitial brachytherapy is indicated. © Curr Gynecol Oncol 2016.
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.
Miszczyk L.,Zaklad Radioterapii
Nowotwory | Year: 2012
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.
Pedziwiatr K.,Zaklad Radioterapii |
Skowronska-Gardas A.,Zaklad Radioterapii
Nowotwory | Year: 2012
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.
Topczewska-Bruns J.,Zaklad Radioterapii |
Filipowski T.,Zaklad Radioterapii
Wspolczesna Onkologia | Year: 2010
A large part of oncological patients will be treated using radiation therapy. The effect of the action of ionizing radiation on the skin is radiation dermatitis, which may have a different level of intensity. Skin reaction is a source of a number of ailments such as burning, itching or pain on the irradiated area. A severe degree of radiation dermatitis can not only significantly impair quality of life of the patient, but also require the interruption of irradiation which can influence results. Prevention and treatment of radiation skin reaction is a daily practice for radiotherapist, but unfortunately, there is little evidence on which to base therapeutic decisions. This article presents a review of clinical trials for the prevention and treatment of radiation dermatitis.
Bodusz D.,Zaklad Radioterapii
Przegla̧d lekarski | Year: 2013
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.
Latusek T.,Zaklad Radioterapii |
Miszczyk L.,Zaklad Radioterapii
Onkologia i Radioterapia | Year: 2015
The aim. The aim of the study is to evaluate the efficacy of retrobulbar space irradiation in the treatment of patients with Grave’s disease, as well as to identify possible prognostic and predictive factors. Material and method. The analysis included a group of 89 patients irradiated in the years 2007–2014 in Gliwice, Poland. The study group consisted of 28 men and 61 women; the average age was 55.5 (SD=10.3). Patients’ medical records have been analyzed and a telephone survey has been carried out. The following were assessed during the study: differences in the CAS scale (Clinical Activity Score) and NO SPECS severity classification of the American Thyroid Association (both scales assess the severity of orbitopathy – the higher the value, the greater the severity), the administration of steroids and their dosage as well as the concentration of TSH, FT4, FT3 and, finally, the dose of levothyroxine before irradiation and during the subsequent check-up visits. Results. In 10% of patients, orbitopathy intensified after RT, in 16% – stagnancy was observed, and in 74% of patients, the lesions regressed. The health status of patients improved (reduced score in the CAS scale and in the NO SPECS classification). A positive, statistically non-significant correlation has been found between the score in the NO SPECS classification after RT and the applied dose of levothyroxine during the last check-up visit (p=0.06; r=0,5). A correlation between the score in the CAS scale before RT and the concentration of FT4 after RT has also been detected (p=0,04; r=- 0,5). Solumedrol was administered to 51 patients before RT. Patients who experienced health status improvement had received a higher total dose of solumedrol (p=0.9; t=1.7). Conclusions. The obtained results allow to conclude that retrobulbar space irradiation is an effective method of treatment for patients suffering from thyroid-associated orbitopathy. The severe disease course (a higher score in the NO SPECS classification) requires the administration of high doses of levothyroxine. A high dose of solumedrol administered before radiotherapy seems to be a positive predictive factor. © 2015, Medical Project Poland. All Rights Reserved.
Kozakiewicz B.,Zaklad Radioterapii
Current Gynecologic Oncology | Year: 2011
Since 1929, surgical treatment is an accepted treatment for endometrial cancer. Implementation of radiotherapy as an adjunct to surgical excision resulted in improved cure rates in patients with unfavorable prognostic factors. In this group of patients, many are those with internal medical comorbidities coexisting with their endometrial cancer, precluding surgical treatment. The paper presents a retrospective analysis of outcomes obtained using radiotherapy as the sole therapeutic modality since 1968 thru 1985. Study population includes 107 patients aged 43 to 83 years (mean age: 76 years). In 55 patients at clinical stages I and II, surgical treatment was impracticable mostly because of severe comorbidity. Fifty-two patients were at clinical stage III. Brachytherapy by application of Heyman capsules was performed in 75 patients, irradiation from external sources combined with radium brachytherapy using vaginal applicators and uterine probes - in 24 patients, while external beam radiotherapy only - in 8 patients. Upon irradiation, all patients underwent triple fractionated curettage of uterine cavity. Hysteroscopic inspection of uterine cavity is being performed since 1981, combined with collection of tissue samples under visual control for microscopic study. In the entire study population, 5-year survival rate was 47%. In the subgroup treated by Heyman capsules only, 5-year survival rate was 45%. Patients at clinical stages I and III had 5-year survival rates of 56% and 44%, respectively. © Curr. Gynecol. Oncol. 2011.
Kleszyk L.,Zaklad Radioterapii |
Urbanczyk H.,Zaklad Radioterapii
Przeglad Menopauzalny | Year: 2012
Introduce and aim of the study: A common problem during radiotherapy of breast cancer patients, is both early (mainly skin reactions) and late (occuring withing months to years after treatment completion) normal Tytissue toxicity. This study aims to evaluate the tolerance of radical radiotherapy in patients with breast cancer aged over 75 years. Material and methods: Retrospective analysis was performed on a group of 44 patients over 75 (ranging from 75 to 85 years old, median 77 years), treated with radical radiotherapy to the chest wall, in Maria Skłodowska- Curie Memorial Cancer Center and Institute of Oncology in Gliwice between 2008 and 2009. Surgical treatment was performed in 42 patients (95,5%). A breast amputation was performaed in 37 patients, 5 patients had undergone breast conserving surgery (BCT). Two patients were treated with radiotherapy alone. Total dose ranged from 44 to 70 Gy with a median of 50 Gy. Fractional dose ranged from 2 to 2.5 Gy (median 2 Gy). Most patients (75%) also received radiotherapy to supraclavicular and axillar lymph nodes. Total treatment time ranged from 21 to 67 days (median 35 days). Toxicity was assessed using the EORTC / RTOG scale, statistical analysis was performed using descriptive statistics in Statistica. Results: Acute skin toxicity was noted in 41 (93%) patients, the majority (78%) presented grade I effects. 10% and 12% of all patients presented respectively grade II and III effects and their occurrence was related closely to the total dose escalation. Median time for an acute skin reaction to occur was 23 days (ranging from 10 to 50 days). Acute grade I hematologic toxicity (anemia, leucopenia, thrombocytopenia) was diagnosed in 8 (18%) patients, occuring between 17 and 83 (median 47,5) days from the start of the treatment. Late grade I pulmonary toxicity (sporadic exertional dyspnea) was reported in one patient, occuring 202 days after completion of the treatment. One patient required a break during radiotherapy, 5 patients (11.5%) had the total dose reduced due to increased skin toxicity Conclusions: Modern radiotherapy is a safe and well tolerated method of radical breast cancer treatment, whether adjuvant or alone, which is especially important in elderly patients disqualified from surgical and/or systemic treatment.
Bodusz D.,Zaklad Radioterapii |
Glowacki G.,Zaklad Radioterapii |
Miszczyk L.,Zaklad Radioterapii
Nowotwory | Year: 2011
Background. Prostate mobility is one of the problems of contemporary radiotherapy. but image-guided radiation therapy (IGRT) techniques enable soft tissues visualization. These techniques include cone beam computed tomography (CBCT) based on X-ray and SonArray based on ultrasound. The disadvantages of both these systems include their long duration and the subjectivity in the assessment of the prostate localization. Golden markers could be a very useful tool for increasing the precision of target localization using 2D/2D kV or X-Ray systems. Consequently this allows to reduce CTV margins, but the reduced margins should include possible intrafraction prostate mobility. M a t e r i a l a n d methods. In a group of 56 irradiated prostate cancer patients we performed 530 measurements of intrafractional prostate displacement. The 2D/2D kV system was used for patient positioning. Prostate position was assessed using implanted markers (GoldAnchor) and appropriate corrections were done. Twice a week post-treatment images (anterior-posterior and lateral) were taken. To assess intrafractional prostate mobility shifts were calculated on post-treatment images. Re s u l t s. The means of absolute values of intrafractional prostate mobility were: 0.18 cm in superior-inferior (SI) direction, 0.17 cm in anterior-posterior (AP) direction and 0.07 cm in left-right (LR) direction. The mean of vector of intrafractional prostate mobility differs significantly depending on the radiotherapy technique. The p-value for IMRT vs RapidArc, 3DCRT vs RapidArc and IMRT vs 3DCRT were 0.000014, 0.012085, 0.054445 respectively. Conclusions. During prostate cancer radiotherapy one observes intrafractional prostate mobility. The mean of absolute values of prostate mobility increases with the duration of the radiotherapy session. The lowest prostate mobility was observed in volumetric arc therapy (RapidArc), the greatest mobility was observed in intensity modulated radiation therapy (IMRT).