Zaklad Teleradioterapii

Łódź, Poland

Zaklad Teleradioterapii

Łódź, Poland

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Nowikiewicz T.,Oddzial Kliniczny Nowotworow Piersi i Chirurgii Rekonstrukcyjnej | Biedka M.,Oddzial Radioterapii I | Krajewski E.,Oddzial Kliniczny Nowotworow Piersi i Chirurgii Rekonstrukcyjnej | Koper K.,Katedra i Klinika Ginekologii Onkologicznej i Pielegniarstwa Ginekologicznego CM UMK W Bydgoszczy | Windorbska W.,Zaklad Teleradioterapii
Current Gynecologic Oncology | Year: 2012

Sentinel lymph node biopsy in patients with early-stage breast cancer is an example of a surgical procedure which, despite its long history, has had no uniform standard of performance implemented. This is a problem which concerns both the indications and limitations of this method as well as many of the technical aspects connected with the procedure. This paper is an attempt to resolve some of the controversies mentioned above based on the clinical experience of the authors. Material and method: The group consisted of 974 patients suffering from breast cancer and treated from January 2004 through October 2011 in the Clinical Department of Breast Cancer and Reconstructive Surgery of the Oncology Center in Bydgoszcz who were also scheduled for sentinel lymph node removal. Data regarding the preoperative diagnosis of the primary tumor, such as minimally invasive methods (FNAB, core biopsy, and mammotome biopsy) or open surgical biopsy (tumorectomy, quadrantectomy, or past breast operations with no relation to the current treatment) of the location of the lesion and the sentinel lymph node identification method (combined isotope-dye, isotope, or dye method) was analyzed. Results: Ninety-four point five percent of all sought nodes were detected. The detection rate for the combined SLN marking and isotope methods amounted to 94.4% each, whereas in the case of the dye method, it amounted to 100%. Of all the patients who underwent surgery for the first time, 95.0% had the sentinel lymph node location isolated during the operation, whereas in the case of patients who had previously undergone surgical treatment of the breast or surgical biopsy of a tumor it was 92.1%. Moreover, the location of the tumor within the breast did not have a significant impact on the success of the sentinel lymph node biopsy. Conclusions: The surgical biopsy of the primary lesion preceding the removal of the sentinel lymph node does not have a significant impact on the possibility of the detection of the node sought. The situation is similar with regard to the selected method of sentinel lymph node detection and the location of the primary tumor. As a result, it is possible to extend the usage of the sentinel lymph node biopsy into a wider range of cases. © Curr. Gynecol. Oncol. 2012.


Jonska-Gmyrek J.,Zaklad Teleradioterapii | Bobkiewicz P.,Zaklad Patologii | Gmyrek L.,Kliniczny Oddzial Ginekologii | Zolciak-Siwinska A.,Zaklad Brachyterapii | And 2 more authors.
Ginekologia Polska | Year: 2013

Merkel cell carcinoma (MCC) is a rare malignant neoplasm, mostly affecting the skin (97% of cases). It is usually found in elderly people, in the sun-exposed areas of the skin. About 50-60% of MCC cases are located on the head and the neck, less often on the extremities and the torso, and extremely rarely in the genital area. Ultraviolet radiation may be the main factor responsible for the development of the tumors but viral etiology is also debated. Due to extremely rare incidence of MCC in the area of the vulva, proper management remains a challenging task. Aim: To present a case of an aggressive MCC of the vulva and a review of the literature. Material and methods: A previously healthy, 72-year-old patient presented at the Oncology Center of the Maria Sklodowska-Curie Institute, Warsaw, in June 2010. Four months previously the patient noticed a painless lump in the vestibular region of the vagina. She received anti-inflammatory treatment at her local gynecological clinic, with no success. In February the patient underwent removal of the vulvar tumor. Histopathological examination confirmed anaplastic carcinoma. Microscopic evaluation revealed the tumor diameter to be 15mm. Surgical margins were free of neoplastic infiltration. The patient did not receive adjuvant therapy due to the results from the histopathological protocol. The disease recurred after three months. Radical vulvectomy and bilateral inguinal femoral lymphadenectomy were performed in May 2010. Histopathological examination confirmed microcellular carcinoma with no metastases to the lymph nodes and complete resection of the tumor (R0). The disease recurred in the next two months: a 50-mm tumor was found in the right inguinal lymph nodes. The decision to verify all histopathological material obtained during all procedures performed so far was made. Immunohistochemical evaluation confirmed MCC. Adjuvant radiotherapy was recommended. The area of the vulva, pelvic and inguinal lymph nodes were irradiated. One month after therapy completion the patient complained of pain in the lumbar area. An ultrasound examination of the abdomen revealed a tumor (9 cm in diameter) in the para-aortic region but it was not histopathologically verified due to extremely poor overall condition of the patient. As the condition of the woman deteriorated systematically, the patient was referred to a hospice facility, where she died 9 months since the primary diagnosis. Conclusions: MCC of the vulva is a rare neoplasm with an aggressive course. Clinical and histopathological diagnostic difficulties and consequently lack of standardized management, result in low survival rates. © Polskie Towrzystwo Ginkoogiczne.


Multiple simultaneous ipsilateral breast cancer incidence is some 10% of new breast cancer cases. Update of clinical- -pathological view of multitumor breast cancer in the context of 7th Edition of AJCC Classification is the main aim of this article. 7th Edition of AJCC Classification does not apply terms multifocal and multicentric for multitumor breast carcinomas. Term multiple carcinoma is used instead for all cases of multiple unilateral breast carcinomas. 7th Edition of AJCC Classification defines multiple carcinomas as follows: multiple tumors grossly presented in the same breast, tumors are separated by at least 0.5 cm, invasion is confirmed by microscopic evaluation, microscopically confirmed absents of invasion in breast tissue between tumors. 7th Edition of AJCC Classification considers mainly the dimension of the largest invasive tumor in cases of multiple carcinomas. Presence of additional tumors with invasive histology is reported only by parameter "m"(e.g., pT(m)1c) or by a parameter considering number of tumors (e.g., pT(3)1c - for three invasive breast carcinoma tumors, in which the largest one is more than 1cm and up to 2 cm in diameter. © Polskie Towarzystwo Onkologiczne.


The definition of quality of life is derived from the WHO's general definition of health and reflects coping with normal stress, productive work and social functioning. Assessing quality of life in clinical trials is of crucial importance. Implications of medical interventions have to be evaluated not only in terms of hard endpoints (e.g. death, overall survival etc.) but also soft ones like for instance sexual functioning. The importance of assessing quality of life is sometimes underestimated in clinical trials and in everyday clinical practice. The purpose was a survey of current literature in the field of quality of life in breast cancer patients and survivors. The authors paid special attention to the sexual aspects of quality of life. The article outlines the influence of various demographic factors such as age, marital status, educational level and race on quality of life scores in breast cancer patients. The authors elucidated the differing impact of the type and stage of treatment (surgery, reconstruction, systemic therapy and radiotherapy) on quality of life in the group described above. Within this article the readers will also find information about quality of life in breast cancer patients in subsequent years after finalization of treatment. The relation of psychiatric disorders, more common in cancer patients, and their treatment with general and sexual quality of life is also presented and discussed. The readers will find the information contained in this article as a current review of quality of life literature and guidelines which could be incorporated into routine medical care.


Aim of the study. The analysis of early and late toxicity was assessed comparing two schedules of irradiation - conventional fractionation (CF) and accelerated fractionation (AF). Our population of patients had squamous cell carcinoma of the larynx stage T1-T3N0M0. All were treated with radical intent. Material and method. Patients treated 1995-1998 in the Centre of Oncology in Warsaw were separately analyzed in a phase III multicentre clinical trial. Patients were irradiated with Co-60, in the CF arm to a total dose of 66 Gy in 33 fractions with an overall treatment time of 45 days. In the AF arm the overall treatment time was 7 days shorter but the rest of parameters were not changed. Results. A higher percentage of acute post-irradiation reactions was observed in patients who underwent AF. The early reactions settled down after termination in 5 to 8 weeks in both fractionation methods. There were no serious late post-irradiation complications stated in both group of patients examined. © Polskie Towarzystwo Onkologiczne.


Introduction. In the last 20 years, anthracycline and taxanes (AT) have been implemented in breast cancer treatment. The aim of this work is to estimate the prognostic factors and long-term disease-free survival in breast cancer patients after radical mastectomy and postoperative radiotherapy before implementation of AT.


Breast cancer is the most common type of malignancy among women in the Polish population. A majority of breast cancer patients require radiotherapy and some of them suffer from radiation-related toxicity. The symptoms of radiotherapy toxicity manifest as acute injuries during the initial 3 months after treatment and late toxicities that occur after 6 months following radiotherapy. Local toxicity due to breast cancer irradiation mostly develops in the form of light skin injury, fibrosis and adiponecrosis, and sporadically as telangiectasia or bleeding ulcer. Adiponecrosis may imitate malignancy and may necessitate further diagnostic procedures. The article presents factors which play significant roles in inducing radiation toxicity due to breast cancer radiotherapy. The paper also outlines practical tips how non-oncologists can prevent and cope with radiationinduced toxicities occurring on skin and breast fat tissue in patients undergoing radiotherapy of that region. Diagnostic tools most useful in differentiating adiponecrosis from a malignant process are also enumerated and discussed in depth. The issue of the importance of a multispecialist team - one including surgeons, oncologists and physiotherapists - in coping with radiotherapy-induced toxicities is also discussed. © 2011 Termedia Sp. z o.o. All rights reserved.


Introduction: In early stage non-small cell lung cancer (NSCLC) the stereotactic body radiation therapy (SBRT) gives promising results, similar to the results of surgical series. However, not all such patients are the candidates for this treatment method. The retrospective analysis of the results of three-dimensional conformal radiotherapy (3D-CRT) in stage I and II of NSCLC was undertaken, with a special focus on the patients who were candidates for SBRT treatment, but received 3D-CRT due to no access to the SBRT. Material and methods: One hundred thirty-two consecutive stage I-II NSCLC patients who received radical 3D-CRT between 1998 and 2009 were included. Different radiotherapy schedules were used; thus the biologically equivalent doses (BED) were calculated for all. Sixty-eight patients met criteria of qualification for SBRT (peripheral T1-3N0 tumors with diameter £ 5 cm). Overall survival and local progression free survival (LPFS) were estimated for the whole group and compared for patients being and not being candidates for SBRT. Uni- and multivariate analyses were performed for prognostic factors. Results: Median BED value was 74 Gy (58-82 Gy). Patients who met SBRT criteria had significantly smaller gross tumor volume (GTV) comparing to the remainder (p < 0.00001). Three-year overall and local progression free survival rates were 37% and 50%, respectively. In comparison of SBRT candidates and others, only significant difference in three-year LPFS was obtained, 58% and 35%, respectively, p = 0.04. However, in the multivariate analysis, GTV, performance status, and stage were the only three prognostic factors for LPFS. Conclusions: After 3D-CRT, superior local control for early stage NSCLC patients who met criteria of inclusion for SBRT in comparison with the remainder was demonstrated. However, this outcome was inferior to the local control after SBRT reported in the literature.


Socha J.,Zaklad Teleradioterapii | Kolodziejczyk M.,Zaklad Teleradioterapii | Kepka L.,Zaklad Teleradioterapii
Pneumonologia i Alergologia Polska | Year: 2013

The value of PET-CT in radiotherapy for non-small cell lung cancer (NSCLC) with regard to determination of target volumes is established. It is less clear whether its use can improve clinical outcomes of irradiated NSCLC patients compared to conventional staging. The outcome of NSCLC patients included in a previously published prospective study of the value of PET-CT in curative radiotherapy candidates was assessed. Materials and methods. Patients were treated according to the PET-CT findings. The survival data were compared between 67 patients treated curatively and 22 patients with palliative treatment given after upstaging based on the PET-CT findings. Survival of curatively treated stage III patients was compared with a previously published outcome of 173 stage III patients treated in the same institution with the same radiation schedule but without PET-CT. Results. The 3-year overall survival was 42% and 0% (median: 21 months and 7 months), for curatively and palliatively managed patients, respectively (p < 0.0001). However, the median overall survival of 17 months for 50 stage III patients was the same as that in a previously published series of stage III patients treated with the same radiation schedule but without PET-CT. Three-year overall survival rates were 33% for the PET-CT group and 19% for historical group, p = 0.1. Twenty-one local recurrences and 21 distant metastases were reported. Three of 50 patients (6%) treated without elective nodal irradiation developed isolated nodal failure (without local recurrence). Conclusions. The high early mortality rate in the patients disqualified from curative radiotherapy after PET-CT suggests the potential value of PET-CT for improving the radiotherapy outcome. However, this benefit seems to be limited in stage III patients. © 2013 Via Medica.


PubMed | Zaklad Teleradioterapii
Type: Journal Article | Journal: Ginekologia polska | Year: 2013

The impact of the tumor size on treatment outcomes in cervical cancer patients remains a subject of controversyThe assessment of prognostic value of pretreatment tumor size in cervical cancer patients.Patients of Maria Sklodowska - Curie Memorial Cancer Centre in Warsaw, treated between January 1996 and December 2000, were included into the retrospective study. 242 patients were diagnosed with a histologically confirmed squamous cell carcinoma and 42 with adenocarcinoma, FIGO staged IB-IVA, having undergone the clinical assessment and USG examination of the tumor treated with curative intent with surgery and/ or radiotherapy. The widest tumor diameter was adopted as the tumor size. In most cases of adenocarcinoma, the tumors were described as endocervical and the tumor measurement was connected with the risk of mistake, therefore, the analysis of the squamous cell cancer patients only was performed. A multivariate analysis of 242 patients with regard to overall survival (OS) and disease-free survival (DFS), depending on the selected clinico-pathological factors, was performed. The mean potential follow-up time for surviving patients was 50 months (range 8.7-62). The 5-year overall survival (OS) rate was 62%.As the result of the multivariate analysis, the impact of FIGO stage (p=0.002), hemoglobin pretreatment concentration (p=0.031) and tumor size before treatment (p = 0.044) on OS, and FIGO stage (p=0.001), hemoglobin level before treatment (p=0.019) on DFS, was demonstrated.Tumor diameter before treatment in squamous cell cervical cancer patients provides important prognostic information, regardless of other prognostic factors.

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