Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies--the question of long-term palliation.

BACKGROUND/AIMS: To evaluate the effect of a combination of intraluminal brachytherapy and metallic stent implantation in the treatment of patients with nonresectable biliary tumors. METHODOLOGY: Thirty-two patients aged 41-80 years with nonresectable biliary malignancies--Klatskin's tumor (n = 17), gallbladder carcinoma (n = 11) and carcinoma of papilla Vateri (n = 4)--were treated with a combination of intraluminal brachytherapy (source Ir192, high-dose radiation regimen, total dose 30 Gy) and metallic stent implantation. Intraluminal brachytherapy and stent insertion (metallic, spiral-Z stent) were performed percutaneously in all patients. RESULTS: The mean survival in patients with Klatskin's tumor was 457 days (range: 64-1186; median: 358 days), in patients with gallbladder carcinoma 237 days (range: 92-609; median: 210 days) and in patients with carcinoma of papilla Vateri 850 days (range: 48-1518; median: 1277 days). The rate of 2-year survival in these groups as 27, 0 and 50%, respectively. The survival time differed significantly at the 5% level. The mean time of stent patency was 418, 220 and 850 days, respectively. No complications related directly to intraluminal brachytherapy were observed. CONCLUSIONS: Intraluminal brachytherapy combined with stent implantation is a safe method and appears to prolong survival in inoperable patients with Klatskin's tumor and carcinoma of papilla Vateri compared with nontreated patients in previous studies. In contrast no similar effect should be expected in patients with gallbladder carcinoma.

Breast reconstruction as an integral part of breast carcinoma therapy (a self-present final report of a research project IGA MZ CR).

This comparative prospective study elucidates whether breast reconstruction that is not associated with systemic oncological treatment may trigger a tumour relapse, and if there is any difference between the evaluated reconstruction methods, a simple procedure using an implant versus a TRAM flap, on this hypothetical influence. The study group of 95 patients suffered from stage I-II of breast carcinoma. As regards the available reconstruction procedures, the study group was divided into two subgroups, the first using an implant (n1 = 33) and the second using a TRAM flap (n2 = 62). All oncological problems manifesting during the subsequent 12 months were considered as a response to the reconstruction. The oncological course was compared with two control groups. The first control group (k1 = 82) corresponded to the study group in terms of tumour stage (I-II), average age, time of initial diagnosis, type of primary surgery, i.e. mastectomy with axilla exenteration, and subsequent oncological treatment. The second control group (k2 = 19,625) was based on the National Oncology Register data. It was formed from all patients with breast carcinoma stage I-II from 1985-1994. The disease development in terms of the relative number of relapses and deaths was compared to the number of healthy and living patients, respectively, in the preceding year. The working hypothesis of late breast reconstruction (i.e. not associated with oncological treatment) being a possible trigger effect on the subsequent course of breast cancer has not been confirmed. No statistically significant differences at the 5% significance level were found between individual reconstruction methods and control groups in terms of the number of local relapses and survival length.

[Tumors of the biliary tract: possibilities of multimodality therapy]. / Nádory biliárního stromu: moznosti multimodální lécby.

BACKGROUND: Tumours of the biliary system (NBS) account for as many as 16% of all tumours of the GIT. Early diagnosis is difficult, contemporary treatment is not satisfactory and the prognosis is poor. It seems that one of the few therapeutic perspectives is multimodal treatment. The objective of the present work is to assemble experience with multimodal treatment of NBS. METHODS AND RESULTS: From January 1987 to December 1993 347 patients with NBS were treated, using bilioduodenal endoprostheses (BDE). In 26 patients treatment was supplemented by regional chemotherapy, in 10 by intraluminal radiotherapy, using lr 192. Average periods of survival:BDE 230 days, BDE+regional chemotherapy 662 days. Endoprostheses+intraluminal radiotherapy-survival period 96-293 days. The investigation has not yet been completed, as the majority of patients still survives. CONCLUSIONS: Implantation of BDE combined with regional chemotherapy significantly prolongs the life of patients with NBS. It seems that similar results will be obtained also by a combination of BDE and intraluminal radiotherapy. Multimodal treatment of NBS can be nowadays considered the method of choice in the treatment of tumours in this region.

[Lymphangioma of the orbitopalpebral area]. / Lymfangiom orbitopalpebrální oblasti.

AIM: The authors refer about five patients with different types of lymphangioma, who were followed-up at the Department of Ophthalmology, Faculty Hospital Královské Vinohrady (Kings Vinegards), Charles University, Prague, Czech Republic, E.U., during the period 1995 - 2013; the follow-up period lasted from 5 to 17 years. The lymphangioma of the orbitopalpebral area is discussed according to the evaluation of the tumor development, histological verification, treatment, and its results. METHODS: In four boys, the first signs of tumor were eyeball protrusion (exophthalmos) and bleeding into the conjunctiva or palpebral skin before the age of 5 years. In all four patients, the histological confirmation of the orbital lymphangioma was performed in the beginning of the disease. In three cases, it was the orbital type, and the fourth one was frontal type with bilateral orbital lymphangiomatosis. In one girl, there were present conjunctival changes only, appearing as one-sided hyperplastic changes. For these changes, she was followed-up since her 13 years of age under the false diagnosis of chronic conjunctivitis. The definite histological confirmation of only conjunctival lymphangioma was done from the diagnostic probatory biopsy not until ten years of symptoms and unsatisfactory treatment. RESULTS: In the girl with superficial conjunctival lymphangioma and in the patient with lymphangiomatosis, the follow-up was recommended only. In two patients with extraconal type of orbital tumor, the total or sub-total resection was performed. In the years of the follow-up, the remission of the disease was observed. In the patient with mostly intraconal type of the tumor, causing decrease of the visual acuity according to the optic nerve neuropathy and macular cystoid edema, the focused actinotherapy by means of linear accelerator treatment with the dose of 30 Gy after previous evacuation of chocolate cysts under ultrasound control. The regression of the tumor and normalized visual functions lasted for 17 years. CONCLUSION: As method of treatment of extraconal lymphangiomas, it seems, it is its resection, and in the intraconal localization of the tumor it is the focused actinotherapy by means of linear accelerator.Key words: orbital lymphangioma, conjunctival lymphangioma, lymphangiomatosis, tumor resection, linear accelerator actinotherapy.

[Computer tomography of the renal bed after nephrectomy]. / Výpocetní tomografie luzka po nefrektomii.

An early diagnosis of the tumour relapse after performed nephrectomy for a malignant kidney tumour is necessary in order to influence further fate of the patient. The most suitable method for determining a correct diagnosis is computer tomography. The authors present a cohort of 79 patients with a pathological finding in 21 of them. In the other patients the finding after the operation proved to be normal, i.e. the bed was free after the performed nephrectomy, retroperitoneal vessels were free and the line of m. psoas on the surgically treated side proved to be intact. Computer tomography can prove not only the relapse, but also metastatic affection of other organs, particularly in the liver and adrenals.

Effect of human recombinant interleukin-2 on cytotoxic response of peripheral blood mononuclear cells in melanoma patients before surgery.

Natural killer activity against K562 targets and recombinant interleukin-2 induced cytotoxicity to NK resistant targets (MEL-4 and T24) was investigated in 15 melanoma patients. Before elective surgery no differences in cytotoxic activities were demonstrated when compared with patients with colorectal adenocarcinoma and controls. No correlation with the depth of the melanoma lesion was observed. Numbers of precursors of IL-2 induced killers in melanoma patients were in normal range. In conclusion, no defects in non-specific NK and IL-2 induced behavior in peripheral blood of melanoma patients were found. Other factors, specific, non-specific, related or unrelated to the tumor side should be thus considered.