Peri-operative chemotherapy in patients with oesophageal and gastro-oesophageal junction cancer - three years of experience.

Peri-operative chemotherapy has been found to benefit patients with oesophageal and gastro-oesophageal junction adenocarcinoma. This study's aim was to evaluate the efficacy and tolerance of this treatment. The study included patients with carcinoma of the lower oesophagus and gastro-oesophageal junction in whom the disease was evaluated as potentially operable. Chemotherapy (CHT) consisted of three preoperative and three postoperative cycles of intravenous epirubicin and cisplatin on day 1 plus a continuous infusion of fluorouracil for 21 days (ECF) or oral capecitabine for 14 days (ECCap). Postoperative radio-chemotherapy (CRT) with fluorouracil or capecitabine after CHT was indicated in patients with two and more positive lymph nodes. Sixty-three patients started the treatment. Median follow-up was 32 months. Preoperative CHT was completed by 62 patients, 52 had surgery, 46 had radical resection, 25 patients had pN0 and 21 patient pN plus findings. Postoperative CHT was started in 39 (62%) patients and completed in 32 (51%). Ten (16%) patients had postoperative CRT. Adverse events of grade 3 and 4 were: neutropenia 17%, vomiting 8%, fatigue 5%, diarrhoea 3%. Reasons for omitting surgery in 11 (17%) patients were: progression in 7 patients, medically unfit in 3 patients, other in 1 patient. In the reporting period there were recurrences in 39 of all patients, in 7 locoregional only, in 10 distant plus locoregional, and in 19 distant metastases. Median survival was 24.1 months and 3-year survival rate was 42%. Peri-operative chemotherapy ECF/ECCap was feasible and well tolerated. Radical resection was performed in most patients.

New approaches in palliative systemic therapy of anal squamous cell carcinoma.

BACKGROUND: Metastatic and locally recurrent inoperable anal squamous cell carcinoma (ASCC) belong to rare tumours - ASCC accounts for about 2% of gastrointestinal tumours. Synchronous metastatic involvement is usually confirmed in approximately 15% of patients and about 20 % of patients develop relapse in the form of distant metastases after curative treatment. The current standard palliative systemic treatment is a PF regimen composed of 5-fluorouracil (5-FU) with cisplatin (cDDP) or a combination of carboplatin with paclitaxel. PURPOSE: The aim of this study is to summarize other options for systemic palliative care in ASCC, including the results of relevant clinical trials performed with new or modified regimens. Triple combinations with taxanes have yielded promising treatment results, and in particular, the inclusion of the DCF regimen (cDDP + 5-FU + docetaxel) in first-line treatment results in a significant increase in treatment responses with good treatment tolerance. Another promising option for palliative care is immunotherapy with checkpoint inhibitors PD-1 or PD-L1, which can be successfully used in palliative systemic treatment or in curative regimens. Epidermal growth factor receptor inhibitors remain the subject of research, whose role in the primary or palliative treatment of ASCC is not entirely clear. CONCLUSION: Compared to standard chemotherapy, available data confirm the treatment outcomes improvement in the use of triple combination DCF with docetaxel or immunotherapy with checkpoint inhibitors in the treatment of metastatic ASCC.

Radiotherapy and radiosensitivity syndromes in DNA repair gene mutations.

BACKGROUND: Ionizing radiation DNA damage is the main mechanism of radiotherapy (RT) action and the outcome of treatment and healthy tissue toxicity is influenced by a number of external and internal factors, including mutations in DNA damage recognition and repair. Disorders of DNA repair may result in increased sensitivity to cancer treatment. PURPOSE: The mechanism of DNA repair and an overview of genetic syndromes with mutations in genes involved in DNA repair clarify the accelerated carcinogenesis and increased radiosensitivity in RT cancers. Most radiosensitivity syndromes are autosomal recessively inherited; examples are ataxia teleangiectasia, Nijmegen breakage syndrome, xeroderma pigmentosum, Cockayne syndrome, Bloom syndrome and Werner syndrome. CONCLUSION: Radiotherapy is contraindicated in most homozygous patients with recessive radiosensitivity syndromes. Asymptomatic heterozygotes may have an increased risk of tumor incidence and a small part of them slightly increased risk of RT intolerance; however, this does not limit RT treatment. The high risk of secondary malignancies after radiotherapy is a contraindication to adjuvant RT in Li-Fraumeni syndrome.

Chemoradiotherapy in the treatment of cervical cancer - a single institution retrospective review.

BACKGROUND: The aim of this study is a retrospective analysis of treatment outcomes and toxicity in a group of patients with cervical cancer who underwent (chemo) radiotherapy at the Institute of Radiation Oncology in Bulovka University Hospital in Prague in the period 2014-2017. PATIENTS AND METHODS: During this period, 141 patients were treated, 105 (74.5%) of them underwent combined (chemo) radiotherapy with radical intent and palliative radiotherapy was performed in 36 (25.5%) cases. According to the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification, the most numerous stages were IIB in 39 (27.7%) and IIIB in 64 (45.4%) cases; according to FIGO 2018, a significant number of newly established stages is evident: IIIC1 in 55 (39.0%) patients and IIIC2 in 22 (15.6%) cases. RESULTS: The median progression-free survival (PFS) and overall survival (OS) reached 31.3, resp. 40.1 months in the whole group. In the subgroup of patients treated with radical intent, the median PFS was 44.0 months and OS 48.8 months; in the palliative subgroup, the median PFS was 9.4 months and OS 14.8 months. In a radically treated subgroup, 7 (6.7%) patients had gastrointestinal or genitourinary manifestations of G3-4 toxicity, and overall acute toxicity (including skin and haematological reactions) of G3-4 occurred in 18 (17.1%) patients. Late toxicity of G3-4 was reported in 13 (12.4%) cases. Patients who underwent complete brachytherapy (BRT) showed significantly better survival compared to patients with a lower number of BRT fractions. The prognostic potential of PS (performance status) and anemia was confirmed; significantly longer overall survival was observed in patients in good general condition or in those without anemia. CONCLUSION: Our results confirmed the key role of BRT for the delivery of the curative dose to the target volume. The prognostic role of PS and anemia is evident. The side effects were in acceptable limits but we expect improvements because of the use of modern radiotherapy technologies.

Oncology wounds - recommendations for care based on multidisciplinary cooperation.

BACKGROUND: Oncology wounds and wounds of other etiology are rare but serious complications, which significantly impair patients quality of life. Preventive and curative interventions and education of healthcare personnel and patients reduce the risk of either their occurrence or their impact and consequences. A working group of authors from professional groups (the Supportive Care Group of the Czech Society for Oncology, the Czech Society for Wound Healing, the Society for Radiation Oncology, Biology and Physics, and the Czech Nurses Association) prepared recommendations for care. A comprehensive approach to the treatment of oncological wounds, including symptomatic treatment of associated healing complications, prevention, early detection, interdisciplinary cooperation and education are essential to deal with wounds related to chemotherapy administration, radiotherapy and oncological treatment in general. The proper choice of local care products and the eventuality of active oncological treatment are important elements of care in ulcerating tumors. PURPOSE: A basic summary of recommended interventions to prevent and treat oncology wounds in daily practice, defined based on expert societies guidelines, trials and literature data, proven practice and on the consensus opinions of the authors group members. The recommended procedures contribute to the reduction of the development, severity and consequences of oncological wounds and wounds of other etiology in oncological  patients.

Clinical application of time factor principles in radiotherapy in compensation of radiation series interruptions.

BACKGROUND: The time factor plays a key role in radiotherapy. The radiotherapy overall treatment time is one of the most important predictive factors in the treatment effectiveness and is associated with better local control and impact on the overall survival. The length of the time from the dia-gnosis to radical radiotherapy or from surgery to adjuvant radiotherapy or the use of alternative fractionation schemes shortening the total treatment time also play an important role. The prevention of prolongation of the radiation series remains a fundamental and well feasible way of applying the time factor in radiotherapy. PURPOSE: Interruption of radiotherapy usually occurs for technical reasons, due to factors at the patients side or for personnel reasons of the department. Standard procedures for the compensation for treatment breaks are part of the treatment protocols at radiotherapy departments. Possible risks of the discontinuation of radiotherapy are considered on the basis of the type and extent of the disease, the treatment intent and the condition of the patient, and the need of compensation for a break in the treatment is set. Patients are classified into three categories according to the above mentioned parameters. Compensation for the pause in radiotherapy is performed by calculating the equivalent dose in 2 Gy per fraction (EQD2); the preferred method of compensation is the one which enables observation of the planned total time of radiotherapy without extension. The benefit of local tumor control and the risk of increased acute or especially late toxicity should always be considered. In the current epidemiological situation, radiotherapy is often discontinued for COVID-19, and due to longer breaks in the treatment, it is necessary to combine multiple compensation methods in one patient.

Effect and Toxicity of Radiation Therapy in Selected Palliative Indications.

BACKGROUND: Radiotherapy (RT) is a mainstay of oncology treatment in both curative and palliative situations. With respect to palliative and supportive care, RT improves local control of disease and relieves symptoms, particularly pain, compression of surrounding structures, and/or bleeding. The aim here was to evaluate the effects and toxicity of palliative RT in our department from April 2015 to April 2018. PATIENTS AND METHODS: During this period, 338 cases received palliative RT, representing approximately one third of indications for this treatment method. We evaluated selected subgroups of patients: those with advanced lung cancer, bone metastases, or soft tissue metastases. Patients were irradiated by the IMRT (intensity modulated radiation therapy) technique using the TomoTherapy HD (Accuray, USA) platform. RESULTS: Palliative RT for primary lung cancer was performed for 29 patients. Of these, symptoms were relieved in 22 patients (76%) and local control (confirmed by imaging) was achieved in 19 patients (66%). Treatment-related toxicity was acceptable. Overall, 104 patients received irradiation for bone metastases; pain relief was achieved in more than 75% of cases. Another 71 patients were irradiated to treat soft tissue metastases; symptoms were relieved in 60% of cases. Treatment-related toxicity in our patients was lower than reported previously, suggesting improved quality of life for patients irradiated using modern RT technologies. CONCLUSION: Palliative RT provided excellent symptom control in our patients, with minimal toxicity. Thus, RT is an effective and easy-to-use method for many palliative indications. Key words: palliative care - radiotherapy - lung neoplasms - neoplasm metastasis - bone metastases - pain management The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 28. 8. 2018 Accepted: 29. 10. 2018.

Gender differences in health: evidence from the Czech Republic.

Gender differences in health have been linked to gender stratification in the United States. Women's relation to production, paid and unpaid work, and their experience of this gender inequality disadvantage their self-rated health compared to men. Men's consumption or health lifestyles disfavors their comparative health. This formulation is tested in the Czech Republic with a sample of matched wives and husbands (N = 577 households). This extends previous research in the United States on gender differences in health in two ways: into post-communist Europe and by comparing paired wives and husbands. Respondents completed questionnaires in 1994 on their health and well-being, jobs and finances, non-economic life events, marriage, psychological states, opinions about the changes in the Czech Republic, and socioeconomic background. Wives and husbands filled out separate questionnaires. The relation to production (both the objective relation and its subjective experience) did not impair wives' self-reported health any more than that of their husbands, and husbands' consumption or health lifestyles did not put them at a health disadvantage. Interpretations of these findings rest on both the extension of the study into post-communist Europe and by comparing matched wives and husbands.

Education and health in the Czech Republic.

Researchers in the United States have found that education and health are related. This relation may be due to the better market position of the educated, their greater store of personal and social resources, and/or their healthier lifestyle. These three connections between education and health are tested in the Czech Republic with three waves of panel data. We regress self-reports of health and physical functioning in 1994 on multiple indicators of market position in 1994, change in market position from 1989 to 1994, personal/social resources and health lifestyle with demographic controls. These regressions are followed by a longitudinal analysis of changes in panel members' health and physical functioning between 1994 and 1996. The cross-sectional results are similar to those in the United States with important exceptions. Unlike the United States, market position does fully mediate the relation between education and health in the Czech Republic, largely through subjective feelings regarding market position. The longitudinal analysis shows that prior health and physical functioning mediate the effect of education on health and physical functioning in 1996.