Ophthalmic applicator displacement as a method of treating large diffuse uveal melanomas.

Purpose: The presentation of results of an ophthalmic plaque displacement as a brachytherapy treatment method of large diffuse uveal melanomas. Material and methods: This was a retrospective analysis of treatment results of 9 patients with large diffuse uveal melanomas using ophthalmic plaque displacement. Patients were treated with this method in our center between 2012 and 2021 (last follow-up visit in 2023). To achieve appropriate radiation dose distribution for large tumors with a base greater than 18 mm, brachytherapy (106Ru in 7 patients and 125I in 2 patients) with applicator displacement was used as primary treatment. Median follow-up was 2.9 years, and for patients with positive primary treatment results, it was 1.7 months. Median time to local relapse was 2.3 years. Results: In 5 patients, a positive result of local treatment was obtained, out of whom, one patient underwent enucleation due to complications. In the next 4 cases, local recurrence developed. In all tumors, the use of applicator displacement method caused that planning target volume (PTV) was effectively covered with treatment isodose. Conclusions: Brachytherapy with ocular applicator displacement allows for the treatment of tumors with base measurements larger than 18 mm. The application of this method may be considered as an alternative for eye enucleation in particular cases of large diffuse tumors, such as a neoplasm of the eye with vison, or when a patient does not consent to enucleation.

The Variability of function of the Eustachian tube in patients with chronic sinusitis.

BackgroundThe Eustachian tube is a complex and inaccessible structure, which is responsible for the ventilation of the middle ear. The aim of the study was the assessment of an impact of chronic sinusitis on the auditory tube function. MethodsThe prospective analysis of 84 surgically treated chronic sinusitis patients was carried out. This study is based on preoperative results of impedance audiometry in correlation with the data from the medical history of chronic sinusitis, symptoms reported by the patients, results of Computered Tomography (CT) and the stage of inflammatory changes according to Lund and Mackay score. ResultsThe significant majority of patients of our study (65) had advanced auditory tube symptoms, while 4 patients suffered from symptoms significantly impacting daily life. In patients with chronic sinusitis the analysis demonstrated that tympanometry type B (12.67) and C (12.4) occured with significantly higher number of points of Lund-Mackay score than type A (9.2). In allergy sufferers type B of tympanometry was more often observed with characteristically bilaterally located inflammatory changes in maxillary and anterior ethmoid sinuses.ConclusionThe profile of chronic sinusitis patient in whom Eustachian Tube Dysfunction is more often observed, is as follows: Lund and Mackay score above 12pathological changes are bilaterally observed in maxillary and frontal ethmoid sinuses decrease of nasal patency nad postnasal dripAllergyoverusing alcohol and cigarettes, at least alcoholWorse result of Lund and Mackay score and the age of patients are 2 factors favoring the dysfunction of the Eustachian Tube.

[111In]In-CP04 as a novel cholecystokinin-2 receptor ligand with theranostic potential in patients with progressive or metastatic medullary thyroid cancer: final results of a GRAN-T-MTC Phase I clinical trial.

INTRODUCTION: Medullary thyroid cancer (MTC) is a rare malignant tumour of the parafollicular C-cells with an unpredictable clinical course and currently suboptimal diagnostic and therapeutic options, in particular in advanced disease. Overexpression of cholecystokinin-2 receptors (CCK2R) represents a promising avenue to diagnostic imaging and targeted therapy, ideally through a theranostic approach. MATERIALS AND METHODS: A translational study (GRAN-T-MTC) conducted through a Phase I multicentre clinical trial of the indium-111 labelled CP04 ([111In]In-CP04), a CCK2R-seeking ligand was initiated with the goal of developing a theranostic compound. Patients with proven advanced/metastatic MTC or short calcitonin doubling time were enrolled. A two-step concept was developed through the use of low- and high-peptide mass (10 and 50 µg, respectively) for safety assessment, with the higher peptide mass considered appropriate for therapeutic application. Gelofusine was co-infused in a randomized fashion in the second step for the evaluation of potential reduction of the absorbed dose to the kidneys. Imaging for the purpose of biodistribution, dosimetry evaluation, and diagnostic assessment were performed as well as pre-, peri-, and postprocedural clinical and biochemical assessment. RESULTS: Sixteen patients were enrolled. No serious adverse events after application of the compound at both peptide amounts were witnessed; transient tachycardia and flushing were observed in two patients. No changes in biochemistry and clinical status were observed on follow-up. Preliminary dosimetry assessment revealed the highest dose to urinary bladder, followed by the kidneys and stomach wall. The effective dose for 200 MBq of [111In]In-CP04 was estimated at 7±3 mSv and 7±1 mSv for 10 µg and 50 µg CP04, respectively. Administration of Gelofusine reduced the dose to the kidneys by 53%, resulting in the organ absorbed dose of 0.044±0.019 mSv/MBq. Projected absorbed dose to the kidneys with the use of [177Lu]Lu-CP04 was estimated at 0.9±0.4 Gy/7.4 GBq. [111In]In-CP04 scintigraphy was positive in 13 patients (detection rate of 81%) with superior diagnostic performance over conventional imaging. CONCLUSION: In the present study, [111In]In-CP04 was shown to be a safe and effective radiopharmaceutical with promising theranostic characteristics for patients with advanced MTC.

Brachytherapy or enucleation in ring melanoma patients: which is better? Preliminary results of the authors' own experiences.

PURPOSE: A retrospective evaluation of effectiveness of brachytherapy or enucleation in treatment of rare form of uveal melanoma: ring melanoma. MATERIAL AND METHODS: Analysis comprised 49 patients treated from 2000 to 2019 for ring melanoma involving ciliary body. In 15 patients, primary treatment consisted of brachytherapy (106Ru or 125I), whereas in 34 patients, eyeballs were enucleated. The evaluation concerned differences between analyzed groups relating to the clinical and histopathological features as well as overall survival, cancer-specific overall survival, and disease-free survival. RESULTS: No significant differences between the analyzed groups were found with regards to clinical and histopathological features, apart from intra-ocular pressure (increased in the enucleation group). Kaplan-Meier analysis did not reveal any significant differences between the group treated with enucleation and the group undergoing brachytherapy, both with regards to overall survival (p = 0.325) and cancer-specific overall survival (p = 0.477). A significant difference was observed in disease-free survival (p = 0.009), which was significantly shorter in the group undergoing brachytherapy. In the analysis of parameters of the applied brachytherapy, no significant differences between patients with and without local recurrence were found. Mean observation period was 350.8 weeks (range, 24-996 weeks, SD = 231.6). A local recurrence occurred in 11 (22.4%) patients, including 3 (6.1%) in enucleation and 8 (16.3%) after brachytherapy groups. Metastasis developed in 11 (22.4%) cases after a mean follow-up of 133 weeks (33.25 months), range 3-655 weeks. CONCLUSIONS: Preliminary observations may suggest that brachytherapy in this rare form of uveal melanoma, such as ring melanoma involving the ciliary body, may be taken into consideration as a useful alternative to enucleation. However, the confirmation of such an approach requires a larger patients' group to be gathered, and also a longer follow-up period. This is especially important in patients with a good baseline visual acuity in the affected eye, or when the neoplasm is present in the remaining eye with vision.

Stability of ABR Wave V Threshold in Early Hearing Diagnostics in Children from Selected Groups at Risk of Congenital Hearing Loss.

<b>Introduction:</b> Upon hearing that the "little" patient has trouble with hearing, we are mostly interested in the level of his hearing threshold. When the child is in the first year of life, results can only be achieved by means of ABR test. Subsequent control tests, especially in children from the hearing loss risk groups selected in this study, show that the obtained outcomes are subject to fluctuations. Their fluctuating nature is manifested by the instability of wave V threshold in subsequent diagnostic periods. Such variability often delays the implementation of the appropriate proceeding. Knowledge of the dissimilarity of behavior of the wave V threshold occurring in individual groups at risk of hearing loss allows for the correct interpretation of the obtained results, and thus, effective therapeutic measures. <br><b>Aim:</b> The aim of the paper is to analyze the stability of wave V threshold during the first year of life in children from selected risk groups for congenital hearing disorders. <br><b>Material and methods:</b> From the patient population of 2,114 individuals examined in 2015-2016 at a reference center participating in the Universal Neonatal Hearing Screening Program in 2015-2016, the results of 250 children were subjected to retrospective analysis. Furthermore, 4 groups of little patients were formed (children with Down syndrome; children with other diseases or damage to the nervous system; children with cleft palate or cleft lip and cleft palate; children with congenital cytomegaly) in whom diagnostic practice revealed variable results of the wave V threshold. We analyzed the results of tests obtained during the first year of the child's life divided into 4 diagnostic periods. <br><b>Results:</b> The highest percentage of instability in the established threshold of wave V between individual diagnostic periods occurred in the group of children with cleft palate or cleft lip and cleft palate. In the group of children with Down syndrome, it was observed that the instability of the ABR test results decreased over time. In the group of children with other diseases or damage of the nervous system, the highest percentage of the lack of stable ABR wave V thresholds was observed between the 1st and 2nd as well the 1st and 4th diagnostic periods. On the other hand, in the group of children with congenital CMV, there was a relatively low percentage of instability of results. <br><b>Conclusions:</b> (1) Although the ABR test is a diagnostic standard, in particular groups of patients the study is burdened with high variability of measurement results in subsequent diagnostic periods. Such a group of patients are children with cleft palate or cleft lip and cleft palate; therefore, it must receive particular attention in treatment planning; (2) in selected groups at risk of hearing loss, due to the high percentage of children with hearing impairment (70%), the validity of performing newborn hearing screening tests was confirmed.