Prognostic value of the interval from surgery to initiation of radiation therapy in correlation with some histo-clinical parameters in patients with malignant supratentorial gliomas.

AIM OF THE STUDY: To determine the relationship between the interval from surgery to initiation of radiation therapy (ISRT) and prognostic factors, such as age, performance status, tumour location, extent of surgical resection and tumour histology in patients with malignant gliomas. MATERIALS AND METHODS: From 1995 to 2005, 308 adults patients with supratentorial malignant gliomas (198 glioblastomas, and 110 anaplastic astrocytomas) received postoperative radiotherapy with radical intent. A total tumour dose of 60 Gy in 30 fractions in 6 weeks was delivered. ISRT varied from 15 to 124 days, with median time of 37 days, and it was a cut-off value to assess the results. The end point in our study was two-year overall survival. RESULTS: The two-year overall survival rate in the whole group was 17%, with 24% for patients with ISRT value ≤ 37 days, and 14% for patients with an interval longer than 37 days (p = 0.042). Univariate analysis showed that delayed initiation of radiotherapy influenced the outcome of patients with glioblastoma older than 40 years, and with other than frontal location of tumour. Two-year overall survival rates for ISRT ≤ 37 days were 15%, 18% and 22% respectively, compared to 8%, 4% and 11% for ISRT > 37 days. In a multivariate analysis (Cox's model) the only variables that were significantly associated with worse survival were older age and ISRT prolonged for more than 37 days. CONCLUSION: The study showed longer than 37 days waiting time from surgery to initiation of radiotherapy to be a significant predictor of overall survival for adult patients with malignant supratentorial gliomas.

Long-term follow-up in adult patients with low-grade glioma (WHO II) postoperatively irradiated. Analysis of prognostic factors.

AIM: To report the long-term follow-up of a cohort of adult patients with LGG post-operatively irradiated in one institution, and to identify prognostic factors for progression free survival. BACKGROUND: There is little consensus about the optimal treatment for low-grade glioma (LGG), and the clinical management of LGG is one of the most controversial areas in neurooncology. Radiation therapy is one option for treatment of patients with LGG, whereas other options include postoperative observation. MATERIALS AND METHODS: Between 1975 and 2005, 180 patients with LGG (WHO II) received postoperative irradiation after non radical (subtotal or partial) excision. Patients had to be 18 years of age or older, and have histologic proof of supratentorial fibrillary (FA), protoplasmic (PA) or gemistocytic astrocytoma (GA). Radiotherapy was given within 3-10 weeks after surgery. Treatment fields were localized and included the preoperative tumor volume, with a 1-2 cm margin, treated to a total dose of 50-60 Gy in 25-30 fractions over 5-6 weeks. RESULTS: Actuarial ten-year progression free survival (APFS) in the whole group was 19%. The worse prognosis was observed in patients with GA. Ten-year APFS rates for GA, PA and FA were 10%, 18% and 22%, respectively. CONCLUSION: The findings from our long-term cohort of 180 patients with LGG confirmed by uni- and multivariate analysis demonstrated that only astrocytoma histology significantly determined the prognosis. The best survival was observed in patients with the fibrillary variant, and the worst for the gemistocytic one.

Application of IMRT in adjuvant treatment of soft tissue sarcomas of the thigh-Preliminary results.

BACKGROUND: Fracture of the femur is the most frequent late complication in patients with soft tissue sarcomas (STS) who receive external beam radiotherapy after limb-sparing surgery. AIM: To reduce the risk of bone fracture following radiotherapy of STS of the thigh, we minimized the dose to the femur and to surrounding normal tissues by applying intensity modulated radiation therapy (IMRT). We report preliminary results of post-surgery IMRT of the thigh in patients with STS in this extremity. MATERIALS AND METHODS: 10 adult patients undergoing post-operative radiotherapy of STS of the thigh were treated using IMRT. Clinical IMRT plans with simultaneous integrated boost (SIB) and 3-phase three-dimensional conformal radiotherapy (3D-CRT) were designed to adequately treat the planning target volume and to spare the femur to the largest extent possible. Dose distributions and dose-volume histograms were compared. RESULTS: For either technique, a comparable target coverage was achieved; however, target volume was better covered and critical structures were better spared in IMRT plans. Mean and maximum doses to OAR structures were also significantly reduced in the IMRT plans. On average, the mean dose to the femur in 3D-CRT plans was about two times higher than that in IMRT plans. CONCLUSION: Compared with 3D-CRT, the application of IMRT improves the dose distribution within the concave target volumes and reduces dose to the OAR structures without compromising target coverage.

[Analysis of treatment outcome in patients with endometrial cancer limited to the uterus]. / Analiza wyników skojarzonego leczenia chorych na niezaawansowanego raka endometrium.

OBJECTIVES: The aim of study was to analyse results of treatment patients with uterine-confined endometrial cancer which underwent surgery and postoperative radiotherapy in Center of Oncology in Kraków between 1985 and 1997. MATERIAL AND METHODS: The research included a group of 650 women. All patients undergo total abdominal hysterectomy with bilateral salpingo-oophorectomy and postoperative radiotherapy. 155 patients with intermediate-risk of recurrence (IA-G3, IB-G1, G2) received postoperative whole pelvic irradiation only. In the group of 495 patients with high-risk of recurrence (IB-G3, IC, II) 210 patients received brachytherapy vaginal cuff only and 285 patients whole pelvic and vaginal cuff irradiation. RESULTS: In the group of patients with intermediate-risk of recurrence five NED survival was 93.5%. In the group of patients with high-risk of recurrence five NED survival was statistically lower in patients treated with brachytherapy vaginal cuff only (83.2% vs. 71.9%). CONCLUSION: In uterine-confined endometrial cancer patients, with intermediate-risk of recurrence treated with surgery and postoperative whole pelvis irradiation, 5-year NED survival is above of 90%. In the group of patients with high-risk of recurrence the adjuvant treatment of choice is whole pelvic and vaginal cuff irradiation.

[Prognostic factors in patients with cervical--confined endometrial carcinoma treated with surgery and postoperative radiotherapy]. / Czynniki prognostyczne w grupie chorych na niezaawansowanego raka trzonu macicy leczonych chirurgicznie z uzupelniajacym napromienianiem.

OBJECTIVE: The aim of the study was to determine prognostic factors in the group of the patients with uterine--confined endometrial carcinoma treated with surgery and postoperative radiotherapy. MATERIAL AND METHODS: The authors analyzed 102 patients (mean age 58 years) with stage 1 (74 patients) and stage 11 (28 patients) endometrial carcinoma. All patients were treated with surgery (abdominal hysterectomy and bilateral adnexectomy) and postoperative radiotherapy: external beam pelvic irradiation (20 patients), vaginal cuff irradiation (33 patients) and combination (49 patients). Analysed were prognostic factors as follows: age, stage, tumor grade, depth of myometrial invasion, hormone receptors, expression of the tumor suppressor gene p53, Her 2/neu and MIB-1 (ki-67 paraffin). RESULTS: In our group of patients, multivariate analysis has identified tumor grade, progesterone receptors status and MIB-1 as independent significant prognostic factors.

[The effectiveness of postoperative external beam radiotherapy for incompletely resected non-small cell lung cancer]. / Ocena skutecznosci pooperacyjnej teleradioterapii chorych na niedrobnokomórkowego raka pluca po niedoszczetnym zabiegu operacyjnym.

In a retrospective analysis of 150 incompletely resected NSCLC patients treated with adjuvant external beam radiotherapy 32 (21.3%) survived 3 years with no symptoms of disease. Ipsilateral mediastinal/hilar lymph node involvement and macroscopic incomplete surgery were the prognostic factors that unfavourably influenced survival in Cox's proportional hazards model. Postoperative external beam radiotherapy was the efficient adjuvant treatment method in microscopically incompletely resected NSCLC, predominantly with no nodes involvement, but had no benefit in those with macroscopic incomplete surgery.

[The efficacy of adjuvant thoracic radiation therapy in NSCLC patients with ipsilateral mediastinal/hilar lymph nodes involvement (clinical trial)]. / Ocena skutecznosci pooperacyjnej teleradioterapii chorych na NDRP zoperowanych miejscowo doszczetnie z obecnoscia przerzutów w usunietych wezlach chlonnych sródpiersia albo wneki (kontrolowane doswiadczenie kliniczne).

Between 1992 and 1999 at the Oncology Centre in Cracow 138 NSCLC patients after complete resection of the tumour with mediastinal/hilar node involvement were included in the prospective clinical trial. The analysis of the results did not show any improvement of survival in the postoperatively irradiated group. Three-year survival rates with no symptoms of disease in postoperative radiotherapy patients compared to surgery alone group were 30% and 29% respectively. In this study adjuvant radiotherapy significantly improved local recurrence rate from 28% in surgery only group to 9% in postoperatively treated patients.