Gender-related significance of time interval between radiotherapy and surgery in hypofractionated preoperative radiotherapy for rectal cancer patients' survival.

AIM AND BACKGROUND: An optimal break between radiotherapy (RT) and surgery in short-course of RT (SCRT) for locally advanced rectal cancer is not clearly established. The aim of the study was to investigate the influence of the break in the preoperative SCRT and overall treatment time (OTT) for locally advanced rectal cancer patients (whole group and male/female subgroups) on patients overall survival (OS), recurrence-free survival (RFS), metastasis-free survival (MFS). MATERIALS AND METHODS: 131 patients were treated with SCRT (5 Gy/5 days), followed by surgery 3-53 days later. Break was calculated as the time interval between the end of irradiation to surgery and OTT as time interval from the beginning of RT to surgery. RESULTS: Mean break was 21.5 (range 3-53.0) days and mean OTT was 26.5 (range 7-58.0) days. In univariate analysis, a break longer than 15 days and OTT >23 days were negative prognostic factors for OS for all patients, and particularly for the male patients' subgroup. RFS was non-significantly higher (P = 0.066) for patients treated with a break ≤15 days and OTT ≤23 days (P = 0.099), irrespectively of patients' sex. Patients treated with a break longer than 15 days and OTT >23 days had non-significantly lower level of MFS than those treated with a shorter break (P = 0.269) and OTT ≤23 days (P = 0.498). CONCLUSION: In SCRT, a break in the treatment longer than 15 days, especially in the male patients subgroup, should be avoided, because it negatively affects patients' survival.

Role of irradiation in combined treatment of head and neck paragangliomas at the Centre of Oncology in Krakow between 1970-2005.

AIM OF THE STUDY: Aim of the study is to evaluate the results of postoperative radiotherapy of paragangliomas, prognostic factors and causes of treatment failure. MATERIAL AND METHODS: Forty-four patients (39 females and 5 males) aged 20 to 74 years were treated for paraganglioma between 1970 and 2010 at the Centre of Oncology in Kraków. Patient survival probability was estimated with the Kaplan-Meier method. Log-rank tests and Cox proportional hazard model were used in univariate and multivariate analysis, respectively. RESULTS: The most common locations of paragangliomas were the following: the ear, carotid body and internal jugular vein bulb. Forty (91%) out of them were benign and 4 - malignant. All patients underwent surgery followed by adjuvant radiotherapy. The delivered dose ranged from 50 to 72 Gy, the mean dose was 60 Gy. Five-year overall survival was 84%. Five-year relapse-free survival was 84%, either. The multivariate analysis has shown that the dose in an independent prognostic factor for the overall survival. The univariate analysis has shown significantly higher 5-year overall survival in patients who received a dose of 60 Gy or higher - 92% vs. 70% in patients who received a dose lower than 60 Gy. CONCLUSIONS: Postoperative radiotherapy with doses higher than 60 Gy in patients with paragangliomas is associated with longer overall survival.

Gender-related differences in pathological and clinical tumor response based on immunohistochemical proteins expression in rectal cancer patients treated with short course of preoperative radiotherapy.

BACKGROUND: Prognostic value of pretreatment expression of proteins in rectal cancer for early pathological tumor response (pTR), clinical tumor response (CTR) to preoperative radiotherapy (RT), and the potential difference between these parameters depending on patient gender is not established. MATERIAL AND METHODS: One hundred eleven patients were treated with short preoperative course of RT (SCRT) with 5 Gy dose per fraction during 5 days, followed by surgery 3 to 53 days (mean, 21 days) later. Expression of CD34, Ki-67, GLUT-1, Ku70, BCL-2, and P53 proteins was assessed immunohistochemically. RESULTS: There were 76 men and 35 women. There were 27, 69, and 15 clinical tumor-node-metastasis (cTNM) tumor stages I, II, and III, respectively. Significant differences in Ki-67, GLUT-1, Ku 70, and BCL-2 expressions between male and female tumors were observed for pathological TNM (pTNM) stage and grade. Association between proteins expression and pTNM, pTR, and CTR was analyzed separately for short (≤15 days) and long (>15 days) break between RT and surgery and males and female patients. For SCRT with short break, no protein was significantly related to pTNM; for pTR, higher Ki-67 and lower BCL-2 expression were correlated with pTR. In the male subgroup, BCL-2 overexpression was predictive. For SCRT with long break, none of the proteins was predictive for pTR, but Ki-67, Ku70 (in female subgroup), and BCL-2 expressions were positively correlated with pTNM. BCL-2 overexpression was associated with CTR in the females only. CONCLUSION: In SCRT, long break in the treatment should be avoided because correlation between Ki-67, KU70, and BCL-2 expressions and pTNM after RT might indicate tumor progression.

Bromodeoxyuridine labeling index as an indicator of early tumor response to preoperative radiotherapy in patients with rectal cancer.

PURPOSE: Assessment of tumor proliferation rate using Bromodeoxyuridine labeling index (BrdUrdLI) as a possible predictor of rectal cancer response to preoperative radiotherapy (RT). METHODS AND MATERIAL: Ninety-two patients were qualified either to short RT (5 Gy/fraction/5 days) and surgery about 1 week after RT (schedule I), or to short RT and 4-5 weeks interval before surgery (schedule II). Tumor samples were taken twice from each patient: before RT and at the time of surgery. The samples were incubated with BrdUrd for 1 h at 37 degrees C, and the BrdUrdLI was calculated as a percentage of BrdUrd-labeled cells. RESULTS: Thirty-eight patients were treated according to schedule I and 54 patients according to schedule II. Mean BrdUrdLI before RT was 8.5% and its value did not differ between the patients in the two compared groups. After RT tumors showed statistically significant growth inhibition (reduction of BrdUrdLI). As the pretreatment BrdUrd LI was not predictive for early clinical and pathologic tumor response, prognostic role of the ratio of BrdUrdLI after to BrdUrdLI before RT was considered. The ratios were calculated separately for fast (BrdUrd LI>8.5%) and slowly (BrdUrd LI

[Results of radiotherapy in elderly patients with early laryngeal cancer]. / Ocena skutecznosci radioterapii niezaawansowanego raka krtani u chorych powyzej 70 roku zycia.

UNLABELLED: Evaluation of the results of radiotherapy in elderly patients with early laryngeal cancer, the relation between comorbidities and the overall treatment time, and the influence of treatment interruptions on the outcome of treatment. MATERIALS AND METHODS: A clinical retrospective analysis of a group of 117 patients (over the 70 years old) with early laryngeal cancer was carried out. Patients were irradiated between the years 1980 and 2000 in the Centre of Oncology in Cracow. The analysed group consisted of 105 men (90%) and 12 women (10%). Patients' age ranged from 70 to 87 years, median - 73 years. Most of them had various comorbidities. Three different irradiation techniques and fractionation schemes were used according to the site, stage and grade of cancer: two oblique beams including the larynx with total dose of 60 Gy in 24 fractions (46 patients), two parallel opposing beams including the larynx and cervical lymph nodes with total dose of 60 Gy in 30 fractions (38 patients), and mixed photon-electron unilateral beam including the larynx with total dose of 60 Gy in 30 fractions (33 patients). RESULTS: The median follow-up was 48 months. During the follow-up period 78 patients (66.6%) died. Among them 29 patients (37.2%) died of laryngeal cancer, 6 (7%) patients of other malignancy, and 43 (55%) patients died of concomitant diseases without evidence of cancer. The actuarial 5/10-year overall survival (OS) and disease specific survival (DSS) were 51%/23% and 77%/68%, respectively. The overall tolerance of radiation therapy was good; only 3 patients had G3 early mucosal reaction, and 1 patient had G3 early skin reaction were observed. Comorbidities were not demonstrated to have statistically significant influence on DSS rate. In 6 (5.1%) from 117 patients complete tumor regression was not achieved after radiotherapy. During the follow-up period loco-regional relapse were observed in 27 patients (23.5%), and distant metastases in 2 patients (1.7%). CONCLUSIONS: Radiotherapy of the elderly patients with laryngeal cancer is effective and well tolerated method. Comorbidities do not significantly influence the treatment results. T stage, localization in supraglottic area, age over 73 years old, fractionation dose under 2 Gy and overall treatment time over 43 days are statistically significant negative prognostic factor for DSS rate.

[Choroidal metastases of malignancies. Review of treatment methods with special regard to application of radiotherapy]. / Przerzuty nowotworowe do naczyniówki galki ocznej. Przeglad metod leczenia ze szczególnym uwzglednieniem radioterapii.

Choroidal metastases are developed in 4 - 12% of patients with solid malignancies. Typical symptoms are loss of visual acuity or visual field, photophobia and floaters. In therapy of choroidal metastases are used following methods: surgery, laser photocoagulation, radiotherapy, and systemic treatment (anti-neoplastic chemotherapy or hormonotherapy). At choice of method of treatment it is taking not only features associate with choroidal metastases (as size, shape, number of changes and localization) but also: performance status of patient and the presence of metastases in any sites. The purpose of this paper is the review of treatment methods of choroidal metastases with special regard to application of radiotherapy. Radiotherapy is a conservative method of treatment, and it is used as brachytherapy or external beam irradiation (teleradiotherapy). Brachytherapy is recommended in case of single change, with base diameter below 18 mm. The positive results are observed in 90% cases. Teleradiotherapy is used in metastatic tumours which size exceed possibility successfully using of brachytherapy, and in case of multiple foci of choroidal changes, and metastases bilaterally localized. 70 - 89% patients developed regression of choroidal metastases after external beam irradiation. The preservation of bulbus oculi is observed in 98% patients. Presented paper showed application of methods of brachytherapy used in Ophthalmological Department of Jagiellonian University, and technique of teleradiotherapy used in Radiotherapy Department of Oncology Centre in Krakow, which are used in treatment of choroidal metastases.

[The bilateral breast cancer in patient treated for Ewing sarcoma in childhood--the case report]. / Obustronny rak piersi u chorej leczonej w dziecinstwie z powodu miesaka Ewinga --opis przypadku.

This paper presents a patient with bilateral breast cancer who was treated for Ewing sarcoma in childhood.

S-phase fraction and menopausal status as the most important prognostic factors of disease-free survival for node negative patients with breast cancer. A prospective study.

The aim of our study was to determine a prognostic value of DNA flow cytometry measurements performed on fresh breast cancer tissues, separately for patients' groups defined by nodal status, with special attention to histological type of tumor. Between 1993 and 1996 samples from 677 patients were analyzed and 457 cases were included in the survival analysis. Two-hundred and nine patients from them were node negative (N0). The median time of follow-up was 74 months. In multivariate analysis of disease-free survival (DFS), S-phase fraction (SPF) and menopausal status were found to be independent prognostic parameters for N0 group. A combination of this factors allowed us to distinguish three groups different in respect of the risk of recurrence. Our results showed that: 1. SPF and menopausal status could be prognostically valuable factors for DFS in N0 breast cancer patients; 2. prognostic value of SPF and ploidy should be evaluated separately for each histological type of breast cancer.

Analysis of treatment results in advanced Hodgkin's disease: the case for adjuvant radiotherapy.

PURPOSE: To assess the treatment results in patients with advanced Hodgkin's disease in a single center and to evaluate the clinical and therapeutic prognostic factors, including verification of the significance of the prognostic score. METHODS AND MATERIALS: Treatment results were analyzed in 133 patients with newly diagnosed Stage IIIB and IV Hodgkin's disease. Treatment consisted of six courses of hybrid chemotherapy (mechlorethamine, vincristine, procarbazine, and prednisone [MOPP]/doxorubicin (adriamycin), bleomycin, and vincristine [ABV]) followed by irradiation (RT) in patients with an indication for RT (84 patients). Chemotherapy was then continued for another two cycles. The indications for consolidation RT included bulky disease and/or partial response after six cycles of chemotherapy. In 31 patients, extended-field RT was performed, and in 53, limited fields were irradiated. The median radiation dose was 39 Gy. RESULTS: The median follow-up was 78 months. Complete remission after whole treatment was achieved in 88.7% of patients. The actuarial overall survival rate was 78% and 71%, and relapse-free survival rate was 73% and 65% at 5 and 10 years, respectively. The independent adverse prognostic factors in multivariate analysis appeared to be older age, low serum albumin, low serum gammaglobulin, lower number of chemotherapy cycles, and no RT. The value of the prognostic score was confirmed; the higher the prognostic score, the worse the survival. CONCLUSION: In patients with advanced Hodgkin's disease, consolidation RT improved survival. The best results were achieved with the use of large-volume RT.