CALIBRATION OF GAFCHROMIC EBT3 FILM FOR DOSIMETRY OF SCANNING PROTON PENCIL BEAM (PBS).

Gafchromic EBT3 films are applied in proton radiotherapy for 2D dose mapping because they demonstrate spatial resolution well below 1 mm. However, the film response must be corrected in order to reach the accuracy of dose measurements required for the clinical use. The in-house developed AnalyseGafchromic software allows to analyze and correct the measured response using triple channel dose calibration, statistical scan-to-scan fluctuations as well as experimentally determined dose and LET dependence. Finally, the optimized protocol for evaluation of response of Gafchromic EBT3 films was applied to determine 30 × 40 cm2 dose profiles of the scanning therapy unit at the Cyclotron Centre Bronowice, CCB in Krakow, Poland.

Distant metastases from invasive lobular breast carcinoma classic type - treatment and prognosis.

INTRODUCTION: Invasive lobular carcinoma (ILC) comprises 4-15% of all malignant neoplasms of the breast. The "classical variant of ILC" (C-ILC) constitutes some 60-80% of this cancer. The main cause of treatment failures is dissemination observed in 8-38% patients The disant metastases (DM) are frequently localized in: bones, gastrointestinal tract, uterus, leptomeninges, and ovaries. The aim of this study was to present the methods and results of the treatment of patients with DM from the classical variant of ILC (C-ILC) at a single institution in Poland. MATERIALS AND METHODS: Between January 1983 and December 2004, 210 women with C-ILC of the breast were primarily treated surgically (mastectomy in 182 (86.7%) patients and breast conserving therapy in 28 (13.3%) patients). Then adjuvant therapy (radiotherapy, chemotherapy, and hormonotherapy) was applied according to presence of clinical indications. RESULTS: The present study focused on a group of 41 patients with a median age of 59 that died with DM from C-ILC during the ten-year follow-up. This failure developed on average 65 months (3-186) after surgery of ILC. The most frequently DM developed: bones (39.1%), GI (small bowell, stomach, colon, rectum) - 31.8%, and reproductive organs (ovary, uterus) - 19.1%. In therapy of DM, different configuration surgery, radiotherapy, and chemo-hormonotherapy were used. The median survival after the diagnosis of DM was connected with localization of distant metastases. CONCLUSION: Patients with classic variant of infiltrate lobular cancer of breast should be regularly follow-up, which could permit early diagnosis of distant metastases and improve treatment results.

The biological markers and results of treatment in male breast cancer patients. The Cracow experience.

Male breast cancer is a rare form of carcinoma with an incidence rate of approximately 0.5-1% compared with cases of breast carcinoma as a whole. Male breast cancer reacts effectively to endocrine therapy because of a high frequency of hormone receptor expression.The aim of the present study was the assessment of correlations between stage, grade, expression of steroid receptors, basal/mesenchymal markers and proliferation index, as well as analysis of the impact of the above-mentioned parameters on overall (OS) and disease-free survival (DFS) in the group of 32 male breast cancer patients, treated at the Centre of Oncology in Cracow.We showed the significant positive correlation between MIB-1 LI and tumor stage, and hormone receptors (ER or PgR) immunonegativity, and expression of EGFR, vimentin (p<0.05) and P-cadherin (the last at statistical border). The presence of any of basal or masenchymal markers correlated with a more advanced tumor stage. Moreover tumors without vimentin expression were characterised by lower MIB-1 LI and were more frequently EGFR immunonegative.We found that hormone receptor negativity, vimentin immunopositivity and high MIB-1 LI are significant independent indicators of poor OS and DFS for male breast cancer patients (p<0.05).

Cancer of the larynx in females.

PURPOSE: The aim of this paper is to present results of analysis of 102 females with laryngeal cancer. MATERIALS AND METHODS: Between 1974 and 1995, 102 female patients with cancer of larynx were treated at Radiotherapy Department of Oncology Centre in Kraków. Twenty-six of them had positive familial oncological history. The treatment method depended on stage of disease. Primary radical irradiation was performed in 66 patients, 29 patients received postoperative radiotherapy after surgery (total or partial laryngectomy), seven patients received induction chemotherapy followed by laryngectomy with postoperative radiotherapy or radical irradiation. The median dose applied with radiotherapy was 60 Gy, and dose per fraction was 2 Gy. RESULTS: The actuarial 5-year rates were as follows: 88.9% for overall survival, 84.2% for disease-free survival, and 85.4% for local control. Only tumour stage and nodal involvement were found to be significant factor for all three endpoints. We found that younger patients had more supraglottic primary localisation, and these patients frequently were non-smoker. CONCLUSIONS: The tumour stage and nodal involvement were found to be significant prognostic factors in analysed group of female treated with laryngeal cancer.

[A case of tracheal adenoid cystic carcinoma in a young woman]. / Przypadek raka gruczolowato-torbielowatego tchawicy u mlodej chorej.

A case of an adenoid cystic carcinoma of trachea is presented. A 30-year-old non-smoking woman with strong inspiratory dyspnea at rest was admitted to the Dept. of Pulmonary Diseases. At auscultation a respiratory murmur was more silent at right lung and stridor over trachea was heard. CT scan revealed tumor at the bifurcation of the trachea. Bronchoscopy was made and biopsy established the diagnosis: adenoid cystic carcinoma. The tumor was partially removed with rigid bronchoscope and radiotherapy was started. Clinical improvement occurred; in control CT scan tumor vanished. The trachea cancers are rare. Symptoms often mimic asthma or chronic bronchitis. Thus in every patient with chronic cough and dyspnea bronchoscopy should be made. A treatment of choice is primary resection and postoperative radiotherapy.

The efficiency and tolerance of half-body irradiation (HBI) in patients with multiple metastases. The Krakow experience.

AIM: To present our experience regarding the efficiency and tolerance of half-body irradiation in patients with multiple cancer metastases. PATIENTS AND METHODS: Between January 1986 and December 1997, 102 patients with multiple cancer metastases received half-body irradiation (HBI) at the Center of Oncology--Maria Sklodowska-Curie Memorial Institute in Krakow. Most of the patients (93/102) had bone metastases (Table 1). The HBI was performed with 9 MV photon beam from linear accelerator. In 88 patients only one region (upper, mid or lower) was treated, and 14 patients received upper and lower HBI (13 patients), or upper and mid HBI (one patient) (Table 2). The mean doses were: 6 Gy in upper HBI, 8 Gy in mid HBI, and 9 Gy in lower HBI (Table 3). RESULTS: The positive palliative effect (complete or partial pain relief) was observed in 77 (75.5%) patients (Table 4). Complete pain relief was higher in patients with prostate cancer, and in patients who received mid or lower HBI. During follow-up 47 (46.1%) patients developed pain progression after treatment (Table 5). The probability of survival without pain progression was higher in patients who developed complete pain relief (86.7% at 6 months, 69.3% at 12 and 24 months) than in patients with partial response (52.9% at 6 months, 32.8% at 12 months, and 5.5% at 24 months) (Figure 1). In most of the patients (74/102, 72.5%) the tolerance was good. CONCLUSIONS: HBI is an efficient method for palliation in patients with multiple painful metastases.

[The development of non-Hodgkin's lymphoma during the course of autoimmune diseases. Five case reports]. / Rozwój chloniaka nieziarniczego w przebiegu choroby autoimmunologicznej. Opis pieciu przypadków.

The development of five of non-Hodgkin lymphomas during the course of autoimmune diseases was presented. The treatment methods of autoimmune disease included: irradiation steroids, non-steroidal anti-inflammatory drugs or immuno-suppressive drugs. The time interval between diagnosis of autoimmune disease and lymphoma was from 2 to 28 years. High-grade lymphoma was observed in all cases. After treatment (irradiation with or without combination with multidrug chemotherapy) the complete regression was observed and disease-free survival between 16 and 48 months after treatment was obtained.

[The role of radiotherapy in the management of benign lymphoepithelial lesions]. / Rola radioterapii w leczeniu benign lymphoepithelial lesion.

Benign lymphoepithelial lesion (BLL) is observed as a diffuse or nodular enlargement of major salivary gland. In 80% it appears in woman in the sixth and seventh decade. The histopathologic appearance consist of a triad of parenchymatous atrophy, interstitial lymphocytic infiltration and epimyoepithelial islands. This disease co-exists in 50% of cases with connective tissue disorders. In patients with BLL the risk of the development of a malignant lymphoma may be as high as 40:1 in comparison to the control group. From 1960 to 1991 ten women with BLL in salivary glands were treated in Oncology Centre in Kraków. The disease was localized in parotid glands (8 pts), in submandibular glands (1 pt) and in parotid and submandibular gland (1 pt). In this group 3 patients were treated for the rheumatoid arthritis and in 1 women presented symptoms of Sjögren' syndrome. Exclusive surgical treatment was performed in 2 patients, 7 patients were treated with irradiation, and 1 patient received combined therapy: surgery and radiotherapy. The doses of irradiation were from 12 to 36 Gy given in 6 to 18 fractions. Complete remission was observed in 2 patients who received only surgical treatment. In group of 8 patients treated with irradiation and surgery and irradiation we have observed local control in six women after 1 series and in two women after 2 series of irradiation. During the observation malignancies developed in 4 patients between 11 to 39 months after radiotherapy. One patient developed cancer of salivary gland. In remaining 3 patients it was observed malignant lymphomas. Our results of therapy of BLL in salivary gland are similar to presented by the other authors and indicate the efficiency of local (surgical or irradiation) treatment.

Results of treatment of inoperable recurrences of laryngeal cancer after total laryngectomy.

BACKGROUND/PURPOSE: The results of conventional radiotherapy in patients with inoperable recurrence of laryngeal cancer after total laryngectomy are bad. Therefore experimental methods including neutron therapy and combination of chemo- and radiotherapy have been used. This presentation evaluates results of different treatment modalities in patients with inoperable recurrences of laryngeal cancer after total laryngectomy. PATIENTS AND METHODS: Forty-two patients with inoperable recurrences of laryngeal cancer after total laryngectomy were treated. Thirty patients received radiotherapy alone, and 12 patients received multidrug chemotherapy and radiotherapy. Patients were irradiated with cobalt-60 beam, neutron beam and with mixed cobalt-60 and neutron beam. The tumor dose in cobalt-60 therapy was 60 Gy in 20 to 30 fractions. In 8 patients additional dose of 10 to 20 Gy in 5 to 10 fractions was given to the reduced field. The doses used in neutron irradiation varied from 10 to 13 Gy in 5 to 20 fractions. RESULTS: In 20 patients (47.6%) complete regression after therapy was observed, but only 9 (21.4%) patients survived without evidence of disease at 2 years after radiotherapy. In patients treated with radiotherapy alone the 2-year disease-free survival was observed in 16.7% and in patients who received induction chemotherapy with Cisplatin followed by radical irradiation the 2-year disease-free survival was observed in 40%. CONCLUSION: The results of therapy of inoperable recurrence of laryngeal cancer after total laryngectomy remain bad. Radiotherapy combined with multidrug chemotherapy including cisplatin may contribute to some improvement of the patients survival.

[Results of the treatment of inoperable recurrences of larynx carcinoma after total laryngectomy]. / Wyniki leczenia nieoperacyjnych wznów raka krtani po laryngektomii totalnej.

Since 1975 to 1989 in the Department of Radiotherapy of Centre of Oncology in Krakow 49 patients with inoperable recurrences of the larynx carcinoma after total laryngectomy were treated. The palliative therapy (chemotherapy and/or palliative radiotherapy) was used in 18 patients. This study presents the group of 31 patients which were treated with radical intent. Radical radiotherapy was used in 20 patients. Combined multidrug chemotherapy and radiotherapy was used in 11 patients: in 2 patients chemotherapy VBM was used in combination with radiotherapy and 9 patients received the induction chemotherapy (treatment schedules containing Cisplatin) followed by radical radiotherapy. Observations show that the effectiveness of the induction chemotherapy combined with radiotherapy. Two year symptom-free 3 patients (15). Better results were observed after combined treatment with the use the induction chemotherapy combined with radiotherapy. Two year symptom-free survival was achieved in 4 patients (44%). These findings require confirmation in the greater group of patients.