[Radiotherapy in vulvar cancer treatment]. / Radioterapie v lécbe karcinomu vulvy.

OBJECTIVE: To provide an actual review of radiotherapy in the treatment of vulvar carcinoma. DESIGN: A review article. SETTING: Department of Oncology and Radiotherapy, University Hospital in Hradec Králové. METHODS: A review article evaluating the application of ionizing radiation in the treatment of early and advanced vulvar carcinoma, based on the most significant previously published studies. CONCLUSION: Postoperative groin irradiation in patients with positive groin lymph-nodes improves local control, time to progression, and overall survival; especially in 2 positive nodes and in N2/3 initial findings. In case of positive inguinal nodes, radiotherapy of both groins and at least lower pelvic iliac node-chains should follow. Adjuvant irradiation of the primary remains controversial, except for positive resection margins where radiotherapy improves overall survival. Concurrent chemoradiotherapy seems to be appropriate primary treatment of advanced vulvar carcinomas, in attempt to avoid mutilating intervention or exenteration. Chemoradiation should be followed by subsequent surgery, including potential groin dissection in case of lymph-node involvement. Definitive chemoradiotherapy is of limited evidence, and radical dose escalation to the gross tumor is essential for its implementation. Modern radiotherapy techniques, especially with intensity modulation, are convenient for dose escalation.

[Intensity modulated radiation therapy technique in the treatment of gynecologic malignancies]. / Technika radioterapie s modulovanou intenzitou zárení v lécbe gynekologických malignit.

OBJECTIVE: A description of intensity modulated radiation therapy (IMRT) technique and its implementation in the treatment of gynecologic malignancies. SUBJECT: A review article. SETTING: Department of Oncology and Radiotherapy, University Hospital in Hradec Králové. SUBJECT AND METHOD: General explanation of IMRT priciples, its benefits and limitations, and a review of published data about its utilization in the treatment of endometrial, cervical, and vulvar carcinoma. CONCLUSION: IMRT represents an accessible and highly conformal external beam radiothrapy technique, which enables a significant sparing of healthy tissue with consequent reduction of radiation morbidity in comparison with other conventional and conformal techniques. A feasibilty of dose excalation with preservation of low toxicity is another advandage of IMRT. It can be utilized in the treatment of most frequent gynecologic tumors, especially in endometrial, cervical, and vulvar carcinoma.

[Extended field radiotherapy and high-dose brachytherapy combined with chemotherapy in patients with locally advanced cervical carcinoma]. / Radioterapie velkými poli a brachyterapie s vysokým m dávkovým príkonem s konkomitantní chemoterapií u pacientek s lokálne pokrocilým cervikálním karcinomem.

OBJECTIVE: Evaluation of results of extended field radiotherapy and high-dose rate brachytherapy combined with chemotherapy in patients with locally advanced cervical carcinoma. TYPE OF THE STUDY: A retrospective study. SETTING: Department of Oncology and Radiotherapy, University Hospital Hradec Králové. METHODS: Forty five patients with stage IIB - IVA cervical cancer and radiologically suspicious pelvic and/or paraaortic lymph nodes were treated at the Dept. of Oncology and Radiotherapy Hradec Králové with pelvic and paraaortic radiotherapy, high-dose rate brachytherapy and concomitant chemotherapy with cisplatin or cisplatin and paclitaxel. RESULTS: The 3-years disease free survival estimate was 64%. Hematological toxicity was the most limiting factor of concomitant chemotherapy. Late toxicity grade III and IV was observed in 7 patients. One patient underwent surgery due to ileus caused by lymphoma. CONCLUSIONS: Concomitant chemoradiotherapy with paraaortic fields results in high tumor control but also significant acute and late toxicity. New techniques of radiotherapy, such as intensity modulated radiotherapy, may improve the therapeutic ratio.

[Chemotherapy intensity importance in concurrent chemoradiotherapy of locally advanced cervical cancer]. / Význam intenzity chemoterapie v konkomitantní chemoradioterapii lokálne pokrocilého karcinomu hrdla delozního.

OBJECTIVE: Concurrent chemoradiotherapy with weekly cisplatin became a standard procedure in patients with locally advanced cervical carcinoma. The objective of this retrospective study was to evaluate the therapy toleration and the survival of patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy with weekly cisplatin of 40mg/m2. SUBJECT AND METHOD: From January 2000 to December 2004, 40 patients with locally advanced cervical cancer were treated with concurrent chemoradiotherapy with weekly cisplatin of 40mg/m2. Radical radiotherapy consisted of external beam radiotherapy 25 x 2 Gy to the pelvis, high-dose rate brachytherapy 6 x 4 Gy to the tumor, boost 7 x 2 Gy to the pelvic walls. 21 patients also recieved 22 x 2 Gy to the para-aortic lymphatic nodes. RESULTS: Only 16 patients recieved full five doses of cisplatin. Causes of discontinuance of the chemotherapy: acute hematological toxicity with leukopenia (10), thrombocytopenia (1), anaemia (1), increased levels of creatinine (2), profuse vomiting (1), haematemesis (1). Stage dependent two-year overall survival (OS) was 72% (IIB) against 64% (III, IVA). Two-year disease-free survival (DFS) dependent on the number of cisplatin doses was 77% (> or = 3 doses) against 56% (<3 doses) in patients with IIB stage. CONCLUSION: Acute hematological toxicity with leukopenia was the most frequent cause of discontinuance of the chemotherapy. The results of two-year OS and DFS show difference in dependence on the number of applied doses of chemotherapy. However, the difference was not significant due to a low number of patients subject to the study.

Weekly paclitaxel combined with local hyperthermia in the therapy of breast cancer locally recurrent after mastectomy--a pilot experience.

BACKGROUND: The combination of chemotherapy and hyperthermia (HT) is a promising approach in the treatment of malignant tumors. In the present report we evaluate the efficacy and toxicity of a combination of weekly paclitaxel combined with local hyperthermia in breast cancer. PATIENTS AND METHODS: 7 patients were treated for inoperable local recurrence of breast cancer after mastectomy, irradiation, and chemotherapy or hormonal therapy. They weekly received paclitaxel (60-80 mg/m(2)) in 3-h infusions followed by local HT 41-44 degrees C for 45 min for 6-18 cycles. RESULTS: Objective local response was observed in all treated patients (complete response in 4 patients and partial response in 3 patients). There were no grade 3 or 4 toxicities, neurologic toxicity or hypersensitivity reactions. Local tolerance to this regimen was also good, with only 4 patients developing mild transient erythema. CONCLUSION: Our experience indicates that the combination of weekly paclitaxel and HT may be effective in the treatment of locally recurrent breast cancer after mastectomy.

Liposomal doxorubicin combined with regional hyperthermia: reducing systemic toxicity and improving locoregional efficacy in the treatment of solid tumors.

Incorporation of doxorubicin into polyethylene glycol-coated (pegylated) liposomes increases the therapeutic index, prolongs circulation time and enhances tumor localization. Pegylated liposomal doxorubicin (PLD) is an established therapeutic agent in epithelial ovarian carcinoma (EOC), breast carcinoma or Kaposi's sarcoma, and PLD administration results in reduction of toxicity. Addition of regional hyperthermia increases liposome extravasation, induces the doxorubicin release from the liposomes, and the combination of hyperthermia and doxorubicin itself may be supra-additive, resulting in enhanced antitumor efficacy in the heated region. Encouraging results have been reported for the combination of PLD and hyperthermia in EOC, breast carcinoma and hepatocellular carcinoma.

Pegylated liposomal doxorubicin in combination with hyperthermia for treatment of skin metastases of breast carcinoma: a case report.

BACKGROUND: Incorporation of doxorubicin hydrochloride into pegylated liposomes (PLD) may decrease chemotherapy side effects and increase the activity. Hyperthermia could further potentiate its effectiveness. CASE REPORT: A patient with skin metastases of breast carcinoma was treated with intravenous infusion of PLD (Caelyx) in combination with ultrasound hyperthermia. Each cycle consisted of infusion of 40 mg PLD absolute dose, followed by 2 fractions of hyperthermia 41-43 degrees C for 45 min 1 and 48 h after infusion. A complete remission was observed after the combination treatment with no significant toxicity. CONCLUSION: Present observations suggest that the combination of PLD with hyperthermia of skin metastases of breast carcinoma may be an active and well tolerated treatment.

Endovascular brachytherapy of transjugular intrahepatic portosystemic shunt.

Purpose: To evaluate the technical feasibility and efficacy of endovascular brachytherapy with Iridium-192 in the prevention of restenosis caused by neointimal hyperplasia of transjugular intrahepatic portosystemic shunt (TIPS).Materials and Methods: The endovascular brachytherapy with high dose rate automatic afterloading system was performed in six patients with recurrent of stenosis of TIPS. We used a single dose fraction of 12 Gy delivered at 3 millimeter (mm) from the source axis to the stenotic vessel segment in five patients with spiral Z-stent, and 15 Gy at 5 mm in one patient with Wallstent.Results: Follow-up time ranged from 148 to 639 days. In one patient, restenosis occurred in the treated vessel segment, diagnosed 71 days after endovascular brachytherapy by doppler ultrasound. All other patients were, during the follow-up time, without restenosis in the irradiated vessel segment. Radiation-associated side effects were not observed.Conclusions: Endovascular brachytherapy of TIPS is technically feasible and may be done as a part of the percutaneous revision of the shunt. This pilot study may be the largest experience of treating TIPS restenosis in humans to date. For definitive conclusions, a lot of studies are needed.

Conformal radiotherapy for prostate cancer--longer duration of acute genitourinary toxicity in patients with prior history of invasive urological procedure.

The incidence and predictors of acute toxicity were evaluated in patients treated with three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer. Between December 1997 and November 1999, 116 patients with T1-T3 prostatic carcinoma were enrolled in the study. Ninety patients were treated with 70 Gy and 26 patients with T3 tumors received 74 Gy. Of the 116 patients 42 (36.2%) had a prior history of invasive urological procedure (IUP) (transurethral resection of the prostate or transvesical prostatectomy for benign prostatic hyperplasia). Acute gastrointestinal (GI) and genitourinary (GU) symptoms were graded according to the EORTC/RTOG scoring system. Toxicity duration after the completion of 3D-CRT was recorded. The majority of patients experienced only mild or no (Grade 1) acute toxicities. Medications for GI and GU symptoms (Grade 2) were required by 28.4% and 12.9% of patients, respectively. Only one case of Grade 3 GI toxicity (0.9%) was observed. Seven patients (6.1%) experienced severe GU toxicity (Grade 3 or 4). No correlation was found between acute toxicity and age, stage, dose (70 Gy vs. 74 Gy), IUP and pelvic lymphadenectomy. A significant relationship was observed between the duration of acute GU toxicity and prior IUP. Symptoms persisted for more than 4 weeks in 51.9% and 26.0% of patients with and without a prior history of IUP, respectively (p = 0.02). The incidence of acute complications, associated with 3D-CRT for prostate cancer, was acceptable in our cohort of patients. A prior history of IUP resulted in a significantly longer duration of acute GU toxicity.

Endovascular brachytherapy in the prevention of vascular restenosis.

PURPOSE: To evaluate the technical feasibility and efficacy of endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS: Ten patients with recurrence of stenosis in the femoropopliteal region underwent PTA followed by endovascular irradiation with Iridium-192 a high-dose rate after-loading technique. We used a single fraction of dose 12 Gy given in 3 mm from the source axis in the stenotic vessel segment. RESULTS: During follow-up of 59-580 days restenosis occurred in four patients 111, 460, 472 and 580 days after irradiation. All other patients are without restenosis. No radiation-associated side effects were observed. CONCLUSIONS: Endovascular brachytherapy of restenosis in the femoropopliteal region is technically feasible, and may be done as a part of the PTA. These encouraging results open the possibility of reduction of restenosis by the present method.

Endovascular brachytherapy potentiated by hyperthermia in the prevention of vascular restenosis. A case report.

BACKGROUND: The combination of hyperthermia and radiotherapy has additive or synergistic effects. This combination has been studied extensively in radiation oncology, but not in the prevention of vascular restenosis. CASE REPORT: A patient with restenosis of cephalic vein underwent percutaneous transluminal angioplasty (PTA) followed by endovascular irradiation with 192Iridium (12 Gy) using a high dose rate afterloading technique. After endovascular irradiation, one fraction of external ultrasound hyperthermia was administered to the irradiated segment. There was no restenosis in the treated vessel segment according to duplex sonography performed 192 days after treatment. No radiation or hyperthermia associated side effects were observed. CONCLUSIONS: Present observations suggest that endovascular brachytherapy of restenosis potentiated by hyperthermia is a technically feasible and well-tolerated treatment. The additive and synergistic effects of hyperthermia, in conjunction with radiation, could be of benefit in the prevention of vascular restenosis.

Endovascular brachytherapy of transjugular intrahepatic portosystemic shunt.

PURPOSE: To evaluate the technical feasibility and efficacy of endovascular brachytherapy with Iridium-192 in the prevention of restenosis caused by neointimal hyperplasia of transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: The endovascular brachytherapy with high dose rate automatic afterloading system was performed in six patients with recurrent of stenosis of TIPS. We used a single dose fraction of 12 Gy delivered at 3 millimeter (mm) from the source axis to the stenotic vessel segment in five patients with spiral Z-stent, and 15 Gy at 5 mm in one patient with Wallstent. RESULTS: Follow-up time ranged from 148 to 639 days. In one patient, restenosis occurred in the treated vessel segment, diagnosed 71 days after endovascular brachytherapy by doppler ultrasound. All other patients were, during the follow-up time, without restenosis in the irradiated vessel segment. Radiation-associated side effects were not observed. CONCLUSIONS: Endovascular brachytherapy of TIPS is technically feasible and may be done as a part of the percutaneous revision of the shunt. This pilot study may be the largest experience of treating TIPS restenosis in humans to date. For definitive conclusions, a lot of studies are needed.