[SentiMag--the magnetic detection system of sentinel lymph nodes in breast cancer]. / Magnetická detekce sentinelových uzlin u karcinomu prsu metodou SentiMag.

INTRODUCTION: The aim of this study was to assess the feasibility of the new detection system of sentinel lymph nodes in breast cancer (SentiMag) and to compare its use to the standard method of detection with a radioisotope and a gamma-probe. METHODS: Twenty breast cancer patients scheduled for sentinel lymph node biopsy underwent standard lymphatic mapping with a radioisotope and also with the Sienna+ tracer. During the surgery, sentinel lymph nodes were identified preferably with the SentiMag system. The gamma-probe was used only at the end of the surgery to verify whether all sentinel lymph nodes had been harvested. RESULTS: The sentinel lymph node was detected in all cases. Both methods agreed in 18 cases, i.e. the lymph node with the highest magnetic value ex vivo was the same node as the one with the highest radioactivity. A metastasis in the sentinel lymph node was found in three patients. It is very likely that with the sole use of the SentiMag system, the results would have been identical to those of using the standard method with a radioisotope and the gamma-probe. CONCLUSION: The new magnetic detection method of sentinel lymph nodes (SentiMag) is feasible and clinically comparable to the gold standard method of detection with a radioisotope and the gamma-probe in patients with breast cancer. The new method could find its use not only in hospitals where the department of nuclear medicine is not available but in all hospitals performing sentinel lymph node biopsies in breast cancer and possibly other types of cancer.

[Axilloscopy--an option in axillary lymph nodes dissections in breast carcinomas]. / Axiloskopie--alternativa v disekci axilárních lymfatických uzlin pri karcinomu mammy.

Authors in this randomised prospective study, which occurred in years 2007 to 2008 on the St. Anne's First Surgical Clinic in 56 breast cancer female patients, compare the results of minimally invasive axillary dissection to those of the classical axillary dissection and point to the advantages and setbacks of this new method both for the patient and surgeon.

[Accuracy of preoperative establishment of invasive breast carcinoma size using ultrasound and mammography]. / Presnost predoperacního stanovení velikosti invazivního mamárního karcinomu ultrasonografií a mamografií.

INTRODUCTION: Accurate preoperative assessment of breast cancer size is important for choosing appropriate surgical treatment. Mammography and ultrasonography are the most widely used breast imaging techniques. The aim of this study was to compare the tumour size measured by these two modalities with the pathological size of native specimen. METHODS AND SUBJECTS: From 2001 to 2007, a retrospective review was conducted of 299 patients operated on at Masaryk Memorial Cancer Institute for the diagnosis of invasive breast carcinoma detected on ultrasonography or mammography as a nucleus shadow lesion where the preoperative size was estimated. Pearson's correlation to pathological size was tested and the mean deviation was analysed in the whole group of patients as well as in subgroups defined by pathological size (pT), histogical type and grading. RESULTS: Ultrasonography was accurate in determination of the tumour size (i.e. within the deviation of 5mm) in 195 patients (74%), it underestimated in 45 cases (17%) and overestimated in 24 cases (9%). Pearson's correlation coefficient (r) was 0.610 and mean deviation minus 0.115 cm. Mammography estimated accurate results in 162 patients (81%), the size was underestimated in 14 cases (7%) and overestimated in 25 (12%). Pearson's correlation coefficient (r) was 0,645 and mean deviation 0.08 cm. Generally lower accuracy in assessing the size was noted in lobular carcinomas. CONCLUSIONS: Despite some limitations of our study, we can resume that in most cases (approximately 75%) the size assessment of invasive tumour lesion by both ultrasound and mammography is relatively reliable within the deviation of 5mm from the pathological size. But there's still been some portion of cases remaining where the estimation is not accurate, therefore we are not completely able to avoid redundant removal of tissue or, on contrary, demand of consecutive operations due to positive resection margins.

[Surgical treatment of breast cancer in the Masaryk Memorial Cancer Institute]. / Chirurgická 1écba karcinomu prsu v MOU.

Breast cancer represents the most frequent malignancy in women in the Czech Republic. Although surgery plays the basic role in the therapy of its early stages there hasn't existed any specialized training in surgical oncology in our country so far. Majority of patients are surgically treated at departments of general surgery where sometimes outdated procedures are used as we know from our own experience. In the Masaryk Memorial Cancer Institute we perform approximately 500 breast surgeries a year and provide a team of surgeons specialised in this field. The aim of our article is to give a basic review of modern techniques in breast cancer surgery, to describe more precisely the most frequent ones and to give a list of some relevant literary sources.

Preoperative radiotherapy and concomitant capecitabine treatment induce thymidylate synthase and thymidine phosphorylase mRNAs in rectal carcinoma.

This work is intended to study the effect of preoperative capecitabine and radiotherapy treatment on the levels of thymidylate synthase (TS), thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) mRNAs in rectal carcinoma. 55 patients with locally advanced rectal carcinoma (cT3-4, N0, M0 or cT2-4,N+, M0) were treated with capecitabine 825 mg/m2 twice a day and pelvic radiotherapy 1,8 Gy daily up to cumulative dose of 45 Gy, boosting up to 50,4 Gy. Patients underwent surgery 6th week after the completion of chemoradiotherapy. Biopsies of rectal carcinoma were taken before starting therapy and 14 days after its cesation. Biopsies were examined for TS, DPD and TP mRNA levels. CEA in serum was examined to monitor relapses. Both TP and TS mRNA increase two weeks after starting therapy (p<0,001). TP mRNA median levels were elevated 2,3x after starting therapy. Moreover responders exhibit 1,5x higher induction than non-responders both before and after starting therapy, but difference is significant before therapy only (p=0,017). Non-responders have most frequent TS induction. Complete remission was observed in 17% and substantial responses with microscopic residuum only in additional 19% of cases were achieved. The pathologic downstaging rate was 76%. Our data show that TS and TP mRNA are induced by preoperative chemoradiotherapy in both responders and nonresponders. TP induction is in accordance with the expected role of TP in the activation of capecitabine and the known promoting role of TP in tissue fibrosis frequently associated with tumor regression.

Sentinel node biopsy in breast cancer: short time results show appropriate regional control.

Sentinel node biopsy becomes a standard diagnostic and therapeutic tool in breast cancer in certain indications, while in other indications its validity is still reviewed. The authors present their experience with this method. In the years 2000-2006 700 patients underwent surgery. 704 sentinel node biopsies were performed (bilaterally in 4 cases), 7 times surgery was unsuccessful. In the unsuccessful cases immediate axillary lymph node dissection (ALND) was performed. 985 sentinel nodes were found, the average was 1.4 nodes, maximum 6 nodes. In 7 patients contralateral ALND for node positive contralateral cancer was necessary along with sentinel node biopsy. A positive sentinel lymph node (SLN) was found in 188 (26.9%) patients. A strong correlation between tumor size and lymph node positivity was found, 5.3% in pT1a, and 40.4% in pT2, respectively. The sentinel node metastases could be divided according to their size. The number of affected further nodes did correlate with this size, yet with the exception of isolated tumor cell detection, small size metastases did not exclude the possibility of further affection. Our findings support the role of sentinel node biopsy in breast cancer. 332 patients reached at least 2 years of follow up by the time of statistic evaluation, 2.5% of SLN negative and 5.6% of SLN positive patients experienced a recurrence. All of these recurrences were distant with no regional (axillary) involvement to this date. We conclude that sentinel node biopsy is not only a safe and accurate diagnostic tool, but it also provides acceptable regional control of the disease.

Pilot study of sole conformal peroperative interstitial brachyradiotherapy of early stage breast carcinoma using high-dose rate afterloading.

In this study of high-dose-rate brachyradiotherapy to the lumpectomy site as the sole radiation are documented a three-dimensional treatment planning and preliminary results of accelerated partial- breast irradiation. From March 2002 to July 2004 25 patients were prospectively included in this study. Six patients were excluded becuase of definitive histology of lobular carcinoma or positive margin. The median age was 63.2 years (range: 44-77 years). Median follow-up of all patients is 11 months (range: 3-25 months) with a minimum follow-up of 3 months. Radiation was delivered using the high-dose-rate remote afterloader VariSource with [192]Ir source. The patients received radiation twice a day at least 6 hours apart for a total of 10 fractions over five days with a single dose of 3.4 Gy. The total dose was 34.0 Gy prescribed as a minimum peripheral dose to match or minimally exceed the volume defined by the surgical clips as seen on CT scans. Freehand technique allows conformal placement of the catheters to the shape of the lumpectomy cavity. We use the method of geometric optimalisation which allows the calculations of dose distribution in relation to target. At a median follow-up of 11 months none of patients developed in-field breast recurrences, one patient had out-of-field recurrences. There were no regional nodal recurrences. At each patient, there was calculated target volume size in cm3 (median 91.3 cm3) dose volume histogram (DVH), dose homogenity index (DHI). Median DHI was 0.42. Median volume of breast tissue getting 100% of the prescription dose, V(100), is 87%; and V(150) 48.5%. We have noticed two treatment complications: hematoma and abscess in the place of tumorous bed after exstirpation. At last follow-up, patients rated the overall cosmetic outcome excellent. This method is suitable just for patients with histologically confirmed small tumors (<3 cm in diameter) without negative prognostic factors for local recurrence (age at least 40 years, negative surgical margins, nodal involvement - maximum three positive nodes without extracapsular extension).

Neoadjuvant treatment for locally advanced rectal adenocarcinoma with concomitant radiotherapy and oral capecitabine.

PURPOSE: Concomitant chemoradiotherapy prior to surgery of locally advanced rectal carcinoma (clinical T3- 4, and/or N+) might improve the therapeutic results. We report on our clinical experience with 34 patients receiving concurrent preoperative radiotherapy and capecitabine. PATIENTS AND METHODS: Between September 2001 and March 2003, 34 patients with a median age of 62 years (range 18-75 years) were treated for adenocarcinoma of the rectum. Capecitabine was administered orally at a dose of 825 mg/m(2) twice-daily concomitantly every day during pelvic irradiation. The planned total dose of radiotherapy was 50.4 Gy, given with daily fractions of 1.8Gy, 5 days a week, over a period of about 5.5 weeks. Large pelvic dose (PTV-1) was 45.0 Gy/25 fractions in 5 weeks. Higher dose up to 50.4 Gy in further 3 fractions was given using boost fields (PTV-2). Radiotherapy was performed with high-energy photon beam (18 MV) linear accelerator using 3-dimensional (3D) treatment planning for 3 or 4 fields technique. RESULTS: Toxicity was low: grade (G) 3 local dermatitis in 2 (6%), G3 diarrhea in 3 (9%) and G3 leucopenia in 1 (3%) patients. However, 2(6%) patients required drug dose reduction by 80%. Sphincter-sparing surgery was possible in 25 (76.5%) patients while 9 (26%) patients had radical surgery with removal of all macroscopic disease. Tumor mass downstaging by TNM criteria has been achieved in all of the treated patients. Pathological (p) complete response (CR) was verified in 7 (21%) patients and minimal microscopic residual cancer was found in 6 (17%) patients, for a total of 13 (38%) patients with substantial disease remission. CONCLUSION: Preoperative concomitant radiotherapy and oral capecitabine chemotherapy for locally advanced rectal adenocarcinoma appears to be an effective and safe therapeutic choice, improving the chance for rectal-sparing surgery. The follow-up time is rather short to evaluate time to progression and survival.

[Principles of post-resection brachytherapy of solid tumors using high dose rate (HDR) afterloading]. / Principy poresekcní brachyterapie solidních nádoru s vyuzitím HDR afterloadingu.

Postresection interstitial brachytherapy is one of the modern methods of radiotherapy the aim of which is to administer a larger radiation dose without greater irradiation of the surrounding sound tissues. The administration of higher radiation doses leads in some solid tumours to better local control of the disease and makes it thus possible to use the organ and its function after preserving surgical operations. Post-resection interstitial brachytherapy belongs in the wider concept to intraoperative radiotherapy the advantage of which is direct control of the irradiated area during surgery. The method of introduction of the radiation source into the applicators in the tumour during surgery (afterloading technique) makes its possible to start radiotherapy after obtaining the definite histological result. Post-resection brachytherapy reduces markedly the total time of irradiation treatment.

[Sentinel lymphadenectomy in malignant cutaneous melanoma--short-term results and prognostic significance]. / Sentinelová lymfadenektomie u kozního maligního melanomu--krátkodobé výsledky a prognostický význam.

The predictive value of sentinel node status in skin melanoma was studied. Between August, 2, 1994 and February, 20, 1998, in Surgical Department of Masaryk Memorial Cancer Institute, Brno, 166 lymphatic regions were explored in 153 patients with 154 melanomas. We were not able to visit any other institute performing this procedure, so our beginning failure rate has been quite high, approx. 40% declining to final less than 3%. Lymphatic mapping was performed with the use of Patentblau V dye (BYK, Germany), injected preoperatively intradermally to the tumour or into the scar after nonradical removing of melanoma. Lyphoscintigraphy has been used in cases of dubious lymphatic spread, especially in trunk melanomas. Hand held gamma probe could not be used for unacceptable cost. From 143 identified sentinel nodes were 26 positive in 24 patients. From these patients 10 relapsed, with 6 locoregional and 4 distant recurrences. 2 Patients died. In 108 patient with negative sentinel node 3 recurrences occurred, one nodal, and two local, no distant metastases occurred till now. The incidence of positive sentinel nodes was growing with Breslow thickness. Extremely poor prognosis can be expected in patients with Breslow > 4.0 mm and positive sentinel node.

[Myositis ossificans--a rare complication after axillary dissection]. / Myositis ossificans--vzácná komplikace po disekci axily.

We are showing a case of the myositis ossificans, appearing after the dissection of axilla simulating a metastasis of a malignant melanoma. In these circumstances this is a very rare case. It can, however, lead to an unnecessary operation. For this reason it should be useful to bera this possibility in mind.

[Partial mastectomy in the treatment of breast cancer]. / Parciální mastektomie v terapii rakoviny mlécné zlázy.

In the submitted paper the authors summarize findings on conservative surgery in the treatment of breast cancer. Based on data in the literature and their own experience with surgical treatment of breast cancer of all stages and a detailed analysis of a group of 52 conservatively treated patients, the authors discuss indications for this treatment which must respect staging, typing and grading of tumours as well as attitudes of patients. In particular in tumours classified as T1, NO, MO (as well as T2, NO, MO up to 3 cm) with a non-central localization it is possible by using conservative surgery to avoid somatic mutilation and psychic sequelae of radical procedures. When an individual approach is used and the correct indication is selected, partial mastectomy with dissection of the axilla and postoperative radiotherapy is equivalent to therapeutic results of radical operation.

[A surgical technique for partial mastectomy]. / Operacní technika parciální mastektomie.

The authors are describing the technique of the partial mastectomy for the breast cancer in this work, as used in the Masaryk oncological institute. For easy understanding they are adding illustrations of the singular phases of this operation. They are also discussing the indications and are showing a short historical review of the authors having published the results of this surgery.