[Therapeutic results of the treatment brain tumors using radiosurgery and stereotactic radiotherapy]. / Výsledky lécby mozkových tumoru stereotaktickou radioterapií a radiochirurgií

BACKGROUND: We reviewed the results of treatment of patients treated with stereotactic radiation methods in our department. MATERIAL AND METHODS: Patients with primary brain tumor or brain metastases underwent CT and MR examination. Then they were treated on X knife in the Clinic of Radiation Oncology in Masaryk Memorial Cancer Institute Brno. RESULTS: A total of 101 patients with primary brain tumors underwent stereotactic treatment. These were mainly meningeomas, high-grade gliomas and low-grade gliomas. In 37% of cases patients underwent reiradiation. Stereotactic radiosurgery was applied with a median dose of 18 Gy. Hypofrakcionated stereotactic radiotherapy was applied at a doses of mostly 5 × 5 Gy. Total toxicity of treatment was low: 8% acute G1, late toxicity in 1% of cases. In the whole group achieved partial remission 10 patients (9,9%). One patient had complete remission (0,99%). It was a diagnosis of pituitary adenoma. In 69 patients stable disease was observed (68,3%) and 12 patients had progression (11,88%). Median follow up the entire group was 22,4 months. A statistically significant difference in survival was found in the comparison of different diagnosis, patients who received prior radiotherapy and patients without previous irradiation. Another significant difference in survival was observed compared to patients treated with stereotactic treatment or stereotactic radiosurgery and the size of the tumor volume larger / smaller 10 cm3. In the group with brain metastases there were 56 patients. In 10% of cases preceded radiotherapy neurosurgical performance. Twenty four patients underwent cranial irradiation entire dose of 30 Gy. Median stereotactic radiosurgery dose was 20 Gy, the application of stereotactic treatment were mostly of 5 × 5 Gy. G1 acute toxicity occurred in 2 patients (3.8%), grade G2 in one patient (1.9%). Late toxicity was observed in 2 patients (one G1 and one G3). Complete remission was achieved in 4 patients (7.1%), partial remission in 27 patients (48.2%), stable disease in 9 (16.1%) and progression was observed in 5 patients (8.9%). Median follow-up the entire group was 13.3 months. There was no statistically significant difference in survival with respect to gender, age, KI, irradiation of the whole brain or type of treatment used. Patients who have undergone neurosurgery prior to irradiation had no difference in survival compared to patients without surgery, but the time to progression was significantly longer (p = 0.016). CONCLUSION: Stereotactic radiation methods are part of modern radiotherapy. Their indication is necessary to consider with regard to the benefit of the patient. Quality equipment radiotherapy department and trained personnel are the condition for their correct using.

[Adjuvant radiotherapy in the therapy of uterine cancer in the first clinical stage]. / Adjuvantní radioterapie v lécbe karcinomu delozního tela 1. klinického stadia.

OBJECTIVE: The aim of our study was to find the influence of the postoperative radiotherapy on local control and overall survival in patients with carcinoma of the uterus. Endometrial carcinoma is the most frequent gynecologic malignity. Surgery, radiotherapy, chemotherapy and hormonal therapy are used in the treatment of this disease. The optimal cure strategy has not been established yet. DESIGN: Retrospective study. SETTING: Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno. METHODS: We followed up 246 patients with the diagnosis of endometrial carcinoma. All patients were in clinical stage 1. Median of the age was 60 years. Every patient underwent radical hysterectomy and adnexectomy. Most of them had adjuvant radiotherapy. Combined radiotherapy was used (external beam radiotherapy and brachyradiotherapy). Some of patients underwent only external beam radiotherapy, other had only brachytherapy. We used Kaplan-Meier survival function and methods of Statistica. RESULTS: The median of the follow up was 8.3 years. Local recurrence was proved in 16 cases. The time to the local relapse was 3.2 years. Dissemination occurred in 12 patients. The time to the progression was 5.9 years. Five-year DFS was 80.9%, five-year overall survival was 82.9%. Patients, who had risk factors, were proved to suffer from worse overall survival. The adjuvant radiotherapy improved the local, and the distant control in the group of patients with risk factors. CONCLUSION: The influence of the radiotherapy on the local control was proved in many studies, the influence on the overall survival was not statistically significant. Temporally there is the option not to apply adjuvant radiotherapy. Our study shows the important benefit of the adjuvant treatment in cases of endometrial carcinoma and risk factors.

Treatment of uterine sarcoma. A survey of 49 patients.

PURPOSE: Surgery, radiotherapy and chemotherapy are employed in the treatment of uterine sarcoma. We claim to evaluate the role of radiotherapy in the treatment of uterine sarcoma. PATIENTS AND METHODS: We report a retrospective study of 49 patients with uterine sarcoma treated from 1990-1999 at Masaryk Memorial Cancer Institute in Brno. All 49 patients had surgery, 19 (38.7%) had adjuvant radiotherapy and 25 (51%) had chemotherapy. Using the FIGO classification: 71.4% had stage I, 6.1% stage II, 16.3%, stage III and 6.1% stage IVa disease. 42.9% of tumors were mixed Müllerian tumors, 34.7% leiomyosarcomas and 22.4% endometrial stromal sarcomas. 12 cases (24.5%) had a local recurrence, 7 (14.3%) had hematogenous dissemination. There was an increased disease free interval (DFI) for patients treated with adjuvant radiotherapy (p = 0.005). The DFI was favourably influenced by the stage of the disease. Of 12 patients with a local recurrence only one had postoperative radiotherapy. Radiotherapy had an impact on overall survival (OS). The five-year OS probability was 51.6% without radiotherapy and 88.9% with radiotherapy (p = 0.0066). CONCLUSION: We conclude that postoperative radiotherapy in our series of patients diagnosed with uterine sarcoma has an impact on locoregional and disease-free progression intervals (LRFI, DFI) and overall survival (OS). The most important prognostic factor is the extend of the disease (stage). Stage I patients have a significantly better survival.