Hyperthermia Is Now Included in the NCCN Clinical Practice Guidelines for Breast Cancer Recurrences: An Analysis of Existing Data.

BACKGROUND: Hyperthermia has been included in the 2013 National Comprehensive Cancer Network (NCCN) guidelines as an option for the treatment of breast recurrences. The purpose of this article is to demonstrate the important role of hyperthermia as a therapeutic modality by presenting clinical trials on this subject carried out in the last decades. MATERIALS AND METHODS: All relevant trials published since 1987 were retrieved from Medline and reviewed. RESULTS: Results show that the addition of hyperthermia to radiotherapy and/or chemotherapy for the treatment of breast cancer enhances treatment response and can increase local control. CONCLUSION: Further studies are required to evaluate potential benefits of hyperthermia in the treatment of other kinds of superficial tumors.

A new role of PET/CT for target delineation for radiotherapy treatment planning for head and neck carcinomas.

Fluorine-18-fluorodeoxyglucose- positron emission tomography ((18)F-FDG PET) in head and neck cancer patients is useful for staging, identification of macroscopic disease, detection of invaded lymph nodes and distant metastases, delineation of radiotherapy target volume and assessment of treatment response. This brief review addresses the potential role of PET in radiotherapy planning as compared to MRI and CT scan. Positron emission tomography is considered by radiation oncologists a useful test for the identification of the specific target volume for treatment. In addition, a number of hypoxia-related PET radiopharmaceuticals such as the fluorine-18-fluoromisonidazole ((18)F-FMISO) and the fluorine-18-fluoroazomycin arabinoside ((18)F-FAZA) are now available in order to identify hypoxic tumor subvolumes helping to implement new radiotherapy techniques. Magnetic resonance imaging (MRI) has the advantage to discriminate the soft tissue contrast from the tumor, against computerized tomography (CT), but PET/CT scans have the additional advantage to incorporate the metabolic imaging for improving the delineation of variable and hypoxic tumor tissue in the head and neck region. Regardless of the method used for determining the gross tumor volume, clinical examination remains irreplaceable. In conclusion, PET/CT offers complementary information for the delineation of the primary tumor and the corresponding lymph nodes compared to the use of MRI and CT and can support the use of modern radiotherapy techniques, having fewer toxicities.

Long term chemoradiotherapy-related dental and skeletal complications in a young female with nasopharyngeal carcinoma.

We describe the long-term complications six years after chemoradiotherapy in a 20-year old woman with nasopharyngeal carcinoma. We wanted to know whether the radiation dose was constant throughout the oral cavity, and thus uniformly affecting the corresponding dental and skeletal structures. Clinical and radiologic findings are described six years after chemoradiotherapy based on a two-dimensional computerized treatment planning system. This revealed radiation caries limited only to posterior teeth, proximal caries in the anterior teeth, limited but continuous salivary flow, mild periodontal infection, mild xerostomia, and a regenerative capacity of bones and the developmental process. The quantitative assessment of radiation delivered to the mandible revealed a high radiation dose in the posterior area and a minimal dose in the anterior area. This explains the differences in caries manifestation between the anterior and posterior teeth. According to the present study, individualized radiation fields, using a two-dimensional treatment planning system, result in restriction of severe damage of the dental and skeletal structures, which usually follows chemoradiotherapy. Orthodontic treatment could be initiated according to individual patient needs.

Granulosa cell tumor of the ovary: tumor review.

Granulosa cell tumors of the ovary are rare neoplasms that originate from sex-cord stromal cells. The long natural history of granulosa cell tumors and their tendency to recur years after the initial diagnosis are the most prominent of their characteristics. The secretion of estradiol is the reason for signs at presentation such as vaginal bleeding and precocious puberty. Abdominal pain and hemoperitoneum, which occasionally can occur, are attributable to tumor rupture. The most common finding in pelvic examination is a tumor mass, which is subsequently confirmed with imaging techniques. Surgery is the mainstay of initial management for histological diagnosis, appropriate staging, and debulking. A more conservative unilateral salpingo-oophorectomy is indicated in patients with stage I disease and patients of reproductive age. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the appropriate surgical treatment for postmenopausal women and those with more advanced disease. The stage of disease is the most important prognostic factor associated with the risk of relapse. There are no clear conclusions regarding the role of postoperative chemotherapy or radiotherapy in stage I disease and in those with completely resected tumor. The use of adjuvant chemotherapy or radiotherapy has sometimes been associated with prolonged disease-free survival and possibly overall survival. Chemotherapy is the treatment of choice for patients with advanced, recurrent, or metastatic disease, and BEP (bleomycin, etoposide, and cisplatin) is the preferred regimen. Although the overall rate of response to treatment is high, the impact of treatment on disease-free or overall survival is unknown. Prolonged surveillance is mandatory because tumors tend to recur years after the initial diagnosis.

Evaluation of cardiotoxicity five years after 2D planned, non-simulated, radiation therapy for left breast cancer.

INTRODUCTION: Radiation treatment has been associated with radiation induced cardiotoxicity, especially with older, long-outdated, techniques. Such complications include pericarditis, myocardial fibrosis, valvular injury, ischemic heart disease, and myocardial infarction. AIM: To assess the effect of outdated breast radiation therapy (RT) - using a diagnostic CT scanner in the absence of a CT simulator - on cardiac function in women with stage II left breast cancer. PATIENTS AND METHODS: Sixty-two women under 65 with stage II left breast cancer who received post-operative RT using a diagnostic computed tomography scanner were studied between 1997 and 2001. Participants underwent a clinical interview, ECG, and echocardiography before and 6 months and 5 years after RT. RESULTS: There was no serious cardiotoxicity at 6 months and 5 years after radiotherapy. A 23% increase in hypertensive patients, and a slight decrease (2.3%) in ejection fraction was observed after 5 years, with 3 patients (5%) developing abnormalities. Two patients presented abnormal electrocardiographic findings within 6 months of RT. CONCLUSION: Our study showed that RT for left breast cancer was not associated with significant alteration in heart morbidity or mortality within 5 years of treatment, despite the lack of a simulator.

Cyclin-dependent kinase (CDK) inhibitor olomoucine enhances gamma-irradiation-induced apoptosis and cell cycle arrest in Raji cells.

Gamma-irradiation leads to apoptosis and cell cycle arrest in eukaryotic cells. Olomoucine is a novel purine analog acting as a cyclin-dependent kinase inhibitor. The effects of olomoucine in gamma-irradiation mediated cell growth inhibition and apoptosis were studied in the Raji cell line (Burkitt's lymphoma). Gamma-irradiation caused a G2 arrest, increasing the G2/M fragment of the cells. Apoptosis by gamma-irradiation was apparent both by DNA-electrophoresis and PARP-1 cleavage. The combination of olomoucine with irradiation caused an increased G2 arrest and decreased cell survival and DNA synthesis in the non-apoptotic fraction of the remaining cells. Irradiation, as well as olomoucine and the combination of both, induced apoptosis. It seems that olomoucine delays the apoptotic process and inhibits DNA fragmentation, but it decreased survival, cell cycle progression and proliferation of irradiated cells.

Radiotherapy plus either transdermal fentanyl or paracetamol and codeine for painful bone metastases: a randomised study of pain relief and quality of life.

OBJECTIVE: To compare the effects of providing analgesia with either transdermal fentanyl (TTS-fentanyl) or paracetamol and codeine (P/C) in addition to radiotherapy in patients with metastatic bone pain. METHODS: In a prospective study, 26 patients with radiologically confirmed bony metastases received radiotherapy (R/T). They were randomised to receive either 500 mg paracetamol and 30 mg codeine four times per day (P/C group), or transdermal fentanyl patches delivering 25 microg fentanyl/h (TTS-fentanyl group). Pain was assessed using visual analogue pain ratings (VAS) and the Greek Brief Pain Inventory (G-BPI) questionnaire administered before R/T and after 3 months. RESULTS: Data were available from 24 eligible patients. Use of TTS-fentanyl was associated with significantly superior pain relief. Mean VAS fell from 7.0 to 1.1 with TTS-fentanyl and from 8.3 to 4.3 with P/C, p< 0.01. The TTS-fentanyl group also showed significantly greater improvements of important G-BPI domains including global quality of life, pain, and physical, cognitive, and role functioning, than the P/C group (p< 0.01). Four patients receiving TTS-fentanyl and three receiving P/C reported severe nausea/vomiting. CONCLUSIONS: Transdermal fentanyl combined with R/T was more effective in reducing metastatic bone pain and resulted in greater improvements in quality of life than paracetamol and codeine.