Recommendation for preventive and therapeutic skin care of patients undergoing radiotherapy.

BACKGROUND: Radiation dermatitis is a very common reaction to radiotherapy, affecting approx. 95% of patients with varying intensity. It is crucial to minimize its side effects. The working group that prepared this document includes physicians, nurses, representatives of the Society for Radiation Oncology, Biology and Physics of the Czech Medical Association of J. E. Purkyně, the Supportive Treatment and Care Section of the Czech Society for Oncology of the Czech Medical Association of J. E. Purkyně, the Czech Wound Management Association, the Oncological Section of Czech Association of Nurses, and dermatologists. The document has been approved by the committees of these associations. PURPOSE: Recommendation for preventive and therapeutic skin care of patients undergoing radiotherapy in the Czech Republic.

Preoperative CT for postoperative radiotherapy planning in breast cancer.

INTRODUCTION: The exact location of the original tumor should be known for a targeted increase in the dose to the tumor bed after breast cancer surgery. Therefore, at our site, we perform CT examinations of patients in the radiation position before breast cancer surgery. METHODS: Preoperative native CT scans were performed in the patients in the planning position for radiotherapy; these data were fused with standard planning CT for boost irradiation. We evaluated whether the tumor was accurately identifiable in preoperative CT scans. We also contoured one irradiation volume in the standard planning CT scans and the other in the fusion CT scans with preoperative examination, and compared these volumes. RESULTS: Out of the total number of 554 patients, we were able to identify the exact location of the breast tumor in 463 cases (83.6 %). In a group of 50 randomly selected patients, the clinical target volume for the boost dose to the postlumpectomy cavity was changed in 20 patients (40%) - decreased in 9 cases (18%) and increased in 11 cases (22%). CONCLUSION: As shown by the results of our study, preoperative CT in the planning position can be used in patients with confirmed breast cancer. This method allows us to more accurately locate the tumor bed and thus more accurately draw the target volume for boost irradiation. We confirmed that preoperative CT had an impact on the size of the target volume.

Deep-inspiration breath hold radiotherapy in patients with left-sided breast cancer after partial mastectomy.

INTRODUCTION: The purpose of this study was to compare the radiation dose to organs at risk for deep-inspiration breath hold (DIBH) and free-breathing (FB) radiotherapy in patients with lef-sided breast cancer undergoing adjuvant radiotherapy after partial mastectomy.  Methods: One hundred patients with left-sided breast cancer underwent DIBH and FB planning computed tomography scans, and the 2 techniques were compared. Dose-volume histograms were analyzed for heart, left anterior descending coronary artery (LAD), and left lung.  Results: Radiation dose to heart, LAD, and left lung was significantly lower for DIBH than for free breathing plans. The median mean heart dose for DIBH technique in comparison with FB was 1.21 Gy, and 3.22 Gy respectively; for LAD, 4.67 versus 24.71 Gy; and for left lung 8.32 Gy versus 9.99 Gy.  Conclusion: DIBH is an effective technique to reduce cardiac and lung radiation exposure.

Association of triple positivity with prognostic parameters and overall survival in a population-based study of 6,122 HER2-positive breast cancer patients: analysis of real-world clinical practice based on a research database.

Triple-positive breast cancer (TPBC), i.e. HER2-positive (HER2+) and hormone receptors-positive breast cancer, is a specific subgroup of breast cancers. TPBC biology is characterized by strong mutual interactions between signaling pathways stimulated by estrogens and HER2 amplification. The present study aims to carry out a population-based analysis of treatment outcomes in a cohort of hormone receptor (HR) positive and negative breast cancer patients who were treated with anti-HER2 therapy in the Czech Republic. The BREAST research database was used as the data source for this retrospective analysis. The database covers approximately 95% of breast cancer patients treated with targeted therapies in the Czech Republic. The analysis included 6,122 HER2-positive patients. The patients were divided into two groups, based on estrogen receptor (ER) or progesterone receptor (PR) positivity: hormone receptor negative (HR-) patients had both ER- and PR-negative tumors (n=2,518), unlike positive (HR+) patients (n=3,604). HR+ patients were more often diagnosed premenopausal at the time of diagnosis, presented more often at stage I or II and their tumors were less commonly poorly differentiated. The overall survival (OS) was significantly higher in subgroups of HR+ patients according to treatment setting. When evaluated by stages, significantly higher OS was observed in HR+ patients diagnosed at stages II, III, and IV and regardless of tumor grade.

Long-Term Clinical Results of IGRT in Prostate Cancer Treatment.

BACKGROUND: The combination of intensity modulated radiation therapy (IMRT) and image guided radiotherapy (IGRT) plays a significant role in sparing normal tissue during prostate cancer treatment. We report the clinical outcomes of 260 patients treated with high-dose IGRT as well as the toxicity of high-dose IGRT in these patients. MATERIALS AND METHODS: From September 2008 to February 2012, 260 men with clinically localized prostate cancer underwent radical radiotherapy. Two hundred patients were treated with IMRT (78 Gy in 39 fractions) to the prostate and base of seminal vesicles using an adaptive protocol combining cone-beam computed tomography (CBCT) and kilovoltage image matching with individualized safety margin calculation. Sixty patients underwent treatment with the same prescribed dose using RapidArc with a reduced safety margin of 6 mm and daily online matching using CBCT. Late toxicity was scored prospectively according to the RTOG/FC-LENT scale. RESULTS: Eighteen patients (6.9%) experienced acute grade 2 gastrointestinal toxicity. There was no acute grade 3 or 4 gastrointestinal toxicity. Thirty-nine patients (15%) experienced acute grade 2 genitourinary toxicity and 6 patients (2.3%) had grade 3 gerourinary toxicity. Genitourinary toxicity grade 4 was observed in 5 (1.9%) patients, due to installation of a urinary catheter. At a median follow up of 84.2 months, the estimated 7-year cumulative incidences of grade 2 gastrointestinal and genitourinary toxicity were 4.4 and 7.1% respectively. The estimated 7-year prostate specific antigen relapse free survival was 97.1% for low-risk disease, 83.6% for intermediate-risk disease and 75% for high-risk patients. CONCLUSION: The use of IMRT in combination with IGRT results in a low rate of late toxicity. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 9. 2019 Accepted: 25. 10. 2019.

[Five-year results of IMRT for prostate cancer - toxicity]. / Petileté výsledky IMRT karcinomu prostaty - toxicita.

BACKGROUND: Intensity modulated radiotherapy (IMRT) plays a crucial role in the treatment of prostate cancer thanks to its capacity for healthy tissue sparing. This work reports on the acute and late toxicity rates among 233 patients treated with high-dose IMRT. MATERIAL AND METHODS: From June 2003 to December 2007, 233 men with clinically localized prostate cancer underwent radical radiotherapy. One hundred sixty patients were treated with IMRT to the prostate and the base of seminal vesicles to 78 Gy in 39 fractions, 73 patients underwent simultaneous integrated boost. Prescribed doses were 82 Gy and 73,8 Gy in 41 fractions to the prostate and seminal vesicles, respectively. Late toxicity was evaluated prospectively using a RTOG/FC-LENT score. RESULTS: Thirty patients (12.8%) experienced acute Grade 2 gastrointestinal (GI) toxicity. No acute Grade 3 or 4 GI toxicity developed. Forty two patients (18.1%) experienced acute Grade 2 genitourinary toxicity and 23 patients (9.9%) had Grade 3 GU toxicity. Grade 4 Genitourinary toxicity was observed in nine (3.8%) patients, due to a need of short-term urinary catheterization. With a median follow-up of 49.2 months, the estimated 5-year cumulative incidence of Grade 2 gastrointestinal toxicity was 22.4%. The estimated 5-year cumulative incidence of Grade 2 genitourinary toxicity was 17.7%. CONCLUSION: Intensity modulated radiotherapy enables dose escalation to 78-82 Gy with an acceptable toxicity.

[Five-year results of IMRT for prostate cancer - tumor control]. / Petileté výsledky IMRT karcinomu prostaty - kontrola nádoru.

BACKGROUND: Intensity-modulated radiation therapy (IMRT) is the method of choice in external-beam radiotherapy tolocalized prostate cancer. This work analyses five year results of IMRT with a dose of 78/82 Gy. PATIENTS AND METHODS: From June 2003 to December 2007, the IMRT technique was employed to treat 233 patients with T1-3 N0 M0 prostate cancer. It was supplemented by hormone therapy especially in high-risk patients. Two IMRT techniques were applied - IMRT with a dose of 78 Gy in 39 fractions to prostate and seminal vesicles (SV) (IMRT 78) and IMRT with simultaneous integrated 82 Gy boost to prostate concurrently with 73,8 Gy in 41 fractions to SV (IMRT SIB 82). The IMRT 78 technique was used in 160 patients (69%). Seventy-three (31%) patients with intermediate (IR) or high-risk (HR) prostate cancer without SV involvement were treated with IMRT SIB 82 technique. The PSA relapse was defined as an increase in PSA of at least 2.0 ng/mL above the nadir or in comparison to the value at the initiation of hormone therapy. Clinical relapse was defined as an occurence of distant metastases and/or local recurrence. RESULTS: The median follow-up of our patients´ population was 4.3 years (range 0.6-8.9 years). The estimated 5-year PSA relapse-free survival in low-risk (LR), IR and HR patients was 86%, 89% and 83%, respectively (p = NS). In a multivariate analysis, Gleason score (GS) 8-10 was associated with significantly higher risk of PSA relapse (RR 2.76), while higher age at the time of diagnosis significantly decreased the PSA relapse risk (RR 0.94). The estimated 5-year clinical relapse-free survival in LR, IR and HR patients was 100%, 99% and 95%, respectively (p = NS). In a univariate analysis, both GS and PSA had a significant impact on the 5-year clinical relapse-free survival - GS 2-7 97 % vs GS 8-10 88 % (p = 0.03), PSA 20 98 % vs PSA > 20 85 % (p < 0.01). CONCLUSION: Treatment of localized prostate cancer using IMRT with a dose 78/82 Gy yielded an excellent 5-year tumour control with a risk of clinical relapse being less than 5%.

Experience with intensity-modulated radiotherapy in the treatment of head and neck cancer.

PURPOSE: Studies using intensity-modulated radiation therapy (IMRT) in the treatment of head and neck tumors have shown to decrease acute and late radiation toxicity. However, the high conformity of this technique can increase the risk of recurrence due to geographic miss. The aim of this study was to analyze whether the results of IMRT met the theoretical expectations concerning treatment efficacy. METHODS: From a total of 185 patients (152 males and 33 females, mean age 58±10.36 years) 176 were evaluable and were studied. Eighty-nine (48.1%) patients had surgical treatment and 50 of them were scheduled for concomitant cisplatin chemotherapy. Irradiation was performed using IMRT, a sliding window with 9 fields in a Varian 2100 C/D linear accelerator, X-ray beam, 6 MeV. The prescribed dose in the planning treatment volume (PTV1), i.e., the area of the primary tumor and nodal area, was 66 Gy/2.2 Gy-70 Gy/2.12 Gy. In the PTV2 (the area at high risk) the dose was 60Gy/2 Gy-59.4 Gy/ 1.8 Gy, and in the PTV 3 (the area treated with prophylactic irradiation) the prescribed dose was 54 Gy/1.8 Gy/50.4 Gy/1.53 Gy. RESULTS: The 3-year overall survival (OS) and relapse-free survival (RFS) of IMRT-treated patients, most of whom were in stages III and IV (158 out of 177), were 50 and 57%, respectively. Using postoperative radiotherapy/chemoradiotherapy 3-year locoregioncal control was achieved in 75% of the cases as compared with 35% in non-operated patients. CONCLUSIONS: The worst outcomes were found in oral cavity and hypopharyngeal tumors, and the best in laryngeal and oropharyngeal tumors. Better results were found in surgically treated patients, and in lower disease stages. Despite the high conformity of dose distribution and efforts to spare healthy tissues, most cases of locoregional relapse occurred in areas receiving the full radiation dose. If dividing relapses into cases of persistence and local recurrence, the former predominated.

Neoadjuvant hormonal therapy in prostate cancer - impact of PSA level before radiotherapy.

PURPOSE: To retrospectively investigate the impact of prostate specific antigen (PSA) level after neoadjuvant androgen- deprivation therapy (ADT) on biochemical relapse-free survival in patients with prostate cancer who received radical radiotherapy (RT). METHODS: Between March 2003 and March 2008, 128 men with localized prostate cancer underwent neoadjuvant ADT for 4-6 months followed by radical RT. Biochemical relapse-free survival was compared between patients with pre-RT PSA ≤ 0.1 vs > 0.1 ng/mL. RESULTS: At a median follow up of 47.3 months, biochemical relapse-free survival was significantly higher in patients with a pre-RT PSA ≤ 0.1 ng/mL compared with pre-RT PSA > 0.1 ng/mL (85.6 vs 63.2%, p = 0.0025). CONCLUSION: The current analysis demonstrating better treatment outcome in patients with excellent biochemical response to neoadjuvant ADT, supports an individualized treatment strategy.

Perioperative interstitial CT-based brachytherapy boost in breast cancer patients with breast conservation after neoadjuvant chemotherapy.

Intraoperative placement of catheters in the tumor bed during breast-conserving surgery (BCS) enables postponed targeted boost irradiation in high risk breast cancer patients. Twenty-three patients with high risk breast cancer underwent neoadjuvant chemotherapy and multifractionated perioperative brachytherapy as a boost to the tumor bed using three-dimensional (3D) CT-based planning. Plastic catheters for brachytherapy were implanted during surgery and targeted irradiation was delivered in the course of 2-3 weeks. Acute and late toxicities were scored according to the RTOG Common Toxicity Criteria. Cosmetic outcomes were assessed using the Harvard criteria. No major perioperative complications were recorded. Circumscribed wound infection occurred in one patient (4.3%). Only 3 patients (13%) experienced acute skin toxicity Grade 1. We observed no teleangiectasias or pigmentations. The cosmetic outcome at last follow-up visit was rated as excellent/good, in 82.6%, fair, in 13% and poor in 4.4% of patients, respectively. There was no evidence of disease recurrence after median follow-up of 43. 4 months. Systematic integration of the perioperative fractionated 3D CT-based HDR brachytherapy as a boost for patients with breast cancer after BCS is feasible and seems safe. It might be beneficial especially for women with high risk of local recurrence.

PET/CT significance for planning radiotherapy of head and neck cancer.

The combination of positron emission tomography and computed tomography (PET/CT) offers metabolic mapping in addition to anatomic information of the primary lesion, nodal and distant metastases in patients with head and neck tumors, and may be therefore beneficial for radiotherapy planning. The aim of our study was to evaluate benefits of combined PET and CT imaging for staging and target volume delineation in this group of patients.Fifty three patients (40 men and 13 women) with confirmed advanced, inoperable or non-radically operated head and neck cancer were assessed based on the results of PET/CT as well as standard diagnostic examinations. All patients were subsequently treated with intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) of 6 MV X-rays. There was an agreement between the standard examinations results and results of PET/CT in 30 cases. In 23 cases there was disagreement either in tumor size, nodal involvement or presence of distant metastases. Results of the tumor size assessment differed significantly in 5 cases. There was no agreement found in nodal involvement in 10 cases. The cancer confirmed by standard examination was not found by PET/CT in 2 cases; 3 PET/CT positive findings were not confirmed by standard examinations. In 3 patients PET-CT revealed new distant metastatic disease. Based on PET/CT assessment we changed treatment strategy and applied potentially curative dose of radiotherapy to previously undiscovered regions in 9 patients. We decided to change the treatment intent in 3 cases and only palliative treatment was applied. Based on our experience and the literature review, PET/CT may be considerable contribution to the standard diagnostic procedures in approximately one third of cases.

[3D MRI-based brachytherapy in patients with locally advanced cervical carcinoma - early clinical results]. / 3D MR-based brachyterapie v lécbe lokálne pokrocilého karcinomu delozního hrdla - casné klinické výsledky.

OBJECTIVE: To demonstrate the clinical benefit of MRI-based brachytherapy using CT and MRI data fusion. DESIGN: Clinical trial. SETTING: Oncology Centre, Multiscan and Pardubice Regional Hospital, Pardubice. METHODS: Thirty six patients with locally advanced cervical cancer were treated with MRI-based brachytherapy (MRI-based preplanning 15 patients, MRI approximation 21 patients). All patients were continuously followed during and after treatment. Tumor control and toxicity were evaluated at each visit. Late gastrointestinal and genitourinary symptoms were recorded, using Fox Chase (FC) modification of the Radiation Therapy Oncology Group (RTOG) and Late Effects Normal Tissue Task Force (LENT) toxicity criteria. RESULTS: We observed no complications during the entire MRI procedure at the radiology department. The cumulative incidence of grade 2 late genitourinary and gastrointestinal toxicity at median follow up of 30.3 months was 4.8% and 9.5% for MRI approximation, respectively 0% and 13.3% for MRI-based preplanning. Local control was 86.7% for MRI-based preplanning and 76.2% for MRI approximation. CONCLUSION: 3D MRI-based brachytherapy with consecutive CT/MRI data fusion yields excellent local control with minor toxicity.

[Adaptive IG-IMRT for prostate cancer]. / Adaptivní IG-IMRT karcinomu prostaty.

BACKGROUNDS: Adaptive image-guided intensity-modulated radiation therapy (IG-IMRT) is a perspective method for the treatment of localized prostate cancer. Validate optimal protocols for IG-IMRT using kilovoltage cone-beam CT (CBCT) are required. PATIENTS AND METHODS: Seventy-six patients with prostate cancer were treated using adaptive IG-IMRT. Based on the CBCT performed during the first 10 fractions of radiotherapy, an average prostate position in relation to the pelvic bones was determined in antero-posterior AP, supero-inferior SI, and right-left axes. An adapted treatment plan for the second phase of the treatment included an isocenter shift into its average position (correction of the systematic error sigma). A margin between a clinical and planned target volume (CTV-PTV) was adjusted according to the magnitude of random error sigma. During the second phase of radiotherapy, set-up of patients was performed daily on pelvic bones using kilovoltage skiagraphic imaging in two projections (kV-kV). Follow-up CBCTs were repeated once a week. RESULTS: An average isocenter position differed from the position of a reference planning CT isocenter in at least one axis in 63 patients (83%). Major changes were recorded in AP axis - shift > or = 2 mm in 33 patients (43%), shift > or = 5 mm in 7 patients (9%). PTV for the second phase of radiotherapy was in the range of 6-10 mm in AP axis, 6-8 mm in SI axis, and 6 mm in RL axis. Mean sigma value in the AP axis was smaller in patients with a specific diet compared to patients without the diet (2.2 mm vs. 2.7 mm, p = 0.05). We evaluated 446 follow-up CBCT images from the second phase of radiotherapy (66 patients had 6 CBCT, 10 patients had 5 CBCT). Set-up error exceeding CTV-PTV margin occurred in 4 cases with no more than once per patient. Safety margin was sufficient in 72/76 patients (95%). CONCLUSION: IG-IMRT protocol integrating CBCT and kV-kV imaging provided adequate coverage of the target volume and proved to be compatible with departmental workflow. Margin reduction around the CTV is a prerequisite for dose escalation aimed at a intraprostatic lesion.

MRI-based pre-planning in patients with cervical cancer treated with three-dimensional brachytherapy.

OBJECTIVE: The aim of this study was to analyse the feasibility and determine the benefits of MRI-based pre-planning with CT/MRI data fusion in patients with cervical cancer treated with radical radiotherapy. METHODS: Patients underwent MRI examination prior to external beam radiotherapy and prior to the first and fourth fraction of brachytherapy with applicators in place. Insertion of applicators at the radiology department was performed under paracervical anaesthesia. The benefit of MRI pre-planning was determined by comparing conventional treatment planning with dose specification to "point A" and dose specification to 90% of the high-risk clinical target volume (HR-CTV D90). Tolerance of MRI evaluation with applicators, coverage of HR-CTV and dose-volume parameters for organs at risk (OAR) has been assessed in 42 brachytherapy procedures. RESULTS: Insertion of applicators at the radiology department was successful in all patients and there were no complications. The target dose was higher for MRI planning than for conventional planning (5.3 Gy vs 4.5 Gy). Maximum doses in the bladder and rectum were significantly lower (p<0.05) for MRI planning than for the conventional approach (6.49 Gy vs 7.45 Gy for bladder; 4.57 Gy vs 5.06 Gy for rectum). We found no correlation between the International Commission on Radiation Units (ICRU) point dose for OAR and the maximum dose in OAR. Nevertheless, a strong correlation between the maximum dose in OAR and the minimal dose in a volume of 2 cm(3) has been observed. CONCLUSION: MRI-based pre-planning with consecutive CT/MRI data fusion is feasible and safe, with the advantage of increasing the dose to the tumour and decreasing the dose to the organs at risk.

Time course of late rectal toxicity after radiation therapy for prostate cancer.

Rectum and bladder are the crucial organs at risk for curative radiation therapy of localized prostate cancer. We analyzed the incidence, profile and time course of late rectal radiation toxicity. A total of 320 patients with T1-3 prostate cancer were treated with three-dimensional conformal radiation therapy (3D-CRT). The prescription dose was 70 Gy for T1 and T2 patients (n=230) and 74 Gy for patients with locally advanced T3 tumors (n=90). Late rectal toxicity was graded according to the Fox Chase modification of the Radiation Therapy Oncology Group (RTOG) and Late Effects Normal Tissue Task Force (LENT) criteria. The median follow-up time was 6.2 years (range 0.2-10.7 years). At 5 years, the risk for the development of grade 2 and 3 rectal toxicities was 15.6 and 7.0%, respectively. All new cases of grade 2 and 3 rectal toxicities were observed within 5 years after treatment. Prevalence of grade 2 and 3 rectal symptoms showed fluctuation with maximum at 1.5 years and the minor peak at 4.5 years. Toxicity profile changed significantly over time. The proportion of rectal bleeding within grade 2 and 3 toxicity decreased from 85% at 1.5 years to 46% at 4.5 years. Conversely, the proportion of fecal incontinence among grade 2 and 3 rectal symptoms gradually increased (0% at 1.5 years vs 27% at 4.5 years). Late rectal radiation toxicity represents a dynamic process. Rectal bleeding decreases and fecal incontinence increases over time.

[Use of PET/CT examination in head and neck cancer radiotherapy planning]. / Vyuzití PET/CT vysetrení pri plánování radioterapie nádoru ORL oblasti.

BACKGROUND: Using conformal techniques and IMRT in radiotherapy allows dose increase in the target volume and sparing of healthy tissues. In comparison with conventional techniques it requires more accuracy in the target volume delineation. It is important to use all relevant diagnostic methods to reduce the risk of relapse.The basic method is CT examination which allows the dose distribution to be calculated. New imaging dimensions are associated with PET (positron emission tomography), which supplements the morphological image (CT or MRI) with a functional view.The aim of this study was to evaluate the benefit of PET/CT fusion in radiotherapy planning for head and neck cancer. PATIENTS AND METHODS: 40 head and neck cancer patients treated by definitive radiotherapy were evaluated. The patient group consisted of 30 men and 10 women, with a median age of 56 years (range 34-81 years). Postoperative radiotherapy was used in 10 cases and 30 patients were irradiated without prior surgery. IMRT technique with simultaneous integrated boost was used with 6 MV photons. RESULTS: Comparing diagnostic CT with planning PET/CT, there was no difference in tumour extent in 20 out of 40 patients. In 6 cases (15%) the nodal involvement was more extensive according to PET/CT while in 3 cases (7.5%) the nodal involvement was detected to be less extensive. In 2 patients (5%) the primary tumour was reclassified, in both cases towards tumour enlargement. Two patients with positive histopathological margin were PET/CT negative. PET/CT imaging resulted in a change in the target volume in 11 (27.5%) patients and the treatment strategy was changed in 3 cases. CONCLUSION: We tested use of the PET/CT examination in radiotherapy treatment planning of the head and neck carcinoma and it was introduced as a standard clinical practice at our department.

[The progress in the treatment of cervical cancer--3D brachytherapy CT/MR-based planning]. / Pokroky v lécbe karcinomu delozního hrdla--3D plánování HDR brachyterapie pomocí CT/MR.

Brachytherapy plays a major role in the therapeutic management of patiens with cervix cancer. The rapid dose fall-off provide a very high dose to the tumor, while relative sparing bladder, rektum, sigmoid and small bowel. The CT/MR-based planning provides better information on target and organ volumes and dose-volumes histograms in contrast to radiography-based planning, that provides doses only at selected points.

[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.

High dose rate brachytherapy in the treatment of oral cancer--the preliminary one institution experience.

Low dose rate brachytherapy is well established treatment modality of oral cancer. Data about high dose rate brachytherapy (HDR BT) are still scarce with heterogenous results. The aim of our study was to evaluate preliminary results in a small group of oral cancer patients treated by HDR BT. Seventeen applications were performed on 16 patients in years 2001-2004, in 15 cases for new tumor (mobile tongue 10x, floor of mouth 2x, lip 3x) and in 2 cases for local recurrence after radiotherapy. Ten treatments (for T1-2N0 tumors and recurrences) were performed with brachytherapy alone (18 x 3 Gy twice daily), seven patients (T2-3 N0-2 tumors) were treated with a combination of external beam radiotherapy (40-68 Gy) and brachytherapy (2-6 x 3 Gy twice daily). The plastic tubes technique was used for brachytherapy. Follow-up periods were between 8-46 months (median 17). Fifteen patients were disease free during follow-up period. One patient (brachytherapy alone for T2N0M0 mobile tongue cancer) died immediately after neck dissection for the neck recurrence due to the heart failure. The other one died due to distant metastases but without local recurrence. Acute complications were mucositis gr. II at maximum, late complications were ulcer of soft tissues in 3 and superficial bone necrosis in 2 cases. The evaluation of the brachytherapy implants was done according ICRU 58 recommendations. Hyperfractionated high dose rate brachytherapy alone or as a boost to external beam radiotherapy is feasible with promising local control. Carefull planning of the implant and mandibular shielding are necessary to avoid complications.