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.

Is There a Benefit of HER2-Positive Breast Cancer Subtype Determination in Clinical Practice?

BACKGROUND: Breast cancer (BC) with increased expression of human epidermal growth factor receptor 2 with tyrosine kinase activity (HER2+) is a clinically and bio-logically heterogeneous dis-ease. In terms of gene expression, there are four major molecular subtypes - Luminal A, Luminal B, HER2-enriched (HER2-E), and Basal-like. The most common subtype is HER2-E (50- 60%). In hormone-dependent (HR+) HER2-positive tumors, the subgroup HER2-E represents 40- 50% of cases; others are luminal A and B subtypes. PURPOSE: The aim of this review is to provide information on the significance of the distribution of HER2-positive tumors accord-ing to subtype, which is considered a predictive parameter for guid-ing treatment decisions. For example, HER2-E subtype is characterized by a higher probability of achiev-ing complete pathological remission when treated with chemother-apy and antiHER2 ther-apy, and it is thought that it could be treated us-ing a dual HER2 blockade without chemother-apy. Currently, triple-positive tumors, a specific subtype of breast cancer characterized by HER2+ and HR+, are more often subjects of interest. Their unique bio-logical properties are due to complex interactions between HER2 and estrogen receptor (ER) signalling, which result in lower effectiveness of endocrine ther-apy in these patients than in HR+ and HER2-negative patients and, at the same time, the ER positivity in HER2+ tumors can result in resistance to antiHER2 ther-apy. This type of BC is a non-homogeneous group where the impacts of HER2 positivity on tumor malignant behavior and activity of the estrogen-driven signal-ing pathway are inconsistent. Current studies focus on test-ing new treatments such as dual HER2 block-ing or immunother-apy, in combination with antiHER2 targeted ther-apy with fulvestrant, aromatase inhibitors, cyclin dependent kinase 4/ 6 inhibitors, or inhibitors of the PI3K (phosphatidylinositol-3-kinase) pathway. CONCLUSION: The distribution of HER2+ BC accord-ing to individual subtype provides information that can contribute to achiev-ing more accurate decisions about the most appropriate ther-apy. Key words breast cancer - subtype - HER2 - trastuzumab - HER2 positive - triple positive - HER2 enriched 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: 27. 9. 2018 Accepted: 26. 11. 2018.

[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.

[IKARUS Project--incidence of bone events in breast cancer: retrospective analysis of patients in oncological centres in the Czech Republic and Slovakia]. / Projekt IKARUS--zjistení incidence kostních príhod u karcinomu prsu: retrospektivní analýza nemocných dispenzarizovaných v onkologických centrech Ceské a Slovenské republiky.

BACKGROUND: Bone incidents today represent, in terms of frequency and the overall effect on the quality of life of patients with breast cancer, a serious health problem. In a number of clinical studies bisphosphonates have been shown to have a positive impact on reducing the risk of bone events and therefore to be effective in the prevention of bone events. The primary objective of this project was to identify the incidence of bone events in patients with metastatic breast cancer treated in the Czech and Slovak Republics. SUBJECTS: Retrospective, multi-centre, non-interventional, epidemiological and explorative studies to identify the incidence of bone events in the defined group of patients and a description of the practice of prevention and treatment of skeletal events in the years 2000-2005. Enrolled were patients with advanced metastatic breast cancer diagnosed in 2000. METHODS AND RESULTS: Analysis of overall survival and survival to disease progression, analysis of patterns of treatment of bone events and the practice of the use of bisphosphonates in the prevention of bone events in metastatic skeleton affection in the normal conditions of clinical practice, analysis of patient compliance in the treatment with bisphosphonates, analysis of the time interval between the occurrence of bone metastases and the occurrence of bone events and, last but not least, survival analysis of patients in relation to bone events. CONCLUSION: This work has shown that the practice of treatment with bisphosphonates since 2000 and assessed the survival of patients with metastatic breast cancer.

[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.

Intensive cyclic chemotherapy and transplantation of autologous peripheral blood progenitor cells (PBPC) or whole blood in high-risk breast cancer - follow up at 10 years.

AIM: The main aim of our paper is to contribute to objectification of currently widely discussed results of overall survival (OS), disease free survival (DFS) and time from relapse to tumor progression (TTP) in women with breast cancer. METHODS: Forty consecutive patients fulfilling the eligibility criteria were admitted to the study. Fifty-six women were included in the control group. All patients received 6 cycles of adjuvant intensive cyclic combined chemotherapy with epirubicin 150 mg/m(2) and cyclophosphamide 1250 mg/m(2) (EC) applied each 14 days. To overcome haematological toxicity transplantations of autologous peripheral blood progenitor cells (PBPCs) or whole blood enriched of PBPC were used. RESULTS: We found statistically significant difference in OS regardless of the stage of the disease to the benefit of women treated by intensive cyclic EC chemotherapy when compared with the control group. In evaluation of DFS no statistically significant difference was found in survival between the control group and the group with all stages of the disease. TTP in women without relation to the stage was statistically significantly longer than in the control group. CONCLUSION: In our study intensive cyclic EC chemotherapy did not show better curative effect when compared with conventional dosage chemotherapy.

[Our experience with the sentinel lymph node detection]. / Nase zkusenosti s detekcí sentinelové uzliny.

BACKGROUND: Axillary lymph node staging is the most powerful predictor of survival in breast cancer women. Sentinel lymph node biopsy (SLNB) is more accurate method in evaluation of axillary lymph node staging than complete axillary lymph node dissection (CALND) because of more precious histological and imunohistochemical assessment of the first draining lymph nodes. Furthermore, SLNB eliminates complications resulting from CALND. MATERIAL AND METHODS: SLNB is either performed using blue dye technique or using of combination of blue dye and radioguided technique. We prefer two days protocol in application of Tc 99 radiocolloid. There were used both techniques for detection sentinel lymph nodes and results were compared. RESULTS: There were performed 21 SLNBs using blue dye technique, Group A, and 20 SLNBs using combination of blue dye and radioguided technique, Group B, from October 2001 to November 2003. Sentinel lymph nodes were not detected in Group A in two cases, false negativity occurred two times in this group. Sentinel lymph nodes were detected in all cases in Group B and there was no false negativity present in this group. CONCLUSION: Combination of blue dye and radioguided technique is more precious in detection of sentinel lymph node than blue dye technique itself. Two days protocol of application of Tc 99 radiocolloid enables performing this method even in hospitals, where the Department of Nuclear Medicine is not available.