Search results

1

Role of recombinant human erythropoietin in the treatment of cancer-related anaemia

100%

Jankowski T., Kubiatowski T.

OncoReview

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2017

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vol. 7

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issue 2

98-103

EN

Anaemia is one of the most frequently diagnosed complications in cancer patients and also occurs during the course of cancer treatment. The condition can be observed in as many as 60–70% of patients who receive chemotherapy or radiotherapy. As a cancer symptom, it is found in 30% of cases and is particularly severe when accompanied by kidney failure. In patients undergoing cancer therapy, anaemia is treated with PRBC transfusions and/or recombinant human erythropoietin. The article discusses 3 case studies of patients with late-stage cancer (pleural mesothelioma, urothelial kidney carcinoma, and lung carcinoma), who suffered from moderate to severe anaemia during aggressive treatment with chemo- and radiotherapy. All 3 patients were treated with erythropoietin, which made it possible for them to stay on chemotherapy and/or undergo radiotherapy. Thanks to erythropoietin, they did not require PRBC transfusions and their general condition and quality of life improved. They tolerated the treatment well and no complications were observed.

2

The impact of radiotherapy on the quality of life in patients with early-stage clinical head and neck cancer

100%

Milecki J., Żmijewska-Tomczak M., Osmola K., Wierzbicka M.

Polish Journal of Otolaryngology

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2021

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vol. 75

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issue 5

1-8

EN

Introduction: Radiotherapy (RT) for patients with head and neck squamous cell carcinoma (HNSCC) affects vital functions related to the irradiation volume of the head and neck region and, in addition, has a negative impact on social functioning, thereby significantly impairing patients’ quality of life (QoL). Aim: The aim of this study was to assess changes in the quality of life in patients with head and neck cancer treated with curative RT at 12 months after completion of RT. The aim of this study was to assess the differences between the baseline QoL of patients with early clinical stage HNSCC and at 12 months after curative/radical RT. Material and methods: The prospective clinical study included 92 patients in good general condition (ECOG 0–1 – Eastern Cooperative Oncology Group performance status), without regional or distant metastases, diagnosed with pathomorphologically confirmed early-stage head and neck squamous cell carcinoma treated with definitive RT. All patients participating in the study signed an informed consent form. QoL was assessed using the standard EORTC QLQ-C30 and QLQH&N35 questionnaires. In addition, information on clinical aspects and data relating to socio-demographic factors were obtained from each patient. Statistical analysis was performed using a statistical package (SPSS 17.0). T-test was used for dependent and independent samples. A general linear model was used for repeated measures. Results: Patients’ QoL deteriorated significantly after definitive RT. Worse QoL Core-30 scores in patients 12 months after the end of RT, compared with baseline QoL, before the start of RT, were observed in domains such as physical performance, fulfillment of life roles, cognitive functioning, loss of appetite, fatigue and constipation. For the QLQ-H&N35 questionnaires, patients 12 months after the end of RT reported problems in relation to aspects of life such as senses, mouth opening, dry mouth, thick saliva, pain, and weight loss. Conclusion: RT, even in early clinical stage head and neck cancer, has a negative impact on QoL, despite modern treatment techniques.

3

Combined effects of radiotherapy and photodynamic therapy on an in vitro human prostate model.

100%

Colasanti A., Kisslinger A., Quarto M., Riccio P.

Acta Biochimica Polonica

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2004

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vol. 51

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issue 4

1039-1046

EN

Human prostate cancer cells were evaluated for growth after photodynamic therapy, radiotherapy, and combined treatment. Indocyanine green was tested as a photosensitizer and radiosensitizer. Two human cell lines were used: PC-3 derived from prostate carcinoma, and EPN derived from normal prostate tissue. The light source used for the photoactivation experiments was a diode laser peaked at 805 nm. The light dose incident on cells was 108 J/cm2. Ionizing radiation was produced by a linear accelerator, and the dose was 2, 4 and 6 Gy. Cytotoxicity was evaluated by measuring the colony forming ability of cells. Our results show that indocyanine green induces cell death by photoactivation, but it does not act as a radiosensitizer if used with ionizing radiation. The combined treatment of photodynamic therapy and radiotherapy produces an additive effect which does not depend on the sequence of the two treatments. Combined treatments could be more useful since they allow the reduction of the ionizing radiation dose to obtain the same effect as one obtainable by radiotherapy alone.

4

Cardiotoxicity in breast cancer patients after radiotherapy – modern methods of minimizing the dose to the heart and dilemmas of choosing critical cardiac structures for monitoring dose distribution

100%

Pudełek K., Pudełek J., Nawrocki S.

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EN

Radiotherapy in breast cancer patients is an important component of multidisciplinary treatment. It reduces the risk of local recurrence and mortality from breast cancer. However, it can lead to secondary effects due to the presence of the heart within the irradiation field. Adjuvant radiation therapy for breast cancer increases the risk of coronary artery disease, myocardial infarction and cardiovascular death. It is important to determine the optimal treatment to minimize cardiotoxicity. Modern radiotherapy techniques may reduce radiation-induced cardiac toxicity, but it is necessary to determine the most sensitive structures within the heart, tolerance doses, and methods for early detection and monitoring of adverse effects.

5

A retrospective analysis of thyroid dysfunction following multi-modality treatment of head & neck malignancies

100%

Malik J., Sharma A., Monga S., Alam S., Joshi A., Rasool S., Bahadur S.

Polski Przegląd Otorynolaryngologiczny

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2020

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vol. 9(3)

17-22

EN

Introduction: The purpose of this study was to determine the incidence of radiation induced hypothyroidism after treatment with radiotherapy alone or in combination with surgery/chemotherapy in head & neck cancer patients. Methods: This study was a retrospective non-randomized trial performed on 100 patients of head & neck cancer in whom definitive radiotherapy, postoperative radiotherapy or radiotherapy in combination with chemotherapy was given. Values of TSH, T3 & T4 were analyzed at baseline and at 6 monthly follow-up. Subclinical hypothyroidism was defined as TSH value of > 4 mU/L and Clinical hypothyroidism was taken as TSH > 10 mU/L with decreased T3 & T4. Results: Out of 100 patients, 73 individuals were euthyroid at the end of 2-year follow-up, 21% had subclinical hypothyroidism and 6% had clinical hypothyroidism. The incidence of subclinical hypothyroidism in the surgery plus radiotherapy group and the radiotherapy group was 22.3% & 50%, respectively. The incidence of clinical hypothyroidism in the surgery plus radio therapy group and the radiotherapy group was 6.5% & nil, respectively. Conclusion: The incidence of hypothyroidism is high in head & neck cancer patients receiving radiotherapy. The risk is higher in patients who undergo surgery in combination with radiotherapy. Regular thyroid function test is, therefore, recommended.

6

Modern radiation techniques for treatment of head and neck cancers

100%

Kiprian D.

Polski Przegląd Otorynolaryngologiczny

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2015

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vol. 4(4)

1-10

EN

Alongside surgery, radiation therapy remains the mainstay of treatment for head and neck cancers. Because the head and neck contain a number of critically important structures, it is crucial to try to curtail the adverse effects of radiation therapy by increasing its precision. Such precise radiation techniques include the three-dimensional conformal as well as highly conformal radiotherapy. The latter includes, for instance, intensity modulated radiation therapy (IMRT), stereotactic radiation, and proton-beam therapy. All of the above-mentioned techniques are available in Poland and give the opportunity of a more aggressive treatment that lead to improved outcomes, curtailment of adverse effects, and by that, a better quality of life.

7

Complications of radio- and radiochemotherapy in patients undergoing major salivary gland cancer surgery

100%

Kordzińska-Cisek I., Grzybowska-Szatkowska L.

Otolaryngologia Polska

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2019

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vol. 73(3)

26-31

EN

Purpose: The aim of this retrospective study was to present the prevalence of early and late radiation-induced reaction and factors affecting its formation and severity in patients after adjuvant radio- or radiochemotherapy in salivary gland cancer. Material and methods: A total of 113 patients with early and 91 with late radiation-induced reaction, irradiated in 2006-2016 were enrolled in the study. The frequency of acute mucosal radiation-induced reaction, time of onset, intensity, healing time, as well as the incidence of late radiation-induced reaction from the skin and subcutaneous tissue were analyzed. Factors that could influence the development and intensity of reaction were identified. Results: Acute severity and the presence of late radiation-induced reaction do not affect overall survival. Dosage in the tumor bed site, as well as the dosage in the nodal region, affect the severity of the acute radiation-induced mucosal reaction. The severity of the early radiation-induced reaction is higher in men, more advanced patients (higher T and N+ in TNM classification), irradiated into a larger area, and those in whom two-dimensional planning and complementary chemoradiotherapy were applied. The late reaction of the skin and subcutaneous tissue was dominated by patients irradiated in the nodal regions and those with a higher intensity of early radiation-induced reaction. Conclusions: Supplementary radiotherapy or radiochemotherapy in salivary gland cancer is associated with acceptable toxicity which has no effect on overall survival.

8

Complications of radio- and radiochemotherapy in patients undergoing major salivary gland cancer surgery

100%

Kordzińska-Cisek I., Grzybowska-Szatkowska L.

Polish Journal of Otolaryngology

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2019

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vol. 73

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issue 3

26-31

EN

Purpose: The aim of this retrospective study was to present the prevalence of early and late radiation-induced reaction and factors affecting its formation and severity in patients after adjuvant radio- or radiochemotherapy in salivary gland cancer. Material and methods: A total of 113 patients with early and 91 with late radiation-induced reaction, irradiated in 2006-2016 were enrolled in the study. The frequency of acute mucosal radiation-induced reaction, time of onset, intensity, healing time, as well as the incidence of late radiation-induced reaction from the skin and subcutaneous tissue were analyzed. Factors that could influence the development and intensity of reaction were identified. Results: Acute severity and the presence of late radiation-induced reaction do not affect overall survival. Dosage in the tumor bed site, as well as the dosage in the nodal region, affect the severity of the acute radiation-induced mucosal reaction. The severity of the early radiation-induced reaction is higher in men, more advanced patients (higher T and N+ in TNM classification), irradiated into a larger area, and those in whom two-dimensional planning and complementary chemoradiotherapy were applied. The late reaction of the skin and subcutaneous tissue was dominated by patients irradiated in the nodal regions and those with a higher intensity of early radiation-induced reaction. Conclusions: Supplementary radiotherapy or radiochemotherapy in salivary gland cancer is associated with acceptable toxicity which has no effect on overall survival.

9

Radiotherapy in patients with cardiac implantable electronic devices – clinical experience

88%

Blamek S.

OncoReview

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2017

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vol. 7

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issue 2

64-69

EN

The number of patients with cardiac implantable electronic devices (CIEDs) constantly increases and due to growing incidence of cancer, many of them will require an anticancer treatment. At least a half of patients treated for malignant neoplasms, apart from other treatment methods, require radiotherapy. Although papers presenting the results of in vitro studies provide clues on the susceptibility of CIEDs to ionizing radiation, the research methods used often stand out from typical clinical situations. Direct irradiation of the devices is avoided and the doses delivered to pulse generators are far below those seen in the in vitro studies. In this review the most important clinical observations made during irradiation of patients with CIEDs are summarized and practical directions for physicians and physicists involved in radiation treatment planning and delivery are given.

10

Ameloblastoma of the maxillary sinus – a case report

88%

Łapienis M., Kaczmarczyk D., Zimmer-Nowicka J., Niedźwiecka I., Jesionek-Kupnicka D., Morawiec-Bajda A.

Otolaryngologia Polska

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2008

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vol. 62(6)

784-786

EN

Ameloblastoma (adamantinoma) is a benign neoplasm deriving from the enamel organ. Its etiology has not been ultimately determined. It constitutes about 1% of all head and neck tumours, and about 11% of teeth-originating tumours. Usually it occurs in the mandible near premolar and molar teeth, more rarely in its anterior part. About 20% of described cases of ameloblastoma relate to the jaw, its very rare location is gingiva or cheak tunica mucosa. The essay presents a case of ameloblastoma of a maxillary sinus in a 65-year-old man. The diagnostic and treatment algorithm in ameloblastoma is discussed.

11

Planning and verification in radiotherapy: our experience in a filmless hospital

88%

Torresin A., Carbonini C., Ferrari M., Asnaghi D., Botturi M.

Polish Journal of Medical Physics And Engineering

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2009

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vol. 15

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issue 2

103-112

EN

In our hospital we have recently installed a new radiotherapy treatment planning and verification system. Our system allows to follow the normal clinical workflow: from patient identification to follow-up through the treatment delivery with the study of the best irradiation geometry. We designed a new technical solutions relating to the use of four linear accelerators, a Record and Verify system, a Treatment Planning System (TPS) and a clinical folder, completely paperless. All the procedures for treatment planning, setup and verification are integrated in our digital imaging long-term archive. The integration is based on the existing HL7 and DICOM standard protocols described in the International Committee and IHE RO Technical Framework, which is able to support the workflow. All the images used for planning and setup are stored in the Oncentra DICOM archive server for short-term archiving and then are sent to the Agfa DICOM long-term archive for legal and scientific purposes.

12

Analysis of the calibration results of ionization chambers for orthovoltage and brachytherapy

88%

Ulkowski P., Bulski W., Gwiazdowska B., Rostkowska J.

Polish Journal of Medical Physics And Engineering

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2009

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vol. 15

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issue 1

11-24

EN

An analysis of the exposure calibration coefficients for ionization chambers used for dose determination in orthovoltage radiotherapy and in brachytherapy in the Polish SSDL was performed. The coefficients were determined by calibrating the chambers in the X-ray beam of 235 kV or 290 kV and HVL of 2.5 mmCu or 4 mmCu respectively, and also in the Co-60 gamma beam. Calibration procedures followed IAEA recommendations in Report No. TECDOC 1274 and Technical Reports Series No. 277. The characteristics of the energy dependence of various types of chambers used in orthovoltage radiotherapy and in brachytherapy are presented. On the basis of the summarized data and on the energy dependence curves it was possible to conclude that: 1) in he case of calibration of the chambers for orthovoltage radiotherapy the energy dependence has to be established for the full range beam qualities; 2) in the case of calibration, of the investigated chambers, for brahytherapy with Cs-137 and Ir-192 sources, establishing of the exposure calibration factor for Co-60 is sufficient.

13

An analysis of calibration coefficients measured in water and in air for Farmer-type cylindrical ionization chambers

88%

Bulski W., Ulkowski P., Gwiazdowska B., Rostkowska J.

Polish Journal of Medical Physics And Engineering

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2008

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vol. 14

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issue 2

113-121

EN

A comparison of calibration coefficients of Farmer-type cylindrical ionization chambers calibrated in a Co-60 beam according to the IAEA Reports 277 and 398 formalisms.91 calibration coefficients measured in air and in water.The 398ND, W/277ND, W ratios were calculated, taking into account the wall material of the chambers. The correlation between 398ND, W and NK, ND, air277ND, W was made and the equations of the regression straight lines were determined.Calibration coefficients, determined according to the IAEA Report 398, are higher by about 1% than those determined according to the IAEA Report 277, and they depend slightly on the wall material of the chamber.The introduction of the IAEA dosimetry Report 398 resulted in an increase in the doses delivered to patients by about 1% as compared with the period of application of Report 277. The regression equations may assure increased accuracy in retrospective comparative calculation of doses according to both reports as compared with the correction based on mean percent values.

14

Treatment of advanced laryngeal and laryngeal throat cancer - review of literature and own experience

88%

Krawczyk P., Osuch-Wójcikiewicz E., Majszyk D., Bruzgielewicz A., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2018

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vol. 7(2)

25-30

EN

As many as 70-85% of laryngeal and laryngopharyngeal cancers are diagnosed at a high staging, comprising a great diagnostic and therapeutic challenge with influence on poor treatment results. Patients with advanced lesions, that is, stages III and IV, qualify for primary surgical treatment or chemoradiotherapy, depending on the clinical stage, poor prognostic factors and preferences of the patient. Reliable qualifications standards for treatment that would allow to establish homogenous therapeutic recommendations and improvement of treatment results in the group of patients have not yet been developed.

15

Typical variant of takotsubo cardiomyopathy in oncological patients. Two case reports and review of the literature

75%

Stępień K., Nowak K., Pasieka P., Warmuz K., Stępień A., Nessler J., Zalewski J., Stępień K., Nowak K., Pasieka P., Warmuz K., Stępień A., Nessler J., Zalewski J.

Folia Medica Cracoviensia

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2020

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vol. 60

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issue 1

16

Zastosowanie radioterapii i radiochirurgii stereotaktycznej w leczeniu chorych na glejakomięsaki mózgu – doniesienie wstępne

75%

Napieralska A., Blamek S.

Annales Academiae Medicae Silesiensis

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2014

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vol. 68

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issue 5

315– 322

EN

AIM The aim of the work is to evaluate the results of the treatment of gliosarcoma according to the applied therapeu-tic methods. MATERIAL AND METHODS 43 patients (15 women and 28 men) aged 21 to 80 years were treated for brain gliosarcoma in the years 2002– –2014 in Institute of Oncology in Gliwice. In 22 cases the tumor was located in one lobe, in 20 at least two lobes of the brain were occupied. The initial diameter of the tumor, assessed in 22 patients (CT/MRI), ranged from 2 to 8 cm (median 5). Surgery was the primary treatment in 42 cases. Radiotherapy was performed in 35 patients (81.4 %), in 16 radical (median TD = 60 Gy, 12 cases of radiochemotherapy with temozolomide), in 12 palliative (median TD = 20 Gy), in 7 palliative combined with a stereotactic boost (median TD of boost 9.5 Gy, range: 6–15 Gy). 28 patients had regular check-ups. In 20 recurrence of the tumor was found. In the treatment of the recurrence, radiotherapy was used in 9 patients (in 6 patients combined with surgery; in 7 stereotactic radiotherapy (TD = 8–16 Gy, fd = 6–10 Gy), in 2 surgical treatment. RESULTS The follow-up ranged from 1.3 to 74 months. 32 patients died due to disease progression. The median survival for patients treated with surgery alone, surgery and palliative radiotherapy, surgery and palliative radiotherapy combined with stereotactic boost, surgery and radical radiotherapy was respectively 2.1, 5.4, 9.7 and 14.1 months (p = 0.008). In the case of recurrence, the median survival in the case of symptomatic treatment, sur-gery, and stereotactic radiosurgery was respectively 5.4, 6.5 and 18 months. CONCLUSIONS Radiotherapy is an essential element of brain gliosarcoma treatment resulting in significant prolongation of life. Stereotactic radiosurgery as a complementary element of palliative treatment and treatment of progres-sion/recurrence additionally increases survival in this group of patients.

PL

CEL Ocena wyników leczenia glejakomięsaków w zależności od zastosowanych metod terapeutycznych. MATERIAŁ I METODY 43 pacjentów (15 kobiet i 28 mężczyzn) w wieku od 21 do 80 lat leczonych z powodu glejakomięsaka mózgu w latach 2002–2014 w Centrum Onkologii Oddział Gliwice. W 22 przypadkach guz znajdował się w 1 płacie, w 20 zajęte były co najmniej dwa płaty mózgu. Pierwotny wymiar guza, oceniony u 22 chorych (TK/MR), zawierał się w przedziale od 2 do 8 cm (mediana 5). W 42 przypadkach leczeniem pierwotnym była operacja. Radioterapię zastosowano u 35 chorych (81,4%), u 16 radykalną (mediana dc = 60 Gy; 12 przypadków radiochemioterapii z temodalem), u 12 paliatywną (mediana dc = 20 Gy), u 7 paliatywną połączoną z boostem stereotaktycznym (boost mediana dc = 9,5 Gy, rozrzut: 6–15 Gy). Kontrolom podlegało 28 chorych. U 20 stwierdzono wznowę nowotworu. U 9 chorych w leczeniu wznowy zastosowano radioterapię (u 6 połączoną z operacją; u 7 radioterapia stereotaktyczna (dc = 8 – 16 Gy, df = 6 – 10 Gy), u 2 leczenie operacyjne. W Y N I K I Okres obserwacji wynosił od 1,3 do 74 miesięcy. 32 chorych zmarło z powodu progresji choroby. Mediana przeżycia dla chorych poddanych samodzielnej operacji, operacji i radioterapii paliatywnej, operacji i radioterapii paliatywnej połączonej z boostem stereotaktycznym, operacji i radioterapii radykalnej wynosiła odpowiednio: 2,1, 5,4, 9,7 i 14,1 miesiąca (p = 0,008). W przypadku wznowy mediana przeżycia w przypadku leczenia zachowawczego, operacji, radioterapii stereotaktycznej wynosiła odpowiednio: 5,4, 6,5 i 18 miesiecy. W N I O S K I Radioterapia jest niezbędnym elementem leczenia glejakomięsaków mózgu, skutkującym znacznym wydłużeniem życia chorych. Radiochirurgia stereotaktyczna jako element uzupełniający leczenia paliatywnego i leczenia progresji/wznowy dodatkowo wydłuża przeżycia w tej grupie chorych.

17

Aktualne i nowe strategie leczenia aktywnej orbitopatii tarczycowej

75%

Wierzbowska J.

OphthaTherapy

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2020

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vol. 7

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issue 2

108-115

EN

Graves’ ophthalmopathy is a consequence of an autoimmune orbital reaction that is caused by an antigen or antigens that are common to the thyroid and orbit. This review discusses the pathogenesis of thyroid orbitopathy, current treatment strategies, and new treatment options for both hyperthyroidism and the active phase of ophthalmopathy. The traditional strategy for treating Graves’ ophtalmopathy involves immunosuppressive therapy with steroids, orbital radiation therapy, and surgical decompression. New treatment options include the use of drugs that modulate specific cellular proteins that are involved in orbital autoimmune pathways. These include monoclonal antibodies, cytokine inhibitors, and selective immunosuppressants.

PL

Orbitopatia tarczycowa, zwana także oftalmopatią Gravesa, jest następstwem reakcji autoimmunologicznej w oczodole wywołanej przez wspólny dla tarczycy i oczodołu antygen lub antygeny. W niniejszym artykule na podstawie koncepcji patogenezy orbitopatii tarczycowej omówiono aktualną strategię oraz nowe kierunki leczenia zarówno hipertyreozy, jak i aktywnej fazy oftalmopatii. Tradycyjna strategia leczenia orbitopatii obejmuje leczenie immunosupresyjne za pomocą glikokortykosteroidów, radioterapię oczodołów i dekompresję chirurgiczną. Nowe kierunki terapii związane są z zastosowaniem leków specyficznie modulujących określone białka komórkowe zaangażowane w szlaki reakcji autoimmunologicznej w oczodole. Należą do nich przeciwciała monoklonalne, inhibitory cytokin oraz selektywne związki immunosupresyjne.

18

Wpływ radioterapii na jakość życia pacjentek w trakcie leczenia nowotworu piersi w zakładzie radioterapii we Włocławku

63%

Kurtys J.

Innowacje w Pielęgniarstwie i Naukach o Zdrowiu

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2023

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vol. 8

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issue 3

7-28

EN

Introduction. Radiotherapy, like other oncological treatment methods, is associated with a significant deterioration in the daily functioning of patients in all spheres of life. Aim. The aim of the study was to assess the impact of radiotherapy on the quality of life of patients during breast cancer treatment. Material and methods. The research material that was used to develop the work was obtained using the research method, which is a diagnostic survey. The study included women undergoing breast cancer treatment between the ages of 18 and 70. The research was carried out from 01.09 to 30.10.2022. The paper was based on a self-survey and standardized questionnaires EORTC QLQ-C30 and EORTC QLQ-BR2 were used. Results. The assumed hypotheses were confirmed. During radiotherapy, patients indicated significant problems when performing strenuous activities. They also felt significant limitations during their work and hobbies. During radiation therapy, women experienced some problems related to cognitive functioning. Radiation therapy affected the social and emotional functioning of the patients. Radiation significantly affected the sensation of pain, shortness of breath, difficulty sleeping, lack of appetite, constipation, diarrhoea and financial problems. There were also side effects of the treatment. Conclusions. The study showed that the patients' quality of life changed during radiotherapy and significantly deteriorated cognitively, emotionally, and socially.

PL

Wstęp. Radioterapia tak jak i inne metody leczenia onkologicznego wiążą się ze znaczącym pogorszeniem codziennego funkcjonowania chorych we wszystkich sferach życia. Cel. Celem pracy była ocena wpływu radioterapii na jakość życia pacjentek w trakcie leczenia nowotworu piersi. Materiał i metody. Materiał badawczy, który posłużył do opracowania pracy uzyskano korzystając z metody badawczej jaką jest sondaż diagnostyczny. Badaniem objęto kobiety w trakcie leczenia nowotworu piersi w wieku od 18 do 70 roku życia. Badania przeprowadzono w terminie od 01.09- 30.10.2022 roku. W pracy oparto się na ankiecie własnej i wykorzystano standaryzowane kwestionariusze EORTC QLQ-C30 i EORTC QLQ-BR2. Wyniki. W trakcie radioterapii pacjentki wskazywały na znaczne problemy podczas wykonywania męczących czynności. Odczuwały również znaczne ograniczenia podczas wykonywanej pracy i przy realizowaniu hobby. Podczas radioterapii kobiety trochę odczuwały problemy związane z funkcjonowaniem poznawczym. Radioterapia wpłynęła na funkcjonowanie społeczne i emocjonalne pacjentek. Naświetlanie znacznie wpłynęło na odczuwanie bólu, duszności, trudności ze snem, brak apetytu, zaparcia, biegunki i na kłopoty finansowe. Wystąpiły także efekty uboczne leczenia. Wnioski. Badania wykazały, że jakość życia pacjentek uległa zmianie podczas radioterapii i w znacznym stopniu uległa pogorszeniu w aspekcie poznawczym, emocjonalnym i społecznym.

19

Skojarzone leczenie chorych na mięsaki macicy – ocena wyników i analiza czynników prognostycznych

63%

Michalak A., Karolewski K., Jakubowicz J., Blacharz P., Dymek P., Piwowarczyk S.

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2006

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vol. 4

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issue 1

23-30

EN

Objectives: The aim of the study was to assess the efficacy of combined therapy (surgery plus radiotherapy) and reasons of treatment failure in patients with uterine sarcoma. Material and methods: The analyzed clinical material involved 95 patients with uterine sarcoma (US) treated in the Cracow Branch of the Center of Oncology between 1980 and 1999. The studied group consisted of 70 patients with leiomyosarcoma (LS) and 25 patients with endometrial stromal sarcoma (ESS). Seventy-three women were diagnosed with stage I and II and 22 with stage III and IVA US. All patients in this group underwent radical hysterectomy with salpingooophorectomy followed by postoperative irradiation consisting of vaginal brachytherapy and external beam radiotherapy of the small pelvic area. Results: Out of 95 patients in the tested group, 46 (48.4%) patients survived 5 years with no evidence of disease. In the group of early-stage US there were 60.3% 5-year disease-free survivals. None of 9 patients with stage IVA was cured. In 36 among 47 uncured patients (76.6%) distant metastases was found. Conclusion: Combined surgery plus radiotherapy treatment was effective therapy in patients with early-stage US, nevertheless, it was ineffective in the group with advanced US, as none of the 9 patients with grade IVA was cured. The basic cause of treatment failure in the LS group was the spread of malignancy, whereas in the ESS group – locoregional recurrence.

PL

Cel: Celem pracy była ocena skuteczności leczenia skojarzonego (chirurgia + napromienianie) i analiza przyczyn niepowodzenia leczenia chorych na mięsaka macicy. Materiał i metody: Przeprowadzono analizę materiału klinicznego obejmującego 95 chorych na mięsaka macicy (MM) leczonych w Centrum Onkologii, Oddział Kraków w latach 1980-1999. W skład badanej grupy weszło 70 chorych na leiomyosarcoma (LS) oraz 25 chorych na endometrial stromal sarcoma (ESS). U 73 pacjentek rozpoznano MM w I i II, a u 22 w III i IVA stopniu zaawansowania. W badanej grupie u wszystkich chorych wykonano zabieg radykalnego usunięcia macicy wraz z przydatkami, a następnie przeprowadzono uzupełniające pooperacyjne napromienianie składające się z brachyterapii dopochwowej i teleradioterapii terenu miednicy mniejszej. Wyniki: Spośród 95 chorych z badanej grupy 5 lat bez objawów nowotworu przeżyło 46, tzn. 48,4% chorych. W grupie osób z niezaawansowanym MM uzyskano 60,3% bezobjawowych przeżyć 5-letnich. Skojarzone leczenie chirurgiczne z pooperacyjnym napromienianiem okazało się nieskuteczne w grupie chorych na zaawansowanego MM – nie wyleczono żadnej spośród 9 chorych w IVA stopniu zaawansowania. U 36 spośród 47 chorych (76,6%) z niewyleczonym procesem nowotworowym stwierdzono przerzuty odległe. Wnioski: Skojarzone leczenie chirurgiczne z pooperacyjnym napromienianiem było skuteczne u chorych na niezaawansowanego MM, natomiast u chorych na zaawansowanego MM skojarzone leczenie okazało się nieskuteczne, ponieważ żadna z 9 chorych na MM w stopniu IVA nie została wyleczona. Głównym powodem niepowodzenia leczenia w grupie chorych na LS były przerzuty odległe, a w grupie chorych na ESS – wznowa lokoregionalna.

20

Zastosowanie hipertermii w onkologii

63%

Timorek-Lemieszczuk A., Nalewczyńska A., Śpiewankiwicz B.

Current Gynecologic Oncology

|

2009

|

vol. 7

|

issue 4

264-269

EN

Hyperthermia may be defined as a way of controlled elevation of temperature, targeted on neoplasm or adjacent tissues, organs, body part(s) or entire body. The first medical application of hyperthermia in modern medicine was described by Westermark in 1898: he used containers with continuous flow of water at temperature of 42-44°C to treat inoperable cervical cancer. In studies performed to date, hyperthermia was combined with standard therapeutic modalities – radiotherapy and chemotherapy, both intravenous and intraperitoneal. Studies revealed that effects of hyperthermia include induction of apoptosis, both mediated by suppressor protein p53 and by an independent mechanism. Depending on the range of temperatures used, hyperthermia may be classified as mild (about 39°C), moderate (40-41°C) and intense (over 42°C). Chemotherapeutic agents whose effect is enhanced by concomitant hyperthermia include alkylating drugs (ifosfamide, cyclophosphamide), antineoplastic antibiotics (bleomycin, adriamycin, mitomycin C and actinomycin), platinum derivatives, antimetabolites (5-fluorouracil) and gemcitabine (administered a day before or a day after heating). Hyperthermia combined with radiotherapy has a synergistic effect. This effect depends on degree of temperature elevation in target tissue (the higher the temperature, the greater the effect), duration of heating and chronologic order of implementation of both modalities. It appears that hyperthermia may contribute to improvement of still unsatisfactory treatment outcomes in gynecologic oncology, particularly in patients with ovarian cancer, cervical cancer and endometrial cancer.

PL

Hipertermia może być definiowana jako metoda kontrolowanego podwyższenia temperatury, której celem jest guz nowotworowy, jak również otaczające tkanki, narządy, część lub nawet całe ciało. Pierwsze zastosowanie hipertermii w czasach nowożytnych zostało opisane przez Westermarka w 1898 roku; użył on pojemników z ciągłym przepływem wody o temperaturze 42-44°C w leczeniu nieoperacyjnych przypadków raka szyjki macicy. W dotychczas przeprowadzonych badaniach hipertermię łączy się ze standardowo stosowanymi terapiami – radioterapią oraz chemioterapią dożylną i dootrzewnową. W badaniach stwierdzono również, że jednym z działań hipertermii jest indukowanie apoptozy zarówno zawiązanej z białkiem supresorowym p53, jak i w mechanizmie niezależnym. W zależności od zakresu stosowanych temperatur możemy podzielić hipertermię na: łagodną (około 39°C), o średnim nasileniu (od 40 do 41°C) oraz bardzo nasiloną (powyżej 42°C). Do chemioterapeutyków, których efekt działania zostaje zwiększony w wyniku łącznego stosowania z hipertermią, należą: leki alkilujące (ifosfamid, cyklofosfamid), antybiotyki przeciwnowotworowe (bleomycyna, adriamycyna, mitomycyna C i aktynomycyna), pochodne platyny, antymetabolity (5-fluorouracyl) oraz gemcytabina (podana dobę przed lub dobę po nagrzewaniu). Hipertermia w połączeniu z radioterapią wykazuje działanie synergistyczne. Działanie to zależne jest od uzyskanego wzrostu temperatury w tkance docelowej (im wyższa temperatura, tym większy efekt), czasu nagrzewania oraz kolejności łączenia obu tych metod. Wydaje się, iż hipertermia jest metodą, która może mieć wpływ na poprawę ciągle niezadowalających wyników leczenia w ginekologii onkologicznej, szczególnie u chorych na raka jajnika, szyjki macicy i endometrium.

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