Zeszyty Naukowe WCO, Letters in Oncology Science最新文献

Aim

Analysis of the daily correction shifts obtained from the cone beam computed tomography (CBCT) and from the two orthogonal X-ray images (2D-kV).

Materials and methods

15 patients with prostate cancer treated by radiotherapy were taken for the study. The analysis was based on the image data obtained from two different methods of the image guidance (CBCT and 2D-kV). In particular, analysis included the comparison of the: (i) correction shifts, (ii) systematic and random errors and (iii) margins derived from the CBCT and 2D-kV.

Results

The analysis showed that the widest spreads (standard deviation) of the shifts were recorded along the sagittal and vertical axis, and were respectively 0.5 cm CBCT and 0.3 cm 2D-kV for sagittal and 0.4 cm CBCT and 0.3 cm 2D-kV for vertical axis. The systematic errors resulting from the use of both image guidance methods are comparable. The biggest discrepancy between the random errors was observed for the sagittal and vertical axis, and were respectively 0.46 cm CBCT and 0.29 cm 2D-KV for sagittal and 0.36 cm CBCT and 0.25 cm 2D-kV for vertical axis. The margins calculated for each of the imaging methods were respectively: (i) 1 cm for the sagittal axis and 0.9 cm for the transverse and vertical axes based on the CBCT imaging; and (ii) 0.9 cm for the transverse axis and 0.8 cm for the sagittal and the vertical axes based on the 2D-kV imaging.

Conclusion

CBCT allows the correction of displacement of the prostate based on the soft tissues and the bone anatomy. 2D-kV allows correction of prostate shifts only on the basis of the bones. The results obtained by the method of 2D-kV are flawed by 20% (along the sagittal axis) and by 9% (along the vertical axis) error with respect to the CBCT method.

Aim

The aim of this study was to analyze the influence of the size of the clinical target volume (CTV) on the displacement obtained from the patients irradiated because of the left breast cancer using the geometric verification with the megavoltage images.

Material and method

Examined group of 100 patients was treated with the three-dimensional conformal radiotherapy. The analysis was performed on the 396 megavoltage images. The examined group of patients was divided into two subgroups according to the breast's CTV volume. The first subgroup (I) was the patient with the CTV ≤ 700 cm³ and the second (II) one CTV > 700 cm³. The displacements were obtained in the three directions: anterior-posterior (AP), crania-caudal (CC) and left-right (LR). The systematic (Σ), random (σ) errors and safety margins (SM) were calculated.

Results

The range of the Σ error was 0,20–0,34 cm for the (I) and 0,26–0,42 cm for the (II). The maximum value of the σ error was 0,46–0,26 cm, respectively. The lowest value of the SM was in the AP and the largest one in the CC direction. The SM ranges were 0,65–1,00 cm for CTV ≤ 700 cm³ and 0,88–1,37 cm for CTV > 700 cm³. SM for the whole group of the breast patient was in the range 0,80–1,24 cm.

Conclusions

The set-up of the breast patient with the smaller volume of the CTV ≤ 700 cm³ is much accurate and connected with smaller values of the geometric displacements. Safety margin used during the treatment planning should be selected individually depending on the size of the breast volume – CTV.

An idea of stereotactic body radiation therapy in early stage has been presented in this work. Implementation, outcomes and toxicity of the method are revealed. Some approaches to compare the technique with surgery have been presented. The author has outlined the trends and some research problems.

In the last decades, prostate cancer (PC) has become one of the most common cancer in Europe and in the United States. Hormonal therapy (HT) is the current mainstay for systemic treatment of patients with metastatic disease but lower disease patients are treated with local methods such as: radiation therapy (RT) or radical prostatectomy. However the efficacy of treatment for high-risk of disease progresion patients supported by RT and radical prostatectomy is not satisfactory. Experimental studies based on animal models showed that the idea of addition of HT to RT might improve the results of combined treatment. Outcomes from randomised trials indicated that combined treatment (HT plus RT) leads to significantly better overall and disease–specific survival results than RT alone. Nowadays the combination of long-term HT with RT is considered the treatment of choice for high-risk patients. For patients treated with radical prostatectomy the role of adjuvant HT is still controversial because there are a low number of trials which confirm the efficacy of this treatment modality.

In this review we summarize the available evidence from randomized III phase trials concerning the use of HT in both the RT and radical prostatectomy scenarios and also the most common side effects of HT.

Prostate cancer is the second most common neoplasm in the male population in Poland. We manage to cure most of them and provide a long survival. That is the reason why the Quality of life is very important in that group of patients. I have carried out an analysis of articles from PubMed database about the Quality of life after oncological treatment of prostate cancer. It was said that different treatment techniques influence the quality of life in different ways. In patients after radiotherapy the most important were bowel symptoms (rectal urgency, bleeding). Patients after prostatectomy have symptoms relating to the bladder (urinary incontinence). In patients after brachytherapy the most common symptoms are from the urethra (dysuria, urinary hesitation, polyuria). Patients should be informed about different symptoms which may occur after different ways of treatment. It is very important for them to make a conscious choice about the way of treatment they accept the most.

Prostate cancer is the most common malignancy in developed countries. In recent years, an intense research aimed at finding new markers for prostate cancer treatment regimen to facilitate the selection and control of its effectiveness. The presence of circulating tumor cell population is postulated as a new prognostic and predictive marker for patients with unresectable prostate cancer. The aim of the study was to verify the molecular diagnostic method for the evaluation of circulating prostate cancer cells in metastatic patients in clinical stage.

Metastatic prostate cancer, which shows progression despite castration testosterone levels, was previously defined as hormone-refractory. This definition has been recently changed to the one presently used-castrate-resistant prostate cancer. Numerous fundamental studies have provided the evidence that the development of hormone-refractory prostate cancer is constantly dependent on the concentration of androgens. The aim of the metastatic castrate-resistant prostate cancer treatment is currently to obtain the lowest possible androgen concentration. The effectiveness of such management has been proven by the results of clinical studies on the latest hormonal and chemotherapeutic medications. In the last two decades, new effective chemotherapeutics have become available on the market: abiraterone, enzalutamide, docetaxel, cabazitaxel, zoledronic acid, denosumab and alpharadin. They significantly contribute to extending patients’ survival and to improving their quality of life. Therefore, the question arises whether using LHRH analogues is still a necessary element of the therapy. A detailed analysis of study regimens involving the above-mentioned medications and of available publications support the view that LHRH analogues are the basic strategies in the treatment of patients with metastatic castrate-resistant prostate cancer. All clinical trials evaluating new therapies still followed the principle of obtaining castration testosterone levels as a result of using LHRH analogues simultaneously with the new medications.

Chemoradiation (CT-RT) is currently a recognised standard of treatment for advanced squamous cell carcinoma of the head and neck. An adjuvant neck node dissection remains a controversial issue. Some authors suggest that surgery should be proposed for all patients with advanced N-stage at diagnosis regardless of the response to organ-preservation protocol which is CT-RT. Others recommend that the decision on surgery should be based on the clinical assessment of the response to radical CT-RT. Both strategies are characterised by a comparable regional control and progression free survival rates. They differ, however, in the quantity and quality of induced complications, and generate different costs. Therefore, an intensive search for (clinical or radiological) predictors to treatment response is needed to identify a specific group of patients who would benefit from adding neck dissection and without exposing complete responders to unnecessary complications. In this respect, the use of PET-CT scanning has gained some interest in selecting patients appropriate for lymphatic surgery. This method, however, has been found to have some faults and limitations.