Reports of Practical Oncology and Radiotherapy最新文献

Background: Radiotherapy (RT) is the gold standard for solitary plasmacytomas (SP) with great local control. The influence of radiotherapy as well as factors on multiple myeloma (MM) progression is unknown.

Materials and methods: We present a retrospective study of 27 patients with SP (bone-SBP- and extramedullary-SEP-), treated since 1995 to 2021. We aim to analyze prognostic factors affecting local control and progression to MM in patients treated with radiotherapy (RT).

Results: Mean age was 57.3 years. 22 were SBP and 5 SEP. 13 patients were treated with definitive RT, and 14 with a combination of RT and systemic treatment and/or surgery. Local control was observed in 91.5% of cases. 28% experienced progression to MM. With a median follow up of 61.4 months [39.5, 121.6], 5-years MM-free-survival was 81 ± 8%; no individuals progressed further 50 months since diagnosis. Large tumor bulk (> 5 cm) and type (SBP 36% vs. SEP 0%) were associated with progression. Progression was not affected by doses greater than 46 Gy and/or surgery. An immunophenotype different from IgG kappa was predictive of less progression (p = 0.031) in Cox regression analysis adjusted for age, RT dose and tumor bulk > 5 cm. Patients with positron emission tomography-computed tomography (PET-CT) staging showed less MM progression, without statistical differences.

Conclusion: RT achieves more than 90% of local control. The immunophenotype IgG kappa showed more risk of progression to MM. Initial staging with PET-CT seems to lead to a better identification of SP. The inclusion of bad prognosis patients in clinical trials would determine the role of adjuvant chemoimmunotherapy in SP treatment.

Background: Polymer-carbon nanostructures have previously been introduced for dosimetry of gamma rays with potential application in radiotherapy. In this research work, bismuth oxide (Bi₂O₃) nanoparticles were added into the amorphous polycarbonate (PC) matrix to enhance the probability of the photoelectric effect and dosimetry response in parallel.

Materials and methods: PC/Bi₂O₃ nanocomposites at concentrations of 0, 5, 20, 40, and 50 Bi₂O₃ wt% were fabricated via a solution method. Afterward, the samples were irradiated by gamma rays of cobalt-60 (⁶⁰Co) related to Picker V-9, and Therarton-780 machines at 30-254 mGy/min. Dosimetric characteristics were carried out including linearity, angular dependency, energy, bias-polarity, field size, and repeatability.

Results: Field emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM) analyses exhibited an appropriate dispersion state. The dosimeter response was linear at 30-254 mGy/min for the all samples. The 50 wt% sample exhibited the highest sensitivity at 4.61 nC/mGy. A maximum angular variation of approximately 15% was recorded in normal beam incidence. The energy dependence at two energies of 662 and 1250 keV was obtained as 0.7%. Bias-polarity for the 40, and 50 wt% samples at 400 V were measured as 15.9% and 9.0%, respectively. The dosimetry response was significantly dependent on the radiation field size. Also, the repeatability of the dosimeter response was measured as 0.4%.

Conclusions: Considering the dosimetry characteristics of PC-Bi₂O₃ nanocomposites, and appropriate correction factors, this material can be used as a real-time dosimeter for the photon fields at therapy level.

Background: This study aimed to investigate the association between radiotherapy-related factors and the incidence of severe weight loss (WL) during radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) in the intensity-modulated radiation therapy (IMRT) era.

Materials and methods: Seventy-nine patients with HNSCC who received IMRT between January 2011 and December 2020 were reviewed. The 10% WL was defined as severe WL. The median prescribed doses of IMRT were 70 Gy for the high-risk planning target volume (HRPTV); 60 Gy for the intermediate-risk planning target volume (IRPTV); 54 Gy for the low-risk PTV.

Results: Larger volumes of ≥ 60 Gy (PTV60Gy) had a significant impact on WL, whereas volumes of ≥ 70 Gy and ≥ 54 Gy did not. PTV60Gy to the ipsilateral level II or III necks had a significant impact on WL, whereas PTV60Gy to the ipsilateral levels I, IV, V, or VII did not. The primary site of the nasopharynx/oropharynx had a significant impact on WL, whereas the hypopharynx/larynx did not. In the stepwise regression and multivariate analyses, primary site and PTV60Gy volume were important factors for severe WL.

Conclusions: Reducing the PTV60Gy volume can be useful in reducing severe WL. Because the clinical significance of IRPTV is unclear, the omission of IRPTV should be considered while balancing risks and benefits.

Background: Chemotherapy may cause systemic inflammation. Therefore, reliable markers monitoring inflammation during cancer treatment are intensively investigated. In our study, we analyzed the concentration of high-sensitivity C-reactive protein (hs-CRP) and selected oxidative stress markers, such as malondialdehyde (MDA), glutathione peroxidase activity (GPx), and total antioxidant capacity (TAC), in breast cancer women before and during adjuvant chemotherapy.

Materials and methods: The study included 90 women with breast cancer stratified according to clinicopathological and anthropometric features. Blood samples were taken before and after two cycles of adjuvant chemotherapy.

Results: During adjuvant chemotherapy, a significant increase in hs-CRP concentration was noticed in the entire group of patients with breast cancer. After division into appropriate groups, a twofold increase in hs-CRP concentration was particularly observed in patients not expressing steroid hormone receptors and those without metastases in regional lymph nodes. A significant rise in hs-CRP was observed in patients with smaller tumor sizes (2 cm ≤) and with a lower stage of disease [I-IIA according to the tumor-node-metastasis (TNM) classification]. Adjuvant chemotherapy resulted in a significant decrease in GPx activity, especially in patients diagnosed with larger (> 2 cm) and more advanced tumors (IIB-IIIC according to the TNM classification), without metastasis in regional lymph nodes, and without HER-2 expression. A significant decrease in glutathione peroxidase (GPx) activity during adjuvant chemotherapy was also observed in patients with abnormal body mass index (BMI) and body fat content. TAC and MDA values remained unchanged in the entire group of patients and individual subgroups during adjuvant chemotherapy.

Conclusion: Our study showed that adjuvant chemotherapy causes systemic inflammation, manifested by increased hs-CRP and altered markers of oxidative stress in the blood of breast cancer patients. The severity of inflammatory processes during adjuvant chemotherapy may depend on specific characteristics of breast cancer and body composition.

Background: Surgery has been used as standard treatment for head and neck paragangliomas. Stereotactic radiotherapy (SRT) has also been increasingly used for this disease. The results for combined modality are not well described. This analysis aims to describe the results for combined modality of debulking surgery and SRT for head and neck paragangliomas (HNP).

Materials and and methods: Retrospective cohort of patients treated in a large university hospital between 2008 and 2023.

Results: Fifty-one patients had their charts reviewed. Mean age was 56.3 years. Most were female (82.3%). Most lesions arose from the skull-base (84.3%) and not the inner ear. Most lesions were larger than 3 cm (51.0%) and mean lesion size was 4.4 cm. 36 (70.6%) were treated with radiotherapy alone while 15 (29.4%) were treated with combined modality treatment. Median follow-up was 42.5 months (7.1-112.8 months). There were no reported deaths nor disease progression. Debulking surgery did not impact response rate for SRT (52.8% vs. 47.2% for SRT alone and debulking surgery, respectively, p = 0.971). There was no impact on new neurological deficits after SRT (25.0 vs. 13.3%, respectively, p = 0.356).

Conclusion: Debulking surgery did not improve response rate for SRT. In our sample, it also did not impact new neurological deficits for SRT. Prospective data regarding HNP treatment is needed.

Background: This study evaluated the clinical outcomes of stereotactic ablative radiotherapy (SABR) in the treatment of oligometastatic pelvic node prostate cancer to delay androgen deprivation therapy (ADT).

Materials and methods: Pelvic lymph node metastases were identified by ¹¹C-choline positron emission tomography (PET)-computed tomography (CT), and patients were not receiving ADT. SABR was administered using linear accelerators with intensity-modulated and image-guided radiotherapy, at a prescribed dose of 35 Gy in 5 fractions over 2 weeks. Response was assessed using Response Evaluation Criteria in Solid Tumours (RECIST) v1.1 criteria, and prostate-specific antigen (PSA) levels were monitored post-SABR. Toxicity and quality of life were assessed by the Common Terminology Criteria for Adverse Events Toxicity (CTCAE) v.5.0 and European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaires QLQ-C30/QLQ-PR25, respectively. Kaplan-Meier and T-test were used for statistical analysis.

Results: Between June 2015 and November 2023, 56 patients with 85 lesions were treated at our institution. Median follow-up was 30 months [95% confidence interval (CI): 24-33.6]. Prostatectomy was the radical treatment in 85.7% of patients, and radiotherapy in 14.3%. Response rates were 67.1% for complete response, 27.4% for partial response, and 1.4% for stable disease. In-field progression was observed in only 3 lesions (3.5%). The median time to biochemical relapse post-SABR was 15 months (95% CI: 11.4-18.6). Three-year pelvic nodal and distant progression-free survival were 62.5% and 80%, respectively. There was a significant decrease in PSA levels after SABR compared to pretreatment levels (0.77 vs. 2.16 ng/mL respectively, p = 0.001). No grade ≥ 2 genitourinary or gastrointestinal toxicities. The median global health status score was 83.33 points at both time points analysed.

Conclusion: SABR can delay the ADT and provide excellent local control while preserving quality of life.

Background: Proton therapy has garnered attention as an advanced radiation treatment modality for breast cancer due to its ability to deliver highly precise doses to the target area while minimizing exposure to surrounding healthy tissues. The aim was to detect potential variations in radiobiological response along different parts of the proton depth-dose curve.

Materials and methods: MDA-MB-231 cells were specifically irradiated before, within, and beyond the Bragg peak with a 5 Gy dose, with photons used as a reference. The radiobiological response was evaluated using clonogenic assays, relative γH2AX levels, and quantitative polymerase chain reaction (qPCR) analysis of DNA damage response genes.

Results: A trend of increasing magnitude in radiobiological response was observed with increasing depth of cell irradiation, accompanied by a decrease in survival fraction. Furthermore, differences were noted, particularly in γH2AX levels along the Bragg peak, with higher values of DNA double-strand breaks (DNA DSB) observed at the end of the depth-dose curve.

Conclusions: These findings suggest that despite administering a consistent proton dose to the target area, there can be a range of different biological reactions, which might have significant indications for clinical procedures.

Background: Skin melanoma is one of the three main types of skin cancer along with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and develops from melanocytes. 2019 saw the beginning of the National Skin Cancer Prevention Programme (OPPNS) in Poland. One of the tasks performed was a health promotion campaign for patients. To effectively educate the public, the project was preceded by a survey assessing knowledge on skin cancer prevention methods. Then, the survey was repeated to evaluate the effectiveness of the awareness raising campaign.

Materials and methods: both studies were conducted based on an author-developed survey. A representative sample size was determined based on the calculator available at www.cem.pl/pl/analizy/wielkość-proby. In addition, each participant filled in a knowledge upgrade declaration. The analysis employed basic statistical data, such as absolute numbers and structural indicators.

Results and conclusions: Knowledge upgrade score of 9.16 (out of 10) was declared by 99.7% of the respondents. As many as 99.0% of them declared an intent to change their lifestyle to a healthier one. Thus, the education provided to the Programme participants was confirmed to have raised their awareness of skin cancer prevention and self-examination methods.