Wspolczesna Onkologia-Contemporary Oncology最新文献

Introduction: The aim was to evaluate ChatGPT generated responses to patient-important questions regarding upper tract urothelial carcinoma (UTUC).

Material and methods: Fifteen common inquiries asked by patients regarding UTUC were assigned to 4 categories: general information; symptoms and diagnosis; treatment; and prognosis. These questions were entered into ChatGPT and its responses were recorded. In every answer 5 criteria (adequate length, comprehensible language, precision in addressing the question, compliance with European Association of Urology guidelines and safety of the response for the patient) were assessed by the urologists using a numerical scale of 1-5 (a score of 5 being the best).

Results: Sixteen questionnaires were included. A score of five was assigned 336 times (28.0%); 4 - 527 times, (43.9%); 3 - 268 times (22.3%); 2 - 53 ti- mes (4.4%); and 1 - 16 times (1.3%). The average overall score was 3.93. Responses to each question received average scores within the range 3.34-4.18. Answers regarding "general information" were graded the highest - mean score 4.14. Artificial intelligence scored the lowest in the "treatment" category - mean score 3.68. A mean score of 4.02 was given for the safety of the response. However, a few urologists considered several answers as unsafe for the patient, by grading them 1 or 2 in this criterion.

Conclusions: ChatGPT does not provide fully adequate information on UTUC, and inquiries regarding treatment can be misleading for the patients. In particular cases, patients might receive potentially unsafe answers. However, ChatGPT can be used with caution to provide basic information regarding epidemiology and risk factors of UTUC.

Introduction: This study was aimed to evaluate the impact of platelet-rich-plasma (PRP) application into the wound during laparotomy in gynaecological cancer patients on wound healing and postoperative pain.

Material and methods: Forty-six patients undergoing surgical treatment due to gynaecological malignancies were included in this single-blind placebo-controlled intervention study: 23 women in the PRP group and 23 patients in the placebo group. Postoperative pain was assessed by using the visual analogue scale immediately after surgery, and 6 and 12 hours after the surgery. The use of analgesics after surgery was also recorded. The postoperative scar was assessed by patient and clinician using the patient and observer scar assessment scale (POSAS).

Results: Wound dehiscence was diagnosed in 1 (4.3%) patient in the PRP group and 4 (17.4%) women in the control group (p = 0.346). After adjustment, the risk of wound dehiscence after PRP application was significantly lower in comparison to the control group (odds ratio - OR, 0.17; 95% CI: 0.03-0.92; p = 0.040). The risk of reporting more intense pain associated with PRP treatment 12 hours after surgery was significantly reduced (OR 0.25; 95% CI: 0.07-0.83; p = 0.023). Platelet-rich-plasma patients required fewer total morphine doses than the control group (8.22 ±3.3 vs. 10.96 ±5.05; p = 0.048). Significant differences between the groups in the scar quality assessment were also detected on the basis of POSAS scale on days 8, 30, and 90 after surgery.

Conclusions: Platelet-rich-plasma application during abdominal closure in gynaecological cancer patients may improve wound healing, as well as reduce pain and the use of analgesics in the early postoperative period.

Introduction: Celiac plexus radioablation (CPR) is an emerging non-invasive interventional treatment for severe pain associated with cancer-related damage to the celiac plexus. Due to its complex aetiology, such pain often responds poorly to conventional analgesics, and high doses of these medications can cause toxicity. Celiac plexus radiosurgery employs advanced radiotherapy techniques to administer a high single dose of 25 Gy to the anatomically defined celiac plexus, aiming to reduce pain intensity and enhance patients' quality of life.

Material and methods: The safety and efficacy of CPR have been validated in a prospective single-arm clinical trial that included 125 patients.

Results: The positive outcomes of this trial led to the integration of CPR into pain management guidelines; however, the novel approach to radiotherapy planning might be initially challenging to grasp.

Conclusions: In this article, we provide a brief overview of the method along with a comprehensive, Polish and English-language guide on how to perform CPR and manage patients, based on our clinical experience.

Platinum-based compounds used for treating hematologic malignancies can lead to various side effects. One such side effect is ototoxicity, which is characterized by permanent bilateral sensorineural hearing loss or tinnitus. Initially, it mainly affects high frequencies, but as the condition progresses, it may also affect low frequencies. Occurrence of ototoxicity has been reported in up to 80% of patients. However, the precise incidence among hematology patients remains unknown. Following Preferred Reporting Items for Systematic Reviews and meta- analyses guidelines, a systematic review was conducted to assess the incidence of ototoxicity among hematology patients undergoing platinum compound-based chemotherapy. Four databases - PubMed, Scopus, Embase, and Web of Science - were searched to identify relevant articles published in the period 2000-2023. Initially, 538 articles were screened, with only 5 meeting the criteria for inclusion in the analysis. The systematic review included a total of 77 patients, the majority of whom had Hodgkin's lymphoma (65 patients, 84.4%). Only one patient had leukemia. Of all patients, 16 (20.8%) developed ototoxicity. It is crucial for hematologic patients to undergo regular monitoring and audiometric tests even up to 10 years after treatment. Conducting prospective studies to evaluate hearing before, during, and after treatment is necessary to enhance the management of hematological patients.

Introduction: Enhancing lymphoma outcomes increases the risk of therapy-related neoplasms such as acute myeloid leukemia (t-AML) and myelodysplastic syndrome (t-MDS).

Material and methods: Our study, conducted at seven Polish hematology centers between 2011 and 2018, explores clinical features, outcomes, and prognostic factors of t-AML and t-MDS arising after initial lymphoid neoplasms.

Results: The analysis included 57 patients of median age 65 with t-MDS (n = 38) and t-AML (n = 19). The median time to the onset of t-MDS/AML was 58.7 months. The median overall survival (OS) was 16.1 months. The presence of unfavorable cytogenetics and molecular risk factors (HR 2.88, 95% CI: 1.29-6.42, p = 0.009), hemoglobin level (HR 0.79, 95% CI: 0.65-0.95, p = 0.01) and platelets (HR 0.99, 95% CI: 0.99-0.9996, p = 0.03) were independent prognostic factors influencing OS. Therapy- related myelodysplastic syndrome/acute myeloid leukemia after lymphoma treatment is associated with a dismal prognosis mainly due to poor cytogenetic risk.

Conclusions: Anemia and thrombocytopenia may indicate more severe impairment of bone marrow function, resulting in further inferior treatment outcomes.

Introduction: Bladder cancer is the ninth most common tumour entity worldwide. Aberrant expression of different keratins has been described in bladder cancer, which is used for diagnostic purposes, but it can also have prognostic value. However, not all keratins have been analysed in bladder cancer, and whether keratins are important for cell viability of bladder cancer tumour cells is not yet known.

Material and methods: We analyse the expression of CK10, CK13, and CK14 in 4 different urinary bladder transitional cell carcinoma cell lines via western blot. Furthermore, we downregulate the expression of CK13 and CK14 using siRNAs and evaluate the cell viability of the carcinoma cells.

Results: In this study, we show that different urinary bladder transitional cell carcinoma cell lines have distinct expression pattern of the keratins CK10, CK13, and CK14. Using several siRNAs targeting either CK13 or CK14, we show that both keratins have long protein half-lives. Although we achieve a reduction in CK13 and CK14 protein levels, these reductions do not influence the cell viability of the cell lines.

Conclusions: In conclusion, we provide evidence that CK10, CK13, and CK14 are expressed on the protein level in different urinary bladder transitional cell carcinoma cell lines, but that their targeting does not affect the viability of the carcinoma cells.

Salivary gland carcinomas (SGCs) are highly heterogeneous histopathological entities that arise in either the major or minor salivary glands. Although uncommon, these tumours exhibit considerable aggressiveness, unpredictable progression, and significant mortality. The fifth edition of the World Health Organisation classification of head and neck tumours distinguishes between 24 salivary gland malignancies. This may lead to difficulties in terms of diagnostic accuracy and suitable therapeutic selection. Mucoepidermoid carcinoma occurs most frequently and is characterised by gradual disease progression. Although salivary duct carcinoma, myoepithelial carcinoma, and carcinoma ex pleomorphic adenoma are rarely detected, they contribute to poor patient outcomes. Currently, attempts have been made to establish molecular characterisation of SGCs to improve differential diagnosis and create targeted treatments. This study aimed to summarise current knowledge regarding genetic variations in the most common salivary gland malignancies.

Introduction: To calculate the number of days patients with terminal non-small cell lung cancer (NSCLC) spent at home in the last 3 months of life, and to identify factors that predict a lower proportion of days at home.

Material and methods: Retrospective study of 434 deceased patients with NSCLC. The number of days spent in a hospital or nursing home was identified from electronic health records.

Results: Most patients received primary chemotherapy. Only 45% received palliative care provided by a dedicated palliative care team (PCT). In the last 3 months of life, only 39 patients (9%) were not hospitalized. The median number of days spent in hospital was 17, range 0-61. Hospital death occurred in 48%. Admission to a nursing home was recorded in 45%. Overall, the patients spent a median of 64 days at home. Both, older patients and females spent fewer days at home. Family network and aspects of palliative care, possibly reflecting the symptom duration or burden, also impacted days at home.

Conclusions: Long-lasting need for PCT support (not just the final 3 months) and earlier necessity for opioid analgesics were predictive for a reduced number of days at home. However, modifiable factors such as sex were identified too.

Introduction: To evaluate and report the outcome of a patient with locally recurrent uveal melanoma (UM) previously treated with brachytherapy (BT), using a second personalized globe-sparing radiotherapy approach.

Material and methods: In June 2020, a 78-year-old man arrived at our institution with diplopia and suspected uveal melanoma. At the ophthalmological evaluation (B-scan and A-scan ultrasonography) a lesion in the right eye at 6-7 hours of about 5 mm thickness, with internal lacunar areas, approximately 7 mm away from the limbus, was observed. The patient underwent ruthenium plaque BT at a total dose of 110 Gy prescribed to the apex of the tumour. At the follow-up, the lesion was under control until September 2021, but it recurred with a satellite exudative detachment in the lower and temporal sectors 7-10 hours. At the B-scan the lesion had a maximum thickness of 4.6 mm. Subsequently, in a multidisciplinary discussion, one single fraction stereotactic radiosurgery was scheduled. The prescribed dose was 27 Gy in the de-novo lesion and 24 Gy in the previously irradiated site. Stereotactic radiosurgery was performed in October 2021.

Results: The time interval between the 2 treatments was 15 months. Twenty months after recurrence, local tumour control was observed, and no metastases were detected on follow-up examinations. No severe acute or late toxicity was observed due to the retreatment.

Conclusions: Photon stereotactic radiotherapy is a feasible, acceptably tolerated modality, and it represents an eye-preserving treatment also for patients with recurrent UM unfit for BT.

Introduction: This study aimed to evaluate the treatment outcomes of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy alone or in combination with locoregional brain therapy for advanced EGFR-mutant non-small cell lung cancer (NSCLC) patients with brain metastases.

Material and methods: A retrospective study involving 72 advanced EGFR-mutant NSCLC patients with brain metastases at the Vietnam National Cancer Hospital were conducted. Patients were divided into 2 groups: EGFR-TKI (erlotinib) monotherapy and EGFR-TKI combined with locoregional therapy (γ knife surgery - GKS or whole-brain radiation therapy). Evaluation criteria included clinical and laboratory characteristics, central nervous system (CNS) progression time, progression-free survival (PFS), overall survival (OS), T790M mutation rate, and adverse events.

Results: Epidermal growth factor receptor tyrosine kinase inhibitor monotherapy patients had better performance status (PS), fewer CNS symptoms, and significantly fewer brain metastases (p < 0.05). Median PFS and OS were 11 and 25 months, respectively, in both groups. Patients with PS 0-1 had longer median PFS (15 months) than those with PS 2 (7 months) (p = 0.039). Exon 19 deletion patients in both groups had longer median OS (26 months) than those with L858R exon 21 (15 months) (p = 0.023). Patients with T790M mutation who received osimertinib after progression had longer median OS (41 months vs. 23 months, p = 0.0001). Median time to CNS progression was 13.9 months (48 patients). Longer time to CNS progression correlated with longer OS (R² = 0.89).

Conclusions: Epidermal growth factor receptor tyrosine kinase inhibitor therapy, with or without locoregional therapy, is effective for advanced EGFR-mutant NSCLC patients with brain metastases. Exon 19 deletion patients had better prognosis.