Beata Sas-Korczyńska

Comparison of the Effectiveness of “Late” and “Early” Prophylactic Cranial Irradiation in Patientswith Limited-Stage Small Cell Lung Cancer

Purpose:To evaluate the effectiveness of timing of application of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer in limited stage of disease (LS SCLC).Patients and Methods:Between 1995 and 2004, 129 patients with LS SCLC were treated within two consecutive phase II studies assessing different schedules of combined treatment. All patients received chemotherapy and concurrent thoracic radiotherapy. In 86 patients (66.7%) who developed complete response in the thorax, PCI was performed either after chemoradiotherapy (“late” PCI , n = 45 [52.4%]) or during chemoradiotherapy (“early” PCI, n = 41 [47.7%]). In the latter case, PCI was given immediately after the end of thoracic radiotherapy and prior to the last cycles of chemotherapy to a total dose of 30 Gy in 2-Gy fractions to the whole brain. The results were evaluated with regard to 4-year rates of overall survival, disease-free survival, and brain metastases-free survival. Additionally, the prognostic role of PCI application and its time delay in relation to survival rates and incidence of brain metastases was estimated.Results:The 4-year survival rates were 25.5% for overall survival, 26.8% for disease-free survival, and 67.8% for brain metastases- free survival. During the observation period, 32 patients (24.8%) developed brain metastases, which occured in 20 of 43 patients (46.5%) without and only in twelve out of 86 patients (14%) with PCI. The 4-year brain metastases-free survival rates were 81.8%, if PCI was applied, versus 32.2%, if no such procedure was used (for p = 0.0000). The timing of PCI appeared to be an important factor in terms of decreasing the incidence of brain metastases.Conclusion:PCI significantly decreases the incidence of brain metastases and delays their development in patients with LS SCLC. “Early” PCI is more effective than PCI applied after combined therapy.Ziel:Evaluation der Effektivitat einer korrekten zeitlichen Planung einer prophylaktischen Ganzhirnbestrahlung (PCI) bei Patienten mit kleinzelligem Bronchialkarzinom im Limited-Disease-Stadium (LS-SCLC).Patienten und Methodik:Zwischen 1995 und 2004 wurden 129 Patienten mit LS-SCLC in zwei aufeinanderfolgenden Phase-II-Studien behandelt, in denen zu unterschiedlichen Zeitpunkten eine Kombinationstherapie verabreicht wurde. Alle Patienten erhielten eine Chemotherapie mit gleichzeitiger thorakaler Bestrahlung. 86 Patienten (66,7%), die eine positive Reaktion im Thorax entwickelten, wurden einer PCI unterzogen, wobei diese in 45 Fallen (52,4%) nach der Radiochemotherapie („spate“ PCI) und in den restlichen 41 Fallen (47,7%) während derselben („fruhe“ PCI) durchgeführt wurde. In letzterem Fall wurde die PCI unmittelbar nach Beendigung der Thoraxbestrahlung vor den letzten Chemotherapiezyklen in einer Gesamtdosis von 30 Gy in 2-Gy-Fraktionen auf das gesamte Gehirn verabreicht. Die Ergebnisse wurden in Bezug auf die 4-Jahres-Raten des Gesamtüberlebens, des krankheitsfreien Überlebens und des hirnmetastasenfreien Überlebens beurteilt. Zusatzlich wurde die prognostische Rolle der PCI-Anwendung und deren zeitlicher Verzogerung im Hinblick auf Überlebensraten und Inzidenz von Hirnmetastasen bewertet.Ergebnisse:Die 4-Jahres-Überlebensraten betrugen 25,5% fur das Gesamtüberleben, 26,8% fur das krankheitsfreie Überleben und 67,8% fur das hirnmetastasenfreie Überleben. Bei 32 Patienten (24,8%) traten während des Beobachtungszeitraums Hirnmetastasen auf, die sich bei 20 von 43 Patienten (46,5%) ohne und lediglich bei zwölf von 86 Patienten (14%) mit PCI entwickelten. Die hirnmetastasenfreie 4-Jahres-Überlebensrate betrug bei Einsatz der PCI 81,8% gegenüber 32,2% bei den Patienten, die keine PCI erhielten (fur p = 0,0000). Der richtige Zeitpunkt der Durchführung einer PCI erwies sich als wichtiger Faktor fur die Abnahme der Inzidenz von Hirnmetastasen.Schlussfolgerung:Eine PCI senkt die Inzidenz von Hirnmetastasen signifikant und verzogert deren Entwicklung bei Patienten mit LS-SCLC. Eine „fruhe“ PCI ist effektiver als eine nach Kombinationstherapie durchgeführte PCI.

The Efficiency and Tolerance of Half-Body Irradiation (HBI) in Patients with Multiple Metastases

Aim To present our experience regarding the efficiency and tolerance of half-body irradiation in patients with multiple cancer metastases. Patients and Methods: Between January 1986 and December 1997, 102 patients with multiple cancer metastases received half-body irradiation (HBI) at the Center of Oncology – Maria Sklodowska-Curie Memorial Institute in Krakow. Most of the patients (93/102) had bone metastases (Table 1). The HBI was performed with 9 MV photon beam from linear accelerator. In 88 patients only one region (upper, mid or lower) was treated, and 14 patients received upper and lower HBI (13 patients), or upper and mid HBI (one patient) (Table 2). The mean doses were: 6 Gy in upper HBI, 8 Gy in mid HBI, and 9 Gy in lower HBI (Table 3). Results: The positive palliative effect (complete or partial pain relief) was observed in 77 (75.5%) patients (Table 4). Complete pain relief was higher in patients with prostate cancer, and in patients who received mid or lower HBI. During follow-up 47 (46.1%) patients developed pain progression after treatment (Table 5). The probability of survival without pain progression was higher in patients who developed complete pain relief (86.7% at 6 months, 69.3% at 12 and 24 months) than in patients with partial response (52.9% at 6 months, 32.8% at 12 months, and 5.5% at 12 and 24 months) (Figure 1). In most of the patients (74/102, 72.5%) the tolerance was good. Conclusions: HBI is an efficient method for palliation in patients with multiple painful metastases.Ziel Darstellung unserer Erfahrungen hinsichtlich Wirksamkeit und Verträglichkeit der Halbkörperbestrahlung bei Patienten mit multiplen Tumormetastasen. Patienten und Methodik: Zwischen Januar 1986 und Dezember 1997 erhielten 102 Patienten mit multiplen Metastasen am Onkologie-Zentrum des Maria-Sklodowska-Curie-Memorial-Institutes in Krakau eine Halbkörperbestrahlung. Die meisten Patienten (93/102) hatten Knochenmetastasen (Tabelle 1). Die Halbkörperbestrahlung wurde mit 9-MV-Photonen eines Linearbeschleunigers durchgeführt. Bei 88 Patienten wurde nur eine Region (obere, mittlere oder untere) bestrahlt; 14 Patienten erhielten eine obere und untere Halbkörperbestrahlung (n = 13) oder obere und mittlere Halbkörperbestrahlung (n = 1) (Tabelle 2). Die Dosis betrug im Mittel 6 Gy bei oberer Halbkörperbestrahlung, 8 Gy bei mittlerer und 9 Gy bei unterer Halbkörperbestrahlung (Tabelle 3). Ergebnisse: Eine gute Palliation (vollständige oder teilweise Schmerzlinderung) wurde bei 77 Patienten (75,5%) beobachtet (Tabelle 4). Zu kompletter Schmerzlinderung kam es häufiger bei Prostatakarzinompatienten und bei Patienten, die mittlere oder untere Halbkörperbestrahlung erhalten hatten. Im weiteren Verlauf kam es bei 47 Patienten (46,1%) zur Schmerzprogression (Tabelle 5). Die Wahrscheinlichkeit, ohne Schmerzprogression zu überleben, war bei Patienten mit kompletter Schmerzlinderung höher (86,7% nach 6 Monaten, 69,3% nach 12 und 24 Monaten) als bei Patienten mit partiellem Ansprechen (52,9% nach 6 Monaten, 32,8% nach 12 und 5,5% nach 24 Monaten) (Abbildung 1). Die Verträglichkeit war bei den meisten Patienten gut (74/102; 72,5%). Schlussfolgerung: Die Halbkörperbestrahlung ist eine wirksame Palliativmethode für Patienten mit multiplen schmerzhaften Metastasen.

Palliative thoracic radiotherapy for patients with advanced non-small cell lung cancer and poor performance status

OBJECTIVE The evaluation of efficacy of palliative thoracic radiotherapy (PTR) in patients with advanced non-small cell lung cancer (NSCLC) and to compare it with efficacy of supportive care (SC) alone. MATERIALS AND METHODS Between 2000 and 2012, 235 patients with advanced NSCLC (IIIB and IV) and Karnofsky Performance Status accounted 40-30, were qualified to PTR. In fact, 125 (53.2%) out of them were treated with PTR, and 110 (46.8%)-with SC alone, in accordance with patients expectations. There were no differences between PTR and SC group with respect to patient and tumor characteristics as well as with respect to the type and incidence of symptoms related to the local growth of NSCLC. In all 125 PTR patients the delivered tumor dose was 20Gy given in five daily fractions over five treatment days. All 110 patients who refused PTR were treated with SC in another hospital (28.2%), in a hospice (21.8%) or by general practitioners at home (50.0%). RESULTS The 90-day overall survival rate in the group of PTR patients was 20.0%, and in the group of SC patients it was 18.2%. Median survival amounted 58 and 59 days, respectively. The efficacy of PTR and SC, relative to the symptoms associated with the local growth of NSCLC, was comparable. Tolerance of PTR was poor and early toxicity-significant. Moreover 41.6% of irradiated patients received PTR within the last 30 days of their lives and 16.0% of these patients-within the last 15 days prior to death. CONCLUSION The life expectancy of patients with advanced NSCLC and poor performance status (Karnofsky 40-30), who presenting moderate or severe symptoms related to the local growth of cancer, is measured in days or weeks. The effective method of treatment for these patients is modern supportive care rather than PTR.

Tracheal cancer: Role of radiation therapy.

PURPOSE To assess the results of tracheal cancer patients treatment and factors influencing prognosis. BACKGROUND Primary malignant neoplasms of the trachea are rare. The treatment of choice for tracheal carcinomas is resection. Radiation therapy is recommended as a part of radical treatment or for palliation of symptoms. MATERIALS AND METHODS Between 1962 and 2006, 50 patients diagnosed with tracheal cancer were treated at the Centre of Oncology in Krakow. The analysis focused on locoregional recurrence-free survival (LRRFS), disease free survival (DFS) and overall survival (OS). Survival rates, univariate and multivariate analyses of prognostic factors were performed using the Kaplan-Meier method, the log rank test and Coxs proportional hazard method, respectively. For over 40 years, patients were treated using different modalities: surgery followed by radiotherapy (6%), radiotherapy (78%), chemoradiotherapy (8%), and symptomatic treatment (8%). RESULTS The 5-year LRRFS was 18%, DFS was 15% and OS was 17%. gender (favoured females) was the only prognostic factor for LRRFS. For OS, the independent prognostic factors were performance status (favoured Karnofsky higher than 80), stage and year of start of the treatment (later than 1988 vs. earlier - 5-year OS 20% vs. 12%). 5-year OS in the following (strongly differentiated over the time) treatment modalities were: surgery followed by radiotherapy (66%), radiotherapy (16%), chemoradiotherapy (0%), and symptomatic treatment (0%). Of 44 patients treated with radiotherapy symptomatic partial response was observed in 32 patients and follow-up imaging studies revealed complete response in 5 patients, partial response in 25, stable disease in 4 or progressive disease in 4. CONCLUSIONS Radical treatment in patients in early stage and good performance status seems to be correlated with the improvement of survival. However, despite the fact that results of treatment are poor, radiotherapy offers symptomatic improvement.

Degree of Enhancement on Contrast Enhanced Spectral Mammography (CESM) and Lesion Type on Mammography (MG): Comparison Based on Histological Results

Background Contrast enhanced spectral mammography (CESM) is a new method of breast cancer diagnosis in which an iodinated contrast agent is injected and dual-energy mammography is obtained in multiple views of the breasts. The aim of this study was to compare the degree of enhancement on CESM with lesion characteristics on mammography (MG) and lesion histology in women with suspicious breast lesions. Material/Methods The degree of enhancement on CESM (absent, weak, medium, or strong) was compared to lesion characteristics on MG (mass, mass with microcalcifications, or microcalcifications alone) and histology (infiltrating carcinoma, intraductal carcinoma, or benign) to compare sensitivity of the two modalities and to establish correlations that might improve diagnostic accuracy. Results Among 225 lesions identified with CESM and MG, histological evaluation revealed 143 carcinomas (127 infiltrating, 16 intraductal) and 82 benign lesions. This is the largest cohort investigated with CESM to date. The sensitivity of CESM was higher than that of MG (100% and 90%, respectively, p=0.010). Medium or strong enhancement on CESM and the presence of a mass on MG was the most likely indictor of malignancy (55.1% p=0.002). Among benign lesions, 60% presented as enhancement on CESM (were false-positive), and most frequently as medium or weak enhancement, together with a mass on MG (53%, p=0.047). Unfortunately, the study did not find combinations of MG findings and CESM enhancement patterns that would be helpful in defining false-positive lesions. We observed systematic overestimation of maximum lesion diameter on CESM compared to histology (mean difference: 2.29 mm). Conclusions Strong or medium enhancement on CESM and mass or mass with microcalcifications on MG were strong indicators of malignant transformation. However, we found no combination of MG and CESM characteristics helpful in defining false-positive lesions.

Pure and Mixed Mucinous Carcinoma of the Breast: A Comparison of Clinical Outcomes and Treatment Results.

Mucinous breast carcinoma (MBC) carcinoma represents approximately 1–6% of all malignant breast carcinoma and is divided into pure (PMBC) and mixed (MMBC) subtypes. This study presents the comparison of clinical characteristics and treatment results in 70 patients with PMBC and 40 patients with MMBC, treated at a single institution during 25 years. Performed analyses showed that only nodal status was different in both subtypes. Patients with MMBC showed a significantly higher incidence of axillary nodal metastases in comparison to PMBC (25% versus 10%, respectively). Instead, the 10‐year disease‐free survival rate was significant higher in PMBC than MMBC (85.7% versus 65%, p < 0.02, test log rank). Authors own observations and data from literature proved that MMBC should be considered as subtypes of mucinous breast cancer.

Mucinous breast cancer – clinical characteristics and treatment results in patients treated at the Oncology Centre in Kraków between 1952 and 2002

Aim of the study To present the characteristics and clinical outcomes in 94 patients with mucinous breast cancer treated at the Oncology Centre in Krakow between 1952 and 2002. Material and methods Stage I or II carcinomas were found in 66 patients (69.4%) of the presented group and in the remaining 28 patients (29.8%) stage III disease was diagnosed. In 27 cases regional lymph nodes were involved. All patients had been treated with surgery: mastectomy (90 patients) or breast-conserving treatment (4 patients). Radiotherapy was administered in 14 patients, adjuvant chemo-therapy in 14 patients, and endocrine therapy in 39 patients. Results The maximum follow-up was 257 months. Ten-year survival was as follows: 75.7% (overall survival), 82.5% (disease-free survival). During the follow-up, 4 patients developed local recurrence, 5 patients developed metastases. Second primary cancer was found in 8 patients. Conclusions The presented results confirm the good prognosis in patients treated for mucinous breast cancer. The diagnosis of early-stage breast cancer based on mammography can allow breast-conserving treatment.

Preliminary results of proton radiotherapy for choroidal melanoma - the Kraków experience

Aim of the study The objective of the study was to present the preliminary results of proton radiotherapy as a method for treating 15 patients with choroidal melanoma. Material and methods The proton radiotherapy was administered using beams providing energy levels of 60 MeV, which ensures a clinical range of 28.4 mm. In addition, the beam has a very narrow penumbra of 1.3 mm and a sharp distal dose fall-off. All patients received the dose of 60 CGE (cobalt gray equivalent) given to the PTV (planning target volume). This dose was administered in 4 fractions over 4 successive days of treatment. Results The tumour had regressed in 8 patients (53.3%) and remained stable in 3 patients (20%). The large tumours in another 3 patients (20%) were removed during vitrectomy (endoresection), which increased the number of patients with tumour regression up to 11 (73.3%). In the case of 1 patient, despite intraocular tumour regression occurring the choroidal melanoma had spread multifocally into the orbit, which necessitated orbit exenteration. The results ensured that the eyeballs of 14 patients (93.3%) could be saved. The follow-up period for the 15 patients ranged between 8 and 26 months (average: 17.4 months, median: 19 months). In this period some side effects were noted: an increase in intraocular pressure, retinal detachment, cataract, maculopathy, neuropathy and vitreous haemorrhaging. Conclusions The preliminary results confirm that proton radiotherapy is an effective method for treating patients with choroidal melanoma. This method ensures an eyeball preservation rate of 93%, with the vision function of 80% of the patients being saved.

Metaplastic breast cancer with rapidly progressive recurrence in a young woman: case report and review of the literature

Corresponding author: Jerzy W. Mituś MD, PhD Department of Surgical Oncology Centre of Oncology Maria Skłodowska-Curie Memorial Institute Krakow Branch 11 Garncarska St 31-115 Krakow, Poland Phone: +48 12 422 49 28 Fax: +48 12 423 10 76 E-mail: jerzy.mitus@gmail.com 1 Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Krakow, Poland 2 Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland 3 Clinic of Oncology, Department of Breast and Chest Cancer, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Krakow, Poland 4 Department of Tumour Pathology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Krakow, Poland 5 Department of Systemic and Generalized Malignancies, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Krakow, Poland

Radiotherapy alone as a method of treatment for sinonasal mucosal melanoma: A report based on six cases and a review of current opinion

Objectives Radiotherapy in patients with sinonasal mucosal melanoma (SNMM) was given as alternative treatment to surgery in cases with advanced, inoperable tumors or those not eligible for surgery. We presented the outcomes for patients with SNMM treated with radiotherapy alone. Material and methods The retrospective review of 6 consecutive SNMM (nasal cavity - 4 pts. and paranasal sinus - 2 pts.) patients (3 males and 3 females at mean age 64 years) treated between 2008 and 2016 was presented. The stage of disease was: T3 (1 pt.), T4a (3 pts.), T4b (2 pts.); with N0 and M0 in all patients. All patients underwent definitive primary photon radiotherapy (IMRT) alone; dose 66-72 Gy was delivered in 22-24 fractions given in 5 fractions (3 Gy) a week. Results The complete remission was observed in all our patients but only one patient survived 5 years without disease. Five patients died due to multiple distant metastases; two of those patients developed associated local recurrence 7-8 months after radiotherapy. Conclusion SNMM has a poor prognosis due to its high metastatic potential. Based on our numerically small report and data from literature we concluded that primary radiotherapy alone assured complete remission and even 5-year disease-free survival in only a few individual patients.