Elżbieta Pluta

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.

Postoperative Irradiation of Incompletely Excised Gemistocytic Astrocytomas

Background and Purpose:Although gemistocytic astrocytomas are considered slow-growing tumors, they often behave aggressively and carry the least favorable prognosis among low-grade astrocytomas. The aim of this study is to evaluate the outcomes and prognostic factors of patients with incompletely excised gemistocytic astrocytomas irradiated postoperatively.Patients and Methods:Records of 48 patients with incompletely excised gemistocytic astrocytoma, irradiated between 1976 and 1998 at the Department of Radiation Oncology, Maria Skłodowska-Curie Memorial Cancer Center, Cracow, Poland, were reviewed. The total dose ranged from 50 to 60 Gy (mean: 59.35, median: 60 Gy) delivered in daily fractions of 2 Gy, 5 days a week. The treatment volume covered the residual tumor with a margin of 1–2 cm.Results:Toxicity was acceptable. The overall actuarial survival rates at 5 and 10 years were 30% and 17%, respectively. Age and gender had an influence on overall survival by univariate and multivariate analysis (p < 0.05). Patients ≤ 35 years of age and female patients carried the best prognosis.Conclusion:In most patients with gemistocytic astrocytoma, combined surgery and postoperative radiotherapy result in only short-term survival. Older age is the most important unfavorable prognostic factor in patients with gemistocytic astrocytoma.Hintergrund und Ziel:Gemistozytische Astrozytome gehören zur Gruppe der langsam wachsenden Tumoren, sind jedoch sehr aggressiv und besitzen die schlechteste Prognose unter den hochdifferenzierten Astrozytomen. Ziel dieser Arbeit ist die Beurteilung der Behandlungsergebnisse und prognostischer Faktoren bei Patienten mit gemistozytischen Astrozytomen nach nicht radikaler Tumorexzision und adjuvanter Bestrahlung.Patienten und Methodik:Eine Gruppe von 48 Patienten mit gemistozytischen Astrozytomen, die in den Jahren 1976–1998 nach nicht radikaler Tumorexzision im Onkologiezentrum Krakau, Polen, adjuvant bestrahlt worden waren, wurde analysiert. Die Gesamtdosis lag zwischen 50 und 60 Gy (Mittelwert: 59,35, Median: 60 Gy) in täglichen Fraktionen von 2 Gy an 5 Tagen pro Woche. Der bestrahlte Bereich umfasste den Resttumor mit einem Rand von 1–2 cm.Ergebnisse:Die Therapie wurde gut toleriert. Die aktuarische Gesamtüberlebensrate nach 5 bzw. 10 Jahren betrug 30% bzw. 17%. In der uni- und multivariaten Analyse zeigten Alter und Geschlecht einen signifikanten Einfluss auf das Gesamtüberleben. Patienten ≤ 35 Jahre und Frauen hatten die beste Prognose.Schlussfolgerung:Durch die Kombination aus Operation und Bestrahlung lässt sich bei den meisten Patienten mit gemistozytischem Astrozytom das Überleben nur kurzfristig verlängern. Hohes Alter ist der wichtigste ungünstige prognostische Faktor bei Patienten mit gemistozytischen Astrozytomen.

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.

The tolerance of proton radiotherapy — preliminary results

Introduction. Because the specific proton beam dose distribution (i.e. the so-called ’Bragg curve’), proton radiotherapy ensures that the high-dose region is precisely confined to the target volume while minimizing the dose delivered to healthy tissues/critical organs surrounding the tumour or to those lying in the path of the proton beam. This method has been used for patients in Krakow since November 2016. Aim. To report the early tolerance outcomes to proton radiotherapy in patients completing their treatment just before the end of August 2017. Materials and methods. Study subjects were 47 patients who had completed their treatment before the end of August 2017 with a mean age of 41.6 years (range: 16–76, median: 40). The most frequent diagnoses were skull base tumours (22 pts. — 46.8%) and brain G1 or G2 gliomas (17 pts. — 36.2%), whereas the most frequent histological types were chordomas (17 pts. — 36.2%). Proton radiotherapy was administered by pencil beam scanning and consisted of using the intensity modulated proton therapy (IMPT) technique. The total dose given per cancer type averaged as follows: (i) 70 and 74 Gy(RBE), for respectively chodrosarcomas and chordomas, (ii) 54 Gy(RBE) for brain gliomas and (iii) 70 Gy(RBE) for paranasal sinuses tumours. Early tolerance was prospectively evaluated and measured according to the CTCAE scale, version 4.03. Results. In all, 91 side effects (SE) were recorded in 44 patients. The intensity of SEs were as following: 62 SEs (68.1%) were of grade 1 intensity, 21 SEs (23.1%) were of grade 2 and 8 SEs (8.8%) were of grade 3. The most frequently developed SEs were skin reactions (29 pts. — 61.7%) or oral/pharyngeal mucositis (20 pts. — 42.6%). Because the patient follow-up period was short, presented results only describes the early tolerance to this therapy. Our findings of mild intensities for the most early side effects, at (grades 1 or 2) are consistent with other published studies.

Methods and results of local treatment of brain metastases in patients with breast cancer

This article presents methods and results of surgical treatment and radiation therapy of brain metastases in breast cancer patients (brain metastases from breast cancer BMF-BC). Based on the literature data, it was shown that patients with single BMF-BC, aged less than 65 years, with Karnofsky score (KPS) of 70 or more and with cured or controlled extracranial disease are the best candidates to surgical treatment. Irrespective of the extracranial disease control status, there are indications for surgery in patients with symptomatic mass effect (tumour diameter larger than 3 cm) and patients with obstructive hydrocephalus from their BMF-BC. Stereotactic radiosurgery (SRS) has some advantages over surgery, with similar effectiveness: it may be used in the treatment of lesions inaccessible to surgery, the number of lesion is not a limiting factor if each lesion is small (< 3) and adequate doses can be delivered, it is not contraindicated in patients with active extracranial disease, it does not interfere with ongoing systemic treatment, and it does not require general anaesthesia or hospitalisation. A disadvantage of SRS, as compared to whole brain radiotherapy (WBRT), in patients with BMF-BC is the possibility of subsequent development of new lesion in the non-irradiated field. Thus the majority of the BMF-BC patients are not good candidates to surgery or SRS; WBRT alone or combined with a systemic treatment still plays a major role in the treatment of these patients.

Role of irradiation in combined treatment of head and neck paragangliomas at the Centre of Oncology in Krakow between 1970–2005

Aim of the study Aim of the study is to evaluate the results of postoperative radiotherapy of paragangliomas, prognostic factors and causes of treatment failure. Material and methods Forty-four patients (39 females and 5 males) aged 20 to 74 years were treated for paraganglioma between 1970 and 2010 at the Centre of Oncology in Kraków. Patient survival probability was estimated with the Kaplan-Meier method. Log-rank tests and Cox proportional hazard model were used in univariate and multivariate analysis, respectively. Results The most common locations of paragangliomas were the following: the ear, carotid body and internal jugular vein bulb. Forty (91%) out of them were benign and 4 – malignant. All patients underwent surgery followed by adjuvant radiotherapy. The delivered dose ranged from 50 to 72 Gy, the mean dose was 60 Gy. Five-year overall survival was 84%. Five-year relapse-free survival was 84%, either. The multivariate analysis has shown that the dose in an independent prognostic factor for the overall survival. The univariate analysis has shown significantly higher 5-year overall survival in patients who received a dose of 60 Gy or higher – 92% vs. 70% in patients who received a dose lower than 60 Gy. Conclusions Postoperative radiotherapy with doses higher than 60 Gy in patients with paragangliomas is associated with longer overall survival.

Postoperative treatment of patients with anaplastic oligodendrogliomas. Thirty years' experience of the Maria Sklodowska-Curie Memorial Centre in Kraków, 1975–2000

Summary Background Anaplastic oligodendrogliomas (AO) are infiltrative, mostly supratentorial tumours, often bilaterally affecting the white matter. Radiotherapy alone or in combination with chemotherapy have a role in the adjuvant treatment of AO, but currently the efficacy of various treatment modalities could not be definitively determined because of the heterogeneity of the therapies used. Aim Assessment of the efficacy of altered therapy schedules in postoperative treatment of patients with anaplastic oligodendrogliomas Materials/Methods Between 1975 and 2000, 101 adult patients with anaplastic oligodendrogliomas were postoperatively treated in our institution. During this period patients received conventional radiation therapy and chemotherapy (CRT/CH), conventional radiation therapy (CRT), and split course hypofractionated radiation therapy (SCHRT). Between 1975 and 1985, CRT/CH was applied in 42 patients. Whole brain irradiation was delivered; the tumour dose of 5Gy in 25 fractions over 5 weeks was calculated at the midplane of the skull. Then treatment fields were reduced and a 10Gy boost was given in 5 fractions over 5 days to the known tumour bearing area. On the last day of irradiation patients began the first of six planned series of chemotherapy with CCNU, given 100mg/ 2 , orally every 8 weeks. From 1986 to 1990, CRT was received by 27 patients. Irradiation was only as described above. Between 1991 and 2000, 32 patients were given SCHRT. There were 3 courses of irradiation separated by a one-month interval. In each of the two first series patients received 20Gy in 5 fractions in five days to the whole brain, and in the third course a 20Gy boost in 5 fractions over 5 days was given as in the CRT regimen. Results Actuarial overall survival rates at two and five years were 38% and 10% respectively for patients treated with CRT/CH, 36% and 11% for the CRT group, and 23% and 6% for the SCHRT option. Multivariate analysis revealed that only age was a significant factor. Patients aged 45 years or less carried the best prognosis. Conclusions The efficacy of different postoperative treatments administered to our patients with anaplastic oligodendrogliomas gave approximately comparable and unrewarding poor results.

Napromienianie dwa razy dziennie podwyższoną dawką frakcyjną chorych z przerzutami nowotworów złośliwych do mózgu. Wyniki końcowe prospektywnego badania klinicznego w nierandomizowanej grupie chorych

Streszczenie Cel Ocena toksyczności i efektywności napromieniania 2 x dziennie u chorych z przerzutami nowotworu zlośliwego do mozgu. Material / metoda W tym celu dokonano prospektywnej oceny napromieniania u 116 chorych leczonych w Klinice Radioterapii Centrum Onkologii Oddzial w Krakowie w okresie od 1992 do 2000 r. Napromienianie prowadzono dwa razy dziennie podwyzszoną dawką dzienną wynoszącą 3 Gy z minimalną przerwą 6 godzin do dawki calkowitej 39 Gy. Chorzy zakwalifikowani do badania byli w stanie ogolnym wynoszącym przynajmniej 50 wedlug skali Karnofskiego. Średni wiek chorych wynosil 55 lat. Wyniki Wczesna tolerancja leczenia byla dobra, jedynie 20 chorych wymagalo leczenia przeciwobrzekowego. Ocena efektywności wykazala, ze w 22% (26/116) stwierdzono poprawe stanu neurologicznego. U 86 chorych stan neurologiczny nie ulegl zmianie, a jedynie u 3 chorych ulegl pogorszeniu. Przezycie ogolne 12-miesieczne oraz 12-miesieczne przezycie bez objawow progresji objawow neurologicznych wyniosly odpowiednio 21% i 10%. Najlepsze rokowanie zaobserwowano u chorych, u ktorych radioterapia byla poprzedzona operacyjnym usunieciem ogniska przerzutowego w mozgu. Podsumowanie Napromienianie dwa razy dziennie podwyzszoną dawką frakcyjną jest metodą leczenia o akceptowalnej toksyczności leczenia i charakteryzującą sie dobrą skutecznością.