Małgorzata Moszyńska-Zielińska

Bone metastases from gynaecological epithelial cancers

The aim of this study was to investigate the clinical features and prognosis in patients with gynaecological epithelial cancers metastasised to bones. A total of 26 patients were studied retrospectively. Clinical and pathological data were analysed along with a follow-up. It was found that the interval from primary diagnosis of cancer until bony relapse varied between 0 and 163 months (31.4 ± 36.8). Bone metastases were solitary in 11 cases and multifocal in 15 cases. A total of 14 patients demonstrated only bony metastases while 12 had both bony and non-bony metastases. The time to follow-up from the diagnosis of osseous relapse varied between 1 and 43 months (10.0 ± 10.4). During follow-ups, 13 patients died and 13 patients survived. In both univariate and multivariate analyses, synchronous non-bony metastases and symptomatic treatment without oncological therapy impaired prognosis. It was concluded that even in the presence of multiple bone metastases, some patients may benefit from radiotherapy, chemotherapy or a combination of both, rather than palliative care alone, providing they do not have additional soft tissue metastases.

Does obesity hinder radiotherapy in endometrial cancer patients? The implementation of new techniques in adjuvant radiotherapy – focus on obese patients

The increasing incidence of obesity in Poland and its relation to endometrioid endometrial cancer (EEC) is resulting in the increasing necessity of treating obese women. Treatment of an overweight patient with EEC may impede not only the surgical procedures but also radiotherapy, especially external beam radiotherapy (EBRT). The problems arise both during treatment planning and when delivering each fraction due to the difficulty of positioning such a patient – it implies the danger of underdosing targets and overdosing organs at risk. Willingness to use dynamic techniques in radiation oncology has increased for patients with EEC, even those who are obese. During EBRT careful daily verification is necessary for both safety and treatment accuracy. The most accurate method of verification is cone beam computed tomography (CBCT) with soft tissue assessment, although it is time consuming and often requires a radiation oncologist. In order to improve the quality of such treatment, the authors present the practical aspects of planning and treatment itself by means of dynamic techniques in EBRT. The authors indicate the advantages and disadvantages of different types of on-board imaging (OBI) verification images. Considering the scanty amount of literature in this field, it is necessary to conduct further research in order to highlight proper planning and treatment of obese endometrial cancer patients. The review of the literature shows that all centres that wish to use EBRT for gynaecological tumours should develop their own protocols on qualification, planning the treatment and methods of verifying the patients’ positioning.

Expression of Vascular Endothelial Growth Factor (VEGF) and its Correlation with Clinical Symptoms and Endoscopic Findings in Patients with Chronic Radiation Proctitis

The aim of this study was to assess the expression of vascular endothelial growth factor (VEGF) as a key proangiogenic factor and determine whether there is any correlation between its expression and clinical symptoms or endoscopic changes in patients with chronic radiation proctitis (ChRP).

Central nervous system metastases from epithelial ovarian cancer

The aim of the study was to assess the clinical features and prognosis in patients with epithelial ovarian cancer (EOC) metastasised to the central nervous system (CNS). A total of 15 patients were studied retrospectively. Clinical and pathological data and follow-up were analysed. It was found that at the diagnosis of primary EOC, the patients were 41–69 years old (56.6 ± 8.3). The interval from diagnosis of primary EOC until the relapse was 2–39 months (19.1 ± 10.5). Palliative radiotherapy was the treatment of the CNS relapse in 13 patients (86.7%). The follow-up after CNS relapse varied 0.5–15 months (4.7 ± 4.2). At the time of retrospective analysis, none of the patients were still alive. Multifocality of the CNS metastases, the presence of synchronous extracranial metastases and locations in the brain were not associated with survival. It was concluded that the development of the CNS metastases seems to be not uncommon in patients with advanced ovarian cancer. Despite oncological treatment, they are indicators of poor prognosis, and most of the patients do not survive beyond the first year of follow-up.

Prolonged retention of the Lippes loop intrauterine device as a cause of vaginal bleeding 10 years after chemoradiotherapy of locally advanced cervical carcinoma: case report and review of the literature

Leszek Gottwald, Małgorzata Moszy nska-Zieli nska, Leszek _ Zytko, Adam Tomalczyk, Karolina Loga and Jacek Fijuth Department of Radiotherapy, Medical University of Lodz, Lodz, Poland; Department of Teleradiotherapy, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Lodz, Poland; Department of Imaging Diagnostics, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Lodz, Poland; Department of Radiotherapy and General Oncology, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Lodz, Poland

Pregnancy-related cervical cancer in the material of the Regional Cancer Centre, Łódź, between 2011 and 2014

Introduction. Pregnancy-related cancer is defined as cancer diagnosed during pregnancy or in the first postpartum year. Cervical cancer affects approximately 1 in 1000 pregnant women and is the most common malignancy affecting pregnancy. We retrospectively analysed the clinical outcome and results of treatment in patients with pregnancy-related cervical cancer. Material and methods. We retrospectively analysed the medical records of nine patients with invasive cervical cancer diagnosed during pregnancy and the postpartum period who had been treated in the Regional Oncological Centre, Łodź, between 2011–2014. Results. Three patients with cervical cancer at stage I were diagnosed between the 14 th and 17 th week of pregnancy afterwards and underwent radical surgery. Two patients with cervical cancer at stage Ib who were diagnosed in the 19 th and 24 th week of gestation decided to continue pregnancy until the 30 th and 32 nd week; then a cesarean section combined with radical surgery was performed. In three patients with inoperative cervical cancer diagnosed between the 26 th and 28 th week of pregnancy, a cesarean section was performed at week 30–32. In one patient cervical cancer at stage IIb was diagnosed during the post-partum period. All patients were treated using intensity-modulated radiotherapy (IMRT) to a total dose of 44 Gy/2Gy, weekly cisplatin (40 mg/m 2 ) concurrent with radiotherapy and brachytherapy. No toxicity was observed. During follow-up, two patients with inoperable cervical cancer were diagnosed with a recurrence 2 and 10 months after treatment, respectively. Conclusions. The management of pregnancy-related cervical cancer is mainly determined by the week of the pregnancy and the stage of the disease at diagnosis, but also by the patient choice. The general condition and follow-up of newborns from pregnancies complicated by cervical cancer are similar to those of newborns arising from non-complicated pregnancies. Treatment toxicity is similar in cases with pregnancy-related cervical cancer and in non-pregnant women with cervical cancer. The major prognostic factor in pregnancy-related cervical cancer remains the stage of the disease at diagnosis.

[Synchronous occurrence of four malignancies in a 55-year-old woman with uterine cervical cancer. Case report and review of literature].

Multiple primary malignancies are no longer rare in clinical practice. The incidence of multiple primary malignant neoplasms is the consequence of progress in oncological treatment and diagnostic methods, as well as the higher overall survival rate and life expectancy rate. We present a case of a patient who synchronously developed four malignancies: cervical cancer, breast cancer, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and an olfactory groove meningioma. This case proves that the diagnosis of the cervical cancer does not exclude the occurrence of other malignancies. It also emphasizes the fact that every case of uterine cervical cancer with atypical clinical presentation should be thoroughly analyzed to avoid diagnostic mistakes, which in turn may worsen the prognosis.