[show abstract][hide abstract] ABSTRACT: Tumor volume (TV) is recognized as a prognostic factor of treatment outcome for head and neck tumors but is not routinely included in the treatment decision-making process. The purpose of the study was to define its prognostic role for patients with T2 laryngeal cancer.
TV of 160 patients who underwent RT between 2002 and 2006 for T2 laryngeal squamous cell carcinoma were reviewed. The tumor was located in the glottis and epiglottis in 82 (51 %) and 78 (49 %) patients, respectively. TV was manually contoured on pretreatment, planning, contrast-enhanced CT scans and the volumetric measurement (cm(3)) was calculated by the volume algorithm.
The median TV value was 2.01 cm(3) (range 0.15-21.68 cm(3)). The median TV was significantly lower in patients with glottic tumors (p < 0.0001), N0 (p < 0.001), or well histopatologically differentiated tumors (p = 0.01). A significant correlation between TV, hemoglobin concentration (p < 0.01), and total dose (TD; p < 0.001) was observed. On univariate analyses, TV influenced local control (LC; p = 0.02) and overall survival (OS, p < 0.001). On multivariate analysis, both age (HR 1.038, p = 0.03) and TV (HR = 1.075, p = 0.01) remained significantly related to LC and OS (age: HR 1.038, p = 0.005; TV: HR 1.097, p = 0.0001).
Large TV worsen prognosis of patients with T2 laryngeal cancer. A large TV is more common for supraglottic, poorly differentiated tumors and may suggest higher risk of nodal spread. The routine estimation of TV prior to therapy may be essential in order to select the best treatment option for patients with T2 laryngeal cancer.
Strahlentherapie und Onkologie 08/2013; · 4.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this retrospective study was to report on the efficacy of radiotherapy alone in patients with T4-stage laryngeal cancer and to establish the prognostic value of (a) the size and location of the extralaryngeal tumor extensions and (b) of emergency tracheostomy.
A group of 114 patients were treated with definitive radiotherapy between 1990 and 1996. The piriform recess was involved in 37 cases (33 %), the base of the tongue and glosso-epiglottic vallecula in 34 cases (30 %), and the hypopharyngeal wall in 10 cases (9 %). In 16 cases (14 %), emergency tracheostomy was performed before radiotherapy. The mean total dose was 68 Gy (range, 60-77.6 Gy). The mean treatment time was 49 days (range, 42-74 days).
Actuarial 3-year local control (LC) was noted in 42 % of patients, disease-free survival (DFS) in 35 %, and overall survival (OS) in 40 %. The best prognosis was for the lesion suspected of cartilage infiltration: 56 % 3-year LC. The worst results were noted in the cases with massive infiltrations spreading from the larynx through the hypopharynx: 13 % 3-year LC. Emergency tracheostomy before radiotherapy was significantly connected with the worst treatment results (p = 0.000): 3-year LC in patients with tracheostomy was 0 % vs. 48 % in patients without tracheostomy.
Conventional radiotherapy of T4 laryngeal cancer is a method of treatment with limited effectiveness. The efficacy of radiotherapy is dependent on the location and extent of extralaryngeal infiltrations. Emergency tracheostomy is a prognostic factor connected with the worst prognosis.
Strahlentherapie und Onkologie 07/2013; · 4.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: A growing body of evidence shows that early life stress and breaking the mother-newborn bond (early maternal neonatal separation) cause damage to the natural breathing pattern, the immune response and to the general reaction to stress. Research on immune effects of emotional expression (Pennebaker), psychosomatic network (Pert et al.), mindfulness, pranayamas and neurobiology research on periaqueductal gray with associated neuro philosophy (Damasio, Watt) suggest beneficial impact of rhythmic conscious breathing on endocrine, immune and nervous system, counteracting early life stress.
The goal of this study was to create a new form of body psychotherapy for cancer patients – Integrative Breathwork Psychotherapy (IBP) and compare its psycho-physiological, immune and endocrine outcomes to the results of a matched control group.
Key words: breast cancer, Integrative Breathwork Psychotherapy, psychoneuroimmunology
9 th INTERNATIONAL CONFERENCE BONDING PSYCHOTHERAPY “Attachment, the essence of relationship.” June 7-9th 2013 Bruges – Belgium; 06/2013
[show abstract][hide abstract] ABSTRACT: Extraskeletal Ewing's sarcoma arising in the head and neck region is an extremely rare malignant neoplasm. We describe the unusual case of a tumor originating in the larynx of a 68-year-old male with hoarseness and occasional aphonia. We report successful treatment with sequential chemo- and radiotherapy. Complete regression and larynx preservation with voice function recovery was achieved. To our knowledge, this is the first report of this type of tumor in the larynx with cartilage invasion that documents the effectiveness of radiotherapy as an alternative to surgical management. At present, after 30 months of follow-up, the patient is free of tumor relapse and in very good condition.
Strahlentherapie und Onkologie 06/2013; · 4.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: The precise analysis of tumour markers in blood such as circulating cell-free DNA (cfDNA) could have a significant impact in facilitating monitoring of patients after initial therapy. Although high levels of total cfDNA in plasma of cancer patients are consistently demonstrated, a low sensitivity of DNA alterations is reported.
The major question regards the recovery of tumour-specific cfDNA such as KRAS mutated DNA and cancer-associated type 16 of human papillomavirus (HPV16).
TaqMan technology was used for detection of KRAS mutation, HPV16 and to quantify cfDNA in blood plasma.
Comparison of four different column-based commercial kits shows that the cfDNA purification carried out by the Genomic Mini AX Body Fluids kit and the QIAamp Circulating Nucleic Acid kit gave us the possibility to improve the sensitivity of detection of KRAS mutation and HPV16. The optimized method was used to follow the reduction in cancer-specific cfDNA after therapy. We found that large volume extractions with low volume of DNA eluate enabled trace amounts of tumour-specific cfDNA from cancer patients to be effectively identified.
Data presented in this study facilitate detection of tumour-specific cfDNA and improve standards needed for the implementation of cfDNA technology into routine clinical practice.
Cancer biomarkers: section A of Disease markers 01/2013; 13(5):385-94. · 0.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: Wegener's granulomatosis is a rare disease (10 per 1 000 000 new cases per year), etiologically connected with necrotizing vasculitis of small to medium-size vessels. The disease occurs predominantly in the upper respiratory tract, lungs and kidneys, but any organ may be affected during the course of the illness. It may be difficult to diagnose, especially when c-ACNA antibodies (serologic symptom of Wegener's granulomatosis) are undetectable and chest X-ray is normal. Early diagnosis is crucial for treatment results. Untreated disease may lead to death. Cyclophosphamide used simultaneously with prednisone is the treatment of choice as the first line procedure. Resistance to standard systemic treatment may be a significant problem. New drugs (rituximab, infliximab) are still under clinical investigation, with promising results. Very limited data concerning effectiveness of radiation therapy exist. We present a report of a female patient with solitary form of Wegener's granulomatosis located in the facial region, who underwent successful radiation therapy with a complete response.
[show abstract][hide abstract] ABSTRACT: Zbadanie jak zaburzenia nastroju, często towarzyszące chorobie nowotworowej, wpływają na jej leczenie i tolerancję u chorych na nowotwory głowy i szyi poddawanych przyspieszonej radioterapii (ART) Katz et al (2004) wykazali, że skala HADS jest efektywnym narzędziem przesiewowym u chorych na NGiSz, oraz że wynik sumy podskal lęku i depresji ≥15 punktów oznacza występowanie klinicznych zaburzeń nastroju. Do oceny stanu psychicznego i jakości życia chorych na NGiSz poddawanych przyspieszonej radioterapii zastosowano HADS, QLQ-C30 z modułem H&N35 (razem 35 podskal), pomiar bólu okolicy głowy/szyi oraz ramienia i barku zmodyfikowaną skalą VAS oraz satysfakcji z życia (SWLS). Do analizy włączono takie zmienne jak: czas od pojawienia się symptomów do diagnozy i od diagnozy do rozpoczęcia leczenia, ZUBROD przed i po leczeniu, palenie tytoniu przed leczeniem, czas trwania i nasilenie dysfagii w trakcie leczenia, pobierania sterydów i całkowitej regresji guza, utratę wagi w trakcie leczenia, intensywność leczenia przeciwbólowego, maksymalny ostry odczyn popromienny w skali Dische. Analizowano różnice między podgrupami o sumarycznym wyniku HADS < i ≥ 15 punktom. Do analizy zastosowano test U Manna-Whitneya, w tabelach zawarte są dane znamienne statystycznie. Kliniczny wynik w skali HADS osiągnęło 28 % pacjentów objętych badaniem podłużnym i 27% pacjentów z badania przekrojowego. W badaniu obserwacyjnym w grupie o wyjściowo wysokim wyniku HADS zaobserwowano statystycznie, większe dolegliwości bólowe, częstsze zastosowanie analgetyków takich jak tramadol i opiaty, niższą satysfakcję z życia i poziom optymizmu, głębsze zaburzenia nastroju utrzymujące się w trakcie i po leczeniu (tab.2, tab.3, tab.4) oraz gorsze wyniki w zakresie wielu podskal QLQ-C30 i H&N35 na początku leczenia (15 z 35 podskal, tab.1), w trakcie maksymalnego natężenia ostrego odczynu popromiennego (15/35, tab.2), po zakończeniu ART (17/35, tab.3) i 3 miesiące później (6/35, tab.4). W grupie objętej badaniem przekrojowym zaobserwowano istotne statystycznie różnice na niekorzyść osób o klinicznym wyniku HADS w 22 z 35 podskal QLQ-C30 i H&N35, poziomie agresji, dolegliwości bólowych obszaru głowy/szyi oraz barku i ramienia. Poziom optymizmu i satysfakcji z życia był znacząco niższy. Częściej palili papierosy przed leczeniem, w trakcie leczenia częściej wymagali leczenia sterydami (tab.5).
III Kongres Onkologii Polskiej, 10-13.10.2012; 10/2012
[show abstract][hide abstract] ABSTRACT: The goal of this research was to evaluate the healing processes of acute mucosal radiation reactions (AMRR) in patients with head and neck cancer.
In 46 patients with oral and oropharyngeal cancer patients irradiated with conventional (n = 25) and accelerated (n = 21) dose fractionation AMRR was evaluated daily during and after radiotherapy. Complex of morphological and functional symptoms according to the Dische score were collected daily until complete healing.
Duration of healing after the end of radiotherapy ranged widely (12-70 days). It was on the average 8 days longer for accelerated than for conventional radiotherapy (p = 0.016). Duration of dysphagia was also longer for accelerated irradiation (11 days, p = 0.027). Three types of morphological symptoms were observed as the last symptom at the end of AMRR healing: spotted and confluent mucositis, erythema, and edema. Only a slight correlation between healing duration and area of irradiation fields (r = 0.23) was noted. In patients with confluent mucositis, two morphological forms of mucosal healing were observed, i.e., marginal and spotted. The spotted form was noted in 71% of patients undergoing conventional radiotherapy and in 38% of patients undergoing accelerated radiotherapy. The symptoms of mucosal healing were observed in 40% patients during radiotherapy.
The wide range of AMRR healing reflects individual potential of mucosa recovery with longer duration for accelerated radiotherapy. Two morphological forms of confluent mucositis healing were present: marginal and spotted. Healing of AMRR during radiotherapy can be observed in a significant proportion of patients.
Strahlentherapie und Onkologie 06/2012; 188(8):686-91. · 4.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: The decision regarding treatment of early supraglottic carcinoma remains controversial. Single institution clinical data of patients with T2 supraglottic carcinoma treated exclusively with radiotherapy in terms of prognostic factors and treatment results were analyzed. Patient-related factors that would potentially by useful for optimal therapeutic decision to be undertaken were especially investigated. Between 1994 and 2004, 78 patients with T2 supraglottic carcinoma underwent radiotherapy (RT) in Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Poland. There were 54 (69%) males and 24 (31%) females in the median age of 61 years. There were 17 (22%) patients with N+. Median body mass of patients before (BM0) and after RT (BM1) was 74 kg (range 45.2-130 kg) and 72.9 kg (range 49.9-122.5 kg), respectively. Median hemoglobin concentrations before (Hb0) and after (Hb1) RT were 14.3 and 13.4 g/dl, respectively. Median change of Hb concentration during RT (dHb) was -0.8 g/dl. All were treated up to total doses (TD) ranged from 62.5 to 72 Gy. The overall treatment time (OTT) ranged from 30 to 70 days. Estimates of local control (LC), ultimate local control (uLC), and overall survival (OS) were calculated using the Kaplan-Meier method. Log rank statistics, Cox proportional hazard model and step-wise Cox regression hazard model were employed to identify prognostic factors for LC, uLC, and OS in univariate and multivariate analyses. The 5-year LC, RC, uLC and OS rates were 85, 92, 88, and 56%, respectively. In multivariate analysis N+ (p = 0.01) and prolonged OTT (p = 0.03) significantly decreased LC. Females (p = 0.02), higher BM0 (p = 0.03), and HB0 (p = 0.006) significantly prolonged OS. Patient-related factors like gender, hemoglobin concentration, and body mass may predict treatment outcome. Radiotherapy is effective for T2 supraglottic carcinoma of the larynx unless higher dose intensity is provided. Involved regional lymph nodes significantly deteriorate locoregional cure.
Archives of Oto-Rhino-Laryngology 11/2011; 269(3):923-9. · 1.29 Impact Factor
[show abstract][hide abstract] ABSTRACT: The study aimed to detect features of human serum proteome that were associated with exposure to ionizing radiation. The analyzed group consisted of 46 patients treated with radical radiotherapy for larynx cancer; patients were irradiated with total doses in a range from 51 to 72 Gy. Three consecutive blood samples were collected from each patient: before the start, 2 weeks after the start, and 4-6 weeks after the end of radiotherapy. The low-molecular-weight fraction of the serum proteome (2,000-13,000 Da) was analyzed by the MALDI-ToF mass spectrometry. Proteome profiles of serum samples collected before the start of radiotherapy and during the early stage of the treatment were similar. In marked contrast, mass profiles of serum samples collected several weeks after the end of the treatment revealed clear changes. We found that 41 out of 312 registered peptide ions changed their abundance significantly when serum samples collected after the final irradiation were compared with samples collected at the two earlier time points. We also found that abundances of certain serum peptides were associated with total doses of radiation received by patients. The results of this pilot study indicate that features of serum proteome analyzed by mass spectrometry have potential applicability as a retrospective marker of exposure to ionizing radiation.
Journal of Radiation Research 07/2011; 52(5):575-81. · 1.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: The plasma proteome was analysed as a potential source of markers of radiosensitivity in patients treated with definitive radiotherapy for head and neck cancer.
Acute mucosal reactions that developed during radiotherapy were assessed in 55 patients. Blood samples were collected from each patient before the treatment and also from 50 healthy donors. The low-molecular-weight fraction of the plasma proteome (2,000-10,000 Da range) was analysed by the Matrix-Assisted Laser Desorption Ionisation mass spectrometry. The capacity for DNA break repair was assessed by the comet assay using lymphocytes irradiated in vitro.
Spectral components registered in plasma samples were used to build classifiers that discriminated patients from healthy individuals with about 90% specificity and sensitivity (components of 4469, 6929 and 8937 Da were the most essential for cancer classification). Four spectral components were identified (2219, 2454, 3431 and 5308 Da) whose abundances correlated with a maximal intensity of the acute reaction. Several spectral components whose abundances correlated with the rate of DNA repair in irradiated lymphocytes were also detected. Additionally, a more rapid escalation of an acute reaction was correlated with a higher level of unrepaired damage assessed by the comet assay. conclusions: The plasma proteome could be considered as a potential source of predictive markers of acute reaction in patients with head and neck cancer treated with radiotherapy.
International Journal of Radiation Biology 02/2011; 87(7):711-9. · 1.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the feasibility and preliminary results of intraoperative radiotherapy (IORT) with low-energy photons as a boost in patients with early-stage oral cancer with the indications for postoperative radiotherapy.
Between 2003 and 2006, 16 patients with early-stage cancer of mobile tongue (n = 10 [63%]) or floor of the mouth (n = 6 [37%]) treated at Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland, were evaluated for IORT boost with the INTRABEAM®System (Carl Zeiss Surgical GmbH; IORT-PRS) because of the high risk of local recurrence due to positive margins on frozen pathologic section. After tumor resection, the applicator was positioned in the tumor bed. The applicator's diameter (range: 1.5-5 cm) was selected to encompass high-risk area of tumor recurrence. The dose (5 Gy, 7 Gy, or 7.5 Gy) was applied according to tumor volume and bone proximity. External-beam radiotherapy (EBRT) was provided to the tumor bed in all patients (50 Gy) and to the nodal area, when needed. Toxicity and local tumor control were assessed.
Median follow-up was 36 months. IORT did not increase acute mucosal reaction. Local tumor control was found in all cases. Early mucosal reaction did not exceed 3 according to the RTOG scale and healed in median time of 35 days after completion of EBRT. No late adverse effects were observed.
This preliminary report has demonstrated the feasibility of IORT-PRS for patients with early oral cancer with the indications for postoperative radiotherapy. This method may be considered an alternative boost technique, although additional studies are needed to establish long-term results in a larger group of patients.
Strahlentherapie und Onkologie 09/2010; 186(9):496-501. · 4.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the normal tissue reactions and loco-regional control rates (LRC) in patients treated with 7-days-a-week postoperative continuous irradiation (p-CAIR) compared to conventionally fractionated 5-days-a-week postoperative radiotherapy (CF).
Between 2001 and 2004, 279 patients with high-risk squamous cell cancer of the larynx (158 pts.) or cancer of the oral cavity/oropharynx (121 pts.) were enrolled. They were stratified according to the primary cancer site (larynx vs. others) and the treating center and randomized to receive 63 Gy in fractions of 1.8 Gy given 5-days-a-week (140 pts: CF) or 7-days-a-week (139 pts: p-CAIR).
The acute and late toxicity was considered acceptable, although the proportion of patients with confluent mucositis was higher in p-CAIR compared to CF (60.0 vs. 33.3%). The actuarial 3-year LRC were 64 vs. 70% for CF and p-CAIR, respectively, p=0.32. A statistically significant improvement in 3-year LRC in p-CAIR arm appeared in a subset of the patients with cancer of the oropharynx/oral cavity (74% p-CAIR vs. 53% CF, p=0.02). By contrast, there was no improvement in LRC in a subset of the patients with cancer of the larynx (p=0.46).
An improvement in LRC attributable to acceleration of postoperative radiotherapy appeared restricted to the patients with cancer of the oropharynx/oral cavity. In patients with cancer of the larynx acceleration of postoperative radiotherapy did not have any beneficial effect.
Radiotherapy and Oncology 06/2008; 87(2):155-63. · 4.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Conscious Connected Breathing Training Decreases Level of Anxiety and Depression and Increases NK Cell Counts in Breast Cancer Patients: Preliminary Report.
Authors: Alicja Heyda, Marek K. Jurkowski, Magdalena Głowala - Kosińska , Andrzej Czuba, Krzysztof Składowski
Marie Sklodowska – Curie Memorial Cancer Center and Institute of Oncology, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
Purpose: Psychotherapeutic and yogic methods based on rhythmic breathing are known to be beneficial for mood and health. Our goal was to check if conscious connected breathing training might be beneficial for immune and emotional status of breast cancer patients undergoing radical radiotherapy.
Methods: 15 breast cancer patients (T1-T4, 9 patients had amputation, 6 had BCT, 14 had previous chemotherapy) had ten long 45-minute sessions three times per week and short 15-minute session in other days of the week. After long sessions they always shared their insight and session experiences with psychotherapist. After finishing basic training most of them trained at home in prescribed rhythm: 6 short sessions and one long session per week.
Patients filled Polish adaptations of Hospital Anxiety and Depression Scale – Modified (HADS – M, with additional Irritation Scale available in Polish version), Mini-Mental Adjustment to Cancer Scale (Mini-MAC) and Courtauld Emotional Control Scale (CECS). In this preliminary report we analyzed blood samples taken right before starting radiotherapy and breathing training and about 8 weeks after hospitalisation using flow cytometry to count NK cells and capillary blood gasometry to check bicarbonate and oxygen levels.
Results: Patients eagerly trained at home after hospitalisation: they did average 17 short and 3 long sessions per month. Analysis showed significant decreases in anxiety (p<0,01) and depression level (p<0,01) after training. HADS-M Irritation level and all Mini-MAC scales didn’t show any changes. Partial oxygen pressure (pO2) shows an increasing trend, just like oxygen saturation (SO2). Blood gas parameters that significantly decreased after training: - partial bicarbonate pressure (pCO2, p<0,02), - concentration of bicarbonate (cHCO3, p<0,01). NK cell counts and percentage significantly increased (p<0,05) after training.
Conclusion and Clinical Implications: conscious connected breathing training significantly improved emotional state of participants. NK cells counts and percentage increased. It shows that this method may have positive impact on psychoimmune status of cancer patients.
Research Implications: Research and further analysis is in process
Acknowledgement of Research Funding: none
Keywords: conscious connected breathing, rhythmic breathing, breathwork, body -psychotherapy, NK cells, breast cancer
9th World Congress of Psycho-oncology , International Psycho-Oncology Society,9th World Congress of Psychooncology , International Psycho-Oncology Society,16-20.09 2007; 09/2007
[show abstract][hide abstract] ABSTRACT: Background
Irradiation of salivary glands during the treatment of head and neck cancer may lead to an alteration in the amount of saliva produced. Because of this, patients can suffer dryness of the mouth with oral discomfort, taste disturbance and dental decay.
The aim of this study is to estimate late toxicity dependence on radiotherapy method. The main goal is to investigate the correlations between the radiation doses in salivary glands and their salivary excretion fractions (SEF) measured by dynamic scintigraphy.
In 40 patients with pharyngeal and laryngeal cancer irradiated by IMRT or conformal 3D to a total dose of 62.5–72.0Gy, parotid SEFs were measured. Parotid dose-volume histograms were obtained from 3D computer treatment planning. SEF measurements were performed before (baseline), and 6 weeks and 6 months after radiotherapy by 185MBq 99 Tc injected intravenously and next SEF rates were analysed in relation to radiation doses accumulated. The late radiation toxicity of salivary glands was tested according to the CTC v. 3.0 and SOMA-LENT scales. The non-parametric Mann Whitney test was used for the estimation of relationships.
Pre- and post-treatment SEFs were measured in 31 patients treated by IMRT and in 9 patients treated by 3D CRT. Six weeks after radiotherapy SEF was generally lower by 34%, and 6 months after irradiation by 29.3% in IMRT technique. In 3D CRT relatively it was lower: after 6 weeks by average 52% and after 6 months by 35.5%. Late radiation toxicity of salivary glands was observed at a similar level according to CTC and SOMA-LENT scales in both methods of radiotherapy.
The level of SEF in parotid glands measured 6 weeks after radiotherapy clearly reflects the dose-response relationship of irradiated salivary tissue; 6 months later changes of SEF are the result of partial recovery of parotids.
The results of sparing salivary glands can be optimized in the future; that is, a further reduction of xerostomia can be achieved by using improved IMRT techniques and focusing on sparing major and minor salivary glands.
Reports of Practical Oncology and Radiotherapy 01/2007; 12(5):253-260.
[show abstract][hide abstract] ABSTRACT: The authors presented a specification of seven cases of multiple primary tumors treated in the Otolaryngological Department of Voivodenship Hospital No. 4 in Bytom (in the years 1991-2004). One case above-mentioned was described more closely. The presented case shows criterions for recognizing the malignant multiple primary tumors. The case describes a case of 42 years old patient treated for 3 primary tumors, metachronic--larynx, oral cavity and pharynx during 12 years. Two tumors have been radicaly removed in surgical treatment, the third one was cured by irradiation. The authors show more frequent appearance of malignant multiple primary tumors and their not clear etiology and emphasizing the significance of systematic follow up examinations after the treatment of primary tumors.
Otolaryngologia polska. The Polish otolaryngology 02/2006; 60(2):223-5.
[show abstract][hide abstract] ABSTRACT: Aim of the study is evaluation of radiotherapy treatment in cancer of oropharynx and nasopharynx. Retrospective analysis was based on 283 patients in III and IV clinical stage of disease without distant metastases who were treated between 1989-2001. 201 patients were treated radiotherapy alone and 82 by combined modality: radiotherapy and chemotherapy. Induction chemotherapy and radiotherapy was used in 34 cases, concomitant chemoradiotherapy--25 and adjuvant chemotherapy and radiotherapy in 23 cases. Following methods of radiotherapy fractionation were used: accelerated in 35 cases, conventional--26, hyperfractionation--21. Accelerated treatment mainly was used in concomitant combined modality. Log-rank statistical analysis revealed better results of treatment for combined modality: radiotherapy and chemotherapy. Most effectiveness method of combined modality was concomitant radiochemotherapy. Locoregional control in 3 years observation interval was better for concomitant mode about 18% comparing to induction chemotherapy and radiotherapy and 30% to adjuvant chemotherapy and radiotherapy. Based on this data, the optimal mode of treatment in III and IV stage of oropharyngeal and nasopharyngeal cancer, especially with extensive nodal disease and extranodal involvement is concomitant treatment with accelerated fractionation dose of radiotherapy.
Otolaryngologia polska. The Polish otolaryngology 02/2005; 59(2):229-34.
[show abstract][hide abstract] ABSTRACT: Background
The EORTC/RTOG late effects classification has been used for many years and covers nearly all organs and tissues, which may develop late radiation injuries. Dische developed a scoring system for radiation toxicity in which each clinical sign or symptom, that is characteristic for disturbance of function in an irradiated organ, is given scores for severity individually. EORTC and RTOG formed working groups to up-date their systems, for the recording of late injury to normal tissues, to be used in future clinical trials. The resulting system is called LENT-SOMA (1993).
In preparation for the introduction of the LENT-SOMA scale into clinical practice at the Centre of Oncology-Institute in Gliwice, we followed a sizeable cohort of patients using two scoring systems for the assessment of delayed radiation toxicity at each follow-up examination which took place every 6 months for up to 5 years after curative radiotherapy for head and neck cancer.
The analysed material comprised of 113 patients with oral cavity, pharyngeal or supraglottic cancer (T2-4N0-1) irradiated by conventional methods (18 patients), continuous accelerated irradiation (CAIR) (52 patients) or concomitant boost (CB) (43 patients). Total dose was in the range of 66–74 Gy. Delayed radiation toxicity was evaluated by two classification systems, those of Dische and LENT-SOMA, in the mucosal membranes, skin, larynx, salivary glands and spinal cord every 6 months after completion of radiotherapy treatment. The values in every scale were normalised (as a proportion of the maximum intensity for all symptoms) which permitted statistical comparison of the scales by use of the Wilcoxon test.
Analysis of all materials indicated a difference in the intensity of late radiation toxicity as estimated by the Dische and LENT-SOMA scales. The intensity of delayed radiation toxicity in the normalised Dische scale, for mucosal membranes and for skin, had higher values than observed in the LENT-SOMA system for the majority of examined patients. In the case of the larynx and salivary glands, the opposite situation was noted. The extent of conformity between normalised scales was evaluated in the case of the spinal cord.
The scoring systems of Dische and LENT-SOMA can not be interchangeably used, in clinical practice, for the estimation of delayed radiation toxicity in tissues of the head and neck region. The sensitivity of the scoring systems is similar only for the evaluation of radiation reactions in spinal cord.
Reports of Practical Oncology and Radiotherapy 01/2005; 10(4):179-192.