Andrzej Kawecki

Publications of Andrzej Kawecki

• [The results and toxicity of organ preservation treatment for locoregionally advanced laryngeal and hypopharyngeal cancer].

  Authors: Dorota Kiprian, Andrzej Kawecki, Andrzej Jarząbski, Wojciech Michalski, Beata Pawłowska-Sendułka

  Otolaryngologia polska. The Polish otolaryngology. 09/2011; 65(5):363-8.

  The most frequent malignant tumor of the head and neck region is a squamous cell cancer of the larynx. Squamous cell cancer of the hypopharynx is diagnosed rarely, but it has poorer prognosis thanThe most frequent malignant tumor of the head and neck region is a squamous cell cancer of the larynx. Squamous cell cancer of the hypopharynx is diagnosed rarely, but it has poorer prognosis than laryngeal cancer. The surgical treatment, especially in advanced disease, is a laryngectomy with the definitive tracheostomy, what negatively influenced the quality of life. Therefore, oncologists have been interested in new alternative methods of conservative treatment from many years. The evaluation of efficacy and toxicity of the organ preservation treatment in patients with locally advanced laryngeal and hypopharyngeal cancer. The patients with diagnosed squamous cell laryngeal and hypopharyngeal cancer in III and IVa clinical status were treated with concomitant radiochemotherapy with intention of the organ preservation. Conformal 3D radiotherapy and SIB-IMRT technique was applied in all cases. Concomitant chemotherapy consisted of cisplatin in daily dose100mg/m(2) given two times during irradiation (1 and 22 day of treatment) or once weekly in dose 40mg/m(2). Between January 2004 and November 2008 146 patients were treated with this method. There were 83 patients diagnosed with laryngeal cancer and 62 patients with hypopharyngeal cancer in this group. The median follow up is 42 months. Five years overall survival is 75% and disease free survivak is 63%. Three years laryngectomy free survival (LFS) is 82% and 5-years LFS is 76%. This group of patients is alive with larynx preservations. In 17.3% patients local recurrence was observed (4.5% regional recurrence and 1.8% locoregional). Those patients underwent salvage surgery or were treated with palliative chemotherapy. No severe life risking early and late complications were observed. Only 7% of patients have required temporary tracheostomy because of difficulties in breathing due to larynx edema. We can conclude that organ preservation treatment is a valuable alternative to surgical procedure in patients diagnosed with laryngeal and hypopharyngeal cancer in III and IVa clinical status.

• Impact of Screening Kindreds for SDHD p.Cys11X as a Common Mutation Associated with Paraganglioma Syndrome Type 1.

  Authors: Mariola Peczkowska, Zoran Erlic, Michael M Hoffmann, Mariusz Furmanek, Jaroslaw Cwikla, Agata Kubaszek, Aleksander Prejbisz, Zbigniew Szutkowski, Andrzej Kawecki, Krzysztof Chojnowski, Anna Lewczuk, Mieczyslaw Litwin, Witold Szyfter, Martin Walter, Maren Sullivan, Charis Eng, Andrzej Januszewicz, Hartmut P H Neumann

  The Journal of clinical endocrinology and metabolism. 10/2008;

  Context and Objective: Germline mutations of the genes SDHB, SDHC and SDHD predispose to paraganglioma syndromes. Mutation-specific counseling, risk assessment and management recommendations ideallyContext and Objective: Germline mutations of the genes SDHB, SDHC and SDHD predispose to paraganglioma syndromes. Mutation-specific counseling, risk assessment and management recommendations ideally should be performed. Here, we provide data for a single common mutation of the SDHD gene. Methods: The European-American Pheochromocytoma-Paraganglioma Registry served as the source for unrelated index cases affected by pheochromocytoma or paraganglioma. Patients with the SDHD c.33 C>A (p.Cys11X) germline mutations were reinvestigated by whole body magnetic resonance imaging and 24-hour urinary catecholamine assay. First degree relatives underwent genetic testing and those testing positive had same clinical investigations. Microsatellite analyses were used to test the hypothesis that all index cases were related and the mutation a founding one. Results: Sixteen index cases with the mutation SDHD p.Cys11X are registered. After testing their relatives, there were a total of 25 mutation carriers. We excluded 7 subjects who inherited the mutation from the mother because of maternal imprinting. Thus, 18 mutation carriers were clinically affected. Among these 16 (89%) had head and neck paragangliomas, 6 (33%) thoracic tumors, 6 (33%) extraadrenal retroperitoneal and 5 (28%) intra-adrenal. Of note, 16 (89%) had multiple tumors at first diagnosis, and 1 (5%) had signs of malignancy during follow-up. Overall penetrance was 100% at age 54. Haplotype analyses revealed evidence for a founder effect. Conclusions: The SDHD p.Cys11X mutation is a founding mutation associated with a high penetrance for paraganglial tumors of the skull base, neck, thorax and retroperitoneum in the first 4 decades of life and, rarely with malignacy.

• [Results of treatment in patients with paranasal sinus carcinoma. Analysis of prognostic factors].

  Authors: Zbigniew Szutkowski, Andrzej Kawecki, Ewa Wasilewska-Teśluk, Ewa Kraszewska

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(1):37-43.

  Analysis was based on the results of successful and unsuccessful treatment of 137 patients with paranasal sinus cancer at the Oncology Centre in Warsaw between 1987-2002. Patients with clinicalAnalysis was based on the results of successful and unsuccessful treatment of 137 patients with paranasal sinus cancer at the Oncology Centre in Warsaw between 1987-2002. Patients with clinical stages T3 and T4 constituted 87% of cases (110 patients). Radical treatment was performed on 84 patients. Five-year overall survival in 137 cases amounted to 27%; and survival without recurrence was 24%. Five-year overall and recurrence-free survial among patients treated with surgery and radiotherapy were 36% and 32% retrospectively. Multivariate analysis of 61 patients with complete data, who were treated with radical surgery and radiotherapy, emphasized the influence of prognostic factors on survival. A worse prognosis correlated with advanced locoregional T and N stage. It is evident that total dose greater than 6000 cGy had a clear impact on the results of treatment. It was also shown that planning with the manually and hand-measured isodoses impacted negatively on the survival in comparison with 2D and 3D planning. Analysis of recurrence-free survival showed that metastatis to the lymph nodes, and a manually-planned treatment method, had a negative impact on the results of treatment. It is asserted that local recurrences are the main cause of failure in cases treated with surgery and radiotherapy.

• Predictors and prevalence of paraganglioma syndrome associated with mutations of the SDHC gene.

  Authors: Francesca Schiavi, Carsten C Boedeker, Birke Bausch, Mariola Peçzkowska, Clara Fuentes Gomez, Thomas Strassburg, Christian Pawlu, Mary Buchta, Maren Salzmann, Michael M Hoffmann [......] Jörg Schipper, Martin K Walz, Pascal Pigny, Catherine Bauters, Joan E Willet-Brozick, Bora E Baysal, Andrzej Januszewicz, Charis Eng, Giuseppe Opocher, Hartmut P H Neumann

  JAMA : the journal of the American Medical Association. 10/2005; 294(16):2057-63.

  CONTEXT: Paraganglioma syndrome includes inherited head and neck paragangliomas (HNPs) and adrenal or extra-adrenal pheochromocytomas and are classified according to the susceptibility genes SDHB,CONTEXT: Paraganglioma syndrome includes inherited head and neck paragangliomas (HNPs) and adrenal or extra-adrenal pheochromocytomas and are classified according to the susceptibility genes SDHB, SDHC, and SDHD. In contrast with those with germline mutations of the SDHB and SDHD genes, clinical and genetic data on patients with mutations of SDHC are scarce. OBJECTIVE: To determine the prevalence and clinical characteristics of SDHC mutation carriers compared with patients with SDHB and SDHD mutations and with sporadic cases. DESIGN, SETTING, AND PATIENTS: Genetic screening for SDHC mutations in an international HNP registry of 121 unrelated index cases and in 371 sporadic cases from a pheochromocytoma registry, conducted January 1, 2001, until December 31, 2004. Identified index cases and affected relatives were clinically evaluated. MAIN OUTCOME MEASURES: Prevalence of and clinical findings for SDHC mutation-associated HNPs vs those with SDHB and SDHD mutations. RESULTS: The prevalence of SDHC carriers was 4% in HNP but 0% in pheochromocytoma index cases. None of the SDHC mutation carriers had signs of pheochromocytoma. We compared HNPs in 22 SDHC mutation carriers with the HNPs of SDHB (n = 15) and SDHD (n = 42) mutation carriers and with 90 patients with sporadic HNPs. Location, number of tumors, malignancy, and age were different: more carotid body tumors were found in SDHC (13/22 [59%]) than in sporadic HNPs (29/90 [32%], P = .03), as well as fewer instances of multiple tumors in SDHC (2/22) than in SDHD (24/42; P<.001), 0 malignant tumors in SDHC vs 6/15 in SDHB (P = .002), and younger age at diagnosis in SDHC than in sporadic HNPs (45 vs 52 years; P = .03). CONCLUSIONS: Patients with HNP, but not those with pheochromocytoma, harbor SDHC mutations in addition to those in SDHB and SDHD. In total, more than one quarter of HNP patients carry a mutation in 1 of these 3 genes. Head and neck paragangliomas associated with SDHC mutations are virtually exclusively benign and seldom multifocal. Analysis for germline mutations of SDHC is recommended in apparently sporadic HNP to identify risk of inheritance.

• [Concomitant radiochemotherapy followed by adjuvant chemotherapy in patients with poorly differentiated nasopharyngeal cancer; tolerance and early results of treatment].

  Authors: Andrzej Kawecki, Beata Jagielska, Andrzej Jarzabski, Zbigniew Szutkowski, Dorota Kiprian, Wojciech Rolski, Beata Pawłowska-Sendułka

  Otolaryngologia polska. The Polish otolaryngology. 01/2005; 59(5):671-6.

  Recently, concomitant radiochemotherapy became a method of choice in patients with poorly differentiated nasopharyngeal cancer. The aim of this study is to estimate tolerance and early results of theRecently, concomitant radiochemotherapy became a method of choice in patients with poorly differentiated nasopharyngeal cancer. The aim of this study is to estimate tolerance and early results of the concomitant radiochemotherapy followed by adjuvant chemotherapy (modified US Head and Neck Intergroup protocol). Analysing protocol consist of conventionally fractionated radiotherapy (TD = 70 Gy) given concomitantly with cisplatin (30 mg/m2 daily during 3 days every 3 weeks). This part of treatment was followed by 3 courses of PF (cisplatin + 5-fluorouracil) chemotherapy. Between August 1998 and September 2003 thirty six patients (27 male and 9 female) were qualified to treatment. Median age was 33 years. Tolerance of concomitant radiochemotherapy was acceptable. Intensive mucosal acute reactions (>G2) were observed in 67% patients. Life threatening complications (sepsis + DIC) was observed in single case. All patients received radiotherapy in planned total dose. Eighty six percent of patients received cisplatin in planned cumulated doses. Tolerance of the adjuvant chemotherapy was worse. Only 44% patients received all three courses of PF chemotherapy. The reasons of incomplete chemotherapy were neutropenia, infections, prolongated acute reactions or performance status decreasing. Complete regression was obtained in 86% patients. Two years overall and disease free survival rates were 83% and 72%, respectively. Our results confirm high activity of the concomitant radiochemotherapy followed by chemotherapy in patients with poorly differentiated nasopharyngeal cancer. Those results confirm also high toxicity of this regimen, what suggest very careful patients qualification to treatment.

• [Retrospective appreciation of results of treatment and early and late radiologic mucositis and other postradiological complications in patients with parotid gland cancer irradiated postoperatively]

  Authors: Zofia Laskus, Andrzej Kawecki

  Otolaryngologia polska. The Polish otolaryngology. 02/2004; 58(2):297-304.

  We describe results and complications of combined (surgery and radiotherapy) treatment of parotid gland cancer. 86 patients, 31 women and 55 men, have been treated between the years 1984-1997 inWe describe results and complications of combined (surgery and radiotherapy) treatment of parotid gland cancer. 86 patients, 31 women and 55 men, have been treated between the years 1984-1997 in Cancer Center--Institute in Warsaw. Mean age of patients was 56.6 years and ranged from 15 to 84 years. Surgical treatment was microscopically radical in 16 patients, macroscopically radical in 59 patients and debulking was performed on 11 patients. 5-year overall survival has been estimated as 58.2%. Distant metastases were observed in 23.3% of patients, local recurrences were observed in 12.8% of patients. Late serious postirradiation skin reaction (grade IV EORTC) was observed 6 months after completion of radiotherapy in 1 patient, and symptoms subsided completely during next 18 months. Late mucosal postirradiation complications (grade I and II EORTC) after 6 to 8 months after radiotherapy were described in 22.9% of patients and after 24-26 months in 15.9% of patients. There were no serious--grade III and IV EORTC--mucosal complications. Observed xerostomia was minimal due to compensation of saliva production by contralateral major salivary glands and did not worsen patients quality of life. Early middle ear postradiological inflammation occurred in 18.6% of patients, late reaction in the middle ear (6 to 8 months after completion of radiotherapy) was observed in 19% of all patients. In the group of 57 patients who survived 2 years after radiotherapy 1 developed temporo-mandibular joint fibrosis. Late postradiological changes in petrosal bone were detected in 2 patients (1 in Rtg imaging and 1 in CT imaging)-they were painful and primarily suspected as recurrence. None of the patients had clinically overt temporal lobe complications. Our patients survival results were a little worse than reported in the literature. Observed tolerance of combined treatment was very good.

• [The role of hemoglobin concentration in the outcome of definitive radiotherapy of the oropharyngeal cancer]

  Authors: Zbigniew Szutkowski, Andrzej Kawecki, Ewa Wasilewska-Teśluk, Andrzej Hliniak, Ewa Kraszewska

  Otolaryngologia polska. The Polish otolaryngology. 02/2004; 58(5):941-8.

  INTRODUCTION: Squamous cell carcinoma of the oropharynx is potentially curative by radiotherapy. The impact on the treatment results have factors related to neoplasm, to the patient and factorsINTRODUCTION: Squamous cell carcinoma of the oropharynx is potentially curative by radiotherapy. The impact on the treatment results have factors related to neoplasm, to the patient and factors related to the method of radiotherapy. The aim of this paper is evaluation of the impact of hemoglobin concentration (Hb) on treatment results in these patients. METHODS: 241 patients with squamous cell carcinoma of the oropharynx were treated between 1984-1995 in Radiotherapy Department II of Centre of Oncology in Warsaw. Most of them had locally and regionally advanced disease (T3-T4 in 63% and N2-3 in 41% of the patients). The pretreatment level of Hg was determined. All patients underwent definitive radiotherapy with the mean total dose 66-70 Gy. RESULTS: The estimated 5-year overall survival in this group was 23%. Analysis of clinical factors and factors related to the treatment has shown independent impact of the Hb concentration on radiotherapy results. In the group of patients with Hb level above 13 g/dL the risk of death and risk of locoregional recurrance were two times lower in comparison with group where Hb level was equal to or below 13 g/dL (p = 0.0002 and p = 0.013 respectively). CONLUSION: In the group of the patients with squamous cell carcinoma of the oropharynx, Hb concentration is important prognostic factor of the local control probablility and overall survival.

• [Lymphatic metastasis in the neck from unknown primary. Analysis of treatment results and prognostic factors.]

  Authors: Zbigniew Szutkowski, Andrzej Kawecki, Ewa Wasilewska-Teśluk, Ewa Kraszewska

  Otolaryngologia polska. The Polish otolaryngology. 01/2003; 57(6):861-6.

  The aim of this study is to analyze the results of treatment results and prognostic factors related to clinical and treatment characteristics in patients with neck lymph nodes metastases from theThe aim of this study is to analyze the results of treatment results and prognostic factors related to clinical and treatment characteristics in patients with neck lymph nodes metastases from the unknown primary site. 90 patients with pathology proven cancer metastases in the neck lymph nodes from the unknown primary site were treated between 1984-1998. Most of them (58 patients--63%) had advanced disease in lymph nodes N3. The rest had stage N2abc before initial treatment. 40 patients underwent combined treatment--surgery and definitive radiotherapy. 3 patients had induction chemotherapy followed by resection and radiotherapy. 30 patients received radiotherapy alone or radiotherapy and chemotherapy. In 7 cases chemotherapy after surgical resection were used. Curves of overall survival were estimated using Kaplan-Meier method. Analysis of the prognostic factors was performed using Cox's multivariate proportional risk model. 5 years overall survival probability was 24%. In the group of patients who underwent surgery and radiotherapy probability of 5 years overall survival was 43%. In patients who received radiotherapy alone or radiotherapy and chemotherapy probability of 5 year overall survival was 2%. Multivariate analysis showed significant influence of the performance status (PS--WHO scale), sex and stage N3 on overall survival. The patients with PS 0-1 had better prognosis comparing with PS 2-3 (p < 0.001). Male had worse prognosis then female (p = 0.05). N3 stage reduced overall survival in comparison to N2abc (p = 0.06). In the analysis of disease free survival N3-stage was the only independent factor concerning with poor outcome (p = 0.03). Patients who had surgery followed by radiotherapy had better prognosis. Poor performance status, sex-male and N3 stage were identified as the important factors influencing overall survival. N3-stage was an independent factor influencing disease free survival.