Romuald Krajewski

Maria Sklodowska Curie Memorial Cancer Centre, Gleiwitz, Silesian Voivodeship, Poland

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Publications (29)17.25 Total impact

  • M. Rysz · W. Grabczan · F. Nowakowski · S. Starościak · R. Krajewski

    No preview · Article · Oct 2015 · International Journal of Oral and Maxillofacial Surgery
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    ABSTRACT: Objective: The study focuses on the comparison of tissue reaction to titanium and bioresorbable implants with and without postoperative irradiation on an animal model. Materials and methods: Thirty-nine LEW/W rats were randomly assigned to experimental or control groups. One titanium and one bioresorbable screw (poly-L-lactide [PLLA] and L- and D-lactide poly-L/D-lactide [PDLLA]) were implanted into the left scapulas of 24 rats. Half of them received 30 Gy to the operation site and the other half received 42 Gy. In the control groups, 3 rats received 30 Gy, and 6 rats received 42 Gy to the scapula area without operation; and 6 rats had implants inserted as in the experimental group, but received no postoperative irradiation. The scapulas were removed 14 or 30 days after irradiation and a histologic analysis was performed. Results: The host tissue reaction to titanium and PLLA-PDLLA screws without postoperative irradiation was of similar intensity. In irradiated animals, the inflammatory tissue reaction was more evident around the titanium screws than around the bioresorbable screws, irrespective of the radiation dose and of the time that elapsed from the irradiation. The reaction was more evident on the 14th day than on the 30th day after the last radiation dose (70 and 86 days after surgery, respectively). The intensity of the inflammatory tissue reaction, irrespective of the implant type, was more intense in the group irradiated with 42 Gy. Conclusions: PLLA-PDLLA implants appear to cause less tissue reaction after irradiation and could be safer reconstructive devices than titanium implants for patients undergoing surgery and adjuvant radiotherapy for cancer.
    No preview · Article · Sep 2015

  • No preview · Article · Mar 2015
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    ABSTRACT: The investigation was performed in order to evaluate the use of Gafchromic EBT films for measurements of dose distributions created during radiotherapy in tissues surrounding titanium or resorbable implants used for joining and consolidating facial bones. Inhomogeneous dose distributions at implant-tissue interfaces can be the reason of normal tissue complications observed in radiotherapy patients after surgery with implants. The dose measured at a depth of 2.5 cm on contact surfaces, proximal and distal to the beam source, between the titanium implant and the phantom material was 109% and 92% respectively of the reference dose measured in a homogeneous phantom. For the resorbable implants the doses measured on the proximal and the distal contact surfaces were 102% and 101% respectively of the reference dose. The resorbable implants affect the homogeneity of dose distribution at a significantly lesser degree than the titanium implants. Gafchromic EBT films allowed for precise dose distribution measurements at the contact surfaces between tissue equivalent materials and implants.We measured doses at contact surfaces between titanium implants and RW3 phantom.We measured doses at contact surfaces between resorbable implants and RW3 phantom.We compared doses measured on contact surfaces and doses in homogeneous phantom.Doses at contact surfaces between RW3 phantom and titanium were distorted about 8-9%.Doses at RW3 phantom and resorbable implant contact surfaces were distorted about 2%.
    Full-text · Article · Oct 2014 · Radiation Physics and Chemistry
  • M. Rysz · B. Ciszek · M. Rogowska · R. Krajewski
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    ABSTRACT: Knowledge of the anatomical course of the anterior maxillary wall and alveolar process arteries is essential for sinus lift procedures. The aim of this study was to analyse the localization of anastomoses between the infraorbital and posterior superior alveolar artery on 101 computed tomography (CT) scans of maxillary sinuses (patients aged 18–70 years). The distance from the anastomosis to the bone point was measured on CT scans for each tooth location; for edentulous patients measurements were made to the lower edge of the alveolar process, and for dentate patients to the neck of the tooth. Measurements were done independently by two observers. The anastomosis analysed was identified on 50% of CT scans. The distance to the anastomosis was longest above the premolar (20.4 mm from tooth cervical line) and shortest above the first molar (15.9 mm to the edge of the alveolar process). The anastomosis can be localized on a CT scan for exact positioning of the antrotomy in 50% of patients. For the remaining patients, the anatomical information provided in this study can be used to reduce the risk of damage to the anastomosis. This study provides information on the distance from the anastomosis to the neck of preserved teeth in partially edentulous patients, which can be used as a reference point during sinus lift procedures.
    No preview · Article · Sep 2014 · International Journal of Oral and Maxillofacial Surgery
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    Andrzej Kawecki · Romuald Krajewski
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    ABSTRACT: Principles of follow-up management in patients treated for head and neck tumors are not very strictly defined, and practice varies between countries, centers, and specialists. Details of follow-up procedures, including timing of outpatient visits and diagnostic imaging, are specific for tumor types and localizations but also depend on treatment modalities used, availability of diagnostic procedures, and socioeconomic factors. The authors describe general principles of follow-up in head and neck cancer patients. Clinical observation and laboratory and imaging studies in patients who had received radical treatment should focus on early identification of recurrent or second primary tumors to allow for a salvage radical therapy. In patients who initially had received a palliative care, the follow-up should focus on proper management of symptoms.
    Preview · Article · May 2014 · memo - Magazine of European Medical Oncology
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    Maciej Rysz · Janusz Jaworowski · Romuald Krajewski · Joanna Barańska
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    ABSTRACT: In head and neck region leiomyosarcoma is a very rare finding. This tumor is usually located in abdominal cavity. We report a case of 78-year-old man with tumor of the auricle that was resected with 0.7cm margin. Histological and immunohistochemical analysis revealed the leiomyosarcoma. Adjuvant therapy was not advised. During 3 years of follow-up there are no signs of recurrence. Review of the literature shows that the survival of patients with leiomyosarcoma in head and neck region seems to be similar to other kinds of sarcomas in this localization. It is not clear, how large surgical margins should be to achieve satisfactory local control.
    Preview · Article · Feb 2014 · Otolaryngologia polska. The Polish otolaryngology
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    ABSTRACT: To determine timing and type of surgical field contamination in 50 consecutive resections for advanced head and neck cancer with same-stage tissue reconstruction and to analyze relationship between contamination and surgical site infection (SSI). Swabs from surgical field and from surgical drapes close to the field were taken every 2 hours (at 0h, 2h, 4h, 6h) and sent for standard microbiological diagnostic procedure. Results were recorded in MS Excel and analyzed with SPSS. We collected 336 swabs of which 71% were contaminated. Polymicrobial contamination was observed in 153 samples (45%). 26 species of pathogens were found, the most frequent was Streptococcus species. SSI with positive culture occurred in 3 patients. In head and neck surgery for advanced cancer standard aseptic procedures do not prevent contamination of the surgical field with physiological bacterial flora of the skin and oral cavity. Although contamination was common, SSI was rare. Head Neck, 2013.
    No preview · Article · Nov 2013 · Head & Neck
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    ABSTRACT: Introduction: Surgical treatment of tumors of the head and neck region is associated with extensive tissue defects. The introduction of modern reconstructive surgery techniques allows replace the resected bone and soft tissue. The aim of reconstruction is to fill the defect and ensure proper appearance and functioning of affected area, but functional defects caused by harvesting the graft are also important for the patient. The aim of this paper is to describe changes in gait pattern and gait parameters after harvesting free fibular flap and the flap from the iliac crest for reconstruction of the mandible in patients treated for head and neck cancer. Material and methods: Two patients who underwent reconstruction with fibular and iliac crest flaps had gait tests performed three times: before, one month and three months after surgery. The patients had an intensive rehabilitation and physiotherapy started on 1st postoperative day and it was continued for 2 months. Results: The analysis of tests results showed deterioration in gait parameters one month after operation. 3 months after operation these parameters returned to the level before surgery. Conclusions: Harvesting fragment of fibula and of iliac crest affects the function of gait. Systematic physical therapy and rehabilitation on inpatient and outpatient basis allowed the patients to return to the same level of gait functioning as before the operation. Further research is needed to develop a more complete picture of patobiomechanic after bone resection. The results will help to create standard procedure after both treatments.
    No preview · Article · Jan 2013 · Advances in Rehabilitation
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    ABSTRACT: Mesenchymal chondrosarcoma (MChS) is a rare, high-grade malignant tumor which occurs both in the bone and soft tissue. The extraskeletal location comprises one third of all MChS and in review of the up-to-date literature, about 30 cases of the orbital involvement were found. The authors present clinical, radiological and pathological findings of two cases of MChS of the orbit occurring in young adult females: primary extraskeletal MChS of the orbit and skeletal MChS of the ethmomaxillary complex with secondary orbit involvement. The histopathological examination revealed a characteristic biphasic pattern composed of small round to spindle-shaped cells, mimicking Ewing sarcoma family of tumors, with areas of a haemangiopericytoma-like pattern and admixed cartilage foci. One of the patients had local recurrence 3 years after initial surgical removal. Subsequently, she underwent enucleation followed by chemotherapy. The other patient had a biopsy and debulking resection of the tumor and started chemotherapy. Ten months follow-up of this patient show no evidence of metastasis.
    No preview · Article · Jan 2012 · Polish journal of pathology: official journal of the Polish Society of Pathologists
  • Maciej Rysz · Janusz Jaworowski · Romuald Krajewski · Joanna Barańska
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    ABSTRACT: In head and neck region leiomyosarcoma is a very rare finding. This tumor is usually located in abdominal cavity. We report a case of 78-year-old man with tumor of the auricle that was resected with 0.7 cm margin. Histological and immunohistochemical analysis revealed the leiomyosarcoma. Adjuvant therapy was not advised. During 3 years of follow-up there are no signs of recurrence. Review of the literature shows that the survival of patients with leiomyosarcoma in head and neck region seems to be similar to other kinds of sarcomas in this localization. It is not clear, how large surgical margins should be to achieve satisfactory local control.
    No preview · Article · Jan 2012
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    ABSTRACT: Analysis of surgical approaches to primary tumors localized in parapharyngeal space used in Head & Neck Cancer Department, Cancer Center Institute in Warsaw. Description of differences in terminology used to describe fascial compartments of the neck. Retrospective analysis of medical records of 8 selected patients who had an operation for primary parapharyngeal space neoplasm. Analysis has been done of operation protocols, diagnostic images, tumor size and histopathology. Transcervical, transparotid and transmandibular approaches were used with additional rhinotomy and craniotomy in selected cases. Selection of approach should take into account tumor localization, its size and histopathology. Planning of surgical procedure for parapharyngeal space tumor should be based upon analysis of diagnostic images and selection of the approach depends on tumor localization, size and histopathology. Differences in terminology of superficial and middle cervical fascial compartments can lead to inappropriate clinical decisions.
    No preview · Article · Nov 2011 · Otolaryngologia polska. The Polish otolaryngology
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    ABSTRACT: Concomitant radiochemotherapy has recently become the treatment of choice for locally advanced head and neck cancer. However, this modality often correlates with severe toxicity and only some patients obtain effective therapeutic benefits. Aim of the study. To estimate the tolerance of treatment and long term results in patients with locally advanced oropharyngeal cancer treated with definitive concomitant radiochemotherapy and to analyse the prognostic factors with the intent to define a group of patients able to obtain therapeutic benefits. Patients and method. We analysed patients with locally advanced oropharyngeal cancer treated with concomitant radiochemotherapy at the Department of Head and Neck Cancer of the Cancer Center and Institute of Oncology in Warsaw between 1996 and 2002. The treatment protocol consisted of conventionally fractionated radiotherapy (Df = 2 Gy, 5x weekly, total dose 66-70 Gy) and cisplatin 20 mg/m2 daily given concomitantly with irradiation on days 1-5 plus 5-fluorouracil 450-500 mg/m2 daily on days 1-7. Next patients received 5-fluorouracil 500 mg/m2 once weekly until the end of radiotherapy. The integral part of the protocol was the option of neck dissection after radiochemotherapy in patients with only partial regression within the cervical lymph nodes. Early reactions were estimated according to EORTC/RTOG scales. Chemotherapy tolerance was estimated according to the CTC scale. Overall survival and progression-free survival curves were calculated by the Kaplan - Meier method. The influence of the histoclinical factors on survival was analysed with Cox's proportional hazards method. Eighty three patients with homogenous criteria were included in the study. Results. Early tolerance of treatment was acceptable, but the mucosal reactions were extensive in a majority of patients. Four-year overall survival and progression-free survival were 59% and 52%, respectively. Independent prognostic factors negatively influencing overall survival included the T4 stage (p=0.049), performance status WHO 1 (p=0.035) and weight loss > 10% (p=0.025). Independent prognostic factors influencing progression-free survival included performance status WHO 1 (p=0.001) and weight loss > 10% (p=0.017). Conclusions. Our results confirm the high efficacy of the concomitant radiochemotherapy regimen in patients with locally advanced head and neck cancer. Statistical analysis has shown that apart from the T-stage also the performance status and alimentation significantly influenced survival. Those factors should be carefully considered during patient qualification to such an aggressive treatment regimen.
    No preview · Article · Jan 2008

  • No preview · Article · Jan 2008 · European Journal of Anaesthesiology

  • No preview · Article · Jan 2007 · Skull Base Surgery

  • No preview · Article · Jan 2007 · Skull Base Surgery

  • No preview · Article · Jan 2007 · Skull Base Surgery
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    Romuald Krajewski · Andrzej Kawecki · Andrzej Kukwa
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    ABSTRACT: AimTumours situated in the region of the base of the skull are at the limits of possibility for radical resection and in patients with malignant tumours it is necessary to use combined methods of treatment. The purpose of this paper is to evaluate the early results of combined treatment tumours of the base of the skull.Materials/MethodsBetween 1994 and 2004 68 patients with malignant tumours of the base of the skull and 10 with benign tumours were treated by an interdisciplinary group. Treatment included surgery, radiotherapy, and chemotherapy.ResultsAfter a period of post operative observation (median length 19 months), 32 patients with malignant tumours were without recurrence of disease, 8 lived with the tumour, 21 died as a result of disease progression and 4 died of other causes. Information was unavailable for 3 patients. Among 10 patients with benign tumours, 5 lived without symptoms of disease and 5 with the tumour.ConclusionsBecause of the limited possibilities regarding radical removal of malignant tumours in the region of the base of the skull, combined treatment using radiotherapy, surgery and, in some cases, chemo therapy is standard. Use of aggressive treatments gave local control in about half the patients though further observation is necessary in order to assess later oncological results.
    Preview · Article · Dec 2005 · Reports of Practical Oncology and Radiotherapy
  • M. Symonides · P. Sowinski · R. Krajewski

    No preview · Article · May 2005 · European Journal of Anaesthesiology
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    ABSTRACT: We present the case of a 66-year old man treated for laryngeal cancer recurrence with infiltration of the cervical oesophagus and the skin of the neck. The tumour was excised within healthy tissue margins, as confirmed by intraoperative histopathological examination. Reconstruction of the oesophagus was performed using a free jejunal flap and the skin defect was reconstructed with a pedicled myocutaneous pectoral flap. Recovery was uneventful. On the 14th postoperative day the patient was administered liquids by mouth and on the 30th day - solid food. On follow-up examination seven months after the procedure there is no evidence either of recurrence or of distant metastases. The basic treatment method applied in patients with laryngeal cancer recurrence after laryngectomy and radiotherapy is salvage surgery. Such factors as clinical staging of the recurrence, histopathological grading, evidence of metastases, time lapse between treatment completion and diagnosis of recurrence and previous irradiation of the head and neck region affect the success of the treatment and should be considered carefully. It is not a mistake to operate patients with an advanced recurrence. In such cases, however, it is necessary to excise important structures of the head and the neck and perform complicated reconstructions. The method of choice for reconstructing the cervical oesophagus is a free jejunal transplant, while for the excised skin of the neck a pedicled flap should be considered in order to avoid excess tension.
    No preview · Article · Jan 2004