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Copyright of Strahlentherapie und Onkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The occurrence of brain metastasis from colorectal carcinoma (BM-CRC) ranges from 0.06-4%. Their rare occurrence makes various issues associated with these lesions controversial. Based on the literature data, this article presents population characteristics and clinical features of BM-CRC, their treatment methods and prognostic factors in these patients. It has been demonstrated that BM-CRC is mainly detected in patients with advanced CRC (III° and IV°) and is usually preceded by lung and liver metastases. The authors report population- based characteristics of BM-CRC, i.e. greater frequency in males and mean patient age of 51-73 years, and clinical features, such as supratentorial location in over a half of cases, the occurrence of a single BM-CRC in a half of patients and median size of 24-33 mm. Moreover, the authors discuss treatment methods in BM-CRC, including surgery (stereotactic radiosurgery, SRS), whole brain radiotherapy (WBRT) and systemic treatment, applied either alone or in combination. The observation made in literature reports that aggressive surgery or SRS prolong survival and improve quality of life, particularly when combined with WBRT, has been confirmed. WBRT alone remains the mainstay of palliative BM-CRC treatment. It is also used in patients ineligible for surgery or SRS, with multiple BM-CRC, with poor performance status and with uncontrolled extracranial disease. Patients with BM-CRC present poor prognosis. Median overall survival (OS), as presented in the references from 2014-2016, ranges from 2 to 7 months. Higher OS rates are reported in selected groups of patients, mainly those primarily treated with surgery or SRS (5-14 months). The main positive prognostic factors in patients with BM-CRC are: the Karnofsky Performance Score (KPS) ≥70, BM-CRC number not greater than 2 and no active extracranial CRC. [ABSTRACT FROM AUTHOR]

Surgery, with an attempt to remove a tumor within a margin of healthy tissues, is the preferred primary treatment of head and neck mucosal melanoma (HNMM). Despite radical surgery, the tumor tends to recur locally and give regional or distant metastases in many patients. Classical radical surgery is usually applied for sinonasal mucosal melanoma. Endoscopy is an alternative to classical surgery, but can be used in specific clinical cases and when appropriate criteria are met. The basic treatment method in patients with oral mucosal melanoma is ablation of various degrees depending on tumor location and local advancement. The presence of metastases from HNMM in the regional lymph nodes is an indication to lymphadenectomy. Experts from the National Comprehensive Cancer Network emphasize the role of prophylactic lymphadenectomy in oral mucosal melanoma but see no reason for its application in sinonasal mucosal melanoma. HNMM patients have not been and still are not frequently included in clinical trials investigating cutaneous melanoma. Adjuvant systemic treatment of patients operated for HNMM raises many doubts. Patients with a generalized disease and/or inoperable locally advanced tumor frequently receive systemic treatment similar to that applied for cutaneous melanoma. However, a different clinical picture, histopathological features and significant molecular differences suggest that a different systemic treatment would be more adequate. To date, none systemic therapy has been found effective in this group of patients. New drugs for molecular targeted therapy (vemurafenib, dabrafenib, imatinib) and immunotherapy (ipilimumab, pembrolizumab, nivolumab) are promising in terms of effective treatment of patients with generalized and/or inoperable HNMM. Therapy outcomes are poor and much worse when compared to cutaneous melanoma patients. Five-year overall survival ranges from 20% to 40%. [ABSTRACT FROM AUTHOR]

Introduction. The continuously improving cancer detection at an early stage and improving survival rates have been observed and, therefore, patients are predisposed to detection of multiple primaries. It has been reported that the incidence of multiple primaries in breast cancer patients ranges from of 4% to 17%. Materials and methods. A group of 112 breast cancer patients with synchronous malignancies was presented. They constituted 0.09% of patients (118,952 cases) who were treated for breast cancer at the same time period, and made up 3.5% of all patients (3,176 cases) with multiple primary cancers, and 21.7% of all patients (517 cases) with breast cancer who developed multiple primaries. Results. The most frequent type of synchronous primary malignancy was breast cancer (63.4%) and 90.1% of them were diagnosed at the same time or within one month following the first breast cancer diagnosis. Among cases of non-breast synchronous primaries, female genital organ malignancies were predominant (36.6%). Synchronous breast cancer was diagnosed significantly earlier than non-breast cancers (mean time was 0.4 and 1 month, respectively, p = 0.0123). Better results in the group with synchronous contralateral breast cancer in comparison to synchronous breast and non-breast cancer were observed (5-year overall survival rates were 90.9% and 66.3%, respectively, and 5-year disease-free survival rate — 62.5% and 51.3%, respectively). [ABSTRACT FROM AUTHOR]

Head and neck mucosal melanoma (HNMM) accounts for merely 0.03% of all malignant neoplasms and 0.7-1% of all melanomas. Its rare occurrence makes various issues associated with this neoplasm controversial. The first part of the publication discusses HNMM epidemiology, as reported in the literature, with particular emphasis on their location in the oral cavity, nasal cavity and paranasal sinuses. Differences in the incidence between populations, which indicate that HNMM is much more common in Asian people, are underlined. It is shown that the pathogenesis of HNMM is basically unknown, and that the only suspected risk factor is formaldehyde exposure. Subsequently, population-based HNMM features are presented, i.e. similar incidence in women and men as well as median age of 60-65 years. Moreover, the most common clinical signs are discussed, i.e.: obstruction and watery or purulent nasal discharge, persistent and progressive epistaxis, facial pain, watering eye, vision disorders etc. in patients with sinonasal mucosal melanoma; and flat pigmented or nodular, frequently exophytic and ulcerated lesions in patients with oral mucosal melanoma. The risk of lymph node invasion was evaluated at 10-20% and the risk of distant metastases was estimated at 5-10% at the time of the diagnosis based on literature data. It is mentioned that the diagnosis of mucosal melanoma is mainly based on results of microscopic assessment and detection of three markers: S100, HMB-45 and Mela-A in the tumor tissue. It is concluded that the most frequent molecular anomalies typical of HNMM are NRAS and c-KIT mutations. Finally, the current HNMM staging system (UICC 2010) and the principles of the diagnostic workup of this disease are presented. [ABSTRACT FROM AUTHOR]

Copyright of Onkologia i Radioterapia is the property of Wydawnictwo SALVE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary surgery, with an attempt to remove a tumor within the margin of healthy tissues, is the treatment of choice in head and neck mucosal melanoma (HNMM). Unfortunately, radical procedures are frequently difficult, mainly due to the anatomical conditions in the operated region associated with close proximity of numerous critical structures with important functions. It must be underlined that HNMM is characterized by particularly frequent local recurrences. The analysis of the literature shows that a vast majority of authors prove in a relatively unambiguous way that the usage of postoperative radiotherapy (PRT) reduces the occurrence of locoregional recurrences compared with surgery alone. Unfortunately, PRT does not affect remote survival outcomes, which is mainly associated with the tendency of HNMM to disseminate early and massively. Commonly acknowledged criteria for PRT include failure to obtain macro- or microscopic radicality of surgery. Other indications, as suggested by certain authors, encompass patients in whom the procedure was radical with a relatively small microscopic margin. Currently preferred total dose of radiation is 60-70 Gy administered in the period of 6-7 weeks according to a conventional fractionation system, i.e. 1.8-2.0 Gy delivered once daily. Primary radiation therapy is used in patients with advanced neoplasm or those who are not eligible for surgery due to poor performance status; this group also includes patients who do not consent to surgical treatment. Primary radiotherapy gives a chance not only for a good palliative effect, but also, in certain patients, for complete local control. The condition is the application of, for example, intensity-modulated radiotherapy (IMRT) and administration of an adequately high dose of biological radiation, usually using hypofractionation. The fact that proton beam therapy or irradiation with carbon ions gives hope for a marked improvement in local curability in this group of patients is incontestable. [ABSTRACT FROM AUTHOR]

A literature review is presented on proton radiotherapy when used for treating the most common carcinoma types such as cancer of the lung, breast and prostate. This is based on analytic parameters of dosimetry and clinical outcomes (efficacy and toxicity), along with studies on cost-effectiveness as compared to those achieved by conventional photon radiotherapy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We compared the status of stromal podoplanin-positive cancer-associated fibroblasts (ppCAFs) between primary tumors and paired synchronous lymph node metastases (LNMs) and analyzed the prognostic significance of tumoral ppCAFs in 203 patients with human epidermal growth factor receptor 2-positive breast carcinoma. ppCAFs were found in 167/203 and in 35/87 tumors and LNM, respectively. ppCAFs were most frequently found in tumors and corresponding LNM (n=52, 59.8%; p=0.001). However, for all LNMs (n=12) without ppCAFs, their paired tumors also lacked ppCAFs. In both tumors and LNMs, ppCAFs were α-smooth muscle actin-positive and cluster of differentiation 21 protein-negative, suggesting them not to be resident lymph node cells. Moreover, in our series, the presence of ppCAFs in tumors was borderline related to poor disease-free survival (p=0.058). These results speak in favor of a hypothesis suggesting ppCAFs accompany metastatic cancer cells migrating from tumor to LNMs., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

It is assumed that the spread of breast cancer cells via the lymphatic system might be influenced by inflammatory reactions and/or the application of chemotherapy or molecularly targeted therapy. Therefore, we analysed survival according to lymphatic vessel density (LVD), lymphovascular invasion (LVI) (both assessed using podoplanin as immunohistochemical marker of lymphatic endothelium) and well-established clinico-pathological features in a group of 358 patients with invasive ductal breast cancer: 139 chemotherapy-naïve (pT1-2/pN0/M0) and 219 treated with chemotherapy (pT1-4/pN1-3/M0). Univariate analysis revealed that high LVD was related to unfavourable disease-free survival (DFS) in pN0/chemotherapy/trastuzumab-naïve patients (P = 0.028). Conversely, in pN+/chemotherapy-treated individuals high LVD was related to favourable DFS (P = 0.019). LVI was a significant indicator of survival (P = 0.005) only in pN0/chemotherapy/trastuzumab-naïve patients. The following parameters were significant independent adverse prognostic factors for DFS: (i) in pN0/chemotherapy/trastuzumab-naïve patients: high LVD (LVD > 7 vessels/mm 2 ; RR = 2.7, P = 0.039), LVI (RR = 3.3, P = 0.046) and high tumor grade (G3 vs. G1 + G2; RR = 2.6, P = 0.030); (ii) in pN+/chemotherapy/trastuzumab-treated patients: low LVD (RR = 1.8, P = 0.042), the number of involved lymph nodes (pN3 vs. pN1-2; RR = 2.3, P = 0.012) and the breast cancer subtype (expression of steroid receptors together with HER2 immunonegativity and high proliferation index vs. other breast cancer immunophenotypes; RR = 3.0, P < 0.001). High LVD may identify high progression risk in pN0/chemotherapy/trastuzumab-naïve patients, and low progression risk in pN+/chemotherapy-treated patients. This phenomenon might be explained by potential involvement of lymphangiogenesis in two processes related to cancer eradication: a chemotherapy-stimulated activity of the immune system against cancer cells, or increased tumour drainage influencing the efficacy of cytotoxic drugs.

Purpose: The aim of the research was to evaluate of intraocular complications after proton beam therapy of choroidal melanomas, Material and Methods: A total 105 patients (48 female and 57 male) from Department of Ophthalmology and Ocular Oncology of University Hospital in Cracow, who received proton beam radiation due to choroidal melanoma were enrolled. The mean age was 52.3 years (51.8 y. in females, 52.6 y. in males). Total irradiation dose was 60 cGy and it was applied in 4 fractions per 15 cGy (on 4 consecutive days). We evaluated the incidence of complications classifying patients by age, tumor location, tumor thickness, longitudinal and transversal basal diameter and follow-up period, which ranged between 5 and 57 months., Results: Complications of intraocular irradiation were observed in 33 out of 105 treated patients. Retinopathy occurred in 18 cases, including 4 patients with macular edema. Neuropathy was confirmed in 8 patients, secondary glaucoma in 6 cases; we noted 9 cases of initial or progress existing cataract, 4 cases of dry eye syndrome and 1 patient with central retinal vein occlusion. A statistically significant positive correlation was demonstrated between the length of the follow-up period and the incidence of complications, which were more common and more severe with the longer follow-up period. There was no statistically significant correlation between the incidence of complications and patient’s age, tumor location, tumor thickness as well as longitudinal and transversal basal diameter., Conclusion: All forms of radiation therapy used in intraocular tumors are associated with some risk of complications; proton beam radiotherapy is not free of that risk, either.