Search

The paper reveals the changing pattern of Bulgarian Radiotherapy (RT) care after the successful implementation of 15 projects for 100 million euro under the European Regional Development Fund in Operational Programme for Regional Development 2007-2013. The project enables a total one-step modernization of 14 Bulgarian RT Centres and creation of a new one. At the end of the Programme (mid 2015), 16 new Linacs and 2 modern cobalt machines will be available together with 11 virtual CT simulators, 5 CT simulators, 1 MRI and 1 PET CT for RT planning and all dosimetry facilities needed. Such a modernization has moved Bulgarian RT forward, with 2.7 MV units per one million of population (MV/mln.inh) in comparison with 0.9 MV/mln.inh in 2012. Guild of Bulgarian Radiotherapists includes 70 doctors, 46 physicists and 10 engineers, together with 118 RTTs and 114 nurses and they all have treated 16,447 patients in 2013. Major problems are inadequate reimbursement from the monopolistic Health Insurance Fund (900 euro for 3D conformal RT and 1500 euro for IMRT); fragmentation of RT care with 1-2 MV units per Centre; no payment for patient travel expenses; need for quick and profound education of 26% of doctors and 46% of physicists without RT license, along with continuous education for all others; and resource for 5000-9000 more patients to be treated yearly by RT in order to reach 45-50% from current service of 32%. After 15 years of struggle of RT experts, finally the pattern of Bulgarian RT care at 2014-2015 is approaching the level of modern European RT.

Primary osteogenic sarcoma of the breast is a rare neoplasm, diagnosed mainly by pathohistological and immunohistochemical analysis. We hereby present a case of primary osteogenic sarcoma in the right breast of a 62-year-old woman with synchronous appearance of an invasive ductal carcinoma. Clinical findings are manifested with two separate painless formations 2.5 cm/2 cm and 1.5 cm/1 cm in size, located on the border of the upper and lower lateral quadrant of the right breast. No axillary lymphadenopathy was diagnosed. The pathohistological and immunohistochemistry findings of both tumors revealed a synchronous manifestation of two distinct neoplasms - epithelial and non-epithelial. Multimodality treatment consisted of Patey's radical mastectomy; 3 cycles of adjuvant chemotherapy; postoperative 50 Gy radiotherapy to the chest wall followed by additional 3 cycles of chemotherapy and anti-estrogen hormonotherapy. Due to the rarity of osteogenic mammary sarcoma, even more so in a combination with epithelial breast tumors, its clinical features are unclear and optimal treatment remains controversial. Considering the poor prognosis of the combination of both malignomas, we discuss a number of diagnostic and therapeutic issues.

Background: Pelvic organs morbidity after irradiation of cancer patients remains a major problem although new technologies have been developed and implemented. A relatively simple and suitable method for routine clinical practice is needed for preliminary assessment of normal tissue intrinsic radiosensitivity. The micronucleus test (MNT) determines the frequency of the radiation induced micronuclei (MN) in peripheral blood lymphocytes, which could serve as an indicator of intrinsic cell radiosensitivity., Aim: To investigate a possible use of the micronucleus test (MNT) for acute radiation morbidity prediction in gynecological cancer patients., Materials and Methods: Forty gynecological cancer patients received 50 Gy conventional external pelvic irradiation after radical surgery. A four-field "box" technique was applied with 2D planning. The control group included 10 healthy females. Acute normal tissue reactions were graded according to NCI CTCAE v.3.0. From all reaction scores, the highest score named "summarized clinical radiosensitivity" was selected for a statistical analysis. MNT was performed before and after in vitro irradiation with 1.5 Gy. The mean radiation induced frequency of micronuclei per 1000 binucleated cells (MN/1000) and lymphocytes containing micronuclei per 1000 binucleated cells (cells with MN/1000) were evaluated for both patients and controls. AN ARBITRARY CUT OFF VALUE WAS CREATED TO PICK UP A RADIOSENSITIVE INDIVIDUAL: the mean value of spontaneous frequency of cells with MN/1000 ± 2SD, found in the control group., Results: Both mean spontaneous frequency of cells with MN/1000 and MN/1000 were registered to be significantly higher in cancer patients compared to the control group (t = 2.46, p = 0.02 and t = 2.51, p = 0.02). No statistical difference was registered when comparing radiation induced MN frequencies between those groups. Eighty percent (32) of patients developed grade 2 summarized clinical radiosensitivity, with great variations in MNT parameters. Only three patients with grade 2 "summarized clinical radiosensitivity" had values of cells with MN/1000 above the chosen radiosensitivity threshold., Conclusion: The present study was not able to confirm in vitro MNT applicability for radiosensitivity prediction in pelvic irradiation.