Search

Introduction. The paper presents an original, used in our Institute, method of lung volume irradiation in patients with pneumonia during COVID-19 infection. Material and methods. Procedures such as the simulation of treatment and radiotherapy are performed in a treatment room. Real time radiation treatment planning is realized as 2D planning (Irreg Planning VMS) in a separate room, and the 3D (eclipse VMS) dose distribution is calculated after the treatment. During radiation exposure, a fluence map is measured. Results. A method of irradiating the lungs of patients with COVID-19 was developed, which allows to shorten the time the patient is on the treatment table and minimize contacts between the patient and staff. Conclusions. The presented procedure made it possible to minimize the time of patient’s stay in the radiotherapy department and at the same time, it retains all the required quality assurance procedures in radiotherapy treatment.

Head and neck cancer is a serious clinical and social problem. Surgery and radiotherapy play the most important role in treatment and give the chance of cure. Optimal treatment of patients with head and neck cancer should provide for the maximum destruction of cancerous tissue, saving as much healthy tissue as possible. Despite this, due to radiotherapy still almost 90% of patients develop skin symptoms. It seems that the mechanism of radiodermatitis is quite clear, but studies assume that its pathogenesis is not fully understood and there is much to be clarified. Acute and chronic dermatitis caused by radiotherapy is usually diagnosed according to clinical criteria. It seems that it would be useful to have a photographic classification that would facilitate and unify the clinical evaluation. In this article we shall summarize the current knowledge about the mechanisms of formation, risk factors, clinical classifications and methods for the prevention and treatment of acute and chronic radiation dermatitis. We have included clinical photos that depict individual stages according to the clinical classification of RTOG.

Paragangliomas of the head and neck are a group of neoplasms which occur very rarely. Most of them are benign tumours. Tinnitus, headaches and dysfunction of the cranial nerves are typical symptoms. Some paragangliomas have metastatic abilities and they can produce catecholamines. There are some typical imaging features in CT and MRI scans which help to determine the correct diagnosis without the necessity of performing a biopsy which can be associated with a haemorrhage risk. Therapeutic management consists of the choice between an active observation, surgical procedure, as well as radiotherapy and systemic therapy in the case of malignant paragangliomas.

Summary 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. Aim 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. Materials/Methods 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. Results 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. Conclusions 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.

Squamous cell carcinoma is an extremely rare neoplasm of the thyroid (SCTC) that represents no more than 1% of all primary thyroid malignancies. We report a case of a 42-year-old woman with rapidly growing mass in the right lower neck, primarily diagnosed in fineneedle aspiration cytology as a low-differentiated carcinoma. After the surgery, exclusion of all the other possible primary tumour locations, and immunohistochemistry tests, the diagnosis of primary squamous cell carcinoma of the thyroid gland was established. Because of close surgical margins and metastatic neck node, the patient was referred to adjuvant postoperative irradiation. With five-year follow-up the patient is free of disease and still in very good condition.

Alm Endobronchial HDR brachytherapy (E-HDR-BT) is a well-established method of palliative treatment in patients with lung cancer. There is, however, no consensus on optimal radiation and the rate of complications. The aim of the work is to evaluate early effectiveness and tolerance of E-HDR-BT in palliative treatment of patients with lung cancer treated in Oncology Centre in Gliwice. Material and methods Since 2000 in Oncology Centre in Gliwice HDR (Ir192) E-HDR-BT is used in palliative treatment of patients with bronchial obturation due to lung cancer. Regression of bronchial obturation and improvement in dyspnoea, cough and haemoptysis after therapy was analyzed for the first thirty patients. The total dose was 18 Gy, calculated at 1cm from the source, in 3 fraction (of 6 Gy) given everyweek. Results Twenty-five patients finished therapy as planned. Five patients didn’t complete treatment: two of them (6.6%) died because of massive haemoptysis; one patients suffered from exaggeration of angina pectoris, one patients developed high hectic fever not responding for antibacterial treatment, one suffered from exaggeration of their symptoms prohibiting continuation of the treatment. Changes in obturation of the bronchi and in patient's symptoms are shown in Table 1 . Table 1 . Changes in obturation of the bronchi and in patient's symptom. Symptoms Improvement Nochanges Exaggeration Obturation #/% 22/88% 3/12% 0 Dyspnoea #/% 15/54% 11/40% 2/7% Cough #/% 4/27% 10/67% 2/7% Haemoptysis #/% 2/14% 10/72% 2/14% More detailed analysis of improvements in symptoms has been carried out according to own scoring system for dyspnoea, cough and haemoptysis. Mean duration of palliative response was 55 days (1–405). Mean survival time was 114 days (2–406). Conclusion E-HOR-BT is an effective method of palliation of symptoms related to bronchial obturation in course of lung cancer. The most frequent serious treatment complication of E-HOR-BTwas massive haemoptysis.

Background & Aim Our experience with CAIR fractionation, recognized as an effective organ preservation treatment for moderately advanced head and neck cancer, have induced us to idea on concomitant combination of continuous radiotherapy (7 fractions in 7 days) with chemotherapy, dedicated for advanced, stage III and IV, patients. This report evaluates early results of toxicity and cure of patients treated during the years 1999–2003. Material 47 male patients with median age 51 years were prospectively evaluated-36 patients (77%) with stage IV and 11 (23%) with stage III. Oropharynx was the most freaquent tumour location-16 patients (34%). Chemotherapy, four cycles of cisplatinum and vinorelbin given in 1-day schedule, started on the day 1st, each 21 days. CAIR-scheme radiotherapy started on the 22nd day to the total dose of 68Gy. Compliance to the RT protocol was 98%. During the first year 57% of patients completed 4 courses of chemo, 11 (24%)-3 cycles and 9 (19%)-2 courses. After reduction the doses of cisplatinum (100 to 70 mg/m 2 ) and vinorelbine (30 to 20 mg/m 2 ) chemotherapy was conducted with at least 3 cycles. One patient died because the treatment toxicity. All patients developed confluent mucositis lasted medially 60 days. Grade IV and III of leucopenia were found in 4 (8%) and 15 (32%) patents. Median follow up was 446 days (ranged from 7 to 1486 days). Results CR was observed in 38 (81%) patients. The rates of LC, DSF and OS were 81%, 62% and 80% respectively after 2 years. On univariate analysis N3 stage was significantly associated with decreased rates of all survival criteria; the higher LC and DSF rates were also found for patients receiving all 4 courses of chemotherapy and with egzophitic tumour-growth pattern. Multivariate analysis revealed that N3 stage and necrosis in metastatic Iymph nodes were the idependent negative prognostic factors influencing LC and DSF. Conclusions Chemo-CAIR produces promising early results of cancer cure. Treatment toxicity is high, but satisfactorily tolerated and did not affect the ability to deliver planned doses of radiotherapy. The most important factor affected treatment outcome were N3 stage and necrosis in Iymphatic nodes.

Purpose To analyze the influence of overall radiation treatment time and duration of the interval surgery-radiotherapy on local tumor control (LTC) in postoperative radiotherapy (PRT) for squamous cell head and neck cancer (SCHNC). Material/methods A multivariate Cox proportional hazard regression analysis included 942 patients with locally advanced SCHNC. Mean total radiation dose, dose per fraction, treatment time, and the interval surgery-PRT were 62,5 Gy, 2,1 Gy, 46 days, and 62 days respectively. No interruptions during PRT (except for weekend brakes) appeared in 29% of patients, while 28% had more than 5 days of gap. The data were grouped into seven categories depending on the position of gap (weeks 1–7). Results Increase in treatment gaps, the presence of tumor recurrence after surgery, N stage, and extra-laryngeal site of cancer were significantly related to decrease in LTC. The duration of time interval surgery-PRT had only marginal significance for LTC. Other variables did not appear significant. Consideration of seven time intervals for treatment gaps in the multivariate model has shown a significant progressive increase in the hazard of recurrence for gaps in the respective weeks 1 to 7. Conclusions This analysis shows a detrimental effect of interruptions during PRT, and only marginal decrease in LTC from the extension of the interval surgery-PRT. Therefore it seems unjustified to rush with PRT at the expense of possible increase in radiation treatment gaps. However, excessive delays in initiating PRT should be avoided, since they may lead to a recurrence prior to irradiation.