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Although the multimodal cancer treatment techniques have greatly improved over the years, irradiation-induced late gastrointestinal toxicity remains a great concern as it may highly affect the quality of life of a patient. The aim of this study was to define the prevalence of late gastrointestinal toxicities. Electronic databases of Cochrane Library, Embase, Web of Science, CENTRAL and PubMed were searched until September 2019. We used the following keywords: radiotherapy, radiation therapy, irradiation, rectal cancer, gastrointestinal toxicity, adverse effects, late effects, pelvic radiation and pelvic radiation disease. Nine studies were included into this review out of 4785 that were preidentified as potentially relevant. Overall prevalence of severe (Grade 3 or higher) late irradiation-induced gastrointestinal toxicities was up to 19%. Most frequent toxicities of any grade were reported to be diarrhoea (up to 35%), faecal incontinence (22%), incontinence to gas (71%), rectal bleeding (9%), rectal pain (13%) and obstruction (7.4%). Preoperative treatment approaches and more advance radiotherapy techniques such as intensity-modulated and image-guided radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) turn out to result in lower late gastrointestinal toxicity rates. After great improvements in rectal cancer treatment, late gastrointestinal toxicity after radiotherapy is experienced less frequent and less severe; however, it remains a great concern associated with worse quality of life.

Introduction Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). Methods Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. Results A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. Conclusions Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.

Background: During radiotherapy (RT), most breast cancer patients experience ionizing radiation (IR)-induced skin injury—acute radiation dermatitis (ARD). The severity of ARD is determined by a physician according to CTCAE or RTOG scales, which are subjective. Reflectance confocal microscopy (RCM) is a noninvasive skin imaging technique offering cellular resolution. Digital dermoscopy (DD) performed in conjugation with RCM can provide more information regarding skin toxicity. The purpose of this study is to create an RCM and DD features-based ARD assessment scale, to assess the association with CTCAE scale and possible predictive value. Methods: One hundred and three breast cancer patients during RT were recruited, every week, clinical symptoms of ARD (CTCAE scale) were evaluated and RCM, together with digital dermoscopy (DD), was performed. Results: According to RCM, after 2 RT weeks, exocytosis and/or spongiosis were present in 94% of patients, after 3 weeks, mild contrast cells (MMCs) were detected in 45%, disarrayed epidermis (DE) was present in 66% of patients after 4 weeks and in 93% after 5 weeks, abnormal dermal papillae (ADP) were present in 68% of patients after 5 weeks. The coefficients of RCM features (RCMcoef) alone and together with dermoscopically determined erythema (RCM-ERYcoef) were significantly associated with ARD severity grade. RCMcoef is a significant predictive factor for the clinical manifestation of ARD. Conclusions: RCM features of irradiated skin appear earlier than clinical symptoms, have a characteristic course, and allow the severity of ARD to be predicted.

The pandemic spread of the COVID-19 virus significantly affected daily life, but the highest pressure was piled on the health care system. Our aim was to evaluate an impact of COVID-19 pandemic management measures on cancer services at the National Cancer Institute (NCI) of Lithuania. We assessed the time period from 1 February 2020 to 31 December 2020 and compared it to the same period of 2019. Data for our analysis were extracted from the NCI Hospital Information System (HIS) and the National Health Insurance Fund (NHIF). Contingency table analysis and ANOVA were performed. The COVID-19 pandemic negatively affected the cancer services provided by NCI. Reductions in diagnostic radiology (−16%) and endoscopy (−29%) procedures were accompanied by a decreased number of patients with ongoing medical (−30%), radiation (−6%) or surgical (−10%) treatment. The changes in the number of newly diagnosed cancer patients were dependent on tumor type and disease stage, showing a rise in advanced disease at diagnosis already during the early period of the first lockdown. The extent of out-patient consultations (−14%) and disease follow-up visits (−16%) was also affected by the pandemic, and only referrals to psychological/psychiatric counselling were increased. Additionally, the COVID-19 pandemic had an impact on the structure of cancer services by fostering the application of modified systemic anticancer therapy or hypofractionated radiotherapy. The most dramatic drop occurred in the number of patients participating in cancer prevention programs, the loss was 25% for colon cancer and 62% for breast cancer screening. Marked restriction in access to preventive cancer screening and overall reduction of the whole spectrum of cancer services may negatively affect cancer survival measures in the nearest future.

According to the guidelines on cancer treatment up to 52% of newly diagnosed cancer patients should be treated with external beam radiotherapy. Ionizing radiation (IR)-induced skin injury (radiation dermatitis) occurs in up to 95% of radiotherapy patients and can manifest from mild erythema till necrosis and ulceration. Individual radiosensitivity was proposed to be an important factor for the development of adverse reactions to IR. Therefore, assessment of radiosensitivity could be useful in predicting and dealing with radiation injuries caused by both radiotherapy and accidental overexposure. Here, we present a case of early diagnosis of IR-induced skin lesions performed by reflectance confocal microscopy in comparison to clinical evaluation in a highly radiosensitive patient.

Introduction. It’s about three decades when prostatebrachytherapy with radioactive implants has beenperformed in cancer treatment practice. The transrectalultrasound guidance let this method to developand to become more and more usable. AccordingESTRO/EAU/EORTC recommendations – dose tothe target (prostate) must be 145 Gy or higher . Itis essencial condition to reach good treatment results.Consolidation of various MRI regimes (T2,MRI diffusion, perfusion, spectroscopy) can giveus this information ,which nor other method can.Because of this we can use multiparametrical MRInot for only diagnostic but also brachytherapy planningpurposes. We define adaptive radiotherapy orbrachytherapy as radiation tumour treatment, whenradiation dose is delivered to the exact tumour (focaltherapy) or when there are several volumes withdifferent radiation doses. According to the literature– prostate brachytherapy with I-125 implant is notpart of adaptive prostate treatment protocols, buttechnically is possible and could be an ideal methodof adaptive prostate cancer treatment.Objectives. In 2010 in Vilnius University Instituteof Oncology (VUOI) we initialized clinical studycalled “Adaptive prostate cancer treatment withI-125 implants, safety and efficacy study”. It is openprospective non-randomized study. In this reviewwe will concentrate on giving the early and late radiationtoxicity results of our study and shortly deliversome our experience about impact of US andMRI in prostate tumour diagnosis and treatmentwith adaptive I-125 brachytherapy.Methods and materials. From July 2011 until December2013 52 (50 planned) patients who had favorablerisk cancer took part in this study. The ageof the patients was 49 – 75 years. Patients’ T werefrom cT1c to cT2c. PSA level 3,13 – 14,6 ng/ml.Gleason score of all patients – 6. All these low andintermediate risk prostate cancer patients undergonethe procedure of real time planned low dose rate(LDR) brachytherapy with I-125 prostate implants.During the adaptive prostate low dose rate (LDR)brachytherapy (BT) with I-125 implants we havedone dose escalation 200 Gy or more to the prostatemalignant lessions defined with biopsy, MRI and/orUS and the dose to the other prostate area were homogeneousand reached not less than 160 Gy(from 167 Gy – to 194 Gy).Results. This is a table with incidence and degree ofearly (until 6 mths. after treatment) and late (after 6mths. after treatment) genitourinary (GU) and gastrointestinal(GI) toxicity of adaptive prostate LDRBT study (Table).Conclusions. Acute GU toxicity is presenting in allpatients, but there are very low count of IIItoxicity. Late grade II GI toxicity manifested withblood traces in faeces, which were managed withmedicines. Late toxicity rates of our study is similarto those demonstrated by other authors. Still our adaptive brachytherapy methodic is very newground in brachytherapy and the count of patientseither follow up period is very short, so we shouldkeep on doing this technique and keep on goingwith follow up of these patients to get more confidentresults on toxicity.PSA dynamics, quality of life and benefits of MRIand US for our method remains the main questionsto answer in our early future articles.

Cetuximab (CTX) is used for the concurrent treatment with radiotherapy (RT) in squamous cell carcinoma of head and neck (HNSCC). There are no reliable clinical predictive markers of effectiveness of CTX at yet. We describe the clinical case of patient who received a CTX/RT to cure locoregionally advanced hypopharyngeal SCC. 2-Deoxy-2-[(18)F]fluoro-d-glucose positron emission tomography and computed tomography ((18)FDG-PET/CT) was performed before the treatment and repeated 10 days after CTX induction dose. A repeated (18)FDG-PET/CT scan showed dramatic decrease of metabolic parameters. Patient had a complete response after treatment and is still alive and cured after 5 years.

Context Recently, a new oral prolonged-release formulation of morphine sulfate for once-daily dosing has been developed based on an injection-molded matrix (abuse-deterrent, prolonged-release erodible matrix [ADPREM]). Objectives The objective of this double-blind, randomized, exploratory crossover study was to assess the efficacy and safety of once-daily ADPREM compared with twice-daily controlled-release morphine (CRM; MST Continus®Napp Pharmaceuticals, Cambridge, UK). Methods Thirty-eight adult cancer pain patients participated in the study, which consisted of a run-in period for stabilization and two consecutive fixed-dose treatment periods of two weeks' duration each. Rescue medication, immediate-release morphine sulfate, was available during the entire study for treatment of breakthrough pain (BTP). Results There was no difference between the treatments in use of rescue medication. The medians of the average number of rescue doses per day were 1.0 and 0.7 during the ADPREM and CRM treatment periods, respectively, with an estimated median difference of 0.07 dose/day (95% confidence interval: −0.21, 0.29). Likewise, no differences between treatments were found for the number of BTP episodes per day or morning and evening ratings of pain intensity (current, average, minimum, and maximum). Median assessment of the drugs was "good" for both treatments, and neither of the treatments was preferred. Steady-state trough concentrations of morphine and its metabolites in plasma before morning dosing were similar after either treatment period. The adverse events were as expected in an opioid-treated cancer population and showed no differences between ADPREM and CRM. Conclusion In this study, dosing with ADPREM at intervals of 24 hours was therapeutically equivalent to CRM dosed at intervals of 12 hours.

Background. The outcomes after different low rectal resection types applied for rectal cancer treatment are still uncertain. The aim of the investigation was to evaluate long-term functional results, the rate of complications and post-operative lethality after rectum low resection operations (connection with J-pouch group: coloplasty – group 2 and “straight” anastomosis – group 3). Patients and methods. In 2003, a randomized study was started and completed on December 2007. The study included 82 patients (38 females and 44 males). The patients were randomized into three groups. They were suffering from cancer stage I–III. Results. There were no postoperative deaths after 82 resections with total mesorectal excision (TME) and low connection. The overall rate of postoperative complications was 28%, and the rate of anastomosis suture leakage was 11%. The rate of postoperative complications was 20.7% (6 patients) in group 1, 28.6% (6 patients) in group 2, 34.3% (11 patients) in group 3. The rate of complications was substantially higher in groups 2 and 3; however, this difference was statistically not significant (p = 0.2636). The functional results after 3, 6, 9, 12 and 24 months showed no statistical difference among the groups; moreover functional results after 24 months in all groups were similar (p = 0.046). Anastomosis with or without pouch does not influence postoperative lethality. The incidence of complications and suture leakage is higher in cases of straight anastomosis; however, this finding is not statistically significant. Necrosis was observed only in patients for whom anastomosis with pouches were performed. Conclusion. Comparison of functional results after 3, 6, 9, 12 and 24 months showed no statistically significant differences among the groups.The necrosis of pulled-down bowel was observed only in the pouch groups. Keywords: rectal cancer, anastomosis, J-pouch, coloplasty, functional results

Tyrinėjant objektinius aparatūros projektavimo metodus, siekiama rasti sąsajų su jau žinomais ir plačiai naudojamais programinėje įrangoje metodais. Tai leistų sumažinti aparatūros projektavimo sudėtingumą, kuris nuolat didėja. Šiame darbe ir siekiama rasti bei išanalizuoti galimus objektinio projektavimo metodus. Pagrindinės objektinio projektavimo priemonės yra šios: abstrakcija, skaidymas, kompozicija bei apibendrinimas. Aptariamas žinomų iš programinės įrangos šablonų taikymas aparatūros aprašymo kalboje. Naudosime aukšto abstrakcijos lygio sistemų projektavimo kalbą UML ir automatizuoto projektavimo priemones aparatūrai aprašyti. Išnagrinėjęs aparatūros projektavimo kalbų galimybes, pasirinkau SystemC kalbą, nes ji kilus iš C++ programavimo kalbos ir turi daugiausia objektinio aparatūros projektavimo galimybių. Researching object-oriented (OO) design techniques, we seek to develop links with already known widely used software design methods. This would let to decrease hardware design complexity, as it constantly increasing. In addition, this paper seeks to find and analyze possible object-oriented design methods. The main OO design techniques are as follows: abstraction, separation of concerns, composition and generalization. Considered-about templates, known for software, use in hardware language. We will use UML – the standard specification language of high-level systems, and automatic design techniques for a hardware describing. After exploring possibilities of hardware design languages, I pick SystemC, because it has derived from C++ language and contain the most OO design possibilities from hardware languages.

Straipsnio tikslas. Apžvelgti literatūros šaltinius ir supažindinti urologus, radioterapeutus, onkologus su stroncio-89 galimybėmis gydyti ligonių, sergančių priešinės liaukos, krūties vėžiu ir atsiradus dauginių metastazių kauluose, skausmo sindromą. Daugelio tyrėjų duomenimis, apie 80 proc. pacientų, gydytų stroncio-89 chloridu, pasireiškė įvairaus laipsnio skausmą malšinantis poveikis, kuris išliko nuo 3 iki 6 mėnesių. Gydymas pasižymi vidutinio stiprumo hematotoksiškumu. Straipsnyje apžvelgiamos indikacijos skirti stroncį-89, gydymo veiksmingumas, gydymo trukmė, šalutinis stroncio-89 poveikis. The aim of this article was to review the available literature regarding to the use of strontium 89 in the palliation of osteoblastic bone pain. The data of many researchers showed that approximately 80% of patients with pain from osteoblastic lesions resulting from prostate or breast cancer experience significant pain relief by administration of strontium-89, with only mild levels of hematotoxicity. The duration of pain relief in some cases exceeded 3–6 months. Indications for administration of strontium 89, effectiveness and duration of the treatment, side effects are reviewed in this article.

The aim of this article was to review the available literature regarding to the use of strontium-89 in the palliation of osteoblastic bone pain. The data of many researches showed that approximately 80% of patients witch pain from osteoblastic lesions resulting from prostate or breast cancer experience significant pain relief by administration of strontium-89, witch only mild levels of hematotoxicity. The duration of pain relief in some cases exceeded 3-6 months. Indications for administration of strontium-89, effectiveness and duration of the treatment, side effects are reviewed in this article.

Taking into account the possibility of interaction of immune and antioxidant systems, the aim of this study was to investigate the changes in the parameters of immune and antioxidant systems in patients with cervical cancer and to compare them with the corresponding data obtained from healthy women. Ninety-four women with cervical cancer at II and III stage comprised the patient group and 69 healthy women were taken as the control group. The investigation results showed that the cellular immunity functions of patients with cervical cancer were suppressed in comparison with the same of healthy women. Though with respect to age, in 35-49-year-old women group with cervical cancer, some immune system indices were suppressed (quantity of T-, B-lymphocytes, NK); however in order to maintain the immune homeostasis of the organism other immune system functions were compensatorily stimulated (neutrophils and its phagocytic activity, CD8(+), IgG and IgA concentration were higher). The activity of the antioxidant system in patients with cervical cancer was impaired: the concentration of lipid peroxidation products was increased, the level of the endogenous antioxidant vitamin E and the activity of the antioxidant enzyme superoxide dismutase were decreased in comparison with the control group.

According to the published data there are 10–65% local recurrences after radical surgical intervention of rectal carcinoma depending on pre-treatment conditions and surgical techniques (1, 2). Also treatment results and disease free survival strongly depend on effective use of pre- and postoperative radiotherapy. It is well known that the main reasons for local recurrences are that cancer cells have been left in the pelvic lymph system and that biologically active malignant cells have been disseminated during the intervention to the diseased area. Preoperative radiotherapy may significantly decrease the vitality of malignant cells and block the mitochondrial activity of the tumor peripheral cells.

To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application.A prospective study was performed. Over a three-year period, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. All patients included in the study were irradiated for prostate cancer. The patients ranged in age from 56-77 years (average 70 ± 5 years). All of the patients were referred for formalin therapy after noninvasive management had failed. Twenty-four (63.2%) patients underwent a single application, 10 (26.3%) patients underwent 2 applications, and 4 (10.5%) patients underwent 3 applications.Two to 36 mo (average 12 ± 3 mo) following treatment, 34 patients were interviewed (four were lost to follow-up). Twenty (58.8%) subjects reported complete cure, 8 (23.5%) subjects reported significant improvement, and 6 (17.7%) subjects reported no change. One patient (who underwent a colostomy at a regional hospital with no specialized services available for previous bleeding episodes from radiation proctopathy) was cured, and the colostomy was closed. One patient (2.6%) developed rectal mucosal damage after the second application.A 4-min application of 4% formalin for hemorrhagic radiation-induced proctopathy under perianal anesthetic infiltration in patients who have received external radial radiation therapy for prostate cancer is simple, reasonably safe, inexpensive, generally well tolerated, and effective.