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Colorectal cancer is one of the most common malignant diseases worldwide. A multidisciplinary approach to treatment involves surgery and chemotherapy, while radiotherapy is used in the treatment of tumors localized in the pelvis. Stereotactic radiotherapy allows the delivery of high, ablative radical radiotherapy doses to target volumes, with a reduced risk to the surrounding organs, making it suitable for irradiating localized disease. A 59-year-old female S.M. presented to the doctor due to the appearance of a perianal fistula. Colonoscopy was performed, revealing a moderately differentiated adenocarcinoma. Magnetic resonance imaging (MRI) examination diagnosed a tumor lesion of the rectosigmoid junction with a perilesional abscess collection and several fistulous channels communicating with the perianal skin. The patient underwent surgery with adjuvant chemotherapy. A follow-up MRI examination 8 months after surgery revealed a soft tissue lesion in the perianal tissue characterized as a recurrence of the disease, and stereotactic body radiotherapy (SBRT) was applied. Six months after SBRT follow-up examinations indicated a complete clinical response to radiotherapy without the recurrence of the primary disease. Stereotactic radiotherapy can be applied as an effective and safe ablative technique, particularly when considering the significant morbidity and impairment of the quality of life in patients after surgical treatment.

Introduction. Early breast cancer is usually treated with breast conserving surgery followed by radiation treatment. Whole breast irradiation is standard of care so far, but currently there is an increasement in accelerated partial breast irradiation for selected patients which showed many advantages. The aim of this paper is to present the implementation of the accelerated partial breast irradiation in Oncology Institute of Vojvodina. Case outline. A 54-year-old woman was referred to radiotherapy after breast conserving surgery. After she met all of the inclusion criteria, she underwent accelerated partial breast irradiation with 38.5 Gy in 10 fractions. Active breathing control device was used during the treatment and cone beam computed tomography was performed before each fraction for the purpose of target position control. She terminated therapy in good health condition with only adverse effect of mild radiation dermatitis of irradiated area. On the first follow up, she was without any symptom or sign of disease or complication. Conclusion. Accelerated partial breast irradiation is safe and effective. Radiation oncologist should be encouraged to implement this technique.

Introduction/Objective Left breast cancer patients undergoing radiotherapy are at higher risk of cardiovascular diseases (CVD), as a partial volume of the heart is anatomically close to target volume. This may cause CVD in the years following cancer treatment. The aim of this work was to develop a scoring system which identifies patients with increased risk of development of CVD, as a consequence of the left breast irradiation. Methods The patients followed up in this study were treated during 2009. Eight years later, they were invited to participate in a study where they underwent a cardiology evaluation. Their current condition was statistically correlated to the doses received by their heart and left anterior descendant artery (LAD). Results Out of 114 patients, 31 women were evaluable for cardiology assessment. Out of these 31 subjects, six women were with a history of CVD before cancer treatment. Four women never developed any kind of heart associated disease, while in the other 27, newly onset CVD were diagnosed ranging from hypertension to myocardial infarction, strongly positively correlated to doses to heart and LAD (p = 0.003). Severity of developed cardiovascular toxicity was formulated through the correlation of mean heart and mean LAD doses with CVD developed in the form of a scoring system. Conclusion The doses to critical organs depend on patient anatomy and technique of irradiation. The cardiovascular complications are proven as consequence of radiotherapy. Scoring system based on doses received by heart and LAD is a reliable tool in predicting CVD.

Background/Aim. The transition from standard to highly conformal radiation therapy techniques requires the implementation of complex advanced dosimetry. The aim of the study was to compare dosimetric parameters of the three-dimensional conformal radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT) plan, as well as complications after treatment in relation to dosimetric parameters in gynecological cancer patients. Methods. A total of 49 gynecological cancer patients were included in the study. All patients were planned for 3DCRT, but due to un-acceptable doses to organs at risk (OARs), treatment plans for intensity modulated radiation therapy (IMRT), or VMAT, were generated for 21 patients. The patients were prescribed 50.4 Gy/28 fractions (4 patients) and 45 Gy/25 fractions (45 patients). The coverage of planning target volume (PTV) and doses to OARs were recorded. PTV margins were evaluated for both techniques according to the Van Herk formula. Results. ICRU 83 criteria were fulfilled in all 3DCRT/VMAT/IMRT plans providing optimal coverage of PTV. Doses to OARs, on average, the V45Gy in the small bowel in IMRT/VMAT plans was four times smaller than the same in 3DCRT plans. The V45 Gy of small bowels was, on average, 49.4 cm3 in IMRT/VMAT plans, while in 3DCRT plans, it was 211.6 cm3. In the case of the femoral head, a significant reduction in V30Gy (10.8% vs. 33.1%) and mean dose in the case of IMRT/VMAT plans was recorded (30.4 Gy in 3DCRT vs. 23.6 Gy). Rectum was planned with a significantly lower dose in terms of V30Gy (79.5% vs. 95.2%) in IMRT/VMAT plans. The bladder was better spared in VMAT plans in terms of V40Gy (51% vs. 91%), but the maximum dose was higher in VMAT plans than in 3DCRT (50.1 Gy to 48.1 Gy on average). For all OARs, there was a statistically significant difference registered at p ˂ 0.05. Toxicities recorded in VMAT and 3DCRT patients included mainly radiation-induced cystitis and enteritis. Patients treated with 3DCRT generally had longer recovery time. The homogeneity index was 0.11 for VMAT plans and 0.09 for 3DCRT plans. Conclusions. Analysis of dosimetric parameters revealed significant differences in normal tissue doses for the same 3DCRT and VMAT patients, which confirmed the necessity for the implementation of advanced techniques for as many patients as possible.

Introduction/Objective. Locally advanced lung cancer is often accompanied by atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on the patients’ quality of life, the length of the progression-free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced lung cancer or endobronchial metastasis of other malignancy were treated with the high-dose-rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients’ clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p < 0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the quality of life of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Reaeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.

Introduction/Objective. The incidence of radiation-induced side effects in patients with head and neck (H&N) cancer depends on the planning technique and the irradiation dose, as well as primary tumor location within the H&N region. The aim of our research is to establish the incidence of side effects in patients with H&N cancer treated with conformal radiotherapy planning with computed tomography (CT) or computed tomography fusion with magnetic resonance imaging (CT-MRI fusion). Methods. Prospective analysis was performed on 40 patients with oropharynx carcinoma and on 40 patients with larynx carcinoma prospectively followed after radiotherapy. Forty patients with H&N cancer were irradiated by using 3D conformal radiotherapy planning with CT, while other 40 patients were treated using 3D conformal radiotherapy planning with CT-MRI fusion. In all cases standard fractionation was used at 2 Gy per day, five days a week. Results. Of the total of 80 patients treated, 52 patients (52/80; 65%) reported a side effect and the incidence of complications was higher in patients irradiated with 3D technique planning with CT (31/52; 60% for 3D CT vs. 21/52; 40% for 3D CT-MRI; p = 0.02). There were more complications in chemoradiotherapy group of patients than observed when only radiotherapy was used – 35/52 RT + HT vs. 17/52 RT (67%: 33% and p = 0.004). Conclusion. 3D radiotherapy technique planned solely on the basis of CT is related to high incidence of toxicity, which significantly affects the quality of life of irradiated patients. 3D conformal radiotherapy planned with CT-MRI fusion reduces the incidence of oral complications. Following the example of developed countries, this technique should be considered as a standard method for irradiating patients with H&N cancer. Planning technique with fusion technique using MR imaging is more suitable for delivering higher doses to the tumor with fewer side effects.

Introduction. Streptococcus bovis is labeled in the literature as a cause of bacteremia and endocarditis, which are often associated with gastrointestinal malignancy. Case Outline. In our paper we present a patient with endocarditis induced by Streptococcus bovis who was also, after completed cardiologic examination and treatment, diagnosed colon cancer in situ by targeted endoscopy. Owing to the timely diagnosis, and after successful cardiologic surgery with implantation of an artificial aortic valve, patient underwent surgery of the colon, and is now asymptomatic and in good health. Conclusion. Complete and detailed endoscopic examination of the colon must be done in patients with endocarditis caused by Streptococcus bovis, even if the patient is asymptomatic. By following these recommendations, it is possible to detect precancerosis or cancer at an early stage and save the patient’s life.

With one third of patients with locally advanced cervical cancer (LACC) expected to develop cancer recurrence in the first two years after therapy, accurate assessment of the response and timely detection of cancer recurrence after concurrent chemo- and radiotherapy (CCRT) treatment is of great importance. Although there is neither definite consensus about the preferred imaging modality, nor the time interval until the first diagnostic examination after CCRT, the National Comprehensive Cancer Network (NCCN) recommends the use of MRI and 18F-FDG PET/CT as a post-treatment LACC response-assessment imaging tools. In this study, we tried to appraise the early therapy response in LACC patients by both 18F-FDG PET/CT and MRI in regard to the follow-up imaging results and their mutual interrelationship, and to ascertain if the post-treatment 18F-FDG PET/CT and MRI results were related to the progression-free and overall survival rate in women with LACC after CCRT. We also aimed to estimate the early and follow-up diagnostic imaging impact on further therapy management. Based on our results, we concluded that 18F-FDG PET/CT did surpass MRI in the early assessment of therapeutic response in LACC patients after CCRT. Both modalities provided information that may serve as predictive biomarkers of outcome and LACC patients' survival. [ABSTRACT FROM AUTHOR]

Aim Accurate preoperative staging is essential in determining optimal therapeutic procedures and planning for individual patients. Advances in imaging technology have raised interest in the potential role of positron emission tomography-computed tomography (PET-CT) examination for staging of rectal cancer. The primary end point of the study was the correct classification of the tumornode-metastases (TNM) tumor stage using whole-body PET-CT examination. Methods This prospective study was performed from October 2011 to October 2012. Patients with histopathological diagnosis of rectal cancer after biopsy underwent PET-CT before surgical treatment and TNM staging. Twenty patients who fulfilled inclusion criteria were included in the study. All of the patients were operated and histopathology served as the standard of reference. Results There was no statistical significance in T staging comparing PET-CT and histopathological staging, according to the Monte Carlo simulation (p=.066). Also, there was no statistical significance between two methods in mesorectal fascia involvement analysis (p=1). There was statistical difference between PET-CT and histopathological staging. Sensitivity of the PET-CT for N staging was 86.7% and it was higher than for the histopathology. Two patients showed liver metastases. Conclusion Positron emission tomography-computed tomography examination could play an important role in the initial staging for the rectal cancer. Good patient selection for preoperative chemoradiotherapy ensures survival benefit. Avoidance of unnecessary therapeutic procedures allows an acceptable quality of patient's life. [ABSTRACT FROM AUTHOR]

Introduction. In locally advanced cancers of the cervix, endometrium and vulva, radiotherapy is the primary treatment modality. In recent years, new modern techniques of external radiation have been developed in radiation oncology, with the goal of dose escalation to the target volume, while sparing healthy tissues. The aim of this study is to determine the impact of volumetric modulated arc therapy on clinical outcomes of patients with gynecological malignancies. Material and Methods. Data were retrospectively collected from 60 patients treated for International Federation of Gynecology and Obstetrics stage I – III cervical, endometrial and vulvar cancers, using definitive (n = 35) or adjuvant (n = 25) radiotherapy/chemoradiotherapy. Thirty patients underwent three-dimensional conformal radiation therapy (definitive in 22 and adjuvant in 8) and the other 30 patients were treated with volumetric modulated arc therapy (definitive in 13 and adjuvant in 17). The following clinical outcome parameters were compared between the two groups: complete clinical response, disease free survival, progression free survival, and 4-year overall survival. Results. Progression free survival of patients treated with definitive radiotherapy/ chemoradiotherapy using volumetric modulated arc therapy was 17.2 months, while in the group treated with three-dimensional conformal radiation therapy it was 7.9 months (p= 0.300). Four-year overall survival in patients who were treated with definitive radiotherapy/chemoradiotherapy using three-dimensional conformal radiation therapy was 50%, and 61.5% in the group treated with definitive volumetric modulated arc therapy (p = 0.200), while in patients treated using adjuvant radiotherapy/chemoradiotherapy it was 75% vs. 88.2%, respectively (p = 0.400). Conclusion. Although without statistical significance, volumetric modulated arc therapy showed better results with respect to progression free survival and 4-year overall survival in previously unoperated patients who underwent definitive radiotherapy/chemoradiotherapy. [ABSTRACT FROM AUTHOR]

The international radiotherapy (RT) expert panel has revised and updated the RT guidelines that were accepted in 2020 at the 4th Hungarian Breast Cancer Consensus Conference, based on new scientific evidence. Radiotherapy after breast-conserving surgery (BCS) is indicated in ductal carcinoma in situ (stage 0), as RT decreases the risk of local recurrence (LR) by 50-60%. In early stage (stage I-II) invasive breast cancer RT remains a standard treatment following BCS. However, in elderly (≥70 years) patients with stage I, hormone receptor-positive tumour, hormonal therapy without RT can be considered. Hypofractionated whole breast irradiation (WBI) and for selected cases accelerated partial breast irradiation are validated treatment alternatives to conventional WBI administered for 5 weeks. Following mastectomy, RT significantly decreases the risk of LR and improves overall survival of patients who have 1 to 3 or ≥4 positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes axillary dissection can be substituted with axillary RT. After neoadjuvant systemic treatment (NST) followed by BCS, WBI is mandatory, while after NST followed by mastectomy, locoregional RT should be given in cases of initial stage III-IV and ypN1 axillary status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Polgár, Kahán, Ivanov, Chorváth, Ligačová, Csejtei, Gábor, Landherr, Mangel, Mayer and Fodor.)