Lucyna Kepka - Academia.edu (original) (raw)

Papers by Lucyna Kepka

Research paper thumbnail of PD-0519: Short course vs. standard course radiotherapy, in elderly and/or fragile patients with glioblastoma multiforme

PD-0519: Short course vs. standard course radiotherapy, in elderly and/or fragile patients with glioblastoma multiforme

Radiotherapy and Oncology, 2014

Research paper thumbnail of PET-CT use and the occurrence of elective nodal failure in involved field radiotherapy for non-small cell lung cancer: A systematic review

PET-CT use and the occurrence of elective nodal failure in involved field radiotherapy for non-small cell lung cancer: A systematic review

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Jan 17, 2015

Current guidelines do not recommend the use of elective nodal irradiation for NSCLC, for several ... more Current guidelines do not recommend the use of elective nodal irradiation for NSCLC, for several reasons. One of these is that PET-CT provides adequate nodal staging. We compared the published rates of elective nodal failures (ENFs) defined as regional failures that occur without local recurrence irrespectively of distant metastases status in patients who did or did not undergo PET-CT for staging. Reports of the occurrence of ENFs were considered. Only studies that used involved fields and specified the number of ENFs in patients with and without PET-CT use were included. A chi-squared test was used for the comparison of the risk of ENF in patients staged with and without PET. Forty-eight studies were included; 2158 and 1487 patients with and without PET-CT performed before radiotherapy were identified. The proportion of patients treated with SBRT was higher in the group with PET-CT (71%) than it was in the group without PET-CT (20%; p<.001). There were 136 (6.3%) and 98 (6.6%) E...

Research paper thumbnail of 18/Ocena wpływu napięcia mięśni na obszar napromienianych tkanek regionu miednicy

18/Ocena wpływu napięcia mięśni na obszar napromienianych tkanek regionu miednicy

Reports of Practical Oncology & Radiotherapy, 2004

ABSTRACT cel Ocena potencjalnego wpływu napięcia mięśni na błędy w odtwarzalności półnapromienian... more ABSTRACT cel Ocena potencjalnego wpływu napięcia mięśni na błędy w odtwarzalności półnapromieniania. Materiał i metody Do badania włączono dwudziestu dziewięciu kolejnych chorych na raka odbytnicy. Symulacja pola bocznego w ułożeniu na brzuchu była wykonana dwukrotnie: pierwsza z rozluźnionymi, druga z napiętymi mięśniami miednicy. Podczas drugiej symulacji, stół przesuwano tak, aby środek pola napromieniania pokrył się z tatuażem na skórze wykonanym podczas pierwszej symulacji. Oba obrazy pól napromieniania nakładano na siebie tak, aby struktury kostne pokryły się. Mierzono przesunięcie punktu centrowania oraz skręcenie pól, traktując jako referencyjny obraz pola z pierwszej symulacji. Obliczano średnie używając bezwzględnych wartości pomiarów. Wyniki W kierunku przednio-tylnym średnia arytmetyczna przesunięć wyniosła 15.3 mm, odchylenie standardowe (OS) 6.9 mm, a wartość największa 37 mm. Wkierunku głowa-nogi średnia arytmetyczna przesunięć wyniosla, 4.4 mm (OS) 4 mm, a wartość największa 17 mm. Średnia arytmetyczna skręcenia miednicy wyniosła 5.3 stopni, (OS) 2.4, a wartość największa 11 stopni. Większość przesunięć odnotowano w kierunku tylnym (86%) i do nog (55%). Kierunek większości rotacji był zgodny z kierunkiem wskazówek zegara (76%). Stwierdzono, że napięcie mięśni powoduje przesunięcie brzegu odbytu i zmianę położenia tkanek pod indywidualną osłoną. Wniosek Różnice w napięciu mięśni są potencjalnym źródłem błędów w odtwarzalności pól napromieniania.

Research paper thumbnail of Hypofractionated conformal radiotherapy in combination with chemotherapy in limited disease small cell lung cancer patients

Pneumonologia i Alergologia Polska, 2014

Research paper thumbnail of Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials

Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials

Radiotherapy and Oncology, 2006

According to common conviction rectal tumour shrinkage after preoperative radio(chemo)therapy inc... more According to common conviction rectal tumour shrinkage after preoperative radio(chemo)therapy increases the likelihood of anterior resection (AR). In order to verify this belief, we performed a systematic review of randomised trials. We identified 10 randomised trials encompassing altogether 4596 patients in whom preoperative radio(chemo)therapy resulted in tumour shrinkage in the experimental arm as compared to the control arm. Tumour shrinkage observed in the experimental groups did not result in a statistically significant higher ARs rate in any study when we performed an analysis of all the randomised cases. Subgroups of patients considered to be candidates for abdominoperineal resection before randomisation were identified in three trials. A statistically significantly higher rate of ARs was demonstrated in the experimental arm of the CAO/ARO/AIO 94 study. However, in that study, sphincter preservation was a secondary endpoint and some features of the trial may bias the estimation of the effect. The benefit of sphincter preservation was not confirmed by subgroup analyses performed in the Lyon R90-01 study and in the Polish study, which were originally designed to evaluate the sphincter preservation issue. The body of evidence gathered from randomised trials does not support the concept of a beneficial effect of preoperative radiotherapy on the ARs rate.

Research paper thumbnail of Tumour regression grading in patients with residual rectal cancer after preoperative chemoradiation

Radiotherapy and Oncology, 2010

Background and purpose: To explore the utility of tumour regression grading (TRG, the amount of r... more Background and purpose: To explore the utility of tumour regression grading (TRG, the amount of residual tumour cells in relation to extension of fibrosis) after chemoradiation of rectal cancer. Materials and methods: Of 131 patients who received preoperative chemoradiation in the frame of the randomized trial, pathological complete response (pCR, TRG0), good regression (TRG1), moderate regression (TRG2), and poor regression (TRG3) were recorded in 17%, 31%, 31%, and 22% of patients, respectively. Results: The rates of ypN-positive category for TRG0, TRG1, TRG2, and TRG3 groups were 5%, 23%, 45%, and 46%, respectively, p = 0.001. When ypT-category and TRG were evaluated by the logistic regression analysis, only ypT-category remained significant for independent prediction of the risk for mesorectal nodal metastases, p = 0.006. The 4-year (median follow-up) disease-free survival (DFS) for TRG0, TRG1, TRG2, and TRG3 groups were 91%, 67%, 54%, and 47%. When patients with persistent disease (TRG1 vs. TRG2 vs. TRG3) were analyzed separately, TRG had no prognostic value for DFS, p = 0.402. Conclusions: TRG in patients with residual cancer had no prognostic value for the incidence of nodal disease and for DFS. Our findings and literature data question the need for the inclusion of TRG assessment into a routine pathological report.

Research paper thumbnail of Incidence of isolated nodal failure in non-small cell lung cancer patients included in a prospective study of the value of PET–CT

Radiotherapy and Oncology, 2012

Purpose: Elective nodal irradiation (ENI) is not recommended in PET-CT-based radiotherapy for NSC... more Purpose: Elective nodal irradiation (ENI) is not recommended in PET-CT-based radiotherapy for NSCLC despite a low level of evidence to support such guidelines. The aim of this investigation is to find out whether omitting ENI is safe. Materials and methods: Sixty-seven patients treated within a frame of a previously published prospective trial of the value of PET-CT were included in the analysis. Seventeen (25%) patients received ENI due to higher initial nodal involvement and in the remaining 50 patients (75%) with N0-N1 or single N2 disease ENI was omitted. Isolated nodal failure (INF) was recorded if relapse occurred in the initially uninvolved regional lymph node without previous or simultaneous local recurrence regardless of the status of distant metastases. Results: With a median follow-up of 32 months, the estimated 3-year overall survival was 42%, local progression-free interval was 55%, and distant metastases-free interval was 62%. Three patients developed INF; all had ENI omitted from treatment, giving a final result of three INFs in 50 (6%) patients treated without ENI. In this group of patients, the 3-year cause-specific cumulative incidence of INF was 6.4% (95% confidence interval: 0-17%). Conclusions: The omission of ENI appears to be not as safe as suggested by current recommendations.

Research paper thumbnail of Target volume for postoperative radiotherapy in non-small cell lung cancer: Results from a prospective trial

Target volume for postoperative radiotherapy in non-small cell lung cancer: Results from a prospective trial

Radiotherapy and Oncology, 2013

A previous prospective trial reported that three-dimensional conformal postoperative radiotherapy... more A previous prospective trial reported that three-dimensional conformal postoperative radiotherapy (PORT) for pN2 NSCLC patients using a limited clinical target volume (CTV) had a late morbidity rate and pulmonary function that did not differ from those observed in pN1 patients treated with surgery without PORT. The aim of this study was to assess locoregional control and localization of failure in patients treated with PORT. The pattern of locoregional failure was evaluated retrospectively in 151 of 171 patients included in the PORT arm. The CTV included the involved lymph node stations and those with a risk of invasion &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10%. Competing risk analysis was used to assess the incidence of locoregional failure and its location outside the CTV. Overall survival at 5years was 27.1% with a median follow-up of 67months for 40 living patients. The 5-year cumulative incidence of locoregional failure was 19.4% (95% CI: 18.2-20.5%) including a failure rate of 2% (95% CI: 0-17%) in locations outside or at the border of the CTV. The use of limited CTV was associated with acceptable risk of geographic miss. Overall locoregional control was similar to that reported by other studies using PORT for pN2 patients.

Research paper thumbnail of Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: Report of a randomised trial

Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: Report of a randomised trial

Radiotherapy and Oncology, 2007

Patients (N=316) with resectable cT3-4 low-lying and mid-rectal cancer were randomised to receive... more Patients (N=316) with resectable cT3-4 low-lying and mid-rectal cancer were randomised to receive either preoperative 5x5Gy irradiation with subsequent surgery performed within 7 days or chemoradiation (50.4, 1.8Gy per fraction plus boluses of 5-fluorouracil and leucovorin) followed by surgery after 4-6 weeks. No differences were found in sphincter preservation, survival, local control and late complications. Early complications were less frequent in the short-course group. The aim of this report is to find out whether large doses per fraction of short-course schedule result in more severe anorectal and sexual dysfunction and quality of life (QoL) impairment. Patients who were free of disease were asked to answer the QLQ-C30 and those without stoma were, additionally, asked to fill in a questionnaire of anorectal (19 items) and sexual function (1 item). Two hundred and twenty-two patients (86% response rate) completed the QLQ-C30 and 118 (86% response rate) the anorectal-sexual function questionnaire. The median time from surgery to filling in the QLQ-C30 questionnaire was 12 months, and to filling in the anorectal-sexual function questionnaire - 13 months. We did not find significant differences between the randomised groups regarding QoL and the anorectal and sexual functions. Approximately two-thirds of patients had anorectal function impairment. Approximately 20% of patients stated that this considerably influenced their QoL. QoL and the anorectal and sexual functioning did not differ in patients receiving short-course radiotherapy, as compared to those receiving chemoradiation.

Research paper thumbnail of O-294 Tumor (T)-and lymph nodes (N)- volume rather than TNM stage predict outcome in definitive radiotherapy for NSCLC

Lung Cancer, 2003

Purpose: To assess prognostic value of GTV (in cm3) as derived from 3-D planning systems, volume ... more Purpose: To assess prognostic value of GTV (in cm3) as derived from 3-D planning systems, volume of mediastinal nodal disease, traditional TNM staging and patient-related parameters in radiotherapy for NSCLC.

Research paper thumbnail of Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: An analysis of outcomes in a randomized trial

International Journal of Radiation Oncology*Biology*Physics, 2007

Purpose: To compare 5 ؋ 5 Gy preoperative radiotherapy with immediate surgery vs. preoperative ch... more Purpose: To compare 5 ؋ 5 Gy preoperative radiotherapy with immediate surgery vs. preoperative chemoradiotherapy (50.4 Gy, 5-fluorouracil, leucovorin) with delayed surgery in a randomized trial for cT3-T4 low-lying rectal cancer. Despite the downstaging effect of chemoradiotherapy, similar long-term outcomes were observed in both groups. Methods: The Cox model was used to evaluate the prognostic value of ypTN ("yp" denotes that pathologic classification was performed after initial multimodality therapy) categories and the surgical margin status in 291 patients. Results: Disease-free survival (DFS) (hazard ratio [HR] 1.05, 95% confidence interval [CI], 0.73-1.51), distant metastases (HR, 1.17; 95% CI, 0.77-1.78), and local control (HR, 1.45; 95% CI, 0.74 -2.84) were similar in both arms. The ypN status was the only independent prognostic factor for DFS ( p < 0.001). An interaction ( p ‫؍‬ 0.016) between N stage and the assigned treatment was demonstrated. For ypN-negative patients, DFS was similar in both arms (HR, 0.83, 95% CI, 0.47-1.48); however, for ypN-positive patients, DFS was worse in the chemoradiotherapy arm (HR, 1.73; 95% CI, 1.07-2.77). The 4-year (median follow-up) DFS rate in N-positive patients was 51% in the 5 ؋ 5-Gy arm vs. 25% in the chemoradiotherapy arm. The corresponding 4-year rates for the incidence of local recurrence and distant metastases were 14% vs. 27% (HR, 1.95; 95% CI, 0.78 -4.86) and 38% vs. 68% (HR, 2.05; 95% CI, 1.21-3.48). Conclusion: N-positive disease after chemoradiotherapy indicates radiochemoresistance. N-positive disease after 5 ؋ 5 Gy RT includes both radiosensitive and radioresistant tumors, because the interval between radiotherapy and surgery was too short for radiosensitive cancer to undergo necrosis. Thus, the greater risk of distant metastases recorded in the chemoradiotherapy arm suggests that radiochemoresistance of nodal metastases from rectal cancer is associated with a high potential for developing distant metastases.

Research paper thumbnail of HDR brachytherapy for the reirradiation of cervical and vaginal cancer: Analysis of efficacy and dosage delivered to organs at risk

Gynecologic Oncology, 2014

Evaluation of the efficacy of HDR brachytherapy (BT) for the reirradiation of cervical cancer • E... more Evaluation of the efficacy of HDR brachytherapy (BT) for the reirradiation of cervical cancer • Evaluation of the toxicity of HDR BT for the reirradiation of cancer arising within a previously irradiated area • A cumulative EQD2 of approximately 100 Gy can be safely delivered to 2 cm 3 of the bladder and rectum.

Research paper thumbnail of Radiochemotherapy in the elderly with lung cancer

Radiochemotherapy in the elderly with lung cancer

Expert Review of Anticancer Therapy, 2009

Lung cancer is the leading cause of cancer mortality with the median age of incidence being 69 ye... more Lung cancer is the leading cause of cancer mortality with the median age of incidence being 69 years in males and 67 years in females. Radiochemotherapy (RT-CHT) is indicated in locally advanced non-small-cell lung cancer and limited-stage small-cell lung cancer; however, a significant under-representation of the elderly has been observed in patient recruitment in cancer treatment trials. In the last decades of the 20th Century, studies showed that elderly patients achieved the best quality-adjusted survival with radiotherapy alone, but recent trials have found that fit elderly patients benefit from concurrent RT-CHT, although with more short-term toxicity. Age alone should not exclude fit patients and deprive them of the standard treatment. Using tools, such as comprehensive geriatric assessment, a patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s tolerance to therapy can be assessed and monitoring can be performed. This review will focus on RT-CHT treatment in elderly patients with nonoperable stage III non-small-cell lung cancer and limited-stage small-cell lung cancer exclusively.

Research paper thumbnail of Combination of radiotherapy and chemotherapy in locally advanced NSCLC

Combination of radiotherapy and chemotherapy in locally advanced NSCLC

Expert Review of Anticancer Therapy, 2009

The combination of radiotherapy and chemotherapy is considered to be a standard approach for pati... more The combination of radiotherapy and chemotherapy is considered to be a standard approach for patients with locally advanced, stage III non-small-cell lung cancer. The current state of the art of combined radiochemotherapy supported by evidence-based data is presented. As shown in the meta-analyses, the concurrent radiochemotherapy gives a superior outcome in terms of survival compared with sequential delivery of both modalities. This is obtained at the expense of higher toxicity, which makes further intensification of radiochemotherapy challenging. Eligibility of patients with non-small-cell lung cancer for such an approach is limited. The new methods to improve treatment results, such as selection of proper strategies, incorporation of molecular agents into combined treatment and radiotherapy technique modifications are discussed.

Research paper thumbnail of Radiochemotherapy in small-cell lung cancer

Radiochemotherapy in small-cell lung cancer

Expert Review of Anticancer Therapy, 2009

Thoracic radiotherapy and prophylactic cranial irradiation (PCI) in combination with chemotherapy... more Thoracic radiotherapy and prophylactic cranial irradiation (PCI) in combination with chemotherapy is an established standard of treatment of limited-disease (LD) small-cell lung cancer (SCLC). Both types of radiotherapy increase 3-year survival by approximately 5%, as shown in the meta-analyses. There is some evidence that earlier commencement of thoracic radiotherapy for good performance status LD-SCLC patients results in better outcome. Total dose, fractionation type and irradiation volume are still matter of debate. The ongoing Phase III randomized trials aim to answer the question of total dose in LD-SCLC. For PCI, in LD-SCLC a standard dose of 25 Gy in ten fractions should remain a standard, as has recently been demonstrated. The PCI in extensive-disease SCLC improves survival at the expense of worsening of short-term health-related quality of life. There is evidence that consolidation thoracic radiotherapy may be of value in extensive-disease SCLC. The recently initiated prospective trials may answer this question.

Research paper thumbnail of Radiochemotherapy for Lung Cancer in Developing Countries

Radiochemotherapy for Lung Cancer in Developing Countries

Clinical Oncology, 2009

Radiochemotherapy has become a standard approach in locally advanced non-small cell lung cancer a... more Radiochemotherapy has become a standard approach in locally advanced non-small cell lung cancer and limited disease small cell lung cancer. Most of the data supporting this observation come from the developed world and only extremely rarely have good-quality clinical trials been carried out in developing countries. It is therefore of paramount importance to put the experience of the developed world into the context of the limited resources and other health care problems of developing countries. In this overview, the problems with the implementation of such data are discussed. The necessity of carrying out clinical trials specifically designed to address the needs of developing countries is emphasised. The research on cheaper ways of radiochemotherapy combination should be encouraged. The specific national guidelines for local needs should be created and followed. The availability of radiotherapy equipment is of major importance, as radiotherapy has a pivotal role in non-surgical treatment of lung cancer, especially in the developing world.

Research paper thumbnail of Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

Acta Oncologica, 2008

To estimate the doses of incidental irradiation in particular lymph node stations (LNS) in differ... more To estimate the doses of incidental irradiation in particular lymph node stations (LNS) in different extents of elective nodal irradiation (ENI) in 3D-conformal radiotherapy (3D-CRT) for non-small cell lung cancer (NSCLC). METHODS; Doses of radiotherapy were estimated for particular LNS delineated according to the recommendations of the University of Michigan in 220 patients treated using 3D-CRT with different (extended, limited and omitted) extents of ENI. Minimum doses and volumes of LNS receiving 40 Gy or more (V40) were compared for omitted vs. limited+ extended ENI and limited vs. extended ENI. For omission of the ENI the minimum doses and V40 for particular LNS were significantly lower than for patients treated with ENI. For the limited ENI group, the minimum doses for LNS 5, 6 lower parts of 3A and 3P (not included in the elective area) did not differ significantly from doses given to respective LNS for extended ENI group. When the V40 values for extended and limited ENI were compared, no significant differences were seen for any LNS, except for group 1/2R, 1/2L. Incidental irradiation of untreated LNS seems play a part in case of limited ENI, but not in cases without ENI. For subclinical disease the delineation of uninvolved LNS 5, 6, and lower parts of 3A, 3P may be not necessary, because these stations receive the substantial part of irradiation incidentally, if LNS 4R, 4L, 7, and ipsilateral hilum are included in the elective area while this is not case for stations 1 and 2.

Research paper thumbnail of Risk of isolated nodal failure for non-small cell lung cancer (NSCLC) treated with the elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) techniques – A retrospective analysis

Risk of isolated nodal failure for non-small cell lung cancer (NSCLC) treated with the elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) techniques – A retrospective analysis

Acta Oncologica, 2008

To estimate retrospectively the rate of isolated nodal failures (INF) in NSCLC patients treated w... more To estimate retrospectively the rate of isolated nodal failures (INF) in NSCLC patients treated with the elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT). One hundred and eighty-five patients with I-IIIB stage treated with 3D-CRT in consecutive clinical trials differing in an extent of the ENI were analyzed. According to the extent of the ENI, two groups were distinguished: extended (n = 124) and limited (n = 61) ENI. INF was defined as regional nodal failure occurring without local progression. Cumulative Incidence of INF (CIINF) was evaluated by univariate and multivariate analysis with regard to prognostic factors. With a median follow up of 30 months, the two-year actuarial overall survival was 35%. The two-year CIINF rate was 12%. There were 16 (9%) INF, eight (6%) for extended and eight (13%) for limited ENI. In the univariate analysis bulky mediastinal disease (BMD), left side, higher N stage, and partial response to RT had a significant negative impact on the CIINF. BMD was the only independent predictor of the risk of incidence of the INF (p = 0.001). INF is more likely to occur in case of more advanced nodal status.

Research paper thumbnail of Successful Rescue in a Patient with High Dose Methotrexate-Induced Nephrotoxicity and Acute Renal Failure

Successful Rescue in a Patient with High Dose Methotrexate-Induced Nephrotoxicity and Acute Renal Failure

We describe the case of a 35-year old male who developed acute renal failure following high dose ... more We describe the case of a 35-year old male who developed acute renal failure following high dose methotrexate therapy for Burkitt&amp;amp;#39;s non Hodgkin lymphoma. Serum methotrexate levels reached 37 micromol/l, and remained higher than 1 micromol/l for more than a week. Folinic acid rescue was intensified to 200-400 mg intravenously every 4 hours. As methotrexate binds markedly to proteins, plasma exchange was initially chosen, 4 sessions being performed from day 2 to day 4. The methotrexate pharmacokinetic profile was not significantly modified during plasma exchange, and serum drug level was 3 micromol/l. Continuous veno-venous hemodiafiltration was therefore performed from day 5 to day 10. This procedure also seemed ineffective, with evidence of low ultrafiltrate clearance. No extrarenal toxicity was observed in our patient. Thus, conventional extrarenal procedures appear to have a limited role in the setting of overexposure to methotrexate. The use of very high doses of folinic acid in our case probably played a major role in the eventual favorable outcome.

Research paper thumbnail of Outcome of treatment of recurrent glioblastoma multiforme in elderly and/or frail patients

Outcome of treatment of recurrent glioblastoma multiforme in elderly and/or frail patients

Journal of Neuro-Oncology, 2015

Optimal treatment of recurrent glioblastoma multiforme (rGBM) in elderly and/or frail patients re... more Optimal treatment of recurrent glioblastoma multiforme (rGBM) in elderly and/or frail patients remains virtually unexplored, the best supportive care (BSC) only is routinely administered due to the fatal prognosis. We evaluated the impact of different treatment methods on post-progression survival (PPS) and overall survival (OS) of such patients. Data from 98 elderly and/or frail rGBM patients, treated initially with 1-week or 3-week radiotherapy (RT) within the phase III IAEA study (2010-2013), were analyzed. KPS at relapse and salvage treatment methods were recorded. Kaplan-Meier method was used to estimate PPS and OS for different treatment modalities. Eighty-four patients experienced recurrence: 47 (56 %) received BSC, 21 (25 %)-chemotherapy (CHT), 8 (9.5 %)-surgery, 3 (3.5 %)-RT, for 5 (6 %) the data was unavailable. Median OS from randomization for all 84 patients was 35 weeks: 55 versus 30 weeks for any treatment versus BSC, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001. Median PPS was 15 weeks: 23 weeks with any treatment versus 9 weeks with BSC, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001. For local treatment (surgery and/or RT) median PPS was 51 versus 21 weeks for CHT, p = 0.36. In patients with poor KPS (≤60) at relapse median PPS was 9 weeks with BSC versus 21 weeks with any treatment, p = 0.014. In poor KPS patients median PPS for local treatment was 14 weeks versus 21 weeks with CHT, p = 0.88. An active therapeutic approach may be beneficial for selected elderly and/or frail rGBM patients. Poor KPS patients may also benefit from active treatment, but there is no benefit of local treatment over CHT.

Research paper thumbnail of PD-0519: Short course vs. standard course radiotherapy, in elderly and/or fragile patients with glioblastoma multiforme

PD-0519: Short course vs. standard course radiotherapy, in elderly and/or fragile patients with glioblastoma multiforme

Radiotherapy and Oncology, 2014

Research paper thumbnail of PET-CT use and the occurrence of elective nodal failure in involved field radiotherapy for non-small cell lung cancer: A systematic review

PET-CT use and the occurrence of elective nodal failure in involved field radiotherapy for non-small cell lung cancer: A systematic review

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Jan 17, 2015

Current guidelines do not recommend the use of elective nodal irradiation for NSCLC, for several ... more Current guidelines do not recommend the use of elective nodal irradiation for NSCLC, for several reasons. One of these is that PET-CT provides adequate nodal staging. We compared the published rates of elective nodal failures (ENFs) defined as regional failures that occur without local recurrence irrespectively of distant metastases status in patients who did or did not undergo PET-CT for staging. Reports of the occurrence of ENFs were considered. Only studies that used involved fields and specified the number of ENFs in patients with and without PET-CT use were included. A chi-squared test was used for the comparison of the risk of ENF in patients staged with and without PET. Forty-eight studies were included; 2158 and 1487 patients with and without PET-CT performed before radiotherapy were identified. The proportion of patients treated with SBRT was higher in the group with PET-CT (71%) than it was in the group without PET-CT (20%; p<.001). There were 136 (6.3%) and 98 (6.6%) E...

Research paper thumbnail of 18/Ocena wpływu napięcia mięśni na obszar napromienianych tkanek regionu miednicy

18/Ocena wpływu napięcia mięśni na obszar napromienianych tkanek regionu miednicy

Reports of Practical Oncology & Radiotherapy, 2004

ABSTRACT cel Ocena potencjalnego wpływu napięcia mięśni na błędy w odtwarzalności półnapromienian... more ABSTRACT cel Ocena potencjalnego wpływu napięcia mięśni na błędy w odtwarzalności półnapromieniania. Materiał i metody Do badania włączono dwudziestu dziewięciu kolejnych chorych na raka odbytnicy. Symulacja pola bocznego w ułożeniu na brzuchu była wykonana dwukrotnie: pierwsza z rozluźnionymi, druga z napiętymi mięśniami miednicy. Podczas drugiej symulacji, stół przesuwano tak, aby środek pola napromieniania pokrył się z tatuażem na skórze wykonanym podczas pierwszej symulacji. Oba obrazy pól napromieniania nakładano na siebie tak, aby struktury kostne pokryły się. Mierzono przesunięcie punktu centrowania oraz skręcenie pól, traktując jako referencyjny obraz pola z pierwszej symulacji. Obliczano średnie używając bezwzględnych wartości pomiarów. Wyniki W kierunku przednio-tylnym średnia arytmetyczna przesunięć wyniosła 15.3 mm, odchylenie standardowe (OS) 6.9 mm, a wartość największa 37 mm. Wkierunku głowa-nogi średnia arytmetyczna przesunięć wyniosla, 4.4 mm (OS) 4 mm, a wartość największa 17 mm. Średnia arytmetyczna skręcenia miednicy wyniosła 5.3 stopni, (OS) 2.4, a wartość największa 11 stopni. Większość przesunięć odnotowano w kierunku tylnym (86%) i do nog (55%). Kierunek większości rotacji był zgodny z kierunkiem wskazówek zegara (76%). Stwierdzono, że napięcie mięśni powoduje przesunięcie brzegu odbytu i zmianę położenia tkanek pod indywidualną osłoną. Wniosek Różnice w napięciu mięśni są potencjalnym źródłem błędów w odtwarzalności pól napromieniania.

Research paper thumbnail of Hypofractionated conformal radiotherapy in combination with chemotherapy in limited disease small cell lung cancer patients

Pneumonologia i Alergologia Polska, 2014

Research paper thumbnail of Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials

Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials

Radiotherapy and Oncology, 2006

According to common conviction rectal tumour shrinkage after preoperative radio(chemo)therapy inc... more According to common conviction rectal tumour shrinkage after preoperative radio(chemo)therapy increases the likelihood of anterior resection (AR). In order to verify this belief, we performed a systematic review of randomised trials. We identified 10 randomised trials encompassing altogether 4596 patients in whom preoperative radio(chemo)therapy resulted in tumour shrinkage in the experimental arm as compared to the control arm. Tumour shrinkage observed in the experimental groups did not result in a statistically significant higher ARs rate in any study when we performed an analysis of all the randomised cases. Subgroups of patients considered to be candidates for abdominoperineal resection before randomisation were identified in three trials. A statistically significantly higher rate of ARs was demonstrated in the experimental arm of the CAO/ARO/AIO 94 study. However, in that study, sphincter preservation was a secondary endpoint and some features of the trial may bias the estimation of the effect. The benefit of sphincter preservation was not confirmed by subgroup analyses performed in the Lyon R90-01 study and in the Polish study, which were originally designed to evaluate the sphincter preservation issue. The body of evidence gathered from randomised trials does not support the concept of a beneficial effect of preoperative radiotherapy on the ARs rate.

Research paper thumbnail of Tumour regression grading in patients with residual rectal cancer after preoperative chemoradiation

Radiotherapy and Oncology, 2010

Background and purpose: To explore the utility of tumour regression grading (TRG, the amount of r... more Background and purpose: To explore the utility of tumour regression grading (TRG, the amount of residual tumour cells in relation to extension of fibrosis) after chemoradiation of rectal cancer. Materials and methods: Of 131 patients who received preoperative chemoradiation in the frame of the randomized trial, pathological complete response (pCR, TRG0), good regression (TRG1), moderate regression (TRG2), and poor regression (TRG3) were recorded in 17%, 31%, 31%, and 22% of patients, respectively. Results: The rates of ypN-positive category for TRG0, TRG1, TRG2, and TRG3 groups were 5%, 23%, 45%, and 46%, respectively, p = 0.001. When ypT-category and TRG were evaluated by the logistic regression analysis, only ypT-category remained significant for independent prediction of the risk for mesorectal nodal metastases, p = 0.006. The 4-year (median follow-up) disease-free survival (DFS) for TRG0, TRG1, TRG2, and TRG3 groups were 91%, 67%, 54%, and 47%. When patients with persistent disease (TRG1 vs. TRG2 vs. TRG3) were analyzed separately, TRG had no prognostic value for DFS, p = 0.402. Conclusions: TRG in patients with residual cancer had no prognostic value for the incidence of nodal disease and for DFS. Our findings and literature data question the need for the inclusion of TRG assessment into a routine pathological report.

Research paper thumbnail of Incidence of isolated nodal failure in non-small cell lung cancer patients included in a prospective study of the value of PET–CT

Radiotherapy and Oncology, 2012

Purpose: Elective nodal irradiation (ENI) is not recommended in PET-CT-based radiotherapy for NSC... more Purpose: Elective nodal irradiation (ENI) is not recommended in PET-CT-based radiotherapy for NSCLC despite a low level of evidence to support such guidelines. The aim of this investigation is to find out whether omitting ENI is safe. Materials and methods: Sixty-seven patients treated within a frame of a previously published prospective trial of the value of PET-CT were included in the analysis. Seventeen (25%) patients received ENI due to higher initial nodal involvement and in the remaining 50 patients (75%) with N0-N1 or single N2 disease ENI was omitted. Isolated nodal failure (INF) was recorded if relapse occurred in the initially uninvolved regional lymph node without previous or simultaneous local recurrence regardless of the status of distant metastases. Results: With a median follow-up of 32 months, the estimated 3-year overall survival was 42%, local progression-free interval was 55%, and distant metastases-free interval was 62%. Three patients developed INF; all had ENI omitted from treatment, giving a final result of three INFs in 50 (6%) patients treated without ENI. In this group of patients, the 3-year cause-specific cumulative incidence of INF was 6.4% (95% confidence interval: 0-17%). Conclusions: The omission of ENI appears to be not as safe as suggested by current recommendations.

Research paper thumbnail of Target volume for postoperative radiotherapy in non-small cell lung cancer: Results from a prospective trial

Target volume for postoperative radiotherapy in non-small cell lung cancer: Results from a prospective trial

Radiotherapy and Oncology, 2013

A previous prospective trial reported that three-dimensional conformal postoperative radiotherapy... more A previous prospective trial reported that three-dimensional conformal postoperative radiotherapy (PORT) for pN2 NSCLC patients using a limited clinical target volume (CTV) had a late morbidity rate and pulmonary function that did not differ from those observed in pN1 patients treated with surgery without PORT. The aim of this study was to assess locoregional control and localization of failure in patients treated with PORT. The pattern of locoregional failure was evaluated retrospectively in 151 of 171 patients included in the PORT arm. The CTV included the involved lymph node stations and those with a risk of invasion &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10%. Competing risk analysis was used to assess the incidence of locoregional failure and its location outside the CTV. Overall survival at 5years was 27.1% with a median follow-up of 67months for 40 living patients. The 5-year cumulative incidence of locoregional failure was 19.4% (95% CI: 18.2-20.5%) including a failure rate of 2% (95% CI: 0-17%) in locations outside or at the border of the CTV. The use of limited CTV was associated with acceptable risk of geographic miss. Overall locoregional control was similar to that reported by other studies using PORT for pN2 patients.

Research paper thumbnail of Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: Report of a randomised trial

Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: Report of a randomised trial

Radiotherapy and Oncology, 2007

Patients (N=316) with resectable cT3-4 low-lying and mid-rectal cancer were randomised to receive... more Patients (N=316) with resectable cT3-4 low-lying and mid-rectal cancer were randomised to receive either preoperative 5x5Gy irradiation with subsequent surgery performed within 7 days or chemoradiation (50.4, 1.8Gy per fraction plus boluses of 5-fluorouracil and leucovorin) followed by surgery after 4-6 weeks. No differences were found in sphincter preservation, survival, local control and late complications. Early complications were less frequent in the short-course group. The aim of this report is to find out whether large doses per fraction of short-course schedule result in more severe anorectal and sexual dysfunction and quality of life (QoL) impairment. Patients who were free of disease were asked to answer the QLQ-C30 and those without stoma were, additionally, asked to fill in a questionnaire of anorectal (19 items) and sexual function (1 item). Two hundred and twenty-two patients (86% response rate) completed the QLQ-C30 and 118 (86% response rate) the anorectal-sexual function questionnaire. The median time from surgery to filling in the QLQ-C30 questionnaire was 12 months, and to filling in the anorectal-sexual function questionnaire - 13 months. We did not find significant differences between the randomised groups regarding QoL and the anorectal and sexual functions. Approximately two-thirds of patients had anorectal function impairment. Approximately 20% of patients stated that this considerably influenced their QoL. QoL and the anorectal and sexual functioning did not differ in patients receiving short-course radiotherapy, as compared to those receiving chemoradiation.

Research paper thumbnail of O-294 Tumor (T)-and lymph nodes (N)- volume rather than TNM stage predict outcome in definitive radiotherapy for NSCLC

Lung Cancer, 2003

Purpose: To assess prognostic value of GTV (in cm3) as derived from 3-D planning systems, volume ... more Purpose: To assess prognostic value of GTV (in cm3) as derived from 3-D planning systems, volume of mediastinal nodal disease, traditional TNM staging and patient-related parameters in radiotherapy for NSCLC.

Research paper thumbnail of Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: An analysis of outcomes in a randomized trial

International Journal of Radiation Oncology*Biology*Physics, 2007

Purpose: To compare 5 ؋ 5 Gy preoperative radiotherapy with immediate surgery vs. preoperative ch... more Purpose: To compare 5 ؋ 5 Gy preoperative radiotherapy with immediate surgery vs. preoperative chemoradiotherapy (50.4 Gy, 5-fluorouracil, leucovorin) with delayed surgery in a randomized trial for cT3-T4 low-lying rectal cancer. Despite the downstaging effect of chemoradiotherapy, similar long-term outcomes were observed in both groups. Methods: The Cox model was used to evaluate the prognostic value of ypTN ("yp" denotes that pathologic classification was performed after initial multimodality therapy) categories and the surgical margin status in 291 patients. Results: Disease-free survival (DFS) (hazard ratio [HR] 1.05, 95% confidence interval [CI], 0.73-1.51), distant metastases (HR, 1.17; 95% CI, 0.77-1.78), and local control (HR, 1.45; 95% CI, 0.74 -2.84) were similar in both arms. The ypN status was the only independent prognostic factor for DFS ( p < 0.001). An interaction ( p ‫؍‬ 0.016) between N stage and the assigned treatment was demonstrated. For ypN-negative patients, DFS was similar in both arms (HR, 0.83, 95% CI, 0.47-1.48); however, for ypN-positive patients, DFS was worse in the chemoradiotherapy arm (HR, 1.73; 95% CI, 1.07-2.77). The 4-year (median follow-up) DFS rate in N-positive patients was 51% in the 5 ؋ 5-Gy arm vs. 25% in the chemoradiotherapy arm. The corresponding 4-year rates for the incidence of local recurrence and distant metastases were 14% vs. 27% (HR, 1.95; 95% CI, 0.78 -4.86) and 38% vs. 68% (HR, 2.05; 95% CI, 1.21-3.48). Conclusion: N-positive disease after chemoradiotherapy indicates radiochemoresistance. N-positive disease after 5 ؋ 5 Gy RT includes both radiosensitive and radioresistant tumors, because the interval between radiotherapy and surgery was too short for radiosensitive cancer to undergo necrosis. Thus, the greater risk of distant metastases recorded in the chemoradiotherapy arm suggests that radiochemoresistance of nodal metastases from rectal cancer is associated with a high potential for developing distant metastases.

Research paper thumbnail of HDR brachytherapy for the reirradiation of cervical and vaginal cancer: Analysis of efficacy and dosage delivered to organs at risk

Gynecologic Oncology, 2014

Evaluation of the efficacy of HDR brachytherapy (BT) for the reirradiation of cervical cancer • E... more Evaluation of the efficacy of HDR brachytherapy (BT) for the reirradiation of cervical cancer • Evaluation of the toxicity of HDR BT for the reirradiation of cancer arising within a previously irradiated area • A cumulative EQD2 of approximately 100 Gy can be safely delivered to 2 cm 3 of the bladder and rectum.

Research paper thumbnail of Radiochemotherapy in the elderly with lung cancer

Radiochemotherapy in the elderly with lung cancer

Expert Review of Anticancer Therapy, 2009

Lung cancer is the leading cause of cancer mortality with the median age of incidence being 69 ye... more Lung cancer is the leading cause of cancer mortality with the median age of incidence being 69 years in males and 67 years in females. Radiochemotherapy (RT-CHT) is indicated in locally advanced non-small-cell lung cancer and limited-stage small-cell lung cancer; however, a significant under-representation of the elderly has been observed in patient recruitment in cancer treatment trials. In the last decades of the 20th Century, studies showed that elderly patients achieved the best quality-adjusted survival with radiotherapy alone, but recent trials have found that fit elderly patients benefit from concurrent RT-CHT, although with more short-term toxicity. Age alone should not exclude fit patients and deprive them of the standard treatment. Using tools, such as comprehensive geriatric assessment, a patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s tolerance to therapy can be assessed and monitoring can be performed. This review will focus on RT-CHT treatment in elderly patients with nonoperable stage III non-small-cell lung cancer and limited-stage small-cell lung cancer exclusively.

Research paper thumbnail of Combination of radiotherapy and chemotherapy in locally advanced NSCLC

Combination of radiotherapy and chemotherapy in locally advanced NSCLC

Expert Review of Anticancer Therapy, 2009

The combination of radiotherapy and chemotherapy is considered to be a standard approach for pati... more The combination of radiotherapy and chemotherapy is considered to be a standard approach for patients with locally advanced, stage III non-small-cell lung cancer. The current state of the art of combined radiochemotherapy supported by evidence-based data is presented. As shown in the meta-analyses, the concurrent radiochemotherapy gives a superior outcome in terms of survival compared with sequential delivery of both modalities. This is obtained at the expense of higher toxicity, which makes further intensification of radiochemotherapy challenging. Eligibility of patients with non-small-cell lung cancer for such an approach is limited. The new methods to improve treatment results, such as selection of proper strategies, incorporation of molecular agents into combined treatment and radiotherapy technique modifications are discussed.

Research paper thumbnail of Radiochemotherapy in small-cell lung cancer

Radiochemotherapy in small-cell lung cancer

Expert Review of Anticancer Therapy, 2009

Thoracic radiotherapy and prophylactic cranial irradiation (PCI) in combination with chemotherapy... more Thoracic radiotherapy and prophylactic cranial irradiation (PCI) in combination with chemotherapy is an established standard of treatment of limited-disease (LD) small-cell lung cancer (SCLC). Both types of radiotherapy increase 3-year survival by approximately 5%, as shown in the meta-analyses. There is some evidence that earlier commencement of thoracic radiotherapy for good performance status LD-SCLC patients results in better outcome. Total dose, fractionation type and irradiation volume are still matter of debate. The ongoing Phase III randomized trials aim to answer the question of total dose in LD-SCLC. For PCI, in LD-SCLC a standard dose of 25 Gy in ten fractions should remain a standard, as has recently been demonstrated. The PCI in extensive-disease SCLC improves survival at the expense of worsening of short-term health-related quality of life. There is evidence that consolidation thoracic radiotherapy may be of value in extensive-disease SCLC. The recently initiated prospective trials may answer this question.

Research paper thumbnail of Radiochemotherapy for Lung Cancer in Developing Countries

Radiochemotherapy for Lung Cancer in Developing Countries

Clinical Oncology, 2009

Radiochemotherapy has become a standard approach in locally advanced non-small cell lung cancer a... more Radiochemotherapy has become a standard approach in locally advanced non-small cell lung cancer and limited disease small cell lung cancer. Most of the data supporting this observation come from the developed world and only extremely rarely have good-quality clinical trials been carried out in developing countries. It is therefore of paramount importance to put the experience of the developed world into the context of the limited resources and other health care problems of developing countries. In this overview, the problems with the implementation of such data are discussed. The necessity of carrying out clinical trials specifically designed to address the needs of developing countries is emphasised. The research on cheaper ways of radiochemotherapy combination should be encouraged. The specific national guidelines for local needs should be created and followed. The availability of radiotherapy equipment is of major importance, as radiotherapy has a pivotal role in non-surgical treatment of lung cancer, especially in the developing world.

Research paper thumbnail of Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

Acta Oncologica, 2008

To estimate the doses of incidental irradiation in particular lymph node stations (LNS) in differ... more To estimate the doses of incidental irradiation in particular lymph node stations (LNS) in different extents of elective nodal irradiation (ENI) in 3D-conformal radiotherapy (3D-CRT) for non-small cell lung cancer (NSCLC). METHODS; Doses of radiotherapy were estimated for particular LNS delineated according to the recommendations of the University of Michigan in 220 patients treated using 3D-CRT with different (extended, limited and omitted) extents of ENI. Minimum doses and volumes of LNS receiving 40 Gy or more (V40) were compared for omitted vs. limited+ extended ENI and limited vs. extended ENI. For omission of the ENI the minimum doses and V40 for particular LNS were significantly lower than for patients treated with ENI. For the limited ENI group, the minimum doses for LNS 5, 6 lower parts of 3A and 3P (not included in the elective area) did not differ significantly from doses given to respective LNS for extended ENI group. When the V40 values for extended and limited ENI were compared, no significant differences were seen for any LNS, except for group 1/2R, 1/2L. Incidental irradiation of untreated LNS seems play a part in case of limited ENI, but not in cases without ENI. For subclinical disease the delineation of uninvolved LNS 5, 6, and lower parts of 3A, 3P may be not necessary, because these stations receive the substantial part of irradiation incidentally, if LNS 4R, 4L, 7, and ipsilateral hilum are included in the elective area while this is not case for stations 1 and 2.

Research paper thumbnail of Risk of isolated nodal failure for non-small cell lung cancer (NSCLC) treated with the elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) techniques – A retrospective analysis

Risk of isolated nodal failure for non-small cell lung cancer (NSCLC) treated with the elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) techniques – A retrospective analysis

Acta Oncologica, 2008

To estimate retrospectively the rate of isolated nodal failures (INF) in NSCLC patients treated w... more To estimate retrospectively the rate of isolated nodal failures (INF) in NSCLC patients treated with the elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT). One hundred and eighty-five patients with I-IIIB stage treated with 3D-CRT in consecutive clinical trials differing in an extent of the ENI were analyzed. According to the extent of the ENI, two groups were distinguished: extended (n = 124) and limited (n = 61) ENI. INF was defined as regional nodal failure occurring without local progression. Cumulative Incidence of INF (CIINF) was evaluated by univariate and multivariate analysis with regard to prognostic factors. With a median follow up of 30 months, the two-year actuarial overall survival was 35%. The two-year CIINF rate was 12%. There were 16 (9%) INF, eight (6%) for extended and eight (13%) for limited ENI. In the univariate analysis bulky mediastinal disease (BMD), left side, higher N stage, and partial response to RT had a significant negative impact on the CIINF. BMD was the only independent predictor of the risk of incidence of the INF (p = 0.001). INF is more likely to occur in case of more advanced nodal status.

Research paper thumbnail of Successful Rescue in a Patient with High Dose Methotrexate-Induced Nephrotoxicity and Acute Renal Failure

Successful Rescue in a Patient with High Dose Methotrexate-Induced Nephrotoxicity and Acute Renal Failure

We describe the case of a 35-year old male who developed acute renal failure following high dose ... more We describe the case of a 35-year old male who developed acute renal failure following high dose methotrexate therapy for Burkitt&amp;amp;#39;s non Hodgkin lymphoma. Serum methotrexate levels reached 37 micromol/l, and remained higher than 1 micromol/l for more than a week. Folinic acid rescue was intensified to 200-400 mg intravenously every 4 hours. As methotrexate binds markedly to proteins, plasma exchange was initially chosen, 4 sessions being performed from day 2 to day 4. The methotrexate pharmacokinetic profile was not significantly modified during plasma exchange, and serum drug level was 3 micromol/l. Continuous veno-venous hemodiafiltration was therefore performed from day 5 to day 10. This procedure also seemed ineffective, with evidence of low ultrafiltrate clearance. No extrarenal toxicity was observed in our patient. Thus, conventional extrarenal procedures appear to have a limited role in the setting of overexposure to methotrexate. The use of very high doses of folinic acid in our case probably played a major role in the eventual favorable outcome.

Research paper thumbnail of Outcome of treatment of recurrent glioblastoma multiforme in elderly and/or frail patients

Outcome of treatment of recurrent glioblastoma multiforme in elderly and/or frail patients

Journal of Neuro-Oncology, 2015

Optimal treatment of recurrent glioblastoma multiforme (rGBM) in elderly and/or frail patients re... more Optimal treatment of recurrent glioblastoma multiforme (rGBM) in elderly and/or frail patients remains virtually unexplored, the best supportive care (BSC) only is routinely administered due to the fatal prognosis. We evaluated the impact of different treatment methods on post-progression survival (PPS) and overall survival (OS) of such patients. Data from 98 elderly and/or frail rGBM patients, treated initially with 1-week or 3-week radiotherapy (RT) within the phase III IAEA study (2010-2013), were analyzed. KPS at relapse and salvage treatment methods were recorded. Kaplan-Meier method was used to estimate PPS and OS for different treatment modalities. Eighty-four patients experienced recurrence: 47 (56 %) received BSC, 21 (25 %)-chemotherapy (CHT), 8 (9.5 %)-surgery, 3 (3.5 %)-RT, for 5 (6 %) the data was unavailable. Median OS from randomization for all 84 patients was 35 weeks: 55 versus 30 weeks for any treatment versus BSC, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001. Median PPS was 15 weeks: 23 weeks with any treatment versus 9 weeks with BSC, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001. For local treatment (surgery and/or RT) median PPS was 51 versus 21 weeks for CHT, p = 0.36. In patients with poor KPS (≤60) at relapse median PPS was 9 weeks with BSC versus 21 weeks with any treatment, p = 0.014. In poor KPS patients median PPS for local treatment was 14 weeks versus 21 weeks with CHT, p = 0.88. An active therapeutic approach may be beneficial for selected elderly and/or frail rGBM patients. Poor KPS patients may also benefit from active treatment, but there is no benefit of local treatment over CHT.