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The outbreak of SARS-CoV-2 coronavirus rapidly altered radiotherapy service delivery around the world. AIM: The main objective of this study was to assess the impact of precautionary measures implemented in response to the COVID-19 pandemic on the performance of a radiation oncology departments and on mitigation the risk of COVID-19 contagion between and among patients and staff. METHODS: The study period was from March 15 until May 22, 2020. We evaluated total number of patients irradiated and those who initiated treatments, taking into account tumours localisations. We assessed the relationship of potential risk of contagion with patients' domiciles locations in regions with high number of COVID19 case. RESULTS AND CONCLUSIONS: The number of patients treated with radiotherapy during the study period decreased due to precautionary measures. After five weeks, the number of radiotherapy treatments began to increase. Just over half of the radiotherapy patients (53.5%) treated at the GPCC reside in the city of Poznan or in one of the ten surrounding counties where COVID19 incidence was low and reached at the end of the study period cumulative number of cases n = 204. The precautionary measures were effective qRT-PCR tests were performed in 1545 individuals (patients and hospital staff) revealing four staff members and none patient with a positive PCR result. Immunoglobulin testing was performed in 1132 individuals (patients and hospital staff). A total of 63 individuals were positive for antibodies.

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BACKGROUND: In a phase III trial in patients with castration-resistant prostate cancer (CRPC) and bone metastases, denosumab was superior to zoledronic acid in reducing skeletal-related events (SREs; radiation to bone, pathologic fracture, surgery to bone, or spinal cord compression). This study reassessed the efficacy of denosumab using symptomatic skeletal events (SSEs) as a prespecified exploratory end point. PATIENTS AND METHODS: Patients with CRPC, no previous bisphosphonate exposure, and radiographic evidence of bone metastasis were randomized to subcutaneous denosumab 120 mg plus i.v. placebo every 4 weeks (Q4W), or i.v. zoledronic acid 4 mg plus subcutaneous placebo Q4W during the blinded treatment phase. SSEs were defined as radiation to bone, symptomatic pathologic fracture, surgery to bone, or symptomatic spinal cord compression. The relationship between SSE or SRE and time to moderate/severe pain was assessed using the Brief Pain Inventory Short Form. RESULTS: Treatment with denosumab significantly reduced the risk of developing first SSE [HR, 0.78; 95% confidence interval (CI) 0.66-0.93; P = 0.005] and first and subsequent SSEs (rate ratio, 0.78; 95% CI 0.65-0.92; P = 0.004) compared with zoledronic acid. The treatment differences in the number of patients with SSEs or SREs were similar (n = 48 and n = 45, respectively). Among patients with no/mild pain at baseline, both SSEs and SREs were associated with moderate/severe pain development (P < 0.0001). Fewer patients had skeletal complications, particularly fractures, when defined as SSE versus SRE. CONCLUSION: In patients with CRPC and bone metastases, denosumab reduced the risk of skeletal complications versus zoledronic acid regardless of whether the end point was defined as SSE or SRE.

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BACKGROUND: Breast cancer endocrine therapy (ET) is one of the most basic therapeutic methods in oncology. Well-balanced physical activity exerts positive influence on bone strength (BS) and body composition (BC), which has been confirmed by the clinical research regarding osteoporosis, prevention and treatment alike. Accordingly, in the following study, an attempt was made to assess the selected parameters of young, premenopausal women's clinical state under the influence of breast cancer ET, as well as to define the influence of physical activity on the studied parameters. AIM: The assessment of the influence of aerobic and resistance training (AT and RT) on BS and BC in premenopausal women during breast cancer ET. DESIGN: This was a nonrandomized, prospective clinical study. SETTING AND POPULATION: The study was performed in 41 outpatients in the Greater Poland Cancer Centre. METHODS: The examinations were made with the anthropometric and dual energy X-ray absorptiometry measurements. The examinations were conducted according to the schedule: at the baseline, II-after 6 months of ET, III-after 6 months of AT (in 12 months of ET), IV- after following 6 months AT and RT (18 months of ET). RESULTS: After 6 months of the ET without physical activity the bone mineral density (BMD) in all regions and the hip structure parameters were lower in comparison to the baseline and there was a significant increase in fatty tissue. After 6 months of AT the BMD of all regions was lower than in 6 months ET. An introduction of RT caused the analyzed values of BS parameters to increase. Also a significant growth of lean body mass and free fat body mass was observed and so was an insignificant fall in fat. CONCLUSION: The breast cancer ET is related to the changes in BS and BC in premenopausal women. The introduction of AT caused a slowdown in negative changes in bones, and body fat was reduced. The introduction of RT reversed an adverse tendency for BS and sarcopenia. CLINICAL REHABILITATION IMPACT: The study results show that mixed type physical activity (AT and RT) during breast cancer ET could prevent negative changes, of this treatment, in body build in premenopausal women.

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Bone metastases in prostate cancer constitute the most frequent cause of systemic failure in treatment, which results in numerous complications and finally leads to patient's death. Pain is one of the first and most important clinical symptoms of bone metastases and can be found among more than 80% of patients. Therefore, the most analgetic effective and simultaneously the least toxic treatment is an important point of therapeutic management in this group of patients. The aim of this prospective clinical trial was a comparison of analgetic effectiveness and toxicity of monotherapy with 153Sm isotope to combined therapy (153Sm + EBRT) among patients diagnosed with multiple painful bone metastases due to CRPC (mCRPC). 177 patients with mCRPC were included into the prospective randomised clinical trial in which 89 patients were assigned to the 153Sm isotope monotherapy, while 88 patients were assigned to the combined therapy including 153Sm isotope therapy and EBRT. All patients were diagnosed (bone scan and X-ray or/and CT or/and MRI) with painful bone metastases (bone pain intensity >= 6 according to VAS classification). The following additional inclusion criteria were established: histologically confirmed adenocarcinoma of prostate, multifocal bone metastases, no prior chemotherapy or palliative radiotherapy to bone. All patients signed informed consent.The combination of the isotope therapy with EBRT was more effective analgetic treatment than isotope therapy alone. The highest pain decline was noticed in the first weeks after treatment termination. In the whole group, a total or partial analgesic effect was observed among 154 (87%) patients while among 23 (13%) patients there was a lack of analgesic effect or even pain intensification. The results of this clinical trial demonstrated that for patients with multiple mCRPC it is recommended to combine the 153Sm isotope therapy with local EBRT because of a greater analgetic effect. It is important to note that combined therapy did not intensify the toxicity of treatment.

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The aim of this work is to examine the influence of the dose optimization procedure on the value of radiation doses in organs of risk and to compare value of doses measured in healthy tissues according to chosen different PDR brachytherapy (PDRBT) and HDR brachytherapy (HDRBT) fractionation schedule. Fifty one patients treated with PDRBT were qualified for calculations. This group included patients with head and neck cancer, brain tumor, breast cancer, sarcoma, penile cancer and rectal cancer. The doses were calculated in chosen critical points in surrounded healthy tissues. For all treatment plans the doses were compared with the use of the BED (Biologically Equivalent Dose) formula and PDR along with HDR values were calculated. Differences among total doses in PDRBT and different schemas of HDRBT in critical points before and after dose point and volume optimization, were analyzed. The same dependences were examined also for BEDs. One ascertained that in biologic equivalent (to PDR) HDRBT the increase of fraction dose from 4 Gy to 10 Gy caused the necessity of decrease of total dose in treatment area (p<0,001). The use of HDR instead of PDR essentially lowered physical and biological doses in examined organs of risk. In many examined critical points in organs of risk where biological equivalence dose in the treatment area was the same, one ascertained the decrease of total physical HDR dose according to the growth of the fraction dose. Similar dependences appeared also for biologically equivalent doses. The optimization process in PDRBT improved the dose homogeneity in the treatment area, but simultaneously induced unprofitable (essential statistically) increase of dose in some healthy organs of risk, what makes an increase risk for radiation-induced complications. The use of biologically equivalent HDRBT instead of PDRBT makes for the decrease of physical doses in the treatment area and the decrease of physical and biologically equivalent doses in healthy organs of risk.

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Treatment of prostate cancer (PC) is a challenge for both urologists and radiation oncologists. Currently, two radical methods of treatment are recommended in localized prostate cancer (PC)--i.e. radical prostatectomy (RP) and radiotherapy (RT) with excellent long-term results. However, the outcome of RT, which is the treatment of choice in locally advanced stages of the disease, is unsatisfactory due to the high risk of regional or distant metastases and local failure. Lately, hormonal therapy (HT), which had mainly been indicated for treatment of patients with distant metastases, has been added to radiotherapy to improve the efficacy of treatment. The general rationales for combining RT and HT are four-fold: decreasing prostate gland volume, diminishing the number of cancer cells, improving tumor oxygenation, and eliminating distant and regional micrometastases. Over the last 20 years several randomized clinical trials evaluating the results of combined HT and RT treatment have been carried out. The RTOG 85-31, RTOG 86-10, EORTC 22863 and RTOG 92-02 trials were completed from the mid 80s to the mid 90s and long-term follow-up data on all important end-points are now available. These data have been evaluated by panels of experts and served as the basis for the latest American (NCCN 2005) and European (EAU 2005) recommendations on prostate cancer. However, despite the long-term results of these trials, there are still no clear-cut answers to the following crucial questions: What is the optimal timing of hormonal therapy? What types of patients can benefit most from combined strategies? What is the spectrum and potential reversibility of side effects of long-term combined treatment? How does it influence the patients quality of life and care costs? Other questions concern the possible role of androgen deprivation therapy combined with brachytherapy. The only randomized trial to evaluate this issue to date was stopped due to incomplete accrual. Therefore, answers must be sought in the large body of nonrandomized studies. There is a constant need for properly designed randomized clinical trials to precisely identify the subgroup of patients who will benefit most from combined RT and HT treatment. Results of ongoing clinical trials (RTOG 9901, RTOG 9408) are expected to yield some answers to the questions mentioned above. Currently, we can conclude that in the group of patients with high risk of relapse (T3 or GS > 7 or PSA >20 ng/ml), combined hormonal and radiation therapy improves prostate cancer treatment results and should be highly recommended.

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The purpose of the study was to determine the relation between the incidence of radiation pneumonitis (RP) and available parameters from a dose-volume histogram (DVH) in patients with non-small cell lung cancer (NSCLC) who underwent three-dimensional conformal radiotherapy treatment. Between January 1999 and August 2003 in the Greatpoland Cancer Center, 62 patients with NSCLC were treated using three-dimensional conformal radiotherapy (3D CRT). All patients were treated 5 days per week with daily fractionation of 2 Gy to total dose of 60 Gy. All patients were available for analysis for symptomatic RP. Radiation pneumonitis was graded according to the RTOG/EORTC morbidity scoring classification. Logistic regression analysis was performed to test the association between RP and the following DVH parameters: mean lung dose (MLD), volume of lung receiving > or =20 Gy (V20 ) and > or =30 Gy (V30) and normal tissue complication probability (NTCP). Additionally, correlation of the following clinical factors such as: age, sex, tumor site, performance status (KPS), and additional therapy (chemotherapy) with incidence of the RP were performed. Moreover, correlation between DVH parameters were tested using Spearman method. Thirty out of 62 patients (48%) developed RP grade 0 or 1 (0 grade -- 12%, 1 grade -- 36%) and 32 (52%) grade 2 or 3 (2 grade -- 47%, 3 grade -- 5%). In the logistic regression analysis, all DVH parameters were associated with RP (p in range from 0.004 to 0.007). The strongest association was observed for NTCP and V30 (p=0.004). On the other hand, a weak association was found for V20 (p=0.007). The correlations between all DVH parameters for lung were sufficient (r Spearman in range from 0.87 to 0.93). The best correlation among DVH parameters were observed between V20 and NTCP (r=0.93, p<0.001). On the other hand, the least but sufficient association was found for V30 and V20 (r=0.87, p<0.001). There was no association between clinical factors and RP. NTCP and V30 parameters were the best predictors of symptomatic radiation pneumonitis for patients after three-dimensional conformal radiotherapy of non-small cell lung cancer.

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Our purpose was to compare the three-field and the four-field planning techniques in patients with localized prostate cancer. Twenty patients with localized prostate cancer stage (T1-T2N0M0) were chosen for the analysis of treatment plans. Simulation and CT planning were performed in all cases in the supine position with a "comfortably" full bladder. The planning treatment volume (PTV) was defined as the prostate gland with a 10 mm margins around the clinical target volume (CTV), except for the posterior margin (prostate gland - the anterior part of rectum wall), where a 5 mm margin was applied. The clinical target volume (CTV) was defined as prostate gland. For each patient the following organs at risk (OAR) were outlined: rectum, bladder, and right femoral head. The following three-field and four-field plans were made: 3 field techniques with beam angles orientations 0 degree, 120 degrees, 240 degrees and 0 degree, 90 degrees, 270 degrees, and 4 field technique (0 degree, 90 degrees, 180 degrees, 270 degrees). Two versions of treatment plans were also made including different range of applied energy of photons (6 MV or 20 MV) for the therapeutic machine - Clinac 2300 CD. Beam portals were conformal by shaped by a multileaf collimator (MLC). The daily fractionation dose 1.8 Gy and the total dose 73.8 Gy were applied in each case. One hundred and twenty treatment plans were made and compared according to the following parameters: the mean total dose (MTD) in the target, the tumor control probability (TCP), the mean total dose (MTD) in the OAR (rectum, bladder, and right femoral head), the normal tissue complication probabilities (NTCP), and the volume of OARs which received arbitrary chosen fraction (%) of the total prescribed dose (73.8 Gy=100%). ANOVA statistical methods to verify the significance of differences between the treatment plans were used. There were no significant differences in the distribution of MTD and TCP in the PTV for the evaluated treatment plans. There were no significant differences in the MTD, NTCP, V80, and V90 distribution in bladder. The distribution of MTD, NTCP, and V80 for rectum indicated that lower parameters were achieved in the case of the three-field technique with the orientation of beams 0 degree, 90 degrees, 270 degrees. The distribution of MTD, NTCP, and V70 in right femoral head for each treatment plan was below the tolerance dose. The study has shown that the three-field technique (an anterior and two opposing lateral fields with the portals orientation 0 degree, 90 degrees, 270 degrees) and applied energy photons 20 MV, provides the best rectal protection. All evaluated plans according to the dose distribution in the target (PTV) have not indicated any significant differences. None of the techniques has shown any significant advantages in sparing bladder. The risk of morbidity in the femoral heads for all the applied techniques, in a dose up to 73.8 Gy was not a therapeutic problem. However, the three-field technique with beams orientation 0 degree, 120 degrees, 240 degrees gave the best sparing effect for femoral heads.

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BACKGROUND AND PURPOSE: To compare in a phase III study the loco-regional control, disease-free survival and overall survival induced by an accelerated regimen (AF) as compared with conventional regimen (CF) and to analyze the early and late post-radiation morbidity in both arms. MATERIALS AND METHODS: Patients with age < or = 75, WHO 0-1, suitable for a radical course of radiotherapy T1-T3, N0, M0, stage of glottic and supraglottic laryngeal cancer were randomized to either CF: 66Gy given in 33 fractions over 45 days or AF: 66Gy given in 33 fractions over 38 days (2 fractions every Thursday). A total of 395 patients were included from 05.1995 to 12.1998. RESULTS: Early toxicity: At the end of radiotherapy patients treated with AF complained for more severe reactions than patients treated with CF. In 8 weeks after treatment completion patients treated with AF complained only for more severe pain on swallowing (P=0.027). In 4 months after treatment completion all types of toxicity except for skin teleangiectasia (P=0.001) were similar in the two groups. Loco-regional control: comparison between CF and AF showed no difference in terms of loco-regional control (P=0.37). CONCLUSIONS: The improvement in AF in terms of loco-regional control is estimated to be 3-5% in comparison with conventional regimen and is not significant. The intensity of reactions after 4 months was similar in both arms, what suggests the possibility of further shortening of the overall time by few days or enhancing the total dose within the limits of acceptable morbidity.

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In nowadays development in radiotherapy head and neck cancers has been achieved step by step in 3 main fields: technological, radiobiological and general strategy of oncological treatment. One of the most important technical changes are: the introducing of three dimensional treatment planning (3 DCRT) system and application of new radiological imaging methods (CT, MRI) in treatment planning with a computer technology calculation of dose distribution. From the radiobiological point of view a very important fact has been to distinguishing two kinds of tissue (acute and late reacting tissue) which response depends on change in fraction dose. It has given the theoretical basis to clinical trials of new methods of fractionation (hyper-, accelerated hyperfractionation). The dynamic development of surgery and chemotherapy have established a new place for radiation therapy in the complex treatment of tumours (adjuvant, elective, concomitant treatment). It has been established that in advanced tumours, the first modality of treatment is surgery in conjunction with postoperative radiotherapy. Routine application of chemotherapy in head and neck cancer is still controversial with exception of radiochemotherapy of nasopharyngeal cancer, particularly in cases of lymph nodes metastases.

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The analysis of survival of 311 patients after total laryngectomy due to cancer and conventional postoperative radiotherapy was performed. During irradiation in a part of patients were introduced interruptions in treatment and no related diseases. The gap in treatment was taken in account and for this factor all patients were divided into 3 groups; without gap in treatment (A), with short gap--below 7 days (B) and with long gap--over 7 days (C). All groups were comparable. It was concluded that the long gaps increase the failure in treatment for about 30%.

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Supplementary irradiation is the essential element of combined treatment for patients after total laryngectomy due to laryngeal cancer. The most effective and causing no side-effects methods of radiotherapy are incessantly searched. The gaps in radiotherapy may occur during the course of treatment. Protraction of irradiation period may be connected with worse prognosis.

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