RESUMEN
PURPOSE: The primary treatment of choice for patients with phyllodes tumor of the breast (PTB) is surgery. Two major problems regarding the treatment of such patients remain unclear: what is the appropriate surgical margin and what role is played by adjuvant radiotherapy (ART). METHODS: The study provides a retrospective review of all patients with PTB treated between 1952 and 2013 at a single institute. The histology slides were re-examined based on WHO criteria. The clinical characteristics and therapy outcomes were obtained. The five-year survival with no evidence of disease (NED) was used as the end point. RESULTS: The study population comprised 340 women with PTB. Fifty-five percent of the patients were diagnosed with the benign, 11.8% with borderline and 33.2% with malignant PTB. All the patients received primary treatment with surgery (mastectomy-27.1%, and BCS- 72.9%). Local recurrence (LR) was found in 28 (9.1%) of these patients. Four patients with borderline and 8 with malignant PTB who were treated with BCS and had tumor-free margins < 1 cm received ART. None of these patients had LR and all survived 5 years NED. Of the 340 patients from our group, 294 (86.4%) survived five-years NED. CONCLUSION: The prognosis for benign PTB is excellent and can be cured with surgery alone. A sufficient margin would be 0.1 cm (data from the literature) or 0.2-0.4 cm (our study). We recommend application of ART for such patients but the role of ART in patients with borderline and malignant PTB treated with BCS and with surgical margin < 1 cm remains uncertain.
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Neoplasias de la Mama/terapia , Márgenes de Escisión , Mastectomía Segmentaria/métodos , Recurrencia Local de Neoplasia/epidemiología , Tumor Filoide/terapia , Radioterapia Adyuvante/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Instituciones Oncológicas , Femenino , Humanos , Mastectomía/métodos , Persona de Mediana Edad , Tumor Filoide/patología , Pronóstico , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Invasive lobular carcinoma (ILC) comprises 4-15% of all malignant neoplasms of the breast. The "classical variant of ILC" (C-ILC) constitutes some 60-80% of this cancer. The main cause of treatment failures is dissemination observed in 8-38% patients The disant metastases (DM) are frequently localized in: bones, gastrointestinal tract, uterus, leptomeninges, and ovaries. The aim of this study was to present the methods and results of the treatment of patients with DM from the classical variant of ILC (C-ILC) at a single institution in Poland. MATERIALS AND METHODS: Between January 1983 and December 2004, 210 women with C-ILC of the breast were primarily treated surgically (mastectomy in 182 (86.7%) patients and breast conserving therapy in 28 (13.3%) patients). Then adjuvant therapy (radiotherapy, chemotherapy, and hormonotherapy) was applied according to presence of clinical indications. RESULTS: The present study focused on a group of 41 patients with a median age of 59 that died with DM from C-ILC during the ten-year follow-up. This failure developed on average 65 months (3-186) after surgery of ILC. The most frequently DM developed: bones (39.1%), GI (small bowell, stomach, colon, rectum) - 31.8%, and reproductive organs (ovary, uterus) - 19.1%. In therapy of DM, different configuration surgery, radiotherapy, and chemo-hormonotherapy were used. The median survival after the diagnosis of DM was connected with localization of distant metastases. CONCLUSION: Patients with classic variant of infiltrate lobular cancer of breast should be regularly follow-up, which could permit early diagnosis of distant metastases and improve treatment results.
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Neoplasias de la Mama/patología , Carcinoma Lobular/patología , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapia , Carcinoma Lobular/mortalidad , Carcinoma Lobular/terapia , Femenino , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , PronósticoRESUMEN
BACKGROUND: Here, the treatment methods and results of patients with phyllodes tumor of the breast (PT) with distant metastases at a single institution are presented. METHODS: A retrospective analysis was performed on a group of 295 patients with PT treated from 1952 to 2010. RESULTS: Distant metastases developed in 37 (12.5 %) patients; 3/160 (1.9 %) patients had benign PT, 6/36 (16.7 %) were considered borderline, and 28/99 (28.3 %) had malignant PT. Most frequently, the metastases were located in the lungs; 28 (75.7 %), bone 7 (18.9 %), brain 4 (10.8 %), and liver 2 (5.4 %). Metastases occurred on overage 21 months (2-57) after surgery. Patients with lung metastases were generally treated with monochemotherapy or polychemotherapy. In one patient Testosterone and in two patients resection of metastases combined with Doxorubicin were used. Patients with bones or brain metastases were treated with palliative radiotherapy only or combined with Doxorubicin. The mean survival (MS) from diagnosis of distant metastases (DM) was 7 months (2-17). The longest mean survival in patients with bones metastases was 11.8 months, the worst survival was for patients with brain metastases--2.8 months. Hormone therapy appeared to have low efficacy (MS: 2 months) as well as monochemotherapy (MS: 3-5 months). Improved MS was obtained using Doxorubicin (7 months) and Doxorubicin with Cisplatin, Cyclophosphamide, or Ifosfamide (9 months). CONCLUSION: The prognosis of patients with DM from PT is poor. The role of surgery and irradiation of such patients is very limited. There appears to be no role for the use of hormone therapy. This study showed that polychemotherapy with Doxorubicin and Ifosfamide suggest that it might be more effective than once thought.
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Neoplasias de la Mama/patología , Tumor Filoide/secundario , Tumor Filoide/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/secundario , Neoplasias Óseas/terapia , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/terapia , Terapia Combinada , Doxorrubicina/administración & dosificación , Femenino , Humanos , Ifosfamida/administración & dosificación , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/terapia , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
AIM OF THE STUDY: The analysis of acute and late toxicity of concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC) based on review of 120 patients treated in Centre of Oncology in Krakow between 2001 and 2007. MATERIALS AND METHODS: Medium age of the patients was 52 years (43-66). Overall, 12 patients (10.0%) were in Stage IB2, 54 (45.0%) in Stage II, 43 (35.8%) in Stage III, and 11 (9.2%) in Stage IVA. Squamous cell carcinoma was present in 114 (95.0%) patients. Well-differentiated (grade 1) tumour was found in 39 (32.5%) patients, moderately differentiated (grade 2) in 41 (34.2%), and poorly differentiated (grade 3) in 40 (33.3%). Karnofsky performance status score was 70 in 72 (60.0%) patients, and 80-90 in 48 (40%). External radiation therapy was delivered with high-energy six to 15 MV photon beams using four-field brick technique. The total dose of 50 Gy was given in 25 fractions within five weeks using standard fractionation. Concurrently with external radiotherapy, six cycles of chemotherapy were administered to all the patients as an intravenous infusion of once-weekly cisplatin 40 mg/m2. On completion of external beam radiotherapy, low-dose rate brachytherapy with tandem and two colpostats was performed to deliver the dose of 40 Gy to point A in two 20 Gy insertions at weekly intervals. RESULTS: Of the 120 patients in the investigated group, 78 (65%) were disease-free for five years. Symptoms of acute treatment-related toxicity grade 3 or 4 (WHO) occurred in 21.6% of patients including leucopoenia in 7.5%. anaemia in 5.0%, nausea and vomiting in 3.3%, diarrhea in 5.0%, and urinary tract infection in 0.8%. Full planned treatment (teleradiotherapy + chemotherapy + brachytherapy) completed 78.3% of the group; full planned radiotherapy without full chemotherapy completed 20% of the patients. Late treatment complications of grade 3 or 4 were observed in two (1.6%) patients (narrowing of large intestine requiring surgery and recto-vaginal fistula). CONCLUSIONS: In patients with LACC treated with CCRT, the most frequent acute toxic effects include: haematological disorders (leucopoenia, anaemia), gastrointestinal disorders (nausea and vomiting, diarrhea), vulvo-vaginal disorders, and urinary tract infection. The most frequent late toxic effects included: rectal bleeding, bowel complications requiring surgery, stenosis or recto-vaginal fistula, and haematuria.
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Anemia/etiología , Antineoplásicos/efectos adversos , Braquiterapia/efectos adversos , Carcinoma de Células Escamosas/terapia , Quimioradioterapia/efectos adversos , Cisplatino/efectos adversos , Enfermedades del Colon/etiología , Leucopenia/etiología , Fístula Rectovaginal/etiología , Neoplasias del Cuello Uterino/terapia , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Estudios de Cohortes , Constricción Patológica/etiología , Diarrea/etiología , Supervivencia sin Enfermedad , Femenino , Humanos , Estado de Ejecución de Karnofsky , Persona de Mediana Edad , Náusea/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Infecciones Urinarias/etiología , Neoplasias del Cuello Uterino/patología , Vómitos/etiologíaRESUMEN
PURPOSE: The aim of the present retrospective study is to evaluate toxicity and early clinical outcomes of interstitial hyperthermia (IHT) combined with high-dose rate (HDR) brachytherapy as a salvage treatment in patients with biopsy-confirmed local recurrence of prostate cancer after previous external beam radiotherapy. PATIENTS AND METHODS: Between September 2008 and March 2013, 25 patients with local recurrence of previously irradiated prostate cancer were treated. The main eligibility criteria for salvage prostate HDR brachytherapy combined with interstitial hyperthermia were biopsy confirmed local recurrence and absence of nodal and distant metastases. All patients were treated with a dose of 30 Gy in 3 fractions at 21-day intervals. We performed 62 hyperthermia procedures out of 75 planned (83 %). The aim of the hyperthermia treatment was to heat the prostate to 41-43 °C for 60 min. Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, v. 4.03). Determination of subsequent biochemical failure was based on the Phoenix definition (nadir + 2 ng/ml). RESULTS: The median age was 71 years (range 62-83 years), the median initial PSA level was 16.3 ng/ml (range 6.37-64 ng/ml), and the median salvage PSA level was 2.8 ng/ml (1.044-25.346 ng/ml). The median follow-up was 13 months (range 4-48 months). The combination of HDR brachytherapy and IHT was well tolerated. The most frequent complications were nocturia, weak urine stream, urinary frequency, hematuria, and urgency. Grade 2 rectal hemorrhage was observed in 1 patient. No grade 3 or higher complications were observed. The 2-year Kaplan-Meier estimate of biochemical control after salvage treatment was 74 %. The PSA in 20 patients decreased below the presalvage level, while 11 patients achieved a PSA nadir < 0.5 ng/ml. All patients are still alive. Of the 7 patients who experienced biochemical failure, bone metastases were found in 2 patients. CONCLUSION: IHT in combination with salvage HDR brachytherapy is a well tolerated and effective treatment.
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Braquiterapia/métodos , Hipertermia Inducida/métodos , Recurrencia Local de Neoplasia/terapia , Neoplasias de la Próstata/terapia , Terapia Recuperativa , Anciano , Anciano de 80 o más Años , Terapia Combinada , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Neoplasias de la Próstata/patología , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Retratamiento , Insuficiencia del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to present the clinical picture of infiltrating lobular carcinoma (ILC) of the breast. MATERIALS AND METHODS: A detailed analysis was performed for the group of 96 ILC patients subject to initial surgical treatment in the Krakow Branch of Centre of Oncology between 1983 and 1996. The investigated group was selected out of 2,347 breast cancer patients treated during that period, based on re-examination of histologic specimens of the initial patient group. RESULTS: The following distinctive demographic and clinical features of ILC were found: average age of patients: 59 years (37 - 83); average duration of pathological symptoms: five months; most frequent site of primary tumor: upper outer quadrant (54.2%); primary tumor Stage: I/II0 (64.6%), III0A (35.4%); tumor size in breast: up to five cm (69.8%), larger than five cm (30.2%); no axillary lymph nodes involvement in 51% of patients; multifocality of lesions in 10% of patients; contralateral disease occurrence in eight percent of patients; atypical pattern of distant metastases, e.g. gastrointestinal system, gynaecologic organs, and cerebral meninges. CONCLUSIONS: Based on this analysis as well as on literature reports, it was found that the fundamental differences between ILC and infiltrating ductal carcinoma (IDC) included demographic and clinical features as patient age, primary tumor size at diagnosis, incidence of multifocality and contralateral disease, sites of distant metastases, and histopathological status of axillary lymph nodes.
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Neoplasias de la Mama/patología , Carcinoma Lobular/patología , Factores de Edad , Anciano , Axila , Neoplasias de la Mama/epidemiología , Carcinoma Lobular/epidemiología , Femenino , Humanos , Incidencia , Ganglios Linfáticos/patología , Persona de Mediana Edad , Metástasis de la NeoplasiaRESUMEN
BACKGROUND AND PURPOSE: The aim of this study was to assess the potential prognostic factors in patients with primary invasive vaginal carcinoma (PIVC) treated with radical irradiation. PATIENTS AND METHODS: The analysis was performed on 77 patients with PIVC treated between 1985 and 2005 in the Maria Sklodowska-Curie Memorial Institute of Oncology, Cancer Center in Krakow. A total of 36 patients (46.8 %) survived 5 years with no evidence of disease (NED). The following groups of factors were assessed for potential prognostic value: population-based (age), clinical (Karnofsky Performance Score [KPS], hemoglobin level, primary location of the vaginal lesion, macroscopic type, length of the involved vaginal wall, FIGO stage), microscopic (microscopic type, grade, mitotic index, presence of atypical mitoses, lymphatic vessels invasion, lymphocytes/plasmocytes infiltration, focal necrosis, VAIN-3), immunohistochemical (protein p53 expression, MIB-1 index), cytofluorometric (ploidity, index DI, S-phase fraction, proliferation index SG2M) factors. RESULTS: Significantly better 5-year NED was observed in patients: < 60 years, KPS ≥ 80, FIGO stage I and II, grade G1-2, MIB-1 index < 70, S-phase fraction < 10, and proliferation index < 25. Independent factors for better prognosis in the multivariate Cox analysis were age < 60 years, FIGO stage I or II, and MIB-1 index < 70. CONCLUSION: Independent prognostic factors in the radically irradiated PIVC patients were as follows: age, FIGO stage, MIB-1 index.
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Biomarcadores de Tumor/sangre , Citocinas/sangre , Ubiquitina-Proteína Ligasas/sangre , Neoplasias Vaginales/sangre , Neoplasias Vaginales/radioterapia , Adulto , Anciano , Femenino , Citometría de Flujo/métodos , Humanos , Inmunohistoquímica/métodos , Persona de Mediana Edad , Polonia/epidemiología , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Resultado del Tratamiento , Neoplasias Vaginales/epidemiologíaRESUMEN
INTRODUCTION: The aim of the study was to present an institutional experience in radiation therapy of primary invasive vaginal carcinoma (PIVC) patients treated in the Krakow Branch of Centre of Oncology, with special regard to treatment effectiveness and failure causes. MATERIALS AND METHODS: Between February 1967 and January 2007, 162 PIVC patients were treated with radical radiotherapy in the Krakow Branch of Centre of Oncology, Maria Sklodowska-Curie Memorial Institute. Twenty-seven (16.7%) patients in Stage I(0) were treated with intracavitary brachytherapy alone; for 127 (78.4%) patients in Stage I(0)- IV(0) intracavitary brachytherapy was combined with external radiation therapy; and eight (4.9%) patients in Stage IVA(0) were given only external radiotherapy. RESULTS: In the investigated group of 162 patients, five-year disease-free survival was observed in 46.3% of the cases. Patient age and FIGO Stage of neoplastic disease were independent prognostic factors. Five-year disease-free survival was observed in 64.9% of the patients < 60 years of age and only in 30.7% > or = 60 years of age; and in 62.3% of PIVC patients in Stages I and II(0) as compared to 19.7% of Stages III(0) and IV(0) cases. Among 78 patients who died of PIVC, in 60 (76.9%) cases the cause of death was locoregional failure; in six (7.7%), locoregional failure and distant metastasis; and in 12 (15.4%), distant metastasis. CONCLUSIONS: Radiotherapy is effective treatment for PIVC patients. Age below 60 years and non-advanced neoplastic disease were independent favourable prognostic factors in the investigated group of patients. The primary cause of treatment failure was failure to achieve locoregional disease control.
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Neoplasias Vaginales/radioterapia , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Neoplasias Vaginales/mortalidad , Neoplasias Vaginales/patologíaRESUMEN
AIM OF THE STUDY: The analysis of prognostic factors and treatment outcomes in 106 patients with Stage I and II endometrial carcinoma (EC) treated between 1980 and 2005 in the Center of Oncology, Maria Sklodowska-Curie Memorial Institute, Kracow, Poland, who developed vaginal or pelvic recurrences. MATERIAL AND METHODS: The median age of patients was 61. Stage IB and IC of EC was diagnosed in 48 (45.3%) patients and Stage IIA and IIB in 58 (54.7%) patients. All patients were treated previously with surgery (TAH-BSO) and postoperative radiotherapy. There were 17 (16%) patients with vaginal vault recurrences, 30 (28.3%) with lower one-third vaginal recurrences, and 59 (55.7%) with pelvic recurrences. Palliative treatment (chemo- or hormonotherapy) or best supportive care only was undertaken in 53 (50.0%) patients. Radical treatment was conducted in 70.6% (12/17) of vault recurrences, 86.7% (26/30) of lower one-third vagina recurrences, and 25.4% (15/59) of pelvic recurrences, with surgery (4 patients), brachytherapy +/- chemotherapy (34 patients), and teleradiotherapy +/- chemotherapy (15 patients). RESULTS: The 5-year overall survival rate in the observed group was 17%. Five-year survival was 23.3% (14/60) for patients with KPS 60-70 vs 8.7% (4/46) with KPS 40-50, 25% (12/48) patients with Stage I EC vs 10.3% (6/58) with Stage II EC, and 34% (16/47) patients with vaginal recurrence vs 3.4% (2/59) with pelvic recurrences. CONCLUSIONS: In the analyzed group of 106 patients with Stage I and II EC, treated previously with surgery and postoperative radiotherapy, 5-year overall survival rate was low; in radically treated patients it was 42.1%, and 13.3% for vaginal and pelvis recurrences, respectively. Univariate analysis showed a statistically significant, unfavorable impact of KPS < 60, Stage II and recurrence pelvic. Cox multivariate analysis demonstrated that the only independent prognostic factor for 5-year overall survival was the site of recurrence.
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Carcinoma Endometrioide/secundario , Neoplasias Endometriales/patología , Recurrencia Local de Neoplasia/patología , Neoplasias Pélvicas/patología , Neoplasias Vaginales/secundario , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Endometrioide/mortalidad , Carcinoma Endometrioide/terapia , Supervivencia sin Enfermedad , Neoplasias Endometriales/diagnóstico , Neoplasias Endometriales/mortalidad , Neoplasias Endometriales/terapia , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , Cuidados Paliativos , Neoplasias Pélvicas/diagnóstico , Neoplasias Pélvicas/mortalidad , Neoplasias Pélvicas/terapia , Polonia , Radioterapia Adyuvante , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Neoplasias Vaginales/mortalidad , Neoplasias Vaginales/terapiaRESUMEN
OBJECTIVES: To analyze the results of treatment of 70 patients with stage III and IV ovarian cancer after second look laparotomy with negative findings and to identify causes of failure and prognostic factors. MATERIALS AND METHODS: Between 1985 and 1998, seventy patients with ovarian cancer stage III and IV were treated with surgery and at least six courses of chemotherapy with cisplatin doxarubicin and cyclophosphamide. Then a second look laparotomy was performed. RESULTS: The actuarial survival rate without evidence of disease was 50% at 5 years. Locoregional failure was observed in 31 patients (88%) and distant metastases in 9, but they were the sole reason for unsuccessful treatment in only 4 (12%). Adverse prognostic factors were: grade 3 differentiation, primary stage IIIC and IV, and residual infiltration exceeding 2 cm after first laparotomy. CONCLUSION: Our results are comparable with reports in the literature. The actuarial survival rate without evidence of disease at 5 years in patients with advanced ovarian cancer after second look negative laparotomy is 50%.
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Laparotomía , Recurrencia Local de Neoplasia , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Segunda Cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Factores de Riesgo , Factores de TiempoRESUMEN
AIM: To present our experience regarding the efficiency of treatment in patients with uterine-confined endometrial cancer. PATIENTS AND METHODS: 775 patients with uterine-confined endometrial cancer (UCEC) were treated between July 1985 and June 2000 in the Krakow Branch of Sklodowska Memorial Institute. RESULTS: Among the 775 patients, 5-year disease-free survival was observed in 82.8% patients; 96% patients with low risk of disease recurrence, 93.6% patients with intermediate risk and 78.3% patients with high risk survived five years with no evidence of disease. In the group with a high-risk disease recurrence rate, 5-year disease-free survival was statistically higher among patients treated with adjuvant brachytherapy plus external beam radiotherapy (EBRT) in comparison to patients treated with adjuvant brachytherapy (BRT) alone (82.4% vs 72.1%). CONCLUSIONS: The recommended treatment in patients with high and moderate differentiation of UCEC with FIGO Stage IA is surgery alone. Surgery with adjuvant EBRT in the group of patients with intermediate risk of cancer recurrence allows over 90% of patients to be cured. In the group of patients with a high risk of disease recurrence adjuvant BRT with EBRT is statistically more efficient in comparison to BRT alone.
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Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Braquiterapia , Neoplasias Endometriales/radioterapia , Neoplasias Endometriales/cirugía , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Supervivencia sin Enfermedad , Neoplasias Endometriales/patología , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Radiografía , Radioterapia Adyuvante/métodos , Estudios Retrospectivos , Medición de Riesgo , Resultado del TratamientoRESUMEN
AIM: To present our experience regarding the efficiency and tolerance of half-body irradiation in patients with multiple cancer metastases. PATIENTS AND METHODS: Between January 1986 and December 1997, 102 patients with multiple cancer metastases received half-body irradiation (HBI) at the Center of Oncology--Maria Sklodowska-Curie Memorial Institute in Krakow. Most of the patients (93/102) had bone metastases (Table 1). The HBI was performed with 9 MV photon beam from linear accelerator. In 88 patients only one region (upper, mid or lower) was treated, and 14 patients received upper and lower HBI (13 patients), or upper and mid HBI (one patient) (Table 2). The mean doses were: 6 Gy in upper HBI, 8 Gy in mid HBI, and 9 Gy in lower HBI (Table 3). RESULTS: The positive palliative effect (complete or partial pain relief) was observed in 77 (75.5%) patients (Table 4). Complete pain relief was higher in patients with prostate cancer, and in patients who received mid or lower HBI. During follow-up 47 (46.1%) patients developed pain progression after treatment (Table 5). The probability of survival without pain progression was higher in patients who developed complete pain relief (86.7% at 6 months, 69.3% at 12 and 24 months) than in patients with partial response (52.9% at 6 months, 32.8% at 12 months, and 5.5% at 24 months) (Figure 1). In most of the patients (74/102, 72.5%) the tolerance was good. CONCLUSIONS: HBI is an efficient method for palliation in patients with multiple painful metastases.
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Metástasis de la Neoplasia/radioterapia , Adulto , Anciano , Neoplasias Óseas/radioterapia , Neoplasias Óseas/secundario , Neoplasias de la Mama , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/fisiopatología , Dolor/etiología , Dolor/prevención & control , Cuidados Paliativos , Aceleradores de Partículas , Fotones/uso terapéutico , Probabilidad , Neoplasias de la Próstata , Tolerancia a Radiación , Dosificación Radioterapéutica , Factores de TiempoRESUMEN
The goal of this study was the prognostic evaluation of histology, mitotic rate, S-phase fraction (SPF) and expression of proliferative antigen Ki67 and p53 protein in phyllodes tumor of the breast. The study was performed in the group of 118 patients with phyllodes tumor treated by surgery from 1952 to 1998. Mitotic rate was assessed on the representative histological specimens. Expressions of Ki67 and p53 were evaluated by immunohistochemistry on a section from the corresponding paraffin blocks which were also used for flow cytometric DNA evaluation. Histologically, 52 tumors were benign (LGM), 24 borderline malignancies (BM) while among 42 malignant tumors, 20 were monomorphous (HGM) and the remaining 22 revealed heterologic elements (HGH). Tumor recurrencies occurred in 17 patients, predominantly during the first three years after surgery, and 13 patients died of the tumor (1 BM, 12 both malignant variants). Multivariate analysis demonstrated mitotic rate, SPF and p53 expression as independent prognostic parameters for the disease-free survival. Histological tumor type and expression of Ki67 influenced independently the overall survival. In conclusion, the histological type of tumor phyllodes forms the basis for the prognosis of clinical outcome, but the indicators of the proliferative activity, especially Ki67 index, are valuable prognostic factors among patients with malignant variant of phyllodes tumor of the breast. Expression of the p53 protein in tumor cells could be also useful when the percentage of cells and intensity of expression are considered.
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Neoplasias de la Mama/genética , División Celular , ADN de Neoplasias/análisis , Regulación Neoplásica de la Expresión Génica , Tumor Filoide/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor , Neoplasias de la Mama/patología , Ciclo Celular , Supervivencia sin Enfermedad , Femenino , Citometría de Flujo , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Antígeno Ki-67/análisis , Antígeno Ki-67/biosíntesis , Persona de Mediana Edad , Índice Mitótico , Recurrencia Local de Neoplasia , Tumor Filoide/patología , Pronóstico , Proteína p53 Supresora de Tumor/análisis , Proteína p53 Supresora de Tumor/biosíntesisRESUMEN
PURPOSE: In a prospective randomized trial, our aim was to evaluate and compare the tolerance and efficacy of postoperative radiotherapy and chemotherapy in the treatment of early ovarian cancer. MATERIAL AND METHODS: Between 1990 and 1996, 150 patients with ovarian cancer stage IA, IB grades G2-3, and all patients classified IC and IIA, who did not have evidence of residual disease after surgery, were randomized to two treatment branches: radiotherapy or chemotherapy (CH). In the radiotherapy branch (76 patients), a whole abdomen irradiation of 30 Gy in 24 fractions over 5 weeks, with a pelvic boost to 50 Gy, was delivered. In the chemotherapy branch (74 patients), there were six series of polychemotherapy separated with 3-weeks interval. In each series patients received association of cisplatin (50 mg/m2, d1), adriamycin (50 mg/m2, d1) and cyclophosphamide (500 mg/m2, d1). RESULTS: The tolerance of the treatment was good and comparable in both groups. In the radiotherapy branch, three late grade G3 intestinal complications were observed (three bowel obstructions, which required surgery in two cases). The actuarial survival rate without evidence of disease was 81% at 5 years for both groups. In our series we found that histological grade had the strongest influence on survival prognosis; it was the only significant factor in a multivariate analysis. Patients with grade G3 tumors had the worst survival. CONCLUSION: These data suggest that efficacy of postoperative radiotherapy and chemotherapy administered to our patients with early ovarian cancer gave approximately identical results.
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Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/radioterapia , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/cirugía , Cuidados Posoperatorios , Estudios ProspectivosRESUMEN
The role of teleradiotherapy in the treatment of patients with thyroid cancer is presented. The indications for external irradiation include patients with: primary inoperable disease or inoperable recurrence, microscopic or gross residual disease after surgery, high risk of local regional failure, and metastatic thyroid cancer, especially with skeletal, brain and mediastinal metastases.
Asunto(s)
Teleterapia por Radioisótopo/métodos , Neoplasias de la Tiroides/radioterapia , Neoplasias Óseas/secundario , Neoplasias Encefálicas/secundario , Carcinoma/radioterapia , Carcinoma/secundario , Humanos , Neoplasias Torácicas/secundarioRESUMEN
PURPOSE: To report the results of a prospective randomized study concerning the role of radiotherapy in the treatment of stage III, unresectable, asymptomatic non-small cell lung cancer. MATERIAL AND METHODS: Between 1992 and 1996, 240 patients with stage III, unresectable, asymptomatic non-small cell lung cancer were enrolled in this study, and sequentially randomized to one of the three treatment arms: conventional irradiation, hypofractionated irradiation and control group. In the conventional irradiation arm (79 patients), a dose of 50 Gy in 25 fractions in five weeks was delivered to the primary tumor and the mediastinum. In the hypofractionated irradiation arm (81 patients), there were two courses of irradiation separated by an interval of four weeks. In each series, patients received 20 Gy in five fractions in five days, in the same treatment volume as the conventional irradiation group. In the control group arm, 80 patients initially did not receive radiotherapy and were only observed. Delayed palliative hypofractionated irradiation (20-25 Gy in four to five fractions in four to five days) was given to the primary tumor when major symptoms developed. RESULTS: The two-year actuarial survival rates for patients in the conventional irradiation, hypofractionated irradiation and control group arms were 18%, 6% and 0%, with a median survival time of 12 months, nine months and six months respectively. The differences between survival rates were statistically significant at the 0.05 level. CONCLUSION: Although irradiation provides good palliation, the results are disappointing. The comparison of conventional and hypofractionated irradiation shows an advantage for conventional schedules.
Asunto(s)
Carcinoma de Células Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Carcinoma de Células Pequeñas/patología , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Estudios Prospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
A retrospective analysis of 7 patients with adenoid cystic carcinoma of the breast operated at Center of Oncology in Kraków is presented. Ten years without evidence of disease survived 6 (85.7%) patients. One patient only, with poorly differentiated carcinoma, presented axillary metastases and died of metastases to the lungs and hepar.
Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma Adenoide Quístico/cirugía , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Carcinoma Adenoide Quístico/mortalidad , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
An analysis of 80 patients with infiltrating lobular carcinoma of the breast treated at Center of Oncology in Kraków is presented. All patients underwent radical mastectomy. The evaluation of treatment results showed stage, pathological tumor size, and involvement of axillary nodes as the prognostic factors. The ten-year survival rate NED in all group was 38.8%; for stage I, II, and III it was 62.5%, 48.8%, and 19.4% respectively.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Lobular/patología , Carcinoma Lobular/cirugía , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Carcinoma Lobular/mortalidad , Carcinoma Lobular/secundario , Femenino , Humanos , Metástasis Linfática , Mastectomía Radical , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Four cases of solitary extramedullary plasmocytoma of the larynx (3 men, 1 women) treated with radiotherapy are presented. Laboratory and X-ray examinations showed no evidence of systemic plasmacytoma. One patient was treated with conventional X-ray therapy and 3 patients with telegammatherapy Co-60. All patients survived 10 years with no evidence of disease.
Asunto(s)
Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/radioterapia , Plasmacitoma/diagnóstico , Plasmacitoma/radioterapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND AND OBJECTIVES: The 1990s have established the contribution of multimodality therapy in the management of IIIb noninflammatory breast cancer (IIIb NIBC), by reducing the odds of recurrence and death. METHODS: A total of 300 women with IIIb NIBC received a multimodality therapy. The treatment consisted of neoadjuvant chemotherapy [FAC (5-fluorouracil, Adriamycin, cyclophosphamide) regimen], radical (Halsted) mastectomy or modified (Patey mastectomy), postoperative radiotherapy, and adjuvant chemohormone therapy [FAC regimen + cyclophosphamide, 5-fluorouracil and methotrexate (CMF) regimen or Tamoxifen]. RESULTS: Complete or partial clinical response (CR or PR) after neoadjuvant chemotherapy was obtained in 83% patients. Ninety-nine patients (33%) survived 5 years without evidence of disease (NED). The uni- and multivariate analyses factors that had significant influence on the treatment results were: clinical response to neoadjuvant chemotherapy, pathological tumor size, and microscopical status of the axillary lymph nodes. CONCLUSIONS: We conclude that neoadjuvant FAC regimen chemotherapy is very effective in producing objective tumor regression and offers the benefit of radical mastectomy to patients with previously unresectable IIIb NIBC.