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The aim of the study was to optimise the present therapy for colorectal carcinoma according to the standard therapeutic protocol. At the Ist Department of Surgery of the LF MU St. Anna Hospital in Brno and at the Department of Radiation Oncology of the same hospital, 262 patients with colorectal carcinoma were treated in period 2000-2002. Neoadjuvant radiotherapy concomitant with chemotherapy was applied for 5-6 weeks. After this procedure, a 5-6-week break, the restaging and the surgical intervention have followed. A radical surgical operation was carried out in 74.1% cases. The survival of stage IV patients was worse compared to other stages, and the presence of organ metastases markedly impaired the prognosis. We have shown in our study, that radical surgery is still the best therapeutic method for colorectal tumors. Within the surgical technique, the use of a harmonic scalpel has proved beneficial, as it enables a bloodless operative field while ensuring the necessary radicality and preserving the nerve plexuses. Neoadjuvant chemo-radiotherapy is considered a method of choice in rectal tumors surgery; it shows better results than radiotherapy only. Its inclusion into standard protocols has been still hindered by the lacking evidence of effectiveness at the II or I level. The possibility of administering oral fluoropyrimidines makes these studies even more attractive (Fig. 6, Ref. 30).

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An efficient therapy of patients with tumorous diseases should include maximum killing of malignant cells with minimal damage to cells in healthy tissues. Radiotherapy and chemotherapy are frequently associated with a series of undesirable effects. Side effects related to the therapy may unfavorably influence quality of life for a short or long period of time, may cause the need to decrease the dosage or shorten the overall period of treatment or survival of the patient. Therefore, particular attention has recently been paid to compounds, which mitigate or eliminate the undesirable effects of the therapy. A way to decrease toxicity is the administration of radioprotective or chemoprotective compounds. The cytoprotection of healthy tissues by compounds from the aminothiol group is one of the most promising directions of research and clinical practice. Amifostin protects healthy tissue from damage induced by radio- or chemotherapy. In comparison with patients treated by radiotherapy only, radiotherapy supplemented with amifostin proved to cause significantly less acute and late untoward effects of therapy. The paper describes the possibilities of using radioprotective drugs, especially amifostin, in the therapy of tumors with particular emphasis to the needs of physicians dealing with the problems of internal medicine.

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Immune parameters, including cytokine levels and CD profiles were determined in 78 renal cell carcinoma patients (RCC) prior to nephrectomy. The values were correlated with the outcome of disease and response to cytokine-based treatment during a 3-year follow-up. Significantly lower frequency of progressions and higher proportion of survivors were recorded in 24 treated patients compared to 43 untreated ones (22.9% vs. 53.5% and 82.9% vs. 55.8%) illustrating the beneficial effect of immunotherapy on the course of RCC at localized stage. RCC-related immune changes are demonstrated by reduced proportion of CD19+, CD28+, HLA-DR+, CD19+/80+ and CD8+/28+ subsets, by increased serum levels of IL-6, sIL-2R, CRP and by impaired production of IL-2 and TNF-alpha released by in vitro stimulated PBMC. Only increased CRP, IL-6 serum values, decreased CD8+ and increased CD122+ were significantly related to patients' prognosis. Comparisons of preoperative CD profiles and cytokine values with the response to IL-2/IFN-alpha based therapy disclosed significant correlation in only CD80+ and CD19+/80+ subsets. Treated patients who relapsed during the 3-year follow-up exhibited at the diagnosis significantly reduced proportion of CD80+ and CD19+/80+ cells (CD80+ means - 0.79 vs. 1.69 and CD19+/80+ means - 0.32 vs. 0.61) comparing to those surviving disease-free. In addition initial proportion of CD3+, CD8+ and CD19+ cells was reduced in treated patients who manifested progression but statistical difference from those remaining disease-free was not proved.

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This prospective study was carried out to explore cytokine-related immune alterations in 69 renal cell carcinoma patients (RCC) and to look for changes which might potentially serve as a reliable predictors of response to cytokine-based therapy. Interleukin-2 (IL-2), its soluble receptor (sIL-2R) and tumor necrosis factor (TNF-alpha) levels produced in vitro by PHA activated and intact mononuclear cells (PBMC) were determined. Concentrations of IL-2, IL-4, IL-6, sIL-2R, TNF-alpha and CRP were measured in sera. Cytokine level was evaluated by enzyme-linked immunoadsorbent assay (ELISA) and CRP was determined by means of turbidimetric method. All measurements were performed in patients without any prior treatment. PHA activated PBMC of RCC patients were significantly defective in producing IL-2 and TNF-alpha comparing to controls (p < 0.03 and p < 0.001). The difference of sIL-2R was noted in metastatic stage only (p < 0.03). Unstimulated PBMC manifested decrease in IL-2 (p < 0.03) and increased level of TNF-alpha in advanced disease (p < 0.02). This impairment reflected tumor size and differentiation stage. Serum concentrations of IL-2, sIL-2R and TNF-alpha were within normal range. However, in relation to the clinical stage, significantly increased serum IL-2 was noted in combined Stage I and II as compared to controls (p = 0.012). IL-6 and CRP showed markedly elevated levels with a significancy which allowed to distinguish samples from metastatic patients. In conclusion careful comparisons of these data with clinical course of cytokine treated patients will disclose which of those tests may possess predictive power in the individual patients who are likely to respond to cytokine-based treatment.

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Orbital radiation therapy appears to be an effective and safe treatment of Graves' ophthalmopathy. Five patients with Graves' ophtalmopathy were treated with external beam radiotherapy during 1996 and 1997 in St. Ann University Hospital. Four of them patients had a past history of hyperthyreoidism, one hypothyreoidism. The radiotherapy was performed with high-energy beam of a linear accelerator. The technique of irradiation employs 2 opposed beams tilted 5 degrees posteriorly. The use of the asymetric jaws is necessary to protect surrounding normal tissues. A course of radiotherapy 20.0 Gy (2.0 Gy per fraction) was given to the patients. The therapy was well tolerated. We have not observed any side late effects of radiotherapy. All patients showed good or excellent responses. The improvement of symptoms appeared within 3-6 months after the irradiation.

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Authors evaluated longterm results of the survival of patients with metastasis of adenocarcinoma in long bones and pelvis in 72 cases which were treated and followed at Ist Orthpaedic Clinic of the Faculty Hospital of St. Ann in Brno in the period of 1970-1995. Patients were divided into two groups. One group of patients was treated with intralesional operation and in the second group the metastasis was radically resected. The period of survival in the second group was longer. Authors also present a general survey of adjuvant therapy of metastasis of adenocarcinoma in bones. Key words: metastasis of adenocarcinoma in long bones and pelvis, method of treatment.

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The authors used between October 1993 and January 1997 in 131 patients with inoperable malignant or benign stenosis of the oesophagus an expansible metal stent. In 25 patients the stenosis was in the upper third of the oesophagus, in 44 in the medium part, in 53 in the lower third of the oesophagus and in 9 patients in the area of the anastomosis. All patients suffered at the time when the stent was introduced from marked dysphagia (stage 3-4 according to the international classification). In 45 patients the authors introduced more than one stent. 112 patients suffered from malignant stenosis (67 squamous cell carcinoma, 27 adenocarcinoma, 9 pulmonary or bronchogenic carcinoma, in two instances lymphoma, in two instances leiomyosarcoma and in five patients another type of tumour). Seventeen patients suffered from benign stenosis (8 complications of reflux oesophagitis, 3 stenosis in the anastomosis, in two instances corrosion by acid, 2 cases of epidermolysis bullosa oesophagi and one post-radiation stenosis). In these patients repeatedly before introduction of the stent dilatation of the stenosis by means of a balloon dilatation catheter was attempted. In two instances the etiology of the stenosis was obscure. Complications related to the procedure proper or after insertion of the stent were recorded in 49 patients-dislocation of the stent 23x, occlusion of the stent 17x, development of a fistula 6x, ulceration 16x, haemorrhage 4x, hyperplasia of the mucosa 21x, ileus 2x, inadequate expansion of the stent 8x.

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During the period of January 1969 to December 1980, 649 patients have been treated by radical radiotherapy for Stage IIb, IIIb, and IVa carcinoma of the cervix uteri. This retrospective study was performed to assess therapeutical results in two groups of patients. Clinical staging and the methods of treatment were standard in both groups. Group I was treated by external irradiation of the pelvis minor with 60Co in combination with intracavitary radium administration. Group II patients were irradiated with a 42 MeV betatron according to the findings of lymphography, again in combination with radium brachytherapy. In Group I the 5-year survival rate was 59.2%, that in Group II was 66.7%. There was a statistically significant difference in the 5-year survival rate in Stage IIb patients of Group II (85.5%) against that in Group I (75.6%). The incidence of serious complications elicited by radiotherapy increased from 4.8% in Group I patients to 7.5% in Group II. Clinical stage, age at the time of diagnosis, findings of lymphography and tolerance to irradiation are prognostically important factors that influence the cure of the patients. On the basis of these findings, the possibilities of further therapeutic improvements are discussed.

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The principle of the therapy of carcinoma cervicis uteri in the Research Institute of Clinical and Experimental Oncology in Brno is the combination of betatron megavoltage irradiation and cobalt 60 irradiation with intracavital radium irradiation. On the basis of many years' study concerning the therapy and therapeutic results of this tumor accurate directions of total therapy were elaborated. Carcinoma is diagnosed and classified precisely according to valid international directions. In addition to basic examination, limb lymphography was introduced giving the strategy of irradiation when lymphatic system is involved and in early stages of the disease. By preliminary evaluation of the obtained data a certain improvement of therapeutic results is proven. About 15% more patients are alive till 5 years without any signs of the disease than in precedent years. In spite of a high dose summation given by the extent of megavoltage irradiation the number of postirradiation reaction, nor early late, is increased to much. Complex therapy of this tumor is performed by a team of physicians composed of gynecologist, radiologist, rentgendiagnosticist, pathologist, and radiation physicist. By increasing the number of cured patients and their return and enclosure into further working process the savings in state budget are achieved. The effectiveness of the carcinoma cervicis uteri therapy is therefore dependent not only on earlier diagnosis and modern irradiation technique, but also on the cooperation of a team of physicians who plan, perform and follow the therapy.

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Two modalities of motion therapy both with electron and bremsstrahlung irradiation are described. Both therapy modes were used in the therapy of 62 patients with tumors of the kidneys, 13 patients with tumors of the esophagus, 20 patients with tumors of the prostate and urinary bladder and 170 patients with tumors of the breast. The advantage of the described method is the possibility of simple, precise and easily reproducible irradiation in given localizations, good therapeutic effect and very good general tolerance as the patient concerns.

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The article deals with the therapy of cancer of the cervix with external 42 MeV betatron bremsstrahlung irradiation in combination with intracavitary applicated radium. The described irradiation technique using special shielding blocks extends the dose distribution till to the region of paraaortic nodes in an extended field. The extended irradiation field is used on the basis of lymphographic examination. In the region of pelvis minor, sufficiently uniform dose distribution is attained with lethal tumor effect. The dose variability with betatron or cobalt external irradiation was also studied.

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In the presented work we have tested another fractionation schemes than simple fractionation in some so-called radioresistant tumors, i. e. in breast cancer and malignant melanoma. We have found the advantage of the irradiation with divided series (split irradiation) namely in malignant skin melanoma where we gained therapeutic results with 58% 5-year survival. Periodical irradiation especially with higher fractions once a week had encouraging success in advanced stages of the breast cancer where a single fraction of 8 Gy/tumor up to total dose of 40 Gy/tumor was determined as optimal. With the use of higher fractions more pronounced late postirradiation changes are to be expected. Fraction schemes were compared using NSD and TDF equations.

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