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Pala M, Novakova P, Drbohlavova T, Vrana A, Pechacova Z, Votavova K, Subrt A, Krejci D, Holeckova P, Tesarova P. Negative Prognostic Impact of Smoking on Long-term Survival in Patients With Nasopharyngeal Carcinoma Treated With Curative (Chemo)radiotherapy. In Vivo 2023; 37:1775-1785. [PMID: 37369456 DOI: 10.21873/invivo.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND/AIM To evaluate the effectiveness of curative (chemo)radiotherapy in patients with nasopharyngeal carcinoma and to identify prognostic factors influencing treatment outcomes. PATIENTS AND METHODS We conducted a retrospective study of 73 consecutive patients, treated with definitive (chemo)radiotherapy from 2002 to 2019 (median stage III/IV 78%). The median total dose of radiotherapy achieved was 70 Gy. Concomitant chemotherapy was given to 82% of patients. RESULTS The five- and ten-year locoregional controls were 73% and 72%, respectively; the five- and ten-year distant controls were 93% and 93%, respectively. The five- and ten-year overall survival rates were 46% and 34%, respectively. A multivariate analysis identified age, smoking, and the initial response to treatment as the strongest prognostic factors in predicting survival. CONCLUSION Smoking ≤5 years before starting curative (chemo)radiotherapy for nasopharyngeal carcinoma was shown to be an independent negative prognostic factor for overall survival with a four-fold higher risk of death compared to non-smokers.
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Affiliation(s)
- Miloslav Pala
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic;
| | - Pavla Novakova
- Radiophysics Department of Bulovka University Hospital, Prague, Czech Republic
| | - Tereza Drbohlavova
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Antonin Vrana
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Zdenka Pechacova
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Karolina Votavova
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Adam Subrt
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Daniel Krejci
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Petra Holeckova
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Petra Tesarova
- Institute of Radiation Oncology of the 1 Faculty of Medicine Charles University and Bulovka University Hospital, Prague, Czech Republic
- Department of Oncology of the 1st Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
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Pala M, Vrana A, Novakova P, Drbohlavova T, Podlesak T. Long-term results of postoperative and definitive (chemo)radiotherapy in sinonasal carcinoma. Adult Comorbidity Evaluation 27 score as a predictor of survival. Rep Pract Oncol Radiother 2023; 28:147-158. [PMID: 37456702 PMCID: PMC10348334 DOI: 10.5603/rpor.a2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
Background The objective was to evaluate the efficacy and toxicity of curative radiotherapy in patients with sinonasal carcinoma and to identify prognostic factors influencing treatment outcomes. Materials and methods The authors conducted a retrospective study of 61 consecutive patients treated with postoperative or definitive radiotherapy from 2002 to 2018 (median age 59 years, current/former smokers 71%, maxillary sinus 67%, nasal cavity 26%). The majority of patients were diagnosed with locally advanced disease (85% clinical stage ≥ III). Regional cervical metastases were initially diagnosed in 23% of patients. The most common histology was squamous cell carcinoma (61%). Radiation therapy was preceded by radical surgery in 64% of patients. 29 patients received chemotherapy (48%). Results The median follow-up was 53 months. The median total dose of radiotherapy achieved was 70 Gy. The 5- and 10-year locoregional control, distant control, overall survival, and disease-free survival were 74% and 64%, 90% and 90%, 51% and 35%, and 38% and 25%, respectively. Severe acute toxicity occurred in 36%, severe late toxicity in 23% of patients. Severe unilateral visual impairment occurred in 6 patients, temporal lobe necrosis in 1 patient, and osteoradionecrosis requiring surgery in 2 patients. Conclusion The results of the study demonstrated the high effectiveness of curative treatment in patients with sinonasal carcinoma with long-term locoregional and distant control. The multivariate analysis indicated that N-staging, age, comorbidity score [as assessed by Adult Comorbidity Evaluation 27 (ACE-27)] and initial response to treatment were the strongest prognostic factors.
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Affiliation(s)
- Miloslav Pala
- Department of Radiation Oncology, Bulovka University Hospital, Institute of Radiation Oncology, Prague, Czech Republic
| | - Antonin Vrana
- Department of Radiation Oncology, Bulovka University Hospital, Institute of Radiation Oncology, Prague, Czech Republic
| | - Pavla Novakova
- Radiophysics Department, Bulovka University Hospital, Prague, Czech Republic
| | - Tereza Drbohlavova
- Department of Radiation Oncology, Bulovka University Hospital, Institute of Radiation Oncology, Prague, Czech Republic
| | - Tomas Podlesak
- Department of Otorhinolaryngology, Bulovka University Hospital, Prague, Czech Republic
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Pala M, Novakova P, Pechacova Z, Vesela L, Vrana A, Sukova J, Holeckova P, Drbohlavova T, Podlesak T, Petruzelka L. Long-term results of radio(chemo)therapy in metastatic carcinoma to cervical lymph nodes from an unknown primary. Adult Comorbidity Evaluation 27 score as a predictor of survival. Strahlenther Onkol 2023; 199:149-159. [PMID: 35943554 DOI: 10.1007/s00066-022-01983-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 07/10/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the effectiveness and toxicity of curative (chemo)radiotherapy in patients with metastatic carcinoma to cervical lymph nodes from an unknown primary. METHODS Retrospective study of 90 consecutive patients, treated with curative radiotherapy from 2003 to 2018 (median age 59 years; current/former smokers 76%) was conducted. The distribution of nodal staging was as follows: N1: 12%, N2a: 21%, N2b: 43%, N2c: 10%, N3: 13%. In 62% of patients, neck dissection was performed before radiotherapy. Concomitant chemotherapy was given to 64% of patients. RESULTS The median follow-up of surviving patients was 86 months. The median total radiotherapy dose achieved was 70 Gy. The 5‑ and 10-year locoregional control were 84% in both cases, while 5‑ and 10-year distant control were 90% and 89%, respectively. A primary tumor in the head and neck area was detected in only 2 patients. No patient had an initial failure in the pharyngeal axis or contralateral cervical nodes. The 5‑ and 10-year overall survival were 55% and 42%, respectively. Severe early toxicity occurred in 71%; severe late toxicity in 33% of patients. Multivariate analysis demonstrated N‑status (hazard ratio [HR] 2.424; 95% confidence interval [CI] 1.121-5.241; p = 0.024) and comorbidity scores assessed by ACE-27 (Adult Comorbidity Evaluation; HR 3.058; 95% CI 1.489-6.281; p = 0.002) as two independent prognostic factors for overall survival. CONCLUSION The results of our work study demonstrate the high effectiveness of curative (chemo)radiotherapy on the pharyngeal axis and bilateral cervical nodes with long-term locoregional and distant control in 3/4 of the treated patients. N‑status and comorbidity scores were shown as strong prognostic factors influencing overall survival.
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Affiliation(s)
- Miloslav Pala
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic.
| | - Pavla Novakova
- Radiophysics Department, Bulovka University Hospital, Prague, Czech Republic
| | - Zdena Pechacova
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic
| | - Lucie Vesela
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic
| | - Antonin Vrana
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic
| | - Jarmila Sukova
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic
| | - Petra Holeckova
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic
| | - Tereza Drbohlavova
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic
| | - Tomas Podlesak
- Department of Otorhinolaryngology, Bulovka University Hospital, Prague, Czech Republic
| | - Lubos Petruzelka
- Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic
- Department of Oncology of the 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Vranova J, Arenbergerova M, Arenberger P, Vrana A, Zivcak J, Kolarova H, Rosina J. Malignant melanoma in the Czech Republic: Incidence and mortality according to sex, age and disease stage. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:438-46. [DOI: 10.5507/bp.2012.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Indexed: 02/03/2023] Open
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Vranova J, Arenbergerova M, Arenberger P, Stanek J, Vrana A, Zivcak J, Rosina J. Incidence of cutaneous malignant melanoma in the Czech Republic: the risks of sun exposure for adolescents. Neoplasma 2012; 59:316-25. [PMID: 22296501 DOI: 10.4149/neo_2012_041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Czech Republic reported one of the highest incidence rate in cutaneous melanoma (CM) in Europe and because this incidence has been increasing, mainly among young people, the main goal of our study was to establish sun exposure behavior risk factors for CM formation and to evaluate whether the young generation of Czechs is exposed to a higher risk of CM than the older generation. A questionnaire-based case-control study was conducted. We obtained 978 completed questionnaires: 216 from patients with CM and 762 from healthy respondents. The healthy individuals were further divided to adolescents (n = 460) and older respondents (n = 302). Three logistic regression models were developed: 1. patients with CM vs. healthy older respondents, 2. adolescents vs. healthy older respondents, and 3. patients with CM vs. adolescents. The main risk factors for all three models were the number of sunburn episodes and the use of the sunscreen in the childhood. The most alarming results for adolescents included: all day sun exposure, including times of maximum risk (11 AM to 3 PM), inadequate use of sunscreen in adulthood, and frequent mountain holidays. Our results show that sun-safety in the young generation is satisfactory, when the responsibility for sun exposure behavior is in the hands of their parents; however, when children become adolescents, they become immune to sun-safety and risk prevention campaigns and their behavior becomes much more risky. Our results further suggest the sun-safety campaigns need to be modified in such a way as to have greater impact and influence on adolescent sun-risk behaviors.
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Affiliation(s)
- J Vranova
- Department of Medical Biophysics and Medical Informatics, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
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Zak A, Kazdova L, Vrana A, Tvrzicka E, Zeman M. W09.265 Effects of fish oil on glucoregulation and insulin release in hereditary hypertriglyceridemic rats. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chytry V, Letourneur D, Vrana A, Jozefonvicz J. Insulin bound to chiral polymer with N-acetyl-D-glucosaminyl units. Lacks of mitogenic activity on rat aorta smooth muscle cell proliferation. J Control Release 1998; 50:197-203. [PMID: 9685886 DOI: 10.1016/s0168-3659(97)00134-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Insulin was covalently attached to two terpolymers of N-(2-hydroxypropyl) methacrylamide, N-methacryloyldiglycine and a) R-(-)-1-methyl-2-methacryloylamidoethyl 2-acetamido-2-deoxy-beta-D-glucopyranoside or b) S-(+)-1-methyl-2-methacryloylamidoethyl 2-acetamido-2-deoxy-beta-D-glucopyranoside. The mitogenic effect of both conjugates on vascular smooth muscle cell proliferation was investigated. The results indicated that insulin bound to both carriers with pendant N-acetylglucosaminyl groups possesses hypoglycemic activity but not the mitogenic effect of native insulin. This study shows that for these insulin conjugates, the effect does not depend on the steric configuration of the sugar-containing monomer units incorporated in the terpolymer. A hypothesis is developed that some competition is taking place between N-acetylglucosaminyl groups on the polymeric insulin carrier and the same moieties in the insulin receptor expressed on the surface of smooth muscle cells leading to a lack of mitogenic activity.
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Affiliation(s)
- V Chytry
- Institute of Macromolecular Chemistry, Academy of Sciences of the Czech Republic, Prague, Czech Republic
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