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Tuček L, Sirák I, Hodek M, Kašaová L, Grepl J, Paluska P, Pohanková D, Hruška L, Vošmik M, Petera J. High-dose-rate brachytherapy at 3 Gy per fraction for lip carcinoma: Treatment outcomes and toxicity at 5-years. Brachytherapy 2023; 22:496-502. [PMID: 37015847 DOI: 10.1016/j.brachy.2023.02.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/17/2022] [Accepted: 02/02/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Low-dose-rate brachytherapy (LDR-BT) is a well-established treatment for lip cancer. High-dose-rate (HDR)-BT is a promising alternative to LDR-BT, but data are limited. In this context, we retrospectively evaluated treatment outcomes in a series of patients who underwent HDR-BT for lip carcinoma between 2003 and 2021. MATERIALS AND METHODS A total of 32 patients were included in this study, with a median age of 73.5 years (range, 61 - 88). The indications for HDR-BT were as follows: primary treatment (n = 17), adjuvant treatment (n = 3), and recurrent disease after surgery (n = 12). The prescribed dose was 18 fractions of 3 Gy administered twice daily. RESULTS At a median followup of 45 months (range, 12 -232), the 5-year local recurrence-free interval was 96.9% (95% CI: 90.9-100%), the disease-free interval was 85% (95% CI: 70.9-99.1), and 5-year overall survival was 64.7% (95% CI: 44.7-84.8). Eleven patients died, all on age related comorbidities. Acute toxicity manifested as G1 dry desquamation in 6 patients (18.8%), G2 erythema in 10 patients (31.2%) and G3 confluent moist desquamation in 16 patients (50%). Late complications included G1 fibrosis (100% of cases). G1 and G2 depigmentation was observed in 8 (25%) and 6 (18%) patients, G1 telangiectasia occurred in 5 patients (16%). CONCLUSIONS These data support the use of HDR-BT for lip cancer. The dose and fractionation schedule used in this study (18 fractions x 3 Gy twice daily) seems to be effective and safe.
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Affiliation(s)
- Luboš Tuček
- Deptartment of Stomatology, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Igor Sirák
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Miroslav Hodek
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Linda Kašaová
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Jakub Grepl
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Petr Paluska
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Denisa Pohanková
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Libor Hruška
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Milan Vošmik
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic.
| | - Jiří Petera
- Deptartment of Oncology and Radiotherapy, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
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Sirák I, Fibír A, Slaninka I, Paulík A, Kolářová I, Motyčka P, Grepl J, Paluska P, Vošmik M. Breast reconstruction and radiotherapy. Onkologie 2023; 17:113-118. [DOI: 10.36290/xon.2023.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
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Williamson CW, Sirák I, Xu R, Portelance L, Wei L, Tarnawski R, Mahantshetty U, Heide ES, Yashar CM, McHale MT, Bosch W, Lowenstein J, Saenz CC, Plaxe S, Eskander R, Einck J, Mundt AJ, Mayadev J, Mell LK. Positron Emission Tomography-Guided Bone Marrow-Sparing Radiation Therapy for Locoregionally Advanced Cervix Cancer: Final Results From the INTERTECC Phase II/III Trial. Int J Radiat Oncol Biol Phys 2022; 112:169-178. [PMID: 34419564 PMCID: PMC8688221 DOI: 10.1016/j.ijrobp.2021.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 06/10/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To test effects of positron emission tomography (PET)-based bone marrow-sparing (BMS) image-guided intensity modulated radiation therapy (IG-IMRT) on efficacy and toxicity for patients with locoregionally advanced cervical cancer. METHODS AND MATERIALS In an international phase II/III trial, patients with stage IB-IVA cervical carcinoma were treated with either PET-based BMS-IG-IMRT (PET-BMS-IMRT group) or standard image-guided IMRT (IMRT group), with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy. The phase II component nonrandomly assigned patients to PET-BMS-IMRT or standard IMRT. The phase III trial randomized patients to PET-BMS-IMRT versus IMRT, with a primary endpoint of progression-free survival (PFS) but was closed early for futility. Phase III patients were analyzed separately and in combination with phase II patients, comparing acute hematologic toxicity, cisplatin delivery, PFS, overall survival (OS), and patterns of failure. In a post-hoc exploratory analysis, we investigated the association between pretreatment absolute lymphocyte count (ALC) and OS. RESULTS In total, 101 patients were enrolled on the phase II/III trial, including 29 enrolled in phase III (PET-BMS-IMRT group: 16; IMRT group: 13) before early closure. Median follow-up was 33 months for phase III patients and 39 months for all patients. PFS and OS at 5 years for all patients were 73.6% (95% confidence interval [CI], 64.9%-84.3%) and 84% (95% CI, 76%-92.9%]), respectively. There were no differences in number of cisplatin cycles, OS, PFS, or patterns of failure between groups for the combined cohort. The incidence of acute grade ≥ 3 neutropenia was significantly lower in the PET-BMS-IMRT group compared with IMRT for randomized patients (19% vs 54%, χ2P = .048) and in the combined cohort (13% vs 35%, χ2P = .01). Patients with pretreatment ALC ≤ 1.5 k/µL had nonsignificantly worse OS on multivariable analysis (HR 2.85; 95% CI, 0.94-8.62; adjusted P = .216), compared with patients with ALC > 1.5 k/µL. There was no difference in posttreatment ALC by treatment group. CONCLUSIONS PET-BMS-IMRT significantly reduced acute grade ≥3 neutropenia, but not treatment-related lymphopenia, compared with standard IMRT. We found no evidence that PET-BMS-IMRT affected chemotherapy delivery or long-term outcomes, and weak evidence of an association between pretreatment ALC and OS.
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Affiliation(s)
- Casey W. Williamson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Ronghui Xu
- University of California San Diego, La Jolla, California
| | | | | | - Rafal Tarnawski
- Marie Sklodowska Cancer Center and Institute of Oncology, Gliwice, Poland
| | | | | | - Catheryn M. Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | | | - Walter Bosch
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | | | | | - Steve Plaxe
- University of California San Diego, La Jolla, California
| | - Ramez Eskander
- University of California San Diego, La Jolla, California
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Arno J. Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California,La Jolla Center for Precision Radiation Medicine, La Jolla, California
| | - Loren K. Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California,La Jolla Center for Precision Radiation Medicine, La Jolla, California
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Sirák I, Laco J, Vošmiková H, Mell LK, Herrera FG, Šenkeříková M, Vošmik M. SMARCA4-Deficient Carcinoma of Uterine Cervix Resembling SCCOHT-Case Report. Pathol Oncol Res 2022; 27:1610003. [PMID: 34970085 PMCID: PMC8712336 DOI: 10.3389/pore.2021.1610003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Small cell carcinoma of hypercalcemic type (SCCOHT) is a rare gynaecological neoplasm, originating mostly in the ovaries. Cervical origin of this very aggressive malignancy with unknown histogenesis is an extremely rare condition, without published management recommendations. Alterations in SMARCA4 gene are supposed to play the major role in SCCOHT oncogenesis and their identification is crucial for the diagnosis. Adequate genetic counselling of the patients and their families seems to be of great importance. Optimal management and treatment approaches are not known yet but may extremely influence the prognosis of young female patients that suffer from this very resistant disease. Nowadays, a translational research seems to be the key for the further diagnostic and treatment strategies of SCCOHT. The purpose of the case report is to provide practical information and useful recommendations on the diagnosis, management, and treatment of SMARCA4-deficient carcinoma of the uterine cervix resembling SCCOHT.
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Affiliation(s)
- Igor Sirák
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Jan Laco
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Hana Vošmiková
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Fernanda G Herrera
- Ludwig Institute for Cancer Research, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mária Šenkeříková
- Department of Medical Genetics, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Milan Vošmik
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
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Vošmik M, Kopecký J, John S, Kubeček O, Lochman P, Banni AM, Hruška L, Sirák I. Combined Therapy of Locally Advanced Oesophageal and Gastro-Oesophageal Junction Adenocarcinomas: State of the Art and Aspects of Predictive Factors. Cancers (Basel) 2021; 13:4591. [PMID: 34572818 PMCID: PMC8469285 DOI: 10.3390/cancers13184591] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
The following main treatment approaches are currently used in locally advanced adenocarcinomas of the oesophagus and gastrooesophageal junction (GOJ): preoperative chemoradiotherapy and surgery, and perioperative chemotherapy and surgery. While preoperative chemoradiotherapy is used primarily in oesophageal tumours, perioperative chemotherapy is the treatment of choice in Western countries for gastric cancer. The optimal treatment strategy for GOJ adenocarcinoma is still not clear. In comparison to other malignancies, biomarkers are used as predictive factors in distal oesophageal and GOJ adenocarcinomas in a very limited way, and moreover, only in metastatic stages (e.g., HER2 status, or microsatellite instability status). The aim of the article is to provide an overview of current treatment options in locally advanced adenocarcinomas of oesophagus and GOJ based on the latest evidence, including the possible potential of predictive biomarkers in optimizing treatment.
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Affiliation(s)
- Milan Vošmik
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (J.K.); (S.J.); (O.K.); (A.M.B.); (L.H.); (I.S.)
| | - Jindřich Kopecký
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (J.K.); (S.J.); (O.K.); (A.M.B.); (L.H.); (I.S.)
| | - Stanislav John
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (J.K.); (S.J.); (O.K.); (A.M.B.); (L.H.); (I.S.)
| | - Ondřej Kubeček
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (J.K.); (S.J.); (O.K.); (A.M.B.); (L.H.); (I.S.)
| | - Petr Lochman
- Department of Surgery, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
- Department of Field Surgery, Faculty of Military Health Sciences, University of Defence, 500 05 Hradec Králové, Czech Republic
| | - Aml Mustafa Banni
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (J.K.); (S.J.); (O.K.); (A.M.B.); (L.H.); (I.S.)
| | - Libor Hruška
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (J.K.); (S.J.); (O.K.); (A.M.B.); (L.H.); (I.S.)
| | - Igor Sirák
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (J.K.); (S.J.); (O.K.); (A.M.B.); (L.H.); (I.S.)
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Ndukwe MO, Práznovec I, Štěpán M, Sirák I, Fibír A, Špaček J. Treatment options for locally recurrent vulvar cancer. Ceska Gynekol 2021; 86:246-248. [PMID: 34493049 DOI: 10.48095/cccg2021246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Summarizing of treatment options for locally recurrent vulvar cancer in patients after previous complex oncological treatment and presenting a case report from our department. METHODS Presenting a case report of a patient after previous complex oncological treatment for spinocellular cancer of the vulva who presented with a locally recurrent tumor. The patient was treated with a wide radical local excision of the tumor followed by a posterior thigh flap graft. CONCLUSION Surgical intervention is the primary mode of treatment in locally recurrent cancers of the vulva. Wide radical local excision as a mode of treatment can be optimized by the use of grafts aiding in wound healing.
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Cruz-Garcia L, O’Brien G, Sipos B, Mayes S, Tichý A, Sirák I, Davídková M, Marková M, Turner DJ, Badie C. In Vivo Validation of Alternative FDXR Transcripts in Human Blood in Response to Ionizing Radiation. Int J Mol Sci 2020; 21:ijms21217851. [PMID: 33113898 PMCID: PMC7660203 DOI: 10.3390/ijms21217851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
Following cell stress such as ionising radiation (IR) exposure, multiple cellular pathways are activated. We recently demonstrated that ferredoxin reductase (FDXR) has a remarkable IR-induced transcriptional responsiveness in blood. Here, we provided a first comprehensive FDXR variant profile following DNA damage. First, specific quantitative real-time polymerase chain reaction (qPCR) primers were designed to establish dose-responses for eight curated FDXR variants, all up-regulated after IR in a dose-dependent manner. The potential role of gender on the expression of these variants was tested, and neither the variants response to IR nor the background level of expression was profoundly affected; moreover, in vitro induction of inflammation temporarily counteracted IR response early after exposure. Importantly, transcriptional up-regulation of these variants was further confirmed in vivo in blood of radiotherapy patients. Full-length nanopore sequencing was performed to identify other FDXR variants and revealed the high responsiveness of FDXR-201 and FDXR-208. Moreover, FDXR-218 and FDXR-219 showed no detectable endogenous expression, but a clear detection after IR. Overall, we characterised 14 FDXR transcript variants and identified for the first time their response to DNA damage in vivo. Future studies are required to unravel the function of these splicing variants, but they already represent a new class of radiation exposure biomarkers.
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Affiliation(s)
- Lourdes Cruz-Garcia
- Cancer Mechanisms and Biomarkers Group, Radiation Effects Department, Centre for Radiation, Chemical & Environmental Hazards, Public Health England, Chilton, Oxfordshire OX11 0RQ, UK; (L.C.-G.); (G.O.)
| | - Grainne O’Brien
- Cancer Mechanisms and Biomarkers Group, Radiation Effects Department, Centre for Radiation, Chemical & Environmental Hazards, Public Health England, Chilton, Oxfordshire OX11 0RQ, UK; (L.C.-G.); (G.O.)
| | - Botond Sipos
- Oxford Nanopore Technologies, Gosling Building, Edmund Halley Way, Oxford OX4 4DQ, UK; (B.S.); (S.M.); (D.J.T.)
| | - Simon Mayes
- Oxford Nanopore Technologies, Gosling Building, Edmund Halley Way, Oxford OX4 4DQ, UK; (B.S.); (S.M.); (D.J.T.)
| | - Aleš Tichý
- Department of Radiobiology, Faculty of Military Health Sciences in Hradec Králové, University of Defence in Brno, 500 01 Hradec Králové, Czech Republic;
- Biomedical Research Centre, Hradec Králové University Hospital, 500 01 Hradec Králové, Czech Republic
| | - Igor Sirák
- Department of Oncology and Radiotherapy and 4th Department of Internal Medicine—Hematology, University Hospital, 500 05 Hradec Králové, Czech Republic;
| | - Marie Davídková
- Department of Radiation Dosimetry, Nuclear Physics Institute of the Czech Academy of Sciences, 180 00 Prague 8, Czech Republic;
| | - Markéta Marková
- Institute of Hematology and Blood Transfusion, 128 00 Praha 2, Czech Republic;
| | - Daniel J. Turner
- Oxford Nanopore Technologies, Gosling Building, Edmund Halley Way, Oxford OX4 4DQ, UK; (B.S.); (S.M.); (D.J.T.)
| | - Christophe Badie
- Cancer Mechanisms and Biomarkers Group, Radiation Effects Department, Centre for Radiation, Chemical & Environmental Hazards, Public Health England, Chilton, Oxfordshire OX11 0RQ, UK; (L.C.-G.); (G.O.)
- Correspondence: ; Tel.: +44-(0)1235-825-088; Fax: +44-(0)1235-833-891
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Novotná V, Sirák I, Pohanková D, Jandík P, Kašaová L, Grepl J, Paluska P, Motyčka P, Asqar A, Kretzler L, Petera J. Cardiac doses of accelerated partial breast irradiation with perioperative multicatheter interstitial brachytherapy. Strahlenther Onkol 2020; 197:288-295. [PMID: 33067652 DOI: 10.1007/s00066-020-01699-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/09/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To quantify mean heart dose (MHD) and doses to the left anterior descending artery (LAD) and left ventricle (LV) in a retrospective series of patients who underwent perioperative accelerated partial breast irradiation with multicatheter interstitial brachytherapy (MIB-APBI). METHODS Sixty-eight patients with low-risk left breast cancer were treated with MIB-APBI at our institution between 2012 and 2017. Interstitial tubes were inserted during the tumorectomy and sentinel node biopsy and APBI was started 6 days later. The prescribed dose was 34 Gy in 10 fractions (twice a day) to the clinical target volume (CTV). The heart, LAD, and LV were contoured and the distance between each structure and the CTV was measured. The MHD, mean and maximum LAD doses (LAD mean/max), and mean LV doses (LV mean) were calculated and corrected to biologically equivalent doses in 2‑Gy fractionation (EQD2). We also evaluated the impact of the distance between the cardiac structures and the CTV and of the volume receiving the prescribed dose (V100) and high-dose volume (V150) on heart dosimetry. RESULTS Mean EQD2 for MHD, LAD mean/max, and mean LV were 0.9 ± 0.4 Gy (range 0.3-2.2), 1.6 ± 1.1 Gy (range, 0.4-5.6), 2.6 ± 1.9 Gy (range, 0.7-9.2), and 1.3 ± 0.6 Gy (range, 0.5-3.4), respectively. MHD, LAD mean/max, and LV mean significantly correlated with the distance between the CTV and these structures, but all doses were below the recommended limits (German Society of Radiation Oncology; DEGRO). The MHD and LV mean were significantly dependent on V100. CONCLUSION Perioperative MIB-APBI resulted in low cardiac doses in our study. This finding provides further support for the value of this technique in well-selected patients with early-stage left breast cancer.
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Affiliation(s)
- Veronika Novotná
- Dept. of Oncology and Radiotherapy, University Hospital and Medical Faculty, Sokolská 281, 500 05, Hradec Kralove, Czech Republic
| | - Igor Sirák
- Dept. of Oncology and Radiotherapy, University Hospital and Medical Faculty, Sokolská 281, 500 05, Hradec Kralove, Czech Republic.
| | - Denisa Pohanková
- Dept. of Oncology and Radiotherapy, University Hospital and Medical Faculty, Sokolská 281, 500 05, Hradec Kralove, Czech Republic
| | - Pavel Jandík
- Dept. of Surgery, University Hospital and Medical Faculty, Hradec Kralove, Czech Republic
| | - Linda Kašaová
- Dept. of Oncology and Radiotherapy, University Hospital and Medical Faculty, Sokolská 281, 500 05, Hradec Kralove, Czech Republic
| | - Jakub Grepl
- Dept. of Oncology and Radiotherapy, University Hospital and Medical Faculty, Sokolská 281, 500 05, Hradec Kralove, Czech Republic
| | - Petr Paluska
- Dept. of Oncology and Radiotherapy, University Hospital and Medical Faculty, Sokolská 281, 500 05, Hradec Kralove, Czech Republic
| | - Petr Motyčka
- Dept. of Surgery, University Hospital and Medical Faculty, Hradec Kralove, Czech Republic
| | - Ahmed Asqar
- Dept. of Surgery, University Hospital and Medical Faculty, Hradec Kralove, Czech Republic
| | - Lucie Kretzler
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jiří Petera
- Dept. of Oncology and Radiotherapy, University Hospital and Medical Faculty, Sokolská 281, 500 05, Hradec Kralove, Czech Republic
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Hruška L, Sirák I, Laco J, Fridrichová P, Nosková H, Slabý O, Pál K, Bočkayová V, Hodek M, Petera J. Rare Hereditary Burden associated with a Hypercalcemic Small-Cell Carcinoma of Cervix in a Young Female Patient. Klin Onkol 2020; 32:456-462. [PMID: 31842565 DOI: 10.14735/amko2019456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Oncological diseases have, in most cases, a multifactorial etiology, composed of a combination of external and internal environmental factors. Hereditary tumorous syndromes are mostly autosomal dominant diseases with incomplete but very high penetrance. OBSERVATION The patient, an 18-year-old virgin female, consulted a gynecologist in June 2018 because of metrorrhagia. Magnetic resonance imaging revealed a cervical tumor with the dimensions 80 × 90 × 80 mm. Histological analysis confirmed the presence of a very rare hypercalcemic type of small-cell carcinoma of the cervix. Further investigation of the germinal exom of the patient showed pathological variations in genes PALB2 and BRCA2, presented with recommendation of detailed examination by medical genetics. CONCLUSION Clinical experience with this type of tumor is very limited, but it still comes with some useful outcome. Small cell carcinomas of the gynecologic tract are very rare, aggressive diseases, with very poor prognosis, affecting mainly young women. Their origin is most often the ovaries, based on most clinical data, but these tumor also localize to the endometrium, cervix, vagina and vulva. It is an extremely rare type of cancer, for which clinical data is scant due to the extremely low number of reported cases. In this patient, the carcinoma had an unusual genetical mutation burden, which she inherited from her parents. In the light of these findings, we recommend that patients suspected of having a small-cell of the gynecologic tract provide a detailed family history, and that genetic testing be considered in similar cases. This work was supported by MH CR grant 16-33209A and research program of Charles University Progress Q40/06. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 10. 6. 2019 Accepted: 9. 9. 2019.
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Vošmik M, Hodek M, Buka D, Sýkorová P, Grepl J, Paluska P, Paulíková S, Sirák I. Cardiotoxicity of radiation therapy in esophageal cancer. Rep Pract Oncol Radiother 2020; 25:318-322. [PMID: 32194352 DOI: 10.1016/j.rpor.2020.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/06/2019] [Revised: 01/22/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
With a development of radiotherapeutic techniques, availability of radiotherapy data on cardiotoxicity, and slowly improving esophageal cancer outcomes, an increasing emphasis is placed on the heart protection in radiation treated esophageal cancer patients. Radiation induced heart complications encompass mainly pericardial disease, cardiomyopathy, coronary artery atherosclerosis, valvular heart disease, and arrhythmias. The most frequent toxicity is pericardial effusion which is usually asymptomatic in the majority of patients. The use of modern radiotherapy techniques is expected to reduce the risk of cardiotoxicity, although this expectation has to be confirmed by clinical data.
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Affiliation(s)
- Milan Vošmik
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Miroslav Hodek
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - David Buka
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Petra Sýkorová
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Jakub Grepl
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Petr Paluska
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Simona Paulíková
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
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Sirák I, Hodek M, Jandík P, Grepl J, Paluska P, Petera J. Accelerated partial breast irradiation in elderly breast cancer patients. Transl Cancer Res 2020; 9:S29-S36. [PMID: 35117946 PMCID: PMC8798666 DOI: 10.21037/tcr.2019.07.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/27/2019] [Indexed: 12/02/2022]
Abstract
Breast-conserving surgery with adjuvant whole-breast irradiation has become the standard treatment for early breast cancer (EBC) patients. Partial breast irradiation, which targets only the postoperative cavity, has been established as an alternative to whole-breast therapy in selected patients. The treatment of elderly breast cancer patients differs from the therapeutic approach in younger ones, as elderly patients are prone to geriatric frailty and comorbid conditions, the incidence and severity of which increase with age. A review of the evidence, process, techniques, and results of accelerated partial breast irradiation (APBI) in elderly EBC patients, seems to indicate that APBI is an advisable postoperative approach in properly selected elderly EBC patients, combining advantages of a radical approach that minimizes the risk of undertreatment with efficient reduction of redundant irradiated volume, treatment toxicity, overall treatment time, staff workload, radiation technique workflow, patient transportation, and the potential for non-compliance. There is no “one size fits all” technique of APBI, the best technique always depending on willing patients, individual anatomy, performance status, patient frailty and comorbid conditions, and tumour location.
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Affiliation(s)
- Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Miroslav Hodek
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Pavel Jandík
- Department of Surgery, University Hospital, Hradec Králové, Czech Republic
| | - Jakub Grepl
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Petr Paluska
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Jiří Petera
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
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Pohanková D, Sirák I, Kašaová L, Grepl J, Paluska P, Louda M, Holub L, Špaček J, Prošvic P, Petera J. High-Dose Rate Brachytherapy in the Treatment of Early Stages of Penile Carcinoma. Klin Onkol 2019; 32:52-57. [DOI: 10.14735/amko201952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pohanková D, Sirák I, Jandík P, Kašaova L, Grepl J, Motyčka P, Asqar A, Paluska P, Ninger V, Bydžovská I, Kopecky V, Petera J. Accelerated partial breast irradiation with perioperative multicatheter interstitial brachytherapy-A feasibility study. Brachytherapy 2018; 17:949-955. [PMID: 30227977 DOI: 10.1016/j.brachy.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/25/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the feasibility of high-dose-rate perioperative multicatheter interstitial brachytherapy to deliver accelerated partial breast irradiation (APBI) in selected patients with early breast cancer. METHODS AND MATERIALS Perioperative multicatheter interstitial brachytherapy for APBI has been used at our department since 2012 for patients with low-risk breast cancer. Interstitial catheters were inserted perioperatively via hollow needles immediately following tumorectomy with sentinel node biopsy. APBI started on Day 6 after surgery. The prescribed dose was 34 Gy (10 fractions of 3.4 Gy bid). Hormonal therapy was prescribed in all cases. RESULTS Between June 2012 and December 2017, 125 patients were scheduled for APBI. Of these, APBI was not performed in 12 patients (9.6%) due to adverse prognostic factors identified on the definitive biopsy. We observed wound dehiscence in 2/113 cases (1.8%), inflammatory complications requiring antibiotics in 7/113 cases (6.2%), transient Grade I radiodermatitis in 6/113 patients (4.4%), and seroma which resolved spontaneously in 3/113 patients (2.7%). With median followup of 39 months (range 3.3-75.3) no relapses were observed. No late complications in Radiation Therapy Oncology Group Grade 3 or higher were documented. Cosmetic outcome in patients with followup > 2 years was excellent or good in 92%. CONCLUSION Our preliminary results show that the perioperative multicatheter interstitial high-dose-rate brachytherapy for APBI in selected patients with early breast cancer is feasible. This treatment schedule reduces treatment duration, spares the patients of repeated anesthesia, and enables precise application of the afterloading tubes under direct visual control.
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Affiliation(s)
- Denisa Pohanková
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic.
| | - Pavel Jandík
- Department of Surgery, University Hospital, Hradec Králové, Czech Republic
| | - Linda Kašaova
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Jakub Grepl
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Petr Motyčka
- Department of Surgery, University Hospital, Hradec Králové, Czech Republic
| | - Ahmed Asqar
- Department of Surgery, University Hospital, Hradec Králové, Czech Republic
| | - Petr Paluska
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
| | - Vladimír Ninger
- Department of Surgery, Hospital Chrudim, Chrudim, Czech Republic
| | - Ivana Bydžovská
- Department of Surgery, Hospital Chrudim, Chrudim, Czech Republic
| | - Viliam Kopecky
- Department of Surgery, Hospital Chrudim, Chrudim, Czech Republic
| | - Jiří Petera
- Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic
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Vošmik M, Vošmiková H, Sieglová K, Sirák I, Laco J, Ryška A, Petera J, Melichar B, Soumarová R. HPV Status and Mutation Analysis Using Multiparallel Sequencing in Distal Oesophageal and Gastro-oesophageal Junction Adenocarcinomas. Folia Biol (Praha) 2018; 64:41-45. [PMID: 30338755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The incidence of adenocarcinoma of oesophagus or gastro-oesophageal junction is increasing in Europe and other regions of the Western world. Research of possible causes has shifted to the molecular level. This study evaluated human papillomavirus (HPV) using real-time PCR and mutational status of selected genes using the multiparallel sequencing method (NGS) in DNA extracted from paraffin-embedded tumour tissue of 56 patients with oesophageal or gastro-oesophageal junction adenocarcinoma. The genetic material was in sufficient quality for the analysis in 37 cases (66 %). No HPV-positive sample was found. NGS revealed higher frequency of mutations in TP53, ARID1A, PIK3CA, SMAD4, ERBB2, MSH6, BRCA2, and RET genes. Association between gene mutations and histological grade, subtype according to Lauren, or primary tumour site was not statistically significant. In conclusion, the study did not confirm any HPV-positive sample of oesophageal and gastro-oesophageal junction adenocarcinoma. The study confirmed the usefulness of NGS analysis of paraffin-embedded tissue of these tumours, and it could be used in clinical studies to evaluate the prognostic and/or predictive value of the tested mutations. The association between gene mutations and histological features should be tested in larger patient cohorts.
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Affiliation(s)
- M Vošmik
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králove, Hradec Králové, Czech Republic
| | - H Vošmiková
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králove, Hradec Králové, Czech Republic
| | - K Sieglová
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králove, Hradec Králové, Czech Republic
| | - I Sirák
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králove, Hradec Králové, Czech Republic
| | - J Laco
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králove, Hradec Králové, Czech Republic
| | - A Ryška
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králove, Hradec Králové, Czech Republic
| | - J Petera
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králove, Hradec Králové, Czech Republic
| | - B Melichar
- Department of Oncology, Palacký University, Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - R Soumarová
- Department of Radiotherapy and Oncology, Charles University, Third Faculty of Medicine and University Hospital Královské Vinohrady, Prague, Czech Republic
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Sirák I, Petera J, Zoul Z. The Influence of Cisplatin Dose upon Survival in Concurrent Chemoradiotherapy of Locally Advanced Cervical Carcinoma with Weekly Cisplatin. Acta Med (Hradec Kralove, Czech Repub ) 2017; 51:95-9. [DOI: 10.14712/18059694.2017.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study was to evaluate the influence of cisplatin dose upon 3-year overall and disease-free survival rate of patients with advanced cervical cancer treated with concurrent chemoradiotherapy with weekly cisplatin. Seventy-three patients with stage IIB – IVA cervical carcinoma were treated with pelvic (or pelvic + paraaortic) externalbeam radiotherapy, high-dose rate brachytherapy and concomitant chemotherapy with weekly cisplatin of 40 mg/m2 in the time period form January 2000 to December 2006 at our department. The 3-year overall survival and disease-free suvival rates were evaluated with regard to the number of cisplatin cycles applied during the external radiotherapy. Only twentyeight patients received the intended five doses of chemotherapy. The most frequent cause of chemotherapy delay was the acute hematological toxicity with leukopenia. The 3-year overall survival was 71 % and the 3-year disease-free survival was 61 %. Survival analyses didn’t prove a statistically significant influence of cisplatin dose upon 3-year survival in cervical carcinoma patients treated by exclusive chemoradiation with weekly cisplatin.
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Manning G, Tichý A, Sirák I, Badie C. Radiotherapy-Associated Long-term Modification of Expression of the Inflammatory Biomarker Genes ARG1, BCL2L1, and MYC. Front Immunol 2017; 8:412. [PMID: 28443095 PMCID: PMC5385838 DOI: 10.3389/fimmu.2017.00412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 12/13/2016] [Accepted: 03/23/2017] [Indexed: 12/14/2022] Open
Abstract
Ionizing radiation (IR) exposure of cells in vitro and in vivo triggers a complex cellular response among which modifications of gene expression have been consistently reported. Nevertheless, little is currently known about the transcriptionally responsive genes which play a role in the inflammation response. In order to improve our understanding of such transcriptional response to radiation in vivo, we simultaneously monitored the expression of 249 genes associated with the inflammation response over the course of the radiotherapy treatment in blood of patients treated for endometrial or head and neck cancer. We have identified genes whose transcriptional expression is either upregulated (ARG1, BCL2L1) or downregulated (MYC) several fold in vivo. These modifications were consistently detected across patients and further confirmed by quantitative real-time polymerase chain reaction (QRT-PCR); they were specifically significant toward the end of the radiotherapy treatment, 5 weeks following the first radiation fraction and more pronounced in endometrial patients (respectively, 2.9, 4.1, and 1.8 times). Importantly, in an attempt to correlate expression levels with normal tissue reaction to IR, we also identified three other genes CD40, OAS2, and CXCR1 whose expression level fluctuations during radiotherapy were more pronounced in patients developing late normal tissue responses to curative radiotherapy after the end of the radiotherapy treatment. Overall, we identified inflammation-associated genes which are promising biomarkers of IR exposure and susceptibility to radiation-induced toxicity.
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Affiliation(s)
- Grainne Manning
- Cancer Mechanisms and Biomarkers Group, Centre for Radiation, Chemical and Environmental Hazards, Radiation Effects Department, Public Health England, Oxfordshire, UK
| | - Aleš Tichý
- Department of Radiobiology, Faculty of Military Health Sciences in Hradec Králové, University of Defence, Brno, Czechia.,Biomedical Research Centre, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Igor Sirák
- Clinic of Oncology and Radiotherapy, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Christophe Badie
- Cancer Mechanisms and Biomarkers Group, Centre for Radiation, Chemical and Environmental Hazards, Radiation Effects Department, Public Health England, Oxfordshire, UK
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Laco J, Chmelařová M, Vošmiková H, Sieglová K, Bubancová I, Dundr P, Němejcová K, Michálek J, Čelakovský P, Mottl R, Sirák I, Vošmik M, Ryška A. SMARCB1/INI1-deficient sinonasal carcinoma shows methylation of RASSF1 gene: A clinicopathological, immunohistochemical and molecular genetic study of a recently described entity. Pathol Res Pract 2017; 213:133-142. [PMID: 28069272 DOI: 10.1016/j.prp.2016.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/02/2016] [Accepted: 10/21/2016] [Indexed: 02/06/2023]
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18
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Buka D, Dvořák J, Sitorová V, Hátlová J, Richter I, Sirák I. Changes in the CD8+ Density of Tumor Infi ltrating Lymphocytes after Neoadjuvant Radiochemotherapy in Patients with Rectal Adenocarcinoma. Klin Onkol 2016; 29:204-9. [DOI: 10.14735/amko2016204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hodek M, Sirák I, Ferko A, Örhalmi J, Hovorková E, Hadži Nikolov D, Paluska P, Kopecký J, Petera J, Vošmik M. Neoadjuvant chemoradiotherapy of rectal carcinoma : Baseline hematologic parameters influencing outcomes. Strahlenther Onkol 2016; 192:632-40. [PMID: 27272661 DOI: 10.1007/s00066-016-0988-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/27/2016] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The link between the blood count and a systemic inflammatory response (SIR) is indisputable and well described. Pretreatment hematological parameters may predict the overall clinical outcomes in many types of cancer. Thus, this study aims to systematically evaluate the relationship between baseline blood count levels and treatment response in rectal cancer patients treated with neoadjuvant chemoradiotherapy. PATIENTS AND METHODS From 2009-2015, 173 patients with locally advanced rectal cancer were retrospectively enrolled in the study and analyzed. The baseline blood count was recorded in all patients 1 week before chemoradiation. Tumor response was evaluated through pathologic findings. Blood count levels which included RBC (red blood cells), Hb (hemoglobin), PLT (platelet count), neutrophil count, WBC (white blood cells), NLR (neutrophil-to-lymphocyte ratio), and PLR (platelet-to-lymphocyte ratio) were analyzed in relation to tumor downstaging, pCR (pathologic complete response), OS (overall survival), and DFS (disease-free survival). RESULTS Hb levels were associated with a response in logistic regression analysis: pCR (p = 0.05; OR 1.04, 95 % CI 1.00-1.07); T downstaging (p = 0.006; OR 1.03, 95 % CI 1.01-1.05); N downstaging (p = 0.09; OR 1.02, 95 % CI 1.00-1.04); T or N downstaging (p = 0.007; OR 1.04, 95 % CI 1.01-1.07); T and N downstaging (p = 0.02; OR 1.02, 95 % CI 1.00-1.04); Hb and RBC were the most significant parameters influencing OS; PLT was a negative prognostic factor for OS and DFS (p = 0.008 for OS); an NLR value of 2.8 was associated with the greatest significance for OS (p = 0.03) and primary tumor downstaging (p = 0.02). CONCLUSION Knowledge of pretreatment hematological parameters appears to be an important prognostic factor in patients with rectal carcinoma.
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Affiliation(s)
- Miroslav Hodek
- Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Alexander Ferko
- Department of Surgery, University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Július Örhalmi
- Department of Surgery, University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Eva Hovorková
- Fingerland Department of Pathology, University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Dimitar Hadži Nikolov
- Fingerland Department of Pathology, University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Petr Paluska
- Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Jindřich Kopecký
- Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Jiří Petera
- Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Milan Vošmik
- Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic
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Beránek M, Sirák I, Vošmik M, Petera J, Drastíková M, Palička V. Carrier molecules and extraction of circulating tumor DNA for next generation sequencing in colorectal cancer. Acta Med (Hradec Kralove, Czech Repub ) 2016; 59:54-8. [PMID: 27526306 DOI: 10.14712/18059694.2016.54] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aims of the study were:i) to compare circulating tumor DNA (ctDNA) yields obtained by different manual extraction procedures,ii) to evaluate the addition of various carrier molecules into the plasma to improve ctDNA extraction recovery, andiii) to use next generation sequencing (NGS) technology to analyzeKRAS,BRAF, andNRASsomatic mutations in ctDNA from patients with metastatic colorectal cancer. Venous blood was obtained from patients who suffered from metastatic colorectal carcinoma. For plasma ctDNA extraction, the following carriers were tested: carrier RNA, polyadenylic acid, glycogen, linear acrylamide, yeast tRNA, salmon sperm DNA, and herring sperm DNA. Each extract was characterized by quantitative real-time PCR and next generation sequencing. The addition of polyadenylic acid had a significant positive effect on the amount of ctDNA eluted. The sequencing data revealed five cases of ctDNA mutated inKRASand one patient with aBRAFmutation. An agreement of 86% was found between tumor tissues and ctDNA. Testing somatic mutations in ctDNA seems to be a promising tool to monitor dynamically changing genotypes of tumor cells circulating in the body. The optimized process of ctDNA extraction should help to obtain more reliable sequencing data in patients with metastatic colorectal cancer.
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Chmelařová M, Sirák I, Mžik M, Sieglová K, Vošmiková H, Dundr P, Němejcová K, Michálek J, Vošmik M, Palička V, Laco J. Importance of Tumour Suppressor Gene Methylation in Sinonasal Carcinomas. Folia Biol (Praha) 2016; 62:110-119. [PMID: 27516190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Epigenetic changes are considered to be a frequent event during tumour development. Hypermethylation of promoter CpG islands represents an alternative mechanism for inactivation of tumour suppressor genes, DNA repair genes, cell cycle regulators and transcription factors. The aim of this study was to investigate promoter methylation of specific genes in samples of sinonasal carcinoma by comparison with normal sinonasal tissue. To search for epigenetic events we used methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) to compare the methylation status of 64 tissue samples of sinonasal carcinomas with 19 control samples. We also compared the human papilloma virus (HPV) status with DNA methylation. Using a 20% cut-off for methylation, we observed significantly higher methylation in RASSF1, CDH13, ESR1 and TP73 genes in the sinonasal cancer group compared with the control group. HPV positivity was found in 15/64 (23.4 %) of all samples in the carcinoma group and in no sample in the control group. No correlation was found between DNA methylation and HPV status. In conclusion, our study showed that there are significant differences in promoter methylation in the RASSF1, ESR 1, TP73 and CDH13 genes between sinonasal carcinoma and normal sinonasal tissue, suggesting the importance of epigenetic changes in these genes in carcinogenesis of the sinonasal area. These findings could be used as prognostic factors and may have implications for future individualised therapies based on epigenetic changes.
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Affiliation(s)
- M Chmelařová
- Institute for Clinical Biochemistry and Diagnostics, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
| | - I Sirák
- Department of Oncology and Radiotherapy, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
| | - M Mžik
- Institute for Clinical Biochemistry and Diagnostics, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
| | - K Sieglová
- The Fingerland Department of Pathology, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
| | - H Vošmiková
- The Fingerland Department of Pathology, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
| | - P Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - K Němejcová
- Institute of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - J Michálek
- Department of Clinical and Molecular Pathology, Palacký University Olomouc, Faculty of Medicine and Dentistry and University Hospital Olomouc, Czech Republic
| | - M Vošmik
- Department of Oncology and Radiotherapy, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
| | - V Palička
- Institute for Clinical Biochemistry and Diagnostics, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
| | - J Laco
- The Fingerland Department of Pathology, Charles University in Prague - Faculty of Medicine in Hradec Králové and University Hospital in Hradec Králové, Czech Republic
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Petera J, Dušek L, Sirák I, Soumarova R, Jarkovsky J. Cancer in the elderly in the Czech Republic. Eur J Cancer Care (Engl) 2015; 24:163-78. [DOI: 10.1111/ecc.12287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 12/26/2022]
Affiliation(s)
- J. Petera
- Department of Oncology and Radiotherapy; University Hospital and Medical Faculty; Hradec Kralove Czech Republic
| | - L. Dušek
- Institute of Biostatistics and Analyses; Masaryk University; Brno Czech Republic
| | - I. Sirák
- Department of Oncology and Radiotherapy; University Hospital; Hradec Kralove Czech Republic
| | - R. Soumarova
- Department of Radiotherapy and Oncology; Mendel Cancer Centre; Nový Jičín Czech Republic
| | - J. Jarkovsky
- Institute of Biostatistics and Analyses; Masaryk University; Brno Czech Republic
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Sirák I, Šinkorová Z, Šenkeříková M, Špaček J, Laco J, Vošmiková H, John S, Petera J. Hypersensitivity to chemoradiation in FANCA carrier with cervical carcinoma-A case report and review of the literature. Rep Pract Oncol Radiother 2014; 20:309-15. [PMID: 26109920 DOI: 10.1016/j.rpor.2014.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 08/08/2014] [Revised: 10/01/2014] [Accepted: 11/17/2014] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Compared to Fanconi anemia (FA) patients with homozygous defective two-alleles inheritance, there is a scarce or no evidence on one defective allele FANCA carriers, with respect to their cancer incidence, clinical and in vitro radiosensitivity and chemosensitivity. On that account, we report a case of a 30-year old FANCA mutation carrier woman with uterine cervix adenocarcinoma who was treated with chemoradiotherapy, in which unexpected acute toxicity and fatal late morbidity occured. METHODS We also report the results of an in vitro test for radiosensitivity, immunohistochemical examination with FANCA staining and human papillomavirus genotypization, and a review of the literature for FA carrier patients with respect to cancer incidence, clinical and in vitro response to chemo/radiotherapy, options of early heterozygosity detection, and methods of in vitro prediction of hypersensitivity to oncologic treatment. CONCLUSION Although there are no standard guidelines for management of FA carriers with malignancies and reports about chemo- or radiosensitivity in this population are scarce; patients with FA-A heterozygosity may have a high rate of complications from chemo/radiotherapy. Up to now, an optimum method for the prediction of radiosensitivity and the best parameter has not been found. Clinical radioresponsiveness is unpredictable in FA carriers and there is a pressing need of new rapid and predictive in vitro assays of radiation responses. Until then, the treatment of FA carriers with malignancies should be individualized, with respect to potential hypersensitivity to ionizing radiation or cross-linking agents.
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Affiliation(s)
- Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Sokolská 581, Hradec Kralove 500 05, Czech Republic
| | - Zuzana Šinkorová
- Department of Radiobiology, Faculty of Health Sciences, University of Defence in Brno, Sokolská 581, Hradec Kralove 500 05, Czech Republic
| | - Mária Šenkeříková
- Department of Medical Genetics, University Hospital Hradec Králové, Sokolská 581, Hradec Kralove 500 05, Czech Republic
| | - Jiří Špaček
- Department of Gynecology and Obstetrics, University Hospital Hradec Králové, Sokolská 581, Hradec Kralove 500 05, Czech Republic
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, Hradec Kralove 500 05, Czech Republic
| | - Hana Vošmiková
- The Fingerland Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, Hradec Kralove 500 05, Czech Republic
| | - Stanislav John
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Sokolská 581, Hradec Kralove 500 05, Czech Republic
| | - Jiří Petera
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Sokolská 581, Hradec Kralove 500 05, Czech Republic
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Richter I, Dvořák J, Blüml A, Cermáková E, Bartoš J, Urbanec M, Sitorová V, Ryška A, Sirák I, Buka D, Ferko A, Melichar B, Petera J. [Influence of preoperative chemoradiotherapy on changes of epidermal growth factor receptor expression in patients treated by preoperative chemoradiotherapy for local advanced rectal carcinoma]. Klin Onkol 2014; 27:361-6. [PMID: 25312714 DOI: 10.14735/amko2014361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The aim of this retrospective study was to determine the prognostic impact of expression of epidermal growth factor receptor (EGFR) changes during neoadjuvant chemoradiotherapy in patients with locally advanced rectal adenocarcinoma. MATERIAL AND METHODS One hundred and three patients with locally advanced rectal adenocarcinoma of stage II and III were evaluated. All patients were administered the total dose of 44 -- 50.4 Gy. Concomitantly, the patients received capecitabine in the dose 825 mg/ m² in two daily oral administrations or 5- fluorouracil in the dose 200 mg/ m² in continuous infusion. Surgery was indicated at intervals of 4-8 weeks from chemoradiotherapy completion. EGFR expression in the pretreatment biopsies and in resected specimens was assessed with immunohistochemistry. RESULTS All of 103 patients received radiotherapy without interruption up to the total planned dose. Downstaging was described in 64 patients. Six patients had complete pathologic remission. Recurrence occurred in 49 patients. Local recurrence was found in 22 patients, generalization of disease was reported in 27 patients. A total of 51 patients died. Increased EGFR expression was found in 26 patients. The statistically significantly shorter overall survival (p < 0.001) and disease-free survival (p < 0.001) was found in patients with increased expression of EGFR compared with patients where no increase in the expression of EGFR was observed during neoadjuvant chemoradiotherapy. CONCLUSIONS The overexpression of EGFR during neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma is associated with significant shorter overall survival and disease-free survival.
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Petera J, Sirák I, Laco J, Kašaová L, Tuček L, Doležalová H. High-dose-rate brachytherapy in early oral cancer with close or positive margins. Brachytherapy 2014; 14:77-83. [PMID: 25264037 DOI: 10.1016/j.brachy.2014.08.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 07/04/2014] [Revised: 08/08/2014] [Accepted: 08/22/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Retrospective evaluation of high-dose-rate brachytherapy (HDR BT) in early oral cancer and factors influencing tumor control. METHODS AND MATERIALS A total of 30 patients with T1-T3N0 tongue and floor of mouth cancer were treated with tumor excision±elective neck dissection and HDR BT 18×3 Gy b.i.d. The Kaplan-Meier model was used for survival analyses, and the log-rank test and Cox regression analyses were used to evaluate the influence of T-stage, histologic grade, resection margin, depth of invasion, and vascular endothelial growth factor (VEGF) intensity on local control (LC), nodal control (NC), disease-free survival (DFS), and overall survival (OS). Median followup was 40 months (6-145). RESULTS Actuarial 3-year LC, NC, DFS, DFS after salvage treatment, and OS were 85.4%, 69.2%, 65.4%, 75.6%, and 73.0%, respectively. The log-rank test and univariate Cox regression analysis revealed the following correlations, namely tumor grade correlated with LC, DFS, and OS; T-stage with NC and DFS; depth of invasion and VEGF intensity with NC, DFS, and OS. Associations detected on the multivariate analysis were as follows: tumor grade with LC, depth of invasion with NC, depth of invasion and tumor grade with DFS, and VEGF intensity with DFS after salvage treatment. Only one case of osteoradionecrosis and two cases of soft tissue necrosis occurred. CONSLUSION The HDR BT 18×3 Gy b.i.d. is a safe treatment of early oral cancer with a good LC. The T-stage, tumor grade, depth of invasion, and intensity of VEGF were significant predictors of locoregional control.
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Affiliation(s)
- Jiří Petera
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Linda Kašaová
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Luboš Tuček
- Department of Stomatosurgery, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Helena Doležalová
- Department of Stomatosurgery, University Hospital Hradec Králové, Hradec Králové, Czech Republic
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Sirák I, Hodek M, Petera J, Zoul Z, Vošmik M, Jansa J. [Radiotherapy in vulvar cancer treatment]. Ceska Gynekol 2013; 78:257-262. [PMID: 23869832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide an actual review of radiotherapy in the treatment of vulvar carcinoma. DESIGN A review article. SETTING Department of Oncology and Radiotherapy, University Hospital in Hradec Králové. METHODS A review article evaluating the application of ionizing radiation in the treatment of early and advanced vulvar carcinoma, based on the most significant previously published studies. CONCLUSION Postoperative groin irradiation in patients with positive groin lymph-nodes improves local control, time to progression, and overall survival; especially in 2 positive nodes and in N2/3 initial findings. In case of positive inguinal nodes, radiotherapy of both groins and at least lower pelvic iliac node-chains should follow. Adjuvant irradiation of the primary remains controversial, except for positive resection margins where radiotherapy improves overall survival. Concurrent chemoradiotherapy seems to be appropriate primary treatment of advanced vulvar carcinomas, in attempt to avoid mutilating intervention or exenteration. Chemoradiation should be followed by subsequent surgery, including potential groin dissection in case of lymph-node involvement. Definitive chemoradiotherapy is of limited evidence, and radical dose escalation to the gross tumor is essential for its implementation. Modern radiotherapy techniques, especially with intensity modulation, are convenient for dose escalation.
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Affiliation(s)
- I Sirák
- Klinika onkologie a radioterapie FN, Hradec Králové
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Petera J, Sirák I, Tuček L, Hodek M, Paluska P, Kašaová L, Paulíková S, Vošmik M, Doležalová H, Cvanova M, Halamka M, Laco J. Predicting factors for locoregional failure of high-dose-rate brachytherapy for early-stage oral cancer. Per Med 2012; 9:879-887. [PMID: 29776235 DOI: 10.2217/pme.12.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM Brachytherapy is an alternative to surgery in the treatment of the early stages of oral tongue cancer. The aim of this retrospective study was to analyze the clinical risk factors and possible candidate biomarkers of local and regional tumor control. PATIENTS & METHODS Twenty-four patients were treated between the years 2001 and 2010. Median follow-up was 37.4 months. Correlation between disease-free survival and clinical stage, tumor grade, resection margin, depth of invasion, and p16, EGF receptor, NF-κB, HIF-1α, HER2, Ku-80, COX-2 and VEGF expression was evaluated. RESULTS The estimated 5-year local control was 81% and locoregional control was 62%. Depth of tumor invasion (p = 0.018) and higher VEGF expression (p = 0.016) were significantly predictive for worse disease-free survival in Cox multivariate analysis. CONCLUSION Intensity of VEGF expression and depth of tumor invasion may be significantly negative predictors of disease-free survival in tongue cancer patients treated by brachytherapy alone. Predictive value of VEGF deserves evaluation in larger studies.
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Affiliation(s)
- Jiří Petera
- Department of Oncology & Radiotherapy, University Hospital Hradec Králové, Sokolska 581, 50005, Hradec Králové, Czech Republic.
| | - Igor Sirák
- Department of Oncology & Radiotherapy, University Hospital Hradec Králové, Sokolska 581, 50005, Hradec Králové, Czech Republic
| | - Luboš Tuček
- Department of Stomatology, University Hospital Hradec Králové, Czech Republic
| | - Miroslav Hodek
- Department of Oncology & Radiotherapy, University Hospital Hradec Králové, Sokolska 581, 50005, Hradec Králové, Czech Republic
| | - Petr Paluska
- Department of Oncology & Radiotherapy, University Hospital Hradec Králové, Sokolska 581, 50005, Hradec Králové, Czech Republic
| | - Linda Kašaová
- Department of Oncology & Radiotherapy, University Hospital Hradec Králové, Sokolska 581, 50005, Hradec Králové, Czech Republic
| | - Simona Paulíková
- Department of Oncology & Radiotherapy, University Hospital Hradec Králové, Sokolska 581, 50005, Hradec Králové, Czech Republic
| | - Milan Vošmik
- Department of Oncology & Radiotherapy, University Hospital Hradec Králové, Sokolska 581, 50005, Hradec Králové, Czech Republic
| | - Helena Doležalová
- Department of Stomatology, University Hospital Hradec Králové, Czech Republic
| | - Michaela Cvanova
- Institute of Biostatistics & Analyses, Masaryk University, Brno, Czech Republic
| | | | - Jan Laco
- Fingerland Department of Pathology, University Hospital Hradec Králové, Czech Republic
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Kasaová L, Sirák I, Jansa J, Paluska P, Petera J. Daily prostate volume and position monitoring using implanted gold markers and on-board imaging during radiotherapy. Acta Medica (Hradec Kralove) 2012; 54:149-52. [PMID: 22283108 DOI: 10.14712/18059694.2016.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to evaluate prostate volume changes and prostate motions during radiotherapy. METHODS In 2010, twenty-five patients were treated for prostate cancer by external beam radiotherapy with implanted fiducial markers. Coordinates of three gold markers on kilovoltage images were calculated daily. Volume changes in target structure were observed through changes in intermarker distances. Differences in patient position between laser-tattoo alignment and gold marker localization were evaluated. Intrafraction motion was assessed by measuring marker displacement on kilovoltage images acquired before and after fraction delivery. RESULTS Prostate shrinkage was observed in 60% of patients. The average shrinkage was 7% of the prostate's initial volume. Corrections after laser-tattoo alignment remained mostly below 1 cm. The difference between marker centroid position on the actual images and the planning images was 2 +/- 1 mm on average. The extension of intrafraction movements was 7.6 +/- 0.2 mm on average. CONCLUSIONS In our retrospective study, the possibility for prostate volume changes during radiotherapy was revealed. Intrafraction movements turned out to be the limiting factor in safety margin reduction.
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Affiliation(s)
- Linda Kasaová
- Department of Oncology and Radiotherapy, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic.
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Beránek M, Drastíková M, Paulíková S, Sirák I, Vosmik M, Petera J. Analysis of D1853N ATM polymorphism in radiosensitive patients with cervical carcinoma. Acta Medica (Hradec Kralove) 2012; 54:111-6. [PMID: 22250480 DOI: 10.14712/18059694.2016.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Clinical oncologists have been focusing their efforts on attempting to define risk groups of patients with unusual biological reactions to the recommended therapy regimens using molecular biology techniques. THE AIMS OF OUR STUDY WERE (i) to find a design and validate a method for fast and reliable analysis of the D1853N (5557G>A) genetic polymorphism in the ATM (ataxia-telangiectasia mutated) gene; (ii) to use side-directed mutagenesis to generate ATM 5557A-positive DNA (reference ATM5557A DNA); and (iii) to analyze a group of patients suffering from cervical carcinoma with adverse responses to radiotherapy. The 5557A variant was found in three of twenty women (15%). Our data show that the prevalence of the 5557A allelic variant in cervical cancer subjects with adverse responses after irradiation probably does not differ from the prevalence common in Caucasians. A larger population study should confirm these preliminary results.
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Affiliation(s)
- Martin Beránek
- Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic.
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Sirák I, Kacerovský M, Hodek M, Petera J, Špaček J, Kašaová L, Zoul Z, Vošmik M. Non-closure of peritoneum after abdominal hysterectomy for uterine carcinoma does not increase late intestinal radiation morbidity. Rep Pract Oncol Radiother 2012; 17:19-23. [DOI: 10.1016/j.rpor.2011.10.007] [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] [Received: 06/05/2011] [Revised: 08/07/2011] [Accepted: 10/11/2011] [Indexed: 10/14/2022] Open
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Jensen L, Mahantshetty U, Shi M, Albuquerque K, Sirák I, Pande S, Kim Y, Khorprasert C, Harris E, Igdem S. Survey of IMRT Practices in Centers Participating in the International Evaluation of Radiotherapy Technology Effectiveness in Cervical Cancer (IntERTECC) Trial. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tuček L, Petera J, Sirák I, Vošmik M, Doležalová H, Brokešová S, Hodek M, Kašaová L, Paluska P. Hyperfractionated high-dose rate brachytherapy in the treatment of oral tongue cancer. Rep Pract Oncol Radiother 2011; 16:243-7. [PMID: 24376988 DOI: 10.1016/j.rpor.2011.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 04/19/2011] [Revised: 06/09/2011] [Accepted: 07/11/2011] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Low-dose rate brachytherapy is a well established treatment modality of oral cancer. Data about high-dose rate (HDR) brachytherapy are still sparse with various fractionation schedules and heterogeneous results. AIM The aim of our retrospective study was to evaluate the results of HDR brachytherapy with doses of 3 Gy twice daily. PATIENTS AND METHODS Twenty patients with squamous cell tongue cancer were treated in the years 2001-2009 by exclusive HDR BT 18 × 3 Gy twice daily. The plastic tube technique was used. Median follow up was 47 months (7.8-118) since brachytherapy. RESULTS The local and locoregional control was 85% and 68%, respectively. Bone necrosis developed in one case treated without mandibular shielding and soft tissue necrosis in 2 cases. CONCLUSION It can be concluded that HDR brachytherapy with 18 × 3 Gy twice daily is safe with promising local control. The risk of nodal recurrences is substantial.
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Affiliation(s)
- Lubos Tuček
- Department of Stomatology, University Hospital, Hradec Králové, Czech Republic
| | - Jiri Petera
- Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Milan Vošmik
- Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Helena Doležalová
- Department of Stomatology, University Hospital, Hradec Králové, Czech Republic
| | - Simona Brokešová
- Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Miroslav Hodek
- Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Linda Kašaová
- Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Petr Paluska
- Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
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Petera J, Sirák I, Kašaová L, Mačingová Z, Paluska P, Zouhar M, Kutílek P, Brod'ák M, Vošmik M. High–dose rate brachytherapy in the treatment of penile carcinoma—First experience. Brachytherapy 2011; 10:136-40. [PMID: 20702142 DOI: 10.1016/j.brachy.2010.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 03/30/2010] [Accepted: 05/10/2010] [Indexed: 10/19/2022]
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Petera J, Kasaová L, Paluska P, Sirák I, Jansa J, Macingová Z, Dvorák J, Soumarova R. Intensity-modulated radiotherapy in the treatment of subhepatic carcinomas. Hepatogastroenterology 2011; 58:331-335. [PMID: 21661392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIMS The aim of our study was to evaluate preliminary results of intensity modulated radiotherapy (IMRT) in patients with inoperable subhepatic tumors. METHODOLOGY Thirteen patients with inoperable cholangiocarcinoma or gall bladder carcinoma were treated by biliary drainage and intensity modulated radiotherapy. In patients with tumors limited to the biliary duct only tumor stenosis was irradiated to the dose of 50-60 Gy. In patients with bulky extraductal tumors the dose was 50 Gy/25 fractions to the whole tumor and an integrated boost was used to raise the dose to the malignant stenosis to 60 Gy/25 fractions. RESULTS Doses to organs at risk (duodenum, small intestine, liver) were in tolerable limits. In four patients transient fever occurred; one patient had duodenal bleeding that resolved after conservative treatment. Recurrent dilatation of the biliary tract was observed in 4 patients and was managed by exchange of the internal biliary drainage. Median survival was 10.4 months, 5 patients survived for more than one year following diagnosis. CONCLUSIONS IMRT of inoperable extrahepatic biliary tract tumors allows application of high doses of radiation to the tumor with effective sparing of healthy tissues. The control of jaundice is good. In selected cases IMRT may prolong overall survival.
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Affiliation(s)
- Jirí Petera
- Department of Oncology and Radiotherapy, Charles University Medical School and University Hospital, Hradec Králové, Czech Republic.
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Sirák I, Kasaová L, Petera J, Vosmik M, Zoul Z. [Intensity modulated radiation therapy technique in the treatment of gynecologic malignancies]. Ceska Gynekol 2010; 75:177-181. [PMID: 20731296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE A description of intensity modulated radiation therapy (IMRT) technique and its implementation in the treatment of gynecologic malignancies. SUBJECT A review article. SETTING Department of Oncology and Radiotherapy, University Hospital in Hradec Králové. SUBJECT AND METHOD General explanation of IMRT priciples, its benefits and limitations, and a review of published data about its utilization in the treatment of endometrial, cervical, and vulvar carcinoma. CONCLUSION IMRT represents an accessible and highly conformal external beam radiothrapy technique, which enables a significant sparing of healthy tissue with consequent reduction of radiation morbidity in comparison with other conventional and conformal techniques. A feasibilty of dose excalation with preservation of low toxicity is another advandage of IMRT. It can be utilized in the treatment of most frequent gynecologic tumors, especially in endometrial, cervical, and vulvar carcinoma.
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Affiliation(s)
- I Sirák
- Klinika onkologie a radioterapie, Fakultní nemocnice Hradec Králové
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Petera J, Soumarová R, Růzicková J, Neumanová R, Dusek L, Sirák I, Macingová Z, Paluska P, Kasaová L, Hodek M, Vosmik M. Perioperative hyperfractionated high-dose rate brachytherapy for the treatment of soft tissue sarcomas: multicentric experience. Ann Surg Oncol 2010; 17:206-210. [PMID: 19711130 DOI: 10.1245/s10434-009-0684-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 08/07/2023]
Abstract
BACKGROUND Low-dose rate brachytherapy is a well-established adjuvant treatment for soft tissue sarcomas (STS). The experience with high-dose rate brachytherapy (HDR BT) in this indication is limited. The purpose of our study was to evaluate the viability of perioperative hyperfractionated HDR BT for STS. METHODS Forty-five patients with primary (17 cases) or recurrent (28 cases) STS were treated with resection and HDR BT between 1998 and 2007. Eleven patients were treated with HDR BT alone (mean dose 40 Gy; 30-54 Gy) and 34 were treated with a combination of HDR BT (mean dose 24 Gy; 15-30 Gy) and external beam radiotherapy (EBRT) (40-50 Gy). Hyperfractionation, 3 Gy twice daily, was used for HDR BT with plastic tubes. Adjuvant chemotherapy was indicated for patients with high risk of dissemination. RESULTS Local control (LC) was achieved in 17 patients (100%) treated for primary tumor and in 18 of 28 patients (64%) treated for recurrence; this difference was statistically significant (p = 0.004). Distant metastases occurred in seven patients (15.6%). The 5-year overall survival was 70%; the 5-year local control was 74%. LC was significantly better for extremities sarcomas in comparison with trunk tumors, for patients treated with EBRT and BT in comparison with BT alone, and for doses >65 Gy. CONCLUSIONS Our study suggests that perioperative HDR BT is a promising method for achieving high biological doses with good LC in the postoperative radiotherapy of STS and that combination of BT and EBRT provides better tumor control than BT alone.
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Affiliation(s)
- Jirí Petera
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
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Sirák I, Hatlová J, Petera J, Vosmik M, Ryska A, Vosmiková H. [Epidermal growth factor receptor and radiotherapy]. Klin Onkol 2008; 21:338-347. [PMID: 19382597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Epidermal growth factor receptor (EGFR) plays an important role in cell-cycle regulation, proliferation, differentiation, and surviving of epithelial tissues. Aberrant overexpression of EGFR can initiate uncontrolled cell proliferation with subsequent formation of epithelial carcinomas. Correlation between EGFR overexpression and increased resistance of tumor tissues to ionizing radiation has been described by many authors. Strategy of tumor radiosensitization by EGFR inhibition seems to have a great potential in the treatment of epithelial cancers. Rationale for EGFR inhibition in combination with ionizing radiaton arises from published results of many radiobiological studies, which describe the role of EGFR in cytoprotective and pro-proliferative reactions of human tumor cells, induced by irradiation. These reactions result in accelerated tumor repopulation, which is subsequently counter-productive to the effect of radiotherapy. Presented article is an overview of EGFR and its function in healthy and tumor tissues; likewise, it describes the relation of EGFR to ionizing radiation; therapeutic approaches to EGFR function modulation in combination with radiotherapy in preclinical and clinical use.
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Affiliation(s)
- I Sirák
- Klinika onkologie a radioterapie, Fakultní nemocnice v Hradci Králové, LF UK, Hradec Králové.
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Petera J, Odrázka K, Dolezel M, Zoul Z, Vaculíková M, Sefrová J, Sirák I. [Extended field radiotherapy and high-dose brachytherapy combined with chemotherapy in patients with locally advanced cervical carcinoma]. Ceska Gynekol 2007; 72:126-30. [PMID: 17639735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Evaluation of results of extended field radiotherapy and high-dose rate brachytherapy combined with chemotherapy in patients with locally advanced cervical carcinoma. TYPE OF THE STUDY A retrospective study. SETTING Department of Oncology and Radiotherapy, University Hospital Hradec Králové. METHODS Forty five patients with stage IIB - IVA cervical cancer and radiologically suspicious pelvic and/or paraaortic lymph nodes were treated at the Dept. of Oncology and Radiotherapy Hradec Králové with pelvic and paraaortic radiotherapy, high-dose rate brachytherapy and concomitant chemotherapy with cisplatin or cisplatin and paclitaxel. RESULTS The 3-years disease free survival estimate was 64%. Hematological toxicity was the most limiting factor of concomitant chemotherapy. Late toxicity grade III and IV was observed in 7 patients. One patient underwent surgery due to ileus caused by lymphoma. CONCLUSIONS Concomitant chemoradiotherapy with paraaortic fields results in high tumor control but also significant acute and late toxicity. New techniques of radiotherapy, such as intensity modulated radiotherapy, may improve the therapeutic ratio.
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Affiliation(s)
- J Petera
- Klinika onkologie a radioterapie, FN a LF Hradec Králové.
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Sirák I, Petera J, Odrázka K, Dolezel M, Zoul Z, Vaculíková M. [Chemotherapy intensity importance in concurrent chemoradiotherapy of locally advanced cervical cancer]. Ceska Gynekol 2006; 71:308-11. [PMID: 16956043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Concurrent chemoradiotherapy with weekly cisplatin became a standard procedure in patients with locally advanced cervical carcinoma. The objective of this retrospective study was to evaluate the therapy toleration and the survival of patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy with weekly cisplatin of 40mg/m2. SUBJECT AND METHOD From January 2000 to December 2004, 40 patients with locally advanced cervical cancer were treated with concurrent chemoradiotherapy with weekly cisplatin of 40mg/m2. Radical radiotherapy consisted of external beam radiotherapy 25 x 2 Gy to the pelvis, high-dose rate brachytherapy 6 x 4 Gy to the tumor, boost 7 x 2 Gy to the pelvic walls. 21 patients also recieved 22 x 2 Gy to the para-aortic lymphatic nodes. RESULTS Only 16 patients recieved full five doses of cisplatin. Causes of discontinuance of the chemotherapy: acute hematological toxicity with leukopenia (10), thrombocytopenia (1), anaemia (1), increased levels of creatinine (2), profuse vomiting (1), haematemesis (1). Stage dependent two-year overall survival (OS) was 72% (IIB) against 64% (III, IVA). Two-year disease-free survival (DFS) dependent on the number of cisplatin doses was 77% (> or = 3 doses) against 56% (<3 doses) in patients with IIB stage. CONCLUSION Acute hematological toxicity with leukopenia was the most frequent cause of discontinuance of the chemotherapy. The results of two-year OS and DFS show difference in dependence on the number of applied doses of chemotherapy. However, the difference was not significant due to a low number of patients subject to the study.
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Affiliation(s)
- I Sirák
- Klinika onkologie a radioterapie LF UK a FN, Hradec Králové
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