[Treatment of seminoma I stage disease]

About 35% of men with malignant testicular germ cell cancer are diagnosed with seminoma, up to 80% of them with stage I disease. The number of men succesfully treated reaches 100%. For many years radiotherapy following radical orchiectomy was considered the golden standard for treatment. Treatment efficiency of radiotherapy is limited by it's late sequlae, notably gastrointestinal diseases, second cancer development, cardiovascular toxicity or infertility. Therefore there has been an effort made to minimalise this late toxicity--by radiation field reduction, radiation dose reduction, surveilance or chemotherapy with carboplatine as a single agent. According to available studies the efficiency of radiotherapy reduced either in field area or dose are as efficient as previously used radiation regimens and is as efficient as adjuvant chemotherapy with carboplatine. On the other hand the results of surveillance studies are comparable to those of active therapies, especially in patients with contra-indications to active treatment especially without prognostic risk factors, i.e. tumour size >4 cm, invasion to rete testis, pre-operative elevation of tumoru markers (beta HCG). All of the above described treatment modalities (adjuvant radiotherapy or chemotherapy and surveillance of patients without risk factors) reach comparable 5 years' survival from 93.1% in surveillance to 96% in patients after radiotherapy or chemotherapy. Nowadays, according to the new NCCN guidelines 2008, we have several options for management strategies for post--orchiectomy treatment, i.e., adjuvant radiotherapy, surveillance and newly also adjuvant carboplatine - based chemotherapy. In our review article we discuss advantages and disadvantages of the various treatment modalities.

[Effect of growth factor on the phenotype of subpopulations and on the kinetics of CD34+ cells in the peripheral blood and in grafts of peripheral stem cells in patients with non-Hodgkin's lymphoma indicated for autologous peripheral blood stem cell transplantation]

BACKGROUND

Peripheral blood stem cells are the preferred source for transplantation of hematopoiesis in patients with non-Hodgkin's lymphoma. Application of hematopoietic growth factors is a part of the mobilization chemotherapy regimen. Time overlap of the highest leukocyte and CD34+ cell count is required for optimal graft collection. Authors analyzed the effect of two growth factors (leridistim and filgrastim) on the kinetics and phenotype of CD34+ cells in patients with non-Hodgkin's lymphoma indicated for autologous peripheral blood stem cell transplantation.

METHODS AND RESULTS

Authors analyzed phenotype of CD34+ cell subpopulations and their kinetics in peripheral blood and leukapheresis products by flow cytometry during mobilization and graft collection. Statistically significant differences in expression of lineage-committed antigens between growth factors were found (CD3, CD5--T-lineage, CD56 NK-lineage, CD20 for B-lineage, p < 0.05), as well as for lineage non-specific antigens (CD38, p < 0.05 and CD54, p < 0.01). The most significant divergence was observed between CD34+CD19+ subpopulations of leridistim and filgrastim stimulated blood and graft (p < 0.001).

CONCLUSIONS

Expression of lineage-committed antigens on CD34+ subpopulations between two growth factors was statistically different. Kinetics of CD34+ cells during mobilization regimen with leridistim was not superior to filgrastim concerning the quality of graft.

[Treatment of non small cell lung cancer]

According to the recent data lung cancer in Czech republic is the most common malignancy in men (incidence 93/100 000) and is the leading cause of cancer death in men (mortality 90/100 000). In women is the incidence of lung cancer 30/100 000. Non-small-cell lung cancer (NSCLC) accounts for 70% to 75% of all lung cancers, while small-cell lung cancer (SCLC) accounts for 25% to 30% of cases. These two types of lung cance have a different biological characteristics which leads to a different approach in the treatment of NSCLC and SCLC. The treatment of NSCLC is based on clinical stage of disease and different treatment modalities alone or in combination are used: surgery, radiotherapy, chemotherapy and recently a novel treatment strategy--targeted therapy with biologic agents.

[Histiocytosis from Langerhans cell in adults--experience of one department and review of treatment alternatives]

Thirteen patients with Langerhans cell histiocytosis (LCH) have been treated in hospital Brno Masaryk University during the last 15 years. In 4 cases of this total amount, the diagnosis was made in childhood and these young adults were referred to our department from Pediatric cancer center. In 9 cases, the diagnosis has been made in people elder than 18 years. The disease recidived in 3 patients with LCH diagnosed in childhood, in one case with neurodegenerative impairment of brain. In 4 patients from the total of 9 with LCH diagnosed in age over 18 years, the disease had aggressive course with several recidives. In one case it was pulmonal and multifocal osseal manifestation, in two cases multifocal osseal disease. Isolated pulmonal form of LCH was diagnosed only in one patient. By the first patient, high dose melphalan and etoposide with peripheral blood stem cell transplantation was performed after failure ofvincristin and prednison therapy and failure of etoposide therapy. The first remission after this high dose therapy lasted only 2.5 years. For relapse second cycle of the same high dose therapy was administered, but the next remission was much shorter. By the two patients with multifocal recidives in bones 2-chlordeoxyadenosine was administered as initial therapy. These patients are followed up for more then 24 months and they are without relapse of this disease. The 2-chlordeoxyadenosine is very efficient in multifocal bone form of LCH and has potential to reach long remission. Therefore in a case of aggressive multifocal disease we would prefer 2-chlordeoxyadenosine therapy as therapy of the first choice.

[Density expression of the CD20 antigen on population of tumor cells in patients with chronic B-lymphocyte lymphoproliferative diseases]

BACKGROUND

Rituximab is being used successfully in the treatment of patients with chronic B-cell lymphoproliferative diseases. The success of treatment by rituximab is influenced, among other factors, by the antigen density on tumor cells. Therefore, the authors analyzed and compared the densities of the CD20 antigen in patients with chronic lymphoproliferative diseases.

METHODS AND RESULTS

Previously untreated patients with B-chronic lymphocytic leukemia (B-CLL), mantle-cell lymphoma (MCL), and small-cell lymphocytic lymphoma (SCLL) were evaluated by flow cytometry. The control group consisted of blood donors. The CD20 density was measured on tumor cell populations in patients and on the B-lymphocytes of the control group. The density was expressed in MESE In the patients with B-CLL and SCLL, the CD20 density was low (25,300 vs. 36,100 MESF) and it was significantly lower than in donors (172,800 MESF; p<0.001). The difference between B-CLL and SCLL patients was not statistically significant. The density in MCL patients (196,300 MESF) was comparable to that of donors.

CONCLUSIONS

We did not prove statistical different density of CD20 antigen in patients with SCLL when compared with B-CLL patients. High density in MCL patients may be helpful in differential diagnosis against B-CLL and

Neoadjuvant treatment for locally advanced rectal adenocarcinoma with concomitant radiotherapy and oral capecitabine

PURPOSE

Concomitant chemoradiotherapy prior to surgery of locally advanced rectal carcinoma (clinical T3- 4, and/or N+) might improve the therapeutic results. We report on our clinical experience with 34 patients receiving concurrent preoperative radiotherapy and capecitabine.

PATIENTS AND METHODS

Between September 2001 and March 2003, 34 patients with a median age of 62 years (range 18-75 years) were treated for adenocarcinoma of the rectum. Capecitabine was administered orally at a dose of 825 mg/m(2) twice-daily concomitantly every day during pelvic irradiation. The planned total dose of radiotherapy was 50.4 Gy, given with daily fractions of 1.8Gy, 5 days a week, over a period of about 5.5 weeks. Large pelvic dose (PTV-1) was 45.0 Gy/25 fractions in 5 weeks. Higher dose up to 50.4 Gy in further 3 fractions was given using boost fields (PTV-2). Radiotherapy was performed with high-energy photon beam (18 MV) linear accelerator using 3-dimensional (3D) treatment planning for 3 or 4 fields technique.

RESULTS

Toxicity was low: grade (G) 3 local dermatitis in 2 (6%), G3 diarrhea in 3 (9%) and G3 leucopenia in 1 (3%) patients. However, 2(6%) patients required drug dose reduction by 80%. Sphincter-sparing surgery was possible in 25 (76.5%) patients while 9 (26%) patients had radical surgery with removal of all macroscopic disease. Tumor mass downstaging by TNM criteria has been achieved in all of the treated patients. Pathological (p) complete response (CR) was verified in 7 (21%) patients and minimal microscopic residual cancer was found in 6 (17%) patients, for a total of 13 (38%) patients with substantial disease remission.

CONCLUSION

Preoperative concomitant radiotherapy and oral capecitabine chemotherapy for locally advanced rectal adenocarcinoma appears to be an effective and safe therapeutic choice, improving the chance for rectal-sparing surgery. The follow-up time is rather short to evaluate time to progression and survival.

[Chemoradiotherapy of non-small-cell bronchogenic carcinoma]

Lung cancer is the worldwide most widespread tumor disease with very poor prognosis. It is the most frequent cause of death on a malignancy. Surgery remains the treatment of choice, however, it can be applied to a small number of patients who are at the time of diagnosis in the operable stage. Chemoradiotherapy can be used either as an exclusive or as a neoadjuvant treatment. This paper reviews chemoradiotherapy regiments in those two clinical situations. With exclusive chemoradiotherapy, the concomitant scheme seems to be the most favourable.

[Concomitant radiochemotherapy in rectal tumors]

Requirements for improved cancer control led to the testing of the combined-modality therapy for many types of cancer. This review attempts to analyse possibilities of the simultaneous application of both strategies in the treatment of rectal cancer. Postoperative radiochemotherapy has been shown to be effective in rectum carcinomas. Preoperative combined-modality therapy can ensure downstaging (T3, T4). Operation was carried out 4 to 6 weeks after the end of preoperative therapy.

[Birth weight and gestational age in relation to risk factors of social conditions and health status]

BACKGROUND

The participants of European Longitudinal Study of Pregnancy and Childhood (ELSPAC) are women permanently resident in Brno, whose expected term of delivery corresponded with the prelimited period. In midpregnancy, 3327 of them filled in two research questionnaires with data concerning their marital status, health, education, dwelling, their up-bringing and stress in childhood as the essential information for the study of birth weight and gestational age variations of expected newborns.

METHODS AND RESULTS

Sharing the flat with the parental generation, heating with solid fuel or gas and more smokers at home meant the risk for antenatal development of foetus. A certain influence seemed to have the number of rooms, too. Education of the mother-to-be as well as that of her partner and partly of her mother, too, determined the birth weight. To a certain degree, partner's position in employment and his health status played also a role. An important factor predetermining the birth weight and gestational age was the marital status of the mother: in the best situation were children born in complete families and greatly handicapped were offsprings of single mothers not living with their partners.

CONCLUSIONS

Small influence on the prenatal development had the medical history of mothers, character of the upbringing in their original families and presence stressogenic events occurring in their girlhood up to 18 years of age.

[Birth weight and gestational age in relation to the course of pregnancy]

BACKGROUND

In midpregnancy, more than 3000 women in Brno filled in the questionnaires for the ELSPAC study. They informed of their health, activities, stress and psychological state during this pregnancy.

METHODS AND RESULTS

Out of medical documentation, the results from routine prenatal examinations were extracted and records concerning all disorders occurred during the gravidity. After delivery, information coming from both sources were linked to the birth weight (BW) and gestational age (GA) data of newborns and analysis of variance was performed. In statistically significant relations the differences were stated in BW (grams) and in GA (weeks) between the group means and sample means for boys, girls and all newborns together. BW, GA or both values were significantly lower after taking some medicaments, alcohol drinking, in offsprings of mothers who felt feeble around the quickening, who worked part time, who were in leading position in their employments, who experienced serious disease, who tempted a suicide, who worried that the foetus might be handicapped in any way and who did not take their future motherhood for a priority. Heavier were newborns of women who married during pregnancy and longer GA had children of those who took folic acid. The relation of neurotic symptoms to the outcome of pregnancy was not found and stressogenic events showed only a limited effect on it. A strong deficit in BW and GA followed after premature abruption of placenta, after eclampsia, placenta praevia, cervical cerclage, partus premature imminens, bleeding in the 2nd trimester, hypertension and hospitalization, namely when repeated. BW only was lower with IUGR, oligohydramnion, and higher BW followed after oedemas. GA only was affected in those whose mothers omitted the sonographic examination and who were obliged to have a special diet.

CONCLUSIONS

When newborns BWs were divided into 8 classes by 500 g and some maternal characters followed across the scale, significant trends were found in maternal heights, in all their weight indicators including maternal BW as well as in the weight gain in pregnancy, in the highest means found during pregnancy of systolic and diastolic blood pressures and in the lowest haemoglobin levels.

High dose rate intraluminal brachytherapy in the treatment of malignant airway obstructions

Endobronchial brachytherapy has been increasingly used in an effort to improve local control and relieve symptoms of malignant airway obstructions. Results of the high dose rate (HDR) intraluminal brachytherapy in 67 patients with inoperable endobronchial tumor treated by combination of teletherapy and brachytherapy with curative (group A ) or palliative (group B) intent, patients with recurrent tumors after previous radiotherapy treated by endobronchial brachytherapy alone (group C), and patients treated by brachytherapy without teletherapy (group D) are presented. Symptomatic improvement was achieved in 66%, 74%, 64% and bronchoscopic response in 70%, 85%, 78% of patients in groups A, B and C, respectively. Median survival was 365, 242 and 884 days from diagnosis and 245, 151 and 153 days from the first brachytherapy application in groups A, B and C, respectively. In group D complete bronchoscopic response was achieved in 3 of 4 patients with early tumor and partial response in 6 of 7 patients with advanced disease. We observed 4 acute and 9 late complications. Brachytherapy is an effective palliative treatment of malignant airway stenosis, but the effect on survival is not apparent.

[Concomitant radiochemotherapy in solid tumors]

The need for improved cancer control led to the investigation of combined-modality therapy for many cancers. This review is an attempt of analysis of possibilities to apply simultaneously both treatment modalities in treatment of cancer diseases and shows the possible mechanism of interaction between chemotherapy and radiotherapy. Further in this review is showed benefits of this method combined therapy and strategies of using chemotherapy and radiotherapy to treat different cancers.

Management of inoperable carcinoma of the breast by curative radiotherapy and chemo-hormonotherapy

BACKGROUND

The aim of this study was to evaluate local control and its relation to survival in patients with locally advanced breast cancer treated with curative irradiation and systemic therapy.

PATIENTS AND METHODS

240 patients with unresectable breast cancer were treated with curative radio- and chemo- or hormonotherapy from 1990-1995. The frequency of distant dissemination and the overall survival of patients with and without complete local control were compared.

RESULTS

Complete local control was achieved in 63% of patients. Complete local control correlated with decrease of distant metastases and increase of survival in comparison with patients without complete local control.

CONCLUSION

Radiotherapy without surgery provides insufficient local control in patients with locally advanced breast cancer. Complete local control is an important factor for prevention of distant dissemination and for survival.

Radiotherapy of early stages Hodgkin's disease. 10 years experience of the Masaryk Memorial Cancer Institute

Radiotherapy and chemotherapy, alone or in combination, are curative treatment methods in early stages of Hodgkin's disease (HD). The choice of treatment depends on the stage of the disease, histological type and localization of the tumor, as well as on other prognostic factors. A retrospective study was conducted including 145 patients with clinical Stages I and II of HD according to Ann Arbor classification, all treated in the Masaryk Memorial Cancer Institute in Brno during the years 1985 through 1994. 80 patients were males (55%) and 65 patients females (45%). The age of the patients ranged from 11 to 77 years, with an average of 34.8 years. 41 patients were diagnosed with Stage IA tumor, 1 patient with Stage IB, 75 patients with Stage IIA and 28 with Stage IIB disease. The histological types of the disease were lymphocyte predominant in 23 patients, nodular sclerosis in 49 patients, mixed cellularity in 65 cases and lymphocyte depletion in 8 cases. 91 patients were treated with radiotherapy alone. In this group 14 patients relapsed within the radiation field (15%) and 25 outside the radiation field (28%). 39 patients were treated with combination of radiotherapy and chemotherapy. In this group relapse occurred within the radiation field in 3 patients (8%) and outside the radiation field in 7 patients (18%). 15 patients were given chemotherapy alone, 7 patients from this group experienced a relapse. The five-year survival was 81% in patients with Stages IA and IIA disease, 65% in Stages IB and IIB disease. The five-year survival in the patients who relapsed was 56%. Radiotherapy remains the curative method of choice in highly selected group of patients with early stages of Hodgkin's disease. The results of radiotherapy alone are unsatisfactory in unselected clinical Stage I--II patients because of the presence of patients with adverse prognostic factors, particularly B symptomatology, mixed cellularity/lymphocyte depletion histology, higher age. These patients are candidates for combined treatment. Modern equipment and meticulous treatment are conditions crucial for the outcome of curative radiotherapy in patients with Hodgkin's disease. Combination chemotherapy is very effective in the treatment of relapse following the primary radiotherapy.

HDR intraluminal brachytherapy in the treatment of malignant bronchial obstructions

Symptomatology of malignant intrabronchial obstructions has a serious negative effect on the quality of patients' life. Intrabronchial brachytherapy can play an important role in the palliation of these symptoms. Between December 1996 and September 1998 48 patients suffering from malignant intrabronchial obstructions were treated with intraluminal brachytherapy in the Dept. of Radiation Oncology at the University Maternity Hospital in Brno. Gammamed HDR automatical afterloading equipment was used to treat all patients. The first group (23 patients) was treated with a combination of intraluminal brachytherapy and external radiotherapy. The second group (18 patients who had relapsed after previous external radiotherapy) was given intraluminal radiotherapy only. A third group (7 patients) underwent intraluminal brachytherapy only. In the first group 17 patients (77%) showed symptomatic relief with tumor regression on X-ray in 16 patients and with bronchoscopic regression in 19 patients. Seven patients died before October 1998 having survived 1-6 months after the first brachytherapy application. Sixteen patients are still alive (1-14 months). In the second group, 10 patients (56%) reported significant improvement of symptoms, with endoscopic regression in 12 patients. Twelve patients died before October 1998 surviving 1-6 months after the first brachytherapy session, 6 patients are still alive 1-5 months after the first brachytherapy fraction. In the third group, bronchoscopy confirmed a complete disappearance of intrabronchial lesion in two cases with early intrabronchial tumor. Five patients reported symptomatic improvement with endoscopic regression of the tumor. There was only one complication recorded: bronchospasm in one patient. The short follow up and limited number of patients does not allow comment on the late effects and survival, yet. In conclusion, intraluminal brachytherapy is an effective and safe approach for palliation of malignant bronchial obstructions.

[Therapeutic strategy in colorectal carcinoma]

The authors review the contemporary optimal approach in the treatment of colorectal carcinoma. They emphasize the necessity of a comprehensive therapeutic approach, i.e. a combination of surgery, radiotherapy and chemotherapy in the treatment of colorectal carcinoma. Possibilities of curative and palliative treatment are presented.

Urinary amylase isoenzymes and amylase polymorphism variants in families with diabetes mellitus type 1

Insulin-dependent diabetes mellitus type 1 is an autoimmune disease of pancreatic beta-cells with a certain genetic predisposition that is not yet clear. In spite of the confirmed association of diabetes mellitus type 1 with several HLA haplotypes it is considered that other loci must be involved for total genetic susceptibility to the disease. The relationship of insulin deficiency and decreased pancreatic amylase activity suggests that insulin itself is a direct activator of amylase gene expression. Endocrine pancreatic function was monitored by the indirect non-invasive method of urinary pancreatic amylase activity determination (expressed in percentage of total amylase activity) in diabetic children, their parents, healthy sisters and brothers, and in a separate group of women with diabetes type 1 of over 20 years duration. The incidence of hereditary amylase polymorphism variants in these subjects was also ascertained. Decreased pancreatic amylase activity in urine (under 58%) was found to be a characteristic trait in diabetics, and a susceptibility trait in asymptomatic family members. Normal pancreatic amylase activity (66.7 +/- 5.4%) is rare in diabetic patients type 1, but may be seen as a favourable prognostic trait, representing resistance to diabetic complications. The results support the suggestion that hereditary predisposition to the disease is inherited from the father rather than the mother, and that heterozygous amylase polymorphism variants protect their carriers against diabetes mellitus type 1.