PURPOSE: To evaluate the effectiveness and toxicity of curative (chemo)radiotherapy in patients with metastatic carcinoma to cervical lymph nodes from an unknown primary. METHODS: Retrospective study of 90 consecutive patients, treated with curative radiotherapy from 2003 to 2018 (median age 59 years; current/former smokers 76%) was conducted. The distribution of nodal staging was as follows: N1: 12%, N2a: 21%, N2b: 43%, N2c: 10%, N3: 13%. In 62% of patients, neck dissection was performed before radiotherapy. Concomitant chemotherapy was given to 64% of patients. RESULTS: The median follow-up of surviving patients was 86 months. The median total radiotherapy dose achieved was 70 Gy. The 5‐ and 10-year locoregional control were 84% in both cases, while 5‐ and 10-year distant control were 90% and 89%, respectively. A primary tumor in the head and neck area was detected in only 2 patients. No patient had an initial failure in the pharyngeal axis or contralateral cervical nodes. The 5‐ and 10-year overall survival were 55% and 42%, respectively. Severe early toxicity occurred in 71%; severe late toxicity in 33% of patients. Multivariate analysis demonstrated N‐status (hazard ratio [HR] 2.424; 95% confidence interval [CI] 1.121-5.241; p = 0.024) and comorbidity scores assessed by ACE-27 (Adult Comorbidity Evaluation; HR 3.058; 95% CI 1.489-6.281; p = 0.002) as two independent prognostic factors for overall survival. CONCLUSION: The results of our work study demonstrate the high effectiveness of curative (chemo)radiotherapy on the pharyngeal axis and bilateral cervical nodes with long-term locoregional and distant control in 3/4 of the treated patients. N‐status and comorbidity scores were shown as strong prognostic factors influencing overall survival.
- MeSH
- dospělí MeSH
- karcinom * patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické metastázy patologie MeSH
- lymfatické uzliny patologie MeSH
- nádory hlavy a krku * patologie MeSH
- nádory neznámé primární lokalizace * terapie patologie MeSH
- retrospektivní studie MeSH
- staging nádorů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND/AIM: To evaluate the effectiveness of curative (chemo)radiotherapy in patients with nasopharyngeal carcinoma and to identify prognostic factors influencing treatment outcomes. PATIENTS AND METHODS: We conducted a retrospective study of 73 consecutive patients, treated with definitive (chemo)radiotherapy from 2002 to 2019 (median stage III/IV 78%). The median total dose of radiotherapy achieved was 70 Gy. Concomitant chemotherapy was given to 82% of patients. RESULTS: The five- and ten-year locoregional controls were 73% and 72%, respectively; the five- and ten-year distant controls were 93% and 93%, respectively. The five- and ten-year overall survival rates were 46% and 34%, respectively. A multivariate analysis identified age, smoking, and the initial response to treatment as the strongest prognostic factors in predicting survival. CONCLUSION: Smoking ≤5 years before starting curative (chemo)radiotherapy for nasopharyngeal carcinoma was shown to be an independent negative prognostic factor for overall survival with a four-fold higher risk of death compared to non-smokers.
BACKGROUND: The objective was to evaluate the efficacy and toxicity of curative radiotherapy in patients with sinonasal carcinoma and to identify prognostic factors influencing treatment outcomes. MATERIALS AND METHODS: The authors conducted a retrospective study of 61 consecutive patients treated with postoperative or definitive radiotherapy from 2002 to 2018 (median age 59 years, current/former smokers 71%, maxillary sinus 67%, nasal cavity 26%). The majority of patients were diagnosed with locally advanced disease (85% clinical stage ≥ III). Regional cervical metastases were initially diagnosed in 23% of patients. The most common histology was squamous cell carcinoma (61%). Radiation therapy was preceded by radical surgery in 64% of patients. 29 patients received chemotherapy (48%). RESULTS: The median follow-up was 53 months. The median total dose of radiotherapy achieved was 70 Gy. The 5- and 10-year locoregional control, distant control, overall survival, and disease-free survival were 74% and 64%, 90% and 90%, 51% and 35%, and 38% and 25%, respectively. Severe acute toxicity occurred in 36%, severe late toxicity in 23% of patients. Severe unilateral visual impairment occurred in 6 patients, temporal lobe necrosis in 1 patient, and osteoradionecrosis requiring surgery in 2 patients. CONCLUSION: The results of the study demonstrated the high effectiveness of curative treatment in patients with sinonasal carcinoma with long-term locoregional and distant control. The multivariate analysis indicated that N-staging, age, comorbidity score [as assessed by Adult Comorbidity Evaluation 27 (ACE-27)] and initial response to treatment were the strongest prognostic factors.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Úvod: Audit je nezávislý dokumentovaný proces za účelem kontroly správnosti prováděných činností; má vést ke zvyšování kvality poskytované zdravotnické péče a k efektivnějším pracovním postupům. Rozlišují se dva základní typy auditů: interní, který se provádí v rámci organizace, a externí realizovaný akreditovanou firmou. Záměrem auditu je zajištění nezávislé zpětné vazby, prověření funkčnosti systému a analýza rizik. Postupy pro zajištění kvality v radioterapii včetně provádění auditů jsou definovány mezinárodní i českou legislativou - závazné jsou dokumenty mezinárodních organizací (IAEA, EURATOM, WHO) a tuzemská legislativa - Zákon o specifických zdravotních službách č. 373/2011 Sb., Národní radiologické standardy a další. Konkrétní forma interního klinického auditu je stanovena v rámci jednotlivých pracovišť. Cílem sdělení je prezentace vlastních zkušeností s interním klinickým auditem oddělení radioterapie Ústavu radiační onkologie 1. LF UK a FN Bulovka v Praze. Audit je prováděn ve čtyřech částech: radiační ochrana, lékařské postupy, fyzikálně-technická část a postupy radiologických asistentů.
Background: An audit is an independent documented process for checking the accuracy of the activities performed and is intended to increase the quality of provided healthcare and more efficient working procedures. There are two basic types of audits: internal, which is performed within the organization, and external, performed by an accredited company. The purpose of the audit is to provide independent feedback, verify the functionality of the system and analyse risks. Procedures for quality assurance in radiotherapy, including audits, are delineated by international and Czech legislation. The specific form of internal clinical audit is defined within individual departments. The aim of this contribution is to present our own experience with internal clinical audit at the radiotherapy department of the Institute of Radiation Oncology of the University Hospital Bulovka in Prague. The audit is performed in four parts: radiation protection, medical procedures, physical-technical part and procedures of radiation therapists.
BACKGROUND AND AIMS: We have recently shown that an Arabidopsis thaliana double mutant of type III phosphatidylinositol-4-kinases (PI4Ks), pi4kβ1β2, constitutively accumulated a high level of salicylic acid (SA). By crossing this pi4kβ1β2 double mutant with mutants impaired in SA synthesis (such as sid2 impaired in isochorismate synthase) or transduction, we demonstrated that the high SA level was responsible for the dwarfism phenotype of the double mutant. Here we aimed to distinguish between the SA-dependent and SA-independent effects triggered by the deficiency in PI4Kβ1 and PI4Kβ2. METHODS: To achieve this we used the sid2pi4kβ1β2 triple mutant. High-throughput analyses of phytohormones were performed on this mutant together with pi4kβ1β2 and sid2 mutants and wild-type plants. Responses to pathogens, namely Hyaloperonospora arabidopsidis, Pseudomonas syringae and Botrytis cinerea, and also to the non-host fungus Blumeria graminis, were also determined. Callose accumulation was monitored in response to flagellin. KEY RESULTS: We show here the prominent role of high SA levels in influencing the concentration of many other tested phytohormones, including abscisic acid and its derivatives, the aspartate-conjugated form of indole-3-acetic acid and some cytokinins such as cis-zeatin. We show that the increased resistance of pi4kβ1β2 plants to the host pathogens H. arabidopsidis, P. syringae pv. tomato DC3000 and Bothrytis cinerea is dependent on accumulation of high SA levels. In contrast, accumulation of callose in pi4kβ1β2 after flagellin treatment was independent of SA. Concerning the response to Blumeria graminis, both callose accumulation and fungal penetration were enhanced in the pi4kβ1β2 double mutant compared to wild-type plants. Both of these processes occurred in an SA-independent manner. CONCLUSIONS: Our data extensively illustrate the influence of SA on other phytohormone levels. The sid2pi4kβ1β2 triple mutant revealed the role of PI4Kβ1/β2 per se, thus showing the importance of these enzymes in plant defence responses.
Naším hlavním cílem bylo prozkoumat v animálním modelu u potkana akutní účinky delta-9-tetrahydrokanabinolu (THC) na lokomocní aktivitu (test otevřeného pole) a senzorimotorické zpracování informací (prepulzní inhibice akustické úlekové reakce, PPI ASR). Smyslem experimentu bylo zjistit, zda akutní účinky THC mohou indukovat psychóze podobné chování. V našich experimentech jsme prokázali, že THC u potkanů narušilo normální chování v testu otevřeného pole a současně vedlo k narušení PPI ASR. Vzhledem k podobnosti těchto nálezů s nálezy u schizofrenních pacientů a v jiných modelech psychóz tyto výsledky podporují relevanci akutních účinků THC jako modelu psychózy.
Our main aim was to examine the effect of acute administration of delta-9-tetrahydrocannabinol (THC) on locomotor activity (open field test) and sensorimotor gating (prepulse inhibition of acoustic startle reaction, PPI ASR) in animal model in rats. The purpose of the experiment was to determine whether acute effects of THC administra- tion can induce psychosis-like behavior. Our experiments showed that THC altered normal behavior in the open field test and at the same time it disrupted PPI ASR. When we take into consideration the resemblance of these findings to the data acquired from schizophrenic patients and other models of psychosis these results support the relevancy of acute effects of THC as a model of psychosis.
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- anestezie MeSH
- dospělí MeSH
- karcinom chirurgie MeSH
- laparoskopie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita diagnóza chirurgie komplikace MeSH
- nádory ženských pohlavních orgánů chirurgie MeSH
- pooperační komplikace MeSH
- předoperační péče MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
