Background: A favourable dose distribution has been described for proton beam therapy (PBT) of anal cancer in dosimetric studies. The relationship between dosimetric parameters in bone marrow and haematologic toxicity, treatment interruptions, and treatment efficacy has also been documented. There are only few references on clinical results of PBT for anal cancer. The primary objective of the retrospective study was to assess the efficacy of pencil beam scanning intensity-modulated proton therapy (PBS IMPT) in the definitive chemoradiotherapy of anal cancer. Secondary objectives were established to identify the risks of acute chronic toxicity risks and to assess colostomy rates. Materials and methods: Patients were treated for biopsy-proven squamous cell cancer (SCC) of the anus at initial or advanced stages. Eligible patients received PBS IMPT at a single institution. Treatment was administered in two volumes: 1-tumour with margins plus involved lymph nodes; 2-regional lymph node groups: perirectal (mesorectal), obturatory, inguinal, internal, external, and common iliac. The total doses of 57.5 GyE and 45 GyE, respectively, were administered in volumes 1 and 2 in 25 fractions, 5 fractions per week, respectively (a simultaneous integrated boost). Concomitant chemotherapy cisplatinum (CDDP) plus 5-FU or CDDP plus capecitabine was administered as per protocol. The treatment effect was assessed using DRE (digital rectal examination) and MRI (magnetic resonance imaging) within the follow-up period. Toxicity was scaled using CTCAE version 4.0 criteria. Results: 39 of 41 patients treated during the period of February 2014-August 2021 were eligible for analysis. All patients completed treatment, 76.9% without interruption. The median treatment time was 35 days (32-35). The median follow-up period was 30 months, 34 patients are alive to-date, 5 patients died prior to the date of analysis, and 2 deaths were unrelated to the primary disease. The 2-year overall survival, relapse-free survival, and colostomy-free survival were 94.2%, 93.8%, and 91.0%, respectively. Complete regression was achieved in 36 patients (92.3%), partial regression was achieved in 2 (5.1%), and immediate progression at end of treatment occurred in 1 patient (2.6%). Salvage resection was indicated for two patients in partial regression and due to severe chronic dermatologic toxicity. The grade 3 and 4 haematological toxicity rates were 7.7% and 5.1%, respectively. The most frequent non-haematological acute toxicities of grade 3-4 observed were dermatitis (23.1%), diarrhoea (7.7%), and dehydration (7.7%). Chronic toxicity emerged predominantly as skin atrophy/ulceration grade 2 (26.5%) and grade 3-4 (5.8%), and radiation proctitis grade 2 (38.2%) and grade 3 (2.9%). Discussion, conclusions: This single-institution study showed the high efficacy of PBS IMPT, achieving a high rate of complete regression. The haematological acute toxicity of grade 3-4 remained low; however, the impact of altered chemotherapy (CDDP instead of mitomycin C) remains unclear. The incidence of other acute toxicities shares similarity with photon therapy investigated in large studies. The acute toxicity completely resolved in all patients, had no lethal outcomes, and never resulted in the necessity for colostomy. By contrast, it was chronic toxicity, skin ulceration, perirectal fistulation, and fibrosis that resulted in salvage surgery and/or the need for a colostomy. A challenging question remains: to what extent can PBT prevent chronic toxicity? Longer follow-up remains necessary.
- Publikační typ
- časopisecké články MeSH
- MeSH
- hepatocelulární karcinom * radioterapie MeSH
- lidé MeSH
- protonová terapie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
The immune synapse (IS) is a temporary interface between an antigen-presenting cell and an effector lymphocyte. Viral synapse is a molecularly organized cellular junction that is structurally similar to the IS. Primary cilium is considered as a functional homologue of the IS due to the morphological and functional similarities in architecture between both micotubule structures. It has been hypothesized that endogenous electromagnetic field in the cell is generated by a unique cooperating system between mitochondria and microtubules. We are extending this prior hypothesis of the endogenous electromagnetic field in the cell postulating that polarized centriole in immune and viral synapse could serve as a monopole antenna. This is an addition to our hypothesis that primary cilium could serve as a monopole antenna. We simulated the distribution of electric field of centriole of polarized centrosome as a monopole antenna in immune and viral synapse. Very weak electromagnetic field of polarized centriole of CD8+ T lymphocyte in IS can contribute to the transport of cytolytic granules into the attacked (cancer) cell. Analogically, very weak electromagnetic field of polarized centriole in viral synapse of infected CD4 cells can aid the transport of viruses (human immunodeficiency virus) to non-infected CD4 cells. We hypothesized that healthy organisms need these monopole antennas. If, during the neoplastic transformation, healthy cells lose monopole antennas in form of primary cilia, the IS aims to replace them by monopole antennas of polarized centrioles in IS to restore homeostasis.
- MeSH
- CD8-pozitivní T-lymfocyty imunologie MeSH
- centrioly genetika MeSH
- centrozom imunologie MeSH
- elektromagnetická pole MeSH
- imunitní systém * MeSH
- lidé MeSH
- mikrotubuly genetika metabolismus MeSH
- nádory genetika imunologie patologie MeSH
- polarita buněk genetika imunologie MeSH
- synapse genetika virologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- adjuvantní radioterapie metody využití MeSH
- Darierova nemoc * diagnóza terapie MeSH
- hormony terapeutické užití MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- mastektomie * metody využití MeSH
- nádory prsu * diagnóza farmakoterapie radioterapie MeSH
- sentinelová uzlina chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
- MeSH
- adenokarcinom diagnóza chirurgie MeSH
- dospělí MeSH
- katetrizační ablace metody využití MeSH
- kolorektální chirurgie metody využití MeSH
- kombinovaná farmakoterapie metody využití MeSH
- lidé MeSH
- lymfadenopatie farmakoterapie chirurgie MeSH
- metastázy nádorů farmakoterapie terapie MeSH
- monoklonální protilátky * aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- nádory jater farmakoterapie chirurgie sekundární MeSH
- nádory rekta * farmakoterapie chirurgie MeSH
- protokoly antitumorózní kombinované chemoterapie * terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
Pooperační radioterapie karcinomu prsu je jednou z nejčastějších indikací léčby zářením. Cílem ozařování je snížení rizika lokální recidivy a prodloužení celkového přežití. I tato léčba prochází svým vývojem, který je podmíněn zlepšováním technických možností radioterapie, a který je zaměřen na prospěch pro pacienta. Novými směry v radioterapii kacinomu prsu jsou například hypofrakcionace, akcelerované parciální ozáření prsu (APBI), ozáření protonovým svazkem a ozařování v hlubokém nádechu.
Postoperative radiotherapy of breast cancer is one of the most common indications of radiation therapy. The aim of irradiation isto reduce the risk of local recurrence and to prolong overall survival. Even this treatment goes through its development, which isconditioned by the improvement of the technical possibilities of radiotherapy, and which is aimed at the benefit to the patient.New directions in breast cancer radiotherapy include, for example, hypofractionation, accelerated partial breast irradiation (APBI),proton beam irradiation, and irradiation in deep respiratory breathold.
- Klíčová slova
- ozařování v hlubokém nádechu, akcelerovaná parciální radioterapie prsu,
- MeSH
- adjuvantní radioterapie * metody škodlivé účinky MeSH
- hypofrakcionace při ozařování MeSH
- kardiotoxicita MeSH
- lidé MeSH
- nádory prsu * chirurgie radioterapie MeSH
- nemoci srdce chemicky indukované MeSH
- plicní nemoci chemicky indukované MeSH
- protonová terapie MeSH
- sekundární prevence metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- diagnostické techniky a postupy MeSH
- diagnostické zobrazování metody MeSH
- lidé MeSH
- nádory dělohy diagnóza terapie MeSH
- nádory děložního čípku diagnóza terapie MeSH
- nádory vaginy diagnóza terapie MeSH
- nádory vaječníků diagnóza terapie MeSH
- nádory ženských pohlavních orgánů * diagnóza terapie MeSH
- prognóza MeSH
- protokoly protinádorové léčby MeSH
- trofoblastické nádory diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- diagnostické techniky a postupy MeSH
- lidé MeSH
- nádory hlavy a krku * diagnóza terapie MeSH
- protokoly protinádorové léčby MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
