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
- Klíčová slova
- paliativní radioterapie,
- MeSH
- lidé MeSH
- metastázy nádorů MeSH
- nádory kostí * radioterapie MeSH
- nádory močového měchýře * radioterapie MeSH
- radioterapie metody MeSH
- senioři nad 80 let MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: The Czech Republic has reported one of the highest incidence rates of cutaneous melanoma (CM) in Europe and the rate continues to rise. Our study undertook a detailed investigation of the incidence and mortality of melanoma relative to sex, age and disease stage. The main goals were to elucidate the causes of the rising trends and explain the differences in development relative to sex, age and disease stage. METHODS AND RESULTS: The estimated annual percentage change (EAPC) using the Joinpoint Regression Model was calculated separately for men and women for all age categories and for all T stages of TNM classification. The EAPC for women was slightly higher than for men. This was only found in melanomas thinner than 1 mm (T1). For all other stages (T2, T3 and T4) the situation was worse in men. A higher incidence rate of CM and the higher value of EAPC were found for women in younger age categories (up to 49 years). In the next age category, from 50 to 59 years, the incidence of CM was comparable in both sexes as well as the EAPC. In the older age categories, i.e. 60 years and older, a significant increase was found predominantly in men. The mortality rates were only comparable between men and women in the 20 to 29 year age group. In all other categories there was a higher mortality for men. CONCLUSIONS: The number of melanoma cases in the Czech Republic is increasing faster than any other cancer. Despite improved survival rates, the death rate from CM continues to climb as a result of exponential increases in incidence. Thus primary and secondary prevention campaigns are essential for future reductions in CM incidence and mortality in the Czech Republic.
- MeSH
- dospělí MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanom mortalita patologie MeSH
- míra přežití MeSH
- nádory kůže mortalita patologie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- staging nádorů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Klíčová slova
- 13-C-methacetin, infračervená spektroskopie, transmitance, absorbance, kumulovaná dávka,
- MeSH
- acetamidy * diagnostické užití chemie MeSH
- analýza rozptylu MeSH
- dechové testy * metody přístrojové vybavení MeSH
- dospělí MeSH
- jaterní cirhóza * MeSH
- jaterní testy * MeSH
- játra patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- ROC křivka MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- spektrofotometrie infračervená metody přístrojové vybavení MeSH
- srdeční selhání MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
V práci je uveden krátký přehled statistických metod používaných v klinické a experimentální medicíně, a to od základních ukazatelů a parametrů popisné statistiky, přes testování hypotéz (parametrické i neparametrické metody), až po popis nejčastěji používané mnohorozměrné metody v lékařských vědeckých publikacích, po logistickou regresi. Je také představena analýza hlavních komponent, která je jednou z metod používaných ke snížení dimenze úlohy čili k redukci počtu vstupních nezávislých proměnných. Správné použití statistických metod je demonstrováno na konkrétních klinických případech a výsledcích.
The paper presents a brief overview of statistical methods used in clinical and experimental medicine, ranging from basic indicators and parameters of descriptive statistics and hypotheses testing (parametric as well as non-parametric methods) to a description of the most frequently used multivariate methods in medical scientific publications, to logistic regression. The paper also describes Principle Component Analysis (PCA), which is one of the methods used to decrease a data dimensionality. The proper use of statistical methods is demonstrated on specific clinical cases.
- Klíčová slova
- průměr, medián, t-test, Mannův-Whitneyův U-test, ANOVA, Kruskal-Wallisova ANOVA, Pearsonův χ2-test, logistické regrese,
- MeSH
- analýza hlavních komponent MeSH
- interpretace statistických dat MeSH
- klinické lékařství statistika a číselné údaje MeSH
- statistika jako téma MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- finanční podpora výzkumu jako téma MeSH
- glukosa metabolismus MeSH
- hypertriglyceridemie genetika metabolismus patologie MeSH
- inzulinová rezistence MeSH
- krysa rodu rattus MeSH
- modely nemocí na zvířatech MeSH
- nenasycené mastné kyseliny MeSH
- rybí oleje terapeutické užití MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
