PURPOSE: MRI-only adaptive brachytherapy (MRI-ABT) is the state-of-the-art for treating locally advanced cervical cancer (LACC) in combination with concurrent chemoradiotherapy. We aimed to evaluate the pattern of pelvic recurrence after the treatment. MATERIAL AND METHODS: A total of one hundred LACC patients were treated between January 2017 and December 2023 with concurrent chemoradiotherapy of 45 Gy in 25 fractions ± boost to lymphadenopathy (up to a maximum dose of 60 Gy in 25 fractions) with concurrent weekly cisplatin chemotherapy at the dose of 40 mg/m2/week, and MR-ABT. RESULTS: At a median follow-up of 30.2 months, there were 2 local recurrences (2%) and 9 regional pelvic recurrences (9%). The median time to local/regional recurrence was 11 months (range 6-21). For all stages, the 3-year local control was 97.66%, and the 3-year pelvic control was 89.45%. Twenty-four patients died during follow-up; the 3-year overall survival was 75.11%, and the 3-year disease-free survival was 70.97%. CONCLUSION: MRI-ABT combined with external beam radiotherapy and concurrent chemotherapy for LACC demonstrates excellent local and regional pelvic control. Most local/regional recurrences occur inside or at the edge of the external-beam irradiated field. Recurrences inside the field of brachytherapy are rare. Distant recurrences are the predominant cause of death in LACC patients treated with definitive CRT and MRI-ABT.

• Klíčová slova
• Adaptive brachytherapy, Cervical cancer, MRI-only brachytherapy, Recurrence,
• MeSH
• brachyterapie * metody   MeSH
• chemoradioterapie metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru * MeSH
• magnetická rezonanční tomografie * metody   MeSH
• nádory děložního čípku * patologie   radioterapie   diagnostické zobrazování   terapie   mortalita   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: It is hypothesized that systemically administered antibiotics penetrate wound sites more effectively during negative pressure wound therapy (NPWT). However, there is a lack of clinical data from patients who receive NPWT for deep sternal wound infection (DSWI) after open-heart surgery. Here, we evaluated vancomycin penetration into exudate in this patient group. PATIENTS AND METHODS: For this prospective observational study, we enrolled 10 consecutive patients treated with NPWT for post-sternotomy DSWI. On the first sampling day, serum and exudate samples were synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3 and 6 h after vancomycin administration. On the following three consecutive days, additional samples were collected, only before vancomycin administration. RESULTS: The ratio of average vancomycin concentration in wound exudate to in serum was higher for free (unbound) (1.51 ± 0.53) than for total (bound + unbound) (0.91 ± 0.29) concentration (p = 0.049). The percentage of free vancomycin was higher in wound exudate than serum (0.79 ± 0.19 vs. 0.46 ± 0.16; p = 0.04). Good vancomycin wound penetration was maintained on the following three days (vancomycin trough exudate-to-serum concentration ratio > 1). The total hospital stay was significantly longer in patients with DSWI (46 ± 11.6 days) versus without DSWI (14 ± 11.7 days) (p < 0.001). There was no in-hospital or 90-day mortality. Two patients experienced late DSWI recurrence. All-cause mortality was 4.8% during a median follow-up of 2.5 years. CONCLUSION: Vancomycin effectively penetrates wound exudate in patients receiving NPWT for DSWI after open-heart surgery.The protocol for this study was registered at ClinicalTrials.gov on July 16, 2024 (NCT06506032).

Vancomycin effectively penetrates into wound exudate in patients receiving NPWT to treat post-sternotomy DSWI after open-heart surgery.NPWT promotes the penetration of vancomycin into the infection site.

• Klíčová slova
• Deep sternal wound infection, exudate, negative pressure wound therapy, open-heart surgery, vancomycin, wound penetration,
• MeSH
• antibakteriální látky * farmakokinetika   aplikace a dávkování   MeSH
• exsudáty a transsudáty metabolismus   mikrobiologie   MeSH
• infekce chirurgické rány * MeSH
• kardiochirurgické výkony * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• sternotomie * škodlivé účinky   MeSH
• sternum chirurgie   MeSH
• terapie ran pomocí řízeného podtlaku * metody   MeSH
• vankomycin * aplikace a dávkování   farmakokinetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• antibakteriální látky * MeSH
• vankomycin * MeSH

OBJECTIVES: The incidence of oral and oropharyngeal cancer is continually rising and affects increasingly younger patients. Consequently, many studies focus on early diagnosis using appropriate biomarkers. Neopterin and interleukin-6 (IL-6) are promising predictive and prognostic markers of immune response activation, both systemic and local, due to the anatomical proximity of malignancies to the salivary glands. MATERIAL AND METHODS: We collected oral fluid samples from 50 patients before and after the surgical resection of squamous cell carcinoma of the oral cavity and oropharynx. Additionally, blood samples were withdrawn from 20 of these patients and levels of neopterin and IL-6 were estimated using ELISA commercial kits. All gathered data were subsequently statistically analyzed for evaluation and compared to values from a control group of healthy individuals. RESULTS: In patients with oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC), there was a significant decrease in neopterin and IL-6 levels in saliva following the surgical removal of the malignancy. These postoperative levels approached those of the control group. There was no significant decrease in neopterin and IL-6 levels in plasma. CONCLUSION: Detection of neopterin and IL-6 in saliva is a reliable diagnostic method for early detection of OSCC and its recurrence, as well as for monitoring therapeutic success, compared to plasma. Neopterin and IL-6 appear to be promising prognostic and predictive markers of the disease.

• Klíčová slova
• interleukin‐6, neopterin, squamous cell carcinoma of head and neck,
• MeSH
• dospělí MeSH
• interleukin-6 * krev   analýza   metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádorové biomarkery * krev   analýza   metabolismus   MeSH
• nádory orofaryngu * krev   metabolismus   chirurgie   diagnóza   MeSH
• nádory úst * krev   metabolismus   chirurgie   diagnóza   MeSH
• neopterin * krev   analýza   metabolismus   MeSH
• prospektivní studie MeSH
• senioři MeSH
• sliny * chemie   metabolismus   MeSH
• spinocelulární karcinom * krev   chirurgie   metabolismus   diagnóza   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• IL6 protein, human MeSH Prohlížeč
• interleukin-6 * MeSH
• nádorové biomarkery * MeSH
• neopterin * MeSH

Giant cell tumor of bone (GCTB) is an intermediate locally aggressive osteolytic tumor with low metastatic potential and a high recurrence rate. It comprises two main types of cells-neoplastic mononuclear stromal cells and osteoclast-like giant cells-which are responsible for the resorption of bone. In addition to surgery, which is the primary treatment of choice, adjuvant therapy is used to lower the risk of recurrence. However, denosumab, the standard adjuvant treatment currently used, only targets osteoclast-like giant cells and does not affect neoplastic stromal cells. Since some GCTBs are inoperable, or even after surgery, there can be residual tumor cells at the site of the tumor, novel therapies, especially those that target neoplastic stromal cells, are needed. Both cell types in GCTB show altered expression of various specific genes and molecules, and these deregulated molecular profiles could serve as biomarkers and targets for targeted therapy. Herein, we summarize the potential biomarkers for both cell types in GCTB and therapeutic agents targeting these molecules with the hope of finding a therapy with improved outcomes and a lower risk of recurrence.

• Klíčová slova
• Biomarkers, Giant cell tumor of bone, Neoplastic stromal cells, Osteoclast-like giant cells, Targeted therapy,
• MeSH
• cílená molekulární terapie * MeSH
• lidé MeSH
• nádorové biomarkery * metabolismus   MeSH
• nádory kostí * metabolismus   farmakoterapie   terapie   patologie   MeSH
• obrovskobuněčný nádor kosti * metabolismus   farmakoterapie   terapie   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• nádorové biomarkery * MeSH

BACKGROUND: Whether the number or cumulative volume of brain metastases affects survival in patients with metastatic non-small cell lung cancer (NSCLC) remains controversial. We conducted a volume matched multi-center study to determine whether patients with a single metastasis had better outcomes than patients with > 20 brain metastases. METHODS: Between 2014 and 2022, 317 NSCLC patients (21.14% female; single tumor: 278 patients; >20 tumors, 39 patients) underwent stereotactic radiosurgery (SRS). The prescribed margin dose, cumulative tumor volume, 12 Gy volume, and concurrent systematic disease managements were recorded. The overall survival (OS), local tumor control (LTC), adverse radiation effect (ARE) risk, and new tumor development were compared. RESULTS: No difference in OS was found between patients with > 20 brain metastases and patients with a single metastasis (p = 0.61). Compared to the single tumor cohort, where 217 of 278 (78.06%) patients had no recorded local tumor progression, patients with > 20 brain metastases had a local tumor control rate of 76.92% (p = 0.25). Patients with > 20 tumors had a significantly higher rate of distant tumor development (69.2%) after SRS compared to patients with single tumors (35.3%; **p = 0.024). No significant difference of ARE rate was found. CONCLUSION: In this volume matched multi-center study, patients with > 20 tumors showed comparable OS and LTC outcomes compared to patients with single tumors. The number of brain metastases should not be used as a criteria to exclude patients from receiving SRS.

• Klíčová slova
• Adverse radiation effects, Non-small cell lung cancer, Stereotactic radiosurgery,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory mozku * sekundární   chirurgie   radioterapie   mortalita   MeSH
• nádory plic * patologie   mortalita   MeSH
• následné studie MeSH
• nemalobuněčný karcinom plic * patologie   radioterapie   mortalita   chirurgie   MeSH
• radiochirurgie * MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie 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
• multicentrická studie MeSH
• srovnávací studie MeSH

INTRODUCTION: Electrical cardioversion (ECV) remains a treatment option for atrial fibrillation (AF). The study aimed to find predictors of SR maintenance after ECV using spectral and vector cardiographic (VCG) analysis of ECGs. METHODS: Consecutive patients with AF referred for elective ECV were prospectively enrolled. A digital ECG recording was obtained before the ECV and was analyzed using spectral and VCG analysis. AF activity was analyzed using spectral analysis to determine the dominant frequency (DF), RI (regularity index), and OI (organizational index). QRS complexes were analyzed using vectorcardiography to determine the dXmean, dYmean, and dZmean (derivation of VCG signals). We used Lasso Logistic Regression (LLR) in five-fold cross-validation for feature selection and to build combined predictive models of SR maintenance. For model training and evaluation, data were split in a 60%-40% ratio for training and testing, respectively. RESULTS: A total of 80 patients were enrolled (age 70.2 ± 10.6 years, 49 (61%) were men, BMI 29.7 kg/m2). At the 3-month follow-up, AF recurrence was present in 36 patients (45%). The best single VCG parameter to predict SR maintenance was dZMean (OR 0.18, 95% CI 0.06-0.51, p < 0.001). VCG-domain parameters combined into the LLR model showed an area under the curve (AUC) of 0.78. From the spectral analysis domain, the best predictor was DF (OR 3.54, 95% CI 1.28-10.25), p = 0.006; spectral features led to an AUC of 0.76 when combined in the LLR model. Clinical features did not form a model since no features passed feature selection. Combining VCG and spectral analysis features led to an LLR model with an AUC of 0.79. CONCLUSION: The combination of spectral analysis of AF activity and VCG analysis of ventricular activity provided more accurate predictive information than either analysis alone.

• Klíčová slova
• atrial fibrillation, electrical cardioversion, prediction of sinus rhythm, spectral and vectorcardiographic analysis,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: In oral squamous cell carcinoma (OSCC), the current staging system fails to reliably identify high-risk patients, and potential biomarkers improving the prognostic, and predictive stratification of OSCC are sought. Due to the importance of tumor immune microenvironment in the development and progression of cancer, here we investigated the prognostic impact of immune phenotypes in OSCC. METHODS: The study included 119 OSCC patients treated by curative surgery. Based on the extent and spatial distribution of TILs in hematoxylin and eosin-staining, the tumors were classified as immune-excluded, immune-inflamed, and immune-desert. The prognostic significance and clinicopathological correlations of immune phenotypes were investigated, immunohistochemically detected PD-L1 expression levels were correlated with immune phenotypes. RESULTS: Immune-desert and immune-inflamed phenotypes significantly correlated with lymph node metastasis, higher stage, grade, and perineural invasion. A higher incidence of local recurrence was demonstrated in patients with immune-inflamed phenotype. PD-L1 expression levels correlated with immune phenotypes, with the highest expression levels in inflamed tumors. In Kaplan-Meier analysis, inferior survival rates were demonstrated in immune-desert and immune-inflamed OSCC (p < 0.0001). Cox regression showed an independent negative prognostic impact of both immune-inflamed and immune-desert phenotypes on disease-free (HR 5.327 and 4.256, respectively), disease-specific (HR 12.09 and 4.337), and overall survival (HR 4.502 and 4.300). CONCLUSIONS: Our findings support that the histological evaluation of tumor immune phenotype might provide significant information on OSCC hazard discrimination, prognostication, and treatment decisions. The study identified immune-desert and immune-inflamed OSCC phenotypes associated with worse prognosis reflecting the lack of pre-existing anti-tumor immunity or immunosuppressive tumor immune microenvironment.

• Klíčová slova
• Histopathology, Immune phenotype, Oral squamous cell carcinoma, PD-L1, Prognosis,
• MeSH
• antigeny CD274 metabolismus   MeSH
• dospělí MeSH
• fenotyp MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádorové biomarkery MeSH
• nádorové mikroprostředí imunologie   MeSH
• nádory úst * imunologie   patologie   mortalita   MeSH
• prognóza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spinocelulární karcinom * imunologie   patologie   MeSH
• tumor infiltrující lymfocyty imunologie   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
• Názvy látek
• antigeny CD274 MeSH
• CD274 protein, human MeSH Prohlížeč
• nádorové biomarkery MeSH

PURPOSE: Herein, we report a rare case of recurrent hematocornea due to a non-pigmented adenoma of the ciliary body and its successful management with repeated deep anterior lamellar keratoplasty (DALK). OBSERVATIONS: A 27-year-old man presented with significant visual acuity loss in his only functional eye due to hematocornea. Initial management involved visco-DALK, which restored visual acuity to 0.8. After 6 months, recurrent hematocornea prompted the removal of the underlying neoplasm through a scleral approach, which was histologically confirmed as a non-pigmented adenoma of the ciliary body. A repeat DALK was performed, followed by phacoemulsification with intraocular lens implantation for subsequent cataract development. Postoperative recovery was uneventful, and visual acuity stabilized at 0.8. CONCLUSIONS AND IMPORTANCE: This case highlights the feasibility and efficacy of visco-DALK in managing hematocornea while preserving endothelial integrity. The approach facilitated subsequent interventions, including neoplasm excision, repeat DALK, and cataract surgery, with favorable visual outcomes.

• Klíčová slova
• Adenoma of the ciliary body, Corneal neovascularization, Deep anterior lamellar keratoplasty, Hematocornea, Intracorneal hemorrhage, Viscodissection,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF REVIEW: To summarize recent evidence on the role of radiotherapy in managing pelvic lymph node (PLN) recurrence following curative-intent primary therapy for prostate cancer (PCa), focusing on radiotherapy strategies, novel medical imaging, and oncological outcomes. RECENT FINDINGS: Prostate-specific membrane antigen PET (PSMA-PET) has improved accuracy of staging in patients with PCa; however, more often than not, it fails to correctly identify PLN metastases, and the impact on clinical outcomes of the patients is uncertain. Metastasis-directed therapies (MDT) combined with short-term androgen-deprivation therapy (ADT) in patients with PLN recurrence are associated with a significantly higher risk of recurrence compared to more comprehensive approaches. Emerging data support the role of elective nodal radiotherapy (ENRT) combined with short-term androgen deprivation therapy (ADT) and radiotherapy boost to the PLN metastases to enhance disease control. Notably, despite treating a more extensive pelvic region than MDT, ENRT does not appear to significantly increase acute toxicity or negatively impact quality of life (QoL). Recent evidence suggests a role for androgen receptor pathway inhibitors (ARPI), such as enzalutamide, in patients with high-risk biochemical recurrence, introducing a new treatment paradigm for patients ineligible for salvage radiotherapy. Ongoing prospective studies are refining the role of radiotherapy in combination with systemic treatments. SUMMARY: Despite PSMA-PET allowing for improved staging and better patient-tailored decisions, patients with PLN recurrence continue to benefit from comprehensive multimodal treatment approach. Elective PLN irradiation combined with radiotherapy boost and ADT lead to improved disease control, without compromising safety and toxicity. ARPI+ADT and ARPI-monotherapy emerge as alternatives for select patients.

• Klíčová slova
• PET, local, neoplasm recurrence, pelvic radiotherapy, prostatic neoplasm, salvage therapy,
• MeSH
• antagonisté androgenů terapeutické užití   MeSH
• kvalita života MeSH
• lidé MeSH
• lokální recidiva nádoru * radioterapie   MeSH
• lymfatické metastázy radioterapie   MeSH
• lymfatické uzliny * patologie   účinky záření   diagnostické zobrazování   MeSH
• nádory prostaty * patologie   terapie   radioterapie   MeSH
• ozařování lymfatického systému * škodlivé účinky   metody   MeSH
• pánev MeSH
• staging nádorů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antagonisté androgenů MeSH

PURPOSE OF REVIEW: We aimed to summarize the recent advancements in management of biochemical recurrence (BCR) after primary curative therapy for prostate cancer (PCa), and the role of advanced imaging technologies in guiding and improving treatment decisions. RECENT FINDINGS: Recent studies have reshaped the approach to managing BCR after primary treatment for PCa. A key shift is the preference for early salvage radiotherapy (sRT), which has proven to offer comparable or even superior outcomes to immediate adjuvant therapy when closely monitored for progression. PSA kinetics (PSA doubling time) continue to guide treatment decisions, together with the time to PSA rise, Gleason Grade of the original tumor, and PSMA-PET imaging at the time of recurrence. While PSMA-PET significantly enhances the precision of recurrence detection, its sensitivity for smaller pelvic lymph node metastases remains limited, underscoring the need for careful consideration of all factors together to develop a risk-based consulting for all individualized treatment plan integrating patient wishes and health. SUMMARY: Recent studies underscore the efficacy of early sRT in managing BCR, with PSA kinetics and ISUP score as a crucial factor in guiding treatment decisions. Furthermore, the integration of PSMA-PET imaging has improved the precision of recurrence detection, facilitating more tailored and effective treatment strategies for patients with BCR. We are finally entering the age of personalized, risk-based, patient-centred case delivery, where treatment of the primary tumor with curative intent is offered to patients with BCR.

• Klíčová slova
• PSMA-PET, biochemical recurrence, prostate cancer, salvage therapy,
• MeSH
• adjuvantní radioterapie MeSH
• hodnocení rizik MeSH
• klinické rozhodování MeSH
• lidé MeSH
• lokální recidiva nádoru * terapie   krev   diagnóza   MeSH
• nádory prostaty * terapie   krev   patologie   diagnostické zobrazování   MeSH
• pozitronová emisní tomografie MeSH
• prostatektomie MeSH
• prostatický specifický antigen krev   MeSH
• stupeň nádoru MeSH
• výsledek terapie MeSH
• záchranná terapie * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• prostatický specifický antigen MeSH