Radiotherapy has been used to treat loco-regional recurrences located at various intra-thoracic sites, but long-term survival of these patients has been rarely observed. We report herein a lung adenocarcinoma patient with locoregional recurrence, who was successfully treated with high-dose radiotherapy. The patient could survive with no evidence of recurrence 5 years after thoracic irradiation. It is probably safe to administrate high-dose radiotherapy for some loco-regional recurrent patients with favorable prognostic factors such as good PS, no body weight loss. Further studies will be required to define a favorable subset of patients most likely to benefit from an aggressive approach.

• MeSH
• adenokarcinom radioterapie   sekundární   MeSH
• celková dávka radioterapie MeSH
• lidé MeSH
• lokální recidiva nádoru radioterapie   MeSH
• lymfatické metastázy MeSH
• mediastinum MeSH
• nádory plic patologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• celková dávka radioterapie * MeSH
• izotopy kobaltu MeSH
• lidé MeSH
• metody MeSH
• nádory hrudníku radioterapie   MeSH
• nádory průdušek radioterapie   MeSH
• radioisotopová teleterapie MeSH
• vysokoenergetická radioterapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• izotopy kobaltu MeSH

Radical radiotherapy of lung cancer with dose escalation has been associated with increased tumor control. However, these attempts to continually improve local control through dose escalation, have met mixed results culminating in the findings of the RTOG trial 0617, where the heart dose was associated with a worse overall survival, indicating a significant contribution to radiation-induced cardiac morbidity. It is, therefore, very likely that poorly understood cardiac toxicity may have offset any potential improvement in overall survival derived from dose escalation and may be an obstacle that limits disease control and survival of patients. The manifestations of cardiac toxicity are relatively common after high dose radiotherapy of advanced lung cancers and are independently associated with both heart dose and baseline cardiac risk. Toxicity following the treatment may occur earlier than previously thought and, therefore, heart doses should be minimized. In patients with lung cancer, who not only receive substantial heart dose, but are also older with more comorbidities, all cardiac events have the potential to be clinically significant and life-threatening. Sophisticated radiation treatment planning techniques, charged particle therapy, and modern imaging methods in radiotherapy planning, may lead to reduction of the heart dose, which could potentially improve the clinical outcomes in patients with lung cancer. Efforts should be made to minimize heart radiation exposure whenever possible even at doses lower than those generally recommended. Heart doses should be limited as much as possible. A heart dosimetry as a whole is important for patient outcomes, rather than emphasizing just one parameter.

• Klíčová slova
• Cardiac toxicity, Heart dose constraints, Lung cancer, Thoracic radiotherapy,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (<6 years old). There is a need for multicentre research on vertebral radiotherapy dose distributions for children, but until more valid data become available, these recommendations can provide a basis for daily practice for radiation oncologists who have patients that require vertebral radiotherapy.

• MeSH
• celková dávka radioterapie normy   MeSH
• dítě MeSH
• konformní radioterapie normy   MeSH
• lidé MeSH
• nádory patologie   radioterapie   MeSH
• pediatrie normy   MeSH
• předškolní dítě MeSH
• radiační onkologie normy   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Damage of the skin and its underlying structures is a common side effect of radiotherapy. These conditions limit further treatment and dealing with these complications is a routine practice of clinical oncologist. The majority of the complications are immediate, with a perspective of healing ad integrum within a few weeks. Less frequently, but sometimes with severe manifestations, chronic toxicity occurs belatedly after months, or even many years after irradiation, in form of post-radiation ulcer, for instance with potential of secondary malignant transformation. Regarding surgery, it might be one of the most challenging chronic wounds to treat. In extreme cases, extensive resection of the entire affected area is needed, inevitably ending with demanding reconstruction of the resulting defect. CASE REPORT: This case report presents a female patient with rapidly progressive post-radiation chest wall defect 33 years after the irradiation, when relatively insignificant skin injury occured. Prior to this sudden deterioration, only long-term, non-progressive changes, without a cutaneous defect, were described during the dispensarisation. After a protracted outpatient treatment with unsatisfactory results, when the patient repeatedly refused mastectomy, the condition inevitably led to the complex surgical procedure with necessary cooperation of breast, plastic and thoracic surgeons. CONCLUSION: Although changes of the similar severity rarely occur even after many years following the treatment, we havent found such a dramatic change of the patients condition three decades after the therapy with urgency of this type of complex, surgical intervention in current literature.

• Klíčová slova
• case report, radiotherapy, radiotherapy − breast carcinoma − post-radiation defect − breast and plastic surgery − case report,
• MeSH
• adjuvantní radioterapie MeSH
• hrudní stěna * MeSH
• lidé MeSH
• mastektomie MeSH
• nádory prsu * radioterapie   chirurgie   MeSH
• prsy MeSH
• radiační poranění * etiologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Radiotherapy with systemic corticosteroid therapy has been used to treat intramedullary spinal cord metastasis (ISCM), but recovery of function and long-term survival of these patients has been rarely observed. We report herein a small cell lung cancer (SCLC) patient with recurrent thoracic ISCM, who was successfully treated with radiotherapy and systemic corticosteroid therapy. A 70-year-old man, who was diagnosed as having SCLC seven months previously, developed thoracic ISCM. Soon after the detection of the lesion, the patient received radiotherapy with systemic corticosteroid therapy. Sensory disturbance in both extremities and neurogenic bladder and bowel dysfunction was recovered. The patient could walk after irradiation again. The patient received additional chemotherapy and survived 20 months after the diagnosis of ISCM recurrence. Prompt diagnosis and appropriate treatment for ISCM and effective chemotherapy for recurrent SCLC might be the favorable factors for such patients. Further studies will be required to define a favorable subset of patients most likely to benefit from a conventional approach.

• Klíčová slova
• intramedullary spinal cord metastasis, long-term control, small cell lung cancer,
• MeSH
• adjuvantní radioterapie MeSH
• dexamethason terapeutické užití   MeSH
• glukokortikoidy terapeutické užití   MeSH
• hrudní obratle patologie   MeSH
• lidé MeSH
• malobuněčný karcinom plic patologie   sekundární   terapie   MeSH
• nádory míchy sekundární   terapie   MeSH
• nádory plic patologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• dexamethason MeSH
• glukokortikoidy MeSH

INTRODUCTION: Thymic carcinoma is a rare and aggressive thymic neoplasm. The European Society of Thoracic Surgeons developed a retrospective database collecting patients undergoing resection for thymic tumors from 1990 to 2010. METHODS: Of 2265 patients with thymic tumors, there were 229 thymic carcinomas. Clinicopathological characteristics were analyzed including age, associated paraneoplastic diseases, stage (Masaoka-Koga), World Health Organization histologic subtypes, type of resection (total/subtotal/biopsy/no resection), tumor size, pre/postoperative treatments, and recurrence. Outcome measures included overall survival (OS), freedom from recurrence, and cumulative incidence of recurrence. RESULTS: A complete resection was achieved in 140 patients (69%). Recurrence occurred in 54 patients (28%). Five- and 10-year OS rates were 0.61 and 0.37. Five- and 10-year freedom from recurrence rates were 0.60 and 0.43. Cumulative incidence of recurrence was 0.21 (3 yr), 0.27 (5 yr), and 0.32 (10 yr). Survival was better after surgical resection versus biopsy/no resection (p < 0.001), after complete resection versus subtotal resection (p < 0.001), and when using Masaoka-Koga system (stages I-II versus III versus IV) (p < 0.001). The use of multidisciplinary treatments resulted in a survival advantage which was significant in the surgery + radiotherapy group (p = 0.02). Incomplete resection (p < 0.0001) and advanced stage (Masaoka-Koga III-IV) (p = 0.02) had a negative impact on OS at multivariable analysis. Administration of adjuvant radiotherapy was beneficial in increasing OS (p = 0.02). CONCLUSIONS: The results of our study indicate that patients with thymic carcinoma should undertake surgical resection whenever possible; a complete resection and early Masaoka-Koga stage are independent predictors of improved survival; our results also suggest that postoperative radiotherapy is beneficial in improving survival.

• MeSH
• databáze faktografické * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru mortalita   patologie   chirurgie   MeSH
• míra přežití MeSH
• mladý dospělý MeSH
• nádory brzlíku mortalita   patologie   chirurgie   MeSH
• následné studie MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spinocelulární karcinom mortalita   patologie   chirurgie   MeSH
• společnosti lékařské MeSH
• staging nádorů MeSH
• thymom mortalita   patologie   chirurgie   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
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Cardiovascular diseases represent the most common non-oncologic cause of death in patients following radiotherapy (RT) in the thoracic region. Radiation-induced heart disease (RIHD) can manifest as various heterogeneous clinical entities. However, the influence of RT on the cardiac conduction system has only recently gained more attention. Arrhythmogenic toxicity, i.e., conduction disorders and arrhythmias, constitutes a significant part of these adverse effects. The cardiac conduction system is not routinely monitored as an organ at risk (OaR). Its specific histological nature and function suggest different sensitivity and response to radiation. The heart is a highly heterogeneous organ, and the routinely monitored dose to the whole heart may not adequately characterize the risk of increased arrhythmogenic toxicity from RT. Cardiac structures, including the conduction system, appear to be additional OaRs for which dose distribution should be monitored. MATERIAL AND METHODS: For the systematic selection of studies, we utilized the PubMed database with keywords derived from the analysis of existing literature. The search was limited to English-language publications, and the selection criteria included relevance to the topic and the quality of methodology. PURPOSE: This article summarizes the impact of RT on the cardiac conduction system. CONCLUSION: Radiotherapy-induced cardiotoxicity significantly affects morbidity and mortality. The heart exhibits heterogeneity in terms of radiosensitivity. Certain cardiac subregions in the dose distribution show a higher correlation with poorer overall survival than routinely monitored doses to the whole heart and derived parameters (the volumes irradiated with the doses of 5 or 30 Gy - V5 or V30, respectively). The most radiosensitive subregions appear to be the base of the heart, including the beginning of the conduction system. Higher doses to the conduction system, especially the sinoatrial (SA) node, are associated with a higher incidence of a wide range of arrhythmias and poorer overall survival. However, dose limits (Dmean and Dmax) for the conduction system have not yet been established. Dosimetric studies have identified cutoff doses to the SA node, exceeding which there is a significant increase in mortality and the occurrence of arrhythmias.

• Klíčová slova
• arrhythmias, cardiac, cardiotoxicity, heart conduction system, organs at risk, radiation injuries, sinoatrial node,
• MeSH
• kritické orgány účinky záření   MeSH
• lidé MeSH
• převodní systém srdeční * účinky záření   patofyziologie   MeSH
• radiační poranění etiologie   MeSH
• radioterapie škodlivé účinky   MeSH
• srdeční arytmie etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

An eight-month-old male child was admitted with weakness and swelling in the feet. Paraparesis and bilateral lower extremity edema were present in the neurological examination. Thoracic MRI showed an intradural intramedullary mass 61 x 11 mm in size in the T5-T10 levels. Laminotomy between the T5-T10 vertebrae was performed. A mass with smooth borders was separated from most of the neural tissue. In the postoperative MRI, we observed a contrast enhancing area, considered a residual fragment, only 5 x 4 mm in size. Histopathological properties were compatible with the intermixed subtype of ganglioneuroblastoma. Only a limited number of thoracic cord Ganglioneuroblastoma reports have been previously published. Although very rare in children and young adults, ganglioneuroblastoma should be included in the differential diagnosis of thoracic cord tumors. It is difficult to obtain a preoperative diagnosis with clinical features and radiological investigations. Diagnosis depends on histopathological examinations. Curative treatment should be in the form of a complete resection of the tumor. In partially resected cases, adjuvant radiotherapy may become necessary, along with close follow-up.

• MeSH
• ganglioneuroblastom * diagnóza   chirurgie   MeSH
• hrudní obratle MeSH
• kojenec MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory míchy * diagnóza   chirurgie   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory hrudníku radioterapie   MeSH
• plíce patologie   MeSH
• plicní nemoci etiologie   MeSH
• senioři MeSH
• vysokoenergetická radioterapie škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH