Radiation therapy, including image-guided adaptive brachytherapy based on magnetic resonance imaging, is the standard of care in locally advanced cervical and vaginal cancer and part of the treatment ...in other primary and recurrent gynaecological tumours. Tumour control probability increases with dose and brachytherapy is the optimal technique to increase the dose to the target volume while maintaining dose constraints to organs at risk. The use of interstitial needles is now one of the quality indicators for cervical cancer brachytherapy and needles should optimally be used in ≥60% of patients. Commercially available applicators sometimes cannot be used because of anatomical barriers or do not allow adequate target volume coverage due to tumour size or topography. Over the last five to ten years, 3D printing has been increasingly used for manufacturing of customised applicators in brachytherapy, with gynaecological tumours being the most common indication. We present the rationale, techniques and current clinical evidence for the use of 3D-printed applicators in gynaecological brachytherapy.
The aim of this retrospective single institution study was to analyse long term results of vulvar cancer treatment with conventional 2D radiotherapy in Slovenia between years 1997-2004.
Fifty-six ...patients, median age 74.4 years +/- 9.7 years, mainly stage T2 or T3, were included in the study. All patients were treated with radiotherapy, which was combined with surgery (group A), used as the primary treatment (group B) or at the time of relapse (group C). Chemotherapy was added in some patients. Histology, grade, lymph node status, details of surgery, radiation dose to the primary tumour, inguinofemoral and pelvic area as well as local control (LC) and survival were evaluated.
Overall survival (OS), disease specific survival (DSS) and LC rates at 10-years for all patients were as follows: 22.7%, 34.5% and 41.1%, respectively. The best 10-years results of the treatment were achieved in the primary operated patients treated with adjuvant radiotherapy +/-chemotherapy (OS 31.9%, DSS 40.6% and LC 47.6%). Positive lymph nodes had a strong influence on LC. In case of positive nodes LC decreased by 60% (p = 0.03) and survival decreased by 50% (p = 0.2). There was a trend to a better LC with higher doses ≥ 54.0 Gy (p = 0.05).
The best treatment option for patients with advanced vulvar cancer is combined treatment with surgery and radiotherapy +/- chemotherapy, if feasible. Radiotherapy with the dose of ≥ 54.0 Gy should be considered to achieve better LC if positive adverse factors are present.
Oligometastatic disease (OMD) is a stage between locally advanced disease and polymetastatic disease, a group of diseases that are used interchangeably based on treatment history, ongoing treatment ...status, and imaging findings. The diagnosis of OMD is based on imaging because, as of yet, we are not aware of any specific biomarkers that would enable us to recognize patients with a low disease burden. In recent years, there has been an increasing interest in optimizing the treatment of OMD, owing mostly to the promising outcomes of combining local and systemic treatment. For the first time, the prospect of achieving long-term cures or possibly curing these individuals was established using this form of treatment. The standard name of OMD subgroups allows for the comparison of diverse circumstances in everyday clinical work, as well as the classification for clinical study comparability.
To evaluate the clinical use of 3D printing technology for the modelling of individual applicators for advanced gynecological tumors in magnetic resonance imaging (MRI)-based brachytherapy (BT).
We ...tested individually designed 3D-printed applicators in nine patients with advanced gynecological cancer. Before BT was performed, all patients were treated with external beam radiotherapy (EBRT). The most common indication for individualized BT was advanced gynecological tumors where the use of standard BT applicators was not feasible. Other indications were suboptimal dose-volume histogram (DVH) parameters for high-risk clinical target volume (CTV-T
) at the first BT (V
≤ 90% of CTV-T
volume and D
≤ 80%, D
≤ 100%, and D
≤ 60% of dose aim). The EQD
dose aim to the target volume D
CTV-T
per one BT fraction was 20 Gy for cervical or recurrent endometrial cancer and 16 Gy for vaginal cancer patient. The first BT with the standard applicator
was used as the virtual plan for designing a 3D-printed applicator. The next BT was performed with a 3D-printed applicator
. The primary endpoint was to improve CTV-T
DVH parameters without exceeding the dose to the organs at risk (OARs).
All DVH parameters for CTV-T
were significantly higher with the use of an individually designed applicator. Mean D
CTV-T
improved from 14.1 ±5.4 Gy to 22.0 ±2.5 Gy and from 7.1 Gy to 16.2 Gy for cervical/recurrent endometrial and vaginal cancer, respectively (
< 0.001). The mean D
bladder, rectum, sigmoid, and bowel dose was within institutional dose constraints, and increased from 13.0 ±1.5 Gy to 13.6 ±1.5 Gy (
= 0.045), 10.8 ±1.2 Gy to 11.7 ±1.3 Gy (
= 0.004), 8.9 ±3.2 Gy to 10.3 ±3.3 Gy (
= 0.008), and 8.7 ±3.8 Gy to 9.2 ±3.1 Gy (
= 0.2).
With the use of individual 3D-printed applicators, all DVH parameters for CTV-T
significantly improved without compromising the dose constraints for the OARs.
The aim of this retrospective study was to analyse results of the two-dimensional (2D) uterine cervix cancer treatment at the Institute of Oncology Ljubljana from 1998 till 2002, before the ...three-dimensional (3D) approach was introduced in our clinical practice.
Ninety-eight patients with the following FIGO stage distribution were analysed: 10% IB, 7% IIA, 37% IIB, 4% IIIA and 42% IIIB. The influence of age, haemoglobin level, histology, grade, stage, lymph node status, cumulative point A dose, and an overall treatment time on the survival and local control (LC) were evaluated. Acute and late side effects were assessed.
Five and 8-year overall survival (OS), disease specific survival (DSS) and LC rate were as follows: 47.2% and 43.0%, 54.7% and 53.4%, 74.9% and 72.5%, respectively. Point A dose and histology of the tumour influenced OS, positive lymph nodes DSS and point A dose LC rate. Probability of grade three and four late complications in the first five years was 7.1% for gastrointestinal tract and 3.3% for genitourinary system and vagina.
Point A dose was independent predictor of OS and LC rate, lymph node status predicted DSS, while histology of the tumour influenced OS.
Radiotherapy for benign disease Ivica Ratoša; Blaž Grošelj; Boris Jančar ...
Onkologija,
06/2024, Volume:
28, Issue:
1
Journal Article
Peer reviewed
Open access
Radiation therapy for benign disease aims to restore function and can improve quality of life. Irradiation for benign conditions is usually performed with a low daily and total radiation dose and a ...lower number of treatment fractions (compared to the dose used for malignant diseases). With modern radiation therapy, the risk of damaging healthy tissue is minimal. The radiation is directed precisely to the affected area so that healthy tissue is spared. Radiation therapy for benign diseases is safe and effective. However, it is crucial to recognize the disadvantages of radiation therapy. It is also always essential to evaluate if the benefits of radiation outweigh the potential negative effects.
Background: This study aims to define the financial burden experienced by Slovenian cancer patients, including both objective financial consequences and subjective financial worries resulting from ...their disease and treatment. Additionally, we investigate the impact of financial toxicity (FT) on quality of life (QoL). Prior to this study, no research had been conducted on this topic in Slovenia. Aim: The objective of this study was to evaluate the financial burden experienced by cancer patients in Slovenia, its impact on their QoL, and to test the effectiveness of existing tools for assessing FT and QoL. Methods: A survey methodology was employed to measure FT. We developed our own questionnaire to assess FT, and the internationally validated FACIT-COST and EORTC QLQ-C30 questionnaires were used. The study was prospective and cross-sectional and was held at the Institute of Oncology Ljubljana from June to October 2023. Results: We analysed 590 valid surveys. Based on the FACIT- -COST questionnaire, we found that the majority of surveyed patients (53.7%) had no FT, and 42.9% of surveyed patients mostly had mild to moderate FT. The low FT among Slovenian cancer patients was also confirmed by the EORTC QLQ-C30 questionnaire and our own questionnaire. The majority of patients (85.1%) estimated that they did not incur any major costs due to their disease and treatment. Based on the FACIT-COST and the EORTC QLQ-C30 indicator for financial burden, we found that the risk groups for increased FT were mainly patients with a lower net household income (p ≤ 0.001), younger patients (p < 0.001), breast cancer patients (p = 0.016), working patients (p < 0.001) and patients undergoing active oncological treatment (p = 0.039). In our own questionnaire, a lower level of education (p ≤ 0.001), a rural environment (p = 0.033) and the type of health insurance (p = 0.006) also proved to be important for FT. The effect of religion on FT is not associated with higher FT based on our own questionnaire, as shown by the FACIT-COST and EORTC QLQ-C30 questionnaires. We also confirmed the effect of lower income on poorer QoL. Other parameters influencing QoL are: a very low or very high level of education, head and neck cancer and treatment activity. Conclusions: In Slovenia, the majority of cancer patients do not suffer from FT, and 42.9% have mild to moderate FT. FT is statistically significantly associated with income level, age, type of cancer, employment status, oncological treatment activity, education level, rural environment and type of health insurance. Higher FT is associated with poorer QoL. It is also associated with income level, education level, cancer type and oncological treatment activity.
Smernice za obravnavo bolnic z rakom jajčnikov, jajcevodov in s primarnim peritonealnim seroznim rakom so izšle v samostojni obliki prvič po letu 2002. Tistega daljnega leta so bile smernice za vse ...ginekološke rake še združene v eni knjižici, dandanes pa nova dejstva in spoznanja ter razvoj novih zdravil terjajo bolj poglobljen pristop k obravnavi teh bolnic. Avtorji smo še posebej veseli dejstva, da so prve samostojne smernice izšle ob 1. Ginekološki šoli z naslovom Rak jajčnikov, 13. novembra 2015, nekoliko dopolnjena 2. izdaja smernic pa je izšla ob ponovitvi šole 18. marca 2016. Namenoma smo iz teh smernic izpustili redke vrste raka jajčnikov (kot na primer germinalni in stromalni rak), saj sta klinična pot in potek bolezni pri teh oblikah drugačni. Smernice so na voljo v dveh knjižnih izdajah, v velikem formatu in žepni obliki, v spletni obliki pa so dostopne na spletni strani Onkološkega inštituta, kjer se bodo tudi sproti posodabljale. Slovenskih smernic nismo želeli le povzeti po vzoru tujih, temveč smo v njih vnesli tudi naše izkušnje z zdravljenjem teh bolezni.
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