Greater Poland Cancer Centre Research Articles

Porównanie dawek indywidualnych promieniowania jonizującego otrzymanych przez personel Wielkopolskiego Centrum Onkologii w latach 1990–1994 i 2006–2010 w rentgenodiagnostyce

The analysis of doses received by personnel performing X-ray diagnostic procedures is a requirement for safe work with ionising radiation. AimThe aim of this study was to analyse and compare individual doses of ionising radiation received by the personnel performing X-ray diagnostic procedures at the Greater Poland Cancer Centre in the years 1990–1994 and 2006–2010. MethodBased on individual documents of ionising radiation exposure, so-called dosimetric passports, an analysis was made of individual doses of ionising radiation received by the personnel performing X-ray diagnostic procedures at the Greater Poland Cancer Centre in the years 1990–1994 and 2006–2010. The doses were checked for their meeting the standards established in the Nuclear Law Act. ResultsIndividual doses of ionising radiation received by the personnel performing X-ray diagnostic procedures maintained at an approximately stable level of 0.5mSv, except for several cases when dosimeters indicated higher than usual mean effective “whole body dose”.The increase in the mean effective doses was caused by the increased number of diagnostic procedures performed within the reference periods at the GPCC. ConclusionDoses received by the personnel performing X-ray diagnostic procedures at the GPCC fall within the dose limits set by the Nuclear Law Act. The differences found in the size of doses result mainly from different sensitivity levels of the dosimetric equipment used.

Rola zespołu interdyscyplinarnego w diagnostyce i leczeniu chorych z nowotworami krtani i gardła dolnego

IntroductionIn Poland the annual incidence of cancer of the larynx is about 3,000 cases which accounts 2% of all malignant tumors. Results of treatment of head and neck cancers are still unsatisfactory (five-year survival – 50%). In order to improve the outcome in Greater Poland Cancer Centre in 2010 a multidisciplinary team was created which is involved in the individual qualification of each patient to the best form of therapy. AimThe aim of the publication is to evaluate the work of the multidisciplinary team in the diagnostic, therapeutic, and post-operative follow-up of patients with larynx and hypopharynx cancer treated in Greater Poland Cancer Centre in 2007–2012. Materials and methodsThe analysis included 558 patients (84% men, 16% women) aged 38–82 years who were treated in the Department of Head and Neck Surgery Greater Poland Cancer Centre in the years 2007 to 2012 because of cancer of larynx and hypopharynx. Patients were divided into two groups – the first consisted of patients qualified without the cooperation of the multidisciplinary team – 312 patients (56%), the second – patients qualified with help of the multidisciplinary team – 246 patients (44%). In the two groups of patients evaluated were: mean time required for the implementation of additional tests and specialist consultations before treatment, the average time from the appearance of the patient to the start of treatment, the distribution of qualifications to specific forms of therapy. ResultsEvaluating type of treatment administered after the establishment of the team noticed were an increase by 11% the number of patients treated with surgery. There has been a reduction in the time between the appearance of the patient at the clinic and the start of treatment and reduce the waiting time for diagnostic imaging and specialist consultations. It was also an increase in the number of regular check-ups and a decrease in the number of patients who stopped visits. ConclusionThe work of the multidisciplinary team improves the effectiveness of treatment by optimizing the process of preparation and organization, and finally by contributing knowledge and experience in decision-making. His creation results in benefits for the patient, his family and the medical staff. Qualification for the most optimal treatment within the multidisciplinary team should be used in all patients with cancer of the head and neck.

Styles of coping with stress of cancer in patients treated with radiotherapy and expectations towards medical staff – Practical implications

BackgroundIt is essential to adjust oncological treatment to medical procedures but also to the expectations of patients themselves. Expectations of patients may depend on the way of coping with the stress of cancer. Many researchers have dealt with this issue. However, it is difficult to find studies concerning relations between the styles of coping and expectations of patients towards medical staff. AimTo demonstrate the relationship between the style of coping with stress of cancer shown by patients undergoing radiotherapy at the Greater Poland Cancer Centre and the nature of their expectations towards the medical staff, and to present work of the Clinical Psychology Unit in response to the expectations of patients. Materials and methodsQuestionnaire survey. The respondents filled in a questionnaire consisting of a patient request form (PRF), the mini-mental adjustment to cancer scale (Mini-MAC), and personal data. Obtained results were subjected to statistical analysis. ResultsSignificant associations: the expectation to have the disease explained is associated with anxious preoccupation, fighting spirit, helplessness–hopelessness; the expectation of emotional support is associated with anxious preoccupation and helplessness–hopelessness; and the expectation of information on examinations and treatment is associated with anxious preoccupation and helplessness–hopelessness. ConclusionsExpectations of patients undergoing radiotherapy in the Greater Poland Cancer Centre towards the medical staff depend on their styles of coping with the stress of cancer.

Rozsądne korzystanie z promieniowania UV oceniane na podstawie badania ankietowego przeprowadzonego w Wielkopolskim Centrum Onkologii

IntroductionIn Europe of the 1990s, the incidence of melanoma of the skin doubled as compared to the 1960s which can be attributed to a higher exposure to sun light. In the 21st century, the Greater Poland Cancer Centre, responding to the call of the World Health Organisation, is implementing a variety of actions in the area of primary and secondary cancer prevention. The main objective of this study was to assess the efficacy of the action: “Słonecznie – bezpiecznie” (Safe in the Sunshine) held regularly at the Greater Poland Cancer Centre. Materials and methodsTo achieve this aim, a survey was organised at the Greater Poland Cancer Centre during the “Słonecznie – bezpiecznie” campaign. ResultsMost of the respondents (99.1%) realise that sun bathing without an appropriate protection may lead to a number of diseases, including cancer, and believe to take a good care of their health. The study demonstrated that there are no statistically significant differences between the awareness of a healthy lifestyle and the level of education nor between women and men. ConclusionThe popularity of the “Słonecznie – bezpiecznie” project among the community of Poznań and the region and the fact that seven cases where detected during the action confirms the usefulness of such undertakings. It has also turned out that information advertising the action reaches all the local community (patients of the Greater Poland Cancer Centre represented only 33.3% of all respondents). Health education provided to the inhabitants of Poznań and the region will allow them to enjoy sunshine more reasonably and thus to protect themselves from its harmful effects.

Sentinel node biopsy in breast cancer using infrared laser system first experience with PDE camera

Background Sentinel node biopsy (SNB) is a gold standard in staging of early breast cancer. Nowadays, routine mapping of lymphatic tract is based on two tracers: human albumin with radioactive technetium, with or without blue dye. Recent years have seen a search for new tracers to examine sentinel node as well as lymphatic network. One of them is indocyanine green (ICG) visible in infrared light. Aim The aim of this study is to evaluate clinical usage of ICG in comparison with standard tracer, i.e. nanocoll, in SNB of breast cancer patients. Materials and methods In the 1st Department of Surgical Oncology and General Surgery, Greater Poland Cancer Centre, Poznań, 13 female breast cancer patients have benn operated since September 2010. All these patients had sentinel node biopsy with nanocoll (human albumin with radioactive technetium), and with indocyanine green. The feasibility of this new method was assessed in comparison with the standard nanocoll. Results A lymphatic network between the place of injection of ICG and sentinel node was seen in infrared light. An area where a sentinel node was possibly located was confirmed by gamma probe. Sensitivity of this method was 100%. Conclusion SNB using ICG is a new, promising diagnostics technique. This procedure is not without drawbacks; nevertheless it opens new horizons in lymphatic network diagnostics.

Wpływ wybranych czynników na rehabilitację logopedyczną chorych po całkowitym usunięciu krtani

The operation of total laryngectomy deprives patients of the ability of voiced communication, causes isolation and loneliness. The loss of voice and speech leads to a predominant cripplehood, disturbs verbal communication in the social and family circle. The best ways of voiced communication of the patients after laryngectomy are an esophageal speech and the speech using voice prosthesis. The aim of the study is to estimate the voice and speech rehabilitation of the patients after total laryngectomy. The study comprised 30 patients who in the years 2007-2009 underwent an operation of laryngectomy at the Department of the Surgery of the Head and Neck and the Laryngological Oncology in the Greater Poland Cancer Center in Poznań. In this group 9 patients used voiced speech after grafting the voice prosthesis, 15 patients (12 men and 3 women) underwent a classical rehabilitation of the esophageal speech, 6 patients (4 men and 2 women) used an electronic voice prothesis. The most important factors which influenced on mastering an esophageal speech were: pressure inside the esophagus, appearing a reverberation, time of training at home, length of time of logopedic rehabilitation, age and education. Necessary time to master a speech in the group of 9 patients with voice prothesis was 4-5 days. Length of time of the classical speech rehabilitation lasted from 3 to 8 months. 3 persons (20%) mastered a very good degree of esophageal speech, 7 patients a good degree (46.67%) and 2 patients (13.33%) - a sufficient degree of esophageal speech despite of low pressure inside the esophagus and appearing a reverberation quickly. 3 patients (20%) used an oral and guttural pseudo-whisper, a voiced reverberation was not obtained during the whole time of logopedic rehabilitation. The surgical voice rehabilitation, in spite of the possibility of complications, enjoys a great popularity among patients. The classical rehabilitation of the esophageal speech was more difficult for the tasted group of patients but mastering a speech to a very good and good degree lets communicate naturally.

Vacuum-assisted core-needle biopsy as a diagnostic and therapeutic method in lesions radiologically suspicious of breast fibroadenoma

Background Treatment of breast fibroadenoma remains a subject of clinical discussion. Recommended methods include clinical observation or surgical excision of the lesion. The procedure involves hospitalisation and anaesthesia, leaving a scar on the breast. Aim The aim of this study was to present the Centre's experience in removing lesions radiologically suspicious of fibroadenoma by means of an ultrasound-guided vacuum-assisted core-needle biopsy as an alternative to a classical surgery. Materials and methods Between March 2007 and April 2010, 196 ultrasound-guided vacuum-assisted biopsies were performed in the Mammotome Biopsy Laboratory of the 1st Surgical Oncology and General Surgery Department at the Greater Poland Cancer Centre in Poznań. The procedure was delivered to female patients aged 17–91 years (mean 40.8, median 39). Qualified for removal were ultrasound identified lesions described as fibroadenomas. Results The average size of excised lesions according to pre-biopsy ultrasound image was 13.53 ± 8.92 mm (median 11 mm, range 4–60 mm). In 184 cases (93.9%), benign lesions were found in the final histopathologic examination. Pre-cancer lesions were found in 10 cases, and invasive lesions in two cases. Overall, after follow-up ultrasound examination, four patients were qualified for subsequent surgical resection of lesions that had been left behind. Conclusion Vacuum core-needle biopsy is an effective tool enabling removal of breast fibroadenomas. It combines features of a lesion resection and histopathologic material collection providing an access with minimum invasiveness.

Radiotherapy combined with hormonal therapy in prostate cancer: the state of the art

Radiotherapy combined with hormonal therapy in prostate cancer: the state of the art Piotr Milecki1,2, Piotr Martenka1, Andrzej Antczak3, Zbigniew Kwias31Department of Radiotherapy, Greater Poland Cancer Center, Poznan, Poland; 2Department of Electroradiology, Medical University, Poznan, Poland; 3Chair of Urology, Medical University, Poznan, PolandAbstract: Androgen-deprivation therapy (ADT) is used routinely in combination with definitive external beam radiation therapy (EBRT) in patients with high-risk clinically localized or locally advanced disease. The combined treatment (ADT–EBRT) also seems to play a significant role in improving treatment results in the intermediate-risk group of prostate cancer patients. On the other hand, there is a growing body of evidence that treatment with ADT can be associated with serious and lifelong adverse events including osteoporosis, cardiovascular disease, diabetes, and many others. Almost all ADT adverse events are time dependant and tend to increase in severity with prolongation of hormonal manipulation. Therefore, it is crucial to clearly state the optimal schedule for ADT in combination with EBRT, that maintaining the positive effect on treatment efficacy would keep the adverse events risk at reasonable level. To achieve this goal, treatment schedule may have to be highly individualized on the basis of the patient-specific potential vulnerability to adverse events. In this study, the concise and evidence-based review of current literature concerning the general rationales for combining radiotherapy and hormonal therapy, its mechanism, treatment results, and toxicity profile is presented.Keywords: prostate cancer, radiotherapy, androgen deprivation, combined treatment

Quality Management In Radiotherapy: Nonconformities in Radiotherapy Recorded over a 7 Year Period

The implementation of the quality management system based on ISO norm 9001:2008 in radiotherapy has many positive aspects. One of the most important is that, once introduced, it must be continuously planned, maintained, verified and improved. All of aforementioned elements of the Deming Cycle (PDCA) are equally important, however the aim of this publication is (i) to present the model of an internal quality audit for radiotherapy implemented in the Greater Poland Cancer Centre, as one of the basic and the most crucial tool for an identification of nonconformities occurring in radiotherapy process; (ii) to classify nonconformities recorded between 2003 and 2009 in the Greater Poland Cancer Centre and (iii) to identify their major causes.

Influence of length of interval between pulses in PDR brachytherapy (PDRBT) on value of Biologically Equivalent Dose (BED) in healthy tissues.

PurposeDifferent PDR treatment schemas are used in clinical practice, however optimal length of interval between pulses still remains unclear. The aim of this work was to compare value of BED doses measured in surrounded healthy tissues according to different intervals between pulses in PDRBT. Influence of doses optimization on BED values was analyzed.Material and methodsFifty-one patients treated in Greater Poland Cancer Centre were qualified for calculations. Calculations of doses were made in 51 patients with head and neck cancer, brain tumor, breast cancer, sarcoma, penis cancer and rectal cancer. Doses were calculated with the use of PLATO planning system in chosen critical points in surrounded healthy tissues. For all treatment plans the doses were compared using Biologically Equivalent Dose formula. Three interval lengths (1, 2 and 4 hours) between pulses were chosen for calculations. For statistical analysis Friedman ANOVA test and Kendall ratio were used.ResultsThe median value of BED in chosen critical points in healthy tissues was statistically related to the length of interval between PDR pulses and decreased exponentially with 1 hour interval to 4 hours (Kendall = from 0.48 to 1.0; p = from 0.002 to 0.00001).ConclusionsProlongation of intervals between pulses in PDR brachytherapy was connected with lower values of BED doses in healthy tissues. It seems that longer intervals between pulses reduced the risk of late complications, but also decreased the tumour control. Furthermore, optimization influenced the increase of doses in healthy tissues.

The Expression of Phosphorylated mTOR in Breast Cancer from BRCA1-Mutation Carriers.

Abstract Background: The mammalian target of rapamycin (mTOR) is a serine-threonine kinase coupling growth stimuli and metabolic signals to cell cycle progression and protein synthesis. mTOR represents also a novel therapeutic target in various types of cancer. The role of mTOR in development and progression of breast cancer is not fully understood. There are studies suggesting that mTOR is responsible for the resistance of breast cancer to tamoxifen, trastuzumab and various chemotherapeutic agents. Since there are no studies evaluating the activation (phosphorylation) of mTOR in breast cancer cells carrying a germinal mutation of BRCA1, we have decided to assess activation of this kinase in tumor specimens in BRCA1-mutation carriers.Materials and methods: Formalin fixed paraffin-embedded tumor samples were obtained from 19 patients carrying BRCA1 germinal mutation and 24 patients with intact BRCA1 gene. All patients have been treated in the Great Poland Cancer Center between 2000-2008. The blocks were retrieved from the archives of the Department of Pathology and immunostained for phospho mTOR (Phospho-mTOR (Ser 2448), rabbit antibody, Cell Signaling).Results: Phosphorylation of mTOR was not detected in any of 19 patients carrying the mutated BRCA1 gene. Most of the BRCA1-mutated cancers were ER and HER2 negative (18 (95%) and 16 (94%), respectively). In the tumors with a wildtype BRCA1 gene, mTOR activation was detected in 12 samples (50%). Lack of mTOR phosphorylation was again observed mostly in ER and HER2 negative tissue samples (10 (83%) and 11 (92%), respectively).Discussion: Our findings have demonstrated differential activation of mTOR between tumors carrying a wild-type and mutated BRCA1 gene. We have also observed a negative correlation between ER and HER2 status and phosphorylation of mTOR. Although our study included a relatively low number of cases, the results indicate that activation of mTOR and probably also of its upstream targets do not play a crucial role in biology of tumors with a BRCA1 mutation or with the triple-negative phenotype. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3144.

Ultrastructural assessment of adenoid cystic carcinoma with emphasis on tumour infiltration periphery

Summary Background There is a wide variety of morphological and clinical types of tumours of the salivary glands. Almost 30 histological types of these neoplasms are known. Adenoid cystic carcinoma is a rarely occurring malignant epithelial neoplasm. It occurs in major salivary glands, but may also originate in the salivary glands of the respiratory tract. Aim The aim of the present study was the ultrastructural assessment of the infiltration periphery of different histological types of adenoid cystic carcinoma of the salivary glands. Materials and Methods Tissue samples from patients with adenoid cystic carcinoma of the salivary glands were studied. The study group consisted of 30 pts. 21 pts with tumour of parotid, 8 with submandibular and 1 with tumour of sublingual salivary glands. All patients were surgically treated and undergone supplementary treatment using radiotherapy in the Greater Poland Cancer Centre. Assessment of tissue samples was performed using morphological diagnoses and ultrastructural evaluation. Results Ultrastructural electron microscopy assessment of adenoid cystic carcinoma revealed differentiation of the tumour cells towards ductal salivary, myoepithelial and pluripotential cells. Epithelial cells showed an increased nucleus-cytoplasm ratio, and their nucleoli were characteristic for actively proliferating cells. The analysis showed histological and structural differences between the central and peripheral parts of the tumour. Conclusions The ultrastructural assessment of adenoid cystic carcinoma revealed that the cells in the peripheral parts of the tumour show a lower degree of maturation than the ones in its centre, peripheral stroma contains fewer collagen fibres, and dominant elements at the periphery of the tumour are proteoglycans and glycosaminoglycans, no histoformative features typical of the principal (central) part of the tumour were found at its periphery.

High-dose-rate brachytherapy in the treatment of lung cancer – Greatpoland Cancer Center experience

High-dose-rate brachytherapy in the treatment of lung cancer – Greatpoland Cancer Center experience

PDR brachytherapy combined with hyperthermia in head and neck recurrences – Greatpoland Cancer Center preliminary results

PDR brachytherapy combined with hyperthermia in head and neck recurrences – Greatpoland Cancer Center preliminary results

933 POSTER Quality Management System and organization of services in radiotherapy as a result of implementation of European Union directives and other international documents to the Polish law based on the experience of Great Poland Cancer Centre

Quality management systems (QMS) are tools that serve to structure, control and improve the usual activities that take place in an organization or service.The ISO 9001:2015 is an internationally recognized standard, which provides the necessary resources to help an organization to improve its performance, based on the principle of plan-do-control-act, in order to obtain continuous improvement. In the field of health, it is an essential tool for the management of the services offered to patients.The ISO quality certification allows to demonstrate compliance, according to established quality standards.The process of implementing a QMS follows several phases that culminate with the completion of an external audit, which once passed, allows obtaining the quality certification ISO 9001:2015.This article describes the steps to follow to obtain this certification in a Dermatology Service.Los sistemas de gestión de calidad (SGC) son herramientas que sirven para estructurar, controlar y mejorar las actividades habituales que se desarrollan en una organización o servicio.La norma ISO 9001:2015 es una norma reconocida internacionalmente que proporciona los recursos necesarios para ayudar a una organización a mejorar su rendimiento, basándose en el principio de planificar-hacer-controlar-actuar, con el fin de obtener una mejora continua. En sanidad es una herramienta clave para la gestión de los servicios ofrecidos a los pacientes.La certificación de calidad ISO permite demostrar el cumplimiento de dicha norma, de acuerdo a unos estándares de calidad establecidos.El proceso de implantación de un SGC siguiendo esta norma debe seguir varias fases, que culminan con la realización de una auditoría externa que, una vez superada, permite obtener la certificación de calidad ISO 9001:2015.En este artículo se describen los pasos a seguir para obtener dicha certificación en un Servicio de Dermatología.

Preliminary assessment of results obtained by the Endoscope Department of Great Poland Cancer Centre, Poznań, in the framework of the Screening Programme for Early Diagnostics of Colon Cancer in years 2004-2005

Summary Background Colonoscopy screening and polypectomy are one of the most effective ways to reduce the incidence of colon cancer. One of the best achievements in Poland is the Colorectal Screening Programme that was started in 2000. Aim The aim of our study is to present the results of the examination made by the Endoscope Department of Great Poland Cancer Centre in the framework of the Polish Screening Programme for early diagnosis of colon cancer in the years 2004 and 2005. Materials/Methods We admitted to the screening programme asymptomatic persons aged 50–65 years (main group), persons between 40 and 65 years old with familial history of colorectal cancer, and people aged 25–65 from HNPCC or FAP families. Results We examined 1000 individuals. 982 total colonoscopies (98.2% effectiveness) were done, and finally 806 polyps were removed. Adenomas were found in 83 removed polyps (10%), including neoplastics lesions in 24 (28.9%) cases: tubulovillous adenomas in 15 (18.1%), villous adenomas in 5 (6.0%) and serrated adenomas in 4 (4.8%) cases. Two of the removed polyps (0.2%) were malignant. Summarized colorectal neoplasia was detected in 26 (2.6%) participants. We observed a 0.9% complication rate among all the participants. Conclusions The fundamental importance and consequence of early cancer detection and removal of premalignant adenomatous polyps has been shown to prevent death due to colorectal cancer and to reduce colorectal cancer incidence. Screening by colonoscopy with polypectomy can be an excellent and safe procedure with good levels of acceptability and high level yield for advanced colorectal neoplasia.

Intraluminal pulsed dose rate (PDR) brachytherapy and trans-hepatic technique in treatment of locally advanced bile duct cancer – preliminary assessment

Summary Background Treatment options for bile duct cancer remain limited due to the large number of patients with advanced disease at the time of diagnosis. Radical surgery is possible in less than 10–15% of these cases. Unresectable bile duct cancers are very difficult to treat with external beam therapy alone due to the proximity of adjacent normal organs and the high doses required to effectively irradiate these neoplasms. Indications for brachytherapy include all malignant strictures of the bile duct which can be cannulated. Patients should be fit enough for the procedure and should have been reviewed to confirm that they are not suitable for resection. Combined treatment is possible in patients who are in good condition; it is usual to combine bile duct brachytherapy (BT) with external beam radiation therapy (EBRT). Aim To assess the feasibility of intraluminal palliative pulsed dose rate brachytherapy (PDR-BT) in the treatment of locally advanced bile duct cancer. Materials/Methods Seventeen patients with advanced inoperable bile duct cancer were treated between May 2002 and December 2005 in Greatpoland Cancer Centre. Patients were disqualified from surgery or radical external beam radiation therapy (EBRT). Thirteen patients were treated exclusively with PDR brachytherapy, 4 patients were qualified for combined treatment: PDR brachytherapy and palliative EBRT. Percutaneous trans-hepatic technique was used to implant a catheter into the bile duct. All patients received 25 pulses of 0.8Gy hourly to the total dose of 20Gy. In 4 cases PDR was repeated after one week. Target Volume encompassed tumour visualized at cholangiography and a one or two cm margin taken proximally and distally. Dose was prescribed at 10mm from the source axis. For palliative EBRT 15MV photons were used. Results In all 17 cases trans-hepatic technique allowed insertion of the BT catheter into the bile duct and safe application of PDR-BT. In 13/17 (76.5%) cases improvement in jaundice was noted at the first check-up after 4 weeks. Median overall survival time (OS) was 10 months, longest survival time was 36 months, shortest was 2 months. Acute and late complications were not observed. Conclusions 1. It was established that the use of pulsed dose rate brachytherapy was feasible and had a low early complication rate. A new percutaneous trans-hepatic technique allowed whole treatment (insertion of catheter, PDR brachytherapy) to be performed in one day. 2. In most cases a satisfactory palliative effect was achieved.

The rotary dual technique for total skin irradiation in the treatment of mycosis fungoides – a description of the applied method

The aim of total skin electron irradiation in the therapy of mycosis fungoides is to obtain total or partial remission of the disease while concurrently lowering the toxicity level. Total skin electron radiotherapy should fulfill the EORTC requirements from the year 2002. The aim of this work is to present the rotary dual method for total skin electron irradiation used in the Great Poland Cancer Centre including its specific technical and physical aspects. These aspects include the parameters and conditions for the treatment (geometrical conditions of the technique, homogeneity of the dose, patient's positioning, additional fields and the method of dose fractionation), the absolute dosimetry (parameters and functions characterizing the electron irradiation beam used in the rotary dual method of the rotary dual method of the total skin electron irradiation) and in-vivo dosimetry conducted during the therapy with rotary dual fields, which allowed to control the dose distribution and to indicate additional skin areas, which should be irradiated with local fields. The rotary dual method of the Total Skin Electron Irradiation proposed by the author, is based on the combination of the two most frequently used methods: 1) six dual fields’ method and 2) rotary method. The original, calculation algorithm elaborated by the author was based on the two dimensional algorithm proposed by Podgorsak et al. The new algorithm, proposed by the author takes into the changes in doses along the vertical and horizontal axis of the object. Moreover the elliptical; shape of the object proposed by the author, is more approximated to the shape of the patient than the cylindrical object proposed by Podgorsak et al. Parameters used by authors: nominal energy – 6 MeV, mean energy at the skin surface – 2.8 MeV, values of the PDD (at the skin surface – 100%, at the 4 mm – 83.6% and at the 20 mm – 1.8%), SSD – 300 cm, field size equal to 230 cm by 115 cm, fraction dose – 1.5Gy, total time of treatment from 6 to 7 weeks were compatibility with EORTC recommendations. The elaboration of the rotary – dual method of total skin electron irradiation allowed to reduce SSD distance compared to irradiation with the rotary method. Moreover the dimension of most therapeutic rooms is usually too small to realize the total skin electron irradiation methods with SSD distance higher than 350 cm. Patient set-up and rotation during irradiation (based on rotary method) allow to reduce the number of dual fields used in Stanford method from six fields to one dual field (rotary-dual method). This modification leads to reduction of time assigned for set-up verification). Presented results of in-vivo dosimetry for selected patients treated in Great Poland Cancer Centre confirm the needfulness for using additional local for areas of perineum, scalp vertex, hands, neck-shoulders, plants. Moreover, obtained results indicate that total dose prescribed for additional fields depends on height and obesity and should be prescribed individually for each patient.

Prognostic factors in melanoma

Summary Background There are clinical and pathological factors associated with the clinical course of melanoma. These parameters allow us to predict survival times and establish a course of treatment. Aim The aim of the study was to assess the significance of immunohistochemical markers in the progression of melanoma, and relate these findings to the influence of clinical and histological factors on survival time. Materials/Methods In this study, archival histological material obtained from 50 melanoma patients operated on in the Great Poland Cancer Centre between 1990–1995 was analysed. Using immunohistochemistry we detected the presence of markers known to be important in the diagnosis of melanoma, including: HMB-45, PCNA, Ki-67, MMP-2, CD44 and nm23. Following this, univariate logistic regression was performed and clinical, histopathological and immunohistochemical data of statistical significance were correlated with survival time using the Cox nonparametric proportional hazard regression model. Results The results suggested that the most important prognostic factors correlating with survival time were: the presence of nm23 antigen (p = 0.0342) and the thickness of the melanoma, as measured by the Breslow method in mm (p = 0.0191). According to the univariate analysis there were correlations between patient death or survival and the histological type, Superficial Spreading Melanoma Malignum (SSMM) (p = 0.0187), regional lymphatic metastases (p = 0.0030) and positive Ki-67 results (p = 0.0282). Conclusions Taken together, our results allowed us to conclude (a) that there was a correlation between survival time and nm23 antigen expression and the thickness of melanoma, as measured by the Breslow method in mm, (b) that there were correlations between patient survival or death and the histological type of Superficial Spreading Melanoma Malignum, regional lymphatic metastases and positive Ki-67, (c) that other parameters (age, gender, anatomical location of the melanoma, the presence of ulceration, lymphatic infiltration, the existence of satellites, and positive PCNA and MMP-2) showed no significant influence on survival.

The influence of the European and Polish acts of law, regulations and standards on the forms and the contents of the informed consent for oncological treatments

Summary Aim The aim of this work was to analyze the influence of the European and the Polish acts of law, the principals of The Polish, Physician's Code of Ethics, and the standards of The Accreditation Program for Hospitals on the forms and contents of the informed consent for oncological treatments given by the patients in The Great Poland Cancer Centre. Materials/Methods The Polish acts of law, The European Convention on Bioethics, the guidelines of The Polish, Physician's Code of Ethics and the standards of The Accreditation Program for Hospitals were compared in terms of their similarities and compatibility referring to the informed consent. Subsequently based on the related contents of the above documents, the informed consent forms for the oncological treatments were designed. Results As a result the following examples of informed consent forms for oncological diagnostics and treatments were designed: a) informed consent form for diagnostics examination with contrast medium, b) informed consent form for radiotherapy, c) informed consent form for surgery. Discussion It is undeniable that the consent of the patient is a prerequisite to any medical treatments. The individual must be informed and understand the treatment that he or she will undergo. The patient has to know the advantages (benefits) and disadvantages (risks, potential complications) of the proposed medical intervention. When obtaining the consent the patient should be informed of details of diagnosis and prognosis with or without the proposed medical intervention and the uncertainties and questions should be explained and answered. Therefore the informed consent forms used in The Great Poland Cancer Centre are not only documents proving that the patient agreed to perform the treatment but also tools that allow the patient to comprehend the purpose, benefits and risks of the proposed medical intervention and to participate in the decision making process.