Greater Poland Cancer Centre Research Articles

Adjuvant radiotherapy in laryngeal cancer over the last few decades: the evolution of treatment policy in the great poland cancer centre

Summary Aim to evaluate changes in the treatment trends of the larynx cancer over the last few decades concerning the time factor in postoperative radiotherapy (OTT) after total laryngectomy and defining the target in adjuvant radiotherapy after partial laryngectomy with the reconstruction of the larynx. Material and methods The first part of the analysis was based on the comparison of OTT in two groups of patients (group A and B) irradiated postoperatively after total laryngectomy. Group A consisted of 311 patients who were treated between 1986 and 1990. The postoperative radiotherapy (RT) was given 5 times a week at the daily dose of 2 Gy per fraction to the mean total dose of 61.2 Gy (range: 57–66 Gy), the mean time of the RT course was 47 days (range: 40–74 days). Group B encompassed 270 patients treated with a similar technique in the years 2000–2002 with the same fraction and total dose. The second part of the analysis concerning the change of strategy in relation to the indication for adjuvant radiotherapy after partial laryngectomy (supracricoid laryngectomy with cricohyoidopexy, cricohyoidoepiglottopexy, horizontal laryngectomy, and fronto-lateral laryngectomy) during the last decade. The analysis was based on the review of patients who were treated between 1996 and 2002 at our department. One of the main aims of radiotherapy technique was to avoid the irradiation of a newly reconstructed larynx. All patients were irradiated postoperatively in a conventional way to the elective dose of 50 Gy to the neck with a boost dose from 10 to 16 Gy to the bed of the removed lymph nodes. Acute and late morbidities were evaluated according to the RTOG/EORTC morbidity scoring system. Results and conclusion In group A gaps were observed in 52% of all the treated patients and their mean time was 8.2 days (range: 1–16 days). In group B gaps occurred in 26% of all treated patients with the mean gaps duration of 4.2 days (range: 1–15 days). The first part of the analysis revealed a significant time reduction in gap duration (4.2 days) and their frequency (26%) in the last decade (p=0.002). The second part of the analysis showed that the protection of the newly reconstructed larynx led to the avoidance of significant side effects. Combined treatment, which consisted of partial laryngectomy and adjuvant RT of the neck with the protection of larynx, plays an important role in the decrease of treatment morbidity and makes it possible to preserve laryngeal function.

1/The rotary-dual technique of the total skin electron irradiation

The aim of the total skin electron irradiation in the therapy of mycosis fungoides is to obtain the total or partial remission of the disease concurrently lowering the toxicity level. Total skin electron radiotherapy should fulfill the EORTC requirements from the year 2002. The rotary dual method of the total skin electron irradiation used in The Great Poland Cancer Centre including the specific technical and physical aspects, was described in this work. These aspects include the parameters and conditions of 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 total skin electron irradiation) and in-vivo dosimetry conducted during the therapy with rotary dual fields, which allows to control the dose distribution and to indicate the additional skin areas, which should be irradiated with local fields.

334. Intraluminal Pulsed Dose Rate (PDR) brachytherapy for locally advanced bile ducts cancer: A case report

Purpose To assess the feasibility of intraluminal Pulsed Dose Rate (PDR) brachytherapy in the treatment of locally advanced bile duct cancer. Two cases are reported which were treated using a new trans-hepatic technique. Material and methods Two patients with advanced bile duct cancer were treated using trans-hepatic technique since May 2003 in Greatpoland Cancer Center. One patients was treated with combined treatment: brachytherapy and external beam therapy, one exclusively with brachytherapy. Percutaneous trans-hepatic technique was used to implant catheter into bile duct. Brachytherapy was started in the same day after insertion of intraductal catheter. A French 5 catheters (Nucietron) were used. Patients received 25 pulses of 0.8 Gy hourly, total dose was 20 Gy. Target Volume encompass tumour visualized at cholangiography and a 1 or 2 cm margin taken proximally and distally. Dose was prescribed at 10 mm from the source axis. In second phase of combined treatment – external beam therapy 15 MV photons were used. Patient received 40 Gy in 20 fractions of 2 Gy daily. Results and Conclusions It has been established, that the use of Pulsed Dose Rate brachytherapy is feasible and has a low early complication rate. A new percutaneous trans-hepatic technique allowed to perform whole treatment (insertion of catheter, PDR brachytherapy) in one day.

222. Results and toxicity of immunotherapy with genetically modified tumor vaccine (GMTV) combined with brain metastases irradiation in melanoma patients

Brain metastases are associated with poor prognosis. Median survival of such melanoma patients is 4 month. Standard treatment comprises palliative radiation therapy or palliative excision of solitary metastases in selected patients. Only patients with resected solitary metastases live a few months longer. The aim of this study was to asses results and toxicity of combined treatment with GMTV and irradiation in melanoma patients, who developed brain metastases. Since 1996 in Department of Cancer Immunology Great Poland Cancer Centre a group of 250 melanoma patients was treated with GMTV consisted of allogenic melanoma cell lines Mich1 and Mich2 modified with IL-6 and sIL-6R genes or fusiongene lL-6/sIL-6R. All patients were stage III and IV (AJCC). Before or during the immunization 22 patients presented symptoms of brain metastases. All patients were irradiated with the doses 30–39 Gy, using 3 Gy/fraction, 5 fractions/week. Toxicity and clinical results (CT, OS) were evaluated. In part of patients CTL and NK cytotoxicity and Th1 vs. Th2 profiles were evaluated in vitro. Side effects of irradiation were tolerable, 0–2 degree according to WHO criteria (standard dexamethasone treatment in all patients). There were no radiation encephalopathy or radiation necrosis. In 12/22 patients stabilization or partial remission were observed. Overall survival measured from brain metastases diagnosis ranged from 2 to 20 months. Median survival was 9 months. In 12 responder patients median survival was 13 months, ranged from 7 to 20 months. In 10 remaining patients median survival was 4 months. There were no differences in CTL activity but we noticed changes in NK activity and Th1/Th2 ratio (pooled in Th1 direction) after irradiation. Radiotherapy combined with GMTV compared with radiotherapy alone prolongs survival in melanoma patients, who developed brain metastases.

989 Poster Meningiomas treated in Greatpoland Cancer Center between 1990 – 1997

989 Poster Meningiomas treated in Greatpoland Cancer Center between 1990 – 1997

High dose rate endobronchial brachytherapy in the management of advanced lung cancer – comparison of different doses – preliminary assessment

Purpose Brachytherapy is one of the most efficient methods of overcoming endobronchial obstruction in palliative treatment of lung cancer. In single cases, brachytherapy is performed as radical treatment, however in most of cases, due to advanced clinical stage it has a palliative aim. In the absence of clear consensus regarding the value of doses used in brachytherapy different fraction doses are used in clinical treatment. The aim of this work is to compare results of palliative high dose rate brachytherapy using various treatment protocols with the view to analysing differences in survival and diminishing breathing difficulties. Material and methods Between May 1999 and February 2000 at the Greatpoland Cancer Center, 69 patients with advanced lung cancer were treated by high dose rate brachytherapy. They were disqualified from radical treatment due to advanced clinical stage. The age of the patients ranged from 39 to 76 years (average 53,2 years). Fifty-one patients received a total dose of 22,5 Gy in 3 fractions once a week, 18 patients received one single fraction of 10 Gy. All the patients were divided into two groups according to their clinical stage and the Karnofsky score – those with the Karnofsky score lower than 50 were qualified for a single fraction treatment. They were under clinical and endobronchial observation as regards survival rates, local remission and subsiding dyspnoea, breathing, cough and haemoptysis in the first, third, sixth and twelveth month of observation. Results Four weeks after the end of treatment subjective improvement (subsidence of all symptoms) was ascertained in 61/69 (88,4%) patients. In 12 cases (17,4%) complete remission (CR), in 49 cases (71,0%) – partial remission (PR) of the tumor were found. During one year of observation 45 (65,2%) patients died, in 10 cases (14,5%) improvement of in dyspnoea was observed and in 14 cases (20,3%) recurrence and progression of the disease were noted. There was no statistical difference in the survival rates between the two groups of patients treated with different fractions protocols. Conclusions 1. Brachytherapy in advanced lung cancer is an efficient method that led in most of patients to subcidence of symptoms and to improvement of the quality their lives. 2. The two treatment protocols showed similar efficiency in overcoming difficulties in breathing. 3. Survival rates were similar in both group of patients treated with different treatment protocols.

78. Screening for prostate cancer in Greatpoland Cancer Center

Introduction Between November 2000 and January 2001 screening for prostate cancer has been conducted in Greatpoland Cancer Centre. Among men in Poland prostate cancer is one of the most common cancers and cause of deaths. The incidence of clinically diagnosed prostate cancer rises more rapidly with age than does any other malignancy. Material and methods The screening involved 1657 male participants. Our research was design with participants eligibility restricted to men 50 to 70 years old who were not already being evaluated for the disease. Screening for prostate cancer was based on prostate specific antigen and digital rectal examination. Results Among patients with elevated PSA level, analysis at PSA ratio was performed (52 patients). All patients with abnormal PSA level and digital examination had (TRUS). Biopsy was performed for 6 patients. Three of them were proven for cancer. During our research we looked for genetic aspect of prostate cancer. Conclusions Screening for prostate cancer was met with big enthusiasm among men and hopefully very similar screening would be introduced for larger group of patients.

71. The results of postoperative radiotherapy in 63 patients with low-grade gliomas treated in Greatpoland Cancer Center

Low-grade glicomas represents 15% of all primary brain tumors. Between 1990–97 63 patient with low-grade gliomas were treated in Greatpoland Cancer Center (39 males, 24 females; age between 20–60 year). 15 patients had andegrone complete surgical excision, 48 partial or subtotal excision of tumor. The frontal lobe was affected in 33 patients, the temporal lobe in 14 patients. Patients received conventional irradiaton of 60 Gy. *Five patients with histologically verified pilocytic astrocytomas(I) were treated after partial excision, median of age 29.2 year median survival 58 months (27–108). Only one patient died 27 months after radiotherapy. *Thirteen patients with fibrylar astrocytomas(II)-11 post subtotal excision-median age 37.7 year median survival 32.5 months. Recurrent tumor in two patients. Five patients are alive. *Ten patients with protoplasmatic astrocytoma(II)-7 post subtotal excision median of age 43.5 year median survival 30.8 months. Four patients alive. *Seven patients with gemistocytic astrocytomas(II) (6 post subtotal excision)-median age 36 year, median survival 32 months. Only one patient alive. *Eleven patients with oligoastrocytomas(II)-11 post subtotal excision, median age 38.6 year, median survival 43.9 months. Two patients with recrrent tumor. Alive 8 patients. *Seventeen patients with oligodendrogliomas (11 post subtotal excision) median age 39 years, median survival 39 months. One patien with recrrent tumor. Alive 8 patients. *30 patients are alive(48%); *histopathologic diagnosis pilocytic astrocytomas asociated with age 10 years younger then either low-grade gliomas and long-term survivors; *poor prognistic factor in gemistocytic astrocytomas-only one patient alive; *five patients with recurrent tumor among 17 to 49 months after radiotheraphy.

65 A comparison of three groups of patients with endometrial cancer treated in Greatpoland cancer centre in the 30 years' period

65 A comparison of three groups of patients with endometrial cancer treated in Greatpoland cancer centre in the 30 years' period

284 poster Retrospective analysis of treatment of women with breast cancer treated in the the years 1983–1987 in Greatpoland Cancer Centre

284 poster Retrospective analysis of treatment of women with breast cancer treated in the the years 1983–1987 in Greatpoland Cancer Centre

39. Pulsed dose rate brachytherapy – describing of a method and a review of clinical applications

Pulsed Dose Rate (PDR) treatment is a new brachytherapy modality that combines physical adventages of high-dose-rate (HDR) technology (isodose optimization, radiation safety) with the radiobiological adventages of low-dose-rate (LDR) brachytherapy. Pulsed brachytherapy consists of using a stronger radiation source than for LDR brachytherapy and is giving a senes of short exposures of 10 to 30 minutes in every hour to approximately the same total dose in the same overall as with the LDR. Modern afterloading equipment offers some advantages over intersitial or intracavitary insertion of separate needles, tubes, seeds or wires. Isodose volumes in tissue can be created flexibly by a combination of careful placement of the catheter and adjustment of the dwell times of the computerized stepping source. Automatic removal of the radiation sources into a shielded safe eliminates radiation exposures to staff and visitors. Radiation exposure is also eliminated to the staff who formerly loaded and unloaded a multiplicity of radioactive sources into the catheters, ovoids, tubes etc. This retrospective study based on summarized clinical investigations analyses the feasibility, differences between methods of brachytherapy and preliminary oncologic results of PDR brachytherapy. Since July 2000 15 patients were treated in Greatpoland Cancer Center using PDR brachytherapy. They were 10 patients with recurrent brain malignant glioma, 2 with recurrent nasopharyngeal cancer, and patients with lip cancer, recurrent breast cancer and recurrent salivary gland cancer. Only patient with lip cancer was treated radically. Nucletron PDR unit with 1 Ci source and PLATO planning system were used. Short time of observation doesn’t allow to draw a radical conclusions. On the ground of literature and preliminary own results it seems that PDR brachytherapy is save and efficient method of treatment. The most important complication was a local infection in place of implanted catheter. In some cases (for example in patients with recurrent malignant glioma after teletherapy) PDR brachytherapy perhaps could be a treatment of choice.

Hormonal therapy and 3D conformal radiotherapy in prostate cancer: early toxicity of combined treatment

Summary Purpose To evaluate acute toxicity of combined treatment (androgen ablation and high-dose 3D conformal radiotherapy [3D-CRT]) in patients with a localized cancer of prostate. Materials and methods Between April 1999 and March 2000, at the Greatpoland Cancer Centre in Poznan, 22 patients with prostate cancer (T1–T3 N0 M0) were treated with 3 D conformal radiation therapy and hormonal therapy. Patients represented a localized disease (T1 = 4 patients, T2 = 11 patients), and locally disease (T3 = 7 patients). No patients had clinically detectable distant metastases. Neoadjuvant androgen ablation therapy (bilateral orchiectomy or LH-RH agonists and flutamide) was administered to all patients. Radiotherapy was performed using 15 MV photons in the daily fraction of 1.8 Gy to the total median dose of 70.2 Gy (range, 67.8 to 72 Gy). Acute toxicities were evaluated according to the Radiation Therapy Oncology Group morbidity scoring scale. Results All patients completed the entire course of radiotherapy and were assessable for evaluation of acute toxicities. The most common side effects of androgen ablation were “hot flushes” and gynecomastia, although these were mild. The main problems during irradiation and a few weeks after the completion of radiotherapy were related to: - the genitourinary tract (urgency, nocturia, dysuria) with toxicities of grade 0 and 1 (80% of patients) and grade 2 (20% of patients) - the gastrointestinal tract (rectal discomfort and mild diarrhea) with toxicities grade 0 and 1 (75% of patients) and grade 2 (25% of patients). Conclusions Preliminary results of combined treatment (androgen ablation and 3 D-CRT) have suggested that such modality is well tolerated with only modest acute toxicities of the gastrointestinal and genitourinary tracts.

70. Meningiomas treated in Greatpoland Cancer Center between 1990–1997

Introduction We analyzed correlation between age of patient with anaplastic meningiomas, extension of tumor excision, histopatological recognition and time to recurrence and survival. Material and methods Between 1990–1997 7 patients with anaplastic meningioma, 3 patients with haemangiopericytoma, 2 patients with sarcoma meningeum (6 women and 6 men) have been irradiated. 7 patients underwent radical excision of the tumor, 5 patients non radical. The patients were irradiated from limited fields to total dose 56–60 Gy/T mostly by energy Co-60 (9 patients) and photons 9 MV (3 patients). Results There are 6 patients with anaplasticum meningioma still alive. 3 patients living 96–108 months, 3 other 30–39 months. Recurrence was confirmed in two male participants who underwent radical surgery in 12 and 29 month from the start of treatment. The first patient died after 16 months with recurrence of the disease. One patient (39 years old) with heamangiopericytoma lives 40 months after radical surgery without evidence of recurrence. Two patients died – one 11 months after radical surgery (41 years old) and the other one (42 years old) 21 months after non radical surgery. Both patients (24 and 59 years old) with sarcoma died (one after 8 months, and the other one after 21 months). Conclusions Patient with anaplastic meningiomas have long survival. The extension of tumor excision didn’t influence on survival.

87. High dose rate endobronchial brachytherapy in the management of advanced bronchial cancer – comparison of different doses

Introduction In palliative treatment of lung cancer one of most efficient methods in overcoming difficulties in breathing caused by endobronchial obstruction is brachytherapy. From regard on location of the change on some of the patients brachytherapy is a treatment from choice. Brachytherapy in single cases is performed as radical treatment, in most of cases due to advanced clinical stage has an palliative aim. Because of lack of clear consensus regarding value of doses used in brachytherapy there are different fraction doses used in clinical treatment. The work is about result (t of palliative treatment with high dose rate brachytherapy using different treatment schemas. Material and methods From May 1999 to February 2000 in Greatpoland Cancer Centre were treated 69 patients on bronchial cancer using high dose rate brachytherapy. They were disqualified from radical treatment due to advanced clinical stage. The age of the patients ranged from 39 to 76 years, average 53,2 years. 51 patients received total dose of 22,5 Gy in 3 fractions every week, 18 patients received one single fraction of 10 Gy. Patients were divided into two groups according to clinical stage and Karnofsky scare for single fraction patients were qualified when Karnofsky scare was smaller then 50. They have undertaken clinical and endobronchial observation with rating of local remission and retiring difficulties with breathing, cough and hemoptysis in thirst, third, sixth and twelve month of observation. Results After 4 weeks from the end of the treatment in 61/69 (88,4%) patients has been ascertained subjective improvement (retiring of all symptoms). In 12 cases was found out complete remission (CR), in 49 partial remission (PR) of tumour. During one year of observation 45 patients died, in 10/24 cases we observed still an improvement of dyspnoea, in 14/24 cases we observed recurrence and progression of disease. There was no statistical difference in survival between two groups of patients treated with different schema. Conclusions 1. Brachytherapy in advanced lung cancer was an efficient method that caused in many patients retiring of the symptoms and improvement of life quality. 2. Both treatment schema had similar efficiency in overcoming difficult breathing. 3. High local dose did not influenced the growth of the frequency of complications.

46. Stereotactic Mammotome Breast Biopsy – analisis of results

The purpose of work is to assess stereotactic mammotome biopsy technology in diagnostics of nonpalpable breast lesions. In the period from April to December 2000 mammotome biopsy procedure was performed on395 female patients at the I Oncological Surgery department the Greatpoland CancerCenter in Poznan. In all patients, diagnosed lesions were non-palpable and categorisedas BI-RADS III, IV, V. Patients were aged between 16 and 78 (average 52.6 years). They divided into three groups depending on radiological characteristics of the examined lesions – separate analyses were carried out for patients with microcalcifications suspicious tumores and radial scar. Diagnostic examination was performed on an ambulatory basis. Procedurewas carried out on a Fischer mammotome table using the Mammotome Biopsy System. The Cancers were detected in 17 % cases. All patients with diagnosed cancer underwent further surgical procedure. In 83 % patients in whom begin lesions were found mammography screening was recommended at 6 month intervals. The Stereotactic Mammotome Breast Biopsy System is a sensitive, minimally invasive diagnostic technology characterised by: very high diagnostic precision, minimal traumatisation of surrounding tissues, excellent cosmetic effect, economical procedure.

Treatment of advanced lung cancer by external beam radiotherapy and high dose rate (HDR) brachytherapy

Purpose Brachytherapy is a highly valued and effective palliative treatment for lung cancer, especially as it reduces intensity of dyspnoea and other symptoms arising from tumours inside the respiratory tract. In some cases, due to the location of the lesion brachytherapy is a treatment of choice. However, its curative role is unclear. A combination treatment of brachytherapy and an external beam irradiaton may play a significant role when the mediastinal lymph nodes are involved. The paper presents the results of treatment of advanced lung cancer patients by external beam irradiation and brachytherapy, and the role of this palliative treatment is discussed. Material and methods Between May 1999 and March 2000 at the Greatpoland Cancer Centre fifteen patients with advanced lung cancer were treated by HDR brachytherapy and palliative external beam irradiation using the method of hypofractionation. The patients’ age ranged between 39 to 80 years, mean: 54.3 years. The treatment consisted of external beam irradiation (total dose of 20–30 Gy), and a weekly high dose rate (HDR) brachytherapy (three fractions of 7.5 or 10 Gy, at 1 cm from the source). In three cases the treatment was started with external irradiation, whereas in 12 cases the first stage was brachytherapy. During the patients’ clinical and endobronchial follow-up of 1, 3 and 6 months, local remission and regression of difficulties in breathing, cough, pain and haemoptysis were assessed. Results In all our patients subjective improvement (regression of all symptoms) was found on the first check-up following treatment. In one case complete remission of the tumour lasted for over 6 months, in 9 cases partial remission and in two cases progression were found. Severe complications due to the high total local dose were not observed. Conclusions Combined palliative treatment (intraluminal brachytherapy and external beam irradiation) in advanced lung cancer was an efficient method that led to regression of symptoms and improvement of well-being in many patients.

19. Does in vivo dosimetry improve quality of radiotherapy: evaluation of 1000 patient's checks

Radiotherapy is a part of a complex treatment administered to patients with cancer. It uses a radiation which is generated and processed by specialized and sophisticated equipment. Since the beginning of the 20th century the main idea of radiotherapy remained unchanged. It is based on a proven interaction between radiation and human tissues resulting in their partial or total damage. Over the years more knowledge has been gained, especially on fractionation, doses and the reactions of different tissues and organs. The new sources of radiation have begun to be used, including high energy photon end electron beam accelerators. It became evident that major advance in clinical results might be achieved by limitation of the dose strictly to the target volume (tumour) and by sparing normal tissues. The issue of critical importance was the execution of the prescribed treatment. When treatment planning with the accuracy expressed in milimmitres became possible it it had to be proved that subsequent treatments would make it possible to assure such accuracy. In-vivo dosimetry was believed to be of help in increasing the accuracy in radiotherapy. Since its aim was not to modify the treatment but only to execute it according to a prescribed schedule dosimetry should bring about only benefits when implemented in the routine work However, being an extensive procedure, dosimetry consumed a lot of effort. In regular work, it is difficult to imagine that each beam could be measured in-vivo for each fraction. Measurements at more than one point for one beam were only considered for special and rare procedures such as mantle fields. In the practice of radiotherapy as carried out at the Greatpoland Cancer Centre routine in-vivo dosimetry was started in 1999, first applied to the patient's head and neck, and then extended to all patients. At least two measurements for each patient were made during the whole treatment. Whenever discrepancy occurred, exceeding 10% between the calculated and measured dose, the search for its cause was initiated. The very first problem involving the implementation of our method to the routine, was the number of dosimeters required. Transporting the dosimeter from one unit to another when dosimetry was requested involved a larger error due to the instability of the detecting unit. Another problem was the staff required. At first, physicists took care of dosimetry, but then technologists were trained who are now making the majority of measurements. A protocol from each measurement is included in the patient's record and is shown for approval to the physician. For the evaluation of our method a group of 1123 patients were analysed: 850 patients with head and neck cancer, 228 with breast cancer and 45 with lung cancer. The number of measurements was at least twice as large because each patient was irradiated from more than one beam. The mean percent differences between the calculated doses and those measured in-vivo were −1.5% (Standard Deviation, SD of 7.8) for the head and neck, +3.4% (SD=4.9) for breast, and −2.4% (4.3) for the lungs. The estimation of the error usinf a total differential method for a single measurement gives the value of more than 10% (upper limit of error). However, the statistical analysis of the measurements on the whole group with nearly a normal distribution provided a more realistic error of about 6%. Conclusions In-vivo dosimetry is a standard procedure in conformal radiotherapy. It does not help to avoid casual and even large errors since it is not done for all beams every time. It makes it possible to reduce the mean error in whole group of patients, which in effect should lead to more effective radiotherapy.

The role of radiotherapy in the treatment of malignant melanoma

Summary Malignant Melanoma is recognised by several radiotherapists to be radioresistant. Many radiobiological data and well-known differences in the morphology of melanoma suggest that this claim may be false. The data obtained are presented in the paper in a historical overview. Principles of the radiotherapy of melanoma are discussed. The results of palliative irradiation of 27 patients, treated at the GreatPoland Cancer Center in the years 1985–1989 are discussed.

The results of breast conservative therapy in early breast cancer in Greatpoland Cancer Centre

We are presenting results of our treatment during 3 years (1993–1995) in Greatpoland Cancer Centre. We treated 67 women with early breast cancer performing breast conservative surgery and radiation therapy. For treatment we chose women with breast tumor up to 3 cm in diameter and unpalpable axillary lymph nodes. The therapy consisted of quadrantectomy and axillary dissection and then radiation therapy. Chemotherapy was used for patients with histologically positive lymph nodes metastases. Due to the local recurrence the mastectomy was performed in four patients. Five women were treated with cytostatics because of metastases to the liver and bones. Three women died. The other women remain in the periodical observation in our hospital. These results have a preliminary character, because of the short follow up.

The results of postoperative radiotherapy in patients with renal cell carcinoma in third stage of clinical advancement based on data of Greatpoland Cancer Centre

The role of complementary radiotherapy in patients with stage III renal cell carcinoma after radical nephrectomy still remains a matter of discussion. In connection with lack of alternative solutions the treatment is still conducted in many centres. In Greatpoland Cancer Centre in period 1985–1991 complementary radiotherapy was carried out in 169 patients with infiltration of adipose capsule and/or renal stalk or metastases in closest lymph nodes confirmed during operation. The patients were irradiated from two opposite fields including a bed of the removed kidney and regional lymph nodes. Total dose amounted 50 Gy (25 fractions), 2 Gy daily, five times a week. Early complications after radiotherapy like lack of appetite, diarrhoea and moderate leucopenia, disappearing after pharmacologhical treatment, were observed in 20% of patients and did not cause interruption in treatment. No late complications were observed. 5-year survival without recurrence was achieved in 47% of thease patients. In the whole group only four local recurrences were found. The reasons of treatment failure were distant metastases. We proved that teleradiotherapy turned out to be efficient method protecting against local recurrence of disease but did not influence significantly 5-year survival rate.