Uveal melanoma is the most prevalent primary intraocular cancer in adults. Although it accounts for only 5% of all melanomas, it is responsible for 13% of deaths due to this type of cancer. A wide variety of therapeutic options of primary tumor is available and progress in its management is noticeable. The fact still remains, however, that almost half of patients develop metastases which may be due to practically undetectable cancer spread present as early as at diagnosis of the primary focus. Metastatic disease is uniformly fatal despite systemic therapy. Prediction of metastasis is crucial for prognosis. It also allows targeting of emerging new therapeutic methods to the appropriate group of patients. The Authors reviewed literature concerning epidemiology and etiopathogenesis of uveal melanoma, and its clinical, histopathological and cytogenetic prognosticators.

The focus of the present review is to investigate the role of melanin in the radioprotection of melanoma and attempts to sensitize tumors to radiation by inhibiting melanogenesis. Early studies showed radical scavenging, oxygen consumption and adsorption as mechanisms of melanin radioprotection. Experimental models of melanoma in hamsters and in gerbils are described as well as their use in biochemical and radiobiological studies, including a spontaneously metastasizing ocular model. Some results from in vitro studies on the inhibition of melanogenesis are presented as well as radio-chelation therapy in experimental and clinical settings. In contrast to cutaneous melanoma, uveal melanoma is very successfully treated with radiation, both using photon and proton beams. We point out that the presence or lack of melanin pigmentation should be considered, when choosing therapeutic options, and that both the experimental and clinical data suggest that melanin could be a target for radiosensitizing melanoma cells to increase efficacy of radiotherapy against melanoma.

This study confirms that children with CCBM have a more favorable survival than young adults 18 to 25 years of age, adjusting for TNM stage and gender. The association between gender and survival varies between age groups.

In recent years, a significant number of studies have investigated the preventive role of vitamin D in a number of different neoplasms. In this study, we analyze various components of the vitamin D signaling pathways in the human uveal tract and uveal melanoma, including analysis of the expression of vitamin D receptors (VDR), the activating and inactivating hydroxylases, respectively, CYP27B1 and CYP24A1, and the retinoic acid-related orphan receptors (ROR) α (RORα) and γ (RORγ) in these tissues. We further analyzed the expression of VDR, CYP27B1, CYP24A1, and ROR in relation to melanin levels, clinical stage and prognosis. Our study indicated that the uveal melanoma melanin level inversely correlated with VDR expression. We further showed that vitamin D is metabolized in uveal melanoma. This is significant because until now there has been no paper published, that would describe presence of VDR, hydroxylases CYP27B1 and CYP24A1, and RORα and RORγ in the human uveal tract and uveal melanomas. The outcomes of our research can contribute to the development of new diagnostic and therapeutic methods in uveal tract disorders, especially in uveal melanoma. The presented associations between vitamin D signaling elements and uveal melanoma in comparison to uveal tract encourage future clinical research with larger patients’ population.

Aim of the studyThe objective of the study was to present the preliminary results of proton radiotherapy as a method for treating 15 patients with choroidal melanoma.Material and methodsThe proton radiotherapy was administered using beams providing energy levels of 60 MeV, which ensures a clinical range of 28.4 mm. In addition, the beam has a very narrow penumbra of 1.3 mm and a sharp distal dose fall-off. All patients received the dose of 60 CGE (cobalt gray equivalent) given to the PTV (planning target volume). This dose was administered in 4 fractions over 4 successive days of treatment.ResultsThe tumour had regressed in 8 patients (53.3%) and remained stable in 3 patients (20%). The large tumours in another 3 patients (20%) were removed during vitrectomy (endoresection), which increased the number of patients with tumour regression up to 11 (73.3%). In the case of 1 patient, despite intraocular tumour regression occurring the choroidal melanoma had spread multifocally into the orbit, which necessitated orbit exenteration. The results ensured that the eyeballs of 14 patients (93.3%) could be saved.The follow-up period for the 15 patients ranged between 8 and 26 months (average: 17.4 months, median: 19 months). In this period some side effects were noted: an increase in intraocular pressure, retinal detachment, cataract, maculopathy, neuropathy and vitreous haemorrhaging.ConclusionsThe preliminary results confirm that proton radiotherapy is an effective method for treating patients with choroidal melanoma. This method ensures an eyeball preservation rate of 93%, with the vision function of 80% of the patients being saved.

Background: The aim of this study was the analysis of the influence of prognostic factors on short-and long-term outcomes of gastric cancer resection. Patients and Methods: A database of 709 patients who had gastric cancer resection between 2007 and 2015 was compiled. Results: Total gastrectomy (TG) and subtotal proximal gastrectomy (SPG) significantly increased the risk of overall complications (p=0.0015 and 0.0173, respectively) and surgical complications (p=0.0141 and 0.0035, respectively). Moreover the resection of an additional organ was an independent prognostic factor of overall complications (p<0.0001), systemic complications (p=0.0503), surgical complications (p<0.0001) and relaparotomy (p=0.0259). T stage (p<0.0001), N stage (p<0.0001), M stage (p<0.0001) and radical resection (p<0.0001) significantly affected 5year survival rates. Conclusion: Early diagnosis and radical resection was crucial in 5-year survival rates. However, the type of gastrectomy and the resection of an additional organ were the most important factors in short-term outcomes of treatment for such patients.Gastric cancer is the second most common cancer of the gastrointestinal tract in the world. In 2020, the incidence of new cases of gastric cancer was estimated at 1,089,103, with a mortality rate of 768,793 people globally. Unlike East Asia, gastric cancer is a relatively rare neoplasm in North America and some highly developed countries in Western Europe. However, even there it is one of the most common causes of death from malignant neoplasms (1). In Poland, the number of deaths from gastric cancer reaches 5000 per year. In 2018, 3155 men and 1745 women died from this in our country (2).Currently, the majority of publications concern aspects of multimodal therapy with pre-and perioperative chemotherapy, even in the presence of oligometastasis. Nevertheless, surgical resection is still the most effective treatment for such patients, and the principles of surgery of gastric cancer are usually well established (3)(4)(5).Although data from a large number of articles reveals the impact of prognostic factors on the prognosis of patients with gastric cancer resection, survival is significantly improved by the effectiveness of surgical treatment measured by short-term outcomes. Most reports involving prognostic factors for patients after gastric cancer resection focus on the 5-year survival rate. There are no in detail articles on the influence of prognostic factors on short-term outcomes of treatment such as overall complications, systemic complications, surgical complications, relaparotomy and perioperative mortality (6-30). There are many prognostic factors that could affect the short-term outcomes of gastric cancer resection including gender, age, location, histologic type, tumour staging, type of gastrectomy, number of retrieved lymph nodes or resection of an additional organ.In this study we carried out univariate and multivariate analysis of prognostic factors which, in addition to long-term outcomes (5-year survival), also affecte...

PurposeThe aim of the study was an evaluation of I-125 brachytherapy patients with uveal melanoma with special consideration for the relationship of the treatment results and the irradiation dose applied to the tumor apex.Material and methodsMedical records of 344 adults with uveal melanoma treated with I-125 brachytherapy in the Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College in Cracow, Poland were retrospectively analyzed. The study was conducted between 2003 and 2012, and the study group was divided into two subgroups depending on the irradiation dose applied to the top of the tumor: 80 Gy to 100 Gy (n = 177) and 100 Gy to 120 Gy (n = 167).ResultsIt was found that the height of the tumor and the largest diameter of the tumor base decreased with every consecutive follow-up measurement and differed significantly in all comparisons (p < 0.0001). No significant correlation between frequency of complications was found between both study groups (χ2 = 0.27; p = 0.6067). The correlation between survival and the irradiation dose as applied to the tumor top was statistically irrelevant (χ2 = 0.44; p = 0.5084). A logistic regression model showed that patient survival depended on the largest diameter of the base and the height of tumor (p = 0.0216), and the risk of death was larger as these dimensions increased (IR, 1.17). An increase of the largest diameter of the base by 1 mm meant a 17% increase in chances of death. In 13.4% of cases, an enucleation was necessary.ConclusionsThe treatment of choroidal melanomas with I-125 iodine isotope brachytherapy is an efficient and recommended method of treatment and in many cases, an alternative to the enucleation of an eyeball.

Background/Aim: This study analysed the prevalence of the characteristics evaluated in dermatoscopy for melanocytic infiltrations of the conjunctiva with various degrees of malignancy. Patients and Methods: A total of 160 conjunctival pigmented lesions were studied. Each lesion was scored using dermatoscopic patterns and the characteristics of malignancy described by Kittler. Also, the Authors' own clues were added to the evaluation. Results: In melanomas, the following characteristics were identified: asymmetry of the pattern and colour, larger average number of colours, the presence of grey colour, structureless area, polymorphic vessels and feeder vessels. A pattern of black dots and a black colour was typical of malignant lesions and pre-cancerous (premalignant) lesions -primary acquired melanosis (PAM) with atypia. Cysts were observed only in the group of naevi. Conclusion: The patterns evaluated with dermatoscopy are present in pigmented lesions of the conjunctiva. There are, however, some characteristics which allow differentiation between melanoma and pigmented naevus and melanosis and also between PAM.There are several lesions that arise from the melanocytes of the conjunctiva. The most common are naevi, primary acquired melanosis (PAM) and malignant melanoma (MM). The predominant conjunctival pigmented tumour is naevus (1, 2). Naevus accounts for 28% of all conjunctival tumours and 52% of melanocytic lesions (3). It is a benign lesion, with a less than 1% (3, 4) tendency to malignant transformation. It is usually a unilateral, slightly elevated, variably pigmented lesion, with clear cysts, and feeder vessels, and is predominantly located in the bulbar conjunctiva (3). All naevi require serial observation using photographic documentation. Any changes in size, shape or colour are suspicious of malignant transformation and should be treated like melanoma. Some patients demand excision for cosmetic reasons (4, 5).PAM accounts for 11% of all conjunctival tumours and 21% of conjunctival pigmented lesions (2, 6, 7). It can be divided into melanosis with atypia and without atypia, depending on the nuclear features and growth pattern of melanocytes in the histopathological examination. The presence of atypia is associated with a very high risk (13-50%) of malignant transformation, while absence of atypia carries no risk for melanoma development (4-6). PAM with atypia is considered to be a form of melanoma in situ, similar to lentigo maligna of the skin (6, 8). PAM occurs as a flat, unilateral, brown, patchy or diffuse lesion usually in middleaged Caucasian individuals (9). It is thought that it is impossible to distinguish clinically PAM without atypia from PAM with atypia (4). PAM must be differentiated from racial melanosis, which is usually bilateral and symmetrical (6). The procedure proposed by Shields and co-workers in patients with PAM involves observation or surgical treatment in combination with cryotherapy and/or topical chemotherapy depending on the size of the lesion. In cases of very large tumours, ...