Rak piersi współistniejący z ciążą stanowi 10-20% wszystkich nowotworów piersi u kobiet poniżej 30. roku życia. Jego diagnostyka i leczenie wymagają uwzględnienia ryzyka poszczególnych metod postępowania dla zarodka lub płodu. Za badania bezwzględnie przeciwwskazane w ciąży uważa się tomografię komputerową i pozytonową tomografię emisyjną. Standardem leczenia jest zabieg operacyjny: mastektomia radykalna, którą można przeprowadzić na każdym etapie ciąży, lub operacja oszczędzająca pierś, zalecana wyłącznie w III trymestrze. Chemioterapię opartą na doksorubicynie i antracyklinach uważa się za względnie bezpieczną w II i III trymestrze. Przeciwwskazane są: leczenie hormonalne, stosowanie trastuzumabu i bifosfonianów. Szczególne ograniczenia dotyczą stosowania radioterapii. Skutki wewnątrzmacicznej ekspozycji na promieniowanie zależą od okresu ciąży, dawki promieniowania oraz mocy dawki. Narażenie na promieniowanie w okresie preimplantacji może prowadzić do śmierci zarodka lub popromiennej karcynogenezy. W okresie organogenezy istnieje ryzyko opóźnienia wzrostu płodu oraz powstania malformacji narządowych. Ekspozycja na promieniowanie pomiędzy 8. a 25. tygodniem ciąży wiąże się z ryzykiem rozwoju upośledzenia umysłowego, mikrocefalii i karcynogenezy. Powyżej 25. tygodnia ciąży stwarza wyłącznie ryzyko karcynogenezy. Oszacowano, że zastosowanie u kobiet ciężarnych terapeutycznych dawek radioterapii na obszar klatki piersiowej wiąże się z niedopuszczalną ekspozycją płodu na promieniowanie. Jedyną metodą napromieniania dopuszczalną w ciąży, w I i II trymestrze, jest śródoperacyjna radioterapia wiązką elektronową na obszar loży po guzie piersi. Decyzja o podjęciu i kontynuacji leczenia onkologicznego u ciężarnych kobiet powinna być poprzedzona szczegółową analizą potencjalnych korzyści i ryzyka oraz uwzględniać wolę pacjentki. Słowa kluczowe: ciąża, radioterapia, rak piersi, promieniowanie, wytyczne Pregnancy-associated breast cancer accounts for 10-20% of all breast cancers in women under the age of 30 years. The diagnosis and treatment of this type of cancer require an assessment of the risk of different management methods for the embryo or fetus. Computed tomography and positron emission tomography are absolutely contraindicated in pregnancy. Surgical management, i.e. radical mastectomy, which may be performed at any stage of pregnancy, or breast conserving treatment, which is recommended only in the third trimester, is standard treatment. Doxorubicin/anthracycline-based chemotherapy is considered relatively safe in the second and the third trimester. Hormonal treatment, trastuzumab and bisphosphonates are contraindicated. Special restrictions have been introduced for radiation therapy. The consequences of intrauterine exposure to radiation depend on the stage of pregnancy, radiation dose and dose rate. Preimplantation radiation can cause death of the embryo or radiation-induced carcinogenesis. There is a risk of delayed fetal growth and organ malformations in the period of organogenesis. Exposure to radiation betwee...
e20082 Background: Patients with advanced non-small cell lung cancer (NSCLC) are candidates for different types of treatment, including chemotherapy and radiotherapy or supportive care. Despite the fatal prognosis in advanced disease, many experienced radiation oncologists will apply radiation at low doses with the intention of palliative care. Choosing an effective radiation dose that does not cause significant complications remains under discussion. Methods: We used an extensive database of medical patients diagnosed with NSCLC, treated with palliative radiotherapy at the Oncology Centre in Bydgoszcz, Poland, from June 1998 to December 2013. A group of 3202 patients was divided into subgroups: A) 1762 patients irradiated on the lung tumor (without distant metastases): Total dose: A1) 6 Gy/1 fr.(n = 19); A2) 8 Gy/1 fr.(n = 276); A3) 20 Gy/5 fr.(n = 1349); A4) 30 Gy/10 fr.(n = 118). B) 548 patients irradiated on the central nervous system (CNS) metastases: B1) 20 Gy/5 fr.(n = 476); B2) 30 Gy/10 fr.(n = 72). C) 892 patients irradiated on the bone metastases: C1) 8 Gy/1 fr.(n = 452); C2) 10 Gy/1 fr.(n = 30); C3) 20 Gy/5 fr.(n = 341); C4) 30 Gy/10 fr.(n = 69). Date of death was obtained from medical records. Patients who were alive or whose date of death could not be determined were censored at the date of their last encounter. Survival was calculated from the start of treatment to the date of death or censorship. Results: Overall Survival (in months) for each group was: A1) = 6; A2) = 5; A3) = 7; A4) = 7. B1) = 4; B2) = 4. C1) = 5; C2) = 4; C3) = 4; C4) = 5. There was no significant difference in survival between patients treated with single fraction pRT or multi-fractionation schedules in all groups of patients. Conclusions: The patients who were prescribed single fraction palliative radiotherapy did not have poorer prognoses or experience shorter survival than patients who were prescribed multi-fraction pRT in the case of lung tumor, brain metastases and bone metastases.
:Melanoma is considered to be a very aggressive cancer due to its rapid growth, early and multiple metastases and limited response to standard treatment. Many researchers have hypothesized that the combination of radiation therapy and immunotherapy in the treatment of melanoma primary tumors and metastases improves the efficiency of these methods as compared to their use separately. Therefore, combined therapy is an increasingly popular topic in radiation oncology. Although the mechanism of immune response to ionizing radiation remains unclear, known are the factors involved in the immune response, including NK and CD8(+) T cells. Many studies have demonstrated the importance of inflammatory factors, primarily cytokines, in the response to ionizing radiation. In turn, many cytokines released in an irradiated organ, such as tumor necrosis factor α (TNFα), interleukins IL1 and IL6 and transforming growth factor beta (TGFβ), can induce the production of significant amounts of reactive oxygen species that are associated with the induction of DNA damage in tumor cells.In relation to anticancer immunotherapy, the clinical data obtained to date can encourage future studies combining radiation therapy and the inhibitors of cell division checkpoints in the treatment of advanced melanoma. In a recent study, melanoma cell lines became more sensitive to radiation after BRAF inhibition, which provides a potential synergistic mechanism of BRAF inhibitor (BRAFi) combined with radiation therapy for better effects of treatment.In this article, we present a systematic review of the literature on the use of the combination of radiation therapy and immunotherapy in the treatment of melanoma.
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