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Aim: The aim of the study was to analyze long term results and prognostic factors in women with preinvasive breast cancer (DCIS - ductal carcinoma in situ) who underwent breast conserving surgery with subsequent radiotherapy., Materials and Methods: A total number of 106 patients was analyzed aged 29-78 years; mean age was 54,3 years and median 55 years. In 78 (73,5%) patients the tumor was diagnosed incidentally on mammography or ultrasound scan, 28 (26,5%) had palpable lesion. 57 patients had the tumor in the left breast and 49 in the right one. Most often the tumor was localized in external quadrants, namely in 56 (52,8%) patients. All patients had breast conserving surgery and then adjuvant radiotherapy of the breast in typical doses. For evaluation of survival we used the Kaplan-Meier test and for evaluation of cumulated loco-regional recurrence we have applied the method of competing risks., Results: At present 101 patients are still alive, 85 have no relapse. 15 patients had local recurrence and 8 had another cancer. Five patients died during follow-up period. Overall 15-years survival in analyzed group was 88% and disease free survival was 74%. Of all prognostic factors only the value of Van Nuys index was relevant. Patients who had the index value less than 7 had significantly worse prognosis than patients with value 7 or more (p=0,043)., Conclusions: At present 101 patients are still alive, 85 have no relapse. 15 patients had local recurrence and 8 had another cancer. Five patients died during follow-up period. Overall 15-years survival in analyzed group was 88% and disease free survival was 74%. Of all prognostic factors only the value of Van Nuys index was relevant. Patients who had the index value less than 7 had significantly worse prognosis than patients with value 7 or more (p=0,043)., (© 2018 MEDPRESS.)

Haemangiopericytomas (HPCs) in the spinal canal are extremely rare and have only been infrequently reported. Severe and sustained spinal cord compression resulting from these intraspinal tumours may cause potentially irreversible neurological impairment. We described a rare case of primary intradural extramedullary HPC recovered from serious compression of thoracic spinal cord in a 65-year-old man suffered from a rapidly progressive disease with complete paralysis of the lower limbs. Magnetic resonance imaging (MRI) and spinal angiography exhibited an unusual hypervascular mass, which was confirmed as HPC by pathological examination, in the dorsal aspects of T7 to T8 spine. Total surgical resection was performed followed by adjuvant radiation. Moreover, this patient had been undergoing specific training of lower limbs from the onset of paralysis and continuous rehabilitation was conducted after discharge. Increased strength of his lower limb muscles was shown in the period of follow-up. Remarkably, four years after surgery, this patient was able to walk with sticks. No signs of local recurrence or metastasis occurred. Conclusively, surgical removal is still the preferred treatment for HPC, and adjuvant radiotherapy and/or chemotherapy may help control tumour recurrence or metastasis. Additionally, it is possible that rehabilitation training potentially promotes neurological function recovery to some extent.

Malignant tumors of the kidney, which the most common is renal cell carcinoma (RCC) is diagnosed in Poland in more than 5,000 patients each year. Most cases of kidney cancer occurs after the age of 55 years. In men, the risk is 2 times higher than in women. Among the various histological subtypes of RCC, 5% of cases of chromophobe renal cell carcinoma (chRCC). The 1% is in combination with oncocytoma, creating a hybrid chromophobe renal cell carcinoma. The paper presents a case report of a patient operated on because of a kidney tumor - eosinophilic type of chromophobe cancer. During subsequent care of patients experienced a rare complication of this type of tumor, ie. metastasized to the paraaortic lymph nodes. Another surgery and radiotherapy were later stages of treatment. Discussed in the paper example of a patient with type eosinophilic chRCC indicate the variable nature and mileage as compared with typical of the tumor, thus requiring increased surveillance oncology. This requires a careful approach clinicians at the stage of diagnosis and then treatment and aftercare., (© 2015 MEDPRESS.)

Merkel cell carcinoma (MCC) is a rare, neuroendocrine tumour of the skin characterized by a very aggressive course. Firm, red-to-purple, typically non tender papules or nodules is a common of it's clinical manifestation. This carcinoma is more common among white Caucasians males in advanced age. The important risk factors for MCC are immunodeficiency or immunosuppression in patients after organ transplantation. MCC observed in organ recipients is associated with especially rapid progression as compared with general population and tendency to metastasis. Surgical excision of primary tumour with adequate margins and sentinel lymph node dissection with adjuvant radiotherapy improves regional control of disease and patients survival. Chemotherapy is usually used as a palliative treatment for advanced forms of the disease.

Merkel cell tumor is a highly aggressive cancer of the skin and mucous membranes. It is most common in elderly patients and in individuals with impaired immunity. Merkel Cell Carcinoma can develop anywhere, but it most frequently affects the heac and neck, as well the skin of the upper limbs. Clinically, it occurs as red, glistening tumor with telangiectasias on the surface At the moment of diagnosis, 50% of patients have already developed metastases, most commonly to regional lymph nodes. The treatment depends on the severity and consists primarily of surgical excision with a margin of healthy tissue followec by possible complementary radiotherapy. Chemotherapy is introduced in advanced cases.

Introduction: The aim of the study was to evaluate the results of radical surgery in group of 355 patients with advanced laryngeal cancer., Material and Method: The paper presents results of treatment in group of 355 patients with advanced laryngeal cancer treated in the ENT Clinical Department in Zabrze in the following years 1998-2007. The advancement stage was defined as III in 147 patients (42%), as IV in 208 patients (58%). Group of 250 patients (70%) underwent total laryngectomy and group of 105 patients (30%) underwent pharyngolaryngectomy. In the group of 327 patients (92%) operation was performed microscopically radically. 298 patients (84%) underwent postoperative radiotherapy. Median follow-up period was 5 years. Local recurrence, nodal recurrence and distant metastasis were rated as treatment failure. Treatment effectiveness was evaluated in relation to overall survival, disease-free survival, local control, locoregional control and observation free from metastases. All of these parameters were analyzed with the method of updated percentages., Results: During observation period 177 patients (50%) died. Local recurrence occurred in 47 patients (13%), nodal recurrence occurred in 19 patients (5%). Distant metastases occurred in 26 patients (7%). 5-year overall survival rate (OS) was 50%. 5-year disease-free survival rate (DFS) was 47%. 5-year local control rate (LC) was 81%. 5-year locoregional control rate (LRC) was 75%. The updated 5-year observation free from metastases rate (FFM) was 89% respectively., Conclusion: Radical surgery is the chance of 5-year survival of 50% of patients with advanced cancer of the larynx and of 5-year locoregional control of 75% patients., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Introduction: The aim of the study was to indicate independent prognostic factors of treatment in group of patients with advanced cancer of the larynx., Material and Method: The paper presents results of univariate and multivariate analysis of selected clinical and morphological factors in the group of 355 patients with advanced laryngeal cancer treated in the ENT Clinical Department in Zabrze in the following years 1998-2007. The analysis of the results of treatment in relation to clinical and morphological features of the tumor was based on overall survival, disease-free survival, local control and locoregional control. The results of analysis allowed to indicate the independent prognostic factors for outcome in patients with advanced laryngeal cancer., Results: Univariate analysis showed that the increase of clinical advancement of laryngeal cancer was associated with worse prognosis, as well as the fact that the primary location of the tumor in supraglottis and infiltration in laryngeal part of pharynx determined the worse outcome. Univariate and multivariate analysis confirmed that the number of lymph node metastases in the surgical specimen and microscopic radical of surgery were the most important prognostic factors for survival and cure in the study group., Conclusion: The strongest independent prognostic significance for all efficacy criteria have: completeness of operation and number of metastatic lymph nodes., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Intimal sarcoma of the heart and pulmonary artery is a very rare, malignant, primary tumour. The prognosis in patients with primary sarcoma of the pulmonary artery, including intimal sarcoma, is poor. We present the case and 3-years follow-up of 36-year-old woman who was successfully treated with surgical, partial resection of the tumour followed by radiotherapy.

Uterine carcinosarcoma is a rare, metaplastic subtype of endometrial cancer comprised of two distinct malignant components - epithelial and mesenchymal, with phenotypic features. This tumor shows very aggressive behavior including both local recurrence and distant metastases. Surgery consisting of total hysterectomy bilateral salpingo-oophorectomy and dissection of pelvic and para-aortic lymph node, with detailed examination of the entire abdominopelvic cavity and maximal cytoreduction of the lesions, is the principal treatment. The optimal postoperative therapy has not been determined, and is individualized. In a randomized trial a postoperative radiotherapy was shown to improve local control but no survival benefit. High rate of distant metastases suggests a potential role of the systemic therapy However the benefit of postoperative chemotherapy in high-risk patients has not been confirmed in randomized studies. This method, in addition to palliative radiotherapy and surgery is used in recurrent and advanced disease. Currently chemotherapy including the combination of paclitaxel with ifosfamide or carboplatin is considered the most effective regimen, with the latter having a better toxicity profile.

Cervical cancer is a malignancy associated with high morbidity and mortality in Poland. In a high number of cases the disease is diagnosed at an advanced stage, namely FIGO IB2-IVA. The standard method for radical treatment in these patients is external beam irradiation, together with concurrent chemotherapy based on cisplatin in the first stage, and brachytherapy in the next step. Despite such radical treatment, nearly half of women have relapses within the genital tract and regional lymph nodes. The procedure in these patients is a difficult therapeutic problem in gynecologic oncology There is a small percentage of relapses, which are located exclusively in the genital tract. In these cases appropriate treatment offers a chance for permanent cure, but also a high risk of lower quality of life, which is the consequence of surgery or radiotherapy Therapeutic options available in this strictly selected group of patients are the subject of the present analysis.

Unlabelled: The results of combined treatment patients with olfactory neuroblastoma in material of Cancer Center in Warsaw, Aim: The analysis of the results of combined treatment patients with olfactory neuroblastoma in material of Cancer Center in Warsaw., Material: Authors present material of 27 cases olfactory neuroblastoma treated in Cancer Center of Warsaw from 1965 to 2008. The median age was 44 years (range 10-74). The median observation was 72 months (range 2-235).The tumors were seen in 15 women and 12 men. According to Kadish staging there were one A, eight B, and seventeen C stage tumor. The patients in stage A and B was treated by surgery and radiotherapy (mean dose in whole material was 57.15 Gy range 44-70). Five patients in stage C was treated by surgery, radiotherapy and adjuvant chemotherapy. Five patients were treated by neoadjuvant chemotherapy and radiotherapy. Six patients underwent surgery and radiotherapy. One patient was died during adjuvant chemotherapy. One patient in stage B had local recurrence, one local recurrence and metastases and one had only metastases. In stage C 4 patients was died because of metastases, one had local recurrence and, 3 was died because of other reasons. Patients who was failed, underwent surgery, chemotherapy or radiotherapy, it was dependent of clinical situation., Results: A complete regression was seen in 100% patients in early stages (A and B) and 82% patients in stage C. The 5-year local progression-free survival rate was 91% in early stages and 60% in stage C. The LPFS in whole group was 66.7%. The 5-year disease-free survival rate was 91% in early stages, 46% in stage C. The DSF rate in whole group was 44.4%. The 5-year overall survival rate was 80% in stages A and B, 41.2% in stage C. The OS in whole group was 55.6%. The 5-year survival rate was 20% for patients who had recurrence and/or metastases., Conclusion: A combination of surgery and radiotherapy appears to be adequate treatment for early stages (A and B) olfactory neuroblastoma. There are still no clear protocols of treatment patients in stage C., (Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.)

Unlabelled: The growing number of patients with head and neck cancer is a reason to search for new effective treatment strategies. Results of treatment for locally advanced squamous cell head and neck cancer with surgery and/or radiotherapy are still unsatisfactory. During last decade concomitant chemoradiotherapy became a new standard in this group of patients. The treatment method is charged of high toxicity and real therapeutic advantages are obtained by limited number of patients. Intensive clinical investigations on novel therapeutic strategies are in progress. One of them is the combination of induction chemotherapy with taxan (TPF) and concomitant chemoradiotherapy join with cisplatin. The aim of the study was to estimate the treatment tolerance and early term results with combination of induction chemotherapy with TPF and concomitant chemoradiotherapy join with cisplatin in patients with locally advanced, squamous cell carcinoma of head and neck., Material and Methods: Patients with locally advanced oropharyngeal and larynx cancer treated in the Institute of Oncology in Bialystok at the Department of Radiotherapy II from latter half of 2009 year were included in the study. The treatment protocol consisted of 3 courses of induction chemotherapy TPF (Taxotere 75 mg/m2, DDP 100 mg/m2, 5-Fluorouracyl 1000 mg/m2 every 3 weeks) and conventionally fractionated radiotherapy (Df=2 Gy, 5 x weekly) to total dose of 66-72 Gy and for neck cervical lymph nodes up to 60-66 Gy with concomitant of cisplatin 100 mg/m2 every 3 weeks. Early reactions were estimated according to EORTC/RTOG scales, and chemotherapy tolerance was evaluated according to the CTC scale. Twelve patients with homogenous criteria were included in the study., Results: The treatment tolerance was acceptable. However several adverse reactions were present. The main adverse effect was the extensive mucosal reaction. Neutropenia and anemia were also observed in most of the patients. Some patients complained of diarrhea, vomiting and nausea in mild or moderate intensity which were persisted temporarily., Conclusions: Induction chemotherapy TPF and concomitant radiochemotherapy with cisplatin in patients with locally advanced head and neck cancer in III-IV clinical stages came out as the treatment of high efficacy.

In case study, we presented patient with glioblastoma multiforme-brain tumor-grade IV-WHO. Patient after surgery, followed by radiotherapy and chemotherapy, after cycles of chemotherapy with temozolomid. During therapy with temozolomid, it is recommended to check morphology on the 22nd day of cycle. Patient did not come for follow-up appointment, also she did not do any of follow-up tests. She came to the hospital 2 weeks later, in poor general condition with peripheral pancytopenia, neurological disorders and shortness of breath.

The authors describe a clinical case of extensive olfactory neuroblastoma, comprehensive the nasal cavity, paranasal sinuses and orbit who was treated in Otolaryngology Department of the Regional Hospital in Tarnów. The patient was treated with surgery and radiotherapy without orbit exenteration and the 2--year local progression--free survival was observed. Staging system, diagnostics and therapeutic methods were analyzed. Diagnostic difficulties in olfactory neuroblastoma recognition and value of the immunohistochemical examinations were emphasized.

Currently over 90% of children and adolescents with Hodgkin's disease (HD) can be cured thanks to use of multidrug chemotherapy (CT) combined with involved-field radiotherapy (IF-RT). However, the intensive treatment may increase the risk of late complications which may impair the patients' quality of life. In order to decrease the incidence of late complications the protocol with limited use of IF-RT was introduced in centers of Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG). This study presents the treatment results of patients treated with CT only in comparison with the therapy results of children treated with CT and IF-RT. From 1997 to 2006, 634 children (age: 2-22,5 years) with HD were treated in 14 oncological centers of PPLLSG. Majority of patients received CT (3-8 cycles of MVPP/B-DOPA) combined with IF-RT. In 45 patients with IA-IIA stages presenting favorable risk factors (small mediastinal tumor, peripheral nodular mass of a maximum diameter < 6 cm, involvement of less than three nodular regions, ESR < 50 mm after 1 h, histologic type other than lymphocyte depletion and very good treatment response assessed after 3 CT cycles) IF-RT was omitted. Among 634 children first complete remission (RC) was not achieved in 2.4% of patients. Relapses occurred in 24 children (3.9%). The rates of 5-year overall survival (OS), relapse-free survival (RFS) and event-free survival (EFS) were 97%, 96% i 92%, respectively. All patients treated with CT only remain in first CR. All serious late complications (including 7 second neoplasms) occurred in patients treated with CT combined with RT. Seven children died because of severe complications, among them two in first CR (aplastic anemia, sepsis). Our results show that the use of CT only in precisely selected group of patients with HD do not impair the treatment results and may decrease the risk of late life threatening complications. Treatment response assessment with the use of PET may in future increase the number of patients treated without RT and limit the need of the use of invasive diagnostic methods in patients with residual mass.

Patients aged 70 years and older accounted for 42% of all lung cancer deaths in Poland in 2005. Although the incidence of lung cancer in elderly people is growing in Poland, like in other developed countries, the standards of treatment for this subset of population are not well established. Prospective elderly-specific trials concerning curative treatment are lacking. The results from prospective trials including elderly participants show similar effectiveness as in younger population at the expense of higher toxicity. Selection bias may limit the ability to generalize results of clinical trials to the entire population of elderly people. Methods of curative treatment (surgery, radiotherapy, chemotherapy as adjuvant for non-small cell lung cancer and basic treatment for limited-stage small cell lung cancer) are discussed. Some treatment options and modifications of standard strategies which are particularly promising in elderly patients, as VADS surgery, stereotactic radiotherapy or abbreviated treatment for SCLC, are presented.

Coexistence of Graves-Basedow disease with orbitopathy and thyroid cancer is believed to be a rare event. A 39-year-old man with clinical features of hyperthyroidism associated with exophthalmos and goitre presented to out patient clinic. Thyroid function tests showed hyperthyroidism with elevated thyroid-stimulating antibodies. Graves-Basedow disease was diagnosed. Ultrasound revealed diffuse thyroid enlargement with hypoechoic pattern and hypoechoic lesions with regular edges of 1.0 cm diameter at the left and right lobe. Fine needle aspiration biopsy was negative. Due to the patient's nodular goitre and mild orbitopathy, after some further 3 months of anti-thyroid medication, near total thyroidectomy was performed. Histologically, papillary microcarcinoma was found. Following surgery, the patient was referred to our Department of Endocrinology, L-thyroxine suppression treatment was commenced. Approximately 8 weeks post surgery, the patient reported with eye discomfort, soft tissue oedema and double vision. On CT thickening of the left superior rectus muscle was found. Methylprednisolone pulse therapy was applied (4 weeks, 2 grams per week). Glucocorticoid therapy resulted in significant improvement of soft tissue inflammation and of diplopia. The patient was qualified for 131I radioiodine complementary therapy (3657 MBq) and orbital irradiation. While some authors suggest that radioiodine therapy may be associated with worsening of pre-existing orbitopathy, so far we have not observed it in our patient, perhaps due to thyroid removal as a source of autoreactive T lymphocytes and the protective effect of applied glucocorticoids.

We present the case of a 74 year old patient suffering from primary Non Hodgkin's lymphoma of the thyroid and Sjogren's syndrome. A massively enlarging goitre, causing breathlessness in a female patient previously treated for autoimmune inflammation of the thyroid (Hashimoto's disease) and Sjogren's syndrome, indicated the need for a fine needle aspiration biopsy (FNA) of the thyroid gland. Non Hodgkin's lymphoma of the thyroid was diagnosed and chemotherapy was begun. After 10 months of cytostatic treatment clinical tests and imaging indicated complete local regression. However, two months after cessation of chemotherapy the patient suffered a relapse of the disease owing to infiltration of the central nervous system. During the course of palliative radiotherapy the patient died. The main purpose for presenting this case was to describe the problem of primary lymphoma of the thyroid in cases of autoimmune disease. As many years of immunisation may lead to carcinogenesis it is important to raise awareness among medical staff with regard to cases of chronic autoimmune disease. In cases of Hashimoto's autoimmune disease of the thyroid, monitoring of the anti-thyroid antibodies is indicated, at least annually, as an increase in the concentration of these antibodies over a period of at least seven years would suggest further development of autoimmune disease. If such conditions are accompanied by tumours of the thyroid, surgery should be considered. It is worth keeping in mind that the thyroid can be a site for extra-lymphatic lymphoma.

Thyroidorbithopaty is inflammatory disease against the autoimmune reaction. Clinical symptoms are connected within-creasing the volume of retrobulbar tissues. As a result of the autoimmune reaction is reaching to the blow-up, thickening extrabulbar muscles, of appearance of the swelling of the inflammable body of the fat body and tear glands. Heightened retrobulbar pressure is leading to the exophthalmos of the eyeball. He can be a consequence of the exophthalmos insuffiency of eyelids, drying, ulcerations of the cornea. In external eyball muscles changes are leading to eyeball mobility limitation, the double vision, whereas the pressure on the optic nerve can be a reason of injuring it what next serious complications constitute thyroidorbitopathy. In the case active orbithopaty an immunosuppression is an essential way of curing. Disabled advanced form thyroidorbithopaty is a reading for curing applying treatment methods. Outside clinical symptoms among others findings of CT, MR examinations are deciding using it. A treatment is one of methods of operating intranasal curing, of endoscopic decompression of the orbital cavity. Authors are showing the method of operating curing on the basis of the case ill around thyroid orbithopathy in the course of illness Graves- of Basedow with accompanying diabetes.

Introduction: Leiomyosarcoma is a malign neoplasm coming from the non-epithelial tissue. It rarely developes in the larynx. 0,5-1% of all of the neoplasm of the larynx is leiomyosarcoma. It usually developes in the age of 40-70 and mostly effects men., Aims: Improvement of the therapy of patients with leiomyosarcoma of the larynx., Material and Methods: The analysis of the medical documentation of the 5 patients with the diagonosis of leiomyosarcoma laryngis treated in Otorhinolaryngologic Clinic UJ in 1996-2006 was performed. The procedures and effects of the therapy were analized., Results: In this particular period of time 11 patients was operated because of the sarcoma of the larynx. In this group there were 5 cases of leiomyosarcoma, 4 cases of chodrosarcoma and 1 case of agniomyxofibrosarcoma and 1 case of sarcomy synoviale., Conclusions: On the basis of the material of the Clinic the frequency of these tumors was estimated and the therapeutic procedure including widening of the surgical indications for the partial laryngectomy and narrowing the indications for nodular surgery of the neck was proposed.

Introduction: Carcinoma of the large intestine is a common and relatively well known neoplastic malignancy of the digestive tract. In a very few cases its spread seems unpredictable and can cause a distant metastasis to head and neck region., Material and Methods: A 58 years old patient was admitted to the ENT Department because of an exulcerated tumour mass of the left mental and buccal region. 9 months earlier he underwent anterior resection of rectum due to carcinoma. Histopatological examination of specimen from the facial skin lesion revealed adenocarcinoma cells. Radiological findings suggested isolated character of lesion. The patient was treated by surgery and chemotherapy. Wide excision of tumour mass with partial mandibulectomy was performed and the tissue defect reconstructed with a pectoralis major musculocutaneous flap. A postoperative chemiotherapy with FA and 5-FU followed the surgical procedure. Regardless of the first promising results of the oncological treatment the patient died eight months later., Results and Conclusions: We present this case report as an example of an unusual and rare secondary malignancy of head and neck, emphasizing the interdisciplinary character of oncological treatment and the role of oncological vigilance on every step of diagnosis.

Purpose: To evaluate the prognostic factors for the risk of distant metastases after postoperative radiotherapy for laryngeal cancer., Material and Methods: Medical records of 267 patients cancer treated between 1997 and 2003 were analyzed. All pts had locally advanced squamous cell laryngeal cancer treated with surgery and postoperative radiotherapy. Metastasis Free Survival was analyzed using Kaplan-Meier method. A multivariate Cox proportional hazard model and logistic regression model was used to evaluated influence of the following variables on MFS and the ultimate risk of metastases: age, sex, localization, TN stage, HGB before and at the end radiotherapy, total radiation dose, dose per fraction, overall treatment time, interval surgery-radiation time, pathological margins and positive nodes in surgical specimen., Results: The crude incidence of distant metastases was 12% (33/267 pts). One year, 3-year, 5-year actuarial metastases free survival were 95%, 85% and 84% respectively. The lungs and bones were the most common sites of metastases (58% and 33% respectively), whereas metastases to liver (6%) and brain (3%) were rare. Localization of cancer (glottic vs. supraglottic) and number of positive lymph nodes at pathological staging significantly and independently affected MFS., Conclusions: Number of positive lymph nodes in pathological specimen and site of primary cancer (glottic vs. supraglottic) significantly and independently predict a risk of distant metastases in combined modality treatment for laryngeal cancer.

Malignant fibrous histiocytomas (MFH) of the upper respiratory tract are rare, aggressive mesenchymal neoplasms. Ultrastructurally MFH consisted of five different types of cells. It occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. There have been sporadic laryngeal cases reported in the literature. We report a case of a glottic malignant fibrous histiocytoma on a 45 year old man. There was difficulty to find finally diagnosis. Pathologic and immunohistochemical evaluation revealed tumor a few months after first symptoms. There was unilateral metastases into the neck lymph nodes. Immunohistochemical staining was positive for F13a, CD68 and negative for desmin and cytokeratin. Wide, aggressive excision of the tumour with total larygectomy to be the treatment of choice because it was difficult to prove clinically and pathologically that it was MFH. Unilateral neck dissection was done due to metastases into the neck lymph nodes. Radiation have been used after surgery. About two years after total laryngectomy the patient is well and free of disease.

Introduction: Tumors of parotid gland represent a diverse group of neoplasms with varied clinical behaviors., Material and Methods: The diagnostic methods and treatment of salivary gland tumors are presented in this paper. The authors describe the group of 44 patients with salivary gland tumors treated surgically in ENT Departament Laryngology of Medical University in Łódź. Enucleation, partial and total parotidectomy were performed. Neurosign 100 unit was used during parotidectomy to monitoring course of facial nerve., Results: Tumor mixtus was a dominate type of tumors. Only three patients with malignant tumor had facial nerve paralysis after surgery., Conclusions: (1) The extent of the surgical procedure depends on histopathologic diagnosis. (2) Using of facial nerve monitoring during parotid surgery improves its outcomes.

In the last years, a sharp rise in the morbidity due to lung cancer is observed, especially in the male population. Despite the intensive, multidirectional development of oncology, early detection and effective treatment of lung cancer is still limited. Its detection is delayed because of the lack of characteristic early signs. Especially poor in prognosis are patients with small cell lung cancer (SCLC), who usually die in consequence of distant metastases. This may result due to coating of the surface of circulating neoplastic cells with thrombocytes and clots. Platelets aggregates on the surface of neoplastic cells may have a protective action in relation to cytostatic drugs. This is why neoplastic cells that persist through this phase, implant themselves into various organs giving rise to metastases. The aim of the 1st part of the paper was to evaluate the influence of antiplatelet drugs (AD) on the haemostatic system of patients with SCLC. There is data in literature indicating a ameliorating influence of AD on time of survival of patients with certain neoplasms. The study was performed in 87 male patients aged 35-73 years with SCLC, limited to half of the chest (limited disease). After 2 i.v. chemotherapy series in 3 week intervals (VAC scheme according Greco): --Adriamycin (ADR) 40 mg on 1sq.m of body surface; --Vincristin (VCR) 1 mg; on 1sq.m of body surface; --Cyclophosfamid (CTX) 1000 mg on 1sq.m of body surface; radiation was also applied--40 Gy during 20 days on the tumor and mediastinum. The described treatment was performed in 22 patients from controls (Group I). Patients from Group II (n = 22) received additionally Defibrotide, Group III (n = 22) Ticlide and Group IV (n = 21) Aspirin. To evaluate of the influence of AD on the haemostatic system--every 3 months during the consecutive 27 weeks, the following tests were performed: bleeding time, clotting time, platelet aggregation, platelets aggregation ratio, euglobulin clot lysis time (ECLT), fibrinogen and fibrinogen degradation products (FDP). It was shown that AD prolonged bleeding and clotting time, increased the threshold ADP and collagen concentration causing platelets aggregation as well as increased platelet aggregation ratio. The used AD (Defibrotide, Ticlide) resulted in activation of the plasma fibrynolytic system as expressed by a shortening of the ECLT, lowering of fibrinogen level and increasing FDP. The influence of observed changes in the haemostatic system, as a result of AD on the remission and survival time of patients with SCLC will be presented in the 2nd part of this paper.

Heterotopic ossification (HO) is defined as pathological bone formation in soft tissues, for example in muscles, where physiologically there is no osseous tissue present. It is one of the most common complications of total hip joint replacement surgery. A wide variety of risk factors for heterotopic ossification have been identified to date. Almost 90% of total hip arthroplasty patients are at high risk for HO. There are two primary methods of preventing heterotopic ossification: pharmacotherapy with NSAIDs (non steroid anti-inflammatory drugs) and radiotherapy. Symptomatic heterotopic ossifications are treated by extracorporeal shock wave therapy (ESWT) and surgery, followed by NSAID pharmacotherapy or radiotherapy. The arterioles adjacent to areas of heterotopic ossification are usually embolized prior to the operation. This article describes the state of the art in the prevention and treatment of heterotopic ossifications based on the available literature.

Unlabelled: The aim of this study was retrospective analysis of evidence concerning to malignant tumors of the nasal cavity and the paranasal sinuses diagnosed in Otolaryngology Clinic of the Military Institute of the Health Service 1971-2005. The methods of therapy were also discussed., Material and Methods: Material comprised 113 patients (35 females and 78 males) with diagnosis of malignant tumors of the nose and paranasal sinuses. The clinical aspects, sex, age, TNM classification and therapy methods (surgery, radiotherapy, chemotherapy) were analysed., Results: There were 31% females and 69% males (ratio 1 : 2.23). Each year on average 3.23 cases occurred. The highest morbidity was observed in 1997 and 2001 (6 cases each). In 89 subjects (23 females and 66 males) the neoplasm of epithelial origin were diagnosed. The age range of patients was 14-74 years (mean 68.2 years). The most numerous were groups of 60-69 (50 patients) and 70-79 (44 patients). In 82 cases (over 72%) tumors in advanced stages (T3, T4) were revealed. Two subjects (T1) were opera tem on and others 88 (T2, T3, T4) were treated surgically with subsequent radiotherapy. Three of patients did not agree for therapy., Conclusions: The most frequent of malignant tumors of the nose and paranasal sinuses was cancer. The clinical symptoms of tumor were disclosed most often in age of 60-80 years. The method of choice in treatment is surgery combined with postoperative radiation.

Introduction: Primary frontal sinus cancer is rare tumor of the paranasal sinuses. Tumors in the frontal sinuses are more often extensions from the ethmoid sinus--secondary involvement. The authors present a case of man with primary squamous cell carcinoma of the right frontal sinus., Material and Methods: A 49 years old man was admitted to the Dep. of Otolaryngology with right frontal sinus tumor. The man had painless forehead and upper lid swelling followed by orbital symptoms--diplopia. CT showed large destruction of anterior frontal sinus wall and invading thought inferior wall to the orbit. The patient was qualified to frontal sinus operation with right orbit content removal. Histopathologic postoperative examination showed squamous cell carcinoma G2 of right frontal sinus., Results: A combined treatment, surgery and postoperative radiotherapy succeeded in good result. The 5-year survival rate in this case is 100%., Conclusions: Frontal sinus cancers are rare and diagnosed in late clinical stage. The treatment is both, surgery and obligatory postoperative irradiation. The effect of treatment is still insufficient in most cases.

Introduction: The sinonasal tumors belong to rare diseases. They state 0.2-0.8% of all the malignant neoplasms and about 3% of head and neck tumors. These tumors are two times frequent observed in men than in women, mainly between 50 and 70 years old. In the sinonasal complex besides the primary are seen also the metastatic tumors. They state about 1% of all tumors (kidney, testum, breast, pulmonary)., Aim: The aim of our study was to retrospective analysis of the sinonasal tumors, treated in the ENT Department Silesian Medical University in Zabrze. The special attention was carried on the preoperative diagnostics and proper qualification to the surgical treatment., Material and Methods: 26 patients treated in the ENT Department Silesian Medical University in Zabrze between 2000 and 2006 suffered from the sinonasal tumors were retrospectively analyzed., Results: In the histological examination in 4 patients the benign neoplasm and in 22 patients malignant tumors were diagnosed. 24 patients were surgically treated (2 patients were not qualify to surgery because of the general diseases). On the basis of the CT and MRI examination as well as the description of the surgical procedure we stated that in 13 cases the primary localization of neoplasm was the maxillary sinus, in 5 cases ethmoidal cells, in 3 nasal cavity. In one patient the estimation of primary tumor localization was not possible, because of the very large extension of the neoplasm. The choice of the surgical procedure was depend on the tumor extension and localization. In 19 cases lateral rhinotomy with different modifications was performed. In one case the cranial incision was done. In 8 patients with the infiltration of lateral nasal wall the medial maxillectomy were performed. In 8 other patients upper maxillary resection were done. In two cases the total maxillectomy were performed, in the next two lower maxillary resection. All the patients were postoperatively treated by radiotherapy.

Unlabelled: The aim of the work was to assess the results of breast conserving treatment (BCT) in early breast cancer in patients treated in Lower Silesian Oncology Centre., Material and Methods: Analysis of data from 167 women treated between 1997 and June 2003 with BCT and adjuvant therapy was performed., Results: Only in 14 patients (8.3%) failure of treatment was observed. In 7 cases (4.8%) there was local recurrence, all of them underwent mastectomy m. Patey and they are all alive without disease symptoms. In 6 women (3.6%) dissemination of cancer was observed. Death of 5 patients (3%) between 21 and 68 months from operation took place. In Cox-Mantel test only dependency between N status and dissemination (p < 0.05) was noted. Better results of treatment were connected with estrogen receptor (ER) overexpression. Our results do not differ from data published by leading oncology centers around the world.

According to the results of the metaanalyses the postoperative radiotherapy (PORT) after completely resected non-small cell lung cancer (NSCLC) is detrimental for early stages (I and II). Its role for pN2 patients is unclear. Therefore, the PORT is not recommended for patients after complete resection. However, the PORT metaanalysis raised many criticisms, because of the methodological issues and inclusion of series with outdated radiotherapy techniques. The potential advantages and disadvantages of PORT especially for stage III disease in the context of modern radiotherapy techniques and adjuvant chemotherapy regimens are discussed. Such a prospective study exploring mainly the issues of cardiac and pulmonary toxicity is currently conducted in Poland. The reasons of the common use of PORT, also for early stages of the disease, as shown by patterns of care surveys are presented in the light of the quality of surgery issues.

A squamous cell carcinoma of the nasal vestibulum is rare variant of skin cancer and constitutes only 7% of malignant tumors of the nasal cavity. Authors presents a case of neck lymph node metastases from primary site (nose vestibulum) which was completly surgical excision 3 months before. When another primary site of cancer were non confirmed selective neck dissection and adjuvant radiotherapy was performed.

Introduction: The aim of this study was to compare the early outcomes between two groups of patients with differentiated thyroid carcinoma (DTC) who received 60 or 100 mCi of (131)I for remnant ablation., Material and Methods: 224 DTC patients with primary tumor > 1 cm of diameter or multifocal were randomised into prospective clinical trial. Patients with extrathyroideal extension of primary tumor and nodal metastases or M1 were not enrolled. 99 patients received 60 mCi, and 125--100 mCi of radioiodine as the first ablative dose., Results: The effectiveness of thyroid ablation was evaluated after one year, during endogenous TSH (thyroid stimulating hormone) stimulation, and after two years during Lthyroxine therapy. Whole body scintigraphy (WBS) was performed under thyroxine withdrawal and thyroglobulin serum level was assessed. Distant micrometastases were detected in 9.8% of patients by post-therapy WBS, 11 patients in group A treated with 60 mCi and 11 in group B treated with 100 mCi. In other patients no symptoms of persistent disease were detected. At one year follow up full remission was diagnosed in 176 patients: 76 in group A and 100 in group B. The remaining ones, 13.3% and 11.2% respectively, received the second course of (131)I for remnant ablation. There were no statistically significant differences in Tg (thyroglobulin) serum level either 12 or 24 months after 131I treatment., Conclusions: Our evaluation of early efficacy of adjuvant radioiodine treatment in low risk DTC patients shows no differences between two radioiodine activities - 60 and 100 mCi in relation to thyroid ablation. Thus, the activity of 60 mCi is recommended.

Introduction: Despite progress in neuro-oncology, treatment results of children and adolescents with brain stem tumours remain poor. There are also controversies concerning the role of chemotherapy in the treatment of these tumours. THE AIM of our study was to analyze treatment results of patients with brain stem tumours treated with radiotherapy alone and with the addition of chemotherapy and to assess which chemotherapy protocol is the most efficient., Material, Methods: Between 1981-2004, 126 patients were treated in our department. The patients were divided into 2 groups according to treatment methods applied. The first group consisted of 49 patients treated with radiotherapy alone. In the second group 77 patients were irradiated and received chemotherapy. Overall survival (OS) at 1 and 5 years was analyzed in both groups. The efficacy of treatment of patients from the second group was assessed by evaluating reaction to radiotherapy, to different chemotherapy protocols and duration of tumour regression. Additionally OS was assessed separately for patients with low grade gliomas treated in the second group., Results: Seven out of 49 patients from the first group are alive with a follow up from 8 years 9 months to 24 years, median 6 years 7 months. In the second group, 25 out of 77 patients are alive with the follow up from 7 months to 8 years 2 months, median--l year 7 months. OS at l and 5 years for patients treated with radiotherapy alone is 48 and 14% and for those receiving additionally irradiation 59 and 18% respectively (statistically insignificant). Best tumour response was achieved in 42% of patients with radiotherapy but in 75% of cases regression lasted from 2 weeks to l year 3 months, median 4 months. Addition of chemotherapy consisting of cisplatinum and temozolamide resulted in tumour regression in 27% of patients lasting from 4 weeks to 4 years 5 months, median 4 months. OS for patients with LGG was 34.6% at 5 years., Conclusions: 1. Radiotherapy in brain stem tumours allows to achieve tumour regression but short duration of remission and poor final outcome forces to search for other, effective treatment. 2. Patients with brain stem tumours may benefit from chemotherapy in terms of prolonging survival. 3. Chemotherapy consisting of temozolamide and cisplatinum seems to be promising and might add to improvement of treatment results, but further clinical studies are needed. 4. Patients with low grade gliomas of the brain stem constitute a separate group with a better prognosis.

Unlabelled: THE AIM of the study was to evaluate the incidence of pulmonary complications in children cured from Hodgkin's disease (HD)., Material and Methods: 42 children with HD were treated in the Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk, between 1994 and 2004. Stages of HD: II--26 children, III--10, IV--6; general symptoms (group B) were present in 50% of patients. Mediastinal involvement was found in 33 children, lung parenchyma infiltration in seven and bronchi involvement in one. In 1/3 of these patients the localization of HD within the chest was massive and symptomatic with signs of the superior caval vein symptoms, cough, dyspnea and cardiac tamponade. The treatment was conducted according to the schemes of the Polish Paediatric Leukaemia /Lymphoma Study Group. Eleven patients required therapy modification including six, in whom the intense line II chemotherapy Salvage 95 was introduced. 29 patients received chest irradiation with doses between J 75 and 36.5 Gy. Pulmonary function was evaluated from the results of clinical examination, 1 chest radiography (CXR), computed tomography, spirometry and lung scintigraphy., Results: Pulmonary complications occurring as fatigue and diminished physical effort tolerance was observed in only two children. Some of the remaining 40 patients demonstrated asymptomatic abnormalities in the analysed tests. Abnormalities in CXR (upper mediastinal fibrosis, postoperational changes within the diaphragm and pneumonitis) were found in six children, minor ventilation problems in spirometry--in 12 and decreased lung perfusion in five. The scintigraphic signs of lung embolisation were not observed in our material. Most of the pulmonary complications occurred in children with enlarged lymph notes located within the chest, especially these with bulky disease presenting with cardio-pulmonary symptoms. In this group of patients the chest irradiation was performed in all except four children, three patients were also administered aggressive salvage chemotherapy., Conclusion: The pulmonary complications in children after completed therapy of HD are not common and mainly asymptomatic and occur predominantly in patients with massive mediastinal and/or lung involvement at diagnosis. The issue needs further evaluation of a more numerous group of HD survivors and a longer follow-up.

Unlabelled: The cure rate in children with Hodgkin's disease (HD), at present time exceeds 90% but the prognosis in stage IV HD is much worse. THE AIM of the study was to analyze the initial symptoms, course and results of oncological therapy in children with stage IV of Hodgkin's disease., Material and Methods: The analyzed group comprised of 15 patients with IV stage HD (M/F: 11/4, mean age: 12 years), treated from January 1993 to March 2005, in two Polish centres of paediatric oncology in Gdansk and Lublin. The diagnosis and therapy were carried out according to the current protocols approved by the Polish Paediatric Leukaemia / Lymphoma Study Group (PPGBCh)., Results: Mean duration of initial symptoms was 4.5 months, with most children presenting general symptoms of HD. At diagnosis, the involvement of mediastinal and/or hilar lymph nodes was found in nine patients, lung infiltrations in six, involvement of the spleen, liver and bones in five, three and one patient, respectively. The nodular sclerosis histopathological type of HD predominated. Poor response to standard treatment was observed in five children. One patient received additional cycles of chemotherapy MVPP/B-DOPA, four children were administered the 2nd line chemotherapy Salvage 95. One boy with very poor response to the 1st and 2nd therapy lines additionally underwent megachemotherapy with peripheral blood stem cells transplantation. Radiotherapy was given to 13 children. 13 out of 15 children are alive and free of disease with mean follow-up duration of 6 years. In two of them late complications affecting hormonal status, cardio-pulmonary disorders and chronic B and C hepatitis were observed. Two children died including one admitted in a very severe condition, after long-lasting medical history who died of neutropenia-related sepsis. The second boy died 12 months after stem cell transplantation because of a second neoplasm--acute myeloblastic leukaemia., Conclusion: Chemo- and radiotherapy implemented according to protocols approved by the PPGBCh for children with stage IV HD, result in complete remission in most patients. Diagnosis made at earlier stages would result in giving less aggressive therapy, connected with a lower risk of durable late complications.

Unlabelled: Non-rhabdomyosarcoma soft tissue sarcomas (NR STS) are a rare group of neoplasms of mesenchymal origin. The incidence of these tumours in children is low and due to it's heterogeneity and different response to chemotherapy and radiotherapy, unified treatment methods have not yet been established. THE AIM of our study was to analyze methods and treatment results of patients with NR STS treated in our centre., Materials and Methods: Between 1996 and 2004, 64 patients with NR-STS, aged 2.5-21.5 yrs, were treated in our institution. Treatment protocol included primary tumour resection or biopsy, induction (neoadjuvant) chemotherapy, local treatment: surgery and/or radiotherapy and adjuvant chemotherapy. Results of treatment were analyzed in relation to stage, tumour diameter, extent of surgery and response to chemotherapy., Results: Out of 64 patients, 48 are alive (75%), with a median observation time 4 yrs 3 m. Sixteen patients died: 1 of treatment complications, the rest from basic disease. Four years overall (OS) and event free survival (EFS) are 75% and 64% respectively. Early stage, tumour size less than 5 cm in diameter, radical surgery, complete and very good response to induction chemotherapy had a significant influence on survival., Conclusions: Our results indicate that besides stage and tumour size, radical surgery played key role in the treatment of NRMSSTS and that radical resections were possible to perform after induction chemotherapy in 33% of patients with primarily unresectable tumours. High number of patients with stage IV disease at diagnosis, occurrence of distant relapses and good response to chemotherapy indicate the necessity for the use of chemotherapy in patients with NR STS.

Unlabelled: Malignant neoplasms of the nose and paranasal sinuses occur rarely but due to late diagnosis and poor treatment effects still remain a serious problem. The aim of the study was the analysis of all nose and paranasal sinus neoplasms treated at Lower Silesia in the years 1992-2001., Material and Methods: In the years 1992-2001 in Lower Silesia region there were 182 patients treated for malignant nose and paranasal sinus tumors. Males outnumbered females significantly with male : female ratio was 1.9:1. Principal management was combined therapy--surgery with radiotherapy in 84% of the cases. Radiotherapy alone was performed in 8.8% and chemotherapy as palliative treatment in 7.1%. Fifteen patients (8.2%) underwent radical neck dissection followed by radiotherapy., Results: The analysed group constituted 79.6% patients with epithelial tumors and 20.4% with nonepithelial tumors. Cases T3-T4 predominated in the material in amount of 77.9% (113). There were 15 T2 cases (10.4%) and none of T1. Most of the tumors (57%) arose from middle segment of ethmomaxillary sinuses. Upper segment tumors constituted 18.6% of cases and lower segment--10.4%. Enlarged lymph nodes were diagnosed in 8.2%. Survival rate analysis in patient treated in the years 1992-2001 revealed 37.9% (69) of 3-year survival and 30.2% (55) of 5-year survival., Conclusions: Unsatisfactory results of treatment are an effect of a high advanced stage of the tumor while diagnosed. Its direct causes are: asymptomatic course of the disease, localization in complex anatomical structure, not enough experience among medical staff dealing with the disease very rarely.

The study presents a case of ovarian cancer recurrence in extraperitoneal localization observed after twenty nine years of radical surgery and radiotherapy. New focus of ovarian cancer has been placed near right oval ligament of uterus. Long-term survival and ovarian cancer recurrence in extra-abdominal place may be taken as a confirmation an opinion about a role of multifocal neoplasia of mesothelium in pathogenesis and recurrence of ovarian cancer.

Occurrence of anxiety and depression was investigated in 76 patients with recognized larynx and/or hypopharynx cancer and with or without alcohol dependence. The patients were treated using total or partial laryngectomy or radiotherapy. Patients were examined three times using questionnaires: SCID, BDI, STAI. The greatest intensity of anxiety was observed before treatment, especially in patients qualified for surgery. After finishing the treatment, independently of the type of operation, intensity of anxiety was lower than in patients treated using radiotherapy In patients after total laryngectomy the greatest intensity of depression was observed 7 days after operation. The mood of these patients has improved significantly before discharge from hospital. In patients treated with partial laryngectomy such great changes of mood were not observed. In patients treated using radiotherapy were stated greater intensity of depression at the end of treatment - despite of initial mood improvement. Patients with alcohol dependence were stated greater intensity of anxiety and depression than in the other patients. Dynamics of the intensity of anxiety and depression in the different diagnostic and therapeutic groups of patients with laryngeal or hypopharyngeal cancer should be done under consideration of their prophylactic and rehabilitative effects.

Unlabelled: Malignant neoplasms localized in the parameningeal region include mainly soft tissue sarcomas (MTM), non-Hodgkin s lymphomas (NHL-B) and, less frequently, nasopharyngeal carcinomas. The aim of the study was to analyze diagnostic and therapeutic problems in children with parameniingeal neoplasms treated in Departments of Paediatric Oncology in Gdansk and Lublin between 1992 and 2004., Material and Methods: The study includes 32 patients (M/F: 23/9), aged 2 to 17 years, mean 6,3 years. In 17 children MTM was diagnosed: in nine NHL-B-cell and in six--nasopharyngeal carcinoma (lymphoepithelioma). The diagnosis of NHL-B and undifferentiated MTM were made in two children treated previously for NHL-nonB and retinoblastoma. Two cases of NHL appeared in a girl with ataxia-teleangiectasia syndrome., Results: Initial symptoms lasted from 2 weeks to 24 months, mean 4,5 months for the whole group. In NHL patients mean period ofsymptoms was 4,5 weeks, in MTM- 5,5 months and in lynmphoepithelioma--7 months. Symptoms associated with the tumours localisation (snoring, breathing through the mouth, epistaxis, chronic purulent rhinitis, dysphagia and earache) predominated and were treated initially as upper respiratory tract infections. Cervical lymph nodes enlargement was observed in 30% children with MTM and 83% with lymphoepithelioma. Most of patients presented with highly advanced stages of neoplasms. MTM and NHL-B treatment was conducted according to the protocol approved by the Polish Paediatric Solid Tumours and Leukaemia/Lymphoma Studies Group. In patients with lymphoepithelioma different treatment schemes were administered, including chemo- and radiotherapy. Good response to therapy was found in 13/32 patients (41%). The group included 24% children with MTM (all with embryonic subtype), 56% with NHL-B and 67% with lymphoepithelioma. All these patients attained complete remission after standard line I therapy. But 13 children with MTM, four with NHL-B and two with lymphoepithelioma required more aggressive line II treatment because ofpoor response to therapy (NR) or relapse. Finally, 20 of 32 followed-up patients (62,5%) are in durable complete remission from 10 months to 11 years 4 months (mean 4 years) after therapy discontinuation. This group consists of all nine patients with NHL-B, 67% children with lymphoepithelioma and 41% with MTM. In six children (30%) persistent complications of oncological treatment occurred, including: hypoacusia, postradiation defect of the eye ball, postsurgical facial nerve palsy and cranio-nasal fistula complicated with pneumocephaly. A patient with MTM of maxillary sinus developed a second neoplasm 2 years after first therapy. This was glioblastoma multiforme located in the left parietal lobe (outside the radiation field). At present, the boy is in complete remission 2,5 years after treatment for the second tumour Among 32 children with parameningeal neoplasms 11 patients died (nine with MTM and two with lymphoepithelioma), all in the phase of disease progression (five NR and six after relapse). In two of them (with MTM) the direct cause of death was myelosupressive, gastrotoxic and infectious complications of antitumour therapy. One child still undergoes treatment for MTM relapse.

Aim: analysis of the course, outcome and therapy complications in bladder/prostate soft tissue sarcomas (STS) in children treated from I'1997 to II'2003 according to CWS-96 protocol in Poland., Material and Methods: 22 children (M/F: 17/5, age: 8 months - 17 years 2 months; median 5,3y). Histopathology: RMS-20 patients (RME-14), non-RMS-2 patients., Results: 96% presented with advanced neoplasm (III - 14, IV - 7). In 18 patients (82%) primary tumour exceeded 5cm; in 17 (77%) extended beyond site of origin. Lymph nodes metastases were stated in six (27%), distant metastases in seven patients (32%). No patient underwent primary complete tumour excision. All received chemotherapy for high risk group. Response to chemotherapy after three cycles was favourable in eight and unfavourable in eight children. Delayed resections were performed in 11 patients (mutilating - 7) proving complete in only five. Radiotherapy (32-50,4Gy) was given to 16 patients, mainly after delayed incomplete surgery. Five patients developed local relapse, four--continual disease progression. None of these nine patients had ever complete tumour resection. Nine patients died: seven due to neoplasm progression, two of therapy complications (septic shock, ARDS). Thirteen patients are alive (59%) with mean follow-up of 42 months. Eight children had bladder removed with continent ileal pouch formed in four., Conclusions: 1) Advanced stages of bladder/prostate sarcomas in children suggest the necessity of earlier diagnosis. 2) Due to adjuvant chemo- and radiotherapy approximately 60% of patients with this diagnosis may be nowadays cured of bladder/prostate sarcomas without mutilating surgical procedures.

Aim: Analysis of therapy efficacy in non-bladder/prostate genitourinary sarcomas in children treated from I'1997 to VI'2003 with CWS-96 protocol in Poland., Material and Methods: 19 children (M/F: 15/4, age: 3m-17,5y; median 7,2y). Histopathology: RMS - 15pts (RME-13), non-RMS- 4., Results: Primary site: testes - 9 patients, paratesticular region - 6, uterus - 2, vagina and ovary-1 of each. 63% presented with low stage neoplasm (I - 7, II - 5). Primary tumour exceeded 5cm and/or invaded surrounding tissues in 7 patients (37%). 3 patients had regional, 2 patients--distant lymph nodes metastases. Primary excision: complete in 7 patients, incomplete - 12 (microscopically - 5, macroscopically - 7). Six of 7 patients with macroscopic tumour residues responded to chemotherapy (CR-4, GR-2). One patient (stage III triton tumour of uterus) did not, respond but obtained complete remission after mutilating delayed surgery. No other patient required delayed tumour resection. Radiotherapy (23,5-54 Gy) was given to 8 patients. 3 children developed local relapse, 3 patients died (16%): 2 due to neoplasm progression, 1 of neutropenia-related sepsis. 16 patients are alive (84%) with mean follow-up 48 months. The only permanent complications result from mutilating surgery., Conclusions: 1) prognosis in children with non-bladder/prostate genitourinary sarcomas is favourable despite incomplete primary excision of the neoplasm. 2) chemotherapy and radiotherapy were accompanied by severe but transient myelosupression in the HR group.

Surgery remains the standard radical therapy of esophageal cancer. Esophagectomy is accompanied by high proportion of morbidity and mortality, and on overall provides relatively poor results. Recently in esophageal cancer, radiation therapy has been more frequently combined with other modalities including chemotherapy and surgery. Survival benefit following preoperative chemoradiotherapy was demonstrated in only one randomized trial including patients with adenocarcinoma. Similarly, no survival benefit following postoperative chemoradiotherapy was demonstrated. Therefore, such two-modality strategies are not recommended as a standard management. Definitive radiotherapy is indicated in early-stage esophageal cancer patients not amenable to surgery because of comorbid conditions, in those who refused surgery, and in selected patients with locally advanced disease. Improved survival rates, yet at the expense of increased toxicity, were reported by the combining of radiotherapy with chemotherapy including 5-fluorouracil and cisplatin. Both brachytherapy and external beam radiotherapy are the main palliative approaches in patients with dysphagia.

Objectives: The aim of study was to analyse results of treatment patients with uterine-confined endometrial cancer which underwent surgery and postoperative radiotherapy in Center of Oncology in Kraków between 1985 and 1997., Material and Methods: The research included a group of 650 women. All patients undergo total abdominal hysterectomy with bilateral salpingo-oophorectomy and postoperative radiotherapy. 155 patients with intermediate-risk of recurrence (IA-G3, IB-G1, G2) received postoperative whole pelvic irradiation only. In the group of 495 patients with high-risk of recurrence (IB-G3, IC, II) 210 patients received brachytherapy vaginal cuff only and 285 patients whole pelvic and vaginal cuff irradiation., Results: In the group of patients with intermediate-risk of recurrence five NED survival was 93.5%. In the group of patients with high-risk of recurrence five NED survival was statistically lower in patients treated with brachytherapy vaginal cuff only (83.2% vs. 71.9%)., Conclusion: In uterine-confined endometrial cancer patients, with intermediate-risk of recurrence treated with surgery and postoperative whole pelvis irradiation, 5-year NED survival is above of 90%. In the group of patients with high-risk of recurrence the adjuvant treatment of choice is whole pelvic and vaginal cuff irradiation.

Purpose: To investigate the impact of hemoglobin concentration (Hb) at the start and end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy on the loco-regional control in postoperative radiotherapy for patients with advanced laryngeal cancer., Materials and Methods: Between January 1993 and December 1996, 254 patients with pT3 or pT4 and pN0-pN2 laryngeal cancer were treated with a total laryngectomy and adjuvant radiotherapy (RT). The median age of patients was 56.3 years (range: 30-70 years). The analyzed group consisted of 236 males (92%) and 18 females (8%). In all cases a total laryngectomy was performed. 196 out of 254 patients underwent homolateral neck dissection and 58 out of 254 underwent bilateral neck dissection. The primary tumor bed was irradiated to the median total dose of 61.2 Gy (range: 57 - 64 Gy) and all regional lymph nodes were treated in all patients to a dose of 50 Gy. Indications for postoperative RT were close postoperative margins at the tumor site or pathological status of lymph nodes described as pN1 or pN2. Univariate analyses were used to determine the predictors for locoregional failure. The following factors were studied for prognostic importance of loco-regional outcome: the hemoglobim concentration at the start of radiotherapy, at the end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy, age, sex, pT and pN categories., Results: The actuarial 5-year overall survival was 49%, the actuarial loco-regional control rate was 70%. Univariate analysis, using log-rank test indicated that pN +, Hb level at the end of RT (p = 0.004) and drop during RT (p = 0.038) were predicted for the loco-regional control of postoperative radiotherapy., Conclusions: Analysis showed that the low level of Hb at the end of radiotherapy and the drop during radiotherapy were correlated with decreasing of the loco-regional control of adjuvant radiotherapy for patients with advanced laryngeal cancer.

The authors present 18 patients with malignant neoplasms of the ear and temporal bone who were treated in the Clinic of Laryngology Medical University of Silesia in Katowice in the years 1991-2001. The most frequent was squamous cell carcinoma (11 patients--61%). The neoplasm was located on the auricle in 7 patients (39%), in the external auditory canal in 4 (22%) patients, in the middle ear in 5 patients (28%) and in 2 cases (11%) it was difficult to establish primary site. Ten patients (55.5%) were treated in stage T4. All patients had surgery and in advanced cases the radiotherapy was added. The best outcomes were in auricular neoplasms. The treatment results were much worse in neoplasms of the external auditory canal and the middle ear. Over 3 year follow-up in 10 patients (55%) with ear and temporal bone neoplasms shows no recurrence.

Aim of the study is evaluation of radiotherapy treatment in cancer of oropharynx and nasopharynx. Retrospective analysis was based on 283 patients in III and IV clinical stage of disease without distant metastases who were treated between 1989-2001. 201 patients were treated radiotherapy alone and 82 by combined modality: radiotherapy and chemotherapy. Induction chemotherapy and radiotherapy was used in 34 cases, concomitant chemoradiotherapy--25 and adjuvant chemotherapy and radiotherapy in 23 cases. Following methods of radiotherapy fractionation were used: accelerated in 35 cases, conventional--26, hyperfractionation--21. Accelerated treatment mainly was used in concomitant combined modality. Log-rank statistical analysis revealed better results of treatment for combined modality: radiotherapy and chemotherapy. Most effectiveness method of combined modality was concomitant radiochemotherapy. Locoregional control in 3 years observation interval was better for concomitant mode about 18% comparing to induction chemotherapy and radiotherapy and 30% to adjuvant chemotherapy and radiotherapy. Based on this data, the optimal mode of treatment in III and IV stage of oropharyngeal and nasopharyngeal cancer, especially with extensive nodal disease and extranodal involvement is concomitant treatment with accelerated fractionation dose of radiotherapy.

Purpose: To assess the toxicity and the efficacy of adjuvant radio-chemotherapy in patients with high-risk gastric cancer., Methods and Materials: Patients with adenocarcinoma of the stomach were enrolled into the study from April 1999 to December 2000. There were 15 females and 27 males, 33 to 69 years old (median 52). There were following inclusion criteria: tumor stages T1-2 N1-3 or T3-4 N0-3, no distant metastases (except resected metastases to sac or spleen). All patients had lymph node and/or serosal involvement. Radiation dose of 42.5 Gy in 1.7 Gy per fraction was delivered to the tumor bed and regional lymph nodes over 5 weeks. In 4 cases of nonradical surgery a boost dose of 8.5 Gy was given. Chemotherapy consisted of 5-Fu 325 mg/m2/day, given on day 1-3 and 29-31 of radiotherapy., Results: All patients completed radiotherapy as planned. Mild nausea/vomiting in 43% of pts., leucopenia WHO 1 and 2 in 43% of pts. as well as WHO 3 in 5% of pts. and diarrhea WHO 1 and 2 in 21% of pts. were the most frequent toxicities. Three year relapse-free survival and overall survival rates were 29% and 31%, respectively (median 12 and 18 months). Three year survival rates in stage II, III and IV were 67%, 24% and 17% respectively., Conclusion: Postoperative radio-chemotherapy in patients with locally advanced gastric cancer was safe and well tolerated. The results obtained in this study and from literature suggest that adjuvant radio-chemotherapy may improve 3-year survival rates by 10-15% compared to historical controls treated with surgery alone.