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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.

Background and Purpose: For patients with rectal cancer treated with full thickness local excision the risk of mesorectal nodal metastases has to be very low. The aim was to assess this risk after preoperative radiotherapy in relation to pathological T-category., Patients and Methods: Three hundred sixteen patients with resectable cT3-4 low rectal carcinoma were randomised to receive either pre-operative 5 x 5 Gy irradiation with subsequent surgery performed within 7 days or chemoradiation (50.4, 1.8 Gy per fraction plus bolus 5-fluorouracil and leucovorin) followed by surgery after 4-6 weeks. The pathological reports of patients who fulfilled entry criteria and had preoperative irradiation followed by transabdominal surgery were analysed., Results: Significant downstaging of primary tumour (P<0.001) and of nodal disease (P=0.007) was observed after chemoradiation in comparison with short-course irradiation. In chemoradiation group, for patients with complete pathological response and for ypT1 category, the rate of nodal metastases was low - 5% (95% confidence interval [CI] 0-14%) and 8% (95% CI 0-24%), respectively. The rate of ypN-positive disease in chemoradiation group was similar to that recorded in short-course irradiation group for ypT2 category 26% (95% CI 14-38%) vs. 28% (95% CI 16-40%), P=0.83 and for ypT3-4 category 55% (95% CI 41-69%) vs. 64% (95% CI 54-74%), respectively, P=0.37. For ypT2 category after chemoradiation, the rate of nodal disease remained high even in subgroup with low residual cancer cells density (20%, 95% CI 4-36%)., Conclusions: For patients with tumours downstaged by chemoradiation to ypT0 and ypT1 full thickness local excision may be considered as an acceptable approach, because the risk of mesorectal lymph nodes metastases is low. The selection criteria for preoperative radio(chemo)therapy and local excision are discussed.

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.

Introduction: Selection of treatment schedule in patients with small cell lung cancer (SCLC) appears to be a subject of controversies. One of the most controversial issue is influence of planned and unplanned gaps in radiotherapy and chemotherapy on efficacy of radical treatment of patients with limited disease. These controversies created the basis for current research., Material: 245 patients with LD-SCLC treated in Cancer Center in Gliwice between 1989 and 2001 were included in the present analysis. There were 60 women and 185 men, median age 58 years; All these patients were in good general condition. Cisplatine based chemotherapy and total radiation dose higher than 30Gy were used in all of them., Methods: Overall survival was analyzed using Kaplan-Meier analysis. The variables potentially influencing overall survival including dose-intensity of chemotherapy and radiotherapy were analyzed using multivariate Cox regression model., Results: 3-year actuarial overall survival in a whole group of patients was 10 percent. The following variables had negative influence on overall survival in multivariate Cox model: performance status ZUBROD higher than 0 (p<0.0001), metastases to supraclavicular nodes (p=0.001), dyspnoea according to Borg scale higher than 2 (p=0.004) and radiation dose intensity less than 80% (p=0.02). Gaps in chemotherapy did not appear significant., Conclusions: Radiation treatment gaps had significant negative influence on survival of the patients with LD-SCLC, while interruptions of chemotherapy did not. This may suggest that within the range of doses and dose-intensities used in this group, interruptions of chemotherapy due to treatment toxicity are justified, while interruptions of radiotherapy should be promptly avoided.

Purpose/objective: Our goal was to analyze the repopulation of surviving tumor cells during a treatment gap in radiotherapy for head-and-neck cancer., Methods and Materials: Clinical material is based on the records of 1502 patients treated by radiotherapy alone in Maria Sklodowska-Curie Memorial Institute in Gliwice during the period between1980 and 1989. All patients had histologically confirmed squamous cell carcinoma of the larynx or pharynx. The mean gap duration was 9 days. Only 10% of patients were treated without gaps. The dose per fraction was in the range of 1.5 to 2.5 Gy. Patient data were fitted directly to the mixed linear-quadratic model using maximum-likelihood estimation. Tumor stage or tumor localization was introduced into the equation as a categorical variable. Tumor proliferation was estimated by dividing the treatment gaps into three groups: the first 2 weeks, second 2 weeks, and the period after 4 weeks of irradiation., Results: Tumor control probability was significantly correlated with radiation dose, tumor progression (according to TNM), overall treatment time, and gap duration. Laryngeal cancers had a better prognosis than cancers of the oro- and nasopharynx. Significant tumor repopulation was found after the first 2 weeks of radiotherapy. During the treatment gap, the proliferation rate was equal to 0.75 Gy/day. During the days with irradiation, repopulation was slower and equal to 0.2 Gy/day., Conclusion: The repopulation of tumor cells is faster during a gap than during the normal days of irradiation. Accelerated repopulation probably starts soon after 2 weeks of irradiation.

The basic biological principle for 131I treatment of patients with thyroid cancer is the ability of well-differentiated tumor cells to uptake iodine. The absorption of adequate activities of radioiodine may sterilize primary tumor cells and the metastatic deposits. The basic factors which determine the effectiveness of radioiodine treatment include the effective half-life of 131I, the discrete energy of its beta decay, the effective range of emitted beta-rays, the activity of individual therapeutic doses, the intrinsic ability of tumor to uptake radioiodine, and the absorbed total radiation dose. The biological factors, which contribute to the effectiveness of radioiodine treatment, can be referred to "five Rs" of radiobiology: radiosensitivity, repair, redistribution, reoxygenation, and repopulation. The theoretical radiobiological considerations suggest that improvements in therapeutic indexes of radioiodine treatment are possible, e.g. by unconventional fractionation of 131I, or by combining the radionuclide therapy with external-beam irradiation. The net effect of such strategies in the clinic is, however, often unpredictable, and remains investigational and controversial. This illustrates the need for improved design of new research in clinical and experimental radiobiology of radioiodine treatment.

Thirty-seven previously untreated patients with advanced, inoperable head and neck were treated with a sequential courses combining hypofractionated irradiation with chemotherapy (5-fluorouracil and cis-platinum). Each course was repeated every 4 weeks. Tumor response was evaluated and for 15 patients (41%) with a partial or complete regression after 3 radio-chemotherapy courses conventional radiotherapy was added. Eleven percent of all patients were in complete remission at the end of a treatment. This tumor response rate and the 50% rate of pain subside after first course for symptomatic patients contributed for a good palliative effect in the present study. However, the median survival of 7.2 months was considered unsatisfactory.