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Purpose or Objective. Superiority of post-IC (induction chemotherapy) GTV (gross tumour volume) over pre-IC GTV still has not been tested. We assessed the results of patients with locoregionally advanced head and neck squamous cell cancer (LAHNSCC) treatment with IC following by chemoradiotherapy (CRT), using post-IC PET/CT images for IMRT planning. Material and Methods. Two PET/CT were performed: one prior IC, and one 14 days after 3 cycles of IC (docetaxel 75mg/m2, cisplatin 75mg/m2 and 5-FU 750 mg/m2 day 1-5). The gross tumour volume (GTV70) and gross nodal disease (GTV60) on the post-IC PET/CT scans were contoured by the radiation oncologist working in cooperation with an experienced nuclear medicine physician.. The boost clinical target volume (CTV70) and nodal clinical target volume (CTV60) were obtained by GTV70 and GTV60 plus 5 mm respectively. The elective CTV (CTV50) included CTV70, CTV60 and bilateral elective lymphnodes. The margin of 3 mm was added for each CTV to create the planning target volumes (PTV70, PTV60 and PTV50). For high-risk volumes (PTV70 and PTV60) the prescribed doses were 70 Gy and 60 Gy respectively, for PTV50 – 50 Gy. CRT consisted of a chemotherapy with cisplatin (40 mg/m2 weekly) and RT (2 Gy once daily, 5 days a week). The primary end points was PFS. Secondary end points were OS and treatment toxicities. Acute toxicities were assessed using CTCAE v.4.0, late toxicities - using RTOG /EORTC criteria. Results 47 patients with histologically confirmed LAHNSCC (oroand hypopharyngeal), HPV negative, KPS 70% and signed written informed consent approved by the Lithuanian Bioethics Committee. The mean follow-up period was 30.1 (7-55) months. The mean PFS was 38.8 months (95% CI, 33.1-44.6) and mean OS was 38.1 months (95% CI, 32.7-43.4). The 3-years PFS and OS rate were 59% and 52%, respectively. The most common acute toxicities of grade 3-4 were febrile neutropenia 13.4%, leucopenia 23%, mucositis 30.2%. Late toxicities of grade 3-4 were: dysphagia 4.2%, xerostomia 6.4% and osteoradionecrosis 2.1%. Conclusion. This study suggests the efficacy of post-IC PET/CT based target volume delineation in selected patients undergoing IMRT for LAHNSCC. Further analysis is required to ascertain main clinical outcomes.

Purpose/Objective: In the latest decade increase the amount of publications, where are shown the results of external beam radiotherapy (EBRT) and high dose brachytherapy (HDR-BRT) in the treatment of recurrent head and neck squamous cell carcinoma (HNSCC), but there are no studies, where EBRT and HDR-BRT were compared. The aim of this study is to evaluate and to compare the efficacy and toxicity of the three-dimensional radiotherapy (3D-RT) and high-dose-rate brachytherapy (HDR-BRT) in the treatment of recurrent HNSCC. Materials and Methods: From October 2008 to February 2013, prospective clinical study was conducted in our clinics. 64 patients with HNSCC relapse were randomly assigned, in a 1:1 ratio, to receive 3D-RT (50 Gy/25 fractions), either received HDR-BRT (30 Gy/12fractions). All patients were evaluated for eligibility and the following selection criteria was applied: 1) histologically confirmed HNSCC relapse; 2) relapse identified in an area which had been irradiated during primary EBRT with a total dose of ≥50 Gy; 3) no bony invasion by the tumor; 4) no distant metastases; 5) no late grade 3 - 4 toxicity after the primary EBRT. One patient in 3D-RT group after randomization was removed from analysis due to myocardial infarction. The median time between the primary EBRT and reirradiation was 15 months (interval 3-26.1 months); administered median total dose was 66 Gy (interval 50-70 Gy). All patients completed the planned reirradiation, 15 (48.4%) patients in 3DRT group and 16 (50%) patients in HDR-BRT group received surgical treatment prior to the reirradiation, none of the patients received the chemotherapy. Results: The median overall survival (OS) of patients treated with HDRBRT was 33.4 months, and 1 and 2-year OS was 74% and 67%, respectively. The median OS of patients treated with 3D-RT was 11.9 . [...].

This report presents a case of a neck epithelioid sarcoma in a 20-year-old male with poor prognosis. The patient underwent surgery followed by external beam radiotherapy and brachytherapy performed as a boost. The treatment was well-tolerated, and there was no local recurrence or distant metastasis.

Summary. Surgery remains the main treatment modality for gastric cancer. Adjuvant radiochemotherapy and adjuvant chemotherapy are becoming more and more popular in the treatment of advanced gastric cancer. Early postoperative intraperitoneal chemotherapy as one of the methods of adjuvant chemotherapy is currently being extensively investigated. The aim of the present study was to evaluate the toxicity of early postoperative intraperitoneal chemotherapy and its impact on postoperative complications as well as longterm survival. Material and methods. A prospective study including 46 patients with gastric cancer who underwent radical resection was carried out during 2004–2005. Fourteen patients who received early postoperative intraperitoneal chemotherapy with 5-FU (EPIC group) were compared with 32 patients not receiving intraperitoneal chemotherapy (control group). All patient, except one patient in the EPIC group, received adjuvant radiochemotherapy or adjuvant chemotherapy. The toxicity of early postoperative intraperitoneal chemotherapy was evaluated using the WHO scale, and survival was estimated by the Kaplan-Meier method. Results. The rate of postoperative complications was similar in both the groups (14.3% in the EPIC group vs. 12.5% in the control group). Four patients (28.6%) in the EPIC group developed grade III toxicity. There was no difference in survival comparing the EPIC group with the control group (median survival, 30 months and 34 months, respectively; P=0.500). Conclusions. Early postoperative intraperitoneal chemotherapy with 5-fl uorouracile demonstrated acceptable toxicity and was relatively simple to perform. No survival benefi t was documented combining early postoperative intraperitoneal chemotherapy with adjuvant radiochemotherapy or adjuvant chemotherapy.

Prostatos vėžiui gydyti plačiai naudojama ultragarsu reguliuojama transperininė brachiterapija. Be biocheminio atkryčio (be PSA padidėjimo) 10 metų išgyvenamumas po prostatos brachiterapijos – 80–90 proc. Ilgalaikiai stebėjimo rezultatai rodo, kad po brachiterapijos I-125 ar Pd-103 šaltiniais išgyvenamumas be PSA atkryčio dažnai yra geresnis nei po įprastos nuotolinės spindulinės terapijos ir panašus kaip po radikalios prostatektomijos. Dažniausiai naudojami dozimetrijos parametrai yra D90 (dozė, kuria apšvitinama 90 proc. priešinės liaukos tūrio, kuris apibrėžtas poimplantaciniuose kompiuterinės tomografijos vaizduose), V100 (priešinės liaukos tūris, 100 proc. apšvitinamas paskirtąja doze). Išgyvenamumas be PSA atkryčio koreliuoja su skiriamos dozės dydžiu. Geros prognozės pacientams 140–160 Gy D90 dozė yra pakankama, o blogesnės prognozės vėžiu sergantys pacientai turėtų būti gydomi didesnėmis nei 200 Gy dozėmis. Po implantacijos dažniausia ankstyvoji komplikacija yra ūminė šlapimo retencija. Vėlyvosios urologinės spindulinės komplikacijos yra šlapimo nelaikymas ir šlaplės striktūra. Šlapimo nelaikymas yra retas, tačiau ši komplikacija yra dažnesnė tiems pacientams, kuriems dėl prostatos adenomos prieš sėklų implantavimą ar dėl šlaplės obstrukcijos prieš ar po implantavimo buvo atlikta transureterinė prostatos rezekcija. Tiesiosios žarnos spindulinės komplikacijos (proktitas, kraujavimas iš tiesiosios žarnos) yra retos. Po brachiterapijos panašiai kaip po nuotolinės spindulinės terapijos, bet skirtingai nei po radikalios prostatektomijos išsaugojama ejakuliacija, potencija išlieka gera 50–85 proc., o pacientų lytinė funkcija ir jos kokybė yra išsaugojama. Nuo 2007 m. liepos mėnesio pirmą kartą Lietuvoje ir Baltijos šalyse pradėta prostatos brachiterapija palaidomis I-125 sėklomis. I-125 brachiterapija buvo taikyta 150 geros prognozės (≤T2a, Gleason ≤6, PSA ≤10) pacientų. Apžvelgti klinikiniai tyrimai rodo, kad brachiterapija pastoviais jonizuojamosios spinduliuotės implantais yra geras neišplitusio prostatos vėžio gydymo būdas.

Objective. Adjuvant chemoradiation for gastric cancer is used more frequently, but there is no general opinion about the effect of this treatment. The aim of this study was to compare adjuvant chemoradiation with adjuvant chemotherapy after radical operation for stomach cancer. Material and methods. A total of 133 patients were included in this prospective study. Sixty-three patients after curative gastrectomy and D2 lymphadenectomy for gastric cancer were assigned to the chemoradiotherapy group and 70 to the chemotherapy group. The groups were identical by age, sex, and cancer stages. Toxicity was evaluated by the WHO scale, and survival was evaluated by the Kaplan-Meier method. Results. Grade III and IV toxicity was found more frequently in the chemoradiation group than in the chemotherapy group (44.4% and 7.1%, respectively; P

Cervical cancer is one of the most common cancers in women. The purpose of this article is to analyze the main diagnostic and treatment strategies for all stages and recurrences of cervical cancer. The article reviews the epidemiological situation, clinical features, diagnostic procedures for detection of this tumor and for evaluation of the dissemination of the disease, staging criteria, TNM (Tumor, Nodes, Metastases) and FIGO (Federation Internationale de Gynecologie et d’Obstetrique) classification, as well as treatment and prognosis. Surgical treatment (radical type II or III hysterectomy and lymphonodectomy) for early stage I and IIA cervical cancer is the main treatment method. Delivery of adjuvant postoperative radiation therapy or concomitant chemoradiation depends on the prognostic factors (tumor penetration to cervical tissues, lymphovascular invasion, tumor invasion to paracervical tissues, and surgical margins). For treatment of more advanced stages of cervical cancer (IIB, IIIA, IIIB, IVA) concomitant chemoradiation: external beam radiotherapy with chemotherapy and brachytherapy is used. Description of the treatment guidelines for each stage of cervical cancer is given in this article. These guidelines are useful for good treatment practice.

In the world five-year overall survival of patients with pancreatic cancer is low, i.e. about 5–6%. Patients without treatment live few months. Patients with pancreatic cancer are treated with combined treatment modalities. Chemotherapy is one of the three treatment methods. In the article we review chemotherapeutic agents that are used in everyday practice like fluorouracil and it’s use in combination with other chemotherapeutic agents, and also, new drugs like gemcitabine, taxanes, capecitabine and other. Effectivity of the treatment with these agents, results of survival, toxicity and particularities of intraarterial chemotherapy are discussed. New perspectives in the treatment of patients with pancreatic cancer and methods of new chemotherapeutic strategies are analyzed.

Animal models are widely used in preclinical studies in order to explain the mechanisms of action of chemotherapy, radiotherapy and concomitant chemoradiation, to analyze pathophysiology of tumors and to evaluate the treatment of choice for malignant tumors. The choice of murine tumor or human tumor xenograft system is still debated. Xenografted human tumors have two main advantages: their human origin and wanted pathological type, which is necessary for future clinical studies. There are a lot of disadvantages of xenografted tumors: the stroma and vascular network of transplanted tumors have murine orign, the graft is mostly ectopic, the volume of transplanted tumors at the time of chemoradiotherapy is much smaller than that of the tumor in man; due to residual immunity it is difficult to determine response to cytotoxic treatment. It is still imposible to extrapolate the results obtained in a tumor model in animal to man. These investigations are usefull for interpretation of clinical results and for proposing the less empirical method of chemoradiation for phase II clinical trials.

The aim of this study was to analyze survival dependence on 3-D conformal radiotherapy dose applied to non-small cell lung cancer patients treated in Kaunas University of Medicine Hospital from year 1999 to 2001. One hundred fifteen patients with median age 67.3 years were analyzed. There were 101 men and 14 women. Squamous cell carcinoma was the most common type of histology (80.86% patients). Most patients (61.7%) had locally advanced lung cancer (stage III). Radiotherapy doses applied ranged from 30 Gy (3.0 Gy/10 fractions) to 70 Gy (2.0 Gy/35 fractions). After analysis of radiotherapy dose influence on survival statistically significant improvement in median survival with higher doses was found (p=0.0001 Breslow). The group of patients irradiated with higher than 50 Gy dose demonstrated better survival than patients treated with smaller doses. (Log rank p=0.0061, Breslow p=0.0013). There was a correlation between dose and conformity of dose distribution.

This study presents the results of analysis of 134 lung cancer patients treated with radiotherapy in 1999–-2002. The objective of the paper was to evaluate the importance of some prognostic factors on survival of lung cancer patients. We have analyzed influence of patient’s age, stage of the disease, tumor size, lymphnodes status, histological type and radiotherapy dose to the survival of lung cancer patients. Among analyzed patients 87% were males and 73.9% were more than 60 years old. Locally advanced lung cancer was diagnozed in 65.6% of cases. The non-small cell lung cancer was diagnozed in 83.8% of cases. During the study period 58.2% of patients died. Statistically significant prognostic factors in our study were: stage, locally advanced lung cancer, involvement of the lymphnodes, III B and IV of the disease. The survival of the patients depends on the radiotherapy dose in our study. The better survival was associated with the biger than 50 Gy dose (p

Concomitant radio-chemotherapy is widely used in the treatment of various localisations of cancer. Numerous interactions are known between ionizing radiation and cytotoxic agents, which in vitro may modify the dose-response relationships. The main interactions are spatial cooperation, independent cell kill, cell synchronization, inhibition of repair of radiation damage, reoxygenation, reduction of the hypoxic fraction and increased apoptosis. Exposure of irradiated cells to cytotoxic agent lead to increase the number of unrepaired double-strand breaks. By this mechanism the action of DNA repair of both therapeutic modalities enhance therapeutic efficiancy. The main effects of chemoradiotherapeutic combination in the laboratory are inhibition or antagonism, subadditive, additive and supra-additive effects. The most important for clinical pactice are supraadditive effects, when the cytotoxic effect of the combinaton is greater than the sum of the effects of radiotherapy alone and that of chemotherapy alone. It is however difficult to extrapolate laboratory and experimental results to clinical practice because the conditions for interaction of chemo- and radiotherapy in vitro are different. Clinical conditons usually are more compatible for additive and subadditive interactions. The main role of laboratry and experimental investigations is to propose new drug – radiotherapy combination to phase II trials.

This study aim was to identify the frequency and risk factors of bowel obstruction after the radiation therapy for cervical and endometrial cancers. For this reason medical data of patients treated in LSMUL KK Oncology and Hematology clinic, Surgery clinic between January 1 2008 – December 31 2014 was retrospectively analyzed. The study enrolled 78 women: 49 treated for cervical cancer (17 women with bowel obstruction, 32 women without bowel obstruction), 29 treated for endometrial cancer (9 women with bowel obstruction, 20 women without bowel obstruction).

[...]. Aim of the study. To establish the role of ionizing radiation dose and polymorphism of genes encoding for cytokines in the treatment of bone disease caused by multiple myeloma. Objectives of the study. 1. To evaluate and comnpare efficiency of the pain syndrome treatment when prescribing two different radiotherapy regiments for bone lesions due to multiple myeloma. 2. To establish any significant demographic and clinical factors determining pain relief in a bone destruction caused by multiple myeloma site after radiation treatment. 3. To evaluate the frequency of recalcification when prescribing two different radiotherapy regiments for bone lesions due to multiple myeloma and establish any significant factors determining recalcification in a bone destruction site after radiation treatment. 4. To evaluate and compare the patients' quality of life when prescribing two different radiotherapy regimentsfor bone lesions due to multiple myeloma. 5. To evaluate the impact of polymorphism of genes encoding cytokins (IL-6, IL-10, TNFα, IL-1α, IL-1β, IL-1RA) on the pain syndrome due to bone disease caused by multiple myeloma. [...].

Bendrojoje populiacijoje 1 iš 72 moterų suserga kiaušidžių vėžiu ir 1 iš 95 moterų miršta nuo šios ligos. Tyrimų duomenys rodo, kad ligos eiga nėra priklausoma vien tik nuo klasikinių prognozinių rodiklių, tokių kaip histologinis naviko tipas, naviko diferenciacija, ligos stadija, taikytas gydymas.Prognozinių veiksnių paieška krypstą link genetinių veiksnių galinčių įtakoti ligos eigą. Literatūros duomenys apie klinikinę BRCA1/2 genų reikšmę yra kontroversiški – nuo visiškai bereikšmio iki ženkliai teigiamo poveikio ligos eigai prognoziniu požiūriu.. Mūsų tyrėjų grupės atlikto tyrimo tikslas buvo nustatyti BRCA1/2 genų mutacijų dažnį ir jų įvairovę tarp pacienčių, sergančių išplitusiu kiaušidžių vėžiu, ir įvertinti šių mutacijų įtaką berecidyviam ir bendrajam išgyvenamumui. Mes nustatėme , kad tarp pacienčių sergančių išplitusių epiteliniu kiaušidžių vėžiu buvo net 51,4 proc. BRCA 1/2 mutacijų genuose turinčių pacienčių. 98,2 proc. šių pacienčių sirgo serozine papiline adenokarcinoma. Šios histologinės formos kiaušidžių vėžio buvo ženkliai daugiau mutuotų BRCA1/2 genų pacienčių grupėje nei tarp pacienčių be mutacijų (p-0,029). Tyrimo metu nustatėme dažniausiai sutinkamą arba bendro protėvio BRCA 1 4035 delA mutaciją bei taip kad statistiškai reikšmingos įtakos sergančiųjų išplitusiu kiaušidžių vėžiu berecidyviam išgyvenamumui turi pacienčių amžius (p=0,005), BRCA1/2 genų mutacijos(p=0,049) bei operacijos apimtis (p

In general population 1 of 72 women develop ovarian cancer and to 1 of 95 women this disease is lethal. A great number of clinical trials have shown that the course of the disease is not dependent only on the classical prognostic indicators such as histological tumor type, tumor differentiation, stage of the disease or treatment modalities. More than two decades ago the first publications on heredity factors indicated similarity among the patients diagnosed ovarian malignancies and their first degree relatives. The first genetic autosomal dominant inheritance was determined in the high-risk cancer tumor suppressor BRCA1/2 genes. In spite of the abundant number of trials studying the BRCA1/2 genes role in breast and ovarian carcinogenesis still it is not sufficiently clear the influence of these genes for the disease prognosis. The aim of our conducted trial was to determine the BRCA1/2 genes prognostic significance for progression-free and overall survival in the event of advanced ovarian cancer. In case of advanced ovarian cancer the BRCA1/2 mutation frequency was 51,4 %. Among all determined BRCA1/2 gene mutations BRCA1 4035delA or founder mutation was most frequent. It amounted to 63.6%. Non-optimal cytoreduction (p

Šio tyrimo tikslas buvo įvertinti aktininės keratozės klinikinius ypatumus ir fotodinaminio gydymo skirtingomis raudonosios šviesos dozėmis veiks-mingumą. Aktininė keratozė – tai ikinavikinė odos liga, pasireiškianti ilgalaikio saulės poveikio srityse, o jos diagnozė nustatoma remiantis klinikiniu vaizdu. Histologinis tyrimas atliekamas tik neaiškiais atvejais. Vis tik pasitaiko diagnozavimo klaidų ir nesuta¬pimo atvejų tarp tyrėjų dermatologų bei dermatopatologų. Šiame darbe įvertinome ir nustatėme AK klinikinės raiškos ypatumus bei jų sąsajas su histologiniais požymiais, o taip pat AK klinikinio tyrimo jautrumą ir specifiškumą, remiantis histologinio tyrimo duomenimis. Nuo 0,025 iki 20 proc. atvejų AK transfor¬muojasi į plokščiųjų ląstelių karcinomą. Aktininę keratozę rekomenduojama gydyti, nes prognozuoti, kuri AK plis iš epidermio į gilesnius odos sluoksnius ir taps plokščiųjų ląstelių karcinoma, neįmanoma. Veiksmingas bei saugus būdas gydyti AK yra vietinio poveikio foto¬dinaminis gydymas, tačiau jo trūkumas – skausmas procedūros metu. Atlikę perspektyvųjį tyrimą, įvertinome aktininės keratozės klinikinės raiškos ypatumus po fotodinaminio gydymo su 5-aminolevulino rūgštimi. Nustatėme skausmą procedūros metu įtakojančius veiksnius. Nustatėme šio gydymo dviejomis raudonosios šviesos dozėmis veiksmingumą po dvejų metų stebėjimo bei AK atkrytį prognozuojančius veiksnius. Pateikėme praktines šio AK gydymo rekomendacijas. The aim of this study was to evaluate clinical characteristics of actinic keratosis and the efficacy of photodynamic treatment with different red light doses. The diagnosis of AK is based upon its typical clinical aspects. However, there are data stating that diagnosing single AKs clinically is not precise and that there are even interobserver disagreements between dermatologists and dermatopathologists. In this study we assessed the clinical peculiarities of AK and its correlation with histological characteristics. We assessed the sensitivity and specificity of AK clinical diagnosis based on histopathological analysis. In 0.025% to 20% cases AK transforms into squamous cell carcinoma. It is impossible to predict which AK will spread from the epithelium into the deeper layers of the skin. Therefore, treatment of actinic keratosis is recommended in all cases. Topical photodynamic treatment is safe and effective therapy for AK but pain is the limitation of the procedure. We performed a prospective within-patient study and evaluated the clinical pecularities of actinic keratosis after photodynamic treatment. We assessed the factors that influence pain during the treatment. We assessed the efficacy of photodynamic treatment with different red light doses for actinic keratosis after two-years follow-up. Factors that influence the recurrence of AK were evaluated. Follow-up data for two years was used to formulate the practical recommendations of the study.

Accurate phenotyping of multitransfused patients is often complicated - mostly due to the presence of circulating transfused donor’s RBCs in the recipient’s blood, leading to discrepancies in the assessment of test results. The question when genotyping including Duffy and Kidd systems should be used for patients undergoing chronic RBC transfusions is still being discussed. Serological testing and evaluation of the antigens and antibodies of Duffy and Kidd systems are among the main problems in multitransfused patients. The research on immunohematology and blood group genetics has been caried out for the first time in Lithuania. A high rate (more than 30%) of disagreements between the results of phenotyping and genotyping in our study demonstrates the benefit of DNA-based testing for chronically-transfused patients. In order to estimate the value of phenotyping and genotyping of Duffy and Kidd antigen systems in patients undergoing long-term RBC transfusions, the impact of demographic, clinical, immunohaematological or transfusion-related factors, on the discrepancy of the results, was investigated. Time frame that could be appropriate to obtain reliable results of conventionaly used serologic tests (hemmagglutination reaction) after the last transfusion was established as well as appropriate recommendations were made. We believe that these studies could be helpful for clinical practice as well as in decreasing the risk of transfusion of red blood cells.

Apie 5–10 proc. visų krūties navikų atvejų sudaro paveldimas vėžys. BRCA1 ir BRCA2 genai yra patys svarbiausi polinkį susirgti krūties vėžiu sąlygojantys genai. Kiti reikšmingai su padidėjusia krūties navikų išsivystymo rizika susiję – CHEK2 ir NBS1 genai. Šiame darbe ištirtos paveldimos dažniausiai Europos regione nustatomos šių genų mutacijos. Nustatytas BRCA1 ir CHEK2 genų mutacijų dažnis tarp jaunų krūties vėžiu susirgusių moterų, ištyrinėtos jų sąsajos su pacientės amžiumi, naviko klinikinėmis ir morfologinėmis savybėmis. Išanalizuota šeiminės anamnezės prognozinė vertė nustatant paveldimus BRCA1 ir CHEK2 genų pokyčius. Pirmą kartą Lietuvoje įsisavintas CHEK2 bei NBS1 genų tyrimas, nustatyta, kokios CHEK2 geno mutacijos dažniausios. Nors NBS1 geno mutacijų nerasta, bet įsisavinta metodika, kuri bus panaudota ateities tyrimams. Sukurtas kompleksinis BRCA1 bei CHEK2 genų mutacijų radimo prognozavimo modelis. Šiandien klinikinėje praktikoje panašūs modeliai naudojami įvertinti BRCA1/2 genų mutacijų tikimybę. Jų pritaikomumas ir specifiškumas skirtingose etninėse grupėse gali skirtis. Naudojant tirtų pacienčių charakteristikas, įtraukiant ne tik šeiminę anamnezę, pacientės ypatybes, bet ir klinikinius bei molekulinius navikų požymius, sukurti mūsų regionui pritaikyti modeliai bei nustatyti kriterijai, kurie padės atrinkti pacientes genetiniam konsultavimui dėl BRCA1 bei CHEK2 genų mutacijų. Šis naujas požiūris turi didžiulę praktinę naudą. Approximately 5–10% of all breast cancer cases are considered to be hereditary. BRCA1 and BRCA2 genes are the most important breast cancer predisposing genes. Other genes significantly linked with an increased risk of breast tumors are CHEK2 and NBS1 gene. In this scientific work were studied the most prevalent in European region mutations of these genes. The rate of BRCA1 and CHEK2 gene mutations in young women with breast cancer was evaluated and the relationships between these mutations and patient's age, clinical and morphological tumor features are examined. The prognostic value of family history was analyzed when forecasting hereditary BRCA1 and CHEK2 gene mutations. For the first time in Lithuania the CHEK2, NBS1 genes tests were applied and the evaluation of which CHEK2 gene mutations are most prevalent was obtained. Although NBS1 gene mutations were not found, but applied test technique will be used in future research. There was created a prognostic model for determination of BRCA1 and CHEK2 gene mutations. In today's clinical practice similar models are used to assess the likelihood of the BRCA1/2 mutation. Their applicability and specificity in different ethnic groups may vary. Applying the studied data there was created a model adapted to our region. Testing patients, there were considered not only family medical history and personal characteristics, but also the clinical and molecular features of tumors. The criteria have been found which will help in selecting... [to full text]

After radical treatment of head and neck cancer 20–50% of patients are diagnosed with the locoregional recurrence during first two years. In the literature the results of studies, using reirradiation by three-dimensional radiotherapy for head and neck cancer recurrence, according to a 2-year overall survival and toxicity, are poor: overall survival reached 15.2–40%, the grade 3 - 4 toxicity reached 1.4–47% and grade 5 - 7.6%. The results of phase II and retrospective studies using the high-dose-rate brachytherapy for treatment of head and neck cancer relapse were: 2-year overall survival was 19–63%; grade 3 - 4 late toxicity 4–22.2%. In these studies 3–4 Gy per fraction up to 30–40 Gy total dose were administered. So far, the randomized study, comparing the high-dose-rate brachytherapy with the three-dimensional radiotherapy, treating head and neck cancer relapse, hasn’t been conducted. We compared different radiotherapy methods: three-dimensional conformal radiotherapy was administered to the control group (25 fractions of 2 Gy, total dose of 50 Gy); the hypofractionated high-dose-rate brachytherapy was administered to the experimental group, while applying a new regime of fractionation: 2.5 Gy per fraction, two fractions per day, up to 30 Gy total dose. Such fractionation regimen was selected in order to reduce the rate and grade of toxicity, while the total dose is biologically equivalent to the total doses, which have been used in previous studies.

Po radikalaus gydymo 20–50 proc. pacientų, kuriems nustatytas galvos–kaklo srities vėžys lokoregioninis atkrytis nustatomas per pirmus dvejus metus. Literatūroje paskelbtų tyrimų rezultatai taikant pakartotinę nuotolinę spindulinę terapiją dėl galvos-kaklo vėžio atkryčio prasti: 2-jų metų bendras išgyvenimas siekė 15,2–40 proc., vėlyvųjų 3-4 laipsnio komplikacijų dažnis buvo 1,4–47 proc., 5 laipsnio - 7,6 proc. Retrospektyvinių ir II fazės tyrimų rezultatai naudojant didelės dozės galios brachiterapiją galvos-kaklo srities vėžio atkryčiui gydyti: 2-jų metų bendras išgyvenimas siekė 19–63 proc., vėlyvųjų 3-4 laipsnio komplikacijų dažnis buvo 4–22,2 proc. Tyrimų metu skirtos 3–4 Gy frakcijos iki 30–40 Gy suminės dozės. Iki šiol neatlikti tyrimai lyginantys nuotolinės spindulinės terapijos ir didelės dozės galios brachiterapijos gydymo veiksmingumą ir saugumą. Šioje disertacijoje palyginti skirtingi spindulinio gydymo metodai gydant galvos-kaklo srities vėžio atkrytį: kontrolinei grupei taikytas nuotolinis konforminis spindulinis gydymas (25 frakcijos po 2 Gy, suminė dozė 50 Gy), tiriamajai grupei - hipofrakcionuota didelės dozės galios brachiterapija skiriant naują frakcionavimo režimą – po 2,5 Gy per frakciją po dvi frakcijas per dieną, iki 30 Gy suminės dozės. Toks frakcionavimo režimas pasirinktas siekiant sumažinti spindulinių reakcijų dažnį ir sunkumo laipsnį, o suminė dozė yra biologiškai ekvivalentiška suminėms dozėms, kurios buvo naudotos ankstesniuose tyrimuose. After radical treatment of head and neck cancer 20–50% of patients are diagnosed with the locoregional recurrence during first two years. In the literature the results of studies, using reirradiation by three-dimensional radiotherapy for head and neck cancer recurrence, according to a 2-year overall survival and toxicity, are poor: overall survival reached 15.2–40%, the grade 3 - 4 toxicity reached 1.4–47% and grade 5 - 7.6%. The results of phase II and retrospective studies using the high-dose-rate brachytherapy for treatment of head and neck cancer relapse were: 2-year overall survival was 19–63%; grade 3 - 4 late toxicity 4–22.2%. In these studies 3–4 Gy per fraction up to 30–40 Gy total dose were administered. So far, the randomized study, comparing the high-dose-rate brachytherapy with the three-dimensional radiotherapy, treating head and neck cancer relapse, hasn’t been conducted. We compared different radiotherapy methods: three-dimensional conformal radiotherapy was administered to the control group (25 fractions of 2 Gy, total dose of 50 Gy); the hypofractionated high-dose-rate brachytherapy was administered to the experimental group, while applying a new regime of fractionation: 2.5 Gy per fraction, two fractions per day, up to 30 Gy total dose. Such fractionation regimen was selected in order to reduce the rate and grade of toxicity, while the total dose is biologically equivalent to the total doses, which have been used in previous studies.

Krūties vėžys yra dažniausia moterų liga, kuriai būdingi dideli sergamumo ir mirtingumo rodikliai. Visame pasaulyje krūties vėžys tarp moterų sudaro apie 23 proc. visų vėžio formų. Dėl mirčių nuo krūties vėžio visuomenė praranda daugybę gyvenimo metų: Ispanijos moterys dėl šio susirgimo per metus netenka 58 800, o Japonijos – 255 046 gyvenimo metų. Lietuvoje krūties vėžiu kasmet suserga apie 1500 moterų, iš jų – beveik pusė (46,4 proc.) – darbingo amžiaus, tačiau iki šiol nėra paskelbta sveikatos ekonomikos darbų, nagrinėjančių krūties vėžio kaštus ir išeitis. Atliktas tyrimas – pirmasis tokio pobūdžio tyrimas Lietuvoje, jo metu gauti rezultatai sudaro prielaidas sveikatos technologijų ekonominiam vertinimui, tolimesnei krūties vėžio stebėsenai, efektyvesniam išteklių paskirstymui bei sergančiųjų gyvenimo kokybės gerinimui. Tyrimo metu atliktas duomenų bazių sujungimo galimybių įvertinimas. Remiantis gautais rezultatais gali būti koreguojama mokėjimo už krūties vėžio gydymo paslaugas sistema. Taikant savalaikes modernias ankstyvosios diagnostikos priemones, galima diagnozuoti kuo daugiau ankstyvųjų krūties vėžio stadijų atvejų. An estimated 180,000 new cases of breast cancer occur in Europe every year. According to WHO, BC causes about 77,000 deaths in the world every year. The disease accounts for 58,800 years of life lost per year in Spain and 255,046 years of life lost in Japan. It is the first research performed in Lithuania during which the evaluation of the possibility of pooling different databases has been performed; obtained results set preconditions for economic evaluation of health technologies, further monitoring of BC, more effective allocation of resources, and improvement health-related quality of life of patients. On the basis of these results, modifications in health care payment system can be developed. Considering clinical and molecular properties of tumour, effective treatment with fewer side effects might be administered – with the aim to help women to control the disease, return to active life, and enhance health-related quality of life.

Židininiai kepenų pakitimai (ŽKP) – vieni dažnesnių patologinių radinių tiriant pacientus dėl įvairių virškinimo ar kitų organizmo sistemų ligų. Įvairių spindulinės diagnostikos metodų dėka nustačius patologinius židinius kepenyse ypač svarbi jų klinikinė diferencinės diagnostikos reikšmė. ŽKP diferencinės diagnostikos esmė yra kiek įmanoma tikslesnis židinio kepenyse kraujotakos nustatymas ir aprašymas. Šios problemos sprendime naujų galimybių įgyja santykinai nauja ir Lietuvoje niekur kitur dar neatliekama UG tyrimo su i/v kontrastavimu metodika, kurios metu gaunami rezultatai lyginami su dominuojančių įprastų KT ir MRT kontrastinių tyrimų rezultatais. Tikslas: nustatyti radiologinių tyrimų vertę diagnozuojant židininius kepenų pakitimus (ŽKP) Uždaviniai: 1. Nustatyti įprastinio UG, UG su i/v kontrastavimu ir KT su i/v kontrastavimu diagnostikos metodų tikslumo rodiklius nepiktybiniams ir piktybiniams ŽKP. 2. Nustatyti UG ir KT su i/v kontrastavimu vertingiausius diagnostikos kriterijus vertinant židininių kepenų pokyčių prigimtį. 3. Palyginti tarpusavyje UG ir KT su i/v kontrastavimu nustatytų židininių kepenų pakitimų diagnostikos metodų tikslumo rodiklius nepiktybiniams ir piktybiniams ŽKP. 4. Įvertinti kepenų hemangiomų radiologinių diagnostikos metodų tikslumo vertę. Focal hepatic lesions (FHL) are one of the most common pathological findings in patients who are examined for gastrointestinal or other diseases. The rigorous description of blood circulation in the hepatic focus is essential in differential diagnosis of FHL. US with i/v contrast enhancement is a new imaging method enabling definition of nature of FHL, follow-up, treatment efficacy and monitoring for possible relapse of the process. This study is conducted solely in the Radiology Department of Kaunas University of Medicine Hospital. Aim of the study To evaluate and compare the value of ‘bolus’ contrast-enhanced CT and contrast-enhanced US in diagnostics of focal hepatic lesions. Tasks of the study 1. To determine rates of diagnostic accuracy of conventional US, US with i/v contrast enhancement and ‘bolus’ contrast-enhanced CT in diagnosis of benign and malingnant FHL. 2. To establish the main and most effective diagnostic criteria of US and CT with i/v contrast enhancement for the assessment of nature of focal hepatic lesions. 3. To compare rates of diagnostic accuracy of US with i/v contrast enhancement and ‘bolus’ contrast-enhanced CT in diagnosis of benign and malingnant FHL. 4. To assess the reliability of radiological diagnostics of hemangioma, comparing the results of US, CT, and MRI.

Prostatos vėžys yra dažniausia vyrų onkologinė liga JAV, Vakarų Europoje bei Lietuvoje. Dėl senstančios visuomenės ateityje bus nustatoma dar daugiau naujų prostatos vėžio atvejų. Lietuvos vėžio registro duomenimis 1995 – 2005 metais vidutinis metinis prostatos vėžio sergamumo didėjimas - 14,5 proc. per metus. Vyrų sergamumas prostatos vėžiu Lietuvoje 2005 metais siekė 125,9/100000 atvejų, o mirtingumas nuo šios ligos siekė 31/100000 atvejų. Vyrų mirtingumas nuo prostatos vėžio antras pagal dažnį po plaučių vėžio su vėžiu susijusio mirtingumo grupėje. Todėl daugelis tyrėjų pabrėžia, kad norint mažinti mirtingumą, reikia ankstinti prostatos vėžio nustatymo laiką. Pradėta Lietuvos vyrų ankstyvosios prostatos vėžio diagnostikos programa ir dažnas prostatos specifinio antigeno nustatymas lėmė padidėjusį apsilankymų pas urologus skaičių ir padidino prostatos biopsijų kiekį. Norint efektyviai ir optimaliai ištirti šiuos pacientus, reikia daug materialinių išteklių ir laiko.Šio darbo tikslas buvo optimizuoti pacientų su padidėjusia prostatos vėžio rizika ištyrimą ir stebėjimą bei nustatyti ryšį tarp prostatos vėžio rizikos veiksnių ir prostatos vėžio diagnozavimo padidėjusios rizikos grupėje. Darbo uždaviniai: 1. Išanalizuoti prostatos vėžio nustatymo dažnį pirmąja ir kartotinėmis lateralinėmis sekstantinėmis prostatos biopsijomis ir įvertinti jų efektyvumą. 2. Nustatyti amžiaus, rūkymo, alkoholio vartojimo, prostatos vėžio šeiminės anamnezės, viršsvorio ir padidėjusio cholesterolio... [toliau žr. visą tekstą] Prostate cancer is the most frequent malignant disease in men in United States, Western Europe and in Lithuania. Due to ageing population incidence of prostate cancer will rise even more in the future. Since the year 2003 prostate cancer became the most common form of cancer diagnosed in men in Lithuania (more than 1500 new prostate cancer cases a year). There were 2005 of new prostate cancer cases diagnosed in the year 2005. According to Lithuanian Cancer Registry data during the years 1995-2005 the prevalence of prostate cancer was increasing 14.5 percent annually. Prostate cancer was detected in 24.3 percent of all cancer cases in men in the year 2005 in Lithuania and in 48.3 percent of them disease was detected in the stages I and II. In the year 2005 the prevalence of prostate cancer in Lithuanian men was 125.9 per 100000 population and mortality was 31 per 100000 population. Prostate cancer is a second common form of death after lung cancer in cancer-associated mortality group in Lithuania. Prostate cancer mortality ranged between 19 and 55 per 100000 in Europe and it was 23.2 per 100000 populations in the year 2006 in European Union. Many authors stress that it is important to diagnose prostate cancer in the early stages in order to reduce prostate cancer mortality rate. The aim of the study was to optimize investigation and follow-up of the high prostate cancer risk patients, and to define the relation between prostate cancer risk factors and prostate cancer... [to full text]