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Abstract Background There is a lack of clinical data on the validity of neoadjuvant chemotherapy in the treatment of ovarian cancer. The aim of this study was to compare the impact of the adjuvant and neoadjuvant chemotherapy regimens on the clinical outcomes in patients with advanced ovarian cancer. Methods We performed a retrospective analysis of 574 patients with advanced ovarian cancer admitted to four Lithuanian oncogynaecology departments during 1993–2000. The conventional combined treatment of cytoreductive surgery and platinum-based chemotherapy was applied to both the group that underwent neoadjuvant chemotherapy (n = 213) and to the control group (n = 361). The selection criterion for neoadjuvant chemotherapy was large extent of the disease. Overall and progression-free survival rates and survival medians were calculated using life tables and the Kaplan-Meier method. Results There was no difference in median overall survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (25.9 months vs. 29.3 months, p = 0.2508) and stage IV patients (15.4 months vs. 14.9 months, p = 0.6108). Similarly, there was no difference in median progression-free survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (15.7 months vs. 17.5 months, p = 0.1299) and stage IV patients (8.7 months vs. 8.2 months, p = 0.1817). There was no difference in the rate of the optimal cytoreductive surgery between patients who underwent the neoadjuvant chemotherapy and patients primarily treated with surgery (n = 134, 63% vs. n = 242, 67%, respectively). Conclusion There was no difference in progression-free or overall survival and in the rate of optimal cytoreductive surgery between the neoadjuvant and adjuvant chemotherapy groups despite the fact that patients receiving neoadjuvant chemotherapy had a more extensive disease. Multivariate analysis failed to prove that neoadjuvant chemotherapy could be considered as an independent prognostic factor for survival, and the findings need to be investigated in the future prospective randomised studies.

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<0.0001). Treatment was not finished in 27% of patients in the chemoradiation group and 11.4% in the chemotherapy group (P=0.03). Overall survival was better in the chemotherapy group as compared with the chemoradiation group (P=0.039). Median survival for patients with stage III and IV cancer was 41 months in the chemotherapy group and 18 months in the chemoradiation group (P=0.085). Survival of patients with stage IIIA cancer in the chemotherapy group was significantly better (P=0.005)., Conclusions: Median survival is shorter in the adjuvant chemoradiation group after curative gastrectomy for gastric cancer as compared with the adjuvant chemotherapy group. Adjuvant chemoradiation is more toxic and should be recommended only for patients with advanced-stage cancer.

Ultrasound-guided transperineal prostate brachytherapy is now widely used modality in the treatment of prostate cancer. The overall prostate-specific antigen (PSA) progression-free survival at 10 years is 80-90% for low-risk patients. The results of long-term follow-up have showed better biochemical disease-free survival after I-125 and Pd-103 brachytherapy than after conventional external-beam radiotherapy and similar survival after radical prostatectomy. The most commonly reported dosimetric quantifiers include D90 (the dose that covers 90% of the prostate volume outlined on postimplant computed tomography images) and V100 (the fractional volume of the prostate that receives 100% of prescription dose). The biochemical disease-free survival correlates with the dose. In low-risk patients, achieving a D90 dose of 140-160 Gy might be adequate for prostate-specific antigen control. However, high-risk disease might require a D90 dose higher than 200 Gy. In the immediate posttreatment period, the most common complication is acute urinary retention. Urinary symptoms such as frequency, nocturia, and dysuria occur commonly and are documented in about 80% of patients complaining of symptoms 2-3 months after treatment. Late urinary complications of brachytherapy include urethral stricture and incontinence. Incontinence is rare and mainly occurs in patients who had transurethral resection of the prostate either prior or after brachytherapy. Rectal complications (proctitis, rectal bleeding) are rare after prostate brachytherapy. Brachytherapy like external-beam radiotherapy but unlike surgery preserves ejaculation; potency rates also appear to be relatively high after brachytherapy, at 50-85%, and most patients' sexual quality and function are preserved. Since July 2007, the real-time I-125 prostate brachytherapy has been started in Lithuania and Baltic countries at the Hospital of Kaunas University of Medicine. A total of 150 low-risk patients (< or =T2a, Gleason < or =6, PSA < or =10) were treated by this method. Permanent prostate brachytherapy is an appropriate method for standard treatment of localized prostate cancer.

Primary cytoreductive surgery remains the standard care in advanced ovarian cancer. Optimal cytoreductive surgery is defined as a residual tumor load less than 1 cm. after operation. The randomized clinical trials showed that interval debulking surgery improved survival in patients who did not undergo optimal primary debulking surgery. The retrospective trials have suggested that the outcome for patients treated with neoadjuvant chemotherapy followed by interval debulking surgery is the same as for patients treated with primary debulking surgery followed by adjuvant chemotherapy. The neoadjuvant chemotherapy should not to be used for clinical practice until the randomized clinical trial carried out by Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer and National Cancer Institute of Canada answers this question. There are no data from randomized trials to show the survival advantage in patients who received second-look operation as compared to those who did not.

The main objective of this review is to present various types of treatment which are available for patients with bladder cancer. Some treatments are standard and some are being tested in clinical trials. Nowadays we have a lot of new treatment approaches and can use them for bladder cancer treatment. For superficial bladder cancer the main treatment method is operation. Adjuvant chemotherapy is indicated only for high-risk patients and the tumor recurrence rate is decreased to about 20%. Surgery and radiotherapy is used for muscle-invasive bladder cancer. There are no clear indications for neoadjuvant treatment administration. Radiotherapy and chemotherapy are suitable after no radical operation. Administration of palliative chemotherapy for metastatic disease might improve survival. We have to use different methods of treatment (operation, chemotherapy, radiotherapy, biology therapy) as multimodality treatment option for bladder cancer.

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.

Purpose: To assess the benefit of treatment modalities on the survival in patients with pancreatic cancer., Material and Methods: Eighty-five patients with pancreatic cancer were treated by surgery, radiotherapy, chemotherapy and combined therapy. The data was reviewed retrospectively and the benefit of various treatment methods to the median survival time of the patients was assessed., Results: Median survival time of the patients diagnosed with local disease treated by radical resection and adjuvant treatment was 21.5 months; with radical resection only--12.6 months (p = 0.6). In patients with locally advanced disease and treated by radical resection and adjuvant therapies the median survival time was 12.1 months and by radical resection only 7.7 months (p = 0.6). For patients treated by palliative surgery, chemotherapy and radiotherapy median survival was 8.8 months and by palliative surgery alone 1.8 month (p = 0.015). 1-year actual survival of patients treated with radical resection and adjuvant therapies was 11.7%. For patients with radical resection only--10.5%. 3-year actual survival for the same groups of patients was 3.5% and 2.3%, respectively. 1-year actual survival of patients treated by palliative methods was 2.3%., Conclusions: Surgery with adjuvant treatment seems to be beneficial for pancreatic adenocarcinoma patients. In locally advanced and metastatic pancreatic cancer palliative chemotherapy or radiotherapy statistically significantly improved survival.

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.

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 origin, 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 impossible 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.

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 diagnosed in 65.6% of cases. The non-small cell lung cancer was diagnosed 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 bigger than 50 Gy dose (p<0.001).

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 efficiency. The main effects of chemoradiotherapeutic combination in the laboratory are inhibition or antagonism, sub-additive, additive and supra-additive effects. The most important for clinical practice are supra-additive effects, when the cytotoxic effect of the combination 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 conditions usually are more compatible for additive and sub-additive interactions. The main role of laboratory and experimental investigations is to propose new drug--radiotherapy combination to phase II trials.