Proton beam therapy

Ob kirurškem in sistemskem zdravljenju je radioterapija eden od treh stebrov zdravljenja raka. Izjemen tehnološki razvoj na področju pospeševalnikov nabitih delcev je pripeljal do uveljavitve protonske radioterapije kot terapije izbora pri določenih skupinah bolnikov obolelih za rakom, v prvi vrsti otrok. Velika konkurenčnost med proizvajalci je botrovala postopnemu znižanju cen protonskih pospeševalnikov, ki so v zadnjih letih postali dostopni tudi državam, ki ne sodijo med najbogatejše. Kompleksnost radioterapije s protoni, velikost naprav in še vedno sorazmerno visoka cena so glavne ovire, da protonskih centrov že v tem trenutku ni več in da takšnega centra še vedno ni niti v Sloveniji niti ne drugod v jugovzhodni Evropi. Izbor bolnikov, ki bi imeli pomembno klinično korist od protonske radioterapije, je zahteven in tudi v svetu še ne docela dorečen. Prednost protonske pred konvencionalno fotonsko radioterapijo je v večji biološki učinkovitosti protonskih žarkov. Tudi fizikalno gledano so dozimetrične lastnosti protonskih žarkov bistveno ugodnejše glede sevalne obremenitve zdravih tkiv in rizičnih organov: večina njihove energije se sprosti na mestu, kjer je tumor, za razliko od fotonskih žarkov, kjer se večina energije sprosti v prvih nekaj centimetrih pod površino kože, kjer žarki vstopajo v telo. Podobno kot mnoge druge države je tudi Slovenija pred odločitvijo, kdaj in kako ustvariti pogoje za protonsko terapijo, ki pa jo bo treba sprejeti hitro in transparentno.Together with surgery and systemic treatment, radiotherapy constitutes one of the three pillars of cancer treatment. Tremendous technological development of particle accelerators has led to the implementation of proton beam therapy as the treatment of choice for a specific group of patients with cancer, especially children. Competition among several manufacturers has contributed to the lowering of prices of proton accelerator, which have lately also become accessible to less wealthy countries. The complexity of proton therapy, size of accelerators, and lingering high prices are the three main reasons for a relatively low number of proton therapy centres around the world, and the fact that there are no such centres in Slovenia as of yet. While proton therapy is a valid treatment of choice for the particular patient group, it is still difficult to determine unambiguously which patients would benefit from it most. From a strictly physical point of view, the dosimetric properties of proton beams differ significantly from those of photons, and are advantageous compared to photons. Protons traverse the tissue and deposit only a small part of their energy until they reach a certain depth where nearly all of their energy is deposited, while photons deposit their energy almost entirely in the first few centimetres of the tissue exposed to the beams. Like many other countries, Slovenia is at a crossing where it has to decide on the time and mode of photon therapy implementation, which will have to be carried out in a prompt and transparent manner

Acute side effects of radiation therapy in the head, neck and thoracic region

Stranski učinki so kljub napredku radioterapije v zadnjih desetletjih še vedno pomemben in neizogiben sopojav tovrstnega zdravljenja, ki pomembno vpliva na kvaliteto življenja bolnikov z rakom. Akutni stranski učinki se razvijejo znotraj 90 dni od pričetka obsevanja. Pri zdravljenju raka v področju glave in vratu ter prsnega koša se najpogosteje srečujemo z radiodermatitisom in radiomukozitisom, ki se pojavljata pri več kot 90% obsevanih bolnikov, pogosto pa se jima pridružujejo tudi pomanjkanje sline (kserostomija), motnje okusa (disgevzija) in težave pri požiranju (disfagija). V pričujočem članku so omenjeni stranski učinki na kratko predstavljeni, navedeni pa so tudi ukrepi za preprečevanje in zdravljenje le-teh.In spite of the advances in radiation therapy in the last decades, radiation side effects still remain an important and unavoidable issue, with a great impact on cancer patients\u27 quality of life. Acute side effects develop up to 90 days from the beginning of therapy. In patients receiving treatment in the head, neck and thoracic region, radiodermatitis and radiomucositis are the most common acute side effects, followed by lack of saliva (xerostomia), altered taste (dysgeusia) and difficulties in swallowing (dysphagia). This article offers a short description of aforementioned side effects and presents the preventive and therapeutic measures

Katepsini in njihovi inhibitorji kot tumorski označevalci pri raku glave in vratu

The invasion and metastasizing of tumor cells is closely connected with the disintegration of basement membranes and extracellular matrix. The carriers ofthese processes are different proteolytic enzymes, among them cysteine and aspartic cathepsins B, H, L and D as well, a group of ubiquitous lysosomal proteases, and endogenous inhibitors of the former, cystatins. The aim of the present review was to collect the current knowledge on the predictive and prognostic value of cathepsins and their inhibitors in squamous cell carcinomaof the head and neck. In this particular tumor type, the UICC/AJCC TNM-classification system and histopathological characteristics of the tumors were found inadequate to reliably predict either the response to therapy or patients\u27 survival. Moreover, to date, no factor within the wide spectrum of biochemical and histological factors has yet been idenrified as reliably predicting the natural course of the disease or its response to therapy. To construct a prognostically meaningful tumor profile, new markers are intensively investigated.Invazija in zasevanje tumorskih celic sta tesno povezana z razgradnjo bazalnihmembran in zunajceličnega matriksa. Nosilci teh procesov so različni proteolitični encimi, med njimi tudi skupina ubikvitarnih lizosomskih encimov,tj cisteinske proteaze katepsini B, H in L, aspartatna proteaza katepsin D in endogeni inhibitorji prvih, cistatini. Namen tega pregleda je bil zbrati dosedanje vedenje o napovedni in prognostični vrednosti katepsinov in njihovih inhibitorjev pri ploščatoceličnem karcinomu glave in vratu. Pri tej vrsti raka so se UICC/AJCC TNM-klasifikacijski sistem in histopatološke značilnosti tumorjev izkazali kot nezanesljivi kazalci za napoved bodisi odgovora na zdravljenje bodisi preživetja bolnikov. Poleg tega do sedaj še noben dejavnik iz širokega spektra biokemičnih in histoloških dejavnikov ni bil spoznan kot zanesljiv napovedovalec naravnega poteka bolezni ali odgovora na zdravljenje. Prav z namenom izdelati zanesljiv prognostični profil tumorja potekajo intenzivne raziskave številnih novih označevalcev

Ekstramedularni plasmacitom grla

Purpose. To report three cases of extramedullary plasmacytoma of the larynx treated at the Institute of Oncology in Ljubljana between 1969-1999. Results. All three patients were treated with radiotherapy only, whieh resulted in permanent local and regional control of 7.8, 4.7 and 3.5 years. The funetion of the larynx was preserved in all of them. Two patients died, both to the causes other than plasmacytoma. In none of the patients disease progressed to multiple rnyeloma. Conclusions. Extramedullary plasmacytoma of the larynx is arare disease, highly curable when radiotherapy is used. Moderate radiation doses and limited fields ensure excellent cosmetic and funetional result.Namen. Predstavitev treh primerov ekstramedularnega plazmacitoma grla, ki so bili zdravljeni na Onkološkem inštitutu v Ljubljani v obdobju 1969-1999. Rezultati. Vsi trije bolniki so bili zdravljeni samo z obsevanjem. Pri vseh treh je bila dosežena permanentna lokalna in regionalna kontrola bolezni v trajanju 7.8, 4.7 in 3.5 let ter ohranjena funkcija grla. Dva bolnika sta umrla, oba zaradi vzrokov, ki niso bili povezani s plazmacitomom. Pri nobenem izmed bolnikov bolezen ni napredovala v multipli mielom. Zaključki. Ekstramedularni plazmacitom grla je redka bolezen, ozdravljiva pri večini bolnikov, zdravljenih z obsevanjem. Srednje visoke obsevalne doze in polja omejenega obsega zagotavljajo odličen kozmetski in funkcionalni rezultat

Lost and Found in Translation

Panel: Lost - and Found - in Translatio

Role of radiotherapy in melanoma management

BACKGROUND: In melanoma, radiotherapy has generally been considered as a palliative treatment option indicated only for advanced cases or disseminated disease. In the 70s of the previous century, the technological advances in radiotherapy, linked to rapid development of computer sciences, resulted in restored interest for radiotherapy in melanoma management. Although a fundamental lack of well designed prospective and/or randomized clinical trials critically influenced the integration of radiotherapy into treatment strategies in melanoma, radiotherapy was recently recognized as an indispensable part in the multidisciplinary management of patients with melanoma. Altogether, approximately 23% of melanoma patients should receive at least one course of radiotherapy during the course of the disease. In this review, radiobiological properties of melanoma that govern the decisions for the fractionation patterns used in the treatment of this disease are described. Moreover, the indications for irradiation and the results of pertinent clinical studies from the literature, creating a rationale for the use of radiotherapy in the management of this disease, are reviewed and a brief description of radiotherapy techniques is given. CONCLUSIONS: Basic treatment modality in melanoma is surgery. However, whenever surgery is not radical or there are adverse prognostic factors identified on histopathological examination of resected tissue specimen, it needs to be supplemented. Also, in patients with unresectable disease or in those not being suitable for major surgery or who refuse proposed surgical intervention, other effective mode(s) of therapy need to be implemented. From this perspective, supported by clinical experiences and literature results, radiotherapy is a valuable option: it is effective and safe, in curative and palliative setting