Biomedical subjects

R Soumarová

Publications and source records attributed to R Soumarová.

At least 19 recordsLinked to original sources

PubMed2006

[Acute adverse effects of high dose brachytherapy in combination with external radiotherapy in localized prostate cancer].

BACKGROUND: Over the past few years, brachytherapy has become more and more common in the treatment of prostate cancer. Part of the reason behind this growth in the use of brachytherapy for the treatment of organ-confined prostate cancer is the reduced amount of acute and chronic side effects. On the other hand, brachytherapy allows for dose escalation, resulting in significant improvements in the treatment results. METHOD AND RESULTS: From August 2004 to June 2005, we irradiated 40 patients with T1c-T3a prostate cancer. All of the patients underwent transperineal transrectal guided high dose rate (HDR) brachytherapy (two fractions, 8 Gy per fraction) and course of external beam radiotherapy with a median dose of 45-50.4 Gy. The patients were classified into three groups: low risk of recurrence (11 patients - 27.5%), medium risk (14 patients - 35%) and high risk (15 patients - 37.5%). The medium age of the patients was 68.7 years (range of between 55 and 77). Hormonal treatment was carried out with 17 of the patients (42.5%). We evaluated the quality of each implantation, including the maximum urethral and rectal dose. The calculated doses were compared with measurements by in vivo dosimetry. Acute toxicity was evaluated in all of the patients according to the Radiation Therapy Oncology Group (RTOG) scale. Each of the patients completed an International Prostatic Symptom Score (IPSS) questionnaire. Acute genitourinary morbidity grade 1 was recorded in 37.5% of patients, and grade 2 in 15% of patients. Urine retention in one of the patients resulted in the need to perform an epicystostomy. According to the IPSS score, the majority of patients (90%) experienced an improvement in symptoms related to quality of life. Grade 1 acute gastrointestinal toxicity was recorded in 40% of the patients. Grades 2-4 were not recorded. CONCLUSIONS: We showed that the combination of external beam radiotherapy and HDR brachytherapy in the treatment of early prostate cancer to be feasible and well tolerated. Acute toxicity was low and scarcely influenced the quality of life. Among the risk factors of genitourinary toxicity was the volume of the prostate. For gastrointestinal toxicity, risk factors included a combination of HDR brachytherapy and external beam radiotherapy to the pelvis, as well as hormonal treatment.

Aged↗

PubMed2006

[Laparoscopy-assisted exenteration of the pelvis in a locally advanced rectal carcinoma].

INTRODUCTION: In this pilot study, based on three case-reviews, the authors report on their initial experience with the laparoscopy-assisted total exenteration of the pelvis, conducted in patients with locally advanced rectal carcinomas. METHODS: In two patients with histologically confirmed rectal carcinomas, the neoadjuvant radiochemotherapy was initiated, due to the locally advanced tumor finding, aiming to downstage and locally control the disorder. The pelvic exenteration was indicated, based on the control findings of the imagining methods. In one patient, due to repetitive enterorrhagies, the primary surgical management was indicated. RESULTS: The surgical procedures were multidisciplinary, assisted by urologists. In all three cases, the laparoscopic resections, followed by planned conversions and constructions of the ileouretheral conduit and the terminal sigmoidostomies (resp. with their maintenance), were completed. Prior to the procedures, in all the three patients, the presence of distant metastases was excluded. No peroperative complications were recorded in the case-reviews. In one case, postoperative re-suturing of the wound was inevitable, due to its dehiscence. In this patient, the enzymatic acute MI, without the ECG correlate, was diagnosed. CONCLUSION: The laparoscopy-assisted pelvic exenteration may be a suitable modification of the classical surgical procedure in selected patient groups with locally advanced colorectal carcinomas. Good visualisation and exact orientation in the region of the small pelvis, as well as other generally accepted advantages of miniinvasive procedures, are the pros of the method.

History, 17th Century↗

PubMed2006

Acute toxicity of conformal high dose interstitial brachytherapy boost in prostate cancer.

Over the past few years, brachytherapy has become more and more common in the treatment of prostate cancer, largely thanks to the reduced amount of acute and chronic side effects. At the same time, brachytherapy also allows dose escalation, resulting in significant improvements in the treatment results. From August 2004 to June 2005, we irradiated 40 patients suffering from T1c-T3a prostate cancer. All of the patients underwent external beam radiotherapy with a median dose of 45-50.4 Gy and a conformal high dose interstitial brachytherapy boost (two fractions, 8 Gy per fraction). The patients were divided into three groups: low risk of recurrence (11 patients - 27.5%), intermediate risk (14 patients - 35%) and high risk (15 patients - 37.5%). The medium age of the patients was 68.7 years (between 55 and 77). Hormonal treatment was carried out 17 patients (42.5%). We evaluated the quality of each implantation, including the maximum urethral and rectal dose. The calculated doses were compared with measurements by in vivo dosimetry. Acute toxicity was evaluated in all of the patients according to the Radiation Therapy Oncology Group (RTOG) scale. Each of the patients completed an International Prostatic Symptom Score (IPSS) questionnaire. Acute genitourinary morbidity grade 1 was recorded in 37.5% of patients; grade 2 in 15% of patients. Urine retention in one of the patients resulted in the need to perform an epicystostomy. According to the IPSS score, the majority of patients (90%) experienced an improvement in symptoms related to quality of life. Grade 1 acute gastrointestinal toxicity was recorded in 40% of the patients. Grades 2-4 were not recorded. Here, we show that the combination of external beam radiotherapy and high dose rate (HDR) brachytherapy in the treatment of early prostate cancer to be feasible and well tolerated. Acute toxicity was low and scarcely influenced the quality of life. Among the risk factors of genitourinary toxicity was the volume of the prostate. For gastrointestinal toxicity, risk factors included the combination of HDR brachytherapy and external beam radiotherapy to the pelvis, as well as hormonal treatment.

Aged↗

PubMed2006

[Colorectal cancer--short time results of laparoscopic resection in 350 patients].

BACKGROUND: Laparoscopic resection of the colon with its results is fully acceptable method of choice in patients with colorectal cancer. Authors present their own experiences. METHODS AND RESULTS: A retrospective study of 350 patients who undergone laparoscopic resection because of colorectal carcinoma (curative or palliative) from January 1, 2002 to December 31, 2005. From these patients 50.8 % were operated in the 1. and II. grade of the disease, it means without detectable metastases of the lymphatic nodes. Patients with the carcinoma localised in rectosigma and rectum - 61.1 % dominate in our study. The conversion of the laparoscopic operation was necessary in 9.1%, in 13.1% there were surgery postoperative complications and postoperative mortality was 1.4%. Normal eating was allowed to patients in average 4.1 days after the operation and the average hospitalisation time was 8.3 days. We mentioned also the time of operation in various types of resection, size of resection express by the number of detectable lymph nodes and necessity of the postoperative analgesic therapy. CONCLUSIONS: Laparoscopic resection of the colorectal cancer is today method of choice, which is safe for patient and with the same morbidity and mortality as in open surgery, provides advantages of mini-invasive approach.

Adult↗

PubMed2004

Perioperative fractionated high-dose rate brachytherapy in the treatment of soft tissue sarcomas.

The purpose of the study was to investigate the viability of perioperative fractionated high dose rate brachytherapy (HDR BT) for primary and reccurent soft tissue sarcomas (STS). From February 1998 through June 2002, 21 adult patients, 11 females and 10 males with either low grade or high grade soft tissue sarcomas were treated by perioperative HDR BT. Surgical margin was negative in 10 cases, close in 4 and positive in 4 in cases. In 3 cases it was not described. BT was used as a part of primary treatment in 10 cases and for the treatment of reccurent tumor in 11 cases. The localisation of the tumor was the extremity in 16 patients and the trunk in 5 patients. Ten patients were treated with HDR BT alone (total mean dose 40 Gy) and 11 were treated with combination of external beam radiotherapy (EBRT) (40-50 Gy) and brachytherapy (total mean dose 24 Gy). Hyperfractionation 2.4-3 Gy twice daily at 10 mm from the source was used for BT. Follow-up periods were between 7--48 months (median: 20 months). Local control in patients treated pro primary STS was 100%.The pulmonal metastases were a cause of death in one case, one patient was alive with dissemination and one patient was disease free after salvage surgery and chemotherapy for lung metastases. Local control was achieved only in 3 of 11 patients treated for reccurent tumor (27%). Six patients were disease free after salvage surgery, 2 patients died of disease progression, one patient died of toxicity of chemotherapy without evidence of disease and 2 patients are alive with distant metastases. Local control was achieved in 5 of 11 (45%) patients with positive, close or not stated surgical margin and in 5 of 10 (50%) patients with negative margin. Local control was 100% in patients treated by EBRT + BT, but only 20% in patients treated by BT alone. No infection or delayed wound healing has occurred after BT. Soft tissue necrosis was seen in 4 cases, subcutanous fistula in one case and peripheral nerve palsy in one case. Despite small number of patients and short follow up our study suggest that perioperative HDR BT is easy and promissing when used as a part of primary treatment for STS. The treatment results for recurrence are poor and in a lot of cases radical surgical approach should have been considered for the salvage.

Adult↗

PubMed2003

[Principles of post-resection brachytherapy of solid tumors using high dose rate (HDR) afterloading].

Postresection interstitial brachytherapy is one of the modern methods of radiotherapy the aim of which is to administer a larger radiation dose without greater irradiation of the surrounding sound tissues. The administration of higher radiation doses leads in some solid tumours to better local control of the disease and makes it thus possible to use the organ and its function after preserving surgical operations. Post-resection interstitial brachytherapy belongs in the wider concept to intraoperative radiotherapy the advantage of which is direct control of the irradiated area during surgery. The method of introduction of the radiation source into the applicators in the tumour during surgery (afterloading technique) makes its possible to start radiotherapy after obtaining the definite histological result. Post-resection brachytherapy reduces markedly the total time of irradiation treatment.

Brachytherapy↗

PubMed2003

[Conformal radiotherapy].

The aim of curative radiotherapy is the administration of tumor-lethal dose to an exactly defined target volume with minimal surrounding healthy tissue toxicity. In the conformal radiotherapy it is possible to conform the shape of irradiated volume to an irregular target volume. It allows using more intensive tumor irradiation without increase of the surrounding tissue toxicity. Dose intensification for the tumor tissue significantly improves the local control and thus it can considerably increase the patient's chance for survival. Decrease of the surrounding tissue toxicity can bring about also a higher quality of the patient's life.

Humans↗

PubMed2003

[Concomitant chemoradiotherapy of tumors of the head and neck].

Head and neck carcinomas represent a histopathologically variable group of tumors with different location. Treatment strategy is similar for most of them. Surgery followed with radiotherapy or chemotherapy is a standard treatment. Radiotherapy becomes the main treatment modality in locally progressive or inoperable tumors. Prognostic outcome is rather poor. Use of different fractionation radiotherapy schemes combined with chemotherapy is aimed to improve the treatment results. Results of recent metaanalyses have shown that concomitant chemoradiotherapy can improve overall survival of patients with locally progressive or inoperable disease.

Combined Modality Therapy↗

PubMed2003

[Concomitant chemoradiotherapy in nasopharyngeal carcinoma].

Radiotherapy is a standard treatment method for the nasopharyngeal carcinoma due to the anatomy of these tumors and their easy locoregional spreading. Surgery is used only in case of recurrent or persistent lymph node involvement. Nasopharyngeal carcinomas are dose dependent. Results of conventional and fractionation radiotherapy has reached a stable level. Improvement of local control and overall survival depends on new technologies and research results. Concomitant chemoradiotherapy represents a standard method in the treatment of locally progressive disease. Hyperfractionated or accelerated radiotherapy combined with chemotherapy has been used in some clinical studies to shorten the treatment time.

Combined Modality Therapy↗

PubMed2003

[Review of combined chemoradiotherapy in the treatment of esophageal carcinoma].

At diagnosis, nearly 50% of patients with carcinoma of the esophagus have a metastatic disease. Less than 60% of patients with locoregional disease can undergo a curative resection. Surgical principles include a wide resection of the primary tumor, including resection margins of 5 cm or more, plus regional lymphadenectomy. Radiotherapy alone can be considered for palliation in patients with locoregional disease who are medically unsuitable for surgery and in patients with contraindication for chemotherapy. The median length of survival is approximately 12 months. Effectiveness of chemoradiotherapy has been studied in randomized trials in patients with locoregional carcinoma (stage I-III). Chemoradiotherapy should include 50 to 60 Gy of radiotherapy plus concurrent chemotherapy with 5-fluorouracil (5-FU) plus cisplatin. Chemoradiotherapy is now an established alternative to surgical therapy (predominantly in patients with squamous cell carcinoma). In patients treated with chemoradiotherapy, a follow up endoscopy of the upper gastrointestinal tract 4 to 6 weeks after its completion is recommended. If a complete remission can be confirmed, patients are observed or offered esophagectomy. Patients with unresectable (T4) carcinoma can be treated with radiotherapy plus concurrent chemotherapy and those with adenocarcinoma of the distal esophagus with positive nodes should receive adjuvant postoperative radiotherapy and chemotherapy with 5-FU plus cisplatin.

Adenocarcinoma↗

PubMed2003

[Role of adjuvant chemoradiotherapy in the treatment of gastric carcinoma].

Gastric carcinoma is often diagnosed at the advanced stage. Approximately 50% of patients with locoregional disease cannot undergo any curative resection. 5-year survival rate in patients who undergo a curative resection (R0) ranges from 30-40%. In patients with curatively resected gastric carcinoma who are at high risk of relapse the adjuvant postoperative chemotherapy with 5-FU/leucovorin is recommended. It should be followed by radiotherapy with concomitant 5-FU/leucovorin, and then two more courses of 5-FU/leukovorin (INT-0116 trial) should be added. For the surgery alone group, the overall survival was 27 months; in the chemoradiotherapy group it was 36 months. The recommended therapy for inoperable or medically unsuitable patients with locoregional carcinoma is the combined radiation therapy (45 to 50.4 Gy) with concurrent 5-fluorouracil or cisplatin based chemotherapy.

Carcinoma↗

PubMed2003

[Concomitant chemoradiotherapy in tumors of the pancreas].

Pancreatic tumors are malignancies with poor prognosis. The total five-year survival is achieved only in 1-2% of patients of all stages. Only the surgical approach represent a curative treatment. Unfortunately, in the time of diagnosis, only 10-20% of tumours are in the resectable stages. The main reason is probably the low specificity of initial symptoms. Local control of this disease can be improved by adjuvant chemoradiotherapy, however, without effects on the overall survival. In potential resectable tumours the concomitant chemoradiotherapy can increase the probability of curative resection. Treatment of locally advanced inoperable tumours is considered as palliative treatment and therefore it is focused namely on the improvement of the quality of the patient's life. Supporting care must become an inseparable part of the concomitant chemoradiotherapy.

Combined Modality Therapy↗

PubMed2003

[Concomitant chemoradiotherapy in the treatment of carcinoma of the uterine cervix].

Cervical carcinoma represents a serious medical and social problem. Its incidence in the Czech republic is two times higher than it is in countries of the European Union. Initial stages of the disease have the best treatment results. But most of patients at the time of diagnosis have advanced inoperable carcinoma. Radiotherapy plays the main role in the treatment. Even though methods of radiotherapy have developed, treatment results have not been satisfying enough. The aim of chemotherapy is to improve these results. The effectiveness of adjuvant, neoadjuvant and concomitant chemotherapy was studied by number of authors. Concomitant chemoradiotherapy is considered as the most effective treatment. Concomitant weekly application of cis-platinum in the dose of 40-50 mg/m2 is a widely used standard regimen. Radiopotential effect of other cytostatic drugs has been studied in several ongoing trials.

Carcinoma↗

PubMed2003

[Concomitant chemoradiotherapy in the treatment of vulvar carcinoma].

Vulvar carcinoma belongs between the less frequent gynaecologic malignancies. Despite to the low morbidity its mortality is high. The reason is locally advanced disease at the time of diagnosis. Radical surgery is mutilating for patient. Radiotherapy was not considered as a standard treatment. Recently, due to technical improvement, mega-voltage facilities and knowledge of radiobiology, radiotherapy has become a part of standard treatment modalities. It plays an important role in the curative, adjuvant and palliative treatment. Concomitant chemoradiotherapy has been used since the eighties of the last century to improve results and reduce extent of surgery in locally advanced vulvar carcinomas. Results show that concomitant chemoradiotherapy is a method of choice in the treatment of locally advanced or recurrent disease. Additional studies are necessary to determine the specific categories of patients who would benefit most from concomitant chemoradiotherapy.

Carcinoma↗

PubMed2003

[Adverse effects of concomitant chemoradiotherapy and their prevention and treatment].

Concomitant chemoradiotherapy plays an important role in the treatment of malignancies. Concomitant chemoradiotherapy improves the local control and overall survival compare to separate treatment modalities. Combined treatment leads to higher toxicity. Most frequent side effects during concomitant chemoradiotherapy are diarrhoea, mucositis, skin reactions and haematologic toxicity. Optimal combination of treatment modalities, fractionation and dosage of radiotherapy, modern planning techniques and use of radioprotective drugs could decrease the treatment toxicity.

Antineoplastic Agents↗

PubMed2002

[Concomitant radiochemotherapy in rectal tumors].

Requirements for improved cancer control led to the testing of the combined-modality therapy for many types of cancer. This review attempts to analyse possibilities of the simultaneous application of both strategies in the treatment of rectal cancer. Postoperative radiochemotherapy has been shown to be effective in rectum carcinomas. Preoperative combined-modality therapy can ensure downstaging (T3, T4). Operation was carried out 4 to 6 weeks after the end of preoperative therapy.

Antineoplastic Agents↗

PubMed2002

Treatment of uterine sarcoma. A survey of 49 patients.

PURPOSE: Surgery, radiotherapy and chemotherapy are employed in the treatment of uterine sarcoma. We claim to evaluate the role of radiotherapy in the treatment of uterine sarcoma. PATIENTS AND METHODS: We report a retrospective study of 49 patients with uterine sarcoma treated from 1990-1999 at Masaryk Memorial Cancer Institute in Brno. All 49 patients had surgery, 19 (38.7%) had adjuvant radiotherapy and 25 (51%) had chemotherapy. Using the FIGO classification: 71.4% had stage I, 6.1% stage II, 16.3%, stage III and 6.1% stage IVa disease. 42.9% of tumors were mixed Müllerian tumors, 34.7% leiomyosarcomas and 22.4% endometrial stromal sarcomas. 12 cases (24.5%) had a local recurrence, 7 (14.3%) had hematogenous dissemination. There was an increased disease free interval (DFI) for patients treated with adjuvant radiotherapy (p = 0.005). The DFI was favourably influenced by the stage of the disease. Of 12 patients with a local recurrence only one had postoperative radiotherapy. Radiotherapy had an impact on overall survival (OS). The five-year OS probability was 51.6% without radiotherapy and 88.9% with radiotherapy (p = 0.0066). CONCLUSION: We conclude that postoperative radiotherapy in our series of patients diagnosed with uterine sarcoma has an impact on locoregional and disease-free progression intervals (LRFI, DFI) and overall survival (OS). The most important prognostic factor is the extend of the disease (stage). Stage I patients have a significantly better survival.

Adult↗

PubMed2002

[Diagnosis and therapy of pancreatic tumors].

Pancreatic tumours belong among oncological diseases with a very poor prognosis. The total five-year survival is 1-2%. Surgical resection with a curative intention increases the probability of five-year survival to 10-20%. However only some 10% tumours are diagnosed in the resectable stage. The reason is the low specificity of initial symptoms. Earlier diagnosis and improvement of survival could be promoted by improvement of imaging methods and endoscopic techniques. Improvement of therapeutic results in selected indications can be achieved by adjuvant treatment (chemotherapy, radiotherapy, possibly their combination). Treatment of inoperable stages of the disease is focused in particular on improvement of the quality of the patient's life. Its aim is specially to mitigate pain and reduce the consumption of analgesics, to ensure bile derivation or release the passage through the digestive tract. This can lead also to improvement of the patient's general condition. Despite advances in molecular biology of pancreatic cancer the results of systemic treatment remain unsatisfactory in advanced tumours. Nevertheless therapeutic nihilism must not prevail nowadays. It is necessary to use new findings in diagnosis and therapy. Patients with this disease should be included in clinical trials investigating optimal therapeutic procedures.

Humans↗