- Kraków, Malopolskie, Poland
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Introduction/Background Expected median survival for patients with cervical carcinoma stage IV B is 17–26 months. Methodology This is a case report of 6 years survival for patients with metastatic cervical cancer. Results 59 years old... more
Introduction/Background Expected median survival for patients with cervical carcinoma stage IV B is 17–26 months. Methodology This is a case report of 6 years survival for patients with metastatic cervical cancer. Results 59 years old women was diagnosed with squamous cell cervical cancer in 2012. MRI- revealed cervical tumor 7 cm involving anterior fornix, vaginal wall, parametrium and metastases to iliac lymph nodes. FDG/PET confirmed disease in pelvis and show metastases to III and X segment of the right lung. The patient was treated with palliative radiotherapy directed to pelvis (20 Gy, 4 Gy/fx). Completed response was achieved. After RT 4 cycles of chemotherapy (Carboplatin and Paclitaxel) stabilization was observed but the treatment had to be ceased because of toxicity. Three months after the chemotherapy, CT show progression of the lung metastases. Stereotactic radiation therapy (SRT) was applied: 40 Gy, 20Gy/fx to the tumors. Complete regression on CT was observed but after 5 months a new lesion in the apex of the right lung was diagnosed. It was treated with SRT (45 Gy, 15Gy/fx) - three months after the treatment a complete response was observed but a new nodules was seen in the right hilum. This one was treated with SRT (30 Gy, 10 Gy/fx). A complete regression was observed. The patient was well until the February of 2018 when local recurrence was diagnosed. The patient was reirradiated (30 Gy, 10 Gy/fx). Near complete regression was seen. After one months a second local progression was observed. The patients underwent palliative chemotherapy, but it was discontinued due to lack of effectiveness. The treatment described above allowed sixed year survival for patients with metastases to lung. Conclusion Agressive treatment is warrant in radiosensitive cervical cancer, even in case of multiple metastases. Disclosure Nothing to disclose.
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The optimal timing of adjuvant radiochemotherapy (RCT) in glioblastoma (GBM) patients remains unknown and the paradigm of 'the sooner, the better' has been challenged by many recent publications. In this study, we present unique... more
The optimal timing of adjuvant radiochemotherapy (RCT) in glioblastoma (GBM) patients remains unknown and the paradigm of 'the sooner, the better' has been challenged by many recent publications. In this study, we present unique data on the outcomes of patients with significant treatment delays. The study group consisted of 346 GBM patients (median age 56.8 years) who received surgical treatment (total or subtotal resection) and then underwent adjuvant concurrent RCT at one institution. The main endpoint was overall survival (OS). The Univariate and multivariate Cox Proportional-Hazard Model, log-rank test, and Kaplan-Meier method were used for the analysis. The median OS was 18.7 months and the 5-year overall survival was 8.5%. The median time interval from surgery to RCT was 9.8 weeks. The Cox regression showed that the time interval had no statistically significant impact on OS both in uni- and multivariate analysis. The explorative analysis suggested a positive trend for improved survival for patients in the 1st quartile of the time interval, especially for patients with residual disease or local recurrence prior to RCT, However, considering the 6.9 weeks median interval in the 1st quartile, this subgroup should still be regarded as 'moderate delay' compared with other literature data. The results indicate that the time interval is not a clear prognostic factor in the treatment of GBM. Prospective trials are highly warranted, as data suggest that moderate delays in the initiation of adjuvant treatment might be associated with survival benefit.
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Abstract Although there are several data analysis frameworks, both commercial and open source, supporting the detection of tumours on nuclear magnetic resonance (NMR) sequences, none of them gives satisfactory results in the case of low... more
Abstract Although there are several data analysis frameworks, both commercial and open source, supporting the detection of tumours on nuclear magnetic resonance (NMR) sequences, none of them gives satisfactory results in the case of low volume tumors. The majority of the frameworks require the detailed analysis of at least two sequences of the examined sample, or give sample specific thresholds distinguishing between the tumor and subtypes of healthy tissue. In this paper, we present a novel algorithm for the automated estimation of tumor specific cut-off values in the domain of the apparent diffusion coefficient (ADC). Once the cut-off characteristics for a particular type of tumor is estimated, their further usage on other independent samples does not require any calculations except for an easy thresholding. The proposed methodology is a combination of classical decomposition of ADC distribution into a Gaussian mixture model (GMM) with k-means clustering subsequently performed on the parameters of mixture model components, leading to the identification of ADC distributions for every tissue type. The maximum conditional probability criterion gives the final threshold estimate. The developed signal analysis pipeline was applied to the problem of Glioblastoma Multiforme grade IV brain tumor segmentation, with a dataset of 119 randomly chosen ADC maps and Leave-One-Out cross-validation procedure for population error estimate. Additionally, a comparison to standard GMM based tumor segmentation algorithms as well as to three other automated segmentation methods was performed and the obtained tumor regions were referenced to the segmentation done by a human expert. The results demonstrate the average MiMSeg similarity to the expert-curated decision measured by the Dice coefficient as equal to 89.2% (with 95% confidence interval 87.7 ÷ 90.6). The MiMSeg algorithm significantly outperforms other techniques in the case of small tumors (of volume less than 10%), obtaining similarity to the expert-curated decision at the level 86.7%, with 44.9% obtained by standard GMM, 79.0% by Self-Organising-Maps algorithm, 68.7% by Murakami’s algorithm, and 78.2% by Kang’s method.
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To measure changes in spontaneous growth rate and radiation response in the progeny of irradiated squamous cell carcinoma cells. Murine SCC cells of the line AT478 were grown as epithelial megacolonies in vitro, using both the original... more
To measure changes in spontaneous growth rate and radiation response in the progeny of irradiated squamous cell carcinoma cells. Murine SCC cells of the line AT478 were grown as epithelial megacolonies in vitro, using both the original line and two subsequent passages derived from a clone that had recurred after a high radiation dose. Radiosensitivity was evaluated in terms of local control following single dose irradiation of standard size megacolonies (0.8 cm2). In addition, original megacolonies were given a priming dose of 20 Gy and the recurrent clones arising in situ were retreated at three dose levels for analysis of curability. A marked increase in radiosensitivity was observed in the megacolonies grown from irradiated progeny as compared to original megacolonies, reflected in a shift of the TCD50 from 24.5 to 16.5 Gy. Direct parameter estimation from the cure data suggested that the underlying change was a lowered number of clonogenic 'stem' cells rather than increased cellular sensitivity. A similar decrease in clonogen density was also apparent for the recurrent clones in situ. The change in megacolony curability was paralleled by a substantial growth retardation. The data demonstrate persistent changes in the progeny of irradiated SCC tumour cells that affect both growth and radiosensitivity and are compatible with the expression of delayed reproductive death.
Research Interests: Biology, Stem Cell, Medicine, Cell Division, Parameter estimation, and 14 moreCell line, Mice, Animals, Squamous Cell Carcinoma, Oral Squamous Cell Carcinoma (OSCC), Radiation Dose, Irradiation, Growth rate, Radiosensitivity, Radiation Tolerance, Gamma Irradiation, Clonogenic Assay, Growth Retardation, and Radiotherapy and Oncology
Research Interests: Incidence Geometry, Brachytherapy, Radiotherapy, Medicine, Humans, and 15 moreInternal Medicine, Female, Feasibility Studies, Bone marrow, Incidence, Clinical Sciences, Cisplatin, Middle Aged, Carcinoma, Gastrointestinal Tract, Chemoradiotherapy, Antineoplastic Agents, Adenocarcinoma, neutropenia, and leukopenia
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Research Interests: Radiation Therapy, Nuclear medicine, Radiotherapy, Medicine, Humans, and 13 moreFemale, Feasibility Studies, Bone marrow, Aged, Middle Aged, Adult, Intensity Modulated Radiation Therapy, Intensity Modulated Radiotherapy, Atlas of human anatomy, Uterine Cervical Neoplasms, Radiotherapy and Oncology, Computer Assisted, and Positron emission tomography computed tomography
In der Bestrahlungsplanung bei Hirntumoren wird typischerweise ein Sicherheitsabstand von 2 − 2, 5 cm um das im T2-Flair MR-Bild hyperintense Gebiet eingeplant. Verlasliche Vorhersagen des Tumorwachstums konnen dazu beitragen, die... more
In der Bestrahlungsplanung bei Hirntumoren wird typischerweise ein Sicherheitsabstand von 2 − 2, 5 cm um das im T2-Flair MR-Bild hyperintense Gebiet eingeplant. Verlasliche Vorhersagen des Tumorwachstums konnen dazu beitragen, die Strahlendosis noch besser auf gefahrdete Regionen zu konzentrieren und gleichzeitig gesundes Gewebe zu schonen. Aktuelle Verfahren aus der Forschung nahern sich diesem Problem mit einer expliziten, generativen Modellierung des Wachstumsprozesses. Wir prasentieren ein alternatives, diskriminatives Verfahren. Mit Hilfe einer annotierten Datenbasis und uberwachtem Lernen wird ein Wachstumsmodell trainiert und im nachsten Schritt auf ungesehene Daten angewendet. In allen 6 Testpatienten lieferte der Ansatz genauere Vorhersagen (DICE 0, 80±0, 09) als die bisherige Herangehensweise (DICE 0, 56 ± 0, 07).
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ABSTRACT Die Erstellung von Trainingsdaten für lernbasierte Segmentierungsverfahren ist häufig sehr zeitaufwendig und fehleranfällig. Gleichzeitig muss die Lernbasis an die konkrete Bildgebung einer Klinik angepasst werden, was eine weite... more
ABSTRACT Die Erstellung von Trainingsdaten für lernbasierte Segmentierungsverfahren ist häufig sehr zeitaufwendig und fehleranfällig. Gleichzeitig muss die Lernbasis an die konkrete Bildgebung einer Klinik angepasst werden, was eine weite Verbreitung solcher automatischer Segmentierungsverfahren in der klinischen Routine verhindert. Wir schlagen daher ein Verfahren vor, welches durch die Verwendung eines Domain Adaption Ansatzes auf spärlichen, leicht anzufertigenden Segmentierungen trainiert werden kann. Wir validieren das vorgestellte System auf einem Kollektiv von 19 Patienten mit malignen Gliomen und zeigen, dass unser Ansatz die benötigte Annotierungszeit deutlich reduziert, während die Klassifikationsergebnisse gegenüber klassisch trainierten Segmentierungsansätzen kaum beeinträchtigt werden. Der vorgestellte Ansatz erhöht die Attraktivität automatischer Segmentierungsverfahren für den klinischen Einsatz. Weiterhin lässt er die Erstellung umfangreicher Datenbanken mit großen Fallzahlen für unterschiedlichste Szenarien in greifbare Nähe rücken.
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Research Interests: Magnetic Resonance Imaging, Radiosurgery, Radiation Therapy, Nuclear medicine, Positron Emission Tomography, and 12 moreMedicine, Humans, Multimodal imaging, Clinical Sciences, Pituitary Adenoma, Acromegaly, Radiopharmaceuticals, Adenoma, Organometallic Compounds, CYBERKNIFE, Pituitary Neoplasms, and Cavernous sinus
Introduction: Despite routine use of 3D radiotherapy planning in radical radio(chemo)therapy for oropharyngeal cancers, volumetric data have not been implemented in initial staging. We analyzed 228 oropharyngeal cancer cases treated at... more
Introduction: Despite routine use of 3D radiotherapy planning in radical radio(chemo)therapy for oropharyngeal cancers, volumetric data have not been implemented in initial staging. We analyzed 228 oropharyngeal cancer cases treated at one institution between 2004 and 2014 to compare the predictive value of volumetric staging and tumor nodal metastasis staging system (TNM) and determine whether they could be complementary for the estimation of survival. Methods: This retrospective study analyzed 228 consecutive oropharyngeal cancer cases treated with radiotherapy (76.9%) or concurrent radiochemotherapy (23.1%) between 2004 and 2014. The volumetric parameters included primary gross tumor volume (pGTV), metastatic lymph nodes gross tumor volume (nGTV), and total gross tumor volume (tGTV), and were compared with the 7th edition of the TNM staging system. Results: Median overall survival (OS) was 30.3 months. In the receiver operating characteristic analysis, tGTV had the highest area under the curve (AUC) of 0.66, followed by pGTV (AUC,0.64), nGTV (AUC 0.62), and TNM (AUC 0.6). The median OS for patients with tGTV ⩽32.2 mL was 40.5 months, compared to 15.4 months for >32.2 mL ( p < 0.001). This threshold allowed for a statistically significant difference in survival between TNM stage IV cases with low and high tumor volume ( p < 0.001). Despite both TNM and tGTV reaching statistical significance in univariate analysis, only the tGTV remained an independent prognostic factor in the multivariate analysis (hazard ratio 1.07, confidence interval 1.02–1.12, p = 0.008). Conclusions: tGTV is an independent prognostic factor, characterized by a higher discriminatory value than the TNM staging system, and can be used to further divide stage IV cases into subgroups with significantly different prognosis.
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The purpose of our study was to evaluate the discriminatory power of MRI in high-field magnet (1.5 T) for differentiation of adrenal non-adenomas vs adenomas assessing the following parameters separately and in combination: mean diameter... more
The purpose of our study was to evaluate the discriminatory power of MRI in high-field magnet (1.5 T) for differentiation of adrenal non-adenomas vs adenomas assessing the following parameters separately and in combination: mean diameter of adrenal mass; previously described and new ratios as well as index calculated from signal intensity (SI) on SE T2-weighted images, chemical shift imaging (CSI), and Gd-DTPA-enhanced dynamic studies. One hundred eight adrenal masses (36 non-hyperfunctioning adenomas, 27 pheochromocytomas, 23 aldosterone-secreting adenomas, 20 malignant masses and 2 cortisol-secreting adenomas) in 95 patients were evaluated with SE sequences, CSI and Gd-DTPA dynamic studies. Indices and ratios of SI for all examined MRI methods were calculated and examined retrospectively for significance of differences between the groups with calculation of sensitivity and specificity. Receiver operating characteristics (ROC) analysis of calculated parameters in combination was performed. The multifactorial analysis of all four parameters, including size of the tumor, T2(liver) index, CSI ratio reflecting lipid content in the tumor and Wo(max/last) ratio reflecting maximal washout of contrast agent from the tumor had 100 % sensitivity and 100 % specificity in characterization of adrenal non-adenoma. The best performance of combination of mean tumor diameter with single MRI SI parameter was achieved in combination with T2(liver) index for all adrenal masses (area under ROC 0.987) and CSI ratio for non-hyperfunctioning adrenal masses (area under ROC 0.991). Magnetic resonance imaging enables sensitive and specific diagnosis of adrenal non-adenoma.
Research Interests: Magnetic Resonance Imaging, Medicine, Biopsy, Cortisol, Humans, and 13 moreNeuroradiology, Magnetic Resonance, Differential Diagnosis, ROC Curve, Clinical Sciences, Retrospective Studies, Indexation, Sensitivity and Specificity, Adenoma, Chemical Shift Imaging, Receiver Operating Characteristic, Magnetic resonance image, and roc analysis
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The addition of CDK4/6 inhibitors to endocrine therapy in advanced hormone receptor-positive HER2-negative breast cancer has led to practice-changing improvements in overall survival. However, data concerning the safety of CDK4/6i... more
The addition of CDK4/6 inhibitors to endocrine therapy in advanced hormone receptor-positive HER2-negative breast cancer has led to practice-changing improvements in overall survival. However, data concerning the safety of CDK4/6i combination with radiotherapy (RT) are conflicting. A retrospective evaluation of 288 advanced breast cancer patients (pts) treated with CDK4/6i was performed, and 100 pts also received RT. Forty-six pts received 63 RT courses concurrently and fifty-four sequentially before CDK4/6i initiation (76 RT courses). Neutropenia was common (79%) and more frequent during and after concurrent RT than sequential RT (86% vs. 76%); however, CDK4/6i dose reduction rates were similar. In patients treated with CDK4/6i alone, the dose reduction rate was 42% (79 pts) versus 38% with combined therapy, and 5% discontinued treatment due to toxicity in the combined group. The risk of CDK4/6i dose reduction was correlated with neutropenia grade, RT performed within the first two...
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Malignant gliomas are highly heterogeneous brain tumors with complex an- isotropic growth patterns and occult invasion. Computational modeling of cell migration and proliferation has been subject of intensive research aiming at a deeper... more
Malignant gliomas are highly heterogeneous brain tumors with complex an- isotropic growth patterns and occult invasion. Computational modeling of cell migration and proliferation has been subject of intensive research aiming at a deeper understanding of the tumor biology and the ability to predict growth and thus improve therapy. However, current modeling techniques follow a generative approach and make strong assumptions about underlying mechanisms. The tumor is so far treated as homogeneous entity with behavioral parameters extrapolated from previous longitudinal image information. We present a novel way of approaching this problem by employing data driven, discrim- inative modeling techniques that learn relevant features from observed growth patterns and are able to make meaningful predictions solely on basis of local and regional tissue characteristics at one given point in time. We demonstrate superior performance of the proposed discriminative method (DICE score 83) compared t...
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BackgroundPembrolizumab plus lenvatinib is a novel combination with promising efficacy in patients with advanced and recurrent endometrial cancer. This combination demonstrated high objective response rates in a single-arm phase 1b/2... more
BackgroundPembrolizumab plus lenvatinib is a novel combination with promising efficacy in patients with advanced and recurrent endometrial cancer. This combination demonstrated high objective response rates in a single-arm phase 1b/2 trial of lenvatinib plus pembrolizumab in patients with advanced endometrial cancer (KEYNOTE-146/Study 111) after ≤2 previous lines of therapy. In a randomized phase 3 trial of lenvatinib in combination with pembrolizumab versus treatment of physician's choice in patients with advanced endometrial cancer (KEYNOTE-775/Study 309), after 1‒2 previous lines of therapy (including neoadjuvant/adjuvant), this combination improved objective response rates, progression-free survival, and overall survival compared with chemotherapy.Primary ObjectiveTo compare the efficacy and safety of first-line pembrolizumab plus lenvatinib versus paclitaxel plus carboplatin in patients with newly diagnosed stage III/IV or recurrent endometrial cancer, with measurable or ra...
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spectroscopy
Acute cerebral ischemia triggers local and systemic immune response. The aims of this project was to assess the blood serum concentration of the markers of inflammation and markers of the blood brain barrier damage on the first day of... more
Acute cerebral ischemia triggers local and systemic immune response. The aims of this project was to assess the blood serum concentration of the markers of inflammation and markers of the blood brain barrier damage on the first day of ischemic stroke, and the mutual correlations between these marker levels. Patients with first-in-life stroke were analysed according to: plasma concentration of the following markers on the first day of stroke: interleukin 2 (IL-2) and interleuki 6 (IL-6), S100B, tumor necrosis factor-α (TNF-α), progranulin (GRN), neuron specific enolase (NSE), urokinase-type plasminogen activator (uPA), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), C-reactive protein (CRP), leucocyte and thrombocyte counts; their neurological status on the first day of stroke (NIHSS) and their functional status at 30 days following stroke (mRS). The study included 138 patients with mean age: 73.11 ± 11.48. Patients with a higher score on the NIHS...
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BACKGROUND In the phase III OlympiAD trial, olaparib significantly increased progression-free survival (PFS) compared with chemotherapy of physician's choice in patients with germline BRCA-mutated (gBRCAm), human epidermal growth... more
BACKGROUND In the phase III OlympiAD trial, olaparib significantly increased progression-free survival (PFS) compared with chemotherapy of physician's choice in patients with germline BRCA-mutated (gBRCAm), human epidermal growth factor 2 (HER2)-negative metastatic breast cancer (mBC). The phase IIIb LUCY trial assessed the clinical effectiveness of olaparib in similar patients, in a setting reflecting clinical practice. METHODS This open-label, single-arm trial of olaparib (300 mg, twice daily) enrolled patients with BRCAm, HER2-negative mBC who had received taxane and/or anthracycline in the (neo)adjuvant/metastatic setting and not more than two lines of prior chemotherapy for mBC. Patients with hormone receptor-positive mBC had progressed on at least one line of endocrine therapy in an adjuvant/metastatic setting and were unsuitable for further endocrine treatment. This interim analysis was planned after 160 PFS events. RESULTS Of 563 patients screened, 252 patients with gBRCAm were enrolled and received at least one dose of olaparib. The median investigator-assessed PFS was 8.11 months (95% confidence interval [CI], 6.93-8.67; 166/252 events [65.9% maturity]). The investigator-assessed clinical response rate was 48.6%, and median time to first subsequent treatment or death was 9.66 months (95% CI, 8.67-11.14). The most common treatment-emergent adverse events (TEAEs; >20% patients) were nausea, anaemia, asthenia, vomiting and fatigue. Eleven patients (4.4%) discontinued treatment because of a TEAE. Grade 3 or higher TEAEs occurred in 64 patients (25.4%), including anaemia (33 patients; 13.1%). CONCLUSION Olaparib was clinically effective in patients with gBRCAm, HER2-negative mBC with safety outcomes consistent with previous findings. ClinicalTrials.gov identifier: NCT03286842.
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PURPOSE To test effects of positron emission tomography (PET)-based bone marrow-sparing (BMS) image-guided intensity modulated radiation therapy (IMRT) on efficacy and toxicity for patients with locoregionally advanced cervical cancer.... more
PURPOSE To test effects of positron emission tomography (PET)-based bone marrow-sparing (BMS) image-guided intensity modulated radiation therapy (IMRT) on efficacy and toxicity for patients with locoregionally advanced cervical cancer. METHODS AND MATERIALS In an international phase II/III trial, patients with stage IB-IVA cervical carcinoma were treated with either PET-based BMS-IG-IMRT (PET-BMS-IMRT group) or standard image-guided IMRT (IMRT group), with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy. The phase II component non-randomly assigned patients to PET-BMS-IMRT or standard IMRT. The phase III trial randomized patients to PET-BMS-IMRT vs. IMRT, with a primary endpoint of progression-free survival (PFS) but was closed early for futility. Phase III patients were analyzed separately and in combination with phase II patients, comparing acute hematologic toxicity, cisplatin delivery, PFS, overall survival (OS), and patterns of failure. In a post-hoc exploratory analysis, we investigated the association between pretreatment absolute lymphocyte count (ALC) and OS. RESULTS In total, 101 patients were enrolled on the phase II/III trial, including 29 enrolled in phase III (PET-BMS-IMRT group: 16; IMRT group: 13) before early closure. Median follow-up was 33 months for phase III patients and 39 months for all patients. PFS and OS at 5 years for all patients were 73.6% (95% CI 64.9%, 84.3%) and 84.0% (95% CI 76.0%, 92.9%), respectively. There were no differences in number of cisplatin cycles, OS, PFS, or patterns of failure between groups for the combined cohort. The incidence of acute grade ≥ 3 neutropenia was significantly lower in the PET-BMS-IMRT group compared to IMRT for randomized patients (19% versus 54%, c2 p=0.048) and in the combined cohort (13% vs. 35%, c2 p=0.01). Patients with pretreatment ALC ≤ 1.5 k/mL had non-significantly worse OS on multivariable analysis (HR 2.85, 95% CI 0.94, 8.62, adjusted p-value p=0.216), compared to patients with ALC > 1.5 k/mL. There was no difference in post-treatment ALC by treatment group. CONCLUSIONS PET-BMS-IMRT significantly reduced acute grade ≥ 3 neutropenia, but not treatment-related lymphopenia, compared to standard IMRT. We found no evidence that PET-BMS-IMRT impacted chemotherapy delivery or long-term outcomes, and weak evidence of an association between pre-treatment ALC and OS.
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Introduction/Background Vulval cancer is a rare malignancy, accounting for 3–5% of all cancers of female genital organs, with approximately 500 new cases diagnosed in Poland yearly. The study has been aimed at the analysis of the... more
Introduction/Background Vulval cancer is a rare malignancy, accounting for 3–5% of all cancers of female genital organs, with approximately 500 new cases diagnosed in Poland yearly. The study has been aimed at the analysis of the frequency of adverse prognostic factors in patients undergoing radical electro-surgery and groin lymphadenectomy. Methodology A total of 28 cases have been analysed. All patients covered by the study had FIGO stage IB-III vulval cancer and were treated with radical electro-surgery and groin lymphadenectomy between March 2016 and December 2018 The patients' age ranged from 46 to 82 years old, and their eligibility for treatment was decided by a designated panel of specialists made up of gynaecologic oncologists, radiotherapy specialists and clinical oncologists. Surgical treatment consisted in radical electro-resection and groin lymphadenectomy. Results Early recurrence was found in 6 patients (22%). 4 out of 6 patients had local vulvar recurrence, which was treated with a wide excision with a surgical margin = 1 cm. In all cases of early recurrence, the primary tumour had involved the clitoris. The remaining 2 patients suffered from groin recurrence. In all these cases, a narrow original surgical margin ≤ 0.3 cm was determined, and the patients had post-surgically received adjuvant intensity modulated radiation therapy (IMRT) in a dose of 50 Gy/25 fr. Conclusion 1.Adverse prognostic factors in vulval cancer patients treated with radical electro-resection surgery and groin lymphadenectomy include: -clitoral involvement, -narrow surgical margin ≤ 0.3 cm, the latter correlating with a higher incidence of groin recurrence. Disclosure Nothing to disclose
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Introduction/Background Mucinous cystic tumor with mural nodules: anaplastic carcinoma and sarcoma like-nodules are very rare. Mural nodules are single or multiple nodules arising within the wall of mucinous tumours whether they are... more
Introduction/Background Mucinous cystic tumor with mural nodules: anaplastic carcinoma and sarcoma like-nodules are very rare. Mural nodules are single or multiple nodules arising within the wall of mucinous tumours whether they are benign, borderline or malignant. The prognosis of SLMNs is excellent, their presence does not affect the prognosis of cystic ovarian tumor. In contrast, the foci of anaplastic carcinoma are aggressive components of cystic ovarian tumors. They carry an unfavorable prognosis, and most patients with mural nodules of anaplastic carcinoma have a malignant, frequently rapid course. Methodology A woman aged 41 presented abdominal pain. CT scan revealed a cystic mass 110×90×85 mm located in retroperitoneal space. Results Exploratory laparotomy was performed, and tumor was excised. Grossly the cystic tumor measured 10 cm and was partially lined with mucus epithelium exhibiting features of moderate atypia. There was a pleomorphic infiltrate formed in the cyst wall formed of oval spindle cells and giant multinucleated cells. Approximately 50% of the infiltration was necrosis. The tumor developed within the mucinous cystic tumor of Mullerian epithelium in the form of a mixed wall tumor. She was diagnosed with Mucinous cystic tumor with mural nodules: anaplastic carcinoma and sarcoma like-nodules. Afterwards bilateral salpingo-oophorectomy, appendectomy, pelvic lymphadenectomy and omentectomy were performed. Microscopic examination showed no pathological findings. CT scan performed after laparotomy revealed several suspicious small nodules within both lungs. Subsequentally the patient received chemotherapy consisting of Cisplatin, Adriamycin and Cyclophosphamide. PET-CT performed after completion of chemotherapy showed no evidence of metastatic or recurrent disease. Six months following the completion of therapy the patient is in good condition with no signs of disease. Conclusion Careful histologic and immunohistochemical analysis of mural nodules is essential for the determination of treatment and prognosis. Disclosure Nothing to disclose.