1. Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapyIvica Ratoša, Aljaša Jenko, Željko Šljivić, Maja Pirnat, Irena Oblak, 2020, izvirni znanstveni članek Povzetek: The aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients% individual anatomy, including breast volume. Patients and methods. In the study, the whole heart and cardiac substructures were delineated for 60 patients using cardiac atlas. For each patient, 3D-CRT and t-IMRT plans were generated. The prescribed dose was 42.72 Gy in 16 fractions. Patients were divided into groups with small, medium, and large clinical target volume (CTV). Calculated dose distributions were compared amongst the two techniques and the three different groups of CTV. Results. Mean absorbed dose to the whole heart (MWHD) (1.9 vs. 2.1 Gy, P < 0.005), left anterior descending coronary artery mean dose (8.2 vs. 8.4 Gy, P < 0.005) and left ventricle (LV) mean dose (3.0 vs. 3.2, P < 0.005) were all significantly lower with 3D-CRT technique compared to t-IMRT. Apical (8.5 vs. 9.0, P < 0.005) and anterior LV walls (5.0 vs. 5.4 Gy, P < 0.005) received the highest mean dose (Dmean). MWHD and LV-Dmean increased with increasing CTV size regardless of the technique. Low MWHD values (< 2.5 Gy) were achieved in 44 (73.3%) and 41 (68.3%) patients for 3D-CRT and t-IMRT techniques, correspondingly. Conclusions. Our study confirms a considerable range of the planned doses within the heart for adjuvant 3D-CRT or t-IMRT in node-negative breast cancer. We observed differences in heart dosimetric metrics between the three groups of CTV size, regardless of the radiotherapy planning technique.
Ključne besede: breast cancer, radiotherapy, 3D-CRT
Objavljeno v DiRROS: 16.07.2024; Ogledov: 9; Prenosov: 3
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4. Preoperative treatment with radiochemotherapy for locally advanced gastroesophageal junction cancer and unresectable locally advanced gastric cancerIvica Ratoša, Irena Oblak, Franc Anderluh, Vaneja Velenik, Jasna But-Hadžić, Ajra Šečerov Ermenc, Ana Jeromen, 2015, izvirni znanstveni članek Povzetek: To purpose of the study was to analyze the results of preoperative radiochemotherapy in patients with unresectable gastric or locoregionally advanced gastroesophageal junction (GEJ) cancer treated at a single institution. Between 1/2004 and 6/2012, 90 patients with locoregionally advanced GEJ or unresectable gastric cancer were treated with preoperative radiochemotherapy at the Institute of Oncology Ljubljana. Planned treatment schedule consisted of induction chemotherapy with 5-fluorouracil and cisplatin, followed by concomitant radiochemotherapy four weeks later. Three-dimensional conformal external beam radiotherapy was delivered by dual energy (6 and 15 MV) linear accelerator in 25 daily fractions of 1.8 Gy in 5 weeks with two additional cycles of chemotherapy repeated every 28 days. Surgery was performed 4-6 weeks after completing radiochemotherapy. Following the surgery, multidisciplinary advisory team reassessed patients for the need of adjuvant chemotherapy. The primary endpoints were histopathological R0 resection rate and pathological response rate. The secondary endpoints were toxicity of preoperative radiochemotherapy and survival. Treatment with preoperative radiochemotherapy was completed according to the protocol in 84 of 90 patients (93.3%). Twenty patients (22.2%) did not undergo the surgery because of the disease progression, serious comorbidity, poor performance status or still unresectable tumour. In 13 patients (14.4%) only exploration was performed because the tumour was assessed as unresectable or diffuse peritoneal carcinomatosis was established. Fifty-seven patients (63.4%) underwent surgery with the aim of complete removal of the tumour. Radical resection was achieved in 50 (55.6%) patients and the remaining seven (7.8%) patients underwent non-radical surgery (R1 in five and R2 in two patients). In this group of patients (n = 57), pathological complete response of tumour was achieved in five patients (5.6% of all treated patients or 8.8% of all operated patients). Down-staging was recorded in 49 patients (86%), in one patient (1.8%) the stage after radiochemotherapy was unchanged while in seven patients (12.3%) the pathological stage was higher than clinical, mainly due to higher pN stage. No death was recorded during preoperative radiochemotherapy. Most grade 3 and 4 toxicities were due to vomiting, nausea and bone marrow suppression (granulocytopenia). Twentysix (45.6%) patients died due to GEJ or gastric carcinoma, one died because of septic shock following the surgery and a reason for two deaths was unknown. Twenty-eight patients (49.1%) were disease free at the time of analysis, while 29 patients (50.9%) developed the recurrence, mostly as distant metastases. At two years, locoregional control, diseasefree survival, disease-specific survival and overall survival were 82.9%, 43.9%, 56.9% and 53.9%, respectively. Preoperative radiochemotherapy was feasible in our group of patients and had acceptable toxicity. Majority of patients achieved down-staging, allowing greater proportion of radical resections (R0), which are essential for patientsʼ cure.
Ključne besede: neoadjuvant radiochemotherapy, perioperative chemotherapy, chemotherapy, adenocarcinoma, carcinoma, surgery
Objavljeno v DiRROS: 23.04.2024; Ogledov: 197; Prenosov: 64
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5. Results of postoperative radiochemotherapy of the patients with resectable gastroesophageal junction adenocarcinoma in SloveniaAna Jeromen, Irena Oblak, Franc Anderluh, Vaneja Velenik, Marija Skoblar Vidmar, Ivica Ratoša, 2012, izvirni znanstveni članek Ključne besede: gastroesophageal junction adenocarcinoma, postoperative radiochemotherapy, toxicity
Objavljeno v DiRROS: 21.03.2024; Ogledov: 272; Prenosov: 82
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6. Stereotaktična radioterapija za zdravljenje refraktarne prekatne tahikardije: prikaz primerovTamara Jarm, Krištof Knap, Bor Antolič, Boštjan Berlot, Rihard Hudej, Aljaša Jenko, Ajra Šečerov Ermenc, Jasna But-Hadžić, Ivica Ratoša, 2023, strokovni članek Povzetek: Stereotaktična radioterapija aritmij (STAR) predstavlja novo in obetavno možnost za bolnike z refraktarno prekatno tahikardijo, ki je odporna proti konvencionalnim metodam zdravljenja. STAR omogoča natančno neinvazivno ablacijo aritmogenega substrata ob minimalni prizadetosti sosednjih organov. Ta metoda zdravljenja je uporabna za bolnike, pri katerih je tarčno tkivo s katetrsko ablacijo nedosegljivo, pogosti šoki implantabilnega kardioverter-defibrilatorja pa močno nižajo njihovo kakovost življenja ali kadar sta ti metodi zdravljenja zaradi slabega zdravstvenega stanja kontraindicirani. Tarčo obsevanja (predel levega prekata) natančno opredelimo s predhodno slikovno diagnostiko, elektrokardiogramom, posnetki prekatne tahikardije in po potrebi invazivnim ali neinvazivnim elektrofiziološkim mapiranjem srca. Po pripravi na obsevanje na simulatorju sledi enkratno obsevanje z visokim odmerkom 25 Gy, ki je trenutno edina standardna frakcionacija. Bolniki obsevanje dobro prenašajo. Dosedanje raziskave so poročale o dobri učinkovitosti zdravljenja z bistvenim zmanjšanjem pogostosti epizod prekatne tahikardije in brez večjih neželenih učinkov. Poročamo o prvi skupini štirih bolnikov z visokorizično refraktarno prekatno tahikardijo, ki so bili zdravljeni s stereotaktično radioterapijo na Onkološkem inštitutu Ljubljana. Izvedba STAR se je izkazala kot učinkovita metoda z nizko stopnjo akutnih neželenih učinkov in predstavlja novo možnost obravnave te ranljive skupine bolnikov v slovenskem prostoru.
Ključne besede: stereotaktična radioterapija, aritmije, prekatna tahikardija, radioablacija srca
Objavljeno v DiRROS: 26.02.2024; Ogledov: 259; Prenosov: 81
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7. Protibolečinsko obsevanje kostnih zasevkovEva Pribožič, Ivica Ratoša, Jasna But-Hadžić, 2023, drugi znanstveni članki Povzetek: Kostni zasevki povzročajo bolečino, ki vpliva na kakovost življenja bolnika in lahko vodijo do zapletov, ki zahtevajo urgentno ukrepanje. Ko zaradi kostnih zasevkov grozi oziroma je prisoten patološki zlom ali maligna kompresija hrbtenjače, je nujno oceniti, ali bolnik potrebuje kirurško intervencijo, ki ji sledi pooperativno obsevanje. Kadar bolnik ni kandidat za operativno zdravljenje, se priporoča urgentno obsevanje. Pri bolečih kostnih zasevkih, brez grozečega oziroma prisotnega patološkega zloma ali maligne utesnitve hrbtenjače, ne glede na velikost samega zasevka, prvi pristop zdravljenja bolečine predstavlja farmakološko zdravljenje, ki ga podpre in dopolni protibolečinsko paliativno obsevanje. Pri paliativnem obsevanju so celokupne obsevalne doze nizke, obsevanje je izvedeno v enem odmerku ali v kratkih obsevalnih režimih. Bolniki, ki ne odgovorijo na prvo obsevanje, ali se jim bolečina ponovi, so lahko varno ponovno obsevani na istem mestu. Na Onkološkem inštitutu Ljubljana smo opravili retrospektivni pregled paliativnih obsevanj kosti med leti 2018 – 2021. Letno obsevamo 800 kostnih zasevkov, upažamo pa upad števila obsevanj. Najpogostejša frakcionacija je 5 x 4 Gy, samo 10% bolnikov pa prejme obsevanje v enem odmerku. Protibolečinsko obsevanje kosti je učinkovito, stroškovno učinkovito in varno. Pomembno je prepoznati bolnike, ki bi imeli korist od protibolečinskega obsevanja, in jih napotiti na konzilij. S poenostavitvijo radioterapevtskih postopkov in odločitvijo za obsevanje v enem odmerku, je lahko obsevalno zdravljenje bolniku prijaznejše in dostopnejše.
Ključne besede: kostni zasevki, bolečina, paliativno obsevanje, frakcionacija
Objavljeno v DiRROS: 26.02.2024; Ogledov: 301; Prenosov: 89
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