Browsing by Author "Miskovic, Ivana (57126111500)"

Purpose: The toxicity of postoperative radiotherapy for cervical cancer affects patients’ quality of life. We evaluated acute toxicity in postoperative intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) as well as the influence of dosimetric parameters and concomitant chemotherapy. Methods: A total of 45 patients with early operable cervical cancer underwent postoperative IMRT with 40-45 Gy. The control group of 50 patients was treated with 3DCRT. Brachytherapy and concomitant cisplatin chemotherapy were performed in all patients according to pathologic and histologic findings. The patients were monitored for acute gastrointestinal, urological and hematological toxicity classified according to the RTOG acute radiation morbidity scoring criteria. We also analyzed the influence of dosimetric parameters on acute toxicity. Results: Significant differences were found in overall acute toxicity (p=0.018), acute genitourinary toxicity (p=0.029), anemia (p=0.043) and neutropenia (p=0.027) but not in acute gastrointestinal toxicity between the IMRT and 3DCRT groups. In all patients, regarding chemotherapy administration, differences were found between the chemoradiotherapy and radiotherapy group as far as overall acute toxicity (CHRT vs RT; p=0.011) and hematological toxicity were concerned (p=0.001). Patients with ≥3 cycles of chemotherapy showed increased hematologic toxicity. In the IMRT group according to the administration of chemotherapy (chemoradiotherapy vs radiotherapy), statistically significant difference for leukopenia (p=0.009) was found and in the 3DCRT group for anemia (p=0.021) and neutropenia (p=0.029). According to chemotherapy administration (chemoradiotherapy vs radiotherapy), a statistically significant difference in leukopenia (p=0.009) was found in the IMRT group while in the 3DCRT group the differences were in anemia (p=0.021) and neutropenia (p=0.029). Conclusion: IMRT is associated with lower acute toxicity and better dosimetric parameters in organs at risk (OAR) compared to 3DCRT. Higher hematological toxicity occurred when concomitant chemotherapy was performed, regardless of RT technique. Further reduction of toxicity is expected with protocol and technical improvement and research of gene-related toxicity. © 2019 Zerbinis Publications. All rights reserved.

Purpose: The toxicity of postoperative radiotherapy for cervical cancer affects patients’ quality of life. We evaluated acute toxicity in postoperative intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) as well as the influence of dosimetric parameters and concomitant chemotherapy. Methods: A total of 45 patients with early operable cervical cancer underwent postoperative IMRT with 40-45 Gy. The control group of 50 patients was treated with 3DCRT. Brachytherapy and concomitant cisplatin chemotherapy were performed in all patients according to pathologic and histologic findings. The patients were monitored for acute gastrointestinal, urological and hematological toxicity classified according to the RTOG acute radiation morbidity scoring criteria. We also analyzed the influence of dosimetric parameters on acute toxicity. Results: Significant differences were found in overall acute toxicity (p=0.018), acute genitourinary toxicity (p=0.029), anemia (p=0.043) and neutropenia (p=0.027) but not in acute gastrointestinal toxicity between the IMRT and 3DCRT groups. In all patients, regarding chemotherapy administration, differences were found between the chemoradiotherapy and radiotherapy group as far as overall acute toxicity (CHRT vs RT; p=0.011) and hematological toxicity were concerned (p=0.001). Patients with ≥3 cycles of chemotherapy showed increased hematologic toxicity. In the IMRT group according to the administration of chemotherapy (chemoradiotherapy vs radiotherapy), statistically significant difference for leukopenia (p=0.009) was found and in the 3DCRT group for anemia (p=0.021) and neutropenia (p=0.029). According to chemotherapy administration (chemoradiotherapy vs radiotherapy), a statistically significant difference in leukopenia (p=0.009) was found in the IMRT group while in the 3DCRT group the differences were in anemia (p=0.021) and neutropenia (p=0.029). Conclusion: IMRT is associated with lower acute toxicity and better dosimetric parameters in organs at risk (OAR) compared to 3DCRT. Higher hematological toxicity occurred when concomitant chemotherapy was performed, regardless of RT technique. Further reduction of toxicity is expected with protocol and technical improvement and research of gene-related toxicity. © 2019 Zerbinis Publications. All rights reserved.

Purpose: Within implementation of intensity-modulated radiotherapy (IMRT) in the postoperative irradiation of cervical cancer we evaluated and compared IMRT and threedimensional conformal radiotherapy (3DCRT) dosimetric parameters for target volumes and organs at risk (OAR). Methods: We randomized 95 patients with cervical cancer, UICC stage I-III, in groups depending of the type of external beam postoperative radiotherapy. Forty-five patients were treated with IMRT and 50 with 3DCRT. All patients underwent brachytherapy, and according to risk factors some of the patients had concomitant cisplatin chemotherapy. The study was done in a period of three years from December 2015. Analysis of dosimetric parameters for target volume coverage and OARs was performed. Results: IMRT plans showed better conformity compared to 3DCRT plans, represented with homogenity index and conformity index, with higher maximum dose (PTV105 and D2). Both plans achieved adequate planning target volume coverage described with PTV95. Statistically significant difference between groups was found for bladder, rectum and bowel high dose regions: bladder V45 (p=0.000), rectum V40 (p=0.043) and V45 (p=0.000), bowel V45 (p=0.000), and bone marrow dosimetric parameters V20-V45; all were better in IMRT plans. Significant difference was found for volume of patient body normal tissue receiving dose of 20Gy, which was higher in IMRT. Conclusion: IMRT is a highly conformal technique. Satisfactory target volume coverage was achieved with both techniques, with better sparing of OARs in the IMRT group. With this technique improvement, we expect better quality of life in cervical cancer patients with good prognosis. © 2019 Zerbinis Publications. All rights reserved.

Purpose: Within implementation of intensity-modulated radiotherapy (IMRT) in the postoperative irradiation of cervical cancer we evaluated and compared IMRT and threedimensional conformal radiotherapy (3DCRT) dosimetric parameters for target volumes and organs at risk (OAR). Methods: We randomized 95 patients with cervical cancer, UICC stage I-III, in groups depending of the type of external beam postoperative radiotherapy. Forty-five patients were treated with IMRT and 50 with 3DCRT. All patients underwent brachytherapy, and according to risk factors some of the patients had concomitant cisplatin chemotherapy. The study was done in a period of three years from December 2015. Analysis of dosimetric parameters for target volume coverage and OARs was performed. Results: IMRT plans showed better conformity compared to 3DCRT plans, represented with homogenity index and conformity index, with higher maximum dose (PTV105 and D2). Both plans achieved adequate planning target volume coverage described with PTV95. Statistically significant difference between groups was found for bladder, rectum and bowel high dose regions: bladder V45 (p=0.000), rectum V40 (p=0.043) and V45 (p=0.000), bowel V45 (p=0.000), and bone marrow dosimetric parameters V20-V45; all were better in IMRT plans. Significant difference was found for volume of patient body normal tissue receiving dose of 20Gy, which was higher in IMRT. Conclusion: IMRT is a highly conformal technique. Satisfactory target volume coverage was achieved with both techniques, with better sparing of OARs in the IMRT group. With this technique improvement, we expect better quality of life in cervical cancer patients with good prognosis. © 2019 Zerbinis Publications. All rights reserved.

Purpose: The aim of this study was to present the management and treatment of children with medulloblastoma in Serbia, a middle-income country (MIC). Methods: The data of 87 children diagnosed with medulloblastoma and treated at the Institute for Oncology and Radiology of Serbia from 2000 to 2013 were analyzed. Results: The children’s median age was 8.3 years (range 2.5-17.3). Eighty-two (94.2%) were 3 years or older. Sixty-two (71.3%) patients had stage M0 medulloblastoma, 12 (13.8%) had stage M1 and 13 (14.9%) had stage M2 or M3. As of October 2015, 51 (58.6%) patients were alive and 31 (35.6%) had died. Five patients (5.7%) were lost to followup. Twenty-six patients relapsed. The median follow-up time was 58 months (range 4–187). Mean overall survival (OS) was 76.4% at 3 years, 66.2% at 5 years and 59.2% at 10 years. Mean disease-free survival (DFS) was 75.8% at 3 years, 62.8% at 5 years and 56.6% at 10 years. Mean OS of stage M0 patients was 86.4% at 3 years, 74% at 5 years and 63.1% at 10 years. The OS of stage M1, M2 and M3 patients combined was 48.9% at 3 years, 44.0% at 5 years and 37.7% at 10 years. Conclusion: In Serbia, a MIC, it is possible to achieve good treatment results in children with medulloblastoma using international treatment guidelines and recommendations, available resources and an experienced team of professionals dedicated to pediatric neurooncology. © 2018 Zerbinis Publications. All Rights Reserved.

Purpose: The aim of this study was to present the management and treatment of children with medulloblastoma in Serbia, a middle-income country (MIC). Methods: The data of 87 children diagnosed with medulloblastoma and treated at the Institute for Oncology and Radiology of Serbia from 2000 to 2013 were analyzed. Results: The children’s median age was 8.3 years (range 2.5-17.3). Eighty-two (94.2%) were 3 years or older. Sixty-two (71.3%) patients had stage M0 medulloblastoma, 12 (13.8%) had stage M1 and 13 (14.9%) had stage M2 or M3. As of October 2015, 51 (58.6%) patients were alive and 31 (35.6%) had died. Five patients (5.7%) were lost to followup. Twenty-six patients relapsed. The median follow-up time was 58 months (range 4–187). Mean overall survival (OS) was 76.4% at 3 years, 66.2% at 5 years and 59.2% at 10 years. Mean disease-free survival (DFS) was 75.8% at 3 years, 62.8% at 5 years and 56.6% at 10 years. Mean OS of stage M0 patients was 86.4% at 3 years, 74% at 5 years and 63.1% at 10 years. The OS of stage M1, M2 and M3 patients combined was 48.9% at 3 years, 44.0% at 5 years and 37.7% at 10 years. Conclusion: In Serbia, a MIC, it is possible to achieve good treatment results in children with medulloblastoma using international treatment guidelines and recommendations, available resources and an experienced team of professionals dedicated to pediatric neurooncology. © 2018 Zerbinis Publications. All Rights Reserved.

Objectives: Nasopharyngeal carcinoma is a rare malignancy in children. The aim of this study was to provide analysis of children with nasopharyngeal carcinoma treated in a single institution. Methods and materials: Between 1999 and 2016, fourteen pediatric patients with a diagnosis of undifferentiated nasopharyngeal carcinoma were treated in our institution, and the patients’ clinical characteristics, treatment modality, outcome, and toxicity were analyzed. Results: The median age at diagnosis was 15,5 years. The gender ratio was 1:1. The majority of patients had regionally and/or locally advanced tumors and one had bone metastases at the time of diagnosis. All patients received chemotherapy before radiotherapy, with partial response in thirteen patients and complete response in one. Radiation dose to the primary tumor and involved cervical lymph nodes was 55–60 Gy, uninvolved cervical and supraclavicular regions received prophylactic radiation with dose of 45–50 Gy. Ten patients received adjuvant chemotherapy. Three-year progression-free rate and three-year overall survival (OS) rates were 75% and 73% respectively. Five-year progression-free rate was 65% and OS 63% respectively, and after ten years progression-free rate and OS remained the same. At the end of follow-up period, ten patients were alive, and four died. All of the patients that had distant metastases died. Most common late complications were skin fibrosis and xerostomia. Conclusions: Multimodal therapy of children with nasopharyngeal carcinoma is associated with long-term survival. It is expected that further advances in the management of these patients, with improved radiotherapy and chemotherapy, will reduce acute and late toxicity and improve quality of life of treated children. © 2018