Browsing by Author "Saric, Milan (19738345400)"

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.

Purpose: To estimate the incidence of acute and late lower gastrointestinal tract toxicity (LGIT) in patients treated with 3D conformal radiotherapy (3DCRT)for localized prostate cancer (PC) and estimate the influence of dosimetric parameters and other possible factors. Methods: Ninety-four patients with localized PC treated with 3DCRT, with an estimated risk of lymph node involve-ment <15%, according to the Roach formula, were evaluated in this study. All patients received a total dose of 72Gy in 36 fractions. Acute and late lower gastrointestinal tract (LGIT) toxicity were graded according to the EORTC radiation morbidity scoring scale. Characteristics such as alcohol intake, gastrointestinal (GI) co-morbidities, hemorrhoids, previous abdominal or pelvic surgery (PAPS), diabetes mellitus (DM), the use of antiaggregants, and dosimetric parameters, were analyzed as possible predictive factors of radiation (RT) toxicity. Results: Grade 2 2 acute LGIT toxicity during 3DCRT developed in 41 of 94 patients (43.6%). At univariate logistic regression analysis (UVA) using the baseline model, alcohol consumption (p=0.068), hemorrhoids (p=0.004), GI co-morbidities (p=0.018), PAPS (p=0.033), V60 (p=0.070), V65 (p=0.046) and V70 (P=0.056) were significant predictive factors for any grade of acute LGIT toxicity. Predictive factors of grade acute toxicity in the multivariate logistic regression analysis (MVA) were current hemorrhoids (p=0.007), and the GI co-morbidities (p=0.025). Late grade 1 LGIT toxicity occurred in 17(18.1%) patients. Late grade >2 LGIT toxicity as a maximum toxicity score occurred in 9 (9.57%) patients during a median follow-up of 27 months. Following UVA, hemorrhoids (p=0.001) and use of antiag- gregants (p=0.034) were significant predictive factors for any grade of late LGIT toxicity. In the MVA, hemorrhoids were significantly associated with late grade LGIT toxicity (p=0.005). Conclusion: Hemorrhoids and GI co-morbidities had a significant impact on the occurrence of acute grade >1 LGIT toxicity. Hemorrhoids had significant influence on the development of any grade of late LGIT toxicity.

Purpose: To estimate the incidence of acute and late lower gastrointestinal tract toxicity (LGIT) in patients treated with 3D conformal radiotherapy (3DCRT)for localized prostate cancer (PC) and estimate the influence of dosimetric parameters and other possible factors. Methods: Ninety-four patients with localized PC treated with 3DCRT, with an estimated risk of lymph node involve-ment <15%, according to the Roach formula, were evaluated in this study. All patients received a total dose of 72Gy in 36 fractions. Acute and late lower gastrointestinal tract (LGIT) toxicity were graded according to the EORTC radiation morbidity scoring scale. Characteristics such as alcohol intake, gastrointestinal (GI) co-morbidities, hemorrhoids, previous abdominal or pelvic surgery (PAPS), diabetes mellitus (DM), the use of antiaggregants, and dosimetric parameters, were analyzed as possible predictive factors of radiation (RT) toxicity. Results: Grade 2 2 acute LGIT toxicity during 3DCRT developed in 41 of 94 patients (43.6%). At univariate logistic regression analysis (UVA) using the baseline model, alcohol consumption (p=0.068), hemorrhoids (p=0.004), GI co-morbidities (p=0.018), PAPS (p=0.033), V60 (p=0.070), V65 (p=0.046) and V70 (P=0.056) were significant predictive factors for any grade of acute LGIT toxicity. Predictive factors of grade acute toxicity in the multivariate logistic regression analysis (MVA) were current hemorrhoids (p=0.007), and the GI co-morbidities (p=0.025). Late grade 1 LGIT toxicity occurred in 17(18.1%) patients. Late grade >2 LGIT toxicity as a maximum toxicity score occurred in 9 (9.57%) patients during a median follow-up of 27 months. Following UVA, hemorrhoids (p=0.001) and use of antiag- gregants (p=0.034) were significant predictive factors for any grade of late LGIT toxicity. In the MVA, hemorrhoids were significantly associated with late grade LGIT toxicity (p=0.005). Conclusion: Hemorrhoids and GI co-morbidities had a significant impact on the occurrence of acute grade >1 LGIT toxicity. Hemorrhoids had significant influence on the development of any grade of late LGIT toxicity.

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

Purpose: The purpose of this study was to present treatment results of childhood Ewing’s sarcoma (ES) of the bone in Serbia and to analyze prognostic factors. Methods: We performed a detailed analysis on a series of 107 patients with ES of the bone treated at the Institute for Oncology and Radiology of Serbia between 2000 and 2014, using modern multimodal therapy. Results: Median age at the time of diagnosis was 14 years, with 56.07% of the patients being =14 years. There was a male predominance (59.81%). The most common primary sites were pelvis (25.23%), femur (17.76%) and tibia (12.15%). Thirty-four patients (31.78%) had metastatic disease, 17 of which had isolated lung metastases, 9 bone metastases and 8 patients had both. Tumor size = 8 cm had 38.32% and >8 cm had 61.68% patients. Overall, 51.4% patients underwent surgery and radiotherapy as a local treatment modality after neoadjuvant chemotherapy. Radiotherapy alone was performed in 24 patients. The 5-year overall survival (OS) was 43.8%. For patients with localized disease, the 5-year OS was 56.4% and for patients with metastatic disease 17.6%. In patients with initially nonmetastatic disease, age under 14 years, with tumor size <8 cm and a good response to the neoadjuvant chemotherapy, the OS correlated with better outcome. Conclusions: Modern multidisciplinary approach in treatment of childhood ES of the bone in accordance with the recommended pediatric protocols, gives good treatment results. Therapy should be performed in referral centers. © 2018 Zerbinis Publications. All Rights Reserved.

Purpose: The purpose of this study was to present treatment results of childhood Ewing’s sarcoma (ES) of the bone in Serbia and to analyze prognostic factors. Methods: We performed a detailed analysis on a series of 107 patients with ES of the bone treated at the Institute for Oncology and Radiology of Serbia between 2000 and 2014, using modern multimodal therapy. Results: Median age at the time of diagnosis was 14 years, with 56.07% of the patients being =14 years. There was a male predominance (59.81%). The most common primary sites were pelvis (25.23%), femur (17.76%) and tibia (12.15%). Thirty-four patients (31.78%) had metastatic disease, 17 of which had isolated lung metastases, 9 bone metastases and 8 patients had both. Tumor size = 8 cm had 38.32% and >8 cm had 61.68% patients. Overall, 51.4% patients underwent surgery and radiotherapy as a local treatment modality after neoadjuvant chemotherapy. Radiotherapy alone was performed in 24 patients. The 5-year overall survival (OS) was 43.8%. For patients with localized disease, the 5-year OS was 56.4% and for patients with metastatic disease 17.6%. In patients with initially nonmetastatic disease, age under 14 years, with tumor size <8 cm and a good response to the neoadjuvant chemotherapy, the OS correlated with better outcome. Conclusions: Modern multidisciplinary approach in treatment of childhood ES of the bone in accordance with the recommended pediatric protocols, gives good treatment results. Therapy should be performed in referral centers. © 2018 Zerbinis Publications. All Rights Reserved.