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Options of treatment for childhood cancer
GREGOROVÁ, Tereza
This bachelor thesis focuses on oncological diseases in children and adolescents. It deals with differences between pediatric patients and adults, what are the causes of their malignant diseases, prevention, symptoms and treatment. In the practical part I focused on radiation therapy in children, using photon beam and proton beam, their advantages and disadvantages. I dealt with the incidence of the most common malignancies in children aged 0-19 years in the period 1996-2016. I analyzed the data from the National Cancer Registry and processed it into graphs and tables. I also looked at the data on the long-term survival of cured patients. The collected data show rather a decreasing tendency in the incidence of childhood malignancies in the monitored period 1996-2016. Tumor mortality in children has been decreasing in the period under review, after an initial sharp decline in recent years rather slightly. The higher incidence of malignancies in children aged 0-19 is in boys. I also graphically processed the age distribution of patients, where the first wave of increased incidence is recorded in the youngest patients under 4 years and the second wave in adolescents aged 15-19 years, which is different from the distribution of tumor incidence in the adult population where the risk of cancer increases with age. The relative percentage of five-year survival in pediatric cancer patients over time has increased with the development of cancer treatment and supportive care and dispenzarzation. The content of this work can serve as a basic overview of cancer of children and adolescents for health professionals and the general public.
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Comparison of doses in the target volume and critical organs for Intensity Modulated Radiation Therapy (IMRT) and proton therapy
STIEBLINGOVÁ, Tereza
The topic of this thesis is a view at the two selected modern irradiation techniques - IMRT (Intensity-Modulated Radiation Therapy) and proton therapy. I compared them at a general level in the theoretical part, and in the practical part I focused on the absorbed doses in selected critical organs in patients with prostate cancer. In the theoretical part I worked with specialized literature and articles from medical journals and also with a number of internet sources. For example I worked with a publication titled Radiační onkologie by Pavel Šlampa or Klinická onkológia a rádioterapia by Ľudovit Jurga. I made a concept based on the obtained information, which is composed of generally related topics, e.g. the position of radiotherapy in the treatment of oncological diseases, characteristics of ionizing radiation, the process of radiation treatment planning etc. After these introductory chapters I focused specifically on photon IMRT technique and proton therapy which are among the most modern methods of contemporary radiation oncology. In the theoretical part I set the description of these selected techniques as a goal, with an emphasis on their advantages and disadvantages. In the practical part I analyzed these two techniques in terms of received minimum, medium and maximum doses in selected critical organs rectum, bladder and both femoral heads using different fractionation schemes. The results were compared with information from the theoretical part. In the practical part, the testing of this hypothesis was set as my goal: During the treatment of prostate cancer with accelerated protons the healthy surrounding tissue and critical organs will receive smaller amount of radiation dose than IMRT technique. Proton Therapy Center (PTC) in Prague provided me with some irradiation plans including CT scans from 20 anonymous patients diagnosed with prostate cancer and treated with protons. Then I worked with these plans in planning program to create a photon IMRT plan for each proton plan and in order to be able compare these two techniques in each patient in different fractionation schemes. When I compared IMRT technique and proton therapy, both in norm-fractionated scheme, moderate doses were lower with protons in all 20 patients in all selected critical organs. The average difference in moderate doses of these techniques in all selected critical organs is 11,022 Gy. Specifically, from the results is further evident, that the bladder and the rectum absorb less minimal and medium dose if proton therapy has been used in any fractional mode (short, long, norm-fractionated scheme) than in the photon IMRT therapy. These results were obtained in all 20 patients. When I compared IMRT technique and proton therapy, both in short scheme or long scheme, in terms of the maximum doses in the bladder and rectum, the values were comparable in the both critical organs. In none of the literature used as a source is a mention of minimal and medium doses on heads of both femurs. But if I compare the median doses proton's therapy with doses IMRT's photon therapy, both in norm-fractionated scheme, the medium doses were lower if proton therapy had been used. The results of minimal doses are contradictory and conclusions are not so unequivocal. The values of the maximum doses of the right and left femoral head were lower in overwhelming majority of 20 patients in proton therapy (in the short and also in long scheme). The average difference in the left head of femur is 3,434 Gy (proton's short scheme vs. photon's short scheme), respectively 6,654 Gy (proton's long scheme vs. photon's long scheme). The average difference in the right head of femur is 5,422 Gy (proton's short scheme vs. photon's short scheme), respectively 9,273 Gy (proton's long scheme vs. photon's long scheme).
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Development of prostate cancer radiotherapy from the 80s to the present day
SUCHANOVÁ, Markéta
Prostate cancer (CaP) remains the most common cancer diagnosed in men. This desease has worldwide increasing incidence. In the Czech Republic incidence has tripled during the last 20 years. The increase of the mortality is much more slower, but CaP is still the third leading cause of cancer-related death in men. CaP treatment management options may include active surveillance, radical prostatectomy, brachytherapy and external beam radiation therapy. The radiotherapy occupies an irreplaceable position. It is used as a curative therapy for clinically localized CaP with a low and intermediate risk. In the case of high risk CaP and locally advanced tumors are often treated with the addition of the hormonal therapy, which enhances tumor control and overall patient's survival. The radiotherapy is also used in some cases as an adjuvant treatment following a radical prostatectomy, as well as a salvage therapy in a biochemical relapse or as a palliative treatment if the cancer progresses. The aim of this study is to provide an overview of the development of CaP radiotherapy from the 80s till the present day. The specific objective of the study is to assess the incidence of the radiation-related complications (RRC) in patients with CaP treated with IMRT and PT. Among the methods of processing this thesis was using secondary data analysis. Practical information were obtained during the visits to the Department of the Radiation Oncology at the Hospital Ceske Budejovice a.s. (NCB) and the Proton Therapy Center Czech s.r.o. (PTC). During these visits was observed the radiotherapeutic treatment of the patients with CaP and valuable information were obtained through interviews with Mrs.Vančurová, MD and Mr. Vítek, MD., Ph.D., MBA This study analysed the incidence of the acute and late RRC in patients with CaP treated in these facilities. The acute and late side effects was assessed for GU and GI toxicity using RTOG / EORTC score. The specific problems were measured with the CTCAE v.4.0 scale. The overall incidence of the RRC was subjected to the statistical hypothesis testing using a two-sample unpaired t-test. The examined sample consisted of the 30 patients with CaP irradiated at NCB and the 30 patients from PTC with low, intermediate and high risk CaP. It was found that for the patients from NCB the rectum mean dose was 40,7 Gy and the mean dose of bladder was 39,4 Gy. For the patients treated at PTC the mean dose to the rectum was 13,2 Gy and to the bladder 11.1 Gy. This is related to the incidence of the RRC. Acute GU and GI toxicities Grade 2+ occurred in 33 % and 23,3 % of the patients treated in NCB. With a median follow-up of 22 months there was late GU toxicity Grade 2+ in 13,3 %. Late GI toxicity Grade 2+ occurred in 26,7 %, which exceeds incidence of the RRC described in the literature. Incidence of late GI toxicity Grade 3 and 4 was also increased, it appeared in 10 % (3 patients). Furthermore in one case cancer reoccurred and metastasized one and half year after the radiotherapy. In PTC no acute or late Grade 3+ toxicities were observed. Acute GU and GI toxicities Grade 2 occurred in 13,3 % and 6,7 %. After median follow-up of 21,5 months there was incidence of late GI toxicity Grade 2 3,3 %, late GU toxicity appeared only Grade 1 in 13,3 %. There was found statistically significant difference in occurrence of RRC in patients treated in NCB and PTC. The hypothesis that PT reduces the incidence of the radiation side-effects compared to the IMRT technique in the patients with the prostate cancer was confirmed. The prostate can move greatly during the day. It is recommended using CBCT, which is part of new linear accelerators at NCB, to check the position of the prostate before each irradiation. This study provides an overview of the treatment of CaP and may serve to increase of awareness of the RRC. The main contribution can be seen in the comparison of a standard approach with a promising alternative.
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