Adjuvant radiotherapy for breast cancer reduces the risk of locoregional recurrence, distant disease and improves the survival of breast cancer patients. The incidence of breast cancer in pregnancy is constantly increasing, and it is expected that an increasing number of pregnant breast cancer patients will require radiation. Ionizing radiation can have a harmful effect on the fetus, which depends on the radiation dose and the gestational age of the fetus at the time of exposure to ionizing radiation. Pregnancy is not an absolute contraindication to radiotherapy for breast cancer, provided that radiation is carefully planned and appropriate protection is used
Objectives: The purpose of the study was to investigate the safety of contrast agents in the field of medical radiology. Methods: We conducted a comprehensive literature review through databases such as PubMed, Google Scholar, Scopus, and ScienceDirect, with the selection of relevant articles based on keywords, publication in English, study design, and publication criteria from 2020 to 2024. Results: In the course of the study, we determined that iodine containing contrast agents are often used in medical imaging, but their safety is a concern, especially in patients with renal impairment and a tendency to allergic reactions. It is recommended to observe a 4-12 hours interval between procedures to minimise the risk of contrast-induced nephropathy. Iodised contrasts are more likely to cause adverse reactions compared to gadolinium-based contrasts, but serious cases such as anaphylaxis remain rare (0.06%). Low concentration iodine-containing contrasts for cerebral angiography have shown high safety, reducing toxic effects. Barium contrast agents have demonstrated a high level of safety when used in diagnostics, including procedures such as oral barium test. Special attention was paid to reducing radiation exposure and compliance with safety protocols during the COVID-19 pandemic, which prevented the spread of infections. Contrast agents based on linear gadolinium more often contribute to its deposition, which could be associated with potential long-term risks, although their clinical consequences have not been fully examined. In contrast, macrocyclic gadolinium chelates show better stability and less often cause such effects, which makes them preferable in clinical practice. Conclusions: The introduction of strict recommendations on the use of gadolinium-containing contrast agents has reduced the incidence of nephrogenic systemic fibrosis, but further studies on their accumulation in the body remain relevant.
Neuroendocrine tumors of the ileocecal valve are rare, frequently manifesting with nonspecific symptoms that complicate early diagnosis. This report examines a 66-year-old woman with significant comorbidities, including diabetes mellitus and chronic renal failure, who presented to the emergency department with severe cramping abdominal pain, vomiting, and a mild fever. Initial imaging and laboratory tests yielded inconclusive results. However, a CT scan of the abdomen and pelvis revealed a small bowel obstruction at the ileocecal valve, caused by a tumor mass. Given the acute nature of her symptoms, the patient underwent an emergency right hemicolectomy with ileocolostomy. Histopathological analysis confirmed a 4 cm, well-differentiated grade 2 neuroendocrine tumor with lymphovascular invasion, along with metastases in 4 out of 17 examined lymph nodes. The patient had an uncomplicated postoperative course and was discharged on the tenth day in stable condition. This case highlights the need to consider neuroendocrine tumors in the differential diagnosis of bowel obstruction when imaging reveals a mass near the ileocecal region. Early detection and prompt surgical intervention are essential for optimal outcomes. Due to the rarity of neuroendocrine tumors in this anatomical location, this case provides valuable insights into the diagnostic anmanagement complexities they pose. Continuous follow-up with a multidisciplinary team remains essential to monitor for potential recurrence or metastasis.
Indication for radiotherapy of regional lymph nodes in patients with breast cancer is based on the clinical stage of the disease, surgical procedure, intraoperative and pathohistological report. It is supported by a meta-analysis of randomized clinical trials with long follow-up. However, many of these trials were performed decades ago, and, in the meantime, tremendous progress has been made in diagnostics, understanding of tumor biology, tailoring and effectiveness of systemic treatment, and technical possibilities of radiotherapy. Based on these new data, the approach to the axillary radiotherapy should be tailored, and a subset of patients in which de-escalation of axillary treatment is feasible defined.
Malignant brain tumors represent a serious health issue concerning both children and adults, and are often difficult to manage. Tumor metabolism has recently emerged as a promising target for new cancer treatment. Malignant brain tumors strongly depend on glycolysis for energy, predominantly using glucose and glutamine, whereas healthy brain cells primarily utilize ketone bodies under reduced glucose supply. As a metabolic disorder involving the dysregulation of glycolysis and cellular respiration, there is hope that brain cancer could be at least partially managed through changes in the metabolic environment. The objective of this review is to examine the metabolic changes in brain tumors and to summarize the latest knowledge of certain metabolic processes in tumorigenesis, as well as the associated potential therapeutic approaches.
