Viral hepatitis infections can complicate treatment in patients with cancer. Chronic hepatitis infections such as HBV,HCV, and CMV should be diagnosed and treated before oncological treatment. Moreover, latent infections that canbe reactivated (especially HBV infection) during oncological treatment should be taken into consideration. Duringtreatment, acute hepatitis infections such as HAV and HEV affect treatment and blood test results. This article presentsthe natural course of viral hepatitis, which should be suspected in cases of increased liver enzyme activity.
INTRODUCTION: Re-irradiation for locoregional recurrence or second primary tumors in previously irradiated regions isconstrained by cumulative organ-at-risk tolerance. Proton therapy may improve dose conformality and spare criticalstructures. MATERIAL AND METHODS: We retrospectively reviewed 91 patients treated with repeat proton beam radiotherapybetween 2017 and 2023. Patients (37 women, 54 men; age 28–90 years) were not eligible for salvage surgery, had histopathologicallyconfirmed local failure, and had no distant metastases on PET. Recurrence was present in 67 patients(74%) and second primary tumors in 24 (23%). Re-irradiation was delivered with SIB IMPT at 1.8–2.0 Gy relative biologicaleffectiveness (RBE)/fraction to 20–78 Gy(RBE) (mean 63.6). Treatment planning reconstructed the primary radiotherapyplan and applied cumulative dose limits to organs at risk using an ALARA-based approach. RESULTS: Eighty-nine patients (98%) completed the planned course; two discontinued due to deterioration in generalcondition. Acute toxicity included grade 3 skin reactions in 7% and grade 2 in 74%, and grade 3 mucosal reactionsin 12% and grade 2 in 59%. Two patients required packed red blood cell transfusions for grade 3 anemia during treatment.Three-month MRI demonstrated disease stabilization in 50%. Median overall survival (OS) was 16.9 months; OSwas 48% at 1 year, 40% at 2 years, and 28% at 5 years. OS did not differ by sex, T or N category, or recurrence versussecond primary tumor, but varied by primary tumor location (p = 0.008), with the most favorable survival in chordoma. CONCLUSIONS: Repeat proton beam therapy enabled radical re-irradiation in selected patients across diverse sites withacceptable acute toxicity and clinically meaningful survival. Longer follow-up and prospective validation are warrantedto refine selection and cumulative dose constraints.
Complementary and alternative medicine (CAM) use is widespread among cancer patients, and has been linked todelayed conventional care, often leading to late-stage presentation. This study aimed to synthesize current evidenceon the association between CAM use and delays in cancer diagnosis and treatment. The literature search using Pub-Med and Google Scholar with search terms “delay,” “diagnostic delay,” “treatment delay,” “complementary and alternativemedicine,” and “cancer” was conducted. Included studies focused on assessing CAM use as a factor associated withdiagnostic or treatment delay among cancer patients. It was found that the duration of diagnostic and treatmentdelays ranged from 14 days to 4 months. Herbal medicine and homeopathy were the most commonly reported CAMmodalities. Pooled analysis showed that CAM use was associated with higher diagnostic delay [OR = 2.12 (95% CI1.59–2.83)] and treatment delay [OR = 2.00 (95% CI 1.03–3.90)], but the small number of studies and patients limitsthe results of heterogeneity analysis. These findings highlight the need for healthcare providers to discuss CAM usewith patients and to strengthen early detection and timely initiation of therapy.
Head and neck cancers are a complex group of diseases defined by a variety of histological features, anatomical locationsand etiologies. Stage IV disease may be classified as resectable, unresectable, or metastatic. The standard treatmentof resectable, stage III–IVb disease is surgery with or without adjuvant radiotherapy or adjuvant radiochemotherapy.Another solution is primary RT-CHX. However, over 50% of patients with HNSCC will be diagnosed with locoregionallyadvanced and unresectable disease, or the resection will result in significant mutilation or unacceptable functional outcome.Some may also present with a high risk of non-radical resection. Given this shift in site of recurrence, therapeuticstrategies to suppress distant metastases may be the next goal for further improvement of survival. In this contextthe use of induction chemotherapy in the setting of locally advanced disease — both resectable and unresectable iswarranting reassessment.
