Intorduction. HPV infection stimulates a local immune response, because HPV positivity in cervical cancer places these tumors in a prognostically better group in terms of response to radiotherapy (RT). However, the response to RT treatment in locally advanced cervical cancer depending on the presence of a certain subtype of the HPV virus has been very little investigated in previous research. Taking into account the high incidence rate of cervical cancer in developing countries, where the disease is most often diagnosed at a locally advanced stage, the aim of this review of the available literature was to analyse predictive potential of HPV typing in terms of the response to the RT with/without chemopotentiation as a standard treatment approach. Method. A review of studies dealing with the analysis of the predictive significance of HPV typing in locally advanced cervical cancer patients treated with definitive RT with or without chemopotentiation, from 2000 to 2024, was conducted. Results. Six clinical studies were identified that met the search criteria. The most frequently analyzed subtypes were HPV 16,18,33 and 52. In five studies the HPV 16 subtype was identified in more radioresistant cervical cancers. Conclusion: there is an exceptional clinical importance of HPV typing in order to create an individual treatment strategy, especially in the era of immunotherapy given concurrently with definitive RT. It is also necessary to conduct clinical studies with a large number of patients and consider what the treatment outcomes are depending on the applied RT technique, dose and fractionation regime.

The optimal treatment of oropharyngeal cancer (OPC) associated with human papillomavirus (HPV) is currently a subject of clinical research. This questionnaire study investigated current trends in the treatment of HPV-associated (HPV+) OPC in Slovakia with the incorporation of deintensification of oncological treatment into routine clinical practice outside of clinical trials. The Slovak Cooperative Head and Neck Cancer Group (SCHNCG) developed a questionnaire aimed at identifying trends in the oncological treatment of HPV+ OPC intended for all radiation oncology (RO) facilities in Slovakia. Specialists in the field of RO responded to general questions about the character of their individual institutions as well as to 4 theoretical clinical scenarios (case reports) regarding the treatment of HPV+ OPC, focusing primarily on the applied dose of radiotherapy (RT), the extent of target volumes, and the type of concurrent chemotherapy (CHT). The questionnaire study involved 35 RO specialists from 14 institutions in Slovakia. Regarding primary chemoradiotherapy (CRT) in T1N1M0 HPV+ OPC, 16 respondents (45.7%) would consider de-escalation of the RT dose to <70 Gy. In the case of postoperative RT in pT1pN1M0 HPV+ OPC with negative resection margins (R0) and absent extracapsular extension (ECE), 4 physicians (11.4%) would consider de-escalation of the RT dose to <60 Gy in the tumor bed area, while the majority of the treating specialists (n=19, 54.3%) would omit concurrent CHT. In the case of primary RT in elderly patient with T2N1M0 HPV+ OPC, the same number of physicians (n=16, 45.7%) would consider de-escalation of the RT dose to <70 Gy, and 14 respondents (40.0%) would completely omit CHT. In a high-risk patient with T2N3M0 HPV+ OPC with a complete response after 3 cycles of induction chemotherapy (iCHT), none of the respondents would indicate a reduction in the RT dose to the area of the original tumor and lymphadenopathy to <60 Gy. The doses and extent of irradiated volumes in the treatment of HPV+ OPC in Slovakia vary among different institutions. The tendency to de-escalate RT doses and reduce doses of concurrent systemic therapy in Slovakia is high and there was also an observed trend to reduce the extent of radiation treatment fields.

Introduction: In the past decade, breast cancer prognosis has significantly improved due to early diagnosis, an improvement in molecular characterization and innovative treatments availability. Breast cancer represents a heterogeneous disease, where different biological subtypes show disease-specific outcomes, that is different response to applied treatment and different prognosis. Method: Current literature review was performed, providing up-todate overview of literature and clinical trials in breast cancer molecular profile topics. Overview: Standard approach to breast cancer treatment depends on the stage of the disease as well as the clinical and pathological characteristics of the tumor. Gene expression profiling and next generation sequencing can provide additional insight into tumor biology and response to treatment. Available literature shows that the molecular profile of breast cancer has a significant impact on tumor development, plays a role in determining therapy type and response to it, as well as overall survival and progression free survival. Unlike systemic therapy, the role of the molecular profile and its influence on the response to the radiation therapy has not yet been precisely defined and widely applied in clinical practice, although individual studies have been published that have shown that certain types of breast cancer have a significant benefit from the radiation therapy. Conclusion: The molecular subtype of breast cancer, in combination with the characteristics of the patient and the disease itself, plays a significant role in the response to specific oncological treatment. Future knowledge will provide insight into the complex molecular mechanisms of breast cancer and its treatment responses.

Background: The optimal hypofractionated schedule of post-prostatectomy radiotherapy remains to be established. We evaluated treatment outcomes and toxicity of moderately hypofractionated post-prostatectomy radiotherapy in 16 daily fractions delivered with intensity-modulated radiotherapy. The treatment schedule selection was motivated by limited technology resources and was radiobiologically dose-escalated. Methods: One hundred consecutive M0 patients with post-prostatectomy radiotherapy were evaluated. Radiotherapy indication was adjuvant (ART) in 19%, early-salvage (eSRT) in 46% and salvage (SRT) in 35%. The dose prescription for prostate bed planning target volume was 52.8 Gy in 16 fractions of 3.3 Gy. The Common Terminology Criteria v. 4 for Adverse Events scale was used for toxicity grading. Results: The median follow-up was 61 months. Five-year biochemical recurrence-free survival (bRFS) was 78.6%, distant metastases-free survival (DMFS) was 95.7% and overall survival was 98.8%. Treatment indication (ART or eSRT vs. SRT) was the only significant factor for bRFS (HR 0.15, 95% CI 0.05–0.47, p = 0.001) and DMFS (HR 0.16, 95% CI 0.03–0.90; p = 0.038). Acute gastrointestinal (GI) toxicity grade 2 was recorded in 24%, grade 3 in 2%, acute genitourinary (GU) toxicity grade 2 in 10% of patients, and no grade 3. A cumulative rate of late GI toxicity grade ≥ 2 was observed in 9% and late GU toxicity grade ≥ 2 in 16% of patients. Conclusions: The observed results confirmed efficacy and showed a higher than anticipated rate of early GI, late GI, and GU toxicity of post-prostatectomy radiobiologically dose-escalated hypofractionated radiotherapy in 16 daily fractions.

Over the last two decades, human papillomavirus (HPV) has caused a new pandemic of cancer in many urban areas across the world. The new entity, HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), has been at the center of scientific attention ever since, not only due to its distinct biological behavior, but also because of its significantly better prognosis than observed in its HPV-negative counterpart. The very good treatment outcomes of the disease after primary therapy (minimally-invasive surgery, radiation therapy with or without chemotherapy) resulted in the creation of a separate staging system, reflecting this excellent prognosis. A substantial proportion of newly diagnosed HPV-driven OPSCC is diagnosed in stage I or II, where long-term survival is observed worldwide. Deintensification of the primary therapeutic methods, aiming at a reduction of long-term toxicity in survivors, has emerged, and the quality of life of the patient after treatment has become a key-point in many clinical trials. Current treatment recommendations for the treatment of HPV-driven OPSCC do not differ significantly from HPV-negative OPSCC; however, the results of randomized trials are eagerly awaited and deemed necessary, in order to include deintensification into standard clinical practice.

Management of patients with recurrent head and neck cancer remains a challenge for the surgeon as well as the treating radiation oncologist. Even in the era of modern radiotherapy, the rate of severe toxicity remains high with unsatisfactory treatment results. Intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and heavy-ion irradiation have all emerged as highly conformal and precise techniques that offer many radiobiological advantages in various clinical situations. Although re-irradiation is now widespread in clinical practice, little is known about the differences in treatment response and toxicity using diverse re-irradiation techniques. In this review, we provide a comprehensive overview of the role of radiation therapy in recurrent or second primary head and neck cancer including patient selection, therapeutic outcome, and risk using different re-irradiation techniques. Critical review of published evidence on IMRT, SBRT, and heavy-ion full-dose re-irradiation is presented including data on locoregional control, overall survival, and toxicity.

Radiation therapy (RT) is an important treatment modality in head and neck cancer (HNC) irrespective of stage, histology, and location of the primary tumor in both curative and palliative setting, with or without other treatment modalities such as surgery or chemotherapy. Based on advances with better imaging and introduction of sophisticated software for treatment and planning systems, radiation oncology of HNC witnessed major advantages resulting in both improved local control and better sparing of organs at risk. From computed tomography to magnetic resonance imaging and introduction of positron emission tomography with various radiotracers it became possible not only to diagnose and stage HNC with more confidence but also to introduce these technologies in RT treatment planning, and to use it during the RT course for the evaluation of response and additionally sculpture RT fields. Furthermore, it became possible to predict outcome based on anatomic and metabolic changes in HNC. Community of radiation oncologists successfully adopted transition from two-dimensional to three-dimensional RT and then to intensity modulated RT, as well as stereotactic radiotherapy (either single- or multi-fraction) regimens. There is renewed interest in heavy particles with both neutrons, carbon-ions and protons, the latter two being used more frequently in the recent years. This review article summarizes the most important accepts of novel RT technologies in HNC.

Recidivujici nadory hlavy a krku jsou terapeutickou výzvou pro chirurgy i pro radiacni onkology. Navzdory velkemu pokroku v primarni lecbě těchto nadorů se recidivy vyskytuji velmi casto a významně přispivaji k mortalitě pacientů. Reiradiace externim paprskem je stale považovana za kontroverzni lecebnou intervenci, jejiž uzký terapeutický poměr v eře dvou- a trojrozměrne konformni radioterapie dlouhodobě vedl k obavam, že potencialni benefit nedokaže dostatecně vyvažit vysoke riziko iatrogenniho poskozeni. Nepřiznivý terapeutický poměr lze pozitivně ovlivnit použitim modernich technik radioterapie s modulovanou intenzitou svazku (intensity-modulated radiation therapy – IMRT), volumetricky modulovane radioterapie (volumetric-modulated arc therapy – VMAT), stereotakticke ablativni radioterapie (stereotactic body radiation therapy – SBRT) a radioterapie těžkými casticemi (protony, uhlikove ionty). Cil: Cilem tohoto přehledoveho clanku je vytvořeni prakticke pomůcky pro klinicke rozhodovani o typu pacienta vhodneho k reiradiaci a ozařovaci technice s ohledem na jeji ocekavaný lecebný efekt, profil toxicity a dostupnost na jednotlivých pracovistich. Uvodem clanku je definovana selekce pacientů s důrazem na faktory, ktere zasadnim způsobem ovlivňuji celkove přežiti a mohou být zvlastě užitecne při rozhodovani v multidisciplinarnich týmech. Dale text pojednava o typech jednotlivých technik externi radioterapie (IMRT, SBRT, ozařovani těžkými casticemi) s přehledným souhrnem terapeutických výsledků a toxicity z vědeckých praci, ktere zasadnim způsobem ovlivnily klinickou praxi.

Recidivující zhoubné nádory hlavy a krku jsou terapeutickou výzvou pro celý multidisciplinární tým specialistů, krční chirurgy, klinické a radiační onkology, nutriční specialisty i pro psychology.Terapeutické možnosti jsou v této klinické situaci častokrát výz namně omezeny a je nutné je vzájemně kombinovat k dosažení optimálních léčebných výsledků, čímž stoupá i riziko kumulativní toxicity spojené s terapií.Při pozorné selekci pacientů představují záchranná chirurgická léčba a reiradiace terapeutické intervence s kurativním potenciálem.Reiradiace je ale dlouhodobě spojena s vysokým rizikem závažné toxicity, která významně neklesá ani v éře technik moderní konformní radioterapie.Cílem tohoto přehledového edukačního článku je shrnutí základních poznatků o konkrétních technikách reiradiace zevním zářením, nebo brachyterapií a o doporučené dávce a frakcionaci.Článek přináší zák ladní informaci o očekávaném riziku toxicity a její typickém profilu, který

Recidivujici zhoubne nadory hlavy a krku jsou terapeutickou výzvou pro celý multidisciplinarni tým specialistů, krcni chirurgy, klinicke a radiacni onkology, nutricni specialisty i pro psychology. Terapeuticke možnosti jsou v teto klinicke situaci castokrat významně omezeny a je nutne je vzajemně kombinovat k dosaženi optimalnich lecebných výsledků, cimž stoupa i riziko kumulativni toxicity spojene s terapii. Při pozorne selekci pacientů představuji zachranna chirurgicka lecba a reiradiace terapeuticke intervence s kurativnim potencialem. Reiradiace je ale dlouhodobě spojena s vysokým rizikem zavažne toxicity, ktera významně neklesa ani v eře technik moderni konformni radioterapie. Cilem tohoto přehledoveho edukacniho clanku je shrnuti zakladnich poznatků o konkretnich technikach reiradiace zevnim zařenim, nebo brachyterapii a o doporucene davce a frakcionaci. Clanek přinasi zakladni informaci o ocekavanem riziku toxicity a jeji typickem profilu, který je charakteristický pro jednotlive techniky ozařovani.

Patients with limited disease small cell lung cancer (LD SCLC) represent one-third of all patients with SCLC. Accumulated evidence over the past several decades points to as early concurrent thoracic radiation therapy (TRT) and platinum-etoposide (PE) as possible (cycle 1 or 2). TRT dose and fractionation favor hyperfractionated accelerated TRT using 45 Gy in 30 fractions in 15 days, but researchers and groups/societies still recommend conventionally fractionated TRT doses to 60–70 Gy. Increased evidence of efficacy of various immunotherapy agents in non-small cell lung cancer led to a number of prospective clinical trials investigating same compounds as part of combined modality approach in LD SCLC.

Locally advanced non-small cell lung cancer is one of the major battlegrounds in clinical research in lung cancer. Improved diagnostic and staging opportunities were not followed by increased efforts in a systematic way, e.g., prospective randomized studies which could have helped us optimize our treatment approaches. Although limited prospects for all of the treatment options remain nowadays, the vast minority of patients are treated with surgery in combination with other treatment modalities. The remaining one, and they represent the vast majority of cases treated either alone with radiation therapy or systemic therapy or various combinations in both curative and palliative setting. In curative setting, though, evidence accumulated over the past 3 decades supports superiority of concurrent radiochemotherapy over other existing treatment options. It is expected that with novel radiotherapy technologies and new generations of drugs overall results in this disease are further improved.

Meta-analyses of chemotherapy in Head and Neck Cancer (MAC-HNC) showed that adding chemotherapy (CHT) to locoregional treatment improves the treatment outcome. However, it was observed only with concurrent administration of radiotherapy (RT) and CHT. Among many drugs used in this setting, cisplatin (CDDP) has most consistently been used as a single-agent with radical RT. The two most common administrations of CDDP included 100 mg/sqm every three weeks and 40 mg/sqm weekly, both during the course of RT. While a direct comparison of the two modes of CDDP administration in the definitive treatment of locally advanced squamous cell (SQC) HNC is basically lacking, recent summary brought somewhat conflicting results. Questions largely unexplored is the total CDDP dose deemed necessary when administered concurrently with radical RT. Subset analyses from various prospective randomized trials and meta-analyses seem to indicate that one may not need a total CDDP dose of significantly higher than 200 mg/sqm if at all higher than that, irrespective of the type of RT administered and seemingly unnecessary in HPV+ oropharyngeal cancer patients. Due to presumably lower but still effective threshold level of total CDDP given with RT may depend on other factors, such as frequency of CDDP administration or RT fractionation pattern and be closely interrelated with anticipated toxicity, researchers continue with their quest to find optimal approach in this setting. Large clinical trials should detect small differences between treatment options in an era when "old" but effective drugs still dominate the research arena of SQC HNC.

Východiská: Reožarovanie, v kombinácii so systémovou a bio logickou liečbou, sa v súčasnosti stáva významnou opciou pre recidivujúce tumory a "in-field" sekundárne malignity, pokiaľ je chirurgia kontraindikovaná.Rozvoj zobrazovacích metód a nových ožarovacích techník v rádioterapii vytvorili priestor pre vývoj a aplikáciu presnejších postupov reožarovania s využitím rádiobio logického modelovania účinkov v režimoch hypofrakcionácie a jej extrémneho módu -stereotaxie.Normálne tkanivá a orgány po rádioterapii dokážu regenerovať a opraviť svoje poškodenie.Zvyšková tolerančná dávka orgánov v riziku (OaR) je však značne rozdielna.Pri tkanivách so skorou odpoveďou dochádza temer ku kompletnej obnove v priebehu niekoľkých mesiacov, takže druhá séria ožiarenia by mohla byť aplikovaná skoro v rovnakej výške dávky.Pre tkanivá a orgány s neskorou odpoveďou rozsah poškodenia závisí na výške celkovej dávky z ožiarenia, štruktúre funkčných subjednotiek a na intervale medzi sériami.Výrazná obnova prebieha do 3-6

Although conventional fractionated (CF) radiotherapy (RT) became the most common non-surgical approach delivering 66-70 Gy in 33-35 daily fractions (fx) in 6.5-7 weeks several decades ago due to a good local control (LC) with low normal tissue complication rates, recent decades also brought altered fractionated RT regimens based on better understanding of radiobiology. Of these, split course RT is largely abandoned due to inferior results caused by the treatment gap, which led to inferior local control rates and consequently survival. Hyperfractionated (Hfx) RT and various forms of accelerated (Acc) RT had consistently shown improvement in the treatment outcome, given either alone or with concurrent chemotherapy (CHT). Hfx RT was most consistently superior to CF and frequently to Acc RT, while moderate Acc RT also holds promise to be used more often in daily clinical practice. The use of Hfx RT may face the challenge of applicability in busy radiotherapy departments around the world despite unequivocally having been proven as superior regarding both local/regional tumor control and overall survival. With concurrent CHT, although results favor it, risks of accompanying toxicity rise and should be considered when planning such intensified treatment approach.