Chakalaroski, Petar
Preferred name
Chakalaroski, Petar
Official Name
Chakalaroski, Petar
Alternative Name
Cakalaroski Petar
Chakalaroski Petar
Cakalaroski P
Chakalaroski P
Чакалароски Петар
Чакалароски П
П Чакалароски
Петар Чакалароски
P Chakalaroski
P Cakalaroski
Petar Chakalaroski
Petar Cakalaroski
Main Affiliation
Email
petar.cakalaroski@medf.ukim.edu.mk
chakalaroski@yahoo.com
cakalaroskip@gmail.com
18 results
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Item type:Publication, DEFINITIVE TREATMENT OF PLANOCELLULAR OROPHARYNGEAL CARCINOMA WITH MODERATE ACCELERATION OF INTENSITY MODULATED RADIATION THERAPY WITH SIMULTANEOUS INTEGRATED BOOST(Macedonian Association of Anatomists and Physiologists, 2020); ; ; Stoleska, MarinaIntroduction: Intensity Modulated Radiation Therapy (IMRT) represents a new technique in the treatment of head and neck carcinomas. Oropharyngeal carcinomas are ideal target for this radiation technique, because of their anatomic localization close to critical healthy organs. Simultaneous Integrated Boost (SIB) in IMRT allows in at the same time at the same fraction delivering of different dose to different structures to irradiated volume with distribution on higher dose to the tumor and lower dose in elective irradiated regions. Moderate acceleration of IMRT-SIB allows in shorter time delivering of higher dose to planning target volume and achieving bigger tumor control. Objective: Aim of this study was to present planning technique IMRT – SIB with 95% dose coverage of volume of planning target volumes referring to primary oropharyngeal carcinoma, metastatic lymph nodes, elective region in head and neck which is irradiated and to critical organs near the tumor, achieving in the future better tumor control and fewer side effects on healthy tissues. Materials and methods: This retrospective study included 31 patients with advanced planocellular oropharyngeal cancer treated at University clinic of Radiotherapy and oncology- Skopje, with modulate acceleration of IMRT-SIB and weekly concurrent cisplatin. Results: With IMRT SIB we achieved high 95% dose coverage of the planned target volumes (PTV54 = 99,46 % and PTV66 = 98.74 %) and successfully spare the spinal cord as the most important organ at risk. Conclusion: IMRT- SIB fulfill the goal of better tumor coverage and moderate acceleration achieve dose reduction in critical healthy organs. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, RADIATION-INDUCED MUCOSITIS IN PATIENTS WITH OROPHARINGEAL CANCER TREATED WITH MODERATE ACCELERATION OF INTENSITY-MODULATED RADIATION THERAPY AND SIMULTANEOUS INTEGRATED BOOST CONCOMITANT WITH WEEKLY CISPLATIN(Scientific foundation Spiroski, 2021); ; ; Stoleska MarinaRadiation-induced mucositis is one of the limiting factors during radiotherapy, disturbing the quality of life and in some cases leading to discontinuation of therapy. Intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) represents advanced form of radiotherapy technique in treatment of oropharyngeal carcinoma enabling precision cancer targeting with reducing dose to healthy normal tissues. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dosimetric evaluation of two intracavitary brachytherapy modalities in treatment of inoperable cervical cancer(Eight international conference on radiation in varoius fields of research, 2020-07-24); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Multimodality treatment of brain metastases from ovarian cancer(Macedonian Association of Pathology, 2016-09); ; ; Objective: Brain metastases from ovarian cancer are uncommon and usually associated with mean survival less than 12 months. In some cases, multimodality treatment may achieve an improved outcome in these patients. Material and Methods: Two cases of multiple brain metastases from ovarian cancer are presented. A combination of whole-brainradiotherapy (WBRT) and chemotherapy (Topotecan) was used. Results: Case 1: A 62-year-old patient was diagnosed and treated for primary ovarian cancer in 2012. She underwent optimal surgical resection and adjuvant platinum-based chemotherapy (Carboplatin/Paclitaxel, 6 cycles). Eleven months after the initial treatment the patient developed right hemiparesis. Brain CT documented multiple brain metastases in the left frontal and parietal lobe. She proceeded to WBRT and subsequent 4 cycles of Topotecan. At a follow-up of 24 months, there is no evidence of recurrent disease. Case 2: A 63-year-old patient was diagnosed with primary ovarian cancer in 2012. Initially, she received neoadjuvant chemotherapy (Carboplatin/Paclitaxel, 6 cycles and Doxorubicin/Carboplatin, 3 cycles) followed by surgical treatment. After 1-year follow-up, multiple brain metastases in the right temporoparietal and occipital lobe were detected by brain MRI. She underwent WBRT followed by 4 cycles of Topotecan. Better motor performance was achieved and the MRI scan evaluation showed volume reductions of brain metastases. Nine months later, CT scan revealed a progression of the metastatic disease and re-WBRT was performed. At a follow-up of 18 months, she is in good clinical condition. Conclusions: In ovarian cancer patients with multiple brain metastases, multimodal therapeutic approach including radiotherapy followed by chemotherapy may lead to prolonged survival. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COMPARISON OF TWO RADIOTHERAPY TECHNIQUES IN TREATMENT OF PATIENTS WITH INOPERABLE (ADVANCED) CERVICAL CANCER(Macedonian Association of Anatomists, 2022-08-31); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The effect from Paclitaxel/Carboplatin regimen to advanced ovarian carcinoma(RAD Association, 2018-06-18); ; ; Gordana PetkovskaIntroduction: Ovarian cancer is the leading cause of death in developed countries and fifth most common cause of mortality in female population. Due to non specific symptoms, compression of bladder and/or rectum it is usually diagnosed in later stages. Approximately 70% are initially diagnosed in stage III with ascites. Treatment outcome is related with the stage. Clinical exam, abdominal ultrasound, CT scans and laboratory (including marker Ca125) are reguired for initial diagnosis. MR may be useful prior operation. Methods: Surgery should be the first treatment option. The aim of surgery is to achieve optimal debulking, at the same time providing tissues for histopathology analysis. Further treatment depend on staging, usually chemotherapy of carboplatin-paclitaxel. The number of cycles administered depends on estimated risk of recurrence. Results: This pattern can be modified to the individual characteristics of certain patients at the presentation. Patient aged 28, referred to University Clinic of Radiotherapy and Oncology in decreased performance status (ECOG1) for chemotherapy treatment with advanced ovarian carcinoma. Explorative laparotomy with multiple biopsies from otherwise, technically inoperable tumor was performed. HP diagnosis revealed ovarian cystadenocarcinoma. Initial high value of Ca125 marker (over 1000 U/ml), with other laboratory findings in referent ranges, allowed the use of chemotherapy with carboplatin-paclitaxel regimen. Pre-treatment CT (Jan 2017) showed bulky abdominal and pelvic tumour mass with enlarged lymph nodes. Her performance status improved shortly after the start of chemotherapy. Ca125 was reassessed after two cycles and it’s value depleted by half (Ca125=473 U/ml), thus suggesting good response. The level of Ca125 entered normal range values after the fourth cycle of chemotherapy. After the administration of planned six cycles of chemotherapy she was in good performance status, without any symptoms or complains. CT scan from (May 2017) revealed complete response, without radiological disease. Subseguent surgery (Jun 2017) was carried out and she had confirmed complete response according to histopathology analysis. First follow up, three months after the treatment (Sept 2017) consisted of clinical exam, abdominal ultrasound and measurement of Ca125 showed no evidence of disease. Conclusion: This is one more confirmation for the “golden standard” of carboplatin-paclitaxel regimen in treatment of ovarian carcinoma. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Brachytherapy alone in the postoperative treatment of stage I endometrial carcinoma(Institut za onkologiju Vojvodine, 2018-11-17); ; ; Dimoski IIntroduction: This study evaluate the local control efficacy and toxicity of postoperative intravaginal brachytherapy (IVBT) alone among patients with endometrial cancer stage I. Material and methods: Between January-2004 and December-2011, 60 stage I endometrial adenocarcinoma patients were treated with IVBT alone, 47 in stage IA, 13 patients in stage IB. The surgical approaches were total abdominal hysterectomy (HTA) and bilateral salpingoopforectomy (BSO) in 45 patients, plus bilateral pelvic, paraaortic lymph node dissection in 15 patients. The mean interval between the surgery and the brachytherapy was 30-37 days. <½ miometrial invasion was found in 48 patients, and >½ in 12 patients. The brachytherapy was applied in 3 weekly fractions of 7Gy per fraction, prescribed at depth of 0,5cm from the applicator surface with HDR, Iridium-192. The mean diameter of the vaginal applicator was 3 (2-3,5) cm. Results: With a mean follow up time of 38 months (12-84), all 60 patients are alive. Reccurence was observed in 5 patients (8,3%): 3 patients experienced local recidiv and 2 patients developed a pelvic mass. The mean rectal dose was estimated 14,1Gy and the mean bladder dose was 13Gy. Acute genitourinary toxicity was observed in 31 patients during the therapy. Vaginal stenosis as late complication occurred in 3 patients. Conclusion: Intravaginal brachytherapy alone in the postoperative treatment of stage I endometrial carcinoma achieves local control associated with acceptable toxicity and minimal morbidity. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PROGNOSTIC VALUE OF MOLECULAR MARKER ON OUTCOME IN PATIENTS WITH HIGH-GRADE GLIOMA. SINGLE INSTITUTIONAL EXPERIENCE(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University Skopje, R.N.Macedonia, 2020-10); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Adjuvant chemotherapy and radiotherapy for Stage III endometrial cancer: Impact on Survival(RAD Association, 2018-06); ; ; Introduction. Adjuvant treatment options for advanced-stage endometrial cancer include chemotherapy (CT) and radiation therapy (RT), but the optimal treatment strategy is currently under debate. The aim of this study is to investigate the utilization of adjuvant RT and CT in patients with stage III endometrial cancer and their impact on overall survival (OS) and disease-free survival (DFS). Materials and Methods. A retrospective review was performed of 40 patients with Stage III endometrial cancer who received adjuvant treatment at University Clinic of Radiotherapy and Oncology (UCRO) in Skopje between 2012 and 2015. Postoperative treatment was administered based on performance status and medical comorbidities. Chemotherapy regimens comprised of Carboplatin (AUC 5) and Paclitaxel (175 mg/m2), a 3-week interval for 6 cycles (chemotherapy alone) and 4 cycles (sequential arm). RT was delivered using 3-D CRT with a total dose of 50 Gy in 25 fractions prescribed in PTV for 5 weeks with/without an additional 7 Gy prescribed at a depth of 0.5 cm from the vaginal surface. The primary endpoints were overall survival (OS) and disease-free survival (DFS). Combined radiotherapy and chemotherapy were compared with radiotherapy alone and chemotherapy alone. Results. The distribution of surgical stages is as follows: IIIA accounted for 60% (n=24), stage IIIB accounted for 9.8% (n=4) and stage IIIC accounted for 30% (n=12). The median age was 65 years and median follow-up was 35.5 months. There were 40 patients who received adjuvant treatment, 10% (n=4) received CT alone, 27.5% (n=11) received RT alone, and 62.5% (n=25) received sequential combined CT followed by 3D CRT with/without vaginal vault brachytherapy. Relapse occurred in 55% (n=22) of the patients. High grade and lymphovascular space invasion (LVSI) are risk factors for recurrence and poor prognosis. Overall survival (OS) and Disease-free survival (DFS) at 3 years for patients receiving combined CT and RT, adjuvant RT alone and adjuvant CT alone were 68.8%, 41.26%, and 37.57% for OS and 58.03%, 33.08%, and 24.96% for DFS, respectively. DFS and OS were significantly longer in patients treated with combined RT and CT than in those treated with CT alone (DFS: p= 0.0005; hazard ratio [HR], 5.677; OS: p= 0.0143; HR, 4.289) or RT alone (DFS: p = 0.0137; HR, 2.482; OS: p = 0.0151; HR, 3.036). Conclusion. Combined modality treatment with chemotherapy and radiotherapy can improve both overall and disease-free survival in patients with Stage III endometrial cancer compared with single modality alone. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dose differences between two-dimensional and three-dimensional approach to high dose brachytherapy dose reporting of organs at risk in inoperable cervical cancer treatment(SIXTH INTERNATIONAL CONFERENCE ON RADIATION AND APPLICATIONS IN VARIOUS FIELDS OF RESEARCH, RAD 2018, 2018-06-22); Introduction. Definitive treatment protocols of inoperable cervical cancer utilize radiotherapy in a form of external beam (EBRT) and brachytherapy (BT). Usually EBRT is applied in a form of concurrent chemo-radiotherapy (CCRT), followed by BT. Radiotherapy goal is to achieve a cumulative dose of 80 to 85 Gy into the target volume while obtaining optimal dose reduction in organs at risk (OAR). Maximal tolerant doses in OAR volume of 2 ccm are 95(±22) Gy (α/β=3) for bladder and 65(±12) Gy (α/β=3) for rectum respectively. Dose constrains in two-dimensional (2D) dose planning are calculated as a percentage of applied brachytherapy dose to point A, i.e. 80% for bladder and 70% for rectal dose constrain. Cumulative 2D dose constrains for the whole BT treatment (cumulative brachytherapy dose of 21 Gy) are 16.8 Gy for bladder and 14.7 Gy for rectum. Materials and methods. 16 patients were analyzed (total of 48 applications) with diagnosed inoperable cervical cancer. All patients prior have received CCRT total dose of 50.4 Gy in 28 daily fractions (5 days/week) along with weekly applied Cisplatin (for the duration of 5 weeks). HDR BT was applied in 3 consecutive weekly applications with target dose of 7 Gy to point A per application (total of 21 Gy for the whole BT treatment). We used GammaMedPlus™ an Ir-192 apparatus, patients were positioned on C-Arm for 2D and a computer tomography scanner for 3D planning. Brachytherapy contouring and planning used DICOM and BrachyVision software. Patients that received higher than dose constrains received corticosteroid and anti-inflammatory drugs. Results. Bladder dose reporting for 2D planning gave an average dose (to bladder point) of 7.79 Gy per application (2.10 – 28.61 Gy) and an average of 23.37 Gy for the whole BT treatment (9.00 Gy – 68.06 Gy). 3D dose was reported in OAR volume of 2 ccm and showed an average of 5.08 Gy per application (1.70 Gy – 13.60 Gy) and 15.25Gy for the whole BT treatment (6.78 – 31.4 Gy). Rectal dose reporting for 2D planning showed an average dose of 4.48 Gy per application (1.83 – 9.62 Gy) and an average dose of 13.45 Gy (6.33 – 22.49 Gy) for the duration of whole BT treatment. 3D dose was also reported in OAR volume of 2 ccm and the average dose per application was 3.38 Gy (1.50 – 6.53 Gy). For the whole BT treatment cumulative 3D rectal dose was 10.13 Gy in average (5.57 – 15.37 Gy). All patients that developed mild to average irradiation side-effects such as cystitis and proctitis were successfully treated. Conclusion. 3D dose (in volume) dose reporting offers combined dose/volume display, which gives information about the OAR location and volume where the dose is actually absorbed. Smaller dose-affected OAR volume – should be linked to reduced radiation toxicity. While short term side-effects may vary, long term side-effects should correlate with lower degree of radiotherapy treatment late toxicity.