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Real-life assessment of treatment outcomes with everolimus and exemestane after cyclin-dependent kinase 4/6 inhibitor use in hormone receptor-positive metastatic breast cancer in a tertiary United Kingdom cancer center
No full textIntroduction. Everolimus and exemestane (EXE+E) have been used for patients with metastatic hormone receptor-positive breast cancer who progress on nonsteroidal aromatase inhibitor (NSAI) treatment, since the BOLERO-2 trial in 2011-12. The patient population in BOLERO 2 had previous treatments with hormones and/or chemotherapy only. Cyclin-dependent kinase (CDK) 4/6 inhibitors were approved for use in 2017 in the UK. The effectiveness and response rates of EXE+E in patients in a tertiary Cancer Centre in the UK were reviewed in comparison with the original BOLERO-2 outcomes in a post CDK 4/6 inhibitor setting.
Material and methods. Retrospective analysis of patient medical records from December 2017 to December 2022 was done, of those who were treated with EXE+E after CDK 4/6 inhibitor use, in hormone receptor positive, human epidermal growth factor receptor 2-neu (HER2 neu) negative metastatic breast cancer setting. Data was collected on basic patient demographics, EXE+E dose, number of cycles, subsequent line of management after cessation of EXE+E. Median progression-free survival (mPFS) was calculated and presented as Kaplan–Meier curve. Toxicities and overall survival (OS) were not analysed in this study.
Results. There was a total 69 patients who received EXE+E after use of a CDK 4/6 inhibitor. 43 and 21 patients had EXE+E in the second and third line respectively. The median PFS from our patient group was 5 months, which is lower than the mPFS reported in the BOLERO-2 trial.
Conclusions. There have been no studies in the UK, according to available research, looking at the efficacy of EXE+E after relapse on NSAI and CDK-inhibition. The mPFS from the present data is not as promising as that seen in the BOLERO-2 trial
Rare case of Burkitt’s lymphoma localized in paranasal sinuses in a 3.5-year-old boy
No full textAbstract
Introduction: Head and neck cancers constitute 5-12% of all malignant tumors in children. They are most often of non-epithelial origin. Hodgkin lymphoma constitutes the majority (approx. 80%) of head and neck lymphomas. Among the complaints that may raise oncological suspicions with which young patients report to an otolaryngologist, one should mention: enlarged lymph nodes in the neck, deformity in the facial skeleton and neck, dyspnea, swallowing disorders.
Objective: To present a rare case of a 3.5-year-old patient with Burkitt's lymphoma located in the right maxillary sinus.
Case description: On 12.06.2024, a 3.5-year-old boy was transferred to the Maria Konopnicka University Pediatric Center of the Central Teaching Hospital of Łódź due to a suspected hyperplastic process of the right maxillary sinus.
The patient's parents had been observing gradually increasing swelling of the eyelids of the right eye for about two weeks, without visual impairment, without neurological disorders. A CT scan of the head revealed a pathological mass in the right maxillary sinus, causing destruction of its bony walls. The patient was qualified for a biopsy of the hyperplastic lesion of the right maxillary sinus, which was performed under general anesthesia under endoscopic control in the operating theater. The histopathological result obtained - Burkitt's lymphoma.
Chemotherapy was started with good results.
Conclusions: Burkitt's lymphoma is a tumor with an extremely aggressive course and a short doubling time of its mass. Localization within the paranasal sinuses is very rare (case reports in the literature)
Artificial intelligence development for facilitating the diagnosis of heart failure subtypes: Preliminary results
No full textAdjuvant systemic treatment in luminal breast cancer — what else apart from hormone therapy?
Full text linkThe luminal subtype [hormone receptor (HR) expression and absence of HER2 overexpression] occurs in more than 70% of patients with early breast cancer. These patients are characterized with a differentiated prognosis depending on the stage and the biological aggressiveness of the tumor, which can be assessed by examining the degree of HR expression, histological malignancy (grade, G), the severity of tumor cell proliferation (Ki67 index) or gene expression in a molecular test. Besides, the young age of the patient, especially under 35 years, is associated with a worse prognosis. In all patients with HR expression, indications for adjuvant hormone therapy should be considered. However, in patients with a higher risk of relapse and death, there are additional systemic treatment options that can reduce this risk: chemotherapy and targeted drugs (cyclin-dependent kinase 4/6 inhibitors, PARP inhibitor for patients with germline BRCA 1/2 mutation). The aim of the review is to discuss indications for these forms of adjuvant therapy in HR+ HER2– patients
Comparison of clinical, pathological, and prognostic features of small bowel tumors
Full text linkIntroduction. Although approximately 75% of the digestive system’s length and almost 90% of its surface area consists of the small intestine, small bowel tumors are rare. In this study, we aimed to compare the clinical, pathological and prognostic features of small bowel tumors.
Material and methods. 107 patients diagnosed with small bowel tumor were evaluated retrospectively. Their clinical and pathological features were examined. The effects of the evaluated parameters on survival were analyzed, and overall survival rates were determined.
Results. Of the 107 patients diagnosed with small bowel malignancy included in the study, 44 (41%) were diagnosed with adenocarcinoma, 27 (25%) were diagnosed with GIST, 22 (20.6%) were diagnosed with NHL, and 14 (13.1%) were diagnosed with NET. Distant metastases were more common at diagnosis in adenocarcinoma patients [22 patients (50%)] than in GIST [5 patients (18.5%)] and NHL patients [3 patients (13.6%)] (p = 0.011, p = 0.006, respectively). The median OS in the adenocarcinoma group was 1.1 (min–max = 0.7–1.6) years, in the NET group it was 8.8 (min–max = 3.5–14.2) years, in the NHL group it was 10.7 (min–max = 1.9–19.6) years, but in the GIST group the median OS was could not be reached. OS differences between adenocarcinoma and other groups were statistically significant (p < 0.001).
Conclusions. The overall survival of adenocarcinoma was significantly lower than other small bowel tumor subgroups
Pleural fluid matrix metalloproteinase-9 levels and cancer ratio as diagnostic tools for malignant pleural effusion
Full text linkIntroduction. Malignant pleural effusion (PE) poses significant diagnostic and therapeutic challenges due to its diverse etiologies and variable clinical presentations. Accurate differentiation between malignant and non-malignant effusions is crucial for guiding appropriate treatment decisions and improving patient outcomes. Among the biomarkers studied for this purpose, matrix metalloproteinase-9 (MMP-9) in pleural fluid and the cancer ratio (CR) have shown promise in recent research.
Material and methods. This study used a non-randomized cross-sectional observational design, carried out at Saiful Anwar Hospital (January–June 2023), to determine the levels of MMP-9 and CR in pleural fluid in patients with malignant and non-malignant PE and to compare these levels between the two groups.
Results. MMP-9 was higher in malignant PE compared to non-malignant (238.12 vs. 192.27, p < 0.05). CR in malignant PE was higher than in non-malignant PE (40.71 vs. 22.73, p < 0.05). AUC values for MMP-9 and CR were 0.543 (p = 0.025) and 0.788 (p = 0.000), respectively. The sensitivity and specificity of MMP-9 (cut off 112.5) were 57.6% and 63.6%, respectively, while CR (cut off 21.337) were 72.7% and 74.5%, respectively. A combination of MMP-9 > 122.5 and CR > 21.337 provided sensitivity of 45.45%, specificity of 87.27%, and diagnostic accuracy of 71.59% and turned out to be the diagnostic threshold value for the malignant group (p = 0.001)
Conclusions. CR has higher sensitivity and accuracy compared to other biomarkers. The combination of Pleural Fluid MMP-9 and CR shows good specificity
Obstetric and neonatal risks of Streptococcus agalactiae in adolescent pregnancy: a retrospective matched cohort study
No full textObjectives: Streptococcus agalactiae (GBS) infection is significant in obstetric and neonatal complications. Maternal age, particularly adolescent pregnancy, may influence the prevalence of GBS colonization and associated clinical outcomes. This study aimed to evaluate the impact of maternal age on obstetric and neonatal outcomes, with a specific focus on the modifying effect of GBS status. The analysis explored whether the associations between maternal age and selected outcomes remained statistically significant after adjusting for GBS interactions. Material and methods: A retrospective matched cohort study was conducted with 582 participants, comprising a study group and a matched control group selected through propensity score matching. The study group included adolescents (≤ 19 years, n = 194) and older individuals (> 19 years, n = 388). Inclusion criteria required GBS screening after the 35th week of gestation, bacterial culture upon hospital admission, and delivery during the same hospitalization. Statistical analyses included logistic and linear regression models adjusted for interactions with GBS. Results: In unadjusted analyses, adolescent mothers showed a higher likelihood of postpartum hemorrhage (OR = 2.715, p = 0.02), uterine atony (OR = 3.594, p = 0.043), transient tachypnea of the newborn (TTN) (OR = 6.16, p = 0.027), and shorter neonatal length (estimation = –0.791, p = 0.001). However, after adjusting for interactions with GBS, these associations lost statistical significance: postpartum hemorrhage (AOR = 0.67, p = 0.711), uterine atony (AOR = 2.417, p = 0.315), TTN (AOR = 4.87, p = 0.117), and neonatal length (estimation = –0.207, p = 0.584). Conclusions: These findings indicate that GBS colonization confounds the observed relationships between maternal age and these outcomes. These results underscore the importance of accounting for GBS status in assessing age-related risks during pregnancy and tailoring clinical management accordingly
Clinical implications of adrenal incidentaloma — a mini review
No full textIn the era of rapid advancements in imaging techniques and improved accessibility to diagnostic imaging, the detection of focal adrenal lesions in patients who undergo examinations for unrelated reasons has been steadily increasing. Most adrenal incidentalomas are hormonally inactive adrenal cortical adenomas with benign radiological features. However, some lesions may be hormonally active and/or exhibit radiological characteristics of malignant growth (pheochromocytomas, adrenocortical carcinomas, metastatic lesions). In such cases, prompt therapeutic intervention is necessary. The 2023 guidelines issued by the European Society of Endocrinology introduced significant updates to the recommendations for diagnosing and managing these lesions, particularly in terms of the evaluation of mild autonomous cortisol secretion (MACS). Given that adrenal incidentalomas may occur in up to 10% of elderly patients and are likely to be diagnosed with increased frequency due to the improvement in quality and availability of imaging, the aim of this paper is to provide a comprehensive overview of current approach to adrenal tumors.
Non-small cell lung cancer in the young patients — a clinico-molecular review of an uncommon presentation
No full textAlthough non-small cell lung carcinoma (NSCLC) typically occurs in older patients, some patients develop it at a young age. Patients with young-onset NSCLC have unique genetic, histological and clinical characteristics, yet this population is poorly described. Oncogenic driver alterations are more frequently detected in young patients, which creates the possibility of using targeted therapy in these cases. A frequent occurrence of specific molecular alterations in these patients determines their distinct clinical profile. Young patients with NSCLC also exhibit different histological features and a different immunological profile of the tumor microenvironment. Risk factors for developing NSCLC in the young population are less understood than those of the general patient population; the most important risk factor for NSCLC is tobacco smoking, it plays a minor role in early-onset lung cancer. Instead, genetic and environmental factors are more important. Prognostic data for young patients compared to the general population remains unclear; however, studies indicate particularly good outcomes for young patients with specific molecular alterations. For this reason, comprehensive genetic profiling is essential in young patients. In this paper, molecular, histological, and clinical characteristics of NSCLC among the young population will be discussed, focusing on the differences between young patients and the general population with NSCLC. Also described are the risk factors for early-onset NSCLC, including environmental and genetic factors