Onkologija
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DNA vakcine za zdravljenje raka
Get PDFDNA vaccination has emerged as a promising immunotherapeutic approach against cancer due to its simplicity, stability, and safety. DNA vaccines for cancer immunotherapy are designed to deliver one or several genes encoding tumor antigens, thereby eliciting an immune response against antigens that play a central role in tumor initiation, progression or metastasis. Despite all advantages, DNA vaccines face challenges in inducing potent antigen-specific immune response in humans, which limits the successful translation from preclinical models to the clinic. Different strategies to enhance immunogenicity of DNA vaccines against tumor antigens are used, for example optimization of plasmid structure, search for new tumor antigens, development of new delivery systems and utilization of molecular adjuvants and immunomodulatory signals. These very promising approaches are employed in numerous clinical trials and hold promise for increasing the immunogenicity of cancer DNA vaccines, enhancing cancer eradication and contributing to easier translation of DNA vaccination into human clinical use.DNA vakcine predstavljajo obetaven pristop imunoterapije raka, predvsem zaradi njihove enostavnosti, stabilnosti in varnosti. DNA vakcine temeljijo na vnosu plazmidne DNA z zapisom za enega ali več tumorskih antigenov, udeleženih v nastanku, napredovanju ali zasevanju rakavih celic. Z vnosom DNA vakcine spodbudimo imunski odziv usmerjen proti tumorskemu antigenu, kar potencialno vodi do uničenja rakavih celic. Kljub številnim prednostim DNA vakcin pred klasičnimi vakcinami njihovo uporabo v humani kliniki omejuje prešibak antigen-specifični imunski odziv. Za izboljšanje imunogenosti DNA vakcin se razvoj osredotoča na optimizacijo sestave plazmidne DNA, raziskovanje novih tumorskih antigenov, razvoj novih dostavnih sistemov in sočasna uporaba adjuvantnih in imunomodulatornih molekul. Tovrstni pristopi so del številnih kliničnih raziskav na področju imunoterapije raka in predstavljajo korak bližje k izboljšanju imunogenosti DNA vakcin, učinkovitejšemu uničenju rakavih celic in lažjemu prenosu DNA vakcinacije v humano klinično prakso
Integrativna onkologija
Get PDFIntegrative oncology is patient oriented and centered, evidence based medicine, including mind-body practices, natural products, lifestyle modifications in conjuction with convencional cancer treatments.Integrativna onkologija je orientirana na bolnika in ob standardnem onkološkem zdravljenju, in vključuje z dokazi podprta različna komplementarna zdravljenja in tehnike za um in telo, naravna zdravila in modifikacijo življenskega stila bolnika
Radiološka slikovna diagnostika gliomov pri odraslih
Get PDFGliomas are the most commonly occurring primary brain tumours. Since recent introduction of new guidelines we distinguish between different types of primary brain tumours on the basis of molecular markers which can provide important information for personalized treatment. Tumour identification can be either invasive (biopsy based) or non-invasive. The latter has recently been getting more recognition due to development of radiogenomics, which studies the connection between tumour imaging phenotypes and genomics. Magnetic resonance imaging, which uses many standard and nonstandard sequences, can serve as non-invasive identification method for tumour genotypes based on their specific morphological features. After having overviewed the existing literature about the topic, the authors of the article have assessed the imaging features of three tumour genotypes: isocitrate dehydrogenase mutation, 1p19q codeletion and methylguanine methytransferase promoter methylation. Despite the fast development of radiogenomics, there is still lack of comprehensive studies with standardized and sufficient patient samples to present more reliable results.Gliomi so najpogostejši primarni možganski tumorji. Po novih smernicah jih razlikujemo na podlagi molekularnih markerjev, kar daje pomembno podlago za razvoj zdravljenja po meri bolnika. Tipizacija tumorjev je lahko invazivna s pomočjo biopsije in neinvazivna. Slednja v zadnjem času pridobiva veliko vlogo zaradi razvoja radiogenomike, ki proučuje povezavo med slikovnimi fenotipi tumorjev in genomiko. Magnetnoresonančna ocena tumorjev, pri kateri uporabljamo številne standardne in funkcionalne sekvence, omogoča neinvazivno tipizacijo tumorjev glede na specifične morfološke značilnosti posameznih vrst tumorjev s posameznimi molekularnimi markerji. Po pregledu obstoječe literature so avtorji v članku opisali slikovne značilnosti treh tumorskih genotipov, in sicer mutacije izocitratne dehidrogenaze, kodelecije 1p19q in metilacije promotorja metilgvanin metiltansferaze. Kljub hitremu razvoju radiogenomike primanjkuje obširnih študij z dovolj velikimi in standardiziranimi vzorci bolnikov, ki bi podale zanesljivejše rezultate
Vloga Bolnišničnega registra raka Onkološkega inštituta Ljubljana
Get PDFCancer registries are crucial in collecting and providing data on the cancer burden at both the population and the regional level. Hospital-based cancer registries are engaged in the collection of information on cancer patients treated in a particular hospital. Their main purpose is to contribute to clinical patient care in terms of efficiency, quality and hospital management. Hospital-Based Cancer Registry of the Institute of Oncology Ljubljana was established at the same time as the population-based Cancer Registry of Republic of Slovenia in 1950 and contributes to the Slovenian Cancer Registry one third of all notifications of cancer. The data collected in the hospital-based register are also valuable for the professional and research work of the Institute. One of the tasks of hospital-based cancer registries is the preparation of annual reports for management and other users. Annually at the Institute of Oncology Ljubljana, we treat more than 6000 new cancer patients. The number of patients increased by 16% in the period 2008-2016.Registri raka so ključni pri zbiranju in zagotavljanju podatkov o bremenu raka tako na populacijski kot na regionalni ravni. Bolnišnični registri raka se ukvarjajo z zbiranjem informacij o bolnikih z rakom, ki so obravnavani v določeni bolnišnici. Njihov glavni namen je prispevati h klinični oskrbi bolnikov z vidika učinkovitosti, kakovosti in bolnišničnega upravljanja. Bolnišnični register Onkološkega inštituta Ljubljana je bil osnovan ob ustanovitvi državnega populacijskega registra raka leta 1950 in prispeva v državni register tretjino vseh prijav. Podatki, zbrani v bolnišničnem registru, so dragoceni tudi za strokovno in raziskovalno delo Inštituta. Ena od nalog bolnišničnih registrov raka je priprava letnih poročil za vodstvo in druge uporabnike. Letno na Onkološkem inštitutu Ljubljana sprejmemo več kot 6000 novih onkoloških bolnikov. Število bolnikov se je v obdobju 2008–2016 povečalo za 16 %
Intraperitonealna aerosolna kemoterapija pod povišanim pritiskom
Get PDFPatients with peritoneal carcinomatosis have a poor prognosis despite multimodal treatment with surgery and chemotherapy. Cytoreductive surgery is the only curative option for the treatment of carcinomatosis but only minority of patients are eligible for surgical treatment. For non-resectable peritoneal carcinomatosis, chemotherapy is the only possible option with limited effect on the peritoneal metastases due to poor vascularization and low penetration of the drug. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a new minimally invasive method using laparoscopy to deliver chemotherapy in the form of pressurized aerosol into the abdomen allowing better distribution of the drug in the abdominal cavity and deeper penetration of the drug. PIPAC is technically feasible and safe procedure useful as a treatment option for isolated peritoneal carcinomatosis of various origins. Promising results have been published in the treatment of the peritoneal metastases of all origin with PIPAC. Many prospective clinical trials are ongoing evaluating oncological efficacy of PIPAC in multiple indications with various drugs.Bolniki s peritonealnimi metastazami imajo kljub multimodalnemu zdravljenju s kirurgijo in kemoterapijo slabo prognozo. Samo citoreduktivna kirurgija je lahko kurativna pri zdravljenju peritonealne karcinoze, toda le manjši delež bolnikov je primeren za kirurško zdravljenje. Pri neresektabilni peritonealni karcinozi je kemoterapija edina možna terapija z omejenim učinkom na peritonealne metastaze zaradi slabe vaskularizacije in nizke penetracije zdravila. Intraperitonealna aerosolna kemoterapija pod pritiskom (PIPAC) je nova minimalno invazivna metoda, ki s pomočjo laparoskopije omogoča aplikacijo citostatika v abdomen v obliki aerosolov pod povišanim pritiskom, kar omogoča boljšo razporeditev zdravila v abdominalni votlini in globjo penetracijo zdravila. PIPAC je tehnično varen postopek, ki omogoča zdravljenje izolirane peritonealne karcinoze različnih vrst tumorjev. Objavljeni rezultati zdravljenja peritonealnih metastaz različnih vrst tumorjev s PIPAC so obetavni. Trenutno potekajo številne prospektivne študije, ki analizirajo terapevtsko učinkovitost PIPAC-a pri različnih indikacijah z različnimi zdravili
