Onkologija
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Epitelijski rak jajčnikov, rak jajcevodov, primarni peritonealni serozni karcinom (PPSC): priporočila za sistemsko zdravljenje
Get PDFEpithelial ovarian cancer is known to be one of the most sensitive to systemic treatment with chemotherapy. Objective response to treatment was achieved in more than 80% of patients. Therefore, chemotherapy treatment is a standard part of primary treatment after completed surgery (adjuvant treatment). If surgical treatment is not possible, patients begin treatment with preoperative (neoadjuvant) chemotherapy, which is followed by surgery. In primary systemic treatment, we have been using chemotherapy in combination with taxanes and platinum-based preparations. In systemic treatment of fallopian tube cancer, we also use – besides chemotherapy – bevacizumab, an inhibitor of the vascular endothelial growth factor (VEGF). Systemic treatment presents the principal treatment also in disease recurrence. The type of systemic treatment in disease recurrence depends on the time elapsed since the end of primary treatment until recurrence. In the last couple of years, we have been again witnessing the introduction of new medicines for treatment of patients with fallopian tube cancer. For this reason, the Institute of Oncology Ljubljana this year updated its guidelines for systemic treatment of epithelial ovarian cancer. In this paper, we present the current recommendations for systemic treatment of epithelial ovarian cancer in Slovenia. Epithelial ovarian cancer, fallopian tube cancer and primary peritoneal serous cancer (PPSC) have the same clinical course and the same systemic treatment, therefore they are all managed in the same manner.Ni abstrakta
S kapecitabinom povzročen transmuralni miokardni infarkt
Get PDFFluoropyrimidine are agents that comprise the so-called antimetabolites (inhibitors of cell metabolism). An important representatitve of this group are 5-fluorouracil (5-FU) and capecitabine (an oral analogof 5-FU), which belong to a group called pyrimidine analogs. Both represent the cornerstone of chemotherapy regimens, which are used in the treatment of solid tumors of the gastrointestinal tract and are indispensable in the treatment thereof. Among the rare side-effects of both appears cardiotoxicity including myocardial infarction. The spectrum of capecitabine-induced cardiotoxicity is wide and icludes angina, arrhythmias, myocardial infarction and death. Due to its increasing use in oncologic therapy, specialists should be aware of cardiotoxicity especially when used in patients with the history of ishaemic heart disease.
We present a case of a female patient without previous cardiovascular symptoms who developed transmural myocardial infarction during the treatment with capecitabine.Fluoropirimidini so citostatiki, ki jih uvrščamo med tako imenovane antimetabolite (zaviralce celične presnove). Pomembna predstavnika te skupine sta 5-fluorouracil (5-FU) in kapecitabin (peroralni analog 5-FU), ki spadata v skupino t.i. pirimidinskih analogov. Oba predstavljata temelj vseh kemoterapevtskih shem, ki jih uporabljamo pri zdravljenju solidnih tumorjev prebavil in sta kot taka nepogrešljiva pri zdravljenju le-teh. Med redkejše neželene učinke obeh spada kardiotoksičnost, med drugim tudi miokardni infarkt. Spekter s kapecitabinom oz. 5-FU povzročene kardiotoksičnosti je širok in med drugim poleg miokardnega infarkta vključuje angino pektoris, aritmije, kongestivno odpoved srca, kardiogeni šok in nenadno srčno smrt. Zaradi množične uporabe v onkološkem zdravljenju različnih solidnih tumorjev, moramo biti pozorni tudi na možnost kardiotoksičnosti, še posebej pri bolnikih z pridruženo znano ishemično boleznijo srca. Predstavljamo primer bolnice brez predhodno znanih kardiovaskularnih bolezni, pri kateri je prišlo do razvoja transmuralnega miokardnega infarkta tekom terapije s kapecitabinom
Novosti v sistemskem zdravljenju bazalnoceličnega karcinoma
Get PDFThe majority of primary basal cell carcinomas (BCCs) are treated surgically or, in surface lesions, using non surgical methods. The risk of recurrence increases with tumour size, poorly defined lesion margins, an aggressive histologic sub-type and previous recurrence. In some cases, the tumour can destroy the surrounding tissues (muscles, bones, cartilage etc.) due to long-term absence of treatment or aggressiveness of the tumour (locally advanced form of BCC - IaBCC).
In extremely rare cases, BCC spreads also to distant tissues (metastatic BCC - mBCC). In multiple local recurrences or invasion of surrounding/distant structures (laBCC/mBCC), where surgery and/or radiation therapy are not appropriate, it is important to use a multidisciplinary approach in patient management.
Abnormal activation of the Hedgehog signalling pathway is responsible for the occurrence of the disease in 90 % of BCCs. By selectively binding to the transmembrane protein SMO (Smoothened Transmembrane Protein), the active substance vismodegib selectively inhibits the abnormally activated signalling pathway. Phase II clinical trial ERIVANCE BCC reported on the efficacy and safety of vismodegib in patients with laBCC and mBCC. The primary objective of this study was objective response rate (complete and partial) as assessed by an independent review board. The study results showed that an objective response was achieved in 33.3% of patients with mBCC and 47.6% of patients with laBCC. Disease control (objective response + stable disease) was confirmed in 94% of patients with mBCC and 83%
of patients with laBCC. After 24 weeks of treatment, a total of 54% of patients with laBCC had no histopathological signs of basal cell carcinoma. According to the most recent data, the median duration
of objective response was 14.8 months in mBCC and 26.2 months in laBCC. The encouraging results of treatment with vismodegib in a phase II trial show a significant decrease in the size of multiple lesions and number of newly occurred lesions in patients with Gorlin syndrome.
The most common adverse effects included muscle cramps, loss of taste, hair loss and fatigue.Večino primarnih bazalnoceličnih karcinomov (BCK) zdravimo kirurško ali pri površinskih lezijah z nekirurškimi metodami. Tveganje za ponovitev povečujejo velikost tumorja, slabo definiranimi robovi lezije, agresiven histološki podtip in prejšnja ponovitev. V nekaterih primerih lahko tumor uniči okoljna tkiva (mišice, kosti, hrustanec itd.), zaradi dolgotrajne odsotnosti zdravljenja ali agresivnosti tumorja (lokalno napredovala oblika BCK – lnBCK). V izjemno redkih primerih BCK napreduje v oddaljena tkiva (metastatski BCK – mBCK). Pri večkratnih lokalnih ponovitvah ali pri invaziji okoljnih/oddaljenih struktur (lnBCK/mBCK), kjer kirurgija in/ali obsevanje nista primerni, je pomemben multidisciplinarni pristop pri obravnavi bolnika.Nenormalna aktivacija signalne poti Hedgehog je odgovorna za nastanek bolezni pri 90 % BCK. S selektivno vezavo na transmembranski protein SMO (Smoothened TransmembraneProtein) učinkovina vismodegib selektivno zavira nenormalno aktivirano signalno pot. V klinični raziskavi faze II, ERIVANCEBCC, so poročali o učinkovitosti ter varnosti vismodegiba pri bolnikih z lnBCK in mBCK. Primarni cilj raziskave je bil objektivni delež odziva (popolni in delni), kot ga je ocenila neodvisna ustanova za pregled. Rezultati raziskave so pokazali,da je bil objektivni odgovor dosežen pri 33,3 % bolnikov zmBCK in 47,6 % bolnikov z lnBCK. Kontrola bolezni (objektivni odgovor + stabilna bolezen) je bila potrjena pri 94 % bolnikov z mBCK in 83 % bolnikov z lnBCK. Po 24 tednih zdravljenja 54 % bolnikov z lnBCK ni imelo histopatoloških znakov bazalnoceličnega karcinoma. Po zadnjih podatkih je bila mediana trajanja objektivnega odgovora 14,8 meseca pri mBCK in 26,2 meseca pri lnBCK. Vzpodbudni rezultati zdravljenja z vismodegibom v raziskavi faze II kažejo na bistveno zmanjšanje velikosti multiplih lezij in števila novonastalih lezij pri bolnikih z Gorlinovim sindromom. Najbolj pogosti neželeni učinki so bili mišični krči, spremembe okusa, izguba las in utrujenost
Pomen hipoksije pri obsevanju
Get PDFThe success of radiation therapy (RT) treatment depends on numerous factors, one of which is also tumour cell oxygenation. Tumour cells which are well-supplied with oxygen can be up to 3 times more sensitive to radiation than hypoxic tumour cells. In addition, hypoxia functions as selective pressure in tumours, which results in the survival of only more malignant cells with diminished apoptotic potential. Presence of hypoxia increases the genomic instability and metastatic potential of tumour cells, while also increasing cell resistance to chemotherapy, all of which affects the success of treatment with RT. Hypoxia is a result of an imbalance between cellular respiration, concentration of oxygen in the blood and tumour perfusion, with the most common pathogenic mechanisms being inappropriate vascularization, disturbed oxygen diffusion and anaemia which may be a consequence of cancer or treatment. Using invasive and most recent non-invasive diagnostic techniques, we can assess the proportion of hypoxic cells in the tumour, adapting the therapeutic approach accordingly. A better effect of irradiation of less oxygenated tumours can be achieved using radio sensitizers, by improving tumour oxygenation, through selective destruction of hypoxic cells, and with irradiation of hypoxic areas using higher doses of radiation and with the help of radio protectors or using modern irradiation techniques.Uspešnost zdravljenja z radioterapijo (RT) je odvisna od številnih dejavnikov, med katerimi je tudi oksigenacija tumorskih celic. Tumorske celice, ki so dobro preskrbljene s kisikom, so namreč na obsevanje tudi do 3-krat bolj občutljive kot hipoksične tumorske celice. Poleg tega deluje hipoksija v tumorjih kot selekcijski pritisk, zaradi katerega preživijo le bolj maligne celice, z manjšim apoptotskim potencialom. V prisotnosti hipoksije se povečata genomska nestabilnost in metastatski potencial tumorskih celic, zveča pa se tudi odpornost celic na kemoterapijo, kar vse vpliva na uspešnost zdravljenja z RT. Hipoksija je posledica neskladja med celičnim dihanjem, koncentracijo kisika v krvi in perfuzijo tumorja, pri čemer so najpogostejši patogenetski mehanizmi neustrezna ožiljenost, motena difuzija kisika ter anemija, ki je lahko posledica rakave bolezni ali zdravljenja. Z uporabo invazivnih in novejših neinvazivnih diagnostičnih metod lahko ocenimo delež hipoksičnih celic v tumorju in temu prilagodimo terapevtski pristop. Boljši učinek obsevanja slabše oksigeniranih tumorjev lahko dosežemo z uporabo radiosenzibilizatorjev, z izboljšanjem tumorske oksigenacije, s selektivnim uničenjem hipoksičnih celic s citotoksini ter z obsevanjem hipoksičnih predelov z višjimi obsevalnimi odmerki ob pomoči radioprotektorjev in z uporabo sodobnih obsevalnih tehnik
Letno srečanje ASCO
Get PDFIn the end of May this year, Chicago hosted the traditional annual meeting of oncologists from around the world, which was organised by the American Society of Clinical Oncology (ASCO). Once again, the meeting was attended by more than 30,000 oncologists and other scientists from all over the world.
The main topic of this year’s ASCO meeting was definitely cancer immunotherapy. For many years, we have hoped to be able to destroy or at least control cancer cells by stimulating the organism’s own defence. There have been some ups but mostly many downs of immunotherapy. Interferons, interleukins and vaccines have shown a very small level of efficacy, and, even so, only in some types of cancer, alongside a disproportionally high toxicity. A breakthrough was achieved a few years ago, when new immuno-medicines, inhibitors of control switches in T lymphocytes (so-called checkpoint inhibitors), were introduced into clinical trials. In many types of cancer, these medicines led to remissions, which were, most importantly, long-term in patients with remission.Ni abstrakta
Vloga radioloških in nuklearnomedicinskih slikovnih preiskovalnih metod pri karcinomu nosnega dela žrela
Get PDFNasopharyngeal carcinoma (NPC) is a rare disease in the Slovenian population. Treatment depends also on the TNM stage of the carcinoma, which is determined also with the help of radiologic and nuclear medicine imaging methods. The radiologic imaging examination method of choice for detecting NPC and lymph node metastases is MRI, whereas spreading of NPC to bone structures is best shown using CT. To continue, PET-CT is the method of choice for detecting distant metastases and disease recurrence 3 to 6 months after completed treatment.Karcinom nosnega dela žrela je v slovenski populaciji redka bolezen. Zdravljenje je odvisno tudi od TNM-stadija karcinoma, katerega določamo tudi s pomočjo radioloških in nuklearnomedicinskih slikovnih preiskovalnih metod. Radiološka slikovno-preiskovalna metoda izbora za ugotavljanje KNŽ in zasevkov v bezgavkah je MR, širjenje KNŽ v kostne strukture pa si najboljše prikažemo s pomočjo CT. PET-CT pa je metoda izbora za ugotavljanje oddaljenih zasevkov in ponovitve bolezni 3 do 6 mesecev po zaključenem zdravljenju
16. svetovni kongres o raku prebavil
Get PDFThe 16th World Congress on Gastrointestinal Cancer took place in Barcelona from 25 to 28 June 2014. The congress was attended by general practitioners, gastroenterologists, hepatologists, internist oncologists, surgeons and different researchers, who wish to upgrade their knowledge needed for treating patients with gastrointestinal cancer. The congress hosted presentations about the importance of screening, diagnostics and recent findings regarding clinical management of patients with common and less common types of gastrointestinal cancer. The emphasis was on individual patient management and the importance of a multidisciplinary approach, as well as most recent molecular mechanisms known to date. Over 70 world-renowned lecturers, all experts in their fields, presented the latest findings and recommendations or led small targeted groups of physicians who discussed issues of their interest. At the congress, the participants were also given a chance to present our research results, with the abstracts being published in the Annals of Oncology. Three specialists from Slovenia attended the congress, namely a gastroenterologist, an internist oncologist, and a radiation therapist, each with his or her own contributions.Ni abstrakta
Značilnosti raka požiralnika in raka želodca
Get PDFAccording to the Globocan data, a total of 12.7 million people were diagnosed with cancer and 7.6 million people died of this disease in 2008. As many as 56% of new cancer cases and 63% of cancer deaths were recorded in less developed regions of the world. The most common cancers were lung cancer (1.61 million; 12.7% of all cases), breast cancer (1.38 million, 10.9% of all cases) and colorectal cancer (1.23 million, 9.7% of all cases). The leading causes of cancer-related death were lung cancer (1.38 million, 18.2% of all cancer deaths), gastric cancer (738 thousand, 9.7% of all cancer deaths) and liver cancer (696 thousand, 9.2% of all cancer deaths). Projections of the cancer burden are even grimmer. In 2030, a total of 20.3 million people will be newly diagnosed with cancer, and 13.2 million people will die from this disease. The incidence is thus said to increase by 75% and to almost double in less developed countries compared to 2008. Cancer will become the leading cause of morbidity in every country of the world. Everywhere, we will witness an increase in the share of colorectal cancer, breast cancer and prostate cancer, while the most developed countries will also note an increase in lung cancer in women. The incidence of gastric and cervical cancers will drop, as will the incidence of lung cancer in men in the developed countries (2).Ni abstrakta
Vloga endoluminalnih opornic med neoadjuvantnim zdravljenjem karcinomov požiralnika
Get PDFThe first goals of treatment of symptomatic malignomas of the oesophagus include maintenance of the nutritional path and prevention of haemorrhage and pain. All patients require a multidisciplinary assessment in order to get the appropriate regular multi-modal therapy. Definition of the most appropriate nutritional support for the oesophageal cancer patient must be individual. Treatment depends on the disease stage, symptoms, the available technology and experience of the attending doctor. We present our method for treating dysphagia with the help of intraluminal oesophageal stents. In our practice, the intraluminal oesophageal stent has proven to be a very effective and the most patient-friendly method for optimal delivery of nutrients before and during neoadjuvant therapy. There are few complications, and insertions do not have a negative impact on the perioperative outcomes.Prvi cilji zdravljenja simptomatskih malignomov požiralnika vključujejo vzdrževanje prehranske poti, preprečevanje krvavitev in bolečin. Vsi bolniki potrebujejo multidisciplinarno oceno, da jim zagotovimo primerno, običajno več-modalno terapijo.
Opredelitev najbolj ustreznega načina prehranske podpore bolnika z rakom požiralnika mora biti individualna. Zdravljenje je odvisno od stadija bolezni, simptomov, razpoložljive tehnologije in izkušenj lečečega zdravnika.
Predstavljamo naš način reševanja disfagije s pomočjo znotraj- -lumenskih opornic požiralnika. V naši praksi se je znotraj- -lumenska opornica požiralnika pokazala za zelo učinkovit in bolniku najprijaznejši način zagotavljanja optimalnega vnosa hranil pred ter med neoadjuvantno terapijo. Zapletov je malo, vstavitve pa nimajo negativnega vpliva na perioperativne izide
Pogled zdravnika radioterapevta na zdravljenje raka požiralnika
Get PDFOesophageal carcinoma is a disease with an increasing incidence in the world, and the prognosis of which is generally still poor, despite the progress achieved in oncology in the last years. In 2010, a revised TNM classification for oesophageal carcinomas was published, which is currently still applicable and takes better account of the natural course of the disease and biological characteristics of squamous cell carcinomas compared to adenocarcinomas. Radiation plays an important part in the treatment of patients with oesophageal carcinoma, both in the scope of preoperative treatments (with concurrent chemotherapy) as well as in non-operative treatment methods.Karcinom požiralnika je bolezen, katere incidenca po svetu narašča in katere prognoza je praviloma, kljub vsemu doseženemu napredku v onkologiji v zadnjih letih, še vedno slaba. V letu 2010 je bila objavljena revidirana, trenutno veljavna TNM klasifikacija za karcinome požiralnika, ki bolje upošteva naravni potek bolezni in biološke značilnosti ploščatoceličnih karcinomov v primerjavi z adenokarcinomi. Pri zdravljenju bolnikov s karcinomom požiralnika ima obsevanje pomembno vlogo, tako v sklopu predoperativnih zdravljenj kot (ob sočasni kemoterapiji) tudi pri neoperativnih načinih zdravljenja