Onkologija
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Dedni rak debelega črevesa in danke
Get PDFIn five to ten percent of patients with colorectal cancer there is a family anamnesis where patients indicate a number of relatives of different generations on one side of the family (mother or father) who were also diagnosed with colorectal cancer and/or related cancers. Such patients are often of a young age and are diagnosed with the disease 10 to 20 years earlier than it is common in the population. These types of cancer are called »hereditary colorectal cancers«. Some patients with hereditary colorectal cancer may be diagnosed with more than one cancer (2). The occurrence of hereditary colorectal cancer is connected to the inheritance of a specific mutation - defect in the hereditary material, therefore a person who inherits this mutation is at a greater risk of developing this disease. Thus, there is a greater probability that a hereditary colorectal cancer will occur in someone who has inherited this genetic change compared with the general population, although it is not certain that the cancer will develop. Inheritance of gene mutations associated with the occurrence of colorectal cancer is very complex and is a feature of several syndromes. We present two most common ones.Ni abstrakta
Rezultati kirurškega zdravljenja resektabilnih jetrnih metastaz pri raku debelega črevesa in danke v UKC Maribor
Get PDFBackground: Only surgical treatment in patients with liver metastases (LM) in colorectal cancer (CC), which is nowadays often combined with other forms of treatment, offers the possibility of long-term survival or even hope of a cure. The aim of this study is to present the possibilities of multimodal treatment and to assess the results of such treatment of LM in CC in our patients.
Methods: In the period from 1 July 1997 to 31 December 2011, a total of 377 liver surgeries were performed in 281 patients with metastases of CC (107 men, 103 women; mean age 63.3 years; span of 27 to 85 years).
Results: Of 377 surgeries for LM of CC, liver resection was performed 324 times, and in 28 of those patients in combination with RFA. 235 (79.4%) were R0 resections, 54 (18.2%) were R1 and 7 (2.4% were R2 resections. A total of 53 procedures were RFA of LM. In 113 patients, LM were diagnosed synchronously with CC, and 168 men had metachronous LM. Unilobar metastases were found in 145 patients, and 136 had bilobar metastases. On average, there were 2.9 liver metastases with an average size of 4.3 cm. In 46 patients, the disease was present also outside the liver. Prior to liver surgery, 131 patients underwent neoadjuvant chemotherapy. In 16 cases, portal embolisation was performed to increase the residual liver volume, and ligature of the right branch of the vena porta was performed 10 times. Simultaneous liver resection was performed in 41 patients. At the first surgery, liver resection was performed in 252 patients. Liver resection alone was performed in 239 patients, whereas in 23 patients, it was combined with radiofrequency ablation of LM (RFA). Of 239 LM resections without additional RFA, 198 (83%) were R0 resections, 36 (15%) were R1 and 5 (2%) were R2 resections. In 29 patients, only RFA of LM was performed (open RFA 20 times, percutaneous RFA 9 times). Surgery for disease recurrences was performed on 73 patients, who underwent 96 procedures (1 to 6 per patient). Considering all surgeries (377), the total post-operative incidence was 25.5%, and 30-day morbidity was 1.9%. The expected 5-year survival in patients with R0 resection of LM and no disease outside the liver was 38.3% (median survival: 43 months
Conclusions: Liver resections are safe (morbidity: 25.5%; 30-day morbidity: 1.9% in R0 resections). Considering the expected long-term survival (5-year of 38.8%, median of 43 months), they currently represent the most effective method for the treatment patients with metastases of CC. The focus is on the importance of a multidisciplinary approach and multi modal treatment of patients with metastases of CC.Izhodišča: Pri bolnikih z jetrnimi metastazami (JM) pri kolorektalnem raku (KRR) le kirurško zdravljenje, sedaj pogosto kombinirano z drugimi načini zdravljenja, nudi možnost dolgotrajnejšega preživetja ali pa celo upanje na ozdravitev. Namen raziskave je prikaz možnosti multimodalnega načina zdravljenja in ocenitev rezultatov takšnega zdravljenja JM pri KRR pri naših bolnikih. Metode: V obdobju od 1. julija 1997 do 31. decembra 2011 je bilo opravljenih 377 jetrnih operacij pri 281 bolnikih z metastazami KRR (178 moški, 103 ženske; povprečna starost 63,3 leta; razpon 27 do 85 let). Rezultati: Od skupno 377 operacij zaradi JM KRR je bila 324-krat opravljena resekcija jeter, od tega pri 28 bolnikih kombinirana z RFA. 235 (79,4 %) je bilo R0 resekcij, 54 (18,2 %) je bilo R1 in 7 (2,4 %) R2 resekcij. Skupno 53 posegi so bile RFA JM. Pri 113 bolnikih so bile JM ugotovljene sinhrono ob ugotovitvi KRR, pri 168 pa je šlo za metahrone JM. 145 bolnikov je imelo unilobarne, 136 pa bilobarne metastaze. Povprečno je bilo 2,9 jetrnih metastaz, povprečna velikost metastaz pa je bila 4,3 cm. Pri 46 bolnikih je bilo obolenje prisotno tudi zunaj jeter. 131 bolnikov je pred jetrno operacijo prejemalo neoadjuvantno kemoterapijo. 16-krat je bila za povečanje preostanka jeter opravljena portalna embolizacija, 10-krat pa ligatura desne veje vene porte. Simultana resekcija jeter je bila narejena pri 41 bolnikih. Pri prvi operaciji je bila opravljena resekcija jeter pri 252 bolnikih. Pri 239 bolnikih je bila narejena samo resekcija jeter, pri 23 bolnikih pa je bila resekcija kombinirana še z radiofrekventno ablacijo JM (RFA). Od 239 resekcij JM brez dodatne RFA je bilo 198 (83 %) resekcij R0, 36 (15 %) R1, 5 (2 %) pa R2 resekcij. Pri 29 bolnikih je bila narejena samo RFA JM (20-krat odprta RFA, 9-krat perkutana RFA). Zaradi ponovitve obolenja smo operirali 73 bolnikov, pri katerih smo opravili 96 posegov (1 do 6 na bolnika). Upoštevajoč vse opravljene operacije (377) je bila skupna pooperacijska obolevnost 25,5 %, 30-dnevna umrljivost pa je bila 1,9 %. Pričakovano 5-letno preživetje pri bolnikih z R0 resekcijo JM in brez zunaj jetrnega obolenja je bilo 38,3 % (mediano preživetje: 43 mesecev). Zaključki: Resekcije jeter so varne (morbiditeta: 25,5 %; 30 mortaliteta: 1,9 pri R0 resekcijah), glede na pričakovano dolgoročno preživetje (5-letno 38,3 %, mediana 43 mesecev) pa trenutno predstavljajo najučinkovitejši način zdravljenja bolnikov z metastazami KRR. Poudarjen je pomen multidisciplinarnega pristopa in multimodalnega zdravljenja bolnikov z metastazami KRR ; slv - slovensk
Ponovne operacije jeter pri recidivu zasevkov raka debelega črevesa in danke: prikaz primera
Get PDFHalf of colorectal cancer patients may develop liver metastases. Multidisciplinary management is the basis for successful treatment, and liver resection represents the only potentially curative form of therapy. Despite a successful surgery, liver metastases may later recur. In such cases, it is wise to restart treatment with a combination of chemotherapy and target drugs, and to plan repeat liver resections. After the treatment, some patients can live for years without disease recurrence.Pri polovici bolnikov z rakom debelega črevesa in danke se lahko pojavijo zasevki v jetrih. Multidisciplinarna obravnava predstavlja temelj uspešnega zdravljenja, resekcija jeter pa je edina potencialno kurativna oblika terapije. Kljub uspešni operaciji pa se lahko jetrni zasevki kasneje ponovijo. Tudi v takšnem primeru je smiselno znova začeti zdravljenje, ki zajema kombinacijo kemoterapije, tarčnih zdravil in načrtovanja ponovnih jetrnih resekcij. Nekateri bolniki živijo brez ponovitve obolenja več let po začetku zdravljenja
Prizadetost pljuč in srca po obsevanju ter kemoterapiji Hodgkinove bolezni: prikaz primera
No full textAcute and chronic defects following childhood cancer treatment are rare with modern treatment techniques and usually without any clinical signs and symptoms. In a patient who was treated for childhood Hodgkin's lymphoma with irradiation to the neck, supraclavicular lymph nodes and mediastinum and chemotherapy, the consequences include a probable combination of adverse effects of this treatment on the lungs and heart. Considering the course and progression of lung impairment, vascular impairment - pulmonary vasculopathy was found to be at the forefront in our patient, which was confirmed by histological examination of the lung-tissue bioptat.
By describing this case, we wish to point to the chronic and progredient course of the disease which requires complex management by specialists and causes severe disability 22 years after treatment.Akutne in kronične okvare pljuč po zdravljenju raka v otroštvu so po sodobnem zdravljenju redke in običajno brez kliničnih znakov ter simptomov. Pri bolnici, ki je bila v otroštvu zdravljena zaradi Hodgkinovega limfoma z obsevanjem vratu, supraklavikularnih bezgavk in mediastinuma ter s kemoterapijo, so kvarne posledice verjetna kombinacija neugodnih učinkov tega zdravljenja na srce in pljuča. Pri naši bolnici je glede na potek in napredovanje pljučne prizadetosti v ospredju vaskularna prizadetost - pljučna vaskulopatija, ki je bila s histološkim pregledom bioptata pljučnega tkiva tudi potrjena. Pri opisu želimo opozoriti na kroničen ter progredienten potek bolezni, ki terja zahtevno obravnavo specialistov in 22 let po zdravljenju povzroča težko invalidnost
Stereotaktična radiokirurgija možganskih zasevkov malignega melanoma
Get PDFSince 2007, the Oncology Institute of Ljubljana carried out 97 SRS procedures, 9 of which were performed in patients with malignant melanoma brain metastases. Another patient was treated with hyperfractionated stereotactic radiotherapy (hfSRT), as the irradiated area was too large for irradiation with SRS and, based on the radiobiological characteristics of the tumour, we decided for targeted radiation therapy with a higher daily dose (6). Median survival was 30 weeks for all malignant melanoma patients, with the same survival time until local recurrence of the disease. Following SRS, there were less local recurrences among patients compared to progressions or recurrences of the disease outside the central nervous system (CNS). The irradiation dose delivered to patients treated with SRS was 22.5 Gy (20-25) in a single dose. The patient treated with hfSRT received 30 Gy in total, namely 5 doses of 6 Gy. Eight out of nine patients also received WBRT, and one was treated with WBRT after the first surgery for brain metastases and did not receive it after the SRS. The patient treated with hfSRT due to systemic therapy administered after radiation therapy (vemurafenib) did not receive WBRT and experienced disease progression in the CNS outside the irradiated three months later. The response was achieved in all patients (a stable disease in 4 patients, a partial response in 4 patients, a complete response in 1 patient), with patients with a stable disease experiencing disease progression outside the CNS a few weeks after the therapy. A complete response was achieved in one patient, but six months later, he also experienced disease progression in the CNS outside the SRS area.Ni abstrakta
Samomor kot pozna posledica zdravljenja raka v otroštvu: vsi trije primeri v Sloveniji
Get PDFPatients treated for childhood cancer are particularly vulnerable to suicide. There is increased suicidal ideation and a high incidence of suicide among them. In Slovenia, we have recorded no increase in the suicide rate in this group of patients. Out of 1,647 patients who were treated for cancer in childhood, only three died by suicide. The following article presents all three patients who committed suicide. With the help of the available data, we established the similarities and differences that contributed to the development of suicidal behaviour in each of these three patients. We can find that despite the differences in the course and treatment of the disease, all three patients had one thing in common: none of them received professional psychological help intended for patients after childhood cancer treatment. The development of a well-functioning professional network in this field would enable the inclusion of a larger number of patients, allowing them to speak out about their psychological problems. By doing so, we would contribute significantly to preventing suicide in this vulnerable group of patients.Pacienti po zdravljenju raka v otroštvu so glede samomorilnosti izrazito občutljiva skupina. Pri njih sta povišana tako razmišljanje o samomoru kot tudi dejanski samomor. V slovenskem prostoru sicer ne beležimo povišane stopnje samomora pri tej skupini pacientov. Od 1.647 pacientov, ki so bili v otroštvu zdravljeni za rakom, so zaradi samomora umrli trije. V pričujočem članku so predstavljeni vsi trije pacienti, ki so storili samomor. Iz podatkov, ki so nam na voljo, smo sklepali na sorodnosti in različnosti, ki so botrovale razvoju samomorilnosti pri vsakem od njih. Ugotovimo lahko, da je bilo kljub razlikam v poteku in zdravljenju bolezni skupno vsem trem pacientom to, da niso bili deležni polne strokovne psihološke pomoči, ki naj bi bila namenjena pacientom po zdravljenju raka v otroštvu. Razvoj dobre strokovne mreže na tem področju bi lahko omogočil vključitev večjega števila pacientov, da bi lahko spregovorili o svojih psihičnih težavah. S tem bi lahko pomembno prispevali k preprečevanju samomora pri tej ranljivi skupini pacientov
Vloga obsevanja pri zdravljenju raka danke
Get PDFTreatment of a locally-advanced rectal cancer is distinctively multidisciplinary and comprises both local (surgery and irradiation) and systemic treatment (chemotherapy). Compared to operative treatment alone, post-operative radio-chemotherapy statistically significantly improves local control and survival of patients. A German randomised study confirmed the advantage of pre-operative radio-chemotherapy compared to post-operative treatment in terms of minor acute and late toxicity, better local control and greater proportion of patients with preserved intestinal continuity. However, there are still many unresolved questions, such as the role of short-course pre-operative radiotherapy, the role of post-operative chemotherapy after neoadjuvant treatment, whether the type of surgery can be adjusted to the tumour's response to pre-operative treatment, and whether a more aggressive systemic treatment would improve the outcome of the disease so that we might be able to avoid radiotherapy.
The paper describes the role of radiotherapy in the combined treatment of rectal cancer.Zdravljenje lokalno napredovalega raka danke je izrazito multidisciplinarno in zajema tako lokalno (operacijo in obsevanje) kot tudi sistemsko zdravljenje (kemoterapijo). V primerjavi z operativnim zdravljenjem samim, pooperativna radiokemoterapija statistično značilno izboljša lokalno kontrolo in preživetje bolnikov. Nemška randomizirana raziskava je potrdila prednost predoperativne radiokemoterapije pred pooperativnim zdravljenjem v smislu manjše akutne in pozne toksičnosti, boljše lokalne kontrole ter večjega deleža bolnikov z ohranjeno kontinuiteto črevesa. Še vedno pa ostaja nepojasnjena vrsta vprašanj, med katerimi so vloga kratkega predoperativnega obsevanja, vloga pooperativne kemoterapije po neoadjuvantnem zdravljenju, ali lahko tip operacije prilagodimo odgovoru tumorja na predoperativno zdravljenje, ali bi agresivnejše sistemsko zdravljenje izboljšalo izid bolezni in bi se lahko celo izognili zdravljenju z obsevanju. V prispevku je opisana vloga radioterapije v kombiniranem zdravljenju raka danke
Teleradioterapija kostnih zasevkov
Get PDFThe bone is the third most common site of metastasis of solid tumours. As a result of metastases, complications on the skeleton reduce the quality of life of patients, their mobility and increase the cost of treatment.
Radiation therapy remains the most important palliative method for the treatment of painful bone metastases. The selection of both the modality and the irradiation regime is individualised, depending on the patient's clinical status, life expectancy and quality of life. This paper gives a review of palliative treatment of bone metastases using teleradiotherapy.Kosti so tretje najpogostejše mesto zasevanja solidnih tumorjev. Zapleti na skeletu kot posledica zasevkov zmanjšujejo kakovost bolnikovega življenja, njegovo mobilnost in povečajo stroške zdravljenja.
Radioterapija ostaja najpomembnejša paliativna metoda zdravljenja bolečih kostnih zasevkov. Izbor tako modalitete kot tudi režima obsevanja je individualiziran glede na bolnikovo klinično stanje, pričakovano življenjsko dobo in kakovost življenja. V prispevku je podan pregled paliativnega zdravljenja kostnih zasevkov s teleradioterapijo
Ovire in izzivi v kliničnem raziskovanju v onkologiji
Get PDFCancer burden is increasing in the world and also in our country. Research work in oncology is of prime importance for successful cancer control. Despite all the advances in research, further efforts will be required in the future to ensure successful cancer control. The key here is knowing the obstacles of research in oncology and how to overcome them.Breme raka pri nas in po svetu postopoma narašča. Za uspešno obvladovanje raka je ključnega pomena raziskovalno delo v onkologiji. Kljub vsem dosedanjim raziskovalnim dosežkom bodo v prihodnje potrebni nadaljnji napori za uspešno obvladovanje raka. Ključnega pomena pri tem je poznavanje ovir pri raziskovalnem delu v onkologiji in njihovo odpravljanje
Paliativna sedacija
Get PDFPalliative sedation is the controlled use of medications intended to induce and maintain the state of reduced consciousness. In this state, the patient does not suffer from symptoms that we can no longer control (refractory symptoms). The most frequent reasons for palliative sedation are uncontrollable terminal anxiety and difficulty breathing.
Midazolam is the medicine of choice for palliative sedation. The appropriate dose is determined by gradually increasing the initial dose until the desired effect – symptom control (titration) – is reached. The palliative sedation protocol sets out a clearly defined medical indication, the management and instructions for medical care as well as legal and ethical principles. Palliative sedation is not a synonym for euthanasia, nor does it shorten life.Paliativna sedacija je nadzorovana uporaba zdravil, ki povzročijo in ohranjajo stanje zmanjšane zavesti. V tem stanju bolnik ne trpi zaradi težav, ki jih ne moremo več obvladati (neobvladljiv simptom). Najpogostejša vzroka, da se odločimo za paliativno sedacijo, sta neobvladljiv terminalni nemir in težko dihanje.
Midazolam je zdravilo izbora za paliativno sedacijo. Ustrezno dozo določimo s postopnim višanjem doze zdravila do želenega učinka-obvladanje simptoma (titracija). Paliativna sedacija po protokolu predpisuje jasno opredeljeno medicinsko indikacijo, vodenje in napotke za zdravstveno nego ter pravna in etična načela. Paliativna sedacija ni sinonim za evtanazijo in ne skrajšuje življenja