Onkologija
Not a member yet
431 research outputs found
Sort by
Addisonska kriza pri bolnici z neprepoznavnim panhipopituitarizmom po obsevanju atipičnega meningeoma
Get PDFRadiotherapy is a proven and successful way of treating brain tumors. One should be aware, however, of its acute side effects as well as late consequences, often only apparent years after concluded treatment. The endocrine glands, primarily the hypothalamus and pituitary gland, are the most commonly affected organs. We present a clinical case to illustrate that, after irradiation of the head, patients should have periodic endocrinological testing and adequate hormonal substitution, when necessary.Obsevanje je utečen in uspešen način zdravljenja možganskih tumorjev, vendar moramo vedeti, da ima poleg akutnih neželenih učinkov lahko tudi pozne posledice, ki se pokažejo šele leta po končanem zdravljenju. Med največkrat na ta način okvarjenimi organi so endokrine žleze, predvsem hipotalamus in hipofiza. Na podlagi kliničnega primera želimo pokazati, da bolniki po obsevanju glave nujno potrebujejo tudi redno endokrinološko testiranje in po potrebi ustrezno hormonsko nadomestno zdravljenje
Presejanje na okužbo z virusom hepatitisa B in preprečevanje reaktivacije hepatitisa B: current clinical recommendations
No full textAs a supplement to the September 2010 issue, the Slovenian Medical Journal published Slovenian national guidelines for prevention of hepatitis B reactivation in the patients undergoing immunosuppressive treatment. These guidelines, based on the orientations provided by two international organizations for liver cancer prevention, the European EASL and the American AASLD, suggest screening for hepatitis B infection (HBV) in all patients to whom immunosuppressive treatment, including also systemic cancer treatment, is indicated. In cases where a latent infection is determined, application of antiviral therapy is suggested. In several individual studies as well as in a meta-analysis of 11 studies, antiviral therapy reduced the risk of hepatitis B reactivation and mortality due to it, while there is no proof of a significant impact on the overall survival. Within almost the same timeframe, several provisional clinical opinions on screening and prevention of reactivation of hepatitis B in cancer patients receiving cytostatic treatment were published by the American Society for Clinical Oncology (ASCO); they all promote the use of screening for HBV infection only in the group of cancer patients who show a high risk for chronic HBV infection and in all patients to whom highly immunosuppressive therapies, such as high-dose chemotherapy with bone marrow transplantation or treatment of lymphoma patients with rituximab, are indicated. ASCO does not suggest prophylactic treatment with lamivudin in all patients with latent infection, but promotes an individual approach to treatment based on cost-benefit analysis in each individual patient. These two publications and their not entirely unanimous guidelines are confronting the present Slovenian oncologists with the dilemma which of the current approaches to patient treatment is optimal in everyday clinical practice. To resolve these issues, a group of specialists in the field of medical oncology and infectology conducted a round table discussion in November 2010. The conclusions and proposals derived from this meeting are presented in this article. In order to obtain an even more clear statement on whether screening for HBV infection should be used in all cancer patients receiving systemic therapy as well as on the safety and efficiency of antivirus treatment in latent HBV carriers, additional data gathered in the frame of prospective clinical trials are needed. The decision was made to plan and conduct a prospective clinical trial in Slovenia, which will provide us with the data on the occurrence of chronic HBV carriers in the current population of patients with lymphoma and solid cancer patients as well as with the answers on the safety and efficiency of preemptive antivirus treatment or chemoprophylaxis in our patients. On the basis of the findings of this widely set out prospective trial and taking into account additional data obtained in the frame of international trials already under way, we will be able to define more precise and clear guidelines on screening and prevention of hepatitis B reactivation in Slovenian cancer patients receiving systemic therapySeptembra 2010 so bile v Zdravniškem vestniku objavljene slovenske nacionalne usmeritve za preprečevanje reaktivacije hepatitisa B pri bolnikih, ki potrebujejo imunosupresivno zdravljenje. Te smernice temeljijo na usmeritvi dveh mednarodnih združenj za preučevanje bolezni jeter, evropskega EASL in ameriškega AASLD in predlagajo presejanje na okužbo z virusom hepatitis B (HBV) pri vseh bolnikih, pri katerih je predvideno imunosupresivno zdravljenje, med katere spada tudi sistemsko zdravljenje raka. Če se pri teh bolnikih ugotovi latentna okužba, se priporoča uvedba protivirusne učinkovine. Protivirusno zdravljenje po podatkih posameznih raziskav in metaanalize 11 raziskav zmanjša tveganje za reaktivacijo hepatitisa B in umrljivost zaradi reaktivacije hepatitisa B, medtem ko značilnega vpliva na skupno umrljivost ni bilo zaznati. Skoraj istočasno je ameriško združenje za klinično onkologijo ASCO objavilo začasna klinična priporočila za presejanje in preprečevanje reaktivacije hepatitisa B pri rakavih bolnikih na citostatskem zdravljenju. V njih je priporočeno presejanje na okužbo s HBV samo pri rakavih bolnikih z velikim tveganjem za kronično okužbo s HBV ter pri vseh bolnikih, pri katerih je predvideno zdravljenje z močno imunosupresivnim sistemskim zdravljenjem, kot je visokodozna kemoterapija s presaditvijo matičnih krvotvornih celic ali zdravljenje limfomskih bolnikov z rituksimabom. Profilaktičnega zdravljenja z lamivudinom ta skupina ne priporoča pri vseh bolnikih z latentno okužbo, ampak svetuje individualni razmislek o zdravljenju, ki naj temelji na tehtanju koristi in slabosti zdravljenja z lamivudinom pri vsakem posameznem bolniku. Ti dve objavi in njuna ne povsem enoznačna priporočila postavljajo pred slovenske onkologe vprašanje o najprimernejši oskrbi bolnikov v trenutni vsakodnevni klinični praksi. Zato smo v okviru ozke skupine strokovnjakov internistične onkologije in infektologije novembra 2010 pripravili okroglo mizo, katere sklepe objavljamo v tem prispevku. Za jasne sklepe o tem, ali je smiselno presejanje na okužbo s HBV pri vseh rakavih bolnikih na sistemskem zdravljenju, ter o varnosti in učinkovitosti protivirusnega zdravljenja pri kroničnih nosilcih HBV potrebujemo dodatne podatke, pridobljene v okviru prospektivnih kliničnih raziskav. Tudi v Sloveniji bomo izvedli prospektivno klinično raziskavo, ki nam bo odgovorila na vprašanje o pojavnosti kroničnih nosilcev HBV med našimi bolniki z limfomi in solidnimi raki ter nam dala podatke o učinkovitosti in varnosti protivirusnega predčasnega zdravljenja oz. kemoprofilakse pri naših bolnikih. Samo na lastnih izsledkih, pridobljenih v okviru načrtovane prospektivne študije, in ob upoštevanju izsledkov dodatnih, že potekajočih mednarodnih kliničnih raziskav bo mogoče oblikovati jasna in dokončna priporočila o presejanju in preprečevanju reaktivacije hepatitisa B pri slovenskih bolnikih z rakom, ki se sistemsko zdravijo
Ultrazvočno vodena aspiracijska biopsija s tanko iglo v diagnostiki ledvičnih tumorjev
Get PDFIn Slovenia the ultrasound-guided fine needle aspiration biopsy is a standard diagnostic procedure for assessment of renal tumors with non-characteristic radiologic features. Over the past year the interest in this method has been increasing across Europe, especially for the evaluation of small renal masses, defined as smaller than or equal to 3 cm. Our analysis confirmed that the method is reliable for the assessment of small renal masses, provided that cellular material is sufficient and representative for the lesion. Adjunct methods like immunocytochemical stainings can improve typing of renal cell carcinomas: clear cell, papillary and chromophobe type.Ultrazvočno vodena aspiracijska biopsija je v Sloveniji že dolga leta standardna metoda za morfološko diagnostiko radiološko težavnih ledvičnih tumorjev. V zadnjih letih se zanimanje za to diagnostično metodo povečuje tudi v Evropi, predvsem za dodatno diagnostiko majhnih tumorjev, ki merijo največ 3 cm. V naši analizi smo potrdili, da je metoda uporabna za diagnostiko majhnih tumorjev, če so vzorci dovolj celularni in reprezentativni za lezijo. V citopatološki diagnostiki so nam v pomoč tudi imunocitokemična barvanja, s katerimi lahko natančneje opredelimo tip ledvičnega karcinoma: svetlocelični, papilarni in kromofobni karcinom ledvičnih celic
Nevroendokrini tumorji prebavil
Get PDFNeuroendocrine tumors (NET) belong to the group of rare tumors, though their incidence is increasing. Diagnosis and treatment vary among groups of different primary origins. NETs of gastrointestinal origin (GEP-NET) are slow growing tumors; however, most patients with GEP-NET are not diagnosed until the metastatic spread of the disease has already occurred. Somatostatin analogues are the mainstream treatments of symptom and tumor growth control in these patients. Other systemic therapies depend on the biologic potential of the tumor. S100B – Tumor marker in cutaneous melanoma Barbara Perić, Ivana Žagar, Srdjan Novaković, Janez Žgajnar and Marko Hočevar Introduction. An increased level of serum S100B can serve as a marker of metastatic spread in patients with cutaneous melanoma (CM). In patients with elevated S100 B and/or clinical signs of disease progression, a PET-CT scan is a valuable tool for discovering metastases and planning treatment. The aims of this study were to determine whether regular measurements of serum S100B are a useful tool for identifying patients with CM metastases and for evaluating the diagnostic value of PET-CT during the follow-up. Methods. From September 2007 to February 2010, 115 CM patients included in regular follow up at the Institute of Oncology Ljubljana were appointed to receive PET-CT scans. They included 82 (71.3%) patients with clinical signs of disease progression and 33 (28.7%) asymptomatic patients with two subsequent elevated values of S100B. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) of S100B and PET-CT were calculated using standard procedures. Results. Disease progression was confirmed in 81.7% of the patients (in 86.5% of patients with clinical signs of disease progression and in 69.7% of asymptomatic patients with elevated S100B). Sensitivity, specificity, PPV and NPV of S100B was 33.8%, 90.9%, 96.0% and 17.5%, respectively, in patients with clinical signs of disease progression. For 20.0% of the patients increased serum S100B was the only sign of disease progression. Sensitivity and PPV of S100 in this group of patients were 100.0% and 69.7%, respectively. PET-CT disease progression was diagnosed in 84.2% of symptomatic patients and in 72.7% of asymptomatic patients with elevated S100B. The sensitivity, specificity, PPV and NPV of PET-CT for symptomatic patients was 98.5%, 90.9%, 98.5% and 90.9%, respectively, and 100%, 90.0%, 95.8% and 100%, respectively, for asymptomatic patients with elevated S100. Conclusions. Measurements of serum S100B during regular follow-up of patients with CM are a useful tool for discovering disease progression in asymptomatic patients. The value of its use increases if measurements are followed by extended whole body PET-CT.Nevroendokrini tumorji (NET) so redki tumorji, vendar njihova incidenca narašča. Obravnava in zdravljenje se razlikujeta glede na lokalizacijo primarnega tumorja. NET prebavil (GEP NET) so praviloma počasi rastoči, vendar jih večinoma odkrijemo šele v napredovalih fazah. V njihovem sistemskem zdravljenju uporabljamo predvsem analoge somatostatina, glede ostalega sistemskega zdravljenja pa se odločamo na podlagi biološkega potenciala tumorja, klinične slike in razsežnosti bolezni
Natančno obsevanje lokalno napredovanega visokorizičnega raka prostate
Get PDFIn radiotherapy of prostate cancer, it is very important to conform the irradiation fields as much as possible to target volume, i.e. to position the patient as accurately as possible, thereby allowing smaller safety margin. In this way, an optimal shielding for the organs at risk may be provided at a prescribed dose to the target volume.
Image-guided radiotherapy (IGRT) allows the reduction of the safety margin that accounts for the daily prostate movements. After the translation of prostate is subtracted, only the prostate rotation is to be considered. With the analysis of daily prostate rotation between the fractions of the first part of radiotherapy course, the safety margin can be optimized. Optimal size of the safety margin around the prostate may be used for the second and third part of the radiotherapy course and the radiotherapy plan may be adaped accordingly.Pri radioterapiji raka prostate je zelo pomembno oblikovati obsevalna polja tako, da se čim natančneje prilegajo volumnu, ki ga je treba obsevati. To pomeni, da moramo bolnika pri obsevanju čim natančneje nastaviti, saj s tem zmanjšamo potreben varnostni rob. Ob predpisani dozi na tarčni volumen bomo tako optimalno zaščitili kritične organe. Slikovno vodena radioterapija (IGRT) nam omogoča zmanjšanje varnostnega roba, ki zajema dnevna premikanja prostate. Ko z natančno nastavitvijo v marker upoštevamo translacijo prostate, moramo zajeti le še rotacijo prostate.
Z analizo dnevnih rotacij prostate med frakcijami prvega dela radioterapije lahko varnostni rob okoli prostate optimiziramo. Njegovo optimalno velikost lahko uporabimo za drugi in tretji del radioterapije in prilagodimo obsevalni načrt (adaptivna radioterapija)
Smernice za celostno obravnavo žensk s predrakavimi spremembami materničnega vratu
Get PDFNo abstract.Ni abstrakta