Onkologija
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Razvoj novih sistemskih zdravljenj pri bolnikih z razsejanim rakom prostate
Get PDFHormonal therapy with castration is initially effective in the majority of men with metastatic prostate cancer, but the disease invariably progresses. Docetaxel in combination with prednisone is the standard first-line treatment in men with metatstatic castration-resistant prostate cancer (mCRPC). Although several experimental agents have been evaluated in combination with docetaxel to date, none of these combinations improved the efficacy of docetaxel. Cabazitaxel and abirateron acetate are new options for systemic treatment in men with mCRPC who have progressive disease after treatment with docetaxel.Hormonsko zdravljenje s kastracijo je v začetku navadno učinkovito pri večini bolnikov z razsejanim rakom prostate, vendar bolezen čez čas neizbežno napreduje. Docetaksel v kombinaciji s prednizonom predstavlja standardno zdravljenje v prvi liniji zdravljenja bolnikov z razsejanim, proti kastraciji odpornim rakom prostate (rKORP). Do danes je bilo v kliničnih raziskavah preizkušenih več učinkovin v kombinaciji z docetakselom, vendar se nobena kombinacija ni izkazala za učinkovitejšo od docetaksela samega. Za bolnike z rKORP, pri katerih bolezen napreduje po zdravljenju z docetakselom, predstavljata kabazitaksel in abirateron acetat novi možnosti sistemskega zdravljenja
Neželeni učinki radioterapije na možgane
Get PDFThere are numerous and often unpredictable side effects of radiotherapy on the brain. The damage can be direct or indirect, and becomes apparent acutely or even many years thereafter. The distinction between these forms is important since early side effects are predominantly reversible whereas late ones usually are not. The incidence of radiotherapy-induced side effects is hard to estimate due to the differing definitions and methodologies used in clinical studies. Nevertheless, the clinical picture often resembles the progression of pre-existent malignant disease. The mechanism underlying side effects of radiotherapy is mainly injury to glial cells and cerebral endothelial cells. The hippocampus is especially prone to radiation damage. The burden of radiation damage in a given individual is dependent upon many factors. Concomitant systemic and intrathecal chemotherapy adds significantly to neurotoxicity. Diagnosing side effects of radiotherapy can be a daunting task since the time interval between radiotherapy and the occurrence of neurological side effects is variable. What is more, the clinical picture can resemble metastatic, paraneoplastic or other neurological disease. It is therefore of crucial importance to be aware of the fact that the clinical picture can be ascribed to side effects of radiotherapy only after other possible reasons (mainly tumor progression) have been effectively ruled out. The article entails a broad spectrum of direct and indirect radiotherapyinduced consequences on the brain. Acute encephalopathy is connected to blood-brain barrier disruption. Early-delayed encephalopathy is caused by demyelination. Late-delayed encephalopathy is represented mainly by radiation necrosis. Cognitive decline as a consequence of radiotherapy is still a matter of hot debate.Neželeni učinki radioterapije na možgane so številni in pogosto nepredvidljivi. Lahko gre za neposredno ali posredno okvaro možganov. Okvara se lahko pojavi akutno ali več tednov, mesecev ali celo let po končani radioterapiji. Ločevanje med temi oblikami je pomembno, saj so zgodnji zapleti navadno reverzibilni, pozni pa se večinoma ne popravijo. Incidenco neželenih učinkov radioterapije na možgane je težko oceniti. Razlogi za to so v različnih opredelitvah in metodoloških razlikah v raziskavah ter v klinični sliki, ki se pogosto prekriva z napredovanjem osnovne maligne bolezni. Med mehanizmi radiacijske okvare možganov je v ospredju okvara celic glije in možganskih endotelijskih celic. Za radiacijsko okvaro je zlasti občutljiv hipokampus. Obseg okvare možganov je odvisen od številnih dejavnikov. Dodatna sistemska ali intratekalna kemoterapija pomembno poveča nevrotoksičnost. Diagnosticiranje neželenih učinkov radioterapije na možgane je težavno, saj je časovni interval med radioterapijo in pojavom nevroloških simptomov precej variabilen, klinična slika pa lahko posnema metastatsko, paraneoplastično ali drugo nevrološko bolezen. Zavedati se je treba, da klinično sliko lahko pripišemo neželenim učinkom radioterapije na možgane šele po izključitvi drugih vzrokov. V članku opisujeva različne klinične oblike neposredne in posredne radiacijske okvare možganov. Pri akutni encefalopatiji ima pomembno vlogo okvara krvno-možganske pregrade. Pri zgodnji odloženi encefalopatiji je pomembna demielinizacija, pri pozni odloženi encefalopatiji pa radiacijska nekroza. O kognitivnem upadu kot posledici radioterapije so mnenja še vedno deljena
Razporeditev genotipov človeških virusov papiloma pri bolnicah z rakom materničnega vratu in cervikalno intraepitelijsko neoplazijo tretje stopnje (CIN 3) v Sloveniji
Get PDFCervical cancer (CC) evolves through several stages of precancerous lesions and can therefore be prevented by means of a screening program; if detected at an early stage it can also be efficiently treated. Sexually transmitted infection with oncogenic human papillomavirus (HPV) genotypes has been confirmed to be a single necessary etiological factor for the development of cervical precancerous lesions and CC. In order to assess the potential local benefit of prophylactic HPV vaccination, we established the distribution of HPV genotypes in a representative sample of women with CC and high grade cervical intraepithelial lesions (CIN 3) in Slovenia. HPV DNA was found in 262/278 CC samples (94.2%). HPV 16, HPV 18 and HPV 33 were the HPV genotypes most frequently found in CC samples in Slovenia. HPV DNA was found in 253/261 samples of CIN 3 (96.9%). In 80.6% of the samples infection with a single HPV genotype was found, whereas in other samples more than one HPV genotype was found (2 to 9 HPV genotypes). Prophylactic HPV vaccination with currently available vaccines could theoretically prevent up to 77% of cases of CC and up to 60% of cases of CIN 3 caused by HPV 16 and HPV 18 in Slovenia.Rak materničnega vratu (RMV) se razvije prek več stopenj predrakavih sprememb in ga je z učinkovitim presejalnim programom mogoče preprečiti oz. odkriti in v zgodnjem stadiju uspešno zdraviti. Spolno prenosljiva okužba z visokotveganimi genotipi človeških virusov papiloma (angl. human papillomavirus, HPV) je nujni dejavnik tveganja za nastanek predrakavih sprememb na materničnem vratu in RMV. Pred uvedbo cepljenja proti HPV smo želeli opredeliti razporeditev genotipov HPV pri bolnicah z RMV in bolnicah s predrakavimi spremembami najvišje stopnje (CIN 3) v Sloveniji. Razporeditev genotipov HPV smo analizirali na 284 vzorcih RMV. HPV dezoksiribonukleinsko kislino (DNK) smo dokazali v 262 od 278 vzorcev RMV (94,2 %). Ugotovili smo, da RMV najpogosteje povzročajo HPV 16, HPV 18 in HPV 33. Razporeditev genotipov HPV smo določili tudi na 261 vzorcih brisov materničnega vratu, odvzetih ženskam s CIN 3. V 253 od 261 vzorcev CIN 3 (96,9 %) smo dokazali prisotnost HPV DNK. V 80,6 % vzorcev smo našli le en visokotvegani genotip, v drugih vzorcih smo našli po več genotipov HPV (2 do 9 genotipov). Pri ženskah s CIN 3 so bili najpogosteje zastopani HPV 16, HPV 31 in HPV 33. Profilaktično cepljenje s trenutno dostopnimi cepivi proti HPV bi lahko preprečilo do 77 % primerov RMV in do 60 % primerov CIN 3 v Sloveniji, ki ju povzročata HPV 16 in HPV 18
Prizadetost srca po obsevanju in kemoterapiji Hodgkinove bolezni: opis primera
Get PDFCardiac damage can develop many years after treatment of Hodgkin’s disease with irradiation and chemotherapy. In the presented case, we found cardiac damage 25 years after treatment. In the last decade, it has been severily escalating. The patient was diagnosed with the diastolic dysfunction of the left ventricle, fibrosis of the aortic and mitral valves and thickening of the pericardium. In childhood cancer survivors, lifelong follow-up is necessary. The majority of cardiac late effects can be discovered with non invasive ultrasound examination.Po zdravljenju Hodgkinove bolezni z obsevanjem in kemoterapijo v otroštvu se lahko šele čez leta pojavijo posledice na srcu. Pri predstavljenem bolniku smo 25 let po zdravljenju ugotovili spremembe na srcu, ki so se med desetletnim opazovanjem stopnjevale. Ugotovili smo prizadetost diastolične funkcije levega srčnega prekata, fibrozo na aortni in mitralni zaklopki ter zadebelitev osrčnika. Pri mladostnikih, ki so se v otroštvu zdravili zaradi raka, je potrebno sledenje poznih posledic do konca življenja. Večino neugodnih posledic na srcu lahko odkrijemo z neinvazivno ehokardiografsko preiskavo
Vnetni rak dojk: priporočila za diagnostično obdelavo in zdravljenje
Get PDFInflammatory breast cancer (IBC) represents 1-5% of all breast cancer. Early and accurate diagnosis of this aggressive disease is of critical importance for the outcome. Diagnosis is made based upon its typical clinical appearance (breast erithema, edema and/or peau d’orange) and histopathological confirmation of invasive cancer. A multimodality approach is recommended for treatment. The initial treatment recommended in a localised disease is primary systemic chemotherapy with anthracyclines and taxanes for a duration of 4-6 months. The surgical treatment of choice is a modified radical mastectomy, followed by adjuvant radiation of the mammary region and ipsilateral supraclavicular region. According to predictive factors, adjuvant hormonal and/or trastuzumab therapy is indicated; the latter could be used in combination with taxanes even in the neoadjuvant setting. Despite the multimodality approach, the outcome of IBC is not optimal (median overall survival in localised disease patients is less than four years). Patients with IBC should be treated in experienced oncological centres with the possibility of cooperation in international randomised clinical studies.Vnetni rak dojke predstavlja 1 do 5 % raka dojke. Zaradi agresivne narave bolezni sta bistvenega pomena zgodnja diagnoza in začetek zdravljenja. Diagnoza se postavi na podlagi značilnega kliničnega videza (rdečina, edem in/ ali »pomarančna« koža dojke) in histopatološke potrditve diagnoze raka dojke. Zdravljenje je multimodalno. Začetno zdravljenje pri lokalizirani bolezni je sistemska neoadjuvantna kemoterapija z antraciklini in taksani, ki traja 4 do 6 mesecev, sledita modificirana radikalna mastektomija ter dopolnilno obsevanje mamarnega predela in ipsilateralne supraklavikularne lože. Glede na prediktivne dejavnike je indicirano še morebitno zdravljenje z dopolnilnim hormonskim ali biološkim zdravljenjem s trastuzumabom, ki se v kombinaciji s taksani lahko uporablja tudi že v neoadjuvantnem zdravljenju. Kljub multimodalnemu zdravljenju je izid vnetnega raka dojke še vedno slab (srednje preživetje manj kot 4 leta), zato priporočamo zdravljenje v specializiranem onkološkem centru, ki ima izkušnje s tem in kjer je možnost vključevanja v prospektivne mednarodne klinične raziskave
Intratekalna aplikacija trastuzumaba in rituksimaba
Get PDFNeoplastic meningitis is a serious complication of malignant disease. In spite of low incidence, its frequency is increasing. This is believed to be due to better cancer patient survival and improved diagnostic procedures. Treatment of neoplastic meningitis usually consists of systemic and intrathecal therapy along with radiotherapy of central nervous system. Trastuzumab and rituximab are monoclonal antibodies that significantly improved the outcome of breast cancer and nonHodgkin lymphoma patients. While the two monoclonal antibodies are effective agents for their respective disease states, their efficacy is poor in the treatment of neoplastic meningitis as they are unable to cross the blood-brain barrier. This is a review of evidence for the potential use of intrathecal trastuzumab and rituximab.Neoplastični meningitis je resen zaplet maligne bolezni. Kljub majhni incidenci njegova pogostost narašča, domnevno zaradi daljšega preživetja bolnikov in izboljšane diagnostike. Neoplastični meningitis se zdravi s sistemsko in intratekalno kemoterapijo ter z obsevanjem osrednjega živčevja. Trastuzumab in rituksimab sta monoklonski protitelesi, ki sta ob intravenskih aplikacijah pomembno izboljšali preživetje bolnikov z rakom dojk in Nehodgkinovim limfomom. Manj sta učinkoviti pri zdravljenju neoplastičnega meningitisa, saj zaradi velikosti ne prehajata krvno-možganske pregrade. Novejše raziskave preučujejo tudi možnost intratekalne aplikacije monoklonskih protiteles
SLORA: spletna stran z epidemiološkimi podatki o raku
Get PDFCancer registration in Slovenia has a long tradition. The Cancer Registry of the Republic of Slovenia was founded at the Institute of Oncology Ljubljana in 1950; it is one of the oldest population-based cancer registries in Europe. Cancer incidence, prevalence and survival data are collected and published for more than 60 years and traditionally distributed to users in the form of printed annual reports and technical papers. Last year, a novelty was introduced in the field of data dissemination and presentation: an interactive website called SLORA was activated on the web address www.slora.si. The principle objective of the SLORA interactive web portal is to provide public health and clinical professionals, health care organizations, civil society associations, the media and general public with a simple but complete up-to-date overview of cancer burden in Slovenia, EU and worldwide. In addition, it is aimed to offer some additional content and credible information on the risk factors and possible ways to prevent cancer. This information is important for planning and evaluation of the effectiveness of oncological primary and secondary prevention, diagnosis, treatment, rehabilitation and palliative care, as well as for planning the resources (personnel, medical equipment, bed capacity …), and for clinical and epidemiological research.Ni abstrakta
