Prva iskustva s trodimenzijskom konformalnom radioterapijom u liječenju raka prostate u Klinici za tumore u Zagrebu

Three-dimensional (3D) conformal radiation therapy is a standard of care in prostate cancer patients. It is delivered in either adjuvant or salvage setting, and only occasionally as palliative treatment. The University Hospital for Tumors in Zagreb, Croatia introduced the technique in November 2005. During the introductory period of six months, 3D-conformal radiotherapy was given to 86 prostate cancer patients, the majority of them with primary prostate cancer (60.47%). Only 4 patients received palliative treatment, and the remaining 30 were administered post-surgical (adjuvant or salvage) radiotherapy. The paper presents characteristics of patients and their treatment. The median duration of irradiation planning was 17.5, 15 and 13 days for primary, adjuvant and salvage radiotherapy, respectively. A radiation dose exceeding 70 Gy was delivered to 48 (92.31%) of primary irradiated patients with the median dose of 76 Gy. The median dose in both adjuvant and salvage irradiated patients was 10 Gy lower. The standard box technique was applied in 98.91% of patients. Treatment took longer than anticipated for the median of 10 days at primary and adjuvant radiotherapy, and for 15 days at salvage radiotherapy. Acute urinary and rectal side effects of radiation were reported in 22.54% and 23.94% of patients, respectively. The first experiences show the feasibility of 3D-conformal radiation therapy for prostate cancer patients at the University Hospital for Tumors. The complexity of the procedure, non-existence of a unique algorithm, and also heavy linac workload are the reasons for the relatively long irradiation planning. Longer treatment is less a result of side effects than of occasional problems with linear accelerators. The low rate of early side effects primarily results from a retrospective study and incomplete records of radiotherapy side effects.Trodimenzijska konformalna radioterapija predstavlja standard u primarnom liječenju bolesnika s rakom prostate. Primjenjuje se i pri adjuvantnoj i tzv. radioterapiji \u27spasa\u27 (engl. salvage), a u palijativnom zračenju tek sporadično. U Klinici za tumore u Zagrebu ova je tehnika uvedena u studenom 2005. godine. Tijekom prvog šestomjesečnog razdoblja trodimenzijska konformalna radioterapija započela je u 86 bolesnika s rakom prostate. Većinom se radilo o primarnom liječenju raka prostate (60,47%). Tek je u 4 bolesnika provedeno palijativno liječenje, dok je u ostalih 30 bolesnika provedena poslijeoperacijska radioterapija (adjuvantna ili terapija \u27spasa\u27). Prikazane su osobine bolesnika i provedenog liječenja. Medijan trajanja pripreme zračenja iznosio je 17,5 dana pri primarnoj, 15 dana pri adjuvantnoj te 13 dana pri radioterapiji \u27spasa\u27. Dozu zračenja veću od 70 Gy primilo je 48 (92,31%) primarno zračenih bolesnika uz medijan doze od 76 Gy. Medijan doze adjuvantno zračenih bolesnika i onih koji su primali radioterapiju \u27spasa\u27 bio je za 10 Gy niži. Standardna \u27box\u27 tehnika zračenja primijenjena je u 98,91% bolesnika. Liječenje je trajalo duže od predvi|enog za medijan 10 dana pri primarnoj i adjuvantnoj te 15 dana pri radioterapiji \u27spasa\u27. Akutne urinarne nuspojave zračenja zabilježene su u 22,54%, a od strane rektuma u 23,94% bolesnika. Prva iskustva upućuju na provedivost trodimenzijske konformalne radioterapije u bolesnika s rakom prostate u Klinici za tumore. Složenost postupka, nepostojanje jedinstvenog algoritma, no i opterećenost ure|aja za zračenje razlozi su relativno dugog trajanja pripreme za zračenje. Duže trajanje liječenja od predvi|enog manje je posljedica nuspojavanego povremenih kvarova linearnih akceleratora. Zabilježena mala pojavnost ranih nuspojava temeljno je posljedica retrospektivne studije i nepotpunog bilježenja nuspojava u kartone zračenja

Prva iskustva s trodimenzijskom konformalnom radioterapijom u liječenju raka prostate u Klinici za tumore u Zagrebu

Three-dimensional (3D) conformal radiation therapy is a standard of care in prostate cancer patients. It is delivered in either adjuvant or salvage setting, and only occasionally as palliative treatment. The University Hospital for Tumors in Zagreb, Croatia introduced the technique in November 2005. During the introductory period of six months, 3D-conformal radiotherapy was given to 86 prostate cancer patients, the majority of them with primary prostate cancer (60.47%). Only 4 patients received palliative treatment, and the remaining 30 were administered post-surgical (adjuvant or salvage) radiotherapy. The paper presents characteristics of patients and their treatment. The median duration of irradiation planning was 17.5, 15 and 13 days for primary, adjuvant and salvage radiotherapy, respectively. A radiation dose exceeding 70 Gy was delivered to 48 (92.31%) of primary irradiated patients with the median dose of 76 Gy. The median dose in both adjuvant and salvage irradiated patients was 10 Gy lower. The standard box technique was applied in 98.91% of patients. Treatment took longer than anticipated for the median of 10 days at primary and adjuvant radiotherapy, and for 15 days at salvage radiotherapy. Acute urinary and rectal side effects of radiation were reported in 22.54% and 23.94% of patients, respectively. The first experiences show the feasibility of 3D-conformal radiation therapy for prostate cancer patients at the University Hospital for Tumors. The complexity of the procedure, non-existence of a unique algorithm, and also heavy linac workload are the reasons for the relatively long irradiation planning. Longer treatment is less a result of side effects than of occasional problems with linear accelerators. The low rate of early side effects primarily results from a retrospective study and incomplete records of radiotherapy side effects.Trodimenzijska konformalna radioterapija predstavlja standard u primarnom liječenju bolesnika s rakom prostate. Primjenjuje se i pri adjuvantnoj i tzv. radioterapiji \u27spasa\u27 (engl. salvage), a u palijativnom zračenju tek sporadično. U Klinici za tumore u Zagrebu ova je tehnika uvedena u studenom 2005. godine. Tijekom prvog šestomjesečnog razdoblja trodimenzijska konformalna radioterapija započela je u 86 bolesnika s rakom prostate. Većinom se radilo o primarnom liječenju raka prostate (60,47%). Tek je u 4 bolesnika provedeno palijativno liječenje, dok je u ostalih 30 bolesnika provedena poslijeoperacijska radioterapija (adjuvantna ili terapija \u27spasa\u27). Prikazane su osobine bolesnika i provedenog liječenja. Medijan trajanja pripreme zračenja iznosio je 17,5 dana pri primarnoj, 15 dana pri adjuvantnoj te 13 dana pri radioterapiji \u27spasa\u27. Dozu zračenja veću od 70 Gy primilo je 48 (92,31%) primarno zračenih bolesnika uz medijan doze od 76 Gy. Medijan doze adjuvantno zračenih bolesnika i onih koji su primali radioterapiju \u27spasa\u27 bio je za 10 Gy niži. Standardna \u27box\u27 tehnika zračenja primijenjena je u 98,91% bolesnika. Liječenje je trajalo duže od predvi|enog za medijan 10 dana pri primarnoj i adjuvantnoj te 15 dana pri radioterapiji \u27spasa\u27. Akutne urinarne nuspojave zračenja zabilježene su u 22,54%, a od strane rektuma u 23,94% bolesnika. Prva iskustva upućuju na provedivost trodimenzijske konformalne radioterapije u bolesnika s rakom prostate u Klinici za tumore. Složenost postupka, nepostojanje jedinstvenog algoritma, no i opterećenost ure|aja za zračenje razlozi su relativno dugog trajanja pripreme za zračenje. Duže trajanje liječenja od predvi|enog manje je posljedica nuspojavanego povremenih kvarova linearnih akceleratora. Zabilježena mala pojavnost ranih nuspojava temeljno je posljedica retrospektivne studije i nepotpunog bilježenja nuspojava u kartone zračenja

Contemporary Procedures in the Prevention, Early Diagnosis and Treatment of Prostatic Cancer

Rak prostate je iz puno razloga u samome vrhu interesa svjetske onkologije, a osobito zbog činjenice da se u novije vrijeme opaža ubrzan porast njegove pojavnosti te stope smrtnosti. Porast broja novooboljelih objašnjava se djelomice provođenjem programa ranog otkrivanja i produljenja prosječnog vijeka muškaraca, dok porast stopa smrtnosti upućuje na djelovanje i nekih drugih čimbenika. Danas je rak prostate najvarijabilniji zloćudni tumor koji ima velik raspon stupnjeva zloćudnosti, često nepredvidljivo i ćudljivo ponašanje te odgovor na liječenje. Danas je u svijetu rak prostate četvrti zloćudni tumor po učestalosti u muškaraca, iza raka pluća, želuca i debeloga crijeva, dok se u razvijenim zemljama nalazi na drugome mjestu. U SAD-u i Kanadi, ako ne računamo rak kože, vodeće je sijelo raka. Najvažniji rizični čimbenici za pojavu raka prostate jesu dob, rasa i obiteljska predispozicija, dok puno manji utjecaj imaju drugi čimbenici, primjerice profesionalna ekspozicija, alkohol, pušenje, vazektomija, zračenje, spolno ponašanje i prehrana. Upravo zbog još uvijek sa sigurnošću neutvrđenih čimbenika rizika, mogućnosti primarne prevencije vrlo su male. Unatoč kontroverznim stavovima glede učinka sekundarne prevencije, čini se kako rano otkrivanje raka ima svoje opravdanje i to ponajprije u muškaraca s obiteljskom anamnezom i kroničnom upalom prostate. U novije vrijeme postignut je napredak u dijagnostici i terapiji svih stadija bolesti. Ovo se posebno odnosi na veće mogućnosti radikalne radioterapije uvođenjem novih tehnika radioterapije (konformalna i IMRT), laparoskopske prostatektomije te novijih citostatika i hormonskih lijekova.Prostatic cancer is for many reasons a current topic in the fi eld of oncology, especially because of its rapidly increasing incidence and mortality rates. A higher incidence could be partly attributed to early detection and longer life expectancy, while mortality rate is additionally affected by some other factors. Today, prostatic cancer is the most variable malignant disease with a huge range of malignancy stages and characterised by frequent episodes of unpredictable and moody behaviour and response to treatment. Prostatic cancer is today the fourth most frequent malignant tumour in males worldwide, coming after lung, stomach and colon cancer, and the second most frequent in developed countries. In the USA and Canada, it is the second most common cancer after skin cancer. The most important risk factors for prostatic cancer are age, race and family predisposition, while the impact of other factors, such as occupational exposure, alcohol, smoking, vasectomy, radiation, sexual behaviour and diet is much lower. As these risk factors have not been determined with certainty, the possibility of early prevention is rather poor. In spite of controversial opinions on the secondary prevention effects, it seems that early detection of prostatic cancer in men with a family history and chronic prostatitis is justifi ed. Recently, progress has been made in diagnostics and treatment of all stages of the disease, primarily due to advancement in radical radiotherapy and use of the state-of-the-art technologies (conformal and IMRT), laparoscopic prostatectomy, and new cytostatics and hormones

Radioterapija nemalignih bolesti - "Scleredema adultorum Buschke" – prikaz slučaja

Scleredema adultorum Buschke is a very rare disease characterized by thickening of the dermis of the neck, head, and the upper trunk. The etiology of the disease is still unknown, and it predominantly occurs in young females. The disease is usually self-limiting with no optimal therapy modality for the severe forms of the disease having been yet defined. A 62-year-old patient presented at our Hospital in 2006 with the already established diagnosis and clinical picture typical for scleredema adultorum. After several unsuccessful dermatology treatments, the patient underwent radiation therapy receiving a total irradiation dose of 20 Gy delivered in 10 daily fractions (2 Gy a day). During radiotherapy, and immediately after the therapy, no clinical improvement, or skin induration improvement was observed. A couple of months later the skin infiltration was partially reduced. However, complete regression did not occur, and this finding remained unchanged to date.Scleredema adultorum Buschke izrazito je rijetka bolest obilježena zadebljanjem dermisa u području glave, vrata i gornjeg dijela trupa. Etiologija bolesti je nepoznata, a predominantno se pojavljuje u mlađih ženskih osoba. Obično je bolest samolimitirajuća i do danas još nije definiran jedinstven terapijski modalitet za liječenje ovog poremećaja. Bolesnik u dobi od 62 godine prvi se puta obratio se u našu Kliniku u 2006.g. s već postavljenom dijagnozom i tipičnom kliničkom slikom scleredema adultorum. Nakon višekratnog neuspjeha dermatološke terapije, bolesnik je podvrgnut radioterapiji, te je primio ukupnu iradijacijsku dozu od 20 Gy, podijeljenu u 10 dnevnih frakcija (2 Gy dnevno). Tijekom provođenja radioterapije, kao i neposredno po završenoj terapiji, klinički nije došlo do poboljšanja. Nakon nekoliko mjeseci kožna infiltracija se djelomično smanjila. Međutim, potpuna regresija nije nastupila, a takav nalaz je do danas ostao nepromijenjen

Primjena 3D-konformalne radioterapija jednim ciljnim volumenom u bolesnika s dva primarna tumora – prikaz slučaja

A male patient, aged 54, was admitted to the University Hospital for Tumors for primary radiotherapy of neoplasms in the hypopharynx and mid-esophagus, by biopsy both shown as planocellular carcinoma. Prior to initial radiation, the patient underwent 3 cycles of chemotherapy (cisplatin + 5-FU). The main problem occurring during the radiation planning was that the target volumes of the above mentioned primary tumors were detached, making together a unique, very big volume. In addition, part of that volume was to be irradiated only electively in order to prevent microscopic disease expansion, and another smaller part required an application of the full radical tumor dose. During radiotherapy, the continuation of chemotherapy was indicated (2 cycles of cisplatin and 5-FU). Despite the large target volumes irradiated and concomitant application of chemotherapy, the patient took the entire course of primary radiochemotherapy well and without a necessary recess. The patient was discharged with his general condition improved, and at the control visit three months after the completion of radiotherapy, the diagnostic evaluation showed no signs of residual disease.Bolesnik u dobi 54 godine zaprimljen je u našu Kliniku zbog provođenja primarne radioterapije neoplazme hipofarinksa i neoplazme srednjeg dijela jednjaka. Biopsijom obje promjene dobije se planocelularni karcinom. S obzirom na isti histološki tip oba tumora, prije početka zračenja bolesnik je primio 3 ciklusa kemoterapije cisplatinom i 5-fluorouracilom. U pripremi i planiranju zračenja temeljni problem je bio što su se ciljni volumeni odvojenih primarnih tumora doticali te su činili jedinstveni veliki volumen. Uz to, dio tog volumena valjalo je zračiti samo elektivno sa ciljem suzbijanja mikroskopske bolesti, a tek u dijelu je bilo nužno aplicirati radikalnu dozu. Tijekom zračenja određen je nastavak kemoterapije i to 2 ciklusa s cisplatinom i 5 fluorouracilom. Unatoč velikim ciljnim volumenima zračenja i konkomitantno primijenjene kemoterapije, bolesnik je dobro i u cijelosti, bez stanke u zračenju, podnio primarnu radiokemoterapiju. Otpušten je u poboljšanom općem stanju, a na prvom kontrolnom pregledu, tri mjeseca po završenoj terapiji nije bilo znakova povrata bolesti

Radioterapija nemalignih bolesti - "Scleredema adultorum Buschke" – prikaz slučaja

Scleredema adultorum Buschke is a very rare disease characterized by thickening of the dermis of the neck, head, and the upper trunk. The etiology of the disease is still unknown, and it predominantly occurs in young females. The disease is usually self-limiting with no optimal therapy modality for the severe forms of the disease having been yet defined. A 62-year-old patient presented at our Hospital in 2006 with the already established diagnosis and clinical picture typical for scleredema adultorum. After several unsuccessful dermatology treatments, the patient underwent radiation therapy receiving a total irradiation dose of 20 Gy delivered in 10 daily fractions (2 Gy a day). During radiotherapy, and immediately after the therapy, no clinical improvement, or skin induration improvement was observed. A couple of months later the skin infiltration was partially reduced. However, complete regression did not occur, and this finding remained unchanged to date.Scleredema adultorum Buschke izrazito je rijetka bolest obilježena zadebljanjem dermisa u području glave, vrata i gornjeg dijela trupa. Etiologija bolesti je nepoznata, a predominantno se pojavljuje u mlađih ženskih osoba. Obično je bolest samolimitirajuća i do danas još nije definiran jedinstven terapijski modalitet za liječenje ovog poremećaja. Bolesnik u dobi od 62 godine prvi se puta obratio se u našu Kliniku u 2006.g. s već postavljenom dijagnozom i tipičnom kliničkom slikom scleredema adultorum. Nakon višekratnog neuspjeha dermatološke terapije, bolesnik je podvrgnut radioterapiji, te je primio ukupnu iradijacijsku dozu od 20 Gy, podijeljenu u 10 dnevnih frakcija (2 Gy dnevno). Tijekom provođenja radioterapije, kao i neposredno po završenoj terapiji, klinički nije došlo do poboljšanja. Nakon nekoliko mjeseci kožna infiltracija se djelomično smanjila. Međutim, potpuna regresija nije nastupila, a takav nalaz je do danas ostao nepromijenjen

Primjena 3D-konformalne radioterapija jednim ciljnim volumenom u bolesnika s dva primarna tumora – prikaz slučaja

A male patient, aged 54, was admitted to the University Hospital for Tumors for primary radiotherapy of neoplasms in the hypopharynx and mid-esophagus, by biopsy both shown as planocellular carcinoma. Prior to initial radiation, the patient underwent 3 cycles of chemotherapy (cisplatin + 5-FU). The main problem occurring during the radiation planning was that the target volumes of the above mentioned primary tumors were detached, making together a unique, very big volume. In addition, part of that volume was to be irradiated only electively in order to prevent microscopic disease expansion, and another smaller part required an application of the full radical tumor dose. During radiotherapy, the continuation of chemotherapy was indicated (2 cycles of cisplatin and 5-FU). Despite the large target volumes irradiated and concomitant application of chemotherapy, the patient took the entire course of primary radiochemotherapy well and without a necessary recess. The patient was discharged with his general condition improved, and at the control visit three months after the completion of radiotherapy, the diagnostic evaluation showed no signs of residual disease.Bolesnik u dobi 54 godine zaprimljen je u našu Kliniku zbog provođenja primarne radioterapije neoplazme hipofarinksa i neoplazme srednjeg dijela jednjaka. Biopsijom obje promjene dobije se planocelularni karcinom. S obzirom na isti histološki tip oba tumora, prije početka zračenja bolesnik je primio 3 ciklusa kemoterapije cisplatinom i 5-fluorouracilom. U pripremi i planiranju zračenja temeljni problem je bio što su se ciljni volumeni odvojenih primarnih tumora doticali te su činili jedinstveni veliki volumen. Uz to, dio tog volumena valjalo je zračiti samo elektivno sa ciljem suzbijanja mikroskopske bolesti, a tek u dijelu je bilo nužno aplicirati radikalnu dozu. Tijekom zračenja određen je nastavak kemoterapije i to 2 ciklusa s cisplatinom i 5 fluorouracilom. Unatoč velikim ciljnim volumenima zračenja i konkomitantno primijenjene kemoterapije, bolesnik je dobro i u cijelosti, bez stanke u zračenju, podnio primarnu radiokemoterapiju. Otpušten je u poboljšanom općem stanju, a na prvom kontrolnom pregledu, tri mjeseca po završenoj terapiji nije bilo znakova povrata bolesti

National program of prevention and early detection of cancer in Croatia

U Hrvatskoj je rak drugi najznačajniji uzrok smrti (četvrtina od svih umrlih). Od 1988. do 2005. godine porasla je stopa incidencije na 100.000 sa 303,9 na 466,8, a stopa umrlih na 100.000 porasla je sa 217,7 na 284,8. Ne računajući rak kože, godišnje (2005. godine) dijagnosticira se blizu 21.000 novih bolesnika od raka, a umire blizu 13.000 ljudi. Najučestalija sijela raka u muškaraca su rak pluća, kolorektalni rak, rak prostate, rak mokraćnoga mjehura i rak želuca, a u žena rak dojke, kolorektalni rak i rak jajnika. Iako su mnoga sijela raka lako dostupna dijagnostici i terapiji te iako danas raspolažemo suvremenom dijagnostičkom opremom, u našoj zemlji zabilježeno je nisko 5-godišnje preživljavanje. Vijeće Europske Unije 2003. godine pozvalo je zemlje članice da donesu nacionalne programe prevencije i ranoga otkrivanja raka i započnu njihovo provođenje. Testovi koji se preporučuju (uz osiguranu odgovarajuću kvalitetu rada) jesu ovi: mamografija za probir raka dojke žena u dobi 50-69 godina, okultno fekalno krvarenje za probir raka debeloga crijeva u dobi 50-74 godine i Papa-test za probir raka vrata maternice u žena, koji ne treba započeti u žena mlađih od 20 godina, a treba započeti prije 30. godine života. Prijedlog nacionalnoga programa prevencije i ranoga otkrivanja raka u Hrvatskoj predstavljen je na 2. kongresu Hrvatskoga onkološkoga društva 2004. godine i publiciran na hrvatskom i engleskom jeziku. Nešto revidiran program publiciranje 2007. godine pod nazivom Kako spriječiti i rano otkriti rak? Ciljevi su Programa sljedeći: 1. Promotivnim aktivnostima i zdravstvenim odgojem smanjiti prevalenciju poznatih rizičnih čimbenika u stanovništvu (kontrolom pušenja, pravilnom prehranom, tjelesnom aktivnošću i izbjegavanjem prekomjerne tjelesne težine, umjerenijom konzumacijom alkohola, smanjenjem izloženosti karcinogenima na radu i okolišu, imunizacijom protiv hepatitisa B, izbjegavanjem izloženosti suncu te zdravstvenim odgojem u odnosu na spolne i reproduktivne čimbenike povezane s rakom. 2. Smanjiti ukupni mortalitet od raka za 15% u pet godina nakon početka provedbe programa. 3. Povećati postotak bolesnika u kojih je zloćudna bolest dijagnosticirana u pretkliničkom i lokaliziranom stadiju, povećati uspješnost liječenja i preživljavanja i time smanjiti troškove skupoga liječenja te poboljšati kvalitetu života bolesnika. Ciljevi su ranoga otkrivanja raka dojke ovi: za 25% smanjiti mortalitet od raka dojke pet godina nakon početka provođenja programa; ciljna su skupina žene u dobi 50-69 godina svake druge godine s obuhvatom od najmanje 70%. Test za probir: visokokvalitetna mamografija, klinički pregled između probira kao i za žene koje ne će sudjelovati u programu. Nakon mamografije očekuje se 4% pozitivnih za daljnju obradu. Ciljevi su ranoga otkrivanja raka debeloga crijeva smanjiti mortalitet od raka debeloga crijeva za 15% pet godina nakon provođenja programa uz obuhvat populacije od 75% do 2010. godine. Test za skrining: testiranje okultnoga fekalnoga krvarenja (FOBT) ili imunokemijski test (FIT) jednom godišnje (ili makar svake druge godine, odnosno najmanje svake treće godine), kod pozitivnih ispitanika na okultno fekalno krvarenje treba učiniti kolonoskopski pregled kako bi se utvrdio uzrok okultnoga krvarenja i mogući karcinom debeloga crijeva (s istovremenom endoskopskom terapijom-polipektomijom, ako je ona potrebna). Očekivani broj pozitivnih ispitanika na okultno fekalno krvarenje je od 2-3%. Primjenom programa za rano otkrivanje raka vrata maternice očekuje se smanjenje invazivnoga karcinoma za žene u dobi od 25 do 64 godine za 60% devet godina od početka programa, a za žene u dobi od 25 do 69 godina smanjenje mortaliteta za 80% nakon 13 godina. Test za skrining: Papatesta za žene u dobi od 25 do 64. godine starosti svake 3 godine. Idealni obuhvat bi bio 85%. Treba težiti sljedećim metodama skrininga: za žene u dobi od 25 do 30 godina koristiti Papa-test (konvencionalna ili tekuća citologija, uz kontrolu kvalitete u citološkim laboratorijima sukladno uputama EU) 3 godine, a za žene iznad 31 godine do 64. godine koristiti kombinaciju Papatesta i HPV-testiranja svakih 5 godina. U pozitivnih žena provedba Programa nadopunjena je kolposkopijom i ciljanom biopsijom. U budućim se programima prevencije raka vrata maternice očekuje cjeloviti sustav prevencije koji obuhvaća i cijepljenje protiv HPV-a. Cilj je ranoga otkrivanja raka prostate smanjiti mortalitet od raka prostate pet godina nakon početka programa. Ciljna su skupina muškarci u dobi iznad 40 godina kod kojih postoji pozitivna obiteljska anamneza za rak prostate (njih oko 10%), muškarci u dobi iznad 50 godina sa simptomima prostatizma, te onih u toj dobi bez simptoma koji zatraže pregled za rano otkrivanje raka prostate. Testovi za skrining: digitorektalni pregled, određivanje prostatičnoga serumskoga antigena (PSA) jednom godišnje. Pozitivni ispitanici upućuju se na daljnje dijagnostičke pretrage (oko 5-10% ispitanika). Nositelji programa probira određuju se ovisno o sijelu raka, a nužne su intenzivne promotivne aktivnosti na svim razinama. Monitoring i vrjednovanje skrininga provode zavodi za javno zdravstvo. Hrvatski zavod za javno zdravstvo koordinira aktivnosti i redovito izvješćuje Ministarstvo zdravstva i socijalne skrbi. Krajem 2006. godine (listopad) započelo se s programom ranoga otkrivanja raka dojke mamografijom i to pozivanjem žena 1937., 1954. i 1955. godišta, a u 2007. godini pozivane su žene 1938., 1939.-1943. i 1948.-1953. godišta. Do studenog 2007. godine pozvano je 330.000 žena, odaziv za prva pozivana godišta bio je 51,9%, a broj otkrivenih karcinoma 353. Krajem 2007. započeo je i program ranoga otkrivanja raka debeloga crijeva FOBT-om i pozivanjem osoba 1933. i 1937. godišta.Cancer is the second most frequent cause of death (a quarter of all deceased) in Croatia. Number of cases increased in the period 1988- 2005 from 303,9 to 466,8 out of 100.000, and number of the dead increased from 217,7 to 284,8 out of 100.000. There are almost 21 000 new cancer patients (skin cancer excluded) diagnosed every year (year 2005) and almost 13 000 die. The most frequent cancer sites in men are lungs, colorectum, prostate, urinary bladder and stomach and in women breasts, colorectum and ovaries. Although these organs are easily available for both diagnosis and therapy and even though today we posses modern equipment for diagnosis, survival stretches up to a short period of 5 years. In the year 2003 the European Council invited the member countries to create and start implementing programs for cancer prevention and early detection. Tests, which were recommended (with adequate quality in performance) were: mammography for detecting breast cancer in women aged 50-69, occult fecal blood test for detecting large intestine cancer from the age of 50 to 74 and the Pap test for detecting cervical cancer, which should not be performed in women younger than 20, but should definitively be done before they are 30 years old. Proposal of the National Program for Cancer Prevention and Early Detection in Croatia was presented at the 2nd Congress of the Croatian Oncologic Association in 2004 and published in Croatian and English language. A somewhat reviewed program was published in 2007 under the title "How to Prevent and Early Detect Cancer?". Aims of the Program: 1. to reduce prevalence of known risk factors in the population by different promotional activities and health education (control of smoking, healthy diet, physical activity and avoiding excessive body weight, promoting moderate consuming of alcohol, reducing the exposure to carcinogens at work and in the environment, immunisation against hepatitis B, avoiding sun exposure and health education regarding sexual and reproductive factors connected to cancer; 2. to reduce total cancer mortality by 15% five years after the implementation of the program; 3. to increase percentage of patients, who were diagnosed with this malignant disease in preclinical and in situ stage, to increase success of treatment and survival and to reduce expenses of costly treatment and improve life quality of patients. Aims of early detection of breast cancer are the following: to reduce mortality from breast cancer by 25% five years after implementation of the program; target group are women aged 50-69 every two years with the scope of at least 70% of the population. Screening test: high quality mammography, clinical examination between screenings, as well as for women, who are not going to participate in the program. It is to be expected that after mammography 4% of women would have to be subjected to further treatments. Aims of early detecting a colorectal cancer are to reduce mortality from the colorectal cancer by 15% five years after implementation of the program with the scope of 75% of the population until 2010. Screening test: occult fecal blood test (FOBT) or immunochemical test (FIT) once a year (or once every two years, i.e. at least once every three years); with persons who were tested positive to occult fecal blood haemorrhage, colonoscopy should be performed, in order to determine the cause of occult haemorrhage and possible colorectal cancer (with endoscopic therapy - polypectomy performed at the same time, if needed). Expected number of people positive to occult fecal blood test is from 2 to 3%. By applying the program for early detection of cervical carcinoma, reduction by 60% of invasive carcinoma for women aged 25 to 64 is to be expected nine years after the program implementation and for women aged 25 to 69 the reduction of mortality by 80% after 13 years. Screening test: the Pap test for women aged 25 to 64 every three years. Ideal scope would be 85%. We should try to accomplish the following screening methods: for women aged 25 to 30 to use the Pap test (conventional or current cytology, with quality control in cytological laboratories pursuant to the EU instructions) every three years, and for women aged 31 to 64 to use a combination of the Pap test and HPV- testing every 5 years. In women, who were tested positive, the Program included also colposcopy and target biopsy. It is to be expected that the future programs for cervical cancer prevention will include the whole prevention system, which will include vaccination against HPV. The aim of early detection of prostate cancer is to reduce prostate cancer mortality five years after the program implementation. Target group: men older than 40 with a positive family prostate cancer history (approximately 10% of them), men older than 50 with symptoms of prostatism, as well as men of the same age without symptoms, who want to be examined for early detection of prostate cancer. Screening tests: digital-rectal examination, determining of prostate serum antigen (PSA) once a year. Those who were tested positive are referred to further diagnostic tests (approximately 5-10%). Participants in the screening program are determined according to cancer site and obligatory intensive promotional activities in all fields. Monitoring as well as evaluation of the screening is performed by public health institutes. Croatian Public Health Institute coordinates activities and informs the Ministry of Health and Social Welfare on regular basis. The program of early detection of breast cancer - mammography started at the end of 2006 (October) by inviting women born in 1937, 1954 and 1955, and in the year 2007 women born in 1938, 1939-1943, as well as those born 1948-1953 were invited. Until November 2007, 330 000 women were invited, the response of the first women invited was 51,9% and the number of detected cancers was 353. The Program for early detection of colorectal cancer by FOBT as well as invitation of people born in 1933 and 1937 started at the end of the year 2007

Immunohystochemical Expression of Cancer/Testis Antigens (MAGE-A3/4, NY-ESO-1) in Non-Small Cell Lung Cancer: The Relationship with Clinical-Pathological Features

The aim of this study was to explore the expression of cancer/testis tumor associated antigens (C/T TAAs) MAGE-A 3/4 and NY-ESO-1 in lung squamous cell carcinoma and adenocarcinoma, and to evaluate their association with the standard clinical-pathological features of surgically treated lung cancer patients. The study included 80 patients with non-small cell lung cancer (40 adenocarcinomas, 40 squamous cell carcinomas) who had undergone surgery in the period between 2002 and 2005. The MAGE-A3/4 and NY-ESO-1 antigen expression was analyzed immunohistochemically (IHC). The results showed MAGE-A3/4 and NY-ESO-1 positive staining in 65.1% and 23.3% of squamous cell carcinomas and 18.9% and 10.8% of adenocarcinomas, respectively. A statistically higher MAGE-A3/4 expression was observed in planocellular bronchial carcinoma (p<0.001), while no difference was found in the expression of NY-ESO-1 in adenocarcinoma and planocellular carcinoma (p=0.144). A significant association was found between the MAGE-A3/4 expression and presence of tumor necrosis in squamous cell cancer specimens (p=0.001), but not in adenocarcinoma (p=0.033). A statistically significant association was noted between the NY-ESO-1 expression and positive hilar and mediastinal lymph nodes in adenocarcinoma (p=0.025) whereas it was not the case in squamous cell carcinoma. Non-small cell lung cancer frequently expresses cancer/testis tumor associated antigens. Our results demonstrate that the MAGE-A3/4 and NY-ESO-1 expression was significant associated with prognostic factors of poor outcome of disease (presence of tumor necrosis and lymph node metastasis). As C/T antigens are important for inducing a specific immune reaction in lung cancer patients, there is an intention to form a subgroup of patients in the future, whose treatment would be enhanced by specific immunotherapy based on the observed scientific results