Liječenje karcinoma rektuma

Carcinoma of the rectum represents a major public health issue, affects many patients and causes controversies about the optimal treatment modalities and their timing. Based on the results of numerous studies neoadjuvant chemoradiotherapy is newly often favorised in all localized tumors, except the earliest ones. With this multimodal approach a significant tumor regression with acceptable side-effects can be achieved and later surgical procedures alleviated or even omitted in highly selected cases. In this review paper the latest data on rectal cancer treatment and expected future research ideas are explained and discussed in detail.Rak rektum predstavlja značajan javnozdravstveni problem, zbog brojnosti pacijenata i nedoumica oko optimalnog slijeda raznih vidova liječenja. Na temelju rezultata brojnih studija neoadjuvantna kemoradioterapija se u zadnje vrijeme pretpostavlja u liječenju lokaliziranih tumora, izuzev najranijih stadija. Takvim multimodalnim pristu pommože se postići značajna regresija tumora uz prihvatljive popratne pojave, čime su kasniji kirurški postupci olakšani ili ih se čak može izbjeći u izabranih pacijenata. U ovom preglednom članku se podrobno iznose i raspravljaju najnoviji podaci o liječenju raka rektuma i ideje o očekivanim budućim istraživanjima

Suvremeno liječenje karcinoma rektuma

In the last few decades we have witnessed a great advancement in the treatment of rectal carcinoma. This advancement has partly been enabled by the development of new surgical techniques, magnetic resonance imaging as an optimal diagnostic tool and of new histopathological techniques for resected specimen evaluation. Other important contributions include the development of sophisticated radiotherapy treatment techniques which, applied with new cytostatics and smart drugs, induce a better tumor response while reducing toxicity. Although each discipline has contributed to a better understanding of the disease, it is the multidisciplinary approach that has yielded success in treatment so far.Posljednjih desetljeća svjedoci smo velikog napretka u liječenju karcinoma rektuma. Razvoj novih kirurških tehnika, magnetske rezonance kao optimalnog dijagnostičkog alata i novih histopatoloških tehnika evaluacije reseciranog uzorka omogućili su dio ovih promjena. Ostatak je posljedica razvoja sofisticiranih radioterapijskih tehnika koje u kombinaciji s novim citostaticima i pametnim lijekovima postižu bolji odgovor tumora na primijenjeno liječenje uz smanjenje toksičnosti. Iako je svaka disciplina doprinijela boljem razumijevanju bolesti, tek je multidisciplinarni pristup omogućio sadašnju razinu uspjeha liječenja

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

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

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

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

Uloga parametara kompletne krvne like u bolesnika s kolorektalnim karcinomom

Chronic inflammation has been linked with many cancers. It seems that easily available and usual blood inflammatory markers might serve as a prognostic factor for overall survival and disease-free survival in patients with various cancers. Preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as hemoglobinemia, thrombocytosis, elevated C-reactive protein values, neutropenia and leukocytosis have been shown to affect overall survival and disease-free survival in patients with colorectal cancer (CRC), however, with controversial results. Complete blood count, NLR and PLR were determined in 71 patients with CRC (stages 3 and 4) after neoadjuvant chemo-radiotherapy and before surgery, treated at Hospital for Tumors in Zagreb. Statistical analysis included Mann-Whitney U test, Student’s t-test, univariate and multivariate analysis. The results of Mann-Whitney U test and Student’s t-test showed that neutrophil count (p=0.024), NLR (p=0.003) and PLR (p=0.007) correlated significantly with overall survival. However, there was no significant correlation of age, leukocyte, lymphocyte and platelet counts and hemoglobin values with overall survival of patients. Furthermore, the same tests showed that leukocyte (p=0.04), neutrophil (p=0.0014) and platelet (p=0.006) counts, NLR (p=0.0006) and PLR (p=0.0015), as well as hemoglobin values (p=0.028) correlated significantly with disease-free survival. The results of univariate analysis showed that unlike PLR, NLR correlated with overall survival and disease-free survival (p=0.0002), although the correlation of PLR and disease-free survival almost reached significance (p=0.059). Furthermore, the results of univariate analysis showed significant correlation of advanced pathological TNM stage with overall survival. There was no correlation of patient age and gender, tumor stage and neoadjuvant chemo-radiotherapy with overall survival and disease-free survival. The results of multivariate analysis showed that NLR (cut-off value 3.27) and advanced pathological TNM stage significantly correlated with disease-free survival but not with overall survival. It seems that NLR might be an accurate marker for overall survival and disease-free survival in CRC patients after neoadjuvant chemo-radiotherapy and before surgery.Kronična upala je povezana s mnogim karcinomima. Čini se da lako dostupni i uobičajeni upalni biljezi u serumu mogu biti prognostički čimbenik za ukupno preživljenje i razdoblje bez bolesti u bolesnika s različitim karcinomima. Prijeoperacijski odnos neutrofila i limfocita (NLR) te trombocita i limfocita (TLR), kao i hemoglobinemija, trombocitoza, neutropenija i leukocitoza su povezani s ukupnim preživljenjem i razdobljem bez bolesti u bolesnika s kolorektalnim karcinomom (KRK), doduše, s proturječnim rezultatima. Kompletna krvna slika, NLR i TLR su određeni u 71 bolesnika s KRK (stadij 3 i 4) nakon neoadjuvantne kemoradioterapije i prije kirurškog zahvata, koji su liječeni na Klinici za tumore u Zagrebu. Statistička analiza je uključivala Mann-Whitneyev U test, Studentov t-test, univarijatnu i multivarijatnu analizu. Rezultati Mann-Whitneyeva U testa i Studentova t-testa su pokazali da su broj neutrofila (p=0,024), NLR (p=0,003) i TLR (p=0,007) značajno povezani s ukupnim preživljenjem. Ipak, nije bilo značajne povezanosti između dobi, broja leukocita, limfocita i trombocita te hemoglobina s ukupnim preživljenjem bolesnika. Nadalje, isti testovi su pokazali da su broj leukocita (p=0,04), neutrofila (p=0,0014) i trombocita (p=0,006), NLR (p=0,0006) i TLR (p=0,0015), kao i hemoglobin (p=0,028) značajno povezani s razdobljem bez bolesti. Rezultati univarijatne analize su pokazali da, za razliku od TLR, NLR korelira s ukupnim preživljenjem i preživljenjem bez bolesti, iako je korelacija zamalo postignuta između TLR i razdoblja bez bolesti (p=0,059). Nije bilo povezanosti između bolesnikove dobi i spola, stadija tumora i neoadjuvantne kemoradioterapije s ukupnim preživljenjem i razdobljem bez bolesti. Rezultati multivarijatne analize su pokazali kako NLR (granična vrijednost 3,27) i uznapredovali patološki stadij TNM značajno koreliraju s preživljenjem bez bolesti za razliku od ukupnog preživljenja. Čini se da je NLR pouzdan biljeg ukupnog preživljenja kao i preživljenja bez bolesti u bolesnika s KRK nakon neoadjuvantne kemoradioterapije i prije kirurškog zahvata