Predicting the survival probability of functional neuroendocrine tumors treated with peptide receptor radionuclide therapy: Serbian experience

IntroductionPeptide receptor radionuclide therapy (PRRT) is a treatment option for well-differentiated, somatostatin receptor positive, unresectable or/and metastatic neuroendocrine tumors (NETs). Although high disease control rates seen with PRRT a significant number NET patients have a short progression-free interval, and currently, there is a deficiency of effective biomarkers to pre-identify these patients. This study is aimed at determining the prognostic significance of biomarkers on survival of patients with NETs in initial PRRT treatment.MethodologyWe retrospectively analyzed 51 patients with NETs treated with PRRT at the Department for nuclear medicine, University Clinical Center Kragujevac, Serbia, with a five-year follow-up. Eligible patients with confirmed inoperable NETs, were retrospectively evaluated hematological, blood-based inflammatory markers, biochemical markers and clinical characteristics on disease progression. In accordance with the progression og the disease, the patients were divided into two groups: progression group (n=18) and a non-progression group (n=33). Clinical data were compared between the two groups.ResultsA total of 51 patients (Md=60, age 25-75 years) were treated with PRRT, of whom 29 (56.86%) demonstrated stable disease, 4 (7.84%) demonstrated a partial response, and 14 (27.46%) demonstrated progressive disease and death was recorded in 4 (7.84%) patients. The mean PFS was a 36.22 months (95% CI 30.14-42.29) and the mean OS was 44.68 months (95% CI 37.40-51.97). Univariate logistic regression analysis displayed that age (p<0.05), functional tumors (p<0.05), absolute neutrophil count (p<0.05), neutrophil-lymphocyte ratio-NLR (p<0.05), C-reactive protein-CRP (p<0.05), CRP/Albumin (p<0.05), alanine aminotransferase-ALT (p<0.05), were risk factors for disease progression. Multivariate logistic regression analysis exhibited that functional tumors (p<0.001), age (p<0.05), CRP (p<0.05), and ALT (p<0.05), were independent risk factors for the disease progression in patients with NETs. Tumor functionality was the most powerful prognostic factor. The median PFS (11.86 ± 1.41 vs. 43.38 ± 3.16 months; p=0.001) and OS (21.81 ± 2.70 vs 53.86 ± 3.70, p=0.001) were significantly shorter in patients with functional than non-functional NETs respectively.ConclusionThe study’s results suggest that tumor functionality, and certain biomarkers may serve as prognostic survival indicators for patients with NETs undergoing PRRT. The findings can potentially help to identify patients who are at higher risk of disease progression and tailor treatment strategies accordingly

Economics of cancer related medical care: Worldwide estimates and available domestic evidence

Background: The aims of this article were to report findings of domestic research related to assessment of hospital treatment costs of Serbian patients suffering from cancer and show similar study results among foreign trials. The authors also intended to suggest likely strategies to improve local cost containment in future. Cost-of-illness studies of most high-income economies have proven that malignant disorders belong to top five disorders according to their overall financial burden. Methods: Our trial was conducted as an in depth, retrospective, bottom-up, trend analysis of services consumption patterns and expenses relative to diagnosis at discharge, from perspective of the third party payer. Discounting rates were calculated according to the average official exchange rates of the National Bank of Serbia in respective years. Financial value of medical goods and services consumed was taken out of current price lists of the National Republic Institute on Health Insurance on a day when particular service was provided. Results: There were 434 patients and 4850 admissions processed in 2007, consuming 48,483,740.49 RSD (€613,562.90) while in 2010 there were 539 patients and 9509 admissions, consuming 68,880,953.27 RSD (€658,832.65). In total, drugs value accounts for only 5%, radiotherapy 54% and the rest of expenditure 41% (consultations, surgery, consumables, nursing care, other). Average overall cost per patient treated was 125,922.34 RSD and per hospital admission, it was 8,297.99 RSD. Cancer-related medical care costs, in domestic currency, increased by almost one third in only four-year time span. Conclusion: Higher awareness of clinicians on cost limitations and necessity of prioritization in funding health care, would provide wiser resource allocation and more care with money available. © 2011, Oncology Institute of Vojvodina, Sremska Kamenica

Hospital oncology costs among the cohort of elderly in an aging South-Eastern European nation

<a href="http://dx.doi.org/10.7175/fe.v16i1.1167">http://dx.doi.org/10.7175/fe.v16i1.1167</a

Macroeconomic Policy Impact On Oncology-Related Public Expenditure In An Emerging European Market – Signs Of Early Recovery

Healthcare financing in Serbia has faced many challenges over the past few decades. One of the most severe challenges is a global macroeconomic recession whose far-reaching consequences deserve particular attention from policymakers in cases of the most demanding major prosperity diseases, such as cancer. The objective of the study was to assess the precise cost matrix of oncology medical care and its chronological evolution during the key years of the macroeconomic recessionary period during 2010-2013

Primary Small Cell Carcinoma Of Lung With Metachronous Breast Metastasis

Breast metastases from an extra-mammary malignancy are rare. Among the lung malignancies that metastasise in the breasts, previous literature has described approximately 30 cases of NSCLC and only a few cases of SCLC. Here, we present a 54-year-old woman with metachronous breast metastasis from pulmonary small cell carcinoma. She presented with a soft tissue mass in the right lung hilum. After bronchoscopy with biopsy, SCLC was verified. Th e patient was given 4 cycles of etoposide and cisplatin followed by radiation therapy. Seven months after the diagnosis of primary lung cancer, the patient palpated a mass in her right breast. Clinical examination and further diagnostics revealed the suspected malignancy, and a radical mastectomy was performed. Immunohistochemical findings suggested metastatic SCLC in the breast. Differentiation between primary and metastatic cancer in the breast is very important for therapeutic plannin

Primary small cell carcinoma of lung with metachronous breast metastasis

© 2017, University of Kragujevac, Faculty of Science. All rights reserved. Breast metastases from an extra-mammary malignancy are rare. Among the lung malignancies that metastasise in the breasts, previous literature has described approximately 30 cases of NSCLC and only a few cases of SCLC. Here, we present a 54-year-old woman with metachronous breast metastasis from pulmonary small cell carcinoma. She presented with a soft tissue mass in the right lung hilum. After bronchoscopy with biopsy, SCLC was verified. The patient was given 4 cycles of etoposide and cisplatin followed by radiation therapy. Seven months after the diagnosis of primary lung cancer, the patient palpated a mass in her right breast. Clinical examination and further diagnostics revealed the suspected malignancy, and a radical mastectomy was performed. Immunohistochemical findings suggested metastatic SCLC in the breast. Differentiation between primary and metastatic cancer in the breast is very important for therapeutic planning

Narrow-band ultraviolet B radiation induces the expression of beta-endorphin in human skin in vivo

PURPOSE: To assess and compare the costs of first-line monoclonal antibodies (mAbs) treatment protocols in breast cancer, non-Hodgkin lymphoma and colorectal carcinoma in South-Eastern Europe. METHODS: A retrospective, bottom-up case series study design was implemented with one-year time horizon and payer's perspective. The study sample size was 265 patients (breast cancer, N=137; colorectal cancer, N=44; and non-Hodgkin lymphoma, N=84), while treatment protocols included adjuvant mAbs: trastuzumab (N=137), bevacizumab (N=28), rituximab (N=16) and cetuximab (N=84). ICD-10 related resources use included history of medical services utilization, chronology (time out of service provision) and unit consumption of examinations, drugs prescribed, imaging, radiotherapy and surgical procedures provided etc., direct medical and lost productivity costs (euro) across treatment groups during 2010-2013. RESULTS: The average length of observation was 125+97 days per patient. Total mean direct and indirect costs of care were: trastuzumab for breast cancer group euro 17,740 per patient; bevacizumab for colorectal carcinoma group euro8,775 per patient; cetuximab for colorectal carcinoma group euro 27,181 per patient; and rituximab for non-Hodgkin lymphoma group euro19,431 per patient. An average mAbs-treated patient incurred euro17,897 costs of medical care. The total combined budget of these 330 patients was euro4,742,775. CONCLUSIONS: The use of mAbs strongly correlated with high costs in first-line cancer medical care and dominated other cost domains. Cetuximab-based treatment protocols in colorectal carcinoma patients was substantially more expensive compared to trastuzumab (C50), bevacizumab (C20), and rituximab (C80) alternatives. Extremely high costs of mAbs are the key-issue for Eastern European policy makers by crossing the upper limits of affordability in middle-income economies