Imunoterapija karcinoma mokraćnog mjehura

Urothelial urinary bladder carcinoma represents 9th most common malignancy in the world. This disease is held responsable for more than 165000 deaths throughout the world. In the past 30 years there were no major advances in treatment of this tumor. Chemotherapy regimens used for treatment are based on platinum compounds. In a recent time a series of immune system modulating drugs have been developed. This drugs have achieved excellent results in the treatment of urinary bladder carcinoma.Karcinom mokraćnog mjehura je deveti najčešći maligni tumor u svijetu. Bolest je uzrok više od 165.000 smrtnih slučajeva. U posljednjih 30 godina nije bilo većih pomaka u mogućnostima liječenja ovoga tumora. Kemoterapijski protokoli za liječenje uznapredovale ili metastatske bolesti mokraćnog mjehura bazirani su uglavnom na spojevima platine. U posljednje vrijeme razvijen je niz novih lijekova koji moduliraju imunološki odgovor organizma na tumorske stanice i time omogućavaju uspješno liječenje karcinoma mokraćnog mjehura

Evaluation of Adjuvant Chemotherapy in Patients with Colorectal Cancer in Primorsko-goranska and Istarska County – A Twenty Years Retrospective Study

Colorectal cancer is the second most common malignant disease in developed countries, with about one million new cases worldwide every year, accompanied with high mortality rate. We examined the survival rate and recurrence (occurrence of distant metastases and/or local recurrence) of patients with colorectal cancer in Primorsko-Goranska and Istarska County who received adjuvant chemotherapy, compared to those who did not in the period since 1980. until 1999. This study involves 483 patients with colorectal cancer stages II and III of Primorsko-Goranska and Istarska County, which were underwent curative resections of colorectal cancer at the Clinical Hospital Centre Rijeka, and then treated with chemotherapy (288) or without Chemotherapy (195). We analyzed the five year survival rate and the recurrence of malignant disease in the adjuvant treatment group in comparison with not treated group with chemotherapy, depending on the stage of disease, degree of histological differentiation, patient age and location of cancer (colon or rectum). After follow-up of 60 months died 44.79% (129/288) of patients who received chemotherapy and 53.33% (104/195) of patients who did not receive chemotherapy. The relative risk of death (from any cause) in chemotherapy-treated group versus the group without chemotherapy was 0.82 (p<0.008). Recurrence of malignant disease in the chemotherapy group was 38.54% (111/288), and in the group without chemotherapy was 46.15% (90/195). The relative risk of recurrence of malignant disease in the chemotherapy group versus the group without chemotherapy was 0.78 (p<0.001). There was no difference in treatment efficacy regard to the localization of the tumor, but there were differences in efficiency with respect to disease stage, grade and age. Chemotherapy with 5-fluorouracil and leukovorin ameliorate the survival and reduces recurrence and distant metastases in patients with colorectal cancer stages II and III

The »Round Block« Surgical Technique in the Management of Multicentric Fibroadenomas

The »round block« surgical technique in the treatment of a female patient with multiple, multicentric fibroadenomas in both breasts is presented. The advantages of this technique for patients with multicentric benign breast lesions are minimal postoperative scar and a favourable aesthetic result. Breast dimensions and the areolar diameter were measured in 203 subjects of Primorsko-goranska county during examination in the Out-Patient Hospital for Breast Diseases, including the operated patient. Smaller breast dimensions and a larger areolar diameter provide an easier access to any part of the breast due to a smaller distance between the incision and a fibroadenoma and a larger circumference of circular periareolar incision, thus facilitating the surgery. The analysis of average, maximum and minimum values measured shows that the »round block« technique can be performed in all cases of multiple and multicentric fibroadenomas regardless of breast size, areolar diameter and the location of fibroadenoma in the breast

The »Round Block« Surgical Technique in the Management of Multicentric Fibroadenomas

The »round block« surgical technique in the treatment of a female patient with multiple, multicentric fibroadenomas in both breasts is presented. The advantages of this technique for patients with multicentric benign breast lesions are minimal postoperative scar and a favourable aesthetic result. Breast dimensions and the areolar diameter were measured in 203 subjects of Primorsko-goranska county during examination in the Out-Patient Hospital for Breast Diseases, including the operated patient. Smaller breast dimensions and a larger areolar diameter provide an easier access to any part of the breast due to a smaller distance between the incision and a fibroadenoma and a larger circumference of circular periareolar incision, thus facilitating the surgery. The analysis of average, maximum and minimum values measured shows that the »round block« technique can be performed in all cases of multiple and multicentric fibroadenomas regardless of breast size, areolar diameter and the location of fibroadenoma in the breast

Imunoterapija karcinoma mokraćnog mjehura

Urothelial urinary bladder carcinoma represents 9th most common malignancy in the world. This disease is held responsable for more than 165000 deaths throughout the world. In the past 30 years there were no major advances in treatment of this tumor. Chemotherapy regimens used for treatment are based on platinum compounds. In a recent time a series of immune system modulating drugs have been developed. This drugs have achieved excellent results in the treatment of urinary bladder carcinoma.Karcinom mokraćnog mjehura je deveti najčešći maligni tumor u svijetu. Bolest je uzrok više od 165.000 smrtnih slučajeva. U posljednjih 30 godina nije bilo većih pomaka u mogućnostima liječenja ovoga tumora. Kemoterapijski protokoli za liječenje uznapredovale ili metastatske bolesti mokraćnog mjehura bazirani su uglavnom na spojevima platine. U posljednje vrijeme razvijen je niz novih lijekova koji moduliraju imunološki odgovor organizma na tumorske stanice i time omogućavaju uspješno liječenje karcinoma mokraćnog mjehura

Imunoterapija karcinoma mokraćnog mjehura

Urothelial urinary bladder carcinoma represents 9th most common malignancy in the world. This disease is held responsable for more than 165000 deaths throughout the world. In the past 30 years there were no major advances in treatment of this tumor. Chemotherapy regimens used for treatment are based on platinum compounds. In a recent time a series of immune system modulating drugs have been developed. This drugs have achieved excellent results in the treatment of urinary bladder carcinoma.Karcinom mokraćnog mjehura je deveti najčešći maligni tumor u svijetu. Bolest je uzrok više od 165.000 smrtnih slučajeva. U posljednjih 30 godina nije bilo većih pomaka u mogućnostima liječenja ovoga tumora. Kemoterapijski protokoli za liječenje uznapredovale ili metastatske bolesti mokraćnog mjehura bazirani su uglavnom na spojevima platine. U posljednje vrijeme razvijen je niz novih lijekova koji moduliraju imunološki odgovor organizma na tumorske stanice i time omogućavaju uspješno liječenje karcinoma mokraćnog mjehura

Aksilarnu limfadenektomiju trebalo bi izostaviti kod bolesnica sa karcinomom dojke i minimalnom rezidualnom bolesti u sentinel limfnom čvoru nakon neoadjuvantnog sistemskog liječenja

Background: In modern breast cancer management, SLNB is a standard of care. For the patients with limited sentinel lymph node involvement in the upfront surgery setting, ALND can be safely omitted. However, for any sentinel node metastasis detected following neoadjuvant systemic treatment (NST), ALND is still considered a mandatory procedure. Patients and methods: Present retrospective analysis has included all breast cancer patients submitted to surgery following NST in Clinical Hospital Centre (CHC) Rijeka in the period from 2017 till 2020. Results: SLNB was performed in 151 of 222 consecutive patients, and sentinel node metastasis was detected in 49 cases. The risk of non-sentinel lymph node involvement in sentinel node-positive patients was 34.7%, but exclusively for cases with macro-metastatic disease detected in the sentinel node. In addition, for the patients diagnosed with clinically uninvolved axilla, the risk of ypN2-3 status was only 2.8%. Conclusions: ALND following NST is overtreatment in 65.3% of sentinel node-positive patients. Axillary irradiation with the omission of ALND should be considered for the sentinel-positive patients with only micro-metastatic disease detected in the sentinel node following neoadjuvant chemotherapy, as well as for those with low volume macro metastatic disease, diagnosed with the uninvolved axilla.Uvod: U modernom kirurškom pristupu liječenja kacinoma dojke SLNB je univerzalno prihvaćeni standard. Izostavljanje ALND, u slučajevima sa metastazom pronađenom u do dva sentinel limfna čvora, ne utječe na onkološke ishode kod primarno kirurški liječenih pacijentica, Međutim, svaka metastaza detektirana u sentinel limfnom čvoru nakon provedenog neoadjuvantnog sistemskog liječenja još uvijek se smatra apsolutnom indikacijom za ALND. Pacijenti i metode: Sve pacijentice operirane zbog karcinoma dojke u Kliničkom Bolničkom Centru (KBC) Rijeka nakon provedene neoadjuvantne kemoterapije, u periodu od 2017. do 2020., uključene su u ovu retrospektivnu analizu. Rezultati: SLNB je učinjena kod 151 od 222 uzastopne pacijentice, a metastaza u sentinel čvoru pronađena je u 49 slučajeva. Rizik metastatske bolesti u ne-sentinel limfnim čvorovima kod sentinel-pozitivnih pacijentica je 34.7%, međutim isključivo u slučajevima sa makrometastazom u sentinel čvoru. Nadalje, kod skupine pacijenica dijagnosticiranih sa klinički i radiološki negativnom aksilom, rizik od ypN2-3 statusa je samo 2.8% Zaključak: Nakon neoadjuvantne kemoterapije ALND je overtreatment u 65.3% sentine-pozitivnih pacijentica. Izostavljanje ALND uz zračenje aksile nakon provedenog neoadjuvantnog liječenja je opcija koju bi trebalo razmotriti za sentinelpozitivne bolesnice sa mikro-metastazom u sentinel čvoru, kao i za bolesnice sa malim volumenom makrometastatske bolesti u sentinel limfnim čvorovima, a koje su inicijalno dijagnosticirane sa klinički negativnom aksilom

Operabilni invazivni karcinom dojke u eri konzervativne kirurgije; retrospektivna analiza 5-godišnjeg preživljenja i kontrole bolesti

Background: Following breast cancer treatment recommendations, the conservative approach is accepted and highly respected in the Clinical Hospital Center (CHC) Rijeka. However, we have found that institutional follow-up data are lacking. This retrospective analysis aims to update institutional data on survival and disease control rates. Methods: From 2011 till 2014, 915 breast cancer patients underwent surgery at CHC Rijeka, and 615 were included in this analysis. The Institutional Ethics Committee approved the analysis. Results: All patients were female, and the average age was 59 years. In the 5-year postoperative period, local, regional, and distant recurrence-free survival rates and overall survival and disease-free survival were calculated. All rates negatively correlate with a higher T and N status and a higher stage of the disease. The analysis has also demonstrated that in the pT1-3 pN0-1 subgroup, sentinel lymph node biopsy (SLNB) was not inferior to axillary lymph node dissection (ALND) in terms of locoregional control of disease and overall survival. Conclusion: Besides updating institutional data, the analysis confirmed that overall survival and locoregional control of the disease in the upfront-surgery patients are similar between pN0 and pN1 subpopulations and between pN2 and pN3, but statistically significantly different between pN0-1 and pN2-3. Currently ongoing, prospective observational multicenter clinical trial aims to translate the significance of these results into the neoadjuvant era.Uvod: Temeljem suvremenih preporuka za liječenje karcinoma dojke, u Kliničkom bolničkom centru (KBC) Rijeka prihvaća se i zagovara konzervativni kirurški pristup. Međutim, na razini naše institucije, ali i na nacionalnom nivou, malo je obrađenih rezultata liječenja. Cilj ove retrospektivne analize je ažuriranje institucionalnih podataka o preživljenju i kontroli bolesti. Metode: U periodu od 2011. do 2014. godine, u KBC Rijeka operirano je 915 pacijentica oboljelih od karcinoma dojke, a njih 615 uključeno je u ovu analizu. Istraživanje je odobreno od Etičkog povjerenstva KBC Rijeka. Rezultati: Sve su pacjentice bile žene, prosječno stare 59 godina. Izračunate su ukupne stope preživljenja bez lokalnog, regionalnog i udaljenog recidiva, te stope ukupnog preživljenja i preživljenja bez povrata bolesti u petogodišnjem postoperativnom periodu. Sve su stope u negativnoj korelaciji sa višim T i N statusom kao i višim stadijem bolesti. Osim navedenog, rezultati su potvrdili da je biopsija sentinel limfnog čvora ekvivalentna aksilarnoj disekciji u smislu lokoregionalne kontrole bolesti kao i ukupnog petogodišnjeg preživljenja u pT1-3 pN0-1 podskupini. Zaključak: Osim ažuriranja podataka naše institucije, ova je analiza potvrdila da su stope preživljenja i lokoregionalne kontrole bolesti u eri primarnog kirurškog tretmana slične između pN0 i pN1 subpopulacija kao i među pN2 i pN3, međutim statistički značajno različite između pN0-1 I pN2-3 podskupina. Prospektivno, opservacijsko, multicentrično kliničko istraživanje koje je u tijeku pokušava istražiti značenje ovih rezultata u neoadjuvantoj eri

Imunoterapija karcinoma mokraćnog mjehura

Urothelial urinary bladder carcinoma represents 9th most common malignancy in the world. This disease is held responsable for more than 165000 deaths throughout the world. In the past 30 years there were no major advances in treatment of this tumor. Chemotherapy regimens used for treatment are based on platinum compounds. In a recent time a series of immune system modulating drugs have been developed. This drugs have achieved excellent results in the treatment of urinary bladder carcinoma.Karcinom mokraćnog mjehura je deveti najčešći maligni tumor u svijetu. Bolest je uzrok više od 165.000 smrtnih slučajeva. U posljednjih 30 godina nije bilo većih pomaka u mogućnostima liječenja ovoga tumora. Kemoterapijski protokoli za liječenje uznapredovale ili metastatske bolesti mokraćnog mjehura bazirani su uglavnom na spojevima platine. U posljednje vrijeme razvijen je niz novih lijekova koji moduliraju imunološki odgovor organizma na tumorske stanice i time omogućavaju uspješno liječenje karcinoma mokraćnog mjehura

Treatment of kidney cancer – oncological approach

Napredak u razumijevanju i poznavanju molekularnih puteva rasta i razvoja tumora bubrega doveo je do razvoja čitavog niza lijekova kojima je danas moguće liječiti oboljele od ove bolesti. Brojne kliničke studije dokazale su učinkovitost novih terapija. Svakodnevna primjena posljednjih dostignuća svjetske znanosti omogućava ostvarenje jednog od primarnih onkoloških ciljeva, a to je izlječenje pacijenata ili pretvaranje ove teške bolesti u dugotrajnu kroničnu bolest.Improvement in knowledge of molecular pathways of growth and developement of malignant kidney cancer has led to development of a number of efficient drugs. In this way the treatment of this condition nowadays is possible and successfull as documented by many clinical trials. New ways of treating kidney cancer tend to fulfill primary oncology goals which are to cure completely the patient or to make this serious disease a longlasting chronic disease