34 research outputs found
Novosti u imunoterapiji tumora jednjaka i želuca
A high frequency of somatic mutations has been detected in stomach and esophageal cancers which makes them a possible suitable target for the application of immunotherapy. Contemporary immunotherapeutic approaches rely on monoclonal antibodies that inhibit immune checkpoints. The results of early clinical studies are promising, while only a few phase III studies have published their results so far. A particulary promising treatment strategy is the combination of checkpoint inhibitors with other treatment modalities, such as chemotherapy, targeted therapy, radiotherapy or T cells agonists.U karcinoma jednjaka i želuca je naÄena visoka uÄestalost somatskih mutacija Å”to ih Äini pogodnom metom za primjenu imunoterapije. Suvremeni pristupi u lijeÄenju imunoterapijom temelje se na inhibiciji imunoloÅ”kih kontrolnih toÄaka monoklonskim protutijelima. Rezultati kliniÄkih studija ranih faza su obeÄavajuÄi dok je svega nekoliko studija faze III do sada objavilo svoje rezultate. Osobito je obeÄavajuÄa strategija lijeÄenja kombinacijom inhibitora kontrolnih toÄaka s drugim modalitetima lijeÄanja poput kemoterapije, ciljane terapije, radioterapije ili terapije agonistima T stanica
U kojih bolesnika primijeniti radioterapiju u metastatskom hormonalno osjetljivom karcinomu prostate?
The standard of treatment of metastatic hormone-sensitive prostate cancer (mHSPC) is androgen deprivation therapy (ADT ) with docetaxel or abiraterone. However, numerous retrospective studies suggested outcome benefit of prostate radiotherapy. Small randomized trial
(HORRAD) showed no overall survival (OS) benefit of the addition of prostate radiotherapy to ADT but there was a trend toward survival benefit in a low volume disease. Although the results of large randomized study (STAMPEDE ) have also not proved improvement of OS in unselected patients, robust improvement of failure-free survival was found. In addition, OS was significantly improved in patients with a low volume disease. In the absence of reliable molecular markers, the extent of metastatic disease has emerged as an important factor for treatment decision making. In this review, we summarize data from non-randomized as well as from randomized studies concerning prostate radiotherapy to contribute to the improvement of treatment tailoring for each individual patient with mHSPC in order to achieve the best possible treatment outcomes.Standard lijeÄenja metastatskog hormonski osjetljivog karcinoma prostate (mHSKP) je androgen deprivirajuÄa terapija (ADT) s docetakselom ili abirateronom. MeÄutim, brojne retrospektivne studije su ukazale na korist od radioterapije prostate. Rezultati male randomizirane studije (HORRAD) nisu pokazali poboljÅ”anje ukupnog preživljenja kod primjene radioterapije prostate uz ADT , no uoÄen je trend ka poboljÅ”anju preživljenja kod bolesnika s malim volumenom metastatske bolesti. Iako rezultati velike randomizirane studije (STAMPEDE ) takoÄer nisu pokazali poboljÅ”anje preživljenja u ukupnoj populaciji bolesnika, preživljenje bez neuspjeha lijeÄenja bilo je znaÄajno poboljÅ”ano. Pored toga, ukupno preživljenje je bilo znaÄajno
poboljÅ”ano u bolesnika s malim volumenom metastatske bolesti. U nedostatku pouzdanih molekularnih markera, opseg metastatske bolesti pojavio se kao važan Äimbenik kod odluÄivanja o lijeÄenju. U ovom preglednom radu iznosimo rezultate ne-randomiziranih i randomiziranih studija o radioterapiji prostate kako bi doprinijeli poboljÅ”anju izbora lijeÄenja za svakog pojedinog bolesnika oboljelog od mHSKP s ciljem postignuÄa najboljeg moguÄeg ishoda lijeÄenja
Larynx Preservation: Advantages and Limitations
For a long time standard treatment approach for resectable squamous cell carcinoma of larynx was surgery with or without subsequent radiotherapy. Surgery, particulary total laryngectomy, has been associated with serious impairment of quallity of life. Between nonsurgical approaches, concurrent cisplatin based chemoradiotherapy has become a very promising treatment modality for larynx preservation. However, concurrent chemotherapy has been associated with serious toxicity. The most recent treatment approach in larynx preservation is related to taxan based induction chemotherapy
Novosti u imunoterapiji tumora jednjaka i želuca
A high frequency of somatic mutations has been detected in stomach and esophageal cancers which makes them a possible suitable target for the application of immunotherapy. Contemporary immunotherapeutic approaches rely on monoclonal antibodies that inhibit immune checkpoints. The results of early clinical studies are promising, while only a few phase III studies have published their results so far. A particulary promising treatment strategy is the combination of checkpoint inhibitors with other treatment modalities, such as chemotherapy, targeted therapy, radiotherapy or T cells agonists.U karcinoma jednjaka i želuca je naÄena visoka uÄestalost somatskih mutacija Å”to ih Äini pogodnom metom za primjenu imunoterapije. Suvremeni pristupi u lijeÄenju imunoterapijom temelje se na inhibiciji imunoloÅ”kih kontrolnih toÄaka monoklonskim protutijelima. Rezultati kliniÄkih studija ranih faza su obeÄavajuÄi dok je svega nekoliko studija faze III do sada objavilo svoje rezultate. Osobito je obeÄavajuÄa strategija lijeÄenja kombinacijom inhibitora kontrolnih toÄaka s drugim modalitetima lijeÄanja poput kemoterapije, ciljane terapije, radioterapije ili terapije agonistima T stanica
Multidisciplinarni tim u lijeÄenju karcinoma glave i vrata - iskustvo KBC-a Zagreb
Head and neck cancers are associated with significant morbidity and mortality
despite advancements in treatment in recent decades. A multidisciplinary approach to the treatment
of these diseases is thus of essential importance and is becoming the gold standard. Head and neck
tumors also endanger relevant structures of the upper aerodigestive tracts, including bodily functions
such as voice, speech, swallowing, and breathing. Damage to these functions can significantly influence
quality of life. Thus, our study examined not only the roles of head and neck surgeons, oncologists
and radiotherapists, but also the importance of the participation of different scientific professions such
as anesthesiologists, psychologists, nutritionists, stomatologists, and speech therapists in the work of
a multidisciplinary team (MDT). Their participation results in a significant improvement of patient
quality of life. We also present our experiences in the organization and work of the MDT as part of
the Center for Head and Neck Tumors of the Zagreb Clinical Hospital Center.Karcinomi glave i vrata povezani su sa znaÄajnim morbiditetom i mortalitetom unatoÄ napretku u lijeÄenju posljednjih
desetljeÄa. Multidisciplinarni pristup lijeÄenju ovih bolesti stoga je od iznimne važnosti i postaje zlatni standard. Tumori
glave i vrata takoÄer ugrožavaju relevantne strukture gornjeg aerodigestivnog trakta, ukljuÄujuÄi funkcije kao Å”to su glas, govor,
gutanje i disanje. OÅ”teÄenje ovih funkcija može znaÄajno utjecati na kvalitetu života. Stoga je naÅ”e istraživanje ispitivalo
ne samo ulogu kirurga glave i vrata, onkologa i radioterapeuta, veÄ i važnost sudjelovanja razliÄitih drugih kliniÄkih profesija
poput anesteziologa, psihologa, nutricionista, stomatologa i logopeda u radu multidisciplinarnog tima (MDT). Njihovo
sudjelovanje rezultira znaÄajnim poboljÅ”anjem kvalitete života bolesnika. TakoÄer predstavljamo svoja iskustva u organizaciji
i radu MDT-a u sklopu Centra za tumore glave i vrata KBC-a Zagreb
Primary malignant fibrous histiocytoma of the heart with skeletal muscles metastases
Malignant fibrous histiocytoma is an extremely rare primary malignant tumor of the heart. It is usually diagnosed when it is locally aggressive or has already metastasized. The prognosis is poor with an average survival time of one year. We report a case of recurrent left atrial malignant fibrous histiocytoma initially misdiagnosed as myxoma. The patient underwent repeated surgical resections followed by chemotherapy. Despite adjuvant chemotherapy, 18 months after initial diagnosis, definitive tumor relapse in left atrium was diagnosed. This is the 48th case of primary cardiac fibrous malignant histiocytoma reported in the literature
Immunotherapy of kidney cancer
Rak je bubrega neoplazma koja je razmjerno otporna na postojeÄu kemoterapiju, hormonsko i iradijacijsko lijeÄenje, stoga se u lijeÄenju bolesnika s rakom bubrega primjenjuju i testiraju lijekovi ili terapije s imunomodulatornim djelovanjem. U kliniÄkoj praksi, a sa svrhom imunoterapije, najÄeÅ”Äe se primjenjuju rekombinantni citokini interferon-alfa (INF-a) i interleukin-2 (IL-2). Ta dva citokina mogu izazvati terapijski odgovor u 10% do 30% bolesnika s metastatskim rakom bubrega. DugoroÄno preživljenje ipak je rijetko, neÅ”to ÄeÅ”Äe u bolesnika koji su primali visokodozni IL-2. Kako lijeÄenje raka bubrega usprkos brojnim studijama s razliÄitim terapijama nije zadovoljavajuÄe, u tijeku su i kliniÄke studije s drugim imunoterapijskim postupcima.Renal cell carcinoma (RCC) is generally resistant to standard chemotherapy, hormonal or irradiation treatments. Therefore, various drugs or therapies with immunomodulatory action were or are tested in kidney cancer patients. In clinical praxis many approaches have been investigated of which interferon-alpha (INF-") and interleukin-2 (IL-2) are the most extensively studied ones. These two cytokines can achieve response rates in 10% to 30% of patients with metastatic RCC. Long-term survival, however, is achieved only in few patients. More frequently in the ones who have been receiving high-dose IL-2. Consequently, the treatment of RCC is far from being optimal. Therefore, other and novel immunotherapeutic strategies are ongoing or planned to be tested in clinical trials
HORMONAL THERAPY OF PROSTATE CANCER: ARE THERE ANY DILEMMAS LEFT?
Strategija lijeÄenja bolesnika s adenokarcinomom prostate ovisi o procjeni proÅ”irenosti bolesti, procjeni rizika od povratka bolesti, dobi, oÄekivanom trajanju života, komorbiditetima, afinitetima i naÄinu života. Jedan od standardnih terapijskih modaliteta jest i hormonska terapija. Hormonska terapija raka prostate zapravo je terapija koja suprimira androgen (AST) ili koja terapija deprivira androgen (ADT). Njezinom primjenom dolazi do sniženja razine androgena u krvi, a kako su stanice adenokarcinoma najveÄim dijelom (Ā³80%) hormonski ovisne o androgenima, prestanak stimulacije stanica raka androgenima dovodi do njihove apoptoze, usporava se rast tumora i smanjuje se njegova veliÄina. Stoga se ta vrsta terapije rabi u lijeÄenju karcinoma prostate. Hormonska terapija indicirana je kao prvi terapijski modalitet kod nalaza metastatske bolesti. U sluÄaju primjene radioterapije na prostatu zahvaÄenu rakom s kurativnom namjerom (kod nemetastatske bolesti) preporuÄuje se primjena terapije koja deprivira androgen u bolesnika sa srednjim i visokim rizikom od povratka bolesti prije, za vrijeme i poslije radioterapije u trajanju od 6 mjeseci ili 2ā3 godine ovisno o procijenjenom riziku od povratka bolesti. U vezi s primjenom terapije koja deprivira androgen, a koja se može primijeniti na viÅ”e naÄina i u viÅ”e kombinacija, za odreÄene kliniÄke situacije ne postoje konaÄne preporuke. Razloga je viÅ”e: premalen broj odgovarajuÄih kliniÄkih studija, heterogenost bolesnika u studijama Å”to otežava interpretaciju podataka te nekonzistentni rezultati. TakoÄer, kako novije dijagnostiÄke metode i postupci omoguÄavaju ranije otkrivanje raka prostate, a ranije i sve uspjeÅ”nije lijeÄenje produžava život bolesnika s metastatskom boleÅ”Äu, rezultati Ā»ranijihĀ« kliniÄkih studija mogu gubiti na aktualnosti. Isto tako, sa sve dužim preživljenjem bolesnika sve važnija postaje kvaliteta života, odnosno nuspojave lijeÄenja, kao i procjena koristi u odnosu prema Å”tetnosti same terapije. Cilj je prikaza da upozori na novije spoznaje, kao i na moguÄe dileme o mjestu i primjeni terapije koja deprivira androgen.The strategy for treating prostate cancer patients depends on the assessment of disease extent, assessment of the risk of disease relapse, assessment of life expectancy, comorbidities, affinities and life-style. Since the activity and survival of prostate cancer cells is at least initially dependent on androgen stimulation, hormonal therapy is one of the several standard treatment modalities. Hormonal therapy is aimed at decreasing this androgen stimulation either by lowering androgen production or by blocking receptor binding. Hormonal therapy is in fact androgen-suppressive therapy (AST) or androgen-deprivation therapy (ADT). If effective, it results in the lack of cancer cell stimulation, thus causing their apoptosis and consequently decline in tumor growth and size. Hormonal therapy is used as a first-line treatment modality for metastatic disease. In addition to this indication, hormonal therapy is also used as an adjunct to radiotherapy with curative intent for patients with non-metastic disease but having an intermediate and high risk of disease relapse. In combination with radiotherapy, hormonal therapy can be applied before, concomitantly and after radiotherapy for the duration of 6 months or 2 to 3 years depending on the risk estimation. Regarding hormonal therapy, it can be applied in combination with other treatments, in several ways, and sometimes there might be several options available. This possible lack of a specific recommendation is a consequence of the fact that there is a limited number of adequate clinical studies which, moreover, may have yielded inconsistent results sometimes simply due to the patientsā heterogeneity. Moreover, thanks to the newer and better diagnostic methods enabling the discovery of prostate cancer in earlier disease stages, as well as to the more effective treatments, there is also a prolongation of relapse-free survival and possibly of overall survival in patients having metastic disease. Consequently, the results of earlier clinical studies might no longer be applicable to the new Ā»generationsĀ« of upcoming patients. As regards this improved survival, issues of patientās quality of life and possible side-effects of hormonal therapy are also becoming increasingly relevant because hormonal adverse events are time-dependant and tend to increase in severity with prolongation of hormonal manipulation. Therefore, this paper aims to give an overview of the more recent findings, indications and observations regarding hormonal therapy
Gender-Specific Growth Patterns of Transversal Body Dimensions in Croatian Children and Youth (2 to 18 Years of Age)
In a cross-sectional study of growth, 5,260 healthy children of both sexes from Zagreb (Croatia) aged 2 to 18 years
were measured. Six transversal body dimensions were studied: biacromial, transverse chest, antero-posterior chest, biiliocristal,
bicondylar humerus and bicondylar femur diamters. A significant increase in body diameters has been observed
until the age of 14 to 15 in girls and until the age of 16 in boys, showing that girls have a 1 to 2 years shorter period of
growth. Compared to boys of the same age, they achieved larger amounts of final transversal bone size throughout the
whole growth period. The most pronounced example was the knee diameter that in girls attained 95% of adult size as
early as the age of 10. In both genders, the adult size is achieved earlier in widths of the extremities than in those of the
trunk. The studied transversal body segments showed different growth dynamics, which is gender-specific. While sexual
dimorphism in pelvic and shoulder diameters emerged with pubertal spurt, gender differences in chest and extremitiesā
diameters started early in life. In all ages, boys had larger chest, elbow and knee diameters. In pubertal age boys gained a
significantly larger biacromial diameter (from the age of 13 onwards), while girls exceeded them in biiliocristal diameter
(from 10 to 14 years). The findings of gender differences were compared to those reported for other European populations
and their growth patters were discussed comparing viewpoints
CLINICAL RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH CANCER OF UNKNOWN PRIMARY SITE
Rak nepoznata primarnog podrijetla obuhvaÄa vrlo heterogenu skupinu razliÄitih malignih tumora koji se prezentiraju u metastatskoj fazi bolesti. Dijagnoza se postavlja na temelju patohistoloÅ”ke potvrde maligne bolesti uz nemoguÄnost dokaza postojanja primarnog tumora nijednom dostupnom dijagnostiÄkom metodom. Iako je opÄenito loÅ”e prognoze, prepoznati su prognostiÄki povoljni kliniÄki entiteti koji Äine temeljnu skupinu bolesnika za aktivno onkoloÅ”ko lijeÄenje. U tekstu koji slijedi sadržane su kliniÄke upute s ciljem standardizacije dijagnostiÄkih postupaka, lijeÄenja i praÄenja bolesnika s nepoznatim primarnim rakom u Republici Hrvatskoj.Cancer of unknown primary (CUP) site comprises very heterogeneous group of various malignant tumors presented in metastatic phase of the disease. Diagnosis is set when primary site remains unidentified after a thorough diagnostic evaluation in patients with histologically proven malignant metastatic disease. Despite poor prognosis in most patients, favorable prognostic clinical entities have been recognized constituting the most important group of patients for oncological treatment. The following text presents the clinical guidelines in order to standardize the diagnosis, treatment and follow-up of patients with cancer of unknown primary site in the Republic of Croatia