Clinical Outcome of Hereditary Breast Cancer in the Lithuanian Population

Breast cancer family history has been known to be one of the main cancer risk factors. Members of high-risk families should be given recommendations which may improve prophylaxis, early diagnosis and treatment. Detection of high-risk families is possible by identification of mutations in cancer susceptibility genes like BRCA1 and BRCA2 as well as by family history showing breast and/or ovary cancer aggregation. In a group of 521 breast cancer patients we identified 26 patients with hereditary breast cancer who fulfilled the following criteria: one more relative with breast cancer, vertical transmission, at least one breast cancer patient affected at the age under 50 years. 8 patients of these developed second primary breast cancer. We also compared the frequency of hereditary cancers in stage I-III with the frequency of respective cancers with negative family history. Hereditary breast cancers were diagnosed less frequently in stage I and more frequently in stage II and III (RR = 0.49, RR = 1.39, RR = 1.62, respectively). Because of importance of family history as well as genetic testing for breast cancer susceptibility genes (BRCA1/2), it is necessary to create a nationwide network of hereditary cancer clinics for proper diagnosis, treatment, and prophylaxis of these patients

Comparison of adjuvant and neoadjuvant chemotherapy in the management of advanced ovarian cancer: a retrospective study of 574 patients

BACKGROUND: There is a lack of clinical data on the validity of neoadjuvant chemotherapy in the treatment of ovarian cancer. The aim of this study was to compare the impact of the adjuvant and neoadjuvant chemotherapy regimens on the clinical outcomes in patients with advanced ovarian cancer. METHODS: We performed a retrospective analysis of 574 patients with advanced ovarian cancer admitted to four Lithuanian oncogynaecology departments during 1993–2000. The conventional combined treatment of cytoreductive surgery and platinum-based chemotherapy was applied to both the group that underwent neoadjuvant chemotherapy (n = 213) and to the control group (n = 361). The selection criterion for neoadjuvant chemotherapy was large extent of the disease. Overall and progression-free survival rates and survival medians were calculated using life tables and the Kaplan-Meier method. RESULTS: There was no difference in median overall survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (25.9 months vs. 29.3 months, p = 0.2508) and stage IV patients (15.4 months vs. 14.9 months, p = 0.6108). Similarly, there was no difference in median progression-free survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (15.7 months vs. 17.5 months, p = 0.1299) and stage IV patients (8.7 months vs. 8.2 months, p = 0.1817). There was no difference in the rate of the optimal cytoreductive surgery between patients who underwent the neoadjuvant chemotherapy and patients primarily treated with surgery (n = 134, 63% vs. n = 242, 67%, respectively). CONCLUSION: There was no difference in progression-free or overall survival and in the rate of optimal cytoreductive surgery between the neoadjuvant and adjuvant chemotherapy groups despite the fact that patients receiving neoadjuvant chemotherapy had a more extensive disease. Multivariate analysis failed to prove that neoadjuvant chemotherapy could be considered as an independent prognostic factor for survival, and the findings need to be investigated in the future prospective randomised studies

Cancer mortality differences among urban and rural residents in Lithuania

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to describe and to compare the cancer mortality rates in urban and rural residents in Lithuania.</p> <p>Methods</p> <p>Cancer mortality has been studied using the materials of the Lithuanian cancer registry. For the period 1993–2004 age-standardized urban and rural population mortality rates (World standard) were calculated for all malignant neoplasm's and for stomach, colorectal, lung, prostate, breast and cervical cancers. The annual percentage change (APC) was calculated using log-linear regression model, two-sided Mantel-Haenzel test was used to evaluate differences in cancer mortality among rural and urban populations.</p> <p>Results</p> <p>For males in rural population cancer mortality was higher than in urban (212.2 and 197.0 cases per 100000) and for females cancer mortality was higher in urban population (103.5 and 94.2 cases per 100000, p < 0.05). During the study period the age-standardized mortality rates decreased in both sexes in urban residents. The decreasing mortality trend in urban population was contributed by decline of the rates of lung and stomach cancer in male and breast, stomach and colorectal cancer in female. Mortality rates in both urban and rural population were increasing for prostate and cervical cancers.</p> <p>Conclusion</p> <p>This study shows that large rural and urban inequalities in cancer mortality exist in Lithuania. The contrast between the health of residents in urban and rural areas invites researchers for research projects to develop, implement, and enhance cancer prevention and early detection intervention strategies for rural populations.</p

Increasing thyroid cancer incidence in Lithuania in 1978–2003

BACKGROUND: The aim of this paper is to analyze changes in thyroid cancer incidence trends in Lithuania during the period 1978–2003 using joinpoint regression models, with special attention to the period 1993–2003. METHODS: The study was based on all cases of thyroid cancer reported to the Lithuanian Cancer Registry between 1978 and 2003. Age group-specific rates and standardized rates were calculated for each gender, using the direct method (world standard population). The joinpoint regression model was used to provide estimated annual percentage change and to detect points in time where significant changes in the trends occur. RESULTS: During the study period the age-standardized incidence rates increased in males from 0.7 to 2.5 cases per 100 000 and in females from 1.5 to 11.4 per 100 000. Annual percentage changes during this period in the age-standardized rates were 4.6% and 7.1% for males and females, respectively. Joinpoint analysis showed two time periods with joinpoint in the year 2000. A change in the trend occurred in which a significant increase changed to a dramatic increase in thyroid cancer incidence rates. Papillary carcinoma and stage I thyroid cancer increases over this period were mainly responsible for the pattern of changes in trend in recent years. CONCLUSION: A moderate increase in thyroid cancer incidence has been observed in Lithuania between the years 1978 and 2000. An accelerated increase in thyroid cancer incidence rates took place in the period 2000–2003. It seems that the increase in thyroid cancer incidence can be attributed mainly to the changes in the management of non palpable thyroid nodules with growing applications of ultrasound-guided fine needle aspiration biopsy in clinical practice

Krūtį tausojančios operacijos ir kombinuotojo gydymo rezultatai

Valerijus Ostapenko1, Saulius Bružas1, Algimantas Mudėnas1, Jonas Sabonis1, Algirdas Jackevičius1, Juozas Kurtinaitis1, Anatolijus Ostapenko2, Narimantas Evaldas Samalavičius1, Laima Bloznelytė-Plėšnienė1 1 Vilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08661 Vilnius2 Vilniaus universiteto Medicinos fakultetas, Čiurlionio g. 21, LT-03101 VilniusEl. paštas: [email protected] TikslasKrūtį tausojančios operacijos (KTO) pastaruoju metu yra pripažintas krūties vėžio gydymas, kuriam chirurgija teikia pirmumą. Krūtį tausojančių operacijų skaičius didėja industrinėse pasaulio šalyse, taip pat ir Lietuvoje. Šio darbo tikslas – įvertinti Vilniaus universiteto Onkologijos instituto (VUOI) KTO kombinuotojo gydymo rezultatus. Ligoniai ir metodaiDarbe atliekama retrospektyvi 349 pacienčių, sergančių I, II, III stadijos krūties vėžiu ir gydytų KTO, analizė. Visoms pacientėms buvo taikytas kombinuotasis gydymas. Ligonių amžius mediana buvo 51 metai, stebėjimo mediana – 9,4 metų. RezultataiBendras ligonių, sergančių I stadijos krūties vėžiu, penkerių išgyvenimas 93,6 % (88,3–96,5), II stadijos – 76,4 % (69,5–81,9), o III – 64,0 % (42,2–79,4). Pasitaikė 22 lokalūs recidyvai. Atkryčio išsivystymo tikimybė siekė 8,0 % (5,2 %–12,3 %). IšvadaDarbo rezultatai leidžia teigti, kad KTO įdiegus VUOI, atkryčių nepadaugėjo, o bendrieji išgyvenimo rezultatai buvo panašūs į tarptautinių randomizuotų klinikinių studijų rezultatus. Reikšminiai žodžiai: krūties vėžys, krūtį tausojančios operacijos, gydymo rezultatai. Breast preserving surgery and results of combined treatment Valerijus Ostapenko1, Saulius Bružas1, Algimantas Mudėnas1, Jonas Sabonis1, Algirdas Jackevičius1, Juozas Kurtinaitis1, Anatolijus Ostapenko2, Narimantas Evaldas Samalavičius1, Laima Bloznelytė-Plėšnienė1 1 Institute of Oncology,Vilnius University, Santariškių Str. 1, LT-08661 Vilnius, Lithuania2 Medical Faculty Vilnaus University, Čiurlionio Str. 21, LT-03101 Vilnius, LithuaniaE-mail: [email protected] BackgroundBreast conservation therapy (BCT) is now well established as an oncologically safe treatment for primary breast cancer. BCT rates are growing in industrial countries, also in Lithuania. The aim of the study was to analyze the results of combined treatment of breast conservation therapy at the Oncology Institute of Vilnius University. Patients and methodsA retrospective analysis of 376 patients with stages I, II, III breast cancer, who underwent BCT treatment at the Oncology Institute of Vilnius University in 1999–2000, was performed. The patients’ age median was 51 years and the follow-up median 9.4 years. ResultsThe overall 5-year survival in stage I was 93.6% (88.3–96.5), stage II – 76.4% (69.5–81.9), stage III – 64.0% (42.2–79.4); 22 local recurrences were observed. The cumulative probability of local recurrence was estimated to be 8.0% (5.2–12.3%). ConclusionsThe implementation of BCT at the Oncology Institute of Vilnius University did not peaked the recurrence rates, and patients’ survival was found to be comparable to the findings of randomized clinical studies. Keywords: breast cancer, breast-preserving surgery, results of combined treatment

The impact of age on post-operative outcomes of colorectal cancer patients undergoing surgical treatment

BACKGROUND: the purpose of study was to evaluate the impact of age on outcomes in colorectal cancer surgery. METHODS: patients on hospital database treated for colorectal cancer during the period 1995 – 2002 were divided into two groups: Group 1 – patients of 75 years or older (n = 154), and Group 2 – those younger than 75 years (n = 532). RESULTS: In Group 1, for colon cancers, proximal tumors were significantly more common (23% vs. 13.5%, p < 0.05), complicated cases were more frequent (46 % vs. 33%, p = 0.002), bowel obstruction more common at presentation (40% vs. 26.5%, p = 0.001), and more frequent emergency surgery required (24% vs. 14%, p = 0.003). Postoperative overall morbidity was higher in the elderly group, but with no differences in surgical complications rate. Overall 5 year survival was 39% vs. 55% (p = 0.0006) and cancer related 5 year survival was 44% vs. 62% (p = 0.0006). Multivariate Cox analysis showed that age was not an independent risk factor for postoperative mortality. CONCLUSION: Preoperative complications and co-morbidities, more advanced disease, and higher postoperative nonsurgical complication rates adversely affect postoperative outcomes after surgery for colorectal cancer in the elderly

The value of prognostic factors for uterine cervical cancer patients treated with irradiation alone

<p>Abstract</p> <p>Background</p> <p>The aim of our study was to investigate and evaluate the prognostic value of and correlations between preclinical and clinical factors such as the stage of the disease, blood Hb level before treatment, size of cervix and lymph nodes evaluated by CT, age, dose of irradiation and duration of radiotherapy related to overall survival, disease-free survival, local control and metastases-free survival in cervical cancer patients receiving radiotherapy alone.</p> <p>Methods</p> <p>162 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIA-IIIB cervical carcinoma treated with irradiation were analysed. Univariate and multivariate analyses using the Cox regression model were performed to determine statistical significance of some tumor-related factors.</p> <p>Results</p> <p>The Hb level before treatment showed significant influence on overall survival (p = 0.001), desease free survival (p = 0.040) and local control (p = 0.038). The lymph node status (>10 mm) assessed on CT had impact on overall survival (p = 0,030) and local control (p = 0,036). The dose at point A had impact on disease free survival (p = 0,028) and local control (p = 0,021) and the radiotherapy duration had showed significant influence on overall survival (p = 0,045), disease free survival (p = 0,006) and local control (p = 0,033).</p> <p>Conclusion</p> <p>Anemia is a significant and independent prognostic factor of overall survival, disease-free survival and local control in cervical cancer patients treated with irradiation. The size of lymph nodes in CT is an independent prognostic factor for overall survival and local control in cervical cancer patients. The size of cervix uteri evaluated by CT has no prognostic significance in cervical cancer patients treated with radiotherapy. The prognostic value of FIGO stage of cervical cancer is influenced by other factors, analyzed in this study and is not an independent prognostic factor.</p

Vyrų krūties vėžio diagnostika ir gydymas

Algirdas Jackevičius, Leonarda Šarakauskienė, Valerijus Ostapenko, Saulius Bružas, Juozas Kurtinaitis, Algimantas MudėnasVilniaus universiteto Onkologijos institutas,Santariškių g.1, LT-08660 VilniusKauno medicinos universiteto Onkologijos ligoninė,Volungių g. 16, LT-45434 KaunasEl paštas: [email protected] Įvadas / tikslas Vyrų krūties vėžys yra reta onkologinė liga. Šiame straipsnyje pateikiame 75 ligonių, gydytų dviejose onkologijos ligoninėse, klinikinius duomenis, tiesioginius ir vėlyvuosius gydymo rezultatus. Ligoniai ir metodai Straipsnyje nagrinėjami Vilniaus universiteto Onkologijos instituto klinikoje ir Kauno universiteto Onkologijos ligoninėje1988–2003 metais gydytų 75 vyrų, sirgusių krūties vėžiu, klinikiniai duomenys. Ligonių amžiaus vidurkis – 69,2 metų (jauniausias 41, vyriausias 90 metų). Aštuoniems (10,7%) ligoniams diagnozuotas pirmos stadijos vėžys, 35 (46,7%) – antros, 22 (29,3%) – trečios, 10 (13,3%) ligonių – ketvirtos. Pagal histologinius vėžio tipus dažniausiai diagnozuota intraduktalinė karcinoma – 40 ligonių, 8 ligoniams – lobulinė karcinoma, tačiau 14 ligonių vėžio histologinis tipas nenustatytas. Dažniausiai, t. y. 53 ligoniams, buvo atlikta modifikuota Maddeno mastektomija, aštuoniems – paprastoji mastektomija, 8 ligoniams taikyta spindulinė terapija, 6 ligoniams dėl sunkių gretutinių ligų – simptominis gydymas. 37 ligoniai gydyti kombinuotu būdų: 30 – spinduline terapija, 5 – chemoterapija, 2 – abiem gydymo metodais. Rezultatai Vėlyvieji gydymo rezultatai nebuvo geri: iš 75 gyvena 28 liginiai, 47 mirė. Penkerius metus išgyveno 83,3% (95% PI 27,3–97,5) sergančiųjų pirmos stadijos krūties vėžiu, 69,6% (95% PI 49,1–83,1) – antros stadijos ir tik 6,2% (95% PI 4,2–24,2) – trečios. Nė vienas ligonis, kuriam diagnozuota ketvirta ligos stadija, neišgyveno penkerių metų. Išvados Lietuvoje vyrų sergamumas krūties vėžiu per pastaruosius metus nepakito. Nemažai vyrų buvo gydyti nuo IIIB stadijos krūties vėžio, kai navikas jau buvo lokaliai išplitęs ir susiformavo vėžinė opa. Vyrų, sergančių trečios stadijos krūties vėžiu, prognozė yra blogesnė negu moterų. Ligos stadija nulemia ligonių gyvenimo trukmę, tai patvirtina statistinis vėlyvųjų gydymo rezultatų skaičiavimas. Reikšminiai žodžiai: vyrų krūties vėžys, diagnostika, gydymas, vėlyvieji rezultatai The diagnostics and treatment of male breast carcinoma Algirdas Jackevičius, Leonarda Šarakauskienė, Valerijus Ostapenko, Saulius Bružas, Juozas Kurtinaitis, Algimantas MudėnasVilnius University Institute of Oncology,Santariškių str. 1, LT-08660 Vilnius, LithuaniaKaunas Medical University Oncological Hospital,Volungių str. 16, LT-45434, Kaunas, LithuaniaE-mail: [email protected] Background / objective Male breast cancer is an uncommon oncological disease. In this paper, we have analysed the results of treatment of 75 patients treated in two oncologycal clinics. Patients and methods We analysed 75 male patients treated in 1988–2003 in the clinics of the Institute of Oncology of Vilnius University and Hospital of Oncology of Kaunas University of Medicine. The mean age of patients was 69.2 years (range, 46–90 years). The staging of disease: stage I 8 (10.7%) patients, stage II 35 (46.7%), stage III 22 (29.3%). Ten (13.3%) patients were treated in stage IV of the disease. The most common method of treatment was radical mastectomy by Madden which was performed in 53 cases. In 8 cases mastectomy simplex was performed. Eight patients received radiotherapy. The patients received this conservative treatment in late stages of the disease. In seven cases the patients were in poor health state, and only palliative treatment was applied. 37 patients received combined treatment: 30 patients were treated with radiotherapy, two patients received radiotherapy and chemotherapy, in 5 cases after mastectomy the patients were treated with chemotherapy. Results The follow-up results were not satisfactory: from 75 patients 28 patients are alive and 47 died. The 5-year survival of the patients according to the stage of disease: 83.3% (95% CI 27.3–97.5) of patients in stage I, 69.6% (95% CI 49.1–83.1) in stage II, stage III 6.2% (95% CI 4.2–24.2). In this period, all patients in stage IV of the disease died. Conclusions The incidence of male breast cancer in Lithuania is low, and over the last years has remained at the same level. Many of our patients had ulceration of tumor and were treated in stage III B of the disease. The prognosis of male breast cancer in stage III of the disease is worse than of female breast cancer of the same stage. The stage of the disease was statistically significant for the survival of patients. Keywords: male breast carcinoma, diagnosis, treatment, follow-up result