29 research outputs found
Zdravljenje bolnikov v zgodnjem stadiju bolezni
Stereotaktično obsevanje je natančno obsevanje, pri katerem je doza vsakega posameznega
obsevanja in skupna doza zelo visoka, skupno število pa ne presega osem obsevanj. Doza in
število frakcij sta odvisna od lege in velikosti tumorja. Na ta način obsevamo inoperabilne
bolnike z zgodnjim pljučnim rakom ali tiste, ki operacijo odklonijo. SBRT tehnika omogoča
le obsevanje tumorjev, ki so med obsevanjem vidni, ne obsevamo pa ultra-centralno ležečih
tumorjev in tistih, ki vraščajo v mediastinalne strukture. V Sloveniji obsevamo s SBRT tehniko
od leta 2016. Raziskave kažejo, da lokalne kontrole po 5 letih znašajo preko 90 %, celokupna
preživetja pa so po petih letih nekoliko slabša kot za bolnike, ki so operabilni
Imunoterapija prvič tudi za zdravljenje lokalno napredovalega nedrobnoceličnega pljučnega raka
During the last fifteen years, we have witnessed rapid development in the field of the lung cancer treatment, which remains cancer with the highest morbidity and mortality worldwide. Most patients with metastatic disease are treated with chemotherapy, targeted treatment is appropriate for less than 20% of patients with non-small cell lung cancer (NSCLC). In 2010, we were impressed by the results of research from the field of immunotherapy. Tumor cells must be recognized as foreign in order to be removed by the immune system. However, tumor cells have developed various mechanisms to escape immune control, one of which is the release of immune inhibitory molecules such as the ligand programmed cell death (PD-L1), which is the principal mediator of immunosuppressive action. Medicinal products which are currently used to treat metastatic NSCLC are monoclonal antibodies against PD-L1 or PD-1. By binding to PD-L1 or its PD-1 receptor on immune cells, they prevent the immunosuppressive effect and enable the activated T lymphocytes to function successfully. In Slovenia, two medicinal products with the described mode of action are registered, nivolumab and pembrolizumab. At the ESMO 2017 Congress, the results of PACIFIC study showing benefit with immunotherapy treatment also in locally advanced patients with NSCLC were presented. Patients had received durvalumab or placebo after standard treatment with chemoradiotherapy. In the group treated with durvalumab, the progression-free survival was significantly longer. The synergistic effect of irradiation, a widely recognized method of local treatment, in combination with immunotherapy, blurs the boundaries between the systemic and local treatment of cancer, as has been shown by numerous pre-clinical studies. Future research will provide answers which method of combining immunotherapy and irradiation is most appropriate.V zadnjih petnajstih letih smo priča hitremu razvoju na področju zdravljenja pljučnega raka, ki ostaja v svetovnem merilu še vedno rak z najvišjo obolevnostjo in umrljivostjo. Večina bolnikov z metastatsko boleznijo se zdravi s kemoterapijo (KT), tarčno zdravljenje je primerno za manj kot 20% bolnikov z nedrobnoceličnim pljučnim rakom (NDPR). V letu 2010 so nas navdušili rezultati raziskav na področju imunoterapije. Tumorske celice morajo biti prepoznane kot tuje telesu, da jih imunski sistem lahko odstrani. Vendar so tumorske celice razvile različne mehanizme za izmikanje imunskemu nadzoru, eden od teh je tudi sproščanje imunskih zaviralnih molekul kot je ligand programirane celične smrti (PD-L1), ki je glavni mediator imunosupresivnega delovanja. Zdravila, ki se trenutno uporabljajo za zdravljenje metastatskega NDPR, so monoklonska protitelesa proti PD-L1 ali PD-1. Z vezavo na PD-L1 ali njegov receptor PD-1 na imunskih celicah preprečijo imunosupresiven učinek in omogočijo uspešno delovanje aktiviranih T limfocitov. V Sloveniji sta registrirani dve zdravili z opisanim načinom delovanja, nivolumab in pembrolizumab. Na kongresu ESMO 2017 pa so bili predstavljeni rezultati raziskave PACIFIK, ki opisujejo dobrobit zdravljenja z imunoterapijo tudi pri lokalno napredovalih bolnikih z NDPR. Bolniki so po standardnem zdravljenju s kemoradioterapijo prejemali durvalumab ali placebo. V skupini, zdravljeni z durvalumabom, je bil čas brez napredovanja bolezni značilno daljši. Sinergistično delovanje obsevanja, ki je splošno priznan način lokalnega zdravljenja, v kombinaciji z imunoterapijo briše meje med sistemskim in lokalnim načinom zdravljenja raka, kar so pokazale tudi številne predklinične raziskave. Bodoče raziskave bodo podale odgovore, kateri način kombiniranja imunoterapije in obsevanja je najbolj primeren
Stereotaktična radioterapija telesa pri bolnikih s pljučnim rakom
Stereotactic body radiation therapy (SBRT) is used for treatment of early stage lung cancer for patients without lymph node involvement. The standard treatment option for early disease is surgical resection; however, this type of treatment might be too risky due to age, co-morbidities and an impaired lung function. Traditionally, the three-dimensional conformal radiotherapy (3D CRT), radiofrequency ablation or symptomatic palliative treatment have been used for these patients in the past, but significantly worse local control of disease and survival rates were achieved compared to surgery. The SBRT technique offers patients with lung cancer treatment results comparable to surgery and a lower risk of impaired lung function compared to the standard 3D CRT. Due to a lower number of fractions, the whole treatment is shorter and more convenient for the patient. This enables patients a better treatment outcome and an increased quality of life; and therefore it has become part of the global guidelines for treatment of inoperable lung cancer in the early stages of the disease and for those who refuse surgery.Stereotaktična radioterapija telesa (SBRT) bolnikov s pljučnim rakom je metoda zdravljenja bolnikov v zgodnjem stadiju bolezni, ki nimajo prizadetih regionalnih bezgavk. Standardno so ti bolniki zdravljeni z operacijo, ki pa je lahko preveč tvegana zaradi starosti, spremljajočih bolezni ali slabe pljučne funkcije. V teh primerih smo bolnikom nudili druge načine zdravljenja, kot so tridimenzionalno konformno obsevanje, radiofrekvenčna ablacija ali pa le podporna terapija. S temi pristopi je bila kontrola rakave bolezni in preživetje bolnikov občutno slabše kot z operacijo. Obsevanje s tehniko SBRT pa bolnikom ponuja primerljive rezultate zdravljenja kot operacija ob manjšem tveganju za poslabšanje pljučne funkcije kot standardno obsevanje. Zaradi manjšega števila obsevanj je zdravljenje krajše in bolnikom bolj prijazno. Vse to bolnikom omogoča boljši izid zdravljenja in boljšo kakovost življenja ter je zato že postalo del svetovnih smernic za zdravljenje neoperabilnega raka pljuč v zgodnjem stadiju bolezni in tistih, ki operacijo odklonijo
Stereotactic body radiation therapy (SBRT) in patients with lung cancer
Stereotaktična radioterapija telesa (SBRT) bolnikov s pljučnim rakom je metoda zdravljenja bolnikov v zgodnjem stadiju bolezni, ki nimajo prizadetih regionalnih bezgavk. Standardno so ti bolniki zdravljeni z operacijo, ki pa je lahko preveč tvegana zaradi starosti, spremljajočih bolezni ali slabe pljučne funkcije. V teh primerih smo bolnikom nudili druge načine zdravljenja, kot so tridimenzionalno konformno obsevanje, radiofrekvenčna ablacija ali pa le podporna terapija. S temi pristopi je bila kontrola rakave bolezni in preživetje bolnikov občutno slabše kot z operacijo. Obsevanje s tehniko SBRT pa bolnikom ponuja primerljive rezultate zdravljenja kot operacija ob manjšem tveganju za poslabšanje pljučne funkcije kot standardno obsevanje. Zaradi manjšega števila obsevanj je zdravljenje krajše in bolnikom bolj prijazno. Vse to bolnikom omogoča boljši izid zdravljenja in boljšo kakovost življenja ter je zato že postalo del svetovnih smernic za zdravljenje neoperabilnega raka pljuč v zgodnjem stadiju bolezni in tistih, ki operacijo odklonijo.Stereotactic body radiation therapy (SBRT) is used for treatment of early stage lung cancer for patients without lymph node involvement. The standard treatment option for early disease is surgical resectionhowever, this type of treatment might be too risky due to age, co-morbidities and an impaired lung function. Traditionally, the three-dimensional conformal radiotherapy (3D CRT), radiofrequency ablation or symptomatic palliative treatment have been used for these patients in the past, but significantly worse local control of disease and survival rates were achieved compared to surgery. The SBRT technique offers patients with lung cancer treatment results comparable to surgery and a lower risk of impaired lung function compared to the standard 3D CRT. Due to a lower number of fractions, the whole treatment is shorter and more convenient for the patient. This enables patients a better treatment outcome and an increased quality of lifeand therefore it has become part of the global guidelines for treatment of inoperable lung cancer in the early stages of the disease and for those who refuse surgery