16 research outputs found
OzraÄivanje slezene u bolesnika sa zloÄudnim i drugim hematoloÅ”kim bolestima ā iskustva jedne bolniÄke ustanove
Splenic irradiation has long been known as a palliative treatment modality in patients with various malignant hematologic diseases aiming to ameliorate clinical symptoms of splenomegaly as well as clinical sequels of hypersplenism. It provides considerable effect with low toxicity although exact radiotherapy dose and fractionation schedule are not known. During the 1996-2010 period, eleven patients were treated at our institution with splenic irradiation. They received 16 courses of fractionated radiotherapy. There were six patients with non-Hodgkinās lymphoma, four with chronic lymphocytic leukemia, and one patient with myelofibrosis. The median of the dose received was 7 Gy, while the median of dose received per fraction was 1 Gy. Both parallel opposed anterior-posterior fields and tangential fields were used. Due to the clinical target volume shrinkage, the treatment field was reduced in 44% of courses. Of the courses initiated for symptom control, 71% resulted in effective palliation, whereas of the courses started to treat hematologic sequels of hypersplenism 50% produced desirable effects. The most common side effects included thrombocytopenia and anemia. Splenic irradiation provides effective and low-toxic palliation of symptoms but it is much less successful in treating hematologic disorders caused by hypersplenism.OzraÄivanje slezene je najstariji poznati naÄin palijativnog lijeÄenja bolesnika s razliÄitim zloÄudnim hematoloÅ”kim bolestima. Ima za cilj umanjiti kliniÄke simptome splenomegalije, kao i posljedice hipersplenizma. OzraÄivanje slezene ima znaÄajan uÄinak uz nisku toksiÄnost, ali toÄna radioterapijska doza kao i naÄin frakcioniranja nisu poznati. IzmeÄu 1996. i 2010. godine 11 bolesnika je lijeÄeno u naÅ”oj ustanovi ovim postupkom. Ti bolesnici su primili ukupno 16 aplikacija frakcioniranog zraÄenja. Å est bolesnika je imalo ne-Hodgkinov limfom, Äetiri kroniÄnu limfatiÄnu leukemiju, a jedan bolesnik je imao mijelofibrozu. Medijan aplicirane tumorske doze bio je 7 Gy, a medijan aplicirane doze po frakciji 1 Gy. KoriÅ”tena su nasuprotna paralelna te tangencijska radioterapijska polja. Zbog smanjenja kliniÄkog ciljnog volumena terapijsko polje je tijekom postupka radioterapije smanjeno u 44% radioterapijskih aplikacija. Od radioterapijskih postupaka zapoÄetih s ciljem kontrole simptoma 71% ih je rezultiralo uspjeÅ”nom palijacijom, dok je od postupaka koji su zapoÄeti radi popravka hematoloÅ”kih posljedica hipersplenizma njih 50% izazvalo željeni uÄinak. NajÄeÅ”Äe nuspojave bile su trombocitopenija i anemija. OzraÄivanje slezene omoguÄuje uÄinkovitu i nisko toksiÄnu palijaciju simptoma, ali je manje uspjeÅ”no u lijeÄenju hematoloÅ”kih poremeÄaja uzrokovanih hipersplenizmom
Radiation Therapy in Treatment of Fibrodysplasia Ossificans Progressiva: A Case Report and Review of the Literature
Fibrodysplasia ossificans progressiva (FOP) is an extremely rare genetic disorder with diffuse extra-skeletal bone formation.
The genetic mutation responsible for FOP has recently been discovered and is connected with excessive activation
of bone morphogenetic protein receptor. This disease usually begins with typical ossification pattern in early childhood,
causing increasing disability and making patients totally disabled by the age of 30. Ectopic ossification develops
spontaneously and can be triggered by any trauma and even intramuscular injections. The symptoms of FOP are often
misdiagnosed as cancer, causing unnecessary biopsies, which can precipitate further progressive heterotopic ossification.
There is no effective treatment for this severe condition. Radiotherapy can be helpful in impeding ossification, although
the strict evidence for that is lacking. There are only two reports in the literature referring to the use of radiotherapy in
treatment of FOP. Herein, we present a 35-year-old patient successfully treated with small doses of fractionated radiotherapy
in several courses. This case indicates that radiotherapy can be useful in treating patients with FO
Imunoterapija karcinoma bubrega
Targeted therapy has been the standard of care for the treatment of metastatic renal cell carcinoma (mRCC). The current standard of care focuses on tyrosine kinase inhibitors (sunitinib, sorafenib, pazopanib, axitinib), antibodies to circulating VEGF receptor (bevacizumab) and m-TOR inhibitors (temsirolimus, everolimus). New immune-based therapies are emerging as a promising treatment for mRCC. Immune checkpoint blockade has shown clinically signifi cant antitumor response. Monoclonal antibodies against immune checkpoint blockade molecules including PD-1 (programmed cell death 1) and CTLA-4 (cytotoxic T lymphocyte antigen 4) have become a major focus in the immune-based therapy since it has been reported that they have impressive antitumor eff ects.
The most studied inhibitors in the PD-1 pathway are: nivolumab, pembrolizumab and atezolizumab. Based on the results of the phase III clinical trial (CheckMate025) nivolumab, humanized monoclonal IgG4 antibody against PD-1, is the only agent that is approved by the FDA for the second-line treatment of mRCC. Ipilimumab is the fi rst-in-class immunotherapeutic for blockade of CTLA-4. The immunotherapy combinations have demonstrated promising results in a randomized
trials. The use of cancer treatment vaccines is another approach to immunotherapy and will be systematically evaluated in the future.
Immunotherapy has demonstrated great clinical potential and it represents crucial component of mRCC treatment. Developing immunotherapy to the point of clinical utility presents a number of issue and challenges, and more rigorous studies are needed.Ciljana terapija danas predstavlja osnovicu sistemskog lijeÄenja metastatskog raka bubrega (mRB), a standard lijeÄenja su tirozin-kinazni inhibitori (sunitinib, sorafenib, pazopanib, aksitinib), protutijela na cirkulirajuÄi VEGF receptor (bevacizumab) i m-TOR inhibitori (temsirolimus, everolimus). Noviji imunoterapijski principi predstavljaju znaÄajne iskorake u lijeÄenju mRB. Jedna forma imunoterapije je inhibicija imunoloÅ”kih kontrolnih toÄaka (eng. immune checkpoint). Blokiranjemjednog od dva najistraživanija imunoloÅ”ka receptora; antigen 4 povezan s aktivnoÅ”Äu citotoksiÄnih T-limfocita (CTLA-4) i receptor programirane staniÄne smrti (PD-1), potenciramo antitumorski imunoloÅ”ki odgovor.
MeÄu najistraživanije anti-PD-1 inhibitore ubrajamo: nivolumab, pembrolizumab i avelumab. Nivolumab je ljudsko monoklonalno antitijelo kojega je AmeriÄka agencija za hranu i lijekove odobrila u drugoj liniji lijeÄenje mRB, a na osnovi rezultata kliniÄke studije faze III (CheckMate025). Ipilimumab je prvi registrirani checkpoint inhibitor koji blokira inhibitorni signal (CTLA-4 receptor) na povrÅ”ini citotoksiÄnih T limfocita. Veliki pomak u imunoterapiji mRB postigut je primjenom
konkomitantnih protokola lijeÄenja. Novija istraživanja primjene imunoterapije u lijeÄenju raka bubrega ukljuÄuju i pronalaženje cjepiva koje bi prepoznavalo i uniÅ”tavalo promijenjene tumorske stanice.
Imunoterapija ima jasno mjesto i veliki potencijal u lijeÄenju raka bubrega. Ipak, postoji joÅ” niz problema i pitanja te su potrebna brojna daljnja istraživanja kako bi se iskoristio njen puni potencijal
Parenhimni angiosarkom poslije zraÄenja: prikaz sluÄaja
Secondary angiosarcoma is an aggressive tumor that can develop in breast cancer patients treated with conserving therapy and radiotherapy. The symptoms can be misleading, whereas mammography and fine-needle aspiration (FNA) are typically negative in early stage of the disease. A high grade of clinical suspicion is very important for early diagnosis. A case of angiosarcoma involving breast parenchyma in a patient treated with quadrantectomy and radiotherapy for T1cN1Mx breast carcinoma is presented.Sekundarni angiosarkom je agresivni tumor koji se može razviti kod bolesnica s rakom dojke lijeÄenih terapijom oÄuvanja i radioterapijom. Simptomi mogu dovesti u zabunu, dok su mamografija i citoloÅ”ka punkcija redovito negativne u ranom stadiju bolesti. Za ranu dijagnozu vrlo je važna visoka kliniÄka sumnja na ovu bolest. Prikazuje se sluÄaj angiosarkoma koji je zahvatio parenhim dojke u bolesnice lijeÄene kvadrantektomijom i radioterapijom zbog raka dojke T1cN1Mx
Clinical recommendations for diagnosis, treatment and monitoring of patients with bladder cancer
Rak mokraÄnog mjehura (RMM) jest, u skladu s podatcima hrvatskog Registra za rak iz 2015. godine, drugi prema uÄestalosti tumor urinarnog sustava, odmah nakon raka prostate. U 90% sluÄajeva radi se o urotelnom karcinomu, a razlika u preživljenju kod bolesnika s miÅ”iÄnoinvazivnim RMM-om (MIRMM) i nemiÅ”iÄnoinvazivnim RMM-om (NMIRMM) znatna je. LijeÄenje NMIRMM-a usmjereno je na smanjenje recidiva i sprjeÄavanje napredovanja bolesti, a sastoji se od transuretralne resekcije (TUR) tumora i primjene intravezikalne terapije ovisno o procjeni rizika od povrata bolesti. Temelj lijeÄenja bolesnika s MIRMM-om jest radikalno kirurÅ”ko lijeÄenje, tj. cistektomija kojoj u bolesnika koji su sposobni primiti cisplatinu prethodi neoadjuvantna kemoterapija (NKT). U trenutku postavljanja dijagnoze bolest je kod 4 ā 6% bolesnika proÅ”irena, dok Äe se u 50% bolesnika razviti povrat bolesti nakon cistektomije. Metode lijeÄenja proÅ”irenje bolesti ukljuÄuju: kemoterapiju temeljenu na cisplatini, imunoterapiju, palijativnu radioterapiju te simptomatsko i potporno lijeÄenje. Važno obilježje RMM-a jest prisutnost visoke stope somatskih mutacija koje su omoguÄile promjenu paradigme u lijeÄenju proÅ”irenog RMM-a i dovele do odobravanja niza novih lijekova koji pripadaju inhibitorima PD-1 i PD-L1, tj. inhibitorima nadzornih toÄaka imunosnog odgovora posredovanog T-stanicama .Bladder cancer is the second most common malignancy of urinary system according to data from the Croatian National Cancer Registry for 2015. In 90% of cases the underlying histology is urothelial carcinoma.
Difference in survival in patients with muscle-invasive disease (MIBC) compared to the survival of patients with non-muscle invasive disease (NMIBC) is enormous. Management of NMIBC, traditionally, has been focused on the reduction of subsequent bladder recurrence and prevention of disease progression and is primarily based on transurethral resection (TUR) of the tumor, followed by intravesical therapy based on estimated individual risk of recurrence. Conversely, in patients with MIBC radical cystectomy remains the corne stone of the treatment, optimally in conjunction with neoadjuvant platinum-based chemotherapy in cisplatin-eligible patients. At the moment of
diagnosis, 4ā6% of patients already have distant metastases, and post cystectomy recurrence could be expected in 50% of patients. Treatment options in metastatic disease range from cisplatin-based chemotherapy, immunotherapy, palliative radiotherapy and finally supportive care. Landmark feature of bladder cancer is the high prevalence
of somatic mutations which enabled profound change for decades held treatment paradigm for advanced bladder cancer leading to regulatory approval of whole array of novel immunotherapy agents. These emerging therapeutics (programmed death ligand-1 (PD-L1) and programmed cell death protein-1 (PD-1)) belong to the
class of inhibitors of checkpoint proteins, which are key targets that regulate T-cell mediated immune response
KliniÄke upute za dijagnostiku, lijeÄenje i praÄenje bolesnika oboljelih od raka mokraÄnog mjehura Hrvatskoga onkoloÅ”kog druÅ”tva i Hrvatskoga uroloÅ”kog druÅ”tva Hrvatskoga lijeÄniÄkog zbora [Clinical guidelines for diagnosing, treatment and monitoring patients with bladder cancer - Croatian Oncology Society and Croatian Urology Society, Croatian Medical Association]
Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-GuƩrin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia
Clinical guidelines for diagnostics, treatment and monitoring of patients with testicular cancer
Rak testisa najÄeÅ”Äi je solidni tumor u muÅ”karaca u dobi od 15. do 34. godine. Incidencija raka testisa u svijetu udvostruÄena je u posljednjih 40 godina. Tumori zametnih stanica Äine 95% svih tumora testisa, a podijeljeni su u dva osnovna histoloÅ”ka tipa: seminomi i neseminomi. Osobito znaÄenje daje im velik postotak izljeÄivosti i u diseminiranoj fazi bolesti. Tom je uspjehu najviÅ”e pridonijela kemoterapija, ali kirurgija je i dalje neizostavan dio uspjeÅ”nog lijeÄenja. U znatnog dijela bolesnika danas se nastoji odrediti terapijski minimum kojim se izbjegava niz nuspojava, a dovodi do jednakog uspjeha kao i donedavno agresivniji terapijski pristup. U tekstu koji slijedi iznesene su kliniÄke upute radi standardizacije dijagnostike, lijeÄenja i praÄenja bolesnika s tumorima
zametnih stanica testisa u Republici Hrvatskoj.Testicular tumors are the most common solid tumors in men between age 15- 34 years. The worldwide incidence of these tumors has doubled in the past 40 years. Germ cell tumors comprise 95% of malignant
tumors arising in the testes and they are classified as seminoma and nonseminoma. Testicular cancer has high cure rates even in disseminated stage of disease. The chemotherapy mostly contributed to these results, but surgery is an unavoidable part of this success. In significant number of these patients treatment algorithms today
have intention to offer the same cure rates with minimally aggressive therapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for diagnosis, treatment, and follow-up of patients with testicular cancer in the Republic of Croatia