Kemoterapija u liječenju epitelnog raka jajnika

Systemic chemotherapy following the appropriate surgical procedure is the cornerstone of first – line treatment of epithelial ovarian malignancy. Ovarian carcinoma is the leading cause of cancer deaths of the female reproductive system. Early – stage ovarian carcinoma is generally asymptomatic; therefore , the majority of women are diagnosed with advanced – stage disease (FIGO stage III or IV). Five – year survival rates for women with stage III or IV disease range from less than 5% to 20%. Current systemic therapy for ovarian cancer consists of combination of carboplatin and paclitaxel. While the majority of patients achieve clinical complete remission after six cycles of chemotherapy , the relapse rate stands at over 50%. Median survival time for patients after recurrence is approximately 2 years. New treatment approaches for patients with advanced ovarian cancer include consolidation and maintenance therapy, intraperitoneal administration of cytotoxic agents, new combination chemotherapy regimens, the development of new cytotoxic agents, and molecular-target therapies. Palliation and optimizing quality of life as the primary treatment goals for patients with recurrence, as the probability of cure for this population is remote. Patients with recurrent ovarian carcinoma are typically divided into two groups with differing prognoses. Patients with progression on primary therapy or after a treatment-free interval of less than 6 months are considered platinum-resistant; those who relapse or develop progression after a treatment-free interval of greater than 6 months after chemotherapy are platinum sensitive. Platinum sensitive patients are more likely to demonstrate a response to subsequent chemotherapy: therefore, they have a more favorable prognosis.Sistemska kemoterapija nakon odgovarajućeg kirurškog zahvata temelj je terapije prvoga reda u liječenju epitelnog raka jajnika. Karcinom jajnika je glavni uzrok smrti od raka ženskog spolnog sustava. Početni stadij raka jajnika obično je bez simptoma pa se stoga u većine žena dijagnosticira tek u uznapredovalom stadiju (FIGO stadij III. ili IV.). Petogodišnje stope preživljenja u žena sa stadijem bolesti III. ili IV. kreću se od manje od 5% do 20%. Sistemska terapija koja se trenutačno primjenjuje u liječenju raka jajnika, sastoji se od kombinacije karboplatina i paklitaksela. Premda većina bolesnica postiže kliničku potpunu remisiju nakon šest ciklusa kemoterapije, stopa relapsa i dalje je veća od 50%. Medijan preživljenja za bolesnice nakon ponovne pojave bolesti je otprilike 2 godine. Novi pristupi uliječenju za bolesnice s uznapredovalim rakom jajnika uključuju konsolidaciju i terapiju održavanja, intraperitonejsku primjenu citotoksičnih lijekova, nove kombinacije kemoterapijskih shema, razvoj novih citotoksičnih lijekova i lijekova koji djeluju na ciljane molekule. Palijacija i postizanje optimalne kvalitete života postavljeni su kao primarni ciljevi u liječenju bolesnica u kojih se bolest ponovno pojavila jer su za tu populaciju izgledi za izlječenje slabi. Bolesnice u kojih se rak jajnika ponovno pojavio obično se dijele u dvije skupine koje se razlikuju prema prognozi bolesti. Bolesnice u kojih je došlo do progresije dok su primale primarnu terapiju ili nakon razdoblja od manje od 6 mjeseci u kojemu nisu primale terapiju, smatraju se otpornima na platinu; one u kojih se bolest pogoršala ili u kojih je došlo do progresije nakon što više od 6 mjeseci nakon kemoterapije nisu primale nikakvu terapiju, osjetljive su na platinu. Veća je vjerojatnost da će bolesnice osjetljive na platinu reagirati na sljedeću kemoterapiju: prognoza je za njih stoga povoljnija

Topotekan u liječenju recidiva raka jajnika

Topotecan is an efficacious agent in the treatment of ovarian cancer recurrence after the failure of primary chemotherapy with platinum and its derivatives. Twenty-five patients with recurrent ovarian cancer were treated with topotecan at the Department of Gynecologic Oncology, Clinic for Gynecology and obstetrics, Clinical Hospital Zagreb in the period from January 2004 – January 2005. All patients were primarily operated and assessed as stage III or IV of ovarian cancer, and therefore received chemotherapy with platinum (in combination with paclitaxel or cyclophosphamide). After their first recurrence in a less than a 6-month interval, topotecan was administered. A complete clinical response was achieved in 2 patients (8%), a partial response in 15 patients (60%), progression in 8 patients (32%). All patients receiving topotecan were without early reactions (GI- nausea, vomiting), and experienced only mild late reactions (moderate myelosupression). Eight, 9, 6 and 2 patients received 6, 4, 2 and 1 treatment cycles, respectively. Based upon the low number of patients included in the study, we may say that topotecan is well tolerated, without significant early and late side-effects and with satisfying treatment response in patients with recurrent ovarian cancer, who are resistant to chemotherapy with platinum.Topotekan je djelotvoran citostatik u liječenju recidiva raka jajnika nakon neuspjeha primarne kemoterapije s platinom i njenim derivatima. Na Zavodu za ginekološku onkologiju Klinike za ženske bolesti i porode KBC Zagreb u razdoblju od 01/04 – 01/05 liječili smo 25 bolesnica s recidivom raka jajnika topotekanom. Sve bolesnice su bile primarno operirane i stupnjevane kao III ili IV stadij raka jajnika zbog čega su primale kemoterapiju s platinom (u kombinaciji s paklitakselom ili ciklofosfamidom). Nakon pojave prvog recidiva u vremenu kraćem od 6 mj primjenili smo topotekan. Kompletni klinički odgovor postigli smo kod 2 bolesnice (8%), djelomični odgovor u 15 bolesnica (60%), progresiju u 8 bolesnica (32%). Sve bolesnice podnijele su primjenu topotekana bez ranih reakcija (GI- mučnine, povraćanje), uz blage kasne reakcije (umjerena mijelosupresija). Osam bolesnica primilo je 6 ciklusa, 9 je primilo po 4 ciklusa, 6 bolesnica po 2 ciklusa, 2 bolesnice po jedan ciklus. Zaključak: na osnovi našeg malog broja bolesnica možemo reći da se topotekan dobro podnosi bez značajnijih ranih i kasnih nusdjelovanja uz zadovoljavajući odgovor na liječenje u bolesnica s recidivom jajnika koje su rezistentne na kemoterapiju s platinom

ROLE OF NEOADJUVANT CHEMOTHERAPY IN THE ADVANCED OVARIAN CANCER

Primarni kirurški zahvat i danas se još smatra temeljem liječenja lokalno uznapredovalog epitelnog raka jajnika. Kemoterapija uobičajeno slijedi nakon provedene operacije. No, preživljenje bolesnica s uznapredovalim epitelnim rakom jajnika, prema International Federation of Gynecology and Obstetrics (FIGO) stadiji IIIC i IV, koje čine više od 75% svih bolesnica s rakom jajnika još ne zadovoljava. U tih bolesnica često nije moguće provesti adekvatnu resekciju svih promjena u abdomenu (optimalni »debulking« – odstranjenje svih vidljivih tumorskih promjena u abdomenu) pa je učinkovitost citostatika smanjena. Zbog toga se kao mogući optimalni pristup nameće prijeoperativna kemoterapija (neoadjuvantna) koja dovodi do smanjenja primarnog tumora i mogućih presadnica po abdomenu. Takvim pristupom omogućava se kraći i jednostavniji kirurški zahvat nakon 3–4 ciklusa kemoterapije uz veću vjerojatnost optimalnog smanjenja tumorskih masa u abdomenu. Neoadjuvantna kemoterapija (NAC) epitelnog raka jajnika danas je jedna od mogućnosti uspješnog liječenja uz značajno smanjenje postoperativnih komplikacija u bolesnica lošijeg općeg stanja ili primarno inoperabilne bolesti.Primary surgery is still thought as cornerstone in treating locally advanced epithelial ovarian cancer. Subsequent to surgery is usually chemotherapy. Survival of patients with advanced epithelial ovarian cancer, according to International Federation of Gynecology and Obstetrics (FIGO) stage IIIC and IV, who make over 75% of total patients with ovarian cancer is still unsatisfactory. With these patients it is often impossible to perform adequate resection of all changes in the abdomen (optimal debulking) and so is the effectiveness of chemotherapy decreased. Therefore as a possible optimal approach appears neoadjuvant chemotherapy (NAC) that leads to the decreasing of the primary tumour and possible metastasis in the abdomen. With such an approach an operation procedure is shorter and easier after 3–4 cycles of chemotherapy with a stronger possibility of optimal »debulking«

INFLUENCE OF THE HORMONAL REPLACEMENT THERAPY ON MAMMOGRAPHIC CHANGES

Cilj istraživanja. Do danas nije točno određeno koliko često treba raditi mamografije ženama koje uzimaju hormonsko nadomjesno liječenje (HNL), pa smo odlučili provesti retrogradnu analizu mamografskih nalaza žena koje su na HNL. Želja nam je izdvojiti rizičnu skupinu žena, koje imaju povišeni rizik za razvoj raka dojke i koje bi trebalo češće kontrolirati. Materijal i metode. Istraživanje je obuhvatilo 79 žena koje uzimaju HNL. U svih njih je prije započinjanja HNL učinjena mamografija. Ispitanice su podijeljene u dvije skupine: u 39 žena kontrolni pregled uz mamografiju je ponovljen nakon jedne godine, a u 40 žena je kontrolna mamografija učinjena nakon dvije godine. Mamografski nalazi su klasificirani prema Wolfeu. U ispitanica je promatrano nekoliko parametara za koje se pretpostavilo da bi mogli utjecati na povećanje rizika za pojavu raka dojke. To su: osobna anamneza, obiteljska anamneza, broj poroda, dojenje, prethodna hormonska terapija te tip HNL. Rezultati. Mlađe žene u prosjeku uzimaju gestagensku hormonsku terapiju, a starije su uglavnom na kombiniranoj hormonskoj terapiji. Nije uočeno da vrsta HNL utječe na mamografski nalaz. U obje skupine ispitanica je u jednolikim udjelima došlo do pogoršanja ili poboljšanja mamografskog nalaza. Pogoršanje nalaza nađeno je u 5% žena koje su uzimale HNL jednu godinu te u 10% žena koje su primale HNL dvije godine. Zaključak. Kratkotrajno uzimanje HNL ne utječe na mamografski nalaz, te se mamografija može raditi jednom u dvije godine u žena koje uzimaju HNL.Objective. To date is not clear how often mammography should be performed in women on hormonal replacement therapy (HRT). We decided to make a retrograde analysis of mammograms in women on HRT in order to identify women at risk of breast cancer, who require more frequent follow-up examinations. Material and methods. The study included 79 women on HRT. All of them have performed mammography before introducing HRT. The patients were randomly assigned in two groups: in 39 patients clinical and mammographic follow-up was repeated after 1 year and in 40 patients after 2 years. The mammograms were classified according to Wolfe’s classification. Several parameters which were expected to potentially influence the risk of breast cancer were observed. These parameters include: personal history, family history, number of deliveries, lactation, earlier hormonal therapy and type of HRT. Results. The younger women on average are more often on progestin therapy while older women use a combined hormonal therapy. The type of HRT has not been observed to have any influence on mammograms. In both groups mammogram changes were observed in similar proportions of patients, e.g. no significant difference was observed. The follow-up mammogram was worse in 5% of the women on HRT during 1 year and 10% in the women on HRT during 2 years. Conclusion. The short-term use of HRT does not appear to have any influence on mammogram and it could be repeated every two years in women on HRT

Koriokarcinom maternice – prikaz slučaja

Choriocarcinoma is one of the histological types of entities called gestational trophoblastic neoplasia (GTN) that refers to a rare group of malignancies that are formed by abnormal proliferation of trophoblastic tissue. Choriocarcinoma is the most aggressive GTN histological type and is characterized by early vascular invasion and disseminated disease. The clinical presentation depends on the spread of the disease and the location of the seedlings. In this paper we present the case of a 32-year-old patient sent to our Department for a specific oncological treatment of uterine choriocarcinoma diagnosed in an external institution. The disease is according to FIGO and WHO scale classified as III stage, low risk and chemotherapy with methotrexate and folic acid is indicated. The chemotherapy achieved negativity of the initially elevated tumor marker human chorionic gonadotropin (hCG) and full regression of lesions described in computerized tomography (CT).Koriokarcinom jedan je od histoloških tipova gestacijske trofoblastične neoplazije (GTN), rijetke skupine malignoma nastale abnormalnom proliferacijom tkiva trofoblasta i predstavlja najagresivniji histološki tip GTN. Odlikuje se ranim krvožilnim bujanjem i udaljenim presadnicama. Klinička slika ovisi o proširenosti bolesti i smještaju presadnica. U ovom radu prikazan je slučaj 32 godišnje bolesnice upućene u našu ustanovu radi specifičnog liječenja koriokarcinoma maternice dijagnosticiranog u drugoj ustanovi. Bolest je prema FIGO i WHO ljestvici klasificirana u III stadij niskog rizika. Liječenje metotreksatom i folnom kiselinom dovelo je do negativizacije početno izrazito povišenog tumorskog biljega humanog korionskog gonadotropina (hCG) i potpunog povlačenja promjena opisanih CT-om

Podnošljivost bevacizumaba u bolesnica starije dobi oboljelih od raka jajnika: iskustvo Zavoda za ginekološku onkologiju u Kliničkom bolničkom centru Zagreb

Introduction: Bevacizumab is a recombinant humanized anti-VEGF monoclonal antibody. It is an effective treatment for epithelial ovarian cancer, both in primary and recurrent disease. The incidence of ovarian cancer increases with advancing age. Despite the high prevalence of the ovarian cancer in elderly, the management of these patients is often less aggressive than in younger patients. In Croatia, from February 2017, we have opportunity to treat patients with epithelial ovarian, fallopian tube, or primary peritoneal cancer with bevacizumab in the first-line and second-line settings. Our aim was to investigate the safety of bevacizumab administration in patients older than 65 years. Methods: We have retrospectively analyzed the archive data of 65 patients with epithelial ovarian, fallopian tube, or primary peritoneal cancer who started treatment with bevacizumab in primary advanced and in first relapse setting at the Department of Gynecologic Oncology in the University Hospital Centre Zagreb in the period from January 2017 to December 2018. Patients were divided in two categories according to age: group 1 (≤65 years) and group 2 (>65 years). Results: Our analysis included 65 patients:47 (72.3%) patients in group 1 compared with 18 (27.7%) in group 2. Bevacizumab was administered to 39 (60%) patients as first-line treatment and to 26 (40%) patients as second-line treatment. The median age was 70 years (range 66-76 years) in group 2 and 55 years (range 35-65 years) in group 1. ECOG status 0 had 44.7% of patients in group 1 compared with only 22% in group 2. At the time of diagnosis, elderly patients had presented with at least one comorbidity in 94.4% of the cases, compared with 42.6% in group 1. The median number of cycles of bevacizumab was 9 in elderly patients and 17 cycles in group 1. Among those patients receiving bevacizumab in the first-line setting, median progression free interval (PFI) was 12 months in younger patients versus 7 months in elderly patients. Similarly, among those receiving bevacizumab in the second-line setting PFI was 9 months in younger patients versus 1 months in elderly patients. The occurrence of non-hematological adverse events did not increase in elderly patients; 51.1% of patients in group 1 reported some of non-hematological adverse events versus only 27.8% in elderly patients. Conclusion: Our experience in treating patients with bevacizumab shows good results with acceptable toxicity and our findings suggest that its use in the elderly population should be considered as safe and manageable.Uvod: Bevacizumab je rekombinantno humanizirano anti-VEGF monoklonsko antitijelo. Učinkovit je u liječenju epitelnog raka jajnika, kako u primarnom liječenju tako i kod pojave recidiva bolesti. Incidencija raka jajnika povisuje se sa starosnom dobi. Unatoč velikoj prevalenciji raka jajnika u starijih osoba, liječenje starijih bolesnica često je manje agresivno nego kod mlađih bolesnica. U Hrvatskoj, od veljače 2017. imamo mogućnost liječenja bevacizumabom u bolesnica s epitelnim rakom jajnika, jajovoda i primarnim peritonealnim rakom, kako u prvolinijskom liječenju tako i u prvom recidivu bolesti. Cilj nam je bio istražiti sigurnost primjene bevacizumaba u bolesnica starijih od 65 godina. Metode: Retrospektivno, analizirali smo medicinske podatke 65 bolesnica s epitelnim rakom jajnika, jajovoda ili primarnim peritonealnim rakom koji su započeli liječenje bevacizumabom u prvolinijskom liječenju u bolesnica s uznapredovalom bolesti kao i prvom recidivu bolesti u Zavodu za ginekološku onkologiju, KBC Zagreb u razdoblju 01.01.2017. do 31.12.2018. Bolesnice su bile podijeljene u dvije skupine prema dobi: skupina 1 (≤65 godina) i skupina 2 (>65 godina). Rezultati: U naše istraživanje bilo je uključeno 65 bolesnica: 47 (72,3%) bolesnica u skupini 1 u usporedbi s 18 (27,7%) u skupini 2. Bevacizumab je primijenjen kod 39 (60%) bolesnica kao prvolinijsko liječenje te kod 26 (40% ) bolesnica kao drugolinijsko liječenje. Medijan dobi bio je 55 godina (raspon 35-65 godina) u skupini 1 i 70 godina (raspon 66-76 godina) u skupini 2. ECOG status 0 imalo je 44,7% bolesnica u skupini 1 u usporedbi sa samo 22% u skupini 2. U vrijeme postavljanja dijagnoze, u starijih bolesnica zabilježen je barem jedan komorbiditet u 94,4% slučajeva, u usporedbi s 42,6% u skupini 2. Medijan broja apliciranih ciklusa bevacizumaba bio je 9 u bolesnica starijih od 65 godina , a 17 apliciranih ciklusa u skupini 1. U bolesnica koji su primale bevacizumab kao prvolinijsko liječenje, medijan intervala bez progresije bolesti (PFI) bio je 12 mjeseci u skupini 1 u odnosu na 7 mjeseci u bolesnica starijih od 65 godina. Slično tome, među onima koji su primali bevacizumab u drugoj liniji liječenja medijan PFI bio je 9 mjeseci u mlađih bolesnica u odnosu na 1 mjesec u bolesnica starijih od 65 godina. Pojava ne-hematoloških nuspojava nije se povećala u starijih bolesnika; 51,1% bolesnica u skupini 1 prijavilo je neku ne-hematološku nuspojavu nasuprot samo 27,8% u starijih bolesnica. Zaključak: Naše iskustvo liječenja bolesnica bevacizumabom pokazuje dobre rezultate s prihvatljivom toksičnošću, a naše istraživanje sugerira da je primjena bevacizumaba sigurna i podnošljiva i u bolesnica starijih od 65 godina

COMPARISON OF CYTOLOGIC FINDINGS OF NIPPLE DISCHARGE WITH GALACTOGRAPHIC FINDINGS

Uvod. Jedan od simptoma raka dojke je i iscjedak iz dojki. Citološki nalaz hiperplastičnih stanica bez anizocitoze te s anizocitozom, eritrociti i maligne stanice u iscjetku indikacija su za daljnju obradu – galaktografijom. Galaktografija je kontrastna pretraga tijekom koje se kanalić iz kojega je dobiven iscjedak ispuni kontrastom i slika. Prema nalazu galaktografije indicira se operativni zahvat. Cilj rada. U radu se željelo pokazati kolika je podudarnost između boje iscjetka, citološkog nalaza te galaktografskog nalaza. Materijal i metode. U razdoblju od 01. 01. 1993.do 31. 12. 2007. godine, u Ambulanti za bolesti dojke Klinike za ženske bolesti i porode KBC-a Zagreb učinjena je nakon citološke obrade iscjetka 91 galaktografija. Citologija iscjetka prema kojoj je indicirana galaktografija bio je nalaz hiperplastičnih stanica, bez ili s anizocitozom ili eritrociti, odnosno kombinacija oba nalaza. Tijekom očitavanja galaktografije promatrana je širina i pravilnost grananja kanalića, uz analizu stijenke i defekata punjenja unutar kanalića. Ukoliko se našao defekt punjenja, nepravilna proširenja kanalića ili oboje, bolesnica je bila upućena na biopsiju. Rezultati. Prema boji iscjedak je bio podijeljen u 5 kategorija: serozni i mliječni iscjedak nađen je u po 10 bolesnica (22%), njih 29 (31,8%) imalo je obojeni iscjedak (zelenkast, smeđi, žućkast), u 2 (2,2%) bolesnice bio je gnojni iscjedak dok je najveći broj bolesnica, njih 40 (44%), imalo krvavi iscjedak. Citološkom analizom iscjetka dobiveni su sljedeći rezultati: samo eritrociti nađeni su u 18 (19,8%) bolesnica, 19 (20,8%) bolesnica imalo je u iscjetku papilarne nakupine hiperplastičnih duktalnih stanica, u 7 (7,8%) bolesnica nađene su papilarne nakupine duktalnih stanica i anizocitoza, a u 47 (51,6%) bolesnica uz eritrocite su nađene i papilarne nakupine hiperplastičnih stanica. Razlikovale su se tri kategorije galaktografskih nalaza: uredan nalaz (19 bolesnica, 20,8%), hiperplazija – proširenja kanalića uz neravnosti stjenke (56 bolesnica, 61,6%), te suspektan nalaz – defekti punjenja kanalića, izrasline (16 bolesnica, 17,6%). Bolesnice sa suspektnim nalazom, njih 16, bile su upućene na biopsiju. Patohistološki nalaz u operiranih bolesnica bio je: u četiri (25%) papilom, 10 (62,5%) bolesnica imalo je duktalnu hiperplaziju, a u dvije (12,5%) nađen je karcinom. Prosječna dob bolesnica u kojih je bila indicirana galaktografija je bila 48 godina, dok je u bolesnica s karcinomom bila 63 godine. Zaključak. Naši rezultati upućuju na dobru korelaciju citološkog i galaktografskog nalaza. Hiperplazija duktalnih stanica u citološkom razmazu potvrđena je galaktografski u 62,5% ispitanica. Citološki, u svih 16 bolesnica u kojih su nađeni eritrociti uz hiperplaziju, što je upućivalo na intraduktalni proces, nalaz je ujedno dokazan i galaktografski. Sve ove ispitanice imale su krvavi iscjedak već pri uzimanju uzorka.Introduction. Nipple discharge is one of the symptoms of the breast cancer. Hemorrhagic discharge are always arousing suspicion for intraductal process (papilloma, carcinoma). The cytologic finding of red blood cells, atypical ductal cells and malignant cells in the discharge are indication for further analysis – including galactography. Objective. The aim was to show connection between colours of nipple discharge, cytologic findings and galactographic findings. Materials and methods. During the period January 1, 1993 and December 31, 2007 91 galactography were performed in Outpatient Clinic for breast disease, Department Gynaecology and Obstetrics, University Hospital Zagreb. Galactography was performed after cytological analysis of the discharge. Indication for galactography was the presence of red blood cells and atypical duct cells or combination of both. During the reading we observed the width and irregularity of ducts branching together with analysis of the wall and defects of filling (charging) within the ducts. In case of some irregularities the patients were referred to the biopsy. Results. Discharge was divided into 5 categories according to the colour: colourless or serous discharge was found in ten patients (11%), the same number had milky discharge, the largest number, 29 (31.8%) had coloured discharge (greenish, brownish, yellowish) and in 2 (2.2%) purulent discharge was found while in 40 (44%) patients the discharge was bloody. Cytological analysis gave the following results: red blood cells alone were found in 18 (19.8%) of the patients, papillary hyperplastic duct cells were found in 19 (20.8%) of the discharges and tight papillary clusters with anisocytosis were found in 7 (7.8%) patients and in 47 (51.6%) patients together with red blood cells, tight papillary cluster cell groups were found. Galactographical findings were divided into three categories: normal (19 patients – 20.8%), hyperplasia – proliferation of ducts with roughness of the wall (56 patients – 61.6%), and suspicious – defects in filling of the duct, tumours (16 patients – 17.6%). Patients with suspicious findings, 16 of them, were referred to surgery. Pathohisiological finding was papilloma in 4 (25%) of the surgical specimens, 10 (62.5%) had duct hyperplasia and carcinoma was found in 2 (12.5%) patients. Conclusion. Our results show good correlation between cytological and galactographical finding. It has been noticed that the presence of hyperplasia of duct cells in cytological smear is connected with hyperplasic changes of the ducts in 62.5% of the patients. In all 16 patients where red blood cells together with duct cells hyperplasia were found, cytological finding indicated to intraductal process, the finding was at the same time proven galactographgically as well

Razina hemoglobina u odgovoru na preoperativnu kemoiradijaciju u bolesnica s lokalno uznapredovalim rakom vrata maternice

Hemoglobin level is a very important prognostic factor in patients with gynecological carcinomas. Anemia in patients with cervical carcinoma occurs frequently and is due to the aggressive biological potential of a tumor as well as because of the poor response of patients to radiation therapy. Chemoradiation is a standard treatment followed by surgery in patients with locally advanced cervical carcinomas. Good overall results after such treatment, good quality of life, and almost no recidivism have established this method as a treatment of choice for patients with locally advanced cervical carcinomas. Sixty-four female patients with cervical carcinoma underwent neoadjuvant chemoradiation, followed by radical hysterectomy at the Department of Gynecologic Oncology, University Medical Center in Zagreb. The stages of the disease ranged from FIGO stage Ib1 to FIGO stage IIIa. Histopathological findings were squamous cell carcinoma and glandular carcinoma of the cervix. The ECOG performance status was graduated from 0 to 1. Neoadjuvant chemoradiation regimen included cisplatin (40 mg/m² once a week for 4 weeks) with concomitant radiotherapy (40 Gy total pelvic + brach therapy). Furthermore, the time interval between chemoradiation and surgery was evaluated. Response to chemoradiation therapy was observed, and the hemoglobin level and general conditions (according to the ECOG performance status) were evaluated. All the 64 patients had chemoradiation therapy prior to radical surgery. The median dosage at point A was 77.28 Gy and the median duration time of chemoradiation was 34.37 days. The time interval from chemoradiation to radical surgery was approximately 34.4 days. Hemoglobin levels decreased from 120.7 to 108.7 g/l at the end of concomitant chemoradiation. The mean tumor diameter was significantly decreased after neoadjuvant chemoradiation, and we classified the results after chemoradiation therapy as complete remission, partial remission, and stabilization of the disease, according to the WHO response criteria with respect to the size of a residual tumor. After chemoradiation and surgery, the hemoglobin level and long-term survival were evaluated. The correlation between the hemoglobin level and long-term survival after neoadjuvant chemoradiation and radical surgery in patients with different stages of cervical cancer was studied. We found that hemoglobin level could be a prognostic factor, but mostly, along with other prognostic factors, such as ECOG performance status, stage of the disease, dosage at point A, and interval between chemoradiation and surgery. However, we observed that the cellular types of tumor were of no significance.Razina hemoglobina važan je prognostički pokazatelj u odgovoru na zračenje bolesnica s ginekološkim malignomima. Anemija udružena s rakom vrata maternice česta je i pokazatelj je ne samo biološki agresivnijeg tumora već može biti i uzrokom slabijeg odgovora na zračenje. Kemoiradijacija je uobičajeni način liječenja bolesnica s lokalno uznapredovalim rakom vrata maternice s ciljem poboljšanja odgovora na liječenje i preživljenja. Operativni zahvat nakon neoadjuvantne kemoiradijacije smanjuje lokalni recidiv. U Zavodu za ginekološku onkologiju u razdoblju od 1/01 do 12/04 liječene su 64 bolesnice s rakom vrata maternice. Stadij bolesti određivao se prema FIGO-klasifikaciji (od Ib1-IIIa), patohistološki se radilo o pločastom i žljezdanom tipu raka vrata maternice, a opće stanje određivalo se prema ECOG-u (0-1). U svih bolesnica provedeno je vanjsko zračenje zdjelice u dozi od 40 Gy, a potom i unutarnje zračenje, 1 aplikacija LDR s Cezijem 137 u dozi od 35-38 Gy u točku A. Tijekom vanjskog zračenja bolesnice su primale 1x tjedno Cisplatinu u dozi od 40 mg/m2 ukupno 4x kao radiosenzibilizator. Nakon provedenog zračenja bolesnice su operirane (histerektomija s adneksektomijom uz resekciju forniksa vagine, a u nekih bolesnica učinjena je i zdjelična limfadenektomija). Za vrijeme zračenja pratili smo vrijednosti hemoglobina 1x tjedno kao i opće stanje koje smo stupnjevali prema ECOG-u. Sve bolesnice su prije operacije ozračene. Srednja doza u točku A bila je 77,2 Gy, prosječno vrijeme zračenja bilo je 34,37 dana. Vrijeme između završetka zračenja i operacije iznosilo je 34,4 dana. Razina hemoglobina i veličina tumora znatno su se smanjivali tijekom kemoiradijacije. Procjenu odgovora na kemoiradijaciju učinili smo na patohistološkom nalazu uklonjenog vrata maternice prema WHO podjeli kao potpuni odgovor (CR), djelomičan odgovor (PR) te stabilnu bolest (SD). Početna vrijednost hemoglobina te redovito praćenje razine hemoglobina tijekom kemoiradijacije pokazali su kako je veći postotak CR i PR u bolesnica s višim vrijednostima hemoglobina (>120 mg/L nasuprot <100 mg/L). Bazalne i kontrolne vrijednosti hemoglobina u bolesnica s lokalno uznapredovalim rakom vrata maternice koje su liječene kemoiradijacijom i operacijom pokazale su se kao dobar prognostički pokazatelj odgovora na primijenjeno liječenje. Ovaj pokazatelj mora se uzeti u obzir s ostalim kao što su: stupanj uznapredovalosti bolesti, histološka diferencijacija i opće stanje bolesnice