Razlika između karakteristika bolesnika s karcinomom lijevog i desnog kolona - iskustvo jedne ustanove

Objectives: The purpose of the study was to determine the difference in time until the appearance of relapse or metastases in patients treated for colorectal cancer, depending on the location of the tumor in the left or right colon at the Oncology Clinic of Clinical Medical Centre Osijek between 1st January 2010 and 31st December 2012. Study design: historical prospective study Material and methods: Study included patients whose data were recorded from medical archive at the Oncology Clinic of Clinical Medical Centre Osijek. The data on patients’ deaths were recorded from the Registry Office of the Republic of Croatia. Results: The study included 272 patients, 160 (58.8%) men and 112 (41.2%) women. According to the location, left sided colon tumor was discovered in 211 (77.6%) patients and right-sided in 61 (22.4%). The median age was 67 years. Right-sided colon tumors are considerably larger with median diameter of 6 cm, with median number of 16. Median of time until the appearance of the metastases is 20 months (interquartile range is from 8 to 29 months); marked time being shorter in right-sided colon tumors. Positive outcome of the treatment was achieved in 205 (75.4%) patients, with no significant difference in comparison to the colon cancer localization. By using Kaplan-Meier analysis of patients’ survival rates, a total 5- year survival rate of 72% was achieved in right-sided colon tumor in comparison to 62% in patients with the left-sided colon tumor. Conclusion: This study confirms that there is a difference in colorectal cancer according to its localisation. Patients with right-sided colorectal cancer are older, the carcinoma is larger, the time until the appearance of a relapse or a metastases is shorter in right sided colon cancer while 5-year survival rate is lower in left sided colon cancer.Cilj Istraživanja: Utvrditi razliku u vremenu do pojave recidiva ili presadnica kod bolesnika liječenih zbog kolorektalnog karcinoma ovisno o smještaju u lijevom ili desnom kolonu u pacijenata liječenih na Zavodu za onkologiju, KBC-a Osijek od 1. siječnja 2010. do 31. prosinca 2012. Nacrt studije: Povijesno prospektivna studija Materijal i metode: U istraživanje su uključeni ispitanici čiji su podatci preuzeti iz arhive medicinske dokumentacije Zavoda za onkologiju KBC-a Osijek, podatci o smrti pacijenata preuzeti su od nadležnog Matičnog ureda Republike Hrvatske. Rezultati: U istraživanje je uključeno 272 pacijenta, od kojih je 160 (58,8 %) muškaraca i 112 (41,2 %) žena. Prema lokalizaciji, ljevostrani tumor kolona ima 211 (77,6 %) bolesnika, a desnostrani njih 61 (22,4 %). Središnja dob pacijenta (medijan) je 67 godina. Značajno su veći u promjeru desni tumori kolona, medijana 6 cm. Medijan vremena do pojave metastaza iznosi 20 mjeseci (interkvartilnog raspona 8 do 29 mjeseci), pri čemu je značajnije kraći kod desnih tumora kolona. Pozitivan ishod liječenja imalo je 205 (75,4 %) bolesnika, bez značajne razlike u odnosu na lokalizaciju tumora kolona. Kaplan – Meierovom analizom preživljenja promatranih bolesnika podijeljenih prema lokalizaciji, dobiveno je petogodišnje ukupno preživljenje 72 % za tumor u desnom kolonu, u odnosu na 62 % kod bolesnika koji su imali tumor u lijevom kolonu. Zaključak: U ovom istraživanju potvrđeno je da postoji razlika u kolorektalnom karcinomu s obzirom na njegov položaj. Pacijenti s desnim kolorektalnim karcinomom su starije dobi, tumor je veći u promjeru,vrijeme do pojave presadnica ili recidiva je kraće, te je petogodišnje preživljavanje manje

Perioperativno liječenje karcinoma želuca - kratak pregled

Adenocarcinoma of the gastroesophageal junction (GEJ) and gastric cancer have poor outcomes in most patients. Perioperative chemotherapy became a standard of care for resectable adenocarcinoma of the upper GI tract based on the results of the MAGIC trial. The study includes patients with Stage II or III resectable adenocarcinoma of the stomach, GEJ, and lower esophagus. The ACCORD trial essentially supported the results of the MAGIC study. Both studies showed that preoperative chemotherapy could induce downstaging and enhance the possibility of potentially curative R0 resection, thus increasing the probability of disease-free survival and overall survival. The NeoFLOT study investigates the application of prolonged neoadjuvant chemotherapy (NACT). This study indicates that NACT with six cycles of FLOT is highly effective in resectable gastroesophageal cancer. The CRITICS trial compares perioperative chemotherapy with preoperative and postoperative chemoradiotherapy in patients with resectable gastric adenocarcinoma. Postoperative chemoradiotherapy did not improve overall survival compared with postoperative chemotherapy in patients with resectable gastric cancer treated with adequate preoperative chemotherapy and surgery. In recent years, guidelines for the treatment of gastric cancer have changed frequently. Because gastric cancer treatment is complex and perioperative chemotherapy is present in all treatment guidelines, a multidisciplinary team with experienced physicians is the foundation of effective gastric cancer treatment.Adenokarcinom gastroezofagealnog prijelaza (GEJ) i karcinom želuca bolest je koja je kod većine bolesnika povezana s lošim ishodom. Perioperativna kemoterapija postala je standard liječenja za resektabilni adenokarcinom gornjeg dijela GI trakta na temelju rezultata ispitivanja MAGIC studije. Studija uključuje bolesnike s II ili III stadijem resektabilnog adenokarcinoma želuca, GEJ-a i donjeg dijela jednjaka. Rezultati studije MAGIC u osnovi su podržani ispitivanjima ACCORD. Sumirajući, obje studije pokazale su da preoperativna (neoadjuvantna) kemoterapija može izazvati smanjenje veličine tumora i povećati mogućnost potencijalne R0 resekcije, povećavajući tako vjerojatnost preživljavanja bez bolesti i ukupnog preživljavanja. Studija NeoFLOT istražuje primjenu produljene neoadjuvantne kemoterapije (NACT). Ova studija pokazuje da jeNACT sa 6 ciklusa FLOT-a vrlo učinkovita kod resektabilnog gastroezofagealnog karcinoma. Ispitivanje CRITICS uspoređuje perioperativnu kemoterapiju s preoperativnom i postoperativnom kemoradioterapijom u bolesnika s resektabilnim adenokarcinomom želuca. Postoperativna kemoradioterapija nije poboljšala ukupno preživljenje u usporedbi s postoperativnom kemoterapijom u bolesnika s resektabilnim karcinomom želuca koji su liječeni odgovarajućom predoperativnom kemoterapijom i operativnim zahvatom. Posljednjih godina često se mijenjaju smjernice za liječenje karcinoma želuca. Iz razloga što je liječenje karcinoma želuca kompleksno i perioperativna kemoterapija je prisutna u svim smjernicama za liječenje, multidisciplinarni tim s iskusnim liječnicima temelj je učinkovitog liječenja karcinoma želuca

Uloga radioterapije u liječenju lokalno uznapredovalog karcinoma penisa

Penile cancer is a rare but aggressive tumor, most commonly squamous cell carcinoma. Treatment modalities depend on the stage of the disease, but the backbone of treatment is surgical resection of the primary tumor and regional lymph nodes with the use of neoadjuvant/adjuvant chemotherapy and radiotherapy. Our case report is about a 59-year-old patient which was presented with bilateral inguinal lymphadenitis, scrotal and penile edema. A biopsy of the change in the penis confirmed squamous cell carcinoma. Partial amputation of the penis and an excisional biopsy of the inguinal lymph nodes was performed, which confirmed the metastasis to the lymph nodes. Diagnostic imaging revealed bilateral enlarged inguinal lymph nodes which were later surgically removed. Postoperative CT scan showed three suspected lung metastases. The patient was then treated with polychemotherapy. Follow-up CT scan showed complete regression of metastatic changes in the lungs but also showed local recurrence in the area of the penile root. Radiotherapy with concomitant administration of cisplatin was conducted. Penile cancer is an aggressive disease that can be cured at an early stage if adequate treatment is applied. We highlight the importance of a multimodal and multidisciplinary approach consisting of polychemotherapy, surgical treatment, and radiotherapy.Rak penisa rijedak je, ali agresivan tumor, najčešće karcinom pločastih stanica. Načini liječenja ovise o stadiju bolesti, ali okosnica liječenja je kirurška resekcija primarnog tumora i regionalnih limfnih čvorova uz upotrebu neoadjuvantne / adjuvantne kemoterapije i radioterapije. U našem prikazu slučaja radi se o 59-godišnjeg pacijentu koji se javlja s bilateralnim ingvinalnim limfadenitisom, edemom skrotuma i penisa. Biopsija promjene penisa potvrdila je karcinom pločastih stanica. Izvršena je djelomična amputacija penisa i ekscizijska biopsija ingvinalnih limfnih čvorova, čime su potvrđene presadnice u limfne čvorove. Dijagnostičkom obradom otkriveni su povećani ingvinalni limfni čvorovi obostrano koji su kasnije kirurški uklonjeni. Postoperativni CT pokazao je tri suspektne presadnice u plućima. Pacijent je zatim liječen polikemoterapijom. CT je nakon provedene polikemoterapije pokazao potpunu regresiju metastatskih promjena u plućima, ali i lokalni recidiv u području korijena penisa. Provedena je radioterapija uz istodobnu primjenu cisplatine. Rak penisa agresivna je bolest koja se može izliječiti u ranoj fazi primjenom odgovarajuće terapije. Želimo ovim putem naglasiti važnost multimodalnog i multidisciplinarnog pristupa koji se sastoji od polikemoterapije, kirurškog liječenja i radioterapije

Toksičnost imunoterapije

Immune checkpoint inhibitors, such as CTLA-4 inhibitors (ipilimumab), PD-1 (nivolumab, pembrolizumab), and PDL1 inhibitors (atezolizumab, durvalumab) have become standard in the treatment of numerous malignant tumors. Immunotherapy blocks the body’s natural protective measures with immune checkpoint inhibitors. It prevents immune over-activation, but it can also affect normal tissue, and cause autoimmune side effects. They cover a diverse spectrum of events and require different treatment approaches. Immune related side effects can affect any organ or tissue, but most commonly affect the skin, colon, lungs, liver and endocrine organs (such as the pituitary or thyroid). We can divide them according to the anatomical location where they cause side effects. Most of these side effects are mild to moderate and reversible if detected early and treated appropriately. The most common side effects of CTLA-4 inhibitor and PD-1 / PD-L1 inhibitor are skin symptoms (such as rash and itching). Gastrointestinal symptoms (such as diarrhea) are more common with CTLA-4 inhibitors, while lung symptoms and thyroid dysfunction occur more frequently with the use of PD-1/PD-L1 inhibitors. It is important to determine the side effect, and the degree of the same to be able to treat it adequately. First-grade side effects are mild, second grade moderate, third grade severe, and fourth grade very severe. Re-administration of immunotherapy after immunotherapy in patients with significant irAE (immune-related adverse events) during initial treatment with either a CTLA-4 inhibitor and/or a PD-1 / PD-L1 checkpoint inhibitor can be safely repeated after discussing and ensuring that the patient does not experience a new serious side effect.Inhibitori imunoloških kontrolnih točaka, poput CTLA-4 inhibitora (ipilimumab), PD-1 (nivolumab, pembrolizumab) i PD-L1 inhibitora (atezolizumab, durvalumab) postali su standardni u liječenju brojnih malignih tumora. Imunoterapija blokira prirodne zaštitne mjere tijela inhibitorima imunoloških kontrolnih točaka. Sprječava imunološku pretjeranu aktivaciju, ali može utjecati i na normalno tkivo i uzrokovati autoimune nuspojave. Oni pokrivaju raznolik spektar događaja i zahtijevaju različite pristupe u liječenju. Imunološke nuspojave mogu utjecati na bilo koji organ ili tkivo, ali najčešće zahvaćaju kožu, debelo crijevo, pluća, jetru i endokrine organe (poput hipofize ili štitnjače). Možemo ih podijeliti prema anatomskom mjestu gdje izazivaju nuspojavu. Većina ovih nuspojava blaga je do umjerena i reverzibilna ako se rano otkrije i liječi na odgovarajući način. Najčešće nuspojave inhibitora CTLA-4 i inhibitora PD-1 / PD-L1 su nuspojave kože (poput osipa i svrbeža). Gastrointestinalni simptomi (poput proljeva) češći su kod inhibitora CTLA-4, dok se plućni simptomi i disfunkcija štitnjače češće javljaju uz upotrebu inhibitora PD-1 / PD-L1. Važno je utvrditi nuspojavu i stupanj iste kako biste ju mogli adekvatno liječiti. Nuspojave prvog stupnja su blage, drugog stupnja umjerene, trećeg stupnja teške i četvrtog vrlo teške. Ponovna primjena imunoterapije nakon imunoterapije u bolesnika sa značajnim irAE (imunološki povezane nuspojave) tijekom početnog liječenja bilo inhibitorom CTLA-4 i / ili inhibitorom kontrolne točke PD-1 / PD-L1 može se sigurno ponoviti nakon isključivanja mogućnosti ponovnog povratka ozbiljne nuspojave

Smoking Cessation after a Cancer Diagnosis: A Cross-Sectional Analysis in the Setting of a Developing Country

Since smoking accounts for around 30% of all cancer deaths, public health campaigns often focus on smoking cessation as a means of primary prevention. However, smoking after cancer diagnosis is also associated with a higher symptom burden and lower survival rate. As data regarding smoking cessation vary dramatically between different populations, we aimed to analyze smoking prevalence in cancer patients, smoking cessation after cancer diagnosis, and the factors associated with smoking cessation in the setting of a developing country. We performed a cross-sectional survey on 695 patients in two clinical hospital centers. After cancer diagnosis, 15.6% of cancer patients stopped smoking. Male gender, younger age, and smoking-related cancer were the main factors associated with greater smoking cessation (p < 0.05). A total of 96% of breast cancer patients continued to smoke after cancer diagnosis and, compared to lung and colorectal cancer patients, exhibited a lower reduction in the number of cigarettes smoked (p = 0.023). An alarming rate of smoking prevalence was recorded in younger patients (45.6% at the time of cancer diagnosis) suggesting a future rise in smoking-related cancers and complications. These results should guide anti-smoking public health campaigns in transitional countries with a critical focus on younger and breast cancer patients

Dynamic Contrast-Enhanced Study in the mpMRI of the Prostate—Unnecessary or Underutilised? A Narrative Review

The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate

The Impact of Pentraxin 3 Serum Levels and Angiotensin-Converting Enzyme Polymorphism on Pulmonary Infiltrates and Mortality in COVID-19 Patients

Objectives: The aim of this study was to examine the impact of the pentraxin 3 (PTX3) serum level and angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism on the severity of radiographic pulmonary infiltrates and the clinical outcomes of COVID-19. Methods: The severity of COVID-19 pulmonary infiltrates was evaluated within a week of admission by analyzing chest X-rays (CXR) using the modified Brixia (MBrixa) scoring system. The insertion (I)/deletion (D) polymorphism of the ACE gene and the serum levels of PTX3 were determined for all patients included in the study. Results: This study included 80 patients. Using a cut-off serum level of PTX3 ≥ 2.765 ng/mL, the ROC analysis (AUC 0.871, 95% CI 0.787–0.954, p ACE I/I polymorphism, D/D polymorphism significantly increased the risk of severe CXR infiltrates, OR 7.7 (95% CI: 1.9–30.1), and p = 0.002. Significant independent predictors of severe CXR infiltrates include hypertension (OR 7.71), PTX3 (OR 1.20), and ACE D/D polymorphism (OR 18.72). Hypertension (OR 6.91), PTX3 (OR 1.47), and ACE I/I polymorphism (OR 0.09) are significant predictors of poor outcomes. Conclusion: PTX3 and ACE D/D polymorphism are significant predictors of the severity of COVID-19 pneumonia. PTX3 is a significant predictor of death