Intensive anticancer therapy in elderly patients – does it make sense? A case report

Anticancer therapy in elderly patients poses a great challenge for doctors since not all available therapeutic modalities can improve the wellbeing, alleviate symptoms or improve prognosis in this patient population. The paper presents a case of a 75-year-old woman diagnosed with advanced ovarian cancer who, despite advanced age, received intensive anticancer therapy, i.e. surgical treatment (modified posterior exenteration with the resection of pelvic peritoneum and tumor invasion in the diaphragmatic peritoneum along with its fragment, subtotal colectomy, resection of the omentum, spleen and gastric fragment along with the gastro-transverse ligament and an end ileostomy) as well as adjuvant chemotherapy. Severe complications occurring during treatment were not directly related to the therapy, but resulted from the lack of proper patient care in a home setting

Bowel or ovarian cancer? : ambiguous diagnosis and non-standard treatment with good outcomes : a case report

Leczenie pacjentów z chorobą nowotworową staje się w ostatnich latach coraz bardziej skomplikowane i jest dla onkologów dużym wyzwaniem. W niniejszej pracy zaprezentowano przypadek 54-letniej chorej leczonej z powodu raka gruczołowego jelita cienkiego – po pierwotnym zabiegu operacyjnym i chemioterapii uzupełniającej – u której stwierdzono rozsiew procesu nowotworowego w obrębie jamy brzusznej. Początkowo zastosowano chemioterapię według schematu XELOX, a następnie wykonano zabieg wielonarządowej resekcji w interdyscyplinarnym zespole chirurgiczno-ginekologicznym oraz wdrożono chemioterapię dootrzewnową w hipertermii (HIPEC). Leczenie było powikłane upośledzonym gojeniem rany i powstaniem przetoki skórno-jelitowej. Obecnie chora pozostaje w obserwacji, bez cech wznowy procesu nowotworowego. Rany po zabiegu i przetokach są zagojone, przewód pokarmowy funkcjonuje prawidłowo.The treatment of patients with cancer has recently become more complex and challenging for oncologists. The paper presents a case of a 54-year-old woman treated due to small bowel adenocarcinoma, who underwent primary surgical procedure and adjuvant therapy, and who developed intra-abdominal cancer dissemination. Initially, XELOX regimen was administered, followed by multiorgan resection performed by an interdisciplinary team of gynecologists and surgeons as well as hyperthermic intraperitoneal chemotherapy (HIPEC). The therapy was complicated by impaired wound healing and an enterocutaneous fistula. Currently, the patient is under a follow-up and shows no evidence of recurrence. The wounds after the surgery and fistulas are healed, normal gastrointestinal function is preserved

The use of supramolecular structures as protein ligands

Congo red dye as well as other eagerly self-assembling organic molecules which form rod-like or ribbon-like supramolecular structures in water solutions, appears to represent a new class of protein ligands with possible wide-ranging medical applications. Such molecules associate with proteins as integral clusters and preferentially penetrate into areas of low molecular stability. Abnormal, partly unfolded proteins are the main binding target for such ligands, while well packed molecules are generally inaccessible. Of particular interest is the observation that local susceptibility for binding supramolecular ligands may be promoted in some proteins as a consequence of function-derived structural changes, and that such complexation may alter the activity profile of target proteins. Examples are presented in this paper

Silver ions as EM marker of congo red ligation sites in amyloids and amyloid-like aggregates

Congo red (CR) is a known selective amyloid ligand. The focus of our work is identification (by EM imaging) of dye binding sites and their distribution in amyloids and amyloid-like aggregates formed in vitro. In order to produce the required contrast, CR has been indirectly combined with metal via including Titan yellow (TY) by intercalation which exhibits a relatively strong affinity for silver ions. The resulting combined ligand retains its ability to bind to proteins (which it owes to CR) and can easily be detected in EM studies thanks to TY. We have found, however, that in protein aggregates where unfolding is stabilized by aggregation and therefore is irreversible, TY alone may serve as both, the ligand and the metal carrier. The formation of ordered structures in amyloids was studied using IgG light chains with amyloidogenic properties, converted into amyloids by shaking. The resulting EM images were subjected to interpretation on the basis of the authors' earlier research on the CR/light chain complexation process. Our results indicate that dimeric light chains, which are the subject of our study, produce amyloids or amyloid-like complexes with chain-like properties and strong helicalization tendencies. Cursory analysis suggests that the edge polypeptide loops belonging to unstable light chains form intermolecular bridges which promote creation of loose gel deposits, or are otherwise engaged in the swapping processes leading to higher structural ordering

The role of neoadjuvant chemotherapy in the management of advanced ovarian cancer in geriatric patients

It is increasingly common for ovarian cancer to affect older women, with over half of all cases involving patients aged 65 years and older. Unfortunately, elderly patients with ovarian malignancy tend to be treated less aggressively than younger patients, with less extensive surgery and less intensive chemotherapy regimens. This is due to a variety of factors, such as overall medical fitness and the function of specific organs. Moreover, multiple morbidities are typical for geriatric patients and affect their eligibility for certain forms of cancer therapy as well as their treatment outcomes, which are commonly less satisfactory than in younger patients. Additionally, for fear of complications, treating physicians sometimes limit the extent of the necessary surgery, or adjust chemotherapy doses, even though such a course of management tends to be largely misguided. One available management option is neoadjuvant chemotherapy followed by a surgical treatment known as interval debulking surgery. This type of combination therapy is associated with fewer postoperative complications, thus increasing the patient's chances of receiving a full course of adjuvant treatment. The decision to begin treatment with neoadjuvant chemotherapy tends to restrict later surgical therapy; however, under certain circumstances, this therapy can be a valid therapeutic option and, in fact, facilitate surgery. Prior to initiating therapy in elderly patients, their eligibility for combination therapy must be evaluated and the geriatric assessment of their performance and condition must be considered during the course of interdisciplinary preoperative management