77 research outputs found
Influence of tumor and GIST patients' characteristics on survival
Primarni cilj provedenog istraživanja bio je procijeniti kako karakteristike bolesnika i primarnih tumora utjeÄu na prognozu te koja od triju klasifikacija GIST-ova (Aminova, Newmanova ili Fletcherova) najbolje predviÄa prognozu. NACRT STUDIJE Studija je obuhvatila bolesnike koji su zbog GIST-ova probavnog sustava kirurÅ”ki lijeÄeni u Klinici za tumore od 1. sijeÄnja 1995. do 31. prosinca 2011. godine. Procjenjivalo se kako karakteristike bolesnika (životna dob, spol) i primarnih tumora (lokalizacija, imunohistokemijska izraženost CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) utjeÄu na duljinu preživljenja i vjerojatnost smrtnog ishoda. ISPITANICI I METODE Ukupno 63 bolesnika s GIST-om bilo je klasificirano prema spolu i životnoj dobi. Tumori su bili klasificirani prema lokalizaciji i prema Aminovoj, Newmanovoj i Fletcherovoj klasificikaciji te je na svima imunohistokemijski odreÄena izraženost odreÄenih proteina (CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1). REZULTATI Raspodjela prema spolu bila je ravnomjerna (49,2 % (31/63) muÅ”karci vs 50,8 % (32/63) žene) bez znaÄajne razlike u prosjeÄnoj životnoj dobi, duljini preživljenja i vjerojatnosti smrtnog ishoda. Bolesnici s primarnim GIST-om omentuma imali su veÄu vjerojatnost umiranja u odnosu na bolesnike s primarnim tumorima želuca (p = 0,003) bez znaÄajne razlike u duljini preživljenja (p = 0,061). UoÄena je pozitivna povezanost vjerojatnosti smrtnog ishoda i stupnja zloÄudnosti prema Aminovoj, Newmanovoj te Fletcherovoj klasifikaciji. Å to je tumor pripadao zloÄudnijoj skupini, postojala je veÄa vjerojatnost smrtnog ishoda. Bolesnici s dobroÄudnim i niskoriziÄnim tumorima su znaÄajno dulje živjeli u odnosu na bolesnike s agresivnijim tumorima. Nije zabilježena znaÄajna razlika izmeÄu triju klasifikacijskih sustava (Aminove, Newmanove i Fletcherove klasifikacije) u predviÄanju smrtnog ishoda i duljine preživljenja. Postojanje metastaza u trenutku dijagnoze najloÅ”iji je prognostiÄki Äimbenik. Imunohistokemijska izraženost niti jednog ispitivanog proteina (CD 117, CD34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) nije bila povezana sa smanjenom ili poveÄanom vjerojatnosti smrtnog ishoda bolesnika. Bolesnici sa S-100 pozitivnim GIST-ovima znaÄajno su kraÄe živjeli u odnosu na bolesnike s negativnim S-100 GIST-ovima (24 mjeseca vs 39 mjeseci, p = 0,034). ZAKLJUÄAK Prognoza GIST-ova može se odrediti na temelju njihovih morfoloÅ”kih i lokalizacijskih karakteristika, a bez uporabe skupih i složenih imunohistokemijskih obrada.AIM Primary study aim was to estimate how patients' and tumors' characteristics influence prognosis and which of GISTs' classification systems (Amin's, Newman's, Fletcher's) is optimal in predicting prognosis. STUDY DESIGN Study comprised patients surgically treated for gastrointestinal GISTs at the Unversity Hospital for Tumors since 01.01.1995. untill 31.12.2011. Estimation of tumors' (localization, immunohystochemical expression of CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) and patients' characteristics (age, gender) influence on survival and possibility of dying was done. PATIENTS AND METHODS Study comprised 63 GIST patients. Patients were classified according to age and gender. Tumors were classified according to localization. Considering pathohystological characteristics which defined malignant potential of tumors, they were classified according to Amin's, Newman's and Fletcher's classification. All tumors specimens were immunohystochemically stained with CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1. RESULTS Patients' distribution according to gender was even (49,2 % (31/63) men vs 50,8 % (32/63) women), with no significant difference in average age, survival or possibility of dying. Patients with primary omental GISTs had greater possibility of dying then patients with primary gastric GISTs (p = 0,003), with no significant difference in survival lenght (p = 0,061). Positive correlation between possibility of dying and malignancy grade according to Amin's, Newman's and Fletcher' classification was observed. The higher malignancy grade was correlated with higher possibility of dying. Patients with benign and low risk tumors lived significantly longer in comparison with patients with more aggressive tumors. There was no difference between three classification systems in predicting survival and possibility in dying. The existance of metastatic disease at diagnosis is the worst prognostic factor. Immunohystochemic expression of none of investigated proteins (CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) was associated with diminished or increased possibility of dying. Patients with S-100 positive GISTs lived significantly shorter comparing to those with S-100 negative tumors (24 vs 39 months, p = 0,034). CONCLUSION GISTs prognosis can be deteremined considering morphologic characteristics and localization of tumors, with no additional need for expensive and complicated immunohystochemical studies
PluÄna fibroza izazvana oksaliplatinom: prikaz sluÄaja
Oxaliplatin is part of the standard chemotherapy regimens for treating colorectal
carcinoma. Pulmonary fibrosis is a serious but rare side effect of oxaliplatin treatment, which resulted
in patient death in more than half of the reported cases. The precise pathophysiological mechanism of
this phenomenon has not been clarified yet. Analysis of the reported cases strongly suggests that
early diagnosis and immediate corticosteroid treatment are crucial for better prognosis. Here we report
a case of pulmonary fibrosis related to the FOLFOX regimen in a patient with early colorectal
carcinoma.Oksaliplatin je dio standardnih kemoterapijskih protokola za lijeÄenje kolorektalnog karcinoma. PluÄna fibroza je ozbiljna,
ali rijetka nuspojava primjene oksaliplatina, koja je rezultirala smrÄu bolesnika u viÅ”e od polovine prijavljenih sluÄajeva.
ToÄan patofizioloÅ”ki mehanizam nastanka ove nuspojave joÅ” nije u potpunosti razjaÅ”njen. Analiza prijavljenih sluÄajeva je
pokazala da su rana dijagnoza i rani poÄetak lijeÄenja kortikosteroidima od kljuÄne važnosti za bolju prognozu. Ovdje prikazujemo
sluÄaj pluÄne fibroze uz primjenu oksaliplatina u bolesnika s ranim kolorektalnim karcinomom
Sustavno lijeÄenje karcinoma glave i vrata
Systemic therapy of head and neck carcinoma is reserved for locally advanced and metastatic disease. Concomitant use of cisplatin and irradiation is still standard protocol for treatment of locally advanced disease although immunoradiotherapy with cetuximab seems to be a good alternative with similar results. The best option for fi rst-line treatment of advanced or metastatic disease is polychemotherapy with addition of cetuximab in patients in good clinical condition. Limited options are available for second-line therapy mostly due to poor performance status of the patients. HPV-positive tumors make a special subgroup of HNSCC in which targeted therapy plays the most important role.Sustavno lijeÄenje karcinoma glave i vrata je rezervirano za lokalno uznapredovalu i metastatsku bolest. Konkomitantna primjena cisplatine uz zraÄenje joÅ” uvijek predstavlja standard lijeÄenja za lokalno uznapredovalu bolest, iako imunoradioterapija s cetuximabom predstavlja dobru alternativu sa sliÄnim rezultatima. Najbolja opcija za lijeÄenje uznapredovale ili metastatske bolesti je polikemoterapija uz dodatak cetuximaba za sve bolesnike u dobrom kliniÄkom stanju. MoguÄnosti druge linije lijeÄenja su vrlo ograniÄene, najviÅ”e zbog loÅ”eg opÄeg stanja bolesnika. HPV-pozitivni tumori predstavljaju posebnu podgrupu karcinoma ploÄastih stanica glave i vrata u kojima najvažniju ulogu igra lijeÄenje ciljanom terapijom
Rijetke nuspojave terapije sunitinibom u bolesnice s metastatskim karcinomom bubrega: prikaz sluÄaja
Sunitinib is an orally administered multikinase inhibitor. This therapy can provoke uncommon side effects such as pancytopenia, tumor lysis syndrome, cardiac disorders, thromboembolic incidents, intestinal perforation, pancreatitis, acute renal failure, etc. We report a case of a 63-year-old female admitted to the hospital due to abdominal pain, nausea, vomiting and elevated blood pressure. One month earlier, sunitinib therapy for metastatic renal cell carcinoma was initiated. During the first cycle of therapy, after three weeks of sunitinib 50 mg daily, symptoms started and she stopped taking the drug. At admission, laboratory tests revealed elevated serum and urine amylase, C-reactive protein, urea and creatinine, and lowered platelet and leukocyte counts and hemoglobin value. Urine test showed proteinuria, erythrocyturia, leukocyturia and granulated cylinder. The patient was diagnosed with acute pancreatitis grade III, acute renal failure grade II, pancytopenia and urinary infection, and was hospitalized for five days. She was treated symptomatically and with antibiotic therapy because of persistently elevated C-reactive protein and pathologic urinary sediment, which led to subjective and clinical improvement. Acute pancreatitis, renal insufficiency and pancytopenia are rarely described side effects of sunitinib therapy, and clear connection between these conditions and drug activity is not yet determined. Medical specialists who prescribe and treat patients with sunitinib should be aware of the possible occurrence of these conditions and perform regular checkups of sunitinib treated patients.Sunitinib je oralni multikinazni inhibitor. LijeÄenje može izazvati pojavu rijetkih nuspojava kao Å”to su pancitopenija, sindrom lize tumora, srÄani poremeÄaji, tromboembolijski incidenti, perforacija crijeva, pankreatitis, akutno zatajenje bubrega itd. Ovdje prikazujemo sluÄaj 63-godiÅ”nje bolesnice hospitalizirane zbog bolova u trbuhu, muÄnine, povraÄanja i poviÅ”enog krvnog tlaka. Mjesec dana ranije je zapoÄela lijeÄenje sunitinibom zbog metastatskog karcinoma bubrega. U bolesnice su se tijekom prvog ciklusa lijeÄenja, nakon tri tjedna uzimanja 50 mg sunitiniba na dan, pojavili navedeni simptomi zbog Äega je bolesnica prekinula uzimati lijek. Pri prijmu u bolnicu su laboratorijski nalazi pokazali poviÅ”ene vrijednosti serumskih i mokraÄnih amilaza, C-reaktivnog proteina, ureje i kreatinina, sniženi broj trombocita i leukocita te sniženu vrijednost hemoglobina. Postavljena je dijagnoza akutnog pankreatitisa gr. III., akutnog bubrežnog zatajenja gr. II, pancitopenije i urinarne infekcije te je bolesnica hospitalizirana tijekom pet dana. LijeÄena je simptomatski te antibiotikom zbog poviÅ”ene vrijednosti C-reaktivnog proteina i patoloÅ”kog sedimenta mokraÄe, Å”to je dovelo do subjektivnog i kliniÄkog poboljÅ”anja stanja. Akutni pankreatitis, bubrežno zatajenje i pancitopenija su rijetko opisivane nuspojave primjene sunitiniba i jasna veza izmeÄu tih stanja i aktivnosti lijeka joÅ” nije utvrÄena. Specijalisti koji propisuju i lijeÄe bolesnike sunitinibom trebali bi biti svjesni moguÄnosti pojave ovih stanja i provoditi redovite kontrole u bolesnika lijeÄenih ovim lijekom
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