Larynx Preservation: Advantages and Limitations

For a long time standard treatment approach for resectable squamous cell carcinoma of larynx was surgery with or without subsequent radiotherapy. Surgery, particulary total laryngectomy, has been associated with serious impairment of quallity of life. Between nonsurgical approaches, concurrent cisplatin based chemoradiotherapy has become a very promising treatment modality for larynx preservation. However, concurrent chemotherapy has been associated with serious toxicity. The most recent treatment approach in larynx preservation is related to taxan based induction chemotherapy

Retroperitoneal and Metachronous Testicular Germ Cell Tumors with Different Histology and Teratoma Growing Syndrome – A Case Report

It is presented a case of a 32-year-old male with the three primary tumors diagnosed within a time period of 3 years; retroperitoneal nonseminoma in 2002, retroperitoneal mature teratoma in 2004, and metachronous testicular seminoma in 2005. We discuss the unusual presentation of these three rare events occurring in the same patient without known risk factors

Tularemia – a case report

Prikazana je prethodno zdrava žena u dobi od 44 godina, koja je razvila tonziloglandularni oblik tularemije praćen kožnim osipom. Klinički tijek kao i neučinkovitost prethodne terapije penicilinom upućivali su na moguću tularemiju. Inicijalno pozitivan nalaz imunokromatografskog testa je sugerirao dijagnozu koja je potvrđena serološki testom aglutinacije (serokonverzija titra protutijela). Provedena je terapija gentamicinom tijekom 10 dana s dobrim kliničkim učinkom.We present a previously healthy 44-year-old female patient who developed tonsilloglandular form of tularemia with skin rash. Clinical course of disease as well as unsuccessful penicillin therapy indicated possible tularemia. Initially positive finding of immunochromatographic assay suggested the diagnosis that was confirmed with serological agglutination test (seroconversion of antibody titers). Gentamicin therapy was implemented for 10 days with good clinical effect

The Appearance of 4-Hydroxy-2-Nonenal (HNE) in Squamous Cell Carcinoma of the Oropharynx

Tumor growth is associated with oxidative stress, which causes lipid peroxidation. The most intensively studied product of lipid peroxidation is 4- hydroxy-2-nonenal (HNE), which is considered as a “second messenger of free radicals” that binds to proteins and acts as a growth-regulating signaling factor. The incidence of squamous cell carcinoma of the oropharynx is associated with smoking, alcohol and infection of human papilloma virus (HPV), with increasing incidence world-wide. The aim of this retrospective study involving 102 patients was to determine the immunohistochemical appearance of HNE-protein adducts as a potential biomarker of lipid peroxidation in squamous cell carcinoma of the oropharynx. The HNE-protein adducts were detected in almost all tumor samples and in the surrounding non-tumorous tissue, while we found that HNE is differentially distributed in squamous cell carcinomas in dependence of clinical stage and histological grading of these tumors. Namely, the level of HNE-immunopositivity was increased in comparison to the normal oropharyngeal epithelium in well- and in moderately- differentiated squamous cell carcinoma, while it was decreasing in poorly differentiated carcinomas and in advanced stages of cancer. However, more malignant and advanced cancer was associated with the increase of HNE in surrounding, normal tissue. This study confirmed the onset of lipid peroxidation, generating HNE-protein adducts that can be used as a valuable bioactive marker of carcinogenesis in squamous cell carcinoma of the oropharynx, as well as indicating involvement of HNE in pathophysiological changes of the non-malignant tissue in the vicinity of cancer

HORMONAL THERAPY OF PROSTATE CANCER: ARE THERE ANY DILEMMAS LEFT?

Strategija liječenja bolesnika s adenokarcinomom prostate ovisi o procjeni proširenosti bolesti, procjeni rizika od povratka bolesti, dobi, očekivanom trajanju života, komorbiditetima, afinitetima i načinu života. Jedan od standardnih terapijskih modaliteta jest i hormonska terapija. Hormonska terapija raka prostate zapravo je terapija koja suprimira androgen (AST) ili koja terapija deprivira androgen (ADT). Njezinom primjenom dolazi do sniženja razine androgena u krvi, a kako su stanice adenokarcinoma najvećim dijelom (³80%) hormonski ovisne o androgenima, prestanak stimulacije stanica raka androgenima dovodi do njihove apoptoze, usporava se rast tumora i smanjuje se njegova veličina. Stoga se ta vrsta terapije rabi u liječenju karcinoma prostate. Hormonska terapija indicirana je kao prvi terapijski modalitet kod nalaza metastatske bolesti. U slučaju primjene radioterapije na prostatu zahvaćenu rakom s kurativnom namjerom (kod nemetastatske bolesti) preporučuje se primjena terapije koja deprivira androgen u bolesnika sa srednjim i visokim rizikom od povratka bolesti prije, za vrijeme i poslije radioterapije u trajanju od 6 mjeseci ili 2–3 godine ovisno o procijenjenom riziku od povratka bolesti. U vezi s primjenom terapije koja deprivira androgen, a koja se može primijeniti na više načina i u više kombinacija, za određene kliničke situacije ne postoje konačne preporuke. Razloga je više: premalen broj odgovarajućih kliničkih studija, heterogenost bolesnika u studijama što otežava interpretaciju podataka te nekonzistentni rezultati. Također, kako novije dijagnostičke metode i postupci omogućavaju ranije otkrivanje raka prostate, a ranije i sve uspješnije liječenje produžava život bolesnika s metastatskom bolešću, rezultati »ranijih« kliničkih studija mogu gubiti na aktualnosti. Isto tako, sa sve dužim preživljenjem bolesnika sve važnija postaje kvaliteta života, odnosno nuspojave liječenja, kao i procjena koristi u odnosu prema štetnosti same terapije. Cilj je prikaza da upozori na novije spoznaje, kao i na moguće dileme o mjestu i primjeni terapije koja deprivira androgen.The strategy for treating prostate cancer patients depends on the assessment of disease extent, assessment of the risk of disease relapse, assessment of life expectancy, comorbidities, affinities and life-style. Since the activity and survival of prostate cancer cells is at least initially dependent on androgen stimulation, hormonal therapy is one of the several standard treatment modalities. Hormonal therapy is aimed at decreasing this androgen stimulation either by lowering androgen production or by blocking receptor binding. Hormonal therapy is in fact androgen-suppressive therapy (AST) or androgen-deprivation therapy (ADT). If effective, it results in the lack of cancer cell stimulation, thus causing their apoptosis and consequently decline in tumor growth and size. Hormonal therapy is used as a first-line treatment modality for metastatic disease. In addition to this indication, hormonal therapy is also used as an adjunct to radiotherapy with curative intent for patients with non-metastic disease but having an intermediate and high risk of disease relapse. In combination with radiotherapy, hormonal therapy can be applied before, concomitantly and after radiotherapy for the duration of 6 months or 2 to 3 years depending on the risk estimation. Regarding hormonal therapy, it can be applied in combination with other treatments, in several ways, and sometimes there might be several options available. This possible lack of a specific recommendation is a consequence of the fact that there is a limited number of adequate clinical studies which, moreover, may have yielded inconsistent results sometimes simply due to the patients’ heterogeneity. Moreover, thanks to the newer and better diagnostic methods enabling the discovery of prostate cancer in earlier disease stages, as well as to the more effective treatments, there is also a prolongation of relapse-free survival and possibly of overall survival in patients having metastic disease. Consequently, the results of earlier clinical studies might no longer be applicable to the new »generations« of upcoming patients. As regards this improved survival, issues of patient’s quality of life and possible side-effects of hormonal therapy are also becoming increasingly relevant because hormonal adverse events are time-dependant and tend to increase in severity with prolongation of hormonal manipulation. Therefore, this paper aims to give an overview of the more recent findings, indications and observations regarding hormonal therapy

MULTIPLE PRIMARY MALIGNANCIES

Multipli primarni tumori koji se javljaju kod istog bolesnika, metakrono ili sinkrono, relativno su rijedak događaj s porastom učestalosti posljednjih desetljeća. Cilj je ovog istraživanja utvrditi njihovu učestalost kod bolesnika liječenih hospitalno u Zavodu za radioterapijsku onkologiju Klinike za onkologiju Medicinskog fakulteta Sveučilišta u Zagrebu, KBC Zagreb u periodu od 2003. do 2009. godine. Učestalost je multiplih malignih tumora u navedenom periodu bila 2,4%. Od ukupno 103 bolesnika 97 je imalo dva, a 6 tri primarna tumora. Metakronih je tumora bilo 88, a sinkronih 20. Učestalost im je bila veća kod žena nego kod muškaraca, a i pojavljivali su se ranije kod žena nego kod muškaraca. Najčešće su kombinacije prvog i drugoga metakronog tumora kod muškaraca bile: rak prostate-maligni tumor probavnog sustava (osobito rak rektuma i debelog crijeva) i obrnutim redoslijedom te hematološke zloćudne bolesti-maligni tumor probavnog sustava; a kod žena: rak dojke-rak kontralateralne dojke i hematološke zloćudne bolesti (osobito ne-Hodgkinov limfom)-rak dojke. Valja očekivati da će učestalost bolesnika s višestrukim primarnim tumorima rasti, i zbog programa ranog otkrivanja tumora i zbog uspješnijeg liječenja i dužeg očekivanog trajanja života.Multiple primary malignancies, metachronous or synchronous, in a single patient are relatively rare event with the increase of incidence in recent decades. The aim of this research is to study their incidence in patients hospitalized at the Division of Radiotherapy, Department of Oncology, University of Zagreb, School of medicine, University Hospital Centre Zagreb from 2003 to 2009. The incidence of multiple primary malignancies was 2.4%. Among 103 patients, 97 had two, and 6 three primary tumors. Eighty-three cases were metachronous, while 20 cases were synchronous malignancies. The frequency was higher in females than males and their age at diagnosis of tumors was younger than in males. The most common tumor combinations in males were: prostate cancer-digestive system malignancy (especially colorectal cancer) and viceversa, and hematological malignant tumors-digestive system malignancy; while in women there were: breast cancer-cancer of contralateral breast and hematological malignant tumors (especially lymphoma non Hodgkin)-breast cancer. The incidence of multiple primary malignancies is expected to increase due to the better screening programs for early detection of malignancies as well as considerable improvement in their treatment and longer life expectancy

CLINICAL RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH ESOPHAGEAL AND ESOPHAGOGASTRIC JUNCTION CANCERS

Rak jednjaka i ezofagogastričnog prijelaza obuhvaća histološki i biološki različite zloćudne tumore kod kojih se napredak u razumijevanju ovih bolesti još nije pretočio u znatnije poboljšanje preživljenja oboljelih. Dijagnoza se postavlja biopsijom učinjenom tijekom ezofagogastroskopije. Liječenje lokoregionalne bolesti najčešće je multimodalno te uključuje kirurgiju, radioterapiju i kemoterapiju. Utvrđivanje njihova optimalnog redoslijeda predmet je brojnih kliničkih ispitivanja i metaanaliza. Metastatska bolest liječi se palijativnom kemoterapijom i suportivnom terapijom. Odluku o liječenju donosi multidisciplinarni tim individualiziranim pristupom svakom bolesniku. U tekstu koji slijedi sadržane su kliničke upute radi standardizacije dijagnostičkih postupaka, liječenja i praćenja bolesnika s rakom jednjaka i ezofagogastričnog prijelaza u Republici Hrvatskoj.Esophageal and esophagogastric junction cancers comprise histologically and biologically different malignant tumors in which the progress in the understanding of the disease has not been followed by the improvement in the survival. Diagnosis is set by tumor biopsy during endoscopy. Multimodal approaches containing surgery, radiotherapy and chemotherapy are frequently applied in the treatment of locoregionally advanced disease. However, the optimal sequence of the treatment options is still the issue of numerous clinical trials and meta-analyzes. Metastatic disease is treated with palliative chemotherapy and best supportive care. Treatment decisions should be individualized according to patients’ characteristics and made after multidisciplinary team discussion. The following text presents the clinical guidelines in order to standardize the diagnostic procedures, treatment and monitoring of patients with esophageal and esophagogastric junction cancers in the Republic of Croatia

Kliničke upute za dijagnozu, liječenje i praćenje odraslih bolesnika oboljelih od glioma središnjega živčanog sustava [Clinical guidelines for diagnosing, treating and monitoring of adult patients with gliomas of central nervous system]

Gliomas of the central nervous system are glial cell tumors that are divided in low and high grade group. Multidisciplinary approach to treatment consists of surgery, radiotherapy and chemotherapy. The type and order of treatment depend on the characteristics of the tumor and the patient. We present the clinical guidelines for diagnostic procedures, surgical treatment, oncological treatment and follow up of patients with this type of tumor in the Republic of Croatia

CLINICAL GUIDELINES FOR DIAGNOSING, TREATING AND MONITORING OF ADULT PATIENTS WITH GLIOMAS OF CENTRAL NERVOUS SYSTEM

Gliome središnjega živčanog sustava čine tumori glijalnog podrijetla niskog i visokoga gradusa. Liječe se multidisciplinarnim pristupom kirurški, radioterapijom i kemoterapijom. Vrsta i redoslijed liječenja ovise o osobitostima tumora i bolesnika. U tekstu koji slijedi nalaze se kliničke upute za dijagnostičke postupke, operativno liječenje, onkološko liječenje i praćenje bolesnika s ovom vrstom tumora u Republici Hrvatskoj. Smjernice su pisane u ime Hrvatskoga onkološkog društva Hrvatskoga liječničkog zbora. Cilj je smjernica postići izjednačenost liječenja gliomskih tumora u onkološkim centrima Republike Hrvatske.Gliomas of the central nervous system are glial cell tumors that are divided in low and high grade group. Multidisciplinary approach to treatment consists of surgery, radiotherapy and chemotherapy. The type and order of treatment depend on the characteristics of the tumor and the patient. We present the clinical guidelines for diagnostic procedures, surgical treatment, oncological treatment and follow up of patients with this type of tumor in the Republic of Croatia

CLINICAL GUIDELINES FOR DIAGNOSING, TREATING AND MONITORING OF ADULT PATIENTS WITH GLIOMAS OF CENTRAL NERVOUS SYSTEM

Gliome središnjega živčanog sustava čine tumori glijalnog podrijetla niskog i visokoga gradusa. Liječe se multidisciplinarnim pristupom kirurški, radioterapijom i kemoterapijom. Vrsta i redoslijed liječenja ovise o osobitostima tumora i bolesnika. U tekstu koji slijedi nalaze se kliničke upute za dijagnostičke postupke, operativno liječenje, onkološko liječenje i praćenje bolesnika s ovom vrstom tumora u Republici Hrvatskoj. Smjernice su pisane u ime Hrvatskoga onkološkog društva Hrvatskoga liječničkog zbora. Cilj je smjernica postići izjednačenost liječenja gliomskih tumora u onkološkim centrima Republike Hrvatske.Gliomas of the central nervous system are glial cell tumors that are divided in low and high grade group. Multidisciplinary approach to treatment consists of surgery, radiotherapy and chemotherapy. The type and order of treatment depend on the characteristics of the tumor and the patient. We present the clinical guidelines for diagnostic procedures, surgical treatment, oncological treatment and follow up of patients with this type of tumor in the Republic of Croatia