Review of Polish and international guidelines on hormonal therapy in localized prostate cancer

Prostate cancer is the second most common male malignancy in Poland. We present guidelines of Polish and international oncology and urology societies on hormonal therapy for localized prostate cancer

Chemotherapy for advanced colorectal patients: daily practice results may not reflect the outcomes of prospective clinical trials

Introduction. Colorectal cancer is the second cause of cancer deaths worldwide. The development of new drugs in recent years has improved the outcomes, but it is not clear whether this progress also includes patients managed in daily clinical practice. Treatment outcomes in patients with advanced colorectal cancer treated in Poland outside of clinical trials are scare. Methods. We analyzed the results of first-line chemotherapy in 165 patients with advanced colorectal cancer treated between May 2010 and December 2013 in two institutions. Results. The mean patient age was 61 ± 8.7 years; 105 patients received irinotecan-based regimens (CLF1 or XELIRI), 41 oxaliplatin-based regimens (FOLFOX4 or XELOX) and 19 patients received single-agent 5-fluorouracil. A partial response was achieved in 48 patients (29%), stable disease in 71 (43%) and 46 patients (28%) progressed during treatment. Median survival in the entre group was 14 months. Respective average response rate and median overall survival in recent clinical trials were 39% and 17 months, respectively. Compared to single agent treatment, multidrug chemotherapy was associated with increased general toxicity (p = 0.039), in particular with higher occurrence of diarrhea (p = 0.003) and peripheral neuropathy (p < 0.001). There was no apparent impact of chemotherapy on overall quality of life. Conclusions. Treatment results of advanced colorectal cancer in daily practice may be worse than those obtained in prospective clinical trials. The use of palliative chemotherapy has no noticeable impact on quality of life

Pulmonary bleedings

Krwawienia z dróg oddechowych towarzyszą najczęściej zaawansowanym stadiom przewlekłych schorzeń układu oddechowego. Nasilone krwawienie, oprócz związanego z nim bezpośredniego zagrożenia, wywołuje na ogół u chorych poczucie silnego lęku i znacznie obniża jakość ich życia. Istotne jest zatem szybkie rozpoznanie przyczyny krwawienia i niezwłoczne podjęcie właściwego leczenia. Doraźne postępowanie obejmuje zabezpieczenie drożności oskrzeli, uspokojenie chorego, dożylne podanie 10–40 ml 10-procentowego roztworu NaCl, podanie leków przeciwkaszlowych i hamujących fibrynolizę, a także inhalacje roztworem epinefryny. Wskazane jest wykonanie bronchoskopii, co pozwala ustalić przyczynę i miejsce krwawienia, odessać zalegającą krew, usunąć skrzepy i podjąć próbę zatamowania krwawienia. W wybranych przypadkach należy rozważyć zabieg operacyjny. W leczeniu wspomagającym krwawień z dróg oddechowych stosuje się preparaty nasilające hemostazę i zwiększające biosyntezę protrombiny. Skuteczną metodą leczenia nawracających krwawień jest embolizacja naczyń tętniczych. W krwawieniach towarzyszących nowotworom układu oddechowego metodą z wyboru jest radioterapia wiązką zewnętrzną lub brachyterapia.Pulmonary bleedings typically accompany advanced chronic diseases of the respiratory system. Massive bleedings, apart form imminent threats, is associated with strong patient fear and considerably deteriorates quality of life. Immediate diagnosis and active therapy are therefore essential. Emergency measures include facilitating bronchial passage, sedation, intravenous injection of 10–40 ml of 10% NaCl solution, antitussive and antifibrinolitic agents, as well as epinephrine inhalations. Bronchoscopy should be attempted to establish the cause and localisation of bleeding, to allow blood aspiration and clot removal. In selected cases surgical intervention should be considered. Supportive therapy includes antihemostatic agents and compounds stimulating prothrombin synthesis. Effective palliative measure of recurrent pulmonary bleeding is vessel embolisation. Bleeding related to advanced lung cancer should primarily be managed with externalbeam irradiation or brachytherapy