Cardiotoxicity of mediastinal radiotherapy Ratosa, Ivica; Ivanetic Pantar, Maja
Reports of Practical Oncology and Radiotherapy,
11/2019, Volume:
24, Issue:
6
Journal Article
Peer reviewed
Open access
To explore available recent literature related to cardiotoxicity following mediastinal radiation.
Radiotherapy-related heart injury is well documented, with no apparent safety threshold dose. The ...number of long-term cancer survivors exposed to mediastinal radiotherapy at some point of their treatment is increasing. Heart dosimetric parameters are of great importance in developing a treatment plan, but few data are available regarding radiosensitivity and dose-volume constraints for specific heart structures.
In October 2018, we identified articles published after 1990 through a PubMed/MEDLINE database search. The authors examined rough search results and manuscripts not relevant for the topic were excluded. We extracted clinical outcomes following mediastinal radiotherapy of childhood cancers, lymphoma, medulloblastoma, thymic cancers and hematopoietic cell transplantation survivors and evaluated treatment planning data, whenever available.
A total of 1311 manuscripts were identified in our first-round search. Of these manuscripts, only 115 articles, matching our selection criteria, were included.
Studies uniformly show a linear radiation dose-response relationship between mean absorbed dose to the heart (heart-Dmean) and the risk of dying as a result of cardiac disease, particularly when heart-Dmean exceeds 5Gy. Limited data are available regarding dose-volume predictors for heart substructures and the risk of subsequent cardiac toxicity. An individual patient’s cardiotoxicity risk can be modified with advanced treatment planning techniques, including deep inspiration breath hold. Proton therapy is currently showing advantages in improving treatment planning parameters when compared to advanced photon techniques in lymphoma, thymic malignancies, malignant mesothelioma and craniospinal irradiation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Development of brain metastasis (BM) and leptomeningeal (LM) disease in breast cancer (BC) patients indicates poor prognosis and impairs patients’ quality of life. Prognostic survival scores for BM ...can help predict expected survival in order to choose the most appropriate treatment. The aim of our study was to analyze national data for BC patients treated with radiation therapy for BM/LM disease and validate the applicability of different survival prognostic scores. We retrospectively evaluated medical records of 423 BC patients with BM/LM disease receiving radiation therapy between April 2005 and December 2015. Patients were classified by BC Recursive Partitioning Analysis (B‐RPA), Breast Graded Prognostic Assessment (Breast‐GPA), Modified Breast Graded Prognostic Assessment (MB‐GPA), and Simple Survival score for patients with BM from BC (SS‐BM). Overall survival (OS) was calculated from the development of BM/LM disease to death or last follow‐up date. After a median follow‐up of 7.5 years, the median OS was 6.9 months (95% CI 5.5‐7.8, range 0‐146.4) and 1‐ and 2‐year survival rates were 35% and 17%, respectively. Survival analysis showed significant differences in median OS regarding biologic subtypes (P < 0.0001), as follows: 3.2 (95% Confidence Interval (CI) 2.5‐3.9), 3.9 (95% CI 2.3‐5.6), 7.1 (95% CI 4.3‐9.8), 12.1 (95% CI 8.3‐15.9), and 15.4 (95% CI 8.8‐22.1) months for primary triple‐negative BC (TNBC), Luminal B HER2‐negative, Luminal A, HER2‐enriched, and Luminal B HER2‐positive tumors, respectively. Good Karnofsky Performance Status (KPS), single metastasis, and absence of LM or extracranial disease all demonstrated better OS in univariate and multivariate analysis. All four employed prognostic indexes provided good prognostic value in predicting survival. SS‐BM and MB‐GPA showed the best discriminating ability (Concordance indexes C were 0.768 and 0.738, respectively). This study presents one of the largest single‐institution series validating prognostic scores for BC patients with BM/LM. SS‐BM and MB‐GPA proved to be useful tools in the clinical decision‐making process.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
3.
Paliativna oskrba v obdobju epidemije s covidom-19 Krčevski Škvarč, Nevenka; Ebert Moltara, Maja; Pekarovic, Vesna ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
12/2020, Volume:
89, Issue:
11-12
Journal Article
Peer reviewed
Open access
V prispevku so predstavljena priporočila za obravnavo simptomov v paliativni oskrbi bolnikov v različnih okoljih v obdobju epidemije s covidom-19. Podlaga za priporočila so učna gradiva za paliativno ...oskrbo Slovenskega združenja za paliativno in hospic oskrbo ter priporočila za obravnavo bolnikov s covidom-19 v paliativni oskrbi več evropskih in svetovnih združenj. Priporočila so odziv na trenutno stanje z okužbami s SARS-CoV-2 in slonijo na strokovnih dokazih ter izkušnjah. Uporabnost priporočil bomo sproti preverjali in po potrebi posodabljali z naslednjo verzijo.
Backgound: Palliative care is a part of the holistic treatment of a patient with advanced cancer, which enables the patient and his or her relatives to live a quality life. In Slovenia, palliative ...care is provided at two levels: basic and specialized palliative care. As a specialized palliative care hospital, the Institute of Oncology Ljubljana provides care for patients with the most complex problems, an outpatient clinic for early palliative care, and a counselling service, as well as telephone support and home visits for patients at home. The mobile palliative care unit, which was implemented in September 2021, is the latest activity. Methods: We analyzed the data of all patients involved in specialized palliative care throughout the year, from the beginning of the operation of the mobile palliative unit until the end of August 2022. We observed age, gender, place of permanent residence, diagnosis, and place of death, and compared groups of patients who were monitored in the context of specialized palliative care with or without the support of the mobile palliative team. Results: Between September 2021 and August 2022 1,086 patients were included in all specialized palliative care activities at the Institute of Oncology Ljubljana, of which 347 patients (32%) received a total of 574 home visits (an average of 1.7 visits per patient (range 1-8)). 317 (91%) patients had their permanent residence in the Central Slovenia region, while 9% were visited outside the borders. A comparison of groups of patients referred to specialized palliative care with or without the activation of a mobile palliative unit clearly shows a higher proportion of those who died at home when support was provided by home visits (80% vs 62%) of the mobile palliative team. Conclusion: The mobile palliative care unit represents an important element of the palliative care network and ensures more frequent dying in the home environment.
In 2019, the Recommendations for the management of patients with lung cancer were published bringing much-needed standardisation of diagnosis and treatment to improve survival of patients with lung ...cancer. Three years after the original Recommendations were published, the update of the Recommendations brings the most innovations in the chapter on systemic treatment of patients with lung cancer. This reflects the remarkable progress made in the field of understanding the oncogenesis and biology of lung cancer and thus the development of new drugs. The burden of lung cancer remains high, as lung cancer is still the most common cause of cancer related death in our country and worldwide. Lung cancer is responsible for one of five cancer-related deaths. Almost one third of patients with lung cancer do not receive any oncological treatment, either because of poor performance status, comorbidities or the extent of the disease. Half of the patients have metastatic disease at diagnosis, resulting in only small improvements in survival despite advances in the treatment of lung cancer patients. These data remind us that if we are to make major shifts in the management of lung cancer patients, we will need to take different approaches. The most promising seems to be the detection of early stages of lung cancer which offers the best treatment results. The Recommendations written here are guidelines for the management of patients with lung cancer. Only with comprehensive multidisciplinary treatment approach, the best outcome from the prognostically unfavourable disease can be offered.
In 2019, the Recommendations for the management of patients with lung cancer were published bringing much-needed standardisation of diagnosis and treatment to improve survival of patients with lung ...cancer. Three years after the original Recommendations were published, the update of the Recommendations brings the most innovations in the chapter on systemic treatment of patients with lung cancer. This reflects the remarkable progress made in the field of understanding the oncogenesis and biology of lung cancer and thus the development of new drugs. The burden of lung cancer remains high, as lung cancer is still the most common cause of cancer related death in our country and worldwide. Lung cancer is responsible for one of five cancer-related deaths. Almost one third of patients with lung cancer do not receive any oncological treatment, either because of poor performance status, comorbidities or the extent of the disease. Half of the patients have metastatic disease at diagnosis, resulting in only small improvements in survival despite advances in the treatment of lung cancer patients. These data remind us that if we are to make major shifts in the management of lung cancer patients, we will need to take different approaches. The most promising seems to be the detection of early stages of lung cancer which offers the best treatment results. The Recommendations written here are guidelines for the management of patients with lung cancer. Only with comprehensive multidisciplinary treatment approach, the best outcome from the prognostically unfavourable disease can be offered.
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