Karcinom pluća jedan je od vodećih javno-zdravstvenih problema, kako u svijetu, tako i u Republici Hrvatskoj. Većina bolesnika u Hrvatskoj otkriva bolest u lokalno uznapredovalom ili metastatskom ...stadiju bolesti, što u konačnici rezultira petogodišnjim preživljenjem od svega 10%. Nakon učinjene slikovne obrade i postavljene sumnje na tumor pluća, u sklopu daljnje dijagnostičke obrade slijedi uzorkovanje tkiva za citološku i patohistološku dijagnostiku, što može predstavljati velike izazove za kliničara. Cilj ovog istraživanja je ukazati na problematiku prilikom postavljanja dijagnoze kod bolesnika s nesitnostaničnim karcinomom pluća u Općoj bolnici Zadar, odnosno odrediti vremenske intervale za pojedine dijagnostičke postupke prije patohistološke ili citološke potvrde bolesti. Ovaj rad ukazuje na poteškoće u pravovremenom postavljanju dijagnoze karcinoma pluća kod određenog broja bolesnika, što u konačnici rezultira odgodom početka onkološkog liječenja.
Lung cancer remains a significant global public health concern, and the Republic of Croatia is no exception where a majority of patients are diagnosed in advanced stages, leading to a five-year survival rate of only 10%. The diagnostic process for non-small cell lung cancer (NSCLC) involves image processing followed by cytological and histopathological sampling. This study aims to identify the challenges clinicians face during the diagnostic procedure and determine the time intervals required before obtaining histopathological or cytological confirmation of the disease in Zadar General Hospital. By analyzing these time intervals, this paper points to the factors contributing to delayed diagnosis, which leads to a delay in the initiation of crucial oncological treatments for patients.
Onkologija predstavlja važan segment sveukupnoga hrvatskoga zdravstvenog sustava. Sama onkologija
jedna je od trenutačno najpropulzivnijih medicinskih struka te smo svakodnevno svjedoci ekspanzivnog ...rasta
novih modaliteta onkološkog liječenja. Ove činjenice nameću imperativ stvaranja onkološke mreže koja bi kao
zadatak imala standardiziranje onkološkog liječenja i osiguravanje dostupnosti novih modaliteta liječenja za sve
oboljele od zloćudnih bolesti, neovisno o njihovom mjestu boravka.¹ Hrvatska već ima prepoznate i definirane
regionalne onkološke centre u sklopu kliničkih bolničkih centara u Zagrebu, Rijeci, Osijeku i Splitu. Nasreću, u
Hrvatskoj postoji tradicija, stara nekoliko desetljeća, razvoja onkoloških centara u općim i županijskim bolnicama.
Poimence, to su neklinički onkološki centri u Županijskoj bolnici Čakovec, Općoj bolnici Dubrovnik, Općoj bolnici
Karlovac, Općoj bolnici Koprivnica, Općoj bolnici Pula, Općoj bolnici Slavonski Brod, Općoj bolnici Šibenik, Općoj
bolnici Varaždin i Općoj bolnici Zadar. Svrha ovoga istraživanja, provedenog u svim nekliničkim onkološkim
centrima
Hrvatske te korištenjem podataka Državnog zavoda za statistiku i Hrvatskog zavoda za zdravstveno osiguranje,
bila je uvidjeti kako je trenutno organizirana onkološka skrb u Republici Hrvatskoj i koja je uloga nekliničkih
onkoloških centara u liječenju bolesnika sa zloćudnim bolestima u Republici Hrvatskoj.
SAŽETAK
Rak dojke je najčešći zloćudni tumor u žena koji se može probirom, redovitim kontrolama i zdravstvenim odgojem otkriti u ranim stadijima bolesti i uspješno liječiti. Metode liječenja ...uključuju kirurgiju, kemoterapiju, radioterapiju, endokrinu terapiju, imunoterapiju, ciljanu terapiju te simptomatsko-suportivnu terapiju, koja se primjenjuje ovisno o stadiju bolesti, biološkim obilježjima tumora i općem stanju, dobi i komorbidetima bolesnica. Plan liječenja definira multidisciplinarni tim. S obzirom na pojavnost ove bolesti, mogućnost ranog otkrivanja i mogućeg značajnog učinka terapijskih postupaka na tijek bolesti, potrebno je definirati i pravilno standardizirati pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu su iznesene smjernice s ciljem primjene standardiziranih postupaka u svakodnevnom radu s bolesnicama s rakom dojke u Republici Hrvatskoj.
Aim: To evaluate the treatment outcomes, with emphasis on the efficacy and safety of olaparib, in patients with platinum-sensitive, BRCA-mutated, recurrent ovarian cancer treated at the University ...Hospital Center Split in the period from June 2016 to April 2021. Methods: Data were collected retrospectively from a medical history of 28 patients with platinum-sensitive, BRCAmutated, recurrent ovarian cancer. Medical records were reviewed for clinico-pathological characteristics, number of previous chemotherapy lines and platinum-free interval before olaparib, response to olaparib, survival outcomes (time to disease progression, time from first cycle of olaparib to the first cycle of chemotherapy for the first and second relapse / progression, overall survival) and safety. Median follow up time was 27 months. Results: All patients were BRCA mutated, with a 75% predominance of BRCA1 mutation. The median platinum-free interval was 13 months. Most patients were treated after the first relapse (64%) with a three weekly TC protocol (68%). Olaparib maintenance therapy provided clinical control rate in 43% of cases. The median progression free survival was 24 months. Discontinuation of olaparib treatment was reported due to disease progression in 16 patients. The median time to first subsequent chemotherapy was 31 months and time to second subsequent chemotherapy was 38 months. The tolerability of olaparib was good and the side effects were low intensity. The median overall survival is not reached. Conclusion: This retrospective analysis of patients with platinum-sensitive, BRCA-mutated, recurrent ovarian cancer showed that the treatment outcomes, ie efficacy and tolerability of olaparib after platinum based chemotherapy in everyday clinical practice, are comparable to those observed in clinical trials with olaparib in the same indications.
To analyze correlation between immunoexpression of E-cadherin and efficacy of first line platinum-based chemotherapy in patients with advanced-stage high-grade serous ovarian carcinoma. The ...expression of E-cadherin was analyzed immunohistochemically in formalin-fixed, paraffin-embedded samples from 98 patients with advanced-stage high-grade serous ovarian cancer and related to clinical features (stage according to the International Federation of Gynecology and Obstetrics (FIGO) and residual tumors after initial cytoreductive surgery), response to platinum-based chemotherapy (according to Response Evaluation Criteria in Solid tumors (RECIST 1.1 criteria)), platinum sensitivity (according to platinum free interval (PFI) as platinum-refractory, platinum-resistant and platinum-sensitive) and patients progression free survival (PFS) and overall survival (OS). E-cadherin immunostaining was positive in 74 and negative in 24 serous ovarian carcinomas. E-cadherin immunoreactivity was not associated with FIGO stage, residual tumor after initial cytoreductive surgery and number of chemotherapy cycles. Positive E-cadherin expression predict significantly better response to first line platinum-based chemotherapy (
p
< 0.001) and platinum sensitivity (
p
< 0.001). Moreover, positive E-cadherin expression predict significantly longer PFS (
p
< 0.001) and OS (
p
< 0.001). The multivariate analysis for OS showed that positive E-cadherin expression is predictor to platinum sensitivity (
p
< 0.001) and longer OS (
p
= 0.01). Positive E-cadherin expression seems to be a predictor of better response to first line platinum-based chemotherapy, platinum sensitivity and favorable clinical outcome in patients with advanced-stage serous ovarian cancer. Negative E-cadherin expression was shown to be significant, independent predictor of poorer PFS and OS. E-cadherin as a marker has predictive and prognostic value.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UL, UM, UPUK, VKSCE, ZAGLJ
Information on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), later termed coronavirus disease (COVID-19), first emerged by the end of 2019. As the pandemic spread, cancer patients ...were immediately recognized as a high-risk population with regard to COVID-19 infection. Moreover, epidemiological measures, like social distancing and lockdowns, additionally burdened patients with cancer. Even outside pandemic breast cancer patients are prone to psychological distress with prevalence ranging approximately 20-40%. This multicentric study aimed to examine the impact of COVID-19 pandemic on the level of distress among breast cancer patients in Croatia while the first wave of COVID-19 pandemic.
Fife hundred forty-five breast cancer patients were offered to participate in the study. A total of two hundred and one patient, with disease stages ranging I-IV, completed the questionnaire. The questionnaire consisted of disease and socio-demographic characteristics followed by the Distress Thermometer and a problem list. The cut off value of 4 was used to define the high level of distress within Distress Thermometer.
High distress level was reported in 54.2% of patients. The most significant problems reported by the participants of our study affected emotions, causing worry, sadness, depression, fear, and nervousness. Additionally, specific practical problems emerged (e.g., child care, housing, and work/school), most probably partly due to the lockdowns and social distancing. Interestingly enough, none of the socio-demographic or disease characteristics were linked to the level of distress.
During first wave of COVID-19 pandemic more than half of breast cancer patients, undergoing active oncologic treatment, experienced a high level of distress. Therefore, distress driven by the COVID-19 pandemic should be promptly addressed and additional psychological and social support, targeting specific practical and emotional problems, should be provided for those patients. All the more so as global COVID-19 pandemic far exceeded the duration of the first wave.
The coronavirus disease (COVID-19) pandemic has greatly affected the oncology community worldwide. Lockdowns, an epidemiological measure, have made it difficult for oncologists to provide care. In ...this study, we analysed the impact of the COVID-19 pandemic on Croatian cancer care.
This was a multicentre cross-sectional observational study of 422 patients who received systemic oncology therapy during the pandemic. The patients completed a survey to capture their views on the impact of the COVID-19 pandemic on their cancer care. Univariate descriptive and bivariate analyses were performed to analyse the relationship between the patients' perspective on the impact of the COVID-19 pandemic on cancer care and the quality of Croatian cancer care and their clinical and sociodemographic data.
Discontinuation or change in cancer treatment during the COVID-19 pandemic was observed in 10.2% of cases. Most did not change their place of treatment owing to the lockdown (97.6%). 14.7% of the patients felt that the quality of cancer care received had changed during the pandemic.
In the first few months of the pandemic, Croatia had a favourable epidemiological situation. However, 25% of patients with cancer reported that the pandemic affected cancer treatment and the quality of cancer care.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Breast cancer is the most common cancer in women, which can be diagnosed early through screening, early detection and through education. When diagnosed early, it can be successfully treated. ...Treatment modalities include surgery, chemotherapy, radiotherapy, endocrine therapy, immunotherapy, targeted therapy and supportive therapy applied depending on the stage of the disease, tumor and patient´s characteristics. Treatment should be defined by a multidisciplinary team. Due to the incidence of this disease, opportunity of early detection and possible significant influence of various treatment modalities on the course of the disease, it is important to define and implement a standardized approach for diagnosis , treatment and monitoring algorithm. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis, treatment and monitoring of breast cancer patients in the Republic of Croatia.
Cilj: Ispitati ishode liječenja, s naglaskom na učinkovitost i sigurnost olapariba, kod ispitanica s platina-osjetljivim, BRCA mutiranim recidivom karcinoma jajnika liječenih u Kliničkom bolničkom ...centru Split u razdoblju od lipnja 2016. do travnja 2021. godine.
Metode: Retrospektivno su prikupljeni podatci iz povijesti bolesti 28 bolesnica s platina-osjetljivim, BRCA mutiranim recidivom karcinoma jajnika. Iz medicinske dokumentacije pregledane su kliničko-patološke karakteristike, broj prethodnih linija kemoterapije i interval bez platine prije olapariba, odgovor na olaparib, ishodi preživljavanja (preživljenje do progresije bolesti, preživljenje od prvog ciklusa olapariba do prvog ciklusa kemoterapije za prvi i drugi recidiv/progresiju, ukupno preživljenje) i podnošljivost liječenja olaparibom. Medijan praćenja bio je 27 mjeseci.
Rezultati: Sve bolesnice su bile BRCA mutirane, sa 75% prevlasti BRCA1 mutacije. Medijan platina slobodnog intervala iznosio je 13 mjeseci. Većina bolesnica liječena je nakon prvog relapsa (64%) trotjednim TC protokolom (68%). Terapija održavanja olaparibom osigurala je kliničku kontrolu bolesti u 43% slučajeva. Medijan preživljavanja bez progresije bio je 24 mjeseca. Prekid liječenja olaparibom prijavljen je zbog progresije bolesti u 16 bolesnica. Medijan vremena do prve sljedeće kemoterapije bio je 31 mjesec, a do druge sljedeće kemoterapije bilo je 38 mjeseci. Podnošljivost olapariba bila je dobra, a nuspojave slabog intenziteta. Medijan ukupnog preživljenja nije postignut.
Zaključak: Ova retrospektivna analiza liječenja bolesnica s platina-osjetljivim, BRCA mutiranim recidivom karcinoma jajnika je pokazala da su ishodi liječenja, odnosno učinkovitost i podnošljivost olapariba nakon kemoterapije temeljene na platini u svakodnevnoj kliničkoj praksi, usporedivi s rezultatima kliničkih istraživanja s olaparibom u istoj indikaciji.
Jetra je najčešće sijelo metastaza karcinoma debeloga crijeva. U većini slučajeva se prilikom postavljanja dijagnoze metastaza u startu detektiraju višebrojni sekundarni depoziti unutar jetrenog
...parenhima koji se ne mogu operirati.
U ovom članku prikazan je rijedak slučaj postizanja višegodišnje kontrole bolesti kod pacijenta operiranoga zbog karcinoma debeloga crijeva, stadija IIIB, kod kojega su se postoperativno u dva navrata
razvile jetrene metastaze. U oba navrata prvo su metastaze kirurški odstranjene (metastazektomija), a nakon toga je sprovedena postoperativna kemoimunoterapija.
Kombinacija kirurškoga liječenja (metastazektomija) i postoperativne kemo(imuno)terapije predstavlja najučinkovitiji način liječenja u pacijenata s primarno resektibilnim jetrenim metastazama. Rezultat je dugotrajna kontrola bolesti.
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