To evaluate the efficacy and toxicity of preoperative chemoradiotherapy with capecitabine in locally advanced rectal cancer.
Between June 2004 and January 2005, 57 patients with operable, clinical ...stage II-III adenocarcinoma of the rectum entered the prospective phase II study. Radiation dose was 45 Gy (25x1.8 Gy). Concurrent chemotherapy with a daily dose of 1650 mg/m2 capecitabine was administered orally, divided into two equal doses per day, including weekends. Patients were evaluated weekly for acute toxicity and compliance with the protocol. Surgery was scheduled 6 weeks after the completion of the chemoradiotherapy.
A single female patient died after receiving 27 Gy, because of pulmonary embolism. All other patients completed the preoperative chemoradiotherapy according to the protocol and a definitive operation was performed in all but one of these patients. The complete pathological response was recorded in 5 patients (9.1%). Tumor (T), lymph nodes (N), and overall downstaging rates were 40%, 52.9%, and 49.1%, respectively. Total sphincter preservation rate was 65.5% (36 out of 55 patients) and the rate in 27 patients with tumors located within 5 cm of the anal opening was 37% (10 out of 27 patients). The most frequent side-effect of the combined therapy was dermatitis (grade 3 in 19 patients). After surgery, a single patient died due to sepsis during the early perioperative period. Nonlethal perioperative complications were recorded in 24/55 patients.
Preoperative chemoradiotherapy with oral capecitabine is safe and well tolerated. It has a downstaging potential and can increase the possibility for sphincter preservation surgery.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
V članku je opisana zgodovina klasifikacije vmesne skupine ščitničnih rakov, ki so uvrščeni med zrele oblike ščitničnega raka (WDTC) in nezrele oblike (ATC). Ta vmesna skupina se imenuje slabo ...diferencirani rak ščitnice (PDTC). Tumorji iz te skupine povzročajo slab potek bolezni z lokalno ponovitvijo bolezni ali oddaljenimi zasevki ali z obojim, medtem ko je pri največji skupini dobro diferenciranih rakov ščitnice, ki predstavljajo veliko večino rakov ščitnice, napoved poteka bolezni večinoma veliko ugodnejša. Po poteku so slabo diferencirani raki ščitnice podobni nezreli obliki ščitničnega raka, vendar pa je ob izbranem zdravljenju pričakovati znatno boljše preživetje kot pri anaplastičnem raku. Opisane so nekatere patološke značilnosti slabo diferenciranih rakov in osnovna klinična slika. Prikazani so tudi 3 primeri bolnikov, od tega 2 bolnic z izjemnim potekom in 1 bolnika s pričakovanim potekom bolezni. Nakazane so tudi nove možnosti sistemskega zdravljenja raka ščitnice.
Paliativna oskrba prinaša neozdravljivo bolnim mnoge prednosti. V zadnjih dnevih pred smrtjo se lahko pojavi 5 najpogostejših simptomov (bolečina, slabost in bruhanje, nemir in zmedenost, dispneja, ...povečan izloček dihalnih poti), ki jih blažimo z vnaprej predpisanimi zdravili. Namen retrospektivne raziskave je bil ugotoviti razlike v porabi zdravil v zadnjih 6 dnevih med bolniki v paliativni oskrbi, ki jih je vodil tim za paliativno oskrbo, in bolniki, ki so bili vodeni na drugih oddelkih Onkološkega inštituta in paliativni tim v njihovo oskrbo ni bil vključen (kontrolna skupina). V vsaki skupini je bilo po 25 bolnikov; skupini sta bili primerljivi glede na mesto primarnega tumorja in starost bolnikov. Ugotovili smo, da je večina bolnikov v obeh skupinah prejemala močne opioide, druga zdravila za blaženje simptomov (haloperidol, midazolam, deksametazon, butilskopolamin, metoklopramid) pa je prejelo več bolnikov v paliativni oskrbi. Bolniki v paliativni oskrbi so v povprečju prejeli 10 različnih zdravilnih učinkovin, v kontrolni skupini pa 14. Stroški za zdravila so bili 2,7-krat manjši v skupini bolnikov, vključenih v paliativno oskrbo, in so znašali 15 € na bolnika na dan, medtem ko so za bolnika v kontrolni skupini znašali 42 € na dan. Razlika v stroških je bila predvsem posledica nepotrebnega predpisovanja nizkomolekularnih heparinov, sistemskih antibiotikov in antimikotikov ter parenteralne prehrane.
In a prospective randomized clinical study, simultaneous postoperative application of irradiation (RT), mitomycin C, and bleomycin was tested in a group of patients with operable advanced ...head-and-neck carcinoma. It was expected that the planned combined postoperative therapy would reduce the number of locoregional recurrences and prolong survival.
A total of 114 eligible patients with Stage III or IV squamous cell head-and-neck carcinoma were randomized to receive postoperative RT alone (Group 1) or RT combined with simultaneous mitomycin C and bleomycin (Group 2). Patients were stratified according to the stage and site of the primary tumor and the presence or absence of high-risk prognostic factors. Primary surgical treatment was performed with curative intent in all patients. Patients in both groups were postoperatively irradiated to the total dose of 56–70 Gy. Chemotherapy included mitomycin C 15 mg/m
2 after 10 Gy and 5 mg of bleomycin twice a week during RT to the planned total dose of 70 mg.
At 2 years, patients in the radiochemotherapy group had better locoregional control (86%) than those in the RT alone group (69%;
p = 0.037). Disease-free survival and overall survival was also better in the radiochemotherapy group compared with the RT-alone group (76% vs. 60%,
p = 0.099; and 74% vs. 64%,
p = 0.036, respectively). Patients who benefited from chemotherapy were those with high-risk factors.
The results of the present study indicate that concomitant postoperative radiochemotherapy with mitomycin C and bleomycin improves locoregional control and survival in patients with advanced head-and-neck carcinoma. The patients who benefited from chemotherapy were those with high-risk factors.
Abstract Systemic chemotherapy plays the major role in the management of patients with small cell lung cancer. Cisplatin plus etoposide is the most widely used regimen and is considered as standard ...in patients with limited disease. Cisplatin plus irinotecan improved survival compared to cisplatin plus etoposide in a Japanese trial but failed to do so in two trials in Caucasians. Cisplatin plus topotecan had similar efficacy compared to cisplatin plus etoposide in patients with extensive disease. In the second-line setting, topotecan showed similar efficacy but better tolerability compared to cyclophosphamide, doxorubin plus vincristine. Oral topotecan was as efficacious as its intravenous formulation and was shown to improve survival compared to best supportive care alone in patients previously treated with chemotherapy. Thus topotecan is considered as the standard second-line chemotherapy in patients with small cell lung cancer.
Tumorski označevalci so snovi, ki jih izloča tumor ali pa nastanejo kot odgovor na tumor v telesu. Samo na podlagi določitve koncentracije tumorskega označevalca ne moremo postaviti diagnoze raka, ...ker je koncentracija lahko povečana tudi pri bolnikih, ki nimajo raka, in normalna pri bolnikih z rakom, poleg tega pa označevalci večinoma niso specifični za določeno vrsto raka. Koristni so predvsem pri vrednotenju uspešnosti zdravljenja, v manjši meri pa tudi pri spremljanju bolnikov po končanem zdravljenju nekaterih vrst raka, da bi zgodaj odkrili ponovitev bolezni.
Gastrointestinalni tumorji (GIST) so redke neoplazme mezenhimskega izvora, ki na celični površini izražajo transmembranski receptor KIT, produkt c-kit protoonkogena. Pri patogenezi GIST so pomembne ...mutacije KIT. Njihova posledica je aktivacija KIT signalne poti, ki vodi do nekontrolirane proliferacije celic in rezistenco na apoptozo. Do nedavnega je bilo radikalno kirurško zdravljenje edina uspešna oblika zdravljenja za manjše in dobro omejene GIST, za razsejano bolezen pa ni bilo uspešne terapije. Z odkritjem imatinib mesilata in kasneje sunitiniba, ki inhibirata KIT signalno pot, se je prognoza bolnikov z GIST močno izboljšala. Srednje preživetje bolnikov z razsejano boleznijo se je iz pol leta povečalo skoraj na pet let. Od leta 2001 smo na Onkološkem inštitutu Ljubljana uspešno zdravili 51 bolnikov. Srednje preživetje naših bolnikov je 66 mesecev. To lahko pripisujemo timski obravnavi bolnikov, ki je glede na velikost Slovenije in nizko incidenco GIST smiselna na enem mestu.
