Optimal sequencing of available therapy lines in patients with advanced prostate cancer often poses quite a challenge. The guidelines are sometimes equivocal and clinical trial data are not always ...applicable to a particular patient. There is a difference in availability of therapy options throughout the world. In decision making, a patient as a whole should be taken into consideration, not just the stage and biology of the disease, but also patient's age, performance status, comorbidities, previous therapy lines, drug's safety profile and patient's preferences. This review article will show certain therapeutic options in the treatment of advanced hormone-sensitive prostate cancer and castration resistant prostate cancer: non- metastatic and metastatic. An attempt will be made to clarify the optimal sequencing.
Anti HER2 therapy and left breast adjuvant radiation therapy (RT) can both result in cardiotoxicity. The aim of this study was to evaluate the influence of radiation dose on cardiac structures on the ...values of the early cardiotoxicity marker high-sensitivity cardiac troponin I (hscTnI) in patients with HER2-positive left breast cancer undergoing adjuvant concomitant antiHER2 therapy and radiotherapy, and to establish a correlation between the hscTnI values and cardiac radiation doses. Sixty-one patients underwent left breast hypofractionated radiotherapy in parallel with anti-HER2 therapy: trastuzumab, combined trastuzumab–pertuzumab or trastuzumab emtansine (T-DM1). The hscTnI values were measured prior to and upon completion of radiotherapy. A significant increase in hscTnI was defined as >30% from baseline, with the second value being 4 ng/L or higher. Dose volume histograms (DVH) were generated for the heart, left ventricle (LV) and left anterior descending artery (LAD). The hscTnI levels were corelated with radiation doses on cardiac structures. An increase in hscTnI values was observed in 17 patients (Group 1). These patients had significantly higher mean radiation doses for the heart (p = 0.02), LV (p = 0.03) and LAD (p = 0.04), and AUC for heart and LV (p = 0.01), than patients without hscTnI increase (Group 2). The patients in Group 1 also had larger volumes of heart and LV receiving 2 Gy (p = 0.01 for both) and 4 Gy (p = 0.02 for both). LAD differences were observed in volumes receiving 2 Gy (p = 0.03), 4 Gy (p = 0.02) and 5 Gy (p = 0.02). The increase in hscTnI observed in patients receiving anti-HER2 therapy after adjuvant RT was positively associated with radiation doses on the heart, LV and LAD.
Adekvatno sekvencioniranje dostupnih terapijskih linija u uznapredovalom raku prostate predstavlja velik izazov. Smjernice
ponekad znaju biti nedorečene a podaci iz kliničkih studija često se ne mogu ...točno preslikati na pojedinog bolesnika.
Također, sama dostupnost lijeka varira među pojedinim zemljama. Kod donošenja odluke treba uzeti bolesnika u cjelini, ne
samo stadij i biologiju bolesti već i dob, opće stanje, druge bolesti od kojih eventualno boluje, ranije linije liječenja, očekivani
profil nuspojava lijeka ali i preferencije bolesnika. U ovom preglednom radu će biti prikazane terapijske mogućnosti kod
uznapredovalog hormon- senzitivnog raka prostate, te kastracijski rezistentnog raka prostate: nemetastatskog i metastatskog.
Pokušat će se razjasniti optimalno sekvencioniranje liječenja za pojedine skupine bolesnika.
Radiotherapy presents one of the essential modes of treatment in patients with prostate cancer at almost any stage of the disease. It can be delivered as external beam radiotherapy, as brachytherapy ...or two methods combined. Higher radiation doses are proven to be more effective than low doses and moderate hypofractionation with doses up to 3.4 Gy per fraction is proven equivalent to standard fractionation using 1.8- 2 Gy per fraction. Stereotactic body radiotherapy (SBRT) with doses from 3.4 to 7.25 Gy per fraction presents valuable option in certain subgroups of patients. In case of local regional disease relapse, radiotherapy is used in curative setting.
Radiotherapy presents one of the essential modes of treatment in patients with prostate cancer at almost any stage of the disease. It can be delivered as external beam radiotherapy, as brachytherapy ...or two methods combined. Higher radiation doses are proven to be more effective than low doses and moderate hypofractionation with doses up to 3.4 Gy per fraction is proven equivalent to standard fractionation using 1.8-2 Gy per fraction. Stereotactic body radiotherapy (SBRT) with doses from 3.4 to 7.25 Gy per fraction presents valuable option in certain subgroups of patients. In case of local regional disease relapse, radiotherapy is used in curative setting. Key words: prostate cancer, radiotherapy, brachytherapy, hypofractionation, stereotactic body radiotherapy, salvage radiotherapy Radioterapija predstavlja jedan od osnovnih modaliteta lijecenja bolesnika s rakom prostate u gotovo svim stadijima bolesti. Moe se koristiti kao vanjsko zracenje, kao brahiterapija (unutarnje zracenje) ili kombinacija ove dvije metode. Vie doze zracenja su dokazano ucinkovitije od niih a umjereno hipofrakcionirano zracenje dozama do 3,4 Gy po frakciji je jednako ucinkovito kao i zracenje standardnim frakcioniranjem od 1,8-2 Gy po frakciji. Stereotaksijsko zracenje dozama od 3, 4 do 7, 25 Gy po frakciji predstavlja vrijednu opciju kod odredenih podskupina bolesnika. U slucaju lokoregionalnog povrata bolesti, zracenje se moe provoditi s ciljem izljecenja bolesnika. Kljucne rijeci: rak prostate, radioterapija, brahiterapija, hipofrakcioniranje, stereotaksijsko zracenje, spasonosna radioterapija
Kod postavljanja indikacije za adjuvantno zračenje bolesnica s rakom dojke vodimo se vrstom kirurškog zahvata (radikalni ili poštedni) te patohistološkim nalazom. U slučaju da je sistemska terapija ...provedena prije kirurškog zahvata, nedostaje dio patohistološkog nalaza koji je okosnica u donošenju odluke. Objavljenih prospektivnih randomiziranih studija nema a retrospektivni podaci su nekonzistentni. Trenutne smjernice nisu jasne za veliku podskupinu bolesnica. Osim toga smjernice i podaci iz kliničke prakse se često ne podudaraju. Cilj ovog rada je prikazati podatke iz literature po pitanju rizika nastanka lokoregionalnog relapsa nakon neoadjuvantnog sistemskog liječenja, učinak radioterapije na smanjenje rizika lokoregionalnog relapsa, kliničku studiju koja bi trebala dati odgovor kod koje skupine bolesnica bi bilo uputno provesti zračenje te objavljene podatke iz kliničke prakse.
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