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.
Uvod: Primarni hiperparatireoidizam liječi se kirurški. Opseg i uspješnost operacije ovise o točnosti prepoznavanja lokalizacije patološki promijenjene žlijezde dijagnostičkim pretragama prije ...operacije te o intraoperativnoj potvrdi uklanjanja izvora povišene koncentracije PTH. Materijali i metode: Učinjena je retrospektivna analiza bolesnika s dijagnozom primarnog hiperparatireoidizma liječenih u Klinici za tumore u periodu od 2012. do 2019. Godine. Uključena su 54 bolesnika s dijagnozom primarnog hiperparatireoidizma, jedna bolesnica operirana je dva puta. Raspon normalnih koncentracija intaktnog PTH je 15 – 65 pg/mL, a ukupnog kalcija 2,14 – 2,53 mmol/L. Preoperativna koncentracija PTH mjerena je nakon uvoda u opću anesteziju. Intraoperativna koncentracija PTH mjerena je 15 minuta nakon vađenja žlijezde koju smo smatrali zahvaćenom. Kriterij uspješno učinjene operacije bio je pad koncentracije PTH veći od 50% u odnosu na početnu vrijednost. U slučaju izostanka pada koncentracije PTH, prema odluci kirurga, a ovisno o intraoperativnoj situaciji, operacija je produljena traženjem zahvaćene žlijezde, te ponavljanim mjerenjem. Rezultati: Prosječna koncentracija PTH prije operacije bila je 117,4 (39,6 – 305,4) pg/mL, a ukupnog kalcija 2,75 (2,45 – 3,15) mmol/L. Prosječna koncentracija intraoperativnog PTH bila je 35,6 (8,1 – 198,6) pg/mL. Intraoperativne vrijednosti bile su 67,6% manje u odnosu na preoperativne. Kod 44
bolesnika bilo je dovoljno jedno intraoperativno mjerenje koncentracije PTH, dok je kod 11 bolesnika bilo potrebno više mjerenja. Prosječna koncentracija ukupnog kalcija šest mjeseci nakon operacije bila je 2,39 (1,96 – 2,7) mmol/L. Primjenom intraoperativnog određivanja PTH postignuta je uspješnost operacije kod 53 bolesnika (98,14%). Određivanje intraoperativnog pada koncentracije PTH ima visoku osjetljivost 88,7% i pozitivnu prediktivnu vrijednost 97,9%. Zaključak: Intraoperativna potvrda pada koncentracije PTH povećava uspjeh kirurškog
liječenja primarnog hiperparatireoidizma, posebno u skupini bolesnika s multiglandularnom bolesti. Zaključak je temeljen na skupini bolesnika kod kojih je bilo potrebno više od jednog određivanja intraoperativnog PTH.
The aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer.
A retrospective analysis of 179 ...patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups.
A total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLNd group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLNd group. The rate of persistent hypoparathyroidism in the TT and TT + CCLNd groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLNd group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant.
While its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies.
Our results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy.
In vivo study has been conducted on 47 healthy women and men in order to investigate whether daily intake of powdered propolis extract during 30 days has any influence on the following blood ...parameters: activity of superoxide dismutase, glutathione peroxidase and catalase, concentration of plasma malondialdehyde, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, glucose, uric acid, ferritin and transferrin, together with routine red blood cell parameters.
The effect of daily propolis intake seems to be time and gender related. For the men test group after the initial 15 days of propolis treatment, 23.2% (
p
=
0.005) decrease in concentration of malondialdehyde was observed. After 30 days of treatment, statistically significant (
p
=
0.010) 20.9% increase in superoxide dismutase activity and change in some of the red blood cell parameters were detected. For the women test group, the propolis treatment did not induce a change in any of the measured parameters.
Aim: The aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer. Methods: A retrospective ...analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups. Results: A total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLNd group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLNd group. The rate of persistent hypoparathyroidism in the TT and TT + CCLNd groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLNd group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant. Discussion: While its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies. Conclusion: Our results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy. Key Words: differentiated thyroid cancer, total thyroidectomy, central compartment lymph node dissection, paratracheal dissection, postoperative hypoparathyroidism Cilj rada je usporediti incidenciju postoperativnog hipoparatireoidizma izmectu dvije skupine bolesnika lijecenih zbog dobro diferenciranog karcinoma stitnjace. Metode: Retrospektivno smo analizirali 179 bolesnika koji su u nasoj ustanovi lijeceni zbog dobro diferenciranog karicnoma stitnjace u periodu od sijecnja 2011 do prosinca 2018. U studiju su bili ukljuceni samo bolesnici kod kojih je inicijalno ucinjena totalna tiroidektomija te oni koji na osnovu preoperativne obrade nisu imali potvrcene metastaze na lateralnom vratu i u regiji VI. Analizirane su dvije skupine bolesnika. U prvu skupinu su ukljuceni bolesnici kod kojih je u istom aktu ucinjena totalna tireoidektomija i disekcija regije VI. Svi ostali bolesnici kod kojih je ucinjena samo totalna tireoidektomija ukljuceni su u drugu skupinu. Stopa tranzitornog i trajnog hipoparatireoidizma je usporectivana izmectu dvije skupine. Rezultati: Kod ukupno 117 bolesnika (65,4%) ucinjena je disekcija regije VI istodobno s totalnom tireoidektomijom. (TT + CCLNd skupina). Kod preostalih 62 bolesnika (34,6%) ucinjena je samo totalna tireoidektomija. (TT skupina). Ukupno 22,6% bolesnika iz TT skupine je razvilo postoperativni hipoparatireoidizam usporedno s 25,6% bolesnika iz TT + CCLNd skupine. Stope trajnog hipoparatireoidizma u TT i TT + CCLNd skupinama su iznosile 3,2 i 6 %. Stopa tranzitornog kao i trajnog postoperativnog hipoparatireoidizma nije bila statisticki znacajna izmecu dvije skupine. Unutar TT + CCLNd skupine, kod 82,9% bolesnika je ucinjena disekcija ipsilateralnih paratrahealnih limfnih cvorova, za razliku od 17,1% bolesnika kod kojih je ucinjena disekcija bilateralnih paratrahealnih cvorova. Stopa postoperativnog hipoparatireoidizma je analizirana u dvjema podskupinama i nije se pokazala statisticki znacajnom. Rasprava: Iako je utjecaj elektivne disekcije regije VI na lokoregionalno recidiviranje i dalje kontroverzan, ona moze biti odlican alat za probir bolesnika koji mogu imati korist od adjuvantne radiojodne ablacije. S druge strane, disekcija regije VI potencijalno moze povecati rizik hipoparatireoidizma zbog nenamjerne ozljede dostitnih zlijezda ili/i njihove krvne opskrbe. Nasa studija nije pokazala statisticki znacajnu razliku u stopi postoperativnog hipoparatireoidizma izmectu skupine bolesnika kod kojih je ucinjena disekcija regije VI u usporedbi sa skupinom bolesnika kod kojih je ucinjena samo totalna tireoidektomija. Nasi podaci su u proturijecju s nekim ranije publiciranim studijama. Zakljucak: Nasi rezultati su pokazali da je elektivna disekcija regije VI sigurni postupak i znacajno ne povecava rizik postoperativnog hipoparatireoidizma kada se izvodi istodobno s totalnom tireoidektmijom. Kljucne rijeci: dobro diferencirani karcinom stitnjace, totalna tiroidektomija, disekcija regije VI, paratrahealna disekcija, postoperativni hipoparatireoidizam
This study aimed to identify and quantify the clinical significance of the HE4 and ROMA index in patients with an adnexal tumour. We recruited 159 women and the HE4 and CA125 were measured with an ...electrochemiluminescence immunoassay in the sera. We used the Kolmogorov-Smirnov test, Mann-Whitney's test and logistic regression to interpret the data. In the premenopausal group (n = 57), the ROC analysis (with cut-off: 86.1 pmol/L for HE4; 40.7 U/L for CA125 and 21.9% for ROMA) demonstrated the superior prognostic potential of those markers when the higher cut-offs used are compared to producer
s
. The AUC for HE4/CA125/ROMA were 0.846/0.867/0.846, respectively. The HE4/ROMA showed 85.7% sensitivity and 94% specificity. In the postmenopausal group (n = 102), the ROC analysis cut-off values were: 99.8 pmol/L for HE4; 45.8 U/L for CA125 and 38.4% for ROMA. AUC for HE4/CA125/ROMA were 0.928/0.899/0.927, respectively. HE4 had an 86.1% sensitivity at 92.4% specificity, while ROMA showed an 88.9% sensitivity at a 90.9% specificity.
Impact Statement
What is already known on this subject? The incidence of ovarian cancer has been increasing, despite the improvement of diagnostic, operative and therapeutic procedures. As a part of the multiparametric approach, the HE4 and ROMA index improve the diagnostic sensitivity and specificity of CA125 in the detection of ovarian cancer.
What the results of this study add? The evaluation of HE4 and ROMA efficacy in the preoperative stratification was made by logistic regression analysis. The better prognostic potential of ROMA index, in patients with present adnexal mass, was obtained using our higher cut-offs for the ROMA index (21.9% for premenopausal and 38.4% for postmenopausal) in comparison to the producer's (11.7% for premenopausal and 29.9% for postmenopausal). The HE4 and ROMA index had 14.29 +LR, 0.15 -LR, 67% PPV and 97.9% NPV in the premenopausal patients. In the postmenopausal group, the HE4 had 11.37 +LR, 0.15 -LR, 75.6% PPV and 92.4% NPV, the ROMA showed 9.78 +LR, 0.12 -LR, 91.2% PPV and 95.2% NPV.
What the implications are of these findings for clinical practice and/or further research? Application of a higher cut-off for HE4/CA125/ROMA index can significantly reduce the percentage of FP and FN in the preoperative stratification of ovarian cancer and justify speculations about this subject in the future.
PDF
