Combined modality therapy of non-small cell lung cancers.

Lung cancer represents the leading cause of cancer mortality. Non-small cell lung cancer (NSCLC) accounts for about 75% to 80% of lung cancer cases and carries a 5-year survival of about 10% to 15% for all stages. Approximately one third of NSCLC patients present with stage III disease, which is defined as locally advanced tumour confined to the chest without distant metastasis. The traditional treatment for stage III patients has been thoracic radiotherapy (RT). However, the impact of thoracic RT alone has been minimal with published studies showing median survival < 1 year and 5-year survival of 5% to 7%. Thus, the treatment of stage III NSCLC remains a significant challenge. The metastatic nature of this disease has been responsible for the poor survival statistics and emphasises the need for effective systemic treatment. In recent years, cisplatin-containing combination chemotherapy has emerged as a viable option in the treatment of NSCLC. Combined modality therapy employing systemic (chemotherapy) and local (RT with or without surgery) approaches has shown favourable results in patients with stage III disease. Randomised studies have demonstrated the benefit of concurrent or sequential chemoradiation in selected patients with a good performance status and minimal weight loss. The exact sequence has yet to be determined. Moreover, randomised studies in stage IIIA potentially resectable disease show survival advantage for patients receiving combined modality treatment. Thus, combined modality treatment has the potential to improve overall survival by increasing both local and distal control. These recent reports of randomised clinical trials of combined modality therapy for stage III NSCLC form the basis for this report. Several new agents, like the taxanes, CPT-II and gemcitabine show promising activity in NSCLC treatment. Ongoing studies are evaluating the potential role of these new agents in combined modality treatment but since the phase III trials have not been reported yet these studies will not be discussed.

Combined modality therapy of rectal cancers.

Rectal cancer accounts for about 10% of new cancer cases each year. It strikes men and women at nearly the same rate, generally in the range of 50-80 years of age, with rising incidence with age. Despite simple screening procedures rectal cancer is often advanced when discovered. Current trends in the management of cancer have focused on organ preservation and improved quality of life without compromising the overall survival. During the last decade substantial progress has been made in treatment modalities: new and improved radiation techniques (conformal radiotherapy, altered fractionation, brachytherapy), chemotherapy (protracted infusion, use of radiosensitizers) and development of surgical procedures-enabling safer postoperative irradiation. In patients with advanced/unresectable disease aggressive combined chemoradiation can be added prior to surgery to downstage the tumour and increase the proportion treated with anal-rectal-sparing procedures. Preoperative chemoradiation therapy regimens are as safe and tolerable as the standard postoperative treatment. In this presentation indications for preoperative radiochemotherapy will be discussed in detail, together with treatment-related side effects, prognostic parameters, tumour response and outcome. Different irradiation settings and chemotherapy schedules are described. In patients with primary resectable disease (mainly Dukes C) several prospective randomised trials have shown less local recurrence with postoperative combined modality therapy.

[Radiotherapy of lung cancer]. / Radioterapija raka pluca.

The paper is aimed at approaching radiation therapy methods to physicians of other specialties and pointing to the potential of radiation therapy in the management of lung cancer patients. With the reference to its incidence and mortality rates, lung cancer ranks among the most frequent human malignant tumors. Therapy procedures for lung cancer depend upon tumor histology type, stage of disease and patient general condition. The said parameters therefore determine the application of surgery, radiation therapy and/or chemotherapy. In general, treatment results are usually rather poor, primarily due to lung cancer being the most frequently detected only as locally advanced or metastatic disease. Alike surgery, radiotherapy is a local form of treatment aimed at achieving local tumor control. This curative or palliative form of treatment is either applied alone or in combination with other treatment modalities. Irradiation is usually delivered by high energy photon beams from a telecobalt device or linear accelerator. The success of radiation therapy complies with the irradiation dose managed to be applied to tumor or tumor bed, which depends on patients general condition and site, size and spread of tumor. Radiotherapy with curative intent is applied in stage I, II and III non-small cell lung cancer patients with surgery being primarily applied in those with stage I and II. The efficacy of surgical treatment is to be improved by a combined-modality treatment. In stage III patients, who are more frequent than others, radical radiotherapy alone or in combination with chemotherapy is applied. Results of clinical trials report patients of relatively good general condition benefiting from combined-modality therapy. Palliative radiotherapy is to be applied in patients with stage IV non-small cell lung cancer. On the other hand, in patients with small cell lung cancer chemotherapy is the primary modality treatment. When the disease is limited to the lungs, the aim of radiotherapy is to optimize local control of the primary tumor.

[Inflammation of the female genital organs caused by Chlamydia trachomatis]. / Upale zenskih spolnih organa uzrokovane Chlamydiom trachomatis.

Chlamydia trachomatis has been presented in a growing number of recent papers as a causative agent of diseases such as cervicitis, endometritis, salpingitis and peritonitis. Based on the results available in literature, significance of an early detection of female genital tract inflammations caused by Chlamydia trachomatis because of its often asymptomatic flow, irreparable sequels of uncured inflammation and possible curing with tetracyclines and macrolides therapy has been discussed.

[Chlamydia trachomatis in women with endocervicitis]. / Klamidija trahomatis u zena s endocervicitisom.

In 378 women coming for examination with the symptoms of a chronic inflammation of the previously randomly treated endocervix, the presence of Chlamydia trachomatis was found in 17.2%, i.e. in every fifth woman with chronic cervicitis. The diagnosis of the cervical inflammation was made according to the criteria of Harrison and co-workers. The patients' age range from 17 to 58 years.