RESUMO
Breast cancer is the most common malignancy in women. Early diagnosis and more effective treatment of invasive breast cancer resulted in significant mortality reduction, improvement of survival and the quality of life of the patients. The management od non-invasive breast cancer, on the contrary, is still controversial and the problem of overdiagnosis and overtreatment of patients come to evidence. In the following text a multidisciplinary team of experts brings the first consensus guidelines aimed to standardize and optimize the criteria and management in diagnosis, treatment and monitoring of non-invasive breast cancer patients in the Republic of Croatia.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , HumanosRESUMO
Multiple primary malignancies, metachronous or synchronous, in a single patient are relatively rare event with the increase of incidence in recent decades. The aim of this research is to study their incidence in patients hospitalized at the Division of Radiotherapy, Department of Oncology, University of Zagreb, School of medicine, University Hospital Centre Zagreb from 2003 to 2009. The incidence of multiple primary malignancies was 2.4%. Among 103 patients, 97 had two, and 6 three primary tumors. Eighty-three cases were metachronous, while 20 cases were synchronous malignancies. The frequency was higher in females than males and their age at diagnosis of tumors was younger than in males. The most common tumor combinations in males were: prostate cancer-digestive system malignancy (especially colorectal cancer) and viceversa, and hematological malignant tumors-digestive system malignancy; while in women there were: breast cancer-cancer of contralateral breast and hematological malignant tumors (especially lymphoma non Hodgkin)-breast cancer. The incidence of multiple primary malignancies is expected to increase due to the better screening programs for early detection of malignancies as well as considerable improvement in their treatment and longer life expectancy.
Assuntos
Neoplasias Primárias Múltiplas/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Feminino , Humanos , Masculino , Neoplasias Primárias Múltiplas/diagnóstico , Segunda Neoplasia Primária/diagnósticoRESUMO
To avoid, or at least to reduce complications in patients who require head and neck radiotherapy, adequate oral cavity treatment is necessary before the therapy. Recent management guidelines speak of possibilities of preventing osteoradionecrosis with hyperbaric oxygen, using long-wave ultrasound in stimulating osteoblasts growth, and surgical transfer of submandibular salivary glands to submental area with 99% effectiveness in preventing xerostomia, besides traditional therapy. Preventive measures are naturally the best choice, since late complications treatment is not needed as often, and should draw special attention of physicians and patients. Since wide a spectrum of preventive and curative measures is required, the need exists for standard teams to look after the patients during and after radiotherapy, and which should include, besides radiotherapist, oral or maxillofacial surgeon in cooperation with oral medicine specialist.
Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Doenças da Boca/diagnóstico , Lesões por Radiação/diagnóstico , Humanos , Doenças da Boca/etiologia , Doenças da Boca/prevenção & controle , Doenças da Boca/terapia , Osteorradionecrose/diagnóstico , Osteorradionecrose/prevenção & controle , Osteorradionecrose/terapia , Lesões por Radiação/prevenção & controle , Lesões por Radiação/terapia , Xerostomia/diagnóstico , Xerostomia/prevenção & controle , Xerostomia/terapiaRESUMO
Anemia with consequent tissue hypoxia is common problem in cancer patients. Developed via various patophysiological mechanisms, it has deleterious effect on quality of life and survival of patients with cancer. Recognition of symptoms and timely initiation of treatment improve patients' quality of life, as well as efficacy of oncological treatment. Red blood cells transfusions are well known and efficient way of anemia correction. They are "golden standard" in treatment of cancer-related anemia today, and are unavoidable in almost all patients with hemoglobin concentration below 80 g/L. Newest therapy guidelines in developed countries, supported by recent literature, encourage use of recombinant human erythropoietin (rHu-EPO), although detailed meta-analyses and prospective randomized clinical trials have shown that rHu-EPO decreases the need for transfusions in only 9-45% patients with cancer, only if they have mild anemia, rHu-EPO increases incidence of thromboembolic events, and suspicion arises that it supports tumor cells growth and multiplication. Therefore, it is necessary to define subgroups of patients which are best candidates for rHu-EPO therapy, to accomplish lower intensity of transfusion therapy.
Assuntos
Anemia/terapia , Neoplasias/complicações , Anemia/etiologia , Animais , Transfusão de Sangue , Epoetina alfa , Eritropoetina/uso terapêutico , Humanos , Qualidade de Vida , Proteínas RecombinantesRESUMO
Erdheim-Chester disease (ECD) is a rare histiocytosis usually affecting the skeletal system, but visceral organs and central nervous system involvement are common as well. Probability exists that immunomodulatory therapies and disorders can play a role in clinical course of the disease. Because of rarity of the disorder, it is hard to classify it and standardize the treatment options, but, according to published material and our experience, cytotoxic chemotherapy and long-term steroids have therapeutic benefit. Although this approach can probably be accepted as standard of care management, novel therapeutic modalities should be explored, and pathogenesis and disorder classification should be cleared out as well. The case of ECD affecting skeletal system and lungs and concomitant laryngeal tuberculosis successfully treated with chemotherapy and long-term steroid therapy is presented.
Assuntos
Antituberculosos/uso terapêutico , Doença de Erdheim-Chester/complicações , Doença de Erdheim-Chester/tratamento farmacológico , Esteroides/uso terapêutico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Doença de Erdheim-Chester/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
The aim of this study is to test the possible prognostic significance of p53 and Ki67 expression in inverted papilloma of the lateral nasal wall and adjacent sinuses regarding their malignant potential and recurrence. 49 biopsies of the lateral nasal wall and adjacent sinuses obtained from 41 patients from three hospitals were investigated. Immunohistochemically demonstrated p53 and Ki67 expression was measured and statistically evaluated. p53 immunoreactivity was demonstrated in most of papillomas with carcinomas but only in two benign papillomas, while Ki67 demonstrated stronger immunoreactivity in carcinomas and surrounding epithelium. Immunohistochemical staining of inverted sinonasal papillomas for p53 and Ki67 can give useful information concerning the existence of synchronous carcinoma and, in case of high Ki67, a hint toward possible recurrence.
Assuntos
Antígeno Ki-67/metabolismo , Papiloma Invertido/metabolismo , Neoplasias dos Seios Paranasais/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papiloma Invertido/patologia , Neoplasias dos Seios Paranasais/patologia , PrognósticoRESUMO
It is often presumed that the main role of hormone binding to albumins and binding proteins (BPs) is to reduce oscillating levels of free hormone molecules and to transport steroid hormones. This paper is an attempt to define possible consequences of hormone molecules binding to carrier proteins in circulation. Binding to albumins and BPs prevents exact and quick control of hormone actions. Hormones without significant protein binding govern vital and fast acting regulatory mechanisms (blood glucose or calcium) in which any added inertia might be dangerous. In the presented model, the added inertia for a partially bound hormone (H) is defined as: H(bound)/H(free). Values, calculated from the reported data, range from 0.4 for GH to more than 2000 for T(4). In comparison to albumins, high-affinity BPs make more stable reserve that would cover periods of low or no hormone secretion. At the same time, hormone molecules are taken away from the blood level control and thus might be considered sequestrated. For hormones without protein binding, the well-perfused areas of the body, or the areas with increased capillary permeability, would be more exposed, making an uneven distribution among target tissues. For the hormone that binds blood proteins, places of secretion and tissue perfusion become unimportant, since the hormone is being liberated anywhere in the circulation (i.e., for strongly bound IGFs, IGF binding proteins do not just stabilize proinsulin actions of IGF-1, but also make all parts of body to be under the same exposure to liberated IGFs, an important feature to promote a symmetrical bone growth). Estrogens are known to stimulate liver secretion of different BPs. A possible explanation is that in the follicular phase there is a small initial mass of granulosa cells, and it takes time to saturate free estrogen carriers, before the normal free hormone level can be reached and FSH secretion inhibited. Less inert peptide inhibin might suppress FSH before free estrogens reach the required level. Without inhibin suppression, an increased FSH level with an increased number of growing follicles can be expected. Estrogens increased production of BPs augments inertia of the estrogen loop and possibly modulates the FSH/estrogen negative feedback.
Assuntos
Sistema Endócrino/fisiologia , Hormônios/metabolismo , Albuminas/metabolismo , Animais , Sistema Endócrino/patologia , Estrogênios/metabolismo , Hormônio do Crescimento/metabolismo , Humanos , Modelos Teóricos , Ligação ProteicaRESUMO
During implementation of the total skin electron treatment, using six-dual-field technique, at radiotherapy department a large number of measurements are needed. To assess depth dose curve required by clinicians and dose uniformity over a whole treatment plane, combinations of different irradiation parameters are used (electron energy, beam angle, scatterers). Measurements for each combination must be performed. One possible way to reduce number of measurements is to model the treatment using the Monte Carlo simulation of electron transport. We made a simplified multiple-source Monte Carlo model of electron beam and tested it by comparing calculations and experimental results. Calculated data differs less than 5 percent from measurements in the treatment plane. During the treatment patient can be approximated using cylinders with different diameters and orientations. We tried to model the depth dose variations in the total skin electron treatment not just around the body cross-section (simplified to cylinders of different diameters), but also along the body to account for the variations in body curvature longitudinally. This effect comes down to the problem of modeling distribution in different cylinders, but varying the longitudinal orientation of those cylinders. We compared Monte Carlo calculations and film measurements of depth dose curves for two orientations of the cylindrical phantom, which were the simplest for experimental arrangement. Comparison of the results proved accuracy of the model and we used it to calculate depth dose curves for a number of other cylinder orientations.
Assuntos
Radioterapia de Alta Energia/métodos , Pele/efeitos da radiação , Humanos , Modelos Biológicos , Método de Monte Carlo , Micose Fungoide/radioterapia , Dosagem Radioterapêutica , Neoplasias Cutâneas/radioterapiaRESUMO
Inverted papilloma is an epithelial neoplasm of the lateral nasal wall and adjacent sinuses characterized by a marked propensity for recurrence and a significant association with carcinoma. In this retrospective study we present 31 cases treated by our departments between 1982 and 1999. The aim was to compare our results to those of other authors especially regarding surgical management. The male to female ratio of these patients was 2:1 and most patients were in the 6th and 7th decades of life. Conservative surgery was used in most cases as the initial treatment. The overall recurrence rate was low and there were 3 cases associated with carcinoma. We conclude that the results of conservative surgery in selected cases are comparable to those using radical methods. A review of the literature is presented and particular attention is dedicated to the literature concerning analysis of p53 expression, HPV and Epstein-Barr infection and apoptosis in inverted papilloma.
Assuntos
Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Recidiva Local de Neoplasia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Papiloma Invertido/patologia , Papiloma Invertido/cirurgia , Adolescente , Adulto , Idoso , Infecções por Vírus Epstein-Barr , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/genética , Neoplasias Nasais/virologia , Papiloma Invertido/genética , Papiloma Invertido/virologia , Infecções por Papillomavirus/complicações , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Proteína Supressora de Tumor p53/biossíntese , Infecções Tumorais por Vírus/complicaçõesRESUMO
AIMS AND BACKGROUND: The aim of the study was to investigate whether use of the antiestrogen tamoxifen and heat treatment in combined therapy with the well-known anticancer drugs cisplatin, dacarbazine and cyclophosphamide enhances their therapeutic efficacy on mouse B16-F10 melanoma in vivo. The results of systemic melanoma therapy have been mostly disappointing. Therefore, there is still a great need for strategies that can improve existing chemotherapy options. METHODS AND STUDY DESIGN: The tumor model for the investigation of antitumor activity was a mouse B16-F10 melanoma transplanted into the footpad of C57BL/6 Zgr/Hr mice. Drugs were given intraperitoneally 15 min before the application of local hyperthermia, and tumor growth and mouse survival were followed. RESULTS: Hyperthermia alone determined a significant delay of tumor growth, but mouse survival was not affected. In bimodal combinations with hyperthermia, all the tested antitumor drugs significantly increased both tumor growth delay and mouse survival. Tamoxifen alone did not show any inhibitory effect on B16-F10 melanoma in vivo. However, in the trimodal therapy with a particular drug and hyperthermia, it potentiated the inhibitory effects of the respective bimodal treatments, especially that of cyclophosphamide and hyperthermia. CONCLUSIONS: Our results obtained on the mouse B16-F10 melanoma in vivo confirmed the enhanced therapeutic efficacy of the trimodal therapy tamoxifen, hyperthermia and anticancer drug combinations in melanoma treatment. Further studies should optimize the heat-drug time scheduling and drug doses that will result in the best possible therapeutic achievement for these trimodal therapy options.
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Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Hipertermia Induzida , Melanoma Experimental/tratamento farmacológico , Tamoxifeno/administração & dosagem , Tamoxifeno/farmacologia , Animais , Ciclofosfamida/administração & dosagem , Ciclofosfamida/farmacologia , Feminino , Injeções Intraperitoneais , Melanoma Experimental/prevenção & controle , Camundongos , Camundongos Endogâmicos C57BL , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Isolated ureteral metastasis from gastric cancer is extremely rare. CASE REPORT: We describe a 50 year old man with a history of subtotal gastrectomy who presented 4 years later with an ureteral metastasis. He was asymptomatic and diagnostic tests were performed due to the elevated creatinine level disclosed incidentally. The partial resection of distal right ureter as well as the resection of the right ureterovesical junction was performed with the implantation of double J stent. Histopathology revealed a metastasis of the adenocarcinoma that matched perfectly a tumour specimen from the gastric cancer surgery. It was first and isolated manifestation of gastric cancer dissemination. CONCLUSIONS: Although rare, the ureteral metastasis from gastric cancer can be the first, sole and asymptomatic manifestation of gastric cancer dissemination after a period of time.
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BACKGROUND: The prognosis for patients with liver metastases from colorectal carcinoma is limited because of the low number of patients who are eligible for curative hepatic resection. In this phase I study, 31 liver metastases in 24 patients with nonresectable metastases from colorectal carcinoma were treated with photodynamic therapy (PDT). METHODS: The photosensitizer 5,10,15,20-tetrakis(m-hydroxyphenyl)bacteriochlorin (mTHPBC) was intravenously administered in a dose of .6 mg/kg (n = 12) or .3 mg/kg (n = 12). After 120 hours (n = 18) or 48 hours (n = 6), tumors were illuminated for 300 to 600 seconds through percutaneously inserted optical fibers with a light dose of 60 J/cm of diffuser (740 nm). RESULTS: Tumor necrosis at 1 month after PDT was achieved in all treated lesions. Laser treatment was associated with mild pain (n = 8) and transient subclinical hepatotoxicity (n = 21). In one patient, PDT damage to the pancreas was inflicted, and in another patient, PDT damage of the skin occurred, but no serious clinical complications from PDT were reported. Administration of .6 mg/kg of mTHPBC led to transient phlebitis in 10 patients, and 3 patients experienced mild skin phototoxicity after excess light exposure. CONCLUSIONS: Colorectal liver metastases that are ineligible for resection can be safely and effectively treated with interstitial mTHPBC-based PDT.
Assuntos
Neoplasias Colorretais/secundário , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Fotoquimioterapia/métodos , Porfirinas/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Infusões Intravenosas , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/efeitos adversos , Pele/patologiaRESUMO
We report on a 62-year-old HIV-negative male patient with Kaposi sarcoma. After 8 years of treatment of smaller localized skin lesions with surgery and local radiotherapy, the patient developed extensive lesions of the whole skin. The extent of the lesions required the administration of the total skin electron therapy (TSET). Until then, TSET had been used at our Department only for the treatment of mycosis fungoides. The dose delivered was 30 Gy higher than in a conventional radiotherapy treatment, where doses are usually between 8 and 24 Gy. Six months after the TSET therapy, the lesions completely regressed, except for two large facial lesions, which were surgically removed. Major side effects were mild erythema and hyperpigmentation of the skin. Erythema disappeared a month after the therapy.
Assuntos
Radioterapia de Alta Energia/métodos , Sarcoma de Kaposi/radioterapia , Neoplasias Cutâneas/radioterapia , Irradiação Corporal Total/métodos , Biópsia por Agulha , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Sarcoma de Kaposi/patologia , Índice de Gravidade de Doença , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
We investigated the expression of tumor-associated antigens (TAA) of the cancer/testis (C/T) gene family in cervical squamous cell carcinomas. First, we focused on the HeLa cervical cancer derived cell line, and we found that it expresses MAGE-A1, MAGE-A2, MAGE-A3, MAGE-A4, MAGE-A6, MAGE-A12, GAGE-3/6, LAGE-1, and PRAME genes, encoding defined C/T TAA. In contrast, no expression of MAGE-A10, BAGE, GAGE-1/2, or NY-ESO-1 genes was observed. Corresponding gene products could also be detected by immunoblotting and immunocytochemistry, taking advantage of monoclonal antibodies recognizing discrete TAA. Capitalizing on these data, a monoclonal antibody predominantly recognizing MAGE-A4 TAA in paraffin-embedded sections (57B) was used to investigate the C/T gene expression in clinical tumor samples. A group of 60 patients was studied, and 57B positivity was detectable to different extents in 33% of the cases (20/60). In 13 of them (21%), staining of over 50% of the tumor cells was evident, whereas healthy cells always scored negative. Remarkably, MAGE-A4 expression was significantly (p < 0.05) more frequently detectable in poorly differentiated tumors (8/13) than in well-differentiated or moderately differentiated cancers (3/15 and 9/32, respectively) and in stage FIGO II as compared with stage FIGO Ib tumors (12/23 and 5/24, respectively, p = 0.04). Interestingly, staining was mostly nuclear in well-differentiated tumors, but involved both nuclei and cytoplasm in less differentiated cancers. Positivities of comparable frequency were also detectable in a smaller series of specimens upon staining with MAGE-A1- or NY-ESO-1/LAGE-1-specific reagents. Considering the high tumor specificity of C/T TAA, our data provide the rationale for the design of immunotherapy procedures targeting these antigens in cervical cancers.
Assuntos
Antígenos de Neoplasias/análise , Carcinoma de Células Escamosas/imunologia , Neoplasias Testiculares/imunologia , Neoplasias do Colo do Útero/imunologia , Anticorpos Monoclonais , Antígenos de Neoplasias/imunologia , Carcinoma de Células Escamosas/patologia , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Immunoblotting , Imuno-Histoquímica , Masculino , Antígenos Específicos de Melanoma , Invasividade Neoplásica , Proteínas de Neoplasias/análise , Células Tumorais Cultivadas , Neoplasias do Colo do Útero/patologiaRESUMO
BACKGROUND: Photodynamic therapy (PDT) currently is approved for the palliative treatment of malignancies of the aerodigestive tract using laser-activated porfimer sodium. A new approach has been developed, based on intratumoral placement of a nonlaser light device that activates talaporfin sodium, that may expand the use of PDT to include a broader range of treatment-resistant malignancies. The safety of this approach was assessed in a Phase I study in patients with locally advanced, refractory tumors. METHODS: Twenty-one patients with radiation-resistant or chemotherapy-resistant or inoperable malignancies were enrolled in four cohorts representing four light doses. Patients were treated with a single intratumoral light device and a fixed photosensitizer dose. Safety assessments were based on review of adverse events (AEs) and serious adverse events (SAEs), and independent evaluation of computed tomography (CT) images. RESULTS: The observed occurrence of treatment-related AEs and SAEs was minimal. No cutaneous phototoxicity was observed in any patient. The overall observed tumor response rate was 33%. CONCLUSIONS: Photoactivation of talaporfin sodium using intratumoral nonlaser light was found to be safe in the patient population of the current study at all light dose levels tested.