Search

No abstract.

Populacijsko preživetje bolnikov z rakom je sestavljen kazalnik, v katerem se zrcalijo tako značilnosti bolnikov kot tudi organizacija, dostopnost, kakovost in učinkovitost sistema zdravstvenega varstva. Register raka Republike Slovenije je letos izdal že četrto obsežnejše poročilo o preživetju slovenskih bolnikov z rakom zbolelih med letom 1997 in 2016, ki kaže na napredek, ki sta ga v dvajsetih letih zagotovila slovenska onkologija in slovensko zdravstveno varstvo skupaj s celotno družbo. Preživetje slovenskih bolnikov z rakom se s časom povečuje. V zadnjih dvajsetih letih se je petletno čisto preživetje povečalo za dobrih 11 odstotnih točk. Znatno bolj se je povečalo preživetje pri moških. Starost in stadij ob diagnozi sta še vedno ključna za preživetje bolnikov z rakom. Pri obeh spolih se je preživetje bolnikov s kožnim melanomom, rakom debelega črevesa in danke ter pljučnim rakom v zadnjih dvajsetih letih značilno izboljšalo. Napredek je bil dosežen tudi pri najpogostejših rakih pri posameznem spolu: raku dojk pri ženskah in raku prostate pri moških. Izboljšanje preživetja slovenskih bolnikov z rakom, ki ga opazujemo v zadnjih letih, predstavlja osnovo in spodbudo za nadaljnje izboljšave.

Introduction: In the spring of 2020, the covid-19 pandemic broke out with a major impact on global society, particular on the healthcare system. Epidemiological conditions and consequent measures have affected the treatment of patients enrolled in specialized palliative care. Methods: The study collected data about the number and type of treatments for cancer patients included in acute palliative care at the Institute of Oncology Ljubljana (OI) and provided observations on the covid-19 outbreak compared to pre-epidemic data. Results: In 2020, we recorded 25% more referrals than in 2019. The average length of stay decreased from 6,2 days to 5,1 days. The average number of family meetings in the period before covid-19 was 148 but last year 214. The calendar year and dismissals or deaths are statistically significantly related. In 2020, statistically significantly more people died at OAPO than expected (p

Comprehensive systemic approaches are needed to address cancer, which is a major public health issue. In 2010, Slovenia adopted the first National Cancer Control Plan. A new document, for the period 2022–2026, will include issues set forward in the Europe's Beating Cancer Plan, which was adopted in 2021. The National Cancer Control Plan has three strategic goals: (1) to slow the increase in the incidence of cancer, (2) to improve survival, and (3) to improve the quality of life of cancer patients through comprehensive rehabilitation and palliative care and here we present achievements and indicate our future challenges. Prevention programmes for chronic non-communicable diseases and the introduction of national screening programs for cervical and colorectal cancer had significant impact on the incidence of preventable cancers. Of concern, however, is the rising trend of lung cancer in women. The survival of all cancer patients improved, more cancers were detected at an earlier stage and modern treatments are widely available. Our challenge in the future is to establish monitoring of quality of care by establishing clinical registries for the five most common cancers. To improve the quality of life of patients, a pilot project for breast cancer patients has been launched in the field of integrated rehabilitation in two regions. Its results will serve as a model for implementation in the whole country and also for other types of cancer. In the field of palliative care, we are facing many challenges that we are only slowly overcoming. Comprehensive rehabilitation and palliative care are certainly areas to which we need to pay more attention.

Priporočila za obravnavo rakov glave in vratu (RGV) v Sloveniji sledijo priporočilom in usmeritvam, povzetim v publikaciji neprofitne mreže 30 vodilnih severnoameriških inštitucij za obravnavo raka, National Comprehensive Cancer Network, in hkrati upoštevajo obstoječe zmožnosti slovenskega zdravstvenega sistema. Smernice predstavljajo poenoteno mnenje vseh štirih najpomembnejših deležnikov na področju obravnave rakov glave in vratu v državi: Klinike za otorinolaringologijo in cervikofacialno kirurgijo, Kliničnega oddelka za maksilofacialno in oralno kirurgijo ter Stomatološke klinike UKC Ljubljana, Klinike za otorinolaringologijo, cervikalno in maksilofacialno kirurgijo UKC Maribor ter Onkološkega inštituta Ljubljana.

Abstract Background: Cardiotoxicity is an important side effect of trastuzumab therapy and cardiac surveillance is recommended. Objectives: The aim of our study was to prospectively assess baseline patients' characteristics, level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic parameters as possible predictors of trastuzumab-related cardiac dysfunction. Methods: In a prospective cohort study, clinical, echocardiographic and neurohumoral assessment was performed at baseline, after 4, 8 and 12 months in breast cancer patients undergoing post-anthracycline (3-4 cycles) adjuvant therapy with trastuzumab. Trastuzumab-related cardiac dysfunction was defined as a decline of ≥ 10% in left ventricular ejection fraction (LVEF). Results: 92 patients (mean age, 53.6 ± 9.0 years) were included. Patients who developed trastuzumab-related LVEF decline ≥ 10% (20.6%) during treatment had significantly higher baseline LVEF (70.7 ± 4.4%) than those without (64.8 ± 5.5%) (p = 0.0035). All other measured baseline parameters (age, body mass index, arterial hypertension, level of NT-proBNP and other echocardiographic parameters) were not identified as significant. Conclusions: Our findings suggest that baseline patient' characteristics, level of NT-proBNP and echocardiographic parameters, as long as they are within normal range, are not a reliable tool to predict early trastuzumab-related cardiac dysfunction in patients undergoing post-low dose anthracycline adjuvant trastuzumab therapy. A LVEF decline in patients with high-normal baseline level although statistically significant is not clinically relevant.

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.

Ni abstrakta.

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.

Klasifikacija, diagnostika in zdravljenje stromalnih ter mezenhimskih neoplazem prebavil je v zadnjih 30 letih doživela obsežen napredek. Gastrointestinalni stromalni tumorji (GIST) predstavljajo manj kot 1 % vseh malignih tumorjev prebavil.Klinična slika je odvisna od mesta, velikosti in malignega potenciala GIST. Razsejani GIST predstavlja primer uspešnega zdravljenja s tarčno terapijo, saj se je z odkritjem KIT in PDGFR signalne poti ter tirozin kinaznih inhibitorjev, kot staimatinib mesilat in sunitinib, prognoza te bolezni pomembno izboljšala. Izhod zdravljenja slovenskih bolnikov z razsejanim GIST je primerljiv z izhodom zdravljenja bolnikov, ki so bili zdravljeni v pomembnih večjih mednarodnih kliničnih raziskavah, srednji čas do progresa bolezni pri naših bolnikih je 52 mesecev in srednje preživetje 72 mesecev. Uporabljali smo protokol sledenja, ki je poleg kontrastne računalniške tomografije trebuha vključeval tudi preiskavo trebuha z ultrazvokom. S tem smo ob primerljivem preživetju izboljšali kakovost življenja naših bolnikov in zmanjšali stroške zdravljenja. ; slv - slovenski

Ni abstrakta.

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.

Ni abstrakta.

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.

The present article presents the Slovenian multidisciplinary agreement statement on the definition, staging, clinical classification and multimodal approach to the treatment of cachexia in cancer patients. The consensus was reached during a multidisciplinary plenary session, and is based on the international definition of cancer cachexia adopted in 2011. Cancer cachexia is a multifactorial metabolic syndrome defined by an ongoing loss of skeletal muscle with or without concomitant loss of fat, which cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterized by a negative energy and protein balance due to a variable combination of reduced food intake and metabolic changes. In cancer patients, the cachexia syndrome can develop progressively through various stages – from precachexia to cachexia and finally, to refractory cachexia–represent-ing a continuum of metabolic changes, clini-cal signs and symptoms. Patients can progress from precachexia to cachexia, and reverse from cachexia into precachectic stages, while (as the term itself implies), the condition of refractory or irreversible cachexia has poor therapeutic response. A clinical algorithm for recognition and treatment of cachexia in cancer patients is presented. All cancer patients should be screened for cachexia and precachexia on presentation. Patients who fulfil diagnostic criteria for cancer cachexia should have its clinical stage determined. According to phenotype / clinical stage, a multimodal approach should be adopted in the treatment of all cases of cancer cachexia. A typical multimodal management plan in cachectic patients consists of early dietary intervention, exercise, anti-inflammatory therapy and early cancer-related symptom relief. The cachexia treatment pathway should be adopted as a pathway parallel to conventional cancer treatment. Practical implementation of cancer cachexia consensus represents the therapeutic approach with possible positive impact on cancer burden control in Slovenia.

Background: The aim of this overview is to show time trends of 5-year relative survival rates of some malignant diseases in Slovenia, to compare them with other countries of the European Union (EUROCARE 4) and to compare incidence and mortality rates for breast cancer. The 5-year relative survival is improving with timo for most cancers, the difference in survival rates between men and women is diminishing. Survival rate for all cancers in men is between the lowest in Europe, mainly on the account of low survival in prostate cancer, a frequent cancer in men. Cancers that are treated centrally, mainly at the Institute of Oncology Ljubljana have very good survival rates, above European mean, some even among the best in Europe (thyroid, Hodgkin’s disease, soft tissue sarcomas, non-Hodgkin lymphomas) while worse survival of cancers treated all over Slovenia is reported.

In prospectively designed randomized clinical trial the efficacy of simultaneous application of irradiation, Mitomycin C, and Bleomycin was tested. 64 patients with previously untreated, histologically confirmed inoperable squamous cell carcinoma of the head and neck region were randomly assigned to receive either radiation therapy alone (group A) or radiotherapy combined with simultaneous application of Mitomycin C and Bleomycin (group B). In patients with inoperable oropharyngeal carcinoma, the disease free survival was significantly better in combined radiochemotherapy group (48%) then in only irradiated patients (10%) (p = 0.001).The same combination was later tested in 114 patients with advanced but still resectable disease in the head and neck region as postoperative treatment. In prospective randomized clinical study, patients were treated postoperatively by irradiation alone (group A), or received postoperatively also concomitant chemotherapy (group B). At four years1, in patients from radiochemotherapy group, locoregional control (86%) was significantly better than in radiotherapy group (57%) (p = 0.037). Also, the overall survival for radiochemotherapy group was significantly better than for radiotherapy group (71% and 43% respectively) (p = 0.036). From the subgroup analysis, it seems that the patients who benefited by chemotherapy were those with high risk factors.Proposed combined treatment scheme became in Slovenia the therapy of choice for patients with inoperable oropharyngeal carcinoma as well as for patients operated for advanced but still resectable head and neck carcinoma with one or more high risk factors.

Ni abstrakta.

Ni abstrakta.