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1.
The correlation between the levels of tissue inhibitor of metalloproteinases 1 in plasma and tumour response and survival after preoperattive radiochemotherapy in patients with rectal cancer
Irena Oblak, Vaneja Velenik, Franc Anderluh, Barbara Možina, Janja Ocvirk, 2013, izvirni znanstveni članek

Povzetek: Background. The aim of this study was to analyse whether the level of tissue inhibitor of metalloproteinases (TIMP) 1 is associated with the tumour response and survival to preoperative radiochemotherapy in rectal cancer patients. Patients and methods. Ninety-two patients with histologically confirmed non-metastatic rectal cancer of clinical stage I- III were treated with preoperative radiochemotherapy, surgery and postoperative chemotherapy. Plasma TIMP-1 concentrations were measured prior to the start of the treatment with an enzyme-linked immunosorbent assay (ELISA). Results. Median follow-up time was 68 months (range: 3-93 months) while in survivors it was 80 months (range: 68-93 months). The 5-year locoregional control (LRC), disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) rates for all patients were 80.2%, 56.4%, 63.7% and 52.2%, respectively. The median TIMP-1 level was 185 ng/mL (range: 22-523 ng/mL) and the mean level (standard deviation) was 192 (87) ng/mL. Serum TIMP-1 levels were found to be significantly increased in patients with preoperative CRP>12 mg/L and in those who died from rectal cancer or had cT4 tumours. No correlation was established for age, gender, carcinoembriogenic antigene (CEA) level, platelets count, histopathological grade, response to preoperative therapy, resectability and disease reappearance. On univariate analysis, various parameters favourably influenced one or more survival endpoints: TIMP-1 <170 ng/mL, CRP <12 mg/L, platelets count <290 10E9/L, CEA <3.4mg/L, age <69 years, male gender, early stage disease (cN0 and/or cT2-3), radical surgery (R0) and response to preoperative radiochemotherapy. In multivariate model, LRC was favourably influenced by N-downstage, DFS by lower CRP and N-downstage, DSS by lower CRP and N-downstage and OS by lower TIMP-1 level, lower CRP and N-downstage. Conclusions. Although we did not find any association between pretreatment serum TIMP-1 levels and primary tumour response to preoperative radiochemotherapy in our cohort of patients with rectal cancer, TIMP-1 levels were recognized as an independent prognostic factor for OS in these patients.
Ključne besede: rectal cancer, radiochemotherapy, tissue inhibitor of metalloproteinases
Objavljeno v DiRROS: 22.03.2024; Ogledov: 37; Prenosov: 14
.pdf Celotno besedilo (370,87 KB)

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Cetuximab in preoperative treatment of rectal cancer - term outcome of the XERT trial
Vaneja Velenik, Janja Ocvirk, Irena Oblak, Franc Anderluh, 2012, izvirni znanstveni članek

Povzetek: Preoperative capecitabine-based chemoradiotherapy (CRT) is feasible for the treatment of resectable locally advanced rectal cancer (LARC). To try to improve efficacy, we conducted a phase II studz in which the epidermal growth factor receptor-targeting monoclonal antibody cetuximab was added to capecitabine-based CRT. The results for long-term survival and for an analysis investigating the relationship between survival and patient and disease characteristics, including tumour KRAS mutation status, and surgery type, are presented. Patients with resectable LARC received capecitabine (1250mg/m2 twice daily, orally) for 2 weeks followed by cetuximab alone (400 mg/m2 for 1 week) and then with CRT (250 mg/m2/week) comprising capecitabine (825 mg/m2 twice daily) and radiotherapy to the small pelvis (45 Gz in 25 1.8-Gz fractions), five dazs a week for five weeks. Surgery was conducted six weeks following CRT, with post-operative chemotherapy with capecitabine (1250 mg/m2 twice daily for 14 days every 21 days) three weeks later. Forty-seven patients were enrolled and 37 underwent treatment. Twenty-eight of the patients (75.7%) had T3N+ disease. Thirty-six patients were evaluable for efficacy. The median follow-up time was 39.0 months (range 5.0-87.0). The three-year local control, disease-free survival, relapse-free survival and overall survival rates were 96.9% (95% CI 90.0-100), 72.2% (57.5-86.9), 74.3% (95% CI 59.8-88.8) and 68.1% (95% CI 36.7-99.4), respectively. There was no significant association between survival and gender, age, tumour location in the rectum, type of surgery, pathological T or N status, tumour regression grade or tumour KRAS mutation status, although sample sizes were small. Preoperative cetuximab plus capecitabine-based CRT was feasible in patients with resectable LARC and was associated with an impressive three-year local control rate. The use of tumour KRAS mutation status as a biomarker for the efficacy of cetuximab-based regimens in this setting requires further investigation.
Objavljeno v DiRROS: 21.03.2024; Ogledov: 50; Prenosov: 19
.pdf Celotno besedilo (332,74 KB)

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Long term outcome after combined modality treatment for anal cancer
Irena Oblak, Primož Petrič, Franc Anderluh, Vaneja Velenik, Albert-Peter Fras, 2012, izvirni znanstveni članek

Povzetek: Background. The aim of the retrospective study was to evaluate the effectiveness and toxicity of radiochemotherapy in patients with squamous cellcarcinoma of the anal canal treated at a single institution. Patients and methods. Between 1/2003 and 9/2010, 84 patients were treated with radical radiochemotherapy at the Institute of Oncology Ljubljana, Slovenia. The treatment consisted of 3-dimensional conformal external beam radiotherapy with concurrent chemotherapy (5-fluorouracil and mytomycin C), followed by brachytherapy or external beam boost. The toxicity of therapy and its effectiveness were assessed. Results. The treatment was completed according tothe protocol in 79.8% of patients. The median follow-up time of 55 survivors was 53 months (range: 16-105 months). The 5-year locoregional control(LRC), disease-free survival (DFS), disease-specific survival (DSS), overall survival (OS) and colostomy-free survival (CFS) rates were 71%, 68%, 81%, 67% and 85%, respectively. No treatment-related mortality was observed. The most frequent acute side-effect of the treatment was radiodermatitis (grade 3-4 in 58.2% of patients). LENT-SOMA grade 3-4 late radiation side effects were observed in 15 (18%) patients. In patients with brachytherapy boost a trend of less late side effects was observed compared to patients with external beam boost (P=0.066). On multivariate analysis, complete clinicaldisease response was identified as an independent prognostic factor for LRC, DFS and DSS, the salvage surgery for LRC and DFS, whereas Hb below 120 g/l retained its independent prognostic value for OS. Conclusions. Radiochemotherapy provides an excellent disease control and the survival with preserving anal sphincter function in majority of patients. Surgical salvage with abdominoperineal resection for persistent or recurrent disease has curative potential.
Objavljeno v DiRROS: 21.03.2024; Ogledov: 54; Prenosov: 22
.pdf Celotno besedilo (533,54 KB)

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Postoperative radiochemotherapy for gastric adenocarcinoma : long term results
Irena Oblak, Franc Anderluh, Vaneja Velenik, 2009, izvirni znanstveni članek

Povzetek: Background. To analyze the efficacy of postoperative radiochemotherapy with 5-florouracil (5-FU) and leucovorin (LV) applied in the patients with gastric carcinoma treated in a single institution. Patients and methods. Between 2001 and 2004, 123 patients with resected gastric adenocarcinoma were treated with postoperative concomitant radiochemotherapy with 5-FU and LV. The adjuvant treatment consisted of five cycles of chemotherapy with 5-FU (425mg/m2 IV) andLV (20 mg/m2 IV) and concomitant radiotherapy with the total dose of 45 Gy.Results. The treatment was completed according to the protocol in 82% of patients. The frequency and severity of early toxic effects induced by radiochemotherapy were manageable. Median follow-up time of 56 survivors was 64.5 months (range: 51.7-96.4 months). The 5-year locoregional control (LRC), diseasefree survival (DFS), disease-specific survival (DSS) and overall survival (OS) were 81%, 48.3%, 50.4%, and 48.4%, respectively. The multivariate analysis showed that the tumor involvement of cardia and low intensity of chemotherapy were independent adverse prognostic factors for DSS and OS. More advanced pT-stage and tumors with diffuse growth type according to Lauren were identified as negative independent prognostic factor for OS. They were also on the threshold of statistical significance for DSS. Conclusions. Postoperative radiochemotherapy for gastric carcinoma has acceptable toxicity, and is effective particularly in regard to LRC. High incidence of distant metastases calls for more effective systemic regimens.
Objavljeno v DiRROS: 08.03.2024; Ogledov: 62; Prenosov: 23
.pdf Celotno besedilo (94,49 KB)

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Managing anemia with epoetin alfa in patients with rectal cancer
Vaneja Velenik, Irena Oblak, Veronika Kodre, 2005, izvirni znanstveni članek

Povzetek: Background. Anemia is one of the most challenging problems in clinical oncology due to its high prevalence among the patients with malignant diseases. The purposes of our study were: (1) to assess the potential of epoetin alfa therapy to prevent the decline in Hb concentrations that typically accompanies chemotherapy/radiotherapy (ChT/RT) of the patients with rectal cancer; (2) to test the hypothesis that the use of epoetin alfa significantly reduces the transfusion requirements in the patients with rectalcancer treated with ChT/RTafter surgery, and (3) to evaluate the safety profile of the administration of epoetin alfa in the clinical setting. Methods. Sixty patients who underwent surgery for rectal cancer were prospectively enrolled. Group A consisted of 39 patients with Hb concentrations <13 g/dl at the start of ChT/RT following surgery, and group B of 17 patients with Hb concentrations >13 g/dl at the start of ChT/RT following surgery, but whose Hb concentrations fell below 13 g/dl during the ChT/RT protocol. The starting dose of epoetin alfa in both proups was 10,000 IU subcutaneously (se) three times a week (tiw). The following major parameters were evaluated: (1) change in Hb concentrations relative to the baseline as measured at 4-week intervals, (2) allogenic blood transfusion requirements in relation to Hb concentrations, and (3) incidence and severity of adverse events and their potential relationship to epoetin alfa administration. (Abstract truncated at 2000 characters)
Objavljeno v DiRROS: 14.02.2024; Ogledov: 103; Prenosov: 32
.pdf Celotno besedilo (135,72 KB)

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Primer pregleda literature stereotaktičnega obsevanja trebušne slinavke skozi oči radiološkega inženirja
Irena Oblak, Nena Galunič, Valerija Žager Marciuš, 2023, objavljeni znanstveni prispevek na konferenci

Povzetek: Rak trebušne slinavke ali kot mu tudi rečemo »tihi rak«, je bolezen, ki jo praviloma odkrijemo pozno, v bolj napredovali obliki, ko je bolezen običajno že neozdravljiva. Kakovost življenja teh bolnikov je lahko zelo okrnjena. Za raziskovanje pomena uvedbe stereotaktičnega obsevanja pri raku trebušne slinavke smo se odločili, ker smo želeli s pomočjo pregleda literature raziskati dobrobit in smiselnost tovrstnega zdravljenja pri omenjenem raku. Uporabili smo deskriptivno metodo in sistematični pregled literature, kjer smo si določili namen, izbrali vire znanstvene literature, opredelili ključne iskalne besede, ter izvedli iskanje. Skupno smo identificirali 16536 virov, s presejanjem smo pridobili 134 virov za natančnejšo analizo. Glede na ustreznost celotnega besedila smo v rezultate vključili 22 najustreznejših virov. Iskanje je potekalo od 10. 1. 2022 do 29. 9. 2022. Za deskriptivni del smo glede na zanesljivost in uporabnost podatkov uporabili skupno 78 virov. Pri mejno operabilnih bolnikih lahko stereotaktična radioterapija pripomore k zmanjšanju tumorja in zajetega žilja in omogoči popolno kirurško odstranitev bolezni. Pri lokalno napredovalih tumorjih, ki so neresektabilni, pa omogoči visoko stopnjo lokalne kontrole, ki je po uspešnosti primerljiva kirurški resekciji. V večini študij v pregledu literature je delež enoletne lokalne kontrole raka trebušne slinavke med 78 % in vse do 94 %, ob zadovoljivo nizki stopnji toksičnosti. Glede na to, da je lokalna kontrola po stereotaktični radioterapiji odlična, je v bodoče pričakovana tudi kombinacija tovrstnega pristopa obsevanja z ostalimi metodami zdravljenja, predvsem sistemskim zdravljenjem z novimi citostatiki, tarčnimi zdravili in morebitno imunoterapijo.
Ključne besede: rak trebušne slinavke, stereotaktično obsevanje, onkološko zdravljenje
Objavljeno v DiRROS: 16.06.2023; Ogledov: 320; Prenosov: 123
.pdf Celotno besedilo (1,38 MB)
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