20.500.12556/DiRROS-19905 Rak neznanega izvora nas izvor bolezni še zanima Cancer of unknown primary does primary still matter Rak neznanega izvora (RNI) je opredeljen kot karcinom ali nediferencirana neoplazma, pri kateri z naborom standardnih diagnostičnih postopkov ni mogoče odkriti izvornega mesta bolezni. Tradicionalno RNI delimo v dve podskupini, pri čemer le približno 15 % primerov predstavlja prognostično ugodno skupino. Velika večina bolnikov spada v prognostično neugodno skupino in ima ob prvi prezentaciji obsežno breme bolezni. Možnosti zdravljenja so omejene, izidi bolnikov, zdravljenih z empirično kemoterapijo (KT) s platino ali taksani, pa so še vedno slabi, srednje celokupno preživetje je manj kot 10 mesecev. Za mnoge bolnike ostaja optimalna izbira najboljše možno podporno zdravljenje. Novi pristopi k obravnavi teh bolnikov se zdijo obetavni in so temeljit premik v paradigmi zdravljenja RNI; od zdravljenja, specifičnega za organ/tkivo, k zdravljenju, usmerjenemu na posameznega bolnika, ki temelji na genomskih spremembah njegovega tumorja. Prispevek povzema trenutne dokaze o uporabi vsakega od teh pristopov. Predstavljeno je tudi zdravljenje treh bolnikov z neugodnim RNI. Cancer of unknown primary (CUP) is defined as a carcinoma or undifferentiated neoplasm in which a standardized diagnostic workup fails to identif y the primary tumour responsible for me-tastatic seeding. Survival after diagnosis of CUP remains poor and has not improved significantly over time. Traditionally, CUP has been divided into two subsets, with only about 15% of cases in the favourable subset. The vast majority of patients are in the unfa-vourable subset and present with a high metastatic burden at first presentation. Their treatment options are limited and outcomes for patients treated with empiric chemotherapy consisting of platinum- or taxane-based doublets remain poor, with median overall survival of less than 10 months. Best supportive care remains the best treatment option for many patients. Some novel approaches to the treatment of patients with CUP are promising and represent a fundamental shift in the paradigm of cancer treatment from organ/tissue-specific to individual patient-focused treatment based on tumour-specific genomic alterations. This paper summarizes the current evidence on the application of each of these approaches. The treatment of three clinical cases with unfavourable CUP using novel approaches is presented. rak neznanega izvora molekularne značilnosti biološki označevalci true false true Onkolološki inštitut Ljubljana Slovenski jezik Angleški jezik by Authors Neznano 2024-07-26 13:31:49 2024-07-26 13:31:50 2024-08-01 03:52:43 0000-00-00 00:00:00 2024 0 0 str. 62-68 št. 1 Letn. 28 jun. 2024 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 2024-06-01 616-006 1408-1741 200508931 RAZ_Matos_Erika_2024.pdf RAZ_Matos_Erika_2024.pdf 1 163AA599DA2A976A118DCFF310F39E43 6b0a83049e400fb6733c7b7ee9eb5f5c0cf743bc1bf37f0991b935f9cc5a072e 7a0d23a6-4b32-11ef-b487-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=27631 Onkološki inštitut Ljubljana Onkologija : strokovni časopis za zdravnike 0 0 0