1. Does concurrent gynaecological surgery affect infectious complications rate after mastectomy with implant-based reconstruction?Nina Pišlar, Barbara Perić, Uroš Ahčan, Romi Cencelj-Arnež, Janez Žgajnar, Andraž Perhavec, 2023, original scientific article Abstract: Background. Women who undergo breast cancer surgery often have an indication for gynaecological procedure. The aim of our study was to compare infectious complications rate after mastectomy with implant-based reconstruc-tion in patients with and without concurrent gynaecological procedure.Patients and methods. We retrospectively reviewed clinical records of 159 consecutively operated patients after mastectomy with implant-based reconstruction. The patients were divided in 2 groups: 102 patients without (Group 1) and 57 with (Group 2) concurrent gynaecological procedure. Infectious complications rates between the groups were compared using χ2-test. Logistic regression was performed to test for association of different variables with infec-tious complications.Results. There were240 breast reconstructions performed. Median follow-up time was 297 days (10–1061 days). Mean patient age was 47.2 years (95% CI 32.8–65.9); 48.2 years (95% CI 46.1–50.3) in Group 1 and 45.8 years (95% CI 43.2–48.3) in Group 2; p = 0.002). Infectious complications rate was 17.6% (17.6% vs. 17.5%, p = 0.987), implant loss occurred in 5.7% (4.9% vs. 7.0%, p = 0.58). Obesity (body mass index[BMI] > 30 kg/m2), age, previous breast conserv-ing treatment (BCT) with radiotherapy (RT) were identified as risk factors for infectious complications in univariate analysis. Obesity (adjusted odds ratio [aOR] 3.319, 95% CI 1.085–10.157, p = 0.036) and BCT with RT (aOR 7.481, 95% CI 2.230–25.101, p = 0.001) were independently associated with infectious complications in multivariate model.Conclusions. Concurrent gynaecological procedure for patients undergoing mastectomy with implant-based re-construction did not carry an increased risk for infectious complications. Keywords: rak na dojki, infekcijski zapleti, rekonstrukcija z vsadki Published in DiRROS: 25.07.2024; Views: 127; Downloads: 85
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2. Completely resected stage III melanoma controversy : 15 years of national tertiary centre experienceBarbara Perić, Sara Milićević, Andraž Perhavec, Marko Hočevar, Janez Žgajnar, 2021, original scientific article Abstract: Background Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients% treatment from Slovenian national CM register to leading international clinical guidelines. Patients and methods Since 2000, all Slovenian CM patients with primary tumour % TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests. Results Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280). Conclusions Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III. Keywords: cutaneous melanoma, surgery treatment, sentinel node biopsy Published in DiRROS: 17.07.2024; Views: 154; Downloads: 77
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3. Does regular quality control improve the quality of surgery in Slovenian breast cancer screening program?Andraž Perhavec, Sara Milićević, Barbara Perić, Janez Žgajnar, 2020, original scientific article Abstract: The aim of our study was to evaluate the quality of surgery of Slovenian breast cancer screening program (DORA) using the requested EU standards. Furthermore, we investigated whether regular quality control over the 3-year period improved the quality of surgical management. Patients and methods. Patients who required surgical management within DORA between January 1st, 2016 and December 31st, 2018 were included in the retrospective study. Quality indicators (QIs) were adjusted mainly according to European Society of Breast Cancer Specialists (EUSOMA) and European Breast Cancer Network (EBCN) recommendations. Five QIs for therapeutic and two for diagnostic surgeries were selected. Additionally, variability in achieving the requested QIs among surgeons was analysed. Results. Between 2016 and 2018, 14 surgeons performed 1421 breast procedures in 1398 women. There were 1197 therapeutical (for proven breast cancer) and 224 diagnostic surgical interventions respectively. Overall, the minimal standard was met in two QIs for therapeutic and none for diagnostic procedures. A statistically significant improvement in three QIs for therapeutic and in one QI for diagnostic procedures was observed however, indicating that regular quality control improves the quality of surgery. A high variability in achieving the requested QIs was observed among surgeons, which remained high throughout the study period. Conclusions. Adherence to all selected surgical QIs in patients from screening program is difficult to achieve, especially to those specifically defined for screen-detected lesions. Regular quality control may improve results over time. Reducing the number of surgeons dedicated to breast pathology may reduce variability of management inside the institution. Keywords: breast surgery, mammography, screening program, quality control Published in DiRROS: 12.07.2024; Views: 119; Downloads: 47
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4. Spremljanje bolnikov s kožnim melanomomBarbara Perić, 2024, published professional conference contribution (invited lecture) Abstract: Obravnava bolnikov s kožnim melanomom je eno tistih področji onkologije, ki se je v zadnjem desetletju temeljito spremenilo ob sodobnem sistemskem zdravljenju. Spremembe odpirajo nova vprašanja in ponujajo možnost za dodatne izboljšave obravnave bolnikov ter njihove kakovosti življenja. V prispevku povzeti podatki o epidemiologiji kožnega melanoma skušajo prikazati izziv spremljanja bolnikov v času zdravljenja in po njem ter vzpostavitve programa celostne podpore bolnikov s kožnim melanomom, t. i. survivorshipa. Keywords: bolniki, melanom, spremljanje bolnikov Published in DiRROS: 06.06.2024; Views: 251; Downloads: 111
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5. Influence of magnesium sulphate infusion before total thyroidectomy on transient hypocalcemia - a randomised studyNikola Bešić, Špela Žagar, Gašper Pilko, Barbara Perić, Marko Hočevar, 2008, original scientific article Abstract: Background. Transient hypocalcemia is the most common complication after thyroidectomy. Normomagnesemia is needed for normal secretion of PTH and end-organ responsiveness. Our aim was to determine the influence of infusion of magnesium sulphate before thyroidectomy on the incidence of laboratory and clinical transient hypocalcemia. Methods. In our prospective study, 48 patients (5 men, 43 women; age 22-73 years, median 45 years), who underwent total or near-total thyroidectomy, were randomised preoperatively. Half of them received intravenously 4 ml of 1M magnesium sulphate at the beginning of the surgical procedure, the other half were the control group. Serum concentrations of calcium, ionised calcium, magnesium, phosphate, albumin and PTH were measured prior to surgery and on the first day after surgery. Results. Laboratory postoperative hypocalcemia was present in 27% of patients and 23% of patients had clinical signs and/or symptoms of postoperative hypocalcemia. The concentration of total calcium (p=0.024) and of albumin (p=0.01) was lower in the group that received magnesium sulphate. Conclusions.The patients who received infusion of magnesium sulphate before total thyroidectomy had lower concentration of total serum calcium and albuminin comparison to the control group. There was no statistical differencein the incidence of clinical transient hypocalcemia. Published in DiRROS: 08.03.2024; Views: 352; Downloads: 71
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6. Kirurško zdravljenje nemelanomskega kožnega raka : BCC in SCCBarbara Perić, 2023, published scientific conference contribution Abstract: Osnovno zdravljenje nemelanomskih kožnih rakov je kirurški poseg. Izrez kože s tumorjem v lokalni anesteziji še vedno predstavlja zdravljenje, ki zagotavlja življenje z majhnim tveganjem za ponovitev bolezni. Da bi to zagotovili, moramo ob tumorju odstraniti tudi ustrezen pas zdrave kože v skladu s priporočili za posamezno vrsto nemelanomskega kožnega raka in mesto, kjer se ta nahaja. Vedno stremimo k primarnemu zaprtju nastalega defekta kože. Nemelanomski kožni raki redko zasevajo, ko odkrijemo regionalne zasevke teh rakov, sprva opravimo disekcijo bezgavk prizadete lože. Le redko je potrebno pri kirurškem zdravljenju lokoregionalno napredovale bolezni poseči po metodah kot so hipertermična izolirana ekstremitetna perfuzija uda ali elektrokemoterapija. Keywords: rak kože, melanom, kirurško zdravljenje Published in DiRROS: 18.05.2023; Views: 531; Downloads: 260
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7. Zarodne in somatske mutacije kožnega melanomaBarbara Perić, 2023, published scientific conference contribution Abstract: Vsaka celica telesa ima svoj lasten genski zapis. Kakšen je ta zapis in kako se prevede v beljakovine je odvisno od zarodnih sprememb genov in od vplivov okolja. Genski zapis je osnova za nastanek, razumevanje in dandanes tudi zdravljenje raka. V zadnjih dveh desetletjih so bili melanociti in kožni melanom, ki nastane iz njih predmet številnih molekularnogenetskih raziskav. Tako vemo, da med osebami z družinsko obremenitvijo za kožni melanom najpogosteje odkrijemo patogeno različico CDKN2A gena ob kateri je zvišano tako tveganje za kožni melanom kot za rak trebušne slinavke. Ko govorimo o somatskih mutacijah, je gotovo najbolj znana BRAFV600Emutacija, ki predstavlja enega prvih dogodkov v patogenezi kožnih melanomov nastalih na intermitentno soncu izpostavljeni koži. Leta raziskav tovrstnih gonilnih mutacij so pripeljala tudi do razvoja tarčne terapije. Keywords: rak kože, melanom, kožni melanom Published in DiRROS: 16.05.2023; Views: 505; Downloads: 194
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8. Combination of pembrolizumab with electrochemotherapy in cutaneous metastases from melanoma : a comparative retrospective study from the InspECT and Slovenian Cancer RegistryLuca Giovanni Campana, Barbara Perić, Matteo Mascherini, Romina Spina, Christian Kunte, Erika Kis, Petra Rozsa, Pietro Quaglino, Maja Čemažar, Maša Omerzel, Gregor Serša, 2021, original scientific article Abstract: Electrochemotherapy (ECT) is an effective locoregional therapy for cutaneous melanoma metastases and has been safely combined with immune checkpoint inhibitors in preliminary experiences. Since ECT is known to induce immunogenic cell death, its combination with immune checkpoint inhibitors might be beneficial. In this study, we aimed to investigate the effectiveness of ECT on cutaneous melanoma metastases in combination with pembrolizumab. We undertook a retrospective matched cohort analysis of stage IIIC%IV melanoma patients, included in the International Network for sharing practices of ECT (InspECT) and the Slovenian Cancer Registry. We compared the outcome of patients who received the following treatments: (a) pembrolizumab alone, (b) pembrolizumab plus ECT, and (c) ECT. The groups were matched for age, sex, performance status, and size of skin metastases. The local objective response rate (ORR) was higher in the pembrolizumab-ECT group than in the pembrolizumab group (78% and 39%, p < 0.001). The 1 year local progression-free survival (LPFS) rates were 86% and 51% (p < 0.001), and the 1 year systemic PFS rates were 64% and 39%, respectively (p = 0.034). The 1 year overall survival (OS) rates were 88% and 64%, respectively (p = 0.006). Our results suggest that skin-directed therapy with ECT improves superficial tumor control in melanoma patients treated with pembrolizumab. Interestingly, we observed longer PFS and OS in the pembrolizumab-ECT group than in the pembrolizumab group. These findings warrant prospective confirmation. Keywords: electrochemotherapy, metastatic melanoma, skin metastases Published in DiRROS: 10.10.2022; Views: 706; Downloads: 368
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9. Medullary thyroid carcinoma and associated endocrinopathies in Slovenia from 1995 to 2021Sara Milićević, Mateja Krajc, Ana Blatnik, Barbara Perić, 2022, original scientific article Abstract: Background: Medullary thyroid cancer (MTC) is a rare endocrine tumour that is sporadic in 75% of cases and occurs as a part of inherited cancer syndromes in approximately 25% of cases. The aim of this study was to determine the frequency and type of RET pathogenic variants (PVs) in the Slovenian MTC patient population diagnosed between 1995 and 2021 and to elucidate the full range of associated endocrinopathies. Methods: A retrospective analysis of medical records of 266 MTC patients and their relatives seen in a tertiary centre between 1995 and 2021 was performed. Sequence analysis of exons 10, 11, 13, 14, 15, and 16 of the RET gene was analysed in most patients using Sanger sequencing. From 2017, the entire sequence of RET gene was analysed in most patients using targeted next-generation sequencing. Results: Germline PVs in the RET proto-oncogene were identified in 21.6% probands from 21 different MTC families. Of their tested relatives, 65% (67/103) were RET-positive and 35% (36/103) were RET-negative. PVs were detected in codon 618 and codon 634 in 28.6%, and in codon 790 in 23.8%. The RET-positive group consisted of 52 MTC patients, 13 patients with C cell hyperplasia and 2 individuals with neither. Associated endocrinopathies were diagnosed in 8/21 families: primary hyperparathyroidism (PHPT) in six families and pheochromocytoma (PHEO) in five families. In 62% of RET-positive families (13/21), no associated endocrinopathies were diagnosed. PHEO was most commonly associated with C634R (6/13) and PHPT with C634R (4/7). Hirschsprung’s disease appeared in one patient with RET PV in codon 618. Based on data from the Cancer Registry of Republic of Slovenia, only individual cases of common cancers with well understood environmental risk factors were discovered; lung cancer in 2/21 of families, papillary thyroid cancer in 3/21 of families, cutaneous melanoma in 2/21 of families, cervical cancer in 1/21 families, and lymphoma in 1/21 families. Conclusions: Analysis of prospectively collected MTC cases during a 27-year period revealed that 21.6% of Slovenian patients are RET PV carriers. Sixty-two percent of families had none of the associated endocrinopathies, confirming the thesis that FMTC is the most common presentation. This could suggest using risk-stratified management approaches when screening for PHEO and PHPT in RET PV carriers. However, more studies are needed to evaluate potential genetic risk modifiers as well as safety, improved quality of life, and medical cost reduction in the case of a patient-oriented approach. Keywords: medullary thyroid carcinoma, multiple endocrine neoplasia, primary hyperparathyroidism Published in DiRROS: 23.09.2022; Views: 755; Downloads: 344
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10. BAP1-defficient breast cancer in a patient with BAP1 cancer syndromeAna Blatnik, Domen Ribnikar, Vita Šetrajčič Dragoš, Srdjan Novaković, Vida Stegel, Biljana Grčar-Kuzmanov, Nina Boc, Barbara Perić, Petra Škerl, Gašper Klančar, Mateja Krajc, 2022, original scientific article Abstract: BAP1 cancer syndrome is a rare and highly penetrant hereditary cancer predisposition. Uveal melanoma, mesothelioma, renal cell carcinoma (RCC) and cutaneous melanoma are considered BAP1 cancer syndrome core cancers, whereas association with breast cancer has previously been suggested but not confirmed so far. In view of BAP1 immunomodulatory functions, BAP1 alterations could prove useful as possible biomarkers of response to immunotherapy in patients with BAP1-associated cancers. We present a case of a patient with BAP1 cancer syndrome who developed a metastatic breast cancer with loss of BAP1 demonstrated on immunohistochemistry. She carried a germline BAP1 likely pathogenic variant (c.898_899delAG p.(Arg300Glyfs*6)). In addition, tumor tissue sequencing identified a concurrent somatic variant in BAP1 (partial deletion of exon 12) and a low tumor mutational burden. As her triple negative tumor was shown to be PD-L1 positive, the patient was treated with combination of atezolizumab and nab-paclitaxel. She had a complete and sustained response to immunotherapy even after discontinuation of nab-paclitaxel. This case strengthens the evidence for including breast cancer in the BAP1 cancer syndrome tumor spectrum with implications for future cancer prevention programs. It also indicates immune checkpoint inhibitors might prove to be an effective treatment for BAP1-deficient breast cancer. Keywords: BAP1, breast cancer, hereditary cancer syndromes, immunotherapy Published in DiRROS: 19.09.2022; Views: 642; Downloads: 260
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