21. Improved survival after introduction of chemotherapy for malignant pleural mesothelioma in Slovenia : population-based survey of 444 patientsViljem Kovač, Matjaž Zwitter, Tina Žagar, 2012, original scientific article Abstract: Background. Malignant pleural mesothelioma is a rare tumour with increasing frequency throughout the world. Due to long latency after exposure to asbestos, restrictions in the production and use of asbestos have not yet alleviated the burden of mesothelioma. During the last decade, several trials confirmed the benefit of systemic treatment with drugs such as doublets with cisplatina and gemcitabine or pemetrexed for carefully selected patients in good performance status. The purpose of this survey was to assess the impact of systemic treatment for the whole national population of patients with mesothelioma. Patients and methods. A retrospective study included all patients in Slovenia with histologically confirmed diagnosis of malignant pleural mesothelioma in the period from 1974 till 2008. Data from the Cancer Registry of Slovenia were supplemented by review of clinical records of the Institute of Oncology in Ljubljana where virtually all non-surgical treatment for mesothelioma was performed. We analysed the incidence, treatment, and survival of patients treated in the era of infrequent chemotherapy (1974-2003,the first period) and after it (2004-2008, the second period). Results. The survey included 444 patients, of whom 325 and 119 were diagnosed in the first and second period, respectively. Joinpoint regression analysis showed that after 1995 the trend in crude incidence rates increased more rapidly; the annual change was 0.03 per 100,000 per year before 1995 and 0.06 per 100,000 per year after. There was clear male predominance (70%) throughout the period covered by the survey. The proportion of patients above 65 years of age increased from 41.8% to 54.6% for the first and second period, respectively (p = 0.02). With a total of 52 (11.7%) operated patients, surgical treatment was rare and used only for selected patients with early disease and without comorbidity, leading to their relatively long median survival of 13.6 months. Chemotherapy was applied to 56 (17.2%) and to 96 (80.7%) patients during the first and second period, respectively. While a variety of older drugs were used in the first period, the most common regimen in the second period (applied to 91 patients) was doublet of low-dose gemcitabine in prolonged infusion and cisplatin. For the whole population of patients regardless the mode of treatment, median survival was 7.4 and 12.6 months (p-value = 0.037) for the first and second period, respectively. Conclusions. Increasing incidence, male predominance and increased proportion of older patients confirm that the burden of mesothelioma persists in spite o fa 15-years old ban in the production of asbestos. Modern chemotherapy, and in particular treatment with low-dose gemcitabine in prolonged infusion and cisplatin significantly prolonged median survival of patients with malignant pleural mesothelioma in Slovenia.
Published in DiRROS: 21.03.2024; Views: 260; Downloads: 74
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28. Is there any progress in routine management of lung cancer patients? A comparative analysis of an institution in 1996 and 2006Lučka Debevec, Tina Jerič, Viljem Kovač, Marko Bitenc, Mihael Sok, 2009, original scientific article Abstract: Background. The aim of the study was to establish eventual progress in routine management of lung cancer patients over a ten-year period at University Clinic for Respiratory and Allergic Diseases Golnik, Slovenia, comparing the results of analysis of 345 patients, diagnosed in 1996 (with analysis performed in 2002), and 405 patients, diagnosed in 2006 (with analysis performed in 2008).Patients and methods. The patients of both analysed groups were of comparable age and number of patients in stage I and II, but there were relatively more females, patients with better performance status, more precise clinical staging and tumour histology in the 2006 group. The parameters used for assessing the progress of management were as follows: time period from admittance to diagnosis and to surgery; precision of staging; accordance of clinical and pathological staging in resected patients; percentage of exploratory thoracotomy; and use of new treatment modalities. The proportion of patients in selected/actual primary treatment modality and survival rate could also be used for assessing the progress. Results. Althoughunessential longer time from admittance to microscopic confirmed diagnosis increased from a mean 7.4 to 8.6 days in 2006 progress was established by the following: more precise clinical staging (stage I and II also A and B stage, TNM staging also in small-cell lung cancer patients); improved accordance with clinical and pathological staging in resected patients (46% against 58%); decreased percentage of exploratory thoracotomy (13% against 4%); increased use of multimodality therapy as primary treatment modality (radiotherapy/chemotherapy, neoadjuvant chemotherapy); newly performed radio frequency tumour ablation. The proportion in selected/actual surgery increased from 76% to 93% and median survival rate of all patients from 6.2 to 10.6 months. (Abstract truncated at 2000 characters)
Published in DiRROS: 08.03.2024; Views: 309; Downloads: 75
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30. Malignant spinal cord compressionMirjana Rajer, Viljem Kovač, 2008, review article Abstract: Malignant spinal cord compression (MSCC) is a common and debilitating neurological complication of cancer. Because of the rapid progression of the neurological dysfunction, it is considered a medical emergency that demands a prompt diagnosis and treatment. Almost all of the MSCC are caused by an epidural compression from a tumour or a bony fragment from the collapsed vertebra affected by the metastasis. The most common of the tumours that metastasize to the spinal cord are breast and lung cancer, followed by lymphoma, myeloma, prostate cancer and sarcoma. Conclusions. The most common symptom of MSCC is pain, followed by muscular weakness and autonomic dysfunction. MRI provides the best information regarding MSCC, so all patientsshould have a MRI as soon as possible. If the MRI is contraindicated, patients should have the CT scan done. All patients with newly diagnosed MSCC should receive corticosteroids immediately, even before the definitive diagnosis is made. Other treatment options are surgery with postoperative radiotherapy, radiotherapy only, specific medical therapies according to the tumour type and symptomatic therapy, (mainly opiates). The decision of treatment modalities should be made according to the NOMS (neurological, oncological, mechanical and systemic) principles. In spite of the advances, the treatment is still palliative and many patients with MSCC have a poor prognosis and a short survival.
Published in DiRROS: 07.03.2024; Views: 338; Downloads: 64
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