1. Primary debulking surgery versus primary neoadjuvant chemotherapy for high grade advanced stage ovarian cancer : comparison of survivalsBorut Kobal, Marco Noventa, Branko Cvjetičanin, Matija Barbič, Leon Meglič, Maruša Herzog, Giulia Bordi, Amerigo Vitagliano, Carlo Saccardi, Erik Škof, 2018, izvirni znanstveni članek Povzetek: The aim of the study was to analyze the overall survival (OS) and progression free survival (PFS) of patients with high grade and advanced stage epithelial ovarian cancer (EOC) with at least 60 months of follow-up treated in a single gynecologic oncology institute. We compared primary debulking surgery (PDS) versus neoadjuvant chemotherapy plus interval debulking surgery (NACT + IDS) stratifying data based on residual disease with the intent to identify the rationale for therapeutic option decision and the role of laparoscopic evaluation of resectability for that intention. Patients and methods. This is observational retrospective study on consecutive patients with diagnosis of high grade and International Federation of Gynecology and Obstetrics (FIGO) stage III/IV EOC referred to our center between January 2008 and May 2012. We selected only patients with a follow-up of at least 60 months. Primary endpoint was to compare PDS versus NACT + IDS in term of progression free survival (PFS) and overall survival (OS). Secondary endpoints were PFS and OS stratifying data according to residual disease after surgery in patients receiving PDS versus NACT + IDS. Finally, through Cox hazards models, we tested the prognostic value of different variables (patient age at diagnosis, residual disease after debulking, American Society of Anesthesiologists (ASA) stage, number of adjuvantchemotherapy cycles) for predicting OS. Results. A total number of 157 patients were included in data analysis. Comparing PDS arm (108 patients) and NACT + IDS arm (49 patients) we found no significant differences in term of OS (41.3 versus 34.5 months, respectively) and PFS (17.3 versus 18.3 months, respectively). According to residual disease we found no significant differences in term of OS between NACT + IDS patients with residual disease = 0 and PDS patients with residual disease = 0 or residual disease = 1, as well as no significant differences in PFS were found comparing NACT + IDS patients with residual disease = 0 and PDS patients with residual disease = 0; contrarily, median PFS resulted significantly lower in PDS patients receiving optimal debulking (residual disease = 1) in comparison to NACT + IDS patients receiving complete debulking (residual disease = 0). PDS arm was affected by a significant higher rate of severe post-operative complications (grade 3 and 4). Diagnostic laparoscopy before surgery was significantly associated with complete debulking. Conclusions. We confirm previous findings concerning the non-superiority of NACT + IDS compared to PDS for the treatment of EOC, even if NACT + IDS treatment was associated with significant lower rate of post-operative complications. On the other hand, selecting patients for NACT + IDS, based on laparoscopic evaluation of resectabilty prolongs the PFS and does not worse the OS compared to the patients not completely debulked with PDS.
Ključne besede: epithelial ovarian cancer, advanced stage, primary debulking surgery, interval debulking surgery
Objavljeno v DiRROS: 11.06.2024; Ogledov: 71; Prenosov: 45
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2. Primary pulmonary choricarcinomaŽiga Snoj, Igor Kocijančič, Erik Škof, 2017, pregledni znanstveni članek Povzetek: The aim of the study was to establish whether there are different clinical entities of primary pulmonary choriocarcinoma (PPC) that deserve different diagnostic approach and the most optimal treatment. Patients and methods. A systematic review with PubMed search was conducted to identify studies that reported cases of PPC. The eligibility criteria were histological diagnosis of pulmonary choriocarcinoma and thorough examination of the reproductive organs to exclude potential primary choriocarcinoma in the gonads. Furthermore, to illustrate the review we additionally present a patient referred at our institution. Results. 55 cases (17 men) were included in the review with a median age of 34 years. Women with the history of gestational event showed better survival outcome than women without the history of gestational event. Patients treated with combined modality treatment (surgery and chemotherapy) survived longer than the patients without combined modality treatment. Furthermore, multivariate analysis of prognostic factors showed that the combined modality treatment had independent prognostic significance. Size of the tumour showed significant prognostic influence in univariate and multivariate analysis. Conclusions. PPC is an extreme rarity with variable clinical characteristics and outcome. It is important to capture and treat patients in the early stages of the disease. Women with the history of gestational event may show better survival, therefore genetic examination could help us to predict patient%s prognosis. Surgery followed by adjuvant chemotherapy appears to represent the best treatment for PPC.
Ključne besede: choriocarcinoma, gestational event, pulmonary tumor, primary horiokarcinom
Objavljeno v DiRROS: 10.05.2024; Ogledov: 212; Prenosov: 98
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3. The role of neoadjuvant chemotherapy in patients with advanced (stage IIIC) epithelial ovarian cancerErik Škof, Sebastjan Merlo, Gašper Pilko, Borut Kobal, 2016, izvirni znanstveni članek Povzetek: Primary treatment of patients with advanced epithelial ovarian cancer consists of chemotherapy either before (neoadjuvant chemotherapy, NACT) or after primary surgery (adjuvant chemotherapy). The goal of primary treatment is no residual disease after surgery (R0 resection) what is associated with an improvement in survival of patients. There is, however, no evidence of survival benefits in patients with R0 resections after prior NACT. Methods. We retrospectively reviewed the records of patients who were treated with diagnosis of epithelial ovarian cancer at Institute of Oncology Ljubljana in the years 2005%2007. The differences in the rates of R0 resections, progression free survival (PFS), overall survival (OS) and in five-year and eight-year survival rates between patients treated with NACT and patients who had primary surgery were compared. Results. Overall 160 patients had stage IIIC epithelial ovarian cancer. Eighty patients had NACT and eighty patients had primary surgery. Patients in NACT group had higher rates of R0 resection (42% vs. 20%; p = 0.011) than patients after primary surgery. PFS was 14.1 months in NACT group and 17.7 months after primary surgery (p = 0.213). OS was 24.8 months in NACT group and 31.6 months after primary surgery (p = 0.012). In patients with R0 resections five-year and eight-year survival rates were 20.6% and 17.6% in NACT group compared to 62.5% and 62.5% after primary surgery (p < 0.0001), respectively. Conclusions. Despite higher rates of R0 resections achieved by NACT, survival of patients treated with NACT was inferior to survival of patients who underwent primary surgery. NACT should only be offered to patients with advanced epithelial cancer who are not candidates for primary surgery.
Ključne besede: ovarian cancer, advanced ovarian cancer, neoadjuvant chemotherapy, primary surgery
Objavljeno v DiRROS: 30.04.2024; Ogledov: 227; Prenosov: 75
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10. Imunoterapija pri raku telesa materniceErik Škof, 2023, objavljeni znanstveni prispevek na konferenci Povzetek: Nova molekularna klasifikacija raka telesa maternice je omogočila novo, usmerjeno zdravljenje bolnic z rakom telesa maternice. Glavno novost predstavlja imunoterapija z zaviralci imunskih nadzornih točk (zaviralci PD-1) pri bolnicah z metastatskim rakom telesa maternice v 2. liniji zdravljenja, po predhodnem zdravljenu s kemoterapijo. Evropska agencija za zdravila (EMA) je odobrila uporabo dveh zaviralcev PD-1 receptorjev - dostarlimab in pembrolizumab v monoterapiji v primeru, da gre za okvaro MMR proteinov v tumorju (dMMR/MSI-H karcinom). Odobrena je tudi kombinacija pembrolizumaba in lenvatiniba (zaviralec tirozin kinaz) v 2. liniji zdravljenja metastatske bolezni, po predhodnem zdravljenju s kemoterapijo, ne glede na status MMR proteinov, torej tudi v primeru, da ne gre za okvaro MMR proteinov v tumorju (pMMR/MSS karcinom). Pred kratkim so bili objavljeni rezultati, ki kažejo učinkovitost pembrolizumaba in dostarlimaba v kombinaciji s kemoterapijo v 1. liniji napredovale ali metastatske bolezni. V adjuvantnem zdravljenju zaenkrat še nimamo podatkov o učinkovitosti imunoterapije - potekajo klinične raziskave.
Ključne besede: rak maternice, ginekološki raki, ginekološka onkologija
Objavljeno v DiRROS: 30.05.2023; Ogledov: 412; Prenosov: 197
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