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Abstract: Utrudljivost je zelo pogosta pri bolnikih z rakom in pomembno vpliva na njihovo kvaliteto življenja. Predstavlja najpogostejši stranski učinek zdravljenja raka. Njena osnovna značilnost je, da ne izzveni po počitku ali spanju. Veliko število bolnikov z rakom (80-90%) navaja težave z občutkom utrujenosti, kar je najbolj izraženo tekom sistemskega zdravljenja. Glede na čas trajanja razlikujemo: akutno utrudljivost, ki traja do štiri tedne in kronično utrudljivost, ki traja več kot štiri tedne do nekaj mesecev ali ves čas zdravljenja. V nadaljevanju je opisan primer bolnice z napredovalim, metastaskim melanomom levega očesa, z metastazami v jetrih, pri kateri je prišlo do razvoja utrujenosti ob hudi insuficienci nadledvične žleze, povzročene z imunoterapijo.
Keywords: neželeni učinki, bolniki, sistemsko zdravljenje
Published in DiRROS: 23.01.2023; Views: 80; Downloads: 32
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Abstract: Holangiokarcinom je razmeroma redka oblika raka (manj kot 1% vseh malignomov), je heterogena skupina malignih bolezni. Glede na lokalizacijo razlikujemo: intrahepatični in ekstrahepatični (perihilarni in distalni) rak žolčnih vodov. Anatomska lokalizacija tumorja vpliva na molekularne karakteristike samega tumorja, na pristop pri zdravljenju in prognozo. V nadaljevanju je opisan primer bolnika z napredovalim, metastaskim adenokarcinomom distalnega holedohusa, HER-2 pozitivnim, pri katerem je prišlo do dobrega odgovora na sistemsko zdravljenje s kemoterapijo po shemi FOLFOX v kombinaciji s trastuzumabom.
Keywords: rak biliarnega trakta, sistemsko zdravljenje, rak prebavil
Published in DiRROS: 12.01.2023; Views: 94; Downloads: 25
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Abstract: V prvem sklopu z naslovom Osnovne preiskave v nevroonkologiji smo predstavili novo klasifikacijo tumorjev osrednjega živčevja, nato smo se osredotočili na molekularno genetsko diagnostiko. Nadaljevali smo z nevroradiološkimi preiskavami s poudarkom na magnetno rezonančnih značilnostih možganskih tumorjev ter sklop zaključili s pregledom nuklearnoštevilnih medicinskih preiskav v nevroonkologiji. V drugem sklopu smo se osredotočili na zdravljenje in spremljanje bolnikov z možganskimi tumorji. Možganski tumorji so zelo heterogene bolezni, zato so bile predstavljene različne možnosti terapije z vidika nevrokirurga, internističnega onkologa, radioterapevta in pediatra. Vlogo v zdravljenju možganskih tumorjev in različne pristope do lobanjske baze nam je predstavil specialist otorinolaringolog. Seznanjeni smo bili s sodobnimi, najnovejšimi tehnikami obsevanja številnih možganskih metastaz kot tudi benignih možganskih tumorjev. Poudarjeni so bili tudi zapleti zdravljenja in pozne posledice onkološkega zdravljenja. Klinična psihologinja je razložila vpliv onkološkega zdravljenja na nevrokognitivno funkcijo. Pomembnost multidisciplinarnega sodelovanja je bila nagovorjena s predavanjem nevrologa.
Keywords: nevroonkologija, centralni živčni sistem, klasifikacija, kirurško zdravljenje, sistemsko zdravljenje, molekularna biologija, endoskopska kirurgija, radiokirurgija, radioterapija, sledenje pacientov, kognitivne funkcije, zborniki, elektronske knjige
Published in DiRROS: 15.12.2022; Views: 182; Downloads: 84
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Abstract: Colorectal cancer (CRC) is still one of the most common types of cancer in the world, and the gut microbiome plays an important role in its development. The microbiome is involved in the carcinogenesis, formation and progression of CRC as well as its response to different systemic therapies. The composition of bacterial strains and the influence of geography, race, sex, and diet on the composition of the microbiome serve as important information for screening, early detection and prediction of the treatment outcome of CRC. Microbiome modulation is one of the most prospective new strategies in medicine to improve the health of individuals. Therefore, future research and clinical trials on the gut microbiome in oncology as well as in the treatment of CRC patients are warranted to determine the efficacy of systemic treatments for CRC, minimize adverse effects and increase survival rates.
Published in DiRROS: 19.09.2022; Views: 147; Downloads: 73
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Abstract: Purpose: To develop quantitative molecular imaging biomarkers of immune-related adverse event (irAE) development in malignant melanoma (MM) patients receiving immune-checkpoint inhibitors (ICI) imaged with 18F-FDG PET/CT. Methods: 18F-FDG PET/CT images of 58 MM patients treated with anti-PD-1 or anti-CTLA-4 ICI were retrospectively analyzed for indication of irAE. Three target organs, most commonly affected by irAE, were considered: bowel, lung, and thyroid. Patient charts were reviewed to identify which patients experienced irAE, irAE grade, and time to irAE diagnosis. Target organs were segmented using a convolutional neural network (CNN), and novel quantitative imaging biomarkers - SUV percentiles (SUVX%) of 18F-FDG uptake within the target organs - were correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance. Patients who did not experience irAE were used to establish normal ranges for target organ 18F-FDG uptake. Results: A total of 31% (18/58) patients experienced irAE in the three target organs: bowel (n=6), lung (n=5), and thyroid (n=9). Optimal percentiles for identifying irAE were bowel (SUV95%, AUROC=0.79), lung (SUV95%, AUROC=0.98), and thyroid (SUV75%, AUROC=0.88). Optimal cut-offs for irAE detection were bowel (SUV95%>2.7 g/mL), lung (SUV95%>1.7 g/mL), and thyroid (SUV75%>2.1 g/mL). Normal ranges (95% confidence interval) for the SUV percentiles in patients without irAE were bowel [1.74, 2.86 g/mL], lung [0.73, 1.46 g/mL], and thyroid [0.86, 1.99 g/mL]. Conclusions: Increased 18F-FDG uptake within irAE-affected organs provides predictive information about the development of irAE in MM patients receiving ICI and represents a potential quantitative imaging biomarker for irAE. Some irAE can be detected on 18F-FDG PET/CT well before clinical symptoms appear.
Keywords: melanoma, malignant melanoma, immune-checkpoint inhibitors, molecular imaging biomarkers
Published in DiRROS: 07.09.2022; Views: 172; Downloads: 69
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