1. Intercalated chemotherapy and erlotinib for advanced NSCLC : high proportion of complete remissions and prolonged progression-free survival among patients with EGFR activating mutationsMatjaž Zwitter, Karmen Stanič, Mirjana Rajer, Izidor Kern, Martina Vrankar, Natalija Edelbaher, Viljem Kovač, 2014, izvirni znanstveni članek Povzetek: Background. Pharmaco-dynamic separation of cytotoxic and targeted drugs might avoid their mutual antagonistic effect in the treatment of advanced non-small cell lung cancer (NSCLC). Patients and methods. Eligible patients were treatment-naive with stage IIIB or IV NSCLC. In addition, inclusion was limited to never-smokers or light smokers or, after 2010, to patients with activating epidermal growth-factor receptor (EGFR) mutations. Treatment started with 3-weekly cycles of gemcitabine and cisplatin on days 1, 2 and 4 and erlotinib on days 5 to 15. After 4 to 6 cycles, patients continued with erlotinib maintenance. Results. Fifty-three patients were recruited into the trial: 24 prior to 2010 (of whom 9 were later found to be positive for EGFR mutations), and 29 EGFR mutation-positive patients recruited later. Unfavourable prognostic factors included stage IV disease (51 patients - 96%), performance status 2%3 (11 patients - 21%) and brain metastases (15 patients - 28%). Grade 4 toxicity included 2 cases of neutropenia and 4 thrombo-embolic events. The 15 EGFR negative patients had 33% objective response rate, median progression-free survival (PFS) 6.0 months and median survival 7.6 months. Among 38 EGFR positive patients, complete response (CR) or partial response (PR) were seen in 16 (42.1%) and 17 (44.7%) cases, respectively. PET-CT scanning was performed in 30 patients and confirmed CR and PR in 16 (53.3%) and 9 (30.0%) cases, respectively. Median PFS for EGFR mutated patients was 21.2 months and median survival was 32.5 months. Conclusions. While patients with EGFR negative tumors do not benefit from addition of erlotinib, the intercalated schedule appears most promising for those with EGFR activating mutations.
Ključne besede: non-small cell lung cancer, EGFR activating mutations, gemicitabine, erlotinib
Objavljeno v DiRROS: 11.04.2024; Ogledov: 75; Prenosov: 14
 Celotno besedilo (590,54 KB) |
2. Brain metastases in lung adenocarcinoma : impact of EGFR mutation status on incidence and survivalKarmen Stanič, Matjaž Zwitter, Nina Turnšek, Izidor Kern, Aleksander Sadikov, Tanja Čufer, 2014, izvirni znanstveni članek Povzetek: The brain represents a frequent progression site in lung adenocarcinoma. This study was designed to analyse the association between the epidermal growth factor receptor (EGFR) mutation status and the frequency of brain metastases (BM) and survival in routine clinical practice. Patients and methods. We retrospectively analysed the medical records of 629 patients with adenocarcinoma in Slovenia who were tested for EGFR mutations in order to analyse the cumulative incidence of BM, the time from the diagnosis to the development of BM (TDBM), the time from BM to death (TTD) and the median survival. Results. Out of 629 patients, 168 (27%) had BM, 90 patients already at the time of diagnosis. Additional 78 patients developed BM after a median interval of 14.3 months; 25.8 months in EGFR positive and 11.8 months in EGFR negative patients, respectively (p = 0.002). EGFR mutations were present in 47 (28%) patients with BM. The curves for cumulative incidence of BM in EGFR positive and negative patients demonstrate a trend for a higher incidence of BM in EGFR mutant patients at diagnosis (19% vs. 13%, p = 0.078), but no difference later during the course of the disease. The patients with BM at diagnosis had a statistically longer TTD (7.3 months) than patients who developed BM later (3.1 months). The TTD in EGFR positive patients with BM at diagnosis was longer than in EGFR negative patients (12.6 vs. 6.8, p = 0.005), while there was no impact of EGFR status on the TTD of patients who developed BM later. Conclusions. Except for a non-significant increase of frequency of BM at diagnosis in EGFR positive patients, EGFR status had no influence upon the cumulative incidence of BM. EGFR positive patients had a longer time to CNS progression. While EGFR positive patients with BM at diagnosis had a longer survival, EGFR status had no influence on TTD in patients who developed BM later during the course of disease.
Ključne besede: brain metastases, lung adenocarcinoma, EGFR mutations
Objavljeno v DiRROS: 11.04.2024; Ogledov: 179; Prenosov: 12
Celotno besedilo (685,08 KB) |
3. |
4. Triple synchronous cancers : a medical and ethical problemLučka Debevec, Rok Cesar, Izidor Kern, 2007, izvirni znanstveni članek Povzetek: Background. In a patient with suspicious synchronous multiple tumours, there are limited possibilities for effective therapy. Therefore, the decision for invasive diagnostics and precise staging of tumours is questionable, especially in elderly patients suitable only for symptomatic therapy. Case report. A 78-year-old man with hypertension and angina pectoris was admitted to the hospital due to syncope. Two primary lung tumours and a kidney tumour were detected by imaging investigation. The patient refused invasive diagnostics and left the hospital. After 19 months he was readmitted in an impaired clinical condition and subsequently died of bronchopneumonia. The autopsy revealed squamous cell carcinoma of the right upper lobe with metastases to regional lymph nodes and to the brain, small-cell carcinoma of the left upper lobe with metastases to regional lymph nodes and to the spleen,and clear-cell kidney carcinoma with multiple metastases to the lungs. All tumours were necrotizing, and therefore we assumed that any attempt at specific therapy would have been ineffective. Conclusions. In an elderly patient with advanced lung tumors and suspicious synchronous triple cancers, the "wait and see" option can be suitable.
Objavljeno v DiRROS: 22.02.2024; Ogledov: 151; Prenosov: 32
Celotno besedilo (147,54 KB) |
5. Surgical treatment of malignant pleural mesotheliomaJanez Eržen, Stanko Vidmar, Mihael Sok, Andrej Debeljak, Peter Kecelj, Viljem Kovač, Marjeta Stanovnik, Tomaž Rott, Izidor Kern, 2005, izvirni znanstveni članek Povzetek: Background. The aim of the study was to identify perioperative morbidity and mortality, the category and mode of adjuvant treatment, local recurrence and survival in patients treated by extrapleural pneumonectony (EPP) for malignantpleural mesothelioma (NLPM). Methods. From 2000 to 2003, 18 patients with MPM were referred to the Department of Thoracic Surgery in Ljubljana, and17 of them were operated on. Two patients underwent explorative thoracotomy, and 15 patients were evaluated. Five female and nine male patients (aged 52-68 years) were treated by EPP and one male patient by pleurectomy. Eight patients received both adjuvant chemotherapy (ChT) and radiotherapy (RT), with cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2 gemcitabine 1000 mg/m2 and external beam radiation with 24 Gy - 58 Gy respectively, three patients received no adjuvant therapy, three patients weretreated by adjuvant ChT, two of them were given cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2, and one patient cisplatin 100 mg/m2 on the first day and gemcitabine 250 mg/rn2 in prolonged 6 hours infusion on the first and on the eighth day. One patient was treated only by adjuvant RT. Results. There were no perioperative deaths and the postoperative morbidity was 42%. Of the 15 evaluable patients, and in the median follow up of 40 months (28-64), we noticed nine (60.0%) recurrences, seven local and two abdominal. Eight (53.3%)patients died, all because of the local progress of disease. (Abstract truncated at 2000 characters)
Objavljeno v DiRROS: 14.02.2024; Ogledov: 142; Prenosov: 34
Celotno besedilo (82,10 KB) |
6. Characterization of lung cancer patients, their actual treatment and survival : experience of SloveniaLučka Debevec, Andrej Debeljak, Janez Eržen, Viljem Kovač, Izidor Kern, 2005, izvirni znanstveni članek Povzetek: Background. The aim of the study was to establish characteristics of lung cancer patients diagnosed at the University Clinic of Respiratory and AllergicDiseases Golnik in 1996, their selected and realized therapy, and survival. Methods. The retrospective study comprises 345 patients aged from 37to 90 years (mean 65), 285 males and 60 females. Performance status (Karnofsky): > 80 in 171 patients, 60-80 in 130 and < 60 in 44 patients. Mirroscopically confirmed tumour in 97%: by bronchoscopy 281, transthoracic needle biopsy 23, peripheral lymph nodes biopsy 12, sputum cytology 7, pleural(effusion) cytology 4, distant metastases biopsy 2, mediastinoscopy 1, autopsy 4 patients. Histology and/or cytology: squamous 131, adenocarcinoma 86, large cell 63, small cell 51, non-small cell 1, unclassified 2. Clinical staging of non-small cell lung cancer (NSCLC): stage I 63, stage ll 32, stage IIIA 48, stage IIIB 59, stage IV 77, undeterminable 2 patients. Staging in small cell lung cancer (SCLC): limited disease 24, extended disease 27 patients. Results. The selected primary oncological therapy was changed in 11%. Realized primary therapy: radiotherapy 102 (30%), surgery 77 (23%), chemotherapy 47 (14%), supportive treatment 111 (33%). In resected patients staging was correct in 46%, underestimated in 44%, overestimated in 10%. The overall five-year survival was 7.8% (median 6.2 months) and the five year survival of resected patients was 41.9% (median 33 months). The median survival of irradiated patients was 5.7 months, of supportively treated patients 2.5 months. The survival was significantly different according to theperformance status and stage. (Abstract truncated at 2000 characters)
Objavljeno v DiRROS: 14.02.2024; Ogledov: 118; Prenosov: 29
Celotno besedilo (88,13 KB) |
7. Cytology of mediastinal tumorsMilivoj Mermolja, Izidor Kern, Marjeta Terčelj-Zorman, Marjan Jereb, 1997, izvirni znanstveni članek Povzetek: Our experience with cytological examinations of tumorous mediastinal lesions is evaluated. A group of 117 patients with mediastinal tumor have been included into the study. Among them carcinomas prevailed (60,7%), followed by lymphomas (18,8%), other tumors (15.4%) and thymic neoplasms (5.1%). Malignantor suspicious cells were found in 77.4% of patients with carcinoma. The cells indicating a possibility of non-Hodgkin's lymphoma were found in 9 out of 14 patients. In 5 out of 6 thymic neoplasms the cytological pattern wasconsistent with the diagnosis of thymic neoplasm. One case of thymoma was cytologically falsely diagnosed as malignant lymphoma. One case of neurofibroma was falsely diagnosed as adenocarcinoma. The sensitivity of cytological examinations was 67.5%. If 18 patients with diagnostically unsatisfactory material were excluded from the analysis, the sensitivity wouldincrease to 80.8%. Owing to the wide variety of primary and metastatic tumors that can occur in the mediastinum, apart from the routine cytological techniques, additional staining methods should be used. For final cytological diagnosis the integration of cytological findings with clinical and radiological data is often required. Owing to the characteristics of the obtained material and biological behaviour of some mediastinal tumors, some tumors cannot be definitively diagnosed by cytological examinations alone.
Objavljeno v DiRROS: 18.01.2024; Ogledov: 163; Prenosov: 45
Celotno besedilo (1,10 MB) |
8. Biological behaviour of lung carcinoids : a retrospective analysis of 71 patientsIzidor Kern, Tomaž Rott, Marija Zupančič, Jurij Šorli, Urška Gantar-Rott, Janez Eržen, Janez Orel, Bogo Hrabar, 1994, strokovni članek Ključne besede: rak (medicina), pljuča, pljučni rak, novotvorbe
Objavljeno v DiRROS: 11.01.2024; Ogledov: 152; Prenosov: 40
Celotno besedilo (478,69 KB) |
9. Priporočila za obravnavo bolnikov s pljučnim rakomMartina Vrankar, Nina Boc, Izidor Kern, Aleš Rozman, Karmen Stanič, Tomaž Štupnik, Mojca Unk, Maja Ebert Moltara, Vesna Zadnik, Katja Adamič, Jernej Benedik, Marko Bitenc, Jasna But-Hadžić, Anton Crnjac, Marina Čakš, Dominik Časar, Eva Ćirić, Tanja Čufer, Ana Demšar, Rok Devjak, Goran Gačevski, Marta Globočnik Kukovica, Kristina Gornik-Kramberger, Maja Ivanetič Pantar, Marija Ivanović, Urška Janžič, Staša Jelerčič, Veronika Kloboves-Prevodnik, Mile Kovačević, Luka Ležaič, Mateja Marc-Malovrh, Katja Mohorčič, Loredana Mrak, Igor Požek, Nina Turnšek, Bogdan Vidmar, Dušanka Vidovič, Gregor Vlačić, Ana Lina Vodušek, Rok Zbačnik, Ivana Žagar, 2023, strokovni članek Povzetek: Leta 2019 so bila objavljena Priporočila za obravnavo bolnikov s pljučnim rakom, ki so v slovenski prostor vnesla prepotrebno poenotenje diagnostike in zdravljenja z namenom izboljšanja preživetja bolnikov s pljučnim rakom. Posodobitev Priporočil tri leta po izidu izvirnika prinaša največ novosti v poglavju o sistemskem zdravljenju bolnikov s pljučnim rakom. To kaže na izjemen napredek na področju razumevanja onkogeneze in biologije pljučnega raka ter s tem razvoja novih zdravil. Breme pljučnega raka ostaja veliko, saj je pljučni rak pri nas in v svetu še vedno najpogostejši vzrok smrti zaradi raka. Za vsako peto smrt zaradi raka je odgovoren pljučni rak. Skoraj tretjina bolnikov s pljučnim rakom ne prejme specifičnega onkološkega zdravljenja, bodisi zaradi slabega stanja zmogljivosti, spremljajočih bolezni ali obsega bolezni. Polovica bolnikov ima ob diagnozi razsejano bolezen, zaradi česar izboljšanje preživetja z malimi koraki sledi napredku v zdravljenju bolnikov s pljučnim rakom. Ti podatki nas opominjajo, da se bomo morali za velike premike v obravnavi bolnikov s pljučnim rakom lotiti drugačnih pristopov. Kot najbolj obetavno se ponuja zgodnje odkrivanje bolezni, ko so možnosti ozdravitve pljučnega raka najboljše. Zapisana Priporočila so usmeritev za obravnavo bolnikov s pljučnim rakom. Le s sodobnim multidisciplinarnim pristopom obravnave lahko bolniku ponudimo zdravljenje, ki mu omogoča najboljši izhod prognostično neugodne bolezni.
Ključne besede: pljučni rak, priporočila
Objavljeno v DiRROS: 27.07.2023; Ogledov: 379; Prenosov: 136
Celotno besedilo (708,18 KB)
Gradivo ima več datotek! Več... |
10. Priporočila za obravnavo bolnikov s pljučnim rakomMartina Vrankar, Nina Boc, Izidor Kern, Aleš Rozman, Karmen Stanič, Tomaž Štupnik, Mojca Unk, Maja Ebert Moltara, Vesna Zadnik, Katja Adamič, Jernej Benedik, Marko Bitenc, Jasna But-Hadžić, Anton Crnjac, Eva Ćirić, Tanja Čufer, Goran Gačevski, Marta Globočnik Kukovica, Kristina Gornik-Kramberger, Maja Ivanetič Pantar, Staša Jelerčič, Veronika Kloboves-Prevodnik, Mile Kovačević, Luka Ležaič, Mateja Marc-Malovrh, Katja Mohorčič, Bogdan Vidmar, Dušanka Vidovič, Gregor Vlačić, Ana Lina Vodušek, Rok Zbačnik, Ivana Žagar, 2022, ni določena Ključne besede: elektronske knjige
Objavljeno v DiRROS: 24.11.2022; Ogledov: 658; Prenosov: 212
Celotno besedilo (3,01 MB)
Gradivo ima več datotek! Več... |
