21. Circulating serum sVCAM-1 concentration inadvanced ovarian cancer patients : correlation with concentration in ascitesMarina Jakimovska, Katarina Černe, Ivan Verdenik, Borut Kobal, 2014, original scientific article Abstract: Background. Vascular cell adhesion molecule-1 (VCAM-1) is associated with ovarian cancer progression but theorigin of its soluble form (sVCAM-1) in serum is not well investigated. The purpose of this study was to elucidate whetherthe concentration of sVCAM-1 in serum correlates with the concentration in ascites, that represents local tumour environment,and with systemic inflammation, various clinicopathological characteristics, and patient outcome.Patients and methods. Thirty-six patients with advanced ovarian cancer were included in the study. Serum forsVCAM-1 analysis was obtained prior to surgery. Ascites samples were collected at the beginning of the operation.Clinical data were collected from patients medical records. sVCAM-1 in samples was analysed by flow cytometricbead-based assay. The mean follow-up period was 11 months (range 0-23) from the time of surgery.Results. Serum sVCAM-1 concentrations are positively correlated to ascites sVCAM-1 concentrations. There was aweakly positive correlation of serum sVCAM-1 with tumour size and no correlation with inflammatory tumour markers,FIGO stage or grade. Higher concentrations of sVCAM-1 were associated with poor disease outcome (death fromovarian cancer) in almost all cases before chemotherapy was started.Conclusion. This is the first study demonstrating that serum concentrations of sVCAM-1 in advanced ovarian cancerpatients correlate with sVCAM-1 concentrations in ascites, thus expressing the biologic potential of malignant diseaseto metastasis, rather than systemic inflammation. Higher serum and ascites sVCAM-1 concentrations might have predictivepotential for different biologic behaviour.
Published in DiRROS: 16.04.2024; Views: 33; Downloads: 8
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22. Segmentation of hepatic vessels from MRI images for planning of electroporation-based treatments in the liverMarija Marčan, Denis Pavliha, Maja Marolt-Mušič, Igor Fučkan, Ratko Magjarević, Damijan Miklavčič, 2014, original scientific article Keywords: electrochemotherapy, non-thermal irreversible electroporation, treatment planning, hepatic vessel segmentation, non-invasive tumor treatments, MRI of liver
Published in DiRROS: 16.04.2024; Views: 49; Downloads: 26
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25. Identification of three anatomical patterns of the spinal accessory nerve in the neck by neurophysiological mappingBoštjan Lanišnik, Miha Žargi, Zoran Rodi, 2014, original scientific article Abstract: Background. In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND). Methods. The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor. Results. The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66 %). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22 %). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12 %). The nerve than exits this junction more medially as a single trapezius branch. Conclusions. The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.
Keywords: spinal accessory nerve, nerve mapping, neck dissection, anatomy, shoulder disability
Published in DiRROS: 11.04.2024; Views: 194; Downloads: 39
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26. 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, original scientific article Abstract: 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.
Keywords: non-small cell lung cancer, EGFR activating mutations, gemicitabine, erlotinib
Published in DiRROS: 11.04.2024; Views: 83; Downloads: 20
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27. Induction gemcitabine in standard dose or prolonged low-dose with cisplatin followed by concurrent radiochemotherapy in locally advanced non-small cell lung cancer : a randomized phase II clinical trialMartina Vrankar, Matjaž Zwitter, Tanja Bavčar-Vodovnik, Ana Milič, Viljem Kovač, 2014, original scientific article Abstract: The optimal combination of chemotherapy with radiation therapy for treatment locally advanced non-small cell lung cancer (NSCLC) remains an open issue. This randomized phase II study compared gemcitabine in two different schedules and cisplatin - as induction chemotherapy, followed by radiation therapy concurrent with cisplatin and etoposid. Patients and methods. Eligible patients had microscopically confirmed inoperable non-metastatic non-small cell lung cancer; fulfilled the standard criteria for platin-based chemotherapy; and signed informed consent. Patients were treated with 3 cycles of induction chemotherapy with gemcitabine and cisplatin. Two different aplications of gemcitabine were compared: patients in arm A received gemcitabine at 1250 mg/m2 in a standard half hour i.v. infusion on days 1 and 8; patients in arm B received gemcitabine at 250 mg/m2 in prolonged 6-hours i.v. infusion on days 1 and 8. In both arms, cisplatin 75 mg/m2 on day 2 was administered. All patients continued treatment with radiation therapy with 60-66 Gy concurrent with cisplatin 50 mg/m2 on days 1, 8, 29 and 36 and etoposid 50 mg/m2 on days 1-5 and 29-33. The primary endpoint was response rate (RR) after induction chemotherapy; secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). Results. From September 2005 to November 2010, 106 patients were recruited to this study. No statistically signifficant differences were found in RR after induction chemotherapy between the two arms (48.1% and 57.4%, p = 0.34). Toxicity profile was comparable and mild with grade 3/4 neutropenia as primary toxicity in both arms. One patient in arm B suffered from acute peripheral ischemia grade 4 and an amputation of lower limb was needed. With a median follow-up of 69.3 months, progression-free survival and median survival in arm A were 15.7 and 24.8 months compared to 18.9 and 28.6 months in arm B. The figures for 1- and 3-year overall survival were 73.1% and 30.8% in arm A, and 81.5 % and 44.4% in arm B, respectively. Conclusions. Among the two cisplatin-based doublets of induction chemotherapy for inoperable NSCLC, both schedules of gemcitabine have a comparable toxicity profile. Figures for RR, PFS and OS are among the best reported in current literature. While there is a trend towards better efficacy of the treament with prolonged infusion of gemcitabine, the difference between the two arms did not reach statistical significance
Keywords: induction chemotherapy, non-small cell lung cancer, radiation therapy, randomized clinical trial
Published in DiRROS: 11.04.2024; Views: 81; Downloads: 20
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28. MRI-assisted cervix cancer brachytherapy pre-planning, based on application in paracervical anaesthesia : final reportPrimož Petrič, Robert Hudej, Omar Hanuna, Primož Marolt, Barbara Šegedin, 2014, original scientific article Abstract: Background. Optimal applicator insertion is a precondition for the success of cervix cancer brachytherapy (BT). We aimed to assess feasibility and efficacy of MRI-assisted pre-planning, based on applicator insertion in para-cervical anaesthesia (PCA). Patients and methods. Five days prior to BT, the pre-planning procedure was performed in 18 cervix cancer patients: tandem-ring applicator was inserted under PCA, pelvic MRI obtained and applicator removed. Procedure tolerability was assessed. High risk clinical target volume (HR CTV) and organs at risk were delineated on the pre-planning MRI, virtual needles placed at optimal positions, and dose planning performed. At BT, insertion was carried out in subarachnoidal anaesthesia according to pre-planned geometry. Pre-planned and actual treatment parameters were compared. Results. Pre-planning procedure was well tolerated. Median difference between the pre-planned and actual needle insertion depth and position were 2 (0%10) mm and 4 (0%30) degrees, respectively. The differences between the pre-planned and actual geometric and dosimetric parameters were statistically non-significant. All actual needles were positioned inside the HR CTV and outside the organs at risk (OAR). Conclusions. Our pre-planning approach is well tolerated and effective. Pre-planned geometry and dose distribution can be reproduced at BT.
Keywords: cervix cancer, pre-planning, image-guided brachytherapy
Published in DiRROS: 11.04.2024; Views: 88; Downloads: 31
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29. Mediastinal teratoma with hydrops fetalis in a newborn and development of chronic respiratory insufficiencyMilanka Simončič, Silvester Kopriva, Živa Zupančič, Maja Jerše, Janez Babnik, Matevž Srpčič, Štefan Grosek, 2014, review article Abstract: Background. Mediastinal fetal teratoma can be detected as a mass in the chest during a routine prenatal ultrasound screening. Because of the pressure on mediastinal structures it can be the cause of non-immune hydrops fetalis and polyhydramnion. The development of hydrops fetalis leads to fetal death or premature delivery in most reported cases. Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period. Case report. A 31-year-old gravida carrying twins, with spontaneous membrane rupture at 32 weeks gestation underwent urgent caesarean section after antenatal ultrasound revealed severe polyhydramnion and hydrops fetalis in geminus A. The child was intubated immediately after birth due to severe respiratory distress. Ultrasound and X-ray revealed a tumour mass in the right hemithorax. Tumour resection was performed at the age of 7 days. Histology examination revealed an encapsulated immature teratoma. The postoperative course was complicated with respiratory insufficiency which turned into chronic at the age of eight months. Conclusion. This is the fifth reported child with fetal mediastinal teratoma and severe hydrops fetalis that survived the neonatal period. Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.
Keywords: mediastinal teratoma, non-immune hydrops fetalis, diaphragm paralysis, chronic respiratory insufficiency, novorojenčki, mediastinalni teratom, kronična respiratorna insuficienca
Published in DiRROS: 11.04.2024; Views: 77; Downloads: 35
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30. 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, original scientific article Abstract: 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.
Keywords: brain metastases, lung adenocarcinoma, EGFR mutations
Published in DiRROS: 11.04.2024; Views: 191; Downloads: 15
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