1. The role of PET-CT in radiotherapy planning of solid tumoursStaša Jelerčič, Mirjana Rajer, 2015, pregledni znanstveni članek Povzetek: PET-CT is becoming more and more important in various aspects of oncology. Until recently it was used mainly as part of diagnostic procedures and for evaluation of treatment results. With development of personalized radiotherapy, volumetric and radiobiological characteristics of individual tumour have become integrated in the multistep radiotherapy (RT) planning process. Standard anatomical imaging used to select and delineate RT target volumes can be enriched by the information on tumour biology gained by PET-CT. In this review we explore the current and possible future role of PET-CT in radiotherapy treatment planning. After general explanation, we assess its role in radiotherapy of those solid tumours for which PET-CT is being used most. Conclusions. In the nearby future PET-CT will be an integral part of the most radiotherapy treatment planning procedures in an every-day clinical practice. Apart from a clear role in radiation planning of lung cancer, with forthcoming clinical trials, we will get more evidence of the optimal use of PET-CT in radiotherapy planning of other solid tumours.
Ključne besede: positron emission therapy, radiotherapy, radiotherapy planning, tumour biology
Objavljeno v DiRROS: 16.04.2024; Ogledov: 45; Prenosov: 6
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2. 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: 83; Prenosov: 20
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3. Malignant spinal cord compressionMirjana Rajer, Viljem Kovač, 2008, pregledni znanstveni članek Povzetek: 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.
Objavljeno v DiRROS: 07.03.2024; Ogledov: 109; Prenosov: 24
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