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Abstract: Background. In patients with non-metastatic gastric cancer surgery still remains the treatment of choice. Postoperative radiochemotherapy with 5-fluorouracil and leucovorin significantly improves the treatment outcome. The oral fluoropyrimidines, such as capecitabine, mimic continuous 5-fluorouracil infusion, are at least as effective as 5-fluorouracil, and such treatment is more comfortable for the patients. Patients and methods. In the period from October 2006 to December 2009, 101 patients with gastric cancer in stages Ib-IIIc were treated with postoperative chemoradiation with capecitabine. Distal subtotal resection of the stomach was performed in 46.3%, total resection in 50.5% and multivisceral resection in 3.2% of patients. The main endpoints of this study were loco-regional control (LRC), disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS). The rates of acute side-effects were also estimated. Results. Seventy-seven percent of patients completed the treatment according to the protocol. The median followup time of all patients was 3.9 years (range: 0.4-6.3 years) and in survivors it was 4.7 years (range: 3.2-6.3 years). No death occurred due to the therapy. Acute toxicity, such as nausea and vomiting, stomatitis, diarrhoea, hand-foot syndrome and infections of grade 3 or 4, occurred in 5%, 1%, 2%, 8.9% and 18.8% of patients, respectively. On the close-out date 63.4% patients were still alive and with no signs of the disease. The 4-years follow-up survey showed that LRC, DFS, DSS and OS were 95.5%, 69.2%, 70.7%, and 66.2%, respectively. Higher pN-stage and splenectomy were found to be independent prognostic factors for all four types of survival and perineural invasion and lower treatment intensity for DFS, DSS and OS.
Keywords: gastric cancer, adjuvant therapy, radiochemotherapy
Published in DiRROS: 11.04.2024; Views: 50; Downloads: 8
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Published in DiRROS: 22.03.2024; Views: 77; Downloads: 33
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Abstract: This paper deals with the problem of finding a continuous extension of the hypercomplex (quaternionic or octonionic) logarithm along (quaternionic or octonionic) paths which avoid the origin. The main difficulty depends upon this fact: while a branch of the complex logarithm can be defined in a small open neighbourhood of a strictly negative real point, no continuous branch of the hypercomplex logarithm can be defined in any open set which contains a strictly negative real point. To overcome this difficulty, we use the logarithmic manifold: in general, the existence of a lift of a path to this manifold is not guaranteed and, indeed, the problem of lifting a path to the logarithmic manifold is completely equivalent to the problem of finding a continuation of the hypercomplex logarithm along this path. The second part of the paper scrutinizes the existence of a notion of winding number (with respect to the origin) for hypercomplex loops that avoid the origin, even though it is known that the definition of winding number for such loops is not natural in ${\mathbb R}^n$ when $n$ is greater than $2$. The surprise is that, in the hypercomplex setting, the new definition of winding number introduced in this paper can be given and has full meaning for a large class of hypercomplex loops (untwisted loops with companion that avoid the origin). Finally an original but rather natural notion of homotopy for these hypercomplex loops (the $c$-homotopy) is presented and it is proved to be suitable to comply with the intrinsic geometrical meaning of the winding number for this class of loops, namely, two such hypercomplex loops are $c$-homotopic if, and only if, they have the same winding number.
Keywords: hypercomplex logarithm, continuation of the hypercomplex logarithm along paths, winding number
Published in DiRROS: 04.03.2024; Views: 122; Downloads: 46
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Abstract: Kostni zasevki povzročajo bolečino, ki vpliva na kakovost življenja bolnika in lahko vodijo do zapletov, ki zahtevajo urgentno ukrepanje. Ko zaradi kostnih zasevkov grozi oziroma je prisoten patološki zlom ali maligna kompresija hrbtenjače, je nujno oceniti, ali bolnik potrebuje kirurško intervencijo, ki ji sledi pooperativno obsevanje. Kadar bolnik ni kandidat za operativno zdravljenje, se priporoča urgentno obsevanje. Pri bolečih kostnih zasevkih, brez grozečega oziroma prisotnega patološkega zloma ali maligne utesnitve hrbtenjače, ne glede na velikost samega zasevka, prvi pristop zdravljenja bolečine predstavlja farmakološko zdravljenje, ki ga podpre in dopolni protibolečinsko paliativno obsevanje. Pri paliativnem obsevanju so celokupne obsevalne doze nizke, obsevanje je izvedeno v enem odmerku ali v kratkih obsevalnih režimih. Bolniki, ki ne odgovorijo na prvo obsevanje, ali se jim bolečina ponovi, so lahko varno ponovno obsevani na istem mestu. Na Onkološkem inštitutu Ljubljana smo opravili retrospektivni pregled paliativnih obsevanj kosti med leti 2018 – 2021. Letno obsevamo 800 kostnih zasevkov, upažamo pa upad števila obsevanj. Najpogostejša frakcionacija je 5 x 4 Gy, samo 10% bolnikov pa prejme obsevanje v enem odmerku. Protibolečinsko obsevanje kosti je učinkovito, stroškovno učinkovito in varno. Pomembno je prepoznati bolnike, ki bi imeli korist od protibolečinskega obsevanja, in jih napotiti na konzilij. S poenostavitvijo radioterapevtskih postopkov in odločitvijo za obsevanje v enem odmerku, je lahko obsevalno zdravljenje bolniku prijaznejše in dostopnejše.
Keywords: kostni zasevki, bolečina, paliativno obsevanje, frakcionacija
Published in DiRROS: 26.02.2024; Views: 113; Downloads: 30
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Keywords: kostna bolečina, paliativna oskrba, onkologija
Published in DiRROS: 23.11.2023; Views: 150; Downloads: 65
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