16th world congress on gastrointestinal cancer irena oblak

ONKOLOGIJA / abstracts

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leto XIX / št. 1 / junij 2015

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ONKOLOGIJA / abstractsleto XIX / št. 1 / junij 2015

The role of radiological and nuclear medicine imaging methods in nasopharyngeal carcinoma

MajaJakič,KatarinaŠurlanPopovič

Nasopharyngealcarcinoma(NPC)isararediseaseintheSlovenianpopulation.TreatmentdependsalsoontheTNMstageofthecarcinoma,whichisdeterminedalsowiththehelpofradiologicandnuclearmedicineimagingmethods.Theradiologicimagingexamina-tionmethodofchoicefordetectingNPCandlymphnodemetastases

isMRI,whereasspreadingofNPCtobonestructuresisbestshownusingCT.Tocontinue,PET-CTisthemethodofchoicefordetect-ingdistantmetastasesanddiseaserecurrence3to6monthsaftercompletedtreatment.

16th World Congress on Gastrointestinal Cancer

IrenaOblak,JernejBenedik

The16thWorldCongressonGastrointestinalCancertookplaceinBarcelonafrom25to28June2014.Thecongresswasattendedbygeneralpractitioners,gastroenterologists,hepatologists,internistoncologists,surgeonsanddifferentresearchers,whowishtoupgradetheirknowledgeneededfortreatingpatientswithgastrointestinalcancer.Thecongresshostedpresentationsabouttheimportanceofscreening,diagnosticsandrecentfindingsregardingclinicalmanagementofpatientswithcommonandlesscommontypesofgastrointestinalcancer.Theemphasiswasonindividualpatientmanagementandtheimportanceofamultidisciplinaryapproach,as

wellasmostrecentmolecularmechanismsknowntodate.Over70world-renownedlecturers,allexpertsintheirfields,presentedthelatestfindingsandrecommendationsorledsmalltargetedgroupsofphysicianswhodiscussedissuesoftheirinterest.Atthecongress,theparticipantswerealsogivenachancetopresentourresearchresults,withtheabstractsbeingpublishedintheAnnalsofOncology.ThreespecialistsfromSloveniaattendedthecongress,namelyagastroenter-ologist,aninternistoncologist,andaradiationtherapist,eachwithhisorherowncontributions.

The importance of hypoxia in radiation therapy

PeterKorošec,MitjaAnžič,MonikaČešnjevar,GaberPlavc,IrenaOblak

Thesuccessofradiationtherapy(RT)treatmentdependsonnumer-ousfactors,oneofwhichisalsotumourcelloxygenation.Tumourcellswhicharewell-suppliedwithoxygencanbeupto3timesmoresensitivetoradiationthanhypoxictumourcells.Inaddition,hypoxiafunctionsasselectivepressureintumours,whichresultsinthesurvivalofonlymoremalignantcellswithdiminishedapoptoticpotential.Presenceofhypoxiaincreasesthegenomicinstabilityandmetastaticpotentialoftumourcells,whilealsoincreasingcellresistancetochemotherapy,allofwhichaffectsthesuccessoftreatmentwithRT.Hypoxiaisaresultofanimbalancebetweencellularrespiration,concentrationofoxygeninthebloodandtumourperfusion,with

themostcommonpathogenicmechanismsbeinginappropriatevascularization,disturbedoxygendiffusionandanaemiawhichmaybeaconsequenceofcancerortreatment.Usinginvasiveandmostrecentnon-invasivediagnostictechniques,wecanassesstheproportionofhypoxiccellsinthetumour,adaptingthetherapeuticapproachaccordingly.Abettereffectofirradiationoflessoxygenatedtumourscanbeachievedusingradiosensitizers,byimprovingtumouroxygenation,throughselectivedestructionofhypoxiccells,andwithirradiationofhypoxicareasusinghigherdosesofradiationandwiththehelpofradioprotectorsorusingmodernirradiationtechniques.

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ONKOLOGIJA / abstractsleto XIX / št. 1 / junij 2015ONKOLOGIJA / abstracts

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New findings in systemic treatment of basal cell carcinoma

JanjaOcvirk

Themajorityofprimarybasalcellcarcinomas(BCCs)aretreatedsurgicallyor,insurfacelesions,usingnon-surgicalmethods.Theriskofrecurrenceincreaseswithtumoursize,poorlydefinedlesionmargins,anaggressivehistologicsub-typeandpreviousrecurrence.Insomecases,thetumourcandestroythesurroundingtissues(muscles,bones,cartilageetc.)duetolong-termabsenceoftreatmentoraggressivenessofthetumour(locallyadvancedformofBCC-IaBCC)Inextremelyrarecases,BCCspreadsalsotodistanttissues(metastaticBCC-mBCC).Inmultiplelocalrecurrencesorinvasionofsurrounding/distantstructures(laBCC/mBCC),wheresurgeryand/orradiationtherapyarenotappropriate,itisimportanttouseamultidisciplinaryapproachinpatientmanagement.AbnormalactivationoftheHedgehogsignallingpathwayisresponsi-blefortheoccurrenceofthediseasein90%ofBCCs.ByselectivelybindingtothetransmembraneproteinSMO(SmoothenedTransmem-braneProtein),theactivesubstancevismodegibselectivelyinhibits

theabnormallyactivatedsignallingpathway.PhaseIIclinicaltrialERIVANCEBCCreportedontheefficacyandsafetyofvismodegibinpatientswithlaBCCandmBCC.Theprimaryobjectiveofthisstudywasobjectiveresponserate(completeandpartial)asassessedbyanindependentreviewboard.Thestudyresultsshowedthatanobjectiveresponsewasachievedin33.3%ofpatientswithmBCCand47.6%ofpatientswithlaBCC.Diseasecontrol(objectiveresponse+stabledisease)wasconfirmedin94%ofpatientswithmBCCand83%ofpatientswithlaBCC.After24weeksoftreatment,atotalof54%ofpatientswithlaBCChadnohistopathologicalsignsofbasalcellcarcinoma.Accordingtothemostrecentdata,themediandurationofobjectiveresponsewas14.8monthsinmBCCand26.2monthsinlaBCC.TheencouragingresultsoftreatmentwithvismodegibinaphaseIItrialshowasignificantdecreaseinthesizeofmultiplelesionsandnumberofnewlyoccurredlesionsinpatientswithGorlinsyn-drome.Themostcommonadverseeffectsincludedmusclecramps,lossoftaste,hairlossandfatigue.

Epithelial ovarian cancer, fallopian tube cancer, primary peritoneal serous cancer (PPSC) – systemic treatment recommendations

ErikŠkof,OlgaCerar

Epithelial ovarian cancer is known to be one of the most sensitive to systemic treatment with chemotherapy. Objective response to treatment was achieved in more than 80% of patients. Therefore, chemotherapy treatment is a standard part of primary treatment after completed surgery (adjuvant treatment), If surgical treat-ment is not possible, patients begin treatment with preoperative (neoadjuvant) chemotherapy, which is followed by surgery. In primary systemic treatment, we have been using chemotherapy in combination with taxanes and platinum-based preparations. In systemic treatment of fallopian tube cancer, we also use – be-sides chemotherapy – bevacizumab, an inhibitor of the vascular endothelial growth factor (VEGF).

Systemic treatment presents the principal treatment also in disease recurrence. The type of systemic treatment in disease recurrence depends on the time elapsed since the end of primary treatment until recurrence. In the last couple of years, we have been again witnessing the introduction of new medicines for treat-ment of patients with fallopian tube cancer. For this reason, the Institute of Oncology Ljubljana this year updated its guidelines for systemic treatment of epithelial ovarian cancer. In this paper, we present the current recommendations for systemic treatment of epithelial ovarian cancer in Slovenia. Epithelial ovarian cancer, fal-lopian tube cancer and primary peritoneal serous cancer (PPSC) have the same clinical course and the same systemic treatment, therefore they are all managed in the same manner.


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ASCO Annual Meeting

TanjaČufer

IntheendofMaythisyear,Chicagohostedthetraditionalannualmeetingofoncologistsfromaroundtheworld,whichwasorganisedbytheAmericanSocietyofClinicalOncology(ASCO).Onceagain,themeetingwasattendedbymorethan30,000oncologistsandotherscientistsfromallovertheworld.Themaintopicofthisyear’sASCOmeetingwasdefinitelycancerimmunotherapy.Formanyyears,wehavehopedtobeabletodestroyoratleastcontrolcancercellsbystimulatingtheorganism’sowndefence.Therehavebeensomeupsbutmostlymanydownsof

immunotherapy.Interferons,interleukinsandvaccineshaveshownaverysmalllevelofefficacy,and,evenso,onlyinsometypesofcan-cer,alongsideadisproportionallyhightoxicity.Abreakthroughwasachievedafewyearsago,whennewimmuno-medicines,inhibitorsofcontrolswitchesinTlymphocytes(so-calledcheckpointinhibitors),wereintroducedintoclinicaltrials.Inmanytypesofcancer,thesemedicinesledtoremissions,whichwere,mostimportantly,long-terminpatientswithremission.

Capecitabine-induced transmural myocardial infarction – case report

MiroslavVujasinović,MarkoBoc,ZdenkoKikec,CirilaSlemenikPušnik

Fluoropyrimidineareagentsthatcomprisetheso-calledantimetabo-lites(inhibitorsofcellmetabolism).Animportantrepresentatitveofthisgroupare5-fluorouracil(5-FU)andcapecitabine(anoralanalogof5-FU),whichbelongtoagroupcalledpyrimidineanalogs.Bothrepresentthecornerstoneofchemotherapyregimens,whichareusedinthetreatmentofsolidtumorsofthegastrointestinaltractandareindispensableinthetreatmentthereof.Amongtherareside-effectsofbothappearscardiotoxicityincludingmyocardialinfarction.The

spectrumofcapecitabine-inducedcardiotoxicityiswideandicludesangina,arrhythmias,myocardialinfarctionanddeath.Duetoitsincreasinguseinoncologictherapy,specialistsshouldbeawareofcardiotoxicityespeciallywhenusedinpatientswiththehistoryofishaemic heart disease. Wepresentacaseofafemalepatientwithoutpreviouscardiovascularsymptomswhodevelopedtransmuralmyocardialinfarctionduringthetreatmentwithcapecitabine.


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38


ASCO Annual Meeting

TanjaČufer

IntheendofMaythisyear,Chicagohostedthetraditionalannualmeetingofoncologistsfromaroundtheworld,whichwasorganisedbytheAmericanSocietyofClinicalOncology(ASCO).Onceagain,themeetingwasattendedbymorethan30,000oncologistsandotherscientistsfromallovertheworld.Themaintopicofthisyear’sASCOmeetingwasdefinitelycancerimmunotherapy.Formanyyears,wehavehopedtobeabletodestroyoratleastcontrolcancercellsbystimulatingtheorganism’sowndefence.Therehavebeensomeupsbutmostlymanydownsof

immunotherapy.Interferons,interleukinsandvaccineshaveshownaverysmalllevelofefficacy,and,evenso,onlyinsometypesofcan-cer,alongsideadisproportionallyhightoxicity.Abreakthroughwasachievedafewyearsago,whennewimmuno-medicines,inhibitorsofcontrolswitchesinTlymphocytes(so-calledcheckpointinhibitors),wereintroducedintoclinicaltrials.Inmanytypesofcancer,thesemedicinesledtoremissions,whichwere,mostimportantly,long-terminpatientswithremission.

Capecitabine-induced transmural myocardial infarction – case report

MiroslavVujasinović,MarkoBoc,ZdenkoKikec,CirilaSlemenikPušnik

Fluoropyrimidineareagentsthatcomprisetheso-calledantimetabo-lites(inhibitorsofcellmetabolism).Animportantrepresentatitveofthisgroupare5-fluorouracil(5-FU)andcapecitabine(anoralanalogof5-FU),whichbelongtoagroupcalledpyrimidineanalogs.Bothrepresentthecornerstoneofchemotherapyregimens,whichareusedinthetreatmentofsolidtumorsofthegastrointestinaltractandareindispensableinthetreatmentthereof.Amongtherareside-effectsofbothappearscardiotoxicityincludingmyocardialinfarction.The

spectrumofcapecitabine-inducedcardiotoxicityiswideandicludesangina,arrhythmias,myocardialinfarctionanddeath.Duetoitsincreasinguseinoncologictherapy,specialistsshouldbeawareofcardiotoxicityespeciallywhenusedinpatientswiththehistoryofishaemic heart disease. Wepresentacaseofafemalepatientwithoutpreviouscardiovascularsymptomswhodevelopedtransmuralmyocardialinfarctionduringthetreatmentwithcapecitabine.

V tej številki so sodelovali:

Mitja Anžič, dr.med., Onkološki inštitut LjubljanaJernej Benedik, dr.med.,specialist internistične onkologije, Onkološki inštitut LjubljanaMarko Boc, dr.med., specialist internistične onkologije, Onkološki inštitut Ljubljanaprim.Olga Cerar,dr.med., specialistka interne medicine, Onkološki inštitut LjubljanaMonika Češnjevar, dr.med., Onkološki inštitut Ljubljanaprof.dr.Tanja Čufer, dr.med, specialistka interne medicine, Maja Jakič,dr.med., Medicinska fakulteta Univerze v LjubljaniZdenko Kikec, dr.med., Splošna bolnišnica Slovenj GradecPeter Korošec,dr.med., Onkološki inštitut Ljubljanaizr.prof.dr.Janja Ocvirk, dr.med., specialistka interne medicine, Onkološki inštitut Ljubljanadoc.dr.Irena Oblak, dr.med., specialistka onkologije in radioterapije, Onkološki inštitut LjubljanaMatjaž Musek,univ.dipl.bibl, Onkološki inštitut LjubljanaGaber Plavc, dr.med., Onkološki inštitut Ljubljanaprim.Cirila Slemenik Pušnik, dr.med., specialist interne medicine, Splošna bolnišnica Slovenj GradecErik Škof, dr.med., specialist interne medicine, Onkološki inštitut Ljubljana doc.dr. Katarina Šurlan Popovič,dr.med.,specialistka radiologije, UKC Ljubljanaasist. mag. Miroslav Vujasinović, dr.med., specialist interne medicine, Splošna bolnišnica Slovenj Gradec

16th world congress on gastrointestinal cancer irena oblak

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