16th world congress on gastrointestinal cancer …...irena oblak, jernej benedik the 16th world...
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ONKOLOGIJA / abstracts
36
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
37
leto XIX / št. 1 / junij 2015
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.
ONKOLOGIJA / abstracts
38
leto XIX / št. 1 / junij 2015
38
ONKOLOGIJA / abstractsleto XIX / št. 1 / junij 2015
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.
ONKOLOGIJA / abstracts
38
leto XIX / št. 1 / junij 2015
38
ONKOLOGIJA / abstractsleto XIX / št. 1 / junij 2015
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