Klinicka Onkologie最新文献

Background: Total mesometrial resection (TMMR) has shown excellent locoregional control for treatment of cervical cancer without adjuvant radiation therapy in highly selected centers. However, this procedure was never evaluated in resource-limited setting. We hypothesized that the procedure can be reproduced outside the university centers without compromising results.

Materials and methods: This is a retrospective, observational, multicenter cohort study of patients with IB1-IIB cervical cancer who underwent TMMR in developing countries and omitted adjuvant radiation therapy.

Results: A total of 124 patients who met the inclusion criteria were identified between 2015 and 2024 in three centers. The median follow-up was 29 months. The relapse rate was 6.1% (2 out of 33) for IB1, 3% (1 out of 33) for IB2, 11.1% (2 out of 18) for IB3, 20% (1 out of 5) for IIA1, and 16% (6 out of 24) for node-positive patients. No relapses were detected among IIA2 and IIB stages (3 and 8 patients, respectively). There was no significant difference (P = 0.36) in the relapse rate between patients who met the Sedlis criteria (2.9%) and those who did not (8.8%).

Conclusion: According to the study, TMMR outcomes can be reproduced without compromising oncologic outcomes. However, prospective evaluation, longer follow-up and a larger cohort are needed to confirm these preliminary data.

Background: Tauroursodeoxycholic acid (TUDCA) is a naturally occurring hydrophilic bile acid in the human body. Its therapeutic effects have been recognized in traditional Chinese medicine since ancient times and continue to be used in contemporary Western medicine. TUDCA is classified as a secondary bile acid and is formed by conjugating ursodeoxycholic acid (UDCA) with taurine. Due to its hepatoprotective properties and ability to promote bile production and flow, UDCA has been approved by the US Food and Drug Administration (FDA) for the treatment of primary biliary cholangitis. TUDCA was originally used in the treatment of liver disease, but according to recent findings of current research, TUDCA has therapeutic potential beyond the hepatobiliary area.

Purpose: In this paper, we aim to summarize the latest findings on the therapeutic potential of TUDCA in a broader clinical context. New findings show that TUDCA finds use not only in the treatment of hepatic disorders, but also in the treatment of cancer, neurodegenerative and cardiovascular diseases, gastrointestinal dysfunctions and glucose metabolism disorders. Due to its multifunctional effects, TUDCA appears to be a promising substance with the potential to become an important part of modern medicine in the treatment of diverse pathological conditions.

Background: Horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. While the incidence of renal cell carcinoma (RCC) in HSK is not higher than in anatomically normal kidneys, altered renal anatomy makes surgical management technically challenging. Minimally invasive, image-guided therapies such as microwave ablation (MWA) have emerged as promising alternatives.

Observation: We present the case of a 65-year-old male with HSK and a 2.0 cm RCC in the right renal moiety who underwent CT-guided MWA with no complications. Hydrodissection was used to protect the psoas muscle and lumbosacral nerves. Follow-up imaging confirmed local tumor control with no signs of remnant or recurrence. Only a limited number of similar cases have been reported.

Conclusion: This case highlights the feasibility and safety of percutaneous MWA for RCC in HSK. It adds to the growing evidence supporting MWA as a minimally invasive option in anatomically complex renal tumors.

Background: Childhood cancer is a serious health issue that still does not receive sufficient attention on a global scale compared to cancer in adults. Specialized pediatric cancer registries play a crucial role in collecting detailed data on tumor types, treatment outcomes, genetic determinants, predisposition syndromes, and long-term treatment toxicity.

Aim: The aim of this review is to emphasize the importance of collaboration between general and specialized pediatric cancer registries in epidemiological research of childhood malignancies and its impact on improving completeness of ascertainment, diagnosis, treatment, and follow-up care.

Conclusion: The effective integration of data collected in general and pediatric cancer registries improves data quality and enables analysis of all relevant data, leading to advances in research, optimization of treatment, and improvement in the quality of care for pediatric cancer patients.

Background: The importance of stress in cancer has been noted by physicians since the time of Galen. However, it is only in the last two decades that combined oncological and neuroscientific research has allowed to explore this relationship in an exact way and to describe the pathways and mechanisms that mediate the stimulatory effect of stress on cancer. This adverse effect of stress is mediated mainly by the mediators of the sympathoadrenal system, norepinephrine and epinephrine, which, by activating adrenergic receptors in the tumor micro- and macro-environment, stimulate tumor cell proliferation and neoangiogenesis and inhibit antitumor immunity, reducing the efficacy of standard anticancer therapies. It has also been found that interventions reducing the effects of stress on the body not only improve the quality of life of cancer patients but may also improve their survival. Given the complexity of the impact of stress on the organism, experimental and clinical studies have overwhelmingly focused on investigating the effect of a single intervention reducing the stimulatory influence of the sympathoadrenal system on the cancer process.

Purpose: The aim of this opinion article is to highlight the possibility of a synergistic effect of a combination of several interventions limiting the activation of the sympathoadrenal system and, based on the available data, to propose a combination of these interventions that is applicable in the supportive treatment of cancer patients even nowadays.

Conclusion: The Protocol Synergy, which includes non-pharmacological interventions aimed at reducing the effects of stress on the cancer patient, has the potential to improve the quality and, in certain patients, the prognosis of their disease. Although the introduction of this protocol into routine clinical practice will require addressing the personnel and financial aspects associated with its implementation, it has the potential to significantly improve the level of care for cancer patients.

Background: In terms of epidemiology, colorectal carcinoma (CRC) represents one of the most prevalent tumors worldwide. Progress in research has translated into reduced mortality of the disease, but the trend of early onset CRC troubles most of the developed countries. Identification and validation of effective prognostic biomarkers are crucial for improving diagnostic accuracy and treatment outcomes.

Purpose: The objective of the work is to analyze the latest data on the epidemiology and risk factors of CRC. A narrative review also aims to summarize current knowledge about various prognostic biomarkers in the treatment of CRC, including indicators of performance status, nutritional, and inflammatory markers.

Conclusion: CRC pose major health problem in most of the countries and the tumor biomarkers as well as patients pre-treatment condition are crucial to establish prognosis of the disease. Nutritional and performance status indicators play an essential role in assessing the patient's condition and influence treatment decisions, with a potential impact on treatment outcomes. Inflammatory markers have demonstrated significant prognostic value, correlating with the patient's immune response to the tumor and inflammatory processes that may promote disease progression. Despite promising predictive capabilities, these biomarkers are not yet routinely used in clinical practice due to the need for further research validation. The integration of new biomarkers into clinical practice could lead to more personalized treatment decisions and improved treatment outcomes. For a more comprehensive assessment of the validity of these biomarkers and their application in regular clinical practice, further research is necessary.

Objective: The present publication focuses on the analysis of the development of basic epidemiological indicators of the most frequently occurring cancers in elderly population in Slovakia.

Results: The proportion of the elderly in cancer incidence and mortality in Slovakia is higher than that of younger patients (0-64 years) and is increasing. The most frequently diagnosed cancers include bronchus and lung cancer, colorectal cancer, breast cancer in females and prostate cancer in males. The average age of the whole population at diagnosis and at death for all diagnoses (except prostate cancer) in both males and females increases over the study period. The average age at diagnosis of prostate cancer is decreasing, while the average age at death is increasing. The age-standardized rate (world) (ASR-W) incidence and mortality rates for lung cancer in elderly males are decreasing, whereas they are increasing in females. ASR-W incidence of colorectal cancer is stable in elderly males but shows an increasing trend in females. Mortality from colorectal cancer is decreasing in both males and females. ASR-W incidence and mortality for prostate cancer in elderly males are decreasing. ASR-W incidence of breast cancer shows an increasing trend in elderly females, while the mortality rate is decreasing insignificantly.

Conclusion: The growing cancer burden in the elderly will place an increasing burden on the health care system, so focus on prevention and early cancer diagnosis will be necessary.

Background: Leiomyosarcomas are malignancies of smooth muscle differentiation that can metastasize early through hematogenous spread. Leiomyosarcoma of the sternum is extremely rare, with an incidence of < 0.7% among malignant bone tumors.

Case: We report the case of a 66-year-old male with a retroperitoneal metastasis located in the right pararenal space, originating from a sternal leiomyosarcoma. Three years earlier, the patient had undergone partial excision of the sternum and costal cartilages, followed by thoracic wall osteosynthesis, for the primary tumor. Follow-up imaging with CT and PET-CT revealed a mass in the right perirenal space, situated between the upper pole of the right kidney and the right adrenal gland. In the absence of other metastatic lesions and following multidisciplinary oncology team discussion, the patient underwent laparoscopic en bloc metastasectomy and right adrenalectomy.

Results: Histopathological examination confirmed the metastatic nature of the tumor with negative resection margins. Postoperatively, the patient experienced fever due to atelectasis, which resolved with intravenous antibiotics. He was discharged on the 6th postoperative day and remains free of recurrence at a two-year follow-up.

Conclusion: Minimally invasive surgical techniques allow for oncological resection of retroperitoneal metastatic lesions with low perioperative morbidity and mortality. Resection of isolated lymph node metastases has been shown to improve overall survival and disease control.

Background: Multiple myeloma (MM) with extramedullary disease (EMD) represents a subgroup with particularly poor prognosis. The application of precision medicine principles, especially targeted therapy based on the tumor's molecular profile, is a potentially effective treatment strategy.

Case: We present a case of a patient with relapsed/refractory MM and extensive EMD in whom a BRAFV600E mutation was identified using next-generation sequencing. Based on these results, combined treatment with BRAF (enkorafenib) and MEK (binimetinib) inhibitors was initiated, resulting in early regression of tumor lesions and a biochemical response. The therapy was well tolerated despite the patient's advanced disease and comorbidities. After several months, a new plasmacytoma lesion developed that no longer responded to treatment.

Results: Molecular analysis of the resistant lesion revealed biallelic inactivation of the TP53 tumor suppressor gene, which was not present in the original lesions. This alteration likely represents a mechanism of acquired resistance. The dynamics of the BRAFV600E mutation were also monitored in plasma using cfDNA and digital PCR.

Conclusion: This case illustrates the potential of precision therapy in the treatment of MM with BRAFV600E mutation. Panel sequencing and minimally invasive approaches to diagnosis and disease monitoring can significantly contribute to personalized care and a better understanding of disease dynamics.

Background: Urothelial carcinoma (UC) is the second most common malignancy of the urinary tract. While distant metastases are relatively frequent in advanced UC, cardiac involvement is exceedingly rare and typically asymptomatic. When present, it may mimic acute cardiovascular events, complicating timely diagnosis and management.

Case: We describe the case of an 81-year-old man with a history of metabolic syndrome and stable cardiac disease, who was diagnosed with high-grade urothelial carcinoma of the renal pelvis with pulmonary metastases. Two months after nephroureterectomy and during first-line carboplatin chemotherapy, the patient presented with progressive dyspnoea. ECG showed ST-segment elevations suggestive of acute myocardial infarction, yet urgent coronary angiography and laboratory markers excluded acute coronary syndrome. Echocardiography and cardiac MRI revealed a large myocardial metastasis infiltrating the right ventricle and interventricular septum. Given the advanced stage and poor prognosis, active oncologic treatment was discontinued, and palliative care was initiated.

Results: This case highlights a rare presentation of cardiac metastasis mimicking ST-elevation myocardial infarction in a patient with advanced urothelial carcinoma. Multimodal cardiac imaging was key to establishing the diagnosis. Despite its rarity, myocardial infiltration should be considered in oncologic patients presenting with cardiac symptoms and ECG abnormalities.

Conclusion: Cardiac metastases from urothelial carcinoma are rare but clinically significant, often associated with poor outcomes. ECG changes resembling myocardial infarction warrant thorough evaluation, particularly in patients with known malignancy. Early diagnosis, even in the absence of curative options, may help guide appropriate palliative care.