Klinicka Onkologie最新文献

Background: International Federation of Gynaecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique - FIGO) introduced a new staging system for endometrial carcinoma - FIGO 2023 - in June 2023.

Objective: The new staging system differs significantly from previous versions. The new system represents a significant departure from the traditional staging systems for other gynaecological cancers, as the definition of individual stages includes not only the traditional anatomical extent of the tumour, but also the molecular profile of the tumour and other histopathological parameters - histological type of tumour, tumour grade and the presence of substantial lymphovascular invasion. The new system defines stages I and II in a completely different way and expands the definition of stages III and IV, allowing for different types of tumour spread outside the uterus. The introduction of molecular testing is the main change in the new staging system. When certain molecular markers are detected, stage I or II is completely changed. By including these non-anatomical parameters, the FIGO 2023 staging system improves the accuracy of a patient's prognosis at a specific stage with better options for individualized treatment, including the use of immunotherapy. Another goal was to synchronise staging as much as possible with the recommendations of three professional societies: the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP). The staging system for carcinosarcoma remains identical to the staging system for endometrial cancer.

Conclusion: This article presents an overview of the new FIGO 2023 endometrial cancer staging system and discusses its advantages and disadvantages for clinical practice.

Background: There are no reports of concurrent chemoradiotherapy for gastric cancer with peritoneal oligometastases.

Case description: A 70-year-old man with gastric cancer and peritoneal oligometastases received concurrent adaptive radiotherapy and oral S-1. After radiotherapy, S-1 was discontinued, and 2 years later the tumor had completely regressed, with no recurrence or metastasis 6 years after radiotherapy.

Conclusion: Peritoneal oligometastatic gastric cancer may be a candidate for curative treatment with concurrent adaptive radiotherapy and oral S-1.

Background: Malignant liver tumors are highly aggressive with a poor prognosis. Metalothionein (MT) is a low-molecular intracellular protein, whose primary function is to regulate the homeostasis of heavy metals in many organisms. There are only few studies focusing on the molecular mechanisms of MT expression. Recent studies show its significant relations to carcinogenesis, spontaneous mutagenesis and efficiency of antitumor medicine. In previous studies, the increase of MT levels in cancer patients was proven. The aim of this work is to study MT as well as to increase the efficiency of malignant liver tumor diagnosis.

Methods: In our pilot study (2022-2023) we observed a group of 15 patients with hepatocellular carcinoma (diagnosis C220) and a group of 15 patients with hepatoblastoma (diagnosis C222). The control group included 20 healthy probands. We developed our own modified method for the analysis. Blood serum samples of the probands were denaturated (99 ˚C, 20 min). MT was determined by an electrochemical method. Obtained data were stored and processed in the laboratory information system QINSLAB.

Results: In denaturated blood serum samples, we obtained voltametric curves of MT. We determined concentrations of MT by evaluating the area under the curve (AUC). To differentiate normal and abnormal concentrations of MT, blood samples of healthy probands were used (N = 20), with the average MT levels of 2.0 ± 1.3 µg/L and median 1.9 µg/L. In patients diagnosed with HCC, the average MT levels were 9.1 ± 6.5 µg/L and median 9.0 µg/L. The receiver operating characteristic (ROC) analysis showed AUC 0.864 (95% CI 0.736-0.992), sensitivity 0.74 and specificity 0.75. In patients diagnosed with hepatoblastoma, the average MT concentrations measured were 11.5 ± 7.5 µg/L and the median was 10.9 µg/L. The ROC analysis displayed AUC 0.868 (95% CI 0.751-0.993), sensitivity 0.84 and specificity 0.86. The correlation analysis showed correlation between MT and carcinoembryonic antigen (CEA) (r = 0.99), uric acid (r = -0.86) and potassium ions (r = -0.94).

Conclusion: In this pilot study, we observed the association of MT levels in healthy probands and malignant liver tumor patients. Many previous studies show that MT concentrations are increasing as the illness progresses. We assume that this increase is connected to the high metabolic activity of cancer cells. This study will continue with collecting a larger number of samples.

Background: Typically, the management of locally advanced rectal cancer consists of neoadjuvant chemoradiotherapy, followed by surgery and adjuvant chemotherapy. In addition to neoadjuvant chemoradiotherapy, total neoadjuvant therapy (TNT) involving radiotherapy and combined chemotherapy has been increasingly used and shown to reduce the risk of distant metastasis and improve local control. Patients with microsatellite instability and deficient mismatch repair (MSI/dMMR) tumors represent a specific group that benefits from different approaches if TNT is considered.

Case: Our case report describes the diagnosis and treatment of a patient with locally advanced rectal cancer indicated for clinical characteristics to predictive molecular testing. Microsatellite instability was confirmed. Based on this finding, after short-course radiotherapy, she was offered neoadjuvant immunotherapy with checkpoint inhibitors. She subsequently underwent surgery with a confirmed pathologic complete response. The treatment was well-tolerated and she stays in complete remission, with a follow-up according to the standard recommendations.

Conclusion: This case highlights the importance of molecular testing in rectal cancer, which should be performed in all advanced cases requiring more intensive oncologic therapy than surgery alone. MSI/dMMR status indicates the need for a specific approach that may significantly improve the outcomes of these patients.

Background: Regardless of cancer type or stage of treatment, physical activity (PA) has been shown to reduce the risk of cancer recurrence and death. It is associated with a range of positive effects on patients' physical and psychological well-being, particularly in the areas of aerobic fitness, fatigue, mental health and perceived overall quality of life. However, in current oncology practice, the combination of its indication with treatment is still relatively rare. At the same time, cancer patients' participation in regular physical activity is usually very low. However, as PA is an effective method to support cancer treatment and plays an important role in prevention, it is necessary to find effective strategies to involve patients more widely in physical activities. To this end, physical activity programmes organised directly by facilities providing comprehensive cancer care appear to be very suitable.

Purpose: This literature review maps the main barriers and facilitators to cancer patients' participation in physical activity programmes. In particular, economic factors related to health policy, reflected in the availability of this type of supportive care for patients, the level of health literacy, the organization of PA programs, health care providers - both physicians and health care workers, social support and intrapsychic influences on the part of patients play a major role. Since the implementation of physical activity programmes into the existing cancer care system is a rather challenging process, the paper also deals with the possibilities of using the Health Belief Model. In the given context, this model allows the prediction and identification of barriers and supportive factors to patients' involvement in PA programs in order to maximize their effectiveness and adapt them to the needs of patients and, at the same time, to the capabilities of a specific medical facility.