Klinicka Onkologie最新文献

The guidelines for clinical practice for carriers of pathogenic variants in clinically relevant genes predisposing to Lynch syndrome and colorectal cancer define the steps of primary and secondary prevention that should be provided to the individuals at high risk of developing hereditary cancer in the Czech Republic. The drafting of the guidelines was organized by the Oncogenetics Working Group of the Society for Medical Genetics and Genomics of J. E. Purkyně Czech Medical Society, in cooperation with representatives of oncology, oncogynecology, and gastroenterology. The guidelines are based on the current recommendations of the National Comprehensive Cancer Network (NCCN), European Society of Medical Oncology (ESMO) and take into account the capacity of the Czech healthcare system.

Background: Early diagnosis of cancer is essential for its effective treatment. Currently, established screening tests are cancer-specific and require screening for each type of cancer separately. The primary objective of cancer research is to develop methods that can detect multiple types of tumors from a single body fluid sample. Multicancer early detection tests aim to detect fragments of circulating tumor DNA, cell-free DNA, circulating microRNAs, or proteins released by cancer cells in the patient's body fluids. However, these tests are not suitable for routine cancer prevention due to their high cost. Therefore, in recent years, cancer screening tests have been developed to detect volatile organic compounds in urine using living organisms, such as nematodes, Caenorhabditis elegans. Measuring only 1 mm in length, C. elegans has the potential to offer a new, efficient, cost-effective, quick, and painless method to detect the presence of tumor.

Purpose: The purpose of this review is to present an overview of the literature on the development and validation of C. elegans-based cancer detection methods. The potential benefits of these assays are significant, as they could become a valuable tool for the early identification and diagnosis of cancer, even though this research is still in its initial stages of development.

Background: Positron emission tomography (PET) is a state-of-the-art diagnostic method of nuclear medicine, used for diagnostics of many pathological states in the organism, first and foremost in oncological issues. The first analysis of utilization and potential utilization of PET in the Czech Republic was published in 2013. In the following years, there was a sharp increase in a number of PET/CT and PET/MRI scanners in the country; in 2013-2021, it doubled. Simultaneously with the increase in scans performed, the range of available radiopharmaceuticals also broadened.

Material and methods: The study analyses the numbers and structure of PET, PET/CT and PET/MRI scans in the 2013-2021 period, using the pseudonymized data acquired from the General Health Insurance Company of the Czech Republic. The data was evaluated through a series of qualitative and quantitative indicators (number of scans performed, structure of diagnoses, use of different tracers, and availability of a scan for a patient).

Results: In the observed interval of time, the number of scans performed practically doubled, both thanks to more scanners installed and more radiopharmaceuticals available. The percentage of oncological and non-oncological scans remains more or less the same. Nevertheless, the regional differences in a number of scans performed persist, as does the availability of the scan for patients.

Conclusion: PET is still a dynamically developing molecular imaging method in the Czech Republic. The analysis of a number and structure of scans performed offers a priceless overview of the development of the method over the years, in regard to diagnoses, utilization of individual radiopharmaceuticals or geographic distribution of scans performed. The observed findings are a motivation for further analyses.

Background: Metastatic pancreatic ductal carcinoma (mPDAC) is one of the most lethal malignancies. The European Society for Medical Oncology (ESMO) guidelines recommend a gemcitabine doublet + nab-paclitaxel (Gem/Nab-P) or a modified FOLFIRINOX regimen (mFOLFIRINOX) as options for systemic chemotherapy. Gemcitabine monotherapy is an option for patients in a worse performance status (PS). Indirect comparisons of pivotal trials with Gem/Nab-P and mFOLFIRINOX vs. gemcitabine monotherapy (PRODIGE-4 and MPACT) indicated longer overall survival (OS) in patients treated with mFOLFIRINOX. However, it should be taken into account that the MPACT study with Gem/Nab-P included patients with an overall worse performance status. A direct comparison of these chemotherapy regimens was lacking. Indirect comparisons from real practice show their comparable effectiveness in terms of OS, progression-free survival and overall response rate. The safety profile is consistently different. The recently published phase II/III GENERATE trial, which directly compared Gem/Nab-P and mFOLFIRINOX in treatment-naïve mPDAC patients, demonstrated significantly longer OS in Gem/Nab-P-treated patients exceeding 17 months with a lower incidence of non-hematologic toxicity. The results sparked a lively discussion at the ESMO 2023 Congress. The comparison of Gem/Nab-P and mFOLFIRINOX was also addressed by prof. Prager in his presentation at the PragueONCO 2024 conference. Prager, who highlighted comparable efficacy of both regimens and better safety of Gem/Nab-P and demonstrated the benefit of Gem/Nab-P also in patients older than 70 years and those with Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2. It should also be taken into account that the choice of first line treatment determines the therapeutic options in the 2nd line. If the Gem/Nab-P regimen is used in the first line, pegylated liposomal irinotecan (nal-IRI) in combination with 5-fluorouracil and leucovorin (5-FU/LV) can be used in the second line. This regimen demonstrated prolongation of OS compared to 5-FU/LV in phase III study NAPOLI-1. In patients pretreated with the mFOLFIRINOX regimen, gemcitabine monotherapy or Gem/Nab-P can be used in the second line. Early examination of molecular predictive parameters will enable the identification of cases for which appropriate targeted therapy or immunotherapy is available.

Background: Bronchial cysts (BCs) can be difficult to diagnose because of non-specific site of occurrence and heterogeneous density of cyst content in some patients. We present herein a BC case with such nonspecific findings.

Case: A 23-year-old man referred to our hospital because of an abnormal chest image during a mass-screening. CT revealed a cystic nodule in the posterior mediastinum. The content of the cystic lesion was heterogeneous, measuring 30-100 Hounsfield Units, and it was surgically resected and diagnosed as a BC.

Conclusion: Diagnosis of BC could be difficult in patients like this, who have cysts that occur in relatively rare sites such as the posterior mediastinum, or whose cyst contents are highly dense and heterogenous. If atypical findings are observed on images, it is necessary to actively perform histological diagnosis to differentiate it from other diseases.

Background: Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis that presents clinically with obstructive icterus, histologically with infiltration of pancreatic parenchyma by inflammatory cells leading to chronic inflammation with fibrosis, and therapeutically with good response to corticosteroid therapy. Clinically, it may resemble malignant disease, making diagnosis difficult and requiring a multidisciplinary team (gastroenterologist, endoscopist, radiologist, surgeon, pathologist). Two types of AIP are distinguished. Type 1 is associated with elevated serum immunoglobulin IgG4 and systemic manifestations (IgG4 related diseases). Type 2, without IgG4 elevation, is typically associated with the occurrence of idiopathic inflammatory bowel disease, especially ulcerative colitis. The first line treatment of symptomatic AIP is corticotherapy with an initial dose of 0.6-1 mg/kg/day for the first 2-4 weeks, followed by a gradual de-escalation to prevent frequent relapses. Chronic inflammation, or chronic pancreatitis, is a well-known risk factor for the development of malignancy. The association between carcinogenesis and AIP is widely discussed, but due to the rarity of the disease and a small number of studies, risk estimates vary. Pancreatic carcinoma development is most common in patients with type 1 autoimmune pancreatitis. However, it has been observed that the incidence of extra-pancreatic cancer (stomach, lung, and prostate cancer) is often equal or even higher. It is also considered that AIP may develop from coexisting malignancies as a paraneoplastic syndrome. Screening of patients with AIP for potential carcinogenesis should not be overlooked.

Purpose: The aim of this review article is to point out a rare (autoimmune) form of chronic pancreatitis with the necessity of follow up with regard to the potential risk of malignancy.