With the recent advances in technology, highly sophisticated hardware (linear accelerators specially designed for Stereotactic Radio-Surgery or Stereotactic Body Radiation Therapy (SBRT) using novel image guidance prior to and during the procedure) and equally sophisticated planning treatment software (static and dynamic Intensity Modulated Radiation Therapy) became available, allowing for ablative doses to be delivered with an accuracy of less than 1 mm to targets which are non-static due to respiratory motion.
Malignancies originating from thymic epithelial tissue are rare and treatment approach depends on the individual situation. There are no randomized trials that provide evidence of therapy for patients with thymoma and thymic carcinoma. Treatment includes surgery, radiation therapy, and systemic therapy. For early stage tumors, surgery is the treatment of choice. Long-term survival depends on histologic type, presence of invasion, and quality of surgical resection. For locally advanced thymomas and thymic carcinomas, multimodal treatment includes neoadjuvant chemotherapy and adjuvant radiation. Patients with metastatic tumors are mainly treated with palliative chemotherapy. The optimal chemotherapy combination has not yet been established, although platinum-based drug regimes show reasonable response rates. For patients with poor performance status, the somatostatin (SST) analog octreotide with high affinity for SST receptors could be a potential treatment alternative. Small trials showed tumor responses, especially in combination with prednisolone. In the last decade, an effort has been made to establish targeted agents in the treatment of thymomas and thymic carcinomas. Nevertheless, up to now these agents have had only limited activity in this rare malignancy.
Minimally invasive video-assisted thoracoscopic surgery (VATS) is considered as an alternative to thoracotomy for early stage lung cancer. Since 2009, we use a VATS approach for all early stage lung tumors as well as benign indications for lung lobectomy. As experience with the technique is growing, indications are expanded. Here, we report our first minimally invasive pneumonectomies of two patients with non-small cell lung cancer (NSCLC). Case 1: A 60-year-old man was diagnosed with a centrally located tumor of the right lung invading all three lobes without any obvious lymph node metastasis in the preoperative work-up. The patient was scheduled for a right-sided VATS pneumonectomy. Case 2: A 62-year-old woman was diagnosed with a centrally located tumor of the left lung with an ipsilateral positron emission tomography (PET) positive lymph node (aortopulmonary window). After neoadjuvant treatment, the patient was scheduled for a left-sided pneumonectomy. Written informed consent was given in both cases. The procedures were completed using three incisions. A complete mediastinal lymph node dissection was performed. The postoperative courses were uneventful. VATS pneumonectomy is feasible in highly selected cases. It offers all advantages known from minimally invasive lung lobectomy with less pain and faster rehabilitation, which might facilitate the delivery of adjuvant treatment.
Cancers of the upper gastrointestinal tract and pancreas are still among the most devastating neoplastic diseases. Cure is achieved only if the diagnosis is made at an early stage. Given the low incidence of these neoplasias in the Western world, surveillance programs are not available and practicable; therefore, most of the patients suffering from these cancers are diagnosed in a locally advanced or metastatic stage and treated in a palliative setting. Treatment response and duration is crucial and maintenance strategies are therefore desperately warranted. Molecular targeted therapies with a low toxicity profile could make ideal proponents for this attempt. This short review summarizes the relevant trials investigating maintenance treatments in esophageal cancer, gastric cancer and pancreatic cancer.
The abstracts are a selection of clinically relevant papers presented at the American Society of Clinical Oncology (ASCO) 2012. The results of the EMILIA study were a milestone presented at the meeting. A total of 991 patients with metastatic Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer had been pretreated with a taxane and trastuzumab. They were randomized into two groups: Trastuzumab emtansine conjugate (T-DM1) or capecitabine-lapatinib. Significant differences were found with regard to progression-free survival and the two-year overall survival. Another study analyzed the relevance of the hormone-receptor (HR) status for the prognosis of patients with operable HER2-overexpressing breast cancer. A significant difference in the risk of the development of brain metastases was found depending on the HR status. In the MA.27 study, patients received adjuvant therapy with aromatase inhibitors. A significant proportion of cases reported therapy of osteoporosis, mainly with bisphosphonates. Osteoporosis therapy influenced recurrence-free survival. In another study, the prognostic influence of Ki-67 was evaluated before and after neoadjuvant chemotherapy with TAC (docetaxel/doxorubicin/cyclophosphamide). A metaanalysis analyzed the possible discordance between the HR status and the HER2 status in the primary tumor as compared to metastasis in 2,806 breast cancer patients. The estrogen-receptor (ER)-, and the progesterone-receptor (PR) status as well as the HER2 status changed in a significant proportion of cases. Parenteral nutrition in 129 terminal oncological patients with progressive cancer was investigated within a randomized placebo-controlled trial. They either received one liter of 0.9 % physiological saline subcutaneously or placebo. Survival, symptoms of dehydration, and quality of life were analyzed.
Chronic myelomonocytic leukaemia (CMML) is a clonal disorder of the haematopoietic stem cell characterised by the presence of an absolute monocytosis in peripheral blood. The disease carries myelodysplastic and myeloproliferative features. This dilemma was sought to be overcome by the World Health Organization (WHO) in 2001, when CMML was classified within a new category of myelodysplastic syndromes/myeloproliferative neoplasms (MDS/MPN). The identification of molecular markers in patients with CMML has dramatically increased over the past couple of years. However, the impact on prognosis and therapeutic interventions needs to be defined. Testing of new agents in the setting of CMML proves to be difficult due to limited number of patients. This review has a focus on current diagnosis including new molecular data and treatment of CMML.
In patients with chronic lymphocytic leukemia (CLL), infections exert a substantial influence on morbidity and mortality. Hypogammaglobulinemia is one important predisposing factor for development of infections. The use of purine analogs, such as fludarabine, and monoclonal antibodies, such as rituximab and alemtuzumab, has introduced a new spectrum of infectious complications caused by pathogens such as Pneumocystis jiroveci, mycobacteria, listeria, and herpes viruses, as well as of fungal infections; these infections are mainly related to cellular immunosuppression induced by these agents. This short review focusses on risk factors, the causative spectrum of infectious complications, and possible preventive approaches in CLL patients, including antimicrobial, immunoglobulin prophylaxis, and vaccination strategies.
Sramkova, Lucie; Sterba, Jaroslav; Hrstkova, Hana; Mihal, Vladimir; Blazek, Bohumir; Timr, Pavel; Cerna, Zdena; Prochazkova, Daniela; Hak, Jiri; Sedlacek, Petr; Janotova, Iveta; Vodickova, Elena; Zemanova, Zuzana; Jarosova, Marie; Oltova, Alexandra; Zdrahalova, Katerina; Hrusak, Ondrej; Mejstrikova, Ester; Schwarz, Jiri; Zuna, Jan; Trka, Jan; Stary, Jan
Nada, Krstovski; Milos, Kuzmanovic; Dragana, Vujic; Lidija, Dokmanovic; Dragan, Micic; Bojana, Slavkovic; Dejan, Skoric; Jelena, Lazic; Ankica, Jovanovic; Milena, Jovic; Nada, Konstantinidis; Gordana, Kostic; Predrag, Rodic; Dragana, Janic
We present the results of a retrospective study of acute myeloid leukemia (AML) treatment in Serbia in the period 2000–2012. Treatment was performed in four centers, two of which were located in Belgrade, one in Nis, and one in Novi Sad. Children affected by non-acute promyelocytic leukemia (non-APL) subtypes received treatment regimens derived from protocols of Berlin Frankfurt Munster AML study group, whereas children with APL were treated according to the AIEOP/GIMEMA ATRA plus Idarubicin “AIDA” protocol. Total number of patients was 106, out of whom 48 were girls (45.3 %) and 58 boys (54.7 %); median age at diagnosis was 9.0 years (range 1 month–17.9 years). In total, 82.1 % of patients achieved complete remission after induction treatment. Twelve patients (11.3 %) died during induction, before achieving complete remission; there were nine deaths during remission (10.5 %) and 20 patients relapsed (23.2 %). Median time of follow-up was 54 months. Two patients (1.9 %) were lost to follow-up. Event-free survival was 50.3 % and overall survival was 58.9 %.