Zhoubné nádory těla děložního jsou nejčastější gynekologickou malignitou vyspělých zemí. V pokročilém stadiu je diagnostikováno přibližně 10-15 % pacientek. Léčba metastatického karcinomu endometria v posledních letech pokročila, za což vděčíme také velmi pestrému molekulárnímu profilu nádorového onemocnění. Kromě chirurgického řešení a radioterapie jsou k dispozici nejen cytotoxická chemoterapie, ale také imunoterapie, hormonální terapie a cílená léčba. Článek je přehledem současně používané léčby tohoto onemocnění v ČR.
Malignant tumors of the uterine body are the most common gynecological malignancy in developed countries. In advanced stages, approximately 10-15 % of patients are diagnosed. The treatment of metastatic endometrial carcinoma has advanced in recent years, thanks in part to the diverse molecular profile of the disease. In addition to surgical and radiotherapeutic approaches, not only cytotoxic chemotherapy but also immunotherapy, hormonal therapy, and targeted treatment are available. This article provides an overview of the currently used treatments for this condition in the Czech Republic.
- MeSH
- Antineoplastic Agents, Hormonal pharmacology therapeutic use MeSH
- Immunotherapy MeSH
- Humans MeSH
- Neoplasm Metastasis MeSH
- Endometrial Neoplasms * therapy MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
PURPOSE: To quantify mean heart dose (MHD) and doses to the left anterior descending artery (LAD) and left ventricle (LV) in a retrospective series of patients who underwent perioperative accelerated partial breast irradiation with multicatheter interstitial brachytherapy (MIB-APBI). METHODS: Sixty-eight patients with low-risk left breast cancer were treated with MIB-APBI at our institution between 2012 and 2017. Interstitial tubes were inserted during the tumorectomy and sentinel node biopsy and APBI was started 6 days later. The prescribed dose was 34 Gy in 10 fractions (twice a day) to the clinical target volume (CTV). The heart, LAD, and LV were contoured and the distance between each structure and the CTV was measured. The MHD, mean and maximum LAD doses (LAD mean/max), and mean LV doses (LV mean) were calculated and corrected to biologically equivalent doses in 2‑Gy fractionation (EQD2). We also evaluated the impact of the distance between the cardiac structures and the CTV and of the volume receiving the prescribed dose (V100) and high-dose volume (V150) on heart dosimetry. RESULTS: Mean EQD2 for MHD, LAD mean/max, and mean LV were 0.9 ± 0.4 Gy (range 0.3-2.2), 1.6 ± 1.1 Gy (range, 0.4-5.6), 2.6 ± 1.9 Gy (range, 0.7-9.2), and 1.3 ± 0.6 Gy (range, 0.5-3.4), respectively. MHD, LAD mean/max, and LV mean significantly correlated with the distance between the CTV and these structures, but all doses were below the recommended limits (German Society of Radiation Oncology; DEGRO). The MHD and LV mean were significantly dependent on V100. CONCLUSION: Perioperative MIB-APBI resulted in low cardiac doses in our study. This finding provides further support for the value of this technique in well-selected patients with early-stage left breast cancer.
- MeSH
- Brachytherapy methods MeSH
- Radiotherapy Dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Breast Neoplasms radiotherapy MeSH
- Breast radiation effects MeSH
- Retrospective Studies MeSH
- Heart radiation effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Východiska: Chemoterapie (CHT) je důležitou modalitou využívanou v léčbě nádorových onemocnění. V užším smyslu se pod pojmem chemoterapie rozumí léčba cytostatiky. Tato léčba je spojena s množstvím nežádoucích účinků (NÚ), které jsme v současnosti více či méně schopni ovlivňovat a předcházet jim. Mezi nejčastější NÚ patří únava, nauzea a zvracení, vypadávání vlasů, průjem a zácpa, změny v krevním obrazu jako anémie, neutropenie, trombocytopenie a s tím související infekce, horečka nebo krvácení. Mnoho vedlejších účinků chemoterapie se vyskytuje u pacientů jeden až několik dní po podání chemoterapie, pacienti jsou často již v domácím prostředí. Pacienti a jejich rodiny by měli být informováni o tom, jaké vedlejší účinky je u jednotlivých druhů chemoterapie možné očekávat a měli by mít základní informace o způsobu možnosti zvládání těchto nežádoucích obtíží. Velmi důležitá je také pro pacienta informace o tom, v jakých případech je vhodnější vyhledat lékařskou péči a kam se obrátit pro pomoc, když si není jistý, jak vzniklý zdravotní problém řešit. Proto je potřeba pacienty seznamovat s možnými nežádoucími účinky a možností jejich terapie a prevence už v ambulanci před podáním samotné chemoterapie.
Background: Chemotherapy is an important modality used in treating cancer diseases. Strictly speaking, the term chemotherapy refers to treatment with cytostatic drugs. This treatment is associated with a number of adverse effects that, more or less, can currently be managed and prevented. The most common adverse effects include fatigue, nausea and vomiting, hair loss, diarrhoea and constipation, blood count alterations such as anaemia, neutropenia, thrombocytopenia and associated infections, fever, or bleeding. Many side effects of chemotherapy occur in patients within one or several days of chemotherapy administration, after patients have returned home. Patients and their families should be informed on what side effects can be expected with particular types of chemotherapy, and should obtain basic information on how to manage these adverse effects. Of major importance for patients is the information on when they should seek medical attention and where to turn for help when not certain how to manage a health problem that has occurred. Therefore, it is necessary to acquaint patients with possible adverse effects and the ways of treating and preventing them already in the office prior to chemotherapy administration. Purpose: The review article discusses chemotherapy adverse effects, their management and possible prophylaxis. Conclusion: Nowadays, not only the treatment of cancer disease itself, but also the quality of life of the patient treated for the disease are both very important. Hence, adequate attention has to be paid to adverse effects that may occur as a result of treatment, as well as to the use of prophylaxis that is an equally important part of patient care.
- Keywords
- myelosuprese,
- MeSH
- Anemia chemically induced etiology drug therapy MeSH
- Granulocyte Colony-Stimulating Factor therapeutic use MeSH
- Chemotherapy-Induced Febrile Neutropenia diagnosis prevention & control MeSH
- Filgrastim therapeutic use MeSH
- Skin Manifestations MeSH
- Humans MeSH
- Neoplasms drug therapy MeSH
- Nausea chemically induced drug therapy prevention & control MeSH
- Nail Diseases chemically induced prevention & control MeSH
- Neurotoxicity Syndromes etiology prevention & control MeSH
- Drug-Related Side Effects and Adverse Reactions drug therapy classification prevention & control therapy MeSH
- Diarrhea chemically induced etiology prevention & control therapy MeSH
- Constipation chemically induced prevention & control therapy MeSH
- Vomiting chemically induced drug therapy classification prevention & control MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
