Adjuvantní léčba maligního melanomu prodělala v posledních 20 letech významný rozvoj. Před 20 lety byly k dispozici jen přípravky na bázi interferonu. V posledních letech, díky nástupu protilátek proti receptoru programované buněčné smrti 1 (anti-programmed death-1, anti-PD-1), je revolucí v léčbě maligního melanomu. Anti-PD-1 terapie byla nejprve použita v paliativní léčbě maligního melanomu. V roce 2015 byla publikována studie CHECKMATE 238, která prokázala účinnost anti-PD-1 léčby - nivolumabu v adjuvantním podání. Později byla publikována další studie KEYNOTE 054 s pembrolizumabem v adjuvantním podání. I tato studie prokázala účinnost pembrolizumabu v adjuvanci. Nyní již můžeme anti-PD-1 protilátky rutinně využívat v adjuvantní terapii maligního melanomu. Jejími velkými výhodami jsou účinnost a bezpečnost s relativně malým počtem závažných nežádoucích účinků. Ale je nutno si uvědomit, že i když je počet nežádoucích účinků relativně malý, existuje zde pořád riziko závažných komplikací. Proto je nutné anti-PD-1 protilátky indikovat u pacientů, kde budou mít maximální přínos.
Adjuvant treatment of malignant melanoma developed significantly in recent 20 years. Twenty years ago, just interferon-based therapy was available in adjuvant treatment of malignant melanoma. Recently, due to beginning of anti-programmed death-1(anti-PD-1) therapy era is this therapy significant benefit for patient suffering malignant melanoma. In 2015 CHECKMATE 238 trial was published proving efficacy of anti-PD-1 therapy in adjuvant setting. Later, another trial - KEYNOTE 054 trial was published, confirming efficacy of pembrolizumab in adjuvant setting. Recently, we can use anti-PD-1 therapy in adjuvant treatment of malignant melanoma routinely. The most significant advantage of anti-PD-1 therapy is efficacy and safety with small rate of serious adverse effects. But we should mind, even the rate of serious adverse event is low, the risk of serious complications is still present. In this reason should be used in patients which would have benefit from this treatment.
- MeSH
- adjuvancia imunologická * terapeutické užití MeSH
- humanizované monoklonální protilátky terapeutické užití MeSH
- inhibitory kontrolních bodů terapeutické užití MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- melanom * terapie MeSH
- metastázy nádorů prevence a kontrola MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
AIMS: Intraoperative radiotherapy (IORT) for locally advanced rectal cancer as an integral part of multimodal treatment, may lead to reduced local recurrence but it is not routinely used. The aim of this paper is to describe our experience with IORT in the treatment of patients with locally advanced adenocarcinoma of the lower third of the rectum. MATERIAL AND METHODS: Laparoscopic abdominoperineal amputation of the rectum with intraoperative radiotherapy was performed on 17 patients, 13 men and 4 women, median age 64 years (49-75 years) between 2010-2011. All patients underwent complete therapy according to the treatment protocol. RESULTS: In one patient, the laparoscopic procedure had to be converted to an open resection. The duration of the surgical procedure with IORT was 185 to 345 min (median 285 min). In 14 cases, the intraoperative dose was 10 Gy and in two patients a dose of 12 Gy was used. There were no severe intraoperative complications. Blood loss ranged from 30 to 500 mL (median 100 mL). There were postoperative complications in 4 patients (23.5%); 2 necessitated surgical reintervention (11.8%). The duration of postoperative hospitalization was 6 to 35 days (median 7 days). In the follow-up of 2 to 16 months (median 12 months), no local recurrence or disease generalization have been found to date. CONCLUSIONS: The results show the technical feasibility of laparoscopically assisted abdominoperineal amputation of the rectum in combination with IORT in the treatment of locally advanced rectal carcinoma with an acceptable risk of postperative complications.
- MeSH
- adenokarcinom radioterapie chirurgie MeSH
- kombinovaná terapie MeSH
- laparoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory rekta radioterapie chirurgie MeSH
- peroperační péče MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
AIMS: The aim of this prospective study is to elucidate feasibility of protocol of neoadjuvant concomitant radiochemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too. METHODS: We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12 cm from the anocutaneous verge. The average follow-up time was 23.9 months. RESULTS: All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4-8 weeks following the concomitant chemoradiotherapy - in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10%, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Re-operation was needed in 5% cases. CONCLUSIONS: We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine. Copyright (c) 2009 Elsevier Ltd. All rights reserved.
- MeSH
- antimetabolity antitumorózní aplikace a dávkování MeSH
- časové faktory MeSH
- deoxycytidin analogy a deriváty aplikace a dávkování MeSH
- dospělí MeSH
- fluorouracil analogy a deriváty aplikace a dávkování MeSH
- kolektomie metody MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory rekta farmakoterapie chirurgie patologie radioterapie MeSH
- následné studie MeSH
- neoadjuvantní terapie MeSH
- pooperační komplikace MeSH
- prekurzory léčiv MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- staging nádorů MeSH
- výsledek terapie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
