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Jassem J.,Medical University of Gdańsk | Duchnowska R.,Klinika Onkologii | Kawecki A.,Klinika Nowotworow Glowy i Szyi | Krajewski R.,Klinika Nowotworow Glowy i Szyi | And 7 more authors.
Nowotwory | Year: 2014

Surveillance after oncological treatment constitutes a necessary element of comprehensive cancer care. Determining optimal follow-up schedules, including their cost effectiveness, is critical on clinical, organisational and economic grounds. Owing to a lack of prospective clinical studies providing the highest level of evidence, in most cancers optimal surveillance schemes cannot be determined. Hence, currently most recommendations are based on retrospective studies and expert opinions. In Poland comprehensive and uniform recommendations on post-treatment surveillance in cancer patients are not available. This article, prepared by a group of experts in oncology and family medicine, presents a proposal for the follow-up schemes after treatment in major solid malignancies in adults. © Polskie Towarzystwo Onkologiczne.

Klimczak A.,Klinika Nowotworow Tkanek Miekkich | Pekul M.,Zaklad Patologii | Wiater K.,Klinika Nowotworow Tkanek Miekkich | Rutkowski P.,Klinika Nowotworow Tkanek Miekkich
Nowotwory | Year: 2011

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor composed mostly of perivascular epithelioid cells (PEC). The PEComa related tumors encompass angiomyolipoma, clear cell "sugar" tumor of the lung, lymphangioleiomyomatosis (AML) and clear cell myomelanocytic tumor (CCMT). Tumors of the PEComa family are rare and usually occur sporadically. LAM and AML are also frequently observed in patients with tuberous sclerosis simplex complex (TSC). Most PEComas are benign and do not recur after complete surgical resection. However, a subset of PEComas exhibit malignant behaviour. There is no known effective systemic therapy for PEComa. Recently published studies have shown that inhibition of the mTOR signaling pathway might constitute a promising treatment modality in patients with PEComa.

Klek S.,Oddzial Chirurgii Ogolnej i Onkologicznej | Jankowski M.,Nicolaus Copernicus University | Kruszewski W.J.,Medical University of Gdańsk | Fijuth J.,Medical University of Lódz | And 5 more authors.
Nowotwory | Year: 2015

Malnutrition affects a large part of patients with malignant neoplasm. Proper nutritional treatment determines the effectiveness and success of therapy in these patients. Given the importance of this issue, thanks to the collaboration of scientific societies: Polish Society of Surgical Oncology (PTChO), Polish Society of Oncology (PTO), Polish Society of Clinical Oncology (PTOK) and Polish Society for Parenteral, Enteral Nutrition and Metabolism (POLSPEN) standards for nutritional therapy in oncology have been set. An introduction to nutritional therapy is the correct identification of malnourished patients. In Poland, hospitalized patients are subject to screening towards malnutrition. Nutrition intervention should be tailored to the clinical situation. It involves the use of dietary advice, use of oral diet products (oral nutritional support), enteral or parenteral nutrition, in hospital or in home, in consideration of special situations. © Polskie Towarzystwo Onkologiczne.

Rutkowski P.,Klinika Nowotworow Tkanek Miekkich | Spiewankiewicz B.,Klinika Ginekologii Onkologicznej | Kosela H.,Klinika Nowotworow Tkanek Miekkich | Switaj T.,Klinika Nowotworow Tkanek Miekkich | And 4 more authors.
Current Gynecologic Oncology | Year: 2013

Uterine sarcoma is a rare malignancy, accounting for 3-8% of all malignant tumors of the uterus. As a rule, patients are treated in reference centers by multispecialty diagnostic-therapeutic teams. Sarcoma of the uterus originate basically from two tissues-uterine muscle and endometrial stroma and constitute a heterogenous group of tumors. A standard of local treatment of all these tumors is transabdominal hysterectomy. High recurrence rate supports the rationale for adjuvant treatment, although to date no effect of adjuvant radiotherapy on overall survival andlocal recurrence rate has een proven. Some reports concerning stromal uterine sarcomas suggest an improved survival in patients undergoing postoperative hormonal therapy. The role of chemotherapy in adjuvant treatment of leiomyosarcomas remains to be defined. In the treatment of advanced stromal uterine sarcomas, there is a place for hormonal therapy (progesterone analogs, aromatase inhibitors and GnRH analogs). Treatment of far-advanced/metastatic leiomyosarcoma cases and non-differentiated sarcomas is similar to systemic treatment of other soft-tissue sarcomas. The topic of this paper are current recommendations concerning diagnostic and therapeutic management of uterine sarcoma patients. Based on own experience confronted with literature data, we present current classifications, epidemiology, risk factors and generally accepted therapeutic protocols used to treat these malignancies.

Salamacha M.,Klinika Nowotworow Tkanek Miekkich | Kosela H.,Klinika Nowotworow Tkanek Miekkich | Falkowski S.,Klinika Nowotworow Tkanek Miekkich | Cybulska-Stopa B.,Klinika Nowotworow Ukladowych I Uogolnionych | And 2 more authors.
Nowotwory | Year: 2011

Neurofibromatosis comprises a group of three disorders - schwannomatosis, type 2 neurofibromatosis, and the most common - type 1 neurofibromatosis (NF1). NF1 is inherited in an autosomal dominant fashion and is found in 1 per 3500 live births. Type 1 neurofibromatosis is caused by a mutation in the NF1 gene, the gene product being neurofibromin . This protein is a negative regulator of the Ras kinase pathway. Neurofibromin alters or weakens this protein, allowing rapid, uncontrolled growth of cells. The range of symptoms is very wide; they vary from minor cutaneus lesions to malignancies. NF1 is associated with a higher incidence of soft tissue sarcomas, such as MPNST and GIST. MPNST arise from preexisting plexiform neurofibromas, due to a somatic mutation leading to the loss of heterozygosity of the NF1 gene. It requires intensive treatment modalities, often leading to disability and the prognosis is often poor. New therapeutic modalities have been investigated recently, as a consequence of discovering cell pathways leading to this type of cancer. GIST (gastrointestinal stromal tumor) is another soft tissue sarcoma often occurring in NF1 patients. Imatinib - an inhibitor of tyrosine kinases - applied as a standard therapy in the group of sporadic GIST, can be useless for NF1 patients with GIST, because of different pathogenesis.

Clinical trials are fundamental for the advancement of knowledge in medical sciences (including oncology) therefore strict legal and ethical conditions should be applied to their planning and conducting. Regulation No 536/2014 of the European Parliament was enforced in June 2014 to increase the number of clinical trials conducted in EU Member States. This new legislation regulates clinical trials and is mandatory in all EU countries. These new rules not only simplify the application procedure for authorization of a clinical trial and shorten waiting time for the authorization to begin study, but also introduce new definitions, including biomedical trials or clinical trials with a low degree of intervention. Particularly significant changes concern non-commercial research, including academic research projects in medicine and trials initiated by investigators (Investigator Initiated Study) based on universities, scientific societies, scientific research groups or research institutes. According to the provisions of the Regulation, it is necessary to take national legislative measures in order to support such projects. Therefore, oncology societes in our country propose means to enhance non-commercial clinical trials to be conducted in Poland.

Koseloa-Paterczyk H.,Klinika Nowotworow Tkanek Miekkich | Kozak K.,Klinika Nowotworow Tkanek Miekkich | Klimczak A.,Klinika Nowotworow Tkanek Miekkich | witaj T.,Klinika Nowotworow Tkanek Miekkich | Rutkowski P.,Klinika Nowotworow Tkanek Miekkich
Nowotwory | Year: 2015

Introduction. Trabectedin is a novel drug approved for the treatment of patients with advanced soft tissue sarcoma. It shows activity especially in the palliative treatment of liposarcomas (LPS) and leiomyosarcoma (LMS). The aim of this work was to analyze the results of treatment with the use of trabectedin in one oncology center. Materials and methods. From April 2008 to October 2013, 50 patients (23 women, 27 men) with metastatic/locally advances L-sarcomas have been treated with trabectedin. Pathological diagnosis were as follows: 20 leiomyosarcoma (LMS), 30 liposarcoma (LPS) . including 13 myxoid LPS (MPLS). Median age at treatment start was 51 years. Nearly all patients had previous chemotherapy based on doxorubicin. 14 (28%) patients received trabectedin in second line of treatment, 23 (46%) in third line, 13 (26%) in > third line of treatment. Responses to treatment were evaluated every 3 months by computed tomography imaging according to RECIST 1.1 criteria. Results. Median of received cycles of treatment is 5 (range 2.40); 18 patients (36%) received ≥ 10 cycles. 4 patients (8%) had partial response according to RECIST, 23 (46%) had stable disease, 23 (46%) had progressive disease. After 6 months 47% of the patients were free from disease progression, more in the LPS group - 66% than in LMS group - 27% p = 0,023. Progression free survival (PFS) was significantly longer in patients receiving trabectedin in 2. or 3. (median 7 months) line than > third line of treatment (median 2 months) p = 0,038. Median overall survival (OS) is 13 months with 37 patients died at the time of analysis. Neither hemoglobin level nor LDH level at the start of treatment had impact on the results. 34 patients after progression received next line chemotherapy. Histology had impact on OS (p = 0.008), almost 70% of patients with MLPS lived longer than a year. Toxicity was moderate. 30 (60%) patients had some kind of treatment toxicity, in majority grade 1 or 2. Three patients required dose reductions. Conclusion. Our analysis confirms efficacy and safety of trabectedin in patients with advanced L-sarcomas. Use of the drug give possibility for long lasting control of the disease with good tolerance of the treatment. The longest overall survival could be observed in patient with the diagnosis of myxoid liposarcoma. © Polskie Towarzystwo Onkologiczne.

Hazards related with the choice of progression-free survival as a criterion for assessment of the value of systemic anticancer therapy are presented in this study. The arguments for overall survival as reliable end-point in clinical trials in oncology are discussed. © Polskie Towarzystwo Onkologiczne.

Kwapisz D.,Klinika Nowotworow Tkanek Miekkich | Kozak K.,Klinika Nowotworow Tkanek Miekkich | Turska E.,Pododdzial Diagnostyki I Terapii Onkologicznej Oddzialu Chemioterapii | Kalinka-Warzocha E.,Pododdzial Diagnostyki I Terapii Onkologicznej Oddzialu Chemioterapii | And 3 more authors.
Nowotwory | Year: 2014

The incidence of cutaneous melanoma is constantly increasing. The primary treatment in early stage of disease remains surgery. New therapeutic strategies such as immunotherapy or selective BRAF inhibitors - vemurafenib and dabrafenib, have improved outcomes of treatment in the group of patients with stage IV melanoma. In Poland still only vemurafenib is available in routine clinical practice. In this article we present clinical experiences in treating of BRAF-positive metastatic melanoma patients with use of vemurafenib. © Polskie Towarzystwo Onkologiczne.

Talimogene laherparepvec (T-VEC) is the first (approved recently in the European Union) oncolytic immunotherapy which demonstrated therapeutic benefit for cutaneous melanoma in a phase III clinical trial. This resulted in a higher that previously obtainable response rate and median overall survival, particularly in untreated patients or those with stage IIIB, IIIC, or IVM1a disease. T-VEC was well tolerated and is currently studied in combined therapy with immunological checkpoints and in a neoadjuvant setting. In the review, current data on its efficacy and safety in melanoma therapy are discussed. © Polskie Towarzystwo Onkologiczne.

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