Onkologicka Klinika LF UP

Czech Republic

Onkologicka Klinika LF UP

Czech Republic
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Kalita O.,Neurochirurgicka Klinika LF UP | Vaverka M.,Neurochirurgicka Klinika LF UP | Hrabalek L.,Neurochirurgicka Klinika LF UP | Zlevorova M.,Onkologicka Klinika LF UP | And 4 more authors.
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2013

The aim of our study was to establish a strategy of diagnosis, treatment and follow-up of patients after surgery for CNS haemangioblastoma (HB) and to evaluate its use in our group of patients. Primarily, it was necessary to distinguish between patients with sporadic HBs and those with von Hippel-Lindau disease (mVHL). Originally, the diagnosis of this genetically transmitted disease was made based on clinical findings only, including a combination of HB presence and mVHL-associated tumours and both familiar and multilocal or recurrent HBs. This diagnostic approach resulted in many false positive as well as false negative conclusions. The introduction of VHL gene DNA analysis into clinical practice facilitated unequivocal identification of patients with mVHL. We then focused on patient screening. If mVHL was not proved and postsurgical MRI was negative, no further follow-up was indicated. In the presence of positive germinal VHL gene mutation and absence of other CNS lesions, MRI was repeated every 12 months. In case of newly identified CNS HBs not indicated for surgery, MRI is performed and surgical treatment reconsidered every six months. It depends on the patient's clinical condition, cyst and solid tumour volume and, in particular, on tumour location. Clinical signs are also influenced by neoplasm growth rate and character. This strategy has been extrapolated to mVHL-associated extraneuronal tumours. CNS HB was the only manifestation in a substantial number of patients with confirmed VHL gene mutation. Surgical approach tumour location and characteristics are of major importance. A DNA analysis-based follow-up strategy was designed and applied to all patients with histologically verified HB. The goal is to detect other signs of mVHL before they are manifested clinically.


Melichar B.,Onkologicka klinika LF UP | Zezulova M.,Onkologicka klinika LF UP | Prochazkova-Studentova H.,Onkologicka klinika LF UP
Onkologie | Year: 2011

The therapy of gastrointestinal stromal tumors may serve as an example of success of multidisciplinary approach in the therapy of malignant disorders. A significant progress in the therapy of metastatic GIST was obtained with the use of molecular targeted therapy (imatinib). The advent of targeted therapy also resulted in improved possibilities of surgical intervention and imatinib is currently used in the adjuvant as well as neoadjuvant indication. Close collaboration between surgical and medical oncologist as well as the concentration of patients with this rare tumor to specialized centers are of fundamental importance for optimal therapy and outcome.


Zezulova M.,Onkologicka klinika LF UP | Melichar B.,Onkologicka klinika LF UP
Onkologie | Year: 2011

The article summarizes the use of cytokines in treating metastatic renal cell carcinoma from the time when, given the radioresistant and chemoresistant properties of renal cell carcinoma, they were virtually the only systemic therapy until present day when they give way and are being replaced with new biological agents, such as tyrosine kinase inhibitors or mTOR inhibitors. It is only interferon-á in combination with bevacizumab (a monoclonal antibody against VEGF) that has retained its position as one of the therapeutic options in the first-line treatment for mRCC. The article also deals with the mechanisms of effects of cytokines, including adverse effects that limit the use of this treatment.


Prochazkova-Studentova H.,Onkologicka klinika LF UP | Melichar B.,Onkologicka klinika LF UP
Onkologie | Year: 2011

Renal cancer differs from other tumours by its biological behaviour, having an impact on its therapeutic approach. Due to chemoresistance, targeted therapy plays a major role in the treatment of renal carcinoma, targeting mainly vascular endothelial growth factor, a keystone in renal carcinoma etiopathogenesis and progression.


Melichar B.,Onkologicka klinika LF UP | Prochazkova-Studentova H.,Onkologicka klinika LF UP | Zezulova M.,Onkologicka klinika LF UP
Onkologie | Year: 2011

The last 10 years have witnessed a fundamental progress in the therapy of metastatic renal cell carcinoma. The development of targeted therapy against vascular endotheial growth factor and mammalian target of rapamycin pathways has lead to the introduction of a number of new agents, including sunitinib, sorafenib, bevacizumab, temsirolimus and everolimus into the treatment of this tumor. Other drugs are in final phase of development and, currently, the research is focused on defining the optimal algorithm of targeted therapy in this tumor.

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