Adjuvant radiotherapy for breast cancer reduces the risk of locoregional recurrence, distant disease and improves the survival of breast cancer patients. The incidence of breast cancer in pregnancy is constantly increasing, and it is expected that an increasing number of pregnant breast cancer patients will require radiation. Ionizing radiation can have a harmful effect on the fetus, which depends on the radiation dose and the gestational age of the fetus at the time of exposure to ionizing radiation. Pregnancy is not an absolute contraindication to radiotherapy for breast cancer, provided that radiation is carefully planned and appropriate protection is used
Objectives: The purpose of the study was to investigate the safety of contrast agents in the field of medical radiology. Methods: We conducted a comprehensive literature review through databases such as PubMed, Google Scholar, Scopus, and ScienceDirect, with the selection of relevant articles based on keywords, publication in English, study design, and publication criteria from 2020 to 2024. Results: In the course of the study, we determined that iodine containing contrast agents are often used in medical imaging, but their safety is a concern, especially in patients with renal impairment and a tendency to allergic reactions. It is recommended to observe a 4-12 hours interval between procedures to minimise the risk of contrast-induced nephropathy. Iodised contrasts are more likely to cause adverse reactions compared to gadolinium-based contrasts, but serious cases such as anaphylaxis remain rare (0.06%). Low concentration iodine-containing contrasts for cerebral angiography have shown high safety, reducing toxic effects. Barium contrast agents have demonstrated a high level of safety when used in diagnostics, including procedures such as oral barium test. Special attention was paid to reducing radiation exposure and compliance with safety protocols during the COVID-19 pandemic, which prevented the spread of infections. Contrast agents based on linear gadolinium more often contribute to its deposition, which could be associated with potential long-term risks, although their clinical consequences have not been fully examined. In contrast, macrocyclic gadolinium chelates show better stability and less often cause such effects, which makes them preferable in clinical practice. Conclusions: The introduction of strict recommendations on the use of gadolinium-containing contrast agents has reduced the incidence of nephrogenic systemic fibrosis, but further studies on their accumulation in the body remain relevant.
Neuroendocrine tumors of the ileocecal valve are rare, frequently manifesting with nonspecific symptoms that complicate early diagnosis. This report examines a 66-year-old woman with significant comorbidities, including diabetes mellitus and chronic renal failure, who presented to the emergency department with severe cramping abdominal pain, vomiting, and a mild fever. Initial imaging and laboratory tests yielded inconclusive results. However, a CT scan of the abdomen and pelvis revealed a small bowel obstruction at the ileocecal valve, caused by a tumor mass. Given the acute nature of her symptoms, the patient underwent an emergency right hemicolectomy with ileocolostomy. Histopathological analysis confirmed a 4 cm, well-differentiated grade 2 neuroendocrine tumor with lymphovascular invasion, along with metastases in 4 out of 17 examined lymph nodes. The patient had an uncomplicated postoperative course and was discharged on the tenth day in stable condition. This case highlights the need to consider neuroendocrine tumors in the differential diagnosis of bowel obstruction when imaging reveals a mass near the ileocecal region. Early detection and prompt surgical intervention are essential for optimal outcomes. Due to the rarity of neuroendocrine tumors in this anatomical location, this case provides valuable insights into the diagnostic anmanagement complexities they pose. Continuous follow-up with a multidisciplinary team remains essential to monitor for potential recurrence or metastasis.
Indication for radiotherapy of regional lymph nodes in patients with breast cancer is based on the clinical stage of the disease, surgical procedure, intraoperative and pathohistological report. It is supported by a meta-analysis of randomized clinical trials with long follow-up. However, many of these trials were performed decades ago, and, in the meantime, tremendous progress has been made in diagnostics, understanding of tumor biology, tailoring and effectiveness of systemic treatment, and technical possibilities of radiotherapy. Based on these new data, the approach to the axillary radiotherapy should be tailored, and a subset of patients in which de-escalation of axillary treatment is feasible defined.
Malignant brain tumors represent a serious health issue concerning both children and adults, and are often difficult to manage. Tumor metabolism has recently emerged as a promising target for new cancer treatment. Malignant brain tumors strongly depend on glycolysis for energy, predominantly using glucose and glutamine, whereas healthy brain cells primarily utilize ketone bodies under reduced glucose supply. As a metabolic disorder involving the dysregulation of glycolysis and cellular respiration, there is hope that brain cancer could be at least partially managed through changes in the metabolic environment. The objective of this review is to examine the metabolic changes in brain tumors and to summarize the latest knowledge of certain metabolic processes in tumorigenesis, as well as the associated potential therapeutic approaches.
Cervical cancer is the fourth most common cancer in women worldwide, primarily caused by persistent HPV infection, particularly types 16 and 18. In Croatia, 268 new cases of cervical cancer were reported in 2021, along with 109 cervical cancer-related deaths reported in 2022. Accurate staging, utilizing the 2018 FIGO or TNM classifications, is essential for treatment planning and prognosis. In 2018, the FIGO system incorporated imaging and pathology findings, such as lymph node status, into the staging criteria, enhancing treatment precision. Magnetic Resonance Imaging (MRI) is the preferred imaging modality for local staging, assessing eligibility for fertilitysparing surgery, evaluating treatment response, and detecting recurrence of cervical cancer. This case study discusses a 61-year-old woman diagnosed with stage IIB/IIIC1 cervical cancer in January 2023. After completing chemotherapy, external beam radiation therapy, and brachytherapy, MRI confirmed tumor regression, achieving a complete response by October 2023. The case highlights the critical role of pelvic MRI in cervical cancer staging and its integration into the FIGO system. Ongoing advancements in imaging techniques, such as functional MRI, hybrid imaging, and radiomics, are promising to enhance the understanding of disease spread and support personalized clinical decision-making.
Breast cancer survivors face an increased incidence of cardiac toxicities, which heightens their risk for cardiovascular disease compared to individuals without cancer, leading to poorer overall survival rates. Although trastuzumab has notably improved patient outcomes, its potential to induce cardiotoxicity has become a significant clinical concern. HER2 signaling and neuregulins play critical roles in maintaining cardiac function. Although the exact mechanism behind trastuzumab-induced cardiotoxicity remains unclear, it differs from anthracycline-induced cardiomyopathy, as trastuzumab-induced cardiotoxicity (type II) is mostly reversible. This is because it stems from reduced myocyte contractility, rather than permanent damage to the myocytes. Single-nucleotide polymorphisms (SNPs) – the most common form of genetic variation – are associated with differences in both the effectiveness of systemic treatments and the occurrence of treatment-related toxicities. However, findings regarding the relationship between specific SNPs and cardiotoxicity remain inconclusive. Early detection of trastuzumab-induced cardiotoxicity is crucial for minimizing side effects and enabling the customization of therapeutic strategies for patients at high risk of developing cardiac complications.
The National Colorectal Cancer (CRC) screening program in Croatia recorded a low screening response rate. It was only in 2022 that the response to the fourth cycle invitation increased to 36%. The share of people who responded to the invitation is still no higher than 25%, which is still insufficient to start achieving the long-term goals of the tested National Program. The study Improvement of the National Program of Early Colon Cancer Detection in the Osijek Baranja County through Increased Integration of the Program in the Practice of Family Medicine included 104 non-responders to the CRC program. 25 persons (24%) immediately accepted the screening invitation. After a motivational interview with the family medicine doctor, 40 of them (56%) responded to the screening, while 33 of them (44%) did not respond to the invitation. The family medicine (FM) examinees who responded to the screening consider being invited to a screening by their team as a very acceptable way of being invited, and they give their consent to it in 100% of cases. Members of FM involved in the study suggest education of all FM teams and their active involvement in the program, as well as stimulation of involvement outside of diagnostic and therapeutic procedures (DTP). The importance of personal contact and the support of family medicine doctors is emphasized. They also propose an evaluation of the contributions of all involved in the CRC screening program.
Introduction: According to the World Health Organization, breast cancer remains a pervasive global health problem, affecting millions of women each year and posing significant challenges to health systems worldwide. Understanding epidemiology and therapeutic methods, especially in regional contexts such as Croatia, is key to optimizing patient care. The etiology of the disease is unknown, but there are risk factors such as family history, hormonal influence, lifestyle, and exposure to radiation and certain chemicals. Early diagnosis, through regular mammography examinations, is crucial in successful treatment and survival. Objective: To retrospectively analyze age and types of surgical treatment. Methods: The research was conducted at the Dubrava Clinical Hospital. Patients surgically treated at Dubrava Clinical Hospital with breast cancer in the period from January 1, 2004, to December 31, 2023, were analyzed. Results: 3710 patients were analyzed. The mean age is 57.41 ± 13.04 (95% CI 56.99 – 57.83). The median age is 57 years. There were 1728 breast-conserving surgeries, 1015 mastectomies without reconstruction, 363 mastectomies with body tissue breast reconstruction, and 604 mastectomies with direct-to-implant reconstruction. Conclusion: The hypothesis that the average age of patients operated on with a diagnosis of breast cancer is between 35 and 55 years was rejected, and the hypothesis that more breast-conserving than radical surgical procedures were performed was rejected. The hypothesis that the number of direct-to-implant reconstructions is greater than the number of reconstructions with autologous tissue has been accepted.
Neuropathic pain is relatively common, often poorly treated, and associated with impaired quality of life. Neuropathic pain therapy is carried out with a multidisciplinary approach, and rehabilitation as an integral part of therapy must be included early because it can significantly affect the patient’s functioning and improve the quality of life. In oncology patients, there is limited experience in the application of physical therapy methods for the treatment of neuropathic pain. The most significant evidence exists for kinesitherapy methods, and the evidence for the effectiveness of transcutaneous electrical nerve stimulation (TENS) is inconsistent due to the low quality of evidence from the included studies.
In the female population, breast cancer is the most common malignant disease. Breast cancers caused by mutations in the BRCA 1 and BRCA 2 genes are responsible for up to 10% of all cases. With advances in genetics, there is the possibility of identifying women at high risk of developing breast cancer. These women receive assistance in the form of genetic counseling, psychological support, and surgical treatments to reduce their risk of developing breast cancer. Prophylactic mastectomy can be performed as a skin-sparing mastectomy, a skin and nipples sparing mastectomy, and a simple mastectomy, which involves the complete removal of the parenchyma, skin, and nipples of both breasts. In the same act as the prophylactic mastectomy, breast reconstruction can be performed as either a primary reconstruction within the same surgical act or as a separate surgical procedure, in which case it is referred to as secondary reconstruction. Artificial material implants are predominantly used today due to their superior aesthetic results, faster healing, and smaller scars. Such surgeries can lead to various postoperative issues, including infection, hematoma, and seroma formation, while capsular contracture, implant rupture, and anaplastic large cell lymphoma have all been linked to the use of artificial implants.
This study aimed to better understand the current epidemiology, treatment patterns, and outcomes of biliary tract cancers (BTC), and identify potential improvements in all aspects. We analyzed data from patients diagnosed with BTC in our clinic over 4 years (2019-2022). Among the 85 identified patients, 47.1% (n=40) were initially metastatic (M1). 60% (n=51) of patients had surgery, with curative intent for 45.9% (n=39) of patients. Among them, 50% were treated with adjuvant chemotherapy, and the remaining patients were followed up. We evaluated the disease-free survival (DFS) of the entire subset of patients with the M0 stage, regardless of the adjuvant treatment, and found a median DFS of 34 months. Out of 58 patients with M1 stage (68.2% of the entire cohort included in the analysis), 74.1% (n=43) of the patients received first-line systemic therapy (LOT1), and 25.9% (n=19) received best supportive care (BSC). We noticed a decrease in the number of patients with each subsequent LOT due to disease progression and deterioration of performance status (PS). The median OS of the entire cohort was 26.4 months; 22 months for the M1 stage and 61.6 months for the M0 stage. We confirmed that BTC is mostly diagnosed at an older age (median of 70 years) and in the advanced stage of the disease. Almost one-third of M1- stage patients never received any systemic anticancer therapy, highlighting the enormous unmet need. The value of targeted therapy based on precision medicine should be further investigated and potentially available to all patients with actionable mutations.
Introduction: Cancer patients are at higher risk of developing second primary cancer compared to the general population. Primary hyperparathyroidism is associated with a higher incidence of malignant disease. This research aims to investigate the incidence of malignant diseases in patients treated for parathyroid adenoma and papillary thyroid carcinoma in the University Hospital for Tumors cohort. Patients and Methods: Data about malignant diseases in patients treated for parathyroid adenoma and papillary thyroid cancer were collected from the Head and Neck Surgery Department (University Hospital for Tumors) database. Differences were tested using c2-test and the Mann-Whitney test. Results: Among 75 patients surgically treated for parathyroid adenoma, fourteen (18.6%) had a malignant disease. Among 90 patients surgically treated for papillary thyroid cancer, thirteen (14.4%) were treated for another malignant disease. The difference between groups was not statistically significant (p=0.465). Breast cancer was the most common malignant disease in both groups. Conclusion: Awareness of increased risk for malignancy in patients treated for neck endocrine tumors could lead to earlier detection of malignant diseases.
Objective: The objective of this case report is to present a rare case of inflammatory undifferentiated pleomorphic sarcoma in a male breast. Case report: a 64-year-old man palpated a painless nodule on the left breast. Core needle biopsy did not reveal the final diagnosis as it was classified as B3 so an excisional biopsy of the tissue was performed, which revealed an undifferentiated pleomorphic sarcoma with a diameter of 4.5 cm, infiltrated with inflammatory cells. After we confirmed the sarcoma operation therapy was indicated. Stewart incision was performed and mastectomy was done. Pathohistological analysis confirmed negative surgical resection margins. After one month PET CT scan revealed lungs metastases and the patient underwent 6 chemotherapy cycles of doxorubicin with good response and contribution of lungs metastases remission. Three years later, the tumor recurred and infiltrated the thoracic wall. The patient underwent again to surgical procedure. We did the extirpation of tumor, resection of thoracic wall with large pectoral muscle and within fifth, sixth and seventh ribs resection and thoracoplasty with core matrix and bio-net was performed for reconstruction of the defect. On pathohistology findings distal resection margin was infiltrated by tumor cells so radiotherapy was performed. Larger thoracic resection was not possible as it would affect breathing mechanics. The postoperative course was normal, without paradoxical breathing. The patient has been in remission according to PET-CT examination for four years after them treatment. Conclusion: We have presented a rare case of undifferentiated pleomorphic sarcoma in the breast, its potential for recurrence and distant metastases, the possibilities of treatment, the importance and limitations of operative treatment as well as benefit of oncological procedures and unpredictable clinical course of disease.
Melanoma is the most aggressive type of skin cancer and is often associated with extensive disease and poor outcome. We present a case of a 63-year-old man with no prior health issues who presented with high fever and malaise. After clinical and histopathological examination, multiple sites of metastatic disease were diagnosed with no site of primary melanoma. The patient started treatment with palliative radiotherapy to relieve bone pain, and immunotherapy with pembrolizumab was initiated, resulting in a complete response after ten applications of therapy. Over the next two years, control scans revealed two new metastases in the adrenal gland and small intestine, which were subsequently surgically removed. After 4.5 years, the follow-up scan still shows complete response to therapy.
Organized screening programs for the detection of colorectal cancer (CRC) in the Republic of Croatia include testing for occult bleeding in the stool. Traditionally, the guaiac fecal occult blood test (gFOBT) has been used. Another well-established method is the fecal immunochemical test (FIT). In the Department of Medical Biochemistry in Oncology laboratory, at the University Hospital for Tumors, Sestre milosrdnice University Hospital Center, FIT verification was performed on the OC-SENSOR Ceres device according to CLSI guidelines. The parameters of precision, trueness, carryover, stability, and a comparison with gFOBT were assessed. Precision was demonstrated with the calculated expanded relative measurement uncertainty, which was 2,54%, 1,24%, and 5,38%. Accuracy was calculated and shown as bias (2,1%, 0,8%, and 1,3%). Hemoglobin stability in the sample was determined for up to 10 days at 2–8°C (4,95%) and even at room temperature (9,57%). The obtained result for analyte carryover was -0,43%. A comparison of gFOBT and FIT found that gFOBT shows a higher number of false-negative results (38%). Considering all the advantages of FIT compared to gFOBT and the successful verification of the method, it is justified to replace gFOBT with FIT.
In the last 30 years, the introduction of new targeted cancer drugs has changed the approach to cancer patients, as well as the prognosis and expected survival. Some clinical studies show improved survival when radical local radiotherapy is added to standard systemic therapy in oligometastatic disease. This work aimed to show the positive impact of neck dissection on survival in selected cases of patients with supraclavicular neck metastasis of remote (infraclavicular) primary sites. In a 10-year period, 15 patients treated with neck dissection (for supraclavicular metastasis from infraclavicular primary origin) in the Head and Neck Surgery Department database were found. There were 13 patients with breast cancer, one patient with lung cancer, and one patient with ovarian cancer. In 2/13 patients with breast cancer, a long follow-up period without signs of disease was achieved. The patient with lung cancer had uneventful long-term follow-up. The patient with ovarian cancer gained three years without signs of the disease before dissemination occurred. This case series suggests neck dissection as a reasonable treatment of choice in selected patients with neck metastasis from remote primary sites. Despite overall rare complete control of the disease, described in the literature and our study, long-term disease-free follow-up can be achieved in some patients.
Objective: The study aimed to apply morphometric grading to cytological samples of invasive breast cancer and assess the potential for routine application, to describe the biological variability of morphometric parameters within and between grades, to optimize and determine the minimal, currently undefined, sample size required for morphometric analysis. Subjects and methods: The study included 45 female patients diagnosed with breast cancer on cytological breast aspirates and confirmed on histological samples at the General Hospital Dr. Josip Benčević. Morphometric analysis was conducted using the SFORM software. Results: The analysis of differences in the distribution of morphometric parameters by grade shows a significant, gradual increase in measured features with increasing grade. Grade accounts for approximately 35% of the variability in cell and nucleus morphometric characteristics. The majority of the variability in characteristics results from interindividual differences or heterogeneity of grade among participants, with minimal intraindividual variations. The minimal, currently undefined, sample size required for morphometric analysis was standardized to 100 cells per sample, as this ensures a narrow margin of error. Conclusion: Grading by the morphometric method is statistically significant, but due to the low contribution of the grade to the variability of the morphometric characteristics, and the wide range of overlapping morphometric parameters among the grades, morphometry as a method does not have discriminatory but only indicative capability.
Radical radiotherapy is a novel non-surgical approach to the treatment of early breast cancer. In order to administer a sufficient dose of radiation to the tumor while minimizing the side effects, the exposure to the surrounding normal tissues must be minimized. A 46-year-old woman with early-stage triple-negative breast cancer was treated curatively with MRI-guided hypofractionated intensity-modulated radiation therapy after a whole-breast integrated boost radiation, because the patient refused surgery and chemotherapy. Six months after treatment, the tumor disappeared completely without adjuvant chemotherapy, and there were no recurrences or adverse events two years after treatment. In conclusion, MRI-guided hypofractionated intensity-modulated radiation therapy following simultaneous whole-breast integrated boost radiotherapy may be a feasible alternative treatment for early breast cancer.
