Recommendations for the management and treatment of patients with soft tissue sarcoma emphasize the importance of individualized treatment in a referral center with a multidisciplinary sarcoma team. The only referral sarcoma center in Slovenia is the Institute of Oncology Ljubljana. Key components include imaging diagnostics using MRI and CT scans and a core needle biopsy. Surgical treatment remains the cornerstone of therapy, while radiotherapy reduces the risk of local recurrence. Systemic treatment with chemotherapy or targeted drugs is primarily considered for advanced, metastatic disease. The 2026 recommendations are available at the Institute of Oncology Ljubljana website.
Preživetje slovenskih bolnikov z rakom se v zadnjih desetletjih vztrajno izboljšuje, kar odraža napredek slovenske onkologije in nacionalnega zdravstvenega sistema. Državni program obvladovanja raka zagotavlja integriran okvir dejavnosti na področju preventive, diagnostike, zdravljenja, rehabilitacije in paliativne oskrbe. Z vidika zmanjševanja bremena raka, izboljšanja kakovosti življenja bolnikov in zagotavljanja ekonomske vzdržnosti sta ključna dosledno izvajanje na dokazih temelječih preventivnih programov ter pravočasno, strokovno utemeljeno zdravljenje. Razvoj medicinske znanosti je v zadnjih dveh desetletjih prinesel pomembna nova spoznanja, med katerimi ima vse vidnejšo vlogo integracija komplementarnih, na dokazih temelječih metod. Med njimi ima tradicionalna kitajska medicina (TKM), zlasti akupunktura, pomembno mesto kot podporna metoda v onkološki obravnavi. Na Onkološkem inštitutu Ljubljana (OIL) se akupunktura izvaja že 40 let, predvsem za lajšanje neželenih učinkov onkološkega zdravljenja in kot del multimodalnega obvladovanja bolečine. V zadnjih letih pridobiva pomen tudi v okviru strukturirane onkološke rehabilitacije (OREH).
Germline pathogenic variants in the TP53 gene are associated with an increased risk of developing cancer. The most penetrant of these variants are associated with Li-Fraumeni syndrome (LFS), a rare hereditary cancer predisposition syndrome. In this overview, we aim to present the genetic causes and clinical characteristics of the syndrome, as well as recommendations forgenetic testing and preventive surveillance in individuals with LFS. This predisposition has been linked to a wide variety of tumours, which occur in all age groups, the most common being adrenocortical carcinoma, breast cancer, central nervous system tumours, osteosarcoma, and soft tissue sarcoma. The protein product of the TP53 gene is involved in many cellular processes, including the repair of replication errors accumulated during cell division and programmed cell death. Our understanding of the syndrome and management of individuals with LFS has progressed greatly since it was first described. In parallel, indications and methods for performing genetic testing have also evolved over the years. Preventive surveillance after diagnosis ofLFSis very intensive and includes yearly whole-body magnetic resonance imaging. Its aim is to enable better treatment through early detection of malignant tumours, which leads to improved survival and quality of life for individuals with LFS. The majority of patients with LFS seen at the Institute of Oncology Ljubljana in the years 2015-2026 opted for surveillance in accordance with the guidelines and managed to adhere to their preventive programmes.
Introduction: Advances in oncology have raised questions about the appropriateness of treatment at the end of life. Palliative radiotherapy is not currently considered an indicator of aggressive end-of-life care. This study aimed to evaluate the use of specific oncological treatments in patients with advanced solid cancer at the end of life. Methods: We conducted a retrospective analysis of adult patients with advanced solid cancer treated exclusively at the Institute of Oncology Ljubljana who died between 2015 and 2019. We assessed the prevalence of aggressive oncological treatments in the last month and the last two weeks of life. Results: A total of1,736 patients were included. At least one form of aggressive treatment was administered to 538 patients (31%) in the last month of life and to 250 patients (14.4%) in the last two weeks. Systemic therapy was the most common modality (15.7% in the last month; 7.2% in the last two weeks), with chemotherapy administered to 10.5% of patients in the last month and 4.4% in the last two weeks. Radiotherapy was used in 15.6% of patients in the last month and 6.8% in the last two weeks. Its use in the last month declined (2015-16.7% and 2019-12.5%), while remaining stable in the last two weeks (2015-6.3 % and 2019-6.7 %). Conclusions: Radiotherapy use in the last month of life is declining, while remaining stable in the last two weeks; however, it is still frequently used. Given its comparable use to systemic therapy, radiotherapy should be considered an indicator of aggressive care at the end of life.
Predstavljamo uspešno genetsko analizo 59 let starega, arhivskega, v formalinu fiksiranega in v parafin vklopljenega (FFPE) vzorca tkiva z namenom opredelitve dedne predispozicije za razvoj raka. V družinah z obremenilno družinsko anamnezo raka, kjer ključni oboleli sorodniki niso več živi, je povednost standardnega genetskega testiranja živih družinskih članov pogosto omejena. V predstavljenem primeru je bila iz tumorskega vzorca, odvzetega leta 1960, izolirana DNA in izvedeno sekvenciranje naslednje generacije (NGS). Kljub starosti vzorca so bili doseženi vsi parametri kakovosti za zanesljivo molekularno-genetsko analizo. Ugotovljena je bila patogena različica CHEK2:c.1100del p.(Thr367Metfs*15), povezana s povečano ogroženostjo za razvoj raka dojk. Družinsko testiranje je omogočilo natančnejšo opredelitev ogroženosti pri živih sorodnikih in ustreznejše preventivne usmeritve. Opisani primer poudarja klinično vrednost analize arhivskih FFPE vzorcev pri genetski obravnavi družin s sumom na dedno nagnjenost k raku ter odpira vprašanje pomena dolgoročne hrambe reprezentativnega histološkega materiala za diagnostične, preventivne in raziskovalne namene.
