Breast cancer, along with lung cancer and melanoma, is one of the most common origins of central nervous system metastases. Due to improvement of systemic therapy options for primary disease and consequential prolonged survival, treatment of brain metastasis (BM) is presenting an evolving challenge. While new systemic therapy approaches for breast cancer brain metastasis are focusing on overcoming the blood brain and blood tumor barrier, as well as targeted therapies, local therapy remains the primary line of treatment. The decision of which local therapies to use, depends upon the number and volume of BM, their localization, patient’s clinical status, previously used treatments, status of extracranial disease and patient’s prognosis. In cases when an active approach, including surgery and/or radiotherapy, does not bring benefit to the patient’s quality of life or overall survival, best supportive care is recommended.

Prikazana je problematika lijecenja lokoregionalnog recidiva raka dojke nakon adjuvantnog lijecenja postedno operiranog raka dojke. Dan je prikaz ogranicenja ponavljanja kako sistemne terapije tako radioterapije.

e21126 Background: Cancer testis antigens (CTAs) are expressed in a variety of malignant tumors. In normal adult tissues CTA expression is restricted predominantly to germs cells of the adult testis and placenta. Based on their tumor-restricted expression pattern, CTAs are regarded as valuable targets for cancer immunotherapy. The prognostic significance of CTAs in breast cancer has not been analyzed previously. Methods: To evaluate the potential prognostic significance of two member of this family, MAGE-A10 and NY-ESO-1 antigens, we examined their expression in breast cancer patients who underwent curative surgery at our hospital between 2002 and 2003. Paraffin embedded tumor sections were collected retrospectively from 165 breast cancer patients and immunohistochemical staining for MAGE-A10 and NY-ESO-1 was performed. Impact of MAGE-A10 and NY-ESO-1 expression on disease free survival (DFS) and overall survival (OS) was analyzed by the Kaplan-Meier method using 8-year follow up data. Results: MAGE-A10 expression (score ≥2+) was detected in 105/164 (64%) and NY-ESO-1 expression (score ≥2+) was observed in 14/164 (8.5%) patients. 8-year DFS for MAGE-A10 positive patients was 69% and 73% for MAGE-A10 negative (p=0.452). 8-year OS for MAGE-A10 positive patients was 80% and 90% for MAGE-A10 negative (p=0.134). For NY-ESO-1 positive patients 8-year DFS was 67% and 70% for NY-ESO-1 negative patients (p=0.837). 8-year OS for NY-ESO-1 positive patients was 83% and 84% for NY-ESO-1 negative patients. (p=0.991) Conclusions: To our knowledge this is the first study analyzing prognostic significance CTAs in breast cancer. In this retrospective study we did not show statistically significant correlation between MAGE-A10 and NY-ESO-1 expression and clinical outcome. Additional studies are warranted to determine weather this antigens might have prognostic value in breast cancer patients.

Recent studies indicate that ER/PR/HER-2-negative (triple-negative, TN) breast cancers may be "CTA-rich" tumors, suggesting the possibility of CTA-based cancer vaccines as a treatment option for patients bearing these tumors. MAGE-A10 together with NY-ESO-1 is probably the most immunogenic CTA, representing a potentially highly attractive target of active specific immunotherapies. Paraffin-embedded tumor sections were collected retrospectively from 165 breast cancer patients diagnosed between 2002 and 2003. Immunohistochemical staining for MAGE-A10 and NY-ESO-1 was performed. The expression of MAGE-A10 and NY-ESO-1 was correlated with other clinicopathological variables. MAGE-A10 expression (score ≥ 2+) was detected in 105/164 (64%), and NY-ESO-1 expression (score ≥ 2+) was observed in 14/164 (8.5%) patients. No correlation between MAGE-A10 and NY-ESO-1 expression and tumor size, tumor grade, Ki-67 and lymph nodes status was detectable. MAGE-A10 expression was significantly associated with ER-negative (P = 0.002), PR-negative (P = 0.002) and HER-2-negative (P = 0.044) tumors. We clearly showed that MAGE-A10 is frequently expressed in the group of TN patients, where the majority (85.7%) of tumors express this CTA. Because of limited therapeutic options for the triple-negative breast cancer, the frequent expression of MAGE-A10 CTA in these cancers may offer the opportunity for a much needed additional treatment for this group of patients.

Neurobiologija boli, Farmakologija analgetika, Klasifikacija i epidemiologija boli, Lijecenje akutne poslijeoperacijske boli, Porođajna bol, Bol pri opeklinama, Križobolja i vratobolja, Bol u reumatoidnom artritisu i ostalim upalnim neinfektivnim artritisima, Osteoartritis, dijagnostika i lijecenje, Izvanzglobni reumatizam, Sindrom fibromijalgije, Visceralna bol u trbuhu, Bol u gastroenterologiji, Lijecenje boli u prsnome kosu, Kronicna bol u zdjelici, Bolne periferne neuropatije, Bolesti sredisnjeg živcanog sustava popracene simptomom boli, Kompleksni regionalni bolni sindromi, Postamputacijski sindromi, Glavobolja, Trigeminalna neuralgija i orofacijalna bol, Orofacijalna bol, Bol oka i orbite, Bolni sindromi pri zlocudnoj bolesti, Lijecenje boli pri zlocudnoj bolesti, lijecenje boli u djece pri zlocudnoj bolesti, Bol u terminalnoj fazi bolesti, Infekcija HIV-om i lijecenje boli, Akutni herpes zoster i postherpeticna neuralgija, Fizikalna terapija u lijecenju boli, komplementarne i alternativne metode lijecenja boli, Minimalno invazivni zahvati u lijecenju boli, Psihijatrijske intervencije u lijecenju boli, Placebo, Organizirani pristup lijecenju boli, Eticko-pravni aspekti lijecenja boli