ABSTRACT
INTRODUCTION: Lung cancer represents the most frequent cause of cancer-related deaths in the industrialized countries. The aim of this study was to analyze the lung cancer incidence and mortality and the possible reasons for any differences discovered in two neighboring Central European countries-the Slovak Republic. METHODS: We used linear regression model when analyzing incidence and mortality; the trends are presented with corresponding 95% confidence intervals (CI) and p-value with null hypothesis being constant with time. RESULTS: Statistically significant increase of age-standardized incidence (0.707/100,000/year, 95% CI 0.107-1.307, p = 0,025) and mortality (1.339/100,000/year, 95% CI 1.050-1.629, p < 0.0001) of the lung cancer was revealed in males in the Slovak Republic (1980-1991). On the contrary, values of both indicators were stabilized in the Czech Republic. Since year 1991-2005 a statistically highly significant decrease of both incidence and mortality values was observed in males, which was greater in the Slovak Republic. Peak of the curve was not reached in women population, while incidence and mortality values have significantly continuous growth in both countries. CONCLUSIONS: According to the lung cancer incidence and mortality trends in both countries (in correlation with smoking prevalence) we consider the support of efforts to change the attitude towards smoking predominantly in women and younger generation to be the most accurate action to reduce these trends (AU)
Subject(s)
Humans , Male , Female , Lung Neoplasms/complications , Lung Neoplasms/metabolism , Lung Neoplasms/mortality , Lung Neoplasms/diagnosis , Lung Neoplasms/ethnologyABSTRACT
BACKGROUNDS: Treatment of recurrent ovarian cancer is not standardized. Pre-clinical tests have confirmed the synergistic effect of gemcitabine and platinum, which can break through drug resistance to platinum. Therefore, efficacy of a combined gemcitabine and platinum-based regimen can be expected not only in therapy platinum-sensitive but also in platinum-resistant disease. Surgery--so-called secondary (eventually tertiary) cytoreductive surgery, should be considered in recurrent disease before planning the chemotherapy. PATIENTS AND METHODS: This is a retrospective analysis of 58 patients with recurrent ovarian cancer treated with a gemcitabine and platinum-based regimen (GP) as the second or third-line chemotherapy. Some of the patients underwent secondary cytoreductive surgery before starting the systemic treatment. The aim of the study was to detect the response rate, progression-free survival and overall survival in the whole group of patients and in subgroups with platinum-sensitive and platinum-resistant disease. Another aim was to detect the correlation between secondary cytoreductive surgery and the efficacy of chemotherapy. RESULTS: Systemic treatment (GP) has helped to achieve a response rate of 53.5%, with time to progression 10 months and overall survival 23.5 months. A better response rate, progression free survival and overall survival were achieved in the group of patients with platinum-sensitive disease compared to patients with platinum-resistant disease, but this difference was not statistically significant. 20 patients underwent effective secondary cytoreductive surgery before the systemic treatment. Patients who underwent effective secondary cytoreductive surgery had a statistically better response rate (RR: 80% vs 39.5%), longer progression-free survival (PFS: 13.5 m vs 9 m, p = 0.006) and longer overall survival (OS: 40 m vs 16.9 m, p = 0.006) when compared to patients without secondary cytoreductive surgery. CONCLUSION: We have confirmed the efficacy of a gemcitabine and platinum-based regimen in the therapy of recurrent ovarian cancer, in both platinum-sensitive and platinum-resistant disease. An important prognostic factor in the whole group of patients was the realization of effective secondary cytoreductive surgery.
Subject(s)
Neoplasm Recurrence, Local/therapy , Ovarian Neoplasms/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Female , Humans , Middle Aged , Neoplasm Recurrence, Local/surgery , Ovarian Neoplasms/surgerySubject(s)
Antineoplastic Agents/therapeutic use , Breast Neoplasms/genetics , Breast Neoplasms/pathology , Central Nervous System Neoplasms/secondary , Genes, erbB-2 , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Breast Neoplasms/drug therapy , Female , Humans , TrastuzumabABSTRACT
BACKGROUNDS: Primary debulking surgery and chemotherapy (paclitaxel and carboplatin) remain the standard treatment for advanced ovarian cancer. The size of the residual tumour after primary debulking surgery has proved to be an important prognostic determinant. Complete tumour debulking without any macroscopic residual disease is considered the optimal primary debulking surgery. It is not possible to perform such an aggressive operation in patients with advanced ovarian cancer due to the bad performance status and extensive disease. Neo-adjuvant chemotherapy and interval debulking surgery seem to be an effective treatment strategy in this group of patients. MATERIAL AND METHODS: The retrospective analysis evaluated the efficiency of interval debulking surgery in correlation with progression-free and overall survival in patients with advanced ovarian cancer. 38 patients were treated with standard chemotherapy: paclitaxel 175 mg/m2 and carboplatin 5-6 AUC every three weeks. According to the clinical response, surgical debulking was considered, after which postoperative chemotherapy was given. Ineligible patients for interval debulking were treated with 2nd line chemotherapy. RESULTS: After neo-adjuvant chemotherapy, 24 patients of the group of 38 achieved partial remission and interval debulking surgery was indicated. Optimal interval debulking surgery was performed in 12 patients, suboptimal debulking surgery in 12 patients. Of the entire group, 14 patients did not show any adequate response to the primary treatment, they did not have interval debulking surgery indicated and they were treated with 2nd line chemotherapy. Progression-free survival in patients after optimal debulking was 11 months, median overall survival was not achieved (OS > 42.5 months). Progression-free survival in patients after suboptimal debulking was 6 months and median overall survival was 33 months. Median overall survival in patients without surgical treatment was 21.5 months. CONCLUSION: The results of the study confirm that neo-adjuvant chemotherapy with subsequent interval debulking surgery is a suitable therapeutic approach in primary inoperable patients with advanced ovarian cancer.
