Organizational aspects of breast cancer screening in Sarajevo region.

PURPOSE: To analyze basic parameters of success and organizational aspects of screening for breast cancer implemented in the Sarajevo Canton area during the period 2000- 2006 and, based on the acquired experience, to suggest the most adequate model of screening in order to create a continuing and efficient constituent part of the population healthcare system. PATIENTS AND METHODS: Out of 30,134 women of the target age group 45-55 years, an invitation was delivered to 27,473 of them. 16,085 (53.4%) women were screened. Out of this number 33.6% came after the invitation and the remaining 66.4% were informed of the screening project from other sources, most of them after their doctor's advice. RESULTS: In 355 (2.2%) examined women mammographic findings were suspicious for malignancy, and out of this number in 187 (1.16%) women cancer was histologically proven. All diagnosed cancers were potentially curable by surgery. Even though this screening project could be considered as successful after its termination, early detection of breast cancer is not carried out as regular activity due to non existing system to refer women for examination, insufficient technical equipment and shortage of qualified and trained medical personnel. CONCLUSION: Based on the experience acquired, we believe that breast cancer screening, as an overall and continuing process, should be part of the regular healthcare system rather than a project or campaign. Screening needs to be an integral part of the primary healthcare system with family medicine as a starting point. Sufficient number of qualified and trained medical personnel, mammographers, spare parts, maintenance and service of the equipment are necessary. Good cooperation and communication of institutions included in the screening and fl ow of relevant information are of basic importance.

Randomized phase II study of induction chemotherapy with gemcitabine plus cisplatin followed by sequential radiotherapy versus radiotherapy alone in patients with stage III non-small cell lung cancer.

PURPOSE: This randomized phase II trial was conducted to compare the overall response rate (ORR) of gemcitabine plus cisplatin combination followed by sequential radiotherapy (RT) (arm A) versus RT alone (arm B) in chemonaive patients with stage IIIA or IIIB non-small cell lung cancer (NSCLC). Secondary objectives were to evaluate time to progressive disease (TTPD), overall survival, and treatment tolerability in both arms. PATIENTS AND METHODS: Eligible patients were required to have stage IIIA or stage IIIB NSCLC, no previous chemotherapy, ECOG performance status of 0-2, bidimensionally measurable disease, and age 18 to 75 years. Patients randomized in arm A were given 3 cycles of induction chemotherapy with gemcitabine 1250 mg/m(2) on days 1 and 8, plus cisplatin 80 mg/m(2) on day 1, every 21 days, followed by RT. In both arms, total dosage of RT was 63 Gy given in 34 fractions. Treatment continued until disease progression or unacceptable toxicity. RESULTS: Enrolled patients in both arms (30 in each arm) were well balanced for demographics and disease characteristics. The ORR, median TTPD and overall survival duration were 46.6/26.6%, 9.9/7.1 months and 12.5/10.0 months for arm A and arm B, respectively. The chemoradiation arm (arm A) was associated with significantly higher hematologic toxicities (anemia, neutropenia and thrombocytopenia) and nonhematologic toxicities (nausea, vomiting, paresthesias and alopecia). CONCLUSION: Sequential chemoradiation seems to be more effective than radiation alone, with acceptable toxicity profile. Confirmation phase III studies are warranted.

[95 years' of radiology in Sarajevo]. / Devedesetpet godina radiologije u Sarajevu.

The development of the radiology in Sarajevo from its beginning in "Zemaljska bolnica", 3-4 years after Rontgen's epochal finding of X-rays, till now has been reviewed in this paper. Equal and parallel development of the diagnostic radiology, as well as radiotherapy is given chronologically, regarding the stuff, equipment and premises. This is referred to the period before and after The Second World War till 1973, when--after stagnation--radiology started developing relatively quickly. With the integration of the service within the Sarajevo Region, building the annex, modernizing the equipment, especially by providing digital radiological techniques, current organisation of the work and necessary, adequately educated medical stuff, the development of radiology in Sarajevo was on its way up, in professional, educational and scientific aspect. At the end, present condition and the needs of premise, equipment and stuff, as well as some points of the possible further development of the radiology in Sarajevo have been summarized in this paper.

[Combined modalities in the treatment of limited small cell lung cancer]. / Kombinirani modaliteti u lijecenju ogranicenog mikrocelularnog raka pluca.

A combined modalities approach--radiotherapy plus chemotherapy to the treatment of limited small cell lung cancer are presented. There are three strategies for the treatment: sequential, concurrent and alternative therapy. Concurrent and alternative appear to be preferred. Thoracic radiotherapy can be administered continuously or "split course". There is a trend favouring the combination of Cisplatin + Vepeside as the chemotherapy regimen of choice in combined modality therapy for limited small cell lung cancer.

[Post-radiation fibrosis of the lung]. / Postradijaciona fibroza pluca.

The lung fibrosis after irradiation of lung cancer is described in this paper, as well as pathologic physiology, clinical signs and symptoms, and radiographic changes. Carefully treatment planning using CT scans, simulator and computer planning system is the only way to prevent excessive irradiation of the lung and correspondent lung fibrosis.

[The most frequent side effects of adjuvant chemotherapy in patients with breast carcinoma]. / Najcesci nezeljeni effekti adjuvantne hemoterapije kod bolesnica sa karcinomom dojke.

Cytostatics, besides having a desired therapeutic effect on the tumor, also cause side effects which are sometimes a limiting factor in their application. We have observed the type and intensity of side effects of cytostatic therapy suffered by patients with breast cancer during postoperative period (after radical mastectomy) 28 patients have been treated by CMF protocol (cyclophosphamide, methotrexate, 5-fluorouracil) 29 patients by FAC protocol (5-fluorouracil, adriamycin cyclophosphamide) 31 patients by Cooper protocol (cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, prednizon). The patients have been under observation during a six-months period, while they have been submitted to the adjuvant chemotherapy. On the basis of the results obtained, it can be concluded that CMF protocol turned to be best tolerated. Protocol CMF was to a much lesser extent cause to alopecia, paresthesia, vomiting, urogenital disorders as componed to FAC and Cooper protocols. For that reason the adjuvant chemotherapy for patients with breast cancer should start with the CMF protocol, while FAC and Cooper protocols should be saved for the second line of treatment in case of unfavourable reaction to the CMF protocol.

[Gynecological dispensary and stationary services in the treatment of mammary disorders (author's transl)]. / Mjesto i mogucnosti ginekoloske dispanzerske i stacionarne sluzbe u sanaciji obolenja dojke.

The authors examined 29,230 women. In addition to clinical examination, they were also examined mammographically. The methods used were mass mammography, standard mammography, contact thermovision, xerography, pneumocystoraphy, galactography, exfoliative and aspiration cytology, and pathohistological diagnosis. The diagnosis revealed 964 (2.4%) solid or cystic tumours, 453 mastopathies, 216 secreting mammae, and 215 malignomas. By the use of a large number of gynecological consulting units and dispensaries it is possible to select atypical and suspected changes in the breast, while in large stationary gynecological institutions, by an interdisciplinary collaboration of radiologists, surgeons, and cytologists, it is possible to make a definite diagnosis and provide treatment for patients with atypical changes. The ultimate goal is to refer to therapeutists latent and early forms of malignant mammary disorders.