[Treatment of colorectal liver metastases: a current view]. / Soudobý pohled na lécbu jaterních metastáz kolorektálního karcinomu.

BACKGROUNDS: The Czech Republic has the world's highest incidence of colorectal cancer, with over 4,500 people dying of this disease each year. It is a well-known fact that up to 50% of patients develop distant metastases. METHODS: While thanks to novel drugs and the emergence of biological therapy, chemotherapy has been most successful in prolonging patient survival, a complete cure is impossible. Consequently, surgical treatment continues to be the only option potentially capable of achieving complete cure. Advances in surgical management, primarily in reducing morbidity and mortality rates after liver resection, have made it possible to perform surgery on a higher number of patients. Despite this, a large proportion of patients remain in fact primarily inoperable because of the extent of their disease. A combination of individualized surgical and cancer therapy developed by a multidisciplinary team substantially increases the number of patients eligible for radical resection, thus not only improving overall five-year survival rates but, also, significantly extending the symptom-free period. AIM: The aim of the paper is to summarize a new perspective of the strategy for treating liver metastases of colorectal cancer and to develop guidelines for new appropriate algorithms.

[Pancreatic resection for metastatic renal cell carcinoma]. / Resekce pankreatu pro metastázy karcinomu ledviny.

BACKGROUNDS: Late metastases of renal cell carcinoma (RCC) are quite common. However, metastases in the pancreas are rare. Between 2004-2008 the Department of transplantation surgery of the institute of clinical and experimental medicine performed 87 pancreatic resections for tumour. From this, metastasis of RCC was histologically verified in four cases.The aim of this study was to summarize in the form of brief case reports our experience with the surgical treatment of pancreatic metastasis of RCC. OBSERVATION: The interval from nephrectomy to the occurrence of pancreatic metastasis was 10, 11, 15 and 16 years. All patients were examined to exclude metastatic generalization. Surgical treatment was: one total pancreatectomy, two subtotal pancreatectomies and one caudal resection. Two patients had solitary pancreatic metastasis, one had two metastases and one had multiple metastatic lesions. No complications were observed in the postoperative period. All patients are living with survival time of 7, 23, 26 and 52 months. None of them has signs of recurrence of the primary disease. CONCLUSION: The follow up in patients with a history of RCC should be lifelong. Considering the low response of RCC and its metastases to oncological treatment, pancreatic resection is a safe method with a low rate of complications in patients with RCC metastases limited only to the pancreas and detected in time.

[Transarterial chemoembolization in hepatocellular carcinoma]. / Transarteriální chemoembolizace u hepatocelulárního karcinomu jater.

INTRODUCTION: Hepatocelullar carcinoma (HCC) is the fifth most common cancer in the world. It mostly occurs in patients with cirrhosis. In the Czech Republic, about 250 new cases are reported per year. Surgery, i.e. liver resection or transplantation, as the only potentially curable method is possible in 15-20% of them. For the rest, palliative treatment is indicated. This includes ablative methods (radiofrequency ablation, alcoholization), transarterial chemoembolization (TACE), systemic chemotherapy or biological treatment by sorafenib. TACE is method of choice in patients unsuitable for surgery and ablative treatment. Another indication is embolization of HCC before liver transplantation to prevent tumour progression. In combination with other methods, down staging of the tumour and curable treatment afterward is possible. AIMS: To assess the outcome of transarterial chemoembolisation in patients with hepatocellular carcinoma. METHODS: Between 2004-2008 we performed 30 TACE. Of that number, 28 TACE were performed in 20 patients with HCC. We super selectively catheterized the tumour via arteria femoralis and used Doxorubicin with Lipiodol as embolic material. In follow up, we carried out laboratory studies and CT. RESULTS: We have not noticed any major complications. Post-embolization syndrome with fever, nausea and right upper quadrant pain occurred after 10 TACE (33%). One-, two- and three years survival of the patients was 53%, 40% a 20%. CONCLUSION: TACE is safe method prolonging patients' survival with unresectable HCC. For the correct treatment of HCC, its concentration to cancer centres and the cooperation between multiple specialists is necessary.

[Neutron capture therapy in the treatment of glioblastoma multiforme. Initial experience in the Czech Republic]. / Neutronová záchytová terapie v lécbe glioblastoma multiforme. První zkusenosti v Ceské republice.

BACKGROUND: Glioblastoma multiforme is the most frequent primary brain tumor in adults. Despite advances in surgery, radiotherapy and chemotherapy, its treatment remains unsatisfactory with very limited overall survival. In the year 2001, in cooperation with Department of Neurosurgery, Nemocnice Na Homolce and Nuclear Research Institute in Rez, we have started to treat glioblastoma patients with boron neutron capture therapy (BNCT). METHODS AND RESULTS: Cells of malignant brain tumors, especially that of glioblastomas, are able to accumulate boron compounds. If BNCT should be successful, it is necessary to reach selective accumulation of sufficient amount of 10B in the tumor and low accumulation in the normal brain tissue. After BSH administration, radiation with low energy thermal neutrons is delivered. It results in nuclear capture and fission reactions with subsequent selective damage of tumor cells. At the time of analysis 9 patients have been enrolled. Therapy was completed in 5 patients. Treatment has been very well tolerated. We observed minimal acute toxicity associated with radiation and no laboratory abnormalities after administrations of BSH. Unfortunately treatment results were quite unsatisfactory. The median time to progression and overall survival were shorter then expected with conventional treatment. CONCLUSIONS: BNCT is very well tolerated with only a modest toxicity. In contrast to standard radiation, BNCT patients receive only one dose of radiation. Nevertheless, in this small pilot study first results were inferior when compared either to outcomes of conventional therapy or to results reported from other BNCT groups. It might be explained that lower dose of radiation had been used. Further study will show whether the higher dose radiation can improve treatment results.