Rapid screening of depression and anxiety in cancer patients: Interview validation of emotion thermometers.

BACKGROUND AND OBJECTIVE: This study aimed to determine the degree of depression and anxiety in cancer patients using the Emotion Thermometers (ET) and confirming their clinical usefulness compared to the gold standard interview, as well as determining optimal cut-off values for the appropriate identification of cancer patients' distress. METHODS: We included 238 cancer patients and we used ET (Emotion Thermometers) to screen depression and anxiety and the Beck depression inventory for adults (BDI-II), the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Mini-International Neuropsychiatric Interview (M.I.N.I) was used as the criterial validity standard. RESULTS: The prevalence of anxiety on the M.I.N.I. was 24% and depression was 11%. The optimal value for diagnosis of depression from ET (Dep ET) appears to be > 4.5 (AUC 0.928) against M.I.N.I. Optimal score for anxiety from ET (AnxT ET) compared to GAD according to M.I.N.I. we determined the value of 3.5 (AUC 0.899). To determine the cut off score for distress using from ET (DT), we compared against GAD-7 and BDI-II RS (raw total score) and the most optimal was 4.5 (AUC 0.953). For analysis of the cut off score for quality of life (QoL) against the total sums of all parts of the ET, the value of 14.5 (AUC 0.892) forms the cut off between the negative and the positive clinical finding. CONCLUSIONS: The results of the study support the use of ET as a rapid screening tool for the detection of depression, anxiety and distress in cancer patients.

Expression of selected microRNAs in pancreatic ductal adenocarcinoma: is there a relation to tumor morphology, progression and patient's outcome?

Pancreatic ductal adenocarcinoma (PDAC) remains a disease with extremely poor prognosis and limited effective available treatment. Differential expression of miRNAs isolated from tumor tissue has been proposed as a marker for tumor diagnosis, progression, and prognosis. Nevertheless, the prognostic value of miRNAs expression in PDACs for patient outcome still remains unclear. Expression of 7 selected miRNAs, isolated from FFPE samples of 54 PDAC patients, was quantified using RT-qPCR. The relationship of miRNA expression levels with tumor histology, clinicopathological characteristics, patient overall survival (OS), and progress-free survival (PFS), was subsequently evaluated. Overexpression of miR-21, miR-155, and miR-210 was observed in PDACs (up to 72.62, 232.36, and 181.38-fold, respectively), in comparison with non-neoplastic tissues. On the other hand, miR-96 and miR-217 were significantly downregulated in PDACs (up to one hundred times). No differences were, however, noticed between cancer and normal tissues for the expression levels of miR-148a and miR-196a. On the other hand, expression levels of all 7 miRNAs failed to demonstrate a significant correlation with parameters of tumor progression, such as tumor stage, grade, nodal involvement, perineural, and vascular invasion. The positive correlation of miR-210 levels was, however, observed with patient age (ρ=0.35). Additionally, miR-148a and miR-217 expressions have shown a positive association with tubular tumor growth pattern (ρ=0.39; ρ=0.28). The negative correlation of miR-148a values was also demonstrated with dissociative growth pattern and nuclear atypia (ρ=-0.30; ρ=-0.27). Finally, no statistically significant correlation could be demonstrated with the expression levels of all 7 tested miRNAs and PDAC patient survival; neither for OS nor for PFS (p>0.05). Our data have confirmed abnormal miRNAs expression in PDACs in comparison with adjacent non-neoplastic tissue. On the other hand, no correlation was discovered between miRNA expression and parameters of tumor progression. We have found a significant association between histologic tumor growth patterns and miRNA expression, making this work the first study, which analyses this aspect of PDAC. Finally, in our group of patients, no relationship of miRNA levels and patient prognosis could be demonstrated. Therefore, further investigation is required to evaluate the predictive and prognostic potential of miRNAs in a clinical setting.

Cardiotoxicity of breast cancer radiotherapy - overview of current results.

Adjuvant radiotherapy after breast cancer surgery is an important part of breast cancer treatment improving local control and overall survival. However, a higher risk of cardiac mortality was observed when conventional radiotherapy techniques were used. Cardiac morbidity and mortality after radiation therapy have been studied in many meta-analyses. In those focused on modern radiotherapy techniques, cardiac morbidity and mortality were no longer presented. However, an extremely long follow-up period is required. Importantly, the cardiac morbidity rates vary depending not only on the dose delivered to the heart, but also on the systemic therapies administrated and the pre-existing cardiac disease. Systematic heart dose monitoring is of great importance, as are efforts to constantly decrease doses, using advanced radiotherapy techniques. Nowadays, it is essential to individualize treatment according to tumor characteristics and anatomical predispositions, and to consider the cost and benefits.

HPV Status and Mutation Analysis Using Multiparallel Sequencing in Distal Oesophageal and Gastro-oesophageal Junction Adenocarcinomas.

The incidence of adenocarcinoma of oesophagus or gastro-oesophageal junction is increasing in Europe and other regions of the Western world. Research of possible causes has shifted to the molecular level. This study evaluated human papillomavirus (HPV) using real-time PCR and mutational status of selected genes using the multiparallel sequencing method (NGS) in DNA extracted from paraffin-embedded tumour tissue of 56 patients with oesophageal or gastro-oesophageal junction adenocarcinoma. The genetic material was in sufficient quality for the analysis in 37 cases (66 %). No HPV-positive sample was found. NGS revealed higher frequency of mutations in TP53, ARID1A, PIK3CA, SMAD4, ERBB2, MSH6, BRCA2, and RET genes. Association between gene mutations and histological grade, subtype according to Lauren, or primary tumour site was not statistically significant. In conclusion, the study did not confirm any HPV-positive sample of oesophageal and gastro-oesophageal junction adenocarcinoma. The study confirmed the usefulness of NGS analysis of paraffin-embedded tissue of these tumours, and it could be used in clinical studies to evaluate the prognostic and/or predictive value of the tested mutations. The association between gene mutations and histological features should be tested in larger patient cohorts.

[Sternal resection for metachronous metastasis from renal carcinoma]. / Resekce sterna pro metachronní metastázu karcinomu ledviny.

In this report, the authors describe a rare case of complete sternal resection for a metachronous metastasis from renal carcinoma in a 59-year-old female patient 12 years after primary left nephrectomy. Due to the large extent of resection, a polyester double layer mesh with bone cement was used for chest wall reconstruction. The postoperative course was uneventful without any indication for adjuvant treatment. The patient has been followed up for 20 months without any signs of complications and recurrence of her malignancy.Key words: sternum resection bone metastases renal carcinoma.

[Treatment of locally advanced rectal cancer - is it time for a change?] / Lécba lokoregionálne pokrocilého karcinomu rekta je cas na zmenu?

Treatment of locally advanced rectal cancer remains a very topical issue. The method of choice is surgery withpre- or postoperative chemoradiotherapy. Benefits of neoadjuvant chemoradiotherapy have been demonstrated in a number of randomized studies, including its advantages over postoperative treatment.Recently, however, there have been cases ofneoadjuvant chemoradiotherapy beingreplaced bychemotherapy alone. Although very controversial, another possible strategy for treating locally advanced rectal cancer is performing no operation in patients after neoadjuvant chemoradiotherapy who achieved complete remission. The necessity of using adjuvant chemotherapy after radical surgery and neoadjuvant chemoradiotherapy is also widely discussed. All these topicsareaddressed, albeit not exhaustively, in our paper. We are going to try to answer the question whether it is time for changes in the therapeutic strategy for advanced colorectal cancer.Key words: locally advanced rectal cancer neoadjuvant chemoradiotherapy induction chemotherapy.

[Reverse strategy for synchronous colorectal liver metastases Therapeutic protocol completion, 3-year survival and progression pattern in 32 patients]. / Reverzný prístup k synchrónnym pecenovým metastázam kolorektálneho karcinómuAbsolvovanie liecebného protokolu, strednodobé (trojrocné) prezívanie a vzorec progresie ochorenia u 32 pacientov.

INTRODUCTION: Reverse, liver-first strategy is an alternative for patients with complicated liver metastases where disease progression would prove inoperable, or for patients with locally advanced pelvic disease where postoperative complications after primary tumour resection may lead to delayed treatment of metastatic disease. METHODS: Retrospective unicenter analysis of 32 patients approached liver-first approach between 2011 and 2015. During this period reverse strategy was considered a preferred approach for all initially or potentially resectable synchronous colorectal liver metastases based on multidisciplinary team consensus. RESULTS: 26 patients (81.3%) completed their surgical plan (hepatectomy and primary tumour resection) but only 16 (50%) completed their oncosurgical plan (hepatectomy, primary tumour resection and full dose and length of perioperative or adjuvant systemic (bio)chemotherapy). Median overall survival was 50.5 months with the survival rate of 83.7% at 3 years. 20 patients (62.5%) progressed during the follow-up with median time to progression of 21.6 months. The liver was the most common site of recurrent disease followed by the lungs (65% and 20% of all recurrences, respectively). CONCLUSION: While reverse strategy may allow complete tumour removal in the majority of patients, only half of them complete their oncosurgical plan even with the liver-first approach. The most problematic aspect of the liver-first strategy is the timing and length of perioperative (bio)chemotherapy. When deciding on preoperative chemotherapy in up-front resectable lesions one should take into account the risk of disease progression while on chemotherapy as well as the risks of complete radiologic response. KEY WORDS: colorectal carcinoma reverse strategy liver-first approach liver metastases.

Cancer in the elderly in the Czech Republic.

Population ageing presents a challenge to oncological care due to the particularities of cancer treatment in this population. We evaluate cancer epidemiology, treatment and survival, in the Czech Republic by age groups. Data published by the Czech National Cancer Registry from the years 2006 to 2010 were used for this study. The following cancer types were evaluated: colorectal, pancreatic, head and neck, lung, skin melanoma, breast, gynaecological, prostate, kidney and stomach cancers. The following data were recorded and analysed: crude incidence by 5-year age group; dynamics of crude incidence rates in the age group ≥70 years; disease stage; percentage of patients treated by surgery, radiotherapy and chemotherapy; and age standardised 1-year mortality and 5-year relative survival according to age group. Patients over age 70 accounted for 41% and 46%, respectively, of the cancer incidence and mortality of the whole population. Anticancer therapies are significantly less common in patients over age 70 (P < 0.050), with the exception of skin melanoma. Survival was markedly worse in older patients (P < 0.050) when radical treatment modalities were significantly underused (P < 0.050). In the Czech Republic, the crude cancer incidence in seniors is increasing. In general, elderly patients are undertreated, with worse treatment results compared with younger patients.

Prognostic and predictive molecular biological markers in prostate cancer - significance of expression of genes PCA3 and TMPRSS2.

UNLABELLED: Prostate specific antigen and digital rectal examination have low specificity for detecting prostate cancer and they poorly predict the presence of aggressive disease. We present recent findings on PCA3 and TMPRSS:ERG fusion and assessed the relationship between PSA, urine PCA3 and TMPRSS2:ERG and corelation with pathological findings. We tested the PCA3 score in two groups. The first comprised 96 men treated in urology out-patient units with suspicion of prostate cancer, who had elevated PSA and/or positive DRE. The second group comprised 28 patients, who were treated by radiation for localised prostate cancer, and whose PCA3 was regularly monitored. A further cohort comprised patients with already-diagnosed tumors, who had undergone radical prostatectomy. With these, using histopathological samples, we examined samples of the TMPRSS2:ERG fusion gene and compared the results with Gleason score values and level of PSA. We also examined the TMPRSS2:ERG gene in patients who had positive biopsy. Part of the genetical analysis was also an examination of the MSMB gene.The sensitivity of PCA3 testing was 66.7% and the specificity 78.5%. TMPRSS2:ERG gene was correllated with the Gleason score. Neither the TMPRSS2:ERG (p=0.13) nor the MSMB (p=0.556) genotype had an influence on the value of the Gleason score. However a difference was found between the homozygote and wild type (WT) in the TMPRSS2 gene.FISH analysis of TMPRSS/ERG gene fusion was evaluated as positive in 8 (36.8%) of the biopsically verified tumors and in 20 (37.3%) of the evaluated patients after RAPE of parafin slicing.We did not confirm a corellation between fusion and Gleason score (p=0.29).PCA3, with its higher sensitivity in comparison with PSA, is more useful for eventual screening examination. Identification of further molecular markers such as TMPRSS2, may be very promising ways to determine further prognosis of patients with prostate cancer. KEYWORDS: prostate cancer, PSA, PCA3.

Up front hepatectomy for metastatic rectal carcinoma - reversed, liver first approach. Early experience with 15 patients.

Timing and sequence of therapeutic interventions in patients with colorectal cancer (CRC) and synchronous liver metastases is a matter of ongoing discussion. The aim of this report is to show the feasibility and safety of a reversed strategy in patients with up front resectable synchronous liver metastases. Consecutive series of 15 patients with locally advanced rectal carcinoma and liver synchronous metastases where up front liver resection was carried out as an initial intervention is presented. Local treatment of both, metastatic disease and primary tumor, was preferred. Liver resection was followed by neoadjuvant (preoperative) concomitant radiochemotherapy (RCT) for local pelvic disease control and subsequent resection of rectum. Systemic adjuvant chemotherapy was placed at the end of the entire treatment cycle. All 15 patients after up front hepatectomy were able to proceed with their treatment plan. 14 patients completed their RCT for primary tumor and subsequent rectal resection was successfully carried out. In 12 of them. 3 patients showed complete clinical response on cross sectional imaging and a careful "wait-and-see" policy was adopted for them. In two patients metastatic disease progression was noticed during the treatment cycle.Liver first approach in patients with up front resectable colorectal liver metastases (CRLM) is safe and feasible. Local neoadjuvant treatment after CRLM resection may result in preoperative downsizing or even complete clinical response of the primary tumor. Reversed strategy may to a degree eliminate negative oncologic impact of surgical complications after rectal surgery as CRLM has been already addressed.

[Colon cancer - evaluation of complications and risks of planned resections]. / Karcinom tlustého streva - zhodnocení komplikací a rizik plánovaných resekcních výkonu

INTRODUCTION: Resection procedures for colorectal cancer are burdened with a relatively high number of complications. The aim of this study is to define risk factors associated with the development of postoperative complications based on retrospective data analysis. MATERIAL AND METHODS: From January 1 st 2007 to December 31st 2012, 1093 patients underwent surgery for colorectal cancer. Retrospectively, we selected a group of 406 patients who underwent planned, elective colon resection for colon cancer. Open surgery was performed in 158 patients (38.9%), laparoscopic resection in 248 patients (61.1%). Based on initial staging of the disease, there were 85 patients (20.9%) in stage I, 137 patients (33.8%) in stage II, 110 patients (27.1%) in stage III and 74 patients (18.2%) in stage IV. Postoperative complications were evaluated according to Clavien - Dindo classification. RESULTS: Grade I complications were observed in 34 patients (8.4%), grade II in 25 patients (6.2%), grade III in 43 patients (10.6%), grade IV in 7 patients (1.7%) and grade V in 8 patients (2.0%). The highest incidence of complications was observed in left colon resection procedures (41.1%), open resections (39.8%), procedures lasting longer than 301 minutes (50%), patients older than 81 years (41.6%) and in procedures performed by the youngest, less experienced surgeon (40.6%). CONCLUSION: Our results confirmed that the type and approach of surgical procedure, patients age and surgeons experience are risk factors associated with a higher incidence of postoperative complications. High-risk surgical patients should be operated on by experienced surgeon who regularly performs a high number of resection procedures.

ATM and TGFB1 genes polymorphisms in prediction of late complications of chemoradiotherapy in patients with locally advanced cervical cancer.

The purpose of our study was to evaluate a possible correlation between genetic polymorphisms in ATM and TGFB1 genes and late toxicity of chemoradiotherapy for locally advanced cervical cancer. Fifty five patients with FIGO stage IIB and higher without a disease recurrence with a mean follow up of 6 years were included. Late toxicity was assessed by EORTC/RTOG late toxicity criteria. Univariate and multivariate logistic regression model was used for statistical analysis. Degree of association between polymorphisms and late toxicity of chemotherapy was assessed on the basis of phi-coefficient (φ) as well. We did not find any association between 5557G>A polymorphism in the ATM gene or single TGFB1 polymorphisms and late toxicity. TGFB1 compound homozygosity (-1552delAGG, -509C>T, L10P) was a significant predictive factor of grade III-IV and any grade of complications in both univariate and multivariate logistic regression analyses and statistical significance of association between polymorphisms and late toxicity of chemoradiotherapy was confirmed also by the evaluation of phi-coefficient (φ). We conclude that haplotypes instead of single nucleotide polymorphic sites in the genes may better characterize the individual radiosensitivity.

[Venous access devices in oncology]. / Zilní vstupy v onkologii.

Specific anti-cancer therapy is administered mainly via the parenteral route, Adequate venous access is, therefore, a topical issue in oncology In some patients on long-term therapy, the peripheral venous system is extensively burdened We present an overview of risk factors associated with parenteral application of medicins We provide a comparison of different types of venous access devices and discuss recommendations on general indications for permanent venous access devices We suggest an approach to the choice of the most appropriate venous access device for an oncology patient available to date We present our experience with PICC (peripherally implanted central catheters) implantations used in 30 oncology patients in our centre In addition to venous ports, PICCs represent another safe method of permanent venous access with low rate of complications Indications for the use of a specific permanent venous access device (PICC or port) partly overlap and evidenced-based recommendations are lacking However, we discuss the few suggestions that have been formulated on this issue.

Molecular predictive factors of outcome of radiotherapy in cervical cancer.

Radical radiotherapy with concurrent cisplatin-based chemotherapy is an established treatment for cervical cancer patients with stage FIGO IIB and higher. The tumor control can be achieved in 40-80% of patients, the treatment is associated with the risk of late postiradiation complications in 10 - 15% of cases. Detection of the factors predictive for tumor control and late morbidity is a possible direction how to individualize radiotherapy dose and technique. The aim of our review is to summarize results of studies inquiring various molecular markers predicting tumor response to radiotherapy and a risk of late complications. A lot of candidate molecules were evaluated in histochemical studies: membrane receptors (EGFR, HER-2), cell cycle regulators (p53, p21), proliferative markers (Ki-67), hypoxia and angiogenetic factors (HIF, VEGF), HPV status, and others (COX-2), with promising results in some of them (HPV, HIF-1α, Ku80, ATM polymorphism). Microarray studies identified decades of genes with different expression in radiosensitive/radioresistant cervical tumors and sets of genes are able to comletely separate responding and nonresponding tumors, but these sets differ across studies. Further well designed studies will be necessary to achieve results matured for use in clinical practice.

[Detection of minimal residual disease and its significance for establishing prognoses in patients with laparoscopic resections of colorectal carcinomas]. / Detekcia minimálnej reziduálnej choroby a jej význam pre prognózu pacientov s laparoskopickou resekciou kolorektálneho karcinómu.

AIM: The aim of the study was to detect minimal residual disease (MRD) in bone marrow samples, portal and peripheral blood samples collected from colorectal carcinoma (CRC) patients, and to assess the results in relation with clinical stages of the disorder and to evaluate potential correlation between the MRD presence and the disease relapse and overall patient survival rates. MATERIAL AND METHODS: The study included patients with primary CRCs indicated for laparoscopic resections. From September 21, 2006 to December 31, 2008, the authors selected 159 subjects with median age of 56. 126 patients (79.25%) were operated for CRC stage I-III, 33 patients (20.75%) had CRC stage IV. Six samples were collected in each subject to detect the MRD presence (systemic venous blood and bone marrow at the beginning of the procedure, venous blood from the mesenteric bed, systemic venous blood after the resection procedure, systemic venous blood and bone marrow one month after the procedure), as well as samples of the tumor tissue. Real-time RT-PCR method was use to detect the MRD. RESULTS: The study confirmed correlation between MRD positivity in preoperative bone marrow samples and the disease stage (p < 0.035). It showed correlation between findings in preoperatively collected systemic venous blood samples and in mesenteric venous blood samples (p < 0.003), correlation between findings in systemic venous blood samples collected after the resections procedures and in systemic venous blood samples one month after the procedure (p < 0.015), as well as correlation between findings in preoperative systemic venous blood samples and findings in systemic venous blood samples collected after the procedures (p < 10(-5)). The authors found out that the surgical procedure affected the MRD presence in systemic venous blood samples in primary negative patients (p < 0.025). During the study period, the authors revealed no statistically significant correlation between the MRD findings in stage I-III patients and their disease-free survival (p < 0.59). Considering the above results, possible direct correlation between positive MRD findings in systemic venous blood samples, which were collected preoperatively in CRC stage I-III patients, and reduced survival time is expected (p < 0.075). During the study period, the overall survival time was significantly reduced in stage I-III patients with positive findings in postoperative systemic venous blood samples, compared to that in negative patients (p < 0.004). CONCLUSION: The data suggest certain correlations between the MRD findings and the disease prognosis. The authors continue to collect further samples and assess the outcomes in order to enlarge the patient study group and the data, and plan to evaluate the outcomes in a 5-year to 10- year follow up period.

[The role of permanent brachytherapy in the treatment of localized prostate carcinoma]. / Místo permanentní brachyterapie v lécbe lokalizovaného karcinomu prostaty.

The popularity of permanent brachytherapy is now growing dramatically. The development of several new technologies has led to an improvement in dose distribution and results and can also return the patients to normal daily activities. The role of permanent brachytherapy in the treatment of localized prostate carcinoma is described in the present article. Indications and contraindications and a comparison of the results with other modalities of treatment are discussed. Emphasis is also placed on the morbidity of the treatment and the quality of life, which plays a very important role in the process of making a decision as to which therapy should be applied. Permanent brachytherapy is most often used separately, but in certain cases may be combined with external radiotherapy and hormonal treatment.

[Intraoperative radiotherapy in multimodality treatment of locally advanced rectal carcinoma]. / Intraoperacní radioterapie v multimodalitní lécbe lokálne pokrocilého karcinomu rekta.

Multimodality treatment of locally advanced rectal cancer combines radical surgery, radiotherapy and chemotherapy. This method leads to improvement of local control and overall survival. However, some of the patients incur local failure of disease, which are localized predominantly in presacral region. The integration of intraoperative radiotherapy as part of a multimodal treatment approach helps to a further dose escalation without increasing toxicity, and reduces the likelihood of otherwise difficult curable local failure.

Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum - toxicity and complications of the treatment.

AIMS: The aim of this prospective study is to elucidate feasibility of protocol of neoadjuvant concomitant radiochemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too. METHODS: We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12 cm from the anocutaneous verge. The average follow-up time was 23.9 months. RESULTS: All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4-8 weeks following the concomitant chemoradiotherapy - in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10%, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Re-operation was needed in 5% cases. CONCLUSIONS: We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine.

[Modern radiotherapy in the complex management of soft tissue and bone sarcomas in adults--current overview and the author's experience]. / Moderní radioterapie v komplexní lécbe sarkomu mekkých tkání a kostí u dospelých--aktuální prehled a vlastní zkusenosti.

Soft tissue sarcomas and primary bone tumours constitute very heterogenic group. Gold treatment standard is surgery in most of them. Nowadays the combination surgery with radiotherapy is preferred, because thanks new radiotherapeutic technology is possible to apply very high dose of radiation which necessary for local control of these tumours. The goal of our article is to describe new possibilities of radiotherapy, including neoadjuvant and adjuvant setting, intraoperative radiotherapy, interstitial brachytherapy and the combination with surgery. But very important is multidisciplinary cooperation to until recently in prognostic bad group of patients, concentration these patients to centers with modern technique and clinical experience with treatment of soft tissue sarcomas and bone tumours.

[IKARUS Project--incidence of bone events in breast cancer: retrospective analysis of patients in oncological centres in the Czech Republic and Slovakia]. / Projekt IKARUS--zjistení incidence kostních príhod u karcinomu prsu: retrospektivní analýza nemocných dispenzarizovaných v onkologických centrech Ceské a Slovenské republiky.

BACKGROUND: Bone incidents today represent, in terms of frequency and the overall effect on the quality of life of patients with breast cancer, a serious health problem. In a number of clinical studies bisphosphonates have been shown to have a positive impact on reducing the risk of bone events and therefore to be effective in the prevention of bone events. The primary objective of this project was to identify the incidence of bone events in patients with metastatic breast cancer treated in the Czech and Slovak Republics. SUBJECTS: Retrospective, multi-centre, non-interventional, epidemiological and explorative studies to identify the incidence of bone events in the defined group of patients and a description of the practice of prevention and treatment of skeletal events in the years 2000-2005. Enrolled were patients with advanced metastatic breast cancer diagnosed in 2000. METHODS AND RESULTS: Analysis of overall survival and survival to disease progression, analysis of patterns of treatment of bone events and the practice of the use of bisphosphonates in the prevention of bone events in metastatic skeleton affection in the normal conditions of clinical practice, analysis of patient compliance in the treatment with bisphosphonates, analysis of the time interval between the occurrence of bone metastases and the occurrence of bone events and, last but not least, survival analysis of patients in relation to bone events. CONCLUSION: This work has shown that the practice of treatment with bisphosphonates since 2000 and assessed the survival of patients with metastatic breast cancer.