Please enable JavaScript.
Coggle requires JavaScript to display documents.
UTERUS (UTERINI SARKOMI (Općenito (Dijagnostika (FIGO (LMS, ESS (I (uterus…
UTERUS
UTERINI SARKOMI
3 podtipa
LEJOMIOSARKOM
th
OP
metastatski
stanica
target
PDGFa
Doxo+/- ola, PFS 6vs 4nSS, OS 26 vs 14 SS, HR 0.50
kemoth
trabektidin
1L
1 more item...
2L
1 more item...
okoliš
adjuvatna
kemoth
5 studija, f2, od 25 do 160 pts, 3 studije st I-II, 2studije st I-IV, OS
jakna
2 triala henesi
2 more items...
POH
Harter
1 more item...
Omura
1 more item...
Potjera
1 more item...
općenito
prognoza
stadiji
I
5y 55%, >60 mj
II
30 mj
III
20 mj
IV
13 mj
hematogeno u pluća
MMMT
komponente
epitelna, kao high gr endometrij
ESS
gr
niski
obilježja tumora endometrija-poz horm, indolentan
visoki
obilježja LMS, MMT
GOG 150
https://www.google.ba/search?q=gog+150+study&tbm=isch&source=lnms&sa=X&ved=0ahUKEwjzs72S3sTZAhWKyKQKHSMZBz0Q_AUICigB&biw=1229&bih=607&dpr=1.56#imgrc=AEhovhmEmxPrYM
:
Općenito
4% svih tm endometrija
Dijagnostika
FIGO
MMT kao endometrij
LMS, ESS
I
uterus, <5 cm, >5 cm
II
pelvis
III
abdomen
IV
a, b
CT pluća
prognoza
ne pr faktori sarkom na uterin sarkom
PODTIPOVI
SARKOM
gradus
low
high
nediferencirani
terapija
OP
TAH, BSO
kod mladih mogu se poštedit ovariji
RT
adjuvatna
studije
1RCT
EORTC 55, LC na MMMT, LMM
2 retrospektivne
SEER
Mayo
WAI vs KT (CIMx3, =učinak
GOG 150
indkiacije
R1 ili R2 LMS
MMMT
R2
involment
cervix
50% stijenke
LČ
AE
:silhouette:
stadij IV
ZAJAM
DAJMOND
Općenito
interesi
metastaze
PLUĆA
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613792/figure/F5/
multiple
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613792/figure/F6/
JETRA
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613792/figure/F9/
RAD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613792/
RIZIČNE GRUPE
https://ascopubs.org/na101/home/literatum/publisher/asco/journals/content/jco/2019/jco.2019.37.issue-27/jco.19.00037/20190905/images/large/jco.19.00037t1.jpeg
terapija
modaliteti
OP
stadiji
vrste operacija
minimalno invazivne op
GOG-LAP 2
https://www.google.com/search?q=gog-+lap+2&rlz=1C1VASI_enBA525BA526&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi7sfmgiJPgAhXEDywKHUXFDREQ_AUIDigB&biw=1536&bih=755#imgrc=GsnERLhIIQJGxM
:
LACE =
laparatomija DA
stariji, velik uterus, metastatska prezentacija
robotska kirurgija
histerektomija
https://www.google.com/search?q=hysterectomy+type+of+surgery&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiF4aLLxdHqAhXptYsKHVHHCXUQ_AUoAXoECAwQAw&biw=1920&bih=937#imgrc=9VtZifx_5zG2nM
LČ
SLB
retro studije, meta analiza
detekcija LČ 80%
kontroverzno kod high grade
ultrastaging
https://www.google.com/search?q=sln+ultrastaging&rlz=1C1VASI_enBA525BA526&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjz3s3th5PgAhXFESwKHQk2ALIQ_AUIDigB&biw=1536&bih=755#imgrc=yU2xd4vU_0ENrM
:
NCCN nedovršeno
limfadenektomija
studije
2Europske
rez ishod=, potvrda LČ pozitiviteta
full Pelvis+PA, nešto retrotro bolji ishod
limitacija
selekcija paciejntata
ekxtenzivnost LČ
postop terapija
druge
bez centralne patologije
iskustvo kirurga
statistička snaga
kome i koliko
NE- miometrija (<50%) manje (<2cm) dobro ili srednje
PA
visoko rizične
iznad DMA
studija selkcija
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364412/
cilj indentifikacija pacijenta zaaadj th (RT/KT)
kontra kod uterine sarkoma
RT
vrste
BT
adjuvatno
st I
studije
meta analaiza, Konig,bez benefita u OS-u
impakt
ERT
mono
inop
meta analiza, 5y OS (50%), DSS (80%), LC 80%, ERT+BR vs BT AE-3%
mix
adjuuvatno
% LR (vaginalna zaraslica)
ERT vs KT
JGOG 99, 450 pts, intermediete, ERT (50Gy) vs CAP, OS krivulje jednake
Italijanska, 350 pts, G3 (I, II), III, ERT (45-0Gy) vs CAP, NSS OS i PFS
PORTEC 3, ,visokorizični, KRT (Cisx2+RT pa TCx4) vs ERT, NSS OS 5y 82%, 5yPFS 78%- ali postoji mala delta
4 studije
2 GOG, Finska, Skandinavska (+PFS)
1 more item...
pacijentiu 2<200, 2>500
zajedničko: neg OS i PFS za KRT, osim 1 studije (Skandinavks a+PFS)
stadij I-III, osim 1 GOG (III-IV)
udaljeni relaps =
ERT vs BT
studije
PORTEC 2, >400 pts, TAH+BSO, bez LND
4 more items...
ERTvs praćenje
4 studije uloga
svi staging
1 more item...
1 studija 50% staging
1 more item...
2 bez staginga
2 more items...
ERTvs BT+kemo
GOG 249
HIR
ERTvs ERT+BT
pooled Alders
IMRT
TIME-C
reducirana morbidnost
:fire:
RT vs KT// RTvsKRT//KTvsKRT
https://ascopubs.org/na101/home/literatum/publisher/asco/journals/content/jco/2019/jco.2019.37.issue-27/jco.19.00037/20190905/images/large/jco.19.00037t2.jpeg
kemoth
adj
4 studije (RT vs KT)
2 GOG
st
I-II
III-IV
+PFS i OS (AP)
GOG 122
1 more item...
GOG 184
1 more item...
Italija i Japan
st III-IV
zajedničko, neg PFS i OS osim 1 studije
u tijeku
KT vs obs
EN2, f2, st I-II (inter, high risk), KT (TCx6) vs obs
meta
kemoth
RR
single 30%
doble 70%
PFS
8 mj
OS 15 mj
2 L
RR 4-22%
Cis
kategorije
doble
doble
triple
1 more item...
RT
1 more item...
one
1 more item...
zajedničko
1 more item...
LAD, metastatski
stanični
VGFR
bev
END2, 100 pts, st III-IV, PFS 8.7 vs 13 mj, SS, HR0.60
EN2, f2, nintedanib, 1L +/-
HER amplifikacija 30%, RR0%
mTOR
metmorfin
prevencija EC (epidemiološka data) - inhibicija mTOR-a
GOG 286, u tijeku, TC +met pa met održavanje vs placebo
mTOR inhibitori, RR 5%
PIK/mtor
2 studije
Letr+Eve, RR32%
Eve+Bev, RR25%, toxičan
CDK 4/6
PALEO, u tijeku, Letro+Palbo vs Letro
SINE (selektivni ingibitori nuklernog exporta) inhibitori
SIENDO, PR na 1 ili 2 L KT, održavanje
Selinexor
PARP inhibitori, trebaju se napraviti studije
okoliš
CPI
PDL1
MANGO, TC+Atezo pa Atezo održavanje
POLE, visok broj mutacija
:fire:
JCO velika serija
https://ascopubs.org/na101/home/literatum/publisher/asco/journals/content/jco/2019/jco.2019.37.issue-27/jco.19.00037/20190905/images/large/jco.19.00037t3.jpeg
HT
adjuvatno
metastaski
th
AI
SERm
progestini
antiestrogeni
nema konsenzusa koji, doza
doza MPA 220 vs 1000, RR 25%, CR 11%, PFS 3 mj, OS 11
za indoletnu bolest
RR 30% (nema date za serozi/clear
3 kategorije
Review
radovi
Recent advances in endometrial cancer: a review of key clinical trials from 2015 to 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567288/
studije adj RT
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567288/table/T1/?report=objectonly
JCO specijalna serija
Uterine Cancer: Adjuvant Therapy and Management of Metastatic Disease
https://ascopubs.org/doi/full/10.1200/JCO.19.00037
Progress and Promise in Treating Gynecologic Cancers
https://ascopubs.org/doi/full/10.1200/JCO.19.01097
:silhouette:
stadij IV
stadij I
algoritmi
https://www.google.ba/search?q=endometrial+cancer+target+therapy&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjo9oO8lOraAhXCA5oKHSYkCQwQ_AUICigB&biw=1229&bih=548#imgrc=2I17_kvGF_v-TM
:
PACIJENTI
lako prepoznat
CREST
dehiscijencija
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797405/
Lancet
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00417-9/fulltext
caseovi
http://sci-hub.tw/10.1259/0007-1285-69-822-548
abstrat
https://acrabstracts.org/abstract/adverse-events-with-the-use-of-radiotherapy-in-patients-with-connective-tissue-diseases-and-cancer-a-systematic-review-and-meta-analysis/
recidiv
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434165/
