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CERVIX (Primarni tretman (RT (primarna (Moris (RT p vs RT p+PA, Moris, =OS…

- - - - studija GOG 92 (Rotman), kod LVI, 1/3 inavazija, bolja LC 25vs15%, trend OS
        
        https://www.google.ba/search?q=gog+92&source=lnms&tbm=isch&sa=X&ved=0ahUKEwio67z53sTZAhVP16QKHU4ZA_IQ_AUICigB&biw=1229&bih=607#imgrc=a4dc63z9KadjNM:
        
        nastavak
        
        GOG 263
        
        https://www.google.ba/search?q=gog+263&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiR3Me838TZAhWKsKQKHY0NAEQQ_AUICigB&biw=1229&bih=607#imgrc=ho2fpcPFeNqjNM:
        
        GOG 0724
        
        https://www.google.ba/search?biw=1229&bih=607&tbm=isch&sa=1&ei=MpqUWtnMKYP4kwWX0KeIAw&q=gog+0724+study&oq=gog+0724+study&gs_l=psy-ab.3...3545.6589.0.6937.7.7.0.0.0.0.108.662.4j3.7.0....0...1c.1.64.psy-ab..0.0.0....0.oqBfwM8Um5M#imgrc=I-XM2aXAzRiG5M:
    - - GOG 71 (Keys), adj hister, OS = ali trend LC 25vs15%
      - Moris
        
        RT p vs RT p+PA, Moris, =OS (trend 10y 50vs40%), više AE, LC jednaka
    - - BT
        
        Teshima, st I-III, = LC, manje AE 10 vs 4% za BT
        
        IA1-TD 75Gy LDR, LC 97%
        
        brzina
        
        LD 4-9 cGy/h
        
        HD 12Gy/h
        
        točke
        
        organi
        
        nuspojave
        
        prednost
        
        aplikacija
        
        doza
        
        izvori
        
        LD-Cz137
        
        HD
  - - - stadij IB2 do IV
      - 5 studija 1990
        
        Eifel
        
        RTOG 90-01, KRT (cis+5FU)vs RT (+PA LČ)IA2-IVA, 8y OS 67vs 43%, BT, 400 pts
        
        Rose
        
        GOG 120, IIb-IVA, KRT (cis+hid vs c+hy+5FU)vs RT (BT>>80 Gy), 4y OS 65 vs 50%, LR, 500 pts
        
        Peters
        
        GOG 109, nako OP; adj KRT (cis+5FU)vs RT, +RR, +LČ, +parametrija, IA2-IIA, 4yOS 80vs70, bez benefita 1+LČ, <2cm, bez BT, 270 pts
        
        Keys
        
        GOG 123, 370 pts, 3y OS 80vs70%, pCR 50vs 40%, 370 pts
        
        Whytney
        
        GOG 85, 370 pts, CRT (cis+5FU)+PA disekcija vs RT +hyd
        
        HR za rekurens bolesti 0.50 osim Whytni 0.79
        
        https://www.google.ba/search?q=5+study+cervical+cancer+chemoradiotherapy&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj48fv35N3aAhVjKpoKHSBRBsEQ_AUICigB&biw=1229&bih=548#imgrc=PC_SysIXiZWkZM:
      - 5y OS 65%
      - Splitska studija, 118 pts, IB2-IV, OS 8y 80%, LC 97%
      - studije KRTvs RT
        
        kanadska studija
        
        bolja KRT
        
        meta anaaliza OS 6% bolji
        
        dugi FU 3 studije
        
        redukacija smrti za 30-50%
    - - KRT vs KT
        
        EORTC 55941- u tijeku
      - +/-KT pa OP
        
        GOG 141, bolji OS i LC za KT
      - KT pa OP vs RT primarna
        
        Italijanska, bolji OS
    - - konsolidacijska kemoth
        
        splitska studija
        
        http://ar.iiarjournals.org/content/35/7/4161.long
        
        Duenos Gonzales
        
        https://www.google.ba/search?q=outback+study+cervical+cancer&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiRremN4MTZAhVG66QKHa00BXUQ_AUICigB&biw=1229&bih=607#imgrc=jYTPoAeGqxLvsM:
        
        u tijeku studije
        
        RTOG 724 (iGNoRe)
        
        https://www.google.com/search?q=rtog+0724&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjN7IucrtLgAhWwlosKHUG4C8EQ_AUIDigB&biw=1218&bih=582#imgrc=YhhBC08dWtc32M:
        
        OUTBACK
        
        https://www.google.com/search?q=outback+study+cervical&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjeut71rdLgAhWro4sKHc1bBxQQ_AUIDigB&biw=1218&bih=582#imgrc=0a6GvSLHmMfsEM:
  - - - VEGR
        
        GOG 240, 452 pts, Krišnansu Tewari, TC (50 mg) vs pak (3tj)lTopo (0.75 mh/3 dana)+/- bev, 17vs 13 mOS, HR 0.67, ,PFS 8 vs 6 mj; RR 50 vs 35%, AE (preforacija 2% (5pts, fistule 5%, HTA 25%, TE 8%)
        
        GOG 227, mono bev, poz impulsi (1-2L KT bez KRT), PFS 3 mj
      - IT
        
        PD1
        
        Pembro
        
        KN 028, 1b multikohortna, 24 pts, 40% 1 ili 3L kt, RR 17% (4PR), AE 20% gr3
        
        kod H&N-HPV poz 70% expresija PDL1
        
        Cemiplimab
        
        f1 prva kod ljudi, 60 pts, RR 18.6%,
        
        f3, u tijeku, EMPOVER-CERVICAL, prethodno 2 ili više linija, 350 mg/3 tj
        
        kuke
        
        https://www.youtube.com/watch?v=k1XFWNT7pAM
        
        https://www.youtube.com/watch?v=4Zb0ccmKnYQ
        
        https://www.youtube.com/watch?v=w7fuOkF74Zw
        
        NIvo
        
        NRG 002, meatastaski, 25 pts, prethodno 1L th, u tijeku
        
        TIL
        
        protiv HPV
        
        f1, 9 pts, 2CR i 1 PR, prethodn više L KT, biopsija metastaze, izolacija TIL-a, multiplikacija TIL-a
        
        f2, 47% pts, sigurnost, učinkovitost, barem 1 L th prethodno
        
        CTL4
        
        f1/2, 42 pts, prethodno th, 2PR a primarni cilj bio 4 PR, Ipi 10 mg/kg 3 tj x4
        
        atenuirane bakterije
        
        Lysteria monocitogenis
        
        NRG 0265, perzistentni ili rekuretni s PD, 50 pts, Advaxis do PD ili 3 doze, 12 mj OS 40% vs pretostavljenog 25%, studija
        
        https://www.youtube.com/watch?v=-3t8_OxerG0
        
        MOA, u serumu, luči T+AA (Tumor Asoc AntigeN - APC pretdočavaju T lim (CD) + LL (LysteroLizin-protektor mikrookolišne inhibije od TREG (imunosup)
        
        f3, u tijeku, visokorizični (III-IVA, I-I+LČ, ili+PA), Advax vs placebo
        
        u 2L, +/- Nivo vs 2L KT ICT
      - nove mete
        
        TF(tkivni faktor)
        
        Tisotumab Vedotin, ADC, MOA: veže se na TF (uloga u koagulaciji, angiogenezi), unutar stanice otpušta molekulu koja degradira mikrotubul (auristatin), smrt stanic a degraddirani dijelovi auristatina degradacijom stanice uzorkuju smrt okolni stanica
        
        kuka
        
        https://www.youtube.com/watch?v=p3GVk5Jk74g
        
        https://www.youtube.com/watch?v=PzosQb0B6Og
        
        studije
        
        GEN 701, prva u ljudi, multikoho, 34pts (s PD na dostpne th), RR 32% (8PR), AE g1 konjuktivitis i neurpath, G3 3%
  - - - mono, GOG 43 (1987, bolji RR
      - kombi
        
        ifo poboljšan RR
        
        pakl, GOG 179, poboljšan RR, PFS
        
        topotekan GOG 169, poboljšan RR, PFS, OS
        
        GOG 169, 179, večina prethndno KRT, RR 30%, PFS 5 mj, OS 10 mj-kombo, mono RR 20%, PFS 3mj, OS 6-8 mj
        
        https://www.google.ba/search?q=gog+169&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi7q-Ka38TZAhWDKewKHZv-DXcQ_AUICigB&biw=1229&bih=607#imgrc=ExJg8VkMiQKi7M:
  - - - 5 studija
  - - - PA disekcija
        
        do IMA
        
        https://www.google.com/search?q=inferior+mesenteric+artery+vertebral+level&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiPzcaZotLgAhVXAxAIHcK0BUQQ_AUIDigB&biw=1218&bih=582#imgrc=_ojCP4O1s6INoM:
      - dubina invazije
        
        https://www.google.com/search?q=stromal+invasion+cervical+cancer&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiM-dbeoNLgAhXClIsKHc7tAmQQ_AUIDigB&biw=1218&bih=582#imgrc=Rlo6dr3QhmZGmM:
      - vrste operacija
        
        pelvična egenteracija
        
        https://www.google.com/search?q=pelvic+exenteration&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjR0-_hotLgAhWnk4sKHSIRBacQ_AUIDigB&biw=1218&bih=582#imgrc=cYs-uXB7IcgfgM:
        
        histerektomija
        
        https://www.google.com/search?q=type+of+hysterectomy&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiDnsqgmtLgAhXFlYsKHcmTDdkQ_AUIDigB&biw=1218&bih=622#imgrc=9VtZifx_5zG2nM:
        
        trhlektomija
        
        https://www.google.com/search?q=trachelectomy&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiPw4jHmdLgAhVRp4sKHRMrBeIQ_AUIDigB&biw=1218&bih=622#imgrc=6kavJBa2eggo3M:
        
        cone biopsija
        
        https://www.google.com/search?q=cone+biopsy&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiG-Z-smdLgAhXP_CoKHZHiDJIQ_AUIDigB&biw=1218&bih=622#imgrc=o2EQ2cIY5mmWyM:
      - pelvična egenteracija
        
        prikaz
        
        https://www.google.ba/search?q=pelvic+exenteration&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjIrfW76ezaAhXrC5oKHfIzBqAQ_AUICigB&biw=1229&bih=587#imgrc=1VbRDmzrgLHpAM:
      - naziv op
      - st I
        
        vs RT
        
        Landoni, 4yOS 80vs 70 nSS trend za primRT, AE gr 2-3- 28vs12 manje za RT, 60% primilo RT kod OP
        
        http://sci-hub.tw/10.1016/S0140-6736(97)02250-2
        
        histerektomija IA2
      - HGSL, CIN3
        
        LEEP, konizacija (može kod IA1 (DOI<3mm)
        
        https://www.google.com/search?q=leep&source=lnms&tbm=isch&sa=X&ved=0ahUKEwim56LKodLgAhVwx4sKHXtUDYoQ_AUIDigB&biw=1218&bih=582#imgrc=D8bk8QSXAJ3uPM:
        
        https://www.youtube.com/watch?v=hjRb8u2v06k
- - - - http://sci-hub.tw/10.1038/nrdp.2016.87#
      - http://sci-hub.tw/10.1038/nrdp.2016.86
  - - - http://www.primeoncology.org/online-education/solid-tumor/gyn-conference-2018-slides/monk/?login
    - - https://www.youtube.com/watch?v=DD4eBUCeX1E
- - - - brojevi
      - dob
      - svijet, Hr
      - globocan
        
        https://www.google.com/search?q=cervical+cancer+incidence+in+world&rlz=1C1VASI_enBA525BA526&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiyusOU1-_fAhXJBSwKHVCcATMQ_AUIDigB&biw=1536&bih=702#imgrc=ok3FVW0TQidJLM:
    - - HPV, podtipovi
        
        molekularno ONKOPROTEINIE6, E7, visok VEGR
        
        E7
        
        2 načina
        
        TSS RB
        
        disregulacija p21 puta
        
        1 more item...
        
        histon deacetilaze
        
        porast HIF-a
        
        E6
        
        TSS-p53
        
        porast trombospondina
        
        porast VEGR
      - dob, spolne osobitosti
      - unapredovali
      - PAPA test
      - pušenje
      - prevencija
        
        4 tipa HPV (6, 11, ova dva (70%)16, 18)
        
        odobrena kvadrivalentna, za djevojčice i Ž od 9do 26 y
        
        NEJM, f3, 5000 Ž (15-26y), 3 doze vakcine SS manje C53 (bez značajnijh AE)
    - - in situ
      - lokalizirani
      - uznapredovali
    - - radiološka
        
        PET,
        
        sen i spe 90%
        
        GOG 183
        
        https://www.google.ba/search?q=gog+183+study&source=lnms&sa=X&ved=0ahUKEwiy29TO3sTZAhVJKewKHQ3nCpYQ_AUICSgA&biw=1229&bih=607&dpr=1.56
      - FIGO
        
        prognostička vrijednost
        
        slika
        
        https://www.google.com/search?q=cervical+cancer+staging&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi_3-O8m-bgAhVFl4sKHWY3DlIQ_AUIDigB&biw=1229&bih=603#imgrc=g2qEBWgRG0Z1OM:
      - predikcija LČ
        
        IB +LČ 15% pel, PA 5-8%
      - prognostički
        
        anemija
      - stadij
        
        https://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_11
    - - CERVIX/VAGINA
        
        https://www.google.com/search?q=vagina+on+ct&tbm=isch&ved=2ahUKEwjswvzSyNHqAhUGOuwKHbj_CKgQ2-cCegQIABAA&oq=vagina+on+ct&gs_lcp=CgNpbWcQA1DCe1jOiAFgu4oBaABwAHgAgAFtiAGbB5IBAzguMpgBAKABAaoBC2d3cy13aXotaW1n&sclient=img&ei=dSwQX6y0C4b0sAe4_6PACg&bih=937&biw=1920#imgrc=txJ2LeLtlGe2tM
  - - - https://www.google.com/search?biw=1218&bih=582&tbm=isch&sa=1&ei=zIJxXM_AEYusUpTBl9AE&q=cervix+cancer+incidence&oq=cervix+cancer+incidence&gs_l=img.3...1361.4994..5240...0.0..0.119.1996.17j4......1....1..gws-wiz-img.......35i39j0i8i30j0i8i10i30j0i19j0i8i30i19.3IrwRGbdk3Y#imgrc=ok3FVW0TQidJLM:
    - - https://www.google.com/search?biw=1218&bih=582&tbm=isch&sa=1&ei=zIJxXM_AEYusUpTBl9AE&q=cervix+cancer+risk+factor&oq=cervix+cancer+risk+factor&gs_l=img.3..0i19.2000.6523..6847...1.0..0.132.1196.10j2......1....1..gws-wiz-img.......0i8i30i19.6KDOtr_ZZd0#imgrc=SAXm8q9KYkJi_M:
    - - https://www.google.com/search?q=cervix+cancer&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjwyfejsNLgAhWhiIsKHWwwCQkQ_AUIDigB&biw=1218&bih=582#imgrc=DZfqZ9JDdkVC9M:
    - - 5 studija