Biomedical subjects

Elona Juozaityte

Publications and source records attributed to Elona Juozaityte.

At least 19 recordsLinked to original sources

PubMed2006

Comparison of adjuvant and neoadjuvant chemotherapy in the management of advanced ovarian cancer: a retrospective study of 574 patients.

BACKGROUND: There is a lack of clinical data on the validity of neoadjuvant chemotherapy in the treatment of ovarian cancer. The aim of this study was to compare the impact of the adjuvant and neoadjuvant chemotherapy regimens on the clinical outcomes in patients with advanced ovarian cancer. METHODS: We performed a retrospective analysis of 574 patients with advanced ovarian cancer admitted to four Lithuanian oncogynaecology departments during 1993-2000. The conventional combined treatment of cytoreductive surgery and platinum-based chemotherapy was applied to both the group that underwent neoadjuvant chemotherapy (n = 213) and to the control group (n = 361). The selection criterion for neoadjuvant chemotherapy was large extent of the disease. Overall and progression-free survival rates and survival medians were calculated using life tables and the Kaplan-Meier method. RESULTS: There was no difference in median overall survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (25.9 months vs. 29.3 months, p = 0.2508) and stage IV patients (15.4 months vs. 14.9 months, p = 0.6108). Similarly, there was no difference in median progression-free survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (15.7 months vs. 17.5 months, p = 0.1299) and stage IV patients (8.7 months vs. 8.2 months, p = 0.1817). There was no difference in the rate of the optimal cytoreductive surgery between patients who underwent the neoadjuvant chemotherapy and patients primarily treated with surgery (n = 134, 63% vs. n = 242, 67%, respectively). CONCLUSION: There was no difference in progression-free or overall survival and in the rate of optimal cytoreductive surgery between the neoadjuvant and adjuvant chemotherapy groups despite the fact that patients receiving neoadjuvant chemotherapy had a more extensive disease. Multivariate analysis failed to prove that neoadjuvant chemotherapy could be considered as an independent prognostic factor for survival, and the findings need to be investigated in the future prospective randomised studies.

Aged↗

PubMed2006

[Multiple endocrine neoplasia type 2A].

Multiple endocrine neoplasia (MEN) type 2A, or Sipple syndrome, is a rare autosomal dominantly inherited syndrome, which is characterized as combination of medullary thyroid carcinoma, pheochromocytoma, primary hyperparathyroidism, sometimes with rarer inherited disorders like Hirschsprung disease and cutaneous lichen amyloidosis. Syndrome is caused by germinative mutations in c-ret protooncogene, which are typical for different MEN 2 syndromes. We report a clinical case of MEN 2A. A 43-year-old female patient was operated on for pheochromocytoma 7 years after diagnosis and treatment of spread medullary thyroid carcinoma. This is the most common combination of MEN 2A tumors. Diagnosis was based upon clinical data, tumors combinations and analysis of inherited endocrine pathology in first-line relatives. This syndrome has already been diagnosed in Lithuania, but in the last decade after determining the genetic basis of MEN 2 and applying modern genetic examinations in clinical praxis, the strategy of diagnostics and prophylaxis of this syndrome has changed and survival prognosis for patients with this syndrome has improved. Conception of pathogenesis and clinical features of MEN 2A syndrome, genetic selection of inheritors of this syndrome is one more step in early cancer diagnosis, which allows to use cancer prevention measures in time, to apply effective treatment and improve patients' prognosis. Reporting this clinical case of MEN 2A we aimed to pay attention of general practitioners to this rare, but in Lithuania diagnosed too, syndrome and its clinic, diagnostic, and treatment features.

Adrenal Gland Neoplasms↗

PubMed2006

[Angiosarcoma of the breast: a case report and literature review].

Sarcoma of the breast is a rare tumor (makes up 0.5 to 1% of all malignant breast tumors). In literature, only isolated cases of primary angiosarcoma of the breast were described. Secondary angiosarcomas are more frequently diagnosed in women and mostly in patients who underwent breast-conserving surgery and were treated by radiotherapy. In this article a very rare case of angiosarcoma of the breast is presented. The tumor in the breast was diagnosed after breast trauma. After surgery the diagnosis of hematoma was made. Nine months after surgery tumor spread was observed in subdermal layer, lymph nodes, and lungs. After review of histopathology slides the likely diagnosis of angiosarcoma of the breast was made. The effect of chemotherapy and radiotherapy was only partial and short. The tumor extended further to the lungs, pleura, and peritoneum. A patient from the time of diagnosis survived for 8 months. The mean survival of patients with angiosarcoma of the breast, described in literature, ranges from 13 to 22 months, and the treatment in this case most likely could not have an effect on survival of the patient.

Adult↗

PubMed2006

[Effect of combined treatment methods on quality of life in patients with pancreatic cancer].

In Lithuania, about 400 cases of pancreatic cancer are diagnosed each year, and more than 50% of patients are diagnosed with stage IV disease. Quality of life is an important issue in pancreatic cancer patients. A prospective randomized clinical study on the treatment of patients with resectable and unresectable pancreatic cancer was conducted at the Department of Oncology of Kaunas University of Medicine Hospital, and in this study, quality of life was analyzed. The aim of the study was to analyze the effect of combined treatment methods on quality of life in patients diagnosed with pancreatic cancer. MATERIAL AND METHODS. During 2000-2005, two concomitant chemoradiation treatment methods (radiotherapy with 5-fluorouracil and radiotherapy with gemcitabine) were analyzed in the study. A total of 60 patients were enrolled: 41 patients diagnosed with resectable and 19 patients diagnosed with unresectable pancreatic cancer. Quality of life was assessed using European Organization for Research and Treatment of Cancer Quality of Life Core 30 (EORTC QLQ-C30) questionnaire. Three main quality of life scales (general health status, functional, and symptom scales) were assessed and compared between two treatment groups. RESULTS. The analysis of quality of live assessment showed a statistically significant decrease in quality of life after treatment in patients with resectable pancreatic cancer and treated with radiotherapy and gemcitabine. Decreased quality of life later after treatment was also observed in patients diagnosed with unresectable pancreatic cancer and treated with the same regimen. Treatment with radiotherapy and 5-fluorouracil changed only some aspects of quality of life and did not have a significant impact on quality of life.

Adult↗

PubMed2005

[Multiple endocrine neoplasia syndromes. Type 2].

The second type of multiple endocrine neoplasia syndromes can be described as rare syndromes, heritable in autosomal dominant manner and linking medullary thyroid carcinoma to different tumors of endocrine organ system and endocrinopathies. This syndrome is divided into multiple endocrine neoplasia syndrome type 2A (MEN 2A), characterized with combination of medullary thyroid carcinoma, pheochromocytoma and primary hyperparathyroidism; type 2B (MEN 2B), characterized with combination of medullary thyroid carcinoma, pheochromocytoma, marfanoid habitus and ganglioneuromatosis, and familial medullary thyroid carcinoma syndrome, characterized with the only indication, which is hereditary medullary thyroid carcinoma. Though type 2 multiple endocrine neoplasia syndrome has been known since 1961, yet, the cause of the syndrome, which is germline mutations of c-ret protooncogene, was detected just a decade ago and syndrome pathogenesis with its characterized endocrine neoplasia carcinogenesis machinery were detected. Implementation of progressive genetic researches in clinical practice enabled precise diagnosis of multiple endocrine neoplasia syndrome and its subtypes not only for ill patients but also for healthy syndrome inheritors, e.g. relatives of the sick. Stated genotype link to phenotype helps to prognosticate possible combinations of endocrine neoplasia and endocrinopathies, and to choose purposeful patient observation. Genetic screening of the inheritors of multiple endocrine neoplasia type 2 syndrome enabled purposeful researches and observations of patients with a huge risk of uprising endocrine neoplasia, it also enabled application of effective prophylaxis methods, avoidance or early diagnostic of malignant tumors and life prognosis improvement for patients with malignant tumors while practicing well-timed treatment adaptation. This literature review contains the newest data on multiple endocrine neoplasia syndrome type 2 and its pathogenesis, diagnostics, patient observation, endocrine cancer prophylaxis and methods of treatment, which are characteristic for syndrome and which are being chosen according to biochemical endocrine neoplasia symptoms and genetic diagnosis.

Adolescent↗

PubMed2005

Impact of different treatment methods on survival in advanced pancreatic cancer.

UNLABELLED: The aim of the study was to evaluate the impact of different treatment methods on survival of patients treated for advanced pancreatic cancer at Kaunas University of Medicine Hospital from 1987 to 2003. MATERIALS AND METHODS: Data on 262 patients with advanced pancreatic cancer treated from 1987 to 2003 were analyzed retrospectively. Four groups of patients were analyzed. One hundred eighty patients underwent palliative bypass or endoscopic bile duct stenting or observation alone. Forty three patients in addition to surgery were treated by radiotherapy. Twenty five patients received gemcitabine in standard doses and schedules. Fourteen patients received concomitant chemoradiotherapy (with gemcitabine or 5-fluorouracil). All patients were grouped by treatment method and median survival was analyzed. RESULTS: Median survival of patients treated by palliative surgery only or observation alone was 1.9 month, and for patients treated by palliative surgery and radiotherapy was 6.1 months (p=0.00007). Median survival of patients treated with gemcitabine was 9.5 months (p<0.001), and median survival of patients treated with concomitant chemoradiotherapy was 8.5 months (p=0.00003). CONCLUSION: Patients diagnosed with advanced pancreatic cancer in addition to surgical treatment should be treated by chemotherapy, concomitant chemoradiotherapy or radiotherapy.

Antimetabolites, Antineoplastic↗

PubMed2004

Impact of morphology and biology on the prognosis of patients with gliomas.

Gliomas are the most common type of primary intracerebral neoplasm. They carry a dismal prognosis. The main prognostic factors are patient age, performance status and malignancy grade. Because patients with the same histologic diagnosis have variable outcomes, there is a need to develop better prognostic markers with the aim of predicting tumor behaviour and response to therapies. This paper reviews different morphological, genetic, molecular factors and their association with survival. Tumor associated morphological features such as predominant cell type, cellularity, cytological atypia, proliferation activity, microvascular proliferation, necrosis and apoptosis are discussed in some detail.

Adult↗

PubMed2004

[Surgical treatment of advanced epithelial ovarian cancer].

Primary cytoreductive surgery remains the standard care in advanced ovarian cancer. Optimal cytoreductive surgery is defined as a residual tumor load less than 1 cm. after operation. The randomized clinical trials showed that interval debulking surgery improved survival in patients who did not undergo optimal primary debulking surgery. The retrospective trials have suggested that the outcome for patients treated with neoadjuvant chemotherapy followed by interval debulking surgery is the same as for patients treated with primary debulking surgery followed by adjuvant chemotherapy. The neoadjuvant chemotherapy should not to be used for clinical practice until the randomized clinical trial carried out by Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer and National Cancer Institute of Canada answers this question. There are no data from randomized trials to show the survival advantage in patients who received second-look operation as compared to those who did not.

Algorithms↗

PubMed2004

[The guidelines for diagnostics and treatment of cervical cancer].

Cervical cancer is one of the most common cancers in women. The purpose of this article is to analyze the main diagnostic and treatment strategies for all stages and recurrences of cervical cancer. The article reviews the epidemiological situation, clinical features, diagnostic procedures for detection of this tumor and for evaluation of the dissemination of the disease, staging criteria, TNM (Tumor, Nodes, Metastases) and FIGO (Federation Internationale de Gynecologie et d'Obstetrique) classification, as well as treatment and prognosis. Surgical treatment (radical type II or III hysterectomy and lymphonodectomy) for early stage I and IIA cervical cancer is the main treatment method. Delivery of adjuvant postoperative radiation therapy or concomitant chemoradiation depends on the prognostic factors (tumor penetration to cervical tissues, lymphovascular invasion, tumor invasion to paracervical tissues, and surgical margins). For treatment of more advanced stages of cervical cancer (IIB, IIIA, IIIB, IVA) concomitant chemoradiation: external beam radiotherapy with chemotherapy and brachytherapy is used. Description of the treatment guidelines for each stage of cervical cancer is given in this article. These guidelines are useful for good treatment practice.

Adult↗

PubMed2004

[Multiple endocrine neoplasia syndroms. Type 1].

Multiple endocrine neoplasia (MEN) type 1 syndrome or Wermer syndrome is a classical malignant neoplasia syndrome, inherited in the autosomal dominant pattern, when hyperplastic and/or neoplastic injury develops synchronously or metachronously in the cells of the parathyroid gland, pancreas islets, hypophysis, and rarer in other neuroendocrine organs. The syndrome develops when germinative MEN 1--neoplasia suppression gene inactivation mutations occurs. More than 95 percent of patients have this MEN 1 gene mutation, when the penetration of mutation is almost 100 percent. An early stage of this syndrome is hyperfunction in organs, with the syndromes of hormone excess, later benign and/or malign neoplasia develops, this mostly determines the prognosis for the patient. The risk of this syndrome developing should be estimated for all the patients diagnosed with endocrine organ hyperplasia, which determines hyperfunction, or endocrine organs neoplasia. For patients with multiple endocrine neoplasia type 1 syndrome, endocrine neoplasia develops earlier than in sporadic cases; multifocality is typical for them. Multifocality of neoplasia, typical combinations of injuries and anamnesis of the family helps to diagnose the syndrome. Diagnosis is confirmed through genetical analysis, which is also important in determining the inheritors of mutations, potential patients. After genetically diagnosing multiple endocrine neoplasia type 1 syndrome, it is not enough to analyze and look after patients with malignant neoplasia, or to make early diagnosis on pre-neoplasic disease and neoplasia, or to apply means of prevention and start well-timed treatment, but also to diagnose this syndrome for the patient's relatives, and to determine their risk of getting cancer. This opens new possibilities in early diagnostics and prevention of malignant neoplasia. The main purpose of this literature review is to introduce medical-practitioners to the newest theories of type 1 multiple endocrine neoplasia syndrome pathogenesis, clinical peculiarities, methods of diagnostics and treatment.

Adult↗

PubMed2004

Evaluation of clinical factors and treatment results in patients with advanced pancreatic cancer.

OBJECTIVE: The aim of the study was to assess the benefit of treatment modalities on the survival in patients with advanced pancreatic cancer and clinical factors affecting treatment efficacy and survival. MATERIAL AND METHODS: One hundred eleven patients with advanced pancreatic cancer were analyzed retrospectively. Patients were grouped by treatment method, clinical stage, and Karnofsky Performance Index. Fifty-three patients were diagnosed with locally advanced disease and 58 with metastatic pancreatic cancer. Thirty-three patients at the time of diagnosis had Karnofsky Performance Index higher than 70, and in 78 patients it was 70 or lower. Fourteen patients were treated by concomitant chemoradiotherapy with gemcitabine or 5-fluorouracil, 25 - with gemcitabine only, and 72 patients underwent surgical palliation or observation alone. RESULTS: Patients treated with gemcitabine alone survived for 9.5 months, p<0.001. Overall median survival of patients treated with concomitant chemoradiation was 8.5 months. Comparison of survival results between groups of patients treated with gemcitabine alone and the patients who have received radiation therapy with 5-fluorouracil (median survival 6.4 months) or gemcitabine (median survival - 8.8 months) revealed no difference. Median survival after surgical palliation or observation was 1.9 months. Patients diagnosed with locally advanced pancreatic cancer and patients with Karnofsky Performance Index higher than 70 at diagnosis lived statistically longer than patients diagnosed with metastatic disease or Karnofsky Performance Index of 70 or lower. CONCLUSIONS: Patients diagnosed with locally advanced pancreatic cancer, better performance status at diagnosis and treated with monochemotherapy with gemcitabine or combination of gemcitabine or 5-fluorouracil with radiation survived longer, than patients diagnosed with metastatic disease, patients of worse functional status and treated by palliative methods only.

Adenocarcinoma↗

PubMed2004

[Update on treatment of bladder cancer].

The main objective of this review is to present various types of treatment which are available for patients with bladder cancer. Some treatments are standard and some are being tested in clinical trials. Nowadays we have a lot of new treatment approaches and can use them for bladder cancer treatment. For superficial bladder cancer the main treatment method is operation. Adjuvant chemotherapy is indicated only for high-risk patients and the tumor recurrence rate is decreased to about 20%. Surgery and radiotherapy is used for muscle-invasive bladder cancer. There are no clear indications for neoadjuvant treatment administration. Radiotherapy and chemotherapy are suitable after no radical operation. Administration of palliative chemotherapy for metastatic disease might improve survival. We have to use different methods of treatment (operation, chemotherapy, radiotherapy, biology therapy) as multimodality treatment option for bladder cancer.

Angiogenesis Inhibitors↗

PubMed2003

[The role of the regional (intra-arterial) chemotherapy in the treatment of hepatic metastases of colorectal cancer].

This focuses on review one of the methods of locoregional treatment - intraarterial hepatic infusion. Metastatic hepatic malignancies are the leading cause of cancer death. Surgical resection of metastatic hepatic malignancies has been the only established treatment modality offering potential for cure. Although surgical resection has significantly improved survival, only 5-20 percent of patients with colorectal carcinoma metastatic to the liver are surgical candidates. Conventional systemic (intravenous) chemotherapy with fluoropirimidines is effective only for 10-21 percent of patients with metastatic colorectal carcinoma. The limitations of surgical resection and the limited efficacy and generalized toxicity of systemic chemotherapy have sparked considerable interest in intraarterial hepatic infusion and especially in combination of systemic and intraarterial chemotherapy.

Antibiotics, Antineoplastic↗

PubMed2003

[Preclinical studies of concomitant chemoradiation].

Animal models are widely used in preclinical studies in order to explain the mechanisms of action of chemotherapy, radiotherapy and concomitant chemoradiation, to analyze pathophysiology of tumors and to evaluate the treatment of choice for malignant tumors. The choice of murine tumor or human tumor xenograft system is still debated. Xenografted human tumors have two main advantages: their human origin and wanted pathological type, which is necessary for future clinical studies. There are a lot of disadvantages of xenografted tumors: the stroma and vascular network of transplanted tumors have murine origin, the graft is mostly ectopic, the volume of transplanted tumors at the time of chemoradiotherapy is much smaller than that of the tumor in man; due to residual immunity it is difficult to determine response to cytotoxic treatment. It is still impossible to extrapolate the results obtained in a tumor model in animal to man. These investigations are usefull for interpretation of clinical results and for proposing the less empirical method of chemoradiation for phase II clinical trials.

Animals↗

PubMed2003

[The influence of conformal radiotherapy on survival of lung cancer patients].

The aim of this study was to analyze survival dependence on 3-D conformal radiotherapy dose applied to non-small cell lung cancer patients treated in Kaunas University of Medicine Hospital from year 1999 to 2001. One hundred fifteen patients with median age 67.3 years were analyzed. There were 101 men and 14 women. Squamous cell carcinoma was the most common type of histology (80.86% patients). Most patients (61.7%) had locally advanced lung cancer (stage III). Radiotherapy doses applied ranged from 30 Gy (3.0 Gy/10 fractions) to 70 Gy (2.0 Gy/35 fractions). After analysis of radiotherapy dose influence on survival statistically significant improvement in median survival with higher doses was found (p=0.0001 Breslow). The group of patients irradiated with higher than 50 Gy dose demonstrated better survival than patients treated with smaller doses. (Log rank p=0.0061, Breslow p=0.0013). There was a correlation between dose and conformity of dose distribution.

Adult↗

PubMed2003

[Influence of prognostic factors on the survival of lung cancer patients].

This study presents the results of analysis of 134 lung cancer patients treated with radiotherapy in 1999-2002. The objective of the paper was to evaluate the importance of some prognostic factors on survival of lung cancer patients. We have analyzed influence of patient's age, stage of the disease, tumor size, lymphnodes status, histological type and radiotherapy dose to the survival of lung cancer patients. Among analyzed patients 87% were males and 73.9% were more than 60 years old. Locally advanced lung cancer was diagnosed in 65.6% of cases. The non-small cell lung cancer was diagnosed in 83.8% of cases. During the study period 58.2% of patients died. Statistically significant prognostic factors in our study were: stage, locally advanced lung cancer, involvement of the lymphnodes, III B and IV of the disease. The survival of the patients depends on the radiotherapy dose in our study. The better survival was associated with the bigger than 50 Gy dose (p<0.001).

Age Factors↗

PubMed2003

[Molecular factors of pancreatic cancer pathogenesis and prognosis].

There are more than 400 new pancreatic cancer cases in Lithuania each year. More than half of these cases are a stage four diseases. The survival of patients with pancreatic cancer is short (median survival of patients with metastatic disease is about 6 months) and the treatment is not very effective. Analysis of the etiopathogenesis of pancreatic cancer and search for the effective early diagnostic methods, which could predict the response to treatment and increase the survival of these patients, is important. This article is the review of literature about molecular pathogenetic and prognostic factors of pancreatic cancer. Most important of these factors to date are K-ras gene mutation and p53 abnormal protein detection. The detection of K-ras mutation has prognostic value. This mutation could be detected in different human tissues: in the tumor, in regional lymph nodes, plasma, pancreatic juice, stool and other body fluids. Analysis of factors of pancreatic cancer pathogenesis and prognosis will not only help in earlier diagnosis of this cancer, but also will help to apply the current treatment methods more effectively. Research on such factors will be the basis for creation of new treatment modalities like biological therapies.

Codon↗

PubMed2003

[Guidelines for the diagnosis and management of brain metastases].

Brain metastases are one of the most common palliative oncologic problems. Approximately 20% to 40% of all cancer patients eventually develop metastases to the brain. In this review, we discuss the clinical presentation, diagnostic work-up, prognostic factors and appropriate therapeutic choices for these patients. Radiotherapy is the treatment of choice for most patients with brain metastases. Surgery and whole brain radiotherapy for the treatment of single brain metastasis in patients with stable extracranial disease is at the present time the best treatment option for this particular group. Radiosurgery, treatment that is a possible replacement for surgery, is not yet established as an effective treatment. Chemotherapy is not the primary therapy for these patients. The overall prognosis for patients with brain metastases remains poor.

Adult↗