Selected articles
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New treatment options of transitional cell carcinoma of the urinary bladder in the era of immunotherapy
05/2021 MUDr. Tomáš Blažek; doc. MUDr. Renata Soumarová, Ph.D., MBA
The treatment of transitional cell carcinoma of the urinary bladder has been changed and evolved over the last decade. New findings in the field of immuno-oncology research largely contribute to treatment improvements. Conventional treatment modalities, i.e. surgical treatment, radiotherapy and systemic chemotherapy are expanded in the light of emerging immunotherapy options. Historically, one of the first immunotherapeutic agents was the attenuated Bacillus Calmette-Guérin (BCG) vaccine. It was used for the treatment of superficial, non-invasive transitional cell carcinomas of the bladder. Since that, the study of immune mechanisms and interactions in the tumor microenvironment, supported with the efficacy of the BCG vaccine, contributed to the development of further improvements in immunotherapy. In the modern era of immunotherapy, new active molecules, i.e. checkpoint inhibitors, are used. The use of these active molecules, targeting surface receptors located on the tumor cells and immune system of the patient, offer new perspectives in the systemic treatment of metastatic or locally advanced transitional cell carcinoma of the urinary bladder. Specific aspects of immunotherapy, particularly the effectiveness, tolerance and toxicity profile, which have an important impact on the quality of life of patients, make immunotherapy a new, alternative modality in addition to conventional systemic chemotherapy. The purpose of this article is to provide an overview of the current possibilities of systemic therapy for bladder cancer using immunotherapy and checkpoint inhibitors.
ENTIRE ARTICLE
The treatment of transitional cell carcinoma of the urinary bladder has been changed and evolved over the last decade. New findings in the field of immuno-oncology research largely contribute to treatment improvements. Conventional treatment modalities, i.e. surgical treatment, radiotherapy and systemic chemotherapy are expanded in the light of emerging immunotherapy options. Historically, one of the first immunotherapeutic agents was the attenuated Bacillus Calmette-Guérin (BCG) vaccine. It was used for the treatment of superficial, non-invasive transitional cell carcinomas of the bladder. Since that, the study of immune mechanisms and interactions in the tumor microenvironment, supported with the efficacy of the BCG vaccine, contributed to the development of further improvements in immunotherapy. In the modern era of immunotherapy, new active molecules, i.e. checkpoint inhibitors, are used. The use of these active molecules, targeting surface receptors located on the tumor cells and immune system of the patient, offer new perspectives in the systemic treatment of metastatic or locally advanced transitional cell carcinoma of the urinary bladder. Specific aspects of immunotherapy, particularly the effectiveness, tolerance and toxicity profile, which have an important impact on the quality of life of patients, make immunotherapy a new, alternative modality in addition to conventional systemic chemotherapy. The purpose of this article is to provide an overview of the current possibilities of systemic therapy for bladder cancer using immunotherapy and checkpoint inhibitors.
Status of radiotherapy and concomitant chemoradiotherapy in locally advanced non‑small cell lung cancer and small cell lung cancer
05/2021 MUDr. Tereza Kohlová; doc. MUDr. Renata Soumarová, Ph.D.; Ing. Anna Negri; Ing. Šárka Šípová
Radiotherapy is the basic treatment modality in lung cancer across all its stages. There is a therapeutic benefit in settings up to 77 per cent, but the worldwide use is lower, in the Czech Republic about 25 percent. The advanced radiotherapeutic techniques, such as IMRT (intensity modulated radiotherapy) and IGRT with monitoring of respiratory motion (image guided radiotherapy), enable to reduce a dose to the organs at risk (heart, contralateral lung), the risk of pneumonitis and they prolong the survival.
ENTIRE ARTICLE
Radiotherapy is the basic treatment modality in lung cancer across all its stages. There is a therapeutic benefit in settings up to 77 per cent, but the worldwide use is lower, in the Czech Republic about 25 percent. The advanced radiotherapeutic techniques, such as IMRT (intensity modulated radiotherapy) and IGRT with monitoring of respiratory motion (image guided radiotherapy), enable to reduce a dose to the organs at risk (heart, contralateral lung), the risk of pneumonitis and they prolong the survival.
Pancreatic cancer – current treatment options
03/2021 MUDr. Marián Liberko; doc. MUDr. Renata Soumarová, Ph.D., MBA
Pancreatic cancer represents disease with the worst long-term survival across all malignancies. In clinical practice, due to asymptomatic or non-specific signs and symptoms we diagnose patients mainly with locally advanced and metastatic disease, where median survival is approximately one year. Nevertheless, even in early stages after curative surgery we observe early local recurrence, or distant metastases and long-term survival is an exception even in early stages of disease. Nevertheless, in the last few years there is an improvement in median overall survival also in patients with pancreatic cancer. It is due to advancements in diagnostics, surgery, but mainly due to improvements in cancer treatment (chemotherapy - adjuvant, neoadjuvant, perioperative, induction and palliative, and also radiotherapy). There were published results of many studies across all stages (resectable, borderline resectable, locally advanced, metastatic) which showed improved survival. The aim of this article is to provide overview of current treatment options for pancreatic ductal adenocarcinoma.
ENTIRE ARTICLE
Pancreatic cancer represents disease with the worst long-term survival across all malignancies. In clinical practice, due to asymptomatic or non-specific signs and symptoms we diagnose patients mainly with locally advanced and metastatic disease, where median survival is approximately one year. Nevertheless, even in early stages after curative surgery we observe early local recurrence, or distant metastases and long-term survival is an exception even in early stages of disease. Nevertheless, in the last few years there is an improvement in median overall survival also in patients with pancreatic cancer. It is due to advancements in diagnostics, surgery, but mainly due to improvements in cancer treatment (chemotherapy - adjuvant, neoadjuvant, perioperative, induction and palliative, and also radiotherapy). There were published results of many studies across all stages (resectable, borderline resectable, locally advanced, metastatic) which showed improved survival. The aim of this article is to provide overview of current treatment options for pancreatic ductal adenocarcinoma.
Prostate cancer – treatment of oligometastatic disease – case reports
02/2021 Doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Tereza Kohlová
Oligometastatic disease is a separate category of metastatic prostate cancer. In recent years, more and more attention has been focused on its optimal definition and treatment. Central to the identification of oligometastatic prostate cancer is not only the number and location of metastases, but also the use of new imaging methods in their identification. Treatment of oligometastatic prostate cancer may have curative potential. It includes systemic and radical local treatment, which can be targeted at both primary tumors and metastases. Radiotherapy, especially the technique of stereotactic radiotherapy, is more widely used as a locally ablative treatment. In this case, topical treatment not only prevents local disease progression, but also improves overall survival. The boundaries between curative and palliative treatment are thus constantly shifting. Better identification of patients who will benefit from topical treatment and better classification of oligometastatic prostate cancer subgroups based on biomolecular markers is the task of further studies.
ENTIRE ARTICLE
Oligometastatic disease is a separate category of metastatic prostate cancer. In recent years, more and more attention has been focused on its optimal definition and treatment. Central to the identification of oligometastatic prostate cancer is not only the number and location of metastases, but also the use of new imaging methods in their identification. Treatment of oligometastatic prostate cancer may have curative potential. It includes systemic and radical local treatment, which can be targeted at both primary tumors and metastases. Radiotherapy, especially the technique of stereotactic radiotherapy, is more widely used as a locally ablative treatment. In this case, topical treatment not only prevents local disease progression, but also improves overall survival. The boundaries between curative and palliative treatment are thus constantly shifting. Better identification of patients who will benefit from topical treatment and better classification of oligometastatic prostate cancer subgroups based on biomolecular markers is the task of further studies.
News in radiotherapy in 2020
01/2021 Doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Tereza Kohlová
The aim of the article is to provide an overview of studies published in 2020 that change and have changed clinical practice in radiation oncology. The list of studies does not have the ambition to be complete, it will certainly not include all the interesting, but most of the most important randomized phase III studies. Radiotherapy, like other fields in 2020, was affected by the Covid-19 pandemic, and therefore shorter hypofractionation regimens were introduced more quickly into practice. On the other hand, it is important to realize how important the time factor is for the results of our patienťs treatment. In the first place in every situation are mainly oncological results and procedures based mainly on the data of large randomized studies.
ENTIRE ARTICLE
The aim of the article is to provide an overview of studies published in 2020 that change and have changed clinical practice in radiation oncology. The list of studies does not have the ambition to be complete, it will certainly not include all the interesting, but most of the most important randomized phase III studies. Radiotherapy, like other fields in 2020, was affected by the Covid-19 pandemic, and therefore shorter hypofractionation regimens were introduced more quickly into practice. On the other hand, it is important to realize how important the time factor is for the results of our patienťs treatment. In the first place in every situation are mainly oncological results and procedures based mainly on the data of large randomized studies.
Significant response to neoadjuvant treatment in locally advanced pancreatic cancer – case report
05/2020 MUDr. Marián Liberko; doc. MUDr. Renata Soumarová, Ph.D., MBA
This case report describes a patient with locally advanced pancreatic cancer. By combination of chemotherapy and chemoradiotherapy, conversion of unresectable disease (locally advanced pancreatic cancer) in to resectable disease with significant pathological response was achieved.
ENTIRE ARTICLE
This case report describes a patient with locally advanced pancreatic cancer. By combination of chemotherapy and chemoradiotherapy, conversion of unresectable disease (locally advanced pancreatic cancer) in to resectable disease with significant pathological response was achieved.
Non‑small cell lung cancer radiotherapy and consolidation therapy with durvalumab
02/2020 Doc. MUDr. Renata Soumarová, Ph.D., MBA; MUDr. Tomáš Blažek; MUDr. PharmDr. Jan Dvořák
Treatment of inoperable non-small cell lung cancer stage III is based on concomitant chemoradiotherapy. However, most patients experience relapse. Efforts to improve the results have resulted in various combinations of cytostatics administered concurrently with or after radiotherapy, an improvement in the irradiation technique, or an increase in the radiation dose administered. However, only a combination of concomitant chemoradiotherapy with immunotherapy led to a significant improvement in progression-free survival and overall survival. In the PACIFIC study, durvalumab was given as consolidation therapy after chemoradiotherapy was completed. The results of the study are discussed in detail in the article and represent a change in current clinical practice and a new standard in the treatment of patients with non-small cell lung cancer III. stages.
ENTIRE ARTICLE
Treatment of inoperable non-small cell lung cancer stage III is based on concomitant chemoradiotherapy. However, most patients experience relapse. Efforts to improve the results have resulted in various combinations of cytostatics administered concurrently with or after radiotherapy, an improvement in the irradiation technique, or an increase in the radiation dose administered. However, only a combination of concomitant chemoradiotherapy with immunotherapy led to a significant improvement in progression-free survival and overall survival. In the PACIFIC study, durvalumab was given as consolidation therapy after chemoradiotherapy was completed. The results of the study are discussed in detail in the article and represent a change in current clinical practice and a new standard in the treatment of patients with non-small cell lung cancer III. stages.
Inclusion of chemoradiotherapy to primary tumor in patient with synchronous liver metastases – case report
01/2020 Special Edition - MUDr. Marián Liberko; doc. MUDr. Renata Soumarová, Ph.D.
Case report describes a case of patient with stenosing rectal cancer and multiple liver metastases. Systemic chemobiotherapy (mFOLFOX6 + Vectibix) led to significant response of liver metastases enabling curative surgical resection of liver metastases - liver first approach. Subsequent chemoradiotherapy of primary rectal cancer led to significant regression based on imaging methods and patient was indicated to curative surgery of rectal cancer. Combination of modalities of oncological treatment may represent in selected group of patients with metastatic colorectal cancer potentially curative approach with chance of long-term survival.
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Case report describes a case of patient with stenosing rectal cancer and multiple liver metastases. Systemic chemobiotherapy (mFOLFOX6 + Vectibix) led to significant response of liver metastases enabling curative surgical resection of liver metastases - liver first approach. Subsequent chemoradiotherapy of primary rectal cancer led to significant regression based on imaging methods and patient was indicated to curative surgery of rectal cancer. Combination of modalities of oncological treatment may represent in selected group of patients with metastatic colorectal cancer potentially curative approach with chance of long-term survival.
The importance of radiotherapy of primary tumor in synchronous metastatic disease
01/2020 Special Edition - Doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Tomáš Blažek; MUDr. Marián Liberko
Radiotherapy has an important role in treatment of malignant tumors. It is usually used in treatment of localized disease in combination with surgery or as a curative treatment with or without chemotherapy. In metastatic setting, radiotherapy has palliative intent with the aim to relief from suffering. Nevertheless, with improvements in radiotherapy techniques there are also new indications for radiotherapy. Curative radiotherapy doses and techniques are used in metastatic setting with the aim to improve not only local control but also overall survival. Preclinical and experimental studies prove systemic treatment effect of radiotherapy, which leads to immune reactions also outside of irradiated target volume. Combination of radiotherapy with immunotherapy represents new treatment option. The aim of this review is to provide summary of studies, which studies added effect of radiotherapy of primary tumor in synchronous metastatic disease.
ENTIRE ARTICLE
Radiotherapy has an important role in treatment of malignant tumors. It is usually used in treatment of localized disease in combination with surgery or as a curative treatment with or without chemotherapy. In metastatic setting, radiotherapy has palliative intent with the aim to relief from suffering. Nevertheless, with improvements in radiotherapy techniques there are also new indications for radiotherapy. Curative radiotherapy doses and techniques are used in metastatic setting with the aim to improve not only local control but also overall survival. Preclinical and experimental studies prove systemic treatment effect of radiotherapy, which leads to immune reactions also outside of irradiated target volume. Combination of radiotherapy with immunotherapy represents new treatment option. The aim of this review is to provide summary of studies, which studies added effect of radiotherapy of primary tumor in synchronous metastatic disease.
Complete and long‑term response of HER2 positive locally highly advanced metastatic breast cancer – case report
04/2019 MUDr. Lenka Rušinová; doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Marián Liberko
Unfortunately, we are currently encountering locally very advanced and generalized breast cancers. However, due to systemic therapy and especially targeted therapy, we can see excellent long-term responses in patients with HER2 positive tumors. The discovery of novel products targeting the extracellular domain of the human epidermal growth factor receptor 2 (HER2) and the combination of this monoclonal antibody with the microtubule inhibitor T-DM1 (trastuzumab emtansine) has resulted in a statistically significant increase in overall survival and has changed metastatic HER2 positive breast cancer to chronic disease.
ENTIRE ARTICLE
Unfortunately, we are currently encountering locally very advanced and generalized breast cancers. However, due to systemic therapy and especially targeted therapy, we can see excellent long-term responses in patients with HER2 positive tumors. The discovery of novel products targeting the extracellular domain of the human epidermal growth factor receptor 2 (HER2) and the combination of this monoclonal antibody with the microtubule inhibitor T-DM1 (trastuzumab emtansine) has resulted in a statistically significant increase in overall survival and has changed metastatic HER2 positive breast cancer to chronic disease.
When and why to indicate breast cancer radiotherapy after neoadjuvant systemic therapy
04/2019 Doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Lenka Rušínová
Adjuvant radiotherapy after both radical and partial mastectomy has an effect on local disease control as well as overall survival, as evidenced by large studies with long-term follow-up. However, postoperative radiotherapy indications for patients after neoadjuvant chemotherapy are controversial. This is due to a different tumor response to neoadjuvant treatment and a lack of prospective studies. Currently, when considering post-operative radiotherapy after neoadjuvant treatment, both the very accurate pre-treatment classification and the tumor characteristics including molecular subtypes and the definitive pathological classification must be taken into account. The most difficult decision is especially in the group of patients who have achieved a pathological complete response.
ENTIRE ARTICLE
Adjuvant radiotherapy after both radical and partial mastectomy has an effect on local disease control as well as overall survival, as evidenced by large studies with long-term follow-up. However, postoperative radiotherapy indications for patients after neoadjuvant chemotherapy are controversial. This is due to a different tumor response to neoadjuvant treatment and a lack of prospective studies. Currently, when considering post-operative radiotherapy after neoadjuvant treatment, both the very accurate pre-treatment classification and the tumor characteristics including molecular subtypes and the definitive pathological classification must be taken into account. The most difficult decision is especially in the group of patients who have achieved a pathological complete response.
Does proton radiation have a role in adjuvant breast cancer treatment?
04/2018 Doc. MUDr. Renata Soumarová, Ph.D.
Adjuvant radiotherapy in breast cancer using proton bundles is not yet part of any recommendations despite undisputable dosimetric benefits, including mainly lower doses for the heart, the lungs and the second-sided breast. The reason is the lack of clinical data on proton radiotherapy in breast cancer, which would confirm its theoretical advantage in practice. The results of studies evaluating cardiovascular morbidity after irradiation of the left side of the chest are not unambiguous; however, cardiac doses should be monitored and reduced even when performing photon radiotherapy. Modern techniques that allow this to happen include the technique of breath holding or irradiating only tumor beds in a certain group of patients, or by placing a patient on the abdomen using a so-called breast board. Questions about the clinical benefit of proton RT in breast cancer should be answered by ongoing clinical trials.
ENTIRE ARTICLE
Adjuvant radiotherapy in breast cancer using proton bundles is not yet part of any recommendations despite undisputable dosimetric benefits, including mainly lower doses for the heart, the lungs and the second-sided breast. The reason is the lack of clinical data on proton radiotherapy in breast cancer, which would confirm its theoretical advantage in practice. The results of studies evaluating cardiovascular morbidity after irradiation of the left side of the chest are not unambiguous; however, cardiac doses should be monitored and reduced even when performing photon radiotherapy. Modern techniques that allow this to happen include the technique of breath holding or irradiating only tumor beds in a certain group of patients, or by placing a patient on the abdomen using a so-called breast board. Questions about the clinical benefit of proton RT in breast cancer should be answered by ongoing clinical trials.
Tomotherapy – use in radiation treatment in oncological patients
03/2018 Doc. MUDr. Renata Soumarová, Ph.D.; Ing. Pavel Dvořák, Ph.D.; MUDr. Eva Kindlová; doc. MUDr. Martina Kubecová, Ph.D.
Tomotherapy is a radiotherapy procedure providing a highly conformal dose distribution that allows critical organs to be investigated and/or a local dose increase in the target volume. The principle of the technique is to place a small megavoltage linear accelerator on a rotating gantry, including the acquisition of a CT verification before each fraction. A similar technology is volumetric modulated arc therapy (so-called VMAT) on a conventional linear accelerator. There are several studies that directly compare volumetric radiotherapy and tomotherapy. The results indicate a generally faster delivery of the dose by VMAT technique, tomotherapy provides a relatively more consistent and homogeneous dose distribution. Tomotherapy is used in the adjuvant, neoadjuvant, radical and palliative treatment of a wide range of diagnoses.
ENTIRE ARTICLE
Tomotherapy is a radiotherapy procedure providing a highly conformal dose distribution that allows critical organs to be investigated and/or a local dose increase in the target volume. The principle of the technique is to place a small megavoltage linear accelerator on a rotating gantry, including the acquisition of a CT verification before each fraction. A similar technology is volumetric modulated arc therapy (so-called VMAT) on a conventional linear accelerator. There are several studies that directly compare volumetric radiotherapy and tomotherapy. The results indicate a generally faster delivery of the dose by VMAT technique, tomotherapy provides a relatively more consistent and homogeneous dose distribution. Tomotherapy is used in the adjuvant, neoadjuvant, radical and palliative treatment of a wide range of diagnoses.
Brachytherapy of prostate cancer – choice of optimal technology
03/2018 Doc. MUDr. Renata Soumarová, Ph.D.
Brachytherapy is one of the basic standard options for the treatment of localized prostate cancer. Long-term data confirm efficiency and safety of using brachytherapy for treating a prostate cancer and make it an adequate choice of treatment along with benefits, which this procedure provides. It is suitable for all risk groups either as a single treatment or in combination with external radiotherapy.
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Brachytherapy is one of the basic standard options for the treatment of localized prostate cancer. Long-term data confirm efficiency and safety of using brachytherapy for treating a prostate cancer and make it an adequate choice of treatment along with benefits, which this procedure provides. It is suitable for all risk groups either as a single treatment or in combination with external radiotherapy.