01/2020 Special Edition
Renata Soumarová, Tomáš Blažek, Marián Liberko
Gabriela Krákorová, Hana Steinbergerová, Miloš Pešek, Jindřich Fínek, Tomáš Svoboda
Marián Liberko, Renata Soumarová
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.
Modern immunotherapy using immune check-point inhibitors has experienced a huge boom in routine clinical practice. In preclinical and clinical practice, synergy of immunotherapy and radiotherapy is observed. The reason is the ability of radiotherapy to activate anti-tumor immunity, even outside the irradiated tumor (abscopal effect). Activated anti-tumor immunity is one of the important conditions for the therapeutic effect of immune check-point inhibitors.
Radiotherapy is one of the methods of therapeutic armamentarium used in all stages of cancer. In the vast majority of cases, the indication of radiotherapy is local treatment of the tumor. The use of modern techniques can increase the effect while reducing the side effects. Numerous literature sources also describe the so-called abscopal effect - an immune-mediated response of non-irradiated tumor cells. The combination with immunotherapy, the so-called checkpoint inhibitors (anti-CTL, anti-PD-1 and anti-PD-LI), brings new possibilities in enhancing the complex tumor effect while using the abscopal effect.
Therapy of brain metastases is a very attractive topic in the era of the new systemic palliative treatment approaches and improved local treatment techniques. The new radiotherapy techniques, targeted therapy and immunotherapy substantially changed the prognosis of the patients and their overall survival. The most important factors are the number of metastases, their localization, histological type and presence or absence of key structures such as receptors or ligands in order to be the therapy targeted. The aim of this article is to provide an overview of current treatment options and discuss the challenges and future visions of the treatment.
Non-small cell lung cancer even today is a big socioeconomic problem for beeing diagnosed in an advanced or metastatic stage in majority of tumors when our treatment methods available at that time unfortunately are not associated with satisfactory results except few patients with tumors carrying specific mutations. Radiochemotherapy remains the basic standard regimen while adding induction or maintenance cytotoxic treatment did not count for any other benefit. However, modern immunotherapy by PD-1 and PD-L1 inhibitors brings a huge hope today. Mainly it's combination with radiation therapy sensibilizing to a better immunotherapy effect could become a standard part in majority of treatment guidelines. In this context, hypofractionated radiation regimens with limited target volumes seem to be preferred to normofractionation and larger fields. The role of abscopal effect remains still uncertain.
Inclusion of chemoradiotherapy to primary tumor in patient with synchronous liver metastases – case report
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.
Lung cancer represents the leading cause of cancer death worldwide. Most of the patients are diagnosed with advanced disease. Targeting immune-checkpoint inhibitors represents a standard option for advanced non-small cell lung cancer. The aim of this review is to summarize and discuss the clinical evidence for the use of durvalumab in advanced NSCLC.
Treatment of metastatic hormone dependent breast cancer with combination palbociclib and letrozol – case report
Anti-tumor effect of CDK4/6 inhibitors in combination with hormone therapy significantly prolong progression free survival with prolongation time of lifetime. The use of this combination therapy in routine clinical practice fundamentally changes the treatment options of our patients.