Selected articles
Articles for label Válek Vlastimil are displayed.. Show all articles
Diagnosis and interventional treatment of colorectal cancer
06/2019 Prof. MUDr. Vlastimil Válek, CSc., MBA
The prevalence of hepatocellular carcinoma (HCC) is increasing and the Czech Republic is no exception. Therefore, effective care for these patients is becoming increasingly important. Radiology plays a crucial role in the diagnosis and treatment of these patients. The diagnosis of HCC can be made even without histological verification only on the basis of finding by imaging methods. A number of invasive radiological procedures, with thermoablation and chemoembolization, can be used to treat these patients. The data of the Institute of Health Information and Statistics of the Czech Republic show that in centers in the Czech Republic, where a comprehensive diagnostic, and above all therapeutic approach to HCC treatment is offered, the average survival of these patients is statistically significantly longer.
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The prevalence of hepatocellular carcinoma (HCC) is increasing and the Czech Republic is no exception. Therefore, effective care for these patients is becoming increasingly important. Radiology plays a crucial role in the diagnosis and treatment of these patients. The diagnosis of HCC can be made even without histological verification only on the basis of finding by imaging methods. A number of invasive radiological procedures, with thermoablation and chemoembolization, can be used to treat these patients. The data of the Institute of Health Information and Statistics of the Czech Republic show that in centers in the Czech Republic, where a comprehensive diagnostic, and above all therapeutic approach to HCC treatment is offered, the average survival of these patients is statistically significantly longer.
Patient with synchronous metastatic colorectal cancer and multiple liver metastases – case report
06/2019 Doc. MUDr. Igor Kiss, Ph.D.; MUDr. Martin Ondrák; prof. MUDr. Zdeněk Kala, CSc.; MUDr. Vladimír Procházka, Ph.D.; prof. MUDr. Vlastimil Válek, CSc.; MUDr. Tomáš Andrašina, Ph.D.
The case report describes a case of a patient in excellent general condition, highly motivated for surgical resection of liver, in whom no metastases were recorded before, during or after liver resection. Patients with „hepatic impairment only“ generally have a better prognosis. The patient tolerated the treatment very well and could undergo several cycles of systemic treatment with minimal hematological and neurological toxicity of systemic treatment. Even in the case of relapse, a rapid and significant effect of systemic treatment has been reported.
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The case report describes a case of a patient in excellent general condition, highly motivated for surgical resection of liver, in whom no metastases were recorded before, during or after liver resection. Patients with „hepatic impairment only“ generally have a better prognosis. The patient tolerated the treatment very well and could undergo several cycles of systemic treatment with minimal hematological and neurological toxicity of systemic treatment. Even in the case of relapse, a rapid and significant effect of systemic treatment has been reported.
Diagnosis of colorectal cancer
06/2019 MUDr. Miriama Šmajerová; MUDr. Jakub Foukal, Ph.D.; prof. MUDr. Vlastimil Válek, CSc., MBA
Imaging methods are an important part of the diagnosis and monitoring of patients with colorectal cancer. In addition to the still used ultrasonography and simple chest X-ray, magnetic resonance (MR) of the pelvis is one of the basic methods of staging today. In cases where the finding is unclear or borderline, we use computed tomography (CT) of the chest, abdomen and pelvis or a method combining positron emission tomography (PET) with CT (PET/CT) or PET/MR. Especially in preoperative rectal tumor staging, PET/MR has great potential as a first choice method. In patients with disseminated disease, CT is the standard method for monitoring. In some cases, however, we can take advantage of PET examination.
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Imaging methods are an important part of the diagnosis and monitoring of patients with colorectal cancer. In addition to the still used ultrasonography and simple chest X-ray, magnetic resonance (MR) of the pelvis is one of the basic methods of staging today. In cases where the finding is unclear or borderline, we use computed tomography (CT) of the chest, abdomen and pelvis or a method combining positron emission tomography (PET) with CT (PET/CT) or PET/MR. Especially in preoperative rectal tumor staging, PET/MR has great potential as a first choice method. In patients with disseminated disease, CT is the standard method for monitoring. In some cases, however, we can take advantage of PET examination.
Imaging methods
06/2017 MUDr. Šárka Bohatá, Ph.D.; prof. MUDr. Vlastimil Válek, CSc., MBA
The golden standard for primary diagnosis of colorectal cancer is colonoscopy together with biopsy. Exact staging and the preoperative assessment are crucial for optimal management of colorectal carcinoma, influencing decision making in case of neoadjuvant treatment and also determining the prognosis. EUS depicts the anatomic layers of the rectal wall with a high degree of accuracy and thus enables precise determination of the tumor extent in relation to the different wall layers (T staging). EUS accuracy is about 85% for T staging and 70-75% for nodal staging. Compared with the other commonly used techniques, CT scan is more largely accessible, faster, inexpensive and less operator-dependent, however CT is not the first choice method for local staging, because the definition of the bowel wall layers is not possible, but is one of the preferred tools to evaluate mainly distant spread, because of its high reproducibility and availability. High-resolution MRI in hands of experienced radiologist plays a pivotal role and has become almost mandatory in the pretreatment assessment of primary rectal cancer. MRI is currently the only imaging modality that is highly accurate (with specificity 92%) in predicting whether or not it is likely that a tumor-free margin can be achieved and in determination of the local invasion depth. Especially in distal tumors MRI provides important information for surgeon's decision whether sphincter-sparing surgery is possible. In patients with advanced rectal cancer extramural vascular invasion of the tumor can be depicted, used as an independent negative prognostic factor for local and distant recurrence rate and shorter overall survival rate. MRI can determine which patients can be treated with surgery alone and which will require radiation therapy to promote tumor regression. MRI can differentiate patients with good therapy response from non-responders. Tumor regression grade assessment is an independent predictor of overall survival and overall symptom-free survival rates and also plays substantial role in patients with the local recurrence. In patients with rectal cancer who have received concurrent chemotherapy and radiation therapy before surgery, all methods have lower accuracy in prediction of the pathologic stage owing to overstaging or understaging. The factors related to this problem include fibrosis, desmoplastic reaction, oedema, inflammation, and viable tumor nets at a fibrotic scar from a previous tumor.
ENTIRE ARTICLE
The golden standard for primary diagnosis of colorectal cancer is colonoscopy together with biopsy. Exact staging and the preoperative assessment are crucial for optimal management of colorectal carcinoma, influencing decision making in case of neoadjuvant treatment and also determining the prognosis. EUS depicts the anatomic layers of the rectal wall with a high degree of accuracy and thus enables precise determination of the tumor extent in relation to the different wall layers (T staging). EUS accuracy is about 85% for T staging and 70-75% for nodal staging. Compared with the other commonly used techniques, CT scan is more largely accessible, faster, inexpensive and less operator-dependent, however CT is not the first choice method for local staging, because the definition of the bowel wall layers is not possible, but is one of the preferred tools to evaluate mainly distant spread, because of its high reproducibility and availability. High-resolution MRI in hands of experienced radiologist plays a pivotal role and has become almost mandatory in the pretreatment assessment of primary rectal cancer. MRI is currently the only imaging modality that is highly accurate (with specificity 92%) in predicting whether or not it is likely that a tumor-free margin can be achieved and in determination of the local invasion depth. Especially in distal tumors MRI provides important information for surgeon's decision whether sphincter-sparing surgery is possible. In patients with advanced rectal cancer extramural vascular invasion of the tumor can be depicted, used as an independent negative prognostic factor for local and distant recurrence rate and shorter overall survival rate. MRI can determine which patients can be treated with surgery alone and which will require radiation therapy to promote tumor regression. MRI can differentiate patients with good therapy response from non-responders. Tumor regression grade assessment is an independent predictor of overall survival and overall symptom-free survival rates and also plays substantial role in patients with the local recurrence. In patients with rectal cancer who have received concurrent chemotherapy and radiation therapy before surgery, all methods have lower accuracy in prediction of the pathologic stage owing to overstaging or understaging. The factors related to this problem include fibrosis, desmoplastic reaction, oedema, inflammation, and viable tumor nets at a fibrotic scar from a previous tumor.