<abstract xml:lang="en"><title style='display:none'>Titanium dioxide in our everyday life; is it safe?</title><bold>Background.</bold> Titanium dioxide (TiO2) is considered as an inert and safe material and has been used in many applications for decades. However, with the development of nanotechnologies TiO2 nanoparticles, with numerous novel and useful properties, are increasingly manufactured and used. Therefore increased human and environmental exposure can be expected, which has put TiO2 nanoparticles under toxicological scrutiny. Mechanistic toxicological studies show that TiO2 nanoparticles predominantly cause adverse effects via induction of oxidative stress resulting in cell damage, genotoxicity, inflammation, immune response etc. The extent and type of damage strongly depends on physical and chemical characteristics of TiO2 nanoparticles, which govern their bioavailability and reactivity. Based on the experimental evidence from animal inhalation studies TiO2 nanoparticles are classified as "possible carcinogenic to humans" by the International Agency for Research on Cancer and as occupational carcinogen by the National Institute for Occupational Safety and Health. The studies on dermal exposure to TiO2 nanoparticles, which is in humans substantial through the use of sunscreens, generally indicate negligible transdermal penetration; however data are needed on long-term exposure and potential adverse effects of photo-oxidation products. Although TiO2 is permitted as an additive (E171) in food and pharmaceutical products we do not have reliable data on its absorption, distribution, excretion and toxicity on oral exposure. TiO2 may also enter environment, and while it exerts low acute toxicity to aquatic organisms, upon long-term exposure it induces a range of sub-lethal effects.<bold>Conclusions.</bold> Until relevant toxicological and human exposure data that would enable reliable risk assessment are obtained, TiO2 nanoparticles should be used with great care.</abstract>

Department for Nanostructured Materials, Jožef Stefan Institute, Ljubljana, Slovenia

Department for Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia

Titanium dioxide in our everyday life; is it safe?

<abstract xml:lang="en"><title style='display:none'>Effect of response quality and line of treatment with rituximab on overall and disease-free survival of patients with B-cell lymphoma</title><bold>Background.</bold> The introduction of rituximab into the treatment of patients with non-Hodgkin's lymphomas has improved the overall response rate, as well as the response duration and the overall survival of patients with B-cell lymphomas. But only a few studies have addressed the question whether the better response (complete response) and the early introduction of rituximab into the treatment translate into the better survival. The aim of this retrospective study was to assess the potential relationship between either the quality of the response or the line of the rituximab treatment and the overall survival (OS) as well as the disease-free survival (DFS) of patients with B-cell lymphomas.<bold>Patients and methods.</bold> In the study, we analysed treatment outcomes in patients with different histological types of B-cell lymphomas who were treated at the Institute of Oncology between 2003 and 2007 with rituximab and chemotherapy. We included only patients who had the level of CD20 expression assessed prior to the introduction of the treatment with quantitative flow-cytometric measurements. The OS and DFS were evaluated by Kaplan-Meier survival curves.<bold>Results.</bold> One hundred and fourteen patients were enrolled in the study. Patients who achieved a complete response after the rituximab containing treatment had a significantly longer OS than those reaching a partial response (hazard ratio [HR], 0.34; 95% CI, 0.05 to 0.91, P = 0.0375) and than patients with stable (hazard ratio [HR], 0.11; 95% CI, 0.0002 to 0.033, P &lt; 0.0001) or progressive disease (hazard ratio [HR], 0.09; 95% CI, 0.003 to 0.03, P &lt; 0.0001). Patients who achieved a complete response (CR; n = 70; 61.4%) had also a significantly longer DFS (hazard ratio [HR], 0.26; 95% CI, 0.021 to 0.538, P = 0.0068) than those reaching only a partial response (PR; n = 17; 14.9%). Patients treated with rituximab as the first-line treatment (n = 50; 43.9%) had a significantly longer OS than those treated with rituximab for the first (hazard ratio [HR], 0.27; 95% CI, 0.106 to 0.645, P = 0.0036) or second relapse (hazard ratio [HR], 0.22; 95% CI, 0.078 to 0.5, P = 0.0006). Also the DFS of patients treated with rituximab as the first-line treatment (n = 46; 52.9%) was significantly longer (hazard ratio [HR], 0.32; 95% CI, 0.088 to 0.9, P = 0.0325) than in patients treated with rituximab for their first relapse (n = 25; 28.7%).<bold>Conclusions.</bold> These data indicate that a better response to rituximab therapy presumably translates into an improved OS and DFS for patients with B-cell lymphomas. The early introduction of rituximab into the treatment (i.e. first-line treatment) might improve OS. Therefore, the response adapted first-line therapy with rituximab should be considered when the treatment decision is taken in B-cell lymphoma patients.</abstract>

Effect of response quality and line of treatment with rituximab on overall and disease-free survival of patients with B-cell lymphoma

<abstract><title style='display:none'>Abstract</title><sec id="j_raon-2020-0008_s_004_w2aab3b8c76b1b7b1aab1c18b1Aa"><title style='display:none'>Background</title>Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults.</sec><sec id="j_raon-2020-0008_s_005_w2aab3b8c76b1b7b1aab1c18b2Aa"><title style='display:none'>Materials and methods</title>We systematically searched three databases (<italic>PubMed, Scopus</italic> and <italic>Web of Science</italic>) for articles on cancer incidence and SES. Qualitative synthesis was performed on the 91 included English language studies, published between 2000 and 2019 in Europe, which focused on adults, relied on cancer registry data and reported on relative risk (RR) estimates.</sec><sec id="j_raon-2020-0008_s_006_w2aab3b8c76b1b7b1aab1c18b3Aa"><title style='display:none'>Results</title>Adults with low SES have increased risk of head and neck, oesophagogastric, liver and gallbladder, pancreatic, lung, kidney, bladder, penile and cervical cancers (highest RRs for lung, head and neck, stomach and cervix). Conversely, high SES is linked with increased risk of thyroid, breast, prostate and skin cancers. Central nervous system and haematological cancers are not associated with SES. The positive gap in testicular cancer has narrowed, while colorectal cancer shows a varying pattern in different countries. Negative associations are generally stronger for men compared to women.</sec><sec id="j_raon-2020-0008_s_007_w2aab3b8c76b1b7b1aab1c18b4Aa"><title style='display:none'>Conclusions</title>In Europe, cancers in almost all common locations are associated with SES and the inequalities can be explained to a varying degree by known life-style related factors, most notably smoking. Independent effects of many individual and area SES measures which capture different aspects of SES can also be observed.</sec></abstract>

Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies

<abstract xml:lang="en"><title style='display:none'>Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition?</title><bold>Introduction.</bold> Secondary lymphedema following cancer therapy is a frequent, often painful, quality of life disturbing condition, reducing the patients' mobility and predisposing them to complications, e.g. infections and malignancies. The critical aspect of lymphedema therapy is to start as soon as possible to prevent the irreversible tissue damage.<bold>Patients and methods.</bold> We performed a retrospective study of patients with lymphedema, treated at the Department of Dermatovenereology, University Medical Center Ljubljana, from January 2002 to June 2010. The patients' demographic and medical data were collected, including type of cancer, type and stage of lymphedema, and time to first therapy of lymphedema. The number of referred patients with lymphedema following the therapy of melanoma, breast cancer, and uterine/cervical cancer, was compared to the number of patients expected to experience lymphedema following cancer therapy, calculated from the incidence reported in the literature.<bold>Results.</bold> In the period of 8.5 years, 543 patients (432 females, 112 males) with lymphedema were treated. The results show that probably many Slovenian patients with secondary lymphedema following cancer therapy remain unrecognized and untreated or undertreated. In the majority of our patients, the management of lymphedema was delayed; on average, the patients first received therapy for lymphedema 3.6 years after the first signs of lymphedema.<bold>Conclusions.</bold> To avoid a delay in diagnosis and therapy, and the complications of lymphedema following cancer therapy, the physician should actively look for signs or symptoms of lymphedema during the follow-up period, and promptly manage or refer the patients developing problems.</abstract>

Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition?

<abstract xml:lang="en"><title style='display:none'>Radiation effects on skeletal muscle</title><bold>Background.</bold> Adult skeletal muscle is considered resistant to ionizing radiation unless higher doses of radiation are applied; a fact that is attributed to the low number of radiosensitive proliferating cells in adulthood. However, developing skeletal muscles are highly sensitive to ionizing radiation, thus radiotherapy in childhood may induce muscular atrophy. Radiation affects muscle satellite cells by impairing their activation, proliferation and differentiation, as well as neuromuscular junction, by influencing the ionic membrane permeability affecting the Na+/K+ pump. It also prevents muscle growth during development and after injury.<bold>Conclusions.</bold> The results of the investigation performed after radiation point to the occurrence of a significant change in muscle satellite cell activity. Inhibitors of some proteins such as cytokines in muscle satellite cells could provide a therapeutic benefit in diseases for which muscle mass is limiting, improve response to cancer therapy, and increase life span in patients with cachexia.</abstract>

College of Health Care Izola, University of Primorska

Science and Research Centre Koper, University of Primorska, Slovenia

Radiation effects on skeletal muscle

<abstract><title style='display:none'>Abstract</title><sec id="j_raon-2016-0041_s_001_w2aab3b8c45b1b7b1aab1c15b1Aa"><title style='display:none'>Background</title>The study was conducted to evaluate the frequencies of the anatomic variations and the gender distributions of these variations of the pancreatic duct and their relevance with the Cambridge classification system as morphological sign of chronic pancreatitis using magnetic resonance cholangiopancreatography (MRCP).</sec><sec id="j_raon-2016-0041_s_002_w2aab3b8c45b1b7b1aab1c15b2Aa"><title style='display:none'>Patients and methods</title>We retrospectively reviewed 1312 consecutive patients who referred to our department for MRCP between January 2013 and August 2015. We excluded 154 patients from the study because of less than optimal results due to imaging limitations or a history of surgery on pancreas. Finally a total of 1158 patients were included in the study.</sec><sec id="j_raon-2016-0041_s_003_w2aab3b8c45b1b7b1aab1c15b3Aa"><title style='display:none'>Results</title>Among the 1158 patients included in the study, 54 (4.6%) patients showed <italic>pancreas divisum</italic>, 13 patients (1.2%) were defined as <italic>ansa pancreatica</italic>. When we evaluated the course of the pancreatic duct, we found the prevalence 62.5% for descending, 30% for sigmoid, 5.5% for vertical and 2% for loop. The most commonly observed pancreatic duct configuration was Type 3 in 528 patients (45.6%) where 521 patients (45%) had Type 1 configuration.</sec><sec id="j_raon-2016-0041_s_004_w2aab3b8c45b1b7b1aab1c15b4Aa"><title style='display:none'>Conclusions</title>Vertical course (p = 0.004) and Type 2 (p = 0.03) configuration of pancreatic duct were more frequent in females than males. There were no statistically significant differences between the gender for the other pancreatic duct variations such as <italic>pancreas divisium, ansa pancreatica</italic> and course types other than vertical course (p &gt; 0.05 for all). Variants of <italic>pancreas divisum</italic> and normal pancreatic duct variants were not associated with morphologic findings of chronic pancreatitis by using the Cambridge classification system. The <italic>ansa pancreatica</italic> is a rare type of anatomical variation of the pancreatic duct, which might be considered as a predisposing factor to the onset of idiopathic pancreatitis.</sec></abstract>

Department of Radiology, Bozyaka Training and Research Hospital, Izmir,

Department of Radiology, Urfa Balõklõgol State Hospital, Urfa,

Department of Surgery, Bozyaka Training and Research Hospital, Izmir,

Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>Spine stereotactic body radiation therapy (SBRT) for the treatment of metastatic disease is increasingly utilized owing to improved pain and local control over conventional regimens. Vertebral body collapse (VBC) is an important toxicity following spine SBRT. We investigated our institutional experience with spine SBRT as it relates to VBC and spinal instability neoplastic score (SINS).</sec>
<sec><title style='display:none'>Patients and methods</title>Records of 83 patients with 100 spinal lesions treated with SBRT between 2007 and 2022 were reviewed. Clinical information was abstracted from the medical record. The primary endpoint was post-treatment VBC. Logistic univariate analysis was performed to identify clinical factors associated with VBC.</sec>
<sec><title style='display:none'>Results</title>Median dose and number of fractions used was 24 Gy and 3 fractions, respectively. There were 10 spine segments that developed VBC (10%) after spine SBRT. Median time to VBC was 2.4 months. Of the 11 spine segments that underwent kyphoplasty prior to SBRT, none developed subsequent VBC. No factors were associated with VBC on univariate analysis.</sec>
<sec><title style='display:none'>Conclusions</title>The rate of vertebral body collapse following spine SBRT is low. Prophylactic kyphoplasty may provide protection against VBC and should be considered for patients at high risk for fracture.</sec>
</abstract>

Vertebral body collapse after spine stereotactic body radiation therapy: a single-center institutional experience

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>This study aimed to assess 68Ga-DOTA-TATE (-TOC) PET/CT quantitative parameters in monitoring and predicting everolimus response in neuroendocrine tumor (NET) patients with hepatic metastases (NELM).</sec>
<sec><title style='display:none'>Patients and methods</title>This retrospective analysis included 29 patients with 62 target lesions undergoing everolimus treatment and pre-therapy, and follow-up 68Ga-DOTA-TATE (-TOC) PET/CT scans. Response evaluation utilized progression-free survival (PFS) categorized as responders (R; PFS &gt; 6 months) and non-responders (NR; PFS ≤ 6 months). Lesion size and density, along with maximum and median standardize uptake value (SUV) in target lesions, liver, and spleen were assessed. Tumor-to-spleen (T/S) and tumor-to-liver (T/L) ratios were calculated, including the tumor-to-spleen (T/S) ratio and tumor-to-liver (T/L) ratio (using SUVmax/SUVmax, SUVmax/SUVmean, and SUVmean/SUVmean).</sec>
<sec><title style='display:none'>Results</title>PET/CT scans were acquired 19 days (interquartile range [IQR] 69 days) pre-treatment and 127 days (IQR 74 days) post-starting everolimus. The overall median PFS was 264 days (95% CI: 134–394 days). R exhibited significant decreases in Tmax/Lmax and Tmean/Lmax ratios compared to NR (p = 0.01). In univariate Cox regression, Tmean/Lmax ratio was the sole prognostic parameter associated with PFS (HR 0.5, 95% CI 0.28–0.92, p = 0.03). Percentage changes in T/L and T/S ratios were significant predictors of PFS, with the highest area under curve (AUC) for the percentage change of Tmean/Lmax (AUC = 0.73). An optimal threshold of &lt; 2.5% identified patients with longer PFS (p = 0.003). No other imaging or clinical parameters were predictive of PFS.</sec>
<sec><title style='display:none'>Conclusions</title>This study highlights the potential of quantitative SSTR-PET/CT in predicting and monitoring everolimus response in NET patients. Liver metastasis-to-liver parenchyma ratios outperformed size-based criteria, and Tmean/Lmax ratio may serve as a prognostic marker for PFS, warranting larger cohort investigation.</sec>
</abstract>

Christine.schmid-tannwald@med.uni-muenchen.de

Quantitative SSTR-PET/CT: a potential tool for predicting everolimus response in neuroendoctine tumour patients

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>The aim of the study was to provide insight into the influence of the COVID-19 on the frequency and characteristics of urgent and emergent tracheostomies (TS), comparing data collected both before and during the pandemic. Our two hypotheses were that <italic>during COVID-19, more TS were performed in the emergent setting</italic> and that <italic>during COVID-19 more TS were performed under general anaesthesia</italic>.</sec>
<sec><title style='display:none'>Patients and methods</title>The research was retrospective. The study period included the two years before and after the COVID-19 outbreak in Slovenia. Forty-one patients in each period met the inclusion criteria. Their medical charts were reviewed. The anamnestic, clinical, surgical and anaesthesiological data were collected. The two groups of patients from corresponding time periods were statistically compared.</sec>
<sec><title style='display:none'>Results</title>Predominantly men required the surgical resolution of acute upper airway obstruction (76% of patients). The causes for acute respiratory distress included head and neck cancer (62%), infections (20%), vocal cord paralysis (16%), and stenosis (2%). There were no statistically significant differences either in the (emergent/urgent) setting of TS or in the type of anaesthesia used. Both hypotheses were rejected. A statistically significant rise in use of the C-MAC laryngoscope during COVID-19 (from 3% to 15%) was reported.</sec>
<sec><title style='display:none'>Conclusions</title>The outbreak of COVID-19 did not have a statistically significant effect on the frequency of performing emergent and urgent tracheostomies nor on the use of general or local anaesthesia. It did, however, require a change of intubation technique. Consequently, a significant rise in the use of the C-MAC laryngoscope was noted.</sec>
</abstract>

Tracheostomy before and during COVID-19 pandemic

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Patients with familial adenomatous polyposis (FAP) develop early colorectal adenomas and if left untreated, progression to cancer is an inevitable event. Prophylactic surgery does not prevent further development of cancer in the rectal remnant, rectal cuff in patients with ileal pouch anal anastomosis (IPAA) and even on the ileal mucosa of the pouch body. The aim of this review is to assess long-term rates of cancer and adenoma development in patients with FAP after prophylactic surgery and to summarise current recommendations for endoscopic management and surveillance of these patients.
</sec>
<sec><title style='display:none'>Materials and methods</title>
A systematic literature search of studies from January 1946 through to June 2023 was conducted using the PRISMA checklist. The electronic database PubMed was searched.
</sec>
<sec><title style='display:none'>Results</title>
Fifty-four papers involving 5010 patients were reviewed. Cancer rate in the rectal remnant was 8.8–16.7% in the western population and 37% in the eastern population. The cumulative risk of cancer 30 years after surgery was 24%. Mortality due to cancer in the rectal remnant is 1.1–11.1% with a 5-year survival rate of 55%. The adenoma rate after primary IPAA was 9.4–85% with a cumulative risk of 85% 20 years after surgery and a cumulative risk of 12% for advanced adenomas 10 years after surgery. Cumulative risk for adenomas after ileorectal anastomosis (IRA) was 85% after 5 and 100% after 10 years. Adenomas developed more frequently after stapled (33.9–57%) compared to hand-sewn (0–33%) anastomosis. We identified reports of 45 cancers in patients after IPAA of which 30 were in the pouch body and 15 in the rectal cuff or at the anastomosis.
</sec>
<sec><title style='display:none'>Conclusions</title>
There was a significant incidence of cancer and adenomas in the rectal remnant and ileal pouch of FAP patients during the long-term follow-up. Regular endoscopic surveillance is recommended, not only in IRA patients, but also in pouch patients after proctocolectomy.
</sec>
</abstract>

Endoscopic management of patients with familial adenomatous polyposis after prophylactic colectomy or restorative proctocolectomy – systematic review of the literature

The influence of anaesthesia on cancer growth

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Recent evidence brought by novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates is leading to significant changes in HER2-negative breast cancer (BC) best practices. A new targetable category termed ‘HER2-low’ has been identified in tumors previously classified as ‘HER2-negative’. Daily practice in pathology and medical oncology is expected to align to current recommendations, but patient access to novel anticancer drugs across geographies might be impeded due to local challenges.
</sec>
<sec><title style='display:none'>Materials and methods</title>
An expert meeting involving ten regional pathology and oncology opinion leaders experienced in BC management in four Central and Eastern Europe (CEE) countries (Bulgaria, Croatia, Serbia, Slovenia) was held. Herein we summarized the current situation of HER2-low metastatic BC (mBC), local challenges, and action plans to prevent delays in patient access to testing and treatment based on expert opinion.
</sec>
<sec><title style='display:none'>Results</title>
Gaps and differences at multiple levels were identified across the four countries. These included variability in the local HER2-low epidemiology data, certification of pathology laboratories and quality control, and reimbursement conditions of testing and anticancer drugs for HER2-negative mBC. While clinical decisions were aligned to international guidelines in use, optimal access to testing and innovative treatment was restricted due to significant delays in reimbursement or limitative reimbursement conditions.
</sec>
<sec><title style='display:none'>Conclusions</title>
Preventing delays in HER2-low mBC patient access to diagnosis and novel treatments is crucial to optimize outcomes. Multidisciplinary joint efforts and pro-active discussions between clinicians and decision makers are needed to improve care of HER2-low mBC patients in CEE countries.
</sec>
</abstract>

University Hospital of Split, University of Split - School of Medicine

Advancing HER2-low breast cancer management: enhancing diagnosis and treatment strategies

<abstract><title style='display:none'>Abstract</title><sec id="j_raon-2019-0018_s_008_w2aab3b7b5b1b6b1aab1c18b1Aa"><title style='display:none' id="d2965566e197_w2aab3b7b5b1b6b1aab1c18b1aAa">Background</title>Platinum-based anticancer drugs are widely used in the chemotherapy of human neoplasms. The major obstacle for the clinical use of this class of drugs is the development of resistance and toxicity. It is therefore very important to understand the chemical properties, transport and metabolic pathways and mechanism of actions of these compounds. There is a large body of evidence that therapeutic and toxic effects of platinum drugs on cells are not only a consequence of covalent adducts formation between platinum complexes and DNA but also with RNA and many proteins. These processes determine molecular mechanisms that underlie resistance to platinum drugs as well as their toxicity. Increased expression levels of various transporters and increased repair of platinum-DNA adducts are both considered as the most significant processes in the development of drug resistance. Functional genomics has an increasing role in predicting patients’ responses to platinum drugs. Genetic polymorphisms affecting these processes may play an important role and constitute the basis for individualized approach to cancer therapy. Similar processes may also influence therapeutic potential of nonplatinum metal compounds with anticancer activity.</sec><sec id="j_raon-2019-0018_s_009_w2aab3b7b5b1b6b1aab1c18b2Aa"><title style='display:none' id="d2965566e205_w2aab3b7b5b1b6b1aab1c18b2aAa">Conclusions</title>Cisplatin is the most frequently used platinum based chemotherapeutic agent that is clinically proven to combat different types of cancers and sarcomas.</sec></abstract>

Cisplatin and beyond: molecular mechanisms of action and drug resistance development in cancer chemotherapy

<abstract xml:lang="en"><title style='display:none'>Magnetic nanoparticles as targeted delivery systems in oncology</title><bold>Background.</bold> Many different types of nanoparticles, magnetic nanoparticles being just a category among them, offer exciting opportunities for technologies at the interfaces between chemistry, physics and biology. Some magnetic nanoparticles have already been utilized in clinical practice as contrast enhancing agents for magnetic resonance imaging (MRI). However, their physicochemical properties are constantly being improved upon also for other biological applications, such as magnetically-guided delivery systems for different therapeutics. By exposure of magnetic nanoparticles with attached therapeutics to an external magnetic field with appropriate characteristics, they are concentrated and retained at the preferred site which enables the targeted delivery of therapeutics to the desired spot.<bold>Conclusions.</bold> The idea of binding chemotherapeutics to magnetic nanoparticles has been around for 30 years, however, no magnetic nanoparticles as delivery systems have yet been approved for clinical practice. Recently, binding of nucleic acids to magnetic nanoparticles has been demonstrated as a successful non-viral transfection method of different cell lines in vitro. With the optimization of this method called magnetofection, it will hopefully become another form of gene delivery for the treatment of cancer.</abstract>

Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia

Magnetic nanoparticles as targeted delivery systems in oncology

<abstract xml:lang="en"><title style='display:none'>Triple negative breast cancer - prognostic factors and survival</title><bold>Background.</bold> Triple negative breast cancer (TNBC) is defined by a lack of expression of both estrogen (ER) and progesteron (PgR) receptors as well as human epidermal growth factor receptor 2 (HER2). Our retrospective analysis addressed prognostic factors for short- and long-term outcomes of patients (pts) with TNBC pts treated in routine clinical practice.<bold>Patient and methods.</bold> Our retrospective study included 269 TNBC treated at Institute of Oncology Ljubljana between March 2000 and December 2006. The collected data included patients', tumours' and treatments' characteristics. The survival analyses were performed using the Kaplan-Meier method. The Cox proportional hazard model was used in the multivariate analysis.<bold>Results.</bold> The median age of our patients was 55.3 yrs (23-88.5) and the median follow-up was 5.9 yrs (0.3-9.6). Six (2%) pts experienced local only, 79 (92%) pts distal recurrence and 66 (24%) died. The predominant localisation of the first relapse was in visceral organs (70.4%). The 5-year disease-free survival (DFS) for the entire group was 68.2% and the 5-year overall survival (OS) was 74.5%. We found a pattern of high recurrence rate in the first 3 years following the diagnosis and a clear decline in recurrence rate over the next 3 years. In the univariate analysis age, nodal status, size and lymphovascular invasion (LVI) were found to have a significant impact on DFS as well as on OS. In the multivariate analysis only age (HR=1.79; 95%CI=1.14-2.82; p=0.012) and nodal status (HR=2.71; 95%CI=1.64-4.46; p&lt;0.001) retained their independent prognostic value for DFS and for OS only the nodal status (HR=2.96; 95%CI=1.51-5.82; p=0.002).<bold>Conclusions.</bold> In our series of TNBC pts nodal status and age (older than 65 yrs) were found to be independent prognostic factors for DFS, whereas for OS only the nodal status. We found a pattern of a high recurrence rate in the first 3 years following the diagnosis and a decline in the recurrence rate over the next 3 yrs with higher rate of distal versus local recurrence and a predominant localization of distal metastases in visceral organs.</abstract>

Triple negative breast cancer - prognostic factors and survival

<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title>Modern radiotherapy techniques enable delivery of high doses to the target volume without escalating dose to organs at risk, offering the possibility of better local control while preserving good quality of life. Uncertainties in target volume delineation have been demonstrated for most tumour sites, and various studies indicate that inconsistencies in target volume delineation may be larger than errors in all other steps of the treatment planning and delivery process. The aim of this paper is to summarize the degree of delineation uncertainties for different tumour sites reported in the literature and review the effect of strategies to minimize them.</sec><sec><title style='display:none'>Conclusions</title>Our review confirmed that interobserver variability in target volume contouring represents the largest uncertainty in the process for most tumour sites, potentially resulting in a systematic error in dose delivery, which could influence local control in individual patients. For most tumour sites the optimal combination of imaging modalities for target delineation still needs to be determined. Strict use of delineation guidelines and protocols is advisable both in every day clinical practice and in clinical studies to diminish interobserver variability. Continuing medical education of radiation oncologists cannot be overemphasized, intensive formal training on interpretation of sectional imaging should be included in the program for radiation oncology residents.</sec></abstract>

Department of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia

Department of Radation Oncology, National Centre for Cancer Care and Research, Doha, Qatar

Uncertainties in target volume delineation in radiotherapy – are they relevant and what can we do about them?

<abstract><title style='display:none'>Abstract</title> Background. Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age. Methods. We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis. Results. HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease. Conclusions. Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.</abstract>

Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan, Poland

Poznan University of Medical Sciences, Poznan, Poland

The Greater Poland Cancer Centre, Poznan, Poland

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature

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