Faculty of Medicine
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Item type:Publication, Capecitabine as Second and Third-line Chemotherapy in the Treatment of Platinum-refractory Epithelial Ovarian Cancer(Elsevier, 2011-09); ; Background: The aim of the study was to evaluate the value of Capecitabine (Xelode) in treatment of epithelial ovarian cancer, after failure of initial chemotherapy. Response rates to first-line chemotherapy in women with ovarian cancer are high but most patients relapse and need further treatment. Recurrent disease is incurable, however, many patients can obtain good palliation from further treatment. Material and Method: The study included 20 patients with epithelial ovarian cancer treated initially with cytoreductive surgery and followed by chemotherapy treatment: 14 patients received platinum/paclitaxel therapy and 6 patients received platinum/cyclophosphamide therapy. Progression of disease was manifested with hepatic metastases in 11 patients (55%), lung metastases in 2 (10%) and an increase in serum CA125 in 5 patients (25%). Comparison of the value of serum CA125 before and after treatment was taken as an indicator of response to chemotherapy. The treatment schedule consisted of oral capecitabine 1250mg/m2 administrated twice daily for 14 days, followed by 7-day rest period. Treatment was administrated orally within 30 min of breakfast and dinner, and swallowed with approximately 200ml of water. The cycle was repeated every 21 days. Results: 18 patients (80%) received 6 courses chemotherapy with Capecitabine, 4 (20%) did not achieve the planned 6 courses of chemotherapy due to deterioration of their general condition. In 10 patients (50%) deceased value of CA125 was observed, in 8 (40%) value was unchanged, and in 2 (10%) an increase of serum CA125 was noted. All 20 patients were evaluable for safety. Capecitabine was very well tolerated, with the most common clinical adverse events being nausea and diarrhoea, neither of which occurred with grade 3 or 4 intensity. Conclusions: Capecitabine has demonstrated promising activity and a favorable safety profile in the treatment of platinum-refractory epithelial ovarian cancer. The safety and convenience advantages afforded to patients over current i.v. options make capecitabine an ideal agent for administration in the outpatient setting, potentially freeing them from the burden of i.v. therapy. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Multimodality treatment of brain metastases from ovarian cancer(Macedonian Association of Pathology, 2016-09); ; ; Objective: Brain metastases from ovarian cancer are uncommon and usually associated with mean survival less than 12 months. In some cases, multimodality treatment may achieve an improved outcome in these patients. Material and Methods: Two cases of multiple brain metastases from ovarian cancer are presented. A combination of whole-brainradiotherapy (WBRT) and chemotherapy (Topotecan) was used. Results: Case 1: A 62-year-old patient was diagnosed and treated for primary ovarian cancer in 2012. She underwent optimal surgical resection and adjuvant platinum-based chemotherapy (Carboplatin/Paclitaxel, 6 cycles). Eleven months after the initial treatment the patient developed right hemiparesis. Brain CT documented multiple brain metastases in the left frontal and parietal lobe. She proceeded to WBRT and subsequent 4 cycles of Topotecan. At a follow-up of 24 months, there is no evidence of recurrent disease. Case 2: A 63-year-old patient was diagnosed with primary ovarian cancer in 2012. Initially, she received neoadjuvant chemotherapy (Carboplatin/Paclitaxel, 6 cycles and Doxorubicin/Carboplatin, 3 cycles) followed by surgical treatment. After 1-year follow-up, multiple brain metastases in the right temporoparietal and occipital lobe were detected by brain MRI. She underwent WBRT followed by 4 cycles of Topotecan. Better motor performance was achieved and the MRI scan evaluation showed volume reductions of brain metastases. Nine months later, CT scan revealed a progression of the metastatic disease and re-WBRT was performed. At a follow-up of 18 months, she is in good clinical condition. Conclusions: In ovarian cancer patients with multiple brain metastases, multimodal therapeutic approach including radiotherapy followed by chemotherapy may lead to prolonged survival. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Prevention of chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients receiving adjuvant chemotherapy: Single institution experience(2020); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PRIMARY BREAST LYMPHOMA – CASE REPORT(Macedonian Association of Anatomists and Morphologists, 2021-02); ; ; Introduction: The entity "Primary breast lymphoma" (PBL) refers to a malignant lymphoma occurring primarily in the breast, without the prior presence of lymphoma in the lymph nodes. Case presentation: We present a case of a 40-year-old woman with PBL of the right breast and an enlarged right axillary node and thrombosis of the right arm. The pathological diagnosis (made in the Institute of Pathology, "Ss. Cyril and Methodius" University, Skopje, Republic of Macedonia) was Non-Hodgkin's lymphoma (aggressive B-cell type). According to the Ann Arbor staging system, the stage was IIE. The patient was treated in the University Clinic of Hematology, "Ss. Cyril and Methodius" University, Skopje, Republic of Macedonia). She received 8 cycles of CHOP protocol. (Rituximab was ceased due to a very severe allergic reaction). After finishing with chemotherapy she was in remission with almost complete restitution of the breast and arm. At a follow-up period of 5 years, the patient has survived with no evidence of disease. Conclusion: This strongly suggests that central nervous system (CNS) prophylaxis should be associated with systemic chemotherapy in localized PBL. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Granulocytic-colono stimulating factor (Neupogen) in improving of myocardial hemodinamic function in patients treated with chemotherapy(European Hematology Association/Nature Publishing Group, 2003); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute Mucosal Reactions in Patients with Advanced Head and Neck Cancer Treated with Concurrent Chemoradiotherapy(Association for Medical Physics and Biomedical Engineering, Skopje, Macedonia, 2010-11-06); ; ; We conducted a clinical study to analyze the acute reactions in the oral cavity and the oropharyngeal (OCOPH) mucosa in patients with advanced head and neck cancer (HNC) undergoing a definitive treatment consisted of 3-D conformal radiotherapy combined with concomitant chemotherapy. Twenty nine patients with HNC who were treated between February 2008 and October 2009 were included in the study. The median age was 55 years (range 29-70). The site distribution was as follows: oropharynx, 20.7%; hypopharynx, 41.4%; larynx, 37.9%. The radiation technique used for 3-D conformal radiotherapy was named “oblique photon fields” technique. The OCOPH mucosa as a critical normal tissue was delineated in every patient. Extraction of planning target volume (PTV50) from the volume of OCOPH mucosa led to formation of an OCOPH mucosa with extracted PTV50 (OCOPHEx mucosa). Acute mucosal reactions were recorded using Radiation Therapy Oncology Group (RTOG) grading system. The duration of a maximum grade of reaction was also recorded. A time intensity parameter, so-called Severity-Time Units (STU), quantifying the area under the acute reaction curve, was used to express the intensity of mucositis over time in every patient. Grade 3 acute mucosal reaction was manifested in 19 patients (65.5%). The median duration of confluent mucositis was 21 days (range 14-35). The STU less than 1000 mm2 and the STU more than 1500 mm2 was calculated in equal number of patients (9 patients, or 31.0%). Statistically significant difference in the distribution of the grade 3 reaction was found among patients with different site of the primary tumor (p = 0.003). Statistically significant difference was found between the grade of the acute mucositis and the volume of OCOPHEx mucosa, the dose in 50% of the volume of OCOPHEx (D50%, OCOPHEx) mucosa, and the mean dose to OCOPHEx mucosa (p = 0.02, p = 0.0002, p = 0.00001, respectively). The tested relation between STU and delineated volumes (PTV50 and OCOPHEx mucosa) showed the presence of statistically significant difference (p = 0.044 and p = 0.02, respectively). Statistically significant difference was also found between STU and the mean dose to OCOPHEx mucosa (p = 0.0003). Linear regression showed negative correlation between STU and the volume of OCOPHEx mucosa (r = - 0.7; p < 0.05). The incidence and the duration of confluent mucositis were significantly greater in patients with oropharyngeal primary lesions. The intensity in time of acute mucosal reactions was significantly higher in patients with the greatest PTV50 and in those with the smallest volumes of OCOPHEx mucosa. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The effect from Paclitaxel/Carboplatin regimen to advanced ovarian carcinoma(RAD Association, 2018-06-18); ; ; Gordana PetkovskaIntroduction: Ovarian cancer is the leading cause of death in developed countries and fifth most common cause of mortality in female population. Due to non specific symptoms, compression of bladder and/or rectum it is usually diagnosed in later stages. Approximately 70% are initially diagnosed in stage III with ascites. Treatment outcome is related with the stage. Clinical exam, abdominal ultrasound, CT scans and laboratory (including marker Ca125) are reguired for initial diagnosis. MR may be useful prior operation. Methods: Surgery should be the first treatment option. The aim of surgery is to achieve optimal debulking, at the same time providing tissues for histopathology analysis. Further treatment depend on staging, usually chemotherapy of carboplatin-paclitaxel. The number of cycles administered depends on estimated risk of recurrence. Results: This pattern can be modified to the individual characteristics of certain patients at the presentation. Patient aged 28, referred to University Clinic of Radiotherapy and Oncology in decreased performance status (ECOG1) for chemotherapy treatment with advanced ovarian carcinoma. Explorative laparotomy with multiple biopsies from otherwise, technically inoperable tumor was performed. HP diagnosis revealed ovarian cystadenocarcinoma. Initial high value of Ca125 marker (over 1000 U/ml), with other laboratory findings in referent ranges, allowed the use of chemotherapy with carboplatin-paclitaxel regimen. Pre-treatment CT (Jan 2017) showed bulky abdominal and pelvic tumour mass with enlarged lymph nodes. Her performance status improved shortly after the start of chemotherapy. Ca125 was reassessed after two cycles and it’s value depleted by half (Ca125=473 U/ml), thus suggesting good response. The level of Ca125 entered normal range values after the fourth cycle of chemotherapy. After the administration of planned six cycles of chemotherapy she was in good performance status, without any symptoms or complains. CT scan from (May 2017) revealed complete response, without radiological disease. Subseguent surgery (Jun 2017) was carried out and she had confirmed complete response according to histopathology analysis. First follow up, three months after the treatment (Sept 2017) consisted of clinical exam, abdominal ultrasound and measurement of Ca125 showed no evidence of disease. Conclusion: This is one more confirmation for the “golden standard” of carboplatin-paclitaxel regimen in treatment of ovarian carcinoma.