Faculty of Medicine

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    The latests results about the BEACOPP treatment as a salvage therapy in patients with relapsed and/or refractory Hodgkin’s disease
    (2005)
    Mihajlovska, Ana
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    Dimov, Aleksandar
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    Trimceska, Katerina
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    Lozance, Marija
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    Beacopp treatment as salvage therapy in patients with relapsed and/or refractory Hodgking’s disease
    (2005)
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    Mihajlovska A
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    Ljatifi A
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    Pangovska I
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    Shterjovska A
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    Capecitabine as Second and Third-line Chemotherapy in the Treatment of Platinum-refractory Epithelial Ovarian Cancer
    (Elsevier, 2011-09)
    Veljanoska, Slavica
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    Arsovski, Oliver
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    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.
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    Проксимален тип на епителоиден сарком на вулвата - Приказ на случај и преглед на литературата.
    (Македонско лекарско друштво = Macedonian medical association, 2009)
    Babushku, Jorgo
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    Stefanija, Adela
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    Ivanova, Daniela
    Вовед. Епителоидниот сарком на вулвата е екстремно редок и агресивен тумор. Кај најголемиот дел од пациентите е асимптоматски, а лезиите најчесто се погрешно дијагностицирани како бенигни, што условува поставување на дијагнозата во подоцнежните стадиуми од еволуцијата на болеста. Приказ на случај. Презентираме случај на 38-годишна пацеинтка со дијагноза на проксимален тип на епителоиден сарком (ПЕС) на вулвата. Кај пациентката беше направена широка локална ексцизија на лезијата и на десната голема усна на срамницата. Во моментот на поставувањето на дијагнозата не постоеја докази за присуство на локални и оддалечени метастази. И покрај спроведената адјувантна хемиотерапија кај пациентката се развија метастази во регионалните лимфни јазли три месеци по операцијата и метастази во белите дробови после шест месеци по операцијата. Пациентката почина 10 месеци по поставувањето на дијагнозата, заради дисеминација на болеста. Заклучок. Во англосаксонската литература, досега е објавени само 21 случај на примарен епителоиден сарком на вулвата. Раната дијагноза и иницијалната ерадикација, претставуваат прва тераписка линија во лекувањето на епителоидниот сарком. Улогата на адјувантната терапија, допрва треба да се разгледува. Introduction. Epithelioid sarcoma of vulva is an extremely rare and aggressive tumor. In most patients it is asymptomatic, and the lesions are usually mistaken for benign processes, leading to establishing a diagnosis at later stages. Case report. We report a case of a 38-year-old woman diagnosed as having a proximal-type of epithelioid sarcoma (PES) of the vulva. Wide local excision of the lesion at the right labium majus was performed. There was no evidence of local or distant metastasis at the time of diagnosis. Following adjuvant chemoradiotherapy, the patient developed bilateral inguinal lymph node metastasis 3 months after surgery and lung metastasis 6 months after surgery. Ten months after establishing the diagnosis, the patient died as a result of disseminated disease. Conclusion. Until now only 21 cases of primary epithelioid sarcoma of the vulva have been reported in the English literature. Epithelioid sarcoma is best treated by early diagnosis and initial eradication. The role of adjuvant treatment remains to be determined.
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    Multimodality treatment of brain metastases from ovarian cancer
    (Macedonian Association of Pathology, 2016-09)
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    Veljanoska, Slavica
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    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.
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    Prevention of chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients receiving adjuvant chemotherapy: Single institution experience
    (2020)
    Iljovska, Marina
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    Lazareva, Emilija
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    Introduction. The modern treatment of malignant diseases and the use of antineoplastic agents pose numerous challenges in terms of the side effects from applied specific oncological treatment. Despite to the significant progress in recent years, emesis and nausea are the two most common and most stressful side effects of cancer treatment and their successful management is still a great challenge. Chemotherapy-induced vomiting or nausea (CINV) significantly affects the quality of life of patients, can cause metabolic disorders, diarrhea, eating disorders and general physical and mental disorders and can question the further anti-tumor treatment of the patient. The prevention and the treatment of CINV and antiemetic therapy have central role in modern protocols for oncological treatment of malignant diseases, including breast cancer patients. Aim. The aim of our study was to obtain data about the efficacy of antiemetic prophylaxis in patients with breast cancer who received chemotherapy following the EC75 protocol in adjuvant setting and the compliance of the patients for the both acute and delayed emesis and nausea. Materials and methods. A prospective study was conducted in 32 breast cancer patients receiving chemotherapy following an EC75 protocol in an adjuvant setting for four consecutive chemotherapy cycles between February 2015 and June 2015. All patients received adequate premedication on day 1 prior to chemotherapy and appropriate oral postmedication was recommended in day 2-5 (with 5-HT3 antagonist and corticosteroid). The occurrence of acute and delayed nausea and emesis as well as taking the recommended postmedicaton by patients was evaluated through a specially structured questionnaire that beside general information contained the following information: the appearance of emesis and nausea within 24 hours after receiving chemotherapy and within the next 10 days, taking the recommended postmedication and the number of taken tablets and taking additional therapy besides the recommended. Results. Out of 32 patients, acute onset of nausea, nausea till day 5 and nausea from 5 to 10 day was recorded in 50%, 44% and 31% of patients, respectively. The results of the occurrence of acute emesis, emesis to to day 5 and nausea from 5 to 10 day were 16%, 9% and 0% respectively. Patients who received complete postmedication have reported acute nausea, nausea till day 5 and nausea from 5 to 10 day in 50%, 50% and 20%, while in patients with partial postmedication 50%, 59% and 39%, respectively. Conclusion. The obtained results do not indicate that acute and delayed nausea are more difficult to control. In patients’ good compliance, better control of both acute and postponed emesis is achieved, although the results obtained in patients with partial compliance may be due to failure to follow the recommended treatment. Despite the effectiveness of antiemetic prophylaxis and good compliance, there is a possibility for its improvement with introduction of new generations of antiemetics. Keywords: Chemotherapy, emesis, nausea, breast cancer, compliance
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    PRIMARY BREAST LYMPHOMA – CASE REPORT
    (Macedonian Association of Anatomists and Morphologists, 2021-02)
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    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.
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    Granulocytic-colono stimulating factor (Neupogen) in improving of myocardial hemodinamic function in patients treated with chemotherapy
    (European Hematology Association/Nature Publishing Group, 2003)
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    D. Efremov
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    M. Ivanovski
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    N. Siljanovski
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    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)
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    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.