Faculty of Medicine

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    Adjuvant chemotherapy plus concurrent chemoradiotherapy (CCRT) in advanced gastric adenocarcinoma treatment as standard of care
    (2020)
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    Lazarova, Emilija
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    Berat, Meri
    Introduction. Despite a worldwide decline in incidence based on GLOBOCAN 2018 data, stomach cancer is the 5th most common neoplasm and the 3rd most deadly cancer. In 90% of cases, its histology is adenocarcinoma, either of the intestinal type or of diffuse. Helicobacter pylori infection, smoking, salt and nitrate-rich foods are the most important factors of risk. The interactions between dietary factors, environmental factors and the development of gastric cancer are well described with clearly identified dietary exposures strongly associated with gastric cancer induction and prevention. Postoperative fluoropyrimidine-based CCRT and chemotherapy is standard adjuvant treatment of resected gastric adenocarcinoma. Materials and methods. Patients with subtotal gastrectomy and D1 lymph node dissection were treated with 2 cycles of Capecitabine (DD 2500 mg/m2 po bid/21day cycle) followed by chemoradiotherapy and another of 2 cycles chemotherapy with Capecitabine (DD 2500 mg/m2 po bid/21d cycle). CT simulation with oral contrast application was performed followed by delineation of target volumes and organs at risk according to CRITICS protocol. 3D conformal postoperative chemoirradiation was delivered with standard fractionation (TTD 50.4 Gy/1.8 Gy) with concurrent application of Capecitabine 1650mg/m2/bid/d1-5. Adjuvant treatment was delivered in postoperative period of 6 months. Results. Adjuvant chemotherapy and chemoradiotherapy prolongs disease free survival (DFS) and improves quality of life. CT-based 3D conformal treatment planning and delivery of postoperative chemoirradiation is minimum standard of care of gastric cancer treatment. Conclusion. Multidisciplinary decision making team approach is preferred. Primary treatment option for patients with potentially resectable locoregional gastric tumors is surgery. The guidelines have included postoperative chemo/chemoradiotherapy treatment depending of tumor stage, nodal status, extent of lymph node dissection and other risk factors (differentiation, lymphovascular invasion, neural invasion, surgical margins). Adjuvant chemotherapy and chemoradiotherapy prolongs disease free survival (DFS) and improves quality of life. Keywords: Gastric cancer, chemoirradiation, CCRT, DFS, 3D conformal, postoperative
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    Esophageal, gastric, colorectal, pancreatic, hepatocellular carcinomas and cholangiocarcinomas in Northern Macedonia: A series of patients treated at the University Clinic, between 2015 and 2019
    (Centre for Evaluation in Education and Science (CEON/CEES), 2021)
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    Stefanovski, Goran
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    <jats:p>Introduction: The global burden of gastrointestinal cancer (GIC) is growing. Stomach, colon and liver are among the five most common sites for GIC in men and women worldwide. The incidence of GIC shows significant variation in Europe and North America. Aim: The aim of this paper is to describe hospital morbidity from GI cancer at the University Clinic in Northern Macedonia. Materials and methods: A retrospective longitudinal analysis included a series of cases with GIC, at the University Clinic of Gastroenterohepatology (UCG) in Skopje, in the period 2015-2019. Descriptive statistical methods were used to describe hospital morbidity from GIC, and its distribution by age, sex, and cancer site. Results: In a five-year period, a total of 2,831 patients with GIC were treated at the UCG, of which 1,484 patients had colorectal cancer, 763 patients had gastric cancer and 88 patients had esophageal cancer. Although liver cancers were less common, as many as one eighth of such patients (355 or 13%) had nonspecific liver malignancy. Most patients were in the 60-69 age group, with the exception of esophageal cancer. An increase in the incidence of pancreatic cancer was observed, almost equal, when considering the distribution by sex, and mainly in the age groups 60-69 and 70-79 years. Conclusion: Hospital morbidity due to GIC in North Macedonia shows an increasing trend, so it is important to determine how much screening has contributed to the early detection of these cancers and to ensure access to and availability of therapy for hepatitis B and C.</jats:p>