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Effect of radical surgery and experimental consolidation therapy on immunological parameters in patients with ovarian carcinoma.
Brtnický, Tomáš ; Rob, Lukáš (advisor) ; Zikán, Michal (referee) ; Jurga, Ľudovít (referee)
The incidence of ovarian carcinoma in the Czech Republic is one of the highest in the EU. The five year survival rate of all stages is approximately 40%. The mortality still remains high globally, despite the efforts of diagnostic procedures and modern treatment. After ending the course of chemotherapy, a completely successful clinical response can be achieved in the early stages (stage I. a II.) in almost 100% of patients. However in 20-40 % it is unfortunately impossible to completely eliminate all tumour cells resistant to chemotherapy and almost a third of women have relapses. Today in the late stages (III. a IV.) more than 70 % of cases result in complete clinical remission; however within 2 years more than 50 % of women from this group suffer from relapses. The relaps of disease results from the activation of a chemoresistant clone of malignant cells. Those cell populations that aren't detectable using investigation methods are marked as minimal residual disease. The issue has been divided into three areas. In the first we monitored the amount of regulatory T-cells in peripheral blood of patients with ovarian cancer. In the second we monitored the dynamics of the immune infiltrate, depending on the stage of the disease. In the third, we tested various types of cytostatics in their ability to...
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Importance and methods of sentinel nodes identification in endometrial cancer
Hrehorčák, Martin ; Rob, Lukáš (advisor) ; Roztočil, Aleš (referee) ; Špaček, Jiří (referee) ; Masák, Ladislav (referee)
STRUCTURED ABSTRAKT Title: Importance and methods of sentinel nodes identification in endometrial cancer Author: Martin Hrehorčák Objective: To evaluace the results of tree different protocols of sentinel node identification in endometrial cancer. Design: Prospective observational study. Setting: Department of Obstetrics and Gyneacology, Charles University, 2nd Medical Faculty, University Hospital Motol, Prague, Czech republic. Methods: 141 women with verified endometrial cancer were included into the study. 10 subjects were excluded due to the duplicity with another malignit tumour, extrauterine spread and non- endometroid type of the tumour. Three different protocols for sentinel lymph node detection were described: Tc99 was applied hysteroscopically peritumorous in 22 women. Subserous peritumorous application of the radiocolloid and patent blue dye was performed in 66 women. Subserous diffuse injection of this combination to eight sites was performed in 43 subjects. Results: 2220 lymph nodes were harvested in 131 women, average 16.9 per subject. 215 sentinel lymph nodes in 91 women were obtained, average 2.36 per subject. Detection rate was 69.46. 63.4% sentinel nodes were identified in the external iliac area, 17.8% in supraobturator area, 8.9% in common iliac area, 4.25% in medial part of lateral...
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The influence of reduced radicality of oncosurgical treatment on urogenital tract morbidity
Chmel, Roman ; Rob, Lukáš (advisor) ; Halaška, Michael (referee) ; Mlynček, Miloš (referee) ; Roztočil, Aleš (referee)
Cervical cancer is the fourth most common gynecological malignancy in Czech Republic. The incidence of cervical cancer in 2008 was 19.2/100000 (1021 women) and mortality reached 6/100000. Both radiotherapy and surgery have comparable results in the treatment of cervical cancer but surgical treatment is still the favoured modality especially in young female. Very succesful curability of early stages of this disease (88-97 %) based on individualized therapy currently leads to emphasize the quality of life increasing of treated women. Morbidity related to the treatment is connected with radicality of surgery. The dominant objective of the submitted study was prospective detection of preoperative and postoperative control over the micturition and urinary continence in 142 evaluated women who underwent nerve-sparing radical abdominal hysterectomy type C1, less radical surgery - laparoscopic pelvic lymphadenectomy and laparoscopic assisted vaginal hysterectomy type A or less radical fertility sparing surgery - laparoscopic pelvic lymphadenectomy and simple trachelectomy. Postoperative morbidity is connected with both pelvic lymphadenectomy and resection of the paracervix and proximal part of vagina with hypogastric nerve and inferior hypogastric plexus injury. The lower urinary tract function before and after the...
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Peroperative and postoperation sentinel lymph node detection evaluation in treatment strategy in cervical and vulvar cancer patients
Pluta, Marek ; Rob, Lukáš (advisor) ; Rokyta, Richard (referee) ; Cibula, David (referee) ; Feyereisl, Jaroslav (referee)
Vulvar cancer is not frequent disease regarding individualized treatment approach. Complete inguinofemoral lymphadenectomy is still standard treatment modality with relatively high short and long term morbidity. Anatomical correlation between vulva and regional lymphatic system represented by inguinofemoral region is basic for actual strategy for less radical operations including sentinel lymph node identification and detection. Application technique, timing and identification technique were presented in Czech and foreign publication as well [46] (see attachment no.: 9). Sydney consensus made by expert board in 2008 is based on 10 publications including our one. Consensus recommends in squamous cancer patients up to 4 cm stage I and II only sentinel lymph node identification procedure like an alternative to standard inguinofemoral lymphadenectomy. This procedure is recommended only for oncogynecologic centers with sentinel nodes identification experiences. Most important original information arises from study about in vivo lymphatic drainage and sentinel lymph nodes localization and topography. If we separate superficial groin in thirds, there were no sentinel nodes in outer third. On the other hand, 15% sentinel nodes were localized in deep femoral region. It explains that extirpation only superficial...
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