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Prediction of therapeutical response to neoadjuvant therapy in rectal cancer
Pazdírek, Filip ; Hoch, Jiří (advisor) ; Martínek, Lubomír (referee) ; Šimša, Jaromír (referee)
The treatment of locally advanced rectal cancer is multimodal. It includes neoadjuvant radiochemotherapy (NCHRT), which reduces the risk of local recurrence. However, this treatment is also accompanied by side effects. Accordingly, there is an unmet need to identify predictive markers allowing to identify non-responders to avoid its adverse effects. We monitored circulating tumor DNA (ctDNA) as a potential liquid biopsy-based biomarker. We have investigated ctDNA changes plasma during the early days of NCHRT and its relationship to the immediate tumor response as well as overall patients survival. In all patients, ctDNA was strongly reduced or completely eliminated from plasma by the end of the first week of NCHRT, with no correlation to any of the parameters analyzed. As ctDNA was reduced indiscriminately from the circulation of all patients, therefore the dynamics during the first week of NCHRT is not suitable for predicting the immediate therapeutic response in rectal cancer. The baseline ctDNA presence represented a statistically significant negative prognostic biomarker for the overall patient survival. However, the general effect of rapid ctDNA disappearance apparently occurring during the initial days of NCHRT is noteworthy and should further be studied. Keywords: rectal cancer, neoadjuvant...
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Perineural spread of pelvic tumors: mechanism and diagnosis
Čapek, Štěpán ; Sameš, Martin (advisor) ; Haninec, Pavel (referee) ; Hořínek, Daniel (referee)
Perineural spread of pelvic tumors mechanism and diagnosis Abstract Neoplastic lumbosacral plexopathies are infrequent affections of the lumbosacral plexus. Cases with minimal or non-specific finding on imaging can be particularly puzzling to diagnose. We describe a series of patients with perineural spread from the site of the primary tumor along the visceral autonomous nerves to the lumbosacral plexus and further proximally to the spinal nerves and even intradurally and also distally to the sciatic nerve. On series of 17 patients diagnosed with perineural spread of pelvic malignancy we describe characteristic clinical presentation and imaging finding. In many of these cases a tissue biopsy is necessary to finalize the diagnosis. We describe operative technique of targeted fascicular biopsy of the sciatic nerve and our experience with this procedure. On series of 117 patients, we report the outcome and complication: diagnostic yield was 84.8% and complication rate was 2.7 %. If a tissue sample is needed to conclude the diagnosis, targeted fascicular biopsy does increase the yield at an acceptable complication rate. Perineural spread of pelvic cancer is a new clinical-pathological entity with an unknown natural history or ideal treatment strategy. Based on the imaging finding in this group we present a...
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Toxicity of chemoradiotherapy in patients older 60 years with rectum cancer
BABOROVÁ, Monika
The Czech Republic belongs to countries with high incidence of rectal cancer . Annually, 2600 cases of rectal tumors are detected. In the Czech Republic the rectal cancer is the second most frequent tumor disease in men and women. Mortality is also high, it is the cause of more than 4000 deaths per year. The treatment of particular malignant tumors combines radiotherapy and chemotherapy. The reason for combining radiotherapy with chemotherapy is the enhanced treating effect on the tumor tissue while adverse effects on healthy tissues are still bearable. The administration of appropriate cytostatics may potentiate the effect of the combined treatment. The method of concomitant chemoradiotherapy leads to better therapeutic effects in patients. However, the combined treatment is more toxic both for the tumor and the patient´s healthy tissues in areas affected by both the curative methods.
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