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Central nervous system (CNS) tumors comprise around 20% of childhood malignancies. Germline variants in cancer predisposition genes (CPGs) are found in approximately 10% of pediatric patients with CNS tumors. This study aimed to characterize variants in CPGs in pediatric patients with CNS tumors and correlate these findings with clinically relevant data. Genomic DNA was isolated from the peripheral blood of 51 pediatric patients and further analyzed by the next-generation sequencing approach. Bioinformatic analysis was done using an “in-house” gene list panel, which included 144 genes related to pediatric brain tumors, and the gene list panel Neoplasm (HP:0002664). Our study found that 27% of pediatric patients with CNS tumors have a germline variant in some of the known CPGs, like ALK, APC, CHEK2, ELP1, MLH1, MSH2, NF1, NF2 and TP53. This study represents the first comprehensive evaluation of germline variants in pediatric patients with CNS tumors in the Western Balkans region. Our results indicate the necessity of genomic research to reveal the genetic basis of pediatric CNS tumors, as well as to define targets for the application and development of innovative therapeutics that form the basis of the upcoming era of personalized medicine.

Лумбална дискус хернија је мултидисциплинарни проблем у дијагностичком, терапијском и социјално-епидемиолошком смислу. У 90% случајева се јавља на нивоу Л4/Л5 и Л5/С1. Једна од апсолутних индикација за оперативно лечење овог обољења је моторна слабост плантарне и дорзалне флексије стопала, која настаје као последица компресивног ефекта на спиналне коренове Л5 и С1. Златним стандардом процене моторне слабости сматра се клинички мануелни мишићни тест. Бројни докази из литературе наводе недостатке ове методе. Под недостацима се подразумева субјективност процене степена слабости, која зависи и од лекара и од пацијента. Из ових разлога смо применили неинвазивни систем сензора притиска, који региструје силу притиска при плантарној и дорзалној флексији, код болесника оперисаних од лумбалне дискус херније на нивоима Л4/Л5 и Л5/С1, код којих је постављена индикација за операцију на основу моторног дефицита и налаза на МР дијагностици. Метод.Истраживање је спроведено као ретроспективна кохортна студија, заснована на утврђивању површинске расподеле силе притиска код болесника који су оперисани од дискус херије на нивоу Л4/Л5 и Л5/С1. Систем се састоји од две платформе на којима су, утврђеним распоредом, постављени сензори притиска. На свакој платформи се налази по четири сензора. Сензорима се утврђује сила притиска ослањања прстима и петама. У студију су укључена 33 болесника који су задовољили унапред утврђене критеријуму. Мерење моторне слабости је рађено мануелним мишићним тестом и системом сензора притиска.Поређење добијених вредности смо радили у три времена, преоперативно, седам дана након операције и након спроведене физикалне терапије. Време праћења болесника је било од четири месеца до годину дана. Резултати.Анализом резултата притиска на сензоре левом и десном ногом, преоперативно, без обзира на ниво дискус херније, добија се статистички значајна разлика у смислу ослабљеног ослањања на пету десне ноге. Анализом утицаја примене микродискектомије или дискектомије, није, Lumbar disc herniation is a multidisciplinary problem in diagnostic, therapeutic and socioepidemiological sense. In 90% of cases, disc herniation is at L4/L5 and L5/S1 levels. One of the absolute indications for the operative treatment of this disease, is motor weaknes of plantar and dorsal flexion of the feet, wich occurs as a consequence of compressive effect on spinal roots L5 and S1. The gold standard for assessing muscle weakness is considered manual muscle test. Numerous evidence from the literature indicate deficiency of this method. The main deficiency of manual muscle test is subjective assessment of degree of muscle weakness, which depends on the doctor and the patient. For these reasons, we apply the non invasive system of pressure sensors which register the pressure force during plantar and dorsal flexion of patients who had surgical treatment of the existing disc herniation at L4/L5 and L5/S1 levels. The indication for the operative treatment is set based on the motor deficiency and MRI diagnosis. Method.The research was conducted as retrospective cohort study, based on determing the surface distribution of the pressure force of patients who had surgical treatment of disc herniation at L4/L5 and L5/S1 levels. The system consists of two platforms with pressure sensors set according to a established distribution. The sensors determine the pressure force which occurs when patient stands on the toes and heels. The study included 33 patients who met the inclusion criteria. Measurement of motor weakness was done with manual muscle test and with pressure sensors system. We compared the obtained measurements in three time periods, preoperatively, seven days postoperatively and after physical therapy. The follow-up time of patients is four months to a year.The result of the measurements indicate that pressure sensors show statistically higher sensitivity compared to manual muscle test. Results.By analyzing the results of pressure on the sensors with the left and

Sindrom sagorevanja (eng. burnout) je okupacioni fenomen koji utiče na svakodnevno životno i profesionalno funkcionisanje osobe, a može imati i negativan uticaj na bezbednost pacijenta i kvalitet pružene usluge. Sindrom sagorevanja je definisan kao psihološko stanje koje karakteriše emocionalna iscrpljenost, depersonalizacija i smanjeno lično postignuće. Cilj: Cilj ovog rada je bio procena prevalencije sindroma sagorevanja kod zdravstvenih radnika i zdravstvenih saradnika zaposlenih u najvećem referentnom onkološkom centru u Srbiji i prepoznavanje osetljivih subkohorti zaposlenih koji su u najvećem riziku za nastanak sindroma sagorevanja. Metod: Studija preseka sprovedena je u Institutu za onkologiju i radiologiju Srbije u periodu od maja 2019. do jula 2019. godine. Upotrebom standardizovanih upitnika evaluirali smo stepen sindroma sagorevanja, depresivnost, zamor, socijalno demografske i profesionalne karakteristike i kvalitet života kod lekara, medicinskih sestara/tehničara i zdravstvenih saradnika. Od 576 distribuiranih upitnika, 432 ispitanika je prihvatilo učešće u istraživanju (75%). Rezultati: Prevalencija sindroma sagorevanja kod zdravstvenih radnika i zdravstvenih saradnika je bila 43.4%, sa najvećim stepenom sagorevanja u domenu emocionalne iscrpljenosti (66.9%). U nekorigovanom modelu, rezultati multivarijantne regresione analize pokazali su da medicinske sestre/tehničari imaju 1.41 puta veću verovatnoću da razviju sindrom sagorevanja u odnosu na lekare (OR=1.41, 95% CI 1.16-7.10),i da svaka godina radnog staža u onkologiji povećava rizik za oko 2% (OR=1.02, 95% CI 1.00-1.92). Takođe, utvrđeno je da sa svakim bodom PHQ-9 skora verovatnoća za nastanak sindroma sagorevanja se povećava 14% (OR=1.14, 95% CI 1.07-1.94). Na kraju, nakon kontrole svih potencijalnih pridruženih varijabli, pokazano je da kompozitni skor mentalnog zdravlja ima nezavisnu prognostičku vrednost u proceni sindroma sagorevanja i da sa svakim bodom ovog skora verovatnoća za nastanak sind, Burnout is an occupational phenomenon that affects the psychological well-being and quality of life of healthcare professionals with potential negative impact on patients’ safety and quality of health care. It has been defined as a psychological state of emotional exhaustion, depersonalization and reduced personal accomplishment. Objective: The aim of this study was to investigate the level of burnout and identify who is at highest risk among healthcare professionals (HCPs) working at the largest referent national institution. Methods: A cross-sectional survey was conducted at the Institute of Oncology and Radiology of Serbia from May 2019 to July 2019, evaluating the level of burnout, depression, fatigue, socio-demographic, behavioural and professional characteristics, and quality of life among healthcare professionals. Of the 576 distributed questionnaires among physicians, nurses/technicians and healthcare co-workers, 432 participants returned their questionnaires (75%). All instruments used in our study had been validated and cross-culturally adapted to Serbian language. Results:The overall prevalence of burnout was 42.4%, with the greatest proportion of burned out in emotional exhaustion domain (66.9%). The multivariable-adjusted model analysis showed that nurses/technicians had a 1.41 times greater chance of experiencing burnout, compared to physicians (OR=1.41, 95% CI 1.16-7.10), and that with each year of work experience, the chance of burnout increased by about 2% (OR=1.02, 95% CI 1.00-1.92). Furthermore, it was shown that, with each point in the PHQ-9 score for depression, probability of burnout increased by 14% (OR=1.14, 95% CI 1.07-1.94). Finally, after controlling all these potential confounders, the Mental Composite Score of SF-36 score showed an independent prognostic value in exploring the burnout presence among HCPs (OR=1.17, 95% CI 1.03-2.47). Conclusion: Our research showed a significant level of burnout among healthcare professionals working in o

Cilj: Prikaz glioblastoma i metastaza na konvencionalnom MRI je često jako sličan, ali se terapijski pristup i prognoza bitno razlikuju. Čak i primenom naprednih MR tehnika, u nekim slučajevima dijagnoza ostaje nejasna. Glavni cilj disertacije bio je da utvrdi da li fraktalna ili teksturna, ili obe kvantitativne analize MR slike mogu doprineti diferencijaciji glioblastoma od solitarne metastaze mozga. Metod: Studija je sprovedena na ukupno 96 pacijenata sa dokazanim dijagnozama glioblastoma (50 pacijenata), odnosno solitarne metastaze (46 pacijenata). Izdvojene su slike sa najinformativnijim prikazom lezije (jedan isti presek u tri različite sekvence: CET1, T2 i SWI), a zatim je učinjena njihova kompjuterska analiza, primenom fraktalne metode brojanja kvadrata i teksturne metode bazirane na matrici zajedničke pojave istog nivoa sive boje (GLCM). Rezultati: Analizom sive skale celog tumora i binarne slike unutrašnjosti tumora sa T2 sekvence dobijen je najveći broj parametara koji značajno razlikuju dve vrste tumora (drugi ugaoni moment SASM, inverzni moment razlike SIDM, kontrast SCON, korelacija SCOR, diferencijalna fraktalna dimenzija DDIFF, odnosno binarna fraktalna dimenzija unutrašnjosti DBIN2, normirana fraktalna dimenzija DNORM, lakunarnost Ʌ2), dok su se druge dve sekvence (CET1 i SWI) pokazale manje pogodnim za kvantifikaciju. Kombinacijom parametara povećala se tačnost testiranja (AUC 0,838±0,041, senzitivnost 78% i specifičnost 76% za kombinaciju SASM i SIDM sa CET1 i T2 + SASM sa SWI + DBIN2 i DNORM sa T2). Zaključak: Kvantifikacija MR slike može doprineti diferencijalno dijagnostičkoj odluci između glioblastoma i solitarne metastaze mozga i potencijalno može postati deo svakodnevne radiološke prakse., Purpose: Presentation of glioblastomas and metastases on conventional MRI is quite similar, however treatment strategy and prognosis are substantially different. Even with advanced MR techniques, in some cases diagnostic uncertainty remains. The main objective of dissertation was to determine whether fractal, texture, or both quantitative MR image analysis could aid in differentiating glioblastoma from solitary brain metastasis. Method: Study embraced 96 patients with proven diagnosis of glioblastoma (50 patients), respectively solitary metastasis (46 patients). Images with the most representative lesion (one same slice on three different sequences: CET1, T2 and SWI) were selected, and computer analysis was done by fractal box-counting and texture gray level co-occurrence matrix (GLCM) methods. Results: Gray scale analysis of whole tumor and binary image analysis of tumor´s inner structures, both derived on T2 sequence, obtained the most significantly different parameters between two types of tumors (angular second moment SASM, inverse difference moment SIDM, contrast SCON, correlation SCOR, differential box dimension DDIFF, respectively binary box dimension DBIN2, normalized box dimension DNORM, lacunarity Ʌ2), while the other two sequences (CET1 and SWI) showed less suitable for quantification. The combinations of parameters yielded better results (AUC-0.838±0.041, sensitivity 78% and specificity 76% for next combination SASM and SIDM from CET1 and T2 + SASM from SWI + DBIN2 and DNORM from T2). Conclusions: MR image quantification may aid in differentiation between glioblastoma and solitary brain metastasis, and potentially could become a part of daily radiology practice.

Neuromonitoring je veoma važan element koji je omogućio intraoperativno praćenje akcionih potencijala nerava i mišića i time smanjio mogućnost lezije kičmene moždine i neurološkog deficita. Uvođenje u praksu intraoperativnog neuromonitoringa tokom operacija tumora kičmenog kanala, naročito intramedularnih tumora, omogućilo je direktan uvid u trenutnu funkciju kičmene moždine i time mogućnost da se izbegnu jatrogena oštećenja koja bi dovela do teških neuroloških ispada. On konkretno zamenjuje neurološki pregled pacijenta u opštoj anesteziji u toku operacije. Oštećenje tkiva kičmene moždine tokom operacije može nastupiti direktnom ili indirektnom traumom, kompresijom, ishemijom, istezanjem nervnih elemenata, hipotenzijom, elektrolitnim poremećajima, kompresijom ili krvarenjem. Primena neuromonitoringa može prikazati svaku promenu koja nastaje navedenim mehanizmima, i to u ranoj reverzibilnoj fazi, kada je moguće reagovati (hirurg i anesteziolog) i sprečiti dalje oštećenje. Rezultati hirurškog lečenja intraduralnih tumora kičmenog kanala su u poslednjih dvadesetak godina izuzetno unapređeni, zahvaljujući pre svega uvođenju u standardnu upotrebu u sve većem broju centara operacionog mikroskopa, ultrazvučnog aspiratora i neuromonitoringa. U ovoj disertaciji je prezentovana uloga neuromonitoringa, ali i ispitani prediktori ishoda pacijenata sa intraduralnim tumorima, kao i preživljavanje ovih pacijenata. CILJEVI ISTRAŽIVANJA: Ciljevi ovog istraživanja su: utvrđivanje razlike u neurološkom ishodu pacijenata sa intraduralnim ekstramedularnim i intramedularnim tumorima (pri otpustu, godinu i tri godine nakon operacije) bez i sa upotrebom neuromonitoringa. Potom, otkrivanje uticaja pojedinih nezavisnih preoperativnih i kliničkih faktora na neurološki status pacijenata, kao i otkrivanje uticaja intraoperativnih parametara i faktora na neurološki status pacijenata i krajnji ishod lečenja. Kao cilj je postavljeno i određivanje preživljavanje ovih grupa pacijenata, kao i njihov p, Neuromonitoring is a very important element that enabled tracking of the action potentials of neurons and muscles and thus reduce the the possibility of spinal cord lesions and neurological deficits. Introduction to the practice of intraoperative neuromonitoring during the operation of spinal canal tumors, especially intramedularnih tumors, allow a direct insight into the current function of the spinal cord and thus the ability to avoid iatrogenic damage that would have resulted in severe neurological deficit. It specifically overrides the neurological examination the patient in general anesthesia during surgery. Damage to the tissues of the spinal cord during surgery may perform from direct or indirect trauma, compression, ischemia, neural elements stretching, hypotension, electrolyte disorders, compression or bleeding. Application of neuromonitoring may show each change that occurs with the above mechanisms, and that in the early stages are reversible, when it is possible to react (surgeon and anaesthesiologist) and prevent further damage. The results of the surgical treatment of intradural tumors of the spinal canal in the last two decades are extremely improved, thanks first of all to the introduction and the standard use, in a growing number of centers, surgery microscopes, ultrasonic extraction unit and neuromonitoring. In this thesis the role of neuromonitoring is presented, but also predictors of outcome of patients with intradural tumours was investigated, as well as the survival of these patients. OBJECTIVES: The objectives of this study were: to determine the differences in neurological outcome of patients with intradural extramedullar and intramedullar tumors (at discharge, one year and three years after surgery) without and with the use of neuromonitoring. Then, to uncover the impact of individual independent preoperative and clinical factors in neurological status of patients, and detection of the influence of intraoperative parameters and factors in n

Poslednjih decenija došlo je do porasta stope preživljavanja dece obolele od malignih bolesti, najviše kao posledica standardizacije i intenziviranja protokola lečenja što je dovelo i do porasta broja i težine neželjenih efekata u vidu različitih fizičkih i psihičkih simptoma sa kojima se deca suočavaju tokom lečenja a i kasnije tokom života. Cilj ovog rada bio je procena kvaliteta života dece sa novootkrivenim solidnim tumorima kao i određivanje prediktora kvaliteta života na početku lečenja. Metod: Istraživanje je obuhvatilo grupu dece sa novootkrivenim solidnim tumorima koja su započela onkološko lečenje na Institutu za onkologiju i radiologiju Srbije u periodu od decembra 2016. do januara 2018. godine. Rezultati: Ukupan broj dece bio je 51. Dečaka je bilo 24 (47,1%), a devojčica 27 (52,9%). Većina dece imala je tumore CNS-a (21/51; 41,2%), dok su na drugom mestu bili koštani tumori (19/51; 39,2%). Diseminovanu formu bolesti imalo je 14/51 dete (27%) a najčešće je diseminacija bila prisutna kod koštanih tumora (8/20; 40%). Prosečan uzrast dece sa tumorima CNS bio je 7,3 ± 3,9 godina a najčešći tip tumora je bio meduloblastom (38%). Prosečan uzrast dece sa koštanim tumorima je bio 13,6±5,7 godina a više dece je imalo Ewing sarkom (12/20; 60%). Najčešća lokalizacija koštanih tumora bili su ekstremiteti (60%). Nije uočena razlika u kvalitetu života u odnosu na pol. U domenu za mučninu značajna razlika u odnosu na uzrast postojala je između namlađe i najstarije dece (p=0,06), dok je u odnosu na tip tumora razlika postojala između dece sa tumorima CNS u odnosu na decu sa tumorima kostiju (p=0,019). U domenu kognitivnih smetnji značajna razlika je postojala između dece uzrasta 5-7 i 8-12 godina (p=0,040) kao i između dece uzrasta 8-12 i 13-18 godina (p=0,020). U domenu za uznemirenost zbog lečenja značajna razlika je postojala između dece sa tumorima CNS i dece sa tumorima kostiju (p=0,042). Značajna razlika uočena je u odnosu na tip tumora za domen fizičkog funkcionis, In the last decades, an increase in the survival rate of children diagnosed with malignant diseases has been observed, predominantly as a consequence of standardization and intensification of treatment protocols, which also led to the increase of number and severity of treatment adverse effects represented by various physical and mental symptoms children encounter during the treatment and later in life. The aim of this research was the assessment of the quality of life of children with newly diagnosed solid tumors as well as the assessment of predictors of quality of life at the beginning of treatment. Methods: This research included a group of children with newly diagnosed solid tumors who began their oncological treatment at the Institute for Oncology and Radiology of Serbia from December 2016 until January 2018. Results: The total number of children enrolled was 51, out of which 24 (47.1%) were boys and 27 (52.9%) girls. Majority of children had tumors of the central nervous system (21/51; 41.2%), followed by bone tumors (19/51; 39.2%). Disseminated form of the disease was present in 14/51 children (27%), predominantly seen in bone tumors (8/20; 40%). The average age of children with CNS tumors was 7.3±3.9 years and the most frequent type of tumor was medulloblastoma (38 %). The average age of children with bone tumors was 13.6 ± 5.7 years with Ewing sarcoma as the most frequently diagnosed bone tumor (12/20; 60%). The most frequent localization of bone tumors were extremities (60%). No difference in the quality of life related to gender was observed. In the nausea domain, a significant difference was found between the youngest and oldest children (p=0.06), while in relation to the type of tumor, the difference was found between children with CNS tumors and children with bone tumors (p=0.019). In the cognitive disorder domain, a significant difference was found between children in 5-7 years age group and children in 8-12 years age group, as well as between childr

UVOD: Glioblastom je biološki najagresivniji tip glioma i zastupljen je u oko 50% u odnosu na ostale glijalne tumore, a takođe je tumor sa najlošijom prognozom. Incidenca glioblastoma iznosi oko 3 na 100000 u Evropi i Severnoj Americi. Može se javiti u bilo kom životnom dobu ali je incidenca najveća u periodu od 55. do 60. godine života. Gliomi mozga obuhvataju 2,5% ukupne smrtnosti od malignih bolesti i treći su uzrok smrtnosti od malignih bolesti u periodu od 15. do 34. godine starosti. Pseudoprogresija predstavlja pojavu lezije koja se prebojava kontrastom nakon hemoiradijacije i koja se povlači bez promene terapije. Sam fenomen ima izrazit klinički značaj zato što u veluikoj meri utiče na danje terapijske postupke ali kriterijumi za njeno dijagnostikovanje još uvek nisu jasno definisani. METODOLOGIJA: Ispitivani su pacijenti koji su operisani zbog glioblastoma u Kliničkom centru Srbije u periodu od 2010. do 2012. godine i kod kojih je sprovedena hemio- i zračna terapija. Radiološkim praćenjem je registrovana pseudoprogresija a zatim su ispitivani određeni faktori koji bi mogli da utiču na nastanak pseudoprogresije kao i uticaj pseudoprogresije na nastanak postiradijacione leukoencefalopatije i uticaj na preživljavanje pacijenata. REZULTATI: Na nastanak pseudoprogresije su uticali MGMT status, endotelijalna hiperplazija i prisustvo oligodendroglijalne komponente. Prisustvo kalcifikacija nije uticalo na nastanak pseudoprogresije. Pseudoprogresija je povezana sa nastankom postiradijacione leukoencefalopatije a nije uticala na preživljavanje pacijenata. ZAKLjUČAK: Na osnovu određenih karakteristika tumora može da se pretpostavi da li će doći do pojave pseudoprogresije što ima veliki značaj u svakodnevnom kliničkom radu., INTRODUCTION: Glioblastoma is the most aggressive glioma type. It makes about 50% of all glioma types and has the worst prognosis. In europe and North America glioblastoma incidence iz 3 per 100000. It can occur in all ages but the highest incidence is between 55. and 60. years. Gliomas are responsable for 2.5% of mortality of all malignant diseases and they are the third cause of death of malignant diseases in the age between 15 and 34 years. Pseudoprogression represent contrast enhancement lesion which regesses without therapy. Clinically this phenomena is very important beause it has a great influence on therapeutic procedures but, diagnostic criteria for pseudoprogression are not still precisely defined. METHODOLOGY: This research included patients who are operated because glioblastoma in Clinical centre Serbia in perod from 2010. to 2012. years. After operation it was performed radiotherapy and chemotherapy. Pseudoprogression was diagnosed by radiological following and after that we have determined influence of certain factors on pseudoprogression occurring and also it was determined influence of pseudoprogression on leukoenceephalopathy occurring and on patient survival. RESULTS: We show influence of MGMT status, endothelial hyperplasia and oligodendroglial component on pseudoprogression occurring. Calcifications didn’t have influence one pseudoprogression. Pseudoprogression is related with radioinduced leukoencephalopathy and didn’t have influence on patient’s survival. CONCLUSION: Based on certain tumor characteristics it can be assumed pseudoprogression occurring and it has great importance in everyday clinical practice.

Uvod: Gliomi su najčešći primarni tumori mozga čija je etiologija nepoznata. Cilj ove slučaj kontrola studije je bio da ispita vezu između glioma i različitih faktora rizika. Pacijenti i metode istraživanja: Slučaj kontrola studija je obuhvatila 100 ispitanika sa patohistološki potvrđenim gliomom i 200 ispitanika kontrolne grupe mečovanih po polu i godinama bez malignih bolesti u ličnoj i porodičnoj istoriji u Kliničkom centru Kragujevac. Nakon potpisivanja Informisanog pristanka svi pacijenti su popunjavali Epidemiološki upitnik. Za statističku obradu podataka korišćena je multivarijantna logistička regresija. Rezultati: Rezultati multivarijantne logističke regresije sugerišu da maligni tumori u porodici (OR=3.563 95%Cl 1.558–8.146, p=0.040), stres (OR=6.610 95%Cl 3.153–13.856, p<0.0005), konzumiranje piva (OR=5.131 95%Cl 2.722–18.820, p<0.0005), konzumiranje banana nedeljno i češće (OR=3.967 95%Cl 1.836–8.571, p <0.0005), konzumiranje krušaka nedeljno i češće (OR=5.238 95%Cl 2.381–11.523, p<0.0005) povećavaju rizik od nastanka glioma. Pozitivna porodična anamneza za šećernu bolest (OR=0.269 95% Cl 0.108–0.669, p=0.005), alergije (OR=0.070 95%Cl 0.015–0.429, p=0.003), uzimanje vitamina (OR=0.159 95%Cl 0.066–0.386, p<0.0005) i veća telesna težina (OR=0.966 95%Cl 0.942–0.991, p= 0.008) smanjuju rizik za pojavu glioma. Zaključak: Pozitivna porodična anamneza za maligne tumore u porodici povećava rizik za nastanak glioma oko dva puta. Stres u poslednjih godinu dana pre pojave bolesti povećava rizik za nastanak glioma za oko 3 puta. Takođe, konzumiranje piva, banana i krušaka nedeljno i češće povećava rizik za nastanak glioma. Opservirana je značajna inverzna veza između pozitivne porodične anamneza za šećernu bolest i veće telesne težine i rizika za nastanak glioma. Alergije smanjuju rizik za nastanak glioma za oko 5 puta, dok upotreba vitamina smanjuje rizik za nastanak glioma za oko 70%., Introduction:Gliomas are the most common primary brain tumors and the etiology is unknown. The purpose of this case control study was to examine the association between glioma and different risk factors. Patients and methods: The case-control study included 100 pathologically confirmed cases of glioma and 200 age- and sex-matched controls without malignant diseases in personal and family history at the Clinical centre Kragujevac. After signing the informed consent all the patients filled out an epidemiological questionnaire. Multivariate logistic regression is used in statistical data processing. Results:Results multivariate logistic regression suggest that positive family history of malignant disease (OR=3.563 95%Cl 1.558–8.146, p=0.040), stress (OR=6.610 95%Cl 3.153–13.856, p<0.0005), consuming beer (OR=5.131 95%Cl 2.722–18.820, p<0.0005), consuming bananas per week and more often (OR=3.967 95%Cl 1.836–8.571, p<0.0005), consuming pears per week and more often (OR=5.238 95%Cl 2.381–11.523, p<0.0005). positive family history of diabetes mellitus (OR=0.269 95%Cl 0.108–0.669, p=0.005), allergies (OR=0.070 95%Cl 0.015–0.429, p=0.003), taking vitamins (OR=0.159 95%Cl 0.066–0.386, p<0.0005) and higher body weight (OR=0.966 95%Cl 0.942–0.991, p=0.008) decreased risk of glioma. Conclusion: Positive family history of malignant disease increased risk of glioma for about 2-hold. Stress in the last year before the onset of the disease increased risk of glioma for about 3-hold. Аlso, consuming beer, banana and pears per week and more often increased risk of glioma. We observed significant inverse assotiation between positive family history of diabetes mellitus and higher body weight and risk of glioma. Allergies decreased risk of glioma for about 5-hold, while the use of vitamins decreased risk of glioma by about 70%.

Savremenim multidisciplinarnim lečenjem meduloblastoma hirurgijom, kraniospinalnom radioterapijom i hemioterapijom značajno je poboljšano preživljavanje bolesnika. Cilj rada je bila analiza ishoda lečenja i nezavisnih prognostičkih faktora i analiza trodimenzionalne konformalne radioterapije koja omogućava optimalnu uniformnost i konformalnost distribucije doze u željenom volumenu mete i veću poštedu okolnih zdravih tkiva. Metod: Istraživanje je obuhvatilo grupu od 87 dece sa meduloblastomom koji su lečeni u Institutu za onkologiju i radiologiju Srbije u periodu od januara 2000. do decembra 2013.godine. Rezultati: Srednji uzrast bio je 8,3 godine ( rang 2,5-17,3). Klasični meduloblastom imalo je 61 (70,1%), nodularni/dezmoplastični 23 (26,4%), a krupnoćelijski/anaplastični 3 (3,4%) bolesnika. U odnosu na metastatski stadijum bolesti 62 (71,3%) su bili M0, 12 (13,8%) M1, a 13 (14,9%) M2 i/ili M3. Totalnu resekciju je imao najveći broj 53 (60,9%), a skoro totalnu resekciju 22 (25,3%) bolesnika. 2D radioterapiju imalo je 50 (57,5%), a 3D 37 (42,5%) bolesnika. Hemioterapijom je lečeno 78 (89,7%), neoadjuvantnom 11 (13%), konkomitantnom 9 (10%) i adjuvantnom najveći broj bolesnika 73 (83,9%). Kada je istraživanje završeno 51 (58,6%) je bilo živo, a 31 (35,6%) je umrlo. Pet pacijenata je izgubljeno iz praćenja. Relaps bolesti imalo je 26 (29,9%) bolesnika. Medijana praćenja iznosila je 58 meseci (rang 4-187). Ukupno preživljavanje (OS) iznosi: trogodišnje 76,4%, petogodišnje 66,2% a desetogodišnje 59,2%. Preživljavanje bez znakova bolesti (DFS) iznosi: trogodišnje 75,8%, petogodišnje 62,8% i desetogodišnje 56,6%. Postoji statistički značajna razlika u ukupnom preživljavanju nemetastatskih ( M0) u odnosu na metastatske meduloblastome (M1,M2,M3) ( p=0,003) OS za grupu sa lokalizovanom bolesti (M0) iznosi: trogodišnje 86,4%, petogodišnje 74%, a desetogodišnje 63,1%. OS za grupu sa diseminovanom bolesti (M1,M2,M3) iznosi: trogodišnje 48,9%, petogodišnje 44%, a desetogodišnje, Standard treatment for meduloblastoma consists of surgery, craniospinal radiation and chemotherapy. The use of these modalities has resulted in improvement of survival. The aim of this study was to analize survival and independent prognostic factors and to analize three-dimensional conformal radiotherapy who is achieving optimal uniformity and conformality dose distribution in treated volume and to minimize the risk of normal tissue damage. Methods: Da on 87 children diagnosed with meduloblastoma who were treated at the Institute for Oncology and Radiology of Serbia between January 2000 amd December 2013 were analysed. Results: The median age was 8,3 years (range 2,5-17,3). The classis histologic variant was observed in 61 (70,1%), nodular/desmoplastic in 23 (26,4%) and large cell/anaplastic variant was observed in 3 (3,4%) patients. Meningeal dissemination within the subarachnoid space ( cranial M2 or spinal M3) was observed in 13 (14,9%) and microscopic metastases within the CSF ( M1) was observed in 12 (13,8%) patients. Most of the patients (62,71,3%) had no metastatic disease (M0). Gross total resection had the most of the patients 53 (60,9%) and near total had 22 (25,3%) patients. Two-dimensional radiotherapy received 50 (57,5%) and three-dimensional radiotherapy received 37 (42,5%) patients. Chemotherapy was used in 78 (89,7%) patients. Postoperative neoadjuvant chemotherapy was used in 11 (13%), chemotherapy during the raditherapy was used in 9 (10%) patients. The majority of patients (73 83,9%) were treated with adjuvant platinum-based chemotherapy. At the end of the study 51 (58,6%) were alive and 31 (35,6%) had died. Five patients were lost to follow-up. Twenty-six (29,9%) patients relapsed. The median follow-up time was 50 months ( range 4-187)...

Multiformni glioblastom predstavlja najčešći maligni primarni tumor mozga u odraslih. Incidenca ovog tumora je 2 do 3 na 100 000 stanovnika godišnje u Evropi. Srednja dužina preživljavanja je 12-18 meseci, u zavisnosti od prognostičkih parametara a stopa petogodišnjeg preživljavanja oko 4%. U literaturi su definisani prognostički faktori koji su povezani sa dužim preživljavanjem, a to su godine starosti pacijenta, stepen resekcije tumora kao i genski profil tumora. Savremeni pristup lečenju ovih pacijenata predstavlja multidisciplinarni pristup, gde operacija predstavlja samo prvi korak u lečenju, dok onkološka terapija zajedno sa intenzivnim praćenjem i pravovremenom reoperacijom u odabranim slučajevima omogućava produžetak preživljavanja, kao i bolji kvalitet života ovih pacijenata. Temozolomid je prvi hemioterapeutik koji je postigao značajan pomak u preživljavanju. Srednje preživljavaje je pomereno sa 12,1 na 14,6 meseci, dok je dvogodišnje preživljavanje sa standardnim protokolom 10,4% pomereno na 26,5%. Ciljevi Ciljevi ovog istraživanja obuhvataju određivanje procenta dvogodišnjeg preživljavanja, kao i procenu faktora koji utiču na dužinu preživljavanja, određivanje značaja stepena hirurške resekcije tumora, upoređivanje dužine preživljavanja pacijenata koji su dobijali karmustin ili lomustin sa onima koji su bili na terapijii temozolomidom, ispitativanje uticaja reoperacije i sekundarne hemioterapije na preživljavanje pacijenata i utvrđivanje kriterijuma za definisanje pseudoprogresije kod pacijenata koji su dobijali zračnu terapiju konkomitantno sa temozolomidom..., Glioblastoma multiforme is the most common malignant primary brain tumor in adults. The incidence of this tumor is 2 to 3 per 100 000 inhabitants per year in Europe. The median survival rate is 12-18 months, depending on the prognostic parameters, and the five-year survival rate is about 4%. The literature defines prognostic factors that are associated with longer survival, which are the age of the patient, the degree of tumor resection, and genetic profile of the tumor. The modern approach to the treatment of these patients is a multidisciplinary approach, where the operation is only the first step in the treatment, while oncological therapy, together with intensive monitoring and timely reoperation in selected cases, allows an extension of survival as well as a better quality of life for these patients. Temozolomide is the first chemotherapeutic who has made significant progress in survival. Mean survival was shifted from 12.1 to 14.6 months, while two-year survival with a standard protocol of 10.4% was shifted to 26.5%. Aims The objectives of this study include determining the percentage of two-year survival, as well as assessing the factors that influence the survival rate, determining the significance of the degree of surgical tumor resection, comparing the length of survival of patients who received carmustin or lomustin with those who were on therapy with temozolomide, examining the effect of the reoperation and secondary chemotherapy on survival of patients and determination of criteria for defining pseudoprogression in patients receiving radiotherapy concomitant with temozolomide. Methodology In the period from January 2010 to December 2012, 110 patients with newly diagnosed glioblastoma were operated on Neurooncology department. The data were collected prospectively, recorded in the electronic database, and subsequently analyzed retrospectively...