Search

Introduction: Within the past two decades, we made significant progress in radiation therapy for prostate cancer. At UH Rijeka IMRT became the technique of choice for radiation therapy following radical prostatectomy since 2016. Previously, an advanced 3-DCRT technique using the field-in-field (FiF) method was used for dose distribution optimization around target volumes and organs-at-risk. This research has been performed to investigate the influence of planning technique choice (FiF or IMRT) on coverage of target volumes with prescribed dose and organs-at-risk sparing. Materials and methods: Comparison of dose distributions calculated using FiF and IMRT techniques was performed retrospectively for ten patients who underwent postoperative radiotherapy. The prescribed dose for all patients was delivered using IMRT, and for this research, we also calculated dose distributions using the FiF technique. For FiF and IMRT techniques, we used linear accelerator photon beams. To determine the influence of planning technique on dose distribution parameters related to target volumes (GTV, CTV, PTV1, PTV2) were analyzed. For organs-at-risk sparing evaluation (rectum, bladder, femoral heads), we used dose-volume constraints. Results and discussion: The analysis of parameters related to target volumes has shown that most of them had no statistically significant difference (V100%(GTV), V100%(CTV), V95%(PTV2), V95%(PTV1)). For both planning techniques, internationally set dose constraints were achieved. Statistically, we found a significant difference for V100%(PTV2), p=0,000534, and V100%(PTV1), p=0,042944 in favor of IMRT. A statistically significant difference (p=0,045966) was found for the volume of the rectum, which receives 40Gy, and for the volume of femoral heads, which receives 30Gy (p=0,000385), where the sparing is better for IMRT. For dose-volume constraints related to the bladder, no statistically significant differences were found. Conclusion: Results of this research show a statistically significant difference for V100% target volume coverage for PTV1 and PTV2, with better dose coverage accomplished by IMRT. Concerning organs-at-risk sparing, a statistically significant difference in favor of IMRT was found for rectum volume, which receives 40Gy. Expectedly, IMRT was superior to the FiF technique. However, differences between the two planning techniques were relatively small, which points to the fact that the FiF technique is viable as a technique of choice. Uvod: U posljedna dva desetljeća, u liječenju raka prostate radioterapijom postignut je veliki napredak. U KBC-u Rijeka, od 2016., jakosno modulirana radioterapija (IMRT) postaje tehnika izbora kod radioterapije operiranog raka prostate. Do tada je tehnika izbora bila napredna 3D konformalna radioterapija (3DCRT) korištenjem tehnike „polja u polju” (FiF). Istraživanje je provedeno s ciljem ispitivanja utjecaja izbora tehnike planiranja (FiF ili IMRT) na doznu pokrivenost ciljnih volumena i poštedu organa rizika. Metode i materijali: Usporedba raspodjela doze izračunate koristeći FiF i IMRT retrospektivno je učinjena kod deset bolesnika kojima je indicirana postoperativna radioterapija. Svim je bolesnicima predana propisana doza IMRT tehnikom, a za potrebe ovog istraživanja izračunate su i raspodjele doze FiF tehnikom. Da bi se utvrdilo utječe li tehnika planiranja na raspodjelu doze, analizirani su parametri važni za ciljne volumene (GTV, CTV, PTV1, PTV2), a kod analize poštede organa rizika (rektum, mokraćni mjehur i glavice femura) korištena su dozno-volumna ograničenja. Rezultati i diskusija: Analizom parametara vezanih za ciljne volumene utvrđeno je da kod većine (V100%(GTV), V100%(CTV), V95%(PTV2), V95%(PTV1) nema statistički značajne razlike. Kod obje tehnike postignuta su dozna ograničenja propisana međunarodnim smjernicama. Statistički značajna razlika utvrđena je kod V100%(PTV2), p=0,000534 i V100%(PTV1), p=0,042944 u prilog korištenja IMRT tehnike. Utvrđena je statistički značajna razlika (p=0,045966) za volumen rektuma koji prima 40Gy, kao i za volumen glavica femura koji prime apsorbiranu dozu 30Gy. U oba slučaja pošteda organa rizika bolja je korištenjem IMRT tehnike. Za promatrana dozno-volumna ograničenja vezana uz mokraćni mjehur nije utvrđena statistički značajna razlika. Zaključak: Rezultati istraživanja pokazuju statistički značajnu razlikukod usporedbe volumena kojemu je predana propisana apsorbirana doza (V100%) za PTV1 i PTV2, tako da je bolja dozna pokrivenost kod IMRT tehnike. Pri poštedi organa rizika statistički značajna razlika u korist IMRT-a utvrđena je kod analize volumena rektuma kojem je predana apsorbirana doza od 40Gy i volumena glavica femura kojima je predana apsorbirana doza od 30Gy. Prema očekivanju, IMRT daje bolje rezultate. Međutim, razlike u analiziranim parametrima između dvije tehnike planiranja (FiF ili IMRT) kod većine analiziranih parametara nisu statistički značajne što upućuje da kvalitetno planirana radioterapija FiF tehnikom može također biti tehnika izbora.

Introduction: With the development of medical linear accelerator and algorithms for absorbed dose calculation and optimization, a great progress has been made in radiotherapy treatment of prostate cancer [1]. At UH Rijeka, since 2016, when the system for dose distribution optimisation based on Monte Carlo calculation has been clinically implemented, IMRT technique (inverse IMRT, I-IMRT) became the technique of choice for radiotherapy treatment following radical prostatectomy [2]. Previously, advanced 3-DCRT technique using field-in-field method was used for dose distribution optimisation around target volumes and organs-at-risk (forward IMRT, F-IMRT). This research has been performed with purpose of investigating how choice of planning technique (F-IMRT or I-IMRT) affects coverage of target volumes with prescribed dose and organs- at-risk sparing. Methods and materials: Comparison of dose distributions calculated using F-IMRT and I-IMRT techniques was done for 10 patients with indicated post-operative radiotherapy, and whose treatment was carried out at the Clinic for Radiotherapy and Oncology at UH Rijeka. Prescribed dose for all patients was delivered using I-IMRT technique, and for purpose of this research, dose distributions using F-IMRT technique were calculated. Absorbed dose of 46Gy was delivered to target volume PTV1 , created by adding a 0.7cm margin around lymph nodes (CTV) and 1.0cm around prostate bed (GTV). Additional 22Gy were delivered to target volume PTV2 with 1.0cm margin around prostate bed [2]. For I-IMRT and F-IMRT techniques, photon beams of linear accelerator equipped with a 160 leaf MLC were used. To determine the influence of planning technique on dose distribution, parameters related to target volumes (GTV, CTV, PTV1 , PTV2 ) were analysed. For organs-at-risk sparing (rectum, bladder, femoral heads), three dose- volume constraints were used. Results and discussion: By analysing parameters related to target volumes, most of them shown no statistical significance (V100%(GTV), V100%(CTV), V95%(PTV2 ), V95%(PTV1 ), D2%). For both planning techniques, internationally set [3] dose constraints were achieved: for GTV, V100%=98, 8±1, 3 (F-IMRT) and V100%=99, 9±0, 2 (I-IMRT), for CTV, V100%=99, 4±0, 9 (F-IMRT) and V100%=99, 4±0, 8 (I-IMRT), for PTV2 , V95%=99, 9±0, 2 (F- IMRT) and V95%=99, 7±0, 4 (I-IMRT), and for PTV1 , V95%=99, 3±0, 6 (F-IMRT) and V95%=99, 9±0, 1(I- IMRT). Statistically significant difference was found for V100%(PTV2 ), p=0, 000534 and V100% (PTV1 ), p=0, 042944 in favour of I-IMRT technique. For PTV2 , V100%=91, 6±3, 8 for F-IMRT and V100%=97, 9±1, 4 for I-IMRT and for PTV1 , V100%=93, 3±2, 0 for F-IMRT and V100%=95, 8±2, 5 for I-IMRT. Comparing the effect of planning technique to organs-at-risk sparing, statistically significant difference (p=0, 045966) was found for V40Gy for rectum where the sparing is better for I-IMRT technique. For dose- volume constraints related to bladder and femoral heads, no statistically significant difference was found. Conclusion: Results of this research show statistically significant difference for minimal absorbed dose delivered to target volumes PTV1 and PTV2 , with better dose coverage in favour of I-IMRT. Concern- Lib Oncol. 2020 ; 48(Suppl 1):73–143 90 ing organs-at-risk sparing, statistically significant difference in favour of I-IMRT was found for V40Gy for rectum. Expectedly, I-IMRT technique provided better results [4]. However, differences for two planning techniques (F-IMRT and I-IMRT) for analysed parameters are rather small which points to the fact that well-executed radiotherapy planning by using F-IMRT technique can be used as a technique of choice as well.

Adenokarcinom prostate najčešća je zloćudna neoplazma u muškaraca u Republici Hrvatskoj. Klinički je često asimptomatski, a najčešće se otkriva na osnovi povišenih vrijednosti PSA u serumu. Odluka o liječenju donosi se na temelju TNM-klasifikacije, gradusne skupine i vrijednosti PSA. Klinički lokalizirana bolest vrlo se uspješno liječi radikalnom prostatektomijom ili radikalnom radioterapijom s hormonskom terapijom ili bez nje. Klinički lokalno uznapredovala bolest najčešće se liječi združenom primjenom radikalne radioterapije i hormonske terapije. Metastatska bolest godinama se može kontrolirati androgenom deprivacijom, a nakon razvoja kastracijski rezistentne bolesti opravdani su kemoterapija ili dodatni oblici hormonske terapije. U radu su prikazane kliničke upute radi ujednačenja postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnika s rakom prostate u Republici Hrvatskoj., Prostate adenocarcinoma is the most common solid neoplasm in male population in Croatia. It is often asymptomatic. The finding of PSA rise is the most common reason for diagnostic workout. Treatment plan is based on TNM classification, grade group and PSA. Clinically localized disease is successfully treated by radical prostatectomy or radiotherapy with or without hormonal therapy. Locally advanced disease is treated with radiotherapy and hormonal therapy. Metastatic disease can be controlled for many years by androgen deprivation. For castration resistant metastatic disease appropriate treatment is chemotherapy or secondary hormonal therapy. The following paper presents the clinical guidelines to standardize procedures for the diagnosis, treatment and follow-up of patients with prostate cancer in the Republic of Croatia.

Svjetlostanični karcinom bubrežnih stanica najčešći je oblik raka bubrega. Klinički je uglavnom asimptomatski, a samo se kod manjeg postotka bolesnika očituje hematurijom, tupom boli i palpabilnom masom u trbuhu. Najčešće se otkrije slučajno tijekom radioloških pregleda zbog nekoga drugog razloga. Dijagnoza raka bubrega potvrđuje se patohistološkim nalazom nakon provedene dijagnostičke obrade. Odluka o liječenju donosi se temeljem kliničke procjene stadija bolesti i drugih čimbenika rizika. Ovisno o tome, mogućnosti liječenja uključuju kirurški zahvat, sustavnu terapiju malim molekulama, imunoterapiju, kemoterapiju u odabranih bolesnika te palijativnu radioterapiju. U tekstu koji slijedi predstavljene su kliničke upute radi standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnika s rakom bubrega u Republici Hrvatskoj., Clear cell cancer is the most common form of kidney cancer. Clinically, it is mostly asymptomatic, and only a small proportion of patients present with hematuria, pain, and palpable abdominal mass. It is most commonly detected incidentally during radiological examinations for other causes. Diagnosis of kidney cancer is confirmed by pathohistological findings after the radiological imaging procedures. The decision on optimal treatment is based on a clinical assessment, stage of the disease and the presence of other risk factors. Depending on this, treatment options include surgical procedure, systemic treatment with small molecules, immunotherapy, chemotherapy in selected patients, and palliative radiotherapy. In the following text clinical guidelines have been presented to standardize procedures and criteria for diagnosing, treating and monitoring kidney cancer patients in the Republic of Croatia.

Intensity modulated radiation therapy (IMRT) is one of the most advanced techniques used for radiation therapy treatment. Medical Physics Department of University Hospital Rijeka acquired a treatment planning system (TPS) dedicated to IMRT (Elekta Monaco) in 2015 and the first patient treatments started in March of 2016. All IMRT patients are treated at the Siemens Oncor Expression linear accelerator equipped with 160 multi leaf collimator. Width of each leaf at the isocenter plane is 5mm. An extensive set of measurements was undertaken to prepare the TPS for clinical use of IMRT in order to achieve high accuracy of dose calculation. Protocols for IMRT treatment planning were also developed. Since the implementation of IMRT, 218 patients were treated and 288 dose distributions were calculated, dosimetrically verified and evaluated. Method of simultaneous integrated boost was used for a certain number of patients, where dose is delivered in up to three different dose levels. Most common treated anatomical sites are head and neck (H&N), post operative prostate and central nervous system (CNS). The main reasons for IMRT implementation to those anatomies is irregular shape of the target volumes and the vicinity of organs at risk (OAR). IMRT solved most of the issues related to the dose conformity for concavely shaped target volumes and OAR sparing. Calculated absorbed dose distributions are optimized so that minimum of 90% of the planning target volume is covered with the 100% of the prescribed dose, and that minimum of 98% of gross target volume is covered with 100% of the prescribed dose. Clinical implementation of IMRT requires a comprehensive quality assurance (QA) program of whole radiotherapy treatment process. Important part of QA program is Patient Specific Dosimetry (PSD), a dosimetric verification and evaluation of individual patient radiotherapy treatment absorbed dose distributions by assessing agreement between calculated and measured dose distributions. To evaluate the agreement between dose distributions, gamma method is applied. The acceptable criteria requires that 95% of evaluated points pass the gamma test with applied 3% dose difference and 3mm distance to agreement. Passing rates for all dose distributions were evaluated and the average gamma passing rate for each anatomical site was calculated. Average gamma passing rate for H&N site is 97.24%, for CNS site is 98.84% and for prostate site is 97.60%. The results show very good agreement between measured and calculated dose distributions. In order to satisfy rigorous acceptable dose calculation criteria, calculation settings were optimized concerning number of segments, number of monitor units per segment, segment area and segment width. In that way we were able to achieve dose distributions which fulfill clinical criteria and satisfy linear accelerator performance and PSD tolerance criteria. We can conclude that achieving such good results stems partially from efficient preparation of the TPS. Another contribution to the achievement of good gamma passing rates is well defined QA program of whole radiotherapy treatment process, especially of the linear accelerator performance. In conclusion, well prepared and routine QA program enables the best possible IMRT plan for the patient.

Urothelial urinary bladder carcinoma represents 9th most common malignancy in the world. This disease is held responsable for more than 165000 deaths throughout the world. In the past 30 years there were no major advances in treatment of this tumor. Chemotherapy regimens used for treatment are based on platinum compounds. In a recent time a series of immune system modulating drugs have been developed. This drugs have achieved excellent results in the treatment of urinary bladder carcinoma., Karcinom mokraćnog mjehura je deveti najčešći maligni tumor u svijetu. Bolest je uzrok više od 165.000 smrtnih slučajeva. U posljednjih 30 godina nije bilo većih pomaka u mogućnostima liječenja ovoga tumora. Kemoterapijski protokoli za liječenje uznapredovale ili metastatske bolesti mokraćnog mjehura bazirani su uglavnom na spojevima platine. U posljednje vrijeme razvijen je niz novih lijekova koji moduliraju imunološki odgovor organizma na tumorske stanice i time omogućavaju uspješno liječenje karcinoma mokraćnog mjehura.

Napredak u razumijevanju i poznavanju molekularnih puteva rasta i razvoja tumora bubrega doveo je do razvoja čitavog niza lijekova kojima je danas moguće liječiti oboljele od ove bolesti. Brojne kliničke studije dokazale su učinkovitost novih terapija. Svakodnevna primjena posljednjih dostignuća svjetske znanosti omogućava ostvarenje jednog od primarnih onkoloških ciljeva, a to je izlječenje pacijenata ili pretvaranje ove teške bolesti u dugotrajnu kroničnu bolest., Improvement in knowledge of molecular pathways of growth and developement of malignant kidney cancer has led to development of a number of efficient drugs. In this way the treatment of this condition nowadays is possible and successfull as documented by many clinical trials. New ways of treating kidney cancer tend to fulfill primary oncology goals which are to cure completely the patient or to make this serious disease a longlasting chronic disease.

Uvod Jakosno modulirana terapija zračenjem (IMRT) predstavlja jednu od najnaprednijih metoda liječenja onkoloških bolesnika ionizirajućim zračenjem. Primjena IMRT omogućuje bolju kontrolu tumora i znatno smanjenje doze na zdravo tkivo, u odnosu na 3D konformalnu terapiju (3DCRT). U sklopu projekta Međunarodne agencije za atomsku energiju (IAEA-CRO6012) koji je vodio Centar za medicinsku fiziku i zaštitu od zračenja nabavljen je najsuvremeniji sustav za planiranje IMRT (Elekta Monaco) čime su u KBC Rijeka stvoreni uvjeti za uvođenje IMRT. U radu je dan prikaz provedenih radnji nužnih za implementaciju jakosno modulirane terapije u kliničku praksu. Materijali i metode Prvi korak u procesu implementacije IMRT je nadogradnja postojećeg sustava osiguranja kvalitete linearnog akceleratora kako bi svi parametri bili podešeni do na visoku točnost. Nakon toga se izvode procedure prihvata sustava za planiranje. U tu svrhu fizičari trebaju provesti opsežno eksperimentalno vrednovanje računalnih algoritama, kao i ostalih komponenata sustava za planiranje. Ono se provodi različitim dozimetrijskim metodama u homogenim i antropomorfnim fantomima. IMRT korištenjem velikog broja malih polja zračenja omogućuje visok stupanj konformacije raspodjele doze prema ciljnim volumenima stoga su točnost i reproducibilnost ključne pa je potrebno voditi računa o svakom segmentu radioterapijskog procesa. IMRT se indicira u pacijenata dobrog općeg stanja kako bi mogućnost prekida terapije i/ili komplikacija bila što manja. Iznimno, uslijed procesa planiranja terapije, može se odabrati IMRT ako se s 3DCRT ne može postići zadovoljavajuća raspodjela doze. Slijedi uzorkovanje CT presjeka anatomskog područja od interesa s visokom točnosti pozicioniranja pacijenata, vodeći računa o njegovoj ponovljivosti kako bi položaj pri izvođenju terapije bio jednak onom na temelju kojeg je izrađen plan terapije. U svrhu smanjenja promjena u anatomiji pacijenta određen je vremenski okvir od CT skeniranja do početka IMRT terapije od najviše 7 dana. Dodatna optimizacija raspodjela doze vezana je za definiranje liste anatomskih struktura koje je potrebno ocrtati u ovisnosti o tumorskom sijelu. Definirane su tehnike planiranja te zadani uvjeti vezani za segmentaciju polja zračenja kao i minimalni uvjeti točnosti izračuna. Kao konačan pokazatelj kvalitete razvijena je dozimetrijska verifikacija IMRT planova koja se izvodi prije početka terapije. Rezultati i zaključak Klinička primjena IMRT započela je u prvoj polovici 2016. i do danas je tretirano 40 pacijenata. Rigorozna provjera sustava i procesa terapije te jasno definirana metodologija doveli su do učinkovite implementacije ove kompleksne metode, uz značajnu korist pacijentima i osiguranje visoke kvalitete svih pojedinačnih koraka u procesu planiranja, kao i izvođenja terapije.

Implementation of immunotherapy in many cancer types has achieved positive results in tumor control and cure. The concept of immunotherapy is diff erent in comparison with conventional tumor therapies. While chemotherapy, hormonal or biological therapies target tumor cells and mechanisms, immunotherapy targets host immune system. Amplifi cation of defending possibilities or unblocking the control of the immune reactions are used. Besides positive results in tumor control, enhancing immunogenicity can provoke harm to other tissues and systems in form of adverse reactions or unwanted side effects of therapy. Early recognition of side effects is of crucial importance and prompt care can diminish the harm and severity. Knowledge about side effects is needed, therefore good education of all medical personnel included in treatment as well as patient education must be assured prior and thorough the treatment. Writt en guidelines are provided and easy reachable and must be used., Provedba imunoterapije u mnogim vrstama karcinoma postigla je pozitivne rezultate u kontroli i liječenju tumora. Koncept imunoterapije razlikuje se u usporedbi s konvencionalnim terapijama tumora. Dok su kemoterapija, hormonska ili biološka terapija svojim djelovanjem usmjerena na uništenje tumorske stanice i mehanizama u tumoru, imunoterapija cilja imunološki sustav domaćina. Pri tome se jačaju obrambeni procesi i reakcije ili se korištenjem imunoterapije dovodi do deblokiranja procesa kontrole imunoloških reakcija. Osim pozitivnih rezultata u kontroli tumora, povećanje imunogenosti može izazvati štetu drugim tkivima i sustavima u obliku nuspojava ili neželjenih nuspojava terapije. Rano prepoznavanje nuspojava od presudne je važnosti, a pravodobno zbrinjavanje može smanjiti oštećenje i težinu popratne pojave. Znanje o mogućim nuspojavama je nužno osigurati kroz dobro i sveobuhvatno obrazovanje svih medicinskih djelatnika uključenih u liječenje, a jednako je tako važno podučiti i s popratnim pojavama upoznati i pacijenata prije liječenja. Pisane smjernice pružene su i lako dostupne i moraju se koristiti.

Radioterapija je jedan od terapijskih postupaka u liječenju zloćudnih bolesti. Ova metoda podrazumijeva primjenu ionizirajućeg zračenja, odnosno upotrebu čestica ili fotona velike energije koji, ionizijarući molekule i atome, oštećuju genetski materijal žive stanice (molekulu DNK-a). Time se onemogućava daljnji rast stanica i njihovo razmnožavanje, što rezultira odumiranjem stanica. Zračenje negativno utječe i na okolne zdrave stanice, ali se one relativno brzo oporavljaju od negativnih utjecaja zračenja. Nuspojave koje se javljaju kao posljedica zračenja mogu izazvati bol i nelagodu. Izraženost nuspojava ovisi o dozi zračenja i lokaciji tumora koji se zrači, ali i o općem stanju te imunološkom statusu pacijenta, pa tako neki pacijenti gotovo da uopće neće imati nuspojave, a drugi će imati velike tegobe., Radiation therapy is one of the methods of treatment of malignant diseases. This method involves the application of ionizing radiation, and the use of particles and high-energy rays that, turning the atoms into ions, damage the genetic material of living cells (DNA molecule). This prevents further growth of the cells and their proliferation resulting from cell. Radiation negatively affects the surrounding healthy cells, but they are relatively quickly recover from the adverse effects of radiation. Side effects that occur as a result of radiation can cause pain and discomfort. Expression of side effects depends on the dose of radiation and the location of the tumor is irradiated, but also on the immune status of the patient, so some patients seem almost will not have side effects and others will have big problems.

UVOD: Perfuzija magnetskom rezonancom (MRP) je neinvazivna metoda, koju koristimo kao brzu i jednostavnu nadopunu standardnompregledu MR mozga, a omogućuje nam procjenu diferencijalne dijagnoze, gradusa tumora preoperativno, razgraničenja tumora prema zdravom tkivu, procjenu rezidue/recidiva/terapijski inducirane nekroze, terpaijskog odgovora i kao pomoć pri stereotaksijskoj biopsiji. Temelji se na mjerenju pada signala u zdravom tkivu, koji u bolesnom varira ovisno o mikrovaskularizaciji zbog čega nam omogućuje procjenu neovaskularizacije. Parametri koje mjerimo su: rCBV (ml/100 g), rCBF (ml/100 g/min), MTT (MTT=CBV/CBF), CBF je najvažniji prediktor agresivnosti tumora i preživljavanja. CILJ: Cilj našeg istraživanja je praćenje učinka terapije – procjena rezidue/recidiva tumora, terapijski inducirane nekroze i njhove kombinacije. METODE: Skupina od 36 bolesnika u dobi od 31-77 godina (18 muškaraca i 18 žena) s gliomskim tumorom visokog gradusa (III – 7 bolesnika, i IV – 29 bolesnika) skenirani su tijekom 2 godine na uređaju jačine 1, 5 T (T2*, 24 axial sl, TR=1940 ms, TE= 30 ms, FOV= 230 mm, matrix= 128x128). Praćeni su prijeoperativno, postoperativno te po provedenoj kemoterapiji i radioterapiji. REZULTATI: Kod 8/36 (22%) ispitanika nije uočena ni rezidua/recidiv tumora niti terapijski inducirana nekroza. Postojanje rezidue/recidiva tumora bez prisutnosti terapijski inducirane nekroze ustanovljeno je kod 14/36 (39%) pacijenata. Terapijski inducirana nekroza bez rezidue/recidiva tumora javila se kod jednog pacijenta 1/36 (3%). Istovremena prisutnost rezidue/recidiva tumora i terapijski inducirane nekroze utvrđena je za 13/36 (36%) ispitanika. ZAKLJUČAK: Naši rezultati potvrdili su MRP kao metodu koja omogućava procjenu postojanja recidiva/rezidue gliomskog tumora uz razlikovanje terapijski inducirane nekroze. Metoda je brza i jednostavna i predstavlja nadopunu osnovnih sekvenci kod skeniranja mozga megnetskom rezonancom. MRP je dio standardnog protokola za praćenje ovih bolesnika u KBC Rijeka.

Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia.

Urotelni rak najčešći je rak mokraćnog mjehura. Hematurija je najčešći simptom pri prezentaciji bolesti. Dijagnoza raka mokraćnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon čega slijedi patohistološka dijagnoza. Nužno je utvrditi je li rak zahvatio mišićni sloj (mišićnoinvazivni rak) ili nije (mišićnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliničkom stadiju bolesti, prognostičkim čimbenicima i čimbenicima rizika. Za mišićnoneinvazivni rak mokraćnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraćnog mjehura s intravezikalnom instilacijom Calmette-Guérinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najčešće se liječi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog članka predstavljanje kliničkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom mokraćnog mjehura u Republici Hrvatskoj., Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia.

Urotelni rak najčešći je rak mokraćnog mjehura. Hematurija je najčešći simptom pri prezentaciji bolesti. Dijagnoza raka mokraćnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon čega slijedi patohistološka dijagnoza. Nužno je utvrditi je li rak zahvatio mišićni sloj (mišićnoinvazivni rak) ili nije (mišićnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliničkom stadiju bolesti, prognostičkim čimbenicima i čimbenicima rizika. Za mišićnoneinvazivni rak mokraćnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraćnog mjehura s intravezikalnom instilacijom Calmette-Guérinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najčešće se liječi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog članka predstavljanje kliničkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom mokraćnog mjehura u Republici Hrvatskoj.