Kliničkopatološke karakteristike, dijagnoza i lečenje melanoma u Srbiji – The Melanoma Focus studija

  • Lidija Kandolf-Sekulović Clinic for Dermatovenerology, Military Medical Academy, Belgrade Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Nada Babović Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
  • Neven Jokić Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
  • Mirjana Balić Clinic for Oncology, Clinical Center, Niš, Faculty of Medicine, Niš, Serbia
  • Borislava Nikolin Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia
  • Dejan Nikolić University Hospital Medical Center “Bežanijska Kosa”, Medical Faculty, University of Belgrade, Belgrade, Serbia
  • Zlata Janjić Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
  • Željko Mijušković Clinic for Dermatovenerology, Military Medical Academy, Belgrade Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Milica Rajović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Plastic and Reconstructive Surgery, Military Medical Academy, Belgrade Serbia
  • Marijan Novaković Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Plastic and Reconstructive Surgery, Military Medical Academy, Belgrade Serbia
  • Svetislav Vrbić Clinic for Oncology, Clinical Center, Niš, Faculty of Medicine, Niš, Serbia
  • Ivica Pejčić Clinic for Oncology, Clinical Center, Niš, Faculty of Medicine, Niš, Serbia
  • Predrag Kovačević Clinic for Plastic and Reconstructive Surgery, Clinical Center, Niš, Faculty of Medicine, Niš, Serbia
  • Dragan Mihajlović Clinical Center Niš, Niš, Serbia
  • Tatjana Roganović Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia
  • Vicko Ferenc Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia
  • Jelena Nikolić Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
  • Marija Marinković Clinical Center of Vojvodina, Novi Sad, Serbia
  • Zorana Bizetić Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
DOI: https://doi.org/10.2298/4657
Ključne reči: melanoma||, ||melanom, diagnosis||, ||dijagnoza, neoplasm staging||, ||neoplazme, određivanje stadijuma, neoplasm metastasis||, metastaze, therapeutics||, ||lečenje, clinical protocols||, ||protokoli, klinički,

Sažetak


Uvod/Cilj. Terapijske mogućnosti za metastatski melanom u Srbiji su ograničene zbog nedostupnosti novoodobrenih bioloških lekova i veoma malog broja multicentričnih internacionalnih kliničkih studija. Takođe, postoji mali broj podataka o terapijskom pristupu metastatskom melanomu u različitim tercijarnim centrima i efikasnosti raspoloživih protokola hemioterapije. Cilj ove studije bio je da se dobiju detaljniji podaci o protokolima lečenja u Srbiji, na osnovu strukturisane ankete u tercijarnim onkološkim centrima. Metode. Podaci o obolelima od melanoma, lečenih u 2011. godini u Srbiji, dobijeni su i analizirani iz bolničkih baza šest referentnih onkoloških centara u Srbiji, na osnovu strukturisane ankete, sa fokusom na metastatski melanom (inoperabilni stadijum IIIC i IV). Rezultati. Ukupno je lečeno 986 (79–315 u različitim centrima) bolesnika, od čega je 320 (32,45%) bilo novodijagnostikovanih. Bilo je 317 bolesnika u stadijumu inoperabilnog melanoma IIIC/IV, 77/317 (24,29%) starosti < 50 godina. U vreme postavljanja dijagnoze 47,3% bolesnika bili su < 60 godina starosti (24,2% < 40 godina, 38% 40–60 godina, 46% > 60 godina). Kod 12,5% bolesnika dijagnoza je postavljena u stadijumu III, a kod 4,5% u stadijumu IV bolesti. Najčešći kliničkopatološki tip bio je površnošireći (50–66%) i nodularni melanom (23,5–50%). Osim regionalnih i udaljenih metastaza limfnih čvorova, najčešće zahvaćeni organi u IV stadijumu bolesti bili su; udaljene metastaze kože i mekih tkiva (12–55%), pluća (19–55,5%), jetra (10–60%) i kosti (3–10%). Prva linija terapije u inoperabilnom stadijumu III i stadijumu IV metastatskog melanoma bio je dakarbazin (dimetril-triazeno-imidazol-karboksamid – DTIC) kod 61–93% bolesnika, dok je druga linija varirala između centara. Kontrola bolesti (kompletan odgovor + parcijalan odgovor + stabilna bolest) ostvarena je kod 25,7% bolesnika lečenih prvom linijom hemioterapije i 23,1% bolesnika sa drugom linijom terapije. Trajanje odgovora bilo je kratko: u prvoj liniji terapije 6,66 ± 3,36 meseci (medijana 6,75 meseci). Više od 90% bolesnika lečeni su van kliničkih studija. Zaključak. Ovo istraživanje ukazuje da postoji velika potreba za novim terapijskim opcijama za lečenje metastatskog melanoma u Srbiji. Razvoj nacionalnih smernica i veće učešće u međunarodnim kliničkim studijama može dovesti do proširenja opcije za lečenje ove bolesti otporne na hemioterapiju.

Biografije autora

Lidija Kandolf-Sekulović, Clinic for Dermatovenerology, Military Medical Academy, Belgrade Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Prof. MD, PhD
Nada Babović, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
MD, PhD
Neven Jokić, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
MD
Mirjana Balić, Clinic for Oncology, Clinical Center, Niš, Faculty of Medicine, Niš, Serbia
Prof., MD, PhD
Borislava Nikolin, Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia
Assistant Professor, MD, PhD
Dejan Nikolić, University Hospital Medical Center “Bežanijska Kosa”, Medical Faculty, University of Belgrade, Belgrade, Serbia
Associate professor, MD, PhD
Zlata Janjić, Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
Prof. MD, PhD
Željko Mijušković, Clinic for Dermatovenerology, Military Medical Academy, Belgrade Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Associate professor, MD, PhD
Milica Rajović, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Plastic and Reconstructive Surgery, Military Medical Academy, Belgrade Serbia
MD
Marijan Novaković, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Plastic and Reconstructive Surgery, Military Medical Academy, Belgrade Serbia
Prof. MD, PhD
Ivica Pejčić, Clinic for Oncology, Clinical Center, Niš, Faculty of Medicine, Niš, Serbia
MD PhD
Predrag Kovačević, Clinic for Plastic and Reconstructive Surgery, Clinical Center, Niš, Faculty of Medicine, Niš, Serbia
prof. MD, PhD
Dragan Mihajlović, Clinical Center Niš, Niš, Serbia
Prof. MD, PhD
Tatjana Roganović, Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia
MD, PhD
Vicko Ferenc, Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia
MD, PhD
Jelena Nikolić, Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
MD
Marija Marinković, Clinical Center of Vojvodina, Novi Sad, Serbia
MD

Reference

Miljuš D, Vukičević A, Živković S. Cancer incidence and mortality in central Serbia (1999–2007) Belgrade: Cancer Registry of Serbia, Institute of Public Health of Serbia “Dr Milan Jovano-vić-Batut”; 2010.

Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G. ESMO Guidelines Working Group. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23(Suppl 7): 86−91.

Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, et al. Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline. Eur J Cancer 2012; 48(15): 2375−90.

Lasithiotakis K, Leiter U, Krüger-Krasagakis S, Tosca A, Garbe C. Comparative analysis of incidence and clinical features of cu-taneous malignant melanoma in Crete (Greece) and southern Germany (central Baden-Württemberg). Br J Dermatol 2006; 154(6): 1123−7.

Nagore E, Oliver V, Botella-Estrada R, Moreno-Picot S, Guillén C, Fortea JM. Clinicopathological analysis of 1571 cutaneous malignant melanomas in Valencia, Spain: factors related to tumour thickness. Acta Derm Venereol 2006; 86(1): 50−6.

de Vries E, Boniol M, Doré JF, Coebergh JW. Lower incidence rates but thicker melanomas in Eastern Europe before 1992: a comparison with Western Europe. Eur J Cancer 2004; 40(7): 1045−52.

Holterhues C, Hollestein LM, Nijsten T, Koomen ER, Nusselder W, de Vries E. Burden of disease due to cutaneous melanoma has increased in the Netherlands since 1991. Br J Dermatol 2013; 169(2): 389−97.

Lebbe C, Lorigan P, Ascierto P, Testori A, Bédane C, Middleton M, et al. Treatment patterns and outcomes among patients diag-nosed with unresectable stage III or IV melanoma in Europe: a retrospective, longitudinal survey (MELODY study). Eur J Cancer 2012; 48(17): 3205−14.

Eigentler TK, Caroli UM, Radny P, Garbe C. Palliative therapy of disseminated malignant melanoma: a systematic review of 41 randomised clinical trials. Lancet Oncol 2003; 4(12): 748−59.

National Comprehensive Cancer Network. NCCN Guidelines. Melanoma v2. 2014. Available from: http://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf

Propper DJ, Braybrooke JP, Levitt NC, O'Byrne K, Christodoulos K, Han C, et al. Phase II study of second-line therapy with DTIC, BCNU, cisplatin and tamoxifen (Dartmouth regimen) chemotherapy in patients with malignant melanoma previously treated with dacarbazine. Br J Cancer 2000; 82(11): 1759−63.

Objavljeno
2015/07/08
Broj časopisa
Vol. 72 Br. 4 (2015)
Rubrika
Originalni članak