PRAĆENJE BOLESNICA NAKON PRIMARNOGA LIJEČENJA RAKA JAJNIKA (Kontroverze i preporučeni postupci)

Autor: Dragan Belci, Herman Haller, Nicoletta Colombo, Angelo Maggioni
Jazyk: chorvatština
Rok vydání: 2008
Předmět:
Zdroj: Gynaecologia et perinatologia : journal for gynaecology, perinatology, reproductive medicine and ultrasonic diagnostics
Volume 17
Issue 3
ISSN: 1330-0091
Popis: SAŽETAK. Objavljene smjernice vezane za follow-up pacijentica primarno liječenih od karcinoma jajnika, ali i drugih ginekoloških malignoma, temelje se na podacima samo nekoliko studija koje nisu randomizirane i koje ne prikazuju učinkovitost i utrošak/dobrobit pretraga što su korištene za dijagnozu recidiva bolesti. Te studije/preporuke nisu usuglašene po vrsti pretraga i vremenskoga intervala pregleda. Uz to kod detekcije recidiva u pacijentica primarno liječenih od karcinoma jajnika, ostaje još terapijska dilema s obzirom na to da će gotovo svaka pacijentica s recidivom bolesti umrijeti. Follow-up asimptomatskih pacijentica najčešće obuhvaća uvid u povijest bolesti, serumski CA 125, ginekološki fizikalni pregled i često ultrazvučni pregled, a koriste se i druge radiološke pretrage kada simptomi i znakovi ukazuju na mogući recidiv bolesti. U literaturi nalazimo dvije oprečne tendencije. Prva koja vodi minimalističkome praćenju i druga koja, na osnovi novih procedura, lijekova i tehnologija, potiče kliničara da se koristi skupim pretragama koje još nisu znanstveno opravdane. Potrebna su velika prospektivna randominizirana ispitivanja koja uspoređuju minimalistički follow-up s intenzivnim skupim pristupom pretraga. Studije moraju voditi računa o ciljevima liječnika (dobri i učinkoviti rezultati koji jamče najbolju kliničku praksu), potrebama pacijentica (percepcija da je liječenje vođeno na odgovarajući način) i realnim mogućnostima zdravstvenoga sustava. Te studije trebale bi jasnije usporediti objektivni klinički ishod (sveukupno preživljenje, vremenski interval bez bolesti i komplikacije) te subjektivni ishod (kvalitetu života i očekivanja pacijentica).
All the guidelines published regarding the follow up of patient primary treated for ovarian cancer and other gynecological cancer, are the results only of few studies not randomised and in absence of evidence of effectiveness and cost/benefit of the procedure used for diagnosis of recurrent disease. Few formal guidelines exist regarding the surveillance of these patients, and there is no agreement in the literature about the type and timing of examinations to perform. Moreover, the objective of follow-up is unclear as recurrent epithelial ovarian cancer continues to be a therapeutic dilemma and quite all the relapsed patients will eventually die of their ¬disease. The follow-up of asymptomatic patients generally include complete clinical history, serum cancer antigen (CA 125) assay, physical examination, and often ultrasound examination, whereas additional radiologic imaging techniques are usually performed when symptoms or signs appear. Currently, there exist two opposite tendencies suggesting different follow-up modalities. On one side »minimalistic« follow-up and on the other side, the introduction of new drugs and new technologies induce the physician to prescribe expensive examinations without proved utility. Prospective randomised clinical trials have to be planned in order to ¬compare minimalistic and intensive follow-up policies. These trials have to evaluate the relationship between the gynecological oncologist’s needs (good quality scentific data available, which leads the best clinical practice), patient’s need (according to the satisfaction degree they feel about the treatments and follow-up) and possibility of health care system. New clinical trials also are needed in order to evaluate the relationship between the objective clinical outcome (overall survival, disease-free interval, and complications) and the subjective outcome (quality of life and expentacies of the patient).
Databáze: OpenAIRE
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