Title Komplikacije liječenja Hodgkinovog limfoma Title (english) Complications following treatment of Hodgkin lymphoma Author Marija Goja Mentor Zdravko Mitrović (mentor)Committee member Vlatko Pejša (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Zdravko Mitrović (član povjerenstva)Granter University of Zagreb Defense date and country 2020-07-17, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Hodgkinov limfom hematološka je neoplazma koja uglavnom zahvaća limfne čvorove. Javlja se kao posljedica klonske pretvorbe stanica B-limfocitnog podrijetla i karakteriziran je Reed-Sternbergovim stanicama. Najčešće se prezentira bezbolnom limfadenopatijom koja može biti praćena B simptomima koji uključuju vrućicu, profuzno noćno znojenje i gubitak tjelesne mase. Liječenje ovisi o stupnju proširenosti bolesti koje se određuje Ann Arbor klasifikacijom. Stadiji I i II dijele se na rani prognostički povoljni i nepovoljni, dok se III i IV smatraju uznapredovalim. Trenutni standard liječenja je kombinacija kemoterapije i radioterapije. Recentni pokušaji izostavljanja radioterapije u ranom stadiju upotrebom PETCT-a nisu dali željeni rezultat. Obzirom da se danas preko 85% bolesnika uspije izliječiti, najveći izazov i problem predstavljaju komplikacije liječenja. Dijele se na rane i kasne. Rane nastaju kao posljedica primjene kemoterapije i radioterapije, a uključuju mučninu, povraćanje, alopeciju, neutropeniju, umor, anemiju, radijacijski dermatitis. Kasne komplikacije javljaju se godinama nakon završetka liječenja. Najvažnije su sekundarni tumori i kardiovaskularne bolesti. Ostale komplikacije su smanjena plodnost, endokrina i pulmonalna disfunkcija, kronični umor, muskularna atrofija i kognitivni poremećaji. Unatoč smanjenju doze radioterapije, smanjenim poljima zračenja i novim radijacijskim tehnikama te smanjenoj primjeni alkilirajućih citostatika, nije reducirana pojava kasnih komplikacija u zadnja dva desetljeća. Danas smo svjedoci komplikacija kemoterapije, a posebno radioterapije otprije 20-30 godina. Budućnost će pokazati može li primjena današnjih metoda liječenja smanjiti njihovu pojavnost. Uloga liječnika je pratiti preživjele bolesnike, poticati ih na zdrav život i smanjenje rizičnih faktora kao što je pušenje. Također, potrebno je provoditi programe ranog
otkrivanja malignih i kardiovaskularnih bolesti.
Abstract (english) Hodgkin lymphoma (HL) is a hematological neoplasm, mostly affecting lymph nodes. It occurs as a result of clonal transformation of B-lymphocytes and is characterized with Reed-Sternberg cells. Patients usually present with painless lymphadenopathy which can be accompanied with B symptoms including fever, profuse night sweating and weight loss.
Treatment depends on stage of disease and it is determined by Ann Arbor classification. Stage I and II represent early favorable or unfavorable disease, while stage III and IV are considered to be advanced. Current treatment is a combination of chemo- and radiotherapy. Recent attempts to omit radiotherapy in early stages of HL by using PET-CT scan were somewhat disappointing. Considering the cure rate of more than 85%, complications of treatment present the most challenging problem today. Complications can manifest as early or late ones. Early complications result from consequences of radiotherapy and chemotherapy and include nausea, vomiting, alopecia, neutropenia, anemia, fatigue, and radiation dermatitis. Long-term survivors are at an increased risk of late effects years after the treatment. Secondary malignancies and cardiovascular diseases are the most important. Other late effects have also been identified, such as subfertility, endocrinal and pulmonary dysfunction, chronic fatigue, muscular atrophy and cognitive impairment. Although, the dose of radiotherapy is reduced with smaller fields and novel irradiation techniques applied, and less alkylating chemotherapeutics is used the late complications have not been reduced over the past two decades. Today, we witness complications following chemotherapy and especially radiotherapy that was used 20-30 years ago. Conversely, the complications of todays treatment will be seen in future. The role of physician is to follow the survivors, encourage the patients to promote healthy lifestyle and avoid risk factors such as smoking. In addition, the screening programs for early detection of malignancies and cardiovascular diseases should be performed.
Keywords
Hodgkinov limfom
rane komplikacije
kasne komplikacije
Keywords (english)
Hodgkin lymphoma
early complications
late complications
Language croatian URN:NBN urn:nbn:hr:105:025507 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2021-09-06 09:49:15
