MF Onkologijos institutas (04.05)

Background and Objectives: Blood product transfusion is an important emergency intervention for patients with acute bleeding, severe symptomatic anemia, and selected hematological conditions. Patterns of ED transfusion may differ according to the local case mix, referral pathways, and blood bank processes. We compared transfusion-related characteristics and outcomes among patients treated in one Lithuanian and two Polish academic emergency departments. Materials and Methods: We performed a retrospective comparative study of adults (aged ≥18 years) in whom a blood product transfusion was initiated in the ED between 1 January 2022 and 31 December 2024 at one Lithuanian and two Polish academic hospitals. We compared patient characteristics, indication categories, shock index values, time to transfusion, blood product use, adjunctive therapies, laboratory values, ED disposition, hospital length of stay, and in-hospital mortality. Findings are reported as center-cohort comparisons and are not intended to represent national practice. Results: A total of 670 patients were included: 367 at the Lithuanian center and 303 across the two Polish centers. GI bleeding was significantly more common in the Lithuanian center cohort (48.8% vs. 22.8%; OR 3.22 [95% CI 2.30–4.53]; p < 0.001), whereas anemia and malignancy-related anemia were more frequent in the Polish center cohort (anemia: 34.7% vs. 18.3%, OR 0.42 [95% CI 0.29–0.6]; p < 0.001; cancer: 26.4% vs. 7.6%, OR 0.23 [95% CI 0.15–0.37]; p < 0.001). The median shock index was significantly higher in the Lithuanian center cohort than in the Polish center cohort (0.9; [IQR 0.7–1.2] vs. 0.7; IQR 0.6–0.9; 0.2 [95% CI 0.1–0.3]; p < 0.001), and pre-transfusion hemoglobin was lower (64.5 g/L [IQR 50–86] vs. 119 g/L [IQR 83–139]; p < 0.001). Uncrossmatched RBC units were more frequently administered in the Lithuanian center cohort (133 (36.9%) vs. 47 (15.6%); OR 3.18 [95% CI 2.18–4.64]; p < 0.001), as was fresh frozen plasma (71 (19.5%) vs. 3 (1%); OR 24.23 [95% CI 7.55–77.8]; p < 0.001). Conversely, platelet transfusions were more common in the Polish center cohort (17 (4.6%) vs. 45 (14.9%), OR 0.28 [95% CI 0.16–0.5]; p < 0.001). The median time from ED arrival to transfusion was longer in the Lithuanian center cohort than in the Polish center cohort (150 [IQR 75–256] vs. 117 [IQR 103–154], 23 [95% CI 9–39]; p = 0.002). Hospital admission was significantly more frequent in the Lithuanian cohort than in the Polish cohort (350 (95.4%) vs. 112 (37.0%); p < 0.001). Among admitted patients, the median hospital length of stay was significantly longer in the Lithuanian cohort compared with the Polish cohort (6 days [IQR 3–11] vs. 1 day [IQR 1–5]; 95% CI for the difference 3–4; p < 0.001). In-hospital mortality was 33.5% (n = 123) in the Lithuanian cohort and 13.9% (n = 42) in the Polish cohort (OR 3.13 [95% CI 2.12–4.63]; p < 0.001). Conclusions: Among transfused patients in the three participating academic EDs, the case mix, blood product use, transfusion timing, and unadjusted outcomes differed substantially. These center-specific findings may inform future prospective studies of how referral pathways, clinical populations, and local transfusion processes influence ED blood product utilization. They do not establish differences in national practice, transfusion appropriateness, or causal effects on clinical outcomes.

Background and Objectives: Rectal cancer management has changed substantially over the past two decades. We evaluated 20-year trends in stage at diagnosis, treatment patterns, and survival at a Lithuanian tertiary referral centre. Materials and Methods: This retrospective cohort study included 839 patients who underwent resection for stage I–III rectal cancer between 2004 and 2023, divided into two periods: 2004–2013 (n = 426) and 2014–2023 (n = 413). Survival was analysed with Kaplan–Meier estimates and Cox proportional hazards regression, truncated at 60 months. Results: Patients in the later cohort were diagnosed at an earlier clinical stage (stage I: 12.6% vs. 2.4%) and more often received neoadjuvant or perioperative therapy (55.2% vs. 37.1%; p < 0.001). Among clinical stage III patients, receipt of neoadjuvant chemoradiotherapy or total neoadjuvant treatment rose from 15.9% to 70.9% (p < 0.001), while pathological complete response among treated patients remained stable (10.8% vs. 10.7%; p = 0.98). Five-year overall survival increased from 64.8% to 71.3% (HR 0.77; 95% CI 0.60–0.99; p = 0.039) and cancer-specific survival from 70.4% to 80.8% (HR 0.60; 95% CI 0.45–0.80; p = 0.0005). The cohort effect persisted after multivariable adjustment for CSS (HR 0.62; 95% CI 0.45–0.85; p = 0.003), with clinical stage explaining only ~13% of the crude effect; stage III sensitivity analysis confirmed the CSS gain (67.9% to 77.3%; p = 0.009). Conclusions: Cancer-specific survival improved substantially and independently of stage migration. The gain coincided with markedly wider and better-targeted delivery of effective neoadjuvant therapy rather than with improved per-patient tumour responsiveness. As an observational comparison of two historical cohorts, this study demonstrates association rather than causation; nonetheless, it provides real-world evidence consistent with the hypothesis that systematic implementation of evidence-based rectal cancer pathways translates into measurable survival benefit.

This study investigated the antiproliferative effects of luteolin (LUT) and its potential to modify the response of breast cancer (BC) cells to ionizing radiation (IR). LUT effects alone or with IR were evaluated in MCF-7 and MDA-MB-231 cells using clonogenic and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Apoptosis and cell cycle distribution were assessed by flow cytometry, while reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Western blotting were used to determine apoptosis-related gene and protein expression. LUT reduced the clonogenic survival and metabolic activity in both BC cell lines. In MCF-7 cells, combined LUT and IR treatment produced a greater reduction in metabolic activity and clonogenic survival than either treatment alone, whereas no comparable effect was observed in MDA-MB-231 cells. LUT induced apoptosis in both cell lines. Cell cycle analysis indicated G2/M phase accumulation, reaching statistical significance in MDA-MB-231 cells. In MCF-7 cells, LUT decreased BCL2 and MCL1 gene expression, with a further reduction following combined LUT and IR treatment. Consistently, BCL-2 protein levels were reduced in MCF-7 cells. In MDA-MB-231 cells, LUT modulated the expression of selected anti-apoptotic genes. Overall, these findings demonstrate cell line-dependent effects of LUT and suggest that its ability to modify the response to IR may depend on the molecular characteristics of BC cells.

Purpose Pancreatic ductal adenocarcinoma (PDAC) has poor survival rates due to late diagnosis and limited early detection methods. Existing serum biomarkers have inadequate sensitivity and specificity. This study assessed whether circulating cell-free DNA (cfDNA) fragmentomic features could distinguish PDAC from chronic pancreatitis (CP) and healthy controls. Methods In this prospective single-center study, 83 participants were enrolled: 56 with histologically confirmed PDAC, 12 with CP, and 15 healthy controls. Plasma cfDNA was extracted from blood samples collected before intervention. cfDNA concentration and fragment length were analyzed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Results PDAC patients had significantly shorter cfDNA fragments (165 bp) than healthy controls (169 bp; p=0.009), whereas no significant difference was observed compared with CP patients (166 bp; p=0.900). cfDNA concentration was significantly higher in PDAC (45.6 ng/mL) than in CP (21.8 ng/mL; p=0.026) and healthy controls (20.2 ng/mL; p=0.002). ROC analysis demonstrated moderate diagnostic accuracy for fragment length (AUC 0.778) and concentration (AUC 0.737–0.796). Conclusion Shorter cfDNA fragment length and higher concentration may help distinguish PDAC from CP and healthy individuals, supporting further investigation of cfDNA fragmentomics as a minimally invasive diagnostic tool.

Tiesiosios žarnos vėžys sudaro apie 30-35 proc. visų kolorektalinio vėžio atvejų ir išlieka viena aktualiausių onkologinių problemų [1, 3]. Per pastaruosius du dešimtmečius šios ligos gydymo taktika iš esmės pasikeitė: tradicinis chemospindulinis gydymas buvo papildytas, o kai kuriais atvejais - pakeistas naujomis gydymo taktikomis. Ypač didelio susidomėjimo sulaukė imunoterapija programuotos ląstelių žūties 1 baltymo (PD-1) receptoriaus inhibitoriais. Šie vaistai padėjo pasiekti puikių rezultatų gydant pacientus, kuriems nustatytas mikrosatelitų nestabilumas (MSI-H) arba klaidingai suporuotų nukleotidų DNR pažaidų taisymo sistemos stoka (angl. deficient mismatch repair - dMMR). Lygiagrečiai plėtojama organų funkcijos išsaugojimo koncepcija daliai pacientų leidžia išvengti radikalios chirurginės intervencijos. Šiame straipsnyje apžvelgiama gydymo evoliucija, aptariami įrodymais grįsti algoritmai ir pateikiamos praktinės rekomendacijos šeimos gydytojams.

Background and Objectives: Early-stage glottic cancer requires highly precise radiotherapy due to laryngeal motion and the proximity of critical structures. Magnetic resonance-guided radiotherapy (MRgRT) enables real-time visualization and motion management, potentially improving dose conformity while reducing treatment margins. This pilot comparative planning study compared the dosimetric characteristics of MR-guided intensity-modulated radiotherapy (IMRT) delivered on the Unity MR-linac with volumetric modulated arc therapy (VMAT) plans generated for the TrueBeam STx and Halcyon systems. Materials and Methods: Ten patients with T1–T2N0 glottic squamous cell carcinoma were included. For each patient, treatment plans prescribing 42.5 Gy in five fractions were generated using all three systems. Planning target volume (PTV) coverage, conformity index (CI), homogeneity index (HI), organ-at-risk (OAR) doses, monitor units, and beam-on times were compared using Friedman and post hoc Wilcoxon signed-rank tests. Results: Unity achieved superior dose conformity (CI 0.97 ± 0.01 vs. 0.78 ± 0.15 for TrueBeam STx and 0.58 ± 0.19 for Halcyon; p < 0.001) and the highest mean dose, while PTV coverage (D95% and D98%) was comparable to TrueBeam STx and higher than Halcyon. Reduced treatment margins resulted in significantly smaller PTV volumes (11.09 ± 3.87 cm3 vs. 17.43 ± 4.75 cm3; p = 0.0001). Halcyon demonstrated the most homogeneous dose distribution (HI 7.88 ± 3.14), whereas TrueBeam STx showed intermediate homogeneity (HI 12.81 ± 3.90). Most OAR dose metrics were comparable among techniques, although selected laryngeal structures and the esophagus differed significantly. Beam-on time was longest for Unity. Conclusions: MR-guided IMRT provided superior dose conformity while maintaining target coverage comparable to TrueBeam STx with clinically acceptable OAR sparing. Prospective clinical studies are required to determine whether these dosimetric advantages translate into improved patient outcomes.

Introduction Radiotherapy is a vital therapeutic option in the treatment of breast cancer nowadays. However, a major obstacle to the full effectiveness of radiation therapy is still the radioresistance of cancer cells. Various studies have proven sulforaphane's (SFN) beneficial effects against cancer and its possible utilization as a radiosensitizer in radiotherapy. This study aimed to investigate whether SFN has a radiosensitizing effect on breast cancer cells.

Material and methods The anticancer efficiency of SFN and radiosensitizing effect in MCF-7 and MDA-MB-231 cell lines were assessed by the MTT assay. Using a flow cytometric assay, the apoptosis level and changes in the cell cycle were measured. RT-qPCR and Western blot analysis were used to determine BCL-2 and BCL-XL genes expresion and proteins level.

Results According to our results, SFN reduced the viability of cells, and combining SFN with radiation therapy (IR) caused much greater anticancer effects on cells. SFN+IR was shown to enhance the number of cells in the G2/M phase and the percentage of cells going through apoptosis. SFN reduced the expression of apoptosis-relative genes BCL-2 and BCL-XL. Consistent with this data, Western blot analysis revealed that BCL-2 and BCL-XL protein levels were decreased in tested cells. As a result of the combination treatment, the downregulation of the BCL-2 protein was observed only in MDA-MB-231 cells.

Conclusions These results indicate that SFN acts as a radiosensitizer by enhancing apoptotic cell death and reducing anti-apoptotic genes in breast cancer cells.

Cancer remains a major health burden in Lithuania, emphasizing the importance of effective undergraduate oncology education. This paper describes the structure and key features of the integrated oncology curriculum at the Lithuanian University of Health Sciences (LSMU). Oncology teaching is embedded within a six-year medical programme, combining early exposure through biomedical sciences with focused clinical training in a mandatory Year IV Hematology and Oncology module. Teaching methods include lectures, small-group seminars, and supervised ward-based learning, with a strong emphasis on case-based discussion and clinical reasoning. Students are introduced to principles of cancer diagnosis, staging, treatment, and multidisciplinary decision-making. Simulation and practical skills training further support clinical competence. Assessment includes written examinations and clinical case assignments, aligned with programme-level evaluations such as OSCE. Teaching is delivered in a multidisciplinary academic environment with structured quality assurance and continuous student feedback. This model provides a clinically grounded and integrated approach to cancer education, ensuring continuity from undergraduate medical education to postgraduate specialist training. Expanding hands-on clinical exposure, strengthening communication training, and incorporating emerging technologies such as artificial intelligence may further enhance the curriculum.

Introduction: Undifferentiated uterine sarcoma (UUS) is a rare, aggressive uterine mesenchymal malignancy with poor prognosis, for which, evidence supporting metastasis-directed treatment strategies is limited. Case presentation: A 59-year-old woman underwent total hysterectomy with bilateral salpingo-oophorectomy (R0) for stage IB UUS in 2016, followed by adjuvant doxorubicin–ifosfamide. Three years later, surveillance CT identified bilateral pulmonary metastases. Video-assisted thoracoscopic resection confirmed metastatic UUS, and stereotactic body radiotherapy (SBRT) was delivered to residual and subsequent lung lesions, achieving sustained local control without systemic therapy. The patient remained progression-free for almost three years. In 2024, follow-up imaging showed no active sarcoma but incidentally detected a left breast lesion; biopsy revealed invasive ductal carcinoma with mucinous features. She underwent breast-conserving surgery with sentinel lymph node biopsy (pT1N0(sn)), followed by adjuvant whole-breast radiotherapy and endocrine therapy with tamoxifen. Outcomes: At 8.5 years from UUS diagnosis and one year after breast cancer treatment, the patient remains alive with no evidence of recurrent or metastatic disease and with excellent performance status (ECOG 0). Conclusions: This case demonstrates prolonged, chemotherapy-free control of metastatic UUS using a metastasis-directed strategy combining surgery and SBRT, and highlights the importance of continued surveillance for secondary primary malignancies. It supports considering an oligometastatic treatment paradigm and multidisciplinary management in selected UUS patients despite the absence of prospective data.