Kairevičė, Laura

Introduction Kidney transplantation is the preferred treatment for end-stage renal disease, significantly improving survival and quality of life compared with dialysis [1,2]. However, long-term immunosuppression substantially increases the risk of cancer [3,4]. Case Presentation A 23-year-old male was diagnosed with end-stage renal disease caused by membranoproliferative glomerulonephritis and underwent a cadaveric kidney transplant in 2007. Three years post-transplant, he was diagnosed with a testicular mixed germ cell tumor (embryonal carcinoma and mature teratoma) with metastases to abdominal lymph nodes, lung and transplanted kidney. The patient underwent orchiectomy, multiple chemotherapy regimens, extensive surgical resections, and three autologous stem cell transplantations. In 2017 CT-scan revealed new solid formation between the aorta and the left psoas major muscle. The clinical course was complicated by acute graft dysfunction, severe infections, and recurrent Clostridium difficile colitis, successfully treated with fecal microbiota transplantation. Despite multiple relapses, combined chemotherapy, surgery, and stereotactic radiotherapy resulted in normalization of tumor markers and long-term disease control. Discussion Post-transplant tumours represent a major cause of morbidity and mortality in kidney transplant recipients [5]. Immunosuppressive therapy diminishes immune surveillance and promotes oncogenesis, while viral infections further increase cancer risk [6,7]. Germ cell tumors after kidney transplantation are rare, and their management is particularly challenging due to nephrotoxicity, infectious complications, and the need to balance oncologic treatment with graft preservation. Multidisciplinary management and individualized immunosuppression adjustment are essential [8]. Conclusions This case highlights the complexity of treating aggressive tumours in kidney transplant recipients. Early diagnosis, close oncologic surveillance, and coordinated multidisciplinary care are crucial to achieving favorable outcomes while preserving graft function.

Introduction and aim Sarcomas are rare malignancies of mesenchymal origin, with an annual incidence of 5–7 cases per 100,000 (1,2). Osteosarcoma (OS) is the most common primary malignant bone tumor, representing around 20% of all primary bone cancers (3). However, craniofacial (skull and jaw) localization is exceptionally rare and accounts for less than 10% of all cases (4). In contrast to conventional osteosarcoma, typically affecting adolescents and young adults, craniofacial OS more often occurs in older patients (4). Clinically, these tumors present as a firm, enlarging mass in the facial or cranial region and might cause symptoms such pain, facial asymmetry, neurologic signs or dental issues (5). Standard treatment of high-grade OS consists of perioperative chemotherapy (ChT) and surgery aiming R0 resection. Treatment should be planned and delivered by a specialized sarcoma multidisciplinary team (MDT) (6). As the anatomical complexity of the skull poses significant challenges for surgical management, achieving wide margins is often unfeasible (4). In such cases, postoperative radiotherapy may be considered (7). Despite optimal treatment, craniofacial OS carries a significant risk of local recurrence up to in 30–40%of the cases. Five-year overall survival in localized disease is 60-70% (7). Notably, these tumors demonstrate lower rates of pulmonary metastases compared to appendicular OS, possibly due to higher rates of local relapse influencing its prognosis (4). We present a case of an adult patient with OS of the skull to highlight its diagnostic and therapeutic complexity and the importance of personalized management in a specialized sarcoma center. Case report A 42-year-old man presented at the Sarcoma Center, Hospital of LUHS Kaunas Clinics, with a progressively enlarging lump on his forehead and intense headache. MRI revealed a 4.4 × 2.8 × 5.0 cm tumor mass occupying the frontal sinuses, with intracranial and extracranial extension. Biopsy confirmed the diagnosis of high-grade osteosarcoma. No evidence of distant metastasis was found. As the patient was deemed fit for ChT and given the importance of a shrinkage to achieve clear margins neoadjuvant MAP ChT was started. However, after the first cycle of metotrexate, the patient developed severe acute kidney injury. Methotrexate and cisplatin were excluded in favor of carboplatin and doxorubicin. After two cycles of ChT MRI showed initial dimensional and tissue response and considering the good tolerability the MDT decided to proceed with two more cycles to improve the quality of surgery. R0 surgery including reconstruction with cement cranioplasty followed, with excellent cosmetic and functional outcome. Due to clear margins and the risk of postoperative complications, adjuvant radiotherapy was not administered. The patient completed two further cycles of postoperative ChT. After a-1-year followup, the patient remains free from disease. Discussion Craniofacial OS are rare and present unique management challenges due to the complex anatomy of the skull and proximity to vital structures (4). In this case, the involvement of both intracranial and extracranial compartments required careful coordination between oncology, radiology, surgery, and supportive care. Since management in a specialized sarcoma center is crucial to coordinate care across disciplines and to provide individualized treatment planning (6) treatment decisions were made through repeated multidisciplinary team (MDT) discussions at a dedicated sarcoma center, enabling timely adaptation of the therapeutic plan based on toxicity and response. The initial use of MAP ChT was guided by the need to achieve maximal tumor shrinkage to allow radical resection. However, the onset of methotrexate-induced nephrotoxicity necessitated a regimen change. Response evaluation after two cycles of carboplatin-doxorubicin showed favorable changes in both size and imaging characteristics (e.g., mineralization, reduced enhancement), which informed the MDT decision to prolong neoadjuvant treatment. This highlights the critical role of dynamic response assessment in guiding the number of ChT cycles and improving resectability. Achieving R0 margins was essential to omit radiotherapy and avoid additional morbidity, which can be significant in such a delicate and functionally critical craniofacial region (7). This case reveals the value of specialized sarcoma center care, where individualized treatment, case-by-case MDT decision-making, and response guided therapy are fundamental for optimal outcomes. Conclusions Management of all sarcomas, including skull OS should be conducted in a specialized sarcoma center to ensure expert, multidisciplinary care. Treatment must be tailored case-by-case, balancing oncologic goals with patient-specific factors and therapy tolerability

Background and Objective Diagnostics and treatment of rectal cancer has changed dramatically over the past 20 years. Detailed radiological examination using MRI, surgical and radiotherapy innovations, neoadjuvant and adjuvant therapy have been implemented into the practice. Multidisciplinary team discussions on regular basis has started in the Hospital since 2013. Indeed, the wide application of screening programs is essential for early diagnosis of the disease – the pilot colorectal cancer screening in Kaunas region has started from 2009 and wide screening program was implemented in all the country since 2013. These innovations affect patients' life expectancy and quality. This is a retrospective analysis covering 20 years of single-institution clinical experience in the diagnostics and treatment of local rectal cancer. Material and Method Data on 924 patients which were treated for local (stage I-III) rectal cancer from 2004 till 2024 were retrospectively collected at the Hospital of Lithuanian University of Health Sciences (LUHS) Kauno klinikos. The period was divided into two decades (A, from 2004 till 2013, and B, from 2014 till March of 2024) to assess treatment progress. The groups were compared in terms of clinical characteristics and applied treatment. [...].

Onkologijoje, gydant tam tikros vietos piktybinius solidinius navikus (storosios žarnos ir galvos kaklo vėžį), naudojami du pagrindiniai biologinės taikinių terapijos atstovai. Jų veikimas pagrįstas epidermio augimo veiksnio receptoriaus blokavimu. Tai monokloniniai antikūnai (mAB) cetuksimabas ir panitumumabas. Pastaruoju metu Lietuvoje pagal LR SAM ministro įsakymą cetuksimabas gali būti skiriamas galvos kaklo vėžiui gydyti kaip biospindulinio gydymo dalis arba derinant su chemoterapija (cisplatina bei fluorouracilu). Vėliau Cet tęsiamas kaip monoterapija iki ligos progresavimo arba netoleruojamų toksiškų reakcijų. Panitumumabas, esant laukinio tipo RAS šeimos genams, pirmiausia gali būti skiriamas metastazavusiam kairiosios storosios žarnos pusės vėžiui, šis gydymas derinamas su chemoterapija arba, jei nebuvo skirtas pagal minėtą indikaciją, naudojamas kaip trečiosios eilės gydymo monoterapija, esant tos pačios vietos metastazavusiam žarnyno vėžiui. [...]

Introduction and Aim Sarcomas are rare cancer of connective tissue with annual incidence rate of 3-7 cases in 100 000 people (1, 2). Soft tissue sarcomas make up to 85% and can be divided tomore than 100 different histological subtypes (3). An undifferentiated pleomorphic sarcoma is one of the most common subtypes. These tumors usually present as growing mass in the body. No distant metastases are found in more than half of the new cases (4). Treatment tactics should be discussed in MDT meeting. Surgical treatment is the most important part of curing local disease and strongly impact prognosis – 10 years OS in patients with optimal resection reach 60% but if resection margins are not clear(R1) it drastically drops to 37% (5). Amputation should be considered only in minority of cases. Neoadjuvant treatment and local procedures such HILP with chemotherapy and TNF-alpha or regional hyperthermia with local chemotherapy can be used in order to avoid amputation and retain limb function (6). Radiotherapy can improve PFS and OS in high risk or not optimally resected tumors and in most of the cases should be used preoperatively (7). Nomograms are used to predict survival and helps to decide if perioperative chemotherapy is needed. If predicted 10 year survival is below 60% perioperative anthracycline based chemotherapy is considered beneficial (6,8). By treating a patient in specialized sarcomas centers with the experienced team best results can be achieved. 5 years OS in localized disease is 81% and 56% in locally advanced tumors (4). We are presenting a case where the patient with localized unresectable disease was successfully operated after HILP and chemotherapy with Melphalan. [...]. Conclusions Hyperthermic isolated limb perfusion with Melphalan may enable possibility of radical surgery in patients with former unresectable soft tissue sarcoma.

Background and objectives: The aim of this study was to analyse trends in penile cancer incidence, mortality, and relative survival in Lithuania during the period of 1998–2017. Materials and methods: The study was based on all cases of penile cancer reported to the Lithuanian Cancer Registry between 1998 and 2017. Age-specific rates standardized rates were calculated, using the direct method (World standard population). The Joinpoint regression model was used to provide estimated average annual percentage change (AAPC). One-year and five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of cancer patients and the expected survival of the underlying general population. Results: During the study period, the age-standardized incidence rate of penile cancer varied between 0.72 and 1.64 per 100 000, with AAPC 0.9% (95% CI -0.8–2.7). The mortality rate of penile cancer in Lithuania during this period varied from 0.18 to 0.69 per 100 000, with AAPC of -2.6% (95% CI -5.3–0.3). Relative one-year survival of patients, diagnosed with penile cancer improved over the time from 75.84% in period 1998–2001 to 89.33% in period 2014–2017. Relative five-year survival rate of patients, diagnosed with penile cancer changed from 55.44% in period 1998-2001 to 72.90% in period 2014–2017. Conclusions: The incidence rates of penile cancer showed an increasing trend, while mortality rates were decreasing in Lithuania during 1998-2017. One-year and five-year relative survival increased, however, it does not reach the highest scores of Northern European countries.

Background: National Comprehensive Cancer Network guidelines recommend either long-course chemoradiation (LC) or short-course radiation (SC, 5 × 5 Gy) for rectal cancer before total mesorectal excision. However, they do not recommend SC for low-lying tumors. As early toxicity of SC is lower than that of LC, and postoperative complications as well as late toxicity are similar, the probable reason is a notion that for low-lying tumors LC may be more effective than SC in assuring local control. Material and methods: A systematic review and meta-analysis of the randomized trials comparing SC with LC was performed to test the hypothesis that for low-lying tumors, LC is superior to SC in reducing the risk of local failure. Results: The systematic search identified four trials including in total 421 patients with tumors <5 cm from the anal verge; 221 were randomized to SC and 200 to LC. The meta-analysis showed that the difference in local failure rate between SC and LC was insignificant; the pooled odds ratio was 0.87, 95% confidence interval 0.53-1.44, P = .59. Heterogeneity between trials was insignificant; I2 = 0.0%, P = .47. Conclusion: Our meta-analysis does not support the notion that LC given prior to total mesorectal excision is superior to SC in reducing the risk of local failure in low-lying tumors.

Background and objectives: The e ectiveness of neoadjuvant therapy, which is commonly used for stage II-III rectal cancer (RC) treatment, is limited. Genes associated with the pathogenesis of RC could determine response to this treatment. Therefore, the aim of this study was to investigate the potential predictive value of VEGFA, COX2, HUR and CUGBP2 genes and the associations between post-treatment changes in gene expression and the e cacy of neoadjuvant therapy. Materials and Methods: Biopsies from RC and healthy rectal tissue of 28 RC patients were collected before neoadjuvant therapy and 6-8 weeks after neoadjuvant therapy. The expression levels of VEGFA, COX2, HUR, CUGBP2 genes were evaluated using a quantitative real-time polymerase chain reaction. Results: The results reveal a significantly higher expression of VEGFA, COX2 and HUR mRNA in RC tissue compared to healthy rectal tissue (p<0.05), and elevated VEGFA gene expression in pre-treatment tissues was associated with a better response to neoadjuvant therapy based on T-stage downstaging (p<0.05). The expression of VEGFA, HUR and CUGBP2 genes significantly decreased after neoadjuvant therapy (p<0.05). Responders to treatment demonstrated a significantly stronger decrease of VEGFA and COX2 expression after neoadjuvant therapy than non-responders (p<0.05). Conclusions: The findings of this study suggest that the pre-treatment VEGFA gene expression might have predictive value for the response to neoadjuvant therapy, while the post-treatment decrease in VEGFA and COX2 gene expression could indicate the e ectiveness of neoadjuvant therapy in RC patients.

[...]. Darbo tikslas ir uždaviniai. Darbo tikslas. Palyginti priešoperacinio chemospindulinio ir stambiafrakcinio spindulinio tiesiosios žarnos vėžio gydymo veiksmingumą ir įvertinti šios ligos prognostinius ir predikcinius veiksnius. Darbo uždaviniai. 1. Palyginti II-III st TŽV sergančių tiriamųjų pacientų, gydytų suderinta chemospinduline terapija (CST) ir stambiafrakcine spinduline terapija (ST), 3-jų ir 5-erių metų išgyvenamumą be ligos (IBL) ir bendrąjį išgyvenamumą (BI). 2. Palyginti tiriamųjų gyvenimo kokybę skirtingose gydymo šakose. 3. Įvertinti klinikinių veiksnių (pacientų amžiaus, lyties, klinikinės TŽV stadijos, pirminio naviko dydžio T, N kriterijaus ir kt.) prognostinę ir priedikcinę vertę. 4. Įvertinti KRAS, NRAS, BRAF ir PIK3CA genų mutacijų dažnį II-III st. TŽV sergančių pacientų biopsinėje ir/ar operacijos metu gautoje medžiagoje. 5. Įvertinti II-III st. TŽV sergančių pacientų KRAS, NRAS, BRAF ir PIK3CA genų mutacijų prognostinę ir predikcinę vertę. [...].

Background and objective: At present, there are common recommendations for treatment for stage II–III resectable rectal cancer patients: preoperative conventional chemoradiotherapy (CRT) with delayed surgery in 6–8 weeks or preoperative short-course radiotherapy (SCRT) followed by immediate surgery. The aim of this study was to compare overall survival (OS) and disease-free survival (DFS) in two treatment groups: preoperative SCRT and CRT both with delayed surgery plus adjuvant chemotherapy in CRT arm. Materials and methods: A total of 150 were randomly assigned into two groups: 75 to CRT (preoperative conventional CRT, 50 Gy/25 fr with fluorouracil and leucovorin on the 1st and the 5th week of RT followed by TME surgery in 6–8 weeks and 4 cycles of adjuvant fluorouracil/leucovorin every 4 weeks; then follow-up) and 75 to SCRT (preoperative short-course RT, 25 Gy/5 fr followed by TME surgery in 6–8 weeks; then follow-up). The data of 140 patients (72 in CRT and 68 in SCRT group) were included in statistical analysis. Primary end points were OS and DFS. Results: Median follow-up was 60.5 (range, 5–108) months. The 5-year DFS was 67% in the CRT group (n = 72) and 45% in the SCRT group (n = 68) (P = 0.013, HR = 1.88; 95% CI, 1.13–3.12; P = 0.015). The 5-year OS was 79% and 62% in the CRT and SCRT groups, respectively (P = 0.015 HR = 2.05; 95% CI, 1.13–3.70; P = 0.017). The 5-year OS for intent-to-treat (ITT) population (n = 150) was 78% in the CRT and 58% in the SCRT group (P = 0.003; HR = 2.28; 95% CI, 1.30–4.00; P = 0.004). Conclusions: The 5-year DFS and OS were significantly better in the CRT than the SCRT group. For ITT population, OS was also significantly better after CRT versus SCRT.