Mirjana Rajer - Academia.edu (original) (raw)

Papers by Mirjana Rajer

Research paper thumbnail of Locoregional control and survival after breast conserving therapy

Background. The purpose of our study was to present a 5-year survival and locoregional control ra... more Background. The purpose of our study was to present a 5-year survival and locoregional control rates in breast cancer patients and to establish eventual impact of the treatment and patient characteristics on lo-coregional control and survival. Methods. From January 1998 to December 1999 564 stage 1 and 2 breast cancer patients were treated with breast conserving therapy. We evaluated the following characteristics: age, histological diagnosis, grade, size, number of metastatic lymph nodes, hormonal receptor status, extensive intraductal component (EIDC), vas-cular invasion, pathologic tumour margins, type of surgery and use of adjuvant therapy. Results. The mean age of our patients was 54.2 years. Invasive ductal carcinoma was the most common di-agnosis (82.4%), followed by invasive lobular carcinoma (10.6%). Most of the tumours were grade 2. Seventy-two % of patients had T1 tumours, 24% T2 and 3% T is tumours. Metastatic lymph nodes were pres-ent in 44% of patients. All patients wer...

Research paper thumbnail of Communication: Back to the Human Side of Medicine

Research paper thumbnail of Locoregional control and survival in breast cancer patients stage I and II after breast conserving treatment: comparison of two groups

Senologie - Zeitschrift für Mammadiagnostik und -therapie

Research paper thumbnail of Quantitative analysis of fine needle aspiration biopsy samples

Radiology and Oncology

The fine needle aspiration biopsy (FNAB) is a quick, simple, safe, painless and inexpensive metho... more The fine needle aspiration biopsy (FNAB) is a quick, simple, safe, painless and inexpensive method. It is of the utmost importance in the preoperative diagnostics of tumours. 1 The diagnostic reliability of the method is good. It enables us to classify tumours as malignant or benignant in almost 100% cases and to further specify the type of the tumour in 80-98% of cases. 2 Serious side effects (pneumothorax, severe bleeding, infection, pain, vomiting etc.) are rare. 3 In the process of aspiration the cells are seldom extensively damaged since the small diameter of the needle enables it to push aside the tissue rather than tearing it. New, highly specialized methods of treatment require the specification of the tumour lesion to the highest extent. Any additional information about the morphology and cell structure, which determines the prognosis and helps to choose an appropriate treat- is lowest in FNAB of lymph nodes (4.9%), followed by breast (16.7%) and thyroid (18%). Conclusions. We concluded that FNAB in the majority of cases grants a sufficient number of cells for the standard microscopic evaluation and also ancillary diagnostic procedures.

Research paper thumbnail of Local control and survival in breast cancer patients stage I and II after Breast Conserving Treatment (BCT); comparison of two groups

Senologie - Zeitschrift für Mammadiagnostik und -therapie, 2007

Research paper thumbnail of Pollution in the working place and social status: Co-factors in lung cancer carcinogenesis

Lung Cancer, 2014

Apart from the association with tobacco consumption, other factors of importance for prevention a... more Apart from the association with tobacco consumption, other factors of importance for prevention and early diagnosis of lung cancer have received little attention. We present a case-control study focusing on professional exposure to carcinogens and social status. A written questionnaire was completed by 551 consecutive patients with lung cancer and 494 patients with large bowel cancer. The groups were balanced regarding gender and age distribution. The questionnaire included data on place of birth, education, smoking history, diet and alcohol intake, body weight and height, occupation, housing conditions and family income. According to standard epidemiological criteria, professional exposure to carcinogens was classified as professions with exposure to confirmed lung cancer carcinogens, professions with exposure to suspected lung cancer carcinogens and other professions. As expected, there were significant differences between the two groups regarding smoking status. While there were no significant differences in educational levels, more immigrants were among patients with lung cancer (17.9% vs 11.6%, p=0.005). On average, lung cancer patients had a lower body mass index (BMI) at 24.77, as compared to 26.14 for large bowel cancer (p=0.000). Lung cancer patients had lower income and poorer housing conditions; the bivariate difference was significant both for income levels (p=0.046) and type of residence (p=0.009). The proportion of patients working in professions with exposures to known carcinogens was 33.5% for lung cancer, and 17.1% for large bowel cancer (p=0.000). In the multivariate analysis, smoking (p=0.000), BMI (p=0.000) and type of occupation (p=0.001) were significant factors. While there is no doubt about smoking in lung cancer carcinogenesis, professional exposure to carcinogens and belonging to lower socio-economic strata also play an important role.

Research paper thumbnail of Intercalated chemotherapy and erlotinib for advanced NSCLC: high proportion of complete remissions and prolonged progression-free survival among patients with EGFR activating mutations

Radiology and Oncology, 2014

Disclosure: No potential conflicts of interest were disclosed.

Research paper thumbnail of The role of PET-CT in radiotherapy planning of solid tumours

Radiology and Oncology, 2000

Disclosure: No potential conflicts of interest were disclosed.

Research paper thumbnail of New Challenges in Communication with Cancer Patients

Research paper thumbnail of Intermittent Chemotherapy and Erlotinib for Nonsmokers or Light Smokers with Advanced Adenocarcinoma of the Lung: A Phase II Clinical Trial

Journal of Biomedicine and Biotechnology, 2011

Background. Intermittent application of chemotherapy and tyrosine kinase inhibitors may avoid ant... more Background. Intermittent application of chemotherapy and tyrosine kinase inhibitors may avoid antagonism between the two classes of drugs. This hypothesis was tested in a Phase II clinical trial. Patients and Methods. Eligible patients were nonsmokers or light smokers, chemo-naïve, with metastatic adenocarcinoma of the lung. Treatment: 4 to 6 cycles of gemcitabine 1250 mg/m 2 on days 1 and 4, cisplatin 75 mg/m 2 on day 2, and erlotnib 150 mg daily on days 5-15, followed by erlotinib as maintenance. Results. 24 patients entered the trial. Four pts had grade 3 toxicity. Complete remission (CR) and partial remission (PR) were seen in 5 pts and 9 pts, respectively (response rate 58%). Median time to progression (TTP) was 13.4 months and median overall survival (OS) was 23 months. When compared to patients with negative or unknown status of EGFR mutations, 8 patients with EGFR gene activating mutations had significantly superior experience: 4 CR and 4 PR, with median TTP 21.5 months and OS 24.2 months (P < .05). Conclusions. Intermittent schedule with gemcitabine, cisplatin and erlotinib has mild toxicity. For patients who are positive for EGFR gene activating mutations, this treatment offers excellent response rate, time to progression and survival.

Research paper thumbnail of Malignant Spinal Cord Compression

Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 2008

Malignant spinal cord compression (MSCC) is an uncommon but debilitating complication of advanced... more Malignant spinal cord compression (MSCC) is an uncommon but debilitating complication of advanced malignancy. Clinician knowledge about diagnosis, prognosis, therapy, and hospice referral is important if MSCC patients are to be treated in an optimal way.

Research paper thumbnail of Two schedules of chemotherapy for patients with non-small cell lung cancer in poor performance status: a phase II randomized trial

Anti-Cancer Drugs, 2010

We present experience from a phase II randomized clinical trial, comparing standard gemcitabine a... more We present experience from a phase II randomized clinical trial, comparing standard gemcitabine as monotherapy with low-dose gemcitabine in long infusion in a doublet with cisplatin at reduced dose for patients with non-small cell lung cancer (NSCLC) and who are unfit for standard platin-based chemotherapy. Eligible patients had microscopically confirmed NSCLC in stage IIIB (wet) or IV, were chemo-naive, and were in poor performance status or presented with significant comorbidity. Standard treatment with gemcitabine, 1250 mg/m in 20-30 min on days 1 and 8 as monotherapy (arm A) was compared with low-dose gemcitabine in long infusion (200 mg/m in 6 h on day 1) and cisplatin at 60 mg/m on day 2 (arm B). Both treatment schedules were repeated every 3 weeks until disease progression, unacceptable toxicity, or to a maximum of six cycles. A total of 112 patients (83 male, 29 female, median age 66 years) were randomized between arm A (57 patients) and B (55 patients). The two groups were balanced for prognostic factors. Fifty-three patients in arm A and 52 in arm B received at least one application of chemotherapy and were evaluable for toxicity and response. The median number of cycles was four and five for arms A and B, respectively. Except for grade 3 anemia (one patient in arm A and two in arm B), no other major toxicity was seen. Regarding response to treatment, arm B was superior: 1 complete response and 13 partial remissions (response rate 26.9%) as compared with five partial remissions (response rate 9.4%) in arm A (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). The median time to progression was 3.8 and 5.6 months, and the median survival was 4.3 and 6.8 months for arms A and B, respectively (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Treatment with low-dose gemcitabine in long infusion and cisplatin at reduced dose has very low toxicity, is effective, was found to be superior to monotherapy with gemcitabine in standard doses, and is suitable for patients with NSCLC who cannot tolerate a standard platin-based doublet.

Research paper thumbnail of Conservative Treatment for Breast Cancer

Research paper thumbnail of A phase II trial of low-dose gemcitabine in a prolonged infusion and cisplatin for malignant pleural mesothelioma

Anti-Cancer Drugs, 2012

After a favorable experience with gemcitabine at a low dose in a prolonged infusion in combinatio... more After a favorable experience with gemcitabine at a low dose in a prolonged infusion in combination with cisplatin for advanced non-small-cell lung cancer, here, we present the results from a phase II trial for patients with malignant pleural mesothelioma. Eligible patients had biopsy-proven malignant pleural mesothelioma, were chemo-naive, Eastern Cooperative Oncology Group performance status 0-2, had normal hematopoietic liver and renal function, and gave informed consent. Treatment consisted of gemcitabine 250 mg/m in a 6-h infusion on days 1 and 8 and cisplatin at 75 mg/m on day 2 of a 3-week cycle for four cycles, followed by two additional cycles without cisplatin. Seventy-eight patients (58 men, 20 women; age 33-82 years, median 58) were recruited into the trial. The histologic types were as follows: epitheloid 56 (71.8%); four sarcomatoid (5.1%); mixed 15 (19.2%); and mesothelioma, three not otherwise specified (3.8%). Grades 3-4 toxicity included two (2.6%) patients with anemia, 18 (23.1%) with neutropenia, and one with nausea/vomiting. Reversible thrombocytosis with platelets over 1000-10/l was recorded in 10 (12.8%) patients and grade 2 alopecia in 60 (76.9%). Four (5.1%) patients showed a complete response and 35 (44.9%) showed a partial response with a response rate of 39/78 (50%). Minimal response or stable disease was seen in 35 (44.9%), whereas only four (5.1%) patients progressed during treatment. Most patients reported symptomatic improvement with a higher or a stable quality of life score in 70 (89.7%) cases. The median progression-free survival was 8.0 months (confidence interval 6.9-9.0). The median overall survival was 17.0 months (confidence interval 14.7-19.2). One-year, two-year, and three-year survival rates were 67.3, 32.7, and 19.8%, respectively. Epitheloid histological type was the only statistically significant favorable prognostic factor for progression-free survival and overall survival. Because of the acceptable toxicity, remarkable activity, and reasonable cost, this treatment should be further explored.

Research paper thumbnail of Locoregional control and survival after breast conserving therapy

Background. The purpose of our study was to present a 5-year survival and locoregional control ra... more Background. The purpose of our study was to present a 5-year survival and locoregional control rates in breast cancer patients and to establish eventual impact of the treatment and patient characteristics on lo-coregional control and survival. Methods. From January 1998 to December 1999 564 stage 1 and 2 breast cancer patients were treated with breast conserving therapy. We evaluated the following characteristics: age, histological diagnosis, grade, size, number of metastatic lymph nodes, hormonal receptor status, extensive intraductal component (EIDC), vas-cular invasion, pathologic tumour margins, type of surgery and use of adjuvant therapy. Results. The mean age of our patients was 54.2 years. Invasive ductal carcinoma was the most common di-agnosis (82.4%), followed by invasive lobular carcinoma (10.6%). Most of the tumours were grade 2. Seventy-two % of patients had T1 tumours, 24% T2 and 3% T is tumours. Metastatic lymph nodes were pres-ent in 44% of patients. All patients wer...

Research paper thumbnail of Communication: Back to the Human Side of Medicine

Research paper thumbnail of Locoregional control and survival in breast cancer patients stage I and II after breast conserving treatment: comparison of two groups

Senologie - Zeitschrift für Mammadiagnostik und -therapie

Research paper thumbnail of Quantitative analysis of fine needle aspiration biopsy samples

Radiology and Oncology

The fine needle aspiration biopsy (FNAB) is a quick, simple, safe, painless and inexpensive metho... more The fine needle aspiration biopsy (FNAB) is a quick, simple, safe, painless and inexpensive method. It is of the utmost importance in the preoperative diagnostics of tumours. 1 The diagnostic reliability of the method is good. It enables us to classify tumours as malignant or benignant in almost 100% cases and to further specify the type of the tumour in 80-98% of cases. 2 Serious side effects (pneumothorax, severe bleeding, infection, pain, vomiting etc.) are rare. 3 In the process of aspiration the cells are seldom extensively damaged since the small diameter of the needle enables it to push aside the tissue rather than tearing it. New, highly specialized methods of treatment require the specification of the tumour lesion to the highest extent. Any additional information about the morphology and cell structure, which determines the prognosis and helps to choose an appropriate treat- is lowest in FNAB of lymph nodes (4.9%), followed by breast (16.7%) and thyroid (18%). Conclusions. We concluded that FNAB in the majority of cases grants a sufficient number of cells for the standard microscopic evaluation and also ancillary diagnostic procedures.

Research paper thumbnail of Local control and survival in breast cancer patients stage I and II after Breast Conserving Treatment (BCT); comparison of two groups

Senologie - Zeitschrift für Mammadiagnostik und -therapie, 2007

Research paper thumbnail of Pollution in the working place and social status: Co-factors in lung cancer carcinogenesis

Lung Cancer, 2014

Apart from the association with tobacco consumption, other factors of importance for prevention a... more Apart from the association with tobacco consumption, other factors of importance for prevention and early diagnosis of lung cancer have received little attention. We present a case-control study focusing on professional exposure to carcinogens and social status. A written questionnaire was completed by 551 consecutive patients with lung cancer and 494 patients with large bowel cancer. The groups were balanced regarding gender and age distribution. The questionnaire included data on place of birth, education, smoking history, diet and alcohol intake, body weight and height, occupation, housing conditions and family income. According to standard epidemiological criteria, professional exposure to carcinogens was classified as professions with exposure to confirmed lung cancer carcinogens, professions with exposure to suspected lung cancer carcinogens and other professions. As expected, there were significant differences between the two groups regarding smoking status. While there were no significant differences in educational levels, more immigrants were among patients with lung cancer (17.9% vs 11.6%, p=0.005). On average, lung cancer patients had a lower body mass index (BMI) at 24.77, as compared to 26.14 for large bowel cancer (p=0.000). Lung cancer patients had lower income and poorer housing conditions; the bivariate difference was significant both for income levels (p=0.046) and type of residence (p=0.009). The proportion of patients working in professions with exposures to known carcinogens was 33.5% for lung cancer, and 17.1% for large bowel cancer (p=0.000). In the multivariate analysis, smoking (p=0.000), BMI (p=0.000) and type of occupation (p=0.001) were significant factors. While there is no doubt about smoking in lung cancer carcinogenesis, professional exposure to carcinogens and belonging to lower socio-economic strata also play an important role.

Research paper thumbnail of Intercalated chemotherapy and erlotinib for advanced NSCLC: high proportion of complete remissions and prolonged progression-free survival among patients with EGFR activating mutations

Radiology and Oncology, 2014

Disclosure: No potential conflicts of interest were disclosed.

Research paper thumbnail of The role of PET-CT in radiotherapy planning of solid tumours

Radiology and Oncology, 2000

Disclosure: No potential conflicts of interest were disclosed.

Research paper thumbnail of New Challenges in Communication with Cancer Patients

Research paper thumbnail of Intermittent Chemotherapy and Erlotinib for Nonsmokers or Light Smokers with Advanced Adenocarcinoma of the Lung: A Phase II Clinical Trial

Journal of Biomedicine and Biotechnology, 2011

Background. Intermittent application of chemotherapy and tyrosine kinase inhibitors may avoid ant... more Background. Intermittent application of chemotherapy and tyrosine kinase inhibitors may avoid antagonism between the two classes of drugs. This hypothesis was tested in a Phase II clinical trial. Patients and Methods. Eligible patients were nonsmokers or light smokers, chemo-naïve, with metastatic adenocarcinoma of the lung. Treatment: 4 to 6 cycles of gemcitabine 1250 mg/m 2 on days 1 and 4, cisplatin 75 mg/m 2 on day 2, and erlotnib 150 mg daily on days 5-15, followed by erlotinib as maintenance. Results. 24 patients entered the trial. Four pts had grade 3 toxicity. Complete remission (CR) and partial remission (PR) were seen in 5 pts and 9 pts, respectively (response rate 58%). Median time to progression (TTP) was 13.4 months and median overall survival (OS) was 23 months. When compared to patients with negative or unknown status of EGFR mutations, 8 patients with EGFR gene activating mutations had significantly superior experience: 4 CR and 4 PR, with median TTP 21.5 months and OS 24.2 months (P < .05). Conclusions. Intermittent schedule with gemcitabine, cisplatin and erlotinib has mild toxicity. For patients who are positive for EGFR gene activating mutations, this treatment offers excellent response rate, time to progression and survival.

Research paper thumbnail of Malignant Spinal Cord Compression

Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 2008

Malignant spinal cord compression (MSCC) is an uncommon but debilitating complication of advanced... more Malignant spinal cord compression (MSCC) is an uncommon but debilitating complication of advanced malignancy. Clinician knowledge about diagnosis, prognosis, therapy, and hospice referral is important if MSCC patients are to be treated in an optimal way.

Research paper thumbnail of Two schedules of chemotherapy for patients with non-small cell lung cancer in poor performance status: a phase II randomized trial

Anti-Cancer Drugs, 2010

We present experience from a phase II randomized clinical trial, comparing standard gemcitabine a... more We present experience from a phase II randomized clinical trial, comparing standard gemcitabine as monotherapy with low-dose gemcitabine in long infusion in a doublet with cisplatin at reduced dose for patients with non-small cell lung cancer (NSCLC) and who are unfit for standard platin-based chemotherapy. Eligible patients had microscopically confirmed NSCLC in stage IIIB (wet) or IV, were chemo-naive, and were in poor performance status or presented with significant comorbidity. Standard treatment with gemcitabine, 1250 mg/m in 20-30 min on days 1 and 8 as monotherapy (arm A) was compared with low-dose gemcitabine in long infusion (200 mg/m in 6 h on day 1) and cisplatin at 60 mg/m on day 2 (arm B). Both treatment schedules were repeated every 3 weeks until disease progression, unacceptable toxicity, or to a maximum of six cycles. A total of 112 patients (83 male, 29 female, median age 66 years) were randomized between arm A (57 patients) and B (55 patients). The two groups were balanced for prognostic factors. Fifty-three patients in arm A and 52 in arm B received at least one application of chemotherapy and were evaluable for toxicity and response. The median number of cycles was four and five for arms A and B, respectively. Except for grade 3 anemia (one patient in arm A and two in arm B), no other major toxicity was seen. Regarding response to treatment, arm B was superior: 1 complete response and 13 partial remissions (response rate 26.9%) as compared with five partial remissions (response rate 9.4%) in arm A (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). The median time to progression was 3.8 and 5.6 months, and the median survival was 4.3 and 6.8 months for arms A and B, respectively (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Treatment with low-dose gemcitabine in long infusion and cisplatin at reduced dose has very low toxicity, is effective, was found to be superior to monotherapy with gemcitabine in standard doses, and is suitable for patients with NSCLC who cannot tolerate a standard platin-based doublet.

Research paper thumbnail of Conservative Treatment for Breast Cancer

Research paper thumbnail of A phase II trial of low-dose gemcitabine in a prolonged infusion and cisplatin for malignant pleural mesothelioma

Anti-Cancer Drugs, 2012

After a favorable experience with gemcitabine at a low dose in a prolonged infusion in combinatio... more After a favorable experience with gemcitabine at a low dose in a prolonged infusion in combination with cisplatin for advanced non-small-cell lung cancer, here, we present the results from a phase II trial for patients with malignant pleural mesothelioma. Eligible patients had biopsy-proven malignant pleural mesothelioma, were chemo-naive, Eastern Cooperative Oncology Group performance status 0-2, had normal hematopoietic liver and renal function, and gave informed consent. Treatment consisted of gemcitabine 250 mg/m in a 6-h infusion on days 1 and 8 and cisplatin at 75 mg/m on day 2 of a 3-week cycle for four cycles, followed by two additional cycles without cisplatin. Seventy-eight patients (58 men, 20 women; age 33-82 years, median 58) were recruited into the trial. The histologic types were as follows: epitheloid 56 (71.8%); four sarcomatoid (5.1%); mixed 15 (19.2%); and mesothelioma, three not otherwise specified (3.8%). Grades 3-4 toxicity included two (2.6%) patients with anemia, 18 (23.1%) with neutropenia, and one with nausea/vomiting. Reversible thrombocytosis with platelets over 1000-10/l was recorded in 10 (12.8%) patients and grade 2 alopecia in 60 (76.9%). Four (5.1%) patients showed a complete response and 35 (44.9%) showed a partial response with a response rate of 39/78 (50%). Minimal response or stable disease was seen in 35 (44.9%), whereas only four (5.1%) patients progressed during treatment. Most patients reported symptomatic improvement with a higher or a stable quality of life score in 70 (89.7%) cases. The median progression-free survival was 8.0 months (confidence interval 6.9-9.0). The median overall survival was 17.0 months (confidence interval 14.7-19.2). One-year, two-year, and three-year survival rates were 67.3, 32.7, and 19.8%, respectively. Epitheloid histological type was the only statistically significant favorable prognostic factor for progression-free survival and overall survival. Because of the acceptable toxicity, remarkable activity, and reasonable cost, this treatment should be further explored.