Institute Of Oncology In Ljubljana Research Articles

Candidaemia in Central Slovenia: A 12-year retrospective survey.

Candida bloodstream infections (BSI) became an important invasive disease in the late 20th century, in particular among immunocompromised patients. Although considerable progress has been made in the management of patients with invasive mycoses, Candida BSI are still widespread among hospitalised patients and are associated with relatively high mortality. We conducted a retrospective study to evaluate patient characteristics, incidence, species distribution and antifungal susceptibility of BSI isolates of Candida spp. as well as outcomes of Candida BSI from 2001 to 2012, before the widespread use of echinocandins. This is the first epidemiological study of Candida BSI in Slovenia so far. All documented candidaemia cases from 2001 to 2012 in two major hospitals-University Medical Centre and Institute of Oncology in Ljubljana, Slovenia-were taken into consideration. Candida BSI were identified in 422 patients (250 male, 172 female). Laboratory and clinical data of these patients were retrospectively analysed. Mann-Whitney U test was used to compare continuous variables and Fisher's exact test or chi-squared test for categorical variables. The average incidence of Candida BSI was 0.524/10.000 patient-days (0,317/1000 admissions); 16/422 were younger than 1year and 251/422 patients were over 60years old. The most commonly isolated species were Candida albicans and Candida glabrata, followed by Candida parapsilosis. Majority of the patients had a single episode of Candida BSI, multiple episodes of Candida BSI occurred in 18/434 patients (4.1%); in 25/434 patients (5.8%) mixed Candida BSI were observed. Crude 30-day case-fatality rate was 55.4%.

Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study.

BackgroundProviding patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life.ObjectiveThe aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources.MethodsOutpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis.ResultsThe mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)—social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced.ConclusionsUse of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated.

EP-1861: Patient Satisfaction with Radiotherapy Services at Institute of Oncology in Ljubljana (Slovenia)

EP-1861: Patient Satisfaction with Radiotherapy Services at Institute of Oncology in Ljubljana (Slovenia)

Screening for Subsequent Pancreatic Cancer in Childhood Cancer Survivors is Needed. A Case Report

Introduction: The survival of children with cancer has improved considerably over the last decades which have led to a growing number of long term survivors. One of the most serious adverse outcomes in this population is subsequent primary neoplasms with the risk as high as six-fold over expected. The relative risk for subsequent pancreatic cancer in childhood cancer survivors is high, especially after subdiafragmatic radiotherapy and/or chemotherapy with alkylating agents. The survival of patient with advanced pancreatic cancer is very low, and early diagnosis is of vital importance. Case report: We present a female patient, treated for Ewing sarcoma of thoracic wall with multimodal treatment at the age of 5. She received chemotherapy containing a high dose of Cyclophosphamide and postoperative radiotherapy to the left hemithorax with the dose of 15 Gy followed by local boost to the tumour bed. She had regular follow-ups at the Late-effect clinic at the Institute of Oncology in Ljubljana. Well differentiated papillary cancer of thyroid with nodal metastases was diagnosed during a regular neck ultrasound 26 years after the completion of cancer treatment. Two years later, at the age of 33, she presented with abdominal distension, inappetence and diffuse liver metastases with ascites were found by abdominal ultrasound. Tumour marker CA 19-9 was high, but pancreas was morphologically normal on the ultrasound and on abdominal helical CT. Cytological test of ascites and hepatic metastases showed poorly differentiated adenocarcinoma. The disease progressed very fast and she died a month after the appearance of the first symptom. The autopsy revealed poorly differentiated adenocarcinoma of the pancreatic head and body with multiple metastases in abdominal organs and lungs. Conclusion: It would be reasonable to introduce the same guidelines for screening of subsequent pancreatic cancer in childhood cancer survivors at high risk for subsequent pancreas cancer as proposed for patients with increased risk for familial pancreatic cancer.

PS-010 Screening of electronically prescribed cytostatic drug protocols for medication errors

Background The Institute of Oncology in Ljubljana is the leading institution for cancer care in the country and has a busy pharmacy department. The prescription and preparation of cytostatic drugs must be closely monitored, since they are highly toxic and pose a serious health hazard if errors occur in prescriptions for medicines. Pharmacists with knowledge of chemotherapy protocols are thus a key factor in improving the standard of patient care, as they can spot specific errors on chemotherapy prescriptions. Purpose To analyse the number of pharmacists’ interventions over a one year period and evaluate their impact on safety and effectiveness of patient care. Material and methods A review of all pharmacists’ interventions from August 2013 to July 2014 has been carried out. All errors detected were then evaluated by the team of pharmacists and sorted according to their potential to cause harm. Measures to eliminate such mistakes in the future have also been proposed. The interventions were communicated by phone to ensure that the right treatment had been selected and the correct medicines validated in the computer program Cypro. Results The total number of prescriptions was 22,120 and the pharmacy dispensed 48,442 cytostatic preparations. The errors causing most concern were: wrong treatment protocol selected, different patient selected (two patients with the same or similar name), omitted validation for 1 or more drugs from the treatment protocol and erroneous dose orders due to a variety of input mistakes (wrong weight or height, body surface area and random bias). Conclusion Medicines errors should not occur when using approved protocols from the computer program (Cypro). Nevertheless, pharmacist supervision is still needed, since medicines prescription errors happen despite the existence of inputted schemes, as was shown in our study. Only experienced pharmacists with expertise in chemotherapy drugs and pharmacology of cytostatic drugs can identify errors, communicate with physicians and validate the correct treatment orders. References and/or acknowledgements No conflict of interest.

Survival of children with neuroblastoma treated at the Institute of oncology in Ljubljana in two periods

Background : Neuroblastoma is a malignant tumor of the sympathetic nervous system, representning about 5 % of all childhood malignancies. The aim of our study was to compare the survival of neuroblastoma patients treated in Slovenia in two time periods, 1994–2007 and 1980–1993, and analyze the influence of different factors on survival. The hypothesis was that there has been an improvement in the survival of neuroblastoma patients treated after 1994. Methods : Seventy-eight neuroblastoma patients, treated at the Department of Pediatrics and at the Institute of Oncology in Ljubljana in the period 1980–2007 were included in the retrospective study. The list of patients and their basic data were collected from the Cancer Registry of Slovenia. Furtjer data about the patients, tumor characteristics and treatment were collected from patients’ records. Results : Thirty-nine (50 %) out of seventy-eight neuroblastoma patients included in the study are alive; of the 39 (50 %) dead, 23 (29.5 %) died during primary tumor treatment, 15 (19.2 %) died after recurrent disease, and the cause of death in one (1.3 %) patient remained unknown. The survival rates according to stage of disease, site of primary tumor and tumor size have improved in children treated after 1994, as compared to those treated before 1994. The most important factors influencing the prognosis in both time periods were stage of disease, patients’ age and tumor size at diagnosis while there was no statistical difference in survival according to age at diagnosis and the extent of surgery. Conclusions : The retrospective study confirmed our hypothesis that the survival of our patients treated after 1994 was better than the survival of those treated before. The most important prognostic factors in both periods were stage of the disease, age at diagnosis and tumor size.

Adult cancer patients on home parenteral nutrition in Slovenia, data analysis by the Clinical Nutrition Unit of the Institute of Oncology in Ljubljana, in the period 2008–2012.

Introduction : Home parenteral nutrition (HPN) represents a kind of therapy for intestinal failure. The system of HPN for adult patients was established in Slovenia by the Clinical Nutrition Unit of the Institute of Oncology, Ljubljana in 2008. The aim of the article is to analyse Slovenian data on HPN in cancer patients in the four-year period from 2008 to 2012. Patients and Methods : In the time period from 2008 to 2012, 53 cancer patients were included in the HPN system in Slovenia–19 males and 34 females. Results : The average age of the patients at enrollment into the HPN system was 53 years. This represents 74.6 % of all patients on HPN who were registered in our unit in this period. Forty-four patients had advanced cancer and 9 patients had no recurrence of cancer during the observation period. In patients with advanced cancer, tumors of the gastrointestinal tract (15 patients stomach and esophagus, 11 patients colon and rectum) and gynecological cancers (10 patients) were represented most frequently.. Gastrointestinal obstruction (74 %) was the major indication for long-term parenteral nutrition in cancer patients. Thirty-seven patients died during the observation period. Median survival time of patients with advanced cancer was 8 months (95 % CI, 3.61 to 12.39 months). Twenty-seven patients received HPN during anti-cancer therapy (chemotherapy, radiotherapy, surgery). Medians for survival time of patients receiving an anticancer therapy and patients without any therapy were 11 months (95 % CI, 3.72 to 18.28 months) and 2 months (95 % CI, 1.26 to 2.74 months), respectively. The survival of patients with anticancer therapy was significantly longer (p < 0.001). The majority of patients (90 %) had HPN each day, 7 times per week. Twenty-eight patients (52 %) had venous access complications . The most common cause of complication was infection in 16 patients (30 %), which did not shorten the survival time of patients with advanced cancer. The number of VAP complications was time-independent and did not affect the survival of the observed patients. The significance value was 0.44 (95 % CI, 0.153–2.275). Conclusion : The results of the retrospective study represent the first Slovenian data on the survival time of cancer patients on HPN treatment for intestinal failure. The results are comparable to the results from European surveys, which are a direct indicator that inclusion criteria for HPN in cancer patients used in Slovenia are good. Introduction of HPN as a therapeutic option also offers a possibility to continue with anticancer therapy and improve the survival rate of patients with advanced cancer. They are also an indirect sign that the quality of HPN service is good and serves as a platform for further development of HPN in cancer patients in Slovenia, and at the same time for other patients who would need a replacement therapy in the form of HPN owing to intestinal failure.

Improved survival after introduction of chemotherapy for malignant pleural mesothelioma in Slovenia: Population-based survey of 444 patients

BackgroundMalignant pleural mesothelioma is a rare tumour with increasing frequency throughout the world. Due to long latency after exposure to asbestos, restrictions in the production and use of asbestos have not yet alleviated the burden of mesothelioma. During the last decade, several trials confirmed the benefit of systemic treatment with drugs such as doublets with cisplatina and gemcitabine or pemetrexed for carefully selected patients in good performance status. The purpose of this survey was to assess the impact of systemic treatment for the whole national population of patients with mesothelioma.Patients and methods.A retrospective study included all patients in Slovenia with histologically confirmed diagnosis of malignant pleural mesothelioma in the period from 1974 till 2008. Data from the Cancer Registry of Slovenia were supplemented by review of clinical records of the Institute of Oncology in Ljubljana where virtually all non-surgical treatment for mesothelioma was performed. We analysed the incidence, treatment, and survival of patients treated in the era of infrequent chemotherapy (1974–2003, the first period) and after it (2004–2008, the second period).ResultsThe survey included 444 patients, of whom 325 and 119 were diagnosed in the first and second period, respectively. Joinpoint regression analysis showed that after 1995 the trend in crude incidence rates increased more rapidly; the annual change was 0.03 per 100,000 per year before 1995 and 0.06 per 100,000 per year after. There was clear male predominance (70%) throughout the period covered by the survey. The proportion of patients above 65 years of age increased from 41.8% to 54.6% for the first and second period, respectively (p = 0.02). With a total of 52 (11.7%) operated patients, surgical treatment was rare and used only for selected patients with early disease and without comorbidity, leading to their relatively long median survival of 13.6 months. Chemotherapy was applied to 56 (17.2%) and to 96 (80.7%) patients during the first and second period, respectively. While a variety of older drugs were used in the first period, the most common regimen in the second period (applied to 91 patients) was doublet of low-dose gemcitabine in prolonged infusion and cisplatin. For the whole population of patients regardless the mode of treatment, median survival was 7.4 and 12.6 months (p-value = 0.037) for the first and second period, respectively.ConclusionsIncreasing incidence, male predominance and increased proportion of older patients confirm that the burden of mesothelioma persists in spite of a 15-years old ban in the production of asbestos. Modern chemotherapy, and in particular treatment with low-dose gemcitabine in prolonged infusion and cisplatin significantly prolonged median survival of patients with malignant pleural mesothelioma in Slovenia.

The sigmoid colon and bladder shielding in whole pelvic irradiation at prostate cancer (forward planned IMRT from Institute of Oncology Ljubljana)

Background. The whole pelvic irradiation (WPI) is again gaining the important role in radiotherapy of prostate cancer. With the conformal irradiation of the large fields that are covering the pelvic nodes, the extra damage is done to sigmoid colon and urinary bladder. Sparing the region between the iliac nodes is necessary since the dose delivered to the organs at risk that are partly included in the mentioned area (the sigmoid colon and bladder) can be importantly reduced. Methods. We are presenting a possible way of shielding the central region between iliac nodes that does not need to be irradiated. Dose volume histograms of standard box technique and technique with additional central shielding of sigmoid colon and urinary bladder in WPI are compared in 10 patients. Results. Applying the described shielding technique 30 to 45 % or in some cases even up to 55% of the sigmoid colon that would with standard box technique be irradiated at doses from 30 to 50 Gy is spared, and also around 10% of the bladder that would receive 45-55 Gy is spared. Conclusions. In the whole pelvic irradiation (WPI) in prostate radiotherapy the sparing of the region between the iliac nodes is crucial since it allows the dose delivered to the sigmoid colon to be reduced to the recommended restrictions. Since the sigmoid colon benefits most from described shielding, the technique is addressed as the Sigmoid Colon Shielding (SCS). The SCS technique is in use at our department at Institute of Oncology in Ljubljana.

108 LDR & PDR gynecological brachytherapy at the Institute of Oncology in Ljubljana, Slovenia — the need of applying the flexible rectal probe

108 LDR & PDR gynecological brachytherapy at the Institute of Oncology in Ljubljana, Slovenia — the need of applying the flexible rectal probe

SURGICAL TREATMENT OF ENDOMETRIAL CANCER

Background. Nowadays, endometrial cancer is the most frequent gynecologic malignancy with a relatively good prognosis. The prognosis and the quality of life of these patients can be improved considering the prognostic factors and more rational treatment. Methods. This retrograde analysis comprised 499 patients with endometrial cancer operated at the Department of Obstetrics and Gynecology and then irradiated at the Institute of Oncology in Ljubljana in the period 1995–1999. Results. Most patients had stage I disease (81.4%), good prognostic histological type (endometroid and adenoacanthoma in 81.3%), well- and moderately differentiated tumors (86%) and early myometrial invasion (72.4%). In the observed period we performed radical hysterectomy »old« Wertheim (Piver II) in only 8.4% of cases, in all other cases simple vaginal or abdominal hysterectomy (in 46.9% with pelvic lymphadenectomy) was done. Adjuvant irradiation was administered to 70% of patients. The analysis of 3- and 5-year survival comprises only 466 patients. The overall 5-year survival was 85.8%, in stage I cases 88.1%. There were no significant differences in survival in stage I cases regarding the type of surgery. In stage I the most important adverse prognostic factors were poor differentiation, deep myometrial invasion and serous-papillary histologic type, whereas lymph node involvement was very rare (less than 1%). Conclusions. For the choice of appropriate surgical treatment of patients with endometrial cancer it is necessary to consider the prognostic factors. In this analysis a more radical surgical procedure did not improve the survival significantly. The usefulness of limphadenectomy in stage I remains open.

The role of radioactive iodine in the treatment of Hürthle cell carcinoma of the thyroid.

It is generally believed that Hürthle cell thyroid carcinoma (HCTC) does not accumulate radioactive iodine (RAI). The aim of our retrospective study was to find out if, after thyroid surgery and RAI ablation of the thyroid remnant, the metastatic or recurrent HCTC accumulates RAI. We reviewed the charts of 48 patients with histopathologically verified HCTC, who were treated at the Institute of Oncology in Ljubljana, Slovenia, from 1972 to 2000. In 16 patients (11 women, five men; 47-77 years old), who had distant metastases at presentation (eight patients) or recurrence (eight patients), whole-body RAI scanning was performed after the withdrawal of thyroid hormone replacement. Whenever RAI uptake was confirmed, the therapy with 5.6 GBq of RAI was performed. In 11 of 16 patients, the uptake (range 0.1-12%) of RAI was confirmed. Altogether, 46 therapeutic applications of RAI were given. We conclude that whole-body scanning with RAI should be performed in HCTC. RAI may be effective in the treatment of HCTC.

Genetic counceling for hereditary breast and ovarian cancer. Our experience at the institute of oncology in Ljubljana, Slovenija

Genetic counceling for hereditary breast and ovarian cancer. Our experience at the institute of oncology in Ljubljana, Slovenija

Prognostic factors in follicular carcinoma of the thyroid—a multivariate survival analysis

Aims: Multivariate studies of the diagnosis, treatment and prognosis of patients with follicular carcinoma of the thyroid gland are relatively scarce. The aim of our multivariate analysis was to study the factors associated with survival of patients with follicular carcinoma in Slovenia, in an iodine-deficient region. Methods: This retrospective study was carried out in a group of 154 patients (113 women, 41 men; median age 61 years) with follicular carcinoma of the thyroid treated at the Institute of Oncology in Ljubljana between 1972–1992. Data on patient gender, age, disease history, extent of disease, morphological characteristics, mode of therapy and survival were collected. Statistical correlations between possible prognostic factors and survival were analysed by univariate and Cox's multivariate analysis. Results and conclusions: The 10-year survival of the 154 patients was 60%. Multivariate analysis showed that tumour differentiation, primary tumour size, vascular invasion, distant metastases, regional lymph-node metastases, histological tumour type and age were independent prognostic factors for survival. The best prognosis was found in patients with well-differentiated T1 or T2 tumours, without extensive vascular invasion, without distant or regional metastases and aged under 46 years. Patients with Hürthle-cell type carcinomas had better prognosis than those with the follicular type. The worst prognosis was found in patients with poorly differentiated T4 tumours, with extensive vascular invasion, with distant or regional metastases and aged over 60 years.

Role of serum thyroglobulin in the pre-operative evaluation of follicular thyroid tumours

There is no reliable diagnostic test for pre-operative differentiation between benign and malignant follicular and Hurthle cell neoplasms. Measurements of serum thyroglobulin (Tg) are currently only used post-operatively as a marker of recurrent disease or distant metastases in the follow-up of patient with differentiated thyroid cancer. In this study pre-operative serum Tg measurements were performed with the aim of investigating whether Tg levels differ in benign and malignant follicular and Hurthle cell neoplasms. In 516 patients who underwent thyroid surgery at the Institute of Oncology in Ljubljana, Slovenia, from 1990 to 1996, serum Tg concentration was measured in addition to the standard pre-operative tests (fine-needle aspiration biopsy, ultrasonography, 99mTc scanning and hormonal profile). After the operation, patients were divided into 11 groups based on their histological diagnosis (papillary cancer--classic, papillary cancer--follicular variant, papillary cancer oncocytic variant, occult papillary cancer, follicular adenoma, follicular cancer, Hurthle cell adenoma, Hurthle cell cancer, anaplastic cancer, medullary cancer, nodular goiter) and the serum Tg values of the different groups were compared. In groups of patients with follicular and Hurthle cell cancer, median Tg values were higher (2895 and 638.5 ng/ml) and, statistically, differed significantly from the serum Tg values in all other groups (P<0.01). Sensitivities and specificities of the tests were 71.8% and 80.4% for follicular cancer and 55.6% and 83.8% for Hurthle cell cancer, while positive and negative predictive values were 75.6% and 77.1% for follicular cancer and 75% and 68.4% for Hurthle cell cancer. These results indicate that pre-operative serum Tg measurements might be an important additional diagnostic tool in the pre-operative work-up of patients with thyroid tumours.

Superior sulcus tumor (SST): management at the Institute of Oncology in Ljubljana, Slovenia, 1981–1994

During the 14-year period under study, 48 patients with SST were treated at the Institute of Oncology in Ljubljana, Slovenia. There were 46 males and two females, aged 29–88 years (median, 60 years). Of 37 cytologically or histologically confirmed tumors, 12 were squamous, eight large-cell, one small-cell, eight adeno, and eight unclassified carcinomas. Performance status (Karnofsky) was assessed as > 90 in eight, 70–90 in 31 and < 70 in nine patients. The duration of symptoms before diagnosis ranged from 1 to 36 months (median, 5 months). All patients had pain, while six also had hemophthysis, 14 Horner's syndrome, and four Horner's syndrome and upper limb paresis. Before the first chest X-ray, 19 patients were treated for shoulder pain by different specialists. Apical tumor infiltration only on the chest X-ray was found in 13, destruction of the ribs in 31, and destruction of the ribs and vertebral bodies in four patients. Treatment was as follows: radiotherapy in 39 patients (22 with radical, 17 with palliative dose), a combination of surgery and radiotherapy in seven, radiotherapy and chemotherapy in one, and symptomatic therapy alone in one patient. One- and four-year survival of all treated patients was 27% and 11%, respectively. One of the seven patients operated on survived for 44 months, and 2 39 irradiated ones survived for 37 and 56 months, respectively, while others died within 24 months from diagnosis. In 81% of patients the pain was subdued after radiotherapy. The disease-specific survival of all patients included in the follow-up correlated with performance status and M stage, while that of those treated by irradiation alone correlated with tumor dose ( P < 0.05).

The development of radiotherapy in Slovenia

The historical data on the development of radiotherapy in Slovenia are presented from its first use in this county in 1902 until the present. The Institute of Oncology in Ljubljana was established in 1938 with the intention of providing a sound development of radium and roentgen cancer treatment. After World War II, the development of radiotherapy was dynamic, which is evident from the data on new radiation sources in external beam therapy (accelerators, telecobalt units), in brachytherapy (various sealed radioisotopes) as well as in the introduction of therapy with unsealed radioisotopes. In 1947, a Chair of Oncology and Radiotherapy was instituted at the Medical Faculty of the University of Ljubljana (with the seat at the Institute of Oncology). In 1955, radiotherapy and oncology were officially recognized as a separate branches of medicine requiring special obligatory postgraduate residency training. Within the Medical Society of Slovenia, the Section for Radiotherapy was established in 1987. The following year, the Section for Radiotherapy of Slovenia became a member of the European Society for Therapeutic Radiology and Oncology. Considering the size of population of Slovenia (nearly 2 million), it was reasonable that by this time radiotherapy became almost completely concentrated in one central institution, the Institute of Oncology, whose core and cohesive activity were represented in the multidisciplinary cancer treatment approach.

Breast‐cancer risk and oral contraceptive use in slovenian women aged 25 to 54

Results of a previous case-control study in Slovenia showed a significantly elevated risk of breast cancer for ever-OC users aged 25 to 54 years. A further study was conducted in 1988-1990 in the whole of Slovenia, employing more rigorous epidemiological methodology. Cases were 624 women with breast cancer, aged 25 to 54 years, diagnosed at the Institute of Oncology in Ljubljana and other Slovenian hospitals. Controls were 624 women identified through the Population Registry, randomly selected and matched with cases by date of birth and commune of residence. Data were collected by personal interview, using coloured photographs of packages of all OC on the Slovenian market since 1964. A calendar of reproductive life events was constructed with participants to improve estimation of exposure. The adjusted odds ratio (OR) for ever-users was 1.09. There was no increase in risk with total duration of use, interval since first use, age at starting OC, according to use before or after first delivery and time between menarche and age at first use. Increased risk (OR = 2.92) was found for OC users at the time of diagnosis and for those stopping them less than 6 months before (current users). The risk was not increased for those who stopped OC more than 6 months before diagnosis. The results of this study are consistent with most studies showing no overall effect of OC in women aged till 55 years ever using them. Increased risk of breast cancer in current OC users suggests a possible promoting effect of the pill in susceptible women, and indicates the need for careful breast surveillance of these women while they are using OC and in the period immediately following cessation.

Clinical experience with water-heated interstitial hyperthermia system

An orignal circulating hot water hyperthermia system for interstitial treatment has been constructed at the University Cliic for Radiotherapy and Radiobiology in Vienna, Austria. At the Institute of Oncology in Ljubljana, Slovenia, animal experiments as well as a few human treatments were done. Results obtained with 4×4 metal needle implants on rabbits and/or pigs thigh showed that a good temperature distribution inside the heated volume could be achieved. The homogeneity of temperature distribution obtained in human applications using plastic tubes was also acceptable. Although somewhat lower temperatures inside the treated volume were measured in human treatments, the minimum temperatures obtained were still on the cytotoxic level (over 42,5 °C). With some improvements using cooling system for the tumor surrounding zone the damage of the healthy tissue inside the treatment volume could be avoided.