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Deschisă înîn România, Amethyst Radiotherapy s-a dezvoltat rapid, devenind în 2 ani cea mai extinsă reţea paneuropeană de centre dedicate tratamentului cancerului prin radioterapie. În prezent, reţeaua Amethyst are 6 clinici deschise în 4 ţări, cumulând 10 acceleratoare liniare şi 4 echipamente de brahiterapie.

La nivel european, printre cele mai frecvente tipuri de cancer tratate în cadrul Amethyst Radiotherapy se numără cancerul de sân, warts treatment singapore de cel de prostată şi plămâni.

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În România, la acestea se adaugă tumorile la nivelul colului uterin şi ORL. Deşi tratamentul modern este disponibil în România la preţuri mult mai mici decât în străinătate, lipsa unui comportament preventiv screening periodic este unul din factorii ce conduc la depistarea cancerului în stadii extrem de avansate, ceea ce reduce şansele de vindecare completă.

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Warts treatment singapore Chiricuţă, directorul medical al Amethyst Radiotherapy România. Christian Chiricuţă. Pacienţii beneficiază de un plan complet de tratament prin radioterapie, care include consulturile medicale warts treatment singapore şi intraterapeutice, analiza dosarului medical, stabilirea strategiei de tratament în comisia oncologică, efectuarea CT-ului de 6 planning, conturarea organelor de risc şi volumul tumoral, stabilirea obiectivelor şi a restricţiilor de doză, efectuarea calculului dozimetric şi verificarea dozimetrică, şedinţele de iradiere, asigurarea şi controlul calităţii.

Amethyst Radiotherapy oferă pacienţilor bolnavi de cancer din Europa tratamente complexe şi complete de radioterapie de tip IMRT — VMAT - una dintre cele mai precise şi rapide tehnici de radioterapie.

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Practica medicală a dovedit astfel că şansele de reuşită în tratarea pacienţilor oncologici sunt mult mai mari decât în cazul unei abordări clasice, unidisciplinare. În cadrul Amethyst, prof. Christian Chiricuţă este director medical şi şef al Comisiei oncologice alcătuite din warts treatment singapore radioterapeuţi, fizicieni, oncologi, radiologi, chirurgi cu o pregătire excepţională în ţară şi în străinătate, membri atât ai Societăţii Române de Radioterapie şi Oncologie Medicală, cât şi a celei europene şi americane.

Amethyst Radiotherapy este liderul paneuropean în tratarea cancerului prin radioterapie, operând în prezent 6 clinici în România, Polonia, Germania şi Franţa.

Compania îşi propune să continue extinderea reţelei de clinici în Europa. Prin tehnologie de ultimă generaţie, experţi de renume european şi prin parteneriatele cu centre de excelenţă precum Centrul de Oncologie Davidoff din Tel Aviv, Universitatea Wurzburg din Germania şi Institutul European de Oncologie de la Milano IEOAmethyst Radiotherapy asigură pacienţilor tratamente la standarde internaţionale de vârf warts treatment singapore domeniu.

warts treatment singapore Gabriel Doru Ghizdăvescu medic primar Oncologie Medicală, şef Secţie Oncologie, Spitalul Schuller Ploieşti Abstract Rezumat Anticancer therapy is now more effective than ever warts treatment singapore, but with the price of important side efects, chief amongst these being cardiovascular side effects. Over the last years, the significance of the cardiac toxicity of anticancer treatment has markedly increased due to improvements in patient survival, aging of the population including cancer patients and the introduction of new anticancer drugs with unique toxicities.

Following cancer treatment in many patients the risk of cardiovascular death may be higher than the actual risk of tumor recurrence.

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Cardiotoxicity is defined as the entirety of significant cardiovascular side effects secondary to anticancer treatment, characterised by the decrease in LVEF, responsible for increased morbidity and mortality.

The most frequent and serious side effect is heart failure with ventricular systolic dysfunction. Other important toxic effects are hypertension, thromboembolic disease, warts treatment singapore disease, arrhythmias and myocardial ischemia.

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Cardiotoxicity can be classified as non-reversible that leads to progressive systolic heart failure and is most typically caused by anthracyclines and reversible cardiac dysfunction that resolves for most patients over time by interrupting anticancer therapy and administering specific cardiac treatment the best known anticancer agent that causes reversible cardiotoxicity is trastuzumab.

All patients undergoing chemotherapy should have prior careful clinic evaluation and assessment of CV risk factors or comorbidities, as well as routine ECG and baseline Doppler echocardiogram. Keywords: anticancer therapy, cardiotoxicity, cardiovascular side effects Terapia antineoplazică este acum mai eficace decât oricând, dar cu preţul unor efecte adverse importante, pe primul loc situându-se efectele secundare cardiovasculare.

Semnificaţia cardiotoxicităţii warts treatment singapore tot mai importantă datorită creşterii supravieţuirii globale inclusiv a pacienţilor neoplaziciapariţiei cancerului la vârste înaintate şi datorită introducerii unor noi agenţi terapeutici cu toxicităţi cardiovasculare importante, ajungându-se în situaţia în papiloame si helminti la mulţi pacienţi riscul de deces prin boli cardiovasculare să fie mai mare decât riscul de recurenţă a cancerului.

Cardiotoxicitatea se defineşte prin totalitatea efectelor adverse cardiovasculare semnificative secundare tratamentului antineoplazic, ca­rac­terizate de scăderea FEVS, responsabile de mor­bi­di­ta­te și mortalitate.

Cel mai important efect advers îl re­pre­zintă insuficienţa cardiacă congestivă. Alte warts treatment singapore se­cun­dare importante sunt reprezentate de HTA, boala tromboembolică, pericardita, aritmiile, ischemia miocardică.

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Din punct de vedere al tipului de cardiotoxicitate, se întâlnesc tipul ireversibil cu progresie spre insuficienţă cardiacă ge­ ne­rată în principal de antracicline şi tipul reversibil în care disfuncţia cardiacă se remite prin întreruperea ad­mi­nistrării terapiei antineoplazice şi administrarea de tra­tament specific cardiologic cel mai cunoscut agent an­tineoplazic care produce cardiotoxicitate reversibilă fiind trastuzumab.

În practică, este necesară evaluarea cli­nică a pacientului şi a factorilor de risc cardiovasculari la prezentare şi pe parcursul tratamentului antineoplazic, pre­cum şi evaluarea paraclinică prin efectuarea de rutină a electrocardiogramei şi a ecocardiografiei Doppler, cu de­ter­minarea FEVS. Tratamentul efectelor secundare cardiovasculare tre­buie să fie rezultatul eforturilor medicului oncolog şi ale me­dicului cardiolog, care trebuie să desfăşoare o muncă în echipă, având ca obiectiv îmbunătăţirea speranţei de viaţă a pacientului, astfel încât să putem trata cancerul protejând inima sau warts treatment singapore se trateze inima permiţându-i pacientului cel mai bun tratament oncologic posibil.

Cuvinte-cheie: terapie anticancer, cardiotoxicitate, efecte secundare cardiovasculare Introduction Cardiac disease and cancer are by far the warts treatment singapore most common disease conditions in the developed world.

Cancer therapy is more effective than ever before at treating cancer, but has a price. Cardiotoxi­ city is a significant adverse effect of cancer treatment, and responsible for increased morbidity and mortality. The most frequent and serious effect of chemotherapeutic agents on the cardiovascular system is heart failure 8 with ventricular systolic dysfunction.

Other toxic effects include hypertension, thromboembolic disease, pericardial disease, arrhythmias and myocardial ischemia.

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In childhood cancer survivors cardiac mortality is increased eightfold. Importantly, not all cardiovascular symptoms in patients treated for cancer are iatrogenic and the differential diagnosis should include co-morbid conditions or the adverse effects of other medications.

The awareness of the cardiovascular risks of cancer treatment may influence the choice of treatment strategy and optimize delivery of therapy. Additionally, this knowledge may also allow for timely interventions, such as life-style changes or treatment of subclinical disease, which may decrease potential harmful effects.

Chemotherapeutic agents and molecular targeted warts treatment singapore can injure the cardiovascular system at central level by deteriorating the heart function or in the periphery by enhancing hemodynamic flow alterations and thrombotic events often latently present in oncology patients.

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Non-reversible or reversible: a cardinal distinction Historically, non-reversible cardiovascular side effects that eventually led to progressive cardiac disease were the consequence of some oncologic therapies; a prime example being anthracycline-induced cardiotoxicity leading to progressive systolic heart failure. With the introduction of warts treatment singapore cancer drugs, such as signalling inhibitors, a new phenomenon has been observed: cardiac dysfunction that resolves for most patients over time.

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In an effort to classify cardiotoxicity of cancer drugs, Ewer proposed warts treatment singapore system to identify drugs that have the potential to cause irreversible damage Type I vs. However, this classification system does have limitations; for example, trastuzumab, a Type II drug, can trigger irreversible cardiac damage in patients with severe preexisting cardiac disease, or potentiate anthracycline Type I cardiotoxicity.

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For cardiovascular side effects from other modern cancer therapeutics, such as angiogenesis inhibitors-induced arterial hypertension and nephrotoxicity, the reversibility remains unknown.

Cardiac dysfunction and heart failure Cardiac dysfunction and heart failure are among the most serious cardiovascular side effects of systemic cancer treatment. Conventional chemotherapeutics, such as anthracyclines, anti-metabolites, and cyclophosphamide, can induce permanent myocardial cell injury - albeit by diverse mechanisms - and by cardiac remodeling.

Understanding the mechanistic pathophysiology of cancer drug-associated cardiac dysfunction is important to predict, treat, and prevent these side effects, although it can be challenging to identify warts treatment singapore proper mechanism in individual patients.

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Data from endomyocardial biopsy and troponin I measurements suggest that myocyte injury may occur during or early after anthracycline exposure. However, due to substantial cardiac reserves and the activation of compensatory mechanisms, clinical manifestation may not warts treatment singapore apparent until months to years after the initial chemotherapy exposure. Clinically, early cardiac side effects are typically reversible and self-limiting and include dysrhythmia, warts treatment singapore changes in the electrocardiogram, pericarditis, and less frequently myocarditis.

It remains uncertain whether patients who experience these early cardiac side effects are also more likely to develop late anthracycline cardiotoxicity, a condition that leads to warts treatment singapore and systolic warts treatment singapore failure. Patients treated with anthracyclines are five times more likely to develop chronic heart failure or reduced left ventricular ejection fraction LVEF compared with those treated with a non-anthracycline-containing chemotherapy.

The incidence of anthracycline-induced cardiotoxicity is dose-dependent. Above this dosage, the rates of cardiotoxicity rise exponentially. However, there is significant interindividual heterogeneity; patients over 65 years of age and children may develop toxicity at lower cumulative dosages.

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Other factors that seem to influence sensitivity to anthracycline-induced cardiotoxicity include genetic predisposition, arterial hypertension, previous or concurrent mediastinal radiation therapy, and combination with alkylating or antimicrotubulechemotherapeutics; many warts treatment singapore risk factors have been studied, and from a practical standpoint we may assume that any insult that has previously damaged i.

It should be noted, however, that those risk factors that have been studied have had a relatively short follow-up period and long-term investigations are needed to better assess the warts treatment singapore impact of risk factors for anthracycline cardiotoxicity. Several methods were investigated to reduce anthracycline cardiotoxicity, including pharmacokinetic modification by liposomal encapsulation, alteration of chemical structure leading to drugs such warts treatment singapore epirubicin, altering drug-infusion regimens to decrease peak plasma levels, and attenuation of iron chelation through pre-treatment with dexrazoxane.

Most of these methods have been associated with a reduction in cardiovascular events in anthracycline-treated patients; however, except for the use of epirubicin, most of these strategies are not in common practice in the clinical setting.

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