| Abstract | Cilj istraživanja: Osnovni cilj rada je bio odrediti vrijeme čekanja na kirurško i onkološko liječenje u bolesnika s dijagnozom tumora središnjeg živčanog sustava koji su bili hospizalizirani u Klinici za neurologiju KBC-a Split u vremenskom razdoblju od veljače 2016. do travnja 2017. godine.
Ispitanici i postupci: Ovo opservacijsko prospektivno istraživanje je provedeno u Klinici za neurologiju KBC-a Split. Obuhvaćena su 73 pacijenata kojima je postavljena dijagnoza tumora SŽS-a u razdoblju od 21. veljače 2016. do 10. travnja 2017. godine. Pretraživanjem povijesti bolesti bolesnika hospitaliziranih u ovom vremenskom periodu u Klinici za neurologiju KBC-a Split, prikupljeni su demografski i klinički podatci o pacijentima. Tijekom istraživanja smo također prikupili podatke o vrsti i vremenu liječenja uvidom u medicinsku dokumentaciju u Klinici za onkologiju KBC-a Split. U slučaju nepotpune medicinske dokumentacije, telefonski smo od pacijenta ili njihove obitelji saznali kojim oblikom terapije su liječeni i kada su je započeli.
Rezultati: Od ukupnog broja oboljelih bilo je 35 muškaraca i 38 žena. Prosječna dob u kojoj se postavljala dijagnoza iznosi 65 godina (min-maks: 24–81 godina). Primarnih tumora je bilo 51, a metastatskih je bilo 22. Najčešća vrsta primarnih tumora SŽS-a u praćenom razdoblju su bili meningeomi, koji su nađeni u 20 pacijenta. Meningeom je češće dijagnosticiran kod žena, ali razlika u odnosu na muškarce nije bila statistički značajna (P=0,199; χ2=1,850). Na drugom mjestu prema učestalosti u našoj studiji se nalazi multiformni glioblastom sa 17 oboljelih. Na trećem mjestu su ostali tumori iz skupine astrocitoma. Osim pojavnosti tumora SŽS-a dijagnosticiranih u Klinici za neurologiju, u istraživanju smo proučavali i specifične oblike liječenja za pojedinu vrstu tumora. Kirurški je liječeno 35, a onkološki je liječeno 14 pacijenata. Kirurškom radioterapijom (gamma knife) liječeno je 5 pacijenata. Prosječno vrijeme čekanja na terapiju bilo je 15,5 dana. Najkraće se čekalo na kiruršku radioterapiju, zatim na operaciju, radioterapiju, kemoterapiju te naposljetku najduže na konkomitantnu kemoradioterapiju. Utvrđena je statistički značajna razlika u vremenu čekanja na onkološku terapiju u odnosu na operaciju (P<0,001; Z=-4,154; U=57,500). Simptomatski je liječeno 16 bolesnika. Nije utvrđena statistički značajna razlika između muškaraca i žena u liječenju tumora (P=0,051; χ2=4,081). Zabilježena su 3 smrtna slučaja za vrijeme boravka u bolnici. Smrt je nastupila u prosjeku 5 dana nakon postavljanja dijagnoze. Kod 12 pacijenata urađena je stereotaksijska biopsija kao definitivna potvrda dijagnoze tumora SŽS-a. Nakon urađene biopsije specifično liječenje je nastavilo 9 bolesnika, te su na terapiju čekali 24 dana.
Zaključci: U navedenom vremenskom razdoblju na kiruršku i onkološku terapiju se u prosjeku čekalo 15,5 dana te je utvrđena statistički značajna razlika između ova dva oblika liječenja, u korist kirurškog liječenja. Najčešće primjenjivana terapija bio je neurokirurški zahvat. Istraživanje je pokazalo da su primarni tumori češći od sekundarnih. Među ženama je bilo više oboljelih, ali statistički neznačajno prema oboljelim muškarcima. Najčešće dijagnosticiran primarni tumor bio je meningeom, a drugi po učestalosti multiformni glioblastom. |
| Abstract (english) | Objectives: The purpose of the study was to determine the waiting time for surgical and oncological treatment in patients with central nervous system tumor diagnosis, who were hospitalized at the Deparment of Neurology, University hospital of Split, in the period from February 2016 to April 2017.
Patients and methods: This observational prospective study was conducted at the Dept. of Neurology, University hospital of Split. Data about the patients were collected by examining inpatients medical records. The study was continued by collecting data on the type and duration of treatment at Oncology Department, University hospital of Split. In the case of incomplete medical records, additional data were obtained directly from the patients or their families.
Results: Out of the total number of patients, there were 35 males and 38 women. The median age of the diagnosis was 65 years (min-max: 24 - 81 years). There were 51 primary tumors, and 22 metastatic ones. The most common type of primary CNS tumor diagnosed at University hospital of Split, in the follow-up period, was meningeoma. They were found in 20 patients. Meningomas have been diagnosed more frequently in women, but the difference comparing to men was not statistically significant (P=0,199; χ2=1,850). Meningeomas were followed by glioblastoma multiforme, which has been diagnosed in 17 patients. Except of the number and types of CNS tumors diagnosed in the Dept. of Neurology, we have also studied the type of therapy for each patient. Surgical treatment was performed at 35, oncological at 14 patients, and 16 patients were treated symptomatically. Gamma knife procedure was applied for 5 patients. All patients waited for treatment on average for 15.5 days. The shortest waiting time was for the surgical radiotherapy (gamma knife), then follows brain surgery, radiotherapy, chemotherapy and finally concomitant chemoradiotherapy (52 days). Patients treated with oncology procedures waited a statistically significant longer than patients for brain surgery (p<0,001; Z=-4,154; U=57,500). There was no statistically significant difference between men and women in the treatment of tumors (P=0,051; χ2=4,081). Three deaths were recorded during hospital stay. Death occurred on average 5 days after diagnosis. At 12 patients, stereotactic biopsy was performed as a definitive confirmation of the tumor type. Nine patients were treated after obtained biopsy results.
Conclusions: In the aforementioned period, patients with brain tumors waited on average 15.5 days for surgical and/or oncological treatment. Statistically significant difference was found between these two forms of treatment. The most common choice of treatment was surgery. Research has shown that primary tumors were more common than the secondary ones. The most commonly diagnosed primary tumor was meningioma, followed by glioblastoma multiforme. |
