Jasmina Mladenović

Institut za onkologiju i radiologiju Srbije, Beograd, Central Serbia, Serbia

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Publications (11)1.45 Total impact

  • J. Mladenovic, S. Susnjar, A. Jaric, D. Gavrilovic
    Breast. 01/2011; 20.
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    Jasmina Mladenović, Marko Dožić, Borojević Nenad D
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    ABSTRACT: BACKGROUND: Breast conserving surgery followed by postoperative radiotherapy, as alternative to radical mastectomy, has been accepted as an optimal method for loco- regional treatment of the majority of women with early stage of breast carcinoma. The aim of the study was to evaluate the results of postoperative radiotherapy after breast conserving surgery in the Institute for oncology and radiology of Serbia. METHODS: During the 3-year period, 109 breast cancer patients with stage I and II were treated with postoperative radiotherapy after breast conserving surgery. Ninety- four patients underwent quadrantectomy with axillary node dissection, and 15 patients underwent only tumorectomy. After surgery all patients received postoperative radiotherapy to the whole breast with tumor dose 50 Gy in 15 fractions every second day. In 52 patients radiotherapy was given to the regional lymphatics with tumor dose 45 Gy in 15 fractions every second day. Twenty-eight patients received a booster dose (10 Gy) to the tumor bed. Adjuvant systemic therapy was administered depending on the nodal involvement and steroid receptors content: 17 patients received adjuvant chemotherapy (CMF or FAC), 18 received adjuvant hormonal therapy (tamoxifen or ovarian ablation), and 6 patients received both chemo- and hormonotherapy. RESULTS: After median follow-up period of 62 months, there was no evidence of loco- regional recurrence in anyone of patients. Distant metastases occurred in 7 patients (6.4%) with median disease free interval of 27.6 months. At last follow-up 91 patients (83.4%) were alive, 4 patients (3.7%) were dead of disease, and the same number was dead of other causes. The 5-year overall survival rate was 92.9% and disease-free survival rate was 92.7%. CONCLUSION: According to our results the combined surgery and radiotherapy approach provides good local control of early breast cancer patients. Postoperative radiotherapy after breast conserving surgery with or without adjuvant systemic therapy has important role in adjuvant treatment of early breast cancer.
    Archive of Oncology. 01/2004;
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    ABSTRACT: Background: Locally advanced breast cancer (LABC) includes a heterogeneous group of breast neoplasms classified from stage IIB, IIIA to IIIB. LABC with ipsilateral supraclavicular adenopathy without evidence of distant disease is included in the stage IV (but regional stage IV). Purpose of this study was to assess the role of radiotherapy (RT) in combined treatment with systemic therapy (chemotherapy and hormonotherapy) in LABC with ipsilateral supraclavicular adenopathy. Methods: In 5-year period 45 patients with LABC and ipsilateral supraclavicular metastases were treated with radiotherapy and chemo- or hormonotherapy depending on the physical condition, age and steroid receptors (ER, PGR) content. Twenty patients received TD 30 Gy in 10 fractions on breast and regional lymph nodes and 25 patients received TD 51 Gy in 15 fractions on the breast and TD 45 Gy in 15 fractions on regional lymph nodes. Twenty-three patients received chemotherapy (CMF or FAC), 10 received hormonotherapy, and 12 received both chemo- and hormonotherapy. Results: After finishing complete treatment the overall response rate was 93.3%. Complete response was 20% and partial response was 73.3%. Locoregional relapse occurred in 5 patients and distant metastases occurred in 10 patients. Conclusion: Treatment of LABC with ipsilateral supraclavicular lymph node involvement should be aggressive, what means combined radiotherapy and systemic chemo-hormonotherapy. Such treatment provides for these patients maximum chance of long-term disease - free and overall survival.
    Archive of Oncology. 01/2003;
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    ABSTRACT: PURPOSE The aim of this study was: 1. to evaluate treatment results of combined therapy (surgery, postoperative craniospinal radiotherapy with or without chemotherapy) and 2. to assess factors affecting prognosis (extend of tumor removal, involvement of the brain stem, extent of disease postoperative meningitis, shunt placement, age, sex and time interval from surgery to start of postoperative radiotherapy). PATIENTS AND METHODS During the period 1986-1996, 78 patients with medulloblastoma, aged 1-22 years (median 8.6 years), were treated with combined modality therapy and 72 of them were evaluable for the study end-points. Entry criteria were histologically proven diagnosis, age under 22 years, and no history of previous malignant disease. The main characteristics of the group are shown in Table 1. Twenty-nine patients (37.2%) have total, 8 (10.3%) near total and 41 (52.5%) partial removal. Seventy-two of 78 patients were treated with curative intent and received postoperative craniospinal irradiation. Radiotherapy started 13-285 days after surgery (median 36 days). Only 13 patients started radiotherapy after 60 days following surgery. Adjuvant chemotherapy was applied in 63 (80.7%) patients. The majority of them (46 73%) received chemotherapy with CCNU and Vincristine. The survival rates were calculated with the Kaplan-Meier method and the differences in survival were analyzed using the Wilcoxon test and log-rank test. RESULTS The follow-up period ranged from 1-12 years (median 3 years). Five-year overall survival (OS) was 51% and disease-free survival (DFS) 47% (Graph 1). During follow-up 32 relapses occurred. Patients having no brain stem infiltration had significantly better survival (p=0.0023) (Graph 2). Patients with positive myelographic findings had significantly poorer survival compared to dose with negative myelographic findings (p=0.0116). Significantly poorer survival was found in patients with meningitis developing in the postoperative period, with no patient living longer than two years (p=0.0134) (Graph 3). By analysis of OS and DFS in relation to presence of the malignant cells in liquor, statistically significant difference, i. e. positive CSF cytology was not obtained, which was of statistical importance for survival (p=0.8207). Neither shunt placement nor shunt type showed any impact on survival (p=0.5307 and 0.7119, respectively). Children younger than three years had significantly poorer survival compared to those older than 16 years (p=0.0473). Although there was a better survival rate in females than in males this was not statistically significant (p=0.2386).The analysis results of treatment showed that significantly better survival occurred in patients in whom total or subtotal tumor removal was possible (p=0.0022) (Graph 4). Patients who started radiotherapy within two months after surgery have better survival, but again this was not statistically significant, probably due to the small number of patients receiving delayed radiotherapy (p=0.2231)(Graph5). CONCLUSION Based on this factors standard and high risk group could be defined. Combined chemotherapy should to be investigated particularly for high risk subgroup. Future research should be done to define new therapeutic modalities (gene therapy, compounds active in tumor antiangiogenesis etc).
    Srpski Arhiv za Celokupno Lekarstvo. 01/2003;
  • Archive of Oncology. 01/2002;
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    Jasmina Mladenović, Borojević Nenad D
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    ABSTRACT: BACKGROUND: Radical or modified radical mastectomy was considered for many years the standard therapy for operable patients. Following radical mastectomy, postoperative irradiation of the chest wall and peripheral lymphatics is indicated in selected highrisk patients. Some studies on breast cancer patients who underwent radical mastectomy and received adjuvant chemotherapy tried to find out whether the addition of irradiation treatment to the chest wall and regional lymph nodes increases survival. The hypothesis in favor of irradiation is that chemotherapy can eliminate distant micrometastases, but is less effective against local and regional diseases, which are better controlled by radiotherapy. METHODS: In one year period, 110 patients with early stage of breast cancer were treated with radical mastectomy, and postoperative radiotherapy. Forty one patients had only postoperative radiotherapy, 27 received also adjuvant chemotherapy, 40 received adjuvant hormonal therapy and 2 patients received both adjuvant chemo and hormonotherapy. Postoperative irradiation was given on the regional lymph nodes (supra and infraclavicular, axillary and internal mammary nodes) with the tumor dose 48 Gy in 22 fractions over a period of four and a half weeks. All fields were treated with Cobalt 60. RESULTS After the median follow up of 67 months, 33 patients (30 %) had some kind of failure in form of local recurrence, distant metastases or both Locoregional relapse alone or associated with distant metastases occurred in 10 patients (9.1 %). Only 1.8 % of patients had local recurrence as the first failure. Distant metastases occurred in 32 patients (29.1%). After the end of follow up, 60 % patients are alive without evidence of disease while 16.4 % patients are alive with disease. The 5 year overall survival rate was 78.19% and 5 year disease free survival rate was 67.44%. CONCLUSION: Postoperative radiotherapy after radical mastectomy has important role in adjuvant treatment of early breast cancer in combination with adjuvant chemotherapy and hormonotherapy.
    Archive of Oncology. 01/2002;
  • Jasmina Mladenovic, Nenad Borojevic, Jelena Sasic
    Srpski Arhiv Za Celokupno Lekarstvo - SRP ARK CELOK LEK. 01/2002; 130:345-350.
  • J Mladenović, N Borojević, S Cikarić, Lj Jelić
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    ABSTRACT: Breast cancer is the most frequent cancer in elderly patients (over 65 years). The recent data indicate that in women aged over 72 years the incidence of breast cancer is twice greater than in women aged 45 years. As more and more women are getting older, the total incidence of breast cancer can be expected to increase. The treatment of these patients is complicated by many other diseases including cardiovascular and pulmonary disorders associated with aging, and because chemotherapy and radical surgery are often contraindicated. In an one year period in the Institute of Oncology and Radiology of Serbia a group of 53 elderly (65 years and more) patients with locally advanced breast cancer were treated. Twenty four patients (group A) were treated with hypofractionated (concentrated) radiotherapy. The irradiation was delivered to the breast with TD24-26 Gy with two tangentional portals and 19 Gy to regional lymphatics with anterior fields owner 8 fractions, breast and lymphatics alternatively. The same treatment plan was repeated after 28 days (split course). Co60 was used. Twenty nine patients (group B) were treated with conventional fractionated radiotherapy. Irradiation was delivered to the breast with 51 Gy tumour dose in 16 fractions and to the lymphatics with 45 Gy in 15 fractions. Breast and lymphatics were irradiated alternatively, during 31 working days. After 51 Gy the whole breast was boosted with 20 Gy tumour dose and axilla with TD 12 Gy. The concentrated radiotherapy is, in fact, an alternative for radical--conventional or protracted radiotherapy according to the so-called hypofractionated split course technique. Both techniques have very similar TDF factors. The aim of such a plan is the achievement of adequate tumour dose adapted to the age of patients (the patients should be treated in a smaller number of fractions). All patients were aged 65 years or were older. The median age in group A was 72 years and in group B 68 years. Also in all patients breast cancer was locally advanced (stadium III). In group A median follow-up was 29.79 months and in group B 23.62 months. All patients had acute skin reactions. In group A (irradiated with concentrated technique) 91.7% of patients had erythema, 8.3% dry desquamation, but moist desquamation was not observed. In group B (irradiated with conventional technique) 27.6% of patients had erythema, 55.2% dry desquamation and 17.2% moist desquamation. Delayed radiation changes manifested as fibrosis of the breast and region of axilla were noted in 29.24% of patients in group A and 13.8% in group B. The relapse in group A was 41.7% with median relapse free interval of 13.9 months and in group B 48.2% with relapse free interval of 15.6 months. There was no significant statistical difference between the two groups according to standard statistical methods (chi 2 = 0.96; DF = 3; p > 0.05). After approximately 30 months of follow-up, 50% of patients in group A are alive without signs of disease; 16.7% are alive with disease, and 16.7% are dead due to primary disease. In group B 24.1% of patients are alive without signs of disease; 24.1% are alive with disease; and 20.7% are dead due to primary disease. There was no significant statistical difference between the two groups (chi 2 = 4.09; DF = 4; p > 0.05). The overall survival rate in group A was 67% after 4 years and 53% in group B. Relapse free survival was 53% in group A after 4 years and 36% in group B. In conclusion, according to our study there was no statistically significant difference in local control between conventional and hypofractionated radiotherapy in the treatment in elderly patients. The main advantage of concentrated schedule is shortening of duration of irradiation, but the main disadvantage is a high incidence of fibrosis which makes difficult the evaluation of local control. Consensus about treatment of breast cancer in elderly women has not yet been clearly established. Our data suggest that hypofractionated schedule is an effective, suitable and comfortable therapeutic approach in the management of breast cancer in elderly women.
    Srpski arhiv za celokupno lekarstvo 01/2000; 128(9-10):322-7. · 0.23 Impact Factor
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    ABSTRACT: To evaluate the correlation of postmastectomy radiotherapy (PMRT) with local relapse rate, disease-free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients at intermediate risk for locoregional relapse (stage I-II with either 1-3 positive axillary nodes, or node-negative grade III BC) treated with radical mastectomy. We evaluated 482 stage I-II BC patients, with either node-negative grade 3 tumors or with 1-3 positive nodes irrespective of tumor grade, treated with radical mastectomy at our Institute from 1986 to 1994. After mastectomy they received either adjuvant CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy (N=172), or adjuvant endocrine therapy (N=310). Postoperative radiotherapy (RT group) to the regional lymph nodes with tumor dose (TD) 48 Gy in 22 fractions was delivered to 199 patients. After a median follow-up of 79.5 months, no difference in relapse rate between the two groups was seen (30.6% in the RT group vs. 36.7% in the no RT group; x(2), p=0.1). Local recurrence rate occurring alone or with distant metastases was 4.52% in the RT group vs. 7.77% in the no RT group (x(2), p=0.1). However, local recurrence rate alone was significantly higher in the RT group compared to the no RT group (2.01 vs. 6.01%, x(2), p=0.041). In premenopausal patients local relapses occurred in 3.2% of patients with postoperative RT and in 8.2% in patients without RT (Fisher's exact test, p=0.48). Non significant difference was registered in postmenopausal patients with (4.76%) or without RT (6.58%). Ten-year DFS and OS were 53.5% and 68.7% in the RT group vs. 52.9% and 75.2% in the no RT group (non significant difference). Our results did not show that PMRT significantly influences the incidence of disease relapse, DFS and OS in stage I-II BC patients with intermediate risk for disease relapse. However, it seems that PMRT might influence the occurrence of locoregional recurrence in these patients.
    Journal of B.U.ON.: official journal of the Balkan Union of Oncology 12(2):215-20. · 0.76 Impact Factor
  • Jasmina Mladenović, Nenad Borojević, Jelena Sasić
    Srpski arhiv za celokupno lekarstvo 130(9-10):345-50. · 0.23 Impact Factor
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    ABSTRACT: The aim of this study was: 1. to evaluate treatment results of combined therapy (surgery, postoperative craniospinal radiotherapy with or without chemotherapy) and 2. to assess factors affecting prognosis (extend of tumor removal, involvement of the brain stem, extent of disease, postoperative meningitis, shunt placement, age, sex and time interval from surgery to start of postoperative radiotherapy). During the period 1986-1996, 78 patients with medulloblastoma, aged 1-22 years (median 8.6 years), were treated with combined modality therapy and 72 of them were evaluable for the study endpoints. Entry criteria were histologically proven diagnosis, age under 22 years, and no history of previous malignant disease. The main characteristics of the group are shown in Table 1. Twenty-nine patients (37.2%) have total, 8 (10.3%) near total and 41 (52.5%) partial removal. Seventy-two of 78 patients were treated with curative intent and received postoperative craniospinal irradiation. Radiotherapy started 13-285 days after surgery (median 36 days). Only 13 patients started radiotherapy after 60 days following surgery. Adjuvant chemotherapy was applied in 63 (80.7%) patients. The majority of them (46; 73%) received chemotherapy with CCNU and Vincristine. The survival rates were calculated with the Kaplan-Meier method and the differences in survival were analyzed using the Wilcoxon test and log-rank test. The follow-up period ranged from 1-12 years (median 3 years). Five-year overall survival (OS) was 51% and disease-free survival (DFS) 47% (Graph 1). During follow-up 32 relapses occurred. Patients having no brain stem infiltration had significantly better survival (p = 0.0023) (Graph 2). Patients with positive myelographic findings had significantly poorer survival compared to dose with negative myelographic findings (p = 0.0116). Significantly poorer survival was found in patients with meningitis developing in the postoperative period, with no patient living longer than two years (p = 0.0134) (Graph 3). By analysis of OS and DFS in relation to presence of the malignant cells in liquor, statistically significant difference, i.e. positive CSF cytology was not obtained, which was of statistical importance for survival (p = 0.8207). Neither shunt placement nor shunt type showed any impact on survival (p = 0.5307 and 0.7119, respectively). Children younger than three years had significantly poorer survival compared to those older than 16 years (p = 0.0473). Although there was a better survival rate in females than in males this was not statistically significant (p = 0.2386). The analysis results of treatment showed that significantly better survival occurred in patients in whom total or subtotal tumor removal was possible (p = 0.0022) (Graph 4). Patients who started radiotherapy within two months after surgery have better survival, but again this was not statistically significant, probably due to the small number of patients receiving delayed radiotherapy (p = 0.2231) (Graph 5). Based on this factors standard and high risk group could be defined. Combined chemotherapy should to be investigated particularly for high risk subgroup. Future research should be done to define new therapeutic modalities (gene therapy, compounds active in tumor antiangiogenesis etc).
    Srpski arhiv za celokupno lekarstvo 131(5-6):226-31. · 0.23 Impact Factor