Robert Slotwinski

Medical University of Warsaw, Warszawa, Masovian Voivodeship, Poland

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Publications (11)7.71 Total impact

  • G Lech, R Slotwinski, I W Krasnodebski
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    ABSTRACT: A steady increase in colorectal cancer (CRC) incidence and mortality has been observed in Europe, despite the continuous advancement in diagnostic and therapeutic methods. Accordingly, further progress is very much desirable in non-invasive diagnostic methods to enable early diagnosis, preand postoperative staging, and to assist in selecting the most suitable neo-adjuvant and adjuvant therapeutic methods and post-treatment follow-up. This review summarizes the current state of knowledge about the role of tumor markers and biomarkers in CRC diagnosis, treatment and follow-up. New biomarkers which are absent in healthy persons and present in CRC are still being investigated, especially those that can be detected at early development stage of the disease and used in screening tests. Unfortunately, no molecule that would meet all of the foregoing criteria has been identified so far. Carcinoembryonic antigen still remains the only tumor marker of recognised efficacy in monitoring patients during and after CRC therapy. Clinical studies and retrospective analyses allowed to discover and introduce to the clinical practice several bioindicators that assist in selecting the proper chemotherapeutic drug. There are attempts to "personalise" chemotherapy based on presence or absence of specific biomarkers. Therapy with anti-EGFR antibodies is desirable in patients with advanced CRC and absence of KRAS or BRAF mutation. Defining tumor phenotype - microsatellite instability (MSI) or microsatellite stability (MSS) and testing for the presence or absence of 18q chromosome deletion is very much desirable in standard 5-FU-based therapy. Analysis of UGT1A1 alleles may be the basis for modified dosing and reducing the potential toxicity of irinotecan. Studies on CRC biomarkers need to continue to closely examine the relationship between therapy and CRC curability. Targeted therapy against membrane receptors appears to be the future of CRC therapy. Keywords: A steady increase in colorectal cancer (CRC) incidence and mortality has been observed in Europe, despite the continuous advancement in diagnostic and therapeutic methods. Accordingly, further progress is very much desirable in non-invasive diagnostic methods to enable early diagnosis, preand postoperative staging, and to assist in selecting the most suitable neo-adjuvant and adjuvant therapeutic methods and post-treatment follow-up. This review summarizes the current state of knowledge about the role of tumor markers and biomarkers in CRC diagnosis, treatment and follow-up. New biomarkers which are absent in healthy persons and present in CRC are still being investigated, especially those that can be detected at early development stage of the disease and used in screening tests. Unfortunately, no molecule that would meet all of the foregoing criteria has been identified so far. Carcinoembryonic antigen still remains the only tumor marker of recognised efficacy in monitoring patients during and after CRC therapy. Clinical studies and retrospective analyses allowed to discover and introduce to the clinical practice several bioindicators that assist in selecting the proper chemotherapeutic drug. There are attempts to "personalise" chemotherapy based on presence or absence of specific biomarkers. Therapy with anti-EGFR antibodies is desirable in patients with advanced CRC and absence of KRAS or BRAF mutation. Defining tumor phenotype - microsatellite instability (MSI) or microsatellite stability (MSS) and testing for the presence or absence of 18q chromosome deletion is very much desirable in standard 5-FU-based therapy. Analysis of UGT1A1 alleles may be the basis for modified dosing and reducing the potential toxicity of irinotecan. Studies on CRC biomarkers need to continue to closely examine the relationship between therapy and CRC curability. Targeted therapy against membrane receptors appears to be the future of CRC therapy.
    Neoplasma 01/2014; 61(1):1-8. · 1.57 Impact Factor
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    ABSTRACT: The purpose of our study was to investigate the changes of innate immunity after immunonutrition in pancreatic cancer patients. Sixty-six patients operated on for pancreatic cancer were included. Before and after preoperative nutrition TLR4,NOD1,MyD88 and TRAF6 gene expression in peripheral blood leukocytes were measured using RT Real-Time PCR. The randomized studies were performed in patients who received the pre-operative enteral nutrition (immunonutrition with glutamine or PAFAs and standard supplementation) and in patients without pre-operative nutrition. Results: TLR4, NOD1 and TRAF6 gene expressions were significantly higher (before surgery and nutrition respectively p= 0.008; 0.0008 ; 0.01) and MyD88 was significantly lower (p= 0.0002) as compared to the healthy controls. Treatment with glutamine was associated with decreased TLR4 gene expression (before versus after immunonutrition p=0.01). After PUFAs and standard nutritional support no changes in gene expressions were detected. Conclusions: Overexpression of TLR4, NOD1 and TRAF6 gene of pancreatic cancer patients may reveal the up-regulation of the innate antibacterial response. This disorders may contribute to cancer progression and increased susceptibility to postoperative septic complications. Preoperative enteral immunonutrition containing glutamine by reducing the overexpression of TLR4 gene may reduce the susceptibility of malnourished patients to post-operative septic complications.
    Annual Meeting of The American Association of Immunologists, Honolulu; 05/2013
  • Clinical Nutrition Supplements 01/2009; 4(2):79-80.
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    Zhongguo fei ai za zhi = Chinese journal of lung cancer 10/2008; 11(5):663-7.
  • Clinical Nutrition Supplements 01/2008; 3:105-106.
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    ABSTRACT: To assess changes of interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1ra) in serum, sputum, and drained pleural fluid of patients operated on due to lung cancer. Twenty-seven patients treated with lobectomy or pneumonectomy, including 14 with complications and 13 without complications, were analyzed. Serum IL-6 and IL-1ra concentration was measured before, at the end of surgery, and on postoperative day 1, 3, and 7, by ELISA test. Additionally, concentration of IL-6 and IL-1ra was measured in sputum at the end of surgery and in pleural fluid on postoperative day 1. In the entire group serum concentrations of IL-6 and IL-1ra were significantly elevated after surgery, in comparison with preoperative values. Serum IL-6 concentration was higher in patients with complications only on day 7 (median 59.0 (range: 41.25-76.65) pg/ml vs 21.5 (9.87-35.0) pg/ml; p=0.012). Patients with complications had higher concentration of IL-6 in pleural fluid (91312 (51812-94872) pg/ml vs 2006 (1926-2108) pg/ml; p=0.00008). Serum IL-1ra concentration was higher in patients with complications on day 1 (1832.4 (1144.7-2362.2) pg/ml vs 1088.4 (817.5-1312.5) pg/ml; p=0.01). Concentration of IL-1ra in drained fluid was higher in patients with complications (68128.8 (48104-108564) pg/ml vs 16470 (15930-16875) pg/ml; p=0.0003). On day 1 after surgery a significant correlation between serum and pleural fluid concentration for IL-6 as well as for IL-1ra were observed (Spearman test for IL-6: r=0.47; p=0.02; for IL-1ra: r=0.48; p=0.02). Elevated concentrations of IL-6 and IL-1ra in pleural fluid on postoperative day 1 are promising early markers of postoperative complications. Elevated concentrations of IL-6 and IL-1ra in serum are good early markers of severity of surgical injury and may reflect development of postoperative complications.
    European Journal of Cardio-Thoracic Surgery 05/2007; 31(4):719-24. · 2.67 Impact Factor
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    ABSTRACT: To investigate whether early enteral immunonutrition in comparison with standard enteral feeding affects the systemic production of pro- and anti-inflammatory cytokines in malnourished patients after pancreaticoduodenectomy with an uneventful postoperative course. Prospective, randomized study. Forty-one patients who had undergone pancreaticoduodenectomy. Patients received early enteral standard nutrition (No. 22) or enteral immunonutrition (No. 19). Cytokines and cytokine inhibitors (IL-1 beta, TNF-alpha, IL-6, IL-8, IL-10, IL-1ra, and sTNFRI) were determined before and on days 1, 3, 7, 10 and 14 after surgery using the ELISA test. Serum concentrations of IL-1ra in the early post-operative period were significantly higher in patients treated with enteral immunonutrition than in those treated with the standard diet (day 7: P<0.001; day 10: P=0.002; day 14: P=0.005). Similar results were observed for IL-6 (day 10: P=0.017; day 14: P=0.001), IL-8 (day 1: P=0.011; days 3, 7, 10, and 14: P<0.001) and IL-10 (days 3 and 10: P<0.001) whereas the post-operative levels of IL-1 beta (day 7: P<0.001; day 14: P=0.022) and TNF-alpha (day 3: P=0.006; day 7: P<0.001) were significantly higher in patients with standard enteral nutrition. Early enteral immunonutrition as compared to standard nutrition has an immunomodulative effect on the changes in the immune response after extensive surgical trauma resulting in the selective stimulation of cytokines and cytokine inhibitors. The interleukin-1 receptor antagonist is the earliest sensitive marker of anti-inflammatory response to enteral immunonutrition in malnourished patients after pancreaticoduodenectomy.
    JOP: Journal of the pancreas 01/2007; 8(6):759-69.
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    ABSTRACT: Objective: To assess changes of interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1ra) in serum, sputum, and drained pleuralfluid of patients operated on due to lung cancer. Methods: Twenty-seven patients treated with lobectomy or pneumonectomy, including 14 with complications and 13withoutcomplications, were analyzed. Serum IL-6and IL-1ra concentration wasmeasured before,at the end of surgery, and on postoperative day 1, 3, and 7, by ELISA test. Additionally, concentration of IL-6 and IL-1ra was measured in sputum at the end of surgery and in pleuralfluid on postoperative day 1.Results:In the entire group serum concentrations of IL-6 and IL-1ra were significantly elevated after surgery, in comparison with preoperative values. Serum IL-6 concentration was higher in patients with complications only on day 7 (median 59.0 (range: 41.25—76.65) pg/ml vs 21.5 (9.87—35.0) pg/ml; p = 0.012). Patients with complications had higher concentration of IL-6 in pleural fluid (91312 (51812—94872) pg/ml vs 2006 (1926—2108) pg/ml; p = 0.00008). Serum IL-1ra concentration was higher in patients with complications on day 1 (1832.4 (1144.7—2362.2) pg/ml vs 1088.4 (817.5—1312.5) pg/ml; p = 0.01). Concentration of IL-1ra in drained fluid was higher in patients with complications (68128.8 (48104—108564) pg/ml vs 16470 (15930—16875) pg/ml; p = 0.0003). On day 1 after surgery a significant correlation between serum and pleural fluid concentration for IL-6 as well as for IL-1ra were observed (Spearman test for IL-6: r = 0.47; p = 0.02; for IL-1ra: r = 0.48; p = 0.02). Conclusions: Elevated concentrations of IL-6 and IL-1ra in pleural fluid on postoperative day 1 are promising early markers of postoperative complications. Elevated concentrations of IL-6 and IL-1ra in serum are good early markers of severity of surgical injury and may reflect development of postoperative complications. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
    Journal of Thoracic Oncology - J THORAC ONCOL. 01/2007; 2.
  • Journal of Thoracic Oncology - J THORAC ONCOL. 01/2007; 2.
  • Gustaw Lech, Slotwinski R., Krasnodebski I.W.
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    ABSTRACT: Treatment of the Crohn’s disease is still a big challenge for many specialist doctors including surgeons. In this paper surgical treatment of the patients with Crohn’s disease, localized in ileocaecal region with the first symptom as acute pain in the right hypogastrium suggesting appendicitis was discussed. Crohn’s disease limited to the appendix is a rare form of this disease diagnosed only in a few percent of all patients. The diagnosis is established usually based on histopathological examination of the resected appendix. Patients, who suffer from this kind of the Crohn’s disease have good prognosis. Appendectomy performed as the first stage should be considered as the only necessary method of treatment. Much more common problem is appendicitis accompanied by typical inflammation localized in the ileocaecal region. It is known that a few percent of patients with Crohn’s disease is diagnosed during operation performed because of the symptoms suggesting appendicitis. In such cases, ileocaecal resection should be considered as correct therapeutic management. According to bowel sparing surgery methods resection should be performed without any margin of healthy bowel. The method of anastomosis, which is important from a surgical point of view seems not to be of great importance.
    Przegląd Gastroenterologiczny 06/2006; 1(2):70-73. · 0.08 Impact Factor
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    ABSTRACT: The clinical implications of increased cytokine levels after major surgery remain unclear. In this study, systemic concentration of a spectrum of cytokines, including interleukins IL-6, IL-8, IL-10, IL-1ra, and soluble tumor necrosis factor receptor-I (sTNF-RI) was examined in patients with and without postoperative septic complications following colorectal surgery. Although there were no significant changes in IL-1beta, TNF-alpha, and IL-8 serum levels during the observation period, there was a significant rise in IL-6, IL-1ra, and sTNF-RI concentrations in the entire group of patients between postoperative day 1 and 14. There were no differences between the group without and with local complications when IL-6, IL-1ra, and IL-10 were examined. The serum levels of sTNF-RI, IL-1ra, and IL-6 were found to be sensitive indicators of the pro- and anti-inflammatory response to the surgical trauma, but only sTNF-RI turned out to be a sensitive early marker of local septic postoperative complications in patients with colorectal carcinoma.
    Journal of Clinical Immunology 10/2002; 22(5):289-96. · 3.38 Impact Factor