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Article ; Online: Radiotherapy and COVID-19 pandemic - a review of the current recommendations

Stepanović Aleksandar / Nikitović Marina

Srpski Arhiv za Celokupno Lekarstvo, Vol 148, Iss 9-10, Pp 644-

2020 Volume 647

Abstract: Cancer patients are at high risk for developing severe symptoms with a high mortality rate due to infection of COVID-19. Radiation therapy is one of the main treatment modalities of central nervous system tumors and lung cancer. Radiotherapy is often ... ...

Abstract	Cancer patients are at high risk for developing severe symptoms with a high mortality rate due to infection of COVID-19. Radiation therapy is one of the main treatment modalities of central nervous system tumors and lung cancer. Radiotherapy is often delivered in a number of fractions, which implies many visits to the radiotherapy center and thus possibly more exposure to the COVID-19. The convenient compromise between the exposure of the patients to the SARS-CoV-2 virus and the optimal treatment is questionable. The most used measures in radiotherapy centers are classification of patients into priority groups and frequent use of hypofractionation. From the beginning of the COVID-19 outbreak, only a few expert group consensuses of radiotherapy treatment are published. In this paper we briefly review available practical recommendations of the expert groups for radiation therapy and oncology as well as the expert opinions for radiotherapy of the central nervous system tumors and lung cancer during the COVID-19 pandemic.
Keywords	covid-19 ; radiotherapy ; brain tumors ; lung cancer ; Medicine ; R
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Serbian Medical Society
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Severe hematologic temozolomide-related toxicity and lifethreatening infections.

Stepanovic, Aleksandar / Nikitovic, Marina

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

2018 Volume 23, Issue 1, Page(s) 7–13

Abstract: Glioblastoma is the most frequent primary malignant brain tumor in adults. With the number of symptoms and signs, it belongs to diseases where a lot of treatment modalities are often applied. A standard treatment for patients with glioblastoma includes ... ...

Abstract	Glioblastoma is the most frequent primary malignant brain tumor in adults. With the number of symptoms and signs, it belongs to diseases where a lot of treatment modalities are often applied. A standard treatment for patients with glioblastoma includes surgical resection followed by radiotherapy with concomitant and adjuvant temozolomide. Each type of treatment has its own toxicity. Temozolomide is an oral alkylating cytotoxic drug and like any other alkylating agent can induce side effects. Although temozolomide is generally a well tolerated drug, with rare severe toxic effects, sometimes certain toxicities can overcome the life risk of the underlying malignancy. By reviewing the literature, we have selected the cases with severe clinical presentation where some of them had a lethal outcome and we have chosen to present them in this article. In some patients with noticeable hematological toxic effects, as well as those with serious infections, attention must be paid to their treatment, as toxic effects can deepen and develop new toxicity, which all lead to a vicious circle without a favorable outcome. Preventive use of antiviral drugs should be considered before the treatment with temozolomide in patients with a positive history of viral infections such as Hepatitis B infection. In order to prevent rare but possible opportunistic infections, it is necessary to familiarize the patients with the treatment, toxicity and rare opportunistic infections. These infections can be triggered by various factors from the nearest environment, including both domestic and wild animals and pets.
MeSH term(s)	Adult ; Antineoplastic Agents, Alkylating/adverse effects ; Brain Neoplasms/drug therapy ; Chemotherapy, Adjuvant ; Dacarbazine ; Glioblastoma/drug therapy ; Humans ; Temozolomide/adverse effects ; Treatment Outcome
Chemical Substances	Antineoplastic Agents, Alkylating ; Dacarbazine (7GR28W0FJI) ; Temozolomide (YF1K15M17Y)
Language	English
Publishing date	2018-03-19
Publishing country	Greece
Document type	Journal Article
ZDB-ID	2040386-0
ISSN	2241-6293 ; 1107-0625
ISSN (online)	2241-6293
ISSN	1107-0625
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Article ; Online: Long-lasting Thrombocytopenia after Transient Pancytopenia Induced by Short-Term Concomitant Radiotherapy and Temozolomide.

Stepanović, Aleksandar / Nikitović, Marina / Bogdanović, Andrija / Grujičić, Danica

European journal of case reports in internal medicine

2020 Volume 7, Issue 10, Page(s) 1785

Abstract: We describe long-lasting and incompletely resolved thrombocytopenia after transient profound pancytopenia in a 62-year-old female patient with glioblastoma after short-term radiotherapy with temozolomide. Pancytopenia was present for more than 4 weeks ... ...

Abstract	We describe long-lasting and incompletely resolved thrombocytopenia after transient profound pancytopenia in a 62-year-old female patient with glioblastoma after short-term radiotherapy with temozolomide. Pancytopenia was present for more than 4 weeks and thrombocytopenia for more than 6 months, without platelet recovery to normal levels. Learning points: Some patients may experience severe haematological manifestations after even short-term radiotherapy with temozolomide.In everyday practice, clinical models precisely predicting the haematological toxicity of concomitant treatment with temozolomide and radiotherapy is necessary, especially in countries where genetic tests are not available.Incomplete recovery of the cells of a particular bloodline over a long period may necessitate permanent discontinuation of chemotherapy or radiotherapy.
Language	English
Publishing date	2020-07-07
Publishing country	Italy
Document type	Journal Article
ISSN	2284-2594
ISSN (online)	2284-2594
DOI	10.12890/2020_001785
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Article ; Online: What did COVID-19 pandemics teach us about single-fraction radiotherapy for painful bone metastases-State of the art or undertreatment?

Arsenijević, Tatjana / Stepanović, Aleksandar / Milošević-Maračić, Brankica / Poparić-Bandjur, Bojana / Mišković, Ivana / Gavrilović, Dušica / Nikitović, Marina

Cancer medicine

2023 Volume 12, Issue 15, Page(s) 15912–15921

Abstract: Background: Choosing the optimal treatment approach for patients with painful bone metastases during the COVID-19 pandemic became challenging. A simple technique, single fraction radiotherapy was recommended for these patients usually referring to bone ... ...

Abstract	Background: Choosing the optimal treatment approach for patients with painful bone metastases during the COVID-19 pandemic became challenging. A simple technique, single fraction radiotherapy was recommended for these patients usually referring to bone metastases as a single entity, although it is a very heterogeneous group of patients. Aim: This study aimed to analyze the response to palliative single fraction radiotherapy in relation to age, performance status, primary tumor, histopathology, and bone localization in the group of patients with painful bone metastases. Methods: A clinical, prospective, non-randomized study was conducted at the Institute for Oncology and Radiology of Serbia, which included 64 patients with noncomplicated, painful bone metastases who underwent palliative, pain-relieving radiation therapy with a single tumor dose of 8Gy in a single hospital visit. Response to treatment was patient reported via telephone interview using visual analog scale. The response assessment was based on the international consensus panel of radiation oncologists. Results: In the entire group of patients, 83% responded to radiotherapy. No statistically significant difference was observed in response to therapy, time to reach the maximum response, degree of pain reduction, nor in response duration depending on the patient's age, performance status, the primary origin of the tumor, histopathology, or location of the metastasis (bone) that was irradiated. Conclusion: Regardless of clinical parameters, palliative radiotherapy with a single dose of 8Gy can be considered very effective in quick pain relief in patients with noncomplicated painful bone metastases. Single fraction radiotherapy in a single hospital visit, as well as patient-reported outcome for these patients may be considered favorable beyond Covid pandemics.
MeSH term(s)	Humans ; Pandemics ; Prospective Studies ; Radiotherapy Dosage ; Dose Fractionation, Radiation ; COVID-19/radiotherapy ; Pain/etiology ; Bone Neoplasms/secondary ; Palliative Care/methods ; Radiotherapy/adverse effects
Language	English
Publishing date	2023-06-14
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	2659751-2
ISSN	2045-7634 ; 2045-7634
ISSN (online)	2045-7634
ISSN	2045-7634
DOI	10.1002/cam4.6231
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Article ; Online: Transitioning from face-to-face to distance education. Part 1: A cross-sectional study in the former Yugoslavia during COVID-19.

Zakarija-Grković, Irena / Stepanović, Aleksandar / Petek, Davorina / Tomičić, Marion / Ožvačić, Zlata / Cerovecki, Venija / Švab, Igor / Homar, Vesna

The European journal of general practice

2023 Volume 29, Issue 1, Page(s) 2283831

Abstract: Background: The countries of the former Yugoslavia have health and education systems with the same tradition but these have changed over the years. Little is known about how family medicine teaching transitioned from face-to-face to distance education ... ...

Abstract	Background: The countries of the former Yugoslavia have health and education systems with the same tradition but these have changed over the years. Little is known about how family medicine teaching transitioned from face-to-face to distance education during the COVID-19 pandemic. Objectives: to investigate student/teacher experience in transitioning from face-to-face to distance education. Methods: A cross-sectional, online survey was conducted among 21 medical schools of the former Yugoslavia between December 2021 and March 2022. Under/postgraduate teachers and students who taught/studied family medicine during the academic year 2020/2021 were invited to participate. Of 31 questions for students and 35 for teachers, all but nine open questions were analysed using descriptive statistics. Results: Seventeen of 21 medical schools contributed data involving 117 participants representing all countries of the former Yugoslavia. At the beginning of the pandemic, 30%, 26% and 15% of teachers, students and trainees, respectively, received formal preparation in distance education. Of these, 92% of teachers and 58% of students/trainees felt they were not adequately prepared. Synchronous teaching was the main method used, with a third using hybrid methods. All participants were least confident about online assessment. More than 75% of respondents agreed that lectures could be kept online, not patient consultations or practical skills' classes. Conclusion: Teachers used various old and new methods to provide learning opportunities despite COVID-19 constraints. Effective technology-based strategies are essential to ensure assessment integrity and enhance the learning environment.
MeSH term(s)	Humans ; Education, Distance ; Cross-Sectional Studies ; Pandemics ; Yugoslavia ; COVID-19 ; Students, Medical
Language	English
Publishing date	2023-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1281338-2
ISSN	1751-1402 ; 1381-4788
ISSN (online)	1751-1402
ISSN	1381-4788
DOI	10.1080/13814788.2023.2283831
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Article ; Online: Transitioning from face-to-face to distance education. Part 2: A qualitative study in the former Yugoslavia during COVID-19.

Petek, Davorina / Zakarija-Grković, Irena / Stepanović, Aleksandar / Tomičić, Marion / Adžić, Zlata Ožvačić / Cerovečki, Venija / Švab, Igor / Homar, Vesna

The European journal of general practice

2023 Volume 29, Issue 1, Page(s) 2283834

Abstract: Background: Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19.: Objectives: To elucidate obstacles and facilitators of the transition from ... ...

Abstract	Background: Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19. Objectives: To elucidate obstacles and facilitators of the transition from face-to-face to distance education. Methods: A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022. Results: In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used. Conclusion: The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.
MeSH term(s)	Humans ; COVID-19 ; Education, Distance/methods ; Cross-Sectional Studies ; Yugoslavia ; Learning
Language	English
Publishing date	2023-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1281338-2
ISSN	1751-1402 ; 1381-4788
ISSN (online)	1751-1402
ISSN	1381-4788
DOI	10.1080/13814788.2023.2283834
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Article ; Online: Factors associated with preoperative and early and late postoperative seizures in patients with supratentorial meningiomas.

Bogdanovic, Ivan / Ristic, Aleksandar / Ilic, Rosanda / Bascarevic, Vladimir / Bukumiric, Zoran / Miljkovic, Aleksandar / Milisavljevic, Filip / Stepanovic, Aleksandar / Lazic, Igor / Grujicic, Danica

Epileptic disorders : international epilepsy journal with videotape

2023 Volume 25, Issue 2, Page(s) 244–254

Abstract: Objective: Risk factors for epilepsy in meningioma patients are not yet clearly defined, however, seizure freedom is a significant factor for quality of life after surgery.: Methods: We performed a retrospective study of the 333 adult patients who ... ...

Abstract	Objective: Risk factors for epilepsy in meningioma patients are not yet clearly defined, however, seizure freedom is a significant factor for quality of life after surgery. Methods: We performed a retrospective study of the 333 adult patients who received surgery for supratentorial meningioma at our center. Various clinical, radiological, and surgical variables were included in the multivariate regression, and the outcomes measured were the occurrence of seizure(s) preoperatively, during the hospitalization, and during the follow-up period. Results: A total of 89 (26.7%) patients experienced preoperative seizures, of whom 62.9% were seizure free after the surgery. Of 244 patients without epilepsy before surgery, 11.9% had at least one seizure postoperatively. In total, 63 of our patients (18.9%) experienced seizures after the surgery, of whom 20 had refractory epilepsy. Multivariate analysis identified the following predictors of preoperative seizures: the absence of headache (OR: 0.23, CI: 2.55-8.50), the presence of significant peritumoral edema (OR: 4.35, CI: 2.57-7.35), and younger age (OR: 0.97 per year increase, CI: 0.95-0.99). Factors associated with early postoperative seizures were: younger age (OR: 0.96 per year increase, CI: 0.93-0.99) and the presence of preoperative seizures (OR: 2.73, CI: 1.13-6.57), while the presence of preoperative seizures (OR: 4.73, CI: 2.05-10.92), tumor progression (OR: 5.38, CI: 2.25-12.89), and neurological worsening (OR: 5.21 CI: 1.72-15.81) were significant for late postoperative seizures. Significance: Our results from a single-center meningioma cohort confirm, in general, data from some previous studies regarding patients' characteristics for both preoperative and overall postoperative epilepsy. Besides previously described risk factors, younger age was important for preoperative and early postoperative seizures. Epilepsy is common in patients with recurrence of meningioma, but the variables of significance for refractory seizures in these patients require further examination.
MeSH term(s)	Adult ; Humans ; Meningioma/complications ; Meningioma/surgery ; Meningioma/diagnosis ; Retrospective Studies ; Quality of Life ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/diagnosis ; Seizures/complications ; Epilepsy/complications ; Supratentorial Neoplasms/complications ; Supratentorial Neoplasms/surgery ; Supratentorial Neoplasms/diagnosis ; Meningeal Neoplasms/complications ; Meningeal Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2023-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2086797-9
ISSN	1950-6945 ; 1294-9361
ISSN (online)	1950-6945
ISSN	1294-9361
DOI	10.1002/epd2.20021
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Article ; Online: Circulating levels of IL-6 and TGF-β1 in patients with prostate cancer undergoing radiotherapy: associations with acute radiotoxicity and fatigue symptoms.

Kopčalić, Katarina / Matić, Ivana Z / Besu, Irina / Stanković, Vesna / Bukumirić, Zoran / Stanojković, Tatjana P / Stepanović, Aleksandar / Nikitović, Marina

BMC cancer

2022 Volume 22, Issue 1, Page(s) 1167

Abstract: Background: The goal of research was to investigate the possible relations between serum concentrations of IL-6 and TGF-β1, individual and clinical characteristics, and adverse effects of radiotherapy in patients with prostate cancer: acute and late ... ...

Abstract	Background: The goal of research was to investigate the possible relations between serum concentrations of IL-6 and TGF-β1, individual and clinical characteristics, and adverse effects of radiotherapy in patients with prostate cancer: acute and late genitourinary and gastrointestinal toxicity, and fatigue. Methods: Thirty-nine patients with localized or locally advanced prostate cancer who were treated with radiotherapy were enrolled in this study. The acute radiotoxicity grades and fatigue levels were assessed during the radiotherapy and 1 month after the radiotherapy. Estimation of the late radiotoxicity was performed every three months in the first year, every four months in the second year, and then every six months. Serum levels of IL-6 and TGF-β1 were determined before radiotherapy and after the 25 Results: The significant positive association between diabetes mellitus and changes in acute genitourinary toxicity grades during the radiotherapy was observed in prostate cancer patients. In addition, patients who were smokers had significantly higher maximum fatigue levels in comparison with patients who were non-smokers. The circulating IL-6 levels were significantly higher after the 25 Conclusions: Our results suggest that serum levels of IL-6 and TGF-β1 might influence the severity of acute genitourinary radiotoxicity and fatigue in patients with prostate cancer. Combining clinical parameters and circulating cytokine levels might be useful for the prediction of adverse reactions to radiotherapy.
MeSH term(s)	Male ; Humans ; Transforming Growth Factor beta1 ; Interleukin-6 ; Prostatic Neoplasms/radiotherapy ; Urogenital System ; Fatigue/etiology
Chemical Substances	Transforming Growth Factor beta1 ; Interleukin-6
Language	English
Publishing date	2022-11-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-022-10255-6
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Article ; Online: Clinical analysis of COVID-19 positive cancer inpatients in National Cancer Center in Serbia.

Stepanović, Aleksandar / Arsenijevic, Tatjana / Stankovic, Vesna / Vujanac, Vukac / Lazovic, Anja / Raonic-Stevanovic, Tanja / Nikitovic, Marina

Journal of infection in developing countries

2021 Volume 15, Issue 9, Page(s) 1286–1292

Abstract: Introduction: The outbreak of COVID-19 has had an impact on global healthcare as well as on radiotherapy practice in many countries. This study aimed to identify clinical characteristics of Coronavirus Disease 2019 (COVID-19) infected cancer inpatients, ...

Abstract	Introduction: The outbreak of COVID-19 has had an impact on global healthcare as well as on radiotherapy practice in many countries. This study aimed to identify clinical characteristics of Coronavirus Disease 2019 (COVID-19) infected cancer inpatients, as well as what impact this infection had on radiation treatment of the patients. Methodology: In this retrospective study, we included cancer inpatients with laboratory confirmed COVID-19 infection during the radiotherapy or chemoradiation in April 2020 in National Cancer Research Center in Serbia. Data were obtained from the medical records between 1 April and 1 July 2020. Results: A total of 49 COVID-19 infected cancer inpatients were included. The most frequently reported cancers were head and neck cancers, in twenty-three patients (46.8%). Lymphopenia was present in 77.5% of the patients. Red blood cells, haemoglobin and platelets were significantly lower during incubation or diagnosis of COVID-19. Twenty-seven (55.1%) patients did not finish radiotherapy. The age of patients who finished radiotherapy after COVID-19 infection was significantly lower compared to the patients who did not finish radiotherapy (60.5 ± 7.8 vs. 68.6 ± 11.2; p < 0.005). Conclusions: COVID-19 infected cancer patients in radiotherapy practice show similar symptoms and demographic characteristics as the general population infected with SARS-CoV-2 virus. Patients with head and neck cancers may be susceptible to infection with COVID-19. Old age and male gender may be risk factors for discontinuation of radiotherapy in COVID-19 infected cancer patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; COVID-19/diagnosis ; Female ; Humans ; Inpatients ; Male ; Middle Aged ; Neoplasms/complications ; Neoplasms/radiotherapy ; Retrospective Studies ; Serbia
Language	English
Publishing date	2021-09-30
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2394024-4
ISSN	1972-2680 ; 2036-6590
ISSN (online)	1972-2680
ISSN	2036-6590
DOI	10.3855/jidc.15104
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Article ; Online: Association between microRNAs 10b/21/34a and acute toxicity in glioblastoma patients treated with radiotherapy and temozolomide.

Stepanović, Aleksandar / Nikitović, Marina / Stanojković, Tatjana P / Grujičić, Danica / Bukumirić, Zoran / Srbljak, Ivana / Ilić, Rosanda / Milošević, Snežana / Arsenijević, Tatjana / Petrović, Nina

Scientific reports

2022 Volume 12, Issue 1, Page(s) 7505

Abstract: A personalized approach to chemoradiation is important in reducing its potential side effects and identifying a group of patients prone to toxicity. MicroRNAs have been shown to have a predictive potential for radiotoxicity. The goal of the study was to ... ...

Abstract	A personalized approach to chemoradiation is important in reducing its potential side effects and identifying a group of patients prone to toxicity. MicroRNAs have been shown to have a predictive potential for radiotoxicity. The goal of the study was to test if levels of miRNA in peripheral blood mononuclear cells of glioblastoma patients are associated with toxicity and to identify the peak time point for toxicity. MicroRNA-10b/21/34a levels were measured in 43 patients with and without toxicity, at baseline, at the 15th, and at the 30th fraction by Real-Time quantitative Polymerase Chain Reaction. MicroRNA-10b/21 levels increased with toxicity grade (p = 0.014; p = 0.013); miR-21/34a levels were significantly different between patients with and without toxicity at the 15th fraction (p = 0.030; p = 0.045), while miR-34a levels significantly changed during treatment (p < 0.001). All three miRNAs showed a significantly high positive correlation with one another. MiR-34a might be considered as a predictive factor for toxicity due to its changes during treatment, and differences between the groups with and without toxicity; miR-10b might be used to predict toxicity; miR-10b/21 might be used for predicting the grade of toxicity in GB patients.
MeSH term(s)	Glioblastoma/drug therapy ; Glioblastoma/radiotherapy ; Humans ; Leukocytes, Mononuclear ; MicroRNAs/genetics ; Real-Time Polymerase Chain Reaction ; Temozolomide/adverse effects
Chemical Substances	MIRN10 microRNA, human ; MIRN21 microRNA, human ; MIRN34 microRNA, human ; MicroRNAs ; Temozolomide (YF1K15M17Y)
Language	English
Publishing date	2022-05-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-11445-9
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