Cancer treatment results

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Benign tumour treatment

Only a robot was able to save me

Diagnosis: Skull base meningioma. 

Georgs (63 years), company director (patient's name has been changed): 

“I had sudden vertigos and vision went black and then as if doubled in the mornings. A doctor referred me to examinations and a MRI scan revealed meningioma, a benign tumour growing from the meninges. When I met professor and neurosurgeon Igors Aksiks, I was morally prepared for a surgery.  But the professor was in doubts and told that it cannot be operated due to very high risk — the meningioma was located very close to the brainstem. Doctor told that a radiosurgery centre is about to be opened in Sigulda and recommended me to wait and go for a treatment there. There was an alternative to take such procedure with CyberKnife in Germany.  I decided to wait and be treated in Latvia. I was waiting for two months and I was one of the first patients of the Sigulda Radiosurgery Centre. 

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Doctor's commentary

The patient was diagnosed with meningioma at the skull base, clivusarea. This is one of the most dangerous and most complicated parts of the skull in case of surgeries. Considering the size and location of the tumour near critical nerves and vascular structures of the brain, 3 radiosurgery sessions with the CyberKnife robotic system were offered. The patient was treated with radiosurgery without complications. 

The patient started to gradually feel better after the manipulation with CyberKnife. A control MRI scan one and a half years after the radiosurgery procedure with CyberKnife showed reduction in tumour size by 15%. Currently the patient's condition is good.

Result of meningioma treatment 2 years later

Meningioma treatment process

No hole had to be cut in my head

Diagnosis: Acoustic neuroma in the left side.

Astra, 59 years (patient's name has been changed): 

“First, there was tingling in ears. I went to all possible doctors, but nobody found anything. When I discovered that hearing a sound was worse with one ear than with other, I went to an otorhinolaryngologist once more, who then recommended to perform a MRI scan of head and I was diagnosed with an acoustic neuroma in the left side. I was consulted by a neurosurgeon who told me that as the tumour grows it would compress nerves leading to impaired movements, droopy side of the face, headache. The doctor also warned me about serious side effects that are possible if acoustic neuroma is removed in a surgery, and recommended to choose operation only when the tumour reaches the size that cannot make me feel any worse.  An idea of growing something incomprehensible in my head and waiting for something to happen seemed scary to me, and I started to look for other options, other treatment methods.  

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Doctor's commentary

Regarding patient's complaints the MRI scan showed acoustic neuroma (neurinoma). Given the type and size of such tumours radiosurgery is one of standard treatment methods. Treatment efficiency: In 97-98% of cases the risk of complications, including facial paralysis, is less than 1%. In this case the patient had one radiosurgery session with the CyberKnife system. 

Within 12 months of the radiosurgery, the patient was feeling satisfactory, even though periodically (1-2 times per month) she had general weakness, sometimes also headache, especially during the change of weather. These symptoms were caused by destruction of tumour cells after the radiosurgery and formation of connective tissues. Usually painkillers and also diuretics are prescribed in such cases to make sure that tumour transformation products are driven out of the body as soon as possible. 1 year after the procedure with CyberKnife, acoustic neuroma of the patient had reduced by 2 mm in diameter. Headache subsided.

Result of treatment of acoustic neuroma 12 months later

Process of treatment of acoustic neuroma

I thought that it would suffice with a surgery, but I was wrong

Diagnosis: Acoustic neuroma on the right side. Condition after the surgery (2013). Tumour continues growing (recurrence). 

Renārs (46 years), sales specialist in a wholesale company (patient's name has been changed):

“I had acoustic neuroma removed surgically already in January 2013, but almost three years later I was again back in the waiting list for a repeated surgery, because the acoustic neuroma had grown almost as big as before the surgery. Then a friend of my wife told that a new radiosurgery centre has been opened in Sigulda and the most advanced robotic radiosurgery system in the Eastern Europe — CyberKnife — is available there. At the first moment I did not understand what that was. What was she talking about? But a neurosurgeon in the University hospital explained it to me, saying that it might be the only option for me. If a tumour has settled in, literally embraced the trigeminal nerve and bones of the skull base, it cannot be cut out in a surgery therefore it would continue growing bigger. If they cut it, a half of my face could remain paralysed forever. I would not like to live with a still face and not to feel taste in my mouth.  

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Doctor's commentary

Radiosurgery with the CyberKnifesystem can be used after a surgical interference, if the tumour has not been fully removed or it has a recurrence. 

In this situation patient first had one part of a large acoustic neuroma removed. Usually radiosurgery with CyberKnife is not applied where tumours exceed 4 cm. 3 years after the surgery, remains of the tumour were detected indicating at continued growing. Patient was recommended to undergo 5 sessions with CyberKnife. Treatment of the patient progressed well. 12 months later it was established that the tumour has stopped growing and started to shrink gradually.

Neuroma treatment result after 12 months

Neuroma treatment process

Treatment of arteriovenous malformation

I don't want another stroke 

Agnese (30 years), works in financial sector in Lithuania (patient's name has been changed): 

“I was hospitalised due to stroke and I was diagnosed with inborn pathological vascular malformation — arteriovenous malformation, which evidently caused the stroke. Doctors told me that if I did not want to go through it one more time only the radiosurgery method could save me. I was told that such procedure was available in neighbouring country Latvia, in Sigulda, so I didn't need to take a long trip. Sure, I did not think for a long time.  On 27 April 2016, I came to consultation and the procedure took place already on 29 April.  It is amazing — I had to lie only for 40 minutes and that's it. I had no bad sensations, nothing. In Sigulda Hospital I felt professional, understanding and kind attitude and everything was explained and clarified to me. The team working here is wonderful.  I was going home and thinking — did it really happen (laughing)?" 

 

Doctor's commentary 

The patient was hospitalised with acute condition in Vilnius where after a diagnostic examination an arteriovenous malformation, i.e. pathological netting of arteries and veins, was detected, and it posed a risk of sudden bleeding in brain. After solving of the acute condition the arteriovenous malformation could not be blocked with embolisation therefore Lithuanian neurosurgeons recommended to turn to the Radiosurgery Centre Sigulda were she was referred to radiosurgery with CyberKnife robot. The patient was treated with radiosurgery without complications. Expected results: if volume capacity of arteriovenous malformation is less than 3 ml, there is 80% likelihood that arteriovenous malformation will close completely within 2-3 years thus a risk of repeated bleeding in brain is reduced to minimum. During the first months after the manipulation the patient gradually started feeling better. When performing the control MRI scan two years after the radiosurgery procedure with CyberKnife, location of arteriovenous malformation actually could not be found. Current condition of the patient is good, no complaints and repeated bleeding has been observed for already 2.5 years.

Arteriovenous malformation treatment process

Prostate cancer treatment

5 days instead of 30 days

Diagnosis: Low risk prostate cancer. 

Oskars, 65 years (patient's name has been changed): 

I am 65 years old and I have always thought of myself as a healthy person. I have been living healthy since young age, and I still continue working. The only exception in my health condition is that I have to get up several times during the night to go to toilet. Sometimes it causes inconvenience, but apart from that, other functions seem to be alright. Besides, a year ago I scheduled a visit to an urologist.  

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Doctor's commentary

Patient was diagnosed with low risk of recurrence and a metastasis-forming tumour, however it progressed through gradual increase of PSA level in the blood. In such cases a radical treatment is justified and radiosurgery shows very high efficiency — 5 years of disease control is reported in 97.3% of cases and 10 years of disease control is reported in 93% of cases. Besides recurrence in the treated area (prostate) is reported only in 2% of cases. Patient had slight side effects after the therapy that disappeared few weeks later, allowing literally the same quality of life as before the therapy.

Process of treatment of primary prostate cancer

Process of treatment of primary prostate cancer

If there are alternatives of treatment,I want to know them

Diagnosis: High risk prostate cancer.

Gatis (44), doctor

In October 2016, within the framework of preventive examination, I was detected an elevated prostate-specific antigen (PSA), standing at 11.3 ng/ml (standard threshold up to 4.0 ng/ml). I had no complaints. Control analyses one week later still showed an increased PSA therefore I made an appointment with an urologist.

The urologist performed transrectal ultrasonoscopy with targeted prostate biopsy in order to specify a diagnosis, finding atypical cells in one out of twelve samples. In November 2016, on the basis of biopsy results, the diagnosis —prostate cancer —was confirmed.

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Doctor's commentary

In case of Gatis, we primarily applied the most cutting-edge technology in cancer treatment —CyberKnife M6 —five faction radiosurgery procedure during which a maximum radiation dose is targeted a a lesion, yet the very prostate was radiated with conventional radiotherapy doses. In order to be able to apply this method, at first we made PET/CT examination with Ga68-PSMA, which made it possible to rule out local and distant metastases as well as to specify the location of the tumour in the prostate and its size.

Main advantages from the applied methods:

  • Destruction of local tumour focus without surgical intervention;
  • Possibility to maximally reduce side effects of other radical therapy;
  • Decreased impact of therapy on potency and sexual function.

Process of treatment of primary prostate cancer

Treatment of prostate cancer metastases

I could not have received such treatment in Great Britain

Diagnosis: Prostate cancer, ogliometastases in lymph nodes, bones, ribs.

Peter from Great Britain, 70 years (patient's name has been changed):

Letter from the patient's wife to Dr. Maris Mezeckis:

Dear Maris, 

We are more than happy with the treatment we have received from you. Your diligence, speed of response to medical questions and clear communication is the reason we chose to come to Latvia in the first place, rather than Eastern Europe, when we could not afford treatment in the UK. You have been excellent in always responding quickly and efficiently to any situation and we realised just how dedicated you are to your job, when we came for treatment in February. You should be very proud of the work you do and you are a credit to the Sigulda CyberKnife centre and therefore no apology was required. Your kindly manner and our trust in you was the reason we returned for further treatment, and your medical team are also excellent.  

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Commentary from managing director M. Skromanis

Thanks to your letter and situation described in it, we have added some employees to our team, which considerably reduces the load of our specialists allowing them to focus on patient care as much as possible. Our team is supplemented with Customer Consultants, Regional Representatives and Customer Service Manager, who must take care of logistics and administrative issues relevant to our customers and comfort of our customers during the treatment.

Unfortunately magnetic resonance imaging is not yet available in Sigulda, but we hope to introduce it in nearest future. Within the framework of the radiosurgery procedure, with a view to ensure maximum comfort to our patients, we offer transfer from Sigulda to Riga and back to Sigulda to take all the necessary medical manipulations and diagnostic services.

Patients from UK (for treatment received in Latvia, including Sigulda) can recover the expenses from NHS. Please ask our consultants for more detail or visit the website of our Regional Consultant at http://medrefund.co.uk/en/

Doctor's commentary

Patient had a recurrence of disease after the radical prostatectomy and PET-CT showed tumour seeding in pelvic lymph nodes and bones. However the number of foci was not that big, therefore the hormonal therapy was supplemented with radiosurgery, giving a break to the hormonal therapy and implementing so-called intermittent hormonal therapy. This approach can reduce side effects of hormonal therapy and, possibly, delay formation of resistance to it. Besides, so-called abscopal effect can be observed regarding many tumours, including prostate cancer; it means that when destroying one lesion with radiation, lesions elsewhere in the body and tumour cells circulating in the body are oppressed by the immune system. It is because when tumour cells divide in the body their protein is released into bloodstream and this allows the immune system resisting other tumour cells.

Process of treatment of primary prostate cancer

Treatment of prostate cancer metastases in thorax

It seemed to be a nonsense or a problem in size of a chestnut

Diagnosis: oligometastatic prostate cancer

Andris (62 years) IT engineer

I was diagnosed with a prostate cancer in spring 2013. Since my work covers an insurance package, once a year I undergo something I call "technical check-up", so I also gave blood test for PSA, which I am taking since I was 55, following my family physician's recommendations. Until 2013,everything was fine, but in spring of 2013 PSA slightly exceeded the threshold. There were no prominent symptoms, the only thing was that I had to go to a toilet more frequently during nights; nevertheless I did not perceive it as a crucial problem. I made an appointment with an urologist, he did a biopsy of the prostate and discovered a cancer; unfortunately the worst scenario happened.

Doctors told me then —if a prostate cancer is detected in early stage, there are good chances and itcan be treated completely. Quoting the patient himself —a problem in size of a chestnut.However, it turned out to be different.

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Doctor's commentary

Patient is a man aged 63, who was diagnosed with a prostate cancer in 2013.In the University Hospital he had a surgery —prostatectomy. A year after removal of the prostate PSA level unfortunately started to raise again and the patient was referred to conventional radiotherapy with 30 sessions where areaof former prostatewas radiated, because a recurrence was suspected there.

When the analyses showed an elevated PSA level once again, the patient took an initiative and approached us in the Radiosurgery Centre at Sigulda Hospital as he was looking for alternative treatment options. We performed PET-CT scan of the patient. It detected three metastases in pelvic lymph nodes —one between aorta and spine, other —where aorta splits into two pelvic arteries, and third —in front of the bladder. Initially we planed to remove two pelvic metastases in a surgery and to radiate only one —the one that was located at the spine. If a metastasis is located close to the spine, CyberKnife can track it very well and a precise radiosurgery needs no external markers to be placed in the body. However the surgeons refused to perform a surgery being afraid that they would not be able to find pelvic lymph nodes’ metastases accurately and there is a high risk to have a serious damage of blood vessels. We decided to place markers and treat all three metastases with CyberKnife.In case of this particular patient we had another challenge —the patient had ahip prosthesis that forced us to adapt the technology. Beams used to control patient's position are falling at angle of 45 degrees and the lesion turned out to be located in a place where the prosthetics is obstructing the beams while thepatient lies on his back. Therefore entire planning and therapy was especially accustomed to his case.
In case of ogliometastases and on the basis of the clinical research, our tactics is as follows: three months later we perform PSA analysis and see if there are any changes. Six months later we repeat PSA analysis and, if needed, we perform PET-CT to make sure that the radiated lesions are inactive and no new lesion has appeared. The first and the simplest indicator is blood count with a focus on PSA. Therapy is efficient if the number decreases and is even 0. If the level of PSA does not decrease, a PET-CT scan can be repeated half year later and test whether the tumour is active in the same region and in such case it would mean that tumour cells have not reacted fully or a new point has activated.Result of the patient in question was evaluated three months later. His PSA level had decreased from 7.3 to 1.3. Eight months after the therapy it was merely 0.3.
The very method of therapy itself is local:CyberKnife radiates only those nodules that can be seen in that moment both in the prostate and places where it has seeded. It does not rule out circulation of tumour cells in bloodstream, and theoretically they can seed in a new location. Advantage of the method is that this radiosurgery procedure can be repeated.

Process of treatment of prostate cancer metastases in pelvis

Treatment of metastases

I thought it was a stroke, but they turned out to be metastases

Diagnosis: Renal cancer, condition after nephrectomy. Metastases (3) in brain.

Aurimas (53 years), works in a bank in Lithuania (patient's name has been changed): 

“I was hospitalised with symptoms similar to those in case of a stroke — speech and movement disorders. After a MRI scan they found two metastases in my head. It turned out that they have formed from the renal cancer, treated three years ago. I thought I was completely healed, because doctors told so after the kidney surgery. Alas, the disease made its comeback. 

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Doctor's commentary

The patient had three renal cancer metastases found in brain. Renal cancer and also melanoma are tumours creating the most radioresistant metastases. Radiation of whole brain in these cases usually has low efficiency. Radiosurgery with CyberKnife is an efficient treatment method in such cases, because it ensures high radiation dose. This patient was treated with CyberKnifetwice: in 2016 and 2017. In the first time 2 metastases were radiated and they started to decrease after the treatment — it was noticeable in MRI scans 3 and 6 months later. During this examination another new metastasis was detected, and it was also treated with the radiosurgery system CyberKnife in 2017. Currently patient's condition is satisfactory, 2 small metastases have almost disappeared. 

Process of treatment of renal cancer metastases

Result of treatment of renal cancer metastases in brain 2 years later

How confidence in myself, CyberKnife and physiotherapy got me back on my feet

Diagnosis: Renal cancer with a metastasis in the tenth thoracic vertebrae. 

Viktors, 68 years (patient's name has been changed): 

My renal cancer was discovered accidentally in 2015. When I was working in Russia, I met a familiar doctor (general practitioner) and she asked me: “When was the last time you visited a doctor?” I told that 20 years ago and that I have noticed — the less I go to them, the less frequently I become ill. She offered to examine me with medical ultrasound. During examination the doctor told she did not like what she was seeing. She organised a consultation with a professor immediately. I went to the consultation and I was told that I have a kidney cancer. From where? No idea. I had no symptoms. I don't know. I have been to many business trips and, as you know, in business trips there is no regular eating and sleeping is disturbed. 

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Doctor's commentary

In 2015, the patient was diagnosed with a renal cancer. A surgery, nephrectomy (damaged kidney was removed), was scheduled. After the surgery he was monitored by an oncologist. No other therapies were recommended. 

In the end of 2016, the patient felt weakness in legs. He was referred to spinal examination — MRI scan during which a metastasis in T10 was found. Weakness in legs intensified prominently. Patient was offered conventional radiotherapy with linear accelerator in the Oncology Centre, but few sessions later patient's condition worsened considerably and he could not move legs anymore. Lower paraplegia developed. Radiotherapy was discontinued. He had an urgent surgery (decompression laminectomy) to prevent the spinal cord from being compressed. Unfortunately due to bleeding it was not possible to detach metastasis completely. Movements in legs were somewhat restored. But the metastasis was still found during post-operative examinations. It meant that the metastasis was still compressing the spinal cord. 

He was offered a radiosurgery with CyberKnife M6 to destroy remains of the metastasis in T10. Three sessions were scheduled. Patient's condition improved significantly after the radiosurgery and was followed by rehabilitation treatment course in Sigulda Hospital. The patient started walking again. Of course, in order to strengthen the spine, another surgery was offered half year after the treatment with CyberKnife. During the surgery the damaged vertebrae was removed and replaced with a fixation system. It was established during a histological examination that there were no more “living” tumour cells in the removed vertebrae (good result after radiosurgery with CyberKnife M6). The Patient went to the medical oncologist and was referred to chemotherapy to prevent progression of the disease and formation of new metastases.

Process of treatment of renal cancer metastases in spine

Quick and painless — cancer can be treated with CyberKnife!
Diagnosis: Renal cancer, metastases in lungs, head.
Anna, 58 years (patient's name has been changed): 

In 2013, a tumour was found in my right kidney — clear cell carcinoma — therefore the kidney had to be removed. Doctor promised that everything would going to be alright and I have to come to examinations on a yearly basis. In spring 2015, I did all the examinations, but in August a cough appeared — dry, very disturbing and unceasing. I went to a pulmonologist who instantly referred me to an X-ray and CT scan. Unfortunately it showed two lesions in lungs. I was referred to further examinations in the Centre of Tuberculosis and Lung Diseases. One lesion was located in the upper lobe whereas the other — in the mediastinum of lung with almost no access to it. I was offered two solutions — to monitor lesions initially or to remove in a surgery, at least the available one. 

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Doctor's commentary

Patient was diagnosed with renal tumour ogliometastases and she had combined therapy — resection of lung segment and treatment of one metastasis with fractioned radiosurgery. Unfortunately the patient had prominent intolerance to chemotherapy (targeted therapy) medications prescribed in treatment, therefore local treatment methods, including radiosurgery is the only way to delay progression and further seeding of the tumour. Unfortunately a likelihood of formation of new metastases increases without additional chemotherapy and patient had 3 solitary lesions in brain treated with short interval between all sessions. However, the therapy was efficient and had relatively mild side effects, allowing the patient to continue living.

Process of treatment of renal cancer metastasis in lung

Result of treatment of renal cancer metastasis in lung 6 months later

I am ready to fight until victory.

Diagnosis: colon cancer, metastasis in scapula.

Maris, 61 years (patient's name has been changed): 

Even though I am a doctor, I can comment on my disease that it is important to listen to your heart and body. First signs indicating at symptoms of the disease were unpleasant feelings in toilet and changing bowel movements. I thought that haemorrhoids are to be blamed, therefore I did not pay so much attention to it, because the work and needs of others always seemed more important. But, when it was followed by rectal bleeding, I understood that I finally have to go to see a doctor. And then it started: surgery to remove a section of the large intestine, a repeated surgery, creation of stoma. Several chemotherapy treatment courses before and after the surgeries, finding and removal of metastasis in lungs, regular examinations, including PET-CT scan and genetic testing of tissue sample, immunity boosting after chemotherapies and virotherapy. To put it simple, I did all I could to defeat my “crab” and continue living like before. 

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Doctor's commentary

From a PET-CT scan the patient was early diagnosed with several metastases and they were successfully removed in a surgery. A metastasis in the scapula was difficult, because surgery options are very restricted due to small dimensions and complicated shape of the bone. Therefore radiosurgery was chosen. Growth of the metastasis was stopped and it was later also reassured in biopsy data, when an increased glucose metabolism in the area treated with CyberKnife was observed.

Treatment process of colon cancer metastasis

The most important thing –I have redeemed the Big Hope!

Diagnosis: salivary gland tumour recurrence.

Livija (49 years) a teacher and poet in her leisure time

Soon I will be fifty. I have been to many and different doctors, hospitals since childhood, and my relatives have been ill. I don’t think that situation with medical staff in Latvia is very bad, like they say in public and media. But specialists, whom I met at the Radiosurgery Centre of Sigulda Hospital, deserve to be invited on the stage and granted with the Medical Award of the Year at least once.

“In 2010, I had one malignant tumour resected. Bad things happen... It was followed by radiotherapy so that everything, already removed by professional surgery and with a reserve, could be ‘eaten’ also with beams. However, every successive year I had to lie on the operation table... Also when after the last surgery (January 2015) I was told that they unfortunately had to remove one of jaw joints to access deeply located recurring tumour, I was still thinking: it is alright, I am alive, and this is going to (will!) be the last time. But when I found out in April this year that there is an extensive recurrence, it was clear to me –surgery is not possible... But to go through the hell of conventional radiotherapy once more... I had said to myself NO a long time ago.

But good people told me about possibilities offered bythe Radiosurgery Centre at Sigulda Hospital.

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Doctor's commentary

Diagnosis: Salivary gland cancer. Condition after repeated surgery, externalbeam therapy (2010).In 2010, the patient was diagnosed with salivary gland cancer. The tumour was surgically removed in the Oncology Center of Latvia and patient was referred to external beam radiotherapy. Unfortunately in 2016 the patient had recurrence. Repeated conventional radiotherapyin area of recurrence, given the previous radiation, posed a high risk of complications and was dangerous. Tumour board (oncologist, radiation oncologist, oncosurgeon from the Head and Neck Departmentof Oncology Center of Latvia) made a decision to refer the patient to radiosurgerysessions with CyberKnife in Sigulda for5 re-radiation sessions.

Treatment progressed well, however few weeks after the treatment with CyberKnife the expected inflammatory reactions appeared in oral cavity near salivary glands in the side of the tumour. Such reactions can be seen in re-radiation cases and they indicate at destruction of tumour cells. Since our doctors were prepared for such reactions, the patient was admitted into Sigulda Hospital, and she received anti-inflammatory and restorative treatment course.

After the treatment when inflammatory and post-radiation reactions subsided, the patient continuedbeing under supervision of the oncologist and also doctors from Sigulda Hospital RadiosurgeryCentre. In the beginning of 2018, a control examination was performed (2 years after the radiosurgery) and decrease in tumour mass was detected and it showed no active tumour cells in the area radiated with CyberKnife.

Unfortunately the tumour has progressed in other partsof the skulland metastases have appeared.The patient was consulted by our medical oncologist. It was recommended to perform molecular genetic testing with OncoDNAtests. On the basis of results of OncoDNA analyses, the medical oncologist referred chemotherapy preparations that are suitable for that type of tumour, metastases have stopped growing and have started to reduce.

Treatment of salivary gland tumour recurrence

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