Clinical Oncology - 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Neoadjuvant treatment of rectal cancer]

PINTÉR Tamás

[Rectal cancer due to its frequent local invasion, high recurrence rate and metastatic potential is a serious health problem, leading to decreased life quality, severe complaints and death. Treatment for locally advanced, resectable rectal cancer improved over the years. Various chemotherapy protocols and combinations with radiation therapy and radical surgery - total mesorectal excision (TMA) - are the main elements of current therapy. Preoperative combined chemoradiation followed by surgery is the preferred treatment sequence. Radiation treatment in combination with fl uoropyrimidines (infusional 5-fl uorouracil [5-FU] or oral capecitabine) is recommended. Clinical trials with oxaliplatin-based neoadjuvant chemoradiation did not improve the pathologic complete response rate (pCR). Oxaliplatin-based treatment was more toxic as compared with 5-FU. The data concerning local recurrence rate and survival are controversial. Adjuvant chemotherapy in some studies improved survival, so - based on positive results in colon cancer - adjuvant FOLFOX chemotherapy may be recommended.]

HUN 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[Maximal safe resection is the fi rst step in the complex neurooncological therapy of adult brain tumors. Surgical management of brain tumors, including the surgical innovations (neuronavigation, intraoperative imaging, awake craniotomy, intraoperative electrophysiology) providing more radical resection with the safe preservation of neurological functions will be presented. In case of malignancy the surgery is followed by radiation and chemotherapy. In this review we describe the postoperative adjuvant therapeutical modatilites available for primary and metastatic tumors, emphasizing the modern chemotherapy of high grade gliomas and stereotactic radiosurgery of brain metastases. As a conclusion we summerize the guidelines and modalities for the most common adult brain tumors, according to histological type and grade.]

HUN 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[The prognosis of brain metastases is very poor. Surgery and radiotherapy provides the fi rst line treatment, while systemic therapy has limited value. Nevertheless, our knowledge is increasing: normal cells contribute signifi cantly to the homing and growth of tumor cells; the molecular profi le of the primary tumor and its metastases could be different, which infl uences the therapeutic strategies; the type of blood supply can change during the tumor growth. It would be very important to optimize the cooperation of the different therapeutic modalities, and to fi nd markers which could predict the risk of metastatization.]

HUN 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Oncological management of gastro-entero-pancreatic neuroendocrine neoplasias]

PETRÁNYI Ágota, UHLYARIK Andrea, RÁCZ Károly, BODOKY György

[Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are unusual and relatively rare neoplasms. They characteristically synthetize, store and secrete a variety of peptides and neuroamines, which can lead to development of disctinct clinical syndromes. Clinical symptoms and presentations vary depending on the location and hormones produced by the tumor. The diagnosis of NETs is established by histological examination and the immunohistochemical detection of general neuroendocrine markers, such as chromogranin A (CgA) and synaptophysin. An update of the WHO classifi cation has resulted in a new classifi cation dividing neuroendocrine neoplasms into neuroendocrine tumors (NETs) including G1 (Ki67 index ≤2%) and G2 (Ki67 index 3-20%) tumors and neuroendocrine carcinomas (NECs) with Ki67 index >20%, G3. The different available therapeutic approaches, including surgery, liver-directed ablative therapies, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, are discussed in this overview.]

HUN 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Development in the treatment of non-operable, metastatic colorectal cancer]

GRAMONT de Aimery

[Today, due to the steady improvement, the survival of patients with non-operable, metastasic colorectal cancer is about 30 months. This review discusses the results of recent clinical trials, the new drugs, the treatment protocols as well as the tumor response after surgery. A suggestion will be made not only on an optimal treament strategy, but also how to increase the survival, and the feasibility of a secunder resection.]

HUN 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Molecular diagnostics of brain tumors - an up-date]

REINIGER Lilla, HANZÉLY Zoltán, BÁLINT Katalin, TURÁNYI Eszter

[In recent years there have been major advancements in the understanding of molecular events driving brain tumor genesis and progression. Although state-of-the-art techniques are not widely available, many of the molecular discoveries lead to novel antibodies that can assist in identifying the major molecular subgroups by immunohistochemistry. Molecular informations will likely be incorporated into the next World Health Organization (WHO) classifi cation of central nervous system tumors, but clinical practice in many centres have already taken on the available informations and therapeutic decisions are made based on genetic/epigenetic information. In the adult population IDH, ATRX and 1p/19q codeletion studies help to defi ne molecular subgroups that correlate better with prognosis and therapeutic response than traditional histology based diagnosis. The KIAA1549-BRAF fusion gene is a hallmark for pilocytic astrocytomas, while diffuse pediatric gliomas lack the IDH mutations and 1p/19q codeletions that are common in adult astrocytomas and oligodendrogliomas. Uncommon in adults, Histone H3.3 mutations are pathognomic in pediatric brainstem malignant gliomas. Molecular subgroups of medulloblastomas have also been identifi ed, and a corresponding set of antibodies are ready to guide treatment decisions in those centres where molecular techniques are not available. These genetic and epigenetic events determine a tumor’s behaviour, and integrating this level of informations into neuropathology practice is essential to provide the best possible care to both pediatric and adult patients.]

HUN 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Psychooncology in the everyday practice]

ROHÁNSZKY Magda, PUSZTAFALVI Henriette

[In the past 40 years the progressively growing fi eld of psychooncology has played an increasing role in the multidisciplinary practice of oncology. In this review methods for identifying and treating cancer patients’ psychological challenges will be summarized. Effective psychological interventiones will be discussed, and two methods especially devised for supporting cancer patients (Simonton Training and Mindfulness Based Cancer Recovery) will be introduced. We also deal with the communication traits that affect the doctor-patient relationship, the mental challenges that affect doctors dealing with terminally ill patients, burnout and its prophylaxis.]

HUN 2015;2(01)

Clinical Oncology

FEBRUARY 10, 2015

[Current strategy in the surgical treatment of abdominal hematogenous metastases]

HARSÁNYI László, BARANYAI Zsolt

[The cornerstone of the therapy of most tumors is still the resecability of the primary tumor: if the cancer can be removed, the chance for recovery will signifi cantly increase. The development of the complex oncologic therapy lead also to the headway of metastasis surgery that used to be a rarity few decades ago. Based on the fi ndings of recent molecular genetic research and multimodular oncologic treatment it was found in more and more tumors that the removal of their metastasis shows benefi t for patients with advanced disease. In order to operate metastatic disease successfully extensive surgical experience and the knowledge of the tumors biologic behavior are required. Thus, the continuous interdisciplinary cooperation and the role of the oncoteam are essential to correct therapeutic decisions. In this review we discuss the possible surgical interventions of abdominal hematogenous metastases of different tumors.]

HUN 2015;2(01)