Clinical Oncology

[Adjuvant chemotherapy for operable breast cancer]

NAGYKÁLNAI Tamás, LANDHERR László

MAY 10, 2015

Clinical Oncology - 2015;2(02)

[The use of adjuvant chemotherapy in early stage breast cancer has made signifi cant progress in the last decades. This review will focus on the benefi cial effects of different chemotherapy regimens on the risk of recurrence and breast cancer mortality.]

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Further articles in this publication

Clinical Oncology

[Invasive endoscopy in oncology]

MADÁCSY László

[Recent advances in interventional gastrointestinal endoscopy have led to a large variety of new diagnostic and minimally invasive endoscopic surgical procedures in oncological patients. Endoscopic ultrasound with the possibility of fi ne needle aspiration is currently one of the most accurate imaging technology for adequate staging of gastrointestinal cancers including oesophageal, gastric, rectal and pancreatic cancer. Endoscopic mucosal resection and endoscopic submucosal dissection offers a minimal invasive endoscopic treatment modality as an alternative for laparoscopic surgery for patients with early intramucosal neoplasias, fl at adenomas and laterally spreading tumors of the oesophagus, stomach, duodenum and colorectum. Self-expandable metal stents are now readily available for endoscopic palliation of different type of malignant gastrointestinal obstructions including oesophageal, duodenal, colonic and biliary stenosis. These recent developments of interventional gastrointestinal endoscopy lead to more precise and accurate tumor staging and more effective oncological therapy for patients with gastrointestinal cancers.]

Clinical Oncology

[Chemotherapy of the thyroid cancer]

UHLYARIK Andrea, PETRÁNYI Ágota, RÁCZ Károly, BODOKY György

[The incidence of thyroid cancers increased signifi cantly over the past few decades, but the mortality rate decreased. The clinical course and therapy for the three types of thyroid cancer (differentiated, medullary and anaplastic) are different. The medical therapy consists of levothyroxin therapy, conventional chemotherapeutic agents and tyrosin kinase inhibitors. The aim of this review is to summarize the therapeutic options of each histological subtype.]

Clinical Oncology

[How the molecular informations infl uence the therapeutic strategy against colorectal cancer?]

AXEL Grothey

[Colorectal cancer is not a homogenous disease, but it has different subgroups based on their molecular characteristics. NCCN and ESMO guidelines emphasize the importance of the determination of RAS and BRAF mutations in those patients who are intended to treat with targeted therapy. The increase in knowledge on the molecular changes will help to design and start a new generation of clinical trials, which will be designed not on their randomization of large groups of unselected patients, but rather on the consideration of the molecular subgroups determined before introducing therapy.]

Clinical Oncology

[Nutritional support in cancer anorexia-cachexia syndrome]

HARISI Revekka

[Cancer anorexia-cachexia syndrome (CACS) defi ned by ongoing loss of skeletal muscle mass, with or without loss of fat mass. In contrast to serious non tumorous cachexia it can not be reversed by conventional nutritional support. CACS affects most of cancer patients and has negative impact on physical function, anticancer treatment response, quality of life and survival. It is known that interactions between tumor and reactive host cells are responsible for tumor progression, metastasis formation and chronic infl ammation, as well. All of the processes are induced by cytokines. The CACS associated changes in carbohydrate, protein and lipid metabolism are caused by the elevated level of infl ammatory cytokines. The new anti-CACS drug development aimed at normalizing of the pathologic pathways. Up to now, megestrol-acetate (MA) administration seems to be the most effective drug in CACS treatment. MA has dual effect, stimulates the NPY activation and inhibits the synthesis and expression of infl ammatory cytokines. Its clinical effects are on line with the aboves, improves appetite, calorie intake and increases body weight. There is paradigm shift in CACS treatment, the traditional nutritional support is replaced by combination of pharmaceutical interventions, nutritional support and use of dietary supplements.]

Clinical Oncology

[Diagnosis and therapy of childhood brain tumors – an update]

GARAMI Miklós

[Childhood cancers are rare disorders. The average annual age-standardized incidence is 149/1000000 (0-14 yrs). Diagnosis of childhood brain tumors, despite the specifi c localization and advanced imaging techniques can cause diffi culties. In recent years, due to better early recognition, number of surgically removable brain tumors is increasing. Early detection of the disease (clinical knowledge), use of modern imaging (fMRI) techniques and detection of characteristic molecular lesions allow up-to-date diagnosis and successful treatments. These approaches provide the basis for risk-adapted personalized treatment options]

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[Breast malignancies: review of the year 2008/2009 radiological diagnostics and therapy news - Onco Update, 2010]

FORRAI Gábor

[Systematic review of the recent articles of the years 2008/2009 about breast tumours’ radiological diagnostics and guided therapy, the actual place of the imaging and interventional methods are presented.]

Hungarian Radiology

[Breast core needle biopsies yielding uncertain results - Experience at the complex mammographic screening unit in Kecskemét]

AMBRÓZAY Éva, BORI Rita, LŐRINCZ Margit, LÓRÁND Katalin, CSERNI Gábor

[INTRODUCTION - On occasion core biopsies yield an inconclusive (B3 or B4) result in the triple diagnostics of breast lesions. These cases may turn to be malignant in the operation specimen. This study evaluates the value of B3 and B4 diagnoses and the consequences of these diagnoses. MATERIALS AND METHODS - Core needle biopsies were generally taken under imaging guidance with an automatic gun using G14 gauge needles. They were evaluated using internationally and nationally accepted categories from B1 to B5. The analysis was based on data collected between 2000 and March 2005. RESULTS - Of the 663 core needle biopsy specimens 31 (4.7%) were classified as B3 and 22 (3.3%) as B4. Specimens were more often fragmented in the latter category (a rate of 0.64 as compared with a rate of 0.26). Patients with a B3 diagnosis were operated on in 23 cases, eight of which turned to be malignant (0.35). B4 diagnoses were followed by operations in 21 cases and were found to be malignant on 19 occasions (0.9). Whenever a B4 diagnosis was associated with radiological findings of malignancy (category 5 on mammography and/or ultrasound) the cases unanimously proved to be malignant. The same association with B3 diagnoses yielded malignancy in a rate of only 0.67. CONCLUSION - Both B3 and B4 diagnoses represent an indication for operation. Our experience suggests that B4 diagnoses when coupled with a radiological opinion of malignancy can be candidates for definitive (therapeutic breast conserving) surgery whereas B3 diagnoses require diagnostic excisions.]

Clinical Oncology

[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.]

Lege Artis Medicinae

[Complex pathological diagnosis of breast cancer and the patient care based on it over the past 20 years]

CSERNI Gábor

[The diagnosis of breast cancer has become more complex in the past 20 years. Intraoperative diagnosis has been mostly replaced by multidisciplinary preoperative/ nonoperative diagnostics. Surgical treatment can be planned in advance for the breast as well as for the axilla. In many cases, routinely performed radical surgery has been replaced by selectively applied, less radical, conservative operations (sectoral or wide local excisions, sentinel lymph node biopsy) that are suitable for smaller tumours mostly detected by screening. In addition to prognostic markers listed in the pathology reports (lymph node status, tumour size, vascular invasion, status of resection margins), an increasing emphasis has been placed on predictive markers (estrogen receptors, progesterone receptors, HER-2, basal and proliferation markers) that allow molecular typing of breast carcinomas and that mostly influence systemic treatment. Tools to predict the efficiency of treatment have become increasingly available, and these might also help in planning neoadjuvant therapies, a modality which has also been introduced in the past 20 years. The present article gives a brief, subjective, thematic insight into some of these changes, selected on the basis of their relation to the pathological diagnosis of breast carcinoma.]

Lege Artis Medicinae

[Changes in the hormonal therapy of breast cancer patients]

MOSKOVITS Katalin

[The hormonal therapy for breast cancer patients seems to be changing. At present the new, third generation aromatase inhibitors are the standard second line therapy for postmenopausal, receptor positive advanced breast cancer patients. Currently, tamoxifen (TAM) stands as the ”gold standard” first line therapy, with ist role changing, due to the aromatase inhibitors which seems to be more effective than TAM and have less side-effects. For these reasons, aromatase inhibitors may be useful in the adjuvant setting, but long-term side-effects are not yet known. In the next few years, sufficient experience will be gained with these drugs which might help us to change practice. Pure antioestrogens are also promising new drugs. Recently, the LHRH analogues were the preferred drug of choice in premenopausal women, in contrast to surgical or radiological ovarian ablation. All receptor positive breast cancer patients should receive hormonal therapy, regardless of age, menopausal status, node status, tumour size, but we should avoid hormonal therapy for the endocrine nonresponsive patients.]