Clinical Oncology

[Experiences – ESMO 2018]

TOKODI Zsófi a1, SZÖLLŐSI Regő1

DECEMBER 10, 2018

Clinical Oncology - 2018;5(04)

AFFILIATIONS

  1. Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Onkológiai Osztály, Budapest

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Further articles in this publication

Clinical Oncology

[News from the World]

Clinical Oncology

[Foreword]

A szerkesztők

Clinical Oncology

[Advancing therapies in metastatic castration-resistant prostate cancer]

GIULIA Baciarello, MARCO Gicci, KARIM Fizazi

[Introduction: Prostate cancer is the second most common cause of cancer world wide and is the most frequently detected cancer in the European Union in men over 50 years of age. Androgen deprivation therapy remains the corner stone of treatment for recurrent or metastatic disease. Unfortunately, nearly all patients will develop resistance to androgen blockade leading to castration-resistant prostate cancer (CRPC). Over the last 10 years, new treatment shaved ramatically improved overall survival of men with mCRPC. Current therapies are basedon AR-axis inhibitors and taxane-based chemotherapies, aswell as radiopharmaceuticals and Sipuleucel T. Areas covered: The authors provide a review of the current fi eld of systemic therapy in metastatic CRPC. This is followed by an in-depth analysis of recent developments in treatment, and the biological rationale behind these therapies. Expert opinion: Since several trials with docetaxel or novel hormonal agents showed improvement in overall survival in metastatic castration-sensitive prostate cancer, aswell as in non-metastatic castrationresistant patients, it is expected that a growing subgroup of patients will be expose dearlierto chemotherapy and to AR targeted agents. It becomes then fundamental to fi nd novel strategies to over come drug resistance and further improve survival.]

Clinical Oncology

[Medical use of marihuana especially in oncology]

VÉGH Éva

[The medical use of marijuana has gained a considerable attention among wide range of cancer patients lately in Hungary. Consequently, oncologist sare facing questions related to cannabinoids more and more in their clinical practice. This article aims to clarify some basic concepts and to give a brief introduction on the current international and national legislation on their accessibility. Numerous publications have dealt with the application of marijuana in various indications. Among the tumour related indications, the concerned studies mainly refer to chemotherapy induced nausea and vomiting, chronic pain, sleep disorders, anorexia and cachexia. The article also to uches upon on knowledge connected to the causal treatment of malignant tumours, which are currently limited to glioblastoma. Information on the carcinogenic potential of cannabis and information on the popularity and attitudes of American oncologists can be found in this article. This paper gives a literature review in the above mentioned themes.]

Clinical Oncology

[Gene-expression profiles in adjuvant treatment of early breast cancer]

PAJKOS Gábor

[Breast cancer is a heterogeneous disease with different subtypes having a distinct biological, molecular, and clinical course. Assessments of standard clinical and pathological features have traditionally been used to determine the use of adjuvant systemic therapy in early-stage breast cancer; however, the ability to identify those who will benefi t from adjuvant chemotherapy remains a challenge, leading to over treatment of some patients. Risk stratifi cation of patients with early stage breast cancer may support adjuvant chemotherapy decision-making. This review details the development and validation of seven multi-gene classifi ers, each of which claims to provide useful prognostic and possibly predictive information for early stage breast cancer patients. A careful assessment is presented of each test’s analytical validity, clinical validity, and clinical utility, as well as the quality of evidence supporting its use.]

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Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Lege Artis Medicinae

[Mobbing and bullying among physicians - when colleagues become enemies]

KAPOCSI Erzsébet

[Workplace mistreatment, mobbing, bully-ing, or psychoterror has become a prioritised field of research in social sciences in the past two-three decades. Mobbing means more than a simple conflict situation between two individuals; it is a complex problem that could and should be investigated in various individual and organisational contexts. In spite of its large-scale theoretical and empirical research, the phenomenon still does not have a uniform definition; it is most commonly de-scribed via its social manifestations. Although the interpersonal constellation of mobbing is diverse, its trigger factors, stages and participants show similar patterns. The description and the evaluation of consequences is also uniform in the literature: workplace mobbing is accompanied by considerable health impairment, and it has severe psychosomatic and mental health effects on both the targeted individuals and the whole community. The latter group has to deal with poor performance, impaired morale and dissatisfaction. All these factors add up and lead to significant financial damage as well. The prevalence of mobbing is especially high in health care. Hierarchy, continuous overload, as well as emotional and physical stress all favour the development of mobbing. In turn, the professional-social culture of medicine that is based on traditions contributes to its acceptance, understatement and denial. The first time medical students have to face psychoterror is typically during their university years. The positive aspects of socialisation and finding their vocation cannot always compensate for the negative experiences. The model role of physicians, their behaviour towards colleagues and students can be protective, but it can also trigger further mobbing. Prevention is essential both at the organisational and individual level, and it requires complex measures whose effect will only be felt in the long term. ]

Clinical Neuroscience

Adult attachment and parental bonding in irritable bowel syndrome and in panic disorder - Implications for psychotherapy

PÉNZES István, CZEGLÉDI Edit, SZALAI Dömötör Tamás, CSALA Irén, TÚRY Ferenc

Background and purpose - Attachment theory provides an integrative perspective about the interplay between cognitive, affective, behavioral and interpersonal processes and is relevant for understanding irritable bowel syndrome (IBS) and panic disorder (PD). The aim of the present study was to examine the adult attachment style and parental bonding of IBS and PD patients. Methods - In a cross-sectional questionnaire-based study, 65 PD and 65 IBS patients with clinical diagnosis participated. Measures were Attachment Style Questionnaire, Experiences in Close Relationships Scale - Revised, and Parental Bonding Instrument. Results - The frequencies of insecure attachment (80.0% vs. 63.1%) and paternal neglect (35.4% vs. 16.9%) were higher in IBS than in PD (χ2 (1)=4.571, p=0.033, and χ2 (3)=7.831, p=0.050, respectively). The frequency of secure attachment was significantly higher for optimal paternal bonding than with suboptimal paternal bonding (75.0% vs. 21.9%, χ2 (1)=19.408, p<0.001). According to the results of multiple binary logistic analysis, optimal paternal bonding predicted secure attachment after adjusting for the background variables (OR=9.26, p=0.001). Conclusion - A high frequency of insecure attachment was present in both groups, especially in IBS. With regard to maternal bonding, IBS and PD groups showed similar patterns, while an apparent difference was observed for paternal bonding. These highlighted the developmental similarities of these two, symptomatically different disorders. While optimal maternal bonding did not predict adult attachment security, paternal bonding did thus replete with therapeutic implications. Attachment functions, like responsiveness, attunement and affection modulation were apparent in the psychotherapist-patient relationship as well.

Hungarian Radiology

[Intraoperative intracranial ultrasound imaging in neurosurgery]

DOBAI József Gábor, GYARMATI János, SZÉKELY György, CSÉCSEI György István

[Diagnostic ultrasound imaging started in the 1940s. Up to the present it underwent on radical changes. Article briefly reviews the major steps of the development of ultrasound technique in neurosurgery, and possibilities of applications of different ultrasound methods in neurosurgery are described. Authors discuss their experiences with Hawk 2102 ultrasound system used in intraoperative procedures in 113 cases. Data compared with the literature. Conclusions are that use of intraoperative ultrasound in neurosurgery is modern and simple and it has various application fields. Intracranial lesions are well localized with its use, so the risk of operations decreases. Main disadvantages that ultrasound imaging requires bony trepanation and special transducers are needed for different lesions.]

Hungarian Radiology

[Recent results of breast diagnostics - Onco update 2004]

FORRAI Gábor

[The purpose of this overview is to demonstrate the recent results of breast diagnostics and the place of the imaging and interventional methods. Review of the most recent articles (September 2002- December 2003) in the following subjects: breast screening, digital mammography, computer assisted diagnosis, breast ultrasound, breast MRI, scintimammography, positron emission tomography, guided biopsies, other interventions, new diagnostical methods, percutaneous tumour ablation. Experiences about breast diagnostic methods are accumulating year-to-year rapidly. Therefore the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are entering in the daily routine. These are the reasons why the up-to-date knowledge of the literature is mandatory.]