Clinical Oncology

[Geriatric oncology]


MAY 10, 2017

Clinical Oncology - 2017;4(02)

[Geriatric oncology has an increasing role since in several types of cancer the median age at diagnosis is above 60 years of age. The treatment of elderly patients are frequently set back by prejudice, stereotypes and lack of information. All these lead to the fact that even in well-developed countries elderly cancer patients often do not receive the necessary treatments. This is even more true in poor-countries, where the fi nancial defi cit accumulated in health care is often attempted to be reduced by the treatment of elderly. If a paediatric oncology patient does not get suffi cient cancer treatment there is a fi erce protest, but everybody is silent if this occurs in the case of an 80 years old patient. For this unacceptable situation both authorities (fi nancing) and professional bodies (treatment, education) are responsible. Clinical data show that elderly cancer patients get the same benefi t of active oncology treatment, as younger ones. Age on its own does not contraindicate any cancer treatment. The aim of this review is to prove by data, that elderly cancer patients should also get active oncology treatment. The questions of assessment include frailty, the relationship of cancer development and ageing, and other problems related to the oncology treatment of elderly patients are also discussed.]



Further articles in this publication

Clinical Oncology


A szerkesztők

Clinical Oncology

[News from the World]

Clinical Oncology

[Adjuvant treatment of breast cancer]


[Choice of optimal adjuvant treatment has been based on present debates, doubts and commit offence against processing or existing evidences. Clinical research has been resulted changes and renewal of practice decisions continuously. 3rd Breast Cancer Consensus Conference held on Kecskemét last year corresponded by Hungarian experts of the fi eld has given up to date and well-defi ned guideline. Present paper try to give a summary of adjuvant treatment courses for early breast cancer in consideration of last results of research since then.]

Clinical Oncology

[Combination of radiotherapy and immunotherapy]

HIDEGHÉTY Katalin, BRUNNER Szilvia, SZABÓ Zoltán Imre, SZABÓ Emília Rita, POLANEK Róbert, TŐKÉS Tünde

[Increasing experimental and clinical evidences demonstrated the synergic effect between the rapidly implemented immunotherapy and advanced forms of focal radiotherapy, not only on the elimination of the irradiated lesion, but also on the enhancement the immune-mediated systemic anti-tumoral activity. It is essential for gaining the most benefi t from the combination of the two modalities to select the appropriate patients, to defi ne the irradiation parameters, such as radiation quality (ie. particle) dosage, (total dose, fraction number) size of the target volume, the use of other supportive and anti-tumor drugs. In this review, we provide an update for the daily oncological practice on the data accumulated up to now on the molecular basis and patomechanism of enhancing radio-immune effect and clinical results, and highlight the most important parameters, which may increase the abscopal effect of ionizing radiation, thereby increasing the effectiveness of immunotherapy. However, development of clinical guidelines for benefi cial integration of immunotherapy and radiotherapy could be expected after evaluation the result of currently ongoing numerous (> 100) clinical trials. If the preclinical results will be confi rmed clinically, it could lead to paradigm shift in the use of ionizing radiation.]

Clinical Oncology

[Why don’t immune checkpoint inhibitors work in colorectal cancer?]

SHI Yuequan, ZOU Zifang, KERR David

[In recent years, immune checkpoint inhibitors have been shown to be effective in treating manifold types of cancer but less robust in colorectal cancer (CRC). While, the subgroup of CRC with microsatellite instability (MSI; also termed as mismatch repair defi cient) showed a moderate response to Pembrolizumab in a single arm phase II clinical trial, microsatellite stable (MSS) cancers were unresponsive. Possible mechanisms that affect immune response in colorectal cancer will be reviewed in this article. We will also propose that histone deacetylase (HDAC) inhibition may reverse the immune editing commonly seen in advanced CRC and render them sensitive to immune checkpoint blockade.]

All articles in the issue

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Clinical Neuroscience

[Dysphagiafelmérések akut stroke-ban]

SZABÓ Pál Tamás, MÛHELYI Viktória, BÉRES-MOLNÁR Katalin Anna, KOVÁCS Andrea, BALOGH Zoltán, FOLYOVICH András

[Stroke associated dysphagia can have serious consequences such as aspiration pneumonia. The Hungarian guideline on nutritional therapy for stroke patients recommends dysphagia assessment, as early screening can optimize disease outcome and hospital cost. Thus far, this may be the first study in Hungarian that has documented a systematic review about the available validated dysphagia assessments of acute stroke. Purpose – The aim of this study was to summarize the instrumentally validated bedside dysphagia screening tools for acute stroke patients, which were published in the last twenty years. Our objective was to describe the characteristics of the validation studies, examine their study design, and sample the sub-tests and the diagnostic accuracy of the assessments. A systematic research was carried out of the literature between 2001 and 2021 in eight scientific databases with search terms appropriate to our objectives. Subjects of the study – 652 articles were found and were reduced to eight. We made a comparative analysis of these. The GUSS test reached a high level of sensitivity compared to the others. In our study sample, the prevalence of instrumentally confirmed dysphagia among acute stroke patients was 56.1%. The focus and the composition of the analyzed studies differed and posed problems such as the ambiguity of the concept of dysphagia, the difference in outcome indicators, or the timing of screening. The GUSS test, which offers domestic management, is a suitable tool for the Hungarian clinical use.]

Hypertension and nephrology

[Cilostazol improves quality of life and lower limb functional capacity in lower extremity arterial disease regardless of age and gender – new results of the SHort-tERm cIlostazol eFFicacy and quality of life (SHERIFF) study]


[Intermittent claudication has a significant negative impact on the patients’ quality of life. Revascularization procedures and noninvasive medical therapie scan improve walking capacity. Cilostazol has IA recommendation for the treatment of intermittent claudication (IC). The aim of this study was to evaluate the effect of three-month cilostazol treatment on the health related quality of life and on the lower limb functional capacity in women (F) and men (M), in patients under 65 years of age (Y) and among patients 65 years of age or older (O) with intermittent claudication in the clinical practice. The study was a multicenter, non-interventional trial, 812 lower extremity arterial disease (LEAD) patients (Fontaine II stage, mean age: 67.17 years, male/female: 58.25/41.75%, 506 patients aged ≥65 years) were enrolled, who received cilostazol (50 or 100 mg b.i.d.) for three months. Quality of life was evaluated with the EQ- 5D-3L questionnaire, functional capacity with the WELCH questionnaire. Walking distances, ankle-brachial index were measured at baseline and after 3-month. Upon conclusion of the study, the EQ-5D index improved (baseline: F [female] –0.49±0.23, M (male –0.44±0.22, Y (age <65 years) –0.45±0.21, O (age ≥65 years) –0.47±0.23; 3rd month: –0.27±0.18, –0.25±0.18, –0.25±0.18, –0.26±0.18; respectively, p<0.0001) and there was a significant increase in the WELCH score as well (baseline: F 18±13, M 20±14, Y 21±14, O 18±13; 3rd month: 31±18, 32±18, 32±19, 31±17; respectively, p<0.0001). Both pain-free and maximal walking distance increased: F 60.94%, (median: +50.26%), 49.57%, (median: + 42.86%), M 50.22%, (median: +50%), 37.7%, (median: + 33,33 %), Y 54,35 %, (median: + 56,2%), 36.78%, (median: +42.86%), O 54.62%, (median: +50%), 46.29% (median: +33.33%); respectively (p<0.001). Three months of cilostazol treatment improved quality of life and lower limb functional capacity in claudicant patients regardless of age and gender. The WELCH questionnaire is a useful tool in clinical practice for the evaluation of intermittent claudication treatment.]

Clinical Neuroscience

[Post-operative management of primary glioblastoma multiforme in patients over 60 years of age]

DARÓCZI Borbála, SZÁNTÓ Erika, TÓTH Judit, BARZÓ Pál, BOGNÁR László, BAKÓ Gyula, SZÁNTÓ János, MÓZES Petra, HIDEGHÉTY Katalin

[Background and purpose - Optimal treatment for elderly patients with glioblastoma multiforme is not well defined. We evaluated the efficacy of post-operative radiotherapy with or without concomitant and/or adjuvant temozolomide in patients aged ≥60 years to assess survival and identify prognostic factors of survival. Methods - A retrospective analysis of overall survival and progression-free survival in patients with newly diagnosed glioblastoma multiforme aged ≥60 years treated with postoperative radiotherapy with or without temozolomide chemotherapy was conducted at our institutions. Prognostic factors were determined by univariate and multivariate analyses. Results - Of 75 study participants (54.7% male; median age at first diagnosis, 65.1 years), 29 (38.7%) underwent gross total resection, whereas others underwent partial resection or biopsy only. All but 1 patient received radiotherapy. Twenty patients received concomitant temozolomide only. Adjuvant temozolomide (1-50 cycles) was administered in 42 patients; 16 received ≥6 cycles. Median overall survival was 10.3 months. One- and 2-year overall survival rates were 42.6% and 6.7%, respectively. Median progression-free survival was 4.1 months. Radiochemotherapy was generally well tolerated. Median overall survival was 15.3 and 29.6 months for patients who received 6-12 cycles and >12 cycles of adjuvant temozolomide, respectively. There were no significant differences in overall survival between age groups (60-64, 65-69, and ≥70 years). Adjuvant temozolomide, Karnofsky performance status ≥70, and additional surgery after progression were significant prognostic factors of longer overall survival (p<0.05). Conclusions: Radiochemotherapy, including ≥6 cycles of adjuvant temozolomide, was safe and prolonged survival of glioblastoma patients aged ≥60 years. Aggressive therapy should not be withheld from patients aged ≥60 years with good performance status because of age.]

Hypertension and nephrology

[Therapy of isolated systolic hypertension III.]


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Lege Artis Medicinae

[What is the doctor like, if female? - Female doctors’ ideal image based on empirical studies]

MOLNÁR Regina, GIRASEK Edmond, CSINÁDY Adriána, BUGÁN Antal

[The aim of our study was to examine thestereotypes about female doctors and howdo the female medical students perceivethe working female doctors whom are theirrole models. In the first study (247 from theAlbert Szent-Györgyi Medical and Pharma-ceutical Centre at the University of Szegedand 256 from the Medical and HealthScience Centre of the University ofDebrecen) the female medical students’professional socialization was compared tothe male counterparts’. In the second study(from University of Szeged, 214 femalemedical students, 132 female jurist stu-dents) female medical and jurist students'professional socialization was comparedincluding the comparison of stereotypes inconnection with working female doctorsand jurists. Female medical students’ professionalsocialization is different that of male coun-terparts in several aspects: being morealtruistic, more family centered, gettingcommited to the profession earlier, havingmore ambiguous carrier planes, and asmaller percentage of their parents’ has adegree or is a medical doctor, then for malemedical students. The female medical doc-tor has positive, idealistic, altruistic charac-ters according to both female studentgroups’ opinions. The female doctor’simage is more often associated with char-actersitics implying problems by femalemedical students then jurists. The unfold-ing image of these stereotypes is a femaledoctor who is willing to help, however,faceing lots of hardnesses during work.If the female medical students’ image of theproblematic life of these idealistic femaledoctors’ is known, it provides an opportu-nity to prepare them for the hardnessesthey’ll face avoiding role conflicts andhealth problems in the future.]