Clinical Oncology

[Mediastinal tumours and their therapy]

AGÓCS László

MAY 20, 2016

Clinical Oncology - 2016;3(02)

[Due to the tissue structure of the mediastinum a large variety of tumours and multiple systemic malignant disease may occur in the region. The tumours show a variation depending upon age and localization besides their signifi cant alterations. Based on the most accepted Shield classifi cation, the author discusses the types, characters and therapeutic discipline of the tumours in the mediastinal region. The author focuses on the surgical indications, their options and forms, highlighting on the minimal invasive methods.]



Further articles in this publication

Clinical Oncology

[Complications of infusion treatment with emphasis on extravasation of cytostatics]

HARISI Revekka

[The extravasation of cytostatics is the most signifi cant complication of infusion therapy in cancer treatment. Extravasation refers to the inadvertent infi ltration of cytostatic drugs into subcutaneous or subdermal tissues surrounding the intravenous or intraarterial administration site. According to literature data incidence estimates between 0,01-7%. Extravasated drugs are classifi ed according to their potential for causing damage as vesicant, irritant and nonvesicant. Knowledge of risk factors, the patientrelated and treatment-related ones is important to minimize the occurrence of extravasation. In order to reduce the risk of extravasation, the staff involved in the tumor infusion therapy must be specially trained to implement several preventive and therapeutical protocols. In 2012, ESMO-EONS has put together a new comprehensive treatment protocol on the topic of cytostatics extravasation. Protocol recommended that every oncological department, who administers chemotherapy have to have extravasation trained team and a standby extravasation kit. According to the new ESMO-EONS guideline subcutaneous corticoids are not recommended, anymore. In case of mechloretamine extravasation the recommendation is immediate subcutaneous injection of sodium thiosulfate. After extravasation of anthracyclines, mitomycin C and platin salts the best treatment opportunity is subcutan dimethyl sulfoxide administration. In case of anthracyclines’ extravasation intravenous dexrazoxane treatment is also effective. Hyaluronidase, injected into or under the skin, facilitates absorption of extravasated drugs because of increases connective tissue permeability, promotes the spreading and reduces the local concentration of the extravasated citostatic agents. Hyaluronidase might be effi cacious in preventing skin necrosis by extravasation due to vinca alkaloids. The treatment of unresolved tissue necrosis or pain lasting more than 10 days is surgical debridement. Because of the medical and juristic importance of the extravasation event, it is necessary to establish uniform guidelines for treatment of extravasation, in all Hungarian Oncological Centers.]

Clinical Oncology



[The interrelations between the well-known characterized oncogenic effects (genetic and epigenetic), the related metabolic alterations and the metabolic reprogramming have high interest in recent studies of tumorgenesis, tumor progression and therapeutic response. Certain tumor cells could possess various metabolic profi les (even independently from their histological type) based on their metabolic changes. These can be characterized by different nutrient demand and utilization pathways (glycolysis, glutaminolysis, fatty acid oxidation, autophagy etc.) besides the alterations can infl uence the survival, the proliferation rate, the metastatic behaviour and the microenvironmental changes of certain tumor cells, as well. Targeting certain metabolic phenotypes or irreversible metabolic adaptation changes in different tumor cells could be expected to be effective in future therapeutic treatments.]

Clinical Oncology

[The role of hospice in the management of cancer patients]


[There is the relationship between the oncological treatment and hospice care proved by the data on morbidity and mortality. Cancer treatment is just partially effective since besides the growing incidence of new patients (90 091 in 2013) in Hungary, the mortality rate is still high (33 278 people in 2013). Revealing the diagnosis of tumorous disease causes an incredible shock for the patients, therefore oncopsychologists have to join to the oncological treatment at a very early stage. They give psychological support to both the patients and their families. By relieving stress and helping to combat the disease, the patients could accept and gradually face to the new situation. The patient keeps hoping as long as the treatment is effective and his/her health does not begin to decline. Today, in most cases the effi cacy of the treatment is just temporary and the patient will reach the stage where only the palliative and hospice care can help to maintain an acceptable but provisional quality of life. A new movement started for the terminally ill patients to keep their dignity. Hospice is an integral part of health care with 205 beds, and 75 home hospice care units (in Hungary). To get into the hospice care we describe the patients’ path including the terminal state, agony and death. We also explain the palliative medical and psychological care as well as the other forms of care at home and in the domestic or hospital care carried out within a team-work. The activity of these two types of care must be integrated and mutually supported. Finally we are going to talk about the problems that prevent the acceptable operation in this system.]

Clinical Oncology


A szerkesztők

Clinical Oncology

[Non-surgical treatment of the biliary tract and gallbladder cancer]

PIKÓ Béla, LACZÓ Ibolya

[Biliary tract cancers are rare, hence only a few high level of evidences related to their treatment are available. The successful treatment and the only chance for long-term survival are based on the radical surgical resection. After the fl uoropyrimidin based protocols chemotherapy regimens prefer gemcitabine combinations (cisplatin, oxaliplatin, capecitabine) or FOLFIRINOX, considering the patient performance status as well. There are no registered targeted therapy in this indication, the most experiences were acquired with erlotinib; nowadays the optimal treatment can be selected by the molecular genetic profi le of the tumour and not by the results of the clinical studies. The radiotherapy and the radiochemotherapy can be administered preoperatively, postoperatively and for palliation as well, in addition to the conventional percutaneous radiotherapy, brachytherapy, intensity-modulated radiotherapy, intraoperative irradiation, radioembolization can also be administered depending on the technical equipments. Besides the photodynamic therapy and several ablation therapies, even interventional radiological procedures can play a signifi cant role.]

All articles in the issue

Related contents

Hungarian Immunology

[Pseudolymphoma orbitae]

VÁNCSA Andrea, GERGELY Lajos, NEMES Zoltán, BÍRÓ Edit, ILLÉS Árpád, BAKÓ Gyula

[INTRODUCTION - Pseudolymphoma orbitae is a rare and difficult entity. The cooperation of the pathologist and clinician is needed to properly manage the patient. CASE REPORT - The authors report the case history of a 38 years old male patient. His disease started at the age of 30. He was previously treated with allergic rhinitis. No definitive diagnosis was made for eight years. Several surgical biopsies were made from nasal mucosa, but no specific histologyical diagnosis was applicable. At the age of 30 he developed an unilateral exophthalmus on the left side. Thyroid associated ophthalmopathy was ruled out several times with laboratory analysis. High dose methylprednisone therapy was repeatedly given with limited results. At the age of 34 orbital CT and MRI scan confirmed the pseudotumour orbitae already compressing the optical nerve. Laboratory analysis again ruled out thyroid associated ophthalmopathy. Churg-Strauss syndrome, Wegener’s granulomatosis or Sjögren’s syndrome could be ruled out. A bone marrow trephine biopsy excluded systemic hematological disease as well. A biopsy was performed from the retrobulbar mass again, which confirmed the lymphoid hyperplasia with B-cell dominance. High dose methylprednisone and local irradiation resulted only moderate decrease of the mass, so systemic chemotherapy was started using CVP (cyclophosphamide, vincristin, prednisone) then CHOP (CVP + anthrycycline) polychemotherapy for eight cycles and subcutaneous interferon-α for 20 months. CONCLUSIONS - This resulted a complete regression of the disease, and the patient is well for 48 months now.]

Clinical Oncology

[Current treatment of gastrointestinal lymphomas]


[The most common extranodal site involved by lymphoma is the gastrointestinal tract. The majority of extranodal lymphoma cases are of the non-Hodgkin subtype. Usually, the involvement of the gastrointestinal tract by nodal lymphomas is secondary, the primary gastrointestinal localisation is rather rare. The most common pathological types are diffuse large B-cell lymphomas and extranodal marginal zone lymphomas of the mucosa-associated tissue (MALT) subtype. Although the primary gastrointestinal lymphoma can involve any part of the gastrointestinal tract, the stomach is the most frequently involved site. The treatment and prognosis are determinated primarily by the histologic type of lymphoma, the stage of disease and the patient’s age and general condition. Helicobacter pylori (HP) infection is one of the major risk factors for gastric lymphomas, the presence or abscence of which radically infl uences the effectivity of treatment. In case of HP positivity, HP eradication itself can result in complete remission. In most cases the treatment is immuno- and/or combination chemotherapy, which is performed according to the internationally accepted protocols, specifi c to the type of lymphoma. Radiotherapy plays a lesser role in the treatment of GI lymphomas, while surgery is performed almost only in complicated cases, such as haemorrhage, occlusion or perforation.]

Lege Artis Medicinae

[The role of hepatitis C virus in the development of non-Hodgkin lymphomas]


[There is a growing body of evidence for the association between chronic hepatitis C virus infection and certain subtypes of Bcell non-Hodgkin lymphoma. The development of a lymphoid malignancy is usually preceded by cryoglobulinaemia. Here, we summarise the most important epidemiologic data, and the possible molecular mechanisms of HCV-associated lymphomagenesis. The direct oncogenic effect of the virus has not been proven, but chronic antigenic stimulation maintained by replication and viral lymphotropism might both contribute to the development of lymphomas. It should be emphasised that elimination of the hepatitis C virus can halt this process in case of cryoglobulinaemia and low-grade malignity (usually marginal zone lymphomas). In these cases, antiviral therapy might be a useful alternative of conventional immune-chemotherapy. Thus, a collaboration between haematologists and hepatologists might be a great step forward in the treatment of these diseases. It is still not established whether interferon-based short-course therapies and interferon-free regimens are also effective in the treatment of associated lymphomas.]