Clinical Oncology

[New challenges and possibilities in the chemotherapy of small cell lung cancer]


SEPTEMBER 05, 2015

Clinical Oncology - 2015;2(03)

[The small cell lung cancer is characterized as a rapidly proliferating systemic neoplasm, where the basic treatment modality is the chemotherapy . Even in the surgically treated cases the platina based chemotherapy combination is obligatory before and after the surgical resection, combined with preventiv cranial irradiation to minimize the risk of the cranial metastases. The platina based chemo-radiotherapy is the gold standard in the locally advanced cases. Palliativ local irradiation could be useful for pain relief or decompression in the metastatic cases. Prophylactic cranial irradiation strongly recommended in any cases. There are no newly developed drugs for the treatment of SCLC, however it is a chemosensitive carcinoma. Topotecan could be effective in second or third line therapy , especially in brain metastasis.]



Further articles in this publication

Clinical Oncology

[Ablation of liver cancer]

DOROS Attila

[Ablative therapies of the malignant liver tumors are used frequently all over the world. It is a very well tolareted minimally invasive treatment, followed by a short observation period. Patients might be sent home within 24 hours. Nowadays, there is suffi cient data supporting its effectiveness in the treatment of early primary liver cancer, equalling the results of surgical resection. The situation is different in liver metastasis, especially from coloectal cancer. In these cases ablative techniques have a supporting role, limiting their action on the multimorbid patients and small non-resectable tumors. These facts and trends - worldwide and in Hungary - are discussed, focusing on effectiveness, places in therapeutic protocols and domestic diffi culties.]

Clinical Oncology

[A structured approach to test the clinical benefi t of treatments of advanced cancer]


Clinical Oncology

[Mucositis - prevention and therapy]

NAGY Zsuzsanna, VALTINYI Dorottya

[Side-effects are critical challenges in cancer therapy. These complications can threaten the quality of life, sometimes the life itself. One of the most frequent side effects is mucositis, the damage of mucosa, either in the oral cavity (oral mucositis, OM), or in the gastrointestinal tract (gastrointestinal mucositis, GIM). Prevention is a key action for the effi cient supportation. Recognition of OM is relative easy, but of GIM is rather diffi cult. The risk factors could come from the patients and/or can be caused by the therapy. The successful management of mucositis mostly depends on the cooperation of the patient, which is highly infl uenced by the success of care (e.g. decreasing the level of pain). In general, mucositis (especially oral mucositis) a well managable disease, burt more informations are required to increase the quality of prevention and therapy. Such expectation could be realized by specifi c and sensitive biomarkers, however, they are still missing]

Clinical Oncology

[Up-to-date treatment of head and neck cancers]


[The head and neck squamous cell cancer is often detected at an advanced stage, resulting in dismal prognosis despite the relevant developments of the oncotherapy in the last decades. The introduction of new techniques, new drugs and combinations though improves the survival for certain subgroups of patients, meanwhile the organ-function preservation and side effects reduction approaches lead to improved quality of life. The preventive-supportive care prior and during the therapy (dental care, nutrition, toxicity management) and the complex rehabilitation has paramount importance. MRI and 18FDG PET-CT and the advanced methods of molecular pathology became part of the diagnostic work up. The selection of the therapy based on the tumor characteristics, HPV detection, on the patient’s condition and wishes, as well as on multi-disciplinary team decision based on the available technical options. Early stage tumors can be successfully treated either by surgery alone or by radiation therapy. For locally advanced cases concomittant chemo-radiotherapy stays in the axis of the complex management using advanced radiation technique (IGRT-adaptive- IMRT) with cisplatin (or if contraindicated with cetuximab), which could be complemented by induction chemotherapy and/or surgery. Several new approaches are currently being tested in clinical studies after establishment of cisplatine-cetuximab treatment for recurrent/metastatic tumors. In the future, detection of molecular processes and driver mutations could result in development of more effective targeted anti-tumor agents, and individual molecular tumor profi le guided therapy, including the various forms and combinations with emerging immunotherapy.]

Clinical Oncology

[Treatment of testicular germ cell tumors – an up-date]

BAKI Márta

[The frequency of germ cell tumors is about 1% of all male cancers. The incidence increases in developed countries. The prevalence is the highest among the young males. The histologic type, extent of disease and therapy is based on international guidelines. The surgery, radio- and chemotherapy can achieve cure in the germ cell cancer patients. Regarding the late toxicity, the minimal invasive tumors are suggested to keep on the wait and see policy. The complex therapy of poor risk groups reached more than 80% permanent remission rate. The chemotherapy is based on cisplatin, but in second and third line therapy paclitaxel, gemcitabin and oxaliplatin is widely used. After the cure of germ cell cancer patients the careful follow up is mandatory.]

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

[Recent strategies in the chemoterapy of soft tissue tumors]

PÁPAI Zsuzsanna, KISS Nóra

[Conventional adjuvant therapy is, in most cases, either the well-known standard doxorubicin monotherapy or the combination of doxorubicin + ifosfamide. No clear guideline has been developed yet - adjuvant therapy is recommended in cases with high grade, larger than 10 cm, sarcoma, where surgery hasn’t been suffi ciently radical, and adjuvant radiotherapy may not be advisable. In locally advanced tumors, due to the requirements of limb salvage, isolated limb perfusion is recommended. As a new compound, hafnium-oxide nanoparticles (NBTXR3) can be useful in local therapy: combining intratumoral injection and radiotherapy may be a fl agship initiative, however further investigations are necessary. In the treatment of metastatic tumors, beside the standard methods, new, targeted treatments are becoming more and more prevalent: in leiomyosarcomas trabectedine, pazopanib and olaratumab; in liposarcomas trabectedine and eribulin; in synovial sarcomas pazopanib; and in imatinib-resistant GIST, sunitinib and regorafenib. Soft tissue sarcomas are rare tumors categorized as heterogeneous histological subtypes. In their treatment, it is key to customize the treatment based on these subtypes and interdisciplinary collaboration with the orthopedic surgeon, the pathologist and the radiotherapist to determine the suitable therapy for each individual.]

Clinical Oncology

[Non surgical treatment of urinary bladder cancer]

PIKÓ Béla, LACZÓ Ibolya

[According to our present knowledge the surgical intervention in the treatment of bladder cancer is essential, but some non-surgical treatment methods play an indispensable role as well. Super- fi cial (non-muscle-invasive) form of bladder cancer can be treated by intravesical chemotherapy or BCG instillation, radiotherapy; the muscle-invasive forms of this tumour (≥pT2a) need neoadjuvant, adjuvant chemotherapy, radiotherapy or radio-chemotherapy. In case of metastatic disease (or locally advanced, recurrent disease) the treatment regimen consist of chemotherapy (given as fi rst line or second line), palliative radiotherapy, interventional methods, radio-isotope therapy and symptoms relief drugs. We present each of the therapeutic modalities and their indications category based on the ESMO and NCCN guidelines.]

Clinical Oncology

[Treatment of head and neck cancer]


[Head and neck cancers cause worldwide a signifi cant problem in health care systems. Despite great advances in therapeutic modalities its prognosis has not changed in the past few decades. It is mainly caused by classical risk factors, like alcohol consumption and smoking, but in a signifi cant number of oropharyngeal cancers HPV infection plays a major role, which is associated with a new patient group characterized by a much better prognosis and therapeutic response. In the diagnostic phase staging examinations (CT scan, MRI, FDG-PET) are also involved which are necessary to multidisciplinary decision making. It can be largely infl uenced by the patient’s preference. The therapy is based on multimodality approach; surgery, radiotherapy, chemoirradiation, chemotherapy and the combination of these are used in early or locally advanced tumours. Targeted agents like EGFR inhibitors are partly used in the recurrent/metastatic setting or in combination with radiotherapy. Immun checkpoint inhibitors are new therapeutic options for pretreated, recurrent/metastatic patients and their role is under investigation in earlier therapeutic lines. Several clinical trials aim treatment desintensifi cation strategies in HPV positive tumours. Molecular genetic tests try to defi ne subgroups of patients to plan individualized treatment. Regarding the signifi cant functional and aesthetic damage of both disease and treatment, supportive care and rehabilitation are of great importance.]

Lege Artis Medicinae

[Opportunities in drug therapy of biliary tract cancer. Past - present- future]


[Biliary tract cancer is relatively rare tumour, but the dismal prognosis renders it frightful. Biliary tract cancers which consist of gall bladder cancers and bile duct cancers can be cured only with surgery thus it is exceedingly important that the surgery should take place in dedicated centres. The multidisciplinary approach may involve drug therapy, too, as an adjunct to surgery or for palliation. This publication summarizes present data about systemic treatment with some chronological point of view. Starting from therapeutic nihilism of the past and projecting anticipatory development of the future it shows the present state of medical treatment in this patient population.]