Clinical Oncology

[New results from San Antonio Breast Cancer Symposium, 2017]

KAHÁN Zsuzsanna

FEBRUARY 10, 2018

Clinical Oncology - 2018;5(01)

[SABCS 2017 has been a 40-year jubilee conference with festive appearance and content. The anniversary provides possibility to look back: today we fi nd the knowledge and practice as of twenty years ago schematic and rough while the changes are overwhelming. Therapy became colorful and personally. There is need for precisious care which means consideration all patient and tumor features when surgical or medical therapy, radiotherapy or even diagnostic issues are decided - this has been the most important message of the conference this year. The Symposium always provides the most modern and breakthrough approaches and attitude that support advancement in patient care.]

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Further articles in this publication

Clinical Oncology

[Foreword]

A szerkesztők

Clinical Oncology

[News from the World]

KLINIKAI Onkológia

Clinical Oncology

[Treatment of hepatocellular carcinoma - an update]

DEMETER Gyula, VÉGH Éva

[Last time we have described about the modern treatment of hepatocellular carcinoma (HCC) in „Klinikai Onkológia” in 2014 (1) and a detailed guideline regarding epidemiology, treatment according to BCLC staging system has been published as well in a special edition in this year (2). Here, we discuss mainly the fi rst- and second line systemic treatment of HCC according to our experience and the new results of clinical trials. 203 patients were treated in our Department between 2010 and 2016. These results have been presented already on the MKOT conference in 2016. In this year we have started second line systemic therapy with regorafenib in 9 cases.]

Clinical Oncology

[Solid organ transplantation and malignancies]

VÉGSŐ Gyula, MÁTHÉ Zoltán

[Recent breakthroughs in the fi eld of organ transplantation and oncology have challenged existing views, and necessitate the revision of several tumor-related issues in transplantation. The need for expanding the donor pool raises the question of how and when it is plausible to transplant the organs of a donor with a history of cancer, such that the risk of tumor inoculation and manifestation due to the graft would be minimal for the recipient. Another point to consider is whether it is acceptable to transplant a recipient with a history of a malignant tumor, and if yes, how much tumor-free survival time is required as a minimum before the transplant. Transplanted patients live longer as a result of modern immunosuppressive therapy. However, the risk of malignant tumors increases proportionally to the length of the immunosuppressed state: their incidence may be as much as 20-30% in the long term. The signifi cance of „de novo” posttransplant tumors is highlighted by the fact that they are among the leading causes of death in transplant patients. Taken together, malignant diseases pose a serious problem from several aspects, the solution for which requires close teamwork of experts in oncology and transplantation, and the integration of up-to-date knowledge in the process of making a therapeutic decision, tailored individually for the patient.]

Clinical Oncology

[Treatment of locally advanced rectum cancer]

FRÖBE Ana, JURETIC Antonio, BROZIC Marić Jasmina, SOLDIC Zeljko, ZOVAK Mario

[Over the last several decades, local control (LC) for rectal cancer has markedly improved because of advances in surgical technique and the adoption of adjuvant or neoadjuvant chemoradiotherapy (CRT). Total mesorectal excision (TME) during surgical resection of localized rectal cancer, which involves removal of the entire circumferential perirectal tissue envelope, decreases rates of both involved surgical margins and local recurrences. Similarly, for patients with locally advanced rectal cancer (LARC), including T3 and T4 tumors and lymph node-positive disease, adjuvant and more preferably neoadjuvant CRT has exhibited the ability to both improve disease-free survival (DFS) and LC. Some patients undergoing neoadjuvant CRT achieve a complete pathologic response (pCR) to CRT and the oncologic outcomes are particularly favourable in this group. In contrast to improved local control, patients’ overall survival rates are in need of improvement, and the major factor limiting the outcome is the appearance of metachronous distant metastases. The main approach to overcome this issue is the escalation of systemic therapy in the neoadjuvant setting, e.g. by addition of induction or consolidation chemotherapy before or after neoadjuvant chemoradiotherapy (the so-called total neoadjuvant treatment, TNT, approach). The aim was to present a short overview of the role of radiotherapy and radiochemotherapy in the management of rectal cancer with a focus on current treatment stand wasards for locally advanced rectal cancer.]

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[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.]

Clinical Oncology

[Clinical role of multigenic prognostic tests in breast cancer therapy]

GYŐRFFY Balázs

[Current clinical practice for breast cancer originates in “evidence based medicine”. In this, each tumor receives a therapy optimal for a given patient population - which might not be optimal for each individual patient. Multigenic tests determining expression of a set of genes can provide additional support in this decision process. Two such tests (MammaPrint and Prosigna) have already received FDA clearance. A number of additional test are commercially available (IHC4, Oncotype DX, EndoPredict, BCI). A common property of these assays is their utility in estrogen receptor positive early breast cancer. The main clinical problem answered by them is the necessity of adjuvant chemotherapy. To date, no reliable algorithm has been identifi ed capable to pinpoint the most effective chemotherapy combination for a given patient. Furthermore, there is no trustworthy test for triple negative breast cancer. The assays utilize different technologies (immunohistochemistry, gene chips, RT-PCR) and a discrepant list of genes - these result in discordance of the predictions for the individual patient. Despite these shortcomings, multigenic tests quickly gained foothold in breast cancer therapy decision process. Their utility is supported by the cost reduction for the health care providers by lowering the number of patients eligible for chemotherapy.]

Hungarian Radiology

[Results of breast cancer screening and clinical mammography at the Kenezy Breast Center, Debrecen between 2002-2003]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, VAJDA Olga

[INTRODUCTION - Breast cancer screening has been started in January 1. 2002. in Hungary in the course of the National Health Program. Breast cancer is the main cause of death among women’s malignant tomors, and the aim of the project is to reduce this mortality. The chance of survival is highly increased by the early detection of the disease. Kenezy Breast Center was connected to this project. PATIENTS AND METHODES - Females between 45-65 years without symptoms participated in the project. Paralel to this women with symptoms, sometimes with palplable masses were clinically examined. Screening mammography films were read by two radiologists and the complementary examinations of the breast and the axillary lymph nodes - ultrasonography, guided biopsy (FNAB, core biopsy) - were performed always by the same doctor. Results of the two projects were compared. RESULTS - The incidence of malignant breast cancer was 4‰ in the screening and 1,5% in the clinical group. 46.5% of the malignant breast cancers revealed by the clinical examinations was diagnosed in the group of women between the age of 45 to 65 years. This is the age when most women are involved in the screening program. 7.3% of the tumors was diagnosed in the 40- 44 year age-group and 11.3% among women aging 66-77 years. The rate of malignant tumors smaller than 1.5 cm was 49.1% according to screening records and 36% in the clinical trial. In both groups, tumor size of 1.5 cm proved to be a critical limit regarding to the development of metastases, mainly in the axillary region. Above this size, metastases were more frequent. CONCLUSIONS - Both breast screening program and clinical exams are of great significance. Based on the data obtained during two years, authors found that women below the age of 40 and above the age of 65 should also be involved in the screening program. Detection of breast tumor is possible at an early stage by screening. In the case of small tumors (smaller than 1.5 cm) the development of axillary metastases is less likely than in the case of larger ones. The lack of metastases in the axillary lymph nodes offers better prognosis according to the published scientific data, which reinforces the importance and necessity of the screening programs.]

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

[Cervix and breast cancer screening in the districts of Hungary]

SÁNDOR János, SZÜCS Mária, KISS István, BONCZ Imre, SEBESTYÉN Andor, KISS Adrienn, EMBER István

[INTRODUCTION - Life expectancy in Hungary has been increasing recently but in a geographically uneven distribution. The mortality trends has remained disadvantageous for cancer patients and also for the malignancies of cervix and breast that can be preventable with screening. The study aimed to describe the participation at the district level in the screening programmes as well as to investigate the relative role of health behaviour of women and of the health services in determining the screening success. METHODS - Age standardised relative screening participation rates were computed for 150 districts of Hungary using discharge reports of the outpatient services for cervical cytology and mammography. RESULTS - 20,12% of all 25-65 years old women was screened for cervical cytology during 3 years (1. July 1998. - 31. June 2001.) and 17,22% of all women aged 45-65 years participated in mammography in a 23 months period (1. July 1998. - 31. May 2000.). The results scattered in a certain fashion. Summarising the screening results, the highest participation ratios were observed in Bonyhád, Kiskunfélegyháza, Paks, Zalaszentgrót, Pécs while the lowest were in Csengeri, Mór, Nyírbátor, Sárbogárd, Enying districts. The screening performances did not correlate with each other and with the socioeconomic indicators (education, unemployment, income), apart from the significant influence of education on mammography participation rate. The emerging explanation is that the health behaviour was not important determinant of screening participation. In this case, the behaviour of target populations would have affected similarly both screening results resulting in a correlation. CONCLUSIONS - Consequently, the performances of providers responsible for screening organisation have been reflected in the observed screening rates. This result and the wide scattering of screening participation rates, which developed in spite of the uniform legislative-economic environment, emphasises the importance of regular monitoring of screening performance.]