Clinical Oncology

[Novelties in the management of Hodgkin lymphoma]

ILLÉS Árpád, MOLNÁR Zsuzsa, MILTÉNYI Zsófia

SEPTEMBER 15, 2016

Clinical Oncology - 2016;3(03)

[Hodgkin lymphoma is a lymphoproliferativ disease, it is about 12-18% of all lymphomas. It has typical morphologic, clinical and therapeutic features, which can distinguish from other lymphoma types. Due to risk- and PET/CT adapted treatment Hodgkin lymphoma is a curable lymphoma with an 80-90% long-term survival, however, refracter- and relapsed patients’ therapy is a great challange. Cure rate can increase due to the development of the diagnostic and treatment modalities, but the use of standard recommendation is necessary. The aim of this review is to show new WHO 2016 lymphoma classifi cation, role of the new diagnostic options, especially 18FDG-PET/CT, Lugano classifi cation and fi rst-line and salvage therapeutic possibilities and to introduce the immunotherapy, like brentuximab vedotin and PD1 inhibitors. Certain points of hemopoietic stem cell transplantation will be also covered.]

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Clinical Oncology

[Foreword]

A szerkesztők

Clinical Oncology

[News from the World]

Clinical Oncology

[Therapy of endometrial cancer - an update]

SIPOS Norbert

[Endometrial cancer is the most frequent gynecologic malignancy in developed countries. Recently, there is a signifi cant increase of incidence caused by epidemic obesity. While the etiology of endometrial cancer can be heterogeneous, the effective therapy should be rather personalized. The primary therapy of endometrial cancer is operative. The recommended surgery is total abdominal hysterectomy and bilateral salpingo-oophorectomy. Management of pelvic and paraaortic lymphadenectomy is supported by the latest international recommendations, except cases of low-risk tumors (stage I/A, grade 1 or 2, endometrioid type, diameter of tumor <2 cm). Method of adjuvant therapy, especially in developed stages, is still controversial. Efficacy of postoperative irradiation, chemotherapy and chemoirradiation is under investigation by several ongoing studies. Recurrent endometrial cancer has bad prognosis, the best solution in this case is chemotherapy. In recent years targeted therapy (especially antiangiogenetic drugs, mTORinhibitors and hormontherapy) gave us some promising results. Around 80% of endometrial cancers can be diagnosed at early stages and cured with efficacy. Unfortunately, there is a group of tumors with bad prognosis, low differentiation, or recurrency, which can be a real challenge for clinicians. In this review we discuss the latest and most promising studies and scientifi c results in connection with treatment of high-risk endometrial cancers.]

Clinical Oncology

[Obesity and cancer]

VALTINYI Dorottya

[The role of obesity in the development of cancer is well-known from ages. However, these days we witness the explosion-like increase of obesity, globally, but mainly in the economically advanced population, and, which is even more alarming, among youngsters. The prognosis of the obesity-related cancer is rather poor, therefore, the prevention, including the screening, have outstanding importance. Unfortunately, the participation of the obes persons, especially obes women, in these programs is very low. The diagnostics and therapies should consider the special features of obesity, which are related to the magnitude, distribution, composition of fatty tissue connected to the changes in pharmacokinetics. Moreover, the problems might be complicated with obesity-associated non-tumorous severe diseases (e.g. cardiovascular, diabetes type 2).This review covers different aspects of obesity-cancer relationships, with an emphasis on everyday oncology.]

Clinical Oncology

[Intersphincteric resection for low rectal tumors]

METZGER Péter

[The technical development of rectal surgery, together with chemo- and radiotherapy, improved the effi ciency of surgical intervention as well as the patients‘ survival and quality of life. The treatment of ultra deep malignancies - 2-3 cm from linea dentata - is a real challenge for rectal surgery. Before the introduction of laparoscopy the removal of the deep tumors with conventional surgical techniques was impossible to save the tumorous rectum. The new techniques made possible the ultra deep resection, i.e. the removal even those tumors which progressed until the linea dentata. The explosive use of laparoscopy and the new waves of chemo- and radiotherapy resulted signifi cance advance contributed to an interdisciplinary therapeutic approach, which is a well adapted method in deep rectal surgery. In case of ultra deep localization of tumors - 0.5-1.0 cm to linea dentata - the neoadjuvant therapy supported the saving the anal sphicter. This new techniques contributed to the preservation of feces continentia of the patient.]

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[Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix combination – a non-interventional trial (RAMONA study)]

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[Purpose: Monitoring the effectiveness and safety of the fix combination formulation Egiramlon® therapy containing ramipril and amlodipin in patients, suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved 9169 patients (age >18) with mild or moderate hypertension [TUKEB No: 16927- 1/2012/EKU (294/PI/12.)]. Ramipril/Amlodipin 5/5, 5/10, 10/5, 10/10 mg combinations were administered/ titrated in three visits, during the four months period according to the physician’s decision Blood pressure was measured by validated blood pressure sphygmomanometry and ABPM (Meditech, Hungary). The dosis of the fix combination formulation was determined individually during the visits by the 923 doctors involved in the study. The target blood pressure value was 140/90 mmHg, but in case of high risk patients population (diagnosed cardiovascular disease, diabetes), 130/90 mmHg target value was determined. Results: In 70.1% of the patients had no protocoll deviation. Patients data and examination results were processed according to this 6423 patient population. The average age of the patients were 60.2 year, in 50-50% sex distribution. The average duration of the treated hypertension was 9.8 years and the average blood pressure value was 157/91 mmHg. Till the end of the study, systolic blood pressure has decreased with 26.4 mmHg and diastolic pressure with 11.8 mmHg. An average 5.5 bpm heart rate frequency decreasing was observed at the end of the study. As a result of the treatment 52.4% of the patient population has reached the target blood pressure value.]

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