Clinical Oncology

[Side effects of CT scans]

SÁFRÁNY Géza1, LUMNICZKY Katalin1

DECEMBER 30, 2020

Clinical Oncology - 2020;7(4)

[Computed tomography (CT) scans which result in relatively high doses of radiation exposure, but have an indisputable diagnostic advantage, are becoming more common among radiological diagnostic imaging procedures. Based on the linear no-threshold model of stochastic radiation effects, even the lowest radiation dose suffered can trigger the formation of tumors. Tumor formation due to radiation exposure during CT scans, thanks to their higher radiation sensitivity and longer life expectancy, mainly affect youngsters. Most epidemiological studies on the subject concluded that CT scans increased the risk of leukemia and brain tumor development in young people in a dose-dependent manner. However, absolute tumor numbers are not really significant, so if appropriately indicated, examinations should be performed as soon as possible. CT scans of the lower abdomen in pregnant women may lead to developmental abnormalities in the fetus. In the vast majority of cases, only a series of CT scans can result in larger than 100 mGy fetal exposures which may raise the potential of abortion. The physician performing the examination is responsible for the justification and optimization of imaging studies involving radiation exposure.]

AFFILIATIONS

  1. Nemzeti Népegészségügyi Központ, Sugárbiológiai és Sugáregészségügyi Főosztály, Budapest

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[The year of 2020 brought unexpected challenges to the healthcare systems all around the globe. Every country had to reorganise their medical priorities to face the COVID19 pandemic. The practice of virtual medicine has expanded in the past years, these new circumstances have increased its speed drastically. Within these unusual circumstances we could take part in the virtual congress of the ESMO 2020 where we were able to hear about the new results of oncology to provide up-to-date care for our patients. Compared to the past years, we did not learn too many breakthrough results, the most of the novelties helped us place our experiences to their ideal place in patient care. The investigations which examined the SARS-CoV2 virus effects on oncologic patients showed grave results, the infection increases the vulnerability and mortality of patients receiving active anticancer therapies or suffering from an active cancer.]

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[Tumor-agnostic therapy is considered as a promising therapeutic approach in oncology, however classification, validation of the targets and standardized methodology for their evaluation is mandatory. The development and approval of the tumor-agnostic drugs should be based on biomarker driven clinical trials. To date three validated biomarkers are known, the high microsatellite instability (MSI-H), the fusion of the neurotrophic-receptor-tyrosine-kinase (NTKR) genes, and the high mutation burden (TMB-H) of the tumors. Pembrolizumab (anti-PD-1 antibody) was the first approved tumor-agnostic drug, the MSI-H status of the tumor was the first indication, then later the TMB-H status was also approved. Larotrectinib and entrectinib are approved for the treatment of NTKR fusion-positive tumours.]

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[In recurrent ovarian cancer, poly(ADP-ribose) polymerase (PARP)-inhibiting agents have transformed the treatment of platinum-sensitive disease. New data support use of PARP inhibitors earlier in the treatment algorithm. We review results from recent phase III trials evaluating PARP inhibitors as treatment and/or maintenance therapy for patients with newly diagnosed ovarian cancer. We discuss the efficacy and safety of these agents in the all-comer and biomarker-selected populations studied in clinical trials, and compare the strengths and limitations of the various trial designs. We also consider priorities for future research, with a particular focus on patient selection and future regimens for populations with high unmet need. Four phase III trials (SOLO-1, PAOLA-1/ENGOT-OV25, PRIMA/ENGOT-OV26 and VELIA/GOG-3005) demonstrated remarkable improvements in progression-free survival with PARP inhibitor therapy (olaparib, niraparib or veliparib) for newly diagnosed ovarian cancer. Differences in trial design (treatment and/or maintenance setting; single agent or combination; bevacizumab or no bevacizumab), patient selection (surgical outcome, biomarker eligibility, prognosis) and primary analysis population (intention-to-treat, BRCA mutated or homologous recombination deficiency positive) affect the conclusions that can be drawn from these trials. Overall survival data are pending and there is limited experience regarding long-term safety. PARP inhibitors play a pivotal role in the management of newly diagnosed ovarian cancer, which will affect subsequent treatment choices. Refinement of testing for patient selection and identification of regimens to treat populations that appear to benefit less from PARP inhibitors are a priority.]

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