Clinical Oncology

[Surgical view on the perioperative oncological treatment of liver metastases originated from colorectal cancer]


FEBRUARY 15, 2016

Clinical Oncology - 2016;3(01)

[Recent development of surgery resulted in fundamental changes in assessment of resectability of liver tumors. Surgical interventions became more radical and more effective. Colorectal liver metastasis (CLM) represents the most frequent hepatic tumor, where therapeutic options require close collaboration between surgeons and oncologists, and up-to-date approach from both. As the fact is, that CLM is a metastasis of a primary colorectal carcinoma, it seems to be obvious to apply perioperative chemotherapy. Results justify serious precaution. Neoadjuvant chemotherapy did not improve overall survival. Several data testify, that even perioperative chemotherapy is not indicated in these cases. Adjuvant chemotherapy can be applied after extended liver resections and two stages hepatectomies. About 20% of patients with initially inoperable CLM may be rendered resecable after systemic chemotherapy. Prognosis of synchron CLM is bad, 5 year survival is less than 20%. Disappearing CLM needs special respect, high level of perfection in liver surgery is essential. After chemotherapy postoperative morbidity is rising, technical diffi culties may occur. Further studies are required to examine possible effect of new targeted molecular therapy-based regimens on resectability. Individualized multidisciplinary treatment planning is mandatory.]



Further articles in this publication

Clinical Oncology

[Oncotherapy associated skin toxicity]

OLÁH Judit

[The last decades opened a new era of oncotherapy, including the development of targeted therapies for different subtypes of malignancies. Cutaneous adverse events are the most frequent toxicities among side effects of personally tailored molecular targeted agents. This review summarizes the practical aspects of the clinical characteristics and the optimal treatment of skin-related complications caused by oncological drugs.]

Clinical Oncology


A szerkesztők

Clinical Oncology

[Prevention and therapy of cervical cancer ]

RÉVÉSZ János, BÍRÓ Mátyás

[The global incidence of cervical cancer is ~530000, the death rate is ~270000 per year. These data shows, that cervical cancer is the fourth common malignancy in woman worldwide and the leading cancer related death in developing countries. HPV infection is the most important factor of carcinogenesis. Immunisation against HPV can prevent infection, and decrease the cancer incidence. In case of invasive cancer the therapeutic principles are surgery and radiotherapy. In case of high risk patients and/or locally advanced disease the adjuvant and neoadjuvant cytostatic treatment has limited evidences. The traditional cytotoxic therapy and the recent antiangiogenic therapy recommended for patients who have extrapelvic metastasis, residual tumor after primary radiotherapy or recidiv non curable tumor by radiotherapy or radical surgery.]

Clinical Oncology

[Follicular lymphoma - a way to personalized and targeted therapy ]


[Although follicular lymphoma is the most frequent non-Hodgkin’s lymphoma with an indolent clinical course, it is a rare disease. Patients with FL are characterized with a long survival with a relatively good quality of life, however using the current standard chemo-immunotherapy, the disease is considered incurable. The increasing knowledge of the molecular genetic background of the disease and the role of the reactive microenvironment lead to a better understanding of the pathogenesis of follicular lymphoma. Furthermore, the detailed functional characterization of the various cell surface antigens and deciphering the complex network of signaling pathways catalyzed the development of a number of novel targeted therapies (monoclonal antibodies, kinase- and NFκB-inhibitors), while understanding the effects of the cell surface receptors of cytotoxic T-cells initiated development of the monoclonal checkpoint inhibitors. The epigenetic therapies represent a novel therapeutic area with methyltransferase inhibitors demonstrating the most favorable results. Among the novel therapies, the immunomodulatory lenalidomide appears as the most promising and most effective drug, which acts via regulating the microenvironment, and in combination with rituximab in fi rst line setting it demonstrated similar effi cacy to the current standard protocols. Indeed, the rational use of the novel data and drugs paves the way towards personalized and targeted therapies for FL, resulting in more effective treatment and further improvement in patients’ survival, with a very long disease-free survival representing cure.]

Clinical Oncology

[Epigenetics and cancer]


[Epigenetics is concerned with the modulation of the genom without structural changes in the nucleotide-sequence. The main target in the regulation of epigenetical activity is gene expression. The main mechanisms in epigenetics the reversible chemical modulation of the DNA and the histones which are regulated by enzyme-complexes, acting directly with the metabolism and the signaling pathways, as well as with the sensors of macro- and microenvironment. New members of the epigenetical family are the non-coding RNAs (e.g. microRNA). The misregulation of these components can infl uence the tumors at different stages of growth and progression. Several inhibitory anticancer drugs (e.g. azacytidine, decitabin, vorinostat, romidepsin, belinostat) are used in the clinical targeted therapy.]

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Association of anterior thoracic meningocele and azygos lobe of the lung

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Clinical Neuroscience

Attitude of spine surgeons towards the application of 3D technologies - a survey of AOSpine members

ÉLTES Endre Péter, KISS László, BARTOS Márton, EÖSZE Zsolt, SZÖVÉRFI Zsolt, VARGA Pál Péter, LAZÁRI Áron

Background - 3D technologies (3D virtual and physical model, 3D printing, computer aided engineering, finite element analysis based simulations) play an important role in personalized spine surgery. Objective - In collaboration with AOSpine a global, online survey-based study was performed in order to determine the acceptance rate and the factors which stand against the wider spread of 3D technologies. Methods - A survey containing 21 questions was developed and divided into five pages, every page corresponding to one chapter. Our analysis is based on the responses of 282 spine surgeons from 57 countries. To interpret our results in a global context, we used the Human Development Index of the respondent's countries in comparisons. Results - Significant difference between the AOSpine regions (p ≤ 0.05) was found, with the highest acceptance in Asia-Pacific region. There was no significant difference in acceptance score according to the field of spine surgery, or the surgical experience in years (p=0.77, and p=0.19). In the case of public practice, we found significantly higher acceptance compared to private and mixed (public and private) surgical practice (p ≤ 0.05). The acceptance of the technology varied based on the respondent’s resident country’s Human Development Index and was significantly different between „Medium” vs “Very high” (p = 0.0005) and „High” vs „Very high” (p=0.019) category. Significant positive correlation was found between the acceptance score and the HDI score (Spearman test, ρ = 0.37, p = 0.007). The main limitation factor was identified as the lack of information. Conclusion - There is high interest among spine surgeons towards the incorporation of 3D technologies into the clinical practice. Education, the healthcare system, and the economic environment plays a major role in acceptance. Our results provide the basis of a strategy to promote the application of 3D technologies.

Clinical Oncology

[Current strategy in the surgical treatment of abdominal hematogenous metastases]


[The cornerstone of the therapy of most tumors is still the resecability of the primary tumor: if the cancer can be removed, the chance for recovery will signifi cantly increase. The development of the complex oncologic therapy lead also to the headway of metastasis surgery that used to be a rarity few decades ago. Based on the fi ndings of recent molecular genetic research and multimodular oncologic treatment it was found in more and more tumors that the removal of their metastasis shows benefi t for patients with advanced disease. In order to operate metastatic disease successfully extensive surgical experience and the knowledge of the tumors biologic behavior are required. Thus, the continuous interdisciplinary cooperation and the role of the oncoteam are essential to correct therapeutic decisions. In this review we discuss the possible surgical interventions of abdominal hematogenous metastases of different tumors.]

Clinical Oncology

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CSÓKA Monika

[Mesenchymal cells can be differentiated into skeletal muscle, smooth muscle, adipose tissue, fi brous tissue, bone and cartilage. Tumors can be originated from these tissues as benign tumors - fibroma, lipoma, osteoma, chondroma, haemangioma, myoma, etc. or as malignant tumors - in childhood, most commonly rhabdomyosarcomas, osteosarcoma, Ewing sarcoma, less often fi brosarcoma, liposarcoma or other rare types. Clinically, the outcome of these tumors have improved signifi cantly in the last decade due to the use of multi-modality treatment (chemotherapy, surgery, irradiation, in some cases targeted therapy). The better treatment results are based on early diagnosis and adequate management according to international treatment protocols in pediatric oncology centers.]