Clinical Oncology

[Systemic treatment of gastrooesophageal adenocarcinoma]


MAY 20, 2016

Clinical Oncology - 2016;3(02)

[Few of chemotherapeutic drugs are effective and used for the treatment aGEA. Palliative chemotherapy prolongs overall survival and improves quality of life. The median OS in large randomized trials are approaching 12 months but in unselected populations the median OS only around 6 months. The median age for mEGA is around 70 years but the median age in most of the randomized trials is only around 60 years or even younger and therefore patients in trials are highly selected. A number of different fi rst-line regimens have been validated for use in this setting, but there is as yet no consensus recommendation on a world-wide combination. A combination of a platinum based (cisplatin or oxaliplatin) and a fl uoropyrimidine (5-FU, capecitabien or S-1) represents the cornerstone of fi rst line treatment. The addition of docetaxel to such doublets improve overall survival further, albeit at the cost of increased toxicity but a docetaxel triple regimen should be considered in fit younger patients. Trastuzumab was the first targeted drug to be approved in aGEA. Addition of trastuzumab to double chemotherapy is very tolerable and increase effi cacy. Second-line therapy is standard and recently it was shown that ramucirumab deliver clinical meaningful benefit as monotherapy or in combination with paclitaxel. The preliminary show promising effi cacy of immunotherapy and randomized study are recruiting patients with aGEA.]


  1. Odense University Hospital & Institute of Clinical Research, University of Southern Denmark
  2. University Medical Center, Johannes GutenbergUniversity Mainz, I. Medizinische Klinik und Poliklinik



Further articles in this publication

Clinical Oncology

[Complications of infusion treatment with emphasis on extravasation of cytostatics]

HARISI Revekka

[The extravasation of cytostatics is the most signifi cant complication of infusion therapy in cancer treatment. Extravasation refers to the inadvertent infi ltration of cytostatic drugs into subcutaneous or subdermal tissues surrounding the intravenous or intraarterial administration site. According to literature data incidence estimates between 0,01-7%. Extravasated drugs are classifi ed according to their potential for causing damage as vesicant, irritant and nonvesicant. Knowledge of risk factors, the patientrelated and treatment-related ones is important to minimize the occurrence of extravasation. In order to reduce the risk of extravasation, the staff involved in the tumor infusion therapy must be specially trained to implement several preventive and therapeutical protocols. In 2012, ESMO-EONS has put together a new comprehensive treatment protocol on the topic of cytostatics extravasation. Protocol recommended that every oncological department, who administers chemotherapy have to have extravasation trained team and a standby extravasation kit. According to the new ESMO-EONS guideline subcutaneous corticoids are not recommended, anymore. In case of mechloretamine extravasation the recommendation is immediate subcutaneous injection of sodium thiosulfate. After extravasation of anthracyclines, mitomycin C and platin salts the best treatment opportunity is subcutan dimethyl sulfoxide administration. In case of anthracyclines’ extravasation intravenous dexrazoxane treatment is also effective. Hyaluronidase, injected into or under the skin, facilitates absorption of extravasated drugs because of increases connective tissue permeability, promotes the spreading and reduces the local concentration of the extravasated citostatic agents. Hyaluronidase might be effi cacious in preventing skin necrosis by extravasation due to vinca alkaloids. The treatment of unresolved tissue necrosis or pain lasting more than 10 days is surgical debridement. Because of the medical and juristic importance of the extravasation event, it is necessary to establish uniform guidelines for treatment of extravasation, in all Hungarian Oncological Centers.]

Clinical Oncology

[Treatment of childhood tumors of mesenchymal origin]

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.]

Clinical Oncology



[The interrelations between the well-known characterized oncogenic effects (genetic and epigenetic), the related metabolic alterations and the metabolic reprogramming have high interest in recent studies of tumorgenesis, tumor progression and therapeutic response. Certain tumor cells could possess various metabolic profi les (even independently from their histological type) based on their metabolic changes. These can be characterized by different nutrient demand and utilization pathways (glycolysis, glutaminolysis, fatty acid oxidation, autophagy etc.) besides the alterations can infl uence the survival, the proliferation rate, the metastatic behaviour and the microenvironmental changes of certain tumor cells, as well. Targeting certain metabolic phenotypes or irreversible metabolic adaptation changes in different tumor cells could be expected to be effective in future therapeutic treatments.]

Clinical Oncology

[The role of hospice in the management of cancer patients]


[There is the relationship between the oncological treatment and hospice care proved by the data on morbidity and mortality. Cancer treatment is just partially effective since besides the growing incidence of new patients (90 091 in 2013) in Hungary, the mortality rate is still high (33 278 people in 2013). Revealing the diagnosis of tumorous disease causes an incredible shock for the patients, therefore oncopsychologists have to join to the oncological treatment at a very early stage. They give psychological support to both the patients and their families. By relieving stress and helping to combat the disease, the patients could accept and gradually face to the new situation. The patient keeps hoping as long as the treatment is effective and his/her health does not begin to decline. Today, in most cases the effi cacy of the treatment is just temporary and the patient will reach the stage where only the palliative and hospice care can help to maintain an acceptable but provisional quality of life. A new movement started for the terminally ill patients to keep their dignity. Hospice is an integral part of health care with 205 beds, and 75 home hospice care units (in Hungary). To get into the hospice care we describe the patients’ path including the terminal state, agony and death. We also explain the palliative medical and psychological care as well as the other forms of care at home and in the domestic or hospital care carried out within a team-work. The activity of these two types of care must be integrated and mutually supported. Finally we are going to talk about the problems that prevent the acceptable operation in this system.]

Clinical Oncology


A szerkesztők

All articles in the issue

Related contents

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.

Clinical Neuroscience

Delirium due to the use of topical cyclopentolate hydrochloride


Introduction - Our aim is to present a rare case where a child had delirium manifestation after instillation of cyclopentolate. Case presentation - A 7-year old patient was seen in our outpatient clinic, and cyclopentolate was dropped three times at 10 minutes intervals in both eyes. The patient suddenly developed behavioral disorders along with gait disturbance, and complained of visual hallucinations 20-25 minutes after the last drop. The patient was transferred to intensive care unit and 0.02 mg/kg IV. physostigmine was administered. The patient improved after minutes of onset of physostigmine, and was discharged with total recovery after 30 minutes. Conclusion - Delirium is a rare systemic side effect of cyclopentolate. The specific antidote is physostigmine, which can be used in severely agitated patients who are not responding to other therapies.

Clinical Neuroscience

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

ÖKTEM Özdemir Ece, ÇANKAYA Şeyda, UYKUR Burak Abdullah, ERDEN Simsek Nazan, YULUG Burak

Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un­clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera­lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.