Clinical Oncology

[Up-to-date treatment of head and neck cancers]


SEPTEMBER 05, 2015

Clinical Oncology - 2015;2(03)

[The head and neck squamous cell cancer is often detected at an advanced stage, resulting in dismal prognosis despite the relevant developments of the oncotherapy in the last decades. The introduction of new techniques, new drugs and combinations though improves the survival for certain subgroups of patients, meanwhile the organ-function preservation and side effects reduction approaches lead to improved quality of life. The preventive-supportive care prior and during the therapy (dental care, nutrition, toxicity management) and the complex rehabilitation has paramount importance. MRI and 18FDG PET-CT and the advanced methods of molecular pathology became part of the diagnostic work up. The selection of the therapy based on the tumor characteristics, HPV detection, on the patient’s condition and wishes, as well as on multi-disciplinary team decision based on the available technical options. Early stage tumors can be successfully treated either by surgery alone or by radiation therapy. For locally advanced cases concomittant chemo-radiotherapy stays in the axis of the complex management using advanced radiation technique (IGRT-adaptive- IMRT) with cisplatin (or if contraindicated with cetuximab), which could be complemented by induction chemotherapy and/or surgery. Several new approaches are currently being tested in clinical studies after establishment of cisplatine-cetuximab treatment for recurrent/metastatic tumors. In the future, detection of molecular processes and driver mutations could result in development of more effective targeted anti-tumor agents, and individual molecular tumor profi le guided therapy, including the various forms and combinations with emerging immunotherapy.]



Further articles in this publication

Clinical Oncology

[A structured approach to test the clinical benefi t of treatments of advanced cancer]


Clinical Oncology

[Mucositis - prevention and therapy]

NAGY Zsuzsanna, VALTINYI Dorottya

[Side-effects are critical challenges in cancer therapy. These complications can threaten the quality of life, sometimes the life itself. One of the most frequent side effects is mucositis, the damage of mucosa, either in the oral cavity (oral mucositis, OM), or in the gastrointestinal tract (gastrointestinal mucositis, GIM). Prevention is a key action for the effi cient supportation. Recognition of OM is relative easy, but of GIM is rather diffi cult. The risk factors could come from the patients and/or can be caused by the therapy. The successful management of mucositis mostly depends on the cooperation of the patient, which is highly infl uenced by the success of care (e.g. decreasing the level of pain). In general, mucositis (especially oral mucositis) a well managable disease, burt more informations are required to increase the quality of prevention and therapy. Such expectation could be realized by specifi c and sensitive biomarkers, however, they are still missing]

Clinical Oncology

[New challenges and possibilities in the chemotherapy of small cell lung cancer]


[The small cell lung cancer is characterized as a rapidly proliferating systemic neoplasm, where the basic treatment modality is the chemotherapy . Even in the surgically treated cases the platina based chemotherapy combination is obligatory before and after the surgical resection, combined with preventiv cranial irradiation to minimize the risk of the cranial metastases. The platina based chemo-radiotherapy is the gold standard in the locally advanced cases. Palliativ local irradiation could be useful for pain relief or decompression in the metastatic cases. Prophylactic cranial irradiation strongly recommended in any cases. There are no newly developed drugs for the treatment of SCLC, however it is a chemosensitive carcinoma. Topotecan could be effective in second or third line therapy , especially in brain metastasis.]

Clinical Oncology

[Treatment of testicular germ cell tumors – an up-date]

BAKI Márta

[The frequency of germ cell tumors is about 1% of all male cancers. The incidence increases in developed countries. The prevalence is the highest among the young males. The histologic type, extent of disease and therapy is based on international guidelines. The surgery, radio- and chemotherapy can achieve cure in the germ cell cancer patients. Regarding the late toxicity, the minimal invasive tumors are suggested to keep on the wait and see policy. The complex therapy of poor risk groups reached more than 80% permanent remission rate. The chemotherapy is based on cisplatin, but in second and third line therapy paclitaxel, gemcitabin and oxaliplatin is widely used. After the cure of germ cell cancer patients the careful follow up is mandatory.]

Clinical Oncology

[Angiogenesis – antiangiogenesis]


[Tumor growth requires vascularization to be supplied by oxygen and nutritients. The vascular network could be different between tumors, even during the development of the same tumor (local and systemic spreading), from the occupation of already present vessels to the real angiogenesis (i.e, proliferation of endothelial cells). Moreover, the tumor cells can create channels, mimicking the normal vessels. This spectrum in morphology should be refl ected in the therapeutic response, in the effectiveness of antiangiogens, but the how is unknown. It is sure that acceptable clinical activity can be achieved only with combinations, both with traditional cytotoxic and targeting drugs. The clinical advantage can be hampered by increased toxicity, demanding supportive actions. One of the key decisions is to select the proper therapy considering the patient and the tumor characteristics (today increasingly at molecular level) and predict the response to the therapy. Such (bio)markers are still missing, although intensive research trying the best. Since the main target of antiangiogenic drugs (today and tomorrow) the VEGF/R family, a useful marker is expected from them. The inhibition of angiogenesis is a logical step against the solid tumors and these steps slowly but steadily can improve the patients life-time, as well as their quality of life.]

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Association of anterior thoracic meningocele and azygos lobe of the lung

DENIZ Ersay Fatih, SENAYLI Atilla, BICAKCI Ünal

Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

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[Nutritional status, realizing sarcopenia and the importance of prehabilitation in surgical departments]

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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.]

Lege Artis Medicinae



[Without treatment, infective endocarditis (IE) is a fatal disease and in spite of contemporary diagnostic and therapeutic tools its prognosis is still poor. The most important first step is the early rise of clinical suspicion which should be confirmed by the new clinical criteria. Echocardiography is a major criterium: transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) both in the diagnosis and in the detection of complications of infective endocarditis. Complications can be valvular (embolism, valvular dysfunction) or perivalvular (abscess, pseudoaneurysm formation) with hemodynamic consequences. TEE is recommended as the first line diagnostic technique (mostly in prosthetic valve infective endocarditis) or as a second study following negative TTE or positive TTE with high clinical risk factors or to define embolic risk. In addition to classical surgical indications, early ”preventive” indications are emphasized which can decrease the still high operative mortality. Improvement of outcome in infective endocarditis can only be expected with agressive management meaning early suspicion, early TEE and early operation.]

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.]