Hungarian Radiology

[Radiotherapy]

MÓZSA Szabolcs

JUNE 20, 2002

Hungarian Radiology - 2002;76(03)

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Further articles in this publication

Hungarian Radiology

[The guest of the guest]

Hungarian Radiology

[NEWS]

NAGY Gyöngyi

Hungarian Radiology

[NEWS]

PALKÓ András

Hungarian Radiology

[Remarks from the President Elect - A debate initiating letter to the members of the Society]

PALKÓ András

Hungarian Radiology

[MR-guided ultrasound surgery]

JÓLESZ Ferenc A., BÉRCZI Viktor, HÜTTL Kálmán, REPA Imre, HYNYNEN Kullervo

[The powerful union of focused ultrasound surgery and magnetic resonance imaging has created a new approach to noninvasive surgery. Using this integrated therapy delivery system the physician can achieve correct localisation of tumors, optimal targeting of acoustic energy, real time monitoring of energy deposition, and the means to accurately control the deposited thermal dose within the entire tumor volume. The advantages of MRI over ultrasound guidance in controlling focused ultrasound surgery lie in the more sensitive detection of tumor target, the real time detection of tissue temperature, and the confirmation of thermally-induced tissue changes - powerful features that eventually can replace the traditional surgical approach. Applying software that connects the therapy and imaging system, the physician can generate an entire plan from quantifying temperature changes to positioning the therapy transducer. The non-invasive debulking of tumors without disturbing adjacent, functionally intact structures is thereby accomplished. Ongoing clinical trials involving the treatment of breast fibroadenoma, localized breast cancers, and uterine fibroids have been most encouraging. But nowhere has the application of MRI-guided focused ultrasound surgery been more compelling than in brain, where not only tumor treatment is possible but also the focal, transient, reversible breakdown of the blood-brain-barrier. The implications of this mechanism for targeted intra-cerebral tumor therapy or other non-oncologic applications are clearly enormous. In addition to tumor treatment, MRI-guided focused ultrasound surgery has other potential clinical applications such as vascular occlusion, targeted drug delivery, and targeted gene therapy. FUS is not a new idea but the emergence of MRI based guidance has accelerated the progres of focused ultrasound surgery technology, certain weaknesses remain including excessively long treatment times, body and organ motion, and difficulties in finding acoustic windows at certain anatomic locations. Nevertheless, the successful clinical implementations of this method is already in progress.]

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TÍMÁR József

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[Increasing experimental and clinical evidences demonstrated the synergic effect between the rapidly implemented immunotherapy and advanced forms of focal radiotherapy, not only on the elimination of the irradiated lesion, but also on the enhancement the immune-mediated systemic anti-tumoral activity. It is essential for gaining the most benefi t from the combination of the two modalities to select the appropriate patients, to defi ne the irradiation parameters, such as radiation quality (ie. particle) dosage, (total dose, fraction number) size of the target volume, the use of other supportive and anti-tumor drugs. In this review, we provide an update for the daily oncological practice on the data accumulated up to now on the molecular basis and patomechanism of enhancing radio-immune effect and clinical results, and highlight the most important parameters, which may increase the abscopal effect of ionizing radiation, thereby increasing the effectiveness of immunotherapy. However, development of clinical guidelines for benefi cial integration of immunotherapy and radiotherapy could be expected after evaluation the result of currently ongoing numerous (> 100) clinical trials. If the preclinical results will be confi rmed clinically, it could lead to paradigm shift in the use of ionizing radiation.]

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[Current management of GIST]

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[Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs are generally resistant to chemotherapy and radiotherapy. The understanding of pathology at molecular level promised the development of novel treatment modalities. KIT and PDGFRA gene mutations play an important role in the pathogenesis of GIST. IMutational analysis should be considered as standard practice during the diagnostic work-up, since it has a predictive value for sensitivity to molecular-targeted therapy and also has prognostic value. The aim of this review is to summarize recent knowledge about diagnosis, treatment and follow up of GIST.]

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[Pilomatrix carcinoma with a lymph node metastasis - First Hungarian publication of a rare case]

VAJDA Adrienne, LÉVAY Bernadett

[INTRODUCTION - Pilomatrix carcinoma is a very rare malignant tumour, which derives from hair matrix cells. The male:female ratio among patients is 4:1, the mean age of patients is 45 years. This tumour type is very aggressive and grows slowly. CASE REPORT - The authors describe the case of a 37-year-old man who presented in 2004 with an approximately 2×2 cm, compact lesion tumour in the lumbar region. The tumour was excised and diagnosed as carcinoma sebaceum on the basis of histological examination. Several weeks after surgery, a protruding, semi-spherical lesion with a diameter of 2 cm appeared in the scar. The patient was referred to our hospital for excision of this lesion and for assessing the possibility of Muir-Torre syndrome. The examinations did not indicate the presence of any internal tumours. The recurrent tumour was excised with a 2 cm intact margin. Histological examination confirmed the diagnosis of pilomatrix carcinoma. In 2005, two new tumours were excised and semithick skin was transplanted in several sessions. At an oncological follow-up examination in 2009, a 13×7 mm lymph node was felt in the righ inguinal region, which was found to be a metastasis of pilomatrix carcinoma on the basis of aspiration cytology. Surgical block dissection was performed, followed by postoperative radiotherapy at a dose of 25×2 Gy. At present, the patient is symptom- free. Thoracic-abdominal CT and clinical examination performed in early June 2011 did not indicate progression of the original disease. CONCLUSION - Pilomatrix carcinoma with a lymph node metastasis has not been previously reported in Hungarian. The diagnosis was established on the basis of histological examination, which was indispensable for successful treatment.]