Lege Artis Medicinae

[Current therapy of Hodgkin’s disease]

ROSTA András, MOLNÁR Zsuzsanna, SCHNEIDER Tamás, VÁRADY Erika, DEÁK Beáta, ÉSIK Olga

JULY 10, 2001

Lege Artis Medicinae - 2001;11(06-07)

[Hodgkin’s disease is a clonal B-cell disease. The exact etiology of the disease has not yet been identified, research data showing the crucial role of the Epstein-Barr virus. The Hodgkin’s disease is curable in 70-80 % of the cases. In the early stage of the disease, the treatment of choice should be the combined modality therapy. The required number of cycles of combined chemotherapy, the dose and the field extension of radiotherapy are all subjects of recent clinical trials. In the advanced stage of Hodgkin’s disease more (6- 8) cycles of combined chemotherapy and, if necessary, radiotherapy of the affected field is the treatment of choice. In advanced Hodgkin’s disease with unfavourable prognosis, the role of higher dose-intensity and the combination of more potent chemotherapeutic agents are evaluated in clinical trials, with special consideration to the danger of late toxicity (BEACOPP, Stanford V protocol). In the treatment of early (within 1 year) chemosensitive relapses of Hodgkin’s disease, high-dose chemotherapy with autologous peripheral stem cell transplantation has improved therapeutic results. Current results of advanced cases with unfavourable prognosis, of primary progressive and resistant disease, relapsing Hodgkin’s disease and the treatment of elderly patients are yet unsatisfactory. The main trends of recent research are: development of new potent chemotherapeutic agents, application of allogeneous "mini" transplantation (graft versus Hodgkin’s disease effect) and the therapeutic use of mono or bispecific monoclonal antibodies. It is desirable, that primary, secondary and further treatments of Hodgkin’s disease are performed in specific hematological or oncological centers where necessary experience of complex treatment is available, as well as the application of aggressive treatment methods, modern radiotherapy and also the facilities for handling unwanted complications.]

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[Endoscopic diagnosis of oesophageal intramural metastasis from an adenocarcinoma of the gastrooesophageal junction]

SZÁNTÓ Imre, VÖRÖS Attila, NAGY Pál, GONDA Gábor, ALTORJAY Áron, BANAI János, GAMAL E. Mohamed, KISS János

[INTRODUCTION - Authors present six cases of intramural oesophageal metastases of adenocarcinomas located in the gastro-oesophageal junction. The tumours and metastases were diagnosed by endoscopic examinations. PATIENTS AND METHODS - Between 01. 01. 1994. and 31. 12. 2000. a total number of 143 patients were examined with the diagnosis of adenocarcinoma of the gastro-oesophageal junction. In six patients (4,19 %), intramural oesophageal metastases were verified. In each case the diagnosis was confirmed by histological examination. TNM stage of the tumours was assessed considering the results of endoscopic ultrasound examination, the findings at initial operation and the pathological data in all cases, where resection was performed. The tumours were localized according to Siewert- Stein’s classification. RESULTS - In six patients who had adenocarcinoma of the gastro-oesophageal junction, the diagnosis of intramural oesophageal metastases was confirmed. The histological structure of the primaer tumours and metastases were the same. Metastases were detected by endoscopic ultrasound examination in three cases of the four examined patients as submucosal masses. All of the cardiac tumours proved to be well advanced: four of them classified as T4N1 by endoscopic ultrasound. Intramural metastases were diagnosed in each Siewert-Stein subgroups. CONCLUSION - Endoscopic examination is of crucial importance in the diagnosis of adenocarcinomas of the gastro-oesophageal junction and in their intramural metastases as well. Beside the endoscopic identification the primary tumour, the thorough examination of the proximal part of the oesophagus seems to be of great importance. These metastatic cancers appeared in the advanced stage of the disease. Endoscopic ultrasound examination is of great help in these cases to identify whether the mass causing oesophageal impression is outside of the wall of the organ, or in which layer it is localized. Endoscopic ultrasound examination also gives the possibility for preoperative assessment of the TNM stage of the disease.]

Lege Artis Medicinae

[The doctor of palatine Wesselényi]

BUBRYÁK Orsolya

Lege Artis Medicinae

[Clinical drug testing in Hungary]

NAGY András László

Lege Artis Medicinae

[CRISP]

MATOS Lajos

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[Grafics of Gábor Roskó]

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