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Clinical Oncology

SEPTEMBER 05, 2015

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

PACZONA Róbert, CSENKI Melinda, HIDEGHÉTY Katalin

[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.]

Clinical Neuroscience

NOVEMBER 30, 2016

Patient characteristics and the effects of intravenous immunoglobulin in patients with Guillain-Barre syndrome

GUZEY ARAS Yesim, TANIK Osman, DOGAN GÜNGEN Belma, KOTAN Dilcan

Purpose - The purpose of this study is to determine the diagnosis- and treatment-related characteristics in Guillain-Barré syndrome (GBS) and to evaluate the effects of early intravenous immunoglobulin (IVIg) treatment on disability, mortality and prognosis. Materials and methods - Adult patients who were diagnosed with GBS in our clinic between January 2000 and January 2014 were retrospectively scanned. While the patients undergoing IVIg treatment were included in the study, the other neuropathic diseases were excluded. Patients were divided into two groups based on the administration time of the IVIg treatment; Group 1 (<7 days) and Group 2 (≥ 7 days) Group 1 consisted of patients undergoing IVIg treatment within 7 days after presentation of symptoms and Group 2 consisted of patients undergoing IVIg treatment on and after 7th day following presentation of symptoms. The scores from Hughes Functional Grading Scale (HFGS) on admission and one month laterwere recorded in all patients in order to evaluate the disability and prognosis in terms of demographic and clinical laboratory characteristics. Results - In this study, 49 GBS patients were included (31 patients in Group 1 and 18 patients in Group 2). Demyelinating form of GBS was determined in 22 (44.8%) patients.). While there was no difference between both groups (p: 0.288, p: 0.762, p: 0.693 respectively) in terms of intensive care and rehabilitation requirement and progression, only 2 patients in Group 1 died. While HFGS mean score on admission in all the patient groups was 3.27±0.974, their HFGS mean score at month 1 was 2.53±1.226. There was no difference between the groups in terms of HFGS mean scores on admission and at month 1. Within each groups, there was a significant improvement between initial (on admission) HFGS scores and HFGS scores acquired at month 1. Conclusion - In this study, demyelinating form was more frequent than axonal form. A total of 2 g/kg dose of IVIg treatment administered for 5 days as a standard in GBS patients ensured a significant improvement on both disability and early and late administration and early administration of the treatment does not lead to any difference in intensive care unit and rehabilitation requirements.

Lege Artis Medicinae

AUGUST 20, 2016

[Cardiovascular aging]

VÁLYI Péter

[The world population in both industrialized and developing countries is aging. The clinical and economic implications of this demographic shift are staggering because age is the most powerful risk factor for cardiovascular diseases. The incidence and prevalence of hypertension, coronary artery disease, congestive heart failure, and stroke increase steeply with advancing age. Although epidemiologic studies have discovered that some aspects of lifestyle and genetics are risk factors for these diseases, age, per se, confers the major risk. There is a continuum of age-related alterations of cardiovascular structure and function in healthy humans, however these alterations are not synonymous with diseases processes. Old age is not a disease. Although cardiovascular aging changes are considered “normative”, they lower the threshold for development of cardiovascular disease, and appear to influence the steep increases in hypertension, atherosclerosis, stroke, left ventricular hypertrophy, chronic heart failure, and atrial fibrillation with increasing age. Specific pathophysiologic mechanisms that underlie these diseases become superimposed on cardiac and vascular substrates that have been modified by an “aging process”, and the latter modulates disease occurrence and severity. Age-associated changes in cardiovascular structure and function become “partners” with pathophysiologic disease mechanisms, lifestyle, genetics, and other presently unknown factors in determining the threshold, severity, prognosis, and therapeutic response of cardiovascular disease in older persons. However, the role of specific age-associated changes in cardiovascular structure and function in such age-disease interactions has not been considered in most epidemiologic and clinical studies of cardiovascular disease. Quantitative information on age-associated alterations in cardiovascular structure and function in health is essential to unravel age-disease interactions and to target the specific characteristics of cardiovascular aging that render it such a major risk factor for cardiovascular diseases. Such information is also of practical value to differentiate between the limitations of an older person that relate to disease and those that might be expected, within limits, to accompany advancing age or a sedentary lifestyle.]

Clinical Neuroscience

MAY 30, 2016

[Genetically determined diseases associated with pathological brain iron accumulation and neurodegeneration]

ÁCS Péter, MOLNÁR Mária Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette

[The rare, genetically determined group of diseases characterized by pathological accumulation of iron in the central nervous system and progressive, typically movement disorder’s symptoms are called NBIA (neurodegeneration with brain iron accumulation). By the rapid development of molecular genetics, it has become apparent that different mutations in numerous genes can lead to pathological cerebral iron accumulation. Simultaneously, it has also been recognized that the age of onset, the symptoms and the prognosis of NBIA disorders are much more diverse than it was previously perceived. To our knowledge, a review article on the most recent clinical data of NBIA has not been published in Hungarian. In the first part of this publication, we survey the general clinical characteristics and the diagnostic algorithm of NBIA diseases and address some considerations for differential diagnostics. In the second part of this review, the particular NBIA disorders are presented in details. The purpose of this article is to provide a clinical overview that may be useful for neurologists, pediatricians and any other medical practitioners interested in this field.]

Hypertension and nephrology

APRIL 10, 2016

[Hungarian virus research and NASA – nephrology aspects]

RADÓ János

[After the occurrence of varicella viruses remain in a latent condition in the ganglions, but could be reactivated from here causing the disease of herpes zoster. In the years of 1960, we described a herpes zoster „house epidemic” where only the steroid treated patients were infected. Varicella zoster virus was identified by virological methods. Also in a steroid treated patient fatal meningoencephalitis was caused by the generalized herpes zoster. The VZ infection was obviously potentiated by the steroid. Our publications about the interaction between the VZ virus and steroid treatment was echoed – among others – by an editorial of four leading medical journals. Investigators of a NASA medical group also cited our articles. They found during and after spaceflight that in the astronauts symptomless reactivation of the VZ virus, EBV and CMV occurred which was contributed to the stress induced hypercortisolemia. Today we see more worries in the prognosis and outlook in certain cases of the herpes zoster than before. One reason of that is the high number of newly recognized complications. Recently also several new pathway of pathomechanisms has been explored, which led to serious risks. In addition, it turned out that in certain disorders as the artheritis temporalis, where today antivirus antibiotic is the first choice drug, instead of steroid administered alone in the past, inducing further progression in the basic disease and sometimes fatal complications when given too long. Nephrological patients are at special risk in the presence of chronic renal disease, high age and associated diabetes mellitus. The risk may even increase after an otherwise successful renal transplantation in response to the administration of steroids and other compounds. Fortunately in the meantime a vaccine was developed against the VZ virus, studied in large populations and found to be very effective. It probably will be a benediction to the old people with chronic renal disease, after transplantation as well as in others suffering from high risk diseases.]

Clinical Oncology

FEBRUARY 10, 2015

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[The prognosis of brain metastases is very poor. Surgery and radiotherapy provides the fi rst line treatment, while systemic therapy has limited value. Nevertheless, our knowledge is increasing: normal cells contribute signifi cantly to the homing and growth of tumor cells; the molecular profi le of the primary tumor and its metastases could be different, which infl uences the therapeutic strategies; the type of blood supply can change during the tumor growth. It would be very important to optimize the cooperation of the different therapeutic modalities, and to fi nd markers which could predict the risk of metastatization.]

Clinical Oncology

FEBRUARY 10, 2015

[Molecular diagnostics of brain tumors - an up-date]

REINIGER Lilla, HANZÉLY Zoltán, BÁLINT Katalin, TURÁNYI Eszter

[In recent years there have been major advancements in the understanding of molecular events driving brain tumor genesis and progression. Although state-of-the-art techniques are not widely available, many of the molecular discoveries lead to novel antibodies that can assist in identifying the major molecular subgroups by immunohistochemistry. Molecular informations will likely be incorporated into the next World Health Organization (WHO) classifi cation of central nervous system tumors, but clinical practice in many centres have already taken on the available informations and therapeutic decisions are made based on genetic/epigenetic information. In the adult population IDH, ATRX and 1p/19q codeletion studies help to defi ne molecular subgroups that correlate better with prognosis and therapeutic response than traditional histology based diagnosis. The KIAA1549-BRAF fusion gene is a hallmark for pilocytic astrocytomas, while diffuse pediatric gliomas lack the IDH mutations and 1p/19q codeletions that are common in adult astrocytomas and oligodendrogliomas. Uncommon in adults, Histone H3.3 mutations are pathognomic in pediatric brainstem malignant gliomas. Molecular subgroups of medulloblastomas have also been identifi ed, and a corresponding set of antibodies are ready to guide treatment decisions in those centres where molecular techniques are not available. These genetic and epigenetic events determine a tumor’s behaviour, and integrating this level of informations into neuropathology practice is essential to provide the best possible care to both pediatric and adult patients.]

Clinical Oncology

DECEMBER 05, 2014

[Emergency radiotherapy in oncology]

HIDEGHÉTY Katalin, DOBI Ágnes, MÓZES Petra, CSERHÁTI Adrienn

[Emergent radiotherapy is requested in 3-5% of all malignancys either presenting as initial manifestation of an unknown tumor or due to the progression of a malignancy under treatment/follow up. In this situation high degree of suspicion, timely diagnosis and adequate treatment for tumor-related complications are crucial, in order to prevent life-threatening or disabling conditions, such as vena cava superior syndrome, spinal cord compression or increased intracranial pressure. After prompt recognition, fast diagnostics and general management are needed to achive stable status. Radiotherapy commenced in some hours can markedly reduce morbidity and mortality and affects the outcome. There are few evidences based recommendations available, but the differential approach according to the tumor type should be considered (i.e. chemotherapy for lymphomas and SCLC causing SVCS, and sugery in certain case of spinal cord compressions). Prognosis and life expectancy should be taken into account and the goals of care have to be explored during initial evaluation. For patients with poor prognosis short course irradiation must be performed with palliative dose, meanwhile in the case of longer life expectancy the fi rst fraction of emergent radiation can be continued with selective techniques up to curative doses, which may improve the survival and quality of life.]

Clinical Oncology

MAY 20, 2014

[Neoadjuvant therapy in breast cancer – an update]

KAHÁN Zsuzsanna, RUSZ Orsolya, UHERCSÁK Gabriella, NIKOLÉNYI Alíz

[Traditionally, neoadjuvant systemic therapy (NST) serves as treatment of advanced breast cancer to achieve technical operability by resulting in tumor regression. Nowadays, NST is advantageous in all cases if adjuvant systemic therapy is needed, since the in vivo study of its effect provides possibility for the estimation of prognosis, the treatment may be modifi ed according to the therapeutic response, the systemic therapy starts earlier as compared to adjuvant therapy, and fi nally, it may result in the reduction of surgical and radiotherapeutical radicality. The type of NST should be selected on the basis of tumor features refl ecting treatment sensitivity. In case of chemosensitive cancers, chemotherapy is taxane- and anthracycline-based, and the planned dose should be delivered prior to surgery. In HER2-positive cancers, the addition of an anti-HER2 agent doubles the rate of pathological complete regressions. In hormone-sensitive tumors, the standard neoadjuvant endocrine therapy consists of an aromatase inhibitor (postmenopause), or tamoxifen or an aromatase inhibitor combined with an LHRH analog (premenopause) for 4-8 months that is continued following the surgery in the adjuvant setting. For the early evaluation of the effect of NST, serial tumor biopsy or imaging studies (MRI, PET) seem promising. Sentinel lymph node biopsy around the NST should be practiced with prudence; it may warrant the avoidance of axillary blockdissection in some cases. For the design of radiotherapy, the initial stage and the degree of regression are considered.]

Clinical Oncology

MAY 20, 2014

[EGFR family and gynecologic cancers]

VERMORKEN B Jan

[The HER family of receptor tyrosine kinases may potentially play an important role in gynecologic malignancies. Amplifi cation and overexpression of various HER family members including epidermal growth factor receptor (EGFR/HER1) and HER2 have been reported in epithelial ovarian cancer and endometrial carcinoma as well as in cancer of the uterine cervix. High expression of EGFR has been associated with poor prognosis independent from histiotype while HER2 expression may be more histotype dependent. This review summarizes the clinical experience with anti EGFR/HER2 directed monoclonal antibody therapy in the three major gynecologic cancer types to date.]