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Clinical Oncology

AUGUST 30, 2019

[Electrochemotherapy]

KIS Erika Gabriella

[Tumors with standard electrochemotherapy (ECT) has raised over the past decade from skin cancers to locally advanced or metastatic tumors. The procedure became a reliable alternative of other local tumor ablation methods, because of its patient tolerability, effi cacy across histotypes, and repeatability. ECT is based on the physical phenomenon of reversible electroporation; short electric pulses are applied to tumor nodules to achieve transient cell membrane permeabilization to otherwire poorly permeant chemotherapy drugs, which consequently increases cytotoxicity. At present recognized indications include superfi cial metastases of malignant melanoma, breast cancer, head and neck skin tumors, Kaposi sarcoma, primary and recurrent nonmelanoma skin cancers, and in well-selected patients mucosal oropharyngeal cancers. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, certain benign skin lesions, and the combination of ECT with systemic immunotherapy. Thanks to the technical developments, the new ECT indications are deep-seated tumors, including bone metastases, liver malignancies, pancreatic and prostate cancers with the use of long needle variable geometry electrodes. Herein we review the present status of ECT from the basic principles to emerging applications, and report the effi cacy of standard ECT across histotypes.]

Clinical Oncology

MAY 20, 2016

[Non-surgical treatment of the biliary tract and gallbladder cancer]

PIKÓ Béla, LACZÓ Ibolya

[Biliary tract cancers are rare, hence only a few high level of evidences related to their treatment are available. The successful treatment and the only chance for long-term survival are based on the radical surgical resection. After the fl uoropyrimidin based protocols chemotherapy regimens prefer gemcitabine combinations (cisplatin, oxaliplatin, capecitabine) or FOLFIRINOX, considering the patient performance status as well. There are no registered targeted therapy in this indication, the most experiences were acquired with erlotinib; nowadays the optimal treatment can be selected by the molecular genetic profi le of the tumour and not by the results of the clinical studies. The radiotherapy and the radiochemotherapy can be administered preoperatively, postoperatively and for palliation as well, in addition to the conventional percutaneous radiotherapy, brachytherapy, intensity-modulated radiotherapy, intraoperative irradiation, radioembolization can also be administered depending on the technical equipments. Besides the photodynamic therapy and several ablation therapies, even interventional radiological procedures can play a signifi cant role.]

Clinical Oncology

SEPTEMBER 05, 2015

[Ablation of liver cancer]

DOROS Attila

[Ablative therapies of the malignant liver tumors are used frequently all over the world. It is a very well tolareted minimally invasive treatment, followed by a short observation period. Patients might be sent home within 24 hours. Nowadays, there is suffi cient data supporting its effectiveness in the treatment of early primary liver cancer, equalling the results of surgical resection. The situation is different in liver metastasis, especially from coloectal cancer. In these cases ablative techniques have a supporting role, limiting their action on the multimorbid patients and small non-resectable tumors. These facts and trends - worldwide and in Hungary - are discussed, focusing on effectiveness, places in therapeutic protocols and domestic diffi culties.]

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.]

Clinical Oncology

SEPTEMBER 10, 2014

[Treatment of hepatocellular carcinoma - today]

VÉGH Éva, DEMETER Gyula, BODOKY György

[The hepatocellular carcinoma (HCC) is one of the main causes of cancer-related death globally, and at the same time, it is the main event leading to death in cirrhotic patients. In the etiology of HCC, the non-alcoholic liver disease may be an important cause besides the viral cirrhosis. The HCC’s staging systems (Child-Pugh scores, Cancer of the Liver Italian Programme/CLIP, Barcelona Clinic Liver Cancer/ BCLC) play an important role in predicting the prognosis and determining the appropriate therapy. In Europe, the treatment strategy is based on the BCLC staging system. Screening of cirrhotic patient is also important because curative therapy is available only for the early-stage HCC. Several therapeutic options exist in the intermediate stage disease; among them the radiofrequency ablation (RFA), the transarterial chemoembolization (TACE) and the percutan ethanol injection (PEI) are most important. For the advanced disease, the only approved systemic therapy is sorafenib, which has been well-tolerated and yielded a substantially relative improvement in overall survival. For patient in end-stage disease with impaired liver function or a poor performance status, only supportive care is recommended.]

Lege Artis Medicinae

FEBRUARY 15, 2015

[Inflammatory myofibroblastic tumor of abdominal wall arising from uterine myoma]

FECSKE Éva, REMETEI Filep Aladár, SALAMON Ferenc, MAGYAR Éva

[INTRODUCTION - The inflammatory pseudotumor appears in various organs. It is well circumscribed, unencapsulated proliferation which simulates malignant tumor clinically as well as radiologically and morphologically. It’s etiology is unknown. The histology prooves inflammatory origin of this process: the nodular structure of the tumor-like mass is composed of fibroblasts, myofibroblasts, plasma cells and lympho­cytes. Recurrence may happen. CASE REPORT - Because of the rapidly expanding uterine myoma of a 40 years old woman laparotomy has been performed. In the lower two-thirds of abdominal wound the myoma penetrated into the abdominal wall. Here the abdominal wall lost it's normal structure, became bacon-like, homogenous in consistency and white-grey in colour. The myoma and the attached part of the abdominal wall was excised together. The part of myoma those in contact with abdominal wall contained proliferating myofibroblasts, fibroblasts and was infiltrated by plasma cells and lymphocytes. These findings could be seen in the abdominal wall too. The rapid proliferation which simulated malignant tumor has been diagnosed as inflammatory myofibroblastic tumor. The patient does well two years after the operation. CONCLUSION - It is important to know about the entity of inflammartory pseudotumor in differential diagnostic point of view, as it mimics malignant tumor. The structure is nodular, the histology is characteristic and the therapy is surgical. The follow up is very important because of possibility of probable recurrence. ]

Lege Artis Medicinae

NOVEMBER 20, 2013

[Therapeutic options for the treatment of neuroendocrine tumors]

TÓTH Miklós

[This paper provides an overview of the latest clinical advances regarding state-of-theart treatment of neuroendocrine tumours. The first-line treatment of any localized neuroendocrine tumour is surgical removal of the tumour. The only exceptions are certain small gastric carcinoids and small, hormonally inactive pancreatic tumours associated with multiple endocrine neoplasia type I. The treatment strategies of disseminated neuroendocrine tumours should be based on a pathological diagnosis that uses the 2010 WHO classification (neuroendocrine tumours G1 and G2, neuroendocrine carcinoma G3). Debulking surgery and radiofrequency ablation can be used effectively not only as an anti-tumour treatment but also in patients with severe symptoms and hormone overproduction resistant to treatment. The use of somatostatin-analogs is considered to be standard treatment in functional neuroendocrine tumours of any origin, as well as in the anti-tumour therapy of G1/G2 small intestinal neuroendocrine tumours. For progressive G1-G2 neuroendocrine pancreatic tumours, streptozocin-based combined chemotherapy is the first-line treatment. Targeted drug therapies, such as mTOR inhibitors and tyrosine kinase inhibitors are used as second- or third-line agents in patients with inoperable pancreatic neuroendocrine tumours. Peptide receptor radiotherapy is increasingly used in Europe; however, its final place amongst other therapeutic modalities remains to be investigated.]

Lege Artis Medicinae

AUGUST 20, 2002

[Changes in the hormonal therapy of breast cancer patients]

MOSKOVITS Katalin

[The hormonal therapy for breast cancer patients seems to be changing. At present the new, third generation aromatase inhibitors are the standard second line therapy for postmenopausal, receptor positive advanced breast cancer patients. Currently, tamoxifen (TAM) stands as the ”gold standard” first line therapy, with ist role changing, due to the aromatase inhibitors which seems to be more effective than TAM and have less side-effects. For these reasons, aromatase inhibitors may be useful in the adjuvant setting, but long-term side-effects are not yet known. In the next few years, sufficient experience will be gained with these drugs which might help us to change practice. Pure antioestrogens are also promising new drugs. Recently, the LHRH analogues were the preferred drug of choice in premenopausal women, in contrast to surgical or radiological ovarian ablation. All receptor positive breast cancer patients should receive hormonal therapy, regardless of age, menopausal status, node status, tumour size, but we should avoid hormonal therapy for the endocrine nonresponsive patients.]