[Use of angioneogenesis inhibitor monoclonal antibody following standard therapy in recurrent or progressive glioblastoma multiforme]. / Érújdonképzodés-gátló monoklonális antitest alkalmazása a szokásos kezelést követoen kiújuló vagy progrediáló glioblastoma multiforme kezelésében.

Glioblastoma is a brain tumor with poor prognosis in the therapy of which operation, postoperative temozolomide sensitized radiochemotherapy followed by temozolomide monotherapy offer the best chances. Administration of temozolomide is also recommended in relapse if the patient is naïve to this treatment. In recurrent or progressive glioblastoma following the above therapy, several biological therapeutic agents were tested, out of which the angiogenesis inhibitor bevacizumab has been approved by FDA (and similar authority of several other countries). Bevacizumab monotherapy resulted in objective tumor response in 28.2%, the median of progression-free survival was 4.2 (2.9-5.8) months, the median of overall survival was 9.2 (8.2-10.7) months. When combined with irinotecan, these results were 37.8%, 5.6 (4.4-6.2) and 8.7 (7.8-10.9) months, respectively. Adverse events were known from the use of bevacizumab in other indications, symptoms affecting the central nervous system were mild, i.e. the therapy proved to be not only effective but safe as well. Reduction of edema provided further advantage. In Hungary the product is available for "off-label" use only through a fairness request process.

[Detection of multiple colon and rectal tumors during diagnostic treatment and follow-up]. / Többszörös vastag- és végbéldaganatok felismerése a kivizsgálás, kezelés és gondozás során.

Recognition of the commonly encountered colorectal cancer (CRC) generally begins and takes place because of and based on symptoms and signs, due to the unsettled screening of this type of cancer. Sometimes, because of advanced stage cancer urgent surgical intervention could become necessary and, if this is the case, there is no time and possibility for searching for an eventual second tumor and perhaps the patient's status does not permit performing intraoperative investigations either. The incidence of multiple colon cancer is considered to be between 2.5 and 30% according to the literature. That is why one should exclude them even in the absence of pre- and intraoperative investigations and complaints. On the other hand, colonoscopy and perhaps irrigoscopy of seemingly healthy followed-up patients is mandatory. In the case of the presence of complaints/symptoms denoting impaired intestinal passage seen in a followed-up patient or during the adjuvant setting or metastatic/recurrent disease, treatment and even during hospice care we should evaluate the possibility of a second metachronous tumor. Moreover, if there is no urgency, the multidisciplinary team (oncoteam) should recommend the adequate treatment by balancing gain/utility and risk.

[Extravasation of cytostatic drugs]. / Citosztatikumok paravazációja.

Paravasation of cytostatic drugs during peripheral intravenous administration is a well known complication. In the United States of America it occurs in seven percent of cases with different severity and consequences. Although methods to completely avoid this complication are still unavailable, we are able to decrease the risks by identifying the patient- and procedure-related factors. The educated patient is a good indicator of paravasation in case he or she can cooperate and call the nurse. When the patient is unable to cooperate, the risks of extravasation is higher and closer nursing surveillance is indicated. The extent of injury depends mainly on the chemical structure of the extravasant substance (vesicant, irritant or non-vesicant) which may be modified by other factors. There is no strong evidence-based guidance for the management of complication. Abrupt cessation of the infusion and drawing back on the inserted venous catheter as well as elevating and resting the affected limb are necessary measures. In the available literature cooling or warming of the affected area is controversial. Similarly there are still open questions regarding the value of using antidotes as dexrazoxane, dimethylsulfoxide, thiosulfate and hyaluronidase (which is not registered as medicament in Hungary). In the event of extravasation early multidisciplinary dermatological and surgical assessment is essential for definitive diagnosis and setting the optimal management.