[Limb saving surgery in cases of bone sarcomas]. / Végtagmegtartó mûtétek csontsarcomáknál.

At the Orthopedic Department of Semmelweis University we operate an internationally recognized bone and soft tissue tumor center. Our specialty is the treatment of benign and malignant bone tumors, tumor-like lesions and surgery of soft tissue tumors. Our main aim, taking into account the appropriate oncologic radicality, is to create the conditions for the development of limb saving surgery. Limb saving surgery is an interdisciplinary activity both in diagnosis and in treatment. We have proper pathology, radiology and interventional radiology background for the fast and advanced pathomorphological and radiomorphological diagnosis of different tumors. Using modern chemotherapy, radiotherapy and other advanced cancer treatment protocols rapid access to oncology background is provided for children and adults as well, both primary and secondary bone tumors and soft tissue sarcoma cases of the extremities. The limb saving surgery after removal of the tumor is essentially a reconstructive surgery. Reconstructive surgery in childhood and younger ages mean mainly the biological solutions (vascularized autologus bone grafts and/or homologous bone graft), otherwise in elderly ages implantation of tumor endoprostheses has a greater significance. Furthermore, the final tumor surgery requires experienced abdominal surgeon, vascular surgeon and plastic surgeon to ensure the background as well. The professional background of our clinical practice is based on participating in international conferences and spending several months abroad in different big tumor centers. Over the past 15 years, several international cancer congresses were organized in Hungary by our Department.

[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.

[Thoughts about thromboembolic events prophylaxis in cancer patients]. / Gondolatok a daganatos betegek vénás trombózisprofilaxisáról.

The risk of venous thromboembolic events (VTE) in cancer patients is higher than in the general population. Treatment may also increase this risk in these patients. Based on the appropriate criteria (of which the most important are the current ministerial guidelines) thrombosis prophylaxis should be started (given that there is no contraindication) on these patients and be continued while they are at risk. In the event of permanent risk thrombosis prophylaxis should be given lifelong. The drug of choice is low-molecular-weight heparin (LMWH) which is safer and more effective than the oral vitamin K antagonists. Platelet aggregation inhibitors have proved unsuccessful in this patient group. The evidence so far suggests that LMWH (during VTE prophylaxis) can have a positive impact on the course of cancer and perhaps it will be registered under the indication section for cancer patients in the future.

Prognostic significance of the thymidylate biosynthetic enzymes in human colorectal tumors.

The aim of the present study was to determine the relative intratumoral activity of two pyrimidine biosynthetic enzymes, i.e. thymidylate synthase (TS) and thymidine kinase (TK), in human colorectal cancers to compare their possible relationship with demographic and pathologic characteristics of the patients and their tumors, and moreover to evaluate their predictive significance regarding 5-fluorouracil (5-FU) sensitivity and the overall survival of patients, respectively. TS and TK levels were significantly increased in the tumor compared to peritumoral tissue. However, no significant relationship between TS/TK activity and demographic features of the patients or pathologic characteristics of their tumors could be demonstrated. Kaplan-Meier analysis showed that the overall survival of patients with low TS activity was significantly longer (p < 0.012) compared to those with high TS activity. Such a difference could not be demonstrated between patients with high or low TK activity; however, combined evaluation of the two parameters proved that TK may contribute to the more precise assessment of disease prognosis, and it may further influence treatment decisions, i.e. the selection of patients for adjuvant therapy with 5-FU and folinic acid. Multivariate analysis showed that among the variables tested, beside Dukes' stage, TS and TK activities were significant prognostic factors for the overall survival of colorectal cancer patients.