ABSTRACT
Összefoglaló. A COVID-19 mortalitását a súlyos társbetegségek, közöttük bizonyos daganatos betegségek is növelik. Immunszuppresszív hatásuk miatt felmerülhet a citotoxikus kezelések rizikónövelo hatása is. Ugyanakkor az onkológiai terápia megszakítása vagy halasztása, különösen az agresszívebb, kiterjedtebb és fiatalkorban jelentkezo daganatok esetében ronthatja a kórjóslatot. Egy 39 éves nobeteg esetét ismertetjük. A járvány során késlekedve felismert, lokoregionálisan kiterjedt emlodaganat miatt primer szisztémás kemoterápiában részesült. A kezelés 5. ciklusa során enyhe légúti tünetek kapcsán, az onkológiai ambulancián SARS-CoV-2-fertozése igazolódott. Kemoterápiás kezelését felfüggesztettük. A diagnózistól számított 3. napon tünetmentessé vált, ám SARS-CoV-2-PCR-pozitivitása még a 43. napon is fennállt. A 19. napon hormongátló kezelést indítottunk. Az 51. napon mastectomia és axillaris block dissectio történt. A 82. napon a megszakított kemoterápiát a hormongátló kezelés leállítását követoen G-CSF-profilaxis mellett újraindítottuk. A kezelés során fertozéses szövodményt nem észleltünk. Kemoterápia és mutét SARS-CoV-2-fertozött, tünetmentes daganatos betegnél szövodménymentesen végezheto elhúzódó virológiai pozitivitás esetén, felszabadító vizsgálat nélkül is. A daganatos betegek koronavírus-fertozése esetén az onkológiai protokolltól történo eltérés egyénre szabott optimalizálásával és a multidiszciplináris team szorosabb együttmuködésével az infektológiai és az onkológiai kockázat együttes alacsonyan tartása is megvalósítható. Orv Hetil. 2021; 162(16): 611-614. Summary. Mortality of COVID-19 is increased when certain co-morbidities, among others advanced malignancies are present. Deleterious effect of cytotoxic therapy, related to its immunosuppressive effect, may also be hypothesised. However, postponing or cancelling oncologic treatment, especially in younger patients with advanced and more aggressive tumors may worsen the prognosis. The case of a 39-year-old female patient is presented, who was diagnosed with loco-regionally advanced breast cancer during the pandemic. Primary systemic chemotherapy was started. The patient presented with acute respiratory tract symptoms during the fifth cycle and subsequently SARS-CoV-2 infection was diagnosed. Chemotherapy was cancelled. Symptoms resolved in three days after diagnosis. SARS-CoV-2 PCR remained positive up to day 43. Antihormonal therapy was introduced on day 19 and she underwent mastectomy with axillary lymph node dissection on day 51. Chemotherapy was reset postoperatively on day 82 with prophylactic G-CSF protection. No adverse event was observed throughout the treatment. Cytotoxic chemotherapy and surgery can be successfully delivered in breast cancer patients with prolonged asymptomatic SARS-CoV-2 PCR positivity, even without negative swab result. Individual optimisation of the therapy may require deviations from standard protocols. Closer multidisciplinary cooperation may contribute to the minimisation of both oncologic and infectious risks. Orv Hetil. 2021; 162(16): 611-614.
Subject(s)
Breast Neoplasms/therapy , COVID-19/complications , Mastectomy , SARS-CoV-2/isolation & purification , Adult , COVID-19/diagnosis , Female , Humans , Polymerase Chain Reaction , SARS-CoV-2/genetics , Treatment OutcomeABSTRACT
PURPOSE: To report 8-year clinical outcome with high-dose-rate brachytherapy (HDRBT) boost using MRI-only workflow for intermediate (IR) and high-risk (HR) prostate cancer (PC) patients. METHODS AND MATERIALS: Fifty-two patients were treated with 46-60 Gy of 3D conformal radiotherapy preceded and/or followed by a single dose of 8-10 Gy MRI-guided HDRBT. Interventions were performed in a 0.35 T MRI scanner. Trajectory planning, navigation, contouring, catheter reconstruction, and dose calculation were exclusively based on MRI images. Biochemical relapse-free- (BRFS), local relapse-free- (LRFS), distant metastasis-free- (DMFS), cancer-specific-(CCS) and overall survival (OS) were analyzed. Late morbidity was scored using the Common Terminology Criteria for Adverse Events (CTCAE 4.0) combined with RTOG (Radiation Therapy Oncology Group) scale for urinary toxicity and rectal urgency (RU) determined by Yeoh. RESULTS: Median follow-up time was 107 (range: 19-143) months. The 8-year actuarial rates of BRFS, LRFS, DMFS, CSS and OS were 85.7%, 97%, 97.6%, and 77.6%, respectively. There were no Gr.3 GI side effects. The 8-year actuarial rate of Gr.2 proctitis was 4%. The 8-year cumulative incidence of Gr.3 GU side effects was 8%, including two urinary stenoses (5%) and one cystitis (3%). EPIC urinary and bowel scores did not change significantly over time. CONCLUSIONS: MRI-only HDR-BT boost with moderate dose escalation provides excellent 8-year disease control with a favorable toxicity profile for IRPC and HRPC patients. Our results support the clinical importance of MRI across the BT workflow.
Subject(s)
Brachytherapy , Prostatic Neoplasms , Brachytherapy/methods , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Neoplasm Recurrence, Local , Pilot Projects , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/radiotherapy , Radiotherapy Dosage , WorkflowABSTRACT
INTRODUCTION: The paclitaxel-carboplatin doublet is an alternative choice in the first line treatment of metastatic or recurrent cervical cancer according to international guidelines. METHOD: The history of seven patients treated with paclitaxel-platinum in the last three years in the Petz Aladár Hospital is reported. A case report, supporting the efficacy of the combination in emergency and in reintroduced settings is presented as well. RESULTS: The average progression-free survival was 10 months. All patients were alive at the time of the submission of the article. CONCLUSION: The results confirm the efficacy of the paclitaxel-carboplatin AUC 5 and the paclitaxel-cisplatin combinations in the treatment of metastatic cervical cancer. Orv Hetil. 2018; 159(24): 974-977.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carboplatin/administration & dosage , Paclitaxel/administration & dosage , Palliative Care/methods , Uterine Cervical Neoplasms/drug therapy , Adult , Aged , Disease-Free Survival , Female , Humans , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Uterine Cervical Neoplasms/pathologyABSTRACT
INTRODUCTION AND AIM: Median life expectancy of non-resectable metastatic colorectal cancer may surpass three years. However, several points of the treatment strategy are subject of ongoing debate. Optimal sequence of targeted agents is not elucidated either. Based on retrospective analyses of six clinical studies and a metaanalysis, the superiority of anti-EGFR agents such as cetuximab and panitumumab over anti-VEGF bevacizumab has been proposed in the treatment of left sided tumours. METHOD: The results of the six major clinical trials were analysed. Insufficiencies of the meta-analysis are pointed: the lack of homogeneity among control groups, the omission of later lines of therapy, the inconsistency between progression free and overall survival benefit and the high proportion of excluded patients. RESULTS: The trials confirm the worse prognosis of right sided versus left sided colorectal cancers. CONCLUSION: To date the data are not strong enough to support the preference of any of the available targeted agents at the first line setting in the treatment of left sided metastatic RAS and BRAF wild type colorectal cancers. Several trials suggest that anti-EGFR treatment has no additional benefit as compared to chemotherapy alone in the treatment of right-sided tumours. Orv. Hetil., 2017, 158(9), 340-344.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/pathology , Antineoplastic Agents/therapeutic use , Disease-Free Survival , Female , Humans , Male , Neoplasm Metastasis , Randomized Controlled Trials as TopicABSTRACT
The authors present the history of two patients. The first patient, a 69-year-old woman was diagnosed with locally invasive triple negative breast cancer with pulmonary and cerebral metastases. Complete radiological remission of the clinically asymptomatic cerebral metastases was detected under systemic chemotherapy with carboplatin-docetaxel (75 mg/m2). Later, the patient received whole brain radiotherapy and a second line of chemotherapy. The overall survival was 20 months from the diagnosis of cerebral metastases with conservation of partial autonomy. The second patient, a 57-year-old woman was diagnosed as having hormone sensitive lobular breast cancer with leptomeningeal, lymphonodular and multiple osseal metastases. Before the appearance of the lymphonodular metastasis the patient received intrathecal methotrexate chemotherapy for the leptomeningeal carcinomatosis. Her neurological symptoms completely disappeared. At the onset of the lymphonodular metastasis systemic chemotherapy with ifosfamide (1000 mg/m2, D1-3) - etoposide (100 mg/m2, D1-3) was started allowing complete clinical remission of the lymphadenomegaly and stability of the asymptomatic neurological status. The overall survival was 13 months from the diagnosis of leptomeningeal carcinomatosis with conservation of autonomy. The two cases support potential efficacy of systemic chemotherapy for intracranial metastases of breast cancer. Orv. Hetil., 2016, 157(45), 1809-1813.
Subject(s)
Breast Neoplasms/pathology , Meningeal Carcinomatosis/drug therapy , Meningeal Carcinomatosis/secondary , Palliative Care/methods , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Ductal, Breast/pathology , Carcinoma, Lobular/pathology , Disease-Free Survival , Female , Humans , Methotrexate/therapeutic use , Middle AgedABSTRACT
Short acting oral morphine has recently been registered again in Hungary. Short acting oral morphine has two essential indications: dose titration at initiation of major analgesic therapy and treatment of breakthrough pain appearing beside round the clock major analgesic therapy. The clinical management of short acting oral morphine is summarised in this article.
Subject(s)
Analgesics, Opioid/administration & dosage , Analgesics, Opioid/pharmacokinetics , Analgesics, Short-Acting/administration & dosage , Analgesics, Short-Acting/pharmacokinetics , Neoplasms/complications , Pain/drug therapy , Pain/etiology , Administration, Oral , Analgesics, Opioid/adverse effects , Drug Administration Schedule , Drug Approval , Fentanyl/administration & dosage , Fentanyl/pharmacokinetics , Humans , Hungary , Hydromorphone/administration & dosage , Hydromorphone/pharmacokinetics , Morphine/administration & dosage , Morphine/pharmacokinetics , Oxycodone/administration & dosage , Oxycodone/pharmacokinetics , Pain Measurement , Therapeutic Equivalency , Time FactorsABSTRACT
AIM: The case of a patient with heavily pretreated, irinotecan-resistant, metastatic colorectal cancer is presented by the authors, and they would like to point to the effectiveness of a new therapeutic option, cetuximab treatment. Additionally, they would like to call attention to the need of performing EGFR determination from all of the biopsy samples (primary tumor, lymph nodes and metastases) to start the treatment. A weak EGFR-positivity of the primary tumor in fact does not mean the contraindication of cetuximab treatment, since the metastases, which are usually treated, could be strongly positive. The therapeutic answer could be excellent in this case, as it occurred in our case.
