[Evaluation of second-line chemotherapies most often used in recurrent epithelial ovarian cancer]. / A hám eredetû petefészekrák kiújulása miatt második vonalban leggyakrabban adott kemoterápiák értékelése.

INTRODUCTION: Second-line chemotherapies result in a progression-free interval of 2,3-42 months. AIM: The authors evaluated the efficacy of second-line paclitaxel-carboplatin, topotecan, and cisplatin-epirubicin-etoposide combinations. METHODS: Paclitaxel-carboplatin (175 mg/m2 and AUC 5) in 3-week intervals and topotecan (1.5 mg/m2/d1-3) in 3-week intervals was given to 13 and 16 patients. The triple combination of cisplatin-epirubicin-etoposide was applied in 48 patients in 4-week courses, with doses of 33 mg/m2/d1-3, 60 mg/m2/d1, and 100 mg/m2/d1-3., respectively. The progression-free interval was calculated by the product limit method of Kaplan-Meier. RESULTS: A significantly better progression-free interval was observed in treatments with paclitaxel-carboplatin and cisplatin-epirubicin-etoposide compared to the topotecan chemotherapy (5 and 5.5 months vs. 4 months, respectively, p = 0.0324 and p = 0.0087). A better progression-free interval was found in the platinum-sensitive tumors compared to the platinum-resistant ones by the above mentioned combinations (6 and 3.5 months, 7 and 4 months, and 6.5 and 3.5 months, respectively). CONCLUSION: The lower priced cisplatin-epirubicin-etoposide combination resulted in a slightly better efficacy compared to the 2 other treatments both in platinum-sensitive and platinum-resistant tumors.

[Frequency of blood transfusions for anemia caused by chemotherapy in ovarian cancer patients. Thoughts about the guidelines modified in 2006 for the treatment of anemic cancer patients by the European Organisation for Research and Treatment of Cancer]. / A petefészekrákos betegek kemoterápiája kapcsán kialakuló anémia kezelésére adott vértranszfúziók gyakorisága. Gondolatok az Európai Rákkutatási és Kezelési Szervezet 2006-ban módosított irányelveihez--a daganatos betegek anémiájának kezelésérol.

INTRODUCTION: The European Organisation for Research and Treatment of Cancer distributed the modified guidelines for blood transfusions and erythropoietic drugs in the treatment of cancer anemia in the year 2006. According to this document the blood transfusions are indicated at the level of 9 g/dL of hemoglobin. Up to this year a definitive limit for applying blood transfusion in chemotherapy-induced anemia has not been determined in Hungary. AIM: The authors evaluated their practice in the treatment of anemia with blood transfusions in ovarian cancer patients treated in 2005. In lack of international or domestic guidelines, considering also the clinical status of the patients, the authors applied blood transfusions at a hemoglobin level of 10 g/dL. MATERIAL AND METHODS: 190 epithelial ovarian cancer patients were given chemotherapy in the Gynecological Department at the National Institute of Oncology, Hungary. Selected for the patient packed red blood cell transfusion was administered if the hemoglobin has fallen below 10 g/dL, and together with it most patients (51/64 = 79,6%) were given erythropoietic drugs as well. RESULTS: Blood transfusion was given in 64 of 190 (34%) chemotherapies patients and almost the half of these latter patients (34/64 = 53%) were transfused more than once. In 86% of patients blood transfusion was given for G2 anemia. The largest rate (16/16) of blood transfusions according to the different types of chemotherapy was done in patients receiving combined therapy with gemcitabine and carboplatin. CONCLUSION: Chemotherapy for ovarian cancer causes severe anemia (hemoglobin level < 10 g/dL) in one third of patients. Besides blood transfusions, physicians have to pay attention to the necessity of erythropoietic drugs, as well.

[About the infrequent thrombotic events during erythropoietin therapy of anemia in ovarian cancer patients treated with chemotherapy]. / A kemoterápiában részesített petefészekrákos betegek vérszegénységének erythropoetin-kezelése kapcsán fellépo trombózis ritka elofordulásáról.

INTRODUCTION: Thrombotic events are infrequently observed in erythropoietin treatments for the anemia in tumorous patients with chemotherapy. The manufacturers call attention to this possible side effect of all kind of such drugs. AIM: To estimate the amount of thrombotic events in erythropoietin administrations during epoetin treatments for ovarian cancer patients treated with antineoplastic drugs. MATERIAL AND METHODS: 275 ovarian cancer patients were treated with erythropoietin in the Gynecologic Department at the National Institute of Oncology, Budapest, in the period between 2000 and 2006: 52 of them were given epoetin-alfa, 157 of them epoetin-beta and 66 of the patients received darbepoetin-alfa. Median age of the patients was 60 (ranges 22 and 84) years. RESULTS: Thrombotic events were detected in 3 patients out of the 275: one with epoetin-alfa and two times with epoetin-beta treatment (3/275 = 1,1%). No definite causal relationship was confirmed between the thrombotic events and the erythropoietin drugs. CONCLUSION: Thrombosis was infrequently monitored among the authors' patients similarly to the literature data.

[Survival reflecting the effectiveness of primary operation in patients with epithelial ovarian cancer]. / Hámeredetû petefészekrákos betegekben végzett elsôdleges mûtét eredményessége a túlélés tükrében.

INTRODUCTION: Primary operation of ovarian cancer patients has a great implication in treatment. The survival of patients operated on optimally is better than in those patients, who have tumor residuum after the operation. The optimal result is more frequent in operations performed by gynecologist oncologists as is in surgery administered by general gynecologists or general surgeons. AIM: Authors evaluated the data of 83 epithelial ovarian cancer patients treated by first-line paclitaxel-carboplatin chemotherapy in Gynecological Oncology Department, at National Institute of Oncology between 2000-2002 through a 35 months follow-up period. MATERIAL AND METHODS: Average age of patients was as 59 +/- 9.8 years. Primary optimal surgery was done in 45, non-optimal operations were administered in 38 patients. Distribution of patients according to the stages was similar in both groups. Evaluation of progression free interval was calculated according to the product limit method of Kaplan-Meier. RESULTS: Progression free interval was 35 and 35 months in the optimal and non-optimal surgery groups and 36 and 35 months in the groups operated on by skillful or less practiced gynecologists in radical surgery. Gynecologist oncologists' first operations showed an optimal result in 76% of patients, contrary to other surgeons' group resulting in only a 43% first optimal surgery. A better progression free interval was observed in the patients having optimal surgery by the interval laparotomy in contrary to those patients, who had no optimal second operation (36 vs 25 months), however, the difference showed no statistical significance. CONCLUSION: Authors believe the similar survival data could be caused by the short follow-up (35 months) and the small numbers in the patient-groups as well as the greater rate of advanced stage patients in the authors' department, in contrary to the partner municipal hospitals (23/29 = 80% versus 33/54 = 61%) resulting in worse survival chances. Proving the efficiency of radical surgery the survey is carried on.

[Effectiveness of pegylated liposomal doxorubicin in relapsed ovarian cancer]. / A pegilált liposzomális doxorubicin kezelés hatékonysága kiújult petefészekrákokban.

AIMS: Pegylated liposomal doxorubicin is considered as one of the treatment options proposed nowadays for recurrent ovarian cancer patients. The aim of this study was to evaluate toxicity profile and effectiveness of this treatment in patients with recurrent ovarian cancer. MATERIALS AND METHODS: Thirteen patients with recurrent epithelial ovarian carcinoma were treated by pegylated liposomal doxorubicin of 50 mg/m2 dose in 4-week courses. No serious hematological toxicity was observed. Only one patient showed grade 2 hand-foot syndrome at the 5-7th course, and she had to switch to another therapy. Progression-free interval (PFI) was calculated by GraphPad Prism (version 2.0) program. RESULTS: Two of the 13 patients (15%) showed complete response for 6 months, and 2 patients had partial response (15%). Median PFI was calculated as 2 months in all patients. CONCLUSION: Pegylated liposomal doxorubicin therapy can be administered with little toxicity in this subset of patients. The PFI is similar to data in the literature (an average of 4 months) in case of excluding data of the incurable patients with very advanced disease who could receive only 1-2 courses of chemotherapy.

[Experience with gemcitabine-carboplatin chemotherapy in relapsed ovarian cancer]. / Kiújult petefészekrákok gemcitabin-carboplatin kezelésével szerzett tapasztalataink.

UNLABELLED: Despite the progress that has been achieved in the primary therapy of ovarian cancer, unfortunately, the disease relapses resulting death in a lot of patients. This is the rationale for several new chemotherapy trials, however the expected results are awaited yet. The pyrimidine analogue drug gemcitabine belongs also to this group of hopeful therapies to increase the outcomes. PATIENTS AND METHODS: 22 patients with platinum-resistant, recurrent epithelial ovarian carcinoma, were treated with gemcitabine, in 98 courses in the Gynecologic Department at National Institute of Oncology, Budapest. Gemcitabine was applied in combination chemotherapy with carboplatin in the 2-8th line with the gemcitabine dose of 1000 mg/qm/d 1, 8 and carboplatin dose of AUC 4/d 1, in 3 week courses. Progression free interval was calculated by GraphPad Prism (version 2.0) program. RESULTS: A 39% overall response and a median 3 months progression free interval were resulted. Complete response was found only in one patient. CONCLUSION: Combination therapy with gemcitabine and carboplatin showed only limited responses in the authors' relapsed ovarian cancer patients. It seems to authors the lesser progression free interval is resulted by the resistant clones of the tumour due to the several (median 4) unsuccessful previous chemotherapies. The authors' early experience with gemcitabine underlines the good tolerability and the possibility of outpatient administration of the drug as well.

[First observations of the dose-dense weekly docetaxel therapy in relapsed ovarian cancer]. / Kiújult petefészekrákos betegek "sûrû dózisú" (dose-dense), hetente adott docetaxel kezelésének elsô tapasztalatai.

UNLABELLED: Weekly docetaxel therapy is a new therapeutical form of relapsed ovarian cancer. Phase I and II trials of this administration form are rare in the literature of this tumor type. The authors report on a retrospective study of this treatment. MATERIALS AND METHODS: Ten patients with recurrent epithelial ovarian carcinoma were treated by dose-dense weekly docetaxel in 57 courses. The patients received a median of 6 courses of docetaxel on day 1, 8 and 15 together with a one-week pause, in 4-week courses. The average age of the patients was 61+/-9 years. Eight patients received a docetaxel monotherapy at a dose of 40 mg/m2, in weekly administration, and two patients weekly docetaxel combination therapy with carboplatin of AUC 3, on the same days as above. The premedication used before docetaxel was the same as the one given in the 3-week protocols: the patients received treatments of 100 mg methyl-prednisolone 12 hours and half an hour before docetaxel infusion. No G4 hematological toxicities were observed. G3 and G2 leucopenia was found in 6/57=11% and 4/57=8% of treatments. No granulocyte colony stimulating factor was given. Progression-free interval (PFI) was calculated by GraphPad Prism (version 2.0) program. RESULTS: Complete response was found in two patients (2/10=20%), and the patients are tumor-free 2 and 3 months after treatment. All the other patients showed tumor progression after some time of stabilization. The median progression-free interval was calculated as 2 months. CONCLUSION: Weekly docetaxel is found to be a tolerable treatment form of relapsed ovarian cancer patients. For the evaluation of the treatment more studies are warranted.

[Review of effectiveness of chemotherapy with gemcitabine in ovarian cancer]. / A petefészekrákokban alkalmazott gemcitabinkezelés eredményessége az irodalmi adatok tükrében.

Ovarian cancers are known to have the highest mortality rate among the gynaecological tumours. Despite the effectiveness of the paclitaxel-carboplatin combination that is usually recommended nowadays the disease does recur, many times causing finally the death of the patient. This phenomenon explains the continual efforts to find further new and potent treatment forms in this disease. From the late 1990 years on the nucleoside analogue gemcitabine has been used against ovarian cancer. Its administration in Hungary was approved in 2005. Publications report on 16.2 +/- 5.6% and 53.9 +/- 20.5% complete response on average with mono- and polychemotherapy using gemcitabine in ovarian cancer. Some chemotherapeutic combinations with gemcitabine for the first line treatment of ovarian cancers are also known and they were found to be superior to the multi-line treatments (81.6 +/- 17.9% complete remission on average with the former). These treatments are usually accompanied by haematological toxicity. Severe G3-4 neutropenia was observed in 45.1 +/- 22.6%, and thrombocytopenia in 24.9 +/- 23.1% of the patients. The first publications on this treatment form are promising, however, a final policy in this matter can only be assumed after finishing the evaluation of the comprehensive, randomised studies (GOG-0182-ICON5) in progress.

[Neoadjuvant chemotherapy in the treatment of ovarian cancer]. / A neoadjuváns kemoterápia helye a petefészekrákok kezelésében.

With certain ovarian cancer patients, programmed primary operation either cannot be attempted or if attempted, it is not successful because of the advanced state of the disease and the very poor condition of the patient. Neoadjuvant chemotherapy before operation is expected to enhance the results of treatment. Based on randomized studies it can be stated that the neoadjuvant chemotherapy improves survival only in cases of optimal tumor reduction. In opposite cases, with lack of optimal debulking, the overall and the progression-free survival rates are similar to those experienced with the nonoperated patients. The results of ongoing randomized trials are awaited to draw the final conclusions. However, neoadjuvant chemotherapy remain as an alternative treatment for patients with ovarian cancer of advanced stage and poor internal status, for whom there is no other choice for tumor elimination.

Recurrent giant fibroepithelial stromal polyp of the vulva associated with congenital lymphedema.

BACKGROUND: The relatively site-specific mesenchymal lesions of the vulvovaginal region can exhibit superficially overlapping histological features and can be diagnostically challenging. Fibroepithelial stromal polyp is generally an easily recognizable entity, but certain cases cause differential diagnostic problems. CASE: We present a case of a 16-year-old girl with a 10-cm polypoid lesion localized to the left labium. The patient has therapy resistant congenital lymphedema localized to the left arm and leg. The labial lesion was resected and recurred after 12 months and 6 years following the initial treatment. Histologically, it exhibited characteristics of a fibroepithelial stromal polyp with scattered bizarre multinucleated giant cells and ectatic tortuous lymphatic spaces. CONCLUSION: This vulvar lesion represents a unique example of giant fibroepithelial stromal polyp developed in association with Nonne-Milroy-Meiges syndrome.

[Results of docetaxel therapy in patients with relapsed ovarian cancer]. / A kiújult petefészekrákos betegekben alkalmazott docetaxel kezelés eredményei.

UNLABELLED: Successful treatment of relapsed ovarian cancer has not been solved. Docetaxel, being one of the medicines of special interest in Hungary from 2002, has been ranked with the other well known treatment forms. In this study the authors evaluated the results of the docetaxel-carboplatin combination treatment in two oncological centers. MATERIAL AND METHODS: Sixteen patients with relapsed ovarian cancer, premedicated with steroids, were given docetaxel-carboplatin chemotherapy at a dose of 75 mg/m2 and AUC 5 in 94 courses at the Gynecological Dept., National Institute of Oncology and Oncotherapeutic Clinic of Szeged University. Median of courses was 6 (range: 2 to 15). RESULTS: CR was found in 1, PR in 4 and PD in 5 patients. Six patients showed stable disease. There was no need for dose reduction. The authors observed no extreme side effects (this evaluation does not contain the data of a patient who refused chemotherapy because of the development of hypersensitivity reaction). Almost all patients developed reversible alopecia. The probability of freedom from progression dropped to 50% 5 months after the beginning of treatment. CONCLUSION: Docetaxel has expanded the chemotherapeutic arsenal in relapsed ovarian cancer. Our results are in harmony with those reported in the literature on other drugs or combination treatments. Further trials are required to improve the effectiveness of chemotherapy.

[Evaluation of progression-free interval in patients with ovarian cancer treated by first-line chemotherapy with paclitaxel and carboplatin]. / Progressziómentes túlélés vizsgálata petefészekrákos betegek elso vonalban alkalmazott paclitaxel-carboplatin kezelését követoen.

UNLABELLED: Combination therapy with paclitaxel is widely proposed for first-line adjuvant treatment in ovarian cancer patients in Hungary as well as worldwide. The authors summarize the results of paclitaxel-carboplatin therapy of the years from 2000 to 2002, and compare them to the results observed in 2002. MATERIAL AND METHODS: 86 patients with ovarian cancer of stage I-IV were treated with the combination with paclitaxel (175 mg/m2, 3 hours) and carboplatin (AUC 5) at the Gynecological Department, National Institute of Oncology, Budapest. Average age of the patients was found 54+/-9.8 years. Optimal surgery (hysterectomy with bilateral adnexectomy and omentectomy with a maximal residual tumor burden of 1 cm) was done in 43 of the 86 patients. RESULTS: Tumor-free status was found in 60% and 31% of the patients in 2002 and 2005 respectively. Tumor-free status was observed in the groups of optimally operated and non-optimally operated patients in 79% and 42% in 2002 and in 44% and 19% in 2005. Median progression-free interval was higher in the optimally than in the nonoptimally operated patients (25 and 11 months), and was resulted in 16.5 months of all patients. CONCLUSION: Our paclitaxel-carboplatin treatment resulted in a similar progression-free interval as that was found in the literature, however, the ratio of tumor-free patients decreased to 31% during the follow-up time (median: 41 months).

[Pure red-cell anemia due to recombinant human erythropoietin and its status in oncology practice]. / A rekombináns humán erythropoietin adagolása során kialakuló, csak a vörösvértestvonalat érintô vérszegénység (PRCA) és elôfordulása az onkológiai gyakorlatban.

A special form of anemia was observed during the treatment with recombinant human erythropoietin having been applied for more than 15 years. The pure red-cell anemia due to antibodies against erythropoietin was described in chronic renal failure patients. Since oncological patients are also treated with rhuEPO it is interesting to know whether this side effect could be observed in the patients with solid tumors as well. It should be considered in tumorous patients when coexistence of antibodies against rhuEPO with pure red-cell aplasia is demonstrated, and its other causes as immunological disease, thymoma, viral infections (eg. Parvovirus B12, Hepatitis B or C) are excluded. The author collected literature data and found the absence of reports on this side effect in cases of treatment with rhuEPO in cancer patients. The rhuEPO treatment is a safe method for the cure of cancer anemia as antibodies against rhuEPO have not been shown together with PRCA among cancer patients. The possible explanation could be the shorter application time in cancer compared to the chronic renal failure patients. The side effect observed in chronic renal failure patients calls the attention to the precise compliance with the instructions of the manufacturers.

Does increasing the steroid dose enhance the efficacy of the antiemetic combination of granisetron and methylprednisolone in gynecologic cancer patients--a randomized study.

OBJECTIVE: The authors administered two doses of oral methylprednisolone in combination with 3mg granisetron intravenously for the prophylaxis of cisplatin-induced emesis in gynecologic cancer patients. MATERIALS AND METHODS: Thirty-nine patients received 100mg (group A) and 25 received 200mg (group B) methylprednisolone in the antiemetic combination in a randomized prospective trial. RESULTS: No vomiting in 90.2 and 96.7%, one emetic episode in 3 and 1.1% and two episodes in 3 and 2.2% were detected in groups A and B, respectively. More than two emetic episodes were considered to be a failure and were observed only in group A (3.8%). There was no significant difference between the two treatment groups (P=0.3160). CONCLUSIONS: There was no evidence for enhanced antiemetic effect of elevated steroidal dose in combination with granisetron.

[Frequency of anemia in patients with ovarian cancer: assessment of our own data in connection with the European Cancer Anemia Survey (ECAS)]. / A vérszegénység gyakorisága petefészekrákos betegekben: a saját adatok felmérése az Európai Rákos Vérszegénység Vizsgálat (ECAS) eredményei kapcsán.

The authors summarized the hemoglobin values of 174 patients in 850 chemotherapy courses with ovarian cancer in the year 2001 on the base of the European Cancer Anemia Survey's results. Chemotherapy was given in first-line in 88, in second-in 68 and in third- and fourth-line in 16 and 2 patients. Patients were divided into 2 treatment (cisplatin and non-cisplatin) groups according to the different anemia-producing characteristics. The average Hb levels in the two groups were as 11.1 g% and 11.2 g%, and the median Hb values were as 11.2 g% and 11.7 g%, respectively (p = 0.3604). The Hb values were lower than the normal Hb limits (G1-4) in 70.5% and in 61.8% in the two groups. There was not found significant difference between the two treatment arms in the G3-4 toxicity (2.9%, 1.1%, p = 0.8572). Data of the authors underline the importance of prophylaxis and treatment of anemia in chemotherapy courses of ovarian cancer patients.

[Metastatic breast cancer in the uterine cervix: two cases of a rare occurrence]. / Emlórák kiújulása a méhnyakban: a ritka elófordulásról két eset kapcsán.

Authors report on the recurrence of breast cancer to the uterine cervix in two patients. In the first patient the tumor recurrence was suspected by cytology 43 months after she was cured for breast cancer. An ultrasound examination revealed the recurrence in the second patient who have been cured for the breast cancer for 53 months. The final diagnoses was proved by cervical conisation in the first patient and by hysterectomy in the second one. Authors call attention for the possibility of the rare site of symptom free recurrence.

[Early results of first-line chemotherapy with paclitaxel and carboplatin in patients with epithelial ovarian carcinoma]. / Hám eredetú petefészekrákok elsó vonalban alkalmazott paclitaxel-carboplatin kezelésével szerzett korai tapasztalatok.

INTRODUCTION: Paclitaxel-carboplatin combination chemotherapy has been administered worldwide in the first-line adjuvant treatment of epithelial ovarian cancers since the mid 1990's. AIM: Goal was to evaluate the early results of the first-line paclitaxel-carboplatin treatment practiced at the Gynecological Department of National Institute of Oncology, Budapest between November 2000 and August 2002. PATIENTS AND METHODS: Paclitaxel and carboplatin were administered in the doses of 175 mg/m2/3 h and AUC 5, respectively. Average age of patients was 54 +/- 9.8 years. The patients were considered into stage I in 18.4% and in stage II-III and IV in 4.6%, 52.9% and 8%. The surgeon did not reported the stage in 16.1% of patients. Statistical analysis was performed by the product limit method of Kaplan and Meier. RESULTS: The progression free interval was found to be 100%, 50%, 71.7% and 71.4% in stages I, II, III and IV, at the end of the 6th chemotherapy course and decreased to 100%, 50%, 52.2% and 42.9% in the same stages at the time of evaluation (16 December 2002). Authors found a 77% CR in the patients at the end of chemotherapy. CONCLUSION: Only progression free interval till the end of treatment could be evaluated because of the short follow up period. The observed 77% CR is similar to the data of the literature. The final conclusions will be made by later follow up.

[Reinduction of paclitaxel therapy after a successfully treated hypersensitivity reaction]. / Paclitaxel-kezelés sikeres újraindítása (reindukciója) hiperszenzitív reakció ellátását követóen.

INTRODUCTION: Paclitaxel containing chemotherapy is considered to be the first-line adjuvant treatment of epithelial ovarian cancers. Hypersensitive reaction is its most serious side effect including hypotension, respiratory distress, extensive urticaria or an intense cardiotoxicity. Due to these signs several physicians abandon of the otherwise hopeful chemotherapy. AIM: Having ceased the hypersensitive reaction one could successfully re-induct paclitaxel therapy after a repeated premedication course. METHOD: A slow paclitaxel infusion rate with a 1/20 dose of the original concentration was administered for reinduction therapy when the patient became symptom-free after treatment with steroid and antihistamines. RESULT: Paclitaxel treatment was uneventfully instituted after reinduction as hypersensitivity has not been developed again. CONCLUSION: According to the authors in case of hypersensitive reaction you need not abandon the otherwise effective paclitaxel treatment: it is worthy to institute the reinduction therapy.

[Early results of topotecan therapy in patients with recurrent ovarian cancer]. / Kiújult petefészekrák topotecankezelésével szerzett korai tapasztalatok.

INTRODUCTION: Topotecan inhibits the topoisomerase-I enzyme resulting its stabilisation on the DNA and the suspension of replication and transcription. AIMS: The authors summarized their first experience on second-line topotecan treatment in a prospective non-randomized study. METHOD: Topotecan was given for recurrent epithelial ovarian cancer in the dose of 1.5 mg/m2/d for 5 days repeated in every 3 weeks in a 30-minute infusion intravenously. RESULTS: Twenty five recurrent ovarian cancer patients were treated between March, 1999 and March, 2001. Complete and partial response rates were found 12% and 12%, respectively. Stable disease was observed in 48% of patients for 4-8 courses, then progression continued. In these 3 groups of patients the median progression free interval was shown as 12 weeks. CONCLUSION: When comparing to previous chemotherapies, topotecan treatment failed to show a definitive improvement in the outcome of recurrent ovarian cancer.