59 research outputs found
Carcinoid daganatok
The authors review the most important clinical aspects of carcinoid tumors. Carcinoid tumors originating in neuroendocrine cells are rare, usually slowly-growing neoplasms, however, they may present as aggressive and rapidly progressing tumors. Epidemiologic data indicates that their prevalence is gradually increasing, which may be explained, at least in part, by the development and wider use of advanced diagnostic methods. A considerable proportion of patients with neuroendocrine tumors are symptom-free, whereas others may have carcinoid syndrome or symptoms of other endocrine syndromes. Early diagnosis may be established by the measurement of biochemical markers (serum chromogranin A, urinary 5-hydroxyindoleacetic acid) and advanced localization methods. A considerable number of patients are diagnosed at the late stages of the disease; in these cases surgical cure is not possible but surgical and/or interventional radiologic procedures which reduce tumoral mass should be still considered. The most effective drugs for symptomatic treatment of carcinoid tumors are somatostatin analogues; in addition to their beneficial effect on clinical symptoms they may stabilize tumor growth for many years and, less frequently, may produce tumor regression. The use of chemotherapeutic agents is considered in patients with aggressive, rapidly growing and advanced tumors; initial findings with temozolomide and thalidomide in clinical trials raise the possibility that these chemotherapeutic agents may prove to be new therapeutic options. Radioisotope-labeled peptide receptor therapy with 131 I-MIBG, 90 Y-DOTA-TOC or 177 Lu-DOTA-TOC may offer a highly effective option for patients with progressive and advanced stage of neuroendocrine tumors. Initial observations obtained in clinical trials with some tyrosine kinase inhibitors, antibodies against tyrosine kinases, and with inhibitors of mammalian target of rapamycin (mTOR) support the possibility that at least some of these new agents may have a role in future treatment options in patients with advanced neuroendocrine tumors
Is the Magyarmecske telluric conductivity anomaly a buried impact structure?
Abstract
A more or less circular high-amplitude telluric conductivity anomaly is located at Magyarmecske, in southwestern Hungary. The authors collected and reinvestigated all available geophysical data previously measured in the area; based on this information it was concluded that the conductivity anomaly may well be explained as a buried impact crater. It is assumed that when the impact occurred, the target area was covered by a thick, coal-bearing Carboniferous sedimentary sequence. The projectile created a complex impact crater in these deposits, of a diameter of approximately 6–8 km. In the neighborhood of the crater the coal was modified by the impact's heat and pressure. Later the impact structure was partly eroded, partly deformed by younger tectonic movements, and covered by Neogene sediments of strongly variable thickness
Áttétes vesedaganatos betegek everolimusterápiájával szerzett hazai tapasztalatok
Everolimus is indicated for the therapy of adults with advanced renal cell carcinoma after failure of treatment with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI). The aim of the study was a multicenter evaluation of efficiency and toxicity of everolimus in patients with metastatic renal carcinoma who received one line of VEGFR-TKI therapy. Data of one hundred and one patients were analyzed retrospectively. Patients received everolimus therapy between January 2010 and July 2013. Data were collected in 7 different oncology institutes in Hungary. Starting daily dose of everolimus was 10 mg in 28-day cycles. Physical and laboratory examinations were done monthly. Imaging tests were performed every 3 months. Tumor response and toxicity were evaluated according to RECIST 1.0 and NCI CTCAE 3.0, respectively. Statistical analysis was performed with SPPS version 20.0 for Windows. Currently 26 (27%) patients are being treated, 52 (54.1%) patients are alive. Median progression-free survival (PFS) was 5.7 months (95% CI 4.07-7.33). Partial remission, stable disease and progression occurred in 6 (6%), 71 (74%) and 19 (20%) patients, respectively. Median overall survival (OS) was 14.3 months (95% CI 6.99-19.81). PFS and OS results were more favorable in patients with ECOG 0-1. Survival was poorer in case of anemia, while better if PFS was longer than 12 months. In anemic patients with ECOG 0-1 and ECOG 2-3 OS was 30.9 and 7.7 months, respectively (p=0.031). Dose reduction and treatment delay happened in 8 (7.9%) and 12 (11.9%) cases, respectively. The most common side effects were the following: exanthema, edema, stomatitis, pneumonitis, anemia and abnormal kidney-, liver functions, blood sugar and cholesterol levels. According to the Hungarian experience, everolimus can safely be administered. PFS and OS results representing the centers' everyday practice, are similar to the results of the respective subgroups in the registration study
Mikroszatellita-instabilitás előfordulása, intratumoralis heterogenitása, prognosztikus és prediktív potenciálja primer colorectalis carcinomák és párosított májáttéteik sebészi kezelését követően
Absztrakt
Bevezetés: A vastagbéldaganatokra jellemző genetikai
instabilitás megnyilvánulhat több úton: kromoszomális instabilitás,
mikroszatellita-instabilitás, illetve „CpG-island methylator phenotype”. Ezek
pontosabb karakterizálásával a rendelkezésre álló kezelések elviekben
optimalizálhatók lehetnek. Célkitűzés: A szerzők a
mikroszatellita-instabilitás előfordulását, heterogenitását, prognosztikus és
prediktív potenciálját vizsgálták 122 primer colontumor szisztematikusan
szelektált régióiban és 69 párosított májmetasztázisban.
Módszer: Szöveti multiblokkok kialakítása után az MLH1,
MSH2, MSH6 és PMS2 kifejeződését vizsgálták immunhisztokémiai módszerrel.
Eredmények: A betegek 11,5%-a (14/122) rendelkezett
mikroszatellita-instabil fenotípusú daganattal. A különböző tumorrégiók
fehérjekifejeződésében nem volt jelentős különbség. A primer
tumor–májmetasztázis párok esetében 20,2%-ban a kettő más mismatch repair
státusba volt sorolható. A relapsusmentes és teljes túlélést tekintve a mismatch
repair státus nem volt prognosztikus. Az 5-fluorouracil-, oxaliplatin-,
irinotecan-, bevacizumab-, cetuximab-, panitumumabterápia hatékonyságát tekintve
mismatch repair státus nem volt prediktív a progressziómentes és teljes túlélés
adatai alapján. Következtetések: A prognosztikus faktorok
pontosabb meghatározása nagyobb esetszámú, pontosan szelektált vizsgálat
keretében hatékonyabbá teheti a kezelés megválasztását. Orv. Hetil., 2015,
156(36), 1460–1471
Rationale and design of the PROMETCO study: A real-world, prospective, longitudinal cohort on the continuum of care of metastatic colorectal cancer from a clinical and patient perspective
The PROMETCO study is collecting real-world data on metastatic colorectal cancer (mCRC) patients with two progressions. This international, prospective, longitudinal, observational cohort study is collecting data on mCRC patients with two disease progressions since diagnosis and receiving subsequent treatment. Objectives include overall survival, treatment patterns, effectiveness and safety and patient-reported outcomes using the EuroQol 5-level, 5-dimensional questionnaire, the Brief Fatigue Inventory and a modified version of the ACCEPTance by the Patients of their Treatment (ACCEPT ©) questionnaire. Data are collected retrospectively and prospectively up to 18 months. As of 13 October 2021, 544 patients from 18 countries had been enrolled. To the authors' knowledge, PROMETCO is the first international, real-world study of the continuum of care of mCRC patients in this setting. Trial registration number: NCT03935763 (ClinicalTrials.gov)
A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról = Resection of vena cava inferior infiltrating by liver tumors
Absztrakt:
Bevezetés: A onkoterápia ígéretes gyógyszerei ellenére a primer
és áttéti májtumorok kuratív kezelését egyelőre még mindig a műtét jelenti. A
májdaganatok sebészetében ma már nem a reszekálandó májszövet mennyisége jelenti
a kihívást, hanem a máj nagy ereit infiltráló tumorok. Betegek és
módszer: Retrospektív vizsgálat során felmértük a Szent János
Kórház Sebészeti Osztályán 2017. május 1. és 2019. május 1. között májreszekción
átesett 33 beteg adatait. Vizsgáltuk a demográfiai, műtéti, szövettani adatokat
és a posztoperatív szakot. Adataikat összehasonlítottuk a két vena cava
reszekciót is igénylő betegünk adataival. Eredmények: A
májreszekált betegek (LR) műtéti ideje 91,7 perc volt, míg a cavareszekált
betegeknél (CR) 250 perc. Az átlagos transzfúziós igény 1,2 E volt az
LR-csoportban és 5 E a CR-csoportban. R0-reszekciót elérni 23 esetben sikerült,
8 esetben R1-, míg 2 esetben csak R2-reszekciót sikerült végezni az
LR-betegeknél, a CR-csoportban mindkét esetben R1-reszekciót. A posztoperatív
intenzív osztályos kezelés hossza és az ápolási napok száma is nagyobb volt a
CR-csoportban (5,0 versus 0,91 nap, illetve 10,5
versus 8,84 nap). Öt, colorectalis metasztázissal operált
beteg adjuváns kemoterápia után került műtétre. Két esetben laparoszkópos
reszekció történt, illetve két esetben a colorectalis tumorral egy ülésben
került eltávolításra a májmetasztázis, ebből egy esetben mindkét beavatkozás
laparoszkóposan történt. Következtetés: A nagy ereket (vena
cava, vena hepatica) infiltráló tumorok során végzett érreszekciók jelenleg a
májsebészet legtechnikásabb beavatkozásának számítanak. Az eseteink kapcsán
áttekintett szakirodalom megerősíti, hogy a vena cava reszekcióját és
rekonstrukcióját szükségessé tevő onkológiai májműtéteknek van létjogosultságuk.
Orv Hetil. 2019; 160(33): 1304–1310.
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Abstract:
Introduction: Despite all new promising agents of oncotherapy,
it is still liver resection that gives potential curative solution for primary
and secondary liver tumors. The size of tumorous liver section for resection
means no question any more but major vessel infiltration of tumor proposes
challenge in liver surgery. Patients and method: Retrospective
analysis was carried out covering 33 patients who underwent liver resection in
St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019.
Demographic, surgical, histological data and postoperative course were taken
into consideration and comparison with two of our patients who needed vena cava
excision simultaneously with liver resection. Results: Patients
with liver resection only (LR) had a mean operation time of 91.7 minutes, while
operation time for patients with cava resection (CR) was 250 minutes. The
average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5
units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8
cases, R2 resection could be performed in 2 cases, in group CR in both cases R1
resection was registered. 5 patients with colorectal liver metastasis were
operated after previous chemotherapy. Two patients underwent laparoscopic liver
resection and two had synchronous colorectal and liver resection, one of these
was treated via laparoscopic approach.
Conclusion: Liver resections in case of large vessel (vena
cava, hepatic vein) infiltrating by liver tumors are indicated the most
challenging procedures of liver surgery. The relating literature refers to
oncological liver resections with vena cava excision and reconstruction to be
safe and applicable. Orv Hetil. 2019; 160(33): 1304–1310
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