Magyar onkologia最新文献

The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.

The surgical treatment of cervical tumours is a complex problem that often puzzles the gynaecological surgeon. The operation was previously named after Ernst Wertheim, who performed the first radical hysterectomy more than a century ago, and has since undergone many modifications. Today, almost 50% of patients are diagnosed at an early stage, when the disease is still localised to the cervix, with a 5-year survival rate of more than 90%. Surgical treatment is the first-line treatment for this group of patients, which offers a good solution in terms of long-term quality of life through ovarian preservation and surgical technique. In the majority of cases where fertility preservation is not an option, radical removal of the uterus and removal of lymph nodes is the basis for surgery. For both interventions, there have been many changes in the last decades and a detailed description of these changes and treatment planning is the main aim of this study.

Cervical cancer is one of the most common cancers among women and one of those completely preventable according to the current state of medical science. The pathogenesis of the disease is known, the human papillomavirus plays an essential role in the development in 99.9% of cases. With the available vaccines against the virus and the use of effective screening methods, the complete elimination of the disease can be achieved within a few decades, according to WHO estimates. Despite all these facts, the current state of the fight against the disease is still very controversial, which can be characterized by the epidemiological indicators of the disease. We would like to present these data in our publication, highlighting the challenges that not only developing but also developed countries face every day in relation to the prevention of cervical cancer.

The development of robotic surgery is another step in the evolution of modern surgery. Robot-assisted minimally invasive procedures undoubtedly have many advantages compared to traditional laparotomy, which is why they have also been introduced in the treatment of gynecological cancers. Numerous studies have confirmed the advantages of robotic surgery in terms of quicker recovery, reduced blood loss, and shorter hospitalization. The technique provides a significant advantage in the minimally invasive treatment of overweight patients. However, in the treatment of cervical cancer, the use of minimally invasive procedures have declined in recent years due to worse oncological results. It is necessary to carry out further clinical trials in this indication using surgical solutions that prevent the spread of the tumor, in order to find out whether minimally invasive surgery regains its important role in the surgical treatment of early cervical cancer.

Cervical cancer is the 4th in incidence and mortality rate among women worldwide. Histologically the majority of cervical cancers are squamous cell carcinomas, with a minor proportion of adenocarcinomas. Cervical carcinogenesis can be followed through different steps of precancerous lesions, previously named dysplasias (mild, moderate and severe), by recently used terminology of the Bethesda classification as LSIL (low-grade squamous epithelial lesion) and HSIL (high-grade squamous epithelial lesion) before progression to invasive cancer by cytological screening together and controlled by histology. Introduction of several newly developed viral and cellular molecular biomarkers are extendedly applied as diagnostic tests for detection of human papillomavirus (HPV) and other markers as signs of cellular transformation, which increased both the sensitivity and specificity of the testing. Cytology, histology, HPV detection in combination with novel molecular tests are incorporated into the modern screening and diagnostic guidelines in several countries which is strongly suggested in Hungary too.

Cervical cancer screening is widely used worldwide, which led to a significant decrease both in incidence and mortality of the disease in several countries. Cervical cancer screening was introduced in the 1950s as opportunistic method for secondary prevention of cervical cancer in Hungary, later, however, became a part of National Immunization Program. Detection of human papillomavirus (HPV) is the first-line method of screening in several countries before cytology, which has been proposed to be introduced in Hungary by several groups. The incidence and mortality of cervical cancer can be reduced further or even completely eliminated by the application of HPV vaccines first by 2- , followed by 4- and recently by 9- valent HPV vaccines. Nationwide vaccination program for 12-year-old girls was introduced in 2014 which was extended for boys of the same age in 2020 involving 60-80% of the target population in Hungary. The next step would be to extend the vaccination program as catch up and pre- or postconization vaccination to approach the WHO goal for elimination of HPV infection and cervical cancer.

Global cervical cancer incidence and mortality rank fourth in women with malignant tumors, which have been reduced by population-based cervical cancer screening. The previously used Papanicolaou cytological testing of cervical smears was replaced by the Bethesda classification, which facilitated the early detection of the pre-cancerous lesions, used together with other methods such as colposcopy, testing of high-risk genotypes of human papillomavirus (hrHPV) and molecular techniques. The recently introduced terminology as ASC (atypical squamous cells), ASC-US (ASC, undetermined significance), ASC-H (ASC, cannot exclude HSIL), as well LSIL and HSIL (low- and high-grade squamous intraepithelial lesions) is widely used in Hungary, which guides the treatments of the patients by the clinicians. The detection of HPV is incorporated into the management of the patients as well. It is, however, highly important to update the domestic cervical cancer screening, especially with the introduction of the first-line, primary HPV screening in Hungary, in agreement with the opinions of other groups.

Radiotherapy has a significant role in the management of cervical cancer. Radiotherapy is indicated in two-thirds of all cervical cancer patients. Indications of radiotherapy are based on level I-II evidences in the vast majority of cases, although in some cases the use of radiotherapy is supported by the results of retrospective clinical trials. In this review, indications of curative and palliative irradiation and radio-chemotherapy are summarized and technological advances of contemporary external beam radiotherapy and brachytherapy are presented.

In the choice of a planned fertility preservation procedure for stage IA1 and IB1 cervical cancer, optimal oncological safety is the main focus of virtually all protocols. The surgeon should remove the appropriate proportion of the cervix for oncological safety, ensuring an adequate tumour-free surgical margin. However, some of the literature on fertility preservation, referring to histological parameters, still considers conisation with excellent fertility results to be optimal for the treatment of tumours with a diameter of 2 cm. With regard to fertility preservation in the case of radical trachelectomy versus simple conisation, we are aware of several ongoing studies, the results of which may provide an answer as to whether a more conservative surgical therapy for smaller tumours (less than 2 cm in diameter) represents an acceptable oncological safety.

Early stage cervical cancer can be successfully treated with either surgery or radiotherapy, but medical therapy is inevitably necessary for the treatment of locally advanced and metastatic cases. Chemotherapy is routinely used to increase the efficacy of radiation therapy (chemoradiation) and in the palliative setting, but it has also been investigated as neoadjuvant and adjuvant therapy. Due to the limited efficacy of chemotherapies in cervical cancer and to the development of the oncological therapies, in the last decade many studies have been performed with novel agents. First the anti-VEGF antibody bevacizumab, later immunotherapeutic agents, lately an antibody drug conjugate have proven their efficiency and gained approval from the federal and European medical agencies. The aim of this paper is to give an overview of the medical therapies of cervical cancer (excluding chemoradiation), focusing on currently available modern treatment options and future possibilities.