Magyar onkologia最新文献

Aim: To summarize the clinical presentation, diagnosis, and therapy of immune checkpoint inhibitor (ICI) induced rare but severe cardiac adverse events, focusing primarily on immune- mediated myocarditis, and also a case presentation of one of our patients.

Methods: Based on a review of the literature and clinical experience, we present the pathophysiology, diagnostic steps, and treatment options for ICI-induced myocarditis.

Results: Myocarditis is associated with high mortality and is difficult to diagnose, as symptoms are nonspecific and the sensitivity of laboratory, imaging, and invasive tests varies. Following early diagnosis, high-dose steroid therapy can significantly improve survival.

Conclusions: With the increasing use of ICI therapies, the recognition and management of severe cardiotoxic adverse events require a multidisciplinary approach and prompt intervention. Further prospective studies are needed to establish standardized therapeutic guidelines.

The surgical treatment is still the most effective method in curing of early breast cancer. Breast preservation and the application of oncoplastic principles became generally accepted, the sentinel lymph node biopsy in the surgical treatment of the axilla is primary, and the indication for axillary block dissection (ABD) is narrowing further. The neoadjuvant oncological treatment that is applied more and more widely presented surgery with new challenges. The expansion of quality assurance measures, the enhancement of breast surgery training, and the acceleration of centralisation through the establishment of dedicated breast cancer diagnostic and treatment centres are all anticipated to contribute significantly to the reduction of breast cancer mortality. Hereunder we summarise our recommendations on the surgical treatment of breast cancer based on the content of the 5th Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations.

This recommendation based on recent international guidelines, literature data and our experience deals with the follow-up, complex rehabilitation, palliative and nutritional therapy of breast cancer patients. Practising intensive follow-up is not justified but early detection and curative management of local/regional tumor relapse is still a priority, while special issues (breast cancer risk, pregnancy) must be handled with expertise. Social rehabilitation should be advised by competent social workers. Various diagnostic and therapeutic methods used for physical rehabilitation all along the management of the disease are presented. Detailed recommendations for the diagnosis, pharmacological therapy or alternative management of various psychooncological disorders are provided. A complex nutritional therapy guideline deals with the nutritional status of breast cancer patients, the recommended diet during and following their treatment or the nutrition therapy as a part of palliative care and ethical considerations. The principles of palliative care and its organisation in Hungary are described.

Aim: To formulate standardized recommendations for recognizing and managing the genetic risk of breast cancer, based on the latest scientific evidence and clinical experience.

Methods: The authors adapted international professional guidelines to local conditions, which were reviewed within the framework of the 5th Hungarian Breast Cancer Consensus Conference.

Results: The consensus document provides detailed guidance on the indications for genetic testing, the process of clinical genetic counseling, and hereditary genetic testing in breast cancer patients. Given their prevalence and importance, separate chapters address breast, ovarian, and other cancer risks in carriers of pathogenic or likely pathogenic BRCA1/2 variants, along with related screening, prevention, and management recommendations, including risk-reducing surgery, chemoprevention, and hormone replacement therapy. The consensus also covers risk assessment and management in carriers of other high-penetrance gene variants (CDH1, PALB2, PTEN, STK11, TP53), as well as the role of moderate-penetrance genes.

Conclusions: This consensus provides a unified professional framework for genetic risk assessment and management in national practice, supporting personalized patient care and contributing to the early detection and prevention of hereditary breast and ovarian cancer.

Following a wide interdisciplinary consultation, the present recommendations have been finalized after their public discussion at the 5th Hungarian Consensus Conference on Breast Cancer. The recommendations cover non-operative, intraoperative and postoperative diagnostics, the determination of prognostic and predictive markers and the content of the cytology and histology reports. Furthermore, it touches some special issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement. The most important changes include the integration of the ASCO/CAP HER2 assessment guidelines from 2023, the reformulation of the role of cytology in breast cancer diagnostics, diagnostic categories of non-operative lymph node assessment, and the revision of PD-L1 assessment related information. The recommendations include the core and non-core elements of the ICCR (International Collaboration on Cancer Reporting) breast cancer related datasets.

The radiotherapy (RT) expert panel revised and updated the RT guidelines accepted in 2020 at the 4th Hungarian Breast Cancer Consensus Conference, based on new scientific evidence. Radiotherapy after breast-conserving surgery (BCS) is indicated in ductal carcinoma in situ (St. 0), as RT decreases the risk of local recurrence (LR) by 50-60%. In early stage (St. I-II) invasive breast cancer RT remains a standard treatment following BCS. However, in elderly (≥70 years) patients with stage I, hormone receptor positive tumour hormonal therapy without RT can be considered. Hypofractionated (15×2,67 Gy) or ultra-hypofractionated (5×5,2 Gy) whole breast irradiation (WBI) and for selected cases accelerated partial breast irradiation are validated treatment alternatives of conventional WBI. Following mastectomy RT significantly decreases the risk of LR and improves overall survival of patients having 1 to 3 or ≥4 positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes, meeting the ACOSOG Z0011 study criteria, axillary dissection can be substituted with axillary RT. After neoadjuvant chemotherapy (NAC) followed by BCS WBI is mandatory, while after NAC followed by mastectomy RT should be given in cases of initial stage IIB-IV, and locoregional RT indicated in cases of ypN1-2-3 axillary status.

Breast radiologists and nuclear medicine specialists have updated their previous recommendation/guidance at the 5th Hungarian Breast Cancer Consensus Conference. They suggest to adopt this actual protocol for the screening, diagnostics and treatment of breast tumors, from now on. This recommendation includes the description of the newest technologies, the recent results of scientific research, as well as the role of imaging methods in the therapeutic processes and the followup. Suggestions for improvement of the current Hungarian practice and other related issues as forensic medicine, media connections, regulations, and reimbursement are also detailed. The guidance has been in agreement with the related medical disciplines.

Over the years since the 4th Breast Cancer Consensus Conference, a substantial body of new evidence based on clinical trial results has been published, necessitating an update of the 2020 recommendations. This professional guideline primarily reflects the current ESMO, NCCN, ABC, and St. Gallen Consensus Conference statements and recommendations. From a didactic perspective, the text first addresses early-stage breast cancer, followed by locally advanced, locoregionally recurrent, and metastatic breast cancer. At the beginning of both the early-stage and metastatic breast cancer sections, we provide a summary of general principles relevant to the respective field, which apply to the subsequent subsections. Within these subsections, therapeutic options are discussed according to genomic subgroups. At the end of the recommendations, considerations for the management of certain rare clinical scenarios are summarized. The appendices cover, among other topics, multidisciplinary team (tumor board) requirements, recommended chemotherapy protocols, and the definition of menopause.

The prognosis of early stage laryngeal carcinoma treated with radiation therapy or surgery (preferably transoral resection) is favorable. In these cases, the choice of the therapy is mainly driven by functional outcomes (speech, swallowing and respiratory function). However, there has not been any substantial improvement in the treatment of locoregionally advanced larynx cancer. The selection of the most ideal therapy is difficult, as upfront total laryngectomy is rather radical, and has a dramatic effect on quality of life, whereas reliable predictors of radiosensitivity are lacking. Moreover, current data undermines the oncologic effectiveness of salvage laryngectomy. In this review, we summarize the current anatomical and functional facts and concepts with respect to the previous clinical trials and studies that might influence the decision making during the treatment of a laryngeal cancer patient in 2025.

Medication-related osteonecrosis of the jaw (MRONJ), associated with antiresorptive and antiangiogenic/immunomodulatory therapies, is a severe condition affecting the jawbones. It most commonly occurs as a side effect of treatments for malignant tumors, osteological, and rheumatological diseases. Spontaneous healing is uncommon, and no definitive causal therapy exists. Surgical interventions, such as sequestrectomy or segmental resection, provide only temporary solutions, as the unpredictable involvement of the entire jawbone complicates the progression of the disease. The development of MRONJ is primarily linked to impaired bone remodeling, especially following trauma, such as tooth extractions. Patients over 65 years of age, those with weakened conditions, diabetes, ongoing steroid therapy, or poor oral hygiene are particularly affected, with the mandibular molar region being especially at risk. This study reviews the causative medications, risk factors, and the importance of early diagnosis and prevention. It also explores research directions aimed at achieving more effective treatments.