Magyar onkologia最新文献

The incidence of head and neck tumours is rising significantly worldwide. Radiotherapy has a significant role in their treatment, not only after surgery, but also as a definitive treatment, as an organ-preserving modality. Nowadays, the incidence of oropharyngeal tumours caused by the human papillomavirus is increasing sharply. They are characterised by a very good therapeutic response, including radiosensitivity, which has led to a number of deintensification trials being carried out or ongoing. Over the past decade, irradiation methods and techniques have improved considerably and changes in therapy have been made to improve the effectiveness of treatment and reduce side effects. Newer treatment options include adaptive irradiation, better definition of the target volume, the use of hadrons, stereotactic irradiation and the rise of artificial intelligence. In the following review, the results of the major publications on the above topics will provide an overview of modern and new therapeutic techniques in the field of radiotherapy of head and neck tumours.

Aim: Our study aimed to conduct a retrospective statistical analysis of 18F-JK-PSMA-7 PET/CT results in high-risk prostate cancer patients as part of primary staging, to assess how these results influenced the original treatment plan.

Methods: The study included high-risk prostate adenocarcinoma patients, localized by conventional imaging, who underwent PSMA PET/CT as part of primary staging between 03/01/2020 and 03/01/2022.

Results: PSMA PET/CT confirmed distant metastasis in 20 out of 74 patients. Among them, 7 received local treatment due to oligometastatic disease. The remaining 13 patients had distant lymph node metastasis (1 patient), bone metastasis only (2 patients), or both (10 patients). Based on PSMA PET/CT results, these 13 patients received systemic treatment instead of local therapy. No significant statistical correlation was found between PSA levels, ISUP score, and distant metastasis verification.

Conclusion: Broader use of PSMA PET/CT in primary staging of high-risk prostate cancer patients could allow for more precise, personalized therapy in the future.

Although most malignant non-melanoma skin cancers are low-risk and curable with surgical intervention, the management of locally advanced and metastasizing tumors is very challenging. Previous systemic treatment options for advanced skin cancer were limited to cytotoxic chemotherapy and anti-epidermal growth factor receptor (EGFR) therapy, with significant morbidity and poor durable response rates, but the newly emerged therapies such as Hedgehog pathway inhibitors and immunotherapies have improved not only the survival, but the patients' quality of life too. The clinical trials of neoadjuvant immunotherapies are still ongoing, but in the case of borderline resection margins or surgical removal with high morbidity or severe functional impairment, immunotherapy can be a good option for aesthetical and functional preservation and provides a long term survival with combination of oncological therapies.

Squamous cell carcinoma is the most prevalent tumor type among the malignancies of the mucosal lined surfaces in the head and neck region. Most frequently the diagnosis is based on the tissue taken from the primary tumor and in some cases an involved lymph node serves as a source of samples. The pathology report plays a crucial role in the decision making which is guided by the different factors included in the report. In this article we aimed to summarize the prognostic and predictive factors regarding squamous cell carcinoma of oral and pharyngeal origin while taking into account the international standards.

Aim: This review aims to evaluate the role of interventional radiotherapy (IRT - brachytherapy) in the clinical management of head and neck (H&N) cancers, focusing on recent technological advancements and their impact on clinical outcomes.

Methods: A comprehensive literature review of clinical applications of IRT in H&N cancers was conducted, emphasizing the role of advanced imaging intensity-modulated IRT and custom applicators. The role of artificial intelligence and several dose calculation algorithms in treatment planning was also analyzed.

Results: IRT demonstrated efficacy across primary treatment, postoperative settings, and reirradiation, offering precise dose delivery while sparing adjacent healthy tissues. Innovations such as image-guided techniques and personalized 3D-printed applicators improved dosimetric accuracy and reduced toxicity. Functional outcomes were particularly favorable in sensitive anatomical regions like the nasal vestibule and oral cavity.

Conclusions: IRT remains a cornerstone of precision oncology for head and neck cancers, achieving high efficacy, reduced toxicity, and improved patient quality of life. These advancements highlight its crucial role in modern oncologic care.

As non-surgical therapies gain acceptance in head and neck tumors, the importance of imaging has increased. New therapeutic methods (in radiation therapy, targeted biological therapy, immunotherapy) need better tumor characterization and prognostic information along with the accurate anatomy. Magnetic resonance imaging (MRI) has become the gold standard in head and neck cancer evaluation not only for staging but also for assessing tumor response, posttreatment status and complications, as well as for finding residual or recurrent tumor. Multiparametric anatomical and functional MRI (MP-MRI) is a true cancer imaging biomarker providing, in addition to high resolution tumor anatomy, more molecular and functional, qualitative and quantitative data using diffusion- weighted MRI (DW-MRI) and perfusion-dynamic contrast enhanced MRI (P-DCE-MRI), can improve the assessment of biological target volume and determine treatment response. DW-MRI provides information at the cellular level about the cell density and the integrity of the plasma membrane, based on water movement. P-DCE-MRI provides useful hemodynamic information about tissue vascularity and vascular permeability. Recent studies have shown promising results using radiomics features, MP-MRI has opened new perspectives in oncologic imaging with better realization of the latest technological advances with the help of artificial intelligence.

The oncological treatment of head and neck tumors, and especially, advanced or metastatic tumor stages, often causes significant impairment in the vital (swallow) and communicative (articulation, phonation) functions. Recently, the quality of life has become such as important as overall survival. Dysphagia has life-threatening consequences, as dehydration, malnutrition and aspiration with choking or pneumonia. The phoniatric rehabilitation with swallow and voice therapy, significantly improves these functions and contributes to the preferred quality of life. Voice rehabilitation after total laryngectomy is one of the most challenging tasks in this rehabilitation field.

Head and neck squamous cell carcinoma (HNSCC) remains a malignancy with high global morbidity and mortality. Over the past decade, systemic treatment paradigms for recurrent/ metastatic (R/M) HNSCC have evolved significantly with the introduction of immuno- and targeted therapies. The phase III KEYNOTE-048 trial established pembrolizumab, alone or in combination with chemotherapy, as a new firstline standard in PD-L1 positive cases. In the second-line setting, the CheckMate 141 and KEYNOTE-040 trials confirmed the survival benefit and favorable safety profile of PD-1 inhibitors. The recent KEYNOTE-689 and NIVOPOSTOP studies highlight the potential role of perioperative and adjuvant immunotherapy in resectable, locally advanced HNSCC. However, multiple negative studies underscore the limitations of immune checkpoint inhibitors in the definitive treatment of locally advanced disease. Defining the optimal sequencing of systemic therapies remains a key clinical challenge in this patient population.

Aim: The reconstruction of large skin tumors in the head and neck region is performed in our center with pedicled flap or free flap. In microvascular reconstructive surgery, the choice of the flap must consider many factors, such as the size and composition of the tissue defect, the distance between the recipient vessels and the defect, or even the donor site morbidity. Taking the resulting quality of life and the donor site morbidity into the account when choosing a reconstructive method is an important pillar of modern reconstructive surgery.

Methods: In this publication, we present a case report of a rarely used SCIP (superficial circumflex iliac artery perforator) flap for the reconstruction of the defect after squamous cell skin cancer tumor resection in temporal region (8×9 cm).

Results: The successful SCIP flap is first published in our national literature in this case report.

Conclusions: SCIP flap usefully completes our reconstructive options due to its low donor site morbidity and its possibility to be harvested in parallel with primary surgery.

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, where the genetic background is of particular importance in terms of the diagnosis, follow-up, treatment and prognosis of the disease. Although the prognosis in benign cases is encouraging, in the case of malignant disease the mortality rates are dramatically worse due to the high tumor burden and possible cardiovascular complications caused by catecholamine oversecretion. In recent years, significant progress has been made both in the functional imaging of the disease and in the therapy of malignant diseases, which in many cases are also related to the underlying genetic background. The aim of our brief summary is to place the diverse genetic background and tumor biology of the disease in the context of diagnostics and therapy, thus highlighting the importance of our understanding of the disease at the individual patient level.