Róbert Farkas

Multisegmented tangential breast fields: a rational way to treat breast cancer.

Purpose:Using three-dimensional conformal radiation therapy (3D-CRT) and multisegmented conformal radiation therapy (MS-CRT) for breast cancer treatment, the dose coverage of the planning target volume (PTV) and the radiation burden on the organs at risk (OARs) were evaluated.Material and Methods:3D-CRT and MS-CRT were planned for 436 unilateral breasts (217 left). All patients were treated with MS-CRT between 2005 and 2007. For PTV delineation and beam orientation, supportive structures were applied. The mean PTV was 1,130 cm3 (in ten patients > 2,200 cm3). Three-dimensional planning with weight-optimized medial and lateral open fields at a total dose of 50.4/1.8 Gy was followed by multisegmented planning with a reasonably high-dose-level dose cloud to define the medial subfield, and renewed optimization. This was repeated for the lateral subfield with a final optimization. For PTV coverage evaluation, the ICRU 50 was considered: the PTV portions receiving 95–107%, < 95% and > 107% of the prescribed dose (PTVD95– 107%, PTVD107%), and the PTV maximal dose (PTVDmax). To compare the OAR radiation burdens, the mean doses to the ipsi-/contralateral lung, contralateral breast, and whole heart were documented.Results:The multisegmented plans furnished significantly (p < 0.0001) better target coverage (PTVD95–107% 82.8% vs. 90.9%, PTVD107% 5.9% vs. 0.3% and PTVDmax 56.6 vs. 54.3 Gy). The mean OAR doses remained almost unchanged: ipsilateral lung 10.5 versus 10.4 Gy, contralateral lung 0.4 versus 0.4 Gy, contralateral breast 0.8 versus 0.8 Gy, and whole heart (for left-sided cancers) 4.8 versus 4.8 Gy. The subfields required a mean of 9.8 MU (monitor units), i.e., a mean total 7.6 MU increment. The planning took 10–20 min, and the delivery 5–10 min.Conclusion:MS-CRT is a good alternative to breast intensity-modulated radiation therapy (IMRT) and seems adequate for right-sided cancers, whereas left-sided cancers necessitate a longer follow-up of heart-related side effects before a final assessment.Ziel:Die Erfassung des Planungszielvolumens (PTV) und die Strahlenbelastung der Risikoorgane (OARs) bei dreidimensionaler konformaler Radiotherapie (3D-CRT) oder multisegmentaler konformaler Radiotherapie (MS-CRT) des Mammakarzinoms wurden ausgewertet.Material und Methodik:Dreidimensionale und multisegmentale konformale Bestrahlungspläne wurden für 436 unilaterale (217 linksseitige) Brüste erstellt. Zwischen 2005 und 2007 erhielten alle Patientinnen eine MS-CRT. Zur PTV-Konturierung und Feldausrichtung wurden Hilfsstrukturen angebracht. Das durchschnittliche PTV betrug 1 130 cm3 (bei zehn Patientinnen > 2 200 cm3). Im Anschluss an die dreidimensionale Planung mit optimal gewichteten medialen und lateralen Feldern bis zu einer Gesamtdosis 50,4/1,8 Gy erfolgte die multisegmentale Planung mit einer angemessen hohen Dosiswolke für das mediale Teilfeld und erneuter Optimierung. Dies wurde für das laterale Teilfeld wiederholt und abschließend optimiert. Bei der Beurteilung der PTV-Erfassung wurde der ICRU 50 berücksichtigt: die Anteile des PTV, die 95–107%, < 95% und > 107% der verordneten Dosis erhielten (PTVD95–107%, PTVD107%), sowie das Dosismaximum (PTVDmax). Zum Vergleich der Dosisbelastung der OARs wurden die Durchschnittsdosen der ipsi-/kontralateralen Lungen, der kontralateralen Brust und des Herzen dokumentiert.Ergebnisse:Die multisegmentale Planung erbrachte eine signifikant (p < 0,0001) bessere PTV-Erfassung (PTVD95–107% 82,8% vs. 90,9%, PTVD107% 5,9% vs. 0,3% und PTVDmax 56,6 vs. 54,3 Gy). Die durchschnittlichen OAR-Dosen blieben nahezu unverändert: ipsilaterale Lunge 10,5 versus 10,4 Gy, kontralaterale Lunge 0,4 versus 0,4 Gy, und kontralaterale Brust 0,8 versus 0,8 Gy, Herz (bei linksseitigem Brustkrebs) 4,8 versus 4,8 Gy. Für die Teilfelder wurden durchschnittlich 9,8 MU (Monitoreinheiten) benötigt, d.h. eine Gesamterhöhung um im Mittel 7,6 MU. Die Planungsprozedur dauerte 10–20 min und die Bestrahlung 5–10 min.Schlussfolgerung:Die MS-CRT stellt eine gute Alternative zur intensitätsmodulierten Radiotherapie (IMRT) der Brust dar und scheint sich vor allem bei rechtsseitigem Brustkrebs anzubieten, während bei Befall der linken Mamma aufgrund der kardialen Nebenwirkungen vor einer abschließenden Bewertung eine längere Nachbeobachtung erforderlich ist.

Chemo-radiotherapy in locally advanced squamous cell oesophageal cancer--are upper third tumours more responsive?

Before neoadjuvant therapy was widely applied, the prognosis of oesophageal cancer had been considered dependent on the location of the tumor, i.e. upper third cancers had had the worst prognosis. The aim of this retrolective study was to prove the efficiency of the neoadjuvant treatment, and to compare the response of esophageal cancer in different locations. Between January 1998 and September 2005, 102 patients with locally advanced squamous cell oesophageal cancer received preoperative chemo-radiotherapy. In 40 cases the tumor was located in the upper third and in 62 cases in the middle third of the oesophagus. After a four-week-long treatment free period restaging was carried out and patients considered resectable were submitted to surgery. From 40 patients with upper third oesophageal cancer 28 underwent oesophageal resection or pharyngo-laryngectomy. Thiry-five percent a complete histopathological remission was observed. From 62 patients with middle third oesophageal cancer 43 underwent oesophageal resection. Histological examination of the resected specimens documented complete response only in three patients. The median survival and the R0 resection rate were similar in the two groups. Although the resection rate, perioperative morbidity, mortality and the median survival were similar in the two groups, a significantly higher rate of complete response (p < 0,05) was observed in patients with upper third oesophageal cancer compared to patients with middle third oesophageal cancer. It seems that upper third oesophageal cancer has superior sensitivity to multimodal treatment therefore our results may support that upper third location is not an unfavorable prognostic factor any more.

Conkiss: conformal kidneys sparing 3D noncoplanar radiotherapy treatment for pancreatic cancer as an alternative to IMRT.

When treating pancreatic cancer using standard (ST) 3D conformal radiotherapy (3D-CRT) beam arrangements, the kidneys often receive a higher dose than their probable tolerance limit. Our aim was to elaborate a new planning method that--similarly to IMRT--effectively spares the kidneys without compromising the target coverage. Conformal kidneys sparing (CONKISS) 5-field, noncoplanar plans were compared with ST plans for 23 consecutive patients retrospectively. Optimal beam arrangements were used consisting of a left- and right-wedged beam-pair and an anteroposterior beam inclined in the caudal direction. The wedge direction determination (WEDDE) algorithm was developed to adjust the adequate direction of wedges. The aimed organs at risk (OARs) mean dose limits were: kidney <12 Gy, liver <25 Gy, small bowels <30 Gy, and spinal cord maximum <45 Gy. Conformity and homogeneity indexes with z-test were used to evaluate and compare the different planning approaches. The mean dose to the kidneys decreased significantly (p < 0.05): left kidney 7.7 vs. 10.7 Gy, right kidney 9.1 vs. 11.7 Gy. Meanwhile the mean dose to the liver increased significantly (18.1 vs. 15.0 Gy). The changes in the conformity, homogeneity, and in the doses to other OARs were not significant. The CONKISS method balances the load among the OARs and significantly reduces the dose to the kidneys, without any significant change in the conformity and homogeneity. Using 3D-CRT the CONKISS method can be a smart alternative to IMRT to enhance the possibility of dose escalation.

The role of neoadjuvant therapy in the treatment of locally advanced squamous cell cancer of the cervical oesophagus

INTRODUCTION Cervical oesophagus represents a critical location for squamous cell carcinoma, which usually requires extensive surgery (pharyngo-laryngo-oesophagectomy). In the last decade, neoadjuvant chemo-radiotherapy was reported to be beneficial in the treatment of locally advanced squamous cell oesophageal cancer. METHODS Between November 1997 and January 2012, 55 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy, where the tumour was localized in the upper third. Patients received preoperative irradiation of 3960 cGy in 180 cGy fractions and simultaneously Cisplatin and 5-FU chemotherapy. Restaging was carried out after four weeks and patients considered operable were underwent surgery. RESULTS In patients with cervical oesophageal cancer 35 of 55 (64%) underwent oesophageal resection or pharyngo-laryngectomy. In 16 out of 35 resected specimens (46%) complete histopathological remission (pCR) was observed. Perioperative mortality and anastomotic leaks were the same: 5/35 (14%). R0 resection rate was 82% and the 2- and 5 years survival rates were 41% and 18%. In 19 cases a larynx preserving pharyngo-oesophagectomy was performed and a free jejunal graft was used for reconstruction after a pharyngo-laryngectomy in 11 cases. CONCLUSION The high rate of pCR (46%) confirmed that upper third oesophageal cancer has superior sensitivity to multimodal treatment. In 30 cases neoadjuvant chemo-radiotherapy was able to achieve tumour regression and render pharyngo-laryngo-oesophagectomy unnecessary.

Possible Predictive Markers of Response to Therapy in Esophageal Squamous Cell Cancer

The aim of the present study was to investigate the relationship between the intensity of biomarker expression and the response to radiochemotherapy in patients with advanced esophageal squamous cell cancer (ESCC). Ninety-two patients with locally advanced ESCC were examined retrospectively. Pre-treatment tumor samples were stained for proteins SOUL, Hsp 16.2, Growth Hormone-Releasing Hormone Receptor (GHRH-R) and p-Akt using immunhistochemistry methods. Kaplan-Meier curves were used to show the relationship between intensity of expression of biomarkers and clinical parameters and 3-year OS. A significant correlation was found between high intensity staining for Hsp 16.2, p-Akt and SOUL and poor response to NRCT. Application of a higher dose of radiation and higher dose of cisplatin resulted in better clinical and histopathological responses, respectively. Among the clinical parameters, the localization of the tumor in the upper-third of the esophagus and less than 10% weight loss were independent prognostic factors for increased 3-year OS. Hsp16.2, p-Akt and SOUL are predictors of negative response to NRCT, therefore these biomarkers may become promising targets for therapy. Furthermore, level of expression of p-Akt, weight loss and the localization of the tumor are significant factors in the prediction of OS in ESCC.

Paradigmaváltás szükségessége a sugárterápiában

Absztrakt A sugarterapia helye es indikacioja az utobbi evtizedben alapjaiban valtozott es bővult. Az uj technikak es sugarbiologiai kutatasok, valamint informatikai fejlesztesek jelentősen javitottak a szolid tumorok es metasztazisok sugarkezeleseben a lokalis eredmenyesseget. A komputertomografia-alapu (egyeb metszetkepalkoto vizsgalatokkal adaptalt) kiegeszitett sugarterapias celterulet kijelolesevel a tumoros es kornyező ep szovetek pontosabb abrazolasa valt lehetőve. Az uj sugarterapias technikak kozul az intenzitas- vagy terfogatmodulalt ivbesugarzassal (volumetric modulated arc therapy) a celteruletben a dozis optimalisan emelhető a kornyező ep szovetek sugarkarosodasa nelkul. Ezek segitsegevel ugyanakkor lehetőseg van uj indikaciokra is. Ezek kozott emlitendő az intracranialis metasztazisok mellett az extracranialis, ugynevezett oligometasztazisok kozel kurativ (hosszu evekig tarto stabil allapot vagy remisszio) stereotaxias sugarterapiaja. Az oligometasztazisok kozott talan leglatvanyosabb eredme...

New methods in the treatment of localized prostate cancer: usage of dynamic arc therapy and kV cone-beam CT positioning

Bevezetes: A prosztatarak az idősebb eletkor es a fejlett vilag daganatos megbetegedese. Lokalizalt prosztatarak eseteben a műteti ellatas mellett komoly szerepe van a definitiv sugarkezelesnek. Celkitűzes: A szerzők intezeteben telepitett Novalis TX gyorsito segitsegevel ugynevezett intenzitasmodulalt sugarterapia, annak dinamikus ivbesugarzassal elvegzett formaja, illetve verifikacio soran haromdimenzios lagy szoveti kepellenőrzest biztosito, integralt kilovoltos cone-beam komputertomografiaval vegzett kepvezerelt sugarterapia kerult bevezetesre, amely modszerekkel szerzett első tapasztalataikat ismertetik a szerzők. Modszer: 2011 decembere es 2013 februarja kozott, doziseszkalaciot kovetően, 102 dinamikus ivbesugarzassal elvegzett kezelest vegeztek, majd 10-10 szelektalt, alacsony es magas kockazatu betegnel (atlageletkor 72,5 ev) elkeszitettek a haromdimenzios konformalis besugarzasi terveket is. Azonos celterulet-lefedettseg mellett osszevetettek a rizikoszervek dozisterheleset. Eredmenyek: A dinamikus ivbesugarzassal elvegzett kezelesek mellett a rizikoszervek szignifikansan alacsonyabb dozisterheleset ertek el, amelyet a kedvező korai mellekhatasprofil is alatamaszt. Kovetkeztetesek: Az intenzitasmodulalt sugarterapia dinamikus ivbesugarzassal elvegzett formaja biztonsaggal alkalmazott standard kezelesi modozatta valt a szerzők intezeteben. Kesői mellekhatasok es lokalis kontroll tovabbi vizsgalata szukseges. Orv. Hetil., 2014, 155(32), 1265–1272. | Introduction: Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. Aim: The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. Method: Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. Results: Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. Conclusions: The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.INTRODUCTION Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. AIM The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. METHOD Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. RESULTS Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. CONCLUSIONS The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.

Új módszerek a prosztatadaganatok sugárkezelé sében: dinamikus ívbesugárzás és kilovoltos .,cone-beam" komputertomográfiás ellenorzés

Bevezetes: A prosztatarak az idősebb eletkor es a fejlett vilag daganatos megbetegedese. Lokalizalt prosztatarak eseteben a műteti ellatas mellett komoly szerepe van a definitiv sugarkezelesnek. Celkitűzes: A szerzők intezeteben telepitett Novalis TX gyorsito segitsegevel ugynevezett intenzitasmodulalt sugarterapia, annak dinamikus ivbesugarzassal elvegzett formaja, illetve verifikacio soran haromdimenzios lagy szoveti kepellenőrzest biztosito, integralt kilovoltos cone-beam komputertomografiaval vegzett kepvezerelt sugarterapia kerult bevezetesre, amely modszerekkel szerzett első tapasztalataikat ismertetik a szerzők. Modszer: 2011 decembere es 2013 februarja kozott, doziseszkalaciot kovetően, 102 dinamikus ivbesugarzassal elvegzett kezelest vegeztek, majd 10-10 szelektalt, alacsony es magas kockazatu betegnel (atlageletkor 72,5 ev) elkeszitettek a haromdimenzios konformalis besugarzasi terveket is. Azonos celterulet-lefedettseg mellett osszevetettek a rizikoszervek dozisterheleset. Eredmenyek: A dinamikus ivbesugarzassal elvegzett kezelesek mellett a rizikoszervek szignifikansan alacsonyabb dozisterheleset ertek el, amelyet a kedvező korai mellekhatasprofil is alatamaszt. Kovetkeztetesek: Az intenzitasmodulalt sugarterapia dinamikus ivbesugarzassal elvegzett formaja biztonsaggal alkalmazott standard kezelesi modozatta valt a szerzők intezeteben. Kesői mellekhatasok es lokalis kontroll tovabbi vizsgalata szukseges. Orv. Hetil., 2014, 155(32), 1265–1272. | Introduction: Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. Aim: The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. Method: Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. Results: Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. Conclusions: The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.INTRODUCTION Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. AIM The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. METHOD Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. RESULTS Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. CONCLUSIONS The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.

Új módszerek a prosztatadaganatok sugárkezelésében: dinamikus ívbesugárzás és kilovoltos „cone-beam” komputertomográfiás ellenőrzés@@@New methods in the treatment of localized prostate cancer: usage of dynamic arc therapy and kV cone-beam CT positioning

Bevezetes: A prosztatarak az idősebb eletkor es a fejlett vilag daganatos megbetegedese. Lokalizalt prosztatarak eseteben a műteti ellatas mellett komoly szerepe van a definitiv sugarkezelesnek. Celkitűzes: A szerzők intezeteben telepitett Novalis TX gyorsito segitsegevel ugynevezett intenzitasmodulalt sugarterapia, annak dinamikus ivbesugarzassal elvegzett formaja, illetve verifikacio soran haromdimenzios lagy szoveti kepellenőrzest biztosito, integralt kilovoltos cone-beam komputertomografiaval vegzett kepvezerelt sugarterapia kerult bevezetesre, amely modszerekkel szerzett első tapasztalataikat ismertetik a szerzők. Modszer: 2011 decembere es 2013 februarja kozott, doziseszkalaciot kovetően, 102 dinamikus ivbesugarzassal elvegzett kezelest vegeztek, majd 10-10 szelektalt, alacsony es magas kockazatu betegnel (atlageletkor 72,5 ev) elkeszitettek a haromdimenzios konformalis besugarzasi terveket is. Azonos celterulet-lefedettseg mellett osszevetettek a rizikoszervek dozisterheleset. Eredmenyek: A dinamikus ivbesugarzassal elvegzett kezelesek mellett a rizikoszervek szignifikansan alacsonyabb dozisterheleset ertek el, amelyet a kedvező korai mellekhatasprofil is alatamaszt. Kovetkeztetesek: Az intenzitasmodulalt sugarterapia dinamikus ivbesugarzassal elvegzett formaja biztonsaggal alkalmazott standard kezelesi modozatta valt a szerzők intezeteben. Kesői mellekhatasok es lokalis kontroll tovabbi vizsgalata szukseges. Orv. Hetil., 2014, 155(32), 1265–1272. | Introduction: Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. Aim: The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. Method: Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. Results: Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. Conclusions: The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.INTRODUCTION Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. AIM The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. METHOD Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. RESULTS Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. CONCLUSIONS The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.

Novel quality assurance method in oncology: the two-level, multi-disciplinary and oncotherapy oncology team system

By now therapy decision taken by a multi-disciplinary oncology team in cancer care has become a routine method in worldwide. However, multi-disciplinary oncology team has to face more and more difficulties in keeping abreast with the fast development in oncology science, increasing expectations, and financial considerations. Naturally the not properly controlled decision mechanisms, the permanent lack of time and shortage of professionals are also hindering factors. Perhaps it would be a way out if the staff meetings and discussions of physicians in the oncology departments were transformed and provided with administrative, legal and decision credentials corresponding to those of multi-disciplinary oncology team. The new form of the oncotherapy oncoteam might be able to decide the optimal and particular treatment after previous consultation with the patient. The oncotherapy oncoteam is also suitable to carry out training and tasks of a cancer centre and by diminishing the psychological burden of the doctors it contributes to an improved patient care. This study presents the two-level multi-disciplinary and oncotherapy oncology team system at the University of Pécs including the detailed analysis of the considerations above.