Tamas Beothe

Laparoscopic Repair of Circumcaval Ureter: One-year Follow-up of Three Patients and Literature Review

OBJECTIVES To describe our experience and 1-year follow-up of 3 patients with circumcaval ureter (CU) treated laparoscopically, with the introduction of a new stenting method and review of the published data. Because of its rarity, more reports are needed to advocate more comprehensive knowledge about the preferred surgical technique for the treatment of CU. METHODS Since November 2005, 3 patients with symptomatic CU have undergone laparoscopic repair of their anomaly at our institutes. In all 3 cases, the ureter was transected and positioned anteriorly with an end-to-end anastomosis. In 2 cases, the retrocavally located ureteral segment was resected. RESULTS The mean operative time in our series was 210 minutes, without any intraoperative or early postoperative complications. In 1 patient, a slight ureteral stricture was detected that resolved with reinsertion of a double-J stent. Histopathologic examination of the resected ureteral segments revealed sclerosis and muscular hypertrophy. All patients remained symptom free during the 1 year of follow-up. CONCLUSIONS With all the advantages of a minimally invasive procedure and preserving therapeutic efficacy, the laparoscopic approach should be considered a standard choice for surgical treatment of CU in symptomatic patients. Care should be taken to diagnose and excise the pathologically narrowed ureteral segment.

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

The aim of our analysis was to compare the cost-effectiveness of high-dose intensity-modulated radiation therapy (IMRT) and hypofractionated intensity-modulated radiation therapy (HF-IMRT) versus conventional dose three-dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality-adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF-IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality-adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF-IMRT. Compared to 3DCRT, both IMRT and HF-IMRT resulted in more health gains at a lower cost. It can be concluded that high-dose IMRT is not only cost-effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost-saving potential for the public payer and may improve access to radiation therapy for patients.

Homozygous losses detected by array comparative genomic hybridization in multiplex urothelial carcinomas of the bladder

Urothelial carcinomas (UCs) may present at first as a solitary or multifocal neoplasm. We applied high resolution array comparative genomic hybridization to 24 solitary and 32 multiplex UCs and used the hidden Markov model algorithm to identify the copy number changes at the probe level. Copy number losses and homozygous deletions at the chromosome 9p region affecting the CDKN2A and MTAP genes were the most frequent alterations in both groups of tumors. We have delineated two new tumor suppressor gene regions at chromosome 9p that harbor the PTPRD and BNC2 genes. Copy number losses at chromosomal regions 2q, 8p, and 18p occurred preferentially in solitary UCs, whereas multiplex UCs displayed loss of large chromosomal regions at 9q, 10q, 11q, 18q, and 21q. Homozygous deletions harboring loci of cell adhesion genes such as claudins, desmocollins, and desmogleins were seen exclusively in multiplex UCs. Amplifications occurred only in invasive G3 UCs irrespective of staging. Our study suggests that solitary and multiplex UCs may have divergent genetic pathways. The biallelic inactivation of cellular adhesion genes by homozygous deletions in multiplex UCs may explain the frequent intravesical spreading of tumor cells. .

Sciellin is a marker for papillary renal cell tumours

There are no adequate immunohistochemical markers for papillary renal cell tumours. The aim of this study was to establish a gene expression profile of papillary renal cell tumours using an expression microarray approach. Through hierarchical clustering and significant analysis of microarrays, we have selected the best 13 genes and analysed their expression by real-time polymerase chain reaction (RT-PCR). Of these genes, we selected SCEL as potential marker of interest. Immunohistochemical staining of tissue microarrays containing all major types of kidney cancers revealed positive staining for sciellin in 87 of 114 papillary renal cell tumours and in 13 of 19 precursor lesions. No other renal tumour types were positive for sciellin. Our study indicates that although not all tumours express sciellin, its expression may help to confirm the diagnosis papillary renal cell tumour.

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.