Tamás Pulay

Does increasing the steroid dose enhance the efficacy of the antiemetic combination of granisetron and methylprednisolone in gynecologic cancer patients--a randomized study.

OBJECTIVE The authors administered two doses of oral methylprednisolone in combination with 3mg granisetron intravenously for the prophylaxis of cisplatin-induced emesis in gynecologic cancer patients. MATERIALS AND METHODS Thirty-nine patients received 100mg (group A) and 25 received 200mg (group B) methylprednisolone in the antiemetic combination in a randomized prospective trial. RESULTS No vomiting in 90.2 and 96.7%, one emetic episode in 3 and 1.1% and two episodes in 3 and 2.2% were detected in groups A and B, respectively. More than two emetic episodes were considered to be a failure and were observed only in group A (3.8%). There was no significant difference between the two treatment groups (P=0.3160). CONCLUSIONS There was no evidence for enhanced antiemetic effect of elevated steroidal dose in combination with granisetron.

Hypersensitivity reactions in paclitaxel treatment of ovarian cancer patients

Paclitaxel (PTXL) chemotherapy for treatment of epithelial ovarian cancers has become common worldwide since the 1990s. In early treatments severe allergic hypersensitivity reactions (HSR) were observed. These reactions included hypotension dyspnoea with or without bronchospasm urticaria angio-oedema or occasionally syncope-causing cardiotoxicity which had required medical intervention. Effective premedication has included corticosteroids together with H1 and H2 histamine antagonists resulting in dramatically fewer and diminished severity of side effects (Markman et al. 2000). In Hungary PTXL was introduced into practice for adjuvant chemotherapy of ovarian cancers in 1996. The authors report on HSRs developed in PTXL treatments. (authors)

Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study

The role of preoperative intrauterine brachytherapy (BT) in the multidisciplinary treatment of early stage cervical carcinoma (ESCC) is controversial. In 2005, a prospective randomized multicenter study was initiated in Hungary in order to explore the potential advantages of preoperative high-dose-rate (HDR) BT. In this article we evaluate the efficiency of preoperative HDR BT by the rate of pathologic complete remission (pCR) in the first 185 patients enrolled in the study at the National Institute of Oncology and at the Uzsoki Municipal Cancer Center in collaboration with the 1st Department of Gynaecology and Obstetrics of Semmelweis University, Budapest, Hungary. In arm A, patients received 2x8Gy preoperative intracavitary HDR BT, while in arm B no preoperative treatment was given. In both arms patients underwent radical Wertheim (Piver III) hysterectomy. The pCR rate was 25.7% after preoperative HDR BT, while it was only 11.2% with surgery alone (p=0.03), in these cases the tumor was eliminated during the diagnostic excision or conisation. The rate of positive surgical margins was 1.5% after preoperative BT, while it was as high as 11.4% without preoperative RT (p=0.02). There was no significant difference in the local tumor control (LTC), distant metastases free survival (DMFS) and overall survival (OS) between the two arms. According to our preliminary results preoperative intracavitary HDR BT significantly increases the rate of pCR and decreases the rate of positive surgical margins in patients with ESCC. Longer follow-up is required to establish the possible impact of pCR on the ultimate LTC and OS.

Frequency of blood transfusions for anemia due to chemotherapy in ovarian cancer patients. Thoughts to the guidelines modified in 2006 for the treatment of anemic cancer patients by the European Organisation for Research and Treatment of Cancer

INTRODUCTION The European Organisation for Research and Treatment of Cancer distributed the modified guidelines for blood transfusions and erythropoietic drugs in the treatment of cancer anemia in the year 2006. According to this document the blood transfusions are indicated at the level of 9 g/dL of hemoglobin. Up to this year a definitive limit for applying blood transfusion in chemotherapy-induced anemia has not been determined in Hungary. AIM The authors evaluated their practice in the treatment of anemia with blood transfusions in ovarian cancer patients treated in 2005. In lack of international or domestic guidelines, considering also the clinical status of the patients, the authors applied blood transfusions at a hemoglobin level of 10 g/dL. MATERIAL AND METHODS 190 epithelial ovarian cancer patients were given chemotherapy in the Gynecological Department at the National Institute of Oncology, Hungary. Selected for the patient packed red blood cell transfusion was administered if the hemoglobin has fallen below 10 g/dL, and together with it most patients (51/64 = 79,6%) were given erythropoietic drugs as well. RESULTS Blood transfusion was given in 64 of 190 (34%) chemotherapies patients and almost the half of these latter patients (34/64 = 53%) were transfused more than once. In 86% of patients blood transfusion was given for G2 anemia. The largest rate (16/16) of blood transfusions according to the different types of chemotherapy was done in patients receiving combined therapy with gemcitabine and carboplatin. CONCLUSION Chemotherapy for ovarian cancer causes severe anemia (hemoglobin level < 10 g/dL) in one third of patients. Besides blood transfusions, physicians have to pay attention to the necessity of erythropoietic drugs, as well.

About the infrequent thrombotic events during erythropoietin therapy of anemic ovarian cancer patients with chemotherapy

Bevezetes: A daganatos betegek kemoterapiaja kapcsan fellepő anemia miatt adott erythropoetin-kezelesek ritka velejaroja a trombozis. Az epoetint gyarto cegek valamennyi ilyen keszitmeny ismertetőjeben felhivjak a figyelmet erre az esetleges mellekhatasra. Cel: A petefeszekrakos betegek kemoterapiaja kapcsan adott epoetinkezelesek soran fellepő thromboticus esemenyek attekintese. Anyag es modszer: Az Orszagos Onkologiai Intezet Nőgyogyaszati osztalyan a 2000 es 2006 kozotti időszakban 275 petefeszekrakos beteg kozul 52 kapott epoetin-alfa, 157 epoetin-beta, 66 beteg pedig darbepoetin-alfa-kezelest. A betegek eletkora median 60 (szelső ertekek 22, 84) ev volt. Eredmeny: A 275 kozul 1 betegben epoetin-alfa-, 2 betegben pedig epoetin-beta-kezeles kapcsan figyeltek meg thromboticus esemenyt (3/275 = 1,1%). A kialakult trombozisok es az epoetinkezeles kozotti egyertelmű okozati osszefuggest igazolni nem sikerult. Kovetkeztetes: A nagy irodalmi metaanalizisekkel megegyezően a szerzők beteganyagaban is csak igen...

Survival reflecting the effectivity of primary operation in patients with epithelial ovarian cancer

A petefeszekrakos betegek kezeleseben az elsődleges műtet nagy jelentősegű. Az optimalis eredmennyel operalt betegek tulelese jobb, mint azoke, akikben a műtetet kovetően meg marad vissza daganat. A nőgyogyasz-onkologusok vegezte műtetekben gyakoribb az optimalis eredmeny, mint az altalanos nőgyogyaszok vagy sebeszek vegezte beavatkozasokban. Celkitűzes: A szerzők az Orszagos Onkologiai Intezet Nőgyogyaszati Osztalyan 2000 es 2002 kozott első vonalu paclitaxel-carboplatin kezelesben reszesitett 83 hameredetű petefeszekrakos beteg adatait ertekeltek 35 honapos kovetesi időszakban. Anyag es modszer: A betegek atlagos eletkora a kezeles elejen 53,9 ± 9,8 ev volt. Elsődlegesen optimalis műtet 45, nem optimalis műtet pedig 38 betegben tortent. A ket betegcsoportban a stadium megoszlasa hasonlo volt. A progressziomentes tuleles statisztikai ertekelese a Kaplan- es Meier-fele produktlimit-eljaras szerint tortent. Eredmenyek: Az optimalis es nem optimalis eredmenyessegű első műtet szerint 35-35 honapos, a radikal...

Evaluation of mostly given second-line chemotherapies of epithelial ovarian cancer recurrences

A petefeszekrakok masodik vonalu kemoterapiaival 2,3–42 honapos progressziomentes tulelesekről lehet olvasni. Celkitűzes: A szerzők a masodik vonalu paclitaxel-carboplatin-, topotecan-, es cisplatin-epirubicin-etoposid kemoterapiakat ertekeltek. Modszer: A paclitaxel-carboplatin kombinaciot 13 beteg 3 hetente 175 mg/m 2 , illetőleg AUC 5-dozisban, a topotecant 16 beteg 3 hetente, 1,5 mg/m 2 /1–5 nap dozisban, a cisplatin-epirubicin-etoposid kombinaciot (33 mg/m 2 /1–3 nap – 60 mg/m 2 /1 nap – 100 mg/m 2 /1–3 nap) pedig 4 hetenkent 48 beteg kapta. A progressziomentes tuleles statisztikai ertekelese a Kaplan–Meier-fele product-limit eljaras szerint tortent. Eredmenyek: A paclitaxel-carboplatin es a cisplatin-epirubicin-etoposid kemoterapiakkal a topotecanhoz kepest szignifikansan jobb progressziomentes időszak (5 es 5,5 honap vs 4 honap, p = 0,0324 es p = 0,0087) igazolodott, es mindharom kezeles jobb progressziomentes időszakot (6 es 3,5 honap, 7 es 4 honap ill. 6,5 es 3,5 honap) eredmenyezett a platinaerz...