Zsuzsa Póti

Concomitant Radiochemotherapy of Cervical Cancer

Purpose:To review the experiences regarding the therapeutic response and side effects of concomitant radiochemotherapy of cervical cancer carried out with different cisplatin doses.Patients and Methods:At the Municipal Center for Oncoradiology, Budapest, Hungary, 92 patients with cervical cancer were treated with concomitant radiochemotherapy in the period between July 2002 and March 2007. The total dose of high-energy external radiation (megavoltage) treatment was 50.4 Gy with a fraction dose of 1.8 Gy on the small pelvis. Before irradiation, cisplatin 40 mg/m2, 30 mg/m2, or 20 mg/m2 was administered once a week.Results:In 17 cases, the cisplatin dose was 30 mg/m2; during radiochemotherapy the number of cisplatin treatments was equal to or more than four in 14 patients (82%). After administering 40 mg/m2 cisplatin to 64 patients, chemotherapy in four or more treatments could only be applied in 37 cases (58%). Eleven patients received cisplatin at the dose of 20 mg/m2; in ten (91%) of them, the number of treatments was four or more. By comparing the side effects, it can be stated that hematologic side effects (mostly leukopenia) grade 3 occurred in 12% of the patients receiving cisplatin 30 mg/m2, and grade G3–4 in 16% of the 40-mg/m2 cisplatin group. For cisplatin 30 mg/m2, 82% of hematologic side effects were in the G1 range. There was no significant difference between the 20- and 30-mg/m2 regimens. As for the gastrointestinal toxicity, similar side effects grade 1 were detected, which occurred in 58% and 38% of the patients receiving 30 mg/m2 and 40 mg/m2, respectively.Conclusion:On the basis of a detailed analysis, the correlation between the number of treatments, the therapeutic and the side effects could be verified. In the course of dose reduction, there was no significant difference when comparing the results of therapy, however, the quality of life was better if cisplatin 30 mg/m2 was administered instead of 40 mg/m2. If cisplatin 20 mg/m2 was given, the results were significantly worse. On the basis of the own results, it can be stated that the optimal weekly dose of cisplatin is 30 mg/m2.Ziel:Reduktion der Cisplatindosis bei der Radiochemotherapie des Zervixkarzinoms in Abhängigkeit von therapeutischen Effekten und Nebenwirkungen.Patienten und Methodik:Zwischen Juli 2002 und März 2007 erhielten 92 Patientinnen mit Zervixkarzinom am Städtischen Onkoradiologischen Zentrum, Budapest, Ungarn, eine Radiochemotherapie. Das kleine Becken wurde mit einer Gesamtdosis von 50,4 Gy (28 Fraktionen à 1,8 Gy) bestrahlt. Vor der Radiotherapie wurde Cisplatin wöchentlich in einer Dosierung von einmal 40 mg/m2, 30 mg/m2 oder 20 mg/m2 Körperoberfläche gegeben.Ergebnisse:17 Patientinnen erhielten zusätzlich zur Radiotherapie 30 mg/m2 Cisplatin, 14 von ihnen (82%) tolerierten vier oder mehr Cisplatinapplikationen. In der Gruppe mit 40 mg/m2 Cisplatin vertrugen nur 37 Patientinnen (58%) vier oder mehr Cisplatinapplikationen. In der dritten Gruppe (elf Patientinnen) erhielten zehn Patientinnen (91%) vier oder mehr Cisplatinbehandlungen mit 20 mg/m2/Woche. Beim Vergleich der Nebenwirkungen konnte festgestellt werden, dass hämatologische Nebenwirkungen (meist Leukopenie) Grad 3 bei 12% der Gruppe mit 30 mg/m2 und Grad 3–4 bei 16% der Gruppe mit 40 mg/m2 Cisplatin auftraten. 82% der hämatologischen Nebenwirkungen unter 30 mg/m2 Cisplatin wurden als Grad 1 eingestuft. Es konnte kein Unterschied zwischen den Schemata mit 20 und 30 mg/m2 gefunden werden. Bezüglich der gastrointestinalen Toxizität wurden ebenfalls Grad-1-Nebenwirkungen beobachtet, die bei 30 mg/m2 in 58% und bei 40 mg/m2 in 38% auftraten.Schlussfolgerung:Die optimale wöchentliche Dosierung für Cisplatin beträgt 30 mg/m2. Zwischen der kumulativen Cisplatindosis und der therapeutischen Effektivität besteht eine deutliche Korrelation. 40 mg/m2 erhöhten die therapeutische Wirkung nicht. Die Lebensqualität der Patientinnen war aber bei kleineren Dosen besser. 20 mg/m2 Cisplatin ergaben signifikant schlechtere Resultate.

Concomitant radiochemotherapy of cervical cancer: is it justified to reduce the dosage of cisplatin?

Purpose:To review the experiences regarding the therapeutic response and side effects of concomitant radiochemotherapy of cervical cancer carried out with different cisplatin doses.Patients and Methods:At the Municipal Center for Oncoradiology, Budapest, Hungary, 92 patients with cervical cancer were treated with concomitant radiochemotherapy in the period between July 2002 and March 2007. The total dose of high-energy external radiation (megavoltage) treatment was 50.4 Gy with a fraction dose of 1.8 Gy on the small pelvis. Before irradiation, cisplatin 40 mg/m2, 30 mg/m2, or 20 mg/m2 was administered once a week.Results:In 17 cases, the cisplatin dose was 30 mg/m2; during radiochemotherapy the number of cisplatin treatments was equal to or more than four in 14 patients (82%). After administering 40 mg/m2 cisplatin to 64 patients, chemotherapy in four or more treatments could only be applied in 37 cases (58%). Eleven patients received cisplatin at the dose of 20 mg/m2; in ten (91%) of them, the number of treatments was four or more. By comparing the side effects, it can be stated that hematologic side effects (mostly leukopenia) grade 3 occurred in 12% of the patients receiving cisplatin 30 mg/m2, and grade G3–4 in 16% of the 40-mg/m2 cisplatin group. For cisplatin 30 mg/m2, 82% of hematologic side effects were in the G1 range. There was no significant difference between the 20- and 30-mg/m2 regimens. As for the gastrointestinal toxicity, similar side effects grade 1 were detected, which occurred in 58% and 38% of the patients receiving 30 mg/m2 and 40 mg/m2, respectively.Conclusion:On the basis of a detailed analysis, the correlation between the number of treatments, the therapeutic and the side effects could be verified. In the course of dose reduction, there was no significant difference when comparing the results of therapy, however, the quality of life was better if cisplatin 30 mg/m2 was administered instead of 40 mg/m2. If cisplatin 20 mg/m2 was given, the results were significantly worse. On the basis of the own results, it can be stated that the optimal weekly dose of cisplatin is 30 mg/m2.Ziel:Reduktion der Cisplatindosis bei der Radiochemotherapie des Zervixkarzinoms in Abhängigkeit von therapeutischen Effekten und Nebenwirkungen.Patienten und Methodik:Zwischen Juli 2002 und März 2007 erhielten 92 Patientinnen mit Zervixkarzinom am Städtischen Onkoradiologischen Zentrum, Budapest, Ungarn, eine Radiochemotherapie. Das kleine Becken wurde mit einer Gesamtdosis von 50,4 Gy (28 Fraktionen à 1,8 Gy) bestrahlt. Vor der Radiotherapie wurde Cisplatin wöchentlich in einer Dosierung von einmal 40 mg/m2, 30 mg/m2 oder 20 mg/m2 Körperoberfläche gegeben.Ergebnisse:17 Patientinnen erhielten zusätzlich zur Radiotherapie 30 mg/m2 Cisplatin, 14 von ihnen (82%) tolerierten vier oder mehr Cisplatinapplikationen. In der Gruppe mit 40 mg/m2 Cisplatin vertrugen nur 37 Patientinnen (58%) vier oder mehr Cisplatinapplikationen. In der dritten Gruppe (elf Patientinnen) erhielten zehn Patientinnen (91%) vier oder mehr Cisplatinbehandlungen mit 20 mg/m2/Woche. Beim Vergleich der Nebenwirkungen konnte festgestellt werden, dass hämatologische Nebenwirkungen (meist Leukopenie) Grad 3 bei 12% der Gruppe mit 30 mg/m2 und Grad 3–4 bei 16% der Gruppe mit 40 mg/m2 Cisplatin auftraten. 82% der hämatologischen Nebenwirkungen unter 30 mg/m2 Cisplatin wurden als Grad 1 eingestuft. Es konnte kein Unterschied zwischen den Schemata mit 20 und 30 mg/m2 gefunden werden. Bezüglich der gastrointestinalen Toxizität wurden ebenfalls Grad-1-Nebenwirkungen beobachtet, die bei 30 mg/m2 in 58% und bei 40 mg/m2 in 38% auftraten.Schlussfolgerung:Die optimale wöchentliche Dosierung für Cisplatin beträgt 30 mg/m2. Zwischen der kumulativen Cisplatindosis und der therapeutischen Effektivität besteht eine deutliche Korrelation. 40 mg/m2 erhöhten die therapeutische Wirkung nicht. Die Lebensqualität der Patientinnen war aber bei kleineren Dosen besser. 20 mg/m2 Cisplatin ergaben signifikant schlechtere Resultate.

[Current methods of chemoradiotherapy for locally advanced cervical cancer. Options for reduction of side-effects].

The advantages of cisplatin based radiochemotherapy have been proven for over one and a half decades, particularly in the treatment of advanced solid tumours. In head and neck, and cervical tumours results of prospective studies are available. Those showed that both in the early and advanced stages, local control and overall survival rates are better than radiotherapy alone. The effect of cisplatin can be probably intensified with novel, more effective molecules, such as m-TOR inhibitors and tirapazamine. The authors review cisplatin and non-cisplatin based radiochemotherapy protocols, which improve previous treatment results. It should be considered, however, radiotherapy for cervical cancer can cause hematological, urogenital and intestinal toxicity, similarly to other combined treatments. The authors briefly outline international recommendations and their own experience for the prevention of these side-effects.

Reszekábilis colorectalis eredetű májáttét esetén javasolt-e a preoperatív szisztémás kezelés? Onkosebészeti nézőpont

Surgical resection is still the only curative treatment for colorectal liver metastases, but this is one part of a complex therapy. Nowadays a patient with colorectal liver metastasis is not treated only by a surgeon or by an oncologist or even only by an invasive radiologist. Collective decisions, complement treatments give the only chance to treat these patients for longer time. Patients with colorectal liver metastases could be regarded as patients with chronic disease. Specially interesting are the various treatment options of resectable colorectal liver metastases. The efficiency and necessity of preoperative chemotherapy are still a hot spot in the treatment of resectable liver metastases. In this study, we try to summarize the international and local experiences and the current evidence of the use of preoperative chemotherapy in the treatment of colorectal liver metastases. Orv Hetil. 2018; 159(21): 823-830.

Változások a korai stádiumú operált méhtestcarcinoma sugárkezelésének indikációjában. Újabb stádiumbeosztás, prediktív tényezők. Tanulságok saját eredményeink alapján

Optimal postoperative radiotherapy indications for early-stage operated endometrial cancers have drastically changed with the new imaging generation (magnetic resonance imaging, positron emission tomography/computed tomography) and more detailed pathomorphology. The depth and growth of tumor invasion, presence or absence of the lymph node metastases, grading and lymphovascular invasion are the most important factors to predict the progression and to influence the prognosis. In 2016, on the basis of these, the European Gynecologist Oncology and Radiotherapy Society published a report in which they proposed unanimously indications for postoperative radio- and/or radiochemotherapy. The basis of their work was prospective multilevel randomized investigations which could avoid over- or undertreatment hazards. The results obtained by the authors of this article from 164 operated patients in early-stage endometrium carcinoma seem to be acceptable, in spite of the fact that their earlier radiotherapy indication was different and in the pathological description lymphovascular invasion was not included and the grading was not always applied.

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...

Novel irradiation techniques in the treatment of solid tumours. Radiotherapy of metastases

Novel developments in percutaneous radiotherapy, such as positron emission tomography/computed tomography, adaptive radiation planning, intensity modulation radiotherapy and intensity modulated arc therapy (RapidArc), as well as the newer generation of image control (cone-beam computed tomography) and image guided radiotherapy ensure increased dosages of planning target volume and clinical target volume of solid tumours without damaging surrounding tissues and providing maximal protection. By raising the dosages of planned target volume and clinical target volume, these novel technical developments have created new indications in the treatment of solid tumours. With the aid of the cone-beam computed tomography and image guided radiotherapy the organ metastasis (lung, liver, spinal cord) and the primary tumour can be treated safety and effectively. Hypofractionation, dose escalation and the use of stereotactic devices can probably decrease radiation damage. The authors review the most common forms of evidence-based fractionation schemes used in irradiation therapy.

Concomitant Radiochemotherapy of Cervical Cancer@@@Radiochemotherapie des Zervixkarzinoms. Kann die Cisplatindosis reduziert werden?: Is It Justified to Reduce the Dosage of Cisplatin?

Purpose:To review the experiences regarding the therapeutic response and side effects of concomitant radiochemotherapy of cervical cancer carried out with different cisplatin doses.Patients and Methods:At the Municipal Center for Oncoradiology, Budapest, Hungary, 92 patients with cervical cancer were treated with concomitant radiochemotherapy in the period between July 2002 and March 2007. The total dose of high-energy external radiation (megavoltage) treatment was 50.4 Gy with a fraction dose of 1.8 Gy on the small pelvis. Before irradiation, cisplatin 40 mg/m2, 30 mg/m2, or 20 mg/m2 was administered once a week.Results:In 17 cases, the cisplatin dose was 30 mg/m2; during radiochemotherapy the number of cisplatin treatments was equal to or more than four in 14 patients (82%). After administering 40 mg/m2 cisplatin to 64 patients, chemotherapy in four or more treatments could only be applied in 37 cases (58%). Eleven patients received cisplatin at the dose of 20 mg/m2; in ten (91%) of them, the number of treatments was four or more. By comparing the side effects, it can be stated that hematologic side effects (mostly leukopenia) grade 3 occurred in 12% of the patients receiving cisplatin 30 mg/m2, and grade G3–4 in 16% of the 40-mg/m2 cisplatin group. For cisplatin 30 mg/m2, 82% of hematologic side effects were in the G1 range. There was no significant difference between the 20- and 30-mg/m2 regimens. As for the gastrointestinal toxicity, similar side effects grade 1 were detected, which occurred in 58% and 38% of the patients receiving 30 mg/m2 and 40 mg/m2, respectively.Conclusion:On the basis of a detailed analysis, the correlation between the number of treatments, the therapeutic and the side effects could be verified. In the course of dose reduction, there was no significant difference when comparing the results of therapy, however, the quality of life was better if cisplatin 30 mg/m2 was administered instead of 40 mg/m2. If cisplatin 20 mg/m2 was given, the results were significantly worse. On the basis of the own results, it can be stated that the optimal weekly dose of cisplatin is 30 mg/m2.Ziel:Reduktion der Cisplatindosis bei der Radiochemotherapie des Zervixkarzinoms in Abhängigkeit von therapeutischen Effekten und Nebenwirkungen.Patienten und Methodik:Zwischen Juli 2002 und März 2007 erhielten 92 Patientinnen mit Zervixkarzinom am Städtischen Onkoradiologischen Zentrum, Budapest, Ungarn, eine Radiochemotherapie. Das kleine Becken wurde mit einer Gesamtdosis von 50,4 Gy (28 Fraktionen à 1,8 Gy) bestrahlt. Vor der Radiotherapie wurde Cisplatin wöchentlich in einer Dosierung von einmal 40 mg/m2, 30 mg/m2 oder 20 mg/m2 Körperoberfläche gegeben.Ergebnisse:17 Patientinnen erhielten zusätzlich zur Radiotherapie 30 mg/m2 Cisplatin, 14 von ihnen (82%) tolerierten vier oder mehr Cisplatinapplikationen. In der Gruppe mit 40 mg/m2 Cisplatin vertrugen nur 37 Patientinnen (58%) vier oder mehr Cisplatinapplikationen. In der dritten Gruppe (elf Patientinnen) erhielten zehn Patientinnen (91%) vier oder mehr Cisplatinbehandlungen mit 20 mg/m2/Woche. Beim Vergleich der Nebenwirkungen konnte festgestellt werden, dass hämatologische Nebenwirkungen (meist Leukopenie) Grad 3 bei 12% der Gruppe mit 30 mg/m2 und Grad 3–4 bei 16% der Gruppe mit 40 mg/m2 Cisplatin auftraten. 82% der hämatologischen Nebenwirkungen unter 30 mg/m2 Cisplatin wurden als Grad 1 eingestuft. Es konnte kein Unterschied zwischen den Schemata mit 20 und 30 mg/m2 gefunden werden. Bezüglich der gastrointestinalen Toxizität wurden ebenfalls Grad-1-Nebenwirkungen beobachtet, die bei 30 mg/m2 in 58% und bei 40 mg/m2 in 38% auftraten.Schlussfolgerung:Die optimale wöchentliche Dosierung für Cisplatin beträgt 30 mg/m2. Zwischen der kumulativen Cisplatindosis und der therapeutischen Effektivität besteht eine deutliche Korrelation. 40 mg/m2 erhöhten die therapeutische Wirkung nicht. Die Lebensqualität der Patientinnen war aber bei kleineren Dosen besser. 20 mg/m2 Cisplatin ergaben signifikant schlechtere Resultate.